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Patient with problems



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May 29, 2003 08:35 PM

Patient with problems


Hi, just found this site and am so glad! I have question about one of my patients. 53yo fe with end stage rectal cancer-has colostomy and catheter- what i am concerned about is her perineal area-she has develped growths on labia- labia is extremely swollen,red,irritated,and very hard to the touch-also skin is sloughing? off and becoming very odorous. COuld tjis be due to her rad tx or is it cancer? she is also manic-depressive and this is driving her crazy.I have tried all sorta of creams and ointments to no avail. Right now she is using a compounded cream from the pharmacy tah contains lidocaine and such to try to deaden the area. has anyone ever experienced this? Any suggestions would be most appreciated..

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5 Comments
No. 1
from aimeee
Old May 29, 2003, 08:58 PM

What a difficult problem! That poor gal! I have never seen this either. Is the lidocaine cream working at all? That would have been one of my suggestions. Could she tolerate cool sitz baths?
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No. 2
from Hellllllo Nurse
Old May 29, 2003, 10:49 PM

Maybe the doc needs to take a look. Is the pt on steroids?
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No. 3
from FrankieJane
Old May 30, 2003, 07:38 AM

I had a pt that had bladder cancer with mets to the vagina. She had growths on her labia and also had growths that protruded through the skin in her groin area. The tumors had a dark brown discharge and a strong odor. The pt used scented candles and spray in the room to help disguise the odor. I don' t know of any creams that help hide the odor, but I am still new to hospice. Depending on the area of the growths, a carboflex dressing can be applied to help absorb the drainage and odor. I do believe that the odor you notice is from the cancer rather than the chemo. I have had pts that just finished radiation that did not have that odor.
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No. 4
from hotweelsmom
Old May 30, 2003, 05:16 PM

Thank you for your replies. No,she is not on steiroids. The lidocaine cream only works to numb the area,of course. She presently has no discharge but she does have urine leakage,even with the foley in place, which also drives her crazy. I will suggest cool sitz baths,but that would only be temporary relief.
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No. 5
from bigjay
Old Jun 04, 2003, 12:30 PM

Sounds like a very difficult situation to manage, especially with the urine leakage. I can think of a couple things that could help. To help with skin breakdown in this type of situation we use a product called no-sting. It's a tacky kind of swab that sets up a transparent barrier on the skin. It's the same kind of stuff used to anchor condom caths. You clean the skin, then apply it and it creates a nice barrier to protect the skin.

For the odour, we often use flagyll cream for rectal and fungating tumors. It does a really nice job and is fairly cheap. The more expensive path would be a carbonet or other charcoal based dressing over the area. They usually filter out odours fairly effectively.

Hope this helps!
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