Well, this had been healing up relatively well, but when the 'bottom' of the hole reached surface level, it refused to grow skin - and then, seemed to grow. Gruesome, as I say. So, this yellowish, ulcer-y looking zone needed some attention. I was whisked from my lovely stoma nurse to the specialist IBD nurse, to the GI registrar, up to dermatology consultant. After about four hours of sitting around feeling sore and trying to mop up Mr Stoma's protestations, PYODERMA GANGRENOSUM was mooted. It turns out the way dermatology works is you sit in a room and various different dermatologists come and look at you and mutter gently to each other. I remember a family friend who was a Dr always said that Dermatology was the nicest specialism to go into because it basically involved looking at things and writing prescriptions for creams.
True to form, I ended up with a prescription for a cream - or rather, a very greasy ointment - Dermovate. Now, I only connected later on that this might be a bit of an issue:
a) because it's actually quite hard to apply a greasy ointment to a slimy ulcer
and
b) a greasy ointment doesn't exactly promote ileostomy bag adhesion.
Ho hum. I'm starting to get that thing that chronically ill people get where they end up with so many different specialists, and no-one really gets an overview - the dermatologists aren't experts in stomas (stomae? ostomy?), and the GI consultants aren't experts in skin problems - so basically I'm the one who has to try and be informed about everything. And of course, the problem with being an outpatient is the slowness of everything - you're not lying there in bed all day, ready for doctors to whisk around every morning and check on you. Instead it's a case of 'try this, come back to clinic in a week or call if anything goes wrong in the meantime' - but of course I'm never sure how 'wrong' is 'wrong'.
S0 - after a week of using the Dermovate ointment, I returned to the Dermatologists - who, in the vein of each department at Chelsea and Westminster having a specific ethnicity, seem to be of Indian extraction, though of the cut-glass-accent variety in which C&W specialises. In the meantime, they'd done some investigation of treatment of peristomal pyoderma gangrenosum, and ta-da, there were issues with adhesion when using a greasy ointment. The solution was apparently an using Orabase paste with mixed-in steroids - hooray. I'd used plain Orabase to pack the original dehiscence wound - it's a plainish paste that promotes healing, and sticks to mucous membranes. I rushed down to the hospital pharmacy with a prescription for 'Adcortyl in Orabase' in my hot little hand, only to find, after a nervous wait, that the product had been discontinued in March 2009.
Oh well. So I'm back on the Dermovate for the moment, awaiting news from the dermatologists. Meanwhile, I have to say, this is really one of the most gruesome things about this whole op so far - I've got used to a lot of really gross things over the last few months, but this looks like a horribly realistic special effect from Nightmare on Elm Street or similar - there's a massive, gruesome ulcer all around the stoma, with some strange kind of strings of flesh and small pockets around the outside. Not so pleasant. So perhaps that's the downside of dermatology - all you have to do is look at things, but they might not be very nice things.
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