=========================================================== Please note: Heavy people are frequently the target of ridicule and scorn. So many size-related words have been turned to hurtful purposes that it is hard to find words to describe larger people that don't cause some sting for someone. If I use some words here that hurt, please know that I deeply don't mean to hurt anyone. As always, I am not a doctor and am only passing on what I hope is helpful and reliable general information. It is no substitute for the advice of your own doctor. All people deserve good medical care and respect. If you have any trouble finding good medical care or products to accomodate your needs, please send me a note and I will try to find sources for help. - Paula DuBourdieu (73021,567), CompuServe Diabetes Forum ========================================================== SKIN CARE FOR HEAVY DIABETICS IS VITAL Good skin care is very important for all diabetics and especially vital for heavy diabetics. People who are heavy have special skin care needs. If special care is not taken, heavy people are likely to develop skin infections and pressure ulcers that can cause terrible damage. WHAT IS A PRESSURE ULCER? Pressure ulcers are areas of damaged tissue. They are usually found in areas over a bone, but can also be found in skin folds and any areas where part of the body is in contact with another surface. Pressure ulcers can develop internally and deep in the tissues. There are several "stages" of pressure ulcers. The first stage might just look like a change in the color of the skin, without any break in the surface of the skin. The most severe stage can be an open wound that extends down to the muscle or bone. WHAT CAUSES PRESSURE ULCERS? Pressure ulcers are caused by unrelieved body contact against any other surface. Even the pressure of a part of our own body pressing against another part of our body can cause pressure ulcers. Indwelling urinary catheters, feeding tubes, and other devices can also cause pressure ulcers in heavy thighs or abdominal folds. Pressure of just 32 mmHg can cause capillary closure and tissue death after just 2 hours. HOW TO AVOID PRESSURE ULCERS 1. Movement. The most important way to avoid pressure ulcers is to move at least every 2 hours. This means at least shifting our positions in our chairs or beds every 2 hours. If we are unable to move ourselves, we must have someone help us move or reposition us at least every 2 hours. This can be done with 'draw sheets' and other methods that a skilled nurse can teach our caregivers. There are special mattresses available that can shift the amount of pressure against our body to help avoid pressure ulcers, if we are not able to move ourselves. If we have partial mobility, a trapeze bar over our bed can help us pull ourselves up and move. 2. Pressure reduction. Chairs and beds can be covered with special pressure reduction pads or devices. Special "foot cradles" are also available to lift heels off the surface of the bed. Heavy and larger people often develop pressure ulcers on the hips and outside of thighs because their armchairs, wheelchairs, walkers, toilet seats, commodes, or hospital bed railings are too narrow. Special products to accomodate larger and heavier people are available. (See end of text for a list of some companies that make products for large and heavy people.) 3. Skin care. Care must be given to keep skin clean, dry (not damp), and well-moisturized. Moisturizing creams and lotions should be applied faithfully to any areas where the skin is overly dry. Areas where perspiration and moisture collects must be kept as clean and dry as possible to avoid fungal infections that can irritate and break down the skin. Any skin irritation or infection or wound should receive prompt attention. People with incontinence must always clean the entire perineal area thoroughly after each episode of incontinence and use special moisture-barrier creams to protect their skin from episodes of incontinence. SOME TRUTH ABOUT SKIN FOLDS Skin folds are the area under a sagging bulge or "roll" of body fat. Skin folds are commonly found around the abdomen or belly, upper arms, thighs, and backs. Most heavy people have many skin folds. Even with weightloss, many people will continue to have these skin folds. After a certain point in life and size, the skin loses a lot of its elastic ability to tighten up and 'shrink.' If the skinfolds are very large, are frequent sites of skin infections or are substantially interfering in your ability to care for yourself or live reasonably, it is possible that a doctor might recommend surgery to remove the loose skin that is sagging. If there is a medically-necessary reason, rather than just cosmetic purposes of appearance, this surgery may be covered by insurance. There are risks in any surgery and diabetics are at greater risk than nondiabetics, so this sort of surgery is not commonly done on most heavy people, but if the skin folds are truly causing a significant problem, surgery can be a solution. Skin folds are a common site for yeast-like fungus infections of the skin. These are very common among people with large thighs, large breasts, and obvious skin folds -- especially if they have diabetes. People may notice itching or burning, pink/red or irritated skin. Sometimes there is fluid, which may have an unpleasant odor. Anti-fungal dusting powders, and anti-fungal ointments (like those use for genital yeast infections) can relieve the discomfort and help clear the fungal infection. Oral antifungal pills are also sometimes recommended. Antibiotic ointments and hydrocortisone creams are not the best or most effective choices for treating a fungal infection on the skin. Keeping the skin fold exposed to air as much as possible can help heal and avoid skin fold infections, but it is not wise to use medical adhesive tape to try to pull the skin back and keep the skin fold open to the air -- it usually is not strong enough to hold the skin apart and usually will tear the skin, causing damage. KEEPING SKIN FOLDS CLEAN AND DRY 1. Washing. It is particularly important to gently clean skin folds, where perspiration can collect and the skin can become chafed or irritated from constant contact with surrounding skin. Gentle soaps and antibacterial soaps can be helpful. Hand-held shower spray extentions can help to rinse areas skin fold areas gently. If standing is tiring, shower seats designed to support larger or heavy people are available. Grab-bars should be sturdy and within easy reach. To be certain that they are mounted firmly enough to support your weight, it might be wise to get a carpenter or expert to install grab bars in the bathroom and shower area. If you cannot afford this or live in an apartment, there is a type of clamp-on grab bar that can be attached to the sidewall of your bathtub without doing damage to the tub. 2. After showering. It is important to dry skin folds gently and carefully after showering. Using large bathsheets, rather than regular-sized bath towels can make it easier to reach difficult spots, such as skin- folds along the back. To protect the skin, people should pat the areas dry and let the towel absorb the moisture, rather than using a scrubbing or 'sawing' motion with the towel. Some may find it helpful to use a hand-held hairdryer (set on cold, * NO heat! *) to gently blow dry areas that are difficult to reach. 3. Clothing. Clothing should absorb and pull moisture off our skin, so that it won't collect on our skin or in skin folds. Cotton under- shorts, t-shirts, bras and panties are helpful and should not have any elastic or seams that irritate the skin. If necessary, wear the clothing inside-out to keep the seams from pressing or rubbing against the skin. If chafing between the thighs is a problem, a tailor can add a soft lining to the inside thigh area of pant legs on suits or trousers. This can increase comfort and increase the life of the pants. Many people find it helpful to wear underwear that goes down to mid-thigh; for women, these are sometimes called petit-pants or bloomers. Many also find it helpful to wear thin knit 'biker shorts' under trousers, dresses, or shorts because they cling to the leg, won't ride up, and keep the thighs from chafing. Anti-chafe "chafe-ease" thigh protectors are also available at some specialty stores, including The Vermont Country Store (see end of text). Women with large breasts may find it helpful to use a cotton bra-liner product called Pampbras between their skin and bra bands. This cotton shield absorbs moisture and helps keep the skin from becoming chafed or irritated by the elastic bra band. Pampbras are available from some lingerie stores and mail-order sources like AmpleStuff and The Vermont Country Store (see end of text). Some find it helpful to place a thin piece of clean cotton flannel against the skin along the countours of the skin fold to absorb moisture and keep the skin from rubbing against itself. 4. Cleaning during the day. Some people find it helpful to keep a bit of soap, a small sponge and a facecloth in a little sandwich-size plastic bag, which can fit in a purse or pocket. Then, as needed through the day, they can discreetly walk into the public restroom, wet the sponge, step into a stall, freshen up any troublesome areas, and then dry off with the facecloth. A FEW WORDS ABOUT NAVELS People with large abdomens or bellies often have fairly deep navels or belly-buttons where perspiration can collect. It is important to keep the area clean, but it is also important not to poke around inside the navel because this can damage the skin. If you have difficulty keeping the navel clean and dry, talk to your doctor. Some people find it helpful to recline, pour in a small amount of hydrogen peroxide, let it sit a moment in the belly-button 'well', and then sit up, let it drain and gently pat it dry with a towel, but navels can be a common site of infections for heavy people, so it is important to get your doctor's advice on how to keep this area clean. If you notice an unpleasant odor coming from the navel area, be sure to see a doctor to check if there is an infection that needs medical treatment. It is very common and nothing to be embarrassed about. A FEW WORDS ABOUT INCONTINENCE Surgery, diabetic nerve damage, strokes and other conditions can cause urinary incontinence. Large or heavy people, as well as disabled people, can have difficulty managing to thoroughly clean themselves well after an episode of incontinence, so it is especially important to use special moisture-barrier creams or skin sealants to protect the surrounding skin from the urine. If the skin is already damaged and 'weeping,' it might sometimes be necessary to use special powders, such as those designed to prevent peristomal breakdown, on the skin before applying the moisture- barrier cream. It is often easier to apply moisture-barrier creams rather than skin sealants on large or heavy people. "Diapers" that at least fit up to 58" waists are available and can be useful, if very careful effort is taken to protect the skin. A FEW WORDS ABOUT TOILETS AND REACH PROBLEMS Many toilets are safe for use by people who weigh up to 350 lbs. People who weigh close to that or more than that might need to consider installing a new toilet for heavier people or perhaps using a separate commode designed for heavier people. Aside from weight issues, using a separate commode might also be helpful for people with larger hips and thighs who are much wider than their toilet seats accomodate. A lot of weight on a small area can cause tissue breakdown, leading to pressure ulcers and tissue failure. It is not uncommon for some heavy people to have pressure ulcers on hips and thighs from using small toilets and toilet seats. Although some might find it distressing to think of using a separate commode, the thought of it is a lot less distressing than the distress that can result from developing skin ulcers, cellulitis, and tissue breakdown from using a toilet or commode that is too narrow to support the body. If you are slightly troubled by the thought of being 'too big' for a regular toilet, please don't let this stop you from doing what you need to do. Large and heavy people have special needs -- and take up more space than other smaller people. "One size fits all" doesn't apply to toilets any more than it does to clothing or furniture. If you happen to notice that the floor seems a little shaky around the toilet or the toilet seems to move or shift a bit when you sit down, it might just be that the wax seal under the toilet needs replacement and some of the floorboards are sagging from getting wet. It is very common that, over time, the wax ring will crack and fail, causing small but steady leakage that wets the floor boards around the toilet. It is not terribly expensive to get this fixed, it's worth doing for good home maintenance, and you might feel a lot more secure, too. Some large or heavy people (as well as people with arthritis, back or shoulder problems) sometimes have difficulty reaching to clean themselves well after using the toilet. There are many things that can help. Some people find it helpful to use special "toilet paper tongs" that can extend their reach. Some people use special washable sponges on a stick, similar to the sort of sponges used to wash drinking glasses. Some people find it helpful to use bidets or to use "portable bidets" which can be attached to the toilet at home or even carried in a sack and used in office lavatories, etc. A helpful, inexpensive booklet on this topic is available from a mailorder company called Amplestuff, which also carries portable bidets, seatbelt extenders and other products specifically designed for large or heavy people. FOOT SKIN CARE Many large or heavy people have difficulty reaching their feet easily. Using a floor mirror and a hand-held mirror with a telescoping handle can help people inspect their feet carefully. It is very important that large or heavy people wear supportive well-fitting shoes. It is also important to keep the skin well- moisturized to avoid developing calluses on the heels and elsewhere. Special pads can be placed under the feet to keep heels from resting on the surface of the sheets, and special foot cradles can help avoid damage to the skin. MORE SOURCES FOR THINGS TO HELP HEAVY OR LARGER PEOPLE The information on this list has been gathered from all over and is not complete, but all of the companies below sell or rent products specially designed to meet the needs of larger or heavy folks. If you know of any other helpful sources, please post a note on the Diabetes Forum board! "FAT-FRIENDLY" HEALTH PROFESSIONALS ----------------------------------- To see a list of doctors and health professionals who treat their large patients with respect, look at the "Fat-Friendly Health Professionals" list on the Internet. The list covers the U.S. and everyone on the list has been recommended by someone who is large and pleased with their care. If you can add a name to the list, please do. The list is available at: http://www.bayarea.net/~stef/Fat/ffp.html BATHING, SELF-CARE, HYGIENE, UNDERWEAR -------------------------------------------------- AmpleStuff (toileting, self-care supplies & book of hygiene tips) Amplestuff, P.O. Box 116, Bearsville, NY 12409 914-679-3316 email: amplestuff@aol.com Convaquip (Commodes, bathseats, transfer seats, shower seats) P.O. Box 3417 Abilene, Texas 79604 800-637-8436 or 915-677-4177 fax 915-677-7217 web: www.convaquip.com Kinetic Concepts, Inc. (oversized commodes ) 800-531-5346 Quality Health Care Products (Confidence Briefs/diapers to 58" waist) 800-600-7273 Sears Home Health Care (bath/shower & transfer seats to 300 lbs, commode to 450 lbs.) 800-326-1750 The Vermont Country Store (Pampbras, cotton panties to size 15, petit-pants,bloomers, men's mid-thigh cotton knit briefs to 3X, cotton socks with no elastic) P.0. Box 3000 Manchester Ctr, VT 05255 802-362-2400 or fax 802-362-0285 BEDS, CHAIRS & FURNITURE ------------------------ Biofit (folding chairs and sit/stand stools) P.O. Box 109, Waterville, OH 43566-0109 800-597-0246 web: www.bioengseat.com Blue Mountain Chairworks (folding oak lounge chairs support to 900 lbs.) 541-963-6672) BodyBilt Big & Tall (office chair to support 7' tall, to 350 lbs.) 1 Bodybilt Place, Navasota, TX 77868 800-364-5673) Kinetic Concepts, Inc. (adjustable beds to support 850 lbs, mattress overlay to support 650 lbs) 800-531-5346 web: www.kci1.com Miller XLT Big & Tall (office chairs up to 500 lbs.) Drawer HP-11, High Point, NC 27261 800-438-4324 Steelcase (office chair up to 500 lbs, 23" wide seat, 10 yr warranty) 901 44th SW Street, Grand Rapids, MI 49509 616-247-2755ith HOSPITAL GOWNS -------------- To purchase a hospital gown that fits up to 10X, ($30), contact Lynn Meletiche at 2065 First Ave, #19D, NY, NY 10029 (tel. 212-721-8259) or call NAAFA (National Assoc. to Advance Fat Acceptance) at 1-800-442-1214. MRI MACHINES -------------- If you need to have an MRI scan, one of the better options to look for is the Hitachi Aris Open-Air MRI machine. For help finding one in your area, call Hitachi at 216-425-1313. You might also try looking for the Philips Gyroscan T5, which can handle patients up to about 500 lbs. For helping finding a Gyroscan T5 in your area, call Philips Medical Systems at 800-536-4963. WHEELCHAIRS, WALKERS, AND SCOOTERS ---------------------------------- Alimeds (wheelchairs up to 600 lbs.) 800-225-2610 Bruno Independant Living Aids, Inc. 1780 Executive Drive PO BX 84 Oconomowoc WI 53066 800-882-8183 Convaquip (Folding wheelchair with seats to 30" wide, walkers) P.O. Box 3417 Abilene, Texas 79604 800-637-8436 or 915-677-4177 fax 915-677-7217 web: www.convaquip.com Electric Mobility (Rascal Scooters) One Mobility Plaza, Dept 8390 Sewell NJ 08080 800-622-4548 Gendron (wheelchairs to 600 lbs.) 800-537-2521 Jazzy Power Chairs Pride Health Care Inc 182 Susquahanna Ave Exeter, PA 18643 888-655-2677 web: www.pridehealth.com Kinetic Concepts, Inc. (oversized walkers and wheelchairs) 800-531-5346 web: www.kci1.com Sears Home Healthcare (wheelchairs up to 410 lbs.) 800-326-1750 21st Century Scientific Inc. (wheelchair seat widths to 48" and custom sizes) 4915 Industrial Way Couer d'Alene Idaho 800-448-3680, 208-667-8800, or fax 208-667-6600 e-mail: info@ wheelchairs.com web: www.wheelchairs.com WheelCare 3883 E. Via Pescador Camarillo CA 93012 888-910-2273 email: wlcr@aol.com web: www.wheelcare-inc.com Wheelchair Institute of Kansas (wheelchairs up to 600 lbs.) PO BX 320 Ellis KS 67637 800-537-6465, fax: 800-327-2447 Wheel Ring Inc 199 Forest St. Manchester CT 06040 203-647-8596 ===== See also HEAVY.TXT in the forum library for more tips.