Dear Dr. Roach: I am 89 years old and just learned that I have the first stages of bed sores on my buttocks. My dermatologist said that I should stay off of it as much as possible and apply hydrocortisone cream.

I have COPD, and I need to sleep sitting up. I wonder if you have any other suggestions to help my pain and discomfort.


Dear A.A.: Bed sores (also called pressure ulcers) are potentially serious problems that require immediate attention. We “stage” bed sores into four categories. Hopefully you have stage one, where there is skin redness, usually over a bony prominence such as the sacrum, the hand-shaped bone at the base of the spine. A stage two bed sore may be a shallow, open ulcer or a blister. At stage three there is full-thickness loss of the skin, while a stage four has exposed muscle or bone. Sometimes, it is impossible to stage ulcers from their appearance alone.

A stage one bed sore is really a warning of potential problems to come. They often are treated with a clear film for protection. Hydrocortisone cream is surprising to me, since steroids can thin the skin when used excessively, which you certainly don’t want to do. The pain should be treated, but you should be taking this as your body’s warning that there is a problem.

The key to preventing further injury is to take pressure off the area. Sleeping sitting up puts all your weight on your lower back, buttocks and thighs, which in turn puts these areas at a high risk for pressure ulcers. There are ways to combat this, including different kinds of mattresses and pads, and a device that adjusts automatically to pressure. Changing positions frequently (every two hours or less) is critical if you’re not using a special mattress or pad. There are wound-management specialists, both nurses and doctors, with such expertise. I would ask your doctor about finding and consulting with one.

People with COPD are at high risk for poor nutrition and getting adequate protein and calories is critical, as poor nutrition is a risk for bed sores. I recommend a visit to a nutritionist and perhaps your COPD treatment could be optimized to make it easier to sleep lying-down.

Dear Dr. Roach: Recently I’ve read several references as to how kudzu has been successfully used to treat alcoholism. Why isn’t it available to the public?


Dear S.M.: A pilot study did show that a kudzu extract reduced the amount of alcohol that people drank (ordinary volunteers, not necessarily people with problems with alcohol). However, it’s a difficult process to prove that the extract is safe and effective in the long term. You can buy kudzu extract at some health-food stores or on the Internet.

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