Yeast infection - responses
John T. Brinkmann
Description
Collection
Title:
Yeast infection - responses
Creator:
John T. Brinkmann
Date:
7/11/2005
Text:
Dear List Members,
Here are some of the responses I received to my question about a Harmony patient with yeast infection. The patient is seeing a physician this week. I've been getting help from Otto Bock, and will try a barrier liner between the RL and the Evolution liner. As several responses recommended, I'll also try moving to an Alpha liner if the problem persists.
Thanks to all who responded - great input.
John Brinkmann, CPO, FAAOP
Responses:
I did have a patient who wore a sheath against the residual limb and then applied the harmony system. This worked. I think if I was to do that again I would call comfort sock and see if they have a sheath with silver impregnated fabric for extra protection.
Is he using any cremes on his leg that could be reacting to the liner materials? I had a patient with ezcema that was using an ointment that caused a great deal of irriation that stopped when he stopped using the cream.
I don't think you are experiencing an isolated incident. I have had a lot of fungal type skin reactions with numerous liners, most recently a TEC liner which virtually started to irritate within 24 hrs. The patient went back to his Alpha and the problem went away. It appears to be fungal but now I'm not sure since it went away with use of the Alpha. One of the Physicians I work with actually indicated that they have a recent outbreak of fungal type irritations with various inpatients, none of which are amputees. I'm not sure if there is any correlation.
It sounds to me like air is being trapped in between the liner and the patients limb when they are donning the liner which is resulting in the infection. The air in the liner allows for greater perspiration and a wonderful envirnment for the infection to develop.
selsun blue selenium shampoo. To be successful liners and body both have to be shampooed and rinsed thoroughly
Yeast is not a bacteria. Yeast is a fungus. Yeast feeds on starch, sugar and oxygen. It's by products are carbon dioxide and alcohol. Guess what? Alcohol will not destroy yeast, since that is one of it's own living by-products. Yeast likes warm, dark, damp and oxygen rich environments. Corn starch (starch!) to maintain surface dryness is, of course, a no no. Soaps with fragrances can contain sugars. Personal hygiene products can contain various problematic additives. Is it possible that the Harmony system allows more oxygen to be in contact with the skin? Is it possible that the Alpha liner kept the skin more protected from oxygen? The vacuum of the Harmony must be moving air in some volume? Alpha locking liners can be prone to distracion and allowing movement that can cause skin breakdown and callousing. Maybe it is time to try suction suspension with a gel liner without the locking pin or vacuum assist? It may take bleach to kill yeast, but, bleach is a no-no with gel line!
rs. Yeast
can live for years in a sealed environment in a dormant state. Bingo, add a little moisture, sugar or starch and you have very active live fungus, again. All liners are probably contaminated. This gentleman may need to discuss his diet with a nutritionist to help determine whether his intake encourages yeast growth? I would recommend that natural crystal (alum) be used to kill bacteria with any prosthetic/orthotic device, where possible. By the way, some types of bacteria added to active yeast causes fermentation. Just some additional food for thought for you guys
When dealing with patients that have psoriasis and have had yeast infections they are sometimes more susceptible to reinfection due to the medication they took to control the problem. In addition if the patient had less problems in the alpha liner you could set him up for a suction socket using the alpha cushion liner and sleeve and see if the patient has the same problem. You must also remember that a vacuum system draws on the tissue so if he has psoriasis and has any skin breakdown it will draw bodily fluids out. The urethane liner and VASS system draws constantly on the tissue and that drawing effect may be more than the patient's tissue can tolerate since the psoriatic skin breaks down easily. One final point, the friction to skin ratio of the urethane is closer and less forgiving than the mineral gel of the alpha liner and your patient may need that little bit of softness to reduce the draw on the tissue.
a Comfort SilverSheath under the liner. I believe it's not recommended with a harmony system, but the silver fiber have excellent anti fungal properties. If not that then, why not apply a topical anti-fungal agent to the limb prior to application of the liner or even both strategies?
As an amputee, female, and Harmony-system wearer, I know that yeast infections (in general) can be troublesome. I'm sure his physician will prescribe a cortisone-based salve or ointment and perhaps an oral medication. I also have found that eating one 8-oz. container of yogurt (even flavored) a day really seems to keep it at bay. I also hope that he is cleaning the liners with alcohol each and every evening.
I am sorry to hear that you are still experiencing skin issues with your patient while using Evolution Liner. Without seeing the patient, liner and prosthesis to fully assess the challenge you face I would like to make several suggestions that may help. I am confident that the platinum cured silicone used in the Evolution Liner cures completely. As a result a completely cured liner is non-porous. However if the liner has cracked it does present an opportunity for the yeast to reside. The liner should be cleaned daily with anti-bacterial soap and dried thoroughly before being donned. In respect to Yeast Infections I can share that they are some times very challenging to eradicate, especially during the warm humid summer months. These infections require not only cleaning the limb but also some time out of the prosthesis to allow the limb to completely heal. I have observed as a clinician and personally experienced re-infecting new liners when it was believed that the infection!
had gone
away. One tip I would pass along that has helped me and my clients is when preparing to utilize a new liner as a result of a yeast infection taking the tough road of staying out of my prosthesis for at least two days and during this time exposing my limb to sunlight (paying attention not to cause a sunburn to very sun delicate skin). I believe this will help dry up the skin as well as expose the tissue to some vitamin D contained in sunlight both helping to eradicate the infection. Only after the limb is free of the infection are you safe to utilize the prosthesis without risk of infection. Hopefully this will help.
---------------------------------
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Here are some of the responses I received to my question about a Harmony patient with yeast infection. The patient is seeing a physician this week. I've been getting help from Otto Bock, and will try a barrier liner between the RL and the Evolution liner. As several responses recommended, I'll also try moving to an Alpha liner if the problem persists.
Thanks to all who responded - great input.
John Brinkmann, CPO, FAAOP
Responses:
I did have a patient who wore a sheath against the residual limb and then applied the harmony system. This worked. I think if I was to do that again I would call comfort sock and see if they have a sheath with silver impregnated fabric for extra protection.
Is he using any cremes on his leg that could be reacting to the liner materials? I had a patient with ezcema that was using an ointment that caused a great deal of irriation that stopped when he stopped using the cream.
I don't think you are experiencing an isolated incident. I have had a lot of fungal type skin reactions with numerous liners, most recently a TEC liner which virtually started to irritate within 24 hrs. The patient went back to his Alpha and the problem went away. It appears to be fungal but now I'm not sure since it went away with use of the Alpha. One of the Physicians I work with actually indicated that they have a recent outbreak of fungal type irritations with various inpatients, none of which are amputees. I'm not sure if there is any correlation.
It sounds to me like air is being trapped in between the liner and the patients limb when they are donning the liner which is resulting in the infection. The air in the liner allows for greater perspiration and a wonderful envirnment for the infection to develop.
selsun blue selenium shampoo. To be successful liners and body both have to be shampooed and rinsed thoroughly
Yeast is not a bacteria. Yeast is a fungus. Yeast feeds on starch, sugar and oxygen. It's by products are carbon dioxide and alcohol. Guess what? Alcohol will not destroy yeast, since that is one of it's own living by-products. Yeast likes warm, dark, damp and oxygen rich environments. Corn starch (starch!) to maintain surface dryness is, of course, a no no. Soaps with fragrances can contain sugars. Personal hygiene products can contain various problematic additives. Is it possible that the Harmony system allows more oxygen to be in contact with the skin? Is it possible that the Alpha liner kept the skin more protected from oxygen? The vacuum of the Harmony must be moving air in some volume? Alpha locking liners can be prone to distracion and allowing movement that can cause skin breakdown and callousing. Maybe it is time to try suction suspension with a gel liner without the locking pin or vacuum assist? It may take bleach to kill yeast, but, bleach is a no-no with gel line!
rs. Yeast
can live for years in a sealed environment in a dormant state. Bingo, add a little moisture, sugar or starch and you have very active live fungus, again. All liners are probably contaminated. This gentleman may need to discuss his diet with a nutritionist to help determine whether his intake encourages yeast growth? I would recommend that natural crystal (alum) be used to kill bacteria with any prosthetic/orthotic device, where possible. By the way, some types of bacteria added to active yeast causes fermentation. Just some additional food for thought for you guys
When dealing with patients that have psoriasis and have had yeast infections they are sometimes more susceptible to reinfection due to the medication they took to control the problem. In addition if the patient had less problems in the alpha liner you could set him up for a suction socket using the alpha cushion liner and sleeve and see if the patient has the same problem. You must also remember that a vacuum system draws on the tissue so if he has psoriasis and has any skin breakdown it will draw bodily fluids out. The urethane liner and VASS system draws constantly on the tissue and that drawing effect may be more than the patient's tissue can tolerate since the psoriatic skin breaks down easily. One final point, the friction to skin ratio of the urethane is closer and less forgiving than the mineral gel of the alpha liner and your patient may need that little bit of softness to reduce the draw on the tissue.
a Comfort SilverSheath under the liner. I believe it's not recommended with a harmony system, but the silver fiber have excellent anti fungal properties. If not that then, why not apply a topical anti-fungal agent to the limb prior to application of the liner or even both strategies?
As an amputee, female, and Harmony-system wearer, I know that yeast infections (in general) can be troublesome. I'm sure his physician will prescribe a cortisone-based salve or ointment and perhaps an oral medication. I also have found that eating one 8-oz. container of yogurt (even flavored) a day really seems to keep it at bay. I also hope that he is cleaning the liners with alcohol each and every evening.
I am sorry to hear that you are still experiencing skin issues with your patient while using Evolution Liner. Without seeing the patient, liner and prosthesis to fully assess the challenge you face I would like to make several suggestions that may help. I am confident that the platinum cured silicone used in the Evolution Liner cures completely. As a result a completely cured liner is non-porous. However if the liner has cracked it does present an opportunity for the yeast to reside. The liner should be cleaned daily with anti-bacterial soap and dried thoroughly before being donned. In respect to Yeast Infections I can share that they are some times very challenging to eradicate, especially during the warm humid summer months. These infections require not only cleaning the limb but also some time out of the prosthesis to allow the limb to completely heal. I have observed as a clinician and personally experienced re-infecting new liners when it was believed that the infection!
had gone
away. One tip I would pass along that has helped me and my clients is when preparing to utilize a new liner as a result of a yeast infection taking the tough road of staying out of my prosthesis for at least two days and during this time exposing my limb to sunlight (paying attention not to cause a sunburn to very sun delicate skin). I believe this will help dry up the skin as well as expose the tissue to some vitamin D contained in sunlight both helping to eradicate the infection. Only after the limb is free of the infection are you safe to utilize the prosthesis without risk of infection. Hopefully this will help.
---------------------------------
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Citation
John T. Brinkmann, “Yeast infection - responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/225202.
