Rural pearls

Hugh M. Perrin, MD
Mount Forest, Ont.

Can J Rural Med 1996; 1 (2): 86


Preventing weight bearing in the mentally impaired patient

In my 14 years as a rural physician, I have been exposed to patients with mental impairment in the form of dementia, as well as having had a large group of handicapped patients. While caring for these patients in both the nursing home and the hospital situation, I have had to develop ways of preventing weight bearing in people who have difficulty learning.

Simply tape to the heel, inside the sock, either a hexagonal nut or a roll of tape. The uncomfortable sensation created by the foreign body prevents full weight bearing on the foot. When the patient is not ambulatory, the foreign body is removed to prevent ulceration. The method prevents the patient from bearing the full body weight, and even quite mentally impaired patients, using a walker, can ambulate with partial or no weight bearing on the affected leg. This approach increases the number of mentally impaired patients who can ambulate successfully after major hip fracture and other leg injuries.


Colostomy in the mentally impaired patient

Doctors and staff often find it difficult to deal with mentally impaired patients who have colostomies. Some of these patients continually fiddle with the bag, pull it off or play with the contents. I have found a simple technique that solves the problem. Have the patient wear full-length coveralls and either put a lock at the top to keep them zipped up, so that the hands cannot get in to the level of the ostomy bag, or put the coveralls on backwards and zip them up the back. This technique makes management at home of slightly impaired patients much easier for their caregivers and works extremely well in institutional care.

Smelly feet

Physicians are often presented with the awkward problem of patients whose feet give off strong odours. The problem can be dealt with by having the patient cleanse the feet nightly with rubbing alcohol. This technique also works for odours in the axilla. The alcohol leaches out the aromatic hydrocarbons that are not removed by water. The technique was introduced to me by a health care aide who had worked with a patient with phenylketonuria who had problems with underarm odour.

Most patients who try the technique are delighted with the results and are relieved to be able to take off their shoes without embarrassment. As a physician who must examine those malodorous feet, I also find it beneficial!


Table of contents: Can J Rural Med vol 1 (2)
Copyright 1996, Canadian Medical Association