Salina Journal
There's a reason the term "festering wound" is used to describe chronic problems such as conflict in the Middle East; it sometimes seems that no real progress is being made, and that the problems may never go away.
In a word, frustrating -- or in another word, hopeless.
Yet for the past four years, Salina Regional Health Center has been home to The Wound Care Clinic, housed on the ground floor of the hospital's now largely vacant Penn Campus, and devoted to the science and art of helping heal those chronic wounds.
While most young, healthy people might see healing as a given, that's not necessarily true, said Dr. David Smith, medical director for the clinic. And many things people used to associate with wound healing, Smith dismisses as "voodoo."
Alcohol, hydrogen peroxide and other home remedies -- including soap for extended periods -- can do more harm than good, he said, by damaging healthy cells at the wound, and so impeding healing.
Additionally, the old idea that a wound needs to be kept dry has been pushed aside by recent research.
"Grandma, and even Mom, thought keeping it dry and scabbed over was the idea," Smith said. "Now we know that moist, not wet, but moist is what works best."
But Mom and Grandma shouldn't feel bad -- even many doctors still don't know as much as they could about how the body heals and how medical professionals can help.
"They don't teach this in medical schools," Smith said. "This is not common in medical school or nursing school."
The range of injuries seen at the clinic is enormous, said Janet Davidson, a registered nurse, certified wound care nurse and team leader at the clinic.
They can include burns, brown recluse spider bites, bed sores, and even "frozen food injuries," Davidson said. Those in that last category are caused by dropping something such as a frozen roast on a foot when removing it from the freezer.
But it's not the wound itself that's usually the problem; rather, it's the fact that even after weeks and weeks, that wound isn't getting better, and may even be getting worse.
Or as Smith, a general surgeon, puts it, "We make big wounds in people every day, and most of them heal."
First, see eight doctors
The clinic's patients are overwhelmingly older -- about 63 percent are on Medicare.
Mary Ann Sullivan retired this spring as a kindergarten teacher in the Clay Center schools after 36 years in the profession, but for a while it looked like she might miss her retirement party -- and the last few weeks of school with her students.
Back in early November, the 66-year-old had worn a pair of compression hose, which she'd used for a few years because of vein problems in her legs, and when she took them off that night, "There was a very, very minute sore. I noticed and put some antibiotic cream on it."
She then went to Kansas City for the weekend "and my daughter saw it and said it didn't look good, and wanted me to see a doctor right then. I put it off until Monday."
That put her onto an odyssey, starting with her doctor, then a podiatrist, a rheumatologist and a bone specialist, and she developed a staph infection in her leg along the way.
One treatment involved an Unna Boot, a tight wrap treated with medications.
"When they took it off, (my leg) resembled a big round of ground round," Sullivan recalled. She said she might have had an allergic reaction to something in the boot. "I said 'Not again.'
"I learned empathy for people who can't get better," Sullivan said. "I was getting kind of discouraged at times -- I'd never been confined like that before."
Making matters worse, she was planning on a trip in October, a cruise she'd already paid for in 2007.
"It was one of the first things I thought about, that I wouldn't be able to make that cruise."
But then a friend told her about Dr. Smith and the wound clinic -- and the friend said, "my leg used to look like yours."
A ring-a-ding ding time
She called in early March -- Smith would be the eighth doctor she'd seen -- and "Dr. Smith told me I'd be up and walking in three to four weeks, and I was in three-and-a-half weeks."
Just this past week, she "graduated" from the clinic and rang the chimes on her way out -- a tradition among those who have healed.
She'll be back to see Smith in July for some vein repair surgery, and she says she won't have to wear compression hose any more, either.
"I made it to my retirement tea," Sullivan said. "A school nurse came and picked me up, and I was still in a wheelchair, but I made it."
And as for that cruise? "Dr. Smith said I'd be able to dance by then."
Removing dead tissue
Much of Sullivan's treatment involved wearing a compression boot, which was put on and pumped up to provide the foot with compression for a few hours each day.
"You kind of look like half an astronaut when you're wearing them," she said. "But it's not anything you can't live with."
But that's just one of many treatments available.
Often one of the first is debriding, the removal of dead tissue from the wound to allow the healthier tissue underneath to grow.
While that can involve scalpels, Davidson said, the clinic also uses an ultrasonic debriding machine, which uses saline and ultrasound to clean out a wound.
While the saline helps clear the wound of bacteria, Davidson said, there's evidence that the ultrasound also works to kill bacteria, including strains that are resistant to antibiotics.
In other cases, laboratory-grown skin can be placed over a wound to aid in healing.
The pieces of skin, grown from foreskins removed during circumcisions, "are just full of growth factors and cells that help a wound heal," Davidson said.
As part of the procedure, she explained, the new skin is punctured in several places as it's attached to the wound.
"That makes it start to try to heal itself -- and that healing goes into the wound," she said.
Don't, don't, don't, don't
There are numerous factors that influence healing, Davidson and Smith say, and while some, like age, can't really be controlled, many others can.
"Don't smoke, don't become obese, and control your diabetes," Davidson said.
Weight and smoking were also at the top of Smith's list of don'ts.
For wounds to heal properly, good circulation is essential -- and smoking robs the blood of oxygen, also essential to quick healing.
"Obesity is epidemic in our society, and that leads to diabetes, which leads to all kinds of problems including poor wound-healing," Smith said. Even the lack of sensation in the extremities that diabetes can bring on can have its own set of dangers.
In one case Smith heard about at a medical conference, a patient went to a doctor complaining of hearing a clicking sound whenever walking around barefoot. As it turned out, the patient had stepped on a bottle cap, which had become embedded in the foot -- but because of the lack of sensation, the person didn't know it was there.
That's why Davidson says "We say our goal is wound healing, but it's really the whole patient, including lifestyle."
So patients can get a variety of services, including nutrition counseling, physical therapy, instruction on the proper use of crutches, and information on starting an exercise program.
"We can pull in lots of other disciplines besides the medical staff," Davidson said.
Wet, messy, malodorous
But for the patient, there's more to getting better than just lying on a bed in an operating room, counting backwards from 100, and waking up a few hours later all better.
"We need to make the patient a member of the health care team," Davidson said -- hence the graduation certificates and chime-ringing ceremony; a patient healing isn't just an achievement of the doctors and nurses.
It's that "patient education aspect, the opportunity to teach overall health habits," that Davidson said led her into this specialty of nursing, which she acknowledges can be "wet, messy and malodorous."
The light's on, but ...
Sullivan was an important factor in her own recovery, but not all patients are -- the clinic has an 82 percent success rate.
"Dr. Smith said so many people don't follow all of his instructions, and that maybe it was because I was a teacher," Sullivan said. "I told him I was the one used to giving orders."
Some patients simply aren't willing or able to change their habits to make the differences needed for healing to happen, Smith said.
"I've had successes -- a two-pack-a-day smoker who quit," he said. "It can happen, but it doesn't happen very often."
Sometimes, the pain and frustration of a long-term wound that won't heal serves as a wake-up call, Davidson said.
"Not always, but sometimes," she said.
One patient, who was a three-pack-a-day smoker got bad enough she had to be hospitalized -- and when it was time to be released, made sure she had cartons of cigarettes at home, Davidson said.
"Others see the light and quit."
And while Smith said he's seen a few patients with well-paying, long-term disability plans who were making enough in disability payments that they had "no motivation" to get better, many others find not being able to work frustrating.
One good old-fashioned remedy that's still considered important is elevating the wound as much as possible -- but "as much as possible" can translate to "very little" if a patient's job is on a production line.
"It can be depressing," Davidson said. "You've got to work to keep your health insurance, but in many jobs you can't work if you have an open wound.
"We had a young man in here a while back," she said. "He wanted to work, he didn't want to be on disability, but when he worked he had to wear steel-toed boots" which kept his foot from healing.
But Davidson says such dilemmas are part of the job.
"If they were easy cases, we'd never see them."
n Reporter Mike Strand can be reached at 822-1418 or by e-mail at mstrand@salina.com.
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