My Nemesis: Problem Wounds

Posted by Allen Rucker in Life After Paralysis on November 30, 2015 # Health

NOTE: This is a two-part blog on my own worst enemies as a paralytic – wounds and infections.

I'm a slow learner or maybe my old, pre-paralysis habits die hard, but it has taken me a goodly part of my nineteen years as a T-10/12 para to get my arms around the infernal problem of skin wounds and their consequences. Which means: I have had a lot of wounds of all kinds, infections of all kinds, and a boatload of misery and frustration along the way. Much of this is due to ignorance, even more to stupidity and neglect. After you read this piece, you will have none of these excuses.

When I left the hospital in January, 1997, newly paralyzed from the neuroimmunologic disorder, transverse myelitis, no one had made any attempt to educate me about wound care -- beyond, “try to avoid wounds, you know, if you can.” Under the constant scrutiny of great nurses, I hadn't experienced any skin breakage in the hospital, and upon leaving, was much more concerned about my fractured ego than compromised skin. It was only a few weeks at home before I had developed my first problem wound, also called an ulcer, a pressure sore, or a bedsore. It was on my right ankle bone, or protrusion, due to the uninterrupted pressure of sleeping on that bone all night. In the wound care business, this is as common as dirt. It often happens on other protrusions as well, like that little knobby thing sticking out on both your knees. Actually, anywhere your skin, below the point of your paralysis, presses against anything for a sustained period is a potential breeding ground for wounds. The answer: don't let your skin press against anything for a sustained period.

How simple is that? About as simple, and as hard, as someone saying, “Lose weight.” As I said, old pre-para habits are stubborn. As a kid growing up in small town America, I'd scrape my shin, knee, elbow, or forehead, slap on a little mercurochrome, and forget about it, knowing it would soon go away. Problem wounds on paralyzed body parts don't go away, but because you can't feel them, you forget about them. You know to clean and dress them, but then you forget to clean and dress them two days later, and they persist. You lack the ability to feel pain. There goes the most reliable physiological early warning system known to man.

So you let it slide and a week or so later, you wake up with a temperature of 101 or greater, often accompanied by chills and a headache, and instinctively know something is terribly wrong. You go to the ER and they are quickly on top of the infection that has arisen from that little ankle scrape. The infection is already spreading to subcutaneous skin tissue, increasing your state of discomfort and possibly much more. This is called cellulitis.

Remember that word. It means that infectious bacteria is spreading in your body and unless eradicated, can attack more skin tissue, muscle tissue, and eventually enter the blood stream. This can lead to septicemia (blood poisoning) which itself can lead to months of intensive hospital care or to sepsis, which can lead to death.

You forget to move your ankle every two hours, get this innocent sounding condition called cellulitis, and end up dying of sepsis. It's that easy and that deadly.

In my early years of paralysis, I had many bouts of cellulitis that demanded hospital stays and heavy doses of heavy antibiotics like vancomycin to eradicate. I would see out-patient wound care specialists who often helped mitigate a problem wound but rarely healed one. In the last ten years or so, wound care treatment has become a lot more sophisticated, with more specially-trained doctors entering the practice. It's a growth business.

If one of my wounds simply persisted, i.e., didn't close but also wasn't immediately leading to a more severe infection, there were two others methods of treatment I tried. One was hyperbaric oxygen therapy, or HBOT. Briefly, this involves spending many hours in a sealed-off glass chamber where highly pressurized oxygen enters your capillaries and speeds up the recovery of damaged cells. HBOT is often used to help divers who suffer from extreme oxygen deprivation or burn victims whose damaged skin cells need rapid repair. I successfully healed two ankle wounds with HBOT but it was an enormous commitment. I endured 80 days of 80 hour-and-a-half sessions lying in that glass coffin, watching every existing rerun of “Law and Order” on a TV mounted outside my chamber. I haven't returned to HBOT treatment for the simple reason that it is an agonizingly slow procedure.

Another common treatment is skin grafting, also known as skin flap surgery. A wound that is almost healed will usually close with a graft. It's a form of plastic surgery, performed by plastic surgeons, who, by the way, are not just sleazy Beverly Hills doctors who ruin the faces of fading movie stars. The best ones are skillful practitioners of reconstructive surgery, microsurgery, and operations involving the removal of bacterial infections that can kill you (see sepsis above).

Problem wounds have simple and often easily avoidable beginnings but can then turn insidious in a myriad of ways. There are a host of different strains of bacteria and they only announce themselves after the fact. There are bacteria highly resistant to any antibiotic, commonly known as MRSA. In those cases, infection disease (ID) specialists often have to concoct a mixture of different antibiotics to solve the problem. In the one time this occurred with me, I had a an extreme allergic reaction to a couple of antibiotics -- Zosyn and Clindamycin, if you are keeping score -- and they came with rashes, fever, and vomiting. In other words, I got sicker before the docs finally came up with the right antibiotic cocktail to end my misery.

NOTE: Too be continued. Stay tuned for Part Two.

© 2015 Allen Rucker | Like Allen on Facebook



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How I Woke Up One Tuesday and Was Paralyzed for Life