​Take Care to Take Care

Posted by Tim Gilmer in Life After Paralysis on August 18, 2021 # Health, Lifestyle

Tim writing One of our biggest obstacles to achieving our goals can be super-charged ambition. I’m talking about the kind of ambition that gets you rolling and carries you along with it, even though you may be unintentionally neglecting to take care of your health needs. You may even have convinced yourself that, despite that nagging pressure sore, you can handle it. Why? Because you’ve done it before and you’re confident you can do it again.

But beware. Your body changes over time, especially your skin, and being overly busy can cause you to skip meals or eat without keeping your nutritional needs foremost. That can also slow down wound healing, and before you know it, that pesky little wound may stop making progress. It may even become chronic. That’s when you are at the greatest risk for wound infection, and that can be a game-changer. The next thing you know, you are in the hospital, and your ambition has been complicit in landing you there.

I’m talking from experience:

In 2016 I committed to a major project that required riding my all-terrain four-wheeler daily for hours. It wasn’t personal ambition that drove me; it was a family obligation. My grown daughter was stuck in a dead-end situation, living in an unhealthy cramped apartment with her unemployed husband and two sons. A few fires had broken out in their apartment complex, burglaries were not uncommon and hypodermic needles littered the parking lot. They were having trouble making rent and paying bills. My wife and I decided we had to help them however we could. We had already bailed them out numerous times, but we (and they) needed a sustainable solution.

The best option was to purchase a good used manufactured home and locate it on our property. That was my job. My wife went to work trying to get a job nearby for our son-in-law.

For six months, I played the role of a general contractor — getting bids, hiring, obtaining needed permits, overseeing the project. It wasn’t a simple process because it involved having to put a new septic system in, supply power and water, deal with county inspectors, move the manufactured home and place it on site, and ride herd on the whole project from my four-wheeler. You guessed it. I got a pressure sore from bumping around on the uneven ground for hours each day. And I couldn’t stop. I couldn’t afford to hire a contractor, and no one else could do the job. I had to carry everything through to completion.

The project succeeded, but afterward, I had to go to bed for a while. Problem was, I didn’t stay down. I figured a little progress was all I needed to get healing jump-started, so I returned to a busy schedule but stopped riding my four-wheeler.

I nursed the wound along for the better part of a year; then infection struck — a bone infection, the worst kind. Skin experts at a wound care clinic told me I now had a chronic wound that required surgery to close. In 2018 I had to spend six months in bed, split between home and two hospital stays. I ended up having to get a colostomy so the plastic surgeon could do a complicated flap surgery.

During that half-year period, I learned a great deal about flap surgeries, our health care system, wound healing beds, nutritional needs, and daily routines required to stay healthy. From bed, I wrote a real-time 7-part blog for New Mobility magazine, sharing my journey. When readers started to respond, I learned how common my wound care ordeal was, especially in the SCI world. Here are some takeaways from my experience.

First, according to Dr. Bruce Ruben, who specializes in treating non-healing wounds (and getting them healed), you need to do all of the five essential things below, or your wound will not completely heal (my experience has been added to the list).

  1. Stay off the wound to avoid trauma. Zero pressure is best if possible.
  2. Beware of infection and contact your doctor or wound care specialist if you suspect it. (2b) Keep the wound clean, but don’t obsess. When delicate granulation tissue forms in the wound, go very easy when cleaning it so as not to disturb it. Granulation tissue is where wound healing starts. If the wound starts draining, cover it and change dressings as needed.
  3. Pay attention to proper nutrition and eat plenty of protein. Wound care experts recommend 1.25 to 1.5 grams of protein per kilogram (2.2 pounds) of body weight for wound healing. You may have to supplement with a balanced high protein drink. Keep your total caloric intake for wound healing at 30-35 cal/kilogram (according to woundsource.com). Taking a zinc supplement orally (too much can be harmful, so check with your doctor first) before or after a meal can also help heal wounds (Mayo Clinic).
  4. Have your circulation to the wound area checked. It may involve an MRI to check arterial blood supply or an ankle-brachial plexus index test for lower extremity wounds. Your blood carries the needed healing ingredients to the wound site and removes waste. Healthy circulation is critical to wound healing.
  5. Reduce swelling, which benefits circulation. Edema is the enemy of wound healing. If you have a lower extremity wound, elevate your legs and feet. If you stay in bed for several few days, you may be surprised at how skinny your legs get. That’s a good thing.

Finally, take my advice as a fellow wheelchair user with a lifetime of experience, not as an expert. I can warn you and share my experience, but I’m a writer, not a doctor or nurse. If you have questions, contact Nurse Linda on this blog site, visit Dr. Ruben’s website or consult with a certified wound care expert near you. And stay positive. Staying in bed is a drag, but believe me, with a comfortable, workable computer setup and some help, you can accomplish a great deal from your bed, even hold down a full-time job if you’re fortunate enough to be able to work remotely.

Tim Gilmer graduated from UCLA in the late-1960’s, added an M.A. from the Southern Oregon University in 1977, taught writing classes in Portland for 12 years, then embarked on a writing career. After becoming an Oregon Literary Fellow, he went on to join New Mobility magazine in 2000 and edited the magazine for 18 years. He has published upwards of 100 articles, 200 columns, occasional movie reviews and essays. He and Sam, his wife and companion of 47 years, also own and operate an organic farm south of Portland, where they live with their daughter and son-in-law, four grandsons, and a resident barn owl. An excerpt from a memoir about his early post-SCI years, as part of a compendium of his writing over the past 30 years, can be read at his website — All You Need

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.