Sunday, April 23, 2017

The Miracle of Wound Care: Stem Cell Technology for People with Disabilities (Part 1)


(Caution: This particular blog describes a wound on my hip, not an uncommon occurrence for folks paralyzed and without sensation on their bodies. Photos of the wound may be too graphic for some readers).

It's now almost two years since I discovered a wound on the upper part of my left hip. At first, my personal care assistant said the wound looked like an ingrown hair or a small pimple about to burst. 

But over the next few days since the wound was noticed, "the pimple did burst," but it didn't heal. The supposed "pimple" oozed a mixture of blood, fluid and puss and continued to get worse.


I soon realized that the wound began at the site where I was given an injection almost 30 years ago during a procedure for my kidneys and bladder called a urodynamics study

Urodynamic testing or urodynamics assesses how the bladder and urethra are performing when it comes to retaining and releasing urine stored in the bladder. Urodynamic tests can help explain symptoms such as: incontinence, frequent urination, sudden, strong urges to urinate but without voiding.


The urologist gave me an injection of an antibiotic that would help prevent an infection from brewing due to the procedure. Since that injection, all I had was a small lump on my hip that didn't hurt [I have no feeling below my chest] or cause any problems. 

One doctor, who checked the wound on a routine visit, a year after the injection was given, suggested I watch the area on my hip and massage it regularly.   

All seemed fine until last October 2015


When the wound failed to heal, I decided to call a local wound treatment center that was part of South Shore Hospital in Weymouth, Massachusetts, and affiliated with the world renowned Brigham and Women's Hospital in Boston.


I would soon learn how fortunate I was to have this wound center located so close to my new "retirement" place of residence in Hanson, Massachusetts.

South Shore Hospital and The Center for Wound Healing


ealing


Dr. Gibbons
The checkup turned out to be not at all routine. Dr. Ralph Froio, a seasoned orthopedic surgeon, examined me and determined the wound was worse than I thought. In fact, Dr. Ralph Froio and Dr. Gary Gibbons, Medical Director and Professor of Surgery, surmised that it was indeed possible that the injection could have caused the wound, since I had no other trauma to my hip. My thighbone was penetrated by something and was leaking calcium into my hip for almost three decades.
Ralph Froio, MD
Dr. Froio


The doctors treated me with traditional wound therapy for several months. But after months of working on the wound, the medical team, led by Dr. Gibbons, began a series of debridement's for “heterotropic bone, off-loading with layered felted foam and acticoat.”

 

The wound wasn't pretty

This treatment uses a hydrocolloid that is an opaque or a transparent[1] dressing for wounds. A hydrocolloid dressing is biodegradeable, non-breathable, and adheres to the skin, so no separate taping is needed. 

 Trade names include Exuderm, Comfeel Plus, Duoderm, Granuflex, Ultec, and 3M Tegaderm Hydrocolloid.


X-ray of bone leaking in wound
The wound grew larger as more and more calcium, blood and fluids continued to seep out of the wound. In addition, the wound continued to expand as more calcium evacuated from the injured site and eventually began to have an odor. The odor was a dead giveaway for infection. 
 
Wound on admission



Although I couldn't feel any pain, I did experience autonomic dysreflexia, with symptoms of sweating, spasticity and fatigue. In other words, my body was trying to fight this infection but the wound wouldn't close.


I also had to stop sleeping on my left side. My normal routine was to sleep on my left side and then on my right, changing positions every night. This was to prevent a skin breakdown from forming on my body. 

I have slept each night like this for almost 35 years since I broke my neck in a body surfing accident - - until this wound setback. This kind of body maintenance is necessary to maintain a healthy lifestyle, considering that I am a C5 – C6 quadriplegic due to a spinal cord injury.

More bad news: hip surgery


The worst that could happen did. On October 2015 a wound decaying accompanied by a strong odor was unveiled during a routine weekly checkup. That added up to infection.

One look by Dr. Gibbons told me that something was horribly wrong. Without hesitation, he told my wife Maggie and I to go directly to  Brigham and Women’s Medical Center for immediate “surgical consultation” and he would contact Douglas Laurence Helm, MD and alert him to the emergency surgery.




                                  [End Part I]
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