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My Nemesis: Problem Wounds Part Two

(NOTE: This is the second part of a two-part blog on problem wounds. As they say on TV…previously on "My Nemesis," I recounted my early years battling the most prevalent form of skin-based infection, cellulitis, and ways to combat it. In Part Two, I describe even more pernicious consequences of letting bacteria into your body via wounds. It can get ugly.)

As I mentioned before, plastic surgeons can be life-savers when problem wounds become more complicated. There are strains of bacteria that are frighteningly aggressive and start doing instant damage. One of the worst can cause an infection called "necrotizing fasciitis," another three dollar phrase to throw around at cocktail parties. Newscasters like to call this rare condition "fleshing-eating bacteria." They are just trying to scare the bejesus out of you so you stick around for the weather and sports, but it is not an inaccurate label. "Fasciitis" means inflammation of the fascia, or fibrous tissue, which encloses muscles. "Necrotizing' means causing necrosis, or death.

On one of those many visits to the ER, I was as sick as I had ever been and for good reason – I had contracted necrotizing fasciitis. Lab tests and MRI's identified its presence. The fact that I had a 104-5 degree temperature that nothing could lower told me all I needed to know. In that state, your head pain is excruciating and you throw up a lot. I was finally laid on a plank of ice to reduce the fever. Meanwhile, my  astute plastic surgeon rushed me to the OR, cut a swath into my leg from just above the ankle to just below the knee, and perform surgical debridement of all that dead tissue and the colony of bacteria killing it.

He got it all before it had spread too far. I never asked him what would have happened if he had sat around for 24 hours thinking about it. I know I could have easily lost a leg and with mortality rates for untreated necrotizing fasciitis in the 70-80% range, probably lost more than that. I'll briefly describe one more incident to demonstrate the pernicious consequences of letting a problem wound get out of hand. I took a hard fall on a marble floor one day and thought a mild headache was the only consequence. Three days later I developed fever, chills, and started vomiting a blue streak, all road signs to the ER. Unbeknownst to me or my principle wound checker, my long suffering wife, I had a wound on my right hip. We didn't see it because there was nothing to see. Only at the hospital did a red bruise appear and only a few days later did the skin start to break down and leave a small ulcer.

Unfortunately, both the location and the nature of this particular infection started a hellish two year period of an unhealable wound. Given its place on my hip, it was virtually impossible to sleep, sit, or function without adding some pressure. Plus, the exact nature of the bacteria was such that twice a week professional wound care couldn't heal the ulcer. Nor could a bothersome device called a Wound VAC, or vacuum assisted closure, where a battery powered vacuum head is attached directly to the wound to provide negative pressure as a healing method. It's an oft-used therapy which, in my case, didn't do the trick.

The ultimate fix to this Wound From Hell was a more elaborate form of plastic surgery that involved building up layers of skin borrowed from a nearby area of my body. Then came perhaps the most agonizing part: I couldn't leave my hospital bed for over a week to do anything – go to the bathroom, get a little fresh air, nothing. I had to lie there with my sutured hip off the mattress, 24 hours a day, for eight days. Then I could go home and get out of bed only ten minutes every two hours for another week. I wasn't bed ridden. I was bed incarcerated.

It took years, but I finally wised up. What I've described here is my own experience with problem wounds, probably much different than someone else, and that goes for how I deal with them. First of all, I keep telling myself, in a daily mantra, that if I develop such a wound, it's my own damn fault. Unlike  my disorder, transverse myelitis, which came out of the blue, most wounds are avoidable. If you don't break the skin, it's hard for pathogens to find their way in. I know, I said this before. It bears repeating.

My strategy is to slow down and try to anticipate every single instance where I might bump, scrap, or apply undue pressure to my paralyzed parts. Be utterly mindful of every transfer, every sitting position, and every accident waiting to happen. If you should break some skin, jump on dressing it properly and watching it constantly until it heals. If you don't know how to nurture a wound back to health, bone up. The world is full of experts.

One expert called this "constructive paranoia." Think that the whole world, at least the whole physical world, is out to give you a wound when you least expect it. So keep one step ahead of the game. Always expect it.

Another longtime solution is something you should discuss with your ID doctor, if you have one, or internist, if you don't. This is the regimen of a low dose of an oral antibiotic every day as a prophylactic against infection. I take 500mg of Keflex daily. Most doctors will tell you this is risky. It can lead to resistant bacteria strains, meaning many antibiotics stop working for you. Given the multiple number of infections I had endured, my own ID doctor thought it was worth the risk. That was two years ago and I haven't had an infection since. Maybe I'm just lucky. Or maybe, at least in my case, popping antibiotic pills every day has significantly lowered the odds of becoming infected.

My own horror stories about problem wounds were horrible to me, but probably not so unnerving to the many people who have deep ulcers that won't heal, are severely restricted in their movements, spend months in a hospital recovering, or have lost a limb when all else failed. Again, maybe I'm fortunate. I have spent a lot of time and effort combating problem wounds, but in every case, I returned to normal. I think I have learned my lesson, albeit the hard way. If you are in this situation, take it easy on yourself. Start paying attention right now.



Purchase Allen's book:
The Best Seat in the House:
How I Woke Up One Tuesday and Was Paralyzed for Life

Posted by ARucker on Dec 9, 2015 1:52 PM America/New_York

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