KONNIE LeMAY / LAKE SUPERIOR MAGAZINE
Hyperbaric chambers are among the tools at St. Luke’s Advanced Wound Care Center, directed by Tania McVean.
Turns out your mother was wrong – picking the scab from a wound can encourage healing. But you should let the professionals do it.
That’s just one of the many blunt discoveries one can make when exploring the medical specialty of wound care. Discussion of caring for wounds resistant to healing is not for the squeamish, but patients faced with such long-term problems find relief in frank talk along with comfort from modern and sometimes ancient tools.
After nearly a year of dealing with difficult-to-heal wounds, Kari Mitchell is not reluctant for some straightforward talk, especially to help others.
“If one story can even touch one person, it’s worth doing,” she says.
As with a majority of people who find themselves needing this specialized care, Kari has underlying medical conditions that complicated her problems.
Kari has had Type 1 Diabetes for 42 years and also has rheumatoid arthritis. Medications for the later masked a problem brewing.
“ I had a callus on the bottom of my foot, which cracked and became infected with Methicillin Resistant Staph Aureus (MRSA) bacteria,” Kari says. “Due to the medications that I take for my rheumatoid arthritis, the infection was masked until it had progressed severely into the bone.
“I had noticed in the beginning of January my foot was kind feeling weird. There was a red bump outside my pinky toe.”
Within three weeks, the pain in the foot became unbearable and she ended up in the emergeny room. “My toe was amputated at that time due to the dry gangrene and bone infection.”
Her medical conditions also made it difficult to harvest a skin graft when needed. “That surgical wound was left open because they didn’t have enough skin to sew it back together. … It just didn’t want to heal, and I was just having problems with it.”
COURTESY ESSENTIA HEALTH
“The skin is the largest organ on the human body,” explains Dr. Boni-Jo Silbernagel (left), a wound-care specialist at Essentia Health. The clinic features private patient treatment rooms.
Kari, who lives in Deer River, Minnesota, was referred to Dr. Boni-Jo Silbernagel, who specializes in wound care for Essentia Health. While the doctor’s main practice is in Duluth, she also visits Essentia’s Deer River clinic. But Kari needed more regular visits – once or twice weekly – and so she often had someone drive her the almost 100 miles into Duluth.
Care of non-healing wounds needs to be agressive and timely, says Boni-Jo. The causes of a chronic wound can be complex, which is also why a team approach works best.
“The nice thing at Essentia,” she says, “is that we have … a very patient-centered focus of care, a multidisciplinary approach, a team.”
Why exactly a wound will not heal creates the main diagnostic dilemma. Sometimes it can be a combination of existing chronic conditions, such as in Kari’s case, but the problems can also be complicated by improper nutrition, hindered vascular or blood-flow issues or by the types of bacteria that might be causing the problem.
“With these patients, they are not healthy patients already,” Boni-Jo says. In her practice, she deals with non-healing or slow-to-heal wounds such as foot or leg ulcers, surgical wounds that have opened, skin grafts or surgical flaps that are not healing, internal injuries or open wounds caused by radiation therapy, bone infections and wounds caused by trauma, such as burns.
Duluth is lucky in that both of its major medical facilities – Essentia and St. Luke’s – have teams surrounding the specialty of wound care.
Almost a year ago, St. Luke’s opened its Advanced Wound Care & Hyperbaric Center and already has added space for patient care. Center Director Tania McVean recently gave up her office to add a patient treatment room.
“We had six treatment rooms,” she says. “My office is No. 7. … We didn’t expect we’d grow this quickly. We doubled our patient base in under nine months.”
Nurses connected to the center get extra training, and patients get the team approach.
“Our goal is to heal people in 14 weeks or less,” Tania says.
Like Essentia, the St. Luke’s center has a variety of tools plus the addition of two chambers of hyperbaric oxygen therapy, especially useful for the kinds of chronic wounds that develop from raditation treatments or connected to diabetic conditions.
The chambers deliver 100 percent oxygen inside, which increases the amount of oxygen your blood can carry and promotes the body’s ability to heal, Tania explains.
COUTESY ST. LUKE’S
The center features two hyperbaric chambers, seen here when they were first moved into the space. These days large-screen televisions are among the amenities that patients in the chambers can enjoy during their several hours absorbing the 100 percent oxygen atmosphere inside.
Dr. Jarrod Buresh, medical director at the center, trained as a vascular surgeon, a practice in which chronic wounds can plague patients. His work there prompted his interest in wound care.
One change in his practice now, he generally sees patients weekly rather than monthly or less. “It doesn’t take much for a wound to go from good to very, very bad,” he says. “A lot happens in 30 days.”
For one patient during the last year at the center, a lot happened in just three days.
Duluthian DeeAnn Jackson flew to Hawaii in January 2017 to visit her son. “I only remember about three days,” she says, “and I don’t remember anything after that until March.”
DeeAnn’s son found her unresponsive when he came home from work. At first, local doctors suspected a bladder infection.
Then she was transferred to a bigger hospital on a different island. There, after determining she had a blockage of the colon, doctors performed a colostomy and an ileostomy, both of which open holes in the abdominal wall to reroute digestion. She woke up after about two months of intensive care. The surgeries left her with an open wound – “big enough to put your fist in.”
Eventually she would be well enough to travel back to Duluth and the services of the St. Luke’s center.
DeeAnn has endured a series of progressions and setbacks with complicated twists and turns.
She’s still on the mend, but has been amazed at some of the techniques that have been able to help her with the original wounds and others that developed later.
“The reversal involved closing up the colostomy and getting to the colon and reattaching it. It’s quite a complex surgery. Then it got an infection and that turned into an abscess.”
She now has a “wound vac” – “a machine that I carry around 24/7; it takes out all of the gunk.”
An unhealed open wound was treated with collagen first in Hawaii and now locally. The protein is found in various parts of the body. “They put collagen in the bottom of the wound and it started to fill up with tissue,” she explains. “I think collogen now is the best new thing.” She’s also had stem cell techniques and other healing methods used.
Many new techniques are being developed in the wound care speciality, some defying old wisdom. Your mom’s “don’t pick a scab” rule, for example, turns out not to be completely helpful.
Removing the scab – in a properly sterile way – can aid the healing and encourage growth of new tissue.
One of the more intriguing techniques, similar to the use of leeches to increase blood flow to certain areas for some patients, is the use of sterile maggots to clean out a wound. The little critters most of us consider disgusting will not only remove dead tissue, but excrete a disinfectant. Tania says St. Luke’s has used the “maggot therapy” for some of its patients.
Use of skin substitutes with stem cells, similar to a skin graft, is also proving useful.
Some healing aids, though, can be more mundane, from correct and constant bandage replacement to proper nutrition for the best ability to heal by oneself.
After her ordeal with the infected pinky toe, Kari Mitchell echoes what all of the wound-care specialists also emphasize.
The most important thing a person with such a wound can do is NOT ignore it.
“Hindsight tells me I should have gone in,” says Kari, who is well on the way to healing.
Under normal circumstances, any wound should heal within a month, according to Essentia’s Dr. Boni-Jo Silbernagel.
Unhealed wounds, though, can create a kind of social stigma and even embarassment to come in for help.
“Losing their extremity or having this hole in their body or this leak or this smell” all can cause people to shun friends, work and help, she explains.
“One of the biggest things is to acknowledge that there is a wound and seek treatment early,” she says. “
Perhaps because of the unsavory nature of discussing a non-healing wound problem, both Kari and DeeAnn found almost as much relief in the atmosphere created by the wound-care staffs in each hospital as in the actual healing procedures.
“They are amazing – they are so nice,” DeeAnn says of her experience at the St. Luke’s center. Since her return home to Duluth last June, she’s been a regular patient there and has needed help from relatives. Now, she’s visiting the center less often and is able to do more without help. “It’s nice to be on my own a little bit.”
As for Kari, she’s also pleased to be able to see a time without the doctor and clinic visits, though she might miss the friendly faces at Essenia’s clinic.
“I can’t say enough great things about the wound clinic,” she says. “They don’t deal with just foot wounds, they deal with everything.”