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Wound Healing

September 27, 2004

Over the past ten days, I've been reminded about what it means to heal
wounds, in very real tangible ways as well as figurative ways.

In haste, I touched my arm against our propane grill when shutting off
the gas, and without giving it enough thought, took the plate of chicken
I was balancing in the other hand and went straight to the dinner table
to serve a hungry family, rather than dousing my arm in cold water as I
should have. The blister was almost immediate, and within two days when
it broke, I watched an advancing infection that covered much of my
forearm around a clearly 3rd degree burn.

Now I know better than to allow something like this to happen, but it
happened anyway, and I slunk into the local emergency room last weekend,
hoping to keep a low profile, but as a busy local doctor, there is no
such thing as a low profile, and as I sat hooked to the IV antibiotics,
I had a long parade of nurses and doctors troop in to see just what
little incident had brought me in. Thankfully, I stayed out of the
hospital (never a healthy place for anyone) and have managed to slowly
heal up at home, but still work daily at getting this deep wound to heal.

The irony is that the burn wants badly to heal itself, but the body is
not always very smart about how it goes about it. The wound covers with
cellular debris and dried serous fluid which must be removed and
debrided daily to allow the growth of healthy new skin along the edges
and in little granulating islands of new pink tissue. This wound must
be "reinjured" to the point of fresh bleeding in order to heal
properly. Burn and wound therapy is one of the most painful, but
ultimately rewarding clinical tasks we do as health care providers.

I learned this years ago with one of our first Haflinger babies--a young
colt who managed during the night to wedge his hoof down between his
stall door and the door sill and then was stuck, lying awkwardly until I
came to the barn in the morning to discover him lying with a mangled
front fetlock horribly damaged by his struggles.

The wound was unimaginable and looked hopeless. The vet shook his head
grimly and gave the poor little guy a 50% chance of making it as there
was exposed pastern and clear muscle damage. But the tendons were
intact and he could actually bear weight on the leg, so I determined
that we had to try.

The initial wound cleaning was very difficult for us all as the vet
cleared away the tissue that was beyond saving and then I began the
routine of penicillin injections rotating between neck and butt twice
daily with wound dressing changes. Our little colt was incredibly brave
and tolerant, learning he had no choice but to stand quietly for all we
did to him, and by the third day, it became a one person procedure,
rather than two.

This wound stayed uninfected thanks to the antibiotics and to my
vigorous debridement to remove the unhealthy tissue. To avoid the
notoriously aggressive granulation tissue that develops and mounds up in
the equine leg wounds, I used a combination steroid and antibiotic
ointment to discourage the too rapid tissue growth. But it meant this
would go on for months.

My little guy took three months to heal and he did. With a thickened
hairless scar around the pastern, but sound. It was a small miracle but
persistence and patience paid off.

Our human wounds are sometimes in places that can't be seen. They may
be very hidden from view, festering and desperately painful to us, yet
not so apparent to others. If not exposed, cleaned, and in some ways
reexperienced, they may never heal. I see this every day in the people
I work with, who are suffering from illness whose roots are from some
previous "injury" they have left covered and unhealed. One of my
detective jobs is to try to find the "wound" that the patient themselves
may have forgotten and then we can work together to find the healing
solution. Last week, two young students tried to take their lives, in
the first week back to college. They were unsuccessful in their
attempts, but they have successfully bought themselves a relationship
with a very persistent and patient health care provider who will pick
away until things heal over properly. At times it will hurt, they won't
like it, and they'll want me to go away. But like my young colt, they
will finally make the decision to aid in their own recovery.

It takes a tangible reminder sometimes of the lessons of life. I'm
bandaging mine twice daily, remembering much bigger, deeper, more
painful wounds I've seen in others, and counting my blessings that I've
learned what it takes to help them heal.

Emily

http://www.briarcroft.com/emily.htm