Patient Stories

Chronic Wounds -- Dennis' Story

Dennis was angry. Again.

Dr. Halsted, his family practice doctor, still hadn't beckoned him into his 3:15 appointment...leaving Dennis feeling as if he were about to ooze his life away in this turquoise and beige waiting room.

Plus, Dennis didn't think Dr. Halsted would approve of everything he had to report: yes, he'd bought one-percent milk, which the doctor had recommended for managing his high cholesterol, but, guess what -- he also bought cigarettes, ("Lady Janes," his favorites) which Dr. Halsted said he shouldn't be smoking at all.

Dennis was funny that way: he spent his entire life pursuing some things that he shouldn't, (smoking) and then doggedly tried to improve on the over-all bad situation (one-percent milk).

What wasn't funny, was his constant companion of pain from chronic wounds.


Types of Chronic Wounds:

His wound, he called it "Beth" (after an ex-girlfriend who broke his heart), was heavily weepy on his left calf.  "Beth," a venous stasis ulcer, 5.5 centimeters by 7.0 centimeters by 0.3 centimeters, ultimately erupted as a result of  Dennis' chronic venous insufficiency.

"Beth" festered into being a few months ago at the Fresno State reunion picnic. That's where Dennis was so intent on nabbing the last ham-and-lettuce-and-mayonnaise roll that glistened in the midday sun on the big, clear plastic serving platter -- that he hadn't really paid attention to just how much he was actually scratching the huge, pink mosquito bite on his leg.

He scratched so hard, the bloody, infected, torn-open bite churned into "Beth," his won't-go-away venous ulcer: loaded with bacteria, oozing yellow gunk, tissue-inflamed, throbbing...all exacerbated by insufficient blood not chugging the way it's supposed to through Dennis' weak veins.

"Oh, ho! There he is!" Dr. Halsted, Dennis' avuncular family practice doctor finally emerged into the waiting room...with all of the blustery clatter that a 73-year-old, long-established primary care physician has a right to.

Since his practice had slowed a bit in the past few years, Dr. Halsted, pleasingly white-haired and double-chinned, made a habit of greeting his patients personally -- often sitting right down with them in the waiting room, the way a friendly waiter named "Chad" at a vegan restaurant might join his diners at their table...just before recommending the tofu Mee Krob.

"Ooh, that looks nasty." Dr. Halsted squinted through his bifocals at the wound on Dennis' left calf. "The good news is, though, I’m not so sure it's a venous stasis ulcer, which you'd Googled. It could just be a bad skin tear or a blister gone wrong."

Dr. Halsted reassuringly patted Dennis' leg. "Come into my office. We'll fix you up with some nice Silvadene cream and Betadine ointment. I also recommend that you sit in a healing whirlpool at least twice a day. Yes, sir! We'll get that wound gone in a jiffy!"


Six months later:

Was Dennis angry now or just frustrated? Or...was the blurred line between the two emotions just as soggy as the ever-widening circumference of his worsening wound?

"I don't know, doc," Dennis said, helplessly waving his meaty hands. "It's bigger, it's drippier...and my leg's really blown up. It's swollen like a big old balloon. You said this wound would get better, but it's worse!"

He didn't mention that while "Beth," the wound, agitated on his leg, memories of Beth the ex-girlfriend, burrowed more pain into his heart.

He'd called her voicemail several times over this past six months, leaving no message save for the background sound of the screaming fire engines that often roared down his street.

"Well," Dr. Halsted clumsily clunked-off his round, wire-framed glasses, then rubbed his deeply-bagged eyes. "Look, Dennis, I...I don't know. Maybe I'm not as up-to-date on this stuff as I thought. Besides," Dr. Halsted's watery, blue eyes flicked to a framed photo of his smiling, brunette wife. She stood in front of their family Grand piano, her hand resting proudly by the keys. Dennis once thought he might want to play the piano...but he could never be bothered to practice.

"Besides," Dr. Halsted wearily continued, "Gloria left me for the Fed Ex man. Can you believe that? The Fed Ex man!?!"

Dennis didn't say anything. Wasn't this doctor's appointment supposed to be about him?

"Okay," Dr. Halsted picked up the vibe. "Why don't I refer you to a good vascular surgeon? Dr. Jin." Dr. Halsted scribbled some information on a pad. "He's a young guy, really with-it. I know him from my rounds at Long Beach Memorial. I'll tell him to expect your call."

Dr. Jin's office was certainly clean, Dennis had to give him that...and the guy looked as if he were in good shape: he had the lean, vein-rippled arms of a man who lifted weights and who didn't eat hamburgers. Beth used to say she found men like that attractive. Heck, this guy probably ate salads with those sprout things on them, Dennis mused. Would Beth find that attractive, too?

"I want to help you, Dennis," Dr. Jin, the vascular surgeon, said in a no-nonsense manner. "Operating on your perforating veins is, at least, one step in the right direction. Do you know much about why you got this wound in the first place?"

"Well, I scratched a big mosquito bite and, then, I don't know...it just never healed."

"Okay. Do you know anything about venous insufficiency?"

"Just what I read about on the internet, Doc," Dennis chuckled, trying to establish a we're-just-a-couple-of-guys-talking-about-disease familiarity. "But it all gets really complicated, so then I usually fall asleep with the television on."

Dennis didn’t add that he was never very good at biology; that he much preferred shop -- where he carved old Jimi Hendrix lyrics onto lacquered pieces of wood, turning that into low nightstands for his E.C. Comics comic book collection.

Dr. Jin chuckled, too, yet maintained a laser-like intensity to his gaze. "I'm assuming that you're often kept awake from your pain? That you have acute discomfort during rest, movement, attempted sleep and every other state of being -- making your life, at times, practically unbearable?"

"Um...yeah." Okay. This guy was good.

"Well, Dennis, I believe you have chronic venous insufficiency," Dr. Jin continued. "Raging venous pressure, due to reflux in your veins, makes healing your chronic wound an ongoing battle.  We'll order an ultra sound to get an exact look at your circulation, which I think is poor, and the specific details of your venous reflux, but... it's fairly clear to me that you have all the symptoms of chronic venous insufficiency: your wound is mired in venous stasis because your superficial veins are over-dilated and exhausted. Your vein valves are weak -- they can't handle pumping enough oxygen-poor blood back to your heart."

"This wound stinks, too, Doc. I try using cologne, but, um..." Dennis let the sentence drift off.

"Yes, that's a symptom, as well: foul odor. With your venous hypertension and lack of calf muscles, your tissue isn't getting enough oxygen. You received the wrong treatment before, that's why your wound 'stalled.'"

"Stall..." Dennis let the word sit behind his lower teeth. Certainly he'd felt stalled in his life: there was that security guard job at the Ivar Apartments. People said "hi, Dennis," sometimes gave him their leftover sandwiches or a Twinkie from the basement vending machine...then what?

His old security guard uniform, an armpit-stained, zip- up khaki jumpsuit, still hung in his hall closet -- kind of pointlessly, Dennis reflected now: he couldn't even fit into it.

"Phew. That's a lot of info," Dennis said out loud,  next ruminating on how Beth got him started on the "Lady Jane" cigarettes (yes, that was why he smoked girl-sounding nicotine), just before she dumped him. He sure could use a cigarette now. He lit one up. "Mind if I...?" He laughed obsequiously.

"You can't smoke in here, Dennis." Dr. Jin wasn't smiling. "Your physical condition is no joke. You're 74 pounds overweight. You have high blood pressure. Your diet is horrible. You've severely compromised your immune system! I want you to switch to lean proteins and to treat your condition with elevation and compression. That," Dr. Jin slammed his thin, strong hand down on his mahogany desk, "will heal your wound."

"Love the tough love, doc. Love the tough love," Dennis laughed again -- this time with admiration. "And then you're gonna try to cut me open at some point, like you said? I mean, that's what you surgeon guys do, right? Stick sharp objects in people, then slice-n-dice?"

Dennis made a dramatic swoosh-swoosh motion in the air. It was something he saw on a late-night commercial for a potato-dicer.

"Vein surgery certainly is an option, as I mentioned," Dr. Jin responded. "But I'd like to try some more conservative wound management at first." Dr. Jin whipped out a prescription pad and a black ballpoint pen. He wrote as he spoke.

"I'd like you to wear a good compression stocking ... Juzo Soft 2000 knee high, 30-40 mmhg, is an effective one." Dr. Jin continued. "We'll treat that wound with some nice gauze dressing...and let's get you started with a good sequential compression pump. I recommend the Lympha Press Petite Basic 701A. That'll really get your circulation going again. Your wound will thank you."

"That's a lot to remember, Doc."

"Don't worry. I wrote it all down. Oh." Dr. Jin scribbled on the pad. "I also want you to go to a good multidisciplinary wound treatment facility.  The Wellingham Wound Care Center is in your area. It's excellent."

With a great flourish, Dr. Jin tore off the pages from the prescription pad. He handed the pages to Dennis. "Now put out that cigarette, Dennis." Dr. Jin sternly said. "With every puff, you restrict your veins and make your blood platelets too sticky. You may not take your health seriously, but I do...and I'm sure as hell not breathing in your second-hand smoke!"

Whoa. The doc meant business. O.k., the man was small, but he was in thrumming good shape. He probably did yoga, which Dennis always thought was a weird-seeming exercise because it sounded too much like "yogurt" and because, apparently, it involved a pose called "downward-facing dog."

Dennis would be darned if he had to pose like a dog-facing downward in order to better his chances at wound-healing. He didn't really like dogs. They always barked at him when he was on his way to buy cigarettes.

One dog in particular, a red cocker spaniel named "Bobo" had a way of barking that appeared to convey: "Stop smoking those coffin nails, you ulcerated, chronic-wound-infested loser!"

Who needed that kind of inter-species guilt?

Still, Dr. Jin spoke with the kind of gravitas that dug up a musty respect from Dennis. This guy really seemed to know what he was talking about. Besides, Beth sometimes spoke to him in that same snappish tone. Dennis equated it with serious love.

Dennis stubbed out his "Lady Jane" on a magazine called Journal of Wound Care. "Okay, Doc. I'll do what you say."

The Wellingham Wound Care Center was abuzz with people and activity.

Dennis had never had so much attentive care from so many different qualified professionals as he did at this multidisciplinary treatment facility. He had to admit...it felt good!

There was "Pete," a smiling, mustachioed podiatrist who examined and treated his feet as if they were fine art objects; another vascular surgeon, Dr. Marion Ungerleider, knowledgeable, nurturing; a plastic surgeon, Dr. Sara Stern, who always brimmed with an infectious, vibrant enthusiasm when she extrapolated about skin grafts; a couple of nurses, Tomas, from the Philippines and Annette from Hawaii, and a highly-skilled nurse practitioner, Fonda Snyder. Certified wound specialist certificates dotted the walls.

"We're going to debride your wound," Fonda said expertly, on Dennis' first visit. "That means we're going to get rid of a lot of the dead tissue.  We want you on a new dressing change regiment, too...uh, we'll need some Calcium Alginate with silver."

Tomas swiftly brought out the dressing.

"And we want to wrap your wound with this nice, new Profore," Annette arrived with the wound wrapping. "We'll change it twice a week to keep the area clean and fresh."

Annette and Tomas proficiently wrapped the Profore from Dennis' toes all the way up to his knee. It felt great and incredibly healing.

"Okay, Dennis," Fonda said gravely. "Dr. Jin told us he warned you about smoking. That's important. Let's talk about other lifestyle changes. You need to shake off some of this weight. It's killing you. Cut out all the saturated fats. Switch to olive oil and nonfat cheese and yogurts. Up your intake of fruits, vegetables and whole grains. Don't eat fried, processed foods. That's just junk. If everything on your plate looks brown and fried, something's wrong."

"And exercise!" Tomas piped up. "Exercise is vital. Even if it's just walking around the block at first, that means something."

"Sure, nursey, sure." Dennis replied. "Look, I already feel better. You guys obviously know what you're talking about.  This bandage thingy makes my wound feel as if it's finally gonna heal."

"Don't call me 'nursey,'" Tomas wasn't smiling.



Dennis' Story Page 2

Dennis' Story Page 3