Dominoes, Pigs, Vacuums & Providence — Musings, Mutterings & Meditations on Wound Care

I recently watched the televised tipping of a single domino whose toppling triggered one of those mesmerizing extended clickity-clickity chain reactions. I thought to myself, “It took some extremely patient guy with extremely steady hands eighteen hours to set his dominoes in place, only to see them reduced to rubble in under three minutes.”

Many of us seldom give a thought to our health. When synced and operational, all systems are go. Each system like a domino, deliberately designed and placed. Their collective arrangement a yet more complex system. Each domino has a designated numeric value, a specific shape, size, weight, and occupies space in relation to all the others in an intentional, intelligent way. We may go years convinced that our physiological dominoes, intelligently designed and placed, resting on their narrow short edges, balanced with precarious centers of gravity, are somehow or another immovably anchored to the floor. In no danger of upset. Ever. During these days of wine and roses, these seasons in the sun, we are like a domino designer who doesn’t realize or who will not admit that the slightest instability within, or any energy randomly and disruptively introduced from without (an intruder), will send his finely tuned complex system into (perhaps sudden) decline.

A spinal cord injury (SCI) patient’s essential physiological dominoes are skin, digestion, respiration, circulation, and the immune system. Wound care (think skin-domino) is an ongoing concern for SCI patients. A wound’s onset is usually associated with sustained pressure and resulting lack of blood flow (think circulation-domino) to a particular area — pressure sores. Wounds can also be caused by the skin coming in prolonged contact with an unpleasant erosive, such as diarrhea — incontinence sores (think digestion-domino).

Not infrequently, wounds are located on SCI patients’ “posteriors.” Having been able to adapt to my injuries, and return to work, most of my day is spent in my wheel chair, seated. For this reason, I affectionately refer to my posterior as the “money-maker.” Over the past four years, I’ve sustained both types of wound. More recently, I’ve been on a year-long wound care quest to manage one of the second type, located in the coccyx region where the sun don’t shine. Its onset in August 2012 was in a particularly yucky way in a particularly tricky location.

After several months trying to self-manage, this rank amateur admitted the need for professional help and began to frequent the nearby wound care center (not surprisingly, my lovely heroic wife was miles ahead of me in this awareness, and greatly relieved when help arrived). And, under professional care, the wound began to show signs of improvement.

Things became a bit more complicated in January 2013, when I was diagnosed with temporal arteritis, an acute inflammatory condition affecting the temporal artery (think circulation-domino), which left untreated can lead to blindness. A biopsy of my left temporal artery confirmed the diagnosis, and required an incision along my left temple where Johnny Quest met Hogwarts. My graying, rakishly Race Bannon-like hairline was soon complimented by a sporty Harry Potter lightning bolt scar.

Temporal arteritis is treated with Prednisone, an immuno-supressive anti-inflammatory steroid (think immune system-domino) of which my rheumatologist grumbled, “At its very best, Prednisone is a horrible drug” (not exactly a ringing endorsement). An intruder in my case, though the lesser of other evils, one of Prednisone’s side effects is its retarding the body’s normal healing processes, and so my wound grew no smaller. Neither, thankfully, did it grow larger. Visit after visit, the professionals would exclaim, “That is one good looking wound!” while taking a picture for the record. Over the months, my Prednisone dose tapered from the initial elephant gun 60 mg. dose, to 50, to 40, to 30, to 25, to 22.5, to 20, to 15. And so, my wound began again to grow gradually smaller.

My impression of the professionals is that they’ve never met a wound whose treatment they didn’t want to “innovate” (translated: mess around with for research and notoriety). I once had a pressure sore treated with electrical stimulation. Yes sir. Two electrodes, left buttock, on either side of the wound. To improve blood flow to the area and speed up the healing process. My picture made it into the ranks of medical text book photos. I knew I should have gotten that gluteal tattoo of a 53-tooth chain ring with “CFH Loves AMH!” in the middle.

My current wound has been filled with acellular porcine (as in pig) skin tissue that is intended to encourage the further closing of a wound. Like a rehydrated pork rind, it was characterized as a scaffold onto which the wound bed tissue can grow and be supported. The results weren’t “Ba-dee, ba-dee, ba-dee . . . That’s all, folks!” Porky Pig fine. But I did start to snort when I laughed, couldn’t wait for truffle season, and had a strong urge to sit on a frying pan.

After unsuccessfully treating the wound using reconstituted bacon, more advanced dressing combinations and changes were the order. Even after rededicating myself to obsessively dutiful weight relief and position shifting throughout the day, these did not achieve a desired result. And so, technology took center stage.

The woundcare experts next referred me to the makers of a negative pressure pump that marries vacuum physics with an airtight seal bandage. The pump exerts negative pressure, creating a vacuum which, by way of a flexible hose connected to a specially engineered, heart-shaped bandage, draws increased blood flow (think circulation-domino) to the wound area.

I received this high-tech hickey unit on St. Valentine’s Day. Present for the reveal were my new best friends, Dave the pump sales guy, Mable, the Visiting Nurse Association (VNA) R.N., and Beenie, another VNA R.N. specializing in wound care. Beenie was cheery, portly, of Asian-Indian descent, raised and educated in the U.K., and sported an East End lilt. We all paraded into my bedroom with eager anticipation. I transferred from wheel chair to bed, rolled onto my side, dropped my shorts backside to half-mast, and clinically exposed the wound. As the professionals took their places bedside, I imagined myself the subject of a new reality series “Wound Care Nannies,” or perhaps a medical drama, “SCI – Wound Care.”

Upon seeing my sacral coccyx wound, and as we discussed a wound care plan, Beenie declared, “Mr. Heidel, we’ll determine the best strategy. We will heal this wound. From your behind to my mind. A true butt-mind meld.” Her declaration, confidently spoken at the time with an evangelical tent meeting fervor, in fact has not yet come to pass.

And so, we soldier on waiting for my Prednisone dose to be further tapered, and discussing, ever more seriously, surgical options, followed by a weeks-long period of flat in bed recuperation. While convalescing under severe ergonomic constraints, working little if at all, and tempted to worry much, may I . . .

. . . (T)hank God and marvel I am fearfully and wonderfully made. His works are wonderful — I know that full well. I have also seen and know that one can be fearfully and horribly broken. Not what I’d have scripted. But, His ways are beyond my full comprehension. Like Aslan, He is not safe, but He is good. Though He — the Good Shepherd — appears hard to me at times and for seasons, I know He is not only good, but the fount and measure of goodness. In this season, I will seek Him, look to Him, and having failed at times, I will return to Him. Though He may have injured me, He will bind up my wounds. Though I be torn to pieces, He will heal me, for He heals the brokenhearted and binds up their wounds. Psalms 23; 139:14; 147:3; Job 5:18; Hosea 6:1; Philippians 4:12,13; Westminster Confession of Faith 5 (Of Providence):1,4,5