Wounds Are "Unglamorous" But Satisfying Work, Says Surgeon
Brian Smeal, M.D., sort of "fell into" the field of wound healing and wasn't sure he would even like it. Some don't. You deal with stubborn wounds in sick patients who can't always communicate, can't always appreciate, he said. And truthfully, sometimes the wounds give off an odor.
The Our Lady of Lourdes Medical Center surgeon has found that he likes the work a good deal, not in spite of, but because of the fact that many patients are incapacitated and written off by some others in society.
"It's not a glamorous surgeon's job," he said. "But I gotta tell you, these wounds can threaten their lives and I appreciate the fact that I can make a difference in the lives of people who some wrongly consider disposable."
Dr. Smeal and his associates in Our Lady of Lourdes Medical Center Surgical Associates [3MB PDF] conduct a comprehensive wound management program that cares for patients both in the medical center and in a network of nursing homes.
A good number of his patients have diabetes and are susceptible for lower extremity wounds.
"The problem with diabetes is that patients lose sensation in their feet so they don't know that they are causing repetitive injury by wearing shoes that don't fit appropriately, for example," he said. "Or, you stick your hand in their shoe and find a big stone in the shoe they've been walking around in for two weeks and so there is a large ulcer on the bottom of their foot."
Other patients include those with spinal cord injuries or other conditions that make them immobile.
"A lot of these wounds happen because of pressure, unrelieved pressure that sort of starts the ball rolling. It is pressure from sitting and also not being able to sense that they need to move and also not having the ability to move. You and I can sense when our buttock is sore, so we shift our weight. These people can not feel that."
Dr. Smeal said he is challenged by the wound healing work "because it has a lot of factors involved and it has a lot of science that goes into it. It's a lot more than picking the right bandage to go on the wound."
The Lourdes surgical group is taking the lead in this work because it requires both basic science knowledge and the skills to identify and surgically remove dead or unhealthy tissue in wounds.
"You can not treat a wound which contains necrotic or devitalized tissue," said Dr. Smeal. "There are plenty of agents out there you can stick on these wounds, but the bottom line is that there is no substitution for surgical removal. When you deal with a bone infection, you need to get to the bone and tissue in the operating room."
"If you treat infection, remove the dead tissue and the pressure, generally you will get the ulcers to heal."
"But when you have an inability to relieve pressure, an inability to treat the infection, a lack of desire to change lifestyle, a lack of income, resources, that's when we have chronic problems and that's when we can't get these wounds healed and that's when it can become threatening."
"A major component in the Lourdes wound management program is the work of Advance Practice Nurses who have the ability to diagnose and treat these wounds," said Dr. Smeal.
"They can see, assess, diagnose and begin treatment plans. One of the things to think about in wound healing is, it is absolutely a team sport. It's the doctor, it's an advanced practice nurse, it's a general surgeon, a vascular surgeon, it's a podiatrist, it's a dietitian, an infection disease doctor - all of these people play roles in wound healing."
Which is why, said the surgeon, he takes the work so personally.
"I see challenges here and I also know that I have established some of the closest relationships I've ever had with patients in the wound healing arena, almost on a par with the women I take care of for breast cancer. It's very intense because some of these patients you can see for a year, sometimes longer."
"It's very satisfying work."
