From the Editor: Wound Dis-ease
Diseases desperate grown,
By desperate appliances are relieved,
Or not at all. - William Shakespeare
A wound is not a disease. Stedman's Medical Dictionary (the layperson editor's right-hand man), defines a wound as trauma to any of the tissues of the body, especially that caused by physical means and with interruption of continuity. A disease is an interruption, cessation, or disorder of body functions, systems, or organs. Even while I sense a great many similarities in these two definitions, both in language and clinical application, my perception of healthcare's overall approach to the subject of wounds is, "Why can't they just go away?" These lingering, malevolent offspring of trauma and vascular and metabolic disorders challenge the endurance and wherewithal of providers and patients, eating up time, energy, and resources as they eat away the body. Recently, it seems that the number of clinicians getting serious on the subject of wounds is increasing… perhaps because, subconsciously or directly, they are likening the wound to a disease state - each wound with its own unique diagnosis, underlying origin, treatment, and prognosis. Wound care is an ancient art that is growing more exact as a science, thanks to diligent pioneers and their disciples pushing for better care and better products.
As this realization grows among the medical community, the "appliances" with which wounds are managed evolve and change according to the type of wound and how it transitions from chronic to healing, underscoring the importance of education, ingenuity, and persistence. Clinicians must stay on top of the latest information through publications and symposia, be willing to try (dare I say "experiment" with) different treatment approaches, and be resolute, as opposed to resigned, regarding skin breakdown, pain, or worse.
A chronic wound - actually, any wound - is "desperate grown." In addition to the risk it adds for infection, disability, and death, a wound affects patient quality of life in a myriad of physical, psychosocial, and financial ways. With disease states that render populations at higher risk for wounds on the rise (eg, diabetes), more and more people will be forced to deal with at least the potential for wounds. They and their physicians cannot be of the belief that with all the other considerations of their disease state (cardiovascular and sight impairment, again to use the diabetes example) a little foot neuropathy is no big deal. Or, when calciphylaxis occurs as part of end-stage renal disease (as noted in the article in this issue), it should not be dismissed; it needs to be addressed as vigilantly as its cause. Beyond our small but growing circle of wound-care aficionados, a feeling of complacency about the inevitability of wounds and wound pain (and the futility of aggressive treatment) must be dispelled.
In doing so, "desperate grown" requires desperate measures, whether preventive or curative. Hence, beds are made to rotate to offset the potential for pressure ulcers, hyperbaric oxygen therapy is initiated, dressings are created and found to be multipurpose, old treatment approaches (such as maggots) are revisited, and the value of monitoring patient response to therapy, as reported this issue, remains. These events mirror the approach to disease, and just as medicine has become more and more specialized with regard to disease management, so, too, has the field of wound care grown as a specialty. Wound management has become a practice destination, not only for the nurses who most often provide the hands-on care, but also for the physical therapists, podiatrists, dermatologists, and practitioners from many other medical disciplines who are adding "CWS" to their credentials.
But what about the "not at all"? Sometimes, despite the most aggressive preventive measures, wounds occur. Age, disease state, and a host of other confounding factors sometimes make wounds almost unavoidable, and once the wound is present, decisions must be made as to just how much "help" the patient can endure. In some cases, complete healing takes a back seat to comfort. When there is little or no hope for wound closure, perhaps the best "closure" for the patient is that the most distressing symptoms be alleviated - quality of life will come from getting on with life as well as possible.
Because it may not be as formulaic as disease management, wound management has been a source of uneasiness, both because of the treatments involved and the uncertainty over which health discipline would best provide them. As wound care grows in recognition as a specialty, evidenced in the increasing number of wound care centers, the growing membership of the Association for the Advancement of Wound Care (AAWC), and the attendance at the Symposium for the Advancement of Wound Care (SAWC), the uncertainty may dissipate. Patients and clinicians will have more direction in pursuing and providing care, leaving the desperation of wound dis-ease more for the musings of literary sages and pensive editors.
For those of you attending this year's SAWC in Orlando, I wish you safe travels, succulent educational sessions on which to feast, and opportunities to network and nurture the Disney-ness in all of us.