Overview

Nutrition and its link to wound healing has gained prominence over the last few years.  Scientists have identified certain nutritional factors as being important components in the wound healing process. Some vendors in this product category include:

The information below was submitted by one of our website participants:

Nutrition - A patient's story

By Yvonne Asay LPN

Odyssey to Wholeness

Our 5 year odyssey began one unsuspecting day when a nickle-sized abrasion appeared in the worst possible place for a C4 quadraplegic.  Seeing that break, in what had been perfect skin integrity for a long, long time, was a shock physically, mentally and emotionally to Scott and I both.  That day changed our lives on every level in ways we could never have imagined.  They don't call them pressure sores for nothing! 

     Being so inexperienced in this area, our first response was denial.  We innocently believed we could continue on with life as usual, including taking 2 long vacation trips already planned.  The "place," as we called it, would just fix itself.  After 5 months, the "place"  became the "wound" and  took on a life of it's own, soon becoming the total focus of our lives.  We had no choice but to move into the next phase: wound treatment and the hope of life restored that comes with handing the problem over to the "wound care professionals."

     The first step was four months in a Clinitron bed at home followed by a short inpatient stay in a rehab center to begin sitting up in a wheelchair again and close the final 2 cms. of the wound.  Hallelujah!  But don't jump to conclusions.  In less than a week it had grown from 2 cms. to 2 inches, so home we went.

     Five months followed with no improvement.  A culture was done showing MRSA acquired in the rehab center.  Next came the first course of  IV treatment at home followed by a new surge of hope.  We now had an appointment with a new and better wound care center with a clean wound ready to be closed.  A year and a half  had passed since that fateful day of discovery.

     As an LPN, I took great comfort in all the clinical things being done - lab work for protein and vitamin levels, the right dressings and treatments, and especially, scheduled clinic visits so someone else could be responsible for the wound healing.  Scott took comfort in my word that this was the answer to our many prayers.  Vitamin C, zinc and a minimal increase in protein were prescribed and  unsuspectingly, we moved into the next phase - the first surgery. 

     On paper this seems like a very reasonable progression.  We needed to open the wound, remove debris and stimulate the body's own healing to start.  All blood tests were "within normal limits" and all systems were go. Again, our inexperience blinded us to the fact that once the first cut is made you move into a whole new realm of wound treatment and life in general.  Now we had an open, clean, much larger wound.

     Let me briefly run through the next 2 years of what ended up being a downward spiral from having a very active life to essentially no life apart from doctors' visits.  Time was marching on but we weren't leaving the apartment.  Scott wasn't leaving his bedroom.  There were 8 more surgeries to open and debride.  We tried the VAC twice which literally sucked the life out of the tissue causing more tissue sloughing and continued debridement.  Scott had a skin graft, a second graft using pig skin and tried essentially every type of dressing and treatment that was available.  It was always 1 step forward and at least 2 steps back.

     Now, at the 3 year mark, Scott's total physical condition had so deteriorated that it became clear he could not continue.  He needed to start some kind of rehabilitation.  He was admitted to a long-term care hospital that would start some physical therapy while he would stay in a Clinitron bed again until the wound healed.  He was supposed to then be transferred to a rehab center to be restored and reconditioned.  Estimated time of arrival to rehab -  2-3 weeks.  Now, again, don't jump to conclusions.  The plastic surgeon sent to write the wound care orders dropped the first bombshell in our war on pressure.  The wound would not close on it's own.  All previous treatment was, in his opinion, a waste of time.  It was over a boney prominence and would require another surgery, a muscle flap, to permanently close it.  New rehab ETA - 6 weeks.

     Let's fast forward through those next 6 weeks, through the surgery, the incision accidentally being torn open  while turning him, a second surgery to repair that damage and leaving the hospital in worse physical condition than before he was admitted.  Mentally and physically we both crashed.

     Scott now adamantly refused to be an inpatient anywhere.  I was totally worn out from making the 70 mile roundtrip nearly everyday for 6 weeks to do his care and bring him home cooked food, so we decided on outpatient PT.  Five months later we were still barely maintaining and Scott was obviously having some type of undiagnosed problem.  Then a deja vu small nickle-sized abrasion in the same place appeared out of the blue.  Medical opinion was a minor fungal infection, easily treated topically. 

     So, having reached the end of every rope we had, a decision was made out of desperation to go on a much needed trip to Kentucky for a family Christmas.  Without realizing it, we had downshifted back into denial. The first night at Scott's parents' house, an easily treated fungal problem was once again a full blown pressure sore.  He spent the week in bed and we made an appointment at the wound care center for as soon as we could get home.

     We had now started the cycle all over again but at a distinct disadvantage.  Scott had been confined to bed for approximately 3 1/2 years and his body was in a very fragile and weakened condition.  He had lost a lot of muscle mass, especially in his shoulders, which was extremely painful and made turning options very limited.  His bones were also demineralizing.  The bigger problem, however, was his mind, spirit and emotions.  They were even more weak and fragile.  He could no longer see any reason to go on.  I had laid my cheerleading pompoms down about a year before.

     The small wound area, while not growing in size, would not respond to anything and began to tunnel inward.  One day, 2 months later, the tunnel broke through and we discovered that the whole inside was completely open.  The second surgery had not taken.  This was a level of shock neither one of us was prepared for.  It was, however, just the first bomb dropped in the "shock and awe" campaign against us.  The culture report that followed was the first bunker buster - MRSA again.

     What made this so devastating was that we had cultured the outside several times with negative results.  This was another hospital acquired infection wiping out all the progress we'd made.  It was also obviously systemic and threatened to wipe Scott out if not attacked aggressively.  The enemy was poised now for the next bombing raid.  After persuading us that we needed to open the whole wound area again to see what the damage was inside, we agreed to surgery #10.

      Following the surgery the doctor ordered a battery of tests and x-rays of Scott's hip and pelvic area to see what was going on.  Bunker buster #2 came crashing down.  The infection was now in the bone.  The wound care center decided they did not want to treat this, so after losing another 2 months, we had to come up with a little "shock and awe" of our own.

     We have a family doctor that God dropped right out of heaven just for us.  We could all see that Scott needed a more comprehensive approach to this situation because of his paralysis and decided he should have someone with spinal cord experience coordinating his care.  He arranged for Scott to be admitted to the rehab center he was supposed to have gone to earlier for his restoration.  This was going to be a meeting of the minds to care for the total man. They would treat the wound, the MRSA and do his PT all at the same time and it was only 12 miles away.  Finally, the troops had arrived!  We expected a 6 week stay and a new, healed man to emerge.  But don't jump to any conclusions here either.

     After Scott came home from his last hospitalization, I finally learned enough about nutrition that I could put together a program for him that we could manage.  He started taking vitamins and, more importantly, a soy protein drink.  I became minorly obsessed with this because he was supposedly on vitamins and a high protein diet during the whole 6 weeks he was hospitalized.  However, by the time he was discharged his nutritional status was so poor, even with me bringing home cooked meals, that his hair follicles were inflamed and you couldn't brush his hair.  The doctor prescribed a medicated shampoo which did nothing.  I gave him vitamin E and it healed in a few days.  A big light went on!  I began to see that Scott's nutritional status was a risk factor far above and beyond what the medical community was prepared to deal with.  Many of his complications such as the loss of muscle mass could have been prevented.  As I studied, the light brightened.

     On this admission I was determined to keep him on the program that we could see was working at home and whatever was added by the doctor, so be it.  The rehab doctor agreed.  He was even mildly interested in what we were doing, especially with the soy protein drink.  We had a false negative reading on a culture done there on admission so after 10 days Scott was discharged without  improvement in any area.  The doctor did agree to let me do a culture before we left for our family doctor to follow up with.  As you have probably guessed, we had added a new bacteria from this institution we didn't come in with. Now we had an extensive, tunneling wound with an infectious process that was obviously manifesting itself systemically in Scott.  He looked and felt really sick.

   So back to the heaven sent doctor who admitted him to a local hospital for yet another group meeting.  This time we had an infectious disease doctor, a plastic surgeon and an orthopedic surgeon.  After 5 days of consultation we were sent home for 7 1/2 weeks of IV meds and surgery #11 in the planning stage, now to include bone removal.

     So home we went with a new battle strategy -  me giving Scott 6-7 doses of IV drugs a day and Home Nursing coming in 3 times a week to draw blood.  I have never been so exhausted and drained in all my life.  Because of the drug schedule I could only sleep 4 hours a night at the most.  Scott, however, was starting to improve.  We went to the plastic surgeon to get his plan but instead got bunker buster #3.  His surgery plan was so extensive and wound treatment so extreme we had to say no thanks.  Once again we had a large, open wound, clean and ready to be closed.  Now what?

     The only viable alternative was to go back to the plastic surgeon who had done the first closure but under new conditions.  This time it was going to be buy one get one free.  I was staying with Scott in the hospital and so was our bag of vitamins and protein drink.  He was going to have a private duty nurse.  Amazingly, the doctor and hospital agreed.  We were admitted, the surgery was successful and so began a month long recovery period in another Clinitron bed with me glued to his side.  The nurses were quite happy to have me there and doing all his care.  We all shared our 50+ year old female issues, I kept my soy milk in their refrigerator and Scott healed so rapidly it was hard to believe.  His stress level was lowered and his nutrition level was raised.  The results were very obvious.

     That was 9 months ago.  I have since dedicated myself to learning all I can and sharing the wealth whenever and wherever the door opens.  Here are a few lessons learned:

     -No wound will heal without the nutrients necessary to rebuild tissue no matter how good the treatment or dressing is.  Even the VAC isn't that good!

     -Your own immune system is your best friend.  Keeping it strong is a high priority.  Your body was designed to be able to heal itself if its given the right nutrients.  It's not as hard as you think and the results are no UTIs, flu, pneumonia and, best of all, no hospitals!

     -Make everybody wash their hands before they reach into the community box of gloves.  That's how infections are spread.  I kept a box for myself and this was our first infection free admission.

     -Keep yourself one step ahead, educating yourself about all that relates to your situation.  This is easier than it sounds.  Prescription for Nutritional Healing by James Balch is an excellent place to start.  It was my main resource.  It lists every vitamin, mineral and herb and tells what they do and what foods contain them.  The Nursing Drug Handbook  gives very comprehensive teaching on drug side effects and adverse reactions and other info not on the handout the pharmacy provides.  Both these books are pretty inexpensive and easy to find.

     -Stress will kill you.  Intervene before depression and despair move in to stay.  Try B complex vitamins, calcium and herbs that are without side effects before taking antidepressants and sleeping pills.  Some of the symptoms of B vitamin deficiencies are loss of appetite, depression and insomnia.  Stress depletes B and C vitamins.  They must be replenished daily.  This is what starts the downward spiral.  Antidepressants and sleeping pills don't correct the loss of appetite and insomnia brought on by the vitamin deficiencies.  Only taking the vitamins corrects them.  You have to eat and sleep to heal.  The time your body heals the most is at night when you are sleeping.

     -It is much easier to stay healthy than to receive healing.  Caregivers and medical staff need just as much help in this area to keep going without sickness or injury as those they care for. We used 2 brands of products during this time.  The first was Spring Valley from Wal-Mart including their soy protein drink which has no aspartame and is covered by food stamps.  This brand is inexpensive and will get some good results.  It has come to my attention that, in Pennsylvania where we live, Medicaid will pay for some vitamins by prescription, so you may be able to work something out with the Wal-Mart pharmacy.  Last March, however, we tried Shaklee products and found a tremendous improvement.  I believe they are the best investment a physically challenged person, or anyone for that matter, can make.  Shaklee products are recognized by the FDA as food.  They are categorized as "food supplements."  I discovered that even expensive vitamins from health food stores, etc., are categorized as "synthetic vitamins" or "isolates" which makes a huge difference in how your body can utilize them.  Shaklee products are also Kosher which shows me the level of concern they have for their customers.

     -Antibiotics kill the good and bad bacteria in your colon.  Fungal infections will abound!  You have to replenish the beneficial bacteria yourself.  A healthy colon absorbs nutrients better.  Try eating yogurt while on the antibiotics.  There is also a Shaklee product called Optiflora that is excellent.

     -Soy protein was dropped from heaven along with our family doctor.  For wound healing, your protein intake must drastically increase.  Any added activity such as physical therapy takes away protein available for wound healing.  We also found out that low protein levels can cause lymphedema which Scott acquired when he started the IV meds.  He got a large increase in fluids but was not eating well enough to deal with it.  Protein affects your muscles, skin, hormones and immune system and gives you a great energy boost..  But protein from meat and dairy has too much fat and is too hard for your body to breakdown and utilize.  You can't consume enough protein from food alone.  Its the amino acids in the protein that you actually need anyway.  Soy protein is the most viable alternative here.  Shaklee is the only source I've found that you can take in large amounts without getting all the extras.  Their Instant Soy Protein Mix has 16 grams of protein with only 1 gram of carbohydrate in less than an ounce of powder.  It is naturally lactose and cholesterol free.  It has all 9 amino acids your body cannot produce itself and can be added to anything you eat or drink.  You can even cook with it.  The best thing to add it to is a muscle building/repairing drink they have called Physique.  This combination is excellent for any phase of the wound healing process or just for daily maintenance.  I took these 2 products together when I injured my SI joint transfering Scott from bed to wheelchair.  The doctor told me I would be down for at least 3 weeks, if I healed at all, but incredibly I was up and pain free in less than a week.  I could actually feel my body responding each time I drank it. Others I have tested it on have had the same results: increased energy, marked decrease in stiffness and soreness, and rapid healing.

     -Forgive yourself and others for wasted time and effort.  This is the greatest stress relief you will find.  Looking back is only more wasted time and effort.  Spend the time learning how to profit from your mistakes and find someone you can help.

     Finally, I would like to emphasize that wound care people are generally very dedicated and compassionate people willing to go the distance with you and try anything that could help.  Apparently, the lab values they use are the minimum required to prevent disease so even if your levels  come back "within normal limits" you could be at the bottom number and wonder why nothing is happening.  I believe this is a real blind spot not only in the nutrition field but also in standard wound care and prevention. 

     No one ever maliciously or purposely tried to prevent us from receiving healing.  They told us we  were the most compliant people they had ever worked with.  Scott even quit smoking to try to improve his oxygenation.  That was the last risk factor they had listed that would keep a wound from healing.  (Soy protein will  help you quit smoking too!)  The bigger problem from that first day was our innocent ignorance.  We were entrenched in the mainstream medical approaches to things.  We were both basically unhealthy and unprepared on every level for the crisis we faced.

     I have been in the unique position of seeing three sides to this coin.  I have seen the devastation in Scott's life as the patient and the physical, mental and emotional pain he has endured for so long.  This all  started during his first year of college and resulted in his eventual withdrawal from school.  He is now 40 years old.  Recovering those 5 years he lost will be a real challenge but now it will be possible.  I have experienced the total burnout of a caregiver also beginning menopause during the last year of this ordeal.  And as a former nurse on the neurosurgery floor of a major medical center, I was the "wound care professional."  Very little that I learned there helped me at all in this situation.

     This story may seem a little long winded but I presented as many different aspects of our situation as I could because I believe that everyone who reads this will find himself in here somewhere.  I want you to see the worst case scenario, which we were, and know that you can jump in at any point and change your circumstances or the circumstances of those you care for.  Now we are prepared for immediate, successful intervention in any situation. We no longer feel like victims but have the confidence to take control and not be rocked by an adverse situation. We know what stress related problems look like and how to increase nutrition to head off breakdown.  We stay one step ahead now, concentrating on prevention instead of repairing damage.  One main priority is keeping the muscle strong that was used to close this wound and not just the skin covering it.  That's one of the reasons why the first surgery to close the wound was not successful and was so easily torn open just by turning Scott.  The muscle was not strong or healthy enough.  We have had no further problems this time.

     The bottom line is you don't have to be a chicken scratching and pecking around in confusion and desperation for any old thing thrown your way.  It is possible to soar like an eagle on the high winds of education and good health.  Take flight now from wherever your are. Thanks for your time and interest in our lives.  Hope this helps to improve yours.

Yvonne

For any questions or comments please email me at healednow@aol.com. 

For information on Shaklee products you can use the same address or go to www.shaklee.net/yvonne.  [Please note there is a financial relationship between the author and Shaklee. The author became a distributor for their products after experiencing the results expressed in this article]

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