Saving Your Skin

The source of the idyllic River Shannon, the longest running through Ireland, can be found in an aquifer-fed pool in County Cavan. Julia* knows the area rather well. She grew up there, after all.

“Oh, it’s very nice,” Julia says. “The weather’s not always very nice because it rains a lot and it’s very windy there, but when the weather is nice, it’s a really beautiful area. I went back there for a wedding recently, and it was quite beautiful.

“The thing I like most about Ireland, though, is the people. Everyone there is so friendly and helpful.

“I think it’s because it’s a small country and everyone is very close there, so it sort of comes natural to everyone. I feel fortunate to have been brought up there.”

Julia lived in Cavan until she was 21. That’s when she and her sister finally accepted a longstanding invitation from a couple of cousins to move to East Orange, New Jersey, where Julia later met her husband, a fire captain, and raised a family.

Julia’s most recent move was to Florida. The lure this time was her five grandchildren. Shortly after, Julia had to take time away from her family after her doctor discovered a basal cell carcinoma, a form of skin cancer, on her left foot.

“It was probably a result of me with my light Irish skin lying on the beach for so many years when I was younger,” Julia says. “My doctors found something similar in a few places on my legs and shoulders before I came to Florida.”

This latest discovery led to Julia undergoing Mohs surgery, a procedure in which layers of cancerous skin tissue are removed until the tissue no longer contains cancer cells. Julia’s surgery was performed in March, but within a month the wound became infected.

“The wound was probably about an inch around and it didn’t really hurt all that much, but it looked terrible,” Julia laments. “The problem was that it just wasn’t getting any better. It wouldn’t heal. That’s why Kristi was called in to help me with it.”

50 Years of Experience

Kristi Lord, DNP, MSN, APRN, FNP-C, CWS, is one of the four advanced practice nurses at Advanced Wound, Ostomy and Continence Care, which boasts 50 years of combined experience in providing wound care, ostomy care, dermatological care and continence care.

“We are a patient-centered practice that uses evidence-based modalities in the treatment of our patients,” Kristi says. “We treat venous leg ulcers, diabetic foot ulcers, pressure ulcers and all other kinds of wounds.

“There is absolutely nothing on your body that we won’t try to fix if it has something to do with the skin or excretion because wounds and excretion are correlated. If you don’t properly rid your body of waste, your wounds are not going to heal, or you’re going to get wounds you didn’t have before.

“Our goal is to help people live comfortably and, in terms of our continence care, we mainly instruct patients on how to improve that issue through pelvic floor exercises, therapy and education.”

When Kristi first visited Julia, she determined rather quickly that the cause of the infection had little to do with how the wound was being treated. Rather, it was a result of something out of Julia’s control.

“In older people, especially, the vasculature at the bottom of the feet and legs can be very small, almost nonexistent,” Kristi explains. “If that’s the case, the blood vessels can’t supply blood the way they’re supposed to, which can prevent wounds from healing.

“And when wounds don’t heal or stay open for too long, they get infected. They get infected because bacteria are present in all wounds. The longer the wound is open, the more the bacteria have a chance to breed, and that allows the wound to become infected.”

To clear the infection and prompt proper healing of Julia’s wound, Kristi began her care by performing an aggressive debridement, which is the removal of dead, damaged and infected tissue to promote healing. She then treated the wound by applying an antibacterial dressing.

“Julia’s wound started healing right away after the very first debridement,” Kristi reports. “After that, I started treating the wound with Endoform. It’s an antimicrobial collagen dressing that encourages new blood vessel growth.

“Once I put that on there, that wound started to heal very quickly. In less than a month, it went from being about an inch in diameter to being no bigger than the size of the tip of a sharpened lead pencil. And now it’s completely healed.”

Where Credit’s Due

Kristi won’t take all the credit for the speedy resolution. She says Julia did her part by following instructions to the letter, which is to say that she left the dressing alone between treatments and kept her hands off the wound.

“Wounds that are messed with daily or every other day, especially after they become chronic, take longer to heal because removing the dressing takes off the bad stuff, but it also takes off the good stuff that’s helping the wound heal,” Kristi educates. “So, with almost any wound, it’s often a case of the longer you leave the dressing on the better. That’s why I usually treat a wound like the one Julia had once a week and use dressings that are clinically indicated to stay on for up to a week.”

Julia’s wound became infected within a couple of weeks of her Mohs surgery. It took Kristi about two weeks to clear the infection and another four weeks for the wound to close, but it is now completely healed and virtually undetectable.

“Kristi did a great job,” Julia enthuses. “That wound was looking pretty nasty there for a while, and I was quite concerned about it. But it got better in a hurry after Kristi started to take care of it. I really appreciate all that she did for me.

“Kristi is a very good nurse and a wonderful person, a great girl. I would gladly recommend her to anyone who has a problem like the one I had. I followed her instructions very specifically, and everything worked out just fine.”

*Patient’s name changed at her request