A disproportionate number of patients in this category have been suffering from lesions in existence from a matter of months to over five years. They have been exposed to an extensive number of therapeutic modalities at multiple centres. These range from dermatological offices to specialized hospital wound clinics. Generally and invariably, they have seen a number of specialists including vascular surgeons, dermatologists, infectious disease controllers, neurologists and family physicians. Most have been treated with several courses of antibiotics, comprising oral, topical and intravenous delivery, along with analgesics, sleep medications and an almost unlimited number of dressing options. Topical applications are so diverse that the attempt to classify them, boggles the mind. Some incorporate silver, others are iodine-based – the list is without end.
Often despite best efforts, wounds continue to increase in dimension at a gradual pace, whether diabetic, atherosclerotic, venous, inflammatory, iatrogenic or of other origin. As the days pass and turn into months, even years, the patient becomes increasingly depressed with the feeling that there is no light at the end of the tunnel. In essence, they lose faith in the power of the healing professions. Many become resigned to their fate; others become angry at the journey that eventually may encompass the loss of a limb. Gradually, they lose interest in the proceedings and cease to care with regard to the objective or the end result. The wound and the extremity on which it is located, from their perspective, ‘now belongs to the therapist’. In the course of this development, they tend to become non-compliant with regard to the prescribed regimen and often, somewhat like alcoholics, disappear for a week or two until someone in their family persuades them to continue with treatment, which by then may present new complications.
At the same time, no matter how caring or attentive the therapeutic environment may be, there is always the danger at this stage of failing to penetrate the patient’s mental armour. They become guarded and somewhat reclusive in communicating their problems and anxieties and may retreat into a shell, which inures them from outside influences and the reality of their situation. On occasion, indeed, they lose total interest in their progress and the objective of the therapeutic exercise, along with the administration thereof. Even when significant healing is demonstrated by serial photographs, they become disinclined to reveal any interest or emotion with relation to these positive events.
The most negative factor often prevalent and frequently reinforced has been the debridement process. The administration of this step is often heavy-handed, painful and engenders the feeling that it may even be destructive. Whereas on occasion it may be required, in our experience, natural debridement, based on the use of hydrogen peroxide and saline compresses, is vastly preferable. Moreover in our opinion, it is better tolerated, more effective and permits new cells to survive.
In an effort to penetrate the negative mindset of these patients, one must reflect on their psychological status and educate them about treatment objectives. The Meditech Laser Therapy Program for Wound Healing stresses a positive approach, along with the development of relevant insight into the patient’s psychological status. The latter involves psycho-therapeutic techniques including guidance to enhance comprehension conversion to become a participant in the healing process and sharing the responsibility for the outcome. It is mandatory that all centres specializing in wound healing understand and incorporate these principles into their programmes.
For references regarding the Meditech Method for Wound Healing, email Fernanda Saraga, our PhD Director of Research: fernanda@bioflexlaser.com