Wednesday, July 31, 2013
Post-Operative Differences and Wound Healing Dilemma’s
Post-Operative Differences and Wound Healing Dilemma’s
Continuing from where I left off in my last post, my mom’s had her surgery and she is in recovery. But I have a couple of issues with the choice of treatment for the post-operative period prescribed by her surgeon and hence I thought I would discuss my dilemmas in this post, with you. The first shock was when the nurses did an allergy test for penicillin allergy and I was flabbergasted (no other word to describe my reaction) on seeing the injection made with the test dose in the forearm to see if there is any reaction. I almost asked the nurse right out "Excuse me, in which century am I? Did I somehow slip back a hundred years or so in a time machine?”
For, as every child knows, penicillin was invented in the last century - even before the Second World War – by a guy called Alexander Fleming and it cured a lot of infections back then but it has been largely superseded by newer and better antibiotics over the years. Currently, we (any doctor who qualified after the millennium) prescribe antibiotic-cocktails based on genomic typing of the bacteria which does a targeted delivery of the lethal dose right into the bacteria's guts and hi-tech stuff like that. And here was a doctor who wanted to prescribe old school penicillin with its history of allergies and all. As everyone knows - any antibiotic or for that matter any medicine has the potential for being allergic to any individual ( we don’t know why but guess it’s genetic) but the safety margin is pretty high with the newer combinations which not only work better but are also far safer even when given in high doses.
And so I ended up having this big dilemma- should I step in and suggest a better (in my view) or newer antibiotic to my mom? And will it be considered an impertinence – by interfering in the work of another surgeon? Or should I silently wait till we got home and then discarding the penicillin shift my mom over to my choice of drugs? After agonizing over the decision like Hamlet, the prince of Denmark, I finally decided to let it go- that maybe giving penicillin was not such a bad trick after all, for just like us the bacteria's would not have seen it for an hundred years or so and hence the suckers wont realize what hit them when they get the penicillin- in rugby parlance- it’s called a hail mary pass or in our local chennai auto driver style- put indicator on left and turn vehicle to right and let’s see if the suckers can be caught unaware.
Besides all these antibiotics are given just for a day or two or three- the immediate post-operative period and only to prevent any infection- as a precaution to make sure that the bacteria don’t take advantage of the patients weakened body after the surgery. So any antibiotic including penicillin should be fine in that limited preventive role. With that thought in mind I decided to let my mom follow her doctor’s post-operative treatment plans and not interfere in it. Decision made- mind at peace.
My next dilemma arose when I realized that my mom’s doctor was not going to prescribe to her any supplements or nutrients for wound healing, as I personally prefer to do for my patients. I gather that the doctor has a personal preference of letting the wound heal naturally, waiting patiently for as long as it takes. But we of the modern generation prefer to give our post-surgery patients -vitamins like b-complex and vitamin c and other minerals like selenium, manganese and calcium which are needed by the body for wound healing. The old standby of giving sathukudi juice (sweet lime juice)/horlicks for wound healing is now only seen in films and television advertisements- not in real life.
There are even newer treatments being studied now - like platelet rich plasma and nano-drug spherules for wound healing, which promise faster wound healing by better nutrients delivery at the exact wound sites. These work on the simple premise that instead of wasting the nutrients in the entire blood stream it’s better to deliver it where actually needed- at the wound site where it will help in healing faster.
As of now when we let natural wound healing take place, the cells in the superficial layer migrate over the gaping wound and close it in a matter of 5-7 days and that’s when the sutures- the threads which hold the two cut edges closely together are removed, because once the cells from the two sides join up in the middle to form a bridge over the wound there is no more need to artificially pull them close and hold them together tightly.
But the bridge analogy still applies to the wound, for what might look completely healed to us (after one week) when we remove the bandages is actually only 20% healed -for the bridge is spanning over a wide abyss- and there is nothing underneath to support. The wound has just a small covering of cells closing it externally and underneath it there is still a big open wound and it takes anywhere from 21 days to 6 weeks for the entire wound to fill up with cells and heal completely and get its original strength back. It’s in order to assist this gap-fill and make it happen sooner -that the newer treatment modalities are trying.
The most popular wound healing research being conducted now is in the Platelet rich plasma technique. Our platelets - the 3rd type of cell in our blood other than the Red blood cells and White blood cells everyone knows about- are mainly responsible for wound healing and blood clotting. As such they contain lots of essential stuff for wound healing and hence a technique called platelet rich plasma is now being tried out in several labs which involves taking out our own blood out of our bodies and then filtering it to get the platelet cells alone and finally injecting them back into the wound area directly instead of waiting for them to travel through the entire body and reach the wound- which might take time. This treatment is still in the experimental stage as not many patients can stand the thought of their blood being taken out, filtered of its cells and injected back again into their bodies.
So to come back to my mom, I have decided to add a vitamin b/c tablet to help the wound healing process along. Of course without asking her doctors permission to do so -which is wrong, I know, I know. But hey, it’s in a good cause right? And I believe every little bit matters when the intention is right. What do you think?
P.s. as my mom is getting discharged tomorrow from the hospital- my hospital series of posts is now at an end. Or maybe not - for I have one final post in mind about how corporate hospitals fleece unwary patients who don’t know any better. But writing it down…..won’t it be like biting the hand which feeds? Time to start my Hamlet Act again.