The Wound Center at Casa Grande Regional Medical Center offers multiple therapies.
Some patients experience the pressure of deep-sea diving in an oxygen-rich hyperbaric chamber. A few undergo maggot therapy. Maggots are nature’s wound custodians — they clean out the dead stuff.
John Morris’ treatment took a different route.
“The vac is what we’re trying right now,” said Anne Donos, a certified wound nurse.
She stood next to Morris, who rested on a hospital recliner in the Wound Center. He’s one of 20-some patients who visit the center on any given day.
He had worn a portable vacuum for a few weeks now. It continually draws out wound debris and blood and helps to bring closure — in a very physical sense — to a wound that had grown to the size of a golf ball.
“We use the words ‘negative pressure wound therapy,’” Donos said.
In his younger days, Morris, 51, worked at a copper smelter. He was paralyzed from the waist down by a gunshot wound in 2007. That wound healed. But he could not properly adjust his weight in the wheelchair. He developed a sore on his right buttock. And that festered and grew. A surgically implanted skin flap did not take. The wound got worse.
Donos cut away the bandages and removed the vacuum hose, feeding off a long rope-like sponge leading to the wound. Tape kept the sponge from leaking. She measured the wound. It had shrunk by a centimeter. Progress was being made.
Wounds, of course, can be nasty business. And they simply don’t vanish with the wave of a wand. As with Morris, healing can be a matter of centimeters.
But healing is the focus. Most of the nurses and the two doctors on staff have undergone specialized training and are certified to treat wounds.
The Wound Center was created as part of a $20 million hospital expansion in 2004.
Dr. Kathleen Bishop is one of the two doctors on staff. The other, Dr. Elias Nalli, is the medical director.
Bishop, 65, was on duty this day. She is distinguished by her thick white hair, often pulled back. She takes a holistic view on the healing powers of medicine. It’s not all about antibiotics or the knife, she said. Nutrition and the mind play a big role, too.
“It’s mind-body-spirit,” she said.
She practices what she preaches. It’s not uncommon to see patients in the Wound Center sporting a few acupuncture needles, placed by Bishop, a certified acupuncturist. Acupuncture has a healing energy, she says.
On the nutrition side, Bishop might advise patients on the benefits of home-grown honey. It’s good for allergies, as the bees get their pollen and nectar from the same plants that make you sneeze.
“The guy selling you the honey has got to have a bee sting,” she said.
Home-grown honey, it happens, relates to wounds. Many Wound Center patients are diabetic. And diabetes is the trigger for many ulcers — essentially open sores — that attack the lower leg. The rise in diabetes tracks with poor nutrition, including increased sugar consumption, Bishop said.
Honey might be better but sugar is harder to kick.
“Sugar is more addictive than nicotine,” she said.
Bishop’s holistic approach is one of attitude as well. She wants her patients to feel good about themselves, and about others. She does her part.
“Everybody that leaves, I hug,” Bishop said.
People don’t come for the hugs, however. Whatever their emotional needs, their body is in need of repair. They have large open sores that simply won’t heal on their own. Patients are referred by primary care physicians. Some come in on their own.
Connie Heron was referred by her physical therapist. She’s now a volunteer at the hospital.
In November 2007, she was injured in a car accident.
“I ended up having an open wound on my leg below the knee,” said Heron, 67.
She also broke her hand in two places. Her doctor told her the wound on her leg would heal on its own, though it didn’t seem to get better. In January 2008, she went to a physical therapist to restore movement to her hand. She asked him if he could look at her leg, too. He said sure. As it happens, physical therapists have a long history with wound care, and this one spotted trouble.
“He went right to the phone and called the Wound Center and made an appointment for me,” Heron said.
Her leg is healed now. She underwent vacuum therapy. She had a skin graft.
In the tank
She did not, however, spend quiet time in one of the center’s two hyperbaric chambers. Parked by the south wall, they look like cryogenic tanks for hibernating space travelers.
But Ken Linton, sealed inside, wasn’t on a frozen journey. Instead, he was at rest in an environment of pure oxygen and high pressure — about twice the earth’s atmosphere.
Increased oxygen levels in the blood promote wound healing.
Linton, 76, is retired. He owned a pool repair company in Casa Grande. His son runs it now. A few years ago, Linton got skin cancer on his left hand. It left a wound. Radiation treatment dealt with the cancer but it killed cells that would help the wound heal.
More than a few Wound Center patients check in with complications arising out of radiation treatment.
This day Linton spent about two hours in the chamber. He would undergo some 30 sessions.
Inside the chamber, the pressure buildup is similar to what scuba divers experience as they go deep. Wound Center staff refer to time spent in the chamber as a dive. Ears pop to equalize the pressure.
While Linton dived, Donos kept close watch. A nurse never lets a hyperbaric patient out of sight, she said. Emergency procedures are in place to bring a patient out as quickly as possible — without risking decompression sickness. Scuba divers can get this if they surface too fast. Treatment, it happens, consists of time in a hyperbaric chamber.
Linton came out of his dive in fine form. He has his own way of coping.
“Just make yourself comfortable, watch the boob tube,” he said.
Patients, on their back, can watch a television bolted high on the wall. He prefers “Animal Planet” to game shows.
Some patients have bigger issues than what’s on TV. They have second thoughts about the treatment itself. They get cold feet at the prospect of spending an hour or more in a space little bigger than a torpedo tube.
Nurses put them at ease.
“We ask the patients if they are at risk for anxieties,” Donos said.
If so, a mild tranquilizer often does the trick. Other precautions are taken as well. Nothing feeds a fire like an atmosphere of pure oxygen. So patients are given a pat down, to make sure they’re not carrying lighters, matches or anything that might create a spark.
Even hair gel is part of a long list of hyperbaric no-no’s.
“Scratch your hair, you can have a spark,” Donos said. “These are all safety precautions.”
Opposite the hyperbaric chambers are outpatient rooms. Here dressings are changed. Vacuums are attached. Maggots are applied.
Eating bad stuff
A day after Linton’s dive, Armando Narvais sat in the recliner. Narvais, 52, owns a car restoration shop in Eloy. On one of his ankles, he had a large sore, a deep hole filled with dead white tissue. He has a condition known as pyoderma gangrenosum, where sores just show up for no apparent reason. It could be a poor immune response, though underlying answers aren’t clear-cut.
Narvais had already undergone a debridement, surgical removal of dead tissue. The wound didn’t heal, so he opted for something different. Maggots.
Nurse Mary Kathryn Hughes entered the room with a small white box, shipped from Monarch Labs in Irvine, Calif. Inside that was a small plastic pill bottle. And inside that were an estimated 458 Medical Maggots. That’s Medical Maggots with capital M’s, as the name is a trademark of Monarch Labs.
It’s the only place in the country that sells therapeutic maggots, big M or small.
Hughes knows the ins and outs of maggot therapy. In the past five years, she and Wound Center staff have treated a dozen patients with maggots. This would be a first time for Narvais, though. He didn’t appear nervous or hesitant — at least not outwardly.
“I’m tripping out on how it’s going to feel,” he said.
Hughes readied the wound for the little scavengers, which Narvais would carry around in his leg for the next 48 hours. Around the site, she placed thick rubberlike strips of medical paste, creating something of a maggot corral. This would keep most of them from wandering off.
Hughes reassured him. “If you have any escapees, don’t panic.”
He can just scoop them up and drop them in a solution of ethyl alcohol. That will kill them. And if a few do get away, they can’t grow up and make babies. They’re sterile.
“Don’t think you can start your own farm,” Hughes joked.
Then she told Narvais they’re picky eaters. “They eat only the infection.”
That includes any dead tissue inside the wound. They stop at good tissue — the part Narvais wants to keep. And that’s the beauty of maggot therapy. They leave a clean wound that will heal much more easily.
As treatments go, maggot therapy is not new. Their use dates back to antiquity.
Hughes opened the pill bottle and — with a gauze pad — gently guided hundreds of tiny white bodies onto their next meal. They dug right in.
Narvais stared down at what had become a maggot feeding frenzy.
“They’re going crazy,” he said.
Hughes sealed them in with some fluff to let them breathe. Dead maggots only add to the problem.
As they dined, Narvais felt something akin to a mild burn. Slight discomfort, but not bad. He asked Dr. Bishop, seated nearby, if she could write a prescription for ibuprofen.
“You want to experience this,” she told him.
Narvais returned two days later. The maggots — bigger and fatter — were rinsed out and disposed of as medical waste. The verdict?
“It was wonderful,” Hughes said. “The wound was 95 percent cleaned. The doctor took off the last little bit of it.”
Score one for the maggots.