Chronic wounds are a hidden health crisis

Chronic wounds impact the lives of millions of Americans, yet the stories of those suffering are rarely told. As a result, chronic wounds have turned into a silent epidemic that remains largely invisible to the general public. Twenty-five years ago, Kevin Fontenot was one of those people, living his life generally unaware of this horrible condition, which is often caused by other diseases such as renal failure, diabetes, circulatory problems or malnutrition. That is, until he himself fell victim to it.

In 1994, Kevin was paralyzed in an auto accident, an occurrence that’s not all that uncommon. In the United States alone, more than2 million people are injured or disabled from road crashes each year, according to the Association for Safe International Road Travel. For Texas specifically, as reported by the Texas Department of Transportation, more than 260,000 people suffered injuries from a car accident in 2016. Kevin’s injuries forced him to lie still on a spinal board for almost two weeks. During that time, he developed a terrible pressure ulcer on his tailbone.

Pressure ulcers are a kind of chronic wound that results from constant pressure on one area, often developing in bedridden patients. They commonly occur in patients with a spinal cord injury and present significant challenges for the patient, their caregivers and their physicians. Chronic wounds can come from anywhere, including car accidents, prolonging the recovery long after the vehicles are repaired. Pressure ulcers can lead to hospitalizations, surgeries and other damaging complications. For patients suffering from spinal cord injuries like Kevin, pressure ulcers and their treatment can be one of the more challenging clinical issues to manage.

That is because for paralyzed people, pressure ulcers are often symptomatic of a mechanical issue — a problem with how they sit, lie down or move — that the rest of us take for granted. Chronic wounds can also be caused by suboptimal nutrition like low vitamin D or insufficient protein in the diet. It can take months to find out what is even causing the wound to form, and with a lack of care coordination, patients are forced into a waiting game while various medical professionals try to make it better.

For a long time, Kevin struggled with accessing care for his chronic wounds. He would drive 70 miles every week to the nearest clinic to receive treatment. For some of his more serious wounds, his friends would take turns driving him more than four hours to a see a specialist.

Unfortunately, lack of access to wound care is too prevalent. For patients facing the silent epidemic of chronic wounds, care is essential to improve quality of life and avoid infection, amputation or even death. But too often, treatment options are either limited or not available at all. Many times, patients are treated improperly or wounds are left untreated until it is too late.

Far too often outcomes are made worse due to a lack of care coordination between orthotists, podiatrists, primary care physicians and everyone in between. I’ve had patients end up with leg amputations because proper footwear was delayed months trying to get diabetic shoe paperwork signed. Even more, suffering patients often do not have the proper insurance to cover wound treatments, leaving them to pay out of pocket or to avoid getting the care they need.

When asked about his experience with chronic wounds, Kevin said, “It affects every aspect of your life. The only time you’re not thinking about it is when you’re sleeping, and then you still have nightmares about it. I have had to set an alarm three to four times a night to remind myself to turn over to keep pressure off my wounds.”

But chronic wounds don’t have to destroy lives. If wound care is made available, administered effectively and coordinated across all aspects of care, patients can regain their mobility and independence — and eventually some sense of normalcy.

If there is one takeaway Kevin wants others to learn from his story, it is that his experience with chronic wounds is not rare: Anyone can suffer from a chronic wound, and there are many ways people can develop an irregularly healing injury that can increase their risk of developing an infection that could lead to an amputation, or even death.

The wound care community, including organizations like the American Association for Wound Care Management, is making a concerted effort to enhance the understanding and acceptance of comprehensive wound care management. So much work needs to be done, and most of it is not about the hole in the patient — it’s about treating the whole patient.