If you have diabetes mellitus, you probably know much about what I have spoken, and it is important that you continue to educate yourselves in all the new treatment possibilities on the market. Sometimes, a general physician may not have the time to be up-to-date on these types of advances and, as a second opinion, you may want to consult an endocrinologist, a physician who specializes in endocrine disease, of which diabetes mellitus is one!
Chapter 21
WOUND HEALING
I wish we'd find a magic way,
For scars and deformity to go away.
Unfortunately, though, the process of healing,
Leaves scars and deformities and some bad feeling!
Healing a wound is like building construction,
It starts with site cleanup and tissue destruction.
Certain cells, the WBC's, remove all the dead and poor tissue,
And then bring equipment to rebuild the issue.
And like any construction, it takes time for achievement,
And depends on the needed equipment receivement.
The roads for supply in the body are arteries.
If you have ‘em in plenty, the work soon gets starteried.
But also you need all the building materials.
Which you get in your body with all the right cereals,
With proteins and lipids and good carbohydrates.
And vitamins, minerals, and adequate heart rates.
And all this assumes you're in top peak condition,
Without Diabetes or heart aches or malnutrition,
Or aged, or fat, or have cancer or infection,
Or jaundice or trauma or lost an election.
In other words, the ideal state is just what it says,
Since most are not perfect in so many ways,
So I have to advise you, and it's not all my fault,
Take this information with a small grain of salt!
The healing process is a very sensible and orderly one, much like building a home. After an injury, which may be traumatic or surgical, the wound, like your building site, has to be cleansed of debris, and the body sends in white blood cells (WBC's) to do this function. The WBC's come in by small arteries (arterioles) and, much like in construction, the body has to build new roads to bring in the heavy building materials. In the body this is called angiogenesis (angio=vessel, genesis=creating), and this allows the entire “repair” team to get into the area for repair.
Most texts describe wound healing in stages, but in actuality many of these processes are happening at the same time. First comes hemostasis and coagulation, stopping the bleeding and sealing off the area from further bleeding. Then comes inflammation, which is a somewhat misunderstood word, because many of us equate inflammation with infection. Not so. Inflammation is actually the process of bringing white blood cells or leukocytes into the area of a wound. They have many roles, but mainly to clean up debris and bring in raw materials for healing. The next stage is the growth of fibroblasts, called fibroplasias, that will go on to form the building block of a strong wound, collagen. During this time another process called epithelialization is occurring in the skin, which means the growth of skin or epithelial or epidermal cells.
Now, how does the body know what to do and how to do it? Recent studies have shown that substances called cytokines appear in the blood stream after an injury or surgery, and these somehow act as messengers to organize this redevelopment process.
A lot of factors will affect your ability to heal properly, as mentioned in the poem, and I will repeat them here for you. If you have any of these factors, you will heal more slowly, and you should understand that the healing process in each individual is different. With a procedure as simple as an appendectomy, some individuals will be ready to go back to normal activity in a few days, whereas others may be incapacitated for a month or more.
The factors are age; general health; whether you have local wound problems such as hematoma or seroma; anemia; presence of malignancy; obesity; trauma; vitamin deficiencies; medications you are on, such as steroids, which markedly inhibit normal healing, diabetes mellitus; chemotherapy; and chronic liver disease, to name a few. Also, if your surgeon treats the tissue badly, it won't heal well. It's also important to keep the wound clean and probably best not to go bungee jumping or play football for a two to four-week period.
In conclusion, I should emphasize that, as of yet, there is no way to make an incision and not end up with a scar. Certain individuals may be scar formers with development of thickened, unsightly scars at the incision site,called hypertrophic scars or keloids. These can sometimes be lessened by the injection of a steroid substance such as Kenalog into the wound, but it usually does not completely eliminate the problem. If you have to have elective surgery, discuss the location of the incision with the surgeon, and he may be able to place it in such a way that it won't ruin your social life!
Chapter 22
ANESTHESIA
Though this profession has its class,
These Docs are known for passing gas.
But you won't know it cause they keep,
All their patients fast asleep.
Actually, that statement is only partly true. Anesthesiology is a profession requiring several years of training after medical school, and these physicians have a whole armamentarium of ways to keep you from experiencing pain during a surgical procedure.
The advent of practical anesthesia in the mid-eighteen hundreds opened the doors for tremendous advances in surgical technique that were impossible in awake or sedated patients. In the last fifty years the advances have progressed to safer and more esoteric methods of dealing not only with eliminating consciousness and pain during surgery, but also to a subspecialty of pain management that allows them to help patients with chronic pain from benign or malignant disease.
The anesthesiologist will take a history from the patient, review the records and do a limited, appropriate physical exam. If you are having a surgical procedure, he will discuss with you the various options, including full general anesthesia, where you are put to sleep, heavy sedation plus local anesthesia, or some type of spinal or regional anesthesia. Except for the completely local anesthetics, most anesthesiologists will need to have an IV started for administration of medications, and he or a nurse will start this in the preop area. Once you have gone into the operating room, you will be hooked up to an EKG monitor. Depending on the seriousness or location of the surgery, he may want to place an arterial line, an IV line in an artery to better monitor your blood pressure and a place to draw blood samples, if needed, and give antibiotics. After you are asleep, he could place a nasogastric tube through your nose into your stomach and a Foley catheter in your bladder to measure urine output. While the surgeon is called the captain of the ship in the operating room, the anesthesiologist is certainly the second captain and manages the patient's vital signs and any non-surgical problems that might arise during the case. This includes a host of medical problems, including heart abnormalities, respiratory problems, paralyzing the patient when needed, and looking for any untoward reactions to the abnormal state of anesthesia.
The patient is usually sedated prior to entering the operating room to allay anxiety, and some of the drugs, like Versed, may cause total amnesia from the time it is given until you wake up in the recovery room. Once in the operating room, the anesthesiologist administering a general anesthetic will give more medications by vein, followed by a combination of intravenous medications and gases, the last of which are given either through a mask held or strapped over the patient's mouth and nose, via an endotracheal tube inserted into the trachea, or a special laryngeal tube fitted into the throat. The anesthesiologist may either breathe for