The Challenge: A Wound That Wouldn’t Heal
Christine Noel, 60, firmly believes a scab is “nature’s band-aid” and knows not to mess with them.
She noticed a wound on her leg that had been there for as long as she could remember. But, since it scabbed over, she didn't give it much thought.
However, in March 2018, when the wound suddenly broke open and wouldn’t heal on its own, Christine knew something wasn’t right. She scheduled an appointment with her PCP, who tried treating the wound with dressings.
When the wound still didn't heal, Christine’s doctor knew a much bigger issue was going on.
“My doctor saw signs of cellulitis in my leg and felt my lymphedema was progressing,” said Christine.
Christine's doctor knew she needed a stronger course of treatment. Not wanting to take any chances, her PCP referred her to a lymphedema clinic near her home.
The Path to UPMC's Vein Center
Before she could progress in her treatment at the lymphedema clinic, Christine ended up in the hospital.
What started out as a small wound on her leg had blossomed into a much more serious problem.
Christine was in excruciating pain. Her leg was swollen, red, warm to the touch, and had discharge coming from the wound. She knew she needed to seek help right away.
Christine's daughter took her to the Emergency Department at UPMC Shadyside — a quick drive for the Pittsburgh resident.
ED doctors admitted Christine for five days and focused their efforts on healing the wound. Her care team gave her IV antibiotics and changed the dressings on her leg multiple times.
By the time doctors discharged Christine, there was a slight improvement in both the inflammation and the pain in her left leg. Still, doctors cautioned her she wasn't in the clear yet and gave her a prescription of oral antibiotics to help with symptoms.
“The doctors told me that there was a likelihood they would see me back in Shadyside. They weren't 100 percent sure what was causing the wound. So, though the symptoms had subsided a bit, they knew I could be back.”
Five days later, the doctors’ predictions came true. While at home, she tried standing for a longer time in the shower and found the pain to be too much.
Christine’s daughter took her back to UPMC Shadyside, where they admitted her once again.
It was during this second admittance that Christine first met the UPMC Heart and Vascular Institute team.
After an exam, doctors determined lymphedema was causing the swelling in Christine’s leg. The edema — the swelling of soft tissue due to fluid accumulation — was preventing the wound from healing.
The Heart and Vascular team felt confident they could help Christine’s wound heal by reducing the swelling in her legs.
Megan Laughlin, CRNP, worked with Christine while she was in the hospital, wrapping her leg and dressing her wound.
“Megan was so positive and upbeat. She was very confident they would be able to get the wound to heal, which was comforting,” Christine explains.
Five days later, Christine went home once more, armed with antibiotics and a follow-up appointment with Megan at the UPMC Vein Center.
“Leaving Shadyside and knowing exactly when my next appointment was, without having to worry about calling to schedule, was a huge help. It brought peace of mind knowing Megan scheduled me with her and all I had to do was show up,” Christine says.
The Solution: Joint Efforts from Vein Center and Lymphedema Therapy
When Christine arrived at the UPMC Vein Center for her follow-up appointment, she had a vein study.
While her right leg seemed okay, doctors found Christine’s left leg had dysfunctional veins causing her swelling and ulcer formation.
Megan explained that this is hereditary and not caused by anything Christine did. This information was beneficial to both Christine and her daughter.
“Megan took a look at my leg and knew she could come up with a plan to help it heal,” Christine explains.
Megan determined the best course of treatment for Christine would be a combination of wrapping and therapy through the UPMC Lymphedema Program.
For the first three weeks, Megan wrapped Christine’s legs once a week. During those weeks, Christine had nurses visit her home to check her vitals and ensure she wasn't getting any type of infection.
While Megan was changing Christine’s wraps, she also dressed the wound on Christine’s left leg.
“I could see how much the swelling had actually gone down every week when Megan would re-wrap my legs,” Christine explains.
“What amazed me was that Megan did not put any kind of medication on the wound itself. Yet, every time she unwrapped my leg, it looked a little better.”
After her initial three weeks of wrapping, Christine began therapy with the Lymphedema Program. Christine began by going three times a week to have her legs re-wrapped.
The therapist, Nina, taught Christine’s daughter how to do the wrappings, which allowed Christine to lessen her visits to twice a week.
With every change in the wrappings, Christine noticed her wound looking better and better, and her legs feeling less and less swollen.
The Results: A Healed Wound
“We’ve declared my wound healed,” Christine proudly exclaims. “It's closed, covered in pink tissue, and no longer needs covered under my wrappings.”
Christine’s lymphedema therapy is slowly winding down. She had her fitting for compression garments, which will allow the active grandmother and nurse to get back to her daily life.
“I’m just looking forward to getting back into my routine of daily life,” Christine explains.
“For the past three months, the only place I really went was therapy. I couldn’t fit into any of my shoes, so I had to wear men’s slippers. I can’t wait to wear my shoes again!"
Christine is also looking forward to getting out into the warm summer sun and giving her legs a chance to breathe. “They’ve been under wrappings almost 24/7 since early April. It’ll be so nice to just sit in the sun.”
A nurse in an assisted living facility, Christine looks forward to going back to work. She knows her custom compression garments will help.
“With the new compression garments, I won’t have to worry about the swelling in my legs while I’m working.”
Christine is thankful for the UPMC Vein Center and Lymphedema Program in helping her get back to the life she loves.
“Everyone was so wonderful. They were so calm and confident that they would be able to help me, which brought a lot of comfort to me.”
Christine's treatment and results may not be representative of similar cases.
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