Dear Editor,
I write as a follow up to my letter of December 25th 2020 on the subject of “Vascular Surgeon desperately needed”. The purpose of my letter is to help my fellow Guyanese struggling with the condition, chronic venous insufficiency (CVI) commonly known as varicose ulcer. This letter is a public thank you to Dr. Carlos Martin, Vascular and General Surgeon, St. Joseph’s Mercy Hospital. In December 2020 my family and I were desperate for the closure of a very large chronic varicose ulcer for a member of our family. We were, as they say, at our wits end. This condition was plaguing my relative for seven years but became chronic in the last two of the seven years.
Prior to this current condition she had for five years been receiving treatment as an outpatient at both public and private hospital clinics and at times as an inpatient at a singular private hospital and home care treatment by a doctor. At the private hospital constant bacteria and infection would be brought under control and she would be good to go for a period of time until one day she jammed the foot in a store-room at her home and the ulcer/wound reopened to remain open for two “long” years. This chronic ulcer caused a Cuban doctor, name unknown, to pronounce amputation on her leg saying, Guyana does not have the treatment for this chronic type of ulcer, much to my consternation, that a doctor would say this to a patient unaccompanied by a family member or friend. I thought the protocol would be to ask her to have a relative accompany her on her next clinic day to disclose his assessment to that person but certainly not the patient. For me, that was cruel and unethical.
Returning to the private hospital foot clinic, she did experience a measure of relief until responses to my December 25th 2020 letter pointed us to Dr. Carlos Martin. From our very first visit with Dr. Martin we began to be assured that his treatment approach could bring closure to this very painful and prolonged chronic disability. He gave us no guarantee but said if we would cooperate with him, he would work with her to bring relief and possible closure by first arresting the bacteria to control the infection. Bacteria and infection are the plagues and breeding ground of ulcers. He told us with the size of the ulcer he could not guarantee an infection-free wound. The process began with a seven-day in-hospital aggressive antibiotic saline treatment which prepared her for a vein stripping surgery to remove the vein that was refluxing and one of the contributory factors to the prolonged open wound. During this process Dr. Martin advised two ways to bring closure to the wound would be, one, with the treatment, the ulcer to close on its own and two, skin grafting to bring an end to the constant infections. All this was an effort to bring an end to this seven-year on and off misery undermining with chronic pain.
The preparation for the surgery required a doppler ultrasound to rule out deep vein thrombosis (DVT) commonly known as blood clots. Once cleared of clots, the day was set for the vein stripping surgery. Another factor was bringing her blood pressure under control before the surgery. She has no history of diabetes. The surgery was successful and the ulcer closed three months after the surgery. During this three-month recuperation, a laboratory culture sensitivity test detected bacteria present in the wound. Antibiotic treatment restarted together with thrice weekly home visit dressings which gradually reduced to two days weekly dressing. The ulcer slowly began to show signs of closing, little by little and eventually one day it was fully closed. No more dressings, no more clinic visits, no more antibiotic treatments, no more pain tablets, no more culture sensitivity tests, no more infections. What a relief, she could again breathe and live as a normal human being without this physical disability.
Next steps, she now wears compression stockings on both feet and advised to do daily calf exercises, up and down on your toes, along with general physical exercise. The Cuban doctor at the Diamond Diagnostic Centre was proved to be incorrect with his assessment and pronouncement of amputation. Today my relative has her two feet in place. Thanks to Dr. Carlos Martin and Nurse Melinda Thomas. Two of our very own doctor and nurse combination brought an end to the chronic suffering of CVI. Our thanks and gratitude too to Dr. Tyrone Sangster for the earlier years’ treatment of aggressive antibiotic saline in-hospital treatment at Davis Memorial Hospital and at times morphine treatment to control the excruciating pain to prevent increase in blood pressure levels. Our thanks also to Dr. Alexis Reid at the Davis Memorial Hospital foot clinic who was part of her treatment care process. To my fellow Guyanese there is hope for an end to varicose ulcers with no choice of amputation. Our Guyanese doctors are competent in their respective study of the science of medicine to treat disease.
We thank God for His divine intervention through Dr. Carlos Martin and team at the St. Joseph’s Mercy Hospital. My relative’s quality of life has improved to almost one hundred percent. A critical component of the treatment is pain management which was only properly addressed when she was being treated by Dr. Martin. In the case of one doctor, the pain was never fully addressed. I conclude that the reason for this ambivalent approach seems, to me, some doctors’ treatment method is the same for all patients. One doctor dealt with it so casually that when she was in extreme pain and distress and an emergency visit had to be made to the same private hospital, she refused to inform her attending physician and chose instead to see another doctor. Dr. Martin always says, once there is infection there will be pain. A three-tier pain treatment approach was introduced reducing the high level of pain and making the condition bearable and bringing about rest to the patient and her blood pressure under control. This aspect of the condition brought into immediate remembrance of a kept newspaper clipping by Mr. Keith Burrowe’s Sunday Chronicle February 2015 article on “Pain Management and Dependency, Part 1”. Remember I shared that this condition was plaguing my relative for seven years, reason Mr. Burrowe’s article came into focus for us, that here there was someone else bringing attention to the need for pain management associated with disease suffering.
I cannot withhold an unbelievable encounter of the rough and unprofessional treatment experienced by my relative at the Campbellville Health Centre in November 2020 when the attending nurse was insistent and adamant that iodine was what is used to clean ulcers and this is all we have, and “lady what’s wrong with you, like you don’t want yuh foot get better.” Even though my relative told the nurse her skin was sensitive to iodine, the nurse applied it and my relative lost it, sent her into a frenzy; the pain was unbearable and she was dizzy for quite a while so much so that going home in a taxi she could not remember where she was living. The pain sensation was more than she could bear. This was cruelty and inhumaneness of a fellow human being to another human being. Pain management education seems to be lacking in the hospital clinics and seems to be an area not studied or properly understood much less to be administered. Woe to the patients that encounter this insensitivity to pain at the different levels of disease by some medical professionals.
A long episode with chronic pain has finally ended for my relative. How come? Because someone cared enough to bring relief to a suffering fellow human being. Understanding the different strains of bacteria and knowing the requisite composition of which antibiotics can be used together to attack and combat the bacteria from its root, seems a key element in this type of disease. Dr. Martin has studied it well and his treatment application conquered the colony of bacteria resident in the body. It was a miracle to watch and observe the progress to the closing stages of the ulcer. What seemed impossible suddenly became miraculous. May God continue to guide the hands of Dr. Carlos Martin and give him wisdom of knowledge and understanding how to treat every disease that presents itself before him.
Sincerely,
Maria Rodrigues
