1. Greer, Kathleen A.

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At age 18, Todd Nicholson was lying in a hospital bed wondering what he was going to do with his life after a car accident had suddenly left him a paraplegic. Then one day, his mother said to him the words that he would adopt as his own motto for life: Never give up on your dreams.


This was the inspirational message shared by Nicholson, a 37-year-old Paralympic Games athlete and gold medalist in sledge hockey, who joined R. Gary Sibbald, BSc, MD, FRCPC (Med)(Derm), FAPWCA, MEd, in delivering the keynote address at the 21st Annual Clinical Symposium on Advances in Skin and Wound Care, September 28 to October 1, 2006, in Lake Buena Vista, FL.


Dr Sibbald, Professor of Public Health Sciences and Medicine at the University of Toronto, Toronto, Ontario, Canada, and Director of the Wound Healing Clinic at The New Women's College Hospital, Toronto, surveyed the world of wound care outside the United States and Canada in his lecture, "Worlds Apart." He took the audience on a journey to many corners of the world to look at global wound care challenges. Then, he invited Nicholson to share a different kind of journey, a first-person patient perspective that highlighted the importance of treating the whole patient, not just the hole in the patient, and paying attention to patient-centered concerns.



As the Chairman of the Third Congress of the World Union of Wound Healing Societies, Dr Sibbald is intensely interested in the global wound care village. He has visited Mexico, Abu Dhabi, India, Iran, and Hong Kong to learn more about wound care challenges around the world. He discussed the human suffering he saw in some of those countries as the result of scleroderma, necrotizing fasciitis, inflammatory ulcers, and diabetic foot ulcer complications, and he described the patient cases, treatment methods, and potential outcomes for each of these difficult wound care situations.


Dr Sibbald also noted that Advances in Skin & Wound Care (for which he is a Clinical Associate Editor) has begun a new column, called "World Union Reports," that examines the state of wound care around the world and demonstrates some of the innovations put into practice to help care for patients. He highlighted the example published in the September 2006 issue of Advances in Skin & Wound Care, which describes how Dr Kshitij Shankhdhar, MBBS, Dip. Diab., DDM, PGDND, FAPWCA, of India uses the simple components of foam, scissors, and adhesive to create an inexpensive offloading system.


The point of sharing this world perspective, Dr Sibbald said, is to provide readers of the journal with inspiration to improvise and innovate in their own clinical practice.


"Improvisation is the key to success in developing countries," said Dr Sibbald. "Remember to accommodate the patient and to implement their perspective into what you are thinking about doing.


"You and your colleagues could also develop new products that could make a difference on the global level," Dr Sibbald said.


He urged attendees to consider how they can develop unique approaches to the challenges in their practice and to remember that they can make a difference in patients' lives by learning from previous experiences, considering patient-centered concerns, innovating with resources to maximize outcomes, and using health care dollars wisely.


"I want to encourage you to think about the fact that sometimes the impossible can be possible," Dr Sibbald said. "We can all learn from experience. You can make a difference."



Next, Dr Sibbald took attendees on a journey into "Todd's World." Nicholson fractured his vertebrae at T12 and lost the use of his legs in 1987. He has fought hard to overcome any obstacles that have gotten in the way of his goals and dreams. A determined and talented athlete, Nicholson had dreamed of playing hockey for Team Canada as a young boy. He was uncertain, however, if he could achieve that goal as a paraplegic.


He learned about a slightly different type of hockey called sledge hockey, where players with disabilities sit in a lightweight sled mechanism that has 2 skate blades underneath. Players hold a shortened hockey stick in each hand; they use the sharpened butt end of the stick to propel themselves up and down the ice.

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In 1991, Nicholson tried out for Canada's national sledge hockey team and his dream came true.


"When I put that jersey on over my neck, I got shivers up my spine. I said to myself, "I have reached a goal that I set when I was a kid.' But I had to do it a little bit differently," said Nicholson.


"That is something you need to realize and you need to tell your patients. There is nothing that you cannot do. You may just have to do it a little bit differently."


By 2002, Nicholson had played hockey in 3 Paralympic Games and had helped his team win bronze and silver medals. He had also earned 4 gold medals in world championship hockey games. In addition to hockey, Nicholson was also competing in triathlons and had participated in international wheelchair basketball competition. He also enjoys sky diving, scuba diving, water skiing, baseball, and golf.



Despite these achievements, Nicholson had one goal he desperately wanted to fulfill: winning the gold medal in sledge hockey for Team Canada in the Paralympic Games. His next opportunity would be in Torino, Italy, in 2006. But a difficult-to-heal abscess that developed after the 2002 Paralympic Games threatened his dream.


Over the next 3 years, Nicholson's wound persisted. He underwent 3 surgeries, 2 flap procedures, negative pressure wound therapy, and bed rest. Toward the end of 2005, Nicholson had been in and out of hospitals for months and he feared he might have to retire as captain of his hockey team. That is when Dr Sibbald entered the picture.


"If it wasn't for this man, some of the goals and dreams in my life definitely would not have come true," Nicholson said, gesturing to Dr Sibbald.


A nurse who is a friend of Nicholson's had seen Dr Sibbald on television. She told Nicholson about him, and Nicholson's family physician quickly placed the phone call that would make a tremendous difference in Nicholson's life.


Bed rest had not worked for the athlete, and Nicholson's psychological outlook had suffered from the long road to recovery. Dr Sibbald put the wound bed preparation paradigm into effect and addressed the cause of the wound, as well as Nicholson's concerns.


"When Gary heard my story, he jumped at the chance to make a difference. He looked after my mental health and got me out of bed," Nicholson said.



To identify a cause of the pressure ulcer that had resisted healing, Dr Sibbald and his staff asked Nicholson to bring to their office the sporting equipment he used in both hockey and triathlon competitions, as well as his water skiing apparatus. They examined Nicholson and this equipment and were able to make adjustments that they thought would relieve some of the pressure points they found.


After a complete clinical assessment, Dr Sibbald determined that Nicholson had a Stage IV pressure ulcer and osteomyelitis. Although Nicholson had been using V.A.C. therapy, the amount of drainage present indicated that the sponge he was using was inadequate and that the antibiotic he was on was not sufficient.


Taking into consideration Nicholson's desire to compete in the Paralympic Games, Dr Sibbald decided that a maintenance mode was the best course of action; that would allow Nicholson to play hockey. Nicholson competed in hockey games while wearing a portable V.A.C. device. He also performed his own dressing changes.


When March 2006 arrived, Nicholson was not only ready to play at the Torino Paralympics Games, he was named as Team Canada's flag bearer in the parade of nations. With Dr Sibbald's help, he had reached his goal of competing as captain of his sledge hockey team.


"Our goal was not to heal that ulcer; our goal was to go to the games," Dr Sibbald said. "We were going to worry about the wound and its healing after the games."


"The wound did not heal, but it stabilized. Todd played all of his games at the Paralympics, getting daily IV antibiotics through a PICC line and reapplying the V.A.C. as soon as he left the ice. He had some exudate, so he also had to change dressings," Dr Sibbald said.


Nicholson said he played each one of those games as if it were going to be his last.


"I had no idea that I would come home with something that I had been wanting for my whole life," said Nicholson. Then he revealed to the audience the cherished gold medal that Team Canada had finally won for the first time ever.


Nicholson expressed his gratitude to attendees for the work they do to push people to achieve the next level, despite whatever obstacles they may have.

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Dr Sibbald agreed, emphasizing the importance of the clinician's ability to see the person with the pressure ulcer, not just the pressure ulcer. Nicholson served as one example of patient preference put into clinical practice.


Nicholson's wound, however, remains an ongoing issue today. Clinicians continue to try treatments and look for answers to heal this persistent wound.



Dr Sibbald concluded the keynote address with a reminder that the Third Congress of the World Union of Wound Healing Societies will meet June 4-8, 2008, in Toronto, Canada. The mission of the World Union is to enhance the lives of people with wounds worldwide. The plan for the meeting is to unite many different worlds together to bridge the gap in global wound care.


The key purpose of the meeting will be to analyze the wound care evidence base and transfer the knowledge, skills, and attitude needed for improved patient outcomes, Dr Sibbald said.


"The world is coming to Toronto and we hope to see you there," he told the audience.


For more information on the World Union meeting, visit


And the Winners Are[horizontal ellipsis]

At the recent Clinical Symposium on Advances in Skin & Wound Care: The Conference for Prevention and Healing, 3 awards were presented to health care professionals for their efforts to advance the wound care profession.


* Cathy Thomas Hess, BSN, RN, CWOCN, is the winner of the 2006 Sharon Baranoski Founder's Award. Ms Hess is President and Director of Clinical Operations, Wound Care Strategies, Inc., Harrisburg, PA, and Clinical Consultant for Advances in Skin & Wound Care. This award honors the overall pursuit of excellence in the field of skin and wound care, and is named in honor of the Conference Founder, Sharon Baranoski, MSN, RN, CWOCN, DAPWCA, FAAN. The award is supported by an educational grant from 3M.


* The winners of the first-ever Roberta S. Abruzzese Publishing Award are Barbara A. Pieper, PhD, RN, CS, CWOCN, FAAN; Thomas Templin, PhD; and John R. Ebright, MD. They won for their research paper, "Chronic Venous Insufficiency in HIV-Positive Persons with and without a History of Injection Drug Use," which was published in the January/February 2006 issue of Advances in Skin & Wound Care. This new award honors the journal's founder, Dr Roberta S. Abruzzese, and is a tribute to her commitment to excellence in clinical practice and her drive to advance the practice of the wound care specialty, particularly through education and the literature. The award is supported by an educational grant from Advances in Skin & Wound Care.


* David M. Brienza, PhD, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA, is the winner of the 2006 Outstanding Peer Reviewer Award from Advances in Skin & Wound Care. The award honors his contributions to furthering the goal of the peer review, which is to provide constructive critiques that assist authors in revising and improving their manuscripts so that they make meaningful contributions to the literature and the skin and wound care field. The award is supported by an educational grant from Advances in Skin & Wound Care.

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