Maxine is fifty-three years old and is originally from Jamaica. She has lived in Canada for the last twenty years. Early on, Maxine was diagnosed with several autoimmune diseases. She has lupus, which involves the body’s immune system mistakenly attacking healthy tissue, including the skin, joints, kidneys, brain and other organs. She also has rheumatoid arthritis (RA), which causes inflammation of the joints in the hands, knees, and feet. As well, Maxine has peripheral neuropathy (peripheral nerve damage), an affliction that often causes weakness, numbness, and pain usually in hands and feet.
Despite her problems, Maxine has lived independently in a subsidized housing program, where she receives support with activities of daily living (bathing, eating, and dressing), as well as support from the Community Care Access Centre (CCAC). However, as a result of suffering from abdominal pain, a wound on her foot, fever, and dysuria (inflammation of the urethra), she was admitted to acute care at St. Joseph’s Health Centre (SJHC) on November 2014.
After Maxine was treated, the health care team determined she needed rehabilitation. She was admitted to The Salvation Army Toronto Grace Health Centre (TGHC) in December 2014. On admission, Maxine had difficulty standing and required assistance to transfer in and out of bed, even with a mechanical lift. Maxine however, was very eager to begin her physiotherapy, and made excellent progress in the first few months. Soon, she was able to transfer from her bed to a rollator walker and no longer required a mechanical lift.
Patients with a weakened immune system have a higher risk of septic arthritis, and in February 2015, Maxine developed septic arthritis in her right knee. She was re-admitted to acute care at SJHC, for minor surgery to drain the infection. After her treatment, Maxine expressed a desire to return to the TGHC’s rehabilitation program. The quality of care she received at TGHC was excellent and she wanted to work with the rehabilitation team once again.
When Maxine was re-admitted to TGHC, she was once again unable to transfer from her bed without a mechanical lift and needed to start her rehabilitation from the beginning. Shortly after her return, Maxine began to develop calcium deposits in her skin (Dystrophic calcification), first on her right toe and later on her ankle.
Dystrophic calcification is mostly found in areas surrounding damaged skin tissue. When tissue is damaged, because of such health disorders as lupus or rheumatoid arthritis, calcium deposits can develop around it. These extrude through the skin and at times may require removal to prevent further tissue damage. This type of wound is very painful and difficult to heal, since while healing one wound other wounds can quickly develop.
Following this development, Maxine was again admitted to acute care at SJHC, this time for the surgical cleaning of her right toe and skin grafting on her ankle. She returned to the TGHC again, but because of the length of her absence, she had to once more start her rehabilitation from the beginning.
By integrating appropriate wound assessment with proper treatment protocols, the wound care team at TGHC were able to manage Maxine’s wounds and stop re-admitting her to an acute care facility. “The wound care team — Josh, Jake, the nurses — really took good care of my wounds they were all wonderful and caring,” said Maxine.
Although her wounds were being managed, they were very painful for Maxine. Still, she persevered and continued through with her rehabilitation, determined to be able to walk. ‘The rehabilitation team motivated me to do a lot of physical exercises,” said Maxine. “Their words of encouragement help me to push myself to continue with my exercises. Even now,” she added, “when I’m transferring from my bed to my walker or my wheelchair, I can still hear Sarah’s voice, my physiotherapist say, ‘you can do it.’”
Maxine was discharged home on April 21, 2017.