GINA B. GOOD / PVT Certified wound specialist Cheryl Bates holds her 6-year-old therapy dog, Dezi, in the therapy wing at Evergreen at Pahrump. Dezi has a cast on his broken leg. Advertisement

Evergreen at Pahrump has a certified wound care specialist available to help heal in-house patients as well as out-patients in their physical therapy department. She works with ailments such as pressure ulcers and ulcers from diabetes, as well as bites and abscesses.

When those of us addicted to TV crime dramas and shoot 'em up video games ponder the nature of a wound, we usually think of the gunshot variety. But according to physical therapist and certified wound care specialist Cheryl Bates, a scratch can be a wound, and so can a surgical incision, or scrape on the knee.

In fact, Bates has helped heal snake and dog bites, human teeth marks and split knuckles. She's also worked on skin craters formed by bites from brown recluse spiders. She said the first time she saw a brown recluse spider bite, it was a hole that measured three inches in diameter and was an inch deep.

"The spider bite eats away the tissue immediately. It can't be sewn up. It has to be healed from the inside out and then have a skin graft."

Bates has been a physical therapist since 1987 and is often in a position to judge how a patient's wounds affect his or her mobility. She was certified as a wound care specialist in 2008, although she had been treating wounds and taking advance classes for years.

Bates was schooled in burns and wounds in Texas. She said there are about 2,500 wound care specialists in the U.S., including doctors, nurses and physical therapists.

At Evergreen, Bates works with a multidisciplinary team of doctors, nurses and others to care for patients. She said 90 percent of the time wounds simply heal. Ten percent of the time, they don't.

"That's when people need somebody like me. When people with poor circulation or diabetes have a wound, it takes longer to heal," explained Bates. "Ulcers can form in the lower legs that resist healing, and long-time diabetics can develop nerve damage, and tiny blood vessels actually dying. That's when diabetics start losing limbs.

"As people age, we find a lot more problems with wounds healing. Venous ulcers make the lower legs look purple. It's harder for the heart to pump blood from the feet up to the knees because of gravitational force. A lot of times, wounds in lower legs do not heal well."

Bates added that even for young, healthy patients, surgical incisions can become infected, which slows healing.

Among other things, Bates is trained in dehiscing wounds, which means she opens a wound around the edges, taking out the stitches and then cleaning the wound so it can heal from the inside.

Bates said she sometimes cuts out dead tissue from a wound, but other times the dead tissue is so adhered to the wound she uses an enzymatic substance, cross hatching the wound until she can clean out the debris.

"A wound will not heal until you get to the clean tissue. A dirty wound will not heal," she emphasized.

Another common situation Bates deals with is wounds from pressure sores.

"We see those sores from patients lying in their beds a long time," she said.

Because patients with neuropathy, or nerve damage, from diabetes or for other reasons, don't have feeling in some areas, they won't realize they are developing a pressure ulcer.

"That also happens with patients who have dementia," Bates added. "Their minds don't process the pain correctly. A pressure ulcer can develop if a patient is wet and is not changed. A pressure ulcer can form in a couple of hours."

Bates offered hints for caring for a loved one who may be in the hospital for a few days. "It's not unusual for one nurse to be caring for 10 patients," she said.

She said visitors can check their family member or friends to see if the sheet and blanket are pulled tightly over their toes. "Loosen the sheet and ask the nurse to leave the sheet untucked. Forcing the foot down into the mattress can cause a sore on the heel that leads to a slow-healing wound.

"Thirty percent of our body weight weighs down on our heels when we are in bed," said Bates.

"Moisturizing your patient's heels with lotion can save him from developing a heel wound. If your patient has poor circulation, wearing knee pressure socks can prevent venous insufficiency from developing and ulcers from forming."

Originally from Las Vegas, Bates graduated from South West Texas State in 1987 because there was no physical therapy school in Nevada at that time. She's been in Pahrump for three years and has worked at Evergreen for the past two years. She works at Evergreen Monday through Thursday.

"We are a good team here. The team is very dedicated to helping the patients and helping each other help our patients. We really get people well here. We try to get people better every day."