Ross Tilley Burn Centre

Going Home

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Table of ConTenTs

InTroduCTIon 3

sKIn Care 3Bathing 3Dry Skin 3Itching 4Heat and Cold Tolerance 4Exposure to Sunlight 4Blisters 5Skin Discolouration 5Cosmetic Camouflage 5Pain and Discomfort 6

eMoTIonal reCoVerY 6

folloW-uP afTer dIsCHarGe 7Ongoing Care 7Doctor Check-ups 7Finances 7

nuTrITIon 8

exerCIse 8Fatigue 9

sPlInTInG 9

sCar forMaTIon and Pressure GarMenTs 9Custom-made Garments 10

QuesTIons and ansWers 11

ConClusIon 11

QuesTIons To asK In burn ClInIC 11

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InTroduCTIon

As you get ready to go home, you will probably have many questions. We hope this booklet will provide you with some of the answers to these questions and at the same time raise other issues which will promote discussion between you, your family and the burn care team.

sKIn Care

Now that you are returning home, your newly healed skin will need some extra attention.

BathingIt is important to keep your skin clean and to avoid further drying or injury. Once a day, use mild soaps to gently cleanse your body. Avoid rubbing hard because this can cause your fragile skin to break down. Dried skin and creams should be gently removed using a soft, soapy cloth.

Always test the temperature of the water before you begin to wash. Use lukewarm, not hot, water. Set your water heater setting to 120°F/50°C to avoid a scald injury. Try adding bath oil to the water or rub it into your skin after you have lightly patted yourself dry with a soft towel. If your skin is very dry, shower instead of soaking in the bath.

Dry SkinHealed burns need to be kept clean and well moisturized. After a burn injury, the skin is not able to produce the same amount of lubricating oils as before. Your skin may now appear dry and scaly. It may also feed tight and less supple. Until your skin is able to produce enough of its own oil, you will have to apply moisturizers.

Use a non-perfumed, non-irritating water-based lotion to make your skin feel more supple. There are many lotions and creams at the drugstore, however, very few are water-based. We will recommend one or two products you can use.

avoid Vaseline® and lanolin/mineral oil-based products as these tend to clog the pores of your skin and do not absorb into the deeper layers of the skin, where dryness begins.

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Using light stroking motions, gently massage the lotion into your skin. Gentle massage not only increases the skin’s flexibility but also decreases the sensitivity of the healed skin and scar tissue. As your skin continues to heal and becomes less fragile, you can massage more firmly. Lotions should be reapplied as often as necessary, making sure that enough is applied to absorb into the skin without forming any greasy “build-up”. If oil is allowed to accumulate, you may notice whiteheads or small pimples forming on your skin. Daily cleansing of applied lotions will help prevent this problem.

ItchingBecause your healed skin is dry and has areas of unsettled scarring, you may also experience itchiness. As burn scars settle down and the skin becomes more lubricated, the itchiness will improve. In the meantime, to help ease the itching, we recommend the following:

• Cleanse with lukewarm, not hot, water once daily• Add bath oil to water or apply after shower• Keep skin lightly lubricated at all times• Apply cool towels to affected areas• Avoid warm places• Adjust humidity and temperature in your home to avoid too much dryness• If needed, wear pressure garments• Wear loose, 100% cotton clothing next to your skin• Avoid scratching or rubbing your skin. If you must scratch, use the pads

of your fingers, not your fingernails

Heat and Cold ToleranceYour newly healed skin is thin, and you may be more sensitive to high or low temperatures. You should adjust your activities and choose clothing according to your own reactions and tolerances. You may experience tingling or numbing sensations in your hands and feet in the cold weather, or you may perspire heavily from the unburned areas of your body. These reactions are normal and will usually decrease within one year after your injury.

Exposure to SunlightYour newly healed skin will be sensitive to direct sunlight. You can sunburn very quickly and healed burn areas can turn a permanent dark brown in the sun’s rays. The sun also draws valuable moisture from your skin.

We strongly advise you to stay out of direct sunlight for at least six months. After six months you may proceed, with extreme caution, to short and numerous exposures to the sun. It is very important to protect all burned areas with light-coloured cotton clothing. Wear a large brimmed hat and sunglasses if yourface and neck have been burned. Apply total sunblocks to protect your skin from the sun’s rays. Ask your pharmacist for sunblocks containing high levels of paraaminobenzoic acid (PABA 15-31).

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BlistersIt is quite common to develop blisters on healed skin. Blisters develop when pressure or friction is exerted against the thin sensitive areas of the healed skin. Do not puncture your blisters. If they break, keep them clean and exposed to the air to promote healing. As your skin becomes thicker over the next six months to one year after your injury, blisters will develop less often.

If you are wearing pressure garments, small blisters or areas where the skin has broken down can be protected with a small piece of plastic kitchen wrap, such as Saran® Wrap. If the open area is large and does not heal within a week, stop wearing your pressure garments and contact your doctor as soon as possible.

Skin DiscolourationAs long as redness remains, your newly healed skin is subject to blistering, breakdown, hypertrophic scarring and contracture formation. Changes in skin discolouration can range from pale pink to deep purple. The change in colour is influenced by temperature, level of activity, standing on your feet with your arms hanging down at your sides for long periods of time and your schedule for wearing pressure garments.

Most discolouration will fade over a period of two years or more. Areas of deep burn may not return to the same skin colour as before the burn injury, but you will notice improvements.

Cosmetic CamouflageOnce your healed skin is past the blistering stage, you may be interested in skin care and cosmetic camouflage. There are a number of specifically blended and reasonably priced skin care products and cosmetics made for male and female burn survivors. The cosmetics are waterproof and have a higher level of pigment than more familiar brands so that they can be easily blended to match the colour of your adjacent unburned skin.

Specially trained paramedical cosmetic camouflage artists are available to help you. Please ask any member of the burn team for further information.

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Pain and DiscomfortAs your burn scars mature over the next two years, you may experience some discomfort. It can be frustrating to continue feeling discomfort after your burns have healed, but it does improve over time. While no medication can take the discomfort away completely, these suggestions may help you manage better.

To relieve discomfort:• Discuss with your doctor or nurse when and how to take prescribed pain

medications. Ask your doctor for information about slowly reducing the amount of medication you will receive at home over the next few weeks

• Ask about relaxation techniques such as deep breathing exercises or listening to your favourite music

• Take short walks outside for a breath of fresh air• Gradually resume your usual routine of activities according to your own

level of tolerance• Follow all skin care instructions closely• If ordered, wear pressure garments according to instructions

Try a variety of these approaches to discover what works best for you. If your discomfort persists, please let your doctor know. In some cases, anti-inflammatory agents may be helpful.

eMoTIonal reCoVerY

Going home after a prolonged hospital stay is an exciting time. It is not unusual, however, to experience some anxiety about returning to family and friends, frustration or anger regarding new physical limitations and periods of depression.

It is important to remember that you will require a period of convalescence at home. A burn injury is physically draining and you may find yourself lacking the usual amount of energy and mobility required to perform routine tasks. Give yourself some time to adjust and allow for extra time when planning your activities.

As you adjust to new routines and altered levels of activity, you may experience some difficulty sleeping. The following suggestions may help:

• Avoid long naps in the day• Try to get outside for a breath of fresh air and some light exercise once

a day• Follow skin care suggestions before going to bed• Try relaxing activities before going to bed

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If you continue to have difficulty sleeping, please speak with your doctor or another burn team member.

You may also experience concerns regarding the physical appearance of your wounds and the length of time required for full recovery. It is helpful to discuss these concerns with family and friends who are eager to help during this period of adjustment. Don’t be afraid to ask for and receive help. You will gradually become more independent with each passing week.

Most importantly, remember that all of these feelings and concerns are a natural part of your recovery. If you wish to discuss any of your concerns with a member of the burn team, please feel free to contact your doctor or burn team member, at any time. We have a number of written materials and videotapes that might be helpful to you and your family. It is important to remember that there is help for you to cope with the emotional healing after your burn injury, just as there was for the physical recovery.

folloW-uP afTer dIsCHarGe

Ongoing CareIf you require the services of a nurse or homemaker, arrangements will be made with your local Community Care Access Centre (CCAC). All arrangements will be made for you prior to your leaving the hospital.

Doctor Check-upsYou will be given an appointment to see your doctor at the Burn Clinic in the next week or two. These appointments are very important in the continuing care of your wounds and, if you are unable to attend, please reschedule the appointment by calling the doctor’s office. Ongoing wound care may be provided by a visiting nurse in your home or at a CCAC wound care clinic.

You should also continue to visit your family doctor on a regular basis to provide him/her with updates on your progress.

FinancesIf you have any concerns regarding your financial situation during your convalescence, please speak with the Burn Centre social worker. If your injury is covered by the Workplace Safety Insurance Board (WSIB), concerns should be discussed with them directly.

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nuTrITIon

While a high-calorie, high-protein diet was necessary to help your body heal in the hospital, it is no longer required once you have recovered from your burn injury.

At this point, the emphasis of your diet should be to provide yourself with a normal nutritious meal plan. Your daily food choices should include selections from each of the four food groups in Canada’s Food Guide. This variety is required on a daily basis for normal body maintenance and the continued healing of your burn wounds. Meat and meat alternatives provide protein, vitamins and minerals, which are important to your skin and underlying tissue. Milk and milk products provide protein and calcium essential to your recovery. Breads and cereals give you energy. Fruits and vegetables contain vitamins and minerals important to skin, hair and muscle function. Adequate fluid intake is also important. Water, juice and milk are good sources of fluid. Use thirst as your indicator of proper fluid requirements.

It is not necessary to take vitamins and mineral supplements if you follow Canada’s Food Guide to Healthy Eating and eat a balanced diet. If you would like some nutritional counselling, you may ask to see a dietitian when you return for your clinic visits or your family doctor may refer you to a dietitian in your area.

exerCIse

It is important to continue your prescribed programme of regular exercise once you have been sent home from the hospital. It will help you maintain your range of motion, strength and endurance. You will be given a written list of exercises with instructions specially designed for you.

You may notice a stiffness or slight pulling in your joints after sleeping or being inactive for long periods of time. In this case, exercise will help you increase your mobility and avoid contractures.

It may be necessary to continue seeing a physio or occupational therapist if you still have limited movement in some joints at the time of your discharge. Therapists may need to come to your home or you may attend an outpatient rehabilitation clinic in a hospital near your home.

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FatigueWhen you go home, you may feel quite tired for the first few months as you work towards increasing your level of activity. For the first while, do not ex-pect to accomplish much more than you did while you were in the hospital. Do not become frustrated. Gradually increase your activities as you feel less tired. This will increase your strength and endurance. It is important to realize that you must continue with your home exercise programme to be assured of the best results.

sPlInTInG

As you have learned, the occupational therapist may use splinting to keep your joints in a position which allows them to function. Splints may also be necessary as your maturing skin continues to change once you are dis-charged from the hospital.

Resting static or serial splints may be used immediately following your range of motion exercises to keep a joint at the maximum range of motion achieved. In order to apply a constant stretch to tight joints, splints may also be applied during the night or for rest periods. Dynamic splints or splints which apply a direct and opposing force are used to reverse any contractures that may occur. It is important that you follow the wearing schedule given to you by your occupational therapist. Splints may be necessary for up to 18 months or until your joints have achieved their maximum range of motion.

sCar forMaTIon and Pressure GarMenTs

Once the burn wound has healed, the first stage of recovery is completed. The second stage of recovery involves the management of “maturing” burn scars. During this period, you may notice that your flat smooth skin is becoming more red and increasingly raised and tight. These changes are part of the normal process of maturing burn scars and will continue to occur until an equal and opposing force is applied.

To apply the pressure, various products are used including tensor bandages, Tubigrip®, Isotoner® gloves, Coban® wrap, rigid face mask and custom-made pressure garments. To assure a good result, all products must be worn continuously – 23 and a half hours a day – for 12 to 18 months or until the redness and elevation of your scars has settled.

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The Burn Centre occupational therapist will discuss the most appropriate scar management routine with you and will follow your progress in the Clinic.

Note: Pressure garments are not effective once your scars are fully mature. It is essential that you follow your schedule of wearing closely during this second stage of recovery.

Custom-made GarmentsCustom-made pressure garments are prescribed by your doctor in consultation with the Burn Centre occupational therapist who will help you decide on an appropriate style. They are used when burn scars are extensive or thickening and will not respond to alternative methods of pressure. You will be measured for your garments in the hospital or during one of your follow-up visits at the Burn Clinic. Since you are required to wear the garments at all times, except when bathing, we recommend that you buy two sets, so one clean set is available while the dirty set is being laundered.

In many cases, burn scars are fragile and may break down easily. The feeling of constant pressure may require some getting use to. We suggest gradually building up your tolerance for wear. For example, on the first day the garments may be worn 1-2 hours; on the second day 6-12 hours, etc. By the end of the first week, the garments should be tolerated for the full 23 and a half hours.

OHIP does not cover the costs of these garments. The Burn Centre occupational therapist is a registered authoriser for the government’s Assistive Devices Program and may be able to apply for funding on your behalf, which would cover 75% of the cost of the garments. If you are receiving social assistance, your coverage might be more than 75%.

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QuesTIons and ansWers

1. Will my burned skin return to its natural colour? Everyone heals differently. Some areas of your burned skin may remain darker or lighter than normal for varying periods of time. Most of the improvement will have taken place in two years.

2. If I get a cut or scratch on my healed burn, what should I do? Do not be alarmed. Your healed skin is very fragile, but it will heal normally with time.

3. Some of the skin where I was burned is now so tight and tough. Will I ever be soft again? Yes. Over a period of two years, it will gradually soften with stretching, the use of water-based moisturizing cream and the proper wear of your pressure garments.

4. If my inserts or splints need renewing or if I’m having problems, do I have to wait until my next Clinic visit? No. Please ask your outpatient therapist if you are already seeing one. The Burn Centre occupational therapist can be contacted over the phone for consultation. The number is (416) 480-6814.

5. How often should I change and wash my pressure garments? Daily, when you take a shower or a bath. Alternate garments daily (you should have two sets) and follow the manufacturer’s instructions for washing. Always hang to dry.

6. Should I wear my pressure garments when bathing or swimming? No. Take your garments off once a day for a short period of time, ie. half an hour for bathing or swimming.

ConClusIon

We hope that you will find this booklet helpful as you prepare to leave the hospital. Please do not hesitate to speak to a staff member regarding any concerns that you may have after you are discharged.

Please use the blank pages provided in the booklet to write down any questions and concerns you would like to discuss when visiting members of the burn team in clinic.

QuesTIons To asK In burn ClInIC________________________________________________________________________________________________________________________________________________________________________________________________________________________________

For more information aboutThe Ross Tilley Burn Centre,

please call 416.480.6814

2075 Bayview Avenue - D7 Toronto ON M4N 3M5

PR 15062 June 2013