Healing burns at Shriners Hospitals for Children Northern California

08/28/2014 12:00 AM

08/27/2014 9:41 PM

For someone who spends his days around severe burns, Dr. David Greenhalgh is exceptionally cool.

Greenhalgh, chief of burns at Shriners Hospitals for Children Northern California, built the facility’s burn program almost singlehandedly at its start in 1997. Now, thanks to his cutting-edge medical research, it has grown into the busiest pediatric burn center on the West Coast and one of the nation’s leading facilities for this specialization.

In a peach-and-mint building nestled next to the UC Davis medical campus on Stockton Boulevard, Greenhalgh treats dozens of burned and scalded children from 13 Western states, plus Mexico and Canada. He also runs the adult burn program at the UC Davis Medical Center across X Street.

He says he has the best job in the world.

“Burns are probably the sickest people you can see who can barely hang on and then still come back and give you a thanks after all is done,” he said. “And especially the kids. We have kids that are barely alive, and then later it’s like it barely affected them. They’re active little kids again.”

Greenhalgh’s research in wound care, skin grafts, reconstruction and burn prevention has made an impact on the lives of hundreds of families as well as in the national burn field. A past president of the American Burn Association and a board member of the Phoenix Society for Burn Survivors, he has devoted his medical career to making a severe burns diagnosis a conquerable feat.

The surgeon is also a proud member of the Shriners, a subset of the Freemason fraternity that is largely responsible for funding the Shriners hospital network, which provides care to insured and uninsured families at no out-of-pocket cost at all of its 22 locations, four of which offer burn care.

The public may recognize Sacramento Shriners by the small tasseled fezzes they sport at parades, football games and other events hosted by the local Ben Ali Shrine chapter.

Sacramento’s Shriners hospital, the only one of the charity’s facilities to treat all four of its specialties – burns, orthopedics, spinal cord injury and cleft lip surgery – receives an average of 2.5 referrals per day, and sees more than 400 children in its out-patient clinic each month. More than 18,000 patients have been accepted for burn and plastic surgeries since the program opened in 1997, after moving from its San Francisco site due to problems with fire codes and asbestos.

Lew Wentworth, business manager of the local Shriners chapter and vice chairman of the board of governors for the hospital, said he is especially fond of the burn care program.

“David came out here to be our chief, and we opened the doors and said build it and they’ll come,” he said. “Burns has just become what we do. … It’s a tough, tough business from a surgical viewpoint.”

Abby Fisk, a patient of Greenhalgh’s who has undergone five major surgeries and countless procedures since an accident in 2008, can attest to that.

The red-headed teen was 8 years old when she fell into the ashes of an agricultural fire on her family’s Modesto farm, incurring second-degree burns on her hands and third-degree burns on her feet, ankles and shins.

“I don’t even remember what my feet looked like before they were burned,” said Abby, now 14. “It was weird accepting that I was different and would never have normal feet again and never look the same.”

Abby’s burns affected about 30 percent of her body, categorizing her as what Greenhalgh calls a “big burn.” Shriners surgeons treat wounds of all sizes – from small burns, which cover less than 15 percent of the body, to 80 or 90 percent burns, which put children at the highest risk of death.

The immediate need for any burn patient is getting the wound covered and safe from infection, said Greenhalgh. An absence of skin, particularly on more than 20 percent of the body, leaves children susceptible to germs that otherwise are blocked from entering the body. To fight them, the body will raise its metabolic rate to fuel the healing process, sometimes consuming muscle and fat to the point of death.

A burn patient will spend approximately one day in the hospital for every percent of his or her body that is damaged.

“The interesting thing about burns is it’s a long process,” Greenhalgh said. “You maybe know them for months and then the child dies. That can be the hard part of the job. … We’re dealing with the tigers, and sometimes the tigers win.”

Now recovered and living in Wisconsin, Fisk still returns to Sacramento periodically so that Greenlagh can perform reconstructive surgery on her skin grafts, which he initially fitted from the top layer of skin off of her unscathed back. This month she’s recuperating from the last of three surgeries on her toes, which were separated after scarring webbed them together.

After a patient’s initial skin graft surgery, Greenhalgh’s mission shifts to restoring functionality and appearance. The first step, in many cases, is fitting the child for a “garment,” a tight spandex casing that flattens the scar.

In a small sewing nook on the second floor, a rainbow of spools offers a bright selection of threads to young patients, many of whom will wear their garments for up to a year.

Fisk, who wore garments in early recovery, said the tight, neutral socks helped her cover her leg grafts until she was comfortable showing them to people.

About half of Greenhalgh’s time is spent on reconstructive surgery. As children’s bodies continue to grow, their skin grafts don’t, causing a tightness as the wounds mature. While physical therapy can help patients stretch the grafts, more surgery is often necessary to remove the outer layer of graft and stretch it out.

“People with big burns or deep burns always have scars,” Greenhalgh said. “We try to make them look as good as possible but also give them the attitude that it’s OK to be a little different looking than you were before. … The ultimate goal is to see kids do what they normally would’ve done without the injury. Everything we do kind of has that focus.”

Any extra time Greenhalgh can squeeze out of his day – time that Shriners CEO Margaret Bryan calls his “27th hour” – is spent in the lab, studying how to improve burns. Or, even better, how to prevent them in the first place.

From fireworks to fireplaces, each season brings a host of easily prevented dangers that worry the physician, whose treatment demographic is among the most curious, and the most uninformed.

While hot-water scalds are the most common among children, Greenhalgh has also spoken out against torchière lamps, electrical fires, propane explosions and water heater accidents. He’s done prevention workshops with PG&E and worked with California State Parks on the “circle of safety” campaign, which teaches children to stay 4 feet away from the campfire at all times.

“He’s concerned about pajamas, mattresses, food containers, toy packaging,” said Bryan, a longtime friend of Greenhalgh’s. “He’s very focused that old problems don’t resurface. He encourages all the staff to think about the ways kids can get hurt. … Theoretically, he could put himself out of business.”

In addition to his published work on burn prevention, Greenhalgh has also put out a large body of research on metabolic changes, skin substitute work and nutrition. Right now, he and fellow researchers are trying to figure out what causes scarring, a problem that he said is particularly difficult to answer given the lack of an animal model.

He said none of it would be possible without the support of the Shriners, and the rest of the hospital staff.

“What’s unique for us is that we have the whole team,” he said. “We have the research in the hospital that can go right along and help make the translation to clinical concepts. … It’s one of the best jobs you can get, having the whole support for dealing with children in the best way you can. (The Shriners) do what’s right for them.”

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