October 17, 2024 • 16 mins
While most cuts and scrapes will heal themselves, some wounds can develop into a more serious situation.
In that case, you may need to see wound care specialists. Dr. Jim Ley, Medical Director of the ChristianaCare Wound Care and Hyperbaric Medicine Center, and Podiatrist Dr. Scott Reich talk to us about the kinds of wounds they see, the specialized treatments they offer such as hyperbaric oxygen therapy, and when to know if you might benefit from their care.
Links
- ChristianaCare Wound Care and Hyperbaric Medicine Center
- ChristianaCare News - What is Hyperbaric Oxygen Therapy?
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
If there's a wound that's not healing within a
short period of time, it canoften become a chronic wound
that has more complications.
Speaker 2 (00:09):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 3 (00:19):
Hello everyone, I'm Megan.
Speaker 2 (00:20):
McGerman and I'm Jason Tokarski.
Welcome to another episode ofFor the Love of Health, brought
to you by ChristianaCare.
Speaker 3 (00:26):
While most cuts and scrapes will heal themselves,
some wounds can develop into amore serious situation.
Speaker 2 (00:33):
In that case, you may need to see wound care
specialists.
Two of those specialists fromthe ChristianaCare Wound Care
and Hyperbaric Medicine Centerare joining us today.
They're Dr Jim Lay, MedicalDirector of the Christiana Care
Wound Care Centers, andpodiatrist Dr Scott Rich.
Speaker 3 (00:47):
Jim and Scott.
Thank you both so much for yourtime today.
Speaker 1 (00:50):
Thank you for having us.
Thank you for having us.
Speaker 3 (00:52):
Can you explain the specialization of wound care and
why that may or may not bebetter for a patient, opposed to
just going to a primary careprovider to care for a wound?
Speaker 1 (01:02):
All of us have had the experience of having a wound
when we were young or growingup, or even in our adult lives,
where we cut ourselves, we put aBand-Aid on it.
It goes away.
But there are wounds that arenot like that and as we get
older, as we get other diseaseslike diabetes, or sometimes when
we have circulation problems,wounds don't heal.
(01:24):
Sometimes, you know, when wehave circulation problems,
wounds don't heal, and so it'sin those settings that the wound
care center provides anexpertise to help navigate those
wounds and try to get healingout of them.
Some people ask well, you know,how long do you have to have a
wound to come to wound carecenter?
And there's no hard or fastrule.
Sometimes people say, well, ifit's there for 30 days, you
should come, but there may besome wounds that people come
(01:48):
sooner than that.
If it's a big, bad wound, thatis going to need some help.
Speaker 2 (01:52):
We're talking about this in terms of Christiana
Care's wound care and hyperbaricmedicine.
Specifically, what setsChristiana Care apart, both
locally and nationally?
Speaker 1 (02:02):
I think Christiana Care has a wealth of clinical
skill sets available for thepatient.
We have plastic surgery, wehave vascular surgery, we have
many podiatrists, we haveinfectious disease doctors,
general surgeons, so there's alot of resources available to
employ these techniques that wedo to get the wounds to heal.
(02:23):
You know so some of ourpatients, you know, in certain
instances will need to have asurgery done to restore blood
flow, for instance to their legs, or they'll have.
You know, people have heard ofcatheterizations, heart caths.
Well, we do catheterizations onthe legs and we can actually
put stents in the legs and doangioplasty, which is the
balloon kind of a thing where weopen up arteries and all of
(02:44):
those things go into helping awound to heal.
We also, of course, have twocenters which are kind of
geographically convenient forpeople, and both of those
centers have hyperbaric oxygencapability, should that be
needed for a particular case.
Speaker 4 (03:02):
The Wound Care Center is a very specialized office
where that's all we see arechronic difficulty heal wounds.
We have a staff of wound carenurses who help manage these
patients on a daily basis.
We have a wide array of woundcare dressings, compression
wraps.
We have access to HBO and wehave access to numerous
specialists that are required orneeded for wound healing, like
(03:26):
infectious disease, podiatry,general surgery, plastic surgery
.
We also have a very specificdocumentation system where we
can monitor these wounds on aregular basis.
We take accurate measurements,we take imaging every time a
patient comes in, and thatallows us to evaluate our
progress or lack of progressprogress, for that matter in
which case we can easily changecourse or treatments.
Speaker 3 (03:50):
You mentioned the hyperbaric chamber.
Can you explain what thatentails?
Speaker 1 (03:54):
Hyperbaric oxygen is basically when you dive down
under the ocean, for instance,there's a pressure that you
experience, your body experience.
We talk about pressure at sealevel as being a certain
pressure.
We call that one atmosphere,and so when you go down under
the ocean that number increases.
(04:15):
If you go down to a certainfoot depth, you know, you can be
two atmospheres or two and ahalf atmospheres when you have
this kind of pressure, or twoand a half atmospheres when you
have this kind of pressure.
What happens to oxygen or othergases is that they're compressed
and some of those gases becomeliquid and so, with oxygen in
the body, normally oxygen goesthrough the bloodstream, through
(04:38):
a molecule called hemoglobin,and that's how it gets to the
tissue.
But when you do hyperbaricoxygen, you can actually get
oxygen into the liquid form,into the bloodstream and it goes
to the tissue.
But when you do hyperbaricoxygen, you can actually get
oxygen into the liquid form,into the bloodstream and it goes
to the tissues much moreefficiently.
When it arrives there it has amedical effect, a medicine
effect, and those effectsinclude helping to fight
infection, promoting healing,encouraging the growth of new
(05:01):
blood vessels so that the tissuecan become more healthy, and
one of the types of diagnosesthat we treat that don't always
have a wound involved isradiation injury.
So we do a lot of hyperbaricmedicine for radiation induced
soft tissue injury and thosediagnoses include sometimes,
like when people have radiationto the prostate they'll have
(05:25):
damage to the bowel or thebladder and they'll have
bleeding or pain.
That the hyperbaric ostrich canhelp to heal those conditions
and reduce the pain and thebleeding or whatever they have.
And we do it for radiation tothe head and neck area where
there's damage to the jaw or theteeth or different kinds of
things.
So it's really broad.
And of course we also do it fordiabetic foot ulcers of certain
(05:48):
types that have to have acertain severity level and also
bone infection.
We'll do it for bone infectionsnot responding to the normal
kinds of treatment.
Speaker 2 (05:58):
What sets ChristianaCare apart, both
nationally and locally, in thatservice?
Speaker 1 (06:08):
We are very careful to evaluate the patient, to have
the appropriate patient intothat treatment.
It is an expensive treatment.
It requires insurance approval.
If you look across the country,there can be quite a few
hyperbaric oxygen facilitiesthat don't always pay attention
to the evidence-based, what wecall evidence-based medicine,
which is, you know, what doesthe science say about the use of
(06:28):
this modality and how does itwork and who is it going to help
and who is it not going to help?
Because the last thing you wantto do is put a person through a
procedure and then they're nothelped by it, you know.
So there's that part.
There are many wound carecenters across the country, so I
think most metropolitan areashave wound care centers,
although I think it's veryimportant to have that local
(06:49):
resource available for people.
Speaker 3 (06:51):
Can you explain why it's so important that you have
this multidisciplinary team onstaff at the wound care center?
Speaker 1 (06:57):
If, say, for instance , somebody comes in with a foot
wound, normally they might go totheir community podiatrist and
that person would see them andstart to do care.
But if they wanted to get thatpatient seen by, for instance,
an infection doctor to deal withan infection issue, or perhaps
(07:17):
vascular surgeon to look at thearterial supply or even just
dealing with some of thespecialty care that we do, it
would take considerable time forthem to get into those people.
But when you have amultidisciplinary setting you
have easy, quick access to thesepeople.
If I need a patient seen by,for instance, a vascular surgeon
(07:41):
, quite often I can get thatappointment within a week or two
of the time that I decide theyneed that service.
Same with podiatry.
We have numbers of podiatristsin the wound care center.
So if I see a foot wound andsay I'm the intake doctor
because we use that term, thedoctor that takes the patient
into the care, does the initialevaluation I can know that
(08:02):
Scott's gonna be there onTuesday.
Or he's gonna be there onTuesday or he's going to be
there on Monday or Friday at onecenter or the other and we can
just say put them on Scott'sschedule this Friday and they're
right in there and we willoften see patients within a week
of the call for asking for anappointment.
Speaker 3 (08:18):
And Scott, you could be that podiatrist that Jim was
talking about.
How does that work day to day?
Speaker 4 (08:24):
So typically I see diabetic foot wounds at the
wound care center, but it's,it's typically.
I'm not the only person whowould see these, these
individuals.
I don't usually just prescribea dressing and and that's it.
You know, we have to evaluatethese patients from, say, their
vascular status, and they gothrough a vascular exam and very
commonly there's some vascularissues.
(08:46):
So I'll send these individualsto our vascular providers at the
center and then when theyfinish I'll see them back.
They typically have imagingdone and if there's an
infectious process they'll gosee infectious disease for help
with the infection, whether it'santibiotics through an IV or
oral antibiotics, and then ifthey need any kind of surgical
intervention, I can usually helpwith that.
Speaker 3 (09:08):
With all of those specialists within the wound
care center.
What are you seeing?
It sounds like a wide array ofwounds, then.
Speaker 1 (09:16):
Yeah, I think we see a combination of diabetic foot
ulcers.
For instance, we see quite afew leg wounds, which we call
venous stasis wounds.
These are wounds that occurbecause of the veins that drain
the legs and so there can beswelling in those legs and
(09:36):
inflammation.
So if there's a subtle injury,or even just no injury, a wound
can appear and then start todrain and not heal.
We also see sometimes woundsthat are based upon just purely
circulation, arterial problems,so that you know there's a wound
that develops maybe on apressure point and it doesn't
(09:58):
heal because there's not goodblood flow.
And another wound type of woundwe see is pressure ulceration.
So people who are less mobileor have some sort of neurologic
injury can have pressure ulcersbecause of the way they're
sitting or lying in bed.
This can result in a wound, andso we need to figure out how to
help them with that wound andget the pressure off of it.
(10:19):
The appropriate action.
So some of our wounds areinfected, some of them are not
infected, they're just openwounds.
Some wounds are from skincancer.
Some wounds are autoimmunewounds, we call them.
It's kind of a category ofwounds which basically simply
means if you have a wound thatis there because the immune
system is attacking the skin andyou make a wound and it just
(10:41):
gets worse and worse because theimmune system is attacking it.
Speaker 2 (10:46):
These sound like some really difficult and
challenging situations that youhave to deal with in treating
these.
What are some of thedifficulties you're facing
beyond that in these?
You know you're talking aboutwhat it takes to get the wound.
What are those challenges fortreating and curing the wound?
Speaker 4 (11:03):
One patient, compliance and managing other
chronic conditions that areneeded in order to heal these
wounds and, for example, a lotof these patients we see with
chronic wounds all have, many ofthem have other chronic
conditions such as, as Jimmentioned, diabetes, peripheral
vascular disease, neuropathy,which is numbness in the lower
(11:25):
extremity, and these issues andthese conditions need to be well
managed and maintained in orderfor us to be successful.
And you know, with that beingsaid, oftentimes patients are
very bogged down in managingtheir other chronic conditions
and they sort of put their woundcare on the back burner
sometimes and it doesn't getenough attention and
(11:48):
unfortunately this opens them upto things like infections, need
for hospitalization, risk ofamputation.
So those are a couple ofchallenges that we face in wound
care.
Speaker 3 (11:58):
What is the patient response to that, when you're
able to help them and withwounds that maybe otherwise,
they've been told are maybeuntreatable or just something
they're going to have to livewith?
Speaker 1 (12:10):
You know there's many stories you could think about
with patients who have woundsthat are not healing.
Come to the wound care center.
You know I've had patients thatcome in with severe pain
related to, for instance, whatwe call radiation cystitis.
So it's kind of like having aurinary tract infection but you
don't, and the antibioticdoesn't help you and you just
(12:30):
have pain and discomfort, maybesome bleeding, and you just have
pain and discomfort, maybe somebleeding.
And we many times see patientsby the end of their course of
treatment.
Their pain levels have gonedown, they're reducing their
pain medication, the bleedinghas improved.
So there's a lot ofgratefulness that people have
for this kind of treatment.
Speaker 4 (12:49):
We had a woman who was dealing with a chronic wound
on her heel for quite some timewell over six months and was
unable to be off of her footbecause of work and family
obligations.
We were able to see her and gether into a device called a total
contact cast, which isessentially a device which
allows people to walk whileoffloading or keeping the
(13:09):
pressure off the bottom of thefoot, and after all that time we
were able to heal her and she'dbeen doing quite well.
We had another patient we sawone evening in the ER who came
in unfortunately aftersustaining a traumatic lawnmower
accident and losing his big toeand resulting in a large wound,
and we were able to get himinto the OR that night and clean
(13:32):
the wound and effectivelydebride it into the OR that
night and clean the wound andeffectively debride it, create a
flap to help close the wound.
But unfortunately he walked onhis foot a little too much after
his procedure and the woundopened up.
So we were able to follow himat the wound center on a regular
basis and treat him with abiologic dressing called a skin
substitute and over a period oftime we were able to heal him
(13:52):
and he's been doing quite well.
Speaker 2 (13:54):
So if somebody is listening or watching this
episode and feels like they'restruggling with a wound that
goes beyond their typical, I cutmyself while making dinner
tonight and they're havingstruggle with it.
What advice do you have forthem if they're looking for more
advanced help?
Speaker 1 (14:11):
Well, anybody who has a wound, who wants to seek
medical attention in the woundcare center, can just call the
number and come, you do not needa referral.
Now, when I say that the cautionis, of course certain
insurances, you know, requirecertain paperwork to see a
specialist, but we do notrequire a referral in terms of a
(14:32):
person to be seen at the woundcare center.
We leave that up to the patientto know what their insurance
requires.
But they can come in forevaluation.
We'll have some patients thatcome in and we look at the wound
and we say you know, this woundis not so bad and we do
something and they're healedwithin one or two visits.
And then there are otherpatients, of course, that have a
more complicated situationwhere it's going to take a
(14:53):
period of time to deal with allthe issues that Scott has been
mentioning.
If there's a wound that's nothealing within a short period of
time, if you don't deal with it, it can often become a chronic
wound that has morecomplications, bone infections.
Then you start to getting intosurgery and taking things off.
That won't cure.
You know there's just a lot ofrisk, especially with the
(15:15):
diabetic ulcerations.
They can be very challenging totreat and you know we've seen
many patients that'll come inand say I've had this wound for
two years and what amazes us isthat something bad didn't happen
in that two years.
You know where a lot of otherpatients.
They had a wound one week andsomething bad happened, so you
(15:36):
can't always count on that, butthe point is that we're there.
We're available to help peoplewith wounds and hopefully be
able to give them good adviceand chart a pathway forward to
healing.
Speaker 3 (15:50):
Jim and Scott.
Thank you both so much for yourtime today.
Speaker 1 (15:53):
It was our pleasure.
Speaker 3 (15:55):
We'll have more information on the
ChristianaCare Wound Care andHyperbaric Medicine Center in
our show notes for today'sepisode.
Speaker 2 (16:02):
And don't forget to subscribe to For the Love of
Health on Apple Podcasts orSpotify.
And you can watch the videoversion of For the Love of
Health on ChristianaCare'sYouTube.
Speaker 3 (16:10):
We'll be back in two weeks with another great
conversation.
Speaker 2 (16:13):
Until then, thanks again for joining us for the
love of health.
If there's a wound that's not healing within a
short period of time, it canoften become a chronic wound
that has more complications.
Speaker 2 (00:09):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 3 (00:19):
Hello everyone, I'm Megan.
Speaker 2 (00:20):
McGerman and I'm Jason Tokarski.
Welcome to another episode ofFor the Love of Health, brought
to you by ChristianaCare.
Speaker 3 (00:26):
While most cuts and scrapes will heal themselves,
some wounds can develop into amore serious situation.
Speaker 2 (00:33):
In that case, you may need to see wound care
specialists.
Two of those specialists fromthe ChristianaCare Wound Care
and Hyperbaric Medicine Centerare joining us today.
They're Dr Jim Lay, MedicalDirector of the Christiana Care
Wound Care Centers, andpodiatrist Dr Scott Rich.
Speaker 3 (00:47):
Jim and Scott.
Thank you both so much for yourtime today.
Speaker 1 (00:50):
Thank you for having us.
Thank you for having us.
Speaker 3 (00:52):
Can you explain the specialization of wound care and
why that may or may not bebetter for a patient, opposed to
just going to a primary careprovider to care for a wound?
Speaker 1 (01:02):
All of us have had the experience of having a wound
when we were young or growingup, or even in our adult lives,
where we cut ourselves, we put aBand-Aid on it.
It goes away.
But there are wounds that arenot like that and as we get
older, as we get other diseaseslike diabetes, or sometimes when
we have circulation problems,wounds don't heal.
(01:24):
Sometimes, you know, when wehave circulation problems,
wounds don't heal, and so it'sin those settings that the wound
care center provides anexpertise to help navigate those
wounds and try to get healingout of them.
Some people ask well, you know,how long do you have to have a
wound to come to wound carecenter?
And there's no hard or fastrule.
Sometimes people say, well, ifit's there for 30 days, you
should come, but there may besome wounds that people come
(01:48):
sooner than that.
If it's a big, bad wound, thatis going to need some help.
Speaker 2 (01:52):
We're talking about this in terms of Christiana
Care's wound care and hyperbaricmedicine.
Specifically, what setsChristiana Care apart, both
locally and nationally?
Speaker 1 (02:02):
I think Christiana Care has a wealth of clinical
skill sets available for thepatient.
We have plastic surgery, wehave vascular surgery, we have
many podiatrists, we haveinfectious disease doctors,
general surgeons, so there's alot of resources available to
employ these techniques that wedo to get the wounds to heal.
(02:23):
You know so some of ourpatients, you know, in certain
instances will need to have asurgery done to restore blood
flow, for instance to their legs, or they'll have.
You know, people have heard ofcatheterizations, heart caths.
Well, we do catheterizations onthe legs and we can actually
put stents in the legs and doangioplasty, which is the
balloon kind of a thing where weopen up arteries and all of
(02:44):
those things go into helping awound to heal.
We also, of course, have twocenters which are kind of
geographically convenient forpeople, and both of those
centers have hyperbaric oxygencapability, should that be
needed for a particular case.
Speaker 4 (03:02):
The Wound Care Center is a very specialized office
where that's all we see arechronic difficulty heal wounds.
We have a staff of wound carenurses who help manage these
patients on a daily basis.
We have a wide array of woundcare dressings, compression
wraps.
We have access to HBO and wehave access to numerous
specialists that are required orneeded for wound healing, like
(03:26):
infectious disease, podiatry,general surgery, plastic surgery
.
We also have a very specificdocumentation system where we
can monitor these wounds on aregular basis.
We take accurate measurements,we take imaging every time a
patient comes in, and thatallows us to evaluate our
progress or lack of progressprogress, for that matter in
which case we can easily changecourse or treatments.
Speaker 3 (03:50):
You mentioned the hyperbaric chamber.
Can you explain what thatentails?
Speaker 1 (03:54):
Hyperbaric oxygen is basically when you dive down
under the ocean, for instance,there's a pressure that you
experience, your body experience.
We talk about pressure at sealevel as being a certain
pressure.
We call that one atmosphere,and so when you go down under
the ocean that number increases.
(04:15):
If you go down to a certainfoot depth, you know, you can be
two atmospheres or two and ahalf atmospheres when you have
this kind of pressure, or twoand a half atmospheres when you
have this kind of pressure.
What happens to oxygen or othergases is that they're compressed
and some of those gases becomeliquid and so, with oxygen in
the body, normally oxygen goesthrough the bloodstream, through
(04:38):
a molecule called hemoglobin,and that's how it gets to the
tissue.
But when you do hyperbaricoxygen, you can actually get
oxygen into the liquid form,into the bloodstream and it goes
to the tissue.
But when you do hyperbaricoxygen, you can actually get
oxygen into the liquid form,into the bloodstream and it goes
to the tissues much moreefficiently.
When it arrives there it has amedical effect, a medicine
effect, and those effectsinclude helping to fight
infection, promoting healing,encouraging the growth of new
(05:01):
blood vessels so that the tissuecan become more healthy, and
one of the types of diagnosesthat we treat that don't always
have a wound involved isradiation injury.
So we do a lot of hyperbaricmedicine for radiation induced
soft tissue injury and thosediagnoses include sometimes,
like when people have radiationto the prostate they'll have
(05:25):
damage to the bowel or thebladder and they'll have
bleeding or pain.
That the hyperbaric ostrich canhelp to heal those conditions
and reduce the pain and thebleeding or whatever they have.
And we do it for radiation tothe head and neck area where
there's damage to the jaw or theteeth or different kinds of
things.
So it's really broad.
And of course we also do it fordiabetic foot ulcers of certain
(05:48):
types that have to have acertain severity level and also
bone infection.
We'll do it for bone infectionsnot responding to the normal
kinds of treatment.
Speaker 2 (05:58):
What sets ChristianaCare apart, both
nationally and locally, in thatservice?
Speaker 1 (06:08):
We are very careful to evaluate the patient, to have
the appropriate patient intothat treatment.
It is an expensive treatment.
It requires insurance approval.
If you look across the country,there can be quite a few
hyperbaric oxygen facilitiesthat don't always pay attention
to the evidence-based, what wecall evidence-based medicine,
which is, you know, what doesthe science say about the use of
(06:28):
this modality and how does itwork and who is it going to help
and who is it not going to help?
Because the last thing you wantto do is put a person through a
procedure and then they're nothelped by it, you know.
So there's that part.
There are many wound carecenters across the country, so I
think most metropolitan areashave wound care centers,
although I think it's veryimportant to have that local
(06:49):
resource available for people.
Speaker 3 (06:51):
Can you explain why it's so important that you have
this multidisciplinary team onstaff at the wound care center?
Speaker 1 (06:57):
If, say, for instance , somebody comes in with a foot
wound, normally they might go totheir community podiatrist and
that person would see them andstart to do care.
But if they wanted to get thatpatient seen by, for instance,
an infection doctor to deal withan infection issue, or perhaps
(07:17):
vascular surgeon to look at thearterial supply or even just
dealing with some of thespecialty care that we do, it
would take considerable time forthem to get into those people.
But when you have amultidisciplinary setting you
have easy, quick access to thesepeople.
If I need a patient seen by,for instance, a vascular surgeon
(07:41):
, quite often I can get thatappointment within a week or two
of the time that I decide theyneed that service.
Same with podiatry.
We have numbers of podiatristsin the wound care center.
So if I see a foot wound andsay I'm the intake doctor
because we use that term, thedoctor that takes the patient
into the care, does the initialevaluation I can know that
(08:02):
Scott's gonna be there onTuesday.
Or he's gonna be there onTuesday or he's going to be
there on Monday or Friday at onecenter or the other and we can
just say put them on Scott'sschedule this Friday and they're
right in there and we willoften see patients within a week
of the call for asking for anappointment.
Speaker 3 (08:18):
And Scott, you could be that podiatrist that Jim was
talking about.
How does that work day to day?
Speaker 4 (08:24):
So typically I see diabetic foot wounds at the
wound care center, but it's,it's typically.
I'm not the only person whowould see these, these
individuals.
I don't usually just prescribea dressing and and that's it.
You know, we have to evaluatethese patients from, say, their
vascular status, and they gothrough a vascular exam and very
commonly there's some vascularissues.
(08:46):
So I'll send these individualsto our vascular providers at the
center and then when theyfinish I'll see them back.
They typically have imagingdone and if there's an
infectious process they'll gosee infectious disease for help
with the infection, whether it'santibiotics through an IV or
oral antibiotics, and then ifthey need any kind of surgical
intervention, I can usually helpwith that.
Speaker 3 (09:08):
With all of those specialists within the wound
care center.
What are you seeing?
It sounds like a wide array ofwounds, then.
Speaker 1 (09:16):
Yeah, I think we see a combination of diabetic foot
ulcers.
For instance, we see quite afew leg wounds, which we call
venous stasis wounds.
These are wounds that occurbecause of the veins that drain
the legs and so there can beswelling in those legs and
(09:36):
inflammation.
So if there's a subtle injury,or even just no injury, a wound
can appear and then start todrain and not heal.
We also see sometimes woundsthat are based upon just purely
circulation, arterial problems,so that you know there's a wound
that develops maybe on apressure point and it doesn't
(09:58):
heal because there's not goodblood flow.
And another wound type of woundwe see is pressure ulceration.
So people who are less mobileor have some sort of neurologic
injury can have pressure ulcersbecause of the way they're
sitting or lying in bed.
This can result in a wound, andso we need to figure out how to
help them with that wound andget the pressure off of it.
(10:19):
The appropriate action.
So some of our wounds areinfected, some of them are not
infected, they're just openwounds.
Some wounds are from skincancer.
Some wounds are autoimmunewounds, we call them.
It's kind of a category ofwounds which basically simply
means if you have a wound thatis there because the immune
system is attacking the skin andyou make a wound and it just
(10:41):
gets worse and worse because theimmune system is attacking it.
Speaker 2 (10:46):
These sound like some really difficult and
challenging situations that youhave to deal with in treating
these.
What are some of thedifficulties you're facing
beyond that in these?
You know you're talking aboutwhat it takes to get the wound.
What are those challenges fortreating and curing the wound?
Speaker 4 (11:03):
One patient, compliance and managing other
chronic conditions that areneeded in order to heal these
wounds and, for example, a lotof these patients we see with
chronic wounds all have, many ofthem have other chronic
conditions such as, as Jimmentioned, diabetes, peripheral
vascular disease, neuropathy,which is numbness in the lower
(11:25):
extremity, and these issues andthese conditions need to be well
managed and maintained in orderfor us to be successful.
And you know, with that beingsaid, oftentimes patients are
very bogged down in managingtheir other chronic conditions
and they sort of put their woundcare on the back burner
sometimes and it doesn't getenough attention and
(11:48):
unfortunately this opens them upto things like infections, need
for hospitalization, risk ofamputation.
So those are a couple ofchallenges that we face in wound
care.
Speaker 3 (11:58):
What is the patient response to that, when you're
able to help them and withwounds that maybe otherwise,
they've been told are maybeuntreatable or just something
they're going to have to livewith?
Speaker 1 (12:10):
You know there's many stories you could think about
with patients who have woundsthat are not healing.
Come to the wound care center.
You know I've had patients thatcome in with severe pain
related to, for instance, whatwe call radiation cystitis.
So it's kind of like having aurinary tract infection but you
don't, and the antibioticdoesn't help you and you just
(12:30):
have pain and discomfort, maybesome bleeding, and you just have
pain and discomfort, maybe somebleeding.
And we many times see patientsby the end of their course of
treatment.
Their pain levels have gonedown, they're reducing their
pain medication, the bleedinghas improved.
So there's a lot ofgratefulness that people have
for this kind of treatment.
Speaker 4 (12:49):
We had a woman who was dealing with a chronic wound
on her heel for quite some timewell over six months and was
unable to be off of her footbecause of work and family
obligations.
We were able to see her and gether into a device called a total
contact cast, which isessentially a device which
allows people to walk whileoffloading or keeping the
(13:09):
pressure off the bottom of thefoot, and after all that time we
were able to heal her and she'dbeen doing quite well.
We had another patient we sawone evening in the ER who came
in unfortunately aftersustaining a traumatic lawnmower
accident and losing his big toeand resulting in a large wound,
and we were able to get himinto the OR that night and clean
(13:32):
the wound and effectivelydebride it into the OR that
night and clean the wound andeffectively debride it, create a
flap to help close the wound.
But unfortunately he walked onhis foot a little too much after
his procedure and the woundopened up.
So we were able to follow himat the wound center on a regular
basis and treat him with abiologic dressing called a skin
substitute and over a period oftime we were able to heal him
(13:52):
and he's been doing quite well.
Speaker 2 (13:54):
So if somebody is listening or watching this
episode and feels like they'restruggling with a wound that
goes beyond their typical, I cutmyself while making dinner
tonight and they're havingstruggle with it.
What advice do you have forthem if they're looking for more
advanced help?
Speaker 1 (14:11):
Well, anybody who has a wound, who wants to seek
medical attention in the woundcare center, can just call the
number and come, you do not needa referral.
Now, when I say that the cautionis, of course certain
insurances, you know, requirecertain paperwork to see a
specialist, but we do notrequire a referral in terms of a
(14:32):
person to be seen at the woundcare center.
We leave that up to the patientto know what their insurance
requires.
But they can come in forevaluation.
We'll have some patients thatcome in and we look at the wound
and we say you know, this woundis not so bad and we do
something and they're healedwithin one or two visits.
And then there are otherpatients, of course, that have a
more complicated situationwhere it's going to take a
(14:53):
period of time to deal with allthe issues that Scott has been
mentioning.
If there's a wound that's nothealing within a short period of
time, if you don't deal with it, it can often become a chronic
wound that has morecomplications, bone infections.
Then you start to getting intosurgery and taking things off.
That won't cure.
You know there's just a lot ofrisk, especially with the
(15:15):
diabetic ulcerations.
They can be very challenging totreat and you know we've seen
many patients that'll come inand say I've had this wound for
two years and what amazes us isthat something bad didn't happen
in that two years.
You know where a lot of otherpatients.
They had a wound one week andsomething bad happened, so you
(15:36):
can't always count on that, butthe point is that we're there.
We're available to help peoplewith wounds and hopefully be
able to give them good adviceand chart a pathway forward to
healing.
Speaker 3 (15:50):
Jim and Scott.
Thank you both so much for yourtime today.
Speaker 1 (15:53):
It was our pleasure.
Speaker 3 (15:55):
We'll have more information on the
ChristianaCare Wound Care andHyperbaric Medicine Center in
our show notes for today'sepisode.
Speaker 2 (16:02):
And don't forget to subscribe to For the Love of
Health on Apple Podcasts orSpotify.
And you can watch the videoversion of For the Love of
Health on ChristianaCare'sYouTube.
Speaker 3 (16:10):
We'll be back in two weeks with another great
conversation.
Speaker 2 (16:13):
Until then, thanks again for joining us for the
love of health.
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