Talk With Your Doctor - TWYD190916
Talk With Your Doctor - TWYD190916
>> good evening.
Welcome to "talk with your doctor."
I'm doug eberhart.
>> i'm dr. jeffrey jahrery at st.
Luke's health neck work.
>> 6,000,000 americans suffer from non-healing wounds.
>> wound care specialists are an important and valuable resource for patients severing pain and complications of non-healing wounds.
At one time on "talk with your doctor" we look at the treatment for non-healing wounds at st.
Luke's non-healing wound centers.
>> in a minute we'll be joined by our experts to take your questions.
"talk with your doctor" will be >> welcome back to the show.
They say that time heals all wounds.
How much time is needed may well depend on the size and shape of the wound, its location and other factors.
More on wounds from our panel of experts.
Let's meet them, please.
>> thank you, doug.
We have three experts with us, the first dr. steven bowers from wound care and hyperbaric medicine.
Next to him is dr. bern seen with the podiatrist office.
>> lastly we have dr. jaun carlos martinez.
Dr. martinez is a plastic and reconstructive surgeon that also takes part in wound care.
Steve, let's start with you.
When should someone seek out your wound care center?
>> we treat wounds considered chronic.
You can look at that from a timeframe perspective, some say four weeks, some say six weeks.
If you have a wound not following a typical sequence or pattern of feeling, you might want to consider that.
It may be a wound that has gotten larger over two weeks when it should be getting smaller, more drainage or those that have had an issue in the past.
They should come in quicker because we know what's going on with them.
We treat acute wounds, traumatic wounds, surgical wounds those more complex, not meant to treat a scrape on a healthy person.
What are the most common wounds, present?
>> surgical incisions that haven't healed properly.
Diabetic foot wounds are an important part of what we do.
We deal with vein arterial uncertainty.
Some patients have wounds that can be from cancer or auto immune diseases, that can be treated somewhere else inappropriately because they didn't know what they were.
That's where we can help out and get the answers on those things.
>> jaun carlos, what are the surgical options you can offer patients that come to our wound care center, realizing that not everyone needs surgery, correct?
>> thank you for having me on the show.
There are times wounds don't progress on the normal path and surgery is warranted because conservative methods are not getting the wound to heal.
We use skin graft or flap surgery when we borrow tissue from one part of the body to another to get it to a healing stage.
Very critical, patients with diabetes, smoking, prior cancer and radiation.
This type of procedure is live.
>> we covered the surgical options.
What are other treatments that don't involve surgery, steve?
>> sure, every patient that comes in, we assess their wound.
We want to remove nor necrotic tissue.
We want to be sure there is no inflammation, take it to the next level.
As dr. bernstein said, it's a venus ulcer we have to determine that.
If it's a pressure ulcer, some people can't get pressure off of the area.
We have to be sure they are on the right cushion, they are getting the right diet, enough protein.
Lastly, arterial, we have to make sure they have blood flow.
We have to get them back to us to expedite healing with standard wound care.
>> you mentioned that one of the more common things you see is a diabetic foot ulcer.
>> it's one of the most important things we do.
In the united states there is an epidemic in diabetics.
Studies show 25% of them get a diabetic foot ulcer at some point in their lifetime.
They have a chance of amputation.
>> i want to put up a disclaimer for the viewers.
This may be found graphic, so just a warning.
We'll have you talk us through the images.
>> you see two patients dealing with diabetic feet.
There is nerve damage that diabetics suffer from and the pressure, steve talked about, that's how they get the ulcers.
They are serious and they don't hurt.
That's a big thing they struggle with.
The important thing to know is when you have a foot ulcer, studies show a mortality rate of a foot ulcer five years is up to 50%.
If there is an amputation, 75%.
Treating them early and successfully is important.
Lots of reasons for amputation.
That's a chance to talk about the limb salvage program we have.
What makes it special?
>> it's an exciting program.
We are one of the first to put our specialists together you said one roof to increase the amount of amputations in the lehigh valley.
We have specialty for modalities, we customize a treatment plan to see if we can spare them an amputation.
As a plastic surgeon, we can borrow skin from the body, so it's an important part of the care of the patients.
>> you do a specialized surgery known as microsurgery.
What is that?
>> it's plastic surgery applying when one part of the body detaches and reconnects the blood supply to bring tissue to restore the wounds.
>> our skin is the body's first line of defense.
Sometimes that's compromised.
When it's minor and leads to something more serious, that's considered a wound.
We have more on this subject in just a minute.
Lukes s >> continuing our conversation on the subject, we do that with this question from jim in north hampton.
>> jim wonders, if he cuts his finger and it takes so long to heal, two to three weeks, what can be done?
>> it lingers.
>> two to three weeks is a normal healing time for even a small cut on a finger.
There are a lot of factors that go into that, how deep is the cut?
How long is the cut?
Three weeks is a normal healing time.
Some things you can do to speed up healing is number one, keep it clean.
You should always keep a wound covered and moist.
You can heal it twice as fast as if you cov leave it open to scab.
What happens, it will form a scab delaying the healing process.
>> how often should you change the dressing?
You don't need -- another thing way over used are topical antibiotics.
If the wound is clean, it doesn't look infected.
You should have no issues healing it.
>> we talked about the wound care centers in st.
Where are they located for viewers that don't know?
>> we have six wound care centers, one in allentown, one in our bethlehem hospital, quakertown, one in our warren phillipsburg hospital, miner's and one in the lehighton hospital area.
>> we are well situated throughout the valley.
>> does insurance cover these visits?
>> insurance covers wound care especially for chronic wounds, greater than 30 days.
Some treatment modalities may not be covered if a wound is healing normally.
A cut on the finger open two to three weeks, there are a lot of modalities insurance might not cover until we show it hasn't healed normally.
We get to the 30 or 45 day mark covering the modalities.
>> learning about the relationship between the wound and its healing.
We have a question from janine in slaightington?
>> janine wonders the success rate helping patients with complicated wounds?
>> success rate?
>> currently, that's one of the things we follow to let us know how good we are doing.
We are usually over 90% healing rate.
We also follow the national average since i have been the medical director, we have been above the national average every month.
>> jaun carlos, what makes our wound care center special compared to any wound care center?
>> it's the ability that we decided together that we have multiple minds together toward the same goal.
We can achieve more toward the patient.
We work together under the same roof at the same time to discuss and see the patient of single situations to have.
Coordinational care is a difficult task.
Patients are sometimes wheelchair bound and need a lot of transportation and travel for a long distance to see in the specialized.
>> so it's collaborative.
>> can you talk about the wounds you see that are not too common to people out there that maybe you treat?
>> in any given year, we have patients come in with a chronic wound on the lower leg for instance that won't heal.
They may have been treated by another physician.
They may have been doing things wrong like leaving it to the open air.
We look at it to realize it's open far too long.
We biopsy it.
There are half dozen cancers a year masquerade as wounds and we can get them appropriate treatment.
>> can someone enlighten us about a venus ulcer?
We have a picture.
>> we have another image coming up.
A venus ulcer, the underlying issue, the veins are not functioning properly.
The blood, instead of being pushed toward the heart, it's coming down toward the leg.
As you see, you get edema, swelling, and because of all of that blood pooling in the lower extremity, the blood starts to steep out and stains the skin.
When you have the edema, it pinches the capillaries and you develop a wound.
We clean that, get the right dressing on that, control the drainage and ultimately, it needs expression which pushes up out of the leg to allow it to heal.
The biggest concern is the occurrence rate is high.
Patients need to keep up with expression.
Not everyone likes wearing expression stockings.
They are hard to get on, hard to get off.
We see a lot of patients until we convince them to wear the expression.
Then usually, symptoms resolve.
>> important for the professionals to distinguish type of wounds.
From easton, stacey has phoned in.
Let's hear what she would like to know?
>> stacey would like to hear about h hyperbaric medicine and how it helps wounds?
>> we have hyperbaric chambers at five of our six facilities.
They breathe 100% oxygen.
Really, the key factor here is, we live at one atmosphere pressure.
It's a lot of pressure.
Going 33 to 50 feet into the ocean.
If you dove 10 feet down, you know the pressure you feel.
That allows the oxygen to be pushed into the liquid part of your blood.
That might be a diabetic foot ulcer, an area damaged by radiation.
We help with failed flaps and graphs to salvage what we can, as well with hyperbaric.
>> it enhances healing?
>> in the right patient, yes.
>> our panelists are here to assess the various situations that may arise with wounds and how best to deal with them.
Here comes another break on our show.
We'll >> we are back.
Time can be of the essence when it comes to treating wounds.
We have time to devote to the topic.
We have another question from the viewer, this one from debbie in allentown.
Let's hear it, please?
>> debbie is looking for what she should notice at the nursing home to prevent wounds.
>> so what to look for and treat them?
>> prevention of wound is a tasking manner for the patient, nursing staff and family members.
Patients at times are bed bound.
You have to prevent being in one position less than ten hours.
The skin is the culprit that causes the pressure injury.
>> we have a photo as well.
You want to talk about that?
>> some of the ulcers, they are successful at healing.
A small percentage didn't progress the way you wanted.
More importantly, when the bone is infected, it's difficult to get a wound to heal.
You have to provide a solution that requires surgery and general anesthesia.
We have to bring tissue to fill the wound and bring blood supply to heal wounds.
>> learning what is practical in addition to other things.
The next call comes from sam in philadelphia.
>> sam had radiation treatment which caused wounds.
How effective is hyperbaric treatment arrayeduation wound?
>> hyperbaric, there was a nice study a couple of years ago that show we heal or improve the symptoms in 70 to 90% of the patients we treat.
Ultimately, it's the best decision for a patient with a delayed radiation injury.
There are no good options out there.
It's a painless, low-risk procedure with good outcomes.
>> jaun carlos mentioned having to do with skin grafts or flaps to cover a wound.
There are substances you use for foot wounds, do you know?
>> sometimes a skin graft is the best way to handle it.
One way, we have technology now.
We can harvest an ep dermal.
It doesn't require a skin graft.
You can have a successful result without the risk of anesthesia.
We are excited about the things we are doing.
>> let's see what kind of exciting question we have next.
Lily in allentown is here.
>> lily had a mammogram showing scar tissue.
There is a throbbing sensation and wonders if she should be worried?
>> how old are you?
>> she's not there to answer the question, unfortunately.
>> at times of breast reduction, it's a common procedure.
At times, what will happen, to reduce the breasts, you have to decrease the volume and the tissue can become scared.
When you do a mammogram, it can be confused with a suspicion for cancer.
They are very good at this kind of difference.
The key is, if you have prior imaging, you can compare with something from before.
Going a year out after a breast reduction, they should be able to distinguish a real entity or a surgical change.
>> a throbbing sensation?
>> it can be fat necrosis.
Some area of the blood supply is not sufficient and will be heal.
If it doesn't, it may require surgery.
>> when you have hyperbaric chamber, is it necessary to put the entire body in the chamber?
The who will body goes in breathing the oxygen in the pressurized environment.
You deliver from tins out from the blood to the tissue.
There are are topical oxygen treatments which is a different thing.
To be considered hyperbaric, you are in the chamber, whole body in the chamber.
>> it's transparent.
>> clear acrylic tube, tv, put movies on.
>> takes away the feel of it.
>> dr. bernstein, diabetic, how often should they check for wounds?
>> if a patient is diagnosed with diabetes, they should check their feet every day for the rest of their life.
They should check to be sure nothing is there.
If it's a once or month thing, see the family doctor to verify.
We recommend against barefoot or any type of shoe that's not protected like sandals and flip-flops.
>> dr. martinez, looking to the future, what advances are you foreseeing in the area of wound care?
>> i think prevention.
Prevention is important.
Technology, microsurgery has revolutionized the way we treat -- especially in cases with radiation injury, things of that nature, i think microsurgery is able to make a significant impact and has done it over the last couple of years.
>> to many, understanding the issues affecting a person's ability to heal is as important as the treatment itself.
Thank you to the three gentleman for telling us about the different type of wound care and wounds.
We appreciate it.
We have another show for you next monday.
This involves gynecologic cancer, starting in a woman's reproductive system.
All women are at risk.
Next monday we discuss the treatment of various gynecologic treatment as well as survivorship.
What does successful treatment look like?
That is our show this evening.
We hope you will join us again next monday.
In the meantime, have a great night and a good week.
>> thank you, and goodnight.