Michael R. Anderson, MD: Hello everybody and welcome to this episode of the FortCast, the official vodcast of Fort Healthcare. I am your host, Dr. Michael Anderson, ear, nose and throat doc and President and CEO of Fort Healthcare, and I am very excited to have our guest today. Dr. Guillermo Valenzuela, who's one of our wound and edema specialists.

Thank you for joining me on today's episode of FortCast, Dr. Valenzuela. Please, I've been with Fort Healthcare for a little over 20 years. Maybe just tell us a little bit of about how long you've been with Fort Healthcare.

Guillermo Valenzuela, MD: So right now, it's been almost two years, uh, since started here. Very happy, that I made this decision.

Host: Trust me, we're happy too. And it's amazing how two years can go so fast. It feels like you just came to our campus yesterday, but we're very excited to have you. You do an amazing job taking care of our patients and community. Now being a wound specialist, Dr. Valenzuela, can you tell us a little bit about your educational background and kind of what, how you ended up doing wound and edema.

Guillermo Valenzuela, MD: Yeah, so well, I'm an internal medicine trained physician. Previously trained in general surgery in Venezuela, where it is where I come from. When was an internal medicine resident, I, and always I had a passion for wound healing, so I decided that I was the field that I wanted to go into.

 I did my research about, how to further train in this other than, you know, being a surgeon and an internist. And I found out that I could pursue fellowship in wound healing and tissue repair. There's actually a few fellowships the country and I was glad I was able to get a position in one of those. And that's how I became a wound healing and repair doctor.

Host: I would really like to highlight that you've had a great deal of education behind being a wound specialist. When people go the internal medicine route, just for our listeners and viewers, that is the gateway to other specialties like cardiology, like pulmonology. So to become a wound specialist is a pretty significant training period. Well, we're very happy that you decided to go that route.

Fort Healthcare's Wound and Edema Center is pretty unique, in that, we're very fortunate to have somebody with your fellowship-trained expertise leading that wound and edema team. Tell us a little bit about what kind of wounds you typically see. And also, when do you see patients and or other physicians refer patients to you?

Guillermo Valenzuela, MD: So as a wound doctor, typically,

 we treat every single wound, right? Most commonly, going diabetic foot ulcers, venous leg ulcers, which are pretty common. We also treat those chronic surgical non-healing wounds that for reason stopped their normal healing. also treat radiation wounds, for our patients that unfortunately have cancer and to go through radiation therapy. That's very common and any wound that has not healed in the normal healing rate, that should be 4 to 6 weeks. Patients normally self-refer most of the time because they see that wound is not healing. But we also have a great deal of patients are being referred, especially by podiatry, by family practice, or by surgeons, which, have already worked on this some time and they don't know else likely can be done on the wounds.

Host: So you would say that typically ulcers of the skin. Those are a big demand for that, non-healing. And did I hear that? If it doesn't heal within four to six weeks, that's typically when you get involved?

Guillermo Valenzuela, MD: Yes. And that's kind of like the common time. Not that that there is a set amount of healing time, but you know, in the standard normal patient, a wound is taking more than four weeks to heal, then we to look into why is this this wound not healing? And that's where my training comes in handy.

Host: So let, let's talk a little bit about that. So say somebody has has a wound that isn't, healing within four weeks, five weeks, and they come to see you, whether it's self-referred or another physician is just saying, hey, can you help me out with this? What are the number one and two causes of that non-healing wound?

Guillermo Valenzuela, MD: So, when I see a for the first time and they come with a chronic wound, the main first thing I do is not just look and ask about the wound. It's about the whole patient itself, right? What's the past medical history, past surgical history? What's going on besides the wound that can be playing a role in this? That's basically the main thing. But then you have to go into kind of main characteristics of the to know is this under control not?

And then we're talking about patient is diabetic or not. If have peripheral arterial disease or good blood flow area. If they smoke not. You know, they're on any kind of a special treatment, like immunosuppressive medication or if they have an autoimmune disease. Also, if there is infection or there a lot of pressure, external pressure being applied to the area where the wound are. So you have to take care of all these areas, kind have them under control and then see if the wound is healing or not.

Host: I'd like to highlight that for a moment. So your background and your education, being an internist is, is extremely helpful in this because it sounds like there's a lot of preexisting or chronic conditions that can lead to a patient being a little bit more vulnerable to a chronic wound. And I, and I think I heard you highlight diabetes, vascular issues, whether it's arterial or venous, potentially autoimmune diseases that are underlying, that all contribute to wounds not healing. So that is very important to assess on the patient first and foremost.

Guillermo Valenzuela, MD: Yes, and I think I am actually pretty happy I was able to the opportunity do the both trainings, right? Surgical and medical. Because I like I can combine best of to treat wound. Majority wounds are going to a medical component. But the surgical component, also it's important. And my training allows me to act on that too. A lot of patients believe that, you know, my diabetes is under control. So I have no issue. But then suddenly they develop ulcer, right? And that's when you tell them you know the damage, was already done, even if the diabetes was controlled or not. So, it is very important, you know, patient education which we also do, and prevention. That's another main part of this clinic too, to do prevention or have to prevent ulcers. How to, you know, if you already have one, what do you do next when start noticing that there is a blanchable spot your skin or if you fall again, what to do? A common thing we also have patients that go to the emergency department because they have cellulitis or a little blistering on the stuff. A majority of the time it's not actually wound related, it's actually heart related. Right. Because leg swelling and the stuff. So majority of the time, is a clinic where those things get diagnosed and then patients get appropriately referred. But it is very important to find why is the wound there. I always say this to my patients, and that the wound is a symptom of something else happening in the body, not just a wound that just appeared.

Host: One thing I'd, I'd like to ask you a little bit more about is you've been able to bring some pretty cutting-edge wound treatments to Fort Healthcare and to our patients and community. So once you've actually assessed the chronic conditions or maybe predisposing factors of the patient, and now you're focused on the actual wound itself, can you just highlight a couple of the advanced wound abilities that you bring to help the wound close. And now I just want to say that I have a feeling that each one of these could be their own vodcast, but if you could just give us, just an, an overarching view of some of the advanced wound healing techniques that you have at your disposal.

Guillermo Valenzuela, MD: So, before I answer that I would like to add that a lot of patients and other providers, sometimes think that wound care clinic is just a place where we change bandaids and put some on and that's not the case. The case is that we have of advanced treatments to heal and help a wound. Main ones obviously are dressings, but we're not talking just basic dressings that are sitting shelf.

We're talking dressings that can help by enzymatically debride a wound. We have sharp debridement, which is the surgical part of this wound care, ultrasonic debrider, where we can take bad tissue, preserving the good tissue, and also stimulating the wounds to heal. We also have hyperbaric oxygen therapy that can help lot of wounds heal. Most importantly too, we have skin substitutes, which are used after we have tried conservative wound care, but hasn't helped. Then we can jump into that specialized, tissue-based products that are very good. Have a wide range from pig placenta to fish skin to actual cadaver skin that we can use this clinic. On top of that, we also have other cold energy based, therapies for wound healing, which are mist ultrasound for wounds that very painful or, I'm working on getting electrical which is also proven help with chronic wound healing.

And also for debridement, we can use, something called bacterial fluorescence imaging, is a device that helps us see bacteria be that we cannot see to the naked eye and do targeted debridement right to, instead of diagnosing wound with infection, we can even catch it before even starting a patient on antibiotics. Also, regular treatments that are, the most common conservative treatment. But pretty much that's it.

Host: Dr. Valenzuela, that was quite the list. And one thing I'd like to circle back to is when you say debridement of a wound, what does that mean and why is it important to healing?

Guillermo Valenzuela, MD: So debridement a wound means basically we clean the wound either by a mechanical way or sharply, right? That's what we call surgical debridement. It is important because every wound, it's what we call colonized with bacteria on a their little house, as call called biofilm. If we do not control the then we are letting the wound get, colonized or infected. And is to to be of main issues why wounds are not healing.

why in every visit, patients are most likely going to get debrided or, clean, wound, to help them heal. The debridement also stimulates, tissue to grow and also resets the wound every time, telling your brain that, oh, we an acute we have to act this and clean. Because chronic wounds are kind of sitting there. The is not paying too attention to them. This is our way to tell the brain, hey, I have something here you need to work on.

Host: Dr. Valenzuela, I'd like to ask you another question centered around potential amputation. So I know sometimes people have non-healing wounds on their, particularly in their lower extremity. And it can lead to discussions on amputation. Do you see those patients? And you do, are there measures you can take to hopefully prevent amputation from happening?

Guillermo Valenzuela, MD: For sure. Those patients are part my panel. Wound care a multidisciplinary specialty. Not only we can catch and prevent big issues amputations, but also, you know make the referrals time. And when I talk about appropriate referrals, I'm not talking about only vascular surgeon for an but also, people that have arterial disease that, you know, are preventing blood flow to the area the wound so can get evaluated and treated with angioplasty or et cetera. Same for people that, come wounds that are not healing and they've been there for years. And then, we get a biopsy, they turn to cancer. So way, we patients to for their appropriate treatment.

We can also, you know, avoid amputations by avoiding infection and having proper workup and treatment of, bone infection, which can happen if you have chronic ulcer on the foot, or any other area on the body.

Host: I think what I heard there, Dr. Valenzuela, is you have a lot of disciplines available to help prevent an amputation. Whether it's something you can do yourself or if you get a vascular surgeon involved and improve the vascularity of the wound.

Those are all techniques where you can really help prevent an amputation from happening.

Guillermo Valenzuela, MD:  Yeah, only not taking of wound, but our ultimate goal limb salvage. Uh, that's like to tell my patients, to always know that not wound but to prevent the future complications.

Host: And then also I'm just curious, when do you consider the hyperbaric oxygen therapy?

Guillermo Valenzuela, MD: Hyperbaric oxygen treatment, it's been widely used for a long time now. However, there are certain diagnoses that are approved by Medicare to use.

One of most common ones or the one we most is for diabetic foot ulcer that have certain criteria met, like infection, haven't healed 30 days. Then that's one the indications to put patients in a chamber.

The goal the chamber is to basically them there breathing 100% oxygen, which at point, oxygen becomes a drug, right? Helping with decreasing inflammation, helping

 with chronic infection, and also creating new blood vessels, are very necessary wound healing.

Host: Thank you for that. Yeah, I, I learn so much in talking you just in our day-to-day interactions. But the hyperbaric oxygen treatment is pretty important to, to wound healing as well. I tell you, Dr. Valenzuela, thank much for joining us on this episode of The FortCast Vodcast. So, thank you.

Guillermo Valenzuela, MD: Thank you for having me.  

Host: And I also want to thank to our listeners and viewers,

Please, if have a non-healing wound or a loved one or friend has a non-healing wound, please reach out to Dr. Valenzuela for further treatment.

 Thank for to today's. Please share us on your social media platforms and have a great day.

I look forward to seeing you again.