Transcription:
Advanced Wound Care

Prakash Chandran (Host): Have you ever had a wound that seemed to take forever to heal? While most minor wounds can easily be remedied at home with first aid treatment, some wounds require more advanced care from medical professionals in order for them to heal properly and to prevent infections. We're going to learn all about it today with Dr. Ferial Abood, an Internal Medicine Specialist and Physician at Gerald Champion Regional Medical Center, and also the Medical Director of Advanced Wound Care since 2000. Welcome to the Champions for Wellness podcast brought to you by Gerald Champion Regional Medical center. We believe knowledge is the key that opens the door to a healthy life.

I'm your host, Prakash Chandran. So Dr. Abood, thank you so much for joining us today. I truly appreciate your time. I'd love for you to start by telling us what types of wounds actually require treatment and why.

Ferial Abood, MD (Guest): Well, there is many kinds of wounds and any breakage in the skin is a wound. And we usually try to treat all kinds of wounds, acute injuries, non-healing ulcers, which has been there for a long time. And people have tried different things over the counter and they don't heal. So any wound anywhere on the skin from head to toe is a wound for us.

Host: Okay. And in terms of treatment, like for example, I might get a paper cut. That paper cut might bleed. I might fix it with Neosporin anda Band Aid or something like that. At what point do I need to come to a wound care where you would see me?

Dr. Abood: If you see any signs of inflammation like redness or heat or swelling, then that is a sign of infection which patient has to go to their PCP or call us and come, we will see them.

Host: Okay. One of the things that we're talking about today is advanced wound care. What exactly is that?

Dr. Abood: Advanced wound care is treatment of wounds, which has been there for a while and non-healing. We have multiple treatment modalities in here. We try to save limbs. And save lives. We have a lot of diabetic patients who has a wound, which is not healing. So, we see those people on regular basis.

Host: Can you talk to us a little bit about who advanced wounds actually affects the most. You talked about non-healing wounds and some things that potentially affect diabetic patients, but can you talk about the demographic of people you see most often?

Dr. Abood: Yeah, the diabetic patient and diabetic foot ulcer is, is a very big number of patients. We have patients who have soft tissue radionecrosis, which is wounds caused by radiation therapy during cancer treatment. We have osteomyelitis, which open wounds to, osteomyelitis is like infection in the bone, which end up opening to the skin.

And those people is a chronic wounds too. Crush injuries, car accidents, post-surgery infection and non-healing surgical wounds is there. We have a lot of these wounds. And also we treat patients, post-surgery the patient who have stuff like in their mouth. Like they have radiation to their neck and they develop ulcers in their oral cavity which doesn't heal and affect their teeth.

Also we can do hyperbaric treatments for these wounds. So these also we take care of.

Host: Okay. And I definitely want to get into the hyperbaric treatment portion of this, but before I do, I just want to understand a little bit more about the chronic wounds. I think you mentioned the osteomyelitis is one of them. Are there other types of wounds that are chronic and are there any preventative measures that people can be aware of to stop them from happening?

Dr. Abood: Yes. Actually at any time there is infection anywhere, people have to attend to these infections and treat them before they become chronic. So sometimes after surgery you can develop pus coming out, things like this, you have to attend to these ulcers to take care of them immediately before they will become chronic.

Host: Okay. And when you say attend to them, what exactly does that mean? Is there pre-treatment at home before they come in? Talk a little bit about that process.

Dr. Abood: Okay. So if I develop infection after surgery, I had a knee replacement and it is red. It is inflamed. I don't sit at home and wait for it to heal. I immediately seek help because then they can take care of it immediately. And before it go and become really, get inside the bone, where it will be harder to treat.

Host: I bet you see that often because so often people just you know, see maybe a wound that turns red and maybe there's a little pus and they just assume that the body's going to handle it over time, but they really need to come in because sometimes that wound will become non-healing and it's much easier to treat earlier on than later. Is that correct?

Dr. Abood: Exactly.Yes.

Host: Okay. So talk to us about the various kinds of treatments that you offer. Like what's the first line measures of treatment and then what are the more advanced options?

Dr. Abood: So usually when the patient come we will see how the wound looks like. We usually take cultures and the start with different kind of modalities we have different kinds of ointments or dressings or you know, it's stuff, which we use first and then every week the patients will come and we we will reassess the wound and we will see the reasons why they are not healing.

And then we will modify it. We can use a skin graft, skin substitutes which we have a lot of those nowadays. Put a treatment plan for the patient. And if they are diabetic, we try to control how their sugar goes up or down and see what the patient is doing. We educate the patient about their diet and what they supposed to do and how to clean their wounds.

We treat the spouse or the family about how they do the dressing. If they cannot, we ask home health care to go to their house, to treat them. And then every week we will assess the wound. If the wound is not healing, we have to reinforce certain things, you know, about the patient developed plan and discuss it with the patient, discuss the plan also with their primary care physician of that patient.

And try to recognize why what is the reason the patients is not healing right. Then we offer to the patients like skin grafts or skin substitutes. Skin substitute can be like placental tissue which is made for this reason. We usually collaborate with their primary care, with their infectious disease doctor. We will give the recommendation and put the plan and discuss it with the patient. And if the patient agree, we will submit the order to their insurance. And once their insurance approve it, we will get the skin substitute and start applying it for the patient.

Some of these skin substitute, they give us permission to do 10 weeks or 12 weeks. So every week we will put for them until they heal. And we will see great progression in their healing with that.

Host: Yeah, that's pretty amazing. Now I want to graduate into the more advanced treatment. You mentioned hyperbaric oxygen therapy. Talk to us a little bit about what that is and the types of results that Gerald Champion Regional Medical Center has seen with this type of treatment.

Dr. Abood: So the hyperbaric oxygen therapy, we call it the HBO, is it medical treatment that use pure oxygen to enhance body's natural ability to heal. So, we use 100% oxygen under pressure, like two to three times greater than the atmosphere pressure in a chamber. It will be like a capsule, like a glass capsule.

The patient will be inside and they the oxygen with high pressure about the three times the atmosphere, it will cause 10 to 15 times increase in plasma oxygen concentration, and that will increase the tissue oxygenation. And this will be like for 90 minutes a day, 90 minutes to two hours treatment daily.

And we will say, for example, a 20 sessions or 30 sessions, it depends on what is the case. And we see a lot of improvement in the wound because the oxygenation help to bring the healing elements to that site.

Host: It sounds absolutely incredible. Like the future. Tell me, does it hurt, you know, when you talk about two to three times the atmosphere and someone has to be in there for two hours, what does it feel like?

Dr. Abood: Sometimes some patients feel ear pressure. So usually we ask them to swallow. It is just like flying in the airplane. Exactly like how sometimes your ears will you feel the pressure in your ears. Exactly. Some people do get anxiety because it is, it's a chamber, but it's a glass. It has a TV outside, which you can see and hear.

You can, you know, listen to music in the chamber. But people get sometimes they feel vision changes during the period they do the hyperbaric, but that is because of the pressure on the eyeball, but it's not painful. It is just, we tell them, don't go and check your vision until we finish the hyperbaric sessions, because it will go back to normal, but they feel the pressure in their ear sometimes. And it's not painful, but it is just like when you are in the airplane.

Host: Got it. And to be clear, there are no side effects right?

Dr. Abood: No, it does not side effects. It's just the pressure.

Host: Now you talked earlier about some of the first-line treatments being, you know, a potential skin graft. How do you distinguish between when to use this hyperbaric oxygen therapy versus the more traditional treatments that you mentioned?

Dr. Abood: Yeah, that's a very good question. Actually not everybody can go to the hyperbaric treatment. There is certain criteria or certain ulcers, which we have, we can do this, like, for example, like diabetic foot ulcer which is not healing. We can do that. If there is necrotizing fasciitis, which is like, the flesh eating bacteria. We can do for that one. For osteomyelitis, which is infection of the bone, we can do that. For a patient who has a skin graft and it doesn't seem like it is taken. Like if they have skin graft or skin flap, we can do that. If they have like acute occlusion of the artery in their limbs, we can do that.

The crush injuries to to the limbs, also we can do hyperbaric. Osteo radio necrosis, that is, I think I told you about this one is if they have radiation, for example, to their jaw or to their neck for cancer, then they develop ulcers in their mouth. We do hyperbaric to treat them, especially if they are going to have a tooth removed or something.

So dentist know about these. They send the patient, we do about to 20 sessions before they do any tooth surgeries or stuff on them. Soft tissue radionecrosis sometimes we have people who have ulcers, which is not healing at the site where they have the radiation done. The other thing is like sometimes we have people with the prostate cancer, they have radiation, after that they develop like rectal bleeding or persistent diarrhea or you know, stuff which show that they are affected by the radiation. We can help them get over that with the hyperbaric treatment. Also like bladder cancer patients and the prostate cancer patient, they can develop hematuria, which is a blood in their urine or incontinence. We can help them also with the hyperbaric treatment.

Host: It definitely sounds like very comprehensive care that you can get when you're doing advanced wound care. Just to close the conversation, you know, Dr. Abood, you've probably seen so many different patients, right. And you have a lot of experience in advanced wound care. What is one thing that, you know, to be true that you'd like to leave with the audience today?

Dr. Abood: We have many patients who was told that they need amputation and they come here and we save their limbs and save their lives.

Host: Wow. That's absolutely incredible. So if you have been told that amputation is required or the prognosis is much more dire; it makes sense to go to advanced wound care, to see you over there at Champion Regional Medical Center, because there may be another way. Is that correct?

Dr. Abood: Yes.

Host: Well, Dr. Abood, I really appreciate your time today. Thank you so much.

Dr. Abood: Thank you for having me. Thank you.

Host: That was Dr. Feriel Abood, an Internal Medicine Specialist and Physician at Gerald Champion Regional Medical Center. Also the Medical Director of Advanced Wound Care since 2012. Thanks for listening to Champions For Wellness, local caregivers, educating our community. If you've missed one of our podcasts, you can go to gcrmc.org/podcast.

My name is Prakash Chandran. Thank you so much. And we look forward to you joining us again.