Transcription:
Hyperbaric Medicine for Non Healing Wounds

Melanie Cole (Host): Millions of people suffer needlessly from chronic non healing wounds such as those caused by diabetes, poor circulation, injuries and other conditions. Most wounds can be treated successfully by a primary care physician, however, when wounds have not healed after several weeks, they may require specialized care. My guest today Leticia Rodriguez. She is a registered nurse and the manager of the Center for Wound Care and Hyperbaric Medicine at Palmdale Regional Medical Center. Welcome to the show Leticia. So, who is at risk for wounds that do not heal on their own?

Leticia L. Rodriguez, RN, BSN (Guest): Well there are several patients at risk. Mainly it would be like diabetes, patients that have vascular disease which is that their blood flow doesn’t flow correctly. We also have patients that have cancer so they have had chemo and radiation, so their skin has had some difficulty where if they get a wound it is more difficult for them to heal. Usually there is underlying issues such as like an autoimmune disease. If you have an autoimmune disease and you are on some kind of steroids, that impedes the healing process. So, there is definitely a lot of issues that we check as far as underlying.

Melanie: So, what should people be on the lookout for? Whether they have diabetes and they have got a wound on their foot, they may sometimes not even know about, but if they have a wound; what should you look at when you see one of these things that would send up some red flags?

Leticia: Well, the main thing is to make sure that they are getting care. To be getting daily care as far as them taking care of it, whether they are cleaning it, whether they see their primary care physician and then at that point, the primary care physician will know when to send them to the wound care center which is within two to three weeks, that’s usually the good rule of thumb. If it is not healing, then they maybe need some kind of debridement or something stronger than just like a topical, maybe something like an antibiotic. But they should always be looking at the wound bed, making sure that it is not changing, if it is getting worse, if it is getting bigger, if they have increased pain, if they have swelling around it, redness, and heat.

Melanie: So, if they do that – do they try to do something about it on their own or is that the time to get in and see a provider??

Leticia: That’s the time to get in to see a provider. And if they are not available, we always tell our patients if someone is not available; we would rather you just go straight to the emergency room.

Melanie: So, people have these wounds, they have had them for a while, some of these red flags have been seen; now what can you do for them?

Leticia: Well, when our patients come in, they come in on a weekly basis. We do several things. Our treatments consist of topical debridements, advanced wound care dressings, we also do compression therapy and in some cases, we do casting. You know casting for pressure wounds where we want them to what we call is offload it; we don’t want them to be on their foot, so we will offload them with a cast. We also have some other advanced care therapies as far as skin substitutes depending on what stage of the wound it is at.

Melanie: So, tell us a little bit about hyperbaric oxygen therapy. People are hearing a little bit more about this. but it is really innovative, so tell us about it Leticia.

Leticia: Well, that is – first of all, that is an adjunctive therapy. It is not a standalone therapy. It is something that we do along with wound care. So, when our patients come in and if they have to have an indication; which there are several indications. One of them is like diabetes, that they have to have a diabetic foot ulcer, chronic refractory osteomyelitis, we have had patients that have had a failed flaps or grafts and we also have later effects of radiation, which consists of like osteoradionecrosis, radiation cystitis, radiation proctitis and also soft tissue radionecrosis. So, if you fall into those indications; then we use that as an adjunctive therapy. So, they come in for about 20 visits, usually is what we start with and it’s been very successful. We have even saved a lot of limbs from using our adjunctive therapy of hyperbaric.

Melanie: Tell us a little bit about how it works and what the patient can expect.

Leticia: Okay, well, it’s a tube and you can see through it. A lot of patients are very concerned like I’m claustrophobic, I can’t do it and once they get in there, they are very comfortable. They are going to be in there for about 90 minutes once they reach depth, which is usually about 33 feet of seawater. So, once they reach that in about 10 minutes, they are in there for 90 minutes at depth. And they watch TV. We put movies on for them to distract them or a lot of times patients take naps.

Melanie: And what does it feel like to be at that depth?

Leticia: We don’t have a lot of – if any concerns, patients will sometimes say it feels like they are in an airplane, if that makes sense. They get a little bit of pressure in their ears. But for the most part, people say they feel really good afterwards. They feel really refreshed.

Melanie: Are there any side effects?

Leticia: It would be the pressure of the ears. The pressure of the ears, some people just depending on what’s going on if they have allergies and we will have them take some kind of over the counter Afrin or something to help clear out the passages and sometimes that may not work, where it is a little more disruptive. But nothing major.

Melanie: And is there any information that the patient needs to let the technician know before they go into this oxygen therapy?

Leticia: Well, they actually have a visit prior to going in. They go in – we call that our education and our hyperbaric technician will actually sit down and go over everything with them as far as no jewelry, no perfume, no makeup. So, that’s all handled in advance so that way when they come in, they put on a gown and then they are able to go in, but as far as anything else; maybe some hardware or some kind or something that is sticking out, some kind of metal, maybe something like that. But not usually, that is usually all flagged beforehand.

Melanie: And how long, how many sessions does it usually take before they start to notice a difference in their wound?

Leticia: At least about two weeks. We do our visits five days a week, Monday through Friday and we do increments of 20, so sometimes patients only need 20 treatments. Sometimes it requires a little more and at that time, they will reassess – the doctors will reassess the patient and see if it this therapy is helping and we will coordinate that with their primary care physician and then we will do another 20.

Melanie: So, then let’s talk a little bit about some care for general wounds and bust up a few myths here, Leticia, because people are not sure whether they are supposed to, if they have injured themselves and they have an open wound; should they keep it covered, should they keep it dry and open to the air, is moisture for it good or bad. Speak about some of general wound care tips for us.

Leticia: Yeah definitely, that has been a misconception where I hear a lot of times the patients come in stating “Oh I am just leaving it open to dry, I want it to air out and to dry out.” Our theory is that you have to have a moist wound bed, not too wet, not too dry, but it is a moist wound bed and you do keep it covered. So, that way you are less susceptible to having any type of infection.

Melanie: And can you wash a wound? Can you put it under the water in soap and water, that sort of thing?

Leticia: Absolutely. What we do tell our patients is wash daily, hygiene is very important. We want them to take a shower, to make sure that they clean the wound and with a gentle soap. Sometimes a baby shampoo or with a soap that doesn’t have any type of scent. Nothing that has a lot of flowery scent or anything that is too strong. We want a light soap, but absolutely. Make sure that they clean their wound daily. Also, another rule of thumb is good health, maintaining a good healthy diet. Sometimes we have patients that if they are staying – if their wound isn’t healing as fast as we would like; we tell them to increase their protein. Protein helps with the healing process. We also give them a list of certain vitamins, vitamin C, zinc, those help with wound healing.

Melanie: And should they before they cover it, should they use Neosporin or Bacitracin? Do you like one over the other?

Leticia: No, not really. By the time they get here, we usually put them on some type of topical. We have several topicals and depending, if they are coming in and their wound is angry and red, the doctor will do a swab and at that time, we get those results and we find out for instance if this is an infected wound; we are going to find out what is susceptible and it may be a certain antibiotic like gentamycin or it may be – or it may not be susceptible, it may be resistant. So, that is how we determine the right fit for each patient.

Melanie: So, if we are at home, can we use one of those things Neosporin or Bacitracin or something when we are covering up our general wound?

Leticia: Yes, absolutely.

Melanie: And do you like gauze or Band-Aids if we are at home?

Leticia: Gauze. Gauze, unfortunately with Band-Aids, they do have a plastic cover so sometimes that will suffocate the wound. It will make it what we call maceration.

Melanie: That’s very interesting, so you don’t like those plastic covered gauzes either?

Leticia: No we don’t. No. What it does is it causes maceration and that maceration, it makes the wound too gooey and it builds that white color, do you know like when you are younger and you take shower or bath for too long your fingers turn a little white? That’s what we try to avoid.

Melanie: That’s so interesting. And so as long as they are looking at this wound, keeping it clean; what should they look for as far as infection?

Leticia: Like I spoke earlier of the redness. You are going to see if anything has changed. Anytime anything changes for the worse; that’s a big red flag to get in right away to either come see us or your primary care or if it is on a weekend, then get to an urgent care or an emergency room. If anything gets worse as far as pain, your pain level has increased or if the redness has gotten worse and it is bigger and the redness is actually moving up or you have some kind of line; any of that type of stuff. Swelling, odor, we explain to them if they have an odor or a drainage that is coming out that is not the same like they came in here one day they were fine and the next day something green is oozing; then that is when we tell them to come back in right away.

Melanie: That’s great advice because sepsis is a risk, right for an infection if you have an infection you can be at risk then for sepsis.

Leticia: Absolutely and that is when we send our patients to an infectious disease doctor, we send them to our emergency room and have them get treated with IV antibiotics.

Melanie: So, just in summary, what would you like to tell people who have nonhealing wounds and why they should come to Palmdale Regional Medical Center for their care.

Leticia: Well, I think one of the major risk factors that we see a lot here is diabetes, so we really try to teach our patients to make sure that they take care of themselves as far as doing daily foot care, making sure that they check their wounds and we do a lot of education and I think that is where we differ from a lot of other places is that we really do have genuine – we are really genuine about making sure that our patients do heal and we have amazing doctors. We have great physicians and a great staff. Our nurses are trained in wound care and here at our center, we see wounds differently. We offer advanced wound care. We see things where we try to find out what is going on with the patient. We see a patient as a whole. We don’t just see a patient for a wound. We want to find out, do you have diabetes? Are your blood sugars up to par. That is going to impede your healing process; vascular disease. If you have vascular disease; we want to make sure that you are on the right compression therapy and we coordinate with our doctors. We work with our primary care physicians and we also work with vascular surgeons, so if we send our patient for some studies and their ABIs come back out of range; then we refer them to a vascular surgeon to make sure that we get that dealt with. Because if the underlying issue isn’t dealt with; then they are going to have the repeat offenders. We are going to still keep getting those wounds.

Melanie: Thank you so much Leticia for being with us today. it is great information. So interesting to hear. You are listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit www.palmdaleregional.com . That’s www.palmdaleregional.com . Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.