Transcription:
How Can the Wound Care Clinic Benefit You

Progressive, respectful, mentoring, compassionate, these are the values of Palmdale Regional Medical Center. And now, we proudly present Palmdale Regional Radio. Here's Melanie Cole.

Melanie: Welcome to Palmdale Regional Radio. I'm Melanie Cole, and I invite you to listen as we discuss the Center for Wound Care and Hyperbaric Medicine. Joining me is Dr. Ian Cook. He's a wound care physician and a member of the medical staff at Palmdale Regional Medical Center. Dr. Cook, it's a pleasure to have you join us today. Tell us a little bit about the most common non-healing wounds that you see. What are some of the most common causes? What do you see in wound clinic?

Dr. Ian Cook: All right. Well, thank you for having me. At our clinic, we see many different types of ulcerations and wounds. The most common that we see are diabetic foot ulcerations as well as arterial ulcerations, which are due to lack of blood flow to the lower extremity; venous ulcerations to the lower extremity, which are secondary to swelling or varicose veins; pressure ulcerations in our paraplegic population as well as our bed bound population.

And we also see trauma wounds after they've been treated acutely. These can be deep lacerations, skin tears, dog bites, cat bites, as well as some post-surgical wounds that require healing from secondary intent, which means they heal from the inside out. And then lastly, we see some radiation-related injuries. These are secondary injuries after treatment for cancer with radiation therapy. They usually develop months to years after the injury. And I like to treat patients with these types of complicated wounds.

Melanie: Well, thank you for that. So, Dr. Cook, you mentioned diabetic foot ulcers. Why do people with diabetes have a special issue when it comes to foot health and wounds? How does some of these complications develop?

Dr. Ian Cook: Well, thank you for that question. Diabetic foot ulcerations actually can be quite complicated. So the diabetes itself can cause many different problems that can lead to a diabetic foot ulceration. One is that over time with diabetes, you develop neuropathy where you do not feel your feet well. And over time, when you're walking, you can develop pressure points that you may not be aware of. And sometimes, you can even have things in your shoes that you're not aware of that can then cause a wound on the bottom of the foot. In addition, diabetes can affect the microvasculature as well as the larger vessels. And you can develop decreased blood flow to the lower extremity and diabetes increases your risk for infection, if it is poorly controlled.

And so the combination of those three things can lead to significant wounds of the foot and lower extremity, and they can result in increased risk for amputation. An amputation can result in severe decreased function of life and increased risk for further amputation once an initial amputation has occurred. So monitoring with daily foot care, having a close followup with the primary physician as well as a podiatrist for general diabetic foot care and diabetic shoes is one of the most important things that our patients can do for prevention.

Now, if prevention does not work and they develop a wound, the earlier they can get to the wound care clinic the better. So if a patient notices a break in the skin on the bottom of their foot or development of the wound that is going through the skin into the subcutaneous layer, the earlier they can reach the clinic, the better, the faster their wounds will heal and the decreased chance of amputation the earlier a patient presents to wound care clinic for treatment.

Melanie: And what about non-diabetic wounds, the other kinds that you see? What are some red flags of a wound that is not healing, whether it's a bed-bound patient or, as you mentioned, diabetes or something else post-surgical? Tell us what some of the warning signs are and the red flags, things they would notice around the wound that would say, "I need to get in and see somebody."

Dr. Ian Cook: So a lot of these wounds start from a simple trauma, especially with our venous stasis ulcerations. Some of them primarily are caused just from the swelling alone, but a lot of times in our patients it'll be caused just by a nick on a coffee table or a dog that jumped up too excitedly and will tear the skin.

And our patients will be treated in our acute center, like an urgent care or the ER with Steri-Strips or sutures. But afterwards, the wound then opened. And so a one that's been present for more than week or within that week to two week range that has some redness around the wound that is open and not completely closing, those are wounds that would really usually need some additional care at the wound care clinic. And so I would say for those types of wounds, if you see something that's there for more than a week, that just doesn't look like it's closing or responding, an evaluation of the wound care clinic will help get that back on track.

The other ones are pressure ulcerations. Those are very much in the same type of category as a diabetic foot ulceration. They're different, but the point being is that the earlier they're treated and the earlier intervention is started the faster they will heal. And what you'll notice what on those is it's a similar category in that if you start seeing a break in the skin, that's through the subcutaneous tissue meaning the skin is open and you can see some fat tissue or some red tissue underneath, the earlier you can get in to the clinic for that the better. And what we do is we're really going to work on those pressure ulcerations on decreasing the pressure.

Now, if before a break in the skin and you're with a primary physician, it's about adjusting what type of offloading devices they have. Do they have an air mattress at home if they are bed bound? Do they have a special wheelchair cushion if they are paraplegic and using a wheelchair? Those are the preventive measures. And if those have already started to fail, returning to the clinic or coming to our clinic, we will assess those and write for new prescriptions if they need renewals or their first prescription, if they don't have one. And then we will treat the wound topically. So one, working on offloading. Two, then addressing the wound itself.

And the way we treat those types of wounds, and actually this is a modality that crosses almost all of the different types of wounds, is debridement of the wound, which is remove the devitalized and dead tissue with a surgical instrument, scalpel or curette. Before doing so, we will provide a topical anesthetic with lidocaine to provide numbing of the wound before any debridement. And then debridement, it sounds like an old term, but basically what happens is clean the wound, remove the dead tissue, remove any bacteria that's building up in the wound. And then we will treat that with a topical antimicrobial or a topical ointment with a dressing. And the combination of those along with the pressure reduction will promote wound healing.

And like most wounds, if you start the treatment earlier, the duration of treatment decreases. Some of our patients come to us that have had wounds for months or sometimes even years, the longer it's been there the general rule is the longer it'll take to heal. And so that's kind of the rundown for why to and what we're looking at doing at the wound care clinic.

Melanie: Such a comprehensive answer there, Dr. Cook. Thank you so much. like you to tell us a little bit about hyperbaric oxygen therapy. People hear about HBOT. They don't know what it is or who it's really beneficial for. Give us a brief little history of it, what you're doing with it. How do you use it and how does it help?

Dr. Ian Cook: Thank you. Well, so hyperbaric oxygen therapy, we do have here at our clinic and we follow strict Medicare guidelines on the use of hyperbaric oxygen. So we follow the medical indications and the science for it. We use hyperbaric oxygen for diabetic foot ulcerations that have been present for 30 days or longer despite adequate medical therapy.

So that would mean a wound that we have been treating that has been there for more than 30 days or a wound that comes from the community. So a primary care physician or their primary podiatrists could be treating the wound. And despite treatment, the wound has still persisted for more than 30 days. We would then treat that patient with hyperbaric oxygen if they're referred to our clinic. Some patients actually have their wound care still with their podiatrist and come to our clinic for hyperbarics only, we are happy to do that. Some of those patients are also referred by their podiatrist or primary care for both wound care and hyperbarics.

So the main criteria for the hyperbarics in terms of diabetic foot ulceration, specifically as a wound that has been present for more than 30 days, but not responding to standard wound care medical therapy. We also use hyperbaric oxygen therapy for radiation related injuries. And again, these are radiation-related injuries as a side effect or a complication of cancer treatment such as hemorrhagic cystitis, which means you have some bleeding in your urine. And these are common in patients that have had radiation therapy for prostate cancer or for uterine cancer and they have bleeding that often can cause anemia. These patients would respond to hyperbaric oxygen therapy.

We also see patients that have what's called osteoradionecrosis of the jaw or mandible, where they've had radiation therapy for oral cancer and they need a dental extraction and they're referred for oxygen before and after the dental extraction.

And these treatments last for about two hours. They're Monday through Friday and we reassess the patient's progress every 20 treatments. We're here every treatment, but we can renew and continue with the treatment after assessing on the 20th treatment. And we can repeat that process up to anywhere between 60 and 100 treatments, depending on the patient's medical condition.

And the main goal of this treatment is what we call angiogenesis. The oxygen in a hyperbaric chamber, you are actually sitting in a chamber that's clear, completely open in terms of the acrylic that you can look through and you are under pressure, like you would be in an airplane or driving up a hill. You'll feel that pressure in your ears and that causes your body to allow more oxygen, to be carried by your blood than is normally possible.

And that increased oxygen actually promotes what's called angiogenesis. It promotes your blood vessels to grow. And by doing that in a wound that is difficult to heal, it helps make blood vessels grow into that wound and therefore help that wound close. And in terms of radiation injury or bladder injury, it actually strengthens that tissue so it doesn't bleed when you urinate. And so it's really a remarkable treatment modality that we have available here at Palmdale.

Melanie: It certainly is. Thank you, Dr. Cook. As we wrap up, can you please offer your best advice for listeners about non-healing wounds and wounds in general really? And you can also summarize the Palmdale Regional Medical Center Wound Care Clinic. But tell listeners when they do get a wound, whether you even mentioned a dog bite earlier, what do we do right at the outset? Wash it? Are we supposed to leave it dry? Band-Aid? Cover it with a gauze? Use Neosporin? Give us just a brief little wound lesson and wrap it up with your best advice.

Dr. Ian Cook: Well, so if you receive a traumatic wound from a dog bite or a cat bite, please go to your urgent care or ER, your primary doctor for antibiotics, clean the wound out and provide a dressing. Any of your longer term wounds, you do want to keep them clean. You can use mild soap and water, but there's a lot of over-the-counter wound cleansers available. Do not use hydrogen peroxide, that's an old treatment. So use a standard wound cleanser or mild baby soap. And then dress your dressing. You can use Neosporin. We don't use that for long-term. But if you're using something for temporary, that's okay. And then contact our wound care clinic for an appointment. We do our best to get patients in the same week of appointment. We try to keep our wait times low.

And at our clinic also, if you've had a long wound or you're not feeling comfortable about your wound, we see every type of wound. Our patients are our main priority here at our clinic. We strive to make our patients feel comfortable. I have the honor of working with a great staff from the front desk all the way to nursing and management, who all care deeply about our patients. We respect your time and treat all of our patients with dignity. And our goal is for our patients to feel very comfortable coming here weekly for their wound care.

Melanie: Great episode, Dr. Cook. Thank you so much for joining us. For more information, please visit PalmdaleRegional.com/services/woundcare. And that concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Please visit our website at PalmdaleRegional.com for more information and to get connected with one of our providers.

Please also remember to subscribe, rate and review this podcast and all the other Palmdale Regional Medical Center podcasts. 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. I'm Melanie Cole.