Liz Unruh (Host): Hello listeners, and thanks for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare.

I'm your host, Liz Unruh, and joining me today is Elaine Papineau, who is an Advanced Practice Provider with the Riverside Wound Center. And today we're going to be talking about why some of our wounds may not heal.

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Host: Elaine, thanks for joining us today.

Elaine Papineau, DNP, APRN-BC, CWCN-AP: Thanks, Liz. I am happy to be here.

Host: Yeah. So can you tell us a little bit about yourself and your background with Riverside?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: I've been with Riverside for seven years when I came back to the area as an Advanced Practice Nurse that specializes in wound care.

Host: Okay, great. So you are an expert in what we're about to talk about today.

Elaine Papineau, DNP, APRN-BC, CWCN-AP: I like to think so.

Host: Yeah. So we're going to start with what exactly is defined as a chronic wound and how would it be different from like a typical cut or injury that would heal on its own?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: A typical cut or injury that heals on its own shows progress of healing. The drainage is decreasing, the pain is decreasing. The size of the wound is decreasing, and that should all occur within about one to two weeks for most wounds. When there's a chronic wound, the patient doesn't see signs of healing. The drainage is still heavy. They may still be having pain, redness, swelling around the wound area, and that would suggest that they need more assistance with their treatment plan.

Host: Yeah, I could definitely see that. Are there some common risk factors or causes, that may lead to a wound becoming chronic?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: Sure. If patients are diabetic and poorly controlled, if they smoke, if they have swelling, for example, cardiac patients that have congestive heart failure are more prone to swelling in their legs. A little bump or a little scratch can turn into a big deal, for all kinds of patients.

Host: Yeah, for sure. So let's say you think you have a chronic wound, and you end up at the wound center. Can you walk us through what happens when a patient first comes to the wound center with a non-healing wound? What does the initial evaluation look like?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: Initially they're greeted by our receptionist and then one of the nurses come out and brings the patient back to the clinic from the waiting room. That nurse will take their vitals, review their health history, review their medications for accuracy, they'll review their immunization history. And they will measure the wound. They'll document what the wound looks like, the amount of drainage, what their pain level is, if they're a smoker, if they're a diabetic, and they'll start some basic teaching of how to manage the wound and what to expect from the wound clinic.

When I come into the room, I explain to the patient that if their goal is healing, we want to see a 50% area reduction in the first four weeks of treatment. The literature indicates that if we're able to get that 50% area reduction in four weeks, 80% or better of the population, all types of wounds are healed by 12 to 16 weeks.

We want to get the patients healed as fast as possible because our skin is our first line of defense against infection getting in. So nice skin covering prevents infection.

Host: Yeah, for sure. I think that's a great thorough explanation of what happens when you come to the clinic. You've touched on these, how do conditions like diabetes or poor circulation complicate the wound healing, and how do you manage those challenges in your care plans?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: So we partner with not only the primary care physician, but the other specialists in the area to manage that diabetes tightly to get a very tight control. We like their A1C to be under eight. Preferably closer to 6.5 the better. The immune system works better, they build better quality cells to heal their wound. If they have poor circulation, we work with both vascular surgery and interventional cardiology to improve, if there's an opportunity to improve that blood flow, to help heal the wound.

Host: Yeah, I think that's great. Showing the collaboration that happens within the wound center. It's not just, you know, you and nurses. There's a lot of physicians that come in as well.

Elaine Papineau, DNP, APRN-BC, CWCN-AP: Absolutely. We, infectious disease, cardiovascular, and endocrine. The primary care to manage the other health issues. Podiatry, we work with the whole gamut.

Host: Yeah, for sure. I know that some people might look at their wound and be like, oh, it's, it's healing just real slow. There are sometimes that someone might not realize the importance of early intervention.

What signs should someone look for that might indicate that a wound is becoming chronic and needs professional care?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: If they haven't seen signs of healing within the first one to two weeks, they should consider seeking more advanced care. If they have chronic conditions, diabetes, heart issues, renal failure. If they have a history of having a non-healing wound before, those are all things that would drive coming into the wound clinic sooner, as opposed to later. If it has an odor, redness, pain, more drainage than what one bandage change a day is able to handle, that would indicate that they need to be seen.

Host: Yeah, I think that's really important things to consider and to think about when you have an open wound. We're going to take a quick break to hear about primary care. Consistency is being able to count on someone to be there when you need them. At Riverside Healthcare, your primary care is dedicated to be in your corner, helping you and your family stay healthy and thrive.

Find the right primary care provider for you@myrhc.net/acceptingnew. From annual screenings to well checks and everything in between, having a primary care provider that you can trust makes all the difference. And we're back. So you touched on being part of a bigger team. So this multidisciplinary team. Can you talk about the different players who are on the team and how you all work together in a little bit more detail?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: We try to be very collaborative with the patient as the center of our focus. We bring in interventionalists, other specialties as needed. Each patient may need a different either, specialty care provider or a different personality. We include vascular surgery to help revascularize, getting more blood flow to the wound, or if it's a venous problem, there may be venous interventions that they can do that help lower the pressure in the veins so that the blood returns better and the swelling goes down. We work with cardiologists to help get the edema down. They may be doing diuretic therapy or other medications that give the heart a better squeeze so that there's better blood flow to and from the wound.

We work with infectious disease to manage chronic infections. We work with many times, either general surgery, orthopedic surgery, podiatry to manage necrotic tissue, maybe there's bone exposed or hardware exposed from previous orthopedic surgeries or, podiatric surgeries. In order to help that wound heal, we may need to have that hardware removed and we go back to the source.

Host: Yeah, I think that's great to show that it is you know, like I said before, the multidisciplinary team that surrounds the wound center is really great. Are there certain types of treatments or therapies that are offered at the wound center that patients might not have access through just like a standard level of care?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: Yes, there is. We offer hyperbaric medicine. That's indicated for radiation tissue necrosis. We see a lot of diabetic foot wounds. We have special dressings that help manage not only the drainage but the odor. We look for comfort on application of the dressing and removal of the dressing because at dressing change times that can be very uncomfortable for the patient.

We, have special cell therapy that if we don't see our area reduction in that first four weeks, that we can put biologic cells that are growing in the lab on their wound to help them build their own new cells and heal their wound.

Host: Yeah, I think those are a lot of really unique opportunities that patients have at the wound center. And it's a great testament to, you know, especially having the hyperbaric oxygen therapy here in town; people don't have to travel for that. They can come just here to Riverside. I think that's great. From your perspective as a wound care provider, what do you wish more people understood about chronic wounds and the healing process?

Elaine Papineau, DNP, APRN-BC, CWCN-AP: That just because it heals slow doesn't mean they have to accept that. There are things that we can do in the wound clinic that help promote their healing and their comfort. Their buy-in to our treatment plan is very, very important. The individuals that follow the treatment plan as closely as possible, they achieve the best and fastest outcomes.

Host: Yeah, I think that's great. And it's important that we as patients also take responsibility for making sure that we're following the instructions of our providers. It's easy to be like, oh, I went and saw this person and they told me this, so it'll be fixed. But we also need to be a champion for our health as well.

Elaine Papineau, DNP, APRN-BC, CWCN-AP: Right. And we appreciate patients that come with questions because we can help alleviate their fears oftentimes. We encourage them to use MyChart to contact us or to call the clinic and we get back to them as fast as we can. I tell my patients that even if you're coming tomorrow to see me and you have a question today, I want you to call because if I can take that fear away, I want to do that as fast as possible.

Host: Yeah. Well, thank you for joining us today, Elaine.

Elaine Papineau, DNP, APRN-BC, CWCN-AP: Thanks Liz. I appreciate it.

Liz Unruh (Host): And thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. To learn more about the services provided by Riverside Healthcare, visit riversidehealthcare.org.