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Wound Care
Dr. Michelle Ribas discusses wounds and how to take care of wounds so they heal properly.
Featuring:
Michelle Ribas, MD
Dr. Michelle Dulude Ribas is a general surgeon with a broad spectrum of general surgery and extensive knowledge of emergency general surgery, trauma, critical care and wound care. She is currently Chief of Surgery at Twin Cities Community Hospital in Templeton, California. Dr. Ribas earned her Doctor of Medicine from the University of California at Davis. She completed her general surgery residency at Kern Medical Center in Bakersfield, California. After completing her training, she joined Associated Surgeons of San Luis Obispo. Dr. Ribas is a member of the American College of Surgeons, Society of American Gastrointestinal Endoscopic Surgeons, American Society of Breast Surgeons and the American Board of Wound Management. Dr. Ribas and her husband have three young sons. Transcription:
Prakash Chandran: We tend to think that all it takes to heal a wound is a bandage and keeping it clean. But for some non healing wounds are real problem that require extra care and attention. We're going to learn about it today with Dr. Michelle Ribas, the Chief of Surgery at Twin Cities Community Hospital. This is Healthy Conversations. The podcast from Tenant Health Central Coast. I'm Prakash Chandran. So first of all, Dr. Ribas, it's good to have you here. Why exactly do some wounds require extra specialized care?
Dr. Ribas: Thank you for having me. Everyone is different. And it depends on the patient's health. So if a person has other medical problems like diabetes or their arteries are not healthy, it poses a problem for the wound to heal. Other things that people usually don't think about is nutrition, having a high protein diet really helps heal the wound or infections.
Host: And why is that? Like for example, you mentioned someone with diabetes, it may take longer for the wound to heal. Does it have something to do with the blood?
Dr. Ribas: Exactly. So, in order for one to heal, you need really good oxygen supply and that has to do with arterial flow of the blood, and it also needs a good venous return, which has to do with the blood getting out of that area. So a lot of the times if the person has problems in either one, it just doesn't get enough oxygen or has a lot of swelling, and that causes a problem.
Host: Okay, that makes sense. But I'm curious as to what a non healing wound looks like and if anyone can fall into this category or if it applies to specific types of wounds?
Dr. Ribas: No, all wounds require good oxygen supply. A wound that doesn't heal it usually takes longer than four weeks. And it just gets worse. So if you get any kind of injury or pressure or trauma that causes a wound, most people are able to heal it. But if it takes longer and the wound itself, it can grow or it looks dirty or like I said, infected, that that's when people get into problems.
Host: I see. I was just going to ask you about some of the signs and symptoms that a wound isn't healing. So if I'm hearing you properly, if a wound doesn't seem to be getting better after four weeks, then it might be time to see someone about it. And what are some of the things that they should look for around the wound to let them know, you know, it's really becoming a problem?
Dr. Ribas: Yeah. So increase pain, drainage, and changes in color. Healthy wounds or pink or red. So if it's yellow or green, those are problems.
Host: If someone suspects that their wound is not healing and exhibit some of the symptoms that you mentioned, what should they be doing?
Dr. Ribas: So seeing their primary care providers, the first step, there is many options in the community and one of them is having home health where there's a nurse that goes to their house and is able to recommend different dressing changes or clean the wound. There's always some wounds that need more advanced treatment, like surgical, debridement’s where we clean the wound out and if the wound continues to not heal, there is a wound clinics. Where there are special physicians like me that we can see the wounds every week and suggest different treatments if it's not healing appropriately.
Host: Yeah. You know, I didn't, I never knew that there were wound clinics before. So it's interesting to hear about them. So let's say someone sustains a wound and they happen to be diabetic, what should they first be doing to treat their wound locally before coming in to see someone?
Dr. Ribas: Yeah, the most important things to keep it clean and try to avoid what caused the wound. A lot of diabetics have less sensation in the feet, so they tend to get a lot of wounds on their feet. So having proper foot care, kind of watching your skin, keeping it clean and controlling your sugars if you're a diabetic will help.
Host: Okay. And you know, another thing that I've noticed before is whenever I get a cut or a bruise, you know, sometimes I'll resort to things like Neosporin or some of the over the counter medicines that help the wound heal faster. What are your thoughts on those?
Dr. Ribas: It does help a lot of the problems with the one if it gets too dry and the good cells die around it. So you want the wound to have some good moisture and that's where the Neosporin helps because it keeps moisture and it combat some superficial bacteria. So for, to start, if you notice that you cut yourself and cleaning it well, putting a little Neosporin and covering it, it's a good start. Again, people that have other medical problems like diabetes or bad arteries, just keep watching it because they wound can get worse fast.
Host: And tell us a little bit about the most common wounds that you see coming into the wound clinic.
Dr. Ribas: Yeah. So the, there's four most common wounds, I would say. One is diabetic wounds, like I said, due to lots of sensation. They tend to get ones in their feet. The second one are arterial wounds. And that's when people don't have good circulation and you know, scratched their legs or, and it tends to last a lot longer. And then venous wounds, which is due to the blood return. So the swelling of the legs and a lot of people suffer from this just as we get older, our veins don't work that well. So the, our legs get swollen and that doesn't let the wounds heal. And then the last one is pressure ulcers from people that are either paraplegic or tend to have the same position. So that affects the skin and it creates a wound.
Host: So as we wrap up here, let's talk a little bit about prevention. Is there anything that people can do to prevent the onset of non healing wounds?
Dr. Ribas: Yes. Again, like we mentioned a little before, it's doing checks on your skin. A lot of the diabetics don't feel it. So just having a daily routine at the end of the day or after a shower, just making sure that you don't see any areas that are red, and going to check your feet and your legs or appropriately check if they have somebody check their backs. Most of those chronic conditions, the chronic wounds start over time. So if they can make sure they check their skin and if there is something that they noticed, like it's red, just check the area, either get a new shoe or get a covered pad to prevent the area from getting into an infection or a wound.
Host: Okay. And you know, you see so many people with non healing wounds. I'm curious as to the one piece of advice that you wish more people knew before they came to see you.
Dr. Ribas: I think one of the biggest things that there is help, it's sometimes to me, it may seem that people deal with this wounds for years before they come in. And they're just used to it. And there is so many different treatments nowadays, that we can apply and you know, STEM cells, the skin substitutes to try to help them. So, and now we have resources here in the communities. There's definitely help, so if somebody is dealing with a wound that has not healed, like I said, for about four weeks and they should contact their physician.
Host: All right, Dr. Ribas really appreciate your time today. It's been very informative. That's Dr. Michelle Ribas, the chief of surgery at Twin Cities Community Hospital. Thanks for checking out this episode of Healthy Conversations, for a referral to Michelle Ribas or another provider call the Tenant Health Central Coast Physician Referral Line at (866) 966-3680. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.
Prakash Chandran: We tend to think that all it takes to heal a wound is a bandage and keeping it clean. But for some non healing wounds are real problem that require extra care and attention. We're going to learn about it today with Dr. Michelle Ribas, the Chief of Surgery at Twin Cities Community Hospital. This is Healthy Conversations. The podcast from Tenant Health Central Coast. I'm Prakash Chandran. So first of all, Dr. Ribas, it's good to have you here. Why exactly do some wounds require extra specialized care?
Dr. Ribas: Thank you for having me. Everyone is different. And it depends on the patient's health. So if a person has other medical problems like diabetes or their arteries are not healthy, it poses a problem for the wound to heal. Other things that people usually don't think about is nutrition, having a high protein diet really helps heal the wound or infections.
Host: And why is that? Like for example, you mentioned someone with diabetes, it may take longer for the wound to heal. Does it have something to do with the blood?
Dr. Ribas: Exactly. So, in order for one to heal, you need really good oxygen supply and that has to do with arterial flow of the blood, and it also needs a good venous return, which has to do with the blood getting out of that area. So a lot of the times if the person has problems in either one, it just doesn't get enough oxygen or has a lot of swelling, and that causes a problem.
Host: Okay, that makes sense. But I'm curious as to what a non healing wound looks like and if anyone can fall into this category or if it applies to specific types of wounds?
Dr. Ribas: No, all wounds require good oxygen supply. A wound that doesn't heal it usually takes longer than four weeks. And it just gets worse. So if you get any kind of injury or pressure or trauma that causes a wound, most people are able to heal it. But if it takes longer and the wound itself, it can grow or it looks dirty or like I said, infected, that that's when people get into problems.
Host: I see. I was just going to ask you about some of the signs and symptoms that a wound isn't healing. So if I'm hearing you properly, if a wound doesn't seem to be getting better after four weeks, then it might be time to see someone about it. And what are some of the things that they should look for around the wound to let them know, you know, it's really becoming a problem?
Dr. Ribas: Yeah. So increase pain, drainage, and changes in color. Healthy wounds or pink or red. So if it's yellow or green, those are problems.
Host: If someone suspects that their wound is not healing and exhibit some of the symptoms that you mentioned, what should they be doing?
Dr. Ribas: So seeing their primary care providers, the first step, there is many options in the community and one of them is having home health where there's a nurse that goes to their house and is able to recommend different dressing changes or clean the wound. There's always some wounds that need more advanced treatment, like surgical, debridement’s where we clean the wound out and if the wound continues to not heal, there is a wound clinics. Where there are special physicians like me that we can see the wounds every week and suggest different treatments if it's not healing appropriately.
Host: Yeah. You know, I didn't, I never knew that there were wound clinics before. So it's interesting to hear about them. So let's say someone sustains a wound and they happen to be diabetic, what should they first be doing to treat their wound locally before coming in to see someone?
Dr. Ribas: Yeah, the most important things to keep it clean and try to avoid what caused the wound. A lot of diabetics have less sensation in the feet, so they tend to get a lot of wounds on their feet. So having proper foot care, kind of watching your skin, keeping it clean and controlling your sugars if you're a diabetic will help.
Host: Okay. And you know, another thing that I've noticed before is whenever I get a cut or a bruise, you know, sometimes I'll resort to things like Neosporin or some of the over the counter medicines that help the wound heal faster. What are your thoughts on those?
Dr. Ribas: It does help a lot of the problems with the one if it gets too dry and the good cells die around it. So you want the wound to have some good moisture and that's where the Neosporin helps because it keeps moisture and it combat some superficial bacteria. So for, to start, if you notice that you cut yourself and cleaning it well, putting a little Neosporin and covering it, it's a good start. Again, people that have other medical problems like diabetes or bad arteries, just keep watching it because they wound can get worse fast.
Host: And tell us a little bit about the most common wounds that you see coming into the wound clinic.
Dr. Ribas: Yeah. So the, there's four most common wounds, I would say. One is diabetic wounds, like I said, due to lots of sensation. They tend to get ones in their feet. The second one are arterial wounds. And that's when people don't have good circulation and you know, scratched their legs or, and it tends to last a lot longer. And then venous wounds, which is due to the blood return. So the swelling of the legs and a lot of people suffer from this just as we get older, our veins don't work that well. So the, our legs get swollen and that doesn't let the wounds heal. And then the last one is pressure ulcers from people that are either paraplegic or tend to have the same position. So that affects the skin and it creates a wound.
Host: So as we wrap up here, let's talk a little bit about prevention. Is there anything that people can do to prevent the onset of non healing wounds?
Dr. Ribas: Yes. Again, like we mentioned a little before, it's doing checks on your skin. A lot of the diabetics don't feel it. So just having a daily routine at the end of the day or after a shower, just making sure that you don't see any areas that are red, and going to check your feet and your legs or appropriately check if they have somebody check their backs. Most of those chronic conditions, the chronic wounds start over time. So if they can make sure they check their skin and if there is something that they noticed, like it's red, just check the area, either get a new shoe or get a covered pad to prevent the area from getting into an infection or a wound.
Host: Okay. And you know, you see so many people with non healing wounds. I'm curious as to the one piece of advice that you wish more people knew before they came to see you.
Dr. Ribas: I think one of the biggest things that there is help, it's sometimes to me, it may seem that people deal with this wounds for years before they come in. And they're just used to it. And there is so many different treatments nowadays, that we can apply and you know, STEM cells, the skin substitutes to try to help them. So, and now we have resources here in the communities. There's definitely help, so if somebody is dealing with a wound that has not healed, like I said, for about four weeks and they should contact their physician.
Host: All right, Dr. Ribas really appreciate your time today. It's been very informative. That's Dr. Michelle Ribas, the chief of surgery at Twin Cities Community Hospital. Thanks for checking out this episode of Healthy Conversations, for a referral to Michelle Ribas or another provider call the Tenant Health Central Coast Physician Referral Line at (866) 966-3680. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.