Transcription:
Specialized Wound Care and HBOT

Melanie Cole (Host):  People with diabetes, heart disease, existing infections or lung disease may have difficulty getting their wounds to heal. However, there have been several advances in this area that provide help to slow or non-healing patients. My guest today, is Dr. Berdj Stepanian. He is the Podiatric Medical Director at St. John’s Riverside Hospital. Dr. Stepanian, let’s talk a little bit about who is at risk for wounds that do not heal on their own. Who is at highest risk?

Berdj Stepanian, DPM (Guest):  Typically, the patients that we see that are at highest risk are the diabetic patients, but it is also not limited to them. It can also be patients who have poor circulation and patients who have poor sensation from one of the diseases that causes that.

Melanie:  How does somebody know that they have a wound that Is not healing? I mean how long do you wait when you see one of these things to determine saying well this thing isn’t looking like it’s getting any better?

Dr. Stepanian:  Well typically, immediately upon noticing anything with their feet, which is what I specifically deal with; I tell my diabetic patients or patients that are at risk to immediately come in so that we can evaluate them for the proper treatment going forward. Obviously, the quicker we diagnose them; the fast we start to implement care, the much better the patient is going to do.

Melanie:  What should they be looking for? What are some red flags? Are there certain kinds of things they should be looking at, checking these wounds on a regular basis and looking for something that would send them to see you right away?

Dr. Stepanian:  Well typically, after we have our first visit, we always tell our patients that are neuropathic or at risk for having a wound, to check their feet every day. And if they notice anything, any redness, any cuts, pus coming out, typically what happens is they don’t feel it, only if they see it or they see something in their sock maybe a little bit of pus coming out of their foot; then they get alarmed and then they call us, and they come in.

Melanie:  Dr. Stepanian, people hear about diabetic foot neuropathy, problems with wounds and they think of amputation. But we are talking today, about limb salvage options and does limb salvage surgery or treatments available; do they offer patients a better quality of life and functional capacity than amputation? Is this becoming more common now?

Dr. Stepanian:  Well it’s actually becoming more common because more and more people are aware of it. Unfortunately, we have a higher risk population now because people are living longer, there is more and more diabetes in the community and if they do not get diagnosed quickly, typically they end up with amputations and the problem with having an amputation is one, it’s a tremendous cost to the patient’s life. Typically, patients who have one amputation go on to having another one within two to five years and their life expectancy decreases significantly every time they have an amputation done.

Melanie:  What are some other treatment options available that would be along the limb salvage type of treatments and what is hyperbaric oxygen therapy?

Dr. Stepanian:  Well typically, when we do have a diabetic patient or anyone with a wound come in to the wound care center; we evaluate them from head to toe. Basically, it is team approach. We use a vascular surgeon. We use an endocrinologist. I, the podiatrist, take a look at them as well. We look at them biomechanically to see how they are walking, what type of shoes they wear and what their lifestyle is. Once we have all that information; then we plan how to treat them, and hyperbaric oxygen happens to be one of the modalities we utilize today, because it is so beneficial and has had such a high success rate. Basically, the patient is put into a chamber, almost if you could imagine a fish tank for an adult, for two hours at a time and they breathe 100% oxygen which then goes through their body and gets to the affected wound site and helps to heal that area.

Melanie:  So, you have mentioned what it is; what does it do? What are the benefits? How can this oxygen therapy help to heal a wound a little bit quicker?

Dr. Stepanian: Well what it does, it does two things. If there is an infection present in the bone or in the wound, it helps to rid the body of that infection and it also increases healing by bringing that oxygen to the wound area causing more blood supply and capillaries to grow in that area so that it heals faster.

Melanie:  Is it safe? What does it feel like?

Dr. Stepanian:  It’s very safe. Patients they get to watch TV while they are in there. It’s a clear tube so you can see outside. We can talk to you, you can talk to us. Other than having to maybe swallow so that your ears are not clogged, kind of like when you are on a plane and your ears get a little clogged, you swallow so that they unclog. That’s typically what most patients have to do when they are in the hyperbaric chamber and then they just basically relax and rest for about an hour and a half to two hours while they get their treatment and they can watch whatever TV program they like. And then they come back out and that’s done typically five times a week. And typically, most patients get anywhere between 20 and 40 treatments before they are healed.

Melanie:  So, what other treatments might be available? Speak about caring for a wound Dr. Stepanian, and what you want people to know should they be looking at these wounds. And people never seem to know whether they should be moist and covered or dry and uncovered. Speak about wound treatment and what else you are doing there.

Dr. Stepanian:  Well typically, the way we treat our wounds is once we evaluate them for their etiology, is it caused by the circulation, is it caused by an infection, is it caused by pressure; once we figure all that out, the first step is to clean the wound and what we use is aggressive debridement in the clinic setting which we clean up all the dead tissue and get to nice healthy tissue and once we have that nice healthy tissue base; then we have modalities that are brand new, cutting edge things like amnion tissue and grafts that we are able to put onto these wounds to help them heal faster. It’s very high tech. It does come at a cost, however, the benefit to the patient outweighs the cost of the product. And they do very well with them. And we have patients who go on to lead productive lives and avoid amputation using these modalities.

Melanie:  And how does somebody care for these things at home? If you do the debridement, or you use a graft, you are doing these things for them; then when they get home, they have to do somethings for themselves. What do you recommend? Do they keep a watch on? What are they supposed to do at home?

Dr. Stepanian:  Well the most important thing if they have something systematically that’s causing the disease is to reverse that. Diet control, making sure their sugars are in control. If we have left a bandage on the foot and put a graft on; we typically do not ask them to remove that because that would remove the graft at the same time. We also use a casting product called Total Contact Casting and that offloads the patient, so they heal quickly. So, mostly, the patient has to take care of themselves systematically and with a diabetic, that’s what they eat, making sure they are taking their medications. With someone who smokes, it’s obviously stopping smoking, and these are the things that we ask them to do at home and obviously, compliance. The hardest thing that we find is that most patients have issues, their life has to go on, to coming in for care and being followed up properly. So those are the things we emphasize when they leave the clinic and if they do have a problem after they leave the clinic; they need to call us immediately, so we can rectify that situation.

Melanie:  Well adherence to your protocol is certainly important. What would you like the listeners to know about your team? Wrap it up for us with first your best advice about wound healing and treatment options available and your team at St. John’s Riverside Hospital.

Dr. Stepanian:  Well the most important thing is prevention. And there are a lot of things today that we can do if the patient comes in just for their annual foot check up to prevent these wounds. But if they did not do that and they unfortunately did get a wound; then our team consists of infectious disease doctors, vascular surgeons, podiatrists, nurses, nutritionists which all lead to helping this patient heal properly. And the team that we have at St. John’s is very good. We are the largest wound care center in Westchester County and our patients do very well. And thank God that we have everyone there because it is a very highly trained staff that we have there. So, we definitely recommend that if someone does have a wound that they come in and see us, so we can get that healing as quickly as possible. So, the most important thing for me on these patients is that we prevent these wounds from happening. We do know how to manage them once they do have them, but all they have to do is a few simple things to prevent them and that is to see their podiatrist, their vascular surgeon and their endocrinologist and their primary care doctor and make sure that their disease state is stable and in a healthy state instead of in a poor state where they would be more prone to having wounds and that would prevent a lot of the aggravation that happens once these wounds occur. But if they do get a wound; we are here for them and we are willing to help them, and we have that team that I spoke about before that is fantastic at managing this stuff.

Melanie:  Thank you so much Dr. Stepanian for being with us today and for sharing your expertise in this very important topic and for people with wounds that don’t heal and your great information about prevention. Thanks again for joining us. You’re listening to Riverside Radio Health Cast with St. John’s Riverside Hospital. For more information please visit www.riversidehealth.org that’s www.riversidehealth.org . This is Melanie Cole. Thanks so much for tuning in.