Joey Wahler (Host): Some wounds need more medical
treatment than others. So, we're discussing where to go for advanced wound
care. Our guest, Loren Elchik, she's a family nurse practitioner specializing
in wound care for UM Upper Chesapeake Health.

Host: Welcome to the Live Greater podcast series,
information for a healthier you from the University of Maryland Medical System.
Thanks for listening. I'm Joey Waller. Hi, Loren. Thanks for joining us.

Loren Elchik: Thanks for inviting me.

Host: Great to have you. So first, what kinds of wounds
typically need extra attention and what exactly does advanced wound care entail
in the first place?

Loren Elchik: Okay. Well, there's actually a variety of
wounds that could require extra attention, anything from pressure wounds to
diabetic wounds, vasculitic wounds, neurogenic wounds, Trauma wounds and even
surgical wounds to just to name a few. And the advanced wound care that we
provide here is you get a thorough assessment when you come in, we perform
debridement right here in the clinic, and we discuss different care treatments
to involve advanced dressings that have different antimicrobial properties to
them, to different cleansers. We also take in consideration of skin
substitutes, which is a graft that we actually apply in the clinic. Sometimes
we need a little bit more help with a consult with infectious disease, maybe
even a surgical consult. We'll do some testing for vascular disease if that's
required. And then, we have a lot of other modalities that we adapt with other
programs that are out there to help people with bed surfaces, compression,
anything that we need to do to get you healed and keep you healed.

Host: So, you touched on it a bit there, but who's
generally most at risk of all for getting advanced wounds?

Loren Elchik: I would say currently in the patient
population of people with diabetes, especially uncontrolled diabetes. When
you're a diabetic, you have a lot of risk factors to include infection issues
and just delayed healing in general. So, we see a lot of diabetics here a lot.

Host: So, it's interesting because I think many people,
especially if they're not affected by wounds, would presume that most people
get them from some kind of an occurrence as opposed to a preexisting condition.
But you're pointing out that actually the latter is the cause of it much of the
time for certain people as well, right?

Loren Elchik: Yeah. A lot of diabetics end up with
wounds, because they end up suffering from neurogenic changes where they have
limited sensation in their feet. So, that's often where we see wounds develop
because they're walking around on a surface that they don't realize that is
actually causing injury and issue, developing wounds. I mean, there are
incidents of course too that cause wounds such as pressure ulcers, people that
have spent a significant time in bed due to illness, whether it be acute or
chronic. Even people that are wheelchair-bound for various reasons can develop
pressure ulcers. So, that's an incident or, I guess, a cause as well.

Host: Gotcha. So during an in-office visit, what's the
typical process of wound assessment and treatment?

Loren Elchik: Well, you come in and we have an excellent
nursing staff that brings you back and starts the initial assessment and then
touches base with me or one of the other providers about what they see. We
review past medical history, trying to put together-- It's basically a puzzle
when you walk in the door as to what the contributing factors are or what it is
that we're dealing with. And then, from there, we discuss with the patient what
we see, if it's appropriate. A lot of times I perform a skin debridement where
I'll remove necrotic tissue, tissue that is present within the wound bed that's
delaying the healing process. And then, from there, we come up with an individualized
treatment that's appropriate for whatever your wound cause is.

Host: So, there are various ways to have a wound
treated. What are the benefits of going to a wound care center like where you
are rather than, say, having someone come to your home?

Loren Elchik: Well, the benefit of coming here is just
the same benefit as seeing your cardiologist or your endocrinologist or your
dentist. This is our specialty. This is what we do. This is what we do all day.
So, it's best to come here, see us. We do work with home care agencies that
then implement a lot of the treatments that we order from this office. So,
there is benefit from receiving wound care at home, but it's best under the
guidance of a wound care clinic.

Host: Understood. So, how frequently does a typical
patient need to be seen in a wound center once they're under your care? And
what factors would determine what that schedule becomes?

Loren Elchik: We have a lot of patients that we see on a
weekly basis. And the need for that is regular assessment of the current
treatment plan that's being implemented, infection prevention, just regular
assessment of the wound bed, making sure that we're seeing the healing that we
want to have occur. But also, things that attributed to your frequency is if
we're putting skin substitutes on or a graph like I mentioned earlier, that
requires weekly visits to get them most benefit until the maximum amount of
skin substitute is applied.

But there are some people that don't need to be seen weekly for
various reasons. Some of our bed and wheelchair-bound patients that have more
difficult accessibility to transportation don't come with as much frequency,
especially those that have home care or really supportive care in the home
setting. Some of our patients that live in long-term care facilities don't come
with as much frequency for the same limited transportation issues. And then,
some people as they start, we see them weekly, they progress, and then we don't
have to see them with as much frequency based on the chronicity or the progress
of the wound that we're treating.

Host: How about in terms of success rates and overall
outcome a patient can expect by coming to your facility? What would you say
they can look forward to there and what is it more so than anything about the
care you provide that makes that possible?

Loren Elchik: So, I don't have any current percentage
data to share. But I can tell you that many of the patients that come to see
us, they have already been through other providers, trying to get to the
ultimate goal of healing. And by the time they come to see us and we implement
a more appropriate strategy, the healing rate exponentially improves. Recently,
I had a patient with an orthopedic wound that her orthopedic doctor said would
never heal. She had been trying to treat her for a couple months. By the time
she came to see us, she saw immediate improvement within the first two weeks.
And we completely healed her in, gosh, I think it was six or seven weeks when
she finally came to full wound closure. And she was a person who was told she
would never heal. So, that's just one example of many. But yeah, the likelihood
that you are to heal coming to see us is much more than seeing many other
providers because wound care is a specialty, and we focus on modalities that a
lot of other providers are just not educated on just for the reasons of that's
how the constructs of wound care education is.

My wound care education was very poor early in my career,
because I just wasn't taught the right thing. And there's many of us out there
that weren't. So now, we are all wound care-certified here or most of us, and
we have years of experience with healing wounds. So, we are the people to come
to.

Host: Certainly sounds like it. Let me follow up and ask
you about that success story you just mentioned. How rewarding is it when you
get a case like that?

Loren Elchik: That's one of the things I love about this
job. There is some instant gratification, if you want to call instant
gratification taking seven to 14 days to see some positive improvement, but you
do. It's very rewarding to know that you got somebody back into a place where
they can physically, mentally and socially function as they did before. Because
chronic wounds or wounds that people feel are embarrassing really limit your
daily life and to know that somebody is able to return to work or return to
their social life or hanging out with their family and just being happy people.
It's very rewarding.

Host: I'm sure it is. How about getting back to
something I asked you about a little bit earlier? You mentioned you do work
with home healthcare agencies. When we talk about at-home versus in-office, how
would a patient know what's best for them?

Loren Elchik: Normally, what happens is a patient is
referred to us quite often through a home care agency, because a lot of our
home care agencies know that we are an extension of them. So, we get referrals
through the agencies themselves. We also get referrals through primary care
doctors who are also starting home care in the home to assist with healing. But
a lot of times people don't realize the benefits of seeing us until they see us
from the patient perspective anyway. A lot of people who are not medical don't
understand how to navigate through much of the system. So, it is helpful if by
chance they have a provider or somebody they're exposed to that can bring them
to us.

Host: Well folks, we trust you are now more familiar
with where to go for advanced wound care from specialists like Loren. Loren
Elchik, thanks so much again.

Loren Elchik: Thank you. It was a pleasure to speak with
you today.

Host: Same here. And for more shows just like this one,
you can visit umms.org/podcast. Again, umms.org/podcast and you can find them
on YouTube as well. Now, if you found this podcast helpful, please share it on
your social media. And thanks again for listening to Live Greater, a health and
wellness podcast from the University of Maryland Medical System. We look
forward to you joining us again. Hoping your health is good health. I'm Joey Wahler.