Medically Speaking #21

Welcome to today’s episode of Medically Speaking. Today I have two special guests with us and we’re going to talk about wound care today. This is going to be a super interesting conversation. I have Dr. Mike White and I have Lauren Koch with us. How do you say it? Coke. Lauren Koch with us today and we will go ahead and kick off. So maybe let’s just start with some introductions. Lauren, why don’t you tell us a little bit about yourself, your background, and how you found yourself to Self Regional Healthcare. Sure. So I was born and raised in Spartanburg. I went to Clemson for my undergrad, and then I did PA school at Francis Marion University. And after, well, kind of throughout my studies at Francis Marion, I knew I wanted to do a surgical field. I like the variety and, you know, it’s definitely not boring. So being from the upstate, I wanted to return to this area and I wound up at Self Regional and I’ve been here for a little over five years and I definitely enjoy it. Good. Well, we’re glad to have you here. Dr. White, tell us a little bit about your background. Sure. I’m originally from West Virginia, went to medical school at Marshall, so go Herd, and did my residency at Florida Hospital in Orlando and I’m actually board certified in both family medicine and undersea and hyperbaric medicine and have been doing this for about 25 years now. And luckily, I was able to work out a plan to come here and work with the good folks here at Self Regional. And I’m very pleased with everything that has come about so far. Well, that’s great to hear. Well, let’s just dive in. Maybe either one of you can kick us off And just tell us a little bit about wound care in general and what type of services are offered at our wound care center. So at the wound care center or the Wound Healing Institute, there are a number of things that we do. We focus on chronic wounds. So if you cut yourself, if you have a scrape, that’s not necessarily the first group of patients that we want to see. We will see those patients, but our main focus is on people who’ve had wounds that won’t heal as they should. You know, luckily, our bodies are designed to heal acute wounds, wounds that you get from, again, a cut, a scrape. But if those wounds are not healing, then that’s when you need to come see us. Additionally, we offer services for hyperbaric oxygen therapy, and there are about 15 different things that we do hyperbaric oxygen therapy for. Some of them overlap with wounds. Some of them are totally independent of wounds, such as soft tissue radionecrosis. If you’ve had radiation and have a wound or a problem related to the radiation. and we can certainly use hyperbaric oxygen therapy to help that. So we have two different service lines that we primarily do, the hyperbaric line and the wound care line. Sometimes they intersect, sometimes they don’t, but we will certainly see any of those patients. Gotcha. Gotcha. Well, thank you for that. So how does the, just give me a little bit of day-to-day, like in the clinic, like what basic hours that you guys are open and just some basic information. Sure. So we’re open Monday through Friday 8:00 to 5:00 we have three full-time nurses about to be four full-time nurses respiratory therapy who helps us with the hyperbaric oxygen chamber and then front office staff as well as well as our manager and so you know when you come in you’ll be greeted you’ll be taken back to the room by a nurse who will start the workup she’ll kind of get a history from you um you know look at your wound take pictures of it measurements of it clean it for you and then in the background we’re gathering more data about you so we know the full picture before we enter the room and then we come up with a plan together and get it rolling how many patients a day do you guys see so we are seeing anywhere between 30 to 40 and our goal is to get up to 20 for each of us. And so we have recently redone our scheduling system so that we can have additional capacity for people who need to be seen quickly. And that’s something that’s very important to us is to get those patients in in a timely fashion. So do most of the patients you see start somewhere else and end up with you guys from like a referral process? Or I know you guys do primarily like wounds that have been maybe festering, if you want to think of it that way for a little while, rather than an acute wound. Like for example, if I step on a nail, I don’t necessarily need to come to the wound center. I could go see my primary care doctor or maybe the emergency department, depending on the situation. But more of like a festering chronic wound, maybe define chronic wound a little bit and the types of wounds a little bit in more detail. So when we think about acute versus chronic wounds, there’s a couple of different ways you can think about them. You can think about time. So when we look at chronic wounds, and depends on which literature you read, quite honestly, somewhere between four to eight weeks where it’s not healing as you would expect, that’s when you start to worry, maybe this thing is not doing what we want it to do. And that’s when you need to come see us. Or if you have certain other medical problems that may make it more likely for you not to heal. If you have bad blood flow to the legs, if you have diabetes, if you are on chronic immunosuppression because of a cancer drug or anything like that, those are the sorts of people that we say, maybe you should come in a little bit earlier and let us get a head start on this. As far as different types of wounds, the four main types of wounds that we see most commonly are venous leg ulcers, and that really is the most common wound in the world. Second are diabetic foot ulcers. Third are pressure injuries, and then fourth are straight arterial ulcers, where somebody has bad blood flow, but they don’t have anything else, and that’s relatively uncommon to not have anything else. So a straight arterial ulcer is the least common type of wound we see, and then we have the catch-all category, which is surgical wounds and other traumatic wounds. Right. I would like to add, we do see ostomy-related wounds also. So certified ostomy nurses do come over and help assist those patients as well. – Okay, okay. How do you decide, like, I guess, who needs to go to hyperbaric oxygen versus not hyperbaric oxygen and treat it other ways? – I mean, so there’s a criteria you have to meet. First and foremost, there’s only specific diagnoses that qualify. So someone with osteomyelitis, which is a bone infection, you know you kind of touched on this earlier about like the radiation type wounds um I would say those are probably your two most common reasons for using the hyperbaric chamber at our location because we’re non-emergent okay um but osteomyelitis wise and wound wise it has to have failed adequate treatment for at least 30 days so no signs of improvement within 30 days okay and and so to go a little further even there are very very specific criteria that we have to to meet before we would even consider hyperbaric oxygen therapy and it’s part of this is because it’s good medicine there’s things that we don’t want to use hyperbaric oxygen therapy for such as diabetic foot ulcers that are not bad enough so according to the the Wagner grading scale If it’s a minor wound, we’re not even going to consider hyperbaric oxygen therapy. If it’s infected, if it is an abscess, if it has dry or wet gangrene, then we’re going to think about using hyperbaric oxygen therapy. If you meet all the other requirements, which as Lauren said, you’ve got to do standard of care. So you’ve got to do good wound care first. And then if it is bad enough and there’s no measurable signs of healing, then we’ll consider hyperbaric oxygen therapy. And for osteomyelitis, you’ve got to do good wound care. you got to treat it. You got to do surgery for it. And if it doesn’t get better, then it becomes chronic refractory osteomyelitis. That’s when we can step in and say, let’s add this to your treatment. So hyperbaric oxygen therapy for the most part doesn’t replace typical treatment, but it’s an add-on or adjunctive treatment. So I know, gosh, if I had one of these wounds on my lower extremity, one of the things I know of particularly diabetics are very keen and keenly aware about is like, I don’t want to lose my leg. I don’t want to lose my foot. Maybe talk a little bit about limb preservation and how the wound center maybe even coordinate with other specialists, like say vascular surgery, for example, and to help prevent a wound from advancing to the stage where you need to have an amputation. Yeah. Yeah. I will go ahead and say the best way to do it is to get seen early. Okay. Don’t come to us with a multi-week problem. It’s much harder to get things to heal at that point. And you’re definitely at risk for more complications. Um, but we do definitely coordinate care a lot with vascular surgery as well as podiatry. Um, but we do work with pretty much all the other specialties as well orthopedics, ENT, urology all of those um so if we look at the literature for what we know hyperbarics does for example a diabetic foot ulcer um what got hyperbarics on the list uh for Medicare to say yes we’ll pay for it was one of the pivotal studies was called the the Faglia study out of Italy. And this was back in like 1996. And what the Faglia study showed was that if you take all other aspects, all other controllable risk factors and keep them the same for groups that get hyperbarics versus not get hyperbarics, the groups that get hyperbarics decrease their risk of above the knee and below the knee amputations. So when people ask us, what do you know hyperbarics does? What we can tell you is it’s going to decrease your risk of losing your leg. That’s what we know it does. There’s great evidence that says it’s going to heal the wound, but we know it decreases your risk of losing your leg. And as Lauren said, we do work with vascular surgery and we want to pull the upcoming and incoming infectious disease doctor into the fold with this as well. Yes, that would be a huge asset for our team. Yeah, awesome. And for the community. For sure. So yeah, so when someone’s getting worked up for these types of conditions. It sounds like they’re getting like vascular studies, like ultrasounds to check the blood flow. I’m sure we’re getting, maybe considering nerve conduction studies, depending on the situations, I guess, if we’re evaluating that. Is there anything that you guys think that the community should kind of know or be aware of in and around wounds or wound care or advancements coming in wound care that might be interesting to share? don’t use hydrogen peroxide, don’t use rubbing alcohol, don’t use turpentine, don’t use whatever your grandmother or your granddad used to pour that in there. My mother, too. I still dread that red bottle. I can still see it in my head. There’s a lot of things that people say, put this on your wounds, but most of the time it’s wrong. You can clean your wounds with soap and water, and that works really, really well. You’re not, quote, boiling anything out with hydrogen peroxide. Uh, and the other part to that is if you have a diabetic foot ulcer or you have diabetes and you don’t want to get an ulcer, wear your diabetic shoes, even in your house. Even if your mother or father said, don’t wear your shoes in the house, you wear your shoes in the house and you look at your feet each day. And so, and if you haven’t been through diabetic education, ask your provider to send you to diabetic education. We have a great diabetic education program here that talks about how to deal with your feet how to keep your feet healthy so that knowledge is very important some people just don’t have that because nobody ever told them yeah I think as far as advancements in wound care I mean it’s not necessarily a new technology but I think negative pressure devices um they’ve been around for 20 25 years give or take um I think that is definitely an advantageous technology in wound care um are we talking about like the wound vac type things yes so that would be like the brand name yeah okay but um you know it gives us the ability to heal a wound that’s very deep and can have tunneling areas or areas we can’t necessarily see it just picks up the healing process in a much more like timely fashion by stimulating that healing at the cellular level instead of the alternative, which would be, you know, I, when patients ask me about it, you know, if they’re hesitant about a wound vac, I would say it could save you many months of healing time. What are the most difficult wounds to treat? As I think about like the really bad sacral decubitus and someone who may have been immobilized for a while, is it that type thing or is it more some of these bad diabetic legs or just curious? It totally depends on the patient and you know that’s that’s one of the the hard things for us is you know we we know that there are some things that can certainly slow down wound healing if you’re not keeping pressure off the wound if you are choosing the wrong dressing if you’re not keeping the wound environment warm and moist so sometimes it’s a matter of trying to figure out what is going on with that specific patient that we need to try to address but more commonly it’s patients who say yes, I know you told me to do this, but I don’t really want to do this, and so I’m not going to do it when I go home. And compliance is one of the big things that we fight. And it’s just the nature of the beast. It’s not anything that’s new in medicine, and all fields of medicine have to deal with this. People who either don’t take their medicines as they were instructed or do things that may be detrimental to their health. But that’s one of the big things that can potentially slow down wound healing is not doing exactly what we ask you to do, Not that we know everything, but we’ve got a pretty good idea about what you should be doing. Yeah, you have to be part of our team. You know, we can give you all the advice and all the tools, but if you don’t go home and do your homework, then you’re not going to see the result. Absolutely. So tell me a little bit more about the Wound Healing Institute in whole. I know we have our practice here in Greenwood, and we’re maybe doing some other things around the community. Maybe we could touch on some of that. So we have plans. Obviously, Self has grown over the years, and we have added some different hospitals to us. There is already a wound healing center in Abbeville, at Abbeville Area Medical Center, and I used to work there. I know the people there, and our goal, if there could be a goal of mine, it would be to bring all the wound services under one umbrella because we want to be able to offer not only just a service but good services to everybody no matter where they are whether that’s in the home environment long-term care in the hospital in the outpatient wound center any of those places people deserve good care and that’s what we want to be able to give them and so as we work towards and through some of these processes we have plans for going into some of the long-term care centers making sure that our policies and procedures, that no matter what Self Regional site you visit, Edgefield, Abbeville, in Greenwood itself, that you’re getting the same product, you know, that people should expect a high level of care no matter where they go, and we want to provide them with that. That’s awesome. I think you guys are doing that. I mean, certainly I’ve heard a ton of positive feedback in the last months, years, etc., particularly Dr. White with your leadership, and we appreciate that, and we look forward to seeing where the Wound Center, Wound Healing Institute of Self Regional Healthcare goes in the future. Anything else you guys would like to share with our audience today? I just want to say that I’ve been here a grand total of about four months, five months now. And one of the things that I just talked to our manager about yesterday was how thankful I am for the staff that we have. You know, anytime you start a new position, you’re very unsure of what’s going to happen. And we have some of the best staff that I’ve ever worked with. Awesome. Awesome. I greatly appreciate those words by the way um um one thing I guess mine would be more more towards the community I think there can be a stigma with wound healing wound care in general that like maybe it’s scary okay and I think it’s just because of the unknown but I promise you it’s not scary we’re not here torture anybody or you know do anything you know out of the ordinary but you know it I want to be able to build a trusting relationship with every patient that walks through the door and I would say everyone in our practice including in Abbeville feels the same way so we look forward to the community trusting us and you know you guys are hitting on some of the core tenets here at Self Regional about being a great place to get care and providing high quality care to every patient that comes in the door and being a great place to work and having a good work environment which is like one of my major goals is for Self Regional Healthcare to be a great place to work and get care and give care so we are very grateful you guys and glad you’re here in the community thank you for joining us and let’s make our communities healthy that’s awesome yeah thank you for having us yeah thank you so much and thank you all today for joining us for today’s episode of Medically Speaking, and we look forward to seeing you next time. Thanks.