Transcription:

Melanie Cole (Host):  Millions of people suffer needlessly from chronic, non-healing wounds, such as those caused by diabetes or poor circulation, injuries.  Other conditions might be something that causes these wounds, and many of them can be treated successfully by your primary care physician.  However, when wounds have not healed after several weeks, they may require specialized care.  My guest today is Karen Balderson.  She’s the program director for Aspirus Riverview Wound and Hyperbarics.  Karen, I’m so glad to have you with us today.  This is such a great topic.  Tell us first who’s at risk for wounds that don’t heal on their own. 

Karen Balderson (Guest):  Millions of people, as you said, are at risk.  As a matter of fact, 6.7 million people in America do live with chronic wounds who do not heal.  We look for people to come to our wound center when they have been treated, as you said, by their primary care doctor for a couple weeks and have not seen any measurable improvement.  We look for people who after about two weeks cannot see any absolute, concrete improvement.  So, we ask that people contact us or work with their primaries to get into the wound care program after about two weeks and definitely before four weeks if they are not seeing measurable improvement.  We tend to see a lot of patients who have other indications like diabetics or people who have arterial disease or have suffered any trauma or surgical wounds.  We have the venous stasis patients who are not feeling the movement of the blood in their legs, who may suffer from something, called a neuropathy, that can’t feel the wounds.  They are definitely at risk.

Host:  So, when you say that someone sees a wound that has no improvement after just a couple of weeks, are there some red flags—when you say no improvement—what does that mean?  What does that look like and what might be the first line of defense when you do spot them?

Karen:  Your first line of defense if you spot a wound as a patient is definitely to make an appointment with your primary care provider and follow up with the—on that wound.  The primary care provider may decide they, at that time, given the severity, to treat the wound on their own or attempt to treat it, or they may refer you right away, depending.  Signs for that would include any obvious infection if you’re seeing any infected wounds.  The size, the location—if it’s on a joint, if it’s on, you know, your foot and you do have chronic wounds, those are definite red flags that this could be a reoccurring issue.  If they have treated it with dressings or any type of modalities, and it’s not seeing any measurable improvement—meaning that it’s not healing or it’s getting worse.  Definitely, those are signs that it’s time to get into a wound center.  

Host:  What would you do for them at a wound center?  What is the first thing that you do as far as treatment, and then, I’d like you to tell us about hyperbaric oxygen therapy.

Karen:  When you come into any wound center, we’ll do our own assessment.   At our center, we do a very, very full comprehensive wound care workup.  We do something called ABIs, which measure the blood flow in your legs to see what type of treatments you would be a candidate for.  We do depths and lengths measurements of your wound to track that progress and see how you’re healing week to week.  We get a history on you.  Do you have any other conditions such as diabetes that would indicate that wounds could be a chronic issue for you, and then we really start to treat you week to week or biweekly.  Whatever the doctor decides is necessary given the extent of your wound and really treat you for that wound.  We have several, several options that we can treat people with.  We have everything from skin substitutes which are—it’s a very fancy term for a type of wrap or a type of synthetic skin that we can lay in the wound to help promote your own skin growing over it.  We have contact casting, which is basically casting your legs to let them heal and avoid any further trauma.  We have several different modalities that we are able to treat patients with in our wound centers.  Hyperbarics is another one of those.  If your wound is not healing—if you meet the criteria for hyperbarics—hyperbaric oxygen is 100% oxygen in a chamber that we have you come daily for five days a week up to 40 to 60 treatments depending on your wound, that can help speed up that process of healing that wound. 

Host:  That is so cool.  How does it do that?  You said it’s 100% oxygen.  What is this like for the patient and how does it work? 

Karen:  So, for the patient, it’s pretty minimal.  Hyperbaric oxygen literally delivers 100% of oxygen at atmospheric pressure.  So, it provides 15 to 20 times the amount of oxygen to the wound site.  From the patient’s experience, they come in every day, and if you’ve ever seen a hyperbaric oxygen chamber, there’s different types.  They have a single chamber which is a very large tube that a patient goes into, and it’s a 90-minute appointment.  They’re not in there for the full 90 minutes always—it depends on what the provider would order, but it’s very similar.  You may hear the term diving a patient—it’s very similar to literally scuba diving.  They are dropped at different decibels to a different oxygen level, and they don’t always feel that other than your ears popping.  So, they sit in a tube, and they watch TV as they have oxygen delivered through their body to speed up the wound healing process.   

Host:  Wow.  So, you said how many treatments are involved and really how long does it take for this to really work for them to see a really big difference?

Karen:  Usually, they see a difference—I would say—in the first couple of weeks, usually by a month for sure.  Again, it’s very dependent on the site of the wound and the severity of the wound.  It is typically 40 to 60 treatments.  So, it is definitely a commitment on the patient’s part to come every day, but it’s very worth it when you get to that point to meet the criteria because it can definitely save an amputation or further surgeries.  

Host:  That’s so important, and it’s a great point, Karen.  So, now, tell us a little bit about some other wound treatments.  If somebody has a wound—and it could be just a cut, a parent has a child who gets cut.  We never know with wounds whether you’re supposed to keep them moist or dry, covered or air.  I swear I hear this every day.  What do we do with wounds?

Karen:  It’s specific to the wound.  So, depending on where the wound is and why you have the wound, it really would depend on how we would treat it.  So, I always say, if you have a cut on your finger, you know, take care of that in your normal ways.  If that cut is not healing, you really do want to get it checked out.  If it’s getting worse, if it seems to be getting infected, you really want to make that appointment and follow up to make sure you don’t have an unhealing wound.  Depending on the type of wound, that’s where our providers are specialized in this because it really does depend.  You may need to leave it open.  You may need to cast the wound.  You may need to go into some of these advanced treatments like skin substitutes to help promote that healing.  It really depends on why you have that wound and what other conditions are sparking that wound to not heal.  

Host:  That’s great information.  Do you have any final thoughts you’d like us to know about those wounds that don’t heal?

Karen:  I think the most important thing to know is that when you notice that wound—especially if you do have other chronic conditions—getting into your provider right away to have them assess that wound is important, and knowing that if that wound is not healing, you can get into a wound center.  I think it’s also important to know that patients can make their own referrals to a wound center.  So, if you are a person who has chronic wounds, and you notice a wound on your foot, you don’t have to go through primary all time.  You can just call to the wound center if you know you have this condition.  I also think it’s incredibly important for people who do have chronic wounds exposed to them and have a history of them to make sure that they have the proper foot care; that they’re doing the proper checks; that they’re making sure they’re on top of noticing those wounds as soon as they start.  

Host:  It’s such a great topic and really great information.  Karen, thank you so much, for joining us today, and that concludes today’s episode of Aspirus Health Talk.  Please head on over to our website and for more information about the Aspirus wound healing services near you, please visit aspirus.org/wound-care, for more information and to get connected with one of our providers.  Please remember to subscribe, rate, and review this podcast and all the other Aspirus podcasts.  For more health tips and updates, follow us on your social channels.  I’m Melanie Cole.