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Melanie Cole (Host): If you have a chronic, non-healing wound, the staff at the center for Wound Care and Hyperbaric Medicine, a program offered at Palmdale Regional Medical Center, can help you get back to the activities you enjoy. My guest today is Dr. John Gambol. He’s board-certified in undersea and hyperbaric medicine and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Gambol. Just tell us. what conditions would typically cause people or contribute to wounds that don’t seem to heal?

Dr. John Gambol (Guest): Wow, that’s a broad question. There are literally probably a multitude of things that will keep wounds from healing. I think overall probably the biggest risk factor that we can look at is probably diabetes and anything that leads to hardening of the arteries, the same risk factors that cause stroke, heart attack, can also lead to poor circulation in the legs and lead to non-healing wounds. I think that’s probably the biggest one. I think you have to throw in there anybody who’s ever had any kind of cancer treatment. Chemotherapy can lead to wounds that do not want to heal, any radiation therapy for patients who had cancer and then any underlying immune process, people that have different types of rheumatoid arthritis or lupus. That’s probably the vast majority of the patients we treat at the Wound Care Center.

Melanie: Some people have wounds that take longer to heal. When is a red flag that says this has gone on long enough?

Dr. Gambol: I think a general rule of thumb which is good for any wound we look at, if your wound has not improved significantly in about a two week time period, then that’s about the time that you should start thinking about seeking a more advanced type of wound care and even earlier than that if you have warning signs of infection or if you’re a high risk person, and that would be things like if you’re wound is very red around it, it smells bad, you have fever, or you’re a high risk patient because you have diabetes, you know you have blocked arteries, or you have underlying cancer or those autoimmune problems that we talked about earlier. If you have any of these red flags, then definitely you should see your primary care physician, go to the emergency department or see a wound care specialist before those two weeks, but definitely if something hasn’t improved in two weeks, that’s a good time for advanced wound care.

Melanie: Are there certain areas of the body that are more susceptible to these types of wounds?

Dr. Gambol: Definitely. A high percentage of our wounds, probably eighty percent or more, are on the lower extremity from the knees down. As you get further down the leg, foot, ankle, and your big toe, you’re moving further away from the heart so that is an independent risk for a wound not wanting to heal. But, again, wounds can happen anywhere on the body. It’s just the foot and ankle and lower leg area are the highest risk locations on the body.

Melanie: If somebody is noticing some of these symptoms you’re describing, what’s the first line of defense for them to take care of that wound?

Dr. Gambol: I think standard good hygiene, making sure a wound is clean, making sure you keep it covered, are probably a good common sense place to start with. And then, again, if you have any concerns, someone who has a wound that they think is high risk, it’s red or they have a fever, or just any concerns about it, they can always check with their primary care physician. Urgent cares are always a good option, and then, of course, the last resort if you’re really concerned and need to be seen now, the emergency department is always a great location to seek help. If someone has a wound and they know it’s not going to heal, they’re always invited to make an appointment at the wound care center and we can always evaluate anything and determine what needs to be done to help a wound heal.

Melanie: Is there any truth to the myth that air heals wounds? Do you like everyone to keep their wounds covered?

Dr. Gambol: I am an oxygen specialist. My specialty is using our hyperbaric chambers to heal certain things and all the oxygen you need to heal a wound comes from your blood. Leaving a wound open does not help a wound heal and, in fact, there are many studies that have been out for many years that show that if you leave a wound open and uncovered and dried out, it’s actually going to take longer to heal and it’s going to be at a higher risk for infection.

Melanie: That’s a great tip and really good information. So, what treatments are available for non-healing wounds?

Dr. Gambol: Again, I think that the amount of treatments is as varied as the type of wounds. We do all kinds of things that help heal a wound along. Most commonly, we look at what’s causing the wound not to heal. We address the underlying problem, really focus on getting people to control their diabetes and then, when it comes to advanced wound therapy, there’s several different surgical techniques we use to help heal a wound. We use several advanced dressings. We work on different types of compression therapies to help control the swelling as that may keep a wound from healing. We have special casting techniques we use to help keep pressure off a wound. There are several different advanced wound care products all the way up from collagen dressings to advanced artificial skins that can almost mimic human skin.

Melanie: Tell us about hyperbaric oxygen therapy and how that can help chronic wounds.

Dr. Gambol: That’s one of my favorite topics. I have seen hyperbarics heal things that other modalities will not heal. All of the things that hyperbarics does is it is very complex but, basically, the long and the short of it is, it helps grow new tissue into a wound area. It actually stimulates a process called “angiogenesis” which means while undergoing a course of hyperbarics, your body will actually grow new microcirculation. You’ll grow new microcapillaries and blood vessels into a wound area which helps a wound to heal. Hyperbarics also will help stimulate your body’s immune system to help fight off infections. It directly kills certain types of bacteria and it also enhances the effect of many of the antibiotics that someone might be on and it will strengthen the antibiotics. That combination is amazing to watch a wound that’s infected or at high risk for needed an amputation, that hyperbarics will often improve that condition and, a lot of times, prevent the need to more aggressive surgery or an amputation.

Melanie: What can patients expect during hyperbaric oxygen therapy?

Dr. Gambol: Overall it’s very, very well-tolerated. It’s one of the safest procedures out there. There’s almost no complication to a round of hyperbarics. About the biggest thing that people feel is sometimes they’ll feel their ears squeeze a little bit like they’re flying in an airplane and, aside from that, they really don’t notice much of anything else.

Melanie: Then, really, how long after they’ve had it can they see results from it?

Dr. Gambol: Again, it varies but, on average, it depends on what we’re treating with hyperbarics but usually a patient will start noticing significant improvement at around a two week time period and then depending on how severe the wound is, they may need hyperbarics from anywhere from one to three months, depending on how severe the underlying problem is. But, it usually it takes about two weeks before you start noticing a difference in the wound with the drainage or the infection mode with a course of hyperbarics.

Melanie: And how long is the session?

Dr. Gambol: An average session is we say it is a 90 minute treatment session but by the time you get into the hyperbaric chamber and get pressed to depth, it usually takes about five to ten minutes. So, you’re at depth for 90 minutes and then another 5-10 minutes to come up. So, we usually tell people it takes roughly around two hours or so for a hyperbaric session. A patient undergoes that daily, Monday through Friday for, again, depending on how their wound is responding, one month to as long as three months.

Melanie: Are there certain people that you want to keep an eye out for wounds? Sometimes people bump into things and don’t even notice or they get little bruises. Is there something that you want them to look for? Should they give themselves a skin check like they would give themselves a skin check for skin cancer? Do you want them to be looking for wounds?

Dr. Gambol: Well, I think that especially if you’re diabetic. It’s recommended that diabetic patients check their feet almost daily for wounds. We definitely recommend daily foot inspections, especially the bottoms of their feet and between their toes which can often be difficult because a lot of patients cannot see the bottoms of their feet. So, in that case, we recommend that they figure out how to get some type of mirror and definitely with the diabetic foot, diabetic patients with any prior history of foot ulcers or even diabetics that have not had problems with their feet, it’s a good idea for them to look and inspect their feet daily for any wound development.

Melanie: And, in just the last few minutes, Dr. Gambol, what should people with chronic wounds be thinking about?

Dr. Gambol: Well, I think it’s probably true for any wound, not just a chronic wound. They should think about, “how long am I going to have this wound? What might I do to get it to heal faster and what kind of risks do I face if I leave the wound open or this wound does not heal?” I think that, especially for the chronic wounds, the longer that wound is open, the higher the risk they are for getting some type of complication, a more serious infection, an infection that could potentially lead to some kind of surgery or an infection that could lead to some kind of thing like blood poisoning or a bad systemic infection.

Melanie: Why should they come to the Center for Wound Care and Hyperbaric Medicine at Palmdale Regional Medical Center?

Dr. Gambol: I think that the physicians that are on staff besides myself as well as the nurses here, we have vast experience dealing with all these strange wounds that do not want to heal and as well as the routine wounds that do not like to heal and we have a high success rate of getting our wounds to heal and we’re really good at figuring out all the little intricacies and all of the little issues that come up in people’s daily lives that tend to get in the way of following a wound-care plan. We do things that some physicians may not have the ability to do or the access to certain techniques and we have a good track record. I think we also have a high patient satisfaction. Most of the people that come through here like what we do and if we find that patients have a recurrent problem or a new wound at a different site or something, that oftentimes if they call us right away and get in so we can take care of the second wound as quickly as we took care of their first wound.

Melanie: Thank you so much. It’s really great information and so important. Thank you, Dr. Gambol, for being with us today. You’re listening to Palmdale Regional Radio. For more information you can go to www.PalmdaleRegional.com. That’s www.PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.