.

But hello and welcome to HealthLine.

I'm Jennifer Bloomquist.

I'm so glad you joined us tonight.

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The text line is open and we welcome your questions at any point we have a familiar face.

It's been quite a few years since I've had the honor of hosting a program with him but I'm so glad you came back.

Dr.

James Edlund and thank you for joining us.

>> Now he's got quite a title so he works in Wound Care and hyperbaric medicine.

You have a background as a colorectal surgeon and now you're specializing in the wound care which is in the notes you sent me.

It sounds like this is really becoming a very you know, growing field like the services are needed and the opportunities for patients needing that care is definitely getting bigger.

>> So we're busy all the time.

Yeah.

And you were you were saying before that there were even just wound care clinics now that you can go is that specialized at this point?

>> Well, it's gotten since I started practice a lifetime ago we had wound in ostomy nurses and at the hospital and all the hospitals now have wound and asked to be nurses.

Even nursing homes have sometimes a visiting wound care nurse.

>> So nursing homes, hospitals all have to provide some kind of wound care and it's a special service because it's time consuming and it's because of the aging population that we have.

>> It's it's a big problem.

So I came to talk about it and tell you what we do and how important it is to take care of yourself and try to prevent wounds and I'll talk about that as well.

>> I remember entertain questions, you know.

>> Oh yes.

Again, you know, call text we got those phone numbers up at the bottom of the screen.

They're going to stay right there throughout the show.

I would encourage you to call in sooner or text in sooner rather than later because we hate to miss your your questions.

So it's a great opportunity to get things answered tonight for free.

I remember the last time we did a show which was quite a few years ago you said having a background as a surgeon you created wounds.

>> Yeah, well I was going to say it was kind of your fascinating yes.

>> Yes.

But you know, if you ever have a surgical practice, you know your life is full and it's hard do the kind of attention that we can do in one clinic.

Plus we're all the wound care centers that I've heard about and I go to national meetings.

So it's all over the country.

Yeah, work as a team and so that's a very important part of what we do.

Surgery is a team in New York and one carries a team and the wound care center where you actually were kind enough to put together a lot of slides for me I said I think we have a slide about just some important facts about wound care that people might not have thought about.

So basically you're saying this is this is affecting usually older patients by and large but it's not exclusively older patients but it is the infirmities of age include wounds that won't heal.

So the things I want to do is shown on the slide when a wound fails to heal there's always a reason.

So one of the most important things we do is find the reason that the wounds won't heal.

Most wounds should be healed within a month and if they haven't healed within a month then you know you have a problem.

An awful lot of patients come in and they've had something and they can't figure it won't heal and they've had it for six months and they didn't tell anybody.

Yeah, very common for people to hide it at any given time and give you an idea of the degree to which wounds occur is that any time two percent of our population that's a big number will have a chronic wound.

Our job and wound care is not only to treat the wound.

You know dressings are important but it's by far not the most important part of wound care.

It's to identify the reasons that it won't heal and help with the help of several other people to heal the wound.

Chronic wounds like any other chronic illness create personal and family problems and God bless our nursing staff and our social workers that that help with this and there's a lot of community resources that can help.

We've got a listing of community resources to help people in most communities have some way to get people to the wound care center.

A lot of times they can't can't drive anymore or you know, they're many of them are living alone and lonely and don't have anybody to care for them and we also have a very blessed number of home health nurses that go to people's homes and help take care of these wounds.

So I like to say it takes a village of providers, family, friends and nursing staff to take care of people with wounds.

>> Um, you had mentioned there's with the aging population and it's becoming, you know, more of a prevalent issue.

We don't have a slide I don't think to bring up for it.

But you had put together something called the age friendly framework age friendly framework and there are the four the the EMS.

>> Yep.

And I can tell you those four EMPSON they are mobility medications, mentation and one that sometimes in health care we've forgotten is what matters to the patient and you have to establish a relationship with patients.

We see them by and large weekly and so most offices see people once a year, maybe twice a year and certainly after surgery we didn't see people very many times.

We saw them as often as we had to but wound care specialists to see people weekly and we have sometimes that they're seeing more than what weekly and there something we call a nurse visit where they come in for a dressing change that they can't do themselves as many people as they get older myself included, have a hard time reaching their feet.

>> Sure they have a wound on their foot.

They'll need help with that.

So the mobility is a big reason some people get once they get them on the back side of their heels, the back side of their knees, their bottom especially in the middle of the sacrum would be called the sacrum and sometimes people get curved backs as you've seen them walking in.

They get a bone sticks out in their back and they'll get a sore over that sometimes people have been in the ICU you ever saw in the back of their head.

>> So we've learned part of our evaluation is check the back into the body and look for you know, look for wounds and mobility is a big part of that.

>> I mean are there some people and that's understandable I guess if you're you know, laying in that position all the time.

>> But you know, maybe for somebody who does have a decent amount of mobility left, are they usually in a better situation for the wounds to be?

>> Well, I don't know.

Is it correct to say you can cure a wound or we can heal the wound?

>> We call it time to heal or healing time.

OK, and most wounds will show improvement in two two weeks.

You know, you should be able to show some amount of improvement in two weeks at four weeks if you haven't shown significant improvement we then refer to it as a recalcitrant wound and then we you know, we do a lot of midcourse adjustments sometimes it's not obvious what the cause is and it takes us some time to do the work up and we have to take a careful history.

You know, sometimes it's very helpful to have a family member there.

>> I say to women all the time don't send your husband to the doctor, bring him.

>> Yes, yes.

I put another way if you want the whole story you should go with them.

I would yeah.

I say men men lie to me because they're stupid.

They're not paying attention.

Women always have a good reason.

Yes.

Yeah.

>> My people don't really want to reveal until they're trusting and the wound is an embarrassing thing.

Yeah.

Any time of life having wound is just unacceptable.

>> We can help even if we can't get it to heal we can make it better manageable.

I was going to say just even from a you know a mental you know, from the mental capacity of it, you know, just I'm sure that becomes burdensome, you know, feeling you know, maybe even feeling like you can't go places you don't want people to see it.

>> You know, it's not a place that's as if it weren't bad enough in our with our elderly population.

>> Right.

Loneliness is a huge issue.

It's terrible.

I agree.

Yeah.

Well, you had put together another slide where you talk about there are different kinds of wounds acute versus chronic .

I think it was slide four for for the control room.

I didn't realize they were divided into different categories.

>> I don't know if you could speak to that effect of acute versus chronic.

Yeah, well basically an acute wound starts with bleeding and the bleeding is a good thing because it coagulates analytica the wound together and then there's inflammation which gets red all the run wound and sometimes people think it's infected when it's just inflamed and then the wound pretty rapidly within three or four days begins to heal.

The redness will go away and the body goes through the next thing where the healing cells called fibroblasts come into play and then once the wound is covered you have to be careful with it because it's tender and it can take up to a year for what I used to call a pink wound to turn white and so very often the wound will mature over the course of a year so it needs to be taken care of once it's even completely healed.

Chronic wounds are ones that haven't healed within 30 days.

>> OK, well they have are there some that just don't ever really every now and again we'll get some but we have, you know, pretty close to a 90 percent healing.

That's great.

And so you're right that some wounds won't heal but we can always help and sometimes it takes several changes in strategy I call midcourse adjustments.

And so that's why we see people weekly to make sure they don't go too long and somebody comes in and then they go away for a month and they come back and then it's often worse.

>> I would think the patient would like that being seen more frequently for something that is probably waiting so prevalently on their mind.

>> Remember so Mobility's nishu correct implementations and issue difficult you know if they can't afford their medications or the dressings it's a huge problem.

>> Sure.

OK, well we do of course we're allowing people to text in tonight and to call in now somebody called in but doctor wanted me to ask the question for them so I'm trying to I'm having a little trouble seeing the screen here.

OK, they want to add they're asking you about that if that plays a role in in healing we would we don't routinely check for zinc deficiency.

But you're absolutely right.

We encourage protein intake and we encourage vitamin intake at the first visit.

>> So our first talk is about smoking cessation and that's can be delicate because they've heard it all before and weight loss and that can be delicate because they've heard it all before and we want them nutritionally is a big important talk and it's the protein intake.

Sometimes people with a large enough wound will lose many grams of protein and B behind on protein even though they're eating a normal diet.

So we emphasize nutrition and we emphasize multiple vitamins.

I don't think you need to do the multiple pill thing but a good multivitamin I always get the one with the silver bottle because that's my age group so we just assume they're going to be zinc as you know is what's in those pills you take to help your sore throat?

>> Oh those those Gaggia lozenges.

And so I have some of those at home and I take them when I first sign of any sore throat or anything.

>> OK, good to know.

Well I want to thank Wesley because he sent us a text message and wanted to know Doctor if dry skin can cause a wound.

>> It's an absolutely marvelous question.

>> Legs legs are the sufferer of dry skin and by and large in the leg if it has good arterial blood supply that's very important.

But the venous return is what suffers in the leg because of gravity legs you're standing up, we're bipedal and we stand up and the bullet always goes to the legs, the valve the veins are supposed to work by having the blood returned to the heart.

>> It's like a fish ladder.

The pump muscle pump moves the blood up and then the little valve holds there when the valves get shot then the blood returns.

It's called reflux and then one of the problems with reflux is the skin loses its nutrition because the nutrition is gone from the blood that's sitting there loses oxygen so it can't heal itself and so it can't put the normal skin protective things that our sweat glands have for us and so the skin gets dry, dry skin will crack dry skin heal, heal that cracks or a toe that cracks is the beginning of a big problem that particularly particularly important in diabetics.

>> So motioning with a good lotion that doesn't have any smell good in it and there's a lot of them on the market is is a must win something like like a petroleum based cream instead of like a lotion like a petroleum with that work I mean I've see ones like that they just they don't really smell good or anything like that but I wonder if they were well we prefer the the ones that are meant for the skin lotion so there's some petroleum in them but we don't want it to be occlusive.

OK, if you're not careful petroleum will include an open wound and allow the skin to breathe.

So there's a bunch of them in the list that we give out and they're all advertised on TV.

>> Sure we can't name the brand unfortunately but we want to do it.

Yeah, you know there's a couple of them that are prescription strength.

Oh, there's a condition called ichthyosaurs.

>> They're fish Flesche skin where your skin you're born with the ability to heal your skin.

Yeah.

And there's a prescription strength medication that we use for particularly bad problems of it.

>> I you know, I'm just in the rule of thumb is if you have an issue like that and it goes on for a few weeks it probably needs to be addressed by a medical professional anything longer than four weeks.

>> One condition that hasn't healed deserves attention.

OK, and of course we don't see the vast majority of them that's done by their primary care doctors and walk in clinics and emergency rooms and sure such here's a question we do have another another question again.

>> This was the first name is James is wondering what causes a wound to not be able to clot ?

>> Well, there's of course inborn errors where you have hemophilia and there's a couple of kinds of that I won't go into that the vast majority of people that have wounds it won't clot are on something aspirin, clopidogrel which is both of those are platelet inhibitors and then there's the old fashioned Coumadin which is a rat poison for a while and then there's the new ones the direct oral anticoagulant cintas for those on the market.

Those don't require testing and don't require adjustment.

Put another way, we're not able to measure them and adjust them on a regular basis.

It's a much more complicated thing.

Cooperton requires careful monitoring, careful dietary interventions.

One of the clinics I work in has anticoagulation unit in it so I I now know all the questions ask was used to and it's a pharmacist that talks to them about you know I can tell you I've been eating broccoli and it's not something they would ever accuse me of on purpose but there's a lot of greens that have that will make the anticoagulation medication work more so OK a wound that won't clot has a number of reasons either something you're born with but if you're an adult you should have known that long ago.

So there's a two or three common things that people are born with including one Hildebrand's disease and then mostly it's medication aspirin, Plavix, direct anticoagulants, direct oral anticoagulants and the time honored Coumadin which has been around for as long as I've been in practice.

>> Yeah, and even in my training it was still there.

All right.

I just want to remind everybody that you have two options tonight.

>> From now on we're going to allow you to text him which is great.

There's a great option or call in so and we've had some folks call him and we've had a text.

So great questions.

We welcome more.

We still have a few minutes left.

We could easily answer some of your questions.

So phone number again is (969) 27 two zero and if you want to text us, go ahead and do that quickly.

It's (969) 27 three zero.

You brought a really nice diagram of the anatomy of Skin and I didn't know if we could bring that up I think is that slide slide number eight I bet some people probably haven't looked at something like that since they were in maybe middle school or high school science and so this is going to put his glasses on to help with that.

>> That's OK.

That's all right.

>> The important thing about skin anatomy is that the outer part is the epidermis and as we age the epidermis gets thinner and so we have an awful lot of people with thin skin.

OK, I've had a couple of people I send them home with a certain dressing that will hold this put a flat back people's tear the skin that gets a flap.

Oh and you can put the flap back and hold it down and that's the best way.

But sometimes they don't come to me till the flap has died and then then you've got an open wound all the way down into the fat.

So there's layers is the epidermis in the dermis that's the skin itself and then the fat underneath the subcutaneous tissue is where the sweat glands live and send in hair follicles live, send them up through the skin so the skin of different parts of your body is different thicknesses and the people of color have a different thickness of the epidermis.

It's a little thicker and it heals less well you get hypertrophic scars and Cloyd's with wounds that are problematic for the appearance of the wound and if you're dealing with skin cancer, skin cancer looks different in people of color.

A melanoma for example is black and finding a black lesion on a black person is especially challenging.

>> So we do have another question.

>> Yeah, we do.

I was going to ask you real quickly how how far down into the skin like are some of the wounds that you treat?

>> Did we treat them full thickness is the majority of the wounds we see sometimes they go all the way to the bone.

Oh do so.

And that's how when you see people that have lost their leg particularly with diabetics.

>> Yeah, they've lost their leg because the bone got infected and it won't heal.

OK, well I'll turn to that question and I see you got glasses.

I had my contacts at so Tom thank you for texting in.

He wanted to know about me if that would affect wound healing.

>> So multiple sclerosis to that effect multiple sclerosis .

Many of our patients have multiple sclerosis, many of them for many years and as time goes on, if it's a if it's a progressive type instead of the relapsing remitting for which there are some medications now but we have some that are basically paraplegic or you know, because of their multiple sclerosis and so that's the mobility part.

Yeah, it doesn't exactly affect wound healing except you know, if you lose function of the your extremity or if you lose sensation of the skin then losing sensation the skin is how diabetes works to cause foot ulcers is that people can't feel this or they can't feel a blister and they walk around on it until it gets infected and don't come in because who checks the bottom of their feet?

>> Diabetics are supposed to and but if your mobility is affected then you can't get your foot up there so MSA is a secondary effect particularly with regards to mobility does affect wound healing.

>> All right.

And we have lots of people with multiple sclerosis that are patients.

>> Yeah, yeah, yeah.

You don't think about that.

You know somebody who's like you said, you know, wheelchair ridden, you know, and just can't get up, you know, and you're always putting pressure on those parts.

Your body is something and think about what causes problems.

What we only have about a minute left Doctor.

So I just want to ask you a couple of quick questions.

I mean I know everybody heals differently and different rates so it's not really a cookie cutter formula is what is what it sounds like.

But what advice would you give to people especially maybe somebody who's maybe you're a caretaker for an older person, maybe things to look for because like you said, a lot of people don't want to talk about it and don't want to show you you know, that they have this problem.

Most important thing is to protect the skin because once it's disrupted that wound healing becomes complicated.

So as I say, we had a nurse manager when I was in colorectal surgery a lifetime ago that called it speedrun.

>> Oh so always check the back side, check the heals the back of the knees, the buttocks, the sacrum, the the wing bones, the back of the head.

And if you have a curved spine or any spinal defect check that so people get bedsores so fast and so quickly and you just can't ignore it.

>> We have a whole population that sleeps in a recliner and we have a condition that we all refer to as recliner.

But and I can tell immediately when I see somebody you know, if that's the deal and there are too immobile to get out of bed so they sleep in the recliner.

>> All right.

Great points to think think about oh Dr.

James Adlen, thank you so much.

>> It's been years since then.

I will have to have you back again soon.

So very interesting.

So there we're happy any time to share.

Thank you.

Thanks everyone.

I'm Jennifer Bloomquist and we will see you right here next week.

>> Take care.

Have a great rest of your week.

But I