Smart wound care

Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Tamika Perry.


RON AARON
Hello everybody, and welcome to the award winning Docs in a Pod. I'm Ron Aaron. We got a great topic we're going to bring to you in just a couple of moments, but let me introduce our co-host, Dr. Tamika Perry. She's the associate regional medical director of quality for North Texas and Houston for WellMed. She oversees several large clinics in the area and is very focused on delivering high quality care. Dr. Perry earned her undergraduate degree from Prairie View A&M University. She then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was National Health Service Corps Scholar. She completed her family medicine residency at Methodist Charlton Medical Center, where she served as Chief Resident. Dr. Perry lives in Dallas with her daughter and in her free time, she loves to travel. Dr. Perry, this is a great topic today, talking about wound care.


DR. TAMIKA PERRY
It is a great topic. Wound care affects so many Americans, especially our senior population because of the disease states that our seniors have. When you get a wound, it has other implications than the average bird. I'm so excited with our guest today. Like I was telling her earlier, I'm going to take notes while she's talking.


RON AARON
Well, let me introduce Amanda Green. She's a nurse practitioner and a wound care nurse practitioner herself, certified in lymphedema therapy and acute care specialist. Amanda Green is board certified acute care nurse practitioner. Over 20 years of nursing experience. She began her career in intensive care, and earned her Master of Science in Nursing from the University of Texas Health Science Center in San Antonio in 2011. Her clinical background includes diabetes and glandular diseases, wound care, hyperbaric and a whole lot more. In 2022, Amanda became a certified lymphedema therapist through the Norton School of Lymphatic Therapy. When she is not doing nursing and wound care, she loves to swim, work in the garden, and is a part time restaurant critic because she likes visiting restaurants all over her hometown of San Antonio. Amanda Green, thanks for joining us today on Docs in a Pod.


AMANDA GREEN, NP
Thank you so much for having me, I appreciate it.


RON AARON
Talk to me a little bit about wound care, because when people hear that, they're not sure what to think because it covers such a broad, broad area.


AMANDA GREEN, NP
You're absolutely right. It does, and there's a lot to it. But when we talk about wound care in my particular setting, I will see acute wounds, chronic wounds, but mostly the chronic. There are several etiologies to wounds, and one of the things that I will tell my patients to help them realize, skin is the largest organ of the body, and it's our first layer of defense, and we really need to take good care of it. When we have something broken down in the skin, it can lead to quite a few complications. So, we want to get to the base of what's going on and get that healing going on as well.


RON AARON
One thing I learned in dealing with the wound care clinic that I visited in San Antonio from nurse practitioner Debora Sheffield is covering a wound and not letting quote “air healing” because the old wives tale is, oh, just let the air heal it. It'll be fine.


AMANDA GREEN, NP
Yes, sir. Thank you so much for saying that. That is so true. I was actually going to bring that up. We do battle the old wives tales of just leave it. Let it air. Let it dry out. There is so much new research out there for wound care and treating these wounds that we do know moist wound healing is imperative in most words. There's a select few, and that would only be arterial, but we're not going to go and focus on that. But yes, it is moist wound healing to get the closure, get the skin cells regenerating together, growing together and create that new layer of skin.


RON AARON
See, one of the things that I always thought growing up was, man, you want to get a great big, hard scab on there. And the answer is no, you don't.


AMANDA GREEN, NP
Correct. You do not. Back in the day when we didn't have all the things we do today, we didn't have all the dressings, all the medications and so forth. That was a good help. It was your own bandage. It was your body's own bandage, and it worked back then. But now we know we can get quicker healing, we can get less scarring and better outcomes if we keep it covered with some kind of moisture therapy.


RON AARON
All right, stay with me. I'm going to go to Dr. Perry in a moment and find out how she and her patients deal with wounds, and when she refers them for wound care. I'm Ron Aaron. Dr. Tamika Perry is our co-host. Our special guest today is Amanda Green. We're talking about wound care and how to deal with the kind of issues that you can face with wounds. You're listening to the award winning Docs in a Pod. Dr. Perry, a patient comes in and one of the concerns, of course, is it's such a wide prevalence of diabetes. For healing. Dr. Perry, diabetes is often a problem.


DR. TAMIKA PERRY
It is a problem because the mechanism of action itself that causes diabetes causes a myriad of other problems in your body. One of the things being peripheral vascular disease or impaired circulation. So, if you can't get fresh blood and fresh oxygen to that wound, it is not going to heal up. One of the things that may actually lead to the wound is neuropathy, meaning that let's just say, for example, you have really bad peripheral neuropathy, meaning neuropathy, meaning nerve pathology, or your nerves are impaired. And what do your nerves allow you to do? They allow you to feel or have sensation. So, if you're walking barefoot and you cut your foot and you don't feel it, you may actually get a wound there. That wound becomes infected, and that soft tissue infection goes from the flesh to the bone. And the treatment for bone, if it gets so bad, is amputation. So, we try to do things from the primary care perspective to prevent the wound, and once it's there, we try to manage those chronic diseases. The big bad bear here is diabetes. So, Amanda can help us heal that wound.


RON AARON
How do you deal with that, Amanda? I've got a good friend who also works in broadcasting who developed a wound on the bottom of his foot. He has diabetes, has peripheral neuropathy, and has no nerve feeling in his legs. He ended up losing his right leg because of an infection that literally went to the bone. How do you prevent that?


AMANDA GREEN, NP
Well, it is multifaceted. All the providers the patient can't see, we want to include all the specialists. So, just like what was brought up, patient education starts first, of course, as well as getting the diabetes under control. But knowledge is power. So, if a patient knows that with uncontrolled diabetes, they'll have these complications, hopefully we can prevent it. So, that includes educating, again, diabetes control. Educating on inspecting your feet daily. You're inspecting for cracks, fissures, new wounds, new sores, any red spots. Because when you have that neuropathy, not only can you step on something, we can educate patients not to walk barefoot for one. But also maybe their shoes are too tight and they don't even notice it. We get that a lot. You buy inexpensive shoes or your income is low and you can't always afford a new pair of shoes, so they're either really old, worn down, or just hand-me-downs. Lots of things. So, education is key. Monitoring regularly. So, daily foot inspection for patients.


RON AARON
How do we do that? Because unlike cats, we can't see every inch of our body because our spine doesn't work that way and we clearly can't see the bottom of our feet. What do you recommend?


AMANDA GREEN, NP
That is true. I ask patients to get a handheld mirror and use that. Put it on the floor, hover their foot over the mirror and see if they can inspect anything different. Or get family and supportive care involved. Sometimes that is necessary. People have limited mobility in the back, knees, everything. So, that is true. Those are very good points. So, we could use mirrors, we can use other folks' for supportive care, and then of course, your provider should be doing foot inspections as well.


DR. TAMIKA PERRY
I'm glad you brought up mobility because immobility can cause wounds and ulcers. You can impressure ulcers. So, if you sit for a long period of time or are bedbound, that tissue is compressed, there's no blood flow getting to it. It's like the water hose we talked about in a different show being the blood vessel. Now that the water hose is smashed, blood can't flow through that tissue and essence becomes vulnerable. Mobility is important. So, shifting your position, moving around, having your caretakers do that to prevent these wounds from happening. Because once we start that cascade, it is not good.


AMANDA GREEN, NP
It's not easy to correct either. So, if we keep individuals on the preventative side of preventing pressure sores, then we can get a lot more movement there. If somebody has limited mobility, then I'm definitely going to ask if they're also incontinent. Can they get to the bathroom in time? Can they feel if they can get to the bathroom in time? Some people can. Some people can't. If that is something that's going on as well, then I ask them to definitely change briefs or underwear frequently throughout the day. Don't wait until you think it might be saturated, do it sooner and use a barrier cream just as prevention. It's inexpensive. It's accessible. You can get it over the counter. You can look for zinc oxide, you can look for Vaseline or your petrolatum. All of those are great barriers to protect your skin from excessive moisture or even excessive drying. So, it just keeps that healthy middle. Now you can advocate for things like cushions that are for offloading. I usually recommend gel because they limit warmth, so they keep it from getting too warm, which can also help decrease excessive moisture. You can get one for your favorite chair. You can look for egg crates for your bed mattress or a gel mattress. So, there's definitely some supportive surfaces that can help with prevention as well.


RON AARON
Why is a gel pad important? What is it doing for you?


AMANDA GREEN, NP
It's going to improve temperature control and prevent your skin from getting too warm. When skin's on foam, it holds in a lot of warmth, which can lead to more moisture. The gel can actually help keep the skin cooler and less diuretic.


RON AARON
So, nobody wants a hot butt, right?


AMANDA GREEN, NP
No. I don't want one. I don't know if anybody else would, but it definitely helps keep the skin cooler and drier. Dr. Perry, you want to jump in? I can see you trying to talk.


DR. TAMIKA PERRY
I was going to tell you to go stand in the corner. You’re on punishment for five seconds. She's absolutely right. I recommend gels, too. Those types of cushions that kind of keep your derriere suspended so it's not smashed up against a hard surface where it’s secluding that flesh and including the blood flow that's vital to that muscle in that fascid layer. We appreciate Amanda Green so much because I can never do what she does. It's not my forte. So, I appreciate her so much, but we want to actually prevent the patient from even getting there. We absolutely do. Those are things like you have to reiterate what she said about the gel-cushions and moving frequently. I do home visits. So, when I go to do my home visits on my patients, I look at their heels if they're bedbound and make sure their heels haven't been sitting there and they don't have pressure on their heels. Me and my medical assistant will roll them over gently on their side to look at their bottoms, to look at the back of their arms to make sure we don't have pressure ulcers there. If they can't move on their own, I always encourage what family member is there, I tell them every 1 or 2 hours I need you to shift this individual for me to prevent this from happening. The running laugh in my family is that if I become old and feeble, I tell my daughter, go ahead. You can put me somewhere, just make sure they turn me over.


RON AARON
Stay with us for just a minute. We're going to turn it right back to you right after we do a little business. I'm Ron Aaron. Thank you to Dr. Tamika Perry, our co-host, and to our guest, Amanda Green. I appreciate you being here. You're listening to the award winning Docs in a Pod.


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RON AARON
Thank you so much for joining us and sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you listen to your podcasts. We're also on the radio in several cities in Texas and Florida as well. But on a podcast, you can hear us anywhere in the world. I'm Ron Aaron along with Dr. Tamika Perry, our co-host, and Amanda Green is with us, a nurse practitioner whose specialty is wound care in something called lymphedema therapy. We'll talk about that in just a moment. Amanda, I want to come back to gel cushion because I mentioned just a minute ago off air that I'm sitting on a chair now and I don't have any kind of pad, and my butt is sore and tired. You mentioned a gel cushion. How does that differ from some other cushions?


AMANDA GREEN, NP
I sure did mention a gel. A gel cushion can be a little different from your egg crate foams in that it will redistribute the weight of your bottom and hips. What that can do is help even the pressure and relieve pressure in that way.


RON AARON
I know my Apple Watch plays a role here, Dr. Perry, and it'll tell me, stand up, get up if you've been sitting too long, which I gather, Dr. Perry, is pretty important as well.


DR. TAMIKA PERRY
It is important because like we discussed earlier that that weight is in one place. The blood vessels that are being occluded, and you're setting yourself up for those pressure ulcers, so stand up. Allow flow, move around.


RON AARON
Amanda, I may be one of the only other human beings who understands what lymphedema therapy is about because a few years ago, both of my legs swelled beyond belief. One of the things I was taught was lymphedema therapy. Nobody knows what it is. What does it mean and why is it important? So, Amanda, the 411 on lymphedema therapy.


AMANDA GREEN, NP
I'm going to try to keep it a little simpler. Lymphedema therapy is going to help get the lymphatics moving in such a way that we can kind of move fluid away from those lymph nodes that are affected and get swelling out of a particular location. Lymphedema can occur anywhere. It can occur in the arms after a mastectomy. It can occur commonly in the lower legs. It can occur in one leg, both legs, lower leg, upper leg. You get what I mean. So, lymphedema therapy can help prevent complications from that chronic swelling which includes ulcers, sores, damage to the vessels or further damage to those lymph nodes. A lot of lymphedema specialists, they'll do what's called MLD. They'll include manual lymph drainage, and then they'll get you started in short stretch compression to contain that swelling in the extremity or wherever it's at and move that fluid up and hopefully help get that lymph node or nodes moving the fluid again. That will get the edema down significantly.


RON AARON
Debora Sheffield, a nurse practitioner who I've seen quite a bit in wound care, has made it very clear that gravity is not our friend. So, when your legs, like mine are right now, are hanging down, it's not a good thing. One thing she emphasized, which I wear, is the compression hose.


AMANDA GREEN, NP
Yes, absolutely. There are compression hoses, which are graduated compression. They're made in such a way where they're tightest at the bottom toward your foot and ankle, and then they get not looser, but there's less compression towards the calf and that moves the fluid up. It helps keep the blood vessels open and those valves in the veins. So, there's valves and veins that can collapse on itself and then have back flow unfortunately, which can cause swelling. There's also other compression garments that we use for specifically lymphedema, which are Velcro garments. Velcro garments give us that short stretch that I just mentioned. It doesn't stretch, it contains swelling. So, you get really good control with a Velcro garment such as Pharos or Sigvaris. Just some examples. Either of those can work for swelling depending on what kind of swelling you have. So, those folks with lymphedema that have really big legs, not getting any improvement with the compression sock, or they can't get the socks on because they're too tight, then you can use or consider Velcro garments, which we do.


RON AARON
Getting the socks on is a challenge.


AMANDA GREEN, NP
It is, and there are lots of good resources to use to help you get them on if you don't have the family or the support. We call those stocking donners. There's all different types of stocking donners. You've got the kind that's a wire cage. Then there's one where it's kind of like a sleeve. You roll it on. There's stocking donors. Look it up online. You'll get a plethora of garments.


RON AARON
That's cool. Dr. Perry, so you recommend compression hoses to some of your patients?


DR. TAMIKA PERRY
Oh, all the time. All day every day. Amanda made a good point that it keeps those tissues compressed. It helps the lymphatic system as well as the venous system take blood back to the heart. But if we digress a little bit and say what is the lymphatic system, it's a system that is part of our immune system, but it complements the circulatory system and helps take tissue fluid and redistribute it throughout our body. So, thinking of it as a plumbing system, that plumbing system becomes clogged or backed up somewhere or removed. If you're removing lymph nodes because they may have cancer in them, we do in the upper arm for breast cancer. Now that tissue fluid from the arm has nowhere to drain, and then that plumbing system backs up. That's why you see this edema where you can have that happen in your lower extremities. Not because of surgery but because of a myriad of other reasons. What do we do to make our circulation better again? We assist it with compression stockings. It forces that to go in the right direction. We elevate our extremities because like you said, gravity is not our friend, so if our legs are hanging on them dangling down, that gravity's going to keep pushing it down. I always give the example to my patients that I would go for walks with my mom and grandma when she was alive. Then when I would come home, my hands would be tight. It would be hard to take my rings off, and that's because gravity has pushed all that fluid in a downward direction. So, keep those legs elevated, keep those compressions stockings on, and go see Amanda so she can wrap it up. These are things we do to assist that lymphatic system in making that drainage appropriate.


RON AARON
Amanda, for a period of time when I struggled with the swelling in my legs, they wrapped them in like ace bandages and kept them wrapped for several days. Is that kind of a last resort?


AMANDA GREEN, NP
Not a last resort. We use a two-layer compression. There's different brands. It's not an ace bandage, the barrier outside will be like the South Stick medical wraps like the Coban. So, this two-layer compression is very special. It gives you a mixture or a cross between a short stretch and graduated compression. So, it is very helpful in getting legs smaller quicker. But it also can be medicated and provides medicated topical treatment for really irritated skin or draining wounds.


RON AARON
Let's take just a minute before we run out of time and talk about the kind of everyday cuts and scrapes that adults suffer and kids as well. What is your go to home bandage?


AMANDA GREEN, NP
Let me just back up. Clean the wound with some soap and water and dry it. Put some Vaseline on it. Yes, Vaseline. Petrolatum, especially if it doesn't look infected, and cover it with a regular bandage. We've got special bandages that I can recommend, but those are for more chronic wounds. Just cover it with a regular Band-Aid if it doesn't irritate your skin. But you can start with just petrolatum. Something simple.


RON AARON
How often should you change it?


AMANDA GREEN, NP
That would depend on that particular wound and how much it's draining. If it's draining quite a bit, you want to get it checked out, but also change it more often, at least daily. If there's not a lot and you're kind of covering something that's a little bit drier, do it every other day.


RON AARON
The go to for every home in America is bacitracin. Do you need that? That kind of antibiotic ointment?


AMANDA GREEN, NP
Not always. If it's a clean wound and it was a clean scrape and you can get to it right away, the petrolatum is that oily emulsion that will be similar to bacitracin. It's just not medicated.


RON AARON
So, that is why they make Aquaphor, right?


AMANDA GREEN, NP
Correct.


DR. TAMIKA PERRY
I keep Aquaphor and Vaseline in my house for those reasons.


RON AARON
It’s your go-to?


AMANDA GREEN, NP
Yeah, they're wonderful. Now if you've got something kind of getting a little bit red and you're not certain exactly what cut it or if it was kind of dirty, then I would recommend bacitracin. Neosporin is a triple antibiotic. Neomycin can really become aggravating to a lot of folks and cause allergic reactions.


RON AARON
Oh wow.


AMANDA GREEN, NP
So, bacitracin is a great start.


RON AARON
I need Amanda on my 911 line.


AMANDA GREEN, NP
We're all here for you.


RON AARON
Thank you. We are just about out of time. I want to thank both of you, our co-host Dr. Tamika Perry, and our specialist in wound care, Amanda Green. Thank you all for joining us today on the award winning Docs in a Pod.


OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.


DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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