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Martha Jefferson HealthWise--June 25th

MANY PATIENTS SEEK PROFESSIONAL HELP FOR WOUNDS THAT DO NOT QUICKLY HEAL. DR. LEWIS OWENS IS A STAFF VASCULAR SURGEON AT MARTHA JEFFERSON HOSPITAL. IN HIS TIME THERE, HE HELPED CREATE THE MARTHA JEFFERSON WOUND CENTER, WHERE HE CONTINUES TO BE A PRACTICING PHYSICIAN.

HE EXPLAINS, OUR CLINIC IS AN OUTPATIENT CLINIC AND WE A SEE A WHOLE SPECTRUM OF PATIENTS AND WOUNDS. TYPICALLY THE PATIENTS COME TO US INITIALLY AND GET A COMPREHENSIVE EVALUATION OF THE MEDICAL PROBLEMS CAUSING THEIR WOUND OR INVOLVED IN POOR WOUND HEALING. ALSO, WE EVALUATE THE WOUND ITSELF AND DETERMINE WHAT TREATMENTS WILL HELP HEAL IT. THAT'S THE MEDICAL ASPECT. THE TEACHING AND EDUCATION ASPECT IS JUST AS IMPORTANT, AND THAT GOES ON OVER A PERIOD OF WEEKS. WE LIKE TO SEE THE PATIENTS WEEKLY, BUT MANY OF THEM TRAVEL A DISTANCE TO THE CLINIC, SO WE WORK IT OUT WITH THEM TO SEE THEM AS OFTEN AS THEY CAN, AND REINFORCE THE TEACHING EVERY TIME THEY RETURN.

IF A PATIENT HAS NO OTHER MEDICAL PROBLEMS, AN INJURY OR A SMALL WOUND IS GENERALLY GOING TO HEAL.
CERTAINLY EVERY PERSON WHO GETS A SMALL WOUND DOES NOT NEED TO GO TO A SPECIALIST-THE MAJORITY OF THEM WILL HEAL WITH BASIC WOUND CARE. IF A PATIENT HAS A WOUND THAT DOESN'T HEAL FOR A COUPLE OF WEEKS' TIME OR IF THEY HAVE DIABETES, VASCULAR DISEASE OR OTHER MEDICAL PROBLEMS, THEY SHOULD CONSULT THEIR PRIMARY PHYSICIAN AND WORK WITH THEM.
USUALLY THEIR PRIMARY PHYSICIANS WILL REFER PATIENTS WHEN THEY HAVE NOT RESPONDED TO THEIR INITIAL THERAPY.

ANY MINOR WOUND IN A PATIENT WITH DIABETES OR PERIPHERAL VASCULAR DISEASE OR OTHER MEDICAL CONDITIONS HAS THE POTENTIAL TO BECOME A MAJOR PROBLEM. THE MOST IMPORTANT THING FOR THOSE PATIENTS IS PREVENTION. FOR A DIABETIC THAT HAS SOME NEUROPATHY OR SOME OTHER PROBLEMS WITH THEIR FEET, WE CERTAINLY RECOMMEND THEY SEE A FOOT SPECIALIST AT LEAST EVERY SIX MONTHS-JUST FOR PREVENTION. BUT FOR SOMEBODY WHO IS OTHERWISE HEALTHY, ITS PRETTY RARE FOR A MINOR INJURY LIKE THAT TO BECOME A NON-HEALING WOUND.

THE FIRST THING IS TO USE COMMON SENSE. YOU WOULDN'T BELIEVE HOW MANY PATIENTS WE GET EVERY YEAR HERE IN THE BEGINNING OF THE SUMMER, WALKING AROUND BAREFOOT ON HOT ROADS. THEY FORGET THAT THEY ARE DIABETIC, THEY DO NOT HAVE FEELING IN THEIR FEET AND IT'S A HOT ROAD SURFACE.
THEY GET BURNS, SO NUMBER ONE IS JUST COMMON SENSE.
PATIENTS SHOULD ALWAYS WEAR THEIR SHOES, MAKE SURE THEY FIT WELL, AND REPLACE THEM WHEN THEY GET WORN. IT IS REALLY WORTHWHILE TO INVEST MONEY IN YOUR FOOTWEAR IF YOU HAVE DIABETES OR OTHER PROBLEMS THAT PLACE YOU AT RISK FOR FOOT PROBLEMS. OTHERWISE, WE ALSO RECOMMEND PATIENTS WITH DIABETES INSPECT THEIR FEET AT LEAST TWO TO THREE TIMES A DAY, LOOK FOR ANY ABRASIONS OR MINOR IRRITATIONS.
SOMETIMES IT MAY JUST BE A LITTLE PEBBLE THAT GETS IN THE SHOE THAT THEY DIDN'T NOTICE OR SOME OTHER PROBLEM THAT THEY CAN CORRECT. FOR SOME PATIENTS, PREVENTION IS AVOIDING ACTIVITIES THAT PLACE THEIR FEET AT RISK, AND THAT'S VERY DIFFERENT FOR DIFFERENT PEOPLE. SOMEBODY THAT HAS A LOT OF FOOT PROBLEMS IN TERMS OF BONE CHANGES AND THINGS CAN'T BE VERY ACTIVE, WHEREAS OTHER PEOPLE CAN BE NORMALLY ACTIVE AND NOT HAVE PROBLEMS.

YOU GO TO DIFFERENT PARTS OF THE COUNTRY AND THERE ARE DIFFERENT HOME REMEDIES THAT PEOPLE USE.
THERE ARE CLASSIC STORIES ABOUT PEOPLE USING POTATO SKINS OR SALT IN THE WOUNDS-THOSE SORTS OF REMEDIES. MOSTLY WE GET PEOPLE USING THINGS LIKE PEROXIDE AND BETADINE AND MERCUROCHROME, AND THINGS LIKE THAT. THOSE SUBSTANCES CAN BE USED IN SOME LIMITED CIRCUMSTANCES, BUT THE USE OF THOSE IN THE LONG TERM IS OFTEN DETRIMENTAL TO WOUND HEALING. SO WE WILL HAVE A PATIENT WHO WILL SAY THEY'VE BEEN PUTTING PEROXIDE ON THEIR WOUND FOR SIX MONTHS-WHICH GOT RID OF THE BACTERIA BUT IT ALSO GOT RID OF ANY CELLS THAT COULD HELP THE WOUND HEAL. SO BASICALLY, THERE'S THAT AND A LOT OF PRODUCTS OUT THERE THAT DO NOT HELP. THEY DON'T NECESSARILY HURT, BUT THEY DON'T HELP. SO IT REALLY IS IMPORTANT IF YOU HAVE A WOUND THAT HAS NOT HEALED IN A NORMAL AMOUNT OF TIME, WHICH FOR A SMALL WOUND SHOULD BE A COUPLE OF WEEKS, TO SEE A DOCTOR AND GET SOME ADVICE.

RIGHT NOW IT IS KIND OF AN EXCITING TIME BECAUSE WE ARE STARTING TO GET SOME SOPHISTICATED NEW PRODUCTS AND TOOLS TO HELP US HEAL WOUNDS. I THINK WE'RE JUST AT THE VERY BEGINNING OF HAVING MORE ACTIVE WOUND HEALING PRODUCTS LIKE GROWTH FACTORS AND TISSUE SUBSTITUTES. BEFORE THIS WE DID NOT HAVE ANYTHING OTHER THAN PRODUCTS THAT PREVENTED INJURY AND ALLOWED NORMAL TISSUE TO HEAL. WE NOW ARE STARTING TO SEE PRODUCTS THAT MAY ACTUALLY STIMULATE NEW TISSUE TO GROW IN AN ACTIVE FASHION. THERE'S A LOT OF RESEARCH GOING ON AND I THINK WITHIN THE NEXT FIVE TO TEN YEARS WE WILL HAVE MORE OF THESE PRODUCTS AVAILABLE AND HOPEFULLY IT WILL MEAN FASTER HEALING TIMES AND BETTER HEALING RATES.


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