Wound Care Pressure Ulcer Radio Interview WOCA

Wound Care Pressure Ulcer Radio Interview WOCA

then a 617 4840 calles information
station 1370 WOC you seven minutes after eleven o’clock thank
you for tuning in it’s been probably six or seven years since my father passed
away and the last few well the last half year of his life he was bedridden and he
had been a very active person all this life but those last that last half a
year especially the part that he spent at home II wanted to die at home and he
was in bed and he had bedsores and I remember well and and all these years
later I can still smell the medication the ointment that the doctors prescribed
for us to to apply to the the wounds if least we call bed sores I think and now
they’re called pressure wounds or maybe both words or expressions are
interchangeable dr. Bardia Anvar is on the phone he is a wound care specialist
and we could have used him those in those years he’s the medical director of
skilled wound care and he’s going to tell you how to avoid pressure wounds in
the first place and some practical tips for treating pressure wounds also known
as bed sores good morning dr. Anwar good morning sir good morning how are you
pretty good where are you were you coming from we our corporate office is
based in Los Angeles California however we are a national group of physicians
where we provide wound care to patients in nursing facilities oh my goodness and
I’m guessing in the nursing facility you probably have your share of that how
long does it take for bed sore to actually develop bedsores can happen
very quickly that can happen in a few hours it depends on the health of the
patient so if the patient is not getting enough nutrition not eating enough has
been in hospital for a long time as their health has deteriorated they can
get them very quickly obviously healthier individuals won’t get a bed
sore or pressure ulcer just in a few hours it takes more so we commonly see
it in patients that have other disease processes
going on in their bodies and then they start to develop these pressure ulcers
as well and is it because the the disease is somehow making them more
fragile to the pressure or is it because they’re simply lying in one place
without moving well some patients they’ve even done studies where they’ve
turned the patients in the intensive care unit and they still develop them
but it’s if the patients are turned every two hours they have to return the
right way but in addition to that the skin has to be kept very clean
moisturize properly so it doesn’t dry out the patient needs to receive enough
nutrition to keep their protein and blood levels up you can prevent them the
most important thing obviously is because they’re called pressure ulcers
the pressure needs to be removed unfortunately a lot of a lot of people
think pressure ulcers are because nurses that in turn the patient or something
you know it’s a result of bad care and medical care visually patients who have
pressure ulcers have three or four other diseases so it’s not just the fact that
something that was for care somewhere along the line of the health care of the
patient and this can also affect people that are ambulatory as well not just
bedridden yes it’s true and as you know I we have about 300 million people in
America and you know we have a population of patients around six
million who have diabetes and then of those patients 25% of them will develop
a wound so and a lot of those patients are walking around they develop the
wounds in their in their feet we don’t call them pressure also really diabetic
wounds yeah and of those patients who have diabetes twenty-five percent of
them will develop a wound and within five years another twenty-five percent
of them may end up with an amputation of that of that of that lat lag if the
wounds get infected so even patients who are walking around especially diabetic
patients they need to be very very careful
about developing these wounds because they can become very very bad infected
and jit you’re a trip pretty quickly so when we self-medicate do we do ourselves
more harm than good let’s say okay let’s say if I saw her wound under my foot I
might say oh my gosh I got to put some desitin I’m just coming up with a name
off of top my head yeah or or neosporin or something like that would I be doing
more harm than good um no actually uh well most of the problems are people
don’t discover the wounds until it’s too late so usually when people discover
them they can prevent them from becoming too infected so the the real the real
work in treating wounds is actually getting the insult the insult or
whatever’s causing them away so putting bacitracin or putting neosporin which is
a triple antibiotic ointment is actually ok but at some point you want to see
your doctor so and you want to try to see a specialist in wound care most
physicians actually only get in medical school one or two hours of training in
wound care so and they don’t get it during their training because it’s not
really something that’s looks upon however there’s about six million
chronic wounds in America right now and it’s a very huge epidemic we’re spending
50 million dollars a year treating these rules a year in America so it’s very
important that people do learn about this and the did you seek out a
specialist and to really take care of these patients I know a few people who
are older than us and they are on blood thinners and every once in a while I’ll
notice new bruises on their arms because they’ll be walking and they’ll just bang
up against a wall or they’re working on a car and they they move their arm and
they bang up and then all of a sudden this huge bruise forms because of the
blood thinner are they a prone to having these wounds not just bruise but also
open up yes those those bruises it depends on
how much blood develops underneath the grooves so if they get a huge pocket of
blood underneath there which we call a hematoma those hematomas could become
infected become so usually it depends on how bad the person’s it isn’t if it
isn’t a ball of blood underneath which is usually called a hematoma it’s a
small bruise those should usually heal and nothing will happen but if they do
swell up you do want to use warm cock calm process to kind of break up the
heart and blood underneath and try to get it to go away sometimes we even have
to open them up and evacuate or take out all of the Dead blood underneath yeah
and then you’re left with a hole there or you know open skin there and that’s
not fun and it takes a while to heal though so you have to be careful if you
are implemented the biggest risk with cumin and obviously is patients fall and
if they have head trauma if they’re being bang their head somewhere pretty
hard they could have a bleed in our head that’s the number one way that patients
were on blood thinners can unfortunately get you know they can die from them so
you have to be very very careful well so um yeah my brother my brother fell you
know here’s I’ll tell you what good for my brother’s story he’s plus 64 yeah
piggy 64 years old he fell in the parking lot at Walmart did not know he
hit his head or at least didn’t think he did and went by ambulance to the
hospital they checked him out and everything was fine and then I see maybe
two months later he his family was reporting that he was slurring his words
he wasn’t the same person his leg was hurting and terribly long story short he
had a brain bleed but they didn’t diagnose it when he went into the
hospital for the fall then the fit in the first place so he had been living
he’s ok now they had to literally drill into his head and drain it out and and
and I guess he’s making a good comeback now see you say that’s kind of the same
thing yeah that’s that’s pretty interesting it
sounds like your brother may have a dural hematoma that bled very very
slowly because that is the case with epidurals patients fall and or they’ll
have some kind of head injury but they won’t lose consciousness they’ll still
be awake and within eight hours though usually it does optus usually you’ll see
symptoms within about you know within 24 hours with any kind of brain injury
where something starts not looking right so it’s pretty unusual that he was okay
for a month or two well and he was a blood thinner Cherie yes here blood
centers yeah oh okay so you may have had a very slow bleed usually that could be
seen on a CT scan so when you go to the hospital they’ll do a CT scan of the
head then there’s the other kind of bleed which as a subdural a bleeder a
subdural hematoma that actually is a little bit faster and you those are
actually harder to manage and those could be more soft for patients
epidurals because they’re outside of the brain there on that surrounding their
outside of the actual protective coat of the brain once they’re evacuated and the
blood is taken out it’s kind of similar you know the hematoma you gave a liar
are the patients or patients are fine afterwards however once it’s inside of
the brain and there’s a bleed it’s it’s much much harder to handle and it could
be a difficult recovery doctor doctor Bardia Anvar is our guest will take a
little break and be right back with dr. Anwar by the way if you have a question
call in right now you’ll be on hold for about two minutes the number 62 296 22
we’ll take a break and continue our conversation and we’re focusing on wound
care dr. Anwar is a wound care specialist we’ll be right back
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underclothes Perfector surcharge or delivery fee 90 minutes after eleven
o’clock you know I don’t know exactly what it’s like to be a doctor because
I’m not one but just going back to the experience I had with my dad I remember
this the people family members would come in and ask the doctor the exact
same question that I asked or somebody else and so they must get the same
questions over and over they have to be doctors are not only doctors their
teachers everybody who has something going on with them always is picking the
brand of the doctor and so I’m guessing dr. Bardia Anvar is the same he’s
probably gets people asking those questions that we were asking him right
now over and over again but don’t don’t let that stop you if you have a need for
question the answered especially about wound care call in now 62 2962 to dr.
Anwar I heard you during the break say something about nursing homes in general
and you know what I what you said earlier that makes me feel good actually
is that sometimes it’s not the incompetents that causes a bed sore and
I think sometimes the US those of us who are not in the medical field think it is
you see a bed sore and you automatically think oh my gosh somebody didn’t do her
job yes and I think there’s there’s there’s a little bit of a negative
impression that people have when they send their family members to a nursing
home you know just to be blunt I think a lot of people look at it as a place they
go or they send someone to die but that’s not really the truth about being
inside of a nursing facility most nursing facilities are designed really
to rehabilitate patient and get them to go home and that’s really why they’re
called skilled nursing facility there’s a term skilled in there so on staff
there are physical therapist on staff there are obviously physicians medical
directors and the facility there’s directors of Nursing and there’s nurses
there rehabilitating patients to get them out unfortunately there there are
some patients who don’t have anywhere to go after the nursing facility so they
stay in the nursing facility and then they become they become resident
and there it’s called the convalescent say but you know when when we decide
that somebody needs to go there we have to go into the nursing facility I think
people can get very scared about it it could be a scary place however it should
not be viewed as such and it’s called a nursing facility because it’s mostly
nurses they’re taking care of you whereas in the hospital you have
physicians rounding and you may have multiple physicians seeing you in the
nursing facility you’re mostly having the nerve system coming to you and the
key difference in the nursing facilities you get your medications from a nurse
you get your vital signs check to get your blood pressure your heart rate
checked every every few hours whereas if you go home straight from the hospital
you can’t do many of these that’s true yeah yeah yeah you you you can’t have a
physical therapist coming home every day and as our health deteriorates some some
patient population needs to go there and you may develop the wounds there or at
the hospital before you go there as well and and what our service does is we go
and go to the vision and see them at the facility to take care of them so why
does a diabetic person develop a sore on the bottom of his foot anyway what’s
going on that then a non-diabetic wouldn’t have the same thing happen um
that’s a very good question there’s actually a number of different reasons
number one diabetes affects will actually overall guys a diabetes affects
many of the different organisms of the body so your eyes your vision becomes
poor you have diabetic retinopathy so they can’t see their feet very very well
number two is that their sensation goes down they sir have a nervous system
problem where it’s called neuropathy so they don’t seal their feet so when a
diabetic patient you hits their bangs are foot against a wall or hit their toe
in their shoe most of us would feel it we would take a look at it they don’t
see that and then once the moves develop because they have high blood sugars
the immune system is suppressed or is not a strong that would be and their
ability to fight infection and not as good so usually their wounds become
infected so it’s all of these factors combined and they also get deformities
of their foot they’re called sharp sharp sharp ko’s deformity or shark old joints
so they’re their feet don’t function is properly either so they have to wear
special shoes and usually we have to really examine the feet every week make
sure the toenails are cut properly moisturizer feet properly so they’re not
very very drying and breaking down either oh wow just real quickly I know
and would there not a sponsor right now but we’ve had a sponsor that sold
diabetic shoes and they would always say that Medicare pays a rape Medicare
Medicaid something like that yeah yes madam Medicare will cover that for
diabetic patients especially if they’re at all at risk for developing and unique
kinds of bloom you talk about hydration staying hydrated in your wound care
practice and using moisturizers because it it just seems that if you have wounds
that for some reason the skin starts drying out yes so most missions of what
we think about is of course that they need to eat so sometimes we’ll even put
a feeding tube in the patient’s stomach and make sure they’re getting enough
nutrition one of the things that we may forget about even when you have a family
member at home that you’re taking care of them are they getting enough you know
water or hydration so there the key thing is that we can measure how much
hydration we we have is by how much urine a patient produces every day
sometimes when they’re at home or in the nursing silly we may not be following
how much they’re producing so they may have very low urine output and that
means they’re dehydrated and they need more water so that’s usually actually
the way we measure it I know a lot of there’s a lot of different formulas out
there you need to drink two liters water a day a leader certainly if you have
something like diabetes these or other diseases it’s not a good
idea to drink soda has a lot of phosphorus and have a lot of different compounds in it that are not good sugars
so really you want to actually just have water have stations taking water and
then moisturizing is very very important in basically keeping the moisture in the
skin so from the lowest level is basically your vaseline based you know
just by getting vaseline petroleum jelly and putting it on your body to getting
actual hydrating moisturizers that actually take water from the surrounding
air and actually suck it into the skin and those are the stronger one and
sometimes when patients really have a lot of dry skin maybe they have heart
disease or a little blood flow to their legs their legs become very very dry you
actually have to get hydrating moisturizers that will bring the water
into the skin to keep it nice and moisturized oh wow and is there is there
a soap that can do this first or something I mean is there a name we look
for how do we know what to get well the Vaseline based ones are things like user
in aqua for those are the lower level ones it’s the highest level ones and
then you have your lanolin based products that are that you see over the
counter that are the most common hand lotions they have landed okay you know
the medical strength one is something like moisture l and then at the highest
level are the ones that have alpha hydroxy acids in them or lack lactic
acid in them such as an laxton cream which is very very strong back that we
bought over the counter too so these need to be used in concert usually you
actually need to have a specialist like if you have really severe dry skin you
actually should go to a doctor so they can give you regimen of what to use and
we’re gonna overall not go ahead well what is it okay when when that when you
get desitin or a death certain type product it says something about ox is
their oxygen in it or something somebody somebody told me that for a wound if you
if you expose it to oxygen and we get well
and you need a product that is oxygen in it is that right well there’s there’s
really no there’s no dressing that you put over wound and it brings oxygen
unless you actually go to a hyperbaric chamber and you put a hundred percent
oxygen but you’re exposing you actually go inside of a chamber desitin is more
of an agent that keeps the area keeps the moisture in so it’s usually used a
lot of times with diaper rash we’ve been used it in babies we use it at children
who get diaper rashes you said it elderly adults a kind of Keith and it
also keeps away if the patient’s having you know a lot of urine or stool hitting
the area making it worse from from getting worse but the key is if you
don’t have wounds is to when you come out of the shower not to take very long
showers for for elderly patients not very hot showers limit them to three to
five minutes there is really no soap but you do want to clean your area at least
three times a week and then once you’re out of the shower is to apply the
moisturizer about while the skin is still damp so not to wait until your
skin is totally dry before you apply your moisturizer before we run out of
time and we’re very close doctor I went to your website skilled wound care calm
and this you have an event happening next next month August twentieth in
Orange County that would be in California obviously right yes yes yeah
okay not the orange in Florida but we we are educating close to three to five
hundred nurses at that event in California for a day and then we are
going to be having these events throughout the United States and reading
nurses about about blue care doctor thank you for sharing your expertise
with us go to skilled wound care calm to learn more dr. Bardia Anvar thank you
we’ll be right back news radio on million moo the
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