 Hello and welcome to this episode of quality of your life. I'm your host Dave Augustine. Today we are going to talk about wound care. In helping us with that discussion is Dr. Todd Summer who is the medical director at HSHS Regional Center Wound Care and Hyperbaric Center. Welcome to the show Dr. Summer. Thank you very much for having me here today. To start out could you give us a background of your study in preparation to get into this field? Well a little bit about my medical history. I actually started my medical training as a podiatrist so I went to podiatrist school. Subsequently did my podiatrist residency practice for 10 years and then went back to medical school so I could enhance just my care of the patient so I could take care of the whole patient and not be focused based just the lower extremity. Did my residency at Mayo Clinic in Rochester Minnesota and then I've been with Prevea Health and associated with the HSHS system since 1999. Joined our wound care center. We started out initially at St. Vincent Hospital which is part of the region of HSHS this part of the state which would include St. Nicholas, St. Vincent Hospital and St. Clair and been associated with wound care since about 2002 and have had the pleasure of being their medical director over the last 12 years and have been associated here with our St. Nick's facility over the last three years. Okay St. Clair that's a recent addition to the HSHS system correct? That's true and our wound center there has just actually just actually recently had the addition of HBO there where the one here at St. Nick's belief has been in existence for about eight years and it's had HBO and wound care associated with it for its whole duration. I remember when I was still at St. Nick I think it was just starting out the wound center as far as that goes with the facilities so it's great to see that you know it's grown and become a regional practice. And as a population ages too it's amazing you know how the wound care market has just changed and the products that are available are just phenomenal. What we can do for wounds compared even a decade ago is just is amazing. So could you give a brief background on wound care and what it all entails? Well wound care is and people will always say too you know when is the appropriate time for a patient to go to the wound center and is this something that people should think of as a self-referral or does it have to be a physician referral? And our job in a wound center is to work with a patient's primary care physician. So in other words it's a team approach. Not only do we work yes our wound center physician and we also have some wonderful nurse practitioners that are part of our wound center team interact with the patient's primary care physician so it's a team approach. They're necessary to optimize the patient's medical conditions. Many of these patients will have diabetes, heart disease, all kinds of medical issues that always need to be optimized if we're going to have good wound healing. The wound healing arena has really changed significantly. Not only have the products available for wound care changed significantly in the last decade but our vascular colleagues the intricacy of the vascular surgery that's being done today has really optimized our limb salvage ability and has really enhanced our wound care ability. Our diagnostic testing that we offer in our wound centers today are just phenomenal and just our whole wound salvage is much greater. If you ask what type of wound or what type of patients and what type of wounds really are the type of wounds that a wound care center is going to see well it's variable just like the age scope. If you take a look at traditionally we'll see patients from all age groups. Wounds are probably a little bit more common in our older population just because as we age our ability to fight off an infection sometimes is compromised. We sometimes as we age have more diseases that can again inhibit wound healing. So we see a potpourri but again a good bulk of our patients would be the older group which sometimes will have more difficult ability to heal their wounds. What type of wounds do you see or you know years ago if you had to cut your finger you spray a little Bactine on it in the Band-Aid and you were good to go so what types of wounds you know when it when it gets in your area how severe are they or what types do you see. Well a lot of the wounds we see we see a lot of acute injuries too like your crush injuries for instance we work in close coordination with our orthopedic group plastic surgery and these groups realize that in those cases hyperbaric which is an oxygen chamber that's utilized to enhance blood flow and oxygen to to injured tissue realize that those kind of patients need to see us acutely. We also see a lot of patients that have chronic wounds it's very common for patients that come in and say you know I've had this wound for two or three years it's been difficult to heal and so they'll come to us for expertise in that area. Okay I can see where with your background you need to be closely in tune with the other disciplines you know with one because there's other health conditions this day and age you know what we're seeing with like you said diabetes and you know high blood pressure and other things that help contribute to you know wound healing as well so you really have to be in tune with. And if you say what group do we work with it's not just the hardcore wound staff but we also have several specialties that we look at for consultants our radiology consultants as well as our vascular who do a lot of the endovascular work for us are important our orthopedic group plastic surgery podiatry all these groups really fall into consultant groups that are necessary to enhance the patient's wound healing ability. Okay in those techniques that you use what are some of the educational you know things you have to go through or advisory you know type things when you're consulting with you know using these techniques. Well if you look at our training basically people will say well let's look at the hyperbaric part for a second what extra training does your staff need just for the HBO portion. Well when we are when a new person comes on board and they're looking to to be part of our staff they're sent out for an intensive week lecture training course hands-on about just the hyperbaric indications for it the actual logistics of the equipment itself and to continue to be efficient that of course we have to take several hours of CME per year and have to complete X amount of dives to keep our competency level in that area. Okay what are some of the methods that you use for wound treatment I mean you mentioned the hyperbaric chamber we can get to that a little bit but what are some of the other you know types of techniques that you use in the wound center. Well I think it depends on the type of wound we're treating okay probably one of the greatest things in wound care has been the wound vac so if we look at some of the surgical wounds and again approximately 1% of surgeries just in general have a risk for infection that will then require assistance from a wound center equivalent wound back vac has been a wonderful device that has helped not just surgical wounds but some of the diabetic wounds and venous stasis wounds it's just amazing how that is really accelerated wound healing it's been a great asset for some of the diabetic foot ulcers and for some of the what's called charco disease it's an advanced deterioration the bones that occur in some of the diabetic extremities and patients that have a neuropathy we do a lot of casting sometimes it's called total contact casting to help assist in healing some of the diabetic ulcers so we use a lot of biologics which would be think of it kind of like a pseudo skin graft that has a lot of growth factors and things that help the body heal ulcers so that's another entity that's used in wound centers quite frequently to assist in wound healing offloading sometimes just education the patient get him to understand the importance of not weight-bearing especially if the wound is on an extremity okay so the wounds are more are the external wounds you know so to speak versus internal wounds well most of the wounds that a woman said they were treating you know would be external okay at least would have a but again there are areas where some of the general surgeons etc. whether we'd be seen some abdominal wounds but usually those would be at least partially closed so we would be seen like you said may the most of the wound we treat would be an external okay is it a path that patients go down it isn't like okay come in once and you're treated ready to go is it usually a repetitious or a certain plan that you go through well if you if we just look at our diabetic group for starters because what you want to know is number one our wounds recurrent and is there chronic city to some of these wounds in the treatment program if we look at the diabetic group and within a lifetime approximately 25% of our diabetics are going to sustain an ulcer or a wound bad enough that's going to need medical care and within any one year there's going to be about three to four percent of these people having ulcers the part that makes it so complex for our diabetic group is they many times have lost feeling in both their feet and hands so they really don't have a clue they have a sore until they sometimes will see either drainage you know on a garment or they will develop a fever and so that what's that's what makes the diabetic group so complex their high risk for recurrence and again chronic city is pretty high with that group as far as their wounds go okay do you also in the treatment of wounds is there like medications involved along with that or is it pretty much just you know looking at the wound itself and treating it with the techniques like you had said well when we were treating the wound it's not just topical medications like you're asking about we're coordinating at many times with antibiotics which can be either IV or oral and on many of these complex cases we have the assistance of our infectious disease colleagues that fine tune our antibiotic choices and many times these can be six sometimes even eight weeks worth of IV antibiotics so again it's a team approach it's not just topical modalities that are used on many of these wounds but many times IV we had to depend on our family practice internal medicine colleagues to optimize their diabetes or some of the other health care issues that might be preventing their wounds from healing so it's a real group a composite of treatment not just topical treatment that goes into wound care okay what about the hyperbaric part of it how does that work I mean that's fairly new in the in the discipline of wounds is it not fairly new if you go back to the history of it of course hyperbarics originally was used for divers with the bends has been used in a lot of institutions for carbon monoxide poisoning our facility traditionally uses our hyperbarics to assist in wound care and it's a whole group of things we treat if you say what are the indications for hyperbarics and what percentage of your wound care patients actually utilize it are you the average utilization is about 10 to 15 percent nationwide of hyperbarics for all wounds in general traditionally the things that are most commonly treated with hyperbarics would be bone infections that are recalcitrant in other words are not resolved with antibiotics and surgery so hyperbarics augments resolution of refractory osteomyelitis as it's called meaning a bone infection that is resistant to the treatment we talked about if you say well what is the hyperbarics do in those cases it enhances blood flow and enhances antibiotic delivery so helps in both of those areas the hyperbarics if you think about it it's a chamber that changes the pressure so it's equivalent to a diver being at 33 feet of seawater so that now increases the pressure to two atmospheres so now the oxygen carrying capacity of the blood in the fluid or plasma part of the blood is enhanced so we can enhance oxygen delivery to the wound and that's how that works so it works well in cases where people are having severe infections crush injuries flaps graphs that are at risk that some of the plastic surgeons have done and a lot of the diabetic foot ulcers that of a certain level of severity it seems to really enhance healing for those so kind of in some summing it up it's just basically helping the body heal itself that's basically what you're doing to get that's a perfect response that's a hundred percent correct nice lately you've been seeing a lot of you know the shingles virus and everything do you treat the shingles virus or is there a possibility like with the hyperbaric or other one thing to treat that or is that a different type well you know that as a as you know tends to be a bullish eruption along a nerve tract that subsequently ulcerates those generally seem to heal quite well and they haven't that particular entity has not really required hyperbarics okay so those usually do pretty well just with standard management okay because I know when you see someone do some reading on it or the you know the pictures online it's like wow it's almost like it's a festering type thing yeah I think you know some of the wound care techniques that might work on it but it's a different animal I guess well as least for hyperbear hyperbear tissue is not necessary to heal those particularly okay okay what are some of the other disciplines are on your team is it just specifically wound care do you have other disciplines of medicines or do you work with other colleagues on you know when you come up with a health plan or wound care plan very good question actually so if we look at our consultant team again because we treat so many different things the other area that we treat with a lot is we treat what's called soft tissue rating necrosis so many of our patients that have had or have had to have required radiation treatment for different types of cancers sometimes that tissue the blood flow years later is compromised so sometimes wounds will develop in those areas if they require surgery and so we many times are interacting with our oncology colleagues to interact as far as wound care that's another area of course that hyperbarics works really well for as some of the areas that have had radiation exposure and now have difficult wounds to heal okay with the whole fairly new practice of wound care and hyperbaric what would you say are the percentage increase of wounds being cured or healed completely versus when we didn't have it well you know if we have to depend on primary care physicians which do a wonderful job of your care and we compare to a wound center that deals with the complex wounds that don't heal and and we always say that you know if if a wound hasn't healed in four weeks then it probably needs the expertise of a wound center to assist and and so what we usually do is build on what the primary care physicians have already done for their wound care and and that seems to work work well okay so when do patients really get involved with a wound center like what you have is that they first they go through there like you had said they go through their primary physician they take a look at it and then they said well we should really get to the wound care or can they you know when they look at a wound let's see right off and you see we got to get this immediately to wound care well we have several entry levels to our wound care center many patients will come through urgent care or the emergency department and the urgent care physician nurse practitioner or the ER physician or mid-level will say gosh this is a wound that looks pretty serious so they will do a direct referral over to the our wound center our primary care physician colleagues and mid-levels also if they see a challenging wound in their clinic that they feel has not responded in what they consider reasonable period of time they will either send it acutely or after they've worked with it for a period of time and we see quite a bit from our surgical colleagues of course if they have a difficult surgical wound where they feel the wound center would assist in their wound healing we get quite a few referrals from them and we get a lot of patients that our self referrals to patients will talk to their friends and they'll say you know oh by the way I had this wound that was healed by our wound center and subsequently we'll do self referrals too so it's kind of a popery if you want to use that term of referrals from several sources so in and the advantage nice thing about our wound center is we're the only one locally of course that has the combination of wound care and hyperbaric together so that makes it very convenient for the patient okay on average what would you see your census being in a let's say just say a month about number of patients well it's average or it's a little difficult because I work at several centers if you look at at St. Vincent Center where I see do more patient care we're here at down here I do more administrative okay endeavors my typical day at a wound center I'm usually seeing somewhere between 30 and 40 patients a day I'm responsible for wow so but of course I have several teams that assist me and that I have an RN a CNA in the room with me so we each have our specific tasks so we can efficiently you know see the patients and and take care of them very well that volume I mean that's that's fantastic you know as our knowledge of medicine you know gets better you know as years go on you know we're actually I think getting ahead of the game or at least doing good where years ago while that was just natural causes you know I didn't have it we're now we're discovering more so we're actually you know helping our quality of life and if you look at when Karen general you know we've been able to lower the amputation rate which is really good and that's again with the composite help of our vascular colleagues as well as the high-tech wound care and you know we're the wound care as our population ages and as the incidence of diabetes increases I think you're going to see wound care centers are going to become more and more important in the future even yeah when you're working with the patients and coordinating a care plan what other services do you coordinate or bring in as far as helping with that plan and aiding well I think you know the questions like the first visit that when we see a patient you know what is the criteria well we want to look at the nutritional status of the patient make sure that their nutritional status is good because that's important for wound healing we really want to look at the vascular status of the patient because if the flow is bad then any kind of wound care locally is not going to be adequate we want to make sure that there's not a severe infectious process going on so if there is we want a colleague again our infectious disease colleagues to assist us so we try to get a very intensive assessment early with the patient so that we can pinpoint where their problems are and hopefully accelerate their their wound healing ability I would imagine family history also plays into that as well a good family history good medical history counseling of course if they have a smoking history try to counsel them and smoking cessation because we all know that that impedes wound healing too and if we see specific deformities that might be causing some of the wounds of course having some of our colleagues assist us and possibly reducing some of those deformities is very important too I would imagine the integrated medical record like epic helps a lot and retrieving that information as well electronic records have definitely made patient data much more accessible I wouldn't say it shortened the workday for the physician obviously but yes I have to agree that's made I think medicine much more efficient in and made the records and and same thing with the digital x-rays made you know the x-rays and everything way much more available when comparing to some of more of the historic records I think the administrative part may be more but the time to get test results to the doctor who's doing the diagnosis has shrunk quite a bit much quicker much more organized instead of waiting for the lab you know to get them developed and they got to come across the street or being sent out and then all that so it's a lot quicker very true very true which is nice what are some of the other specialties that the Woon Center offers here in Sheboyut St. Nick well if you look at our consultant group consultants and again if we look at the the core staff if we start out with that at the Woon Center that would include myself who's a medical director as our physician we have two excellent nurse practitioners actually three excellent nurse practitioners that all have extensive HBO and wound care experience that monitor clinic our consultant staff here is quite extensive our consultant staff would include plastic surgery vascular surgery interventional radiology cardiology orthopedics podiatry internal medicine family practice infectious disease and in chronology so if you look at our consultant team that we have available to assist us with our wound care it's pretty extensive so I think we have pretty much the whole gamut covered that's fantastic so as medical directors or anybody else who substitutes for you like some of the other you know disciplines like radiology they have you know radiologists who rotate between the system and cover so are you pretty much it or are there other colleagues in your area of practice too in the region well there are you know a lot of there are more people in physicians and wound care of course in our Green Bay area than there is right here in our St. Nicholas area so as far as medical director I'm their primary physician you know here with as well as all the consultant physicians and mid-level clinicians that we reviewed previously okay do you see the field of wound care of people entering wound care as far as like what you did you went into it you see that becoming more of a preferred preferred excuse me area of medical practice well you know what you're wondering about is is this a new specialty that's just starting to blossom is the question and I have to agree with that 100 percent if you look at hyperbaric now I'm boarded in hyperbaric which is unusual now you have to do a one-year fellowship to have the same board that I have I was lucky that I had been in the field for X amount of years so with my clinical experience I was able to sit for their exam and subsequently get that board certification in hyperbaric now to get the same one I have you have to do one-year fellowship on top of your regular specialty residency of whatever you're doing besides wound care so as wound care develops I will I could see this very in the very near future becoming a whole residency program by itself nice what do you see the success rate as when somebody comes to a wound center as far as being treated I mean very good question if you look at our success rate of all comers now remember that includes not only acute wounds that are fresh but we treat a lot of wounds where patients have said you know I've had this for 10 years or etc so all comers we vary but we average anywhere from 90 up to as high as 96 percent healed on all wounds so I was very proud of our healing rate and and I think that that's really good when you take a look at some of the wounds that we treat that's fantastic if you had looked in your crystal ball where would you see wound care going in the future well you know as our health care system is going through changes you know the the catalyst is going to be to try to keep people healthy and our goal is to try to be able to treat as much outpatient in the future I think is where it's going so if we can prevent wounds that are of lesser significance from becoming grossly infected limb threatening or just life-threatening wounds sure we are really making a big dent in and helping the patient a lot so I foresee wound care as we go switch to this to as our health care goes through changes that are going to happen in the next several years is going to play a bigger and bigger role to try to keep people healthy definitely as a patient what can I expect when I first come to the wound center well as a patient it's always scary going somewhere new obviously I mean whether you're going to the dentist or going to a new physician but you know we have a really cordial wound center and you're going to be you know greeted by the the RN that's going to be taking your information by the cna who's going to be assisting that RN in information gathering there'll be you know a lot of questions the first visit and then we're going to lay out a strategy or treatment program with that patient and then we're going to make sure the patient agrees with it so it's very important when we make recommendations to say okay here's what I think is best for you mrs x or mr x how do you feel about this do you feel what we're laying out for you as the best treatment strategy that you can make that time commitment and this is something that you feel is agreeable because without that it's very difficult when the patient leaves the clinic if they don't buy into your treatment program then their compliance factor is going to be compromised yep one last question if I'm as a patient want to find out where I can go to or like you'd mention the self-referral is there a website phone number how can I contact sure in fact if you would like our current the phone number here we have for our wound center and shabuagan is of course 920 error code 4595180 is would get you in then to the wound center our schedule or actually schedules both for the green base site and shabuagan site okay so and they would be more than happy to to do that if you have just questions in general we have triage our ends at both sites there would be more than happy to answer any questions that the public would have regarding wound care okay last final thoughts that you have before we wrap we have about a minute left I just feel blessed that I've been part of the wound care system and I just have a passion for it and it's just it's the greatest thing it reminds me of medicine a couple decades ago when you close a patient's wound and they're so happy I mean this is one of the few areas where they still bring in cookies and candy it just the patients they they just love you it's just it's just a really rewarding profession and I'm just proud that I've been part of it okay wonderful as far as the website is it purveyor okay it's www.stnicholashospital.org if you want more information online sorry well thank you Angie who's in our studio audience consultant so um Dr. Summer I'd like to thank you for being on our show for wound care I think this was an excellent subject I mean I've learned a lot about it well thank you for much for having the opportunity to join you okay this concludes this episode of quality of life if you have any questions or like to submit any suggestions or comments you can contact us on our website at www.wscsheboygan.com for quality of life and Dr. Summer I'm Dave Augustine thank you for watching