In our weekly health segment, KC Counts talks with Memorial Wound Care Center's Melissa Cometti about the challenges treating nonhealing wounds and the options for treatment. Here is a transcript of their conversation:
KC Counts:
Melissa, maybe you can start just by telling us a little bit about what some of the common situations are that you see in your line of work.
Melissa Cometti:
So at the Wound Care Center, we see patients with chronic wounds. They can be anything from
Melissa Comett:
Skin tears, surgical wounds that have gotten infected, or they're just having poor wound healing.
Melissa Cometti:
Diabetic foot wounds, diabetic lower extremity wounds, lymph edema.
KC Counts:
You mentioned the diabetic. I think a lot of us think of that in terms of something that is so common. Many of us have someone we know who has found themselves in that situation. I certainly do. Why don't you explain what is so difficult about providing effective care in these situations?
Melissa Cometti:
So patients with diabetic wounds. They have, especially if they're, it depends if their blood sugars are either well controlled or uncontrolled. Many times we see patients, their blood sugars are not optimized. And so this can lead to issues, not just to the largest organ of the body, which is the skin, but to their circulation system, to their healing potential, they usually have immune issues, they have problems with infection. Higher blood sugars usually increase the risk of infection of patients with diabetes. And so there's a lot of different challenges going on with that. Diet is crucial to wound healing. A lot of the diabetics, we have to do education on their nutrition and what they're taking in both food and drinks and focus on, you know, getting their blood sugars under a manageable level. With wound healing, blood sugars need to be under 180 on average. If their blood sugars go over 180, that disrupts the wound healing phases and so that can be very problematic in healing wounds.
KC Counts:
Can you explain how that impacts the wound healing? What is the connection there?
Melissa Cometti:
So wounds go through specific phases of healing, and they need to progress through those wound phases. If they get disrupted at any portion, then it can turn that wound into a chronic wound. So like the wound phases of healing, we start out, you have your wound, it bleeds, the bleeding stops, it goes into the inflammatory phase, and then it goes into a healing phase, and then the scar tissue phase. When blood sugars, specifically in diabetes, are high, it can disrupt the wounds in any of those phases of healing, more specifically in the inflammatory or the remodeling aspect of the wound phase. So if it gets stuck in one of those phases, then that wound becomes chronic. It's at a higher risk of infection. It impairs the immune system. It can drive the blood sugars to be even higher if they get infections. So it's super important to keep the blood sugars well managed.
KC Counts:
Tell me about some of the technology involved in caring for these patients.
Melissa Cometti:
So at Memorial Wound Care Center, whenever we initially see a patient, we of course, do a thorough evaluation of everything that's going on with the patient, because we need to look and see what could be the problem that's causing this wound not to heal. So once we identify that, then we start with advanced care products, wound care products that we can put on the wound, also with educating on lifestyle modifications. But whenever the wounds don't heal, then we can use a therapy called hyperbaric oxygen. Hyperbaric oxygen is a medical treatment where you breathe 100% pure oxygen in a specially pressurized chamber. And this is two to three times higher than normal air pressure. This high-pressure environment forces oxygen directly into your blood plasma, the body tissues, and it helps to aid the healing of chronic wounds, specifically in diabetics. they typically have immune problems and circulatory issues. And so with hyperbaric oxygen, the body can stimulate angiogenesis. And what this is, is it's the growth of new blood vessels. It's called
neovascularization, and what it does is it creates new pathways for oxygen and nutrients to reach those damaged tissues that we're trying to heal in the patient's either lower extremity or in their foot.
KC Counts:
Did I hear you right? You can create new blood vessels?
Melissa Cometti:
Yes, and that's what's really amazing about the hyperbaric oxygen, with the way it pressurizes and it creates a hyperoxygenated blood flow going through the vessels. So it's a very important therapy that we do see a lot of success with in creating that increased blood flow. And you know the main goal is that we're trying to prevent amputation with these wounds and so it's imperative that you know we get them started on this type of therapy to help them that.
KC Counts:
How do we know when there's signs of trouble?
Melissa Cometti:
So with any diabetic they're gonna have the issue of a non-healing wound. Usually, we will do advanced wound care therapy with advanced wound care supplies, and again, lifestyle modification, really focusing on their nutrition and their blood sugars for 30 days. If we don't see any improvement at that point, then there's other things that we can do. We will check their blood flow supply. We will send them for arterial studies, venous studies, and make sure that their vessels are able to to accept this enriched blood flow, and then we start working them up for hyperbaric oxygen. So typically, after 30 days, we do our evaluation. A person with diabetes, there's several indicated therapies that insurance typically covers, but diabetic foot ulcers are one of the more common reasons why we see these patients. The treatment plans are individualized. We do a rigorous medical evaluation to make sure that this therapy is appropriate and safe for this patient. This person can expect to have between 30 and 40 treatments. One thing that some people have a problem with is that this treatment is Monday through Friday. The treatments last for 90 to 120 minutes, and it's Monday through Friday, and it's typically four to six weeks.
KC Counts:
Wow, that's pretty intense.
Melissa Cometti:
It is. But you need that treatment daily because it helps increase that good, healthy blood flow daily.
KC Counts:
And tell me about those successful outcomes. What does that look like, and what challenges still remain for you in this field?
Melissa Cometti:
So we have a lot of success stories with the hyperbaric oxygen. Again, we have diabetic foot ulcers. Our goal is to heal the wound, prevent amputation. We have seen that many times over. We also have patients that get radiation damage. They've had cancer to an area of their body, and it can be months or years later, they notice that there's wounds appearing in that area. We've seen people where we've done hyperbaric oxygen in those cases, and we the wounds to heal, we strengthen the skin and the wounds will heal. We have patients that have bone infections. The goal again is to prevent amputation to try and heal that bone infection with a combination of IV antibiotics and hyperbaric oxygen. So we have patients, we have two chambers and we can see up to six patients a day. We keep the chambers pretty much full every day, Monday through Friday, and we do have a waiting list and we just, the more people that we can get in with in for this, the more people we can, you know, improve their quality of life.
KC Counts:
And you mentioned waiting list. I would imagine that's one of the biggest challenges is just access for everyone who needs it.
Melissa Cometti:
It is. Again, you know, we have to make sure that their insurance will pay for it. We do a strict medical evaluation and then we submit it for insurance. Hyperbaric oxygen, there are FDA approved different therapies such as diabetic foot ulcers, delayed radiation therapy, chronic refractory osteomyelitis, which is a bone infection, and some other indicated conditions that the insurance will pay for. So once we have that approved and we get them started and and we have, you know, people in different phases of their treatment. So we just once we have a free chamber, then we get another patient started and it's just wonderful to hear the improve quality of life of these patients. Some of them are having excruciating pain, or they've been dealing with an open wound for so long, and just that stigma of having that chronic wound, improving their quality of life, that makes this very satisfying and good for the patient.
KC Counts:
Well, what have I not asked you about, Melissa, that you think is important for people to know?
Melissa Cometti:
Well, I would say that, you know, one of the questions that people have at the pressurized chamber, we put, our patients are, our chambers are monoplace chambers. So a monoplace hyperbaric chamber, it pressurizes the environment using 100% oxygen. And what they do is the patient breathes this 100% oxygen, and they're actually in a chamber, a pressurized chamber. And so there are some people that do have anxiety or they might have claustrophobia. We really work with these patients. Our chambers have a clear acrylic. And so they can see us, we can see them, we can communicate with them at all times. And so, you know, we can, there are things that we can do to help them through this. And usually most patients that have this anxiety after one, two, three sessions, they're very comfortable with it and we don't see any other issues.
KC Counts:
Well, Melissa Kameti, thank you so much for sharing this important information with us. We appreciate the time and wish all your patients the best of success stories.
Melissa Cometti:
Thank you very much. We appreciate the opportunity to let patients know about the therapy.
Memorial Medical Center is a financial supporter of KRWG Public Media.
