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OnlineHost: Copyright 1996 America Online, Inc. All Rights Reserved. OnlineHost: Your Emcee is Karen KJW (AOLiveMC5). OnlineHost: Welcome to Columbia's physician chat. Columbia is the nation's largest health care services provider with more than 330 hospitals, 125 outpatient surgery centers and 150 home health agencies. Tonight's chat will feature Drs. Jeffrey A. Stone & Ronald G. Scott, specialists in Wound Care. This chat will last for 45 minutes. Thank you Drs. Stone and Scott. AOLiveMC5: Drs. Stone and Scott, welcome to the Main Stage area of America Online! Wound Doc: Thank you very much. We are glad to be here. AOLiveMC5: We have lots of audience questions, lets get right to them. OK? Wound Doc: Great Question: I was hit in the head with a metal object. I am now seeing a bright light in my right eye. Do you think I may have had a concussion? Wound Doc: Yes, I would check with your doctor. Question: Is the reimbursement adequate to make a profit by opening a wound care clinic? Wound Doc: Yes, but you must also be cost effective. Question: To be reimbursed does the Dr. have to be present for say debridements or can a specialized nurse do and bill under the Dr. PIN? Wound Doc: We feel that the doctor needs to be present. Question: Please define a chronic wound? Wound Doc: Typical causes are diabetes, pressure sores, venous ulcers Our average wound in our clinic has been present for almost a year. Chronic wounds are greater than two months. Question: How many stages of the wound healing process does the hyperbaric treat? Wound Doc: Hyperbarics is indicated in a limited number of cases. Most wounds do fine without hyperbarics. Hyperbarics - by using hyperbarics works through several mechanisms some of these include new vessel growth, inhibition of toxins and direct bacterial killing. Question: Hello, I'm a Physical therapist Practicing in an Acute Care setting. I see lot's of vascular patients, and am interested in your opinion of high volt electrotherapy in wound healing? Wound Doc: In a recent government review electrical stimulation has been shown to be useful in the treatment of certain pressure ulcers. Further research is ongoing. Question: How serious can a staph infection be? Wound Doc: It can be quite serious, depending on the health status of the patient and what body system body system is infected. Question: Burned top of hand on broiler put Benadine on but it gets yellow and wet-keeping it dry but it is thick and dark red. Swelling has gone in past week ,sore around no temperature. Sometimes bleeds. Should I just keep it dry? Wound Doc: You should see a physician. Most wound care physicians believe that chronic wounds need to be maintained in a moist environment. Most hand burns can be very serious. Further follow up may be necessary with your doctor. Question: I've heard a lot about hyperbaric oxygen therapy, what exactly is that? Wound Doc: It is the same as a recompression chamber for the bends, but in this chamber the patient breathes 100% oxygen for certain chronic wounds. Question: How serious are foot wounds for diabetics? Wound Doc: Very. There are 50 thousand amputations a year due to diabetes. Twenty percent of all hospitalizations in the US involve diabetes. Seven percent involve peripheral vascular disease and related tissue damage. Question: I was wondering if you use Procuren in treatment of chronic non healing wounds? Wound Doc: Yes, in approximately one-third of the patients we see we feel that it is a useful adjunct in a comprehensive wound care program. Our average diabetic foot wound that we see has been present for eleven months before we see them. Question: Is there any role for steroids in the treatment of ulcers associated with pyoderma gangrenosum? Wound Doc: Yes, systemic topical and in some cases injected steroids near the lesion are necessary for the healing. More importantly a search for other underlying diseases should be undertaken. Question: RN magazine reported a new wound care product, Biafine that has clinical studies to show 3 stages of wound healing are you familiar with this new product? Wound Doc: No, is it a collagen product? Question: Can an insect bite cause a bacterial infection? Wound Doc: Yes, certain insects can bite and cause sores. These sores can get secondarily infected. Certain stinging insects like a wasp can sometimes cause a direct bacterial infection. Question: Do you have any preferred dressing regimen for healing wounds that have been opened after repair due to wound infection. Traditionally I've used dilute Betadine or saline wet to dry, any better alternative? Wound Doc: We do not use Betadine. We believe that a wound should be in a moist environment with a solution that should do as little damage as possible. Saline is a good solution. Question: Recently my 2 yr old daughter received a burn to her hand. I treated it with cold water and ice. Was that the correct thing to do? She felt discomfort for hours. Wound Doc: Burns can be very painful but in your initial treatment it was correct. If the pain is persisting or if a deep sore is on the hand your doctor may need to look at this. Question: I was taught that Betadine could damage the new tissue growth is that true? Wound Doc: Full strength cleansers can do damage if used repetitively in a chronic wound. Question: Everytime I get a cut and it heals . My skin is left with discoloration. I have Cardiomyopathy. Is that the reason? Wound Doc: Vitamin supplements are important if the patient is not receiving adequate nutrition Wound Doc: No, I don't think so. What is in Biafine emulsion? Question: What do you think about pycnogenol? Good/Bad. Wound Doc: Pycnogenols may not be indicated prior to certain surgeries because of trouble with blood clotting. AOLiveMC5: We received a follow-up comment on the Biafine question. They said it was an emulsion. Wound Doc: Vitamin deficiencies can be a cause of chronic wounds. Question: Is there a natural treatment for ringworm on the leg? Wound Doc: I am unaware of any natural treatment for ringworm. Ringworm is not a chronic wound. Question: What is "aerospace medicine?" Wound Doc: Aerospace medicine, we take care of pilots with certain conditions that may not allow the them to fly. The physiology is different and this is separate from our wound practice. Question: Are there any natural or holistic ways of healing a chronic wound? Wound Doc: Many current dressings on the market contain natural ingredients (comfrey and aloe plant extracts, etc.) There's more than the topical therapy for healing wounds. Look for the cause of the underlying problem and correct it. Question: I once read somewhere that staphylococci produce toxins that were linked to food poisoning. Was this correct? Wound Doc: We do not deal with food poisoning. Question: What is thrombophlepitis? Wound Doc: Blood clots and inflammation in the veins, usually occurs in the legs. It can later lead to problems with circulation that can lead to chronic leg wounds. Question: How do you feel about the use a electrical stimulation to a healing wound? Question: Should all (even minor) wounds have an antibiotic ointment and covering put on them? Wound Doc: All wounds should be cleaned to remove debris and dirt to be kept protected. Not all wounds need an antibiotic ointment. Question: What treatment options exist for treating a stasis ulcer due to poor circulation? Wound Doc: Three areas should be addressed. 1. What you eat and how you live, low-sodium diet and avoidance of prolonged standing. 2. Compression therapy (wraps or support stockings.) 3. In some cases an extremity compression pump is necessary. These should be used along with dressings and a comprehensive wound program. Question: Considering the problem of bacteria becoming resistant to antibiotics, do you feel in certain instances, it is wiser to treat a wound topically rather than by pill or injection? Wound Doc: Wounds should not be treated either topically or systematically if not indicated. Antibiotic therapy should he dictated by the condition of the wound the surrounding tissue, the culture results and the patient's general health status. Question: Are you familiar with the use of concentrated platelet compounds derived by autopheresis for application to chronic wounds? Wound Doc: Yes, topical platelet releasate has a place in chronic wound care in a subset of patients. Question: I have had problems with patients I care for with chronic or acute wound, who also happen to be diabetic and receiving hyperbaric treatments who have had hypoglycemic episodes during treatment Is this common? Wound Doc: Yes, the blood sugar should be checked before entering a chamber. The absorption of insulin from the subcutaneous tissues can be affected by the hyperbaric environment. Timing of the insulin does around the hyperbaric therapy may be necessary. Question: With any burns. Is it good to bust the blisters to let the pus get out to start the healing process? Wound Doc: Not necessarily, the clear fluid inside a blister provides a normal environment for burn healing. However, if the blister ruptures, the wound will require cleaning to remove the dead skin and allow for bandage changes. AOLiveMC5: Here is a nice comment from someone in our audience tonight! Comment: I want to thank you for giving your time and answering important questions. Thanks! Wound Doc: Thank you AOLiveMC5: Nice to be appreciated, isn't it? Question: Does age play a role in how fast the healing process is for any kind of wound? Wound Doc: Yes, the immune system is necessary for the wound healing and infection control. Certain infections that would otherwise not affect a normal immune system can become a problem. AOLiveMC5: We are almost out of time, but lets take one more question from our audience. Wound Doc: Sure. AOLiveMC5: It seemed like an important one to take. Question: I have blood in my urine, with no pain. I am a female , age 34. Do I need to worry? Wound Doc: That really is not a wound related problem, but they may want to consult their physician. OnlineHost: All good things must end. We've run out of time for this event. Drs. Scott and Stone, thank you for being our guest in Center Stage! AOLiveMC5: It's been great having you here Drs. Stone and Scott. And a big thanks to our audience for sending in your questions. Wound Doc: We have enjoyed this thoroughly. Cybernautically yours. Dr. Scott and Dr. Stone. AOLiveMC5: Goodnight everyone! OnlineHost: Copyright 1996 America Online, Inc. All Rights Reserved.