- Chronic wounds, I bet it's not the first thing that comes to mind as something that can impact your overall health.

So what is a chronic wound?

A loose way to define it is a wound that does not heal in a predictable amount of time.

It can be anywhere on your body and they don't heal on their own and require the help of a specialist to heal properly.

On today's episode, we're going to look at the importance of treating both the physiological and psychological results of chronic wounds.

We will speak with a specialist, meet one of his former patients and talk with a clinical social worker about the direct correlation between good mental health and the body's ability to heal itself.

Welcome to A Su Salud, Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

Let's meet our medical expert.

Joining us today from St Luke's University Health Network is Dr Steven Bowers.

Thanks for joining us today, doctor.

- Thanks for having me.

- So let's start here.

I have no idea that doctors could specialize in wound care.

So let's start with this.

What do you do as a wound care specialist?

- Really, we see wounds all day long, different types of chronic wounds, acute wounds, but yeah, it's wounds all day.

- Wound care, I'm sure is probably the last thing on someone's mind when you're thinking about health.

So I found this interesting.

Some wounds actually never heal.

Why is that?

And how can you care for a wound in that case?

- So, yeah, the majority of what we do treat are chronic wounds, so exactly what you're describing and that can be for multiple reasons, it might be a blood flow issue.

It might be that there's too much swelling, might be that they have they're getting too much pressure on a certain area.

And really, that's what we'll do, is figure out why they have a wound or an ulcer that won't heal and then what we need to do to get that to heal.

- So a wound versus a cut that I have on my skin versus a chronic wound.

Can you explain that for us?

- Right.

So your typical acute injury, your fall and scrape your elbow, you know, we usually don't have to get involved.

If it's more complex, if it's not healing, we will get some of those consults to see.

But, you know, normally for a young, healthy person who has a fall or an acute injury, they're going to heal up just fine.

Then you can move on to your non-healing acute injuries.

And then there's chronic ulcers like a diabetic foot ulcer or venous ulcer, a pressure ulcer.

So wounds that haven't healed for six months, six weeks.

I have patients who it's been years for some of them.

And, you know, we do what we can, but not every ulcer can actually even be healed.

- I came across a wound specialist blog, so one of the points that they made was that you are what you eat.

And so nutrition plays a big role when treating wounds.

Why is that?

- Yeah, nutrition plays a huge role, I mean, just like, you know, with everything you do, you've got to have a healthy diet, really, the protein intake, there's plenty of studies to show that you have, especially for sick patients, chronically ill patients.

They might have pressure ulcers and skin breakdown.

Protein is a huge component of that.

So really, we're shooting for 1.5 to 2g of protein per kilogram of body weight.

So the average person, 70 to 80kg, you know, you're looking at well over 100g of protein a day.

So a lot of protein.

We use some supplements really over the counter.

There's plenty of bars now that have 30g of protein or shake mixes that you can use.

And I always tell people make a smoothie, get some veggies, get some fruit, get some other healthy stuff.

And then that's also going to help.

- How do you minimize scarring then?

- Well, I mean, patients are always going to scar, really after we get someone to heal.

It's applying a daily moisturizer.

Once a wound or a chronic ulcer heals, it will continue to remodel and that scar will remodel for up to two years, actually, after you've healed.

So during that remodeling process, a lot of times what happens is the scar will kind of track down, tighten up, might become more prominent, usually becomes paler.

You know, initially it's kind of like baby skin, it's pink, it's healthy, and then it just becomes kind of a pale mass of collagen and that has repaired that area.

So really just putting a daily moisturizer on it.

If it's initially after it's healed, you put sunblock on it because, again, it's like fresh baby skin.

So if it's a large area that that will burn.

But daily moisturizer and most people are just happy to have some of these healed, so... - Yeah, I mean, like everything else, I'm sure there are certain cuts that you get and you just put a Band-Aid on it and hope for the best, but what are some other complications for wounds that are not properly taken care of?

- Yeah, I mean, ultimately, well, you know, initially you're worried about a localized, superficial infection, so some of that surrounding skin might get infected, you'll see some redness, and that might be the reason it's not healing initially.

So we can treat that topically, we debride the wound, we put topical antimicrobial dressings on.

But then if that doesn't happen soon enough or even sometimes if we do do it properly, some of that deeper tissue can get infected.

If that happens and it's not treated, eventually it could lead to a bone infection, which ultimately usually leads to some sort of amputation, especially if it's involving a toe or foot.

You could become septic, which is where the bacteria actually gets in the bloodstream.

And ultimately, I mean, if you really let a bad wound or non-healing ulcer go, I mean, you could lead to amputation and death ultimately.

I mean, that would be the worst outcome.

And it doesn't happen very often.

But there's some large wounds and ulcers that we treat and people end up with some bad infections.

- All right, Doctor, you also specialize in hyperbaric medicine.

Can you tell us what that is?

- Sure, so hyperbaric medicine is another component to what we do at the wound centers, so with hyperbaric oxygen, hyperbaric medicine, we put people in a hyperbaric chamber.

In that chamber, patients breathe 100% oxygen.

So at room air, we breathe 21%.

So they're getting pure oxygen.

And then we pressurize that chamber and what that does is drive the oxygen into the liquid part of our blood so we can saturate, basically eight to ten times the amount of oxygen can get delivered to areas that need it so acutely that will deliver oxygen to a diabetic foot ulcer or patients who have radiation damage.

But over the long term, it can actually grow new blood vessels into that tissue.

So after we hit about 20 treatments, we can grow some small new blood vessels.

So help get some new blood flow and, well-oxygenated.

It's not for all wounds.

It's not for you know, there's very specific things that we can treat like diabetic foot ulcers, people who've had plastic surgery or surgery where they have a flap or graft, if they're having issues with that, healing patients who have radiation issues...

Sorry, radiation damage six months and beyond after they've gotten radiation and now they're having issues with some of the surrounding tissue that that has now also been damaged by radiation.

- Do you hear a lot from your patients that they are afraid of getting their wound wet?

And if so, is it bad to get wounds wet, chronic wounds wet?

- Yeah, and that's really on a on a patient by patient basis.

I mean, if it's again, if it's a young, healthy patient who's got a small cut on their arm, there's usually no issue if it's superficial, if it's not very deep.

For some of the patients that we're seeing where they have deep wounds, some are going down to bone into muscle.

Yeah, you do not want to get those at least wet with cool water or lake water or going in the ocean.

Sometimes we give the OK to take a shower depending again on the location of it.

But usually we have him just irrigate it with a normal sterile saline solution.

We use some specific wound washes.

But really it's not about it's not about the wetness.

It's about you don't want to get introduce any bacteria into that wound.

- Yeah, we're running out of time here.

But I want my last question to be for you our new normal right now, which is living in this pandemic and with the way that the virus spreads, I have to ask, I mean, should you be more careful with open wounds during this time?

- Well, the issue with what's going on now is patients might have a wound or an ulcer on their foot and they're scared to go to the hospital, they're scared to go to the emergency room.

They're scared to go to a wound center or to see their primary care doctor because they don't want to catch Covid.

I've had patients that I sent to the to the emergency room or recommended they go somewhere and or come back and see me in a week.

And they don't want to just because they're concerned that they're in a hospital, they're in a medical office, and they don't want to be exposed to Covid, which makes sense.

So we offer that televisits, virtual visits to keep people out if possible.

But we're really a hands on type of specialty.

We clean the wounds, we debride them, we wrap legs, we put wrap compression wraps, casts on for diabetic foot ulcers.

So it's tough for us to do it virtually.

But we can sometimes manage to do some stuff.

- You really do it all when you talk about all of the things that you guys do in your office.

- Yeah, it's a lot.

It's fun.

- Well, thanks again for being with us today, Dr Bowers.

We appreciate your time.

- Sure.

Thanks for having me.

- Our next guest is Kathleen Simac, a woman who struggles with a disease known as lymphedema, but was also for a while a patient of Dr Bowers she was dealing with and experiencing the pain of chronic open wounds on her legs that went from her kneecaps to her ankles.

Thank you for joining us today, Kathleen.

- You're very welcome.

Thank you for having me.

- Let's start here.

You know, you were once a patient of Dr Bowers.

If you don't mind sharing with us, you know, how did you end up seeing him?

What happened with your legs?

- Sure, thank you.

It was in June 2018, I had very bad wounds and my PCP doctor suggested to go to the wound center.

So that's how I got started.

I went over there and saw I went in and he just took a look at me and he said, I just want "you one commitment."

I said, "OK, what's that?"

And he said, "I want you to come in here "every two weeks.

You have to be here in two weeks "and I'm going to take care of you."

I said, OK.

So, that's what happened.

Started June of 2018, going every two weeks.

- Besides the pain and discomfort you experienced, were there any other symptoms that pointed to this?

- Now, this was a major attack.

No, not at all.

This just happened, boom, it happened like overnight.

It was just amazing.

So, yeah, the wounds were very large.

My whole right leg and left leg was just nothing but flesh.

So, what... Well, that's what happened with it as we explain more as we go through the treatment.

But that's what happened, just happened overnight.

They said this just was a major attack.

- What was your mobility like?

Were you able to move around with these wounds?

- No, I was 210 pounds, OK, so what happened was I was hospitalized too after the treatment.

When you get lymphedema and you're that bad, it drains.

So I had visiting nurses, I had to have my legs in a cast.

And so what happened was I was hospitalized and we had a follow-up with Dr Martin and the PCP doctor so we can get out of the hospital.

I was there for three days with the legs up and everyone coming round the clock to change the wounds.

And what happened was he said to me, you know, we got a find a solution for you.

He said, you know, you are at the wound center, but we have to find a solution.

I recommend bariatric surgery for you.

So I said to him, you know...

He says, we can toss the idea around for a while.

He's like, I think you need to do that.

Otherwise you are going to be wheelchair bound at a very young age.

So I said, OK, I will go to the orientation.

So I was continuing all summer to go to the wound center.

And they were slowly...

The skin was slowly forming, coming together.

The wounds were slowly closing.

A long road to go.

But it was a positive thing.

I started the bariatric process and one of the first steps we have to do is give up sugar and processed foods and switch over to a protein diet with a dietitian.

So that's what I did.

Well, that was from June.

I started in August.

September, I lost nine pounds.

And Dr Bowers...

I was seeing him every two weeks.

And he said to me, what are you doing for diet?

I see improvements.

And I told him, I am starting the bariatric process.

And he looked up, stopped everything because he used to bring wounds to... And he said, that's the best news you could do for yourself.

The combination of both is really going to help you.

So he took a very nice interest.

Every two weeks, continuing that, he would ask, where are you now with the bariatric process?

So today I was...

I went to the wound center from June 2018 to February 14th 2022.

I am just celebrating one year of not going to the wound center, And thanks to the combination of Dr Bowers and Dr Bario, the bariatric surgeon and his whole team, I lost 139 pounds.

I got to save my legs.

The wounds totally cleared up and I went from elephant feet to chicken legs, because of the fluid.

- Now, that's an incredible story, Kathleen.

And when you talk about something that happens almost overnight, like your chronic wounds did, I can't help to think about your mental health.

I mean, what was that like during this process?

- I have a great support team with my family, my friends, even on Facebook and social media.

I have a lot of friends that were just like, you go!

No-one knew what I was going through.

My family did, but nobody knew what I was going through, friends and everything, until I explained the story.

And, yeah, so very determined to do it.

When, you know, Dr Bowers said, you know, we can save the legs, I think that was the best thing anybody could tell me, you know.

I was really blessed with no infection.

I was very, very blessed, I faithfully committed to go to see him every two weeks.

And it was over two years, almost two years during that, even after the bariatric surgery.

He had to approve the bariatric surgery too, because I had to be at a certain...

The drainage was going away and the legs had to go down, the swelling had to go down.

So he had to prove...

He had to give the final blessing on that surgery.

You just can't go and do it.

So he worked really well with Dr Martin and Dr Bario.

Dr Martin my PCP doctor, primary physician care, and Dr Bario was the surgeon.

And then Dr Bowers.

They all three of them worked very well together.

- How about this?

- I mean, what was your family relationships and dynamic like during the course of these two years that you were going through this?

- Well, OK. You know, my family is very supportive, I have a sister who's a doctor - she's a geriatrician - very, very supportive.

I have...

I'm one of four girls.

I have three sisters - very supportive.

I lost my mom six years ago.

She had lymphedema.

But she was a cancer patient, cancer survivor.

This is what was unique about me.

I don't...

I didn't have cancer.

Mine was due to weight.

And they said to me, you've got to get it off and this is how you're going to do it.

So that was the solution for me.

So, yeah, the family was very supportive.

I have eight nieces and nephews and they were just so happy that I was doing something.

The little ones, they range from 21 down to 8, and the little ones, the 8, 9, 10-year-olds are like, you look good, you look pretty!

I said, thank you.

So very supportive.

Everybody was.

- How are you feeling now?

How are you feeling with all this weight lost and now with these wounds gone?

What are you feeling?

I feel like I have a second chance.

I feel I won.

I really feel I won something and I got a second chance at life.

So, yeah, I'm just starting to feel good.

Actually, I faithfully take the vitamins and the vitamin D. That's what you have to do as a bariatric patient.

And... Yeah.

So I'm feeling good now after two years.

It's almost three years, the whole process, but it's two years in April.

I had my surgery the day after Easter, two years ago, 2019.

So it's coming up to two years.

I'm able to keep the weight off.

I'm in maintenance now.

So you go back to solid foods but one wonderful... ..two people at the wound center, part of Dr Bower's team, Jackie and Aaron, they both said to me, close that door to that sugar.

Don't go back.

And I thought that was the best advice anyone could give me through this whole journey, just as a reminder.

And I did that.

I stick to protein, and the three big meals a day I used to eat - Oh, God.

You know, for the last two years...

I was very big on iced coffee at Dunkin Donuts, and Starbucks.

I just passed it.

I don't even go over to decaf.

I just totally gave it up.

When I look at my legs every day, and I have them, it's good enough for me.

- I mean, would you say... ..you know, it's just the mindset, you know, just knowing that you have to do this in order to get your health on track?

- Yes.

Yeah.

And when you've got a lot of people rooting for you family behind you, you know all this...

So it's like, wow, you know, I just always had a position.

You know, always help people.

And now this was time for me to take care of me.

And I'm glad I did.

I really, you know... Because I don't think I would be here today.

I don't know where I'd be.

I don't know if I would not be here or I'd be in a wheelchair or...

It'd be a mess.

- Well, it's great to see you healthy here with us today, sharing your story.

I appreciate your time today, Kathleen.

-Thank you.

Thank you for having me.

I really appreciate it.

-To our next guest is Carolyn Snyder, a licensed clinical social worker right here in Lehigh Valley.

Carolyn practices in Easton and we'll share her insight into the mental health side of chronic wound recovery.

Thanks for joining us today, Carolyn.

- Thank you.

It's my pleasure.

- Carolyn, let me ask you this to begin with.

Can anxiety, depression and stress adversely affect the wound healing process?

- Absolutely it can.

Your mind and body are connected more than people realize.

We go into that fight or flight mode when we're feeling any sort of discomfort or anxiety about any medical condition.

And that triggers off all sorts of hormones into our body that spend more of their energy trying to escape what's going on than staying inward to heal what's actually going on.

So it can have a negative effect on any sort of healing process.

- Well, let me take it a step further.

Can the pain from a chronic wound cause depression?

- Yes, chronic wounds are somewhat complicated.

It all depends on what the cause was.

You know, is it from a chronic illness?

Is it from immobility?

Is it from a traumatic accident?

And in the process of healing, you usually cannot do everything that you used to do.

And that can be very stressful and very depressing.

You get stuck in the why me phase that can lead to depression and anxiety.

- So how important is treating the pain in the healing process, both mentally and physically?

- It's very important.

With medicine they always say that you're better off if you stay ahead of the pain.

You know, don't suck it up and try and, you know, tough it out and go through it, because then it gets harder to reverse once you're at that point.

The same thing goes with mental health.

You need to stay on top of it.

If you take a stress scale from, let's say, zero to ten, having any sort of chronic pain or chronic wound puts you up there at that six or seven level.

If you're not continuously doing things to kind of reduce it as, let's say, a flare-up or something happens, you then get to the point where it's really difficult to control.

- Well, what are some of those ways that you can sort of manage that stress and work through that?

- One of the simplest ways is actually breathing.

The... act of taking a deep breath, you know, repeatedly brings yourself present, and present is the most important thing in healing, and people often don't want to be present because they're afraid, well, that's where the pain is.

I want to think of something else.

But actually focusing on your breath can just really bring you present and, you know, your mind and body are connected.

so if your brain is all anxious and stressed and depressed, you're actually causing your body to fire all those signals.

The active breath then can kind of help reset that signal so that... ..it kind of slows things down and you can actually control your pain with the simple act of breath - As it relates to the body's ability to heal itself and fight infection, what's that chemical change like in the brain as it's related to stress and depression?

Because there's some sort of connection there, right?

- Right.

Right.

I mean, we've heard of the term endorphins.

Endorphins are released that send signals to either heal or escape.

And they're just chemicals in our brain that tell us exactly what we're supposed to be doing.

Chronic stress leads to higher cortisol levels, leads to stress and anxiety hormones, which actually weaken your immune system.

You need a healthy immune system to fight off infections, actually produce healing tissues.

So the higher your stress level, the weaker you're causing your immune system to be and the slower your wounds will heal.

- I think overall, and I think you'd probably agree with me, it's great to have...just been a good mental space overall for good health, you know.

And so when I think about, you know, someone's recovering from surgery or recovering from a wound, I'm sure... Maybe you can answer this.

Does stress prolong the time that it takes to recover in terms of days or months?

- Yeah, I mean, it can increase it significantly.

There have been studies that show people under chronic stress may have extended periods of healing because they're not allowing the body to do what it needs to do, so the more kind of help you can get mentally, whether it be to reach out for help from a professional or listen to different meditations - there's plenty of apps for it on YouTube - or anything to kind of reduce that, it's going to speed up your healing exponentially.

- And for those that don't, unfortunately, would you say that that almost becomes a vicious cycle going back and forth between recovery and then just delaying your progress?

- Yeah, it does.

It becomes almost self-fulfilling because one of the concerns with any sort of recovery, whether it be from a procedure or a wound, is, when is this going to get better?

When I'm going to get back to normal?

And if you're stressing about it, you actually are delaying.

You know, it can throw your blood sugars off.

And so that is bad for wound healing.

And then, you know, you may have part of the wound not heal.

And then that causes additional stress.

And the longer that goes on, the more stressful it becomes.

So it's important to kind of tackle it hand-in-hand with your physical healing, your mental healing as well.

- One of the things that I believe we're all coping with is the Covid-19 pandemic.

And so, you know, I want to ask you, as a licensed clinical social worker helping patients right now during this stressful time that we're in in this pandemic, how has that affected the way that you treat patients?

- Well, me personally, as you can see, I'm working from home right now.

We have been since we shut down last year.

But it's being more present with my patients wherever they're at.

A lot of the coping strategies that people used to use, whether it be go out, get outside, connect with others, maintain friendships, do group activities to kind of help cope and get out of your own space a little bit aren't available anymore.

So, you know, I'm hoping that people can come out of this whole Covid pandemic learning some new skills that they can bring with them when things are more normalized.

So, ways to be content and happy and amusing yourself.

So, teaching people more self-care by themself has been a big shift, especially the longer this has gone on.

- Have you heard from patients?

You know, what's the number one thing that you're hearing from patients that's helping them recover mentally?

- Well, staying connected with friends or family, even is a via a Zoom or a phone call.

There's online activities, coming up with hobbies, taking time for physical health, whether it be coming up with some sort of exercise routine to release healthy endorphins or eat a little healthier.

The running joke on social media is everybody's gained in Covid-19 because we're just stuck in the house with nothing to do but eat.

Start making healthier choices.

That can have an effect on your mental health and start some sort of meditation practice or relaxation practice or taking up yoga or, you know, learning to play a game with the kids.

- Wonderful.

All really great tips.

I think I can use a couple of them myself.

I appreciate your time today, Carolyn.

Thanks so much for your insight.

- It's been a pleasure, Genesis Nice to spend time with you.

- I want to thank our St Luke's University Health Network expert, Dr Steven Bowers, and our other guests, Kathleen Simac and Carolyn Snyder, for being with us today.

And thank you for tuning in.

We look forward to seeing you again soon.

If there is a medical subject you'd like for us to cover, send me a message on social media.

You can find me on Facebook and Instagram and you can tune in to hear more of my reporting on 91.3FM WRVA News, your local NPR news source.

I'm Genesis Ortega, and from all of us here at Lehigh Valley Public Media, stay safe, be healthy and cheers.

Salud to your health!