Speaker 1: Production of Being Well is made possible in part by: Speaker 2: Sarah Bush Lincoln Health System.

Supporting healthy lifestyles, eating a heart-healthy diet, staying active, managing stress and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Speaker 3: Rediscover Paris.

Speaker 4: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital, Family Medical Center.

Speaker 5: HSHS St. Anthony's Memorial Hospital, delivering compassionate care close to home.

From advanced surgical techniques and testing, to convenient care for your family, we promise to make a healthy difference each and every day.

St. Anthony's, together, we are better.

Ke'an: Thank you for joining us for this episode of Being Well.

I'm your host Ke'an Armstrong.

Joining me today are two special guests.

I have Dr. Jeffery Brummer, the Medical Director of the Wound Healing Center, and I also have Jeremiah Roberts, an RN and the Hyperbaric Safety Director, and both are with HSHS St. Anthony Memorial Hospital in Effingham.

Thank you both for joining me today.

Jeffery: Thanks for having us.

Jeremiah: Thank you.

Ke'an: Today we're going to be talking about advanced wound healing.

What is that?

Jeffery: Advanced wound healing is typically dealing with chronic wounds, although we deal with acute wounds as well, but it's taking modalities that your average doctor's office wouldn't have, that we have access to heal the wound as quickly as possible.

Ke'an: When you say chronic and acute, what's the difference between that?

Jeffery: Technically it's about four weeks, but if you have a history of wounds that do not heal, then I would say dealing with it sooner rather than later is always helpful.

Ke'an: If someone is watching right now and they're thinking, "I don't know if this is acute or chronic.

This has been going on for a while."

Jeffery: Then you probably need to come in.

Ke'an: You probably need to come in if you're questioning it.

Jeffery: Yeah.

Ke'an: Okay.

All right.

What are some of the signs that would indicate seeking treatment for getting wound care?

What some of the symptoms are.

Jeffery: Typically any redness, any excess drainage, any ... Ke'an: What's the typical things that you see when you're treating somebody when they come in and they're saying, "I've got this wound," but then they should have recognized earlier what's happening?

Jeffery: Well we see all kinds of things but most typical is that, "I've had this for six months and I didn't think it was anything big, and now it's worse and it's infected."

That's when we typically see them.

Ke'an: Red, maybe some infection showing, some pus or different things like that.

Jeremiah: Pain.

Ke'an: Pain.

Jeremiah: Pain is another one.

Ke'an: Okay.

All right.

What would cause such a wound?

What are some of the different causes?

Jeffery: Well, diabetes is number one for sure.

Any issues with your vascular such as your veins and your arteries can cause a wound not to heal, and any pressure.

Pressure is a big one as well for your quads and paraplegics that have to sit a lot or lay in bed a lot.

Ke'an: Are these wounds ...

I guess if we're talking about diabetes, a lot of times I hear about the feet, the legs, what about other parts of the body?

Do you treat chronic wounds on all parts of the body?

Jeffery: Yeah.

We typically see postsurgical wounds that don't heal correctly.

We see burns, typically first degree or second degree.

Usually those are treated in the ER and then we ... the burns are treated in the ER and then they come and see us afterwards for continued maintenance, and then ... anything I'm forgetting?

Jeremiah: Trauma.

Jeffery: Trauma.

Jeremiah: Trauma.

Ke'an: Okay, and you want to talk a little bit about that Jeremiah?

Jeremiah: Anything that would be delayed.

A normal injury to the body should heal properly in a short amount of time.

That's when we come in if it becomes a chronic wound that either it heals and opens back up or it gets to the point where it just won't heal at all and then that's where we can intervene to speed up the healing process on the trauma wounds.

Ke'an: All right.

Is that when you ... say you're the director of the advanced wound healing, so advanced means that it's in the chronic stage, is that where the advanced word is coming in or?

Jeffery: Advanced word is just some modalities that we use to heal it.

Ke'an: Okay.

All right.

Speaking of that healing, what are some of the treatments that come into play?

Jeffery: We use casting for offloading, we use the hyperbaric oxygen chamber for chronic wounds and bone infections because we see a lot of bone infections with ulcers.

Vascular, we refer to vascular a lot because a lot of people have underlying artery issues, and then we do a lot of compression, a lot of wraps.

We use occupational therapy to help us with that as well for your wounds that are just too wet and we use ... usually they're typically vein related issues or they have lymphedema, which is just a chronic continuous state.

Ke'an: When you say casting, what comes to my mind is like when you break an arm and a cast ... is that the type of casting you're talking about or is it different?

Jeffery: Similar, yeah, to the feet.

It's a contact cast that we can put on in probably 20 minutes.

Ke'an: Is it give pressure or what does it actually do?

Jeffery: No, we don't want pressure, we just want to offload from the front of the foot typically to the back of the foot.

It's just the way the cast works.

Ke'an: Okay.

All right.

Outside of that, what is poor wound care in addition to good wound care?

What should people be doing outside of what you're doing?

Jeffery: It definitely depends on the type of the wound because you always want to see what's the cause of this wound and what's affecting it and you want to address those issues.

Not addressing those issues is I would say poor wound care, whereas addressing the issues is good wound care.

Ke'an: All right.

Poor wound care would be maybe not keeping it dry or ... give me some examples.

Jeffery: Well I always like to describe wound healing as an art of growing flowers in your garden or growing corn in the field.

You have to have enough water but not too much, so the water would be vein related issues where you have too much water, and then the dry areas would be not enough blood flow to that area.

Another aspect of it is pressure and I always think of like a boulder in the middle of your garden, you can't grow anything underneath it, so you want to remove that pressure.

Ke'an: What does water do to it?

Does it create like a bacteria or anything like that?

Jeffery: There's usually bioburden on the wound itself, that in and of itself is bacteria, but a lot of times it's not the cause of the infection per se, but they do ... if they are open long enough they have a tendency towards infection, and a lot of times these traumatic wounds get infected right away based on how it happened.

Ke'an: I didn't mean to interrupt if I did.

Jeremiah: No.

No.

Ke'an: Did you want to add something to that as well?

Jeremiah: What you're talking about with the gardening and the weeding control, getting the weeds out of the garden.

You could talk about that.

Ke'an: Yeah.

Jeffery: That's a debridement that we do, we basically clean the wound.

That's no different than hoeing the garden.

The other aspect of that is, where our advanced modalities come in, as I call fertilizers, we use to help grow new tissue.

Ke'an: All right.

I never would have thought of healing wounds like gardening, that's quite a- Jeffery: I've started this eight years ago and it hasn't failed me yet.

Ke'an: Really?

Well okay.

That's a good way to keep going then.

Is there a typical age that you see with chronic wounds?

You said diabetes to begin with and can that be with children as well?

Jeffery: We do see kids occasionally.

It's very rare.

We've seen dog bites that get infected, and those are difficult to heal sometimes, but most ... majority of our people are Medicare age, above 65.

Ke'an: Is there a difference in men versus women?

Jeffery: I wouldn't say so.

We see a lot of women more so than men I would say, mostly because of the advanced aged men seem to pass away quicker than women, so that's maybe why we see more women.

I wouldn't say there's an age difference.

Ke'an: No, it's pretty balanced.

Jeffery: Not age difference, a man and woman difference.

Ke'an: You mentioned another treatment earlier, hyperbaric ... sorry, I'm trying to figure out the right wording here.

Hyperbaric oxygen therapy.

Jeremiah: Correct.

Ke'an: Right?

Jeremiah: Mm-hmm.

Ke'an: Explain that to me.

Jeremiah: What hyperbaric oxygen therapy is is one of our most advanced modalities we have in our Wound Healing Center.

What it basically is is we place patients, full-body, into a clear seven-foot chamber that's approximately three feet in diameter.

These patients go in and they ... it's actually sealed with about a four-inch thick steel door, and we compress them with 100% compressed oxygen.

Now all of us in this ... right now we're breathing 21% oxygen, that's all that's in our atmosphere, so we're increasing that oxygen percentage by 79%, so that's good.

We need oxygen for our body to survive and to heal itself.

The patients that we treat typically have a hypoxic wound.

Hypoxia is lack of or without oxygen.

Without that oxygen to that cell, to around that wound, it won't heal.

It won't heal properly, or it'll be a delayed healing to the point where it may become ... the infection may take over to where an amputation may need to be performed to get rid of that infection.

We want to take care of that before that happens.

With hyperbaric oxygen, the patients are in the chamber for anywhere from two to two and a half hours a day, Monday through Friday, so it's five days a week, anywhere from eight to twelve weeks of therapy.

What's happening while they're in the hyperbaric chamber, we actually are compressing that oxygen.

It's a gas law that affects any type of gas: carbon dioxide, nitrogen, anything that's in our atmosphere, and that gas is ... basically when we pressurize it, it shrinks that gas bubble down about 20 times smaller than what we're breathing at normal sea, what's considered sea level, but atmospheric pressure.

As they take a deep breath in, as they lay in there in the chamber and breathe, they're actually getting a higher concentration of oxygen at a compressed level.

What that happens, the wounds that we treat like I said are hypoxic, they're hypoxic because of the disease that's caused these wounds, has shrunk the capillaries to the point where they don't get adequate blood flow.

They may have great arterial flow, I use the for example because it's a common treatment, they may have good arterial flow down and good venous return back, but it's the highway between that has shrunk to the point where it doesn't allow adequate blood flow.

What we do, we shrink the oxygen down.

The oxygen can actually be dissolved into the blood plasma, which is the water of the blood, and it can infuse that oxygen into the liquid form that can still pass through those atrophied areas.

Once that happens it can get into the tissue and prevent the hypoxia.

It's a big commitment for the patients to come for 40 or 60 treatments consecutively, but they really lay inside the chamber, watch television, sleep.

Ke'an: Really?

Jeremiah: As long as they're breathing, which we want them all to do, they're healing and they heal once they come every day.

For two and two and a half hours, we're basically speeding up their healing process.

Ke'an: That's an amazing tool that you have to offer.

Is this something that's offered everywhere or is this something special that you have?

Jeremiah: In the last 10 years hyperbaric oxygen has really expanded into the local communities.

We've been providing hyperbaric oxygen in our facility for seven years.

There are some other pop-up centers in the last five years that have made it more available to rural communities such as Effingham.

Before you saw it in St. Louis, Springfield, Chicago, some of the bigger cities, but we're able to come in every single day.

Two and a half hours a day is a big commitment and if you have to drive one way for a treatment, you may have to move to have your therapy, so we've definitely benefited having this in our community.

It's a good tool in our toolbox for chronic wounds for sure.

Ke'an: Yeah.

Absolutely.

When I think of being put in a chamber, it makes me a little bit like, "I don't know if I want to be inside something like that."

How do you deal with that in patients who might have some anxiety about that?

Jeremiah: Medication is probably our biggest help.

Sometimes we give an anti-anxiety medication to patients prior to coming in, kind of lets them be relaxed, but really we set the mood.

We have televisions, we have DVD players that they can take their mind off that.

Like I said the chamber is clear, so once we dim the lights down, you lose the effect of where the chamber starts and stops and it really ... some I set right between two hyperbaric chambers so they know I'm always have my eyes on them at all times.

That really alleviates a lot of stress and anxiety.

Some people just, they walk in, they see them and they say, "No way.

I'm not going in there," but- Ke'an: I'm not going in.

Jeremiah: To get into hyperbarics, you're in a pretty bad spot and they really need this advanced wound healing, so they know they have to do it maybe to overcome some claustrophobia or some anxiety.

Most of them within a couple of days they say, "Piece of cake.

No problem."

Ke'an: Well good.

Now, are there side effects from the hyperbaric oxygen?

Jeremiah: We have a couple of side effects.

The number one side effect is middle-ear barotrauma, and basically that's from pressure related to the middle ear.

If anyone's flown in the airplane before or drove through the mountains, when you change in atmospheric pressure, what happens is that middle ear is an air cavity and it wants to be equal on the outside as it does the inside.

That increased pressure in the middle ear if you have any type of eustachian tube problems where the middle ear can drain, any problems with anatomy, or if you have chronic sinus problems or drainage, that pathway can be shrunk a little bit and the only other way out is the eardrum, and that can become painful.

We monitor our patients very closely in this first couple of day, every day, but especially the first couple of days to see how they'll adjust to that sudden change in pressure.

If they do have any problems with ear pain, we stop them, take them out of the chamber, do an ear evaluation, and we'll send them to an ear nose and throat if there's any signs of trauma or they feel that they can't ... this should be pain-free when they're doing the hyperbarics, but they can put tubes in just like they do kids with chronic ear infections and that allows a passive movement from the middle ear to the outer ear, and they don't have that pressure- Ke'an: Pressure.

Jeremiah: On the eardrum anymore.

Ke'an: All right.

Okay.

Let's get back to you Dr. Brummer for just a second.

What got you interested in advanced wound healing?

Jeffery: Well, I typically do family medicine in a typical day but I got asked eight years ago to do this.

I had some training in residency but I really got started about eight years ago and it just gives me something to hang my hat on.

It gives me ... because family medicine you have to be the juggler between multiple things, whereas this is more of this is ...

I know this, this is the way it is and it just makes me feel good.

I do it for fun on my days off.

Ke'an: You do it for ... okay.

Do you have a patient or a story, something that has resonated with you over time, somebody that you treated that it just kind of sticks with you.

Does anybody stand out?

Jeffery: I have one in particular.

He had a knee replacement and the wound didn't close very well, he had a lot of infection and he had bad arteries underneath there.

He had it replaced again and the wound just wasn't closing and he ...

I guess their 60th wedding anniversary was coming up and we didn't have hyperbarics at that time but he probably would have been in it at that point, but we ended up closing the wound.

It took a long time but he did dance on his 60th wedding anniversary.

It was kind of my favorite.

Ke'an: Yeah, made the day special for him.

Jeffery: Yeah.

Ke'an: Before hyperbaric, what would you do for those severe cases?

Jeffery: Well if they really needed the hyperbarics we would send them to St. Louis or Springfield, but if we felt like we could treat it without hyperbarics, we used a device called a wound vac, which is like a small little vacuum cleaner that's hoked up to basically a hose to the wound and it helps ... shrinks it down.

Ke'an: What would be the first steps that they would take in order to get to yourself or someone who ...?

Jeffery: Well they can self-refer if they're not getting anywhere and I'll ... do you happen to know the ...

I would call the main hospital there and ask for the Wound Healing Center and they'll get you right to us.

Ke'an: Okay, so you don't need a referral?

Jeffery: You don't need a referral.

Ke'an: For those who are probably questioning this, the hyperbaric chamber, is that something that's covered with insurance?

Jeremiah: Yes.

We take care of all the pre-authorization or the Medicare guidelines or any private insurance guidelines.

If anyone has any questions they can always call and ask to speak with someone involving hyperbaric oxygen, and we can definitely find out if it's something that they have an indication for or if it's an insurance question, we take care of all that as well.

Ke'an: What are some things that some folks could do ... maybe is there anything to prevent them getting to you if they do have a wound and they're thinking, "What can I do about this?"

Is there anything at home that they can do for themselves or ...?

Jeffery: With a wound or with no wound preventing?

Ke'an: Either way.

Jeffery: The number one thing that we see is venous issues and all the little ladies and men don't like to wear their compression stockings and starting with that would be number one.

Even if they do get a scratch or something like that, starting to wear your compression stockings again would be helpful in healing it.

Quitting smoking would be another one, and taking care of your blood sugars would be another one, and if you're diabetic you should look at your feet every day.

Those are the big ones and if you have a mother or a grandmother in a nursing home, make sure that they move frequently.

Ke'an: Yeah.

That's another thing I was thinking about when you were talking about this, remembering my mother taking care of my grandfather, had a problem with his foot and having to dress it daily and clean it daily and do different things like this.

What's some different ideas that you can give to family members who might be taking care of a loved one?

Jeffery: As far as taking care of on a daily basis, home health helps a lot and if they do qualify for it that's the first thing that I ... because they're just used to taking care of stuff like that so they know any warning signs.

Taking care of yourself is another one because it's family first, but you're also a caregiver so you got to take care of yourself as well or you can get burnout.

That's another reason why home health would be helpful.

Ke'an: Okay.

All right.

What resources are available out there for folks, either for the hyperbaric or what you treat as well?

Jeremiah: Our website, the St. Anthony Memorial Hospital website has a page dedicated to wound care, have some frequently asked questions.

The internet is a good tool but unfortunately a lot of bad information is out there, so accredited sourcing for medical advice or just calling in and can ask any of us at our center.

We could get you the right information for sure.

Ke'an: Okay.

All right.

Same for you?

Jeffery: Just communicating with your primary and see if this is something that needs to be taken care of by us at the Advanced Wound Healing Center.

Ke'an: Once again if you're questioning, probably a good idea to get in contact.

Jeffery: Probably, yes.

Ke'an: Yeah.

All right.

Okay.

Well, I appreciate both of you coming in today.

It's been very educational on my part, learning about how wound care treatment is like gardening and taking care of yourself.

Thank you so much for joining us.

[music playing] Are you trying to lose weight but struggling to achieve your goals?

Nutritionists say a good night's sleep might be the key.

Kim Hutcherson has more.

Kim Hutcherson: If you're looking to drop a few pounds, experts say getting enough sleep is the key to successful weight loss.

The first reason may seem obvious: if you're asleep, then you're not eating a cheeseburger or ice cream, but there's more to it than that.

According to studies, a lack of sleep can increase the hormone that stimulates appetite.

That means people who haven't gotten enough Zs might feel more hunger than those who did.

The National Sleep Foundation says most adults should get at least seven hours of sleep a night, with some people needing as many as nine.

Here are some tips from experts to help get a good night's rest.

Get some exercise, but do it several hours before you go to bed so you have time to wind down.

Avoid late-night cocktails.

Alcohol can interfere with sleep patterns.

Don't look at your electronic devices.

The blue light they emit can affect your body clock.

For today's health minute, I'm Kim Hutcherson.

Speaker 1: Production of Being Well is made possible in part by: Speaker 5: HSHS St. Anthony's Memorial Hospital, delivering compassionate care close to home.

From advanced surgical techniques and testing, to convenient care for your family, we promise to make a healthy difference each and every day.

St. Anthony's, together, we are better.

Speaker 2: Sarah Bush Lincoln Health System.

Supporting healthy lifestyles, eating a heart-healthy diet, staying active, managing stress and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Speaker 3: Rediscover Paris.

Speaker 4: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital, Family Medical Center.