Injured Senior Podcast
Martha R Kelso: Diabetic Ulcer Wounds, Just One of Many Wounds That Affect the Aging
About Martha R Kelso: Martha is the Chief Executive Officer of Wound Care Plus, LLC, which is the largest wound care provider in the Midwest and they have been so successful that she's now in Florida and New York. She's well on her way to becoming a national mobile wound care company. Her company uses the most innovative products and cutting-edge technology to treat individuals with wound care or skin issues at almost any site of care and has educated thousands of healthcare professionals and caregivers on wound care issues, federal regulations, and national guidelines. She is a published author and on several national advisory boards.
In this episode, Steve and Martha discuss:
1. Are bedsores and pressure ulcers considered wounds?
- That's correct. Anything that is a break in the skin or damaging the underlying tissue, you could define as a wound or an ulcer.
2. Is it accurate to say that bedsores and pressure ulcers are mostly caused by actual pressure from sitting in one position for too long or from shearing on someone who has multiple co-morbidities?
3. What type of wounds would you say are most common in the senior and elderly community?
- According to generic averages, about 25% of the time is pressure, 25% of the time are arterial, 25% venous, and then the other 25% is variety.
4. Martha, are you saying that there is misdiagnosis that is happening where the medical professionals or long-term care settings are actually not properly diagnosing these wounds and they actually are cancer?
- Correct. In the document that I published called Why All the Pressure About Pressure?, I list two cases that were wrong diagnosis cases. We have situations where the primary care physician, the medical director, or even another specialist have ordered studies to determine the etiology, like potential arterial disease; so we're ordering an ABI, or arterial ultrasound, and they're canceling our orders saying, nope, it's pressure. It is a systemic issue in healthcare.
5. Is that just a lack of just general training about wounds, or why is this happening so much?
- What's interesting is in the healthcare world, taxonomy codes are what define what a doctor or nurse practitioner does. So, taxonomy code may list them as a general surgeon or an emergency medicine physician. There is no taxonomy code for wound care. There is one for hyperbaric oxygen, but there is not one for wound care, which basically means anybody can decide that they're going to a specialist. There are certification programs and board certification programs out there that specialists can take. However, the majority of them require that you've been doing wound care for at least two years before you're eligible to sit for the board certification. So, I believe in getting board certified in wound care, at the same time experience over and over and over and over and over again is what differentiates between a good wound specialist versus someone that maybe doesn't know what they're doing.
6. Has wound care been dropped to the bottom as far as priorities for the medical establishment? Shouldn't it be required that they become certified in wound care? Not only long-term care setting employees or directors or nurses but also the actual internist or doctors in general?
- In my opinion, we have to have more training in wound care. I've been in the industry for 27 years and even when I went years ago for my LPN program, there was zero wound care training in our LPN program and my very first job was at a hospital as an LPN. I can remember the doctor coming out of the room saying he needs to get a wound vac put on and to go put it on. That was inherent, “Oh my gosh, I don't know how to do a wound vac” and then feeling guilty but you're a nurse, you should know how to do wound care. Well, you're right, I should know. But yet nobody had trained me. Some of it is the industry having to say “forget it, not one more day”. We have to have wound training in our doctor's programs and NP school, PA school, LPN, RN, PT. The whole industry kind of needs to stop. Some people are making good headway and adding that into their programs, but it's certainly not universal.
7. Are wounds common in the aging population?
- Correct, anytime you have somebody with multiple comorbidities, multiple diagnoses, and then you add age on top of it, the skin is kind of our barometer, right? It kind of tells us what's going on inside the body, skin is an organ. So, if our body is not in a state of homeostasis or balance, we get out of balance the skin is usually one of the things that shows that imbalance whether it's through a rash or a breakdown in an ulcer or a dry patchy spot or blister formation.
8. Is the skin more of a barometer of the general health of the person who's affected by it?
- Generally speaking, most times, that's the case.
9. How chronic are diabetic foot ulcers and is that an arterial issue, a venous issue, and then how systemic is it?
- Diabetes is an atherosclerosis issue, more like hardening of the arteries, which also impairs the microvascular blood flow. So, the capillaries that are feeding blood, nutrients, and oxygen to your tissue, are impaired. The interesting thing is that anybody that's had diabetes for any length of time, even if you manage your blood sugar perfectly, you will still end up with microvascular impairment and atherosclerosis. So, the longer you've had it the more damage there is. Diabetic wounds are generally going to occur in the lower extremity, but diabetic lesions can occur anywhere on the body.
10. The wounds on the feet are because the feet are the farthest from the heart, and the blood flow is affected and circulation is not good?
- Correct. So, in following that same school of thought, let's say they don't have diabetes, but they've had a heart attack or a stroke. That is a huge clue that they have significant arterial disease throughout their body, even if they don't have wounds on their lower extremities yet, the fact that they've already had a heart attack or a stroke means that they are at high risk of developing wounds of their lower extremity because they have some form of blood flow impairment throughout their body.
"Anybody that develops shingles, their immune system is already in a weakened state." — Martha R Kelso
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Show notes by Podcastologist: Kristen Braun
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