Week 3

Hello again!

This week I had four half days with Dr. Stein and Dr. Weiland, as opposed to only two last week.  This means I saw twice the patients, and, therefore, twice the wounds.

Like I mentioned last week, most of the patients are either very old and/or diabetic.  When I say old, I mean really old.  For example, this past week, over 75% of the patients were 85 years old or older.  Age plays a role in the rate wounds heal: the older you get, the more likely you'll have to go see the nice people at Osborn Wound Clinic.

Most of the patients with more severe wounds have to come in weekly to see how they're healing.  Since I came in last Wednesday and Thursday, I was able to see how some of the same patients were progressing with their wounds.  Some of the wounds drastically improved: a patient came in 2/last week with a wound resulting from running his leg into a table (trauma).  I saw him again on Thursday (2/25), and his wound looked a lot better.  Some of the other wounds I saw, however, looked exactly the same.  The patients whose wounds looked worse resulted from them not following the doctors' orders (keeping their leg elevated, wearing a compression sock to reduce swelling, etc), and I learned that possibly the most important thing to do in order to heal is to listen to what your doctor tells you.

Many of the wounds I saw involved hematomas, pictured below:

A hematoma is defined as a localized collection of blood outside of the blood vessels (basically a big bruise).  The elderly can easily get a hematoma because of the thinness of their skin, but a patient who is taking blood thinners can also quickly get a hematoma because of the rate they bleed.  

Many of the patients are interesting as well.  Before I started my rotation, I assumed most patients followed the doctor's orders.  However, I quickly learned this week that this is not the case.  If a doctor prescribed elevation or a compression sock, many of the patients were non-compliant, which surprised me.  And this is why, in many cases, the wounds did not heal.  

Finally, one of the most interesting things I saw this week was a picc line being removed.  A picc line is basically a long lasting IV which is inserted in the arm and goes through a small vein towards the large arteries near the heart.  You can run medication through these for fast-acting results, and its good for patients who need a lot of medication because you can leave it in for a couple weeks.

That's all for this week, folks! Stay tuned for next week for more wound updates! 

Week 2

Welcome back to my weekly blog!  This week, I ironed out the specifics of my project and actually started my rotations with the doctors at the clinic.

I first met with the director of the Wound Clinic, Mark Loudenslagel, to figure out exactly what I'd be doing at the clinic since my pervious plans fell through.  Last week, I discussed that I would be doing a retrospective study using the data collected by the Wound Clinic compared to national data.  I would then be able to determine the effectiveness of the Wound Clinic at Osborn.  We still haven't yet heard back from the legal department at the hospital to see if I would be able to have access to the data, but we have thought of a way around that; the personal information associated with the data can be expunged so that all I will have is raw data to work with (which wouldn't be a problem with the legal department).

I also found an area I would like to focus my project on.  Osborn Wound Clinic has a huge hyperbaric chamber.  The hyperbaric chamber delivers oxygen at a high pressure which aids in wound healing because it delivers a high amount of oxygen to the wound site.

 Over the next 7 weeks I will be able to follow a diabetic patient using the hyperbaric chamber.  I'll have access to pictures of his or her wound each week to see how effective the hyperbaric chamber is.

Finally, I started my rounds with Dr. Stein and Dr. Weiland this week.  I started last Wednesday (2/17) with Dr. Weiland and also went in last Thursday (2/18) with Dr. Stein.  Before going into this project, I assumed most of the wounds were simply a result of trauma.  However, I soon realized this was not true at all: almost all the patients I have seen so far have diabetes.  A patient with diabetes has poor circulation to his or her extremities and has no sensation on their feet.  As a result, their wounds have a difficult time healing on their own due to the low amount of oxygen and, if they step on a sharp object, he or she will have no idea because of the lack of sensation.  This can lead to a Diabetic Foot Ulcer, as pictured below.

Ulcers are not specific to feet, however.  A diabetic patient can also easily develop an ulcer on the lower part of their leg; I saw quite a few of those as well.  I observed some debridement of wounds as well.  Debridement is the removing of dead tissue from wounds to aid in healing. 

This week, I learned a lot about wound care, but I also learned more about myself:  I have a pretty strong stomach. 

Week 1

This week, I officially started my SRP!  Well, almost.  I go into the clinic to observe patients and physicians next week, which I am extremely excited for, but this week was mainly dedicated to changing my plans for my SRP.

In my last post, I mentioned that I would be writing up a protocol to submit to the IRB for a study comparing Dermapure and EndoForm as agents in wound healing.  However, after a closer look at an "Expedited Research Application" template, I soon discovered that I was out of my depth.  I had never seen an Expedited Research Application before, and was confused on how to proceed.  The template was thirteen pages long, requiring answers to specific questions that I did not know.  I, therefore, scheduled a meeting with my mentor at Osborn Hospital and brought the template along to go over some of the questions I had.  Dr. Stein talked through the template with me and I was confident I would be able to write up a successful protocol.  At closer inspection, however, I saw that the principal investigators must have "Human Subject Training" in order to conduct a study.  I asked Dr. Stein about this, and he told me that neither him or Dr. Weiland had completed this.  I, therefore, contacted the director of the Wound Clinic asking whether this would be an obstacle in allowing us to submit the application.  We eventually came to the conclusion that going through the IRB would not be possible because of the lack of Human Subject Training and the limited time constraints of the SRP-- it would take about a week for the application to go through the IRB and I would, therefore, not be able to finish my SRP.

In case this were to happen, however, I had a back up plan.  After my initial meeting with Dr. Stein and Dr. Weiland, I spoke to the director of the Wound Clinic, Mark Loudenslagel, about a potential retrospective study using the data the clinic had collected in the past.  Mr. Loudenslagel also has access to national data regarding wound care, and I would be able to compare the Osborn Wound Clinic's stats to national data.  This is my current plan at the moment.  However, we are still waiting to hear from legal services and Human Resources if I am allowed to have access to this data.  I should  know by Monday at the latest.

This week I've also been completing volunteer requirements: I have so far gotten one tuberculosis (TB) test (which I passed, thankfully), a flu shot, attended volunteer orientation, and am waiting to get my second TB test on Monday (2/15).  I still have to complete some training online, but once that's complete I'll have a hospital badge and will be able to start my SRP.

Next week, I will be going into the clinic for an official tour and will solidify a specific area of wound healing that I will be focused on.  During my meeting with my mentors, I briefly saw a hyperbaric oxygen chamber that aids in wound healing, and I am hopeful to focus on that.  Make sure to read my blog next week to see what exactly I'll be focusing on!