Healthy Living

The burden that problem wounds place on our society in terms of debilitation and costs is staggering. Obviously the best way to avoid this burden is to never develop a problem wound to begin with.

At the Backus Hospital Wound Care and Hyperbaric Oxygen Therapy Center more than 90% of the wounds we see are related to pressure, lower extremity venous disease, or a complication of diabetes.

Pressure or decubitus ulcers often develop in people who are relatively immobile for one reason or another. These ulcers develop because of prolonged pressure on the skin, which results in compromised circulation and resultant skin breakdown.

These people often have issues with nutrition, which further exacerbates the problem of skin integrity. Understanding the cause of these wounds has led to a three-phase approach to caring for, but most importantly, preventing pressure ulcers.

The three phase approach is:

• mobility
• nutrition
• skin health.

Frequent repositioning to avoid prolonged pressure on one area, as well as the use of support surfaces that redistribute pressure, is essential. Repositioning should be done at least every four, and preferably every two hours.

These patients also will benefit from a nutritional assessment and supplements as needed. The use of skin moisturizers, especially to the sacral area, to avoid dry skin has also been shown to be beneficial.

Lower extremity venous disease results from the inability of the valves of the veins to keep the blood from backing up into the legs. This results in fluid retention in the legs and can manifest as a leg ulcer called a venous stasis ulcer. The skin of the legs in this situation is also very susceptible to injury from minor trauma.

Once again, understanding why these ulcers develop is the key to preventing them. Support stockings are available that act as a kind of replacement valve system to keep the blood from backing up. These can be fitted for proper compression. They should be worn during the day and put on before getting out of bed before swelling occurs.

It is important to avoid any trauma to the susceptible skin including sun exposure. Leg shaving should be done with an electric razor to minimize nicks from shaving. Skin moisturizers should be routinely used to prevent skin breakdown, which can lead to ulcers. Washing of the legs should be done with a mild soap and warm water and dried thoroughly by patting the skin dry and avoiding excess skin friction by rubbing with the towel.

Patients with diabetes have several mechanisms at work making them susceptible to ulcer formation. Diabetics have decreased sensation in their legs, or neuropathy, and hence are unaware of repetitive trauma to the same area of the foot. They also often have decreased blood flow, or arterial insufficiency, which further makes them susceptible to skin breakdown. The glucose imbalance of diabetes also makes even minor injury more susceptible to infection.

Understanding these issues can help with effective preventive measures in diabetic patients, including:

• Meticulous attention to foot care and daily foot inspection by the patient are the cornerstone of proper foot care.

• Gentle cleansing with soap and water with gentle drying of the skin followed by topical moisturizers helps maintain healthy skin that can better resist breakdown and injury.

• Thorough nail care and properly fitting shoes are very important in the diabetic patient.

• Because diabetics have decreased sensation, they should exercise great care with exposure to extremes of temperature.

Any of the above patients should have a thorough skin evaluation at the time of healthcare provider visits to evaluate skin integrity and promote good skin care.

These visits, along with patient vigilance, will go a long way to preventing skin breakdown and the resulting patient morbidity and costs associated with these wounds.

Mark Tramontozzi, MD, is board-certified by the American College of Certified Wound Care Specialists and Medical Director of the Backus Wound Care and Hyperbaric Oxygen Therapy Center, which is located in the Backus Outpatient Care Center on Salem Turnpike in Norwich. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Tramontozzi or any of the Healthy Living columnists at healthyliving@wwbh.org

Fall is a great time for a flu shot to protect you and your loved ones before it is too late.

It takes about two weeks for the body to develop immunity after getting vaccinated, so getting a vaccine in October or early November can protect you for the season.

And in addition to the obvious health benefits, flu shots can save you time and money.

The flu can tie you down for 10 days or more, and you end up paying the price through healthcare costs and loss of work. If you are proactive, this can be avoided and you will also protect yourself and loved ones.

The flu vaccine is recommended for everyone age 6 months and older, but especially for those with health issues that can make the flu more dangerous for them, such as heart problems, diabetes and compromised immune systems.

Most healthy adults can infect others beginning one day before symptoms develop and up to five to seven days after becoming sick. Children may pass the virus for even longer.

It is especially important for healthcare workers to get the flu vaccine. The Centers for Disease Control and Prevention, and the Advisory Committee on Immunization Practices, recommend that all healthcare workers get an annual flu vaccine to help protect themselves, their families at home and their patients at work.

Flu outbreaks in hospitals and long-term care facilities have been attributed to low vaccination rates among healthcare professionals. At Backus Hospital, our goal is 100% vaccination and we have multiple flu clinics scheduled for our employees and volunteers, because we know that many of the patients we care for our compromised.

For the public, flu shots are available at Backus Health Centers in Colchester, Montville, Ledyard and Plainfield.

The flu can be fatal in immune-compromised people, such as the elderly, infants and those with medical conditions. The flu can cause serious complications in people with chronic lung diseases, diabetes, heart disease, neurological conditions and pregnancy.

The seasonal flu vaccine protects against three different influenza viruses that research shows will be most common during the upcoming season. The 2011-2012 vaccine will protected against H1N1, H3N2 and influenza B virus.

Parents may want to ask their pediatricians about the nasal-spray flu vaccine, which is an option for healthy people ages 2-49.

The bottom line is this: Get your flu shot now and you can rest easier later.

Christine Orsini is a registered nurse with Concentra and Employee Health Nurse at The William W. Backus Hospital. The information in this column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Ms. Orsini or any of the Healthy Living columnists at healthyliving@wwbh.org

When you are hurt or sick, knowing where to go can be confusing. Making the right decision can save time, money – and lives.

I have seen this confusion firsthand recently at Colchester Backus Health Center. We have had several patients present with serious conditions that required emergency care – drug overdoses, allergic reactions and heart attacks to name a few. These are emergent issues that need to be taken care of in an emergency department.

At the Colchester Backus Health Center and our other health centers in Montville, Plainfield and Ledyard, we do not have the equipment or life-saving drugs required for these situations. We provide “urgent care,” not emergency care.

For minor ailments, health centers are great alternatives, as waits aren’t usually as long (In ERs, more serious cases are treated first) and they can be less costly. We are more like a large doctor’s office than an ER, except we don’t always require an appointment and “walk-in” care, or urgent care, is available.

In addition to scheduled primary care visits, lab tests, diagnostic imaging tests, physicals and flu shots, here are some urgent care examples that health centers can treat:

• Minor broken bones
• Strains and sprains
• Mild asthma attacks
• Infections
• Cuts
• Minor burns and rashes
• Sore throats and flu-like symptoms

While there is a national effort to reduce improper use of emergency rooms, if you have a true emergency you should go to the closest ER. This can mean the difference between life and death.

True emergencies include:

• Abdominal pain
• Allergic reactions
• Drug overdose
• Chest pain
• Heavy bleeding
• Severe troubles breathing
• Serious burns
• Head injuries
• Spinal injuries
• Loss of consciousness
• Severe wounds.

For many medical conditions, your primary care provider or local health center are perfect alternatives for healthcare. But hospital emergency departments, such as The Backus Emergency Care and Trauma Center in Norwich, have specialized equipment and expertly trained staff to take care of you when a true emergency occurs.

Clark Adams is a Physician’s Assistant at the Colchester Backus Health Center. The information in this column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Mr. Adams or any of the Healthy Living columnists at healthyliving@wwbh.org

Ekse ou santi doulè nan pwatrin lan koulye a?

Imagine how frightening it would be to seek medical help for your severe chest pain in the hospital emergency room but you can’t make yourself understood to the doctors and nurses.

Unless you understand Haitian Creole you would not know that the first sentence of this column is “Are you having chest pain right now?”

As The Bulletin has reported recently, 37 different languages are spoken in the homes of students attending NFA. Backus Hospital serves this same community and has dealt with the increasingly frequent challenge of providing healthcare for non-English speaking patients.

So how have we dealt with this challenge? There are three significant initiatives at work towards solving this problem.

The first is language interpretation services. Backus has contracted with a phone language interpreter service, as well as a video interpreter service, both available 24 hours a day to provide immediate interpretation or translation by certified medical interpreters in more than 150 languages.

The second important initiative was to establish a Cultural Diversity Council, made up of 14 staff members from different disciplines and cultural backgrounds. The mission of the Council is to increase cultural competence of our healthcare providers and services through educational programs and to deal with any issues that arise.

The third initiative is the annual fun and exciting “Multicultural Health Fair.”

This year’s fair is entitled, “Discovering Our Diversity” and will be held Thursday, Sept 29, from 3-7 pm in the main lobby conference rooms at Backus.

More than 22 cultures will be represented. There will be music, free food samples from two cultures, dance performances, and informational handouts about the healthcare customs and preferences of each culture.

This is truly an enjoyable event that is free and open to all: hospital staff, patients, visitors, and the community. Come join us and celebrate the rich cultural heritage of our diverse community!

For more info, call (860) 889-8331, ext 2495.

Alice Facente is a registered nurse and clinical educator with the The William W. Backus Hospital Education Department. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Ms. Facente or any of the Healthy Living columnists at healthyliving@wwbh.org