Jason Forbes, DO
Wound Care And Diabetes 7/2/2009
Our guest speaker, Jason Forbes, DO, stressed the importance of the prevention of complications of diabetes. These complications include heart, stroke, atherosclerosis (hardening of the arteries), renal failure, and wounds that won’t or have a hard time healing. Foot wounds can be serious if you are a diabetic. In a diabetic, neuropathy (numbness) of the feet can develop due to poor circulation. Sitting cross-legged can cause poor circulation as well. This numbness can cause a simple thing such as a pebble in your shoe to not be felt, resulting in a serious wound that will not heal.
Poor care of foot wounds can result in amputations if infections set in and are not cared for properly. Dr. Forbes scared me with the statistic that after 5 years, there is a 20% survival rate for amputees. That’s enough to scare me into excellent foot care!
Dr. Forbes advises to always wear good supportive shoes. If you wear sandals, wear ones that adjust so they are not cutting into the sides of your feet and toes. Daily care is critical—wash, dry and check your feet daily for wounds and callouses. Callouses on your feet indicate too much pressure which can cause deep ulcers that can get infected—and infection is our enemy! Trim your toenails straight across; if they become ingrown, see your doctor immediately. And, always moisturize your feet.
If you have an infection, clean thoroughly with Neosporin, cover with a cloth bandage or horse wrap (easily found at Tractor Supply a whole lot cheaper) and use a triple antibiotic cream such as coban or bactoban. It is important to note that alcohol, betadine, iodine, and peroxide are caustic chemicals and will slow your healing down since they will also kill healthy tissue that surrounds the wound.
Wounds on other parts of your body are not as critical as your feet since they take the brunt of everything. But any other wounds you do have can be cared for exactly like you do your feet.
Dr. Forbes was full of information and has expressed he is happy to elaborate on any information given or answer questions you may have. He has offered his email address to contact if he can help you in any way. You can contact him at [email protected]
Refreshments were simply whole grain crackers, pepperjack and cheddar cheese, and fresh sliced cucumbers from my daughter’s garden. Yum yum! Thank you Melissa!
Poor care of foot wounds can result in amputations if infections set in and are not cared for properly. Dr. Forbes scared me with the statistic that after 5 years, there is a 20% survival rate for amputees. That’s enough to scare me into excellent foot care!
Dr. Forbes advises to always wear good supportive shoes. If you wear sandals, wear ones that adjust so they are not cutting into the sides of your feet and toes. Daily care is critical—wash, dry and check your feet daily for wounds and callouses. Callouses on your feet indicate too much pressure which can cause deep ulcers that can get infected—and infection is our enemy! Trim your toenails straight across; if they become ingrown, see your doctor immediately. And, always moisturize your feet.
If you have an infection, clean thoroughly with Neosporin, cover with a cloth bandage or horse wrap (easily found at Tractor Supply a whole lot cheaper) and use a triple antibiotic cream such as coban or bactoban. It is important to note that alcohol, betadine, iodine, and peroxide are caustic chemicals and will slow your healing down since they will also kill healthy tissue that surrounds the wound.
Wounds on other parts of your body are not as critical as your feet since they take the brunt of everything. But any other wounds you do have can be cared for exactly like you do your feet.
Dr. Forbes was full of information and has expressed he is happy to elaborate on any information given or answer questions you may have. He has offered his email address to contact if he can help you in any way. You can contact him at [email protected]
Refreshments were simply whole grain crackers, pepperjack and cheddar cheese, and fresh sliced cucumbers from my daughter’s garden. Yum yum! Thank you Melissa!
Jason Forbes, MD
Managing Diabetic Wounds 9/2/2010
Jason Forbes, MD, Medical Director of the HMH Wound Care Facility was our guest speaker for September. Dr. Forbes wanted to accomplish the following with this meeting:
1. Help us understand the seriousness of diabetes.
2. Help us learn about chronic vs. acute wounds.
3. Help us learn how to prevent chronic wounds.
4. Help us learn about advanced wound care.
Dr Forbes reviewed the complications of diabetes:
Heart disease and stroke
kidney disease
dental problems
complications of pregnancy
Other complications include:
Hyperglycemia > DKA
Dia. KioAcidosis—coma Type 2 diabetics low risk/Type 1 high risk
Decreased immune functions
Nervous system disease
Amputations—non traumatic
20% usually end up dying if > 60 years old
Dr Forbes explained the food cycle—sugar
Type 1—pancrease does not do it’s job
Type 2—cell “key” doesn’t work good (what takes the sugar to metabolize
It is easier to gain weight if you go on insulin. A good diet and exercise is critical.
He discussed exercise using up your sugar and burning your glucose down.
Dr Forbes grossed us out by showing icky foot wound pictures on the pressure areas of the foot. Showed how they can ulcerate and the areas of the skin can die.
Dr Forbes explained how the proteins and cholesterol tear the inside of the arteries but a normal persons arteries inflame and repair themselves. A person with high blood sugar (>200) has too much glucose in their blood. This gets deposited into the plaque inside of the arteries and helps it clog—leading to stroke. Neuropathy is irreversible but you can control it. Plaque removal is reversible.
Dr Forbes talked about when your glucose is too high, there is limited blood flow to the feet which causes neuropathy in the feet and wounds fail to heal.Wounds inflame, remodel and heal.
Chronic is not a “time” thing, it is a condition. Chronic means it is old and/or not going to get better. Acute is that it just happened and can get better fast.
Why wounds don’t heal:
1. > age 60
2. Diabetes (neuropathy)
3. Poor circulation
4. Local swelling
5. Repeated trauma
6. Continuous pressure
7. Bacterial colonization/infection
8. Poor nutrition– protein is important to heal / vitamin c for the skin
The age difference in cell proliferation (wounds healing):
1. New born—7 days
2. Young adult—9 days
3. Older adult—12 days
Prevention is the key:
1. Check your feet every day, wash with soap
2. Dry your feet well, moisturize between toes (skin breaks down and creates fungus growth), and change sweaty socks
3. Keep from getting too dry—use lotion Cetaphil or Eucerin
4. Avoid fancy footwear (no tight socks, pointy shoes, high heals), Medicare has a therapeutic shoe program, if diabetic you qualify every 2 years
5. If you get a wound
-Breaks in the skin is an urgent condition
-If dirty, clean with soap, alcohol or iodine ONCE only! (these kill bacteria and healthy cells.
-cover with a pad
Process is: Clean, Cover and Call.
6. What you should have at home:
1. Flexible fabric bandage
2. Roll bandage—bulky
3. Quick Clot Sport (stops bleeding)
4. Triple antibiotic ointment
5. Moleskin plus padding (Dr Sholls)
Dr. Forbes talked about what you can expect at the wound care center:
1. Vascular assessment (blood flow)
2. Bacterial Culture
3. Compression/offloading (special dressing to reduce swelling)
4. Removal of deal tissue from wound
5. Hyperbaric oxygen _ saturates blood with oxygen to help heal wounds. It puts 2 times the room pressure (100% oxygen) to stimulate tissue.
Dr. Forbes fielded several great questions and met one-on-one with several people with more personal questions. This is the second time Dr. Forbes has spoke to this group and I for one find his information extremely helpful.
1. Help us understand the seriousness of diabetes.
2. Help us learn about chronic vs. acute wounds.
3. Help us learn how to prevent chronic wounds.
4. Help us learn about advanced wound care.
Dr Forbes reviewed the complications of diabetes:
Heart disease and stroke
kidney disease
dental problems
complications of pregnancy
Other complications include:
Hyperglycemia > DKA
Dia. KioAcidosis—coma Type 2 diabetics low risk/Type 1 high risk
Decreased immune functions
Nervous system disease
Amputations—non traumatic
20% usually end up dying if > 60 years old
Dr Forbes explained the food cycle—sugar
Type 1—pancrease does not do it’s job
Type 2—cell “key” doesn’t work good (what takes the sugar to metabolize
It is easier to gain weight if you go on insulin. A good diet and exercise is critical.
He discussed exercise using up your sugar and burning your glucose down.
Dr Forbes grossed us out by showing icky foot wound pictures on the pressure areas of the foot. Showed how they can ulcerate and the areas of the skin can die.
Dr Forbes explained how the proteins and cholesterol tear the inside of the arteries but a normal persons arteries inflame and repair themselves. A person with high blood sugar (>200) has too much glucose in their blood. This gets deposited into the plaque inside of the arteries and helps it clog—leading to stroke. Neuropathy is irreversible but you can control it. Plaque removal is reversible.
Dr Forbes talked about when your glucose is too high, there is limited blood flow to the feet which causes neuropathy in the feet and wounds fail to heal.Wounds inflame, remodel and heal.
Chronic is not a “time” thing, it is a condition. Chronic means it is old and/or not going to get better. Acute is that it just happened and can get better fast.
Why wounds don’t heal:
1. > age 60
2. Diabetes (neuropathy)
3. Poor circulation
4. Local swelling
5. Repeated trauma
6. Continuous pressure
7. Bacterial colonization/infection
8. Poor nutrition– protein is important to heal / vitamin c for the skin
The age difference in cell proliferation (wounds healing):
1. New born—7 days
2. Young adult—9 days
3. Older adult—12 days
Prevention is the key:
1. Check your feet every day, wash with soap
2. Dry your feet well, moisturize between toes (skin breaks down and creates fungus growth), and change sweaty socks
3. Keep from getting too dry—use lotion Cetaphil or Eucerin
4. Avoid fancy footwear (no tight socks, pointy shoes, high heals), Medicare has a therapeutic shoe program, if diabetic you qualify every 2 years
5. If you get a wound
-Breaks in the skin is an urgent condition
-If dirty, clean with soap, alcohol or iodine ONCE only! (these kill bacteria and healthy cells.
-cover with a pad
Process is: Clean, Cover and Call.
6. What you should have at home:
1. Flexible fabric bandage
2. Roll bandage—bulky
3. Quick Clot Sport (stops bleeding)
4. Triple antibiotic ointment
5. Moleskin plus padding (Dr Sholls)
Dr. Forbes talked about what you can expect at the wound care center:
1. Vascular assessment (blood flow)
2. Bacterial Culture
3. Compression/offloading (special dressing to reduce swelling)
4. Removal of deal tissue from wound
5. Hyperbaric oxygen _ saturates blood with oxygen to help heal wounds. It puts 2 times the room pressure (100% oxygen) to stimulate tissue.
Dr. Forbes fielded several great questions and met one-on-one with several people with more personal questions. This is the second time Dr. Forbes has spoke to this group and I for one find his information extremely helpful.