Focus 580; Diabetes Care and Wound Healing

Good morning welcome to focus 580. It's our morning talk show. My name's David Inge. Glad to have you with us. In this part of focus we have a health care topic for you this morning and we try to do various topics throughout the year we have people who specialize in dealing with particular parts of the body and then occasionally we look at particular health issues. And this morning we will be talking a bit about diabetes and diabetes care particularly concentrating on the problem of wound healing. Because certainly there are a number of complications that can be associated with diabetes one of them. The fact that a small injury on the periphery of the body can if it's not well taken care of develop into a serious problem. And we'll be talking this morning here with two guests both of them work at the carle Foundation Hospital in Urbana Dr. Ellen file. From the Karl wound healing and limb preservation center and Monica Hall she is a nurse and diabetes educator at Carl. The questions are certainly welcome this morning as we talk with our two guests. And people have questions about diabetes and diabetes care. I know that they would do their best to answer the question whenever we have physicians here on the program though I also like to try to caution people that we there's a limit to what we can

do on the telephone we can't obviously diagnose over the telephone but we do these programs to add to your store of health knowledge. So if we can answer questions for you I know that the two guests will do their best down here well. Our number here in Champaign Urbana 3 3 3 9 4 5 5. We do also have a toll free line that you may use no matter where you are. As long as you are in the United States maybe I should make that qualification in around champagne Urbana it's 3 3 3 9 4 5 5 and then toll free around Illinois Indiana or if you happen to be listening on the Internet. As long as you're in the United States you may use the toll free line that's 800 to 2 2 9 4 5 5. Well thank you both very much for being here. Thank you appreciate it. I think that one of the things that we know is that there are significant number of Americans with diabetes something over 18 million I believe and the number continues to go up. And there has been particular concern I know I'm sure people have heard about it we've discussed it on this program in the past couple of years particular concern about adolescents developing diabetes.

Why. Why does it seem that this is indeed a growing problem here in the United States. Well David probably the biggest biggest problem that we're kind of running into is adolescence and kids not exercising much at all. Sitting at the TV playing video games. You go by the park there's nobody playing tennis Nobody's playing ball the things that that I did a lot when I grew up were seeing it's replaced by the TV and so a lot of kids are. Sedentary there are unfortunately the diets that they're taking in as Monica I can second that opinion is not the greatest with a lot of high fat high starch foods. So they're ending up overweight at a younger age and that's what the trip then as it hit. And they're diabetic very early age 15 16 even younger. The distinction is this is we're talking about Type 2 diabetics and younger kids there's always been and still will be type 1 diabetics and that's that's a set an entirely different situation that's really not something you can control whether you control your

diet to some degree but this is more than 95 percent of times type 2 that we're talking about and that's that's where weight and being sedentary really is the problem. Type 1 diabetes basal pancreas is not functioning you have to take insulin for a life and that can be at age 5 6 8. Younger people and that was we used to call these childhood in adult diabetes. Right now we have moved away from that just saying Type 1 Type 2 apparently because those putting those labels on there would have been a little bit of misleading bit misleading particularly I guess when it came to type 2 because now indeed we you don't have to be an adult it's not just adults that end up with type 2 diabetes. Right and it only men Monica make a dress some of the dietary majors that really we're going to ask any new diabetic to take. Yes it's the one important thing is watching your carbohydrates and particularly

people get caught up in looking at sugars thinking oh well I have to not eat my cakes in these candy bars and they don't look at the total carbohydrates which is how we are looking at diets now which is including your your sugars like your candies and came to bars but also your French fries and your potatoes and your rice and all of those carbohydrates will will raise your blood sugars. And so we now are teaching people to don't look at the sugars in foods but look at the total carbohydrates because that is is what is going to raise your total blood sugar. So we know that if we asked the question about risk factors for diabetes it seems that your weight would be one if you were overweight. That would be a risk factor and sounds as if your activity level which may indeed be related to the other

thing. Are there other particular things that puts you at risk. Say a side perhaps from the fact that there might be a history of diabetes in your family. Actually the family history is a very large respect are and and you can fool or delay or avoid diabetes even though you may have the gene and you are primed and ready to go if you maintain your ideal body weight for example or if you are exercising a regular basis. You may be preprogramed so to speak to have diabetes but you know actually going to kick in until you get say £250. You know and so it's very important if you have a family history to exercise a regular basis try to keep your head and keep your weight down and also really very important to be screened. I mean we also encourage everyone to see their general practice doctor their Firestarter intro medicine doctor making sure they do fasting blood sugars. Occasionally at least once every five years you can do it even certainly more than that when you're over 40 I'd recommend it more often but even for young people now that's And

teenagers were more really recommending a fasting blood sugar in addition to cholesterol which is a different topic but that's another thing that we want to be screening very carefully. So it is something that's certainly avoidable and it is not viable in all cases. You have some folks that there really are not overweight and maybe are very good at exercising and they get caught and it's not fair. I guess you could say but still the majority of time we really can't control some of this ourselves of our behaviors. Yes. I was just I want to say that there is a newer condition called pre diabetes and this is when a person's blood sugar is higher than normal but not high enough to actually die diagnose them with diabetes. And this is a real important thing to know whether you have pre diabetes or not because at this point you actually can delay or prevent ever developing type 2 diabetes and so that is why it

is important as Dr. Paul said for people to actually be screened because once you are diagnosed with type 2 diet diabetes you will always have it. But if you have the pre diabetes you actually can can start to exercise and watch your diet and prevent ever developing. Well that's a good point and I guess that goes to the recommendation that Dr Phil made that ever everyone not just people who would be considered to be at risk or people with family history of diabetes should have their blood sugar screen because this would be a way of picking up somebody who might be in the pre diabetes condition. When you can really intervene take the opportunity to do that and perhaps you can as you say prevent that person from going on and developing diabetes isn't going to prevent perhaps eventually having to have to take insulin and so forth if you get the good at the lifestyle things that you can do earlier they're going to be easier and will increase the chances then that you'll keep that person healthy.

You know that's correct and honestly we've. We sort of dial down this magic number so to speak. Since my residency days were basically you're OK if you're fasting but your goal is less than 140 an hour with what Monica is discussing here anybody that's in the Tina 105 100 100 now so 100 and above so if you're 110 112 that might have been ignored 20 years ago even pat on the back and say OK you're OK. Now if you're above 100 and you're a player and basically what what I tried to tell my patients in the past is we need to have you believe you're a diabetic right now. I mean basically we want folks that are pre diabetic to to to get on board and understand what's coming and understand what they can try to avoid and and change their diet talk to Monica get the right diet in place get exercise get let's get with it. Because of the food just wait and then pretty soon it's 100 200 to 20 you know that then that there could be some serious big problems down the road. We

also look at a test called a glycol hemoglobin or hemoglobin a 1 seed. There's different terms it's a more of a long term look back at how your sugars have been doing the last three months or 90 days. And that's a nice barometer to look for folks to see that they really are changing their their diet. I mean they may come up with a number say 9 or 10 when they're just diagnosed and they see Monica and then repeat them in three or four months or down to seven and we get into the sexes and then we're very happy about that because that that's that tell it's more like the climate where your sugar on a daily basis is the weather. This gives you more of a climate so we can look back and say You're doing a you know overall you're doing a good job there might be those days when the numbers are up. If you're gonna claim a gunman is on the way down then we're pleased. OK and I guess I just want to make sure that people understand that not when we're talking about people modifying their diet it's not simply modifying their calorie intake. It's not simply that we're wanting people to lose weight and indeed you may be wanting people to lose weight and increase their exercise. So it's not just total calories. It's also where where those

calories coming from and what or what of the various kinds of things are you. Absolutely. Absolutely. We want people to watch their carbohydrate fats and look at their total calories. It isn't just a one step thing you cannot only look at calories or say I'm going to totally totally cut out fat because in most foods that are fat free they have to still make them taste good. And in order to have fat free foods taste better they add a lot of sugar. So you really need to read food food labels now and if it's fat free. Look at the amount of carb carbohydrates you will probably see that it is fairly high in carbohydrates which will in turn raise your blood sugar. And so it is recommended to maybe go half way and choose light

like light dressing. And instead of the fat free salad dressing which is lower in carbohydrates and lower in fat. Yeah I recall some years back getting there was someone who was pushing a diet for diabetics that was extremely carbohydrate restricted that virtually told people that well from now on you're never going to be another potato you're never going to get another slice of bread no more rice no more pasta. Which sounds kind of boring to me although I suppose that if if you have that condition then one of the things that this fit was a physician. I think it was who was advocating it said that he had patients who had previously had to use insulin that as a result of following the diet then no longer had to use their insulin. I guess what I wonder what you think about this it's extreme reduction in carbohydrates and can indeed you do that I mean if you have somebody who is taking insulin and is dependent on that through dietary modification can you actually

make it so that they don't have to take insulin anymore. It depends on how long they have been taking insulin and this and that. Diet is only for type 2. All right but if you are a type 1 you you must actually take insulin. I personally do not like those extreme diets because typically people do not make wise choices. They will go on the very low carbohydrate diet and pick a poor low carbohydrate foods and have the steaks. The big Angus burgers which are typically high in fat and and then they are clogging their art arteries and they and up with heart heart problems. But I yeah I I don't really read I recommend those really extreme low carb diets and carbohydrates are not bad. You

actually need carbohydrates for fuel it. They fuel your brain and so when people think oh carbohydrates are bad. That is wrong. Carb carbohydrates are not bad. Too much of anything is going to be bad for you. Oh it's really there's there's another way to look at this no no bad or good food so to speak. And like Mark is mentioning here it's it's more of a balance of what you're doing. Anything that you do too extreme is usually not healthy. I mean if you exercise too much that could be not healthy for example so really balancing out the act is what we're trying to get out I mean I. Have a very easy way to love another easy way to do this is to really pump up the fruit vegetables meat especially fresh fruit and vegetables you're going to be taking at a low calorie. Going to have very good food source you're going to get your vitamins minerals. And I mean the recommendation of at least five a day at least five a day if especially you're trying to lose weight. It can be very beneficial. It takes some planning and you can easily go a whole day and have no fruit and

vegetables and French fries don't count. But you know it's doable. Well that though raises the question gets back to the question of the sugar. Because I think that people aren't sometimes people when they think about sugar they think of table sugar they think of money that they think of sweeteners they think of candy but of course there is sugar in fruit. And as far as your body is concerned Sugar Sugar doesn't really matter where it comes from your body is going to process it the same way now but it sounds as if from what the doctor is saying that if you follow the standard recommendations for the number of servings of fruit and vegetables it's OK for someone who has diabetes it is ok to eat that fruit or you know there are certain certain ways that you would suggest people approach it. Yes. Our diet diet dietitians will meet with patients and they will give give them a diet plan and that is what we call it. Call it now is

is actually a meal plan not not a diet but a meal plan. And people are giving given a certain number of carbohydrate choices per meal. And we try to have their carbohydrate choices even for every meal. And with a few as snacks and typically a person of average size will have four to five carbohydrate choices per meal. Now one carbohydrate choice is equal to 15 grams of carbohydrates and so typically you know somebody can have 60 to 75 grams of carbohydrates per meal. And then one to two carbohydrate choices as snacks. This makes is a start to some kind of complicated to people actually have to get a kitchen scale and are you encouraging people to weigh up stuff and measure things that carefully does it really matter that much in this surely yes.

But honestly after about two two weeks people can just visualize and they know oh this is one serving of you know fruit which is going to be my 15 grams of carbohydrate or one car choice and one problem David is eating out. You know I'm not going to address that so you may do well at home and control your portions and everything that's going fine but we eat out quite a bit in this town that's when friends come in they're always impressed how many restaurants we have here. So you know that's one that's a significant challenge for diabetics well for really people who are overweight in general. So I do you what kind of tips do you give folks who are going out to eat. Well many restaurants now actually actually have calories and fats and carbohydrates are broken down. If if they don't you actually can can ask for it. They have it at McDonald's Burger King Applebee's. Many places now

have a new a new traditional pamphlet that will break down every you know meal on on their menu. And they're and let you know the cover Heidi. Well I'm sure that that's difficult for people who are concerned about not only their cover hydrates but a concern about how much fat they take and I know just recently we have a physician that's on the program every couple of months and we got into a discussion of high blood pressure and we had a caller call in and say I was trying to be very careful about my sodium intake. And I thought I was doing pretty well. And then I started to look more carefully at how much sodium there was in the food that I was eating and she said I was shocked how much sodium there was and she made apparently a very aggressive effort to try to get her sodium down and for her that was very successful her blood pressure actually came down. But I'm sure that no matter what the issue is for you if you're concerned about your diet it's very difficult

as you say I'm sure that it's difficult if you don't and I'm sure it's difficult if you eat packaged foods because of all the things that go in their fats that maybe aren't healthy. You got to look at your carbohydrates got a look at how much sugar there is and you look how much sodium there is in there. It can be really difficult I'm sure. It is hard but it is very doable. And when you weigh I want to live a long life. It's just important. I recommend reading food labels. People have got to start looking at food labels and knowing how to actually read it correctly. Because food food labels are broken down per serving. And so you need to look and make and make sure that. That one serving is either a whole box or maybe a fourth of a box. It's a call.

An example is a 20 ounce regular soda. I had a patient think that there are 20 ounce soda the whole. So the had. To 200 calories. Well that was purser vain and 20 ounce was actually two and a half servings. And so people really need to look at the servings. And I think that's also a thing that people discover when they look at what are packaged foods what sometimes people the people who make the foods consider to be a serving and what your average person considers to be a serving that we all have this feel we tend to have the tendency to think of a serving should be a much bigger than they think a serving is. So there again the information is there. You just have to read it and figure out how much it is they're talking about. So that depending on how much of that stuff you hear you know are you going to eat for Oreos or are you going to eat six are you going to eat eight What do you think is a serving. Well it's going to make a big difference obviously. Yes.

Well one thing David that that I think helps motivate you know people with diabetes pre-diabetes I mean our old discussion here about food and diet and how it can be difficult. Is what we're really trying to prevent. I mean down the road with increased risk of corn our disease increase risk of actually having kidney failure kidney disease vision problems down the road. Those are those are kind of more front and center most. Most people are aware that what we are specific concern with in the center is moans and the fact that we see a very high volume of complications from patients with diabetes diabetic foot officers for example has a tremendous problem in this country and around the world and can lead to amputation. And that's what that's what we're we're really striving to prevent that here and that Carl and I can talk about that. OK well let's why don't we do that but probably would be a good idea for me to introduce again the guest for anybody who might have just tuned in Dr. Allen file is with the Karo wound

healing and limb preservation Center at the girl Foundation Hospital and Monica Hall is in our end. And she is a diabetes educator at the Carl foundation hospital and we're talking about diabetes care and know we do definitely want to talk a little bit about this wound healing issue and questions of course are welcome people are listening in they want to call in have questions about diabetes and diabetes care. 3 3 3 9 4 5 5 toll free 800 2 2 2 1 9 4 5 5. Well you mentioned that there are a number of complications that are associated with diabetes kidney failure is one of them. Problems with the eyes of another and this problem that you just touched on is one to that injury is sometimes that things that can start out small on the periphery apparently particularly in the area of the feet can if if this goes untreated can develop into a very serious problem as you say one of if it gets bad enough you might actually be looking at amputation. What it what is the the mechanism here what's going on here. Well what happens is essential with with diabetes there's several things there are

not quite functioning right and you can improve that functioning by controlling your blood sugars. So I mean if you have diabetes you keep tight budget or control your. Your problems will become much less. The basic mechanism is that with the diabetes the small blood vessels blood vessels to your skin your muscles all the same as they get smaller and smaller. That's called a micro vast which are the small blood vessels basically became clogged up. Similar to what you've book people know from cholesterol cholesterol plaque and so forth a somewhat similar mechanism and sensually then with the decreased blood flow to all these different organs you run into the biggest biggest problems wound healing can be compromised there are a problem in patients that have had surgical procedures even where they may have gone for a C-section or abdominal surgery of some kind in an area and there are they're healing okay for a while but then the one breaks open or it doesn't keep it doesn't close like you'd expect and so there's a problem in the probably run into very frequently or infection infections in diabetics so this is a

big big issue because the little cells called white blood cells that help fight infection are not operating correctly especially if the sugar is very high. They say they're drunk more or less and they don't do their job like they should. So one of the biggest concerns and the issues that that we try to promote is prevention. I mean it's as with basically everything if you can keep from getting in trouble you're a winner. And so with diabetes especially diabetes. But I bet it feet. We want to make sure that patients look at their feet really on a daily basis. If they can't see down there or they need to get a merit to help them see the bottom of their feet. We highly highly suggest that they have their feet screened by their doctor when they go in to see them for the regular physical. Most of the Xnet would do that anyway but they have to get their shoes and socks off and have have the doctor look around and look at their feet see if there's any cracks for example cracks Fischer's little tears in the skin can lead to big problems like we discussed So the way to help keep that from happening

is to really moisturize the feet. We encourage patients to on a daily basis use some kind of moisturizer on the bottom of the feet partly probably the moisturizer feet also partly to quite frankly get them to look at their foot and make sure it's nothing going on if they have one of the largest problems to run into as patients with callouses. Where they may have had the same callous for years and it's not been a problem but really a callus is similar to walking on a rock. I mean if you think about it you're walking on this push push push every time and it causes pressure and trauma and then the blood vessels are squeezed and the flow is reduced so what ends up happening is or can become a little infection and the callous and very often patients can't feel. I mean they're they're they're they're they're called a raw nerve. Their path a. They can't really sense pain in their feet so they don't even know what's going on until their sock has blood in it for example. Because now those sores opened up and it's potentially to the bone. So that's another screening

tool that the doctor can help them with is called a model filaments like a little fishing wire on a little apparatus that you can put on the patient's toe and their heel and so forth and it's basically one place we test and if they can't feel that then we know that and we really can and emphasize the patient look you didn't even know that I was pushing this you know what should have you should have help painterly able sensation anyway. Now now you can see how important is to really keep track your feet make sure you don't get any sores on it. So prevention is number one. Really being careful and wearing socks and shoes at all times. I had a patient a couple weeks ago that she knew the drill basically socks and shoes and diabetic socks which are a little thicker but she heard some rustling in the backyard and she ran out to see what's going on and she just got out of the shower apparently and didn't have her shoes and socks on and she ended up with a sore on her foot and six weeks later she's seeing us in the one center with the with the sore not healing. So you know really again outside emphasize prevention but then if problems develop in her

more there to help to do it we have a couple callers when we talk with them we have some of the cell phone will go to first line number one. Hello. My question concerns the overweight and I wondered what changes in the body if a person goes from an acceptable weight to overweight chemically. Is that something that you those within your area. I mean you know you'll end up with an increased risk of. Certainly it could increase your risk of diabetes if you're if you're normal weight and then you're increase your weight. Your there's the sugar situations or that can be a problem there's other changes that can go on to certainly request an increase you may be increasing your blood pressure very often in fact as probably you want to talk to the doctor about blood pressure and how incredible weight loss changes people's blood pressure they can become. The hypertension to not even part medicine by losing weight and especially of course throughout your body weight but I don't have I don't have any other real thoughts about that

but I think certainly that's. I would just add that if you are overweight you don't need to lose enough weight to be within a normal weight for it to do any good. Just losing 5 to 7 percent of your current body weight can help your blood sugar significantly. OK and a lot of people are overwhelmed thinking oh great I weigh two hundred and fifty pounds in my. Body weight should be one hundred and fifty fifty. I cannot lose 100 pounds I'm not going to even try. They don't have to think of it as losing 100 pounds just start out losing just 5 to 7 percent of their current body weight is going to to help them a great deal. Not because of my skin very correctly Carl as a weight measure program also that I used to be involved with and we'd see patients losing 5 to 10 percent maybe starting off with 300 pounds going out to 280 and they wouldn't need the blood pressure medicine.

It was surprising to me. I mean I would we would reduce their blood pressure medicine very quickly because just a 10 percent change can dramatically reduce the blood pressure and also your sugar. So it's not something they wake up and go oh my gosh I can lose 100 pounds Well it's baby steps I guess you could say you've got to start someplace and actually do get benefit from from small changes so one of them sure then all it's good all around because you are also reducing that person's risk of heart attack and stroke. That's true in addition to dealing with diabetes you may be reducing hypertension. We know that people who are overweight have problems with their joints and it increases problems back problems and all kinds of things are losing weight and being closer to your ideal weight is a good idea for a long list of things. So it has multiple benefits if you can get people to do that. Right to talk with someone here in Aurora. Well our toll free line line for the little guy.

I do. Didn't Lee. I'm sorry to say I didn't hear it spoken of the fact that if people do get diabetes there is a problem of losing their eyesight. And I remember when I was a student nurse one of the things I had to do was teach a diabetic person about the probabilities and possibilities of the situation. And she didn't want to hear any of it. She just she didn't want to if you didn't care you don't I don't care if I go blind. And of course I being as young as I was I could not understand it. And that's all I want to say that to mention the fact that and I do have a friend now a birdwatching Fred. Going right and it's very sad to watch it every day it watch. Thank you Nicole. We did certainly touch on they haven't brought you can I mean certainly that's that's a critical issue and we always are X get screened by their physicians you know at the mildest

optometrist on an annual or some IO basis every few years at least to make sure there's no early changes. They can pick up on early changes to the retina that may you may not really have a problem with your vision yet and they could see some what are called micro bleeds very small bleeds on the red and they can get after that and take care early and that is another complication just like what we're discussing and some of the other issues that with wound care and so forth and I again like I mentioned before want to really emphasize her eventually but but there is hope and there is there's a lot of things that we do at the car going to the center to help folks get on their way and not have to deal with some of the devastating effects of kind of curve with if left untreated. Well I'm sure that Monica your job really involves once a person has had that diagnosis once and they have been told that their diabetes or have diabetes or perhaps in the pre diabetic condition then you see them and you're the person whose job it is to try to help them understand the condition and what they can do in terms of modifying their lifestyle to be healthier.

What do you do you find that most people what sort of attitude do they come with when they meet with you for the first time. Most people are really receptive to education. I do have a few who as our last caller said they just do not care. And so what you have to do is find what they really care which is just up for for one person. It may be that I tell them that they will not you know live to actually see their children's John grow up. And that motivates them to actually start testing their their blood sugar or watching their diet and starting to exercise. Because I do find people who really not care they will have their leg cut off or have their. I you know go go bad. Beyond dialysis. But they care about it's a

plaint play in their garden and if they find out that that if they lose feeling in in their feelings and they cannot actually you know plant plant their garden they really care about that. And so my job is to actually try and find what they really care about and what will motivate them to actually start caring for it for themselves. I'd like to give the doctor felt a chance to talk a little bit more about more specific about what it is that you do if you have that. I mean it in terms of treatment if you have somebody that has a stubborn wound to resist and wonder it's just not healing properly. What exactly do you do. Well it takes a multi discipline approach really. We have vascular surgeons on staff with us plastic surgery we consult with a dermatologist. The infectious disease doctors are directly on staff with us also a physical medicine rehab doctor Dr. Janet start of the program itself.

And when a patient comes in to see us we really have a fairly in depth discussion about their past history what got them here what problems they may have medically for example some patients with us for example are on prednisone and have problems healing and we can identify that and perhaps change something that they're doing up with their medicine some some medicines people take an affair. If you're at the healing so it's a pretty The initial visit does take quite a bit of time and just trying to vest a gate looking under each rock making sure we're not missing anything. Then one of the most important part especially diabetics is to make sure their vascular supply is adequate so we do arterial study tests and make sure that they're OK. Because if they don't have blood going down to the leg a lot of things that I would do locally to their wound is a waste of time. So once we get that cleared up say they need to see our vessel surgeon perhaps get a bypass or get a bullet wound the same kind of treatments that people have with heart misfires fixing there. You know when they have a coronary Cath and

so forth they do that to the leg so we get that taken care of then we still may be looking at problems with though not healing so them and then we get into a little higher tech level of treatment and we have now. We're using a product called demographic there's another product called epigraph which actually is derived from skin cells called fiberglass and those are the little cells that really are very important in healing and it's kind of like the wood at your house I mean you have to have the fire blast they're going up with no place those cells were developed actually from circumcised baby circumcised. Maybe they cultured the cells out and that's the same cell line now I think it's been going on for 10 years and these cells have grown to cover approximately six football fields worth of this graft. So actually we're able to implant this or base place it on the patient's skin. And they don't have to have another search. They don't it is not surgery they don't have to have there like a skin graft we take a piece of skin from the from the back of the hip. We can

implant it into the loan and then it activates the healing process especially in diabetics. There is a significant detriment in the what are called growth factors these are chemicals that call on all the folks that need to get in the wound to heal. So that's one of the things we use also. We have a nanotechnology Dr. products to one is a silver silver product that we use that is crystals and it's very small crystals and it has a terrific killer of bacteria on the skin. So we can avoid antibiotics and the mouth and the side effects from systemic antibiotics by placing products on the well and trying to get them back to healing. We just opened last week has hired barrack oxygen treatment and this is exciting as well because we're going to now be able to increase that oxygen flow to patients feet of the wound. And it's not just feet but that's for this discussion we talk about that and by way of increasing the actual flow of patients plasma as we're sitting here right now our red

blood cells are doing a great job. They're basically taking all the oxygen in there and then about all that they can get and we're at at the top level right now. Well if you have a diabetic one that's not healing or going the wrong direction and you've been reversed your eyes there you see we've got the artery doctors taking care of it as best they can. The oxygen that we deliver a pressure. It is actually absorbed into the plasma or the water part of your blood. You know not the red blood cell but the plasma. And then it's able to get very close to the wall and to fuse out and touch the wonted area. The chamber that we have was developed by a company called Perry. We have two of these chambers and Parian originally started by making submarines essentially and they've We now have these two chambers and patients actually are completely in the chamber so it's not you don't put oxygen on a little you know tube and stick it on the wound for example you have to breathe this and get into your bloodstream slow little and absorb and go down to where the point is it's a it's a cultural environment people can watch TV they can read their DVDs and there

we have there's hyperbaric tech that's there with them the whole time and and we screen them of course for this procedure but we're very excited about it because in some cases really there is no other alternative. I mean they've they've done everything they've been everyplace. And now they're we're still looking at a spot that really is a problem a potential risk for them down the road as to getting amputated. Another area where this is very exciting and helpful is patient some patients that had radiation to their face or their jaw their head and neck for like a cell cancer from tobacco or from chewing tobacco or other reasons Hodgkin's and for various different cancers but what could happen is you get the radiation treatment and the skin or the muscle can be damaged and this can happen also for example to the rectum when people have colon cancer they may get radiation and the radiation can damage their private area down there as well that the colon and they can get a proctitis it's called or other areas too. Some patients have had radiation or bladder and they get what's called a cyst itis or in this

region it's from basically radiation because radiation once it hits your muscles and your skin and so forth in a controlled dose that's that's great but sometimes the dose gets a little too much and you may require that to help your cancer. Then unfortunately the bone and the skin are become normal and there's very low blood flow. It's called hypoxic and by doing the hardback auction treatments we can we can see alter their course. One thing that I would want to make sure your listeners understand or hear is if if they themselves have ever had radiation treatment for a head neck or for a jaw or a tongue or any of those areas. And if they require at some point down the road to have a tooth pulled for example or need some kind of a dental procedure where they're going to be either the dentist may have to scrape a little bone or the gum or anything that's going to be going on in there. I have a 100 percent dentist is made aware of the fact that they had radiation treatment before because

they very much set up for a significant problems called osteo radio necrosis. And what that basically means is the tissue we know was abnormal abnormal 5 10 15 20 30 years. It stays abnormal after the radiation treatment. So at any point down the road whenever they get their tooth pulled there is a high risk of infection developing and into the into the mandible. And you know the jawbone and basically it can lead to disfigurement. Plastic surgeons and oral maxillofacial surgeons do a very good job of trying to curb this but it can really get a hand in a hurry and if they know that we can they can come to see us before they have the procedure. We do these Burek option treatments about 20 of these treatments and then they can have the procedure done much more safely and with with a much less risk of any bad Sequoyah way down the road. Then there's a protocol that we follow these are developed over time it's kind of interesting the history of this our brick auction as goes back to actually bridge in St.

Louis is one of the places where it was used initially on that when they were building the case ons and sinking tube down into the Mississippi River and patients were getting real sick and they have a decompression illness and they started someone they decided or figured out wait a minute we might be able to do something here and from from that point onward we have really gotten this to up to a science and Beric auction really took it on the chin in the late 90s there were some charlatans out there and they were putting people in they even built a hotel barbaric auction hotel where you go in and you know spend a couple nights and feel great and that's you know of course bologna but. We now replaced it with really a scientific model and controlled studies show the outcomes to be very very good and that's what we're doing to Carl. So it's another it's another it's really another thing that that we do in the can to have one care I mean besides our regular visits where we're going to be taking care of the wounds and trying to clean it up and do whatever we need that's another option that's really exciting. We have a caller who will get to and perhaps I should again introduce the guest for anyone who might have tuned in the last 15 20

minutes are the last person you heard speaking is Dr. Alan file from the coral wound healing and limb preservation center at Coral Foundation Hospital also here with us is Monica Hall she's an R.N. and she's a diabetes educator and we started out talking about diabetes and we have been talking a little bit here about wound healing which can be an issue for people with diabetes but not just for people with diabetes. Questions are certainly welcome we have about seven eight minutes left 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5 and we have someone listening this morning in Chicago with a call on our toll free line line for fellow prong of I really appreciated your courage inside for some reference for them. Metabolism so rough that another thing that some products are now being produced that way as well as recommended sprinkling for women on your food in a certain way.

There's anything that you've observed or known about. Well actually I have just read one article on on the use of cinnamon and helping to lower a person's blood sugar. As is as I say if it works for you that is fine. But but typically it it will only lower your blood sugar just a little bit from what I I have read and really haven't read much on it. But one article that I saw it did lower a person's blood sugar a little bit. Well thank you I was just going to ask about some other particular end day because some people can refer to. Talking about you know I'm going to meet that particular member of glycaemic index or you have to pour through your comments up there.

OK yes this is a new Were the meal meal plan that that some people feel that that following in a glide glycaemic in index meal plan is best. This is based on it's its principle is based on that that every food has a certain light a lie. SEE make in index meaning that it will raise your your blood sugar either quickly or slowly. If there is a food with a high glycemic index that means it is. It would raise your blood sugar quickly if it has a lower glycemic index. It means it'll raise it more more slowly and the thought is that if you keep your your mill plan towards the lower glycaemic index foods you will have better blood blood sugar. For years for some PC

people it works great. But you must keep keep in mind that a high price glycaemic food may actually be a lower one for you or a lower gleich glycaemic food that is listed on on a table my actually work as a high glycemic food for you. And there there are books and tables that actually list out you know certain foods and whether and whether they are high or or low. And and you must look because not all lower glycemic foods are good for you and that all high glycemic foods are bad for 4 for example. A lot of fruits are on the higher glycaemic food list but they are very good for you because they are lower in fat and lower in calories and

different people respond to different foods differently so that means that something that would be on the high end for one person might not be on the high end for somebody else. It is typically on the high end for everybody but for you for some reason it may be on the middle too low. But typically the higher foods are high for everybody and the lower ones are lower for everybody. Who is it that. Has to do frequent testing of their blood sugar themselves I know that there are some people who do this I know there. There are devices that are available for that and that there are some people that periodical throughout the day have to check their blood sugar. Maybe some number of times. Who is this primarily we're talking about people who are insulin dependent diabetic diabetics who have to do this or do more people have to do this. Well every. Every one should you know check every every person with diabetes should check their blood sugars if you

are taking insulin. We typically say to test at least four times every day and that is before eating breakfast before eating lunch before any dinner and before going to bed. If if your blood sugars are consistently within goal range which is typically 90 to 100 and 30 B before eating and your a 1 C as less than 7 then you may you know go down to testing twice every day but alternating times so one day test before eating breakfast and before any dinner and the next day. Test before eating lunch and before going to bed. And that twice a day with alternating times is typically what I tell patients who who are taking oral medications to also test at that frequency. Well we're just about the point that we have to finish as any last sort of thing that you likely would be able. Well yes I would encourage patience to not be

afraid to show their doctor their hoons quite frankly I mean sometimes they there's a long thing many things they want to discuss their doctor and they may not realize that what they should be discussing is the sore of their foot that's been there for six weeks or two months or longer and they're in with other other thing so early early identification is very important and can make their lives a lot easier down the road so I could be my parting. Or to give information you know. And probably for everybody we want to make sure that we do consult your physician about this but everybody periodically ought to have their blood sugar. Absolutely yes. Well I want to thank you both very much. Monica hull she's an R.N. and is a diabetes educator Dr. Ellen file. As with the coral wound healing and limb preservation center they both work at Curl foundation hospital. THANK YOU THANK YOU THANK YOU.