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By Christine Miller, DPM, PhD

Benjamin Franklin famously stated, “An ounce of prevention is worth a pound of cure.” This statement was made in reference to the importance of fire prevention in 18th century Philadelphia, but it aptly applies to modern diabetic limb salvage. The multidisciplinary model for amputation prevention has been in place now for almost two decades, but how far have we really come? Recent literature suggests that there has not been a significant decline in reamputation rates for diabetic patients despite the team approach to care. Diabetes is a complex and aggressive disease that affects multiple organ systems and robs patients of sight, sensation, limb, and quality of life. Treating such an aggressive disease is challenging, to say the least, and often the desired outcome is not achieved.

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By Christine Miller DPM, PhD

The human body possesses an amazing ability to heal itself, if given the right nutrients to carry out the necessary biologic processes involved. The need for nutritional assessment and support is critical for both acute and chronic wound healing and prevents an impaired immune defense that results in infection. Dietary intake must meet the increased demands of the body for recovery from the break in skin integrity. Nutrition in general is often overlooked when assessing healing potential in a patient’s plan of care.

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Wound Healing During COVID

By Christine Miller DPM, PhD

It is an understatement to say that these are trying and uncertain times, as we ride this unpredictable wave of the COVID-19 pandemic. All of us in wound healing as part of the greater health care force are deemed essential, so we cannot "shelter in place." As health care workers, we have to balance our duty to render care with that of protecting ourselves, a tricky tightrope balancing act. The media coverage of this pandemic is constant and anxiety producing, but it has made me ponder the term essential and what that truly means to our patients.

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Patient Noncompliance

Christine Miller, DPM, DMM, PhD, FACCWS

One of the most difficult aspects of patient care is dealing with non-compliance. How do we help those who refuse to help themselves? This question is very convoluted indeed! The best treatment protocols in the world will be unsuccessful if the patient does not follow the recommendations. Patients with chronic wounds are usually those with multiple comorbidities such as uncontrolled diabetes, autoimmune disease, and uncontrolled hypertension. This complex medical picture is challenging enough for all of us trying to heal them, but add the patients' lack of concern for their own health and it is quite frankly maddening. I find myself often saying, "Help me help you" or "Healing is a team event," although mostly my genuine pleas for partnership fall on deaf ears.

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Coordination of Care

By Christine Miller, DPM, DMM, PhD, FACCWS

One of the gratifying aspects of being a wound care physician is the ability to develop such rich relationships with our patients. The frequent and consistent contact with the same provider lays a strong foundation of open communication and trust. I work in an urban safety net hospital’s ambulatory care center, which sees a high volume of high-acuity patients. It is not uncommon for me to see patients with venous leg ulcerations with concomitant uncontrolled hypertension or diabetic foot ulcerations secondary to uncontrolled blood glucose levels. Patient education is a vital part of my clinical encounters, particularly focusing on the systemic nature of wound healing. I always emphasize that while we are treating your wound, it is the full body well-being that is needed for ultimate success.

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