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Christine Miller, DPM, PhD

September is designated as Sepsis Awareness Month, and it offers us time to reflect on the critical medical developments that have brought us to the current era of infectious disease treatment. The first movement toward infection control was with the introduction of antiseptics in the 19th century. To today’s clinicians, it may seem unfathomable that hand washing was once viewed as preposterous, but the progression of medicine can be convoluted. This convolution can be observed when discussing the beginning of the Antiseptic Era.

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Christine Miller, DPM, PhD

Chronic venous leg ulcerations (CVLUs) are one of the most common lower extremity wounds with a recurrence rate of as high as 70%. Among the wound care community, there is a common understanding that optimal healing requires the management of tissue, infection/inflammation, and moisture balance within the wound bed, along with appropriate compression therapy. It is also vital for patients with CVLUs to be evaluated by a multidisciplinary team. This evaluation includes a comprehensive vascular evaluation from both a venous and arterial standpoint. While there has been tremendous progress in treating venous insufficiency from a surgical perspective along with advanced wound healing techniques, CVLUs are still a major hurdle to overcome.

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Christine Miller, DPM, PhD

The role of nutrition in wound healing has been heavily explored since the early part of the 20th century. Addressing the proper balance of both macronutrients and micronutrients is a crucial part of the systemic treatment plan for patients with chronic wounds. Nutrition professionals are often highly valued members of any multidisciplinary healing team. There can often be adverse consequences of malnutrition, such as compromised immune systems and increases in hospital readmission rates. As modern-day clinicians with access to advanced therapies, we may think that adding nutrient supplementation to a care regimen is a contemporary concept, but in reality it is steeped in history.

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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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