Michel Hermans's blog

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monitoring the healing time of partial-thickness burns

By Michel H.E. Hermans, MD

Recently I paid a visit to one of the better known wound care centers in the North East. As I expected, treatment of the common lesions seen in this center, such as venous leg ulcers and diabetic foot ulcers, was top notch. The use of compression and offloading, proper wound debridement and modern dressings (including, where indicated, biologics and matrices), in combination with the option for vascular, plastic and orthopedic (i.e. for Charcot foot) reconstruction resulted in good healing results, with high percentages of reepithelialization within a relatively short time frame.

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Year in review

By Michel H.E. Hermans, MD

At the beginning of a new year, many look back at the previous one in an attempt to analyze what happened, whether it was good or bad or perhaps even special.

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Medication

By Michel H.E. Hermans, MD

Undertreatment of medical issues is not necessarily bad: palliative care usually only treats symptoms but not the underlying cause of the symptoms which, if the patient wants this, is very appropriate. Remember, Hippocrates said something about suffering and while a disease may be not curable, suffering quite often may be treated with proper medication or other interventions (though, unfortunately, this is not always the case). We should not be worried to give somebody with terminal illness and in serious pain the proper type and amount of medication, even if there is a chance the patient would get addicted.

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Health Care Profits

By Michel H.E. Hermans, MD

Your mortgage company will not be able to hike your interest rate by 500% before the maturity date. If they tried, you could sue them for breach of contract and simply go somewhere else. If Mercedes, Hyundai or Ford hiked their prices by 5000%, you would simply visit a different dealership. You have choices and are responsible for these choices.

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By Michel H.E. Hermans, MD

Most of us will treat wounds primarily with Western-medicine techniques and materials, though, occasionally a "side step" is made. MEBO Wound Ointment is a non-Western, botanical cream that is used in the Middle East and the Far East for the management of partial-thickness burns. Although the exact working mechanisms of the ointment are not known, results often are good and some Western physicians have adopted its use.

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scapel for debridement

By Michel H.E. Hermans, MD

There are a number of general rules in surgery. Among these: dead space has to be avoided. interestingly enough, there is virtually no real scientific documentation about this topic but everybody knows this to be true (in ulcers this, of course, applies to fistulae, crevices, etc.).

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honey bees

By Michel H.E. Hermans, MD

In the June 2015 issue of the Journal of Ostomy Wound Management, Bell et al. published an article in which they reacted to the recent decision by CMS (January 22, 2015) to change its HCPCS code for a Manuka honey dressing for Medicare Part B patients to a non-covered code. Apparently, this ruling was based on the fact that the dressing is impregnated with more than 50% (by weight) honey. The authors, rightly so, stated that this would be a major loss for a significant number of patients who, under the previous ruling, would have been able to use the dressing as a reimbursed material. Indeed, this specific dressing is one of the materials with a good record with regard to clinical proo

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journal article review

By Michel H.E. Hermans, MD

The first time you see your name published as the lead author of an article you are filled with pride. If an article is rejected you are filled with frustration.

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Calculator

By Michel H.E. Hermans, MD

The 10 year old son of friends of mine incurred a gash in his right knee. After the injury, he was able to walk without pain in the leg (the gash did hurt, of course) but was taken to the hospital by ambulance. There, an X-ray of the knee was taken which did not show any fractures or other non-skin injuries. The gash was sutured and the patient was referred to an orthopedic surgeon for regular checks of the sutures and for suture removal. Sutures were to be removed 14 days after the accident. On that day, the orthopedic surgeon had no office hours.

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healing rate

By Michel H.E. Hermans, MD

An interesting article in JAMA Internal Medicine (February 2015) by doctors from Massachusetts, Maryland and California (A.B. Jena, M.D. lead author) analyzed mortality and treatment differences in patients who were admitted with cardiovascular pathology during dates of national cardiology meetings and compared these with the situation when the physicians were at the hospital. They found that high-risk patients with heart failure and cardiac arrest had a lower 30-day mortality rate when a national cardiology meeting was taking place. Fewer percutaneous interventions were performed during these meetings without an effect on mortality in patients with an acute myocardial infarction. Although the authors did not state this, one might (cynically?) think that treatment may have been excessive when the (interventional) cardiologists were "at home": perhaps bad for the patient and certainly not good for the cost of health care.

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