Palliative Care

Ron Sherman's picture

By Ron Sherman MD, MSC, DTM&H

This week I was asked about using maggot therapy for treating a tumor that eroded through the skin, causing a foul-smelling, necrotic draining wound. This is not an uncommon question, and it touches upon several important elements of biotherapy, as well as palliative wound care in general. This is also a timely subject because of the upcoming (third) Annual Palliative Wound Care Conference.

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Karen Zulkowski's picture

By Karen Zulkowski DNS, RN, CWS

Last month I talked about the issues that occurred during my husband’s knee surgery. This month I want to bring the focus back to lawsuits and how they arise. What are the implications for the patient and family, and how does palliative wound care fit in?

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Aletha Tippett MD's picture

By Aletha Tippett MD

Palliative wound care is a relatively new field targeting wound treatment for patients at the end of life, or patients with terminal disease or inability to tolerate standard care. The traditional goal of wound care is to heal or prepare for surgical closure, but techniques and procedures used to “heal” a wound can be painful or uncomfortable and very costly, plus patients who qualify for palliative care may not live long enough to heal a wound.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

Food is a major part of our lives with strong emotional and symbolic implications that encompasses nurturing, cultural, religion, tradition and social values. Nutrition and hydration has an effective role in healing wounds, but cannot prevent an individual with co-morbid conditions at the end of life from suffering or imminent death. This concept is often difficult to explain to the individual and especially to the caregivers who view nutrition and hydration as essential for life.

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Aletha Tippett MD's picture

By Aletha Tippett MD

With a theme this month of dressings, I think it is time to give gauze its rightful due. There are a number of wound care providers who would say that “gauze has no cause”. Of course, this is said because of the understanding that moist gauze dries out when on a wound, leading to “wet to dry”, which is a major no-no according to CMS. This wet-to-dry results in debridement of viable tissue. It is also because of the belief and practice that a gauze dressing needs to be changed daily, and with all the cost-consciousness, this makes it more expensive than a once-a-week higher end dressing. However, in real life, how often does a once-weekly dressing actually last the full week, especially on a sacral or buttock wound?

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Karen Zulkowski's picture

By Karen Zulkowski DNS, RN, CWS

As health care professionals we always want to heal our patients and make them better. This may not always be possible. We need to understand that not letting the pressure ulcer or wound we are treating get worse sometimes has to be the realistic goal.

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Aletha Tippett MD's picture

By Aletha Tippett MD

Biotherapy is the use of living creatures for the diagnosis or treatment of a human ailment. Creatures most commonly used include service animals (such as guide dogs or therapeutic horses), fly larvae (maggots), leeches, honey bees, and even viruses (phages). How does this relate to us in the wound care community?

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Aletha Tippett MD's picture
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By Aletha Tippett MD

What is palliative care relative to wound treatment? In short, it is about humanity, caring and compassion. Today I saw a 90 year-old woman in a nursing home. She had hip and ankle fractures, and developed a sacral ulcer in the hospital. She was in excruciating pain, screaming at every touch. To correct her turned-in hips, she was trussed up in a hip abductor device – she called this “the dragon” – that was both uncomfortable and painful.

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