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Stasis Ulcer Information from Dr. Bruce Ruben

Posts Tagged ‘Dr. Bruce Ruben’

Stasis Ulcer Information from Dr. Bruce Ruben

Posted on: October 7th, 2015 by Mindy Ruben No Comments

Overview of Venous Stasis Ulcers

A stasis ulcer is a breakdown of the skin (ulcer) caused by fluid build-up in the skin from poor vein function (venous insufficiency). Fluid leaks from the veins into skin tissue when the blood backs up rather than returning to the heart through the veins.

This wound is a result of venous insufficiency (venous stasis ulcer)--Encompass HealthCare and Wound Medicine, Michigan.

This wound is a result of venous insufficiency (venous stasis ulcer)–Encompass HealthCare and Wound Medicine, Michigan.

Who’s At Risk
Leg vein malfunction (venous insufficiency) affects 2–5% of Americans, and approximately half a million Americans have stasis ulcers. Women are more often affected by stasis ulcers than men.

Your risk for acquiring a stasis ulcer is greater if you:

  • Are overweight.
  • Have varicose veins.
  • Have had blood clots in your legs.
  • Had a leg injury (trauma) that might affect blood flow in your leg veins; even minor trauma may cause an ulcer.

Signs and Symptoms

Swelling of the leg, brown discoloration, or an itchy, red, rough area (stasis dermatitis) may appear before you notice an ulcer. This is often seen on the inner ankle area first, although any area on the lower leg may be affected. Varicose veins may be present. Sometimes there are hard, tender lumps under the skin near the ulcer.

The ulcer is a crater-like, irregular area of skin loss. It may be an open, easily bleeding, painful wound, or it might have a thick black scab. The level of pain varies.
Self-Care Guidelines
People with a leg ulcer should seek medical care if it is anything beyond a small scrape or cut on the surface of the skin.

If the ulcer appears minor:
Clean it with soap and water.
Apply a thin layer of petroleum jelly (Vaseline®) and a clean gauze bandage.
Avoid putting any tape or adhesive on the skin.
Avoid using topical antibiotics and other over-the-counter products, as people with leg ulcers often become allergic to these products.

When to Seek Medical Care

If you have pain, swelling, spreading red areas, fever, or any open wound that does not heal after a few days of self-care, seek medical advice.

Treatments Your Physician May Prescribe
In addition to a thorough exam, your physician may test to evaluate how well your veins are working.

Treatment may consist of:

  • Procedures to reduce leg swelling.
  • Medication for any dermatitis or infection that is present.
  • Special wound dressings.
  • Pentoxifylline to aid healing.
  • Surgery if other medical treatment fails.
  • Compression hose to prevent the ulcer from coming back.
  • Most ulcers heal within 1–4 months, but about 25% will still be present after a year.

Trusted Links
MedlinePlus: Leg Injuries and Disorders
MedlinePlus: Vascular Diseases

References

Bolognia, Jean L., ed. Dermatology, pp.1635. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed. pp.21. New York: McGraw-Hill, 2003.

 

Source: SkinSight.com

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Inky and Pocket

Posted on: November 24th, 2014 by Mindy Ruben No Comments

Inky and Pocket, the WoundDogs at Encompass HealthCare, are members of the beloved staff at the outpatient wound care center. Here, they take time out from napping to tell us about their work and their life at Encompass.

INKY & POCKET: No? You sure? Seriously? Positive? Absolutely sure? Second chance? Once more? Not right now, but later? Maybe?

POCKET: No worries. We’ll keep an eye out in case you drop something.

INKY: It’s what we do. After all, we’re dogs, first.

POCKET: WoundDogs, that’s our family business. We’ve been doing wound care for ‘bout four years now.

INKY:  ‘Bout 28 years.

POCKET: ‘Bout 28 years in dog years.

(Inky is startled by a sound coming from the kitchen)

INKY:  Hey, I just heard the fridge door open. Be right back!

Inky taking a break.

Inky taking a break.

POCKET: Anyway, we’re quite critical to the operation here at Encompass HealthCare. See, Inky and I give the place atmosphere. We put the patients in a good space to heal, h-e-a-l, not the “heel” like “sit down.” It’s aesthetics. We add that “je ne sais quoi” that you won’t find in any other wound care facility.

INKY: False alarm. Doc was just putting his lunch in there.

POCKET: I was just going over what we do here.

INKY: You tell ‘em the French thing?

POCKET: Yes. We provide the “je ne sais quoi.”

A Blue Picardy Spaniel

A Blue Picardy Spaniel

INKY: That certain something. I’m a darn-near-perfect Blue Picardy Spaniel.

POCKET: And I’m a slightly non-traditional Cavalier King Charles Spaniel…

INKY:  …On account of he’s just black and white without the telltale classic brown accents.

POCKET & INKY: But we don’t judge.

INKY:  We’re not here to judge.

POCKET:  Basically, we’re here to look good…

INKY:  Not get in the way…

POCKET:  …and be cute…

INKY:  …Because if a patient seems a little down…

POCKET:  …Or they’re about to drop some food…

INKY:  …Then, we go into F.C.M.: Full-Cute Mode. I sit real pretty with a “you’re the most important person living” expression on my face.

Pocket always seems to be on break.

Pocket always seems to be on break.

POCKET:  And I generally roll onto my back, wag my tail and show you my goods.

INKY: And that’s it.

POCKET: And I can make myself look exactly like the Lady dog in The Lady and the Tramp.

INKY: Except that she’s brown and tan and you’re all black and white.

POCKET: Jeesh! Why can’t you ever let that go?

INKY: What?

POCKET: You never miss a chance to point out my non-traditional coloring. Am I cute?

This is what Pocket thinks he looks like.

This is what Pocket thinks he looks like.

INKY: You’re adorable.

POCKET: Then let’s leave it at that.

(The interview is interrupted by a sound in the kitchen)

INKY & POCKET: FRIDGE!!

(Both dogs high tail it to the kitchen. (Pun intended.)

POCKET:  We were so close.

INKY:  So close to that sliced turkey.

POCKET: But it wasn’t to be. But what is meant to be is that we are WoundDogs. Make no mistake about it. Our job is all about you. Our patients love us and we love them back.

INKY: Along with whatever they might happen to be eating.

POCKET: That’s a ditto.

INKY: So if you come to Encompass HealthCare and Wound Medicine, make sure you say, “hello.”

POCKET: Yeah, because we want to make you feel at home.

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Wound Care & Diabetes

Posted on: September 9th, 2014 by Mindy Ruben No Comments

THE INTERSECTION OF WOUND CARE & DIABETES

Robert Striks, Special Writer, Encompass HealthCare and Wound Medicine

I’m diabetic. I have type-2 diabetes. At 53, I’ve battled it for 22 years now. I’m typing this because I’m sorry to say that I’ve reached a dubious stage in this disease.

Learn more about the link between diabetes and wound care--Encompass Healthcare, Michigan

Learn more about the link between diabetes and wound care–Encompass Healthcare, Michigan

I’m where the disease is making its presence known at the farthest reaches of my body. The tips of my toes. The soles of my feet. Places beyond the larger arteries to the smallest capillaries. Diabetes lives there and loves “de-nerving” those extremities.

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Food Substitutions

Posted on: July 10th, 2014 by Mindy Ruben No Comments

No Substitute For Substitutions

by
Rob Striks, Special Writer
Encompass HealthCare and Wound Medicine

Spaghetti squash is a great substitute for normally high-carb spaghetti.

At Encompass HealthCare and Wound Medicine, we talk a lot about making dietary food substitutions in order to take in more protein, lose weight or gain energy to aid in wound healing.

Sometimes, the substitutions we recommend are appropriate for a much larger audience than just wound care patients. Diabetic, cardiac and obese patients can make important strides in their health by making simple substitutions in their diet.

With that in mind, I made two important discoveries this week that have revolutionized my entire diet. I cooked with garbanzo flour and I learned how to make fried rice out of cauliflower. This is literally, and I use the term “literally” correctly here, the best thing since sliced bread.

Garbanzo Bean Flour is available in supermarkets and online.

Garbanzo Bean Flour is available in supermarkets and online.

That’s because I can now use garbanzo flour in recipes where I used to use wheat products and the end result is not only tastier, it’s infinitely healthier for me. Garbanzo beans are a rich source for protein, dietary fiber and healthy carbohydrates. They’re also very low in fat.

This discovery is a personal triumph for me as I used to pride myself on being able to make healthy substitutions in all my cooking. My substitutions, though, did not necessarily result in a trim body or more energy.

For instance, I learned how to substitute skim milk for whipping cream in Fettuccine Carbonara, which is like ordering a Boston Cooler made with Häagen-Dazs ice cream and telling the server to use Diet Vernors instead of regular Vernors. No big payoff there.

Then when Egg Beaters came along, I saw the clouds part and a heavenly ray of light shine down. Finally, the answer to high cholesterol had arrived! Unfortunately, they arrived along with mandatory nutritional labeling, and you had to be a chemistry major to figure out what they were actually made of. Plus, they didn’t taste all that wonderful.

Then, there is the never-discussed shame of ordering Egg Beaters in a restaurant. If you’re heavy, the server thinks you’re cheating somewhere else in your diet. And if you’re slender, you’re obviously high maintenance. There’s no winning with egg substitutes physically or mentally.

Socca is a gluten-free flatbread made from garbanzo bean flour.

Socca is a gluten-free flatbread made from garbanzo bean flour.

I did make the transition to substituting fresh egg whites for whole eggs in recipes and I learned to accept the texture changes in the finished products. Luckily, it’s 2014 and fresh whole eggs are enjoying some great publicity for being on the Good-For-You List again. I am cutting back on the yolks just a bit.

What brought me to garbanzo flour was the advice from my cardiologist that I give up all wheat, rice and potato products; and the advice from a good friend that I try socca, a food that’s like bread only it’s made with garbanzo flour instead of wheat flour. Cue the choir, it was fabulous.

Then, while putting together a ground turkey meat loaf, I substituted garbanzo flour for breadcrumbs and got another marvelous lift – a super protein, high-fiber meat loaf that held together perfectly. Is there anything these garbanzo’s can’t do?

Luscious chocolate cake made from garbanzo bean flour: Heaven!

Luscious chocolate cake made from garbanzo bean flour: Heaven!

A rich chocolate flourless cake made with garbanzo beans, you ask? The answer is yes and it’s right here. Make it and I guarantee the clouds will part for you

Pulse the cauliflower in a food processor or use a grater to make superb cauliflower fried rice.

Pulse the cauliflower in a food processor or use a grater to make superb cauliflower fried rice.

Now about that fried rice made with cauliflower. Who knew! I saw this demonstration online, I tried it and not only did I not need a nap after eating it, I actually felt quite energized. One of the secrets is using a food processor to pulse the uncooked cauliflower into tiny rice-size pieces. Then during the cooking process, you only use a small amount of liquid to steam the cauliflower so it doesn’t turn mushy.

Once you understand the liquid-holding and liquid-releasing properties in vegetables during cooking, there’s practically no limit to how you can use them as substitutes to enhance your nutrition. Spinach, for example, releases a lot of moisture when it’s cooked.

Spinach releases a lot of moisture during cooking.

Spinach releases a lot of moisture during cooking.

The same goes for mushrooms. So if you’re making quinoa with spinach and/or mushrooms and you want the same drier consistency, you have to use a bit less liquid than the usual two parts water to one part quinoa in the recipe.

In the beginning, using vegetables as substitutes in recipes works best when the seasonings usually overpower the dish. Like in the cauliflower fried rice, the soy sauce and seasonings over power any strong cauliflower taste.

Like spinach, mushrooms release liquid during cooking.

Like spinach, mushrooms release liquid during cooking.

Later, as you become more accustomed to the flavor and texture of the cauliflower, you may find yourself using less of the overpowering flavors in order to let the cauliflower taste come through.

So now that you can’t wait to garbanzo your diet, where do you get garbanzo flour? Well, you can make it yourself by grinding non-hydrated garbanzo beans in a spice grinder until they’re the consistency of flour, you can buy the flour already processed at most big supermarkets, or you can buy it online.

Try garbanzo flour for wheat flour. Check out cauliflower in place of rice. You can even prepare parsnips so they taste like sautéed potatoes. There’s no substitute for substitutions when it comes to eating healthier.

Hmmm…now that I think about it, lentils are beans and they’re also high in protein and low in fat. I wonder what would happen if I put them in my spice grinder and……

I’ll get back with you.

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Read Dr. Ruben’s Article on “Flesh-Eating Disease” (Necrotizing Fasciitis): the Truths and the Fallacies

Posted on: April 10th, 2014 by Mindy Ruben No Comments

The term “flesh-eating” disease (necrotizing fasciitis) is a scary and often misunderstood term. Read Dr. Bruce Ruben’s article here to understand this disease and to set the facts straight.

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Congratulations to Dr. Bruce Ruben! He Has Been Awarded Compassionate Doctor Award, One of Only Three Percent to Receive Honor!

Posted on: February 4th, 2014 by Access Computer No Comments

Congratulations, Dr. Bruce Ruben! Vitals physician rating site has just awarded Encompass HealthCare & Wound Medicine’s Dr. Ruben with a 2013 Compassionate Doctor Award, one of only three percent to receive this honor.
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Learn How To Avoid Frostbite

Posted on: January 27th, 2014 by Mindy Ruben No Comments

Learn How To Avoid Frostbite In Cold Temperatures

Learn how to avoid frostbite and hypothermia this brutal winter. Encompass HealthCare Medical Director Bruce Ruben M.D. imparts valuable preventative tips in the following article.  (more…)

Encompass HealthCare Celebrates Its Third Anniversary

Posted on: January 22nd, 2014 by Mindy Ruben No Comments

Encompass HealthCare and Wound Medicine, celebrates its third anniversary healing pressure sores, diabetic foot ulcers and other serious wounds using the latest treatments and technologies.
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Metro Detroit Wound Care: 6 Reasons to Choose Encompass

Posted on: July 31st, 2013 by Access Computer No Comments

6 Compelling Reasons To Choose Encompass HealthCare for your Wound Care

With our aging population exploding alongside a big increase in the number of new diabetes and poor circulation cases, more and more Americans need comprehensive wound care than ever before. Below, we discuss 6 compelling reasons to choose Encompass HealthCare for professional wound care.

The problem is there are few facilities and even fewer doctors equipped to handle all the facets of modern wound care. As a result, patients are usually forced into a hospital setting where infections and mismanagement run rampant; or worse, they must shuttle between several different doctors, locations and specialties in order to get treatment for all the underlying conditions that contribute to non-healing wounds.

Encompass HealthCare and Wound Medicine in West Bloomfield, MI, represents the new thinking and a new model for wound care: a one-stop outpatient facility that combines all aspects of wound care in one amazingly designed office under one roof.

Why should you seek out a place like Encompass? The reasons are quite compelling considering the current “fractured” delivery of medical care in America.

  1. Encompass HealthCare is an outpatient facility. That means it’s far away from the hospital where hospital-borne infections are rampant.
  2. Because we’re an outpatient facility, you can get your treatment and then get back to your life quicker.
  3. We use advanced thinking along with advanced diagnostics. If it’s a wound that hasn’t healed in four to six weeks, we know something somewhere isn’t functioning properly. In other words, we don’t just treat the wound.  We treat the whole person.
  4. All treatments all the time. From I.V. antibiotics to hyperbaric oxygen treatments to artificial skin overlays to traditional Chinese medicine – we’re armed to heal your wounds with the best technologies on the planet.
  5. Dr. Ruben is triple board certified in infectious diseases, internal medicine and undersea and hyperbaric medicine. So you can see just one doctor to completely heal your wound.
  6. Knowledge is power! Need a special offloading device? We’ll find it for you. Have venous insufficiency and need venous ablation? We’re affiliated with the best in medicine. Nutritional counseling to heal a wound? We know exactly what and how much extra protein you need on a daily basis.

Want to learn more about this revolutionary approach to wound care? Visit Encompass HealthCare online at www.encompasshealthcare.com or call the center today at 248-624-9800.

Encompass HealthCare. We heal wounds from the inside out.

Treating Lymphedema Successfully

Posted on: May 29th, 2013 by Mindy Ruben No Comments

TREATING LYMPHEDEMA SUCCESSFULLY: A CASE STUDY

Treating lymphedema successfully in our outpatient setting has allowed patient M. Silver to begin to heal his bilateral, lower extremity swelling (photo above is not M. Silver, but rather an example of lower extremity lymphedema.)  M. Silver has venous insufficiency, swelling in his legs, and has developed an ulcer between his 1st and 2nd toe, resulting in a fungal infection.

Treatment began with compression therapy, applied by Julia, our certified, manual, lymphedemic physical therapist, an Unna Boot, an increase in his diruetics (medicine to reduce swelling,) an oral fungal pill called Lamisil, and a special powder called Nystatin (both used to treat the fungus.)

M.Silver has been here for only 1 week and he is already improving, estimating his full treatment at about 2-4 weeks total.  All in our outpatient setting, so M.Silver can get his treatment, get healed, and get on with his life.

Treating lymphedema successfully can be achieved if all of the underlying conditions causing lymphedema are addressed.

 

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