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Dr. Ruben’s Venous Insufficiency Article

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Dr. Ruben’s Venous Insufficiency Article

Posted on: December 15th, 2015 by Mindy Ruben No Comments

Dr. Ruben’s Venous Insufficiency Article explains this condition thoroughly in his Woundsource article here.

Venous Insufficiency: blood and other fluids can't travel up toward the heart because of faulty valves inside the vein. This is explained in Dr. Ruben's venous insufficiency article.

Venous Insufficiency: blood and other fluids can’t travel up toward the heart because of faulty valves inside the vein. This is explained in Dr. Ruben’s venous insufficiency article.

Chronic venous insufficiency (CVI) refers to a long-term condition where the veins inside the legs have lost their ability to move blood back up to the heart from the legs. This occurs because the vein walls have weakened to the point where the venous pumps are no longer sufficient enough to send blood back up, against gravity, to the heart. CVI also affects the tiny valves inside the leg veins. When these valves do not close sufficiently, blood seeps back down past the valves and pools in the lower legs.

Many treatments are available including our in-house venous ablation(more…)

Avoid Amputation At Encompass HealthCare & Watch Our Video

Posted on: December 8th, 2015 by Mindy Ruben No Comments

We avoid amputation by delivering the most sophisticated wound healing technology to our patients…all outside of a hospital, safely at our in-house wound treatment center.

At Encompass Healthcare, our patients have been able to avoid amputation because we have access to hospital-level technology without the hassles that hospitals present. Our sophisticated wound care technology includes treatments such as venous ablation, hyperbaric oxygen therapy, I.V. antibiotics, x-rays, special dressings and a home-like atmosphere that is anything but hospital-like!  (more…)

See Dr. Ruben’s Video On Refractory Osteomyelitis

Posted on: November 4th, 2015 by Mindy Ruben No Comments

Refractory osteomyelitis is a recurrent case of osteomyelitis.

This patient has recurring or refractory osteomyelitis of his lower jaw.

This patient has recurring or refractory osteomyelitis of his lower jaw.

Osteomyelitis is a fancy word for bone infection and refractory osteomyelitis can become a problem if untreated.

(more…)

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.

(more…)

SMOKING DELAYS WOUND HEALING

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

We all know that smoking is bad for you. In fact, it’s just about the worst thing you can do to your body.  Over 4,000 compounds are found in cigarette smoke and many of them are toxic and carcinogenic; that means they cause cancer!  To make matters worse, smoking is responsible for several other diseases, such as respiratory illnesses and heart disease.

Smoking delays wound healing

Smoking delays wound healing

Over 440,000 people in the USA die because of smoking each year. According the Centers for Disease Control and Prevention (CDC), $92 billion are costs each year from lost productivity resulting from smoking-related deaths. (source: Medical News Today)

Smoking also slows down wound-healing too. For example, burn wounds take longer to heal on a smoker according to a recent article published in Advances In Skin and Wound Care.  The literature shows that smoking decreases tissue oxygenation and metabolism temporarily. That means oxygen can’t get to the wound to heal it.

Tobacco use has also been linked to prolonged healing time and greater risk for complications in orthopaedic and other surgeries, according to a new study presented at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).  So if you’re hoping for a speedy recovery from that recent hip surgery, put down the smokes!

And don’t be fooled by the new E-Cigarettes.  With nicotine itself containing over 7,000 chemicals, 70 of which are cancerous, the nicotine levels in E-Cigarettes tend to be around 10-15% higher than those found in a regular cigarette.

So, it’s pretty clear that nicotine slows wound healing by impeding tissue oxygenation and a whole bunch of other really awful effects. Put down the nicotine and enjoy a healthier lifestyle!

 

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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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Courage

Posted on: June 8th, 2014 by Mindy Ruben No Comments

I learned about courage at an early age when my dad taught us how to fight. He said that our best weapons in a fight were our legs.  (more…)

Patient Compliance

Posted on: June 6th, 2014 by Mindy Ruben No Comments

Doctor-PatientPATIENT COMPLIANCE AND THE DOCTOR-PATIENT RELATIONSHIP

by Rob Striks, Special Writer
Encompass HealthCare & Wound Medicine 

“That’s a team, gentlemen, and either, we heal, now, as a team, or we will die as individuals. That’s football, guys, that’s all it is. Now, what are you gonna do?” – From the movie, “Any Given Sunday”

Before we get into motivation, which is at the heart of compliance, let me say from the start that I am a saboteur of my own health. I’m my own worst enemy when it comes to following through on my physicians’ long-term health strategies. Obviously, if I did everything my physicians told me to do over the years, I’d probably be a slender, 185 pounds of muscle, have many less stents and be able to run marathons.

If I followed their advice, I’d be the picture of health, able to qualify for millions of dollars of life insurance and basking in the wonderful example I would have been setting for my children.

Mental Barriers quoteBut I didn’t always follow my doctors’ advice, or, if I did, I sabotaged before I could make the lifestyle changes permanent. There’s a phrase for patients like me: Non-Compliant. We don’t comply with the physician’s advice. We’re not necessarily bad people or bad patients. Quite the contrary, we’re generally very good, salt-of-the-earth types who, unfortunately, have mental barriers to doing what’s right for our bodies.

Sometimes, we’re head cases. Like somewhere down deep we don’t want to get healthier or we think we’re too far-gone to get healthier. So we sabotage or we simply don’t comply. Then, when we fail to get healthier, we get to be right and say, “See? I really am too far-gone.” It’s negative reinforcement. It’s also illogical like taking drugs is illogical. It may feel somewhat good while you’re doing it or feeling it, but you’re actually killing yourself.

Rest assured our doctors know all about this stuff as they deal with it every day. They also know all about non-compliance because they’re guilty of the same mentalities. They don’t get a pass just because they’ve gone to medical school. So they know our psyche. Good bedside manner or not, they know about human frailty.

Bullied Patient QuoteBut doctors practice inside very indefinable emotional boundaries. Come down too hard on patients and they may get alienated, they might not come back to finish their treatments. I don’t think any patient can be bullied into complying with their doctor’s advice. Compassion will always trump enforcement when it comes to patient compliance.

On the other hand, going too easy on a patient doesn’t get the job done either. There’s certainly a middle ground where the doctor leads the patient, through education and commitment, to the point where the patient arrives at his or her own conclusion of, “I need to make these lifestyle changes or things are going to continue going downhill for me.”

That’s an entirely different mindset than the old adage, “You can lead a horse to water but you can’t make it drink.” To keep the “care” in healthcare, the methodology should be, “I’m going to lead you to the water while teaching you how you’ll benefit by drinking it. Then, when we get to the water, it’ll be your choice alone whether you drink or not.

Authentic ComplianceThat’s the point where authentic compliance begins. The physician has laid out exactly what is needed to comply in a way the individual patient “gets.” Now it’s up to the patient to take the shot, score the touchdown or whatever sports-related metaphor you can think of that means win.

I love the scene in The Untouchables where Sean Connery tells Kevin Costner what he has to do in order to get Al Capone because it illustrates the motivation a patient needs to comply with his or her doctor’s suggestions.

Malone: You said you wanted to get Capone. Do you really wanna get him? You see what I’m saying is, what are you prepared to do?

Ness: Anything within the law.

Malone: And *then* what are you prepared to do? If you open the can on these worms you must be prepared to go all the way. Because they’re not gonna give up the fight, until one of you is dead.

Can you imagine what it’d be like to hear that from your primary care physician?

Doctor: You said you wanted to get healthy. Do you really wanna get healthy? Then what are you prepared to do? Simply take the medications and hope everything falls into place? If you want to beat heart disease, diabetes or obesity, if you want to fully heal a wound or improve circulation to your legs, then you must be prepared to go all the way. Because those conditions aren’t gonna give up the fight until one of you is dead.

For a certain patient, those words from a good physician could be extremely powerful and motivating, particularly if they were delivered with a deep Scottish accent.

Wishful Thinking QuoteOr, they could fall flat since all patients react differently. And that may be the point of this whole piece. Compliance happens as a result of the patient-doctor relationship. If you’re a physician and you don’t have the relationship, compliance is just wishful thinking.

I’m sure I’m not the first to propose that medical schools teach mandatory classes in how to get patients to comply. Imagine classes titled, “Bedside Manner 101,” “Patient Psychology and Compliance 760,” or “Doctor-Patient Relationship 370.”

I close this out with two emotional appeals from two different films that I try to remember when whatever I’m doing isn’t working. Both scenes are about compliance and motivation. The first is from Rocky III:

Adrian: …you gotta want to do it for the right reasons. Not for the guilt over Mickey, not for the people, not for the title, not for money or me, but for you. Just you. Just you alone.

Rocky Balboa: And if I lose?

Adrian: Then you lose. But at least you lose with no excuses, no fear. And I know you can live with that.

Rocky Balboa: How did you get so tough?

Adrian: I live with a fighter.

And from The Outlaw Josey Wales:

Josey Wales: Now remember, when things look bad and it looks like you’re not gonna make it, then you gotta get mean. I mean plumb, mad-dog mean. ‘Cause if you lose your head and you give up, then you neither live nor win. That’s just the way it is.

So are you ready, doctors and patients?

Comply.

 

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