Wound Healing and Cancer

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers with
00:08 --> 00:11your host, Doctor Anees Chagpar.
00:11 --> 00:12Yale Cancer Answers features the
00:12 --> 00:15latest information on cancer care by
00:15 --> 00:16welcoming oncologists and specialists
00:16 --> 00:19who are on the forefront of the
00:19 --> 00:21battle to fight cancer. This week,
00:21 --> 00:23it's a conversation about wound healing
00:23 --> 00:25and cancer with Doctor Henry Hsia.
00:25 --> 00:27Doctor Hsia is an associate professor of
00:27 --> 00:30surgery and plastic surgery at the Yale
00:30 --> 00:31School of Medicine where Doctor Chagpar
00:32 --> 00:34is a professor of surgical oncology.
00:35 --> 00:37So Henry, maybe we can start off by you
00:37 --> 00:39telling us a little bit more about yourself
00:39 --> 00:41and what it is exactly that you do.
00:41 --> 00:44I'm a plastic surgeon and I
00:44 --> 00:46run the wound program here.
00:46 --> 00:48And what that entails is that
00:48 --> 00:51I see patients with wounds that
00:51 --> 00:53are challenging for any reason.
00:53 --> 00:55You know that might not
00:55 --> 00:56be healing on its own,
00:56 --> 00:58and the reasons for the wound
00:58 --> 01:01can be any sort of reason.
01:01 --> 01:05Whether it's wound after surgery.
01:05 --> 01:08That is from cancer treatment or
01:08 --> 01:10other causes like pressure sores,
01:10 --> 01:12diabetic foot ulcers and and the
01:12 --> 01:15one can be located anywhere in the
01:15 --> 01:19body and it could be in any age
01:19 --> 01:20or you know population of folks.
01:20 --> 01:23I as a plastic surgeon I'm very
01:23 --> 01:25comfortable seeing a wound in
01:25 --> 01:27anywhere on the body for any reason
01:27 --> 01:29as well as in any you know age
01:29 --> 01:31group of you know from one day old
01:31 --> 01:34babies up to 101 year old patients.
01:35 --> 01:38So let's talk a little bit about wounds,
01:38 --> 01:41specifically in the kind of
01:41 --> 01:43group of cancer patients.
01:43 --> 01:45When we think about surgery,
01:45 --> 01:47it's it's frequently a modality
01:47 --> 01:49used to treat cancer patients.
01:49 --> 01:51Our wounds, particularly more
01:51 --> 01:53difficult in cancer patients,
01:53 --> 01:55are there are things about cancer that
01:55 --> 01:57make wounds more difficult to heal.
01:59 --> 02:02It can because you know,
02:02 --> 02:05and this is what I tell every patient
02:05 --> 02:07that comes to see me in the clinic.
02:07 --> 02:08And that is that, you know,
02:08 --> 02:10taking care of a wound is a lot
02:10 --> 02:12more like a gardening project
02:12 --> 02:14than it is a home repair project.
02:14 --> 02:15And you're not just trying
02:15 --> 02:17to seal a hole in the wall,
02:17 --> 02:19you're trying to get something to grow.
02:19 --> 02:22And just as gardeners have no easy
02:22 --> 02:25way to make a plant grow right,
02:25 --> 02:26they can't just force them to bloom
02:26 --> 02:28or bear fruit when we want them to.
02:28 --> 02:29We, really.
02:29 --> 02:31Aren't able to force a wound
02:31 --> 02:32to heal on a body,
02:32 --> 02:34whether it's from surgery or
02:34 --> 02:35for some other reason.
02:35 --> 02:37And you know, in the case of cancer,
02:37 --> 02:39you know, as you might imagine,
02:39 --> 02:41there are a lot of other things going on.
02:41 --> 02:43You know the the tumor itself
02:43 --> 02:45is competing with the body for
02:45 --> 02:46nutrients and resources that
02:46 --> 02:48are important that your body
02:48 --> 02:49needs to get a wound to heel.
02:49 --> 02:51And then there are various treatments
02:51 --> 02:53like you know whether it's medications
02:53 --> 02:55like chemotherapy or radiation that
02:55 --> 02:58you know can actively inhibit the
02:58 --> 02:59body's ability to heal the wound.
03:01 --> 03:03And so how do you manage that?
03:03 --> 03:05I mean, when you think about the
03:05 --> 03:08fact that cancer, as you say,
03:08 --> 03:11can compete for for resources, right?
03:11 --> 03:14It can compete for a blood supply.
03:14 --> 03:15It can compete for nutrients
03:15 --> 03:18which your body needs to heal.
03:18 --> 03:19And yet the cancer if there's
03:19 --> 03:21cancer in that same vicinity,
03:21 --> 03:25it can actively inhibit wound healing so.
03:25 --> 03:27Are there tips and tricks that you
03:27 --> 03:29use that are in your armamentarium
03:29 --> 03:31that help these wounds to heal?
03:33 --> 03:36Well, I would say that I you know,
03:36 --> 03:39I don't typically take the approach that
03:39 --> 03:41I learned during my surgical training
03:41 --> 03:44right where you you you, you know you.
03:44 --> 03:46I guess you know you try to
03:46 --> 03:48tackle a problem head on,
03:48 --> 03:50you know if if there is a tumor,
03:50 --> 03:51you take it out.
03:51 --> 03:54If if there is a a stab wound, you try to,
03:54 --> 03:55you know, stop the bleeding instead.
03:55 --> 03:58I I try to kind of like the
03:58 --> 03:59way a gardener you know,
03:59 --> 04:01Gardner can't make a plant grow
04:01 --> 04:03just by directly pulling on it.
04:03 --> 04:05Right, you try to understand the
04:05 --> 04:07circumstances that that plant or
04:07 --> 04:09garden is in and and see what
04:09 --> 04:12you can do to modify it or or to
04:12 --> 04:13you know to somehow tweak it.
04:13 --> 04:15And so I try a very similar approach
04:15 --> 04:17and so with patients you know
04:17 --> 04:19the very first time they meet me.
04:19 --> 04:21One of the first things I do is I I try to,
04:21 --> 04:23you know, in an efficient manner,
04:23 --> 04:25but go through a whole series
04:25 --> 04:27of questions about you.
04:27 --> 04:29Know whether they have comorbidities
04:29 --> 04:30like diabetes or smoking.
04:30 --> 04:34That might also be problematic for healing.
04:34 --> 04:36Whether they're eating adequately
04:36 --> 04:38to start with right,
04:38 --> 04:41and also to understand her social situation,
04:41 --> 04:43you know I've found that patients
04:43 --> 04:45who live on their own can find it
04:45 --> 04:46particularly challenging to get a
04:46 --> 04:48wound to heal because they they
04:48 --> 04:49have to do everything themselves.
04:49 --> 04:51They don't have any support to
04:51 --> 04:54to get rest and and then with in
04:54 --> 04:56the case of cancer patients,
04:56 --> 04:58I I try to pay attention to what,
04:58 --> 04:59what their you know?
04:59 --> 05:00What kind of therapies are getting
05:01 --> 05:02are or what they're anticipating
05:02 --> 05:03are they're going to are?
05:03 --> 05:04Have they gotten radiation?
05:04 --> 05:06Are they gonna need it in the future,
05:06 --> 05:07and how soon?
05:07 --> 05:09And and in that sense I I try
05:09 --> 05:11to work collaboratively with.
05:11 --> 05:13You know, all the other caregivers to try to,
05:13 --> 05:15you know, hopefully help you know,
05:15 --> 05:17help the patient here in terms of
05:17 --> 05:19the healing and and and and trying
05:19 --> 05:20to balance on one hand right?
05:20 --> 05:22Obviously the priority is to get
05:22 --> 05:23the cancer treated,
05:23 --> 05:25but to do it in a way so that it
05:25 --> 05:27will set them up in the best way to
05:27 --> 05:30recover and and heal in an optimal fashion.
05:31 --> 05:34So you mentioned several things there that
05:34 --> 05:37I think we can dive into a little bit more.
05:37 --> 05:40So one is nutrition and we know that for some
05:40 --> 05:43cancer patients that can be really difficult,
05:43 --> 05:46especially for patients who may
05:46 --> 05:48have cancers in the oropharynx
05:48 --> 05:51or or in the the stomach region.
05:51 --> 05:53We're getting enough.
05:53 --> 05:55Nutrition is really difficult.
05:55 --> 05:57So what advice do you have
05:57 --> 05:58for these patients?
05:58 --> 06:00I mean it it many patients,
06:00 --> 06:02I'm sure ask you well doc,
06:02 --> 06:03you know what should I be eating?
06:03 --> 06:05Should I be taking more supplements?
06:05 --> 06:06Should I be?
06:06 --> 06:08Should I be eating more?
06:08 --> 06:09Protein, you know?
06:09 --> 06:11What do you think about
06:11 --> 06:13supplemental drinks like ensure?
06:13 --> 06:15I mean are those?
06:15 --> 06:18Tell us a bit more about how you might
06:18 --> 06:20optimize people's nutrition and.
06:20 --> 06:23And whether in fact that has a real
06:23 --> 06:25impact in terms of wound healing.
06:26 --> 06:29Though I I drink, I'll try to meet the
06:29 --> 06:31patient where they are right, you know.
06:31 --> 06:34And just as with kids right?
06:34 --> 06:35Even though they're you know with children,
06:35 --> 06:38you want them to get a well balanced diet.
06:38 --> 06:40But especially in this day and age.
06:40 --> 06:42Certainly I'm this way as a parent
06:42 --> 06:44I don't force my children, you know,
06:44 --> 06:45to eat like if they don't like spinach,
06:45 --> 06:47I don't force them to eat spinach,
06:47 --> 06:48but I I try to find another way for them to
06:48 --> 06:50get the same vitamins that they might get,
06:50 --> 06:53and spinach and and so similar with patients.
06:53 --> 06:55I tried to do my best to
06:55 --> 06:56understand our situation.
06:56 --> 06:58You know, if something like ensure
06:58 --> 07:00works and helping them to get more
07:00 --> 07:02protein than I certainly encourage that.
07:02 --> 07:04If they don't like ensure if they you
07:04 --> 07:06know they like carnation carnation
07:06 --> 07:07instant breakfast, then great.
07:07 --> 07:09If they don't like any of those
07:09 --> 07:10things and I you know I,
07:10 --> 07:11I really try to you know,
07:11 --> 07:13let them understand you know what you know.
07:13 --> 07:15Their priorities are so you know protein.
07:15 --> 07:17As you mentioned protein and that
07:17 --> 07:18is very important.
07:18 --> 07:21I try to let have the patient understand
07:21 --> 07:22that protein provides still building
07:22 --> 07:25blocks that the body uses to heal a wound
07:25 --> 07:28and so whatever foods that can provide that.
07:28 --> 07:31Protein, whether it's meat or
07:31 --> 07:35beans or or cheese or nuts,
07:35 --> 07:37you know, or something like?
07:37 --> 07:38Ensure I I tell them.
07:38 --> 07:40The important thing is to get the protein.
07:40 --> 07:41How they get it matters less to me
07:41 --> 07:43than the fact that they're getting it,
07:43 --> 07:45and I take it try to take the
07:45 --> 07:46same path with all the other.
07:46 --> 07:49The vitamins and calories I asked them to,
07:49 --> 07:51you know, not just to you know
07:51 --> 07:53to eat only potato chips, right?
07:53 --> 07:53Obviously?
07:53 --> 07:56But to try to be as balanced as I can,
07:56 --> 07:57but they they need to get into
07:57 --> 07:58something you know, I know.
07:58 --> 08:00Especially in cancer, right?
08:00 --> 08:02You know a lot of times
08:02 --> 08:03appetite is suppressed, right?
08:03 --> 08:05And so if that's a real issue,
08:05 --> 08:07I try to work with the other caregivers or
08:07 --> 08:09find some way to stimulate that appetite.
08:09 --> 08:10Sometimes just a matter of
08:10 --> 08:11finding the right foods, right?
08:11 --> 08:12So I work,
08:12 --> 08:15I work with the family to see what
08:15 --> 08:18what can be done to somehow make you
08:18 --> 08:20know the nutrition as as you know,
08:20 --> 08:21something that's not like a feels like
08:21 --> 08:23a prison sentence to the patient,
08:23 --> 08:24but something that they you
08:24 --> 08:25know they really want to have.
08:26 --> 08:28Dietitians can likely help in
08:28 --> 08:29that process as well, right?
08:29 --> 08:30Yes, exactly, yes.
08:30 --> 08:33So you know, we try to work with the,
08:33 --> 08:34you know, smile centers,
08:34 --> 08:35dietitians and try to communicate
08:35 --> 08:37with them to, you know, you know.
08:37 --> 08:38Usually they're already well plugged in
08:38 --> 08:40by the time the patients kind of see me.
08:40 --> 08:41They're usually well plugged into
08:41 --> 08:43the Smile Support network, but right?
08:43 --> 08:45I make sure I just confirmed that
08:45 --> 08:47they already spoken to a dietitian
08:47 --> 08:49and you know, are you know,
08:49 --> 08:51working towards that goal of whatever
08:51 --> 08:53calorie goal or or protein goal
08:53 --> 08:55that that dietitian has given them,
08:56 --> 08:59you know. The other thing that you mentioned,
08:59 --> 09:02which is prevalent for many cancer
09:02 --> 09:04survivors is is smoking and.
09:04 --> 09:06And that's because smoking really
09:06 --> 09:09leads to a number of cancers,
09:09 --> 09:12but at the same time smoking can be
09:12 --> 09:16really bad in terms of wound healing.
09:16 --> 09:18So can you talk to us a little
09:18 --> 09:20bit more about the effect that
09:20 --> 09:22smoking has on wound healing and
09:22 --> 09:24kind of what you do about that?
09:24 --> 09:27I mean, is it possible to get people?
09:27 --> 09:29To quit smoking and if they quit,
09:29 --> 09:31does that really impact their wound healing?
09:31 --> 09:35If they've been smoking for 20 years or?
09:35 --> 09:36You know, is the cat kind of already
09:36 --> 09:38out of the bag and it really doesn't
09:38 --> 09:39make any difference if they quit now.
09:40 --> 09:44Well, yeah, unlike tumor pathology,
09:44 --> 09:47smoking does have an immediate effect on
09:47 --> 09:50healing and you don't need a whole lot
09:50 --> 09:54in terms of the exposure to slow healing.
09:54 --> 09:57I like to tell patients that in in
09:57 --> 10:01like for certain other types of like
10:01 --> 10:03cosmetic procedures like facelifts,
10:03 --> 10:05many plastic surgeons.
10:05 --> 10:07We're very hesitant to operate
10:07 --> 10:09on someone who even smokes at
10:09 --> 10:11like 1 puff of a cigarette.
10:11 --> 10:13You know every six months,
10:13 --> 10:15because even that small amount of exposure,
10:15 --> 10:16at least empirically,
10:16 --> 10:18we find that leads to a higher
10:18 --> 10:20rate of healing problems after
10:20 --> 10:22a cosmetic surgery and and also
10:22 --> 10:24can affect the scarring outcomes.
10:24 --> 10:25You know, in terms of the appearance, right?
10:25 --> 10:26Which is so important.
10:26 --> 10:29So I take that knowledge and in terms
10:29 --> 10:32of my counseling cancer patients that
10:32 --> 10:34that quitting smoking now right will
10:34 --> 10:36immediately improve their ability to heal.
10:36 --> 10:39I've certainly seen that with my own
10:39 --> 10:42patients and and I and I actually consider
10:42 --> 10:45myself relatively fortunate compared to,
10:45 --> 10:46say, our primary care colleagues,
10:46 --> 10:48who you know who will be.
10:48 --> 10:49Oftentimes, you know,
10:49 --> 10:51preaching the same message that you know that
10:51 --> 10:53quitting smoking is good for your health.
10:53 --> 10:55But in in my instance,
10:55 --> 10:56all the patients are coming to
10:56 --> 10:57me with a concrete problem,
10:57 --> 10:58right?
10:58 --> 10:59They have this wound that isn't healing,
10:59 --> 11:01so it's not an abstract problem that
11:01 --> 11:03that you know that where some of my
11:03 --> 11:05other colleagues may be working with.
11:05 --> 11:06For for me, I have a.
11:06 --> 11:08This concrete problem that is very
11:08 --> 11:10concrete and tangible to the patients,
11:10 --> 11:12and so even if they you know the patients
11:12 --> 11:15say that they've been smoking for 20 years,
11:15 --> 11:16they find it very hard to quit.
11:16 --> 11:18I I don't try to,
11:18 --> 11:19you know, make it sound.
11:19 --> 11:20I'm judging them for not quitting.
11:20 --> 11:22I'm just giving them information
11:22 --> 11:23and you'd be surprised.
11:23 --> 11:24And he said,
11:24 --> 11:26how often actually more often
11:26 --> 11:28than I would have predicted that
11:28 --> 11:30many patients actually quit,
11:30 --> 11:31or at least in the time that they're
11:31 --> 11:32following with me to just long
11:32 --> 11:34enough to get their wound to heal?
11:34 --> 11:37What about other social?
11:37 --> 11:39Habits so you know alcohol can increase
11:39 --> 11:41your risk of a number of cancers.
11:41 --> 11:44Does that have an impact on wound healing?
11:45 --> 11:48There there's not a whole lot of science
11:48 --> 11:52in terms of the direct impact of alcohol
11:52 --> 11:55in terms of the biology of healing I,
11:55 --> 11:56I think it's more just in terms
11:56 --> 11:58of the impact on judgment, right?
11:58 --> 12:00So someone who's had a few drinks
12:00 --> 12:03probably may not make the best
12:03 --> 12:05decisions in terms of doing things
12:05 --> 12:07like like elevating a leg, right?
12:07 --> 12:09That which is very important for healing.
12:09 --> 12:12And so I, I, I personally don't tell
12:12 --> 12:15patients that they can't drink at all.
12:15 --> 12:17Right, but I I tell them, you know,
12:17 --> 12:19they you know use common sense, right?
12:19 --> 12:20You certainly don't want to
12:20 --> 12:22be getting drunk every night,
12:22 --> 12:24and that keeps you from, you know,
12:24 --> 12:26filling all the good habits you need
12:26 --> 12:27in order to make sure you recover.
12:27 --> 12:28Whether it's getting a wound
12:28 --> 12:29to heel or getting,
12:29 --> 12:31you know better from your
12:31 --> 12:32your your cancer diagnosis.
12:34 --> 12:37And one final thing that is a risk
12:37 --> 12:39factor for cancers is exposure
12:39 --> 12:42to sunlight and tanning salons.
12:42 --> 12:44We know that that increases
12:44 --> 12:46the risk of Melanoma.
12:46 --> 12:50Is there an impact of radiation in that
12:50 --> 12:53way of sunlight getting out in the sun,
12:53 --> 12:55going to tanning salons on wound healing?
12:57 --> 12:58I think it's right.
12:58 --> 13:01It's not as clear cut in terms
13:01 --> 13:04of whether sunlight has a direct,
13:04 --> 13:06harmful or beneficial effect, right?
13:06 --> 13:07As you know, you know sunlike
13:07 --> 13:08does kill bacteria, right?
13:08 --> 13:12So exposing a wound to sunlight can help
13:12 --> 13:14with decreasing bacterial overgrowth,
13:14 --> 13:16which can become problematic in
13:16 --> 13:19in in a wound, on the other hand,
13:19 --> 13:21though, leaving it open to the sun
13:21 --> 13:23can also cause the wind to dry out,
13:23 --> 13:25which is not good for healing either.
13:25 --> 13:27And in this case I again compare
13:27 --> 13:28wounds to plants.
13:28 --> 13:30To where that, just like plants,
13:30 --> 13:33wounds need some moisture they don't like.
13:33 --> 13:33Too much moisture,
13:33 --> 13:34just like plants don't like
13:34 --> 13:35to be overwatered,
13:35 --> 13:36but they do need some moisture,
13:36 --> 13:38so keeping it covered and not getting
13:38 --> 13:41exposed to sun well keep it from drying out.
13:41 --> 13:42I think where a sun where it's much
13:42 --> 13:44more clear in terms of what the effect
13:44 --> 13:46of sunlight has is on the healed wound.
13:46 --> 13:47So like on scars, right?
13:47 --> 13:51So sunlight does tend to make scars much
13:51 --> 13:54more prominent after the wound has healed,
13:54 --> 13:56and so I do recommend in patients who
13:56 --> 13:58have who have successfully healed.
13:58 --> 13:59It wants to really be mindful
13:59 --> 14:01of how much direct sun exposure
14:01 --> 14:03that area is getting because.
14:03 --> 14:05By minimizing some exposure,
14:05 --> 14:07make it easier for that scar to fade
14:07 --> 14:09overtime and be less bothersome.
14:09 --> 14:11Also, just and definitely avoiding sunburn,
14:11 --> 14:13because sunburn can really make a
14:13 --> 14:15scar much more likely to get chapped
14:15 --> 14:18and break down again in the future.
14:18 --> 14:20Yeah, so use that sunscreen.
14:20 --> 14:22But for right now we're going to take
14:22 --> 14:24a short break for a medical minute,
14:24 --> 14:26but please stay tuned to learn
14:26 --> 14:27more about wound healing and cancer
14:27 --> 14:29with my guest Doctor Henry Hsia.
14:29 --> 14:31Funding for Yale Cancer Answers
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14:46 --> 14:48Genetic testing can be useful for
14:48 --> 14:50people with certain types of cancer
14:50 --> 14:52that seem to run in their families.
14:52 --> 14:54Genetic counseling is a process
14:54 --> 14:55that includes collecting a detailed
14:56 --> 14:57personal and family history,
14:57 --> 14:58a risk assessment,
14:58 --> 15:02and a discussion of genetic testing options.
15:02 --> 15:04Only about 5 to 10% of all
15:04 --> 15:05cancers are inherited,
15:05 --> 15:07and genetic testing is not
15:07 --> 15:08recommended for everyone.
15:08 --> 15:10Individuals who have a personal
15:10 --> 15:13and or family history that includes
15:13 --> 15:15cancer at unusually early ages.
15:15 --> 15:16Multiple relatives.
15:16 --> 15:18On the same side of the family
15:18 --> 15:19with the same cancer,
15:19 --> 15:21more than one diagnosis of
15:21 --> 15:23cancer in the same individual.
15:23 --> 15:26Rare cancers or family history of a
15:26 --> 15:28known altered cancer predisposing gene
15:28 --> 15:31could be candidates for genetic testing.
15:31 --> 15:33Resources for genetic counseling and
15:33 --> 15:35testing are available at federally
15:35 --> 15:37designated comprehensive cancer
15:37 --> 15:39centers such as Yale Cancer Center
15:39 --> 15:41and Smilow Cancer Hospital.
15:41 --> 15:43More information is available
15:43 --> 15:45at yalecancercenter.org you're
15:45 --> 15:46listening to Connecticut.
15:46 --> 15:47Public radio
15:48 --> 15:50welcome back to Yale Cancer Answers.
15:50 --> 15:53I'm doctor Anees Chagpar and I'm joined
15:53 --> 15:55tonight by my guest Doctor Henry Hsia.
15:55 --> 15:58We're talking about wound healing and cancer,
15:58 --> 16:00and Henry right before the break
16:00 --> 16:02we were talking about a number
16:02 --> 16:04of things that you kind of think
16:04 --> 16:06about in terms of helping cancer
16:06 --> 16:08patients get their wounds to heal,
16:08 --> 16:11and one of the things that
16:11 --> 16:13you mentioned was sleep,
16:13 --> 16:14and that's something that I think
16:14 --> 16:17a lot of patients might not really
16:17 --> 16:19think about in terms of wound healing.
16:19 --> 16:21Can you tell us a little bit more about that?
16:22 --> 16:24Well, you know, I admit there isn't a
16:24 --> 16:27whole lot of study specific studies
16:27 --> 16:29specific to wound research about
16:29 --> 16:33the impact of sleep, but I you know,
16:33 --> 16:34there's certainly definitely evidence
16:34 --> 16:37that you know if you don't get
16:37 --> 16:39enough rest right and that impacts
16:39 --> 16:41your overall body's Physiology,
16:41 --> 16:43then that definitely has a negative
16:43 --> 16:45impact on your body's ability to heal.
16:45 --> 16:49I often see the the wound as sort of the.
16:49 --> 16:51Canary in the coal mine about
16:51 --> 16:53a potential issue, right?
16:53 --> 16:54If a wound is not healing,
16:54 --> 16:57then then there's that's a sense that
16:57 --> 16:58there's something not quite right
16:58 --> 17:00with the the balance of the body
17:00 --> 17:02in terms of either amount of rest,
17:02 --> 17:04it's getting or or some other aspect of it.
17:04 --> 17:07So I definitely, you know,
17:07 --> 17:09tell patients not to push themselves, right?
17:09 --> 17:10I mean, you know,
17:10 --> 17:12it's kind of like common sense after
17:12 --> 17:13you're recovering from cancer surgery.
17:13 --> 17:16But you know many, many patients, right?
17:16 --> 17:17You know, understandably,
17:17 --> 17:18take this, you know.
17:18 --> 17:20View they, they want to get back to normal.
17:20 --> 17:21Life as quickly as possible,
17:21 --> 17:22which I certainly sympathize with,
17:22 --> 17:24and I certainly don't like whenever
17:24 --> 17:26I feel limited for whatever reason.
17:26 --> 17:27But I try to get them to understand that
17:27 --> 17:29you know that they need to pay themselves,
17:29 --> 17:29right?
17:29 --> 17:30And that includes making sure
17:30 --> 17:32they get plenty of rest.
17:32 --> 17:33Plenty of sleep,
17:33 --> 17:34you know,
17:34 --> 17:35if they really want to get
17:35 --> 17:36back to where they were before
17:36 --> 17:39and the other thing that you mentioned
17:39 --> 17:41was having those social support,
17:41 --> 17:44you know making sure that that people were
17:44 --> 17:46around to to help you out with things.
17:46 --> 17:48Can you talk a little bit about that?
17:48 --> 17:50And also about.
17:50 --> 17:53Living conditions you had mentioned
17:53 --> 17:55that sometimes that really plays a role
17:55 --> 17:58in terms of the resources around you
17:58 --> 18:00to help you to take care of a wound.
18:00 --> 18:02Whether those are people,
18:02 --> 18:04resources or physical resources in
18:04 --> 18:07terms of your living environment.
18:07 --> 18:08Yes, actually, I'm glad you brought
18:08 --> 18:10that up nice because that is an
18:10 --> 18:12area where there hasn't been a lot
18:12 --> 18:14of research done and and that's
18:14 --> 18:17something that I've been working with.
18:17 --> 18:21My fellow clinicians at the Wound clinic.
18:21 --> 18:22To trying to better understand,
18:22 --> 18:25establish the impact of the patients
18:25 --> 18:27social situation you're living
18:27 --> 18:30circumstance on their ability to heal,
18:30 --> 18:33and it's it's particularly true for
18:33 --> 18:36patients who completely live on their
18:36 --> 18:38own and have you know no outside
18:38 --> 18:40you know contacts whatsoever you
18:40 --> 18:42know people who are checking in on
18:42 --> 18:44them other than maybe perhaps the
18:44 --> 18:46visiting nurses and so and then,
18:46 --> 18:48that's where I I feel fortunate
18:48 --> 18:50that you know with, you know.
18:50 --> 18:54Being part of the Smilo network that that
18:54 --> 18:57there are these resources that you know,
18:57 --> 18:58many of our patients can turn to.
18:58 --> 19:02Whether it's in terms of free care
19:02 --> 19:04or other support mechanisms that
19:04 --> 19:06that could help them, you know,
19:06 --> 19:07heal better, you know,
19:07 --> 19:08provide whatever they might need in order
19:08 --> 19:10to feel like they have that support.
19:10 --> 19:12Talk a little bit about,
19:12 --> 19:15you know when I'm thinking about the
19:15 --> 19:18the population who get Brett Cancer.
19:18 --> 19:20I I was about to say breast cancer
19:20 --> 19:21because that's my area of expertise.
19:21 --> 19:23At any cancer,
19:23 --> 19:26The thing is that it doesn't discriminate.
19:26 --> 19:28It can affect very wealthy people.
19:28 --> 19:30It can affect very poor people.
19:30 --> 19:32It can affect the person living
19:32 --> 19:35in a mansion in Greenwich.
19:35 --> 19:37It can affect somebody who
19:37 --> 19:39is homeless in New Haven.
19:39 --> 19:44So talk to us about how you tailor
19:44 --> 19:47your recommendations to people
19:47 --> 19:49in different circumstances,
19:49 --> 19:52because clearly that would make a difference.
19:52 --> 19:54In terms of how they're able to follow
19:54 --> 19:56through on the recommendations that
19:56 --> 19:58you have in terms of wound healing,
19:59 --> 20:01I know you're absolutely right and nice,
20:01 --> 20:03and I meant that's one of the greatest
20:03 --> 20:06challenges we face in our wound program.
20:06 --> 20:09You know, because many of the
20:09 --> 20:12dressings that we prefer that you know
20:12 --> 20:15are that might help optimize that.
20:15 --> 20:18That that balance between moisture and not,
20:18 --> 20:20but without too much moisture right there,
20:20 --> 20:21there are specialized
20:21 --> 20:23dressings that are very.
20:23 --> 20:24Good at doing that,
20:24 --> 20:26but they're much more expensive,
20:26 --> 20:30and while they are covered by insurance,
20:30 --> 20:31you know sometimes right.
20:31 --> 20:32As you mentioned there,
20:32 --> 20:34you know someone's homeless a lot of times.
20:34 --> 20:35They probably don't have that
20:35 --> 20:37insurance and and even with the
20:37 --> 20:38folks who do have insurance,
20:38 --> 20:41there's a limit to what will be
20:41 --> 20:43covered by in terms of supplies
20:43 --> 20:45and and so that could be very,
20:45 --> 20:47very difficult to tackle.
20:47 --> 20:50And so and So what we you know.
20:50 --> 20:53Again, I guess sort of similar.
20:53 --> 20:54Approaching like in terms of
20:54 --> 20:55what I mentioned with nutrition
20:55 --> 20:56and other aspects you know,
20:56 --> 20:59try not to do a one size fits all approach,
20:59 --> 21:01but instead trying to meet the patient
21:01 --> 21:05where they are so and it you know with.
21:05 --> 21:07If a patient is having difficult,
21:07 --> 21:09you know because of an insurance limiting.
21:09 --> 21:10You know that certain dressing,
21:10 --> 21:12then I'm willing to work with a
21:12 --> 21:14different type of dressing that you
21:14 --> 21:16know may you know it will be cheaper
21:16 --> 21:18and and might be more comfortable,
21:18 --> 21:19but hopefully we'll accomplish
21:19 --> 21:20the same thing.
21:20 --> 21:21Maybe they just need to change
21:21 --> 21:23it a little more frequently or
21:23 --> 21:24have a little more attention in
21:24 --> 21:26order to have the same effect.
21:26 --> 21:27In the worst case scenario,
21:27 --> 21:29like in someone who actually has no
21:29 --> 21:30resources whatsoever, they're homeless.
21:30 --> 21:31They don't have home,
21:31 --> 21:32they can't get any supplies.
21:32 --> 21:34Then we do have them come to
21:34 --> 21:35our wound clinic for their.
21:35 --> 21:36Wound changes I met.
21:36 --> 21:37It's something that can be
21:37 --> 21:38challenging from a logistics
21:38 --> 21:40standpoint because we are very busy,
21:40 --> 21:41but we'll we'll,
21:41 --> 21:42you know,
21:42 --> 21:44we fortunately have a very dedicated
21:44 --> 21:46wound nursing staff and they will
21:46 --> 21:47set up wound nurse visits to,
21:47 --> 21:48you know,
21:48 --> 21:50at least in the short term,
21:50 --> 21:52to make sure they get that care
21:52 --> 21:53while you know we work with the
21:53 --> 21:54hospital to figure out a good
21:55 --> 21:56social support system so that
21:56 --> 21:58they can get that care at home or
21:58 --> 21:59wherever they happen to be staying.
22:01 --> 22:04In terms of specialized things for wounds,
22:04 --> 22:06some of the things that you might
22:06 --> 22:08have patients ask you about,
22:08 --> 22:10and certainly things that are
22:10 --> 22:12popular in the lay media are
22:12 --> 22:14things like hyperbaric oxygen.
22:14 --> 22:16Can you talk a little bit
22:16 --> 22:18about that and it's value,
22:18 --> 22:20or or lack thereof in terms of wound healing?
22:21 --> 22:23Well so you know full disclaimer.
22:23 --> 22:27Our our wound program doesn't have a
22:27 --> 22:30hyperbaric chamber in our New Haven clinic,
22:30 --> 22:33and that's, you know more for these
22:33 --> 22:34logistical and space reasons.
22:34 --> 22:35Which is, you know,
22:35 --> 22:36too long and boring to go into,
22:36 --> 22:39but we do have chambers at our
22:39 --> 22:41sister wound clinics in Greenwich,
22:41 --> 22:44Bridgeport, Lawrence Memorial and
22:44 --> 22:47and the literature does support,
22:47 --> 22:50you know, does say that it has
22:50 --> 22:52an adjunct role in in specific.
22:52 --> 22:53Circumstances.
22:53 --> 22:58So, for instance, diabetic foot wounds.
22:58 --> 23:00Wounds that are due to radiation,
23:00 --> 23:03or if there's osteomyelitis involved,
23:03 --> 23:06so at least literature is fairly
23:06 --> 23:09strong in in supporting those and
23:09 --> 23:13and so when I have patients who are,
23:13 --> 23:13you know,
23:13 --> 23:14fit those circumstances and and
23:14 --> 23:16if they you know geographically
23:16 --> 23:18if it's convenient for them to go
23:18 --> 23:20to one of our sister programs.
23:20 --> 23:21And I I will refer them down
23:21 --> 23:23there to be evaluated to see if
23:23 --> 23:25they will be eligible for that,
23:25 --> 23:28but I mean it is a controversial.
23:28 --> 23:30Area because of certainly you know,
23:30 --> 23:32not every wound response
23:32 --> 23:33to hyperbaric oxygen,
23:33 --> 23:35no matter how well they seem to
23:35 --> 23:38fit the criteria and and I I mean,
23:38 --> 23:40I've been able to get wounds
23:40 --> 23:41heal without hyperbaric oxygen
23:41 --> 23:42that might otherwise,
23:42 --> 23:45you know fulfill that and I think
23:45 --> 23:47we're hyperbaric auction is helpful.
23:47 --> 23:48Is that it?
23:48 --> 23:50I think it can help speed up
23:50 --> 23:51the process in certain patients,
23:51 --> 23:54but it is challenging to figure out
23:54 --> 23:56exactly who will respond to that.
23:58 --> 24:01What about certain types of
24:01 --> 24:03complementary or alternative therapies?
24:03 --> 24:05That's often something that many
24:05 --> 24:07patients are really interested in.
24:07 --> 24:09Whether it's you know,
24:09 --> 24:11a potion or a save,
24:11 --> 24:13or whether it's a cocktail
24:13 --> 24:15of vitamins and supplements,
24:15 --> 24:17tell us a little bit more
24:17 --> 24:18about the science behind any
24:18 --> 24:20of those and wound healing.
24:22 --> 24:24Well, I guess you can say in in general.
24:24 --> 24:27In broad terms, there isn't a whole lot
24:27 --> 24:30of science among many of these treatments
24:30 --> 24:33that are at least touted right that are.
24:33 --> 24:36You know, kind of the equivalent of milk
24:36 --> 24:38miracle grow for for your wound, right?
24:38 --> 24:41And so the way I talk to patients
24:41 --> 24:42about it just says, you know,
24:42 --> 24:44they're in gardening, right?
24:44 --> 24:45I guess I I do lean heavily
24:45 --> 24:46on the gardening analogy,
24:46 --> 24:48just as in gardening.
24:48 --> 24:51You know there is no substitute for
24:51 --> 24:53the basics in terms of making sure
24:53 --> 24:55your your garden can thrive, right?
24:55 --> 24:57Doesn't matter what special fertilizer
24:57 --> 24:59you use you you're not going to get
24:59 --> 25:01your garden to thrive unless you
25:01 --> 25:03have the basics in terms of sunlight.
25:03 --> 25:04The right soil,
25:04 --> 25:06you know the right amount of water,
25:06 --> 25:08the right environment, right?
25:08 --> 25:10I say the same thing.
25:10 --> 25:13You know I do Council caution and if it's
25:13 --> 25:15something like some kind of you know,
25:15 --> 25:16as you mentioned,
25:16 --> 25:18a potion because many things
25:18 --> 25:20that like supplements that are,
25:20 --> 25:24you know, touted as natural right?
25:24 --> 25:26And and by implication of supposedly
25:26 --> 25:28beneficial or good for you,
25:28 --> 25:29I do mention that you know there
25:29 --> 25:30are many natural substances that
25:30 --> 25:32actually can inhibit healing,
25:32 --> 25:35just like the way steroids as drugs,
25:35 --> 25:37which are, you know.
25:37 --> 25:39Come in natural forms as well as
25:39 --> 25:41synthetic forms that they can slow healing.
25:41 --> 25:44So too can many of these so called
25:44 --> 25:46natural additives and substances.
25:46 --> 25:49In many of these.
25:49 --> 25:51Treatments that are available out there,
25:51 --> 25:53so I again,
25:53 --> 25:57I you know I try not to be a a pro.
25:57 --> 26:00You know I try not to completely
26:00 --> 26:01prohibit things, right?
26:01 --> 26:03I tell patients that you know.
26:03 --> 26:05If you know I asked him to to
26:05 --> 26:06communicate with me, to share with me.
26:06 --> 26:07You know, if they know what's in it,
26:07 --> 26:09let me know first before they try
26:09 --> 26:12something and I'll do my best to look at.
26:12 --> 26:14And if there's something you know,
26:14 --> 26:15if there's nothing in there
26:15 --> 26:16that's obviously harmful, right?
26:16 --> 26:17If it's just a,
26:17 --> 26:19you know several different vitamins.
26:19 --> 26:21And and and things that I don't where
26:21 --> 26:23I don't see a clear red flag that
26:23 --> 26:25might be harmful in terms of healing.
26:25 --> 26:29Then I generally let you know I work.
26:29 --> 26:30I work with the patients too, you know,
26:30 --> 26:31especially makes them feel better.
26:31 --> 26:35But yeah, I do. I do tend to counsel caution.
26:35 --> 26:36I tell them to be very careful and be very,
26:36 --> 26:37you know,
26:37 --> 26:38a very careful about what they
26:38 --> 26:39hear about and ads out there.
26:40 --> 26:42And then there's the whole
26:42 --> 26:44issue of a cancer treatment.
26:44 --> 26:47So you know, we've been talking a
26:47 --> 26:49lot about wounds and and people,
26:49 --> 26:50generally speaking.
26:50 --> 26:52Think about wounds after surgery,
26:52 --> 26:55but many patients require other treatments
26:55 --> 26:58such as chemotherapy or radiation,
26:58 --> 27:00which if you already have a
27:00 --> 27:01wound that's not healing,
27:01 --> 27:04might inhibit that wound from
27:04 --> 27:05healing even further.
27:05 --> 27:08So can you talk a little bit about
27:08 --> 27:11how you kind of do this dance between
27:11 --> 27:14getting a wound to heal before
27:14 --> 27:18giving a therapy that might inhibit
27:18 --> 27:20wound healing versus delaying?
27:20 --> 27:22Really important cancer treatment?
27:22 --> 27:24Because you've got a wound
27:24 --> 27:26that's not healing.
27:26 --> 27:28Yeah, so I think this is where
27:28 --> 27:29communication with your fellow
27:29 --> 27:31providers is extremely important.
27:31 --> 27:34So I I try to again I I don't
27:34 --> 27:36try to be the oncologist right?
27:36 --> 27:38I'm not treating anything cancer itself,
27:38 --> 27:40so I don't consider myself an expert in that.
27:40 --> 27:43And so I I do my best
27:43 --> 27:44to communicate directly,
27:44 --> 27:48to educate myself in terms of you know how,
27:48 --> 27:51how severe is this tumor if you know?
27:51 --> 27:53Obviously that's always a priority.
27:53 --> 27:54So if it's something that needs
27:54 --> 27:57to be treated right away, then.
27:57 --> 27:59Then the wound healing
27:59 --> 28:00considerations become secondary.
28:00 --> 28:03But if if there is something about the
28:03 --> 28:05biology of tumor that allows a delay,
28:05 --> 28:08then then of course then then I'll
28:08 --> 28:10do my best to try to set up all the
28:10 --> 28:13circumstances you know in terms of nutrition,
28:13 --> 28:15you know. Counseling the patient to,
28:15 --> 28:17or sometimes you know I'm a plastic surgeon,
28:17 --> 28:19so sometimes I will, you know,
28:19 --> 28:22try to do a direct revision and
28:22 --> 28:24closure of the wound.
28:24 --> 28:26If it feels that you know we
28:26 --> 28:27can get that healed in a.
28:27 --> 28:28Fast enough,
28:28 --> 28:29short enough period of time
28:29 --> 28:30to allow that patient.
28:30 --> 28:32Get that therapy sooner rather than later.
28:32 --> 28:34Doctor Henry Hsia is an associate
28:34 --> 28:36professor of surgery and plastic
28:36 --> 28:39surgery at the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week
28:51 --> 28:53to learn more about the fight
28:53 --> 28:54against cancer here on Connecticut
28:54 --> 28:56Public radio funding for Yale
28:56 --> 28:57Cancer Answers is provided by
28:57 --> 28:59Smilow Cancer hospital

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June 19, 2022

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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