Case Studies

 

Case Study #1:

Mr. S is a 62-year-old man with a 20-year history of diabetes
mellitus. During the cold winter season, he noticed that the skin
on the sole of his foot was cracking, a condition he attributed to
extremely dry indoor air. Over several weeks, he developed a severely inflamed and necrotic plantar sore on his right foot. His general physician referred him to a wound care center, where the lesion was debrided, and Mr. S. was given instruction to care for his wound.

Unfortunately, the ulcer worsened and was complicated by osteomyelitis, which required repeated antibiotic treatments. After 7  months, the wound care team recommended Mr. S for another surgical debridement, which resulted in a wound 6 cm long, 5 cm wide, and 2.5 cm deep. Mr. S was directed to clean the wound and change the dressings daily, take an oral antibiotic (levofloxacin), and follow his usual diabetic diet. Despite careful attention to wound care and nutrition, Mr. S could not control his blood glucose levels, the foot ulcer failed to heal, and osteomyelitis persisted.

On return to the clinic, the wound care team recommended that Mr. S have hyperbaric oxygen therapy, a consulting surgeon recommended a below-the-knee amputation, and a wound care nutritionist recommended a trial with Abound medical nutrition therapy. Mr. S opted to try Abound first. For the next 2 months, he added 2 packets of Abound to his daily diet.  Typically he mixed one pack of Abound powder with 8 to 10 fl oz of cold water. He had one serving of Abound at 7:30 AM and another at 6:30 PM. Each Abound serving was counted as ½ starch or carbohydrate exchange. 
 
On a follow-up visit to the wound care center, Mr. S reported that he felt stronger and more energetic.  He noted that his foot ulcer appeared to be healing. On examination, the wound had closed, and the ulcer surface has diminished to 3.8 cm long and 1.2 cm wide. Because of this satisfactory ulcer healing, the wound care team decided that neither surgery nor hyperbaric therapy was needed.

 

Case Study #2:

Mrs. B is an 84 year-old woman with diabetes and Alzheimer’s disease; she resided in a facility for skilled nursing care. During the summer, she developed multiple pressure ulcers, including a severe Stage IV wound, on her right gluteal fold.
 
Due to the severity of her condition, Mrs. B was limited to bed, and a Foley catheter was placed. Mrs. B’s initial treatment course involved routine wound care, a specialty mattress, protein powder supplement, and vitamin C, zinc, and multi-vitamins. She received oral food but only finished 50 to 75% of the meals, so she was also given high-calorie liquid medical nutrition supplements.

Mrs. B’s routine was maintained for 6 months. During that time, she made several trips to a wound care center for debridement and medication adjustments. Despite these efforts, the Stage IV wound did not heal, and Mrs. B experienced an overall decline in her health status.
 
In January, Mrs. B was transferred to hospice care with comfort measures only.

After another 7 months, Mrs. B’s health status was sufficiently stable for her return to the skilled nursing care facility. In October, 14 months after her pressure ulcer was first documented, Abound medical nutrition treatment was initiated as 2 servings per day. She was continued on the specialty mattress, protein powder supplement, and vitamin C, zinc, and multi-vitamins. Her Foley catheter remained in place.
 
Just 10 weeks after Abound was added to Mrs. B’s treatment regimen, her Stage IV wound was completely closed. The catheter was removed, and the specialty mattress was no longer needed.  Mrs. B was able to get out of bed and walk.