What you put IN the patient may be as important as what you put ON them

I have been focusing more on nutrition with my patients. Nutrition support and correction of nutritional deficiencies is critical to wound healing.  Arginine, a conditionally essential amino acid, serves as a substrate for protein synthesis, and is a precursor to nitric oxide (NO) and proline production–all of which play a role in wound healing.
A few years ago I learned about the benefit of Arginine with an 84 year old woman who was bedbound with dementia but being cared for lovingly at home by her daughters. He had developed a very large sacral pressure sore that went to the bone and was about the size of a salad plate. She had a lot of unintentional weight loss and an Albumin of 2.3 g/dL.
I suggested her family supplement her with Arginaid®, which they initiated December. Her wound began to granulate and close. They ran out of Arginaid® in late June and the wound began to get worse again. I had the family restart it in August because by then she was also developing a deep tissue injury on the calf and small lesions on her hands and feet. The smaller ulcers resolved quickly and the large sacral ulcer healed by the following May.
Here’s a graph that plots her course on and off Arginaid:
Case 3.2
Join me for a breakfast symposium about the role of nutrition in wound healing on Saturday September 9, at the upcoming APWCA meeting. I will be discussing how practitioners can avoid losing 4% of their Medicare Part B payments by performing a Clinical Practice Improvement Activity (IA) focused on nutritional screening of patients with wounds, and prescribing appropriate supplements.
Arginaid® can be hard to find, but patients can order it to be sent directly to their home at DirectPatient: https://directpatient.com/nutrition