I’ve been talking about how I use IMPACT® in surgical patients who are nutritionally at risk. This is the second patient I tried the approach on. She’s a very beautiful, 33-year-old, previously healthy young woman who developed sepsis with cardiogenic shock and was in the intensive care unit for 3 weeks. She was hypotensive a lot of the time, and unfortunately developed severe pressure injuries to the left heel and lateral foot. She’d only been out of the ICU for 8 weeks when I first saw her in the Wound Clinic. Her calcaneus was exposed under a thick eschar, and tendons were exposed on the lateral foot. She clearly had a limb-threatening lesion, and it was hard to break it to her that she needed to go back in the hospital for a big operation. I didn’t have the heart to tell her that it might be a below the knee amputation.

I used skin perfusion pressure to confirm that her arterial supply was adequate, and immediately started her on IMPACT®, an immunonutrition supplement containing L-arginine, omega-3 fatty acids and nucleotides designed to help meet the nutrient needs of major surgical patients. Nestle donated a month supply and she took it faithfully, 2 cartons a day for a month. That’s about all I could do for her since the problem was clearly a surgical one. I referred her to Dr. Efthymios Gkotsoulias, who saved her foot. It was still healed in follow up 4 months later after she’d begun walking on it.

The first time I saw her foot, my heart sank, so when she came by to show me how well she could walk in her brace, I could have cried for joy. I can’t prove that IMPACT® is what made the difference (I mean, she had a great surgeon and she’s an amazing person) but the odds had not been in her favor. I think IMPACT® evened the score.

I’ll provide more detail later about how we’ve protocolized the use of Impact and other nutritional supplements.

If you are a healthcare professional, Nestle’s Medical Hub has excellent educational resources on nutrition and supplementation. Find it here: