by Caroline Fife, M.D. | Apr 30, 2021 | Do the Right Thing: Thoughts on Quality, Fight the Good Fight, Nutrition & Wound Healing
This is a 35 y.o. woman with type 1 Diabetes, liver disease and end stage renal disease on home peritoneal dialysis after failed renal and liver transplants. She also has other wounds on her body due to pressure and ischemia. The abdominal wound had been present for 9...
by Caroline Fife, M.D. | Apr 14, 2021 | Do the Right Thing: Thoughts on Quality, Fight the Good Fight, Nutrition & Wound Healing, US Wound Registry
This is a young man in his 20’s who is a quadraplegic and suffered a bowel obstruction about 6 months before this photograph was taken. The midline abdominal wound is granulated, but still hasn’t epithelialized. Why? There’s no pressure over this area and it doesn’t...
by Caroline Fife, M.D. | Mar 30, 2021 | Fight the Good Fight, Health Information Technology and Wound Care, Nutrition & Wound Healing
There’s increasing interest in Vitamin D. I became focused on this after a series of patients who failed to heal operative wounds. I found their Vitamin D-OH levels were in the teens (in some cases, single digits) when 30 is the lowest value we want for wound healing....
by Caroline Fife, M.D. | Dec 11, 2020 | COVID-19, Nutrition & Wound Healing
I’ve talked a lot about the importance of having a Vitamin-D-OH level of at least 30 ng/ml for wound healing. The majority of my patients with non-healing wounds have Vitamin D-OH levels less than 30 ng/ml, even though most of them are taking supplemental vitamin D....
by Caroline Fife, M.D. | May 27, 2020 | COVID-19, Do the Right Thing: Thoughts on Quality, Fight the Good Fight, Nutrition & Wound Healing, Skin Perfusion Pressure (SPP)
If you are a wound management practitioner, then like me, you’ve continued to care for patients during the pandemic. It wasn’t easy before COVID-19 and it’s even harder now. My clinic is only able to see half the volume (due to the time required for COVID-19...
by Caroline Fife, M.D. | Aug 2, 2019 | Don't Miss This, Nutrition & Wound Healing
Fifty years ago I stayed up late with my grandfather to watch the Apollo 11 astronauts land on the moon. We sat riveted, watching grainy images on a tiny black and white television set, marveling at how far technology had advanced. In the 1960s, my father was an...
by Caroline Fife, M.D. | Jul 25, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Nutrition & Wound Healing
This month in TWC, learn about the history of total parenteral nutrition and how the Space Race of the 1960’s helped patients with malabsorption. I explain why QCDR quality measures have been a disappointment for all specialties, why Practice Improvement Activities...
by Caroline Fife, M.D. | Mar 11, 2019 | Fight the Good Fight, Health Information Technology and Wound Care, Nutrition & Wound Healing
84 year old man with a history of lymphoma but is purportedly disease free. Severe peripheral edema began 2 years ago. He says he developed this very large ulcer after minor trauma. His skin perfusion pressure is normal (68 mmHg), he has a biphasic PVR and strong DP...
by Caroline Fife, M.D. | Oct 3, 2018 | Fight the Good Fight, Health Information Technology and Wound Care, Nutrition & Wound Healing, Quality Payment Program
What scares me is the fact that I didn’t really pay attention to this until I started developing quality measures for wound care. But now that I’m paying attention, the extent of it is terrifying. In one day I saw three patients who were starving, two of whom had on...
by Caroline Fife, M.D. | May 23, 2018 | Fight the Good Fight, Health Information Technology and Wound Care, Nutrition & Wound Healing
On Saturday May 19th I joined Drs. Jay Shah, Noel Oliveira and Rafael Rafols at the Texas Medical Association (TMA) meeting in San Antonio, Texas for the first ever wound care CME event at a TMA meeting. We focused on wound care for the primary care physician, and it...
