Let's Talk Tootsies!

Jordan Achterhoff, Spencer Hospital Wound Care Clinic Director, joins us to talk about feet!  Foot health is very important to a person's overall health.  Learn more about how to care for your feet and what to watch for that might cause issues down the road.

Transcript

SPEAKER_00 0:02

Hi, I'm Rebecca and I just want to welcome everyone to Spencer Hospital Health Talk. We are delighted that you're joining us again today. And as the weather is getting nicer out, it's time to start thinking about our Tootsies just a bit because we will be out and about showing them off in this beautiful weather. And I have a wonderful person here today to talk to me about foot health. Jordan Achterhoff is our director of the Spencer Hospital Wound Care Clinic. Welcome, Jordan. Thank you. Thank you for having me. This is so exciting. This is very exciting. And to be able to talk about feet.

SPEAKER_01 0:34

That's like most people's favorite topic. Everybody loves to talk about feet, and everybody loves when we bring out the toenail clinic. Oh well, that's coming up later.

SPEAKER_00 0:42

So don't give too much away right now. All right, I'll wait. Now, Jordan, before we really get going, just tell us a little bit about the wound care clinic and some of the things that are happening there because a lot of people don't realize just how much is happening in the wound care clinic and how much Spencer Hospital has to offer through that.

SPEAKER_01 0:58

Yeah. So I think that Spencer Hospital has one of the most outstanding wound care clinics in the region. We have a comprehensive five-day a week, 8 to 430 wound care center. So we have two WOC nurses, which is wound OSMI Continence Nurses. So they are certified in their specialty. And we have a certified nurse practitioner that works with us five days a week. So in our wound care center, you're not just seeing a nurse, you're actually seeing a nurse practitioner as well. And then on top of all that, we actually are lucky enough to have two of our general surgeons here in town actually work in our center as well. So Dr. Slattery and Dr. Helmick are our medical directors. And once a week on Wednesday morning, they practice in the clinic as well. So to be able to have that expertise from our nursing staff to our nurse practitioner all the way to a general surgeon really puts us like above and beyond what a lot of wood care centers in the region can offer.

SPEAKER_00 1:49

That's amazing. Thank you so much for all you and the team do there. Now let's get to the topic at hand today. Feet. Yes. Yes. So to start with, why is foot health so important to overall health, especially as we age or manage chronic conditions?

SPEAKER_01 2:05

I think foot health is really like from what we see in the woodcare center, it can stem a lot of other things in the body. So when it's our foundation, really you work from the feet up, and so do our clinicians in the clinic. So we see people come in with ulcerations on their feet, whether that be from their vascular status or their diabetic status. And so our clinicians are really good at examining those feet and telling our patients exactly how to properly care for them. And we see patients that come in, like even for toenail clinic, and they're here for their trim or for their toenails to be trimmed, and really we can find something else going on, and then we can treat further than just toenail clinic, and we can take them into our wood care center and actually treat them for like that ulceration that we might find. And so when it comes to your overall health, keeping those feet healthy, clean, making sure our vascular status is intact when the patient comes in really leads to a lot of different things, like even your cardiovascular health. You know, if we have poor circulation in our feet or our lower legs, that can stem a lot of other difficulties in the rest of our body. So we're really good at identifying that and locating and even referring out to different specialties. Like we work really closely with ovascular surgeons, and we have a couple that come here at our outreach clinic at Spencer Hospital too. And it's been really nice to have that relationship with them. They do their job, we do our job, and we could collectively like work together and collaborate for the betterment of the patient.

SPEAKER_00 3:30

And people can have that all done right here close to home.

SPEAKER_01 3:32

Yeah, which is great. And actually, what's even more special is our wound care clinic and our outreach clinic actually sit right in the same hallway. So a patient can see your wound care nurse practitioner, and she says, I think we need to get ABIs or we need to get vascular testing. We have our car or our vascular surgeon here tomorrow. You're gonna come right back here and see your vascular surgeon. So we really can stay close to home to get that care.

SPEAKER_00 3:57

That's incredible. Okay, now many people do overlook their feet. Yeah, it's far enough away from our eyes that we just don't even think about it. So, what are some early warning signs that someone should not ignore? Yeah, and the feet as and right now my toes are blue. That's great. But it's because of the finger or the toenail polish that I selected. That's good. Yeah. Okay, yeah.

SPEAKER_01 4:19

So as we get older, one of the difficulties that we our patients express is it's just really difficult for me to bend over and to to look at my own feet. And we understand that. And so we always tell patients if you have a family member or a friend that can kind of examine your feet, especially if you know you have a vascular, you know, vascular problem where your feet are cold, we have less hair on the bottom of our feet or on our legs, we can tell we have some vascular problems in our in our lower legs. So having a friend or family member kind of examine, making sure that our nails are not cracked yellow, making sure that we have no open sores or the start of a sore in the bottom of our feet. So if we're having a lot of callus buildup or redness that we're seeking, you know, either your primary care provider is a great place to start, or just seeking out our toenail clinic and having somebody examine you as well. And then just making sure that if you don't have that support, one thing we teach our patients is a simple mirror. You can take a mirror, try to get your your foot crossed as much as you can, and then use that mirror to look at the bottom of your foot and you can see, and it's really important as well, just for people at home, check between your toes, make sure you're wearing socks. We don't like people to go barefoot. It gives you a chance to barefoot right now. Don't but you have shoes on shoes on, that's true. So wearing socks with our shoes because it helps that moisture not build up, and that moisture can create some ulcerations on our feet. Making sure we're keeping them really clean, just basic soap and water is all you need to keep your feet clean. Wearing socks, wearing really well-fitted shoes, going to a shoe store and having an expert help you pick out shoes, or going to maybe your podiatrist if you're diabetic, and having them refer you to somebody to get a special diabetic shoe is really important because ill proper footwear is one of the reasons we see some ulceration start on the feet. And then the thing to remember with diabetics is that once you get that ulceration, it's really difficult to actually get them to heal. It can be difficult to do it. So proper nutrition is always really important. You know, eating lots of good foods, lots of fresh vegetables, fresh fruit, a lot of really good protein sources. That protein helps our body heal. And then another thing that, you know, we always say is like as much smoking sensation as you can give yourself, we're helping our body as well with not smoking a lot. Yeah, smoking's just bad for everything. Yeah, including your feet. Including your feet. Don't do it because you're decreasing the amount of oxygen oxygenation that we're giving our body by smoking, and we need that extra oxygen to help our body heal.

SPEAKER_00 6:58

Very good advice. Okay, now what are some of the most common foot-related issues that you guys, your team, is seeing in the wound care clinic?

SPEAKER_01 7:06

Well, I would say those diabetic foot ulcers are really common, and we see a lot of VLUs. Like I said, it's that vascular status, and then the big fancy terms. We see a good amount of osteomyelitis.

SPEAKER_00 7:20

Thank you for bringing the fancy terms in today.

SPEAKER_01 7:22

I really appreciate that. Which is basically just when a patient has that ulceration and it's become an infection that has reached the bone. And that's really where you need to seek the wound care center because we have those advanced modalities like how to preparic oxygen therapy that can help fight that. And so the the amount of things that we have in our clinic to help patients overcome these things is is what sets us apart from other clinics as well.

SPEAKER_00 7:46

Now I feel like the advice you've given is really for everyone. Just yeah, watch your feet, look for certain things. But are there certain populations? And you've kind of touched on people with diabetes, maybe also, who are at higher risk for certain like serious foot complications.

SPEAKER_01 8:00

Yep. Basically, it it's anybody that as you're getting older, we might have complications with our feet, right? And so, especially that diabetic status, if you're a smoker, I would pay very close attention to your feet. That was where when some of the ulcerations would start. Proper nutrition really builds our bodies up. And so I guess the more poorer your diet, the more at risk you could be as well, which is nice because another thing in our wound care center is we do have our diabetic education team right within our wound care center as well.

SPEAKER_00 8:32

Oh that's helpful.

SPEAKER_01 8:33

You have somebody come in and our nurse practitioner evaluates their ANC and says, I need I think that you know, we could get you some diabetic education, she can get that referral started as well. So you can have just a really good, full functioning team when you come see the wound care team as well.

SPEAKER_00 8:48

That's incredible. Now, how can proper foot care help prevent wounds or infections in the first place?

SPEAKER_01 8:55

Yeah, just making sure they're not there. So, like I said, once you get that big ulceration, it's really difficult to get them healed. So if you notice, like I just have a skin tear coming in right away, getting it dealt with right away is your best protection on making and not it not getting as severe. So I would say early detection is your best bet.

SPEAKER_00 9:13

Now, at what point should somebody, you know, they look at their foot, they use your trick to see, like with the mirror on the bottom, and they're like, oh, I noticed something's a little bit off. At what point should they seek professional care and not not try to care for it at home anymore, but have somebody else take a look at it?

SPEAKER_01 9:29

I think as as soon as you can, especially when it comes to your feet, get in there right away. Get in there right away, and especially if you think there's their signs of infection. So if you feel like increased warmth in your foot or the skin is starting to get really red, uh, preventing infection is really important. And whether that's going to your primary care provider, because we have such a good relationship with our doctors here at Spencer Hospital and they know when and how to utilize the wound care team, you know, they can send you to us when they think that it's warranted as well. But getting in just to seek professional help right away.

SPEAKER_00 10:00

Okay. Well, that's great advice. Now, can you explain some of the types of treatments that are done, like when somebody comes in and they need care with their feet? Like, what is that? What does that mean? How do you care for them? Yeah. What are you able to do differently than they might be able to do at home or even in their primary care provider?

SPEAKER_01 10:18

I think it's just the the training that our wood care team has had. So to remember that they're certified wood care experts. Like they have a different specialty than just beyond their nursing degree. They've gone and got that extra training. Some different modalities that we have within the center, total contact casting is what we consider the gold standard for a diabetic foot ulcer. The reason for that is ulcerations. We want to get the feet up. We want to offload some of that pressure that we're putting on the feet. So this is truly a cast that we couldn't put on patients and they walk around with the cast for a few weeks. But like I said, it is a gold standard, so it helps that ulceration heal. Pressure off of the wound so it can truly heal. Yeah. And we have all those materials here in-house. Our nurse practitioner, the surgeon, whoever sees you, they evaluate you, they recommend you for it. We do the prior authorization, all that good stuff. So total contact cast. We also have a system called an Ultramus system. And what that is, is it's a debreedment system, big fancy machine. It's not even big, it's like this big. It's a fancy machine, and it is actually two debreed wounds. It's an ultrasonic wave that hits the wound bed. So it really cleans that wound up without having a traditional debreedment done. So a curette or a scalpel. So if a patient is really sensitive to a debreedment, we can try to qualify them for the ultra mist therapy. And it's three times a week, and they come in and it's saline that we shoot through, like a little wand, it looks like, and it hits the wound bed and it just cleans it out really good. It gets all that bad tissue out to let the good tissue heal.

SPEAKER_00 11:49

Heal faster. Yeah.

SPEAKER_01 11:50

And so we've had really good success with that as well. Like I said, we would do the prior authorization, make sure insurance covers it. So we have that modality. We have, you know, your classic modality is like debreedment. And you know, you come in to see the wound care team. Typically, we need to debreed that wound, kind of get that bad tissue off to allow the healthy cells and the healthy tissue to kind of grow on that wound bed. So no matter when you're with us, you're probably getting what we call cleaned up with our wound care team, but that's why you come see us. So we can really make sure that that wound bed is really set up nicely for when you're out of the clinic to get those products that we prescribe you to absorb in there and get it healed.

SPEAKER_00 12:28

Oh, wow. Okay, let's uh let's move on to the toenail clinic. Yeah, it's our favorite. Yeah, it really is. So, what are some of the services that are provided through the toenail clinic and who can benefit from a visit?

SPEAKER_01 12:42

Everybody, everybody can come see us. The best thing about the toenail clinic is you have certified nurses that are actually treating your nails. So now when you say treating your nails, what does a typical visit to the toenail clinic all entail? So it entails we have nail nippers, which is like a basic nail clipper. Okay. They're more high-tech, they're a little fancier, right? We got the surgery ones, and then we have a Dremel. So a lot of patients will come to us and they have thicker nails. As we get older, our nails tend to get thicker and thicker. And so sometimes patients don't necessarily need them trimmed, they just need them filed down. Okay. So we have a nice machine called a Dremel that can actually file those nails down a little bit thinner so they're just not as thick and uncomfortable because sometimes our nails can get so uncomfortable and start to rub on other toes, which we know we want to create less pressure on our toes so we don't get cuts or scrapes on them. So they will trim them, they will file them down, they will just evaluate your your foot as well to make sure that you're not missing anything. And we've had patients come in and they're there for toenail clinic, and then all of a sudden we find something and we're like, hey, we actually would need to treat you for this wound that we found on your foot. So any patient that comes to us, you're getting that full, well-rounded care on your feet and making sure that there's nothing else going on. And then we, of course, we don't paint them.

SPEAKER_00 13:59

Okay. We don't, not yet. Maybe someday. You just you just let people enjoy it the natural look of a healthy nail. Healthy nail. We like healthy. That's good. That's good. But we do that's still a nail that somebody would want to show off with their get those tootsies out there.

SPEAKER_01 14:13

We do put lotion on you. Okay. Give you a nice, like get your feet all moisturized, all that good stuff. I would say the the nurses at work in our center are just fantastic. And we have people that come back and reschedule with us now. Like we've been doing toenail clinic for three years, I believe. And some of the same patients that were the first patients in are continually come back every eight to 12 weeks to see us. So great. Yeah.

SPEAKER_00 14:38

So how often are we doing a toenail clinic?

SPEAKER_01 14:40

We actually spenser hospital. Yeah, when we first started, we were doing it once a month, and it's become so popular that we do it once a week now. Yeah. Oh wow. It is, it's fantastic. Whether you're diabetic or not diabetic, you don't have to be diabetic. You just want your nails done by somebody professional of coming to see us. We how does the payment for that work? The payment works. So insurance is not accepted for a toenail trimming. So we do it's a cash and carry service, so it's $60 at the time of service.

SPEAKER_00 15:06

And so, and but it's really more than just trimming your nails. Yeah, you get you're having it done by a nurse and your feet are getting assessed.

SPEAKER_01 15:12

And so and you get a full hour with your nurse. You know, they can sometimes get it done quicker than an hour, but you're getting that time with your nurse to make sure that everything looks good.

SPEAKER_00 15:20

That seems like a really great opportunity just for kind of a touch point, a check-in to make sure that your feet are healthy overall.

SPEAKER_01 15:27

Yeah. And so people just love to come in and talk to our nursing staff. We have a great nurse that will talk to you about her goats.

SPEAKER_00 15:33

So it's entertaining. Oh my god, I've never even gotten any goat stories. I'll have to come over. Okay, so for individuals who may have difficulty trimming their own toenails safely, how does a toenail clinic help prevent complications? Just keeping those nails short. Keeping them at the right length.

SPEAKER_01 15:50

And it's important to know how to trim your nails as simple as it might seem. We want to prevent ingrown toenails so we know how to trim them properly, that we're gonna prevent an ingrown toenail from happening, or you know, some of that other fungus and different things like that, which I will say for our toenail clinic, ingrow toenails or maybe fungus on the nails, that we still keep to our podiatry office and we let them be the masters of that. So if you have an ingrowed toenail that you're dealing with, or you think there's fungus, we still would like you to see our wonderful podiatrist at North Osho Bone and Joy to because that's their specialty.

SPEAKER_00 16:25

Oh, that's great. So this is really the toenail clinic, it's about more than just vanity. It's really about just like that great foundation, good foot health. Yep. Okay, I appreciate that. Thanks for your team and all they do there. Now, what are some simple everyday foot care tips that people can follow to keep their feet healthy?

SPEAKER_01 16:43

Good shoes, soap and water, washing them every day with soap and water, keeping them dry, limit the moisture in there. Good shoes again, you know, no flat shoes, no flip-flops. Flip-flops, as we're going into summer, flip-flops are terrible for your feet. They're bad. Keeping those nails, you know, trimmed up and just checking them every day, making sure they look good. That's great.

SPEAKER_00 17:06

Let's see. Okay, Dr. Blankers and Dr. Ivy from Northwest Iowa Bone, Joint Sports Surgeons, uh, Department of Spencer Hospital offer podiatry services. What kind of conditions can they help treat right here at Spencer Hospital?

SPEAKER_01 17:19

They do a wide range of services. And like I said, like when it comes to like ingrown toenails, even they treat diabetic foot ulcers. And what I really love about our podiatry team at Northwest South Bone and Joint is how good of a relationship we have with them as well, because we share a load of patients as well. So they will walk right up to the center and talk with our practitioner Kayla about a patient and kind of bounce ideas off of each other and like, hey, I want to do this, I want to do this, you know, what's best for the patient. So the collaboration we have with them is really, really great. And they do a wide variety of different things at Northwest Silobone enjoy too, beyond just wound care.

SPEAKER_00 17:57

Yeah. And then they offer also offer surgical services as well.

SPEAKER_01 18:00

Yep. Yep. So if we have a patient that we think needs like a call it a surgical debridement, we need to take them to the OR to get cleaned out. Those are our two podiatrists that we reach out to. And like I said, it's just a great working relationship that we have with them.

SPEAKER_00 18:12

And they're just wonderful doctors. So it's great to have them right here. Yeah. And easy to get in touch with them should you need any foot care specialists. Yep, just call down to their clinic and and ask for them and talk with their scheduler and they get you in with them. That is awesome. Okay, if someone is experiencing ongoing foot pain or concerns, what's the best way to get connected with the right services here at Spencer Hospital?

SPEAKER_01 18:34

I would always start with your primary care provider as well. And like I said, that relationship is so great that they know exactly when to refer to wound care. So reaching out to your primary care provider and let them kind of be the champion of what's going on. And if they find a wound that you need an advanced modality for, that's when they'll send you our way.

SPEAKER_00 18:51

That's awesome. Thank you so much. Now, I added a bonus question. Oh goodness. You're not prepared for this. Oh, this is exciting. Are you excited? Yeah. Are you a little nervous? A little bit. Okay. Well, this bonus question is how I like to end most of our interviews. I like to ask all of our guests to offer one healthy living tip. So something that you would share with your friends, family, loved ones, some inside advice that you would give them so that they can live a healthier life. Walking.

SPEAKER_01 19:18

It's the simplest thing we can do. Even me who crazy life, two kiddos chasing around, lunchtime, 15 minutes. As it gets really nice outside, especially here at the hospital, we see people using our walking paths all the time. It doesn't have to be much, but after working with the wound care team for so long and working with our diabetic education team, the biggest tip that I can give people is like, after you eat, it's just amazing what five minutes, 10 minutes, 15 minutes of walking can do for your blood sugars to kind of bring them back down and help regulate you out throughout the rest of the day. So a lot of us have office jobs where we're very sedentary and it's really hard to get out of that groove and say, I need to just go spend two minutes and go outside and walk. But it's probably the best thing you can do for your body if you know, like I'm not gonna be able to make it to the gym tonight, I'm not gonna be able to do this or that. Just walk. Take a few minutes, get up out of your chair and just walk.

SPEAKER_00 20:10

That was a really tip, isn't it? Thank you so much. You're welcome. And I just want to thank all of you for tuning in today, listening to us and learning a little bit more about foot health. If you have any foot health concerns, make sure you reach out to your primary care provider, get those concerns addressed so that if you need further treatment, whether you need to see our team here at the wound care clinic, or if you'd like to see one of our podiatrists here at Spencer Hospital, you can be referred on to get that care that you need because feet are so important. And Jordan, just you are an absolute wealth of knowledge, and I just really appreciate you taking some time out of your day to share some foot health with us and to talk about the toenail clinic right here at Spencer Hospital.

SPEAKER_01 20:50

I hope you have me back sometime.

SPEAKER_00 20:51

This is if this is a popular podcast and people really want to hear more from you, we might ask you back. Give us the thumbs up. Is that a thing on podcasts? Give us the thumbs up. Sure. Thumbs up, thumbs up to the toenail clinic. Thanks so much for joining us today. Have a good one and tune in again soon.