Chronic Wound Healing with Jennifer Hookham

Chronic Wound Healing with Jennifer Hookham

 

Trish

Hello, listeners. It’s Trish Hammmond here from the Transforming Bodies podcast again. And today I’m speaking with Jennifer Hookham, who’s from the Dermal Health Alliance and she’s also the Co Director of Mid Coast Health Proprietary Limited. So today we’re going to talk about chronic wound healing, what it is and all about it, because this is her specialty. So welcome, Jennifer.

 

Jennifer  

Thank you Trish Long time no speak or see it’s been so Iong.

 

Trish

I know, I know. And we’ve been wanting to do this for so long. Hey,

 

Jennifer

I know, since the beginning of Covid, I guess.

 

Trish

I know. Exactly, exactly. Awesome. It’s so good to be back to normal. We’re almost normal. Yeah. But tell us I know you’ve been working and I know that it’s your passion and wound healing. But tell us, first of all, what is chronic wound healing?

 

Jennifer 

Chronic wound healing is where wounds on people tend to not heal on their own. So they become, they go from an acute stage of healing, which is something that has occurred from an immediate injury, or subsequent from an injury. But it becomes chronic when it either stalls during the healing process, or it doesn’t heal at all. And a lot of things can impact the healing process, it could be medications, comorbidities that people have, it could be an underlying condition, it could be as a result of chemotherapy radiation. So there’s a lot of different things that will impact how our body will heal and then what will then be the trigger for it becoming from going from an acute wound to a chronic wound, but wounds are not the only thing that I do. I sort of stumbled into that specialisation just recently. 

 

Trish

So what made you love it so much? Because like, actually, before you tell me, like, we get so many people in the Facebook group and and just talking to people that have had procedures, surgical or non surgical or sunspots cut out or whatever. And some people heal well, and some people don’t. But like, what makes the healing like why would someone heal better than another? Is there a specific process you follow?

 

Jennifer  

Yeah, there is. And again, it really depends on the individual what they’ve had that made the injury for a start, and also what their underlying health is, that facilitates a really good word healing potential from anything. So when you’re looking at skin cancer, for example, which is another area that I work in, malignancies can have a massive impact on how the skin repairs itself, how the regeneration process occurs, and just how the wound healing cascade can be interrupted and stalled, which then has a complication across the whole wound healing cycle. So there’s, there’s lots of things that fall into it, it can be anything from, again, underlying health conditions, medications that have an impact on healing vascularization of a wound, it can also have problems with nutrition, some people just aren’t getting the nutritional support or other correct diet to support an adequate wound healing potential. So there’s a whole lot of factors that lie in weight healing. So when we’re looking at a wound, we have to look at the whole person, not just the hole in the person so it’s a holistic approach. That’s where I’m looking at taking this type of wound healing, as opposed to wound management so it’s changing the language around the whole wound care, sort of healthcare sector.

 

Trish 

So if we start with nutrition, we know that some people don’t have the right nutrition. So what does that look like? What is the right nutrition? Or is it different for different people? I guess, but how can someone who likes just a stock standard person, I don’t even know what that means? The stock person? Isn’t a stock standard person? Exactly. I’m definitely not one of those. But there’s a like, what would be the recommendation of someone saying, coming out of the surgery, you know, like, trying to make sure that their wound doesn’t get infected at all.

 

Jennifer 

Yes. So again, that comes down to having a really good assessment before the surgery has even begun. So if there are underlying conditions, for example, diabetes, that’s a really big flag, like a red flag for any kind of healing, whether it’s surgical or anything else, just because diabetes has a massive issue or a massive implication on going to healing and just the restorative properties within the body to do the healing process for us. So it needs to be looked at before any of the trauma has actually occurred, whether it’s surgery or an injury or anything like that. So some comorbidities like diabetes, for example, high risk for lower limb wounds because they have been an insufficiency and other things that go on that are part and parcel of that disease process. So again, if you have someone that is in one of those situations, going to a wound care specialist is one aspect of the treatment planning by having a dietician onboard first to manage the nutritional support, and also try to manage and balance the nutritional requirements that the body needs for that individual. And again, it needs to be an individual approach, because everyone is different. So it might mean that they need blood screening first to see exactly where their levels are, it might mean that they need a medication review, because their diabetes may have been controlled in the past, but it’s not now. So there’s a lot of different things that play into that and again, it’s that diabetes is just one example. 

 

Trish

You’re right. 

 

Jennifer 

Yeah, kinda, it’s a big question to answer.

 

Trish

Well, you know, you were saying that. So you hook up with a dietitian and a wound specialist. So what’s the wound specialist? Like? Where would I find one? Can I just Google wound specialist? Or is that the doctor that you’ve gone to? Or?

 

Jennifer   

Yeah, look at that, that’s a really hard one. Because again, there are certain areas where you can actually go and source a really good wound specialist within your area. And again, for a lot of people that are living with chronic wounds, or have an acute wound, having access to the correct type of physicians for staff that are going to give you that right care is a hard problem, people. So accessibility affordability issues across the board for health care anyway. So in my local health district, the mid north coast, in New South Wales, we do have a limited supply of specialised wound care nurses, and wound care GPs. So the majority of people in regional areas have closed books that’s hard to get in and then if they’re attached to a medical centre, they’ll have practice nurses that are trained in certain areas, or they become more of a generalist type of practitioner so they might do vaccinations and immunizations and acute wounds. And there’ll be some pieces and assist in surgical procedures that are done in a family medical practice but when it comes to managing long term chronic wound healing for a lot of people in there, we’re talking months and sometimes years that people live with a chronic wound, the specialisation is a little bit more rigorous, there needs to be a lot of education around a formalised education to know how to manage complex wounds, and there are tertiary institutions that actually specialise in wound management and wound care. We also have some nurses that work specifically in those areas in hospitals. So again, in acute settings, in hospital systems, whether it’s private or New South Wales Health, for example, you will have some nurses that are specialised practitioners that are clinical nurse consultants or clinical nurse specialist in those areas so it depends on where you are and who’s available.

 

Trish

Got it. So I guess that’s why like, if you’re having a surgery that they like after you have your surgery, and then you usually follow up with your default doctor, but it’s actually the aftercare nurse that you kind of follow up with, because they kind of focus more on that actual thing. Would that be right?

 

Jennifer   

Yeah, I mean, again, in certain situations that can happen. So a lot of the time it will be led by the GP or the Surgeon, and they may have their preferred specialist who will help to support that in a team environment and ideally, that’s what wound care should look like. It should be a multidisciplinary team, because you will have a nutritionist or dietitian that will be involved, you will have a specialised wound nurse that will be involved, you will definitely have the GP or for the physician in charge of this particular client involved as well so it needs to be a team approach. So ideally, we’re looking at a holistic and multidisciplinary approach to wound healing, as opposed to just slapping on a band aid and saying, off you go, I’ll see you next week. We want to have wound healing outcomes, not just management.

 

Trish

Got it. And you know, you said dietician, or nutritionist, is there a difference? Or like, would it matter if there was one or not like, like, is there a preference or I mean, I don’t even know what the difference is. I don’t know if you know what it is. 

 

Jennifer 

But yeah, good question. Again, I think it depends on the preference of the client. And again, the client is definitely the centre of the whole wound care scenario and some people have a preference to go to complementary therapies, which might mean a nutritionist, so they’ve done tertiary education or a Bachelor of Health Science in Nutritional Medicine, or the medical end which is the dietetics. So there are two different branches, they both work in a similar way but they have a slightly different approach, I suppose. But again, if my preference was to go to stay in a medical, and I would be seeing a dietician, and they are often attached to the hospital, and that may be recommended as part of a discharge plan, with a client or a patient, leaving hospital and going into a nursing facility, for example, in nursing, right, so they will make recommendations based on who they have and who they trust. And again, if I was saying, Well, I really want to work with a naturopath and I want to have a different approach to my health, then I would have a say as to who I’d like to go and see. So you have options, it’s not always just about what the doctors recommend, although that’s taken on board, you definitely involve the client as part of that whole planning process, because everyone has a different way of wanting to manage their own health as well.

 

Trish 

Got it. So they’re not a diabetic, and they’ve got a dietitian or a nutritionist on board, what are other things that could cause a wound breakdown, for one of a better word?

 

Jennifer 

Lots of different things, that can be something that’s created as an infection. So there could be something that has got like a foreign body has remained in the wound and that often happens if there’s been searches that have not dissolved or absorbed properly into the tissues. So sometimes they’ll just be someone’s skin cancer move, for example and they’ve had some basic searches there that generally dissolve into the skin but it continues and it doesn’t heal correctly. So when they present back to the doctor, sometimes there’ll be inside the wound, the smallest fragment of a suture that has not dissolved properly. So by removing that the foreign bodies are gone, and wounds heals. So it can be something as simple as just, you know, the sutures haven’t broken down properly, in some instances. And also, the location on the body is relevant as well. A lot of the high risk areas for wound dehiscence, or where surgical sutures become open, because of pressure, or edema, or fluid building up underneath the wound can actually open surgical wounds again, so dominant surgery is a really high risk area for that. So again, they’ve generally left. We’ll stay in the hospital for a little while to have that monitored. So that complication is nipped in the bud if they are potentially a high risk person for that occurring. So there’s lots of things that have to be looked at, depending on the setting, depending on the type of wound where it is all those sorts of things. It’s not that there’s not really a correct answer for any of them there. It’s FSI there’s many ways to skin a cat. It’s a bit of a crude saying, but there’s many ways to address a wound, depending on what the wound is, and what they have at their disposal, and all the other factors that play into wound healing so it’s a complex, complex area of health.

 

Trish 

Yeah, right. It’s so funny, because I was talking to a plastic surgeon the other day, and we were talking about scars and stuff like that and they did like a, I’ve heard it before. But if there’s like a T junction, like say, for example, if someone has a thigh lift, for example, when they cut down the leg and up around the groyne, that can sometimes be really hard to heal, because it’s got that T junction. Yes. So why would a T junction?

 

Jennifer 

That’s a really good question for a surgeon. Yeah. Good. But again, there are certain dermatomes in the skin that will knit back in an easier way than others. And the more you have to go against those, or across those, sometimes the more complicated or the longer the healing time can be. So there’s a whole lot of things that have to be, excuse my phone rings.

 

Trish 

It’s probably a client with a wound.

 

Jennifer 

No, it’s actually my wound fiance because we just did a workshop on the weekend here in Concord, which was fabulous.

 

Trish 

Where were you learning more?

 

Jennifer 

So I’m at the very beginning of my wound healing sort of sojourn into this area of healthcare. So I’m absorbing every bit of information I can get, trying to progress there as a member just be part of the healthcare team, as an allied health professional, and now a nurse. So I’m just at the very beginning, but I like to surround myself with people who know what they’re doing. Of course, that’s my end goal but I really also like to make contact with surgeons because scar revision and scar improvement is also an element of wound healing down the track as well. Of course, lots of modalities that come from my dorm or clinician side of the world to assist in that. 

 

Trish 

So, yeah, well, that just that kind of just makes you a better practitioner, because you kind of have but more info behind you like. So tell me, I know for a fact that like they always talk about, like in Australia, I think it’s a bit different in Europe, but they always talk about that, like you can’t smoke before surgery and they do it because of the you know, the the healing. And so what’s got smoking got to do with it?

 

Jennifer 

So much, I know some surgeons who will refuse to do surgery on patients if they don’t.

 

Trish  

Well, you know what, I haven’t heard of one that will. Yeah, like so far.

 

Jennifer  

Yeah. And the reason is because the carcinogens within cigarette smoking or the impact that cigarette smoking has on the body directly impacts the vascularization or neovascularization within the body. So if you’ve got a wound that needs to have a fresh blood supply, as part of that wound healing cascade, that’s one of those areas that occurs, if you have any kind of impact there, then you can’t get fresh blood to a wound to heal properly and that whole inflammation cascade gets blown out exponentially. And you can have wound by or tissue breakdown, you can have a loss of integrity to the world as well, you have an impaired form of collagen being produced as well, because cigarette smoking directly impacts the vitamin C and the pro collagen that’s formed within the dermis to create a decent or reasonably resilient collagen formation so it has an impact on how quickly a wound will heal and how effectively a wound will heal. And when you’re looking at major surgery, like plastic surgery, reconstructive surgery, where it’s very, very complicated, and high risk, you don’t want any risk at all. That can be where you want to remove all those unnecessary risks. It’s risky without that occurring. So of course, smoking is just not recommended for anyone who’s interested in looking after their skin for a start wanting to slow down the ageing process significantly and can’t be a smoker and being worried about ageing can cause you to don’t go very well together and it has an impact across all systems of the body. Yeah, specifically on the vascularization in healthy tissue.

 

Trish

And so I read somewhere that, like oxygenation has got something to do with I don’t know, I don’t even know what oxygenation is and why it would have something to do with it. So is that a bit like what you’re talking about the fact that the yeah, right.

 

Jennifer   

So collagen lines, all of the vascularisation pathways in the body so that all the capillary network, and your endothelium is lined with very specific collagen, smoking attacks, collagen formation. So again, you have a very weakened, this is in very basic terms, but you have a weakened vascular mechanism. So if you’re going to continue to smoke, you’re not going to have a very robust vascularization that is really needed for healing any kind of trauma or wound, whether it’s surgical or a scrape on the skin or anything, it can take a lot longer and again, it can’t. It’s not often a very resilient wound that is healed from that because it’s extended, the inflammatory phase is extended beyond reasonable movement and that’s where a lot of complications can occur. So you don’t get adequate oxygenation because your vascular pathways that carry all that oxygenated blood are impaired.

 

Trish

Got it? So the only reason I’m asking this is because I spoke to a lady recently, she just recently had a breast reduction and lift. That’s right. And she was a smoker so she had to stop smoking. I think it was on a Saturday, she had to stop smoking a month before but they gave her a tobacco test like a week before a nicotine sorry nicotine test. About a week before of course she stopped smoking but she was still smoking herbal cigarettes. Like there’s a brand of herbal cigarettes that you can buy that have gum, that red clover and something else and I don’t know. So does that make it like, is it just nicotine? Or is it smoking? In general?

 

Jennifer 

It’s a bit of both. I mean, the only thing that should be going into our lungs is not smoke. You know, it’s not just our lungs aren’t designed to be inhaling those sorts of carcinogens and carbon dioxide long term, you know, we have a really delicate infrastructure that is necessary to transport the amount of molecules and the types of nutrients around the body that we need just to have a healthy existence. So continually smoking, anything in the lungs is going to impair the quality of oxygenation that you get to your tissue. The nicotine is another impact altogether, but it has more of an addictive property to it but all of the carcinogens that are attached to a normal cigarette have a common adding effect in the body itself. So if there’s a whole huge list of different chemicals that make up a cigarette, what we see now is tobacco smoke and each of those have a detrimental impact on the body. There’s not really anything that’s positive about smoking. Anything. Yeah, yeah, and I can see. But you know, it’s when you’re looking at going into an environment, whether it’s in a medical hospital or under just, you know, a local anaesthetic to have a skin cancer removed, you are inflicting a wound or a trauma on the body. And when that happens, your body’s natural instincts are to create inflammation to heal, and bring the body back to a balance or homeostasis. So there’s this repair mechanism constantly at play and what we do know about things like too much alcohol, smoking lots of cigarettes, or just not having a great lifestyle, you have a lot of inflammation or inflammatory factors within the body that are not going to give you a positive outcome for inflammation, you’re going to have more inflammation, and not the right kind of inflammation, you want a very short, sharp and acute level of inflammation to heal a wound, not an extended delayed type of healing process, because that’s when all those complications can occur.

 

Trish

Yep. Well, that makes so much sense. Because, like you hear it sometimes. But like, you know, the question is, well, what about vaporising? And what about if I vaporise some herbs and all that? So basically, it’s anything that you inhale into your lungs, although if it was like a herb, it may not be as bad as tobacco, but it’s still not, it’s still going to be bad. 

 

Jennifer 

Yeah, look, there’s lots of different things that people will inhale around their homes. I mean, I love incense, but I’m not going to sit there and have it right next to me all the time, and being hailing up constantly, it’s not healthy. In the hospital situation, or even in a medical situation, like if you went to your GP, we’re always testing blood pressure, we’re testing oxygen saturation in the blood as well, to see how effective your body is at carrying oxygen around, it’s really, really important for nearly every function that we have. And if your oxygen saturation levels drop below 95%, then that sends up a little bit of an alarm bell to us, it’s like you need to breathe better, you need to make sure your quality of bodies is optimised so that all of your functions perform better in the event healing potential is maximised. So all of those things are really, really important when you’re looking at the person across the whole. So oxygenation is just one area.

 

Trish

Yeah, right. It’s so interesting. I just love it. Because it’s like everyone’s always got an answer. Yeah, yeah, totally. It’s not just black and white. And so if I do you reckon, what you do before surgery, or even actually even like a laser treatment, because, like, I had a lady who actually contacted me yesterday through social media, and she said, I really want to do something with my face. She’s got really, really wrinkly skin. I really want to do something with my face. And I said, Oh, you know, like, co2 laser, you can either have a really intense ablative treatment in a hospital, like with another procedure, I believe that this is possible or you can have like a more non ablative treatment, but something like the HALO or just a co2 laser and she said, Oh, that’s sounds fantastic and then she told me that she smoked. And I’m like, but could you still do it?

 

Jennifer 

And look, I think some people would. But again, that would come down to the ethics of the individual. Yes, but the laser device as a rule, if I stepped into my clinic, there would be a lot of treatments that they will be contraindicated for. Because again, fractional ablative, or even ablative laser, and some chemical peels, dermal needling, any of those aesthetic treatments, or the allied health treatments that we do as demo clinicians, they inflict a wound that might be a micro was not quite the same as the surgical wounds that you might just been talking about. But they do inflict a wound that requires the body’s inflammatory cascade to be effective, and to be activated, because that’s really what we’re trying to manipulate to get that end result, which in most cases is improved epidermal appearance and also collagen induction in the dermis so that occurs with a wound occurring scheme. Yep. So again, if we have to have a wound complicated by someone who’s a smoker or a sun lover, it would just contraindicate treatment, they’re not going to get the results that they’re looking for. You’re going to have a delayed healing or delayed downtime, which is significantly more uncomfortable for the client. And again, the longer the downtime, the more complications can occur during that time so we want to, in an ideal situation, we will inflict a micro wound like needling, for example. And we have a very specific timeframe that we’re looking for optimally to get them out of that inflammation cascade. So the normal healing can just occur and collagen induction is going to carry on without complication. So the longer you are impacted by free radical damage, smoking, sun exposure, incorrect product, things like that, or dodgy lifestyle loads and loads of stress in the body, that will have an impact on how the body, how the skin prepares itself and how wound healing will occur in general, yeah.

 

Trish

Yep, that makes sense. And it’s really funny, because this woman actually had diabetes for a start. And I think and for someone like that, I just sort of think, maybe you just shouldn’t do it, you’re gonna have to keep your lines as they are and not do it. Because you know, that’s dangerous, really.

 

Jennifer 

It is. And you have diabetes so you do have another complication potential there as well. So it doesn’t mean that she can’t have treatment, it just means that she can’t have specific types of treatment. Yeah, she would be better off with the non-invasive modes of healthy ageing. But again, if she’s a smoker, and she has either uncontrolled diabetes, or she’s been medicated for diabetes, they’re not really looking at her lifestyle. They won’t help her. Not age like, yeah, she’s taking a few boxes that are sort of pro inflammatory and that just stimulates the ageing process even further.

 

Trish

Totally. Actually, I kind of get that because some, like myself, I’ve only started using really good skin, I have used skincare all my life, but really good anti ageing skincare, probably from my mid 40s, when I found out that you had to use anti ageing skincare. And I’ve actually noticed that I believe that my skin and my face looks better now than it did before I started using the good creams, even though I’ve had Botox and lasers, and some of them, but it still looks better now than it did then. So you wouldn’t get that natural collagen production looking, kind of better looking skin as you went along. You’d just be fixing it, and then it would just start getting crap again.

 

Jennifer

Yeah, you wouldn’t have results that would be sustainable, because you’re constantly bombarding your system with free radical damage and things that are going to just have terrible collagen.

 

Trish

Totally, totally. So if someone’s about to have a procedure be surgical or non surgical, because, like they cost a lot of money, right? So you want to make sure that you’re getting the best bang for your buck that you’re looking at, sorry, you’re getting everything done, you’re looking after something beginning. So if you’re gonna recommend to someone to look like, pre get ready pre surgery, what would you suggest like saying, I’m going to have surgery, I want to get ready, like a month before? Like, what’s something that I could do to help myself? Because of course, it doesn’t mean it’s not going to happen, but you want to give yourself the best chance of a successful procedure, and no wound break down if you can?

 

Jennifer 

Absolutely. Okay, so there are certain things that you can do just long term. I mean, it doesn’t have to be just prior to a procedure. But you know, don’t smoke, reduce the amount of alcohol because again, that puts a lot of pressure on your inflammatory markers in your body. But it also can play patterns in how your body will heal.

 

Trish

I mean, you’re talking about no alcohol at all, like what about?

 

Jennifer 

Just reduction. So I mean, if you’ve gone from drinking every single night, maybe not drinking every single night, for example. So you want to give your body the best fighting chance. So you would want to look at at least a month prior just reducing those like common sense, it comes back to common sense ao definitely don’t smoke. That’s probably the biggest no no reduction in the things that are going to be by their diet so your alcohol, like too much caffeine. Again, just bringing it back to a healthy balance not over intoxicating on anything is not good for the body just puts the body under more stress. Yeah. So you want to make sure that your stress levels internally and externally are being managed really well, getting quality sleep, getting quality nutrition, Vitamin C supplementation is great because it helps to stimulate healthy collagen production. And it also is really beneficial for you know, a faster recovery. It’s also good for the immune system so it has a really good impact there. But I suggest good protein so wound healing likes to have a decent amount of protein. I don’t mean you know about carbs being accountable 24/7, but having good choices of quality protein leading up to it, and also during your healing phase beyond surgery, stay out of the sun. So don’t go and visit yourself in the sun and go within an impaired skin. Because we want to be as healthy as possible. Yeah, what else is there? That’s probably about it just comes down to being, like having common sense. Yeah, your body fighting chance. Stress is one of the biggest indicators that will lead to more complications, post surgery. So try to keep your stress levels calm as much as possible. If you know you’re a bit anxious about the surgery, try and take some steps to do some meditation, calm down, talk to someone get some assistance, if you’re really struggling to come to terms with whatever surgery it is, just so that you’re ticking all of those boxes, because it’s not just the physical that we have to look at, we have to look at the mental health side of things when it comes to any interventions, and also the healing after that. It’s a big thing that I see in hospitals when people have had knee replacement surgery or hip replacement surgery and whilst they’ve got sedation or they’ve got analgesia to the area, they’re fine. As soon as that starts to wear off, and really start to see how much they’re struggling with the mental health side of it, pain can be a really big driver of depression and anxiety so just keeping a lot of those channels open, so people can talk so you can ask for help. So yes, more things like that are important.

 

Trish 

And I guess that goes like that’s the same with after, it’s just as important because I remember hearing, because I’m in our group, in one of our Facebook groups, we have a lot of women who’ve lost a lot of weight, whether it’s through lap band surgery, or gastric sleeve  or non surgical. And of course, like almost when they go in, because they want to get down to as much as I can. So they usually starve nutrients before they go in, then they have surgery and they get massive amounts of skin removed or whatever. And then afterwards, they don’t eat properly, because they don’t want to put on weight or whatever. And so of course, they’re going to have a high risk of having a wound breakdown. Absolutely. as well. So yeah. So it’s, I think it’s even more important afterwards, virtually and it’s sort of, and the only time I found that was why I had back surgery. And I’ve been in. I thought this is the perfect opportunity for me to lose weight and the doctor came in and he’s like, no, no, no, no, you need to eat lots of protein because protein is what’s going to give your body the amino acids that meat needs to build up your strength that year to repair. That’s it. So that makes a lot of sense. I kind of understood that then so putting on weight, but that’s okay.

 

Jennifer 

And once you have recovered, you can look at addressing that. But when you’ve had a surgical procedure, the first thing is healing from a surgical procedure. Yeah, and if that’s impaired by anything else, that can create so many more complications. So the doctors are actually really quite adamant and they scrutinise charts quite often and go, what are they eating? Are they diabetic? Are they getting enough protein? So they’re really on top of that, to make sure that this person’s high risk for having a wound, they want to make sure they’re trying to tick every single box to minimise any sign of complication whatsoever. And I know the plastic surgeons that I’ve worked with, that you’ve worked with, would be in a similar situation, they want to know what your quality of eating is like. They want to know, if you drink a lot, if you smoke, they want to know that they’re having off any complications as much as they can. But it was interesting that you said about people that have had bariatric surgery or lap band surgery. I’ve seen a few of those in hospitals as well during my placement and a lot of them I mean, it’s quite confronting, and invasive the procedure that they’ve been through. But what they don’t take on board a lot of the time is the psychology that they have to start implementing all the way through that process. Because when they come out the other side, they realise that they can’t eat what they want to or what they think they’re going to be eating. It really does start to impact how they see their quality of life, the social aspect evolving from there, and a lot of them are really wrestling with how my life looks now. I can’t even enjoy a mouthful of food without wanting to throw up. You know, there’s that whole mindset around. Well, how do I eat now? What should I do? So I’ve seen a couple of patients that have been like that and they’re just grappling with the decision to undergo such an invasive procedure for their long term health but they’re not really knowing what’s on the other side of that or how to navigate it and the psychological impact on that and that stress that they’re going through post surgery, it really does delay their healing time. So, minimising and maximising their psychological health is important as well for healing. 

 

Trish

So, yep, that’s that. Yeah, it makes so much sense. So basically, as a rundown look after your support during and after, and that’s basically trying to live as clean a lifestyle as possible. Yeah, it’s still being able to have the occasional drink here so be able to go out and have sugar and a cake here and there and all that but just be there have a bit of common sense.

 

Jennifer  

Exactly. You know, sunscreen is your best anti-aging cream.

 

Trish 

Oh my god. Yes. That was one of the best lessons I ever learnt. Oh, actually, sunscreen and fake lashes are the most powerful thing that you can do.

 

Jennifer  

Ratification truth, Trish. Exactly, exactly. Well, I’m happy that you’re using sunscreen, since I work in the skin cancer medicine board. 

 

Trish  

My god, I’m obsessed with sunscreen. And while we’re on sunscreen, you can’t just put it on in the morning and you’re done because I said to my husband, you need to put it on every time because I put it on this morning. I’m like, No, you need to put it on every couple of hours. I actually just do it morning and afternoon, like if I’m going out. If I’m in the office, I’ll put it on in the morning. And then if I go out for a drive, I’ll definitely put it on as soon as I get in the car, I’ve got a little one sitting in the car and then if I forget it, I’ll always top up sunscreen before I step out the door. If it’s been a significant time, it’s easy.

 

Jennifer

That’s really a good idea. And it’s such an important thing, because we’re really good at putting it on before we go out anywhere but it’s great. But every application in Australia is absolutely wonderful. We just don’t do it. You know, we might run in the morning underneath your make up and I know as a female when you walk into work, and you’ve got your makeup done, and you don’t even think about reapplying through the day you think about getting home and taking it off. But you don’t think about getting to lunch them again, I promise you it sounds very long. Oh, but I’ll have a face full of makeup. What’s that going to do to that? So we don’t do it. So, there’s little things that you can implement in your own life that will make those things easier. But ideally, our sunscreen is still being relied on too much as the only method of some protection and it’s the secondary line of some protection. So your clothing, your hat, your sunglasses, your physical barriers to ultraviolet radiation are by far still the first line of defence for us. So wear your long sleeves, put on your gloves, if you’re driving, put a big broad brim hat on when you’re going outside, create as much shade around your body as you can and then on the exposed areas. Of course you have sunscreen. But if you’ve got less exposed areas, and you’re covered with clothing, that’s even better so we just don’t do that so much here in Australia because it’s too hot. Yeah. Yeah. The more you expose yourself, the more sunscreen you need to use.

 

Trish  

Yep. 

 

Jennifer

Reapply every few hours.

 

Trish  

Yeah. Before we go, because I know that you’ve got commitment stuff and I really appreciate your time. So say for example, if you have surgery, because someone said to me, oh, you should go and lie out in the sun and let your sun get that’s not right?

 

Jennifer

No, absolutely not, it is really complicated again, that when we put our bodies out in the sun for any length of time, it creates another type of trauma. So our initial response in the skin as your melanocytes get very activated because they go into a defence mechanism. So extends melanin across all of the top of your cells, your skin cells to protect the DNA underneath. That’s why you get the tan, when you get that flush of colour so all of your body’s melanocytes are activated. When it registers that ultraviolet radiation is hitting the skin that’s one of the mechanisms but you’ve got the whole solid constant so we’re not just looking at UVA and UVB, there’s infrared, there’s near infrared, there’s a whole spectrum of wavelengths that is penetrating your body. Now if you’ve had a trauma like surgery, or you’ve cut yourself and you think that laying out in the sun is going to instigate a healthy healing response. That’s actually contradictory because the sun will exert free radical damage into the skin that’s what we get skin cancers from long term. And free radical damage requires antioxidants mopping up internally and we use antioxidant protection on our skin as well to try and counteract the damage that occurs every time we walk outdoors. So by playing outdoors or by swimming in the ocean, which is another high risk for infection if you’ve got an open wound, you are opening yourself up to a slower healing time, a greater risk of hyperpigmentation or post inflammatory hyperpigmentation because you all melanocytes have to go into a bit of a double whammy of a protective mechanism. So you’re really interfering with a really intricate inflammation cascade that you don’t want to do. You don’t want to complicate it any further so stay out of the sun. Please try to get it out.

 

Trish  

You know what, and I’ve got it. I’ve got a big hat and I got a lecture on the weekend because I was going to walk with my husband wearing a hat. I’m like, No, I’ve got sunblock on. I’ll be fine, you know, but I think he’s right.

 

Jennifer  

Did you put sunscreen on it then Trish on your ears?

 

Trish

All over my face. That’s it. Not my ears.

 

Jennifer   

A lot of the men were saying, Oh, you’re wearing a hat with a baseball cap. They’re only protecting the very front panel of the face. And that is it and it’s not effective. So if you’re having here’s one that just wears a baseball cap, he needs a bigger hat too.

 

Trish

Yeah, you could bring on the big hats. I think they’ll make it come back to sombrero, that’s awesome. Look, I gotta say thank you so much for your help today. So someone wants to come and see you. How do they do it? What do they do?

 

Jennifer

Well, I’m in Port Macquarie in New South Wales, on the mid north coast, but they can contact me through my website, The Dermal Health Alliance or through Facebook. They can contact me through you if they want to contact you because of my details as well. Yep. But yeah, we’re online. And yeah, that’s probably the best way they can leave some information on my website. There’s an Information area there if they want to make an inquiry about anything. Great. Y’all come up because I’m just in skincare tricks for you up north and then we’ll catch up.

 

Trish 

Yeah, absolutely. Thanks so much, Jennifer, for taking the time. 

 

Jennifer   

Pleasure, anytime.

Trish

Lovely. And this is like if you do want to get ahold Jennifer, like what I actually love about her is from the far I met her. She’s really passionate about doing the right thing. It’s not about the money. It’s not about anything. It’s actually about the patient, which is really nice. It’s really nice to come across someone like that. So if you need help you drop me a DM me, ping me whatever you want to do, and I’ll put you in touch. Thank you. Thanks for joining us today, Jennifer. 

 

Jennifer  

Thank you Trish. Have a great day.

 

Trish

You too. Bye soon. 

 

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