DEAR DR. ROACH: Whenever I got a wound while I was young, my mother would take me to the hospital to get stitches. I am now 94. I went to get a wound seen, and the nurse said that it needed to heal from the inside. They treated it with gauze, wrapping and then a stocking. It took months to heal. Why the big change? Why couldn’t they have just put in stitches and saved me months of healing? — D.J.
ANSWER: A wound can be sutured (stitched) closed when it is new, clean and regular. A wound cannot be closed if it is infected or irregular. Most chronic wounds cannot be closed by stitching. Also, if there is a lot of swelling around the wound, there may be so much pressure that the wound cannot be closed and must be allowed to heal over time. This is often the case with larger wounds.
Basic principles of wound healing are to treat and prevent infection by bacteria or other germs, control pain and bleeding, and avoid treatments that are toxic to open wounds. I hear very frequently from people who have mistreated wounds. Strong agents like hydrogen peroxide, iodine, bleach and even soaps will kill more of your body’s healing cells than bacteria, and they should not be used in open wounds.
I also hear people say wounds “need air,” but wounds heal faster when they are moist. A barrier like petrolatum (Vaseline or many other proper wound-care agents) and a clean cover will accelerate wound healing. Most wounds do not need topical antibiotics, and these should only be used when recommended by an expert. The best experts for wound care are wound-care nurses and, in extreme cases, vascular or plastic surgeons.
It takes time for a wound to heal. How much time depends on many factors, but a time span of months is not unusual, especially with a person in their 90s, who may not have the same blood supply they had when they were much younger.
DEAR DR. ROACH: I take 25 mg of quetiapine at night as a sleeping aid, and one of the side effects is an increase in blood sugar. I am curious if that will also show a rise in my A1C blood work as well? — T.F.
ANSWER: Quetiapine (Seroquel), an antipsychotic medication that is often used as a sleep aid due to its side effect of sedation, has at least two ways that it can increase blood sugar.
The first is that it directly acts against insulin, causing the body to try to release more insulin. At the same time, it reduces the ability of the body to make insulin. The combination means that in people who don’t have much reserve (such as people with prediabetes or diabetes), this will increase their blood sugar. Secondly, the resistance to insulin helps promote weight gain, which worsens the resistance to insulin even more.
Any condition that raises blood glucose significantly for a long enough period will increase the A1C. The A1C measures the amount of sugar on hemoglobin molecules in red blood cells. The higher the blood sugar and the longer it stays high, the higher the A1C level.
A dose of 25 mg of quetiapine is relatively small, so it doesn’t usually have these metabolic changes the way that quetiapine used for schizophrenia does — at the usual dose of 400 to 800 mg daily in adults. Still, I do not prescribe quetiapine as a sleep aid, since I greatly prefer nonmedication treatments such as cognitive-behavioral therapy whenever possible.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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