Case Studies

Resolution of Multiple Chronic Pressure Ulcers, Improvement

in Cognitive Function, and Reversal of Weight Loss with a
Bioactive Cystine-Rich Protein Supplement

ProNutra

Patricia Kongshavn, Ph.D.

Karen Wilkie, M.S.
Resolution of Multiple Chronic Pressure Ulcers and Improvement in Cognitive Function
Patient: DO
Medical History
A 64-year-old African male was transferred to LTC with dehydration, hyponatremia, urinary tract infection,
diabetes mellitus, history of multiple cerebral vascular accidents, severe contractures, multiple decubitus
ulcers, history of MRSA (methicillin-resistant Streptococcus aureus), aphasia, vascular dementia,
azotemia and possible sepsis. The patient was PEG tube fed.
The Medical Director reported that the patient had been transferred multiple times between the hospital
and the LTC facility and that multiple pressure ulcers had been present for over a year. He also reported
that the patient was not communicative in any manner, over this period.
The patient was placed on a specific WPI supplement rich in bioactive cystine, 37g BID until he was
transferred out of the LTC facility 35 days later.
Wound healing was monitored at weekly intervals. Owing to the large number of pressure ulcers being
observed, the wound sizes are shown only at a time shortly before starting the supplement and at the end
of the observation period. Some of the pressure ulcers healed and others improved greatly over the time
he received the supplement. (see table next slide)
Cognitive Observations
The patient was also observed to show surprisingly improved cognitive skills. Initially he was unable to
indicate his needs to the staff but, eight days after starting the supplement, he began to communicate with
facial expressions. At 14 days he was able to make eye contact. At 21 days he was alert, able to focus
on movements, and responded ‘yes’ and ‘no’ to statements by nodding and shaking his head. At 23 days
he also then responded to staff by raising his eyebrows and shrugging his shoulders.
 Time Course for Resolution of Multiple Time Course for Resolution of Multiple
Chronic Pressure Ulcers Chronic Pressure Ulcers
14
30
12
Lt Hip
25
Lt Inner Buttock
10
Rt Heel
Lt Buttock Site A 20 Rt Buttock Site 1
Area (cm2)

Area (cm2)
Lt Buttock Site B
15
6

4 10

2 5

0 0
-2 35 Days -8 35 Days

Time Course for Resolution of Multiple Time Course for Resolution of Multiple
Chronic Pressure Ulcers Chronic Pressure Ulcers

6 0.16

0.14
5
0.12
4
0.1

Area (cm2)
Area (cm2)

3 Rt Outer Ankle 0.08 Rt Buttock

0.06
2
0.04
1
0.02

0 0
-5 9 Days -8 30 Days
Resolution of Chronic Pressure Ulcer
Patient: GS Time Course for Resolution of
Medical History Chronic Pressure Ulcer

A 67-year-old male patient had a history of 6

insulin-dependent diabetes, coronary heart
disease, hypertension, chronic anemia, and
5
carcinoma of the prostate and bladder with r Started Supplement
r UTI
repeated urinary tract infections. In July
2003 both legs were amputated owing to 4

Area (cm2) .
progressive necrotizing soft tissue infections
of both lower legs, the right leg below the 3
knee and the left leg above the knee. A
decubitus ulcer on the coccyx was identified 2
and surgically debrided in July 2003 at
which time it measured 10 x 15 x 6 cm. This
1
wound failed to heal and 11 months later the
patient was started on a specific WPI
0
supplement rich in bioactive cystine, 37g
-5 0 5 10
BID until healing was complete. Weeks
 Time Course for Resolution of
Chronic Pressure Ulcer
Resolution of Chronic Pressure Ulcer
3
Patient: JL r Started Supplement

Medical History 2.5

A 91-year-old female patient with
dementia, osteoarthritis, peptic ulcer and 2
anxiety, had a stage III pressure ulcer on

Area (cm2)
the right buttock, measuring 3.4 x 3.2 cm
1.5
on admission to LTC. Approximately 8
months later the pressure ulcer had not
1
resolved. The patient was then given a
specific WPI supplement rich in bioactive
0.5
cystine, 37g BID. This supplement was
used until the ulcer was healed about
one month later. 0
-5 -4 -3 -2 -1 0 1 2 3 4 5

Weeks
Resolution of Non-Healing Wound
Patient: JS
Medical History
A 64-year old female patient had history of peripheral vascular disease, post-operative anemia,
coronary artery disease and hypertension, congestive heart failure, depression and anxiety,
hypercholesteremia, insomnia, tobacco use and failure to thrive. She was admitted with a chronic
non-healing wound with a history of MRSA
(methicillin-resistant Staphylococcus aureus),
resultant from a saphenous vein harvest graft Time Course for Resolution of
Non-Healing Wound
taken 6 months previously. The wound area
was large, necrotic/black in appearance, 70 s Started Supplement
suggesting some infection. It was debrided 60

twice, 3 days apart, and then an axillofemoral-

Area in sq inches
50
femoral-femoral bypass was performed with
40
bilateral profundoplasties, in order to restore
30
blood supply to the area. The wound measured
18 x 4 x 0.4 inches. The patient was 20

transferred from hospital to LTC ten days later. 10

After two days in LTC the patient was given one 0

0 5 10 15
serving of a specific WPI supplement rich in Weeks
bioactive cystine, 37g BID until the wound had
resolved. Throughout the healing process,
there were no signs of infection and the edema
was only moderate.
Resolution of Chronic Pressure Ulcer
Patient: LF
Medical History
A 76-year-old female patient with a history of Guillain-Barre syndrome, diabetes, chronic obstructive
pulmonary disease, depression, osteoarthritis, neuropathy, SIADH and anemia, was observed to have a
stage III pressure ulcer on the coccyx which failed to heal for 7 months. She was kept on an Alamo bed
during this period. She was placed on a specific WPI supplement rich in bioactive cystine, 37g BID until
healing was. Two weeks after starting the supplement she had improved sufficiently to be removed from
the Alamo bed. She continued to heal and the time course for complete healing is shown below.

Time Course for Resolution of

Chronic Pressure Ulcer
4.5

4
s Started Supplement
3.5

3
Week Comments
-3 5 sites of tunneling
Area (cm2)

2.5 -2 4 sites of tunneling

2 -1 3 sites of tunneling
0 3 sites of tunneling
1.5
1 No sites of tunneling
1 2 Granulating well
0.5

0
-5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10

Weeks
Resolution of Multiple Pressure Ulcers
Time Course for Resolution of
Patient: VP
Chronic Pressure Ulcers
Medical History
25
s Started Supplement
A 79-year old female patient had a history
of coronary heart disease, essential
20
hypertension, chronic obstructive A
pulmonary disease, arthritis, chronic hip

Area (cm 2)
pain, mouth pain, depressive disorder and 15

dementia. She was admitted with a

fracture of the right femur at the distal end 10
of a previous total hip replacement and
was operated on to repair the femur. Ten
5 B
days later the surgical wound was healed
and the patient was transferred to LTC. At C
this time she was observed to have a 0
coccyxeal stage III pressure ulcer -5 0 5 10 15 20
Weeks
measuring 4 x 4 cm, and two smaller stage
III ulcers on the left buttock. She was A - coccyxeal stage III
started on a specific WPI supplement rich B - left buttock stage II
C - left buttock stage II
in bioactive cystine, 37g BID. She
developed two additional small ulcers on the left buttock on week four, both of which healed one week later.
After 5 weeks the left buttock ulcers were healed and she was switched to Ensure because the Director of
Nursing felt that she would finish healing without continuing the supplement. This did not happen, so at 13
weeks she was re-started on the supplement, 37g BID until the coccyxeal ulcer was healed.
Resolution of Coccyx Split Wound
Patient: FF
Medical History
An 85-year-old female patient with a history of Parkinson’s disease, dementia, hypothyroidism, urinary
tract infections and chronic renal failure, developed a pressure ulcer stage I (0.3 x 0.2 cm) which was
observed to have progressed to a coccyx split. Two months later she was placed on ProNutra one
serving QID. The wound healed in 26 days.
Reversal of Weight Loss
Patient: AM
Medical history
A 91-year-old female had a medical history of chronic obstructive pulmonary disease, chronic hip
pain, congestive heart failure, depression, senile dementia, anemia, hypercholesterolemia and
hemiarthroplasty (right) hip.
The patient was only on ‘comfort care’.
She was placed on a specific WPI Time Course for Weight Gain
supplement rich in bioactive cystine, 37g 90
BID in order to counteract serious weight
loss and weighed at weekly intervals.
85
At a Care Conference approximately 3

Body Weight (lbs) -

weeks after starting the supplement, it 80
was stated that the patient had multiple
episodes of refusing meals. At that
75
same time the caregiver reported that
the patient had gained 9 lbs with the new
supplement, even though she only ate 70
u Started Supplement
23% of her meals. Moreover, despite
the fact that she was overcoming a bout 65
of pneumonia she still gained weight. -15 (5) 0 5 11
Weeks
 Improved Outcome for Healing of Pressure Ulcers
in Patients Fed a Cystine-Rich Protein Supplement

Before
Background
• Female, 92
• COPD, TIA, cerebrovascular accident, anxiety, aortic
stenosis, depression
• 2 Stage II pressure ulcers
• Treatment: 20g BID of a specific WPI supplement
rich in bioactive cystine
• Rate of Healing: coccyx 0.4 sq cm/mo, and left
buttock 10.7 sq cm/mo
39 Days Later
Days Days

0 (1 x 0.5) 0 (3 x 2.5)

42 Healed 21 Healed

Stage II, Coccyx Stage II, Left Buttock

0 0.25 0.5 0 4 8
Wound Area (cm sq) Wound Area (cm sq)