"There are so many people that come to us with skin breakdown. Often, tube feeding related diarrhea has been a main contributor to the persons poor nutritional status and skin breakdown – the appropriate formula can make a quick impact," said Evelyn Phillips, Clinical Nutrition Manager at Magee Rehabilitation Hospital in Philadelphia. "When you're working with a vent-dependent, C4 quad and you do something that makes them feel better, you've really accomplished something."

Evelyn plans, manages and implements all aspects of nutritional care at Magee, a 96-bed acute rehabilitation hospital specializing in spinal cord (SCI) and brain injuries. She also administers outpatient nutrition counseling for individuals with SCI and pressure ulcers as part of Magee's lifetime follow-up care system.

The daughter of a nurse and physician, Evelyn was one of nine siblings who helped out at her father's inner-city office. "My parents never made a lot of money, but they helped a lot of people," she said. "That made a big impression on me."

At age nine, she was diagnosed with insulin-dependent diabetes. This started a lifelong interest in nutrition. She started in a sales position with several food companies, but decided to go back to school in her twenties to become a dietitian. Her first job was at a 400-bed hospital in a low-income area. It was just Evelyn and a technician. The job allowed her to try every company's standard and specialized feedings and learn what works and what doesn't. From there, she was able to develop a formulary of cost-effective, well-tolerated feedings.

At Magee, the challenges were even more formidable. Patients are often admitted post-injury with advanced wounds and feeding intolerance. CRUCIAL® in the ULTRAPAK® closed system is her treatment of choice for these patients, mainly because as a peptide based formula, Crucial acts to restore gut integrity, thereby correcting the source of the diarrhea. "Crucial is an all-in-one feeding — it contains therapeutic levels of arginine,  glutamine and micronutrients needed for stressed patients with wounds. Our nurses love it. They don't have to add anything extra to the feeding and diarrhea is rarely a problem.

She said the improvement in healing has been significant. For example, many of her patients are on Oxandrin to promote healing. But the anabolic steroid only works if there's adequate protein intake, which requires good absorption. By supporting Oxandrin with CRUCIAL, Evelyn has often been able to cut the drug's dosage in half and achieve the same positive results. Considering that Oxandrin typically costs $36 a day, it's a significant saving.

Typical nutrition protocols start with the least costly formula and advance to a more expensive formula if the person demonstrates poor tolerance. "Why do we need to demonstrate poor tolerance before going to a higher nutrition intervention?" she asked. "When did cost indicate tolerance and appropriateness? We know from the literature and experience that for stressed patients a standard intact protein feeding will result in diarrhea. While standard nutritional interventions are less expensive to purchase, this delay in appropriate nutritional care can prolong healing time, further impair nutritional status, and negate the effectiveness of even the best wound care. Why do we wait until there are complications to give patients the nutrition they need? Too often, facilities save on the food service side and lose on the clinical cost side. We need to think differently."

Evelyn is taking her passion for nutrition support of wound healing beyond Magee. She's presented her published nutritional wound care protocols at several professional conferences and wrote the chapter on nutritional management of pressure ulcers for the online American Dietetics Association Nutrition Care Manual 2004.