| July / August '08 Feature Article |
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HBOT: Help for the Elderly and Others Suffering from Chronic, Non-healing Wounds
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Nearly five million Americans suffer with chronic wounds. Approximately 25 percent of people between the ages of 60 and 69 may develop pressure ulcers. Some of the reasons include a thinning of the skin, drier skin, and complex medical conditions that can lead to overall frail health for elders.
Diabetics and people with vascular disease also run a high risk of developing non-healing skin ulcers. Again, senior citizens are often in these groups of patients. However, people who have a variety of conditions can see real improvements if they are treated with hyberbaric oxygen therapy, also known as HBOT.
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| Wound prior to HBOT treatment. |
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| Wound after HBOT treatment. |
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“Currently HBOT is utilized to facilitate healing ischemic wounds, diabetic foot ulcers, refractory ulcers, osteomyelitis, and compromised/failed flaps and grafts,” said Alan Davis, MD, Medical Director at The Center for Wound Care and HBOT at Northwest Hospital in Randallstown, Md.
Hyperbaric oxygen therapy at 2-2.4 ATM enables patients to breathe 100 percent oxygen inside a pressurized chamber---at sea level, we only breathe 21 percent oxygen at 1 atmosphere. That significantly increases the flow of oxygen to the body’s tissues and facilitates healing. The HBOT procedure (dive) lasts approximately two hours.
Before being accepted for treatment, a prospective patient should be interviewed, spoken with about HBOT, and given a physical examination. Transcutaneous oxygen levels, when applicable, must be measured to determine how ischemic the wound is and the probability of healing it with HBOT. After several treatments, wounds must be re-evaluated to see how well the patient is responding to therapy.
One of the many success stories at The Center for Wound Care and HBOT at Northwest Hospital involves a female, diagnosed with cancer for the second time in the same breast. After her first diagnosis, the patient had surgery and radiation therapy. After the second occurrence, she underwent a mastectomy and had breast reconstruction with an implant at the time of that surgery.
A few months after her reconstruction and chemotherapy, the wound over the implant began to break down, likely a delayed reaction to the radiation. Because the implant was exposed and infected, it was removed. The resulting wound was treated aggressively with multiple treatment modalities, but failed to heal. A large cavity under the skin would not close.
After the patient was evaluated, physicians and the patient agreed that HBOT would be a good adjunct to the multiple therapies being used to allow healing without major re-constructive therapy.
She began her treatment and completed 40 HBOT dives over an eight-week period. There were no complications. The wound improved during her therapy. The undermining and necrosis that were present at the beginning of therapy were resolved. While the wound was not completely healed at the end of therapy, it was pink, granulated, and superficial. The drainage was nearly resolved as well. The patient was very happy with the results and continues to heal by secondary intention at this time.
In addition to the above case of treating radiation injury wounds, HBOT is especially effective for patients undergoing oral surgery in irradiated areas. Patients are treated prior to surgery for teeth extractions and return afterward to complete therapy, which promotes healing.
When radiation cystitis/proctitis cannot be resolved with traditional methods of treatment, HBOT can also be an excellent alternative. The results are impressive. The majority of patients treated are completely healed or moving to an improved status.
Most radiation injuries are treated with a total of 40 dives. Typically, treatments are five days a week, with the weekends off.
Dives are very safe, if all safety regulations are observed. The most common side effect is an ear squeeze/stuffiness. It is similar to going to the bottom of a swimming pool or what many people experience when flying. The HBOT staff should always be in the room to assist a patient in dealing with those issues if they happen. While in the chamber, patients can watch television, DVDs or VHS tapes, or listen to CDs…or simply relax.
In between HBOT treatments, the elderly and other people who suffer from wounds can help themselves. The following are ways physicians can teach patients to keep their skin from breaking down: They should not wear shoes without socks or stockings; they should make sure their toenails are clipped the way a doctor explains; they should only allow a physician removes calluses or corns; they should eat nutritious foods; and they should and take additional vitamins…if recommended by a doctor.
For more information or referrals, healthcare providers can contact The Center for Wound Care and HBOT at Northwest Hospital at 410-496-7191, or by logging onto www.lifebridgehealth.org and searching for “wound care.”
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