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Francine Brooks, mD, FaCEP, and F. gabrielle summers, DPm, discuss a patient's treatment plan for hyperbaric oxygen therapy. comorbidities related to diabetes, an estimated 15 percent of people with diabetes develop foot ulcers, and 6 percent will require hospitalization for treatment, according to the American Podiatric Medical Association. Diabetic ulcers, commonly found on the ball of the foot or the bottom of the big toe, are a major concern for patients with diabetes because the sores can lead to amputation, which used to be the likely resolution for these patients. Treatment of diabetic foot ulcers can range from straightforward solutions — total-contact casts can be used to redistribute the weight placed on one spot on the foot to help reduce the wear on a developing sore — to more complicated, multilayered treatments involving HBOT in conjunction with other therapies, which may include endovenous techniques to revascularize extremities. "Sometimes, patients might just have an ill-fitting shoe," Dr. Hatter says. "This illuminates a major problem with diabetic patients. They don't have a sense of feeling in their feet, which enables wounds to crop up quickly. Patients don't even realize it's happening if they aren't vigilant." under Pressure Patients with diabetic foot ulcers are the most common occupants of Health Quest's seven monoplace HBOT chambers, which provide critical adjunctive therapy to various measures undertaken by wound center physicians. "In the past, patients would get a bad diabetic foot infection, and the only treatment was to amputate part of the foot or the leg," Dr. Hatter notes. "Now, HBOT heals wounds much faster, reducing the healing period from months to weeks and drastically reducing the necessity for amputation." Patients sit in the chambers for 90 minutes while 100 percent oxygen is pumped in. Chambers are pressurized to twice the normal atmospheric pressure to force oxygen into wounds that persisted because of the lack of oxygenated blood reaching the injury. Typical HBOT regimens consist of 40 daily treatments that provide an array of benefits. "Not only does HBOT provide direct oxygenation to the wound, but it also stimulates the bone marrow to produce cells, including stem cells," Dr. Hatter says. "This provides a systemic effect as well "In the past, patients would get a bad diabetic foot infection, and the only treatment was to amputate part of the foot or the leg. Now, HBOT heals wounds much faster, reducing the healing period from months to weeks and drastically reducing the necessity for amputation." —Jeffrey hatter, mD, FaCs, medical Director of the Wound Care and hyperbaric therapy Center at northern Dutchess hospital as the localized oxygenation effect, and the new cells are transported to the wound to promote healing." While this therapy has a proven track record of healing wounds impervious to other measures, HBOT should only be used when other treatments fail. "When we've been treating patients for about four weeks and they're making little to no progress, we know something else is needed," Dr. Hatter says. "We don't implement HBOT as a front-line therapy, but it can be brought in when other interventions have failed." HbOT: A Case Study Francine H. Brooks, MD, FACEP, Interim Medical Director at Vassar Brothers Medical Center's Wound Care and Hyperbaric Medicine Center, notes that HBOT can be used to treat chronic wounds arising from a number of pathologies, including burns, diabetic ulcers, ischemic ulcers, neuropathic ulcers, peristomal skin irritations, pressure ulcers, surgical wounds, traumatic wounds, vasculitis and venous insufficiency. Despite the pain and unsightliness of these wounds, patients often do not seek help immediately. And when they do, some providers aren't equipped to diagnose or treat them. Dr. Brooks recalls the Dr. Brooks evaluates a patient's chronic leg wound. mDNEWS.COm ■ MD News Mid Hudson |7