MDNews - Mid Hudson

Cover Feature the Wound Care and hyperbaric medicine Center team at Vassar Brothers medical Center situation of a young man who nearly lost his toes because he didn't seek specialist treatment. While working in the emergency department, she encountered a young man sitting in the hall. When she asked what the problem was, he responded that his feet hurt. Upon examination, Dr. Brooks found black, necrotic toes. For months, this man had sought help for pain in his feet from podiatrists and physicians, but found no answers. Immediately, Dr. Brooks referred him to a vascular surgeon to identify any potential vascular issues. Vascular studies showed inflamed and swollen blood vessels, characteristic of thromboangiitis obliterans (Buerger's disease). Commonly presenting in patients between ages 20 and 40, Buerger's disease causes severe pain in the affected limbs and can result in amputation. Before Dr. Brooks proceeded with treatment, she had to address one of the major exacerbations of the condition. "Smoking causes vasoconstriction and further decreases blood flow, so we got him to stop," Dr. Brooks explains. "We then brought him in for HBOT and treated the wounds on his feet. Afterward, I sent Francis X. Carroll, mD, medical Director of the Center for Wound healing at Putnam hospital Center, talks with a patient before she enters the hyperbaric oxygen chamber. 8 | Mid Hudson MD News ■ mDNEWS.COm him to a podiatrist, and now, his toes are beautiful. The blood flow was restored, and he now has strong pedal pulses. Most importantly, amputation was avoided. The patient was extremely pleased that we diagnosed Buerger's disease and healed his wounds." Of note, Vassar Brothers Medical Center Wound Care and Hyperbaric Center has been accredited by the Undersea and Hyperbaric Medical Society (UHMS). Collaborative Care Such a case demonstrates the benefits of collaborative care between physicians at all Health Quest wound centers. Physicians with advanced training in wound care and hyperbarics work with primary care providers and podiatrists as well as vascular and plastic surgeons to construct complete treatment plans. "There are four stages of healing, and these patients usually get stuck in phase two or three," Dr. Brooks says. "Our job is to figure out why they're not healing, which necessitates looking at the whole patient to find any underlying causes, such as diabetes or immunologic issues." Before physicians deploy advanced therapies such as HBOT, patients undergo a comprehensive screening and diagnostic process to determine any hidden causes of chronic wounds and construct the most appropriate treatment plan for each patient. Medical Director of the Center for Wound Healing at Putnam Hospital Center and vascular specialist Francis X. Carroll, MD, identifies patients who have vascular disease contributing to a wound forming or failing to heal. Patient history — which includes risk factors, such as diabetes, high cholesterol, hypertension and smoking — illuminates those patients more likely to have vascular disease. A detailed physical, beginning with a very basic but important check for a pulse, can reveal vascular disease — but not definitively. When physical exam and patient history both suggest vascular disease, however, Dr. Carroll has myriad methods by which to diagnose and treat vascular components of patients' conditions. An initial Doppler ultrasound, for example, may reveal reduced arterial circulation. Following a suspicious ultrasound, Dr. Carroll conducts additional tests, which may include standard catheter-based angiography, CT angiography or MR angiography for a more detailed picture of circulation, or lack thereof.

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