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+++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++ CARING FOR THE ELDERLY +++ +++ HYPERBARIC OXYGEN By Kenneth Arsham, MD, and Rajesh Sharma, MD Therapy for Chronic Wounds + Diabetic foot ulcers + Acute peripheral arterial insuffi ciency + Acute traumatic peripheral ischemia H + Compromised or failing skin grafts or fl aps + Osteoradionecrosis + Soft tissue radionecrosis + Necrotizing infections + Actinomycosis + Chronic refractory osteomyelitis + Crush injuries + Gas gangrene This medical therapy vastly increases oxygen concentration in a patient's bloodstream, allowing oxygen to pass more easily through blood plasma into wounds to heal them. Basically, wherever wound healing is hindered by oxygen defi ciency due to poor blood circulation, HBO therapy can help. It's a complement to conventional wound care, including YPERBARIC OXYGEN (HBO) therapy can be essential to healing certain types of chronic wounds: debridement, monitoring of nutritional status, control of diabetes, cardiovascular disease and other comorbidities. HBO therapy is not prescribed for conditions such as pressure ulcers, skin cancers and certain infections. Their underlying causes must be corrected fi rst. During HBO therapy, patients lie on a bed inside a large, clear, acrylic shell. Patients are surrounded with 100 percent oxygen at high atmospheric pressure. (Compare this to room air, which is only 21 percent oxygen at normal atmospheric pressure.) As patients breathe normally inside the chamber, 10 to 20 times more oxygen dissolves into their blood. And, as their blood circulates, their cells and tissues receive more oxygen, which stimulates self-healing. High-pressure oxygen can help form new capillaries in wounds as well as constrict blood vessels, which reduces swelling in injured tissues, such as burns and crush injuries. Treatments (or "dives") typically take two hours — about 90 minutes at the prescribed atmospheric depth, plus time to pressurize and depressurize the chamber. Patients have one treatment a day, Monday through Friday, and 20 to 60 treatments are ordered, dependent upon the patient's diagnosis. Most patients sleep or relax in the chamber. Some watch television or movies. Treatment is painless, although some patients feel a slight pressure in their eardrums, like when landing in an airplane or diving into a swimming pool. Swallowing or using nasal spray can help relieve this ear pressure. Typically, claustrophobia is not a problem for HBO patients, perhaps due to its clear walls. Patients can see out in all directions and interact with the technician through a microphone. Wound center physicians can prescribe medication to help calm patients who feel anxious about treatment. HBO therapy can be a welcome supple- ment to a standard wound-care regimen. Patients with wounds that have not responded to appropriate treatment — or are worsening with treatment — should be referred to a wound center. Wound center physicians can determine whether the patient is a candidate for HBO therapy. Even patients with lung disease, heart failure, history of seizures and lung infec- tions can be considered for HBO therapy on a case-by-case basis. HBO therapy is covered by most com- mercial insurance companies, as well as Medicare and Medicaid. Dr. Kenneth Arsham specializes in plastic and reconstructive surgery and practices at South Pointe Hospital. Dr. Rajesh Sharma is the medical director of the Wound Healing Center at Lutheran Hospital. He is an internist with special interests in wound healing and hyperbaric medicine. n 18 | Cleveland-Akron-Canton MD NEWS MDNEWS.COM NOVEMBER-DECEMBER 2011