Necrotizing Infections: National Story Generates Some Local Interest in Omaha

Widespread coverage of the Georgia woman battling a necrotizing infection in an Augusta hospital has led health journalists across the country in search of the local angle. Of most interest: Doctors report an unusually high number of cases recently at Nebraska Medical Center in Omaha. Hyperbaric medical director Dr Jeff Cooper said his center has treated six patients with necrotizing fasciitis, or soft tissue infections caused by flesh-eating bacteria, in just the last month or so. He cannot account for the sharp increase but briefly explained to Omaha.com how hyperbaric oxygen works against the disease:

Cooper said hyperbaric oxygen therapy is an important part of treating the disease. “It forces oxygen into areas that aren't getting adequate oxygen because of the tissue damage and swelling,” he said. “This revives the immune system locally and causes the antibiotics to work more effectively.”

Today the medical center is holding a press conference on the subject. More on the web at WOWT Channel 6 and the Omaha World-Herald.

[Photo: Nebraska Medical Center]

A Podiatrist Speaks Against Podiatrists Supervising Hyperbaric Oxygen Therapy

A leading podiatric physician and regular Podiatry Today blogger last week spoke up against Doctors of Podiatric Medicine (DPMs) monitoring patients receiving hyperbaric oxygen therapy (HBOT). Citing state law in his home Indiana and discussions with his Healogics wound center colleagues, DeHeer concludes:

Despite being a proud member of the podiatric profession, I feel that until we have a combined MD-DPM degree, it is in our patients’ best interest to have our allopathic and osteopathic colleagues monitor HBOT patients.

In other words, as so often we have commented here and on HyperbaricLink:

Hyperbaric oxygen is serious medicine that should always be prescribed by a physician. Treatments should always be supervised by a qualified hyperbaric specialist (MD or DO) assisted by a certified hyperbaric technician (CHT).

Podiatric physicians play a vital and sometimes leading role in the care of people with diabetic ulcers and other wounds and injuries of the foot. Hats off to Dr DeHeer for working to clarify his profession's role in hyperbaric medicine.

Now we're curious. How does your hyperbaric treatment center involve podiatrists in patient care?

[Image: Podiatry Today DPM Blogs]

Hyperbaric Oxygen for Necrotizing Fasciitis: Georgia Woman Loses Limbs and Fights for Life

Our thoughts today with Aimee Copeland, the 24-year-old University of West Georgia graduate student who is fighting a very public battle against necrotizing fasciitis at Doctors Hospital in Augusta. Copeland suffered a deep gash to her leg in a zip-lining accident on May 1. By May 4 the wound had become infected with the rare flesh-eating bacterium Aeromonas hydrophila. She was rushed to the hospital, where doctors amputated most of her left leg and worked to stop the potentially deadly infection from spreading. Hyperbaric oxygen therapy, begun last Wednesday, failed to salvage her remaining foot and both hands. Copeland remains in critical condition.

In the treatment of necrotizing fasciitis, hyperbaric oxygen inhibits bacteria from replicating, spreading, and releasing damaging toxins. It may also boost the effect of antibiotics, enhance the body’s natural defenses against flesh-eating bacteria, and help resolve or delay the onset of sepsis, a deadly blood poisoning. From the commentary section of our necrotizing infections page:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of soft tissue necrosis. One analysis [Undersea Hyperb. Med. 2005 Nov-Dec; 32(6):437-43] showed significantly fewer deaths and amputations with HBOT. As the [UHMS] writeup concludes: “With such strong case series evidence of reductions in morbidity and mortality for necrotizing fasciitis and the subset of Fournier's Gangrene, it is difficult to envision ever seeing a controlled, double-blinded study of hyperbaric oxygen therapy.” In other words, considering the deadly seriousness of necrotizing infection and the demonstrated effectiveness of HBOT, withholding treatment from a control group for comparative study would not be medically or ethically acceptable. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop.

Keep track of Aimee's condition on Facebook.

[Photo: Copeland family Facebook page]

Headstrong: Postshow Brain Injury Discussion (Part 2)

At long last we bring you Part 2 of Ivan Oransky's postshow discussion May 2 with neuropsychologist Dr Jill Brooks and ESPN senior writer Peter Keating. The stage play Headstrong runs through May 27 at the Ensemble Studio Theater in New York City.

Part 2 (29:03)



Hat tip: Rich Kelley (@rpmkel)

Hyperbaric Oxygen and Type 1 Diabetes: New Animal Study Suggests Preventive Effect

When HyperbaricLink talks diabetes we're usually talking diabetic ulcers. But we note with great interest a promising new paper published online last week in the American Diabetes Association journal Diabetes, in which scientists at the University of Miami say they used hyperbaric oxygen to prevent or slow the progression of Type 1 diabetes in mice.

Our first question is, How does hyperbaric oxygen work? From the abstract:

HOT reduces autoimmune diabetes incidence in NOD mice via increased resting T cells and reduced activation of DCs with preservation of β-cell mass resulting from decreased apoptosis and increased proliferation.

We won't pretend to understand much of this beyond the given abbreviations: hyperbaric oxygen therapy (HOT), non-obese diabetic (NOD), and dendritic cells (DC). But we do know how difficult it can be to translate findings from animal laboratory experiments to human clinical studies. And we're not quite sure how physicians would know how to select patients and whether or when to use hyperbaric oxygen. A neat summary of the paper in HealthDay raises these and other questions.

That hyperbaric oxygen affects diabetes is not news to many researchers. Back in July 2010 we noted a paper in the Polish Journal of Endocrinology concluding "HBOT was shown to have beneficial effects on atherosclerosis and glycaemic control" in a study of 28 diabetes patients with foot ulcers.

The Miami study used 100% oxygen at 2.0 atmospheres absolute (ATA) and the Polish study at 2.4 ATA. Of course such subtleties will not stop every inflatable bag dealer from claiming this evidence as their own. Let the buyer beware.

For the evidence-based hyperbaric medical community, this is an altogether fascinating area of hyperbaric medical research. We have reached out to the Miami research team and eagerly await further studies.

Autism Postscript: State of the Science on Causes and Mechanisms

Friday we lamented the lack of any clinical evidence to support the use of hyperbaric oxygen therapy in children with autism. Yet the science in this field continues to fascinate. Later that night we enjoyed Charlie Rose's enlightening conversation with some leading autism experts: Eric Kandel of Columbia University, Gerald Fischbach of the Simons Foundation, Uta Frith of University College London, Matthew State of Yale University, and Alison Singer of the Autism Science Foundation. Part of Rose's ongoing Brain Series, the discussion touched on the latest findings and prevailing theories about the (especially) genetic causes and mechanisms of autism spectrum disorders.

Hyperbaric Oxygen for Autism: New Systematic Review of the Medical Literature

For anyone interested in the use of hyperbaric oxygen to treat children with autism, we note the publication today of a simple but helpful systematic review in the online open-access journal Medical Gas Research, by Ahmad Ghanizadeh, Director of Research Center for Psychiatry and Behavioral Sciences at Shiraz University of Medical Sciences in Iran. From today's abstract:

The electronically [sic] search resulted in 18 title of publications. Two studies were randomized, double-blind, controlled-clinical trials. While some uncontrolled and controlled studies suggested that HBO therapy is effective for the treatment of autism, these promising effects are not replicated. Therefore, sham-controlled studies with rigorous methodology are required to be conducted in order to provide scientific evidence-based HBO therapy for autism treatment.

Ghanizadeh's findings support the prevailing view of the evidence-based medical community. Even the two supposed randomized controlled trials (RCTs) he identifies do not, in our view, support the practice, except in the course of clinical investigation. Nor do the eight studies listed on ClinicalTrials.gov show much promise of answering the important questions. Look for a quick update of our autism page in the weeks ahead.

Wound Care Advantage: Distinguishing Its Approach and Model from the New Healogics

Soon after the launch of Healogics, with some 540 wound care and hyperbaric centers across the US, comes the first open letter to the community from a key competitor, Wound Care Advantage. Founder and CEO Mike Comer writes:

Granted our approach and model differs from the new Healogics. Wound Care Advantage is focused on turning around existing centers that are doing poorly and helping hospitals take over their own programs in order to have more control and retain more revenue.... I still feel a focused approach on each hospital is key. These hospitals also need a strategy for their wound center to retain as much revenue as possible.

Read the entire post on the Wound Care Advantage blog. We expect to see a lot more competitive positioning against, around, and alongside Healogics in the months and years ahead. We also expect a steady expansion of the provider market to serve a steadily expanding and rapidly aging patient population whose wound care needs remain seriously underserved today.

USC Catalina Hyperbaric Chamber Featured in Scientific American Blog

For the last month the "Expeditions" blog on the Scientific American website has run an excellent series on the University of Southern California Dornsife Scientific Research Diving program. The May 4 installment covers the USC Catalina Hyperbaric Chamber. Written by dive safety officer Gerry Smith, the short piece nicely summarizes the center's important role in treating recreational and scientific divers and others who suffer decompression sickness and air or gas embolism. We've written before about USC Catalina but didn't know the center is funded equally by the Los Angeles County Medical Alert Center and the local diving community and staffed 24/7 by a full-time director, a part-time technician, and some 70 volunteers.

[Photo: Karl Huggins]

Banner Boswell Medical Center in Sun City, Arizona, Adds Third Hyperbaric Chamber

The growing hyperbaric oxygen therapy center at Boswell Banner Medical Center in Sun City, Arizona, helped this man with bladder spasms caused by delayed radiation injury and caught the attention of this local TV health reporter. The center will host a community open house to show off its new chamber 8a to 11a on Wednesday 16 May.