One Last Post Re: Success with Hyperbaric Oxygen Therapy for Necrotizing Infections

Before we take a break from this topic, here's one more quick but inspiring story about success with hyperbaric oxygen therapy for deadly soft tissue infections, or flesh-eating disease, sometimes including gas gangrene or bone infections.

Nurse manager Amy Pakes, RN, MS, says Nassau University Medical Center, a NuHealth hospital in East Meadow, New York, sees a dozen cases of necrotizing fasciitis every year:

At Nassau, as soon as a diagnosis is made, the patient receives powerful intravenous antibiotics. Surgical debridement of the infected tissue immediately follows. In addition, hyperbaric oxygen therapy is given to prevent further tissue loss and promote healing.

"We usually take patients right from surgery to the hyperbaric chamber, but they might have to go back for several more surgeries to remove dead tissues and such," Pakes said.

Monday's story on Nurses.com tells the story of one recent case:

"We used all of our resources—our surgical team, hyperbaric team and skilled nursing in the burn center, who did the complicated wound dressings that accompanied the wound care," Pakes said. "The patient was here for almost a month and we were able to save his arm, but it was a team effort."

Eileen Abruzzo, RN, MSN, CIC, director of infection prevention at Winthrop University Hospital in Mineola, New York, was also interviewed for the Nurses.com report.

[Photo: NuHealth website]

HBOT for Necrotizing Fasciitis: South Carolina Mother of Twins Going Home with All Her Limbs

Lana Kuykendall, this year's "other" high-profile victim of necrotizing fasciitis, or flesh-eating disease, underwent extensive hyperbaric oxygen therapy as part of her remarkable recovery at Greenville Memorial Hospital in Greenville, South Carolina. She also suffered with sepsis and endured more than 20 surgical procedures. Now the mother of twins born in May is heading home with all her limbs. This morning the Kuykendalls got the Today Show treatment, too. Click PLAY to watch the video below. Another heartwarming story with a cool HBOT twist.

Visit NBCNews.com for breaking news, world news, and news about the economy

Necrotizing Fasciitis Postcript: Aimee Copeland in Rehab, Set to Return Home Next Month

The young woman we wrote about in May has won her life-or-death battle against necrotizing fasciitis or flesh-eating disease. Hyperbaric oxygen therapy played some role—we don't know the details—in Aimee Copeland's recovery from a rare and serious bacterial infection. In June her family released a photo of her enjoying some outdoor time and preparing for rehabilitation. Yesterday they announced she will return home sometime in August. Pretty moving stuff after such a  trying ordeal. Cheers to the Copelands and congratulations to the entire staff at Doctors Hospital in Augusta, Georgia.

[Photo: CNN]

Sea Turtle Returns to Sea After Successful HBOT for Osteomyelitis

This just in from Florida. How can we not report it? What else but HBOT works for osteomyelitis (bone infection)? How can you not watch? Go, Kahuna, go!

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]

Lee Memorial Hospital: Local Plug for Fort Myers, Florida, Wound Care Center a Model of Brevity, Clarity

Sometimes just a bit of just the right information communicates best. Hats off to Lee Memorial Hospital in Fort Myers, Florida, for landing the kind of local coverage every hyperbaric oxygen treatment center should covet. This little gem from the local NBC affiliate hits all the basics with minimum effort:

• A stirring tale of a 2-year-old girl recovering from burns.
• A short explanation of what wound centers do and how hyperbaric oxygen therapy works.
• A strong case for adapting to meet the public healthcare demands of a rapidly aging population.
• A believable connection to success with advanced, specialized wound care centers.

No doubt the hospital marketing and public relations team and clinical experts played this one clear and straight. That's why this reporter got a great story, this hospital got some great ink, and these readers got another great reason to look into this great new movement in American medicine. All in about 390 words.

[Photo: Lee Memorial Hospital website]

Diabetes Amputation Rates Declined Sharply in US Between 1988 and 2008

Researchers from the Centers for Disease Control and Prevention (CDC) report a dramatic reduction in amputations due to diabetes over the last two decades. Read "Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: US, 1988-2008" in Diabetes Care, the journal of the American Diabetes Association. In related press coverage (see Newsday) the authors attribute the decline to earlier diagnosis and preventive foot care. We might suggest advanced wound care centers had an awful lot to do with it, too. From the HyperbaricLink Commentary on our diabetic ulcers page:

Hyperbaric oxygen plays an increasingly important role in the treatment of problem wounds and limb salvage. But access to accredited hyperbaric facilities and certified hyperbaric physicians and technicians is a public health problem. In 2004 as many as two-thirds of nursing home patients with NPUAP Stage II or worse pressure ulcers were not enrolled in wound care treatment programs [NCHS, 2011]. In diabetes-related wounds alone, US hospitals performed 66,000 toe, foot, and leg amputations in 2006 [CDC, 2011], for which health economists have estimated a cost of $3 billion per year [ACA, 2008]. More and more hospitals and health networks today are opening advanced wound care and hyperbaric centers to serve this unmet clinical need. Even if chronic wounds were its only indicated use, HBOT would be assured a place in evidence-based medicine for quality and cost-effective healthcare.

That's our story, and we're sticking to it.

[Image: American Diabetes Association, Diabetes Care website]

Hyperbaric Oxygen Treatment Centers: Advantages of Participating in the HyperbaricLink Directory

Let's pick one center at random from today's newsfeed. Almost precisely one year ago, we wrote with enthusiasm about the expansion of the hyperbaric wound care program at Oakwood Heritage Hospital, in your faithful correspondent's idyllic hometown of Taylor, Michigan. We immediately gathered what information was available and posted standard profile MI019 in the HyperbaricLink treatment center directory. Take a quick look and come right back.

What's missing? An email address to contact. The name of a medical director or administrator. What else? Without the benefit of any communication with the center, we simply don't know.

Now go read about the center on the hospital's website. About advanced wound care and hyperbaric oxygen therapy the hospital provides very little information for patients, families, and referring physicians. But here we do learn what conditions this center treats: chronic wounds, diabetic ulcers, skin grafts and flaps, osteomyelitis, and radionecrosis. That's three more than we listed. Had this center worked with us to publish a complete and accurate listing, HyperbaricLink visitors would get all the right information, complete with links to our trustworthy content on HBOT, diseases and conditions treated, the published clinical evidence, and plenty of helpful, reliable resources.

What other advantages might Oakwood Heritage gain by participating with HyperbaricLink? Try googling wound care taylor mi. Your local search results will differ from ours, but likely you'll find our directory listing equals or beats the hospital. List with us, link to us, and we all secure the top spots for the most relevant queries. About this subject we have dedicated an entire page, where you can also request our white paper on Internet Best Practices for Hyperbaric Oxygen Therapy Providers.

ATTENTION Treatment Centers. Start your countdown to a complete and accurate listing in our directory. It's as easy as 3-2-1. See what's new and create the profile that's right for your facility.

CLICK HERE to learn more about directory listing options.  

Only by working together can we make the evidence-based hyperbaric community more prominent and more discoverable on the web. And don't worry, Oakwood. We'll be in touch.

[Photo: Oakwood Healthcare website]

Horse Rescued from Starvation, Trauma, and (Thanks to Hyperbaric Oxygen) Life-threatening Bone Infection

Horse lovers will want to jump immediately to the after photo of Baby Girl, the buckskin quarter horse, pictured right. Read her complete story, "Horse beats odds: From skin and bones to full of health," in The Gainesville Sun. The 2-year-old filly was suffering from starvation and blunt force trauma complicated by an "aggressive" infection of the jaw and skull. With advanced imaging and hyperbaric oxygen treatment for bone infection, or osteomyelitis, veterinarians at the University of Florida Large Animal Hospital and Kesmarc Florida, an equine sports rehabilitation center in Ocala, were able to save Baby Girl. Now she's the very picture of health.

[Photo: The Gainesville Sun]

Hyperbaric Oxygen Therapy as an Adjunctive Treatment for Sternal Infection and Osteomyelitis after Sternotomy and Cardiothoracic Surgery

A retrospective study published in the Journal of Cardiothoracic Surgery concludes that hyperbaric oxygen therapy improved clinical outcomes. Read the abstract and download the provisional abstract.

Update: Hyperbaric Oxygen for Refractory Osteomyelitis (Bone Infection)

Today we have upgraded and updated our Osteomyelitis page. Osteomyelitis is a bone infection, an all-too-common and serious complication of chronic wounds and necrotizing infections and a distinctive feature of Wagner Grade 3 diabetic ulcers. Hyperbaric oxygen therapy is approved and clinically indicated when the going gets really tough. From our new commentary:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of osteomyelitis and surrounding soft tissue necrosis. The approved clinical indication is limited to refractory (persistent or recurring) bone infections that do not respond to accepted surgical and antibiotic treatment. UHMS guidelines recommend daily treatments of 90-120 minutes at 2.0-3.0 atmospheres of absolute pressure (ATA), starting soon after surgical debridement and continuing 4 to 6 weeks. Osteomyelitis, like necrotizing infections, involves some rather frightening germs. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop. 

Who are these microbial troublemakers? Round up the usual suspects: MRSA and other antibiotic-resistant bacteria, mixed with various fungi. 

Our expanded page now includes many more suggestions and links to helpful patient and clinical resources. And we are especially fond of Sherwin B. Nuland's book, The Doctors' Plague, a must-read for anyone concerned about proper healthcare facility and staff hygiene.

[Image: bone 6 by chrisharvey from Fotolia.com]

Hyperbaric Food: Like Pasteurizing With Pressure

Who knew? The foodservice industry uses hyperbaric chambers to kill harmful bacteria, too. And apparently you can shuck a whole lot of shellfish with a whole lot of pressure. Make that 87,000 pounds per square inch, about 5,920 atmospheres. No added oxygen required.

Get a load of the fascinating history of high-pressure food processing, "Warning! Contents Under Extremely High Pressure," in GOOD. And who can resist the continuing adventures of Wholly Guacamole and the Big Mother Shucker? Not us.

Foodborne illness is no laughing matter. Neither are gas gangrene, intracranial abscess, necrotizing infections, osteomyelitis, diabetic foot ulcers, and other chronic wounds and bacterial infections treated with HBOT, where oxygen plays a central role. Lately we're reading like crazy to update our Diseases and Conditions pages for these indications. So please excuse us. But this slightly off-topic discovery was just too good not to share.

[Illustration: Avure Technologies]

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

Weekly Web Roundup: 27 November 2010

We hope our readers in the United States are having a pleasant Thanksgiving holiday and that those elsewhere in the world are enjoying whatever non-stuffed-turkey-involved events are appropriate to their locale. The luxury of few days off has given us the opportunity to relight the boilers and get the weekly roundup moving again.

SCIENCE

Surgeons in the department of thoracic surgery, Ondokuz Mayis University Medical School, Samsun, Turkey, report in the December 2010 issue of The Thoracic and Cardiovascular Surgeon that a week of hyperbaric oxygen therapy helps healing of anastomosis surgery wounds after irradiation and resection of the trachea in an animal study.

Preliminary results from a 24-patient study in China suggest that hyperbaric oxygen therapy may be effective for improving recovery from erectile dysfunction after posterior urethral reconstruction.

Medscape Today provides a case report of a rare necrotizing infection involving an intraperitoneal rupture of an infected urachal cyst. Apparently, HBOT wasn't available in this case.

PRESS/BUSINESS

On December 10th, from noon to 1:00 pm, Dr Thomas Serena, medical director of the Snyder Institute for Vascular Health and Research, will discuss how the Snyder Institute is utilizing hyperbaric oxygen to prevent amputation in diabetics. His presentation is part of a free seminar at the Alle-Kiski Medical Center Hospital in Kittanning, Pennsylvania.

Check out this video tour of McMurdo General Hospital in Antarctica. Conducted by Major Greg Richert, flight surgeon, the tour includes the continent's hyperbaric chamber.

One of the miners who escaped from the Pike River mine in New Zealand after the initial explosion was treated with HBOT for carbon monoxide poisoning according to the New Zealand Herald.

Perry Baromedical has been selected to supply hyperbaric chambers to Restorix Health. Headquartered in Bellevue, Washington, Restorix Health is a community-based center for advanced wound care affiliated with the Restorix Research Institute.

The story in the Pittsburgh Tribune Review on carbon monoxide poisoning reports numerous incidents and insight from Dr. Kevin S. O'Toole, director of the University of Pittsburgh Medical Center's hyperbaric medicine department.

PATIENT STORIES

From the Twin Cities Pioneer Press comes a wonderful success story. The combined efforts of The Hennepin County Medical Center, an Undersea & Hyperbaric Medical Society Accredited Facility, and the renowned Mayo Clinic saved a woman's foot and even seem to have eliminated her migraine headaches. She's published a book and is donating the proceeds to hyperbaric research. Osteomyelitis, or bone infection, is one of the FDA-cleared conditions for hyperbaric oxygen therapy. Migraine and other conditions await more research.

Have news you'd like to share? E-Mail it to us at: press@hyperbariclink.com.

HAIs: Fighting A Pandemic Already In Progress

Yesterday we doubted whether HBOT has any role in treating H1N1, the so-called swine flu, poised for a comeback this fall and winter. But we have no doubt hyperbaric oxygen is a powerful weapon against the baddest bugs our healthcare community is fighting right here right now. Antibiotic-resistant bacteria.

Turns out most of these tiny culprits find life real hard in pure oxygen under high pressure. Researchers have shown us the proof in the petri dish. Clinicians have borne out the evidence in treating chronic wounds and several other approved conditions, including necrotizing infections, intracranial abscess, osteomyelitis, and gas gangrene, where HBOT helps control methicillin-resistant Staphylococcus aureus (MRSA) and other troublesome bacteria.

There's plenty hospitals can do to prevent hospital-acquired infections (HAIs), sometimes also called healthcare-acquired or nosocomial infections. And there's plenty they're not doing. A recent CNN report sings the praises of some of this war's unsung heroes. Our question is, What's the best course of treatment when prevention fails and attacking bacteria outmatch our best antibiotics? We think you'll be seeing HBOT in the mix and in the news more and more.