Medical Director, The Center for Comprehensive Wound Care and Hyperbaric Oxygen Therapy, St. Luke's Medical Center, Aurora Health Care, Milwaukee, Wisconsin
President and Chief Medical Officer of WebCME.net
Associate Professor and Hyperbaric Consultant, Medical College of Wisconsin
MD from the Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland, 1985
BS in Biology from the US Air Force Academy, Colorado Springs, Colorado, 1981
Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, is a recognized wound care and hyperbaric medicine expert,
educator, and entrepreneur. We know him best as president of the American
College of Hyperbaric Medicine (ACHM), a professional organization working to
develop an image of hyperbaric oxygen therapy as a distinct medical specialty,
often requiring full-time practice. His work uniquely spans the clinical, professional,
academic, and business aspects of hyperbaric medicine today. He spoke with us
in his Milwaukee offices in March 2012.
1.
HyperbaricLink: Tell us about the first time you ever saw a
hyperbaric chamber.
Niezgoda: My first exposure to hyperbaric
medicine was many years ago, circa 1976. I grew up here in Milwaukee and had
the privilege of touring St. Luke’s and the hyperbaric unit when I was an
Explorer Scout. I was 17 or 18 years old at the time, and I joined a medical explorer
post, because I wanted to go into medicine. Ironically, the hyperbaric chamber
tour was conducted by Dr. Eric Kindwall, who many years later became my
colleague and mentor, and a dear friend. I clearly remember him showing us the
original multiplace chambers, Bonnie and Clyde. I’m very sad that he’s no
longer with us. I often think back to that day that I first met Dr. Kindwall, at
the time never dreaming of walking in his footsteps. It is amazing to me that I have been so
fortunate to have had the honor and privilege to come back to Milwaukee to
practice hyperbaric medicine.
2.
HyperbaricLink: Can you a recall one real breakthrough success or
aha! moment in your career?
Niezgoda: Yes, it was when I was doing my
fellowship at Travis Air Force Base, in the late 1980s, working with another
one of the world renowned hyperbaric physicians, Dr. Ben Slade. I was still
learning and questioning certain aspects of hyperbaric medicine, in a way trying
to validate it in my own mind. Much of our time was dedicated to treating the
standard conditions. But Ben always liked to push the envelope, and use HBO to
help patients that presented with problems that theoretically would benefit
from hyperbaric. So from time to time we would treat conditions that were
considered experimental back then, under IRB [institutional review board]
guidance, of course. Sometimes the patients improved, sometimes not. One day Dr.
Slade came in to Morning Report and said, “We’re going to start treating a
patient with brain abscess.” I was thinking to myself, “You've got to be
kidding! Here we go again.” The patient was actually incarcerated at the prison
in nearby Vacaville, California. Every day two armed guards brought the
prisoner in from the infirmary, by ambulance, on a gurney, dressed in his orange
garb. I thought that the handcuffs and guards were somewhat silly as the
patient was essentially comatose due to high intracranial pressure and mass
effect from several large abscesses. He
was obtunded and didn’t know who he was or where he was. He had been on
broad-spectrum antibiotics for several days and really wasn't getting any
better. The neurosurgeon who referred the patient to us said, “If I open this
patient’s cranium to drain the abscess, he will end up herniating and dying.” So
this is how it went day after day. The
patient would come in for treatment, we would say hello and he would not
respond in any way. Well, I’ll never
forget it. On hyperbaric day 7 or 8, I was sitting with my back to the door,
charting. Klaus, my med tech, came in and said, “Dr. Niezgoda, Mr. XYZ is here
for his treatment.” Very facetiously, without looking up, I said, “Great! Let
the party begin!” All of a sudden I hear a voice I didn't recognize say, “I’ll
bring the women and the beer!” I turned around and see this guy is sitting up
in his gurney, fully awake, fully conversant, sharp as can be. It was simply amazing.
3.
HyperbaricLink: How would you characterize the status of
hyperbaric oxygen in healthcare today?
Niezgoda: The overall acceptance and
validation of hyperbaric medicine as a true medical specialty is probably the
biggest change that has happened over the last 5 to 10 years. When I was doing
my fellowship we had to really work for patient referrals. There were a lot of naysayers. There was a
lot of skepticism. We were criticized for the lack of hyperbaric literature. We
worked hard to convince our colleagues that HBO was a valid adjunctive
treatment. It often felt like I had to be a cheerleader or salesman for this treatment
modality. Fortunately for our patients, much of this has changed. Some really excellent clinical and research
studies with supporting publications have appeared in the literature. Based on
the literature and excellent clinical outcomes, hyperbaric has truly emerged as
a primary advanced treatment modality for wound care patients. Younger doctors
appear more ready to accept case studies which highlight some really amazing
success stories and refer their patients for care. I think mainstream medicine
has finally accepted hyperbaric as a viable treatment. It is rewarding after
all these years of hard work, advocating for a treatment that I believe in
based on outstanding results and limb salvage, to have physicians who had previously
doubted and questioned hyperbaric—the plastic surgeons, the vascular
surgeons, the general surgeons—now calling and asking for our help.
4.
HyperbaricLink: What can the hyperbaric community do to better educate
the public and referring physicians?
Niezgoda: I don't think that, as hyperbaric
physicians, we like to boast or wave our flag. I think we do a great job of providing care. I think we do a great job
of taking care of patients. However, we
don’t do a very good job of telling our success stories. We have wonderful success stories, great
outcomes, and amazing stories to tell about healing. Unfortunately, this information does not get
shared very well. We need to tell the world what a huge impact we make in
people’s lives. When a young child nearly drowns and is resuscitated and has a
great outcome, the media praise the medical community. It makes the news
headlines. Limb salvage, necrotizing fasciitis, and carbon monoxide cases, quite
frankly, can be just as impressive. Sure, patients go out and talk about it. But
if you try to market anything in the US by word-of-mouth, one by one by one by
one, it’s an incredibly slow and uphill climb. We don’t have an effective
mechanism for selling our success. We
need to better educate our colleagues, we need to tell the community our
success stories.
5.
HyperbaricLink: Where do you see things going in the next 3-5
years?
Niezgoda: I suspect that we will see several
changes in the field of hyperbaric medicine, some good, some not. I would anticipate that within the next few
years several new treatment indications will be accepted. This will be due to current and ongoing
research, but also because of continued efforts on the part of the lay public,
some of whom are strong advocates for use of HBO for conditions that aren’t on
that list of approved indications. One of these indications will relate to the
use of HBO for acute hypoxic or ischemic periods, such as for acute ischemic
injury to the brain, to the heart, to the lower extremities. I am hopeful there
will be an improvement in the way we educate hyperbaric physicians. Newer platforms such as online courses and
certification pathways will enhance the care provided to our patients. CMS has already accepted online hyperbaric
education, now we just need the professional hyperbaric societies to do the
same. Unfortunately, I also see that
reimbursement for wound care and hyperbaric services will be cut, which will
translate to program closure. Without
access to this care, patients will ultimately be negatively impacted, they will
suffer with nonhealing wounds and amputations.
6.
HyperbaricLink: If you could teach the world one thing about
hyperbaric oxygen therapy, what would it be?
Niezgoda: Good question. Hyperbaric oxygen
therapy can achieve some impressive results, some amazing outcomes, and it is complementary
or adjunctive to standard care plans. In a limb salvage effort, for example,
hyperbaric oxygen can augment surgical and medical care, it can be that bridge,
that additional treatment that reverses tissue hypoxia, helps healing, and
prevents amputation. So if I could help my surgical colleagues to consider
hyperbaric oxygen therapy, rather than defaulting to amputation, that would be
a huge lesson. If we could communicate the efficacy of hyperbaric in the care
of diabetic foot ulcers, I think we would be doing our patients a great
service.
