Hyperbaric Oxygen Therapy of Arizona

Take a breath. The air you just took in is about 21 percent oxygen. The capillaries in your lungs pick up the oxygen, and it's dissolved in the plasma of your blood and gets carried to all parts of your body. Your body uses that oxygen to heal itself. 21 percent oxygen is usually plenty to do the job.

When you have a foot ulcer, that tissue and your body could use even more oxygen. The white blood cells that fight infection in an ulcer use 20 times more oxygen when they're killing bacteria. Also, the more oxygen your body has to work with, the more efficiently it lays down wound-repairing connective tissue.

Yet, just when you need more oxygen, you may have less. If you have neuropathy (diabetic nerve damage), that may cause changes in blood flow, resulting in islands of low oxygen levels in your foot. Less oxygen means slower healing, and an ulcer that doesn't heal could eventually lead to an amputation.

So, you should try to get extra oxygen in your blood when you have a foot ulcer. We need to bring the oxygen levels in the tissues around the ulcer up to normal, or even higher.

But, sitting in your living room and breathing in 100 percent oxygen won't do the trick. Under normal circumstances, only so much oxygen will dissolve in your blood.

It's like trying to dissolve salt in water. When you pour a spoonful of salt into a glass of cold water, not all of the salt dissolves. Simply adding more salt doesn't make the water dissolve more salt. But when you pour a spoonful of salt into a glass of hot water, all the salt dissolves. At higher temperatures, more salt dissolves.

What temperature does for salt in water, pressure does for oxygen in blood. At higher pressures, more oxygen dissolves. (Notice the gas leaving solution when you open a can of soda.)

Some studies have suggested that hyperbaric oxygen therapy is effective, when used with other therapies, in treating diabetic foot ulcers and preventing amputations due to ulcers.

But HBO therapy isn't magic. It won't work unless it's part of an aggressive team approach.

To get your ulcer to heal you will need:

: tight blood glucose control

:aggressive removal of dead tissue

:infection control

:correction of circulation problems

:good nutrition and possibly,

:hyperbaric oxygen therapy.

How It's Done

At our facility (and some other centers), we have a walk-in chamber. You sit or recline in an filtered air, pressurized chamber, possibly with one or more people, while you breathe oxygen through a mask or head tent or hood. You can often watch TV or read or sleep.

At some centers, you will lie in a one-person chamber, and the entire chamber is filled and pressurized with oxygen.

But, in a chamber of this type, it is the inhaled oxygen, which is then absorbed by your blood after you breathe it, that speeds wound healing, not the oxygen drifting past the wound.

(You may have seen advertisements for devices that encase a person's leg and deliver oxygen to the skin. This is not hyperbaric oxygen therapy, and it's not effective - your skin doesn't absorb oxygen that way. These devices may even reduce the amount of oxygen that gets to your leg.)

If your ulcer is not infected, treatment once a day for two hours is enough to stimulate healing. You can do this as an outpatient.

However, if your ulcer is infected and there is a high risk of amputation, you will need treatment twice a day. Usually, treatments will continue for three to four weeks. In most cases, you'll have to be on antibiotics. If you take insulin, your doctor may need to change your dose while you are in treatment.

The average cost for an entire course of treatment is $6000. To $8,000. Medicare and insurance companies cover HBO treatments because they are effective, however, may have criteria that must be met to be approved. Aggressive program of wound management is the key to success.

Effects Of Hyperbaric Oxygen Therapy

Oxygen levels remain high in tissues for several hours after a treatment, which encourages capillary growth. New capillaries mean more blood gets to the site of the ulcer, which speeds healing. High oxygen levels also make red blood cells more flexible so they can get through the twists and turns of the capillaries; get to where they're needed.

Although high doses of oxygen can produce a reduction in blood flow to normal tissue, this effect is more than made up for by the 10- to 15- fold increase in the amount of oxygen dissolved in the plasma. And sometimes you want less flow—as long as the flow is rich in oxygen—such as when your foot is already swollen. There are, however, some side effects of HBO therapy.

Side effects due to pressure

During the pressure changes, your ears will pop, as they do when you fly in an airplane or drive in the mountains. If your ears can't equalize the pressure, such as, when you are congested with a cold or hay fever, your ears or sinuses could be damaged. Therefore, you shouldn't have treatments until you handle the congestion. Some people with chronic ear trouble may need to use (as infants may) ear tubes to continue therapy. These are surgically inserted but not permanent.

You will need special consultation and medical

clearance if you have active asthma, emphysema, or other lung problems that would put you at high risk for problems. People with untreated collapsed lung must be excluded. A patient can suffer a collapsed lung during treatment. Lung problems are very rare, occurring in about 1 in 50,000 treatments. In England Dr. James' facility has treated over one million, two hundred thousand treatments with no major incidents. Proper, proven protocol must always be adhered to.

Older people sometimes find that, after treatment, their vision improves. They can read fine print better. Unfortunately, this effect may only last a few weeks.

Oxygen Toxicity

Oxygen can be overdosed and toxic effects, usually affecting the central nervous system or lungscan be produced. Proper, proven protocol must always be adhered to. Long exposure to high doses of oxygen under pressure can cause grand mal seizures. This would be reversed by stopping HBO treatment. Therapy could continue after the seizure stopped.

Susceptibility varies widely, but as oxygen in the blood goes up, so does the risk of oxygen seizures. For this reason, oxygen treatments are performed within the proper pressure limits for given amounts of time. Fever and certain medications can predispose you to oxygen seizures. Always make certain to tell everyone involved what drugs you are taking.

High oxygen levels can cause irritation of the lung tissue, so, treatment schedules have been refined. These complications are virtually unheard of in the United States today. Proper, proven protocol must always be adhered to.

Confinement Anxiety

Because HBO treatments take place in closed chambers, some people get anxious. Some, because of claustrophobia might need sedation but in a multi-person chamber, which is must larger, usually that wouldn't be necessary.

Where Do I Go?

There are over 400 hyperbaric oxygen therapy centers throughout the United States and Canada. Most are in hospitals, many of these are associated with universities. They are necessary whenever there is an ongoing treatment that requires a hospital environment or immediate access to equipment or services.

There are an increasing number of free standing, non hospital hyperbaric facilities. These are generally for mobile, outpatient care, where immediate, emergency care is not necessary.

Many chronic wounds, under the direction of the primary care physician, can access hyperbaric oxygen treatments as part of their regimen through one of these free standing units. Besides the convenience, the (same) therapeutic protocols can be delivered more cost effectively.

Hyperbaric Oxygen Therapy for Foot Ulcers