By: Greg Gadowski, MD
Of the many services offered by the Center for Wound Healing at Brattleboro Memorial Hospital (BMH) we get the most questions about Hyperbaric Oxygen Therapy. BMH has the only comprehensive wound center with hyperbaric chambers in Vermont, so the interest is understandable. Here are the answers to the Hyperbaric Oxygen Therapy questions we get most frequently.
What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy (HBOT) allows patients to breathe pure oxygen while lying comfortably inside a pressurized chamber. Breathing 100 percent oxygen delivered at increased pressure increases the amount of oxygen available to the body’s organs and tissues. This improves the effects of certain antibiotics, activates white blood cells to fight infection, and promotes the healing of chronic wounds.
Why are nautical/diving terms used in this form of therapy?
Much of the technology and information that we currently use in clinical hyperbaric oxygen therapy was developed by the world’s navies during World War II as a result of the use of military divers (”frogmen”) and underwater demolitions. Many of the pioneers of hyperbaric medicine were from military backgrounds, and many current practitioners became interested in hyperbaric medicine through diving-related experiences. Thus, diving-related terminology continues to be used, even though clinical hyperbaric practice has evolved away from its under-water beginnings.
What types of conditions are treated with HBOT?
Hyperbaric oxygen therapy is used in combination with other wound treatments for patients with:
- Diabetic wounds of the lower extremities
- Delayed radiation injuries
- Chronic refractory osteomyelitis (persistent and recurring infection of the bone)
- Compromised skin grafts and flaps
- Other chronic non-healing wounds
What are the common side effects of HBOT?
Most patients tolerate hyperbaric oxygen therapy quite well. However, there are several common side effects that may occur:
- Temporary visual changes: You may experience subtle improvement or worsening of your vision during the course of treatment. Vision will return to pretreatment levels after completing the course of treatment.
- Fullness in the ears: As the hyperbaric chamber pressurizes, you may notice a “popping” or fullness in your ears. This is a temporary sensation and you will be instructed on techniques to clear your ears.
- Increased opaqueness of preexisting cataracts: If you have been diagnosed with cataracts, you should discuss the possibility of increased opaqueness with your ophthalmologist.
What does the HBOT chamber look like?
The chamber is cylinder-shaped allowing you to lie comfortably within it during treatment. You can see through the chamber throughout the session and can watch TV, listen to music or even take a nap. A nurse specially trained in hyperbaric medicine will stay with you at all times while you receive treatment and will stay in constant communication with you via an intercom system.
Are there different types of chambers?
Yes, chambers are classified into two categories: Monoplace and Multiplace.
- Monoplace chambers are defined as chambers designed to accommodate only one patient at a time. Generally, these consist of an acrylic tube with a door at one end through which the patient is placed into the chamber. These chambers can be compressed with either air or oxygen and have the advantage of needing less physical space. The disadvantages are that they allow only limited access to the patient and tend to restrict patient positioning.
- Mulitplace chambers are designed to accommodate two or more patients. Some of these chambers are massive and can hold 20 or more people. Thus, they require a large physical space and significant infrastructure to operate, and can be very expensive to acquire, maintain, and staff. The advantages are that they allow for an inside attendant so full access to all patients is possible, which makes caring for very ill patients easier. Also, their size tends to minimize claustrophobia in susceptible patients.
What type of chamber does the BMH Center for Wound Healing use?
The BMH Center for Wound Healing has two monoplace chambers that generally operate five days per week, between the hours of 8:00 AM – 5:00 PM.
What is the typical treatment process?
Your physician can order 20 to 30 treatments which generally last two hours a day, five days a week. Following an evaluation by a specially certified Wound Center physician, you will be given detailed instructions on how to prepare for treatment and what to expect during treatment.
- Pretreatment preparation: You cannot wear the following while in the chamber: hair spray, perfumes, makeup, nylons (stockings or pantyhose), ointments, liniments, petroleum or Vaseline products, wigs or hair pieces, aftershave, synthetic clothing (rayon, nylon, etc.) or any type of salves. In addition, watches, pens, lighters, cigarettes and matches are not permitted in the chamber.
- Treatment: The first few minutes of treatment will be somewhat noisy. The chamber may seem warm at first and then the temperature will be adjusted to a comfortable setting. You will feel a change in pressure in your ears and will be instructed on how to equalize the pressure. During the remainder of the treatment, you can read, sleep, watch TV or listen to music.
- Post treatment: After completion of the therapy session, the chamber will be decompressed to normal atmospheric pressure. You may feel a bubbling sensation in the ears, but there should be no discomfort. The chamber will cool as it is decompressed.
How do I get a consultation from the wound center?
You may call the Center for Wound Healing directly or be referred by your doctor. To make an appointment directly, call 802-275-3674.
Does insurance cover wound care treatments?
Most health insurance companies, including Medicare, cover treatments you receive at the Center for Wound Healing. Many plans require a co-payment for which you will be responsible. Your plan may also have specific coverage limits. You should call your insurance company with questions you have about your coverage.
The Center for Wound Healing will bill your insurance company based on the information you supply when you register. If your insurance company changes at any time during your treatment at the Center for Wound Healing, it is your responsibility to inform us.
Will I Have to Change my Primary Care Doctor or Specialist?
No. In fact, the Center for Wound Healing prefers to work in partnership with your physician or medical specialist during your treatments. We even keep your doctor informed with frequent progress reports. While you’ll be receiving treatment for your wound from the Center for Wound Healing physicians, you’ll continue to receive all of your routine medical care from your primary care physician.
Gregory Gadowski, MD, is the Medical Director for the Brattleboro Memorial Hospital Center for Wound Healing and a board-certified surgeon practicing at Brattleboro General Surgery. For more information call 802-275-3674 or visit online at www.bmhvt.org.