Is a wound that won't heal keeping you from doing the things you love? Aspirus Riverview Wound & Hyperbarics in Wisconsin Rapids can help. Using their expertise and technology, including two hyperbaric oxygen chambers, they can heal most wounds – even those that haven't responded to conventional treatment.
In this segment, Sarah Falkner, RN, Clinical Nurse Manager with Aspirus Riverview Wound & Hyperbarics, located in Aspirus Riverview Hospital in Wisconsin Rapids, discusses wound healing with Hyperbaric Oxygen Therapy. (HBOT)
Selected Podcast
Wound Healing & Hyperbaric Oxygen Therapy
Featured Speaker:
Sarah Falkner, RN
Sarah Falkner RN, is a Clinical Nurse Manager at Aspirus Riverview Wound & Hyperbarics. Transcription:
Wound Healing & Hyperbaric Oxygen Therapy
Melanie Cole (Host): Have you noticed a wound that won’t heal? Aspirus Riverview Wound and Hyperbarics in Wisconsin Rapids can help. Using their expertise and technology including two Hyperbaric Oxygen Chambers, they can heal most wounds, even those that haven’t responded to conventional treatment. My guest today is Sarah Falkner. She’s a Clinical Nurse Manager with Aspirus Riverview Wound and Hyperbarics located at Aspirus Riverview Hospital in Wisconsin Rapids. Welcome to the show, Sarah. First of all, let’s talk about what type of wounds that we’re talking about – what people should be looking at wounds, and what wounds are we talking about? Where do they generally come from?
Sarah Falkner (Guest): These wounds that we are talking about are diabetic ulcers, where the wound has an infection in it – into the deep structures, into the tendons, or a bone infection -- wounds that do not have diabetes that have osteomyelitis in them, which is the bone infection -- wounds caused from soft tissue radionecrosis -- maybe there’s been some radiation years ago and these are just delayed effects of radiation -- osteoradionecrosis, which is bone necrosis from radiation from years ago, and also failing skin graft or flap. Those are the ones that are typically treated with the Hyperbaric Oxygen Chamber.
Melanie: And when is it that they would start to consider HBOT? If this wound has been watched for a while, how long – and it’s been dressed, and cleaned, and all of the things that you’re supposed to do to keep a wound well, when is it time to start to look at other options?
Sarah: After 30 days. We like to do standard care of 30 days of wound care, treat the wound with the most up-to-date clinical practice guidelines, check for infection, treat the infection. We measure the wounds every week. If those wounds are not meeting goals at four weeks that we want to be at – we would like a diabetic ulcer to be healed at 50% in four weeks. If these wounds are not healing at the correct rate, then we look at advanced modalities, and we see which patients meet the criteria for these advanced modalities.
Melanie: Let’s talk about the advanced modalities like hyperbaric Oxygen therapy. What is HBOT?
Sarah: HBOT is Hyperbaric Oxygen Therapy. What this is, is it is delivering 100% pure Oxygen to a patient through increased atmospheric pressure in an enclosed, hard chamber. What happens when we’re out just walking around and breathing in normal air? What we’re breathing in is 21% Oxygen. When we go into this Oxygen Chamber, the Chamber is filled with 100% Oxygen, and then the Chamber is – we turn a dial, which increases the atmospheric pressure on the patient that they’re delivering through the body. This actually pushes the Oxygen -- which normally just runs through red blood cells – it pushes that Oxygen into the plasma, into the tissues so that the Oxygen can be used as medicine to help heal these wounds.
Melanie: What are some of the benefits of it? How does it work, really?
Sarah: That’s the benefit is getting the Oxygen actually to these areas. Let’s just say with a diabetic ulcer with osteomyelitis, which is that bone infection; it’s going to get the Oxygen to the bone. Oxygen, it treats – it’s antimicrobial, so it fights infection. It’s going to help treat the infection along with the antibiotics, and it enhances the activity of the antibiotic. And also, it just increases Oxygenation to that area and helps the bone grow new bone cells, and new tissue in that surrounding area – the same thing with wounds with chronic refractory osteo, which -- the patient doesn’t have to be diabetic, but they could have just a bone infection. We’re treating that one the same way. Sometimes patients that had radiation years ago, or even just a year ago, or whenever, there’s sometimes just the chance that they could get some soft tissue damage or some bone damage from that radiation that was much needed at the time to treat their cancer. Maybe the area that had the radiation treatment – maybe it was on the tongue, or in the mouth, and now they have dry mouth, and they’re having a hard time swallowing, or they just can’t get good saliva. Or, maybe, there was some radiation to the bowels because there was some colon cancer, and now that patient’s having some diarrhea or some bloody stool. Hyperbarics treats that soft tissue in that area that’s radiated, and when you’re pushing Oxygen through the blood stream, through the plasma, into the tissues, those tissues that have that radio-necrosis start to grow new capillaries, and it grows new skin. And then, those areas that are having problems heal, and those problems resolve, or at least those symptoms are improved.
Melanie: What does it feel like for the patient?
Sarah: When the patient goes in there – if you have ever flown in an airplane before – that’s our most common way that we can describe it to a patient – and you’re taking off on an airplane, and you get that – or when you’re ascending or descending, and you get that terrible pressure in your ears, and you have to clear your ears, that’s what you feel is that pressure in your ears. We teach our patients just how to clear their ears. We work with them. We can adjust the dial a little bit so they can clear their ears. Some patients do have to get some tubes in their ears to help deal with the pressure issues if they are having problems with that, but most patients do fine without that. And while the patient is in that Chamber, they are able to watch TV. We can talk to them with a special telephone that we have hooked up to the Chamber. Some patients take a nap in there. Some patients listen to music. Some patients bring in movies, and they watch a movie while they’re there because it is about a two-hour treatment. The patient comes daily, Monday through Friday, for about two hours, and basically, besides the pressure when they’re going to the depth and when they’re coming back up to depth, that’s the only thing that they’re really feeling in there besides maybe being a little bored in there.
Melanie: Do they ever get claustrophobic?
Sarah: Yep, there are some people with claustrophobia. Some people already have prescription medication, maybe for anxiety, and they’ll take one of their anxiety pills before they go in there and they’re fine. Some patients just know that they get claustrophobic when they have a test. Some of them will just try it and see if they do okay. Some have done just fine and realized it’s actually not that bad. Some have realized they are too claustrophobic, and then our doctor works with them on a medication that will work just to help them feel more relaxed and sleepy, and then they do fine with the treatment. Even the patients with claustrophobia, most of them are able to deal with that, and we help them with those symptoms.
Melanie: And how often, for how long – you mentioned that they come every day for a week – how long does it take for this to really start to work?
Sarah: The patients come every day, and the treatments are two hours each day from start to finish. We don’t start to see improvement typically until 20 treatments, so that’s at the end of one month. Most insurances require that every 20 treatments that we are doing an evaluation – we’re doing that anyways – that we evaluate how are the symptoms doing if we’re treating symptoms? If we’re treating a wound, how is the wound doing? Are the measurements getting smaller? If we’re having progress in the wound healing, if we’re having improvement in the symptoms, then the patient can continue the treatment. We can do up to 40 to 60 treatments, so most patients that complete the full order come two to three months.
Melanie: What information does the technician need to know from the patient prior to this type of therapy?
Sarah: What we do is we do a risk assessment on any patient going into the Chamber. We look at any history of – maybe somebody has problems with their sinuses or clearing their sinuses. Maybe then they could take some Sudafed or something before they go into the Chamber. We look at are they diabetic? If they’re diabetic, we check their blood sugars before they go into the Chamber and when they come out because the Hyperbarics can lower a patient’s blood sugar. We monitor their blood sugars. We’re looking for history of congestive heart failure, different medications that the patient is on so that we just know what we want to watch for when that patient is going in and when they’re coming out what symptoms they may experience so that we can be prepared at all times.
Melanie: Wrap it up for us, Sarah, with your best advice for people who are examining – especially diabetics, who have to really give themselves a good check on their feet and their legs, and check these wounds – what you want them to know about noticing wounds that are not healing, and what you’d like them to know about Hyperbaric Oxygen Therapy.
Sarah: If they’re noticing a wound that is not healing and it is not responding to treatment, it is a good time to take a look to see if they would meet criteria for the Hyperbaric Chamber. Maybe that physician or that patient that’s out there doesn’t know if they meet criteria, we can always at least do a consult and look at the wound history, the treatment history, see what tests have already been ordered, see if they do meet criteria already. Or, our physicians can work with their current physician, or the patient could come to our center, and we could help order the correct tests to see if they would meet the criteria to get into the chamber.
Melanie: Thank you, so much, Sarah, for being with us. If you, or someone you know, are living with a wound that simply will not heal, give Aspirus Riverview Wound and Hyperbarics a call at 715-422-7755. You can also find out more at Aspirus.org/RiverviewWoundCenter. This is Melanie Cole. You’re listening to Aspirus Health Talk. Thanks, so much for listening.
Wound Healing & Hyperbaric Oxygen Therapy
Melanie Cole (Host): Have you noticed a wound that won’t heal? Aspirus Riverview Wound and Hyperbarics in Wisconsin Rapids can help. Using their expertise and technology including two Hyperbaric Oxygen Chambers, they can heal most wounds, even those that haven’t responded to conventional treatment. My guest today is Sarah Falkner. She’s a Clinical Nurse Manager with Aspirus Riverview Wound and Hyperbarics located at Aspirus Riverview Hospital in Wisconsin Rapids. Welcome to the show, Sarah. First of all, let’s talk about what type of wounds that we’re talking about – what people should be looking at wounds, and what wounds are we talking about? Where do they generally come from?
Sarah Falkner (Guest): These wounds that we are talking about are diabetic ulcers, where the wound has an infection in it – into the deep structures, into the tendons, or a bone infection -- wounds that do not have diabetes that have osteomyelitis in them, which is the bone infection -- wounds caused from soft tissue radionecrosis -- maybe there’s been some radiation years ago and these are just delayed effects of radiation -- osteoradionecrosis, which is bone necrosis from radiation from years ago, and also failing skin graft or flap. Those are the ones that are typically treated with the Hyperbaric Oxygen Chamber.
Melanie: And when is it that they would start to consider HBOT? If this wound has been watched for a while, how long – and it’s been dressed, and cleaned, and all of the things that you’re supposed to do to keep a wound well, when is it time to start to look at other options?
Sarah: After 30 days. We like to do standard care of 30 days of wound care, treat the wound with the most up-to-date clinical practice guidelines, check for infection, treat the infection. We measure the wounds every week. If those wounds are not meeting goals at four weeks that we want to be at – we would like a diabetic ulcer to be healed at 50% in four weeks. If these wounds are not healing at the correct rate, then we look at advanced modalities, and we see which patients meet the criteria for these advanced modalities.
Melanie: Let’s talk about the advanced modalities like hyperbaric Oxygen therapy. What is HBOT?
Sarah: HBOT is Hyperbaric Oxygen Therapy. What this is, is it is delivering 100% pure Oxygen to a patient through increased atmospheric pressure in an enclosed, hard chamber. What happens when we’re out just walking around and breathing in normal air? What we’re breathing in is 21% Oxygen. When we go into this Oxygen Chamber, the Chamber is filled with 100% Oxygen, and then the Chamber is – we turn a dial, which increases the atmospheric pressure on the patient that they’re delivering through the body. This actually pushes the Oxygen -- which normally just runs through red blood cells – it pushes that Oxygen into the plasma, into the tissues so that the Oxygen can be used as medicine to help heal these wounds.
Melanie: What are some of the benefits of it? How does it work, really?
Sarah: That’s the benefit is getting the Oxygen actually to these areas. Let’s just say with a diabetic ulcer with osteomyelitis, which is that bone infection; it’s going to get the Oxygen to the bone. Oxygen, it treats – it’s antimicrobial, so it fights infection. It’s going to help treat the infection along with the antibiotics, and it enhances the activity of the antibiotic. And also, it just increases Oxygenation to that area and helps the bone grow new bone cells, and new tissue in that surrounding area – the same thing with wounds with chronic refractory osteo, which -- the patient doesn’t have to be diabetic, but they could have just a bone infection. We’re treating that one the same way. Sometimes patients that had radiation years ago, or even just a year ago, or whenever, there’s sometimes just the chance that they could get some soft tissue damage or some bone damage from that radiation that was much needed at the time to treat their cancer. Maybe the area that had the radiation treatment – maybe it was on the tongue, or in the mouth, and now they have dry mouth, and they’re having a hard time swallowing, or they just can’t get good saliva. Or, maybe, there was some radiation to the bowels because there was some colon cancer, and now that patient’s having some diarrhea or some bloody stool. Hyperbarics treats that soft tissue in that area that’s radiated, and when you’re pushing Oxygen through the blood stream, through the plasma, into the tissues, those tissues that have that radio-necrosis start to grow new capillaries, and it grows new skin. And then, those areas that are having problems heal, and those problems resolve, or at least those symptoms are improved.
Melanie: What does it feel like for the patient?
Sarah: When the patient goes in there – if you have ever flown in an airplane before – that’s our most common way that we can describe it to a patient – and you’re taking off on an airplane, and you get that – or when you’re ascending or descending, and you get that terrible pressure in your ears, and you have to clear your ears, that’s what you feel is that pressure in your ears. We teach our patients just how to clear their ears. We work with them. We can adjust the dial a little bit so they can clear their ears. Some patients do have to get some tubes in their ears to help deal with the pressure issues if they are having problems with that, but most patients do fine without that. And while the patient is in that Chamber, they are able to watch TV. We can talk to them with a special telephone that we have hooked up to the Chamber. Some patients take a nap in there. Some patients listen to music. Some patients bring in movies, and they watch a movie while they’re there because it is about a two-hour treatment. The patient comes daily, Monday through Friday, for about two hours, and basically, besides the pressure when they’re going to the depth and when they’re coming back up to depth, that’s the only thing that they’re really feeling in there besides maybe being a little bored in there.
Melanie: Do they ever get claustrophobic?
Sarah: Yep, there are some people with claustrophobia. Some people already have prescription medication, maybe for anxiety, and they’ll take one of their anxiety pills before they go in there and they’re fine. Some patients just know that they get claustrophobic when they have a test. Some of them will just try it and see if they do okay. Some have done just fine and realized it’s actually not that bad. Some have realized they are too claustrophobic, and then our doctor works with them on a medication that will work just to help them feel more relaxed and sleepy, and then they do fine with the treatment. Even the patients with claustrophobia, most of them are able to deal with that, and we help them with those symptoms.
Melanie: And how often, for how long – you mentioned that they come every day for a week – how long does it take for this to really start to work?
Sarah: The patients come every day, and the treatments are two hours each day from start to finish. We don’t start to see improvement typically until 20 treatments, so that’s at the end of one month. Most insurances require that every 20 treatments that we are doing an evaluation – we’re doing that anyways – that we evaluate how are the symptoms doing if we’re treating symptoms? If we’re treating a wound, how is the wound doing? Are the measurements getting smaller? If we’re having progress in the wound healing, if we’re having improvement in the symptoms, then the patient can continue the treatment. We can do up to 40 to 60 treatments, so most patients that complete the full order come two to three months.
Melanie: What information does the technician need to know from the patient prior to this type of therapy?
Sarah: What we do is we do a risk assessment on any patient going into the Chamber. We look at any history of – maybe somebody has problems with their sinuses or clearing their sinuses. Maybe then they could take some Sudafed or something before they go into the Chamber. We look at are they diabetic? If they’re diabetic, we check their blood sugars before they go into the Chamber and when they come out because the Hyperbarics can lower a patient’s blood sugar. We monitor their blood sugars. We’re looking for history of congestive heart failure, different medications that the patient is on so that we just know what we want to watch for when that patient is going in and when they’re coming out what symptoms they may experience so that we can be prepared at all times.
Melanie: Wrap it up for us, Sarah, with your best advice for people who are examining – especially diabetics, who have to really give themselves a good check on their feet and their legs, and check these wounds – what you want them to know about noticing wounds that are not healing, and what you’d like them to know about Hyperbaric Oxygen Therapy.
Sarah: If they’re noticing a wound that is not healing and it is not responding to treatment, it is a good time to take a look to see if they would meet criteria for the Hyperbaric Chamber. Maybe that physician or that patient that’s out there doesn’t know if they meet criteria, we can always at least do a consult and look at the wound history, the treatment history, see what tests have already been ordered, see if they do meet criteria already. Or, our physicians can work with their current physician, or the patient could come to our center, and we could help order the correct tests to see if they would meet the criteria to get into the chamber.
Melanie: Thank you, so much, Sarah, for being with us. If you, or someone you know, are living with a wound that simply will not heal, give Aspirus Riverview Wound and Hyperbarics a call at 715-422-7755. You can also find out more at Aspirus.org/RiverviewWoundCenter. This is Melanie Cole. You’re listening to Aspirus Health Talk. Thanks, so much for listening.