Hyperbaric Oxygen Therapy (HBOT) will be available at Henry Mayo by summer 2017. HBOT is a therapy that enhances the body's natural healing process by putting the patient in an enclosed environment in which he or she inhales 100% oxygen.
The result is that the amount of oxygen in the patient's blood is increased, which in turn restores the normal levels of blood gases and tissue function to promote healing and fight infection. HBOT is an effective therapy that is used to supplement other advanced wound care treatments.
Henry Mayo's Wound Care Services proudly reports a 90 percent success rate for healing diabetic or pressure ulcers and other hard-to-heal wounds.
Listen in as Brian Downs, DO discusses HBOT and the wound care services at Henry Mayo Newhall Hospital.
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The Latest Development in Treating Chronic Wounds
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Learn more about Brian Downs, DO
Brian Downs, DO
Brian Downs, DO is a clinical director of the Henry Mayo Newhall Hospital wound care clinic.Learn more about Brian Downs, DO
Transcription:
The Latest Development in Treating Chronic Wounds
Melanie Cole (Host): With a focus on aggressive and individualized treatment plans based on the gold standard for wound care, Henry Mayo Newhall Hospital's wound care services proudly reports a very high success rate for healing diabetic or pressure ulcers, and other hard to heal wounds. Hyperbaric oxygen therapy, or HBOT, is one of those options for those hard to heal wounds. My guest today is Dr. Brian Downs. He's the clinical director of Henry Mayo Newhall Hospital Wound Care Clinic. Welcome to the show, Dr. Downs. So, let's talk about wounds. When somebody has a wound, when do you want them to start to notice whether this is not healing and who is at risk for wounds that don't heal?
Dr. Brian Downs (Guest): Well, thank you, Melanie for having me on today. I really appreciate the opportunity to discuss both chronic wounds and hyperbaric therapy. The people that are most at risk, who we generally see the most of are diabetics. People with diabetes tend to have foot ulcerations that tend to heal very poorly. We also see a good number of patients with pressure ulcerations. Those would be bedsores, more commonly known. We also see patients that have chronic non-healing lower extremity ulcerations from venous or arterial problems. Those are the majority of the patients that we see in the wound care clinic and treat those on a daily basis.
Melanie: And who might be at risk for wounds that do not heal? Are there certain parts of the population that are more at risk for this?
Dr. Downs: Certainly, elderly patients are at increased risk for non-healing wounds. They tend to have more chronic health problems such as diabetes and vascular issues. Those are our main focus. We occasionally see a younger patient, but, in general, it would be an older, chronically ill person that has multiple medical issues, not just the wound.
Melanie: Should people, especially maybe diabetics looking at their feet, should they check for wounds and when is a wound, something that you say, "Whoa, okay, this one has not even -- it's not looking any better." When do they come in to see you?
Dr. Downs: Generally, we consider a non-healing wound of concern if it doesn't heal within a couple weeks. Certainly, diabetics should be checking their feet on a daily basis. If they notice any type of wound, I would suggest that they seek medical help as soon as possible. Those wounds tend to heal very poorly without intervention.
Melanie: Now, coming up soon at Henry Mayo Newhall Hospital, you're getting hyperbaric oxygen therapy. Speak about HBOT is, and what it can do for the patients.
Dr. Downs: Yes, we will be starting hyperbaric oxygen treatments sometime in the summer or early fall. Hyperbaric oxygen treatments – or we typically call it HBO medical treatment -- that is used for difficult to treat wounds. It's specifically indicated for certain diagnostic criteria. Again, diabetic foot ulcerations probably top our list for non-healing wounds that are greatly benefited by the use of hyperbaric oxygen. Hyperbaric oxygen treatments involve the use of 100% oxygen. Typically, in our atmosphere, we're breathing 21%. This 100% oxygen is then pressurized. The pressurization comes in a chamber. Typically, there's two different types of chambers: a multi-place chamber and mono-place chambers. There's only one multi-place chamber in all of LA. The remainder of all the mono-place chambers are found throughout the remainder of the wound care clinics in the Los Angeles area. We will be utilizing mono-place chambers. The chambers are designed to withstand the increased pressures and the elevated oxygen atmosphere. A patient typically would receive daily treatments Monday through Friday for approximately 90 minutes.
Melanie: So, what does it involve? What does it feel like for the patient?
Dr. Downs: Really, there's no actual feeling to the patient. It's essentially the patient going into the chamber which is made of Plexiglas. The patient can actually watch TV while the treatment's occurring. Typically, the most common feeling that the patient will have will be the pressure in their ears. It's similar to a person that's taking an airline flight that will have some pressurization issues with their ears. So, typically, we totally monitor the patient during the -- what we call the descent or ascent -- during the treatment phase. This involves gradual pressurization until the patient receives their prescribed amount of oxygen and pressure, and, then, we have them also clear their ears by swallowing or equalization as you do on a plane by chewing gum or yawning. This prevents any difficulty with the eardrums.
Melanie: So what are some of the benefits of hyperbaric oxygen?
Dr. Downs: Well, the benefits include, of course, increased wound healing time. The basic premise is that oxygen will increase the body's ability to produce growth factors as well as stimulate stem cells. Essentially, what's happening is there's an increased budding of vascularity at the wound bed. This increased vascularity allows the wound the opportunity to heal in a more natural and effective way.
Melanie: And, Dr. Downs, other than hyperbaric oxygen, if somebody is trying to control these non-healing wounds what do you tell them are some at-home things? Do you like a wound to be covered? Do you like it to be moist? Do you like it to be dry? People are not quite sure, and there's a lot of myths floating around. So, clear up some wound myths as far as getting them to heal.
Dr. Downs: That's a great question. We typically have patients come in with two or three different providers giving them different information. Some say keep it dry; some say keep it wet. The literature clearly states that moist wounds heal better. A dry wound obviously is not going to heal well. You need to have that vascularity with the moisture to fully granulate a wound bed and allow it to heal in an appropriate manner. A moist wound tends to macerate -- or if you can think of if you're in the bathtub too long, and your skin gets that whitish color. The same thing can happen to a wound bed; that also does not promote wound healing. So, in our clinic, we check the wounds on a weekly basis to make sure that the wound is maintaining the appropriate environment for wound healing. We have a number of different treatment modalities to aid in that healing process. Anywhere from skin substitutes to foam dressings -- we have a gamut of different treatment modalities that are proven to be very effective to maintain that wound environment.
Melanie: And red flags that you'd like people to watch for their wounds? Redness around the wound, you mentioned the white part that can sometimes come with something that's a little bit over moist. What would you like them to be looking for?
Dr. Downs: Well, the hallmarks of infection are certainly something that we clearly review with our patients prior to each discharge from our wound clinic. Those would include basically a wound looking angry -- red, swollen, painful, with a purulent discharge. Purulent discharge would be a yellow or a greenish discharge from the wound bed. Something that just doesn't look normal. Certainly, you're going to have some redness around the wound. That's a normal process, but we review the actual hallmarks of those signs and symptoms with each patient at each clinic visit.
Melanie: So, wrap it up for us, Dr. Downs with your best advice about non-healing wounds; who you would like to really keep track of these things, and about your new hyperbaric oxygen that's coming soon at Henry Mayo Newhall Hospital.
Dr. Downs: Well, we're really looking forward to starting the hyperbaric oxygen treatment. We feel it's going to add a whole other dimension to our treatment modality to improve our wound healing rate. Anybody can give us the call at Henry Mayo and discuss any issues they may be having with their wound. We also frequently and, more commonly, get referrals from the patient's physician. So, we encourage anybody with any questions to give us the call if they have any questions about any wounds that they have that they feel are not healing appropriately. We certainly look forward to having hyperbaric oxygen therapy to aid in the healing of those difficult wounds, and we look forward to treating as many people in our Valley that need it as possible.
Melanie: Thank you so much, Dr. Downs, for being with us today. You're listening to It's Your Health Radio with Henry Mayo Newhall Hospital and for more information, you can go to henrymayo.com. That's henrymayo.com. This is Melanie Cole, thanks so much for listening.
The Latest Development in Treating Chronic Wounds
Melanie Cole (Host): With a focus on aggressive and individualized treatment plans based on the gold standard for wound care, Henry Mayo Newhall Hospital's wound care services proudly reports a very high success rate for healing diabetic or pressure ulcers, and other hard to heal wounds. Hyperbaric oxygen therapy, or HBOT, is one of those options for those hard to heal wounds. My guest today is Dr. Brian Downs. He's the clinical director of Henry Mayo Newhall Hospital Wound Care Clinic. Welcome to the show, Dr. Downs. So, let's talk about wounds. When somebody has a wound, when do you want them to start to notice whether this is not healing and who is at risk for wounds that don't heal?
Dr. Brian Downs (Guest): Well, thank you, Melanie for having me on today. I really appreciate the opportunity to discuss both chronic wounds and hyperbaric therapy. The people that are most at risk, who we generally see the most of are diabetics. People with diabetes tend to have foot ulcerations that tend to heal very poorly. We also see a good number of patients with pressure ulcerations. Those would be bedsores, more commonly known. We also see patients that have chronic non-healing lower extremity ulcerations from venous or arterial problems. Those are the majority of the patients that we see in the wound care clinic and treat those on a daily basis.
Melanie: And who might be at risk for wounds that do not heal? Are there certain parts of the population that are more at risk for this?
Dr. Downs: Certainly, elderly patients are at increased risk for non-healing wounds. They tend to have more chronic health problems such as diabetes and vascular issues. Those are our main focus. We occasionally see a younger patient, but, in general, it would be an older, chronically ill person that has multiple medical issues, not just the wound.
Melanie: Should people, especially maybe diabetics looking at their feet, should they check for wounds and when is a wound, something that you say, "Whoa, okay, this one has not even -- it's not looking any better." When do they come in to see you?
Dr. Downs: Generally, we consider a non-healing wound of concern if it doesn't heal within a couple weeks. Certainly, diabetics should be checking their feet on a daily basis. If they notice any type of wound, I would suggest that they seek medical help as soon as possible. Those wounds tend to heal very poorly without intervention.
Melanie: Now, coming up soon at Henry Mayo Newhall Hospital, you're getting hyperbaric oxygen therapy. Speak about HBOT is, and what it can do for the patients.
Dr. Downs: Yes, we will be starting hyperbaric oxygen treatments sometime in the summer or early fall. Hyperbaric oxygen treatments – or we typically call it HBO medical treatment -- that is used for difficult to treat wounds. It's specifically indicated for certain diagnostic criteria. Again, diabetic foot ulcerations probably top our list for non-healing wounds that are greatly benefited by the use of hyperbaric oxygen. Hyperbaric oxygen treatments involve the use of 100% oxygen. Typically, in our atmosphere, we're breathing 21%. This 100% oxygen is then pressurized. The pressurization comes in a chamber. Typically, there's two different types of chambers: a multi-place chamber and mono-place chambers. There's only one multi-place chamber in all of LA. The remainder of all the mono-place chambers are found throughout the remainder of the wound care clinics in the Los Angeles area. We will be utilizing mono-place chambers. The chambers are designed to withstand the increased pressures and the elevated oxygen atmosphere. A patient typically would receive daily treatments Monday through Friday for approximately 90 minutes.
Melanie: So, what does it involve? What does it feel like for the patient?
Dr. Downs: Really, there's no actual feeling to the patient. It's essentially the patient going into the chamber which is made of Plexiglas. The patient can actually watch TV while the treatment's occurring. Typically, the most common feeling that the patient will have will be the pressure in their ears. It's similar to a person that's taking an airline flight that will have some pressurization issues with their ears. So, typically, we totally monitor the patient during the -- what we call the descent or ascent -- during the treatment phase. This involves gradual pressurization until the patient receives their prescribed amount of oxygen and pressure, and, then, we have them also clear their ears by swallowing or equalization as you do on a plane by chewing gum or yawning. This prevents any difficulty with the eardrums.
Melanie: So what are some of the benefits of hyperbaric oxygen?
Dr. Downs: Well, the benefits include, of course, increased wound healing time. The basic premise is that oxygen will increase the body's ability to produce growth factors as well as stimulate stem cells. Essentially, what's happening is there's an increased budding of vascularity at the wound bed. This increased vascularity allows the wound the opportunity to heal in a more natural and effective way.
Melanie: And, Dr. Downs, other than hyperbaric oxygen, if somebody is trying to control these non-healing wounds what do you tell them are some at-home things? Do you like a wound to be covered? Do you like it to be moist? Do you like it to be dry? People are not quite sure, and there's a lot of myths floating around. So, clear up some wound myths as far as getting them to heal.
Dr. Downs: That's a great question. We typically have patients come in with two or three different providers giving them different information. Some say keep it dry; some say keep it wet. The literature clearly states that moist wounds heal better. A dry wound obviously is not going to heal well. You need to have that vascularity with the moisture to fully granulate a wound bed and allow it to heal in an appropriate manner. A moist wound tends to macerate -- or if you can think of if you're in the bathtub too long, and your skin gets that whitish color. The same thing can happen to a wound bed; that also does not promote wound healing. So, in our clinic, we check the wounds on a weekly basis to make sure that the wound is maintaining the appropriate environment for wound healing. We have a number of different treatment modalities to aid in that healing process. Anywhere from skin substitutes to foam dressings -- we have a gamut of different treatment modalities that are proven to be very effective to maintain that wound environment.
Melanie: And red flags that you'd like people to watch for their wounds? Redness around the wound, you mentioned the white part that can sometimes come with something that's a little bit over moist. What would you like them to be looking for?
Dr. Downs: Well, the hallmarks of infection are certainly something that we clearly review with our patients prior to each discharge from our wound clinic. Those would include basically a wound looking angry -- red, swollen, painful, with a purulent discharge. Purulent discharge would be a yellow or a greenish discharge from the wound bed. Something that just doesn't look normal. Certainly, you're going to have some redness around the wound. That's a normal process, but we review the actual hallmarks of those signs and symptoms with each patient at each clinic visit.
Melanie: So, wrap it up for us, Dr. Downs with your best advice about non-healing wounds; who you would like to really keep track of these things, and about your new hyperbaric oxygen that's coming soon at Henry Mayo Newhall Hospital.
Dr. Downs: Well, we're really looking forward to starting the hyperbaric oxygen treatment. We feel it's going to add a whole other dimension to our treatment modality to improve our wound healing rate. Anybody can give us the call at Henry Mayo and discuss any issues they may be having with their wound. We also frequently and, more commonly, get referrals from the patient's physician. So, we encourage anybody with any questions to give us the call if they have any questions about any wounds that they have that they feel are not healing appropriately. We certainly look forward to having hyperbaric oxygen therapy to aid in the healing of those difficult wounds, and we look forward to treating as many people in our Valley that need it as possible.
Melanie: Thank you so much, Dr. Downs, for being with us today. You're listening to It's Your Health Radio with Henry Mayo Newhall Hospital and for more information, you can go to henrymayo.com. That's henrymayo.com. This is Melanie Cole, thanks so much for listening.