The Wound Healing Center at Doctors Hospital of Laredo provides a comprehensive range of services for patients suffering from chronic or non-healing wounds. The wound care program provides advanced treatment options and a team that specializes in advanced modalities in wound care.
In this segment, Dr. Manuel Gonzalez, General Surgeon and the Medical Director of Doctors Hospital Wound Healing Center, discusses the amazing benefits of HBOT (Hyperbaric Oxygen Therapy) for patients suffering from chronic or non-healing wounds.
Selected Podcast
The Benefits of HBOT (Hyperbaric Oxygen Therapy)
Featured Speaker:
Manuel Gonzalez, MD
Manuel Gonzalez, MD is a vascular surgeon and a member of the medical staff at Doctors Hospital of Laredo. Transcription:
The Benefits of HBOT (Hyperbaric Oxygen Therapy)
Melanie Cole (Host): Hyperbaric Oxygen Therapy, H-B-O-T, is a medical treatment which enhances the body’s natural healing process. It’s used for a wide variety of treatments and may be part of an overall medical care plan. My guest today is Dr. Manuel Gonzalez. He’s a Vascular Surgeon and the Medical Director of Doctor’s Hospital Wound Healing Center. Welcome to the show, Dr. Gonzalez. Tell us a little bit about hyperbaric oxygen therapy and the evolution of it. When did this come about?
Dr. Manuel Gonzalez (Guest): Well, I can’t tell you exactly when it came about, but it’s been around for several decades now. When it first started, it was thought that it would increase the blood supply to the red cells and they would do it by segments of the body. In other words, they would go ahead and put a part of the limb that was ischemic, and/or a non-healing ulcer into a small canister and they would put a high concentration of oxygen into the canister. With time they found out that this was not the right way to go, so therefore, with multiple research they found that it’s submerging the body to two atmospheres of pressure, or two-and-a-half atmospheres of pressure, they could increase the oxygenation to the plasma and not to the red blood cells. What happens is that the plasma is going with the red cells, they reach areas of hypoxia, or areas of low oxygen tension where the oxygen is really needed to help the healing process and/or, as well to augment the reach of antibiotic therapy.
Melanie: So this increased oxygen enhances the ability of, not only what you’re discussing, but the white blood cells to kill bacteria, reduce swelling, so what are some of the benefits? Who is a candidate for HBOT?
Dr. Gonzalez: Well, as time goes on the government has limited us quite a bit in who is a candidate for hyperoxygenation. Some of the people that really benefit from them are, of course, some burn patients, people that have infections of the bone, diabetics, people with ulcerations secondary to peripheral vascular disease that are not healing, people that have had post-radiation therapy – in other words, post-cancer therapy – that have a problem with wound healing secondary to radiation.
Another thing is that they’re also being used a lot for mandibular ischemia and/or necrosis of the mandibular bone at the joint area and also for post-radiation proctitis, which is quite common in this new era where we’re doing advanced surgery down all the way to the anal region for carcinoma of the colon. Many people get radiation at the rectal area and get resected for a cancer cure, but end up with what they call radiation proctitis, which is a very bad situation for patients to have and they benefit greatly with hyperbaric oxygenation.
Melanie: What’s it like? What’s this procedure like for a patient?
Dr. Gonzalez: Well, first of all, what we do is that we make sure that it’s an appropriate candidate. Once we have an appropriate candidate, we make sure that the patients can tolerate hyper-pressure. In other words, we make sure his heart is functioning well, he’s not in any heart failure. We make sure that he has good swallowing mechanisms, that his ear drums and ears are appropriately seen and treated by an ENT specialist prior to diving. Once we have all of these preparations, the patients are brought to the center, he’s given a tour, and an explanation of the entire system or protocol is gone with the patient. After the patient has gone through this, the patient is taken into the hyperbaric room. He is shown the chambers and what to expect and what not to expect and also to alleviate their fear of claustrophobic. Our tanks are made out of clear plastic – acrylic, which maintains the pressure – you can see out. We also have televisions, which is usually standard for most hyperbaric chambers so the patient can lay there and watch a television program to alleviate not only their tension but to pass the time.
Melanie: What does it feel like?
Dr. Gonzalez: I really can’t tell you. I had only been there about ten years ago, and it’s like SCUBA diving. You go down, and you start feeling pressure on your body, and the main thing you have to do is equilibrate your ears. Basically, you don’t feel much except in the tympanic membrane and your earlobes, and you start feeling – like you do on a plane, sometimes your ears pop. The main feeling is mostly in the ENT – Ear, nose, and throat aspect of the body. Otherwise, you don’t feel much.
Melanie: And Dr. Gonzalez, does insurance recognize HBOT?
Dr. Gonzalez: Well, some insurance – most of the private insurance, once you give the proper documentation, they will accept it. Our problem is mostly getting through the government and all the beauroughcratic lingo that we have to go through with Medicare and non-Medicare patients – Medicaid patients. A lot of these do not qualify because they don’t fall into the realm of the protocols of the Medicare/Medicaid system. Basically, there’s -- like I tell you, it’s very limited who can go into the chambers and who can afford it if they have private pay.
Melanie: So how many times would somebody need it if they’ve got a non-healing wound, or if you’re using it for another purpose, then how many times do they have to do this?
Dr. Gonzalez: Well, it depends on the wound, of course, but we usually settle for about 30. We usually go from 20 to 30, to 45. It all depends on the wound, and it all depends on – what we do is at least once a week we assess them for their circulatory status because things change really fast. If their circulatory status changes, the whole protocol changes. But somebody that stays even-keeled, we go about 30 times in the chamber, mostly at 2 atmospheres or 2.5 atmospheres of pressure.
Melanie: And how long would it take somebody to see a result -- if they’ve got a non-healing wound and they’ve done some of these treatments, when would they start to notice a difference?
Dr. Gonzalez: We usually see a difference within a week – two weeks.
Melanie: Wow.
Dr. Gonzalez: Because we do a lot of debridement, so what happens is we look at the wounds quite frequently so we can tell within a week, two weeks if we’re in the right direction. If we’re not, we usually change the debridement protocol and not the hyperbaric protocol.
Melanie: So what would you like to tell patients in the last few minutes, Dr. Gonzalez, about the benefits of hyperbaric oxygen therapy and how to prepare for this treatment?
Dr. Gonzalez: Well, for hyperbaric oxygenation, it’s an adjuvant to good wound care. It’s not the main treatment, but it’s an adjuvant, it helps us. It’s the last 10 yards of a 90-yard run, but the 90-yard run is very important, so that means proper assessment, proper perfusion, proper nutrition, diabetic control, and in the last 10 yards to help us – or the last five yards – is hyperbaric oxygenation. And how to prepare for it? They have to go through the rigamarole of being here and going through the adjustment phase to teach them what it is, so they know what to expect. The most important thing is knowing that the patient knows what to expect when they go into the chamber -- ear cleaning, ear cleaning, swallowing – be sure they feel that they’re not claustrophobic in a closed box, that they can see and watch television. You’ve got to prepare them mentally as well as physically.
Melanie: That’s so important to point out. And why should they come to Doctor’s Hospital of Laredo for their care?
Dr. Gonzalez: Well, I think we’re the only ones in Laredo that offer a surgeon full-time in the wound care center. Second, they have a vascular surgeon full-time at the wound care center, which no one else has. The nursing staff here is superb.
Melanie: Thank you, so much, for being with us today, Dr. Gonzalez. You’re listening to Doctor’s Hospital Health News with Doctor’s Hospital of Laredo, and for more information, you can go to IChooseDoctorsHospital.com, that’s IChooseDoctorsHospital.com. Physicians are independent practitioners who are not employees or agents of Doctor’s Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctor’s Hosptial of Laredo is directly or indirectly owned by a partnership that includes physician owners including certain members of the hospital medical staff. This is Melanie Cole. Thanks, so much, for listening.
The Benefits of HBOT (Hyperbaric Oxygen Therapy)
Melanie Cole (Host): Hyperbaric Oxygen Therapy, H-B-O-T, is a medical treatment which enhances the body’s natural healing process. It’s used for a wide variety of treatments and may be part of an overall medical care plan. My guest today is Dr. Manuel Gonzalez. He’s a Vascular Surgeon and the Medical Director of Doctor’s Hospital Wound Healing Center. Welcome to the show, Dr. Gonzalez. Tell us a little bit about hyperbaric oxygen therapy and the evolution of it. When did this come about?
Dr. Manuel Gonzalez (Guest): Well, I can’t tell you exactly when it came about, but it’s been around for several decades now. When it first started, it was thought that it would increase the blood supply to the red cells and they would do it by segments of the body. In other words, they would go ahead and put a part of the limb that was ischemic, and/or a non-healing ulcer into a small canister and they would put a high concentration of oxygen into the canister. With time they found out that this was not the right way to go, so therefore, with multiple research they found that it’s submerging the body to two atmospheres of pressure, or two-and-a-half atmospheres of pressure, they could increase the oxygenation to the plasma and not to the red blood cells. What happens is that the plasma is going with the red cells, they reach areas of hypoxia, or areas of low oxygen tension where the oxygen is really needed to help the healing process and/or, as well to augment the reach of antibiotic therapy.
Melanie: So this increased oxygen enhances the ability of, not only what you’re discussing, but the white blood cells to kill bacteria, reduce swelling, so what are some of the benefits? Who is a candidate for HBOT?
Dr. Gonzalez: Well, as time goes on the government has limited us quite a bit in who is a candidate for hyperoxygenation. Some of the people that really benefit from them are, of course, some burn patients, people that have infections of the bone, diabetics, people with ulcerations secondary to peripheral vascular disease that are not healing, people that have had post-radiation therapy – in other words, post-cancer therapy – that have a problem with wound healing secondary to radiation.
Another thing is that they’re also being used a lot for mandibular ischemia and/or necrosis of the mandibular bone at the joint area and also for post-radiation proctitis, which is quite common in this new era where we’re doing advanced surgery down all the way to the anal region for carcinoma of the colon. Many people get radiation at the rectal area and get resected for a cancer cure, but end up with what they call radiation proctitis, which is a very bad situation for patients to have and they benefit greatly with hyperbaric oxygenation.
Melanie: What’s it like? What’s this procedure like for a patient?
Dr. Gonzalez: Well, first of all, what we do is that we make sure that it’s an appropriate candidate. Once we have an appropriate candidate, we make sure that the patients can tolerate hyper-pressure. In other words, we make sure his heart is functioning well, he’s not in any heart failure. We make sure that he has good swallowing mechanisms, that his ear drums and ears are appropriately seen and treated by an ENT specialist prior to diving. Once we have all of these preparations, the patients are brought to the center, he’s given a tour, and an explanation of the entire system or protocol is gone with the patient. After the patient has gone through this, the patient is taken into the hyperbaric room. He is shown the chambers and what to expect and what not to expect and also to alleviate their fear of claustrophobic. Our tanks are made out of clear plastic – acrylic, which maintains the pressure – you can see out. We also have televisions, which is usually standard for most hyperbaric chambers so the patient can lay there and watch a television program to alleviate not only their tension but to pass the time.
Melanie: What does it feel like?
Dr. Gonzalez: I really can’t tell you. I had only been there about ten years ago, and it’s like SCUBA diving. You go down, and you start feeling pressure on your body, and the main thing you have to do is equilibrate your ears. Basically, you don’t feel much except in the tympanic membrane and your earlobes, and you start feeling – like you do on a plane, sometimes your ears pop. The main feeling is mostly in the ENT – Ear, nose, and throat aspect of the body. Otherwise, you don’t feel much.
Melanie: And Dr. Gonzalez, does insurance recognize HBOT?
Dr. Gonzalez: Well, some insurance – most of the private insurance, once you give the proper documentation, they will accept it. Our problem is mostly getting through the government and all the beauroughcratic lingo that we have to go through with Medicare and non-Medicare patients – Medicaid patients. A lot of these do not qualify because they don’t fall into the realm of the protocols of the Medicare/Medicaid system. Basically, there’s -- like I tell you, it’s very limited who can go into the chambers and who can afford it if they have private pay.
Melanie: So how many times would somebody need it if they’ve got a non-healing wound, or if you’re using it for another purpose, then how many times do they have to do this?
Dr. Gonzalez: Well, it depends on the wound, of course, but we usually settle for about 30. We usually go from 20 to 30, to 45. It all depends on the wound, and it all depends on – what we do is at least once a week we assess them for their circulatory status because things change really fast. If their circulatory status changes, the whole protocol changes. But somebody that stays even-keeled, we go about 30 times in the chamber, mostly at 2 atmospheres or 2.5 atmospheres of pressure.
Melanie: And how long would it take somebody to see a result -- if they’ve got a non-healing wound and they’ve done some of these treatments, when would they start to notice a difference?
Dr. Gonzalez: We usually see a difference within a week – two weeks.
Melanie: Wow.
Dr. Gonzalez: Because we do a lot of debridement, so what happens is we look at the wounds quite frequently so we can tell within a week, two weeks if we’re in the right direction. If we’re not, we usually change the debridement protocol and not the hyperbaric protocol.
Melanie: So what would you like to tell patients in the last few minutes, Dr. Gonzalez, about the benefits of hyperbaric oxygen therapy and how to prepare for this treatment?
Dr. Gonzalez: Well, for hyperbaric oxygenation, it’s an adjuvant to good wound care. It’s not the main treatment, but it’s an adjuvant, it helps us. It’s the last 10 yards of a 90-yard run, but the 90-yard run is very important, so that means proper assessment, proper perfusion, proper nutrition, diabetic control, and in the last 10 yards to help us – or the last five yards – is hyperbaric oxygenation. And how to prepare for it? They have to go through the rigamarole of being here and going through the adjustment phase to teach them what it is, so they know what to expect. The most important thing is knowing that the patient knows what to expect when they go into the chamber -- ear cleaning, ear cleaning, swallowing – be sure they feel that they’re not claustrophobic in a closed box, that they can see and watch television. You’ve got to prepare them mentally as well as physically.
Melanie: That’s so important to point out. And why should they come to Doctor’s Hospital of Laredo for their care?
Dr. Gonzalez: Well, I think we’re the only ones in Laredo that offer a surgeon full-time in the wound care center. Second, they have a vascular surgeon full-time at the wound care center, which no one else has. The nursing staff here is superb.
Melanie: Thank you, so much, for being with us today, Dr. Gonzalez. You’re listening to Doctor’s Hospital Health News with Doctor’s Hospital of Laredo, and for more information, you can go to IChooseDoctorsHospital.com, that’s IChooseDoctorsHospital.com. Physicians are independent practitioners who are not employees or agents of Doctor’s Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctor’s Hosptial of Laredo is directly or indirectly owned by a partnership that includes physician owners including certain members of the hospital medical staff. This is Melanie Cole. Thanks, so much, for listening.