Darrell Rebouche (Host): Imagine how frustrating it would be if you had a wound that just wouldn't heal. What would you do? Well, what if one of the tools doctors use to help a stubborn wound heal is something you already deal with every day without even thinking about it: oxygen. Imagine putting that oxygen inside a pressurized chamber and using it to help your body repair damaged tissue. It may sound like science fiction, but it's actually an established medical treatment.

Welcome to Health on Point, presented by Willis-Knighton Health. And today, we're talking about under pressure, the science of healing wounds. And our guests are Dr. Steven Kitchings and Dr. Victoria Everton from Willis-Knighton's Hyperbaric Medicine and Wound Care Centers. Dr. Kitchings, it's hyperbaric medicine. People may not know what that is. Can you explain it to us?

Dr. Steven Kitchings: So, hyperbaric medicine's kind of just what you said. It's breathing oxygen under pressure. So when our patients come to see us, we determine if they need or require hyperbaric oxygen. So, what that means, we place you in a chamber, sounds a little scary, but we make it completely safe, and you breathe 100% oxygen under pressure in that chamber. It means you go below atmospheric pressure. We increase the pressure, which increases oxygen in the plasma in your blood, which helps heal these chronic wounds heal up.

Host: All right, Dr. Everton, you are sitting in front of a chamber, and that's kind of cool. So, you have multiple people will go into your chambers as opposed to what Dr. Kitchings says. Can you explain to us the differences?

Dr. Victoria Everton: Yes. So, Willis-Knighton is very fortunate. We have two different locations and two different types of hyperbaric chambers. The chamber that I'm sitting in front of currently can fit technically up to 12 people for a treatment at one time. And we have an attendant that goes in the chamber as well to monitor that oxygen under pressure.

But we're also very fortunate at our Bossier location to have a monoplace chamber, which is a single chamber that the patient can actually lay down in and get that same treatment, that same oxygen under pressure.

Host: Dr. Kitchings, why does oxygen matter so much for wound healing?

Dr. Steven Kitchings: So, wounds require high oxygen environment to heal. They've done studies. A lot of these chronic wounds that are coming in to see us, the diabetic foot ulcers don't have enough, essentially, oxygen getting to that wound to heal. So, people think they can just breathe oxygen through a nasal cannula or O2, but all oxygen's not created equal.

So by putting them in that chamber, we can increase the amount of tissue perfusion that is getting to that wound by them having to breathe 100% oxygen under pressure in the hyperbaric chamber, and that improves their wound healing, it improves their vascular status to that wound, it decreases the bacterial load to that wound. And all those factors together help that wound heal faster.

Host: Dr. Everton, what kind of wounds do you see? I mean, Dr. Kitchings had mentioned, you know, wounds related to diabetes, but you also see injuries. Can you give us kind of the scope of the type of wounds that you all are treating?

Dr. Victoria Everton: Correct. So, we treat wounds related to radiation. You know, let's say for example, somebody had cancer and a significant number of radiation treatments, and they have wounds that are not healing related to that, or bleeding issues related to that. Let's say you had a work injury and a crush injury. We see wounds related to crushed limbs, and we've been able to save limbs by doing hyperbaric oxygen therapy treatments with those. Vascular wounds, if they have a wound that, has a blocked artery, and causes them to have their toes turn black or a different color, we're able to help save limbs and save lives by doing this hyperbaric oxygen therapy treatment.

Host: Dr. Kitchings, it's not just wound care. I mean, that's kind of the preponderance of what you do. But well, you help fight infections, you do tissue repair. Can you elaborate on that for us please? Because there's a lot of stuff we can help with.

Dr. Steven Kitchings: So yeah, wounds can be complicated, especially chronic wounds. So, there's a variety of different factors that influence wound healing. We got to look at their vascular status. Fortunately, here at Willis-Knighton, we're able to use a multidisciplinary approach because we have cardiologists that can examine and determine if the patient needs arterial intervention to increase blood flow to our wounds. We have an appropriate lab where we can culture and even do DNA cultures of these wounds to see what bacteria is growing in the wound and what specific antibiotic kills that bacteria instead of just throwing antibiotics at them. Fortunately, we have great podiatrists here that if they need surgery, we can refer them to those podiatrists. If they have a mechanical problem with a bunion or other problems, if they have an abscess, we can refer them there for surgery. General surgeons work well with us, and it's just great that we have a multidisciplinary approach at Willis-Knighton for these wound healings.

Host: Dr. Everton, sometimes these things can be really, really stubborn, I know. And I wonder, I'd like to know what kind of the average duration of a treatment protocol is, and then what's out on the margins? So, you know, how long can it go?

Dr. Victoria Everton: It varies per patient and based on their other factors, and other health issues. But typically, for a diabetic foot ulcer, we're averaging anywhere from 30 to 45 hyperbaric treatments in addition to wound care, in addition to working with our specialists, infectious disease, vascular, cardiology, podiatry, doing aggressive wound care treatments.

So, it's not just a one-time treatment for these wounds that aren't healing. It does require a significant number of treatments to obtain the results. But ultimately, our goal is to save a limb and save a life.

Host: Yeah, you have to be dedicated. And all of these things, Dr. Kitchings, are related to one another. You got blood flow, you know, oxygen delivery, vascular disease comes into play. So, I guess the big word is comorbidities, but all of these things kind of work together against that wound healing, but you guys try to mitigate that.

Dr. Steven Kitchings: Right. Luckily here, if they refer these patients to us, which we get a lot of referrals, we're going to be the primary care doctor essentially for that wound. We're going to coordinate everything. If they need to go see the cardiologist for their vascular status, we're going to coordinate that.

If they need home health care, for a nurse to come out and dress their wound because they don't feel comfortable for doing that, we coordinate that and give them orders specifically what to do. If they need surgery, we'll refer them to the appropriate surgeon for any kind of surgical intervention that might be needed.

We have to, like, coordinate everything. You need someone that can look at that wound as a whole entity unto itself and kind of distribute and direct that wound care and what is needed for that patient.

Host: Well, Dr. Kitchings, how do people get to you? Are they referred by another physician? Can people come to you directly? Can you explain the process?

Dr. Steven Kitchings: Sure. So, they can either just call our office or we have a Willis-Knighton South office, which Victoria Everton's at. And then, they have the Willis-Knighton Bossier office. Sometimes they do need referrals, it just kind of depends on our insurance. Most insurances now do not require a referral. So, you can simply call our office 318-212-7080 at Bossier or 318-212-5901 at South. And our front desk people are amazing. They'll be glad to help you and get you scheduled forward. If it does require a referral, they can coordinate that with your primary, your surgeon, home health or whoever it needs to get that for us.

Host: Okay. Dr. Everton, we've covered a couple of the practical matters. Now, let's talk about this conceptually. I've heard these sessions referred to as dives. Can you explain that concept to us? What does that mean? And when you're in either one of Dr. Kitchings' mono-chambers or in your multi-person chamber, what's going on in there?

Dr. Victoria Everton: So, what's involved in the visit? From the time they step in our clinic, we start with basics. For diabetics, we always check the blood sugar. We always check the vital signs. We monitor and look for any safety issues. They are required to wear 100% cotton scrubs to go in our chamber. We don't want to put anything in the chamber that is going to catch fire. Because essentially, since we're changing the pressure and doing 100% oxygen, we would not want any safety issues to occur.

And so, we monitor and check everyone for those safety issues before they step into the chamber. And once they step into the chamber and sit down and we close that door, the treatment begins. The first ten minutes is the pressurization. It's kind of like you're going underwater, but you're really not. We're just changing the environment in the chamber itself and monitoring it. And after about ten minutes, we're at depth, hence the term dive or the nickname dive. And then, we put your hood on and let you breathe that 100% oxygen until the end of the treatment.

Host: Dr. Kitchings, the results are similar, if not identical, from the way it is done at Bossier with the mono-chambers and the way it's done at Willis-Knighton South with that big chamber that Dr. Everton's sitting in front of. But I would think you would like to explain to people maybe how those experiences contrast. For instance, you know, the people are inside this big chamber, but you're able to walk among them even though they're inside each individual chamber.

Dr. Steven Kitchings: Yes. So, the South is a multi-place chamber, which means that multiple people can go in there at once, but they always have a certified hyperbaric attendant in there with them. If they get nauseated, they have problems clearing their ears, they want some water to drink, you have somebody in that chamber that can help you.

At Bossier, we have mono-place chambers. That means you go in individually. We're a little bit more flexible on time, and you don't have a certified hyperbaric tech that goes in there with you, but we have one right outside the chamber that is sitting at a desk or standing there and can communicate via phone, all that.

You know, the first time you do the hyperbaric, it's really scary, but knowing that you have somebody in there or right beside you makes it a little bit more friendly. And if they're having an ear block, which we see sometimes when you pressurize in the chamber, they'll talk you through it or they can help you, all that. Like, safety protocols are a major point for us.

Host: And there's always a doctor on hand. That's the best part.

Dr. Steven Kitchings: Always.

Host: This is Health on Point presented by Willis-Knighton Health. Our topic today is hyperbaric medicine. Our guests are Dr. Stephen Kitchings and Dr. Victoria Everton from Willis-Knighton Health, and they practice hyperbaric medicine. Dr. Everton, it's not always wounds. I mean, there are other things the hyperbaric chambers are good at treating. Carbon monoxide poisoning comes to mind. Anything else that's not necessarily a wound?

Dr. Victoria Everton: Well, I certainly have treated patients with chronic bone infections. And this is a tricky one that we work with our orthopedic doctors with. Let's say they had a hip replacement or a knee replacement, and they have issues related to infections surrounding that. So, any infections in the bony areas that are non-healing, that is one indication that we can utilize hyperbaric treatment for, especially if they've failed. You know, they've seen their infection doctor, and they've seen an orthopedic doctor, and they've had antibiotic beads put in and antibiotics by IV and pill, and that is not working. This is one of those indications for hyperbarics. It can kill bacteria and improve any healing on the inside by killing those bacteria.

Host: Dr. Kitchings, what can a patient do at home? They're in the middle of their treatment protocol with you. And so, we talk on our podcast a lot about patient rights and responsibilities. So, what are the patient's responsibilities to themselves and their wound care when they're under your care?

Dr. Steven Kitchings: Yeah. And it kind of depends on the wound. So, let's say we're treating a diabetic foot ulcer in the chamber, we're going to give them specific instructions to, number one, probably the most important, do not smoke. Like, it is the number one. It will completely nullify anything that is being done to help them in that hyperbaric chamber. Number two, get off the wound. Pressure is a major source of keeping that wound from healing, So, we'll tell them to get off that wound. Number three, we'll tell them, "Listen to the nurses and listen to the doctors when they tell you exactly what wound care to do those dressings." We call it freelancing. Don't freelance when your mama tells you it needs to air dry or you need to use hydrogen peroxide or alcohol. Just listen to us on the wound care. That's a big thing, honestly. They like to talk to family members.

And another big thing we're seeing now is essential oils and all that. They're starting to put a lot of that. We just had a patient the other day was using essential oils all over their wounds and everything. So, we're there to help them. We're the experts on this if they'll just listen. I tell them it's like you don't take a car to the mechanic and tell the mechanic what to do to fix it. Just let us help you fix your wound.

Host: So, Dr. Everton, sometimes it's not just what to do, it's often what not to do.

Dr. Victoria Everton: And the other thing we need to concentrate on as well is good nutrition in the home. I often find that patients that have been in the hospital recently or surgery recently, they just aren't eating as well. So, we do monitor their protein levels in their bloodstream closely, and help them obtain supplements, assistance with Council on Aging, and other resources to help them with that nutritional aspect as well. In addition to referring to nutrition over here at Willis-Knighton, again, part of that multidisciplinary approach to help those wounds heal better.

Host: I'm interested in that too, because you've mentioned a couple of people who help, you know, nutritional services, diabetes and nutrition, those kind of things. And Dr. Kitchings, you mentioned just the people who answer the phone who are going to be very, helpful with you. But in the middle, there's a team. And while you and Dr. Everton are the faces of hyperbaric medicine at Willis-Knighton Health, you've got a lot of people rowing in the same direction with you. Can you elaborate on that for us?

Dr. Steven Kitchings: It starts with the front desk. They're going to be friendly to you, help you fill out your paperwork, all that. When you come back, you'll have one of our RNs come and bring you back, and they're going to spend most of the time, even more time probably than we are with you. They're going to go over your medications. They're going to go over your medical history, how you got this wound, who's at home with you to help take care of this wound. Do you require home health? They do a lot of the hard work for us before me and Dr. Everton get in there.

Once we get in there, we're going to talk to you. We might have to debride the wound. We might have to get on you about your diabetes and blood sugar control a little bit. We might have to get onto you about your protein intake, are you getting enough protein in? But then after that, if you do go for the hyperbarics, we have our hyperbaric tech that is going to be—they're all respiratory therapists. They're very knowledgeable about oxygen and hyperbarics, and they'll make that comfortable for you too.

Host: Dr. Everton, somebody thinking they have a wound. It's been pesky. It's been a problem. At what point do they need to seriously consider or just immediately decide, "I need to seek help from the hyperbaric and wound care center because this wound just won't heal"? I mean, when is that turning point?

Dr. Victoria Everton: The sooner the better. Anytime you get that pesky feeling, pick up the phone and call us to get that appointment. The sooner we start wound care, the easier it is to heal. The longer they've had the wound before they come to us, the harder it is for us to heal. I mean, typically, if I can get them within the first two to three weeks, that is ideal.

Certainly, we can take you at any point in this wound healing process. I've had individuals who've had wounds for a year. They were just scared and at home and weren't sure what to do. We are going to treat them no matter what, and we are going to do our best to get that wound healed. But the sooner the better.

Host: I don't necessarily want to get too graphic, Dr. Kitchings. But, you know, we've talked about crush injuries. I mean, is it cuts? Is it open wounds? You know, is there a minimum size it needs to be? I mean, just somebody sitting at home thinking about it, I mean, Dr. Everton said just call because it's better safe than sorry, but what do you think?

Dr. Steven Kitchings: If you have a chronic wound that's not healing, even an acute wound, and it just seems like it's not getting better, call us. You can contact your primary care physician. You can just call our front desk. We'll get you in and evaluate you and say, "Hey, like this is easy to take care of. Here's just what you need to change and need to do to get this to heal up."

A lot of them are more complicated than that. They don't realize they have bad blood flow. They don't realize their blood sugar is 500. They don't realize they're protein malnourished. They don't realize they need to stay off of this. They don't realize they need to stop air drying the wound. Like when in doubt, just call us. And like Victoria said, as soon as possible. The earlier we get it, the better.

Host: We said at the outset, Dr. Everton, that it may seem like science fiction, but it's not. It's reality. And reassure everyone, it helps.

Dr. Victoria Everton: Well, and I do want to reiterate, I've treated patients as young as six weeks and as old as 106. There's no age restriction on wounds that won't heal. There's no restrictions on what type of wound. Burns, weld injuries, diabetic, I just tried to fry the turkey for Thanksgiving and I hurt myself.

Whatever reason it is, wound care has come a long way in the last 20 years. We have products that can heal it faster. And I see mistakes made every day with people using Neosporin and hydrogen peroxide and alcohol, and all the things our grandmothers used to tell us. "Just leave it open to air," or "Soak it in Epsom salts."

And all of those things, we have actually shown scientifically, delay healing. So if we can educate and teach and case manage, and get these wounds as early as possible, and educate about all the new products out there, we can typically heal that wound faster and get those folks back to their normal life doing whatever they want to do, traveling, working, as fast as they can.

Host: Dr. Kitchings, is this an evolving technology, an evolving discipline? What's exciting? What's coming up in the world of wound care?

Dr. Steven Kitchings: It's ever evolving. So, we're now able to use skin substitutes on a lot of our diabetic foot ulcers to help them heal, which if you qualify, is a simple procedure in office where we put a piece of tissue over your wound, helps it heal for our diabetic foot ulcers. Now, I know our orthopedics use PRP in their facility. We're trying to get PRP in our facility now for wounds. It's just ever evolving. Like, there's a lot of exciting scientific evidence and experiments going on that are coming down the pipeline. And the good thing is Willis-Knighton backs us up. They're always willing to listen if we want new products, new procedures, anything like that. So, just call us if you have a wound.

PRP is where we take your own blood, we put it in a centrifuge, spin it down. And then, we take that plasma part and put it back into your wound and seal it. And it has growth factors and all kind of things which we could explain to you that help heal these wounds. They're actually showing evidence that that is helping certain wounds heal up. And it's all about selection in wound care too. We're looking at you have X type of wound. This is what we need. Like, if you have a venous leg ulcer, you need compression. If you have a diabetic foot ulcer, there's a list of things we can do, including skin subs if your insurance approves. If you have a surgical wound, do you need it packed? We even have the wound VAC, the negative pressure wound therapy. That is amazing for surgical wounds. There's a whole plethora of things for us to use in our centers that are not in other clinics or in your orthopedics or general service. That's why you come to a wound care center.

Host: Thank you, Dr. Kitchings. Thank you, Dr. Everton, for your time and your expertise. And remember, everybody, you've got that wound, it just won't heal, don't be afraid, don't be hesitant. Call the Wound Care Center at Willis-Knighton Health, and they'll help you get better. And thank you for joining us for Health on Point, presented by Willis-Knighton Health.