Fayetteville Observer (NC)
Jan. 23--MMore than two years ago, Lordell Ivey got horrible news: his leg had to go.
A small wound on his right shin had worsened rather than healed over more than two years. His doctor told him amputation was necessary to keep it contained.
"I didn't want to give up," Ivey said recently at Southeastern Wound Healing Center in Lumberton, where he sought a second opinion.
Two months ago, Ivey walked out of the clinic on 27th Street, his leg healed.
Ivey received a long series of treatments to close the wound that had caused him pain, but he and his doctors credit hyperbaric oxygen therapy with pushing him over the top in healing the troublesome spot.
The treatments, which place patients in pressurized chambers while periodically breathing pure oxygen, are approved for a number of conditions, including carbon monoxide poisoning, decompression sickness, severe anemia, radiation injury, acute thermal burns, and other skin and wound problems.
But some feel that a lack of awareness among the medical community and the general public about hyperbarics and other wound care means some patients don't get the specialized help they need.
Dr. Andrea Simmons treated Ivey at the Wound Care Center, an affiliate of Southeastern Regional Medical Center.
"He would have lost his leg if the Wound Care Center was not here," Simmons said.
Ivey was relatively healthy, but as a smoker, he had poor circulation that affected his wound's ability to heal. He had surgery in 2011 to open a narrowed artery. His wound had almost healed when doctors there referred him to a surgeon for a skin graft. But his wound never healed as he started smoking again, and Ivey got lost in the referral process.
When he came back to the center last March, the wound was not terribly large -- 2 by 2.4 centimeters -- but it had grown down to the bone of his shin, which had become infected.
Ivey quit smoking, had another surgery to insert a stent into his artery and had a number of traditional treatments for the wound at the center. Meanwhile, Simmons and other center staff repeatedly appealed to Medicaid to cover the hyperbaric treatments in a last-ditch effort to heal the wound and save his leg.
Ivey was finally approved for 15 sessions beginning in August.
"It's really amazing," Ivey said. "You feel so good when you come out of there."
During hyperbaric treatments, patients lie in a mostly transparent cylindrical chamber almost 4 feet tall and nearly 9feet long, according to Healogics Inc., the company that manages the Wound Care Center for Southeastern.
The air inside the chamber is pressurized and pure oxygen is pumped in. Under pressure, the oxygen molecules become smaller and can be more easily transported through the body and to the wound to promote healing.
With pure oxygen being pumped into the chamber, patients must wear 100percent cotton garments and are restricted as to what they can bring inside to reduce the risk of sparks.
According to Ivey, patients inside the tubes cannot hear what is going on outside. Speakers that can play through the machine allow them to hear the TV mounted on the wall above them or instructions from center staff members.
"Your mind just wanders off to another dimension," Ivey said of his time in the chamber, typically called dives.
By October, his leg was nearly healed, and a final treatment with a skin substitute and topical honey sealed it.
Simmons said a lack of awareness among patients and even other physicians, who don't get much wound care training in medical school, can be a problem.
"A lot of doctors don't know these wound care centers exist now, and if you don't have the certain type of training, a lot of patients may end up with amputations and unnecessary procedures because a lot of physicians don't know what to do," Simmons said.
She said she would not know what to do with complicated wounds had she not undergone specialized training through Healogics.
The Jacksonville, Fla.-based company operates most of the wound care centers that offer hyperbaric oxygen treatment in the region. Jessica Taft, a spokeswoman for the company, said Healogics operates more than 30 locations in North Carolina and more than 550 nationwide. At the end of last year, the company opened its first international location in the United Kingdom.
"We are definitely growing," Taft said, "and I think it has to do with raising the awareness of the chronic wound problem in general."
Taft said that increases in obesity and diabetes rates and a growing aging population means more people suffer chronic wounds.
But there is no recognized subspecialty for advanced wound care, leaving companies such as Healogics to take on the specialized training.
"People just didn't know there was an answer for this," Taft said.
In addition to Southeastern's center, Healogics operates wound care centers at Scotland Memorial Hospital in Laurinburg, Betsy Johnson Regional Hospital in Dunn and Sampson Regional Medical Center in Clinton.
The company serves FirstHealth of the Carolinas at its hospitals in Pinehurst and Rockingham and will soon begin a partnership with FirstHealth at its new specialty offices in Raeford.
Cape Fear Valley Health System is a former Healogics client, but the organization struck out on its own at the end of the year and now independently operates its Wound Care and Hyperbarics Center on Robeson Street.
John Dickerhoff, service line director for rehabilitation with Cape Fear Valley, runs the center.
The center can see as many as eight patients a day in its two chambers. Treatment tends to last two hours a day, five days a week for about four weeks, Dickerhoff said, so they typically see only about eight patients a month. When one patient is healed, another falls into the rotation.
Despite keeping a full rotation, Dickerhoff said the center has not seen the need to add a third chamber, which would allow 12 patients to be treated per month.
Taking hyperbaric treatment is a big time commitment, and many patients opt to stick with the more traditional wound treatments, Dickerhoff said. But the infrastructure has already been installed to support another chamber in case demand increases.
Denise Mercado and her husband, John, own Fayetteville Hyperbarics on Boone Trail Extension, a free-standing clinic that offers hyperbaric dives for an expanded list of ailments. Because their clinic is not part of a hospital, Denise Mercado said, they can offer hyperbarics for more than the 13 indications approved by the U.S. Food and Drug Administration and treat such conditions as traumatic brain injury, multiple sclerosis, Lyme disease, and autism and other developmental disabilities.
She said nonverbal autism patients have begun speaking after seven to 12 dives. A cancer patient uses the treatment to help him make it through radiation and chemotherapy treatments, she said, and a diabetic man who had three toes amputated saved his other foot.
While the FDA has cautioned against using hyperbaric dives in place of traditional treatments and therapies for conditions it has not approved, Denise Mercado emphasized that hyperbarics is an adjunct therapy.
"It's not a magic pill," she said. "Somehow, this helps push it and get better results."
Staff writer Paige Rentz can be reached at firstname.lastname@example.org or 486-2728.
(c)2014 The Fayetteville Observer (Fayetteville, N.C.)
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