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Judy Parkey, RN
March 3, 1998Johnston Memorial Hospital Tishomingo, Ok 73460
GWR Medical, L.L.P. Dear GWR Medical, Subject: Topical Hyperbaric Oxygen I would like to share with you the positive results we had using topical hyperbaric oxygen therapy on one of our home health patients. The patient was a 62-year-old noninsulin dependent diabetic truck driver. He presented our emergency room on November 16, 1997 complaining of right foot pain for four days. His boot had to be cut off. The foot required amputation of the 3rd, 4th, and 5th toes and an incision of the plantar aspect of the right foot. By the time he was discharged from the hospital, December 2, 1997, the tunnel between the plantar aspect of his foot and the site of his 3rd toe had sealed itself off. We started our home care of the patient at that time. Th amputated toe site was 3.5 cm by 2 cm with a depth of 2.5 cm. The plantar aspect was 9 cm by 4 cm with a depth of 2-2.5 cm. December 9th our wound consultant made a home visit. Until that time the therapy consisted of daily whirlpool by the physical therapist and twice-daily wet to dry dressing changes with daily packing of the wound with a calcium alginate dressing. Upon review of the THBO literature she felt the patient deserved the opportunity to try the therapy. The patient and physician were willing to try the therapy for 6 weeks and despite the objection and skepticism of the physical therapist we started. Six weeks later the amputated toe site was 2 by 2 cm with a depth of 0.25 cm. The plantar aspect was 6 cm by 2 cm with a depth of 0.5 cm. The wound therapist made a follow up visit to assess the wound and was shocked by the difference. Another six weeks later with continuing daily whirlpool and twice daily wet to dry dressing changes and application to the plantar aspect of the calcium alginate dressing the amputated toe site is completely healed and the plantar aspect is 1.5 cm by 1.5 cm. The plantar aspect is too shallow to pack the wound. Interestingly there is minimal scarring of the plantar aspect. Now he is receiving daily whirlpool with once daily wet to dry dressing change. In addition, the physical therapist performs ultrasound therapy to the remaining part of the wound to promote healing and as needed debridement to prevent build up of eschcar. The foot was making significant progress two weeks into the four days in a row THBO with 3 days off routine and by the fourth week of therapy the patient said he could tell an improvement with each dressing change. The physician stopped the THBO at the end of 6 weeks because he felt the wound was well on its own way of being healed. For baseline parameters the patient had strong and easily palpated pedal pulses bilaterally with brisk capillary refill. His serum prealbumin was within normal limits. The patient quit smoking and managed his elevated blood sugars with insulin. Until the past two weeks the patient was running blood sugars in the 200 to 300 range, and still the healing occurred! He supplemented his diet with a multivitamin with zinc, Vitamin C 1000-mg bid, and Vitamin E 1000-units daily. His pharmacology regimen also included Trental. On January 9th he started a 10 day round of Amoxicillin 250 mg bid as at the time the plantar aspect of his foot had increased redness with edema. That was the only time he was on antibiotics while we saw him. The redness and edema resolved after he finished the antibiotics. He is now in the process of weaning himself off insulin. Of great importance too was the patient's power of positive thinking and positive imagery that his foot would heal.
Best Regards, |