Jessie Thompson has battled diabetes for nearly two decades. Recently, he and his medical team waged an all-out war against the disease when a severe infection threatened both his foot and his life.
“I felt like I wanted to die,” Thompson, of Troy, Va., recalls about the day he arrived at Sentara Martha Jefferson Hospital, suffering from a fever, nausea, chills and weakness.
After a careful examination, doctors discovered a wound on Thompson’s left foot. Diagnosed with diabetes in 2000, Thompson, 67, had developed a foot ulcer and sepsis, which is the body’s response to extreme infection.
After surgeries to clean his wound and months of waiting for it to heal, doctors eventually turned to hyperbaric oxygen therapy to help speed up the process.
A Life-Threatening Illness
Thompson’s odyssey began on Nov. 5, 2018.
“It hit me fast,” says Thompson, a retired police officer who checked into the Emergency Department (ED) at Sentara Martha Jefferson to find out what was wrong.
An ED physician noticed Thompson’s left foot was swollen, inflamed and severely infected. A wound between his big toe and second toe had spread to the bottom of his foot and resulted in sepsis. Without prompt treatment, sepsis can lead to tissue damage, organ failure and death.
Foot ulcers are a common concern for people with diabetes. These patients often experience nerve damage, or neuropathy, which can cause a lack of feeling in the feet and make it harder to notice foot wounds when they occur.
In addition, diabetes causes blood vessels in the legs and feet to narrow and harden, resulting in poor circulation. The decreased blood flow makes wounds more difficult to heal and increases the risk of infections. Patients with diabetes who have wounds that can’t be controlled can even face amputation of toes, feet or entire limbs.
Long Road to Recovery
Following his ED visit, Thompson was admitted to Sentara Martha Jefferson, where podiatrist Robert Baglio, DPM, of Foot & Ankle Specialists of the Mid-Atlantic, operated twice to clean and pack the wound, so it could heal from the inside out.
Due to the extent of the infection, Thompson needed a PICC line to deliver intravenous antibiotics. PICC lines give access to veins through a catheter outside the body, allowing patients to receive intravenous therapy after they leave the hospital.
Thompson spent about two weeks at Sentara Martha Jefferson and then was discharged to a rehabilitation center in Charlottesville. His wife regularly checked him in and out of rehab to have his foot assessed at the doctor’s office.
“I was in a wheelchair and couldn’t put pressure on my foot for months,” Thompson says.
His care team continued to clean and bandage his wound carefully, with the hope that it would heal successfully.
“Dr. Baglio took excellent care of my foot,” Thompson adds.
Turning to Hyperbaric Oxygen Therapy
Thompson’s wound, however, had failed to heal completely, despite months of diligent medical care. In December 2018, Dr. Baglio referred Thompson to the Sentara Martha Jefferson Wound Care Center, which provides advanced treatments to help maximize the body’s capacity to heal chronic and complex wounds. Among the center’s many therapeutic tools are two hyperbaric oxygen chambers.
During treatments in the pressurized chambers, patients breathe in pure, concentrated oxygen. This allows the lungs to take in more oxygen than they could at normal air pressure, circulating more of the healing gas throughout the body via the bloodstream.
Many people associate hyperbaric oxygen therapy (HBOT) with treatment for scuba divers suffering from decompression sickness, also known as “the bends.” In those cases, nitrogen builds up in the blood when a diver ascends too rapidly, forming bubbles that can potentially damage blood vessels and block normal blood flow. For these divers, HBOT drives nitrogen back into its liquid form, so it can be cleared more gradually and safely from the body.
Used in wound healing, the higher blood oxygen level with HBOT helps to fight bacteria, stimulate wound closure, regenerate tissues and aid in the growth of new tissue.
“Diabetic foot ulcers are the most common condition we treat at the Sentara Martha Jefferson Wound Care Center,” notes Becky Smith, manager at the center. “We’ve seen very promising results with HBOT.”
Preparing for HBOT
Before wound patients can be candidates for HBOT, they must first receive 30 days of traditional wound-care treatment.
Patients with diabetic foot ulcers also have to meet thresholds for the severity of the ulcer, as well as blood sugar levels. Levels outside the normal range can delay healing.
A chest X-ray also is required to ensure that the patient doesn’t have an underlying condition that could cause a lung to collapse in the high-pressure chamber, Smith says.
Sessions in an HBOT chamber for a person with diabetes can last up to 90 minutes, and patients may need anywhere from 30-60 sessions to see results for wound healing. Patients receive treatments daily, Mondays through Fridays, for several weeks.
“Patients must be willing to participate in daily treatment, so this requires a significant commitment for patients and their families,” says Dr. John Ligush, medical director of the Sentara Martha Jefferson Wound Care Center. “As such, it’s very important for the patient to have a strong support structure.”
HBOT Session Precautions
For safety reasons, patients must follow several precautions before they can begin HBOT.
While in the chamber, they can only wear a hospital gown, and cannot be wearing deodorant or have any of the following items with them:
• Cell phones or electronics
• Jewelry or watches
• Eyeglasses made of titanium
• Hearing aids
However, patients can pass the time watching a TV situated above the chamber, and they can communicate with techs through a telephone in the chamber. Thankfully, patients can have a hospital pillow and a blanket with them, so some sleep during HBOT sessions.
Before each session, the wound care team checks the patient’s vital signs, and, for diabetes patients, blood sugar levels. Since blood sugar levels drop during HBOT sessions, they must be at least 120 mg/dL going in.
Doctors will also check the patient’s ears. Just as ears can “pop” and cause discomfort in the pressurized environment of an airplane, the same phenomenon can occur as a result of the pressure that occurs with HBOT.
Therapy techs coach patients on how to clear their ears, but sometimes these techniques don’t work well enough. Thompson, in fact, who started HBOT in January 2019, had to interrupt his treatments to address an issue with his ears.
“When I first tried the hyperbaric chamber, my ears hurt,” he recalls. “I went to a few sessions, but I was still experiencing pain. To help resolve the problem, I ended up having surgery to put tubes in my ears.”
Thankfully, the tubes did the trick, allowing Thompson to resume his HBOT sessions.
Back in a Routine
Although Thompson’s insurance had approved 60 sessions for him, his doctors began seeing results sooner than expected. After just 40 sessions of 90 minutes each, he was healed enough to stop the treatments.
Thanks to HBOT, he was also able to graduate from a wheelchair to crutches, and now uses a cane, enabling him to regain much of his independence.
“The hyperbaric chamber did wonders for me,” says Thompson, whose wife now checks his feet daily for any sores.
HBOT is giving new hope and providing better outcomes for patients whose wounds are resistant to traditional therapies.
“Prior to getting the hyperbaric chambers, we were limited to the techniques of traditional wound treatment,” Smith says. “HBOT has given us a new tool to help save more toes and limbs, resulting in improved quality of life for these patients.”
Which Conditions Can Hyperbaric Oxygen Treat?
Hyperbaric oxygen therapy can be used to treat many conditions, including:
• Arterial gas embolism (what scuba divers experience during decompression sickness)
• Brain abscesses
• Crushing injuries (which occur when damaging force is exerted on a body part)
• Diabetic foot ulcers
• Gangrene (which occurs when body tissues die)
• Severe anemia
• Skin and bone infections
• Skin grafts at risk of tissue death
• Sudden deafness
• Vision loss that is sudden and painless
• Wounds resulting from radiation therapy
Foot Care for Diabetic Patients
Foot ulcers are a common concern for people with diabetes, which can cause nerve damage in feet that can make it difficult for patients to detect a wound.
Here are some foot care tips from the American Diabetic Association:
• Check your feet every day. Look at bare feet for red spots, cuts, swelling and blisters. Use a mirror to view the bottom of your feet, or ask someone to check for you.
• Keep blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for five minutes, a few times a day. Don’t cross your legs for long periods. Don’t smoke.
• Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between toes.
• Wash and dry your feet every day.
• Wear shoes and socks at all times.