March 21, 2011

Plain Dealer notes hyperbaric oxygen treatment at St. Vincent Charity Medical Center, other Cleveland hospitals

In story featuring the use of hyperbaric oxygen treatment, The Plain Dealer quotes Dr. Joseph Sopko, a pulmonologist and chairman of the department of medicine at St. Vincent Charity Medical Center in Cleveland, regarding the hospital’s introduction of the service in the community. St. Vincent Charity Medical Center installed its hyperbaric oxygen chambers in 1993, when no other hospital in the city had one.

Today, St. Vincent Charity medical Center, which is a ministry of the Sisters of Charity Health System, is the only Cleveland-area hospital that takes emergency cases 24 hours a day.

Hyperbaric oxygen treatment fights infection and rebuilds the damaged tissue of patients

Published: Monday, March 21, 2011
By Diane Suchetka, The Plain Dealer

Oh, the painful ways doctors make us well. They cut open our bodies, inject nauseating drugs into our veins, jam their fingers into unprintable places.

So it seems a miracle, a prescription as pleasant as this: Climb into a bed. Turn on your favorite TV show. Relax for a couple of hours -- fall asleep if you like. Repeat five days a week, for six to 12 weeks or so.

"I don't know of any side effects from having this done," says Patty Scragg-Hudec, a 51-year-old Twinsburg grandmother who underwent the treatment last year.

"And there's no pain."

She's describing hyperbaric oxygen treatment -- the medical term for healing wounds by lying in a body-size acrylic tube and breathing 100 percent oxygen that's made even more potent because it's under pressure.

It's not something you can do at home. The chambers are available at a handful of hospitals in the Cleveland area, including University Hospitals Bedford Medical Center, Huron Hospital, Lutheran Hospital, Marymount Hospital, St. Vincent Charity Medical Center and South Pointe Hospital.

The oxygen, forced into the chamber under two to three times the normal pressure of air, fills a patient's lungs, then pulses through his blood vessels sending the life-giving element down to the tiniest capillaries.

Once inside the body, the odorless, tasteless gas stimulates the regrowth of blood vessels and helps rebuild damaged tissue. That alone would be wonderful. But O2 is a twofer. It also fights infection by increasing the delivery of blood to the affected tissue.

It's a treatment that's been around for decades.

In 1928, Cleveland became home to a one-of-a-kind, 900-ton steel sphere, called the Cunningham Sanitarium, which used oxygen therapy to treat diabetes, high blood pressure and other illnesses. Its leader, Dr. Orval J. Cunningham of Kansas City, Mo., had the five-story steel ball -- which contained 40 rooms and 40 baths -- built on Lake Shore Boulevard at East 185th Street for $1 million -- that's $12.9 billion in today's money.

The treatment didn't work as promised, and Cunningham was reprimanded by the American Medical Association.

That's the likely reason Cleveland came late to modern use of oxygen treatment, says Dr. Joseph Sopko, a pulmonologist and chairman of the department of medicine at St. Vincent Charity Medical Center in Cleveland, which installed its hyperbaric oxygen chambers in 1993, when no other hospital in the city had one.

Service available for 15 conditions

Medical centers today typically offer the service for 15 conditions approved by Medicare and Medicaid. That means hyperbaric oxygen treatment for those ailments is covered by the government insurance programs as well as many private insurers.

The conditions include failing skin grafts; bone infections; gangrene; diabetic wounds to the feet; severed limbs that have been re-attached; and bladders, bowels and other bone and tissue that have been damaged by cancer-curing radiation.

It's also approved as treatment for carbon monoxide poisoning, often caused by a faulty furnace or operating a gasoline engine in an enclosed space. And for decompression sickness, called the bends, which afflicts scuba divers who surface too quickly.

But St. Vincent is the only Cleveland-area hospital that takes emergency cases 24 hours a day, says Sopko, medical director of the hyperbaric program there.

The treatment has been tried and tested on other ailments -- from heart attack and stroke to traumatic brain injury and post traumatic stress disorder -- but not approved for those, at least not yet.

While hyperbaric oxygen treatment, HBOT for short, is painless and relaxing for most people, it's not trouble free.

"There's the theoretical fire/explosion risk -- but that's never happened in the United States," says Sopko.

Because oxygen is highly flammable, patients can't wear anything that might spark, such as titanium eyeglass frames or metal watch bands that could break or strike gold rings or key chains, all of which are banned from the chamber.

Books and magazines are forbidden, too, because they're fuel for fire. Same for makeup, perfume, after-shave, nail polish or any alcohol or petroleum-based product. And forget synthetic clothing. Patients must be dressed in an outfit that's either 100 percent cotton or a 50/50 blend of cotton and polyester, usually scrubs provided by the hospital that's treating them.

Because the chambers are small, claustrophobia also can be an issue. But all kinds of things help with that, including the chambers' see-through walls, TVs mounted on top of them, anti-anxiety or muscle-relaxing medication -- if necessary -- and microphones that allow patients to talk to the doctors, nurses and technicians who watch over them. Safety regulations require that someone who's trained in hyperbaric medicine monitor the chambers whenever a patient is inside.

Pain and middle-ear damage can result if patients don't equalize the pressure in their ears, as on an airplane.

And some patients notice that their vision changes, for worse or better, during treatment and for a few weeks afterward. Then it bounces back.

On top of all that, it takes time.

The treatment time for most patients is 90 minutes, but because they have to gradually adjust to changes in pressure, have their lungs and vital signs checked and be examined by a doctor before and after treatment, the process takes a little more than two hours.

Treatment has benefits

For most of them, it's worth it.

Scragg-Hudec had a bone infection that she was told would require the removal of about 40 percent of her sternum. Doctors said the surgery could cost her the use of her arms.

She said no thanks.

"I'm in a wheelchair now. That would've made me a quadriplegic."

Instead, she opted for less destructive surgery combined with hyperbaric oxygen therapy.

After 40 treatments, the infection was gone, the tissue in her chest had healed and she could still use her arms to get in and out of her electric chair, drive her van and cut grass on her riding lawnmower.

"I just can't believe that I never had any problems after that," says Scragg-Hudec who was treated at South Pointe Hospital, which has two hyperbaric chambers.

Combining HBOT with other treatment is how it's best used, says Dr. David Perse, a board-certified surgeon, president of Lutheran Hospital in Cleveland and medical director for the hospital's Wound Healing Center.

"In my opinion, hyperbaric oxygen is not a cure, it's an adjunctive therapy for use in challenging cases involving tissue compromise," Perse says.

"You don't just go into a hyperbaric chamber and you're cured."

In addition, very strict guidelines regulate its use.

"And that is why patients need to go to a wound-care center to be assessed for using hyperbaric oxygen therapy as part of the treatment regime," says Dr. Seung Kwon Lee, a board-certified surgeon, certified wound specialist and medical director of the Wound Care and Hyperbaric Medicine Center at Bedford Medical Center.

"If you or your physician have not seen significant healing in four weeks," Lee says, "then ask for a referral to a wound-care specialty center where a variety of treatments -- which may include hyperbaric oxygen -- will help to close these hard-to-heal wounds."

WCPN, the NPR affiliate in Cleveland, also picked up the story.

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