Adjunctive Therapies

By Lydia A Meyers RN, MSN, CWCN

Hyperbaric Oxygen Therapy (HBOT) is a type of therapy that is oxygen done under greater than atmospheric pressure. Treatments are done according to approval by Medicare/Medicaid rules and regulations. At this time HBOT has been approved for the following:

By Christine Shettel, RN, BSN, WCC, DAPWCA, PWRC

Hyperbaric medicine has been used in wound care for over 50 years. As wound care professionals, we are saving patient’s lives, and preserving limbs utilizing Hyperbaric Oxygen Therapy (HBO). As health care professionals we understand the indications and benefits of HBO therapy, however, it’s important to follow clinical pathways and your local coverage determinations to ensure that we are placing the clinically appropriate patients in the chambers. It’s also important to understand what clinical documentation is required in order to qualify your patients for treatments to achieve optimal outcomes.

By Angela Kujath, Executive Director of the ACHM

Most of us can remember a time when we’ve felt extreme anxiety about taking an exam. This anxiety was accentuated if we felt inadequately prepared. In my role as Executive Director of the American College of Hyperbaric Medicine (ACHM), I have often been asked questions about exam preparation for hyperbaric certification. The ACHM has offered a hyperbaric certification exam since the late 90s, but participants simply studied their textbooks and relied on past experience to ready themselves for the exam. I can tell you that this led to many conversations with frustrated and anxious individuals who felt that studying a textbook that they had read as many as 10 years ago was simply not enough to help them feel prepared. This was even more worrisome for the physicians who hadn’t practiced hyperbaric medicine in several years, or for those actively practicing HBO but maybe only doing so part time.

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

Parents of most children growing up in the sixties read them Winnie the Pooh. My father, a Woodrow Wilson fellow in English literature, read us Homer’s Odyssey, four times. I remember listening with excitement and anticipation as Odysseus rowed between the fearsome sea monsters Scylla and Charybdis. More than 40 years later I find myself navigating two equally challenging concepts: Efficacy and Effectiveness.

By Lydia A Meyers RN, MSN, CWCN

Radiation necrosis can be defined as cell death as a result of high doses of radiation as used with aggressive tumors. The dead cells caused by the loss of blood flow can be located anywhere in line with the radiation treatments. This damage can cause wounds that will not heal, pain and skin that can be easily damaged. Radiation necrosis can be divided into the following classifications: acute, sub-acute and delayed complications. Acute damage is direct in-line damage as well as that in the surrounding area. The cells receive damage in the DNA structure enough to prevent mitosis. This damage does not last and can be treated by controlling the symptoms. Sub-acute damage is related to the treatment of lung cancer and mimics bronchitis. Another injury that can happen is related to temporary demylinization of the spinal cord and causes Lhermitte’s syndrome. With Lhermitte’s syndrome the patient suffers electric-like shocks in the legs when stretching the spine. Delayed injuries can happen from all types of treatments and from six months to many years after the initial treatment. This could also include acute injuries that were never resolved and became chronic injuries.

By Lydia A Meyers RN, MSN, CWCN

In recent months, I have gained insight into a problem that appears to be universal across the continuum of care and across the country as I’ve worked in different facilities and in different capacities. I have found some people accepting of new information and others that feel they know it all and are unwilling to accept information from their professional peers. As those that know me well know, wound care is my passion. The only thing that hurts more than having a peer professional discount information is seeing the impact it can have on a patient and witnessing the resulting suffering - loss of limbs, loss of quality of life and loss of independence - all because the one making the wound care decisions couldn’t see beyond the end of their nose.

By Lydia A Meyers RN, MSN, CWCN

I have heard some doctors and a number of other health care professionals talk about Hyperbaric Oxygen Therapy (HBOT) and my sense is not many of them truly understand what it does or how it works. HBOT is not a television station and it is not what Michael Jackson used in an effort to preserve his youth. HBOT is a true way to help wounds heal and create new blood vessels that promote increased circulation. HBOT helps to promote angiogenesis, which is the rebuilding of blood vessels during wound healing. It also promotes increased neutrophils to help fight infection.

By Michael Miller DO, FACOS, FAPWCA

RAMBLINGS OF AN ITINERANT WOUND CARE GUY PT. 6

“IMPOSSIBLE, for a plain yellow pumpkin to become a golden carriage… But the world is full of zanies and fools, who don’t believe in sensible rules, and who won’t believe what sensible people say. And because these daft and dewy-eyed dopes keep building up impossible hopes, impossible, things are happening every day” (Rodgers and Hammerstein’s Cinderella).

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Ultrasound was successfully used as a non-invasive diagnostic tool for years before its potential benefits in wound healing were first investigated. Ultrasound waves, formed when electrical energy is converted to sound waves at frequencies above the range of human hearing, are now routinely used in wound management, and can be transferred to tissue through a treatment applicator. The depth of penetration is dependent on the frequency, with higher frequencies resulting in lower tissue penetration.

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

From the third floor patio of the Foreign Correspondent’s Club (FCC), the evening breeze is a welcome respite from the sweltering heat of Phnom Penh’s hospital wards. An assortment of barges and boats strung with neon lights drifts along the Mekong Delta. This location, made famous by the movie the Killing Fields, has become the meeting place for NGOs (non-governmental organizations) and volunteers of all sorts. Nightly, we would share our tales of life and death in Cambodia’s capital city. A recurring theme was the lack of active ingredients in medicines purchased at local pharmacies. A trio of Brits complained that it was far worse in other resource poor nations. I was appalled that someone would reduce the dose of a medicine for economic gain.