Jim Keenan, a man in his 60s, wasn’t alarmed particularly when he saw a small blister on his heel. After 5 days, his foot was infected so seriously that doctors feared that his lower leg may need amputation.
Keenan, who has Type 2 diabetes, chose to go for hyperbaric therapy instead. Known widely as a treatment for underwater diving disorders, Hyperbaric Oxygen Therapy (HBOT or hyperbaric therapy) involves breathing in pure oxygen inside a pressurized chamber.
Effect of HBOT on Diabetic Foot Ulcers:
The intense flow of oxygen in blood can generate growth of cells, promote new vessel formation, and fight several infections, stated Dr. Alan Davis, the director of the Center for Wound Care and HBOT in Northwest Hospital outside Baltimore.
It has been shown by Swedish researchers that hyperbaric therapy can help in the healing of foot ulcers in certain diabetic patients, as per a study of 2010 published in journal Diabetes Care. It was also found from a review of some other trials that HBOT seems to lower the number of amputations in diabetic individuals with chronic foot ulcers, as per the literature’s Cochrane Review.
The data on the healing of chronic wounds are promising, however, there is a lack of adequate research and several physicians are still quite skeptical.
The Swedish study seemed to be done well, however, it still does not outline which patients will be benefiting by using this highly expensive treatment, stated Dr. Tony Berendt, Oxford’s infectious disease physician and the co-author of various clinical guidelines on foot infection in cases of diabetes.
Diabetes occurs when the body of a person cannot create the normal insulin amount, or does not use it correctly. The role of insulin is to control blood sugar. If the levels of sugar are very high, nerves and/or blood vessel can be harmed, as stated by Davis.
Damage to nerves or blood vessels can lead to lowered sensation or loss of circulation to feet. This may make it hard to identify an injury or a sore.
Individuals with diabetes feel reduced pain, stated David Armstrong, director of Southern Arizona Limb Salvage Alliance in the department of surgery of University of Arizona.
Research by Armstrong has disclosed that about 25% of individuals with diabetes may develop a foot ulcer. Infections develop in over half of foot ulcers, and one out of five infections need amputation.
Hyperbaric therapy may enhance the concentration of oxygen in peripheral tissues, and the heightened oxygen concentration may improve the healing, stated Armstrong. However, he outlined that if blood is not able to flow on account of peripheral vascular disease, the blood with high oxygen level would not reach the extremities and the Hyperbaric Oxygen Therapy (HBOT) would be almost useless.
It’s highly important for a patient to have access to a team – a group of doctors and nurses of various specialties working together, including a podiatric or foot surgeon and vascular surgeon, added Armstrong. He said that it is not what is put over a wound which heals it, it is what is taken off. He also added that if what is dead is carefully and surgically removed and pressure is redistributed so that the patient does not pirouette on a part of the body, when the blood flow is good and infection is absent, most wounds heal well.
Keenan, a resident of Bettendorf in Iowa, was detected of diabetes at the age of 58. He went through 40 treatments of 2 hours in a pressurized hyperbaric chamber for five days per week, for improving flow of oxygen to his foot. Simultaneously, his treatment was done with several grafts, dressings and vascular surgeries for improving the flow of blood to his foot.
The treatment was done for about two years. Keenan is already riding his bike and walking for short distances. He said that he is doing activities he thought he may never do again.
HBOT is still under study, with scientists trying to explore more about its effectiveness in treating various medical conditions.