Radiation or Diabetic Wounds – Will Hyperbaric Oxygen Therapy help me heal?

Matthew Clancy
Featured Speaker:

Matthew Clancy, MD
Matthew Clancy, MD, is the Hyperbaric Medical Director, Aspirus Wausau Hospital. His specialty is Hyperbaric & Undersea Medicine.

Do you have discomfort, skin breakdown, pain, bleeding or other possible side-effects that may have resulted from radiation treatments you received in past years?

These symptoms may be caused from lack of oxygen supply to the affected areas.

For some people, hyperbaric oxygen therapy will help enable the body to heal itself by providing a rich supply of oxygen to affected areas.

Matthew Clancy, MD, is here to explain if Hyperbaric Oxygen Therapy treatments may be the answer you need.

Transcription

Melanie Cole (Host):  Do you have discomfort, skin breakdown, pain, bleeding or other possible side effects that may have resulted from radiation treatments you may have received in past years? These symptoms may be caused from a lack of oxygen supply to the affected areas. For some people, hyperbaric oxygen therapy may help enable the body to heal itself by providing a rich supply of oxygen to the affected areas. My guest today is Dr. Matthew Clancy. He is the Hypobaric Medical Director at Aspirus Wausau Hospital. Welcome to the show, Dr. Clancy. Tell the listeners a little bit about hyperbaric oxygen treatment. What is it?

Dr. Matthew Clancy (Guest):  Normally what we breathe is air, or roughly 21% oxygen at 1 atmosphere of pressure. In hyperbaric oxygen therapy, we are receiving 100% oxygen and usually at two and a half times atmospheric pressure. The way to relate this is that our lungs probably have a hundred TOR, which is a measurement of oxygen, breathing room air. In a hyperbaric chamber, our lungs are probably somewhere between 1200 and 1500 TOR. So, much more oxygen to begin with.

Melanie:  If oxygen is transported typically through the body by red blood cells and carrying with it various things, iron and whatever, what does the HBOT do differently? Does that help oxygen get dissolved in a way or is it just more traveling through the system?

Dr. Clancy:  No, exactly what it does, you allude to. It is that we increase the amount of dissolved oxygen. At regular room air, most of the oxygen is carried by the red blood cells and they’re pretty much saturated. What we utilize is the plasma to deliver at least 1/3 more oxygen to the tissue. This becomes very, very important because what we are talking about, especially with radiation injuries, is we are talking about the diffusion difference between a normal TOR and the 1500 TOR that I was talking about. We can oxygen to diffuse through poorly perfused tissue much further and we can get it to cells that normally aren’t getting a normal amount of oxygen. Radiation, what it does to the healthy cells is, it destroys the blood supply. For the average person, the tissue that was hit by the beam, but not part of the tumor has approximately 30-40% normal capillary density. The diffusion distance now is increased because the partial pressure of oxygen is so much higher that, rather than the usual 65 microns that oxygen can diffuse from a capillary, it can now diffuse 240 microns. Then what happens is, increased oxygen tension is itself a signal to the body to produce new capillaries. This allows the body to produce the signal it needs to produce the new capillaries to help regenerate the oxygen delivery to threatened tissues.

Melanie:  That’s fascinating. What conditions can it treat?  What are some of those benefits if it’s helping with wounds or where adequate oxygen can’t reach that damaged area? Tell us a little bit about some of the conditions you use it for and what are the benefits for those are.

Dr. Clancy:  The two main conditions, by far, are diabetes and radiation necrosis. Diabetes is a multifactorial disease but one of the important things about it is it’s a disease of the microvessels. It is a disease that damages the microvasculature that cannot be fixed surgically. Again, being able to dissolve oxygen in the plasma as we are able to do allows us to deliver jolts of oxygen for the two hours you are in treatment. Then, it’s documented that the wounds that are not responding become metabolically active for six to eight hours after the treatment. Although, by the next day, they have again settled down, by jump starting them every day in a diabetic, we are able to drive them to closure. It's a little bit more complex with the radiation injuries but a perfect example is somebody that will have bladder cancer. The bladder cancer will be treated with radiation and it will be cured. Unfortunately, the mucosa, which is a blood rich tissue lining the bladder, will be damaged. Eventually, what happens oftentimes is these patients find themselves having bloody urine and losing enough blood that they oftentimes need to have transfusions. Again, it is from a lack of blood vessels because they have been damaged by the radiation. With hyperbaric oxygen producing that signal that we talked about, the body is able to regenerate the lost capillaries. We cannot ever get it back to 100% but we can raise it from the 30-40% which results in bleeding and necrosis and we can get it up to 80% which then supports healthy tissue.

Melanie:  Tell us about how HBOT is administered, Dr. Clancy, because people see these things that look like they are right out of Star Trek and you are expected to go in them. Tell us about the chambers and what they are like.

Dr. Clancy:  I went for one treatment just to experience it. It’s more or less like sitting in the cheap seats of an airplane. You hear the air flowing in the background – shhhhh. You are sitting there in a relatively confined but comfortable space.  You are looking at a TV screen in front of you. If you can sit in an airplane, it’s real easy to sit in it. You don’t feel the effects of the pressure because it’s subtle and it’s administered to the outside and inside of the body simultaneously. If you have some sort of a TV program, and also we have DVDs, so movies, to occupy your time, it is just the same as sitting in a theatre or sitting at home and watching TV. Other than that, it is like sitting in a plane. You not going to get up and walk around, you can’t move and there is that little gentle flow of air in the background that you always hear in an airplane. But it is fairly unremarkable. That is the word that just always pops to mind.

Melanie:  Is it claustrophobic for people that might have issues with MRI, for example?

Dr. Clancy:  Not in the least because rather than a closed, semi-dark tunnel, what we have is a chamber that is made out of Plexiglas so it’s a bright, clear tube.  In some setups, they usually bury hyperbaric oxygen in the basement. For our setup, we decided it was important to have a lot of natural light and windows, so it gives a very open and airy feel to it. If you can get into an elevator, it’s easy to tolerate hyperbaric oxygen.

Melanie:  That’s very cool that you moved it up so that you’re getting that nice, fresh light. Does insurance, Dr. Clancy, cover this type of therapy?

Dr. Clancy:   Yes. There are probably 35 different diagnoses that are recommended for treatment by the Hyperbaric Medical Society. Of those, 15 are covered by insurance. Again, the two major ones – by major I mean certainly 98% of our patients either suffer from radiation damage or they suffer from diabetes mellitus. Those are covered by all insurance and Medicare. 

Melanie:  In just the last few minutes--and what a fascinating topic that you work with every day – give us your best advice about people that are considering this type of therapy, that have heard about it and why they should come to Aspirus for their care.

Dr. Clancy:   The thing is, if you are at all a candidate, you should investigate this because the number of times that I have personally witnessed somebody who felt that it was too much of a commitment, they ended up losing their foot and it is simply tragic. Diabetic foot ulcers are one of the major causes of below-the-knee-amputations in America. Again, it does take a commitment. It’s going to be 2-3 hours a day. It is going to be five days a week and it is probably going to be for 8-10 weeks. I mean, I have had relationships that have lasted less time than this. But, it is a commitment that is just worth it because if you think creating the time to come here for treatment is a pain, losing a foot is just going to impact your entire life.

Melanie:  That is such great information. Thank you so much, Dr. Clancy. You’re listening to Aspirus HealthTalk and for more information you can go to Aspirus.org. That’s Aspirus.org. This is Melanie Cole. Thanks so much for listening.

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  - Podcasts
  - Diabetes
  - Wound Care