Thursday, January 29, 2009
“You’re breathing oxygen right now,” says Alain Claudel, “and you kinda like it, right?”
Yes. I do kinda like it.
Claudel, the director of Community Hospital of the Monterey Peninsula’s rehabilitation services, isn’t being facetious, however. He’s making an important point.
We’re at CHOMP, looking at the hospital’s two hyperbaric oxygen chambers, clear cocoon-like machines – if caterpillars were seven feet long and liked listening to Usher or watching The Princess Bride while metamorphosizing into a butterfly.
“The air we breathe is about 21 percent oxygen,” Claudel continues. “We’re at sea level, so [it’s] one atmosphere of pressure.
“The man in the chamber,” he says, motioning to a man inside one of the glass cocoons, “he’s under three atmospheres, breathing 100 percent oxygen.”
While he’s in the chamber – the nurses and doctors here call the treatments “dives,” as in scuba – an increased amount of oxygen dissolves into his blood and tissues, which means he will heal faster. Meanwhile, during his 110-minute dive, he watches the History Channel (each machine comes equipped with a sound system; patients may bring CDs or DVDs, or watch the flat screen TV above the chamber while the audio is pumped into the soundproof chamber).
Hyperbaric medicine has long been used to treat pilots and deep-sea divers who develop decompression sickness, or “the bends.” The technology’s uses for other medical purposes – to treat patients suffering from chronic, hard-to-heal wounds, burns, skin grafts and injuries from radiation treatment – is becoming increasingly popular in wound-care and rehabilitation centers. Some specialists say hyperbaric oxygen therapy is among the fastest growing technologies in the United States; it’s hard to prove this, however, because the country doesn’t chart the growth in medical devices. CHOMP’s program is the newest – and only – in the tri-county region.
Hyperbaric oxygen stimulates the growth of new blood vessels, improves the efficiency of white blood cells that help clear up infection and reduce swelling, says Dr. Ed Johnson, CHOMP’s medical director of wound care services and hyperbaric medicine, rattling off a list of medical conditions he treats.
“The main ones are severe diabetic foot wounds, patients undergoing skin grafting, radiation injury – we treat cancer with radiation, which kills the cancer, but can damage normal tissues – bone injury, gas gangrene,” he says.
It’s also used to treat crush injuries: “A bad crush injury to the leg, for instance, can become swollen quickly. But we can reduce the swelling right away, which allows blood flow to become unrestricted. Because this high concentration of oxygen can pass through the blood stream in liquid phase, it can get into small spaces, even where tissue might be crushed.”
What about people wanting to breathe 100 percent oxygen to look younger and reverse signs of aging, à la Michael Jackson?
“No, we don’t do that,” Claudel says. “If you want to talk about oxygen bars, that’s a different story. They don’t work.”
“IF IT’S GOING TO BE A TWO-WEEK RECOVERY AND YOU CAN HAVE THEM BACK AT WORK IN A WEEK, THAT’S A GOOD THING.”
CHOMP does treat patients who want to recover faster from cosmetic surgery. “Particularly on the face and breast tissue,” Johnson says, “hyperbaric oxygen therapy can decrease recovery time. We’ve seen anywhere between one-third to one-half reduction in recovery time” – good news for some Type A Monterey County professionals who might otherwise “take a vacation” (to L.A.) and return a couple weeks later “looking refreshed” (with tighter skin and wider eyes).
“Do they need it [hyperbaric therapy]?” Johnson asks. “No. But we have some patients who are high-powered attorneys and they need to be back at work yesterday. If it’s going to be a two-week recovery and you can have them back at work in a week, that’s a good thing.”
In a famous 1960 experiment, Dutch doctors put a pig in a hyperbaric chamber, pressurized it to three atmospheres, removed all the pig’s blood and replaced it with saline. The amount of oxygen dissolved in the saline kept the pig alive in the chamber without blood. At the end of the experiment, doctors replaced the blood and brought the pig out of the chamber alive.
“The reason is [that] the oxygen gets pushed into that liquid phase,” Johnson says, adding a note to PETA: CHOMP doesn’t experiment on pigs in the hyperbaric chambers.
Johnson, a Monterey High grad, began his career with a family medicine residency at Natividad Medical Center. He practiced in Salinas for six years before joining the Air Force – living in Nevada, Texas and Utah at various bases – where he became a captain, and used hyperbaric oxygen therapy to treat divers and pilots. While stationed in Texas, he worked with specialists who were using hyperbaric medicine to treat patients who suffered from chronic wounds, burns, failing skin grafts and injuries from radiation treatment.
In 2004, he completed a fellowship in hyperbaric medicine at the University of Pennsylvania before returning to the Central Coast to establish a wound care and hyperbaric medicine center in Santa Barbara.
In December 2006, he moved home, becoming medical director for wound care services and hyperbaric medicine at CHOMP – a first for the Peninsula hospital.
“All of this,” says Claudel, motioning to the chambers, “is meaningless without Dr. Johnson. Without Dr. Johnson’s expertise in hyperbaric medicine and wound care, the community would not have this service.”
About five patients receive hyperbaric therapy each day, according to hospital staff, and they typically treat between 40 and 50 a year. Doctors generally refer patients for a couple dozen dives – “but that could vary from a handful, maybe five treatments for cosmetic, to radiation injuries, which can go up to 40,” Johnson says.
Cost varies widely. “Each treatment can be as high as $1,300 – that’s for two hours of hyperbaric medicine – but most of that, if not all of that, is paid by primary or secondary insurance,” Claudel says.
Johnson shares the story of Harry Smith, a 60-year-old man from King City with a history of diabetes, heart disease and poor circulation.
“It all started with a little crack on my heel,” Smith says. By the time he was referred to Johnson, the wound had grown to the size of a tennis ball.
Johnson first saw Smith in December 2007, at which point Smith had been suffering from the wound for five months. Smith’s second toe on the same foot had already been amputated because of gangrene, and his Salinas surgeon worried Smith might need a below-the-knee amputation of his left leg.
“I was under quite a few doctors’ care, and they had given up hope on saving my foot,” Smith says. “One said, ‘You’re young enough, you’ll be able to learn to walk in a prosthetic foot easily enough. I said, ‘I’d rather keep my foot.’”
Smith told Johnson he’d do whatever it took to keep his limb.
“Within the first week of treatments, the left heel looked much better and I had a feeling we probably be able to save his foot/leg with a lot of effort,” Johnson says.
For the next several months Smith drove from King City to CHOMP and back home, accompanied by his Chihuahua, George. (Smith’s wife works full time, but she made the trek with him when she could, and changed his wound dressings for many months.)
Smith completed two separate series of treatments, totaling 45 dives. On July 23, Johnson declared Smith’s wound 100 percent healed. Today, he’s walking with some help from a special shoe. Smith hopes to try riding a bike in a few weeks. “I love riding my bike, and it’s been a year and a half or better since I’ve been riding. I’m probably way out of shape now.”
But he’s still got both feet.