Hyperbaric Oxygen Chamber Therapy

deltadave wrote:

DoriC wrote:I was also told that this treatment may go on longer than 20 treatments as long as it shows some progress at that point so Medicare will allow recertification for another 20 treatments. If they can't show any improvement then the treatment will be considered a failure and Medicare will not pay for further treatment. My son says we can get around that but I'm hoping it won't be necessary.

Yeah, that osteo can sure be pesky!

Is Mike receiving concurrent antibiotic therapy?

Is his nutrition optimized?

What brand and model HBO chamber are they using?

Since we've got quite awhile to go, do you think we can make this TDCOTBILOTMOAT?

He received 2 weeks of IV antibiotics in the hospital after finding the right combination, 4weeks of oral at home under the care of our Infectious Disease Dr. No one is thinking it's necessary at this point. He drinks a special protein supplement 2x daily prescribed by the hospital nutritionist, takes vits/minerals and eats well. The HBO chamber is Sechrist, Now....I can't answer your last question because maybe I'm "dumb" or because I haven't had my coffee yet so help a girl out!

DoriC wrote:He received 2 weeks of IV antibiotics in the hospital after finding the right combination, 4weeks of oral at home under the care of our Infectious Disease Dr. No one is thinking it's necessary at this point.

Interestingly, HBO enhances the transport and augments the efficacy of antibiotic action (or at least some of them), so it might have been helpful to match those up, but obviously water under the bridge.

DoriC wrote:He drinks a special protein supplement 2x daily prescribed by the hospital nutritionist, takes vits/minerals and eats well.

Got some zinc in there?

DoriC wrote:The HBO chamber is Sechrist...

Good tube. 3600?

DoriC wrote: Now....I can't answer your last question (TDCOTBILOTMOAT)...

The Distant Cousin Of The Brother In Law Of The Mother Of All Threads!

Yes, he takes an enhanced formula called Zinc 220mgs. He's been on it since Jan, been wondering if it's too long so that's on my list of questions for our Friday meeting with the staff. What do you think?
It is a Sechrist 3600, I'm glad you know it's a good model.
Last question... I'm hoping this thread becomes a distant memory very soon...as long as you behave yourself!

I'm a little PO'd because the Dr asked me if I had been using Debrox the last few days because when he tried to clean his ears last week there was a large build up of wax that he couldn't get out and he wanted to remove it today. When I told him I knew nothing about that,except that Mike thought his ears had been cleaned, he seemed quite angry that the nurse hadn't relayed those instructions to me. I heard a door slam down the hall. So now I'll have to do the Debrox until Friday and another Dr who will be covering will have to remove the wax hopefully. Why can't people do their jobs!

DoriC wrote:Yes, he takes an enhanced formula called Zinc 220mgs. He's been on it since Jan, been wondering if it's too long so that's on my list of questions for our Friday meeting with the staff. What do you think?

I think that's a great question to test their knowledge base. Watch for their initial reaction and beware of non-commital response.

OTOH, I don't know if there's really a "right" answer. "A" nutritional recommendation for zinc supplementation in wound healing is a zinc sulfate "blitz" of 220 mg (providing 50 mg zinc) bid x 2 - 4 weeks.

Other references condone long-term (like a year) supplement use.

It also depends on dietary intake.

OTOH2, American Family Physician May 2009 said

A meta-analysis of 181 participants from six RCTs of oral zinc sulfate versus placebo for venous or arterial leg ulcers found no significant difference in time to ulcer resolution.

DoriC wrote:I'm hoping this thread becomes a distant memory very soon...as long as you behave yourself!

Hey, don't look at me-- I'm not the one who deleted all my posts.

Anyway, HBO in osteomyelitis is not simply "let's drive a whole bunch of oxygen in there"-- rather, it is proposed that

• HBO enhances oxygen-dependent leukocyte killing through the production of hydrogen peroxide and superoxide by providing increased oxygen tension in the hypoxic tissue;
• Optimal tissue oxygen tension enhances osteogenesis and neovascularization to fill the dead space with new bone and soft tissues;
• HBO has also been shown to enhance osteoaclastic activity to remove bony debris;
• Synergistic effects of HBO on bone healing with bone morphogenic protein (BMP) were demonstrated; and
• HBO has been shown to potentiate the antimicrobial effects of aminoglycosides, and possibly sulpha drugs and vancomycin, in the killing of susceptible bacteria.

The role and effectiveness of adjunctive hyperbaric oxygen therapy in the management of musculoskeletal disorders.

In regards to the last activity, it is important to note "susceptible" bacteria. ABX Therapy needs to be culture-based.

As noted by a previous poster, UHMS can be an excellent source of information (OK, he didn't say exactly that).

Here's a summary on osteomyelitis:

Osteomyelitis

We're on our way to the hospital so I don't have time now to "digest" everything but just wanted to note that he was treated with a combination of Vancomycin and Sulphur(can't remember the exact name) after blood cultures finally found that Mike's bacteria was susceptible to them. I'm anxious to read more later today. Thanks.

DoriC wrote:...he was treated with a combination of Vancomycin and Sulphur(can't remember the exact name) after blood cultures finally found that Mike's bacteria was susceptible to them.

Vanco?

Whoa, the Dillon of ABx.

What was the bug?

Sulfamethoxazole.

deltadave, you are a terrific resource. I learn a lot from your comments and links, and appreciate your taking the time.

Dori---best wishes.

deltadave wrote:

DoriC wrote:...he was treated with a combination of Vancomycin and Sulphur(can't remember the exact name) after blood cultures finally found that Mike's bacteria was susceptible to them.

Vanco?

Whoa, the Dillon of ABx.

What was the bug?

Sulfamethoxazole.

Dave, thank you so much for taking such a sincere interest in our situation and I feel more empowered because of that and I'm not so frightened. Mike's medical hx is so complicated and lengthy that it would be difficult to discuss in an open forum. This all goes back to 2000 with his first of many surgeries so I don't even remember all the details. Every surgery brought it's own set of complications that had to be treated differently. I'm sure you understand. One piece of good news, the Drs in the HBOTdept in agreement with our surgeon have decided the wound won't be packed anymore, just cleaned and dressed daily, so that's a major relief.It might even speed up healing...maybe?? They also checked his ears today after I put drops in for a few days, they flushed out what was left so check that off the list. I didn't realize how much the buildup of wax in his ear canal could have become a problem in the chamber. Just so you all know what a wonderful facility this is, Mike has been very restless during treatment, the mattress is not very plush, they couldn't make him comfortable so today they put put in a Kenny Rodgers CD instead of the TV and he was much better! BTW, his recording of "Lady" is "our song"!

Sounds like progress Dori, good news!

Great news DoriC, sounds like this may work. Now I just have to ask. At 3 bars of oxygen, I can only imagine the potential for induced centrals.

DoriC wrote:...the mattress is not very plush...

The good news is that the Sechrist mattress (OmniPressure) is specifically designed to distribute weight so as to reduce the likelihood of the pressure sores that may occur in patients that have HBO-qualifying diseases (in many of whom pressure sores are a significant risk).

DoriC wrote:...behave...

Please note that I really have tried...

DoriC wrote:He received 2 weeks of IV antibiotics in the hospital after finding the right combination, 4weeks of oral at home under the care of our Infectious Disease Dr. No one is thinking it's necessary at this point.

OK, this antibiotic thing remains somewhat confusing to me, although as you say, Mike's case is complex and I, in fact, really do not have the SFI what is going on.

However:

• The list of qualifying diseases for HBO is very specific, and it would seem that the only indication Mike has is Chronic Refractory Osteomyelitis.
• If he has CRO, then by definition, the infection is still present.
• Consequently, ABx therapy should be continuing, because:
  
  • As noted previously, many ABx work better (including, for that matter, vanco) in an HBO milieu;
  • HBO is an adjunct to conventional care, not a primary treatment; and
  • If the indication is CRO, some insurers will only approve HBO if the patient is receiving ABx, with coverage limitations such as "HBOT is not used alone but as adjunctive therapy in combination with antibiotics."

Coverage for wounds is limited to "diabetic wounds of the lower extremity".

OTOH, the case has probably been submitted and approved because of a bunch of other stuff not noted, and you're just testing me to see if I'm really paying attention.

oxoxoxox

deltadave wrote:oxoxoxox

OMG, are those hugs and kisses?! He REALLY is a changed man!!

SleepingUgly wrote:

deltadave wrote:oxoxoxox

OMG, are those hugs and kisses?!

Don't be ridiculous.

That's a tic-tac-toe game when you take the lines out.