Diabetic Wound Care, Diabetic Foot Care, Hearing Loss, Autism | IHS India

Doctors


Physicians and healthcare professionals desiring to champion the effort to establish or improve a wound care and hyperbaric program at their hospital are welcome and encouraged to contact us. We'll explore the potential for the program and work the hospital administrators to establish a "center of excellence".

Innovative Wound Centers reward all levels of the medical community including surgeons, physicians, nurses, and technologists. Several opportunities exist for healthcare professionals to positively impact patients that need special attention to wounds.

OPPORTUNITIES


Medical professionals will enjoy complete gratification while practicing advanced wound care modalities in a setting that provides scheduling personnel, outcome tracking, advanced dressings, and hyperbaric technology. Innovative Wound Center medical directors, physicians, and staff are supported and recognized by Innovative Healing Systems India as valued leaders in their respective disciplines. This vision incorporates the support of physicians in their quest for excellent outcomes. Wound care and hyperbaric medicine has evolved to a specialty requiring additional skills, training and the opportunity for certifications.

Surgeons and physicians are supported by Innovative Healing Systems India through the proctorship program in multiple disciplines. In the proctorship program physicians will be mentored and guided toward obtaining certifications in both hyperbaric medicine and wound care. Credentialing of physicians by nationally recognized organizations is a statement to the community of commitment and excellence in a specialization that is on the cutting edge of medical science.

Nurses can enjoy the working with a team of dedicated professionals devoted to healing patients. The opportunity to truly develop a relationship with patients is afforded as their plan of care is developed to treat a problem wound from inception to a final healed result. Patient satisfaction is rewarding for the entire clinical staff. Nurses employed by Innovative Healing Systems India can leverage excellent compensation and benefit packages that include educational support.

Certified Hyperbaric Technologists and Safety Directors employed by Innovative Healing Systems India have ample opportunity in the development, refinement, and implementation of hyperbaric safety protocols as they lead and monitor patient comfort and safety. Many technologists enjoy participation in the patients' plan of care and positive results from their efforts. Innovative Healing Systems India recognizes the key elements of success that differentiate the average wound care and hyperbaric center from a true center of excellence. Carefully crafted education and orientation programs lay strong foundations of growth and opportunity. These programs harness and develop the power of our greatest asset, the team. Certified Hyperbaric Technologists and Safety Directors additionally have access to our continuing education program.

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REFFERALS


Physicians and clinicians are often faced with a patient that has a slow to heal or problem wound requiring advanced, expensive, and time-consuming resources to heal. Innovative Wound Centers can offer the necessary resources to quickly heal the patient. Our specialists collaborate with the patients' primary care physician to personalize a plan of care. These experts will take the time to guide and instruct the patient, their family, and their caregivers on appointment responsibilities, and post treatment care. While patients are treated by the Innovative Wound Center, they remain under the supervision of their primary care physicians who receive detailed progress reports and communications keeping them involved at every opportunity.

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KNOWLEDGE BASE


Below is a question and answer knowledge base designed to address the most frequent topics raised by inquiring medical professionals:

What is Hyperbaric Oxygen Therapy?

Hyperbaric means increased pressure. Hyperbaric oxygen therapy (HBOT) refers to treatment where the patient breathes 100% oxygen at pressures higher than normal atmospheric pressure. The earth's atmosphere exerts a column of pressure and at sea level it is defined as one atmosphere absolute (1 ATA= 760 mm Hg or 14.7 psi). Normally, we breathe air which has approximately 20% oxygen and 80% nitrogen. In HBOT 100% oxygen is given under pressure in a hyperbaric chamber. This can be raised up to 2.4 absolute atmospheres of pressure (ATA) depending on the diagnostic indications.

Innovative Healing Systems, India, uses monoplace hyperbaric chambers where the patient's entire body is totally enveloped in 100% oxygen. There is no need for the patient to wear a mask or hood. When the pressure inside the chamber is increased, oxygen dissolves in the blood plasma and is carried to all body cells, tissues and fluids at up to 10 times normal concentration. This is in addition to oxygen saturation of hemoglobin which is the normal vehicle of transport.

How Does Hyperbaric Oxygen Therapy work?

Increased oxygen delivery to the tissues facilitates healing through a number of mechanisms.

NEOVASCULARIZATION AND EPITHELIALIZATION
High tissue oxygen concentrations accelerate angiogenesis or the development of new blood vessels in both acute and chronic injuries. Regenerating epithelial cells also function more effectively in a high-oxygen environment. These properties are effective in treating tissue ulcers and skin grafts.

STIMULATION OF FIBROBLASTS AND OSTEOCLASTS
Hyperbaric Oxygen Therapy (HBOT ) stimulates fibroblasts and osteoblasts to synthesize collagen and osteoid matrix to accelerate wound and bone healing by overcoming the hypoxic conditions present in some chronic wounds and non-healing bone. Arterial and venous ulcers, diabetic foot ulcers, chronic refractory osteomyelitis and slowly healing fractures benefit from HBOT due to this mechanism.

IMMUNE RESPONSE
When tissue oxygen tensions fall below 30 mmHg, immune responses to infection and ischemia are compromised. High oxygen concentrations prevent the production of certain bacterial toxins and kill anaerobic organisms such as Clostridium perfringens. It also aids in the migration and phagocytic function of polymorphonuclear (PMN) leukocytes. Oxygen is converted within the PMN into toxic substrates (superoxides, peroxides, and hydroxyl radicals) that are lethal to bacteria making HBOT effective in the healing of soft-tissue infections and osteomyelitis. In crush injury and compartment syndrome HBOT helps limit reperfusion injury as it inhibits PMN adherence in post-capillary venules.

VASOCONSTRICTION
High tissue oxygen concentrations cause blood vessels to constrict, which can lead to a 20% decrease in regional blood flow. In HBOT, tissue hypoxia does not develop with this decrease in regional blood flow as it is adequately compensated for by the increased plasma and tissue oxygenation. The net effect is decreased tissue inflammation and edema without hypoxia. This mechanism improves tissue oxygen concentrations in crush injuries and thermal burns while reducing tissue edema.

MAINTAINING HIGH-ENERGY PHOSPHATE BONDS
When circulation to a wound is compromised, resultant ischemia lowers the concentration of adenosine triphosphate (ATP) and increases lactic acid levels. ATP is necessary for ion and molecular transport across cell membranes and maintenance of cellular viability. Increased oxygen delivery to the tissue with HBOT prevents tissue damage by decreasing the tissue lactic acid level and maintains high ATP levels. This prevents tissue damage in ischemic wounds and reperfusion injury.

What are the presenting symptoms that would likely benefit from HBOT?

A person diagnosed with diabetes and a wound that is slow to heal, or is simply not healing are the most common benefactors from HBOT. Additional presenting symptoms that require HBOT are:

  • Wounds that have shown no improvement in 4 weeks.
  • Complicated infections of the bone and skin.
  • Damaged tissue from radiation therapy.
  • Skin grafts with questionable blood supply.
  • Crush injuries or compartment syndrome of a limb


How many HBOT treatments does a person require?

The number of HBOT treatments patients require is based on the type and intensity of the diagnoses. For example, the average number of treatments required to heal a patient with a problem wound is between 20 and 40. These are usually given once daily, 5 to 6 days a week for 2 to 3 months.

Is the HBOT treatment safe?

Yes, the hyperbaric treatment is very safe and non-evasive. Our staff's first priority is to safety and the adherence to all guidelines and procedures including providing patients with complete instructions before, during and after every treatment.

Are there any contraindications to address prior to recommending HBOT?

Malignancies, high fever, viral infections, seizure disorders, pregnancy, implanted pacemaker, lung disease or history of thoracic surgery are screened and addressed with the referring or primary physician prior to treatment.

Additionally, the following medications are screened and addressed with the referring or primary physician prior to treatment:

  • Doxorubicin (Adriamycin)
  • Bleomycin
  • Disulfuram (Antabuse)
  • Cis-Platinum
  • Sulfamylon
  • Amiodarone (Cordorone)


Smoking is strongly discouraged during the course of HBOT as cigarette smoking can cause the blood vessels to constrict and reduce the effects of HBOT.

What are the risks associated with Hyperbaric Oxygen Therapy?

HBOT side effects can be divided into two categories: pressure complications and neurological toxicity.

PRESSURE COMPLICATIONS
Gas-filled structures in the body include the lungs, middle ear, paranasal sinuses, and intestines. Boyle's law states that, at a constant temperature, the volume of a gas is inversely proportional to its pressure. Therefore, any bubble or flexible gas filled space in the body changes volume inversely proportional to the changes in pressure exerted.

Complications may develop when gas-filled structures change volume in response to HBOT pressure changes. The consequences of gases expanding and contracting in flexible spaces such as the intestines are usually insignificant (abdominal cramps, flatulence). Gases contained in rigid spaces such as the middle ear and sinuses, however, usually account for more of the troublesome side effects of hyperbaric therapy.

Middle ear barotrauma is the most common complication of HBOT treatments. It usually produces ear pain and can result in serous otitis media or rupture of the tympanic membrane.

Patients with eustachian tube dysfunction are at higher risk for these conditions.

Sinus pain or "sinus squeeze" is the second most common complication. Both "sinus squeeze" and middle ear barotrauma occur more commonly in patients suffering from an upper respiratory infection and allergic rhinitis.

To prevent some of the pressure complications of HBOT, autoinflation or equalization techniques are performed including the Valsalva's maneuver, chewing movements, biting down on a closed jaw, or building up the pressure in the pharynx while pinching the nose. Patients should be instructed not to perform too vigorous a Valsalva's maneuver or they may suffer a rupture of the round and oval windows. This is usually heralded by the sudden onset of deafness, tinnitus, nystagmus, and vertigo.

Another serious but infrequent complication of HBOT is pneumothorax, which can occur when a patient holds his or her breath during compression or decompression. Pneumothorax should be considered when a patient reports shortness of breath, cough, or chest pain. Because of the pressure, a simple pneumothorax may quickly develop into a life-threatening tension pneumothorax during HBOT, which may require expedient decompression.

NEUROLOGICAL TOXICITY
Oxygen is a medication, and problems can arise with prolonged or repetitive exposures. Most problems are seen in treatments lasting several hours that are repeated for many days. Oxygen toxicity may cause seizures in some patients. These generalized tonic/clonic seizures are usually self-limited. They may occur spontaneously but are usually preceded by symptoms such as nausea, twitching, auditory changes, or dizziness. Oxygen toxicity seizures are rare; the risk has been estimated to be around 1 in 10,000 exposures at routine treatment pressures .Periodic air breaks lower the risk during treatment. Five-minute air breaks are typically administered every 30 minutes when treatments exceed 2.4 ATA.

EYE CHANGES
Progressive myopia can develop in patients undergoing daily treatments for several months. This condition results from refractory changes in the ocular lens but is usually reversible within a few weeks after cessation of HBOT. Retinal changes may occur but are usually limited to premature infants and therefore are typically not an issue in sports medicine. Cataracts, once believed to develop after prolonged exposure to oxygen under pressure, are now not believed to occur from HBOT .

What conditions does Hyperbaric Oxygen Therapy treat?

Primary Indications

  • Diabetic Ulcers
  • Infected Wounds / Bites / Lacerations
  • Arterial Ulcers
  • Burn Wounds
  • Cellulitis
  • Failed Grafts / Flaps
  • Malignant Wounds
  • Osteomyelitis
  • Pressure Ulcers
  • Soft Tissue Necrosis
  • Non-healing Surgical Wounds
  • Traumatic Wounds
  • Vasculitis
  • Venous Ulcers
  • Pressure Ulcers
  • Radiation Treatment Wounds
  • Crush Injuries

 


Secondary Indications

  • Autism
  • Coronary heart disease
  • Myocardial infarction
  • Myocarditis
  • Bronchial asthma and asthmatic bronchitis
  • lschemic cerebrovascular disease
  • Migraine
  • Bell's palsy
  • Peripheral nerve injuries and neuropathies
  • Mountain sickness
  • Brain trauma
  • Brain tumor, post-operative
  • Cerebrovascular disease, post-operative
  • Multiple sclerosis
  • Epilepsy
  • Reimplantation of severed limb, post-operative
  • Myelitis
  • Bone fractures and non-union of fracture
  • Aseptic osteonecrosis
  • Chronic skin ulcer
  • Congenital heart disease surgery
  • Coronary artery bypass operation
  • Paralytic ileus
  • Peripheral vascular disease
  • Chilblain
  • Burns
  • Cosmetic surgery, post-operative
  • Post skin grafting
  • Sudden deafness
  • Acoustic deafness
  • Vertigo
  • Retinal venous thrombosis
  • Central serous retinopathy
  • Retinal concussion
  • Optic atrophy
  • Diabetic retinopathy
  • Viral encephalitis
  • Infectious hepatitis
  • Chronic hepatic insufficiency
  • Peptic ulcer
  • Ulcerative colitis
  • Sports injuries
  • Radiation injury
  • Pharmaceutical and chemical intoxications
  • Pityriasis rosea
  • Shingles
  • Erythema nodosum
  • Periodontal disease
  • Recurrent aphthous ulcer
  • Cancer (combined with radiotherapy and chemotherapy)
  • Pneumonia in children
  • Neonatal asphyxia
  • Fetal distress
  • Cerebral palsy in children


Investigative indications

  • Meningitis
  • Arrhythmia
  • Chronic heart failure
  • Glaucoma
  • Manganese poisoning
  • Autoimmune diseases
  • Diabetes mellitus
  • Radiation-induced vasculitis
  • Cervical spondylopathy
  • Mycosis
  • Parkinson's disease
  • Senile dementia
  • Pyocephalus
  • Progressive niyodystrophy
  • Rheumatoid arthritis
  • Adult respiratory distress syndrome
  • Childbirth in women with heart disease
  • Habitual abortion


The most common conditions treated with hyperbaric oxygen therapy are:

FOOT ULCERS
Arterial, venous and diabetic foot ulcers account for a majority of chronic wounds in the lower extremity. It is well known that adjunctive HBOT reduces the incidence amputations among patients with these conditions and saves limbs.

In HBOT, 20 to 40 sessions of 60 to 120 minutes are given in a hyperbaric chamber using 100% oxygen at greater than 2.0 to 2.4 ATA to improve perfusion to all tissues. A high oxygen concentration gradient between hypoxic and normal tissue is established and poorly perfused tissue is better oxygenated through diffusion. The macrophages are sensitive to this gradient and they produce angiogenic factors in response to this signal.

Other vasculogenic responses include vascular endothelial growth factor production, mobilization of endothelial progenitor stem cells, and thioredoxin activation (which leads to elevations of hypoxia-inducible factors 1 and 2). This initiation of vascular repair can be seen clinically as improved wound healing

AUTISM
Autism is an increasingly common ailment in children and amongst the numerous solutions under evaluation by health professionals HBOT appears to be promising. The use of hyperbaric oxygen therapy for the treatment of autism is relatively recent and so there is not a great deal of scientific evidence specifically related to it, but some positive study results are beginning to come in. HBOT treatments have shown that there is a significant drop in aggression, rage and tantrums. There is also an increase in direct eye contact, reasoning ability and better understanding of verbal commands among children completing HBOT.

The following SPECT scans of a 17 year old boy with autism show the improvement in oxygenation of various parts of the brain after 50 sessions of HBOT, and there was substantial improvement in clinical signs and symptoms.

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