Oxygen treatment saves Nederland woman’s legs

Dr. Waqar Ahmad demonstrates how to wear an oxygen treatment hood in the hyperba

When 64-year-old Nederland resident Gwendolyn Maldonado injured her left leg during a trip-and-fall accident in her living room May 12, 2012, what seemed at that time like a minor mishap turned catastrophic.

“My grandson was here, and I was walking through the living room to take him a popsicle. We had a little stool that was left in the middle of the floor,” Gwen said. “I tripped over it, but I landed on my own two feet. But when I put this leg down, it all split apart. Blood started going everywhere.”

When Gwen went to her primary care physician, she was told her wound was “OK” and “to come back in seven days if problems persist.”

But everything was not OK.

Gwen’s leg began developing venous stasis ulceration, MRSA (methicillin resistant staphylococcus aureus) and progressive necrotizing infection.

Gwen happened to have an appointment that Friday with her hematologist for a checkup.

“He asked me what that bandage was on my leg,” Gwen said. She showed him her leg. “Within an hour I was in St. Elizabeth Hospital with a PICC line,” she said. “He said, ‘Gwen, you may lose your leg.’ It was necrotic to the bone.”

Gwen began receiving painful debridements to remove the dead, damaged, or infected tissue and improve the healing potential of the remaining healthy tissue in an attempt to save her leg. She was treated at the Tracy Byrd Hyperbaric and Wound Care Center at Christus-St. Elizabeth.

“I had debridements every other day,” she said. “They deadened the area and cut out the dead flesh and infected part.”

After months of treatment and a skin graft, the center was able to save Gwen’s leg.

But just as she was recovering from the injury, Gwen had a second fall that broke both arms and severely injured her right leg.

Gwen’s leg had a traumatic wound even worse than the one she had experienced merely months prior. Just as her previous wound, it became infected.

This time however, Gwen would need more than debridements to get the wound ready to be skin grafted. She would need therapy in a hyperbaric chamber.

Hyperbaric oxygen therapy (HBOT) uses a special chamber, sometimes called a pressure chamber, to increase the amount of oxygen in the blood.

HBOT is emerging as an adjunct to traditional surgery and antibiotic therapy for special kinds of problem wounds such as Gwen’s, explained Dr. Waqar Ahmad who specializes in wound treatment and is the medical director at the Tracy Byrd Hyperbaric and Wound Care Center. 

“We give hyperbaric treatment, in combination with surgery, to try to save as much tissue as possible,” Ahmad said.

The chamber, which looks like something you would expect to see on Sealab 2020, seats 12, but the Wound Center usually treats only seven patients at a time for safety reasons in 30 minute- to two hour-sessions called “dives” or “flights.”

The chamber is sealed and filled with pressurized oxygen. During treatment, oxygen flows continuously through the chamber to maintain a clean atmosphere and to control inside temperature. This produces a flow noise, which can vary from time to time but is a normal sound associated with chamber operation. It is also normal during pressurization to experience warming within the chamber. The pressure rises to 2.5 times the normal air pressure, which causes the patient to experience ear popping or mild discomfort. This will normalize once treatment pressure is achieved. Depending upon the treatment pressure used for therapy, the patient might be instructed to periodically breathe air from a facemask inside the chamber. This provides an additional protection against oxygen toxicity. After therapy, technicians will slowly depressurize the chamber.

Ahmad said many patients who have claustrophobia fear entering the chamber. Gwen was one of these.

“I was scared to death. I didn’t want anything covering my head. I didn’t want to be somewhere I could not get out,” Gwen said. Gwen’s doctor told her she really needed the hyperbaric treatment, however, so that her wound could heal enough for skin grafting,

“I was strong enough because I knew I needed it,” she said. “The staff said they would walk me through it and sit with me through the first time, and they did. They taught me what to do. They showed me that I could get out if I needed to. In the beginning, they let me watch other people through the glass.”

The Wound Care center staff showed Gwen how to put the oxygen treatment hood on properly and reassured her that there was nothing to be afraid of.

“Once I got in there and saw that it wasn’t so small, and once I got (the oxygen treatment hood) over my head and saw that I could move my head around, I was better,” Gwen said. “They sat in the chair right next to me and held my hand, gave me gum and candy to chew on to keep my ears open — whatever I needed to keep me calm.”

Gwen received nine sessions of treatment in the hyperbaric chamber, which allowed the tissue on her leg to heal enough to perform the skin graft.

Gwen said the staff at the Wound Care Center, along with her husband Jerry, helped her persevere.

“They make you feel like you are the only patient,” Gwen said. “They make you comfortable. They are very compassionate. When I went in there, I was able to relax because I knew that they were going to do everything they could for me medically, but I also knew they were going to do everything for me emotionally so I could get through the medical part. I didn’t feel like a patient. I felt like they cared about me.”

Gwen said she still has minor to moderate pain in both legs, but that if it wasn’t for the Tracy Byrd Hyperbaric and Wound Care Center, she would most likely be an amputee.

 

This article was originally published in the October 2014 issue of Vital Signs, a tri-annual magazine published by The Examiner Corporation focusing on the medical industry in the Golden Triangle. The article won an honorable mention Texas Medical Association Anson Jones award. Vital Signs can be found in your local hospital or doctor’s office waiting room.

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