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Advertising Feature

If you have diabetes or have received radiation treatment, please retain this booklet for future reference.

Breathe new life into old wounds

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Please visit our website www.hyperbarichealth.com to download a copy of this booklet as a PDF. Alternatively, call 1300 HYPERBARIC (1300 497 372) and we’ll send a copy to you, a relative or a friend who may benefit from hyperbaric treatment.

The boDy hAs A very comPlex

sysTem oF heAling. Among

oTher Things, iT neeDs gooD

builDing blocks For rePAir

(e.g. gooD nuTriTion) AnD A

gooD TrAnsPorT sysTem To geT

The builDing blocks To The

siTe oF AcTion (boTh lArge

AnD smAll blooD vessels).

hyperbaric oxygen Therapy (hboT) delivers very

high concentrations of oxygen to the wound via the

bloodstream, allowing it to ‘kick start’ the healing

process. While doing this, it also develops new small

blood vessels in the tissues, healing the wound from

within and keeping further wounds at bay.

hboT has proven particularly effective in helping

people with diabetes who have long-term wounds,

as well as helping people who are experiencing late

effects of radiotherapy for cancer treatment.

This booklet describes how hboT is a proven

medical treatment and can help breathe new life

into old wounds.

•AllHyperbaricHealthFacilitiesareAchs Accredited and Department of health licenced Private hospitals

•HyperbaricHealthhascontractswithDvA and all major health funds

•Medicarepatientsarebulkbilled

•HyperbaricHealthwillassistinpatient transport and accommodation where available

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Speeding up the healing process from the inside outHyperbaric (‘hyper’ meaning ‘over’, and ‘baric’ meaning

‘pressure’) literally translates to ‘over pressure’. HBOT

exposes the patient to higher than normal pressure while

the patient breathes 100% oxygen. This can only be

achieved in a pressurised vessel (hyperbaric chamber).

Breathing pure oxygen while in a pressurised environment

results in therapeutic effects for the patient. Hyperbaric

treatments for wounds occur at pressures between 2.0

and 2.4 times the pressure at sea level. In real terms, this

delivers up to 15 times the normal level of oxygen to the

body; this can only be achieved in a hyperbaric chamber,

and causes some important changes in the body.

HBOT has many benefits in wound healing, including

the following:

Overcomes areas of poor oxygenation

This is particularly true for parts of the body that have

poor small vessel circulation (such as in people with

diabetes). Oxygen at higher concentrations can supply

the most distant tissues (such as skin on the toes) with

the vital building blocks required to help repair damage.

In turn, this reduces the need for more radical treatment

such as surgery and potentially amputation.

Grows new small blood vessels in areas with poor small vessel circulation

This process is called angioneogenesis (literally ‘new blood

vessel growth’) as shown in Figure 1. This takes between 15

and 40 treatments to work and new small blood vessels can

be grown within tissues with degraded blood vessels.

This is a particular problem for people with diabetes

and people who have had radiotherapy for cancers.

The former may develop wounds that do not heal, leading

to amputations, while the latter can have problems such

as bleeding bowels, bladders or a breakdown of normal

tissues in the areas where they have received radiotherapy.

Increasedactivation

factors

Decreasedactivation

factors MFSCsMFSCs

MFSCmobilisationto circulation

Impaired MFSC

mobilisationto circulation

Bone marrow

Healthy wound

Migratingskin cells

Wound-inducedhypoxia

(low oxygen)Platelet

Blood vesselgrowth factorsBlood vessel

growth factors

Impaired healing enzyme activation

LimitedMFSC homingMFSCs

homingto wound site

CirculationBlood vesselcell migration

Precursors ofstructural cells

Macrophages(white blood cells)

Epithelial cells

Angioneogenesisand wound healing

Limited angioneogenesisand wound healing

Diabetic wound

Increasedactivation of

healing enzymes

Decreasedactivation of

healing enzymes

Improved by HBO therapy

Cell differentiation factors Limited cell differentiation factors

MFSCs = Multifunction stem cells

Macrophagefunction

Figure 1. Difference in healing with normal versus diabetic tissue.

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Fights infection

Infections are naturally attacked by the body’s white

blood cells that use chemicals to destroy bacteria and

are rapidly broken down to limit the damage to normal

tissues. Some of these chemicals are called ‘reactive

oxygen species’ and include chemicals such as hydrogen

peroxide (H2O2). For the white cells to work properly they

need oxygen to convert into these natural ‘antibiotics’ and

the additional oxygen delivered by HBOT optimises this

effect. High levels of oxygen can also deactivate some of

the toxins that are produced by bacteria, particularly in

gas gangrene, reducing the infection’s ability to spread.

In other words, ultra high levels of oxygen energise the

body’s natural immune system to better fight infection.

Delivers building blocks for wound healing

Wound healing is a complex process. It requires many

cellular components to come together at the correct time

in optimal amounts for a rapid, strong wound-healing

response. Several stages of the wound-healing process

require a good level of oxygen for cells to build the

structure around which the wound can heal. In some

conditions (such as diabetes or auto-immune diseases)

the reduced delivery of oxygen creates a weak healing

process ‘scaffold’ which leads to recurrence of the wound

or a wound that does not heal at all (see Figure 2).

Conversely, an increased delivery of oxygen provides a

strong healing ‘scaffold’ and fights infection, resulting in

complete and proper healing of the wound.

Figure 2. The wound healing process.

Enhances the delivery of stem cells

Stem cells are generic cells that can change into specific

cells that are needed in the body. The number of stem cells

decreases with age but they are often required; in particular,

for the process of wound healing. HBOT has been shown

to greatly enhance the development and release of stem

cells as well as their activation in wound healing.

HBOT is only one form of treatment that can help in the treatment of long-term wounds and tissue damage secondary to radiotherapy. However, if you have had a wound for longer than 3 months it is unlikely that it is going to heal by itself; you may like to consider HBOT as an option for treatment.

Skin surfaceRed blood cell

Epidermisanddermisof skin

Wound Platelet

Macrophage

Neutrophils (white blood

cells)

a Injury

Collagen Fibroblast

Fibrin

b Coagulation (clot forming)

d Late inflammation (48 h)

Macrophages(white blood cells)

e Proliferation (building tissue scaffolding – 72 h)

Oxygen dependent processes

c Early inflammation (24 h)

Neutrophils(white blood cells)

f Remodelling (scar formation and strengthening – weeks to months)

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HBOT is a single treatment with many actions Several conditions are treated with HBOT but it is most

commonly used to treat long-term (chronic) wounds

and secondary tissue damage sustained from receiving

radiotherapy for cancer.

Long-term (chronic) woundsThese are wounds that have existed for longer than

3 months and are unlikely to heal by themselves. The

longer the wound exists, the less likely it is to heal with

repeated dressings. This leads to a repetitive, ongoing,

expensive and uncomfortable cycle of dressings and

interventions for complications (such as infections) that

can continue for years.

HBOT seeks to end that cycle through gentle healing.

Many long-term wounds often have an underlying low

oxygen concentration (called hypoxia) that prevents

them from healing. Hypoxia has been measured directly

in the laboratory and can be measured with a skin probe

called a trans-cutaneous oxygen measurement probe

(TCOM). The TCOM measures the amount of oxygen

being delivered to the skin (which is where the wound

occurs) by placing stick-on cups on the patient’s skin

(the procedure is non-invasive).

HBOT delivers oxygen to the wound, allowing it to ‘kick

start’ the healing process by promoting the development

of new small blood vessels. With this approach, the

wound can be healed and further wounds can be kept

at bay.

HBOT is by no means the only available treatment for

long-term wounds and assessment of the large blood

vessels by a vascular laboratory in conjunction with a

vascular surgeon is recommended. Proper dressings

and management of other medical issues (such as good

diabetes control, good nutrition and adequate vitamin

and mineral intake) all contribute to wound healing in

addition to HBOT.

Radiation tissue injuryWhen people have radiotherapy for cancer treatment,

damage invariably occurs to normal tissues around the

area being irradiated. This occurs because the field

being irradiated is slightly larger than the actual cancer

(to make sure all cancer cells are irradiated) and some

radiation must pass through normal tissues in order to

reach the tumour.

This has two effects:

• There can be acute (early) radiation damage such as

swelling and ‘sunburn’ effects, for example on skin

• There can be late-onset radiation damage. This occurs

12–18 months after radiotherapy and is due to damage

of the small blood vessels.

HBOT can help in both cases with reduction of swelling

(increase in size) and inflammation (the redness) in the

early stages, but is much more effective in the treatment

of late-onset radiation effects. This is particularly evident

in people who develop dental cavities (holes in their

teeth) secondary to radiation therapy of the head and

neck, who require removal of the teeth. For people with

cancers of the head and neck, removal of radiation-

damaged teeth can lead to exposure of the mandible

(jaw-bone) and breakdown of both the soft tissues of

the gums and the bone itself. This can require extensive

reconstructive surgery that, because it is in an irradiated

field with poor blood flow, can lead to further wound

breakdown and further surgery.

THe LOngeR THe WOund exISTS, THe LeSS LIkeLy IT IS TO HeaL WITH RePeaTed dReSSIngS

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HBOT is also helpful for people who have undergone

radiotherapy to the pelvis for prostate or gynaecological

cancers and developed injuries to other pelvic organs

(such as the bladder and bowel). In the pelvis, the lining

of the bladder and lower bowel can become damaged

by radiotherapy, leading to bladder and bowel frequency

(frequent visits to the toilet), bleeding (with multiple

transfusions) and considerable pain and discomfort.

These effects do not occur in all people who have

radiotherapy and depend on the type and total amount

of radiotherapy that each person receives.

HBOT can end the potentially destructive downward

spiral of damage to irradiated tissues, surgical operations

in the irradiated field, followed by non-healing of the

surgical wound.

It’s all about ending the cycle.

Figure 3. The downward spiral of chronic wounds.

giving the body building blocks to repair itselfThe body has a very complex system of healing.

you need good building blocks for repair, (e.g. good

nutrition), a good transport system (both large and small

blood vessels), a good ability to fight infection and a good

cellular system to put it all together.

In several medical conditions, some (or all) of these items

are missing or compromised. The problem with this is

that the wound ‘stalls’ in its healing process and patients

can end up in a dysfunctional downward spiral. Without

intervention, this downward spiral continues until the

patient follows one of two pathways:

• a poor outcome (such as amputation in the case of a

person with a diabetic foot ulcer)

OR

• develop an overwhelming problem (such as an

infection), requiring time in hospital.

repeated admissions to hospital

repeated visits to the doctor

repeated expensive wound dressings

non healing wound

HBOT IS an eFFeCTIve, MInIMaLLy InvaSIve Way OF endIng THe WOund CyCLe and MakIng a deFInITe MOve TOWaRd a nORMaL HeaLIng PROCeSS

Ask your doctor whether your wound is suitable for HBOT

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Some facts about wounds• The number of people with long-term wounds

(more than 3 months’ duration) in Australia is

estimated to be approximately 200,000 people1

• The rate of lower limb wounds in diabetics is

estimated at 1.9% at any one time2

• The overall lifetime chance of a person with

diabetes developing a leg wound is up to 25%3

• between 76 and 85% of amputations in people

with diabetes begin as an ulcer4,5

• The chance of requiring further amputation

(either on the same leg or the other leg) after

an amputation is between 30 and 50%6

• Diabetes mellitus is the most common cause of

non-traumatic amputations in Australia2

Some facts about post-radiotherapy damage• Damage can start between 12 and 18 months

after radiotherapy

• infection, surgery or trauma can accelerate

the breakdown of bone and soft tissue in an

irradiated area

• re-operating in an irradiated area can precipitate

further damage and a cycle of operations

and re-operations

references

1. elephant in The room: Wound Awareness campaign 2010. Australian Wound management Association. www.elephantintheroom.com.au. viewed 17 october 2010.

2. Australian institute of health and Welfare. Diabetes: Australian facts 2008. canberra: Australian government, Australian institute of health and Welfare, 2008.

3. singh n, Armstrong Dg, lipsky bA. Preventing foot ulcers in patients with diabetes. JAmA 2005; 293 (2): 217–28.

4. ulbrecht Js, cavanagh Pr, caputo gm. Foot problems in diabetes: an overview. clin infect Dis 2004; 39 (suppl. 2): s73–82.

5. boulton AJ, vileikyte l, ragnarson-Tennvall g et al. The global burden of diabetic foot disease. lancet 2005; 366 (9498): 1719–24.

6. ollendorf DA, kotsanos Jg, Wishner WJ et al. Potential economic benefits of lower-extremity amputation prevention strategies in diabetes. Diabetes care 1998; 21(8): 1240–5.

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Treating people from age 1 to 100+Breathing oxygen is indistinguishable from breathing air. as the pressure gently changes patients will need to

clear their ears just as you may do occasionally on a plane.

HBOT is a very safe treatment. We regularly treat people aged in their 90s. Children can also be safely treated in a

hyperbaric chamber.

There are two main types of chambers:

• multiplace chambers

• monoplace chambers.

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Multiplace chambersMultiplace chambers are large metal chambers that can

treat a number of people simultaneously (hence ‘multi’

place). Patients enter the chamber via a door that creates

a pressure seal and they sit or lie down (depending on

the condition and type of chamber). a trained hyperbaric

nurse is always present within the chamber during the

treatment. While they are being treated, patients can

read a book and breathe normally. It’s just like going for a

ride in a plane. In these chambers pressure is delivered

with air but the patients inside breathe 100% oxygen

either though a fitted mask or a ‘hood’.

This effect is the same as breathing normally if the

chamber was pressurised with 100% oxygen. To increase

safety the chamber is filled with air and 100% oxygen is

only delivered to the hood or mask. The treatment lasts

approximately 2 hours (the actual treatment time at

pressure is 90 minutes but an additional 30 minutes is

allowed for getting the chamber to pressure).

Monoplace chambersMonoplace chambers are single-person chambers that

are generally smaller than multiplace chambers. They

are usually made of acrylic (a very strong clear plastic)

and are pressurised with pure oxygen (i.e. patients

generally don’t have to wear a mask or hood). Patients lie

on a trolley and slide into the chamber. Patients can see

around themselves quite clearly (a bit like a tunnel in a

large aquarium where you can look at the fish swimming

around you) and normally there are video screens so

patients can watch their favourite movie or television show

while undergoing treatment.

advantages of the monoplace chambers are a slightly

faster treatment time and treatment can be based around

the patient’s schedule as there is no need to wait for other

patients to start treatment.

Both chamber types give the same treatment and the type

of chamber patients will have depends on the facilities at the

Hyperbaric Health Wound Centre that is closest to them.

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Medicare recognised treatmentsHBOT is recognised as an effective treatment by Medicare and, for common conditions, Medicare and health

funds will pay for the treatment as a legitimate effective treatment. Hyperbaric Health facilities charge a very

small facility fee (for lunch or afternoon tea after the treatment) but the assessment, management by specialist

doctors and treatment itself do not cost the patient any money.

Hyperbaric Health bulk bills and has ‘no-gap’

arrangements with most of the major private health funds

and the department of veterans affairs.

The conditions that are paid for by Medicare include:

• treatment for soft tissue and bone radionecrosis

(damage due to radiotherapy – both as a preventative

measure and as treatment)

• hypoxic(lowoxygen)andchronic(longterm)wounds

• gasgangreneandnecrotisinginfections

• decompressionillness(thebends)

• arterialgasembolism(AGE).

Other conditions have recognised HBOT as a valid treatment

but currently Medicare will only fund the conditions above.

Recognised indications for Hyperbaric Oxygen TherapyThis list is based on the best evidence currently available and is by no means exhaustive. it is based on

the Australian and new Zealand hyperbaric medicine group (AnZhmg) list of indications for treatment.

Diabetic wounds* ulcers, post-surgical wounds, gangrene

Problem wounds* chronic ischaemic wounds, post surgical problem wounds, venous ulcers

Late radiotherapy tissue injury*prophylaxis and management of bony and soft tissue radionecrosis including radiation

proctitis, radiation cystitis, maxillofacial bony and soft tissue necrosis

Infective conditions necrotising infections*, refractory osteomyelitis, malignant otitis externa

Acute ischaemic conditionscompromised flaps and grafts, crush injury, compartment syndrome, reperfusion

injury, idiopathic sudden sensorineural hearing loss, avascular necrosis

Decompression illness (DCI)* decompression sickness, cerebral arterial gas embolism including iatrogenic injury

Toxic gas poisoning carbon monoxide poisoning

Ocular ischaemic pathology cystoid macular oedema, retinal artery or vein occlusion

Adjuvant to radiotherapy adjunct to radiotherapy for solid tumours

Miscellaneous thermal burns, frostbite

The anZHMg, a sub-committee of the South Pacific underwater Medicine Society (SPuMS), review evidence and recommend conditions for

which HBOT may be employed biennially. Hyperbaric Health, as policy, uses the anZHMg Indications.

*Indications funded by Medicare

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MelbourneLocated at St. John of god Hospitalgibb Street, Berwick vIC 3806berwick@hyperbarichealth.com Ph: (03) 9707 1420 Fax: (03) 9707 1860

Located at Brunswick Private Hospital 82 Moreland avenue, Brunswick vIC 3056brunswick@hyperbarichealth.com Ph: (03) 9383 6505 Fax: (03) 8587 2489

Sydney Suite 3, ground Floor, 46–50 kent Road, Mascot nSW 2020 sydney@hyperbarichealth.com Ph: (02) 9578 0000 Fax: (02) 9578 0050

Perth Opening in 2011Located at St. John of god HospitalSubiaco Wa 6008 perth@hyperbarichealth.com

New ZealandQuay Park Medical Centre 68 Beach Road, Auckland 1010 auckland@hyperbarichealth.comPh: (09) 919 2340 Fax: (09) 919 2341

Referral formFor urgent referrals please contact your nearest facility listed below.

Patient name:

address:

date of birth: (dd-mm-yy) daytime telephone:

Private referral Medicare referral

Please tick indication for hyperbaric oxygen therapy (HBOT)

Problem wounds diabetic non diabetic

Late radiation tissue injury Soft tissue Prophylaxis

Bone established disease

Infective conditions Suspected organism:

acute ischaemic conditions

Compromised flaps/grafts Crush injury/compartment syndrome Reperfusion injury avascular necrosis Sudden sensorineural hearing loss

decompression illness (dCI) Please phone the nearest facility

Toxic gas poisoning Please phone the nearest facility

Ocular ischaemic pathology Retinal artery/vein occlusion

adjuvant to radiotherapy Please discuss with facility prior to referral

Miscellaneous Thermal burns FrostbiteBackground medical history – Please include as much information as possible and attach extra sheets and test results to this referral sheet

Referring doctor:

address:

Telephone: Medicare provider number:

HBOT is a non-invasive medical treatment involving breathing 100% oxygen while inside a pressurised hyperbaric

chamber. HBOT increases oxygen delivery to tissues higher than is otherwise possible.

To find out if you would benefit from HBOT please complete this form in consultation with your doctor and contact

your nearest Hyperbaric Health Wound Centre.

If you have more than one specialist please photocopy this referral and take it to all your doctors.

Do you or someone you care for have a wound or injury that is:

having trouble healing or due to diabetes complications or due to radiation treatment or causing ongoing pain?

hyperbaric oxygen Therapy may help.

speak to your doctor, call 1300 HYPERBARIC (1300 497 372) or visit www.hyperbarichealth.com for more information or to download a copy of this booklet as a PDF.

Call us on our national free call number1300 HYPERBARIC (1300 497 372) or call the Hyperbaric Health Wound Centre closest to you:

BerwickSt. John of god Hospitalgibb Street, Berwick vIC 3806berwick@hyperbarichealth.com Ph: (03) 9707 1420

BrunswickBrunswick Private Hospital82 Moreland avenue, Brunswick vIC 3056brunswick@hyperbarichealth.com Ph: (03) 9383 6505

SydneySuite 3, ground Floor46–50 kent Road, Mascot nSW 2020sydney@hyperbarichealth.com Ph: (02) 9578 0000

PerthOpening in 2011St. John of god HospitalSubiaco Wa 6008 perth@hyperbarichealth.com

New ZealandQuay Park Medical Centre 68 Beach Road, auckland 1010 auckland@hyperbarichealth.comPh: (09) 919 2340

© Hyperbaric Health 2010.