The healing power of oxygen
Carol Tostenson (center) enjoys a walk at Minnehaha Park with her husband, Ron, and their three children, TJ, Brittney and Bobbi.
Carol Tostenson, 46, is ready to get back to being a mom. Moreover, she’s ready to see her son get back to being a teenager. Earlier this year, between several hospital stays and surgeries, Tostenson made 50 visits to Abbott Northwestern Hospital to be treated with hyperbaric oxygen therapy (HBOT). Her entire family, including her 15-year-old son, TJ, became her caregivers, and everyone pitched in to keep the household functioning throughout her illness and recovery.
HBOT is a treatment that uses oxygen to promote wound healing. Patients breathe pure oxygen in a pressurized chamber. Oxygen levels increase in body tissues, promoting the growth of new blood vessels. This helps activate cells that heal wounds and fight infections. In some settings, HBOT is also used to treat decompression sickness ("the bends") and carbon monoxide poisoning.
Tostenson’s ordeal began in 2006, when she was treated for lung cancer. At first she did great, recovering from surgery, radiation therapy and chemotherapy. (She has remained cancer-free ever since.)
But a year later, she began having repeated fevers and respiratory infections. Doctors soon discovered the source: a non-healing wound in the chest wall, a side effect of the radiation therapy used to treat her cancer.
"Radiation therapy kills cancer cells, but it can also damage normal tissue," says Peter Alden, MD, vascular surgeon at the Minneapolis Heart Institute®. "In particular, it damages the arteries that supply blood to tissues."
Abbott Northwestern's Wound Clinic began offering HBOT more than a year ago. It is often used for diabetic patients with non-healing foot ulcers that do not respond to other treatments.
"Changes in circulation among diabetic patients can interfere with oxygen delivery to tissues in the lower legs and feet," Alden says. Foot ulcers demand careful attention because they are a major risk factor for amputation.
While most patients with poor wound healing respond to surgery, advanced wound care, medicines and other treatments, a small group of patients do not. For them, HBOT can make a big difference.
"Initially, I was a bit skeptical about this treatment," Alden says. "Now I can’t imagine how we practiced without it. It is really helping a certain group of patients recover from poor wound healing."
'You do what you have to do'
Late last year, Tostenson had surgery that involved moving muscle tissue over the wound. When this failed to heal properly, Tostenson's doctors decided that HBOT would area for a second surgery, which would be done by David Ruebeck, MD, a plastic surgeon.
Tostenson received 50 treatments, 90 minutes a day, five days a week. The hyperbaric chamber is a clear acrylic tube in which the patient lies while watching television or listening to music. At first, Tostenson wasn’t thrilled about "being in a tube" day after day, but the Wound Clinic staff helped keep her comfortable and relaxed. "You learn to take it in stride and you do what you have to do," she says. "Plus, there’s a sense of kinship that you develop with the other patients."
The good news was that the wound began to improve quickly. "During her treatment, we could see visible evidence that the wound bed was improving," Ruebeck says. That increased the chance of success when he closed the wound with a tissue transfer surgery in May.
"She had run out of surgical options," Alden says. "We had to do everything we could to ensure the success of Dr. Ruebeck’s surgery."