Success in HBOT

Special Focus – Hyperbaric Oxygen Therapy
Interview with Jeffrey A. Niezgoda, MD, FACHM, FAPWCA
Today’s Wound Clinic’s Founding Editorial Board member Dot Weir RN, CWON, CWS spoke with Dr. Jeffrey Niezgoda Medical Director, The Center for Comprehensive Wound Care & Hyperbaric Oxygen Therapy, St. Luke's Medical Center, Aurora Health Care, President and COO Hyperbaric & Wound Care Associates, Milwaukee, WI.
Dr. Niezgoda is also the President of the American College of Hyperbaric Medicine, a professional Society, which is dedicated to providing support, education and resources to professionals committed to the appropriate utilization of hyperbaric oxygen therapy. In addition, he is also the President and Chief Medical Officer of WebCME an online wound care and hyperbaric educational company. Dr. Niezgoda is a recognized hyperbaric and wound care expert and we are pleased to provide this interview and insight into the practice of wound care and hyperbaric medicine in Milwaukee.

Jeffrey A. Niezgoda (JAN): Thank you for this opportunity. I am pleased and honored to be asked to provide this interview for the readers of Today’s Wound Clinic.

Today’s Wound Clinic (TWC): Your wound center has been operational for many years. Can you give us a brief history?
JAN: Certainly. The hyperbaric facility at St. Luke’s Medical Center was one of the first hyperbaric programs in the country and has been operational and treating patients since 1969. One of the founders and first medical directors of our program was Dr. Eric P. Kindwall. Dr. Kindwall is often referred to as one of “The Grandfathers of Hyperbaric Medicine” and worked clinically in the program for many years. Dr. Kindwall has recently transitioned to consulting, research, and writing. He is the author and editor of the definitive textbook on hyperbaric medicine. Dr. Kindwall is also the executive Director of the American College of Hyperbaric Medicine. I was asked to serve as medical director for the program in 1998, and I changed the focus of our program from being primarily a hyperbaric center, to first and foremost being a wound care center that has the additional capability of providing hyperbaric services. My philosophy has always been that hyperbaric oxygen therapy is only one of the modalities that can and should be used to provide standard of care to select patients with compromised wounds.

TWC: How did this philosophy and the opening of a formal wound care center change the program?
JAN: Since I took over the helm as medical director, the program volume has grown from less than 1500 annual visits to combined total volume of over 70,000 in 2009. Patients are not just seen at St. Lukes. We have expanded the program to allow for wound care and hyperbaric services to be provided at 8 other hospitals within the Aurora network.

TWC: Tell us more about the hyperbaric chambers at SLMC. I understand that you recently installed the largest hyperbaric chamber in the United States.
JAN: The backbone of the St. Luke’s hyperbaric program for over 40 years has been our 2 multiplace hyperbaric chambers, affectionately nicknamed Bonnie and Clyde. Bonnie and Clyde were operated nearly every day and have allowed tens of thousands of patients to be treated with hyperbaric oxygen over the years. Unfortunately, as with all types of mechanical equipment, our hyperbaric chambers began to show the effects of age and wear and tear. We made the decision to replace Bonnie and Clyde with newer hyperbaric technology. We accepted delivery of our new hyperbaric chamber in April 2008. Installation and testing were completed in May of last year and we treated our first patients in June of 2009.

TWC: Is the new chamber the largest in the country?
JAN: It is quite big. The chamber is 52-foot-long and weighs 66-tons. It is a triple lock chamber, which provides us with the capability of treating up to 24 patients at one time. Based on weight it is the largest in the U.S.

TWC: I understand that the chamber was transported to Milwaukee from Australia. Why an Australian chamber?
JAN: Yes, our chamber was designed and built by Fink Engineering, a hyperbaric manufacturing company located in Australia. The chamber was fabricated in Australia, shipped to Los Angles and then transported by flat bed truck to Milwaukee. We have been working on this renovation project for over 6 years. At the time Fink was the only company producing a rectangular hyperbaric chamber. We wanted the best and most current technology for our patients and thus we contracted with Fink several years ago. The square design feature provides more patient comfort and space, extra treatment capacity, better esthetics, and minimal claustrophobia. This design is now available from many other chamber companies, including US based companies such as Oxy-Heal.

TWC: Your facility and new chamber sound impressive. I am sure that you have been providing tours for many individuals since you have opened.
JAN: Yes, we certainly have been a medical “tourist attraction” this past year. Would you like to cyber-journey with me to Milwaukee right now? I would be happy to provide a cyber-tour of The Center for Comprehensive Wound Care and Hyperbaric Oxygen Therapy to you and the readership. We will see Bonnie and Clyde as well as our new multiplace. Please follow this link ( https://www.webcme.net/medicalCMECourses.asp?c=21).

TWC: That was fabulous. Thank you for the wonderful experience. What types of patients are typically treated with HBOT?
JAN: I am glad that you enjoyed the tour. Hyperbaric oxygen therapy is primarily used to help treat difficult wounds, and when integrated into Wound Care Center or Limb Salvage Program, HBOT can literally save the lives and limbs of patients at risk for lower extremity amputation due chronic medical conditions such as diabetes and arterial vascular disease. HBOT is also used in the management of severe carbon monoxide poisoning and a variety of other medical conditions. On a daily basis we typically treat between 24-30 patients. Our largest volume day was several months ago when we treated 38 patients in one day. Recently we had our first mass casualty disaster and were able to treat 12 patients with carbon monoxide poisoning at one time. Follow this link to hear the details of this event (www.webcme.net/medicalCMECourses.asp?c=22).
In a typical day, 30% of HBOT patients are being treated for diabetic foot ulcers, 30-40% for radiation tissue injuries, and 30% for necrotizing infections, compromised flaps and grafts, osteomyelitis, and acute arterial insufficiencies and the emergencies such as carbon monoxide and decompression illness.

TWC: How many wound care patients are seen at St. Lukes?
JAN: On average we will see 40-50 patients per day in our outpatient wound care clinic and another 20-25 patients on our in patient service.

TWC: How do you staff for this volume of patients?
JAN: The professional staff is provided by HWCA. Five full-time advanced practice nurse practitioners support the physicians, my partner, Dr. Jack Simanonok, and myself. I cannot say enough about our NPs. They are extremely knowledgeable and skilled in wound care and are fully capable of operating independently. The nursing, technical and administrative staffs are also excellent and Aurora employs them. On a typical day, 8 RNs, 4 wound care and 4 hyperbaric technicians, and 3 secretaries will staff us.

TWC: I know that you do a tremendous amount of education, preceptorships, and product trials. Can you tell us a little about these aspects of your program?
JAN: We have had the opportunity to trial many new devices and technologies. One of the newest and most exciting products that we have been working with is Wound Be Gone. We are initiating randomized clinical trials based on our initial success with this product. I truly enjoy teaching wound care and hyperbaric medicine. We will often have clinicians, fellows, residents, and medical and nursing students from the local area participate in clerkships or clinical rotations. Occasionally we will have a visiting clinician from outside the state or from another country spend time with us. They come to St. Luke’s for both observational as well as hands on clinical experience. While this type of one on one teaching is rewarding it truly limits our ability to provide educational opportunities on a larger scale.

TWC: Is this the motivation behind your online educational efforts?
JAN: Yes. I have formed a specialized company that is focused on providing the highest quality of online education. We combine actual clinical video footage with live lectures given by experts in the field of wound care and hyperbaric medicine. These presentations are recorded and then delivered in HD quality via the Internet. This educational format allows for learning that is self-paced and on demand. You learn wherever and whenever you decide is best for you. This learning experience is also much more effective than traditional learning as the student can rewind and review the lecture at any point to provide emphasis of certain elements. It is also more cost effective in that travel, lodging, meal expenses as well as the cost of lost productivity due to time away from the clinic are avoided. Anyone who is interested can visit us at www.WebCME.net.

TWC: You are the current President of the American College of Hyperbaric Medicine. Please tell us about this organization.
JAN: The American College of Hyperbaric Medicine is an organization that has served as catalyst for new ideas and forum for the exchange of information providing a conduit between the practice of wound care and the field of hyperbaric medicine. The ACHM is credited with several recent achievements including the creation of two certification exams in hyperbaric medicine, one for physicians and one for technicians. In addition the College created a hyperbaric medicine clinical registry to evaluate the effectiveness of HBO for radiation injury. As of December 2009, 2,000 cases have been entered, making this the largest series in the world. An integral part of the ACHM’s mission is quality assurance and improvement in the practice of hyperbaric medicine. The ACHM has set basic training standards for hyperbaric physicians that have been adopted by numerous hyperbaric facilities and third party payers. I would encourage the readership to consider joining the College, as it is an excellent resource for anyone working in the field of hyperbaric medicine (www.achm.org).

TWC: Dr. Niezgoda, we would like to thank you for your time. This interview has been interesting and I truly enjoyed the cyber-tour. Do you have any closing comments?
JAN: Thank you once again for giving me the opportunity to share our program with you and Today’s Wound Clinic. During the past decade I have been allowed the true privilege of working with an outstanding group of individuals who are truly dedicated to providing the highest standards and quality of patient care. My successes are only a reflection of their commitment to excellence, and I salute each of them.

Jeffrey A. Niezgoda, MD, FACHM, FAPWCA, is the Medical Director of The Center for Comprehensive Wound Care and Hyperbaric Oxygen Therapy, St. Luke’s Medical Center, Milwaukee, Wisconsin. He is also the President and Chief Operating Officer of Hyperbaric & Wound Care Associates, a medical specialty group serving Southeastern Wisconsin and Northern Illinois, providing professional wound care and hyperbaric services to the Midwest with annual patient visits exceeding 70,000. Dr. Niezgoda is also the President and Chief Medical Officer of WebCME a novel educational company and industry leader in online wound care and hyperbaric education. Dr. Niezgoda is a recognized wound care expert and has served as faculty at both national as well as international conferences. He has participated on multiple Expert Consensus Panels and has appeared before Medicare and Medicaid Services as a wound care consultant. Dr. Niezgoda is the President of the American College of Hyperbaric Medicine and a Fellow of the American Academy of Emergency Physicians and the American Professional Wound Care Association. Dr. Niezgoda received his Medical Degree from the Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland, and earned a B.S. in Biology from U.S. Air Force Academy, Colorado Springs, Colorado.