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Hyperbaric Oxygen therapy

Discussion in 'Diabetes Discussions' started by martinbuchan, Feb 6, 2008.

  1. martinbuchan

    martinbuchan · Well-Known Member

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    All going well. Have my bespoke surgical shoes (lovely). Intravenous antibiotics finished after 6 weeks. Repeat MRI scan shows great improvement. Middle toe went funny before Xmas and dislocated probably due to infection in the joint. Seems to be settling. Still on oral antibiotics for a while.

    About to start hyperbaric oxygen therapy in the next few days. 30 treatment 'dives' over 6 weeks (£6000 per week!). Great for neuropathy. Might turn my painless numb feet into painful but sensate appendages.

    If any of you have osteomyelitis, or poorly healing wounds, or severe autonomic neuropathy , it might be worth prodding your diabetic team into referral for HBOT . They will want you to have good pulses in your legs and have decent diabetic control. In Scotland, the HBOT is accessed via the Diving Medicine physicians in Aberdeen.

    see http://www.hyperbaric.org.uk for more details.

    Supposed to be great for hangovers......

    Marty B
     
  2. Abi

    Abi · Member

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    I saw osteomyelitis as an approved condition for treatment with hyperbaric oxygen- can it actually help neuropathy as well?
    I am attending the annual professional DUK conference next month- will be interesting to see developments in footcare

    Wishing you all the best. Also wondering why you should still be having problems with an A1c as low as 5.9 %. makes me despair- stuggle to keep it in low 7s and compared to many patients that I see - low 7s is good

    Wouldn't think twice at wearing unattractive footwear if it meant I could stay mobile and lead a normal ife rather than have to stay off my feet
     
  3. martinbuchan

    martinbuchan · Well-Known Member

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    Hi Abi

    I ignored my symptoms for a long time. Thought my foot numbess was tarsal tunnel syndrome (wishful thinking). I was so tired in 2005 - thought it was just due to working too hard (lots of extra lists and building up my meager private practice). You get used to working through tiredness as a junior doctor.

    HBOT has very clearly defined indications (mine is osteomyelitis of 1st & 3rd metatarsals and medial cuneiform). The few reports on autonomic neuropathy look at improvement of the various cardiac indices (means little to this orthopod).

    HBOT for neuropathy is not on the indications lists as yet. Seems alpha lipoic acid should be prescribed though.


    A1c ran at 6.5% last year . It will climb again when I get back to operating, driving, on call etc. I am thinking of measureing my A1C before and just after my weeks on call (one in 5). I am sure it rises as I give my BG a bit of reserve capacity for sudden emergency calls.

    Marty B
     
  4. Abi

    Abi · Member

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    It's difficult this diabetes business. Working in a single handed practice (although only one day per week on a lospam basis) I worry about going hypo and having to do an emergency visit. The clinic that I work in are actually advising patients to refrain from driving for 45 minutes after a mild hypo- one of the consultants was involved in some research with simulators which demonstrated impaired driving ability for this time length after a hypo. Occasionally it wouldn't be ideal to delay a visit for this lenth of time- so I always hope that if I start feeling a bit low there will be enough time to deal with it ( rather than having to ask one of the practice staff to drive me or call a taxi). I imagine being asked to operate at short notice would be even more problematic. Problem is I am insulin and carb senstive and have a fair amount of day to day variability in my glucose readings
     
  5. Abi

    Abi · Member

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    lospam should read lospam- not sure where that came from- must still be recovering from the hypo I had 3o mins ago. Oh well - just goes to show the 45 min advice is probably right- can;t even be trusted with a keyboard
     
  6. Abi

    Abi · Member

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    why can I not type l.o.c.u.m. ?
     
  7. martinbuchan

    martinbuchan · Well-Known Member

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    Abi- you have a pure and untainted personality. It is anti-spam software to protect us dear sensitive diabetics.

    Marty B
     
  8. martinbuchan

    martinbuchan · Well-Known Member

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    The HBOT has been put on hold by Public Health. It is probably as a result of the definition of 'refractory osteomyelitis'. It can be argued that I am in my first treatment cycle therefore it is not refractory. I am going to continue my oral antibiotics for a further 2 months and be reassesed on mRI. If the bone infection still persists then the HBOT will be the next step (to avoid further amputation).

    I am dissapointed but looking forwqard to getting back to work. I lose quite a lot of money not working and I have to get back.
     
  9. Pattidevans

    Pattidevans · Well-Known Member

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    <blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
    <br />The HBOT has been put on hold by Public Health. It is probably as a result of the definition of 'refractory osteomyelitis'. It can be argued that I am in my first treatment cycle therefore it is not refractory. I am going to continue my oral antibiotics for a further 2 months and be reassesed on mRI. If the bone infection still persists then the HBOT will be the next step (to avoid further amputation).

    I am dissapointed but looking forwqard to getting back to work. I lose quite a lot of money not working and I have to get back.
    <hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

    Martin.. I can't believe this is so horrendous! At age 21 I had osteomyelitis in my left forearm. I had it operated on, as I understand it (of course I was <b>not</b> diabetic at that time,) it was the result of a fall. They opened my arm, opened the bone, cleared all the disintegrating bone, cleared and scraped out the marrow, stuffed it all full of antibiotics and sewed me back up again.

    I subsequently had it xrayed several times, the first time when I had my medical to become cabin crew for BOAC (who became BA).... It's never given a moment's problem since. Obviously this isn't the treatment now?

    Patti
    On Levemir/Novorapid. Last hba1c 5.3
     
  10. ash

    ash · Well-Known Member

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    <blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by Abi</i>
    <br />why can I not type l.o.c.u.m. ?
    <hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

    You can't type lo<i>c</i>um due to the swear filters in the forum software ;)


    HBa1C 6.3 T2
     
  11. martinbuchan

    martinbuchan · Well-Known Member

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    Patti- what you had done is still standard treatment. From what I have learned it should be supported by HBOT. IF there is a nidus of dead bone at the centre of the infection it hsd to be removed before any cure can be undertaken. Diabetic foot osteomyelitis is a different kettle of fish. There are a few very dedicated diabetic foot physicians and fewer bone infection units around the UK to deal with these problems. Anyway, feeling fine.

    Reducing my basal levemir as well - probably a mixture of reducing infection and being more active.

    Marty B
     
  12. Pattidevans

    Pattidevans · Well-Known Member

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    <blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
    <br />Patti- what you had done is still standard treatment. From what I have learned it should be supported by HBOT. IF there is a nidus of dead bone at the centre of the infection it hsd to be removed before any cure can be undertaken. Diabetic foot osteomyelitis is a different kettle of fish. There are a few very dedicated diabetic foot physicians and fewer bone infection units around the UK to deal with these problems. Anyway, feeling fine.

    Reducing my basal levemir as well - probably a mixture of reducing infection and being more active.

    Marty B
    <hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

    Sorry it's so complicated Marty.... I wish you well with the treatment and hope you can get on the therapy.

    Patti
    On Levemir/Novorapid. Last hba1c 5.3
     
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