Archive for the ‘Patients’ Category

Three Heart Transplants in 34 Hours

When transplant surgeon John Um, MD, walked into Nebraska Medicine – Nebraska Medical Center the morning of April 11, little did he know, it was the start of two very long days. By the evening of April 12, Dr. Um had performed three heart transplants in 34 hours – a personal best for himself and the transplant team at Nebraska Medicine.

“The surgeries were pretty long. About six to eight hours each,” describes Dr. Um.

3-heart-transplants.jpg

From left to right: Harvey Brandy, Lucas Kollars, Curt Spethman and Dr. John Um. It all started with 24-year-old Lucas Kollars of Arlington, Neb., who was found unresponsive at home by his mother. After receiving a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD), Kollars was on the heart transplant waiting list for 58 hours.

“Dr. Um said I had about two more days to live,” says Kollars.

Twelve hours after finishing Kollars’ heart transplant, Dr. Um started on the second one. The patient was 57-year-old Harvey Brandy of Omaha. Brandy’s heart problems began several years ago with a heart attack. After receiving a stent and pacemaker, Brandy’s name was placed on the transplant waiting list. It took three days to find a match.

“At the time, I was feeling really, really bad,” says Brandy. “My heart was only functioning at ten percent.”

Heart-organ-donation-3.jpg

While Dr. Um finished Brandy’s procedure, 60-year-old Curt Spethman of Omaha was being prepped for surgery. Spethman’s heart issues were fairly recent, but progressing quickly. His name was only on the transplant waiting list for five days.

“I was amazed at how fast it happened,” says Spethman. “You’re scared, but then you go – ‘I’m getting a heart. A second chance.'”

At 10:40 a.m. on April 12, Dr. Um began Spethman’s transplant. Even though it was his third in two days, Dr. Um was prepared and ready to go. He couldn’t let Spethman miss out on his second chance at life.

“I have a couch in my office where I can put my feet up, get some sleep and grab a coffee,” explains Dr. Um. “We also have multiple teams that are able to come in. They’re refreshed as well. This allowed everyone to be working at the best possible level. It’s a testament to the med center to invest in those resources and have the personnel to do those things.”

On May 11, all three patients met each other for the first time. They also thanked Dr. Um for his incredible work.

“I feel great. I’m walking around – about a mile or more a day,” says Kollars. “I want to thank Dr. Um and Dr. Aleem Siddique. They saved my life about nine different times.” “If it weren’t for the team at Nebraska Medicine, I wouldn’t be here. . It’s amazing what they do,” adds Spethman. “I’m now walking down the sidewalk and planting flowers again. It’s incredible.”

“One day, I’m going to come back and buy them a box of donuts,” laughs Brandy. “To show my appreciation.”

To learn more about the three heart transplants in 34 hours, watch this video.

 

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “ John Um, MD is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better heart treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancer care and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Twin Diagnosed With Rare Form Of Cancer, Brother’s Stem Cells Save Life

By: Channing Barker

 

http://www.nwahomepage.com/news/fox-24/twin-diagnosed-with-rare-form-of-cancer-brothers-stem-cells-save-life/659566107

 

FAYETTEVILLE, AR. — – Bruce and Blair Johanson have been together since the moment of conception. They now work side by side in Fayetteville. They look, talk and even walk alike. They were told at birth they were fraternal twins.

“Whenever we would talk about being identical, mother would say no you’re fraternal and we’d say no we’re identical,” said Blair.

Something they doubted, especially in the past year when Bruce was diagnosed with Mantle Cell Lymphoma, a rare form of cancer.

“Once we learned with him what he was going to go through, praying that everything would work well with him and whatever we could do to support him through the process,” said Blair.

That included chemotherapy treatments and a trip to a specialist in Nebraska.

“At the very end, we were talking about family and I said ‘I have a twin brother ‘ and she says ‘What!?’ and she said ‘Well, that changes things,” said Bruce.

Doctors told Bruce, if he had an identical twin, there was a way his brother could be his true life saver.

“We need to have him tested to see if you’re truly identical and we want to use his stem cells versus your own, Since he’s cancer free,” said Bruce.

Blair gave new meaning to the term “brotherly love” and donated his stem cells.

“In my mind there was no question as to who the donor would be,” said Blair.

“It’s pretty special and awesome to have that,” said Bruce. “I mean,  we’re close as it is already, now we’re closer because I have his super cells.”

After dozens of treatments, Bruce was given the cancer free diagnosis last week.

“I wish everybody had a twin brother so they could get their stem cells from their twin brother or twin sister,” said Bruce.

The two are grateful for the doctors and the treatment made available by science.

 


Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Dr. Julie Vose is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better oncology treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancer care and Transplantation patients around the world.”

 

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

 

Longtime UNMC supporter Nancy Armitage dies

by Tom O’Connor, UNMC public relations

Image with caption: Nancy Armitage

Nancy Armitage

One of UNMC’s longtime supporters, Nancy (Roker) Armitage, died Monday at her home following more than a year-long battle with pancreatic cancer. Armitage, who is the wife of James Armitage, M.D., a legendary oncologist at UNMC and its clinical partner, Nebraska Medicine, was 70.

Service information

A memorial service for Nancy Armitage will be held at 1:30 p.m. on Friday, March 3, at Countryside Community Church, 8787 Pacific St.

Both the Armitages grew up in Kearney, Neb., where they first met in nursery school as young toddlers. They went to Kearney High School together as well as the University of Nebraska-Lincoln.

“Everyone needs a guardian angel. Nancy was Jim’s for a lifetime,” said Mike Sorrell, M.D., professor, UNMC Department of Internal Medicine-Division of Gastroenterology-Hepatology and longtime friend.

Nancy Armitage earned a nursing degree and worked at University of Nebraska Hospital, where she helped open the first intensive care unit for surgical patients on 6 West.

As Dr. Armitage’s career as a world-renowned lymphoma expert took off, Nancy Armitage took on the task of being a mother and grandmother to their four children and 11 grandchildren. She also became a key, behind-the-scenes figure in meeting with many of her husband’s patients and providing support to them.

One of the Armitages’ sons, Joel, earned his medical degree at UNMC and is on the UNMC faculty serving as assistant professor, internal medicine-general medicine.

Active in the community, Nancy Armitage played an important role in supporting her husband when he served as king of Aksarben in 1998.

Earlier this year, nearly $600,000 was raised to establish the Nancy Armitage Pancreas Cancer Clinical Research Professorship at UNMC. Much of the money raised came from family friends and former patients who had been treated by Dr. Armitage. Nancy’s mother died of pancreatic cancer at age of 67.

The goal is to raise $1 million, so an endowed chair can be established.

To make a gift to the University of Nebraska Foundation, click here. Pledge cards also are available in the Oncology/Hematology Offices on the 8th floor of the Lied Transplant Center, the Cowdery Patient Care Center on the 2nd floor of the Lied Transplant Center, or by contacting Tom Thompson at the University of Nebraska Foundation at (402) 502-4116.

Click here to read a Jan. 30 column on the Armitages in the Omaha World-Herald.

Heart Transplant Milestone

Dan Alexander became our 100th patient to receive a heart transplant after using an LVAD.

Dan Alexander, seen here in 1990, became our 100th patient to receive a heart transplant after using an LVAD.

114 Patients Have Received a Transplant After Using a Left Ventricular Assist Device

Last year was a record-breaking one for Nebraska Medicine’s left ventricular assist device (LVAD) and heart transplant programs. Forty-two heart transplants were performed – the most in a single year of the program.

Of those 42, 37 were LVAD patients – including Dan Alexander of Papillion, Neb., who became the 100th LVAD to transplant patient at Nebraska Medicine. Alexander’s health problems started in 2013 when he suffered a widow-maker heart attack.

“I’m one of the few who survived it,” he says.

For three years, Alexander relied on the LVAD to keep him alive – until he received a phone call in August 2016 that a heart was available.

“It’s my second chance,” says Alexander. “There’s so much more to do – so much more to give back to the people you love and thousands you don’t know.”

Since his transplant in August, 14 more LVAD patients received a heart transplant at Nebraska Medicine. These days, 63-year-old Alexander is doing well and enjoys volunteering at the hospital – sharing advice and encouragement with other heart patients and families.

“Life is beautiful. It sure is,” he reflects.

To learn more about Alexander, watch this story from WOWT reporter Brian Mastre.

Dan Alexander's story was featured on WOWT.

Dan Alexander’s story was featured on WOWT.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, many of our doctors are inspiring and are a remarkable specialist and researchers working tirelessly to help provide better heart transplants and treatment.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

First in Omaha to Perform New Heart Procedure

Interventional cardiologist Haysam Akkad, MD, is the first to use the absorbing stent in Omaha.

Interventional cardiologist Haysam Akkad, MD, is the first to use the absorbing stent in Omaha.

Jim Makey is competitive by nature. He loves winning and being first. However, being first in Omaha to receive a new absorbing stent, is not something he had in mind.

“I bragged to my friends and family that I was the first person in Omaha to have the new absorbing stent,” Makey says. “I like to be first in everything I do, so I’ll count this as a win.”

During the summer, Makey competed in a pair of half marathons and then the Mayor’s Triathlon in Papillion. The school principal then went on vacation, but once he returned he noticed reoccurring chest pains. Simple tasks like mowing the yard or jogging had required him to take breaks due to the pain.

“At first I thought, ‘man, I really got out of shape during those two weeks of vacation,’” he says.

After visits to doctor, he learned about the coronary artery blockage.

“I have a pretty active lifestyle, so that news really came as a surprise,” Makey says.

On Nov. 29, 2016, Haysam Akkad, MD, interventional cardiology, placed the absorbing stent in Makey, marking the first time this type of stent had been inserted in Omaha.

The absorbing stent received FDA approval in July 2016. Photo credit: Abbott Group

The absorbing stent received FDA approval in July 2016.
Photo credit: Abbott Group

The absorbing stent is the first of its kind and was approved by the Food and Drug Administration in July 2016. The new stent is another option for patients, other than the traditional metallic stent. The dissolving stent treats coronary artery disease like a metal stent. It props open the diseased vessel to restore blood flow, however, it then dissolves after the artery is healed, leaving no metal behind to restrict natural vessel motion. The new stent is made of a naturally dissolvable material called polylactide, similar to dissolving stitches. The stent disappears completely in approximately three years, once it has done its job of keeping a clogged artery open and promoting healing of the artery.

Dr. Akkad describes the absorbing stent as a breakthrough that will change how coronary artery disease is treated. “It takes interventional cardiology to different level, where the patient will have his or her coronaries fixed and have the added benefit of not having any stent material left in his or her body after a few years,” he says.

After almost two month since having the new stent placed, Makey is getting back to feeling like his normal, active self again.

“The recovery has gone really well,” he says. “I’ve even been doing more intervals of walking and jogging on the treadmill without any pain or stress. If someone else finds themselves situation, as I was in, I’d definitely recommend the absorbing stent. Everyone’s situation is different, but it’s been a good decision for me.”

 

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, Dr. Haysam Akkad is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better interventional cardiology treatment.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancer care and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Therapy Shows Promising Results for Lymphoma Patients

Julie Vose, MD, chief of hematology/oncology, is seen talking with lymphoma patient Amy Cheese, who has experienced tremendous results in Dr. Vose's clinical trial.

Julie Vose, MD, chief of Hematology/Oncology, is seen talking with WOWT reporter Brian Mastre and lymphoma patient Amy Cheese, who has experienced tremendous results in Dr. Vose’s clinical trial.

It’s the fifth most common type of cancer in U.S. adults. For years, traditional therapies to treat non-Hodgkin’s lymphoma (NHL) have included chemotherapy, radiation and a stem cell/bone marrow transplant. Currently, a new treatment option is showing great promise at Nebraska Medicine. Chimeric Antigen Receptor (CAR T-Cell Therapy) takes the patient’s own immune system and modifies it to attack the cancer.

“T cells are white blood cells that help our bodies fight infection and cancer,” explains Julie Vose, MD, chief of Hematology/Oncology. “In lymphoma patients, these cells have gone haywire. They don’t fight the cancer properly. This clinical trial allows us to take the patient’s own T cells outside the body and restimulate them to be able to fight their own lymphoma.”
Julie Vose, MD, talks to reporter Brian Mastre regarding her clinical trial recently featured on WOWT.

Julie Vose, MD, talks to reporter Brian Mastre regarding her clinical trial recently featured on WOWT.

Patients like third grade teacher Amy Cheese of Fort Collins, Colo., who was diagnosed with lymphoma 15 months ago. She endured three different types of chemotherapy, but nothing worked to shrink the grapefruit-sized tumor in her chest. Cheese’s oncologist recommended she travel to Nebraska Medicine for Dr. Vose’s clinical trial.

“One month after receiving my modified T cells, 75 percent of the tumor was gone,” explains Cheese. “The T cells will continue to fight the cancer for an additional two months.”

During her most recent visit on Jan. 23 with Dr. Vose, Cheese received the news she’s been waiting to hear.

“I am in remission,” smiles Cheese. “The tumor is gone! I can’t wait to get back to my classroom and start teaching again. I am so thankful for Dr. Vose and her incredible team.”

“It’s a great opportunity for non-Hodgkin’s lymphoma patients who have failed every other therapy,” adds Dr. Vose. “This treatment has the potential for fighting many different types of cancers.”

Nebraska Medicine is the only center in the region offering this therapy option. To learn more, watch this story from WOWT.

HPV-Associated Cancers Continue To Rise; Preventive Vaccine Underused

Omaha’s Fred & Pamela Buffett Cancer Center, 68 other national cancer centers urge action to increase national vaccination rates

Recognizing a critical need to improve national vaccination rates for the human papillomavirus (HPV), the Fred & Pamela Buffett Cancer Center in Omaha again unites with 68 other National Cancer Institute (NCI)-designated cancer centers in issuing a joint statement in support of recently revised recommendations from the Centers for Disease Control and Prevention (CDC).

Sonja Kinney, MD
Sonja Kinney, MD

The Fred & Pamela Buffett Cancer Center – an NCI-designated cancer center – is a collaboration of Nebraska Medicine and the University of Nebraska Medical Center in Omaha.

In October, new guidelines from the CDC recommended that children aged 11 to 12 should receive two doses of the HPV vaccine at least six months apart. Adolescents and young adults older than 15 should continue to complete the three-dose series.

According to the CDC, incidence rates of HPV-associated cancers have continued to rise, with approximately 39,000 new HPV-associated cancers now diagnosed each year in the United States. Although HPV vaccines can prevent the majority of cervical, anal, oropharyngeal (middle throat) and other genital cancers, vaccination rates remain low across the U.S., with just 41.9 percent of girls and 28.1 percent of boys completing the recommended vaccine series.

Sonja Kinney, M.D., director of the division of general obstetrics and gynecology at the University of Nebraska Medical Center, said the vaccine can protect against the two high-risk HPV strains that are responsible for causing 70 percent of all cervical cancers and the two low-risk HPV strains that cause 90 percent of genital warts.

“The incidence of these cancers is rapidly increasing, so we must take action now to prevent a future epidemic,” said Dr. Kinney, who sees patients at Nebraska Medicine. “HPV infections are incredibly common. Almost all sexually active people – 75 to 80 percent — will be infected. Most infections have no symptoms and are naturally cleared. However, in some cases, HPV infection can lead to several types of devastating cancers later in life, including cervical, oropharyngeal, anal and genital cancers.”

The vaccines are given as a series of injections that prompt the body’s immune system to make antibodies. The vaccine also provides protection against head and neck cancers and some anal cancer that may be linked to infection with the HPV virus.

Research shows barriers to overcome to improve vaccination rates, including a lack of strong recommendations from physicians and parents not understanding that this vaccine protects against several types of cancer.

In an effort to overcome these barriers, NCI-designated cancer centers have organized a continuing series of national summits to share new research, discuss best practices, and identify collective action toward improving vaccination rates.

The updated statement is the result of discussions from the most recent summit, hosted last summer by The Ohio State University. Nearly 150 experts from across the country gathered in Columbus to present research updates and plan future collaborative actions across NCI-designated cancer centers.

The Fred & Pamela Buffett Cancer Center – a National Cancer Institute-designated cancer center – is a collaboration of Nebraska Medicine and the University of Nebraska Medical Center in Omaha, Neb. The new cancer center will open in June 2017 with cancer research at the Suzanne and Walter Scott Cancer Research Tower and clinical treatments at the C.L. Werner Cancer Hospital.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, Dr. Sonja Kinney is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better obstetrics and gynecologic treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

One Year Later, Lung Transplant Patient Shares Journey

Phil Sauvageau Says God and Team at Nebraska Medicine Saved His Life

(From left to right:) Aleem Siddique, MD, lung transplant surgical director; Phil Sauvageau, lung transplant patient; and Heather Strah, MD, lung transplant medical director.

(From left to right:) Aleem Siddique, MD, lung transplant surgical director; Phil Sauvageau, lung transplant patient; and Heather Strah, MD, lung transplant medical director.

To find yourself on the brink of death is bound to be a life-changing experience. That’s how Phil Sauvageau described himself just weeks before he received a double lung transplant last January.

“To put things in perspective, on Jan. 24 of last year, I was only expected to live for a few more weeks,” Sauvageau writes. “I desperately needed a lung transplant. Without it, I would die.”

His prayers were answered. Sauvageau became the first patient at Nebraska Medicine to receive a lung transplant. Now that one year has passed, Sauvageau reflected on the experience in a blog he wrote for Nebraska Medicine. Take a moment to read. It’s worth it.


Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, Dr. Aleem Siddique, MD and Heather Strah, MD are an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better lung transplant treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

 

 

Fostering Educational Collaboration in Neurology at UNMC

The Department of Neurological Sciences at University of Nebraska Medical Center/Nebraska Medicine (UNMC), offers highly specialized and individually customized Neurology Preceptorship programs in Parkinson’s, Huntington, Botulinum Toxin Chemo-denervation, Movement Disorders, Deep Brain Stimulation surgery and continuous Levodopa infusion pump therapy. Participation by international healthcare professionals in such program experiences help enhance their skills in specific sub-specialties.

UNMC has a proven track record in clinical services, medical education, biomedical research, and international outreach. Danish Bhatti MD, Director of UNMC says, “Our primary focus has always been to provide exceptional educational opportunities and extraordinary patient care at all levels. Our Neurology Preceptorship program is yet another example to fulfill a strong need of sub-specialty training exposure for practicing international Neurologists”.

UNMC’s one to three month’s Neurology Preceptorship programs are designed for fully-trained international neurologists in active practice, who are interested in advancing knowledge in cutting-edge technology and current guidelines/practices in their area(s) of interest.

“With rapid advancements in all Neurological sub-specialties, our Preceptorship programs enhance experiences in Movement Disorders, Stroke, Neuro-Critical Care, Epilepsy, Neuromuscular Medicine, Multiple Sclerosis, Neuro-Immunology, Inpatient Neurology (Neuro-Hospitalist) and other sub-specialties.” says Dr Bhatti. “Research is also a vital part of the department’s activities, including clinical and translational research for neurologic disorders such as Alzheimer’s, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis, Parkinson’s, Peripheral Neuropathy and Stroke”.

Nizar Mamdani, executive director and founder of the International Healthcare Services says, “Dr. Bhatti is an inspiring and remarkable example of the caliber of specialists and researchers working tirelessly to help provide better Neurology treatment and educational opportunities. Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world,” says Mamdani. Contact: nmamdani@nebraskamed.com; www.unmc.edu/international; +1-402-559-3656.

Oxygen Under Pressure – a future adjunct option for refractory wounds

By Dr. Lon W. Keim

 

Imagine being at risk of losing one of your feet.

That’s what a mother of seven from Kuwait with advanced diabetes mellitus recently faced before coming to Nebraska Medicine and the University of Nebraska Medical Center, through the assistance of the Office of International Healthcare Services.

She presented with a problem wound involving her right foot, now threatened by potential amputation. Her management was further complicated by the need of dialysis three times per week for her end stage renal disease.

Years ago Dr. Jefferson Davis and Dr. Thomas Hunt coined the term “problem wounds,” which they defined as wounds which simply do not heal as they should.

Through their experience and research they determined that a common denominator of problem wounds is tissue hypoxia or oxygen deprivation. Tissue hypoxia is commonly a result of three factors: inadequate oxygen in the blood, insufficient regional blood flow, or most often – focal oxygen demand exceeds delivery. That is the metabolic demands of the wound exceed oxygen delivery from the available blood supply.

Accordingly, the body’s inherent defense mechanisms – the ability to fight infection, generate new blood vessels, build tissue, create strength, provide coverage – are forced to function in an oxygen deficient environment. Thus a problem wound, like the one the woman from Kuwait experienced, is created.

Re-establishment of local regional blood flow through vascular enhancement procedures such as arthrectomies, angioplasties, stent placement, and bypass procedures is the essential cornerstone of initial management.

Hyperbaric Oxygen Therapy (HBO) also has been found to be a useful adjunct in selected patients who tissue oxygenation is not improved to accepted levels by revascularization procedures The patient is entirely enclosed in a monoplace chamber  and breathes 100 percent oxygen at pressures greater than  1.0 atmospheric pressure absolute (ATA).

With increased pressure, the amount of oxygen physically dissolved in the blood is increased. This increased oxygen pressure in plasma enhances diffusion from existing vasculature and improves regional wound tissue oxygen tensions.

The increased oxygen tension will not make a normal wound heal faster, but allows an otherwise compromised wound to heal through improved white cell function, enhanced antibiotic effectiveness, promotion of micro-vessel growth and collagen formation. It should be emphasized that HBO is not a substitute for adequate debridement or appropriate antibiotics, adequate nutrition, or local wound care.

Prior to coming to Nebraska, the mother from Kuwait had been evaluated by clinicians in Europe who believed nothing further could be done with amputation being the next most likely course of action.  She was subsequently referred to Nebraska Medicine where vascular surgeons were able to improve her distal vascular circulation through angioplasties and stent placement.

Subsequent transcutaneous oxygen assessment confirmed marginal tissue oxygen tensions that reversed with Hyperbaric Oxygen Therapy, thereby justifying further treatment with HBO. While continuing her dialysis three times a week, through a series of HBO treatments at 2.4 ATA  for 90 minutes each, local wound care, and pressure off loading, her wound oxygen tensions improved, allowing her wound to heal to a degree it was believed she could be safely discharged and return to Kuwait with her limb intact.

It should be emphasized that her recovery was the result of a team effort that included: skilled surgeons, gifted interventional radiologists, talented infectious disease expertise, attentive nurses, ongoing dialysis support, pressure off loading, aggressive nutritional support, and hyperbaric oxygen therapy.

The Hyperbaric Unit at Nebraska Medicine is equipped with four monoplace chambers capable of treating patients at pressures up to 3.0 ATA. The unit is staffed by hyperbaric trained critical care nurses, and is located immediately adjacent to an ICU. As such, the Nebraska Medicine specialists are capable of both treating walk-in outpatients as well as those requiring intensive critical care support. Although available 24/7 for emergent conditions, the unit routinely runs four shifts a day, with the majority of patients treated once daily five days a week.

HBO is viewed as the primary treatment for only three conditions: (1) acute carbon monoxide intoxication, (2) decompression sickness (bends), and air emboli (air bubbles within the vascular system).

For all other conditions, HBO is viewed as adjunctive therapy to the traditionally accepted mandates of care: adequate debridement and wound care, pressure off loading, edema control, nutrition, wound care, appropriate antibiotics, etc.

The following conditions have been approved and are endorsed by the Undersea and Hyperbaric Medicine Society (UHMS) as appropriate for treatment with HBO: (1) Clostridial myonecrosis – gas gangrene, (2) Necrotizing Soft Tissue Infections, (3) Refractory Chronic Osteomyelitis, (4) Compromised Flaps & Grafts, (5) Diabetes Mellitus – with lower extremity problem wounds refractory to conventional management for > 30 days, Wagner III-IV, (6) Delayed Radiation Injury – to Soft Tissues and Bone including radiation cystitis, radiation caries, colorectal radiation enteritis, or any chronic non-resolving chronic wound within a prior area of radiation, (7) Crush Injury – Skeletal Muscle Compartment Syndromes, (8) Intracranial Abscess, (9) Idiopathic Sudden Sensorineural Hearing Loss, (10) Exceptional Blood Loss Anemia, and (11) Thermal Burns.

The risks and side effects associated with HBO therapy are few. They include: confinement anxiety; barotrauma to the ears sinuses and potentially the lungs; fire (controlled by rigid adherence to strict safety protocols), rare oxygen induced seizures; and occasional transient reversible changes in vision. All in all, it is extremely well tolerated with minimum risks.

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