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From Breast Cancer and Wound Care Patient to New Mother

July 23, 2013

When Risa Moreno took her brand-new baby daughter, Miranda Elisabeth, to the Washington Center for Wound Healing & Hyperbaric Medicine recently, it wasn't because she or the baby was in need of treatment. Ms. Moreno was showing off her pride and joy to the staff members who had helped her recover two and a half years ago from a non-healing wound, with treatments that included hyperbaric oxygen therapy (HBOT).

"I walked into the clinic just as a patient was finishing her treatment, and I showed her my baby," she says. "I told her there is life after hyperbaric oxygen therapy!"

In October 2010, then a 27-year-old psychology student at Cal State East Bay, Ms. Moreno was diagnosed with breast cancer. Because her mother and other close female relatives also had developed breast cancer, she chose to have a double mastectomy that December, followed by breast reconstruction using skin and other tissue from her lower abdomen.

The surgery went well, but a large non-healing wound developed afterward at the skin- and tissue-extraction site on her abdomen. When multiple attempts to treat the wound were unsuccessful, her doctor, plastic and reconstructive surgeon Prasad Kilaru, M.D., referred her to the Center for Wound Healing & Hyperbaric Medicine, where he serves as medical director. The center had just introduced HBOT as a supplement to other treatments for chronic wounds.

"When used in conjunction with other treatments, hyperbaric oxygen therapy can make a big difference in chronic wound patients who have a compromised blood supply," says Dr. Kilaru.

"Hyperbaric" means "increased pressure," so in HBOT, the patient is enclosed inside a pressurized clear acrylic chamber, breathing 100 percent pure oxygen. The air pressure in the chamber is twice the normal atmospheric pressure at sea level. In addition, the air in the atmosphere normally contains only 21 percent oxygen, as opposed to the 100 percent oxygen in the hyperbaric chamber.

"The blood carries oxygen throughout the body," Dr. Kilaru explains. "The body's tissues need an adequate supply of oxygen to function, and injured body tissues need even more oxygen to heal. Oxygen stimulates the immune system to kill bacteria and releases the body's own 'growth factors' that promote healing. Oxygen also stimulates the development of new blood vessels into the wound area. The amount of oxygen the blood carries can be increased dramatically - up to 10 times as much - by using hyperbaric oxygen therapy."

The hyperbaric chamber has a comfortable bed along with a clear ceiling and sides to allow patients to see their surroundings in an attractive treatment room equipped with TVs and video players. HBOT patients come in for about two hours, five days a week, for anywhere from four to ten weeks, depending on their diagnoses and the complexity of their wounds. Being in the chamber feels somewhat similar to scuba diving with the increase of air pressure. Patients may need to yawn to equalize the air pressure in their ears - much like when taking off or landing in an airplane - but the procedure is not uncomfortable.

Dr. Kilaru notes that HBOT may be appropriate as an additional wound care treatment for patients with a variety of chronic wound conditions, such as:

* Diabetic ulcers (open sores that will not heal or keep returning) or other wounds caused by artery blockage, nerve damage or improper functioning of valves in the veins.

* Chronic Refractory Osteomyelitis (CRO) - a persistent infection of bone and bone marrow that can result from a chronic wound.

* Wounds resulting from complications of radiation therapy for cancer, including bone that has been damaged (osteoradionecrosis) or soft tissue injury (soft tissue radionecrosis).

* Skin grafts or "flaps" (such as flaps used in breast reconstruction) that fail to heal well because of poor blood flow and lack of oxygenation.

Although most of the HBOT patients seen at the Center for Wound Healing & Hyperbaric Medicine are over age 50, the treatment can be beneficial for much younger patients, too, as in the case of Ms. Moreno. She completed 30 HBOT treatments over six weeks and grew fond of the staff providing her care.

In addition to Dr. Kilaru, the Safety Officer and the nurses who are specially trained in wound care, the team at the Center for Wound Healing & Hyperbaric Medicine includes a multidisciplinary group of physicians - vascular surgeons, infectious disease specialists, general surgeons and a podiatrist. They also work closely with patients' other primary care and specialist physicians to provide continuity of care and positive outcomes.

"It took about three weeks before I really noticed a difference in the wound, but it healed enough for them to sew it back together, and I had my last HBOT treatment in February 2011," Ms. Moreno recalls. "I was able to start follow-up chemotherapy for the breast cancer, and I finished that on July 14, 2011."

Ms. Moreno's cancer and wound healing treatments had no effect on her ability to get pregnant, she notes. "When I decided to try to get pregnant, it took just two months - and it didn't require in vitro fertilization or any other procedures. I found out I was pregnant last September, and Miranda was born on June 7 at 8 pounds, 7.3 ounces and 21 inches long."

Today Ms. Moreno's future looks bright. She graduated with a bachelor's degree in psychology in March. Now she plans to take a year off to care for Miranda before pursuing a doctorate in psychology and a career as a clinical psychologist.

"I am so happy," she says. "The treatment I got at the wound center was fantastic, and I never had any problems with the wound after it healed up. I did go see Dr. Kilaru when I learned I was pregnant to make sure the mesh net in the tissue-extraction site in my abdomen would hold up during pregnancy. He assured me it would - and he was right. And now I have this adorable baby girl, who was born with a full head of hair and the most beautiful dark blue eyes. A couple of years ago, I wasn't sure I'd be this lucky."

The HBOT treatment protocol provided by the Center for Wound Healing & Hyperbaric Medicine is approved by the FDA and follows the guidelines of the Undersea & Hyperbaric Medical Society (UHMS). The center is the only facility in the Tri-City area to offer HBOT. It also is the only local facility that works in partnership with Healogics, Inc., the largest provider of wound care services in the country. Medicare and most private insurance providers generally cover HBOT treatments. HMO patients usually must be referred by their primary care physician. For more information about the Washington Center for Wound Healing & Hyperbaric Medicine, visit www.whhs.com.

Upcoming Free Seminar: Expert Care for Non-Healing Wounds

The Washington Center for Wound Healing and Hyperbaric Medicine will hold a free seminar on coping with chronic, non-healing wounds. Learn about what type of wounds can be treated and how they are healed. Wound care experts will talk about when you should see a wound care specialist. Anyone with diabetes, neuropathy, poor circulation or a non-healing wound is encouraged to attend. The seminar will be offered three times this year: July 25, September 26, and November 14, from 6 to 7 p.m. at 39141 Civic Center Dr., Suite 106, in Fremont. Registration is required. Call (510) 248-1518.

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