Just one day after the opening of the Wound Healing Center at Missouri Baptist Medical Center, its physicians and staff began saving a man's life.
A Bad Day At Disneyland
Sixty-one-year-old Larry Carter's ordeal began at an amusement park swimming pool when his daughter noticed that one of his big toes was swollen. Carter, who has Type 2 diabetes, hadn't noticed it and, being 1,800 miles from his podiatrist in St. Louis, he thought there was little he could do about it at the time.
He has a family history of diabetes; his father had it, and his grandmother lost both of her legs to the disease. So, Carter knew he had to see his podiatrist as soon as he returned home. "I knew it was infected," he said. "But I didn't know how bad it was."
His podiatrist told him the toe would have to be amputated and the bone behind the toe, called the metatarsal bone, would have to be removed as well. The toe next to the big toe showed some signs of infection, but it was decided to give it a chance to heal.
The Wound Healing Center
Carter has neuropathy; a disease of the nerves resulting in numbness or weakness of the extremities. High levels of blood sugar cause damage to the walls of tiny blood vessels that supply oxygen and nutrients to the nerves at the ends of the hands and feet and other areas of the body. The loss of blood, oxygen and nutrients makes infections more likely and treatment more difficult because the body’s ability to heal itself is severely impaired, thus wounds and ulcers, particularly of the feet, can become life-threatening. Also, the loss of feeling can cause wounds to go undetected.
Eventually, Carter's second toe, also, had to be removed. Even after the loss of the two toes, he was not out of danger. His foot would not heal and gangrene threatened to move into his leg.
When that happens the statistics become grimmer: 50 percent of patients die within five years of an amputation, and the larger the area amputated, the greater the risk.
Carter's podiatrist recommended the Wound Healing Center at Missouri Baptist Medical Center.
"He spoke highly of it," Carter recalled. "He told me, the way it looked, I could lose my leg, so I told him let's do what we have to do."
The Center, which opened its doors in May 2015, specializes in the treatment of wounds that have not healed with conventional treatment. Carter arrived the next day, and was placed in a hyperbaric oxygen chamber, a glass chamber where patients are enclosed in an environment of 100 percent oxygen.
How The Hyperbaric Chamber Heals
Mark Ludwig, MD, a vascular surgeon for 30 years and medical director of the Wound Healing Center, explained that in the highly oxygenated environment of the chamber the extra oxygen enters the bloodstream and spreads out from the larger blood vessels, building up smaller blood vessels that bring healing to the wound area.
"Getting oxygen to those wounds stimulates blood vessels to grow," said Dr. Ludwig. "It helps heal, kills bacteria and increases the effectiveness of antibiotics."
Carter spent two weeks in the hospital, receiving treatments at the Center; it was the first hospital stay of his life. After discharge, he made the 20-mile trip from his home in Florissant to the Wound Healing Center five days a week. Each treatment lasted 90 minutes. At home, he received intravenous antibiotic treatments.
According to Dr. Ludwig, there was no other way to save Carter's foot except by hyperbaric therapy. Only 10 percent of patients are considered to have wounds serious enough to warrant the use of the chambers, but they produce significant results, such as healing wounds caused by cancer-killing radiation therapy, reducing swelling and increasing blood flow in severe crush injuries, breaking up blood clots in the eye, and repairing the damage of internal injuries.
The Commitment of Patient and Staff
"The people at the Center were excellent," Carter said. "They were professional and caring."
"Though he was a bit claustrophobic at first, the staff eased him into the hyperbaric chamber with a towel over his eyes, instructing him to remove it when he was comfortable," said Dr. Ludwig.
"After I took off the towel and looked through the glass, I knew I could do this," Carter said. In fact, he did it 59 more times over the next several weeks.
"I tell patients we have a contract," said Dr. Ludwig. "I will give you your best chance of healing, but you must give me your time each day."
Carter gave his time. What troubled him most was being away from his job for the many months his treatments required. "I had never been off the job that long, and I've been working since I was 15," he said.
Carter, who has three grown children, now also is raising two foster children with his wife, Joyce. "Here's a guy who wasn't feeling sorry for himself; he just wanted to be a productive person again and support his family," said Dr. Ludwig. "I'm so happy we helped him get back to his life."
Local Expertise and National Resources
In addition to hyperbaric therapy, the staff provide treatments for a host of chronic wounds, including burns and pressure ulcers. All of the nurses are certified in wound care.
Throughout Carter's treatment, not only Dr. Ludwig, but also Rafael De La Cruz, MD, board-certified in infectious diseases, monitored his progress.
The Wound Healing Center is part of the Healogics™ network of 800 wound care centers across the nation with access to a vast data base of wound care information. This connects MoBap to other prestigious medical facilities, including Stanford, Duke University and the Cleveland Clinic.
A Good Day at the Wound Healing Center
Dr. Ludwig shows a hyperbaric chamber, which is used to treat some chronic wounds.
"Seven million people have chronic wounds, but only a fraction of them receive good wound care," said Dr. Ludwig. "People with long-term wounds get depressed, won't go out in public, and get sicker. The proper wound care can change all that."
When his hyperbaric treatments were completed, Carter underwent wound debridement, removing dead tissue from the wound. He also received a patch of artificial skin to cover the wound. By November 19, nearly six months to the day after Carter entered the Wound Healing Center, he was proclaimed healed.
"I was elated and I thank God that I was healed," Carter said. "But I think the crew there was happier than I was. It was like, 'We hate to see you go, but glad you are healed.'"
Mark Ludwig, MD, is a board-certified general surgeon on staff at Missouri Baptist Medical Center and medical director of the Wound Healing Center. He received his medical degree from the University of Health Sciences, Chicago Medical School. He completed his residency and internship in surgery at Washington University in St. Louis.