05/10/2022    Steven Kravitz, DPM

Hyperbaric Oxygen is the "Nectar of the Gods": MA Podiatrist (Elliot Udell, DPM)

Dr. Udell points to an interesting but realistic
question and the economic drivers that are
unfortunately involved in medical decision making.
By economic drivers I also reference political
relationship between physicians in the hospital
setting. That includes the need for continued
referral for business.

However you still can stand on your 2 feet and
explain and present the articles that support your
position. There are many articles on HBO.
Unfortunately the vast majority (according to the
major research articles) are poorly constructed
and do not provide valid evidence to support the
use of HBO.

I believe the article I referenced below is the
gold standard and it was revisited in 2013 with an
online version and updated supplemental material.
is worth the read, extensive with over 6,000
patients. There no evidence that HBO has any
effect on the diabetic foot for healing of ulcers.
It also challenges much of the "poor" research
published this in the subject area.

The reference below was republished in 2013 with
updated material by American Diabetes Association
in Diabetes Care.

Should you be faced with the question again, this
is a good article to present it to the hospital
physician and the staff as well. Arguably one the
best studies on subject to date.

One last point is that I have used HBO on a
selected few patients where I believe it helped
improve wound healing when a degree ischemia
involved responded to the hyperbaric oxygen
atmosphere. In conclusion, nothing is black and
white. There are shades of gray and that requires
experience and the right sense of ethics as to how
to treat. But at the end of the day these
decisions need to be medically driven. As you
point out in your article, the pressure from the
wound healing centers to utilize this therapy
needs to be addressed and corrected.

Reference:
Lack of effectiveness of hyperbaric oxygen therapy
for the treatment of diabetic foot ulcer and the
prevention of amputation a cohort study); David
Margolis, MD et. al. American diabetes
Association, update 2013.

Steven Kravitz, DPM, Winston Salem area. NC

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