Hyperbaric oxygen therapy for diabetic neuropathy

Dom Van Loggerenberg shares how hyperbaric oxygen therapy (HBOT) not only healed his wound but helped with diabetic neuropathy.

People tend to think of diabetes as a silent, painless condition. Don’t tell that to the millions of folks with diabetes-induced tingling toes or painful feet. This problem, called diabetic neuropathy, can range from merely aggravating to disabling or even life-threatening. It’s something I have first-hand (or, more appropriately, first-foot)  knowledge about.

If you ask medical professionals what the biggest concerns around diabetes are, at the top of most of the list will be microvascular complications. Uncontrolled blood glucose damages nerves and capillaries (the smallest blood vessels). Starting with those furthest from the spinal cord, the toes and feet.

The start of neuropathy

I have been a Type 1 diabetic for the better part of the last 15 years. Being diagnosed as a young adult forced a lifestyle change on me that I was slow to adopt, and probably caused small medical complications that I will be dealing with for the rest of my life.

I am just over 1.9m tall and a rather large person and have had issues with peripheral circulation since I was a teenager. I have always had cold feet. This rapidly became a problem when I developed diabetes, turning into minor neuropathy that became increasingly severe. What started as a loss of sensation and occasional tingling became complete numbness.

This complication was manageable. Under doctor’s orders I needed to check my feet weekly (yay Sunday night foot rubs) and monthly pedicures. I’m serious, the doctor prescribed pedicures. It was a nice excuse for that end-of-the-month-treat-yourself-time. I also had to be extremely careful of hurting myself because I could very easily stub my toe or stand on a thorn and not even notice.

Small scratch, big problem

Now fast forward to 2020, life is changing for all of us. I don’t need to explain, the pandemic has affected everyone and we’ve all had to experience change as a result.

This is where the latest chapter of my diabetic journey took a turn for the worse. It’s early August and I’m having my first pedicure since lockdown started. It’s not the usual place I go to but a professional who was willing to visit my residence. While not being completely sure the chain of events they probably unfolded as follows: a small scratch on the side of my minimus (little toe). I don’t even react to this because it’s completely numb – so the pedicurist assumes no harm, no foul.

Wrong! Two days after this, I wake with my leg being a little stiff around the ankle. Due to me working from home I only walk maybe five minutes that day: kitchen, bathroom, desk (yes, not the most active). Next thing I know the sun is setting and I stand up from my desk. A sharp intense pain shoots up my leg and I panic. I haven’t felt pain in my foot for the better part of a decade. I start to examine my foot and it’s hot to the touch and very swollen. It’s infected and my toe is a deep purple. I swear it didn’t look like this when I woke up.

I contact my father, who is an emergency medicine specialist, and when I hear him say this is urgent I know I’m in trouble. He arranges a course of antibiotics to get to me that evening and examines my foot personally. I’m take four pills, three times of hospital grade antibiotics and my dad sends me into hospital first thing in the morning.

Diabetic foot

Arriving at the hospital, I have an emergency visit, the diagnosis is immediate: diabetic foot.

The truly scary thing about diabetic neuropathy is a 10-letter word we usually associate with horrific accidents or war veterans: amputation. When sensory nerves in the feet become damaged, a blister, cut, or sore can go unnoticed, allowing time for the wound to become infected. Infections that cause the tissue to die (gangrene) and that spread to the bone may be impossible to treat with cleansing and antibiotics.

Then I hear a sentence that shocks me to the core, one of the best doctors says, “I don’t think I can treat this, I am not comfortable in my ability as a doctor, the risks are too great.”

My mother, who is also a doctor, tells me will have a colleague look at me in the next hour. In the meantime, I have a Doppler ultrasound scan of my foot; it maps the blood flow, veins and arteries. Thankfully finding mine in my foot aren’t completely closed off. It has about 30% of a normal person circulation.

Hyperbaric oxygen therapy (HBOT)

Thankfully this medical horror story takes a turn for the better. About 45 minutes later, I have surgery on my foot and most of the dead and infected tissue is either drained or surgically removed. It’s now up to fate and my ability to heal.

I could completely recover with no permanent damage, and to promote this healing treatment it is suggested that I undergo Hyperbaric oxygen therapy (HBOT). Something that I had only heard of in movies (to treat divers from the bends).

Hyperbaric oxygen therapy is conducted within a pressurised chamber. It involves the type of treatment used to speed up healing of carbon monoxide poisoning, gangrene, stubborn wounds, and infections in which tissues are starved for oxygen.

If you undergo this therapy, you will enter a special chamber to breathe in pure oxygen in air pressure levels 1,5 to three times higher than average. The goal is to fill  the blood with enough oxygen to repair tissues and restore normal body function.

I was placed in a chamber for one hour for five days. This would help increase my healing and the wound would have a greater chance of successfully recovering back to normal.

Excellent results

And, yes, the wound healed well. But that’s not all, after my second treatment, getting out of the chamber and stepping off the bed, to my complete surprise I had tingling in my other foot, a sensation missing since I was first diagnosed. By the end of the week I could feel a touch on my foot and had a visible change in the tissue blood supply.

This was confirmed to still be the case six weeks later, when I went for my quarterly check-up at a diabetic centre. I hadn’t mentioned to my doctor that I went for HBOT yet she noticed the changes in my feet. My wounded one obviously had remnants of the procedure but my other foot had returned blood flow and sensation.

She recommended immediately to continue HBOT to see what changes further sessions could do. If 5 hours for one week could make a noticeable difference. Going for a maximum full six-week course of 30 sessions might do more. Normally five and 10 session sets are recommended. I am seeing what the maximum allowed would do.

Further benefits of hyperbaric oxygen therapy¹

• Many of patients mention that before they started HBOT, they had trouble sleeping. After the first session, their sleeping habits improved as did their attention to their diets.
• HBOT is currently being tested in several antidepressants studies as the oxygenation of the brain seems to help.
• It has long been known to help speed up wound healing and, in particular, wounds that have a poor recovery rate, like burns and skin flaps (it’s used post-surgery at the breast centre).

Reference:

1. Milpark Hyperbaric Medicine Centre