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Connie Waltz, RN – Hyperbaric Medicine Nurse

By Admin | January 19, 2008

Connie Waltz, RN, BSN is the Director of the Robert M. Lombard Hyperbaric Medicine Center located in Columbia, Pennsylvania. We recently had a chance to sit down and talk with her about this interesting medical treatment modality.


How long has the center been in existence? Who founded it and why?

In early 1978, Robert M. Lombard M.D., read an article written by Richard Neubauer, M.D. about using Hyperbaric Oxygen Therapy (HBOT) to treat multiple sclerosis. Dr. Lombard visited Neubauer’s Ocean Hyperbaric Center in Florida, where he learned about hyperbaric oxygenation therapy, but did not get to meet Dr. Neubauer.

Dr. Lombard was intrigued with Neubauer’s approach of using something as simple as 100% oxygen under a bit more pressure to treat people with MS and strokes, so intrigued, that he had his own vision to bring hyperbaric oxygen to his general medical practice in the Central Pennsylvania area.

He studied the physics behind the treatment and thought it worthy of a second look. He flew to Florida to meet with Dr. Neubauer in person and arranged for me, his daughter, and his son, Mark, to learn about hyperbaric oxygenation and to learn to operate the chambers under Dr. Neubauer’s direction.

After several weeks of on the job training, Mark and I returned to find that a Vickers monoplace chamber had been installed in the former Columbia Hospital, directly across the street from his practice. Dr. Lombard was always on the lookout for medical interventions to help his patients.

It was soon apparent that the single chamber in the hospital was not enough. Dr. Lombard built the Hyperbaric Oxygenation Medical Center which opened in May 1979. He added two Sechrist monoplace chambers and another Vickers chamber. The center was busy, as was the chamber in the hospital.

He expanded the hyperbaric center in 1984 by adding an addition to his existing center, which included four handicapped bathrooms, a larger treatment room and several offices.

In 1996, Dr. Lombard retired from his family medical practice and devoted his time to hyperbaric medicine therapy. In 1997, a fourth chamber was added to the treatment room.

In 2000, my sister, Meredith, and I bought the hyperbaric center from him and have continued the Lombard tradition of quality professional service in a family setting.

Long-time employee, Valerie Rhoads, LPN, stayed with the new business, which was renamed after Dr. Lombard to honor him. The staff of the medical center treats each patient like a family member, with respect and dignity. In 2001, Dr. Lombard passed away, leaving another generation to carry on his legacy.

Please describe what hyperbaric medicine is and how you actually receive it?

Hyperbaric oxygenation therapy is a prescribed medical treatment in which a patient breathes pure oxygen at a greater than normal atmospheric pressure.

A special chamber, sometimes called a pressure chamber, is used to increase the amount of atmospheric pressure around a person. When pure oxygen is used to pressurize the chamber, normal respiration allows the bloodstream, and thus the entire body, to become hyperoxygenated. This follows the laws of physics.

We use monoplace pressure chambers (single patient) at our center. A monoplace chamber is filled with pure oxygen and is pressurized to the desired atmospheric pressure (ATA).

The rate of pressurization can be controlled to allow the patient to clear his/her ears. Each person has the protocol to best suits his/her needs. Some conditions (i.e., osteoradionecrosis, Lyme symptoms) call for a higher pressure and others (brain injuries, autism) use a lesser pressure for the best outcome potential.

We have three Sechrist chambers. Each chamber has a litter on which the patient, let’s assume a woman, lies down, either on her back or on her side, or she can move around from side to side during therapy. She doesn’t have to stay still as she would in an MRI.

A mother, who accompanies her young child in the chamber, usually lies on her side, with the child in front of her. The litter is slid into the clear acrylic chamber, the door is closed, and oxygen is introduced and the chamber pressurized.

Our fourth chamber is a Vickers, which opens and closes like a clamshell. The person sits in this chamber looking out of the clear acrylic dome. A parent can be with a child in this chamber, holding an infant or allowing a child to sit on their lap.

The top is closed and sealed and 100 % oxygen is introduced and the chamber is pressurized. All of the chambers have sound piped into them, so the person can watch an external TV, listen to music or books on tape, or just have quiet and relax or sleep during the treatment.

How much do you charge per session?

We currently charge on the basis of $70.00 for every half hour of physician and nurse supervised sessions. If a patient does not require physician supervision, a discount is given per session, provided the patient privately pays weekly for the treatments given.

A one-hour session, private pay, can be as low as $115.00 rather than $140.00. For this, the patient has an individualized treatment in a monoplace chamber, (the treatment is tailored to one individual rather than lumped in with several patients as with a multiplace unit), pressurized with 100% oxygen, no hoods or masks to worry about, has nurse and technician supervision, choice of music, video or television or other entertainment, ear-clearing aids while going to/from the prescribed pressure, flexible scheduling of treatments, cotton gown (if needed), and access to the supervising physician, Dr. Neureuter, should a question arise.

Is there an age limit on who can receive hyperbaric treatments?

No. We have treated infants as young as 2 months who had complications at birth and were anoxic (without oxygen) or hypoxic (low oxygen). Physicians in some countries will treat a newborn right out of the womb if there was a lack of oxygen during the birth!

Our oldest patient was 95. Age is not prohibitive as long as the patient is cleared by a physician for treatment and has no contraindications for therapy.

What are the contraindications?

Pneumothorax is an absolute contraindication to hyperbaric therapy. Heart patients who have a low ejection fraction are also excluded.

There are a few chemotherapy drugs that prevent the person from having the treatments until the drugs clear their systems. A very rare genetic disorder, congenital spherocytosis, makes red blood cells susceptible to fragmentation. Red blood cells must be strong and deformable to withstand the stress of circulating in the blood and passing through narrow capillaries.

Relative contraindications include: pregnancy, upper respiratory infections, high fevers, seizure disorders, and emphysema with CO2 retention. Additional considerations warranting careful monitoring include high blood pressure and diabetics on insulin. It is important to eat before you have a treatment because hyperbaric oxygenation will lower your blood sugar.

What diseases do you treat that insurance covers?

Insurance coverage varies from one company to the next, but typically most carriers follow Medicare guidelines for coverage. Medicare has changed its guidelines and now covers 17 different indications, the newest being non-healing diabetic wounds that haven’t responded to traditional wound therapy.

Other conditions on the generally accepted-as-insurable list include osteoradionecrosis, soft tissue radionecrosis, acute carbon monoxide poisoning, crush injuries, arterial embolism and thrombosis, chronic osteomyelitis and decompression sickness.

What disease or conditions do you treat that insurance will not cover?

Because we are a free-standing center, not only are we able to treat the generally accepted-as-insurable indications, but also we are able to treat the “off-label” or alternative or complementary indications like Lyme disease, stroke, traumatic brain injury, cerebral palsy, autism, sports injuries, multiple sclerosis, RSD and…the list goes on.

We recently were asked by a cancer patient, who was undergoing radiation therapy, to treat her to boost her immune system. All persons must have a prescription for hyperbaric therapy from a medical doctor before therapy can begin, even if they are being treated for an “off-label” condition.

What complications have you had at your center?

We have been very fortunate at our center. Other than a few cases of barotrauma, where the patient could not clear his/her ears properly during pressurization, the complications have been minimal.

Out of over 60,000 treatments we have had two cases of symptomatic low blood sugar, and two, maybe three oxygen-induced seizures. This type of seizure is very rare, and it is important to note that the protocol for those patients was a high pressure for an extended period of time. There were no long-term side effects from the seizures.

A side effect for some patients, rather than a complication, has been a change in clarity of vision after quite a number of treatments at high pressure, because the lens of the eye changes shape in response to the pressure.

Normal vision is usually restored after the series of treatments ends. Also some patients have confinement anxiety and may need to learn relaxation techniques or are prescribed a calming medication. Overall, hyperbaric oxygenation therapy is a very safe medical procedure.


What does it feel like to be inside the chamber during a dive?

Imagine you are in an airplane. As the plane ascends and descends your ears will “pop”. This happens in the chamber too.

Just as on the plane, it is important to equalize your ears while you are being taken to pressure. We offer gum, lollipops and water to help you to equalize them. You may feel warm when going to pressure, comfortable (“normal”) when at pressure, and cooler when the pressure is reduced.

Otherwise, once you are at pressure, the treatment feels like you are in an air-conditioned room. The chambers are made of a clear acrylic so you can see out and watch TV or watch what is happening around you, and we can, of course, monitor you.

Where do your patients come from?

Over the years, since our Medical Center is a freestanding monoplace facility with doctor coverage, and the largest in the Northeast, patients have traveled from out of state and from out of country for treatment.

We have welcomed patients from Italy, Puerto Rico and Canada as well as many people from out-of-state – Michigan, Ohio – who have not found a good hyperbaric facility closer to them.

Our patient base is generally from NewJersey, New York, Maryland, Virginia, West Virginia, Delaware and of course locally in Pennysylvania.

What type of training do you have to run the center and administer the treatments?

Running the center involves two factions: the business side, which Meredith generally handles, and the medical side, which Dr. Neureuter and I oversee. A doctor’s prescription is required for therapy before a treatment is given and the treatment must be administered by a nurse, or the doctor, or, if under the physician’s or nurse’s supervision, a trained technician.

Dr. Neureuter is a board certified hyperbaric physician and we are fortunate to have him as our Medical Director.

I am an advanced certified hyperbaric registered nurse (ACHRN) with just about 30 years of practical hyperbaric medical experience.

We have a licensed practical nurse with 15 years experience in hyperbaric medicine, who studied hyperbaric medicine with Dr. Eric Kindwall in Wisconsin.

We hired a nursing student last year who we trained to operate the chambers under our supervision. I expect the student will sit for her hyperbaric certification this year.

Meredith has extensive training in chamber operation and is quite experienced in patient care. She will assist as a back-up therapist when we are busy or just need an extra hand. I believe that experience plays a big part in patient care.

Is there a physician present in the center during the treatments?

Our Medical Director, Louis J. Neureuter M.D., is present if the treatment requires physician supervision but otherwise is available if necessary. He is Board Certified in Internal Medicine, Pulmonology and Hyperbaric Medicine, and he has a degree in engineering. He is quite knowledgeable and takes great pleasure in answering any questions that may arise.

What is the current “big controversy” in hyperbaric medicine?

I suppose the biggest controversy is the use of “mild hyperbaric” treatments in portable soft-sided units (“mild” or “bag” therapy) and whether the results are the same as being treated in hard-shelled chambers.

The bag units are pressurized with room air, rather than pure oxygen, up to a pressure of 1.3 atmospheres (ATA). They are not FDA approved to be used with supplemental oxygen and may be dangerous in that situation.

Our monoplace hard chambers can be pressurized up to 3 ATA using 100% oxygen—not room air. There is, therefore, a huge difference in the amount of inspired oxygen (a pO2 of 988 mm Hg versus a pO2 of 207 mm Hg).

Here’s the math behind this: Room air is comprised of approximately 21% oxygen and 79% inert gases, primarily nitrogen. It helps to convert “atmospheres” (ATA) to a “barometric pressure” measurement at this step. 1 ATA is equal to 760 millimeters of mercury, written as 760 mm Hg.

The partial pressure of oxygen (pO2) in the room, when breathing room air at normal (sea-level) atmospheric pressure, is approximately 159 mmhg of oxygen. (21% x 760 mmhg = 159 mmhg.) Increasing the pressure to 1.3 ATA and using room air as in bag therapy, the amount of oxygen increases to a pO2 of 207.48 mmhg. (1.3 x 760 mmhg x 21%).

Contrast this to using pure oxygen: the amount of oxygen increases to a pO2 of 988 mmhg! (1.3 x 760 mmhg x 100%.) This is almost five times as much oxygen as with the mild units.

If one calculated the alveolar oxygen (which considers the partial pressure of water vapor and carbon dioxide) the differences are even greater. Alveolar oxygen in the body would be 148 mm Hg with the soft chamber versus 891 mm Hg for the hard chamber at 1.3 ATA, six times the difference. Increases of oxygen content in the body increase as atmospheric pressure is increased. Most of our treatment protocols range from 1.4-2.4 ATA depending on the condition.

The 100% medical grade oxygen used in the hard chambers is filtered, purified, and without impurities that may be found in room air.

Is there a limit to the number of hyperbaric treatments you can get in a year or lifetime?

There is no lifetime limit on hyperbaric oxygen treatments that an individual may receive, provided they don’t acquire any contraindications to therapy. If warranted, we recommend that a patient takes a break of several weeks during prolonged therapy sessions, say after 60-80 treatments, if they are committed to a long-term therapy schedule. This may not be true in treating non-healing wounds, but for other conditions. We have found that patients do better over time when they take a break.

The opinions expressed in this interview are solely those of the person being interviewed and are not attributable to DailyInterview.com or the editors.

Copyright 2008 DailyInterview.com

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