Examples of Enhancing Treatment & Care with Hyperbaric Oxygen Therapy (HBOT): HBOT in the Management of a Non-Healing Wound(Associated with Steatitis)

A 13-year-old male neutered feline was seen for evaluation and treatment of a non-healing, draining wound (Image 1) which had been recognized for at least 30 days prior to referral presentation. The cat had a persistent fever with an elevated white blood cell count. Biopsies (and follow up biopsies) revealed necrotizing steatitis, with lymphoid hyperplasia in regional lymph nodes. Gram negative bacilli were isolated from culture of the involved tissue. The wound had not responded to treatment with marbofloxacin and amoxicillin/clavulanic acid.

Image 1 (left). Image 2 (right).

The patient was admitted to the hospital, and treated with IV fluids, injectable cefovecin, and oral azithromycin. HBOT sessions at 1.5 ATA BID for one hour were begun. The fever resolved, and the patient was discharged five days after admission. HBOT was given BID on an outpatient basis two days after discharge. Wound drainage rapidly ceased, and the wound closed over a two-week period. The follow-up image was obtained at recheck one month after referral. Antibiotics had been discontinued 10 days prior to the follow-up picture. (Image 2) 

SCHEDULE OF HBOT 

9/23 – BID sessions for one hour each at 1.5 ATA 
9/24 – BID sessions for one hour each at 1.5 ATA 
9/25 – BID sessions for one hour each at 1.5 ATA 
9/26 – BID sessions for one hour each at 1.5 ATA 
9/27 – BID sessions for one hour each at 1.5 ATA 
9/29 – BID sessions for one hour each at 1.5 ATA 

HBOT up regulates anti-inflammatory gene expression and down regulates pro-inflammatory gene expression. A recent study demonstrated that BID HBOT provides more prolonged modulation of these genetic expressions. (Reference, Kendall, AC et al, (Different oxygen treatment pressures alter inflammatory gene expression in human endothelial cells”. VHM 2013, Vol 40, No. 2, Pages 115-123). Continuous inhibition of inflammation is important in severe and chronic cases of steatitis. 

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