Crushed

How a hyperbaric oxygen chamber and a team at Mary Greeley saved a Story City man’s foot.

By Stephanie Marsau

As a semiretired farmer, working with skid loaders is familiar territory for Roger Christian.

On March 31, 2020, while helping out at his son’s farm just outside Roland, the unexpected happened. Christian was removing a skid loader bucket when the heavy piece of machinery swung loose, crashing down on his right foot.

Christian had suffered a crush injury, which is just what it sounds like. Crush injuries can be particularly challenging to treat because when they occur, all of the blood vessels that supply that area of the body with oxygen are compromised. Oxygen is needed to help heal the injury.

After arriving at Mary Greeley and being assessed, a decision was made to call Dr. David Cain, a McFarland Clinic foot and ankle surgeon.

“Dr. Cain was on call and came in right away, which I was very thankful for,” Christian said. “We were told that surgery would need to happen within six hours and if he hadn’t come in, I would’ve been transferred to Des Moines. I didn’t want that—I wanted to stay close to home.”

Hyperbaric Oxygen Therapy

“Roger had a pretty severe injury,” Cain said. “The bucket had not only crushed his foot, but it had also lacerated it, which resulted in having to partially amputate his first and second toes.”

Wanting to save the rest of the foot, Cain created skin flaps using skin from the bottom of Christian’s foot. With little to no oxygen able to get through the crushed blood vessels, however, something else was needed to make sure that the skin flaps didn’t fail. If that happened, there was a chance that Christian would lose more of his toes.

“A crush injury is a complex injury as it can cause a 'second hit'," says Cain. "You have the initial injury, which in Roger's case was the bucket crushing his foot. The trauma of the injury can also cause delayed symptoms such as circulatory impairment or arterial spasm and impaired flow from progressing edema. It was imperative that we tried to get Roger on the road to recovery prior to that happening.”

Cain has seen firsthand the healing power of the hyperbaric oxygen chamber and knew that crush injuries are one of the things it can be used for. The only problem was that Mary Greeley didn’t have one yet.

“Oxygen was needed to save the skin flaps on Roger’s toes and there is no better way to do that than in the hyperbaric chamber,” Cain explained. “The chamber increases the atmospheric pressure and then also delivers 100 percent oxygen to the patient. Those two things combined can help provide oxygen to areas of compromised blood flow by increasing the oxygen content of the blood so desperately needed to help with the healing process.”

Mary Greeley has a long-standing collaborative relationship with Boone County Hospital, which has a hyperbaric chamber. Cain made the recommendation that Christian spend 90 minutes a day, five days a week for 30 days in the hyperbaric chamber. His first visit was on April 1, and for the rest of the month Christian drove from his home in Story City to Boone.

“They were concerned initially about how I would react to the chamber because some people feel a little claustrophobic,” Christian remembered. “It is small, but it’s all glass so you can see out of it. You also have a television you can watch, so the whole experience was really pretty comfortable.”

Wound Care

Christian was also being seen weekly at the Mary Greeley Wound Healing Clinic where his skin flaps were monitored and properly cared for, oftentimes by Deb Beelner, CWCN, BSN, RN, Wound Healing Clinic coordinator.

“When Roger first started coming to the Wound Healing Clinic, it was right around the time COVID started,” said Beelner. “We had just put in visitor restrictions so Fran (Christian’s wife) wasn’t able to come in with him. We would oftentimes call her, and either I or Dr. Cain would talk her through what we were doing.”

It was this kind of care that the Christians appreciated.

“They made us feel comfortable and cared for, and they always explained things in a way that we could understand them,” Christian said.

After Christian’s time in the hyperbaric chamber came to an end, it was clear that the skin flaps were going to survive. He continued to visit the Wound Healing Clinic through the beginning of summer, and in June, once his skin flaps healed completely, he was given a clean bill of health.

Now, seven months later, Christian’s foot has healed. While walking feels a bit different, he knows that the outcome could have been far different had it not been for Cain, the Wound Healing Clinic, and the coordination with Boone County Hospital.

“I am so grateful for everyone who took part in the care I received,” Christian said. “Dr. Cain and all of the nurses were wonderful, and I’m so glad that I was able to receive such great care so close to home.”

Hyperbaric Oxygen Chambers Coming to Mary Greeley

In early 2021, Mary Greeley will unveil two hyperbaric oxygen chambers. Hyperbaric oxygen (HBO) therapy is indicated for 14 different conditions. Among them are crush injuries, gangrene, hypothermia, carbon monoxide poisoning, diabetic foot ulcers, and necrotizing fasciitis (flesh-eating disease). 

First used in the 1940s by the United States Navy to treat deep-sea divers with decompression sickness, also known as the bends, HBO therapy started being utilized for other conditions in the 1960s when it was found to be effective in counteracting carbon monoxide poisoning.

When a patient enters the hyperbaric chamber and begins treatment, it is sometimes referred to as “diving,” which is an homage of sorts to its first use in helping deep-sea divers.

During a “dive,” the atmospheric pressure is raised, which allows for the patient to receive 100 percent oxygen. The blood carries the extra oxygen throughout the body, infusing the injured tissues that need more oxygen so they can begin healing. Patients may feel pressure in their ears similar to when they are in the mountains or on an airplane, but swallowing or chewing gum will “pop” their ears back to a normal.

Nurses in the Mary Greeley Wound Healing Clinic have been trained in the use of HBO therapy and will serve as backups for a newly hired hyperbaric oxygen therapy technician who is also cross-trained as a paramedic. A patient in the chamber also has the ability to be supervised remotely by a physician as well as in-house staff.