The Protector
After a dog attack, a team at Mary Greeley helps save the arm of a heroic grandmother.
By Steve Sullivan
Hearing that low growl got Vilma Pankey’s attention. Hearing a little girl’s scream got her running.
The growl was coming from Pankey’s dog, Thurston, and the scream from her three-year-old great-granddaughter, Cheyera.
Pankey, a small woman in her 70s, immediately put herself between Thurston and the girl. What happened next would land Pankey in Mary Greeley Medical Center, where a team of people worked to save her limbs. Part of that collaborative effort involved Pankey being the first person at the medical center to receive hyperbaric oxygen (HBO) therapy, a highly specialized treatment for wounds.
Attack
Pit bulls have been popular with the Pankey family for a long time, and Pankey herself had even taken training for pit owners. There are stereotypes about the breed, though none of Pankey’s dogs had ever given her a problem until now.
Thurston, who had been a part of the family for six years, usually spent his day staring out a picture window at the rabbits bouncing around the yard of Pankey’s rural Ames home. So, it was a surprise when Thurston started acting aggressive toward Cheyera that January day. Thurston had been around the child before. He was protective of her and even slept on the floor with her.
“She loved him, and I think he loved her,” said Pankey.
Cheyera had just sat down in the living room with a lunch of apple slices and a turkey sandwich. Maybe it was the food that provoked the dog—who knows? When Pankey heard Cheyera’s scream and ran from the kitchen into the living room, she found Thurston threateningly standing in front of the terrified girl.
She called out for her husband, who had just returned home from a medical procedure. She then got in between Thurston and Cheyera, grabbing the girl by her arm and moving her to safety behind a chair.
That’s when Thurston leapt at her. Pankey instinctively raised her arm to protect herself and Thurston locked his jaws around her right arm.
“I was calm,” she said. “I never screamed. I just kept talking to him quietly, telling him ‘Thurston let go.’ He looked in my eyes as if asking me, ‘What am I doing? I’m biting my master.’ He knew he had screwed up.”
Her husband grabbed the dog, which pulled Pankey down to the floor—Thurston between them. She remained calm and told her granddaughter, Cheyera’s mom, to get a broomstick. Years ago, Pankey had taken a training class for pit bull owners. She learned to pry the mouth open, to literally unlock a dog’s jaw with a stick.
She pried Thurston off her arm and began to move away, but the frightened, confused dog clamped down on Pankey’s right leg. He eventually let go but not before doing more damage to his master. Pankey’s husband quickly pulled the dog into the garage and then released him into the fenced-in backyard. (Thurston, not surprisingly, had to be put down.)
Though bleeding, Pankey kept her cool while the ambulance arrived. A recent snow made her driveway impassable for the ambulance and she had to be carried out of her home in a blanket.
Saving Vilma's Arm
Pankey was brought to Mary Greeley’s Emergency Department with puncture wounds, skin tears, and broken bones in her right arm and leg. These were potentially limb-threatening injuries. In other words, due to the extent of the damage, amputation of her severely injured arm and leg was a real possibility.
Not long after arriving at Mary Greeley, she was in surgery.
Her right arm had clinical compartment syndrome, the result of the “crush injury” caused by the intense pressure from the dog’s jaws.
“This means there is bleeding inside the muscle compartment,” said Dr. Bryan Warme, McFarland Clinic orthopedic surgeon. “The bleeding can’t get out and that acts as a tourniquet on the arm, cutting off blood flow. She had really bad crush injuries and I had to go in and release the compartment to allow it to get blood flowing again.”
Warme performed a fasciotomy, which involves making an incision that cuts open the skin and fascia, the membrane that covers muscles, nerves, and blood vessels. Pankey had open compound fractures of both leg and arm and Warme had to extensively wash and debride the injuries to reduce the risk of catastrophic infection. He also splinted the broken bones in Pankey’s arm and leg.
Because of the extent and the cause of her injuries, as well as her age, infection was of significant concern.
Members of our Wound Healing Clinic’s hyperbaric oxygen (HBO) therapy team with the clinic’s two HBO chambers: from right, Mary Lynn Papin, family nurse practitioner; Jake Engelken, EMT, HBO technician; and Donette Tilley, RN, BSN.
Fortunately, Mary Greeley had recently expanded its Wound Healing Clinic services with the addition of two hyperbaric oxygen chambers. (Read more about HBO therapy below.) Typically, this is an outpatient treatment, but given the seriousness of the situation, the care team decided to use it for Pankey, an inpatient.
“The timing of the arrival of the chambers and the recognition of it being the appropriate treatment for her injuries was significant,” said Mary Lynn Papin, family nurse practitioner with the Wound Healing Clinic. “I thought about that every day we were treating her. Mary Greeley did the right thing.”
Hero
Pankey had wound vacuums, or wound vacs, placed on her arm and leg injuries. A wound vac covers and protects the wound. It removes air pressure from the wound, assisting in healing. It has several other benefits, including drawing fluid from the wound, reducing swelling, and helping pull edges of the wound together.
Injury to her arteries made Pankey a prime candidate for HBO therapy. Crush injuries are not unusual in Iowa, and it can take a long time for them to heal—many end up with amputation. HBO can provide immediate treatment that can help save a limb, such as in the case of Pankey.
To do the therapy, Pankey would have to spend extended periods of time in a large, clear chamber. The treatments are called “dives,” a reference to HBO as a long-standing treatment for decompression sickness that some people can suffer from scuba diving.
Pankey admits to being nervous about the treatment initially. She’d never heard of it before and she was concerned about feeling claustrophobic. Staff informed her that there would always be someone in the room with her, and that she would be able to communicate with people when inside the chamber. Her family urged her to try it.
“It was an emotional moment with her family,” said Papin, a certified wound ostomy continence nurse practitioner who has extensive experience with HBO therapy. “Her two sons were at her side telling her that she’s here at Mary Greeley and that there’s this new therapy.”
After displaying all that calm while under immense stress, Pankey was now feeling the pain of her injuries, and feeling afraid.
“I told her in that moment that she might have post-traumatic stress and that heroes always have it,” Papin said. “I really felt and reminded her often that we were treating a hero. Remember, she put herself in harm’s way to save her great-granddaughter.”
Into the Chamber
“When you are in the HBO chamber, you are in an oxygen-rich setting. There is no other environment like it,” said Papin. “It’s a pressurized, 100-percent oxygen environment, so your body is pretty much saturated with oxygen.”
This was just what Pankey needed. With a crush injury and compartment syndrome, HBO supplements oxygen availability to tissue that has been deprived of oxygen.
HBO also helped the wound fight infection prior to the skin graft surgery on Pankey’s arm, which was performed by Dr. James Partridge, a McFarland Clinic surgeon. He executed a split-thickness graft, which involves epidermis (skin) and a portion of dermis (the material just under the skin).
HBO therapy also reduces the risk of a reperfusion injury, which can happen post-surgery when blood flow is restored and tissues swell, potentially crushing damaged blood vessels again.
Pankey ultimately did five HBO dives, including one after the skin graft. She spent an average of two hours in the chamber for each treatment and was typically at what is called 2.4 ATA, or atmosphere absolute, which refers to the amount of pressure one would undergo at certain depths. A 2.4 ATA is the equivalent of being down approximately 40 feet in seawater.
“They told me they have this new machine, hyperbaric something, and it looks like a chamber and it will help heal your wounds,” said Pankey, who was an IT tech for the Iowa DOT for 30 years. “It sounded interesting to me, but I’d never seen it before. It was an experience I could never imagine. It made me feel really relaxed. The longer I was in it the warmer I felt. I fell asleep.”
Pankey spent almost two weeks at Mary Greeley and will make return visits to ensure her wounds are healing appropriately. Once healed, she may need Warme’s skill again to put in plates and screws on those broken bones.
Partridge and Warme are believers in HBO treatment. Pankey “is doing better that I ever expected,” said Partridge.
Warme is a believer in HBO treatment. He experienced it himself after a scuba-diving incident where his depth gauge broke and he needed to take steps to prevent decompression sickness.
“I believe in the science. It’s a good therapy,” he said. “We were doing everything we could for her, and HBO was part of it.”
Hyperbaric Oxygen Therapy
Mary Greeley’s Wound Healing Clinic now has two hyperbaric oxygen (HBO) therapy chambers, which significantly expands the clinic’s ability to do what it does best: heal wounds. But how does it work? Who is it for? What does it have to do with diving? To learn more, we turned to Mary Lynn Papin, family nurse practitioner with the Wound Healing Clinic.
How does HBO work?
Hyperbaric oxygen therapy has been used for decades to treat chronic wounds. The patient lies comfortably in the chamber, which is then pressurized to allow the patient to breathe 100 percent oxygen—compared to normal room air containing only 21 percent oxygen. This oxygen-rich environment allows the lungs to absorb greater amounts of oxygen, which is delivered by the blood to the wound or injured area, promoting stronger healing.
What are the benefits of the therapy?
Many people can benefit from HBO therapy, especially those living with slow-healing wounds. Hyperbaric oxygen therapy allows your blood to carry more oxygen to your organs and tissues to promote wound healing by stimulating the growth of new blood vessels, tissue, and skin. It also activates the white blood cells to fight infection and works with antibiotics to make them more effective.
What types of wounds or injuries can it typically treat?
HBO therapy is used along with other medical treatments for slow-healing wounds, diabetic foot ulcers, chronic bone infection, nonhealing surgical skin grafts and flaps, crush injuries, sudden loss of blood flow to an arm or leg, injury caused by radiation therapy such as pain, wounds, dental problems, rectal bleeding or blood in the urine, certain types of sudden hearing loss, sudden vision loss, and even frostbite.
How many sessions might a person need and how long do they last?
Most treatments last about two hours and are repeated daily (M-F) for 30 or more sessions. It depends on what type of wound or injury is being treated.
Some patients are going to be wary of therapy. After all, you are putting them in a chamber. How do you alleviate those fears?
We start with communication and walking patients through the journey before they are ever placed into the chamber. The chambers have clear acrylic walls, so they feel more open and comfortable. Our hyperbaric nurse and/or medical technologist are always close by and monitor the entire process. The staff communicates with the patient through a microphone, and the patient can relax and watch TV or movies or listen to music. It is not uncommon for patients to sleep throughout the procedure.
Mary Greeley has two chambers. How will that benefit our program?
The Mary Greeley Wound Healing Clinic is already an established clinic that has been providing excellent wound care. With the addition of the two HBO chambers, our patients can now receive the care they need without the time and expense to drive elsewhere. With two chambers, we can treat up to eight patients a day with HBO therapy.
What kind of training did our staff get/need to work with HBO? What is your background with the therapy?
The medical staff completed a 40-hour training program, which is recognized by the top two HBO research and membership organizations—the Undersea and Hyperbaric Medical Society and the National Board of Diving and Hyperbaric Medical Technology. I have three years of experience and 80+ hours of training in HBO therapy. It is a privilege to work with HBO therapy patients and watch them heal.
What is the basis for some of the terminology like “dive”?
When a patient goes into the chamber, we call it “diving,” and when they are done, we call it “bringing them up.” There is a historic reason for this. The United States Navy first used HBO therapy in the 1940s to treat deep-sea divers with decompression sickness. The pressures reached in the chamber are generally between one and a half and three times greater than normal air pressure, which simulates hyperbaric conditions under the sea—thus the term “diving.”
Is the service primarily for outpatient scenarios? Can it be used for emergency situations?
Mary Greeley’s HBO therapy is an outpatient service. Our clinic operates Monday through Friday and is not set up for 24/7 emergency treatment.
Is the treatment covered by insurance?
Medicare has approved HBO therapy for many types of chronic nonhealing wounds or injuries. Most private insurance companies also approve HBO therapy when indicated.
