By Roberto Hugo Gonzalez
Mega Doctor News
On August 30, 2015, Dr. Rafael Rafols, a specialist physician in non-healing wounds that utilizes hyperbaric oxygenation therapies, participated in the 2nd Wound Care Workshop presented by Solara Hospitals in the Rio Grande Valley. This workshop was a success with over three hundred attendees. Among them, nursing students, healthcare professionals, and others.
Dr. Rafols presentation was entirely dedicated to wound care and the topic of “Hyperbaric Oxygen and Difficult Wounds”.
It is important to emphasize that Dr. Rafols dedicates his time entirely to wound care and is among the best physicians in his field in the Valley.
“Hyperbaric oxygenation, known as HBO; no, HBO is not cable TV.” He continued, “It is exposure to oxygen under pressure greater than normal atmospheric pressure as a treatment given to patients who for various reasons need more oxygen. It is also called high pressure oxygenation.”
As Dr. Rafols was addressing the attendees he asked, “Did you know, that right now there is a patient somewhere getting an amputation either below the knee or above, in one of these hospitals? What I’m trying to do is point out this could be a family member, it could be my patient, or it could be a friend.”
He emphasized that the main purpose behind his presentation was to deliver the best treatment to prevent amputation. “But unfortunately, sometimes amputations are unavoidable. This is the purpose of this workshop, so I can tell you that prevention plays an important role.”
Dr. Rafols said that there are many tools to avoid amputations and one is the proper assessment and documentation of the case. He explained that one of the tools available to prevent amputations and heal wounds faster is hyperbaric. “When used appropriately it can help avoid costs by healing wounds faster.”
As he was addressing professionals and students, Dr. Rafols was aided by slides that illustrated his important presentation. He used before and after wound photos. He said that in order to apply hyperbaric oxygenation the patient is placed in a sealed enclosure called a hyperbaric chamber. Compressed air is introduced to raise the atmospheric pressure to several times the normal rate.
At the same time, the patient is given pure oxygen through a face mask. The increase in atmospheric pressure forces enough air into the patient so that the pressure within the body equals that in the hyperbaric chamber. Thus all the tissues become flooded with more than the usual supply of oxygen.
While the patient is in the chamber, pressure changes are controlled with extreme care to avoid injury to the lungs or other tissues.
According to Dr. Rafols, this treatment may be administered to patients suffering with different types of disorders in which the oxygen supply is deficient. If, because of injury or disease, the heart or lungs are unable to maintain good circulation and oxygenation, the increase in oxygen can temporarily compensate for this reduction.
Hyperbaric therapy causes the blood to circulate more of oxygen with its natural healing properties to the organs and tissues of the body promoting faster and more efficient healing of many diseases.
It is no secret that the Rio Grande Valley’s community and medical professionals are facing some of the most challenging times. Certain diseases like diabetes, stroke, heart disease, and cancer, to name but a few, are affecting this population in great numbers. That is why Dr. Rafols is an ardent believer in using preventive medicine and making every effort to spread the news of prevention.
Dr. Rafols is also knowledgeable in current technology that he uses effectively to treat patients with very difficult wounds. He told the audience, “I appreciate that you are here because this will open up your mind to other things out there in other fields of medicine.” He continued, “The take-home points, to understand what Hyperbaric Oxygen Therapy (HBO) is used for, and everything I’m going to discuss is based on guidelines from Medicare and Medicaid.”
During his presentation he gave a brief summary of how tools in his field of medicine have transitioned from rudimentary practices to very sophisticated technological equipment.
Dr. Rafols asked, “So, how did Hyperbaric get started?” he continued, “Humankind since the earliest beginnings has had an interest in exploring what’s out there.”
He said that Alexander the Great, back in 320 BC decided to explore the bottom of the ocean which clearly showed the thirst for knowledge. He used a bucket or some kind of device to go to the bottom of the ocean. “Obviously this device didn’t have any windows, it didn’t have any supplemental oxygen, so whoever got sent down there probably died,” he said.
Dr. Rafols said that that’s how things started and recognized the effort of many people who gave their lives to learn more. “It got started in diving, obviously,” he said.
It is well known by those in the field of wound care that in the 1600s, practitioners varied atmospheric pressure in attempts to heal. In 1662, a British clergyman named Henshaw could adjust pressure within a sealed chamber called a domicilium that he created. René Fontaine, a French surgeon, created a mobile chamber using the basic law of physics, (Henry’s law).
More than 200 years later in the 1900’s, Dr. Orval Cunningham observed that patients with cardiovascular disease who dwelled at high altitudes fared less well than comparable patients living closer to sea level.
In 1670, Robert Boyle observed how the eye of a snake could express a gas bubble visible through the cornea (the transparent outer membrane at the front of the eye). In 1845, Triger wrote about symptoms in coal miners consistent with decompression sickness.
In 1854, Pol and Watelle wrote that decompression was necessary for symptoms to develop and — perhaps most important — that recompression reduced symptoms. In 1876, Bert reported that nitrogen bubbles formed in tissue during rapid decompression.
Studies in the 1930s, suggested that supplementary oxygen could play an important role in treating decompression sickness. However, because oxygen could be explosive, three decades passed before equipment was developed that could safely handle its administration.
During the 1960s, studies began on a wide variety of indications for HBO therapy. During the 1970s, the practice of hyperbaric oxygen therapy experienced hard times because (a) more effective therapies such as cardiac surgery became available, (b) efforts to use it for various medical conditions proved unsuccessful, and (c) rogue physicians who were high-profile HBOT advocates damaged its reputation.
However, respectable practices have been defined and established through further research, the development of textbooks and scholarly journals, and the activities of professional associations such as the Undersea and Hyperbaric Medicine Society.
In the United States, strict standards related to construction and safety of hyperbaric chambers and facilities have developed and are enforced.
In March 2000, the American Board of Medical Specialties approved undersea and hyperbaric medicine as a subspecialty of both emergency medicine and preventive medicine.
Dr. Rafols is a Fellow of the Academy of Clinical Wound Specialists and a Certified Wound Specialist Physician by the American Board of Wound Management. He is board certified by the American Board of Family Medicine and an active member of the Undersea and Hyperbaric Medicine Society.
Dr. Rafols received his medical degree from the Universidad de Monterrey in Monterrey, Mexico and he attended the 5th Pathway Program at the Ponce School of Medicine in Ponce, Puerto Rico. He conducted his residency at the McAllen Family Medicine Residency Program in McAllen, Texas. MDN