It was supposed to be a mother-daughter excursion in Omaha for shopping, girl time and a celebration of life.
Marthajane Bisenius didn’t know that she would come close to losing her life.
Marthajane, a 2nd grade teacher in Schaller, Iowa, had been looking forward to this outing for some time. On Wednesday morning, she picked up her daughter, Molly Sporrer, who lives in Odebolt, Iowa, and the two drove to Omaha.
It was a special day. Molly, who was pregnant with twins, had an appointment to have an ultrasound performed. It was Molly’s first pregnancy and Marthajane was excited to share this special occasion with her daughter.
After the appointment, they drove to the home of daughter and sister, Marge Bisenius, MD, where they would spend the night. They chatted with excitement about seeing the tiny twin fetuses in the ultrasound and eagerly mapped out their shopping excursion for the next day.
While getting ready the next morning, Marthajane noticed a small red patch just below her elbow. Strange, she thought — probably just a reaction to something in the environment. She showed it to Marge, who is a family practice physician at The Nebraska Medical Center. “We’ll have to keep an eye on that,” noted Marge.
The three shopped and laughed and shared lunch together before Molly and Marthajane started on their trip back home.
It wasn’t until the drive back that Marthajane noticed the patch near her elbow had grown in size. The quarter-sized patch was now the size of her fist. Her arm had also started to swell and had become very painful. Her face became flushed and she began to feel feverish, achy and flu-like.
She called Marge. Concerned, she instructed the two not to go home but to go straight to the emergency room (ER) in Storm Lake, Iowa.
The ER started Marthajane on antibiotics right away, took some blood tests and decided to keep her overnight. Plans changed quickly, however. Something wasn’t right, said Mark Schultz, DO, the doctor on call. He wanted to have the wound opened — a procedure he didn’t feel comfortable performing himself. So he suggested she be transferred to the hospital in Spencer, Iowa.
Late Thursday night, Marthajane arrived in Spencer. Orthopaedic Surgeon Phillip Deffer, MD, quickly took Marthajane to surgery, opened her wound, drained it and started her on two antibiotics. By Saturday evening, the red patch had begun growing again. Nurses came by every hour to record its growth by drawing lines on her arm with a marker.
Dr. Deffer arrived early Sunday morning to see Marthajane and told her that she had been on his mind all night. “Something wasn’t right,” he told Marthajane. He wanted to open up the wound again. By now, the red patch had traveled to her wrist and up her arm to just below her shoulder. When Dr. Deffer opened the wound, the flesh was gone. He could put his hand all the way up her arm if wanted to, he said. He confirmed that she had necrotizing fasciitis and recommended a speedy transfer to Omaha.
Necrotizing fasciitis, also known as the flesh-eating bacteria, is extremely rare. But it can also be extremely deadly. The infection spreads very rapidly and can overwhelm your body, says Jeffrey Cooper, MD, emergency specialist and medical director of the Hyperbaric Medicine Center at The Nebraska Medical Center.
The infection is caused by bacteria and can destroy skin, fat and the tissue covering the muscles within a very short time. About one of four people who get the infection dies from it. People at greatest risk of getting the infection include those who have a weak immune system; chronic health problems such as diabetes, cancer, liver or kidney disease; those who have recently had chickenpox or other viral infections that cause a rash; and those using steroid medicines, which can lower the body’s resistance to infection.
Marthajane had none of these risk factors. “This is not uncommon,” notes Dr. Cooper. “Many times we don’t know how a patient has contracted the infection.”
Dr. Cooper, an assistant professor for the Department of Emergency Medicine at the University of Nebraska Medical Center (UNMC), began his hyperbaric medicine experience in the navy where he was trained at the Navy Diving and Salvage Training Center. He served several years as an Undersea and Diving Medical Officer with the U.S. Submarine Forces and at the U.S. Naval Hospital in Guam where he treated many serious diving incidents. He recently completed further training in clinical applications of hyperbaric oxygen therapy (HBO).
Marthajane was flown by plane to The Nebraska Medical Center where she was immediately started on her first treatment of HBO under the care of Dr. Cooper. For the next week, she would receive a total of 10 treatments, beginning with two daily for two hours at a time. She was also taken to surgery where her wound was debrided and drained again.
Marthajane could have panicked. But instead, a surprising calmness overcame her. “It was a calming trust in the hospital, in the doctors who were treating me and the Lord,” says Marthajane.
HBO, which has been available at The Nebraska Medical Center since the mid 1980s, involves breathing 100 percent oxygen in a sealed chamber under pressure to treat a variety of disorders including carbon monoxide intoxication, decompression sickness, diabetic wounds, air emboli and life-threatening processes including gas gangrene and other necrotizing infectious wounds.
By delivering oxygen at one and one-half to three times normal atmospheric pressures, the therapy works by forcing more oxygen into areas that aren’t getting adequate amounts due to tissue damage or swelling. This increases the oxygen concentration in the blood and body tissues, which promotes healing. It also helps revive the immune system and helps the antibiotics work more effectively.
Because wounds heal from the inside out, the application of HBO can increase tissue oxygen levels and assist the performance of antibiotics by enhancing the bacteria-destroying capabilities of white cells.
Dr. Cooper says he and his team have treated anywhere from three to as many as 19 cases of necrotizing fasciitis in each of the past four years. Marthajane was their sixth patient so far this year.
“Often this infection has more to do with having a vulnerable host than the organism itself,” says Dr. Cooper. “I suspect we are going to be seeing more of this infection because we have more vulnerable people in our population — people who are diabetic, who have had transplants or are cancer survivors.”
As the week progressed and Marthajane’s HBO treatments continued, the infection gradually began to subside. After eight days of HBO treatment, doctors determined that they had beaten the infection and Marthajane could return home.
It wasn’t until Marthajane was home that she realized how serious her condition was. She had missed recent television reports about several people who had contracted the infection, one losing limbs and several nearly dying.
“Now I know how fortunate I am,” says Marthajane. “If I hadn’t been with my daughters that day, I am sure I would not be here today because I would have ignored it and tried to treat it at home.” That, combined with the quick thinking of the other doctors she saw during her ordeal, followed by HBO at The Nebraska Medical Center, gave Marthajane the best combination of circumstances for stopping the infection.
Although HBO has been a long-standing treatment for things like carbon monoxide intoxication, decompression sickness (the “bends”) and air embolism (bubble) in the bloodstream, it has been met with some skepticism as to its impact on treating other conditions over the years. But that is starting to change with more controlled studies that back its success.
“Over the last 20 years, it has become a more accepted and effective treatment for many types of acute and chronic injuries,” says Dr. Cooper. “We have much more scientific data and its uses are more clearly defined.” The U.S. Department of Health and Human Services has approved HBO to treat 12 conditions.
The Nebraska Medical Center is the only hospital with a 24/7 hyperbaric oxygen unit that can treat acute and critically ill patients in the area. These types of cases are responsible for nearly a third of the patients treated in the unit. Acute cases include patients with gas gangrene, necrotizing fasciitis, carbon monoxide poisoning, crush injuries to the limbs and those suffering from diving accidents. The unit now houses four one-person chambers.
“HBO is an adjunctive treatment that can change a person’s odds,” says Dr. Cooper. “It is most often used in combination with antibiotics and surgery, and if we see the patient early enough, it can stack the deck in a person’s favor. We’re seeing a marked reduction in morbidity and mortality in patients whom we treat. We’re seeing fewer complications and, in some cases, it can mean the difference between an amputation and saving a limb. The key to its success is getting the patient to us before things get out of control. HBO can salvage at-risk tissue, but it can’t recover lost tissue.”
HBO has also become an important therapy in treating hard-to-heal diabetic wounds, anemia and problem flaps or grafts from plastic surgery.
More recently, HBO is being used to treat the delayed side effects of radiation therapy by reversing the radiation-induced vascular injury to affected bone and soft tissues. During radiation, many of the smallest of blood vessels are destroyed, which then limits the access of ingredients necessary for healing such as oxygen, antibiotics, nutrition, vitamins and growth factors. Doctors are finding that the use of HBO after radiation can help improve healing and outcomes significantly. Head and neck surgeons at The Nebraska Medical Center have also seen success in promoting healing for various soft tissue and bone restorative and reconstructive procedures.
“The future of HBO is very promising,” notes Dr. Cooper. “We are finding all types of uses for it from cancer to cardiology and surgery and that is expected to grow.”
For Marthajane, it turned the odds in her favor for saving her arm and possibly her life.