Genesis Wound and Hyperbaric Institute Saves Patient From Lower Leg Amputation

We’ve all gone for a long walk, only to have the edge of a shoe rub against a heel and cause a blister.

Jim Keenan’s long walk caused an abrasion on his heel, too. His abrasion, however, quickly deteriorated into an infected wound that exposed his Achilles’ tendon, painfully persisted for two years and threatened the loss of his foot.

Healing the wound was complicated by his Type 2 diabetes and vascular problems in his legs.

When doctors in Iowa City suggested a lower leg amputation might be necessary, Keenan got another opinion. He found hope, compassion and stateof- the-art treatments at the Genesis Wound and Hyperbaric Institute, which saved his leg.

“After nearly two years, my wound has healed, and I feel very lucky,” Keenan of Bettendorf says. “I had a vascular surgeon and an orthopedic surgeon in Iowa City tell me that I was probably facing lower leg amputation. They didn’t think they could get the wound to heal before my Achilles’ tendon dried out, which just can’t happen.

“Without the clinical judgment and patience of Dr. Brad DeWall and the nurses at the Wound and Hyperbaric Institute, I faced some pretty disheartening surgery and significant life changes.”

More than two years ago, Genesis collaborated with Dr. DeWall and Dr. Richard Sadler, two longtime surgeons and wound care specialists who oversee the institute. The two co-medical directors brought hyperbaric oxygen therapy to Genesis. Wound care services in Pavilion 2 of the Genesis, West Central Park campus in Davenport expanded to make room for three hyperbaric chambers.

Today, the institute has approximately 800 outpatient visits and 250 inpatient visits each month. A second location opened at the Genesis, Illini Campus last fall, and an expansion currently is underway at the Davenport location to accommodate the institute’s growth.

Improving quality of life

Jim Keenan knows all too well the physical and emotional problems that chronic wounds can cause.

For two years, he was on multiple prescription pain-killers. At times, he was on powerful antibiotics to combat infection. Over the first 18 months of treatment, he was in a cast, walked on crutches, wore three different kinds of orthotics and eventually graduated to walking with hiking sticks. Even so, he couldn’t walk very far. He couldn’t ride his bike, swim, ski, dance or hike with his kids in the Grand Tetons, where they live.

The wound that began as a small abrasion consumed his life. “I wasn’t sure I would ever walk naturally again. I was discouraged,” Keenan says. “But I think Dr. DeWall and the nurses will confirm that I never lost my sense of humor, and I never lost my faith in their ability to heal my wound.”

He’s walking today because he walked into the Genesis Wound and Hyperbaric Institute on March 12, 2010.

Keenan’s troubles began when he returned from a long walk and noticed that his shoe had rubbed a small abrasion on his skin, just behind the Achilles’ tendon of his right foot.

“I thought it was no big deal and assumed it would heal on its own,” he recalls. “So, I continued to walk on it, and I literally went from an abrasion on my heel to a serious, infected wound in about five days. My primary care physician, Dr. Andy Edwards, sent me immediately to the Genesis Wound and Hyperbaric Institute but by then the wound was deep enough to expose my Achilles’ tendon.”

Keenan has had vascular problems in his legs for several years and numerous surgeries. His vascular history, along with his Type 2 diabetes, diminished his circulation, making it difficult for his body to deliver enough blood and oxygen to the tissues to heal his wound.

Keenan began wound treatment at the institute about the same time he connected with a new vascular surgeon in Iowa City. “My vascular surgeon, whom I trust implicitly, looked at the wound, became concerned and called in an orthopedic surgeon to look at my Achilles’ tendon,” Keenan recalls. “Both were concerned that I faced a lower leg amputation.”

Dr. DeWall wasn’t ready to accept amputation as the course of treatment.

“At Genesis, we consider amputation to be a ‘treatment failure’ -- not a ‘treatment option.’ Our goal is to save the extremity,” Dr. DeWall says. “We address many different types of wounds with a focus on safety protocols and quality outcomes for our patients.”

Many treatments

Keenan underwent a range of treatments, including specialized dressings, multiple bio-engineered grafts and 40 treatments in the hyperbaric chamber.

During hyperbaric treatment, he reclined inside a pressurized chamber of 100 percent oxygen. The painless therapy delivers high concentrations of oxygen to the bloodstream, accelerates wound healing, fights infection and stimulates the growth of new blood vessels to improve circulation. Wound and hyperbaric treatment is generally covered by health plans, including Medicare.

“I gained substantial, measurable improvement in the flow of oxygen to my feet and the hyperbaric treatment contributed significantly to my healing,” Keenan says. “I also got a two-hour nap in every day, which is a habit I would have cheerfully continued.”

Meanwhile, several more vascular procedures on Keenan’s legs helped improve blood flow to the wound.

Keenan says, “In the early months of dressings, grafts and hyperbaric sessions, Dr. DeWall said, ‘I will tell you when I think we’re over the crest and on the downhill side in healing this wound.’ I think it was more than a year before he finally said, ‘We’re going to get this handled.’

“I trusted his judgment and skill and appreciated his reassurance -- even if the news was discouraging. I sing his praises and the praises of program director Lori Riessen and the institute’s outstanding nurses. They all took a personal interest in me and my problem.”

With his wound now healed, Keenan looks forward to returning to the activities he has missed -- especially walking and biking and a little golf. “I thought I might never be able to do these things again. Now, I think I can,” Keenan concludes.