Understanding Wound Care for the Elderly with Dr. Virendra Mehta and Dean Berthiaume – Connecting the Community

In this episode of Connecting the Community,Affinity Senior Care CEO, Chris Zayid, talks to Surgeon and Hyperbaric Oxygen Therapy Physician Dr. Virendra Mehta, and Dean Berthiaume, BSN, RN from Center for Wound Healing & Hyperbaric Medicine.

Watch the full podcast above or read the edited transcript below to learn more about wound care for Seniors and supercharging the wound healing process through Hyperbaric Oxygen Treatment.

In this episode, you will learn:

  • What is Hyperbaric Oxygen Therapy?
  • Who is a good candidate for this treatment?
  • How to prepare for the treatment?
  • What does a typical session look like?
  • Is it better than other treatment options?


Chris: Welcome to another episode of Connecting the Community podcast. We have two special guests today. I’m honored to introduce you to Dr. Virendra Mehta and Dean Berthiaume. Today we are going to be discussing a really important topic at the Wound Treatment Hyperbaric Center at the Beaumont Center in Dearborn, Michigan.

Let’s get to know these special people in our community that do amazing work here with wound care. Welcome to our show, I appreciate you and thank you.

Dr Mehta, please tell us how did you get started and what was your passion to be a physician?

Dr. Mehta: I was born in India and in India there are only three choices – either you become a doctor or engineer or an accountant. However, I felt like whatever I do I have to be close to God and serve the human race and so that led me to the profession of medicine.

I’ve been living in Northfield for the last 45 years and since then I have practiced in down river Hospital like Heritage, at present Beaumont Hospital in Taylor, and Westland in Trenton, and the Wyandotte hospital. I’ve been practicing for 42 years, but I have retired from a full-time practice for three-four years now.

Chris: Thank you for sharing that. What a journey you’ve had and I’m sure you give that to your patients too – a well-rounded experience about what you’ve done in your journey of life to learn and then I’m sure what they’re receiving is very valuable.

But you’re here for a reason though – how did you get into wound care?

Dr. Mehta: Over 10 or 15 years ago there was a course in Garden City Hospital Wound Care Center regarding a certification on Hyperbaric Oxygen Treatment and Wound Care and I attended that course for two or three days and got the certification.

Chris: So here you are! And obviously you work with a team here and Dean is very special and an important part of this clinic. I know Dean has been here for quite sometime and we’d like to learn more about you Dean.

You have your BSN and you’re a nurse and also a wound care specialist here. Tell us what was your passion to be a nurse and how’d you get here?

Dr. Mehta: I just want to add here. Dean has not only been a great nurse, but also sometimes he will update me on the things that I may not know about wound care or dressing because he always stays current in his knowledge.

Dean: I apparently come across as probably a neophyte as far as wound care compared to Dr Mehta – it’s the years of experience. But one thing that I actively try and do is still remain very Cutting Edge, looking at things like Wound Care. Medicine itself evolves, so we have to keep our finger on the pulse of the evolution of wound care and medicine. That’s really where I encourage a lot of our staff here to think outside the box, let’s look at ways of how we want to do this and one aspect of that is involving the patient in their own care. So, they’re not coming here and we’re not telling them to do things. We’re involved and we’re allowing them to be very involved with their care.

For me, I come from a family of doctors and nurses. I’ve always had it in my blood, I just didn’t know where my fit was at first. I originally started out in physical therapy, got exposed to wound care working in an inpatient facility, started working in sports medicine where we did a lot of outpatient wound care, and then decided, “you know what, I’m going to go into nursing. There’s a lot of opportunities, and if wound care is not my forte, after a while I’ll go off and do something else.”

But I caught the wound care bug and it’s stayed with me. I left it for some time, and I came back to it fortunately and this is where I want to be, this is where I feel like my greatest strengths come in and are able to be utilized in this arena.

Chris: I could tell the passion in your voice and what you do I think the clients need that, especially coming from the senior care world I see wound care is so important and working with the primary care doctors too.

What is Hyperbaric Oxygen Treatment?

I know a lot of people don’t know exactly what Hyperbaric Oxygen Treatment is. Can you explain it to us?

Dean: Yeah. Hyperbaric Oxygen therapy, we call it HBO, in layman’s terms it’s almost like a way for us to supercharge the wound healing process. We’re utilizing chambers that are sealed, and the individual is exposed to 100% oxygen, and the treatments typically last about two hours, and that is typically five days a week that they’re doing those treatments. The purpose of that is we’re actually creating a process called angiogenesis. It sounds like a fancy term but it’s basically we’re trying to establish some of those capillaries and some of that blood flow to help heal that wound.

Dr. Mehta: I just wanted to elaborate on the word angiogenesis. The general population may not to comprehend what is angiogenesis.

Angio means arteries, and Genesis means growth. The Hyperbaric Oxygen treatment, it really helps under the pressure of 2.4 to 3 atmospheric pressure, it really supercharges the battery of the regeneration of the tissue. Oxygen is carried not only by the hemoglobin in the blood cells, but the plasma is also a carrier. Like 800% of oxygen at a three atmospheric pressure, six milliliter of oxygen will dissolve in this plasma solution.

Now the blood has two components – blood cells and plasma and both are carrier for the oxygen, which is carried from the lungs to the heart or to the blood, and blood to the tissue where we need it.

The other effect of a Hyperbaric Oxygen treatment is vasoconstriction. It narrows the blood vessels too and that helps in other disease process. Now by narrowing the blood vessels you are relieving the swelling and edema of the tissue, but through the plasma the oxygen is going to the location of the wound.

The Right Candidate for the Treatment

Chris: Who’s the perfect candidate for this treatment?

Dean: We basically treat a variety; we typically say within about six different types of criteria as far as the conditions that we’ll treat. So, we could do anything from a surgical wound that needs to be treated with oxygen therapy to arterial wounds. We do Radiation type wounds as well, probably missing a couple.

Dr. Mehta: The Hyperbaric Oxygen treatment, the literature even says there are 132 indication of oxygen therapy. In California and big centers, they can entertain all these experimental ideas and explore other diseases, however at Bowman system we got three-four-five categories. Crush injuries, and then carbon monoxide poisoning – smoke inhalation and so forth. And the other is the skin flaps grafts.

Chris: Let’s dive into that. What exactly are skin grafts?

Dr. Mehta: Skin grafts, so they’re like composite skin graft, full thickness skin graft, and partial thickness skin graft, but mainly the full thickness and the composite graft or rotation graft, because many people who are in nursing home laying in the bed, or the patient who is sitting in the wheelchair, constantly the pressure, necrosis causes damage of the tissue skin, and such people also have a lot of infections.

Chris: So, the skin grafts – does that apply to a diabetic patient? What type of diabetic conditions do you see and treat here in the clinic?

Dean: We’re going to see the downside of what diabetes causes, we’re looking at possible amputations, we’re looking at complications due to diabetes like impaired blood flow. Oftentimes we’re seeing patients who may have had amputations of toes, sometimes other limbs as well. So, what we’re doing is we are utilizing the oxygen therapy to help heal that wound whether it’s through a flap procedure, like a graft type procedure, or a surgical type wound that needs to have that kind of Turbo boosted oxygen therapy.

Chris: Is there any advice you would give to a diabetic patient who doesn’t have a wound, but just to prepare themselves for a lifestyle managing this disease.

Dean: Absolutely! Education is a big part of what we do here. It’s about monitoring, diet is a big part of it. I think we use the word compliance quite consistently here, that’s a big part of it. We try to instill what education we can. We’re always giving them tools in order to prevent further complications due to it.

Prepping for the Treatment

Chris: How would you prepare somebody coming in for a treatment?  What are the steps to follow prior to the appointment?

Dean: Fortunately, we do that through our intake. We actually set aside time when they are here to meet with the physician. We set time with them for at least an hour to go over all those steps, make them aware of all the issues that they may experience, any questions. We allow them to have that conversation with us so that we can put a lot of those anxieties to rest.

Chris: Insurance and Primary Care doctors are involved in this right; they have to get it covered before they come for the procedure. How is that process – dealing with their primary care doctor, writing a script, and getting it covered by insurance?

Dean: What the primary care doctor would do is send them to us, we would vet all that, we would make sure we have a team here that looks into that – the insurance, make sure that all the indications are checked off, and then we submit that to Insurance. Insurances typically are able to approve it at that point and then we work consistently with the primaries, we work with other physicians, endocrinologists, orthopedic doctors if we need to, so everyone stays in that plan of care.

Chris: General Surgeons. So, any DoMD can refer to you guys, if they feel it’s out of their scope, and that wound needs to be healed.

Dean: Absolutely!

Chris: How about home care? Do you work with home care companies?

Dean: Yeah, we have some great home cares that we have been able to forge some good relationships with and I think having a good network and a good team is very important and ultimately it’s about arriving and giving a good plan of care for that patient and healing that individual.

Chris: Clients that live at home, they’re Homebound, and then the nurse goes out and they do the treatment, but they’re communicating with you and the physician in the office. The goal is to heal the wound.

Dean: Absolutely! Ideally, and that’s kind of the atmosphere that we’ve wanted to set here, is have that transparency. So through with all us practitioners, we’re able to stay in the loop as far as how that patient is healing

Chris: Order the supplies, make sure it’s in the home.

Dean: Yeah, most definitely.

Chris: And then, if they can’t transport, then bring them here.

Dr. Mehta: So, there are two aspects – hyperbolic oxygen treatment and before that a conservative line of treatment. In that you are trying to clean the wound, try to establish proper circulation, establish proper nutrition of the patient, change of dressing daily and so forth. These things need to be done, you cannot just go, “I’ll try the hyperbaric oxygen treatment.”

Chris: There’s got to be a pre-qualifying process.

Does a patient have to change their primary care doctor to come here for this treatment or can their doctor stay in the loop of things?

Dr. Mehta: No, they don’t have to change their doctor. Hyperbaric Oxygen treatment is an avenue where everything else has failed.

The primary care doctor is sort of the person who turns the key on, they are the one going to write an order and that has to be executed. Without that order I can’t as a patient say I need hyperbaric oxygen treatment. It won’t be possible. It has to start with a primary care doctor.

FAQs About a Typical Session in a Hyperbaric Oxygen Treatment Plan

Chris: Dean, let’s talk about a typical session. I know that there’s many different scenarios family members face when they come in here. However, there’s like some questions I know that they ask you, such as, how many sessions they actually have, and also what are they going to go through from the point they walk in the door and get into the treatment center.

Dean: That’s a typical conversation we have with just about every patient that comes in as a candidate for HBO. Some concerns may be, what’s my transportation, what’s my time commitment, how long is this going to take to heal. Unfortunately, we can’t look into a crystal ball and tell you – that’s going to be six to eight weeks or whatever that is. But what we do is, we educate them on – when they come in, we can provide transportation to them, they would arrive at a scheduled time. Usually, they have that time slot every day for five days a week. The actual treatment itself is two hours, that’s in a chamber. When we say a chamber, we’re not talking about an enclosed chamber. It is open, they do have the ability to see around. The other thing that they’re going to be able to do is actually catch up on their Netflix or any other TV programs because we provide that service to them. So, they’re able to watch movies, they can take naps.

I always tell everyone it’s a wonderful time to get two hours away from family and friends and phone calls and everything else. It’s a time for them to focus on their regeneration and their healing.

Chris: You said two hours.

Dean: Yeah, about two hours. We typically start out at about 30 treatments. Depending on how the wound is progressing, if it’s healing, if we’re making good progress, then they are re-evaluated, and we would approve them for an additional 30 visits at that point. Someone could actually be done within 30 visits, 60 visits, it could go up to 120 visits. Insurance obviously dictates a lot of that, so we have to show some progression of that wound healing.

Dr. Mehta:  And the sessions which you talk of – 30, 60, or 90 – they’re all being designated with the notion what disease process you’re treating. Are you treating just diabetic wound, are you treating some carbon monoxide poisoning, or you’re treating some thermal burnings, or you’re treating and necrotizing soft tissue infection, because necrotizing soft tissue infection may take longer time while carbon monoxide may take short time.

Chris: It depends obviously on what type of procedure they have, but that’s the thorough process that you go through, way before they come in. It’s a pre-qualifying process to understand first, so that way, you can come up with a game plan.

Dr. Mehta: The Hyperbaric Oxygen treatment is not a slipshod, one day job. It’s going to be a slow process, it is very slow, it takes time, at least 30 sessions and maybe more.

But since 1937 when HBO started in America and all over the world, it has been flourishing, not only from an economical point of view, but patient care.  And the most important thing is, we always care about the safety of the patient. That is of prime importance, irrespective of what happens or not. Because when you’re going in a chamber you have to be careful that they don’t take anything, to prevent an explosion.

The other thing is, that each session is for two hours, but you have to give air break after 45 minutes,  and then another 45 minutes. Because by doing air break, you reduce the threshold for seizures and convulsions.

Chris: I never thought of it that way. That’s why we come here to see you.

Dean: And Dr. Mehta brought up some good ideas, there are some good points, contraindications, risks, side effects.

Dr. Mehta: Also, there is no Hyperbaric treatment for untreated pneumothorax. HBO treatment will be a killer in this case. So, you don’t give the treatment. The reason you don’t because it creates more tension in the area where the lung is being pressured.

Chris: With COPD (Chronic Obstructive Pulmonary Disease) clients you have to be careful.

Dr. Mehta: Yes. Because COPD has a lot of emphysematous blebs* (Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. *Info Courtesy: Mayo Clinic)

So, they have to be taught how to breathe when coming out of the depths, and if they hold their breath they can explode like a balloon and that can create problem. So, these are very important.

Chris: Thorough health evaluation before they even have the procedure.

Dr. Mehta: You do chest x-ray, you do cardiograms for all above the age of 65, you do peripheral vascular studies for the treatment of leg ulcers.

Is Hyperbaric Oxygen Treatment a Better Option?

Chris: This is a really important question. A lot of people want to know why is this treatment better than all the other treatments that a physician can handle in their office.

Dean: HBO, Hyperbaric Oxygen therapy is an adjunctive therapy that we utilize and when we’re able to increase the oxygen in the blood we’re able to help facilitate more rapid wound healing that way. Not everyone is a candidate for it, so obviously there’s a lot of things that we have to look at to make sure that they are a candidate for it. But it would be a disservice not to have that ability to add that in addition to the wound healing process.

Chris: We want that blood to go to the location for healing, right.

Dean: Absolutely! It’s like planting a flower, putting it in a beautiful nutrient soil, but we don’t water it. So, we want to make sure that we’re giving it everything that we can and adding in that extra fertilizer and making sure that that’s going to be able to heal.

Chris: What makes this treatment different than all the other treatments?

Dr. Mehta: I would not say it’s better or worse. The point is that there is a whole spectrum of treatment for wound care. To start with, you cannot just think Hyperbaric Oxygen treatment. You have to treat all the other related causes of the ulcers or the wound or infection – antibiotics, cleaning up the wound, nutrition. Because that’s what’s going to help if oxygen has to be given.

Chris: Do you have a Nutritionist on staff here?

Dr. Mehta: There is a hospital nutritionist, a dietitian is there.

Chris: I just wanted to make sure that everyone knew that this treatment never replaces your physician, but if you do have a wound, it’s good to ask them for a referral.

I fear for my mom every day. She has diabetes and she bumps herself, because I know that she won’t heal well. She has to watch herself all the time. She’s in her 70s, but she needs to know that she has to have a healthy lifestyle in order to be able to receive this service. You don’t want to be denied because you’re losing an opportunity. It’s got to be a blessing to be able to be qualified.

Dean: It’s a gift to be able to have that option.

Chris: As a closing statement I just want to say, I know how valuable it is to be able to just learn about this type of treatment.

If you had to give one tip to the public about how they could prepare themselves, have a healthy lifestyle, and prevent a wound.

Dr. Mehta: The wounds are created because of the other social problems. We are creating this problem. Not only diabetes per se, but smoking, drinking, not properly exercising, your legs are swollen, and then accidentally you damage your skin, or scratch, because in diabetic patients they can’t heal easily.

It’s like putting fuel to the fire. One thing leads to other and now we have to retrace all your steps back and try to correct all this problem, but unfortunately it may also be too late.

Chris: Dean, what kind of advice would you give to everyone about having a healthy lifestyle and trying to prevent wounds.

Dean:  We can help in the wound aspect of it, but when it comes to health, we have to be their health coach and we have to allow them to make those decisions and give them the education in order to do that. We can’t assume that everyone knows how to take care of their health and what they need to do and how to eat properly. But hopefully our job is we can instill those tools in them and allow them to get a better understanding.

Chris: If you have any questions or you’d like to learn more about the Hyperbaric Oxygen facility here in Dearborn, Dr. Mehta and Dean are always available.

Thank you for joining us here at our podcast show. I know this information will be super valuable for anyone who needs to learn more about wound care for themselves or for their parents.