Hyperbaric Medicine Center During the Actual Questions About the Treatment Process Are Treatment Process, for All Patients’ Confidentiality, No Always Welcomed

Patient Label / Name

HBO - HYPERBARIC OXYGEN PATIENT EDUCATION - Page | 1

FAQs  HBO is a medical treatment which enhances the body’s natural healing process by inhalation of 100% oxygen in a total body chamber, where atmospheric pressure is

WHAT IS HBO? increased and controlled. It is used for a wide variety of treatments usually as an adjunctive part of an overall  HBO or HBOT stands for: Hyperbaric Oxygen Therapy medical care plan that can be done on an inpatient or WHAT DOES IT DO? outpatient basis.

 HBO or HBOT, simply, HBOT is a means of providing WAIT! CAN YOU TELL ME MORE ABOUT THE additional oxygen to your body tissues. “ENTIRELY CLOSED PRESSURE CHAMBER”? HOW DOES  IT WORK? Your entire body will go in a closely monitored, TRANSPARENT, 100% ACRYLIC topped, sealed chamber.  By exposing the  Most patients have plenty of room to get comfortable entire body to and can enjoy their 1.5-2 hour treatments while watching oxygen under TV (installed on each chamber with internal speakers) or increased napping. atmospheric  A highly qualified Hyperbaric Tech will be in the room pressure. with you at all times during your treatment, and you will be closely monitored before, during and after all HBO  The patient is entirely enclosed in a pressure chamber Treatments. breathing 100% oxygen (O2) at greater than one atmosphere  HBO Chambers have microphones that allow your HBO (atm) pressure. Tech to hear you without need to push any buttons. SO, HOW DOES THAT HELP? Simply call out and you will be heard. If you should need to cut your treatment short or want to get out at any  HBO therapy serves 4 PRIMARY FUNCTIONS: time, your HBO Tech is always right there to safely decompress the chamber and help you out and call for 1. It increases the concentration of dissolved OXYGEN in the transportation. blood, which augments oxygenation to all parts of the body; 2. It replaces inert gas in the bloodstream with OXYGEN, which is then metabolized by the body; 3. It may stimulate the formation of a collagen matrix and angiogenesis; 4. It acts as a bactericide for certain susceptible bacteria.

SO, WHY AM I JUST NOW GETTING HOW DO I KNOW IF I QUALIFY FOR HBOT? EVALUATED FOR THIS MIRACLE TREATMENT??  A HBO Specialist (MD/PA) has been consulted to do an evaluation and will help determine if you are a good  Hyperbaric oxygen therapy (HBOT) is an ADJUNCTIVE candidate. If you meet Clinical Criteria (& your 3rd (complementary or secondary) treatment that does not Party Payor -CMS/Insurance allow) without significant replace standard medical care you should have already contraindications, then you will be scheduled for HBOT. received. HBOT is usually only indicated when standard treatments have failed, and when patients meet specific criteria.

IS HBO FOR ME? DO I HAVE ONE OF THE 15 OK – SO, TELL ME MORE ABOUT THE “ALLOWABLE” DIAGNOSES FOR REASONS WHY HBO MAY NOT BE FOR ME? TREATMENT WITH HBOT? ABSOLUTE NO-NO’S / CONTRA- From CMS NCD 20.29: At this facility and others like it, of the 15 total diagnosis, INDICATIONS: that have been primarily designated as “Non-Emergent HBO Therapy” by CMS are considered reasonable & necessary:  Untreated Pneumothorax (Lung Collapse) & 1. Spontaneous Pneumothorax - who meet the following 3 criteria:  Even with surgical tacking / pleurodesis, this is still considered a contraindication in the monoplace chamber, but a) Patient has Diabetes Type I or Type II and has a lower is “relative” in a multiplace where needle decompression of extremity wound THAT IS DUE TO DIABETES the chest can be performed. 50% of patients with spontaneous pneumothorax have a recurrence. An “absolute b) Patient has a wound classified as ≥Wagner Grade III contraindication” for SCUBA diving. History of “disserved” for ≥30 DAYS. pneumothorax is acceptable for HBO treatment. Absolute contraindication in a monoplace. “Relative” contraindication c) Patient has failed a course of standard wound therapy in a multiplace for ≥30 DAYS.  Untreated, On-going Seizures

 Untreated, Decompensated CHF with an EF <30% 3. unresponsive to conventional medical and surgical  Adriamycin (Doxirubicin) management, treated before.  87% mortality when Adriamycin was used with HBO 4. , as an adjunct to exposure in animal model (Upton, 1986) Potentiates oxygen- conventional treatment. free radicals with HBO. Delay HBO for at least 7 days (6 half- lives). 5. as an adjunct to conventional treatment.  Bleomycin  “Antibiotic” w/ antineoplastic activity. Used for head & neck 6. only as an adjunct to conventional tumors, lymphomas, and testicular tumors. Case reports therapy when the disease process is refractory to suggest that even modest increases in FIO2 to 32% or 45% antibiotics and surgical treatment. during surgery months or yrs following Bleomycin produce severe interstitial pneumonitis. Any history of exposure to 7. ACUTE CARBON MONOXIDE INTOXICATION this drug should be considered a contraindication Scuba Diving also contraindicated if prior exposure to bleomycin 8. DECOMPRESSION ILLNESS  Cisplatin / Carboplatin 9. GAS EMBOLISM  In animal models, the breaking strength of wounds is diminished in the setting of HBO + Cisplatin Nemiroff P. UBR 10. GAS GANGRENE 1988) Elapsed time from last drug use to HBO exposure 6 half lives ~ 99% elimination. 11. ACUTE TRAUMATIC PERIPHERAL ISCHEMIA.

12. CRUSH INJURIES AND SUTURING OF SEVERED LIMBS.  Disulfiram (Antabuse)  Blocks production of Superoxide Dismutase, which protects 13. PROGRESSIVE (ACUTE) NECROTIZING INFECTIONS against oxygen toxicity. HBO is contraindicated if multiple (NECROTIZING FASCIITIS) sessions required (Seizure risk). Single exposure for CO tx probably acceptable 14. ACUTE PERIPHERAL ARTERIAL INSUFFICIENCY  Mefanide (Sulfamylon) 15. CYANIDE POISONING  Carbonic anhydrase inhibitor. Increased risk of Seizure

RELATIVE NO-Nos / CONTRA-INDICATIONS:  These complications are incredibly rare but can be quite serious, particularly if not recognized. CHF, Congestive Heart Failure Pneumothorax History, Risk & CPR  Patients with any history of CHF should have a baseline echocardiogram before HBOT  Tension pneumothorax for pts who were comatose &  Caution should be taken in patients with a low ejection intubated post CPR is associated with HBO therapy. In those fraction (EF) (i.e., <40-45%). cases, the incidence of Tension PTX rose to 12%. It is unlikely  Patients with very low EF will likely need a CARDIOLOGY that the benefits of HBOT will outweigh the risks in an LTAC CLEARANCE prior to HBO. setting, but each case will be looked at individually.  Untreated, Decompensated CHF with an EF <30% cannot go in History Of Thoracic Surgery the chamber.  Patients should be careful to avoid fluid overload before  Air trapping lesions w/ thoracic surgery, such as: HBOT and report it to their HBO Team before treatment pneumonectomy or thoracoplasties are a concern. should it develop.  Mild cases of air trapping can be treated successfully with HTN, Uncontrolled HIGH Blood Pressure slow depressurization (ascent rates 1 psi/min).  However, more significant air trapping in the lungs or  Blood Pressure should be well controlled. anything that leads to pulmonary over-pressurization – as  Blood pressure effects of HBOT can cause a temporary already discussed, can lead to alveolar rupture. increase in both systolic (SBP) & diastolic blood pressure (DBP). This holds true for both hypertensive (HTN) & non- Obstructive Lung Disease (COPD, hypertensive patients, but more so in HTN. EMPHYSEMA, OSA)  HTN Rxs: Calcium channel blockers & beta-blockers are known to exacerbate HBOT effect on blood pressure.  The risk for PULMONARY BAROTRAUMA (PBT) is  Confinement Anxiety & other factors, like wound related pain, essentially zero for patients with normal lungs and an open can add to this phenomenon. glottis. Acute upper respiratory infection  However, the risk does exist for PULMONARY  Before HBO, if possible, mild symptoms should be BAROTRAUMA (PBT) for patients with asthma or chronic controlled with a regimen of decongestant nasal spray, obstructive pulmonary disease [COPD] with active antihistamines, and/or steroid nasal spray just before bronchospasm, mucous plugging, and bullous lung disease. These diseases can lead to PULMONARY OVER- compression. PRESSURIZATION aka lung over-inflation from air  PULMONARY BAROTRAUMA (PBT), [which just means trapping during decompression. DAMAGE = trauma TO THE LUNGS = pulmo RELATED TO PRESSURE = baro]; risk in patients with moderate – severe URI  CXR (Chest X-Ray) +/- Chest CT Scan will be needed to screen symptoms are likely too high for the possible benefit. for PULMONARY LESIONS.  …During depressurization (Ascent at end of treatment), an . IF any significant PULMONARY LESIONS such as acutely ill patient with Moderate to Severe URI or any of the blebs are noted on CXR or CT scan or positive evidence following: for air trapping- it MIGHT be possible to treat with . Severe bronchospasm slow ascent rates of 1 psi/min. . A closed glottis from coughing fit . A closed glottis from seizure  Asthma  May be helped by bronchodilator prophylaxis . Holding their breath  …Can cause PULMONARY OVER-PRESSURIZATION Implanted Medical Devices which can then lead to alveolar rupture. In layman’s  Special consideration needs to be given to any implanted terms: Doing these things at the end of HBO Treatments devices a patient may have, as not all are pressure tested. This will increase the pressure in your lungs, while the pressure includes pacemakers, defibrillators, LVADs, among others. In in the chamber goes down, causing your lungs to possibly addition, external breast prosthesis, Pain & Insulin Pumps, over-inflate and “pop”. Penile (pump) implants or orbital prosthesis can be affected or  The resulting complication depends on where the damaged escaped air escapes to, [whether the mediastinum  Any surgically implanted medical devices that are not cleared (pneumomediastinum), the visceral pleura by the Hospital’s Designated HBO Safety Director as HBO (pneumothorax), or the vasculature (arterial gas Compatible cannot go into the Hyperbaric Chamber. Most embolism)]. medical devices have been tested at 2.0-2.5 ATA, but still require clearance to be used in the HBO Chamber.

WHO MAKES UP THE HYPERBARIC STAFF? WHAT QUALIFIES A PHYSICIAN OR NPP TO BE A HYPERBARIC SPECIALIST? Your HBO MD (DOCTOR) is: Dr. Shahe E. Vartivarian, MD Any Physician or NPP supervising Hyperbaric Oxygen Therapy must be certified in Hyperbaric Medicine by the Your HBO NPP American Board of Emergency Medicine (ABEM), the American (PHYSICIAN Board of Preventive Medicine (ABPM) or the American ASSISTANT) is: Osteopathic Conjoint Committee of Undersea and Hyperbaric María Castro Calzada, Medicine (AOCUHM) or other entity adopting a Hyperbaric PA-C, CHT Medicine training protocol. CAN MY PODIATRIST ALSO BE MY HBO SUPERVISING PHYSICIAN?

 CMS allows for Limited License Providers to supervise hyperbaric medicine services, however, they must have an unlimited licensed physician immediately available to render assistance if needed. Therefore, the answer is sometimes, in some locations, Podiatrists (in partnership with ER Physician Staff or other unlimited licensed physician) can supervise your HBOT. WHAT DOES IT MEAN TO HAVE A SUPERVISING PHYSICIAN OR NPP? The Rest of the TEAM:  Supervising Hyperbaric Specialist Physician & NPP - “Non- Physician Practitioner” (PA and NP), who come from various medical  HYPERBARIC TECHNICIANS (HTs AND CHTs) or surgical specialties, but have later undergone added training to have  MONICA LAWRENCE is Lead HBO Tech at Kindred specialized, unique education and certification in Hyperbaric Medicine Sugarland (and ACLS).

 It means that, according to CMS (Center for Medicare and Medicaid  SAFETY DIRECTOR Services’ National Coverage Policy (Also see Title XVIII of the Social  AILEEN Corros is Nurse Supervisor for HBO Security Act and Title 42 Code of Federal Regulations), with every HBO &Wound Care & Safety Director at Kindred Sugarland Treatment or “Dive” there MUST be a qualified Physician or NPP providing direct supervision who is immediately available.  SUPPORT PERSONNEL  All potential treatment of medical and surgical emergencies arising  Wound Care Techs, CNAs, MAs, PCAs all assist with from HBOT must be within the scope of practice of the supervising vitals, pre and post treatment evaluation and physician / NPP providing direct supervision and the supervising transportation physician / NPP must be ‘immediately available’. WHAT DOES ‘IMMEDIATELY AVAILABLE’  Receptionists, Administrative Assistants assist with REALLY MEAN? scheduling and insurance verification

 In order to satisfy the ‘immediately available’ criteria, CMS states,  Program Directors and other Hospital Staff and “for HBO therapy performed in an outpatient hospital, on-campus or Administrators. off campus provider-based department, the physician / NPP must be present in the HBO / Office Suite OR at any location with a maximum  In addition to the hyperbaric staff you will continue to of a five (5) minute response time to the chamber throughout the HBOT see your Primary Care Physician and your wound care session” specialist as well.

STUFF YOU NEED TO KNOW:  HBO TREATMENTS ARE CUMULATIVE AND WORK BEST A WORD ABOUT INSULIN: ONLY WHEN ALL 5 TREATMENTS ARE COMPLETED EACH WEEK. 1. DO NOT ALLOW ANYONE TO GIVE YOU ANY  REPEATED MISSED TREATMENTS / NON-COMPLIANCE MAY SHORT-ACTING INSULIN 2-4 HOURS BEFORE THE CAUSE YOUR TREATMENTS TO BE DISCONTINUED OR START OF YOUR HBO TREATMENT … AND YOUR MEDICAL COVERAGE TO DENY COVERAGE FOR THE PROCEDURES. 2. EAT A GOOD MEAL BEFORE YOUR HBO  PLEASE NOTE: SOME HBOT TIMES MAY BE SHORTENED / TREATMENTS (ESPECIALLY IF YOU ARE TRUNCATED DUE TO CIRCUMSTANCES BEYOND OUR DIABETIC).  CONTROL, SUCH AS LIMITING RESOURCES (HIGH PATIENT CENSUS, STAFF AND CLINICIAN SCHEDULING CONSTRAINTS). WHAT TO BRING:  MOST 3RD PARTY PAYERS, (MEDICARE & COMMERCIAL), LIMIT HBO TREATMENTS TO #60 MAXIMUM ALLOWABLE  Outpatients: any PRN / “as needed” medications DIVES IN A 12 MONTH PERIOD OF TIME, FOR MOST like AFRIN nasal spray, anxiety medications, DIAGNOSIS - MIRRORING CMS GUIDELINES. insulin (after treatment ONLY), blood pressure  YOU HAVE THE OPTION OF DECLINING HBO TREATMENT medication, pain medication, etc. ALTOGETHER, IN LIEU OF A SHORTENED HBOT TREATMENT.  Diabetics: Glucose tablets or food or juice if you  MOST SHORTENED HBO TREATMENTS ARE REDUCED BY NO know your blood sugar won’t be 120 before HBO. MORE THAN 20 MINUTES (90’ -- > 70’ AT DEPTH).  You will be given a hospital approved HBO gown  HOWEVER, THERE ARE NO GUARANTEES THAT DECLINING or scrubs, daily; 100% cotton undergarments (bras A SHORTENED HBO TREATMENT, WILL ASSURE THAT : A. -FUTURE HBO TREATMENTS WOULD STILL BE INDICATED and underwear only) may be worn under your gown B. -FUTURE HBO TREATMENTS WOULD STILL BE AUTHORIZED or scrubs. BY YOUR 3RD PARTY PAYOR C. -WOULD RESULT IN A BETTER, OR WORSE, OUTCOME. WHAT NOT TO BRING: WHAT HAPPENS ON MY DAY OF TREATMENT? THESE ARE NOT ALLOWED IN THE CHAMBER: You will receive HBOT once a day; Monday through Friday. Each HBOT treatment lasts approximately 2 hours. Your  NO street clothes will be allowed in the chamber. scheduled treatment time may change during the course of  NO pantyhose, slips or camisoles. your treatments; however we will do our best to meet your  We strongly recommend you NOT bring any schedule. valuables with you (expensive watches, jewelry, Compliance with HBO Treatments is CRITICAL to your and large amounts of money). treatment response. The GOLDEN RULE:  NO: Jewelry, hard contact lenses, watches, rings BE READY TO GO TO HBO  NO: newspapers, magazines, books, wigs, hairpieces EACH DAY THE HBO STAFF WILL TAKE YOUR VITAL  NO: prosthetic devices, dentures, hearing aids, SIGNS. IF YOUR BP IS TOO HIGH, MAX OVER 180/90, WE WILL NOT START HBO. TAKE BP MEDS AS ORDERED BY pagers, cell phones YOUR PRACTITIONER.  NO: lighters, matches, hand warmers IF YOU ARE DIABETIC, PLEASE EAT PRIOR TO  NO: alcohol, freshly painted fingernails (must ARRIVAL. wait 24 hours or longer) or petroleum products. BLOOD SUGAR LEVELS WILL BE TAKEN DAILY BEFORE AND AFTER EACH TREATMENT. YOU WILL NEED TO WASH OFF ALL: YOU MAY NOT BE ALLOWED TO START HBO TX  Hair products, make-up, perfume, cologne, UNTIL YOUR BLOOD SUGAR LEVEL IS AT OR ABOVE lipstick, creams, salves, oils, etc. 120.

WHAT WILL I FEEL DURING MY TREATMENT? 1) TAKE A BREATH, PINCH OFF YOUR NOSE WITH YOUR FINGERS AND CLOSE YOUR MOUTH.  At the start of your treatment, during the pressurization (descent) of 2) PLACE YOUR TONGUE AGAINST THE ROOF OF YOUR the chamber, the air will be warm due to the compression of molecules MOUTH. in the air. This is completely normal, if you feel extremely hot let the 3) SIMULATE BLOWING YOUR NOSE WITHOUT BLOWING AIR hyperbaric technician know. INTO THE CHEEKS OF YOUR FACE.  During descent you will also feel pressure in your middle ear and will have to manually force air back into your middle ear; we call this the 4) IF DONE PROPERLY YOU SHOULD FEEL MOVEMENT OF Valsalva Maneuver. YOUR EAR DRUMS (LIKE A “POPPING” IN YOUR EARS).

 If you HELPFUL HINTS TO KEEP INNER EARS PAIN FREE: experience  Keep your head level while performing the Valsalva Maneuver. any pain let your DO NOT tuck your chin to your chest. hyperbaric  Sometimes stretching your neck from side to side while technician performing the Valsalva Maneuver aids in clearing your ears. know  Sometimes patients find it helpful to yawn, mimic chewing immediately. and/or swallow frequently during descent to help clear their ears (can be done in-between Valsalva Maneuvers).

ARE THERE ANY OTHER SIDE EFFECTS TO HBOT?  During depressurization (ascent) at the end of your treatment, of the chamber the air will feel cooler as the compressed molecules in the air separate; this is normal. YES, possibly.  During ascent you may also feel your ears popping; you WILL NOT Hyperbaric oxygen therapy (HBOT) remains among the safest have to do a Valsalva during ascent. therapies used today. Nonetheless, there are side effects  NEVER hold your breath during treatment, especially during ascent. associated with HBOT. Complications present infrequently in individual patients receiving HBOT within single or multi-place HOW DO I DO THE VALSALVA MANEUVER? chambers, but are potentially severe and life-threatening.

THE MAIN SIDE EFFECTS RELATED TO HBOT ARE:

 BAROTRAUMA  Tympanic Membrane Barotrauma (a.k.a. pressure-related pain / injury to the ear drum) – usually referred to as just “Barotrauma”. This is the most common complication of HBOT and the least serious. This happens when you cannot clear your ears properly during first 10-15 minutes of HBOT, during descent of the chamber. T.M. Barotrauma can also (very rarely) be accompanied by a systemic response, including: nausea, vomiting, dizziness, etc. while still in the HBO chamber.  CLAUSTROPHOBIA / ANXIETY  VISUAL DISTURBANCES  Visual changes -Temporary nearsightedness (myopia) caused by temporary eye lens changes are temporary and most commonly reported after 20-30 HBOT. Patients’ near vision / “reading vision” may improve & far vision / “driving vision” may deteriorate. In most cases, vision returns to baseline in 2 –3 months after HBOT is completed, so wait to throw away your “readers" or get any new eye glasses or contact prescriptions. IF you notice that the opposite occurs: IF you’re near / reading vision ability deteriorates – THEN notify your HBO Tech or MD/PA so that you may be referred to an ophthalmologist.  Cataract regrowth, has very rarely been seen or reported, but can reportedly occur, after a very high number of HBOTs.

 OTHER COMPLICATIONS--hypoglycemia, central nervous  Nicotine causes blood vessels to constrict and this constriction system & oxygen toxicity, dizziness, anxiety reactions, dyspnea causes reduction in the amount of blood supply to the tissues, and chest pain—occur in 0.5-1.5% of patients. defeating the purpose of HBO! * Undersea Hyperb Med. 2016 Mar-Apr;43(2):113-22.  Smoke and tar decreases lung functions so that less oxygen is  Oxygen Toxicity - Oxygen is a medication. Like all absorbed by the lungs and less is transferred to the blood and medications the amount or dose given is important. One of the tissues, defeating the purpose of HBO! side effects of too much oxygen can be a seizure, which is VERY RARE, but it does require prompt evaluation. Oxygen toxicity  Carbon Monoxide produced by smoking will inhibit the amount can present with seizures and altered states of consciousness or of oxygen carried in the blood stream, thereby slowing the anxiety or chest pain. healing process, defeating the purpose of HBO!  IF during HBOT / Dive you should have any of these symptoms,  Most Supervising Physicians / NPPs will not dive anyone THEN PLEASE alert the hyperbaric technician immediately: smoking within a minimum of 4 hours (before or after) HBO. . Chest pain, shortness of breath So Medicare & Insurers don’t want to pay for HBOT until . Nausea, vomiting you cut back or quit. . Sudden anxiety or apprehension, muscle twitching . You hear, smell, taste or feel anything unusual/unexplained…  Respiratory Complications - Respiratory Decompensation from when air enters into the space around the lungs. It is also VERY RARE and can almost always be easily avoided by breathing normally during ascent of the chamber (end of treatment). These Respiratory Complications require immediate / emergent attention & differentiation from less emergent (but still important) more common issues, like anxiety and claustrophobia, followed by appropriate interventions.  Sinus Squeeze (sinus pain) - This is caused if you have any sinus congestion from colds, allergies, etc. If you feel congested prior to your treatment notify one of the staff members.

EMERGENCIES  Fire Safety . All potential treatment of medical and surgical emergencies arising in the patient receiving HBOT must be within the scope Fire + 100% Oxygen = BOOM! of practice of the physician / NPP providing direct supervision,  Please follow all of the safety guidelines as instructed, who is immediately available with a maximum of a five (5) minute response time to the chamber throughout the HBOT especially the GO / NO-GO List your HBO Tech will session. Additionally, a Critical Care Telemedicine Physician is review with you, for what can and cannot take in the on call 24/7 as well as the highly trained Kindred LTAC Hospital chamber. Rapid Response / Code Team.  Help our staff help you be safe 100% of the time!  During any emergency you will be instructed on what NO Smoking (or Vaping) to do by the hyperbaric staff.  The hyperbaric & hospital staff has been fully trained  Using tobacco products can sometimes even result in to handle emergencies. your insurance / 3rd party payers to later deny payment for HBO or refuse coverage to renew your treatment  Medications authorization.  You may be prescribed medications by your doctor or the  Smoking is COSTLY! Not just the cigarettes (but, those too!) Not hyperbaric Physician/NPP : just the health effects (but, those too!) . Afrin or Neo-Synephrine nasal spray, Sudafed and other  But because the nicotine habit is SO damaging to your decongestant medication. If your blood pressure is high / circulation & blood vessels, your connective tissue, your oxygen uncontrolled, we may not be able to give you Afrin or any delivery and your ability to heal and fight infection, that more decongestants. and more often expensive health care benefits like HBOT are . Xanax or other anxiety meds as needed for severe denied until patients do the obvious first step and quit the claustrophobia before HBO. cigarettes. . Anti-nausea or Anti diarrhea medications as needed.

. Ear wax loosening / softening drops as needed in case of The phone numbers to the external ear canal obstruction by cerumen (ear wax). . PRN pain medications or muscle relaxers should be taken as HBO Room (MONICA) is 281-275-6098 prescribed by your regular PCP or Attending. & . We ask you to please notify the hyperbaric staff if your Wound Care Office (Aileen) is 281-275-6097 primary care physician changes your medications or starts you on a new medication. . You may continue your normal medications unless otherwise Visitors instructed. Family members, friends or significant others are Questions? encouraged to participate in the initial orientation to the Hyperbaric Medicine Center During the actual Questions about the treatment process are treatment process, for all patients’ confidentiality, no always welcomed. one other than patients are permitted in the treatment area.

 My HBO MD (PHYSICIAN) is: Dr. Shahe Vartivarian  My HBO NPP (PHYSICIAN ASSISTANT) is: Maria Castro Calzada, PA-C, CHT

I DO / MAY / MAY NOT QUALIFY FOR HBO; FOR THE DIAGNOSIS BELOW…

COMPROMISED SKIN GRAFT ______

CHRONIC REFRACTORY OSTEOMYELITIS, “bone infection”______

DIABETIC WOUND(S) OF THE FEET / LOWER EXTREMITIES______

OSTEORADIONECROSIS______

SOFT TISSUE RADIONECROSIS ______

ACTINOMYCOSIS______FURTHER INVESTIGATION / TESTING / OTHER NEEDED… ______

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