HBOT (Hyperbaric Oxygen Therapy) and Hypospadias Repair
Hello and welcome back to PARC Parent Pointers! This week is the long-awaited video about hyperbaric oxygen treatments. If you haven’t already, please check out my previous videos that go into detail about pre/post surgery details, feeding instructions, and when your child can go back to normal activity after surgery.
How to get started:
The first step is to find a facility that treats children. Hyperbaric treatment facilities can be easy to find in your area with a quick google search. Once you have found a facility you would like to use, please email me so that I can send a referral on your behalf. I will include any records and insurance information the facility will need to receive the treatments. Pre-operative treatments should be done as close to the date of surgery as possible so that the last treatment is within a few days of surgery. The HBOT facility will be the ones handling any insurance claims and authorizations, but this is something that should be discussed once the dates are finalized.
Ear tubes:
Once a start date for HBOT is set, our younger children will need to see an ENT for ear tubes. They will usually consult with you first and then schedule the procedure for ear tubes soon after. Most facilities require this for patients under the age of 2 to 3 years old since it is very difficult for children to clear their ears – but every patient is different. We have seen younger children (ages 18-24 months) successfully dive without ear tubes. It helps if the parents appear confident so the child doesn’t feel nervous. In the event that your child does not have ear tubes prior to starting, they can be placed during a separate procedure before HBOT starts. Ear tubes are easy to place and require mild sedation. The entire procedure takes less than 5 minutes. Since the goal is to make HBOT as easy as possible for everyone, it is highly recommended (and sometimes required) for your child to have ear tubes prior to his first dive – depending on the age of your child. There is virtually no recovery period for the ear tubes being placed.
Mono-chamber vs Multi-chamber:
I am sure you are wondering if you can get into the chamber with your child. This is an important question to ask the facility because it makes a difference in figuring out the logistics in what to do during the “dive” or time spent in the chamber. In a mono-chamber, your child will be in a sealed, clear chamber by himself. Depending on the age of your child, a parent or caregiver may be able to or possibly required to “dive” with your child. Check with your facility regarding their policy on this. In the multi-chamber, there are multiple patients that go in the chamber at the same time. These are usually more flexible in allowing parents to go in with their child. However, each patient wears an oxygen hood (that looks like an astronaut helmet) during the course of the dive. Children are often allowed to bring story books, coloring books, etc. in with them. Make sure you ask the facility for their policy regarding what is allowed in the chamber with your child.
Current PARC Protocol:
Our current protocol is to recommend hyperbaric treatments if your child has had 2 or more previously failed surgeries. These treatments will help increase the vascularity of blood flow in this organ that has probably had an increase of scar tissue and poor skin healing. We typically recommend 10 pre-operative treatments and 20 post-operative treatments. Our protocol has adapted and changed as we have learned more about hyperbaric treatments in association with hypospadias. Dr. Snodgrass and Dr. Bush have published a paper about hyperbaric treatments and hypospadias surgery after placing a fresh graft. It has been published and can be accessed on our website and is available here.
The referral process:
Please contact our office once you have found an HBOT facility because we will then fax that facility your son’s records, a letter of medical necessity, and a ‘prescription’ that explains why he needs these treatments. This packet helps the facility understand what needs to occur specifically for your child and also helps them talk with your insurance company in order to get coverage for these treatments. Once the referral has been faxed over to the facility, it is best to contact their office for an update on insurance status because the request is coming from their office directly.
As always, please let me know if you have any additional questions or concerns in regards to hyperbaric treatments and your son. I would be more than happy to help assist you in this process as well as talk with the hyperbaric facility if they have any questions. I can be reached at care@parcurology.com or at 214-618-4405.
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