Six Questions with Dr. Jeffrey Niezgoda

To contact us Click HERE
President, American College of Hyperbaric Medicine (ACHM) 
Medical Director, The Center forComprehensive Wound Care and Hyperbaric Oxygen Therapy, St. Luke's Medical Center, Aurora Health Care, Milwaukee, Wisconsin    
President and Chief Medical Officer ofWebCME.net   
Associate Professor and HyperbaricConsultant, Medical College of Wisconsin 
MD from the Uniformed Services University ofthe Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland,1985    
BS in Biology from the US Air Force Academy,Colorado Springs, Colorado, 1981


Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, is a recognized wound care and hyperbaric medicine expert,educator, and entrepreneur. We know him best as president of the AmericanCollege of Hyperbaric Medicine (ACHM), a professional organization working todevelop an image of hyperbaric oxygen therapy as a distinct medical specialty,often requiring full-time practice. His work uniquely spans the clinical, professional,academic, and business aspects of hyperbaric medicine today. He spoke with usin his Milwaukee offices in March 2012.
1.HyperbaricLink: Tell us about the first time you ever saw ahyperbaric chamber.Niezgoda: My first exposure to hyperbaricmedicine was many years ago, circa 1976. I grew up here in Milwaukee and hadthe privilege of touring St. Luke’s and the hyperbaric unit when I was anExplorer Scout. I was 17 or 18 years old at the time, and I joined a medical explorerpost, because I wanted to go into medicine. Ironically, the hyperbaric chambertour was conducted by Dr. Eric Kindwall, who many years later became mycolleague and mentor, and a dear friend. I clearly remember him showing us theoriginal multiplace chambers, Bonnie and Clyde. I’m very sad that he’s nolonger with us. I often think back to that day that I first met Dr. Kindwall, atthe time never dreaming of walking in his footsteps. It is amazing to me that I have been sofortunate to have had the honor and privilege to come back to Milwaukee topractice hyperbaric medicine.
2.HyperbaricLink: Can you a recall one real breakthrough success oraha! moment in your career?Niezgoda: Yes, it was when I was doing myfellowship at Travis Air Force Base, in the late 1980s, working with anotherone of the world renowned hyperbaric physicians, Dr. Ben Slade. I was stilllearning and questioning certain aspects of hyperbaric medicine, in a way tryingto validate it in my own mind. Much of our time was dedicated to treating thestandard conditions. But Ben always liked to push the envelope, and use HBO tohelp patients that presented with problems that theoretically would benefitfrom hyperbaric. So from time to time we would treat conditions that wereconsidered experimental back then, under IRB [institutional review board]guidance, of course. Sometimes the patients improved, sometimes not. One day Dr.Slade came in to Morning Report and said, “We’re going to start treating apatient with brain abscess.” I was thinking to myself, “You've got to bekidding! Here we go again.” The patient was actually incarcerated at the prisonin nearby Vacaville, California. Every day two armed guards brought theprisoner in from the infirmary, by ambulance, on a gurney, dressed in his orangegarb. I thought that the handcuffs and guards were somewhat silly as thepatient was essentially comatose due to high intracranial pressure and masseffect from several large abscesses. Hewas obtunded and didn’t know who he was or where he was. He had been onbroad-spectrum antibiotics for several days and really wasn't getting anybetter. The neurosurgeon who referred the patient to us said, “If I open thispatient’s cranium to drain the abscess, he will end up herniating and dying.” Sothis is how it went day after day. Thepatient would come in for treatment, we would say hello and he would notrespond in any way. Well, I’ll neverforget it. On hyperbaric day 7 or 8, I was sitting with my back to the door,charting. Klaus, my med tech, came in and said, “Dr. Niezgoda, Mr. XYZ is herefor his treatment.” Very facetiously, without looking up, I said, “Great! Letthe party begin!” All of a sudden I hear a voice I didn't recognize say, “I’llbring the women and the beer!” I turned around and see this guy is sitting upin his gurney, fully awake, fully conversant, sharp as can be. It was simply amazing.
3.HyperbaricLink: How would you characterize the status ofhyperbaric oxygen in healthcare today?Niezgoda: The overall acceptance andvalidation of hyperbaric medicine as a true medical specialty is probably thebiggest change that has happened over the last 5 to 10 years. When I was doingmy fellowship we had to really work for patient referrals. There were a lot of naysayers. There was alot of skepticism. We were criticized for the lack of hyperbaric literature. Weworked hard to convince our colleagues that HBO was a valid adjunctivetreatment. It often felt like I had to be a cheerleader or salesman for this treatmentmodality. Fortunately for our patients, much of this has changed. Some really excellent clinical and researchstudies with supporting publications have appeared in the literature. Based onthe literature and excellent clinical outcomes, hyperbaric has truly emerged asa primary advanced treatment modality for wound care patients. Younger doctorsappear more ready to accept case studies which highlight some really amazingsuccess stories and refer their patients for care. I think mainstream medicinehas finally accepted hyperbaric as a viable treatment. It is rewarding afterall these years of hard work, advocating for a treatment that I believe inbased on outstanding results and limb salvage, to have physicians who had previouslydoubted and questioned hyperbaric—the plastic surgeons, the vascularsurgeons, the general surgeons—now calling and asking for our help.
4.HyperbaricLink: What can the hyperbaric community do to better educatethe public and referring physicians?Niezgoda: I don't think that, as hyperbaricphysicians, we like to boast or wave our flag. I think we do a great job of providing care. I think we do a great jobof taking care of patients. However, wedon’t do a very good job of telling our success stories. We have wonderful success stories, greatoutcomes, and amazing stories to tell about healing. Unfortunately, this information does not getshared very well. We need to tell the world what a huge impact we make inpeople’s lives. When a young child nearly drowns and is resuscitated and has agreat outcome, the media praise the medical community. It makes the newsheadlines. Limb salvage, necrotizing fasciitis, and carbon monoxide cases, quitefrankly, can be just as impressive. Sure, patients go out and talk about it. Butif you try to market anything in the US by word-of-mouth, one by one by one byone, it’s an incredibly slow and uphill climb. We don’t have an effectivemechanism for selling our success. Weneed to better educate our colleagues, we need to tell the community oursuccess stories.
5.HyperbaricLink: Where do you see things going in the next 3-5years?Niezgoda: I suspect that we will see severalchanges in the field of hyperbaric medicine, some good, some not. I would anticipate that within the next fewyears several new treatment indications will be accepted. This will be due to current and ongoingresearch, but also because of continued efforts on the part of the lay public,some of whom are strong advocates for use of HBO for conditions that aren’t onthat list of approved indications. One of these indications will relate to theuse of HBO for acute hypoxic or ischemic periods, such as for acute ischemicinjury to the brain, to the heart, to the lower extremities. I am hopeful therewill be an improvement in the way we educate hyperbaric physicians. Newer platforms such as online courses andcertification pathways will enhance the care provided to our patients. CMS has already accepted online hyperbariceducation, now we just need the professional hyperbaric societies to do thesame. Unfortunately, I also see thatreimbursement for wound care and hyperbaric services will be cut, which willtranslate to program closure. Withoutaccess to this care, patients will ultimately be negatively impacted, they willsuffer with nonhealing wounds and amputations.
6.HyperbaricLink: If you could teach the world one thing abouthyperbaric oxygen therapy, what would it be? Niezgoda: Good question. Hyperbaric oxygentherapy can achieve some impressive results, some amazing outcomes, and it is complementaryor adjunctive to standard care plans. In a limb salvage effort, for example,hyperbaric oxygen can augment surgical and medical care, it can be that bridge,that additional treatment that reverses tissue hypoxia, helps healing, andprevents amputation. So if I could help my surgical colleagues to considerhyperbaric oxygen therapy, rather than defaulting to amputation, that would bea huge lesson. If we could communicate the efficacy of hyperbaric in the careof diabetic foot ulcers, I think we would be doing our patients a greatservice.