BREMERTON, Wash. (NNS) -- When the opportunity to medically support an ailing retiree at risk of serious complications from previous radiation treatment presented itself, Navy Medicine and Navy divers used the historic Navy recompression chamber known as "The Whale" to provide the needed treatments.
Cmdr. Juan Dapena, Submarine Group 9 Undersea Medical Officer and Navy divers assigned to Naval Undersea Warfare Center Keyport Dive Locker have been using hyperbaric oxygen therapy to treat retired Senior Chief Hospital Corpsman Roger Johnson, who recently went through radiation treatment for oral cavity cancer that impacted his jaw area.
Johnson's treatment was initiated and supervised by Lt. Cmdr. Patrick Henderson, a Naval Hospital Bremerton Internal Medicine Department primary care provider. One option actively pursued by Henderson was hyperbaric oxygen therapy, an effective preventative measure used to minimize the risk of complications after oral surgery for patients like Johnson. Henderson's inquiries led him to Dapena and the Keyport Dive Locker.
"Mr. Johnson reached out to us and asked for help," said Henderson. "This was a massive team effort, from Maria Gonzales, our case manager, to everyone else, to literally save his jaw. It is a huge deal to help him out on this. After we did a lot of tests, scans and lab work to ensure he was okay to go through treatment, all hands involved made it happen."
After receiving approval from the Navy Bureau of Medicine and Surgery, Dapena then began the coordination process with NUWC Keyport Dive Locker in utilizing what is affectionately referred to as 'The Whale,' the Navy's oldest certified dive recompression chamber from circa 1930.
"Providing this type of specialized medical support has really been a total coordination between everyone," said Dapena. "It has involved all parties, from the dentist to the provider to the Navy divers and especially the patient because Senior Chief Johnson has had to adjust his time, and that of his family. But we are all making this happen."
Johnson, medically retired in 1989 after 28 years of active duty that included duty with the Marines in Vietnam, went through recent radiation treatment and chemotherapy for oral cavity cancer that impacted his jaw area, specifically in the tissue around his tongue, throat, and teeth.
"It's really not bad; can't be any worse than being in Vietnam with the Marines," quipped Johnson, who is the recipient of three Purple Hearts.
Dapena noted, due to his radiation treatment for oral cancer, Johnson is at risk of developing a condition known as osteoradionecrosis in his jaw. Before any needed oral surgery is performed, especially the removal of teeth, hyperbaric oxygen therapy, provided prior to surgery, can be designated to reduce radiation-related complications and enhance surgical site healing.
"We are trying to prevent a serious complication called osteoradionecrosis (ORN) of the jaw from the radiation treatment he has already received. There is a possibility of ORN without this hyperbaric oxygen therapy treatment," explained Dapena, noting that ORN is regarded as a very severe side effect of radiation therapy and is also referred to as 'bone death.'
Hyperbaric medicine is a specialty of Navy undersea medicine. Hyperbaric oxygen therapy has been accepted by the Food and Drug Administration as an indicated treatment for approximately 14 medical conditions, to include some persistent infections, poorly healing skin grafts, and carbon monoxide poisoning. It has also been found to be effective in preventing conditions like ORN under certain circumstances.
According to Capt. Edward T. Waters, Bureau of Medicine and Surgery head of Undersea Medicine and Radiation Health, Undersea Medicine Specialty Leader, and Operational Medicine and Capabilities Development, the care of beneficiaries with accepted indications for the therapy at Navy recompression chambers is authorized, with strict controls. Those eligible for similar care must meet strict diagnostic criteria and indications. Such treatments are conducted for beneficiaries who have a condition that could benefit from this treatment, which can only be provided in a recompression chamber unless they are referred out to the network.
"I've been told that there's a very good chance I could lose my jaw without coming here," said Johnson. "The care and treatment I've received is very good. Besides I'm such a regular now that I'm also an honorary dive master."
According to Dapena, the air pressure in the dive chamber is increased higher than normal, thereby simulating being underwater, with Johnson's lungs - his entire body actually - receiving significantly elevated levels of oxygen while breathing 100 percent oxygen through a mask.
"Once that oxygen gets in the bloodstream, it flows throughout the body tissues to help promote growth of blood vessels and combat any bacteria, stimulating healing," said Dapena. "A body needs an adequate supply of oxygen to function. Yet if there is any wound or injury, the damaged tissue needs even more oxygen to be repaired and survive. This pure oxygen that Johnson is getting will help to promote new blood vessels and regenerate them as it travels throughout his body, especially the jaw area previously affected by radiation therapy."
The treatment plan had Johnson receiving 20 sessions before his pending oral surgery and then another 10 treatments afterward. One treatment has him receiving three 30-minute sessions with 5-minute breaks in-between.
The hyperbaric chamber is manually pressurized under controlled conditions by the Navy dive team to an equivalent depth of 45 feet of sea water pressure with 100 percent oxygen impacting all body tissue, which Johnson receives for his three 30-minute sessions. The 5-minute breaks between the sessions are to prevent side effects such as seizures.
Chief Navy Diver Andrew Wetzel said he liked what he has seen from his Sailors as they have handled all responsibilities of ensuring each session has been conducted with the utmost safety.
"Working with the undersea medical officer has been very interesting and fascinating," said Wetzel, a Seabeck, Washington, native on his twilight tour.
Wetzel added that having his Navy divers able to handle any responsibility with the chamber allows them all to multitask in any emergency such as a diving casualty.
"It also proves that there is a lot more to the job of Navy divers than just swimming in water," said Wetzel. "Manning the chamber has been excellent training in becoming proficient at a number of positions. Everything comes down to communication and teamwork and that has been apparent throughout. To be able to get valuable work on this antique decompression chamber is really very unique because it is the oldest one in the Navy."
In Johnson's case, he presented not so much a deep water concern, but an alertness required by all hands due to the wear and tear of his advanced age.
"In dealing with the retired senior chief, we did a complete medical assessment because he had not been in a decompression chamber," said Senior Chief Hospital Corpsman Shane Picklesimer, a San Diego native with over 23 years of experience -- including 20 of them in the Navy diver community. "Once he's in there, we are submitting his body to a condition that he's not accustomed to, which is why we always have someone in there with him and the UMO always here."
According to Picklesimer, a Deep Sea Diving Independent Duty Corpsman at the NUWC Keyport Dive Locker, the planned treatment for Johnson is essentially giving him a prescription for pure oxygen, along with having a well-disciplined group of cross-trained Navy divers there to provide constant support.
"Part of my job is to get the patient illness information and then educate our dive team on what that illness is, what precautions and wound protections need to be taken, and that everyone understands their role," said Picklesimer. "Having everyone cross-trained is a tremendous asset for this treatment and any in the future."
When Johnson goes in for his dental procedure, the prevailing sentiment of all hands involved is that his initial 20 treatments will promote enhanced tissue healing and that the restorative process will continue with the remaining 10 sessions he is scheduled to receive.
"There was some added awareness in the coordination because this is a multidisciplinary case. Providing medical care is not a one size fits all. We are here for the patient, now we stand the watch and that patient has a personal life and extended family. The retired senior chief has stood the watch. The dive locker team has helped with taking care of one of our own," said Dapena, echoing the sentiments of Vice Adm. Forrest Faison, who upon his confirmation as the 38th Navy Surgeon General and Chief, Bureau of Medicine and Surgery said, "Navy Medicine is entrusted to provide the best care our nation can offer to those who have sacrificed to defend our freedom."
Even if it includes hyperbaric oxygen therapy with the Navy's oldest certified dive chamber to a veteran in need.
For more news from Naval Hospital Bremerton, visit http://www.navy.mil/local/nhb/.