We are pleased to profile Dr. Jane Fore from the Tri-State Wound Healing and Hyperbaric Center at Tri-State Memorial Hospital in Clarkston, WA, as our Partner in Therapy in this issue of the Newsletter.

Dr. Fore is Board Certified in Internal Medicine. She has been practicing since 1982 and has practiced full-time in the Wound Care specialty exclusively since 2003.  Dr. Fore has been the Medical Director of the Tri-State Wound Healing and Hyperbaric Medicine Center since its inception in 2005.  She is a member of the American Academy of Wound Specialists (AAWS), has been a Certified Wound Specialist since 2002, is certified in Wound Care by the Council for Medical Education and Testing (CMET) and is a fellow of the American Professional Wound Care Association (APWCA) where she chairs the Authors Committee and the Comprehensive Wound Care and Board Review Course.

Dr. Fore is active in several other national professional organizations including the Association for the Advancement of Wound Care, the Wound Healing Society, the Undersea Hyperbaric Medical Society and the Society of Investigative Dermatology.  She has also served on the Board of Directors of the American Academy of Wound Management and continues to lecture extensively nationally on wound healing and hyperbaric medicine.

The Tri-State Wound Healing and Hyperbaric Medicine Center is staffed by Dr. Fore and a highly trained group of nurses and technicians. They use a variety of treatment modalities including Circulator Boot therapy, Microvas for electrical stimulation treatment and two mono-place Hyperbaric Chambers.  Additionally, they have state-of-the-art diagnostic equipment including a laser Doppler for Skin Perfusion Pressure (SPP), Ankle-Brachial (ABI), and Toe-Brachial (TBI) testing. 

Tri-State Memorial Hospital is a 25 bed critical access hospital located in the SE corner of Washington State.  The Wound Center which is hospital owned and operated, opened in 2005 and has quickly grown to serve the surrounding region.

Dr. Fore has been using the Circulator Boot system since 2004.  We asked Dr. Fore to share some of her thoughts and experiences regarding Boot therapy as part of her comprehensive wound protocol:

"I was first introduced to the Circulator Boot at the APWCA meeting in 2003 when Dr. Richard Dillon lectured on this technology that he had developed, tested and marketed.  He had produced positive results in the healing of wounds that were not expected to heal and his results were quite amazing.  Interestingly, through my usage of the Boot, I have been able to generate similar results on a smaller scale.

I spent time at the Bryn Mawr Hospital outside of Philadelphia where Dr. Dillon practiced and really benefited by watching the technicians and talking to the doctors that run the Wound and Vascular Center there.  I also learned quite a bit from talking with the patients that were receiving therapy about their experiences while receiving Circulator Boot therapy.

At Tri-State, we have many patients who can either not be reconstructed for arterial circulation or who get incomplete or inadequate results from revascularization.  I use the Circulator Boot to augment the results for slow-healing wounds post-vascular intervention or to offer a possible healing option for those who can't get revascularized due to non-reconstructable vascular lesions or failed interventions.  I believe this is a great technology for mixed venous vascular disease as well.

I find that the combination of the Circulator Boot therapy followed by Hyperbaric Oxygen (HBO) therapy, improves the transcutaneous oxygen results in the chamber. The two combined therapies I believe are synergistic. 

I have had several dramatic cases following this treatment approach...those that are marginal for adequate response to oxygen challenge are treated with the Circulator Boot for a couple of weeks and then their TcPO2 levels are retested to see if they get a better baseline oxygen result that would predict results to HBO therapy.   In other cases, I have integrated the two therapies at the same time and have seen very good improvement and response with dramatic improvement in the TcPO2 levels that have correlated with healing.

I have done local injections with antibiotics in areas that have marginal perfusion prior to Boot treatments. This concept of delivering a good dose of antibiotics to marginal tissue has produced positive results in tissue in a more rapid and effective way for certain patients that had infection in poorly perfused tissues.

Additionally, we use Sea Soaks routinely with Circulator Boot treatments and also use them for other patients that need skin therapy to help remove scale and treat distressed skin on the feet and lower legs.  It is soothing for the patients, helps to promote normalization of the skin and is a very good way to enhance cleaning the skin.

Overall, I am very happy that we have this technology in my clinic and anticipate an even greater usage in the future.  Dr. Dillon and his research have proven to be very helpful in my patient evaluations and I am glad that Dr. Dillon continues his involvement with the Circulator Boot Corporation (CBC) as the Medical Director.  All of the people at CBC are helpful and passionate about their work and this therapy.  

 I have met a number of physicians throughout the country that use the Circulator Boot and they also report these positive beneficial results. I believe that this is a modality that all physicians involved in Wound Care should consider adding to their practice."