Circulator Boot Therapy in the VA
This VA center is new to boot therapy and hopefully will gain experience in treating the various conditions shown in our case history section. The VA patient population may include others than veterans. At the time of Desert Storm, we were told that the military was planning on hospitalizing the wounded in our VA hospitals. Because of the possibility of there being large numbers of potential amputees, we contacted the army and were told to write the the individual VA hospitals and advise them of the potential role of boot therapy in conserving limbs. Fortunately, the war was brief and the injured few in number. We feel boot therapy has a definite role for the military, however, where it might be used in restablishing blood flow in patients with burns, cold damage, frost bite, crush injuries and other forms of trauma. Further, the vascular support provided by boot therapy has a potential role in the treatment of uremia, congestive heart failure, cardiogenic shock (see patient #26), septic shock (see patient #25) and lactic acidosis. Hopefully, we will not need the casualities of a major war to explore these areas. The drug industry has spent perhaps a billion dollars in bringing Drotrecogn alfa (activated Protein C) to market. Their studies, involving thousands of patients and perhaps 165 medical centers worldwide, showed a 6% mortality benefit in the treatment of septic shock. The drug costs $7000 for a four day treatment. The individual surviving patient cannot know whether the drug had any benefit. In many of our patients, hemodynamic improvement may be seen with the flick of a switch. This VA hospital has an opportunity to save the government large sums of money and to do some research untainted by industry.
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