WHAT IS HYPERBARIC OXYGEN THERAPY (HBOT)?

Hyperbaric Oxygen Therapy (HBOT) is a method of administering pure oxygen at greater than atmospheric pressure to a patient in order to improve or correct conditions.  By providing pure oxygen in a pressurized chamber we are able to deliver 10-15 times more oxygen then if delivered at sea level or at normal atmospheric levels.  Some of the effects this has are to promote the growth of new blood vessels, decrease swelling and inflammation, deactivate toxins, increase the body’s ability to fight infections, clear out toxins and metabolic waste products, and improve the rate of healing.  HBOT should be used to complement conventional therapies and treatments.

 

  • HBOT is very cost-effective
  • HBOT is safe

 

  • HBOT is non-invasive
  • HBOT works well with other therapies

 Historical Link to Diving

Initially, HBOT was developed as a treatment for diving disorders involving bubbles of gas in the tissues, such as decompression sickness and gas embolism.  The chamber cures decompression sickness and gas embolism by increasing pressure, reducing the size of the gas bubbles and improving the transport of blood to downstream tissues.  The high concentrations of oxygen in the tissues are beneficial in keeping oxygen-starved tissues alive, and have the effect of purging the nitrogen from the bubble, making it smaller until it consists only of oxygen which is then re-absorbed into the body.  After elimination of bubbles, the pressure is gradually reduced back into atmospheric levels.

For years, conventional medicine thought of HBOT only as a treatment for decompression sickness, however, the use of HBOT is becoming increasingly common in general practice as more doctors become acquainted with new applications.  Doctors now realize that HBOT has other uses, including the treatment of non-healing wounds, Carbon Monoxide poisoning, various infections, damage caused by radiation treatments, near- drowning, near-hanging, brain and nerve disorders, cardiovascular disorders; and some digestive system disorders.  Unfortunately, in the US there are currently 13 approved indications for HBOT that hospitals will treat.

While most programs limit their hyperbaric treatment protocols to only those 13 indications that are reimbursed by federally funded programs, the Center for New Medicine’s treatment protocols encompass all indications that have proven beneficial effects.   There are approximately 66 applications that have been noted to receive benefit from HBOT, including:

Stroke – There are 1.7 million stroke survivors in this country: survivors who often suffer devastating consequences such as paralysis, a life in a wheelchair, impairments in speech and thought.  They could tremendously benefit from hyperbaric oxygen therapy.  Since the early 1970’s, scientific journals have reported over 1,000 cases demonstrating a 40-100% rate of improvement for stroke patients treated with HBOT.

Traumatic Brain Injury – According to the CDC, each year an estimated 80,000 Americans survive a hospitalization for traumatic brain injury (TBI) but are discharged with TBI-related disabilities.  An estimated 5.3 million Americans are living today with a TBI-related disability.  After brain trauma from an accident, brain cells die or become dormant from lack of oxygen.  It is thought that many of these cells can be revived through hyperbaric oxygen therapy.  The enormous amount of data supporting HBOT as a viable treatment for brain injury has prompted the passage of legislation in Texas that allows for HBOT for acquired brain injury to be paid for by Medicare and insurance.

Bell’s Palsy – Bell’s palsy is a common affliction characterized by the fairly sudden onset of weakness of one side of the face.   Typically, patients are offered steroids early in the course of their illness in hopes of reducing swelling of the nerve involved in facial movement.   Exciting new research demonstrates that hyperbaric oxygen therapy is significantly more effective than steroids in the treatment of Bell’s palsy – both shortening the length of illness as well as increasing the likelihood of full recovery.

Cerebral Palsy – The term “cerebral palsy” describes children who experience brain trauma at birth.  HBOT can treat the underlying problem in children with cerebral palsy – the damaged brain.  The main differences between HBOT and traditional therapies for CP are the rapid gains over time and the impact on cognitive skills, which, in general, are not improved by PT, OT, and speech therapies.

Autism – There are numerous reports of HBOT reducing aggression and improving communication in Autistic patients.

Multiple Sclerosis – A debilitating nervous system disease, multiple sclerosis (MS) results in localized patches of inflammation in the brain and spinal cord, which may eventually scar.  There have been hundreds of treatments for MS.  In fact, there has never been any disease in which so many treatments have been tried.  Unfortunately, some of these treatments produce disastrous results.  Of all the treatments ever administered, hyperbaric oxygen is the safest, most effective, and most cost-effective.  Currently there are 12,000 MS patients being treated at 110 Hyperbaric centers in the United Kingdom. 

Chronic Fatigue Syndrome & Fibromyalgia –  Approximately 40 HBOT treatments followed by weekly treatments as needed seems to resolve CFS symptoms in a majority of patients, and eventually may  resolve them completely.

Wound Healing – For the past 30 years, hundreds of studies have been published testifying to the remarkable healing of wounds with hyperbaric oxygen therapy.  Diabetic ulcers, burns, fractures and skin grafts, bone damage from radiation exposure, or simply healing from plastic surgery or sports injuries: hyperbaric oxygen works in all these cases.  Hyperbaric oxygen therapy is a wonderful tool in a comprehensive wound-healing program.

Diabetes – Some 14-24% of diabetic patients with ischemic lower-extremity ulcers will require an amputation.  Despite much effort toward the prevention of amputation in the past decade, the incidence of lower-extremity amputation in such patients continues to rise.  A study conducted in the UK found that hyperbaric oxygen therapy enhanced the healing potential of ischemic, non-healing, diabetic leg ulcers and may be used as a valuable adjunct to conventional therapy when reconstructive surgery is not possible.

Sports Injuries – HBOT can significantly increase the rate of recovery for sports related injuries such as sprains and torn muscles. 

Cosmetic and Periodontal Surgery – HBOT treatments administered pre- and post- surgery can reduce healing times up to 50%. 

Meniere’s Disease – Patients diagnosed with Meniere’s disease typically suffer from recurrent attacks of disabling vertigo with progressive hearing loss.   Until recently, therapeutic options were limited to either aggressive surgical or medical approaches.

Recent research confirms usefulness of HBOT in Meniere’s disease.   HBOT-treated patients experienced significant improvement in attacks of vertigo as well as hearing.   These improvements continued when these patients were re-evaluated two years after the hyperbaric oxygen treatment program.

Lyme Disease – New and exciting research showing the efficacy of HBOT now offers hope to patients crippled by chronic Lyme disease.   Dr.  William Fife at Texas A&M University has published extensive research demonstrating profound improvements in chronic Lyme disease patients treated with HBOT.   These improvements include pain reduction, return of clarity of mentation, reduction of depression, and frequently the ability to discontinue antibiotics.

Reflex Sympathetic Dystrophy – Although uncommon, reflex sympathetic dystrophy can be a crippling disease characterized by swelling and severe pain of an extremity, at times following what would otherwise have been trivial trauma.   Treatment options including injection techniques and medication have met with only limited success.   Having demonstrated its usefulness in clinical studies, HBOT offers an effective treatment option.

HBOT Possible Side Effects

As with any treatment, side effects are possible.   However, with HBOT they are minimal.   The most common is barotrauma to the ears and sinuses caused by pressure changes.

Patients are taught autoinflationary techniques to promote adequate clearing of the ears during treatment.   Decongestants may be helpful.   This problem is temporary and resolves when HBOT treatment is completed.

If the patient has ear pain or is unable to clear his or her ears, the insertion of myringotomy tubes may be necessary before the treatment continues.   Here at Center for New Medicine, we also use ear docs to massage the area of Eustachian tubes, which aids in equalization utilizing sonic vibration, as well as ear planes, which decrease ear discomfort by means of a pressure regulating device, allowing the ears to equalize in a safe and normal fashion.

Other side effects are more rare:

 

  • Oxygen toxicity can cause CNS and pulmonary effects.   Seizures occur rarely during treatment and are self-limiting.   
    • Seizures will cease when the patient is removed from breathing pure oxygen.
    • Factors such as history of seizures, high temperature, and low blood sugar are taken into account before treatment begins.
    • Pulmonary oxygen toxicity may occur in patients who require supplemental oxygen between treatments.   This is very rarely seen with the limited number of treatments currently used.
  • Some patients may suffer claustrophobia.   This is managed by maintaining communication, use of relaxation techniques and mild sedation if necessary.
  • Rarely, patients develop temporary changes in eyesight; these are minor and occur only in those individuals who have large numbers of treatments.   Vision usually returns to normal within eight weeks following the end of treatments.
  • Patients with cataracts may experience accelerated maturation of the cataract, but the treatments do not cause cataract formation.

 Contraindications

The only absolute contraindication to HBOT is an untreated tension pneumothorax (an accumulation of air or gas in the pleural cavity of the lungs).

Anyone with the following conditions may not be a suitable candidate for HBOT:

 

  1. Asthma – Small airway hyper-reactivity may result in air trapping and pulmonary barotrauma on ascent.  A decision to treat such patients should not be undertaken lightly, particularly in light of evidence that the administration of some bronchodilators may increase the incidence of cerebral arterial gas embolism through pulmonary vasodilation. 
  2. Congenital spherocytosis – Such patients have fragile red cells and treatment may result in massive haemolysis
  3. Cisplatinum – There is some evidence that this drug retards wound healing when combined with HBOT.
  4. Disulphiram (Antabuse) – There is evidence to suggest that this drug blocks the production of suproxide dismutase and this may severely affect the body’s defenses against oxygen free radicals.  Experimental evidence suggests that a single exposure to HBOT is safe but that subsequent treatments may be unwise.
  5. Doxorubicin (Adriamycin) – This chemotherapeutic agent becomes increasingly toxic under pressure and animal studies suggest at least a one week break between last dose and first treatment in the chamber.
  6. Emphysema with CO2 retention – Caution should be exercised in giving high pressures + concentrations of oxygen to patients who may be existing on the hypoxic drive to ventilation.  Such patients may become apnoeic in the chamber and require IPPV.  In addition, gas trapping and subsequent lung rupture are associated with bullous disease.
  7. High Fevers – High fevers (>38.5degC) tend to lower the seizure threshold due to O2 toxicity and may result in delaying of relatively routine therapy.  If patients are to be treated then attempt should be made to lower their core temperature with antipyretics and physical measures
  8. History of middle ear surgery or disorders – These patients may be unable to clear their ears, or risk further injury with vigorous attempts to do so.  An ENT consult for possible placement of grommets is usually wise
  9. History of seizures – HBOT may lower the seizure threshold and some workers advocate increasing the baseline medication for such patients
  10. Optic Neuritis – There have been reports in patients with a history of optic neuritis of failing sight and even blindness after HBOT.  This complaint would seem to be extremely rare but of tragic consequence.
  11. Pneumothorax – A pocket of trapped gas in the pleura will decrease in volume on compression and re-expand on surfacing during a cycle of HBOT.  During oxygen breathing at depth nitrogen will be absorbed from the space and replaced with oxygen.  These fluxes of gases and absolute changes in volume may result in further lung damage and or arterial gas embolization.  If there is a communication between lung and pneumothorax with a tension component, then a potentially dangerous situation exists as the patient is brought to the surface.  As Boyle’s Law predicts, a 1.8 litre pneumothorax at 20 msw is potentially a 6 litre pneumothorax at sea level – certainly a life threatening situation.  For this reason it is mandatory to place a chest tube to relieve a pneumothorax before contemplating HBOT.  Particular care must be taken with patients who give a history of chest trauma or thoracic surgery. 
  12. Pregnancy – The fears that either retrolental fibroplasia or closure of the ductuc arteriosus may result in the fetus whose mother undergoes HBOT appear to be groundless from considerable Russian experience.  However, HHI continues to exercise caution in limiting treatment of pregnant women to emergency situations.
  13. Upper Respiratory Tract Infections – These are relative contra-indications due to the difficulty such patients may have in clearing their ears and sinuses.  Elective treatment may be best postponed for a few days in such cases. 
  14. Viral Infections – Many workers in the past have expressed concern that viral infections may be considerably worsened after HBOT.  There have been no studies to give convincing evidence of this and no reported activation of herpetic lesions associated with HBOT.
  15. Previous thoracic surgery.
  16. Dental – All dental work, root canals and fillings must be complete; otherwise dental baro-trauma is a possibility.   No temporary dental caps or unfinished root canals.

 NOTE:  Nicotine and HBOT

Nicotine causes vasoconstriction, or narrowing of the blood vessels.   This reduces blood flow to the tissues, and interferes with the growth of new blood vessels.   These are two problems that we are trying to counteract with HBOT, and nicotine works against the therapy.   Therefore, it is STRONGLY recommended that you stop all nicotine before starting HBOT.   If you continue to use nicotine, you will not receive the full benefit of HBOT.   Your treatment may take longer, or might not work at all.

 

 

 

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: