An Introduction to
HYPERBARIC OXYGEN THERAPY
A Medical Treatment to Enhance the Body's Natural Healing Process
Contents
INTRODUCTION TO HYPERBARIC OXYGEN THERAPY
IF HYPERBARIC OXYGEN THERAPY IS SO GOOD, WHY IS IT NOT MORE WIDELY ACCEPTED?
WHAT YOU NEVER KNEW ABOUT MULTIPLE SCLEROSIS AND HYPERBARIC OXYGEN
CEREBRAL PALSY STUDY POSITIVE, DESPITE CONTRARY INTERPRETATIONS
INTRODUCTION TO HYPERBARIC OXYGEN THERAPY
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy (HBOT) is a well-recognized medical treatment which enhances the body's natural healing processes. HBOT consists of delivering 100% oxygen at greater than atmospheric pressure. HBOT has been widely employed throughout the world for decades to treat a large array of medical conditions.
HBOT is administered at the Rainier Medical Spa & Infusion Center in a state-of-the-art, Sechrist monoplace chamber. Clear acrylic walls allow trained nurses or HBO technicians to closely monitor you and permit you to readily see outside the chamber. You are in constant communication with the attending technician via intercom. Inside the chamber, your entire body will be totally immersed in 100% pure oxygen at increased pressure, which dissolves high concentrations of oxygen into the blood, plasma, tissues and every cell of the body. There is no need to wear a mask or hood in this type of monoplace chamber. HBOT can deliver up to almost 22 times as much oxygen to tissues as would occur breathing normal room air. The frequency and duration of your treatment will be determined by the attending physician and varies with the condition being treated.
How HBOT Works
When a patient is immersed in and breathes pure oxygen at pressures ranging up to three times normal atmospheric pressure, oxygen tension in the lungs rises from its normal of 90 to 100 to almost 2200 millimeters of mercury pressure. Great amounts of oxygen are dissolved in all body tissues and fluids. Increased levels of oxygen remain for up to several hours after the treatment ends. During this time, white cells are better able to kill bacteria in infected tissues. Healing is accelerated as collagen and fibroblasts are laid down to create a base for new capillary growth. New blood vessel formation is accelerated. The high oxygen concentrations in nerve tissues can revive brain cells stunned by stroke or other neurological injuries.
Treatment Experience
Hyperbaric treatments usually last one to one and one-half hours and are painless. The patient may experience a sensation of "fullness" in the ears, similar to driving down a mountain, flying or scuba diving. The "full" feeling occurs as the eardrums respond to the change in pressure. The HBOT technician demonstrates how to relieve this fullness before treatment.
Once a patient is in the chamber and the door is closed, the oxygen begins to circulate. This starts a gradual increase in pressure-called compression. There may be some slight warmth, but that is temporary. The HBOT technician remains by the chamber throughout the treatment to adjust the rate of compression according to patient tolerance and to coach the patient on relieving the "full" sensation in the ears. Compression generally lasts 10-15 minutes depending on how effectively one can clear his or her ears. When the interior of the chamber reaches the prescribed pressure, the sensation of "fullness" in the ears will cease and the patient is free to rest or watch TV. The temperature in the chamber remains at room temperature.
Near to the end of the treatment, the HBO technician will gradually decrease pressure that was added at the beginning. This is decompression, which generally lasts 10 to 15 minutes. During decompression, there may be a slight "popping" sensation in the ears as a result of the changing (decreasing) pressure. This "popping" is a normal adjustment, similar to what happens when driving up a mountain or ascending in an airplane. It is usually much easier to equalize ear pressure during decompression than during the compression phase.
After Effects
Generally patients experience no after effects from HBOT. However, some patients report a "cracking" sensation in their ears between treatments as oxygen behind the eardrums is absorbed into the blood stream. This can be relieved in the same manner as clearing the ears during compression and decompression. Also, some patients report feeling light headed for a few minutes immediately following a treatment, but this is brief, and they are quickly able to continue with their normal daily activities such as working or driving.
As with all medical procedures and treatments, some potential side effects may result from exposure to hyperbaric oxygen. These are rare, but will be discussed in detail by the doctor before treatment.
PATIENT PREPARATIONS BEFORE HBOT THERAPY
Before each treatment patients will completely disrobe and put on a 100% cotton gown provided by the Center. No articles containing nylon or polyester can be worn in the chamber. A private dressing room and secure storage for your personal items is provided.
Patients must also remove any jewelry, rings, watches, hearing aids, wigs, hairpieces, artificial eyelashes, dentures, contact lenses, or other prosthetic devices before entering the chamber.
Skin ointments, fingernail polish, cosmetics, shaving lotion, perfume, deodorant and hair preparations are not allowed while in the chamber. These should be removed before coming to the center. It is important that cleanliness be maintained during the course of treatment.
Patients should stop the use of tobacco entirely until HBOT is complete. This includes cigarettes, pipe tobacco, cigars, chewing tobacco and snuff. If a person cannot stop entirely, tobacco should be avoided at least 12 hours prior to treatment.
Patients must inform the HBO technician about any medication being taken which has not been previously approved by the doctor for use during hyperbaric oxygen therapy.
Do not take hyperbaric oxygen treatments while you have an acute viral infection such as flu, or serious common cold. Minor congestion without a fever may be tolerated but should first be discussed with the HBOT technician prior to entering the chamber. Congestion of any significant degree can cause difficulty in equalizing air pressure across the eardrums. If pain or pressure in the ears should occur, please inform the technician at once so that the rate of pressure change can be slowed or temporarily reversed until ear pressure is equalized.
Relax and enjoy your treatment!
Supplements
Patients will be instructed to take a regimen of high potency nutritional supplements during and after the course of hyperbaric therapy. These supplements include AntioxPacketsTM, containing a balanced formulation of vitamins and minerals; NeuroNutrientsTM, selected, complementary brain nutrients and herbs; allithiamine, a fat soluble form of the essential brain energy vitamin B1; and alpha lipoic acid, important for brain energy and antioxidant protection.
IF HYPERBARIC OXYGEN THERAPY IS SO GOOD,WHY IS IT NOT MORE WIDELY ACCEPTED?
By Elmer M. Cranton, M.D.
Copyright (c) 2001 Elmer M. Cranton, M.D.
Doctors are rarely taught about hyperbaric oxygen therapy (HBOT) in medical school and therefore most do not know about it. Only about 20 medical schools, less than 15 percent, have actual hyperbaric oxygen facilities, while perhaps another 20 have access to HBOT facilities. If physicians don't know about a therapy, they obviously won't prescribe it. If they don't prescribe HBOT, there is no incentive for more hyperbaric treatment facilities to be established. Therefore, there exist very few hyperbaric chambers, compared with potential need and benefit that could otherwise be achieved-only about 400 chambers in the entire U.S.A. many of those are dedicated to diving accidents (bends) and are not available for other medical conditions. And, many are located in hospitals that restrict HBOT to a small number of medical conditions reimbursed by Medicare.
Hyperbaric facilities are very expensive to establish and outfit. It costs in the neighborhood of $150,000 to equip a small facility with a single monoplace chamber. Larger facilities and those with multi-place chambers can cost millions of dollars. Because so few conditions that could potentially be helped by HBOT are reimbursed by health care insurance, patients must commonly pay the cost out of their own pockets. Fees for HBOT can range from $150 per hour to almost $1,000 per hour. This denial of insurance reimbursement discourages the creation of new facilities and many patients cannot afford the cost of HBOT when refused medical insurance coverage. It is not uncommon to require 50 to 100 of the hour-long treatments for full benefit.
Advertisements and marketing claims for hyperbaric oxygen therapy are regulated like a drug by the government's Food and Drug Administration (FDA). It costs tens of millions of dollars to conduct medical research that meets FDA standards to allow claims for successful treatment of a specific illness. Medical insurance companies commonly take the position that if the FDA has not issued a formal approval, then the therapy is experimental and they refuse to pay. Because oxygen cannot be patented, profits on sales of oxygen are too small to pay for studies that meet FDA requirements.
Psychological defense mechanisms also come into play. If a doctor is not taught about HBOT in medical school (and most are not), and if a doctor therefore does not routinely use or prescribe HBOT for patients, then one of two things must be true in their minds: 1) either that doctor's medical education was deficient and he or she is not providing the best of care for patients; or, 2) other doctors routinely using and prescribing HBOT for conditions that are not FDA-approved (off-label) must be "quacks" who exploit desperate patients. Which do you think their choice will be? It's apparently difficult for many medical doctors to shed an attitude of god-like omniscience and admit that they simply do not know everything there is to know.
The medical profession is becoming polarized concerning HBOT. A large and powerful majority of medical doctors believe that HBOT should be restricted to treatment of those uncommon conditions with prior FDA approval. That majority now criticizes and even attacks the growing number of physicians who have become familiar with more than 30,000 published scientific papers on the subject, and who advocate or use HBOT to treat patients with so-called off-label (non-FDA-approved) conditions. Opponents of such expanded utilization of HBOT should admit that they are remiss in their care of patients; they should open their minds, educate themselves further, and change their ways.
The medical community eagerly accepts scientific research buttressing a therapy it already approves. Somewhat more reluctantly, it examines and debates entirely novel approaches. But what it really hates is reappraising a treatment once rejected-getting the egg off their collective faces. Medicine, after all, is made up of people-people trailing MDs after their names-who, like the rest of us, do not enjoy admitting error.
Someday when HBOT therapy is an established part of standard medical care, historians of twentieth century medicine will wonder how so much supportive research on its benefits could have been published by skillful medical researchers and even more scrupulously ignored by the guardians of our health. By that time, most of the individuals who attempted to keep HBOT on the fringe will probably not be alive to blush, sparing them extensive embarrassment.
The amount of positive research is certainly formidable. And some studies that purport to demonstrate that HBOT doesn't work actually show the opposite. For example, a recent Canadian study of cerebral palsy showed significant benefit. Under political pressure from parents, the study was reluctantly designed and conducted by Canadian physicians who were inexperienced in the use of HBOT. Both the treatment and placebo groups were pressurized and both groups benefited. The published conclusion in that study mistakenly stated that HBOT did nothing. It's easy for opponents to design flawed studies and interpret the results to support their biased positions.
In a sense, we're attempting to set the record straight and to tell people-especially physicians-to become familiar with the published scientific evidence . Mainstream medical journals engage in unconscionable editorial censorship. They refuse to publish positive research studies on alternative therapies, and are quick to print editorial criticism and anecdotal letters to the editor that are biased against such treatments. They have also been quick to uncritically print flawed studies that erroneously allege to disprove a controversial therapy.
WHAT YOU NEVER KNEW ABOUT MULTIPLE SCLEROSIS AND HYPERBARIC OXYGEN
by R. A. Neubauer, M.D.
Published in Hyperbaric Medicine Today. 2000;special edition, page 31.
Having begun hyperbaric oxygenation treatments (HBOT) in the early 1970s under the tutelage of Dr. Edgar End, I encountered several patients suffering simultaneously from chronic refractory osteomyelitis, and multiple sclerosis (MS). The signs and symptoms of MS had been improving during exposures to hyperbaric oxygenation so in 1978 I published several case reports in the Journal of the Florida Medical Association(1). By 1980 I had accumulated data on 250 patients with multiple sclerosis and once again published in the Journal of the Florida Medical Association, concluding the following: 1) this is not a cure; 2) it is dose sensitive; 3) it takes repeated treatments over the long term; and, 4) it alters the natural history of the disease favorably(2). In that 1980 paper, I reported on minimal to dramatic improvement in 91 percent of 250 patients treated with hyperbaric oxygen at pressures of between 1.5 and 2.0 atmospheres absolute (ATA).
In 1970 Boschetty and Cernoch of Romania reported small transient improvement in 16 of 26 patients treated with hyperbaric oxygen at a pressure of 2.0 ATA(3). In 1978 Baixes of Toulon, France reported improvement in 11 patients treated with hyperbaric oxygen.(4) Positive results were again reported in 1980 in a detailed study by Dr. Formai in Italy, who first used hyperbaric oxygen because of centeral similarities between the decompression sickness and multiple sclerosis.(5) In that same year, Dr. Pallotta of Italy independently reported substantial improvement with hyperbaric oxygen in six patients with multiple sclerosis.(6)
Because of those published observations and other sporadic suggestions that hyperbaric oxygenation might be beneficial to treat MS, the National Multiple Sclerosis Society became furious. They went to Dr. Boguslav Fischer, a professor of neurology at New York University Medical School, who was also an experienced physician in hyperbaric oxygenation, and, awarded Dr. Fischer a $250,000 grant to silence such claims. Dr. Fischer conducted an exceptionally well designed double-blind study, as difficult as this may be with multiple sclerosis, and much to the surprise and apparent chagrin of the National MS society, his positive results were published in 1983 in the New England Journal of Medicine(7). However, that original paper was delayed in publication and watered down significantly, under pressure from the National MS society. Consequently, upon publication, Dr. Fischer was asked to seek employment elsewhere.
Those early reports all have several things in common. There was remarkable agreement and uniformity of positive observations, although the studies had been conducted independently by different researchers at widely separated locations around the world. It became obvious that hyperbaric oxygen therapy might well be beneficial in the treatment of MS, especially considering the lack of harmful side effects. Prior to Dr. Fischer's study, they had all been conducted without controls, and only the Neubauer study utilized an established disability scale as a point of reference(2).
I contacted Dr. Boschetty in Romania and it had become very clear to him and to me in centeral practice that repeated long-term treatments were mandatory for sustained benefit. It also came to my attention that Dr. Jacque Baixe in Toulon, apparently had also been treating MS with hyperbaric oxygenation plus carbon dioxide, and had not published all of his data. Dr. Fischer's and mine were the first studies published in peer-reviewed journals.
In the interim, Dr. Charles Shilling introduced me to Dr. Philip James in England. Dr. James had brilliant ideas on the etiology of MS and was a proponent of treatment with hyperbaric oxygenation. He was one of the first to note that microscopic lesions in the spinal cord of MS patients and that of decompression illness were identical. He is currently preparing a book on hyperbaric oxygenation for MS.
In 1982, my wife and I were invited to the United Kingdom to lecture to a lay organization sponsoring research into Multiple Sclerosis. This consisted of a wonderful group of patients who had banded together for self-help and to investigate all new possibilities for improvement. As a result, in the United Kingdom there are now 110 hyperbaric oxygen chambers treating 12,000 cases of multiple sclerosis, in some cases for as long as 16 years. This has been entirely because of the pioneering work of Dr. P. B. James and Dr. David Perrins. Their resulting massive amount of centeral data could never have otherwise been reproduced at any price. Yet, it was denied publication by Lancet and the British Medical Journal because it was not considered a controlled study. Those journals completely ignored the excellent longitudinal data, which fulfilled criteria of the Schumacher dictum(8) (if a patient receiving any type of therapy for MS has not become worse after two years, the therapy is considered a success).
In 1985, a review article critical of HBOT in treatment of MS appeared in Lancet by Drs. Barnes and Bates.(8) This was preceded by a news release in the London Times stating that hyperbaric oxygenation was not indicated or effective in MS and caused side effects. When one reads the article, however, it became obvious that the author(s) had never read Fischer's work completely and had never looked beyond the study title. A dose of 2.0 ATA was mentioned. The original Neubauer work indicated a dose of between 1.5 and 2.0 ATA(2). Fischer measured arterial oxygen pressures while in a multi-place chamber and with the patient breathing oxygen through a mask(7). Because of mask administration, his measured arterial oxygen pressure was equivalent to only 1.3 ATA.