VOLUME: 23 PUBLICATION DATE: Jan 01 2010

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1 January 2010

   Hyperbaric oxygen therapy (HBOT) can be a valuable adjunctive treatment for patients with various types of wounds. These expert panelists discuss their indications for HBOT, their treatment protocol and barriers to the use of HBOT.

   Q: Do you use HBOT for your wound patients and what are the indications?

   A: As Caroline E. Fife, MD, explains, hyperbaric oxygen therapy is the administration of oxygen to the entire body at atmospheric pressures greater than 1.5 times sea level pressure. She notes one should not confuse this with topical oxygen administered to part of the body or oxygen (or air) via “zip up” chambers at very low atmospheric pressures. The usual treatment pressure for wound-related problems is at least 2.0 atmospheres absolute (ATA) although she notes that sometimes patients receive pressures of 2.4 or 2.5 ATA depending on the situation. At these pressures, one can expect tissue oxygen levels in excess of 600 mmHg.

   Dr. Fife notes hypoxia is a common cause of wound healing failure. Non-healing amputations, ulcers due to vascular insufficiency and diabetic foot wounds all share the problem of tissue hypoxia, which Dr. Fife says is usually due to ischemia from vascular disease.

   She says normalizing tissue PO2 enhances resistance to infection, collagen deposition and angiogenesis. However, Dr. Fife sees a disconnect between the rationale for HBOT and what physicians can treat in terms of current Medicare coverage policy.

    “While third-party payers require us to ‘bucket’ wounds and ulcers into neat diagnostic categories, real patients rarely cooperate by falling into clear disease classification systems,” explains Dr. Fife. “A variety of problem wounds exist and are usually the result of multiple local and systemic factors.”

   Kazu Suzuki, DPM, thinks HBOT is “an invaluable adjunctive therapy in modern wound care clinics.” He notes about 10 to 15 percent of his patients who present at his wound care centers have indications for HBOT and he recommends it routinely when indicated. Dr. Suzuki works with the three HBOT centers near his wound care clinic. Two of the centers have monoplace chambers while the other has a multi-place chamber that fits about 10 people at the same time.

   Dr. Suzuki has discovered that most patients prefer monoplace chambers because of the privacy with more open appointment times. This is in contrast to multi-place chamber clinics, which have a fairly rigid schedule for treatment, according to Dr. Suzuki. If the patient is five minutes late, he or she will miss the treatment. However, he always emphasizes that the efficacy of HBOT would be the same in either size chamber, since “oxygen is oxygen” regardless of which clinic they use.

   Michael DellaCorte, DPM, CHT, uses HBOT as an advanced treatment for patients with diabetes and says he has attained “very positive” results. He combines several treatment options with HBOT. These treatment options include negative pressure wound therapy (NPWT), PICC lines, Apligraf (Organogenesis) or Dermagraft (Advanced Biohealing) along with weekly wound care and offloading.

   Q: What are the indications for HBOT? When would you incorporate HBOT into your treatment protocol?

   A: Dr. Suzuki follows the guidelines of the Undersea Hyperbaric Medical Society (UHMS, www.uhms.org). Both he and Dr. DellaCorte use HBOT for diabetic foot ulcers of Wagner grade III or higher.

   In evaluating all the randomized controlled trials (RCTs) on diabetic foot ulcers over the past 10 years, Dr. Fife says only HBOT trials have enrolled patients with Wagner III grade ulcers and/or significant tissue ischemia. She points out that all other RCTs excluded patients with ischemia.1 Accordingly, Dr. Fife says HBOT “stands alone in demonstrating benefit for ischemic diabetic foot ulcers.”

   The Centers for Medicare and Medicaid Services (CMS) cover HBOT for diabetic foot ulcers based on the RCT data.2 As Dr. Fife maintains, while there is no reason to believe that HBOT would not be equally effective for ischemic ulcers in non-diabetics, HBOT is only “covered” for Wagner III diabetic foot ulcers and not for similar limb-threatening ulcers in patients without diabetes. She also notes that HBOT is covered for acute arterial ischemia.

   Drs. Suzuki and DellaCorte will use HBOT for patients with chronic osteomyelitis. Dr. Suzuki notes the synergy among most antibiotics and HBOT, adding that he uses magnetic resonance imaging to monitor treatment progress.

   Hyperbaric oxygen is also covered for chronic refractory osteomyelitis as it increases the oxygen concentration in bone, and directly kills or inhibits the growth of organisms that prefer low oxygen concentrations, according to Dr. Fife. She notes that HBOT also augments the antibacterial effect of certain antibiotics that have an oxygen dependent transport mechanism across the bacterial cell wall. Dr. Fife says these antibiotics include aminoglycosides, vancomycin, quinolones and certain sulfonamides.3

   Drs. Suzuki and DellaCorte also use HBOT for skin flap failure. When it comes to a transmetatarsal amputation, if the plantar skin flap does not heal properly, Dr. Suzuki immediately sends the patient for HBOT for skin flap salvage. He maintains that HBOT in this situation is far better than doing another proximal amputation. Dr. DellaCorte points out that transmetatarsal amputations that start to necrose do not do well with HBOT. Emphasizing that hyperbaric oxygen is not a substitute for revascularization, Dr. DellaCorte says he will refer the patient for bypass first if appropriate for the given patient.

   Dr. Fife says HBOT can help treat compromised flaps that appear to have post-op ischemia. She adds that HBOT can also help minimize the amount of tissue that does not survive after a plastic surgical “flap” and reduce the need for repeat flap procedures.4

   Dr. Suzuki and his partner, a plastic reconstructive surgeon, use HBOT for many cancer patients who have had radiation. Unless the patient received a very short course of radiation treatment, he says most radiation recipients suffer from radionecrosis of soft tissue (burn wound of skin to internal bleeding) and bone (spontaneous fracturing of jaw bone, etc).

    “This HBOT indication is often overlooked but we have made a lot of people happy by offering this treatment option,” says Dr. Suzuki.

   In regard to protocol, Dr. Suzuki starts with the initial consultation with the hyperbaric doctor on site and then prescribes 20 sessions of HBOT for wound indications such as diabetic foot ulcers. Each session is usually 60 to 90 minutes of 2.0 to 2.8 ATA, although each clinic has its own protocols. He says patients with osteomyelitis and radionecrosis indications usually need 30 sessions or more. It is rare but when it comes to traumatic amputation of toes, Dr. Suzuki would recommend twice daily HBOT treatment for a week after re-attachment of the digit and then may reduce that to once-a-day treatment.

   Although treatment varies according to the patient condition, Dr. DellaCorte says most patients receive 90 minutes of HBOT at a pressure of 2.4 ATA for a total time of about 106 minutes in the chamber, including eight minutes to get to the appropriate pressure and eight minutes to decompress. Six weeks or 30 dives/treatments is his standard protocol. As Dr. DellaCorte notes, CMS requires re-evaluation every 10 dives/treatments. If there is no improvement, he stops treatment but treatment will continue if the wound is improving.

   Dr. Fife uses transcutaneous oximetry to screen patients with non-healing wounds to determine if spontaneous healing is possible. If TcPO2 values are low and do not increase with sea level oxygen breathing, she says patients are likely to have vascular disease. She will perform revascularization when possible and subsequently reassess the TcPO2.5

   If values continue to be low and patients have a diagnosis for which HBOT would be covered, Dr. Fife performs in-chamber TcPO2 studies. As she notes, outcome studies suggest that 84 percent of diabetic foot ulcers with in-chamber values >200 mmHg are likely to respond to HBOT. Dr. Fife says treatment can be at 2.0 ATA or greater as long as in-chamber TcPO2 values are >200 mmHg.6 Dr. Fife says it is not clear whether the same in-chamber values are predictive of success for arterial ulcers or failing flaps. The average number of treatments for a DFU is around 35, says Dr. Fife. She notes that if patients fail to demonstrate benefit after 20 treatments, then HBOT should stop.

   Q: In your experience, what is the main barrier to treatment with HBOT?

   A: Dr. Suzuki notes one contraindication is untreated pneumothorax. However, Dr. Fife adds that one can treat pneumothorax if it is vented. Dr. Suzuki asks patients to refrain from getting the treatment when they have sinus congestion as high pressure may exacerbate the symptoms. If the patient is having a hard time clearing the ears during HBOT, both he and Dr. Fife suggest putting pressure equalization tubes in the patient’s ears.

   Dr. DellaCorte adds that ear barotrauma due to chamber pressure and claustrophobia are other barriers to treatment. Dr. Fife notes another relative contraindication includes pulmonary air trapping (chronic obstructive pulmonary disease). Patients with COPD are at risk for pulmonary barotrauma and Dr. Fife says one must decide whether it is safe for these patients to undergo HBOT. Patients with uncontrolled seizures are not recommended for HBOT, according to Dr. Fife.

   Dr. Suzuki’s patients sometimes complain of logistical problems since the ideal HBOT occurs Monday through Friday for 20 days, meaning four weeks of commitment. For out-of-town patients (commuting for an hour or longer) or dialysis patients, he recommends treatment three times a week (on non-dialysis days). Outcome data suggest that regular attendance to therapy affects whether patients benefit, according to Dr. Fife.7 She adds that therapy five days per week can be difficult for chronically ill patients.

   Dr. Suzuki refutes the claim that patients on VAC therapy (KCI) cannot be in the chamber. He says as long as the HBOT technicians know how to disconnect and reconnect the suction hose to keep the machine outside of the chamber, patients using VAC therapy can successfully undergo treatment with HBOT.

   Drs. DellaCorte and Fife note the barrier of insurance coverage. Although it is likely that non-diabetic patients with ischemia would benefit, Dr. Fife says in the absence of acute arterial insufficiency, a failing flap or osteomyelitis, patients whose only diagnosis is chronic arterial disease do not meet current coverage guidelines.

    “This is unfortunate since there are no other interventions likely to prevent limb loss if revascularization has failed to sufficiently increase tissue oxygen levels,” explains Dr. Fife.

   Research has shown that HBOT is cost effective in comparison to amputation and increases quality of life years.8,9 Dr. Fife notes the cost benefit of HBOT is enhanced by proper patient selection. Patients are best referred before tissue loss has progressed to the point where amputation is inevitable, says Dr. Fife. She notes that transcutaneous oximetry can be useful in screening out patients who are likely to get well without HBOT or patients who cannot be helped.

   Dr. Fife says one should not use HBOT as an alternative to proper revascularization. She says those on dialysis or those who have a transplant are less likely to benefit from HBOT, but are also less likely to benefit from any other intervention.

   Dr. Fife maintains that HBOT must be under the supervision of a properly trained advanced care practitioner who can manage complications.

    “When hyperbaric treatment is used in conjunction with standard wound care, researchers have demonstrated improved results in the healing of difficult or limb-threatening wounds in comparison to routine wound care alone,” she says.

Dr. DellaCorte is a Certified Hyperbaric Technologist. He is also a Fellow of the American College of Foot and Ankle Surgeons, and a Fellow of the American College of Foot and Ankle Orthopedics and Medicine. He is in private practice in Maspeth, N.Y.
Dr. Fife is an Associate Professor in the Department of Internal Medicine, Division of Cardiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine.

Dr. Suzuki is the Medical Director of Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.

Editor(s): 

Kazu Suzuki, DPM, CWS

References: 

1. Carter MJ, Fife CE, Walker D, Thomson B. Estimating the applicability of wound-care randomized controlled trials to general wound care populations by estimating the percentage of individuals excluded from a typical wound care population in such trials. Adv Skin Wound Care 2009; 22(1):316-24.
2. Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care 1996;19(12):1338-1343.
3. Mader JT, Shirtliff ME, Calhoun JH. The use of hyperbaric oxygen in the treatment of osteomyelitis. In: Hyperbaric medicine practice. Best Publishing Co., Flagstaff, Arizona, 1999, pp. 603-616.
4. Zamboni WA. Applications of hyperbaric oxygen therapy in plastic surgery. In: Oriani G, Marroni A, Wattel F, eds. Handbook on hyperbaric oxygen therapy. Springer-Verlag, New York, 1996.
5. Fife CE, Smart DR, Sheffield PJ, Hopf HW, Hawkins G, Clarke D. Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence. Undersea Hyperb Med 2009; 36(1):43-53.
6. Fife CE, Buyukcakir C, Otto GH, Sheffield PJ, Warriner RA, Love TL, Mader J. The predictive value of transcutaneous oxygen tension measurement in diabetic lower extremity ulcers treated with hyperbaric oxygen therapy; a retrospective analysis of 1144 patients. Wound Rep Regen 2002; 10(4):198-207.
7. Fife CE, Buyukcakir C, Warriner R, Sheffield P, Love T, Otto G. Factors influencing the outcome of lower extremity of diabetic ulcers treated with hyperbaric oxygen therapy. Wound Repair Regen 2007; 15(3):322-331.
8. Cianci P, Petrone G, Drager S, Lueders H, Lee H, Shapiro R. Salvage of the problem wound and potential amputation with wound care and adjunctive hyperbaric oxygen therapy: an economic analysis. J Hyperbaric Med 1988; 3:127-141.
9. Guo S, et al. Cost effectiveness of adjunctive hyperbaric oxygen in the treatment of diabetic ulcers. Int J Technol Assess Health 2003; 19(4):731-737.

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I had the opportunity to visit with Teri Rich, the founder of Advanced Wound Care Systems, Inc. located in Taylorsville, Utah located inside the Salt Lake City metropolitan area.

Teri Rich and Dr. Sherman Johnson informed me that Advanced Wound Care Systems has been selected as one of approximately 90 installations around the U.S. for providing a Hyperbaric Oxygen therapy program for veterans.   

For more detailed information, you will need to contact Teri Rich directly at 801-964-2008.  Be sure to mention that you found her through the Hyperbaric Discovery blog.

veterans-new

 Here is the beginning of the overview for this program.  It will be completed in subsequent entries:

Department of Defense Brain Injury Rescue and Rehabilitation Project (DoD-BIRR) Rescue for Blunt Trauma, Crush & Acute Traumatic Brain Injury
Summary of Scientific Backgrounds & Overview
 
 Oxygen delivered under pressure, Hyperbaric Oxygen Therapy (HBOT) is one of the most powerful drugs known to man.  Simultaneously, HBOT delivers the substrate of life, oxygen, for which there is no substitute.  HBOT has profound beneficial effects on injury pathophysiologic processes that are common in military casualties.  Moreover, it has been shown to positively impact traumatic brain injury, compartment syndrome, burns, hemorrhage, and reperfusion injury.  These injuries and injury processes comprise the bulk of battlefield caualties.  With timely intervention of HBOT the morbidity and mortality of injured soldiers should substantially improve as they have in their civilian counterparts.  Past foreign military experience strongly suggests this benefit in extremity wounds and it is our conviction that United States soldiers deserve nothing less.  This is the goal of the Brain Injury Rescue and Rehabilitation Project (Dod-BIRR).

HBOT has both acute and chronic drug effects.  HBOT exerts these effects by obeying the Universal Gas Laws, the most important of which is Henry’s Law (2).  Henry’s Law states that the concentration of a gas in solution is proportional to the pressure of that gas interfacing with the solution.

At the point of three atmospheres absolute of pure oxygen (3 ATA), just slightly more than the amount the U.S. Navy has used for 50 years in the treatment of divers with decompression sickness, we can dissolve enough oxygen in the plasma to render red blood cells useless.  Under these conditions as blood passes through the tiniest blood vessels tissue cells will extract all of the dissolved oxygen in the blood without touching the oxygen bound to hemoglobin.  This amount of dissolved oxygen alone can exceed the amount necessary for the tissue to sustain life.  In other words, you don’t need red blood cells for life at 3 ATA of 100% oxygen.  This ability to maintain life without blood has obvious potential to battlefield casualties awaiting transfusion.

As a result of Henry’s Law HBOT is able to exert a variety of drug effects on acute pathyophysiologic processes.  These have been well documented over the past 50 years and include reduction of hypoxia (lack of oxygen), inhibition of reperfusion injury (immune response to injury), reduction of edema (swelling), blunting of systemic inflammatory responses, and a multitude of others.  In addition, repetitive HBOT in wound models acts as a DNA stimulating drug to effect tissue growth.    HBOT has been shown to interact with the DNA of cells in damaged areas to begin the production of repair hormones, proteins, and cell surface receptors that are stimulated by the repair hormones.  The resultant repair processes include replication of the cells responsible for tissure strength (fibroblasts), new blood vessel growth, bone healing and strengthening, and new skin growth.

In the past 12 years scientific research has unequivocally shown that the only drug to completely or nearly completely reverse the reperfusion injury process is hyperbaric oxygen.  This  physiological reaction of the body to trauma is  is a major  source of injury that battlefield casualties experience.  In multiple experiments with different models, different organ systems, different types of blood flow reduction or absence (e.g., heart attack, stroke, cardiac arrest, carbon monoxide, tourniqueting of an extremity, etc.) timely HBOT within hours of reperfusion injury has been shown to completely or nearly completely reverse reperfusion injury.

Simultaneously, due to HBOT’s ability to dissolve large amounts of oxygen in the liquid portion of the blood, oxygen-enriched plasma is able to reach damaged areas of tissue not accessible by normal blood flow and restore oxdative function to those areas.  The net result is a dramatic reduction in the secondary injury process, improved viability of tissue that would otherwise die.

In addition, twenty percent of the wounded in Iraqi experience traumatic brain injury (TBI) a diffuse cerebral insult characterized by primary mechanical disruption of tissue and secondary injury from ischemia, hypoxia, edema, vasospasm, neurochemicals and reperfusion injury.  A review of the medical literature shows that there is substantial data proving a beneficial effect of HBOT on the secondary injury processes of acute TBI.  HBOT has been shown indirectly to improve ischemia and hypoxia in acute TBI by its effect on aerobic metabolism and EEG.  The neurosurgeon authors of the Rockswold study conclude that  “HBOT should be initiated as soon as possible after acute severe traumatic brain injury.”

— TO BE CONTINUED in PART 2

Hyperbaric Oxygen TherapyHyperbaric oxygen therapy, or “HBO”, is a medical treatment in which a patient breathes 100% oxygen while increased atmospheric pressure (generally 2 atm) in a hyperbaric chamber. The purpose of breathing 100% oxygen under pressure is to dissolve more oxygen into the bloodstream which accelerates the body’s natural healing process.

  • What Conditions benefits from HBO?
    • Diabetic wounds or ulcers
    • Soft tissue radiation damage
    • Compromised surgical grafts or flaps
    • Brown recluse spider bites
    • Certain infections of bone or skin
    • Crush injuries where intense oxygenation may save a limb
    • Air embolisms
    • Acute Necrotizing Fascitis
    • Gangrene infection

There are many other possible conditions.  Please contact Advanced Wound Care Systems, Inc and Hyperbaric Healing Center in Salt Lake City Utah at 801-964-2008 for a consultation.

Hyperbaric Oxygen Therapy (HBOT) New evidence has been accumulated

 By Pavel I. Yutsis, MD and Iosif N. Dimant, PhD

 The concept of putting patients in a decompression chamber and raising the ambient pressure around them for therapeutic purposes was at first without scientific basis.  Perhaps intuitively it “seemed like a good idea” to b British clergyman, Henshaw, who in 1662, build a sealed chamber he called a “Domiciulium.” Chamber pressure was controlled by valves which could either raise or lower pressure.  He felt that acute disease of all kinds would respond to increased ambient pressure whereas chronic diseases were better treated with more rarefied air.

             In 1873 Fontaine, a French surgeon, built a mobile operating room on wheels which could be pressurized.  Over 20 surgical procedures were performed in this unit using nitrous oxide as the anesthetic.  Deep surgical anesthesia was possible because its increased effective percentage accompanied by a higher oxygen partial pressure, rendered it safer.  According to the law of physics, compressed air at low atmospheres gives an effective level of 42% inhaled oxygen.  Hernias were seen to reduce more easily and the patient did not have cyanotic color when coming out of anesthesia.

            In 1891, J.L. Corning, the first physician to administer spinal anesthesia, introduced compressed air therapy to the United States and was the first to operate his compressor with electric power.

             Orville J. Cunningham, a professor of anesthesia at the University of Kansas in Kansas City, was a great compressed air enthusiast.  He noted that people with heart disease and certain other circulatory disorders did poorly when living at altitude, but improved on return to sea level.  Taking this concept one step further, he felt that increased atmospheric pressure would be still more beneficial.  During the flu epidemic of 1918, he placed a moribund young resident physician in a chamber which had been used for animal studies, and by compressing him to two atmospheres was able to successfully oxygenate him during his hyposixic crisis, thereby proving to himself that his concept was sound.  He constructed an 88 foot long chamber, 10 feet in diameter, in Kansas City and began to treat a multitude of d diseases.

             Mr. Timkin of the Rollerbearing Company came under his care and apparently had a spontaneous recovery from a uremia while in Cunningham’s chamber.  In gratitude to Dr. Cunningham, Timkin build him the largest hyperbaric chamber ever constructed.  It was a steel sphere six stories high and 64 feet in diameter. T This “steel ball hospital,” located in Cleveland, Ohio, accommodated a smoking room on the top floor, plush carpeting, dining rooms and individual rooms.  It could reach three atmospheres pressure.

             Cunningham felt that some anaerobic-organism “s\which could not be cultured” was responsible for a host of diseases including hypertension, uremia, diabetes and cancer and that compressed air therapy helped inhibit this organism.  The AMA and the Cleveland Medical Society, failing to receive any scientific evidence for his rationale, finally forced him to close in 1930.  Unfortunately, the steel ball hospital was broken up for scrap during World War II.  It would have made magnificent museum.

             Basic and advanced knowledge in hyperbaric medicine was accumulated by Boerema and co-workers in the Netherlands.  During their experiments with pigs they found that life can be sustained in the absence of hemoglobin.  Subsequently, it was established by many researchers that hyperbaric oxygen therapy can provide great beneficial effects in the treatment of chronic refractory osteomyelitis (Perrins), hemmorhagic shock (Cowley), myocardial infarction (Ledingham and others), carbon monoxide poisoning, burns, wound healing, etc.

             It has been suggested by many researchers that the therapeutic effects of Hyperbaric Oxygenation in ischemic processes is based upon adequate oxygenation and improvement of oxygen diffusion and restoration of blood circulation in different tissues and organs, including the brain and its oxygen-sensitive neurons.  In fact, the majority of neurons die within 5-8 minutes of oxygen starvation (anoxia).

             Oxygen plays an important role in (1) regulation of brain metabolism (2) vascular and cellular permeability (3) enzymatic activity (4) functional activity of neuromediators (5) functioning of blood-brain barrier and spinal fluid.  Basic pathogenic factors that determine severity of brain pathology are hypnosis and metabolic derangement caused by circulatory dysfunctions (strokes, thrombosis, brain injuries) followed by brain swelling, infarcts and elevated intracranial pressure.  It is important to point out that restoration of the brain cell tissues are caused by disturbances in brain circulation and can become a long-lasting process.  In fact even in 10-15 years following an acute event, hyperbaric oxygen therapy can still produce a great deal of benefits. It has become obvious that adequacy of brain oxygenation plays a key role.  As it turned out the death of brain cells takes place only in the areas where the blood flow is severely restricted, wherein brain regions of moderately or mildly damaged tissues are not dead but not functional either, and they can remain in such state for many years.  These brain regions with poor blood flow that resulted from stroke or brain injuries are known as the “ischemic penumbra.”  They remain in the “ischemic state” due to inadequate supply of oxygen and nutrients to accumulate enough ATP from both aerobic or anaerobic metabolism to provide nerovasculariztion in the “penumbra.”  Therefore, “ischemic penumbra” will remain ischemic until oxygen delivery from capillaries into the neurons and brain tissues are completely restored.  In the areas of “ischemic penumbra,” anaerobic glycolysis produces only 2 moles of ATP per mole of glucose metabolized, whereas in the normal brain region 36 moles of ATP are formed.

             Hyberbaric oxygen forces oxygen into the plasma.  When the plasma reaches into “ischemic penumbra” it brings enough oxygen to provide for aerobic metabolism (metabolism that utilizes oxygen surges of ATP production while patient remains in the chamber.) As soon as tissues of ischemic penumbra are adequately oxygenated the repair of their “idling neurons,” glial cells and extra cellular matrix begins.

             Conclusively, evidence is steadily accumulating that with the use of hyperbaric oxygen therapy the chance for a recovery for patients with chronic neurological disorders is considerably higher than it was previously believed.

             We have analyzed the medical records of 16 patients with chronic neurological disorders (stroke, traumatic brain injuries, multiple sclerosis, ischemic encephalopathy, etc) the completed treatment at The Yutsis Center for Integrative Medicine, Brooklyn, New York, in 1999.  All sixteen patients were treated with hyperbaric oxygen therapy, using pressure of 1.54 – 1.75 ATA.  Prior to the treatment patients had their arterial blood pressure, pulse and respiratory rate checked and their tympanic membranes and pupils were examined.  Patients were placed into the chamber for 60 minute treatments with twenty minutes for descent and ascent.  Neurological examination was done on a weekly basis.  Total number of treatments varied from 30 treatments to 220.  All these patients required a course physical therapy and acupuncture for the best results.  Encouraged by successful results of the treatments, on many occasions patients requested additional treatments in spite of high out-of-pocket expenses.  The majority of the patients reported improvement of different degrees in a number of functions (improvement in speech, memory, motor functions, reading and writing.)  The majority of patients had a brain SPECT done prior to onset of treatment course and upon its completion.  In the cases of acute disturbance of blood circulation, the same efficacy in the treatment was observed.  It is established that efficacy of treatment depends upon severity of damage.

             Conclusively, in our experience, hyperbaric oxygen therapy provides greater benefits for recovery of different functions in chronic neurological conditions in patients.  We have observed improvement in mental status.  The same good efficacy in restoration of speech, reading and writing in 75% of our patients, 25% did not demonstrate any improvement.  The main difficulties in treatment were observed in restoration of motor functions – 75% of our patients improved in different degrees – 25% reported no improvement.

 Here are some case histories:

            Patient S.B – Five months prior to the beginning of his hyperbaric oxygen therapy, S.B a 60 year old male developed CVA (major stroke.)  He was comatose for about one month and a clot was surgically removed from his cerebellum, however patient was left with blurred speech, bad memory, poor balance and coordination and could not ambulate without using a cane.  His hyperbaric oxygen therapy course consisted of 20 treatments of 1.5 ATA and 25 treatments with 1.75 ATA.  Upon completion of 45 hyperbaric oxygen therapy treatments, patient improved 100% in all his functions.

             Patient J.G. – a 35 year old Italian police officer suffered from hemorrhagic stroke (CVA) 4-1/2 years ago, and underwent hematomectomy in the left temporal region.  During his first visit patient presented with sensory aphasia, right sided hemipharesis, poor memory and used a cane for ambulation.  J.G had 40 1.5 ATA and 85 1.75 ATA hyperbaric oxygen therapy treatments (total 125 treatments.)  During his physical examination patient did not need to use his can anymore.  His mental performance has much improved.  His speech became understandable and range of motions in his right upper and lower extremities improved about 40%.  J.G. started playing baseball with his 9 year old son.

             Patient R.Z – a 58 year-old New Jersey pharmacist, a sufferer of hemorrhagic stroke (CVA) 3-1/2 years ago, was brought to our office with difficulties in swallowing and was fed via gastronomy tube.  R.Z had a history of cerebral palsy with mild right-sided hemiparesis and left-sided hemiparesis as a result of the stroke.  Additionally, motor aphasia of a great severity.  Upon completion of 220 hyperbaric oxygen therapy treatments, difficulties with swallowing has been resolved and gastrosomy tube has been removed.  R.Z. discontinued using his wheelchair and is able to walk with assistance.  His speech is partially improved, his mental clarity is improved and his spasicity has decreased significantly.  Finally R.Z can take care of himself.

             It has become obvious that conventional methods of management of chronicle neurological disorders including stroke, head trauma, ischemic encephalopathy and multiple sclerosis are not satisfactory.  Hyperbaric oxygen therapy showed superior results in improvement of different functions in those affected.

             Hyperbaric oxygen therapy is also extremely safe.  A body of medical literature and clinical data clearly proves efficacy of hyperbaric oxygen therapy in acute events and even years after event.

             Our own experience is identical to JAIN’s results at Fraclinic, Clausenbach Germany.  (December 1987 – May 1989,) where improvement in gait, motor functions, speech, writing, reading and mental performance were reported.

             The data presented in this article is based upon our clinical observations and should serve as a challenge to initiate a controlled study as more data will be accumulated and become readily available.  Both physicians and patients will become encouraged to use hyperbaric oxygen therapy in the treatment of chronic neurological disorders.  The good word of this almost miraculous treatment will be spread among American citizens and reach the headquarters of insurance  carriers.  It will finally force major decision makers to at least pay attention to the benefits of hyperbaric oxygen therapy for stroke, traumatic brain injury and other chronic neurological conditions and hopefully create new reimbursement policies to cover hyperbaric oxygen therapy.

 Correspondence:

            For further information, please contact Dr. Neuberger at The Ocean Hyperbaric Center, 4001 North Ocean Drive, Suite 105, Lauderdale by the Sea, Florida 33308 USA, 954-771-4000 or Dr. Yutsis at The Yutsis Center for Integrative Medicine, 6413 Bay Parkway, Brooklyn, New York 11204 USA, 718-621-0900.

Hyperbaric Oxygen Miracles  By Dennis Gersten, M.D.

Nutritional Medicine and Psychiatry, Encinitas, CA

 In June 2002, I underwent a corneal transplant, after struggling for two years with a transplant that rejected and failed. I was blind and in a lot of pain. Three weeks after the June transplant, the new graft began to reject, which means that the body’s immune system identifies the cornea as “foreign” and begins attacking it. I underwent a very familiar treatment to me – high doses of Prednisone to suppress rejection, steroid eye drops and injections of long-acting steroids under the eye.

 The standard treatment failed and several weeks into the rejection, I knew that my time was running out. Within another week or two the cornea was likely to severely deteriorate. I needed an alternative.

After a great deal of research, I began hyberbaric oxygen therapy (HBO) at the Whitaker Wellness Institute in Newport Beach, California, founded by the well-known pioneer in holistic medicine and author of Health and Healing, Julian Whitaker, M.D.

My response was miraculous, and I kept running into other miracles at the Whitaker Wellness Institute.

After a great deal of research, I began hyberbaric oxygen therapy (HBO) at the Whitaker Wellness Institute in Newport Beach, California, founded by the well-known pioneer in holistic medicine and author of Health and Healing, Julian Whitaker, M.D. I had treatments two days in a row, and then saw my ophthalmologist the next day, who told me that the cornea was 50 percent improved. That was great news and was all the information I needed to commit to twice weekly HBO treatments. After a few months of treatment, my cornea is now 85 to 90 percent recovered.

My response was miraculous, and I kept running into other miracles at the Whitaker Wellness Institute. I asked one fellow what he was being treated for, “I used to be quad… I can’t run very well, but I walk pretty great, don’t you think?” It was hard for this conventionally trained medical doctor (me) to understand how a quadriplegic (like Christopher Reeves) could ever possibly have been cured. And then he explained, “Hyberbaric oxygen dramatically decreased edema (swelling) of the central nervous system and spinal cord after injury. It is the swelling that actually leads to the paralysis in most cases.”

I replied “So, what would Christopher Reeves be like today had he begun with hyberbaric oxygen?”

“He would be the same Christopher Reeves he was before his injury,” came the response.

I was sick for ten years. After hyberbaric oxygen therapy, I completely came out of the fog, reconnected to family and friends regained all of my mental faculties. All that is left is some fatigue.”

On another occasion, I asked a 30 year-old man what he was being treated for, “I developed Reyes Syndrome when I was 19 years old and was in a coma for four days. When I finally was able to leave the hospital and return home with my parents, it was as if I were living in a dream. I knew who my family and friends were but I felt no connection with anyone or anything in the world. I was sick for ten years. After hyberbaric oxygen therapy, I completely came out of the fog, reconnected to family and friends regained all of my mental faculties. All that is left is some fatigue.”

And on and on it went with stories like this. I wondered how I could have been so utterly uninformed about this and other oxygen therapies. I became interested in applications of HBO for my patients and for society at large.

Before going into further scientific explanations, let’s take a “dive” into the hyberbaric chamber. There are a variety of chambers, but a common one is a “three-seater.” It is a twelve-foot long steel chamber with round windows. First, a technician will place an oxygen mask on you. The mask used was the same as those used by Air Force fighter pilots. Next, the chamber door is closed and the oxygen is turned on, and you begin breathing 100 percent oxygen. Then the entire chamber is pressurized to levels between 1.5 and 3 atmospheres, the initial feeling is not unlike begin in an airplane that is either taking off or landing. Most people talk about going for a dive, since the chambers are widely used for decompression illnesses in scuba divers. I personally feel as if I am on a plane going on a vacation.

“Dennis Gersten, M.D., like myself is a conventionally trained physician. However, as a patient at the Whitaker Wellness Institute he received unconventional medical therapy. Like many of our patients, he experienced unexpected and substantial benefits. He was surprised that therapies of such benefit could be completely ignored by conventional doctors. That has disturbed me for over 25 years.”

Julian M. Whitaker, M.D.
President and Founder,
Whitaker Wellness Institute

The duration of the “flight” varies but includes about 10 minutes of pressurization, 60 minutes of treatment, and 10 minutes of depressurization. Now, there is an image to help explain what is happening during HBO. We’ll use an unopened bottle of soda pop to illustrate the process. Before you open the bottle, you can see no bubbles of carbon dioxide (CO2). As soon as you take the lid off, the bottle fizzes, bubbles form everywhere and are clearly visible. They are invisible before opening the bottle because the beverage is sealed under high pressure, causing virtually all of the CO2 to dissolve into the water. As soon as the cap comes off, the pressure leaves, and the CO2 comes out of the solution.

The same principle applies to HBO. You are breathing 100 percent oxygen under high pressure. The high pressure causes the oxygen to dissolve into the blood. As a result, extremely high levels of oxygen saturate your blood and are delivered to your body tissues. As a result of HBO, there is a 10 to 15 fold increases in the concentration of oxygen in the blood, resulting in a dramatic increase in oxygen delivery to your cells. It’s that simple, although one wants to get an HBO treatment center where the staff is well-trained since there is a lot of complexity that the doctors and technicians need to be aware of.

Immediately after the treatment, people often experience more energy, a sense of vitality, and clear-headedness. But that is not the therapeutic effect that is lasting. The true healing impact of HBO comes about after several to many treatments and is explained by several mechanisms.

HYPEROXYGENATION. Supports poorly perfused tissue which helps in wound healing and stroke.

NEOVASCULARIZATION. This means that HBO causes the growth of new blood vessels at a capillary level. If you’ve had a heart attack or are about to, developing increased blood flow, actually growing new blood vessels, via neovascularization could be quite helpful.

ANTI-MICROBIAL ACTIVITY. This is an exciting aspect of HBO, namely its ability to kill bacteria, viruses and mycoplasma. HBO is often used along with antibiotics in treating some bacterial infections and mycoplasma. HBO is often used along with antibiotics in treating some bacterial infections and mycoplasma (a common cause of chronic fatigue syndrome). Viruses cannot live in the presence of oxygen, so it is great news that there are therapies developing that can kill viruses because the anti-viral medications are not a solution to the huge problem that viruses are.

DIRECT PRESSURE. HBO is mainly used in America to treat decompression illnesses in divers, HBO reduces the volume of gases in the bloodstream.

VASOCONSTRICTION. (Constriction of the blood vessels). This occurs without loss of oxygen delivery to the tissues because HBO is delivering highly concentrated oxygen to every cell in the body. This particular mechanism is useful in helping to heal burn wounds.

All five mechanisms are at work during any of the 13 FDA approved indications for HBO therapy.

Carbon monoxide poisoning

Carbon monoxide poisoning complicated by cyanide poisoning

Decompression illness, including air o gas embolism

Gas gangrene (diabetics may develop this)

Chronic osteomyelitis (bone infection)

Radiation tissues injury

Crush injuries and traumatic ischemia

Anemia, including acute blood loss anemia

Intracranial abscess caused by actinomycosis

Necrotizing soft tissue infections

Refractory osteomyelitis (bone infection)

Skin grafts and flaps

Thermal (heat) burns

HBO is being used worldwide for a variety of illnesses and there is tremendous research already supporting these uses. In fact there are more than 30,000 scientific studies. Over the next few years, the documentation will reach the level where the double-blind studies are likely to validate many more treatments.

Here are some of the more intriguing and essential uses of HBO being used both here and abroad:

Near drowning.

Stroke.

Cerebral edema.

Lyme Disease.

Coma.

Cranial nerve disease.

Peripheral neuropathy, often seen in diabetes.

Delayed wound healing.

Diabetic retinopathy.

Tendon and ligament injury.

Accelerated healing from surgery, including plastic surgery.

Ulcerative colitis.

Multiple sclerosis.

The daughter of a woman working at the Whitaker Wellness Institute has multiple sclerosis and has had a lifesaving and life-changing response to HBO.

In Japan no one is more than 30 minutes from a hyberbaric oxygen chamber. In Europe, HBO is the very first treatment for stroke. Hence, HBO chambers are in most European hospitals. And in Moscow, there is a hyberbaric hospital. In the hospital there are large hyberbaric rooms that can hold 30 to 50 people at a time there are even HBO chambers for cats and dogs.

If HBO is the number one treatment for stroke in Europe, one realizes the tragedy going on in America. I have met people who flew in from Indiana for their HBO therapy because there are apparently very few, or no, chambers in the Midwest.

The more I have researched HBO, have experienced my own clinical response, and have spoken with many others helped or cured of dread illnesses, the more I wonder how many people could benefit from this wonderful modality-oxygen. This is a treatment based on one of our body’s greatest needs for survival, along with food and water. I wonder about all the people with brain disorders who might feel better, might lead healthier lives, if they knew about HBO.

I don’t wonder why there are so few HBO treatment centers in America, because we tend to lag 50 years behind scientific breakthroughs. As a specialist in amino acids therapy, I am well aware that we are now 40 years into this modality but years away from any incorporation into mainstream medicine. So I don’t wonder, but I do regret the lag time and I fell for the people who could experience some relief from their suffering if they had access to ( and knew about) hyberbaric oxygen.

To quote Dr. Julian Whitaker, “Most physicians are only aware of HBO’ best-known use, to treat decompression illness (the bends) in divers. This I a shame. This remarkable therapy should be available to millions of patients who would fare much better with it than the drugs and surgical procedures they’re currently getting. Ask your doctor about hyberbaric oxygen therapy, and suggest that he or she look at the medical literature. Patient demand will likely be the deciding factor in making this therapy universally accessible.”

A final word – Prior to World War II there was a gigantic hyberbaric treatment facility in Chicago. However, it was dismantled so that the metal could be used to help fight the war. No such facility has replaced that one. Nonetheless, one at the time we can climb into these healing chambers, perfuse our tissue with oxygen and recover from a variety of symptoms and illnesses.

No, I can’t.  I am going to be out of town” I replied.

With that being said we walked inside the clinic and to Dr. Jolly’s office.  I could not help but to be impressed by the care in which the doctor took in making sure all the items were delivered to the shelter and enlisting the help of others as we got started with our meeting.

Dr. Jolly signed up the clinic with our referral network.  This began a friendship and over the coming months I saw more of Dr. Jolly and interviewed many who had worked with him and Dr. Julian Whitaker’s clinic for enhancing their health.    I began writing about and providing referrals to them with people who were interested in EECP, Chelation, Acupuncture, Hyperbaric Oxygen therapy and the other modalities serviced by the Whitaker Institute and Clinic.

Dr. Jolly also introduced me to Denise Hetrick who at the time was starting a neurofeedback practice in a new location.  The two of them provided an unbelievable amount of knowledge.  Denise is very smart and it took me months to understand what her center did for her clients.

Now that I am more educated on neurofeedback, I have found a wealth of information on its benefits.

deniseneurofeedbackpatient

The story that leads me to Teri Rich and her Hyperbaric Healing Systems, Inc. and Advanced Wound Care Systems, Inc. which is located in Salt Lake City, Utah actually began several years ago in Newport Beach, California.

I first began to understand what hyperbaric oxygen therapy is by an introduction from Dr. Donald Jolly-Gabriel. Dr. “Jolly” as he likes to be called is the Director of Education and Hyperbarics for the Whitaker Institute and Clinic, located in Newport Beach, California.

I have found Dr. Jolly to be an unbelievable humanitarian and a very caring soul. I was originally called by Dr. Jolly after he found my Alternative Medicine Referral Network. We were both located in Newport Beach at the time, and he suggested we collaborate on how we can help each other and we arranged a meeting.

Our initial meeting was during the holiday season, as Thanksgiving was approaching. I saw a man in a lab coat frantically carrying boxes and directing a few people as I parked in the driveway of the Whitaker clinic. It was my appointment – Dr. Jolly and he was taking some time during his break to make sure food and items got delivered for the homeless at a shelter in Orange county. “Are you going to come with us to feed the homeless on Thanksgiving?” He asked.

Dr. Donald Jolly Gabriel PhD and Denise Hetrick of Clear Mind Center standing in front of a Hyperbaric Oxygen device.
Denise Hetrick of Clear Mind Center and Dr. Donald Jolly Gabriel PhD of Whitaker Wellness Institute, standing in front of a Hyperbaric Oxygen device.