Progress & Recognition for this Oxidative Modality
Hyperbaric oxygen treatment is a rapidly growing oxidative modality. One used only to treat dicers with the bends by using high pressure oxygen to force nitrogen gas out of the blood. Today it is recognized by physicians and insurance companies to treat a whole host of conditions.
The list keeps growing. Today it includes Gas Embolism, Carbon Monoxide, Crush Injury, Decompression Sickness, Clostridial Myonecronsis (gas gangrene), Selected Wound problems, Severe anemia, Narcotizing infections (flesh eating bacteria), Osteomyelitis, Radiation tissue damage, Compromising skin grafts, Thermal burns, Intracranial abscess, Diabetic sores.
The idea of treating disease with pressurized air dates back to the 1600's. The early efforts were without scientific basis and were equally unsuccessful. It was not until the 1950's that pure oxygen was used in a pressure chamber for cardiac surgery. It was found to be highly effective for treating carbon monoxide poisoning and gas gangrene.
In the 1970's, however, interest in Hyperbaric Medicine dulled with the invention of the heart lung machine. Since that time, interest in Hyperbaric Medicine has renewed and currently has 14 approved applications by the Undersea and Hyperbaric Medical Society.
The Hyperbaric oxygen (HBO) treatment can be given in two ways - the monoplace or the multiplace chamber. In the monoplace chamber the patient lays on a stretcher which slides into the chamber which is then sealed. Pure oxygen is used to pressurize the chamber. In the multiplace chamber, several patients are treated in a large chamber and breathe oxygen from a face mask or a hood. Both types of chambers enjoy equal results.
Some Examples include the following case histories. A young Marine who came back from Vietnam dying of osteomyelitis of the spine presented a pathetic picture to doctors at Long Beach, California, Naval Hospital.
His weight had dropped from 160 to 80 pounds, and no treatment had been able to arrest the infection rate raging in his bones. But when he was treated with pure oxygen under high pressure (OHP), his condition swiftly turned around and he began not only to recover, but to thrive.
In London, doctors were groping for some treatment to help a 53-year-old man who had been suffering since the age of 8, when he had undergone radical mastoidectomy. Following this surgery, he had a chronic ear discharge which proved resistant to all therapy, including the surgery.
Primarily because there seemed to be nothing to lose, doctors put the patient in a Hyperbaric chamber with 100 percent oxygen at twice normal pressure for 90 minutes on each of four consecutive days. His ear discharge promptly ceased for the first time in 45 years.
In New York, a premature baby fought feebly for his life with an infected meningomyelocele - an abnormal protrusion of the spinal cord. Nothing was able to stop the infection until a doctor used a small portable chamber which could apply pure oxygen under pressure directly to the infected area. Two days later, the infection was cleared up and the infant was ale to undergo corrective plastic surgery.
Fifteen or twenty years ago, most doctors would have laughed at such dramatic successes achieved with nothing but concentrated and pressurized oxygen. And some did more than laugh. Some of the pioneers in the field of Hyperbaric oxygen were subjected to severe criticism and scorn by their colleagues, and at least one report on Hyperbaric oxygen submitted to a medical journal was rejected as "absurd."
Today, Hyperbaric oxygenation should still probably be regarded as in the late experimental stage. But it's undeniable that thousands of people with a variety of problems have been saved from death by the judicious use of OHP.
It's considered the definitive therapy for carbon monoxide poisoning, probably the single most effective treatment for several deep-seated infections such as the gas gangrene which may develop in a limb with bad circulation, and also an extremely promising and often surprisingly effective aid in improving the mentality and behavior of people suffering "senility" caused by poor delivery of oxygenated blood to the brain.
But Hyperbaric (the word simply means high pressure) oxygenation is not without its dangers. In amounts not very much greater than those used therapeutically, excess oxygen becomes toxic to certain enzyme systems and can damage eyes, lungs and even the central nervous system.
Considerable caution must be used with OHP both in selection of patients to be treated and in monitoring the heart, blood, and nerves before, after and preferably during treatment. Today, as more and more hospitals install OHP units, doctors are becoming more familiar with the therapy, and an experienced practitioner should be able to reduce these risks to a very minimal level.
OHP did not become medically "respectable" until about 1970. It is no great testimony to the imagination of the medical profession that OHP is just now beginning to come into its own. Pressurized oxygen was first used medically in England three centuries ago, to treat caisson workers who developed "the bends" when they came out of the water after working in chambers pressurized with ordinary air.
The pressurized pure oxygen dissolved the nitrogen bubbles which had formed in their blood and gradually restored their body chemistry to normal. Today, the same treatment is still used for diving illness and also for carbon dioxide and monoxide poisoning.
Perhaps it is a bit more difficult to understand how pure pressurized oxygen can be of help in conditions where there isn't such an obvious and immediate need to force oxygen into the system. It may help to realize that oxygen is a vitally needed nutrient, just like protein or vitamin C or calcium.
But while weeks or months can go by until a deficiency of protein or vitamins can produce a life-threatening situation, oxygen deficiency symptoms develop in seconds. Irreversible brain damage and death follow in minutes. Every living cell in the body requires oxygen as its basic fuel for life processes.
When oxygen starvation is localized, as it is, for example, in advanced arteriosclerosis of the legs, or frostbite, the cells in those areas grow weak and unable to perform normally, just as a motor or an engine does when it is deprived of its required amount of gasoline or electricity.
Defenses against are vastly lowered. The reparative process becomes paralyzed. Many cells may actually die. The result may be progressive gangrene, necessitating amputation of a limb.
OHP FIGHTS HARMFUL BACTERIA
This leads us to one of the most impressive uses of OHP - and one which is relatively easy to understand: fighting infective anaerobic bacteria. These are microorganisms which can multiply and develop toxins only in the absence of oxygen.
For reasons which are not at all clear, however, only certain of these organisms can be controlled by OHP. Fortunately, the organisms which are involved in a condition called gas gangrene are highly vulnerable to OHP. Gas gangrene (so-called because the bacteria actually produce gas as a metabolic by-product) usually results from an injury in an area where the circumstances is poor, and destroys both muscle and skin as it grows and produces a constant wet discharge.
OHP is particularly valuable here because the bacteria which cause this condition are usually highly resistant to antibiotics. A report in the British Medical Journal in 1965 stated that "Hyperbaric oxygen has saved both life and limb...One of the most dramatic features is the almost immediate arrest of the disease and the improvement in the patient's condition.
Hyperbaric treatment is combined with antibiotics, and surgery is deferred until after it is complete, when the operation can often be confined to simple procedures such as the removal of necrotic sloughs [dead tissue] and skin grafting."
Despite its success in fighting gas gangrene, OHP is almost totally ineffective against tetanus, caused by germs very closely related to the clostridium in gas gangrene.Curiously, Hyperbaric oxygen can also be very effective in beat down infections caused by germs which ordinarily can multiply in the presence of oxygen.
This seems to be the case only when the ? is localized and embedded in dying tissue, such as bedsores. H. Fisher of the New York University School of Medicine wrote in 1971 that "the main purpose of the treatment is to deliver oxygen to tissue that is suffering from relative hypoxia [oxygen starvation]."
Apparently, when damaged tissue cannot utilize oxygen, it has no defense against infection. And OHP, applied locally to these infections, seems to turn the tide in favor of the body's natural defenses.
Dr. Fischer was the physician who reported the case of the premature baby saved from an infection with the help of locally applied OHP. He said the organism involved in that case was the bacteria known as Aerobacter, and added that "strep, staph, and Klebsiella we know are suppressed quickly."
But he also added that two other rather common infective organisms, Pseudomonas aeruginosa and Candida albicans, can actually be stimulated by oxygen if the pressure is not sufficiently high. "I must warn against unwarranted enthusiasm," Dr. Fischer declared. "The therapy must be applied only in properly selected cases. One of the most experienced workers in Hyperbaric oxygenation is Dr. D.J.D. Perrins of London.
It was this physician who reported how OHP cleared up the ear discharge which had afflicted a patient for 45 years. And it was his work with chronic osteomyelitis which was responsible for stimulating doctors at the Long Beach Naval Hospital to try - successfully - OHP for the young Marine dying with this disease.
Dr. Perrins told an international conference on OHP held in 1965 that in 17 of 24 patients with chronic osteomyelitis (an infection seated in the bones which may spread) that he treated with OHP, he obtained healing of the skin and drying up of discharges in anywhere from 4 to 32 days.
He stressed, though, that one ought not to conclude that the underlying disease was influenced by OHP. He suggested rather that the extra oxygen probably stimulated the action of the body's phagocytes to wage more aggressive war against invading pathogens. He also pointed out that Hyperbaric therapy for osteomyelitis is performed in conjunction with more orthodox approaches, including antibiotic therapy.
Dr. George B. Hart, who at the time of this writing was associated with the Baromedical Research Unit of the Naval Regional Medical Center in Long Beach, California, is one of the outstanding clinical researchers in the field of OHP.
In the most recent report of his work (published in 1974) Dr. Hart said that he and his colleagues had treated a total of 90 patients with osteomyelitis, all of whom had failed to improve with antibiotic or surgical therapy. In 63 out of 90 cases, he said, Hyperbaric oxygen therapy achieved complete success. All of the 27 patients who were not healed were improved, with less drainage and less bone pain.
During the course of these treatments, Dr. Hart and his colleague, Dr. Robert C. Winans, discovered that the best results were achieved with patients who had the disease for a relatively shorter period of time. From this, it is reasonable to conclude that osteomyelitis patients should waste no time in talking to the doctors at an OHP clinic.
Another important finding was that treatment failures were often associated with smoking. This prompted the doctors to forbid tobacco to all patients - going so far as to drop them from therapy if they refused to quit.
Good nutrition and adequate vitamin intake were also stressed. In an article written with E. G. Mainous, D.D.S., and P. J. Boyne, D.M.D., on the use of OHP in osteomyelitis of the jawbone, Dr. Hart and colleagues said that "Vitamin E was given routinely to all patients in doses of 100 mg. per day since it has been shown experimentally to reduce the possibility of oxygen toxicity" (Journal of the American Dental Association, December 1973). Depending on the kind of vitamin E used, 100 mg, is equivalent to approximately 125 to 150 international units (I.U.) of vitamin E.
HYPERBARIC OXYGEN TREATMENT IN CASES OF BLOOD LOSS
Dr Hart revealed in a 1974 report how Hyperbaric oxygen can be a literal lifesaver for people such as Jehovah's Witnesses whose religious convictions forbid them from receiving a blood transfusion. He received three patients who had suffered acute blood loss for various reasons, and who all refused to have the blood transfusion that was apparently necessary to save their lives.
Dr. Hart treated the patients by administering intravenous fluids, injections of iron dextran and Hyperbaric oxygen. OHP was administered at the more-or-less typical two atmospheres absolute for 60 to 90 minutes at each treatment. The number of treatments varied according to the patient.
One woman required a total of 35 hours of OHP. Treatment with Hyperbaric oxygen resulted in dramatic improvement, with reversal of the signs and symptoms of hypoxia [lack of oxygen] in all three patients," Dr. Hart reported (Journal of the American Medical Association, May 20, 1974).
What the treatment accomplished was to load the limited number of red blood cells which these patients had with the absolute maximum amount of oxygen, along with the iron needed to carry it. They were then able to get past the crisis stage and survive until their bodies could produce more red blood cells.
For one patient out of the three, though, this didn't work. She continued to bleed from a diverticular lesion of the intestines and although she improved over her initial state, her continued loss of blood could not be overcome by the addition of extra oxygen and iron. On the fourth day of her hospitalization, her husband consented to a transfusion.
Encouraging preliminary studies suggest that Hyperbaric oxygen may be a virtual "specific" in many cases of chronic dizziness. Dr. Sreedhar Nair and associates at the Norwalk Hospital in Connecticut tried a course of the treatment on seven patients with chronic vertigo which had not responded to any other treatment.
Most of the patients became so dizzy simply on standing that they were unable to walk. Others could walk, but only with a staggering gait. Several of the patients were often in a confused state and two had recurrent episodes of nausea. In all but one patient, there was evidence of arteriosclerosis.
Each patient was given Hyperbaric oxygen at two atmospheres absolute during a series of treatments consisting of two-hour units. The total time of treatment ranged from six hours to thirty hours. The doctors reported that the response was "excellent" in five cases and "good" in two others.
Virtually all the symptoms were either entirely cleared up or greatly reduced. A follow-up period indicated that the beneficial effect was not only temporary. Months after the treatment faltered, there were only a few scattered recurrences reported.
No one can yet say why patients with chronic vertigo are benefited by Hyperbaric oxygen. However, as the researchers themselves pointed out, it seems most likely that it did the job by restoring oxygen sufficiency to centers deep in the ear or within the brain which control equilibrium. And this brings us to the most controversial - but perhaps most promising - use of Hyperbaric oxygen.
OHP AND BRAIN DAMAGE
The brain consumes oxygen faster than any other organ of the body. Its need for this nutrient is so great that, deprived of it for only a few minutes, it can no longer maintain consciousness. During cases of cardiac arrest, it is the brain which is in the greatest danger. While the rest of the body can get along amazingly well without oxygen for a limited time, irreversible brain damage is almost certain to occur after about seven minutes of heart stoppage.
N Narrowing and hardening of the blood vessel with advancing age are believed to be a major cause of gross senility. The impairment in oxygen nutrition may also be a factor in much more subtle psychiatric changes associated with age or circulatory impairments such as a stroke.
Theoretically, if oxygen sufficiency could be restored in these cases, there would be a good chance of clinical improvement. So far, the evidence seems to indicate that in some, but not all, cases of cerebral oxygen insufficiency, Hyperbaric oxygen can bring about gratifying improvement.
Pioneering in this application of OHP were Eleanor A. Jacobs, Ph.D., and colleagues, all of Buffalo, New York. In 1969, they reported in the New England Journal of Medicine the results they achieved using OHP to treat 13 elderly male patients, all of whom had been hospitalized for many months, and in some cases for several years, because of the symptoms of senility.
The patients were first given three standard tests designed to evaluate efficiency of memory, concept formation, and presence of physical brain damage. Arterial blood samples were also obtained and tested for oxygen.
Each of the 13 was treated for 90 minutes twice a day, for 15 days, with Hyperbaric oxygen. At the same time, 5 other patients were used as controls, and although put in a chamber, breathed a mixture which was nearly identical to ordinary air.
When all the patients were retested, an average of 12 hours after coming out of the chamber, those who had been breathing pure oxygen showed remarkable increases in their scores, while the control patients had no significant change. In the experimental group, the mean average score on the Wechsler Memory Scale went from 76 to 103; the average score on another test went from 10 to 41; and on a third test from 25 to 49.
Blood samples taken during the tests showed a very marked increase in the amount of oxygen in the blood of those breathing the pure oxygen, while the control subjects had no increase at all. This aimed to establish a very clear relationship between increased oxygenation of the brain and mental performance in elderly senile people.
Now for the big question: Is this improvement temporary or permanent? The answer, although still not clear, is intriguing. Dr. Jacobs and the three M.D.'s she worked with pointed out that when oxygen concentration is increased in the blood, it ordinarily diminishes very quickly, returning to normal in about 30 minutes. Oxygen levels in the brain may be normalized even sooner.
But the tests which revealed improvement were given an average of 12 hours after oxygenation which means that the improvement lasted at least 24 times longer than can be explained by the presence of extraordinary amounts of oxygen in the brain.
This classic study was carried out some years ago. In a more recent report Dr. Jacobs said that a research team had now studied 75 "very deteriorated" persons and results continued to indicate "that improvement persists much longer than we would have expected."
Although she admitted freely that she is not certain exactly how long the improvement lasts, she did venture to say that the treatment holds more promise for patients who are relatively less deteriorated. (On the other hand, she has also said three out of the five "extremely deteriorated" brain-damaged patients exhibited varying degrees of quite unexpected improvement after OHP treatments.)
Doctors at the Miami Heart Institute in Florida in 1973 that they had been using OHP therapy with a total of 54 senile patients with generally good results - although the improvement seemed to be temporary, rather than permanent. In 1974, OHP pioneer, Dr. Hart, and colleague, Dr. Allan E. Edwards, reported gratifying results with 20 volunteers - average age 68 - who complained of recent memory lapses and other signs of approaching senility.
Before-and-after tests indicated the greatest improvement was achieved in the areas of short-term memory and the ability to perform complicated visual tasks. Curiously, two of the subjects reported that after treatment they had to be fitted with new glasses because their visual acuity had actually improved. Drs. Edwards and Hart also noted that following 15 OHP sessions, there was no evidence that these patients had stopped improving.
Dr. Hart has also used OHP to treat stroke patients whose improvement had "plateaued" after other therapy. His tentative conclusion in 1973 was that "there appears to be the sort of improvement that would rule out coincidence."
Dr. Edgar End, Director of the Hyperbaric Unit at Milwaukee County General Hospital, told Medical World News in 1973 that he has seen "encouraging results" using OHP in a small number of brain damaged children. although he insisted that it was too early to draw concrete conclusions, he did note that in several cases, the improvement was so dramatic that teachers called the parents to ask them what had happened to cause the tremendous improvement in attention, cooperation and coordination.
A t least two reports have appeared in the medical literature indicating that simply breathing pure oxygen through a mask, rather than sitting in a pressurized chamber, can bring about beneficial results with senile patients. But another study indicates that oxygen without the extra pressure does not accomplish anything. All three of these studies, however, were conducted with only small groups of patients, so nothing definitive can be said at present about the beneficial psychiatric effects of breathing unpressurized oxygen.
Needless to say, research is finding out more about Hyperbaric oxygen every year. Some of the research centers around relatively obscure conditions such as Fournier's disease - a kind of aggravated gangrene of the scrotum.
Dr. Charles Abbott, Hyperbaric chief at the St. Barnabas Medical Center in Livingston, New Jersey, has used OHP as an important tool in successfully treating 14 patients with this disease. Other research centers around much broader applications - such as the possible use of OHP in maintaining oxygen sufficiency in heart and surgery patients. Some of the early results look very promising.
What is Hyperbaric Oxygen?
HBOT is a prescription only medical treatment in which the patient breathes pure oxygen at a pressure above normal atmospheric pressure. HBOT is used for a wide variety of treatments and is usually prescribed as part of an overall medical care plan. HBOT is simple in concept, but requires expert knowledge to be safely administered and fully effective. The oxygen content of the patient's bloodstream is increased to many times its normal level and this helps to control infections and promote healing in many kinds of illness.
What are the effects?
HBOT is painless, although during pressurization and decompression of the treatment chamber, patients may experience ear popping similar to that experienced when flying in an airplane. The rate of pressure change will however be adjusted for the patient's comfort.
When chamber pressurization is completed, the patient breathes oxygen from an aviation type mask, which is quite comfortable and does not prevent talking. In some cases, patients may feel a little light headed for a few minutes after treatment. For this reason we do not allow them to drive for up to an hour after each exposure.
Is HBOT safe?
The chamber is pressurized with medical quality air and is not therefore considered a hazardous environment. The treatment has no toxic or radiation elements. There is constant monitoring of the patient in the chamber, and the treatment is carefully controlled by a trained Life Support Technician (LST), with the Hyperbaricist in constant attendance. Most patients pass the time during treatment by watching a video, listening to music or sleeping.
How long does treatment take?
Each treatment (exposure) last between 30 to 90 minutes. The number of exposures required will be decided in consultation between your physician and the Hyperbaricist based upon: your condition, its severity, your individual response to therapy and your ability to tolerate chamber time. Treatment may be scheduled daily or in some cases twice daily. Follow up exposures may be scheduled at longer intervals. Vital signs are taken and recorded before and after each treatment.
How should patients prepare for HBOT?
Patients are given a pre-treatment advice sheet when they attend for their pre-exposure consultation with the Hyperbaricist. Only clean cotton clothing is allowed in the chamber. No cosmetics, perfumes, hair preparations, deodorants, wigs, or jewelry will be allowed in the chamber.
A book or magazine, however, is permitted. The Hyperbaricist needs to know if any drugs are being taken by the patient, and patients are advised not to take alcohol or carbonated drinks in the four hours prior to treatment. In most cases, patients should give up smoking and any other tobacco products during the treatment period as these interfere with the body's ability to transport oxygen.
Are there any side effects?
Some patients find that their visual acuity changes during treatment, but this returns to normal following the completion of treatment schedules. Patients are advised not to change their lens prescription. Cataracts may be accelerated by HBOT, but are never caused by it.
There may be some ear discomfort, and this, if it happens, should be discussed with the staff. There are few counter-indications for HBOT, and even fewer unwanted side effects, however, for precautionary reasons we do not treat pregnant women except for life threatening emergencies.
What can be treated?
HBOT is used to treat all conditions which benefit from increased tissue oxygen availability, as well as infections where it can be used for its antibiotic properties, either as the primary therapy, or in conjunction with other drugs. Indications include:
Conditions which are treated as "Treatments of first choice" include the following:
Primary indications Air or gas embolism, Carbon monoxide or smoke inhalation, Cyanide poisoning, Gangrene - including diabetic ulceration) Crush injury and acute ischemia, Wound healing (including surgical wounds), Exceptional blood loss and other acute anernias, Soft tissue necrosis (including spider bite), Osteomyelitis, Osteoradionecrosis, Soft tissue radionecrosis, Thermal burns, Meleney Ulcer, Acute peripheral arterial insufficiency, Skin grafts and flaps including stump ulcerations, Edema, including cerebral or spinal edema, Actinomycosis
Closed head injuries, Sickle cell crisis, Blast injuries, Hydrogen sulfide poisoning, Anoxic brain injuries, Peyote poisoning, Feus, Spinal cord contusions, Vasculitis, Occlusive stroke, Encephalitis and encephalopathy, Cranial nerve syndromes, Peripheral neuropathy, Charcot Marla's Tooth Disease, Cellulitis, Necrotizing Fasciitis, Clostridial bacterial infections, Bone surgery, fractures and grafting, Aseptic necrosis, Peripheral vascular ulceration, Burger's disease, Frostbite, Diabetic retinopathy, Retinal artery occlusion, Retinal vein thrombosis, Leprosy, Migraine, Pneumatosis Cystitis, Pseudomembranous colitis, Rheumatoid Arthritis (acute), Scleroderma, Peptic ulcer, Myocardial infarction, Refractory Mycosis
There are of course many other illnesses which may be treated with HBOT, often in combination with surgery or pharmaceutical drugs. Any condition which has hypoxic elements will benefit from HBOT. Given at the appropriate time, or as an adjunctive therapy, HBOT can significantly reduce recovery time and after care costs.
HBOT is currently one of the most rapidly advancing modalities in American medicine. Research work is being done into the uses of HBOT in the treatment regimes of:
Migraine Alzheimer/senility Damaged brain cells In combination with chemo/radiation therapy Acceleration of tumor necrosis B cell Leukemia Rapid healing for plastic surgery AIDS Cardiac dysfunction Stroke HBOT given to stroke victims in Germany has been shown to reduce aftercare costs by more than 70%.