Hyperbaric oxygen therapy (HBOT) was originally created to treat medical conditions caused by scuba diving. One condition, decompression sickness, or 'the bends,' can be painful and sometimes deadly. During a dive, nitrogen gas enters the body. If a diver surfaces too quickly and returns to normal pressure, the gas expands rapidly inside the body without being released fast enough.
In divers, HBOT is also used to treat gas embolism, which occurs when gas bubbles enter arteries, veins and/or capillaries, resulting in poor blood flow.
Traditionally, HBOT uses a pressurized chamber to deliver 100 percent oxygen to the body. In our normal environment, the air we breathe is about 20 percent oxygen and 80 percent nitrogen. According to the United States National Library of Medicine and the National Institutes of Health, the air pressure inside a hyperbaric oxygen therapy chamber is two and one half times greater than normal atmospheric pressure.
For certain conditions approved by the Undersea and Hyperbaric Medical Society (UHMS), Medicare and some health insurers will cover HBOT. In private clinics, HBOT sessions can cost from $100 to $200 while hospitals may charge over $1,000.
HBOT has also been found to be effective for traumatic brain injury, strokes, cerebral palsy, autism, near drowning, near hanging, birth injury, genetic disorders like mitochondrial disease, multiple sclerosis, chronic fatigue, among other conditions.
Paul G. Harch, M.D., a hyperbaric and emergency medicine physician, talks about hyperbaric oxygen therapy.
What happens inside a hyperbaric chamber?
Dr. Harch: The pressure of the atmosphere in the chamber increases as 100 percent oxygen is added to the chamber. That oxygen is dissolved into the lungs and into the liquid portion of the blood. It reaches areas in the body it normally wouldn't reach because of the very high concentration.
How does hyperbaric oxygen therapy help patients with traumatic brain injuries or brain injuries in general?
Dr. Harch: There is a characteristic of severe traumatic brain injury where normally the blood flow and metabolism, like gasoline and RPMs in an engine, are tightly coupled. In a severe injury, blood flow and metabolism are uncoupled, so blood is rushing through the blood vessels and the cells are damaged and essentially not working. There has never been, in the history of science, any drug or therapy that has been able to recouple this severe derangement until hyperbaric oxygen. It was demonstrated that a single treatment in acute severe traumatic brain injury, in the first few days after injury, could recouple the severe derangement in the brain. Hyperbaric oxygen therapy is a remarkable discovery.
What are you finding when you treat people with hyperbaric oxygen? What does the oxygen do to their brains?
Dr. Harch: A variety of things from the acute injury. Some of the machinery of the cells can be so damaged that they can only live in a kind of low RPM state. The cells are just humming, idling along, and there is something about hyperbaric oxygen that overrides that freeze on the machinery and the next thing you know the cells start to function again. As this is done repetitively, however, what seems to happen is new blood vessels are growing in the damaged areas and that makes the brain cells function better.
What does the oxygen do to the blood vessels?
Dr. Harch: Oxygen stimulates growth of new tissue. Everywhere this has been done in the body with hyperbaric oxygen therapy to chronic wounds, the net effect has been the growth of new blood vessels and new tissue. Indirectly, we proved that in an animal model and there is no other way, I think, to explain what is going on in humans.
How do you treat the patients who come to you with brain injuries and what changes have you seen in them?
Dr. Harch: It depends on their injury, but I do a lengthy physical exam. I usually do a video part on the exam to try to capture things that are not easily captured on and recorded on a written physical exam, and then I often image them. I image them with a brain blood flow type of imaging that shows the functional abnormalities, which leaves us some choices. We can put them in the chamber once, take them out, and repeat that scan and see if we have affected their brain with just one treatment or I treat them in a prolonged fashion and then at some other point, begin to re-image them. Some people we don't image, I just go ahead and start treating them and they go through a series of treatments. I try to get them to about 40 treatments and it seems like it's a magic number for the human body to respond to hyperbaric oxygen. By that point we usually have permanent improvements in function.
One young adult patient, five and a half years after severe traumatic brain injury, had been to every rehab facility and finally, was treated with hyperbaric oxygen. The right temporal lobe and the cerebral lobes, plus other areas in the brain, became very noticeably affected by the hyperbaric oxygen. According to the brain blood flow scan, there had been significant reductions in blood flow due to her injury. After a single hyperbaric treatment we saw noticeable improvements in this patient's very damaged areas that were similarly improved after four months of hyperbaric treatment. Clinically, she was functioning better, she was improved in her ability to write, had improvements in her endurance, ability to walk, and in her emotional state.
What do you see in these people after the 40 treatments, before and after?
Dr. Harch: It depends on the diagnosis. For instance, in the case of near drowning -- the most difficult of all to treat -- you will see some improvements in their tone, awareness. You can see their seizures decrease in frequency and severity. We don't usually see the dramatic types of changes in chronic near-drowning because there is so much brain damage. In patients with traumatic brain injury and, for instance mild traumatic brain injury, there is only microscopic loss of tissue. Most of their deficits are cognitive and emotional; short temperedness, irritability, fatigue, memory problems, attention, concentration. After HBOT there is a general improvement in a majority of those functions; a return to their pre-injury status.
How does the treatment work to reduce symptoms like memory loss?
Dr. Harch: On a biological level, all I can tell you is we appear to be repairing some of the damaged tissue. The hardest evidence I have is what we did in an animal model where we saw an increase in blood vessel density to the damaged area and simultaneously the rats were able to recover some of their lost cognitive abilities (their short-term memory). You have to have new tissue growth and making new connections to recover that function. I think that is probably what is going on in the humans as well.
Are there other human studies that prove hyperbaric oxygen therapy is really working?
Dr. Harch: Yes, in different models and, for instance in an acute severe traumatic brain injury, we have more clues and evidence of the effectiveness of HBOT then we do for almost any one of the other 14 indications that are approved by the FDA and reimbursed by both insurance companies and Medicare.
As you treat these patients, what does this mean for them?
Dr. Harch: It turns their life around, which is what is so rewarding about this and why I keep doing this. Our brain controls all of our being, our intellectual function, our personality, our jobs, our relationships, our emotions -- everything -- and when people who have such dysfunction recover; it changes their lives in immeasurable ways.
What do you see the hyperbaric chamber as being capable of?
Dr. Harch: Oh, I see it as revolutionizing medicine because there are so many applications and I talked about them in the book. It has been confirmed in a study that animals can be resuscitated 25 minutes after warm cardiac arrest or 25 minutes after they are dead. It is unparalleled and it started with a case about a human in a hyperbaric chamber who is alive today and fully functional; however, in human terms, the longest amount of time is usually about 15 minutes of warm cardiac arrest and no one survives. Cardiac arrest, surgical complications, dementia, traumatic brain injuries, residual effects of stroke, cerebral palsy, autism -- the list of possible things treatable with hyperbaric technology goes on and on. This is a little bit of an atypical route that we are going here, but its necessary because the impact of this and the potential, especially now for the hundreds of thousands of brain-injured soldiers just in our country alone; but for traumatic brain injury worldwide, this could change healthcare so dramatically that what we are doing here today is very important.
What does oxygen do inside the brain?
Dr. Harch: As I mentioned to you earlier, it appears to be causing new tissue growth. Between the input of hyperbaric oxygen and the output of new tissue, no one understood the intermediate steps until the last 15 years. Now, with biochemical techniques that are more sophisticated, we are finding the oxygen acts like a drug and the sight of action is in the DNA in the cells. The oxygen is unlocking and stimulating certain gene sequences that code for growth and repair hormones. The oxygen is stimulating the DNA in our cells to begin to transcribe these hormones that then cause growth and repair.
What is the cost of one hyperbaric oxygen treatment if you don't have insurance?
Dr. Harch: About $200.
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