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Pressures on: Hyperbaric Oxygen Therapy

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When Jon Dembo realized his son had autism, he joined the millions of people who have sought out alternative therapies, many times without success. But then he was introduced to hyperbaric oxygen therapy.

“I swear it really made a difference in his growth,” said Dembo, who soon after became a certified hyperbaric technician. Hyperbaric oxygen therapy has not been scientifically proven to help with autism, but many have tried it as an alternative therapy to treat it and many other neurological diseases.

“People really say they feel better and you really do notice a difference, although the results are different for everyone,” Dembo said.

However, those wondering about giving hyperbaric medicine a try might want to think again because insurance has a small and defined list of health problems it covers with hyperbaric treatment, otherwise known to those in the practice as “the 13 Commandments of Hyperbarics.”

Those are: - Air or gas embolism - Carbon monoxide poisoning - Clostridial myositis (Gas Gangrene) - Crush injury or other traumatic ischemias - Decompression sickness - Arterial insufficiencies, (Enhancement of healing in selected problem wounds). - Severe anemia - Intracranial Abscess - Necrotizing soft tissue infections - Osteomyelitis - Delayed radiation injury (soft tissue and bony necrosis) - Compromised grafts and flaps - Acute thermal burn injury

Although there are a variety of different health problems treated with hyperbarics, the most common treated at hospitals is to treat ulcers in diabetes patients.

“Hyperbaric treatments have been shown to reduce amputation in diabetic foot wounds by 80 percent. And diabetic foot wounds are the leading cause of amputations in the United States,” said Richard Gustavson, the hyperbaric medicine program director at University Medical Center in Las Vegas. Gustavson has been with the program for roughly 17 years and has seen his fair share of patients, which has increased year after year.

“We have a greater volume of patients due to a rise in diabetes cases, and that has also resulted in greater awareness of hyperbaric medicine,” Gustavson said.

What is hyperbaric medicine?

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. In the room or tube, the air pressure is raised to a level up to three times higher than normal air pressure.

“Think of it like flying or diving. It’s sort of the same sensation, similar to being 40 feet underwater,” Gustavson said. When undergoing hyperbaric oxygen therapy, the lungs gather up to three times more oxygen, which dissolves in the blood, circulating throughout the body. The oxygen-rich blood then causes the body to release stem cells to the tissue.

This process helps with healing because when tissue is injured it needs more oxygen to survive, and the extra rush of oxygen helps the tissue heal and fight infections. Professionals in the industry call this process a “dive” due to the pressure sensation that parallels the feeling of diving. Distributing the oxygen is not so easy, however, and can only be done under supervision, usually as an outpatient service at a hospital or a private clinic. A hyperbaric therapy technician is usually present administering the oxygen and supervising the patient while he or she undergoes therapy.

There are two different modules used to do the treatment. One is known as a multiperson hyperbaric oxygen room. This is a big room, known as a chamber, where several people usually sit or lie on reclining chairs and lay down. A clear hood that is connected to an oxygen tube is then placed over the head of the patient. In other cases a mask is placed over the patient’s head. The chamber used at UMC measures 12 feet by 20 feet by 10 feet. It had to be lifted with a crane and brought in through the window of the hospital.

A hyperbaric technician stays inside with the patient, but the technician’s exposure is limited to only one time every 24 hours. Patients are typically treated for one to two hours with breaks in 30-minute increments. The chamber is sealed tight for added air pressure and cannot be opened until the treatment is over. “Sometimes if you move your hand back and forth it feels heavy and gives a similar sensation as if you were underwater,” Gustavson said.

The other type of module used in hyperbaric oxygen therapy is an individual 7-foot monoplace that looks similar to a clear plastic tube. Michael Jackson vaulted these monoplace chambers into the spotlight when tabloids revealed he regularly slept in one. Sunrise Hospital and Medical Center uses monoplace chambers in its hyperbaric department as part of its restored compliance wound program and ward.

At Sunrise, the staff works diligently on combining the physician observation with the hyperbarics. “We have a team of physicians, trauma surgeons and other physicians that come to the patients, and we try to coordinate their checkup with their treatment which goes with our goal to promote healing,” said Margaret Russitano, a wound care doctor at Sunrise Hospital.

The majority of hospitals and clinics use the monoplace chambers, and Russitano said she has found it more convenient than the multiplace chambers because they can be more flexible with the scheduling. In any case, whether using the monoplace or multiplace chambers there are restrictions that come with undergoing hyperbaric treatment.

When doing this type of treatment, the technicians or directors on staff have to make sure the patient is not wearing any makeup, such as lipstick, or deodorant or anything made of metal. Patients typically have to wear a gown to go into the chamber. This is due to concern that certain metals or chemicals might create a spark. With the high levels of oxygen, fire safety precautions are paramount.

Paul Watts, the hyperbaric facilities safety directors that works at Sunrise with Russitano, says that although the chambers may appear a little threatening to people, he has only had about six patients out of almost 6,000 who have refused to go into the chamber. But overall Watts said he has seen positive results stemming from hyperbaric medicine.

“I had a gentlemen who had all 10 toes black and after the first treatment you could already see the difference,” Watts said. Such obvious results are pretty uncommon, however, and typically a patient has to go in for several sessions and they have to be consistent and on time with their treatment for it to be effective. A patient who has diabetes, for example, would have to undergo eight to 12 treatments, quit smoking, observe a strict diet and take all prescribed medications. Sometimes if after several treatments there are still no results, the technician or therapist will request another analysis from the physician.

“We have cutoffs for treatments. For example, if after 20 treatments we see no results, we ask the doctors to re-evaluate,” Gustavson said. Hyperbarics as Alternative Therapy Outside of what insurance covers for hyperbaric medicine, there are thousands of people who are willing to pay out of pocket to get treatment for their conditions. Dembo sees many of those patients at his clinic, the Hyperbaric Institute of Nevada. “I used to work at a hospital, but it was frustrating to see that we couldn’t treat everyone who wanted treatment,” he said. There are all types of clients that go to Hyperbaric Institute of Nevada. The most common are stroke patients, traumatic brain injury patients and patients recovering from plastic surgery.

“A lot of times smokers don’t heal well with plastic surgery so they come here pre- and post-surgery for good results,” he said. For patients with neurological problems, Dembo said the results aren’t so obvious. “Mostly it’s the therapists or the caretakers that notice the difference. They realize they have a little more strength or can remember things better and, in turn, this slight change gives the patient a boost of confidence which also helps the recovery process,” Dembo said, “Once you have a 5 percent benefit, it really builds from there.” However, in some cases, Dembo said he has seen the progression of patients go from a wheelchair, to a walker and eventually walking, but he says those recoveries are successful if they do their other treatments as well. “I’ve never really had anyone who said they didn’t notice some kind of difference,” he said. Being in a tourist town, Dembo said he receives lots of calls and visits from international tourists who want to continue their set of treatments while vacationing in Las Vegas. According to Mayoclinic.com, some insurance companies in Europe have a broader coverage for hyperbaric treatment, and a lot of Europeans seek this treatment for multiple sclerosis. Other patients have no real health problems but use the treatment for an extra surge of energy. Dembo said he gets frequent visits from professional athletes, UFC fighters and people training for triathlons. “They come before to get ready for their event and after to recover faster,” he said. Dembo would not release the cost for treatments at his clinic because he said it really depends on each individual case, but many research sites on the Internet put the cost at between $100 and $150 per treatment at private clinics. Many times patients are offered Care Credit, a type of credit line offered for medical procedures usually not covered by insurance. Watts said he wishes he could see treatments for more health problems covered by insurance, but understands the science has to add up. “I wish we could really see near-drowning victims; when I see research I can tell that we are almost there and I feel it is worth a shot,” he said. Gustavson said part of the reason that there may not be more coverage for hyperbaric oxygen therapy is because there is not enough research being done. “The funding isn’t there. I know the military is currently doing some studies for brain trauma for soldiers returning but other than that there is not much research,” he said. “My heart really goes out to those families who feel this is an alternative they need to try. If there was a miracle cure it would be great, but unfortunately all the data just isn’t there.”

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