Hyperbarics for Frostbites

There's one I have never written about before.
I am not a great mountain climber, or researcher of the Antarctica
nor do I live in Alaska or Iceland.

But here is some interesting excerpt from an article about Hyperbaric Oxygen
for the treatment of frostbites.

"Ledinham first reported the use of HBO for the treatment of frostbite in 1963. Other studies have reported considerable success with the use of HBO for frostbite injuries.

Whether local circulatory effects decrease cellular damage or tissue viability, it appears that an increase in local tissue oxygen tension through the use of HBO improves the viability of tissue and allows vascular and cellular regeneration to occur. The immediate effect of HBO is hyperoxygenation of ischemic tissues, resulting from increased amounts of dissolved oxygen in plasma directly in proportion to the partial pressure of inhaled oxygen. Hyperoxia can be of great benefit through numerous mechanisms: improvement of oxygen delivery and preservation of tissue viability in ischemic areas; vasoconstriction with reduction in local edema with preservation of oxygenation; prevention of ischemic/reperfusion injury syndrome; enhancement of host response to local infections; and enhancement of the wound healing process through stimulation of angiogenesis and tissue growth and support. These processes can improve the local circulation and viability of damaged tissues, even when HBO treatments are started 2 weeks or more after the injury. The ideal time to initiate HBO for frostbite is during the rewarming period because of the reperfusion component of the injury."^[1]

This is a lot of medical jargon, but in my books i understand enough to be sure

that I would get some treatments if I ever were unfortunate enough to acquire

a frostbite.

[1] http://www.medscape.com/viewarticle/521451_3

Spider Bites

It's been a while since I have posted something, but I will be
less lazy now again.
One of my friends told me he had been bitten by a Brown Recluse spider,
and that the bite wound looks nasty. He is of course already under the
care of a MD in his hometown. Nevertheless I was of course curious
about what's out there in regards to hyperbarics and spider bites. Here is
what I found:

"Hyperbaric oxygen. Hyperbaric oxygen therapy has been used successfully in the management of necrotic wounds, but not in all cases. It is thought to be useful in the treatment of brown recluse spider bites through two different mechanisms. First, the hypoxic nature of nonhealing wounds suggests a strong relationship between healing and oxygen supply. Sheffield and Dunn showed that wound oxygen tension is elevated with hyperbaric treatments. The second mechanism of action directly involves the venom, possibly inactivating its necrotizing component. Sphingomyelinase-D digests the intercellular matrix, allowing the venom to spread; hypothetically, hyperbaric oxygen therapy denatures the sphingomyelinase-D. One study disputes this theory; however, the sphingomyelinase-D was not tested at clinical levels. Controlled animal and human studies are still needed to conclusively demonstrate the efficacy of hyperbaric oxygen therapy."1

"The effect of hyperbaric oxygen in decreasing the size of necrotic skin lesions resulting from brown recluse envenomation has also been studied. One study using white rabbits showed an earlier reepithelization of the necrotic ulcers when these rabbits were treated with hyperbaric oxygen twice daily. Treatments were initiated at 72 hours after injection of venom. Maynor et al speculated that hyperbaric oxygen inactivated sphingomyelinase D by the disruption of sulfhydryl groups. Hyperbaric oxygen has also been postulated to decrease wound damage secondary to brown recluse envenomation in at least two additional ways. It has been speculated that wound damage is decreased in part because of the pulmonary sequestration of neutrophils. Hyperbaric oxygen therapy also increases the production of collagen by fibroblasts, thereby facilitating wound healing. Beilman et al found that guinea pig models which had hyperbaric oxygen therapy as pretreatment had significantly smaller areas of necrosis when compared with control animals or animals given dapsone as pretreatment."2

Not everything absolutely conclusive, but good enough for me to tell my friend to throw some hyperbaric treatments into his protocol.
Looks like that Brown Recluse venom is real nasty, so every little thing that can help
on top of regular doctors protocols in my opinion should be welcome, especially
in those bite cases where it comes to complications with the wound.






1) http://www.o-wm.com/content/brown-recluse-spider-bites-a-complex-problem-wound-a-brief-review-and-case-study?page=0,3


2) http://www.medscape.com/viewarticle/405814_7

Contraindications

Hey,
it's been a while life is keeping me busy.
This will be a short post but nevertheless important.

Of course even Hyperbaric Oxygen has contraindications.
There is absolute ones (= No no) and relative ones:

Absolute Contraindications:

1. Bleomycin Exposure (This is a chemo agent)
2. Undrained pneumothorax
3. Concurrent chemotherapy/radiation therapy
4. Pressure-sensitive implanted medical device (eg, automatic implantable cardiac defibrillator, pacemaker, dorsal column stimulator, insulin pump)
5. and of course if the Patient refuses.(1)

Relative Contraindications:

1. Severe chronic obstructive pulmonary disease/asthma
2. Severe claustrophobia
3. Chronic sinusitis/upper respiratory infection
4. History of spontaneous pneumothorax
5. High fever/dehydration (1)

Here is what i have to say about some of the relative one's:

In case of Number 3 this is unfortunate because I believe Hyperbaric
Oxygen can actually help, but the problem is that you might not
be able to equalize your ear pressure which occurs during inflation
and deflation of the chamber.

For Number 2: I have seen claustrophobic people going into
Hyperbaric Oxygen chambers, but it is more rare that they will be
able to complete a full session and if they do it usually requires
attended sessions. Rule of thumb is if they want to come out just
let them out don't try to talk them into remaining in the chamber
or make them wrong in any way because they will never come back
and so deprive themselves of the possible benefits.

Numbers 1 and 4 I would probably not put in.

Number 5 i might have to come back to you. I don't see a problem
there but I might be wrong I'll let you know in a later post.

Have a great week :)


(1)

Kindwall EP. Contraindications and side effects to hyperbaric oxygen treatment.

In: Kindwall EP, editor. Hyperbaric medicine practice. Flagstaff, AZ:

Best Publishing, 1995

And about Wound Healing again

I know I keep stressing the relevance of hyperbaric treatments in wound healing.
That's why everytime I come across something that explains why it works
I want to post it here so you can see that it's actually not rocket science to
understand that hyperbaric oxygen is of extreme importance in wound healing.
The following quotation is a bit technical but right to the point:

"In wound healing, biochemical energy supply is a basic requirement. Oxygen is essential for the production of biological energy equivalents (e.g. adenosine triphosphate, ATP) in aerobic glycolysis, the citric acid cycle, and the oxidation of fatty acids. Therefore, sufficient oxygenation of tissue is a prerequisite for adequate energy levels, which are essential for proper cellular function.

In healing tissue, sufficient oxygenation is particularly relevant because of the increased energy demand for reparative processes such as cell proliferation, bacterial defence and collagen synthesis. The strictly oxygen-dependent NADPH-linked oxygenase represents a further highly important enzyme in wound healing; it catalyses the production of reactive oxygen species (ROS) such as peroxide anion (HO₂ ⁻), hydroxyl ion (HO⁻) and superoxide anion (O²⁻). ROS play a prominent role in oxidative bacterial killing and coregulate prevalent processes in wound healing such as cytokine release, cell proliferation and angiogenesis.Against this background, the crucial role of reduced oxygen supply in chronic wound pathogenesis becomes obvious. Chronic wounds are characterized by an insufficient repair process that precludes the establishment of a sustained anatomical and functional result in an appropriate length of time" (1)

Like I said a bit technical but still enough regular English in there to understand

the point.

(1)

From The British Journal of Dermatology

Oxygen in Acute and Chronic Wound Healing

S. Schreml; R.M. Szeimies; L. Prantl; S. Karrer; M. Landthaler; P. Babilas

Authors and Disclosures

Posted: 09/15/2010; The British Journal of Dermatology. 2010;163(2):257-268. © 2010 Blackwell Publishing

Hyperbaric Oxygen and Diabetes

Every time I run into someone with advanced Diabetes, and
they already have the "red legs" or worse and having learned
that that problem has to do with hypoxia, which basically means
not enough Oxygen supply to the extremeties it of course occurs
to me that HBOT should be able to help with that. There is actually
a lot written on the WWW about this but I only post an excerpt
of one of the studies supporting this:

".....Animal and human studies support these findings. All cells require oxygen for aerobic metabolism and cellular energy production. Hunt and Van Winkle showed that a minimum PO₂ of 30 mm Hg is required by cells for functioning. Hunt and Pai demonstrated that collagen synthesis for maintenance and healing is oxygen dependent, with an optimal PO₂ of at least 50 to 100 mm Hg. Sheffield showed that HBOT can provide PO₂ levels in excess of 1,000 mm Hg in ischemic areas. Nemiroff et al., in a randomized, prospective animal study of ischemic flaps, demonstrated markedly greater survival of ischemic tissue when treated with HBOT (p<0.05). Kihara et al., in their controlled study of ischemic neuropathy, demonstrated that “hyperbaric oxygenation will effectively rescue fibers from ischemic fiber degeneration” (p<0.05). The effectiveness of hyperbaric oxygen in clinical human studies is well documented, with acute ischemias arising from surgery and trauma having been particularly well studied. Bowersox et al., showed the effectiveness of HBOT in a large series of patients with ischemic flaps and grafts, as has Perrins. Shupak et al., demonstrated a doubling of the survival rate of ischemic limbs using HBOT. Hill et al., showed that even complex tissues, such as the ear, can survive severe post traumatic ischemia using HBOT........." (1)

And so on.

 It looks to me that diabetic patients don't always need their feet
amputated but they could be rescued with Hyperbaric Oxygen.


(1) http://www.achm.org/index.php/General/Medicare-Accepted-Indications/Acute-Peripheral-Arterial-Insufficiency.html

Does HBOT make cancer grow faster?

Every once and a while somebody will ask me
if it is true that someone should not seek
Hyperbaric Oxygen treatments if they have cancer.
Supposedly the additional oxygen would make the cancer
grow faster.

I could not really answer this question, so I did a little
research and here is one article I came up with:

(Bold print done by me)
"The Issue of Carcinogenesis
An issue that frequently arises when considering a patient for hyperbaric oxygen who also carries a cancer diagnosis is what does HBO2 do to growth or potential recurrence of the malignancy. In a publication from 1994, Feldmeier and his colleagues reviewed the discoverable literature related to this issue. An overwhelming majority of both clinical reports and animal studies reviewed in this paper showed no enhancement of cancer growth.
A small number of reports actually showed a decrease in growth or rates of metastases. In 2001 at the Consensus Conference jointly sponsored by the European Society of Therapeutic Radiology and Oncology (ESTRO) and the European Committee for Hyperbaric Medicine (ECHM), Feldmeier updated this material. In this review, Feldmeier emphasized the differences known in tumor and wound healing angiogenesis. Each has similar but distinctly different processes operational. He showed that there are significant differences between tumors and wounds in the growth and inhibition factors, which modulate angiogenesis. He summarized the literature demonstrating that tumors, which are hypoxic, are less responsive to treatment, less subject to cellular death by apoptosis and more prone to aggressive growth and lethal metastases. Fears that hyperbaric oxygen may promote malignant growth are not supported by scientific evidence, and clinicians should not refuse to consider a patient for hyperbaric oxygen who has had a history of malignancy."  1

1  http://rubicon-foundation.org/dspace/bitstream/123456789/3998/1/15233169.pdf
    Page 9

Newborns can benefit from Hyperbaric Oxygen too

It's been a while since I posted, but life is busy and also finally I got the house
earthquake proved. I guess the japanese scare was big enough.
As far as the radiation is concerned, I am not to worried that we will get anything
here that has high enough radioactivity to harm us.

But here a short one on the subject. It's not from a "double-blind placebo controlled
and whatnot study", still I thought this was very interesting for some parents who have
newborns with healing issues:

"We report the use of hyperbaric oxygen in four neonates with delayed wound healing. Three presented with cyanotic congenital heart disease and had wounds associated with surgical procedures; the fourth had a nonhealing wound as a result of a complication of an umbilical-artery catheter. All were treated in a hyperbaric chamber with 100% oxygen at 2 atmospheres absolute. All wounds healed after institution of hyperbaric therapy. There was no evidence of serious side effects in any patient. These observations suggest, but do not prove, the efficacy of hyperbaric oxygen therapy for neonates with delayed wound healing."1


 

1 Hyperbaric oxygen use in neonates. A report of four patients.

Vazquez RL, Spahr RC.

Department of Pediatrics, Magee Womens Hospital, Pittsburgh, PA 15213.

Just Thoughts on Air

Usually I keep trying to write something "scientifically substantiated", but for today only this:

The two things our bodies need the most urgently to survive are air and water.
We can live like a few minutes without air and like 3 days without water.

In today's world big companies and even governments are playing with our health by not
caring in the case of big business and by not controlling the quality of these resources
in the case of governments.
It's not that long ago that you could still drink water out of a river, what an outrageous
concept nowadays.
And the air ? Let's not get started between cars and industrial chimneys the
atmosphere is like a big toilet of pollutants.
In case you don't believe that keep on dreaming, ignorance is a bliss.

In the light of these thoughts I'd go into a hyperbaric chamber just to have the luxury of
breathing clean air for a couple of hours.

Here is something from a Canadian Government webpage:

"The human health effects of poor air quality are far reaching, but principally affect the body's respiratory system and the cardiovascular system.  Individual reactions to air pollutants depend on the type of pollutant a person is exposed to, the degree of exposure, the individual's health status and genetics.  People who exercise outdoors, for example, on hot, smoggy days increase their exposure to pollutants in the air.
The health effects caused by air pollutants may range from subtle biochemical and physiological changes to difficulty breathing, wheezing, coughing and aggravation of existing respiratory and cardiac conditions.  These effects can result in increased medication use, increased doctor or emergency room visits, more hospital admissions and even premature death."

HBOT helps with Radiation Damage

The following resume of a study might be really important for
people who get radiation treatments for cancer. The number of cancer
patients keeps rising so I thought this can give hope for people trying
to heal from the damage radiation actually does to the tissue:

"Background. Radiotherapy, which is often used for cancer in the head and neck, leads to damage of tissue cells and vasculature. Surgery in such tissues has an increased complication rate, because wound healing requires angiogenesis and fibroplasia as well as white blood cell activity, all of which are jeopardized. Hyperbaric oxygen therapy (HBO) raises oxygen levels in hypoxic tissue, stimulates angiogenesis and fibroplasia, and has antibacterial effects. Methods. In this consecutive retrospective study, 15 patients with soft-tissue wounds without signs of healing after surgery in full-dose (64 Gy) irradiated head and neck regions were treated with HBO and adjuvant therapy. The patients in this study were also compared with patients examined in an earlier study, with corresponding wounds treated without HBO. Results. The healing processes seemed to be initiated and accelerated by HBO. In the HBO group, 12 of 15 patients healed completely, 2 patients healed partially, and only 1 patient did not heal at all. There were no life-threatening complications. In the reference group, only 7 of 15 patients with corresponding wounds without signs of healing eventually healed without surgical intervention, and 2 patients had severe postoperative hemorrhage, which in one case was fatal. Conclusion. Evaluation of obtained results supports the hypothesis that HBO therapy has a clinically significant effect on initiation and acceleration of healing processes in irradiated soft tissues."(1)


(1)Hyperbaric oxygen therapy for wound complications after surgery in the irradiated head and neck : A review of the literature and a report of 15 consecutive patients.
Head Neck 1997; 19:315–22

Hyperbaric Oxygen for Cancer patients

This is a very interesting article on the different applications
of Hyperbaric Oxygen. Actually it is some information I
hadn't read like that before. It looks like HBOT can help repair
some of the damage that occurs during radiation therapy:

"Radiation therapy impairs cellular proliferation, causing a progressive, obliterative endarteritis, which results in hypocellular, hypovascular and hypoxic tissue. This is seen clinically as oedema, ulceration, bony necrosis and poor wound healing that can persist for years after the initial insult. High radiation doses may result in spontaneous radionecrosis.

HBO increases vascular density and oxygenation in radiation-damaged tissue.(1)"

"It improves tissue oxygen gradients and angiogenesis and enhances leukocyte bactericidal activity. Oxygen tension is increased to normal levels, enabling fibroblast proliferation, collagen formation and angiogenesis at the wound edges, further improving oxygenation and re-epithelialization.(2) This facilitates healing and may enable grafts to be placed. "

1. Marx RE, Ehler WJ, Tayapongsak P, Pierce LW. Relationship of oxygen dose to angiogenesis induction in irradiated tissue. Am J Surg 1990; 160:519–24.
2. Greenwood TW, Gilchrist AG. Hyperbaric oxygen and wound healing in post-irradiation head and neck surgery. Br J Surg 1973; 60:394–7

HBOT for ear problems

Here are some numbers from a big study done in Germany.
I thought that was very interesting for the poor victims of tinnitus:

"Accordingly, most of the studies show that HBOT is most effective in reducing hearing loss and tinnitus in the first three months following hearing loss or acoustic trauma. Regarding hearing loss alone, an overview of clinical studies from Germany shows HBOT is effective in 50% of cases in reducing hearing loss by 20 dB or more. Approximately 11% have a full recovery.

Regarding tinnitus, evaluations of 7766 patients in the same overview showed reduction of the intensity of tinnitus by 50% in approximately 70% of the cases treated within 3 months. Approximately 30% of patients had their tinnitus completely resolved. Tinnitus with duration of more than 3 months showed a 50% improvement in the intensity of tinnitus in 30% of patients. After 12 months of chronic tinnitus, no improvement was seen." 1

1. Lamm H.; Deer Influx deer hyperborean Sauerstofftherapie auf den Tinnitus und den Horverlust bei akuten und chronischen Innenohrschaden. Otolaryngol Nova 5 (1995) 161-9.

Hyperbaric Oxygen: So how does it work ?

I thought a little more technical inside wouldn't hurt, so here is what I found on one of the
chamber manufacturer's home page:

"Hyperbaric chambers, used in hyperbaric therapy (HBOT), are any number of enclosures, which can be pressurized to allow a person inside to experience higher atmospheric pressures than the normal environmental pressures.  For example, a treatment at an elevation of 12,000 feet above sea level using a 4 psi (1.27 ATA) can simulate a decent of ~5,843 feet to 6,157 feet above sea level.

At higher elevations, the barometric pressure is lower.  This decrease of pressure also decreases the oxygenation of blood, and is known as anoxia—where molecules of oxygen exert less pressure on the walls of the alveoli (Dalton’s Law). Hyperbaric Oxygen Therapy (HBOT) follows this law.

How does hyperbaric oxygen therapy (HBOT) work?

Hyperbaria - Increased atmospheric pressure as a means of increasing
oxygen uptake without an enriched oxygen source
Hyperoxia - Increased total oxygen content

Hyperbaria is based on the concept of the relationship of gas pressure and uptake in liquids (blood, plasma and tissues).  Henry’s Law states that “a gas is dissolved by a liquid in direct proportion to its partial pressure.”  For example, at sea level, atmospheric pressure is 760 mm Hg, the oxygen concentration is 21% and the body’s oxygen content or partial pressure, pO2, in blood and plasma is ~ 40 mm Hg.

Red blood cells have a limitation as to how much oxygen can bind with hemoglobin.  The plasma portion of the blood typically has about a 3% oxygen concentration.

By placing someone in a 3 psi pressure hyperbaric environment, the increase in atmospheric pressure at sea level goes from 760 mm Hg to 915 mm Hg.  This increase in gas pressure, increases the partial pressure of the oxygen gas and thus forces more oxygen to be dissolved in the plasma.  This saturation of oxygen in the blood, due to the Hyperbaric Oxygen Therapy or HBOT, allows the extra oxygen to be diffused or transported to the surrounding body tissues.  Thus, oxygen transport by plasma is significantly increased under hyperbaric therapy (HBOT).  At three atmospheres pressure, enough oxygen can be dissolved in the plasma to support the oxygen demands of the body at rest in the absence of hemoglobin!

Hyperbaric Oxygen Therapy (HBOT) is designed to boost the supply of oxygen to ischemic tissue or to diseased tissues that respond to increased oxygen levels.  Increasing the volume of oxygen dissolved in the blood plasma, that is brought about by hyperbaric therapy (HBOT), produces five basic effects:

    * Reduction of volume of gas bubbles in the blood
    * Vasoconstriction, which reduces edema and secondary hypoxia
    * Restoration of aerobic metabolism to ischemic tissue
    * Detoxification of poisoned tissues
    * Enhanced phagocytosis

Henry’s Law- Henry’s law states that for a gas-liquid interface the amount of the gas that dissolves in the liquid is proportional to its partial pressure.  So Henry’s law helps to predict how much gas will be dissolved in the liquid.  The actual amount also depends on the solubility of the gas as well as its partial pressure.

Dalton’s Law-John Dalton observed that the total pressure of a gas mixture was the sum of the pressures of each of the gases if they were to exist on their own."

This is another success story I came across. I can really relate to
this one.

"The past year has been an amazing journey from stress and poor

health to energy and a new sense of well-being.

When I began working with this wellness center, I was disabled

by my inability to think straight, to concentrate or to recall simple

words and facts. Stress, poor nutrition, lack of exercise and

an overabundance of chemicals in my life and diet had contributed

to my ill health. I followed the program they recommended

religiously and now feel like a new person ! A very important

milestone was reached recently when I managed to take myself off

of antidepressants. During that process I went to them in desperation

feeling as though I was relapsing into confusion and depression.

They immediately recommended an injection for stress and had me

spend some time relaxing in the hyperbaric oxygen chamber.

On my way home I realized that I had the energy to seek out a piece

of music I had been wanting to play for months. Unable to find the

chart in stores, I purchased the CD and spent the rest of that

afternoon and the next morning doing something I haven’t been

able to do in two years. I patiently and methodically listened to the

music on the CD and created a very complete chart from which I

could play the melody, harmony/chords and bass line.

This may sound easy to many musicians, but I had feared this

level of concentration was lost to me forever. The whole process was

enjoyable and invigorating. I know the Chamber helped bring me

to that place and I thought you’d like to hear about it. Thanks.

V.S., Los Angeles"

This really matches my own experiences about increased focus and
concentration. I do 3 treatments a week myself and I can tell
the increase in energy.
Until next week :)