HYPERBARIC OXYGEN THERAPY

The Undersea and Hyperbaric Medical Society (UHMS) defines Hyperbaric Oxygen Therapy (HBOT) as a medical treatment in which the client is entirely enclosed in a chamber and breathes oxygen while the chamber pressure is increased to a pressure greater than one atmosphere. According to the UHMS, breathing 100% oxygen at one atmosphere of pressure or exposing isolated parts of the body to 100% oxygen does not constitute Hyperbaric Oxygen Therapy; the patient must receive the oxygen by inhalation within a pressurized chamber.

This is a slang term for a single hyperbaric oxygen treatment. It is derived from the mid 1900s when Navy divers were establishing diving protocols through undersea trials. The term morphed into medical terminology as HBOT became more clinically well known.

UHMS is the organization that is nationally and internationally recognized as the authority in making recommendations to the medical community and government agencies concerning HBOT.

A chamber is vessel that may be occupied by humans or animals for the purpose of medical treatment under pressure.

A monoplace chamber accommodates a single client. The entire chamber is filled with oxygen and pressurized. A multiplace chamber accommodates more than one person and may be pressurized with oxygen or ambient air. Professional healthcare personnel can accompany clients in a multiplace chamber during treatment. Canvas or portable chambers are used by professional and collegiate athletes to maintain a high level of health and activity. 100% oxygen may not legally be used with these chambers and they hold pressure to the equivalent of 10 feet fsw.

All chambers work under the same premise to increase pressure, however, a canvas chamber has a limited pressurizing ability and oxygen delivery. Hard shelled chambers may deliver greater pressure and thus treat a greater variety of disorders. A chamber pressurized with 100% rather than ambient air has an increased risk of fire, though still minimal. A monoplace chamber limits the client occupation to one. There is no professional caregiver access. The multiplace chamber allows for a professional to tend to the client, however, privacy is limited due to the multiple client occupation of the chamber.

That depends on the type of chamber. A monoplace chamber accommodates a single client. The entire chamber is filled with oxygen and pressurized, so no hood is required. A multiplace chamber accommodates more than one person and pressurized oxygen is delivered through a hood to each client.

According to Henry’s Law of Physics, a gas will dissolve in a liquid in the presence of pressure. The inhaled 100% oxygen gas shrinks while in the pressurized chamber and is dissolved in the blood stream. The oxygen no longer requires delivery by the red blood cells. Oxygen now travels wherever blood travels for total perfusion of all living cells.

There are a multitude of benefits that come from receiving Hyperbaric Oxygen Therapy:

• Augmented production of stem cells by 8 fold
• Decreased inflammation and swelling
• Amplification of pH from acidic to basic
• Reduction in healing time by 30-50%
• Increased vascularization
• Improved neurogenesis
• Intensified oxygenation
• Diminished pain
• Antifungal, antibacterial and antiviral action
• Immune system support

It’s 300+ years old. But there’s always something new in Hyperbaric Oxygen Therapy today.

Hyperbaric Oxygen Therapy has been in use around the world in the treatment of over one-hundred diseases and health conditions for decades. While there is still more research to be done in verifying the validity of some of these treatments, there are several commonly used and prescribed therapeutic uses for HBOT which are the most commonly requested. Some diagnoses for which benefits have been noted are:

• Brain injuries, including but not limited to stroke, cerebral palsy, near drowning, traumatic brain injury, post traumatic stress disorder, autism, Parkinsons, multiple sclerosis, transverse myelitis
• Infections that are unresponsive to antibiotics, non-healing wounds
• Circulatory/vascular disorders
• Neuropathies
• Cancer
• Sport Injuries
• Before and after surgical procedures for pain reduction and improved healing
• Inflammatory disorders such as but not limited to Crohns, ciliac sprue, fibromyalgia, chronic fatigue syndrome
• Hypoxic disorders

There are a few conditions which could prevent a client from receiving Hyperbaric Oxygen Therapy. Each client is assessed individually before beginning treatments.

• Typically, those being treated with one or more of a handful of formerly used chemotherapy drugs would be required to discontinue their use for one week prior to and during HBOT.
• Any exacerbation of a lung disorder, sinus disorder and/or ear problem would temporarily limit the client from treatment until resolution of symptoms is evidenced.
• A client with a current collapsed lung would be refused treatment; HBOT would be fatal. However, if the condition is resolved and HBOT is prescribed for another indication, with close supervision and pre-assessment, HBOT would be allowable.

All ages, including babies, young children, and the elderly, can safely receive Hyperbaric Oxygen Therapy, unless certain rare physical conditions exclude them from therapy.

Although there are minor risks, like all medical treatments, overall Hyperbaric Oxygen Therapy is extremely safe. With the implementation of standard safety protocols and a diligent professional staff, risks become non-existent. Fatalities make national and international news due to rarity in occurrence.

At the start of the treatment, some clients experience a sensation similar to that felt while flying and/or landing in an airplane. As pressure builds gradually, it is common to feel pressure in the ears. At the end of the treatment, as the pressure is released, the ears “pop” automatically. Most clients rest comfortably throughout treatment. Many read, sleep or listen to music. Because the temperature increases during pressurization, HBOT chamber operators have the ability to exhaust warm air and replenish with cooled air. At the end of treatment, as the chamber is exhausted of pressure, the temperature cools. Blankets are provided to maintain warmth.

Most treatment last from 1 ¼ hours – 2 ½ hours. This time is measured from the moment the door of the chamber is closed until the door is opened. Time with the hood on is measured from 60-90 minutes. The residual time is that required for pressurizing the chamber and depressurizing the chamber.

Treatment pressures range from 1.5 ata through 3 ata. Pressures are set according to client diagnoses, co-morbidities and tolerance. Pressures are set through Navy diving trials, medical research and current medical standards and practices.

The treatment pressure and duration, as well as the number of treatments received, are based on the diagnosis and response to the therapy. In general, clients with chronic conditions usually receive multiple series of treatments. Typically, 20-40 treatments, one or two each at five days per week, are implemented. Consistency in treatment is important for the greatest effectiveness. Some clients may have disorders that require maintenance with HBOT for a lifetime. Others may require as little as 1-10 treatments. Some pretreat with HBOT for surgery and medical procedures; some use HBOT purely for preventive health.

Under proper supervision and the implementation of continually updated protocols, the side-effects associated with HBOT are very minimal. The most common side effect is ear discomfort. Clients are educated prior to treatment for prevention of ear discomfort. Clients are monitored closely for ear discomfort. Rarely, oxygen toxicity, pulmonary barotrauma and vision change can be experienced.

Clients should adhere to important safety guidelines while receiving Hyperbaric Oxygen Therapy. The RN or or chamber technician will be informative concerning proper HBOT attire and chamber rules.

• The right clothing is important for comfort and safety. Fabrics that generate static electricity can pose serious danger in a highly oxygenated environment and should not be worn.
• Removal of shoes, wristwatch, phones and jewelry is required prior to starting each treatment.
• Don’t skip the meal prior to HBOT.
• Limit caffeine and stop smoking.

Yes. Physicians today are free to prescribe HBOT for a variety of “off-label” uses as they see fit. HBOT has been shown to be effective for a number of conditions not recognized by UHMS. Hyperbaric Oxygen Therapy also holds promise in many areas of medicine where researchers are just now beginning to gather and weigh the clinical evidence. In the State of Ohio, oxygen is labeled as a drug and requires a physician prescription.

Clients may be referred by physicians, however, in this highly technological world, most clients are self-advocating and self-informed concerning alternative integrative health issues and treatments and make the initial contact with the facility directly.

The treating facility will need health and physical information, along with the working diagnosis. Insurance information is needed if the diagnosis is reimbursable. The client may present with a prescription from her/his own family physician or the treating facility medical director may prescribe. The facility may request a chest x-ray report or simply request pertinent information resolving the need for an x-ray. Most facilities have a checklist of concerns to be addressed by the client. Other standard paperwork, such as consent for treatment and HIPAA forms, will require signatures indicating understanding and/or agreement.

It all depends on your condition, insurance policy, and documented medical need. The US Centers for Medicare & Medicaid Services (CMS) reimburses HBOT providers for 11 or more different limited conditions. All other conditions are considered off-label or investigational or experimental. But this doesn’t mean you can’t be treated if you have an off-label condition.

The FDA plays an important role in approving the type of chamber used in hyperbaric therapy and the types of indications (conditions) approved to be treated in those chambers, just as it approves the use of other types of machinery or drugs for medical use. The FDA does not regulate the practice of medicine. Once the FDA approves a treatment, licensed physicians can prescribe it for any purpose they consider medically appropriate. Physicians may prescribe certain drugs—like oxygen, for off-label use, a use other than what the FDA approves its use for. This is why off-label conditions may be treated with hyperbaric oxygen. Physicians must still follow FDA guidelines and prescribe oxygen for hyperbaric therapy.

A condition becomes approved to be treated with hyperbaric oxygen when rigorous studies, and double blind studies, demonstrate a measurable degree of improvement in a particular condition. It costs millions of dollars to conduct medical research that meets the FDA standards to allow claims for successful treatment of a specific illness. Because oxygen cannot be patented, profits on sales of oxygen are too small to pay for studies that meet FDA requirements.

The insurance industry often takes the position that if the FDA has not issued a formal approval for the treatment of a particular injury or condition with hyperbaric oxygen, then it must be considered investigational or experimental and does not cover the cost of treatment.

Cost is dependent upon the facility and whether or not the treatments are reimbursable with insurance, Medicaid and/or Medicare. Hospital facilities usually charge anywhere from $1500-2500 per treatment. Most free-standing facilities range from $100-800 per treatment. Sara’s Garden assists the client with treatment costs through fundraising and scholarship programs.