Healthy Living
Hyperbaric Oxygen Therapy
By David Perlmutter, MD, FACN
The Perlmutter Hyperbaric Center is a state of the art hyperbaric oxygen facility. We utilize four Sechrist Model 3200 hyperbaric chambers - the most technologically advanced monoplace chambers available. Treatments are administered by our staff of highly trained, courteous technicians under the direction of Board Certified Neurologist, David Perlmutter, MD, FACN, an internationally recognized leader in the use of hyperbaric oxygen in the treatment of neurological disorders.
What Is Hyperbaric Oxygen Therapy?
Hyperbaric oxygen (HBO) therapy is an exciting medical treatment approved by the FDA and AMA which enhances tissue levels of life giving oxygen. Normally, oxygen is almost exclusively carried by red blood cells. During HBO therapy, there is a substantial increase in the amount of oxygen carried in all body fluids including plasma, cerebrospinal fluid, lymph, and intracellular fluids. This allows increased oxygen levels even in areas with poor or compromised blood supply as well as in areas of tissue damage.
Increasing tissue oxygen levels produces several important long term therapeutic benefits including enhanced growth of new blood vessels, increased ability of white blood cells to destroy bacteria and remove toxins, increase growth of fibroblasts (cells involved in wound healing), and enhanced metabolic activity of previously marginally functioning cells including brain neurons. Patients receiving hyperbaric oxygen therapy enter a 1-person clear acrylic chamber where they breathe 100% oxygen delivered to the chamber under increased atmospheric pressure. During the treatments, which typically last 1½ to 2 hours, patients relax, watch television, or sleep while they are carefully monitored by highly trained technicians with whom they can communicate easily through an intercom system. Hyperbaric oxygen treatments are safe and painless, although approximately 5% of patients (typically those who report ear pain with flying) may experience mild ear discomfort.
Who Can Benefit From Hyperbaric Oxygen Therapy?
Because of the wide range of clinical conditions responding favorably to hyperbaric oxygen therapy, it is now being used world wide. There are over 350 hyperbaric centers in the United States alone. Some of the medical conditions for which hyperbaric oxygen therapy is helpful include air embolism, decompression illness, burns, carbon monoxide poisoning, cerebral edema (brain swelling), closed head injuries, sickle cell anemia, gangrene, near drowning, severed limbs, smoke inhalation, spinal cord injury, organic brain syndrome, stroke, coma, multiple sclerosis, hearing loss, peripheral neuropathy, radiation myelitis, crush injuries, soft tissue injuries, osteomyelitis (both acute and chronic), non-healing fractures, tendon and ligament injuries, delayed wound healing, soft tissue ulcers from arterial or venous insufficiency, decubitous ulcers, frostbite, diabetic retinopathy, migraine headache, cluster headache, myocardial infarction, chronic fatigue, post-polio syndrome, Crohn's disease, Bell’s palsy, Lyme disease, Meniere’s disease, reflex sympathetic dystrophy, and osteoradionecrosis (bone degeneration after radiation exposure).
We treat patients with a variety of medical conditions including:
Multiple Sclerosis
Over the past two decades, extensive international medical research has demonstrated that HBO can play an extremely important role in the treatment of multiple sclerosis (MS). In many European countries, HBO is now considered an integral part of the MS treatment program - in England alone, over 10,000 MS patients are currently receiving hyperbaric oxygen treatment. In a recent publication in the prestigious New England Journal of Medicine entitled, "Hyperbaric Oxygen Treatment of Multiple Sclerosis, a Randomized, Placebo Controlled, Double-blind Study," researchers demonstrated significant objective improvements in a variety of MS symptoms in 70% of patients treated. At one year after treatment, deterioration was noted in 55% of MS patients not treated as compared to only 12% of patients who underwent hyperbaric oxygen treatment.
Barnes and co-workers publishing in the Journal of Neurology, Neurosurgery, and Psychiatry, demonstrated a remarkable slowing of cerebellar function (coordination) deterioration in their report of 120 MS patients one year following hyperbaric oxygen treatment. Other studies have shown an improvement in bladder function in HBO treated MS patients.
Hyperbaric oxygen therapy is a potent therapeutic modality for the successful treatment of multiple sclerosis without the potential side effects associated with many currently used medications.
Bell's Palsy
Bell's palsy is a common affliction characterized by the fairly sudden onset of weakness of one side of the face. Typically, patients are offered steroids early in the course of their illness in hopes of reducing swelling of the nerve involved in facial movement. Exciting new research demonstrates that hyperbaric oxygen therapy is significantly more effective than steroids in the treatment of Bell's palsy - both shortening the length of illness as well as increasing the likelihood of full recovery.
Meniere's Disease
Patients diagnosed with Meniere's disease typically suffer from recurrent attacks of disabling vertigo with progressive hearing loss. Until recently, therapeutic options were limited to either aggressive surgical or medical approaches.
Research published in a recent issue of Audiology confirms usefulness of HBO in Meniere's disease. HBO treated patients experienced significant improvement in attacks of vertigo as well as hearing. These improvements continued when these patients were re-evaluated two years after the hyperbaric oxygen treatment program.
Migraine Headaches
Hyperbaric oxygen therapy is an extremely useful modality in the abortive management of migraine headache. Research at the University of Pittsburgh published in the journal Headache found that 90% of migraine patients experienced virtually complete relief of pain when treated acutely with HBO.
Lyme Disease
Lyme disease, first discovered in 1975, is an infectious illness transmitted by ticks. In the past decade, Lyme disease has spread across the nation and has increased in incidence some ten fold. Lyme infection may produce muscle and joint pain, immune system dysfunction, nervous system abnormalities, cardiac problems, and fever.
Typically, if aggressive antibiotic therapy is initiated early in the course of the illness, successful treatment is achieved. Unfortunately, many patients do not adequately respond to antibiotic therapy and essentially become incapacitated by this illness.
New and exciting research showing the efficacy of hyperbaric oxygen therapy now offers hope to patients crippled by chronic Lyme disease. Dr. William Fife at Texas A & M University has published extensive research demonstrating profound improvements in chronic Lyme disease patients treated with HBO. These improvements include pain reduction, return of clarity of mentation, reduction of depression, and frequently the ability to discontinue antibiotics.
Parkinson's Disease
Exciting new research published by Italian researchers and presented at the 12th International Congress on Hyperbaric Medicine confirms the profound effectiveness of HBOT in reducing symptoms of Parkinson's disease HOC Treatment Protocols - Parkinson's Disease (www.hochealth.com). The researchers demonstrated profound improvements in rigidity, posture, facial expression, slowness of movement, gait, sleep, and mobility. At The Perlmutter Hyperbaric Center HBOT is typically given in conjunction with intravenous administration, a protocol we have developed which has now received FDA approval for research evaluation.
Reflex Sympathetic Dystrophy
Although uncommon, reflex sympathetic dystrophy can be a crippling disease characterized by swelling and severe pain of an extremity, at times following what would otherwise have been trivial trauma. Treatment options including injection techniques and medication have met with only limited success. Having demonstrated its usefulness in clinical studies, HBO offers an effective treatment option in treating reflex sympathetic dystrophy.
Stroke
It has been estimated that at the present time there are about 1.7 million stroke survivors in this country. Regrettably, a commonly held belief is that once an area of the brain has been damaged by a stroke, nothing can be done to restore the function of that area. Recent scientific research has revealed that while the more central areas of stroke involve brain tissue may be irreversibly damaged, there exists an area surrounding this tissue which may be functionally salvaged with the use of hyperbaric oxygen. Since the early 1970’s, scientific journals have reported over 1,000 cases demonstrating a 40-100% rate of improvement for stroke patients treated with HBO. In the journal Stroke, Dr. Richard Neubauer, a pioneer in the use of hyperbaric oxygen and various neurological diseases, reported outstanding results in a group of 122 stoke patients treated with HBO. In one case, significant functional improvement was noted when HBO therapy was given 14 years after the initial stroke event.
The benefit of hyperbaric oxygen in stroke patients likely results from its ability to enhance the metabolism of so-called "idling nerve cells" as well as increasing oxygen supply surrounding the area of maximal damage.
West Germany has long recognized the effectiveness of HBO in stroke rehabilitation to the extent that now virtually all stroke patients in West Germany receive a three week intensive course of hyperbaric oxygen paid for by insurance companies.
In addition to the remarkable results in stroke patients, Dr. Neubauer has reported similar results in other types of brain injury treated with hyperbaric oxygen including traumatic injuries and anoxic events (near drowning and cardiac arrest).
Wound Healing
Without question, one of the most widely recognized applications of hyperbaric oxygen has been in the area of wound healing. Over the past 30 years, hundreds of scientific articles have been published describing profound enhancement in healing of a variety of problematic wounds with hyperbaric oxygen therapy. These conditions include decubitous ulcers, venous stasis ulcers, arterial insufficiency ulcers, burns, crush injuries, severed limbs, non-healing bone fractures, diabetic foot ulcers, brown recluse spider bites, poorly healing skin grafts, and osteoradionecrosis (bone damage as a result of excessive radiation exposure). The mechanisms by which HBO enhances healing include:
- Hyperoxygenation - increase tissue levels of oxygen
- Neovascularization - enhance growth of new blood vessels
- Antimicrobial effect - destroys harmful bacteria
- Leukocyte activation - enhances ability of white blood cell to remove bacteria and debris
- Fibrolastic proliferation - increases growth of cells which form reparative tissue.
Hyperbaric oxygen therapy can be an important adjunct in a comprehensive wound healing program utilized in conjunction with other modalities including surgical, medical, and physiotherapeutic techniques.
Cerebral Palsy
The term "cerebral palsy" is not a specific diagnosis, but is now generally applied to children who experience some form of brain trauma either at the time of birth or shortly before. Typically, these children manifest some degree of cognitive impairment as well as physical impairment, often with weakness and spasticity of arms and legs. Typically treatment therapies for children with cerebral palsy have been directed at the physical manifestations of the underlying problem. That is, most efforts are geared to increase range of motion, reduce spasticity, and increase strength, along with specific therapies designed to enhance skills of communication and academic performance.
Evidence from around the globe is now accumulating providing strong support for the use of hyperbaric oxygen therapy (HBO) as an approach to the actual underlying problem in children with cerebral palsy - a technique which actually targets the abnormalities of brain function. The use of hyperbaric oxygen therapy in cerebral palsy offers an exciting new therapeutic approach for the treatment of cerebral palsy. In actuality however, hyperbaric oxygen therapy itself is not a new technique. It has been utilized for decades for the treatment of injuries related to underwater diving, and in addition has found great utility in the treatment of poorly healing wounds, burns, various bone disorders, complications of radiation therapy, circulatory problems, carbon monoxide poisoning, multiple sclerosis, head injury, and stroke.
Hyperbaric oxygen therapy is approved by the FDA as well as the AMA and acts by enhancing tissue levels of life-giving oxygen. Normally, oxygen is almost exclusively carried by red blood cells. During hyperbaric oxygen therapy, there is a substantial increase in the amount of oxygen carried in all body fluids, including plasma, cerebrospinal fluid, lymph and intracellular fluids. This allows increased oxygen levels in areas of tissue damage or injury. Increasing oxygen levels promotes growth of blood vessels and increases the metabolic activity of previously marginally functioning cells, including brain neurons. Patients receiving hyperbaric oxygen therapy enter a monoplace (one-person) clear acrylic chamber where they breathe 100% oxygen delivered to the chamber under increased atmospheric pressure. Typically, treatments last one to two hours during which time patients relax, watch television, or sleep, while they are carefully monitored by highly trained technicians. Most chambers are large enough to comfortably treat both an adult and a child.
The effectiveness of hyperbaric oxygen therapy in children with cerebral palsy is likely a manifestation of enhanced function of previously damaged neurons. These neurons have been called "idling neurons" in that while they are still alive, they have been damaged to the extent that their function is compromised. The concept of enhancing the function of these idling neurons has been extensively described in stroke patients as we have reported in previous issues of the Perlmutter Letter. Canadian researchers have been vigorously exploring the utility of HBO in cerebral palsy. Dr. Pierre Marois and his team of researchers from McGill University in Montreal have recently studied 25 children with cerebral palsy, aged 4 to 7 years, treated with hyperbaric oxygen therapy on a daily basis for 20 days at McGill University. Another 15 children were treated twice a day for 10 days. Both groups thus received a total of 20 treatment sessions. The results of their post-treatment evaluation were truly remarkable. According to Dr. Marois "…the results are really incredible! 23 of the 25 children have great results. Twenty-three have amelioration with their spasticity and may have amelioration with speech and cognitive function". Further, their published results reveal "the clinical observations do list numerous functional changes, definite improvements, a large amount in the level of arousal/response to communication." From statistical analysis of the objective estimations we confirm these change, more particularly on the level of motor functioning like walking and the quality of sitting position, similarly on the level of spasticity. These results are suprising considering the small number of treatments given (20), and of extreme importance because its (a question of) the first study documenting objectively the prospects of beneficial effects of HBO in the treatment of children suffering from cerebral palsy.
While it is important to recognize that hyperbaric oxygen therapy clearly represents an important tool in the treatment of children with cerebral palsy, it should be viewed as an adjunctive form of therapy to be used in conjunction with other established treatment protocols including physical therapy, occupational therapy, speech therapy, as well as pharmaceutical therapy designed to reduce spasticity. The use of HBO in children with cerebral palsy is now gaining a strong foothold in the United States and there is no doubt that because of its profound effectiveness, its utilization will become much more widespread. Public awareness of the use of hyperbaric oxygen therapy in children with cerebral palsy in North America can be credited in large part to the work done by Mothers United for Moral Support (MUMS). This worldwide organization, founded by Julie Gordon, a mother of a child with cerebral palsy, seeks to unite parents of children with cerebral palsy and other needs and to share information concerning various therapeutic options. They can by contacted at telephone 920-336-5333. E-Mail can be directed to the MUMS National Parent - to - Parent network by contacting MUMs@netnet.net.
We are proud to report that the Perlmutter Hyperbaric Center has become a world leader in the use of hyperbaric oxygen therapy in neurological disorders. To receive more information about hyperbaric oxygen therapy in the treatment of cerebral palsy, stroke recovery, multiple sclerosis or other neurological problem, contact The Perlmutter Hyperbaric Center at 239-434-9699.