Hyperbaric Oxygen Therapy (HBOT)
Your Brain & Oxygen
No person can be kept safe from the risks that are part of athletic and recreational activities, including serious brain injuries sustained through many hits or one major hit to the head. However, the aftermath of these events could be very different with immediate treatments that may limit long-term tissues damage.
The brain needs oxygen. And when the brain experiences an injury or concussion, the affected area is immediately deprived of that precious oxygen. HBOT can help restore the balance.
In the most basic terms, HBOT uses oxygen therapeutically for many conditions in which tissues and neurons have been damaged by varying degrees of oxygen deprivation. HBOT has been around for centuries, beginning in 1664. An Englishman named N. Henshaw would increase the oxygen pressure of a room with two large bellows to increase oxygen intake. We have come a long way since then, but the purpose stays the same: increase oxygen pressure to damaged tissues.
The following article from Dr. Kenneth Stoller eloquently describes HBOT and its benefits:
Hyperbaric therapy is truly a benign and benevolent intervention for children and adults with brain injuries.
It works as its name implies – hyper (more of) and baric (pressure) and in fact that is how it works. It is the increased pressure of the gas we breathe everyday that can actually signal the DNA in our cells to perform healing tasks that the body normally can’t do.
Ground zero for this activity is the mitochondria, which are the little organelles inside of our cells that convert oxygen and sugar into the gasoline the cells run on (ATP) – this is called cellular respiration. It doesn’t take much to knock mitochondria off-line and then that cell can’t perform the job it was assigned. So, be it oxygen deprivation, external toxic exposure, stroke, trauma, or a hyper-immune reaction to an infection or a vaccine the mitochondria will be damaged.
We know how Hyperbaric therapy works – it works by reviving the little mitochondria and actually causes mitochondrial biogenesis, so that if you need more mitochondria in your neurons more of them will form. It is interesting to note that the reason the keotgenic diet helps patients with certain types of neurological problems is that ketone bodies help support mitochondrial function. It is a back door way the mitochondria can receive energy if glucose transport has been compromised. My opinion is that hyperbaric therapy is the most effective way to do this. It is that simple – this is not rocket science, but it is non-invasive brain repair.
When I published an article on using hyperbaric oxygen therapy to treat Fetal Alcohol Syndrome (FAS) in the prestigious PEDIATRICS journal, I thought I would be hearing from a lot of people. After all, FAS is they most common form of non-hereditary mental retardation in the USA. So, when the article was published back in 2005, it was met with resounding silence.
This is emblematic of the trouble hyperbaric therapy (HBT) or hyperbaric oxygen therapy (HBOT) had becoming integrated as standard of care for treating brain injuries. It isn’t as if it doesn’t treat brain injuries already – approved and accepted (insurance reimbursable conditions). Decompression Sickness (DCS) that affects the brain is not about shrinking down the bubbles of nitrogen that DCS can cause – those bubbles are ephemeral and are gone within 5 minutes unless you end up on an autopsy table. So, then what is being treated?
HBOT is treating the inflammatory cascade and hypoxic brain injury those bubbles set off. In other words a brain injury is being treated.
When Carbon Monoxide (CO) poisoning is treated with HBOT is this therapy pulling the CO molecule off the hemoglobin in your red blood cells? That is the answer most medical students would tell you, but the truth is that by the time most patients get into a hyperbaric chamber they have normal Carboxy-Hemoglobin levels. So, what is being treated?
What is being treated are those little mitochondria, and on a DNA level causing mitochondrial biogenesis (new mitochondria) – all this by perhaps the safest procedure in medicine at the pressures used to treat brain injuries.
What Are Hyperbaric Chambers?
There are many types of hyperbaric chambers in all shapes and sizes, but they are not all equal. There are two main types:
“Hard-Shell” Chambers: Small, one-person to submarine-sized, 30-person chambers made of steel and acrylic; can achieve pressures equal to three atmospheres and beyond; compress with 100% oxygen or room air; when using room air, oxygen hoods or masks given to the patient(s) so they can breathe in the enriched oxygen.
“Soft-Shell” Chambers: Chambers of varying sizes able to inflate to 1.3 atmospheres (under current FDA regulations), which is about 12 feet of seawater pressure; increase partial pressure of oxygen by almost 50% by pumping into the chamber by an FDA-licensed oxygen concentrator.
Which Pressure is Best?
There is a therapeutic window that most brain injuries respond to and that is 1.3 to 2.0 atmospheres. There are always exceptions and special cases, but pressures between 1.3 and 1.5 atmospheres seems to be the “sweet spot” for glucose utilization, therefore it is the target pressure for many brain-injury protocols.
More pressure and more oxygen are not necessarily better. The pressurized air (which contains more oxygen because of the increased pressure) or 100% pressurized oxygen act as signaling agents to as many as 8,000 genes. The mitochondria have their own DNA; this is where action occurs to increase energy levels of injured or poisoned brain cells. More genes are actually signaled at 1.5 atmospheres than at higher pressures.
What is Treatment Like?
Hyperbaric treatment facilities that are not connected to hospital operations almost always treat conditions that have yet to be approved by the FDA. These are called “off-label” conditions. These free-standing centers are few and often far between. Since the brain injury protocol requires daily treatments for months, both cost and distance to the nearest clinic become critical matters.
Portable chambers go to 1.3 atmospheres and are not permitted to be inflated with oxygen. However, they pump oxygen at 10 liters per minute by an FDA-licensed oxygen concentrator.
But Isn’t Hyperbaric Therapy Controversial?
Indeed it is, but the controversy is political not scientific. When Canadian parents petitioned their reluctant government to fund a study examining the use of hyperbaric oxygen to treat children with cerebral palsy, the government hired a scientist that delivered biased results. He removed the control group and only looked at two treatment arms: 1) children receiving hyperbaric oxygen at 1.75 atmospheres (100% oxygen); 2) children receiving hyperbaric air at 1.3 atmospheres of room air.
The results of the study showed that Gross Motor Function improved 15 times greater with treatment than with previous therapies in both groups of children. 80% of the 110 children involved in this Canadian study (Lancet 2002) showed improvements including cognition, speech and other outcome measures. So, what did the representative of the Canadian government do who was sent it to obfuscate the results of the study? He called the 1.3 atmosphere group a placebo group and announced hyperbaric therapy didn’t work because the treatment group’s results were no different than those of the placebo group.
Since few physicians and scientists know anything about hyperbaric medicine, there was no one around to point out that 1.3 atmospheres is hardly a placebo when it increases the partial pressure of oxygen by almost 50%. But they knew that – this was all about making sure the government didn’t have to pay for this therapy for handicapped children. Children with CP can not receive hyperbaric therapy from most third-party payers in part because of the propaganda surrounding this ten-year-old study.
The truth is that ten times more progress was made during the two months of hyperbaric therapy (while all other therapies were ceased) than during the three months of follow-up with OT/PT restarted.
Research dating back to 1947, documents numerous articles demonstrating biological effects in animals and humans of exposure to pressure between 1.0015 and 1.30 atmospheres, which includes the pressure range of the so-called “sham” groups in three of four of the recent Department of Defense HBOT studies.
Ultimately, HBOT consists of increased pressure and increased pressure of oxygen over ambient pressure and ambient pressure of oxygen along an entire spectrum of combinations of increased pressures and increased oxygen pressures, not just the narrow range defined by the Undersea and Hyperbaric Medical Society’s HBOT Committee, which has used 1.4 atmospheres of 100% oxygen as a lower limit for the definition. That is just arbitrary if not capricious, which is something “they” can get away with because so few people know anything about this area of medicine.
A true sham group must not contain any therapeutic agents that are active in the experimental group (pressure and oxygen). Yet, all of the DoD “sham” groups contain pressure and oxygen.
The graphic to the left is a functional brain scan called a SPECT scan. You are looking at the front of the brain. Before hyperbaric oxygen was administered there is little to no activity in the temporal lobes and lack of blood flow to the prefrontal cortex. After treatment the horns of the temporal lobes can be seen now and the deficits in the prefrontal cortex are filling in. 1st scan: 1 month after accident shows significant injury to left
frontal area and contra coup injury to right parietal/occipital.
After initial treatments patient became conversant & independently ambulatory with slight spasticity. CT revealed diffuse edema, midline shift, petechial hemorrhages, subarachnoid hemorrhage, small subdural hematoma, basilar skull fracture.
Within 8 weeks of accident patient went from ventilator to walking and talking.
2nd scan: 1 year later after 188 HBOT treatments. Treatments discontinued when patient enrolled in remedial college courses.
In Jan. 2001, 12 years post injury, patient called physician to tell him of 2nd promotion at the bank. Patient active, functional, and employed.
(The scans were done by Paul Harch, MD, Director of the LSU Hyperbaric Medicine Fellowship and were submitted into the Congressional record 2004.)
How Do SPECT Images Reveal the Truth?
While it seems obvious, medicine has been treating the brain for over a hundred years without actually looking at it. But now, a form of functional brain imaging called SPECT (Single Photon Emission Computed Tomography) is used extensively at the Amen Clinics throughout the USA.
It looks at blood flow directly and indirectly at metabolic activity. These scans give an objective measure of how HBOT can reinvigorate neuronal metabolic activity and show the recoupling of blood flow to those now more metabolically active neurons. In working with blast-induced brain injured vets from Afghanistan and Iraq, SPECT has proven itself as a clinically useful tool for documenting the increased neurocognitive function of the injured brain.
Why Hasn’t the Sports Community Heard More HBOT Treatment?
Well, many of us who use and understand HBOT therapy wonder why such a safe and effective treatment continues to have a difficult time finding its rightful role in the treatment of MTBI and TBI along with numerous other conditions. This treatment has been around for decades in the U.S. for treating US. Navy divers with decompression illness (“the bends”).