• Introduction: Hyperbaric Medicine: Healing With Oxygen

• What is Hyperbaric Oxygen Therapy (HBO therapy or HBOT)?

• Understanding Tissue Saturation

• Types Of Hyperbaric Chambers

• What Disorders Is HBOT Approved For?

• What Experimental Indications Is HBOT Used For?

• How HBOT Works...

• Speak To Doctors & Actual Patients of HBOT

• Are You a Candidate For HBOT?

• What To Expect At Your Consultation

• Before Your HBO Therapy

• How HBOT is "Performed"

• The Road To Recovery

• Risks and Complications Of HBOT

• The Least You Need To Know

• Related Links

• Hyperbaric Oxygen Therapy Discussion Forum 

• Hyperbaric Chamber Database - Fully Searchable

Introduction: Hyperbaric Medicine - Healing With Oxygen
For many years, Hyperbaric Oxygen therapy (aka HBO Therapy or HBOT) has been recognized as the definitive treatment for decompression sickness, air embolism, as well as carbon monoxide poisoning.  There are approximately 60 medical indications being treated, worldwide, using HBOT either by itself or in combination with other prescribed medications and protocols.  This section will give you an overview regarding the successes and hopefuls of HBO therapy. 

As with everything in Medical Science, there are approved indications and experimental or investigational indications.  There are 13 conditions or disorders currently approved for treatment in the United States by the FDA.  The Undersea Hyperbaric Medical Society recognizes these treatments as successful alternatives in heightened wound healing and disorder relief. 

What is Hyperbaric Oxygen Therapy?
HBOT is the treatment in which the patient breathes 100% oxygen at pressures greater than normal atmospheric (sea level) pressure.  HBOT involves the systemic delivery of oxygen at levels 2 to 3 times greater than atmospheric pressure.  This way oxygen is literally forced into the tissues to promote nitrogen bubble release for Decompression Sickness (DCS) in which scuba divers, like me, can be subject to if they make a decompression dive without proper decompression stops. 

diving the rigs off the
 coast of New Orleans

Types of Hyperbaric Chambers

• The multiplace chamber is a large chamber varying in size from a two-person capacity to a twelve person or more.  With a multiplace chamber, compression takes place with air and the oxygen is delivered through a mask.  These chambers are capable of depths of 165 feet or more. You can bring more things in with you when you are in a multiplace chamber.
• The monoplace chamber or one-person chamber, compression takes place with 100% oxygen flowing throughout the chamber.  These chambers allow the entire body to be exposed to 100% oxygen and can reach a depth of 66 feet below sea level.  You can't take anything in with you, normally.  And your clothing should be either nothing (bare-naked) or over 100% cotton to be on the safe side or an antistatic blend of cotton and polyester fabric.

Understanding Tissue Saturation
You see, when scuba divers go to deeper  than 35 feet they are subject to increased Nitrogen saturation in their tissues due to breathing the compressed air underwater - under pressure.  This is not saying that they are not subject to pressures of shallower depths -- I am using 35 as a base as this is when we start counting on our dive tables.  The deeper you go, say 80 feet,  the more pressure you and your tissues are subject to.  You know how you may dive to the bottom of a deep pool and feel your ears hurting a little. That is called Ear Squeeze and can be remedied by either holding your nose and holding your mouth closed and then forcing air gently to cause a little pressure to equalize between your ear drum and throat or swallowing.  I personally equalize more easily by swallowing and have even brought down a SCUDA (self contained underwater drinking apparatus) with some fresh water in it.  When you are in a pool -- I highly doubt you will be in one deep enough to actually cause damage.  But, when you are scuba diving at greater depths, if one does not equalize while they are diving they can burst their ear drum and when the cold water rushes in it can make the diver disoriented and dizzy and possibly nauseous.  Sensations and orientation return to normal as soon as the water is heated to body temperature which shouldn't take long.  If you have a sinus problem or a cold and your sinus are blocked it can cause you to not be able to equalize and can also cause your sinuses to bleed (I know first hand).

But the point is: pressures of this magnitude can burst an eardrum if equalization is not met.  Just imagine what it can do to your tissues where you don't feel pains of pressure sickness until it is too late!  Many divers have died because they either stayed down too long at greater depths say over 110 without making decompression stops at certain levels on the way back up.  You see, you can stay at 35 feet practically all day -- you usually run out of air before you run out of time to dive at that level.  BUT!  You can go down to 140 feet and stay there for only a few minutes and it is back on the boat with you until your surface time is met for the proper nitrogen bubble release -- or you don't get to go back down.  UNLESS, you dive by computer (which I do) and the dive computer calculates possible nitrogen saturation and tells you when you go back up to say, 60 feet, how long you can stay there.  The more shallow you go, the longer you can stay.  But even divers who don't need to make decompressions stops still make "afety stops for 3 minutes or so at about 15 to 20 feet (depending upon the wave conditions).  The same problems can happen if a diver dives all day and has obeyed all the depth and time rules and is perfectly fine then he goes into an airplane and that is like yet another dive to his already nitrogen enriched body -- then DCS can set in.  That is why people shouldn't fly within 24 hours after diving.  They can get what is known as the Bends or other forms of DCS which can paralyze and even kill people if left untreated.  Even pilots can get a form of altitude sickness if they are breathing the air at that pressure and altitude.

Well since I am not giving a class on scuba diving nor flying we'll get down to why you came here.  It is just that in order to understand how Hyperbaric medicine can help you -- you should try and understand what your body goes through regarding compression.  When undergoing HBOT it is basically a simulated dive, or dry dive.  Although I must caution you - there have been accounts of sicknesses and deaths involved in the nurses or attending physicians who are subject to repeated dry dives all day.  It tends not to happen as much now as it once did.  Please read the risks and complications associated with HBOT.

What Disorders Is HBOT Approved For?
HBOT is approved for the following:

- air or gas embolism
- carbon monoxide poisoning and smoke inhalation
- cyanide gas poisoning
- Clostridial Myonecrosis (gas gangrene)
- Decompression Sickness (the bends)
- healing problem wounds
- Crush Injury, acute Ischemias
- Anemia or exceptional blood loss
- necrotizing fasciitis (necrotic soft tissue disease of the muscle, fascia or subcutaneous tissue)
- Chronic Osteomyelitis
- tissue damage from radiation therapy (aka osteoradionecrosis)
-Skin Grafts and Flaps that are damaged and subject to extreme conditions and do not have a good chance of tissue survival)
- Thermal burns

By dissolving sufficient oxygen in the plasma, this supports cellular function without using the hemoglobin. Hemoglobin is an [: iron-containing respiratory pigment of red blood cells that functions primarily in the transport of oxygen from the lungs to the tissues of the body] (Merriam-Webster).  HBOT Reduces edema (fluid retention, swelling) through vasoconstriction.  What I mean by vasoconstriction is that it narrows the lumen (or cavity, bore) of the blood vessels 

What Experimental Indications Is HBOT Used For?
The indications that are purely experimental (FOR NOW) are as follows:

- Cerebral Palsy
- Stroke
- Multiple Sclerosis
- Lyme Disease
- Brown Spider bites such as Brown Recluse
- Reconstructive & Plastic Surgery
- Headaches and fatigue
- Neuropathy
- Sports injuries
- Autism
- RSD
- Anti-aging studies
- skin disorders such as eczema, psoriasis, Rosacea

How HBOT Works...
Hyperbaric Oxygen therapy allows your tissues to receive more oxygen than you would normally be able to get.  The act of breathing 100% oxygen while pressure is increased (up to three atmospheres) causes a 10 to 15 fold increase in plasma oxygen concentration.

plas*ma (noun)
: the fluid part of blood and lymph that is distinguished from suspended material and that in blood differs from serum essentially in containing the precursor substance of fibrin in addition to the constituents of serum.

The result is an increase of oxygen in the tissues.  The benefits are delivered via the lungs to the developing capillary bed of the problematic wound, tissue or infection where it helps capillaries produce white cell kill and fibroblasts (collagen) therefore creating new tissue.  It cannot be duplicated with topical O2.  So, that topical oxygenating serum from Bloomingdale's that you sold your kidney for will not even come close to what HBOT can do for you.

HBOT increases the oxygen tension in hypoxic areas (being an oxygen deficiency of  the tissues in the body) such as chronically infected, irradiated or otherwise compromised tissues.  HBOT can significantly enhance the white blood cells' capacity to kill bacteria so that infections are more easily fought off.

Are You a Candidate For HBOT? 
If you have any of the following you are NOT a good candidate of HBOT.  This list only provides the basics and cannot be used as a diagnosis for eligibility.  Only a trained HBOT technician and/or doctor can determine if you are eligible. 

• Upper respiratory infections and chronic sinusitis make it very difficult for the patient to clear his/her ears.  Often decongestants are used to open the sinuses, and occasionally surgical myringotomy is necessary to maintain open Eustachian tubes.  A myringotomy is where they make a small incision in the thin membrane, called the tympanic membrane, which is nothing but a fancy-schmancy word for ear drum.  The ear drum heals very quickly but you should never have this done excessively, unless it is an emergency, due to an increase in scar tissue formation.

• A high fever can make you very susceptible to oxygen seizures but in such cases drugs can be given to lower the fever.

• Severe emphysema and chronic obstructive pulmonary disease (COPD) the only driving force to breathe is hypoxemia (deficient oxygenation of the blood), as people with these disorders have lost their sensitivity to normal levels of CO2.  In other words, these patients may cease breathing if placed in a hyperbaric chamber because their lungs only breathe when it detects enriched levels of CO2 - scary.

• Patients who have a lower than normal seizure threshold may be more prone to develop seizures due to oxygen toxicity.  Oxygen Toxicity occurs when oxygen under pressure negatively affects the psychomotor area of the brain.  If HBOT is a requirement, additional anticonvulsants can be added to a patient's regimen.  Oxygen toxicity can also be very sleight and the observing technician may see odd behavior -- a fixed gaze, continuously fidgeting with something, staring at an object that a person would normally not be very enthralled with, etc. **I have seen this first hand in a very skilled scuba diver.  She just sat there and played with sand for a bit on the ocean floor -- we simply guided her up several feet until we noticed she was fine.  She had no idea she had been affected by this nor does she remember anything strange.  The advised she must have blacked out.

• HBOT is absolutely contraindicated (a major no-no) for patients with pneumothorax, or collapsed lung, and caution is used with HBOT if a patient has a history of spontaneous pneumothorax.

• HBOT is not recommended for patients who have active cancerous conditions.

• If you are pregnant, HBOT is not recommended for precautionary reasons, except in life-threatening emergencies.  You see, just like a scuba dive, a pregnant woman can not participate in this either as a gas bubble can form and be left within any part of the growing fetus or the surrounding tissue.  I f this happens if can prohibit the natural growth of whatever cavity, organ or area the bubble is in. Such as a malformed kidney, brain or heart, etc.  It can also cause spontaneous abortion to the fetus

What To Expect At Your Consultation
Your doctor will discuss with you the risks, the complications, determine if you are a good candidate and assess your needs.  If you have any of the following TELL THEM!!

• You experience cold or flu symptoms, sinus or nasal congestion, or chest congestion

• If there may be a possibility of pregnancy

• ALL medications you are on - including herbal supplements, vitamins or birth control.

• If you have skipped a meal prior to HBO treatment

• If you are diabetic and did not take your insulin prior to treatment

• If you have any concerns or anxiety or are claustrophobic

• Have any depression in you or your family's history

• If you smoke (QUIT!) Smokers have an increased amount of carbon monoxide in their body.

• If you have chronic gas problems (just a precaution)

• If you have ever had a collapsed lung

• As well as ANY of the contraindications mentioned below. This is important! If something happens in the chamber, you can't just open the door - you MUST go through proper decompression before you are let out or someone is let in that isn't already in.

• You will be advised about antioxidants and other supplements during your treatments such as vitamin E, glutathione, GABA, gingko biloba, grape seed proanthocyanids, and N-acetyl-cysteine. These can improve the benefits and safety of your hyperbaric oxygen session.
  

Before Your HBO Therapy
You will go over again the rules, guidelines and protocol of your treatment.  They will ascertain that you have no make-up, lotion, hairspray and all the good stuff mentioned above is not on your body whatsoever.  You will again go over what your body will undergo whilst in the chamber and how oxygen saturated tissue can help you heal or relieve symptoms of your disorder or help with your wound/scar.  Any last minute concerns will be addressed before your session.  Be sure to mention anything that may be of concern to you, NO MATTER HOW SMALL!

How HBOT is Performed
You will be have extensive rules tossed at you.  But, listen to them because they are for your own best interest.  You should come to the clinic fully scrubbed and clean -- no perfume, make-up, hairspray, leave in conditioners, moisturizers, powders, etc. NOTHING.  You will enter the chamber and A HBOT session can be anywhere from an hour to 1 and a 1/2  hours -- depending.  Usually it will be about once a day, but sometimes you may have 2 sessions a day at 3-4 hours apart.  Whatever the case expect to be there for at least 2 hours per session.

After your evaluation and briefing you will be lead into a chamber and if in a multiplace chamber just sit there with an oxygen mask on your face and breathe.  That's it, period.  But, you can not hold your breath in any way - not even for a few seconds.  Especially if you are ascending (decompressing). You do this and your lungs could be very damaged or collapse from a weakened spot bursting from the pressure of the expanding oxygen in your lungs. 

If you are in a monoplace chamber you don't even get to move much -- you basically lie there.  NO anything as the oxygen in the chamber is very flammable and you could quite frankly die from an inner explosion from any ignition of the oxygen.  Your clothing should only consist of  100% cotton, to be safe)  According to the NFPA, 19-3.1.5.4 (b) states "Garments fabricated of 100 percent cotton or an antistatic blend of cotton and polyester fabric shall be permitted in Class A chambers equipped with fire protection as specified in 19.2.5, and in Class B chambers" (Thank you, Tom Workman). 

Let the chamber operator know immediately if you experience any of the following : 

• nausea or vomiting 

• dizziness 

• ear or face pain 

• unusual sights, sounds or smells 

• chest pain 

• difficulty breathing 

• anxiety or claustrophobia 

• diarrhea 

The Road To Recovery
There really is no recovery, per se, connected with HBOT, only decompression.  Your initial complaints are what you are attempting to heal from and HBOT is only a tool in which to speed that process up.  However, you should not go scubadiving after (if applicable) or flying.  Your tissues are still saturated with gases and any further compression of your tissues can lead to more gas saturation, thereby giving you decompression sickness (DCS).  Then you will have to go back in a chamber and re-compress and then be decompressed VERY slowly in hopes that your tissue saturation returns to normal without any long term damage.

Risks and Complications Of HBOT
Research, research, research! I mean it!  This isn't like going to sit in a tanning bed for 30 minutes. Ascertain that the HBOT technicians are following the proper guidelines!   The oxygen present in these chambers are extremely flammable!   And the pressures can be harmful if you cannot equalize.  We spoke about equalization earlier, remember'?  If you can't equalize your ears -- and you'll know it -- you can damage or burst your ear drums, or a filling that is improperly sealed can explode or implode, depending. 

There are regulations that must be followed so be sure you know them just in case the chamber technician doesn't know them.  The technicians should advise you on the rules of what you must do and not do as well as what you can bring into a chamber.  And I don't care how many times you have been there they should ask about these particular items and check if they are, in fact, in your possession.  All kidding aside, this is a matter if life and death.

Do NOT bring in with you any of the following:

• hair spray (this means wearing it or bringing in bottles/cans of it)

• silk rayon or nylon clothes (only garments that are constructed of 100% cotton, to be safe) According to the NFPA, 19-3.1.5.4 (b) states "Garments fabricated of 100 percent cotton or an antistatic blend of cotton and polyester fabric shall be permitted in Class A chambers equipped with fire protection as specified in 19.2.5, and in Class B chambers." 

• Styrofoam cups 

• lighters, matches, etc.

• Thermos flasks, or any container that cannot be opened or relieved to prohibit pressure build-up
• Biro pens or any sealed-vacuum writing instruments
• Battery-containing objects. Radios, laptops, phones, watches, toys, cameras, 
• Shoes, including sandals

Just remember that chambers have actually blown up (not in the US) because of static electricity, or materials brought in that should not have been.

The Contraindications, Risks and Complications with hyperbaric treatments are as follows:

• Claustrophobia can be an issue for some patients.  The chamber is sealed off and can not be opened quickly without necessary decompression.  Sedatives can be used to relieve any anxiety that you may experience.

• Ear and face pain, known as ear or sinus squeeze, can occur in about 5 to 10% of dives to pressure. During compression, the chamber technician will guide you in performing maneuvers such as holding your nose and trying to exhale gently through it.  Like trying to pop your ears or even the simple act of swallowing helps clear (equalize) your ears and sinuses of pressure build-up.  If you are unable to equalize, the descent is ceased -- as you can "pop" your ear drum.  It doesn't go away -- it only gets worse I promise you.  I have had severe ear squeeze while scubadiving after healing from a sinus infection. I had blood in my mask when I came up.  A little blood and a lot of water looks like a lot of blood!

• An irritating cough can develop because of the dryness and irritation of pure oxygen in the lungs.  A cough due to a viral illness can be made much worse by HBOT, so always let the doctor/chamber technician know if you have cold or flu symptoms or are healing from such.

• Seizures can be provoked by oxygen saturation, and medication for epilepsy will need to be reviewed.  The use of short intervals of breathing medical grade air by mask to prevent oxygen build-up may be used.  I have actually seen someone have disorientation at depths over a hundred on plain compressed air while diving.  We had to bring her back up about 20 feet before she came back around.  Just imagine what can happen with oxygen tissue saturation at depths!  Know the risks.

• Blood sugar and insulin levels will have to be closely monitored during HBOT.  If in doubt, a nurse will, or should, check your blood sugar.  You should have an insulin test regardless to be safe.

• If you are pregnant, is is highly doubtful you will be approved for HBOT.  You see oxygen bubbles  can take the place of a mass of developing cells in the fetus and quite frankly the fetus could be born without this area that the bubbles were prior (i.e. lung, brain hemisphere, eye, hypothalamus, etc, etc).  You will also be excluded if you have or have had congestive heart failure, hyperthyroidism, chronic obstructive pulmonary disease, acute fevers, asthma, optic neuritis, pneumothorax (ever had a collapsed lung or weak lung wall), and any recent radiation treatment. Advise how recent your radiation treatment was if this applies to you.

• Cataracts can be made worse by HBOT.

• Let the doctors/technicians know if you have taken insulin, steroids such as cortisone, amphetamines, adrenalin, bleomycin , doxyrubicin, narcotics, alcohol, nicotine, vasodilators, digitalis, sulfamylon, or disulfiram (Antabuse).

• Tooth fillings which may be improperly sealed, unfinished crowns, sinus infections, a cold or flu, stopped up ears or other ailments which pose an equalization hazard.

• During a long course of treatment you may develop temporary vision changes or numbness of your fingers.  These pass in time.

• Rare complications and emergency procedures may require medical consultation or evacuation to critical care facilities. 

The Least You Need To Know

• HBOT isn't a tanning bed, there are risks, complications & contraindications.  Get to know them!

• There are currently 13 conditions or disorders approved for HBOT treatment, but that doesn't mean it doesn't WORK for other things. Although it was been proven to help with persons affected with paralysis, problematic wounds and scarring -- studies are underway for other ailments.

• Make sure that the chamber you are using is CERTIFIED!!!  No homemade tanks!!  This could kill you or leave you in a vegetative state!

• Only choose chamber that are in respectable clinics!

• No salon bags or chambers are going to give you REAL HBOT results.  The salon bags are MAYBE capable of small increments of pressure -- Hardly anything to scream about.

• HBOT is not reported to increase free-radical activity but antioxidant supplements and foods are encourage prior just in case.

• If you have any of the contraindications stated above or any you may feel I have not mentioned please advise your doctor/chamber technician.

• For Goodness' sake don't sneak anything in that shouldn't be in there. It's a matter of life and death -- even to the folks outside the chamber!

• Fees range from *free to $500US per session. You can buy packages as well.
  

Related Links
HBOT.COM - Your Hyperbaric Resource
Hyperbaric Oxygen Therapy (HBOT) Patient Handbook
Indications of HBOT
HBOT - MOBILE hyperbaric oxygen therapy 
eMedicine - Hyperbaric Oxygen Therapy

*free being for patients involved in experimental studies

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