Latest / 20-Minute Health Talk / How hyperbaric oxygen therapy heals the body - Part 1

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How hyperbaric oxygen therapy heals the body - Part 1 · 20-Minute Health Talk

0:03
Welcome to 20-Minute Health Talk,
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I'm Rob Hoell. Getting oxygen to tissues that have been damaged is
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critical to help the body heal and fight off infection. Hyperbaric
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Oxygen therapy can speed up that process by dramatically
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increasing the amount of oxygen to an injured area of the body,
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typically due to crush injuries, chronic wounds resulting from
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diabetes, radiation damage, and a host of other conditions.
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In part one of this two-part conversation, we speak with two
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world-renowned experts in the field
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to learn more about this powerful treatment. With us here in the studio
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is Dr.
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Owen O’Neill, who is the founding and current medical director of the
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Department of Undersea and Hyperbaric Medicine at Phelps Hospital,
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the largest hyperbaric chamber in the northeastern United States.
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Welcome Dr.
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O’Neill. Thank you Rob.
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It's a pleasure to be here, and I really do thank you for having me.
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Our next guest joins us remotely.
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John Peters is the executive director of the Undersea & Hyperbaric Medical Society
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and international non-profit association
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serving physicians, scientists, associates, and nurses, in the fields of
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Hyperbaric and dive medicine.
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He is also a fellow of the American College of healthcare Executives.
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John, welcome to the show.
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Thank you so much,
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it's nice to be here. Dr.
1:15
O'Neill also helps to lead the Undersea and Hyperbaric Medical Society
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as president-elect in addition, he received its 2022 Excellence and
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Hyperbaric medicine award for 30 years of work, in the field, which
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includes
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extensive research. We'll talk more about that in a minute,
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but first, hyperbaric oxygen therapy is often associated with deep sea
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diving but it's also used to treat a variety of other health problems.
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Can you explain how hyperbaric oxygen therapy is used in the
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healthcare setting?
1:41
Certainly Rob. that's a great question, So normally our body consumes
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21% oxygen every time we take a breath in, and the body also requires
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that oxygen to perform many of its physiologic functions. In addition,
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have enough oxygen, we won't heal.
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So hyperbaric oxygen, will provide us with an increased amount of
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pressure — higher than normal atmospheric pressure — where we're sitting
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right now and in doing
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so, we're able to use a significant amount of oxygen and bring the
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tissue oxygen concentration to about 15 times normal
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then we have it right now, and we can achieve these values in a
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hyperbaric chamber.
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We cannot achieve those values
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even if we breathe 100% oxygen, such as using a mask that a patient may
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get in the emergency room.
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Even breathing 100% of oxygen at atmospheric pressure will not bring
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the oxygen levels up significantly as it will
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when in a hyperbaric chamber under the pressure. We're talking about a
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hyperbaric chamber.
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I almost get the vision of like a submarine, what happens during a
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session and how does extra oxygen help the body heal?
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Well the the submarine look
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might be an adequate description.
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I like to think of it more as our chamber at least at Phelps, is about
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the size of a 727 airplane.
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Wow.
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So what happens is with increased pressure —
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let's just take for instance, the example of a garden hose —
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So if we turn our garden hose spigot on, the water kind of plops
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out the end of the hose and that's more or less, how the body normally
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drops oxygen off into the tissues.
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However, if we put a pressurized handle on the end of the hose and we
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squirt it, we'll get a lot more water at the same time.
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In addition we'll also
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increase the distance of where that water goes.
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So in a hyperbaric chamber, we will actually increase the tissue
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oxygen concentration, all of the cells in your body will
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have approximately 15 times the amount of oxygen that it normally gets
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and in cases, where let's say vessels are blocked, or
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circulation, can't get to a wound,
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we are able to deliver that oxygen to the womb because the distance of
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a traveling from capillaries out to the wound is significantly
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increased because of the pressure gradient
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that's created by the hyperbaric chamber.
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Hyperbaric oxygen therapy is approved as a treatment for several
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conditions.
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Those include anemia, severe burns carbon monoxide poisoning,
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chronic wounds that won't heal, such as a diabetic foot ulcer, Crush
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injuries, decompression sickness, gas, gangrene, radiation injury, skin,
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graft flap and risk of tissue death.
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John how is it determined which conditions
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hyperbaric oxygen therapy can treat? Sure, there are 14 approved
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indications
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and we've been publishing a journal since 1976 on those indications
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and it's about 400 pages of action-packed Science and data on those
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indications.
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For what I've heard, you know, being a late person about hyperbaric
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treatment is usually when I hear about firefighters or people with
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carbon monoxide poisoning. Dr.
4:54
O'Neill,
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how commonly is this used in healthcare, and are there a lot of centers
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like the one you have at Phelps?
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Well, it's not overly common in healthcare.
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I think it's become more common over the last I would say 15 years.
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They've been more and more mono place or a single patient chamber
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center's opening up in hospitals as well as some freestanding centers
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but the specialty itself is a specialty
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that's not really taught in medical schools.
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There are a couple of medical schools, including New York Med, where I
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reside as well, they teach hyperbarics in
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the school.
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It's not something that's learned during the curriculum.
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If you don't have a hyperbaric chamber in your residency program, you
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won't learn about it there.
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But there are a significant number of programs especially University
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programs now with Fellowship training and understanding Hyperbaric
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medicine.
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So the specialty is still in the upward direction, we have increased
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the number of centers over the last John, how many years?
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Really from about 2002 to 2015.
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There was an exponential rise and programs, we have about 5800
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hospitals in the United States.
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And of those, maybe about 3,500 are large enough to actually have or
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house a unit, you have other hospitals that are small, rural hospitals
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that don't have the capacity for, for this kind of service.
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So, we grew through 2015, and we kind of contracted, but we're actually
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on an upward trend again this year.
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And the Chamber we have at Phelps is
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the largest in the Northeast but it's one of very
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few centers
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like it in the country. Most of the hospitals are housing
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one patient at a time in hyperbaric chambers, where our chamber can
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sit 12 patients at once. It's about 9 feet in diameter, 28 feet long.
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More importantly than having the largest hyperbaric chamber in the
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northeastern United States,
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I would say that we have one of the best Hyperbaric trained teams in
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the country as well.
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People have been doing it for quite some time.
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I'm doing it for 30 years and
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I still have people with me who have been with me the entire 30
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years.
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John can you tell us a little more about the Undersea and Hyperbaric
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Medical Society?
7:09
Sure, the Undersea and Hyperbaric Medical Society or UHMS for short was
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founded in 1967 as a section of Aerospace Medical Association and we
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stayed a section of asthma until 1970-1974.
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And then eventually
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to form our own organization as officially breaking off from
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them in 1976.
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And so we are a 501, c, 3 non-profit.
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We have approximately 2,000 members and 30 to 35 countries, and we
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are comprised of about 50% position membership and about 50%
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non-physician, those are including technicians nurses, therapists Etc.
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Wow.
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Is this a one-time treatment or do you get multiple sessions in one of
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these chambers?
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It really depends on your diagnosis.
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So for instance, scuba diving is where we started, right?
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So if you come in with a scuba diving illness, IE decompression
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sickness, you might require just one treatment but that one treatment
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may last five and a half hours or longer.
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If you have carbon monoxide poisoning, that might be three treatments
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within a 24-hour, period, but most of the elective or everyday
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treatments that we
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perform as an extra treatment for the normal care patients are getting.
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Those treatments can be anywhere from 20 to 60.
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So, for the most part hyperbaric oxygen is not a quick fix in certain
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cases, it's a longer fix, but some of those treatments that require a
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longer amount of time.
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Hyperbaric oxygen, is one of the only treatments for it. And just to
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paint a picture,
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you know, you described it before, as like, 727, what's it
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like, when you're in the inside the hyperbaric chamber, are you sitting
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down?
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Are you able to do things or you just sleep? Yea the the hyperbaric
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chamber at our institutions is a very comfortable chamber.
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It's more or less like sitting in the first class airplane seat.
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So you'll be sitting on the seat, you'll be wearing a neck down
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or neck ring, which is a plastic holder of a rubber Dam, which goes
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around your neck, like, a turtleneck wood, and the hood that you wear
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inside our chamber snaps down on top of that.
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The hood is very lightweight and see through during the course of the
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treatment
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you could watch
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amovie, you could read a book, you could look at a magazine, our
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system has environmental control
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so we do have air conditioning on compression.
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We have heat on the way up if it gets too cold.
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And like I said, you can watch a movie, you can sleep or you can
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read a book. What would be a scenario where you would have 12 people
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in the chamber at once? Carbon monoxide poisoning is one.
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Family House or a fireman involved in a bad fire.
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We have had 12 patients at once and it was a large
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family.
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Well, we're talking about conditions like diabetes which would also be
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treated by a doctor specializing in that condition is hyperbaric
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oxygen therapy, a secondary treatment?
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Or can it be a primary treatment for some conditions?
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It's a primary treatment for a number of conditions, scuba diving
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illnesses one.
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So if a diver gets decompression sickness, we're the only treatment
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for him.
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If he gets an error gas embolism or there's an error gas embolism
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in the hospital with certain procedures that we do
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now, we're the only treatment for that. I would
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go as far as to include that radiation damage from radiation tissue
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because most of the treatments that occur in the hospital for
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patients with radiation damage, for instance, radiation cystitis,
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which would be a radiation damage with the lining of the bladder,
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their symptoms may be significant bleeding and discomfort.
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So they may get admitted to the hospital to stop the bleeding but all
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the treatments are to treat their symptoms.
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It's not treating their underlying problem, which is the radiation
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damage.
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And we are the only
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treatment that's going to fix that. Tell me exactly what radiation
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damage is.
11:03
Okay.
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So the most important thing for patients who have cancer is to get rid
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of the cancer, right?
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So, radiation therapy is there to dissolve tumors unfortunately, the
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good tissue around those tumors also are subjected to the radiation.
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Now, over the years, we've got a little bit better at that, but we
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still are not there yet.
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So when one person gets radiation, the patient gets radiation therapy.
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What happens
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is it creates an inflammation
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in the lining of the blood vessels in the area where their
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radiated.
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So over a period of time, those blood vessels eventually, coagulate or
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clot and disintegrate.
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So, as time goes on, more and more of those vessels disintegrate, we
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wind up having very low oxygen tissue levels
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in those areas, we have the formation of new blood vessels in a low
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oxygen medium, which don't function very well they're very friable.
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And we also have a significant amount of
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scar tissue form, which we call fibrosis in medicine.
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So hyperbaric oxygen therapy over the long haul.
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Again, we said not a quick fix,
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so over the long haul that 20 to 60, 40 to 60 sessions in radiation
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cases, we will grow new healthy vasculature that will never go away
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unlike the radiated blood vessels that will continue to be destroyed
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throughout the patient's life.
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So the inflammatory process that's
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Caused by radiation damage, never goes away.
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It's always ongoing and we don't know how fast it's going to occur.
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It occurs very slow in some folks and it occurs very fast in others.
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There's no way of telling which category a persons going to fall
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into.
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So we want to treat them as best we can to grow as many new blood
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vessels as we can, to reduce as much fibrosis as we can to prevent
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them from having the symptoms of bleeding discomfort.
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Discomfort or blockage
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Dr.
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O'Neill in addition to your role at Phelps, you do a lot of work
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outside of the healthcare setting.
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Specifically, you actually work in undersea medicine.
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Tell us a little bit about some of these activities that you're
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involved in outside of the hospital.
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Well, as the specialty is named Undersea and Hyperbaric medicine.
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The undersea portion is primarily taken care of divers, commercial
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divers, recreational divers and compressed at workers which is known
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as the sandhogs here in New York, right?
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So, one of the big aspects of the undersea world right now is
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tunneling.
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So we have a lot of space occupied above ground, so we're starting to
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go below ground.
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And unlike they did in the older days in the late 1800s and early
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1900s,
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we no longer dig tunnels by hand.
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We did them with what's called a tunnel boring machine, or a TBM for
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short.
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And these tbms are digging and moving forward and they're
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creating a round space.
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And they are actually building the concrete tunnel behind it.
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But the Cutters and Rippers and the tools at the front of this
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machine, get worn down every now and then, and it does still require
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humans to go in and repair them, replace them and fix them.
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So these tunnel boring machines have hyperbaric chambers actually
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built right into the front of them.
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So that when they have to stop tunneling to repair things, the
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commercial divers are then called in or the compressed air workers or sand
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hog union workers are called in to be pressurised into the hyperbaric
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chamber, and go out the other side to work in the front and then come
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back into the hyperbaric chamber
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at the end of their shift and be decompressed.
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So, when that happens, when they have to stop to fix this machine, my
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medical team gets call and we fly wherever that might be whatever
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state, it might be here in the United States or whatever country
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it might be, and we go there, and we take a look at the depth of the
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job.
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We write the compression, the decompression scheduled for the
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workers,
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we tell them how long they can work out in front of the machine and in
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addition, we examine the workers.
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We want to know what kind of Health they're in.
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We make sure that they have, their ADC diving committee, physicals
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performed on a yearly basis.
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Make sure they had all their testing done beforehand.
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Make sure they feel well, the day they're going into the dive, we
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don't call it a treatment, here we do call it a Dive and then once
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they're fit, we send the men.
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We compress the men, then we decompress them
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and we take them out, examine them again then let them stay
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around with us for an hour because it can still be about an hour
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before decompression sickness sets in.
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So we examine them again
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one hour after they exit the chamber. Once they're cleared, they're
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given some information,
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some health tips and they're sent home and they usually come
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back the following day at the same time for their shift again, and
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this is an ongoing 24/7 service that we provide until the front of the
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machine is workable again and they can start tunneling.
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It's fascinating and
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And when you talk about the sand hogs right here in New York City,
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they were doing that for the, I guess the East end access to Grand
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Central for the Subways.
16:06
That's correct.
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Currently in a job in Los Angeles and before that we actually worked
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on the Big Bertha project in
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Seattle which was the largest tunnel Boring Machine in the world which was
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five and a half stories in diameter.
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Wow, amazing.
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How does a patient who has a chronic illness,
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get hooked up with hyperbaric treatment?
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What we're doing today is we're trying to educate the community which
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I think is a very important item because patients don't need to have
16:33
their own physician
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refer them, they can come on their own, even if they're not sure, we
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can help them,
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we'd be happy to sit down with them and tell them how we can or how we
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can't help them and maybe direct them in the proper direction.
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So, patient education, I think Community Education is crucial. Ongoing.
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and continued physician education regarding hyperbarics is important
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and I've been doing that for 30
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years,
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It does tend to keep us fairly busy.
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But we have certainly seen a number of patients now come in
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self-referred some for the right reason,
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some for the wrong reason, but in my practice, I'd rather see 100
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patients in my office
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that feel hyperbaric oxygen might be beneficial to them.
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and even if I only treat one patient, at least that's one patient we
17:17
didn't miss.
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That's important
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that uhms says on a global scale is working to educate other
17:24
specialties too
17:25
so it is
17:26
a multidisciplinary effect and an effort, really
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where we're working with other specialists who also owned the
17:37
same patients, who were working with them, to address one condition
17:43
that they have potentially a basket of several.
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And so it really is kind of a from a global standpoint,
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whether we're working with family practice or general surgery,
17:55
emergency medicine, or
17:56
other specialists. Is this something that insurance
18:00
covers? Insurance does cover many of the diagnoses.
18:04
As John mentioned earlier, the Undersea and Hyperbaric
18:08
Medical Society has a list of about 14 acceptable indications for
18:12
treatment. Medicare maybe doesn't cover a few of those items, but most
18:18
private insurance companies do cover it.
18:20
Yeah.
18:21
What are the risks of hyperbaric oxygen therapy?
18:24
So the hyperbaric oxygen treatments are probably one of the safest
18:30
treatments we have in healthcare today.
18:33
The important point, like most things in medicine is patients are
18:36
evaluated properly by a board certified or a fellowship trained or
18:41
experienced
18:42
Hyperbaric physician.
18:43
There are very few things that can adversely affect the patient.
18:47
The first thing is pressure. So we all know that we can feel pressure
18:50
in our ears, just swimming to the bottom of a 10-foot pool or driving
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in the car in the mountains.
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So when we pressurize the chamber most patients will feel the
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pressure in their ears, and they're taught how to overcome the
19:02
pressure.
19:03
There are a number of ways of doing that and it becomes a very
19:05
infrequent problem.
19:07
Secondly, would be things like claustrophobia confinement anxiety and
19:11
that would occur
19:12
the one patient at a time Chambers more, so than the chamber we
19:15
have at Phelps, but, you know, people can be talked out of
19:18
claustrophobia confinement, anxiety, even a mono place chamber and
19:21
they can be treated for that as well with medication.
19:24
Lastly at times we make the distance vision after 30 treatments or so
19:29
we can make the distance vision a little blurry.
19:32
If you where readers glasses to read, we make the reading vision
19:36
better.
19:36
We may not need the glasses, those are all temporary changes and
19:40
then come back to normal anywhere within two to six weeks of
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completing treatment. And oxygen toxicity.
19:46
I even think about not even talking about oxygen toxicity
19:51
because it happens so infrequently
19:54
in a
19:54
cynical hyperbaric chamber, but oxygen toxicity can occur, it can be a
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neuromuscular irritant.
20:01
We can also see patients that could have a seizure from oxygen.
20:05
So anybody who comes to us with a history of seizures that requires
20:09
the treatment, remember do no harm to the patient,
20:11
so if they require that treatment and we know that treatments going to
20:15
either save their life or save their limb and they have a seizure
20:18
history or taking seizure medications, we'll discuss that with the
20:22
patients and we'll eventually treat them.
20:24
But if you have no seizure history, your chances of having a seizure
20:28
from oxygen toxicity and hyperbaric chamber textbooks will tell you
20:32
one in 10,000.
20:33
My practice tells me about what an 18,000 so you probably have a
20:37
better chance of getting bitten by a shark walking out to your car
20:40
tonight when you leave the studio.
20:47
That does it for part one of this interview with Dr.
20:49
Owen O'Neill
20:50
and John Peters part 2 will be available next Wednesday, November 30th
20:54
on your favorite podcast app.
20:55
Remember to subscribe to 20-Minute Health
20:57
Talk to stay up-to-date with the latest news and developments in
21:00
healthcare.
21:01
I'm Rob Hoell,
21:02
stay safe and have a great day.