More MS news articles for January 2000

Oxygen therapy stirs hopes and concerns

Jan. 4, 2000  USA Today

By Dr. Stephen A. Shoop and Mike Falcon,
A Doctor In Your

A few less people are "putting on airs" in West Hollywood tonight. O2, the oxygen bar owned by actor Woody Harrelson and friends,  announced last Tuesday they were closing their doors for the holidays - and for good.

It seems there just aren't enough folks in town who'll pay $15 for a 20-minute blast of pure O2 (flavored oxygens extra).

But many people every day across the USA pay 10 times that amount and more for an hour in a hyperbaric chamber breathing two atmospheres or more of pure oxygen. Proponents of hyperbaric oxygen therapy (HBOT) say for a variety of medical conditions, it may be the best deal in town.

Hyperbaric basics

Basically, HBOT delivers 10-15 times the amount of oxygen in normal air to traumatized tissue. While researchers are uncertain about exactly what happens, the concentrated oxygen appears to stimulate repair and new creation of microvessels which supply vital nutrients through the bloodstream to the injured area. As the site becomes increasingly revascularized by the treatment, the body's healing response is activated and promoted.

Without treatment, the immune system seems to identify the damaged cells as unsalvageable, no healing response is initiated, and inevitable tissue death occurs.

Originally developed in the 1930's by the US military to treat decompression sickness (the bends) and air embolism as a result of deep sea diving operations, HBOT has been used in hospitals ever since for the treatment of burns, wounds, external diabetic ulcers, and for rapid reoxygenation of the bloodstream to combat carbon monoxide poisoning.

The therapy has long been embraced in Europe for a much broader range of applications, and in recent years American alternative physicians have extended its use to include:

Regeneration of stroke-damaged brain tissue
Head and spinal cord injuries
Migraine headaches
Tinnitus (ringing in the ears)
Multiple sclerosis
Secondary AIDS infections
Radiated tissue damage
Plastic surgery

While it might seem obvious to expect superoxygenation to help victims of chronic obstructive lung diseases like emphysema, HBOT has not proved especially effective with these conditions. "Surprisingly, hyperbaric work may be at odds with what we want to accomplish in some of these cases," says Dr. Edward Golembe, medical director of the Brookdale Hospital Hyperbaric and Wound Healing Center, Brooklyn, N.Y. "The treatment may alter what fires the breathing mechanism."

Golembe also notes that most physicians using hyperbaric chambers are wary of HBOT in conjunction with certain cancer chemotherapies.

HBOT is, however, a potential life-saving alternative for those whose religious beliefs prohibit blood transfusions. "Ironically, it's the red blood cells which transport oxygen," notes Golembe. "But if your need for a blood transfusion is predicated on the need for oxygen, and you're not allowed a blood transfusion, the hyperbaric chamber may satisfy everyone's needs by supplying a lot of oxygen very rapidly."

Inside information

The first time many people heard about a hyperbaric chamber was when the rumor circulated widely that Michael Jackson had bought himself the apparatus to sleep in. Supposedly the King of Pop believed the pressurized oxygen would keep him young.

Like most rumors, this one was hot air.

But Jackson actually did get into a hyperbaric chamber once during a visit to a burn center. The "man in the mirror" went in fully clothed - no street clothing or jewelry is allowed during actual treatment - just to check it out.

From such innocent moments pseudo-medical mythology is born.

Actually, treatment in a hyperbaric chamber is not the claustrophobic ordeal you might imagine. The single-person chamber - called a monoplace - is a roomy glass cylinder about eight feet long and three feet wide, plenty big enough to accommodate a sizeable man. A comfortable adjustable bed slides in and out on rails.

Once inside, a circular metal door seals shut behind you. Generally there's a feeling of being a bit confined, but not oppressively enclosed. If you want to talk to the doctor or technicians, constant two-way  communication is available by intercom. But most patients go to sleep or watch television through the clear, curved panes.

There are also multi-person hyperbaric chambers, often reconditioned Navy equipment used to decompress divers. "The multi-person units have the capacity for up to six atmospheric units," says Golembe. "But individual differences are difficult to monitor. Navy Seals using the group chambers reported an increased possibility of seizures."

Safety, hope and hype

Estimates place more than 300 hyperbaric chambers in use across the USA. And as conventional medicine refers more and more patients to HBOT, the number of practitioners grows. But with growth comes the need for caution.

"I've been to the so-called oxygen bars," says Dr. Raplh Potkin, pulmonologist and president of the Beverly Hills Center for Hyperbaric Medicine. "With the highly combustible nature of oxygen and cigarette smoking in the same general area, it gave me a feeling like watching children playing with matches in a fireworks factory."

Even in a controlled therapeutic setting, "Pure oxygen is an extremely volatile substance," notes Potkin. Knowledgeable professional care is essential to insure the safety of the patient.

This safety concern includes the critical issues of pressurization levels and treatment durations. "The use of oxygen is like using powerful drugs," notes Golembe. "Consider the pressure of the oxygen analogous to the strength of a prescription medicine. And think of the time in the chamber and the number of sessions required as the frequency with which you need to take the drug over a recommended period."

"In the hands of the unlicensed or inexperienced," Potkin concludes, "you could have very serious immediate consequences."

Golembe also worries about those who exploit the desperate with unsupported claims that extensive multi-session HBOT can effectively treat a laundry list of chronic or profound ailments. "Hope is essential for both patients and their families," admits Golembe. "I'd be the first to congratulate someone who shows us something new that's worked. But I'm also dismayed that money may be misspent on hope for people with something like long term traumatic brain damage when little real chance for improvement may exist."

Plastic surgery

One of the brightest arenas for HBOT is reconstructive and elective plastic surgery. In contrast to administering high-pressure oxygen after the tissue trauma, Potkin's routine calls for saturating the body with additional oxygen a day before the surgery.

"It's like knowing you were going to have a sprain a day ahead of time," says Potkin. "You'd take the anti-inflammatory beforehand to prevent the swelling. As the lungs process the pressurized oxygen and then distribute it efficiently through the bloodstream to various tissues, the white blood cells are better able to kill bacteria and prevent swelling. The effect lasts from 12-24 hours." Plotkin follows up with several sessions during the first 72-96 hours post surgery to promote rapid healing and a quicker return to productivity.

Stephen Shoop is the medical director of A Doctor in Your
Mike Falcon is staff editor.