Novel Treatment Joins Mainstream
By Avram Goldstein
Washington Post Staff Writer
Monday, March 29, 1999; Page B01
On most afternoons, Tom Scott slips off his clothes, checks out his leftfoot and prepares for his regular two-hour" dive." He puts on a George Washington University Hospital gown and climbs into a one-man chamber for a pressurized bath of pure oxygen. A medical technician seals the clear plastic door of the hyperbaric oxygen chamber, and the dive begins for Scott, who is a diabetic.
He lies quietly while the oxygen -- at triple the outside air pressure -- fills his blood so completely that its healing properties reach parts of his body where his blood no longer flows easily. The extra oxygen helps his white blood cells kill bacteria and promotes the growth of small blood vessels that can restore greater natural oxygen supply to the area.
Scott, 51, has gone through this procedure at the center more than 50 times since the wound from a simple callus removal on his foot became so badly infected that gangrene developed in December.
The original deep wound on the bottom of his foot was 3 1/2 inches long and an inch wide. Scott, like many diabetics, had a history of healing poorly. By last week, the wound was the size of a dime, he said. His doctors agree that the treatment has helped him recover.
"It definitely has saved my leg," said Scott, a massage therapist who lives in the District. "I'm very, very appreciative that I had a doctor who is a believer in it, because I think that amputation is just the first thing that comes to mind for a lot of physicians."
Hyperbaric oxygen therapy, viewed for years by many doctors as being outside the mainstream, has gained acceptance in the medical establishment.
A small cadre of physicians across the country is using the therapy to treat a growing list of dangerous conditions, including wounds that won't heal, bone and soft tissue infections, carbon monoxide poisoning and tissue damage to onetime cancer patients who received radiation therapy 10 or 15 years earlier.
The treatment also has been used effectively for diabetics and people with sickle cell anemia.
"We are very aggressive in trying to save their extremities," said George Washington's hyperbaric medicine director, Bob Rosenthal. "Amputation is a tremendous loss."
Today there are about 500 chambers nationwide, including two one-person units at George Washington, two at Shady Grove Adventist Hospital and two at Inova Mount Vernon Hospital. There are more units in Baltimore, including a 60-foot long chamber that the Maryland Shock Trauma Center uses to treat as many as 21 patients at a time.
Prices for a two-hour treatment range from $150 to $2,500. Insurance, including Medicare, covers approved uses.
"There is more and more evidence coming out that it is a valuable tool for certain things -- but not everything," said David Srour, who directs hyperbaric medicine at Shady Grove Adventist. "Even some of the skeptics have come around because they've seen people who have had a wound for several years, and all of a sudden, they heal."
Years ago, many physicians belittled the notion that oxygen therapy could help anyone other than people with carbon monoxide poisoning or decompression sickness, known as the bends, from undersea diving accidents. Critics called it a cure in search of a disease.
But the medical community has expanded approved uses for the therapy to 13 categories that are accepted by Medicare and most insurers. The list is prepared in cooperation with the Undersea and Hyperbaric Medical Society.
A rival group, the American College of Hyperbaric Medicine, is more in tune with doctors in other countries where the therapy is used routinely to treat circulatory or brain complications related to AIDS, multiple sclerosis, Lyme disease, cerebral palsy, stroke, heart attacks and many other conditions. The Undersea group rejects such uses as unproven.
"The Americans look like a bunch of idiots when you see what it's used for overseas -- it's almost embarrassing," said Michelle Reillo, a registered nurse and owner of Lifeforce Hyperbaric Medicine Clinic in Baltimore, which has a six-person chamber. "We're not promoting snake oil. It's very standard medicine."
Most area chambers are used only for Medicare-approved therapies recommended by physicians. "There are some people who stretch the limits of what's proved," said George Washington's Rosenthal. "We reject 50 percent of the patients who contact us and only take medical referrals."
Candidates for treatment must promise to keep to intensive schedules involving two-hour dives five or six days a week.
For the most part, the credibility of oxygen therapy hasn't been helped by celebrities. In the 1980s, pop star Michael Jackson drew global attention for putting a chamber in his home for personal use, giving many people the impression that the chamber had no legitimate purpose. In the past year, three oxygen bars have opened on the West Coast, selling 20 minutes of pure unpressurized oxygen in a nasal tube for $15.
Shawn Settles, 27, of Hyattsville, is a diabetic whose toe was injured in a basketball game, became infected and didn't heal for seven months. He had 50 treatments and is pleased with the results -- but he took a lot of grief from friends who associated oxygen therapy with wackiness.
"It was a running joke about me doing treatments in the tube, and you kind of wonder yourself," he said of his first treatment. "I wasn't sure if I'd remember where my car was parked."
But aside from typical side effects such as elevated blood pressure and pressure changes in the ears similar to those experienced when flying in a jetliner, things went well, he said.
"People really don't understand, and it's kind of hard for them to believe," Settles said. "This stuff really does work." Hyperbaric Oxygen Therapy A growing number of doctors are accepting hyperbaric oxygen therapy as a valid way to treat conditions involving limited blood flow to parts of the body.
What is Hyperbaric Oxygen Therapy? Patient breathes 100 percent oxygen at pressures greater than normal sea level pressure. Either alone, or more commonly in combination with other medical and surgical procedures, this painless procedure can help increase blood vessel growth in and around a wound and stimulate healing.
Here are the conditions for which Medicare and most private insurers will pay for hyperbaric oxygen therapy:
Air bubble in blood stream
Decompression illness (the bends)
Carbon monoxide poisoning, smoke inhalation
Gangrene caused by a bacterial infection
Traumatic injuries in which blood flow is reduced
Exceptional blood loss or severe anemia
Soft tissue infections
Persistent inflammation of bone marrow
Radiation tissue damage
Compromised skin grafts and surgical sites
Other problem wounds that naturally heal slowly
SOURCE: Undersea and Hyperbaric Medical Society © Copyright
1999 The Washington Post Company