Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 some of these links may not be active - this was compiled 4 years ago :(sorry only U.S. centers are compiled).. CONTENTS: 1 HBOT & Epilepsy 2 Brain Injury & HBOT 3 The Recoverable Brain In Certain Pediatric Patients 4 Hyperbaric Oxygen: More Indications Than Many Doctors Realise 5 Multiple Sclerosis: Its Etiology, Pathogenesis, and Therapeutics With Emphasis on the Controversial Use of HBO 6 HBOT & Chronic Fatigue Syndrome FMS & RSD 7 Effects of Hyperbaric Oxygen in Fungal Infections 8 Wound Healing and Collagen Formation 9 Brief Summaries of References to Hyperbaric Oxygenation of Anoxic Encephalopathy and Coma 10 Hyperbaric Oxygen Therapy In The Treatment Of Inflammatory Bowel Disease 11 HBOT & Idling Neurons 12 HBO Treatment Of Post-operative Low-Cardiac-Output Syndrome 13 Hyperbaric Oxygen As An Adjunct In Strokes Due To Thrombosis 14 Use of Hyperbaric Oxygen In Rheumatic Diseases 15 HBOT In Diseases Of The Liver 16 History of Hyperbaric Oxygen 17 Factors Involved In The Underuse Of Oxygen In Medicine 18. Letter By , MD 19 Letter by Rodriquez in Oct 98 MUMS Newsletter 20. Letters by Martha Diase And , MD on Risk of Seizures w/HBOT 21. Hyperbaric Bags 22. HBOT LINKS 23. What On Earth Is HBO/HOT Anyway? 24. Space, Glenn, & HBOT 25. Brain Injury Improves With HBOT - study by Dr. Harch 26. Uses Of Hyperbaric Therapy In The 90s 27. Letter about MS and HBOT by Dr. Philip to hbo list 28. HBOT Facilities In the USA ********************************************************************* #1 Proceedings of the Eleventh International Congress on Hyperbaric Medicine; President: Wen-ren Li, M.D., Fuzhou, People's Republic of China; Secretariat: Frederick S. Cramer, M.D., San Francisco, California, U.S.A. Treatment of Children's Epilepsy by Hyperbaric Oxygenation: Analysis of 100 Cases Hyperbaric Oxygen Treatment Centre, Zhou Gulan, EEG Lab, Zhujiang ----------------- Sex and age: The whole group included 100 patients (72 males, 28 females), ages 4 days to 14 years. 84% of them were between 1 month and 9 years old. Causes of disease: The causes in 23 patients were unknown (primary epilepsy), while others had the following established causes: 1. cerebral lesion due to birth injury in 55 patients; 2. encephalitis in 14 patients; 3. high fever in 2 pediatric patients; 4. anoxic cerebropathy in 4 children; 5. brain tumor in 1 child; 6. cerebrovascular malformation in 1 child. Neuropsychiatric manifestation: * intelligence was impaired in 68 patients: * 45 children had mental symptom and personality change; * local neurosystemic signs were detected in 47 patients. Table 1. Patterns of Seizures Grand mal 32 Psychomotor seizures 12 Petit mal 10 Focal seizures 44 Autonomic symptoms 2 EEG examination: All patients in this group had an EEG test. lt was found that * 92 patients had abnormal EEG¹s; * 66 patients had focal sparkle or sharp wave; * 10 patients had paroxysmal sparkle-slow wave and sharp-slow wave; * 6 patients had paroxysmal cerebral dysrhythmias; * 10 patients had confusing abnormal EEG¹s; * 3 patients had normal EEG¹s; * 5 other patients had boundary EEG¹s. CT and MRI scanning: Seventy-six patients were proved abnormal, including ventricular enlargement due to atelencephalia, focal encephalatrophy, tumours and local low density pathy, skull fracture. The other 24 patients were normal. Seizure frequency: * 21 patients seizured every week; * 18 patients did every month; * 23 patients did every two months, * the other 38 patients seizured more than twice a year. TREATMENT Anticonvulsant medication: * 39 patients were treated systematically * Twenty patients could be controlled by little diazepam and r-amino butyric acid * Forty-one patients received no anticonvulsant because of their parents' objection, since they thought the children were too young * Some individuals were controlled by luminal intramuscular injection on convulsion. Hyperbaric oxygenation treatment: The private hyperbaric oxygen chamber was manufactured by Ninpo Hyperbaric-Oxygen Chamber Factory. ln the chamber, the pure oxygen pressure is 1.7-2.0 atmospheres. The patients were treated for 80 minutes every day. A course was 15-30 days. Some patients had therefore been treated 35-45 times. Curative effect: * The treatment was found effective in 82 patients (82%), significantly effective ln 68 patients (68%). It showed that the seizures greatly diminished, and the EEG was improved. * Forty-three patients had stopped anticonvulsant medication, while in other patients the amount of antiepileptic was decreased. * After hyperbaric oxygenation treatment, 82 patients' intelligence, personality, and mentalities were improved; 51 children studied very well; 10 primary and 4 secondary epilepsy children had no change after being treated 30 times. Electroencephalogram (EEG): After hyperbaric oxygenation treatment, 45 patients had normal EEG¹s; 28 patients had focal abnormal EEG¹s; 3 patients had paroxysmal sharp-slow wave and another 20 patients' EEG¹s were slightly abnormal, 4 patients had boundary EEG¹s. Follow-up: Seventy-six patients had been observed for more than 3 years. Forty children had been completely free of anticonvulsants. Three children had 1 or 2 slight attacks every year. Twenty-five patients were administered a little anticonvulsants and their seizures diminished a lot. The attacks did not change in 11 children with systemic therapy. Mechanism of treatment of children's epilepsy with HBO: Hyperbaric oxygenation could improve the cerebral circulation, provide the brain with more oxygen, and reduce edema. Hyperbaric oxygen could also promote the energy metabolism of cerebral cells and improve the recovery of epileptic foci. Reduction of handicapped children due to epilepsy: Epilepsy often impairs the children's intelligence and personality; hyperbaric oxygenation could not only control the attacks of epilepsy but also prevent the occurrence of intelligence impairment and abnormal personality, so as to diminish the ratio of handicapped children due to illness. The way of gaining a good effect in the treatment: The effect is good in the cases whose causes are known, especially those caused by brain damage due to birth injury. As to the period of treatment, most patients need 2-3 years. If the infants do not have high fever or respiratory inflammation, the treatment can begin from several days after birth. Fifteen to 20 days make a course, and 2 courses a year. ****************************************************** #2 Brain Injury When brain injury occurs, irrespective of the cause, brain blood flow is either directly or indirectly altered and almost invariably decreased. In the region of the injury there is a continue decrease in blood flow between the high flow at the edge of the wound to the absence of blood flow in the center of the wound. The compromised blood flow implies that there is a simultaneous decrease in blood pressure along the affected vessels as well as a decrease in the oxygen delivered to the cells supplied by those affected blood vessels. Significantly decreased blood flow, accompanied by marked decreases in available oxygen, is referred to as ischemia. Research in animals and humans showed that when the available oxygen fall below a certain minimal level, the nerve cells, although alive, become sluggish in their metabolism and can no longer conduct bio-electric impulses. Brain cells which cannot conduct bio-electric impulses behave as if they are metabolically sluggish and electrically Non functioning are called Idling neurons. The region of the wound in which idling neurons are located is referred to as the ischemic penumbra. As the available oxygen and blood flow drop by an additional 50% and the nerve cells eventually die. The amount of brain tissue that dies depends primarily on the extent of damage to and interference with brain blood flow. With tiny wounds, such as may be seen in certain cases of brain decompression sickness, there is less likelihood that the cells will die. However, with large wounds in the brain, such as occur in major strokes, a fair amount of brain tissue dies. However, all brain injuries have varying amounts of ischemic penumbral areas containing idling neurons. Idling neurons may remain quiescent for years. How Oxygen Works The exact mechanism whereby Oxygen exerts its beneficial effects on the brain is not known. It, too, is under investigation. The investigators think that oxygen is working in the brain in a fashion similar to the way it works in the treatment of other wounds. Oxygen is know to stimulate: 1. The metabolism of nerve cells that have been deprived of oxygen. 2. The removal of toxic metabolic products or waste. 3. The efficiency of cells that clean out damaged and dead tissue. 4. The Number of cells that produce new connective tissue in the cleaned out areas. 5. The amount of new connective tissue to fill in the empty spaces. 6. The formation of new blood vessels that will provide a continuous source of oxygen, nutrients and the removal of waste products for all the new cells that have been formed. Neubauer and Gottlieb, based on their clinical studies have found that in their experience has supported the hypothesis in that patients with chronic brain injury or various etiologies have responded favorably to HYPERBARIC Oxygen Therapy, HBOT. *********************************************** #3 8th INTERNATIONAL CHILD NEUROLOGY CONGRESS Hyperbaric Oxygenation: The Recoverable Brain In Certain Pediatric Patients Ljubljana, Slovenia 13-18 September 1998 R. NEUBAUER, J. USZLER* land P. JAMES** Ocean Hyperbaric Center, Lauderdale-by-the-Sea, FL (USA) * Department of Nuclear Medicine Santa -UCLA Medical Center, Santa , CA (USA) ** The Hyperbaric Oxygen Trust Forest Row, England, (UK) and the University of Dundee, Scotland SUMMARY Anoxic-ischemic encephalopathy and traumatic brain injury in children are examples of devastating conditions which can be responsible for decades of disability. A regimen of single photon emission computerized tomography (SPECT) scanning and hyperbaric oxygen (HBO) treatment is now available to identify recoverable (stunned or dormant) brain tissue and potentially improve function in such patients. A baseline scan is performed. A challenge with hyperbaric oxygen ( 1.5 ATA, I Hr. 1-20 txs) is given and the scan is repeated. Observation of increased flow is indicative of increased metabolism since the tracer crosses the blood brain barrier. Such positive changes seen in the SPECT are frequently paralleled with clinical improvement. PT, OT, speech, biofeedback, occasional herbal medications are used as part of a multi-disciplinary brain repair approach. Three such cases will be presented, two cerebral palsy (M ages 3 and 4) and a F age 8, with closed head injury. MATERIALS AND METHODS The protocol is one that had been previously published (1). It involves sequential SPECT (brain) functional imaging with an HBO challenge of (I hr x 1.5 ATA) 1-2 times a day in a monoplace hyperbaric chamber (dickers Ltd, Hampshire, UK). 1020 exposures to HBO were performed to ascertain the possibility of recoverable brain tissue. The second scan was done within two hours following the HBO exposure prior to the second scan. The radioactive tracer used was Tc 99m dl hexamethylpropyleneamine oxime (exametazime, dl HM-PAO, Ceretec). Scanning was done with a single head gamma camera technology (El Scint Model #SP 6). Certain patients required up to 200 exposures for maximum benefit. CASE REPORTS DW (Figs IA & IB): 3 year old white male suffered perinatal hypoxic ischemic encephalopathy with renal failure consisting of acute tubular necrosis, thrombocytopenia, sepsis, respiratory insufficiency, hypovolemia and apnea related to seizure disorder. The CT scan showed progressive cortical atrophy. It is remarkable that this patient survived with the multiple illnesses. The patient received 21 treatments of HBO and is now able to sit up, hold a cup for the first time in his life and is more attentive. He is much more alert' makes new vocal sounds,. is more aware of his surroundings and is beginning to grab at everything. These changes parallel SPECT scan imprint. It is hoped that future HBO treatments will be available with all types of supportive therapy. DS (Figs 2A & 2B): 4 year old white male was seen with a severe traumatic birth, which caused a left mid cerebral rupture and then further developed Lennox-Gastaut syndrome (severe seizure disorder). He was seen four years later and had been continuously receiving PT, OT, and SP three days per week. He had done well on a ketogenic diet and developed the ability to chew. On the daily scale of infant development, mental status, he was less than 50 (normal = 90-110) basically with about an eight month level. He was seen with a spastic paraplegia, barely able to ambulate with assistance. The patient received 92 HBO treatments and improved dramatically. The patient has become very much more active, following more commands, beginning to use his right hand to hold things, responds to his name and now able to run, but still with a slight limp. 8 year old girl in motor vehicle accident, closed head trauma and 3 mo coma, total occlusion of the R mid-cerebral artery and spastic hemiparesis on the left. She wore a brace, had severe limp, speech deficits and was slow mentally, although attempting to go to school. SPECT scan showed an extensive deficit or complete infarct with the R middle cerebral artery distribution. She was seen 11 months post incident. SPECT scan before and after HBO showed substantial improvement. She was only able to stay for 24 treatments, but with HBO along with therapy, she was able to remove the brace. She became sharp mentally and was able to almost enter into full activities with other children. She was most pleased to become more socially accepted by her peers. DISCUSSION Cerebral palsy basically is an all inclusive term. In each instance, there is an ischemic or traumatic event that develops in utero, at birth or post delivery. A study has shown that the reduction of oxygen levels in the newborn has increased the incidence of brain injury or cerebral palsy (2). The use of 100% surface oxygen in infants has been abandoned because of the perceived risk of retrolental fibroplasia, which is only associated with prematurity. The use of intermittent high dosage oxygen under hyperbaric conditions is not associated with such a risk. In other areas of the world HBO has been used to treat in utero small fetuses and neo-nates without complications (3). Traumatic brain injury also produces varying degrees of incapacitation. | It is unfortunate that such children are sometimes not evaluated for hyperbaric oxygen for years after the insult and continue to sustain massive neurologic deficits. Recently, a charity in the United Kingdom " The Hyperbaric Oxygen Trust " was formed which is dedicated to the use of HBO therapy for cerebral palsy and the brain injured child. In this presentation we document specific evidence showing the positive effects of hyperbaric oxygen in three exemplary cases. These SPECT images show the marked increase in brain blood flow and metabolism following exposure to hyperbaric oxygen, paralleling clinical improvement, irrespective of the length of time from the original insult. We feel that the addition of hyperbaric oxygen will " jump start " the brain, particularly in the newborns and younger individuals who will be growing brain tissue in a more appropriate internal milleau. HBO is the use of oxygen at greater than atmospheric pressure. It is the only method to achieve a significant increase in the concentration of oxygen in all body fluids: plasma, lymph, bone, urine and most importantly, the cerebrospinal fluid. According to Henry's Law there is a direct relationship between the pressure and the dissolution of oxygen. The ultimate mechanism of HBO is to furnish free molecular oxygen to hypoxic tissues. With this delivery it is immediately available for metabolic use without energy exchange. A significant experiment was done in 1959 showing that pigs could survive totally without blood in a hyperbaric environment (4). The delivery of oxygen under pressurized means is sufficient to sustain life. Around the world, HBO is relegated primarily to wound care, air embolism, radiation damage, bone infections, decompression illness and carbon monoxide poisoning. More recently, there is a trend to further investigate the use of hyperbaric oxygen in the both acute and long term neurologic deficits. In both acute and chronic brain injury, where there is no matrix, pressurized oxygen has beneficial effects in that it: 1) reduces cerebral edema 2) reduces intracranial pressure 3) restores the integrity of the blood-brain barrier and cell membranes 4) neutralizes toxic amines 5) increases neovascularization 6) acts as a scavenger of free radicals 7) efficiently elevates diffusional driving force oxygen thereby, increasing tissue oxygen availability 8) promotes phagocytosis (thereby internal debridement) 9) stimulates angiogenesis 10) reactivates idling neurons 11) Anti-platelet effects are also known along with a reduction of global and local Ischemia 12) Lactate peaks are promptly reduced 13) Protection of the blood brain barrier and the integrity of the cell wall along with oxygenation of the mitochondria are also achieved. (5) The side effects from the appropriate dose ( dose = depth (ATA) of pressure + length of exposure + frequency + total number of treatments) of HBO are virtually nonexistent (over 1.2 million treatments have been given in the United Kingdom). Perhaps this documentation will stimulate further interest in the use of hyperbaric oxygen therapy in the early and late manifestations of cerebral palsy, anoxia and traumatic brain injury. REFERENCES 1)NEUBAUER RA, JAMES PB. Cerebral oxygenation and the recoverable brain. Neurological Res 20 (Suppl 1): S33-S36, 1998. 2)McDONALD AD. Oxygen treatment of premature babies and cerebral palsy. Develop Med Child Neurol 6: 313-14, 1964. 3)ZERBINI S. personal communication. Rio de Janeiro, Brazil, 1998 4)BOEREMA I, MEYNE NG, BRUMMELKAMP WH, et al. Life without blood. Arch Chir Neer 11: 70-X3 5)JAIN K. Textbook of Hyperbaric Medicine. 2nd revised edition USA, Hogrefe & Huber, 1996. ********************************************** #4 Hyperbaric Oxygen: More Indications Than Many Doctors Realise by P. Kindwall Many British doctors are ignorant of the indications for hyperbaric oxygen and sceptical of its benefits, according to a recent survey of hyperbaric oxygen facilities. The survey, by the BMA's Board of Science and Education, concluded that given the present level of use then provision was sufficient, although doctors may be underusing the treatment.[1] They need to know for which conditions hyperbaric oxygen works and refer accordingly. The telephone advisory service, run by the Institute of Naval Medicine at Gosport (similiar to the National Poisons Unit help line), should be better known. Treatment with hyperbaric oxygen was introduced as an adjunct to cardiovascular surgery before cardiopulmonary bypass techniques and deep hypotheria became available. But when surgery in a hyperbaric chamber was no longer necessary most of the original researchers stopped studying it. Britain helped to pioneer the use of hyperbaric oxygen to treat carbon monoxide poisoning, refractory osteomyelitis,[2] and compromised skin grafts. But with no formal training programmes and little funding, the treatment now attracts little attention in Britian. When administered at pressures greater than one atmosphere, oxygen can assume properties more akin to a drug than a simple support for metabolism. In carbon monoxide poisoning, for example, it stops lipid peroxidation, which spares neuronal cell membranes.[3] It reduces odema by about 50% in post ischaemic muscle through preserving adenosine triphosphate.[4] In acute burns it reduces fluid requirements by 35% in the first 24 hours, thus reducing oedema.[5-8] It reduces white cell adhesion to capillary walls after ischaemic or traumatic insult, mitigating the no reflow phenomenon.[9] Red cell flexibility is doubled in about 15 treatments.[10] White cell killing of aerobic bacteria and some fungi is greatly enhanced at high oxygen pressures,[11] facilitating control of osteomyelitis[12] and reducing the number of operations and mortality in necrotising fasciitis.[13] Extremely important is its stimulation of new capillary and collagen formation in radiated tissue, normalising tissue oxygen tensions to permit surgery, healing, and even bone grafting.[14 15] Finally, it increases tissue levels of superoxide dismutase, which counters the formation of free radicals after injury, resulting in better tissue survival.[16] This is particularly important in cursh injury, replants, and grafts, where free radical formation is responsible for reperfusion injury.[17] Although many doctors believe that good research on hyperbaric oxygen is rare, the converse is true.[18-22] Over 3800 papers have been published on the topic despite the relative scarcity of chambers. The Undersea Medical Society began investigating the claims being made for hyperbaric oxygen treatment in 1977. A committee (which I chaired) considered 64 different allegedly improved by treatment with hyperbaric oxygen. In most of them there was insufficient evidence to warrant its clinical use. In preparing out original report we consulted the largest private insurers in the United States, Blue Cross/Blue Shield, and the Federal Health Care Finances Administration. Since then the report has been continually updated. At present only 12 conditions are approved by the society for reimbursement.[23] Since 1977 the number of clinical chambers in the United States has grown from 37 to nearly 300. For inclusion on the approved list there had to have been controlled studies or large clinical series indicating not only the efficacy but also the cost effectiveness of treatment with hyperbaric oxygen. In disorders for which prospective controlled trials were impossible or unavailable, evidence adduced for the efficacy of hyperbaric oxygen had to be at least as convincing as that used to support reimbursement of other treatments routinely paid for the insurers. The five major British centres for the most part limit treatment to those disorders on the approved list, despite there being no regulation to that effect. This list can serve only as a guide. Though quite useful in diabetic wounds, hyperbaric oxygen is only part of a programme of total wound care. For some diabetic wounds hyperbaric oxygen is inappropriate if the large vessels distal to the trifurcation at the knee are occluded or severely stenotic. Crush injury and impending compartment syndrome need to be treated immediately if any worthwhile result is to follow. Late referral, which gives time for oedema, reperfusion, and injury; free radical damage; and the no reflow phenomenon to do their work, makes the treatment largely a waster of time and money. For some surgical patients the potential dangers of further trauma to the wound during transportation will militate against the use of hyperbaric oxygen. Experience has shown, however, that patients with severe carbon monoxide poisoning can be transported safely over long distances in a properly equipped ambulance or helicopter. Before transfer a critically ill patient is contemplated it should be ascertained that the receiving chamber facility can deliver the necessary level of intensive care. Whenever the use of hyperbaric oxygen is considered, consultation with the physician in charge of the hyperbaric oxygen facility is mandatory to ensure that referral is appropriate. The timing of hyperbaric oxygen in relation to surgery is also critically important. For example, in necrotising fasciitis, surgery is the accepted primary treatment, with hyperbaric oxygen used as a follow up. With gas gangrene, however, the hyperbaric chamber is used before surgery (other than for fasciotomy). In the treatment of radionecrosis the patient should be treated at least 20 to 30 times in the chamber, to induce the formation of new capillaries, before elective surgery is performed if healing is to be expected. NOTES [1] BMA Board of Science and Education. Clinical hyperbaric medicine facilities in the UK London: BMA, 1993. [2] Perrins DJD, Maudsley RH, Colwil MR, Slack WK, DA. OHP in the management of chronic osteomyelitis. In: Brown IW, BG, eds. Proceedings of the third international conference on hyperbaric medicine. Washington, DC: National Academy of Sciences, National Research Council, 1966:578-89.(Publication 1404.) [3] Thom SR. Antagonism of carbon monoxide-mediated brain lipid peroxidation by hyperbaric oxygen. Toxicol Appl Pharmacol 1990;105:340-4. [4] Nylander G, D, Nordstrom H, Larsson J. Metabolic effects of hyperbaric oxygen in post-ischemic muscle. Plast Reconstr Surg 1987;79:91-6. [5] Cianci P, Leuders HW, Lee H, Shapiro RL, Sexton J, C, et al. Adjunctive hyperbaric oxygen therapy reduced length of hospitalisation in thermal burns. J Burn Care Rehabil 1989;19:432-5. [6] Nylander G, Nordstrom H, sson E. Effects of hyperbaric oxygen on oedema formation after a scald burn. Burns 1984;10:193-6. [7] RJ, Yamaguchi YT, Cianci PA, Knost PM, Samadani S, Mason SW et al.The effects of hyperbaric oxygen on adenosine triphosphate in thermally injured skin. Surgical Forum 1988;39:87-90. [8] Wells CH, Hinton JG. Effects of hyperbaric oxygen on post-bur plasma extravasation. In: JC, Hunt TK (eds). Hyperbaric oxygen therapy. Bethesda, land: Undersea Medical Society, 1977:259-65. [9] Zamboni WA, Roth AC, RC, Graham B, Suchy H, Kucan JO. Morphological analysis of the microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen. Plast Reconstr Surg 1993;1110-23. [10] Mathieu D, Coget J, Vinckier F, Saulnier A, Durocher ET, Wattel F. Red blood cell deformability and hyperbaric oxygen. Med Subaquatique Hyperbar 1984;3:100-4. [11] Mader JT, Brown GL, Gluckian JC, Wells CH, Reinarz JA. A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis 1980;142:915-22. [12] JC, Heckman JD, DeLee JC, Buckwold FJ. Chronic non-hematogenous osteomyelitis treated with adjuvant hyperbaric oxygen. J Bone Joint Surg [Am] 1986;68:1210-7. [13] Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS. Hyperbaric oxygen therapy for necrotising fasciitis reduced mortality and the need for debridements. Surgery 1990;108:847-50. [14] Marx RE, RP. Problem wounds in oral and maxillofacial surgery: the role of hyperbaric oxygen. In: JC, Hunt TK, eds. Problem wounds: the role of oxygen. New York: Elsevier Science Publishing, 1988:65-125. [15] Marx RE, RP, Kline SN. Prevention of osteroradionecrosis: a randomised prospective clinical trial of hyperbaric oxygen versus penicillin . J Am Dent Assoc 1985;111:490-554. [16] Kaelin CM, Im MJ, Myers RA, Manson PN, Hoopes JE. The effects of hyperbaric oxygen on free flaps in rats. Arch Surg 1990;125:607-9. [17] Manson PN, Anthenelli RN, Im MJ, Bulkley GB, Hoopes JE. The role of oxygen-free radicals in ischemic tissue injury in island skin flaps. Ann Surg 1983;198:87-90. [18] JC. Hyperbaric oxygen therapy. Intensive Care Med 1989;4:55-7. [19] Goulon M, Barois A, Rapin M, Nouilhat F, Grosbuis S, LaBrousse J. Intoxication oxycarbonee et anoxie aigue par inhalation de gaz de charbon et hydrocarbures. Am Intern Med 1969;120: 335-49. [20] Hart GB, Lamb RC, Strauss MB. Gas gangrene 1: a collective review. J Trauma 1983;23:991-5. [21] Kindwall EP. Uses of hyperbaric oxygen therapy in the 1990s. Cleve Clin J Med 1992;59: 517-28. [22] Strauss MB, Hargens AR, Gershuni DH, Greenberg DA, Crenshaw AG, Hart GB, et al. Reduction of skeletal muscle necrosis using intermittent hyperbaric oxygen in the model compartment syndrome. J Bone Joint Surg [Am] 1983;65:65-62. [23] Thom SR. Hyperbaric oxygen therapy: a committee report. Bethesda: Undersea Hyperbaric and Medical Society, 1992. *********************************************** #5 Multiple Sclerosis: Its Etiology, Pathogenesis, and Therapeutics With Emphasis on the Controversial Use of HBO S. F Gottlieb and R. A. Neubauer Department of Biological Sciences, University of South Alabama, Mobile, AL 36688; and the Jo Ellen Memorial Baromedical Research Institute, 4400 General Meyer Avenue, New Orleans, LA 70131; and Ocean Medical Center, 4001 Ocean Drive, Lauderdale-by-the-Sea, FL 33308 Gottlieb SF, Neubauer RA Multiple sclerosis: its etiology, pathogenesis, and therapeutics with emphasis on the controversial use of HBO.J Hyper Med 1988; 3(3):143-164- A review of the current hypotheses in the etiology and pathogenesis of multiple sclerosis (MS) is presented together with the implications for therapy. A new hypothesis as to etiology is presented. Special emphasis is placed on the controversy surrounding the use of hyperbaric oxygen in a critical analysis of the published double-blind studies and related discussions. Emphasis placed on the predominant infective and autoimmune hypotheses cannot be supported, either from the pathology of the disease or by the response to treatment. It is concluded that the evidence of beneficial effects of hyperbaric oxygen therapy, despite the use of patients with advanced disease in trials, is very impressive, especially in chronic progressive disease. It is also concluded that there is need for further research and that such studies should examine the effects of hyperbaric oxygenation alone, and in combination with other therapeutic agents, in individual patients with the methods of realtime investigation now available. Meanwhile, based on comparative efficacy and safety, hyperbaric oxygenation is recommended for treating early stages of MS, especially for treating cerebellar and bowel-bladder disorders. Introduction Multiple sclerosis (MS) is classified as a demyelinating disease of the central nervous system (1) and is the most common of the demyelinating diseases. Despite over a century of investigation MS remains one of the most frustrating diseases for patients and physicians because there is no agreed upon etiology and there is no cure or agreed upon therapy. Perhaps no other disease has had so many therapies proposed and had them fail (2, 3). The purpose of this article is to review some of the evidence for the etiology and pathophysiology of MS and match the information with current therapies. Specific attention will be directed at a critique of the basis for hyperbaric oxygen (HBO) as a new therapeutic modality for MS (summarized in Table 1). We concentrate on HBO because this therapeutic modality has generated an extremely emotional, as well as an intellectual controversy, perhaps more so than any previously proposed treatment. Conclusions Of all the current therapies presumably based on an understanding of the etiology and pathophysiology of the disease process, HBOT has the soundest foundation. It is also the safest drug available. It is not surprising, therefore, to find that there is much positive evidence concerning the beneficial effects of HBOT on cerebellar and bowel-bladder function to sanction its use for treating MS. Based on comparative efficacy and safety considerations, it is recommended that HBOT be used for treating early MS and for treating MS associated cerebellar and bowel-bladder dysfunction. ***************************************** #6 Chronic Fatigue Syndrome FMS & RSD The etiology of CFS is still not entirely clear, and has been variously suggested as an infection in itís own right, or as the sequel to other infections or Neuro-toxic insults: notably Epsteen Barr Virus (EBV) and allergic reaction to a number of substances including, but not limited to silicone, chemical crop sprays, and petroleum products. In any event, the mechanism in physiology which causes the symptoms of chronic fatigue is insufficiently understood but can be explained by the following hypotheses or postulate which is put forward on the basis that it explains both the mechanism and the therapy. Muscular and other cellular activity requires energy, and this in turn requires glycolysis which relies upon the burning of blood carried sugars with blood carried oxygen. The release of energy by this chemical process produces wasted chemicals, notably lactates, and these in turn impose the symptoms of Fatigue until they are fixed and removed by the same blood chemistry. This is the Krebbís cycle Normal to all life. In the ordinary way, oxygen is transported to the body cells by this chemical cycles in which it combines with hemoglobin in the erythrocytes of the blood stream, and the same chemical (HGB) also removes and fixes the waste lactates for disposal as carbon dioxide into the pulmonary system. In order to low through the veinous system, erythrocytes ( RBCS) must be deformable in that they are larger in diameter than the veins in which they must travel. This is to ensure that a maximum surface contact area is available In cases of Chronic Fatigue, either the internal pressure in the RBCís, or in a percentage of them, is elevated, or the permeability of their cell walls is lowered, or both. The result is that these RBCís are not able to deform and travel in the Micro-circulatory system. This deprives the cells which they should serve of oxygen, and allows accumulated lactates to produce the symptoms of Chronic Fatigue. CONCLUSIONS: The hypothesis can be supported in that if you exhaust a fit subject, his or her RBCís will behave as above roughly in the same percentages as the subjects proportionate fatigue but will recover to normal as the subject recovers. The Chronic Fatigue patient's blood on the other hand will remain abnormal in this aspect, and the patients will remain Fatigued. TREATMENT: Hyperbaric oxygen therapy at 2.4 ata produces an increase elasticity in the RBCís and at the same time seems to reduce the Delta P between their contents and the surrounding medium. There is also a probability that the dissolved Oxygen in the Plasma may oxidize whatever substance is the responsible for the decrease in RBC cell wall permeability. Certainly the most immediate effect of Hyperbaric Oxygen therapy is to relieve the cellular HYPOXIA which is a feature of CHRONIC FATIGUE SYNDROME. 60 mins of treatment every day for five days followed by weekly treatments prn seems to resolve them completely in the majority of patients, and eventually to resolve them completely. Rapid Recovery Hyperbarics 909-989-3378 ************************************************ #7 Effects of Hyperbaric Oxygen in Fungal Infections The growth of Candida Albicans in vitro is inhibited by prolonged exposure to Hyperbaric Oxygen. At 2.5 ata. This protocol was chosen to approximate the levels of oxygen found in tissues found in the tissues of patients treated with HBOT. Prolonged exposure to HBOT between 2.5 and 3 ata is funcidal for C. albican and several other Candida. There is strong evidence that Pneumocystis carinii is a fungus. P. carinii has low levels of antioxidant enzymes and is very susceptible to hyperoxia. A 10 minute exposure to hyperbaric in vitro appears to be lethal for this micoroganism. HBOT appears to represent means for treatment of this fungus where standard anti fungal agents have failed. (posted by Rodriquez) *********************************************** #8 Wound Healing and Collagen Formation " Using oxygen under pressure will enhance and stimulate the body to form new collagen, the basic building block material used in wound healing. New collagen in turn enhances the formation of new capillaries, supporting skin and allowing skin to form new capillaries. HBOT's usefulness in treating radiation damage was first reported in the medical literature in 1973; again by Dr Hart MD in 1980. HBOT caused a marked reduction in the amount of Disease in the 336 patients treated. " Rodriquez Rapid Recovery Hyperbarics ********************************************* #9 Brief Summaries of References to Hyperbaric Oxygenation of Anoxic Encephalopathy and Coma * - abstracts. # - Presented at XII International Congress on Hyperbaric and Underwater Medicine, Milan, September 1996. 1.* Neubauer RA. The effect of hyperbaric oxygen in prolonged coma. Possible identification of marginally functioning brain zones. Medicina Subacquea ed Iperbarica. 1985: (3) 75-79. 17 cases of vegetative coma for 1 - 22 months. 40 - 120 exposures over 20 - 90 days. Glasgow Coma Scale improved in all. Complete recovery of 5. 2.* Eltorai I, Montroy,R. Hyperbaric Oxygen Therapy leading to recovery of a 6-week comatose patient afflicted by anoxic encephalopathy and post-traumatic edema. J. Hyperbaric Medicine 1991: (3) 189-198. 90 mins HBO od. After 24 sessions, started talking and ate meals. Gradually mobilised to a wheelchair. 3.* Harch PG, et al. SPECT brain imaging and low pressure HBO in the diagnosis and treatment of chronic traumatic, ischaemic, hypoxic and anoxic encephalopathies. Undersea and Hyperbaric Med. 1994 (Supp) 4/5 showed improvement in focal cortical & deep grey matter deficits. 4.* Shn-rong Z. Hyperbaric Oxygen Therapy for Coma - report of 336 Cases. In Proc XI Intnl Cong Hyperbaric Med. Best, Flagstaff. 1995; 279-285 HBO is effective in acute brain hypoxia and oedema and can hasten recovery of consciousness, including prolonged coma. 5.# Neubauer RA. Gottlieb SF, Pevsner NH. Long-anoxic ischaemic encephalopathy: predictability of recovery. In Proc XII Intnl Cong Hyperbaric Med. Best, Flagstaff. 1996. (In press). 8 long-term patients with severe anoxic ischaemic encephalopathy between 3 months and 12 years. Improvement in all cases, both clinically and on SPECT scans. Until the introduction of SPECT scanning there has been no diagnostic technique providing evidence that any treatment would be effective. 6.# Quinly C, Shaoji Y. Nursing of Brain-Stem injury with HBO. Ibid. 39 patients treated with HBO. Decreased mortality and increased awake rate. 7.# Zhi Y, et al. Assessment of the efficacy of HBO in patients with a persistent vegetative state. Ibid. 8 patients in coma, longest 281 days prior to HBO. 20 - 86 daily sessions. All resumed consciousness. ----------- 414 cases reported, world wide, in the since 1987. ********************************************* #10 Hyperbaric oxygen therapy may offer a new option in the treatment of inflammatory bowel disease unresponsive to other therapies, according to researchers in Israel. - WESTPORT, Oct 02 (Reuters) Dr. D. Rachmilewitz of Hebrew University-Hadassah Medical School in Jerusalem and multicenter colleagues induced colitis in rats by either flushing the colon with 5% acetic acid or by " ...intracolonic administration of 30 mg trinitrobenzenesulphonic acid (TNB). " Some of the rats were exposed to hyperbaric oxygen (100% oxygen at 2.4 atmospheres) " ...for 1 hour twice on the day of colitis induction and once daily thereafter. " Control rats were not exposed to the oxygen therapy. In rats exposed for 7 days to hyperbaric oxygen, the extent of injury was significantly reduced by 51% in rats with colitis induced by acetic acid and by 62% in the rats administered TNB, compared with control rats. " [C]olonic [nitric oxide synthase] activity was significantly decreased by 61% compared with its activity in untreated rats, " the researchers report in the October issue of Gut. Generation of prostaglandin E2 was also decreased following exposure to hyperbaric therapy. Previous work has linked mucosal prostaglandin E2 to the intestinal damage associated with inflammatory bowel disease. Although other investigators have proposed a therapeutic value for hyperbaric oxygen in patients with inflammatory bowel disease, the Israeli team is the first to elucidate the biochemical mechanisms underlying this therapeutic benefit, according to the report. The rat models differ in some ways from human inflammatory bowel disease, Dr. Rachmilewitz and colleagues acknowledge. However, " ...in the experimental model the inflammatory response resembles, in many aspects, the sequence of events in [inflammatory bowel disease]. " Therefore, they researchers conclude that " [hyperbaric oxygen] may be considered in the treatment of patients with refractory inflammatory bowel disease. " Gut 1998;43:512-518. ********************************************** #11 HBOT And Idling Neurons http://www.hyperbaric-health.com/ " Dying brain cells swell and fluid expands into surrounding tissues. The damaged tissues surrounding the original injury of the brain is referred to as the " ischemic penumbra. " The cells in this area contain idling neurons, are lethargic and non-functional, but remain viable due to low oxygen levels. These cells have the potential of being restored to normal or near-normal function through newly formed blood vessels resulting from HBOT, bringing fresh blood (with oxygen) and nutrients to the damaged tissue. Neurons gradually reconnect, restoring the penumbra area of brain tissue and increases body function. HBOT will not restore dead brain tissue, but will restore some of the surrounding tissues. " *************************************************** #12 HYPERBARIC OXYGEN IN THE TREATMENT OF THE POSTOPERATIVE LOW-CARDIAC-OUTPUT SYNDROME M.H. YACOUB M.B. Cairo, F.R.C.S.., F.R.C.S.E., F.R.C.S.G. SENIOR SURGICAL REGISTRAR G.L. ZEITLIN M.B. Cantab., F.F.A.R.C.S. SENIOR ANAESTHETIC REGISTRAR LONDON CHEST HOSPITAL, LONDON, E 2 It has been our experience that patients who develop the low-cardiac-output syndrome in association with pulmonary hypertension after cardiac surgery seldom recover despite vigorous treatment. We report here the case of a patient who was successfully treated by means of hyperbaric oxygen therapy. Case-report A 50-yr -old man was admitted to the London Chest Hospital on Oct. 23, 1964. He had a history of productive cough, recurrent haemoptysis, and dyspnoea on exertion for 21 years. He had been discharged from the Army 20 years before with mitral valve disease. The operation was performed by Mr J.R. Belcher on Nov. 3, 1964 After the operation the patient displayed all the signs of a low cardiac output - failure to recover consciousness with no localising cerebral signs, severe peripheral cyanosis and a very slow capillary refill in the limbs. Since the patients condition was now desperate, it was decided to use hyperbaric oxygen therapy. He was placed in the Vickers mobile chamber at a pressure of 2 atmospheres absolute. Since there were no facilities in the chamber for artificial respiration, transfusion or drainage these had to be discontinued. The patient's condition began to improve after an hour inside the chamber; he was taken out of it every 2 hours to aspirate from his bronchial tree the considerable amount of heavily bloodstained sputum. After 12 hours treatment, he began to move and gradually recovered consciousness for the first time since the operation. Summary and Conclusions In the immediate postoperative period after mitral valvotomy a patient who had shown signs of pulmonary hypertension preoperatively, and a raised pulmonary artery presure at thoracotomy, displayed all the signs of low cardiac output. In an attempt to lower the pulmonary vascular resistance and raise the cardiac output, he was artificially ventilated with 100% oxygen. This was ineffective, and the patient's death seemed certain. Hyperbaric oxygen treatment was then instituted. Within an hour his condition began to improve, and, though artificial ventilation, pleural drainage, endotracheal suction, and intravenous therapy were not feasible, he continued to improve while in the chamber. This case suggests that hyperbaric-oxygen therapy helps to support life during the critical period of post-operative low cardiac output in patients with pulmonary hypertension and justifies further trial of the technique in similar cases. Abstracted from the Lancet March 13th 1965 pages 581-583 (Yacoub is now Prof Sir MH Yacoub). N.B. The patient was treated in an ambulance in the car park of the hospital. Philip Wolfson Hyperbaric Medicine Unit The University of Dundee **************************************** #13 Hyperbaric Oxygen as an adjunct in Strokes due to Thrombosis A. Neubauer, M.D. Ocean Hyperbaric Center, Lauderdale-by-the-Sea, FL SUMMARY Stroke is a major cause of serious disability in all developed countries. Unfortunately of the 700,000 strokes that occur in the United States each year, only a small percentage makes a full recovery with or without therapy. Currently, world wide there are over 3,200,000 stroke victims alive today requiring various degrees of support. Clearly, a need exists for more effective rehabilitation in the post-stroke problem. With the aging population, the situation will only become more pronounced. Currently over 70% of all stroke victims are age 65 or older. The financial burden to Medicare, Medicaid and insurance carriers is almost catastrophic. ********************************************** History of Hyperbaric Oxygen http://www.kumc.edu/instruction/resp/historyh.html 1620 Cornelius Drebbel developed a one-atm diving bell (forerunner of modern submarines) 1662 Henshaw used compressed air for the treatment of pulmonary disease 1670 Boyle gave the first decription of decompression phenomenon 1837 Pravaz of France constructed largest hyperbaric chamber of that time to treat a variety of aliments 1921 Orville J. Cunningham built a hyperbaric chamber in Lawrence, Kansas used to treat a variety of aliments 1928 Cunningham builds the largest chamber in the world in Cleveland. 1935 Behnke showed that nitrogen is the cause of narcosis in humans subjected to compressed air above 4 ATA 1943 Cousteau contructed aqua lung 1967 Undersea Medical Society founded in the USA. Now known as the Undersea and Hyperbaric Medical Society. 1974 Sechrist Industries, Inc. developed the first monoplace hyperbaric chamber of widespread use *Instrumental in the modern practice of hyperbaric oxygen therapy are Drs. Boerema, Churchill-son, and Bernhard for the treatment of gas gangrene, radiation therapy, and congenital heart defects, respectively. ********************************************* #17 FACTORS INVOLVED IN THE UNDERUSE OF OXYGEN IN MEDICINE Oxygen is the most essential substrate for metabolism and clearly the sooner hypoxia is corrected the better the outcome and in many hypoxic states hyperbaric conditions are necessary to achieve a significant increase in oxygen delivery because of the poor solubility of oxygen in blood. As pure oxygen is freely available around the World it is necessary to analyse why the use of high dosages of oxygen is not accepted and used despite many thousands of publications, including controlled trials, attesting to its value. I Oxygen transport is determined by the percentage respired and the barometric pressure... In normal hospital practice barometric pressure is ignored and it is assumed that patients receiving 100% are being given the same amount. In the UK this is not important but in, for example, Denver Colorado which is at an altitude of 6000 feet, the partial pressure is significantly lower than at sea level and a hyperbaric chamber is needed to given the same amount of oxygen as at sea level. II Tissue hypoxia may be present in the absence of cyanosis... Oxygen supplementation is accepted in the alleviation of cyanosis, where the absolute level of deoxygenated haemoglobin exceeds 5g /100 ml of blood. However, the presence of cyanosis requires blood to be present in the microcirculation of a tissue and there can be significant hypoxaemia without cyanosis when the haematocrit is low or when there is microcirculatory closure. III Plasma oxygen transport is not limited by the saturation of haemoglobin... It is common for physicians to argue that blood is saturated with oxygen when a normal oxygen partial pressure (0.21 atm abs) is breathed at sea level. However it is not blood that is saturated, it is haemoglobin. The transport of oxygen by haemoglobin is finite as each of the ferrous receptor sites on the molecule can only bind one oxygen molecule. However, the plasma oxygen content increases directly as a function of the inspired partial pressure of oxygen. Breathing pure oxygen at twice atmospheric pressure, the plasma oxygen content is ten times the value breathing air at sea level and life can be sustained without haemoglobin. IV Oxygen transport to tissue depends on the tension of oxygen in plasma... Severe tissue hypoxia can be present when arterial oxygen tensions are normal if local circulatory factors, such as arterial occlusion, closure of the microcirculation and oedema are present. An increase in the water content of tissue limits oxygen transport. In inflammation, oedema and the invasion of metabolically active inflammatory cells occurs at the same time, which may cause hypoxia even when the blood flow per unit volume of tissue is increased, hence hyperaemic hypoxia. Oxygen plasma tension can be increased from values of 90 - 100 mm Hg to over 2000 mm Hg increasing the gradient or the transfer of oxygen into tissue 20 fold. V Normal blood flow does not ensure normal oxygenation... Oxygen delivery requires blood flow although blood flow may be normal and the tissue still hypoxic. The only tissue that does not need blood flow for oxygenation is the lung. VI Oxygen is not " Hyperbaric " ... The use of the term " hyperbaric " may appear to imply that the oxygen delivered is different to the molecular oxygen available from the air. Singlet oxygen 0-, and ozone 03 are already known, perhaps some regard hyperbaric oxygen as 04. The correct terminology is hyperbaric oxygenation or hyperoxia. VII The adjunctive nature of most oxygen supplementation... Oxygen may be a primary treatment in some instances, but the impression is often given that oxygen therapy replaces other treatment. In most cases this is incorrect, other therapy is needed and optimal care is not a competition between therapies. VIII The paradox: hypoxia causes oxygen free radical toxicity... Paradoxically it is hypoxia that mediates the release of oxygen free radicals. An inadequate oxygen supply to tissue results in the catabolism of ATP to adenosine and the creation of an electron donor, xanthine. When oxygen is made available the electron is accepted to form the superoxide anion 02 A cascade of interactions leads to the generation of the hydroxyl ion which us capable of damaging membranes and allowing calcium into the cell. It is important to recognise that this is caused by hypoxia. Limiting the period of hypoxia will limit the extent of free radical formation. IX Hyperoxia and oxygen toxicity... It is well known that exposure to pure oxygen for a prolonged period, that is, in excess of 24 hours at 1 atm abs causes reversible damage to the endothelium of pulmonary capillaries. Short term exposure to very high oxygen pressures, for example, 3 ATA for 2 hours may cause convulsions resembling grande mal epilepsy. The time to convulsion is greatly reduced by exercise or an increased metabolic rate. It is suspected that oxygen free radicals are involved in these toxic effects. However the clinical use of hyperbaric oxygen uses well-defined exposure limits where neither of these effects are significant. The sites where autoregulation may fail to limit blood flow are the ends of fingers and toes. This is because arteriovenous shunts are present to return blood in vasodilatation and results in blood flow which is greatly in excess of tissue requirements. Toxicity to peripheral nerve endings is often manifest as parasthesia. X Unfamiliar technology... Hyperbaric medicine is not generally familiar to most physicians because it is rarely taught in medical schools. Those who are involved have generally come from the fields of aviation or diving. As both of these disciplines use high technology, it is not surprising that hyperbaric oxygen itself is viewed in this light. However, the pressures used clinically, up to a maximum of 3 ATA, are very modest in comparison to the maximum human experimental pressurisation of 71.1 atm abs. Unfortunately even physicians familiar with hyperbaric medicine refer to " fitness to go under pressure, " forgetting that we are all subject to normal atmospheric pressure. Xl Finance... The use of increased pressure requires a hyperbaric chamber and therefore some financial investment. In the case of a walk-in multiplace chamber this can be considerable and there are usually building modifications required. Unfortunately there is no commercial promotion of oxygen in the pharmaceutical sense to make medical practitioners aware of the value of hyperbaric oxygen therapy. This will not change and has to be recognised as the major reason for the slow growth of oxygen as a therapy. ********************************************* #18 LETTER BY PHILIP JAMES, MD >Dr Per Oluf Barr in Stockholm has the most experience of >limb salvage and Dr Perrins worked with him for a number of >years. Patients scheduled for amputation were treated. One >patient had 981 sessions which in the USA at $500 an hour would mean >......................... the leg would be amputated. > >Perhaps we all need to be reminded that oxygen is THE ANTIBIOTIC - >for leucocyte activity and microbial killing and such evidence is not >simply anecdotal. The cause of death in meningitis is cerebral >oedema with the brain " crying out for oxygen " (NB for the >UHMS cerebral oedema is not an accepted indication, despite all the >evidence from the dysbaric illnesses. As bacteria develop more and >more resistance to antimicrobial therapy we need to remind our >colleagues that there is unlikely to be any organism resistant to the >hydroxyl radical. > >Thought for the day - we are all anecdotes.The cloning of Dolly (In >Edinburgh, Scotland!) was attacked in the journal Science. The >authors, Vittorio Sgaramella and Norton Zinder stated - " Only one >successful attempt out of some 400 is an anecdote not a result. " In >normal human reproduction some 20 - 40 million sperm attempt >fertilisation.......... " > >Best wishes > >Philip MD >Wolfson Hyperbaric Medicine Unit >University of Dundee >Ninewells Medical School >Dundee ******************************************* #19 Letter by Rodriquez in Oct 98 MUMS Newsletter: <<< Finally after many years of waiting I am able to give credit to the people who have helped us, and in turn may help other parents and their children as well. I intend to focus on my three little girls. However, I think it is also important to explain the illness that I had. In doing so I feel it would be easy to understand the familial disorder, and by using Hyperbaric Oxygen therapy we all were able to regain our health and lead a normal life style. In 1991 I was diagnosed with Lupus, Cerebral Vasculitis, Rheumatoid Arthritis, Including auto immune markers in the spinal fluid that indicated a demyelination process of acute Peripheral Neuropathy, all of which where documented by S.P.E.C.T. Brain scans, blood test, skin biopsy, spinal taps, along with lower and upper EMG's. To shorten this story, I was treated using Hyperbaric Oxygen Therapy, or HBOT for 28 treatments, I was sent back to the doctor who ordered additional S.P.E.C.T. Brain Scans, spinal taps, skin biopsy, EMG's and blood test. All of which returned to normal. My Doctors have since wrote many letters fully endorsing Hyperbaric oxygen therapy treatment! I have three little girls, all are two years apart in age, during the time of my illness and recovery all three little girls had very unusual illness constantly throughout their childhood. This illness included, joint pain with swelling, grand and petite maul seizures, bladder and kidney infections, Asthmatic bronchitis, Otitis Media, high protein in urine, back, neck, knee pain, gastrointestinal reflux confirmed by biopsy, chronic constipation, with fissures, head aches, skin rashes, unable to go in the sun, skin thickening, yeast infections both vaginal and under arms, delayed speech, positive ANA's with patterns abnormal S.P.E.C.T. Brain Scans. All three of my children missed at times 60 days of school in a year. Final diagnosis, Collagen Vascular disease with lupus -like, Scleroderma overlap, connective tissue disorder, and at times their records read, CFS, and FMS. In short, a disease process in which the bodies immune system attacks its self, in the case of my three girls, Central Nervous system, Joints, skin, both internal and external. I had heard that Dr. Harch MD treated children with success, I sent my own S.P.E.C.T. Brain scans to Dr. Harch MD and begged him to treat my three children. He agreed to meet with us in New Orleans. I drove the three children out to New Orleans to meet with Dr. Harch, For I knew that this was the only treatment that would work and I felt it had saved my life! Please understand that a person with a DX as I could normally not be able to drive from California to New Orleans alone without being completely well. Again to make a long story short, all three of the children were given S.P.E.C.T. Brain Scans before and after treatment with Hyperbaric Oxygen Therapy, or HBOT, blood work as well, the first set of blood tests revealed a Sedimentation Rate of more than 100 in one child, upper 60's in the other children, indicating gross inflammation. After using Hyperbaric oxygen therapy the test returned to normal! In addition the S.P.E.CT. Brain Scans were improved near normal as well after 40 treatments of Hyperbaric Oxygen Therapy. Since that time my children have received Hyperbaric Oxygen therapy about twice monthly. The difference in our life is without words! They have improved health, they can now play in the sun, and all of their grades have improved to the point of Principals Honor Roll and the program for the gifted. There treating Md. writes an RX for Hyperbaric yearly. Hyperbaric and Dr. Harch have impacted my life to which it will NEVER be the same. I can never thank Dr. Harch enough. We are deeply grateful to him. Sincerely, and It is for these Reasons we have opened over center for Health, Rapid Recovery Hyperbarics, It is dedicated to Dr Harch and Our children. We Vow to be the most reasonable Hyperbaric Oxygen therapy in the Nation, For we do not feel that One must loose their Home In order to gain their Health! http://www.js-net.com/ahw/HBOCTR.htm >>> *********************************************** #20 Letters by Martha Diase And Dr. on Risk of Seizures w/HBOT Martha Diase wrote: <<< A few weeks ago on this list some discussion about HBO therapy causing seizures appeared. I wrote in that my son had had 41 sessions successfully (we saw no difference in seizures, but did see some positive changes in awareness, balance, etc.). We were scheduled to get another 40 in January, but since Aden's seizures have increased since we started the diet, we have decided to postpone that trip until next June and instead try to get to a ketocenter, get his med doseage much lower, and hopefully get better seizure control. Anyway, (sorry for the rambling) when the HBO/seizure connection arose, I decided to contact Dr. Philip who is an expert on the subject. Here is his response. More details about the 'Chinese experience' he mentions can be found in the HBO packet available from MUMS -- it is one of the many studies on HBO therapy for children with cerebral palsy that that packet contains. >>> Letter From Dr. to Martha Diase: <<< Dear Martha, The Chinese experience is that a course of HBOT may be of value in children with epilepsy and is in line with our limited experience in the UK. Oxygen at the pressures used in therapy (as distinct from diving) does not cause seizures. There is widespread ignorance about this in the USA, which sadly includes many of those clinics who use oxygen under hyperbaric conditions. Please ask for the clinical details if physicians make such statements. Best wishes Philip Wolfson Hyperbaric Medicine Unit University of Dundee >>> ********************************************* #21 Hyperbaric Bags http://www.gorge.net/hamg/hyperbaric.html Hyperbaric Treatment Several portable hyperbaric chambers are now available, and are very helpful in treating severe forms of altitude illness. They all are all similar to the extent that they are air-impermeable bags that completely enclose the patient, and are inflated to a significant pressure above ambient atmospheric. This effects a physiological " descent. " This can be demonstrated with an altimeter inside the bag, and marked improvements in oxygen saturation are measurable with a pulse oximeter. The extent of the descent depends on the altitude at which the bag is used; as an example, at 4250m (14,000 ft), the inside of the bag is equivalent to 2100m (7,000 ft). Typical treatment protocols are to put the patient into the bag, pump it up until the pop-off valves hiss, and keep the patient at pressure for one hour. Unless your bag has a CO2 scrubber system, you need to continue pumping several times per minute to flush fresh air through the system (consult the specific manufacturers' information to determine how frequently). At the end of the hour, the patient is removed from the bag and reassessed. Compressing and decompressing the bag should be done slowly, while talking to the patient. Slow down if s/he experiences ear pain. Despite the concerns about tympanic membrane barotrauma, however, I have not personally seen this happen nor heard any reports of it happening. Patients with severe HAPE may not tolerate lying flat; this problem is readily addressed by putting the bag on a rigid surface (such as a bed) and propping one end up 30-40 cm (12-16 inches). However, it is so much easier for these patients to breathe inside the bag once it is pressurized, that this maneuver is usually not necessary. For maximum therapy, it is possible to put patients inside the bag with oxygen on (I suggest 4-6 l/min); obviously the bottle must be inside the bag with them. Do not hook oxygen up to the pump intake. Remember to put a sleeping bag in with the patient - it can get very cold lying motionless for an hour at high altitude! Conversely, if you are outside in the sun, remember to shade the hyperbaric bag, as the sun is intense at altitude and will " cook " the patient. Absolute contraindications to using the bag include lack of spontaneous respirations, as you can't ventilate the patient from outside the bag. There is a " Gamow Tent " which is about twice the diameter of the standard bag, and accommodates two patients simultaneously. This is useful for treating a critically ill patient with a medical person present, or treating a child with a parent present. Relative contraindications to using the bag are middle ear congestion (small risk of barotrauma), inability to protect the airway in a deeply comatose patient (consider intubation), and claustrophobia. Copyright© E. Dietz, MD Emergency & Wilderness Medicine http://www.gorge.net/hamg/hyperbaric.html ********************************************** #22 HBOT LINKS Indications and Limitations of Coverage for HBOT: http://www.wpsic.com/medicare/policy/phys-056.html Hyperbaric Oxygen Therapy for Radiation Necrosis http://oncolink.upenn.edu/specialty/ped_onc/radiation/hyperbr1.html Hyperbaric Bags http://www.gorge.net/hamg/hyperbaric.html HBOT Treatments And Benefits http://www.hyperbaricrx.com/treat.html Life Force HBOT Baltimore, MD http://www.lifeforcehbo.com/ HBOT For Children With Cerebral Palsy http://www.fseng.demon.co.uk/hot4cp/index.html HBOT Information Center Dallas, TX http://www.marketnet.com/mktnet/wound/hbo2.html Department Of Diving And Hyperbaric Medicine http://www.powh.edu.au/hyperb.htm Hyperbaric Medicine St ph Medical Center http://www.woundcare-hbo.com/hyperbaric.htm HBOT - More Indications Than Many Doctors Realize http://www.livelinks.com/sumeria/oxy/kindwall.html Hyperbaric Chambers Systems and Management http://www.hyperbaric.com/over.htm Excellent Info Packed Site - Includes HBOT Chamber Locations http://www.hyperbaric-therapy.com/ HBOT Links to More Research Studies http://www.unipa.it/~ccare/hbo/hbo_pub.htm http://www.etcusa.com/archive.htm http://www.ishd.demon.co.uk/etcol.htm ********************************************** #23 What On Earth Is HBO/HOT Anyway? http://www.fseng.demon.co.uk/hot4cp/HBO.html HBO-How does it work? (A Layman's explanation of how HBO works) Loss of function to the brain is due both to tissue destruction and to tissue swelling. Humans use only up to 20% of their brain capacity throughout their lives, and it has been shown that dormant cells around the destroyed areas can be revived and taught to take over the function of the dead cells. Computerised scanning of subjects has identified the tissue swelling (which in cases is extensive) as being caused by damaged blood capillaries leaking fluid around the area of cell death. Pressure is thus put on healthy brain tissue preventing all but a maintenance blood supply getting through. An increased amount of oxygen is necessary to heal these capillaries. Under normal conditions there is a limit to the amount of oxygen that can be carried by the red blood cells. Moreover, the capillary damage prevents red blood cells getting through to the areas where oxygen is most needed. However, giving oxygen under increased atmospheric pressure dramatically increases the oxygen carried in the blood plasma. Increasing oxygen intake to the bloodstream actually causes the blood vessels to shrink, reducing the amount of fluid and making the blood 'oxygen-rich'. Thus the net result of giving HBO therapy, by both increasing oxygen delivery and decreasing fluid outpouring, is that oxygen-rich plasma is able to run freely into constricted areas of capillary damage in the brain to promote healing. Scans indicate that, during HBO therapy, capillary healing occurs, fluid leakage is reduced, swelling recedes and effective blood supply is thus restored to previously oxygen-restricted brain tissue. With the help of exercise and therapeutic treatment, functional ability can begin to be restored, as newly revived brain cells are trained to take over the function of dead cells. Taken from the Hyperbaric Oxygen Trust Information For Parents Leaflet. ************************************************ #24 SPACE, JOHN GLENN, AND HBOT http://www.techmall.com/techdocs/TS980508-7.html Meeting Features Research On Hyperbaric Oxygen Therapy; Glenn's Mission; Results from Neurolab; and Applying Lessons from Space to Patients on Earth WASHINGTON, D.C., May 8 -- Hyperbaric oxygen therapy -- a treatment that has been around for several decades -- is making a comeback. Doctors are coupling its use with relatively new diagnostic methods and beginning tests on the therapy as a way to minimize damage from strokes and prevent paralysis after some types of spinal cord injuries. Hyperbaric oxygen therapy is just one focus of a meeting next week of the Space and Underwater Research Group of the World Federation of Neurology. The meeting begins Sunday at the Washington Marriott Wardman Park Hotel, formerly the Sheraton Washington, and continues through Wednesday. Sen. Glenn (D-Ohio) will be the featured speaker at a plenary session on Monday, May 11, at 1 p.m. His topic is " A Vision for Biomedical Research in Space. " Glenn, one of the original astronauts, will become the oldest person to venture into space this fall aiming to conduct space-based research on aging. At a Tuesday morning session, Dr. Anne Frey of the National Aeronautics and Space Administration will talk about the results of the Neurolab Space Shuttle Mission. Her talk will be one of the first opportunities to hear about the discoveries since the mission returned on May 3. And symposiums during the meeting will discuss such topics as epilepsy, embolism detection, future directions in space life science research, among others. Monday's plenary session of the Congress on Cerebral Ischemia, Vascular Dementia, Epilepsy and CNS Injury: New Aspects of Prevention and Treatment from Space and Underwater Exploration also will include: * A report on advances in aging research by Dr. J. Hodes, director of the National Institute on Aging. * Dr. Arnauld E. Nicogossian, Associate Administrator of NASA, talking about the NASA Longitudinal Health Study, which is a long-term follow up on the health of astronauts. * Dr. Reubin Andres, director of the Baltimore Longitudinal Aging Study, presenting highlights from that study. * Three members of the team planning Glenn's flight -- Astronaut Crouch, Dr. Liskowsky, life sciences program scientist, and Dr. Paloski, principal investigator of the flight, which NASA terms STS 95 -- discussing research plans for the mission. The meeting is being coordinated by the Stroke Research Center at the Wake Forest University Baptist Medical Center. Investigators from around the world -- including Russia, Germany, Austria, South America and the United States -- will present papers or scientific posters describing results of recent research. " This will be an international forum for scientific communication among a global network of neurologists, neuroscientists, biomedical engineers, and scientists specializing in space, environmental and underwater physiology and pathophysiology, " said F. Toole, M.D., president of the World Federation of Neurology and one of two conference chairs, along with Franz Gerstenbrand of Vienna, Austria. Toole is Teagle Professor of Neurology and director of the Stroke Research Center at the Wake Forest University Baptist Medical Center. Researchers at the conference will be planning for an acute stroke trial to test the value of using hyperbaric oxygen on stroke patients to slow down the destruction of brain tissue, said Toole. That could extend the time when use of tissue plasminogen activator (tPA) is useful beyond its current limit of three hours after the stroke begins. Hyperbaric oxygen therapy refers to the practice of putting patients in pressure chambers and having them breathe pure oxygen at two or more times normal atmospheric pressure. It significantly increases the amount of oxygen in the blood, and it is accepted treatment for carbon monoxide poisoning, decompression sickness, air embolism and certain other conditions. Other key topics at the conference are: * Use of telemedicine to treat epilepsy in remote locations -- or in space * Use of the low-pressure pants from space to find out which patients are susceptible to strokes caused by their blood pressure medicine * Techniques for reducing the brain damage that follows coronary artery bypass surgery in many patients, and detecting the emboli that cause them. * Behavior changes following open heart surgery. Sponsors at the meeting include NASA, the Aerospace Medical Association, the European Space Agency, the Undersea and Hyperbaric Medical Society, the American College of Hyperbaric Medicine, the American affiliate of the International Stroke Society, the National Stroke Association and companies such as Boehringer Ingelheim GmbH, Glaxo Welcome Inc. and TransWorld Information Systems Inc. Nine embargoed press releases can be found either at EurekAlert! at http://www.eurekalert.org/ or Newswise at http://www.newswise.com/. *********************************************************************** #25 Wednesday May 27 6:17 PM EDT Brain injury improves with hyperbaric oxygen NEW YORK (Reuters) -- Patients with long-standing traumatic brain injury show a general improvement of speech, memory and attention after undergoing a series of hyperbaric oxygen therapy treatments, according to Texas researchers. Dr. Harch and colleagues presented their findings recently in Seattle at the Undersea and Hyperbaric Medical Society Annual Scientific Meeting. The new study included 11 patients from The Transitional Learning Community in Galveston, Texas. All were at least 3 years post-brain injury. The patients underwent a series of single photon emission computed tomography (SPECT) scans to determine whether blood flow in the brain could be altered by hyperbaric oxygen therapy, a technique in which patients breathe pure oxygen in a chamber with a higher-than-normal atmospheric pressure. Hyperbaric oxygen therapy is commonly used to treat people suffering from carbon monoxide poisoning or divers with decompression sickness. Initially, five of the patients had 80 sessions in a hyperbaric unit. After a 5-month rest period, those five patients underwent another 40 hyperbaric sessions. The remaining six patients, serving as controls, did not undergo hyperbaric oxygen therapy. There was no change in the blood flow of the six control patients during the study period. However, patients who did receive the hyperbaric oxygen therapy showed increased blood flow in specific areas of the brain, as well as improvements in speech and memory functions, Harch said. Harch also used the therapy sessions to treat individuals with stroke, cerebral palsy, and dementia. Near-drowning and chronic carbon monoxide poisoning patients were also treated. Those patients were treated a year after the brain injury occurred. " All these are patients with no other treatment options, " Harch said. Patients with the least loss of function following injury show the greatest improvement with hyperbaric oxygen therapy, according to Harch. " Hyperbaric oxygen therapy is a non-specific treatment that seems to be appropriate in many different forms of brain injury, " he said. *********************************************** 26. Uses Of Hyperbaric Therapy In The 90s http://circulatorboot.com/literature/cellulit.html Kindwall, EP: Cleveland Clinic J Med 59: 517-528, 1992. Summary: Hyperbaric oxygen (HO) can produce a variety of effects in addition to reducing air and gas embolism.. It increases the killing ability of leukocytes and is lethal to certain anaerobic bacteria. It inhibits toxin formation by certain anerobes, increases the flexibility of red cells, reduces tissue edema, preserves intracellular ATP, maintains tissue oxygentation in the absence of hemoglobin. In addition, it stimulates fibroblast growth, increases collagen formation, promotes rapid growth of capillaries, and terminates lipid peroxidation. These actions of HO are useful in treating anaerobic infections that result in gas gangrene, as well as severe aerobic infections such as necrotizing fasciitis, malignant external otitis, and chronic refractory osteomyelitis. HO can help preserve ischemic tissues and facilitates the rapid spread and arborization of new capillaries. It promotes healing in certain problem wounds. Adjunctive HO treatment is a new approach to the management of radionecrosis. HO treatment reduces morbidity and mortality resulting from carbon monoxide poisoning. Constant O2 Rx at 2 ATA produces pulmonary O2 toxicity in about 6 hours. O2 at 3 ATA will produce a grand mal seizure in 3 hours... Generally 2 chamber types: large walk-in chamber filled with compressed air and in which patient breathes O2 by mask and 2nd, a monoplace chamber which is filled with 100% O2. ***************************************************** #27 Re; The enquiry about oxygen therapy in MS. Why oxygen helps multiple sclerosis patients Multiple sclerosis is a disease in which there is more than one localised area of leakage from the blood vessels in the brain and spinal cord causing symptoms. Treatment should be instituted when the first area is affected, but this is not yet an objective in neurology. Vessels in the nervous system are engineered to form a barrier - the blood-brain barrier - to prevent the leakage of large molecules such as proteins because their escape causes inflammation. The blood vessels involved in MS are actually veins and the leakage causes inflammation in the surrounding area. This is usually in the white matter, which contains vulnerable cells which form the myelin sheaths. As the damage progresses the sheaths are removed and the fibres are destroyed causing disability. Further progression is characterised by loss of the structure of the tissue and healing by scarring - known as sclerosis. Once the sclerosis has formed, recovery of the normal architecture is not possible. The key to the successful management of the established disease is to give the normal recovery mechanisms the best environment to repair the tissue before scarring takes place. Magnetic resonance scanning techniques have shown both the leakage and the oxygen deficiency created by the swelling in the areas affected in MS. The object of giving a concentrated dose of oxygen is to restore the level of oxygen in the affected area to normal and interrupt the progression to scar formation. Oxygen is necessary, not only for all metabolism, but also for the regulation of many aspects of blood vessel and blood cell function. The blood-brain barrier requires energy and oxygen to maintain its integrity. Giving more oxygen constricts the diameter of blood vessels and yet paradoxically improves the transport of oxygen to the tissues. Oxygen also modulates the behaviour of white blood cells and the inner lining of the vessels. Trials of oxygen therapy in MS patients have shown benefit especially in bladder function and balance but, because neurologists have wanted to avoid the possibility of spontaneous improvement - which is of course oxygen dependent - they have chosen to study patients who have advanced disability. Most trials have used patients with disease durations typically in excess of two years. The only trial in the history of multiple sclerosis which matched pairs of patients and then randomly allocated them to either treated or control groups, demonstrated unequivocal evidence of benefit. (p< 0.0001). Because the blood vessel barrier may not repair completely, many patients need to continue oxygen therapy on a regular basis. This is also the reason for the need to continue with beta interferon injections, which also acts by stabilising the blood-brain barrier. Reference Fischer BH et al. Hyperbaric oxygen in the treatment of multiple sclerosis; a randomised placebo-controlled double-blind trial. New England Journal of Medicine 1983;308:181-186. Best wishes Philip Wolfson Hyperbaric Medicine Unit University of Dundee ***************************************************************** #28 HBOT Facilities In the USA http://www.hyperbaric-therapy.com/ ALABAMA Commander Lyster Army Community Hospital ATTN: MCXY-HBO Fort Rucker, Alabama 36362-5000 Duty Phone: Commercial (334) 255-7394/7346 DSN 558-7394/7346 FAX (334) 255-7790 After Hours/Emergency -Emergency Room, Lyster ACH Commercial (334) 255-7150/7151 DSN 558-7150/7151 Carraway Methodist Medical Center Hyperbaric Medicine Department : 1600 Carraway Blvd Birmingham, Alabamaæ 35234 Department phone: 205.502.5426 Emergencies: 205.502.6000 Fax: 205.502.6360 Medical Director: Dr. Bobby Clinical Coordinator: Helen Norvell E-mail: norvellh@... MAILTO:lewismd@... ARIZONA Columbia Medical Center Phoenix Hyperbaric Unit 1947 East Road Phoenix,, AZ 85016 602-650-7798 Fax:602-279-8137 Joan Aiken : http://www.hyperbaric-therapy.com/providers/providers.html CALIFORNIA Rapid Recovery Hyperbarics Rodriquez, Director San Bernadino, CA http://www.js-net.com/ahw/HBOCTR.htm Dept of Hyperbaric Medicine ide Hospital San Pablo, CA, 94806 Cianci, MD, FACP 510-235-3483 510-284-3057 fax Oxycare Santa Barbara, California Northridge Hospital Medical Center T Rugh Hyperbaric Unit 18300 Roscoe Blvd., Northridge, CA, 91328 818-885-8500 Monterey Peninsula : Pacific Grove Chamber Modesto Hospital Modesto, California UCLA Gonda Center for Wound Healing and Hyperbaric Medicine : 200 UCLA Medical Plaza, Suite B265-29 Los Angeles, CA 90095-6926 Phone: 310-7949014 FAX 310-2671542 Emergency 1800UCLA888 MAILTO:mlieber@... Baromedical Department Long Beach Memorial Medical Center PO Box 1428 Long Beach, CA 90801 M.B. Strauss, MD, FACS, AAOS 310.595.6944 or 3613 vox 310.427.2135 fax Grossmont District Hospital La Mesa, CA Gerald G McClure 5555 Grossmont Center Drive La Mesa, CA, 92042 Washington Medical Center : Culver City, CA Western Medical Center Anaheim, California Hyperbaric Health Centers 72 Orchard Irvine, CA 92714 http://www.hyperbaric-health.com/ mailto:dyzon@... San Diego Hyperbarics : Contact: Schmitt D. mailto:msvescor@... The Wellness Clinic : with Rapid Recovery Hyperbarics 2287 Barton Road,Grand Terrace, Ca 92313 we have complete hyperbaric services! Dr. H. Shah md Web site in the works 909-989-3378 909-783-6625 mailto:hyperbaric1@... St. : BayArea Hyperbarics - HBO services in Mountain View, Northern California. lisasj@... COLORADO Poudre Valley Hospital 1024 South Lemay Avenue Fort , Colorado 80524 Sonya (970)495-8770 FAX: (970)495-7643 FLORIDA Bassett : complete hyperbaric oxygen therapy and full physical rehab facility specializing in Stroke, Coma, Head Injury mailto:HBOTx@... St. 's Hospital Louis , MD 901 45th St. West Palm Beach, FL, 33407 407-881-2852 407-881-2900 Holmes Regional Medical Center Melbourne, Florida Orlando Regional Medical Center Orlando, Florida Baptist Medical Center ville, Florida St. ph's Hospital Wound & Hyperbaric Center Tampa, FL, 33607 Sarasota Memorial Hospital Sarasota, Florida Philip A. Eaton, Director of Planning Sarasota Memorial Hospital Sarasota, Florida Tampa Hyperbaric Enterprise : 700 West Waters Avenue, Tampa, Florida 33604 Phone 813-935-4404 Dr. Capria Hyperbaric Medicine Center Mariners Hospital 305-852-4418. Florida Keys Hyperbaric Center 13365 Overseas Highway, Suite 101 Marathon, Florida 33040 Dean A. Bard, DO Dennis Landmeier 305-743-9891 Fax: 305-289-9300 : mailTO:70550.1266@... Hyperbarics International : 490 Caribbean Drive, Key Largo, Florida, 33037 USA (305) 451 2551, fax (305) 451 5765 MAILTO:dick@... Lauderdale-by-the-Sea Florida Dr. Neubauer, M.D. Jerome s Hyperbaric Facility SHANDS Hospital at the University of Florida Box 100376 Gainesville, Florida 32610 352-395-0425 Dr. li, Medical Director ( Stearns, RN, CHT, Charge Nurse) http://www.hyperbaric-therapy.com/providers/providers.html Pensacola Hyperbaric Care Center : 8550 University Parkway Pensacola, Florida 32514 owner: Camille pager (850) 429-5611 tele:(850)969-7990 Closest hospital: 1/4 mile from West Florida Regional Medical Center State-of-the-art multiplace chamber with 14 oxygen stations Chief tech: Barry Baker mailTO:camilleata@... Bay Medical Center Frederick B Epstein, MD Hyperbaric Medicine 615 N. Bonita Ave. Panama City, FL, 32401 (904-747-6046) (904-872-0321 fax) 02 Wound Care Corp. Hyperbaric Center, : 2238 Highway 44 West, Inverness, FL 34453. (352) 726-7008 Grant, Technical Director MAILTO:chris@... Columbia Aventura Hospital & Medical Center Comeau 20900 Biscayne Blvd Aventura, FL 33180 Work: (305) 682-7131 FAX: (305) 682-7022 Hyperbaric Associates : Hyperbaric Associates offers a consulting program to physicians interested in adding Hyperbaric Oxygen therapy to their practice.Hyperbaric Associates, Inc. 6501 Park of Commerce Blvd., Suite 230 Boca Raton, FL 33487 800-888-4989 Fax: 561-995-6963 mailto:inthitek@... Bertsch J : Mariners Hospital has the only hospital-based hyperbaric chamber in the Florida Keys. The chamber is used to provide care for decompression illness and other emergencies. This facility also treats most UHMS/ACHM approved conditions. mailto:jeffbertsch@... GEORGIA Georgia Baptist Medical Center Hyperbaric Medicine & Wound Care Center Craig E. , MD, FACP 285 Boulevard, NE, Suite 120 Atlanta, GA, 30312 404-265-1650 404-265-1630 fax Palmyra Medical Center Albany, Georgia Phoebe Putney Memorial Hospital Albany, Georgia Cobb Hyperbaric Medicine Helen Bachvarov Gelly, MD 1085 York Trace Marietta, Georgia 30064 404-422-4268 404-422-2929 fax Fitzpatrick, T. : We provide hyperbaric treatment to all eligible military beneficiaries and VA patients using a 12 patient multiplace chamber. mailto:LTC__Fitzpatrick@... IDAHO Idaho Emergency Physicians Boise, Idaho ILLINOIS Lutheran General Hospital 1775 West Dempster Street Park Ridge, Illinois 60068 847-723-2210 INDIANA Professional Emergency Physicians Parkview Memorial Hospital Alan D s, MD 2200 Randalia Dr. Fort Wayne, IN, 46805 219-484-6636 St. ph's Medical Center : Ft. Wayne, IN (219) 425-DIVE(3483) or 425-3555 After-hours emergency calls should be made to the Medical Center at (219) 425-3000 KANSAS Hyperbaric Oxygen Kansas City, Inc. St. ph Health Center Kansas City, Missouri Sonny Holbrook, MD, FACEP Med. Director, Hyperbaric Medicine 1000 Carondelet Dr. Kansas City, MO, 64114 816-943-4600 ee Mission Medical Center ee Mission, Kansas Strobel, Vice-President Kansas University Medical Center Kansas City Overland Park Regional Medical Center Kansas City LOUISIANA Hyperbaric Medicine 2600 Greenwood Rd. Shreveport LA 71103 Ellen M. Barber, CRTT, CHT 318-632-2210 Fax:318-632-2203 Ocean Advanced Research New Orleans, Louisiana Our Lady of the Lake Regional Medical Center Hyperbaric Medicine 7777 Hennessy Blvd. Suite 115 Baton Rouge, LA 70808 504-765-8945 , 504-765-5279 fax R. Hill, Jr. MD JoEllen Memorial Hospital New Orleans, Louisiana Van Meter, MD, FACEP Medical Director Emergency/Hyperbaric Medicine 504-366-7638 FAX: (504)363-7008 MARYLAND LifeForce HBOT / Reillo, director 1006 Morton Street Baltimore, MD 21201 410-528-0150 Phone 410-528-0153 Fax http://www.lifeforcehbo.com/ MASSACHUSETTS Head and Neck Surgery Hyperbaric Medicine Massachusetts Eye and Ear Infirmary Massachusetts General Hospital Boston, Massachusetts L. Fabian, MD, Director MICHIGAN Marquette County Emergency Physicians Marquette, Michigan Marquette General Hospital Regional Medical Center Department of Hyperbaric Medicine, Marquette, Michigan Butterworth Hospital Grand Rapids, Michigan Department of Hyperbaric Medicine Henry Ford Hospital 2799 West Grand Blvd, Detroit, Michigan, 48202. (313) 876-3929 Bettina Laier, RN Emergency Department Henry Ford Hospital mailto:tinarn@... MINNESOTA ennepin County Medical Center Hyperbaric Medicine Unit Minneapolis, MN Multiplace (3 treatment chambers) 612-337-7420 Cher Adkinson MD, Director MISSISSIPPI University of Mississippi : , MS MISSOURI Hyperbaric Oxygen Kansas City, Inc. St. ph Health Center Kansas City, Missouri Sonny Holbrook, MD, FACEP Med. Director, Hyperbaric Medicine 1000 Carondelet Dr. Kansas City, MO, 64114 816-943-4600 University of Missouri : Columbia, MO NEVADA HBO Clinic of Nevada : Neubauer, MD 954-771-4000 NEW YORK The T. Mather Memorial Hospital Long Island, New York ph C. White, MD, P. Ribaudo, MD Co-Med. Directors Long Island Hyperbarics J.T. Mather Memorial Hospital Port Jefferson, New York Department of Anesthesiology State University of New York, Health Science Center in Syracuse, NY Cabrini Medical Center New York, Cullen, Wound therapy featuring hyperbaric oxygen for all approved indications mailto:wcmchbo@... NORTH CAROLINA Columbia Medical Center 218 Old Mocksville Road P. O. Box 1823 Statesville, NC 28677 (704) 873-0281 (704) 838-7613 Duke University School of Medicine : The Divers Alert Network, located at Duke University, provides 24-hour information regarding the diagnosis and management of DCS, and can supply up-to-date information on compression chamber locations. The number for this service is (919) 684-8111. Carolinas Medical Center Charlotte, North Carolina Marsha Ford, MD, FACEP Assistant Chairman Department of Emergency Medicine Presbyterian Hospital Charlotte, NC Landis, MD, FACP Med. Director Hyperbaric Medicine OHIO - AFB Ohio State University Columbus, Ohio H. , MD Assistant Professor Department of Emergency Medicine St. Charity Hospital Kettering Medical Center : Dayton, OH OKLAHOMA St Luke's Medical Center W. Goldmann, MD Hyperbaric Department 2900 W. Oklahoma Ave., P.O.Box 2901 Milwaukee, WI 53201 414-649-6577 414-649-5940 fax St. 's Medical Center Tulsa, Oklahoma OREGON Providence Hospital 4805 N.E. Gleason Portland, OR (503)215-1111 (ask for the ER department) PENNSYLVANIA HYPERBARIC OXYGEN THERAPY PROGRAM Building - Suite 13620 Hamilton Walk Philadelphia, Pennsylvania 19104-6068 http://www.med.upenn.edu/~ifem/HBO_Broch_Physicians.htm Presbyterian University Hospital Hyperbaric Medicine S O'toole MD Univ of Pittsburgh Medical Center DeSoto at O'Hara Streets Pittsburgh, PA, 15213 412-578-3170 University of Pennsylvania Medical Center : Philadelphia, PA Hyperbaric Oxygenation Medical Center : 255 N. 6th Street, Columbia, PA 17512 (717)684-3228 or fax (717) 684-0302 SOUTH DAKOTA McKennan Hospital Sioux Falls, South Dakota TEXAS University of Texas Medical Branch at Galveston Galveston, Texas 77555-1115 409-772-1307 Director: Jon T. Mader, M.D. mailto:mader@... Nix Health Care System : 414 Navarro, Suite 502 San , TXæ 78205 (210) 223-1145 FAX (210) 223-4864 Jefferson C. Wound Care & Hyperbaric Medicine Center : San , TX Dean Heimbach, MD C Baker CHT 4499 Medical Drive, Sub2, San , TX, 78229 210-615-8334 210-615-7619 fax mailto:RDHeimbach@... Curative Health Services,Inc. 1901 N. Central Exp., Suite 200 , TX, 75080-3528 Carol Gleber Columbia Rio Grande Regional Hospital 101 East Ridge Road Mc, TX 78503 210.632.6400 1-800.346.1970 SE Texas Hyperbaric Medicine Center Conroe, Texas A. Warriner, MD, FCCP Med. Director, Hyperbaric Medicine The Osteopathic Hospital of Texas Fort Worth, Texas Hyperbaric Laboratory, Texas A & M : College Station, TX MAILTO:hyplab@... Sam Houston Memorial Hospital Houston, Texas Hermann Center for Hyperbaric Medicine Houston, TX, 77033, Carolyn E Fife, MD mailto:cfife@... Dr. A. Stone, D.O., M.P.H. Wound Care and Hyperbaric Medicine 5477 Glenlakes, Suite 107, Dallas, Texas 75231 Phone: (214) 265-9408 Fax: (214) 265-8752 mailto:woundinfo@... Hyperbaric Medicine Unit 7232 Greenville Avenue Dallas TX 75231 214-345-4638 Fax: 214-349-2922 J. Roland Ballow, Jr. mailto:BallowR@... Presbyterian Hospital : Dallas, Texas Presbyterian Healthcare System 8200 Walnut Hill Ln. Dallas, TX 75231 Kimbrell, N : Provide on-site education and consultation to wound care and hyperbaric medicine centers mailto:75353.224@... UTAH Intermountain Hyperbaric Medicine : Lindell K Weaver, MD Ramona Hopkins, RN, PhD LDS Hospital 8th Ave and C Street Salt Lake City, UT, 84143 801-321-3619 801-321-1668 fax mailto:LWEAVER@... VIRGINIA Mount Vernon Hospital andria VirginiaHyperbaric Unit, R. Bartow, Jr.2501 's Lane andria VA, 22306 703-664-7218 703-664-7382 fax De Medical Center Norfolk, Virginia Metropolitan Hospital Richmond, Virginia WASHINGTON Va. Mason Medical Center : Seattle, WA Neil Hampson, MD (206) 583-6543 mailto:hampson@... Diver's Institute of Technology Seattle (206) 783-5543 Washington Medical Center : Culver City, CA WISCONSIN P Kindwall, MD Medical College of Wisconsin, Clinics At Froedtert Mem. Lutheran Hospital Hyperbaric Unit 9200 W. Wisconsin Ave., Milwaukee, WI, 53226 414-454-5060 414-259-3000 fax mailto:_Kindwall@... St Luke's Medical Center W. Goldmann, MD Hyperbaric Department 2900 W. Oklahoma Ave., P.O.Box 2901 Milwaukee, WI 53201 414-649-6577 414-649-5940 fax http://www.hyperbaric-therapy.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2003 Report Share Posted February 25, 2003 I COULDN'T OPEN IT CAN YOU RESEND IT. THANKS LORI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 2005 Report Share Posted April 12, 2005 You can also join and ask questions here HBOTherapyforAutism/ HTHMandi This site has good links www.miraclemountain.org Mandi x Quote Link to comment Share on other sites More sharing options...
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