Monday, October 27, 2008

Hyperbaric Oxygen Therapy (HBOT)

I have contacted many subject matter experts in the field of hyperbaric medicine over the last several months and have received an overall positive response regarding the use of lower pressure (mild) HBOT to treat brain injury. I found this explanation of HBOT posted to an online support group by a medical doctor, some of which I’ve edited for clarity.

"There are two components to hyperbaric oxygen: increased ambient pressure and increased inspired oxygen concentration. The physics of hyperbaric oxygen in a nutshell is that under increased atmospheric pressure, more gas goes into substances.

This increased oxygenation, or hyperoxia, has several beneficial effects. First, the high level of oxygen in the blood allows improved oxygen delivery to tissues that are not getting enough oxygen at baseline (i.e. hypoxic tissues). Second, having times of alternating hyperoxia and hypoxia (as occurs during a series of HBO treatments) promotes the growth of new blood vessels into the hypoxic tissues, a process known as neovascularization.

In the case of a brain injury, whether from a traumatic brain injury, a stroke, a near-drowning, cerebral palsy, or any incident which causes lack of oxygen to part of the brain, there are some cells that have died.

It is thought that around the area of the dead cells or the "umbra" there is a surrounding area of damaged and dormant nerve cells--the "penumbra"--which can heal over time.

The theory--and there does seem to be considerable evidence to support it--is that when a patient is in a hyperbaric oxygen chamber and given 100% oxygen under increased atmospheric pressure, the oxygen dissolves not only into the red blood cells (as happens normally when we breathe) but also in much higher concentration into the blood plasma, the cerebral spinal fluid, the lymphatic system and all of the body's fluids, bathing all of the body's cells with increased oxygen levels.

The result is high levels of oxygen carried to the brain, bypassing the normal way the brain gets oxygen; by the circulation of the blood stream bringing oxygen rich red blood cells.

At least one study was conducted comparing the use of air, which has about 21 percent oxygen, to the use of 100 percent oxygen. The patients given room air were intended to be the "control" group, and they did as well as those with 100 percent oxygen. The conclusion, erroneously, I think, was that because there was no difference in outcome between the two groups, that hyperbaric oxygen was ineffective.

However, importantly BOTH groups improved. So the conclusion I believe is that the use of hyperbaric pressure does significantly help in healing injured tissue--in this case, the brain.

The KEY is the use of increased atmospheric pressure, so that increased oxygen dissolves into the cerebral spinal fluid to be delivered to the damaged brain tissue to speed up healing.

Dr. Harch and some of the other hyperbaric medicine physicians have found 1.5 ATA with 100 percent oxygen given either once or twice a day to be safe.

It appears--although it would be nice to have better studies--that any amount of oxygen from room air to 100 percent oxygen has a beneficial effect. We know that for prolonged periods, using 100 percent oxygen can be toxic, but those are under conditions of using 100 percent oxygen over days or weeks. The short periods of time used for hyperbaric oxygen chamber treatment don't carry that risk--the exposure is much shorter.

It is way past time for the US government to sponsor controlled studies using a variety of protocols, with careful assessments using SPECT scanning. It is clear to many of us that there is a very great benefit from hyperbaric oxygen in treating a variety of brain injuries and many studies as well as individual case reports which prove this is true."

Our son suffered from lack of oxygen at birth (hypoxic ischemic encephalopathy (HIE)), along with seizures shortly after birth. He has cerebral palsy, developmental delay and cortical vision impairment (CVI), as well as secondary microcephly (small head size) due to this lack of oxygen at birth.

I read The Oxygen Revolution by Paul G. Harch, M.D. and found it to be a well organized text and a good overview of the use of hyperbaric oxygen for off-label indications.

I spoke with a nurse who has been closely involved with clinical trials for many years using HBOT to treat acute traumatic brain injury. She told me in so many words that as a mother; she would be doing what we’re doing.

I also spoke with a clinical research nurse involved in an ongoing clinical trial in Ohio sponsored by the Department of Defense involving 80 some children with cerebral palsy. She informed me of many initial positive results from the study
An Evaluation of Hyperbaric Treatments for Children With Cerebral Palsy. Many children see a decrease in spasticity and increased attention span.

Based on this research and the experts I spoke with we completed 40 sessions lasting 60 minutes each, twice a day (at least 4 hours apart). We observed a definite decrease in the spasticity of our son, as did his Physical and Occupational Therapists. His vision and attentiveness have also improved.

In conclusion, the use of HBOT (1.5 ATA) to treat brain injury has minimal negative side-effects and great potential for positive results. HBOT is certainly not a miracle cure, but it is a valuable therapy to ensure the most complete recovery possible.

The OxyHealth Fortius 420 Hyperbaric Chamber

HBOT Parental Testimonials

Hyperbaric Oxygen Therapy for Cerebral Palsy

Hyperbaric Oxygen for cerebral palsy:1999 McGill Pilot study

Hyperbaric Oxygen (HBOT) for Mathieux and Michel (cp)

HBOT - Grace Kenitz on Montel Williams Show - Part 1

HBOT - Grace Kenitz on Montel Williams Show - Part 2

HBOT - Grace Kenitz on Montel Williams Show - Part 3

HBOT - Grace Kenitz Update On Montel - 2008

Mayci's first Oxygen Therapy

Ashton's story
Will's Story

HBOT Research Studies

Hyperbaric Oxygenation Therapy in the Treatment of Cerebral Palsy: A Review and Comparison to Currently Accepted Therapies
Hyperbaric Oxygen for Neonatal Asphyxia - John H. Zhang, MD. PhD
Hyperbaric Oxygen (HBO) and Traumatic Brain Injury (TBI): A Progress Report - Gaylan L. Rockswold, M.D., Ph.D.
Hyperbaric Medicine Lectures
An Evaluation of Hyperbaric Treatments for Children With Cerebral Palsy
Comparison Between Different Types of Oxygen Treatment Following Traumatic Brain Injury,GL;jsessionid=1iodvfylre31m.alexandra

HBOT References

Medical Terminology

Cerebral Palsy

Hypoxic Ischemic Encephalopathy (HIE)

Cortical Vision Impairment (CVI)


Developmental Delay

Sunday, October 26, 2008

Doctor of Osteopathy (D.O.)

We met with a doctor of osteopathy (otherwise known as a D.O.). If you’re anything like me, you’ve probably never heard of an osteopath before.

So what is an osteopath? Osteopaths have the same amount of schooling as M.D.s and have the same rights in hospitals, but D.O.s specialize in a person’s skeletal structure and take more of a whole body approach. We took our son to a D.O. to hopefully help with the shape of his head.

Introduction to Osteopathy

Many D.O.s don’t practice cranial manipulation, so it’s important to find the right one. This is the second D.O. we’ve met. The first was really nice, but she called herself a “bad D.O.” because she didn’t often apply osteopathy with her patients and had no experience with cranial manipulation. She thought osteopathy would help our son and encouraged us to find a D.O., but unfortunately didn’t know anyone who could help us. Fortunately, we got a reference elsewhere for an osteopath who did have experience with children.

We feel comfortable with the D.O. we are working with. He has worked with children and one of his specialties is cranial manipulation, which is what we wanted for our son.

The doctor manipulated our son's skeleton, which was really interesting. He started with the bottom of our son’s spine and ended the session working on his head. It was hard to get our son to sit still, but he faired well.

It’s a very gentle approach and almost seemed a bit like a massage. The doctor compared the manipulation to working on a stuck drawer. If you pull on a stuck drawer hard, you won’t get anywhere and will only make the drawer worse. But, if you know the correct place to push and are gentle about it, you can easily get a drawer unstuck. We thought this was an effective analogy.

One exciting thing the doctor said was that sometimes osteopathy can help with head growth. That is so exciting! Of course, he can’t promise us anything, but I think either way, this therapy will only help him. After his manipulation, the doctor told us that our son has tightness on the top front of his skull (where his ridge is) and the back of his skull is also tight. The thought is that that tightness is pushing down and could be restricting his head growth.

It’s so interesting to me how D.O.s can be trained to feel the fascia on the skull, can move things around to facilitate growth and to help to prevent the skull from fusing prematurely, and to help make sure the cerebral spinal fluid is flowing correctly. It’s another one of those things I don’t completely understand, but I think that it makes sense. I’m just amazed that he can feel all those things. When I touch our son's head, all I feel is a head. We’ll be seeing this doc once every two weeks for awhile, so it’s looking like this busy lifestyle won’t be slowing down anytime soon.

Here are a few links I found useful.

What is Osteopathy
Cranial Osteopathy
Neurodevelopmental Problems