Friday, December 6, 2013

Detecting Traumatic Brain Injuries in the Living

At present, a definitive determination that a person has suffered from chronic traumatic encephalopathy (CTE) can only be made after death. The accumulation of tau proteins that result from traumatic brain injury (TBI) are not detectable by currently accepted brain imaging techniques.

Work currently being done by scientists at UCLA may change that. As reported today by MIT Technology Review, researchers have developed a new die used in conjunction with positron emission tomography (PET), an imaging technology, to detect the accumulation of tau proteins linked to CTE and the amyloid proteins known to be markers of Alzheimer's Disease.

If proven reliable, this test could be used to evaluate the effectiveness of treatment of traumatic brain injury with hyperbaric oxygen therapy (HBOT). We look forward to reporting on the research as it progresses.

Early detection of CTE and TBI offer hope that post mortem confirmation of the disease does not. While a link between professional football and CTE has been shown in autopsies of former players, as dramatically depicted in a recent Frontline installment, further understanding of causes and treatment will be aided by a diagnostic tool that can be applied to the living. 

It is important to note that there has been nothing to suggest that this new diagnostic technique could be used to evaluate the effectiveness of hyperbaric oxygen therapy in treating other, non-traumatic, neurological conditions. Our Evidence Index presents a summary of totality of research regarding treatment of each listed neurologic condition with HBOT. For a number of neurologic conditions it is unlikely that a new diagnostic technique will reveal HBOT to be more effective than other research has demonstrated. 

As always, clearance and approval are the best indication if HBOT is useful in treating a specific condition. To assess the appropriateness of HBOT for an individual case, consultation with a qualified physician is a must.

[PET brain scan image: Jens Langner]

Use this link to watch Frontline'sLeague of Denial: The NFL's Concussion Crisis.

Tuesday, November 26, 2013

Update: Hyperbaric Oxygen Therapy for Traumatic Brain Injury (TBI)

We have updated and upgraded our traumatic brain injury (TBI) page. In randomized clinical trials hyperbaric oxygen therapy (HBOT) has been shown to significantly reduce the risk of death in patients with traumatic brain injury, but there is little evidence survivors enjoy good outcomes. Research results this year were disappointing, prompting us to lower our Evidence Index score to Scant. From our new commentary:
Even more disappointing has been the scramble for scarce research funds and the solicitation of brain-injured trial subjects by some unqualified providers and practitioners. Patients should avoid HBOT centers requiring a fee for investigational TBI treatment. And surely there is no place for mild HBOT inflatable devices in the treatment of such a serious condition. We eagerly await results from the randomized clinical trials still under way.
Stay tuned. More large clinical trials currently under way should determine once and for all if HBOT, by increasing the circulation of oxygenated blood in the brain, may also help reduce the extent of brain damage and speed recovery and rehabilitation after traumatic brain injury. HBOT has been approved for patients with intracranial abscess and acute traumatic ischemias based on similar claims.

[Illustration: NPR/ProPublica]

Sunday, November 24, 2013

New on HyperbaricLink: Sudden Hearing Loss

Today we have added sensorineural hearing loss to our Diseases and Conditions section. Nerve-related deafness is a sudden or rapidly progressive loss of hearing related to problems with the inner ear and the nerves that connect the ear to the brain. Researchers have confirmed a strong association with circulatory problems or lack of oxygen in the inner ear. As many as 20 per 100,000 people per year experience sensorineural hearing loss. Nearly all cases (9 in 10) involve only one ear. 

This exciting new FDA cleared and UHMS approved indication comes with important warnings and limitations. From our commentary:
How wonderful that hyperbaric oxygen may now be used to save people’s sight (central retinal artery occlusion) and hearing. But in both instances please note the need for speedy referral to a qualified HBOT practitioner. For sudden hearing loss, according to UHMS, "The best evidence supports the use of HBO2 within two weeks of symptom onset." Also note the clinical evidence does not support the use of hyperbaric oxygen for chronic hearing loss or tinnitus. 
We urge interested readers to follow our links to the UHMS page on idiopathic sudden sensorineural hearing loss (ISSHL) and the Cochrane Reviews article on ISSHL and tinnitus. Carson McCullers's classic The Heart Is a Lonely Hunter is for extra credit only.

[Illustration: Earsite.com]

Friday, November 22, 2013

Update: Hyperbaric Oxygen for Autism

We have updated and upgraded our Autism page. Finding scant evidence for hyperbaric oxygen therapy, we now provide more helpful links to patient and clinical resources, to the 2009 Undersea and Hyperbaric Medical Society (UHMS) position paper, and to the indispensable 2011 book, Thinking Person's Guide to Autism. Here's hoping you find our new page nearly as thoughtful.

Hyperbaric oxygen therapy is not FDA cleared or UHMS approved for autism spectrum disorder. That's not apt to change anytime soon. From our new commentary:
People living with autism, beware. Perhaps no patient community today is so beset by healthcare fraud and quackery. Hyperbaric oxygen therapy has gotten caught up in a powerful movement away from evidence-based practice and toward alternative therapists promising miracle cures. Their claims are as wild as their HBOT is mild. What thin evidence we have on HBOT for autism is fraught with contradictions and undercut by investigator bias.
Frankly, we would prefer never again to write of HBOT and autism. But we will keep our eyes peeled for relevant hyperbaric news and especially clinical evidence. Until then, let our new, carefully researched page stand as our final word on the subject.

Monday, August 6, 2012

Six Questions with Dr. Jeffrey Niezgoda

President, American College of Hyperbaric Medicine (ACHM) 
Medical Director, The Center for Comprehensive Wound Care and Hyperbaric Oxygen Therapy, St. Luke's Medical Center, Aurora Health Care, Milwaukee, Wisconsin    
President and Chief Medical Officer of WebCME.net   
Associate Professor and Hyperbaric Consultant, Medical College of Wisconsin 
MD from the Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland, 1985    
BS in Biology from the US Air Force Academy, Colorado Springs, Colorado, 1981


Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, is a recognized wound care and hyperbaric medicine expert, educator, and entrepreneur. We know him best as president of the American College of Hyperbaric Medicine (ACHM), a professional organization working to develop an image of hyperbaric oxygen therapy as a distinct medical specialty, often requiring full-time practice. His work uniquely spans the clinical, professional, academic, and business aspects of hyperbaric medicine today. He spoke with us in his Milwaukee offices in March 2012.

1.
HyperbaricLink: Tell us about the first time you ever saw a hyperbaric chamber.
Niezgoda: My first exposure to hyperbaric medicine was many years ago, circa 1976. I grew up here in Milwaukee and had the privilege of touring St. Luke’s and the hyperbaric unit when I was an Explorer Scout. I was 17 or 18 years old at the time, and I joined a medical explorer post, because I wanted to go into medicine. Ironically, the hyperbaric chamber tour was conducted by Dr. Eric Kindwall, who many years later became my colleague and mentor, and a dear friend. I clearly remember him showing us the original multiplace chambers, Bonnie and Clyde. I’m very sad that he’s no longer with us. I often think back to that day that I first met Dr. Kindwall, at the time never dreaming of walking in his footsteps. It is amazing to me that I have been so fortunate to have had the honor and privilege to come back to Milwaukee to practice hyperbaric medicine.

2.
HyperbaricLink: Can you a recall one real breakthrough success or aha! moment in your career?
Niezgoda: Yes, it was when I was doing my fellowship at Travis Air Force Base, in the late 1980s, working with another one of the world renowned hyperbaric physicians, Dr. Ben Slade. I was still learning and questioning certain aspects of hyperbaric medicine, in a way trying to validate it in my own mind. Much of our time was dedicated to treating the standard conditions. But Ben always liked to push the envelope, and use HBO to help patients that presented with problems that theoretically would benefit from hyperbaric. So from time to time we would treat conditions that were considered experimental back then, under IRB [institutional review board] guidance, of course. Sometimes the patients improved, sometimes not. One day Dr. Slade came in to Morning Report and said, “We’re going to start treating a patient with brain abscess.” I was thinking to myself, “You've got to be kidding! Here we go again.” The patient was actually incarcerated at the prison in nearby Vacaville, California. Every day two armed guards brought the prisoner in from the infirmary, by ambulance, on a gurney, dressed in his orange garb. I thought that the handcuffs and guards were somewhat silly as the patient was essentially comatose due to high intracranial pressure and mass effect from several large abscesses. He was obtunded and didn’t know who he was or where he was. He had been on broad-spectrum antibiotics for several days and really wasn't getting any better. The neurosurgeon who referred the patient to us said, “If I open this patient’s cranium to drain the abscess, he will end up herniating and dying.” So this is how it went day after day. The patient would come in for treatment, we would say hello and he would not respond in any way. Well, I’ll never forget it. On hyperbaric day 7 or 8, I was sitting with my back to the door, charting. Klaus, my med tech, came in and said, “Dr. Niezgoda, Mr. XYZ is here for his treatment.” Very facetiously, without looking up, I said, “Great! Let the party begin!” All of a sudden I hear a voice I didn't recognize say, “I’ll bring the women and the beer!” I turned around and see this guy is sitting up in his gurney, fully awake, fully conversant, sharp as can be. It was simply amazing.

3.
HyperbaricLink: How would you characterize the status of hyperbaric oxygen in healthcare today?
Niezgoda: The overall acceptance and validation of hyperbaric medicine as a true medical specialty is probably the biggest change that has happened over the last 5 to 10 years. When I was doing my fellowship we had to really work for patient referrals. There were a lot of naysayers. There was a lot of skepticism. We were criticized for the lack of hyperbaric literature. We worked hard to convince our colleagues that HBO was a valid adjunctive treatment. It often felt like I had to be a cheerleader or salesman for this treatment modality. Fortunately for our patients, much of this has changed. Some really excellent clinical and research studies with supporting publications have appeared in the literature. Based on the literature and excellent clinical outcomes, hyperbaric has truly emerged as a primary advanced treatment modality for wound care patients. Younger doctors appear more ready to accept case studies which highlight some really amazing success stories and refer their patients for care. I think mainstream medicine has finally accepted hyperbaric as a viable treatment. It is rewarding after all these years of hard work, advocating for a treatment that I believe in based on outstanding results and limb salvage, to have physicians who had previously doubted and questioned hyperbaric—the plastic surgeons, the vascular surgeons, the general surgeons—now calling and asking for our help.

4.
HyperbaricLink: What can the hyperbaric community do to better educate the public and referring physicians?
Niezgoda: I don't think that, as hyperbaric physicians, we like to boast or wave our flag. I think we do a great job of providing care. I think we do a great job of taking care of patients. However, we don’t do a very good job of telling our success stories. We have wonderful success stories, great outcomes, and amazing stories to tell about healing. Unfortunately, this information does not get shared very well. We need to tell the world what a huge impact we make in people’s lives. When a young child nearly drowns and is resuscitated and has a great outcome, the media praise the medical community. It makes the news headlines. Limb salvage, necrotizing fasciitis, and carbon monoxide cases, quite frankly, can be just as impressive. Sure, patients go out and talk about it. But if you try to market anything in the US by word-of-mouth, one by one by one by one, it’s an incredibly slow and uphill climb. We don’t have an effective mechanism for selling our success. We need to better educate our colleagues, we need to tell the community our success stories.

5.
HyperbaricLink: Where do you see things going in the next 3-5 years?
Niezgoda: I suspect that we will see several changes in the field of hyperbaric medicine, some good, some not. I would anticipate that within the next few years several new treatment indications will be accepted. This will be due to current and ongoing research, but also because of continued efforts on the part of the lay public, some of whom are strong advocates for use of HBO for conditions that aren’t on that list of approved indications. One of these indications will relate to the use of HBO for acute hypoxic or ischemic periods, such as for acute ischemic injury to the brain, to the heart, to the lower extremities. I am hopeful there will be an improvement in the way we educate hyperbaric physicians. Newer platforms such as online courses and certification pathways will enhance the care provided to our patients. CMS has already accepted online hyperbaric education, now we just need the professional hyperbaric societies to do the same. Unfortunately, I also see that reimbursement for wound care and hyperbaric services will be cut, which will translate to program closure. Without access to this care, patients will ultimately be negatively impacted, they will suffer with nonhealing wounds and amputations.

6.
HyperbaricLink: If you could teach the world one thing about hyperbaric oxygen therapy, what would it be?
Niezgoda: Good question. Hyperbaric oxygen therapy can achieve some impressive results, some amazing outcomes, and it is complementary or adjunctive to standard care plans. In a limb salvage effort, for example, hyperbaric oxygen can augment surgical and medical care, it can be that bridge, that additional treatment that reverses tissue hypoxia, helps healing, and prevents amputation. So if I could help my surgical colleagues to consider hyperbaric oxygen therapy, rather than defaulting to amputation, that would be a huge lesson. If we could communicate the efficacy of hyperbaric in the care of diabetic foot ulcers, I think we would be doing our patients a great service.

Wednesday, July 18, 2012

Hypoxia and Bends in F-22 Raptor Pilots: USAF and Congressional Inquiry Update

In the wake of new incidents of pilot hypoxia and bends in the F-22 Raptor stealth fighter jet, CNN senior national security producer Mike Mount has filed an excellent report this week on the status of ongoing investigations. Choice quotation:

Last month, the two members of Congress released numbers by the Air Force that showed pilots flying the F-22 Raptor reported illness from oxygen deprivation incidents 10 times as often as pilots of other fighter jets. The data showed Raptor pilots have reported 26.43 hypoxia and hypoxia-like incidents per 100,000 flight hours. While that represents a mere fraction of total flight hours, it is far higher than incidents from other Air Force aircraft, including the A-10, the F-15E and the F-16.

See our May 7 post for the CBS 60 Minutes video that fueled this story. Today the US Air Force keeps 187 Raptors flying from bases in California, Alaska, Virginia, New Mexico, Florida, Nevada, and Hawaii, where the most recent problems occurred.

[Drawing: A.S. Paper Aircraft Lab]

Tuesday, July 17, 2012

One Last Post Re: Success with Hyperbaric Oxygen Therapy for Necrotizing Infections

Before we take a break from this topic, here's one more quick but inspiring story about success with hyperbaric oxygen therapy for deadly soft tissue infections, or flesh-eating disease, sometimes including gas gangrene or bone infections.

Nurse manager Amy Pakes, RN, MS, says Nassau University Medical Center, a NuHealth hospital in East Meadow, New York, sees a dozen cases of necrotizing fasciitis every year:

At Nassau, as soon as a diagnosis is made, the patient receives powerful intravenous antibiotics. Surgical debridement of the infected tissue immediately follows. In addition, hyperbaric oxygen therapy is given to prevent further tissue loss and promote healing.

"We usually take patients right from surgery to the hyperbaric chamber, but they might have to go back for several more surgeries to remove dead tissues and such," Pakes said.

Monday's story on Nurses.com tells the story of one recent case:

"We used all of our resources—our surgical team, hyperbaric team and skilled nursing in the burn center, who did the complicated wound dressings that accompanied the wound care," Pakes said. "The patient was here for almost a month and we were able to save his arm, but it was a team effort."

Eileen Abruzzo, RN, MSN, CIC, director of infection prevention at Winthrop University Hospital in Mineola, New York, was also interviewed for the Nurses.com report.

[Photo: NuHealth website]

Monday, July 16, 2012

HBOT for Necrotizing Fasciitis: South Carolina Mother of Twins Going Home with All Her Limbs

Lana Kuykendall, this year's "other" high-profile victim of necrotizing fasciitis, or flesh-eating disease, underwent extensive hyperbaric oxygen therapy as part of her remarkable recovery at Greenville Memorial Hospital in Greenville, South Carolina. She also suffered with sepsis and endured more than 20 surgical procedures. Now the mother of twins born in May is heading home with all her limbs. This morning the Kuykendalls got the Today Show treatment, too. Click PLAY to watch the video below. Another heartwarming story with a cool HBOT twist.


Visit NBCNews.com for breaking news, world news, and news about the economy

Sunday, July 15, 2012

The Twitter Files: Hyperbaric Chamber Photo from the Penn Medicine Archives

In our daily search for hyperbaric news we enjoyed this 1968 photo from hyperbaric medicine at Penn (University of Pennsylvania in Philadelphia):


Like so many others, Penn Medicine's HyperbaricLink profile could use some work. Twitter is one of the ways we find new and better information about hyperbaric treatment centers on the web.

Friday, July 13, 2012

Hyperbaric Chamber Manufacturers: Meet PBUCH

Thank you, Internet, for bringing a new containerized hyperbaric rescue system to our attention. Add PBUCH S.A., out of Poland, to HyperbaricLink's list of other manufacturers of hyperbaric chambers. PBUCH is short for Przedsiebiorstwo Budowy Urzadzen Chlodniczych, or "Company Plant Engineering," as near as we can tell. Designed to treat decompression sickness (DCS) and for training of submarine crews and undersea divers, the two-compartment system accommodates 10 in treatment and 4 in transfer. We post the video here as a reminder that hyperbaric oxygen therapy has strong roots and many routine uses in military and industrial diving and aviation today. And who doesn't enjoy a product demo so nicely done?



[Video: PBUCH, S.A.]