Carbon Monoxide: Get Your Canary In The Coal Mine

You've got to love a website that touts itself as "the finest public digital expert site available." It's Carbon Monoxide Headquarters and it's a little bit wacky but undeniably chock-full of information. Favorite click-through: The canary button that loads data from a 1912 study comparing birds to mice as an early warning system for coal miners. Another light reminder to purchase and plug in yours.

Chronic Fatigue Syndrome: Let's Call This...

This may be premature, considering the freshness of the new evidence, but we've decided to start calling chronic fatigue syndrome XMRV/CFS. We figure XMRV is to chronic fatigue syndrome as HIV is to acquired immune deficiency syndrome. With this name change we wish for a sea change in the primary research and public health initiatives focusing squarely on the xenotropic murine leukemia virus-related virus itself. We mightn't have much good news to report on the efficacy of HBOT, but soon we'll post a new XMRV/CFS page on HyperbaricLink, as advertised.

CO Poisoning: Bad Furnaces Fire Up ERs

We still hear America heating. Recent close calls involving 30 middle-schoolers in North Dakota and a family of four in Michigan should remind us all to get our furnaces tuned up for the season and plug in those carbon monoxide (CO) detectors. You might also want to check if your local emergency room enjoys 24/7 on-call access to a hyperbaric oxygen chamber. And don't forget Canada, where emergency HBOT was already scarce before one major center in St John's, Newfoundland, went offline earlier this year. We worry the sluggish economy is choking off our best chances for the prevention and treatment of CO poisoning.

Caffeinate To Turn Back Alzheimer's?

Of all the health gurus out there it's hard not to dig Dr Andrew Weil, who blogs today on pretty solid clinical evidence that Caffeine May Reverse Alzheimer's. Mice bred to develop Alzheimer's cut their amyloid-β protein levels in half when fed the human equivalent of five cups of coffee. (But it was caffeine, not coffee, all you teetotalers.) The study was published July 2009 in the Journal of Alzheimer's Disease. So there you have a bit of promising news where we could report none in our 19 Oct post and new Alzheimer's and Dementia page. Bottoms up!

Off-Label HBOT: Complex Regional Pain Syndrome

The peer-reviewed clinical evidence on hyperbaric oxygen therapy for chronic pain would be a total wasteland were it not for a single study conducted at our favorite military training hospital in Turkey. (See our Tuesday post, "Living In A World Of Pain.") Complex regional pain syndrome (CRPS) includes reflex sympathetic dystrophy (RSD) and causalgia. Patients suffer horribly, and doctors have few treatment options, so it's especially heartening to learn HBOT may help reduce pain and tenderness and improve range of motion. Researchers should waste no time in confirming or refuting these promising findings.

Jump to our new complex regional pain syndrome page to learn more and to use our HyperbaricLink Evidence Index to guide your personal research.

HBOT For Eldercare: Palliative Or Aggressive?

A thoughtful piece on the physical toll of dementia makes a fine postscript to our Monday post and new Alzheimer's Disease and Dementia page. Startling that

the life expectancy of a patient with advanced dementia is similar to that of a patient with advanced cancer.

But how much care is too much care toward the end of life? Especially considering the sorry evidence and the cost of treatment, we're apt to consider hyperbaric oxygen therapy more aggressive than palliative.

(Our apologies to the Times and to artist Stuart Bradford for the willful copyright infringement. What a glorious illustration!)

Chronic Fatigue Syndrome: Lose The Name

Yes, indeed, the very name of the disease is changing as we read and study up for next week's CFS posting on HyperbaricLink. Now that's what we call progress. Will it be myalgic encephalomyelitis or X-associated neuroimmune disease or something brand new? Read the excellent op-ed piece by Hillary Johnson in today's NYTimes.

Off-Label HBOT: Fibromyalgia

Blaming the patient is so much easier than working the problem. Especially in light of the recent announcement that a virus may cause chronic fatigue syndrome (the jury's still out), we should all of us refrain from calling anyone's pain and suffering imaginary. Soon science may discover what really afflicts people with fibromyalgia. Until then, hyperbaric oxygen therapy might just help relieve the pain and tenderness, if not the fatigue and sleeplessness. We're on the lookout for studies replicating the promising work out of Turkey.

Jump to our new fibromyalgia page to learn more and to use our HyperbaricLink Evidence Index to guide your personal research.

Evidence: Living In A World Of Pain

A word of advice to the aspiring HBOT researcher: Don't swing for the left field bleachers when all the team needs is a solid base hit. Oh, and don't complain about the lack of reimbursement if you haven't published a tight little study in a nice little journal. Which leads us to today's musical question: Why are we finding all the most promising evidence on hyperbaric oxygen therapy for chronic pain coming out of a military training hospital in Istanbul? Don't answer. We'll take it. More here soon, and new HyperbaricLink condition pages, on chronic regional pain syndrome, fibromyalgia, myofacial syndrome, migraine, and cluster headache.

Off-Label HBOT: Alzheimer's And Dementia

We find scant clinical evidence to recommend the use of hyperbaric oxygen therapy for people with Alzheimer's and dementia. How dearly we'd prefer to report more encouraging news. But unlike intracranial abscess and acute traumatic ischemias, for which HBOT is approved to fight infection and aid in healing healthy brain tissue, cognitive impairments in the elderly present wholly nonvascular and seemingly irreversible mechanisms of cell death and tissue loss. Protein plaques and tangles (illustrated right) make Alzheimer's notoriously relentless in its slow progress.

Jump to our new Alzheimer's and Dementia page to learn more and to use our HyperbaricLink Evidence Index to guide your personal research.

Off-Label HBOT: Traumatic Brain Injury

From our previous posts you'll recall we can get excitable about hyperbaric oxygen therapy for traumatic brain injury. After exhaustive reading and discussions with experts, we can't figure why HBOT isn't already approved and reimbursed for this condition. Why can't centers today treat and code TBI as a bundling of approved indications: acute traumatic ischemias, chronic wounds, and bacterial and other infections akin to intracranial abscess? Even the hardest skeptics acknowledge HBOT significantly reduces the risk of death. What better clinical enpoint could one possibly desire?

We're still wagering traumatic brain injury will become the 14th approved indication within two years. In our new HyperbaricLink writeup we conclude: "TBI has become an especially active area of political action and HBOT research sponsored by the US Department of Defense and Veterans Health Administration." And so we'll wait in bafflement, if not in silence, for the slow wheels of progress to turn.

Jump to our new traumatic brain injury (TBI) page to learn more and to use our HyperbaricLink Evidence Index to guide your personal research.

HBOT For MS In The UK

Many will take issue with our running commentary and review of the published evidence on hyperbaric oxygen therapy for the treatment of multiple sclerosis. In the UK, certainly, they'd be right to say there's nothing scant about the widespread practice and apparent benefits of HBOT for MS. For 25 years the Multiple Sclerosis National Therapy Centres have provided over 2 million HBOT sessions to 13,000 members through a network of 36 charitable clinics. The organization seems to us a model of patient power at work. And what a fine platform it would make for the multicenter clinical trial or landmark observational research the medical literature is sorely missing.

Courage And Persistence In Discovery

When Columbus sailed the ocean blue the best minds of Europe were pretty sure the world was round. Now, of course, it's politically incorrect to say the man discovered anything. But he changed everything. By articulating a hypothesis, designing a study, applying for funding, conducting an experiment, and publishing the findings, he blunted the edge of the Flat Earth for once and for all.

So he was wrong about the Indians. So he came home without the spices. So we've sometimes evilly exploited the place and lately taken to using it as a base to bomb the Moon. Not his fault.

In our exploration of off-label and investigational indications for hyperbaric oxygen therapy, we're ever mindful of the hard work and long patience good research demands. It's a vital if sometimes thankless pursuit. (No bucks, no Buck Rogers.) But true healing begins with true understanding. Take the all-too-recent discovery that H. pylori, not stress, causes most peptic ulcers. Or last week's startling and welcome news that a contagious retrovirus XMRV, not some imaginary yuppie flu, may be the chief cause of chronic fatigue syndrome. All of a sudden medical science can locate 1 to 4 million Americans with CFS on the map. A voyage of discovery ends, a New World of hope begins. O Happy Day, Christopher and everyone.

Off-Label HBOT: Stroke

We paused to read and reread and reflect before scoring the state of the evidence on HBOT for stroke. Let's err on the side of caution: promising. But, really, come on. What's not compelling about increasing blood flow deep in the brain to reduce the extent of tissue damage and speed healing, recovery, and rehabilitation? After all, the very same therapeutic mechanisms were good enough to get HBOT approved for intracranial abscess, not to mention acute traumatic ischemias and chronic wounds. (And stay tuned for traumatic brain injury.)

Jump to our new stroke page to learn more and to use our HyperbaricLink Evidence Index to guide your personal research.

Dr Charles Houston, High-Altitude Medicine Pioneer

K2, The Savage Mountain was a boyhood favorite that may account for a touch of adulthood acrophobia. In the classic book, expedition leader and doctor Charles Houston, who died last week aged 96, recounts his last tragic climb in chilling detail. Houston went on to conduct groundbreaking research on the physiology and treatment of altitude sickness. Every aviator and mountaineer today owes him a debt of gratitude.

CO Poisoning: Turning Up The Heat On ERs

We hear America heating. Everywhere the old furnaces are kicking on this weekend, and so the carbon monoxide season begins. Firefighters rushed eight Utahns to the local hyperbaric chamber. They're hanging on by their chattering teeth in the Twin Cities (see below). How's your town set for the right lifesaving equipment?

Embattled MN Chamber Faces Ax

Land of 10,000 Lakes and just one trauma-grade hyperbaric chamber? Things were looking bad enough for Hennepin County Medical Center's 45-year-old chamber, kept in service with great care by the only emergency HBOT facility in Minnesota. Well, forget a replacement anytime soon. Now, after the defeat of state healthcare legislation, the program's very survival hangs in the balance. This is a vital public health issue, and O2.0 urges national leadership from the hyperbaric medical community. Shouldn't every Level 1 trauma center in America have a reliable chamber? Surely we can count on firefighters, EMTs, hospitals, and ERs to join the cause.

Lyme Disease: Listen To The Lizard King

All hail the western fence lizard!

A protein in their blood kills the bacterium that causes Lyme disease. Western black-legged ticks (Ixodes scapularis) carry the bacterium, Borrelia burgdorferi, in their guts, which they can transfer to a human after biting and remaining attached for 24 to 48 hours. But a tick that sucks the blood of a fence lizard is cleansed of Borrelia, and its bite reduced to nothing more than a nuisance.

No telling how many of the little guys researchers will have to juice or blender to find a cure for humans. In the meantime, let's put HBOT to the test. (And don't forget to check out our our new Lyme disease page to learn more and to use our HyperbaricLink Evidence Index.)

TBI: Army Set To Move Forward With Trial

Next week we'll post our Traumatic Brain Injury (TBI) page and Evidence Index. Yesterday, thanks to some nice reporting from our friends at Hyperbaric Tech Blog, we learned the US Army has already engaged an interim contract research organization and, in two or three weeks, may issue a new Request for Proposals to commence its HBOT and TBI study. Onward!

Off-Label HBOT: Lyme Disease

Maybe the only thing smaller than the blacklegged tick is the clinical evidence on HBOT for Lyme disease. A pity. We've already made our case for biological plausibility, and we wonder if a broader indication for anaerobic bacterial infection merits serious discussion.

O2.0 calls on the hyperbaric medical community to please pick up this cause. But for now, where else can we place our check? Scant.

Jump to our new Lyme disease page to learn more and to use our HyperbaricLink Evidence Index to guide your personal research.