Minnesota: HCMC Fights Back

As the mercury falls in Minnesota, so rises the battle cry to save Hennepin County Medical Center from deep budget cuts. Without swift legislative action, before March 2010, the state's only 24/7 emergency-ready hyperbaric chamber is sure to shut down. (See our October 4 story, "Embattled MN Chamber Faces Ax.")

HCMC is fighting back. Making savvy use of online social media and good old-fashioned grassroots politics, the new Will You Lose? campaign underscores the medical center's proud history and modern role in disaster preparedness and statewide emergency healthcare access, especially for the uninsured. It also offers a great way for the hyperbaric medicine community to get involved. Please join O2.0 in signing up and spreading the word.

(Pictured: Jim Harris, CHT, at the HCMC chamber controls. Photo: Jim Gehrz, Star Tribune)

Carbon Monoxide Poisoning: A Public Health Crisis

We bring you yet more deadly stats for the cold and "flue" season. Carbon monoxide poisoning accounts for some 50,000 emergency room visits annually in the US. Every year about 450 Americans die from accidental exposure alone. Death rates peak in December and January. Almost all survivors experience serious immediate and lasting neuropsychological effects.

Carbon Monoxide Before and After

Rooting through the more recent clinical literature on carbon monoxide poisoning from overseas unearths a few case studies that illuminate some of the difficulties surrounding this condition. In a report from 1993, doctors in Italy described the cases of a husband and wife who had been suffering from headaches, nausea, and neurobehavioral disturbances (which can be involve emotion, learning, or behavior) intermittently for over a year before their diagnosis. It took a careful review of the patient history to determine the source was a mis-functioning heating system. Low level exposure to carbon monoxide can cause symptoms that are overlooked or misdiagnosed.

In another case, a 41-year old woman with no prior history of cognitive or emotional problems developed severe psychiatric problems from carbon monoxide poisoning. Although the patient appeared to make a complete recovery after treatment (hyperbaric oxygen therapy or another therapy), delayed encephalopathy ensued and produced obsessive-compulsive disorder, depression, kelptomania, and psychotic behavior. Brain scans revealed damage in a number of areas. This pattern of symptom, recovery, and re-occurrence is thought to happen in as many as 12 percent of cases.

Together, these examples underscore the need for careful investigation when carbon monoxide poisoning might be suspect, and careful follow-up after an initial series of hyperbaric treatments. Valuable knowledge may be gained if the hyperbaric physician coordinates treatments with assessments by a neurologist.

Postscript: First Response Success With HBOT

Thanksgiving arrived a little early this year in Boston. At a feast two weeks ago today, the Mass Eye & Ear community honored legendary broadcaster Norman Knight, the man who gave the infirmary and the state their first hyperbaric chamber. Even as they were toasting Knight's philanthropy, 14-year-old smoke inhalation victim Shavonne Richards lay recovering at the Norman Knight Hyperbaric Medicine Center. (See also our November 13 post and the November 15 Boston Globe story.)

Not all such young women and not all American cities are so lucky. Reliable access to 24/7 emergency-ready chambers in the US is spotty, at best, and aging equipment and economic woes only compound the problem. Part of the HyperbaricLink mission in 2010 will be to help expose and address this unmet need.

Our thanks this day to all our first responders and to people like Norman Knight, whose quiet generosity and clear vision keep us safer.

Autism: HBOT Among "Risky Alternative Therapies"?

Strong words from the recent Chicago Tribune autism treatment series. At the risk of offending some parents and physicians of children with autism, we recommend it as required reading. Not that we'd lump hyperbaric oxygen in with "risky alternative therapies," but perhaps an HBOT researcher or two can honestly be said to have "hijacked" science to suit their objectives.

Still, individual successes and powerful anecdotes do matter. Medicine invented higher education by case study, after all. O2.0 simply won't view skepticism and hope as mutually exclusive principles but, rather, as equally strong motivators for good evidence-based medicine. So let's get on with it. Once more we urge researchers to raise the pressure from mild to true HBOT and raise the stakes by organizing larger prospective trials and observational studies.

(Baltimore Sun photo by Algerina Perna of Dr Carlos Pardo at Johns Hopkins.)

HyperbaricLink Treatment Center Directory Doubles

In preparation for our next wave of site improvements, we've just restocked the HyperbaricLink directories with more than 500 treatment centers. That's double our previous tally and double the chance every one of our guests will find a facility close to home. Every day we're working hard to build the very best HBOT directory on the Web—not only the most complete listings but also the most searchable, clickable, and usable info on hyperbaric oxygen therapy ever assembled.

Off-Label HBOT: Arthritis

Arthritis is so broad a disease state, with so many treatment options, we can't see hyperbaric oxygen ever gaining any real currency. Yet we find, combined with our reading of the medical literature on other chronic pain disorders, rather promising clinical evidence that HBOT can help reduce the pain and inflammation associated with arthritis. And we suppose any drug-free alternative might be welcome news for many of the 19 million patients with rheumatoid (RA) and osteoarthritis (OA), fibromyalgia, gout, lupus, and more than 100 other forms of this devastating disease—the leading cause of disability in the US today.

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

Off-Label HBOT: Autism

As promised (see our November 9 post), we've read the CARD study, we've spoken with one of its authors, and we're downgrading our Evidence Index score on hyperbaric oxygen therapy for autism. Indeed the early results using room air at mild pressures are now decidedly mixed.

Far be it for us to deny that real children with autism are enjoying real benefits from their hyperbaric oxygen therapy. It would be hasty to dismiss Rossignol's hypotheses and findings altogether. And O2.0 loudly repeats its call for physicians' responsible off-label usage and continuing investigations at higher pressures and 100% oxygen. But from where we sit, that's the sad state of the evidence on HBOT for autism in today's published medical literature: scant.

We've nothing to add but praise for any investigators who bemoan

...the lack of publication of studies with null results. Studies showing a lack of evidence for treatment efficacy are as important as studies demonstrating positive results because they provide important information about treatment approaches with only spurious or anecdotal evidence.

Hear, hear! Jump to our updated autism page learn more and to use our HyperbaricLink Evidence Index to guide your personal research.

Off-Label HBOT: Migraine

Now here's an odd case where hyperbaric oxygen therapy appears highly promising but stubbornly impractical. There's little question HBOT may provide quick relief from severe headache pain, or even stop a migraine in its tracks. The problem is getting into a chamber fast enough to get ahead of the attack. Still, for patients who experience warning signs hours beforehand, hyperbaric oxygen might offer a reasonable and nonpharmaceutical alternative.

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

Off-Label HBOT: Chronic Fatigue Syndrome

We remain giddy about the identification of XMRV as the possible viral culprit behind chronic fatigue syndrome. What an exciting new era in CFS research. What high new hopes for all who have suffered both the pain and the disrespect too often associated with this all too real and prevalent disorder. But after a month scouring the medical literature, and hazarding a few hopeful posts, we've found scant evidence to support the use of hyperbaric oxygen to treat CFS. Slight relief from general fatigue and some potentially relevant data on HIV-related fatigue will keep us digging.

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

First Response Success With HBOT

We note with enthusiasm the prompt application of hyperbaric oxygen therapy in this recent news story out of Boston. Unconscious in a burning building, the victim was rescued by brave, capable Boston firefighters, Massachusetts General Hospital's excellent ER staff, and the Norman Knight Hyperbaric Medicine Center at the Massachusetts Eye and Ear Infirmary. In cases like this, HBOT can provide lifesaving treatment for thermal burns, smoke inhalation, and carbon monoxide poisoning within the golden hour after the traumatic event.

While the trip from Dorchester to the Mass Eye and Ear Infirmary is a short one by ambulance, there are undoubtedly communities without such ready access to an emergency hyperbaric facility. An update to our treatment center directory will provide an index of chambers with 24-hour access and emergency response capabilities.

Autism: CARD Refutes Rossignol

A soon-to-published study by the Center for Autism & Related Disorders (CARD) finds that "24% oxygen at 1.3 atmospheric pressure does not result in a clinically significant improvement" in children with autism.

The study design essentially replicates and refutes Rossignol, in whose work we and many others were encouraged to see promising results using room air at mild pressure. The CARD group studied about half as many subjects (34 versus Rossignol's 61), and neither their news release nor their abstract discloses the number or duration of treatments, so we need to learn more. We've placed our call to the principal investigator and will report what he teaches us.

One thing we know for sure until then: We'd like to see some bright young investigator run the oxygen up to 100%, pump the chamber up to truly hyperbaric pressure, adequately power and size the trial, and publish the results in a proper peer-reviewed journal. Not that we think that'd be a cinch.

Microsoft BizSpark Powers HyperbaricLink

HyperbaricLink is pleased to participate in Microsoft BizSpark, a global program designed to accelerate the success of early stage startups. We're using BizSpark software and support to develop the best Internet resource for hyperbaric oxygen therapy.

CMS Outpatient Supervision Rule Relaxed

Now here's a bit of healthcare reform more of us can agree on. The Centers for Medicare & Medicaid Services (CMS) last week revised its rule that physicians must be present in the hospital outpatient department during treatments they supervise. New rule: It's okay if the doc's available anywhere on campus. For hospital-based HBOT treatment centers the change will surely reduce costs and improve patient access. But, as we understand it, a supervising physician must still attend treatments at off-campus and freestanding centers. Our customary tip of the hat to Hyperbaric Tech Blog for the sharp reportage.

TBI Investigators: Observe That Observer Effect

In physics the very act of observering can sometimes spoil the whole experiment. Don't let's spoil some of the brightest promises of hyperbaric oxygen therapy with sneak peeks and leaks to the press. We're observers, too, and unapologetically enthusiastic about HBOT helping more combat veterans and others suffering from traumatic brain injury. Yet we wince whenever we see reports from any clinical trial still under way—in the case of this LSU study, only halfway done. Film at 11. Such publicity stunts certainly betray the investigators' bias and could cloud this entire field of research. We trust investigators in the Armed Services and elsewhere will observe the observer effect and heed another important lesson of history: Loose lips sink ships.

Coming Soon On HyperbaricLink.com

We're pleased to give O2.0 readers a tiny preview of our big new look. Behind the facelift you'll find:

• Better site navigation
• More news and feature content
  
• Double the diseases and conditions pages
• Five times the treatment center listings

Look for these and more improvements in the days and weeks ahead. And thank you, dear guests, for your many suggestions and constant encouragement.

Oxygen: Much Smaller Than Any Small Molecule Drug

Once you shrink from coffee bean to carbon atom using this cool Cell Size and Scale interactive tool, you'll gain new appreciation for oxygen's diminutive stature among the behemoths of microbiology. That's oxygen in the water molecule, about twice the size of carbon. Pure O2's not much bigger at 292pm. The smallest of small molecule drugs would appear some 125 times larger. (Macrogratitude: University of Utah Genetic Science Learning Center)