U-2 Spy Plane Keeps 'Em Flying Under Pressure

Unmanned drones don't worry about decompression sickness (DCS), but high-flying spies do. A short feature article and slide show in today's New York Times considers the U-2 spy plane's Cold War history and newfound value in the skies over Afghanistan.

Most of us associate DCS, or the bends, with ascending too rapidly from undersea depths. Rapid decompression from a pressurized fuselage at high altitude is every bit as dangerous. U-2 pilots "wear spacesuits because their blood would literally boil if they had to eject unprotected at such a high altitude," the article reports, and

...in 2006, a U-2 pilot almost crashed after drifting in and out of consciousness during a flight over Afghanistan. The pilot, Kevin Henry, now a retired Air Force lieutenant colonel, said in an interview that he felt as if he were drunk, and he suffered some brain damage. At one point, he said, he came within five feet of smashing into the ground before miraculously finding a runway.

Civilian aviators, and certainly commercial airline passengers, very rarely encounter such circumstances. But the risk of the bends is always on the mind of alert military air crews who depend on pressure suits or pressure-demand oxygen systems to breathe. The conditions are just short of spaceflight. At maximum cruise altitude, around 70,000 feet (plenty high enough to see the curvature of the Earth), the U-2's cabin is only pressurized to about 30,000 feet. In commercial airliners, operating at typical cruise altitudes of 30,000–40,000 feet, the cabin is pressurized to 6,000–8,000 feet.

Such high-pressure risks give us yet one more reason to admire our men and women in uniform—or spacesuits, as the case may be—and keep those hyperbaric oxygen chambers at the ready. Fly right!

(NYTimes photo: U-2 pilot USAF Maj Eric Schontz stretching and breathing pure oxygen one hour preflight.)

TBI: Harch IHMA Study Expands

Here we go, against our better judgment, getting swooped up by another Harch media blitz—and bully for him for drumming up support and playing hardball in public relations and healthcare politics. Funded by the nonprofit foundation of the International Hyperbaric Medical Association, the trial will now include 1,000 volunteers, from the military and the general population, treated by 20 investigating physicians for mild to moderate traumatic brain injury (TBI) as well as post-traumatic stress disorder (PTSD). Read the full coverage at Digital Journal. We were especially moved by the story of retired brigadier general Patterson Mamey, pictured right, click here for video.

We're on record in favor of Medicare reimbursement for traumatic brain injury now. All our best to the investigators and patients in their pursuit of better healing and more meaningful, replicable study findings. Now let's all be quiet and do the science.

Books: Hyperbaric Facility Safety? Check.

HBOT operators, manufacturers, and technicians should be delighted to see Hyperbaric Facility Safety (Wilbur Workman, ed, Best Publishing, 2000, 754 pgs, US$129) back in print. Flip through the table of contents on Amazon and you'll see Workman's thorough, practical approach to the subject and his appreciation for international regulations and practices. We're apt to trust the reviewers who say this primer belongs in the library of every hyperbaric unit everywhere. Order direct at www.bestpub.com or telephone +1 928 527 1055 before 31 March if you want to grab it for $99.

And speaking of safety, we've been enjoying The Checklist Manifesto: How to Get Things Right (Macmillan, 2009, 224 pgs, US$24.50), the surprise bestseller by surgeon Atul Gawande. Why did it take a MacArthur genius to come up with such basic stuff? It's a disarmingly simple idea for a complex world, and one that rings true looking back on our own experiences in medicine, pharmacy, manufacturing, communications, aviation, sailing, and information systems. Visit the author's website for bonus reviews by Malcolm Gladwell and Steven Levitt (the Freakonomics guy) plus terrific samples of actual checklists.

Hyperbaric Chamber Stars In Latest Episode Of TV's 24

HBOT couldn't cure what ailed a bomb-vested terrorist in Monday night's installment of 24 on Fox, but the chamber provided the (ahem) high-pressure setting for his dramatic standoff and saved agent Jack Bauer's fictional life. A few geeky observations:

1. Brainstorm on walls with a noxious felt-tip marker only in a well-ventilated area.
2. Use of cell phones, not to mention radio detonator buttons, strictly prohibited.
3. Drilling into a pressurized chamber, even with a low-speed bit, not a good idea.

SPOILER ALERT: The shocking conclusion of the standoff redecorates the room in colors some viewers may find objectionable.

The Hurt Locker: Post-Oscar Stress Syndrome

Last night's top honors for The Hurt Locker, a film that successfully embeds the audience with an explosive ordnance disposal (EOD) unit in Iraq, can only help build awareness and support for the real people who have suffered the physical and mental traumas of war. There has been some flak about the movie's authenticity. (See our favorite piece and amazing video explosions here.) But there's no questioning the larger role hyperbaric oxygen therapy might play in soldiers' recovery. In the past couple months we've been following progress in new clinical studies of HBOT for traumatic brain injury (TBI) and new funding for veterans experiencing posttraumatic stress disorder (PTSD). We will continue our coverage of this vital topic, with a new condition page for PTSD and the occasional push for a TBI indication.

HBOT Holds Hope For Haitian Violinist's Hand

Blind violinist Romel Joseph somehow survived the quake that killed his pregnant wife and destroyed his Port-au-Prince music school, and hyperbaric physicians at Jackson Memorial in Miami are still working to save his gifted left hand. We first met Joseph in Katie Couric's interview, following, from late January. Stevie Wonder has since visited, and we were pleased to get another progress report in Sunday's Washington Post. The story gives the seismic tragedy in Haiti a face and a soundtrack like no other. And we can only hope for a Hollywood ending in the fullness of time.

Welcome The Wound Care & Hyperbaric Magazine

HyperbaricLink congratulates our friends at American Baromedical Corporation upon the long-anticipated launch of The Wound Care & Hyperbaric Magazine. Thumb through Vol 1 No 1 here. Carrying on the editorial mission of its predecessor, Hyperbaric Medicine Today, the publication is sure to be an indispensable resource for scientists, clinicians, technicians, and therapists working in hyperbaric oxygen therapy. As editor Ken Locklear puts it:

First and foremost, we are committed to our readership and will cover topics that are relevant and meaningful to the industry. Those topics include research, clinical applications, and the administrative and business aspects of our field.

Again our congratulations and fond best wishes.

Fibromyalgia: Listening To The Voices

Yesterday the excellent Patient Voices series in the New York Times got around to fibromyalgia, and it's another must-see audio slideshow for patients, clinicians, and anyone with any interest in the disease. Also check out the accompanying Well blog and reader discussion, where for once we got a word in edgewise. That's us behind comment #48:

Let’s dispense with the arrogance and guesswork and agree that skepticism (Dr Hirschberg #1) may be statistically safe and expedient but “I don’t know” (bill #24) is the wiser approach to FM. How little we understand. Not long ago, remember, the medical community blamed peptic ulcers on spicy diets and stress-filled lifestyles. Blamed the patients, in other words, millions upon millions of them. The culprit turned out to be a specific bacterium, H. pylori, today diagnosed with a simple breath test and treated with common antibiotics. Instead of taking shortcuts to a nondiagnosis, the unlistening and uncaring physician should try some humility in the face of such a mystery.

We're not saying hyperbaric oxygen therapy is the answer. We're saying let's ask the right questions, listen to real patients like these, and rely upon real clinical evidence to light the way forward.