Multibillion-dollar Losses at JPMorgan Linked to Key Executive's Struggle with Lyme Disease

When we read "JPMorgan's $6 Billion Case of Lyme Disease" in Forbes we thought maybe it was an Onion headline. But, sure enough, bank insiders and Wall Street traders have placed part of the blame for the massive blunder on the health problems of one top executive. Ina Drew, pictured right, started missing work after she contracted Lyme disease in 2010. Apparently she played a key role in keeping the peace and refereeing shouting matches in the chief investment office, and her frequent absence threw the team into chaos.

Drew resigned earlier this month. She was the bank's fourth-highest-paid officer.

Spend one of your free visits on the fascinating New York Times article that broke the story. You may also wish to join tick and Lyme disease experts in a surprisingly informative discussion with Science Friday. More about hyperbaric oxygen therapy for Lyme disease on HyperbaricLink and in our previous blogposts.

We are told to expect an unusually active tick season after this year's mild winter. No comment about other, possibly human, pests and parasites that may spoil our summer.

[Photo: JPMorgan via Bloomberg News and New York Times]

First Look: Hennepin County Medical Center Replacement Hyperbaric Facility Set to Open in June

The local media is buzzing about the new hyperbaric oxygen treatment center set to open in June at Hennepin County Medical Center (HCMC) in Minneapolis, Minnesota. The TV spot below features a patient story that adds the human element to HCMC's long struggle to build this impressive new facility, designed and constructed by Fink Engineering. We also enjoyed last week's story in the StarTribune. Medical director Cheryl Adkinson, MD, calls the $10.9 million facility "the most advanced chamber anywhere in the world at the moment," and she's probably right.

Memorial Day Reflections on Traumatic Brain Injury and the March 11 Massacre in Panjwei, Afghanistan

This long weekend we, like all Americans, remembered our fallen war dead. But we could not help also thinking about the atrocity of March, when Army staff sergeant Robert Bales murdered 17 Afghan civilians in their homes in the middle of the night. Speculations of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) hit the press even before Bales was identified as the alleged killer.

Of all the coverage since, three pieces struck us as thoughtful and perhaps worth your attention:

Katie Drummond, in the Danger Room at Wired, lays out some of the known and suspected connections between TBIs, PTSD, and violent episodes.

Sharon Weinberger, writing in Nature, focuses on the challenges ahead for Bates's legal team and asks: "Can a traumatic injury explain a killing spree?"

Lena Groeger, for ProPublica, finds serious doubts surrounding the $42 million Automated Neuropsychological Assessment Metrics (ANAM), a 20-minute computer test many soldiers take before redeployment.

The common theme here, and in our sobering reflections, is the need for better diagnosis and more effective intervention to help soldiers who may suffer a lifetime with these conditions. Stay tuned to HyperbaricLink for more news on the state of the clinical evidence on hyperbaric oxygen therapy for TBI (and PTSD).

[Photo: Wikimedia]

Necrotizing Infections: National Story Generates Some Local Interest in Omaha

Widespread coverage of the Georgia woman battling a necrotizing infection in an Augusta hospital has led health journalists across the country in search of the local angle. Of most interest: Doctors report an unusually high number of cases recently at Nebraska Medical Center in Omaha. Hyperbaric medical director Dr Jeff Cooper said his center has treated six patients with necrotizing fasciitis, or soft tissue infections caused by flesh-eating bacteria, in just the last month or so. He cannot account for the sharp increase but briefly explained to Omaha.com how hyperbaric oxygen works against the disease:

Cooper said hyperbaric oxygen therapy is an important part of treating the disease. “It forces oxygen into areas that aren't getting adequate oxygen because of the tissue damage and swelling,” he said. “This revives the immune system locally and causes the antibiotics to work more effectively.”

Today the medical center is holding a press conference on the subject. More on the web at WOWT Channel 6 and the Omaha World-Herald.

[Photo: Nebraska Medical Center]

A Podiatrist Speaks Against Podiatrists Supervising Hyperbaric Oxygen Therapy

A leading podiatric physician and regular Podiatry Today blogger last week spoke up against Doctors of Podiatric Medicine (DPMs) monitoring patients receiving hyperbaric oxygen therapy (HBOT). Citing state law in his home Indiana and discussions with his Healogics wound center colleagues, DeHeer concludes:

Despite being a proud member of the podiatric profession, I feel that until we have a combined MD-DPM degree, it is in our patients’ best interest to have our allopathic and osteopathic colleagues monitor HBOT patients.

In other words, as so often we have commented here and on HyperbaricLink:

Hyperbaric oxygen is serious medicine that should always be prescribed by a physician. Treatments should always be supervised by a qualified hyperbaric specialist (MD or DO) assisted by a certified hyperbaric technician (CHT).

Podiatric physicians play a vital and sometimes leading role in the care of people with diabetic ulcers and other wounds and injuries of the foot. Hats off to Dr DeHeer for working to clarify his profession's role in hyperbaric medicine.

Now we're curious. How does your hyperbaric treatment center involve podiatrists in patient care?

[Image: Podiatry Today DPM Blogs]

Hyperbaric Oxygen for Necrotizing Fasciitis: Georgia Woman Loses Limbs and Fights for Life

Our thoughts today with Aimee Copeland, the 24-year-old University of West Georgia graduate student who is fighting a very public battle against necrotizing fasciitis at Doctors Hospital in Augusta. Copeland suffered a deep gash to her leg in a zip-lining accident on May 1. By May 4 the wound had become infected with the rare flesh-eating bacterium Aeromonas hydrophila. She was rushed to the hospital, where doctors amputated most of her left leg and worked to stop the potentially deadly infection from spreading. Hyperbaric oxygen therapy, begun last Wednesday, failed to salvage her remaining foot and both hands. Copeland remains in critical condition.

In the treatment of necrotizing fasciitis, hyperbaric oxygen inhibits bacteria from replicating, spreading, and releasing damaging toxins. It may also boost the effect of antibiotics, enhance the body’s natural defenses against flesh-eating bacteria, and help resolve or delay the onset of sepsis, a deadly blood poisoning. From the commentary section of our necrotizing infections page:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of soft tissue necrosis. One analysis [Undersea Hyperb. Med. 2005 Nov-Dec; 32(6):437-43] showed significantly fewer deaths and amputations with HBOT. As the [UHMS] writeup concludes: “With such strong case series evidence of reductions in morbidity and mortality for necrotizing fasciitis and the subset of Fournier's Gangrene, it is difficult to envision ever seeing a controlled, double-blinded study of hyperbaric oxygen therapy.” In other words, considering the deadly seriousness of necrotizing infection and the demonstrated effectiveness of HBOT, withholding treatment from a control group for comparative study would not be medically or ethically acceptable. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop.

Keep track of Aimee's condition on Facebook.

[Photo: Copeland family Facebook page]

Headstrong: Postshow Brain Injury Discussion (Part 2)

At long last we bring you Part 2 of Ivan Oransky's postshow discussion May 2 with neuropsychologist Dr Jill Brooks and ESPN senior writer Peter Keating. The stage play Headstrong runs through May 27 at the Ensemble Studio Theater in New York City.

Part 2 (29:03)



Hat tip: Rich Kelley (@rpmkel)

Hyperbaric Oxygen and Type 1 Diabetes: New Animal Study Suggests Preventive Effect

When HyperbaricLink talks diabetes we're usually talking diabetic ulcers. But we note with great interest a promising new paper published online last week in the American Diabetes Association journal Diabetes, in which scientists at the University of Miami say they used hyperbaric oxygen to prevent or slow the progression of Type 1 diabetes in mice.

Our first question is, How does hyperbaric oxygen work? From the abstract:

HOT reduces autoimmune diabetes incidence in NOD mice via increased resting T cells and reduced activation of DCs with preservation of β-cell mass resulting from decreased apoptosis and increased proliferation.

We won't pretend to understand much of this beyond the given abbreviations: hyperbaric oxygen therapy (HOT), non-obese diabetic (NOD), and dendritic cells (DC). But we do know how difficult it can be to translate findings from animal laboratory experiments to human clinical studies. And we're not quite sure how physicians would know how to select patients and whether or when to use hyperbaric oxygen. A neat summary of the paper in HealthDay raises these and other questions.

That hyperbaric oxygen affects diabetes is not news to many researchers. Back in July 2010 we noted a paper in the Polish Journal of Endocrinology concluding "HBOT was shown to have beneficial effects on atherosclerosis and glycaemic control" in a study of 28 diabetes patients with foot ulcers.

The Miami study used 100% oxygen at 2.0 atmospheres absolute (ATA) and the Polish study at 2.4 ATA. Of course such subtleties will not stop every inflatable bag dealer from claiming this evidence as their own. Let the buyer beware.

For the evidence-based hyperbaric medical community, this is an altogether fascinating area of hyperbaric medical research. We have reached out to the Miami research team and eagerly await further studies.

Autism Postscript: State of the Science on Causes and Mechanisms

Friday we lamented the lack of any clinical evidence to support the use of hyperbaric oxygen therapy in children with autism. Yet the science in this field continues to fascinate. Later that night we enjoyed Charlie Rose's enlightening conversation with some leading autism experts: Eric Kandel of Columbia University, Gerald Fischbach of the Simons Foundation, Uta Frith of University College London, Matthew State of Yale University, and Alison Singer of the Autism Science Foundation. Part of Rose's ongoing Brain Series, the discussion touched on the latest findings and prevailing theories about the (especially) genetic causes and mechanisms of autism spectrum disorders.

Hyperbaric Oxygen for Autism: New Systematic Review of the Medical Literature

For anyone interested in the use of hyperbaric oxygen to treat children with autism, we note the publication today of a simple but helpful systematic review in the online open-access journal Medical Gas Research, by Ahmad Ghanizadeh, Director of Research Center for Psychiatry and Behavioral Sciences at Shiraz University of Medical Sciences in Iran. From today's abstract:

The electronically [sic] search resulted in 18 title of publications. Two studies were randomized, double-blind, controlled-clinical trials. While some uncontrolled and controlled studies suggested that HBO therapy is effective for the treatment of autism, these promising effects are not replicated. Therefore, sham-controlled studies with rigorous methodology are required to be conducted in order to provide scientific evidence-based HBO therapy for autism treatment.

Ghanizadeh's findings support the prevailing view of the evidence-based medical community. Even the two supposed randomized controlled trials (RCTs) he identifies do not, in our view, support the practice, except in the course of clinical investigation. Nor do the eight studies listed on ClinicalTrials.gov show much promise of answering the important questions. Look for a quick update of our autism page in the weeks ahead.

Wound Care Advantage: Distinguishing Its Approach and Model from the New Healogics

Soon after the launch of Healogics, with some 540 wound care and hyperbaric centers across the US, comes the first open letter to the community from a key competitor, Wound Care Advantage. Founder and CEO Mike Comer writes:

Granted our approach and model differs from the new Healogics. Wound Care Advantage is focused on turning around existing centers that are doing poorly and helping hospitals take over their own programs in order to have more control and retain more revenue.... I still feel a focused approach on each hospital is key. These hospitals also need a strategy for their wound center to retain as much revenue as possible.

Read the entire post on the Wound Care Advantage blog. We expect to see a lot more competitive positioning against, around, and alongside Healogics in the months and years ahead. We also expect a steady expansion of the provider market to serve a steadily expanding and rapidly aging patient population whose wound care needs remain seriously underserved today.

USC Catalina Hyperbaric Chamber Featured in Scientific American Blog

For the last month the "Expeditions" blog on the Scientific American website has run an excellent series on the University of Southern California Dornsife Scientific Research Diving program. The May 4 installment covers the USC Catalina Hyperbaric Chamber. Written by dive safety officer Gerry Smith, the short piece nicely summarizes the center's important role in treating recreational and scientific divers and others who suffer decompression sickness and air or gas embolism. We've written before about USC Catalina but didn't know the center is funded equally by the Los Angeles County Medical Alert Center and the local diving community and staffed 24/7 by a full-time director, a part-time technician, and some 70 volunteers.

[Photo: Karl Huggins]

Banner Boswell Medical Center in Sun City, Arizona, Adds Third Hyperbaric Chamber

The growing hyperbaric oxygen therapy center at Boswell Banner Medical Center in Sun City, Arizona, helped this man with bladder spasms caused by delayed radiation injury and caught the attention of this local TV health reporter. The center will host a community open house to show off its new chamber 8a to 11a on Wednesday 16 May.

Hyperbaric Oxygen Figures in 60 Minutes Exposé on US Air Force's F-22 Raptor Fighter Jet

Last night 60 Minutes interviewed two pilots who refuse to fly the US Air Force's F-22 fighter jet after experiencing serious health problems, including decompression sickness, vertigo, and a chronic "Raptor cough," apparently caused by hypoxia, or lack of oxygen. One of the pilots reports he had to be treated in a hyperbaric oxygen chamber after one test flight. Faulty emergency oxygen controls, charcoal air filters, and other engineering failures have plagued the new aircraft throughout production and testing. Fortunately, the USAF operates some of the best hyperbaric medicine facilities in the world.

Headstrong: Postshow Brain Injury Discussion (Part 1) and Extended Run

Since this morning's post the Ensemble Studio Theatre production of the stage play Headstrong has been extended through May 27. As advertised, we bring you these videos of Ivan Oransky's postshow discussion last evening with neuropsychologist Dr Jill Brooks and ESPN senior writer Peter Keating.

Part 1 (29:10)



Hat tip: Rich Kelley (@rpmkel)

NFL Legend Junior Seau: Apparent Suicide, Possible Brain Injury, Stirring Tragedy

When football great Junior Seau was found dead at his home yesterday, from a gunshot wound to the chest, his family and the police and reporters and sportswriters everywhere made the logical leap from concussion to chronic traumatic encephalopathy (CTE) to depression to suicide. All you have to say is "Duerson." Select stories here, here, and here, along with our previous coverage.

But just last Friday, our favorite science radio show aired a thought-provoking segment about how very much we still don't know about athletes and concussion. University of Michigan sports neurologist Jeffrey S. Kutcher, MD, cautioned listeners to follow the clinical evidence, which does not explain how repeated traumatic brain injury (TBI) might cause problems with brain function later in life. The discussion was inspired by a new stage play, Headstrong, running at the Ensemble Studio Theatre in New York City through May 13. How we wish we could have attended last night's performance, with a scientific postdiscussion moderated by Ivan Oransky of Reuters Health and Retraction Watch. Video posted here when available.

[Image: Purdue University/Thomas Talavage]

Hyperbaric Physician and Tech Charged with Manslaughter in 2009 Florida Chamber Fire

Three years after the first fatal hyperbaric chamber fire in the US, on 1 May 2009 at Neubauer Hyperbaric Neurologic Center, formerly Ocean Hyperbaric Neurologic Center, in Lauderdale-by-the-Sea, Florida, medical director Dr George Daviglus, 81, and hyperbaric technologist Lance Bark, 51, have been arrested and charged with aggravated manslaughter. The fire killed an Italian boy, Francesco Martinisi, 4, and his grandmother, Vicenza Pesce, 62.

Broward County Sheriff's Detective Frank Ilarraza, pictured above, spoke April 25 about the "gross negligence" revealed by his investigation. The South Florida Sun Sentinel summarizes the arrest report:

• Static electricity caused a spark that ignited dust inside the chamber.
• Neither the chamber hull nor Pesce and Francesco were properly grounded to prevent static electric shocks.
• Pesce's and Francesco's garments included metal and flammable synthetic fabrics, polymers, plastics, and ink.
• Baby wipes containing alcohol and other combustible chemicals were inside the chamber.
• No operator was present.
• The chamber intercom system was not working.
• Operators did not follow emergency procedures for 30-second chamber depressurization.
• The chamber was over 40 years old and had been improperly rewired.

Click here to download the 11-page [PDF] complaint affidavit.

State Fire Marshal's Office Detective Edwin Tapanes called for stricter regulations of hyperbaric facilities across Florida. All across the country, physicians and technicians will be studying these findings and redoubling their efforts to ensure the safe delivery of hyperbaric oxygen therapy. Patients and families should feel confident in asking facility and equipment operators about safety procedures, regulatory compliance, and equipment certifications. More about chamber types and safety here.

[Image: Sun Sentinel video capture]

They Call It Healogics

The company formed by the merger of National Healing Corporation and Diversified Clinical Services now has a name: Healogics. The companies agreed to merge last September and announced the new identity on April 19 at the spring meeting of the Symposium on Advanced Wound Care (SAWC) and Wound Healing Society (WHS). Based in Jacksonville, Florida, Healogics is the largest provider of advanced wound care, managing more than 500 centers in more than 10% of US hospitals.

Click here to download [PDF] the full news release, in which chief medical officer Robert Warriner, MD, said:

The rise in obesity and the growth of the aging population results in a higher number of chronic wounds. It is imperative that we educate medical professionals, patients, and families about the advanced treatments available to promote healing.

Hear! Hear!