About Hyperbaric Oxygen Therapy

Our Clinic provides Edmonton with Hyperbaric Treatment

Oxygen Physiology: 

When inhaled air (a combination of 80% nitrogen and 20% oxygen) reaches the deepest area of the lungs which we call alveoli, there is a two cell layer in which oxygen exchange occurs: one cell of the membrane of the lung and then the adjacent one cell layer of the capillary.

Normally, 45% of the blood is actually made of blood cells, the rest is a liquid we call plasma. Passing through the lung cell, the oxygen molecule dissolves in the plasma passing flowing inside the capillaries of the lungs.

After leaving the lungs and going to the heart, the blood is then distributed throughout the body through arteries which ultimately terminate into capillaries again. 

In the capillaries, is where the oxygen diffuses through into the interstitial fluid that surrounds cells and then into cells and then into the mitochondria of cells for aerobic respiration and ATP production.

The major site of utilization of molecular oxygen within the average cell is the mitochondria, which account for about 80%, while 20% is used by other subcellular organs, such as the microsomes, nucleus, plasma membrane, etc

Hyperbaric Physiology: 

When the walls of capillaries become thickened, in conditions like diabetes, less oxygen is transported across them. When the fluid content surrounding cells increases as it can from edema in injuries, less oxygen again is transported.

We call this tissue hypoxia - when less oxygen is transported to tissues and the tissues are deprived of appropriate oxygen. 

Normally 97% of the oxygen transported from the lungs to the tissues is carried in chemical combination with hemoglobin of red blood cells and only 3% of oxygen is dissolved in the blood plasma because oxygen is also poorly soluble in water (plasma is mostly water). 

Henry's Gas Law represents the basis for Hyperbaric Oxygen Therapy.

The amount of gas that that dissolves in a liquid is directly proportional to the partial pressure of that gas on the liquid. 

More simply, if you take a liquid and place a gas next to it, the gas that will be dissolved into the liquid is at an amount proportional to the pressure of the gas.  The higher the pressure of the gas, the higher amount of gas will be dissolved into the liquid. 

In Hyperbaric Medicine, we place pressurized pure oxygen next to blood plasma.

As we increase the pressure the oxygen is dissolved in the plasma at a higher rate. Our goal is to saturate tissues with oxygen levels about 10x the levels of saturation provided at sea level

Primary Oxygen effects:

Background -  Typically, 2% of our inhaled oxygen is carried in the plasma and 98% is reversibly bound to hemoglobin in our red blood cells. Even breathing 100% O₂ no additional O₂ can be added to the hemoglobin and you can reach a maximum of 15 mL O₂/L blood. 

Hyperoxygenation - The amount of gas that dissolves in a liquid is directly proportional to the pressure (Henry's Law) - so the higher the pressure of the gas, the more that gas can dissolve in a liquid like our blood plasma.

There is a 10 -15 fold increase of oxygen in the plasma under hyperbaric conditions (2.0-2.5 ATA). 

Unrestricted flow - If blood vessels and capillaries are injured or narrowed and red blood cells  cannot enter a tissue, the hyperoxygenated plasma can still enter the area and reach the tissue. 

Tissue Saturation - Massively increased oxygen content in the plasma diffuses naturally from the plasma to the tissues (from an area of high concentration to low concentration).

Time of effect - Elevated O₂ levels in the blood stream return to normal within 10 minutes after completing a Hyperbaric Oxygen Treatment.

However, O₂ tensions in muscle tissue remains elevated for 1-2 hours post exposure, and up to 4 hours in subcutaneous tissues. 

Ultimately, the primary end result of Hyperbaric Oxygen is to provide an oxygen rich environment for tissue metabolism. 

Secondary Oxygen effects:

UHMS Approved Hyperbaric Indications 

Researched Hyperbaric Areas:

Infections

Hyperbaric Therapy has been shown to be an amazing adjunct to the treatment of various infections.

Host defense mechanisms against infection are impaired by hypoxia and oxygen has synergistic effect with antibiotics especially in anaerobic infections.

The high levels of oxygen provided by Hyperbaric Oxygenation to the tissues are detrimental to organisms that thrive in the absence of oxygen.

Chronic wounds tend to have hypoxia due to the destruction of local vasculature, increased oxygen consumption by leukocytes and fibroblasts and chronic wounds tend to be colonized by bacteria 

Hypoxia impairs the immune mechanism of the body, whereas Hyperbaric Treatment increases immune system generation free radicals which are toxic to microorganisms. 

Most infectious data for Hyperbaric Treatment is related to bacteria, and fungi with less information on HBO and viral infections. 

The use of Hyperbaric Oxygen Treatment for Lyme disease often cite the results of a 6-year Texas A&M University pilot program from the 1990s. 

Subjects underwent up to 40 1-h HBOT sessions at a pressure of 2.36 ATA - Improvement or resolution of symptoms was observed in 37 of 38 subjects within 3 weeks post-treatment (Huang et al 2014).

We offer some limited Lyme Disease testing and treatment options at our Edmonton office.

In the double blinded study by Hammarlund and Sundberg, patients with chronic leg venous ulcers but without diabetes or large vessel arterial disease showed a 36% reduction in ulcer size at six weeks after a course of Hyperbaric Oxygen compared with a 3% reduction in the control group treated with hyperbaric air.  

For most infections 100% oxygen is used up to 2.4 ATA for 1 h sessions, which can be given once a day or preferably twice a day.

The immune system is stimulated by oxygen pressures up to 2.5 ATA.
 

Neurology

Hyperbaric Treatment is most commonly utilized for Stroke, Brain Injury and Concussion at our Edmonton office. In particular because there is a wealth of strong data to support its use in these conditions.

For most nervous system injury like Stroke, or Concussion the treatment pressures our Edmonton clinic uses is in the range is 1.5 - 2.0 ATA, and 60 minute sessions.

However data is emerging supporting the use of 90 minute sessions for Stroke Treatment.

In addition to Hyperbaric Treatment, we've seen the incorporation of IV Therapy to be beneficial in Stroke and Concussion Treatment at our Edmonton Clinic.

Stroke:

Efrati et al.(2013)

Hyperbaric Oxygen Treatment in 74 Stroke patients up to 3 years after the Stroke. 

The authors stated "We found that the neurological functions and life quality of all patients in both groups were significantly improved following the HBOT sessions."

Schiavo (2020) 

Hyperbaric Oxygen Treatment in 27 Stroke patients up to 4 years after the Stroke. 

The Hyperbaric Treatment group showed significant improvements in numerous motor function tests and Stroke Impact Scale - superior benefits as compared to the control group.

Brain Injury:

Boussi-Gross (2013)

Hyperbaric Oxygen Treatment in 56 Post Concussion Syndrome patients up to 6 years after the Brain Injury.

A significant improvement was observed in the treated group after HBOT in all cognitive measures: Information Processing Speed, Attention, Memory, and Executive Functions.

Harch (2017)

Hyperbaric Oxygen Treatment in 30 Post Concussion Syndrome patients at least 1 year after the injury.

Significant improvement was seen in neurological exam, symptoms, intelligence quotient, memory, measures of attention, dominant hand motor speed and dexterity, quality of life, general anxiety, PTSD and depression.

Athletics 

Ishii et al (2005) reported that the use of Hyperbaric Oxygen Treatment for muscular fatigue in Olympic Seven athletes who received Hyperbaric Therapy up to 40 minutes at 1.3 ATA with between two and six treatments per athlete.

It was found that all seven athletes had enhanced recovery rates from Hyperbaric Therapy. 

Very commonly we see subacute musculoskeletal injury patients using Hyperbaric Treatment at our Edmonton office.

Cancer 

Hypoxia is also a common feature of the tumor microenvironment and a major cause of clinical radioresistance. 

There is preliminary evidence that Hyperbaric Oxygen and ketogenic diets have a synergistic effect for cancer treatment (Poff 2013). 

Hyperbaric Oxygen has been used with good results in the management of radionecrosis (the term used for radiation-induced tissue death): soft tissues radionecrosis as well as osteoradionecrosis (bone). 

A Review of experiences with 124 patients has shown that HBO therapy led to significant improvement in 94 % of the cases (Slade and Cianci 1998 via Jain 2017). 

HBO is not used in the early postradiation period as it may potentiate the effects of radiation. 

Although not quite as common, we still see our fare share of Delayed Radiation Injury patients at our Edmonton clinic for Hyperbaric Treatment.

Unfortunately not many standard or alternative treatments exist for this but Hyperbaric Treatment has very strong data for a range of radiation damaged tissues.

Pain 

The most common pain condition we use Hyperbaric Treatment for is Fibromyalgia management at our clinic.  

Fibromyalgia - In a prospective, active control crossover trial of 60 female patients with FMS, HBOT administered in forty 90-min sessions, 5 days/week, using 100 % oxygen at 2 ATA led to significant improvement in both treated and crossover groups (Efrati et al. 2015). 

Our Naturopathic Doctors are extremely experienced in Fibromyalgia treatment at our Edmonton clinic.

We frequently employ IV Therapy as some patients have extremely rapid improvements following IV Therapy.

Autoimmunity 

Case Reports exist for the use of Hyperbaric Oxygen in IBD - Crohn's and Ulcerative Colitis.

Several cases of psoriasis have been reported to be successfully treated by HBO.

Anti-inflammatory effects of HBO on prostaglandin, nitric oxide, and cytokines involved in wound pathophysiology as well as the immunosuppressive effects of HBO contribute to the beneficial effect of HBO in these conditions (Dulai et al. 2014).

Our Edmonton office is experienced in Alternative management of Autoimmune conditions.

Risks of Hyperbaric Treatment: 

Hyperbaric Oxygen Treatment is generally extremely safe, however there are a few common concerns that may arise

Visual Changes: After a large number of Hyperbaric Oxygen treatments some changes in vision may occur (myopia or nearsightedness).

These usually return to pretreatment vision levels in a 6 week to 6 month period.

Hyperbaric Oxygen Treatment may cause increased maturation of cataracts but does not cause cataracts. 

Ear Discomfort: The increasing pressure during Hyperbaric pressurization can cause ear discomfort and you must to equalize the pressure by swallowing or yawning "cracking your ears." 

Blood sugar changes: If you are diabetic we'll monitor your sugars pre and post dive.

With diabetics large decrease in blood glucose levels can occur from Hyperbaric treatment, blood glucose should be 5.5 before treatments. 

Signs of oxygen toxicity are tingling in the fingers, nausea, dry cough, seizures and chest pain

Sinus squeeze: Second most common complication, usually during reduction of pressure "descent" - pain because sinus opening blocked by congestion, edema, blood, polyps.

We have not seen oxygen toxicity or visual changes occur from Hyperbaric Treatment at our Edmonton office. These principally are related to higher pressure procedures whereas the treatment of neurological injury (Stroke, Concussion etc) use moderate pressures.

Oxygen Toxicity: Oxygen toxicity can occur if a patient is overly sensitive to oxygen or is exposed to high pressure (>2.4 ATA) for prolonged periods - we have never seen any indication of oxygen toxicity in our patients.

Generally HBO therapy is safe and well tolerated by humans at 1.5–2 ATA. 

Oxygen toxicity seizures are very rare - Diabetes, Hyperthyroidism and Fevers all increase risk.

If you have a history of seizures we will give you air breaks mid-ascent.

Generally speaking, the incidence of adverse effects with Hyperbaric Oxygen administration is extremely low when appropriate pressures and treatment durations are employed.

Other preparations: You need to go to the bathroom before you start your treatment. You cannot leave the chamber mid-treatment or this will end your session. 

You may eat a light meal but no carbonated drinks or pop 2 hours prior to Hyperbaric treatment.

No smoking 2 hours prior and 2 hours after treatment as it decreases the amount of oxygen that can be transported by the blood. 

If you are an insulin dependent diabetic, take your regular meal and insulin prior to treatment.

Do not hold your breath during Hyperbaric Treatment 

Let us know if you have had ear pressure issues before eg. during flying.

For high pressure or long treatments, you may also have to wear a mask intermittently for what are called “air breaks.”

IV Therapy & Hyperbaric Oxygen

The Naturopathic Doctors at TruMed love IV Therapy treatments. We've seen more rapid and dramatic results in our Edmonton patients with treatments of IV nutrients.

Most commonly, IV Therapy is incorporated in the treatment of Neurological injury (i.e. Stroke, Concussion).

The reality is that Hyperbaric Oxygen drives oxidative phosporylation in the cell and our Naturopathic doctors can provide raw substrate for the Krebs cycles with IV Therapy.

The result: massive synergy and enhanced results when Hyperbaric Oxygen is combined with IV Vitamin Therapy. The pressure gradient is also thought to enhance nutrient uptake. 

With treatments like IV Vitamin C, one group has proposed that because the level of tissue oxygenation may be the most im­portant factor in the anticancer activity of IV vitamin C, that the utilization of Hyperbaric Oxygen immediate­ly after IV vitamin C therapy is thought to increase its effectiveness as an anticancer agent.

Likely through it's mechanism related to the formation of hydrogen per­oxide. 

One group out of Seattle has remarked "In our experience, the addition of HBOT to any IV protocol improves efficacy."