Friday, June 28, 2013

Hyperbaric: a short review

A new machine sits in my office and I have just finished setting it up:  a portable, low pressure hyperbaric oxygen chamber.

There are three types of chambers:  standard, hardened chambers (mono-place)  which can deliver high pressures with 100% oxygen, multi-place chambers can deliver high pressure to several patients at the same time and require external oxygen and low-pressure, portable chambers which use external oxygen and must be inflated. 

Hard chambers have a history of treating many acute and serious medical problems, including:  air embolism, decompression sickness (altitude sickness), gas gangrene, crush injuries, carbon monoxide poisoning, necrotizing fasciitis, osteomyelitis, non-healing diabetic ulcers and more.

Low pressure chambers are newer on the market.  Both types of chambers have been used for the treatment of Lyme disease ( anecdotal information only).

There are numerous other conditions treated with low pressure hyperbaric therapy including:  autism, migraine, fibromyalgia, chronic fatigue syndrome, traumatic brain injury and too many to list.

In either case, patients must have daily therapy for several months, at least 2 months. The therapy is ineffective if used sporadically; so starting hyperbaric therapy, with each session typically lasting one hour, is quite a commitment. The treatment is generally used as an adjunct to antibiotic and/or other therapy.

Some benefits of treatment are:  improvement of immune function; antibiotic effects; selectively kills anaerobic bacteria including Lyme; improves the penetration of antibiotics;  is able to reach areas where Lyme hide because of limited blood flow, such as cartilage; leads to formation of oxygen free radicles which kill bacteria, constricts blood vessels while delivering more oxygen and therefore swelling, a byproduct of the inflammation which accompanies Lyme, has good penetration in the brain (blood brain barrier not a factor), quickens the healing of damaged tissues, improves fatigue and stamina, increased brain function has been documented in SPECT scans, including low pressure therapy and most elite athletes use them (low pressure)  because it enhances performance and decreases healing time.  There is some literatue to support the contention that low pressure is more effective than high pressure for certain conditions, including traumatic brain injury; many other benefits are reported as well.

Pressure is measured relative to pressure the atmosphere exerts on our bodies at see level.  The pressures are called ATA, absolute atmospheric pressure.  Low pressure therapy ranges for 1.3 to slightly higher than 1.5 whereas high pressure ranges to about 3. Pressure is for example what your body experiences when you swim underwater:  1.3 ATA is equivalent to swimming 11 feet underwater. Both camps claim effectiveness of their therapy.

A big difference is cost.  High pressure HBO is very expensive and may typically range from 200-250(or more) dollars per treatment.  Low pressure HBO therapy is typically offered in the range of 75-150 dollars per treatment. Discounts may be given when patients sign up for more treatments. For example, a 20 day course of therapy offered in a hard chamber clinic may cost about $3,600 while the same course of treatment may be offered at $1400 in a soft chamber clinic.  Another advantage of low pressure treatment is that serious side effects are virtually absent.

Another very significant advantage of low pressure devices is that these devices may be rented or purchased for home use with a doctor's prescription.

Monday, June 10, 2013

Pregnancy and Lyme

Sitting at my desk today is a delightful 25 year old woman -- she is also 12 weeks pregnant. She lives in a rural wooded area. . Two and one half  years ago she developed an acute, multi-system disease.  She had myriad symptoms, to numerous to list: fatigue, swelling of lymph nodes, headaches, loss of balance, numbness and tingling, weakness with inability to walk associated with a severe loss of balance, painful and swollen joints, spontaneous lactation, depression, OCD, ADD like illness treated with Adderall, severe headaches.
Numerous doctors had been of no help. A friend referred her to me.

Her treatment has been aggressive:  she was on IV antibiotics for more than six months. At some point we treated her for adrenal fatigue and this made a tremendous difference.

 Now, 12 weeks pregnant.she has been hospitalized three times, not for Lyme disease but for hyperemesis gravida. Now resolved.

We had discussed the management of chronic Lyme disease vis-à-vis pregnancy. We had decided to use dual therapy Amoxil and Flagy which took for a short time and had to drop the Flagyl because of GI intolerance. Her gastrointestinal system is still very touchy. At this point we will use mono-therapy with amox.

Depression has been a serious issue: a year ago expressed suicidal ideation without plan or intent.  She still has a modicum of depression
She is on Zoloft. When she lowered the dose from 50mg to 25mg depression worsened: We are titrating the dose  We discussed the pros and cons -- of the medice, I think depression is worse for the fetus than potential risks associated with SSRI therapy. And post-partum depression is expected to be severe.

Did I mention -- today, all the Lyme symptoms are gone: including headache and  knee pain and swelling.

But we know this temporary.

During pregnancy the immune system is tamped down to protect the fetus from inflammation.  After the baby is borne the immune system is turned back on and a Lyme relapse may rage.

Then, we discussed breast feeding.  Lyme has been found in breast mild ---- but a new-born is immune suppressed,  a baby less than 8 weeks can die from herpes sepsis.

Not all babies acquire trans-placenta Lyme.  Cord blood can  be tested at a reference lab  like Clongen, 

Irrespective of the test result, I still recommend breast feeding.  Lyme is transmitted by a tick bite or perhaps an exchange of blood. The critical colostrum and  should not have contact with blood as its goes down the back of the throat; down a tube- the esophagus, and into the cauldron of acid in the stomach. Even when the baby spits up, the milk has already been in contact with stomach contents: and we will have antibiotics on board. Lyme is associated with autism:  lets get a head start with treatment.

I know that many in the Lyme community disagree with my approach; I can only make recommendations based on my understanding of the science and common sense.

From a wheelchair to asking for a note to go back to work today, I am delighted, and so is she.