Friday, July 19, 2013

Hyperbaric update

Lots of questions about my experience treating my patients with low pressure hyperbaric oxygen therapy.

I have only been using this treatment for a few weeks. I have started all of my patients at a pressure of 1.3 ATA, breathing 100% oxygen. All patients have experienced Herxheimer reactions, of varying degrees.  I am not yet seeing much clinical change in my sickest patients (who have completed two weeks). This is not surprising; but I hope to hear good things after a month or more.  I am hearing good things from moderately ill patients already, and this is very exciting.  Of course I cannot rule out the placebo effect. Some patients have reported significant improvements after only 4-10 treatments. Improvements include: rapid wound healing (not a surprise), less joint pain, more energy, less brain fog, less headaches and a greater overall sense of well-being. Changes in function ability have also been reported. One patient reports a tremendous increase in energy and endurance.

A couple of patients have had rather severe Herxheimer reactions characterized by severe fatigue. In these cases I have lowered the frequency of therapy.

My sense so far is that HBOT is like many other treatments: results are variable and treatment programs need to be adjusted.

I suspect that therapy is going to be prolonged for most patients.  I think a 3 day per week schedule will help but may take longer. Perhaps more time in the chamber will help.

A lot of benefits have been described for low pressure HBOT.  Currently I am using 1.3 atmospheric pressure which equates with swimming about 11 feet underwater.  I have supplemental valves which will allow me to raise the pressure to 1.5 ATA, equal to  swimming 18 feet underwater. I will try different pressures with patients to see what works best. 1.5 ATA is the upper limit of what is generally considered low pressure.

There is an argument that low pressure is better than high. A primary mode of action of HBOT is the generation of reactive oxygen species. These compounds are oxidants, not anti-oxidants. At lower levels they reduce inflammation, kill bacteria and promote improved functioning of the immune system. It is possible that excessive amounts of these compounds may have a toxic effect. (I do not know if this is true; I have only read about it).

Does low pressure HBOT work? I think so. Maybe I said this before. All elite athletes own and use HBOT units, finding better recovery from work outs with a lot less muscle pain.  I hear some athletes even sleep in them; but the consensus is that this is likely not a good idea. Home chambers do not exceed 1.3 pressures based on current FDA allowances (which is being challenged).


9 comments:

Unknown said...

As researcher in the area of neurobiology and hyperbaric medicine, the use of HBOT against Lyme makes a lot of sense. The use of oxygen as a bacteriocidal agent is not new. Antibiotics and HBOT are an established treatment protocol in certain clinics (William Fife, Ph.D., 1998), but the lower pressures (1.3 ATA) have not been tested against the spirochette (Fife used 2.36 ATA).

The effects of HBOT are varied, producing a reduced sensation of pain (analgesia), inhibited inflammation response, improved energy metabolism, new blood vessel growth and stem cell release in the peripheral blood.

The Jarisch-
Herxheimer response is typical with HBOT and Lyme, but it does improve with dietary regulation (kerogenic diet) and metabolism support.

Excellent to hear that your patients are improving, but the proof will be in blood cultures. Just recently there have been major improvements in the ability to culture these bugs (galaxydx.com)

Lyme report: Montgomery County, MD said...

There is little hard evidence either way. The one paper you refer to was neither published in a journal nor peer reviewed -- not that it matters to me. There are no studies comparing the efficacy of various pressures in the treatment.

There are many described benefits to HBOT including those that you mention.

One lab provides commercial cultures for doctors already: Advanced Laboratory Services.

Lyme spends virtually no time in the blood stream. It is primarily found in tissues as found in PCR testing.

The diagnosis and treatment will likely remain primarily clinical for the foreseeable future.

Read my next blog which deals with this topic.

Dianne F said...

Excellent blog. I am wondering if you would consider writing a future entry about the "iSpot" test by Pharmasan Labs. This new test allegedly diagnoses Lyme with much more accuracy than the ELISA/Western Blot. My 12-year-old son tested positive on the iSpot, with a score of 60, and I am trying to determine if we should move ahead with treatment. He has been plagued by a series of symptoms post-tick bite for the past two years, but they are not classically Lyme. I would love to hear your take on the iSpot as there is nothing out there about it online except for the company's marketing materials. How exactly does it work? Why is better? Is it for real as a diagnostic tool?

Phoiph said...

I had severe neurological Lyme with Babesia & Bartonella for 8 years...considered an antibiotic failure, and so ill I was homebound for 5 years straight.

My symptoms were extreme and relentless; too many to list here. I was told, even by LLMD's, that I needed a miracle, and there was nothing more they could do for me (I tried many, many protocols with never any improvement, just a continual spiral downward).

I eventually became so toxic and environmentally sensitive that I could do no treatments for 5 years before starting MILD hyperbaric treatment w/supplemental oxygen (I bought my own chamber and self-treated 1 hour daily).

I now have my life back...working again, running (I had been a runner for 17 years, pre-Lyme), traveling, etc. It has been a miraculous recovery, and it is 100% due to mHBOT (along with meticulous gut/nerve healing diet, and gradual, increasing exercise).

I believe success depends on the frequency and consistency of use...many people say they "tried hyperbaric, but it didn't work"...but if you query them, inevitably they didn't do it consistently or frequently enough...or for a long enough duration (altitude is another consideration). You must be committed to this treatment to have success. I treated 1 hour daily 7 days per week, and didn't take a day off for 1 year (although I had significant improvement before that). Although I consider myself well, I continue to use my chamber daily (unless I'm traveling), as I am still noticing enhancements to my health and well being.

I almost made the fatal mistake of returning my chamber after 40 consecutive "dives", not feeling any improvement at that point. Fortunately, I was talked into continuing treatment, and felt the first "change" (not necessarily "improvement") after about 2 months.

It was a rocky, 2-step-forward, 1-step back road, but after several months, although I was not completely well, I was functional again, and after 1-1/2 years, I was "back"...

Now, 2 years and 700+ dives later, I truly have my life back...very active again...no medications...no restrictions...

Low (pressure) and slow WORKS...I'm living proof...

Lyme report: Montgomery County, MD said...

Thank you for the comment.

I think a lot of patients will need to buy their own chambers.

I think the duration of treatments and the length of therapy will generally be the key. Therefore it becomes a moot point whether high or low pressure is better. Low pressure is the only, realistic, affordable option. Safety and toxicity and ease of use are other factors.

I have a chamber capable of slightly higher pressures, 1.5 and 1.6 ATA.

My patients are reporting better results with the higher pressures: more energy, less neuropathy symptoms and increased mental clarity. ( pressures increased after first 10 sessions).

I know companies can only sell chambers with 1.3 ATA pressures for home use because of FDA regulations.

Patients cannot purchase devices without a doctor's prescription.

Physicians can use chambers differently. First off all, we can prescribe for "off label" uses, such as Lyme disease, and we have some flexibility with pressures (with the few chambers on the market which are safe for higher pressures).

Any comments?

Phoiph said...

Here's a link to an article I like about the benefits of lower pressures for neurological conditions, written by Dr. Paul Harch (author of "The Oxygen Revolution"):

http://www.netnet.net/mums/Harch2.htm

His book also features before and after SPECT scans, which are very compelling...

Phoiph said...

Since becoming well from severe neuro-lyme and coinfections (Babesia and Bartonella, etc.) through mild hyperbaric (with supplemental O2), many people have voiced their concerns to me regarding the possibility of HBOT "feeding" Babesia.

I wanted to share an excerpt from a veterinary research article I recently came across.

It is from a study of Babesia in dogs, and is suggestive of how Babesia and other parasites are damaged by oxidative stress...similar to the description of how oxidative stress damages the membrane of the Lyme spirochete.

Oxidative stress is one of the many therapeutic mechanisms in hyperbaric, and, fortunately, with mild hyperbaric, does not damage the body due to an increase in natural antioxidant production.

Here's the quote from the research article:

“...Many parasites including protozoa are sensitive to oxidative stress. Sensitivity to oxidative stress has been reported in malaria (Rockett et al., 1991), hepatozoonosis (Kiral et al., 2005), tropical theileriosis (Visser et al., 1995) and babesiosis (Stich et al., 1998). Reactive oxygen species (ROS) and Reactive Nitrogen Species (RNS) are powerful oxidants and nitrating species that can inactivate enzymes and initiate the process of lipid peroxidation and nitration, which leads to radical chain reactions that further damage membranes, nucleic acids and proteins (Muller et al., 2003). These processes may ultimately lead to the killing of parasitic organisms (Rockett et al., 1991; Kiral et al., 2005)...”

While not conclusive, of course, it certainly challenges the "Babesia Loves Oxygen" rumor...

brookek said...

Hi,
My name is Brooke. I'm a hopeless Lyme/bartonella/babesia, possibly others, too, patient. The infections have spread to my skull bones and I am considering using hyperbarics as it can kill Lyme and have been used with some success in osteomyelitis with other pathogens. I am wondering if anyone has feedback on whether it would make sense to use high or low pressure oxygen and if it is safer for babesia victims to use low pressure. My plan was to hit it first with a round of high pressure and then use a soft chamber for as long as I can if I can raise the money for this. I know that being at deeper pressures actually can cause bone to break down and I wonder having Lyme in the bones if this would be good or bad. Maybe milder pressures? I just need to get the bone tissue healthier, as I have such bad inflammation in whole bones, pereosteum, especially, I can't even have people touch my head, think or use language internally sometimes, or focus my eyes, etc. Thanks to all the bone pain and feelings of swelling, etc. I am perhaps going to have a bone scan, but expect nothing to come of it because Lyme is immune suppressive and I don't think my body is going to have created enough hot spots in response. Any advice is much appreciated. I am also considering a different doctor as I am not getting too far with the five powerful abx I am on by IV and clearly there is a problem with this.
Brooke Kramer

hyperbaricGA said...

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