About Hyperbaric Oxygen Therapy

Our Naturopaths provide Edmonton with Hyperbaric Treatment

TruMed will be offering Edmonton Hyperbaric Oxygen Therapy starting in Fall of 2020.

Our Naturopathic Doctors have summarized some background data on how Hyperbaric Oxygen works - basic physiology and biochemistry of HBOT.

Our Naturopaths offer Edmonton Hyperbaric Oxygen Therapy, IV Therapy, & Modern Nutritional Medicine.

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 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 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 O₂can 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, but 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. Oxygen under pressure forces more oxygen into the tissues.

Secondary Oxygen effects:

Less Edema - Receptors sense high oxygen levels from Hyperbaric treatment, and cause blood vessels to constrict (vasocontriction) which reduces edema which is extremely important in injury. Hyperbaric oxygen therapy causes a 15-20% reduction in regional blood flow and edema, but oxygen content is still 10 to 15 times normal so the tissues still get dramatically more oxygen even though the blood flow is less (in part because edema is less as well).

Increased Collagen Production - The fibroblast is the cell responsible for soft tissue healing (forms collagen), Hyperbaric Oxygen Treatment dramatically increases Fibroblast proliferation.

Improved Immune Activity - Neutrophils which engulfs and kill bacteria, do so with Oxygen generated radicals and Hyperbaric Oxygen allows for the appropriate oxygen tension to do so (30-40mmHg).

Better Bone Repair - Hyperbaric oxygen enhances osteoclastic activity (for resorption and remodeling of bone) and osteoblastic activity (whose function decreases in low oxygen tissues).

Antimicrobial - Hyperbaric oxygen therapy has a "static and cidal" effect on microorganisms especially anaerobic organisms such as clostridia, bacteroides, staph and strep. Furthermore, hyperbaric oxygen can promotes active transport of some antibiotics into microorganisms. HBOT kills some fungi as well.

Stem Cell Release - Yes you read correctly! Hyperbaric Oxygen Therapy stimulates stem cells to produce and release growth factors. Hyperbaric oxygen also seems to mobilize stem cells from the bone marrow including blood vessel stem cells to areas of wounds.

Blood Vessel Generation - Oxygen under pressure from Hyperbaric treatment also encourages new blood vessels to grow (angiogenesis) via production of Ang2 and VEGF (new blood vessels can often require 20-30 treatments to do so however).

Microcirculation effects: HBO improves the elasticity of the red blood cells and reduces platelet aggregation. This, combined with the ability of the plasma to carry dissolved oxygen to areas where RBCs cannot reach, has a beneficial effect on the oxygenation of many hypoxic tissues in various circulatory disorders.

In summary, secondary effects of Hyperbaric oxygen therapy including reduction of edema, increased collagen, improved immune function and bone repair, direct antimicrobial actions as well as creation of new blood vessels and mobilization of stem cells make Hyperbaric oxygen treatment a powerful tool for healing and recovery from a range of conditions.

We are proud to offer Edmonton Hyperbaric Oxygen as part of our clinic.

UHMS Approved Hyperbaric Indications

1. Air or Gas Embolism

2a) Carbon Monoxide (CO) Poisoning

2b) CO Poisening Complicated By Cyanide Poisoning

3. Clostridial Myositis & Myonecrosis (Gas gangrene)

4. Crush Injury, Compartment Syndrome

5. Decompression sickness

6a) Arterial inefficiencies

6b) Arterial Inefficiencies

7. Severe Anemia

8. Intracranial Abscess

9. Necrotizing Soft Tissue Infections

10. Osteomyelitis (Refractory)

11.Delayed Radiation Injury (Soft Tissue & Bony Necrosis)

12. Compromised Grafts and Flaps

13. Acute Thermal Burn Injury

14. Idiopathic Sudden Sensorineural Hearing Loss

These 14 conditions are typically dealt with in a hospital setting.

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 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)

In the double blinded study by Hammarlund and Sundberg, patients with chronic leg veinous 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 2.5 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

Neubauer and End (1980) used Hyperbaric Therapy in 122 patients with strokes due to thrombosis in both the acute and the chronic stages. 65% reported improvement in the quality of life. It was also shown that patients treated with HBO spent fewer days in the hospital. Many studies exist for the use of HBO in cerebrovascular disease.

In a prospective, randomized, controlled trial on 74 patients who suffered a stroke 6–36 months prior to inclusion, HBO therapy led to signifcant neurological improvements (Efrati et al. 2013)

For most nervous system injury the treatment pressure range is 1.5 - 2.0 ATA.

Athletics

Ishii et al (2005) reported that the use of Hyperbaric Oxygen Treatment muscular fatigue in Olympic Seven athletes 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.

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.

Pain

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)

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)

Risks of Hyperbaric Treatment:

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 chamber can cause ear discomfort and you must to equalize the pressure by swallowing or yawning "cracking your ears."

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.

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

Oxygen toxicity seizures are very rare and affects only 1 person in 10,000. Diabetes, Hyperthyroidism and Fevers all increased risk. If you have a history of seizures we will give you air breaks mid-ascent. If you are diabetic we'll monitor your sugars pre and post dive. Vitamin E decreases seizure risk so your TruMed Naturopath will often recommend anti-oxidants including Vitamin E.

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

Risk of ear or sinus pressure injury - Ear Injury is the most common complication of Hyperbaric Oxygen Therapy. If you cannot equalize you will be held at that pressure until you can equalize. Bearing down or saying "K" can help. This is part of the reason patients with upper respiratory tract infections are not allowed to enter the chamber.

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

Preparing for Hyperbaric Treatment

Safety is of utmost importance at TruMed.

Fire is the biggest safety risk because of the 100% oxygen in the Hyperbaric chamber.

Do not to take anything into the Hyperbaric chamber.

No paper or books, metal objects, jewellery, watches, cellphones are allowed in the Hyperbaric chamber.

Hearing aids, contact lenses and piercings are not allowed in the chamber either

Let us know about Implanted devices, pacemakers or AICDs - Automatic Implantable Cardioverter Defibrillator, or External insulin pump or continuous blood sugar monitor.

Gum is not permitted.

You will be asked to remove anything with oil in it including all cosmetics such as: lipstick, makeup, hair oil, cream, hair spray, nail polish, ointments, cologne or perfume, liniments and deodorant.

It's best to come to the clinic with none of these applied that day or removed prior to joining us at the clinic.

You will be given a 100% cotton gown to wear during the Hyperbaric treatment.

Please do not wear any other clothing into the Hyperbaric oxygen chamber without checking with our staff.

You may not wear: Nylons, Synthetic clothing

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 dependant 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.

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. 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."