Welcome to 20-Minute Health Talk, I'm Rob Hoell. Getting oxygen to tissues that have been damaged is critical to help the body heal and fight off infection. Hyperbaric Oxygen therapy can speed up that process by dramatically increasing the amount of oxygen to an injured area of the body, typically due to crush injuries, chronic wounds resulting from diabetes, radiation damage, and a host of other conditions.
In part one of this two-part conversation, we speak with two world-renowned experts in the field to learn more about this powerful treatment. With us here in the studio is Dr. Owen O’Neill, who is the founding and current medical director of the Department of Undersea and Hyperbaric Medicine at Phelps Hospital, the largest hyperbaric chamber in the northeastern United States. Welcome Dr. O’Neill. Thank you Rob. It's a pleasure to be here, and I really do thank you for having me.
Our next guest joins us remotely. John Peters is the executive director of the Undersea & Hyperbaric Medical Society and international non-profit association serving physicians, scientists, associates, and nurses, in the fields of Hyperbaric and dive medicine. He is also a fellow of the American College of healthcare Executives. John, welcome to the show. Thank you so much,
it's nice to be here. Dr. O'Neill also helps to lead the Undersea and Hyperbaric Medical Society as president-elect in addition, he received its 2022 Excellence and Hyperbaric medicine award for 30 years of work, in the field, which includes extensive research. We'll talk more about that in a minute, but first, hyperbaric oxygen therapy is often associated with deep sea diving but it's also used to treat a variety of other health problems.
Can you explain how hyperbaric oxygen therapy is used in the healthcare setting? Certainly Rob. that's a great question, So normally our body consumes 21% oxygen every time we take a breath in, and the body also requires that oxygen to perform many of its physiologic functions. In addition, wound healing requires a significant amount of oxygen, and if we don't have enough oxygen, we won't heal.
So hyperbaric oxygen, will provide us with an increased amount of pressure — higher than normal atmospheric pressure — where we're sitting right now and in doing so, we're able to use a significant amount of oxygen and bring the tissue oxygen concentration to about 15 times normal then we have it right now, and we can achieve these values in a hyperbaric chamber. We cannot achieve those values even if we breathe 100% oxygen, such as using a mask that a patient may get in the emergency room.
Even breathing 100% of oxygen at atmospheric pressure will not bring the oxygen levels up significantly as it will when in a hyperbaric chamber under the pressure. We're talking about a hyperbaric chamber. I almost get the vision of like a submarine, what happens during a session and how does extra oxygen help the body heal? Well the the submarine look might be an adequate description. I like to think of it more as our chamber at least at Phelps, is about the size of a 727 airplane.
Wow. So what happens is with increased pressure — let's just take for instance, the example of a garden hose — So if we turn our garden hose spigot on, the water kind of plops out the end of the hose and that's more or less, how the body normally drops oxygen off into the tissues. However, if we put a pressurized handle on the end of the hose and we squirt it, we'll get a lot more water at the same time. In addition we'll also increase the distance of where that water goes.
So in a hyperbaric chamber, we will actually increase the tissue oxygen concentration, all of the cells in your body will have approximately 15 times the amount of oxygen that it normally gets and in cases, where let's say vessels are blocked, or circulation, can't get to a wound, we are able to deliver that oxygen to the womb because the distance of a traveling from capillaries out to the wound is significantly increased because of the pressure gradient that's created by the hyperbaric chamber.
Hyperbaric oxygen therapy is approved as a treatment for several conditions. Those include anemia, severe burns carbon monoxide poisoning, chronic wounds that won't heal, such as a diabetic foot ulcer, Crush injuries, decompression sickness, gas, gangrene, radiation injury, skin, graft flap and risk of tissue death. John how is it determined which conditions
hyperbaric oxygen therapy can treat? Sure, there are 14 approved indications and we've been publishing a journal since 1976 on those indications and it's about 400 pages of action-packed Science and data on those indications. For what I've heard, you know, being a late person about hyperbaric treatment is usually when I hear about firefighters or people with
carbon monoxide poisoning. Dr. O'Neill, how commonly is this used in healthcare, and are there a lot of centers like the one you have at Phelps? Well, it's not overly common in healthcare. I think it's become more common over the last I would say 15 years. They've been more and more mono place or a single patient chamber center's opening up in hospitals as well as some freestanding centers but the specialty itself is a specialty that's not really taught in medical schools.
There are a couple of medical schools, including New York Med, where I reside as well, they teach hyperbarics in the school. It's not something that's learned during the curriculum. If you don't have a hyperbaric chamber in your residency program, you won't learn about it there. But there are a significant number of programs especially University programs now with Fellowship training and understanding Hyperbaric medicine.
So the specialty is still in the upward direction, we have increased the number of centers over the last John, how many years? Really from about 2002 to 2015. There was an exponential rise and programs, we have about 5800 hospitals in the United States. And of those, maybe about 3,500 are large enough to actually have or house a unit, you have other hospitals that are small, rural hospitals that don't have the capacity for, for this kind of service.
So, we grew through 2015, and we kind of contracted, but we're actually on an upward trend again this year. And the Chamber we have at Phelps is the largest in the Northeast but it's one of very few centers like it in the country. Most of the hospitals are housing one patient at a time in hyperbaric chambers, where our chamber can sit 12 patients at once. It's about 9 feet in diameter, 28 feet long.
More importantly than having the largest hyperbaric chamber in the northeastern United States, I would say that we have one of the best Hyperbaric trained teams in the country as well. People have been doing it for quite some time. I'm doing it for 30 years and I still have people with me who have been with me the entire 30 years. John can you tell us a little more about the Undersea and Hyperbaric Medical Society?
Sure, the Undersea and Hyperbaric Medical Society or UHMS for short was founded in 1967 as a section of Aerospace Medical Association and we stayed a section of asthma until 1970-1974. And then eventually to form our own organization as officially breaking off from them in 1976. And so we are a 501, c, 3 non-profit.
We have approximately 2,000 members and 30 to 35 countries, and we are comprised of about 50% position membership and about 50% non-physician, those are including technicians nurses, therapists Etc. Wow. Is this a one-time treatment or do you get multiple sessions in one of these chambers? It really depends on your diagnosis. So for instance, scuba diving is where we started, right?
So if you come in with a scuba diving illness, IE decompression sickness, you might require just one treatment but that one treatment may last five and a half hours or longer. If you have carbon monoxide poisoning, that might be three treatments within a 24-hour, period, but most of the elective or everyday treatments that we perform as an extra treatment for the normal care patients are getting. Those treatments can be anywhere from 20 to 60.
So, for the most part hyperbaric oxygen is not a quick fix in certain cases, it's a longer fix, but some of those treatments that require a longer amount of time. Hyperbaric oxygen, is one of the only treatments for it. And just to paint a picture, you know, you described it before, as like, 727, what's it like, when you're in the inside the hyperbaric chamber, are you sitting down?
Are you able to do things or you just sleep? Yea the the hyperbaric chamber at our institutions is a very comfortable chamber. It's more or less like sitting in the first class airplane seat. So you'll be sitting on the seat, you'll be wearing a neck down or neck ring, which is a plastic holder of a rubber Dam, which goes around your neck, like, a turtleneck wood, and the hood that you wear inside our chamber snaps down on top of that.
The hood is very lightweight and see through during the course of the treatment you could watch amovie, you could read a book, you could look at a magazine, our system has environmental control so we do have air conditioning on compression. We have heat on the way up if it gets too cold. And like I said, you can watch a movie, you can sleep or you can read a book. What would be a scenario where you would have 12 people in the chamber at once? Carbon monoxide poisoning is one.
Family House or a fireman involved in a bad fire. We have had 12 patients at once and it was a large family. Well, we're talking about conditions like diabetes which would also be treated by a doctor specializing in that condition is hyperbaric oxygen therapy, a secondary treatment? Or can it be a primary treatment for some conditions? It's a primary treatment for a number of conditions, scuba diving illnesses one. So if a diver gets decompression sickness, we're the only treatment for him.
If he gets an error gas embolism or there's an error gas embolism in the hospital with certain procedures that we do now, we're the only treatment for that. I would go as far as to include that radiation damage from radiation tissue because most of the treatments that occur in the hospital for patients with radiation damage, for instance, radiation cystitis, which would be a radiation damage with the lining of the bladder, their symptoms may be significant bleeding and discomfort.
So they may get admitted to the hospital to stop the bleeding but all the treatments are to treat their symptoms. It's not treating their underlying problem, which is the radiation damage. And we are the only treatment that's going to fix that. Tell me exactly what radiation damage is. Okay. So the most important thing for patients who have cancer is to get rid of the cancer, right?
So, radiation therapy is there to dissolve tumors unfortunately, the good tissue around those tumors also are subjected to the radiation. Now, over the years, we've got a little bit better at that, but we still are not there yet. So when one person gets radiation, the patient gets radiation therapy. What happens is it creates an inflammation in the lining of the blood vessels in the area where their radiated.
So over a period of time, those blood vessels eventually, coagulate or clot and disintegrate. So, as time goes on, more and more of those vessels disintegrate, we wind up having very low oxygen tissue levels in those areas, we have the formation of new blood vessels in a low oxygen medium, which don't function very well they're very friable. And we also have a significant amount of scar tissue form, which we call fibrosis in medicine. So hyperbaric oxygen therapy over the long haul.
Again, we said not a quick fix, so over the long haul that 20 to 60, 40 to 60 sessions in radiation cases, we will grow new healthy vasculature that will never go away unlike the radiated blood vessels that will continue to be destroyed throughout the patient's life. So the inflammatory process that's Caused by radiation damage, never goes away. It's always ongoing and we don't know how fast it's going to occur. It occurs very slow in some folks and it occurs very fast in others.
There's no way of telling which category a persons going to fall into. So we want to treat them as best we can to grow as many new blood vessels as we can, to reduce as much fibrosis as we can to prevent them from having the symptoms of bleeding discomfort. Discomfort or blockage Dr. O'Neill in addition to your role at Phelps, you do a lot of work outside of the healthcare setting. Specifically, you actually work in undersea medicine.
Tell us a little bit about some of these activities that you're involved in outside of the hospital. Well, as the specialty is named Undersea and Hyperbaric medicine. The undersea portion is primarily taken care of divers, commercial divers, recreational divers and compressed at workers which is known as the sandhogs here in New York, right? So, one of the big aspects of the undersea world right now is tunneling.
So we have a lot of space occupied above ground, so we're starting to go below ground. And unlike they did in the older days in the late 1800s and early 1900s, we no longer dig tunnels by hand. We did them with what's called a tunnel boring machine, or a TBM for short. And these tbms are digging and moving forward and they're creating a round space. And they are actually building the concrete tunnel behind it.
But the Cutters and Rippers and the tools at the front of this machine, get worn down every now and then, and it does still require humans to go in and repair them, replace them and fix them. So these tunnel boring machines have hyperbaric chambers actually built right into the front of them.
So that when they have to stop tunneling to repair things, the commercial divers are then called in or the compressed air workers or sand hog union workers are called in to be pressurised into the hyperbaric chamber, and go out the other side to work in the front and then come back into the hyperbaric chamber at the end of their shift and be decompressed.
So, when that happens, when they have to stop to fix this machine, my medical team gets call and we fly wherever that might be whatever state, it might be here in the United States or whatever country it might be, and we go there, and we take a look at the depth of the job. We write the compression, the decompression scheduled for the workers, we tell them how long they can work out in front of the machine and in addition, we examine the workers. We want to know what kind of Health they're in.
We make sure that they have, their ADC diving committee, physicals performed on a yearly basis. Make sure they had all their testing done beforehand. Make sure they feel well, the day they're going into the dive, we don't call it a treatment, here we do call it a Dive and then once they're fit, we send the men.
We compress the men, then we decompress them and we take them out, examine them again then let them stay around with us for an hour because it can still be about an hour before decompression sickness sets in. So we examine them again
one hour after they exit the chamber. Once they're cleared, they're given some information, some health tips and they're sent home and they usually come back the following day at the same time for their shift again, and this is an ongoing 24/7 service that we provide until the front of the machine is workable again and they can start tunneling.
It's fascinating and And when you talk about the sand hogs right here in New York City, they were doing that for the, I guess the East end access to Grand Central for the Subways. That's correct. Currently in a job in Los Angeles and before that we actually worked on the Big Bertha project in Seattle which was the largest tunnel Boring Machine in the world which was five and a half stories in diameter. Wow, amazing.
How does a patient who has a chronic illness, get hooked up with hyperbaric treatment? What we're doing today is we're trying to educate the community which I think is a very important item because patients don't need to have their own physician refer them, they can come on their own, even if they're not sure, we can help them, we'd be happy to sit down with them and tell them how we can or how we can't help them and maybe direct them in the proper direction.
So, patient education, I think Community Education is crucial. Ongoing. and continued physician education regarding hyperbarics is important and I've been doing that for 30 years, It does tend to keep us fairly busy. But we have certainly seen a number of patients now come in self-referred some for the right reason, some for the wrong reason, but in my practice, I'd rather see 100 patients in my office that feel hyperbaric oxygen might be beneficial to them.
and even if I only treat one patient, at least that's one patient we didn't miss. That's important that uhms says on a global scale is working to educate other specialties too so it is a multidisciplinary effect and an effort, really where we're working with other specialists who also owned the same patients, who were working with them, to address one condition that they have potentially a basket of several.
And so it really is kind of a from a global standpoint, whether we're working with family practice or general surgery, emergency medicine, or other specialists. Is this something that insurance covers? Insurance does cover many of the diagnoses. As John mentioned earlier, the Undersea and Hyperbaric Medical Society has a list of about 14 acceptable indications for treatment. Medicare maybe doesn't cover a few of those items, but most private insurance companies do cover it.
Yeah. What are the risks of hyperbaric oxygen therapy? So the hyperbaric oxygen treatments are probably one of the safest treatments we have in healthcare today. The important point, like most things in medicine is patients are evaluated properly by a board certified or a fellowship trained or experienced Hyperbaric physician. There are very few things that can adversely affect the patient.
The first thing is pressure. So we all know that we can feel pressure in our ears, just swimming to the bottom of a 10-foot pool or driving in the car in the mountains. So when we pressurize the chamber most patients will feel the pressure in their ears, and they're taught how to overcome the pressure. There are a number of ways of doing that and it becomes a very infrequent problem.
Secondly, would be things like claustrophobia confinement anxiety and that would occur the one patient at a time Chambers more, so than the chamber we have at Phelps, but, you know, people can be talked out of claustrophobia confinement, anxiety, even a mono place chamber and they can be treated for that as well with medication. Lastly at times we make the distance vision after 30 treatments or so we can make the distance vision a little blurry.
If you where readers glasses to read, we make the reading vision better. We may not need the glasses, those are all temporary changes and then come back to normal anywhere within two to six weeks of completing treatment. And oxygen toxicity. I even think about not even talking about oxygen toxicity because it happens so infrequently in a cynical hyperbaric chamber, but oxygen toxicity can occur, it can be a neuromuscular irritant. We can also see patients that could have a seizure from oxygen.
So anybody who comes to us with a history of seizures that requires the treatment, remember do no harm to the patient, so if they require that treatment and we know that treatments going to either save their life or save their limb and they have a seizure history or taking seizure medications, we'll discuss that with the patients and we'll eventually treat them.
But if you have no seizure history, your chances of having a seizure from oxygen toxicity and hyperbaric chamber textbooks will tell you one in 10,000. My practice tells me about what an 18,000 so you probably have a better chance of getting bitten by a shark walking out to your car tonight when you leave the studio. That does it for part one of this interview with Dr. Owen O'Neill and John Peters part 2 will be available next Wednesday, November 30th on your favorite podcast app.
Remember to subscribe to 20-Minute Health Talk to stay up-to-date with the latest news and developments in healthcare. I'm Rob Hoell, stay safe and have a great day.