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WHAT the BLUES say about HBO

Diabetic Foot
Medical photos may shock you!

There are claims for efficacy of HBO. Today the list is much longer than in textbooks of medicine such as Cecil's 1985 17th Edition p.2289 that lists six conditions that benefit from HBO: acute carbon monoxide poisoning, acute cyanide poisoning, clostridial myonecrosis, decompression sickness, air embolism, and osteoradionecrosis.

Supplements have been reported to aid in the management of diabetes, T1DM (search Rogosin Medical Institute). RSV and FPH (Resveratol and fish protein hydrolysate) in combination has been researched. I would empirically add Omega 3 and other numbers.

Wet diabetic foot is an early stage of gangrene. Restriction of venous return aggravates this and hyperbaric oxygen therapy (HBO) may not dry up and heal the diabetic foot. The anatomy of the common femoral vein (CFV) explains this. The CVF is crossed by the common femoral artery (CFA) which lies anterior. A fifty percent reduction in cross sectional area is clinically significant and stenting of the vein at this point may allow drying and improve the result from HBO.

Physiology; A hyperbaric treatment means the patient is breathing oxygen or oxygen enriched air (or mixed gas) under increased pressure. Hopefully that mix has been filtered to remove combustable hydrocarbons and other impurities to make it SafeAir. Air that has 21% oxygen has a greater oxygen concentration (parts per volume) under pressure in the chamber or during the d ive (the percent oxygen has not changed).The pressure is measured in ATA where 1 ATA is sea level pressure 14.7 psi gage. 33 feet of sea water = 1 ATA. Divers measure the pressure in fsw. 0.445 psi = 1 fsw. In converting remember where you started from. If you started from sea level you must add 14.7 psi to convert to ATA.
Blood glucose, a sugar, decreases while breathing increased concentrations of oxygen. Eating before the HBO treatment and between dives does prevent rapid fluctuations of blood glucose. Instant glucose products should be with the diabetic whether in a chamber or in the water. Smoking and consumption of alcoholic beverages while on a diving excursion is ridiculous. The USAF School of Aerospace Medicine teaches us to use hoods or masks for delivery of oxygen and venting of the chamber air enough to reduce the ambient oxygen concentration to less than 25% (as measured as it leaves the chamber).
There are about 28 liters per cubic foot (ref conversion website from one set of units to another). Oxygen consumption 1.6 L/min (ref US Navy Diving Manual free download from Lulu.com). Tidal volume about a half a liter sixteen times a minute, the rate of respiration. The time it takes to reduce the oxygen concentration at standard temperature and pressure to that of Mt. Fuji (just under 15,000 feet altitude) depends on volume of the container the diver is in and the oxygen utilization for that level of activity-assuming that the diver will not be compromised when the ambient oxygen is reduced by half. If there is ventilation of the diver's space that is more than the respiratory minute volume at STP, the diver should not be compromised.

Adequate time for recompression therapy is essential to wash out nitrogen and allow oxygen to enter spaces that have physiological barriers or poor perfusion due to tissue injury or mechanical blocks to circulation by bubbles and foam containing nitrogen gas. Type 1 bends may be due to cavitation or nitrogen coming out of solution during joint motion 9that causes negative pressure in a localized area in a joint between two bones. Type 2 bends or "hit" is when neurologic (peripheral nerve, spinal cord, or central nervous system) dysfunction occurs. Loss of consciousness during ascent usually leads to drowning. Fatigue, light-headedness, blank stare, inability to concentrate, paralysis, numbness, slurred speech, seizures, inability to stand and walk without assistance, inability to calculate, recite one's address and other personal data, remember what they did before they dove, remember names and other details about their diving buddy and the parameters of their recent dive. A complete evaluation and search for other injuries may be necessary prior to recompression. Recompression should be done in a vessel that can go to 2 ATA or 33 fsw gage pressure to give the best results which is rapid amelioration of all symptoms. A U.S. Navy Treatment Table 6 requires 3 ATA and a U.S Navy Treatment Table 6A requires a vessel to go to 3 ATA pressure or 60 fsw. Mild chambers that can supply the diver with at least 50% Oxygen at 5 psi gage equivalent to 11 fsw (5 psi divided by 0.445 psi per fsw=11.2 fsw) allowing a long 10 foot stop with oxygen or oxygen blend. Treatments, even if just breathing 100 percent oxygen by a non re-breathing face mask, are usually effective in relieving symptoms of type 1 and type 2 bends. Exercise Physiology for Swimmers & Divers by Jeffrey H. Rudell, MD ISBN Softcover 978-1-4653-4937-8, pages 9-25, 109-168

Sometimes troubling persistence of symptoms that may include personality changes requires more evaluation. PET scanning has been reported to show glucose metabolism in the brain that changes with therapy. More metabolism that is evenly distributed correlates with recovery. The Oxygen Revolution by Paul Harch, MD ISBN 13:9781578263264, see illustration section To convert Feet;12"/Foot divided by 39.37 inches/Meter=0.305 Meters. Meters =Feet X 0.305. Pressure in Atmospheres Absolute, (10Meters of Seawater Pressure=1ATA) ATA=(depth/33fsw) +1. A BAR is about 1% more than an ATA and about 1% less than a Kg/cubicCentimeter. Portable, fabric hyperbaric chambers are medical devices that are designed to treat medical conditions, they are regulated by the FDA. The oxygen comes form a concentrator that delivers about 95% oxygen, or from an oxygen storage tank. Since the facemask may leak reducing the fraction of oxygen in the inspired mix of gasses. A 1.5 ATA protocol for ADD and Lyme syndrome needs an overshoot on the pressure to achieve the desired result because theoretical FiO2 is not achieved. Numerous centers are reporting remarkable results with CP and AUTISM. DIVEHEART (Making Possibilities for Disabilities) is an organization that can help children whose families and support situation has given up on them. (info@diveheart.org)

Lyme syndrome may be present in the absence of a confirming laboratory test. It is a clinical diagnosis, not a "DISEASE". What confuses patients is the policy of the insurance companies NOT to pay for services and HBO therapy. The condition disables the young person and then bankrupts the family, slowly but surely. The condition of the patient does not improve with time. Rocephin intravenous therapy may help at the outset, but often the treatment is not instituted because at the outset there are no symptoms. A textbook sign is the "bull's eye" lesion,which may be temporary,at the site of the tick bite. This lesion occurs with a tick bite and is not diagnostic of anything. The "bull's eye" is typical at the outset of Lyme Syndrome and its significance usually is overlooked. The fatigue, heart, nervous system, and other aspects of the syndrome take a long time to develop. The affected person may consider themselves lucky if they avoid hospitalization and keep their personal life and family relationships together.

Mild Hyperbaric Treatment seems to have a positive effect on athletic performance in some studies. Mild means less than 1.3 ATA or less than 4 psig. The breathing mix is air, hopefully SafeAir"see the link to ANDIHQ.COM.

The FlexiLite Hyperbaric Chamber

FlexiLite and Solace are popular. The air from the compressor may also be FDA approved. Click the hotlink for more information about the retailer HyperbaricsRx. Air compressors fill the chamber with air. Medical grade air, without impurities, SafeAir www.ANDIHQ.com comes from compressors that are FDA approved. ANDI (516)546-2026 is the Premier Training Agency as well as a supplier of all types of hyperbaric hardware.

The 1.6 ATA or 1.6 bar chamber and accessories varies in cost with the manufacturer. Higher pressure, portable chambers may not be FDA approved; yet, they are still regulated by the FDA, a federal safety standards agency.

Solace is a brand of mild hyperbaric chambers that come in many sizes for various applications. www.Oxyhealth.com markets this brand. The resale value on any chamber is good-especially if you have a warranty. www.ReimersSystemsInc.com. offers the 9600D Series multiplace chambers with 66inch high doors.

The U.S. Navy Diving Manual Revision 6 is available on the internet. Section 5 has indications and tables (www.U.S.NavyTreatmentTable9.org) for medical treatments. Section 20-4 notes that inwater compression of a diver is effective at 30fsw. Various protocols all start at 30fsw and adjust depending on the treatment gas and how the diver responds to therapy. Medical treatments are effective at this pressure and I expect that Revision 7 will state this unequivocally. I also expect and hope that the new revision could state that even lower pressures than 30fsw (13.4 psi) are effective for chronic conditions, requiring many treatments over months, are effective.

The EAD Formula is used to convert actual depths of a dive into what the depth of the dive would be if air was the breathing gas. A deep dive on a mix with reduced nitrogen would calculate out to be much shallower if air with 78% nitrogen was the breathing gas. If air or a mix is the diving gas the U.S. Navy recommends recompression to 30fsw in a chamber if the diver missed his/her decompression stops or surfaces with symptoms of DCS.

Surface-On-Deck (SOD) Decompression without temperature, dehydration, and diver fatigue considerations using a portable chamber is preferable to in-water or hanging on the anchor line method of decompression. On surfacing the diver is more buoyant due to less weight of air in the tank and air swallowing. Buoyant divers holding on a line cannot stay at a constant depth required by their deep, long, and repetitive diving profile. Their decompression becomes much shorter than they are aware of because of their tendency to bob to the surface before they complete their stop.

Seachrist monoplace chambers compress and ventillate with oxygen. Purchase, installation, and instruction for all kinds of chambers are available from www.HYPERBARICSRX.COM. Plexiglass chambers are rated by the number of cycles permitted for the materials involved. An aggressive treatment schedule for a motivated patient with a chronic medical condition is about 150 cycles. Used chambers from a facility may have years of use left for an individual at an affordable outlay. Operating costs for the FlexiLite are less because the oxygen is supplied form the OGSI unit and only the amount inhaled is used. Monoplace chambers require a high flow of oxygen for cooling and ventingl of exhaled CO2. Multiplace chambers compress and vent with air, oxygen goes through a regulator valve to a face mask or a hood. The valve regulates the flow according to the pressure in the chamber which is usually measured in feet of seawater.

Valves and operators monitor the pressure in the chamber. If the chamber pressure is measured in meters instead of feet of sea water and the operator thinks the gage reads feet of sea water then there is a real problem. It has been recommended that operators be trained on more than one system, that video monitors are adjacent to the panel controls, and blow-off valves are tested daily.

http://MARNOX.COM for discussion of how a chamber is used for medical treatments. Even if you do not purchase a chamber you should be aware of how you can obtain and use it effectively. In remote locations a chamber is preferable to all other methods of recompression therapy. If the patient arrives at a fixed chamber facility there should be no confusion because the patient has received treatment in the transport chamber. The transport chamber may be placed into the larger chamber or the patient transferred in the 5 to 10 minute window of opportunity before symptoms worsen. I was shocked to find out that this was a controversial point with some lightly informed people who maintain that transport in a fabric chamber might obfuscate the treating techs decision on profiles. A US Navy Treatment Table 6 is always the treatment of choice. Low pressure oxygen treatment for a few hours will not accelerate oxygen toxity of Paul Bert or Lorraine Smith.

Treatment of medical conditions at home without purchasing oxygen is feasible with the OGSI osygen concentrator. It is efficient and runs on the 120V AC that is found in the home.

Martin, a great guy, was treated at 20 psig (45 fsw) or 2.36 ATA (a modified US Navy Treatment Table 5) by me in a multiplace chamber, about 80 cycles, for OsteoRadioNecrosis of his jaw. In this photo his mandible is held together by an external splint.

To calculate psi multiply the depth in fsw by 0.445.To calculate the ATA add 14.7 to the gage pressure and then divide by 14.7. 10 ft sea water at 0.445 lbs/ft pressure= 4.4 psi.

I advise wound care centers to consider DIAPULSE, a unique, proprietary modality that uses pulsed non-thermal electromagnetic energy. www.DIAPULSE.com has sumitted clinical studies to the FDA and the FDA has approved DIAPULSE. In conjunction with HBO it achieves better wound healing than HBO alone, as in my own fight with osteomyelitis. Unlike HBO, DIAPULSE treatments, that usually last 30 minutes, may be repeated four times a day without fear of any toxicity.

The scientific mechanism for HBO is a net increase in collagen in the wound which correlates to angiogenesis, the collagen increase represents an increase in capillaries; ref. Dr. Paul Sheffield. The scientific basis of DIAPULSE is that there is pearl chain, regular and orderly formation in the tissues which opens channels for tissue fluid that carries oxygen to compromised macrophages, which enables oxygen dependent pathways to work. This may be thought of as akin to iron filings lining up in a magentic field. When the DIAPULSE treatment is over the pearl chains revert to a random pattern; ref. David Ross.

Check out Dr. Carl Edmonds Diving Medicine for Scuba Divers, 2010-free download:

His explanations are authoratative, even though they are from a different viewpoint than mine. I am trying to get divers to use chambers on deck. For example the section on HYPOTHERMIA mentions rewarming. Compressing the diver in a chamber is a fast and safe rewarming method. The compression adds heat and the oxygen aids metabolism. The two go hand in hand with regards to rewarming.

Martin got symptomatic relief of his pain from OSTEORADIONECROSIS of the MANDIBLE & some evidence of healing on X-ray

Lonnie had diabetic foot in addition to cocaine use with recent peripherovascular obstruction. He would not give up cocaine and he did not improve. Cigarette use is a similar complicating factor.

Commercial Diver with the Scott Bibs.

See http://www.comex.fr for application of O2HB under the heading "Expertise& Culture" subheading HYPERBARIC PHYSIOLOGY using O2 to recondition athletes at 1.6b.