Hyperbaric Medicine in your Practice
Hyperbaric oxygen decreases inflammation, enhances cell and tissue function, helps heal slow or non-healing wounds and provides an oxygen path to tissues without a blood supply.
Hyperbaric Medicine, also known as Hyperbaric Oxygen Therapy (HBOT), is the medical use of oxygen as a drug at a level higher than atmospheric pressure. In hyperbaric chambers, the patient breathes 100% oxygen at pressures greater than normal atmospheric (sea level) pressure. This allows the blood to carry more oxygen and deliver 15 to 25 times more oxygen to the tissues and organs of the body. Oxygen has natural healing properties, and increasing the amount that is circulating throughout the body promotes faster and more efficient healing for a wide variety of diseases and ailments1. We have been using HBOT at the Calusa Veterinary Center since 2011 with excellent results.
MECHANISM OF ACTION
Under hyperbaric pressure, healing oxygen is dissolved in the blood plasma, cerebrospinal and lymph fluids, enabling oxygen to reach damaged tissue at least three to four times farther than normally diffused by red blood cells. This is especially important in swollen and inflamed tissues where small blood vessels have been spread apart and oxygen from red blood cells is unable to diffuse out far enough to supply the needs of damaged cells.
Hyperbaric oxygen decreases inflammation, enhances cell and tissue function, helps heal slow or non-healing wounds and provides an oxygen path to tissues without a blood supply. In addition to healing cells, hyperbaric oxygen proliferates and mobilizes the body’s own stem cells2.. These cells are attracted to areas of inflammation in the body where they produce healthy tissues.
HBOT IN VETERINARY PRACTICE
The first HBOT chamber for small animal companion animals was made available in 2011 by Hyperbaric Veterinary Medicine Company (HVM). Incredible stories of healing are unfolding. I used the chamber 600 times in our first year at Calusa Veterinary Center. Though I did not initially appreciate the broad impact of HBOT, it has become a cornerstone to healing in my practice over the last three years.
Saturating the body fluids with up to six times the normal amount of oxygen can have a profound effect on the body’s healing functions. HBOT.3.
• “Jump-starts” cells into a hyper-functioning state. These cells perform at an optimal level, improving healing in all ischemic diseases.
• Allows oxygen to cross the blood-brain barrier effortlessly, for immediate use by the brain and nerve tissue.
• Stimulates the growth of new capillaries, which allows circulation to be restored or improved; this reduces or eliminates hypoxia in affected areas.
• Stimulates connective tissue cells, which are rich in collagen, and promotes the growth of new skin.
• Increases the ability of white blood cells to remove foreign bodies from the bloodstream, including bacteria, fungi, dead cells and waste by-products.
• Stimulates the process involved in the normal remodeling of bone.
• Stimulates the immune response.
• Has potent anti-inflammatory effects.
• Increases the production of glutathione, the body’s main antioxidant powerhouse, by 15%.
• Reduces edema and mitigates damage to the surrounding cells, tissues and blood vessels. Therefore, it is a useful adjunct in treating trauma.
• Reduces the effect of radiation-induced injury to bone, soft tissue and organs by triggering the healing response to these areas.
• Inhibits the growth of some bacteria and kills anaerobic organisms such as those found in gas gangrene and certain Lyme spirochetes. HBOT improves performance of some antibiotics and medications.
• Increases the amount of stem cells circulating in the body.
CONDITIONS RESPONSIVE TO HBOT
While many conditions can be helped with HBOT, in my practice we have had good results with:
Skin grafts and flaps: The success of transferred skin grafts or flaps (which might include skin, deeper tissue, muscle and bone) is largely dependent on sufficient oxygen supply to the affected area. Hyperbaric treatment can be used to saturate the area with oxygen before and after grafting.
Non-healing or difficult to heal problem wounds: Complications of crush injuries, such as those from motor vehicle accidents, are frequent. By increasing oxygen delivery to injured tissues, HBOT reduces swelling, improves healing and helps fight infection. Slow-to-heal wounds show major improvement with HBOT, partly because of the oxygen saturation in areas with poor blood circulation.
Osteomyelitis: HBOT inhibits bacterial growth, increases the power of white blood cells and enhances the effects of some antibiotics.
Other conditions I routinely treat with HBOT include idiopathic thrombocytopenia, idiopathic vestibular disease, arthritic disease, brown recluse spider bite, snake bite, stroke, athletic injury, pancreatitis, brain and spinal cord issues – edema, injury and compression – intervertebral disc disease, swollen limbs, severe sinusitis or septic rhinitis, blastomyces, avascular necrosis of the femoral head, and radio-ulnar ischemic necrosis. I also use it following orthopedic surgery and for any post-surgical swelling.
TEACHING INSTITUTIONS ARE NOW UTILIZING HBOT IN THEIR OWN FACILITIES
Several schools now offer HBOT, and studies are underway. The University of Florida Small Animal Hospital, for instance, has installed a hyperbaric chamber, and so far has used it to treat a number of species, including dogs, cats, ferrets, rabbits, and a monkey. They use hyperbaric oxygen therapy to treat a variety of chronic and acute conditions including:
• Swelling – post-operative, crush injuries, snake bite, burns
• Trauma – internal, head, spinal cord
• Non-healing wounds, especially with blood supply concerns
• Smoke inhalation
• Carbon monoxide toxicity
At the Medical College of Wisconsin, researchers are studying hyperbaric therapy alone and in combination with other treatments. In one study, the researchers pioneered the use of hyperbaric oxygen in conjunction with NASA’s near-infrared lightemitting diode technology for treatment of hard-to-heal wounds.3.
The University of Tennessee’s Department of Large Animal Medicine uses HBOT for conditions or diseases in which circulation to the diseased tissue has been compromised. According to their website, “Hyperbaric therapy is a primary treatment for some diseases including severe smoke inhalation and burns, Clostridial and other anaerobic infections, and compromised wounds.” The Department also lists dozens of equine conditions they treat with HBOT, including desmitis (ligament disease), tendonitis (bowed or diseased tendons), fractures, exercised-induced pulmonary hemorrhage (bleeders), acute laminitis (founder), colic (intestinal obstruction, colon torsions, volvulus, etc.), enteritis and endotoxemia, Lyme disease, neurologic disease and trauma and severe necrosis (snake and spider bites, toxic substances, etc.).4.
CASES HELPED BY THE USE OF HBOT
Here are a few example cases from my own practice:
1. Piper, a seven-year-old Sheltie, was presented with a nonhealing wound infected by an atypical mycoplasma organism resistant to all antibiotics. Along with debridement, surgery, antibiotics and wound vacuum, she had 45 hyperbaric treatments and is now healed and back to normal.
2. Jack, a Yorkshire terrier, was attacked by a pack of dogs after Hurricane Sandy. He was paralyzed until his 20th HBOT session.
3. Sophie, a two-year-old Yorkie, was presented to our practice for HBOT after an anesthetic accident during a routine overiohysterectomy. She awoke blind and paralyzed and the neurologist referred her to us. She had 40 treatments and her vision and ambulation were restored.
4. Ollie was presented unable to stand after being hit in the head with a Bocce Ball. Upon presentation, she was ataxic and circling to the left when she was aided to stand. She was treated 30 times and was returned to normal.
5. Midnight was a female Lab mix found on the streets of Miami with burns over a third of her body; she was covered in maggots. When presented to me, she was at death’s door. Due to the excellent results seen with burn wounds using hyperbarics, HVM decided to sponsor the veterinary care for this dog and we began treating her on August 20, 2013. We debrided all her wounds, started conventional wound care and began her hyperbaric treatments at 2ATA for 45 minutes at pressure. We continued treatments until she was adopted to her forever home in October 2013.
6. Stella’s jaw was broken after a routine tooth extraction, without enough jaw bone left to heal the fracture. Twenty HBOT treatments postsurgery enhanced the osteoblast proliferation and healing of the mandible.
USING HYPERBARIC IN YOUR PRACTICE
The equipment required to produce hyperbaric oxygen consists of a pressure vessel (chamber) and a means of delivering 100% oxygen. The chamber for small animal companions can accommodate animals up to 180 pounds. Since the treatment requires no anesthetic, the chamber features large view ports, through which the patient can look during treatment. This helps alleviate emotional discomfort and, along with a large video monitor, allows for thorough monitoring of the patient.
HBOT treatments are always performed according to a predetermined plan by a trained technician who continuously monitors the patient and may adjust the schedule plan as necessary. At 2ATA, the average treatment time is 45 to 60 minutes. Depending on the condition it will be repeated several times a day, then taper off as healing occurs.5
Treatment is now covered by most pet insurers, as long as the condition itself is covered and HBOT is prescribed as part of the treatment protocol for this condition. One insurer, Trupanion, specifically outlines HBOT treatment under their Additional Care Package.6
While purchasing HBOT is an option, most clinics partner with HVM. In this scenario, HVM places the equipment in the clinic (clinic infrastructure must meet specific guidelines for weight, power, etc.) at no charge and provides complimentary training to clinic staff. The clinic is responsible for providing oxygen. Revenues are then shared between the clinic and HVM on a per use basis. HBOT treatments pricing varies due to local price of oxygen, overhead, and more.
A SIGNIFICANT MODALITY FOR HEALING
Simply put, HBOT helps animals heal much faster than I can achieve with merely holistic or conventional approaches. I cannot imagine practicing without having this therapy available. Though I am fortunate to have HBOT right here on site in my clinic, I wouldn’t hesitate to refer patients to another clinic with HBOT if my practice didn’t have the room or structure to support it. HBOT can increase our ability to help our companions heal and stay healthy, and with the number of serious diseases and conditions affecting our animals today, it’s a treatment protocol whose time has finally come.
Accreditation & Associations
In 2011, the National Board of Diving and Hyperbaric Medical Technology created the Certified Hyperbaric Technologist Veterinary Training and Certification Program. www.nbdhmt.org/chvt.asp
There is board certification in human medicine for hyperbaric technology, hyperbaric nursing, undersea and hyperbaric medicine (American board of preventative medicine and American board of emergency medicine) vet.utk.edu/vhms/review.html.
The University of Tennessee has started the Veterinary Hyperbaric Medicine Society (vet.utk.edu) and equine cases are presented on their site.
1 Jain, KK. The History of Hyperbaric Medicine, Hogrefe Publishers, 2004
2 Lynne H. Thom et al. Stem cell mobilization by hyperbaric oxygen Am J Physiol Heart Circ Physiol 290:1378-1386, 2006. First published Nov 18, 2005.
3 Brawwell and Crowe, Hyperbaric Oxygen Therapy, VetLearn.com: Compendium. March 2012
5 Braswell and Crowe. Hyperbaric Oxygen Therapy. VetLearn.com: Compendium. March 2012
7 Singh, MD1, Shailendra, Gambert, MD, AGSF, MACP, Steven R. Hyperbaric Oxygen Therapy: A Brief History and Review of its Benefi ts and Indications for the Older Adult Patient. Annals of Long Term Care, Volume 22 Issue 7-8, July/August 2014.
8 American Chemical Society: http://www.acs.org/content/acs/en/education/whatischemistry/landmarks/ josephpriestleyoxygen.html
9 Jain, KK. The History of Hyperbaric Medicine, Hogrefe Publishers, 2004
10 Edwards, Melissa L. Hyperbaric Oxygen Therapy. Part 1: history and principles. Journal of Veterinary Emergency and Critical Care 20(3) 2010, pp 284-297.
11-15 Singh, MD1, Shailendra, Gambert, MD, AGSF, MACP, Steven R. Hyperbaric Oxygen Therapy: A Brief History and Review of its Benefi ts and Indications for the Older Adult Patient. Annals of Long Term Care, Volume 22 Issue 7-8, July/August 2014.
16 Haff ty BG, Hurley R, Peters LJ. Radiation Therapy with Hyperbaric Oxygen at 4 Atmospheres Pressure in the Management of Squamous Cell Carcinoma of the Head and Neck: Results of a Randomized Clinical Trial. Cancer Journal from Scientific American 1999; 5(6):341-347