Why month-long chamber regimens?

[Matt S.]

I was reading a story about an injured diver who was getting daily chamber treatments for about a month straight.

I thought the point of chamber treatment was to remove bubbles from tissues, and let excess nitrogen blow off slowly and safely--but are you going to have any excess nitrogen in your tissues after a month of daily chamber rides? I would think that you'd be completely offgassed within days, no matter what kind of nitrogen loading you had.

I'm surely missing something... what's the benefit of such long treatments?

 

[DandyDon]

I was reading a story about an injured diver who was getting daily chamber treatments for about a month straight.

I thought the point of chamber treatment was to remove bubbles from tissues, and let excess nitrogen blow off slowly and safely--but are you going to have any excess nitrogen in your tissues after a month of daily chamber rides? I would think that you'd be completely offgassed within days, no matter what kind of nitrogen loading you had.

I'm surely missing something... what's the benefit of such long treatments?

Where did you read this, please?

 

[DocVikingo]

I'm with Don--it is necessary to have additional information in order to meaningfully respond to the inquiry.

In the meantime, chamber treatment has salubrious effects beyond the reduction of bubble size and facilitation of inert gas washout. When bubbles and the bodily reactions they may trigger (e.g., inflammatory processes, platelet aggregation) are impeding blood flow, treatment can help to oxygenate affected tissues. This is particularly important when critical central nervous tissue is involved, like the spinal cord and brain. In such situations, chamber treatments may continue for some period after all bubbles have disappeared and inert gas loadings have returned to normal.

Nonetheless, receiving daily treatments for an entire month is quite unusual.

Looking forward to reading the entire story.

Happy holidays.

DocVikingo

 

[Matt S.]

Doc, the oxygenation benefit makes sense as the diver in the story had CNS damage. Anyway, here's the story I was reading.

http://www.bishopmuseum.org/research/treks/palautz97/cmd.html

"After 28 treatments, I could walk on my own (very slowly, and with a substantial limp), although I still had no sharp pain or hot/cold feeling in my legs. The increments of improvement in my condition with each passing day had diminished to the point where I really couldn't detect them. So finally, more than a month after the accident, the decision was made to stop the chamber treatments."

I'm afraid the whole story is very long, but the details of the medical treatment start about 2/3 of the way down.

 

[DocVikingo]

Hi Matt,

You've got a good memory.

Believe it or not, I've read that article, although it was many years ago.

Yes, it seems that the severe CNS involvement, along with patient report that up to a point each treatment seemed to bring at least some improvement, drove the protocol. You won't see that extent of treatment very often.

Season's greetings.

DocVikingo

 

[Matt S.]

Thanks, Doc.

 

[Diver Dennis]

Don't they use chambers for other treatments as well? I thought I heard something about quicker healing under conditions of high pressure oxygen.

 

[Dr Deco]

Hello Matt S:

Hyperbaric Therapy

This modality is used in the treatment of decompression sickness since it can reduce the size of the bubbles in vasculature. It also provides oxygen, by diffusion, to tissue with blocked capillaries.

This same oxygen can also treat other disorders such are wounds that are healing poorly because of injured capillaries (e.g., from radiation therapy or diabetes).

Neurological Injury

in some cases, neurological injury will respond to hyperbaric oxygen. In the case of diving injuries, retreatment will often be made until the patient reaches a plateau in recovery. In the case of Richard Pyle, apparently, he continued to experience improvement after several weeks of treatment. This is actually quite a long duration, but you cannot argue with success.

This is a fairly expensive procedure that is generally not covered by health insurance.

Dr Deco :doctor:

 

[Diver Dennis]

Thanks Doc.

 

[DocVikingo]

Hi Diver Dennis,

Yes, hyperbaric oxygen therapy (HBOT) is used to facilitate wound healing as well as in a range of other conditions. It has been tried with maladies as diverse as multiple sclerosis, autism, chronic fatigue syndrome, cerebral palsy, arthritis, AIDS, Lyme disease, and migraine and cluster headaches.

Because HBOT entails costs and its use has sometimes bordered on quackery, the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health & Human Services (HHS) only reimburses for its application in certain conditions. Private medical insurers and other medical plans/organizations typically follow these guidelines.

The CMS approved indications for HBOT are:

"1. Acute carbon monoxide intoxication.

2. Decompression illness.

3. Gas embolism.

4. Gas gangrene.

5. Acute traumatic peripheral ischemia. HBOT is a valuable adjunctive
treatment to be used in combination with accepted standard
therapeutic measures when loss of function, limb, or life is
threatened.

6. Crush injuries and suturing of severed limbs. As in the previous
conditions, HBOT would be an adjunctive treatment when loss of
function, limb, or life is threatened.

7. Progressive necrotizing infections (necrotizing fasciitis, meleney
ulcer).

8. Acute peripheral arterial insufficiency.

9. Treatment of compromised skin grafts.

10. Chronic refractory osteomyelitis, unresponsive to conventional
medical and surgical management.

11. Osteoradionecrosis as an adjunct to conventional treatment.

12. Soft tissue radionecrosis as an adjunct to conventional treatment.

13. Cyanide poisoning.

14. Actinomycosis, only as an adjunct to conventional therapy when the
disease process is refractory to antibiotics and surgical treatment.

15. Diabetic wounds of the Lower Extremities in patient who meet the
following three criteria:
(a). Patient has Type I or II diabetes mellitus and has a lower
extremity wound that is due to diabetes mellitus,
(b) Patient has a wound classified as Wagner grade III or higher; and
(c) Patient has failed an adequate course of standard wound therapy."

Helpful?

Happy holidays.

DocVikingo