November 23, 2022 • 21 mins
Oxygen is crucial to healing — but it has to be able to reach the damaged tissue to help the body recover and fight off infection. Hyperbaric oxygen therapy can facilitate that process by dramatically boosting the amount of oxygen your blood cells deliver to an injury. You may have heard about the therapy’s use in treating scuba diving incidents or carbon monoxide poisoning, but it can also speed healing from crush injuries, chronic wounds related to diabetes, radiation damage from cancer treatment and a host of other conditions. In part 1 of this two-part episode, two world-renowned experts in the field explain the history of this powerful treatment, how it works and what to expect during a session in the "727 airplane-sized" hyperbaric oxygen chamber at Phelps Hospital, who qualifies and the research driving it forward.
Meet the guests
- Owen J. O’Neill, MD, MPH, medical director Division of Undersea and Hyperbaric Medicine at Phelps Hospital
- John Peters, Executive Director of the Undersea & Hyperbaric Medical Society
* Part 2 of this episode will be available Wednesday, November 30.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
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.
(00:26):
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.
(00:48):
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.
(01:10):
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
(01:33):
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,
(01:56):
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
(02:17):
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
(02:39):
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.
(03:00):
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.
(03:21):
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
(03:45):
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
(04:05):
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
(04:28):
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
(04:51):
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
(05:12):
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.
(05:33):
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?
(05:55):
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
(06:16):
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
(06:38):
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.
(06:58):
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
(07:21):
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
(07:46):
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.
(08:07):
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
(08:28):
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.
(08:48):
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.
(09:10):
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
(09:33):
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.
(09:55):
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
(10:16):
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
(10:38):
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.
(10:58):
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
(11:20):
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
(11:46):
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.
(12:07):
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
(12:30):
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
(12:50):
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.
(13:12):
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
(13:36):
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
(14:00):
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
(14:20):
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.
(14:42):
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
(15:04):
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
(15:25):
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
(15:47):
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.
(16:07):
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
(16:30):
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.
(16:51):
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.
(17:14):
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
(17:37):
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
(18:00):
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.
(18:20):
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
(18:41):
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
(19:02):
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.
(19:24):
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.
(19:46):
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
(20:09):
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
(20:32):
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
(20:54):
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.
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.
(00:26):
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.
(00:48):
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.
(01:10):
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
(01:33):
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,
(01:56):
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
(02:17):
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
(02:39):
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.
(03:00):
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.
(03:21):
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
(03:45):
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
(04:05):
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
(04:28):
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
(04:51):
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
(05:12):
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.
(05:33):
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?
(05:55):
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
(06:16):
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
(06:38):
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.
(06:58):
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
(07:21):
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
(07:46):
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.
(08:07):
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
(08:28):
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.
(08:48):
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.
(09:10):
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
(09:33):
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.
(09:55):
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
(10:16):
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
(10:38):
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.
(10:58):
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
(11:20):
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
(11:46):
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.
(12:07):
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
(12:30):
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
(12:50):
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.
(13:12):
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
(13:36):
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
(14:00):
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
(14:20):
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.
(14:42):
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
(15:04):
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
(15:25):
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
(15:47):
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.
(16:07):
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
(16:30):
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.
(16:51):
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.
(17:14):
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
(17:37):
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
(18:00):
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.
(18:20):
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
(18:41):
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
(19:02):
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.
(19:24):
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.
(19:46):
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
(20:09):
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
(20:32):
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
(20:54):
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.
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