*We will be taking a little break, but will be back with new conversations on all things dog in a bit. In the meantime I would love to hear from you! If you have a story of canine companionship you would like to share, a topic you would like to explore on the podcast, a question, or even a comment, please, email me charlotte@thebaroo.com.
Dr. Christina Montalbano from the University of Florida’s veterinary teaching hospital guides us through the world of hyperbaric oxygen chamber therapy for our animal companions. From horses to hamsters, we discuss how this advanced treatment is offering a breath of fresh air to veterinary care, tackling ailments like wound management, spinal cord injuries, and a host of other conditions. Our conversation with Dr. Montalbano peels back the layers of history and science behind this modern marvel, revealing its journey from deep-sea applications to enhancing the well-being of pets and wildlife alike.
We discuss the preparations and protocols necessary to ensure a secure environment inside the chamber. Learn why the smallest details, from removing a dog's collar to monitoring a cat's body temperature, are critical for a successful session. Dr. Montalbano also walks us through the contraindications and challenges of the therapy, sharing her expert perspective on how it's not a one-size-fits-all solution and what it could mean for animals with specific conditions like ear problems or the risk of acquired deafness.
We also explore how hyperbaric therapy holds its own when compared to treatments like ozone therapy, offering up vital information for pet owners seeking the best care
options.
If you are enjoying The Baroo Podcast you can now support the show by buying me a coffee.
Shop the podcast:
https://www.thebaroo.com/shop-pod
Follow The Baroo:
Instagram - https://www.instagram.com/baroopup/
Blog- https://www.thebaroo.com/
Facebook- https://www.facebook.com/baroopet/
Pet parent question or story of canine companionship to share ? Email charlotte@thebaroo.com or call 424-273-5131.
*This podcast is for informational purposes only, even if, and regardless of whether it features the advice of veterinarians or professional dog trainers. It is not, nor is it intended to be a substitute for professional veterinary care or personalized canine behavior advice and should not be used as so. The views expressed in this podcast are solely those of the podcast author or the individual views of those participating in the podcast.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Well, thanks for let's get started guys.
Thanks for popping on andchatting about this with us.
Hyperbaric oxygen chambertherapy correct?
Is that the correct name?
Okay, it's something that Iknow very little about and I
think it might sound kind ofwacky to some people off the bat
, but I know that it's been usedin human medicine for quite
(00:23):
some time, that it's been usedin human medicine for quite some
time, and I don't know when itwas introduced in veterinary
medicine, but that's somethingthat you can elaborate on and
I'd love to just jump in andtalk about it and talk about the
ways that it can benefit ourpets, and if you want to
introduce yourself for ourlisteners, that would be great,
Dr Montalbano.
Speaker 2 (00:44):
Yeah, so my name is Christina Montalbano.
I'm a veterinarian at theUniversity of Florida, at their
veterinary teaching hospital,and I have been clinical faculty
there for just over a year nowbut did all of my post-vet
school training down there.
So I've been there for about atotal of six years and at the
University of Florida we've hada hyperbaric oxygen chamber for
(01:06):
just over 10 years now and Ibelieve we still remain to be
the only vet hospital in theacademic or the teaching
hospitals that has a chamber.
But they are becoming morepopular in private practice and
hopefully continuing to grow.
It is still a relatively newertreatment option for veterinary
(01:28):
patients and can be seen both onthe equine and the small animal
side, but probably in the past20 to 30 years really, the
technology's been available butstill pretty hard to come by.
So everyone who has themavailable to them is fortunate
and should definitely takeadvantage of having them.
Speaker 1 (01:50):
So it was introduced to veterinary medicine about 10
years ago, or so you say 10 or20 years ago, 10 to 20 years ago
.
Speaker 2 (01:56):
yep, it's relatively new, I think.
Before then maybe some petswere getting the benefit from
human chambers, but the vet, thevet-specific chambers much,
much more recent.
Speaker 1 (02:07):
Do you know anything about when it was discovered in
general, for even human medicine, and how.
Speaker 2 (02:14):
So it's something that back in the 1800s the
technology was starting to bedeveloped when, through
construction workers mostly thatwere doing deep sea dives to
build bridges, things like that,where they're at low sea level
and under pressurized conditions, that they found, as they
(02:37):
brought them back up to normal,beyond sea level, to ground
level, that they would get thebends, as well as for other
scuba divers.
So they've figured out that bydoing hyperbaric oxygen therapy
treatment for these constructionworkers they could actually
reverse the signs of the bends.
And along the way physicianshad figured out that, hey, we
(03:05):
can use this for otherindications, to provide high
oxygen to different diseaseprocesses, to stimulate healing
or to correct other diseaseconditions.
It's been technology that'sbeen around for a little while,
but really only since, like the1960s, 1980s, has it grown as a
(03:28):
therapy specifically for medicaltreatments beyond something
like the bends.
Speaker 1 (03:34):
For those of us listening who I know I only know
I've only heard of the bendsbecause I have a friend who
scuba dives and it's like theonly time I've ever ever heard
of it.
For those listening, can youjust briefly explain what the
bends are, because I know it'sdefinitely a term used for, like
professional scuba divers?
Yeah, yeah.
Speaker 2 (03:51):
So the bends is a situation where with quick
changes in pressure, the gasbubbles that are naturally in
the body change in size and whenthat happens too quickly, those
gas bubbles can especiallylodge into the vessels and
vasculature and cause majorissues.
(04:11):
So we don't want those changesin pressure to happen too
quickly.
Speaker 1 (04:15):
Yeah, that makes sense.
So how did you discover, howdid you become interested in
hyperbaric oxygen chambertherapy?
Speaker 2 (04:24):
So it's something that we've offered at the
University of Florida since Istarted there, and so that was
how I learned about it.
Was just starting out there andseeing what they were doing
with patients and starting toperform it myself, seeing the
benefits that it can provide fora variety of different patient
indications.
Speaker 1 (04:44):
Great.
So what are some of thosebenefits?
Can we jump into that?
Yeah?
Speaker 2 (04:49):
Absolutely.
So really any condition thatwould benefit from increased
oxygen to tissues.
So we can think about one ofthe most common indications in
people that we'll use verycommonly in our veterinary
species is wound management.
So when we have wounds we havean area of the tissue that does
(05:10):
not have enough oxygen deliverybecause there's typically
disruption of the blood supply.
There may be bacterialcontamination, all of those
different things that canbenefit from having increased
oxygen to the tissues.
The thing about hyperbaricoxygen is that it's not just
increasing the oxygen deliverybut it's also at a pressurized
(05:31):
state which allows us to bringthat oxygen into deep tissues
without actually needing thenormal oxygen carrying component
of blood, which is hemoglobin.
So even without enough bloodcells in that wound, we can get
the oxygen to the tissues, andoxygen is very important to
(05:53):
promote healing.
So wounds is one of the reallycommon things that we'll use it
for.
Another very common indicationthat I use it for in University
of Florida is for spinal cordinjuries, such as our little
dachshunds or French bulldogsthat very commonly get
intervertebral disc herniations.
(06:15):
We can use this therapy to helpimprove oxygenation to the
spinal cord to help them recoverfrom that disc compression that
happens to those spinal nerves.
So we'll very commonly use itafter surgery for them or as
part of conservative managementto help those spinal nerves heal
(06:37):
.
Speaker 1 (06:38):
That's great.
Speaker 2 (06:40):
There's so many other indications that we can use it
for.
There's so many otherindications that we can use it
for I'd say a couple otherreally common ones that we're
using it for patients that haveosteoarthritis, arthritis of
multiple joints.
We find that it's helpful forpain management for them, things
(07:04):
like pancreatitis to helpreduce the inflammation
associated with that.
And then we're starting to lookat it for cognitive dysfunction
, which is similar toAlzheimer's in people.
That's a disease process that'ssimply caused by reduced oxygen
delivery to the brain.
So if we can improve oxygendelivery to the brain in an
aging animal, can we help toslow the progression of those
(07:26):
cognitive signs of decline.
Speaker 1 (07:28):
Wow, would it be helpful in something like in
like an acute, like emergencysituations?
Specifically, I have a.
This is a little off topic, butI have a client that got bitten
by a snake, a rattlesnake,yesterday, so he's in the ER.
They don't I'm sure they don'thave a hyperbaric oxygen chamber
, but I just got back fromvisiting him and I'm just
(07:49):
thinking like how could thisbenefit his healing process in
any which way, and I'm not surethat it can, but curious.
Speaker 2 (07:57):
Yeah, it definitely depends Specific with snake
bites sometimes we have to be alittle cautious that hyperbaric
oxygen therapy can be so good atreducing swelling that we can
actually get something calledre-envenomation syndrome where
there may be pockets of venomthat can then recirculate.
But in general, any even acuteinjury that causes significant
(08:20):
swelling, bruising, pain, we canhelp to very, very quickly
reduce that pain, even from asingle session.
So often we'll, if we have likea swollen limb, we'll measure
how the circumference of thatleg before and after just even
one session, and often we'll seea pretty significant reduction
in that, which is really nice tosee immediate effects of what
(08:44):
we're doing yeah, absolutely, drLindsay, did you have a
question?
Speaker 3 (08:49):
I did so along those lines.
I'm even thinking for patientsthat undergo chemotherapy and
have some of thechemotherapeutic material leave
the vein, because we actuallychatted about someone that is
really into ozone about howhelpful ozone was in a situation
that she had encountered thatwas very similar.
Is that also something thathyperbaric oxygen therapy could
(09:10):
be beneficial with?
Speaker 2 (09:13):
Yeah, absolutely so.
Any extravasation type injuriescan definitely be beneficial.
We had one that we were workingwith not too long ago that
we're trying to be beneficial.
We had one that we were workingwith not too long ago that
we're trying to kind of correctthe extravasation or that
(09:36):
removal of the drug from outsideof the vessel and trying to
reduce the swelling andpotentially the negative effects
of that medication that canoccur to the surrounding tissues
where it's not meant to be.
And then even going along thatsome people do question whether
this is a therapy that we can doto supplement cancer treatment,
Because there's always thethought that if we're increasing
(09:58):
oxygen to cancer cells maybethat would be negative and that
those cells would use the oxygenas energy to grow, which in
cancer is negative.
But a lot of information on thehuman side is finding that
actually the level of oxygenthat's provided, as well as the
again, the increased pressurethat's provided through
(10:20):
hyperbaric oxygen therapy, canactually inhibit tumor cell
growth that's associated incancers.
So it could actually be part ofa complementary treatment
option for different types ofcancers, especially the types of
cancers that may be sensitiveto radiation therapy.
So we'll think about using itin conjunction with radiation
(10:41):
therapy in patients that areundergoing that type of
treatment for their cancers, andthen can we talk?
Speaker 3 (10:47):
oh, go ahead, Charlotte.
No, you go, you go.
I was going to say can we?
Can we talk about what asession looks like?
So, just to preface this, myown dog underwent hyperbaric
oxygen therapy.
She has been dealing, or wasdealing with one-sided nasal
discharge for a year, and that'sactually how I found you.
(11:08):
I was looking for resources forprotocols because it's very
specialized and although there'sat least in Southern California
, I know of two dermatologiststhat have units so they can use
them they outsource for all oftheir protocols.
They don't actually make themthemselves.
So I myself was even surprisedto kind of watch them go through
(11:28):
the process and the kind ofthings that I would not think
are dangerous but in thatsituation you really have to be
very aware of.
So can you chat a little bitabout kind of what that process
is?
Speaker 2 (11:40):
Absolutely so.
For our patients to go into thechamber, there are a couple of
safety checkpoints that we haveto perform in order to make sure
that this is going to be a safesession for them.
(12:03):
So everyone who operates havecollars or leashes.
They can't have toys, foodbowls with them.
And then for our patients thatare hospitalized or immediately
after surgery, we have to makesure to carefully cover any
intravenous catheters, urinarycatheters, any intravenous
(12:27):
catheters, urinary catheters.
We have to put speciale-collars on if they need to
have an e-collar on.
And then we have to be carefulwhat kind of bedding they have.
So we have 100% cotton towelsthat can go in with them.
So, unfortunately, all of theirfluffy bedding and special toys
have to stay out just for thosesessions.
We also have to be carefulabout things like fentanyl or
lidocaine patches, because thechamber can actually increase
(12:48):
the absorption of thosemedications, so those have to be
removed.
And then making sure that theydon't have alcohol on their fur
or ultrasound gel if they'vejust had an ultrasound.
Or for our orthopedic patients,we use nail polish on their
toes to make sure we know whatlimb is getting surgery, so the
nail polish has to be removed.
So lots of little things thatwe have to make sure are checked
(13:11):
before they go into the chamber.
We also make sure our patientsare at a safe body temperature.
They have a significant feveror are hypothermic.
So if they're too cold that wecan see fluctuations in their
temperature from the pressurethat they undergo in the chamber
(13:33):
and we don't want them to havesignificant changes in their
body temperature during thetreatment.
So once we've made all of thosechecks and made sure that
they're safe to be in thechamber made all of those checks
and made sure that they're safeto be in the chamber then we
spray them with water whichhelps to reduce static
electricity in their hair coatwhich is mostly just a comfort
(13:55):
thing, so that they don't feelthat little bit of static
electricity.
Most of our patients toleratethe chamber very well.
Once we've had them all prepped,we load them in, shut the door
and then slowly start thatpressurization process.
So it takes us about 15 minutesto get them up to the pressure
that we're aiming for, which,depending on what we're treating
(14:16):
, we're aiming for a specificpressure, which typically we'll
use about two atmospheresabsolute or 14.7 psi.
For certain conditions we maychoose to go higher or lower
than that, but that's just kindof what's been shown to be most
efficacious, most beneficial fortreating these patients.
(14:38):
Once they're up to thatpressure that we're aiming for,
we keep them at that pressurefor typically between 45 minutes
to one hour and then slowlybring them back down to normal
pressure.
So, just like I was mentioningbefore that we can see the bends
or decompression sickness.
If we change those pressurestoo quickly we can actually
cause the bends in thehyperbaric chamber by having
(15:00):
them go up or down from pressuretoo quickly.
So we want to make sure to doeverything at a nice slow rate
so that we're not causing anyproblems.
So again, most patientstolerate the sessions very well.
They just sleep or we havelittle windows in our chamber
that they can look out and watchus.
Speaker 1 (15:19):
I was going to ask my question like how do they do
they don't panic or anythingwhen they're in there, or
they're just fine, they know fordon't panic or anything when
they're in there, or they'rejust fine, they know, for the
most part.
Speaker 2 (15:27):
Typically they're very good for patients that do
have like confinement anxiety.
If they're not good in a kennel, we may choose to do some light
oral sedation or light IVsedation, but for the most part
they they honestly do very, verywell with it right, they know
you're trying to help probably.
Exactly.
Speaker 1 (15:44):
I hope so at least.
So what are some?
Are there any contraindicationsother than you know some of the
things you just mentioned,which were really mild, but
anything, any patients thatdon't benefit or wouldn't
benefit from it?
Speaker 2 (15:57):
Yep, so the main patient that we can't put in the
chamber is one who's had traumato their chest wall, where they
have what's called pneumothorax, where there's basically a
penetrating wound into the chestwall, Reason being that because
when we undergo thatpressurization and
(16:18):
depressurization to do thetherapy, they can actually get
air trapped in their chest andthat would be bad.
So that's really the mainreason that we would not do a
session for a patient.
The other thing is we want themto be relatively stable.
So for patients that are stillbeing stabilized after
(16:38):
significant injury or trauma, wecan't get to our patients that
are in the chamber immediately.
So if they're, you know,needing significant changes in
medications, other things tohelp them to feel better quickly
, then we wait until they're alittle bit healthier, a little
(16:59):
bit more stable, to do thattreatment.
We are also limited in the sizeof patients.
So our chamber we can fit ahundred pound dog relatively
easily, but that's about ourcutoff for our particular
chamber.
Like I said, there are chambersfor horses.
So if we had a really largebreed dog or sometimes we'll get
(17:21):
calls about goats and sheep andother species that may need to
come into the hyperbaric We'llsend them to the equine chambers
in the area to get theirtherapies.
Speaker 1 (17:33):
I was just thinking, if I have a dog that I take care
of, and he's 175 pounds, and Iwas like, oh no, they'd have.
Speaker 2 (17:38):
this Might not fit in our chamber so well.
Speaker 3 (17:44):
And then what about inner ear?
Because I know some, I've heardof people using it.
For I guess it's kind of atwo-part question.
One do we have to be worriedabout animals that maybe have
chronic ear infections or havesome sort of compromise to their
eardrum or to panic membrane?
Then the second part of thatquestion is what about using it
in cases for deafness that'sacquired?
Speaker 2 (18:05):
Yeah, yeah, so in people they can more easily tell
us if they have increasedpressure in their ears and
discomfort from thatpressurization, just like if we
were to get on a plane and ourears in pressure specifically
affecting the ears and thetympanic membranes.
Sometimes we will see dogs thatjust as we're increasing the
(18:37):
pressure above like five toseven PSI so pretty low in that
range where we're trying to getto therapeutic levels that
they'll yawn or shake theirheads, but once we get past that
point they're fine.
So, as best as we can tell, wedon't seem to have concerns
about discomfort and increasingpressure.
(18:57):
That being said, we alwaysmonitor our patients throughout
the sessions and especially forpatients that may have deep ear
disease or chronic ear disease,if we see signs of discomfort we
may choose to do a lowerpressure treatment for them, or
that may just be a treatmentthat's not most appropriate for
them and we might have to thinkof other things that we can do
(19:18):
for them.
As far as acquired deafness, Iguess it kind of depends on what
the actual cause is.
If there is inflammation withinthe inner ear, again maybe it
could be helpful for that.
Sometimes we see deafness moreas part of that cognitive
decline in our aging patients.
So again, perhaps thatincreased oxygenation to the
(19:41):
brain could help to either slow,potentially reverse those signs
, but it's something that, I'dsay we don't know for sure.
Speaker 1 (19:57):
So why do we think that it hasn't quite made its
hyperbaric oxygen chambertherapy, hasn't quite made its
way into more veterinary offices?
Why is it still somethingthat's kind of on the outskirts,
Even though it's been likealmost 20 years?
Speaker 2 (20:07):
you're saying, yeah, yeah, that's a great question.
I think it is something that isstill not well known.
Yeah, so we don't have a lot ofresearch about it and it is a
pretty big investment for aclinic to obtain.
It does require a dedicated,trained person to run the
(20:29):
chamber.
So I think a lot of it is justlack of knowledge and lack of
awareness and, um, lack ofunderstanding of what all it can
be used for.
So I think, um, one of the goalsthat we have at university of
florida is encouraging peoplethat are using these chambers to
(20:49):
participate in collaborativeresearch, to to, you know, share
what they're treating, whatthey're using their chambers for
, even if it's just, as you know, little write-ups on patient
successes, case reports.
And in the meantime, we'reworking on bigger projects where
we can maybe prove that itworks well for a particular
(21:10):
indication, or find out how it'sworking for some disease
process and be able to publishthat in journals and textbooks
and share that with more of theveterinary community from that
aspect.
But, like I said, it is alittle bit of a commitment as
far as the cost of the chambers,the dedicated people that have
(21:32):
to run it.
But I think once the chamber isinstalled and once people
realize all of the differentthings that they can use it for,
then a lot of places that havethem are like why did we wait so
long?
Speaker 3 (21:44):
You have a few more, so I I think even one just in
terms of like treatment protocol, because I myself was surprised
by the number of, and the termthat I heard people using was
dives.
So, like, every session thatthey have is a dive.
Speaker 2 (22:03):
The number of dives and sort of the way that you
organize them in terms of thetiming yeah, yeah, so for
different indications we may dodifferent protocols as far as
the frequency and the totalnumber of sessions, and a lot of
what we're basing this off ofis what they do in human
medicine as well as where wedon't necessarily have human
(22:26):
treatment protocols determined,then we're working off of what's
been determined in researchsettings at this point and
seeing what works for ourpatients and going from there.
So our typical protocol that westart with at University of
Florida is three sessions daily.
So over the course of threedays they receive one session a
(22:46):
day and for a lot of our spinalcord injury patients we start to
see that clinical improvementafter that time and then switch
to other types of therapies forthem.
For wound management we may doa very different protocol.
So for wounds we might do up totwice a day for as many days
(23:09):
until we see significant healingof that wound.
So they're often a much longercourse of treatment and, like I
said, potentially even morefrequent.
Instead of the once a day wemight do it twice a day for them
.
In some places they'll even dothree times a day, separated
each session by about four hoursto make sure that the body has
(23:29):
time to kind of recalibrate,return to normal pressurization,
allow the healing energy tokind of take effect, everything
settles down, and then repeatthat session, like I said, up to
three times a day.
For other indicationsoftentimes we'll kind of work
(23:51):
them down to a maintenance.
So one of the conditions that werelatively commonly treat in
Florida, unfortunately, isoomycete infections, pythium and
lagenidium, which can causepretty significant skin wounds
or intestinal and other internalmasses, and unfortunately
(24:14):
there's not a great definitivetreatment for it.
But what we found is that thehyperbaric sessions can help to
reduce the inflammation that'sassociated with that.
So what we do have done forthose patients is we'll do a
week or two of daily treatmentsand then get them down to three
days a week, two days a week,once a week, just to kind of
(24:37):
maintain that reduction ininflammation associated with
those wounds.
So that's a very specializedcondition that we, like I said,
unfortunately have to see andtreat in Florida.
It may not be as commonelsewhere.
Speaker 1 (24:52):
I know I was like can you say that again?
Speaker 2 (24:56):
So it's an oomycete infection.
It's most similar to a fungus.
Speaker 1 (25:02):
That's what I was thinking in my head.
It has to, yeah.
Speaker 2 (25:05):
Yeah, but the two species of oomycete that we see
are Pythium and Laganidium.
Speaker 1 (25:10):
Wow, that doesn't sound fun, poor guys.
Speaker 2 (25:16):
Not so much, yeah, but those protocols definitely
vary with what clinicalindication that we're treating.
Speaker 3 (25:24):
Are there any really, I guess, like interesting or
unexpected outcomes or caseslike something where you guys
were like, okay, no one's reallydone it for X condition before
and then used it and saw goodresults or kind of any out of
the box cases that you'd like toshare?
Speaker 2 (25:42):
Sure, I wouldn't necessarily say out of the box,
but something that hasn't reallybeen looked at on the human
side, which is where we try andget a lot of our information
before we choose to do it in ourveterinary patients.
We've had pretty good success intreating these patients with
multifocal osteoarthritis.
They've already been receiving aslew of other therapies through
(26:05):
rehabilitation oral analgesicmedications, supplements, oral
analgesic medications,supplements and they still have
been having significant mobilitydysfunction, significant pain
and kind of as a last-ditcheffort we say, well, let's see
what hyperbaric can do.
And we've had pretty goodoutcomes with them feeling a lot
(26:25):
better, having more energy andosteoarthritis as well as
lumbosacral disease.
So those were two kind ofsurprising indications that,
like I said, we just haven't hadany information on the human
side really and we have so manyof these patients on the
veterinary side that we'retreating on a daily basis that
(26:48):
again it was a little bitsurprising that they hadn't
responded as well as we wouldhave thought to other rehab
modalities that we do and yetadding in the hyperbaric for
them really made a hugedifference.
Some other fun cases that I'vehad the opportunity to treat we
did have a number of exoticwildlife species that we've
(27:09):
worked with our zoo medicineservice to help out.
So eagles, hawks, owls, thoseare always just fun because it's
a little bit different than thedogs and cats.
And then we had a seahorse onetime, which was pretty cool too.
Speaker 1 (27:25):
So we had a seahorse that had gas bubble disease.
Speaker 2 (27:29):
So basically the seahorse had the bends he went
too far down with.
Um, it's just, it's somethingthat they can develop, that they
they normally should have someamount of gas bubbles that
change in size as they change inpressure for their swimming.
But he was just a pet seahorsethat that couldn't regulate
(27:49):
those gas bubbles.
We were able to do hyperbaricto help him out, poor guy.
Speaker 1 (27:56):
I'm sure he was very grateful.
Speaker 3 (27:59):
For the arthritis cases, if there are people
because I know that there's alot of people that end up, like
you mentioned, using so manydifferent modalities, so many
different supplements, and thenwhen they do get to a point
where they're refractory to thattreatment, what kind of
protocol does that look like?
Like are you seeingimprovements after just one or
two sessions, or do they need tobe on more of a long term
maintenance?
Speaker 2 (28:21):
So typically we do expect to see some benefit after
even one to two sessions forthe patients that will benefit
from that therapy.
So for our osteoarthritispatients we were doing it one to
two times a week initially andif they showed a benefit, then
doing it on a kind of as neededfrequency.
(28:41):
So for some patients that mightbe weekly.
For other patients we might beable to get them down to every
other week.
If they're not needing it everyother week, if they're doing
well in between longer than that, then it's probably something
that they had a flare up.
We've now gotten them back to amore stable point and they
don't necessarily need itongoing, but we can always use
(29:03):
it if they have another flare upagain.
Speaker 1 (29:04):
It'd be helpful for my dog.
He's got osteoarthritis forsure.
Yeah, yeah.
Speaker 3 (29:11):
And then the other thing that I thought was really
interesting is how hungry,because I've had two patients
that have undergone Ceres andthey are starving after
treatment and they had warned meabout that.
But can you talk a little bitabout like the underlying reason
?
Speaker 2 (29:30):
for that, but can you talk a little bit about, like,
the underlying reason for that?
Yeah, that's interesting.
I can't say I've seen that asmuch and that may be because we
tend to have our patients thatare hospitalized.
They're on IV fluids, they'regetting fed quite frequently
throughout the day, but my guesswould be that just the increase
(29:50):
in oxygen as well as it is arather humid environment in the
chamber, there's a lot ofairflow in the chamber so that
could cause some increasedthirst as well as increased
hunger, that we're justsupercharging their metabolism
and they come out of there readyto eat and drink and they come
out of there ready to eat anddrink.
Speaker 1 (30:17):
Are there any?
So would that be considered aside effect?
I guess?
Speaker 2 (30:19):
that would be.
It's probably a good sideeffect, maybe Not necessarily a
bad thing.
Yeah, exactly.
So if we had a patient that was, you know, in the hospital
recovering and they often don'thave the best appetites because
of surgery, pain, maybe somemedications they're on Certainly
coming out of the chamber andbeing willing to eat would be a
good outcome for those guys yeah.
Speaker 1 (30:38):
We talked about on that same vein.
We talked aboutchondroindications, but did we
talk about side effects?
Are there any side effects?
I would assume not really yeah.
Speaker 2 (30:45):
Yeah, we haven't talked about that yet and there
are a couple of side effects tobe aware of and certainly for
pet owners that are thinkingabout this, they should
definitely talk to theirveterinarian about the potential
risks for their particular pet.
One of the main side effectsthat is really not problematic,
(31:06):
kind of goes back to what wewere talking about with ear
disease, that we can have kindof that barotrauma which can be
ear discomfort.
People will report teeth pain,chest pains.
We really don't recognize thosethings in dogs or cats, aside
from, like I said, maybe theyyawn, they shake their head.
(31:27):
It seems to be short-lived andnot cause them any lasting
discomfort.
The more concerning side effectthat we have that is very
uncommon but we do veryoccasionally see it is oxygen
toxicity.
That oxygen is typically areally good thing but sometimes
(31:48):
too much oxygen can be a badthing and in particular it
causes seizures.
So we cannot predict whichpatients may have a seizure in
the chamber but it does seemlike females specifically, dogs
and older patients may be atgreater risk of it's something
(32:14):
that is really scary to hearabout, to see it happening, but
ultimately it doesn't cause anylong-lasting effects in those
patients, so they are not atrisk for having seizures after
being in the sessions.
We've actually continued to doadditional sessions for patients
(32:34):
that have had a seizure in thechamber and they've never gone
on to have a second seizure.
Patients that already have ahistory of seizure don't seem to
be the ones that have thathappen more often.
So it's scary when it happens,it's scary to think about, but
it happens.
We can't predict who it happensto and we have to kind of
(32:56):
outweigh the potential of thatrisk happening versus the much
greater potential benefit ofhyperbaric oxygen therapy for a
particular patient, a particularindication.
Speaker 1 (33:07):
Right, like with any treatment or any medication
Exactly, exactly.
Dr Lindsay, did you have morequestions?
Speaker 3 (33:17):
I guess my only other question is about the
intervertebral disc disease dogsso I know it's, I'm sure that
acute, like they just had thechange in their health status
and having them, as soon asthey're stabilized, undergo the
therapy is probably mostadvantageous.
But is there any, I guess,information or history on dogs
(33:38):
that have had it maybe for alonger period of time, or, like
dachshunds, that tend to berepeat offenders?
Is there any, I guess, benefitin treating them Like, let's say
, they've been trying othermanagement styles for a while
and not seeing responses, wouldit still be appropriate to
consider going through a seriesof treatments?
Speaker 2 (33:57):
appropriate to consider going through a series
of treatments Based on howhyperbaric works.
Definitely the thought would bethat it's more beneficial to
those patients that have justhad an episode because that
injury has caused ischemia ordecreased oxygen flow through
the spinal cord.
So once we have more of thesechronic injuries it may still be
(34:21):
beneficial to promote healing,but likely it becomes less
beneficial, has less potentialfor true healing as time goes on
.
So definitely ideally catchingthose patients early on after
they've had an injury or, forour recurrent patients, before
(34:43):
re-injury, would be best forthose guys.
In addition to intervertebraldisc disease patients, we'll
also very commonly use it forpatients that have had the
non-compressive typemyelopathies, so the
fibrocartilaginous embolism, fceor spinal stroke and other
(35:04):
similar, where they don't trulyhave disc compression.
For these patients surgeryisn't beneficial to them.
So conservative management,rehabilitation is really the
most beneficial treatment optionand we will often do hyperbaric
for those patients as well,because they're still dealing
with the same reduced oxygendelivery to those tissues and
(35:27):
they need to improve oxygen topromote healing.
So we've found that to be veryhelpful for them as well, again
in that more acute phase of theinjury.
Speaker 3 (35:36):
What about vestibular disease?
Speaker 1 (35:40):
That's a good one.
Speaker 2 (35:41):
So it's going to depend on the underlying cause
of the vestibular disease.
For patients with maybe thosedeep inner ear infections we
kind of already touched on thatearlier that could help with the
inflammation that's associatedwith both the ear disease and
then affecting those nerves.
For patients that have thatidiopathic, that old dog onset
(36:11):
of vestibular disease, we don'tultimately know why that happens
still.
So there's thought that it maybe a component of cognitive
dysfunction, which again we'vetalked about the thought that
increasing oxygen to the brainis probably a very good thing
for those patients.
So certainly could be helpfulfor those guys.
In general, for patients thathave nausea, I do find that they
(36:32):
can have increased nausea inthe pressurization of the
chamber.
So for vestibular patients thatstill have significant rolling
dizziness nausea, I wouldprobably wait until they were
feeling a little bit better, butI do think that that could be
beneficial to them a little bitdown the road in their recovery.
And then, if we're dealing withsomething like a cancer causing
(36:57):
the vestibular event, a lot oftimes that does have something
to do with inflammation.
So again, could hyperbaric behelpful to reduce the
inflammation associated withthat cancer and then reduce
those clinical signs.
It's not going to be curativein that case, but could
definitely be helpful for them.
Speaker 3 (37:16):
I have one more kind of specific question, because I
feel like this is another casewhere a lot of people don't have
the best in terms of optionsfor their patients is the saddle
, thrombus and kitties.
So basically, Charlotte, do youknow about that at all?
I don't.
So there are some cats thatit's oftentimes secondary to
heart disease.
They will have a clot that willget stuck basically in the vein
(37:40):
that feeds their back legs andso they'll go from being fine
one moment to just not beingable to use their back legs at
all and they're extremelypainful and there's not a lot of
treatment options that we oftenhave.
And this can affect I'm notgoing to say any age of cat, but
it could in theory.
It's not just something that wesee in older cats, so it tends
to really take a lot of peopleby surprise when it does happen.
Speaker 2 (38:04):
Yeah.
So the again idea of howhyperbaric oxygen therapy works.
It is something that we dosuspect should be beneficial to
these cats with saddle thrombusthat they are dealing with a
lack of oxygen and blood flow totheir back legs and by
increasing the oxygen deliveryto those tissues we should be
(38:28):
able to help reduce pain,improve that blood flow
restarting in those areas andmaybe help to manage their pain.
Ultimately, those cats areoften kind of limited by our
ability to manage their pain, soit's definitely a tricky
disease process to manage, but Ido think that hyperbaric could
(38:51):
be a beneficial part of theirentire therapeutic treatment
plan, of their entiretherapeutic treatment plan.
I've not seen any studies comeout about it Again.
Unfortunately, there's just nota lot of research specific to
the veterinary side.
So we're always reachingtowards what's being done on the
human side and trying tocorrelate their diseases to ours
(39:11):
, that we see in our patients,and it's something that we've
done a small handful of caseshere at UF, but just not enough
for me to say that it'sdefinitely helpful or definitely
not.
Speaker 3 (39:25):
Got you.
And then, from your perspective, can you compare ozone to
hyperbaric oxygen a little bit,because it seems like medical
ozone therapy, because it seemslike they are almost at least in
the same arena compared to theother treatments that a lot of
us are using in integrativemedicine.
But do you see a place whereyou would use both, or is it
usually more than the other, orjust case selection based?
Speaker 2 (39:50):
Given my training in hyperbaric, I exclusively reach
for that.
I don't use ozone just becauseit's not something that I've
done or am as familiar with, butthe idea between both of them
is similar that we're trying toincrease oxygenation to tissues.
The benefit of hyperbaric oxygentherapy is that pressurization
(40:11):
that we can deliver to theentire patient at one time and
that increase in oxygen deliveryto the entire patient at one
time.
So we are not restricted bybeing able to access a
particular area, access aparticular internal organ.
We can reach that treatment toevery single area of the patient
(40:33):
all at once, which is a littlebit different than ozone.
Therapy is typically moreregional, so that's kind of the
benefit is that we can do awhole body treatment.
So we may be indicating totreat, you know, the small wound
that we can see, but we'reactually benefiting that entire
patient all at once.
And a lot of times, even if wesee something small and focal,
(40:56):
there's systemic changes thatare happening throughout the
entire body in response to whatwe can see.
So by treating the wholepatient we can have a much
greater effect on the particulartreatment or the particular
disease or injury that we'retreating.
Speaker 1 (41:14):
That makes sense.
That makes sense.
Um so, as a pet parent, if I'mlistening to this podcast
episode, how do I and I thinkthat this is a therapy that
might benefit that something'shappening with my pet how would
I seek out and find somebody whodoes this like is there a
resource that we could go to orit's?
Do we just talk to ourveterinarian or our regular old
(41:35):
veterinarian, or how would wefind this modality or this
therapy locally?
Speaker 2 (41:41):
Yep, there's a couple different ways.
For sure, I think definitelytalking to your local
veterinarian is a great place tostart, but the particular
chamber that I use is HVM andyou can go to their website and
they have a list of all of theveterinary hospitals that have
(42:01):
their particular chamber, sothat's a great resource.
There are other chamber brandsout there as well, so a pet
parent can always just Googlesearch hyperbaric oxygen therapy
for dogs, for cats, and thatshould lead them to a resource
that they can find someone localto them.
Like I said, it is definitely agrowing therapy option, so
(42:24):
sometimes it might be a littlebit of a drive away for some
people, but I think candefinitely be a worthwhile
treatment for a lot of differentdisease processes.
Speaker 1 (42:33):
And this is not something that we could do on
our own.
We need to do this with alicensed professional.
Yeah, correct, that is asomething that we could do on
our own.
We need to do this with alicensed professional.
Yeah.
Speaker 2 (42:40):
Correct.
That is a good question,because we do get calls.
People who are familiar withsports athletes or sometimes
human medical professionals willhave in-home hyperbaric oxygen
like the soft-sided versions,and we do not recommend those
for our veterinary patient usesfor a couple of reasons.
(43:04):
One is that they're not beingperformed by a veterinary
professional, so this is atherapy that you should really
leave to your veterinarians, whoknow what they're doing.
Those soft sided chambers couldtheoretically be popped by our
dog's nails or teeth, true, sowe don't want to cause any
injuries from that rapiddepressurization if that were to
(43:26):
happen.
Yeah, and then those soft-sidedin-home chambers are also a
much lower pressure than what wecan do in a hospital setting.
So we really don't know thepotential for therapeutic
benefit of those chambers forclinical use for actual treating
diseases.
So don't recommend those.
(43:46):
They're essentially not medicalgrade yeah.
Got it Right, exactly.
Speaker 1 (43:50):
Got it.
Well, that makes sense, sodon't try this at home.
Well, thank you so much.
Do you have anything that youwant to add?
This was fantastic.
Speaker 2 (43:59):
Yeah, I think.
Speaker 1 (44:00):
Yeah.
Speaker 2 (44:01):
Yeah, no, I think that was great.
Speaker 1 (44:04):
Dr Lindsay, do you have anything that you want to
add?
Speaker 3 (44:06):
No, thank you so much .
I'm really hoping that thiswill open people's eyes because,
at least in our area becauseCharlotte and I are both in Los
Angeles there's two dermatologyclinics that each have a machine
, and so I've known of clientsand patients that have utilized
it.
But going through theexperience myself as a pet
parent was very interesting andthey were incredibly
knowledgeable and made us feelvery safe, and I was so grateful
(44:28):
to have your assistance withthat as well.
So Excellent.
Speaker 1 (44:34):
Yeah, thank you, I appreciate this and I appreciate
you taking the time out of yourday to chat about this with us.
So
Well, thanks for let's get started guys.
Thanks for popping on andchatting about this with us.
Hyperbaric oxygen chambertherapy correct?
Is that the correct name?
Okay, it's something that Iknow very little about and I
think it might sound kind ofwacky to some people off the bat
, but I know that it's been usedin human medicine for quite
(00:23):
some time, that it's been usedin human medicine for quite some
time, and I don't know when itwas introduced in veterinary
medicine, but that's somethingthat you can elaborate on and
I'd love to just jump in andtalk about it and talk about the
ways that it can benefit ourpets, and if you want to
introduce yourself for ourlisteners, that would be great,
Dr Montalbano.
Speaker 2 (00:44):
Yeah, so my name is Christina Montalbano.
I'm a veterinarian at theUniversity of Florida, at their
veterinary teaching hospital,and I have been clinical faculty
there for just over a year nowbut did all of my post-vet
school training down there.
So I've been there for about atotal of six years and at the
University of Florida we've hada hyperbaric oxygen chamber for
(01:06):
just over 10 years now and Ibelieve we still remain to be
the only vet hospital in theacademic or the teaching
hospitals that has a chamber.
But they are becoming morepopular in private practice and
hopefully continuing to grow.
It is still a relatively newertreatment option for veterinary
(01:28):
patients and can be seen both onthe equine and the small animal
side, but probably in the past20 to 30 years really, the
technology's been available butstill pretty hard to come by.
So everyone who has themavailable to them is fortunate
and should definitely takeadvantage of having them.
Speaker 1 (01:50):
So it was introduced to veterinary medicine about 10
years ago, or so you say 10 or20 years ago, 10 to 20 years ago
.
Speaker 2 (01:56):
yep, it's relatively new, I think.
Before then maybe some petswere getting the benefit from
human chambers, but the vet, thevet-specific chambers much,
much more recent.
Speaker 1 (02:07):
Do you know anything about when it was discovered in
general, for even human medicine, and how.
Speaker 2 (02:14):
So it's something that back in the 1800s the
technology was starting to bedeveloped when, through
construction workers mostly thatwere doing deep sea dives to
build bridges, things like that,where they're at low sea level
and under pressurized conditions, that they found, as they
(02:37):
brought them back up to normal,beyond sea level, to ground
level, that they would get thebends, as well as for other
scuba divers.
So they've figured out that bydoing hyperbaric oxygen therapy
treatment for these constructionworkers they could actually
reverse the signs of the bends.
And along the way physicianshad figured out that, hey, we
(03:05):
can use this for otherindications, to provide high
oxygen to different diseaseprocesses, to stimulate healing
or to correct other diseaseconditions.
It's been technology that'sbeen around for a little while,
but really only since, like the1960s, 1980s, has it grown as a
(03:28):
therapy specifically for medicaltreatments beyond something
like the bends.
Speaker 1 (03:34):
For those of us listening who I know I only know
I've only heard of the bendsbecause I have a friend who
scuba dives and it's like theonly time I've ever ever heard
of it.
For those listening, can youjust briefly explain what the
bends are, because I know it'sdefinitely a term used for, like
professional scuba divers?
Yeah, yeah.
Speaker 2 (03:51):
So the bends is a situation where with quick
changes in pressure, the gasbubbles that are naturally in
the body change in size and whenthat happens too quickly, those
gas bubbles can especiallylodge into the vessels and
vasculature and cause majorissues.
(04:11):
So we don't want those changesin pressure to happen too
quickly.
Speaker 1 (04:15):
Yeah, that makes sense.
So how did you discover, howdid you become interested in
hyperbaric oxygen chambertherapy?
Speaker 2 (04:24):
So it's something that we've offered at the
University of Florida since Istarted there, and so that was
how I learned about it.
Was just starting out there andseeing what they were doing
with patients and starting toperform it myself, seeing the
benefits that it can provide fora variety of different patient
indications.
Speaker 1 (04:44):
Great.
So what are some of thosebenefits?
Can we jump into that?
Yeah?
Speaker 2 (04:49):
Absolutely.
So really any condition thatwould benefit from increased
oxygen to tissues.
So we can think about one ofthe most common indications in
people that we'll use verycommonly in our veterinary
species is wound management.
So when we have wounds we havean area of the tissue that does
(05:10):
not have enough oxygen deliverybecause there's typically
disruption of the blood supply.
There may be bacterialcontamination, all of those
different things that canbenefit from having increased
oxygen to the tissues.
The thing about hyperbaricoxygen is that it's not just
increasing the oxygen deliverybut it's also at a pressurized
(05:31):
state which allows us to bringthat oxygen into deep tissues
without actually needing thenormal oxygen carrying component
of blood, which is hemoglobin.
So even without enough bloodcells in that wound, we can get
the oxygen to the tissues, andoxygen is very important to
(05:53):
promote healing.
So wounds is one of the reallycommon things that we'll use it
for.
Another very common indicationthat I use it for in University
of Florida is for spinal cordinjuries, such as our little
dachshunds or French bulldogsthat very commonly get
intervertebral disc herniations.
(06:15):
We can use this therapy to helpimprove oxygenation to the
spinal cord to help them recoverfrom that disc compression that
happens to those spinal nerves.
So we'll very commonly use itafter surgery for them or as
part of conservative managementto help those spinal nerves heal
(06:37):
.
Speaker 1 (06:38):
That's great.
Speaker 2 (06:40):
There's so many other indications that we can use it
for.
There's so many otherindications that we can use it
for I'd say a couple otherreally common ones that we're
using it for patients that haveosteoarthritis, arthritis of
multiple joints.
We find that it's helpful forpain management for them, things
(07:04):
like pancreatitis to helpreduce the inflammation
associated with that.
And then we're starting to lookat it for cognitive dysfunction
, which is similar toAlzheimer's in people.
That's a disease process that'ssimply caused by reduced oxygen
delivery to the brain.
So if we can improve oxygendelivery to the brain in an
aging animal, can we help toslow the progression of those
(07:26):
cognitive signs of decline.
Speaker 1 (07:28):
Wow, would it be helpful in something like in
like an acute, like emergencysituations?
Specifically, I have a.
This is a little off topic, butI have a client that got bitten
by a snake, a rattlesnake,yesterday, so he's in the ER.
They don't I'm sure they don'thave a hyperbaric oxygen chamber
, but I just got back fromvisiting him and I'm just
(07:49):
thinking like how could thisbenefit his healing process in
any which way, and I'm not surethat it can, but curious.
Speaker 2 (07:57):
Yeah, it definitely depends Specific with snake
bites sometimes we have to be alittle cautious that hyperbaric
oxygen therapy can be so good atreducing swelling that we can
actually get something calledre-envenomation syndrome where
there may be pockets of venomthat can then recirculate.
But in general, any even acuteinjury that causes significant
(08:20):
swelling, bruising, pain, we canhelp to very, very quickly
reduce that pain, even from asingle session.
So often we'll, if we have likea swollen limb, we'll measure
how the circumference of thatleg before and after just even
one session, and often we'll seea pretty significant reduction
in that, which is really nice tosee immediate effects of what
(08:44):
we're doing yeah, absolutely, drLindsay, did you have a
question?
Speaker 3 (08:49):
I did so along those lines.
I'm even thinking for patientsthat undergo chemotherapy and
have some of thechemotherapeutic material leave
the vein, because we actuallychatted about someone that is
really into ozone about howhelpful ozone was in a situation
that she had encountered thatwas very similar.
Is that also something thathyperbaric oxygen therapy could
(09:10):
be beneficial with?
Speaker 2 (09:13):
Yeah, absolutely so.
Any extravasation type injuriescan definitely be beneficial.
We had one that we were workingwith not too long ago that
we're trying to be beneficial.
We had one that we were workingwith not too long ago that
we're trying to kind of correctthe extravasation or that
(09:36):
removal of the drug from outsideof the vessel and trying to
reduce the swelling andpotentially the negative effects
of that medication that canoccur to the surrounding tissues
where it's not meant to be.
And then even going along thatsome people do question whether
this is a therapy that we can doto supplement cancer treatment,
Because there's always thethought that if we're increasing
(09:58):
oxygen to cancer cells maybethat would be negative and that
those cells would use the oxygenas energy to grow, which in
cancer is negative.
But a lot of information on thehuman side is finding that
actually the level of oxygenthat's provided, as well as the
again, the increased pressurethat's provided through
(10:20):
hyperbaric oxygen therapy, canactually inhibit tumor cell
growth that's associated incancers.
So it could actually be part ofa complementary treatment
option for different types ofcancers, especially the types of
cancers that may be sensitiveto radiation therapy.
So we'll think about using itin conjunction with radiation
(10:41):
therapy in patients that areundergoing that type of
treatment for their cancers, andthen can we talk?
Speaker 3 (10:47):
oh, go ahead, Charlotte.
No, you go, you go.
I was going to say can we?
Can we talk about what asession looks like?
So, just to preface this, myown dog underwent hyperbaric
oxygen therapy.
She has been dealing, or wasdealing with one-sided nasal
discharge for a year, and that'sactually how I found you.
(11:08):
I was looking for resources forprotocols because it's very
specialized and although there'sat least in Southern California
, I know of two dermatologiststhat have units so they can use
them they outsource for all oftheir protocols.
They don't actually make themthemselves.
So I myself was even surprisedto kind of watch them go through
(11:28):
the process and the kind ofthings that I would not think
are dangerous but in thatsituation you really have to be
very aware of.
So can you chat a little bitabout kind of what that process
is?
Speaker 2 (11:40):
Absolutely so.
For our patients to go into thechamber, there are a couple of
safety checkpoints that we haveto perform in order to make sure
that this is going to be a safesession for them.
(12:03):
So everyone who operates havecollars or leashes.
They can't have toys, foodbowls with them.
And then for our patients thatare hospitalized or immediately
after surgery, we have to makesure to carefully cover any
intravenous catheters, urinarycatheters, any intravenous
(12:27):
catheters, urinary catheters.
We have to put speciale-collars on if they need to
have an e-collar on.
And then we have to be carefulwhat kind of bedding they have.
So we have 100% cotton towelsthat can go in with them.
So, unfortunately, all of theirfluffy bedding and special toys
have to stay out just for thosesessions.
We also have to be carefulabout things like fentanyl or
lidocaine patches, because thechamber can actually increase
(12:48):
the absorption of thosemedications, so those have to be
removed.
And then making sure that theydon't have alcohol on their fur
or ultrasound gel if they'vejust had an ultrasound.
Or for our orthopedic patients,we use nail polish on their
toes to make sure we know whatlimb is getting surgery, so the
nail polish has to be removed.
So lots of little things thatwe have to make sure are checked
(13:11):
before they go into the chamber.
We also make sure our patientsare at a safe body temperature.
They have a significant feveror are hypothermic.
So if they're too cold that wecan see fluctuations in their
temperature from the pressurethat they undergo in the chamber
(13:33):
and we don't want them to havesignificant changes in their
body temperature during thetreatment.
So once we've made all of thosechecks and made sure that
they're safe to be in thechamber made all of those checks
and made sure that they're safeto be in the chamber then we
spray them with water whichhelps to reduce static
electricity in their hair coatwhich is mostly just a comfort
(13:55):
thing, so that they don't feelthat little bit of static
electricity.
Most of our patients toleratethe chamber very well.
Once we've had them all prepped,we load them in, shut the door
and then slowly start thatpressurization process.
So it takes us about 15 minutesto get them up to the pressure
that we're aiming for, which,depending on what we're treating
(14:16):
, we're aiming for a specificpressure, which typically we'll
use about two atmospheresabsolute or 14.7 psi.
For certain conditions we maychoose to go higher or lower
than that, but that's just kindof what's been shown to be most
efficacious, most beneficial fortreating these patients.
(14:38):
Once they're up to thatpressure that we're aiming for,
we keep them at that pressurefor typically between 45 minutes
to one hour and then slowlybring them back down to normal
pressure.
So, just like I was mentioningbefore that we can see the bends
or decompression sickness.
If we change those pressurestoo quickly we can actually
cause the bends in thehyperbaric chamber by having
(15:00):
them go up or down from pressuretoo quickly.
So we want to make sure to doeverything at a nice slow rate
so that we're not causing anyproblems.
So again, most patientstolerate the sessions very well.
They just sleep or we havelittle windows in our chamber
that they can look out and watchus.
Speaker 1 (15:19):
I was going to ask my question like how do they do
they don't panic or anythingwhen they're in there, or
they're just fine, they know fordon't panic or anything when
they're in there, or they'rejust fine, they know, for the
most part.
Speaker 2 (15:27):
Typically they're very good for patients that do
have like confinement anxiety.
If they're not good in a kennel, we may choose to do some light
oral sedation or light IVsedation, but for the most part
they they honestly do very, verywell with it right, they know
you're trying to help probably.
Exactly.
Speaker 1 (15:44):
I hope so at least.
So what are some?
Are there any contraindicationsother than you know some of the
things you just mentioned,which were really mild, but
anything, any patients thatdon't benefit or wouldn't
benefit from it?
Speaker 2 (15:57):
Yep, so the main patient that we can't put in the
chamber is one who's had traumato their chest wall, where they
have what's called pneumothorax, where there's basically a
penetrating wound into the chestwall, Reason being that because
when we undergo thatpressurization and
(16:18):
depressurization to do thetherapy, they can actually get
air trapped in their chest andthat would be bad.
So that's really the mainreason that we would not do a
session for a patient.
The other thing is we want themto be relatively stable.
So for patients that are stillbeing stabilized after
(16:38):
significant injury or trauma, wecan't get to our patients that
are in the chamber immediately.
So if they're, you know,needing significant changes in
medications, other things tohelp them to feel better quickly
, then we wait until they're alittle bit healthier, a little
(16:59):
bit more stable, to do thattreatment.
We are also limited in the sizeof patients.
So our chamber we can fit ahundred pound dog relatively
easily, but that's about ourcutoff for our particular
chamber.
Like I said, there are chambersfor horses.
So if we had a really largebreed dog or sometimes we'll get
(17:21):
calls about goats and sheep andother species that may need to
come into the hyperbaric We'llsend them to the equine chambers
in the area to get theirtherapies.
Speaker 1 (17:33):
I was just thinking, if I have a dog that I take care
of, and he's 175 pounds, and Iwas like, oh no, they'd have.
Speaker 2 (17:38):
this Might not fit in our chamber so well.
Speaker 3 (17:44):
And then what about inner ear?
Because I know some, I've heardof people using it.
For I guess it's kind of atwo-part question.
One do we have to be worriedabout animals that maybe have
chronic ear infections or havesome sort of compromise to their
eardrum or to panic membrane?
Then the second part of thatquestion is what about using it
in cases for deafness that'sacquired?
Speaker 2 (18:05):
Yeah, yeah, so in people they can more easily tell
us if they have increasedpressure in their ears and
discomfort from thatpressurization, just like if we
were to get on a plane and ourears in pressure specifically
affecting the ears and thetympanic membranes.
Sometimes we will see dogs thatjust as we're increasing the
(18:37):
pressure above like five toseven PSI so pretty low in that
range where we're trying to getto therapeutic levels that
they'll yawn or shake theirheads, but once we get past that
point they're fine.
So, as best as we can tell, wedon't seem to have concerns
about discomfort and increasingpressure.
(18:57):
That being said, we alwaysmonitor our patients throughout
the sessions and especially forpatients that may have deep ear
disease or chronic ear disease,if we see signs of discomfort we
may choose to do a lowerpressure treatment for them, or
that may just be a treatmentthat's not most appropriate for
them and we might have to thinkof other things that we can do
(19:18):
for them.
As far as acquired deafness, Iguess it kind of depends on what
the actual cause is.
If there is inflammation withinthe inner ear, again maybe it
could be helpful for that.
Sometimes we see deafness moreas part of that cognitive
decline in our aging patients.
So again, perhaps thatincreased oxygenation to the
(19:41):
brain could help to either slow,potentially reverse those signs
, but it's something that, I'dsay we don't know for sure.
Speaker 1 (19:57):
So why do we think that it hasn't quite made its
hyperbaric oxygen chambertherapy, hasn't quite made its
way into more veterinary offices?
Why is it still somethingthat's kind of on the outskirts,
Even though it's been likealmost 20 years?
Speaker 2 (20:07):
you're saying, yeah, yeah, that's a great question.
I think it is something that isstill not well known.
Yeah, so we don't have a lot ofresearch about it and it is a
pretty big investment for aclinic to obtain.
It does require a dedicated,trained person to run the
(20:29):
chamber.
So I think a lot of it is justlack of knowledge and lack of
awareness and, um, lack ofunderstanding of what all it can
be used for.
So I think, um, one of the goalsthat we have at university of
florida is encouraging peoplethat are using these chambers to
(20:49):
participate in collaborativeresearch, to to, you know, share
what they're treating, whatthey're using their chambers for
, even if it's just, as you know, little write-ups on patient
successes, case reports.
And in the meantime, we'reworking on bigger projects where
we can maybe prove that itworks well for a particular
(21:10):
indication, or find out how it'sworking for some disease
process and be able to publishthat in journals and textbooks
and share that with more of theveterinary community from that
aspect.
But, like I said, it is alittle bit of a commitment as
far as the cost of the chambers,the dedicated people that have
(21:32):
to run it.
But I think once the chamber isinstalled and once people
realize all of the differentthings that they can use it for,
then a lot of places that havethem are like why did we wait so
long?
Speaker 3 (21:44):
You have a few more, so I I think even one just in
terms of like treatment protocol, because I myself was surprised
by the number of, and the termthat I heard people using was
dives.
So, like, every session thatthey have is a dive.
Speaker 2 (22:03):
The number of dives and sort of the way that you
organize them in terms of thetiming yeah, yeah, so for
different indications we may dodifferent protocols as far as
the frequency and the totalnumber of sessions, and a lot of
what we're basing this off ofis what they do in human
medicine as well as where wedon't necessarily have human
(22:26):
treatment protocols determined,then we're working off of what's
been determined in researchsettings at this point and
seeing what works for ourpatients and going from there.
So our typical protocol that westart with at University of
Florida is three sessions daily.
So over the course of threedays they receive one session a
(22:46):
day and for a lot of our spinalcord injury patients we start to
see that clinical improvementafter that time and then switch
to other types of therapies forthem.
For wound management we may doa very different protocol.
So for wounds we might do up totwice a day for as many days
(23:09):
until we see significant healingof that wound.
So they're often a much longercourse of treatment and, like I
said, potentially even morefrequent.
Instead of the once a day wemight do it twice a day for them
.
In some places they'll even dothree times a day, separated
each session by about four hoursto make sure that the body has
(23:29):
time to kind of recalibrate,return to normal pressurization,
allow the healing energy tokind of take effect, everything
settles down, and then repeatthat session, like I said, up to
three times a day.
For other indicationsoftentimes we'll kind of work
(23:51):
them down to a maintenance.
So one of the conditions that werelatively commonly treat in
Florida, unfortunately, isoomycete infections, pythium and
lagenidium, which can causepretty significant skin wounds
or intestinal and other internalmasses, and unfortunately
(24:14):
there's not a great definitivetreatment for it.
But what we found is that thehyperbaric sessions can help to
reduce the inflammation that'sassociated with that.
So what we do have done forthose patients is we'll do a
week or two of daily treatmentsand then get them down to three
days a week, two days a week,once a week, just to kind of
(24:37):
maintain that reduction ininflammation associated with
those wounds.
So that's a very specializedcondition that we, like I said,
unfortunately have to see andtreat in Florida.
It may not be as commonelsewhere.
Speaker 1 (24:52):
I know I was like can you say that again?
Speaker 2 (24:56):
So it's an oomycete infection.
It's most similar to a fungus.
Speaker 1 (25:02):
That's what I was thinking in my head.
It has to, yeah.
Speaker 2 (25:05):
Yeah, but the two species of oomycete that we see
are Pythium and Laganidium.
Speaker 1 (25:10):
Wow, that doesn't sound fun, poor guys.
Speaker 2 (25:16):
Not so much, yeah, but those protocols definitely
vary with what clinicalindication that we're treating.
Speaker 3 (25:24):
Are there any really, I guess, like interesting or
unexpected outcomes or caseslike something where you guys
were like, okay, no one's reallydone it for X condition before
and then used it and saw goodresults or kind of any out of
the box cases that you'd like toshare?
Speaker 2 (25:42):
Sure, I wouldn't necessarily say out of the box,
but something that hasn't reallybeen looked at on the human
side, which is where we try andget a lot of our information
before we choose to do it in ourveterinary patients.
We've had pretty good success intreating these patients with
multifocal osteoarthritis.
They've already been receiving aslew of other therapies through
(26:05):
rehabilitation oral analgesicmedications, supplements, oral
analgesic medications,supplements and they still have
been having significant mobilitydysfunction, significant pain
and kind of as a last-ditcheffort we say, well, let's see
what hyperbaric can do.
And we've had pretty goodoutcomes with them feeling a lot
(26:25):
better, having more energy andosteoarthritis as well as
lumbosacral disease.
So those were two kind ofsurprising indications that,
like I said, we just haven't hadany information on the human
side really and we have so manyof these patients on the
veterinary side that we'retreating on a daily basis that
(26:48):
again it was a little bitsurprising that they hadn't
responded as well as we wouldhave thought to other rehab
modalities that we do and yetadding in the hyperbaric for
them really made a hugedifference.
Some other fun cases that I'vehad the opportunity to treat we
did have a number of exoticwildlife species that we've
(27:09):
worked with our zoo medicineservice to help out.
So eagles, hawks, owls, thoseare always just fun because it's
a little bit different than thedogs and cats.
And then we had a seahorse onetime, which was pretty cool too.
Speaker 1 (27:25):
So we had a seahorse that had gas bubble disease.
Speaker 2 (27:29):
So basically the seahorse had the bends he went
too far down with.
Um, it's just, it's somethingthat they can develop, that they
they normally should have someamount of gas bubbles that
change in size as they change inpressure for their swimming.
But he was just a pet seahorsethat that couldn't regulate
(27:49):
those gas bubbles.
We were able to do hyperbaricto help him out, poor guy.
Speaker 1 (27:56):
I'm sure he was very grateful.
Speaker 3 (27:59):
For the arthritis cases, if there are people
because I know that there's alot of people that end up, like
you mentioned, using so manydifferent modalities, so many
different supplements, and thenwhen they do get to a point
where they're refractory to thattreatment, what kind of
protocol does that look like?
Like are you seeingimprovements after just one or
two sessions, or do they need tobe on more of a long term
maintenance?
Speaker 2 (28:21):
So typically we do expect to see some benefit after
even one to two sessions forthe patients that will benefit
from that therapy.
So for our osteoarthritispatients we were doing it one to
two times a week initially andif they showed a benefit, then
doing it on a kind of as neededfrequency.
(28:41):
So for some patients that mightbe weekly.
For other patients we might beable to get them down to every
other week.
If they're not needing it everyother week, if they're doing
well in between longer than that, then it's probably something
that they had a flare up.
We've now gotten them back to amore stable point and they
don't necessarily need itongoing, but we can always use
(29:03):
it if they have another flare upagain.
Speaker 1 (29:04):
It'd be helpful for my dog.
He's got osteoarthritis forsure.
Yeah, yeah.
Speaker 3 (29:11):
And then the other thing that I thought was really
interesting is how hungry,because I've had two patients
that have undergone Ceres andthey are starving after
treatment and they had warned meabout that.
But can you talk a little bitabout like the underlying reason
?
Speaker 2 (29:30):
for that, but can you talk a little bit about, like,
the underlying reason for that?
Yeah, that's interesting.
I can't say I've seen that asmuch and that may be because we
tend to have our patients thatare hospitalized.
They're on IV fluids, they'regetting fed quite frequently
throughout the day, but my guesswould be that just the increase
(29:50):
in oxygen as well as it is arather humid environment in the
chamber, there's a lot ofairflow in the chamber so that
could cause some increasedthirst as well as increased
hunger, that we're justsupercharging their metabolism
and they come out of there readyto eat and drink and they come
out of there ready to eat anddrink.
Speaker 1 (30:17):
Are there any?
So would that be considered aside effect?
I guess?
Speaker 2 (30:19):
that would be.
It's probably a good sideeffect, maybe Not necessarily a
bad thing.
Yeah, exactly.
So if we had a patient that was, you know, in the hospital
recovering and they often don'thave the best appetites because
of surgery, pain, maybe somemedications they're on Certainly
coming out of the chamber andbeing willing to eat would be a
good outcome for those guys yeah.
Speaker 1 (30:38):
We talked about on that same vein.
We talked aboutchondroindications, but did we
talk about side effects?
Are there any side effects?
I would assume not really yeah.
Speaker 2 (30:45):
Yeah, we haven't talked about that yet and there
are a couple of side effects tobe aware of and certainly for
pet owners that are thinkingabout this, they should
definitely talk to theirveterinarian about the potential
risks for their particular pet.
One of the main side effectsthat is really not problematic,
(31:06):
kind of goes back to what wewere talking about with ear
disease, that we can have kindof that barotrauma which can be
ear discomfort.
People will report teeth pain,chest pains.
We really don't recognize thosethings in dogs or cats, aside
from, like I said, maybe theyyawn, they shake their head.
(31:27):
It seems to be short-lived andnot cause them any lasting
discomfort.
The more concerning side effectthat we have that is very
uncommon but we do veryoccasionally see it is oxygen
toxicity.
That oxygen is typically areally good thing but sometimes
(31:48):
too much oxygen can be a badthing and in particular it
causes seizures.
So we cannot predict whichpatients may have a seizure in
the chamber but it does seemlike females specifically, dogs
and older patients may be atgreater risk of it's something
(32:14):
that is really scary to hearabout, to see it happening, but
ultimately it doesn't cause anylong-lasting effects in those
patients, so they are not atrisk for having seizures after
being in the sessions.
We've actually continued to doadditional sessions for patients
(32:34):
that have had a seizure in thechamber and they've never gone
on to have a second seizure.
Patients that already have ahistory of seizure don't seem to
be the ones that have thathappen more often.
So it's scary when it happens,it's scary to think about, but
it happens.
We can't predict who it happensto and we have to kind of
(32:56):
outweigh the potential of thatrisk happening versus the much
greater potential benefit ofhyperbaric oxygen therapy for a
particular patient, a particularindication.
Speaker 1 (33:07):
Right, like with any treatment or any medication
Exactly, exactly.
Dr Lindsay, did you have morequestions?
Speaker 3 (33:17):
I guess my only other question is about the
intervertebral disc disease dogsso I know it's, I'm sure that
acute, like they just had thechange in their health status
and having them, as soon asthey're stabilized, undergo the
therapy is probably mostadvantageous.
But is there any, I guess,information or history on dogs
(33:38):
that have had it maybe for alonger period of time, or, like
dachshunds, that tend to berepeat offenders?
Is there any, I guess, benefitin treating them Like, let's say
, they've been trying othermanagement styles for a while
and not seeing responses, wouldit still be appropriate to
consider going through a seriesof treatments?
Speaker 2 (33:57):
appropriate to consider going through a series
of treatments Based on howhyperbaric works.
Definitely the thought would bethat it's more beneficial to
those patients that have justhad an episode because that
injury has caused ischemia ordecreased oxygen flow through
the spinal cord.
So once we have more of thesechronic injuries it may still be
(34:21):
beneficial to promote healing,but likely it becomes less
beneficial, has less potentialfor true healing as time goes on
.
So definitely ideally catchingthose patients early on after
they've had an injury or, forour recurrent patients, before
(34:43):
re-injury, would be best forthose guys.
In addition to intervertebraldisc disease patients, we'll
also very commonly use it forpatients that have had the
non-compressive typemyelopathies, so the
fibrocartilaginous embolism, fceor spinal stroke and other
(35:04):
similar, where they don't trulyhave disc compression.
For these patients surgeryisn't beneficial to them.
So conservative management,rehabilitation is really the
most beneficial treatment optionand we will often do hyperbaric
for those patients as well,because they're still dealing
with the same reduced oxygendelivery to those tissues and
(35:27):
they need to improve oxygen topromote healing.
So we've found that to be veryhelpful for them as well, again
in that more acute phase of theinjury.
Speaker 3 (35:36):
What about vestibular disease?
Speaker 1 (35:40):
That's a good one.
Speaker 2 (35:41):
So it's going to depend on the underlying cause
of the vestibular disease.
For patients with maybe thosedeep inner ear infections we
kind of already touched on thatearlier that could help with the
inflammation that's associatedwith both the ear disease and
then affecting those nerves.
For patients that have thatidiopathic, that old dog onset
(36:11):
of vestibular disease, we don'tultimately know why that happens
still.
So there's thought that it maybe a component of cognitive
dysfunction, which again we'vetalked about the thought that
increasing oxygen to the brainis probably a very good thing
for those patients.
So certainly could be helpfulfor those guys.
In general, for patients thathave nausea, I do find that they
(36:32):
can have increased nausea inthe pressurization of the
chamber.
So for vestibular patients thatstill have significant rolling
dizziness nausea, I wouldprobably wait until they were
feeling a little bit better, butI do think that that could be
beneficial to them a little bitdown the road in their recovery.
And then, if we're dealing withsomething like a cancer causing
(36:57):
the vestibular event, a lot oftimes that does have something
to do with inflammation.
So again, could hyperbaric behelpful to reduce the
inflammation associated withthat cancer and then reduce
those clinical signs.
It's not going to be curativein that case, but could
definitely be helpful for them.
Speaker 3 (37:16):
I have one more kind of specific question, because I
feel like this is another casewhere a lot of people don't have
the best in terms of optionsfor their patients is the saddle
, thrombus and kitties.
So basically, Charlotte, do youknow about that at all?
I don't.
So there are some cats thatit's oftentimes secondary to
heart disease.
They will have a clot that willget stuck basically in the vein
(37:40):
that feeds their back legs andso they'll go from being fine
one moment to just not beingable to use their back legs at
all and they're extremelypainful and there's not a lot of
treatment options that we oftenhave.
And this can affect I'm notgoing to say any age of cat, but
it could in theory.
It's not just something that wesee in older cats, so it tends
to really take a lot of peopleby surprise when it does happen.
Speaker 2 (38:04):
Yeah.
So the again idea of howhyperbaric oxygen therapy works.
It is something that we dosuspect should be beneficial to
these cats with saddle thrombusthat they are dealing with a
lack of oxygen and blood flow totheir back legs and by
increasing the oxygen deliveryto those tissues we should be
(38:28):
able to help reduce pain,improve that blood flow
restarting in those areas andmaybe help to manage their pain.
Ultimately, those cats areoften kind of limited by our
ability to manage their pain, soit's definitely a tricky
disease process to manage, but Ido think that hyperbaric could
(38:51):
be a beneficial part of theirentire therapeutic treatment
plan, of their entiretherapeutic treatment plan.
I've not seen any studies comeout about it Again.
Unfortunately, there's just nota lot of research specific to
the veterinary side.
So we're always reachingtowards what's being done on the
human side and trying tocorrelate their diseases to ours
(39:11):
, that we see in our patients,and it's something that we've
done a small handful of caseshere at UF, but just not enough
for me to say that it'sdefinitely helpful or definitely
not.
Speaker 3 (39:25):
Got you.
And then, from your perspective, can you compare ozone to
hyperbaric oxygen a little bit,because it seems like medical
ozone therapy, because it seemslike they are almost at least in
the same arena compared to theother treatments that a lot of
us are using in integrativemedicine.
But do you see a place whereyou would use both, or is it
usually more than the other, orjust case selection based?
Speaker 2 (39:50):
Given my training in hyperbaric, I exclusively reach
for that.
I don't use ozone just becauseit's not something that I've
done or am as familiar with, butthe idea between both of them
is similar that we're trying toincrease oxygenation to tissues.
The benefit of hyperbaric oxygentherapy is that pressurization
(40:11):
that we can deliver to theentire patient at one time and
that increase in oxygen deliveryto the entire patient at one
time.
So we are not restricted bybeing able to access a
particular area, access aparticular internal organ.
We can reach that treatment toevery single area of the patient
(40:33):
all at once, which is a littlebit different than ozone.
Therapy is typically moreregional, so that's kind of the
benefit is that we can do awhole body treatment.
So we may be indicating totreat, you know, the small wound
that we can see, but we'reactually benefiting that entire
patient all at once.
And a lot of times, even if wesee something small and focal,
(40:56):
there's systemic changes thatare happening throughout the
entire body in response to whatwe can see.
So by treating the wholepatient we can have a much
greater effect on the particulartreatment or the particular
disease or injury that we'retreating.
Speaker 1 (41:14):
That makes sense.
That makes sense.
Um so, as a pet parent, if I'mlistening to this podcast
episode, how do I and I thinkthat this is a therapy that
might benefit that something'shappening with my pet how would
I seek out and find somebody whodoes this like is there a
resource that we could go to orit's?
Do we just talk to ourveterinarian or our regular old
(41:35):
veterinarian, or how would wefind this modality or this
therapy locally?
Speaker 2 (41:41):
Yep, there's a couple different ways.
For sure, I think definitelytalking to your local
veterinarian is a great place tostart, but the particular
chamber that I use is HVM andyou can go to their website and
they have a list of all of theveterinary hospitals that have
(42:01):
their particular chamber, sothat's a great resource.
There are other chamber brandsout there as well, so a pet
parent can always just Googlesearch hyperbaric oxygen therapy
for dogs, for cats, and thatshould lead them to a resource
that they can find someone localto them.
Like I said, it is definitely agrowing therapy option, so
(42:24):
sometimes it might be a littlebit of a drive away for some
people, but I think candefinitely be a worthwhile
treatment for a lot of differentdisease processes.
Speaker 1 (42:33):
And this is not something that we could do on
our own.
We need to do this with alicensed professional.
Yeah, correct, that is asomething that we could do on
our own.
We need to do this with alicensed professional.
Yeah.
Speaker 2 (42:40):
Correct.
That is a good question,because we do get calls.
People who are familiar withsports athletes or sometimes
human medical professionals willhave in-home hyperbaric oxygen
like the soft-sided versions,and we do not recommend those
for our veterinary patient usesfor a couple of reasons.
(43:04):
One is that they're not beingperformed by a veterinary
professional, so this is atherapy that you should really
leave to your veterinarians, whoknow what they're doing.
Those soft sided chambers couldtheoretically be popped by our
dog's nails or teeth, true, sowe don't want to cause any
injuries from that rapiddepressurization if that were to
(43:26):
happen.
Yeah, and then those soft-sidedin-home chambers are also a
much lower pressure than what wecan do in a hospital setting.
So we really don't know thepotential for therapeutic
benefit of those chambers forclinical use for actual treating
diseases.
So don't recommend those.
(43:46):
They're essentially not medicalgrade yeah.
Got it Right, exactly.
Speaker 1 (43:50):
Got it.
Well, that makes sense, sodon't try this at home.
Well, thank you so much.
Do you have anything that youwant to add?
This was fantastic.
Speaker 2 (43:59):
Yeah, I think.
Speaker 1 (44:00):
Yeah.
Speaker 2 (44:01):
Yeah, no, I think that was great.
Speaker 1 (44:04):
Dr Lindsay, do you have anything that you want to
add?
Speaker 3 (44:06):
No, thank you so much .
I'm really hoping that thiswill open people's eyes because,
at least in our area becauseCharlotte and I are both in Los
Angeles there's two dermatologyclinics that each have a machine
, and so I've known of clientsand patients that have utilized
it.
But going through theexperience myself as a pet
parent was very interesting andthey were incredibly
knowledgeable and made us feelvery safe, and I was so grateful
(44:28):
to have your assistance withthat as well.
So Excellent.
Speaker 1 (44:34):
Yeah, thank you, I appreciate this and I appreciate
you taking the time out of yourday to chat about this with us.
So
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!