Thursday, April 17, 2008

Diabetic Ulcers Heal Faster With Hyperbaric Oxygen

Healing with Hyperbaric Oxygen Therapy

Chronic wounds heal faster with Hyperbarics

Some people develop sores or wounds that just won't heal. This may be due to low oxygen in damaged tissues. HBOT restores the body's ability to heal the wound by increasing oxygen to the area.

HBOT Speeds Up The Healing Process in Smokers
People who smoke do not heal as well as non smokers. HBOT can help smokers undergoing some types of surgeries such as cosmetic surgery heal more normally.

Burn Victims Improve With Hyperbaric Oxygen
HBOT has been used for years to speed up healing in burn victims. It is also beneficial for patients with
smoke inhalation and carbon monoxide poisoning.

Diabetic Ulcers Heal Faster With Hyperbaric Oxygen
Diabetes is a disease that affects the small blood vessels in the tissues which results in wounds or ulcers that may last months to years. These wounds often develop from incidental injuries to the body and may become infected which can spread to the deeper tissues and the bones and may even require amputation. HBOT can help heal these wounds frequently without surgery.

Damaged Tissues from Cancer / Radiation Therapy Improve with Hyperbaric Oxygen
HBOT can restore tissues and cells damaged from chemotherapy and radiation treatments in cancer patients. Head, neck and other cancer treatments that damage the jaw bone may require HBOT to restore the tissues. Side effects of cancer therapy may cause damage to the bladder (hemorrhagic cystitis),
damage to the intestines (radiation enteritis) and other conditions that may be improved by HBOT. Breast cancer patients undergoing reconstruction may need HBOT to allow radiation damaged tissues to heal.

British Medical Journal April 17, 1999
Hyperbaric Oxygen Therapy
(Letter to the Editor)
Author/s: Charlotte Coles

Exposure to hyperbaric oxygen --- Cancer

Exposure to hyperbaric oxygen induces cell cycle perturbation in prostate cancer cells.

Authors: Kalns JE , Piepmeier EH
Davis Hyperbaric Laboratory, Brooks Air Force Base, San Antonio, Texas 78235-5119, USA.
In Vitro Cell Dev Biol Anim 1999 Feb;35(2):98-101

Abstract: Cell cycle synchronization of tumor cells by exposure to hyperbaric oxygenation (HBO) may increase the efficacy of chemotherapy or radiation by placing cells into a chemosensitive portion of the cycle. The purpose of the current study was to examine oxygen pressure-dependent relationships with respect to the cell cycle in prostate tumor cells in vitro. LNCaP cells were grown in an incubator at 21% O2 and then exposed to 100% oxygen at pressures up to 6 atmospheres (atm) for 1.5 h. Cells were then returned to the incubator and evaluated for DNA content by propidium iodide and new DNA synthesis with a pulse-chase experiment. Cell cycle effects were evaluated by flow cytometry. Exposure to HBO increased the percentage of cells synthesizing new DNA in a dose-dependent fashion: 0 atm, 44%; 6 atm, 65%. Cells that synthesize new DNA accumulate in G2/M as a function of partial pressure of oxygen. These results suggest that HBO induces cells to enter the cell cycle and accumulate in G2/M. Cell cycle synchronization and entry of senescent cells into the cell cycle suggest that HBO may be a useful adjuvant to chemotherapy or radiation in the treatment of prostate cancer. There are two potential mechanisms of action that may make HBO efficacious in the treatment of prostate cancer. HBO may potentiate cancer chemotherapeutic agents that cause damage to DNA during DNA synthesis or HBO may inhibit cell division causing accumulation in G2/M.

Does hyperbaric oxygen have a cancer-causing or promoting effect? A review of the pertinent literature [see comments]

Authors: Feldmeier JJ , Heimbach RD , Davolt DA , Brakora MJ , Sheffield PJ , Porter AT
Department of Radiation Oncology, Wayne State University, Detroit, Michigan.
Undersea Hyperb Med; 21(4):467-75 1994

Abstract: We reviewed all known published reports or studies related to a possible cancer-causing or growth-enhancing effect by hyperbaric oxygen. Published articles were retrieved using Medline searches for the period 1960-1993. Additional references were obtained from bibliographies included in those articles discovered in the computer search. Also, hyperbaric medicine text books and the published proceedings of international hyperbaric conferences were visually searched. Studies and reports discovered in this fashion and related to the topic were included in the review. Twenty-four references were found: 12 were clinical reports, 11 were animal studies, and 1 reported both an animal study and a clinical report. Three clinical reports suggested a positive cancer growth enhancement, whereas 10 clinical reports showed no cancer growth enhancement. Two animal studies suggested a positive cancer-enhancing effect, and 10 animal studies showed no such effect. (The report that included both animals and humans is counted in both groups). The vast majority of published reports show no cancer growth enhancement by HBO exposure. Those studies that do show growth enhancement are refuted by larger subsequent studies, are mixed studies, or are highly anecdotal. A review of published information fails to support a cancer-causing or growth-enhancing effect by HBO. (44 Refs) review of the pertinent literature [see comments]

In Philadelphia, researchers at the University of Pennsylvania are laying the groundwork for a series of studies to determine how patients with head and neck tumors benefit from breathing pure oxygen before and after surgery.
The breathing treatment, called hyperbaric oxygen therapy (HBOT), is an unconventional method of treating cancer, though HBOT has been used for decades to treat other conditions such as heart problems, carbon monoxide poisoning, non-healing wounds such as severe burns, and scuba diving-related injuries. Breathing additional oxygen is believed to improve the body's ability to kill germs and heal. HBOT patients breathe pure oxygen, which is twice the atmospheric pressure and administered in either of two ways: The patient lies on a stretcher in a sealed, specially pressurized chamber, or inhales the oxygen from a mask or hood while sitting in a specialized chamber.
"Although scientists have known for years that hyperbaric oxygen can reverse tissue damage, there still are a lot of questions to be answered," said Stephen R. Thom, M.D., Ph.D., the center's principal investigator and a professor of emergency medicine at the University. "Our goals are to try to ascertain, under rigorous methods, the mechanisms of action, safety, and clinical efficacy of hyperbaric oxygen, and to develop and validate a model to say who benefits from this treatment."
The researchers at the new Specialized Center of Research in Hyperbaric Oxygen Therapy want to know "how much of an effect"--including on reversal of body tissue damage and on the growth and spread of tumors--HBOT has on people with head and neck tumors who have had radiation treatments, but need surgery again.
Dr. Thom said that previous studies have shown that HBOT can reverse tissue damage, but did not show by how much. A critical component of the clinical trial is that investigators will measure patient's blood vessels throughout the trial to determine if healthy tissue is growing back. The key question, Dr. Thom noted, is, "Do hyperbaric oxygen treatments have an effect on patient outcomes? We think they do, but the study will tell us for sure."

HBOT & Cancer

The National Cancer Institute issued a consensus statement in 1990 stating that osteoradionecrosis can be prevented but when present is best managed by hyperbaric oxygen (HBO) alone, or with surgery.1 Late radiation tissue injury is a progressive, obliterative endarteritis which results in a hypoxic, hypovascular, hypocellular tissue bed.2 These changes make healing after surgical procedures difficult or impossible. This has led to the development of the "Marx Protocol", which induces neovascularization and healing in these damaged tissues and has been proven clincally effective and cost-effective.
Marx previously reported the 5 year recurrence rate of squamous cell carcinoma in 405 patients followed from 1985-1991.2 Of these patients, 245 received HBO under a protocol for reconstructive surgery, or for mandibular osteoradionecrosis. All were staged using the Joint Commission of Cancer Staging TNM classification system.
Stage Non-HBO Recurred HBO Recurred
I 296 (21%) 36 6 (16%)
II 58 (24%) 94 17 (18%)
III 50 6 (32%) 92 19 (21%)
IV 23 9 (38%) 23 6 (28%)
The results reveal a reduced incidence of recurrence in every stage of squamous cell carcinoma in those who have been exposed to HBO.(Table 1) These differences, though statistically significant, were small, and Marx was quick to point out that while HBO may have a chemoprotective effect, it is also possible that the greater radiation dose was applied to those who required HBO and thus one would anticipate better tumor control.
A recent prospective study followed 46 cancer patients for 3 years who were exposed to a minimum of 30 hours of HBO.3 This study population was compared to a study-group matched for tumor type, age, sex, stage and year of treatment.
Tumor type # Recur. Rate # Recurr. Rate
Gingiva 10 2 10 1
Maxilla 7 3 7 0
Floor of mouth 7 2 7 0
Salivary gland 7 3 7 3
Tonsil 5 1 5 0
Oral tongue 4 1 4 0
Ear cana 3 0 3 0
Thyroid 2 0 2 0
Eye 2 0 2 0
Nose 1 0 1 0
Epipharynx 1 0 1 0

Totals 49 12 (24.5%) 49 4 (8.2%)

Review of this data (Table 2) shows a reduced incidence of cancer recurrence in the HBO group when compared to a matched control group.
Of note is the fact that the matched control group was not statistically different from a larger control group consisting of all 1175 cancer patients treated by the ENT Division of the author's institution, between 1988 and 1992.
Additional review of data indicated that within the HBO-treated group of patients, there were fewer than expected recurrences of maxillary carcinomas, gingival carcinoma, floor of the mouth carcinomas and tongue carcinomas. Only in the recurrence rate of adenoidcystic carcinomas of the salivary glands was there a comparable number between the HBO and non-HBO treated groups.
The preponderance of available literature now suggests that HBO is not cancer causing or cancer promoting.4 Work by both Marx and Granstrom has provided another provocative conflict that requires further clinical research - namely: can HBO be considered chemoprotective against cancer recurrence. Time (and research) will tell.
1.National Cancer Institute: Monograph 1990: No. 9 Consensus Development Conference on Oral Complications of Cancer Therapies: Diagnosis, Prevention and Treatment. US Dept. HHS. National Institute of Health, Washington, D.C.
2.Marx RE:. Radiation Injury to Tissue. In: Hyperbaric Medicine Practice. Kindwall EP, Ed.. Best Publishing Co., Flagstaff (AZ) 1994;23:500-503.
3.Granstrom G: Tumor recurrence and development of new head and neck cancers after HBO treatment, a prospective clinical study. Proceedings: Int. Joint Meeting of Hyperbaric and Underwater Medicine. 1996, Milan:47-60
4.Feldmeier JJ, et al.: Does hyperbaric oxygen have a cancer causing or promoting effect? A review of the pertinent literature. Undersea and Hyperbaric Medicine 1994;21(4):467-475


Discussing patient histories is an essential part of communication and we have more science to support oxygen therapy than any other intervention in medicine. Why increasingthe inspired partial pressure a small amount over what is routinely used should be regarded as snake oil is beyond me and shows the fundamental ignorance of our profession. It is NOT quackery. There is no evidence that cancer is activated by HBO indeed the first post WW 2 use of HBO was as an adjunct to radiotherapy in which high tissue tensions increase the kill rate. There was a trial published from a London medical school about 5 years ago on the value of HBOT in glottic cancer.
Best wishes
Philip James MD

Wolfson Hyperbaric Medicine Unit
University of Dundee