Hyperbaric Medicine Revolution: Long COVID Relief & PTSD Discoveries | Dr. Amir Hadanny

With hyperbaric medicine, you're able to wake neurons up. Those neurons that have low metabolism, low mitochondrial function, if you do a specific protocol, you're able to wake it up, you are able to increase metabolism, you're able to increase mitochondrial function. But not only that, you're able to create more mitochondria. We call that mitochondrial biogenesis. Each mitochondria splits up into 2 mitochondrias.

Well, hello everyone. I'm Dr. David Perlmutter. Welcome again to The Empowered Neurologist. Obviously, I'm not in the studio right now, but I wanted to just introduce this very exciting podcast and interview with Dr. Amir Hadanny. Dr. Hadanny is a Harvard-trained physician who now specializes in the use of a technique called hyperbaric oxygen therapy. We'll learn all about what that means, what is hyperbaric oxygen therapy, and also do a deep dive into his research showing how effective hyperbarics is with respect to things like cognitive impairment and even as it relates to long COVID, which has certainly become a very big issue in our post-COVID world. So, we're going to jump right into the podcast and I think you're going to find this very interesting. Well, Dr. Hadanny, it's nice to see you again. I sure enjoyed my visit there at the Aviv Clinic. How are things going?

It's amazing. Thanks for having me again. We became the largest state-of-the-art center for neurorehabilitation involving hyperbaric medicine. And, the amount of patients and clients that we see here with so diverse conditions that we are able to help and bring their life back is just amazing. And, I would love to thank you. I love it.

We never thought back in the day that neurological injuries of whatever sort, be they infectious, trauma, stroke-related, even cognitive decline, we never thought people would get a second chance. And, it seems like that's what you're providing and that's what you're demonstrating.

Exactly. And, I'm probably the most skeptical guy you'll meet. And, that's exactly me 17 years ago saying being in a neurosurgery residency and seeing all the different injuries and saying, all right, this is how they end up. And then, getting involved in research with hyperbaric medicine with Professor Shai Efrati, really rocked my world. And the significant results we are able to show, show the world, but more importantly, show our patients that they can get second chances, is just outstanding.

Yeah. And in fact, I saw Dr. Frati on the 60 Minutes program just last week talking about your outstanding results with PTSD. So that got a lot of national attention.

Wow. That is an outstanding, a revolutionary study that was just completed in the Sagol Center together, Professor Shaffati, Dr. Karen Duranias. Unbelievable results. This is the first sham-controlled study on chronic PTSD patients that was able to see True healing of brain tissue side by side with actual symptoms relief. And, you know, the results speak to themselves, you know, both on short-term and long-term follow-up. These veterans, combat veterans that really changed their lives by doing the program and the study with hyperbaric medicine.

Well, we're going to be talking about post-COVID, long COVID rather, PTSD, cognitive decline, and And, you know, the many things that you treat. But let's first spend some time visiting the clinic. Talk us through what's it like when we first arrive in the clinic and what do we see? And then maybe we'll move into the actual chamber and some of the therapy areas as well. What would an experience be at the Aviv Clinic?

So this is a very unique place. As you can see here, you enter in, You're basically the hopes of you feeling at home. And I think the first thing you'll see is amazing people. The staff here is just so welcoming and so beautiful to talk to and always accommodating. You're entering the lobby, you're being greeted, and, you know, you can have a seat there and wait for our clinicians to come and pick you up for the meetings. Once you enter there, you're entering the clinical area. You can end up in the vital signs that we always check for the vitals, temperature, heart rate, blood pressure, glucose, etc., that because safety is really critical for us. So every day we're checking vitals. You can have a meeting with a physician. Always we're doing assessment. There are different assessment location imaging, cognitive and physical assessments, as well as cognitive and physical training. We're doing through the process. And obviously, the holy grail is when we enter into the hyperbaric chambers. We call those suites. As you can see here, these are suites. Each of them have 14 seats for clients. Each has their own comfortable sofa that they sit in. Each has their own tablet. Their own tablet. Able to do cognitive training inside, which is pretty revolutionary. And we have a patent on that. And also, if you notice, this is a multi-place chamber, meaning exactly as I said, 14 patients are being treated together. But also there's a place for a nurse or an attendant that's inside the chamber that's always there Together with the clients. And as you can see, this is a very comfortable experience. The moment that the doors are shut, we're pretty much like in an airplane, in the business class of an airplane. Each patient has their own comfortable area. They're sitting, they're hitting the right pressure that we want them to be at. And then each of them get their own mask. And they're breathing 100% pure oxygen while working on the tablet for cognitive training. And, it's pretty immersive experience, comfortable for all.

So, you decided you were going to use this technology for long COVID. And, what I'd like to do first of all before we get to the real nuts and bolts of why you did that and then your study and what your outcome was, Why long COVID? I mean, tell us what's going on with that. I think many people may not really appreciate how big of an issue this is globally. So what's going on with long COVID?

So originally, we didn't know what is long COVID, right? When we think about when we first started it, we're talking about 4 years ago, we're in the middle of the pandemics, people were getting acute COVID, and all of a sudden, people are starting to have long-term sequelae. of this condition. Cognitive decline, physical decline, other symptoms, and people are just a wreck. And they were coming to us looking for answers, and we were pretty much overwhelmed by the enormous number of people who have suffered acute COVID, like most of the general population worldwide, And they're looking for answers. Now, what now? I mean, we passed the acute phase, but we're still suffering. And we didn't know what it is back then, but we said this is pretty much similar to chronic brain injury that we know from other indications. So we said, let's investigate this. Let's do some brain imaging like we do for other indications, such as traumatic brain injury, such as stroke that we know so much about. And we were starting to see brain injuries. We were starting to see that patients who are suffering chronic sequelae from COVID actually has areas in their brain that are affected metabolically, meaning they do not work as they should. So all of a sudden we were talking about, okay, we have a new version of brain injury that we actually knew about a little bit from other viruses. COVID is another virus that we— came to learn a bit more this time. But we understood that we're talking about a chronic brain injury and we asked ourselves, can we actually help that with our protocol? And that led to a randomized controlled study that we have deployed.

Before we get into the study, I have to say that, you know, so often I am approached by various groups with various types of technology with anecdote that, oh, this is a great idea for treating a specific problem. But in your situation, you immediately said, wait, we're gonna do the randomized controlled trial, uh, in a way that it can be published in a peer-reviewed journal to make sure that what we're doing is validated in terms of our results. And I want to also go back to something you said a moment ago, and that is you noticed areas of the brain that were hypometabolic, where the metabolism had been changed. In other words, the cells were still— the neurons were still alive, but they weren't really up to snuff. They were suffering, let's just say, from long COVID. But, you know, we see similar findings in the Alzheimer's brain, diffuse hypometabolism, but also in Alzheimer's-specific areas, the temporal-parietal regions as well, where the cells are still alive, but they're just not able to utilize fuel appropriately. And then, so, Why hyperbarics? I mean, why would you think hyperbarics? I mean, we're talking about mitochondria and the utilization of primarily glucose that ends up donating these electrons in the process of making energy to oxygen. So it makes a lot of sense. So then you constructed this trial, and I think 90, it was 90 individuals who participated. And let's walk through that, how it was designed, What you measured, and then we'll get to the results.

Perfect. So, again, just to touch on the last point. So, exactly like you said, we learned in the past 16, 17 years that if you do a specific protocol with hyperbaric medicine, you're able to wake neurons up. Those neurons that have low metabolism, low mitochondrial function, If you do a specific protocol, you're able to wake it up, you are able to increase metabolism, you're able to increase mitochondrial function. But not only that, you're able to create more mitochondria. We call that mitochondrial biogenesis. Each mitochondria splits up into 2 mitochondrias. So we're ending up with even more mitochondria per neuron. So we're able to increase metabolism in the neurons. Wow.

That's very powerful right there. I mean, because, you know, our audience is certainly well aware of the notion of mitophagy, getting rid of defective mitochondria, and then mitochondrial biogenesis through fasting, ketogenic diet, exercise, perhaps even various supplements and even medications are known to stimulate mitochondrial biogenesis. be effective in that regard. But, it seems to me giving them what they need to become more functional is key. And, in this case, it's oxygen. These are neurons that are functional but not functioning.

Exactly. So, the goal if we want to go into this, so we're giving oxygen but we're giving oxygen in a very, very specific way. We're giving oxygen with fluctuations. So, every time The level of oxygen goes up to 100% and then goes down. We're doing it under pressure, so we're— very supersaturated way of oxygen hitting the mitochondria. So every time we go very high and then back to, let's call it normal, that different shift from very high to normal, very high to normal, we call oxygen fluctuation. The mitochondrial sensor— there are different molecules there— The mitochondria that sense the level of oxygen are actually interpreting this as relative hypoxia. The moment— even though we're never in the hypoxic field, it's always either normal or supersaturated oxygen.

So the mitochondria then are able to determine, to sense the shift from one level of oxygen, whatever it is, to a lower level of oxygen by virtue of the fact that you're manipulating the FiO2, the blood gas. The concentration of the oxygen in the face mask.

Exactly. So what's interesting about it, if you think about it, it's like a HIIT or interval training of the mitochondria. So think about we're going from very high to normal, very high to normal. We're hitting the mitochondria with these exposures to stress by actually waking it up, increasing its metabolism, and also helping it actually to split up and do biogenesis. So it's a HIIT training for the mitochondria.

Wow. So this is mitochondrial therapy at its finest. So I guess we could talk about the hypoxia-inducible factor that's amplified and activated rather, and what that does to mitochondria, what that does to blood supply. But suffice it to say that we're stressing the mitochondria and they are respond— like lifting weights. You stress your muscles and they come back better, build back better. So, same thing here, mitochondria, and we're building better mitochondria. That would seem to be the right thing to do in people who have an acquired problem with their mitochondria that we now call long COVID.

Exactly, exactly. And again, we have shown that in actual live microscopes. Okay. So, we were able in a different study we did on athletes, which we We took their muscles, we actually took and looked at the mitochondrial function and that mitochondrial biogenesis. We were able to show that in humans. We're not talking about rats or any models. We're actual humans that have went through the program and went through the protocol, that specific one, show that those events actually occur. It's not just a theory, it's a translational medicine that

So, this is not just a surrogate marker of mitochondrial functionality or genesis. You actually did muscle biopsies and looked at the mitochondria.

Exactly, exactly. It's really, really important to say that because a lot of different drugs, different interventions are talking about this hypothesis, and they're doing it with mice or models of cells and show that. When you take it to the humans models, the actual patient, it doesn't work. We actually did almost the opposite. We started with the final model, us humans, and showed we're able to do that and we're able to change mitochondrial function.

I'll tell you how I'm feeling right now. I sat at a table with you at the clinic, at the Aviv Clinic, and we started talking. And it was just... So fascinating. And I'm feeling that same way now. This— it's just— it's— yeah, I hate to say breathtaking. That doesn't sound good in a hyperbaric chamber. But nonetheless, so now we go to your study, which involved 90 people who have documented long COVID, fulfilled all the approved parameters of continued symptoms 3 months after. And interestingly, some of these patients actually did well after their acute COVID, but then started to fail weeks to months after, which is not uncommon, is it?

Correct. There are different types of long COVID. You can never recover, always continue with progressive symptoms, but you can actually recover and then rebound into long COVID. There are different— there's a spectrum of symptoms, different symptoms for different patients. And different appearances. So definitely each patient is their own kind of syndrome. That's why we call it long COVID syndrome or post-COVID syndrome because it's a bag of different symptoms that occur in different times.

So I've characterized it, and I can't say that I own this, but long COVID being an acquired mitochondriopathy. In other words, And induced by this viral agent problem with the mitochondria. And you've demonstrated that when we see defects in metabolism on these PET scans, we are seeing metabolism, that's mitochondrial function. So you're seeing the visual representation of defective metabolism, meaning that it's a mitochondrial issue. Exactly. So these people, you— I think there were 90 people, they got 40 sessions for 90 minutes each. Over what period of time were these sessions administered?

For 2 hours. And—

No, but over what length, how many weeks, months did it take to get the 40 sessions in?

8 weeks.

8 weeks.

Correct.

And, you looked at a variety of parameters. What were the things that you were looking at pre and post?

Great. So, obviously, first thing we wanted to make sure this is long COVID, they had to come with a very strict inclusion criteria like you mentioned. They had to have a documented COVID that a certain period of time must have gone through. They had to have cognitive dysfunction that was measured. And then on our assessments, we evaluated cognitive function with a very objective battery during— next to a neuropsychologist. We evaluated their physical function using a cardiopulmonary exercise test. We evaluated different quality of life using questionnaires, and we evaluated brain imaging, which included the MRI and the SPECT scan. We did it pre and post.

Well, hi everyone, Dr. David Perlmutter here. We hope you're enjoying this content, and if you would do so, go ahead and hit the like button. And if you're not already a subscriber to our channel, please consider doing so. We're really grateful to have you as part of our community, so let's get And what sort of— now, you evaluated these people acutely and then you did another follow-up study 1 year later on the same population. We did. So let's look— yeah, let's look at the first, what were your acute— well, I hate to use that term, but what were the— in the early group then, what were your findings then? And then we'll see what happened to these people a year later without treatment.

Right. So we're talking about the short-term evaluation. We compared 37 and 36 patients. Now, importantly, the ones that did not get the treatment, they got a sham treatment, which is really, really important to me to hold on and talk about it. So the first group got our protocol with increased atmosphere and oxygen fluctuations. The second group entered the same chamber and the pressure was off and they got regular air. And we tricked them. And that was the whole— What was the trick? That's the goal of this, to trick them to think that they're getting the actual treatment. So we manipulated them to think that they're doing oxygen fluctuations and that they're actually going into higher pressure. There's a whole different science behind how to do it because if they don't think they're getting it, then we're pretty much disabling the placebo effect or the sham effect. So we had to have it. And we evaluated this. We wanted to make sure that both groups— guessed the same if they're getting true or false treatments. And we did, we actually showed that the blinding of the clients or the patients was pretty effective and each group guessed the same percentages what they're getting. So that was—

So here's the group that you compared to then. So here's the group in the final analysis that did not get actual oxygen above room air delivered in their face mask or really any significant pressure, maybe a pressure change so they could feel like their ears were popping, right? Exactly. So, great. And then, now they complete their 40 treatments and you do what kind of assessment on these people?

Exactly. So, what we showed on the short term, we did cognitive evaluation and we showed significant improvement in all cognitive domains. Now, Let me say this. The sham-treated group, the one that didn't get pressure and oxygen, also improved a little bit, and that's the placebo effect that we were expecting to get.

Yeah, can't argue with that. Not going to argue with that.

And the treated group got much, much better cognitively. And that's the biggest thing we're talking about, significant cognitive improvement. And that, you know, goes back to that what everybody's talking about brain fog. That's cognitive dysfunction. And, that's what really improved in these patients. The other thing that we showed is all their questionnaires, quality of life, sleep quality, pain questionnaires, depression, anxiety, emotional symptoms, all that cleared up compared to the sham group, which is really, really important because eventually that's what the patients go back home with and feeling much better quality of life. This is what we all— inspired to. And, the third component would be the brain imaging. And, this is where we saw that we're actually healing brain tissue. We saw it both on the MRI with improved perfusion to those areas of dysfunction, meaning we were able to build new blood vessels and what we call angiogenesis and improve perfusion in those brain areas. But, not only that, we also evaluated with MRI DTI that measures microstructure of the neurons. And we saw that these neurons were actually— had improved connectivity and improved microstructure. In a later publication, we actually evaluated brain function using functional MRI on the same patients. We just published it in a different journal, then showed the connectivity has improved, meaning different brain networks of the brain were behaving much better compared to the long COVID position. That was the short-term evaluation.

Uh-huh. Let me just, if I may, 'cause it's front of mind for me right now, and for all of the viewers who, and there's gotta be a lot of people out there who are either themselves or know somebody that is suffering from long COVID, just not recovering. I mean, it's been estimated this is 4% of the global population right now. It's a lot of people. And what you are hearing is hopeful. It's extremely positive. And, you know, one could question, well, these, you know, the various types of studies that were done in terms of evaluating fatigue or quality of life. And, you know, we consider those to be pretty objective studies, but there is some subjectivity involved perhaps in how those tests are administered, et cetera. And interpreted. But what you just said, you know, there's— you can't argue with these images that you're seeing, the MRI inspect or PET images that you're seeing pre and post. Uh, it, it's mind-blowing. It really is that, you know, you're seeing this graphic manifestation of what you've done to the— to brain metabolism by virtue of this hyperbaric oxygen intervention. So it's really, uh, Quite astounding. I mean, the hope for me is that we offer, or you offer, are offering hope to these people who have, you know, mainstream really isn't— there's nothing much out there for them. I mean, there are symptomatic medications for the anxiety and the sleep issues and for the chronic pain, etc., treating smoke but not treating the actual underlying issue, which is the mitochondrial issue, the metabolic issue, and the perfusion issue that you are absolutely targeting. So now, you take the same group of people, they receive no more treatment, and you say, come back in 1 year, we're going to take a look at you again. What did you find?

Exactly. So, we contacted them over a year after the last session. And, we reached out, we got 31 of the 37 that were able to grasp and get their long-term response. And what we found that all the benefits that they got persisted. So they got the exact same quality of life, sleep quality, pain, emotional symptoms, everything persisted exactly as they did. And that's exactly what we're talking about. We were able to heal the brain tissue and it remained there. It did not go back. It did not deteriorate. the way we heal that area, that dysfunction is now simply cured and they have the same exact benefit. And I think that's the real difference when you look at long COVID treatment out there, that people are trying to target symptoms while we are actually targeting the brain that's dysfunctional. And that's why The different medications, different treatments that go for the symptoms will be very, very short-lasting, and the moment you stop it, it will go back. Well, if you're healing the brain, that's exactly what we showed, it's persistent. And that was the goal in showing that in the long-term study.

So why don't we actually take a look at a SPECT scan that shows what is actually going on in the brain with this type of treatment? Maybe you can walk us through what we're looking at.

Sure. So here we have one of our patients here from Aviv in Central Florida that went through the program for long COVID syndrome. And this patient suffered from significant cognitive decline and significant symptoms for several years before coming into our clinic. So what we see here on the left side, we have her baseline brain SPECT. So this is how we measure metabolism in her brain. And this is looking at her brain From below, think about imaging like this. This is what we see on the left side. And all those blue areas that you see here are significantly decreased metabolism. And we see here in the temporal poles, in the hippocampi, in the orbitofrontal areas bilaterally. And this is a classic image for a long COVID patient. These are cognitive areas. That really correlate with her cognitive function. And this is basically what the COVID the long COVID is all about. These areas of metabolic dysfunction in these areas causing cognitive deficits and significant symptoms. And then on the middle is after 12 weeks of the Aviv protocol is basically all these blue areas are almost gone. We have a tiny, tiny area in her left temporal pole that's left. But this is exactly what we talked about. This is the change in metabolic function. This is healing of those areas. And it's correlated with all her symptoms to remitted. She's completely healed. And we have her— see her a lot here in the clinic coming to visit us and tell us how well she feels. But not only that, on the right side, you see here is the 6-month evaluation. So we repeated her SPECT scan 6 months after she completed it. And what you see here is it's all gone. Even that tiny area in her left temporal pole is completely healed up. And this is a normal brain SPECT. Her brain SPECT has normalized completely, and that correlates with perfect and normal cognitive function for her age and no long COVID syndrome. So this is a really, really good example.

If I'm interpreting this right, then her improvement continued even after hyperbarics was discontinued. She continued to improve as demonstrated by the image.

Correct, correct. So we see it a lot in the several months, mainly the 3 months after the last hyperbaric session, we still see improvements in their symptoms, in their cognitive function. And again, In their brain SPECT. So that tiny bit that was left over healed up completely at the 6-month checkpoint.

You know, I believe we talked about this before, that an area of interest for me has to do with the changes that occur in the microglial cells from M2 supportive nurturing to the M1 phenotype that continues to foster lack of connectivity, synapse degeneration, neuronal degeneration. Increased permeability of the blood-brain barrier, increasing collection of beta amyloid, et cetera. And we know that the big thing that we see changing within these cells when they revert to being the evil twin is they become metabolically shifted, that mitochondrial function has taken a hit, and they begin to utilize another pathway for energy utilization called glycolysis. And that really involving mitochondrial oxygen utilization type treatment, type energy production. So, I'm wondering what your thoughts are on that. Could we be reprogramming the microglia back to the M2 phenotype with hyperbaric oxygen?

That's a really good hypothesis. And, you know, the problem in evaluating humans is we usually do not tend to do brain biopsies and make those measurements. There are a couple of animal studies that have shown microglia changes after hyperbaric interventions. Unfortunately, most of them are very, very short protocols and none of them do the long protocols that we do with oxygen fluctuations. But it's definitely a valid hypothesis that's what's going on there. And more to come for sure.

Yeah, there is actually a tracer that can be utilized that tags activated microglia. And, you know, I guess after the podcast or at some point we should talk about that. It may be a really fascinating study to carry out pre- and post-individuals getting this type of treatment.

Definitely.

I'd like to move on if we could. You mentioned that the change in cognitive function in the long COVID patients was truly remarkable in comparing untreated and sham-treated to the actual hyperbaric-treated individuals. But you've actually published as well studies using hyperbarics just looking at cognitive change in individuals without long COVID. Yes. I think that might have been actually pre-COVID. Correct me if I'm wrong. But what did you— tell us about that study as well because it's really fascinating.

Right. So, after some time dealing with different neurological pathologies like stroke and traumatic brain injury, we asked ourselves what actually happens if we take the aging brain and see what our protocol can do for that. Because obviously, we can call aging not a disease, but we do know that there is a lot of processes with mitochondrial dysfunction, and atherosclerosis that's really changing our cognitive function through just age. So that was the goal of the study. We took healthy volunteers over the age of 64, and we randomized them doing our protocol versus not doing our protocol, and evaluating it for long-term to see what can change both cognitively And physically. And what we discovered in that study, like you said, it was pre-COVID, and we're still publishing data from that study because these participants have went through a very, very comprehensive testing, blood work, cognitive, physical, imaging, the works. So the first result that we published from that is we showed that we are able to enhance cognitive function of normal, healthy aging, which is pretty, pretty impressive when you think about it. There's not a lot of interventions that are able to do that. Looking at different cognitive training, look at cognitive supplements, none of them have reached that level of statistical significance that we have shown. So, it was pretty impressive to see. And what's more important in that trial that we have correlated those cognitive improvements to the actual changes in brain imaging. So, again, we did brain perfusion and brain microstructure with brain MRI DTI, and we saw the correlation between changes in perfusion and microstructure of brain areas and cognitive improvements.

So do you— I guess the statement then is that, you know, this is a manifestation of The change in brain metabolism induced by the oxygen treatment.

Exactly, exactly. So that was the biggest thing that we were able to do, again, the HIIT training to the mitochondria in the brain, improve metabolism, and enhance cognitive function. The second part of it is, hey, if we're able to train mitochondria in the brain, what happens to the body, right? What happened to the physical part? The second publication that came out of that was we're able to increase physical function. And, the best way to measure that is what we call VO2 max or the maximal oxygen consumption measured in a CPET. And, we were able to show that the patients increased their VO2 max significantly. And, that correlated with cardiac perfusion. So, we did cardiac MRI, meaning MRI of the heart measuring— the microvasculature of the heart. And we were able to see that we're increasing, creating angiogenesis in the heart, creating increased perfusion to the heart correlating with increased VO2 max in those healthy individuals.

It's truly exciting. I mean, because our viewers are certainly well aware of the role of metabolism, body-wide metabolism in terms of brain health. That's certainly the focus of what we talk about and all the tools that We engage to keep our metabolism on track by eating a diet that's lower in ultra-processed foods, by exercising and reducing stress, making sure we get enough sleep. But when things have gone a little bit south, how exciting it is to know now there's a therapy that can help get us back on track, that can help right the ship. That's, that's pretty exciting. I'd like to talk about this real exciting news that you've just released. Well, no, actually it was a little while ago about PTSD. I know it was just on 60 Minutes just last week. And let's talk about what that problem represents, who's involved, and then, you know, kind of the failure of traditional approaches to deal with that and how targeting brain metabolism in your hands seems to have really been effective.

Right. So, you know, PTSD is a very, very complex disorder that's involving different populations. And the biggest one that comes to heart and, you know, in the heart of every American or Israeli is definitely veterans that suffered different injuries and different exposures in their army services, different tours. The biggest thing is when you're talking about PTSD in combat veterans, they don't have to be injured in order to have PTSD. Only the stuff they had to do, that they were exposed, that they seen, that emotional exposure in certain brain can create a brain injury. That's the biggest statement that everybody needs to understand. PTSD is not a mental disorder. It's not these guys are crazy or psychiatric patients. No. These exposures have caused actual brain injury and metabolic dysfunction of specific areas in the brain. The more we understand it, the better our people will be. And that's part of the population, obviously. There are other causes for PTSD. For instance, different emotional exposures, people that were— Trauma. sexually abused or physically abused in their childhood or later adults, people that were even in a motor vehicle accident that was so terrifying that they feared for their lives significantly and felt that hopelessness. The moment you feel hopelessness when you're being exposed to a very severe emotional stress, that can lead to that metabolic dysfunction. That's the way that our brain deals with such a terrifying experience, it decreases metabolism to certain areas in order to dissociate that experience, in order to protect you supposedly. But sometimes that process doesn't end well and it causes this disorder that we call PTSD.

So again, this is an induced metabolic shift in the brain. There's been a change in brain metabolism. In an attempt to isolate certain brain parts, but it can feed forward and create a dysfunctional situation. And so, the idea is then you're going to once again target brain metabolism using hyperbaric oxygen.

Right. And, it took us time to understand it. And again, we're going back almost 8, 9 years ago. We were treating traumatic brain injury patients. And, all of a sudden, we saw those, the ones with PTSD. We saw fibromyalgia patients that were sexually abused and we understood that we were talking about PTSD patients. We designed all those trials for these type of patients. And, that led us to head-on to treat PTSD. And, our first study is because we were so unsure that it's a very complex disorder, we talk about mitochondrial dysfunction. But are we really able to treat that? So the first study that was done was not sham-controlled. We did a randomized controlled study and compared combat veterans that suffered from PTSD versus also combat veterans that did not get the treatment. They were passive control. And we showed significant improvement in their PTSD symptoms that correlated with brain function. And again, we did brain perfusion. Brain microstructure and connectivity using functional MRI. After doing that, we felt much more secure heading on to the best randomized controlled trial that we ever done. Again, sham-controlled. So half of the combat veterans received our protocol for 12 weeks, 60 sessions versus a sham control. Unfortunately, those Poor veterans came in for 12 weeks, didn't receive pressure, didn't receive oxygen, received normal air with supposedly fluctuations. And we tricked them. We had to in order for science to show the world that even with the placebo effect, the treated group was so, so much better, so improved, while basically the sham group did not improve at all. The placebo effect almost didn't move them at all. And that difference is so huge and correlated with brain function that really it tells you how strong this intervention can be for PTSD. And again, I won't involve too much politics into this, but based on that study, that study was stopped by— The government. The Israeli Ministry of Defense said, that's enough data for us. You don't need to do any more. We're going to fund every single veteran and every terror attack survivor to get this treatment funded by the government because that's enough data.

Wow. Well, I'm, you know, I'm certain we have an incredibly large population of PTSD individuals here in America as well. One wonders what it would take for it to become a mainstream Medicare or private insurance covered benefit for individuals with that issue or long COVID for that matter or cognitive decline for that matter. So, you know, you're providing though the groundwork here upon which those decisions can now be made based upon looking at really, really good science. So you have a treatment center in Israel and where else are Aviv Treatment Centers?

Aviv Clinics is currently both in Central Florida and in Dubai in Asia. We're dealing with a lot of pathologies and both clinics are very, very busy in evaluating patients and making sure we're able to help those different pathologies that come and seek our help with. It's definitely growing. And again, the biggest thing is everything is backed up with science and those randomized controlled trials that eventually determine if we're able or not able to help a specific patient.

This is as good as it gets. It really is. I mean, again, we often hear about anecdote of this technology or that, but I cannot imagine that there could be more circumspect of an approach Uh, to verifying how effective a therapy is than what you guys have conducted. You checked, uh, every box, dotted every i, crossed every t, and we'll see what the future holds. But I, I think that, you know, you're to be commended for, for the groundwork that you've done, uh, to really ultimately make this something much more accessible. You know, there, as you well know, there are hyperbaric centers all around the country But they're currently only really being utilized, or at least the hospital-based ones, for the 13 Medicare-approved diagnoses like, you know, radiation necrosis, non-healing diabetic wounds, etc., carbon monoxide poisoning. And, you know, clearly, if the utilization of this technology could be expanded into some pretty prevalent issues like we've talked about today, Boy, we could see a lot of improvement in a lot of people.

Definitely. And that's what drives us. That's what drives me. We will not stop. We will continue to provide data and trials again and again and again to show that it is so, so much beneficial. And again, investigate different pathologies, different mechanisms, because this is the future. This is how we should treat mitochondrial dysfunction. And our goal is to back it up again and again and again until it's common for everybody.

Well, great. I want to absolutely thank you for taking time out of your busy day to spend time with us and our viewers. And this information is really just so leading edge and exciting. So, I can't wait till we get together again and hear what's next for you. But this is Very exciting. Thank you, Dr. Hadanny.

Thank you so much. Thanks for having me. It's a pleasure.