HBOT & Post-Covid (Lesser Known Hyperbaric Oxygen Treatment)

With very good statistical significance. So looking at the statistics themselves to show, because when you get down to 10 people you're trying something on, in order to show an effect, you have to have a pretty good change in, for instance, in this case, their baseline cognitive or fatigue scores versus post-treatment. And so their statistical significance was very good. And The people in the study all improved in all of those, you know, the fatigue and cognitive issues, et cetera. Can hyperbaric oxygen help with long COVID? This is a really interesting question. So I've been involved using and ordering hyperbaric oxygen therapy for patients for a number of years. I also participate in training physicians in the use of hyperbaric oxygen, not in the Dive accident community so much, but in support of other therapies around the chronically ill patient, et cetera. So I have familiarity with the particular modality. Now, if you've never seen hyperbaric or don't know much about it, basically the idea, and this is gonna be a real simplified idea, is that you, the patient, are inside of a chamber, which is a pressurized chamber, can be pressurized. And then after you go in the chamber, chamber, uh, there are valving systems and pumps and all of this that will raise the pressure inside the chamber. Then normally you will be administered some oxygen once you're up to pressure, and that may be, uh, through a mask, it might be through a nasal cannula, and in some cases it might just be pumped into the chamber itself, all of which have different reasons for being done. The oxygen may be on you Continuously, or it might be taken on and off throughout your dive. In the world of hyperbaric oxygen for dive injuries, et cetera, where people are underwater and they have to come up and they're trying to treat the bends, et cetera, there are extremely specific protocols developed by places like the United States Navy, et cetera. And their dive tables are very set with very particular depth Uh, pressures, etc. In the rest of medicine, where hyperbaric oxygen is used more as a synergist for other types of therapy, for example, healing, uh, in diabetic wounds, healing after some surgeries, uh, healing, uh, even now after radiation injuries, etc., the parameters are a little bit less intense than what you see in the Navy dive tables. So that's just a little Now, the other part about hyperbaric oxygen is, well, why are you getting in this chamber or what's it doing with you? Well, what's happening is that you are now in a pressurized system that is a higher pressure than the room around you or the room air around you. And that starts normally at, you are usually around 1 atmosphere. Okay, that's ambient. You get in the chamber and the pump starts to pressurize the chamber up above 1 atmosphere. So hyperbaric oxygen. So, baric activity technically starts anywhere above 1 atmosphere. Now, like I was saying, if you're running Navy dive tables, etc., you may go to many atmospheres and then bring the person back down. But basically, for general medical use, you're going to be in the 1 to 2+ range, okay, 1 to 3, you could say, and sometimes a little bit more depending on the indication. So why would this be something we would consider in long COVID? Well, hyperbaric oxygen, beyond the use of, you know, dive accidents and all of that, and then sort of beyond the use of hospital hyperbaric medicine where, uh, you know, we're working on people who are recovering from surgery or radiation or diabetic issues, etc., if you want to think about hyperbaric medicine as a use, you can think of it As a treatment to help heal a wound, because that's what I just described for the most part of any kind at any location in the body. There is a colleague and mentor of mine, Dr. Paul Harch, in the hyperbaric community who coined that phrase as far as I know, and he's brilliant, and his focus in his practice is 100% hyperbaric medicine. That is the idea. Well, if we're looking at long COVID as a series of Inflammatory injuries that then lead— and again, this is a 16-plus part series on long COVID, so you can go back to some of the earlier parts and look at, uh, we break down, you know, how all these things happen, etc. But if we're looking at it as, uh, a series of injuries that emanate from, you know, an original insult like an infection, and then you get cytokine or chemical changes, then you get inflammatory Response, and then your body takes it from there. So it could be in, you know, hormonal issues, toxic issues, maybe all, all manner of stuff we've talked about. So what you have then is a chemical level, a body-wide potentially chemical level type of injury. And as I mentioned in the neurological section about healing up neurological, uh, issues in long COVID, number one, we use hyperbaric a lot in neurological recovery after long COVID, but also the neurology data talking about the brain in long COVID is essentially saying now that it's the same as a traumatic brain injury. So without hitting your head, you have a traumatic brain injury type of a picture in your brain. Well, one of the things that hyperbaric works very well for is traumatic brain injury. And so if the chemistry and the shifts are the same, it's just, you didn't hit your head, you had COVID or some other insult. And really this relates to all, you know, post-infectious type illness, then what you need to think about is, could hyperbaric be helpful in that setting? Now, one of the things that you are going for with hyperbaric is to get your, the body into the pressurized chamber, and then you have the oxygen. And remember, even room air has oxygen in it, and there's a lot of data shifting around how much oxygen we use and things like that. But the point is that your hemoglobin, which carries your oxygen around, can only saturate to a certain level. So what hyperbaric does is it puts more oxygen into the plasma compartment, which is usually a tiny, tiny little bit of oxygen in the plasma, free oxygen, and it saturates the plasma. So then you not only have your hemoglobin-saturated oxygen going to your cells and your tissues, you now have a saturated plasma with oxygen that can go to the cells and the tissues. The bottom line is that gases like carbon dioxide, oxygen, et cetera, don't have transporters when they get to your cells, they go down their gradient. So if I jack up the gradient inside of the blood and it gets to the cell level, I am naturally gonna deliver more oxygen to the cells. Now, what does that do in the cell? Well, that goes in and it primes the mitochondria, which are your energy-producing parts of your cell, runs oxidative phosphorylation, and then out the other side through cell respiration, you have carbon dioxide as a waste and waste products leave. So one thing that it does is it oxygenates the tissues so that the mitochondria can run, but also it can displace toxins and other metabolic junk that's built up in the cell. Now, in the setting of clinical use of hyperbaric oxygen, you know, outside of the world of dive accidents, what we have found over time is that this is a great process, but it is an It's a 2-part process. There's an oxidative component on the front end where all that oxygen's going in. So that's good at priming your cells and maybe moving some junk out. But if you take and you do that to someone who's really sick and they don't have enough antioxidants to do phase 2, which is to come back and have a rebound effect after the oxidation, then they can get certain types of either oxygen toxicity or sick, et cetera. So. Yeah. What we do in, in more modern times, especially with chronically ill folks like long COVID, et cetera, is we'll give the hyperbaric treatment and then either orally in between hyperbaric treatments or even in, in acute cases and intravenously after the hyperbaric treatment, uh, we'll give nutrients that support glutathione function and all, all the stuff we talked about in the nutrient section. And that, uh, allows 2 things. One is you get more traction with less hyperbaric treatments. And number 2, uh, is you have a much safer treatment protocol over time. So that's kind of the big picture of how it might help. So has anyone— so there are, there's a lot of hyperbaric research around all sorts of topics. Has anyone looked— and it's even— and we did one in the past, we'll link it down in the show notes, to hyperbaric in other situations like COVID and acutely, et cetera. So there's research there, but there's a couple of papers that I reviewed, very recent, obviously, 'cause this is a recent topic. And one was an observational trial. So that means it doesn't have a control arm, but what they did is they did a particular amount of treatment with people who had long COVID, and they were looking at a validated fatigue scale called the Chandler Fatigue Scale. They looked at cognitive function, executive function, attention, information processing, verbal function, you know, all of the brain working or not working well. So here you're thinking about people, you know, with lingering fatigue, People with lingering brain fog, people whose nervous system is just not working right after COVID. And so they took a small group of people, it was 10 patients, and they did 10 sessions of hyperbaric oxygen, pretty standard protocol. They did it in a setting of 12 days. So these were almost daily. Okay. And what I'll tell you about almost daily is if you have like a TBI, traumatic brain injury, other things, the closer together you can do your treatments in the beginning, the better it really is. Sometimes with chronically ill patients, we can't do them that close together, so we'll spread 'em out a little bit. But anyway, they did this, uh, in this particular study, and I'll link it down in the, uh, show notes as well. So if you wanna look at it, uh, and with very good statistical significance. So looking at the statistics themselves to show, because when you get down to 10 people, you're trying something on, enable— in order to show an effect, you have to have a pretty good change in, uh, for instance, in this case, their baseline cognitive or physical fatigue scores versus post-treatment. And so their statistical significance was very good. And the people in the study all improved in all of those, you know, the fatigue and cognitive issues, et cetera. So then, you know, and we hear a lot about this, I talk about it, a lot of other people talk about it much more eloquently, but the so-called gold standard with interventions is to work towards a randomized controlled trial. And that means that you have not only your treatment group, but you have a control group that has, you know, usually the same problem, but you give them a treatment that's like a placebo treatment or something like that. Now, interesting thing with this study, this was just done. It used to be that studies for hyperbaric oxygen would use treatment pressure and then a sham or a placebo pressure. So both Both groups get in the chamber. Otherwise, how, you know, how would you do a placebo with no chamber? So both groups get in the chamber, but what we found over time, and there have been some interesting debate on this in articles, but the old sham pressures turned out to actually have a therapeutic benefit. So you would see that the placebo group, so-called, did almost as good as the treatment group. Well, that was because they were actually getting a treatment. So what's happened over time is they've lowered the placebo pressures. Okay. And what I was very pleasantly surprised to see in this case, and it's again, it's because it's a brand new study, is that their particular sham pressure was appropriate. It was just above 1 atmosphere. So you felt yourself getting pressurized, but you really can't feel beyond that unless you've had a lot of hyperbaric. So the sham group or the placebo group was Now, these guys, 73 patients, so they took and broke them in half. So one gets the placebo-type treatment, one gets the actual hyperbaric treatment. And so it was 36 on one side, 37 on the other side. They got daily hyperbaric to 40 treatments. Now, 40 treatments is traditionally the type of treatment span that we often prescribe in traumatic brain injury, et cetera. So when you're thinking about this, now we have not only a randomization, so we're not cherry-picking, you know, particular patients, we also have a placebo-controlled arm. So we got a control group, and because they're randomized statistically, they're pretty equal on each side. And then they test them for similar things to the other study— cognitive function, fatigue, psychiatric symptoms. But then they also did this really— And I'll link this if you wanna look at it, this really cool thing where they did some MRI perfusion studies as well. And again, the statistical significance was good on all of these as well, 'cause again, it's, you know, 73 is more than 10. It's a randomized trial and it's single-blinded, meaning the patients were blind, but obviously the operators had to know who was getting what. So this worked out really well. And all of those parameters that they looked at had statistically significant benefit in the actual treatment arm. The group that got the real hyperbaric treatment. So in their summary, they say, well, these results indicate that hyperbaric oxygen can induce neuroplasticity and improve cognitive psychiatric function, fatigue, sleep, pain symptoms in post-COVID-19. So, you know, it's a— we knew theoretically that this worked for a lot of other inflammatory things, especially neurological, but also cardiovascular and many of the other things that we're seeing. But also it's nice to have some studies that people are doing now. And, uh, so one of the things kind of as we, as we wrap this up on the other end is, um, where can I get this? What are the parameters, et cetera? It's a little more common to see outpatient hyperbaric centers. There's more of them now than there were 5 or 10 years ago. And, uh, that's the first place I would look. I would, you know, you can search hyperbaric Oxygen or hyperbaric medicine. Now, you may find it at one of the local hospitals. So, for example, in a larger city, there might be 1 or 2 hospitals that have a hyperbaric center, and then any, you know, any pressure accidents are sent to those hospitals. It's not common that you'd be referred into a hospital for this type of treatment unless it was in a study. Generally, that's, that's reserved for injuries and treatment with within the hospital. You might be referred in for hyperbaric. So you have to find an outpatient center. There are also availabilities of low-pressure systems. So they still are in the treatment range, but low-pressure systems that people will have, and some people use them as in-home systems, which seems a little weird. And certainly you need good technical people to help set it up and all that, but That's, uh, that is a thing that goes on now. So I throw that out there. The other thing is that the pressure range is, uh, when you're looking in there, it's in that range where I was saying earlier, you, you're in the middle one, you know, 1 atmosphere. So, you know, 1.35 at the lower end and, you know, 2.5 to 3 at the higher end. Uh, so you're, you're in that range with either type of a system. If you're going in a hyperbaric chamber and it's what we call a hard side chamber, so either it's a see-through hard side or metal hard side, those go to higher pressures. If it's a soft side, they go to lower pressures, and that does depend a bit on where you're located as well. So I think, and I mentioned this in the neuro section, as far as long COVID goes, if you have access to hyperbaric and you have, you know, cardiac, kidney, neurological type injuries, stuff that we seen in other research to be positive for hyperbaric. It's a good synergistic treatment. It's a lot like the IV therapies when we discuss that, though it's not a standalone. It's not that one thing's not going to do everything. And you do want to remember that your body has to have enough antioxidant support in between the hyperbaric sessions to go through the oxidative phase and then the recovery phase so your body can do the most with the hyperbarics trigger healing, which is very important as well. Well, that's about all the time we have for this particular topic, hyperbaric medicine and post-COVID syndrome. Definitely something that we prescribe and we use with people, definitely helpful with neurological conditions, fatigue, brain fog, perfusion of the brain, but also all the other organs are equally benefited. All right, I'm Dr. Paul Andersen. This is Medicine to Health Podcast. Thank you, Dr. Andersen. And I want to thank you for listening. Like, share, subscribe, hit the notifications, and check us out on dranow.com. D-R-A-N-O-W dot com. That's our hub website. So if you're looking for where the pod burners are, where the YouTube channel is, or any newsletters, it's all there. Go there. Thank you very much, and we'll see you in the next session.