Monday, October 7, 2002
Hyperbaric Oxygen Therapy Has Supporters, Skeptics
By Jackie Jadrnak
Journal Staff Writer

Dr. Kenneth Stoller's enthusiasm is infectious when he talks about the wonders of hyperbaric oxygen - a therapy that exposes people to oxygen under greater-than-normal pressure.

"When I tell people all the things it can help, they look at me like I'm a snake-oil salesman," said the Santa Fe pediatrician.

The list he rattles off is a long one. Cerebral palsy and multiple sclerosis. Alzheimer's disease and stroke. West Nile virus and Lyme disease. And even more.

It's a list that puts him well outside the medical mainstream and makes him the only New Mexico doctor providing the therapy for such conditions.

Presbyterian Hospital, the other primary site in New Mexico with a chamber, uses it mainly for situations such as carbon monoxide poisoning.

Hyperbaric oxygen is approved by Medicare for about a dozen conditions - most of them involving wound healing, poisoning (such as carbon monoxide) and air bubbles (most notably "the bends" in divers who surface too quickly).

In those cases, the treatment can work by getting more oxygen to a wound, making the area less hospitable to certain bacteria; squeezing bubbles to a smaller size and pumping in more oxygen that has been displaced by carbon monoxide.

When it comes to treating brain and neurological injuries, though, some neurologists contacted by the Journal were skeptical. They cited studies showing negligible improvement - nothing better than those who didn't get the treatment.

Stoller's response is that doctors reject his claims because they aren't trained in medical school about the benefits of hyperbaric oxygen.

And when they say there isn't evidence to support its benefits, Stoller produces abstracts of many studies that suggest improvements after the treatment.

Molli Doyal doesn't need studies. She's seen what happened to her son, Curtis, 5.
Curtis was born eight weeks premature with cerebral palsy and developmental delays that came from brain damage caused by lack of oxygen at or before birth. For the first 31/2 years of his life, Curtis got traditional therapies and showed progress - but very slow progress.

Then Doyal heard about hyperbaric oxygen from another mother, did some research and she and husband Roy took Curtis from Albuquerque to Arizona for treatments. Curtis got 98 treatments in the pressurized chamber there.

"After three years of traditional therapy, he still was at the (functional) point of a 6-month-old," said Doyal, who is a critical care nurse. "With hyperbaric oxygen therapy, he went from a 6-month-old to a 3-year-old (in level of functioning). Those three years (of improvement) were accomplished in six months."

Curtis had needed a walker with extra supports to move around; now he walks on his own. His vision improved noticeably, Doyal said. And he went from a child with little expression who rarely interacted with others to one who takes part in life around him.

"I got my first hug in four years of his life. For my birthday, he told me 'hiya, momma' on the phone. No amount of money, no amount of therapy can replace that."

Since insurance would not cover the treatments, the Doyals paid the $100 per treatment themselves.

"I see child after child after child who I know would benefit significantly from this therapy, but they're not getting it because they can't afford it," she said. "In my mind, that's like withholding food."

Gary and Jane Smethurst are another Albuquerque couple who took their son Ashston to Phoenix two years ago for the oxygen treatments. The boy was developing normally until he suffered brain damage in a near-drowning after turning 1, said Gary Smethurst.

But the therapy seemed to clear up some of Ashston's lung problems, and it appeared to help him interact more and respond to some requests, Smethurst said. "He has responded to things more.

He makes eye contact a little bit more. You can kind of tell that 'someone's home.' ''

Hyperbaric oxygen is "not a miracle tool," Smethurst said, "but it kind of adds another piece to the whole picture."

Dr. John Phillips, interim director of pediatric rehabilitation at Carrie Tingley Hospital, spends most of his time treating children with cerebral palsy or other brain injuries.

He measured his words carefully when evaluating the worth of hyperbaric oxygen treatment in those children. "I can't argue with parents who feel they are seeing progress, but I've not seen enormous progress in my patients," he said, referring to the half-dozen to a dozen patients who have tried the oxygen therapy.

"My general response is that there is not good evidence in the literature for it," he said, adding, "Perhaps there is an odd patient who, for one reason or another, does respond to it."

Stoller, who installed a hyperbaric chamber in his Santa Fe practice this year, said there is good research to support the treatments. "It's just being ignored because of the politics of medicine in this country," he said.

"Until you see changes in patients, there's part of you that remains beyond skeptical ... because you are indoctrinated in medical school," he said, adding that he practically had to be dragged to see his first hyperbaric chamber but became intrigued after learning more.

The main side effect, Stoller said, involves increased pressure in the ears, similar to what you feel when a plane is changing altitude. People may want to postpone treatments when they are plagued by a cold or allergies, he said.

He offered a few explanations of how the therapy works. In a brain or neurological injury, some cells are killed, but many others are in a "penumbra" where they still live, but don't get enough blood and oxygen to function.

When a person is exposed to oxygen under pressure, the blood picks up more oxygen than normally would be carried by hemoglobin. Oxygen also is soaked up by the plasma, Stoller said. That oxygen saturation may be enough to help the idling cells start functioning again, or it may stimulate growth of new blood vessels to the injured tissue, Stoller said.

He made clear that he doesn't believe dead cells could come alive again. But, he added, the super-oxygenated environment could help stimulate a person's stem cells to form new neurons.

Phillips said he has heard some of the explanations of how the therapy works. "They don't make intuitive sense to me as a neurologist," he said.

Dr. Glenn Graham, director of the cerebrovascular disorders program at the University of New Mexico and the Albuquerque VA Medical Center, said data he has seen are mixed. "Until you have data supporting it as safe and effective, I would not promote it."

High concentrations of oxygen cause blood vessels to constrict, so it's not clear how much of the oxygen-enriched blood would reach injured tissue, he said. And more oxygen creates more free radicals, which are molecules that cause damage in the body by swiping atoms from other molecules. In theory, that would have a bad effect on the brain, he said.

But Stoller said the vascular constriction helps reduce swelling around an injury, aiding blood flow, and the high oxygen concentration still gets more of the gas to an injured area. Also, he contended, the high oxygen helps the body deal with free radicals. Still, patients sometimes are advised to take vitamin E or another antioxidant after treatments, he added.

Hyperbaric oxygen treatment is more common in Europe and countries such as China, Japan and Russia, Stoller said. Proponents in this country have been working to get insurance coverage for the treatments expanded beyond the approved conditions.

Stoller charges $150 a session, with discounts for paying for several sessions in advance.

"If we could get studies to prove it's effective, to bring it down to dollars and cents for the bean-counters ...," said Doyal. "Maybe we could save billions of dollars in health care for special needs children."

But Graham advised caution. He quoted a colleague's aphorism: "The plural of 'anecdote' is not 'data.' ''

"Show me the evidence ... I believe there is a potential to play to a patient's desperation," he said. "When there is not good data, you have to proceed with trepidation."

Copyright © 2002 ABQJournal

[This message was edited by seneca on Oct 08, 2002 at 06:01 PM.]