HBOTT Advice

A

  • No clinical evidence has been produced that the Airnergy machines are effective.The Biolife Solutions Airnergy website does not give any indication of the oxygen dosage their machine delivers and it cannot replace a session of hyperbaric oxygen treatment. Breathing oxygen over a mask or nasal canula in hospital, for example, at the bedside only delivers about 24% oxygen at 2 litres a minute - a modest increase from the  21% in air. To gain a major improvement in oxygen delivery to tissues requires an increase in pressure in a chamber. The oxygen we obtain breathing air depends upon the barometric pressure of the day. On a very low pressure day we get 10% less oxygen than on a very high pressure day. A pressure vessel is needed to be independent of the barometric pressure of the day and to significantly increase the dosage of oxygen. Breathing 100% oxygen at atmospheric pressure via a mask or from a cylinder with a special fitting is more efficient than the Airenergy machine and is a good introduction to the equipment  used for hyperbaric oxygen treatment in MS Therapy Centres.

  • Vertigo associated with a change in air pressure when the middle ear cavities do not equalise together. The vertigo, is a sense of rotation and is usually short-lived but rarely it can persist for days or weeks. The likelihood of the ears not equalising together is increased when there is an upper respiratory infections, like a cold, when the Eustachian tubes which connect the throat to the middle ear cavities are inflamed and blocked.

B

  • Baro = pressure and odontalgia = tooth pain.

    It is also known as a tooth squeeze and most commonly seen in divers. It is painful and may occur after the pressure change.  It is a common problem in air travel and is referred to as ‘flyer’s toothache’. It is due to gas trapped either inside a tooth, often associated with a filling or around the root after incomplete root canal treatment.

  • The reports of battery problems using new technology in the latest Boeing Dreamliner has caused some members anxiety about allowing battery powered equipment in our chambers. The batteries used in aircraft are large and require much power to charge them. Clearly a problem occurring in an aircraft at altitude endangers both passengers and those on the ground but our chambers do not fly and can be decompressed in minutes.

       Many millions of low power batteries using similar technology are produced everyday for items such as laptops music players and phones and there are no special handling or storage requirements. Laptops have only caused problems in aircraft when they have been dropped there are no reports of personal electrical equipment stored in lockers or luggage holds causing problems.

       Like aircraft our chambers use changes in pressure that are much greater than those caused by the weather and this has occasionally caused watch crystals to pop out on decompression and hard drives to fail on compression because they have been squashed. With the latest technology this is now unlikely although it must be pointed out to members that centres cannot accept responsibility should equipment used in the chamber fail or be damaged. 

       Obviously, if any equipment used in the chamber suddenly becomes hotter than normal then it should simply be placed on the floor and the chamber decompressed for it to be removed. If there is any smoke then masks should be left in place. A separate note has been issued about the use of electrically powered wheelchairs in chambers.

  • Although oxygen controls blood flow by constricting blood vessels - which would suggest that BP would rise breathing a higher concentration, it also controls cardiac output which falls with the increased oxygen level.

    At 2 ATA breathing 100% oxygen cardiac output falls by 20% and this, of course, applies both to the right and left sides of the circulation - the right ventricle pumping into the lungs and the left to everywhere else.

    Haemoglobin soon reaches 100% but because of the increase of oxygen dissolved in plasma - typically from 100 mm Hg breathing air to 1000 mm Hg at 2 ATA breathing 100% oxygen, the gradient for the transfer of oxygen from blood into the tissues is improved - obviously by a factor of 10.

    So giving more oxygen is the only way to reduce blood flow and yet improve oxygen delivery because the gradient for oxygen transport to cells increases in direct proportion to the dissolved oxygen concentration.

    Apprehension does increase blood pressure - and of course many people are initially afraid of "Going Under Pressure" because they - and this includes doctors - do not realise we live "under pressure" from gravity pulling the gases of the atmosphere on to the surface of the Earth.

  • Blood thinners are called anticoagulants, for example, warfarin, aspirin, edoxaban etc. and they interrupt the clotting of blood. It is fine for a person to be on this type of medication whilst having oxygen treatment. The additional dissolved oxygen will improve the absorption of anticoagulants taken by mouth and, therefore, their effectiveness.

C

  • It is clear that the uncontrolled division of cells, that constitutes cancer, may be initiated by a vast number of agents from infections, to mechanical factors, even the irritation of the pleural membrane of the lungs by a single fibre of blue asbestos. What is little known is that cells in culture that are intermittently deprived of oxygen become cancerous without any other agent being involved. There has to be a common factor and logic dictates that it is inflammation.

    Given the widespread misinformation about the use of oxygen at an increased ambient pressure in treatment, i.e. hyper baric oxygen treatment - many believe that it may encourage the growth of cancer cells. Not only does the science indicate that this is not the case, vast clinical experience around the World has also shown it is not true – the additional molecular oxygen delivered under hyperbaric conditions has been widely used to improve the results from radiotherapy and also to treat the side effects and complications of radiotherapy, chemotherapy and surgery. The reason is obvious and is a central principle of disease: damage to tissues damages the capillaries they contain reducing the supply of oxygen essential to recovery.

    Lack of oxygen is the common factor in cancer and establishing more normal levels of oxygen in tissues inhibits cancer cells.

  • Does HBOT cause cataracts?

    There is no evidence that higher levels of oxygen for short times cause cataract formation – the most important factor in cataract formation appears to be exposure to the near UV radiation in sunlight. This radiation causes free radical formation from the oxygen that we all breathe in air but the damage occurs at the time of the exposure to sunlight.

    Because the variations in exposure to UV in sunlight are so large, the relationship has been difficult to study and the inference has been from questionable animal experiments which have used very high exposures to UV. Figures are available from the USA – 22 million Americans by the age of 40 have cataracts but 50% who reach the age of 80 have cataracts. Failure to use sunglasses and smoking are established risk factors.

    However, it is possible that very long-term daily high levels of oxygen may accelerate the maturation of existing cataracts. A group in Sweden found this in treating leg ulcers in older patients - the sessions were once daily - 7 days a week often for hundreds of sessions. Monoplace pure oxygen chambers were used at 2 ATA which is equivalent to the dose using a mask in a multiplace chamber achieved at 2.4 ATA. Most patients received over a hundred consecutive daily sessions and several exceeded 1000 sessions.

    The eye surgeon was correct in that oxygen is involved but we have to breathe it from air to stay alive. One hour in a week of 168 hours is unlikely to increase the risk significantly and we do not have much sunlight in our chambers!

  • Oxygen treatment has been shown to improve the results of radiotherapy in patients with cancer - when it is used at the same time. It has also been shown to reduce the side effects of both having chemotherapy and radiotherapy - such as nausea and fatigue. HBO is not recommended in combination with certain cancer drugs (usually with the names ending in christen or mycin, e.g. Adriamycin, bleomycin and vincristine), but these have been mostly replaced by more modern cancer drugs. If you are asked to treat a cancer patient you should find out which cancer drugs they are taking because it increases their effectiveness and refer to the Oxygenhelpline for advice.

  • There have been concerns about the frequency of cleaning hoses. Oxygen is an oxidising agent, for example used in the purification of water and also the antibiotic of the body dealing with infection and inflammation.

    One hose delivers oxygen to the mask and the other hose is in place for the exhaled gas. Non-return valves connect the hoses to the mask which means that a person can not exhale into the oxygen hose but also the exhaled gas from the other hose can not return to the mask.

    Condensation may build up in the exhalation hose and cleaning it with soap and water and hanging it up to dry at the end of the day is sufficient. Hoses do not have to be changed after every person using it. The Covid virus is inactivated by soap!

    Obviously, some of you will run 1-2 chamber sessions per day whereas others may have 5-6 on some days. If you run fewer sessions, hoses may just need to be cleaned in the above mentioned way every other day. The ‘mark one eye ball’ is the best inspection.

    NB: At A Breath For Life we go further than this and clean the hoses throughout the day. We also use a Virkon broad spectrum antiviral solution on masks and hoses.

  • It is safe for a person with a cochlear implant to use the chamber. It is a small electronic device which consists of an external portion behind the ear and a second portion which is surgically placed under the skin. Only very low-voltage batteries are used.

  • A clear colostomy bag is placed over an opening in the abdomen called stoma. There are different types and the patient will be advised by their stoma nurse about frequency of emptying etc. It is no problem to have oxygen treatment sessions. The pressure will be equalised and the bag can not ‘burst’ which is probably what people will be concerned about. Ensure that the bag is not close to needing emptying before the person goes in the chamber !

  • The allegation that patients with COPD stop breathing when given a high dosage of oxygen goes back to the 1960s by what would today be   regarded a totally inadequate study with a low sample size of 4 patients and only 2 of those actually suffering from COPD. Sadly, this is still taught in medical school and the myth is being perpetuated.

    A French study shows it only applies to very ill patients in acute attacks who will be in ICU.

    COPD patients attending for HBOT in a barochamber do not stop breathing. In over 40 years of operation and probably thousands of people with COPD attending MS Therapy Centres not a single incidence has occurred.

    Details of the science underpinning this can be found in the book Oxygen and the Brain by Philip B James.

D

  • No.

    Decompression sickness may result from diving and aerospace activity and the two conditions in which gas enters the circulation are embolism due to burst lung in which air enters from lung damage and decompression sickness in which dissolved gas - nitrogen or helium - emerges from solution as microbubbles. Oxygen breathing is used to prevent the latter happening as breathing oxygen removes these gases from the body.

  • No, not at the recommended decompression rate and barochambers have to exhaust a large volume of air which can not be achieved in seconds.

    The MSNTC Manual clearly states that: Ensure that the trainee operator can end a session in an emergency if the No. 1 Operator becomes incapacitated. Be able to use the exhaust valves for depressurisation at the correct rate e.g., at not more than 0.1 ATA/ min, normally it is good practise for depressurisation to be at about half this rate e.g. 8 to 10 minutes for 1.5 ATA……….

  • No. A deep vein thrombosis occurs due to lack of oxygen, for example, on long haul flights  our tissue oxygen levels drop during the flight to the equivalent of being at an altitude of 8000 ft. We tend to remain seated, not drink enough and the lack of oxygen increases the risk of clotting in the deep veins of the legs.

E

  • No - is the short answer!

    Who has their ears checked prior to flying which regularly causes ear problems? It is actually not possible to check if a person can clear their ears in a chamber.

    Note: Our, insurers do not require an ear check for aircraft or chambers.

  • A condition where the tympanic membrane, that is, the eardrum, gets pulled inwards toward the middle of the ear. The tympanic membrane is a thin layer of tissue between the outer and middle ear which is responsible for transmitting sound vibrations to the bones in the middle ear. A bacterial infection, for example, can cause a vacuum pulling the ear drum toward the middle ear or rapid air pressure changes.

    This risk of this occurring at the slow compression rates in barochambers is extremely low. If a person has had a retracted ear drum perhaps caused by a bacterial infection, oxygen treatment at normal atmospheric pressure may help because oxygen is the natural antibiotic of our body.

  • Functional electrical stimulation, electrical muscle stimulation devices involves the application of an electrical current usually across the skin but these devices can also be implanted.

    These devices are safe in the chamber because they run on low voltage batteries.

  • Patients should be allowed to use electric wheelchairs in hyperbaric chambers to avoid the risk of injury associated with the transfer to standard wheelchairs. The motor should be switched off during the period when the chamber is pressurised.

    It is clear that the well-intentioned advice not to use electric wheelchairs in chambers, which dates from almost twenty years ago, was the result of misunderstandings derived from experience in two situations. First the use of pure oxygen atmospheres in space craft and some clinical monoplace chambers and secondly the effect of oxygen supplied at very high pressure in the presence of grease. Neither of these situations apply to the chambers used in MS Therapy Centres because the level of oxygen enrichment is always less than the US Navy limit of 25%. There is also no possibility of high pressure oxygen being present in a chamber.

    Electric motors may, of course, in normal operation create a small arc in relation to the brush action against the commutator but this is allowed for in the design and does not pose a risk. There is no risk associated with the use of an electric wheelchair in a chamber if the motor is only used to transport a patient into and out of a chamber and there is in any case no reason for the motor to be used during the session. Wheelchairs now use sealed batteries and so there is no risk from the spillage of contents.

    It should be noted that electrical equipment has been used in compressed-air working since the beginning of the last century and high pressure oxygen is in constant use in garages.

  • Epilepsy may affect patients with neurological diseases such as Multiple Sclerosis and also children with cerebral palsy who attend MS Therapy Centres. If it is known that a member has generalized epilepsy, then those in the chamber must be informed. Those with known epilepsy must have a parent or carer with them in the chamber. Oxygen may reduce the likelihood of a fit and being in a chamber reduces the risk of a patient physically harming themselves. Here is the background information:

    What is Epilepsy?


    Epilepsy is a term that describes a brain disorder in which clusters of nerve cells in the brain act together to discharge what are known as ‘action potentials’. The symptoms range from strange sensations or emotions felt by the patients to convulsions which are muscle spasms often associated with loss of consciousness. Epilepsy is the result of brain damage and may result from birth injury, traumatic head injury and multiple sclerosis. Epilepsy is not a diagnosis it is a label used only after a patient has two or more seizures often called fits.

    Seizures

    Seizures fall into two main groups; ‘focal’ seizures, also called ‘partial’ seizures, which occur in just one area of the brain and ‘generalized’ seizures in which most of the brain is involved. They usually last from 30 seconds to 2 minutes and may involve just an arm or a leg (which are not associated with the risk of damage) or the whole body. When the whole body is involved patients may be at risk of harming themselves and the lack of oxygen created by the fit needs to be corrected Hyperbaric Oxygen Treatment has been found effective reducing the number of seizures in patients with epilepsy and also the need for medication. A patient who has a fit in a chamber is not only in a place of safety breathing a high oxygen level protects them from the lack of oxygen that normally occurs breathing just air.

    First Aid

    First aid for epilepsy is basically very simple, the objective is to keep the person safe until the seizure stops naturally by itself.

    •       Keep calm and reassure other people who may be in the chamber or nearby.

    •       Don't hold the person down or try to stop their movements.

    •       Clear the area around the person of anything hard or sharp.

    •       Loosen ties or anything around the neck that may make breathing difficult.

    •       Put something flat and soft, like a folded jacket, under the head.

    •       Turn the patient gently onto one side to help keep the airway clear. Do not try to force the mouth open with any hard implement or with fingers. It is not true that a person having a seizure can swallow his/her tongue. Efforts to hold the tongue down can injure teeth or the jaw.

    •       Wait until the seizure ends naturally and be friendly and reassuring as consciousness returns.

    •       Instruct patients in chamber to make sure person having a seizure is comfortable and safe.

    •       Reassure those who witness the seizure and keep them informed of your actions

    •       Wait until seizure stops before decompressing the chamber there is no reason for undue haste.

    •       It is important NOT to decompress during a seizure because the patient will not be breathing and a rapid reduction of pressure may damage the lungs.

    •       Instruct  patients to give the person oxygen to breathe (if possible free flow the mask) and reassure those in the chamber.

    •       Decompress slowly – at least 20 minutes from 2 ATA.

    If it is known that the patient is prone to fits then there is no need to call an ambulance. However, if not then an ambulance should be called and the paramedics will decide if a hospital visit is necessary. Note that some of the latest MS “Disease-Modifying Drugs” are known to cause seizures.

F

  • Patients must not fast whilst having hyperbaric oxygen treatment as it reduces blood flow and low blood sugar levels can result in a seizure. Epilepsy is a feature of MS although not very common. It is important NOT to reduce the pressure if a patient has a seizure. Again, when the fit has stopped give the patient oxygen for 10 minutes on free flow and then slowly decompress - over about 20 minutes from 2 ATA (33ft).

    Patients going in the chamber as tender not breathing additional oxygen via a mask or hood are fine to do so during fasting.

  • It may sometimes be necessary to change the air in the chamber in order to:

    a) Reduce the oxygen level because mask leakage has increased it
    b) Reduce the temperature, or
    c) Remove odours.

    The pressure should be maintained at the same level during the procedure.

    Before flushing the chamber, operators should give due warning to the occupants, then open the outlet valve and balance the pressure by opening the air inlet valve. The amount the outlet and inlet valves are opened will depend on how much time is required to reduce the oxygen level or temperature to that required: 10 to 15 minutes is usually enough. Where a fan is fitted this will help.

G

  • An eye condition caused by damage to the optic nerve which can lead to visual field loss. An abnormality in the eye’s drainage system can cause fluid to build up and the excessive pressure can cause damage to the optic nerve.

    An increase of pressure inside the chamber does not increase the pressure in the eye and increasing oxygen delivery has a beneficial effect on the optic nerve as well as retinal structures of the eye by reducing inflammation.

  • Integrated continuous glucose monitors. These monitors consist of a sensor which is s small device attached to the arm or tummy sensing how much glucose is in the fluid under the skin. A reader, receiver or smartphone are used to display the results.  These monitors can be worn in the chamber.

  • Notification of a GP has caused endless and unnecessary problems - it was introduced by Professor James in 1982 in the hope  that GPs would begin to refer patients. However GPs have no training at medical school about the importance of pressure and oxygen treatment and cannot be asked about “contra-indications”. Again with government deregulation in 2008 and the fact that no insurance policy requires notification, trustees of member centres should be formally advised that it is no longer recommended.

    Centre members self-refer for oxygen treatment a position accepted by the Care Quality Commission. Members can be given the option to inform the GP if they wish to do so but a form does not have to be signed. Note: Many surgeries have even charged up to £100 for a surgery stamp or doctor’s signature.

H

  • By increasing the pressure in a chamber, blood flow is reduced but at the same time oxygen delivery to tissues increased. The heart has to pump less being in the chamber because more oxygen is dissolved in our blood plasma supplying the heart and all tissues with plenty of oxygen so that healing can take place.

  • Yes.  

    A hole in the heart (patent foramen ovale) is only relevant if people want to go diving. Nitrogen bubbles may form in the circulation and can  travel through the hole in the heart and cause damage in the brain and spinal cord - one form of the “bends”.

  • This refers to fluid build up in the brain and can be present from birth (congenital) or caused by head injury or brain illness such as stroke or a brain tumour. It may require the insertion of a tube to drain the excess fluid but it is safe for people to have oxygen treatment. This will not only reduce tissue swelling and inflammation but minimise the risk of infection and aid healing.

I

  • What if centres do not open 5 days/week

    In an ideal world the course of 20 sessions would follow the protocol of daily 1hr sessions Mon-Fri. Two sessions per day does NOT give twice the benefit and would only be recommended in acute conditions. If a centre is only open on 2-3 days it becomes more difficult to assess which treatment pressure is most suitable for the individual. If the person experiences benefits at 1.5 ATA they remain at that treatment pressure for the remainder of the course, if not continue for at least 2-3 weeks at 1.5 ATA before making a decision on how to continue.

L

  • Lung damage may occur because of the collapse of the air sacs and the recruitment of white blood cells called neutrophils which damage the capillaries causing loss of fluid into the air spaces. Again this is simply not a problem with an hour of oxygen breathing. A paper from Glasgow showed a patient who had 30 hours of oxygen breathing at 2 ATA without any difficulties. The neutrophil problem can actually be dealt with by giving a monoclonal antibody which is effective even after prolonged exposure to oxygen.

    Note: oxygen divers breathe pure oxygen for many hours.

M

  • The position of laptops in the chamber environment has changed over the last couple of years. Old laptops had an independent keyboard, a separate hard disk and the battery power pack was of traditional composition. Today’s machines have  an integral keyboard, an impact protected hard disk and high power chemical reactive batteries. Therefore, the pressure affects the modern machines more than the old ones.


    


    It is interesting to note that over the past 40 years there have been no problems with electrical equipment, however, in the last 10 years a handful of laptops, a couple of palm tops and a few mobile phones even when switched off were damaged in centres.


    It would, therefore, be suggested that new equipment should not be taken into the chamber but if a laptop or DVD player with a long history of working in the chamber is taken in, it is entirely at the owner’s risk. It should never be placed on cushions, or anywhere where it can fall off and break.


    Its a case of if in doubt, keep it out !


N

  • HBOT does not cause nosebleeds. If a member experiences a nosebleed inside the chamber it is no different to any other situation - especially during winter when changes in humidity or temperature can cause the inside of the nostrils to become dry and cracked. Oxygen is a gas and may cause further drying. Members clearing their ears by pinching/ blowing their noses can trigger nosebleeds. Those who take aspirin or anticoagulants (e.g. warfarin) are more prone to nosebleeds.

  • If pressure does not exceed 1.75 ATA and 60 minutes for the first and second session, no action is needed.

    If the pressure is 2 ATA attendants/carers should breathe oxygen for the last 10 minutes of second session and during decompression.

    It is important to note that two sessions or more per day do not give twice the benefit and most people find it too tiring.

    It is only applicable in acute cases when a severe lack of oxygen has to be rectified quickly, for example carbon monoxide poisoning.

O

  • Oil based emollients and petroleum jelly such as Vaseline applied to the skin pose no fire risk in the chamber.. A fire can only occur when the fire triangle is complete. Since no source of ignition is taken into the chamber this is not possible.

  • Members with MS who are planning to go on  long-haul flights can enquire whether the airline will provide oxygen on board. It has to be booked in advance and different airlines will have different rules and regulations. Some will provide a list of portable oxygen concentrators accepted by aviation authorities.

    Breathing additional oxygen on a flight can minimise the risk or may even prevent a relapse. Our tissue oxygen levels drop during the flight to the equivalent of being at an altitude of 8000 ft. We tend to remain seated and the lack of oxygen increases the risk of clotting in the deep veins of the legs.

  • The transfer of oxygen into the blood from the airways occurs in the lungs and depends on the pressure, that is, the concentration of the oxygen inspired during breathing. This depends on the percentage of oxygen in the gas being breathed and the pressure surrounding the person. The oxygen supplied to the masks used in the 60+ charity centres may be from flasks of liquid oxygen at 99.3% or from pressure-swing adsorption equipment that produces about 93%. The pressure in the chamber starts from the barometric pressure at the time and, with the weather systems in the UK this varies by over 10%.

    The actual concentration breathed by patients depends upon the equipment in use, oro nasal masks may allow air past the seal and so hoods are the best option. However, they need a much bigger flow of oxygen. The biggest variable is actually in the transfer of oxygen in the lungs because the gas breathed may be in areas which do not have the best blood flow. This is well-known in medicine and is called the ventilation/ perfusion mismatch. At 2 ATA (33 feet of sea water equivalent) using a full face mask the range of measured arterial oxygen tension in a research study was from 850 to 1140 mm Hg - 1.11 to 1.59 ATA. Similar variations occur at the lower pressures used in MS Therapy Centres – usually 1.5 to 1.75 ATA on the increasing pressure protocol although some centres use 1.25 and some oxygen at 1 ATA outside the chamber.

  • The percentage only indicates the amount of oxygen travelling through the body in the red blood cells but not the level in the blood plasma.

    Oxygen is transported dissolved in the blood and also in combination with haemoglobin in the red blood cells. Although haemoglobin carries most of the oxygen, it is only the dissolved oxygen that passes into the tissues. Breathing high levels of oxygen under hyperbaric conditions dissolves more in all of the body's fluids and so more can reach areas where the circulation is diminished or blocked and so improve recovery.

    - Oxygen session break -

    A session (not dive!!!!) consists of three phases:

    1)    Compression

    2)    Treatment

    3)    Decompression

    Some new patients, especially those with respiratory problems (e.g. asthma, COPD= Chronic Obstructive Pulmonary Disease), people using a wheelchair, obese people, generally unfit people may not have a very good respiratory fitness and, therefore, may find it difficult to breathe over a mask continuously for 60 minutes in the chamber.

    It takes time to build up the respiratory fitness required to breathe via a mask and some new patients may feel very fatigued during the first week. To introduce breaks can reduce or eliminate fatigue.

     Possible solutions:

    -       use freeflow if the mask used provides this option, note however, there may be more leakage from the mask and oxygen usage will increase.

     

    -       make people aware that they can take the mask off at any time during treatment. There is no danger from breathing the air in the chamber.

    -       some people prefer to breathe over the mask for 30 minutes then have a 5 minute break to take the mask off, have a drink of water to moisten their throat (oxygen being a gas can dry out the throat), have a chat with other people, stretch legs

    -       some people prefer to do 20 minute intervals. Breathing 20 minutes over the mask then a 5 minute break…etc.

    Important points to remember:

    -       Every person is different and will find a technique most suitable for them.

    -       Important to stress that taking a mask off at any time in the chamber is not dangerous and can not cause the bends !

    -       The treatment outcome is not significantly less beneficial if people do not breathe exactly 60 minutes of additional oxygen via a mask.

    -       It is equally fine to put the mask on during compression and leave it on during decompression.

    -       Centres use different masks. Stress the importance of the mask to have a tight fit and check that people are breathing over the mask correctly to gain most benefit. Some masks require a stronger breath in (e.g Divex masks) and people need to ‘suck’ for the oxygen if it is not set to freeflow.

    -       Some people find wearing a mask claustrophobic in addition to the effect of being in a chamber. Knowing that they can take the mask off at any time can reduce anxiety.

    -       Centres may consider setting up an additional mask for people to use outside the chamber. The mask will provide close to 100% oxygen. This will have a therapeutic effect because the oxygen dosage is increased significantly above the 21% we breathe.

  • The procedures used in the MS Therapy Centres beginning in 1982 came from the work of the pioneering centre, Dr Neubauer, in the USA which used sessions of 1 hour from “door closing to door opening”. However, one hour was adopted to simplify operations when the first MS Therapy Centre opened in 1982.

    However, research has now shown that oxygen not only allows energy to be produced for healing, it actually up-regulates the genes involved. Measurements of the oxygen levels in problem wounds – the main use of hyperbaric oxygen treatment that is reimbursed by all US health insurers - may take more than 30 minutes breathing oxygen in the chamber to reach their maximum level.

    However, because of its very large blood supply the tissues of the nervous system – the brain and spinal cord reach a peak level much faster – the retina being the fastest at about 20 seconds and the spinal cord the slowest at probably more than 15 minutes.

    This supports that for some people 45 minutes oxygen breathing is sufficient but this does not include compression and decompression times.

    It would be valuable for patients using 45 min sessions to record their experience say for 6 months as it may help in any decision to recommend this to other MS Therapy Centres.

  • How long does oxygen remain in the tissues following an HBO session. Approximately 2 hours in subcutaneous tissue (beneath the skin) and approximately 1 hour in muscle (where it is used up more quickly due to movement and exercise) and only minutes in the brain. However, the improvement of the blood vessels which reduces tissue swelling may last forever – i.e. until the end of life!

  • Molecular oxygen is not toxic but may form free radicals if electrons are available. However, every substance is harmful if improperly used, for example, it is possible to die from drinking too much water. The correct oxygen dosages for hyperbaric treatment have been determined since pressure chambers were first used medically 120 years ago.

    So called oxygen toxicity is not due to oxygen itself but to the products of oxygen and it is not a problem at the low levels - an hour at 1.5 - 2 ATA.

    We cannot live without free radicals - they are a requirement for our defences against bacteria and viruses. Very high levels of oxygen cause death not because of toxicity but because of hypoglycaemia - lack of glucose. The problem is that oxygen controls blood vessels - the more oxygen the less blood flow that is needed.

  • Metal plates, rods, wires and screws are commonly used to fixate and stabilise bones, for example, after a fracture. Internal and external fixation may also be used.

    They will not cause any problems for clients having oxygen treatment and the injuries will heal much faster.

  • This is a catheter system that can be used to aspirate cerebrospinal fluid or to deliver drugs such as chemotherapy to the cerebrospinal fluid. A catheter in one lateral ventricle is attached to a reservoir implanted under the scalp.

    It is fine for a person with an Ommaya reservoir bag to have oxygen treatment in a chamber.

    Ayub K. Ommaya a neurosurgeon invented it in 1963

P

  • It is safe to have oxygen treatment in the MS Therapy Centre chambers which are barochambers that do not exceed pressures of 2ATA.

    The company Medtronic has performed testing on several pacemakers and defibrillators to determine the maximum safe pressure. They concluded that devices similar to the Medtronic pacemakers and defibrillators tested should operate normally at pressures up to 2.5 ATA but will begin to significantly deform at pressures near 5ATA.

  • These are various types of tubes called central venous catheters because they are placed in a large vein. PICCs are used for short-term delivery of IV medications, usually over weeks. Ports are used for longer-term delivery of IV medications, usually over months or often years.

    All of them are safe whilst being in a hyperbaric chamber.

  • It is no problem although the inflammation and tissue swelling will reduce rapidly and this may require a new cast to be fitted rather sooner than expected. On average plaster casts stay on for 6 weeks. However, the fracture will heal faster with oxygen treatment and it is highly likely that the number of weeks required will be reduced.

  • Yes.

  • Yes.

    PEG = Percutaneous Endoscopic Gastrostomy. A feeding tube is placed into the stomach for a person to receive nutrition. There are different types of feeding tubes:

    Nasogastric Tube (NG Tube) Nasojejunal Tube (NJ Tube) Percutaneous endoscopic gastrostomy (PEG)

  • It is safe at any stage of pregnancy to have oxygen treatment sessions. By supplying mother and baby with additional oxygen, the likelihood of complications such as miscarriages are reduced based on Russian research.

    If the mother is diabetic, glucose levels can be better controlled and a harmful effect on the foetus minimised.

R

  • Yes. It is of benefit to do a course of oxygen treatment during a course of radiotherapy to prevent radiation damage to healthy tissue. In the 60s/70s it was standard treatment to place a patient inside a hyperbaric oxygen chamber and administer the radiation treatment through the acrylic chamber at the same time.

  • There are specified periods for certain types of records as set down in various statutes and regulations which are all over the place eg social work records, certain types of education records, tax records. Sadly, there is no one piece of legislation that brings all the different timescales together. Certain types of records relating to health information have to be kept for a certain period of time, however, none of the MS Therapy Centres keep medical records. Records must not contain medical information.

    General advice to keep records is about 7 years.

S

  • This is also called sinus squeeze and is a tissue injury caused by a rapid change in barometric pressure difference between the intrasinusal air and the surrounding atmosphere. It occurs most commonly in scuba divers and flight passengers but some people with a respiratory tract infection or chronic sinusitis may experience it in a barochamber.

    The sinus cavities above the eye brow might be sore when tapped with the finger to indicate sinus disease with the mucosa being inflamed and swollen making it difficult to equalise.

    A decongestant taken prior to a chamber session may resolve the discomfort if a person  is known to suffer from chronic sinus disease.

  • This is a catheter inserted through the abdomen directly into the bladder and left in place. Different types are available with or without a balloon.

    The increase in pressure in the chamber will have no adverse effect on the device. Liquids are not compressible  and pressure changes are equalised.

  • With over 5 million completed sessions since 1982 and about 1000 people a day having oxygen treatment in MS Therapy Centres, some question safety, side effects, “toxicity“ and contraindications.

    At the dosage used in this treatment there are no side effects from the oxygen. Although, the change in pressure may cause some ear or sinus discomfort. Where an extended, intensive course of treatment is necessary (as, for example, in wound healing), some patients may need glasses or a change in their prescription. This change is temporary and reverses a few weeks after treatment stops.

  • These are small portable battery operated devices administering medicines subcutaneously (under the skin) over a certain time period.

    The batteries are low voltage and fine in the chamber. Patients are often being airlifted for treatment and such medical devices should not be affected by minor pressure changes.

    If in doubt consult the manufacturer’s data sheet.

T

  • A Transcutaneous Electrical Nerve Stimulation machine is a small battery operated device with leads connected to electrodes (sticky pads) using a mild electrical current for pain relief.

    It is safe to use a TENS machine in the chamber but since there is no evidence for additional benefit and the risk of the machine being damaged it is best left outside the chamber.

  • A tracheostomy is a surgical procedure that creates an opening at the front of the neck so a tube can be inserted into the windpipe (trachea) to help people breathe. In some cases this can be permanent.

    To give oxygen treatment a hood can be used with the neck seal pulled over the opening and secured down although this requires care as it can be a little difficult to tape into place. Another option is for the hole to be covered with, for example, a large plaster or tape and the person can then use a mask which can be set to free flow to ease breathing.

  • Some centres have 10 litre oxygen concentrators providing about 95% oxygen at atmospheric pressure and others can provide 100% additional oxygen via masks connected to their chamber system.

    The difference to a chamber session is dosage - patients get 100% at 1ATA.

    This is doubled in a chamber session at 2ATA and breathing oxygen at 100% via a mask/ hood.

    Every individual is different and people can try out which way is most beneficial for them.