Deep Diving for a Cure: Part II

The Use of Hyperbaric Oxygen in Lyme Disease.

by Laura Zeller

In Part 1 of "Deep Diving for a Cure" I discussed the basics of the use of Hyperbaric Oxygen therapy (HBOT) for Lyme disease treatment. To summarize, the basic principle is that by exposing the entire body to 100% pure oxygen, under pressure, the Lyme disease bacteria (borrelia burgdorferi) will be destroyed.

HBOT offers a strong alternative to traditional antibiotic therapy, as well as a powerful adjunctive therapy. HBOT has shown promise as a powerful treatment option for those afflicted with Lyme disease, especially when combined with antibiotics. In my experience, monoplace (single person) chambers gave me the best results during my Lyme treatment.

I recently had the opportunity to discuss the use of hyperbaric oxygen treatment in Lyme disease with Julia Sudylo, R.N. Julia is a Certified Hyperbaric Technician (CHT), who owns, and operates a HBOT clinic in Basking Ridge, New Jersey. The following is a question and answer with Julia which will describe the basics of monoplace HBOT.

How can hyperbaric oxygen help Lyme disease patients?

Hyperbaric oxygen increases circulation to the body and that includes the brain. Oxygen crosses the blood brain barrier. This is why simultaneous use of antibiotics with HBOT is highly recommended. The increases of pressure and oxygen allow the antibiotics to penetrate deep into the body tissues where spirochetes like to hide. The 100% pure oxygen, administered at 2.4 ATA has been shown in studies (see references below) to directly kill borrelia burgdorferi.

How does HBO kill the Lyme bacteria?

Borrelia burgdorferi (Bb) is a bacterium that does not survive under increased oxygen. Just as a fish would not survive out of water, these bacteria cannot survive in an increased oxygen environment. Lyme bacteria are microaerophilic, which means that they are debilitated in high oxygen environments.The spirochete that causes Lyme prefers an environment with decreased circulation because of the lack of tissue oxygenation in those areas of the body.

According to a study by Dr. Charles Pavia, spirochetes were shown to die in the presence of hyperbaric oxygen both in vitro and in vivo. As the oxygen penetrates deep into the blood plasma and tissues, it stimulates the formation of new blood vessels, increases circulation to existing blood vessels, and helps those with decreased circulation heal. Most importantly for Lyme disease treatment is the potential for HBO to increase the effectiveness of antibiotics.

As documented by Dr. Glen Burkland in a “Retrospective Review of Lyme Patients who received Hyperbaric Oxygen," Borrelia burgdorferi cannot survive in an oxygen-rich environment, because it is a facultative anaerobe. HBOT increases the amount of oxygen in the body, which in turn causes spirochetes to die. When combined with HBOT, the effectiveness of antibiotics to kill the Lyme organism is increased as the medication is pushed deep into the body, attacking the spirochetes.

What is a typical treatment protocol?

Treatment protocols vary depending on the condition of the patient. They range from 1.5 ATA for brain injury to 2.4 ATA for Lyme disease. This does not account for Decompression Sickness (DCS) where you would require a repetitive dive sequence. Therapeutic sessions are typically 40 sessions long. However, in the Lombard/Burkland study, it was observed that more permanent results where achieved with up to 60 to 80 sessions.

Individual results vary. Typically, Lyme patients begin a protocol of 30-60 initial treatments, followed by 10 treatments every 4-6 weeks for as long as it takes for symptoms to abate. Each patient’s LLMD will prescribe an individual protocol specifying the length of treatment. Each patient responds differently. Some patients dive once daily, while others prefer the more aggressive approach of 2 dives per day.

You must have a doctors prescription for HBOT. William Fife, Ph. D., a Hyperbaric Medicine specialist at Texas A&M University, helped establish the Lyme disease protocols for HBO.

Is HBOT covered by insurance?

Currently, the insurance industry has only been friendly to a limited amount of indications. Reimbursement is limited to the 13 approved conditions by the Undersea Hyperbaric Medical Society (UHMS). Lyme is not one of the diseases that is approved, and although it has shown to be a significant benefit to Lyme patients, it is still labeled as investigational.

What are some preparations for HBO therapy?

A completed physical is indicated, including a chest x-ray. Before any session, it is advisable to consume a healthy meal, free of any carbonated drinks. For those with a history of upper respiratory infections, it is advisable to take a decongestant the evening before going to bed and in some cases before your session. Make a list of all the medications that you are taking, and make sure that you give them to the technician before your sessions.

There are several absolute rules which patients must follow during HBOT. Smoking is not compatible with HBOT. Once HBOT has been prescribed, patients should stop the use of tobacco in any form until therapy is complete. This "no smoking" rule applies to cigarettes, pipe tobacco, and cigars, as well as chewing tobacco and snuff. If a person just cannot stop the use of tobacco, HBOT will not be effective.

Cosmetics such as hair spray, nail polish, perfume, or shaving lotion containing petroleum, alcohol or oil base are not allowed while in the hyperbaric chamber. However, those products may be reapplied after each treatment. It is important to discuss all skin care products with the HBOT technician so they may assure safety.

All patients are provided with 100% cotton scrubs to wear during treatment. No articles containing nylon or polyester can be worn in the chamber. Watches and other jewelry, dentures, contact lenses and other prosthetic devices will also need to be removed before treatment. No titanium glasses, heating patches or dressings that have not been approved by the technician are permitted during treatment. No battery operated items are ever allowed in the chamber.

All medical records, prescription drugs, over the counter drugs, vitamins, and herbs are carefully reviewed for any contraindications. Additional tests may be ordered such as a chest x-ray, pulmonary function testing, examination of ear drums, prescriptions for sinus issues, etc. All patients should be examined by their physician, and all patients will attend an orientation session with a Certified Hyperbaric Technician (CHT) or RN in the chamber.

What are the risks of a HBO dive?

Hyperbaric therapy is generally safe and well tolerated. Most side effects are mild and reversible, although severe consequences can occur in rare cases. There are risks associated with HBOT, similar to some diving disorders. Pressure changes can cause a "squeeze" or barotrauma in the tissues surrounding trapped air inside the body, such as the lungs, behind the eardrum, inside para-nasal sinuses, or even trapped underneath dental fillings. This is why a complete physical is essential to minimize theses risks.

Middle ear barotrauma is the most common side effect of HBOT. It is prevented in most patients by teaching the auto- inflation maneuver or by use of tympanotomy tubes for those who cannot auto- inflate. However, this rarely is a problem. Sinus squeeze is seen less frequently than middle ear barotrauma. The nurse on duty will examine patients and contact your doctor if necessary.

Prescriptions for antihistamines, decongestants, and/or nasal spray should be given by your doctor. Temporarily, the treatment could be postponed. However, with slow compression and decompression, usually there are no problems.

Vision changes (myopia or nearsightedness) caused by swelling of the lens, this is more a temporary side-effect than a complication and usually resolves in two to four weeks following completion of HBOT.

Myopia is a reversible complication of repeated exposure to HBOT. Even when progressive, myopia does occur during a series of HBOT therapies, after treatment the visual acuity changes reverse completely. Acceleration of growth in existing cataracts is a complication of chronic long-term exposure at pressures over 2 ATA. Published reports as well as extensive clinical experience indicate that new cataracts do not develop with in the series of 30 to 50 therapies that are commonly used in the USA.

Pulmonary and neurological manifestations of oxygen poisoning are often cited as major concerns with HBOT. Oxygen tolerance limits that avoid these manifestations are well defined for continuous exposures in normal people. Pulmonary symptoms are not produced by daily exposures to oxygen at 2.0 or 2.4 ATA for 2.0 or 1.5 hours respectively. The incidence of oxygen convulsions when using similar exposures is about 1 per 10,000 patient therapies. Even when oxygen convulsions do occur, there are no residual effects if mechanical trauma can be avoided.

Although rare, one of the risks of HBOT is oxygen toxicity which is treatable by removing the oxygen. It is common to take a five minute "air break" to avoid oxygen toxicity and breathing compressed air through a special mask inside the chamber.

Pulmonary barotrauma during decompression may rarely occur. Patients with airway obstruction have an increased risk for pulmonary barotrauma during decompression. Patients must be cautioned against breath holding during decompression. All patients should attend a private Orientation session accompanied by a CHT or a R.N.

What happens if you feel claustrophobic?

Reassurance, emotional support and entertainment go a long way in preventing confinement anxiety. In some cases, a mild sedative may be required. If you still have anxiety during the treatment, your technician can safely and gradually bring you up from pressure depth. Each chamber is equipped with a telephone system, so your technician can hear you and talk to you while you are undergoing treatment. There is always a technician by your side monitoring you.

Can you bring books, food, or CD’s in the chamber with you?

Many centers will allow you to bring items into a multiple chamber. However, the Undersea and Hyperbaric Medical Society (UHMS) that governs hyperbaric medicine restricts this. It is contraindicated to bring any item into a monoplace chamber where you will be surrounded by a pure oxygen environment.

Most hyperbaric facilities have some form of entertainment such as movies or CD’s that can be used. TVs are viewed through the glass chamber with special speakers inside the chamber.

Can you get the bends like SCUBA divers do?

Air embolism is a rare but possible occurrence. That is why it is essential to have a trained hyperbaric technician offering you this therapy. You wouldn’t go to someone untrained to take an x-ray would you?

Will you herx from HBOT?

Most Lyme patients do experience some form of a Jarisch-Herxheimer reaction during HBOT. It has been noted anecdotally that a few divers have had "reactions" seemingly out of nowhere and later went on to test positive for Lyme. I can not tell you what the mechanism of action is however. It appears to be a herx brought on by the pressure. Also, some people respond to the oxygen immediately. Others do not herx for several days afterward. It is not unusual in either case.

You should start to see herx reactions within the first ten sessions. Some herx immediately and it is not uncommon to herx while in the chamber. You should see gains by forty sessions and in order to maintain those you should do a maintenance session at least once every 4-6 weeks.A Herxheimer reaction occurs when the Lyme bacteria are killed off quickly, and the body suddenly has to deal with a tremendous amount of toxins. The higher the amount of toxins, the stronger the herxheimer reaction will be. The Herxheimer reaction can be used as a clue to help clinically diagnose the presence of Borrellia Burgdorferi.

Are there any contraindications?

Some commonly used medications may potentiate side effects from HBOT. They must be limited or substituted with another drug. These include: high doses of aspirin and prednisone (or similar cortisone type drugs), and morphine, or alcohol within 8 hours of treatment. Some of the drugs that are contraindicated with HBOT are Doxorubicin (Adrianmycin), Bleomycin, Cis-platinum, Disulfiram (Antabuse), and Insulin. HBOT can lower blood sugar, and so hypoglycemic patients require blood monitoring and proper diet. Emphysema with CO2 Retention (COPD) is contraindicated.

Pregnant women are not advised to undergo HBOT unless it is an emergency situation. Patients with high fevers should postpone HBOT until the cause is found, and the patient is stable. An absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax.

Hopefully this question and answer will help any of you who are interested in doing HBOT treatment. It made a tremendous difference in my health, and made my Lyme disease protocol more effective. Although HBOT can be expensive and time consuming, it helped me make tremendous strides in getting my health back. I never experienced any side effects during my 200 treatments.

In my opinion, HBOT is a safe and suitable option for anyone suffering from chronic Lyme disease.

 

References

For more information on HBOT and Lyme disease, please see the following references. Please feel free to contact Julia Sudylo R.N, CHT on the web at http://www.juliashbot.com/

http://www.personalconsult.com/articles/hyperbaricoxygenefficacy.html

http://hbot4u.com/lyme.html

http://www.hbotreatment.com/Lyme- Preliminary in vitro and in vivo findings of hyperba.pdf

http://www.drneubauerhbo.com/Lyme.pdf