Thursday, November 1, 2012

HBOT or not?

Here's the theory behind what hyperbaric oxygen therapy can do for people with TBI.
Why is traumatic brain injury amenable to oxygen therapy?
When cells in the brain die, blood plasma leaks out into surrounding brain tissue causing swelling and reducing blood flow. These otherwise normal cells go dormant because they can't function without enough oxygenHBOTdramatically increases the oxygen carried in the blood plasma, making oxygen available to heal damaged capillary walls, reduce swelling, and aid in new blood vessel formation. Blood flow can be restored to the dormant tissue and these cells then have the potential to function again.

Tuesday's debacle at Valley Medical had an unhappy ending as well. My request for a  prescription for HBOT was declined.

This conversation took place at the end of the appointment. You know, the time when doctors usually tell you instead of what you asked for you're going to settle for what they think you should have. The poor young guy had brought in the Associate Chief Director, Outpatient Clinic. Who said there weren't any good studies on the effectiveness of HBOT for TBI. And there were concerns about risk: too much oxygen in the brain can apparently do damage.

(He mentioned also that the people who have hyperbaric oxygen facilities have to look for reasons to use them. Unlike, thank goodness, the medical establishment in this handsome facility.)

They were both in agreement, these doctors, the young guy nodding his head as the older guy talked. A little short on details though. Zero details, really. No prescription either.

Now, after a stormy 3-hour visit followed by a Halloween candy binge, I'm in a quandry. Does it make sense to blow more than $7k on a hopeful new therapy for TBI? Hope is not a strategy.

Other people are pondering these questions. Like our government. The VA.

And Belgium. This is a gold mine of a document. It's basically a survey in 2008 of HBOT research and facilities and costs.

I know you don't read French. But only the first few pages are in French so go ahead, open it! Fast forward to page 39 for a summary of the evidence:

• Although HBOT is an old technique, evidence from well conducted RCTs [randomized clinical trials]  is poor, due to small trials, lack of blinding and randomization problems. Possible causes for this paucity of data are the technical difficulties to conduct these trials, the small number of patients in individual centres, and the absence of a driving financial interest to perform those trials.

• There is empirical evidence and wide consensus, on the efficacy of HBOT in the treatment of decompression accidents and severe gas embolism.

• There is low quality evidence from small RCTs on the clinical efficacy of adjuvant HBOT in patients with diabetic ulcers, acute deafness presenting early and selected cases of post-radiotherapy tissue damage.

• There is very low quality evidence from small and heterogeneous RCTs on the clinical non-efficacy of HBOT on long-term neurological sequels in carbon monoxide intoxication (compared to normobaric oxygenation).

• There is very low quality or no evidence for the efficacy of adjuvant HBOT in other indications and endorsement by scientific societies is mainly consensual.

• Data on the efficacy of HBOT in a series of new indications is beginning to appear and trials are ongoing. Therefore, new and validated indications could become apparent in the future.

In fact, the folks in San Francisco are part of a large HBOT trial on TBI taking place now in the US. It's already almost full.

And here's a recent TBI study with no control group. If you want, use the comments to weigh in on whether you think it's conclusive.

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