by Portland Chiropractic

Mild Hyperbaric Oxygen Therapy, or mHBOT is the medical use of oxygen in a pressurized environment at a level higher than 1 atmosphere absolute (ATA). Increased pressure allows for oxygen to dissolve and saturate more readily into our blood plasma, cerebrospinal fluid, synovial fluid and all liquids within our body (Henry’s Law of Gases). This is independent of Red Blood Cell (Erythrocyte) counts because under pressure at 4-7 psi, oxygen is increased 300-600% within the plasma and is more easily delivered to every cell throughout the human body. We use 1.3-1.5 ATA (pressure) levels because research has shown to be the best treatment for neurocognitive conditions

We carry oxygen to our brain, organs and other tissues primarily through Red Blood Cells that contain Hemoglobin, which is a protein molecule that binds up to four oxygen molecules and is contained within each Red Blood Cell. Each Red Blood cell has 250,000 Hg molecules with the help of iron that binds oxygen at each subunit, for a total of 1 billion possible oxgyen molecules. We only have a certain amount of RBC’s, so under normal conditions, we are limited in the amount of oxygen we can delivery, known as carrying capacity. 

Why is this important? Oxygen is the necessary requirement to make ATP, or energy for any process within the human body. It is the final electron accpetor in the Electron Transport Chain. As cells receive more oxygen through hyperbaric treatments, they create more energy, regenerating and strengthening, resolving many health conditions and complaints. Not only that, but it increases the flow of all bodily fluids, improving blood flow, cerebrospinal fluid flow, lymphatic flow (aiding in detoxification), stem cell activation within the brain and many other benefits. 

This yields a wide variety of physiological, biochemical and cellular effects. This noninvasive therapy is the most trusted way to increase oxygen levels to all organs of the body. 

This non-invasive therapy is the easiest way for our body to uptake oxygen to tissues and organs that are not able to absorb enough oxygen. It is shown to increase penetration of oxygen 400% deeper into our tissues and organs in comparison with our typical blood supply. Other incredible features of this treatment is that it reduces inflammation, destroys bacteria and increases white blood cell/stem cell production. Mild Hyperbaric Oxygen Therapy (mHBOT) creates substantial, expedited healing for acute and chronic Neurological conditions, Developmental Disorders (ADHD/Autism), Brain injury/Concussion, Autoimmune conditions, Lyme Disease, Migraines, Headaches, Musculoskeletal and athletic injuries, Athletic recovery, Post-surgical healing, Stress, Anxiety, Depression, Wellness and more. Reserach has proven that treatment is cumaltive and is recommended at 60-90 minutes over 40-80 treatments for optimal results. This may seem like a lot, but is essential for rebuilding infrastructure, cellular health and creating neuroplasticity. Due to limited insurance coverage, our goal is to keep our price affordable for patients, which ranges from $40.00-$60.00 per 60 minute session, as treatment recommendations vary for some conditions. 

HBOT has two primary mechanisms of action – Hyperoxygenation and a decrease in bubble size.

1. Hyperoxygenation is an application of Henry’s law and results from an increase in dissolved oxygen in plasma as a result of increased partial pressure of arterial oxygen. 
2. Decrease in bubble size is an application of Boyle’s law according to which the volume of a bubble decreases directly in proportion to increasing pressure (it is the primary mechanism at work in management of decompression sickness and arterial gas embolism) (2). 

Secondary mechanisms of action include-

1. Vasoconstriction
2. Angiogenesis (new blood vessel formation)
3. Fibroblast proliferation (provides the structural framework for our tissues and is critical in wound healing) 
4. Leukocyte oxidative killing (immune system activation)
5. Toxin inhibition and antibiotic synergy (reducing toxins and increasing antibiotic effect) (2). 
6. Strengthening and restoration of the Autonomic Nervous System  

Hyperoxia in normal tissues causes vasoconstriction which reduces post-traumatic tissue oedema (contributing to treatment of crush injuries, compartment syndromes and burns). This vasoconstriction, however, does not cause hypoxia as this is more than compensated by increased plasma oxygen content and microvascular flow. In other words, you’re still getting oxygen to your tissue even if the red blood cells can’t squeeze through, as compared to the much smaller oxygen molecules (2). 

This is important in our office when considering concussion and brain injuries as we can potentially reduce swelling and further damage while promoting neuroplasticity to restore normal brain activity and reduce potential for long-term symptoms. 

Hypoxia is a vital stimulant for angiogenesis, but development of adequate capillary network requires adequate amounts of tissue oxygen concentration. HBOT increaseas the oxygen gradient between the centre and periphery of the wound, thus creating a strong angiogenic stimulus. This along with fibroblastic proliferation leads to increased neovascularisation (2). 

How do oxygen molecules get 400% deeper into your tissues as they do with Hyperbaric Oxygen Therapy? They dissolve into plasma of our blood and oxygen molecules are much smaller than Red Blood Cells and with additional increase in blood flow, tremendous amounts of oxygen are able to reach injured and hypoxic tissues. Oxygen molecules also shrink under this pressure and can squeeze through constricted blood vessels, inflammed tissue, cross the blood brain barrier, enter lymph nodes, cerebrospinal fluid and musculoskeletal system. Essentially, oxygen is delivered to all of our tissues, especially the highly metabolic areas of the brain and other regions as oxygen is essential for the function and maintenance of every cell in our body, regardless of whether it’s an organ, muscle or bone.

This is analagous to what you see in a can of soda as the CO2 particles are under pressure, and therefore decreases their sizes enough that they dissolve into the liquid. When you pop the can open, the pressure is released, the CO2 particles increase in size and you see the fizz. This is exctly what happens to your oxygen molecules as they decrease in size under pressure and dissolve into the blood plasma. This exponentially increases oxygen delivery through the body and makes it posssible for oxygen to enter inflamed tissue or tissue that is starving for oxygen (hypoxic) to support optimal cellular activity and healing. 

We need oxygen for any healing or repair, because it makes energy for our cells – HBOT provides that delivery

Oxygen is the final electron acceptor in the Electron Transport Chain, which is where all of the ATP is produced. This is known as aerobic respiration, or how our cells breath. Oxygen is essential to life, but it is how it affects the function of every cell in the human body that makes it necessary for healing, and ultiamtely life. Without oxygen, we can’t make energy for our brain, organs or any tissue. The more oxygen we can deliver to our tissues, the healthier, energetic and mentally well we feel. It has a very high affinity for electrons (high electronegativity), making it a good electron acceptor and perfect in its role. In summary, Oxygen allows us to make ATP, which is the energy currency of our body required by all cellular processes to function and heal, supporting normal body and brain function.

Brain Injury, concussion, migraines, stress, anxiety, depression and other neurological conditions:

This becomes really important when we are treating the brain as it requires energy, or ATP to heal, as does any cell in our body. Individuals who have sustained a concussion or brain injury, suffering from migraines, headaches or experiencing neurological symptoms can especially benefit from hyperbaric oxygen therapy. Our brain, specifically the autonomic nervous system, regulates where blood flow will be increased or decreased in response to metabolic demand. We often lose our ability to provide appropriate amounts of oxygen to the brain and various other structures of the body when the master system, our nervous system, is damaged. The brain requires oxygen, glucose and activation to maintain normal function and therefore by providing oxygen therough hyperbaric oxgyen therapy, we are able to create neuroplasticity, which is the strenghtening of healthy neurological pathways, patterns and signals, generating new interneural connections, providing a healthier brain. 

Off-label conditions that can benefit from mHBOT:

-Concusion/mild Traumatic Brain Injury           -Migraines               

-Post-surgical healing                                     -Depression        

-Autonomic Dysregulation                               -Autoimmune disease                                  

-Pain                                                             -Neuropathy/Nerve Injury                              

-Lyme                                                            -Musculoskeletal injury                                    

-Crohn’s/IBS                                                  -Burns/Wound Healing     

-Sport Injury/Athletic Recovery                        -Post concussion syndrome    

-ADHD Spectrum/Learning disabilities               -Autism

-Multiple Sclerosis                                           -Headaches

Absolute Contraindications

• Untreated pneumothorax
• Certain medications such as Bleomycin, Disulfiram Cisplatin and Sulfamylon (1) 

Relative Contraindications

• Claustrophobia
• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Pregnancy
• Congenital Spherocytosis
• Upper Respiratory Tract Infection
• Eustachian tube dysfunction
• Fever
• Pacemaker in situ
• Seizures/Epilepsy (1) 

Complications

When used in standard protocols, HBOT is safe (2). In our office, we do not allow pressure to rise above 1.5 ATA, which provides a very safe and comfortable environment for most patients. If not, we remove you from the chamber and alter our protocol for treatment. At these levels, patients could administer at home as seen with some professional athletes. The most common complication during HBOT is barotrauma (injury caused by pressure as a result of an inaiblity to equalise pressure form an air-containing space and the surrounding environment) usually of the middle ear. Development of reversible myopia and clouding of pre-existing cataracts are other complications of HBOT. We take as many precautions as possible so that you do not experience any of these complications and since these are much lower level chambers than hospital settings, there is minimal risk. 

References

(1) Sahni T, Hukku S, Jain M, Prasad A, Prasad R, Singh K. Recent advances in hyperbaric oxygen therapy. Medicine update. Assoc Physicians India. 2004;14:632–9. [Google Scholar]

(2) Bhutani et al. Hyperbaric oxygen and wound healing. Indian JPlast Surg. 2012 May-Aug; 45(2) 316-324.