Hyperbaric Oxygen Therapy News and Updates
Hyperbaric Services of the Palm Beaches, LLC. Selected to conduct study of Hyperbaric Treatment for Traumatic Brain Injury and Post Traumatic Stress Disorder (.pdf)
JCAHO News Release (.pdf)
Marx Protocol for ORN and Tooth Extraction (.pdf)
Treating Sports Concussions with Hyperbaric Oxygen Therapy
(By Grace Van Scoyk - for momsteam.com)
As concussions in sports become an increasingly prevalent issue, it is important for parents to know how they can help their child recover from concussions, regardless of its severity. Hyperbaric Oxygen Therapy is one of the lowest-risk treatments available, and a good way to be proactive about helping a child suffering from post-concussion syndrome return to the classroom and playing field. Hyperbaric Oxygen chamber
In a study by Dr. Paul Harch,  one of the leading doctors in hyperbaric medicine, fifteen military personnel (all previously diagnosed with traumatic brain injury) were treated with forty hyperbaric oxygen treatments. Each patient made significant improvements in injury symptoms, physical exam results, cognitive measurements, and most importantly, quality of life ratings.
No physical injury can heal without oxygen, and the same applies for the brain. Hyperbaric oxygen therapy allows a patient to breathe 100% oxygen (as opposed to air from the atmosphere, which is 21% oxygen and 79% nitrogen) in a pressurized chamber, which creates a higher concentration of oxygen in the bloodstream, which can improve circulation to impaired brain areas.
READ MORE: http://www.momsteam.com/health-safety/treating-sports-concussions-with-hyperbaric-oxygen-therapy#ixzz4ARDprfIg
Medicare Guidelines for Hyperbaric Oxygen Therapy - In Treatment of Wounds
(March 15th 2005 from Medicare Newsroom)
HBO therapy remains a covered Medicare service and should be reported with procedure code 99183, Physician attendance and supervision of hyperbaric oxygen therapy, per session. The following guidelines regarding HBO therapy are taken from the CMS Internet On-Line Manual and continue to be in effect:
For purposes of coverage under Medicare, hyperbaric oxygen (HBO) therapy is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure.
Program reimbursement for HBO therapy will be limited to that which is administered in a chamber (including the one man unit) and is limited to the following conditions:
1. Acute carbon monoxide intoxication.
2. Decompression illness.
3. Gas embolism.
4. Gas gangrene.
5. Acute traumatic peripheral ischemia. HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened.
6. Crush injuries and suturing of severed limbs. As in the previous conditions, HBO therapy would be an adjunctive treatment when loss of function, limb, or life is threatened.
7. Progressive necrotizing infections (necrotizing fasciitis).
8. Acute peripheral arterial insufficiency.
9. Preparation and preservation of compromised skin grafts (not for primary management of wounds).
10. Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management.
11. Osteoradionecrosis as an adjunct to conventional treatment.
12. Soft tissue radionecrosis as an adjunct to conventional treatment.
13. Cyanide poisoning.
14. Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment.
15. Diabetic wounds of the lower extremities in patients who meet the following three criteria:
1. Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;
2. Patient has a wound classified as Wagner grade III or higher; and
3. Patient has failed an adequate course of standard wound therapy.
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After 30 Days of No Results with Standard Treatment, Discuss With Your Physician The Next Level of Treatment
The use of HBO therapy is covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care. Standard wound care in patients with diabetic wounds includes: assessment of a patient's vascular status and correction of any vascular problems in the affected limb if possible, optimization of nutritional status, optimization of glucose control, debridement by any means to remove devitalized tissue, maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings, appropriate off-loading, and necessary treatment to resolve any infection that might be present. Failure to respond to standard wound care occurs when there are no measurable signs of healing for at least 30 consecutive days. Wounds must be evaluated at least every 30 days during administration of HBO therapy. Continued treatment with HBO therapy is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.
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All other indications not specified under §270.4(A) are not covered under the Medicare program. No program payment may be made for any conditions other than those listed in §270.4(A).
No program payment may be made for HBO in the treatment of the following conditions:
1. Cutaneous, decubitus, and stasis ulcers
2. Chronic peripheral vascular insufficiency
3. Anaerobic septicemia and infection other than clostridia
4. Skin burns (thermal)
6. Myocardial infarction
7. Cardiogenic shock
8. Sickle cell anemia
9. Acute thermal and chemical pulmonary damage, i.e., smoke inhalation with pulmonary insufficiency
10. Acute or chronic cerebral vascular insufficiency
11. Hepatic necrosis
12. Aerobic septicemia
13. Nonvascular causes of chronic brain syndrome (Pick's disease, Alzheimer's disease, Korsakoff's disease)
15. Systemic aerobic infection.
16. Organ transplantation
17. Organ storage
18. Pulmonary emphysema
19. Exceptional blood loss anemia
20. Multiple Sclerosis
21. Arthritic Diseases
22. Acute cerebral edema
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Reasonable Utilization Parameters
Search = hyperbaric
Make payment where HBO therapy is clinically practical. HBO therapy should not be a replacement for other standard successful therapeutic measures. Depending on the response of the individual patient and the severity of the original problem, treatment may range from less than 1 week to several months duration, the average being two to four weeks. Review and document the medical necessity for use of hyperbaric oxygen for more than two months, regardless of the condition of the patient, before further reimbursement is made.
Topical Application of Oxygen
This method of administering oxygen does not meet the definition of HBO therapy as stated above. Also, its clinical efficacy has not been established. Therefore, no Medicare reimbursement may be made for the topical application of oxygen.
CMS Transmittal AB-02-183, Change Request 2388 also contains the following information:
CMS has concluded that special supervision and credentialing requirements should not be imposed on physicians who perform HBO therapy. You may not impose a higher level of supervision than direct supervision as is required for all "incident to" therapies. CMS encourages physicians who perform HBO therapy to obtain adequate training in the use of HBO therapy and in advanced cardiac life support.
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Improving neuropsychological function after chronic brain injury with hyperbaric oxygen.
Golden Z, Golden CJ, Neubauer RA. - University of Florida.
Purpose. One suggested treatment for chronic brain injury (CBI) is the use of hyperbaric oxygen therapy (HBOT). The present study was an evaluation of neuropsychological improvement after HBOT in CBI patients.Method. Study 1 compared test - retest results of 21 CBI children treated with HBOT against test - retest results of 42 untreated brain injured and normal children. Study 2 compared 21 CBI adults treated with HBOT against 42 untreated normal and brain injured adults. In each study, subjects received pre and post assessments to evaluate neuropsychological function.Results. The HBOT-treated children showed significant improvement when compared with the two control groups on measures of daily living, socialization, communication, and motor skills. The treated adults made significant gains in all neuropsychological areas tested as compared to controls.Conclusion. The studies were strongly supportive of HBOT as a treatment for lessening the neurological impact of CBI. These studies indicate that HBOT can be an effective aid in ameliorating the neuropsychological and physiological effects of CBI. The absence of a clear sham HBOT treatment group is an issue as it could be that there was a placebo effect, but it should be noted that the controls were receiving more traditional interventions during the study.
Penn Study Finds Hyperbaric Oxygen Treatments Mobilize Stem Cells
University of Pennsylvania School of Medicine
December 28, 2005
According to a study to be published in the American Journal of Physiology-Heart and Circulation Physiology, a typical course of hyperbaric oxygen treatments increases by eight-fold the number of stem cells circulating in a patient's body. Stem cells, also called progenitor cells are crucial to injury repair. The study currently appears on-line and is scheduled for publication in the April 2006 edition of the American Journal.
Stem cells exist in the bone marrow of human beings and animals and are capable of changing their nature to become part of many different organs and tissues. In response to injury, these cells move from the bone marrow to the injured sites, where they differentiate into cells that assist in the healing process. The movement, or mobilization, of stem cells can be triggered by a variety of stimuli -- including pharmaceutical agents and hyperbaric oxygen treatments. Where as drugs are associated with a host of side effects, hyperbaric oxygen treatments carry a significantly lower risk of such effects.
"This is the safest way clinically to increase stem cell circulation, far safer than any of the pharmaceutical options," said Stephen Thom, MD, Ph.D., Professor of Emergency Medicine at the University of Pennsylvania School of Medicine and lead author of the study. "This study provides information on the fundamental mechanisms for hyperbaric oxygen and offers a new theoretical therapeutic option for mobilizing stem cells."
"We reproduced the observations from humans in animals in order to identify the mechanism for the hyperbaric oxygen effect," added Thom. "We found that hyperbaric oxygen mobilizes stem/progenitor cells because it increases synthesis of a molecule called nitric oxide in the bone marrow. This synthesis is thought to trigger enzymes that mediate stem/progenitor cell release."
Hopefully, future study of hyperbaric oxygen's role in mobilizing stem cells will provide a wide array of treatments for combating injury and disease.
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Tuesday, August 15, 2006 - 09:00AM
Recovery time could decrease by up to 60 percent
By Sean Fitz-Gerald,
Williams Turns To Oxygen
Tank To Heal Arm
ST. CATHARINES - Ricky Williams has been spending more than four hours a day lying on his back inside a hissing blue tube made of steel and glass, breathing 100% pure oxygen at 2,000 times the normal atmospheric pressure with hopes of speeding his recovery from a broken arm.
His visits inside a hyperbaric chamber began last week and are scheduled to continue through the rest of this week at a clinic in St. Catharines, where he has been rehabilitating the left forearm he fractured while playing for the Toronto Argonauts late last month in a Canadian Football League game in Regina.
The 29-year-old running back's time in the tube has been broken into morning and afternoon sessions each lasting two hours and 15 minutes. He generally spends his time meditating, watching one of the overhead televisions or performing simple exercises with his left hand. No other objects, such as a book, are allowed inside the chamber.
A black-and-white movie was playing in a DVD player as he began his afternoon session yesterday.
"It's always nice to treat a professional athlete, and Ricky's very down to earth, he's very pleasant," said Dr. Michael Venneri, who heads the Hyperbaric Oxygen Therapy Institute.
"He has really interacted well with the little kids that he's seen here and people that have recognized him. And the ones that really don't even know who he is, he's really noticed that someone is struggling."
Williams broke the radius bone in his left arm while trying to regain his balance after being tripped up in a game against the Saskatchewan Roughriders. He underwent surgery that weekend, with the initial estimates suggesting he would miss between four and six weeks.
The player himself suggested he would need up to eight weeks to heal. He is three weeks into his recovery.
Williams signed with the Argos a week into training camp after the Miami Dolphins finally gave permission for him to spend his National Football League suspension in Canada. Williams was banished from the 2006 season after losing the appeal on his fourth failed drug test earlier this year.
"It will speed the recovery time up by 60%, that's what we're hoping," Venneri said of the hyperbaric therapy. "However, when you deal with breaks, there is some type of complication with soft tissue. And sometimes that can be the factor that may leave the person a longer time [to heal]."
Venneri is a chiropractor and acupuncturist who brought the hyperbaric chambers to Canada seven years ago. His is a private clinic, and a medical doctor works on site to monitor the chambers.
It is all housed inside a nondescript beige building in St. Catharines, which is about a 90-minute drive around Lake Ontario from Toronto. There were four machines in the room where Williams was treated yesterday, with natural light spilling in from one window near the ceiling and potted plants placed for decoration.
"In his case, he's looking at a whole realm of things to help himself get better in an increased time frame," Venneri said. "And he seems to be ahead of schedule. For example, he only had 20 pounds of grip strength when he came here -- he's already up to 60. He's only been here for seven days."
Hyperbaric therapy is used to treat some effects of cancer therapy and complications from diabetes, as well as carbon monoxide poisoning and burns.
Side effects can include a brief loss of equilibrium because of the increased pressure -- akin to what happens during an airplane's ascent -- and claustrophobia. The sinuses can also be affected.
The Vancouver Canucks paid $75,000 for a hyperbaric chamber of their own more than a decade ago. English soccer star Wayne Rooney used a hyperbaric chamber to heal his broken foot before the World Cup, and Dallas Cowboys receiver Terrell Owens flew one into his training camp hotel room last week to help heal his injured hamstring.
Williams, who declined an interview, was believed to be staying in a hotel somewhere in the Niagara region while receiving treatment.
"He's very intelligent, he's got a good heart, and I think that he genuinely cares about people," Venneri said.
"I've noticed that people will start a conversation with him -- just because you're waiting -- and he'll start talking. He interacts really well, and he's very pleasant. "He's very positive, too. We had a person come in last week and ... he hadn't been here in five years and his daughter was getting married and he could hardly walk. He said, 'Mike, you have to fix me because my daughter's wedding's in 10 days.' So he sits down and Ricky says, 'Don't worry. You'll be fixed right away for the wedding.' "
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