New To Diving (Oxygen Question for experienced divers!)

[Duke Dive Medicine]

And it is very unlikely to work anyway. Medical research suggests it's just snake oil.

Hello soggybadger,

Reading through the thread I understand that your wife, an emergency physician, said this. While there are plenty of snake oil hyperbaric O2 salespeople out there who are more than happy to take the money of a desperate individual and who drag down the reputation of the field, there are a number of evidence-based indications for hyperbaric oxygen therapy. I would respectfully refer Dr. Soggybadger to the Undersea and Hyperbaric Medical Society (UHMS) website:

HBO Indications - Undersea & Hyperbaric Medical Society

The UHMS is a consortium of hyperbaric/diving/undersea medicine practitioners who, among many other things, review the medical literature and from time to time approve an indication. Approval means that the indication has met the UHMS's rigorous standards for evidence. In the US, Medicare and many private insurance payors use the UHMS-approved indications as their list of approved uses for hyperbaric oxygen therapy.

For the OP's benefit, TBI is not on the list of UHMS-approved indications. The US Department of Defense is sponsoring research on this, and so far it has shown no significant benefit. There are hyperbaric medical practitioners out there who will treat you, but it seems you've investigated this already. Other posters have described in detail the training and equipment required to do what you want to do. To be clear, I am not advocating that you do treat yourself underwater with hyperbaric oxygen... on the contrary, I would strongly advise against it, for all the reasons that have been described previously. You didn't mention what symptoms you are having, but it's possible that your seizure threshold is lower due to your injury. I hope that the fact that there's no significant evidence of benefit and a possibility of harm will dissuade you from attempting this. However, if you are determined to do it, I strongly recommend that you consult a physician who is trained and experienced in the evaluation of divers and the application of hyperbaric medicine, tell him/her what you plan to do, and request a thorough diving physical. Also, again if you plan to do this despite my own and others' warnings, please be extremely careful and get the proper training and a LOT of dives in a variety of conditions under your belt first. It's relatively easy to learn to dive with higher partial pressures of oxygen, but it's not so easy to learn how to deal with emergencies, including the above mentioned CNS oxygen toxicity seizures. The casual tone of tbone1004's post belies his considerable training and experience (and tbone, I don't recommend it for you either!)

Best regards,
DDM

(edited after further reflection)

 

[anelson-OTS]

I went with them because the diveshops in my town either don't sell FFM's at all or only sell ocean reef. Actually one shop had that weird scubapro FFM on their wall but none of the salesmen even knew anything about it. I wasn't willing to buy something so foreign to me online. OTS and Poseidon need a bigger dealer network, I guess. It would have been nice to have compared brands.

Hi Kelemvor,

OTS has a number of dealers close to Largo, FL which should have some equipment to check out and even try out if you'd like to do so! Within 50 miles of Largo, it looks like we have 4 dealers, all of whom should have equipment.

If you'd like to take a look at where they are located, please feel free to visit our Dealer Locator here : Dealer Locator | Ocean Technology Systems -- Just punch in your city, state or zip and the locations will pop up.

If I can help with anything, please feel free to reach out to me anytime at : anelson@otscomm.com

 

[Dr Simon Mitchell]

Hello,

I did not notice this thread until today. It is a very interesting discussion because it had not occurred to me until now that people might see diving as a means of accessing hyperbaric oxygen therapy (HBOT) in a systematic way. Such is the interest in a number of indications for HBOT at inspired PO2s that are less than typically used in hyperbaric chambers that it is at least plausible that many people might start asking similar questions about accessing it through diving.

Virtually everything that needs to be said has already been said. I would just like to reiterate a couple of key points.

1. The benefit of hyperbaric oxygen in traumatic brain injury (TBI) is at the very least in doubt. I will discuss that in more detail below.

2. There are risks and in particular the risk of oxygen toxicity which is higher when immersed (probably related to CO2 retention) and new seizure risk is indisputably proven to be higher in someone with TBI. A seizure underwater is infinitely more dangerous than a seizure in a chamber.

3. It will not be cheap if you do it properly.

Thus, the risk / cost vs benefit evaluation is not particularly favourable in my opinion.

I would like to discuss the evidence for HBOT in TBI a little more. The OP seems convinced it is effective, and tbone cited a paper describing a randomized trial that seems to support that position.

There are numerous publications describing series of patients with chronic mild TBI who appear to improve (note "improve", not "be cured" per se) when they undergo a series of HBO treatments (often running into quite large numbers). Such reports created sufficient interest that the US military was forced to formally consider it because there are large numbers of servicemen and women returning from deployments with TBI. Each branch of the US military conducted its own randomized sham-controlled trial in which patients with TBI either received HBOT or a placebo exposure (typically breathing air at 1.2 or 1.3 ATA) inside a chamber. The idea was to ensure that the patient did not know which intervention they were receiving. The result in every study was essentially the same. Both groups improved, but there was no significant difference between the groups. In other words, patients with mild TBI improved as much when they thought they were receiving HBOT as they did when they were actually receiving it.

This suggests that a placebo effect is at least partly responsible for the perceived improvements that have been reported when HBOT is used in treatment TBI. This includes the "randomized trial" performed by the Israeli group and cited by tbone above. In this trial TBI patients were randomized to received HBOT or normal care, and then if they were originally in the normal care group, they later "crossed over" and received HBOT. The authors reported improvements with HBOT, but the patients knew what treatment they were getting at all times. Given the finding of what appears to be a prominent placebo effect in the properly sham-controlled / blinded studies discussed above, one could conclude that any study comparing patients who know they are receiving HBOT to patients simply receiving normal care is essentially pointless.

There are a lot of fascinating issues around this subject, and Mike Bennett and I recently published a review which includes a more detailed discussion of the TBI debate.

MITCHELL SJ, BENNETT MH. Unestablished indications for hyperbaric oxygen therapy. Diving Hyperb Med 44, 228-234, 2014

It is intentionally written in a style that is intended to be reasonably lay-person friendly and I would be happy to send it anyone interested if you PM me an email address.

As a post-script to all that, I just spent a week diving in Baja with Lindell Weaver who has been the overall coordinator of the military TBI study effort. We discussed this subject quite a bit. There is more work going on, and it follows that not all results are on the table yet. Nevertheless at this point there is not a particularly convincing case for HBOT in chronic mild TBI unless you believe in intentional use of a placebo effect (another big debate!).

Simon M