December 2009

War, Football and Oxygen

Author: Paul deVere

Traumatic Brain Injury, TBI. It’s called the “signature wound” for U.S. and Coalition forces fighting in Iraq and Afghanistan. Most reported TBIs among service members and veterans have been traced back to Improvised Explosive Devices, or IEDs, used extensively against Coalition Forces. TBI is also one of the most difficult wounds to treat.

Dr. Pete Stephens’ Hyperbaric Therapy of the Lowcountry clinic is taking part in a federally-funded study that could greatly enhance the healing process for soldiers suffering from TBI. “This is a nationwide study headed up by Dr. Paul Harch, the guru in hyperbarics and neurological problems, from Louisiana Sate University. He got Congressional approval and the Veterans Administration has approved it,” Stephens explained. His clinic on Hilton Head Island will be one of the sites used to treat the wounded soldiers.

“TBI can be anything from a mild concussion to serious brain damage. An explosion close to a soldier can bruise the brain or concuss the brain. With concussions, you can’t really see the damage on CAT scan or MRI,” said Stephens.

The therapy the clinic will administer is the same used for everything from diabetic wounds to autism: oxygen. “The physiology is the same. Normally, oxygen is transported to the tissues on the hemoglobin of the red blood cell. Oxygen is what heals; it’s not the blood. That merely carries the oxygen. You put someone in the hyperbaric chamber, you’re dissolving oxygen in the plasma, cerebral spinal fluid, lymphatic fluid, interstitial fluid—all the body fluids—15 times normal,” Stephens said. “Those fluids are carrying oxygen to where the blood can’t get. There are areas of the brain, especially in trauma, that can’t get the blood. Now we’re going to get to that part of the brain through another mechanism: cerebral spinal fluid,” he explained.

The chamber Stephens referred to is a clear, plastic tube-like chamber about the size of a single bed. During a “dive” the chamber is pressurized with 100% oxygen while the patient watches television or reads a book. Each “dive” lasts between 60 to 90 minutes. The treatment is called a “dive” because of its relationship with underwater diving. The experience is very similar to that of a diver in a decompression chamber.

“The earlier you place that patient in the chamber, the better the results. Some of the soldiers we’re studying will have had the injury a year or two, even four years prior. We are going to compare the clinical symptoms of the soldiers before and after treatment.” said Stephens. While there are no guarantees, smaller studies on military personnel, especially one done by Dr. Harch at Louisiana State University, show promising results.

Adding hyperbaric oxygen therapy (HBOT) to the arsenal to treat neurological problems has led Stephens to what he calls his “big mission,” and something that has been making the news lately: football related head injuries. “My big mission right now is to treat football players with concussions. NFL players have 19 times more dementia by age 49 than the general public. That’s from the concussions they get,” Stephens said. But, as it seems with anything involving HBOT, it can be tough going. Right now, there are 13 conditions approved for HBOT by the FDA. Treating concussion isn’t one of them. “It’s called ‘off-label’ treatment. When aspirin was first used as a blood thinner, that was ‘off label’ use,” Stephens said. “The medical community wants double-blind studies on everything before a treatment is accepted. Hyperbaric therapy isn’t in the text books. You would have to wait 25 years and see if they (football players) develop dementia.” Stephens is not waiting. He is getting other physicians, professionals, and universities involved to make it happen.

“Yes, we’re on a mission. Our affiliate, Oasis Hyperbarics in Charleston, is going to join us on this. We are creating another clinic outside of Philadelphia, which should be ready in two months. I’m trying to get other colleagues (there are about 70 around the country) involved in treating the concussed football players. But it’s not just football; it’s the NHL and soccer teams. Hyperbaric therapy is very big in Europe, China, Japan. In fact, most of the literature about hyperbarics comes from other countries,” said Stephens. “To date, the only treatment for a football player with a concussion is rest. That’s it.”

Every day, as patients come in for therapy at his clinic, Stephens continues to be impressed with the power of oxygen. “We treated one girl who fell 13 feet and hit her head. She had 30-some stitches and had a constant headache for five years. We treated her 20 times. She occasionally has a headache now and then, but the therapy called for 40 treatments. If she could have done that, she would be pain free,” Stephens said. That makes him confident about his soldiers and football players, too.

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