A Healing Atmosphere : Pressurized Oxygen Chambers, Once Reserved for Divers, Now an Important Treatment Tool at 3 O.C. Hospitals

Bob Lavacot of La Habra woke up one morning while on vacation with a boil-like ulcer on his chest. He thought little of it until the ulcer started spreading and he began to run a fever.

He cut the vacation short and made an appointment with Dr. Bonnie Bock at Hoag Hospital in Newport Beach.

“The tissue and underlying pectoral muscle were already badly infected,” Lavacot recalls. The chest wound, he learned, was a delayed side effect of radiation treatment he underwent 25 years ago for a cancerous tumor.

The course of treatment Bock prescribed: surgery to cut away the infected area and reconstruct the muscle, skin graft and--to Lavacot’s surprise--hyperbaric oxygen therapy to promote healing of new tissue.

“I had done a lot of scuba diving in the past, and I said, ‘Hyperbaric--isn’t that for divers with the bends?’ I couldn’t believe I was going to be treated in a hyperbaric chamber,” Lavacot says.

His surprise is echoed by many patients these days who learn that part of their treatment will be in a pressurized oxygen chamber the equivalent of being about 65 feet below sea level. The infusion of pure oxygen into damaged tissue has been found to promote healing in a number of difficult conditions such as Lavacot’s. In his case, the wound is nearly healed now, and his prognosis is excellent, Bock says.

Hyperbaric oxygen treatment is typically prescribed today for patients with severe burns, flesh-eating bacteria, gangrene, cyanide poisoning, crush injuries and a number of other specific conditions.

In Orange County, the chambers are in nearly constant use at Hoag Memorial Hospital Presbyterian in Newport Beach, at Western Medical Center-Santa Ana and Martin Luther Hospital in Anaheim. In Los Angles County, there are seven hospital-based hyperbaric programs.

While the chambers are credited with life-saving recoveries, they are not without risk. And though some results achieved with them have been miraculous, they are not the cure-all that some suggest, say those in the medical community experienced with hyperbaric procedures.

The hyperbaric chambers most common in the United States are one-person, see-through acrylic cylinders--about 2 feet in diameter and 7 feet long. The patient lies in the chamber for treatments that last 1 1/2 to two hours. Some patients receive only a few treatments, others as many as 60.

Patients in the chamber are breathing pure oxygen, about five times the concentration of normal breathing air, which is 21% oxygen. The pressure inside the chamber can be three times higher than normal, which, combined with the higher oxygen level, delivers 15 times as much physically dissolved oxygen to tissues as breathing normal air would. To prevent static sparks in the pressurized, oxygen-rich atmosphere, only all-cotton clothing and bedding is allowed in the chamber.

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The leading manufacturer of the chambers, Sechrist Industries Inc., is based in Anaheim. It has built more than 600 of the units, which are in use around the world--predominately in the United States and Japan. The units cost $95,000 to $120,000 and are sold to hospitals and, in some cases, private centers.

The history of hyperbaric medicine is tied to the evolution of diving.

Back in 320 BC, Alexander the Great used a glass barrel “diving bell” to extend the limit of diving beyond the time a person could hold his breath. Around the same time, Aristotle noted in a journal a case of ruptured eardrums caused by a deep-sea dive.

But it wasn’t until 1670 that there was a record made of the decompression phenomenon known as the “bends,” which is caused by nitrogen bubbles expanding in the bloodstream due to rapid ascent. It was in 1841 that “recompression” to relieve its symptoms was devised. In that process, the patient is placed in a chamber where the pressure mimics that of the deep-sea experience and is then slowly brought back to sea level pressure, allowing the nitrogen bubbles time to dissolve.

In the early 1800s, compressed air--or hyperbaric--treatment became popular for a variety of ailments, though there was no documentation of benefits from it. By the early 1900s, pure oxygen replaced regular air in hyperbaric chambers and some specific benefits began to be documented, primarily in pulmonary cases.

During WWII, the Navy began using Jacques Cousteau’s aqua lung, and there was a subsequent increase in decompression chambers. Their increased use led to an important discovery: while compressed oxygen cured the bends, the wounds suffered during a dive also healed at an unprecedented pace.

During the Vietnam War in the 1960s, Dr. George Hart of the Long Beach Naval Hospital decided to put hyperbaric oxygen to another test. He achieved remarkable results treating soldiers who had suffered burns.

Hart was using some European hyperbaric chambers but envisioned improvements and asked friend Ron Sechrist, who was working in the aerospace industry, to build a new version of the pressurized chamber. Sechrist took up Hart’s invitation and in 1975 built his first chamber, which is still in use--although it’s been updated--at Long Beach Memorial Hospital.

Currently there are a dozen prescribed uses for hyperbaric oxygen, known as HBO, as determined by the Undersea and Hyperbaric Medical Society. Most insurance companies pay benefits for treatments--which cost about $150 per session--based on those guidelines.

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After a skin graft on her face failed, Mary Johansen of Mission Viejo heard about hyperbaric oxygen treatment from a friend.

She called Western Medical Center and spoke with Rosie Ramirez in the Hyperbaric Unit.

“Rosie asked me to describe my face,” Johansen recalls. “After I explained my situation to her, she insisted that I begin treatment immediately, but I thought, ‘Wait a minute, what’s the big hurry?’ ”

By the next day, both Johansen’s physician and insurance carrier had approved hyperbaric oxygen therapy, and she began treatment at the Santa Ana hospital. “Within three days the difference in my face was incredible,” Johansen says.

Darryl Werner, medical director of the hyperbaric medicine program at the hospital, says, “Many people either don’t know about HBO or they dismiss it as some sort of voodoo. My greatest challenge is educating people, including physicians, about something that really works. It behooves the patient to be knowledgeable and ask the appropriate questions.”

Werner, who often lectures about hyperbaric to community groups and medical professionals, says that like other treatments, the success of hyperbaric varies with individual circumstances.

Recently, hyperbaric physicians at Western worked closely with the hospital’s replant team to treat a train victim whose leg had been partially severed. Despite the coordinated effort, in this case, treatment was not successful. “HBO doesn’t work miracles,” Werner says, but what it does do is “improve dramatically the chances that injured and marginally viable tissue can resume function.”

Burn victims are among those whose treatment often gets a dramatic boost from HBO.

The Grossman Burn Center at Martin Luther Hospital, which opened in 1995, treats 90% of burn in-patients with hyperbaric.

When 7-year-old Andy Holcomb of Anaheim accidentally spilled hot soup on himself recently, he was taken to the center where his second-degree burns were treated with hyperbaric. Like some adult patients, Andy didn’t know what to make of the chamber and wasn’t keen on entering it. Likening it to a space capsule, technician Mike Schultz crawled in first, doing all he could to make it look like a fun place for a little boy to be. He succeeded, and, after 18 days of treatment, all that was left of Andy’s burn was a pale scar.

“The beauty of HBO for burns is the rapid regeneration of skin,” says Dr. A. Richard Grossman, a longtime leader in burn treatment and namesake of the burn center at Martin Luther as well the one at Sherman Oaks Hospital.

“Second-degree wounds heal at a phenomenal rate because of increased metabolism in the tissue, and skin grafts used on third-degree wounds bond much quicker to the burned area,” Grossman says.

Another benefit is that the area where skin is “harvested” to be grafted elsewhere also regenerates at an accelerated pace. Consequently, when there are burns covering a large portion of a patient’s body, the few areas of healthy skin can be harvested twice as quickly.

Although the chamber at Martin Luther is used primarily for burns, it is open to other patients as well.

John Walker, who suffered from oral cancer, is among the nonburn patients treated there. He had had six weeks of radiation followed by radical surgery to remove muscles from his chest and use them to reconstruct parts of his neck and mouth. Forty two-hour hyperbaric treatments are credited with the prompt growth of new capillaries in the area, heightening circulation and enhancing healing.

Another patient was Marvin Foreman of Lakewood, who, while visiting family in Iowa, fell off some farm equipment and sliced open his leg from the hip down. He stayed in a local hospital for several days while his insurance company arranged a transfer to the Grossman Burn Center. By the time doctors there observed his leg, gangrene had set in. Foreman quickly underwent surgery and a regimen of 52 hyperbaric treatments. Now his leg is completely healed; he even plays an occasional round of golf with technician Schultz.

There are some specific hazards associated with hyperbaric oxygen therapy.

Because patients are breathing 100% oxygen in the chamber, there is the potential of oxygentoxicity. Symptoms of toxicity range from facial twitching and nausea to convulsions.

To prevent toxicity, technicians in the hyperbaric units remain in the room at all times to constantly observe the patient through the acrylic chamber wall. As a further safeguard, a typical regimen is usually restricted to no more than 60 consecutive treatments. If more treatments are deemed necessary, the patient takes a break of several weeks before resuming.

Human error and mechanical failure also pose dangers.

In Orange County, a chamber at the private Health Restoration Center, then in Lake Forest, exploded in December 1994. Two patients suffered from rapid decompression; three others were injured from flying debris. The investigation by the Orange County Fire Authority determined that the chamber, an older model purchased from the Navy and re-engineered for commercial use, was flawed.

In Japan last February, a Sechrist chamber exploded, instantly killing the patient and the technician. Use of the chambers worldwide was halted for a short period while an investigation was conducted. The Japanese Health Ministry determined that a spark triggered by a noncotton blanket taken into the chamber by the patient caused the explosion.

A variety of secondary physical responses to hyperbaric oxygen therapy have been reported. Some say it’s had temporary impact--for better and worse--on their vision and hearing; others report accelerated hair growth, stronger nails, even better memory retention. (Though he has denied it, entertainer Michael Jackson is rumored to sleep in a hyperbaric chamber.)

There are independent centers across the country that offer treatments to clients for conditions that the Undersea and Hyperbaric Medical Society does not recognize as benefiting from them.

Among the private centers not associated with a hospital is the Health Restoration Center in Mission Viejo, which has six chambers and is operated by osteopathic physician David Steenblock.

Steenblock, who is on probation with the Osteopathic Medical Board, moved to Mission Viejo from Lake Forest after the explosion at his center there in 1994. Lawsuits filed against Steenblock in that case are pending.

Despite setbacks, including bankruptcy, Steenblock sees many clients at his center.

He has been treating stroke victims, most of whom are elderly, with HBO for several years. In some cases, the brain damage occurred many years ago. The American Stroke Assn. considers HBO for stroke experimental; it is also not recognized by the Undersea and Hyperbaric Medical Society.

Steenblock’s premise for treatment is that even after stroke--when brain cells are damaged due to a lack of oxygen--there are still “idling neurons” waiting for a restoration of blood supply to “activate” them. Steenblock says that new capillaries in the brain can reach and stimulate these dormant cells.

Those who dispute that premise include Dr. James Pearle of the Western Pulmonary Medical Group in Anaheim and director of the hyperbaric unit at the Grossman Burn Center at Martin Luther.

“Brain cells do not regenerate,” Pearle says. “Once the brain tissue is dead, adding oxygen to the area doesn’t help.”

Peter Verghese, a neurologist at Hoag Hospital, also discounts Steenblock’s premise. “After a stroke, any idling neurons that are still viable produce toxic chemicals that will quickly kill the brain cell. HBO may be useful for stroke, but only in acute cases where the stroke is less than 9 hours old.”

While some argue that those who are working outside the established parameters for HBO may lead the way to new treatments, others see it as an opportunistic holding out of false hope to those desperate enough to try anything.

Stroke, brain damage, even Alzheimer’s disease and multiple sclerosis are among the conditions not recognized as benefiting from HBO that have been subject to experimental treatment; some people have even tried it as a last hope in the treatment of AIDS.

The use of hyperbaric therapy has had a well-documented and profound impact on the treatment of a little-known but much-feared disease: flesh-eating bacteria.

It is a horrific condition that spreads so rapidly that within hours, healthy tissue is consumed by bacteria and dies. Without hyperbaric, chances for survival are in the 20% to 30% range; with hyperbaric oxygen therapy, the survival rate climbs to 80% and higher. The therapy is so successful because the bacteria cannot survive the oxygenated atmosphere in the chamber.

In a much-publicized 1994 case, Thomas Lakin, the Ventura County community colleges chancellor, died of “necrotizing fasciitis,” or the flesh-eating bacteria.

Lakin was one of six patients treated for the deadly disease at Los Robles Hospital that year. Five were given hyperbaric treatment and survived; Lakin did not receive the therapy and died after a 24-hour battle to save his life.

A more recent case in Orange County ended much differently.

After surgery in March, Robert Smith went home to recuperate. At first, the surgical area seemed to improve, but several days later it began to worsen. Ten days after surgery, Smith returned to his doctor with a high fever and complained of pain. His doctor prescribed medication and sent him home.

Two days passed. The fever continued to rise, and Smith became delirious. His wife took him back to the doctor’s office, where he collapsed.

He was rushed to Western Medical Center, where he was found to have the flesh-eating bacteria. By then, Smith had only hours to live unless the spread of the infection could be stopped. He underwent surgery to remove the affected tissue and was given intensive hyperbaric oxygen therapy. His condition turned around and he started to recover.

After the first several treatments in the chamber, Smith began to come to his senses.

“I was fine as long as I was incoherent,” he says. “But as soon as I realized where they were putting me, claustrophobia set in.”

For people such as Smith who cannot tolerate confined spaces, doctors normally administer a mild sedative that wears off after a few hours. But Smith took a different tack.

“Being a retired Marine, I thought about all those POWs in Vietnam who were left in boxes smaller than this chamber for days at a time. I said to myself, ‘If they can handle that, then surely I can stand being in this chamber for a couple of hours.’

“It was all worth it,” he says. “It saved my life.”