0:00

Well , thanks for let's get started guys . Thanks

0:02

for popping on and chatting about

0:04

this with us . Hyperbaric

0:08

oxygen chamber

0:10

therapy correct ? Is that the correct name

0:12

? Okay , it's something that I know very little

0:14

about and I think it might sound kind of wacky

0:17

to some people off the

0:19

bat , but I know that it's been used in human

0:21

medicine for quite some time

0:24

, that

0:28

it's been used in human medicine for quite some time , and I don't know when it

0:30

was introduced in veterinary medicine , but that's something that you can elaborate

0:32

on and I'd love to just jump in and talk about it

0:34

and talk about the ways that it can benefit

0:36

our pets , and if you want to introduce

0:39

yourself for our listeners

0:41

, that would be great , Dr Montalbano .

0:44

Yeah , so my name is Christina Montalbano . I'm

0:46

a veterinarian at the University of Florida

0:48

, at their veterinary teaching hospital

0:51

, and I have been

0:53

clinical faculty there for just over a year

0:55

now but did all of my

0:57

post-vet school training down there . So

0:59

I've been there for about a total of six years and

1:02

at the University of Florida we've had a hyperbaric

1:04

oxygen chamber for just

1:07

over 10 years now and I believe

1:09

we still remain to be the only

1:11

vet hospital

1:13

in the academic or the teaching

1:15

hospitals that has a chamber

1:18

. But they are becoming more popular in

1:20

private practice and hopefully

1:22

continuing to grow . It is

1:25

still a relatively newer treatment option

1:27

for veterinary patients and

1:30

can be seen both on the equine

1:32

and the small animal side , but

1:35

probably in the past 20 to 30

1:37

years really , the technology's been

1:39

available but still pretty

1:42

hard to come by . So everyone

1:44

who has them available to them is fortunate

1:46

and should definitely take advantage of having them .

1:50

So it was introduced to veterinary medicine

1:52

about 10 years ago , or so you say 10 or 20

1:54

years ago , 10 to 20 years ago

1:56

.

1:56

yep , it's relatively new , I think . Before

1:58

then maybe some pets were getting the benefit from

2:00

human chambers , but the vet , the

2:03

vet-specific chambers much

2:06

, much more recent .

2:07

Do you know anything about when it

2:09

was discovered in general , for even

2:12

human medicine , and how

2:14

.

2:14

So it's something that

2:16

back in the 1800s

2:19

the technology was starting

2:21

to be developed when , through

2:23

construction workers mostly that

2:26

were doing deep sea

2:28

dives to build bridges , things like that

2:30

, where they're at low sea

2:33

level and under pressurized

2:35

conditions , that they found , as

2:37

they brought them back up to normal

2:40

, beyond sea level , to

2:42

ground level , that they would get the

2:44

bends , as well as for

2:47

other scuba divers . So they've

2:49

figured out that by doing

2:51

hyperbaric oxygen therapy treatment

2:53

for these construction workers they could actually reverse

2:56

the signs of the bends . And

3:00

along the way physicians

3:03

had figured out that , hey , we can use

3:05

this for other indications

3:08

, to provide high oxygen

3:10

to different

3:12

disease processes , to stimulate

3:15

healing or to correct other disease conditions

3:19

. It's been technology

3:21

that's been around for a little while , but really

3:23

only since , like the 1960s

3:25

, 1980s , has it grown

3:28

as a therapy specifically

3:30

for medical treatments beyond something

3:32

like the bends .

3:34

For those of us listening who I know

3:36

I only know I've only heard of the bends because

3:38

I have a friend who scuba dives and it's like the only time

3:40

I've ever ever heard of it . For

3:42

those listening , can you just briefly explain

3:45

what the bends are , because I know it's definitely

3:47

a term used for , like professional scuba

3:49

divers ? Yeah , yeah

3:51

.

3:51

So the bends is a situation where

3:54

with quick changes

3:56

in pressure , the

3:58

gas bubbles that are naturally in the

4:00

body change in size and

4:02

when that happens too quickly , those gas

4:05

bubbles can especially lodge

4:07

into the vessels and vasculature and

4:10

cause major issues . So

4:13

we don't want those changes in pressure to happen too

4:15

quickly .

4:15

Yeah , that makes sense . So

4:18

how did you discover , how did you become

4:20

interested in hyperbaric oxygen

4:22

chamber therapy ?

4:24

So it's something that we've offered at the University

4:26

of Florida since I started there

4:28

, and so

4:31

that was how I learned about it . Was just

4:33

starting out there and seeing what they

4:35

were doing with patients and

4:37

starting to perform it myself

4:40

, seeing the benefits that it can provide for a

4:42

variety of different patient indications .

4:44

Great . So what are some of those benefits

4:47

? Can we jump into that ? Yeah ?

4:49

Absolutely . So really any condition

4:52

that would benefit from increased oxygen

4:54

to tissues . So we can think about

4:56

one of the most common indications

4:59

in people that we'll use very commonly

5:01

in our veterinary species is wound

5:03

management . So when

5:05

we have wounds we

5:08

have an area of the tissue that does

5:10

not have enough oxygen delivery

5:12

because there's typically disruption

5:14

of the blood supply . There

5:16

may be bacterial contamination , all

5:18

of those different things that can benefit from

5:20

having increased oxygen to the tissues

5:23

. The thing

5:26

about hyperbaric oxygen is that it's not just

5:28

increasing the oxygen delivery but it's

5:30

also at a pressurized state which

5:32

allows us to bring that oxygen

5:35

into deep tissues without

5:37

actually needing the normal oxygen

5:40

carrying component

5:42

of blood , which is hemoglobin . So

5:45

even without enough

5:47

blood cells in that

5:49

wound , we can get the oxygen to

5:51

the tissues , and oxygen is very important

5:53

to promote healing . So

5:55

wounds is one of the really common

5:57

things that we'll use it for . Another

6:00

very common indication that I use it for

6:02

in University of Florida is

6:05

for spinal cord injuries , such

6:08

as our little dachshunds

6:10

or French bulldogs that very commonly get

6:12

intervertebral disc herniations

6:15

. We can use this

6:17

therapy to help improve

6:19

oxygenation to the spinal cord

6:21

to help them recover from

6:24

that disc compression that happens

6:26

to those spinal nerves . So we'll

6:28

very commonly use it after

6:30

surgery for them or as part

6:32

of conservative

6:34

management to help those spinal nerves

6:36

heal .

6:38

That's great .

6:40

There's so many other indications

6:42

that we can use it for . There's so many other indications that we can use it

6:44

for I'd say a couple other really

6:46

common ones that we're using

6:48

it for patients that have

6:50

osteoarthritis , arthritis

6:52

of multiple joints . We

6:54

find that it's helpful for pain management

6:57

for them , things

7:04

like pancreatitis to help reduce the inflammation associated

7:06

with that . And then we're starting to look at it for cognitive dysfunction

7:08

, which is similar to Alzheimer's in

7:10

people . That's

7:12

a disease process that's simply

7:14

caused by reduced oxygen delivery

7:17

to the brain . So if we can improve

7:19

oxygen delivery to the brain

7:21

in an aging animal , can

7:24

we help to slow the progression of those

7:26

cognitive signs of decline .

7:28

Wow , would it be helpful

7:30

in something like in like

7:32

an acute , like emergency situations

7:35

? Specifically , I have a

7:37

. This is a little off topic , but I have a

7:39

client that got bitten by a snake , a

7:41

rattlesnake , yesterday , so he's in the ER

7:44

. They don't I'm sure they don't have a hyperbaric

7:46

oxygen chamber , but I just got back

7:48

from visiting him and I'm just thinking like how could

7:50

this benefit his healing process in

7:53

any which way , and I'm not

7:55

sure that it can , but curious

7:57

.

7:57

Yeah , it definitely depends Specific

8:00

with snake bites sometimes we have

8:02

to be a little cautious that hyperbaric

8:04

oxygen therapy can be so good at reducing

8:07

swelling that we can actually

8:09

get something called re-envenomation syndrome where

8:11

there may be pockets of venom

8:13

that can then recirculate . But

8:16

in general , any even

8:18

acute injury that causes significant

8:20

swelling , bruising , pain

8:23

, we can help to very , very quickly

8:25

reduce that pain , even

8:27

from a single session . So often we'll

8:30

, if we have like a swollen limb

8:32

, we'll measure how the

8:34

circumference of that leg before

8:36

and after just even one session

8:38

, and often we'll see a pretty significant reduction

8:40

in that , which is really nice to

8:42

see immediate effects of what we're doing yeah

8:44

, absolutely , dr Lindsay , did

8:47

you have a question ?

8:49

I did so along those lines

8:51

. I'm even thinking for patients

8:53

that undergo chemotherapy and

8:55

have some of the chemotherapeutic material leave

8:58

the vein , because we actually chatted about someone

9:00

that is really into ozone about

9:02

how helpful ozone was in a situation

9:04

that she had encountered that was very similar

9:06

. Is that also something that

9:08

hyperbaric oxygen therapy could be

9:10

beneficial with ?

9:13

Yeah , absolutely so . Any

9:16

extravasation type injuries

9:18

can definitely be beneficial . We

9:21

had one that we were working with not too long ago that

9:23

we're trying to be beneficial . We had one that we were working

9:25

with not too long ago that we're trying

9:28

to kind

9:34

of correct the extravasation or that removal of the drug from outside of

9:36

the vessel and trying to reduce the swelling and potentially the negative

9:38

effects of that medication that can occur to the surrounding

9:41

tissues where it's not meant to be . And

9:44

then even going along that some

9:47

people do question whether this is a

9:50

therapy that we can do to

9:52

supplement cancer treatment , Because

9:55

there's always the thought that if we're increasing

9:58

oxygen to cancer cells

10:00

maybe that would be negative and that those

10:02

cells would use the oxygen

10:04

as energy to grow , which in

10:06

cancer is negative . But

10:08

a lot of information on the

10:10

human side is finding that actually

10:13

the level of oxygen that's

10:15

provided , as well as the again

10:18

, the increased pressure that's provided through

10:20

hyperbaric oxygen therapy , can

10:23

actually inhibit tumor

10:25

cell growth that's associated in

10:27

cancers . So it could actually be part

10:29

of a complementary treatment option for

10:31

different types of cancers , especially

10:34

the types of cancers that may be sensitive

10:36

to radiation therapy . So we'll

10:38

think about using it in conjunction with radiation

10:40

therapy in patients that are undergoing

10:43

that type of treatment for their cancers

10:45

, and then can we talk

10:47

?

10:47

oh , go ahead , Charlotte . No , you go

10:49

, you go . I was going to say can we ? Can

10:52

we talk about what a session looks like ? So

10:54

, just to preface this , my own dog

10:56

underwent hyperbaric oxygen therapy

10:58

. She has been dealing

11:00

, or was dealing with one-sided nasal discharge

11:03

for a year , and that's actually how

11:05

I found you . I

11:08

was looking for resources for protocols because

11:10

it's very specialized

11:13

and although there's at least in Southern California

11:15

, I know of two dermatologists

11:17

that have units so they can use them they

11:19

outsource for all of their protocols . They don't actually

11:22

make them themselves . So

11:24

I myself

11:26

was even surprised to kind of watch them go through

11:28

the process and the kind of things that I would not

11:30

think are dangerous but in that situation

11:32

you really have to be very

11:35

aware of . So can you chat a little

11:37

bit about kind of what that process is ?

11:40

Absolutely so . For our patients

11:43

to go into the chamber

11:54

, there are a couple of

11:57

safety checkpoints that we have to

11:59

perform in order to make sure that

12:01

this is going to be a safe session

12:03

for them . So everyone who operates have

12:05

collars or leashes . They

12:07

can't have toys , food bowls

12:09

with them . And then

12:11

for our patients that are

12:13

hospitalized or immediately after

12:16

surgery , we have to make sure to

12:18

carefully cover any intravenous

12:21

catheters , urinary catheters

12:23

, any

12:26

intravenous catheters , urinary catheters . We have to put special e-collars on if they need to have

12:28

an e-collar on . And then we have to be careful what kind of bedding

12:31

they have . So we have 100% cotton

12:33

towels that can go in with them . So

12:35

, unfortunately , all of their fluffy bedding and

12:37

special toys have to stay out just for those

12:39

sessions . We also have

12:41

to be careful about things like fentanyl

12:44

or lidocaine patches , because

12:46

the chamber can actually increase the absorption

12:48

of those medications , so those have to be removed

12:51

. And then making

12:53

sure that they don't have alcohol on their fur

12:56

or ultrasound gel if they've just had an ultrasound

12:58

. Or for our orthopedic patients

13:00

, we use nail polish on their toes to

13:02

make sure we know what limb is getting surgery , so

13:04

the nail polish has to be removed . So

13:07

lots of little things that we have to make sure are

13:10

checked before they go into

13:12

the chamber . We also make sure

13:14

our patients are at a safe body

13:16

temperature . They

13:28

have a significant fever or are hypothermic . So if they're too cold that we can see fluctuations

13:30

in their temperature from the pressure that they undergo in the

13:32

chamber and we don't want them to have

13:35

significant changes in their body temperature during

13:37

the treatment . So once

13:39

we've made all of those checks and made sure that they're safe to be

13:41

in the chamber made all of those checks and made sure that they're safe

13:43

to be in the chamber then we spray

13:46

them with water which helps to reduce

13:48

static electricity in their hair coat

13:50

which

13:55

is mostly just a comfort thing , so that they don't feel that little bit of static

13:57

electricity . Most of our patients tolerate the chamber

13:59

very well . Once we've had them

14:01

all prepped , we

14:06

load them in , shut the door and then slowly start that pressurization process

14:08

. So it takes us about 15 minutes to get

14:10

them up to the pressure that

14:12

we're aiming for , which , depending

14:15

on what we're treating , we're

14:18

aiming for a specific pressure , which

14:21

typically we'll use about

14:23

two atmospheres absolute

14:25

or 14.7

14:27

psi . For certain conditions

14:29

we may choose to go higher or lower than that

14:31

, but that's just kind of what's

14:34

been shown to be most efficacious , most

14:36

beneficial for treating these patients . Once

14:39

they're up to that pressure that we're aiming for

14:41

, we keep them at that pressure for

14:43

typically between 45 minutes to

14:45

one hour and then slowly bring

14:47

them back down to normal pressure . So

14:50

, just like I was mentioning before that

14:52

we can see the bends or decompression

14:54

sickness . If we change those pressures too quickly we

14:57

can actually cause the bends in the hyperbaric

14:59

chamber by having them go up or down

15:01

from pressure too quickly . So we want to make sure to do

15:03

everything at a nice slow rate so

15:06

that we're not causing any problems . So

15:10

again , most patients tolerate the sessions

15:12

very well . They just sleep

15:14

or we have little windows in our

15:16

chamber that they can look out and watch us .

15:19

I was going to ask my question like how do they do

15:22

they don't panic or anything when they're in there , or they're

15:24

just fine , they know for don't panic or anything when they're in there , or

15:26

they're just fine , they know , for the most part .

15:27

Typically they're very good for patients that do have like

15:29

confinement anxiety . If they're

15:31

not good in a kennel , we may choose to do

15:33

some light oral sedation or light

15:35

IV sedation , but

15:37

for the most part they they honestly do very

15:39

, very well with it right , they know you're

15:41

trying to help probably . Exactly

15:43

.

15:44

I hope so at least . So what are some

15:46

? Are there any contraindications other than

15:48

you know some of the things you

15:51

just mentioned , which were really mild , but anything

15:53

, any patients that don't benefit

15:55

or wouldn't benefit from it ?

15:57

Yep , so the main patient that we

15:59

can't put in the chamber is one who's

16:02

had trauma to

16:04

their chest wall , where

16:06

they have what's called pneumothorax , where

16:09

there's basically a penetrating

16:12

wound into the chest wall , Reason

16:14

being that because when we undergo that

16:17

pressurization and depressurization

16:19

to do the therapy , they

16:21

can actually get air trapped in their chest

16:23

and that would be bad . So

16:25

that's really the main reason that

16:27

we would not do a session for

16:29

a patient . The other

16:32

thing is we want them to be relatively stable

16:34

. So for patients that are still being

16:36

stabilized after significant injury

16:40

or trauma , we can't

16:42

get to our patients that are in the

16:44

chamber immediately . So if

16:46

they're , you know , needing significant

16:49

changes in medications

16:51

, other things

16:53

to help them to feel better

16:56

quickly , then we wait until they're

16:58

a little bit healthier , a little bit more stable

17:00

, to do that treatment . We

17:03

are also limited in the size of

17:05

patients . So our chamber

17:07

we can fit a hundred pound

17:09

dog relatively easily , but

17:11

that's about our cutoff for our particular chamber

17:14

. Like I said , there are chambers for

17:16

horses . So if we had a really large

17:18

breed dog or sometimes

17:21

we'll get calls about goats

17:23

and sheep and other

17:25

species that may

17:27

need to come into the hyperbaric

17:29

We'll send them to the equine chambers

17:31

in the area to get their therapies .

17:33

I was just thinking , if I have a dog that I take care of , and he's 175

17:36

pounds , and I was like , oh no , they'd have .

17:38

this Might

17:40

not fit in our chamber so well .

17:44

And then what about inner ear ? Because I know

17:46

some , I've heard of people using

17:48

it . For I guess it's kind

17:50

of a two-part question . One do we

17:52

have to be worried about animals that maybe have chronic

17:54

ear infections or have some sort of compromise

17:57

to their eardrum or to panic membrane ? Then

18:00

the second part of that question is what about using

18:02

it in cases for deafness

18:04

that's acquired ?

18:05

Yeah , yeah

18:08

, so in people they

18:11

can more easily tell us if they have increased

18:13

pressure in their ears and discomfort from

18:15

that pressurization , just like if we were to

18:17

get on a plane and our ears in pressure specifically

18:19

affecting the ears and the tympanic membranes

18:22

. Sometimes we will see dogs that just

18:24

as we're increasing the pressure

18:37

above like five to seven PSI

18:39

so pretty low in that range where we're trying

18:42

to get to therapeutic levels that

18:44

they'll yawn or shake their heads

18:46

, but once we get past that point

18:48

they're fine . So , as

18:51

best as we can tell , we don't seem

18:53

to have concerns about

18:55

discomfort and increasing pressure

18:57

. That being said

19:00

, we always monitor our patients throughout the

19:02

sessions and especially for patients that

19:04

may have deep ear disease

19:06

or chronic ear disease , if we see signs

19:08

of discomfort we may choose to do a lower

19:10

pressure treatment for them , or that

19:13

may just be a treatment that's not most

19:15

appropriate for them and we might have to think of other things

19:17

that we can do for them . As

19:20

far as acquired deafness , I

19:22

guess it kind of depends on what

19:25

the actual cause is . If

19:27

there is inflammation within the inner

19:29

ear , again maybe it could be

19:31

helpful for that . Sometimes

19:33

we see deafness more as part of that cognitive

19:35

decline in our aging patients . So again , perhaps

19:38

that increased oxygenation to

19:41

the brain could help to

19:43

either slow , potentially

19:45

reverse those signs , but

19:47

it's something that , I'd say

19:49

we don't know for sure .

19:57

So why do we think that it hasn't quite made its hyperbaric oxygen chamber therapy

19:59

, hasn't quite made its way into more veterinary offices ? Why

20:01

is it still something that's kind of on the outskirts

20:03

, Even though it's been like

20:06

almost 20 years ?

20:07

you're saying , yeah , yeah

20:09

, that's a great question . I think

20:11

it is something that is

20:14

still not well known . Yeah

20:16

, so we don't have a lot

20:18

of research about it and

20:21

it is a pretty big investment for a

20:23

clinic to obtain . It

20:25

does require a dedicated , trained

20:27

person to run the chamber . So I

20:29

think a lot of it is just lack of knowledge and

20:31

lack of awareness and

20:33

, um , lack of understanding

20:36

of what all it can be used for . So

20:39

I think , um , one of

20:41

the goals that we have at university of florida

20:43

is encouraging

20:45

people that are using these chambers to

20:49

participate in collaborative

20:51

research , to to , you know , share

20:54

what they're treating , what they're using their

20:56

chambers for , even if it's just , as

20:58

you know , little write-ups

21:00

on patient successes , case

21:02

reports . And in

21:04

the meantime , we're working on bigger

21:06

projects where we can maybe

21:08

prove that it works well for a particular indication

21:11

, or find out how it's working for

21:14

some disease process

21:16

and be able to publish that in journals

21:20

and textbooks and share

21:22

that with more of the veterinary community from that aspect

21:24

. But

21:26

, like I said , it is a little bit of a commitment as

21:29

far as the cost of the chambers

21:31

, the dedicated people that have to run it . But

21:34

I think once the chamber is installed

21:36

and once people realize all of the different

21:38

things that they can use it for , then a

21:41

lot of places that have them are like why did

21:43

we wait so long ?

21:44

You have a few more , so I I

21:46

think even

21:48

one just in terms

21:51

of like treatment

21:53

protocol , because I myself was

21:55

surprised by the number of , and

21:58

the term that I heard people using was dives . So

22:00

, like , every session that they have is a dive

22:02

.

22:03

The number of dives and sort of the way

22:05

that you organize them in

22:08

terms of the timing yeah

22:11

, yeah , so for different indications we may

22:13

do different protocols as

22:16

far as the frequency and the total number of

22:18

sessions , and a lot

22:20

of what we're basing this off of is what they do in human

22:22

medicine as well as where we don't

22:24

necessarily have human treatment

22:26

protocols determined , then we're

22:29

working off of what's been determined

22:31

in research settings at this point

22:33

and seeing what works for our patients and going

22:35

from there . So our typical

22:38

protocol that we start with at University of Florida

22:40

is three sessions

22:42

daily . So over the course of three

22:45

days they receive one session a day

22:47

and for a lot of our

22:49

spinal cord injury patients

22:51

we start to see that clinical

22:54

improvement after that time and then

22:56

switch to other types of therapies for them

22:58

. For

23:00

wound management we may do a

23:02

very different protocol . So for wounds

23:05

we might do up to twice a day for

23:08

as many days until we see significant

23:11

healing of that wound . So they're

23:13

often a much longer course of treatment

23:15

and , like I said , potentially

23:17

even more frequent . Instead of the once

23:19

a day we might do it twice a day for them

23:21

. In some places they'll even do three

23:24

times a day , separated each

23:26

session by about four hours

23:28

to make sure that the body has time to kind of

23:30

recalibrate , return to normal

23:32

pressurization , allow

23:36

the healing energy

23:39

to kind of take effect , everything settles

23:41

down , and then repeat that session

23:44

, like I said , up to three times a day . For

23:47

other indications oftentimes

23:50

we'll kind of work them down to a maintenance . So

23:53

one of the conditions that we

23:55

relatively commonly treat in Florida

23:57

, unfortunately , is oomycete

24:00

infections , pythium and lagenidium , which

24:03

can cause pretty significant

24:05

skin wounds or

24:07

intestinal and

24:10

other internal masses , and

24:13

unfortunately there's not a great definitive

24:16

treatment for it . But what we

24:18

found is that the hyperbaric

24:20

sessions can help to reduce the inflammation

24:22

that's associated with that . So what

24:24

we do have done for those patients is

24:26

we'll do a

24:29

week or two of daily treatments

24:31

and then get them down to

24:33

three days a week , two days a week

24:35

, once a week , just to kind

24:37

of maintain that reduction

24:40

in inflammation associated with those wounds

24:42

. So that's a very specialized

24:45

condition that we , like I said , unfortunately

24:47

have to see and treat in Florida . It

24:50

may not be as common elsewhere .

24:52

I know I was like can you say that again ?

24:56

So it's an oomycete infection

24:58

. It's most

25:00

similar to a fungus .

25:02

That's what I was thinking in my head . It has to , yeah .

25:05

Yeah , but the two species of oomycete

25:08

that we see are Pythium and Laganidium .

25:10

Wow , that

25:13

doesn't sound fun , poor guys .

25:16

Not so much , yeah

25:19

, but those protocols definitely vary

25:21

with what clinical indication that we're treating

25:23

.

25:24

Are there any really , I guess , like interesting

25:27

or unexpected outcomes

25:29

or cases like something where you guys were like , okay

25:31

, no one's really done it for X condition before

25:34

and then used it and saw good results

25:36

or kind of any out of the box

25:38

cases that you'd like to share

25:40

?

25:42

Sure , I wouldn't necessarily

25:44

say out of the box , but something that hasn't

25:46

really been looked at on the human side , which

25:48

is where we try and get a lot of our information

25:51

before we choose to do it in our veterinary

25:53

patients . We've

25:55

had pretty good success in treating these

25:57

patients with multifocal osteoarthritis

26:00

. They've already

26:02

been receiving a slew of other therapies

26:04

through rehabilitation oral

26:07

analgesic medications , supplements

26:10

, oral

26:14

analgesic medications , supplements and they still have been having significant mobility

26:16

dysfunction , significant pain and kind of as a last-ditch effort

26:19

we say , well , let's see what hyperbaric can do

26:21

. And we've had pretty good outcomes

26:23

with them feeling a lot

26:25

better , having more energy and

26:27

osteoarthritis

26:30

as well as lumbosacral disease . So

26:32

those were two kind of surprising

26:34

indications

26:37

that , like I said , we just haven't had any information

26:39

on the human side really and we

26:42

have so many of these patients on the veterinary side

26:44

that we're treating on a daily basis

26:46

that again

26:49

it was a little bit surprising that

26:51

they hadn't responded as well as we would

26:53

have thought to other rehab modalities

26:55

that we do and yet adding in the hyperbaric

26:57

for them really made a huge difference . Some

27:01

other fun cases that I've had the opportunity to

27:03

treat we did have a

27:05

number of exotic

27:08

wildlife species that we've worked with

27:10

our zoo medicine service to help out

27:12

. So eagles , hawks , owls

27:15

, those are always just fun

27:17

because it's a little bit different than the dogs and cats . And

27:20

then we had a seahorse one time , which was

27:22

pretty cool too .

27:25

So we had a seahorse that

27:27

had gas bubble disease .

27:29

So basically the seahorse had the bends he

27:33

went too far down with . Um

27:36

, it's just , it's something that they can develop , that they

27:39

they normally should have some amount

27:41

of gas bubbles that change

27:43

in size as they change in pressure for

27:45

their swimming . But he was just a pet seahorse

27:47

that that couldn't regulate

27:49

those gas bubbles . We were able to do hyperbaric

27:52

to help him out , poor guy .

27:56

I'm sure he was very grateful .

27:59

For the arthritis cases , if there are people

28:01

because I know that there's a lot of people that end up

28:03

, like you mentioned , using so many different modalities

28:06

, so many different supplements , and then when they do

28:08

get to a point where they're refractory

28:10

to that treatment , what kind of protocol

28:13

does that look like ? Like are you seeing improvements after

28:15

just one or two sessions , or do they need to be

28:17

on more of a long term maintenance ?

28:21

So typically we do expect to see some

28:23

benefit after even

28:25

one to two sessions for the

28:27

patients that will benefit from that therapy . So

28:31

for our osteoarthritis patients we

28:33

were doing it one to two times a week

28:35

initially and if they showed a benefit

28:38

, then doing it on a kind of as

28:40

needed frequency . So for some patients that

28:42

might be weekly . For other patients we

28:44

might be able to get them down to every other

28:46

week . If

28:48

they're not needing it every other

28:50

week , if they're doing well in between longer

28:53

than that , then it's probably something that they

28:55

had a flare up . We've now gotten

28:57

them back to a more stable point and

28:59

they don't necessarily need it ongoing

29:02

, but we can always use it if they have another flare

29:04

up again .

29:04

It'd be helpful

29:06

for my dog . He's got osteoarthritis

29:09

for sure . Yeah , yeah .

29:11

And then the other thing that I thought was really

29:13

interesting is how

29:16

hungry , because I've had two patients

29:18

that have undergone Ceres and they

29:20

are starving after treatment

29:23

and they had warned me about that . But

29:26

can you talk a little bit about like the underlying

29:28

reason ?

29:30

for that , but can you talk a little bit about , like , the underlying

29:32

reason for that ? Yeah , that's interesting . I can't say

29:34

I've seen that as much and that may

29:36

be because we tend

29:39

to have our patients that are hospitalized

29:43

. They're on IV fluids , they're

29:45

getting fed quite frequently throughout the day

29:47

, but my guess would be that

29:49

just the increase in oxygen as well

29:52

as it is a rather humid

29:54

environment in the chamber , there's a lot

29:56

of airflow in the chamber so that could cause

29:59

some increased thirst

30:01

as well as increased hunger , that

30:03

we're just supercharging their

30:05

metabolism and they come out of there

30:07

ready to eat and drink and they come out of

30:12

there ready to eat and drink .

30:17

Are there any ? So would that be considered a side effect

30:19

? I guess ?

30:19

that would be . It's probably a good side effect , maybe

30:22

Not

30:24

necessarily a bad thing . Yeah , exactly . So if we had a patient that was , you know , in the hospital recovering

30:26

and they often don't have the best appetites because

30:28

of surgery , pain , maybe

30:31

some medications they're on Certainly coming out of the

30:33

chamber and being willing to eat would be a good

30:35

outcome for those guys yeah .

30:38

We talked about on that same vein . We talked about

30:40

chondroindications , but did we talk about side effects

30:42

? Are there any side effects ? I would assume not

30:44

really yeah .

30:45

Yeah , we haven't talked about that yet and

30:47

there are a couple of side effects to be aware of

30:49

and certainly for

30:51

pet owners that are thinking

30:54

about this , they should definitely talk to their

30:56

veterinarian about the potential

30:58

risks for their particular pet

31:01

. One of the main side effects

31:03

that is really not problematic

31:05

, kind of goes back to what we were talking about

31:07

with ear disease , that we can

31:10

have kind of that

31:12

barotrauma which can

31:14

be ear discomfort . People

31:16

will report teeth pain , chest

31:20

pains . We really don't recognize

31:22

those things in dogs or cats , aside

31:24

from , like I said , maybe they yawn

31:26

, they shake their head . It seems to be

31:29

short-lived and not cause them any lasting

31:31

discomfort . The

31:34

more concerning side effect that we

31:36

have that is very uncommon

31:39

but we do very occasionally see it

31:41

is oxygen

31:43

toxicity . That oxygen

31:46

is typically a really good thing but sometimes

31:48

too much oxygen can be a bad thing

31:50

and

31:52

in particular it causes seizures

31:55

. So we

31:57

cannot predict which patients may

31:59

have a seizure in the chamber but

32:02

it does seem like females

32:05

specifically , dogs

32:07

and older patients

32:09

may be at greater risk of it's

32:14

something that is

32:16

really scary to hear

32:18

about , to see it happening

32:20

, but ultimately

32:22

it doesn't cause any long-lasting effects

32:25

in those patients , so they are not at risk

32:27

for having seizures after being in

32:29

the sessions . We've actually

32:31

continued to do additional sessions

32:34

for patients that have had a seizure in the

32:36

chamber and they've never gone on to have a second

32:38

seizure . Patients

32:40

that already have a history of seizure don't

32:43

seem to be the ones that have that happen more

32:45

often . So it's scary when

32:47

it happens , it's scary to think about , but

32:51

it happens . We can't predict who it happens

32:53

to and we have to kind of outweigh

32:56

the potential of that risk happening

32:58

versus the much greater

33:01

potential benefit of hyperbaric

33:03

oxygen therapy for a particular patient

33:05

, a particular indication .

33:07

Right , like with any treatment

33:10

or any medication Exactly , exactly

33:12

. Dr

33:14

Lindsay , did you have more questions ?

33:17

I guess my only other question is about the intervertebral

33:20

disc disease dogs so

33:22

I know it's , I'm sure that acute

33:24

, like they just had the

33:26

change in their health status and having them

33:28

, as soon as they're stabilized , undergo the

33:30

therapy is probably most advantageous

33:32

. But is there any

33:34

, I guess , information

33:37

or history on dogs that have

33:39

had it maybe for a longer period of time , or

33:41

, like dachshunds , that tend to be repeat offenders

33:43

? Is there any , I

33:46

guess , benefit in treating

33:48

them Like , let's say , they've been trying other management

33:50

styles for a while and not seeing responses

33:52

, would it still be appropriate to

33:54

consider going through a series of treatments

33:57

?

33:57

appropriate to consider

34:00

going through a series of treatments Based

34:04

on how hyperbaric works . Definitely the thought would be that it's more beneficial

34:06

to those patients that have just had an episode because that

34:09

injury has

34:11

caused ischemia or decreased oxygen

34:13

flow

34:15

through the spinal cord . So once

34:18

we have more of these chronic injuries

34:20

it may still be beneficial

34:22

to promote healing , but

34:25

likely it becomes

34:27

less beneficial , has less potential

34:30

for true healing as

34:32

time goes on . So

34:36

definitely ideally catching those

34:38

patients early on after they've had

34:40

an injury or , for our recurrent

34:42

patients , before re-injury , would

34:44

be best for those guys . In

34:47

addition to intervertebral disc disease

34:49

patients , we'll also very commonly

34:52

use it for patients that have had the non-compressive

34:55

type myelopathies , so the

34:58

fibrocartilaginous embolism , fce

35:00

or spinal stroke and

35:03

other similar , where

35:05

they don't truly have disc compression

35:07

. For these patients

35:10

surgery isn't beneficial to them . So

35:12

conservative management , rehabilitation

35:14

is really the most beneficial

35:17

treatment option and we

35:19

will often do hyperbaric for those patients as well

35:21

, because they're still dealing with the same

35:23

reduced oxygen delivery

35:26

to those tissues and they need to improve

35:28

oxygen to promote healing . So

35:30

we've found that to be very helpful for them as well

35:32

, again in that more acute phase of

35:34

the injury .

35:36

What about vestibular disease ?

35:40

That's a good one .

35:41

So it's going to depend on the underlying cause

35:44

of the vestibular disease . For

35:46

patients with maybe those deep

35:48

inner ear infections we kind of already touched on that

35:50

earlier that could help with the inflammation

35:52

that's associated with both the ear

35:54

disease and then affecting those

35:57

nerves . For

36:10

patients that have that idiopathic , that old dog onset of vestibular disease , we don't ultimately

36:12

know why that happens still . So there's thought that it may be a component of cognitive dysfunction

36:15

, which again we've talked about the

36:18

thought that increasing oxygen to the

36:20

brain is probably a very good thing for those

36:22

patients . So

36:24

certainly could be helpful for those guys

36:27

. In general , for patients

36:29

that have nausea

36:31

, I do find that they can have

36:33

increased nausea in

36:35

the pressurization of the chamber . So

36:37

for vestibular patients that still have

36:40

significant rolling

36:43

dizziness nausea , I would probably

36:45

wait until they were feeling a little bit better , but I

36:47

do think that that could be beneficial to them a

36:49

little bit down the road in their recovery . And

36:53

then , if we're dealing with something

36:55

like a cancer causing

36:57

the vestibular event , a lot

36:59

of times that does have something to do with

37:01

inflammation . So

37:03

again , could hyperbaric be helpful to reduce the inflammation

37:06

associated with that

37:08

cancer and then reduce

37:10

those clinical signs . It's not going to be curative

37:12

in that case , but could definitely be

37:14

helpful for them .

37:16

I have one more kind of specific question , because I feel like this is another

37:19

case where a lot of people don't have the

37:21

best in terms of options for their

37:23

patients is the saddle

37:25

, thrombus and kitties . So

37:29

basically , Charlotte , do you know about that at all ? I

37:31

don't . So there are some cats

37:34

that it's oftentimes secondary to heart disease

37:36

. They will have a clot that will

37:38

get stuck basically in the vein that

37:40

feeds their back legs and so they'll go

37:42

from being fine one moment to just

37:44

not being able to use their back legs at all and they're

37:47

extremely painful and there's not a

37:49

lot of treatment options

37:51

that we often have . And this

37:53

can affect I'm not going to say any age of cat , but

37:55

it could in theory . It's not just something

37:57

that we see in older cats , so it tends to really

37:59

take a lot of people by surprise when it does happen

38:02

.

38:04

Yeah . So the again

38:06

idea of how hyperbaric oxygen therapy

38:09

works . It is something

38:11

that we do suspect should be beneficial

38:13

to these cats with saddle thrombus that they

38:16

are dealing with a lack of oxygen

38:18

and blood flow to their

38:21

back legs and

38:23

by increasing the oxygen delivery

38:26

to those tissues we should be able to

38:28

help reduce pain , improve

38:30

that blood flow restarting

38:32

in those areas and

38:34

maybe help to manage their pain . Ultimately

38:37

, those cats are often

38:39

kind of limited by

38:41

our ability to manage their

38:43

pain , so it's definitely

38:46

a tricky disease process to

38:48

manage , but I do think that hyperbaric

38:50

could be a beneficial part

38:53

of their entire therapeutic treatment

38:56

plan , of their entire therapeutic

38:58

treatment plan . I've not seen any

39:00

studies come out about it Again

39:06

. Unfortunately , there's just not a lot of research specific to the veterinary side . So we're always

39:08

reaching towards what's being done on the human side and trying to correlate their

39:10

diseases to ours , that we see

39:12

in our patients , and it's

39:14

something that we've done a small

39:16

handful of cases here at

39:19

UF , but just not enough for me

39:21

to say that it's definitely helpful or

39:23

definitely not .

39:25

Got you . And then , from your perspective

39:27

, can you compare ozone

39:29

to hyperbaric oxygen a little bit , because it seems

39:32

like medical ozone therapy , because it seems

39:34

like they are almost at least in the same

39:36

arena compared to the other treatments

39:38

that a lot of us are using in integrative

39:40

medicine . But do

39:42

you see a place where you would use both , or

39:44

is it usually more than

39:46

the other , or just case selection based ?

39:50

Given my training in hyperbaric , I exclusively

39:53

reach for that . I don't use ozone just

39:55

because it's not something that I've done or

39:57

am as familiar with , but

40:00

the idea between both of them is similar

40:02

that we're trying to increase oxygenation

40:05

to tissues . The benefit

40:07

of hyperbaric oxygen therapy

40:09

is that pressurization that

40:11

we can deliver to the entire

40:13

patient at one time and

40:16

that increase in oxygen delivery to

40:18

the entire patient at one time . So we

40:20

are not restricted by being able

40:22

to access a particular

40:24

area , access a particular

40:27

internal organ . We

40:29

can reach that treatment to

40:31

every single area of the patient all at

40:33

once , which is a little bit different

40:35

than ozone . Therapy is typically more regional

40:38

, so

40:41

that's kind of the benefit is that we can do a whole body

40:43

treatment . So we may be indicating to treat

40:45

, you know , the small wound that we can see

40:47

, but we're actually benefiting that entire patient

40:49

all at once . And a lot of

40:51

times , even if we

40:53

see something small and

40:55

focal , there's systemic changes

40:58

that are happening throughout the entire body in

41:00

response to what we can see . So

41:03

by treating the whole patient we

41:06

can have a much greater effect on

41:09

the particular treatment or the particular

41:11

disease or injury that we're treating .

41:14

That makes sense . That

41:20

makes sense . Um so , as a pet parent , if I'm listening to this podcast episode , how do I and

41:22

I think that this is a therapy that might benefit that something's happening

41:24

with my pet how would I seek out and find

41:26

somebody who does this like is

41:29

there a resource that we could go to

41:31

or it's ? Do we just talk

41:33

to our veterinarian or our regular

41:35

old veterinarian , or how would we find this modality

41:37

or this therapy locally

41:40

?

41:41

Yep , there's a couple different ways . For sure , I

41:43

think definitely talking to your local

41:45

veterinarian is a great place to start , but

41:49

the particular

41:51

chamber that I use is

41:53

HVM and you can

41:55

go to their website and they have a list of

41:58

all of the veterinary hospitals

42:00

that have their particular

42:02

chamber , so that's a great resource

42:04

. There are other chamber

42:06

brands out there as well , so a

42:09

pet parent can always just Google search

42:11

hyperbaric oxygen therapy for

42:13

dogs , for cats , and that

42:15

should lead them to a resource

42:17

that they can find someone local to them . Like

42:20

I said , it is definitely a growing

42:22

therapy option , so sometimes

42:24

it might be a little bit of a drive away for

42:26

some people , but I

42:28

think can definitely be a worthwhile treatment

42:31

for a lot of different disease processes .

42:33

And this is not something that we could do on

42:36

our own . We need to do this with a licensed professional

42:38

. Yeah , correct , that is a something that we could do on our own . We need to do this with a licensed professional . Yeah .

42:40

Correct . That is a good question , because we

42:42

do get calls . People

42:44

who are familiar with sports

42:47

athletes or sometimes

42:49

human medical professionals will have

42:52

in-home hyperbaric oxygen

42:54

like the soft-sided versions

42:57

, and we do not recommend those

42:59

for our veterinary

43:02

patient uses for a couple of reasons

43:04

. One is that they're not being performed

43:06

by a veterinary professional

43:08

, so this is a therapy that you should really

43:10

leave to your veterinarians , who know

43:12

what they're doing . Those soft

43:14

sided chambers could theoretically be

43:17

popped by our dog's nails or

43:19

teeth , true , so we don't want to cause

43:21

any injuries from that rapid

43:24

depressurization if that were to happen

43:26

. Yeah , and then those

43:28

soft-sided in-home chambers

43:30

are also a much lower pressure

43:32

than what we can do in a hospital

43:34

setting . So we really don't

43:36

know the potential for therapeutic benefit

43:39

of those chambers

43:41

for clinical use for

43:43

actual treating diseases . So don't

43:45

recommend those . They're essentially not medical

43:47

grade yeah . Got it Right , exactly

43:50

.

43:50

Got it . Well , that makes sense , so

43:52

don't try this at home . Well , thank

43:54

you so much . Do you have anything that you want to add ? This

43:57

was fantastic .

43:59

Yeah , I think .

44:00

Yeah .

44:01

Yeah , no , I think that was great .

44:04

Dr Lindsay , do you have anything that you want to add ?

44:06

No , thank you so much . I'm

44:08

really hoping that this will open people's eyes because , at

44:10

least in our area because Charlotte and I are both

44:12

in Los Angeles there's two dermatology

44:15

clinics that each have a machine , and so

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I've known of clients

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and patients that have utilized it . But going

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through the experience myself as a pet parent was

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very interesting and they were incredibly

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knowledgeable and made us feel very safe , and I was

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so grateful to have your assistance

44:30

with that as well . So Excellent

44:33

.

44:34

Yeah , thank you , I appreciate this and I appreciate you

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taking the time out of your day to chat

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about this with us . So