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Mild HBOT - The Importance of Frequency
Of all the variables to discuss concerning hyperbaric therapies, frequency is the most overlooked and undervalued component. Yet, if you search the literature and research, you will find that it is the one common thread... Regardless of the pressure, the oxygen concentration, and even the duration of the sessions, if a certain frequency and total number of treatments is not met, the chance of a successful treatment program will be quite low. Just as with pressure, oxygen concentration, and duration... a lot of misinformation and blindly followed protocols have found themselves prevalent throughout the industry.
The first one I would like to discuss is the idea of five days on, two days off. Many practitioners who prescribe mild hyperbaric therapy recommend a protocol of five days of treatment (sometimes twice per day), followed by two days off treatment. Why? Does the equipment need a break, or does the patient need a break? Maybe it was the staff that needed a break! That's right, this protocol is descendant of the protocol used in an outpatient clinic. Since most clinics are not open on Saturday or Sunday, the patient was given a program of five on, two off. So really, it is the staff that needed the break... not the patient. Consider six days on, one day off to simply be a slight modification of this; or itself a descendant of a center whom is open on Saturdays. Remember our earlier statement about asking questions. Go ahead, ask this question to the practitioner who is recommending the day or two off per week, "Why do we need to take a day or two per week?"... Their response will probably allude to the risk of hyperperfusion. Of which, you can respond to the vague response with another question, "Could you show me the case studies or research that suggest this possibility?"... Trust me on the next part... They don't have any case studies or research to indicate this potential. They simply regurgitated assumed information that was passed down to them from some other individual whom also failed to seek out the truth. Note: This is not to say there isn't a risk; but rather research does not support it and that the history of the weekly days off does not stem from research but rather clinic economics.
The second one I would like to discuss is the idea of a month on and a month off. Please, answer this for me... What does a lunar cycle have to do with hyperbaric medicine! If it has anything to do with hyperbaric medicine, shouldn't we be starting and stopping our treatments on specific days of the cycle to better optimize the benefits. Maybe... who knows... I'm certainly not going to discount the possibility! The reality however, is that we aren't factoring the lunar calendar into hyperbaric protocols, so where then does this concept of thirty days on and thirty days off come from? Answer, Travel and the Magic Number Forty. Before the prevalence of hyperbaric medical facilities, especially those that would offer therapy to individuals suffering from various neurological conditions, patients had to travel to locations that offered the therapy. Forty treatments, or forty hours of therapy (again, not so specific) became known as a benchmark. Patients whom only achieved ten to thirty (hours/treatments) prior to taking a break (traveling home and then returning to the facility after a month or two) would seem to regress and lose many of the benefits they had gained over their initial treatments. In contrast, those who had reached thirty to forty treatments/hours seemed to retain more of the benefits they had achieved during their initial course of therapy. As a result, the protocols evolved into twice a day, five days per week, for four weeks. In other words, forty treatments in a month! Without understanding why the treatments were discontinued after a month (travel), practitioners have blindly recommended that therapy be put on "halt" for a period ranging from a week to thirty days before once again continuing therapy. So, the question one must ask is if a patient were local to such a facility, would they still need to take a "break" after forty hours... Absolutely not! In fact, it really is counterproductive in many ways. Any time you take a break, there will be some degree of regression in any vascular tissue suffering from hypoxia. The reason for this is due to the loss of oxygen to cells that are dividing into the hypoxic zone. Until the tissue has undergone complete reperfusion, these cells have no permanent supply of oxygen to support cellular division and tissue repair. If you take away the artificial source of oxygen (the hyperbaric environment) before the body repairs the vascular system to these cells, dysfunction will once again slowly return. This month-on, month-off protocol has been further perverted by the hyperbaric rental industry, but this time out of convenience to the rental company/physician. If each patient is only allowed one month at a time, it becomes very easy to plan the availability of the unit for the next "customer", or as medicine likes to call "patient". On the other hand, if hyperbaric units were out for an undetermined length of time based on results and patient response (more on this later); planning future reservations can become quite difficult. So, the majority of those who rent chambers do so with strict protocols because they are promising the treatment device to someone else in a specified period of time. Hence, one month on... one or more months off! Once again, ask for the research or even case studies that validate or even suggest a month off would be advisable for some scientific reason! Just like pressure, oxygen concentration, and duration; it would seem that the frequency component is literally drawn from the same hat in most cases... After all, why four weeks, and not five or six? Why not some abstract number of days of treatment such as fifty-seven days? Answer... Economics of travel and business!
So what if you buy a hyperbaric chamber or rent a hyperbaric chamber from a company who won't constrain you to a specific period but rather allow you to keep the unit as long as treatment calls for? What then, how long should treatment persist for? Answer, until those evaluating the therapy have deemed no further benefits can be achieved from the current program, or upon the observation of negative side-effects. Let's discuss a few scenario's to highlight the type of thinking we truly wish to avoid.
Scenario #1 A stroke victim is recommended to undergo therapy for thirty days; twice a day, weekends off. They rent a chamber for thirty days from their physician to undergo home treatment. During the first three weeks, little change or benefit are noticed; in fact, the patient and supportive family are beginning to become discouraged. Two days before the end of the prescribed thirty day period the patient begins to notice some miraculous improvements in strength and coordination. However, without argument, they return the chamber at the end of the thirty day period upon request of their physician with plan to rent the chamber again thirty days later as was originally planned with their physician. The Problem: Without any indication of negative side effects, the patient was forced to discontinue therapy when exactly the opposite began to occur. Sometimes it takes time to get the "ball rolling", why stop the ball once you get it started! Everyone is different and different people with different conditions take more or less time to react to various treatments.
Scenario #2 A family purchases a mild hyperbaric chamber for their daughter who was in a motor vehicle accident with hopes of regaining lost function from the combination of hyperbaric and other adjunctive therapies. Their physician recommends they undergo forty treatments and then take a break to re-evaluate the therapy and progress. After forty treatments in-home, the family has noticed little improvement in their daughters condition and decides to sell the equipment in disbelief the therapy is of any potential benefit. The Problem: The idea of the "Magic Number Forty" as I like to call it, was never designed to be a point for determining the efficacy of the treatment. Unfortunately, many have been turned away from what could have held tremendous promise because they were lead to believe that within forty treatments "Magic" would occur. Forty treatments was designed to be a benchmark in regards to a "suitable" time to take a break should it be necessary for travel or other unforeseen events. Note: I used the term "suitable" not "mandatory". Just as in quitting after getting the "ball rolling", quitting before you get the ball rolling is even worse; especially if it is forever!
In these two scenarios we highlighted a lot of the problematic thinking that surrounds this industry. What is missing most in treatment is evaluation by individuals who understand the therapy; not by individuals who simply heard it could be good and so added it their practice without consideration to protocol or patient. Treatment recommendations without historical and scientific understanding for their basis do more harm than good to an already scrutinized industry.
So the question still remains, what is the ideal frequency of treatment? Answer, unless the patient presents with reason to take breaks, either weekly or monthly... There is no scientific basis for treatment not to be carried out seven days per week. In fact, think about the nature and science for just a moment. In most every condition that mild hyperbaric is utilized for; the primary goal is to get oxygen to tissues which would otherwise be starved of this vital nutrient. Regardless of the cause of the hypoxia and low tissue oxygen saturation, oxygen is necessary for the breakdown of fats and carbohydrates to produce energy at the cellular level. The average person consumes six pounds of oxygen per day and only half of that in water (at least those who are well-hydrated). We understand the importance of eating every day, taking our supplements and drugs every day, yet when it would come to supplying a vital nutrient to compromised tissue, for some reason taking two days off just sounded right! Well, it's wrong (at least until anyone proves otherwise)! Think of those days off as taking a step backward. Two steps forward and one step back. Or, five steps forward and two steps back.
The last concern in regards to treatment protocol is something we have already been pointing towards. How long should treatment continue for? The frequency of treatment is one thing, and if 40 treatments is only supposed to be a benchmark, how many treatments are necessary to ensure success. Well, as with each section that passes in this article, this answer is even more vague...
The fact is, there is a growing movement towards hyperbaric therapy as an effective tool in anti-aging medicine. In other words, utilizing hyperbaric therapy on a daily to near daily basis for the rest of one's life to help combat the effects of aging and to prevent the occurrence of conditions such as Parkinson's, Alzheimers, MS, etc. With this in mind, it is hard to say an end to treatment needs to be factored in. After all, if those who are well are beginning to use it daily... wouldn't it make sense that those who use hyperbaric medicine to become well should consider the same?
Of course, not everyone is going to be sold on the concept of hyperbaric therapy as a daily health practice. So the best advice I can give in regards to "how long treatment should continue for..." goes right back to evaluating treatment and designing and modifying the treatment protocol based on results. If we take money out of the equation, shouldn't we continue therapy until we are absolutely sure we have achieved any and all benefits towards recovery before discontinuing treatment; especially if no indications of negative side-effects present themselves? Answer, the author certainly believes so! Consider that healing takes time, and although hyperbaric medicine is shown to overcome barriers and speed the time to recovery, time is still a factor. It is not reasonable to believe that complete healing of any serious condition or injury should occur in one month time; however, it is reasonable to assume that some degree of healing and recovery should have occurred in three months time. So, if you have undergone months of therapy with little to show for your time, maybe it truly is time to move on or reconsider the other aspects of your protocol (pressure, O2 concentration, duration, frequency). On the other hand, if you have a month under your belt and are feeling discouraged in regards to the effectiveness of the therapy; please, stay positive and realize that you may not even be seeing the tip of the iceberg in regards to the future potential of the therapy.
Last thoughts in regards to long term care...
In conclusion...
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About the Author: Greg Harris is the founder of Hyperbaric Options LLC and has spoken publicly about health & wellness in various settings over the past eight years. Greg has a passion for human potential and is a firm believer that nearly all of the health problems we face today, from degenerative neurological conditions to the common cold, are preventable and reversible. As a health professional, Greg has a unique ability to connect the dots where others have left them scattered; it is this ability to integrate disciplines and think outside of the box that give his lectures and written materials a fresh point of view.
Disclaimer: The information and advice published or made available throughout this article is not intended to replace the services of a physician, nor does it constitute a doctor-patient relationship. Information contained within the following and/or preceding pages is provided for informational purposes only and is not a substitute for professional medical advice. The author encourages all readers to further research any topics of interest and reminds the reader that the comments and materials being presented do not necessarily constitute scientific fact and may contain opinions, theories, and third party views not widely accepted. You should not use the information contained in this published material for diagnosing or treating a medical or health condition. You should consult a physician in all matters relating to your health, and particularly in respect to any symptoms that may require diagnosis or medical attention. Any action on your part in response to the information provided throughout the material is at the reader's discretion. Readers should consult their own physicians concerning the information in this material. Hyperbaric Options LLC is not liable for any direct or indirect claim, loss or damage resulting from use of this material.