Joey Wahler (Host): It's used to treat a wide variety of medical conditions. So we're discussing hyperbaric oxygen therapy, also called HBOT. Our guest, Glenn Butler. He is founder and CEO of Life Support Technologies Group. This is Riverside Radio HealthCast from St. John's Riverside Hospital. Thanks for listening. I'm Joey Wahler.

Hi there, Glenn. Thanks for joining us.

Glenn Butler: An honor. Thank you very much.

Host: Same here. You've got a business that you have turned into something that helps many, many people. So first explain to us the connection between your company, Life Support Technologies Group, and St. John's Riverside Hospital.

Glenn Butler: Well, it's an honor to be affiliated with St. John's Riverside. We've been involved with hyperbaric oxygen therapy for a number of years and, along came an opportunity to work with St. John's and we're very happy to be there.

Host: And you founded your company way back in 1984, I believe. Briefly, Glenn, what was your background and how did you get into the hyperbaric oxygen field?

Glenn Butler: Great question. I was involved with military and commercial diving research and field work for a number of years and as I got a little bit older and decided that I'd rather be home more often with my young son. So I switched over and took the technology of hyperbarics used for diving and then used it for medical purposes. And I started working with hospitals in the New York Tri State area.

Host: Well, I asked for a brief background. You certainly gave me that, but I'm sure that the reality of how you went from the diving world into the medical field is a lot more involved and complicated than that. Right?

Glenn Butler: Sure is, it'll be a long story, a lot more than 30 minutes, but I'm happy to answer anything you want.

Host: Sure. Well, very impressive indeed, to say the least. So for those uninitiated, what in a nutshell is hyperbaric medicine? How does it work in the body for the lay person like myself and many of those listening?

Glenn Butler: Another excellent question. Right now, all the oxygen you can transport in your body is attached chemically to your red blood cell, your hemoglobin. And that gets transported around and jumps off and feeds your body with oxygen for metabolism and picks up carbon dioxide and it takes it back to your lungs and you exhale.

Under hyperbaric conditions, you actually now can dissolve oxygen in the plasma or liquid part of the blood, just the way you would dissolve carbon dioxide in a bottle of soda. So that allows you to carry many, many more times, six times the amount of oxygen in your blood and to transmit it around to the body.

And at those levels, it is both cital to bacteria and virus. And it also helps promote healing in an accelerated manner.

Host: And speaking of which, we'll get into some more details in a moment, but give us please an overview of the conditions that HBOT treats.

Glenn Butler: There are 14 indications approved by Medicare and Medicaid, which is our guideline that we work with. And many commercial companies, insurance companies, also operate within that, in that area. And that would begin with acute infections, diabetic foot ulcers, at risk for amputation, late effects of radiation, bone infections and then consequences of surgery or trauma where there's been some reconstruction or something done traumatically. Everything from mastectomies for breast cancer to trauma from a motorcycle fall where there's tissues that are injured and as part of the repair process, we add hyperbaric oxygen to the plan of care to help accelerate the healing process.

Host: And you mentioned their diabetic patients in danger of amputation. Can HBOT help to avoid that?

Glenn Butler: Yes. That is one of the leading causes of loss of limbs in the world right now. Diabetes is at rampant epidemic proportions, especially among our veterans. And so diabetes destroys the small blood vessels starting with the feet. And the small blood vessels begin die off, and therefore blood flow to the, with nutrients, the things that your body needs to heal itself, are, begin to decline.

If you get, and you also lose sensation in your feet, as part of this process. So patients can step on a nail, or bang their foot, or do a variety of things, don't know they've done that. And now the injury can't heal itself, becomes infected, and then therefore they're at risk for amputation if it isn't caught early enough. So it's one of the main areas of where we can make contributions to help avoid amputation and help people with diabetes get on to a normal, long, happy life.

Host: Wow. That's pretty amazing. So this treatment Glenn, is also used for various types of infections. Which ones does it address?

Glenn Butler: There's a, the primary group of infections that we deal with is something called osteomyelitis or bone infections. Those are very prominent, a lot more prominent than you may think. They can occur in both diabetic foot ulcer, where the bone gets exposed, from fractures and from other sorts of trauma, motorcycle fall or a fall in your house where the bone becomes infected. So, it's very difficult for antibiotics alone to treat those sort of infections because there's very poor flow of blood and other nutrients to the bone area. So it's tough for antibiotics to do much good.

The adding hyperbaric oxygen, which is transparent to the tissues, goes right through the bone and right to the infection and helps eliminate that. Other types of infections that we deal with are gas gangrene, which is a true anaerobic infection, which means that it lives without oxygen and oxygen actually kills it.

So in patients that have gas gangrene, which is fairly rare, they can be, you can kill the infection and with surgery help them get over it. Another type of infection which is devastating is called flesh eating infection or necrotizing fasciitis. That's a very fast moving infection that moves up the leg muscles and or arm muscles and can go from the foot up into the knee and leg in a matter of hours. And so those sort of infections are one where hyperbarics added with hyperbarics and surgery is life saving.

Host: Hyperbaric oxygen is also used to treat patients that suffer injuries from radiation treatments as well, right?

Glenn Butler: Another great question. You're right in there. Yes, so the late effects of radiation, one of the consequences of that is that good blood vessels also get injured with the bad tissue. So the good blood vessels, just like in diabetes, become injured. And that's small, small blood vessels carry nutrients to the tissues and irradiated tissue has less blood flow.

It tends to get harder, leathery, and it can even spontaneously begin to decompose or fail. So some patients have injuries like a sunburn that goes away, that's had prostate cancer resection or something like that. And they have some late effects of radiation, but it's like the sunburn and goes away.

For other patients, six months or a year or two years later, that the tissue that was irradiated, the good tissue, begins to fail. And this can happen in mastectomies, prostate cancer, any one of a number of areas where the tissue is irradiated; some of the surrounding tissue can also be injured and eventually fail. So that is late effects of radiation.

Host: Gotcha. So, Glenn, switching gears a little bit, paint a picture for us here, please. During treatment, what's the basic setup at St. John's Riverside Hospital? How many hyperbaric chambers are there, and how often and how long are these treatments typically?

Glenn Butler: Yeah, we have largest facility in the Westchester area, and we have four large 36 inch diameter chambers. And those chambers are rated for three atmospheres and we're able to compress patients. We have private areas for changing your clothes. We don't go in street clothes.

We go into, in scrubs. Move to the chamber, get it vitalized, get it checked for blood pressure and so forth. If everything is fine and there's no problems and the patient has adequate, if they're diabetic, we check for their blood glucose levels and then the patient will be pressurized.

And it's a lot like going in an airplane. We train the patients how to do it. And they watch TV for about an hour and a half and, or sleep and relax and decompress back out. And then we do this for five days a week for about an hour and a half uh, two hours a day, five days a week. So it's a significant commitment, but it's also a unique therapy that does unique things.

Host: Well, of that, I think you've certainly demonstrated there's no question. So, how long a duration of time does this usually go on for?

Glenn Butler: Patients can be treated for two or three treatments, let's say for carbon monoxide poisoning or for up to 60 treatments for late effects of radiation. The national average for all indications is about 30 to 35 treatments total for all the indications on the average.

Host: Okay. And so you mentioned people can be watching TV just like they would at home while they're getting the treatment. What, if anything, does the patient feel?

Glenn Butler: There's really no sense of being in an airplane. So you feel a slight difference in pressure in your ears, and a little bit of water, but air flowing around. And it's really quite a pleasant experience. I've been a patient myself for 150 times, so, I've enjoyed it. It's a great way to catch up on movies and get some sleep.

Host: That's amazing. So it's like being on the airplane without, of course, occasionally getting stuck on the tarmac, right, Glenn?

Glenn Butler: Yeah, no, it's nice and private. It's like getting first class treatment on an airplane.

Host: Okay. Couple of other things. Medicare and commercial insurance, do they cover this usually?

Glenn Butler: Yes, they do. Medicare and Medicaid have 14 indications that they approve of, including diabetic foot, late effects of radiation, different kinds of infection. All the most current and most incidence of types of infections are covered by Medicare, Medicaid, and from that, commercial insurances also cover some things that are outside that, such as some sports injuries and so forth like an Achilles tendon is a good example. That can take a long time to heal if it's ruptured and surgery does one thing, but it's, there's not much blood flow or oxygen back in that area. So we add hyperbaric oxygen to that, it heals faster.

Host: And finally, how would someone go about being assessed for whether they're a candidate for hyperbaric oxygen?

Glenn Butler: We have a very direct pathway right into the St. John's Riverside through the wound care service. We have physicians there that will just simply call in to the Wound Care Center and the Wound Care Center will take you from there, to make an appointment, assess your situation, your indication, and then have you evaluated by one of our physicians, and then if it's appropriate for you, you may receive Wound Care plus hyperbarics, let's say in a diabetic foot situation, you're also receiving once a week diabetic foot care as well as a hyperbaric therapy on a daily basis.

Host: All right. Well, folks, we trust you're now more familiar with hyperbaric oxygen therapy. Glenn Butler, as you said, you're not just the owner of Life Support Technologies Group, you're also a patient yourself, kind of like the owner of the Big Razor Blade Company years ago, who loved the razor so much he bought the company, right?

Glenn Butler: That's right, that's right. Well, it's been a tremendous asset for me. It's really helped me personally and it's a real joy to watch so many people get benefit from it, and it's one of the best things, career moves I ever made because it's very satisfying to take care of patients and help people get better.

Host: It sounds like it, I'm sure it is. From the diving world to the medical field, helping people to heal. Glenn Butler, a pleasure. Thanks so much again.

Glenn Butler: Hey, thank you and thank you St. John's Riverside. Thank you very much.

Host: Absolutely. And for more information, please call St. John's Riverside's Physician Referral Service, 914-964-4DOC. That's the number 4 DOC, or email FindADoc, D O C, at RiversideHealth.org. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to Riverside Radio HealthCast from St. John's Riverside Hospital.