Amanda Wilde (Host): Welcome to The Pulse at Tallahassee Memorial Healthcare. In this episode, we're talking about hyperbaric oxygen therapy and how this innovative treatment is transforming chronic wound care. I'm Amanda Wilde. And my guest is vascular surgeon and osteopath, Dr. Christopher Griggs. Dr. Griggs, thank you so much for sharing your expertise today. First off, what is a hyperbaric oxygen chamber?

Christopher Griggs, DO: So, hyperbaric oxygen chamber is a large device where a patient is put inside a pressurized tube where they increase the oxygen and pressure in the tube to allow more infusion into the bloodstream. The pressure is two to three times normal atmospheric pressure, which will allow a significant increase in the oxygen absorption in the bloodstream.

Host: I feel like I saw something like that on Star Trek once.

Christopher Griggs, DO: You might have.

Host: How does hyperbaric oxygen therapy work then? How does it specifically aid in the healing process of chronic wounds?

Christopher Griggs, DO: So with the increase in the pressure, the body is able to absorb more of the oxygen. Chronic wounds, one of the main problems with the slow healing or the difficulty with healing of chronic wounds is a lack of appropriate oxygenation at the actual tissue cellular level, whether it be, you know, edema or poor blood flow or lack of blood flow to that specific location. And even in those scenarios with the increased oxygenation in the blood from the pressure and the increased level of pure oxygen, it allows more absorption into the bus stream, which will allow more blood getting to those compromised areas.

Host: Wow. What are the common types of chronic wounds that can benefit from this hyperbaric oxygen therapy?

Christopher Griggs, DO: The number one is probably the diabetic foot ulcerations. You know, diabetes is often associated with poor circulation and nerve damage, radiation injuries. You know, when people get radiation for, say, a cancer for example, it damages the structure of the tissue. The normal pathways for the blood flow, the arterial and venous flow are compromised and the increased oxygenation helps get that oxygen to those tissues better.

Another big one is called chronic refractory osteomyelitis or a bone infection that is not well-treated with antibiotics. In those scenarios, you typically have people on long-term antibiotics, most of the time IV, for approximately six weeks. If the infection's still in the bone at that point in time, then we can consider HBO therapy.

Host: Can you explain what the typical protocol would be for administering this therapy for chronic wound healing? Like, how many sessions are generally required?

Christopher Griggs, DO: Typically, it's a five-day a week protocol. The sessions themselves last anywhere from 90 to 120 minutes. And the number of sessions range from 20 to sometimes up to 60 treatments. This tends to be around 30 to 40.

Host: And how effective do you find HBOT to be in chronic wound management?

Christopher Griggs, DO: It's very effective. Actually, it's been shown to decrease healing times. It can decrease amputation rates. And the research has definitely reinforced the effectiveness of this treatment in, like I said, the chronic non-healing wounds or radiation injuries. It helps with collagen synthesis, which is one of the base structures for healing as well as angiogenesis, which is new blood vessel formation.

Host: Yeah. How do the hyperbaric oxygen chambers contribute to tissue regeneration at a cellular level?

Christopher Griggs, DO: A few different ways. It promotes stem cell formation and mobilization. The high pressure and the increased oxygen level, and that increased infusion of the oxygen into the bloodstream can trigger increased stem cell formation and mobilization up to 800%, which just gives a powerful boost to the body's natural regenerative processes; increased gene expression for all the tissues and growth factors needed for wound healing. Again, the increased pressure and oxygen levels in the bloodstream, kind of give that extra boost, as I said, to the cell to create more of what it needs.

Host: Really incredible. Are there any side effects, risks, or contraindications associated with the hyperbaric oxygen therapy that we should be aware of?

Christopher Griggs, DO: The main ones that people tend to experience are related to the pressure itself, whether it be what's called ear barotrauma or, you know, pain in the ears. You know, sometimes they feels like a pretty strong earache, up to even rupture of the eardrum. If you have any type of sinus congestion, that increased pressure can cause pain in your sinuses, similar to going up and down an airplane, the pressure changes in the airplane. Well, it causes pressure changes in the chamber itself, and you can get those sinus pressure changes as well. You can have what's called pulmonary barotrauma, which is where the lungs get injured. In the worst case scenario, you can have what's called a pneumothorax, which is where the lungs actually collapse.

The only, absolute contraindication for HBO is an untreated pneumothorax, meaning that you have this lung injury where you have air outside of the lung, but inside the chest cavity. And in that scenario, with the increased pressure, it can actually make that overall worse to the point where you can develop a potentially life-threatening condition called a tension pneumothorax, which definitely needs to be treated immediately. You can have oxygen toxicity, increase in the oxygen. In some cases, and it's rare, I don't know that I've ever seen it, to be honest with you over the years, where you get some visual changes, dizziness, seizures, that kind of thing.

Another common one that we have to treat for pretty regularly actually is claustrophobia, even though the chamber is almost like a big fish tank, where it's very large and has clear walls, people still-- since they are locked inside the tube, so to speak-- they do feel that feeling of confinement. And they can get claustrophobic inside the chamber.

The other conditions that we are worried about, but sometimes it's not that bad enough to not do the HBO would be like asthma or COPD and that kind of thing.

Host: How often do you see these side effects in terms of people who take the therapy well and people who have these other issues?

Christopher Griggs, DO: Most people do really well, actually. Probably the more common would be the ear-related issues. We actually send people to get tubes put in their ear. The Ear, Nose, Throat folks put in tubes, which will help equalize the pressure and decrease that risk for trauma to the ears.

Host: If people want to see more about what this is about, are there things we can see online with the hyperbaric oxygen chamber looks like and what it looks like to get the HBOT?

Christopher Griggs, DO: Oh, without a doubt. Yeah. There's many, many videos. There's many websites to talk about it, especially due to the fact that HBO is also used for people that have the bends from diving, like scuba diving. So, it's used for multiple things, not only for wound care, but also, you know, that type of scenario. So, it's pretty common out there.

Host: With all these applications of HBOT, do you see further potential for hyperbaric oxygen therapy in vascular surgery?

Christopher Griggs, DO: I do actually. With all the research that's going on right now, we keep finding more reasons to use it, more successful protocols for different disease conditions. We definitely need to follow the evidence-guided treatment protocols. There are unfortunately some places that dive people for inappropriate reasons and any of the-- I shouldn't say all, but many of the situations where there have been negative effects, such as the fires or the deaths that you hear on the news, a pretty good number of those folks are actually being dove for inappropriate reasons, unfortunately.

Host: Well, Dr. Griggs, this is an amazing technology. Thank you very much for sharing your insights and this valuable information about hyperbaric oxygen therapy.

Christopher Griggs, DO: Thank you.

Host: For more information on wound healing and hyperbaric oxygen therapy, please visit tmh.org/wound care. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to The Pulse at Tallahassee Memorial Healthcare.