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Pressure treatmentCostly high-oxygen therapy still in investigational stageFriday November 23, 2001
The healing power of pressurized oxygen has long been acknowledged for deep-sea divers suffering "the bends" and for other emergency infections and injuries treated in hospital.
Now, the potential of hyperbaric oxygen therapy to treat diseases like stroke, cancer or multiple sclerosis is being promoted in new private clinics popping up across Canada and the United States.
However, despite claims that the therapy can curb the damage of stroke and other debilitating diseases, the costly treatment remains scientifically unproven.
"The fact is there are no sound, valid scientific studies that support that use," said Dr. Fred Lapner of Health Canada's medical devices bureau.
But "you don't know until you try it," hyperbaric technician Mike Snaidero claims.
Snaidero, formerly a commercial diver, is clinical director of Toronto Hyperbaric Inc., a Mississauga clinic that opened a year ago.
He spoke recently to the Cambridge and District Stroke Recovery Association in Preston's Golden Years Nursing Home.
During hyperbaric oxygen therapy, a patient sits in a closed chamber that is filled with pure oxygen at high pressure -- up to six times the normal atmospheric pressure.
The gas therapy has been used successfully for years to treat divers with decompression sickness, more commonly known as the bends.
Oxygen under pressure floods the patient's blood, spreading its natural healing properties and even allowing it to reach parts of the body where blood no longer flows easily.
In Canada, hyperbaric oxygen therapy is licensed by Health Canada for treating conditions such as decompression sickness, gas embolism, carbon monoxide poisoning, traumatic injury, burns, radiation damage, severe anemia and some kinds of chronic or severe infections such as gangrene.
OHIP covers hyperbaric treatments in those emergency situations when it's prescribed by a physician.
But it is not licensed in Canada to treat neurological conditions such as cerebral palsy, multiple sclerosis, migraine and strokes, or other illnesses such as cancer, Lyme disease or AIDS.
Lapner said some anecdotal reports from patients suggest they found hyperbaric treatment helpful, but no scientific studies using strict research guidelines and quantifiable data have appeared.
Before a hyperbaric oxygen chamber can be imported or sold in Canada, Health Canada inspects the device to ensure it is safe, effective and that the manufacturer doesn't make any fraudulent claims about therapeutic value.
All advertising claims must be supported by clinical data before it's licensed, Lapner explained.
But once a chamber is licensed for approved clinical use, it can be used for "investigational" treatments of conditions not approved by the federal government, such as stroke.
That's allowed because care provided by medical professionals is governed by provincial ministries of health, which enforces standards of care.
"The difficulty is if you don't know it's going to work and these people are already sick, is it fair to charge money for the treatment?" Lapner asked. "To me, it's a troublesome ethical issue."
At Toronto Hyperbaric, each one-hour session costs $100. In his talk in Cambridge, Snaidero suggested that at least 40 sessions (four or five sessions a week) are needed to see improvements, which would be a $4,000 investment.
Some people, he said, need hundreds of treatments, boosting the price tag to upwards of $20,000.
The audience, including many who have suffered a stroke, seemed interested in the novel treatment.
However the cost was a big issue, especially since there's no guarantee the treatment works. Norma Rudy, volunteer co-ordinator for the association, organized the session to provide members with information about the new treatment so they could evaluate it for themselves.
After three years of experience, Snaidero said he has found the power of hyperbaric oxygen treatment is unpredictable, sparking slight improvements in most patients and remarkable improvements in a few.
Sometimes the benefits are as basic as improved balance or concentration. Sometimes the benefits linger, sometimes they don't.
"It's not a miracle cure on its own," Snaidero said.
He said hyperbaric oxygen therapy should be combined with traditional treatment such as physiotherapy, nutritional counselling, occupational and speech therapy, depending on the ailment.
"This just gives them that extra push," Snaidero said.
The majority of his patients are children with cerebral palsy who experience a decrease in muscle spasticity after hyperbaric treatments, which makes physiotherapy easier.
On its Web site and brochure, Toronto Hyperbaric says oxygen therapy may benefit a long list of conditions considered "investigational," such as neurological, heart, skin and eye conditions, chronic fatigue syndrome, Lyme disease, head injuries, near-drowning and HIV-related fatigue, to name a few.
Snaidero said he believes hyperbaric oxygen therapy has great healing potential, but admits there is a lack of hard evidence.
He said it's difficult to achieve a true placebo effect in an hyperbaric chamber, as opposed to the ease of comparing sugar pills with the effect of new drugs.
Lapner warns that beyond the questionable therapeutic value, there are potentially deadly dangers in hyperbaric therapy.
"There's an inherent risk in the use of these devices," Lapner said. "You can very quickly have a medical emergency."
Emergencies such as a seizure are difficult to deal with because it takes several minutes to decompress the chamber before anyone can open the hatch to help the patient.
As well, oxygen under pressure can quickly spark a fire.
At Toronto Hyperbaric, the clinic's doctor is not on site for patients' investigational visits because his supervision is not covered by OHIP.
He screens patients first, but it is the hyperbaric technician who administers the actual treatment.
Before considering hyperbaric oxygen treatments, Lapner advises people to check the credentials of the physician and facility, ask if the chamber is licensed and if it met provincial safety standards during the most recent required inspection.
ON THE NET
For more information check out:
Health Canada fact sheets at www.hc-sc.gc.ca/english/iyh.htm
Toronto Hyperbaric at www.torontohyperbaric.com
The Undersea and Hyperbaric Medical Society at www.uhms.org
©Kitchener-Waterloo Record 2000
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