HBOT Conversations:
Tom Fox (Part 1) 

 

Tom is the Research Physiologist for the Hyperbaric Institute for Research and Training, a division of Island Hyperbaric Centre in Pincourt QC. He has worked in the field of Clinical Hyperbaric Oxygen for the last 30 years, and has been intimately involved with the implementation and the development of the US Army’s Clinical Hyperbaric Service at Dwight David Eisenhower Army Medical Center.  Tom is a senior army aviator and flew twelve years as a Medical Evacuation Pilot for the US Army. 

Tom joined the Extivita-RTP team in 2022 as the Safety Director, and is joining us in a 2-part series to discuss the history of Hyperbaric Oxygen Therapy and dive into his personal experience healing patients with HBOT.

Subscribe. Join the discussion. Share the hope.

Watch the Podcast

We appreciate HBOT historian, Tom Fox, returning to HBOT News to dive in deeper to the history of Hyperbarics, which we can date back to the 1660s!

Tom explains that in the 1830s, the first clinical use of hyperbarics was used and introduced, this revived Nathaniel Henshaw’s concept of Hyperbaric treatments.  Nathaniel Henshaw, a clergyman, built a sealed chamber in 1662. Henshaw believed that the application of higher pressure (hyperbaria) was good to treat acute conditions, and that lower pressure (hypobaria) would be better to treat chronic diseases.

1662, Henshaw’s “Domicilium” hyperbaric chamber

This is an interesting fact, because now we’re learning that the cyclic use of hyperbaria (or relative hyperbaria) and hypobaria is very intriguing in what it’s doing from the standpoint of physiology. Tom mentions Dr. Efrati and his group of researchers have been at the forefront of looking at this, and are doing a phenominal job of conducting the hyperbaric studies and getting the hyperbaric education out there. There’s been very limited commitment to do this, he commends Dr. Efrati and his group at Tel Aviv for all they do for the HBOT industry.  What you will witness throughout the history of hyperbarics is that they’ve used slightly pressurized room air, and that’s important to know because the slightly pressurized room air has consistently been assumed not to have any effect.  It’s even offered up as a control in many of the studies, like the placebo.  But the problem is when the placebo helps and the treatment helps, it’s easy to say that the reason both groups are getting better is because of the “participation effect”, or it being “in their heads”.  And Dr. Efrati is bringing all this to light. This information is also changing the way the HBOT industry looks at the application of air breaks within the protocols.  The use of air breaks was thought to fight oxygen toxicity, but now it’s used to establish a relative hypoxia without going into hypoxic conditions.  Host di Girolamo then breaks all of that information down for the viewer to better understand…

So to paraphrase that, you’re breathing pure oxygen and also now you’re breathing air, your body says, ‘oh, oxygen’s depleting, you’re suffocating.’ All these mechanisms occur in your physiology, and then the body’s like, ‘Oh, no, everything’s okay. We have plenty of oxygen.’ So that five minute air break triggers that, and then he’s doing it, I think, three or four times in a 90 minute treatment and it ends up being therapeutic.

Continuing down the timeline of HBOT and fascinating discoveries in the 1800s, Tom Fox brings up a series of articles, Lectures on The Compressed Air Bath and its uses in the treatment of disease, that appeared in the British Medical Journal, dated April 18th, 1885 by a doctor, Theodore Williams.  Tom reads the first paragraph from the first article:

“The use of atmospheric air under different degrees of barometric pressure in the treatment of disease is one of the most important advances in modern medicine. When we consider the simplicity of the agent, the exact method by which it is applied, and the precision with which it can be regulated to the requirements of each individual, we are astonished that in England, this method of treatment has been so little used.” – Theodore Williams

That was almost 150 years ago. Back then they were just taking air and putting you under pressure.  Now it’s a breakthrough medical treatment, and it’s still not being used in the manner that it could/should be.  Almost 200 years ago we were on the cutting edge of medicine!  And today we still have to fight to explain that even slightly pressurized room air has a therapeutic benefit — using pressure for healing purposes has literally been happening since the 1600s.

Now we approach the 1900s in the HBOT history timeline. One of the most famous (and LARGEST) chambers is discussed, the Cunningham Ball, by Dr. Cunningham.  Dr. Cunningham clearly saw the benefits of Hyperbaric Oxygen Therapy and basically risked his entire career/life, and life savings to help people and prove the benefits. Doctor Cunningham was an anesthesiologist by trade, inventing circuits that are still in use and still patented by anesthesiology. In the 1918s, with the last pandemic of the Spanish Flu, Dr. Cunningham made the observation that there was a higher mortality rate when you went to Denver, as opposed to when you were at sea level, because of the pressure and oxygen changes. Ultimately a Spanish Flu patient in Denver was getting a lower dose of oxygen because of the lower air pressure. Dr. Cunningham even saved the life of one gentleman who was turning blue by simply treating with hyperbaric air. This lead to the dedication of $1M in funds to build the famous Cunningham ball, which was almost like a pressurized six story hotel that people would live in for a month or other extended periods of time.

Apparently, Cunningham had some difficulty justifying it all by scientific standards, and this was a very new concept in US medicine.  The world had never seen anything like it!  Unfortunately, Cunningham fell victim toa unusual amount of scrutiny, and was eventually shut down with the chamber being sold for scrap metal during World War II.

So many people now see the value in Cunningham’s efforts and what he contributed to the HBOT industry. Finally, his work can be interpreted as vindication of the God-given miracle of oxygen and pressure to heal our bodies and minds.

Guests

Elena Schertz, NP

Thomas M. Fox, MAS,MS, CHT - Safety Director at Extivita RTP & Research Physiologist for the Hyperbaric Institute for Research and Training

Tom is the Research Physiologist for the Hyperbaric Institute for Research and Training, a division of Island Hyperbaric Centre in Pincourt QC. He has worked in the field of Clinical Hyperbaric Oxygen for the last 30 years. During this time, he has been intimately involved with the implementation and the development of the US Army’s Clinical Hyperbaric Service at Dwight David Eisenhower Army Medical Center. He has provided contract hyperbaric services since 1997. Prior to accepting his current position in Quebec, Canada, Mr. Fox served as the Chief of the Atmospherics Branch of the U.S. Army School of Aviation Medicine, Fort Rucker Alabama. In this capacity, he was responsible for hyperbaric/ hypobaric operations and training of US and NATO aviators, flight surgeons and flight medics. Mr. Fox is a senior army aviator and flew twelve years as a Medical Evacuation Pilot for the US Army.

Tom joined the Extivita team in 2022 as the Safety Director, helping Extivita to maintain a healthy and safe environment for exceptional patient care.

Subscribe Now, It’s Free!

[contact-form-7 id="65934" title="Subscribe"]

Recent HBOT News

Clinical Trial – Haemodynamic Effects During Anorectal Surgery: a Comparison of the Jack -Knife and Lithotomy Position

Background and Goal of Study: Minimal dose of spinal hyperbaric bupivacaine is commonly
performed for adult anorectal surgery. This kind of anaesthesia can cause sinus bradycardia
and hypotension wich reason is body position, autonomic nervus system reaction, reflex
reaction even with low levels of sensory block. However, neither the publication of minimal
doses of spinal hyperbaric bupivacaine effects of haemodynamic modifications nor their
accuracy was widely discussed. The aim of the study is to make a comparison of the
haemodynamic modifications due to minimal dose of spinal hyperbaric bupivacaine for adult
anorectal surgery in lithotomy or jack knife position of steering impedance device.

Materials and Methods: Patients will be included which are over then 18 years old, who
underwent anorectal surgery of the benign pathology, requiring spinal anaesthesia, were
admitted in this clinical randomized study, hospitalized in Hospital of Lithuanian University
of Health Sciences Kaunas Clinics and agree to participate to this study (written
settlement). All patients were implicitly divided in to 4 groups by the position will be
operating (lithotomy or jack knife position and by American Society of Anaesthesiologists
(ASA) clas I-II and III-IV). Technique of anaesthesia were strictly standardized by protocol.
All patients were premedicated with oral diazepam 5mg and diclofenac 100mg 60min before
operation. After arrival in the operating theater peripheral vein 18 or 20G catheter was
inserted, infusion therapy were started with crystalloid 5-7ml/kg/hour. Standard monitoring
was used, including noninvasive arterial blood pressure (BP), electrocardiography (ECG),
heart rate, peripheral oxygenation. Circulatory changes were recorded impedance device. 2
single-neck sensors connected vertically on both sides of the neck just below the ears lobe.
Another pair of sensors attached on both sides of the chest processus xiphoid axillary line
level. Thorax allows a variable electrical current, it travels through the lowest resistance
(blood-filled aorta) and resistance is measured. For each heart contraction during changes in
blood volume and velocity. Accordingly, replacing the resistors obtained by impedance
settings.

Haemodynamic variables were recorded in patients in the use of impedance cardiograph:

1. arrives in the operating room;

2. seating on the operating table;

3. following the puncture;

4. 10 min after spinal puncture;

5. was laid in lithotomy or jack knife position;

6. in the beginning and the end of the operation;

7. patient was placed in the bed.

Each measurement was monitoring and recorded the following data( ar findings):

– Cardiac output (CO);

– Systemic vascular resistance (SVR);

– Systolic index (SI)

– Cardiac index (CI);

– Acceleration index (ACI);

– Heart rate (HR);

– Non-invasive systolic (SAP), diastolic (DAP) and mean (MAP) blood pressure;

– Peripheral oxygenation (SpO2); Patients were placed in the sitting position on the slab
(operating table) back to the doctor. Dural puncture was made at L3-L4 or L4-L5 with 27G
Tamanho spinal needle ( BBraun, Germany) by medial punction in aseptic condition, before
the punction was injected lidocaine 1% subcutaneous. 0.5% 4mg of heavy bupivacaine and
0.01% 10µg fentanyl were injected over 2 minutes after free flow of cerebrospinal fluid
was obtained. After sitting for 10 minutes ( sensory block was checked by the dermatomes
with the methods of cold sensitivity) patients were asked to lie in the position wich
operation will be done (lithotomy or jack knife position).

After 20 min. surgery was started. When anaesthesia was imperfect, 25-100µg of fentanyl was
given IV. General anaesthesia will be give in case of failure . These cases will be value
like a failure, patients will be exclude from the study.

Clinically significant hypotension will be define as a mean arterial blood pressure and heart
rate decrease of 20% below baseline values. Systolic arterial blood pressure will reduce to
90mmHG limit, intravenous ephedrine 5-10 mg will be injected. If heart rate will reduce to 45
bpm, bradycardia will be treated with atropine 0,5 mg IV.

Combined free tissue transfer for the management of composite Achilles defects: functional outcomes and patient satisfaction following thigh-based vascularized reconstruction with a neotendon construct.

Abstract:  Functional outcomes and quality-of-life measures following salvage reconstruction of composite Achilles/posterior leg defects are limited. We present our experience with combined Achilles defect reconstruction utilizing free tissue transfer with...