HBOT Conversations:
Tom Fox (Part 2)

 

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.

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In Part 2 of Ed di Girolamo’s conversation with Tom Fox, we dive further into the history of hyperbarics and how this all plays a part in where we are today in understanding, administering, and healing patients with HBOT.  Part 1 discussed HBOT history up to Cunningham’s ball in the 1920s.

We start our conversation discussing the time when operating rooms were essentially hyperbaric chambers.  Tom explains that was before the FDA, and they started using pressurized rooms and oxygen as an alternative method to do heart surgery and replace valves, because if you super-saturate the body during surgery you can extend the length of time that a patient can go without oxygen.  The time was upwards of 13 to 15 minutes, allowing the surgeon more time to do valve replacement.  This could have been a real game-changer for the HBOT industry, but it was short-lived because the bypass machine replaced hyperbaric operating rooms.

Then in 1963 the HBOT industry had a set-back. President John F. Kennedy had a premature son who had a condition that lead to a hypoxic event (lack of oxygen) following birth. The child was placed in a hyperbaric oxygen chamber at Harvard.  Initially, he did very well.  But, 60 years ago we didn’t know a lot about the toxic effects and the therapeutic limits of the use of oxygen. He was treated at a much greater pressure than physicians would treat people today, and this little baby was treated for extended time, up to 7 hours! So Hyperbaric Oxygen Therapy was seen in a negative light right after that, because as different physicians got involved in it, they said that it was HBOT that killed John F. Kennedy’s baby.  That incident made it difficult for the hyperbaric industry to bounce back into a positive light. Yet, there was a saving grace; thankfully around this same time and soon after Europe and the USSR were developing whole systems and procedures to administer HBOT.   They had hospitals in a former USSR that was using hyperbarics as their principal treatment; so when physicians here in the US wanted to treat with HBOT, they used a machine to translate a Russian manual, so they could get it right.

Moving forward, a lot of the physicians that were fostering and having great success treating with HBOT came out of the military. Tom explains that he has been in the HBOT industry for a long time, 31 years and he has been in the presence of some of the true pioneers in hyperbarics.

And then the Undersea Medical Society enters the picture…..

Tom explains, “Now in 1967, that’s kind of when the Undersea Medical Society came around, you know, what they did was they go, ‘Okay, this is the Wild West. We need to rein this in and we need to identify the rationale, why we’re doing this so that we can structure this into an offering in medicine, a therapeutic offering into medicine.’  And you had doctors like Dr. Kindwall, Dr. Hart, these are pioneers at the time that were instrumental in the formation of the new Medical Society.  You know, that was both a curse and it had a lot of positive effects, too. But the thing was they put hyperbarics and undersea medicine together, and that’s been a problem. It certainly prevents the thought of clinical hyperbarics progressing independently of diving medicine.

Next, the FDA worked together with the Undersea & Hyperbaric Medical Society, and together they produced a committee report that looked at the indications. The indications were a lot more than what we have today, and since then it’s been refined.

Tom stresses that there’s an art to properly using Hyperbaric Oxygen Therapy, and he states the following —

“In the right hands, hyperbarics can do wonderful things. In the wrong hands, most often it won’t do bad things, but it will not have the desired results.”

di Girolamo and Tom Fox further dive into the art of using hyperbarics properly, and even how incorporating things like a good diet and exercise will play just as much of an important part in a person’s health.  Tom stresses that HBOT is not a cure in most cases, but it can be an extremely useful tool to help someone get closer to their baseline.

The one thing that has stood the test of time is that no one can deny that HBOT is effective for hypoxia and inflammation.  Any indication that has those two conditions associated with it, can be positively affected by using Hyperbaric Oxygen Therapy. He ends this segment encouraging everyone to keep an open mind about the god-given miracle of combining oxygen and pressure.

“I think you’re going to find that whether you’re dealing with something currently or you may be having, you know, something going on that you’re not even aware of, HBOT is not going to hurt you. It’s a good option.”

 

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.

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Cerebral hypoperfusion, or insufficient blood flow in the brain, occurs in many areas of the brain in patients diagnosed with autism spectrum disorder (ASD). Hypoperfusion was demonstrated in the brains of individuals with ASD when compared to normal healthy control brains either using positron emission tomography (PET) or single‑photon emission computed tomography (SPECT). The affected areas include, but are not limited to the: prefrontal, frontal, temporal, occipital, and parietal cortices; thalami; basal ganglia; cingulate cortex; caudate nucleus; the limbic system including the hippocampal area; putamen; substantia nigra; cerebellum; and associative cortices. Moreover, correlations between symptom scores and hypoperfusion in the brains of individuals diagnosed with an ASD were found indicating that the greater the autism symptom pathology, the more significant the cerebral hypoperfusion or vascular pathology in the brain. Evidence suggests that brain inflammation and vascular inflammation may explain a part of the hypoperfusion. There is also evidence of a lack of normal compensatory increase in blood flow when the subjects are challenged with a task. Some studies propose treatments that can address the hypoperfusion found among individuals diagnosed with an ASD, bringing symptom relief to some extent. This review will explore the evidence that indicates cerebral hypoperfusion in ASD, as well as the possible etiological aspects, complications, and treatments.

Clinical Trial – Spinal Anesthesia in Caesarean Section

Spinal anesthesia is a safe technique, widely used and tested in the gynecological field, so
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obtain a valid sensor and motor block. Bupivacaine is one of the most widely used drug for
obtaining spinal anesthesia in pregnant women undergoing caesarean section. Bupivacaine is a
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enantiomer of racemic bupivacaine, is a slightly hypobaric solution compared to liquor and
has shown less heart and nerve toxicity, probably due to its ability to bind proteins more
rapidly, and a greater selectivity towards the sensory component compared to Bupivacaine,
presents action and effects better predictable. Its baricity would also offer the advantage
of providing a less sensitive block to the position.

Hypotension is one of the most common complications of spinal anesthesia and is particularly
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it can have repercussions on the fetus through a reduction of placental perfusion.

Some studies have showed a similar incidence of hypotension in patients treated with
bupivacaine compared to those treated with levobupivacaine, while others assert an
equivalence between the two drugs. In most studies, however, a significantly lower incidence
of hypotension and a greater hemodynamic stability were reported in pregnant patients
undergoing spinal anesthesia by caesarean section with levobupivacaine.

Being both hyperbaric bupivacaine and levobupivacaine routinely used at the "G. Rodolico"
Universitary Hospital of Catania for the spinal anesthesia of pregnant women undergoing
caesarean section and being their use decided exclusively at discretion of the treating
anesthesiologist, in the light of the discrepant data in the literature about the incidence
of hypotension with the two drugs, the main objective of this observational study is to
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elective cesarean section and to compare them with those mediated by hyperbaric bupivacaine
in an historical court of pregnant women subjected to caesarean section in the period between
April 2017 and April 2018. The hemodynamic parameters will be monitored in real time with a
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LifeSciences), routinely used in the "G. Rodolico" Universitary Hospital of Catania, allowing
to obtain greater accuracy and veracity of the results compared to previous studies conducted
on such anesthetics.