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.
Watch the Podcast
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
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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Recent HBOT News
Clinical Trial – HBOT Late Radiation Tissue Injury
Background: Radiotherapy is a common treatment for many malignancies. Radiation-related
complications developing months or years after radiation treatment are known as late
radiation tissue injury (LRTI) and are estimated to effect 5%-15% of all long-term survivors
who have received radiation.
Hyperbaric oxygen therapy (HBOT) is a well established treatment of LRTI. Most of the studies
evaluating effect of HBOT on LRTI are focused on survival, resolution of tissue damage and
improvement in LENT-SOMA scale. Very few studies have addressed effect of HBOT on pain in
LTRI. Krahn and colleagues were the first to report the analgesic effect of HBOT in 3 cases
of refractory pain in oncological patients with radiation soft tissue injury. Other studies
showed significant improvement in pain intensity in patients with breast cancer and pelvic
malignancies treated with HBOT for LTRI. In patients that had developed radiation- induced
brachial plexopathy, HBOT elicited an increase in warm pain thresholds and a reduction in
lymphoedema. A prospective case study of 16 patients with gynecological cancer found no
changes with respect to pain and depression outcomes. A trial in patients with radiation
induced proctopathy showed that 75% of patients with rectal pain had some improvement,
although none experienced a complete resolution of pain symptoms.
There are several mechanisms by which HBOT may elicit analgesic effects. There is a growing
body of evidence that HBOT’s analgesic effect related to nitric oxide metabolism and
endogenous opioid secretion. Furthermore, the inhibition of tumor necrosis factor alph
(TNF-α), the production of substance P, and the modulation of serotonergic pathways have all
demonstrated a modification in the pain response following HBOT. In animal studies HBOT
decreased allodynia and hyperalgesia in different models of neuropathic and inflammatory
pain. The long lasting antinociceptive effect of HBOT was found to be dose-dependent in
non-injured tissues.
In human studies, HBOT decreased pain and edema and improved function in patients suffering
from the complex regional pain syndrome, and improved pain scores and range of motion in
patients with idiopathic femoral head necrosis. Women suffering from interstitial cystitis
demonstrated a reduction in pelvic pain following weeks and months of HBOT treatment. In
patients suffering from idiopathic trigeminal neuralgia HBOT produced a rapid reduction in
symptoms and these effects were lasting for 6 months following treatment. HBOT was also found
to be an effective treatment for cluster headaches and migraines and alleviated muscle and
bone pains in patients with myofascial syndrome, fibromyalgia, and biphosphonate-related
osteonecrosis of the jaw.
Based on the evidence presented above and HBOT’s known analgesic effect in many conditions,
the investigators designed this study with the objective to evaluate if HBOT reduces pain,
improves depression and impacts on patients quality of life in patients suffering from late
radiation tissue injury.
Study Design: Prospective observational study (n=300). Patients that have had radiation
therapy for malignancy, developed late radiation injury and suffer from chronic pain.
Clinical Trial – HBOT in Fibromyalgia
Fibromyalgia (FM) is a chronic pain condition affecting several millions of Canadians.
Although the etiology and pathophysiology are poorly understood, there is a well-recognized
association between muscular pain in fibromyalgia and muscular hypoperfusion, hypoxia,
abnormal muscle metabolism and oxidative stress. Currently there is no cure for FM.
Pharmacological and non-pharmacological strategies are directed to control symptoms such as
pain, fatigue, non-restorative sleep and depression.
Hyperbaric oxygen therapy (HBOT) is an intermittent inhalation of 100% oxygen in a hyperbaric
chamber at a pressure higher than 1 absolute atmosphere. Physiological effect of HBOT is
based on a dramatic increase in the amount of dissolved oxygen carried by the blood which
enables oxygenation of ischemic areas with compromised circulation. It also activates
oxidant-antioxidant system, stimulates angio- and neurogenesis, modulates inflammatory
response, induces brain neuroplasticity and possesses analgesic effect.
While some interventions offer benefit for some patients, additional treatment alternatives
are needed for patients with FM in whom currently available options are either ineffective or
poorly tolerated. Given its physiological effect, HBOT could be considered as a potential
therapy for treatment of underlying muscular hypoxia, optimizing oxidant- antioxidant system
and controlling FM symptoms. The results from this study could therefore provide new
information supporting the basic science underling the pathophysiology of this disease and
stimulate novel therapies for patients suffering with FM.
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