You first learned about hyperbaric oxygen at a trauma center at medical school. Can you tell us a little about that early exposure to the therapy?
Dr Scott: I was in my third year of medical school at the University of Maryland. Your third year is when you start doing clinical rounds. I was right next door to a facility called the Shock Trauma Center in Baltimore, which is very well known around the world.
In the basement, they have a very large submarine looking hyperbaric chamber. And I remember being in the trauma bays and seeing this lady come in with necrotizing fasciitis, which is this terrible flesh-eating bacteria that tends to spread very, very fast and oftentimes kill people or kills their limbs. I saw this lady that had just gotten back from being in the hyperbaric chamber. And I remember the surgeons that were looking at her were shocked at how much tissue they were going to be able to salvage after just one treatment in the chamber and talking about doing several more to see how much more they were going to be able to salvage.
I was just flat out shocked that we were able to see the turnarounds that we did for these types of people. So it obviously got me very interested in the technology as a result.
After that first experience, how do you then go about transitioning to focusing your attention on hyperbaric, and all that it could offer people?
SS: Well, as I was working at the shock trauma center, I started doing more research. As synchronicity would have it, my father was starting to get interested in the technology in New York, where I grew up and he has a practice where he was using it for alternative practises. So I started looking at the research that was being done here in the United States and across the world, and how many potential indications it had, not only the 14 indications here in the United States, but also around the world in China and in Japan, as well as Russia, there were 60 to 70 indications. I started doing more research and realizing that there was a path forward. I had to finish my medical training, of course, and I ended up doing an internal medicine residency, where I would have a good foundation and all that, but I wanted to create a practice where hyperbaric therapy could be my focus; where I was also doing an integrative framework that included a lot of the stuff that I had known since I was a kid, and kind of developing a way to work with people in a more integrative framework where you kind of balanced and synergise things from the conventional side and also synergise things from the alternative side at the same time.
How have your opinions evolved over time re: the off-label uses of hyperbaric? Can you speak a little to how your stance has evolved to E.g. treat chronic illness using HBOT, as opposed to say, just acute sporting injury?
SS: Those are good questions. I think re: the on and off-label, what it really came down to for me was understanding the physiology of what's happening in a hyperbaric chamber. If you understand what's happening in the chamber, you understand how various conditions or situations can significantly benefit, even if they don't fall into a direct category of a condition that may be approved or even a direct category of a condition that may have even been studied. So if you have a base physiologic understanding of what's happening in the chamber, as a result of that, it became very obvious to me that it could be used for any number of things.
"it's not if hyperbaric therapy is going to be helpful, it's likely when; when it's going to be most helpful for you."
As I often say, it's not if hyperbaric therapy is going to be helpful, it's likely when; when it's going to be most helpful for you. So the second part of your question, which is a question really regarding the timing of hyperbaric therapy, is a big one. And this is something that I've learned a lot about over the decade I've been in practice. Initially I was burned a lot in the beginning when I did not really understand the framework that if you have an acute issue, hyperbaric therapy by itself can do amazing things without really any other therapies oftentimes.
"If it's an acute issue, hyperbaric therapy on its own can go a long way."
When it comes to inflammation, it can reverse low oxygen states, it can get some stem cells to release, it can fight infection, it can get the immune system activated, and it can help with lymphatic and detox. If it's an acute issue, hyperbaric therapy on its own can go a long way.
However, if it's a chronic issue, or if it's a long-term goal, where you want to have a long-standing benefit from something that you're trying to shift, say you want to reverse your age, or say you want to run in a race in six months and be at your best, then it's a different story, because how hyperbaric therapy works is by shifting your physiology, and you have to have the capacity to be able to do that. You have to have capacity to make energy, you have to have capacity to be able to detoxify, you have to have the capacity to make the therapy as optimal as possible, and then sustain those benefits after you finish hyperbaric therapy. For chronic issues or long-term goals, what it really does require most of the time, in my experience, is a foundational approach that looks at energy metabolism, it looks at detoxification system, it looks at sometimes hormones, sometimes the gut, and things like that, to try to get that stuff at least, if not before hyperbaric therapy, at least concurrently addressed to make sure that you can see long-term benefits for certain types of conditions.
You said before that using hyperbaric is not an ‘if’ thing - if it can be helpful - it is a ‘when’ thing - when it can be helpful. Could you speak to how someone could pinpoint the right timing in their healing journey for hyperbaric use?
SS: The challenge with timing and doing studies is that you have multiple different variables. It's very difficult to know what or which variable caused the move. So it's very difficult in the work that I do - in clinical work - to be able to say that you just have one or the other that's providing the benefit. If you just do one, it's better than two. If you do two, it's better than one because it's too many variables.
"...if I have somebody go into a hyperbaric chamber that has a chronic complex medical illness and they have done nothing to work with that chronic complex illness ...they do not do as well as somebody that's done a comprehensive analysis"
But in clinical practice, it's been pretty obvious over the decade that I've been doing this that if I have somebody go into a hyperbaric chamber that has a chronic complex medical illness and they have done nothing to work with that chronic complex illness except for maybe some conventional care and some medications, they do not do as well as somebody that's done a comprehensive analysis and working with a practitioner that specializes or has a specialty in something similar to what they have going on and then following them throughout the time and watching their recoveries. It's not subtle at all. And it's just because of the basic physiologic mechanisms that are happening in the chamber which are required for you to be able to benefit from being in there.
As I mentioned, if you can't make energy effectively and I'm giving hyperbaric therapy to a patient and I'm revving up their ability or their attempt at making energy but they can't, they're just going to make a lot of reactive oxygen species and oxidative stress. And that's not going to be good because they're also likely going to be antioxidant deficient. And that means that they don't have the capacity to balance out that oxidative load.
"...some people that start hyperbaric therapy and feel really, really, really bad. And that's not often a good sign."
And so some people that start hyperbaric therapy and feel really, really, really bad. And that's not often a good sign. I mean, sometimes people will feel mildly worse, that's okay.
But it shouldn't be so bad that it gets debilitating. And that's often because they need to be more supported. And so in Lyme, for example, I almost always recommend that a Lyme patient is working with a doctor that specializes in Lyme. Because if they are not, I can tell you from personal experience, doing hyperbaric therapy in patients with Lyme, especially in the beginning when I first started, we'd see people get a little bit better, but then their symptoms would recur. And so they had spent 40 hours in hyperbaric treatment protocol. And after two or three months, they were back to where they were before.
And they had a lot of pain and suffering along the way to get them a little bit better before they got back to where they were. So my sense of this is that when it comes down to truly doing the best we can for patients, we have to give them this context. And that's one of the bigger challenges in the hyperbaric community is that it's not that well described by other practitioners, especially clinics themselves, because if you have a hammer, everything looks like a nail.
Why do you think HBOT is arguably under-utilized at the moment in a world where we are progressively getting more and more sick?
SS: Yeah, that's a good question. I think that the financial piece is a big one. Chambers are not inexpensive. Going to a facility versus having one at the house. They're both expensive endeavors. And then the type of chamber that you get also changes the expense. I think the ability to personalize each treatment protocol is also in its infancy overall. As far as how that goes, typically you go to a facility, they're recommending 40 hours in the chamber over two months is like the standard for everybody kind of deal if you have a chronic issue. But what are you doing? My framework here is that I always want to say, let's take a step back here.
What are you doing before, during and after Hyperbaric therapy to leverage that technology? Or in the reverse, how are you using Hyperbaric therapy to leverage the other things that you are doing? And that's the framework that we need to think about. And that's how we can get to personalisation overall. So you can see what your timing is for the various things that you're doing, how that's going to affect your Hyperbaric treatment, how your Hyperbaric treatment is going to affect the timing of the things that you do.
And that's when you can really start personalizing things. And that's really what we're trying to do at OneBase because this is something that I've been doing in my clinical practice for, I mean, almost the whole decade that I've been doing this, but certainly for the last five or so years where there are very few people that understand how best to bring all these technologies together. And most of this is a physiologic plausibility argument.
There's no studies here. But over time, as you get more experience, as I have had more experience combining these things together, there's definitely significant ways where you can leverage and stack things together in a pretty comprehensive way to make significant gains faster if you're doing it.
Is there a particular success story of resilience through adversity that you think really speaks to hyperbaric’s ability to help those who have tried every other healing modality, only to see no progress?
SS: I think that a group of patients that really does stand out would be those that have come in for concussion-related symptoms. There is very little that the conventional community is doing for these people. And it's really just sad, honestly, because there's so many different things, especially now, but even five years ago, that we knew could help these patients. Five years ago, conventional doctors were recommending you stay in a dark room for several days after a concussion and don't do anything. And now at least that has changed a little bit. But I've seen kids that are 12 and 13 that have suicidal ideation. They can't go to school. And after a Hyperbaric protocol, they were back to doing everything they were doing before.
"A veteran, who was getting nightmares with PTSD from the Vietnam War... He started doing Hyperbaric therapy for his PTSD, TBI symptomatology. And in two weeks, his nightmares stopped for the first time since Vietnam."
I had a veteran once where he was getting nightmares with PTSD from the Vietnam War. And he came in, this is like maybe 10 years ago, one of the first patients I saw, and that's why he's memorable. And he started doing Hyperbaric therapy for his PTSD, TBI symptomatology. And in two weeks, his nightmares stopped for the first time since Vietnam. I was just shocked by that. And these stories kept happening and keep happening over and over and over again.
And so with traumatic brain injury especially, I've seen some amazing saves over the years. I've seen a lot of benefits with stroke patients as well. There's not much we can do after the first 90 days of a stroke in the conventional world. And I've seen amazing recoveries even many years later from stroke symptoms, especially cognitive symptoms.
So it's a great population to get in the chamber. The faster, the better. But even after three, six months, even several years, we can still see significant benefits. I've also really enjoyed working in the athletic world and the performance world because these people are really involved in their health and they care about staying at the top of their game. So I've worked with NFL athletes who use the chamber pre-and-post various types of practices, but definitely before games with significant benefit. I've had people with lots of rings on their fingers doing this for years and years with significant benefit.
I've worked with tennis players and major league baseball and NHL players. And to recover from injury, I mean, if you can come back in 40% of the time, meaning 40% faster, is huge for these kinds of people. And then, of course, it's huge for the rest of us if we don't have to be walking around and not able to do the things that we want to do. So the ability to recover faster in the chamber from an injury is dramatic, especially if you're looking to integrate other therapies together. So these are things to think about.
Can you tell us a bit about how HBOT can change gene expression? How it can help you re-build the scaffolding of your tissue?
SS: This just means that the longer the protocol, so the more that we're doing over a period of time, what we're seeing is a shift in how your genes are being expressed. That’s epigenetics. It's epigenetic expression. The genes that are responsible for growth; genes responsible for decreasing inflammation, genes that are responsible for decreasing the death of cells and tissue are all increased. As a result of that, you have a healing environment that's being cultivated as a result of being in hyperbaric protocol. That healing environment and protocol are recreating the architecture or the scaffolding of your tissue. It could be new stem cells or baby cells in the area to make new cells of that type of tissue, new blood vessels, new connective tissue, new collagen, new bone, new heart, new neurons. You just name the tissue and hyperbaric therapy can help develop that tissue in a particular area. That's why I call it rebuilding the scaffolding.
What do you believe the effect of addressing modern-day, multi-systemic inflammation could be?
SS: Inflammation is very common for acute stress. Exercise causes inflammation, causes a breakage of tissue that the body then has to respond to in various ways to create shifts in those genes that I mentioned before and also create a stimulus to remodel tissue and immune system activation along with overall antioxidant response at the same time. What you're looking at with inflammation is when that first part keeps happening and the rest of the parts don't work in conjunction to be able to decrease inflammation. When chronic inflammation happens, the whole system starts to break down. The breakdown starts with the immune system and then also depletes our ability to have antioxidants in the system. And then our body is just more subject to increase stress because we don't have the ability to rebound from it. And so what inflammation ends up doing in the end is disturbing mitochondrial function or the base part of the cell that makes energy. And when that starts happening, the cell starts making less energy and then it becomes a vicious cycle where you're making more stress on the system. There's more inflammation. It's not able to deal with its own inflammation and it just kind of gets out of control and worse and worse. And symptoms continue to develop over, over time. And what hyperbaric therapy can do is that it can decrease the. The chemicals in the body that are responsible for maintaining inflammation and it does that. By working on that genetic expression that I was mentioning before, and as a result can down-regulate the whole inflammatory process, rebuild mitochondrial function at the same time.
"The key with hyperbaric therapy is integration"
In your opinion, how can HBOT work synergistically work with things like supplementation, diet and other healing modalities?
SS: The key with hyperbaric therapy is integration, as far as I'm concerned. Even if it's an acute issue, the more integration you can do, the more likely you are to have a result.. Again, I can't put that in a study because you're doing multiple things together. But if you're thinking about a framework where you're using hyperbaric therapy, and have a before, during, and after idea, then you're gonna have a lot more positive outcomes, at least in my experience. So that can be anything from supplements to technologies to practices that you do personally or practitioners that you go see. It could be related to laboratory analysis and dietary changes. Like those are my main things that I think about. And so I'm looking for supplements that are gonna help with energy production or supplements that are gonna help with dilation of blood vessels. So you can get to the tissue easier. I'm looking for supplements that might help you detoxify easier as well. We can think about technologies that can do all of those same things. Practices that can do all those same things and practitioners that can do all those same things. So the ideas are: create a framework that thinks about it in the before, during and after, and utilize various types of categories or integrations.
What do you see the future of HBOT being? Do you believe it can be democratized in the way that the cold plunge or the sauna has been?
