Friday 29 Mar 2024
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FRESH oxygen, delivered in its purest form and under high pressure, is powering the increasingly popular treatment known as hyperbaric oxygen therapy (HBOT). In fact, according to a study published by US-based Transparency Market Research on March 2, the global HBOT device market is expected to see a compound annual growth rate of 7.2% between 2014 and 2020, and reach US$2,985.5 million (RM11,313 million) by 2020. The device market was valued at US$1,851.6 million in 2013.

What is HBOT? Hyper means high and baric means pressure thus in HBOT, oxygen is administered at high pressure to a patient in an enclosed and controlled environment. This typically occurs in a hyperbaric oxygen chamber or tank.

There are many types of oxygen chambers, according to Tiong Boon Ann, a certified hyperbaric technologist with the PJ Hyperbaric Oxygen Therapy Centre. Soft chambers have a maximum pressure of 1.4 bar or atmospheric pressure, while hard chambers can compress pressure up to three bar. In some hospitals, like the Singapore General Hospital, they use multiplace chambers that can accommodate several patients at a time.

Tiong has three hard monoplace chambers at his clinic, which means he can only serve three patients at any one time. The patients sit in the oxygen chamber while the technologist sits outside observing. Each chamber has a closed-circuit television for the technologist to monitor the patients. There are also windows so that patients can look outside. In multiplace chambers, the technologist must be inside the chamber to monitor the patients.

Tiong uses the HyOx brand monoplace chamber from the UK. Patients sit on a chair inside the chamber and are slowly pushed in, then the door is closed. The door remains shut, with air pressure pushing against it, while the patients are undergoing treatment.

What happens when someone undergoes HBOT? The body is forced to absorb pure oxygen at a higher pressure, says Tiong. “Every breath of oxygen is dissolved in the blood vessels because of the higher pressure.”

This is 15 to 20 times more effective than breathing air under normal atmospheric pressure, he adds. “Your blood circulation will also be three times better during a session.”

Tiong likens the treatment to squeezing a rubber hose. “When you press down on the hose a little, you can see that the water flow is much stronger and that the water comes out at a higher speed.”

What happens during a hyperbaric oxygen session is that your vessels are constricted. This allows blood to be pushed through any blockages. Once it passes through the blockage, the blood will carry more red and white blood cells, nutrients, oxygen and even medicine in the blood stream to the point that needs healing, he explains.

Humans normally take in oxygen at one bar. This is the normal atmospheric pressure. At high altitudes, such as at the peak of Mount Kinabalu, the pressure is 0.5 bar. The combination of low pressure and thin air makes it difficult for people to breathe normally.

Only 21% of the air that we breathe is oxygen. The rest of it is nitrogen, carbon dioxide and other gases. But by the 1900s, the technology was advanced enough for technologists to extract pure oxygen from air. That was the beginning of HBOT.

According to Tiong, hospitals started using hyperbaric oxygen chambers 60 years ago to treat divers for decompression sickness. “Many bridges were being built at the time and people needed to dive under water to build the foundations. Later on, they would need treatment for decompression sickness,” he says.

Today, decompression sickness is just one of the few reasons why people go for HBOT. “Every navy base or hospital should have a hyperbaric oxygen chamber,” says Tiong, citing two main reasons — training and recovery.

“Some of these divers need training before they can be put into extreme conditions. Even astronauts use these chambers for training before going into outer space.”

But the most common use of HBOT among civilians is for the healing of wounds. “We are talking about especially difficult wound healing,” says Tiong. This includes diabetic ulcers and even gangrene.

Such wounds may not heal fast because of two factors. “There is a lack of oxygen supply and poor blood circulation,” he says. When this happens, cell tissues cannot heal.

Dr Norzakiah Mohd Tahir’s 2006 research paper for the Ministry of Health shows that there is a “significant reduction in mortality and morbidity when HBOT is part of the treatment of gangrene”. It can also accelerate healing for post-radiation necrosis. Necrosis is when tissues die, which is what chemotherapy and radiation does to kill cancer cells in the body.

“However, the radiation and chemotherapy not only kill cancer cells, they also destroy good cells,” says Tiong. Often, cancer patients are not able to produce new cells faster than the ones being destroyed by their treatments. “So, what is meant to heal them, kills them instead,” he says.

Norzakiah’s paper also states that HBOT has been “increasingly used as adjuvant therapy [additional cancer treatment given after primary treatment to lower the risk of the cancer coming back] as well as for other non-emergency medical conditions”.

In soft chambers, like the one at BE Urban Wellness, the atmospheric pressure is set at 1.3 bar, which is the minimum for therapeutic effects. According to general manager Balraj Pannu, it is more than just treatment for those with injuries.

Although HBOT is used by athletes such as the All Blacks team, its effects go beyond that. It is very effective for the healing of minor sports injuries, says Balraj. But at BE Urban Wellness, it is about holistic care.

“Going for a massage is good. But when you combine it with additional treatments, such as oxygen therapy, your body will really thank you,” he adds.

A misconception that people tend to have is that only athletes put such heavy pressure on their bodies. But Balraj says even office workers who sit at their desks all day can get inflammation without their knowledge. “This therapy is not just for the sick but also to provide the average person a better quality of life.”

According to Balraj, BE Urban Wellness’ treatments are mainly for clients who want to rejuvenate after a long flight or for anti-ageing purposes. It also offers 80% of the diabetic programmes available in the US for a fraction of the price of a typical diabetic programme. “We have had people who used to live in the US come to us and say it is relatively cheap compared with overseas,” he says, dispelling another misconception that alternative treatments are always expensive.

BE Urban Wellness prices its oxygen treatments from RM220 for 60 minutes. “In the US, they are offering diabetic programmes for US$11,000. But there is no way we could ever charge our Malaysian clientele that,” says Balraj. The centre also offers treatments in hard chambers (the maximum atmospheric pressure is 1.5 bar) for more serious ailments. Treatments at the PJ Hyperbaric Oxygen Therapy Centre start from RM380 for a 90-minute session.

The other side of HBOT is that it is used for aesthetic purposes. Celebrities have made this therapy a part of their lifestyles saying that it promotes the growth of older cells, which effectively slows down the ageing process. HBOT also speeds up the post-plastic surgery healing process.

Of course, with fast healing, there are side effects, but they are minor. According to Tiong, sensitive patients may find themselves having a bit of ear pain from the air pressure.

“It is similar to being in an airplane. But it can be easily overcome by equalising your ears [by swallowing saliva or using the Valsalva manoeuvre, which is pinching your nose, closing your mouth and trying to breathe out of the nose],” he says.

Another side effect is oxygen toxicity. “This only happens when patients are in a chamber for more than two hours at two bar,” says Tiong.

To avoid this, he says he only treats patients up to one and a half hours for wound healing. If patients require more time, he will give them an air break and only conduct the second session three hours after the previous one ended.

Another common problem he encounters is patients who are claustrophobic. But the chamber comes with windows, a microphone and speakers so the patient can see him and communicate with him when they need to. Tiong says he has not had any problems in his 13 years of operating the chambers.

Malaysian doctors seldom refer patients to this alternative therapy because little is known about it and what it does, says Tiong. In fact, very few studies have been conducted on the effects of HBOT. However, the positive results speak for themselves, he points out.

In Malaysia, there are very few clinics that offer this treatment. It is unclear if HBOT is supported by the Ministry of Health. However, there have been research papers written by doctors and published on the ministry’s website. For instance, the paper written by Norzakiah concludes that “there is sufficient evidence that HBOT is safe with few patients having serious side effects. Most of the contraindications and caution in the use of HBOT are based on limited evidence”.

The Armed Forces Hospital in Lumut, Perak, has an oxygen chamber for its divers. There are also centres in Ipoh, Penang and the Klang Valley that provide HBOT.

 

This article first appeared in Personal Wealth, The Edge Malaysia Weekly, on July 20 - 26, 2015.

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