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HBOT.COM

Giving people back their lives!

Hyperbaric Oxygen Therapy in Central Retinal Artery Occlusion

HYPERBARIC OXYGEN THERAPY IN CENTRAL RETINAL ARTERY OCCLUSION
 

By Paul G. Harch, M.D.
Clinical Associate Professor
LSU School of Medicine, New Orleans

 

 

Central Retinal Artery Occlusion (CRAO) is a painless, severe, usually sudden onset loss of vision in the eye that is due to occlusion of the central retinal artery. Visual loss is in the range of light perception to counting fingers in 90% of cases. In primates, if vision isn't restored within approximately 90-100 minutes, permanent injury to retinal cells occurs. In humans, however, the situation is more complicated and depends on retinal vascular anatomy. In patients with a cilioretinal artery that supplies part of the fovea, 10% of the population, 80% will have return of 20/50 vision. In the remainder of the population with CRAO, vision remains at the counting fingers to hand-motion level.

In the 1980s, the physician team at the JoEIIen Smith Hyperbaric Medicine Department in New Orleans, under the direction of Dr. Keith Van Meter, began to treat central retinal artery occlusion. The cases were referred by forward thinking retinal specialists who had read case reports of a small series of patients who had been treated with hyperbaric oxygen therapy. Eventually, we were referred every CRAO patient from a particular ophthalmology practice. Given the typically grim prognosis of these patients and the lack of substantive evidence that established a firm timeline beyond which HBOT would be ineffective, we treated every patient. We were able to achieve improvement in vision in the great majority of patients, despite delays to treatment beyond 12 hours. One of the key features of this treatment was an adaptive approach to dosing where we would decrease the HBOT dose from the traditional 2.4-2.8 ATA to as low as 1.5 ATA, as the patient plateaued at the higher pressures. In 2004, one of our hyperbaric fellows, Dr. Heather Murphy-Lavoie, reviewed our patient series and compared them to an age-matched control group from Charity Hospital, New Orleans. She presented the abstract at the 2004 UHMS meeting in Sydney, Australia. Based on this presentation, she was invited to submit an application to the UHMS HBOT Committee to add CRAO to the accepted indications list. That application was submitted and approved in 2008 with an American Heart Association Class lib level of evidence: "There is fair to good evidence to support its use with retrospective case series but no prospective randomized controlled trials. It is acceptable, safe, considered efficacious but lacks confirmation of efficacy by level 1 studies. There is no evidence of harm and consistently positive results. In addition, there are no alternative therapies with similar outcomes."¹

The importance of the CRAO HBOT Committee approval lies in the implications for the future of additional occlusive vascular indications. CRAO is a rare condition. The impact of HBOT on individual cases is substantial and justifies the application of HBOT for this condition. However, the impact on society is minimal. What is more important is the scientific argument for HBOT that is based on the pathophysiology of CRAO, which is a sudden complete occlusion of arterial blood supply to nervous tissue. Sudden arterial occlusion is nearly identical pathophysiologically to the accepted indication of traumatic interruption of peripheral arterial supply and the Medicare indication of acute peripheral arterial insufficiency. CRAO is the same pathophysiology in the retinal circulation. In all three of these conditions, there is a period of complete or near complete interruption of blood supply which is followed by a period of reperfusion injury as circulation is re-established either surgically or by recanalization. The peripheral arterial interruptions/insufficiencies are better described in lay terms as "acute traumatic stroke" or "acute stroke of the arm or leg" while CRAO then is an "acute stroke of the eye."

The analogy to "stroke" is important because HBOT is the use of greater than atmospheric pressure oxygen as a drug to treat basic disease processes. In all three of these conditions we are treating an underlying complete occlusion or interruption of blood supply to human tissue. Two of the tissues are outside the central nervous system and the third is in the central nervous system. The tissue and its location are somewhat irrelevant, but if we can now accept stroke of the eye based on Class lib evidence, it should expand our thinking to the broad range of pathophysiologically similar conditions characterized by gross cessation/interruption and then re-establishment of blood supply. Examples include hepatic artery occlusion (there are a number of references for HBOT treatment of this condition in the pediatric liver transplant literature), mesenteric artery occlusion, coronary artery occlusion, (acute myocardial infarction), the group of global ischemias (cardiac arrest, near-hanging, near-drowning), and of course, cerebral artery occlusion (stroke). Interestingly, HBOT in cerebral stroke is supported by over 35 animal and an equal number of human studies, some prospective and controlled, with the great majority at least meeting the Class lib or higher level of evidence. The following cases should stimulate your thinking of application of HBOT based on pathophysiology rather than diagnosis.

 

Reference List

1. Heather Murphy-Lavoie, Frank Butler and Catherine Hagan. Central Retinal Artery Occlusion. In: Gesell LB, Chair and Editor, Hyperbaric Oxygen Therapy Indications, 12th Edition. The Hyperbaric Oxygen Therapy Committee Report, Durham, NC: Undersea and Hyperbaric Medical Society, 2008. p.57-66.

 

HBOT in the Treatment of Chronic Traumatic Brain Injury:

 

HYPERBARIC OXYGEN THERAPY IN THE TREATMENT OF CHRONIC TRAUMATIC BRAIN INJURY:

FROM LOUISIANA BOXERS TO U.S. VETERANS, AN AMERICAN CHRONOLOGY

 

PAUL G. HARCH, M.D.
CLINICAL ASSOCIATE PROFESSOR
LSU SCHOOL OF MEDICINE, NEW ORLEANS

 

The application of hyperbaric oxygen therapy (HBOT) to chronic traumatic brain injury (TBI) can be traced to clinical practice and research in South Florida and New Orleans, Louisiana. It is well known that the practice of HBOT in chronic neurological conditions was pioneered by the late Dr. Richard Neubauer in the 1970s. Beginning with a serendipitous finding of gratuitous neurological improvement in two multiple sclerosis patients undergoing HBOT for chronic bone infections, Dr. Neubauer began applying HBOT to patients with other neurological conditions, primarily stroke. In 1994, he published his first case of HBOT treatment of chronic TBI in the Southern Medical Journal.

 




Chad Rovira Acute TBI treated with HBOT

Comprehensive diabetes foot prevention and wound treatment at LSU interim public hospital

 

Comprehensive diabetes foot prevention and wound treatment at LSU interim public hospital

Paul G. Harch, M.D. Director
Myra Varnado, RN CWOCN, Clinical Manager
Wound Care and Hyperbaric Medicine Department

Diabetes foot wounds are an enormous health care problem. Every year 2% of the greater than 18 million diagnosed diabetes patients in the United States develop a foot ulcer. For those diabetes patients with peripheral neuropathy, 5 to 7.5% will develop a foot ulcer each year. In 2006, 65,700 lower extremity amputations were performed among people with diabetes. The personal loss and disability is substantial and is accompanied by significant health care costs. Diabetes foot ulcers result in more hospitalizations than any other complication of diabetes. In 1999 the cost of treating a foot ulcer over two years was $28,000.

LSU Diabetes Alert DayThe greatest personal risk and impact on health care costs, however, is the propensity of diabetes foot wounds to result in extremity amputations. Every year 12-24% of diabetes foot wounds result in amputation; this is over 60% of all non-traumatic amputations in the U.S. According to the CDC, diabetes related neuropathy with wounds has a relapse rate of 66% over 5 years, and 12% of people with wounds progress to amputation. The cost of an amputation exceeds $45,000, but puts the diabetes patient at risk for foot wounds on the opposite leg and eventual bilateral amputation. Fortunately, a substantial portion of these amputations are preventable. Prevention of lower extremity amputation is the primary goal of the LSU IPH Wound Care and Hyperbaric Medicine Department.

 

HBOT Treatment eyed for TBI/PTSD Traumatic Brain Disorder caused by Injury to Head and Post-Traumatic Stress Syndrome Symptoms

Dr. Paul Harch of New Orleans briefed the committee about his use of Hyperbaric Oxygen chambers to treat TBI and PTS, commonly regarded as the signature wounds of the war on terrorism.

Harch has used hyperbaric oxygen treatments for dozens of U.S. veterans who suffered injuries to the head resulting in TBI and who have developed post traumatic stress disorder PTSD. He recently finished up a study on 15 patients who showed improvements in several physical and mental tests after a series of Hyperbaric Oxygen therapy (HBOT) treatments, which involves patients breathing 100 percent oxygen inside a pressurized chamber.

Mother of Three Autistic Children Takes on the State of North Carolina and Wins for HBOT

A blind mother of three autistic boys taking on the state of North Carolina and winning. When people learn of the "dirty pool" and dishonesty in the testimony of the state's experts they will be even more amazed. A debt of thanks is due to this judge. What a remarkable lady; willing to disregard ugly defense testimony and honor the reports of your treating doctor and the power of SPECT brain imaging. The evidence was so convincing that they didn't even attempt an appeal.

Congratulations to you, Dr. Harch.

Letter to American Idol from Tina Hecker about a Traumatic Injury to the Head and TBI HBOT

Harch Hyperbaric Oxygen Therapy Gave Tim His Life Back

I searched daily for possible treatments for brain injuries. We've always been told that we only have one brain and once it is injured, it can not be fixed. I would hope you all haven't been told that same thing. In March 2009, I came across information about a treatment that has truly given Tim his life back. I made a call about a pilot study being run in Louisiana, dealing with soldiers who had TBI's and/or [Post Traumatic Stress Disorder] PTSD. This treatment is called Hyperbaric Oxygen Therapy, or HBOT. The doctor's name is Dr. Paul Harch. My husband walked in for his first treatment with a migraine. He walked out after, the migraine was gone, and he hasn't had one since. He has regained about 80% of his long term memory up to the age of 35. His memories between 35 and 40 years old are still sketchy. His short term memory and cognitive levels are still low, but MUCH better than they were when we began our journey. He has began to hunt and fish again.

NOT ALL Hyperbaric Oxygen Treatment Facilities are the Same! PATIENTS SEEKING Hyperbaric Oxygen Therapy (HBOT) BEWARE!

 

ALL PATIENTS SEEKING Hyperbaric Oxygen Therapy (HBOT) BEWARE!

HBOT

With increasing regularity hyperbaric facilities, their staff, and physicians have been marketing and announcing their services with statements to patients claiming training by Dr. Harch, consulting services with Dr. Harch, use of "Harch Protocols" only, business and collaborative relationships with Dr. Harch, etc. All of these claims are FRAUDULENT. All contractual relationships with Dr. Harch will be listed here on HBOT.COM website only and/or links provided to the contractors from our website.

 

A Tribute to Ken Locklear: A Great Man, Father, Husband, Friend and Contributor to Society

 

A Tribute to Ken Locklear: A Great Man, Father, Husband, Friend, and Contributor to Society

Ken Locklear

 

On January 11, 2011, all of those who knew him, all of those who didn't have the good fortune and privilege of Ken Locklear:  A Great Man, Father, Husband, Friend, and Contributor to Societyknowing him, and all of those who will know and benefit from his legacy in the future lost a father, husband, friend, colleague, employer, and selfless contributor to the betterment of mankind. Ken Locklear, the President of American Baromedical Corporation, Best Publishing Company, and Hyperbaric Medicine and Woundcare Magazine succumbed to cancer, a disease he valiantly resisted and in the process used to advance the field of hyperbaric medicine. Ken's tragically short life is an amazing story and a prideful one for all who knew him. Ken was a Navy diver who experienced a near fatal diving accident earlier in his life. His life was saved by the emergency application of hyperbaric oxygen therapy. Not only did it save his life it launched him on a mission. He believed that his survival was purposeful and he became deeply spiritual. He felt that God had granted him a second chance during which he was to share with everyone the benefits of the therapy that saved him. Coming to the common sense appreciation of Cunningham's Sensible Notion he believed that the application of hyperbaric oxygen therapy acutely to patients with a variety of other devastating injuries could save countless lives. This belief galvanized his commitment to bring hyperbaric oxygen therapy to everyone who was not as fortunate as him. His near death experience propelled him forward in a life dedicated to helping others.

Frustrated with narrow-mindedness, complicated political agendas, and obstructions to the advancement of hyperbaric medicine Ken helped found the International Hyperbaric Medical Association and became its first executive director. As Executive Director Ken was instrumental in securing the Centers For Medicare and Medicaid Services' approval of diabetic foot wounds as the first new CMS hyperbaric indication in 18 years. He was also responsible for inputting recommendations to the Texas State Insurance Commission on the use of hyperbaric oxygen therapy in their newly passed legislation mandating reimbursement of treatment for brain injury. On behalf of patients he represented the IHMA at state Medicaid hearings, medical board proceedings, and brought to the forefront important topics in hyperbaric medicine. Through his efforts he was able to force the publication of an article establishing the ethical basis of off-label application of hyperbaric oxygen therapy, forever changing the institutionalized mischaracterization of off-label hyperbaric oxygen therapy as "experimental. " During his three year tenure he tirelessly advocated for hyperbaric oxygen therapy without a salary and at considerable personal and financial sacrifice. In the midst of trying economic circumstances he self-funded and launched HBO Med Today, a hyperbaric medicine trade journal that quickly became widely read and acknowledged for its fair, balanced, and informative reporting. In HBO Med Today he was able to explore, investigate, and debate controversial important issues and further his work and the message of the IHMA. His work as executive director was precedent setting. The IHMA, the hyperbaric medicine community, and the American public are indebted to Ken for his many contributions as their first executive director.

When Ken resigned as executive director it was not a resignation of his career commitment to advance hyperbaric medicine. It was a strategic move to strengthen the foundation from which he could advance the field much further. He spawned American Baromedical Corporation with a contract at a Michigan hospital that fell to him by default due to his impeccable integrity. He added additional contracts and as an outgrowth of his dedication, hard work, spiritual commitment, and eschewing of greed he was rewarded with professional and financial success and a growing family by the time he was 38 years old. Unfortunately, at that exact age he was stricken with metastatic cancer. He was given a life expectancy of less than 6 months in 2007. Ken then began the greatest fight of his life and in the process made a discovery that will have far-reaching ramifications. Ken combined hyperbaric oxygen therapy with his chemotherapy and never experienced the neutropenia, anemia, peripheral neuropathy, and sickening side effects of chemotherapy. His robust course through chemotherapy was so astounding that he pleaded with his oncologist for additional rounds of chemotherapy receiving over one and half times the amount of toxic chemotherapy for his cancer. Within months he was in complete remission. What soon followed was a successful application for a patent on the use of HBOT during chemotherapy to minimize side effects and a new, once again, self-funded project. This project was a research study on the combined application of chemo and HBOT in an animal cancer model. The preliminary results were positive and announced last year.

Ken's cancer battle also resulted in his realization that he had the means and ability to accomplish his hyperbaric medicine goals through publication. He purchased Best Publishing Company and reformed HBO Med Today as Wound Care and Hyperbaric Medicine. Under these venues he began his balanced non-emotional factual publishing of some of the most important topics in hyperbaric medicine and was poised to make important advances in hyperbaric medicine. More important than all of his contributions above, however, Ken Locklear should be remembered for his character and values. There are few that can match him. It's why I so respected him and called him my friend, and why his loss is so devastating. Ken was a man of unquestioned honesty and trust, a man who not only stood for what is right, but did what was right, even when it was unpopular, stressful, or controversial. He embodied his spiritual commitment and was a beacon of integrity in a field where integrity has been historically questioned. He was never afraid to speak the truth, to stand up and ask a tough question, and try to openly discuss the many controversies and obstructions that have marred the field of hyperbaric medicine. He brought disclosure, openness, and transparency to hyperbaric medicine, tried to mend fences, and dispassionately publish competing viewpoints. In his last year faced with the possibility of the consequences of recurrent cancer he saw life through the eyes of a person with terminal cancer. He had no patience with petty differences and anything that interfered with the advance of hyperbaric medicine. He reached out to people filled with resentment and old grudges, tried to bring antagonists together, and mend fences within the hyperbaric medicine community. At the time of his death he had an ambitious list of projects and believed that he would survive to see them to fruition. If not he had planned for their execution without him. He said his fate was in God's hands as he stopped chemotherapy and hyperbaric oxygen therapy.

Weeks before his death he asked me a final medical question. He wanted to know what the end would be like. I told him that I thought it would be peaceful.

Our condolences to Ken's young family. His passing is simply tragic and premature. We know his family is proud of him for his commitment to the betterment of mankind and his legacy. We will miss him deeply. May he rest in peace. Goodbye Ken.

Paul G. Harch, M.D.
Juliette Lucarini Harch

In lieu of flowers please send donations in Ken's honor to:
First Care Pregnancy Center | PO BOX 15198 West Palm Beach, FL. 33416
Acts 2 Worship Center | 13000 Okeechobee Blvd. Loxahatchee, FL 33470
Oxygen Research Foundation | 2700 PGA Blvd. Palm Beach Gardens, FL 33410

 

ANNOUNCEMENT FROM BEST PUBLISHING

It is with our deepest regret that we announce the passing of Mr. Kenneth Locklear, President of Best Publishing Company and American Baromedical Corporation yesterday, January 11th 2011. Our most sincere sympathies go out to Ken's family and his many friends and colleagues around the world. Ken Locklear was just 41 years old and he leaves behind his wonderful wife Heather and three remarkable children. Ken was at the prime of his life and career. Having established American Baromedical Corporation in 1997, Ken's successful approach to business contributed to the overall advancement of the hyperbaric medicine field. Ken had been instrumental in driving regulatory change and broadening of the indications list for HBO. Ken implemented the Oxygen Research Foundation in 2008 with the intent to achieve as many research studies as financially possible in order to profess the need for this source of alternative medicine to medical care providers, insurance companies, legislation and all other necessary mediums. His latest endeavor was the purchase of Best Publishing Company where he believed that widespread dissemination of education and knowledge was fundamental to the continued long term success of the wound care and hyperbaric industry. His passion led to the launch of WCHMedia Group, a division of Best Publishing which is responsible for the successful publishing of the Wound Care & Hyperbaric Medicine Journal, Calendar and Resource Guide. Ken was a visionary leader who often took the road less traveled which paid dividends over time. Ken always wanted the best for the stakeholders, most important of those, the patients. He was a positive light for all of us and unfortunately it was extinguished too early. We ask that you take a moment and pray for the Locklear family and respect their privacy during this sad time.

 

 

Man survived without oxygen for 25 minutes thanks to controversial rescue

Meg Farris / WWLTV Eyewitness News

 

NEW ORLEANS – Years ago, a commercial diver from Terrytown spent nearly a half hour at the bottom of the Mississippi River with no oxygen. Today, he lives a normal life with no health problems.

Now a local doctor says the mistake that saved his life and prevented brain damage could also be used to save the lives of people who have cardiac arrest and keep them free of brain damage as well.

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