Full Transcript Introduction to PTSD and Hyperbaric Oxygen 0:00 So hyperbaric oxygen has been around for hundreds of years, and it's traditionally for most people known to treat wounds. 0:05 So if you look at PTSD, historically, we thought of it as a psychological disease. 0:09 But in fact, it is a brain physiology disease, there are changes to the brain. 0:14 And when a veteran, for example, comes from a war, you might see their wounds on their legs, but they also have wounds in their brain from PTSD. 0:21 If we apply that concept of treating a wound to treating wounds of the brains for PTSD that makes this a logical treatment choice. 0:42 Post-traumatic stress disorder can be at times a profoundly debilitating condition. 0:47 Hello, I'm Dr. 0:48 David Perlmutter. 0:48 Welcome again to the Empowering Neurologist. 0:50 We're going to be talking about PTSD today and we're gonna be talk about it in the context of a novel and really interesting therapy that's just been developed 0:59 and that is the use of hyperbaric oxygen therapy. 1:01 I will describe what that it is in treatment of this disorder. 1:05 This is a common disorder. 1:07 It's been estimated that about 6% of U.S. 1:10 population will experience PTSD at some time in their lives. 1:14 And at any given time, about 5% percent of the U S population is actually living with PTSD. 1:21 We know that, of course, as expected, this is is higher issue in terms of its incidence in veterans with 11 to 20% veterans who served in Operation Iraqi 1:34 Freedom and enduring freedom, experienced this issue. 1:38 And for Vietnam veterans, the statistics may be as high as 30%. So, you don't have to be involved in combat to have experienced a trauma in your life to 1:50 produce a PTSD. 1:51 We know that, for example, being exposed to climate change events or other traumatic injury can induce PTSD, women are about twice as likely as men to 2:03 become sufferers from PTSD. 2:04 And we know that lifetime prevalence in women is around 10% and about 4% in men. 2:11 The onset of PTSD typically begins around three months after the traumatic event. 2:19 But let's be clear, the actual diagnosis and full manifestation of PTSD may take years to fully manifest. 2:28 It's known that this situation PTSD can, as I mentioned earlier, can be debilitating and it can last for years if not decades if it is left untreated. 2:41 We know there is substantial comorbidity associated with PTSD. 2:47 are at greater risk for things like depression, anxiety disorders, substance abuse, and even cognitive decline and full on dementia. 2:56 So we really have to do our best to explore novel treatments, pharmaceutical treatments that's for sure, interventional types of treatments like cognitive 3:07 behavioral therapy. 3:09 And what we're going to present today is another novel idea and that is the use of hyperbaric oxygen therapy as a treatment and we're going to look at 3:19 some of the research that justifies recommending hyperbarics to treat PTSD. 3:25 Our guest is Dr. 3:26 Mohammed Alamir. 3:27 Let me tell you a little bit more about him. 3:30 Dr. 3:31 Mohammed Alamir or Dr Mo to his patients has been a part of the Aviv clinic team in the villages and here in Florida since the clinic opened in 2020. As
PTSD Prevalence and Clinical Impact 3:42 lead physician, he oversees the medical treatment for all clients at the aviv medical program, collaborating with the other extensive staff of individuals 3:52 creating these clinical programs to provide truly comprehensive care. 3:57 Dr. 3:57 Elamair became involved in the Aviv clinics after his late father suffered a stroke and that sparked his interest in this novel approach to healing the brain. 4:07 He is the father of two children, including a son with autism spectrum disorder. 4:12 and Dr. 4:13 Lamire considers it his life mission to help progress his son's development and better understand the causes and treatment of ASD. 4:23 Today, of course, as mentioned, we are going to be exploring post-traumatic stress disorder and the use of this novel therapy. 4:30 Let's get right to our interview. 4:32 Dr. 4:32 Elamir, good to see you and how cool it is that you're actually doing this broadcast from inside the hyperbaric chamber. 4:39 What's going on behind you? 4:40 What is this chamber all about? 4:42 Yes. 4:42 Thank you for having me, Dr Perlmutter. 4:44 Yes, I'm inside one of our four hyperbolic oxygen suites. 4:47 This is where we administer our hyper baric protocol. 4:50 I myself was in this Chamber two years ago, two hours a day, five days a week for 12 weeks. 4:55 And this is how we treat our clients here at the IV clinic. 4:59 Interesting, along with, you know, multimodal approaches, physical therapy, occupational therapy cognitive training, a whole integrative approach to really 5:07 helping people regain cognitive function and other aspects of brain health. 5:13 I want to just dive deep into the PTSD study and why hyperbarics was so effective. 5:21 But before we do that, let's back it up a little bit and ask, why would anyone even consider that in PTSD hyperbaric oxygen therapy might be effective. 5:33 So mechanistically, why was it chosen and why wasn't the study done? 5:37 Great question. 5:38 Hyperbarric oxygen has been around for hundreds of years and it's traditionally for most people known to treat wounds. 5:44 If somebody has a diabetic foot ulcer, for example, that's not healing properly, hyperbolic oxygen is known help heal that wound. 5:50 so if you look at PTSD, historically we thought of it as a psychological disease. 5:54 But in fact, it is a brain physiology disease. 5:57 There are changes to the brain. 5:58 And when a veteran, for example, comes from a war, you might see the wounds on their legs, but they also have wounds in their brain from PTSD. 6:06 So if we apply that concept of treating a wound to treating wounds of the brains for PTSD, that makes this a logical treatment choice. 6:14 So then what is actually the hyperbaric oxygen doing in the brain of that PTSD patient? 6:21 Yes. 6:22 You know, hyperbolic oxygen is applied in many different ways. 6:25 So you could be in a multi-place chamber like this, or you can be on a mono-chamber. 6:29 There are very different characteristics between chambers and also different protocols that can achieve different things. 6:35 Our specific protocol uses a multiplace chamber to fluctuate oxygen levels in specific way. 6:40 By sitting in here, we can give you an oxygen mask and take it on and off. 6:45 And this is a protocol that Dr. 6:46 Fradi, Dr Hadani, and my colleagues in Israel have developed over the last 15 years. 6:51 The point of the protocol is to trigger the body to have neurogenesis, stem cell proliferation, angiogenesis. 6:59 So growing new cells, growing connections in the brain, new blood vessels, in addition to healing injury. 7:05 So when we see the wound in the brain related to PTSD, this mechanism of cell growth, both the blood vessels, mitochondrial biogenesis is applied to that 7:15 wound and the brane. 7:16 And when you heal that, you can heal and help somebody with PTSD. 7:20 So the individuals that participated in the study, and in fact you had a somewhat of a control group or what you called a sham, 7:29 a group who didn't receive, they were still put in a chamber and pressurized a tiny bit so they kind of experienced their ears, 7:36 for example, with respect to the pressure, but the control group, if we can call it that, did not actually receive oxygen in their face masks. 7:44 Is that how the study was conducted? 7:48 Correct, so you're absolutely right. 7:49 So we have the treatment group doing the full hyperbaric, going to this pressure level of 2.0 atmospheres, breathing oxygen, 7:56 and that specific protocol that we discussed. 7:58 But the sham group is the controlled group and they're sitting in a chamber, it looks exactly the same, And whenever you go through a hyperbaric treatment, 8:05 as the pressurization is happening, you feel a popping sensation in your ears. 8:09 So the sham group got a simulation of a quick burst of pressure to feel that pressure sensation. 8:14 By the end of the treatment study, when they analyzed and surveyed each group, it was statistically significant that they could not understand, 8:22 was I in the Treatment group? 8:23 Was I the Sham group because, of course, oxygen is a colorless, odorless gas. 8:28 When you're just breathing air versus oxygen, So in a sense, then they were fairly well placebo controlled that they did not know. 8:37 I mean, you evaluated them after to determine if they in fact knew and they really didn't.
Meet Dr. Mohammed Alamir and the Aviv Clinic 8:42 Exactly. 8:43 So you evaluate the patients on the front end using a, there's a specific scale that is used in the evaluation of the PTSD patient. 8:53 Can you tell us about that scale? 8:55 Yeah, this is the CAPS scale. 8:57 And CAPs is a great neuropsychological tool to evaluate somebody's PTSD to diagnose and also grade how severe it is. 9:05 So we administer that before and after the study treatment. 9:09 Okay, and how much treatment did these individuals receive? 9:13 So they all received 60 hyperbaric oxygen treatments administered two hours a day, five days a week over those 12 weeks. 9:22 a pretty extensive treatment protocol, but the results seem to really justify that kind of intervention. 9:29 After the treatment, both groups were evaluated and there were multiple ways they were evaluating. 9:35 I guess you obviously redid the scale, the PTSD scale but you did some other things as well like MRI, et cetera. 9:43 Correct. 9:43 So we did a lot of neuroimaging, both functional and structural imaging, the ability to measure the nerve connections within the brain, 9:51 blood flow, metabolism. 9:53 In addition to seeing reduction in their CAP scores and reduction of their PTSD scales, we saw the correlative improvements on the scans, 10:01 objectively correlating everything. 10:04 So you do a kind of sophisticated type of MRI scan, and in the group that was treated with the actual oxygen and pressure intervention, 10:14 characterizing hyperbarics, you demonstrated increased actual connectivity within their brains in areas, for example, like the default mode network. 10:22 We don't need to define that. 10:24 but just the fact that the brain was making better connections. 10:28 And that's an area that seems to be a compromise in the PTSD patient. 10:32 This increase in their connectivity was not seen in at the control group? 10:38 That's exactly correct. 10:39 So even if they might have had some ups and downs on their scales, it wasn't statistically the same as the treatment group. 10:45 And of course, the scans also didn't show a major change. 10:50 So it really confirmed that the treating made a physiologic change in the brain, which correlated with the actual improvement in their symptoms seen in 10:56 this course. 10:57 Now, I recall seeing a description, an appearance. 11:04 I was at CBS this morning on one of those television programs where they actually went into the chamber in Israel with I forget which of your researchers 11:16 it was, but didn't I not see this broadcast on CBS this morning? 11:20 Yeah, that's right. 11:21 Dr. 11:21 Afrati, he was on the broadcast. 11:26 And did it get ultimately approved in Israel for the treatment of combat-related PTSD? 11:33 Yes, so they've actually been doing this for years now where it got approved by their government and every single veteran that has PTSD in the Israeli 11:41 army gets this treatment covered and an amazing service that they do for their veterans. 11:47 Well, and for our viewers, I would just remind you that we have had Dr. 11:51 Shy Afrati on the podcast talking about his work. 11:56 And I will say that many of our views know that I've been involved in hyperbarics for about 30 years. 12:04 Dr Afrate's work was really kind of instrumental in me adopting a hyperbolic oxygen therapy as part of my neurology practice. 12:13 He was writing the original research on stroke recovery, in fact, demonstrating not only functional improvement in clinical evaluation, 12:21 but also even improvement on CT scans in comparing patients receiving this therapy versus not. 12:29 So how did you, it was 60 sessions, I believe, of Hyperbarics. 12:34 How was the actual protocol developed and chosen? 12:38 Was it based upon experience with other entities, other clinical entities?
Why Hyperbaric Oxygen May Help PTSD 12:42 Correct, and the same way you found Dr. 12:44 Afrati and his research was the way I did. 12:47 When my late father had his stroke, that led me to research ways to help him and I found the original research using this protocol to helps stroke patients. 12:57 But when we talk about PTSD as a wound in the brain, Dr Afrati studies with stroke with traumatic brain injury, with age-related changes to the That's 13:07 what led to using that protocol that has been developed over the years for this particular diagnosis and study. 13:14 And that's how they were able to develop it. 13:16 So was there any difficulty in, I mean, 60 treatments is substantial. 13:23 Was there a any difficult in keeping these participants engaged in following through? 13:30 Did you have any dropout, is what I'm asking. 13:33 There were just a few at the beginning for the randomization and selection. 13:38 I believe they started with 63 and then it went to 56 that ended up getting randomized. 13:42 So, you know, a very small attrition rate. 13:44 You know it is a big commitment and as you're going through the treatment, when you sit in here and you are breathing oxygen and doing the protocol on 13:52 and off with the oxygen in air, while you in in for two hours you have the opportunity to sleep, meditate, read, do cognitive exercises as a lot of our 14:02 clients do. 14:03 But the process of healing the brain with PTSD is also a little bit difficult because it can bring about new memories or resurface old memories that were repressed. 14:14 So that's why it's administered with the clinical supervision. 14:18 Having psychotherapists available, having the medical staff available. 14:21 And we tell all of our veterans or anybody going through PTSD, whether it is the trauma of war or childhood trauma or sexual trauma, 14:29 you know, the process of healing the brain can bring these memories up. 14:32 It's important to talk through them and work with clinicians so that we can help you through the Well, you know, one might think, 14:38 connectivity is I think a very operative word here in terms of what is being reestablished. 14:42 And in a sense, perhaps you are establishing reconnectivity with the event or events. 14:49 One wonders if that might not be an important part of the healing process to, I hate to say confront, but to be able to deal with that issue and look at 15:00 it and And as you say, with the type of therapy that's offered, along with hyperbarics, to really work through the problem that you might not have been 15:09 able to be in touch with before because it was so repressed. 15:12 Correct. 15:14 Often I tell my clients before they start, this isn't men in black. 15:16 We're not erasing your memory. 15:18 we're now erasin that trauma. 15:19 But we are helping heal your brain, helping those connections so that can process those memories the appropriate way. 15:26 Without the hypervigilance, without the insomnia, or memory changes, for example. 15:32 We talked a little bit about the control group, the placebo group. 15:37 Was there any effect seen in that group at all in comparison to what you might have expected in somebody who is completely untreated? 15:45 So was there an effect? 15:47 There really wasn't. 15:47 Statistically, the scores were insignificantly changed. 15:52 Whatever placebo effect that could have happened was actually negated when you look at the data, and especially when he combined the scans along with the 16:00 caps and the other evaluations. 16:03 And were you able to control for other potentially confounding influences like other types of therapy, other type of medication or intervention? 16:12 For sure. 16:13 So in the pre-selection criteria, we really tried to standardize other treatments that might have been confounding or medication changes. 16:22 We tried keep everything controlled and stable before they were entered into the treatment and study. 16:27 So I think we're going to be, you know, sparking, oh, that's the wrong term for hyperbaric chamber. 16:31 We're gonna be inducing a lot of interest in our viewers, especially as common as this problem is. 16:39 So one, I would be interested in the potential for side effects. 16:44 What sort of side-effects are observed in general in this type of multi-chamber, multiplace hyperbaric chamber, or just issues that you have to deal with. 16:54 And then let's be specific about dealing with the PTSD individual in the hyperbolic chamber. 17:00 So what do you tell people to be on the lookout for? 17:05 Absolutely. 17:06 And a lot of the side effects are applicable to all hyperbaric treatment, whether it's a mono-chamber or multi- chamber. 17:11 The most common side effect is barotrauma, trauma from pressure. 17:14 So as we close the doors and we start pressurizing the chamber, there is a popping sensation in your ears as your years are trying to equalize.
Study Design, Sham Control, and CAPS Scoring 17:22 We take about 10 minutes to get to pressure, 2.0 atmospheres is what we get you. 17:26 And it's imperative that you're able to equalize. 17:29 In the chamber, there's an inside attendant with you, so their duty is to help make sure you are able equalizing. 17:33 And if you can't all of a sudden, you just have to let the inside attendant know right away so we can stop the pressurization and we have some tools that 17:40 can help you equalized. 17:41 The problem comes if you're a brave soul and you are embarrassed and don't want to raise your hand and say you can't pop it, 17:45 you try to force it. 17:46 You're going to stretch your eardrum a little bit. 17:48 The good news is it's a temporary effect. 17:50 Usually you take the next day off and then you could make that treatment up on the back end. 17:55 That's the number one side effect for most hyperbaric. 17:58 And how old, beyond this study, what are the youngest patients that you were able to treat? 18:07 So in the study, in their 20s was the youngest, but between the clinics we have around the world, we had pediatric cases. 18:16 Young children, even as young as six years old, seven years, and usually those are related to traumatic brain injury. 18:24 We have a sister clinic in Middle East that also treats for cerebral palsy and autism spectrum disorder. 18:32 The age can be as low as that. 18:33 But here being in central Florida, we have a lot of villagers that are in their 90s. 18:38 And then some of them can beat me at pickleball. 18:40 So we always say age is just a number. 18:43 The key is when we do our evaluation that we see in the brain something can't be done physiologically. 18:47 If that's the case, then we're happy to help. 18:49 So they're called villagers. 18:51 You know, I was up there and I, was able to see the golf cart brigade. 18:56 So you call them villagers in the villages, right? 18:59 Yeah. 18:59 Yeah, so in The Villages, it's more than just a gated community. 19:03 This is a large, over three county, 175,000 people. 19:06 It's a whole city and community, and as you mentioned, everything's connected by golf carts. 19:12 But they are living their best lives. 19:13 They're playing pickleball, golfing, part of clubs, learning new things with classes. 19:19 And if they want to improve their health or treat an injury, they come here. 19:22 There you go. 19:23 Well, let me get back to PTSD for just a moment. 19:25 So now you've demonstrated this efficacy and we're going to flesh that out a little bit more in just But with the indication that this is a really meaningful 19:35 therapy for individuals, is there a sense that offering hyperbaric oxygen therapy along with other more accepted or also proven therapies might be the 19:46 way to go? 19:46 In other words, combination therapy? 19:49 Yes, you know, we always believe that holistic approach is the best for every condition and PTSD is definitely no exception. 19:56 So in addition, at least here outside of the study, as we're treating people with PTSD, We are also incorporating psychotherapy, 20:03 neurocognitive training. 20:05 Of course, exercise, physiology and diet are critical, As well as any medical follow up that's always done in unison together so we can get the So we've 20:16 talked about the use of hyperbarics in PTSD, certainly stroke, traumatic brain injury was mentioned, but are there any specific psychiatric defined conditions 20:29 that would also demonstrate benefit from this type of intervention? 20:34 Well, hi everyone, Dr. 20:35 David Perlmutter here. 20:37 We hope you're enjoying this content, and if you would do so, go ahead and hit the like button. 20:41 And if your not already a subscriber to our channel, please consider doing so. 20:46 Were really grateful to have you as part of our community, so let's get right back to the presentation. 20:52 Yes, for sure. 20:53 The key is also to tie it to some brain physiology disorder. 20:57 So whether it's anxiety or depression from long COVID, so we treat long Covid as a condition and the virus can get into the brain, 21:06 the inflammatory response changes the brains and a lot of folks with long covid develop anxiety and depression form the injury and those can be helped 21:14 quite a bit. 21:16 Of course, with a lot of psychiatric conditions, there might not be a specific brain injury. 21:20 In those, we have to be very rigorous with the assessment. 21:23 There might be some things we can help, but there may be things that we cannot. 21:26 That's part of our process. 21:27 We always do the thorough assessment to qualify and make sure we could help somebody before they enroll in the treatment. 21:33 Well, as it relates to long COVID, I would let our viewers know that I did have the opportunity to spend some time on the podcast with Dr. 21:41 Amir Hadani talking about his research using hyperbarics to treat individuals with long Covid. 21:48 And it's pretty exciting, the results that he described. 21:52 But let's get back now to the PTSD study. 21:54 So as these individuals are rated on, let say their disability score that correlates with the degree of PTSD or the depth that they experience,
Brain Imaging Results and Symptom Improvement 22:03 then what did the treatment group versus the control group demonstrate? 22:07 We've talked about the improvement in functional MRI scan, brain connectivity, a brain blood supply, but what about actual rating of these individual on 22:18 the scale? 22:19 Yeah, so in addition to having those objective changes on the scans, the scores on CAHPS, for example, they were lowered significantly to the point where 22:27 some no longer met the criteria for PTSD. 22:31 So that in itself. 22:32 And then we, of course, did some PHQ-9 and some other anxiety scores where they also were able to get rid of those conditions from a functionality standpoint. 22:43 quality of life surveys, the ability to just go back and be back at work or back with their families, having the relationships that they've lost because 22:52 of their condition, all of those were significantly impacted. 22:56 And, you know, I suspect that the assessment of these individuals took place pretty close on the heels of them completing their 60 sessions? 23:06 Correct. 23:06 So there were basically a couple of weeks from assessment to treatment and then from treatment to post-assessment. 23:11 It was a So the obvious question is, okay, they're better, feeling a lot better. 23:17 You have these wonderful scans now. 23:19 Their ratings gone down dramatically on the assessment scale. 23:23 But what about a year or two later? 23:25 What can you tell us about that? 23:29 Yeah, with most of our studies, whether it's long COVID or PTSD, we do one and two year follow up studies. 23:36 And so far with the one year, follow-up study data, over 90% are maintaining these improvements. 23:43 So they're still able to keep those cap scores low, improve their quality of life, still be able be active. 23:49 In many cases, some are doing even better at that one-year followup. 23:53 And you had mentioned that this is something approved for all PTSD patients, soldiers in Israel, that they get this treatment, 24:04 the government takes care of them. 24:06 What does it look like here in America in terms of our military, for example, adopting this as a therapy for our soldiers suffering from PTSD? 24:18 There are a lot in the VA and in government ranks where they recognize, in fact, that this is a treatment that can help. 24:25 On that same CBS morning show program with Dr. 24:30 Friday, they had some senators as well and members of the House that were all in favor. 24:38 It is a matter of time. 24:39 I actually was just in Washington, D.C. 24:41 speaking on behalf of hyperbaric oxygen for TBI and PTSD a few weeks ago. 24:46 So there is lot of traction, especially with the new administration and new members of Congress. 24:52 It's just a manner of where this does get offered to our vets because it's sorely needed. 24:57 Well, I mean, until now, the interventions have pretty much been pharmaceutical, i think. 25:04 The development of a protocol, a pharmaceutical protocol. 25:07 Here's the pill, hope for the best. 25:10 This is certainly a bit of an outlier in terms of just the nature of the intervention, right? 25:15 But you're getting a feeling that there's a little bit more openness now to consider I'm going to say alternative, kind of an alternative approach. 25:24 Do you have a feeling there's a better environment now for considering an approach like this? 25:29 I do because I think the overall shift in medicine and governance around medicine is let's try to tackle the cause of a disease rather than a pill to treat 25:38 the symptom of the disease. 25:40 And as we mentioned that, you know, PTSD is a wound in the brain and if we can heal that wound, we help heal the condition. 25:47 So that just general shift and mindset I really think gives hyperbaric a great chance to help these conditions. 25:53 That's really a great point, because I've talked a lot about in my work that we need to focus on the fire, not just the smoke.
Treatment Protocol, Safety, and Patient Experience 26:01 There is, I often said, there is no treatment, no medical pharmaceutical treatment for diabetes, for example, or high blood pressure. 26:08 You treat the elevated blood sugar and you treat elevated pressure, but take the drugs away and your back to where you started in one day. 26:15 you haven't fixed the problem. 26:16 Whereas what you're describing here with hyperbarics is you are actually fixing the problems such that people can get can get back on the horse and resume 26:25 their lives and not be dependent upon a symptom management protocol based on a pharmaceutical intervention. 26:31 So gosh, it sure seems to make sense. 26:34 Absolutely. 26:35 And I've always appreciated your work and your perspective, whether it's through diet and other modalities getting to the cause of a condition. 26:42 That's the way all medicine should think. 26:45 Well, let's just shift a little bit to, we've kind of danced around the idea of traumatic brain injury. 26:52 And I think, to be fair, there's a lot more data in TBI than there is with PTSD. 26:58 So the research looking at using hyperbaric oxygen to treat traumatic injuries seems to a be a more extensive. 27:06 You know, and has demonstrated incredible efficacy. 27:10 Why is their foot dragging? 27:12 Well, let me ask you, in Israel, are TBIs generally treated, at least in the military, using hyperbarics? 27:19 Yeah, in the military and in civilian population as well. 27:22 And you're right, there has been a lot more and earlier interventions with TBI because traumatic brain injury is a little bit easier to think of, 27:29 hey, it could be a wound in a brain from a blunt trauma. 27:33 It took some time for people to realize that post-traumatic stress is wound to the brain. 27:38 That being said, also, you don't have to have a traumatic war to a have traumatic brain injury. 27:43 The number one cause of TBI in our population here in Florida is falls. 27:47 So just falling and hitting your head. 27:50 We have saying in the clinic, the brain does not discriminate what hurts it. 27:53 Whether it's the floor, a Ford Explorer in a car accident, or a shell shock from a cannon, injury is injury, and if you see that injury we know that this 28:05 treatment can help. 28:06 Well, not to be derogatory towards the Ford Explorer, but you're right. 28:11 Any and slip and fall. 28:12 I mean, one would think that, you know, this coupled with occupational physical therapy, psychological therapy cognitive retraining, 28:21 etc. 28:22 would be absolutely the way to go. 28:24 And to There are a lot of large hospitals that have hyperbaric chambers already in place for utilization for the 13 approved Medicare indications, 28:34 carbon monoxide poisoning, radiation necrosis, non-healing wounds, diabetic foot ulcers, et cetera, osteomyelitis. 28:42 You would think that it would be ultimately the right thing to do and certainly cost effective that stroke patients and TBI patients should be engaged 28:52 in this type of therapy. 28:53 Why not? 28:55 Absolutely, especially because the alternative doesn't exist, um, Especially with stroke and traumatic brain injury. 29:00 Um, you know, back in my previous practice in New Jersey, I was the doctor on the sideline for the Jersey city high school football association. 29:06 And there are plenty of traumatic, brain injuries on. 29:09 You go through your concussion protocols to evaluate and to kind of set up a return to play. 29:15 But, we know with our student athletes, all the way to the professional ranks. 29:20 There are changes days, weeks, months, and even years after a traumatic injury, And that can cause significant disability, 29:27 whether it's through cognitive decline or mood changes. 29:31 So to address those early on will save the life and the cost in the long run in a medical community. 29:38 For sure, we need to use these facilities that we have already. 29:43 Dr. 29:43 Elamir, let me get back to something a little bit more technical. 29:46 I mean, it was thought in the day that more is better, higher pressure, 100% oxygen, maybe a monoplace better than a multiplace chamber because we can 29:58 really give a lot of oxygen under 2.4 atmospheres, even higher perhaps. 30:03 But the new thinking seems to be, and I know that Dr. 30:08 Afrati has talked about this quite a bit. 30:10 It's that that's not necessarily what's going on here. 30:13 And he talks about the delta. 30:15 He talks that it's really the change that is sensed by the brain, the tissues that increases the production of this hypoxia inducible factor one alpha.
Long-Term Outcomes and Broader Uses 30:26 But walk us through how the change in oxygenation affects that chemical pathway, and then downstream, what does that pathway initiate? 30:38 Yeah, you're right. 30:39 That's a very important topic, because this is what separates hyperbaric treatments, is the protocol. 30:43 And the purpose of this, it is to stimulate, as you mentioned, a hypoxia-induced factor. 30:48 This is a factor that gets released in its name, in a hypoxic state, or low oxygen. 30:53 The problem is I can't put my patients in the low-oxygen state because then they're actually going to have cell death. 30:58 So the next best thing is to trick the body, make it think it's in low oxygen when it is not. 31:02 And you mentioned, the best way to do that is have the right delta of oxygen. 31:06 So in here, we close the doors, pressurize to 2.0 atmospheres, and we wear the 100% oxygen mask for 20 minutes. 31:13 While it on, your oxygen level is 17 times higher than normal in the concentration of your plasma. 31:18 Then, after 20 min, you're asked to take the mask off. 31:21 The ambient air in the chamber is 21% oxygen, normal, which is safe, but that safe normal oxygen is perceived as a low oxygen state relative to the high 31:29 you were just doing for 20 minutes. 31:31 So that fluctuation of 20 minutes on high oxygen, five minutes off normal oxygen back and forth for over two hours, 5 days a week for 12 weeks is enough 31:39 of a delta of oxygen concentration to stimulate hypoxia induced factor, thereby a cascade of stem cell proliferation, angiogenesis, 31:48 mitochondrial biogenosis, telomere lengthening. 31:51 All of these things can happen when you have that delta. 31:54 So more isn't better. 31:55 You don't need to risk more barotrauma or even oxygen toxicity by going to 2.4 atmospheres if you'll get the same dose response curve at 2 point zero. 32:04 Wow. 32:05 So it's so exciting. 32:06 It really demonstrates You know, the value of the protocols, of looking at different protocols over time and seeing what works, 32:15 and then finally discovering this whole notion of inducing this factor, hypoxia-inducible factor that is induced, you know with the change going up or down, 32:25 correct, whether it goes up and down we induce this Correct. 32:28 You can go to a hypoxic state low enough to induce it, and it's a protective mechanism because in a low oxygen state, your body will recognize there's 32:35 going to be cell death. 32:36 And that's what that why your wants to create new cells to replace the cells that might die. 32:40 That's why it wants grow new blood vessels to help usher more blood flow to the organs that are starving with oxygen. 32:46 So you can do it that way, but you'll actually have the negative consequences of hypoxia. 32:50 Now you could capitalize on it with the relative hyproxies and get those same benefits. 32:54 You know, in closing, I want to say that my visit to the Aviv Clinic was just the the word, you know words state of the art.
Mechanism of Action and Closing Remarks 33:05 I kept thinking about it. 33:08 It's just a breathtaking facility. 33:10 And what can you tell our audience? 33:12 How can they learn more about your work and about the aviv clinic? 33:18 Absolutely. 33:18 So our website, aviv-clinics.com, that's where you can directly contact us if you're interested or have any questions. 33:26 All of our studies that are published, we actually have them and all the direct links to the journals on our web site as well. 33:32 And any information about all of the conditions. 33:34 Our clinic is here in the villages, which is an hour north of Orlando. 33:38 If you are in central Florida area, you have open tours all time. 33:43 I'm happy to speak with anybody in person or if they want to have a virtual consultation, That's great. 33:49 Well, Dr. 33:49 Elamir, thank you for taking time out of your day to speak to our audience. 33:54 I'm sure people learned a lot today and it's really wonderful that we can offer through this technology hope for TBI patients, 34:05 PTSD patients certainly stroke patients as well. 34:07 So thanks for joining us. 34:09 Absolutely. 34:10 It's an honor and it's our duty to help, whether it is veterans or anybody suffering from stroke. 34:15 I'm happy to helping anybody and I thank you for giving us the opportunity and thank for all the work you've done to Dr. 34:19 Bumrunner. 34:20 Thank you. 34:20 We'll talk soon. 34:21 Bye for now. 34:22 Absolutely, take care. 34:26 Interesting information, isn't it? 34:28 Why would altering the oxygenation of the brain have such profound effects, and yet it does? 34:35 This is what these studies have revealed in PTSD, certainly in traumatic brain injury, stroke, a variety of neurological conditions. 34:44 We've talked about that before on this program. 34:47 This is therapy taking place at the Aviv clinics. 34:50 That's in the villages, which is in central Florida. 34:53 I've had the opportunity to visit Aviva clinics on multiple occasions, and it's really very, very impressive.
Comments