Shae Ryalls ’18, University of Mary, & Patrick J. McCloskey, Editor-in-Chief, 360 Review Magazine

In January this year, Dr. Daphne Denham testified before the North Dakota House Human Services Committee in Bismarck to promote the use of Hyperbaric Oxygen Therapy (HBOT) to treat traumatic brain injuries (TBIs). Also testifying were TBI survivors in support of the bill before the committee to create a Medicaid-funded pilot study to treat 30 TBI patients with HBOT. The study would be conducted by Dr. Denham, who opened a Healing with Hyperbarics of North Dakota clinic in Fargo last summer, after opening her first hyperbaric clinic in the Chicago area three years before.

There are about 1,200 North Dakota residents living with severe brain injuries, which cost Medicaid more than $9 million yearly. Remarkably, the pilot study would seek patients still suffering debilitating symptoms after exhausting all standard care treatments. These symptoms include short-term memory deficits, cognitive impairment, disorientation, depression, frequent headaches and fatigue. In short, the study seeks to help TBI patients whose injuries are beyond the healing powers of traditional medicine.

Every year, there are more than 2.5 million TBI-related emergency department visits in the U.S. This results in about 282,000 TBI-related hospitalizations and 56,000 TBI-related deaths.

Nationwide, the long-term outcomes for people with moderate to severe TBI are daunting. According to the Centers for Disease Control and Prevention (CDC), 57 percent remain moderately to severely disabled, 55 percent are unemployed (but had jobs when injured), 29 percent abuse alcohol and/or drugs, and half die within five years of injury.

Hyperbaric chambers at Healing with Hyperbarics of North Dakota in Fargo. On the left, hyperbaric technician James Scheerenburg monitors a patient in a “dive” inside a chamber, which is transparent, allowing patients to watch TV shows and movies.

The bill is receiving strong support from North Dakota American Veterans (AMVETS), since many veterans suffer from the long-term and often devastating effects of TBI, including post-traumatic stress syndrome (PTSD).

Given the data currently available on HBOT’s efficacy, the pilot study would likely demonstrate significantly improved outcomes for these TBI patients. The study would also likely show how to greatly reduce TBI’s direct and indirect costs, since HBOT can be much less expensive than standard protocols and can bring near complete resolution of all symptoms.

Dr. Denham plans to provide data from the study to Medicaid, Medicare and insurance companies to make the case for coverage of HBOT as part of the standard of care in treating TBI patients.

Prevalence of TBIs & Concussions

Every year, there are more than 2.5 million TBI-related emergency department visits in the U.S. This results in about 282,000 TBI-related hospitalizations and 56,000 TBI-related deaths.

A TBI is “an alteration in brain function, or other evidence of brain pathology, caused by an external force,” according to the Brain Injury Association of America. A TBI “can be caused by a bump, blow or jolt to the head, or a penetrating head injury,” stated the CDC’s recent Report to Congress titled “The Management of Traumatic Brain Injury in Children.” A TBI can also be caused by violent shaking or an indirect event such as a nearby explosion that impacts the brain severely enough to cause injury.

According to the Dakota Medical Foundation, about 15 percent of the state’s 27,000 high school athletes are concussed yearly.

During a TBI, the head and brain move rapidly back and forth, with the brain hitting the skull, causing brain tissue to change shape, which can damage brain cells. Chemical and metabolic changes often occur within brain cells diminishing their ability to function and communicate with each other.

Surprisingly, the Report to Congress stated there is a “lack of robust scientific evidence identifying optimal pathways to recovery.” However, the Report did not consider HBOT, for which there is ample clinical and research evidence to count as an “optimal pathway.” A recent article in the Journal of Neurotrauma noted there has been no major advancement in the treatment of TBI in the previous quarter century—except HBOT. The article reviewed the last 40 years of research regarding severe TBI and concluded that HBOT “has the potential to be the first significant treatment.”

As the reader will see, HBOT’s healing powers are remarkable and wide-ranging. This leads many researchers and physicians to worry initially that HBOT might be too good to be true. Such skepticism is prudent but has proven unwarranted. HBOT practitioners make no hyperbolic claims beyond what the evidence shows. As well, HBOT is increasingly being used with other therapies. For example, a 2017 study reported the reversal of Stage 4 breast cancer with a combination of standard chemotherapy and HBOT.

Hyperbaric Oxygen Therapy

HBOT is a form of medical treatment in which patients breathe pure oxygen in a total body chamber, where atmospheric pressure is increased and controlled. The combination of pressure and 100 percent oxygen greatly enhances the body’s natural healing capacities.

Oxygen is a natural gas that is necessary for life and healing. Pure oxygen is the most natural of all drugs. However, HBOT is primarily the application of physics, rather than chemistry, to medicine. The amount of gas dissolved in a liquid, according to Henry’s Law, is proportional to the pressure of the gas above the liquid, provided that no chemical reaction occurs.

Increased oxygen both enhances cellular repair and reduces inflammation, which is responsible for a majority of the long-term damage seen in [traumatic brain injury].

The oxygen content of normal dry air is about 20 percent. When a patient inhales 100 percent oxygen in a hyperbaric chamber, which increases the pressure up to 3 atmospheres, the amount of dissolved oxygen in the blood stream increases up to 50-fold (from .3 to 15 percent).

Normally, oxygen is carried mostly by red blood cells, but HBOT dissolves oxygen in all the body’s fluids, which has been documented to improve healing. The high level of dissolved oxygen in blood and other fluids enables—actually forces—oxygen to penetrate damaged tissue where blood flow is hindered. Increased oxygen both enhances cellular repair and reduces inflammation, which is responsible for a majority of the long-term damage seen in TBI.

Dr. Daphne Denham (middle) with hyperbaric technicians James Scheerenburg (left) and Tyson Shade (right).

The resulting decrease in swelling restores previous blood flow. Tissues are also stimulated to grow new blood vessels. The increased oxygen augments the ability of white blood cells, which power the body’s immune system, to kill bacteria, viruses and intracellular pathogens.

HBOT is a simple, non-invasive and painless treatment, which is quite safe. Side effects are rare and typically minimal. Much care is taken to screen and monitor patients. For example, patients with diabetes might experience a drop in blood sugar while in the chamber. They are advised to eat before treatment, and their blood glucose levels are monitored prior to a “dive,” the term used to describe a treatment, which is reminiscent of the beginnings of HBOT’s first application in the U.S. by the military, which began testing HBOT after World War I. The treatment has been used safely since the 1930s to treat divers suffering from decompression sickness, also known as “the bends” as often referenced in TV shows and movies.

Healing with Hyperbarics of North Dakota

Dr. Denham established the Healing with Hyperbarics of North Dakota clinic in Fargo last July with the goal of treating concussions and wound healing. Hotel magnate Gary Tharaldson was instrumental in attracting
Dr. Denham to Fargo and getting the clinic built, in order to bring the benefits of hyperbaric medicine to North Dakotans.

Certainly there is a need. According to the Dakota Medical Foundation, about 15 percent of the state’s 27,000 high school athletes are concussed yearly.

In 2015, Dr. Denham opened her first Healing with Hyperbarics clinic in Northbrook, Illinois, where she and her family were living. Dr. Denham gave up her surgical career to spend more time with her six children. As a career change, she became passionate about hyberbaric medicine.

As Dr. Denham observed what HBOT could do, she noticed the high rate of concussion among student athletes. In fact, three of her daughters compete at the collegiate level in rowing and volleyball. One daughter suffered a concussion in January 2016, shortly after the clinic opened.

“I treated her in our hyperbaric chambers,” related Dr. Denham, “and developed the protocol we currently use. She needed only one treatment.”

Athletes Under Pressure

What do Tiger Woods, Michael Phelps, Peyton Manning and Novak Djokovic have in common regarding recovery from performance exhaustion and injury? The answer, often reported in the news but without explanation, includes HBOT as one of the main therapies.

“Concussion” starring Will Smith, was released in 2015.

At the Masters Tournament in 2010, when Tiger was ranked as the world’s top golfer—a position he held for a record 683 weeks in total—he was questioned about how he was able to recover from recent injuries so quickly. He answered he’d been utilizing HBOT.

Quarterback Peyton Manning missed the 2011 NFL season recovering from serious neck injuries. He was accused of using human growth hormone to speed healing but instead was receiving hyperbaric treatments. Manning returned to win league MVP in 2013 and his second Super Bowl in 2016.

Both Phelps, who won a record 28 Olympic medals, and Djokovic, currently the world’s top-ranked tennis player, have used HBOT regularly to speed up recovery from competition, training and injury. Djokovic attests to seeing many other top tennis pros using HBOT.

In fact, in recent years, increasing numbers of professional athletes and sports teams are using HBOT to improve performance, recover from concussions and help heal more rapidly from other injuries.

National Forget-about-it League

Unfortunately, until recent years, athletes in contact sports, such as Mike Webster, didn’t have access to HBOT. Webster suffered the equivalent of “25,000 automobile crashes,” according to medical experts, during his NFL career without the benefit of the most effective therapy for head injuries, HBOT. In effect, Webster was a human crash test dummy in a sports culture dictating that players shake off head injuries and get back in the game.

Webster played football for 25 years in high school, college and in the pros as an offensive center, mostly for the Pittsburgh Steelers (1974-88). He teamed with Hall of Fame quarterback Terry Bradshaw to win four Super Bowls and played in nine Pro Bowls. In retirement, he suffered for years from severe depression, dementia and amnesia. Then in 2002, at only 50 years of age, Webster died.

In 2016, a study by the Academy of Neurology indicated that “more than 40 percent of retired National Football League players … had signs of traumatic brain injury.”

Dr. Bennet Omalu performed an autopsy revealing that Webster suffered from chronic traumatic encephalopathy (CTE), a devastating condition seen in boxers and elderly patients with Alzheimer’s disease. Webster’s tragic struggles and the connection between the multiple concussions he suffered and CTE became the subject of the movie “Concussion,” which was released in 2015, starring Will Smith.

Lawsuits by former players resulted in a billion-dollar NFL concussion settlement. In 2016, a study by the Academy of Neurology indicated that “more than 40 percent of retired National Football League players … had signs of traumatic brain injury.”

High Concussion Rate Among Young Athletes

Because of the movie “Concussion” and many news reports, much more attention is now being given to the prevalence and long-term risks involved in concussions. Most states have passed what are termed “shake-it-off laws” requiring medical clearance of young athletes suspected of sustaining a concussion, before sending them back into a game, practice or training. Better reporting and record-keeping has resulted in more accurate assessment of concussion’s prevalence.

About three-quarters of TBIs are classified as mild TBIs or concussions. Many concussions go unreported and untreated, so the best estimate of occurrence by the CDC is 3.8 million concussions per year in sporting and other recreational activities in 2017. Two-thirds of these (2.5 million) are suffered by teenagers, a million of whom reported two concussions in the previous year.

A study based on Blue Cross Blue Shield (BCBS) medical claims data showed a 71 percent increase in concussions for patients aged 10 to 19 from 2010 through 2015. Most of the increase—from 8.9 to 15.2 percent per 1,000 BCBS members—occurred as “shake-it-off” laws were being enacted.

For 10 to 19 year-olds, fall—during football and the beginning of hockey seasons—is the peak period for concussions, with young males suffering almost twice as many concussions as females. On the previous page is a graph illustrating the distribution of concussion rates by age group. Youngsters in the prime of their middle- and high-school sports careers suffer the most concussions.

Young males were diagnosed with concussions more often than young females at 17 compared to 13.3 diagnoses per 1,000 members. Yet the diagnosis rate for young males increased by 48 percent during the study period, while the increased rate for young females was 150 percent higher. Concussions also occur often among soccer and volleyball players. Overall, patients aged 10 to 19 were over five times more likely to be diagnosed with a concussion than all other age groups combined.

Severe TBIs and mild TBIs (concussions) usually affect children and teenagers more negatively than adults.

Worse for Children & Teens

Severe TBIs and mild TBIs (concussions) usually affect children and teenagers more negatively than adults. “An injury of any severity to the developing brain can disrupt a child’s developmental trajectory and may result in restrictions in school and participation in activities,” the Report to Congress stated. “As a result of TBI, children can experience changes in their health, thinking and behavior that affect learning, self-regulation and social participation, all of which are important in becoming productive adults.”

Clinical eye-tracking results for a male high school athlete who suffered a severe concussion. The results in the top graphic were measured after the concussion and before HBOT. The eye-tracking results on the bottom were measured five days later after eight HBOT sessions.

While most youngsters recover physically from concussions, sometimes there are changes in cognition and behavior that appear months or years later. Typically, symptoms such as dizziness, light sensitivity and headaches manifest in the first week after a concussion. Sometimes, these symptoms persist for months or a year or more, developing into what is called post-concussion syndrome. What’s especially puzzling is that post-concussion syndrome, which includes cognitive, linguistic and neurobiological symptoms, can occur regardless of the severity of the concussion.

Multiple concussions compound this syndrome producing chronic conditions, such as severe depression, impulse control disorder and memory loss, which often lead to alcohol and drug abuse—and worse.

In January 2018, Andrew Carroll, 32, the former captain of the University of Minnesota Duluth hockey team, who played several seasons in the American Hockey League, leapt to his death. Carroll’s family donated Andrew’s brain to Boston University’s CTE Center, which conducts research into the progressive degenerative disease often due to multiple concussions.

The same month, Shane Callahan, a Valley City resident who suffered from deteriorating brain function and acute personality changes due to multiple concussions playing sports, committed suicide at 27 years of age.

In March 2019, Kelly Caitlin, an Olympic silver medalist, committed suicide after suffering a concussion three months earlier. She was 23 years of age.

None of these athletes were treated with HBOT.

Student-Athlete Pilot Study in Fargo

Dr. Denham treats concussions in patients of all ages at both clinics. However, her focus has been mostly on student athletes as she is currently running a pilot concussion study at the Fargo clinic. The study is funded by the Dakota Medical Foundation, which enables her to treat student athletes at no charge to the family. To date, Dr. Denham has treated 140 student athletes in Fargo. On average, each student needed three one-hour treatments to recover fully from concussion—that is, complete resolution of all symptoms. Unfortunately, some athletes didn’t return to finish the protocol, perhaps because their families live far from Fargo, and they might never fully recover.

To help diagnose concussions and confirm HBOT’s efficacy, Dr. Denham uses clinical eye-tracking. A concussion causes a disruption between the brain and eye function. Dr. Denham recently treated an elite male athlete who suffered a concussion while playing for an NHL farm team. His eyes initially reacted erratically in both circular and horizontal tracking and overall stability, similar to the graphics on the right. The young man’s Brain Health Indicator score was 59 out of 100, which is just below functional. After six HBOT treatments over 72.5 hours, his symptoms were completely resolved, as shown by his improved eye-tracking and by his Brain Health Indicator score improving to 91, which is in the normal range for elite athletes.

Cost Savings

TBIs impose a significant financial burden on the nation, in both direct and indirect costs, totaling about $82 billion yearly. To illustrate how HBOT could dramatically reduce health care expenditures, consider the cost differential in the case of a female high-schooler who suffered a severe concussion in August 2017.

Over the next year, this girl and her family followed the conventional protocol, which involved an emergency department visit and multiple appointments with the family physician, a physical therapist and a chiropractor. The cost to the family was $2000, partly in travel expenses, and the insurance company paid out about $11,000, for a total of $13,000. However, when this student started back to school in August 2018, a full year after the injury, it soon became obvious that she was far from full recovery.

“She was a straight-A student who was failing,” Dr. Denham related. “She couldn’t keep up with the increased cognitive demands of being back at school since her brain had not completely healed.”

The girl’s family heard about the pilot study at Healing with Hyperbarics of North Dakota in Fargo and made an appointment with Dr. Denham. After 13 one-hour treatments over a month that fall, the young lady recovered fully—and at 4.3 times less cost. Each hyperbaric treatment was administered at the Medicare fee level (about $225) for a total cost of $3,000.

To date, Dr. Denham has treated 140 student athletes in Fargo. On average, each student needed three one-hour treatments to recover fully from concussion—that is, complete resolution of all symptoms.

Considering the large number of TBIs per year, the savings would soon mount into billions of dollars if HBOT became the standard protocol. The savings in indirect costs would be much greater, considering that a significant percentage of patients suffer long-term issues, including 12 percent of severe TBI patients who live in a nursing home or other institution.

While student athletes won’t experience such devastating outcomes from a single concussion, the long-term effects are often life-altering as well. The young female discussed here might have dropped out of school, which would have greatly dampened her quality of life, limited her career choices and diminished her earnings potential. Also, given her persistent sensitivity to light and motion, she might never have played sports again and certainly never competed again.

HBOT Pioneer

There is now “unequivocal proof that HBOT is effective in the treatment of traumatic brain injury of all severities and injuries of any age in any person,” wrote Dr. Paul G. Harch in the preface to his book, The Oxygen Revolution. Dr. Harch is the Director of the Department of Internal Medicine at Louisiana State University’s School of Medicine and the most renowned pioneer in hyperbaric medicine. Since 1986, he has treated more than 70 cerebral disorders, including stroke, dementia and TBI with HBOT with remarkable success.

The Oxygen Revolution: Breakthrough Gene Therapy for Traumatic Brain Injury & Other Disorders, Paul G. Harch and Virginia McCullough, Hatherleigh Press (2016).

“The evidence is so compelling,” Dr. Harch continued, “that every patient with a brain injury should seek this treatment as soon as possible after receiving a brain injury.” His research shows that HBOT, administered within two to three hours after injury, “significantly quenches the secondary destructive inflammatory reaction.”

Severe brain injuries can also be caused by lack of oxygen (anoxic) as in drowning or stroke. In February 2016, Eden Carlson’s mother thought she was with her siblings, who thought she was with mom. But two-year-old
Eden was drowning in the pool at the family home in Arkansas. Somehow she got through a baby gate and was found floating face down in the pool. She had been there for about 15 minutes. Her parents started CPR and EMT continued it, in total for 100 minutes before her heart beat independently.

Eden was taken to Arkansas Children’s Hospital where she was treated for 35 days. The medical staff did everything they knew how to do for her. When Eden was finally sent home, her mother said, “She was a vegetable, unable to do anything.” She didn’t respond to stimuli, squirmed constantly or was otherwise immobile. Eden had suffered serious injury to her brain with the loss of both white and gray matter.

Today, Eden has recovered much of her brain and motor function, and she continues to improve. Her recovery marked the first documented case of reversal of gray matter loss and white matter atrophy (types of brain damage).

Closer to home, Rusty Ouart has been steadily recovering from injuries—for which he was awarded a Purple Heart—suffered in a mortar attack in Iraq in 2008, while serving in the North Dakota National Guard. He was sent home and for eight months suffered short-term memory loss, vertigo, debilitating headaches and constant fatigue, before military physicians diagnosed him with a severe TBI. Ouart has since recovered for the most part, continues to improve and travels nationwide promoting veterans’ rights.

What healed Eden, Ouart and many other patients with severe TBIs was HBOT, primarily under Dr. Harch’s supervision.

Hyperbaric or Hyperbolic?

These outcomes highlight HBOT’s healing powers. As mentioned earlier, many people, regardless of medical background, believe that accounts of HBOT’s efficacy are hyperbolic—at first. How could something as simple and inexpensive as oxygen under pressure produce such positive results? This is not fully understood and requires more research. Yet, HBOT is being used more widely and integrated into treatment regimes for many conditions precisely because of the mounting supportive evidence.

HBOT practitioners make no claim that hyperbaric medicine is a panacea. Results vary, but virtually all patients benefit with almost no risk of side effects. Currently, HBOT is approved by the U.S. Food and Drug Administration for 14 medical conditions, including burns and carbon monoxide poisoning. Typically, this means major insurance companies won’t pay for HBOT in “off-label” applications, such as treating concussions. Hopefully, HBOT will soon be approved for treatment of TBIs and other injuries.

There is now “unequivocal proof that HBOT is effective in the treatment of traumatic brain injury of all severities and injuries of any age in any person”

Dr. Paul G. Harch

A significant step in this direction would be approval of the bill in the North Dakota legislature to fund the HBOT pilot study that Dr. Denham would conduct. When this publication was sent to the printer in March,
the bill had passed the House and the Senate, but had yet to be signed by
the governor. 