The point of
this report was to figure out if hyperbaric oxygen treatment
influenced Lyme disease due to the spirochete, Borrelia burgdorferi.
The spirochete B. Burgdorferi is a microaerophilic organism carried
by the Deer tick ( Ixodid ) and moved to humans and other mammals by
its bite. Symptoms regularly start by a bulls-eye rash and erythema
migrans.
Symptoms may
include pain in joints and muscles, sore throat, fever, distended
glands, and psychological "fogginess".
If not diagnosed
in the first 1 or 2 months, the illness may become a lingering
infection. At that point it seemingly becomes sequestered in
fibroblasts and other cells which, in turn seem to protect it
against effective treatment by all known antibiotics so far tested.
The illness is hard to diagnose without serological findings and
needs the talent of a very qualified surgeon, experienced in
treating this illness.
Rationale:
It was shown by
Austin the spirochete couldn't survive if transferred in air to
another host, but would survive if transferred in a gas mix of 4%
oxygen. This demonstrated the spirochete could not survive in an
oxygen partial pressure of 160-mm Hg ( the partial pressure of
oxygen in air ), but could survive in a partial pressure of 30-mm Hg
( which is the partial pressure of 4% oxygen at 1 atmosphere,
comprehensive ( ground level pressure ). , it appears clear a lethal
oxygen level for the spirochete lies between thirty mm Hg, and 160
mm Hg. It is also known that while the provoked partial pressure of
oxygen is roughly 160 mm Hg, at the tissue level, the partial
pressure of oxygen normally is roughly 30-35 mm Hg. Therefore , it
wouldn't be predicted that respiring air at ground level would cause
any damage to the spirochete.
However, if the
patient were placed in a hyperbaric chamber and the pressure
increased to two.
36 atmospheres,
comprehensive ( ata ), the total barometric pressure would be 1794
mm Hg. If the patient were then to respire pure oxygen the provoked
partial pressure of oxygen would be 1794 mm Hg. Provoked oxygen is
watered down by carbon-dioxide and water vapor in the alveoli, so
the arterial blood would be exposed to an oxygen partial pressure of
roughly 1700-mm Hg, and the tissue oxygen would be between 2 hundred
and 300 mm Hg. This clearly would be above fatal oxygen levels for
the spirochete since it is anticipated that oxygen routinely would
diffuse throughout all cells of the body. This partial pressure of
oxygen can be securely achieved in a hyperbaric chamber, and the
patients can put up with this level for ninety mins or longer quite
successfully.
Protocol :
This research
received approval by the College Academic Review Board.
Subjects were
selected from those referred by clinical consultants who were
experienced in the treatment of Lyme illness. All subjects presented
with a positive diagnosis of this illness according to the CDC
criteria, including a positive Western blot serology of the correct
bands. All had failed intravenous antibiotics, and many were
continuing to deteriorate although still on assorted antibiotics.
Subjects were given a lecture on the use of the hyperbaric chamber,
including the risks , and confirmed a waiver and release as agreed
by the Belmont Report. They were placed in the multiplace chamber
and compressed to 2.36 ata, whereupon a plastic helmet was placed
over the head and pure oxygen was administered. The oxygen flow
pattern was such the subject impressed one hundred pc oxygen with
each breath. Subjects managed to communicate with the attendant in
the chamber as well as with one another. Treatment duration was
sixty minutes on oxygen, and in most examples the treatments were
administered bid for 5 days followed by a two-day rest.
Several
different series were attempted, starting from ten treatments to
thirty treatments. One subject received 145 treatments over the
course of three months.
Results :
Ninety-one
subjects finished a total of 1,995 hyperbaric oxygen treatments,
although 9 were eliminated later thanks to the presence of another
medical problem not clear during their treatments. These other
medical issues were such items as babesiosis, ehrlichosis, hepatitis
C, and formerly unidentified neurological issues. 2 subjects were
eliminated because of the development of septicemia from IV
catheters, and one due to current breast cancer, though all 3 of
them later showed an improvement of Lyme symptoms with hyperbaric
oxygen administration. Subject analysis was carried out by a
shortened questionnaire taken from the standard test employed by
many Lyme experts as a part of their analysis.
This test was
designed so that nil reflected no symptoms, while 10 reflected grim
symptoms. Though extra statistical analysis still is being carried
out, it seems that roughly 84.8% of those treated showed heavy
improvement by a decrease or elimination of symptoms. Only twelve
subjects ( 13.1% ) claimed no obvious benefit. Before treatment, the
subjects had a median score of 114.12 ( of a probable 270 ), and
after being treated they averaged 49.27.
This reduction
of 64.85 points was statistically heavy in a paired t-test ( p=0.000
). The variability of the scores from patient-to-patient fell as
well after the treatment series. The standard deviation of the
scores was 56.00 before and 44.14 after being treated. The p-value
of this reduction is 0.057 in a Fisher's F-test. Further, 58% of the
respondents had score reduction of 41.86 points or more. All except
one of the 91 subjects developed grim Jarisch-Herxheimer reaction,
often appearing in the first five days of the start of hyperbaric
oxygen treatment.
Customarily ,
the Jarisch-Herxheimer reaction continued across the series of
treatments, and in numerous examples continued for at least a month
after the treatments were finished. Most subjects then started to
show major improvement that in some examples has continued for eight
months.
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