The Baroo: A Podcast for Dogs and Their People
The Baroo: A Podcast for Dogs and Their People
Breathing New Life: Hyperbaric Oxygen Therapy's Role in Veterinary Healing with Dr. Christina Montalbano
*We will be taking a little break, but will be back with new conversations on all things dog in Spring of 2025! In the meantime I would love to hear from you! If you have a story of canine companionship you would like to share, a topic you would like to explore on the podcast, a question, or even a comment, please, email me charlotte@thebaroo.com.
Dr. Christina Montalbano from the University of Florida’s veterinary teaching hospital guides us through the world of hyperbaric oxygen chamber therapy for our animal companions. From horses to hamsters, we discuss how this advanced treatment is offering a breath of fresh air to veterinary care, tackling ailments like wound management, spinal cord injuries, and a host of other conditions. Our conversation with Dr. Montalbano peels back the layers of history and science behind this modern marvel, revealing its journey from deep-sea applications to enhancing the well-being of pets and wildlife alike.
We discuss the preparations and protocols necessary to ensure a secure environment inside the chamber. Learn why the smallest details, from removing a dog's collar to monitoring a cat's body temperature, are critical for a successful session. Dr. Montalbano also walks us through the contraindications and challenges of the therapy, sharing her expert perspective on how it's not a one-size-fits-all solution and what it could mean for animals with specific conditions like ear problems or the risk of acquired deafness.
We also explore how hyperbaric therapy holds its own when compared to treatments like ozone therapy, offering up vital information for pet owners seeking the best care
options.
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*This podcast is for informational purposes only, even if, and regardless of whether it features the advice of veterinarians or professional dog trainers. It is not, nor is it intended to be a substitute for professional veterinary care or personalized canine behavior advice and should not be used as so. The views expressed in this podcast are solely those of the podcast author or the individual views of those participating in the podcast.
Well, thanks for let's get started guys. Thanks for popping on and chatting about this with us. Hyperbaric oxygen chamber therapy correct? Is that the correct name? Okay, it's something that I know very little about and I think it might sound kind of wacky to some people off the bat, but I know that it's been used in human medicine for quite some time, that it's been used in human medicine for quite some time, and I don't know when it was introduced in veterinary medicine, but that's something that you can elaborate on and I'd love to just jump in and talk about it and talk about the ways that it can benefit our pets, and if you want to introduce yourself for our listeners, that would be great, Dr Montalbano.
Speaker 2:Yeah, so my name is Christina Montalbano. I'm a veterinarian at the University of Florida, at their veterinary teaching hospital, and I have been clinical faculty there for just over a year now but did all of my post-vet school training down there. So I've been there for about a total of six years and at the University of Florida we've had a hyperbaric oxygen chamber for just over 10 years now and I believe we still remain to be the only vet hospital in the academic or the teaching hospitals that has a chamber. But they are becoming more popular in private practice and hopefully continuing to grow. It is still a relatively newer treatment option for veterinary patients and can be seen both on the equine and the small animal side, but probably in the past 20 to 30 years really, the technology's been available but still pretty hard to come by. So everyone who has them available to them is fortunate and should definitely take advantage of having them.
Speaker 1:So it was introduced to veterinary medicine about 10 years ago, or so you say 10 or 20 years ago, 10 to 20 years ago.
Speaker 2:yep, it's relatively new, I think. Before then maybe some pets were getting the benefit from human chambers, but the vet, the vet-specific chambers much, much more recent.
Speaker 1:Do you know anything about when it was discovered in general, for even human medicine, and how.
Speaker 2:So it's something that back in the 1800s the technology was starting to be developed when, through construction workers mostly that were doing deep sea dives to build bridges, things like that, where they're at low sea level and under pressurized conditions, that they found, as they brought them back up to normal, beyond sea level, to ground level, that they would get the bends, as well as for other scuba divers. So they've figured out that by doing hyperbaric oxygen therapy treatment for these construction workers they could actually reverse the signs of the bends. And along the way physicians had figured out that, hey, we can use this for other indications, to provide high oxygen to different disease processes, to stimulate healing or to correct other disease conditions. It's been technology that's been around for a little while, but really only since, like the 1960s, 1980s, has it grown as a therapy specifically for medical treatments beyond something like the bends.
Speaker 1:For those of us listening who I know I only know I've only heard of the bends because I have a friend who scuba dives and it's like the only time I've ever ever heard of it. For those listening, can you just briefly explain what the bends are, because I know it's definitely a term used for, like professional scuba divers? Yeah, yeah.
Speaker 2:So the bends is a situation where with quick changes in pressure, the gas bubbles that are naturally in the body change in size and when that happens too quickly, those gas bubbles can especially lodge into the vessels and vasculature and cause major issues. So we don't want those changes in pressure to happen too quickly.
Speaker 1:Yeah, that makes sense. So how did you discover, how did you become interested in hyperbaric oxygen chamber therapy?
Speaker 2:So it's something that we've offered at the University of Florida since I started there, and so that was how I learned about it. Was just starting out there and seeing what they were doing with patients and starting to perform it myself, seeing the benefits that it can provide for a variety of different patient indications.
Speaker 1:Great. So what are some of those benefits? Can we jump into that? Yeah?
Speaker 2:Absolutely. So really any condition that would benefit from increased oxygen to tissues. So we can think about one of the most common indications in people that we'll use very commonly in our veterinary species is wound management. So when we have wounds we have an area of the tissue that does not have enough oxygen delivery because there's typically disruption of the blood supply. There may be bacterial contamination, all of those different things that can benefit from having increased oxygen to the tissues.
Speaker 2:The thing about hyperbaric oxygen is that it's not just increasing the oxygen delivery but it's also at a pressurized state which allows us to bring that oxygen into deep tissues without actually needing the normal oxygen carrying component of blood, which is hemoglobin. So even without enough blood cells in that wound, we can get the oxygen to the tissues, and oxygen is very important to promote healing. So wounds is one of the really common things that we'll use it for. Another very common indication that I use it for in University of Florida is for spinal cord injuries, such as our little dachshunds or French bulldogs that very commonly get intervertebral disc herniations. We can use this therapy to help improve oxygenation to the spinal cord to help them recover from that disc compression that happens to those spinal nerves. So we'll very commonly use it after surgery for them or as part of conservative management to help those spinal nerves heal.
Speaker 1:That's great.
Speaker 2:There's so many other indications that we can use it for. There's so many other indications that we can use it for I'd say a couple other really common ones that we're using it for patients that have osteoarthritis, arthritis of multiple joints. We find that it's helpful for pain management for them, things like pancreatitis to help reduce the inflammation associated with that. And then we're starting to look at it for cognitive dysfunction, which is similar to Alzheimer's in people. That's a disease process that's simply caused by reduced oxygen delivery to the brain. So if we can improve oxygen delivery to the brain in an aging animal, can we help to slow the progression of those cognitive signs of decline.
Speaker 1:Wow, would it be helpful in something like in like an acute, like emergency situations? Specifically, I have a. This is a little off topic, but I have a client that got bitten by a snake, a rattlesnake, yesterday, so he's in the ER. They don't I'm sure they don't have a hyperbaric oxygen chamber, but I just got back from visiting him and I'm just thinking like how could this benefit his healing process in any which way, and I'm not sure that it can, but curious.
Speaker 2:Yeah, it definitely depends Specific with snake bites sometimes we have to be a little cautious that hyperbaric oxygen therapy can be so good at reducing swelling that we can actually get something called re-envenomation syndrome where there may be pockets of venom that can then recirculate. But in general, any even acute injury that causes significant swelling, bruising, pain, we can help to very, very quickly reduce that pain, even from a single session. So often we'll, if we have like a swollen limb, we'll measure how the circumference of that leg before and after just even one session, and often we'll see a pretty significant reduction in that, which is really nice to see immediate effects of what we're doing yeah, absolutely, dr Lindsay, did you have a question?
Speaker 3:I did so along those lines. I'm even thinking for patients that undergo chemotherapy and have some of the chemotherapeutic material leave the vein, because we actually chatted about someone that is really into ozone about how helpful ozone was in a situation that she had encountered that was very similar. Is that also something that hyperbaric oxygen therapy could be beneficial with?
Speaker 2:Yeah, absolutely so. Any extravasation type injuries can definitely be beneficial. We had one that we were working with not too long ago that we're trying to be beneficial. We had one that we were working with not too long ago that we're trying to kind of correct the extravasation or that removal of the drug from outside of the vessel and trying to reduce the swelling and potentially the negative effects of that medication that can occur to the surrounding tissues where it's not meant to be.
Speaker 2:And then even going along that some people do question whether this is a therapy that we can do to supplement cancer treatment, Because there's always the thought that if we're increasing oxygen to cancer cells maybe that would be negative and that those cells would use the oxygen as energy to grow, which in cancer is negative. But a lot of information on the human side is finding that actually the level of oxygen that's provided, as well as the again, the increased pressure that's provided through hyperbaric oxygen therapy, can actually inhibit tumor cell growth that's associated in cancers. So it could actually be part of a complementary treatment option for different types of cancers, especially the types of cancers that may be sensitive to radiation therapy. So we'll think about using it in conjunction with radiation therapy in patients that are undergoing that type of treatment for their cancers, and then can we talk?
Speaker 3:oh, go ahead, Charlotte. No, you go, you go. I was going to say can we? Can we talk about what a session looks like? So, just to preface this, my own dog underwent hyperbaric oxygen therapy. She has been dealing, or was dealing with one-sided nasal discharge for a year, and that's actually how I found you.
Speaker 3:I was looking for resources for protocols because it's very specialized and although there's at least in Southern California, I know of two dermatologists that have units so they can use them they outsource for all of their protocols. They don't actually make them themselves. So I myself was even surprised to kind of watch them go through the process and the kind of things that I would not think are dangerous but in that situation you really have to be very aware of. So can you chat a little bit about kind of what that process is?
Speaker 2:Absolutely so. For our patients to go into the chamber, there are a couple of safety checkpoints that we have to perform in order to make sure that this is going to be a safe session for them. So everyone who operates have collars or leashes. They can't have toys, food bowls with them. And then for our patients that are hospitalized or immediately after surgery, we have to make sure to carefully cover any intravenous catheters, urinary catheters, any intravenous catheters, urinary catheters. We have to put special e-collars on if they need to have an e-collar on. And then we have to be careful what kind of bedding they have. So we have 100% cotton towels that can go in with them. So, unfortunately, all of their fluffy bedding and special toys have to stay out just for those sessions. We also have to be careful about things like fentanyl or lidocaine patches, because the chamber can actually increase the absorption of those medications, so those have to be removed. And then making sure that they don't have alcohol on their fur or ultrasound gel if they've just had an ultrasound. Or for our orthopedic patients, we use nail polish on their toes to make sure we know what limb is getting surgery, so the nail polish has to be removed. So lots of little things that we have to make sure are checked before they go into the chamber. We also make sure our patients are at a safe body temperature. They have a significant fever or are hypothermic. So if they're too cold that we can see fluctuations in their temperature from the pressure that they undergo in the chamber and we don't want them to have significant changes in their body temperature during the treatment. So once we've made all of those checks and made sure that they're safe to be in the chamber made all of those checks and made sure that they're safe to be in the chamber then we spray them with water which helps to reduce static electricity in their hair coat which is mostly just a comfort thing, so that they don't feel that little bit of static electricity. Most of our patients tolerate the chamber very well.
Speaker 2:Once we've had them all prepped, we load them in, shut the door and then slowly start that pressurization process.
Speaker 2:So it takes us about 15 minutes to get them up to the pressure that we're aiming for, which, depending on what we're treating, we're aiming for a specific pressure, which typically we'll use about two atmospheres absolute or 14.7 psi. For certain conditions we may choose to go higher or lower than that, but that's just kind of what's been shown to be most efficacious, most beneficial for treating these patients. Once they're up to that pressure that we're aiming for, we keep them at that pressure for typically between 45 minutes to one hour and then slowly bring them back down to normal pressure. So, just like I was mentioning before that we can see the bends or decompression sickness. If we change those pressures too quickly we can actually cause the bends in the hyperbaric chamber by having them go up or down from pressure too quickly. So we want to make sure to do everything at a nice slow rate so that we're not causing any problems. So again, most patients tolerate the sessions very well. They just sleep or we have little windows in our chamber that they can look out and watch us.
Speaker 1:I was going to ask my question like how do they do they don't panic or anything when they're in there, or they're just fine, they know for don't panic or anything when they're in there, or they're just fine, they know, for the most part.
Speaker 2:Typically they're very good for patients that do have like confinement anxiety. If they're not good in a kennel, we may choose to do some light oral sedation or light IV sedation, but for the most part they they honestly do very, very well with it right, they know you're trying to help probably. Exactly.
Speaker 1:I hope so at least. So what are some? Are there any contraindications other than you know some of the things you just mentioned, which were really mild, but anything, any patients that don't benefit or wouldn't benefit from it?
Speaker 2:Yep, so the main patient that we can't put in the chamber is one who's had trauma to their chest wall, where they have what's called pneumothorax, where there's basically a penetrating wound into the chest wall, Reason being that because when we undergo that pressurization and depressurization to do the therapy, they can actually get air trapped in their chest and that would be bad. So that's really the main reason that we would not do a session for a patient. The other thing is we want them to be relatively stable. So for patients that are still being stabilized after significant injury or trauma, we can't get to our patients that are in the chamber immediately. So if they're, you know, needing significant changes in medications, other things to help them to feel better quickly, then we wait until they're a little bit healthier, a little bit more stable, to do that treatment.
Speaker 2:We are also limited in the size of patients. So our chamber we can fit a hundred pound dog relatively easily, but that's about our cutoff for our particular chamber. Like I said, there are chambers for horses. So if we had a really large breed dog or sometimes we'll get calls about goats and sheep and other species that may need to come into the hyperbaric We'll send them to the equine chambers in the area to get their therapies.
Speaker 1:I was just thinking, if I have a dog that I take care of, and he's 175 pounds, and I was like, oh no, they'd have.
Speaker 2:this Might not fit in our chamber so well.
Speaker 3:And then what about inner ear? Because I know some, I've heard of people using it. For I guess it's kind of a two-part question. One do we have to be worried about animals that maybe have chronic ear infections or have some sort of compromise to their eardrum or to panic membrane? Then the second part of that question is what about using it in cases for deafness that's acquired?
Speaker 2:Yeah, yeah, so in people they can more easily tell us if they have increased pressure in their ears and discomfort from that pressurization, just like if we were to get on a plane and our ears in pressure specifically affecting the ears and the tympanic membranes. Sometimes we will see dogs that just as we're increasing the pressure above like five to seven PSI so pretty low in that range where we're trying to get to therapeutic levels that they'll yawn or shake their heads, but once we get past that point they're fine. So, as best as we can tell, we don't seem to have concerns about discomfort and increasing pressure. That being said, we always monitor our patients throughout the sessions and especially for patients that may have deep ear disease or chronic ear disease, if we see signs of discomfort we may choose to do a lower pressure treatment for them, or that may just be a treatment that's not most appropriate for them and we might have to think of other things that we can do for them.
Speaker 2:As far as acquired deafness, I guess it kind of depends on what the actual cause is. If there is inflammation within the inner ear, again maybe it could be helpful for that. Sometimes we see deafness more as part of that cognitive decline in our aging patients. So again, perhaps that increased oxygenation to the brain could help to either slow, potentially reverse those signs, but it's something that, I'd say we don't know for sure.
Speaker 1:So why do we think that it hasn't quite made its hyperbaric oxygen chamber therapy, hasn't quite made its way into more veterinary offices? Why is it still something that's kind of on the outskirts, Even though it's been like almost 20 years?
Speaker 2:you're saying, yeah, yeah, that's a great question. I think it is something that is still not well known. Yeah, so we don't have a lot of research about it and it is a pretty big investment for a clinic to obtain. It does require a dedicated, trained person to run the chamber. So I think a lot of it is just lack of knowledge and lack of awareness and, um, lack of understanding of what all it can be used for.
Speaker 2:So I think, um, one of the goals that we have at university of florida is encouraging people that are using these chambers to participate in collaborative research, to to, you know, share what they're treating, what they're using their chambers for, even if it's just, as you know, little write-ups on patient successes, case reports. And in the meantime, we're working on bigger projects where we can maybe prove that it works well for a particular indication, or find out how it's working for some disease process and be able to publish that in journals and textbooks and share that with more of the veterinary community from that aspect. But, like I said, it is a little bit of a commitment as far as the cost of the chambers, the dedicated people that have to run it. But I think once the chamber is installed and once people realize all of the different things that they can use it for, then a lot of places that have them are like why did we wait so long?
Speaker 3:You have a few more, so I I think even one just in terms of like treatment protocol, because I myself was surprised by the number of, and the term that I heard people using was dives. So, like, every session that they have is a dive.
Speaker 2:The number of dives and sort of the way that you organize them in terms of the timing yeah, yeah, so for different indications we may do different protocols as far as the frequency and the total number of sessions, and a lot of what we're basing this off of is what they do in human medicine as well as where we don't necessarily have human treatment protocols determined, then we're working off of what's been determined in research settings at this point and seeing what works for our patients and going from there. So our typical protocol that we start with at University of Florida is three sessions daily. So over the course of three days they receive one session a day and for a lot of our spinal cord injury patients we start to see that clinical improvement after that time and then switch to other types of therapies for them. For wound management we may do a very different protocol. So for wounds we might do up to twice a day for as many days until we see significant healing of that wound. So they're often a much longer course of treatment and, like I said, potentially even more frequent. Instead of the once a day we might do it twice a day for them. In some places they'll even do three times a day, separated each session by about four hours to make sure that the body has time to kind of recalibrate, return to normal pressurization, allow the healing energy to kind of take effect, everything settles down, and then repeat that session, like I said, up to three times a day. For other indications oftentimes we'll kind of work them down to a maintenance.
Speaker 2:So one of the conditions that we relatively commonly treat in Florida, unfortunately, is oomycete infections, pythium and lagenidium, which can cause pretty significant skin wounds or intestinal and other internal masses, and unfortunately there's not a great definitive treatment for it. But what we found is that the hyperbaric sessions can help to reduce the inflammation that's associated with that. So what we do have done for those patients is we'll do a week or two of daily treatments and then get them down to three days a week, two days a week, once a week, just to kind of maintain that reduction in inflammation associated with those wounds. So that's a very specialized condition that we, like I said, unfortunately have to see and treat in Florida. It may not be as common elsewhere.
Speaker 1:I know I was like can you say that again?
Speaker 2:So it's an oomycete infection. It's most similar to a fungus.
Speaker 1:That's what I was thinking in my head. It has to, yeah.
Speaker 2:Yeah, but the two species of oomycete that we see are Pythium and Laganidium.
Speaker 1:Wow, that doesn't sound fun, poor guys.
Speaker 2:Not so much, yeah, but those protocols definitely vary with what clinical indication that we're treating.
Speaker 3:Are there any really, I guess, like interesting or unexpected outcomes or cases like something where you guys were like, okay, no one's really done it for X condition before and then used it and saw good results or kind of any out of the box cases that you'd like to share?
Speaker 2:Sure, I wouldn't necessarily say out of the box, but something that hasn't really been looked at on the human side, which is where we try and get a lot of our information before we choose to do it in our veterinary patients.
Speaker 2:We've had pretty good success in treating these patients with multifocal osteoarthritis.
Speaker 2:They've already been receiving a slew of other therapies through rehabilitation oral analgesic medications, supplements, oral analgesic medications, supplements and they still have been having significant mobility dysfunction, significant pain and kind of as a last-ditch effort we say, well, let's see what hyperbaric can do.
Speaker 2:And we've had pretty good outcomes with them feeling a lot better, having more energy and osteoarthritis as well as lumbosacral disease. So those were two kind of surprising indications that, like I said, we just haven't had any information on the human side really and we have so many of these patients on the veterinary side that we're treating on a daily basis that again it was a little bit surprising that they hadn't responded as well as we would have thought to other rehab modalities that we do and yet adding in the hyperbaric for them really made a huge difference. Some other fun cases that I've had the opportunity to treat we did have a number of exotic wildlife species that we've worked with our zoo medicine service to help out. So eagles, hawks, owls, those are always just fun because it's a little bit different than the dogs and cats.
Speaker 2:And then we had a seahorse one time, which was pretty cool too.
Speaker 1:So we had a seahorse that had gas bubble disease.
Speaker 2:So basically the seahorse had the bends he went too far down with. Um, it's just, it's something that they can develop, that they they normally should have some amount of gas bubbles that change in size as they change in pressure for their swimming. But he was just a pet seahorse that that couldn't regulate those gas bubbles. We were able to do hyperbaric to help him out, poor guy.
Speaker 1:I'm sure he was very grateful.
Speaker 3:For the arthritis cases, if there are people because I know that there's a lot of people that end up, like you mentioned, using so many different modalities, so many different supplements, and then when they do get to a point where they're refractory to that treatment, what kind of protocol does that look like? Like are you seeing improvements after just one or two sessions, or do they need to be on more of a long term maintenance?
Speaker 2:So typically we do expect to see some benefit after even one to two sessions for the patients that will benefit from that therapy. So for our osteoarthritis patients we were doing it one to two times a week initially and if they showed a benefit, then doing it on a kind of as needed frequency. So for some patients that might be weekly. For other patients we might be able to get them down to every other week. If they're not needing it every other week, if they're doing well in between longer than that, then it's probably something that they had a flare up. We've now gotten them back to a more stable point and they don't necessarily need it ongoing, but we can always use it if they have another flare up again.
Speaker 1:It'd be helpful for my dog. He's got osteoarthritis for sure. Yeah, yeah.
Speaker 3:And then the other thing that I thought was really interesting is how hungry, because I've had two patients that have undergone Ceres and they are starving after treatment and they had warned me about that. But can you talk a little bit about like the underlying reason?
Speaker 2:for that, but can you talk a little bit about, like, the underlying reason for that? Yeah, that's interesting. I can't say I've seen that as much and that may be because we tend to have our patients that are hospitalized. They're on IV fluids, they're getting fed quite frequently throughout the day, but my guess would be that just the increase in oxygen as well as it is a rather humid environment in the chamber, there's a lot of airflow in the chamber so that could cause some increased thirst as well as increased hunger, that we're just supercharging their metabolism and they come out of there ready to eat and drink and they come out of there ready to eat and drink.
Speaker 1:Are there any? So would that be considered a side effect? I guess?
Speaker 2:that would be. It's probably a good side effect, maybe Not necessarily a bad thing. Yeah, exactly. So if we had a patient that was, you know, in the hospital recovering and they often don't have the best appetites because of surgery, pain, maybe some medications they're on Certainly coming out of the chamber and being willing to eat would be a good outcome for those guys yeah.
Speaker 1:We talked about on that same vein. We talked about chondroindications, but did we talk about side effects? Are there any side effects? I would assume not really yeah.
Speaker 2:Yeah, we haven't talked about that yet and there are a couple of side effects to be aware of and certainly for pet owners that are thinking about this, they should definitely talk to their veterinarian about the potential risks for their particular pet. One of the main side effects that is really not problematic, kind of goes back to what we were talking about with ear disease, that we can have kind of that barotrauma which can be ear discomfort. People will report teeth pain, chest pains. We really don't recognize those things in dogs or cats, aside from, like I said, maybe they yawn, they shake their head. It seems to be short-lived and not cause them any lasting discomfort.
Speaker 2:The more concerning side effect that we have that is very uncommon but we do very occasionally see it is oxygen toxicity.
Speaker 2:That oxygen is typically a really good thing but sometimes too much oxygen can be a bad thing and in particular it causes seizures. So we cannot predict which patients may have a seizure in the chamber but it does seem like females specifically, dogs and older patients may be at greater risk of it's something that is really scary to hear about, to see it happening, but ultimately it doesn't cause any long-lasting effects in those patients, so they are not at risk for having seizures after being in the sessions. We've actually continued to do additional sessions for patients that have had a seizure in the chamber and they've never gone on to have a second seizure. Patients that already have a history of seizure don't seem to be the ones that have that happen more often. So it's scary when it happens, it's scary to think about, but it happens. We can't predict who it happens to and we have to kind of outweigh the potential of that risk happening versus the much greater potential benefit of hyperbaric oxygen therapy for a particular patient, a particular indication.
Speaker 1:Right, like with any treatment or any medication Exactly, exactly. Dr Lindsay, did you have more questions?
Speaker 3:I guess my only other question is about the intervertebral disc disease dogs so I know it's, I'm sure that acute, like they just had the change in their health status and having them, as soon as they're stabilized, undergo the therapy is probably most advantageous. But is there any, I guess, information or history on dogs that have had it maybe for a longer period of time, or, like dachshunds, that tend to be repeat offenders? Is there any, I guess, benefit in treating them Like, let's say, they've been trying other management styles for a while and not seeing responses, would it still be appropriate to consider going through a series of treatments?
Speaker 2:appropriate to consider going through a series of treatments Based on how hyperbaric works.
Speaker 2:Definitely the thought would be that it's more beneficial to those patients that have just had an episode because that injury has caused ischemia or decreased oxygen flow through the spinal cord.
Speaker 2:So once we have more of these chronic injuries it may still be beneficial to promote healing, but likely it becomes less beneficial, has less potential for true healing as time goes on. So definitely ideally catching those patients early on after they've had an injury or, for our recurrent patients, before re-injury, would be best for those guys. In addition to intervertebral disc disease patients, we'll also very commonly use it for patients that have had the non-compressive type myelopathies, so the fibrocartilaginous embolism, fce or spinal stroke and other similar, where they don't truly have disc compression. For these patients surgery isn't beneficial to them. So conservative management, rehabilitation is really the most beneficial treatment option and we will often do hyperbaric for those patients as well, because they're still dealing with the same reduced oxygen delivery to those tissues and they need to improve oxygen to promote healing. So we've found that to be very helpful for them as well, again in that more acute phase of the injury.
Speaker 3:What about vestibular disease?
Speaker 1:That's a good one.
Speaker 2:So it's going to depend on the underlying cause of the vestibular disease. For patients with maybe those deep inner ear infections we kind of already touched on that earlier that could help with the inflammation that's associated with both the ear disease and then affecting those nerves. For patients that have that idiopathic, that old dog onset of vestibular disease, we don't ultimately know why that happens still. So there's thought that it may be a component of cognitive dysfunction, which again we've talked about the thought that increasing oxygen to the brain is probably a very good thing for those patients. So certainly could be helpful for those guys.
Speaker 2:In general, for patients that have nausea, I do find that they can have increased nausea in the pressurization of the chamber. So for vestibular patients that still have significant rolling dizziness nausea, I would probably wait until they were feeling a little bit better, but I do think that that could be beneficial to them a little bit down the road in their recovery. And then, if we're dealing with something like a cancer causing the vestibular event, a lot of times that does have something to do with inflammation. So again, could hyperbaric be helpful to reduce the inflammation associated with that cancer and then reduce those clinical signs. It's not going to be curative in that case, but could definitely be helpful for them.
Speaker 3:I have one more kind of specific question, because I feel like this is another case where a lot of people don't have the best in terms of options for their patients is the saddle, thrombus and kitties.
Speaker 3:So basically, Charlotte, do you know about that at all? I don't. So there are some cats that it's oftentimes secondary to heart disease. They will have a clot that will get stuck basically in the vein that feeds their back legs and so they'll go from being fine one moment to just not being able to use their back legs at all and they're extremely painful and there's not a lot of treatment options that we often have. And this can affect I'm not going to say any age of cat, but it could in theory. It's not just something that we see in older cats, so it tends to really take a lot of people by surprise when it does happen.
Speaker 2:Yeah.
Speaker 2:So the again idea of how hyperbaric oxygen therapy works. It is something that we do suspect should be beneficial to these cats with saddle thrombus that they are dealing with a lack of oxygen and blood flow to their back legs and by increasing the oxygen delivery to those tissues we should be able to help reduce pain, improve that blood flow restarting in those areas and maybe help to manage their pain. Ultimately, those cats are often kind of limited by our ability to manage their pain, so it's definitely a tricky disease process to manage, but I do think that hyperbaric could be a beneficial part of their entire therapeutic treatment plan, of their entire therapeutic treatment plan. I've not seen any studies come out about it Again. Unfortunately, there's just not a lot of research specific to the veterinary side. So we're always reaching towards what's being done on the human side and trying to correlate their diseases to ours, that we see in our patients, and it's something that we've done a small handful of cases here at UF, but just not enough for me to say that it's definitely helpful or definitely not.
Speaker 3:Got you. And then, from your perspective, can you compare ozone to hyperbaric oxygen a little bit, because it seems like medical ozone therapy, because it seems like they are almost at least in the same arena compared to the other treatments that a lot of us are using in integrative medicine. But do you see a place where you would use both, or is it usually more than the other, or just case selection based?
Speaker 2:Given my training in hyperbaric, I exclusively reach for that.
Speaker 2:I don't use ozone just because it's not something that I've done or am as familiar with, but the idea between both of them is similar that we're trying to increase oxygenation to tissues.
Speaker 2:The benefit of hyperbaric oxygen therapy is that pressurization that we can deliver to the entire patient at one time and that increase in oxygen delivery to the entire patient at one time. So we are not restricted by being able to access a particular area, access a particular internal organ. We can reach that treatment to every single area of the patient all at once, which is a little bit different than ozone. Therapy is typically more regional, so that's kind of the benefit is that we can do a whole body treatment. So we may be indicating to treat, you know, the small wound that we can see, but we're actually benefiting that entire patient all at once. And a lot of times, even if we see something small and focal, there's systemic changes that are happening throughout the entire body in response to what we can see. So by treating the whole patient we can have a much greater effect on the particular treatment or the particular disease or injury that we're treating.
Speaker 1:That makes sense. That makes sense. Um so, as a pet parent, if I'm listening to this podcast episode, how do I and I think that this is a therapy that might benefit that something's happening with my pet how would I seek out and find somebody who does this like is there a resource that we could go to or it's? Do we just talk to our veterinarian or our regular old veterinarian, or how would we find this modality or this therapy locally?
Speaker 2:Yep, there's a couple different ways. For sure, I think definitely talking to your local veterinarian is a great place to start, but the particular chamber that I use is HVM and you can go to their website and they have a list of all of the veterinary hospitals that have their particular chamber, so that's a great resource. There are other chamber brands out there as well, so a pet parent can always just Google search hyperbaric oxygen therapy for dogs, for cats, and that should lead them to a resource that they can find someone local to them. Like I said, it is definitely a growing therapy option, so sometimes it might be a little bit of a drive away for some people, but I think can definitely be a worthwhile treatment for a lot of different disease processes.
Speaker 1:And this is not something that we could do on our own. We need to do this with a licensed professional. Yeah, correct, that is a something that we could do on our own. We need to do this with a licensed professional. Yeah.
Speaker 2:Correct. That is a good question, because we do get calls. People who are familiar with sports athletes or sometimes human medical professionals will have in-home hyperbaric oxygen like the soft-sided versions, and we do not recommend those for our veterinary patient uses for a couple of reasons. One is that they're not being performed by a veterinary professional, so this is a therapy that you should really leave to your veterinarians, who know what they're doing. Those soft sided chambers could theoretically be popped by our dog's nails or teeth, true, so we don't want to cause any injuries from that rapid depressurization if that were to happen. Yeah, and then those soft-sided in-home chambers are also a much lower pressure than what we can do in a hospital setting. So we really don't know the potential for therapeutic benefit of those chambers for clinical use for actual treating diseases. So don't recommend those. They're essentially not medical grade yeah.
Speaker 2:Got it Right, exactly.
Speaker 1:Got it. Well, that makes sense, so don't try this at home. Well, thank you so much. Do you have anything that you want to add? This was fantastic.
Speaker 2:Yeah, I think.
Speaker 1:Yeah.
Speaker 2:Yeah, no, I think that was great.
Speaker 1:Dr Lindsay, do you have anything that you want to add?
Speaker 3:No, thank you so much. I'm really hoping that this will open people's eyes because, at least in our area because Charlotte and I are both in Los Angeles there's two dermatology clinics that each have a machine, and so I've known of clients and patients that have utilized it. But going through the experience myself as a pet parent was very interesting and they were incredibly knowledgeable and made us feel very safe, and I was so grateful to have your assistance with that as well. So Excellent.
Speaker 1:Yeah, thank you, I appreciate this and I appreciate you taking the time out of your day to chat about this with us. So
