May 25, 2014

Hyperbaric Oxygen Therapy, aka Flooding the Brain with O

The refrain in Willie Mason's song Oxygen has a lot a 
meaning for me.


On and on and on it goes
The world it just keeps spinning
Until I'm dizzy, time to breathe
So close my eyes and start again anew.

 
That refrain is about rejuvenation, a time of constant do-overs. For me, as a stroke survivor, it doesn't take much to make me happy. Give me air to breathe, a clean outfit with coordinated socks and the self-confidence, or as my grandmother used to call it, chutzpah, to get through yet another day. That's all it takes.

 A lot of people are like me. Fifteen million have strokes and more suffer from other traumatic brain injuries (TBI) every year, worldwide, resulting in psychological disorders, memory loss, and function disabilities. 

So I had the idea to research hyperbaric oxygen therapy (HBOT) because so many people were writing about it on social media sites as a way to improve the disorders, memory, and disabilities. There were personal accounts of people who tried it with success.

The use of hyperbaric therapy is about 350 years old. The first hyperbaric oxygen chamber was erected in 1662 for acute and chronic illnesses. Clinical use of hyperbaric oxygen therapy started in the mid to late 1800s for spa treatments and decompression sickness. However, it wasn't until the 1960s that research was started on a broad spectrum for a multitude of disabilities like stroke, Alzheimer's, Parkinson's, autism, arthritis, learning disabilities, and more.

Specifically, because a lack of oxygen in the brain is associated with stroke, a growing number of doctors, albeit a small number, believe that a way to treat stroke is by flooding the brain with oxygen. Thus, HBOT.


The esteemed Mayo Clinic writes, “Hyperbaric oxygen therapy typically is performed as an outpatient procedure and does not require hospitalization. If you're already hospitalized and require hyperbaric oxygen therapy, you'll remain in the hospital during a hyperbaric oxygen therapy session. Alternately, you may be transported to and from the hospital to a hyperbaric oxygen therapy session if the procedure is performed at an outside facility.
“Depending on the type of medical institution you go to and the reason you require treatment, you may receive hyperbaric oxygen therapy in one of two settings:

  • A unit designed for one person. In an individual (monoplace) unit, you lie down on a padded table that slides into a clear plastic tube about 7 feet long.
  • A room designed to accommodate several people. In a multiperson hyperbaric oxygen room — which usually looks like a hospital waiting room inside — you may sit or lie down. A lightweight, clear hood may be placed over your head to deliver the oxygen to you, or you may wear a mask over your face to receive the oxygen."
The hyperbaric oxygen therapy increases the air pressure in the room is approximately to two or three times normal air pressure, creating a feeling of stuffiness in your ears, comparable to what you might experience in a plane on ascent or descent. 

HBOT may last from one to two hours with a technician monitoring you and the therapy unit during treatment.  

Lightheaded-ness after the treatment is not uncommon. Usually, the feeling disbands within a few minutes. 

The Mayo Clinic uses HBOT for: 

  • Bubbles of air in your blood vessels (arterial gas embolism)
  • Decompression sickness
  • Carbon monoxide poisoning
  • A wound that won't heal
  • A crushing injury
  • Gangrene
  • Skin or bone infection that causes tissue death
  • Radiation injuries
  • Burns
  • Skin grafts or skin flaps at risk of tissue death
  • Severe anemia
But, says the Mayo Clinic, “more research regarding hyperbaric oxygen therapy is under way," so there's insufficient scientific evidence to support claims that hyperbaric oxygen therapy can effectively treat the following conditions:

  • Allergies
  • Arthritis
  • Autism
  • Cancer
  • Cerebral palsy
  • Chronic fatigue syndrome
  • Cirrhosis
  • Fibromyalgia
  • Gastrointestinal ulcer
  • Stroke 


At around the same time that the Mayo Clinic wrote those disappointing words, I read this article that came out in Israel. Dr. Shai Efrati and Professor Eshel Ben-Jacob of Tel Aviv University's Sagol School of Neuroscience confirmed that it is possible to repair brains and thus add to the quality on life for TBI victims, including strokes, even a long time, years even, after the TBI occurred. 

Despite the often dismissive position of the Centers for Disease Control and Prevention, United States Food and Drug Administration, and the medical field as a whole, Dr. Efrati, Professor Ben Jacob, and their collaborators had research behind them.

In a clinical trial, including 56 participants who had been traumatized by TBIs and were still encountering headaches, concentration problems, other cognitive disabilities, the patients' symptoms were ongoing before HBOT.

The participants were divided into two groups in random fashion. One group had the benefit of HBOT treatment for two months while the other, known as the control group, was not given HBOT at all. The patients' brain activity was then assessed by computerized scans and compared with single photon emission computed tomography (SPECT) scans. 

"What makes the results even more persuasive is the remarkable agreement between the cognitive function restoration and the changes in brain functionality as detected by the SPECT scans," said Ben-Jacob. "The results demonstrate that neuroplasticity can be activated for months and years after acute brain injury." (See my blog on neuroplasticity in http://stroketales.blogspot.com/2013/09/how-to-change-your-own-mind-literally.html)

"But most important, patients experienced improvements such as memory restoration and renewed use of language," Dr. Efrati noted. "These changes can make a world of difference in daily life, helping patients regain their independence, go to work, and integrate back into society. This is where HBOT treatment can help," said Dr. Efrati. 

It all started to make sense. Elevated oxygen levels during treatment would supply the energy for aiding the healing process. 

 
Whether you like Israel or not, the country is progressive. The Israelis knew that marijuana was good for some illnesses causing pain and seizures before we knew about it. (Or before I knew about it). Also, the Israelis discovered: 
  • digitized mammography which shows sub-millimeter details
  • 3-D mapping in the diagnosis of heart conditions 
  • combined electro-optical laser and conventional optical instrument for the diagnosis of ocular pathologies
  • a laboratory appliance that can sort chromosomes, cells or tissues by colors, thus designating genetic abnormalities
  • diagnostic equipment for sleep disturbances

Good stuff. Good for them. Good for us. L'chaim.

May 12, 2014

Fatigue and Stroke, aka I'm Hittin' the Wall


(This post is not only for stroke survivors. It is for caregivers, family, friends, health professionals, and others who want to understand fatigue and stroke).

I always pushed myself to the limit. I was like my father, who was shot in his auto parts store by some robbing druggies in 1971 and died on the spot, putting an end to his boundless energy. He worked twelve hours a day, seven days a week, and yet, when he returned home, he ate dinner at 8pm, and sometimes went out again, and always on the weekends, with my mother, who was a stay-at-home mom and had to deal with my boundless energy.

But now that I've had a stroke, my energy has boundaries. All my friends will tell you. I get an entire list of the things I want to do in a day, but I'm always changing the schedule because when it comes to the list, I'm just too damned tired to finish all of it. Why is that? I wanted to know, and I found out a whole lot.

Everybody feels tired at some point. It's the body's way of saying, "Slow down and rest awhile." But the National Stroke Association (NSA) says that post-stroke fatigue (PSF) affects as much as 70 percent of stroke survivors. PSF happens without warning and happens as much as years after the stroke. PSF is not just feeling tired and wanting to take a nap. With PSF, you have to take a nap.





The NSA identified 3 types of fatigue for stroke survivors:

Cognitive (ex: mental fatigue, difficulty focusing, delirium)
 

Physical (ex: function limitations, spasms, pain, muscular weakness, interrupted sleep)

Emotional (ex: motivational deficits, depression, crying and laughing at odd intervals)

I encountered all of them. On the cognitive 
side, I still have mental fatigue and usually rest once a day; just resting, not necessarily napping. I seldom have difficulty focusing, and deliriums only the first year. I have all of the physical ones randomly, except for function limitations all the time. I have right-sided weakness—a paralyzed arm and I walk with the aid of a quad cane. As for emotional fatigue, I am still, somehow, motivated, but I had depression the first year and off and on since then, and less now. I cried and laughed at the wrong times and places, but that confusion went away after two years.





Aside from different types of fatigue, some medications may point to or worsen fatigue. The medication dosage, the time of day of the medication, or the actual medication itself may need to be adjusted.

Be aware of time and place. Loud stimulation such as music and crowds can be overwhelming for a stroke survivor and bring on fatigue. Some survivors keep a diary of the times a places where fatigue occurred--hand-written or recorded--and if that's so, don't take this diary lightly. Remember, a stroke survivor doesn't want to take a nap; they have to take a nap.

Look for which activities have the greatest impact on stamina, or energy level. (The ones in parentheses are my reactions). Is it watching a sports events? (If the team is winning, go team!) Going shopping? (Absolutely nothing gets in the ways of shopping, especially for clothes). Having a meal? (I didn't fall asleep during a meal. Ever).

The top 10 foods, according to the NSA, that can help ward off fatigue include:

1.   Walnuts
2.   Pumpkin seeds

3.   Quinoa
4.   Yogurt
5.   Whole grains
6.   Wheat bran cereal
7.   Red bell peppers
8.   Tea
9.   Watermelon
10. Dark chocolate

But listen up! Every stroke, just like snowflakes, as the yarn goes, is different. As for me, once I found this list a while ago, I eat them all except pumpkin seeds. They make me cough. And I don't take as many naps every day since.

According to strokeassociation.org, survivors expend more-than-normal energy to do everything.

“You may have less energy than before because of sleeping poorly, not getting enough exercise, poor nutrition or the side effects of medicine. You have as much energy as before, but you’re using it differently because of the effects of your stroke. Things like dressing, talking, or walking take a lot more effort. Changes in thinking and memory take more concentration. You have to stay 'on alert' all the time--and this takes energy,” says the association.


In an article entitled “Post-stroke Rehabilitation: Fatigue After Stroke,” Ed Koeneman says, “The medical conditions of a survivor, such as diabetes, heart disease, anemia, respiratory disease, migraines, or pre-stroke fatigue can contribute to a [stroke] survivor's post stroke fatigue. This is because the stroke itself or the side effects of stroke medication may worsen the survivor's fatigue.

"Sleep apnea is also relatively common among stroke survivors and is reported in high rates among individuals who report fatigue after stroke. However, no solid relationship has been proven," says Koeneman.
 

 And there it is--"no solid relationship has been proven." My belief is that stroke fatigue falls to the back burner, but use the suggestions in this post. They may help. One reader, a stroke survivor, wrote, “Every time I turn the television on and water the plants with one hand simultaneously, I get re-energized.” Good for you, C.L. Whatever works.
------------

In collaboration with http://www.just-health.com.au