I hope everyone had a great opportunity to connect and hopefully get to speak to a couple of other attendees during lunch. But today we are going to go ahead and kick it off with our introduction to the third session, which I am very much looking forward to. So without further ado, I'm going to give you a quick introduction of Dr. Paul Hart. He is an emergency medicine and hyperbaric medicine clinician who is the clinical professor of medicine in emergency.
Medicine at the LSU School of Medicine in New Orleans. He has initiated a private practice and has resulted in the largest case experience in neurological hyperbaric medicine in the world. In this practice, he's adapted to the concepts of conventional hyperbaric oxygen therapy to wounds in the central nervous system that have spawned the subsequent academic and research practice. He even worked on the first known case of global regrowth of brain tissue in humans. and has now treated the largest series of drowned children in the world with over 100 individuals as a part of that group.
This human work was, again, just an extension of his work in brain injuries. And in conclusion to that, he also has a lot of literary work as well. So he has a unique perspective on hyperbaric oxygen therapy published in his book, The Oxygen Revolution.
And actually his most recent phenomenon. was that in March 2020, so just last year, he actually was the proposer of the application of HBOT to COVID-19 pneumonia based on the successful use of hyperbaric treatment. So I am thrilled to see what he has to share today.
So I'm going to go ahead and hand it over to Dr. Harch. All right. Well, thank you very much, and a pleasure to be here again. And Tim, where are you? I was crushed to hear that Luke had died.
I had no idea. What a terrible tragedy. And I just wanted to remark the beginning here.
We didn't know about that. Anyways, I'm very thankful to be here again. This is such a wonderful opportunity to reach all the families and talk about hyperbaric oxygen.
And what I'm going to talk about today... among other things is stem cells in conjunction with hyperbaric oxygen. But before we do that, everybody needs to understand what hyperbaric oxygen is. So I'm going to try to characterize hyperbaric oxygen, look at it as a treatment for wounding. essentially in any location in the body and of any duration, and then ask some very important questions.
Why does it work for so many diseases? Does my child have a brain injury? Well, what happens if my child doesn't have a brain injury? And then, of course, when's the best time to start hyperbaric oxygen? And then lastly, we're going to go through a number of things about stem cells, which actually, when I sat down and started pulling the literature, I was even surprised at what I found.
So what's hyperbaric oxygen? Simple question, right? It's been unanswered for 347 years until 2008. And this has been the root of the problem in this specialty. No one has understood it.
And we think we finally do. So if we kind of look at a physiologic definition, it's a treatment that uses increased pressure and increased oxygen to treat diseases. Functionally, what we're doing, we're exploiting all living organisms'sensitivity to pressure and oxygen.
And everybody, of course, understands oxygen. We all are sensitive to it. Without it, we'd be dead.
But how about pressure? Nobody ever thinks about that, and yet we live in a pressurized environment here. And so it turns out what is pressure...
Pressure is the weight of air from the elevation at wherever you're standing up to 60 miles in the atmosphere, where essentially it's very thin. There's no air beyond that. And the weight of that air, 60 miles up, where we are standing right now, is 14.7 pounds per square inch.
That's one atmosphere of pressure at sea level. And then of course there's hydrostatic pressure. So when you go below sea level, under water, you now have increased pressure. And every 33 feet of seawater is equivalent to those 60 miles of air pressure.
So a column of water above you 33 feet is another atmosphere. Well here's a complicated graph and don't waste a lot of time on this thing but... Here is the hyperbaric range of pressure.
So here is outer space, zero pressure, essentially, all the way to deep-sea diving. And, of course, the other way to look at this, that dark line there is sea level. So 10,000, 20, 30, 40, 50, 60,000 feet of altitude. And this is the safe zone where people can exist.
But you see what happens. Here we are at 20% oxygen, roughly. And here is sea level.
We're safe here breathing air. But as we start going to higher elevations, you need more and more pure oxygen to exist. Well, it turns out hyperbaric oxygen is just operating in this range here, and really, mostly that range right there.
So it's a very small range of the entire pressure spectrum. Well, it turns out all living organisms are adapted to the pressure they live at. So if you look at altitude, we have all sorts of different species of birds.
that live at different altitudes. And this is just Everest to show you the different altitudes. But it's true also of livestock, of plants, crops. They have an ideal pressure range where they exist.
Fortunately, most of them do very well at sea level, which is where most of us exist as well. But it's true also below the surface, so it increased pressure. There are different species of plants at different levels in the ocean, and there are different... species of animals. So I don't know if anybody has seen the exploration of the Titanic when they went down with the, I forget his name, James, whatever, went down there with that little robotic submarine and saw the sea life down there at 10,000 feet.
It's like creatures that don't exist anyplace else, but they're specifically adapted to that very, very, very high pressure environment. Okay, so here's atmospheric pressure. Here we are at the surface, and that's the 60-mile limit, or 100 kilometers. Here's where the satellites are, and you can see the airflow, et cetera, et cetera. But the weight of that column of air is one atmosphere of pressure.
And, of course, below sea level, same thing. So wherever you are below sea level, it's the weight of water above you that is that pressure. And I'm going to show you just one equation, and this is very important, because every chemical reaction in the universe and on Earth, and every living organism, those chemical reactions either liberate energy or they consume it.
But there's a change in energy to it, and the important part for all of us is, whoops, not the clicker, it's that right there. Pressure is a component. of every chemical reaction.
So when you change pressure, you are potentially changing every chemical reaction that's going on in our body. So when we deliver a hyperbaric treatment, you shut that chamber door and turn the pressure on, you start changing your body. And in particular, any wounded area in the body is subjected to that.
And there's a universal gas law that governs that. It is inescapable. Everyone in this room, every living organism, shut the door, put it... Turn up the pressure, it is now affecting your biology. Well, what else are we affecting when we turn on the pressure or turn up the pressure?
It turns out we are affecting our genes. Now, when I went to medical school many years ago, we were taught that our genes, you only needed them when you reproduced. Your sex cells, right? You pass on all your traits to your offspring.
No. Every cell in our body, its vitality is dependent on those 46 chromosomes, the genes along those chromosomes continually being read and unread, like a ticker tape. The genes code for proteins. Those proteins run all those chemical reactions in our body.
So our genes are actively working. As it turns out, hyperbaric oxygen is unique in all of medicine in that, first of all, to get the effect, you have to... fully enclose the body in a chamber, and we're then affecting gene expression, which I'm going to show you in a minute. So let's go back to our physiologic definition of what we're doing. It's a treatment that uses increased pressure and increased oxygen to treat diseases.
Well, what kind of diseases? Turns out they're mostly wounding conditions, the vast majority of them. So hyperbaric oxygen is a treatment for wounds in any location and of any duration.
And how do we heal wounds with hyperbaric oxygen? You have to grow new tissue. How do you grow new tissue? You have to stimulate the cell to divide. How do you do that?
You have to go to the nucleus of the cell, which is where cell division takes place. So somehow... Hyperbaric oxygen has to stimulate the nucleus.
So if the daily input is getting in a hyperbaric chamber, turning up the pressure on the oxygen, and the output is growth of new tissue, you have to go through the nucleus, and it turns out what we're doing, this is one of the oldest gene therapies known to man. This is a gene signaling drug. And this finally came to understanding.
I'm going to show you in just a minute. But let's just look at our chromosomes. Everybody's familiar with the double-strand helix of DNA.
Well, DNA, it turns out, has these little purple histone protein balls that are wrapped, I should say the DNA strand is wrapped around these little balls, and then those are wrapped in a greater coil, which is our chromosome. So if we look at one of the smaller coils here with the histones, here's the DNA, and there are the histones in the middle of it, these different colored proteins. They sit on the genes.
And they have these little arms that stick out. And it turns out those little arms are sensitive to everything. The environment, food, additives, chemicals, pesticides, air pollutants, every substance, alcohol, tobacco, drugs, you name it. You chemically can change these things. And when you do, you change the conformation and shape of the protein.
It's electrical charge and it lifts off the gene or it locks it down. But when it lifts off, the gene gets red like a ticker tape, the protein or enzyme is made, and away you go. Well, it turns out you can permanently affect these histone proteins. And what is new to medicine is that if you do that to your ovaries and, you know, your eggs or your sperm, you can pass these traits on to your children. Just like changing the DNA code.
These are called epigenetic changes. It turns out, where is hyperbaric acting? It's acting epigenetically. Somehow, we don't even understand it, it is affecting these proteins and allowing the genes to be read, which goes to the understanding of this therapy. For 347 years, nobody has understood it until 2008. Dr. Godman up in Massachusetts took human cells And what they had done is take skin biopsies from in the hospital, people biopsy a mole, ground it up, and they isolated the cells that line the tiniest blood vessels in our body.
They're called endothelial cells. They are the most reactive. It's where all of the things that occur in our body occur at the tissue level.
It's with these endothelial cells affecting blood supply and cells and nutrients and things going across there. And what they did is put them in a Petri dish and stuck them in a hyperbaric chamber and give them one treatment. and did a mass continuous gene array analysis for 24 hours.
And what did they find at the end of 24 hours? Over 40%, some 8,101, of our 19,000 protein-goating genes in our DNA were turned on or turned off. 40% of our genome affected by a single hyperbaric treatment.
And the largest clusters of genes turned on are the growth and repair hormone genes and the anti-inflammatory genes. Largest clusters turned off. Genes that cause inflammation and the ones that code for programmed cell death.
So every time you get in a chamber, the wounded areas in your body, you're stimulating tissue growth, inhibiting inflammation, and turning off cell death. Which leads to, what are we using it for? Well, this is the United States list of reimbursed indications.
And on the right-hand side, I wrote, they're all wound indications, acute, chronic, subacute, but, you know... That's air in an artery, carbon monoxide, a crush injury like from trauma, diver's disease, problems with diabetic foot wounds, massive blood loss, radiation damaged tissue, flaps and grafts that aren't healing, burns, stroke of the eye causing sudden blindness, sudden hearing loss, and then these five things are infectious diagnoses. The most common one you've probably heard is a flesh-eating bacteria.
They are wounding. infection diagnosis. Not like the simple skin infection. Takes a man of ours, go away, no harm, no foul.
No. These cause wounds. But go to Russia. They treat 70 diseases, 49 in China, 30 some in Japan. An article, Critical of Hyperbaric Medicine, 1987, identified 132 diseases hyperbaric oxygen have been applied to.
The vast majority of them are wounding and inflammatory conditions. I've treated Probably 100 now. Almost 90 of them are neurological diagnoses. Look out for the 132. I'm catching up with you. Well, how does it work for so many wounds?
It doesn't necessarily work by treating the disease, it treats the underlying disease processes that those genes have impact on. So essentially, these processes are common to many, many human diseases. Our body only has certain ways of reacting to an insult, whether it's an infection, a trauma, whatever. And those underlying disease processes that are common to so many diseases is what hyperbaric oxygen targets. The biggest question we have to ask, really, you parents, and because we're talking about pediatrics here, does my child have a wound in his or her brain?
And the answer to that is often not appreciated or apparent, or it's deliberately concealed. I'm going to give you some examples. I got called by a mother, had a five and a half year old boy who had global developmental delays and autistic behaviors, and he was just...
He had so many problems. And we get to talking to her, and he was born three weeks late. She had gestational diabetes. Nobody was checking her. And she delivered a nearly 11-pound little boy, a watermelon.
36 hours of labor, and the child's head was born grossly distorted, big hematoma, blood clot, under his skin, between his scalp and his skull. And from day one had neurological abnormalities. They're in a small town. The neurologist gave him a diagnosis that didn't fit because he didn't want to lay the blame on the birth process and get the obstetrician in trouble. I said, you need to go to a different center.
Go someplace distant, get an independent opinion. She did. She went to an academic medical center, and they gave another diagnosis that didn't fit.
It turns out that neurologist had trained the neurologist in her hometown. I said, go 500 miles and ask the neurologist, do you know these other two guys? Because you need an independent opinion. Had no connection to him, went in there. He reviewed the records, spent a half an hour, and he said, look, your child has a birth injury.
It's very, very obvious. Mom didn't know that. Changed the whole scope now of what we were going to do with the child. Another child of mine, a year and a half old.
Neurological developmental delays, global developmental delays, and nobody has any idea what's wrong with this child. And mom asked me if I treated any children like this. I said, well, yes, we have. We don't know what's wrong with them, but they're developmentally delayed. We've treated them.
They seem to respond. So the day of the appointment, she goes by the hospital to pick up medical records for her, the mom. Mom had a doctor's appointment. And she goes to the clerk, and the clerk said, would you like to get your daughter's medical records, too?
And she goes, I was just here two weeks ago. I got them. you know, sometimes, you know, things come into the medical record.
Okay, yeah, whatever. She brings back the trunk. She goes, oh, look, there's a new folder in here. Copies it, gives it to mom, sticks it in an envelope.
And mom didn't have time, gets on the highway, comes down and comes to help. She goes, oh, I got some new medical records. This may help.
I said, what's it say? She goes, I don't know. Open it up.
Baby was born with a glucose level in the 20s. wasn't discovered for 16 hours, didn't get treated for another eight hours. This was a child with a hypoglycemic injured brain.
Concealed? Where was that? It was in a legal file.
Statute of limitations now had run out. Got back put in the medical record now. And I told her, you take this to the neurologist and let them see it, so it will change their opinion about what's going on with them. Most recent example, a little autistic boy. But this is an autistic boy who, from day one, has had motor delays and problems and coordination, balance and, you know, neurological abnormalities.
And autism, no, it's social reciprocity and speech and repetitive behaviors and all that. He didn't have that. He had a subsequent deterioration that gave him some of those.
But the whole point was, I have the parents send me medical records, birth records, and we get on the phone. And they also send me a self-written history. So I get the birth records in the hospital.
Nothing wrong. Everything is A-OK. Turns out it was a premature stimulated labor. The obstetrician told her to take castor oil because he was going on vacation.
They wanted the baby delivered early. So she went into premature early labor. The child was delivered two and a half weeks early.
But there's no record in the chart of anything wrong. But take a look at this. Mom writes to me. My son was born at 37 weeks, weighed 2.6 kilograms. Meconium was present at birth.
Ho-hum. No family history of autism. Wait a minute.
The child pooped at birth, in the birth canal. Why does a child poop during birth? It's called fetal distress.
The brain is compressed, not getting enough oxygen. The child is in distress, and they poop. Meconium staining, it's a sign of damage and injury at the time of birth. Here's the answer to what is wrong with this child.
She subsequently now went back and got medical records, and what did they find? Pathological analysis of the placenta showed she had an infection that wasn't picked up, wasn't treated. And, of course, nobody told her.
It's in the medical records, the pathology report. And here is just another problem. Sarascan, a spec brain imaging company in Denver, Colorado.
They took 3,600 of the people who came to them for brain problems to get a spec scan, and they got their medical records from birth all the way up to the time of the imaging. And they hired some coders and data extractors, and they had a massive Excel spreadsheet. 1,800 columns.
And they input all the data, age, sex, amount of gestation time, labor time, everything all the way up through their life, doctor visits, all the medicines, everything. What did they find? 60% of these people had a birth incident that they implicated in their neurological problem. And finally, I'm just going to mention the Cowan study in 2001. 300 babies, two groups, all of them born at 40 weeks.
The one group... Picture perfect birth, everything fine, all good, and the first three days of life has a grand mal seizure out of the blue. What happened?
Nobody knows. Compared to term babies who were born, same thing, normal pregnancy and everything, but profound injury at delivery. Uterus ruptured, placenta ruptured, placental bleeding, something, child born in arrest, etc., but unequivocal neurological injury.
They do MRIs on all of them in the first two weeks of life, and what do they find? In the profound neurological injury ones, 78% of them have acute brain injury on MRI. None of them have any injury due to the nine months of pregnancy.
The other picture-perfect births with the single grand mal seizure, 68% had evidence of acute brain injury from birth. None of them had any evidence of a gestational problem. The point is, we take it for granted, but the trip down the birth canal is one of the most perilous in life for many people. And there's a lot of injury that's imparted.
And personally, I believe that that leads to a lot of the diversity, the wide range of normal that your pediatrician often tells them, oh, don't worry, he'll grow out of it. That's normal. No, it may not be. Look to the birth history.
So why is it concealed? Well, you know, liability is the big problem. So what if you don't have?
an acquired injury or one that you can identify. Well, I often have this problem. They call me and say, oh, no, there's no problem, but, oh, my child has ADD. ADD is not normal development.
It's become so common now, but it's very likely from all these environmental insults and other things, and frequently it can be traced to a known injury in the developmental process to a child. But usually that's a sign of an underlying problem in pathology. Well, how about genetic syndromes? People call me up about this, and when I started this, I said, look, the one category of diagnoses we can have nothing to impact, hyperbaric osteo had no impact on would be genetic diseases. That's before we knew about epigenetic effects.
And so in 1995, we had the first premature aging syndrome, 19-year-old girl, steroid lipofuscinosis of the brain. It's a fatty acid problem. that's in all membranes of our cells, and it fails. The patients all die by 25 years of age.
And with brain imaging, with videos, with exam, we treated this girl, and lo and behold, she improved. Now I've treated over 30 genetic disorders, and I can tell you 98% of them have responded. And we believe it's because of this epigenetic influence.
affecting other genes that may overlap and help the genetic syndrome. But it works, surprisingly. Okay, so when's the best time to start hyperbaric oxygen?
Right at the time of injury, and I'm going to talk about this with the drowning. Problem is, we can never do that in the hospital. It's almost impossible.
You know, once there's a wound, there's a timeline, there's an evolution, and the pathology changes with that wound as time goes on. It turns out hyperbaric oxygen, wherever you intervene, can help truncate that, and it stimulates now the repair process. But getting that in the hospital is very, very difficult.
And if you look, this is the story of all the drowned children that I've treated, which is now over 100. First 40 of them were up to the time of little Eden Carlson in 2016. They were all at least a year after drowning, and we saw improvement in them, but it just wasn't anything like we're seeing now. with the children who were four weeks to six months out. But where did the best result come in all of those?
This little guy, Christopher Dixon, 90 minutes after he was pulled out of 15-minute submersion in the pool, in the ER, intubated, paralyzed, now sedated and everything because he was thrashing around and on the ventilator. We got him in the chamber. 90 minutes after they pulled him out of the pool, single treatment, next day, took the sedatives, the paralytics off. He woke up, extubated him.
Went home in three days. That was July 8th, 1997. Went back to school. Went to school over in August. There was a magazine article written about him.
I've written a book chapter for 21 years summarizing this. The evidence for treatment immediately is strong in his type of injury, global ischemia. So, and there's a lead in Carlson.
So now we've got over 100 children. And Mr. Will Boynton. Through his work at Texas Children's with the doctors now, we're raising money, we're almost there, to hire the researchers to go back and review all of these charts and compare them to a control group so that we can get something published to try to leverage the doctors with.
And we're hard at it. But what's the general finding? First of all, global ischemia and anoxia, which is what Dr. Crawford was talking about, is the most difficult of all the neurological diagnoses to treat. It doesn't just selectively injure one area, it's the whole brain.
Some areas more than others. And if we look at this, typically there's been no treatment for it. And I say prior to hyperbarics, I say prior to hyperbarics as well as all these other therapies that Dr. Crawford is doing prior to stem cells now, etc.
But we used to have nothing when I started doing this. And if I look at all of our children over the years, these hundred children, I would tell you 85-90% of them respond. There's about 10% that don't, and these are the ones who were sent home on hospice who are so severe, rigid, locked in, immobile, just extremely damaged. And now there may be some things that can be done, and maybe it was more hyperbarics if we did it in combination with other things, but I would just tell you it's not perfect. But if we look at these 85%, the children with cortical vision impairment and autonomic dysfunction, 100% of them...
We'll get some relief. And there is a published series of six adults out of China, severe traumatic brain injury, who 45 days after the trauma were still in nearly nonstop autonomic storming. They gave them an average of five treatments.
Actually, it was reversed after three hyperbaric treatments, and the storming stopped. So there's precedent for it, and it's been our experience as well. If we look, though, at the other functions that are affected, I tell parents there are eight other things, and on average, we see improvement in five of these. I just can't pick which ones and the degree of it.
But effect on alertness and awareness, gross motor function, fine motor, which is hands, tone, balance, sitting or standing, depending on stage of development, oral motor, which is lip, tongue, faring, swallowing, secretion, handling, speech and cognition, and lastly, temperament. You know, many of these children are very irritable, and it has a calming effect on them. So again, when is the best time? It's in the hospital, but we can't do that. So what can you do instead?
Hyperbaric oxygen, remember, is two components. Increased oxygen, increased pressure. You can still use the increased oxygen, but you can't use it how it's been traditionally used. If I plop over right now, and hopefully somebody does CPR on me.
What's going to happen? EMS gets called, and they're going to stick me on 100% of oxygen. It used to be, you go to the ER, and you stay on 100% oxygen for 24 hours. You will not get the same effects that you do if you give it and take it away, because you're using it for signaling.
And there is precedence for this in acute severe traumatic brain injury, in acute stroke. We used it for years in wound patients in the hospital who ran out of time, reimbursement time or hospital time for hyperbarics. We'd send them home on an oxygen concentrator. Intermittently, a couple times a day, having them breathe oxygen for an hour or so.
And what, I've done this with patients neurologically, and so that's what happened with Eden Carlson, if you read the story. She was too unstable to travel from Fayetteville, Arkansas to New Orleans. There's nine hours of nothing between that. I mean, a lot of woods and a few cities, but you don't want to get caught out in the middle of nowhere with a child who can't breathe.
Pulling into a podunk ER and hoping somebody can intubate her, you know. So I told her, look, we need to strengthen her. So if you look at the video in that article, I had mom video her right before the very first nasal cannula oxygen and afterward. And it is a phenomenal change, you'll see.
We now have done this with somewhere between 60 and 80 children in ICUs all over the country now, and a few internationally. And they respond generally within 24 to 48 hours. You see it first in their eyes and facial expression, but it's used as a signaling device.
Well, what are the barriers to doing this? The first is the mentality and neurology. Neurology is a diagnostic specialty, has been for years. And when I was in medical school, we were taught there is nothing you can do for a neurologically injured patient.
It is time, natural history, letting nature take its course, etc. It is the only organ in our body that the medical profession has taken the attitude you can't do anything for. Think about that. Pediatricians, surgeons of all stripes, cardiologists, kidney doctors, every... specialty, has not said nothing we can do, cross your arms.
But that's been kind of the mentality. And thankfully, it's changing. But it's taken a long time. We've also got medical paternalism, where the doctor is going to make the best decision for you and your child. Your child will have a quality of life.
We're saving your life a heartache only to prolong the inevitable result, which is death. Or that is from one of my mothers. She's bilingual, and I think she translated that the doctor told her child was going to be a vegetable.
So that's what she said. Your child is going to be a plant. This was two months ago.
And of course, what else? There's a rushed organ harvest. This is frankly cruel and criminal because...
Parents are taken advantage of, and it's part of that paternalism. And I have encouraged the parents, it's not going to be believed by me. But you parents need to band together and write about this.
Because there's this rush to organ harvest when there is hope and treatment. And it's just that the problem is the doctors might not know. And so first thing is we end up having to get past the ego.
You know? It's not being done. They're the experts in that ICU care and neurology. And the implication is, wait, if we knew that it worked, we'd be doing it.
But it doesn't work, and that's why we're not doing it. Well, no, they don't even know about it is the problem. And that comes to this, and it's just confrontational immediately. I mean, I end up getting on the phone with them to try to explain even the normal baric oxygen. They've never seen the literature on it.
But about seven years ago, we did a survey of all American medical schools and went to their academic department, their curriculum, what they're teaching medical students, and asked them, how much do you teach about hyperbaric medicine? 75% of American medical schools teach zero about pressure biology, hyperbaric medicine. Another 25%, it's a fraction or maybe one lecture.
So there's a problem out there that they're not informed. Bigger problem is the attitude. You have to be open-minded and admit you might not know something and defer to somebody else.
You know, go ahead, I'll field a question. Ask me about pork bellies and pork belly futures. I'm sorry, I don't know anything about that. Well, in medicine, go to a medical library.
It is filled with a jillion volumes. None of us know all of that stuff. And when you don't, you have to say, I don't know. I can give you an opinion.
but I can't give you an informed opinion. And you're trusting us to give you reliable information, and that's where the problem is here. Well, it turns out the decision-making in severe acute pediatric neurological injury is exceedingly personal.
You know, there are religious implications. There are instinctual things here that, you know, to preserve life. It's complicated by uncertainty. You don't know what the outcome's going to be.
You can't even discern how much neurological activity and brain activity is in your child when they're on a ventilator like that and sedated or not sedated. And many parents, they can sense that their child senses them. They'll say, when I walk in the room, we see him stir, we see his pulse go up, etc.
And the doctor says, ah, it's just reflex. No. I can tell the experiment's been done on near-comatose people, showing the amount of neurological activity in there.
We had no idea they're in there. The reality is, though, we're now achieving results we had never seen before, and with the combination of therapies, it's a whole new world. We don't even know what the upper limit is. And how are we doing that?
Because at least with hyperbaric oxygen, what I know is we are treating the underlying disease processes. And along with those gene effects, what we're doing is influencing stem cells. And so that's the last part of this, and I'm going to kind of have to hurry. What are stem cells?
Dr. Profrock is going to give you a whole lot of information on this. I'm not expert in it. So I'm just going to try to focus on the stuff related to hyperbaric oxygen.
But there are undifferentiated cells. There are premature cells that are formed from, you know, The very beginning, sperm and egg going together, and then the stem cells themselves can develop along the way, and I'll show you a little graph about that. But, you know, the analogy, those stem cells can then develop into any cell in the body, any type of organ, any tissue.
And it's kind of like a child. A child is a stem cell. They can grow up to be a mom, a caregiver, a dentist, a lawyer. Maybe that's a D different. No, I'm just kidding.
A banker. No, I'm not one of those doctor-hating. or lawyer-hating doctors. I am not, but it's always fun to joke about it.
And so differentiation. Well, here's the different types of stem cells. And this is the one we're most commonly seeing and is most commonly used in the medical profession.
And mesenchymal stem cells, they can come from a variety of different areas. You know, our bone, bone marrow, really any tissue, adipose tissue, umbilical cord, woadens, jelly, and of course our peripheral blood. and they can differentiate into all sorts of other cells. So what does hyperbaric oxygen have to do with stem cells?
Well, it turns out quite a bit. But it also turns out that stem cells are in every tissue and organ in our body. And the most important sites are our bone marrow, adipose tissue, which Dr. Profrock's...
going to talk about, and the brain. So here is one of our long bones. That's our femur. That would be the hip socket and the ball that goes in it. And here's right down by the knee.
And two main types, there are others in the bone marrow, but the big ones are the hematopoietic ones that differentiate to all of our blood cells, and the mesenchymal ones that differentiate to all of our different tissue organ cells. Of course, you can go in and harvest them. You can go in your hip, you can go in the long bones and take them out and process them. You can also stimulate them with granulocyte colony stimulating factor, which is a type of hormone, and it'll cause release of them from the bone marrow. Or you can do some other things with it.
which I'm going to show here. But stem cells are also produced in the brain, and there are two primary areas that they're produced. So this is a slice of the brain going straight through my eyes to the back of the head like a stack of pancakes, and you can see the eyes here. Deep in the center of the brain, these two, you can see that kind of looks like a little seahorse?
That's the hippocampus. So that's right at the medial aspect. This is the temporal lobe here on each side.
So it's right deep down in the center of the brain. If we look at the side of the brain, and our ear would be right there, here's our temporal lobe. Makes sense.
It's right under our ear. That's where sound processing is. And the hippocampus runs along like that, that purple structure.
And right along the middle aspect here, the hippocampus, that area is associated with short-term memory. Well, on the very inside edge of it is that green strip there. It's called the dentate gyrus of the hippocampus.
That's where our stem cells are made in the brain. Well, it turns out they're also made in one other area. And so this now is a different slice.
I'm going from the top of the head straight down through my chin, so a slice like this, and you're looking straight on at the person. So right ear's out there, left ear's there. Here are the two temporal lobes, and the hippocampus is right down there, and the dentate gyrus is going to be on the inside there. This is that deep gray matter that Dr. Brad Crawford showed you, the basal ganglia thalamus, but the basal ganglia associated with the motor. But what's up here?
The fluid system in the brain, the ventricles. And what is right on the edge of the ventricles is the subventricular zone. That's the other place our stem cells are made. So the primary, there's also, they're made in the amygdala.
But the point is, the major places are here and down there where our stem cells are made. Okay. Well, it turns out that stem cells can migrate from their birthing places in the brain to sites of injury, and that's the way the brain tries to heal itself. But they also can home from the bone marrow and maybe other sites in the body to the brain and sites of injury.
But natural homing in the brain, what happens if you've injured the subventricular zone and the dentate gyrus? This is the coronal cross-section from top of the brain down through the chin, looking straight at the person, this little drowned child. And if we look at the areas of the brain that are affected in drowning, there it is, the subventricular zone where stem cells are made. And down here, look at that, dentate gyrus of the hippocampus.
And of course, here's the basal ganglia, all bright white and injured. And even the whiteness of this cortex, there's diffuse injury, but the point is, our areas for making new stem cells get preferentially injured in global ischemia. in drowning.
So these kids have a real setback there. And if we look at this, more MRIs looking at both the gray matter areas and the white matter, connecting tracks in the brain that are injured in drowning. This is a big study on, or a sizable study on children in the chronic phase.
So this is months to years afterwards. You can see it's right in the center of the brain here, where Dr. Crawford tried to point that out to everybody. Well, what's so peculiar about it?
It's that same slide that he showed, it's those lentate arteries here. And what happens is they come to a terminal end in this area, which is part of the watershed zone that he mentioned. Watershed zone is where the three major arteries on each side of the brain come to confluence. And it's where blood flow and blood pressure are the least.
And they're the most subjective and sensitive to injury when you drop systemic blood pressure. So one. place has a pressure of 10 and the other place has a pressure of 80 and you drop the blood pressure to 60, where's the blood pressure lost first?
It's in that 10 area. And that's why the watershed areas get damaged so easily. Well, what are those areas controlled?
That's the deep motor area and the connecting tracks from the cortex, the motor area as well, as well as many other structures there. Well, natural homing. also occurs from the bone marrow.
So you've got an injured brain. Your bone marrow is going to release stem cells, and they'll go to your brain. The brain is trying to send them from their birthplace in the brain to your injured areas. But this is a pretty slow process. It's painfully slow, and it needs a kickstart.
And that's what all these therapies are that you're hearing about today. It's trying to stimulate brain recovery. So what does hyperbaric oxygen do?
It does a bunch of things. It stimulates production and release of stem cells from the bone marrow. differentiation of them, meaning maturing into other cells, stimulates proliferation, whoops, proliferation of them and differentiation at the sites of injury, facilitates implantation of them, and we're now finding it stimulates production of them so that you can harvest them. And that's the most exciting thing.
And at the end, and I'm going to try to, I may be running out of time, try to go a little faster here, but all of this came to fruition with hyperbaric medicine in 2006, where they were treating 26 patients for radiation injury to the head and neck. And this is one of the standard indications for hyperbaric oxygen. Had cancer, take the cancer out, irradiate them. It damages the blood supply. The teeth rot.
You now go to take teeth out, and you don't have enough blood supply to heal the socket. You get necrotic bone. It's painful.
It's a terrible condition and problem. But if you give hyperbaric oxygen before, take the teeth out right afterwards, no problem. So what they did was they decided to measure. bone marrow stem cells that are released into the circulation of these people just undergoing hyperbaric oxygen for wound healing. And what they did is, every day, a two-atmosphere oxygen treatment for two hours, which is long, and then they looked at the blood after the first, tenth, and the twentieth hyperbaric treatment.
And here are the stem cells that were in the blood. Before the hyperbaric treatment, everybody has a certain number in their blood, but after one, whoa, big jump, by ten, there were more circulating. after the 10th even more, by 20 even more, and after the 20th even more.
And this is where they stopped measuring. They had designed the experiment. They were going to go all the way to 30, but who knows how far you could go.
You keep stimulating them. And here, of course, was evidence that the stem cells, hyperbaric was causing them to differentiate and start their process in forming new tissue cells. First step in that is they have to change the proteins on their surface. so they can now attach to the blood vessels inside lining, those endothelial cells we talked about, to now take their trip out into the tissue where they start maturing and become like a new heart cell or whatever.
And what they showed is that that change in the surface protein didn't happen until 20 treatments. So the maturation phase of it took a little long with the hyperbaric oxygen, but it still stimulated it. They then looked at mice where...
they took a little gel plug and stuck it under the mouse's skin. Well, that becomes an inflammatory site. It turns out stem cells will home to that. They then gave three groups of mice, different amounts, two hyperbaric treatments, five daily treatments or 10, and then they went and looked in the bone marrow.
Well, they had air control groups for each of those. Look at the stem cells. Stayed the same, untouched.
Same number. But look what happened. Two hyperbaric treatments, significant increase. Five hyperbaric treatments, a whopping fourfold increase. And by 10 days, they still have a big increase.
So you're stimulating production of them in the bone marrow. And you release them into the circulation. And of course, here they are in the bone marrow with their surface proteins. They attach, get out of the bone, or I should say they get out of the bone marrow into the blood vessels. And then they attach it to the cells here and cross over.
and they now start forming new tissue. So, we can stimulate bone marrow stem cells to go into the circulation and home to sites of injury. We can take them out, we can re-inject them, we can take them out and grow them and re-inject them.
It's all the same. Or we can harvest them from someplace in the body and inject them, and they home to sites of injury. And once they're there, they multiply and divide, and they secrete a lot of hormones to stimulate tissue growth. Well, as it turns out, hyperbaric oxygen promotes stem cells in acute stroke.
And it promotes homing of them from the bone marrow to the site of injury in the stroke. And this was a study done in rats where they induced a stroke in the rat. And then immediately after, they started hyperbaric treatment, like we'd like to do in the hospital but can't, that at once a day for two days, five days, or 15 days. And what they found at the end of 15 days was Stroke size decreased, number of stem cells increased around the stroke, new neurons increased around the stroke, there was reduced inflammation around the stroke, and the rats did better neurologically. And they did it with just two hyperbaric treatments, but they did a lot better with 15. And so if you now look at, here are the bone marrow stem cells around the stroke, and this is the group that they just went in, did an operation, but they didn't stroke them, they closed them up.
This is a stroke rat, so... they ended up, they make a little stem cells in response to injury, two hyperbaric treatments, more stem cells, and three weeks of hyperbarics, a whole lot of stem cells around the stroke. And these are the new neurons.
Same thing with hyperbarics, a lot more new neurons that are forming. Well, look at the amount of inflammation in the stroked ones. Way down after just two hyperbaric treatments by 15, it's the same amount of the rats that just got a sham operation and no stroke. So a big effect.
And of course, here is the stroke. So the sham ones, no stroke. There's the stroke, that white area, two hyperbaric treatments, almost gone. By 15, it was almost imperceptible.
Well, it turns out that if you just inject stem cells IV, they will home and differentiate in the brain. And this was another study in rats, where they put an inflammatory focus right up here in the top of the brain. And then They then injected the bone marrow stem cells, and they looked at what happened on day zero, day one, I'm sorry, day nine, day one, and day zero.
And if you look at this, the stem cells are the dark ones. The stem cells all migrated to the area and took over. And you see that here as well. And here was the injury site with inflammation. No stem cells.
Stem cells are in red. And now they start differentiating into new. glial cells, support cells.
Again, the hyperbarics is causing that stimulation. This is one, turns out, hyperbaric oxygen stimulating this in traumatic brain injury. And what they did was take the rats and they dropped a little weight on their head.
Well, this is a rat that didn't get the weight drop. He's got a normal looking brain. There's the big area that was damaged by the weight drop. And here it was after hyperbarics, a substantial decrease in size. And what they did was three hours afterwards, again in the hospital, when you want to give this hyperbaric treatment, they gave a two-atmosphere treatment once a day for seven days, and then looked at this in the rats.
And what they found was increased number of stem cells around the trauma area and down in the hippocampus. Remember, that's where we're forming new stem cells naturally. In addition, they had an increased number of neurons at the site up in the cortex as well. And all this is showing is the new stem cells, as they're growing in the hippocampus there, and these are the new neurons that are also forming.
So, you know, all the same information. But those are all acute conditions. How about in a chronic condition? You know, by the time I've seen 95% of my patients, it's an old injury.
And that's the majority of the patients we've seen over all of these years. And that's what all of this was based on. And these patients improve in the chronic state.
Do we have evidence in a chronic animal model? Yes, we do. And here was a rat study. And when I saw that, I just busted out laughing. Demented rat.
Yeah, I mean, what's that, a rat that can't find his water bottle? The way they did this is they were trying to duplicate vascular dementia. In humans, vascular dementia is small blood vessel growth or multi-strokes that have knocked out enough brain tissue that you're having trouble thinking now. And so they went in and they tied off two of the arteries to the brain.
And what happens is the rats lose brain tissue. 30 days later, they did an avoidance response test. And what they do is they have a little two-room cage, and they shine a light at the rat. And if he doesn't go in the other cage, they give him a little shock on his foot.
And enough times they do that, pretty soon he associates the light with the shock, and he skedaddles into the other room. And it's an avoidance test that they do. So 30 days later, they do the avoidance test. And then... They gave them a hyperbaric treatment once a day for 10 days versus controls and sham-operated ones.
And then they repeated all of this, but they also looked at blood flow in the brain. They stained them for stem cells and neurons up in the area of the brain associated with intelligence in the rat, which is our parietal cortex, right above our ear here. You can put your hand on it. That's your parietal cortex.
And what they found is this. Hyperbaric oxygen improved learning and memory and brain blood flow. It improved stem cells and new neurons up in the cortex, and essentially, it also did the same in the hippocampus, which is where we're normally forming our stem cells. So essentially, in a chronic brain injury model, hyperbaric oxygen reversed memory and learning loss, improved blood flow, neural stem cells, and neurons in the cortex.
And there's a little thing, shine a light, if you don't skedaddle over there, they shock them, and it just shows. They're pretty good at getting into the other room. There is after they're demented, and after hyperbarics, they do better.
And here is their blood flow. When they're demented, it's down. After hyperbarics, it's up. And this is just the figures on the stem cells.
I'm not going to go through it. It's a little bit busy. But the whole point is, new stem cells, new neurons, growing new brain tissue.
Well, where have we seen this before? This is the veteran study I did with hyperbaric oxygen. And what we found after 40 hyperbaric treatments, 88 significant areas in the brain of increased blood flow. And they're in the white matter, which are the connecting tracts, which is where traumatic brain injury damage is located.
And on the surface of the brain in the cortex, we also saw it. But what did we also see? If we look at the bottom row here, is the hippocampus.
Remember, those were green on that other slide I showed you? What we found was significant increase in blood flow to the hippocampus, and simultaneously, improvements in IQ, 15 points, delayed memory, working memory, and an executive function, all significantly improved, just like the rats. In fact...
When I first showed this stuff in humans with the cases, the comment from the doctors in the audience, well, that would be believable if you had an animal model. So we went and we did the animal model, and that's exactly what we found. And to this day, it is the only improvement of chronic brain injury in animals in the history of science.
And the joke was it was the human protocol we'd been doing all those years. So the net result of all those stem cells is the happiest little guy on Earth. This little Jersey McElhachick, what a bright light.
Poor little guy, preemie, quad CP. And after we had treated him, and I think he's also been here and seen Dr. Crawford, he's had a very noticeable improvement. Okay, well, do we have evidence for this in humans? I think I've got to hurry.
We do. And going back to 2006, they took diabetic patients and they harvested their stem cells from their bone marrow. and injected them into the main artery to the pancreas. So the pancreas sits right in the middle of our abdomen here behind the stomach. They injected them in there, but they gave them five hyperbaric treatments before and five after.
A year later, they measured all of this function, and they found fasting glucose had dropped by 50%, from 205 down to 105. Hemoglobin A1c, which is the binding of glucose to our hemoglobin molecule, had gone down from 8.8 to 6.2. All of these are significant. If you look at this, It wasn't just some of them that did this. Look at the error bars on this. All of them were in a very tight, narrow range.
They got the same effect. And here was the amount of insulin. They were taking 35 units of insulin a day.
and they ended up with two and a half units of insulin. Here was another evidence of what the implication was, the hyperbaric oxygen maybe facilitated implantation of the stem cells. Well, then there was this little case from India.
Sixteen-year-old boy, his three older brothers and sisters had all died of this genetic defect, carnitine transporter deficiency. Carnitine is an ammonium compound that transports fatty acids into the cell where your mitochondria then burns it for fuel. And of course, if you can't do that in the heart, you've got a heart that fails, and that's what was happening.
Everybody dies with this. And so here he was in heart failure, and this is just to show you what ejection fraction looks like. So a normal person, the heart squeezes, squeezes blood out. About 70% of it gets squeezed out.
When the heart starts failing, it's less. You're at 60%, and when you're really in failure and down to ejection fraction at 20%, it's just squeezing a little, and you've got a lot of blood left in there. Well, by the time he was 16 years old, Well, here he was at seven years of age before it was really manifest. He was up in the 60% range.
But by the time he was 16, it was down to 30. And after the first stem cell, what they had done was inject stem cells, but they did 20 hyperbaric treatments before and 20 after. And what they found was he got out of the hospital and had already jumped up 5%. Five months later, it had gone up to 55%.
By the following January, they gave him another dose of stem cells and hyperbaric oxygen. It was still at 55, but a year later, look at this, 84%. I mean, it's like super normal. Now, it subsequently drifted down a little bit.
They had to treat him again, but the point was, hyperbaric oxygen may have helped or been implicated in the implantation of these stem cells. Well, here's a group of doctors also that did the same thing in humans, and I'm going to show you with their experiment, but they started first with mice. And they took mice, they irradiated them, so that they wiped out their bone marrow. But before they irradiated them, they did a little test to stain for, illuminate stem cells in their bone marrow. And you can see in both groups, the control group, no hyperbarics.
Before they got irradiated, they all had bone marrow stem cells. All good. Then they irradiated them, and they injected back the stem cells, and then went and measured. And in the ones that didn't get hyperbaric oxygen, where they had just done a single hyperbaric treatment, and then inject the stem cells. Those rats showed no uptake, but the hyperbaric rats, look at that, the stem cells implanted in the bone marrow.
The only difference was one hyperbaric treatment. They then went on to do this in cancer patients where they chemically wiped out their bone marrow and did the same thing. Single hyperbaric treatment, then re-infused blood stem cells, and what did they find? By follow-up 100 days later or so on blood draw, They'd had a significant reduction in the time to repopulate their bone marrow, white blood cells, platelets.
And there's this inflammatory thing that occurs with chemotherapy. You may have heard about it. It's mucositis where people slough the inside of their mouth.
It's painful. It's horrible. You can't eat, can't swallow.
It turns out 64% of the control group had it, 26% in the hyperbaric oxygen. So it appeared the hyperbarics was facilitating the implantation. And the last case that showed this is my most famous patient, a middle-aged man, a very famous man, very wealthy. And his job involves giving talks like I do here.
But he does this for a living. And he had been poisoned with mercury, and cognitively he was failing. He had tried everything. He'd done chelation therapy. He'd gone to eight hyperbaric centers around the world.
He hadn't improved. And he called up and I said, look, maybe we can image you and see if I can get the dose right with you. And he did. I dosed him.
We treated him by 26 treatments. He had made a substantial improvement. And then he decided he'd go get some stem cells. He went and got stem cells. But then the next 11 days, he got nine more hyperbaric treatments.
Got himself up into blue skies territory, I call it, with hyperbarics. And he called up the stem cell place. He said, wow, these stem cells, they are great. I am at the top of my game. It's the best I've ever felt.
And the stem cell facility said, look, I'm sorry. We hate to pop your bubble, but this is not our stem cells. This was the hyperbarics. We don't ever see a stem cell effect in less than 30 days.
What it was, and nobody knew this, but it was very likely the stem cells in the hyperbarics that we were facilitating implantation. And that goes to the last finding that I want to talk about. So we're stimulating production and release of stem cells from the bone marrow. We're stimulating differentiation of them and maturation. We're stimulating proliferation and differentiation at the sites of injury in the brain and migration of it.
We're facilitating implantation of them if you exogenously administer them. But we've now got some evidence we might even be increasing production. I hope Dr. Profar is going to talk about this, because what happened was, based on all the other stuff I showed you, patients would call up and say, you know, we're also thinking of stem cells. And I said, well, let me tell you, we now have some evidence that the hyperbaric oxygen is stimulating. It may even help implantation.
So if you want to do that... Do some hyperbarics for it, and then we'll take a break right in the middle, and you go get your stem cells, come out, and we're going to do them right afterwards, just like these articles suggest. And what ended up happening, the patients started coming back from Dr. Profrock's facility and said, Dr. Profrock said that we had more stem cells than he's been typically harvesting.
And I said, oh, that's kind of interesting. Well, now we've got 12 patients in a row. I don't know, he's going to give you the numbers. But where there's almost three to four fold increase in adipose stem cells that he is harvesting.
And he's going to tell you about it because there's some other changes there that are very interesting. Well, how about that normal baric oxygen we did in the ICU? It turns out, here is a study, there's another one going on right now, where they took rats and they gave them just room air or another group, 40% oxygen, which is oxygen by mass, for two hours a day for 10 days. And then they measured stem cells in the blood and inflammatory markers. And what did they find in the hyper-air group?
TNF-alpha, which is an inflammatory marker given off by white blood cells, way down. And guess what? Stem cells were released into the blood with just some supplemental oxygen. Again, it goes back to part of what we're doing.
Well, I've now done this with over 50 kids. I really think it's up towards 70 or so in ICUs around the country. And we're seeing about 90% of them respond. And of course, it helped take little Eden from where she was in bed and thrashing.
And that's a good picture of her before to, you know, walking and talking. And so lastly, and Dr. Profrock is going to talk about it, is the 12 consecutive patients. So the takeaways from this are, what type of... hyperbaric oxygen. I'm going to tell you, you probably know more about this than 75% of the doctors in the United States, and I'm going to say probably 99%, because none of them are taught anything about this gene expression stuff or anything you saw here today.
And it's all based, all of those were scientific studies I showed you. But it's increased pressure and increased oxygen to primarily treat wounding conditions, even if we can't identify them as a wounding condition. It treats the underlying disease processes. It works by a lot of different lot of mechanisms, but a dominant one is affecting our genes, expressing and suppressing them. And besides that gene activity, we have a wide-ranging effect on stem cells, somewhat depending on dose, and that's going to get figured out in the years ahead.
But we're stimulating production, release, differentiation, implantation, and maybe even production of stem cells for harvest. And likely, when you combine these things together, as we're now seeing in sequence, It's additive and very likely synergistic, all of these therapies together. And the end result is brain repair.
Thank you.