Ken Larsen's web site - Hyperbaric Oxygen therapy (HBOT)

 

As explained in a health blog I wrote, I was treated with radiation and chemotherapy for a tonsil tumor in early 2015.

 

Side effects of radiation on the oral cavity are diminished saliva and decreased micro-vasculature of some sections of the oral cavity.  Radiation destroys healthy tissue as well as cancerous tissue.  This can lead to increased probability of dental cavities ... which is what happened to me.  In late 2017 and early 2018 I had to have 10 cavities repaired.  Also, I'm going to have to have three teeth removed (15, 18, and 31), because they're beyond repair. 

 

Teeth extraction is not a big deal for someone who has healthy tissue, but it can cause problems for anyone who has undergone radiation.  The irradiated tissue has diminished micro-vasculature, and therefore doesn't heal as well.  In some instances, bone tissue is affected, and a condition called Osteoradionecrosis (ORN) can develop.  That is an extremely serious condition which can require bones grafts to correct.  It is something that must be avoided at all costs.

 

To minimize the likelihood of ORN, there are two choices:

 

 

Antibiotic treatment involves the taking of antibiotic two weeks prior and two after the extraction.  Cost:  only a few dollars.  It's the option that my UNC radiation oncologist (Dr. Bisham Chera) recommends.

 

HBOT is a far more complicated and expensive procedure.  I will describe it as well as I understand it in the remainder of this web page.  It should be noted that I am not a doctor, and my understanding of HBOT is based on a few things that I found on the internet (example) plus a two hour "consult visit" that I made on May 24, 2018 to Duke Hospital's hyperbaric chamber and spoke with six members of their hyperbaric team (which included two medical doctors and a PhD doctor).  My oral surgeon (Dr. Debra Sacco) arranged the meeting.  She is a proponent of HBOT.

 

The intent of HBOT is to increase the micro-vasculature of the irradiated tissue by placing the patient in an HBOT chamber and subjecting them to pure oxygen at high pressure for a couple of hours for many sessions.  ["Hyperbaric radiation therapy for treatment of late radiation tissue injury (LRTI)"]  Here are the key attributes of HBOT:

 

Attribute Value Ken's comments
HBOT pressure 2 atmospheres This is pure oxygen.  Normal air is only 21% oxygen, so the patient is being subjected to ten times the oxygen level that they normally breathe.
Length of one session 2 hours and 15 minutes  
Number of sessions needed 30 (20 prior to surgery; 10 after) These would be held five days/week (Monday-Friday).  This would tie me up for five hours/day for six weeks.  Although I only live 11 miles from the Duke Hospital, I have to park in a parking garage ($ 8.00 per day) and walk a half a mile to get to HBOT unit.  That's two hours of commuting every day.
Cost $ 4882 This is what Duke would bill my insurance.  I don't know how much I'd have to pay. 

Based on an internet search, this number would likely be $ 9000 if I didn't have insurance.
Side effects and possible complications *lung damage
*fluid buildup in the middle ear
*sinus damage
*Oxygen poisoning
See "Complications of Hyperbaric Oxygen Treatment" by John Hopkins Medical Center.

None of these were mentioned during my two hour visit with the Duke HBOT team.  I found them on the internet.
Clinical trial results None No formal clinical trials have ever been done on HBOT.

 

HBOT purportedly is better than antibiotic treatment for minimizing the likelihood of ORN, but based on the cost differential, the time differential, and the side effects, it's a no-brainer to me.  I will definitely go the antibiotic route. 

 

It should be noted that I regard myself to be in excellent health, because:

 

Because of these attributes, I assert that I am far less likely than the average person to get ORN.  The Duke team agreed with me on this point.

 

Before I left the consult session, I emphatically told the Duke team that I would not be doing HBOT.

 

I'd feel a lot differently about HBOT if there were hard data to confirm the alleged superiority of HBOT.  For example, it would be ideal if a tooth extraction patient's micro-vasculature could be measured before and after HBOT.  Then, stratify the results by that patient's attributes (smoker, drinker, health issues, medication taken, age, gender, level of fitness, and whether or not they later came down with ORN).   However, they don't have that data. 

 

To help assess the health of my irradiated oral tissue, I bought an oral camera and used it to take this picture of tooth #18 ... which will be extracted on June 6, 2018.  That area was irradiated in 2015, but the gum tissue now looks nice and pink ... which I interpret to mean that it has good micro-vasculature.  I attribute that to all the aerobic activity (e.g. hill sprints) that I routinely do.  If I were a sedentary individual, I suspect that it would not have good micro-vasculature.  In that case, HBOT would make sense.  That's my opinion.

 

Hyperbaric Oxygen Therapy (HBOT) or hill intervals?

 

(June 3, 2018) The casual reader of this web page likely will miss a key point that I'm trying to make.  It's my opinion that my aerobic activity (running) ... particularly my recent "hill intervals" ... is every bit as good, if not better than hyperbaric oxygen therapy.  Two of the articles that I cite seem to confirm that:

 

Article Key sentence
"Hyperbaric radiation therapy for treatment of late radiation tissue injury (LRTI)" "Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for LRTI based upon the ability to improve the blood supply to these tissues."
"Running and Breathing:  A Lesson in Oxygen Intake and VO2 Max" "The good news is that you can increase your tidal volume, expand your capillary network, and increase the number of mitochondria you have. By doing consistent aerobic exercise (running, cycling, swimming, etc.), you'll increase all of the above. The more you run, your body will actually increase and build that important network of capillaries in the muscles and when that happens, you'll actually increase the number and size of the mitochondria in the tissue. When that happens your body will be more efficient at extracting oxygen from the blood and getting it to the muscle where it's needed for energy production. For experienced runners, more intense workouts such as intervals, hill repeats, fartleks, and/or tempo runs will help up their VO2Max."

 

Outcome of tooth extractions

 

I had teeth 15 and 18 extracted on June 6, 2018 by Dr. Debra Sacco.  I had tooth 31 extracted on June 19, 2018 by Dr. Adam Serlo.  An examination by Dr. Serlo on June 27th showed that all three sites were healing nicely.  I went the antiobiotic route.  In retrospect, that was the right choice for me.

 

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