The Oxygen Connection
Is it Just Hot Air? Or the Hottest Treatment Around?
One local physician is having promising results
treating troubling disorders like autism and Lyme disease with hyperbaric oxygen therapy
By Karen Maserjian Shan
Photos Ken Gabrielsen
Dr. Giuseppina B. Feingold had tried almost every type of conventional therapy to help her three-year-old daughter battle the crippling effects of cerebral palsy. Nothing much helped. Then she tried hyperbaric oxygen therapy. Six weeks later, she noticed a few positive signs; six months and 120 treatments later, everything had changed. “My daughter became toilet trained night and day, and she went from saying 30 words to over 1,000 words,” the doctor recalled.
Dr. Feingold was impressed — really impressed. It’s not that hyperbaric oxygen therapy (HBOT), during which patients breathe 100 percent oxygen in an enclosed, pressurized chamber, is new. By the 1950s, the U.S. Navy was using it to treat decompression sickness, better known as “the bends,” and 20 years later the military found it effective for healing stubborn wounds. Currently, the Food and Drug Administration has approved HBOT to help treat 13 conditions (see box), although it is still most commonly used for healing problem wounds, especially those caused by diabetes.
Still, many of those in the medical community have long thought that using HBOT to treat “off-label” conditions (such as cerebral palsy, autism, stroke, multiple sclerosis, and other illnesses) is pure quackery. But Dr. Feingold is now a believer. The emergency room physician enrolled in a weeklong course in conventional HBOT training at Mount Vernon Hospital. But because there were no local training classes for unconventional uses of the therapy, she sought several more weeks of training from two of the field’s foremost practitioners: Dr. Paul G. Harch in Louisiana and Dr. Richard Neubauer in Florida. “I had expected to be an ER doctor all my life,” she said. “I didn’t expect to be anything else.”
It was not to be. In January 2001, Dr. Feingold opened Valley Health and Hyperbarics in Brewster (the office is now located in Mahopac). She is one of the few providers in the Valley to use HBOT to treat patients afflicted with autism (now considered the fastest-growing developmental disability in the U.S.), cerebral palsy, stroke, and other conditions. Currently, half of Dr. Feingold’s 260 patients see her for HBOT; 90 percent of these patients are autistic children. She takes on five to 10 new HBOT patients a week. “I have children who start to talk; I have children who calm down. One little girl started to walk and talk — she wasn’t doing that before. It gives me a lot of satisfaction to see this,” she said.
Still, naysayers in the medical community contend off-label uses of HBOT are nothing more than hot air — offering false hope to patients, not to mention huge medical bills not covered by insurance. (Each session, or “dive,” at Dr. Feingold’s office costs between $150 and $200, so extended treatments can easily run into thousands of dollars.) Many professionals add that there is no empirical evidence to suggest that HBOT has any positive effects on the symptoms of autism, and they dismiss the physician-based research, insisting instead on double-blind tests and animal studies.
But HBOT supporters are hoping that new evidence is right around the corner. Currently, 20 hyperbaric oxygen clinics nationwide are participating in a study that will look at how HBOT affects about 400 autistic children. The National Institutes of Health will evaluate the results. In Dayton, Ohio, a large, federally funded study is underway on the effects of HBOT on children with cerebral palsy.
Dr. Harch, a clinical assistant professor and director of the Louisiana State University School of Medicine Hyperbaric Medicine Fellowship in New Orleans, was among the first doctors in the U.S. to use low-dose hyperbaric medicine on children; he believes he was the only one to treat autistic kids with the therapy through 2000. He has little patience for those not willing to explore HBOT’s alternative uses. “They don’t know about this, they haven’t read about it, and they don’t understand it,” he declared.
“Hyperbaric medicine has been cloistered in the U.S. military all these years. The research is as strong or stronger for the unconventional applications as it is for the traditional reimbursable applications. What has lagged is the awareness of physicians.”
But the word is getting out. Dr. Harch’s new book, The Oxygen Revolution (Hatherleigh Press), details how HBOT can be used to treat everything from stroke to autism to Alzheimer’s disease. (His recently completed study on the therapy using an animal model will be published later this year.) He estimates there are now more than 100 HBOT clinics in the U.S., including sites equipped with portable hyperbaric chambers. “Patients are demanding it,” he said, and they are telling others about it. “The science is becoming better known, and it’s better defined now.”
Dr. Feingold also does her part to bring attention to HBOT’s off-label treatments. Five or six times a year, the Italian-born pediatric specialist travels around the globe to lecture about HBOT for organizations like the American College for Advancement in Medicine and Defeat Autism Now! “HBOT can definitely help, so it should be more readily available,” she believes.
But despite Dr. Feingold’s full schedule of patients, her practice is not lucrative, in part because of the expense and time HBOT requires. So, she continues to work as an emergency room doctor at Nyack Hospital. She is careful to keep her HBOT practice and ER work separate. Even so, she is looking into opening a second office in New Jersey to better serve her patients in that area.
Tricia Zarro’s son Danny, 4, was diagnosed with autism when he was two. “He had 12 ear infections in 14 months,” said Zarro, who lives in Ossining with her husband, Ernie, and their three children. “He was a kid who had a lot of allergies and was constantly colicky and sick with all kinds of different things.” To “yank him out of the claws of autism,” as Zarro put it, Danny has undergone, and continues to participate in, various medical procedures, dietary plans and therapies, including hyperbaric oxygen therapy. Through Danny’s HBOT treatments — he’s undergone three sets of 40 dives with Dr. Feingold in the past year or so — Zarro has seen her son’s motor skills improve appreciably. “It just pushed him forward and accelerated the physical therapy and occupational therapy he was getting,” Zarro said.
While Zarro’s son has made progress, different people respond differently to the therapy. And there’s the exorbitant cost. Because Danny’s HBOT treatments are for autism, they are not covered by insurance. “If it’s not nailed down, we’ve sold it,” said Zarro of her family’s money-raising efforts.
“But he’s really changing,” said Zarro of Danny. “It’s beautiful to watch. It’s hard work, but he’s a different boy than he was a year ago. There’s real, true hope for him.”
Kids like Danny are why Dr. Feingold sacrifices so much time — and money — for this work. “I have a very supportive husband and really good kids, otherwise I couldn’t do it,” says the Suffern resident, whose five children, ages 10 to 12, include 10-year-old triplets.
“This holds a lot of potential for the future,” said Dr. Feingold about HBOT. “We’re having more and more autistic children — the numbers are staggering — and we’re seeing more and more people affected by neurological problems. We don’t really have good alternatives. I think that this is something that is in the future for many, many people. It’s not a magic bullet, but it’s definitely a great tool.”
HBOT: How It Is Done
Dr. Feingold’s office has two mono-chambers, both about seven feet long and two feet in diameter. A patient enters the chamber by lying on a wheeled gurney; its bed is attached to a track inside the chamber. A technician pushes the bed into the chamber and latches the door shut. The pressure inside the chamber is then raised to a particular level based on the patient’s condition, and 100 percent pure oxygen is piped in. (In the normal atmosphere, people usually breathe about 21 percent oxygen.) At this point, the patient may feel like he or she is on a descending airplane.
“It’s a little scary,” admitted Dr. Feingold. Indeed. The mono-chambers are made of transparent glass and acrylic (along with a metal base and tubing). Although patients can use speakers to communicate with people outside the chambers, it seems it would be difficult for anyone with even a mild case of claustrophobia to tolerate even a few minutes in the closed capsule, let alone the one-and-a-half hours he or she would have to endure for a treatment. Typical full therapy sessions require 40 treatments over the course of a month — that’s two 90-minute therapies a day, five days in a row, for four consecutive weeks.
Fortunately, most children enjoy the treatments, said Mary Ellen Zackaroff, Dr. Feingold’s technician. Many crawl around in their “spaceship” during therapy sessions. Dr. Feingold’s office also has two- and four-person chambers. Although not transparent, these are spacious enough to sit in, allowing a parent or friend to accompany a frightened child during treatment. Air pressure is raised in the chamber, with the patient wearing a clear helmet into which the oxygen is piped. Because the use of oxygen is a fire hazard, Zackaroff insists patients change out of their day clothes and remove all makeup and jewelry prior to treatment.
Usually, the air pressure in the chamber is slowly lowered back to normal before a patient is let out. However, the pressure can be lowered rapidly to allow a patient to leave quickly (although this may cause an eardrum to rupture). And although risks associated with low-pressure HBOT are quite small, it can trigger a seizure in some patients. Also, getting too much oxygen by overdoing the therapy can be toxic.
