Friday, August 1, 2008

HBOT - END OF WEEK FIVE - Varied Depth Dives

Ok, so not a very exciting title today but it is Friday :)

Someone asked me what the difference was between the two different depths, why should the two different depths make a difference in the treatment of CRPS? 

Good question. The simple answer, as shared by Susan Rodriguez of RAPID RECOVERY HYPERBARICS ; "RSD is neurological in nature and yet it manifests itself in physical symptoms," she says. "What that means is that the disease needs to be treated with two approaches. One goal is to restore circulation, reduce inflammation or edema, and remove the swelling in affected limbs so the limbs can live. The other goal -- if you want to eliminate the disease -- is to work on the brain."

"With RSD, pain is read through sensors in the sympathetic nervous system. (The sympathetic nervous system is what is activated in phantom leg pain, for example.) "Hyperbaric Oxygenation Therapy, however, can make the switch in the brain back to the central nervous system," Rodriguez says. Under a doctor's direction, she treats both the affected limb and the brain by different atmospheric pressures when the patient is inside the chamber."

"Different undersea depths work on different parts of the body," she explains. "Deeper depths (up to 33 to 45 feet undersea) work more on tissue and bone, while milder hyperbarics (such as 18 to 24 feet undersea) work on the brain. Since we are working on both things, I take patients to all those levels. Almost always, the first symptom to come is the last to go. And then the symptoms are gone!"

You can read more on this article by going to "HBOT, WHAT IS IT" 

Studies have shown that CRPS patients have abnormal blood flow in the brain, and that blood flow is restored to the brain at between 1.2 and 2.0 atm. The goal is to normalize the blood flow and enable the brain to "read pain" properly. That can sometimes be achieved by HBOT at the shallower depths; such as 1.75 to 2.0 atm. But first you have to normalize blood flow and nerve function to the affected part of the body, the CRPS affected area, through the deeper dives. Relief, and a "re-setting back to normal" if you will, can hopefully therefore be achieved by a combination of the two depths. 

This is the idea behind the varied depth dives. 

As I wrote yesterday every patient is different. I have heard from quite a few people who had the varied depth dive protocol and there were a handful of different approaches with basically the same idea; the main variations being the number of total treatments (averaging around 35-40), the days used for each depth (either every other day or switching depths during each dive), minutes at each depth, etc. The bottom line ends up the same. 

I also have some other information to share today.

Some have asked what the larger multi-person chambers looked like; CLICK HERE FOR A PICTURE.

There is even a picture of one of the earliest "monoplace" units used in 1915. Reallllly looks comfortable!

The National Hyperbaric Centre in Ireland website answers another question submitted; "does smoking affect my HBO Therapy or would it preclude me from even trying it?" 

The whole idea behind this treatment is to promote healing and recovery. This process of introducing oxygen, in solution, into the tissues of the body, promotes the clustering of capillaries and increased collagen to the tissues where the body needs the effect the greatest. Tobacco smoke is known to reduce that effect and literally retard the benefit of the therapy the smoking patient receives. It is highly recommended that the patient refrain from smoking during their entire course of treatment, maybe even allowing the patient to quit all together.

Also, Two other questions were asked at the recent pain meeting as well as asked via email. 


That depends upon the reason you are being referred for Hyperbaric Oxygen Therapy. Your Primary Care Physician may refer you directly to us for treatments or he or she may first refer you to a specialist who may then recommend treatment with Hyperbaric Oxygen Therapy.

In any case do not feel intimidated from asking your Primary Care Physician to prescribe the therapy for you. If you need treatment for one of the above source diseases or disorders, you may wish to seek advice from a second physician to be sure you are getting the best treatments available. If your practitioner hesitates or is not completely familiar with Hyperbaric Oxygen Therapy, check out our library of articles and show them to the practitioner, or even refer your practitioner to us.


If you have ever dove to the bottom of a pool, or flown in a plane, you can relate to the sensation of your ears popping. You will be instructed on methods of equalizing the pressure in your ears. Please follow the instructions carefully and avoid a feeling of fullness in your ears, this will protect your from any discomfort during your experience. By holding your nose and attempting to blow through it, or simply swallowing, chewing gum, or sipping on water will allow the pressure to equalize in the middle ear, through the eustachian tube. It is only necessary to do this during the first few minutes of the treatment. The remainder of your treatment should be a time for you to read, sleep, watch TV, or just relax. Patients of all ages generally tolerate the treatments very well.

At first, while the chamber is being pressurized, or what is referred to as a diving to depth, you will experience the sound of the air or oxygen (This is depending upon the type of chamber you are being treated in.), which may be quite noisy. It will get warm at first because as you add pressure to any given object, it will increase the temperature, but when the chamber reaches the pressure or “Depth of Dive”, the temperature will automatically adjusted to a comfortable setting.

Both of these answers come from the National Hyperbaric Centre in Dublin, Ireland


Have a great weekend guys! 

peace, Keith

Thursday, July 31, 2008


Good day everyone! 

Or good evening, depending on when you read this of course.

I want to thank everyone who has not only shared this with their friends but also those who have forwarded it on to the CRPS and RSD websites they are a part of. I appreciate the vote of confidence.

On another note, because this blog has been so successful I was thinking of starting one this weekend for another organization I belong to; Procrastinator's Anonymous. But on second, that can wait until September. 

People have asked how I like it down here in Florida, if it has been good for my CRPS. Absolutely. The cold weather made our CRPS worse. If you check out the RESULTS OF A NATIONAL SURVEY OF CRPS PATIENTS that American RSDHope did a number of years back (most of the results of which remain the same), you will see that 71% of respondents felt that the cold made their pain worse.  16% felt the warm weather made it worse, 22% felt it made no difference. (it adds up to more than 100% because some patients reported that both the warm and cold weather made their pain worse) 

Also in that survey, 95% of CRPS patients reported having Burning Pain; 79% memory problems (I think that was the number);  74% said they dealt with Depression; 89% dealt with Allodynia; 60% were Touch/Sound Sensitive; 64% dealt with Weight Gain. There were many other findings. Drop by and check out some of the findings!

I think that one number that mot likely has significantly increased from the time of the survey is that 44% belonged to a Support Group. I think in the last five years alone membership in these groups, both local and on-line, has increased dramatically; as well it should. 

On-line groups provide a place for patients who aren't mobile and/or don't have access to a local group as well as provide patients with a way to share information regarding their disease. Local groups provide much needed personal contact for not only patients but also their loved ones. They also enable patients to share information on local physicians and therapists. 

It is time we did another national survey though. 

So, how is my HBOT going?

It is going well. We had hit a wall, as most of you know who have been following my blog, a sort of impasse, where my pain had actually increased. This is a typical point in the therapy for CRPS patients unfortunately. It is one most of you will also have to deal with at some point and have to PUSH THROUGH. It isn't easy but any of you who have dealt with this disease, have lived with this disease for a year, or two or five, are tough, are strong. If you can deal with the constant pain of this disease you can handle pushing through the wall, especially when it could mean a lot less pain on the other side!

So how did we do it? What did we do to help get me through, over, around the wall? 

We did something that was brand new to Dr Spiegel and his clinic. Something suggested by Susan Rodriguez of Rapid Recovery Hyperbaric's in CA, and several full-body CRPS patients I know who have been helped. That is, the varied depth dives. 

There are some clinics around the country that are doing variations of this method; where they vary the depth of the dive either from day to day or even during the same dive; from the standard treatment depth of 2.4 atm to the shallower treatment depth of 1.75 atm.

I heard from many places and nearly all had great results. Dr Spiegel was open to trying this since we seemed to have come to an impasse in my treatment. I was not getting beyond the wall so we decided to try three days completely at the shallower depth.  At the end of those three days we seemed to have broken through the ice and the healing seemed to have begun. 

That was last week. You will notice that was when my pain began to drop. 

This week we did, Monday and Wednesday at the standard treatment depth, and Tuesday, Thursday at the shallow depth. If you recall, my burning pain has been receding steadily!

So we will continue on this path and se where we are at the end of next week, and then reassess. 

Now, does this mean that this approach should be used on every patient or that here at Dr Spiegel's clinic he is going to change his protocol for CRPS patient's to the varied depth protocol? 

No and No. 

Remember, every patient is different, especially with CRPS. Every time I speak at a pain conference or meeting I try and stress this point when patients and/or loved ones ask about various treatments. CRPS is a very complex disease. It can begin in many different ways and take many different paths as it progresses. One treatment may work for 3 patients and not for the next 7. About the only thing that holds true is that we need to try and stay away from invasive treatments, anything that can possibly further involve nerve damage.

So, we will continue our therapy, continue trying this version and learning as we go. maybe it will help another patient down the road and hopefully it will continue benefitting me as well.

Take care everyone,

Peace, Keith 

Wednesday, July 30, 2008


Well, it is still too early to tell what the end result will be but it sure has gotten a foot in the door. 

As I mentioned with quite some excitement yesterday the burning in my hands went down to about a one last night. By the morning it went up a little to about a 1.5 or a 2. Still amazing. I am anticipating it will continue to fall. The left foot continues to be about an 8, the right foot has dropped to about a 5, the eyes are still very strong and my ears as well. But, considering I started out with burning almost everywhere, THAT AIN'T VERY MUCH :)

I have noticed that my allodynia hasn't gone down very much yet. Some of the past patients have mentioned they saw a big difference around the 30 to 35 treatment mark. 

So before I get to your questions, here is mine for you.

For those of you who were helped by HBOT, did you have your allodynia decrease as well, and if so, when did that occur? 

Also, I have only heard from four of you who had the varied depth treatment. Are there any others who had their HBO therapy changed after the 25  or so treatment? In other words, where they altered the depth, maybe day to day, going from shallow one day to deep the next? If so, what were the results?

Ok, now here are your questions. 

Someone had written to me asking if it were possible for someone with a spinal column stimulator to have HBOT?

The answer is yes. As a matter of fact I have a link for an HBOT study that was done on patients who had SCS units

Someone else asked, "Why does HBOT work?" 

"Nature has dictated that healing cannot take place without appropriate oxygen levels in the body’s tissues. In many cases, such as those involving circulatory problems, Strokes, anoxic brain injury, and near drowning just to name a few, adequate oxygen cannot reach the damaged area and therefore the body’s natural healing process fails to function properly.Oxygen given with increased pressure can correct many serious health problems. To provide this increased pressure one must be within a pressurized room, a Hyperbaric Oxygen Chamber. Oxygen, given at normal atmospheric pressure is insufficient to raise tissue oxygen levels. The answer is to deliver oxygen with a slight increase in pressure with a chamber to raise the oxygen tension above the normal red blood cell saturation.


Also, it was asked whether you could continue your HBOT if you develop a col or the flu. This is best addressed by your HBO Doctor but the main problem here would be the inability to clear your ears. If you can't clear your ears you won't be able to descend. 

Another question was "How do I know that my HBO Technician is properly trained?"

In 1991 the National Board of Diving and Hyperbaric Medical Technology (NBDHMT) introduced a standard certification program for all hyperbaric technicians.

And someone asked for more testimonials besides the ones on Dr Spiegel's site and the Rapid Recovery Hyperbaric site. Here is yet one more site with more testimonials of various diseases treated with HBOT

Lastly, if anyone is reading this who lives in the Tampa Bay/Palm Harbor area, or happens to be visiting the area, our local CRPS support group will be holding a pool party this Saturday, August 2nd, in Tampa Bay. It should be fun and we will be having a cook-out as well. C'mon over! I promise to try very hard to stay awake for the whole afternoon!

Take care guys, and remember, hug your caregiver tonight!

Peace, Keith 

Tuesday, July 29, 2008


Humor is one of the best ways to deal with chronic pain. Laughing triggers endorphins and that helps battle pain. 

So hear are a few little tidbits for you;

  • Science Exam Quotes (from 11 year olds) 
  • Laurie Sale/Norman Josephs
    • * "Water is composed of two gins, Oxygin and Hydrogin. Oxygin is pure gin. Hydrogin is gin and water."
      * "When you breath, you inspire. When you do not breath, you expire."
      * "Three kinds of blood vessels are arteries, vanes and caterpillars."
      * "Blood flows down one leg and up the other."
    So, what is the latest update? 

    Fantastic news. After this mornings treatment, I noticed the burning in my hands has decreased to only about 10% !!!!!!!!!!!  That is nothing! So exciting!!!!

    The allodynia is still quite strong, as it is in in my feet, legs, and arms still and the burning is still strong in my left foot and a little less so in my right foot. But one step at a time. This is so amazing. 

    After my discussion the other day of the Third Symptom of CRPS, Spasms in the blood vessels and muscles of the extremities, I received a few emails. Some saying they were grateful to hear they weren't the only ones who experienced those things and some asking what the other three symptoms were. I even got two asking if you needed to have all four symptoms in order to have a diagnosis.

    So let me try and answer all of those here :)

    1) Constant Chronic Burning Pain (includes allodynia - extreme sensitivity to touch, sound, vibration, 
    2) Inflammation - This can affect the appearance of the skin, bruising, mottling, etc.
    3) Spasms in blood vessels and muscles of the extremities
    4) Insomnia and Emotional disturbance (includes major changes to the limbic system; among them are short-term memory loss, concentration difficulties, inability to find the right word, depression, etc.)
    There are other CRPS symptoms of course. 

    In answer to the question about whether you need to have all four symptoms; no. But it is unusual for a patient not to have at least three of the four. Not every patient has the constant burning pain but probably 85% of patients do. 

    On another note, we recently added an article from TIMES ONLINE called "IS PAIN ALL IN THE MIND?"

    It is an interesting article but I think it falls far short of what the typical chronic pain patient deals with. It deals more with what I term "simple pain". But check it out and decide for yourself.

    HBOT CLINICS - Someone asked me for a list of clinics around the country. If you visit the links in our HBOT section you can find some of the clinics there and most of them have a list of clinics. For example; the AZ HBO Clinic has a LISTING OF HBOT CLINICS 

    Also, someone asked what conditions are covered for HBOT and which aren't covered by are treated with HBOT.

    On the RAPID RECOVERY HYPERBARIC website, there is a great page that lists these two things right next to each other. Check it out!

    Ok guys, that is it for today. Check back tomorrow!

    peace, Keith 

    Monday, July 28, 2008


    I began my fifth week of HBOT today. 

    So what changes have I noticed? 

    My CRPS, which was full body at the start of this process, seems to be mainly in my feet, hands, eyes, ears, and some in the lower legs and a little in the arms, at this point. 

    Now a "typical" CRPS patient might look at having CRPS in their feet, hands, etc. as being pretty horrible. As well they should. But for those of us with full-body or "systemic" CRPS, that is actually a big improvement. A cause for celebration. 

    Celebrations are all relative, as the joke goes ... 

    My wife and I were sitting at a table at my high school reunion, and I kept staring at a drunken lady swigging her drink as she sat alone at a nearby table. 

    My wife asked, 'Do you know her?' 

     'Yes,' I sighed,  'She's my old girlfriend.  I understand she took to drinking right after we split up those many years ago, and I hear she hasn't been sober since.' 

    'My God!' says my wife, 'Who would think a person could go on celebrating that long?' 

    And that's when the fight started....

    Hmmm.  lol 

    Anyway ... 

    I was speaking at a meeting for a new CRPS group in Orlando on Saturday and someone there asked me "What is it like to have pain everywhere? Is it really head-to-toe?"

    I know she hesitated asking it and even said, "if it is too personal I apologize" or something to that effect. It is a question I have been asked many times. Consider that only about 8% of all patients end up with systemic CRPS and that most patients haven't spoken to or met  many other patients, it isn't unusual for most to have never met someone with full body. I don't mind sharing my story at all, it is part of what I consider my mission, how I enjoy helping other patients and their loved ones. 

    So now my pain isn't everywhere.  Right now , as I mentioned, my pain has "localized", meaning instead of being centered in the brain it seems to have gone out to the extremities and the pain is now being felt where it is supposed to be felt, in the extremities themselves. It is as if the nerves are re-learning the correct pathways again, are re-training themselves to function normally again. Maybe I am oversimplifying it but that is what it seems to me. 

    I did want to answer some questions posed to me over the weekend by either patients considering the treatment or those undergoing it now.

    1) Does HBOT make you tired? Absolutely. It will make you extremely tired, as if you ran a marathon. Most patients take a "hyperbaric nap" after their treatment and then sleep well again in the evening often reestablishing their REM sleep patterns. 

    2) Is it normal that you feel really hungry? Yes. Your body is re-building pathways, generating new blood vessels, growing tissue, etc. I am not sure that is why but it makes sense to me. Either way, yes you will be very hungry and need to eat, especially right after your treatment. It is very important to eat fruit or something along those lines immediately following your treatment. That will also help to prevent those annoying little headaches that can sometime crop up.

    3) Is ear pain a sign I can't have more treatments? Ear pain is a serious issue with regards to HBOT. Because you are constantly descending and ascending you have to use your ears as "balancers" so to speak, they allow you to equalize the pressure as you descend and ascend. There is a small percentage of patients who develop ear issues, these can be serious. If you experience ear pain, let the tech and/or Dr know right away. Don't hide this fact thinking it will go away. 

    Oh oh, ok. guys. we have another one of the many thunderstorms that role through Florida this time of year. Need to get off the computer. 

    If you have questions, send them to me at or leave a comment on the blog and I will try and find the answer for you.

    Thanks for listening. 

    Kei --- arrrrrhhhhhhh

    ooops. That was a close one!