CRPS - Weather changes, do they affect CRPS? RSD?

DOES THE WEATHER AFFECT CRPS? 

Now that the winter season is upon us, for most of the country anyway, many patients are seeing changes in their pain although quite a few may not have ever made the connection. In talking to patients I often run into some who do not know that the changes in the seasons cause changes in their pain. They might have noticed that they get colder in the winter, that storms bother them, etc. but did not understand that there is the direct connection.

Barometric changes, especially drops in the BP, can cause increased pain for many patients. These can come from violent storms such as hurricanes and thunderstorms but they can also come with snowstorms and changes in the highs and lows you hear the weatherman describing all the time. 

When you watch the weather next time, pay particular attention to when the next Low Pressure system is moving in and monitor your pain. See if you notice any changes/increases in your pain. Chances are that you will.

The other issue that CRPS patients face in the winter months, especially those who live in the colder, wintry states, is dealing with the extra pain that comes with the extreme cold. 

One of the ways that CRPS patients suffer pain, (and I realize this is oversimplifying things) is from constricted blood vessels. These constricted blood vessels not only cause pain but also restrict blood flow thereby lowering the temperature of the extremities.  When the temperature drops these blood vessels constrict further, increasing the pain and lowering the temperature even further. 

The patient ends up in more pain and an inability to get their feet/hands warm. 

So what do you do, to decrease the pain and effects of the winter?

Well, you could do what I did, move south! It is nearly Christmas and it is 70+ degrees here. But that isn't practical for most people so you need other solutions.

- Layered clothing helps, and definitely you need to keep your hands and feet and head covered as much as possible. 

- If you have access to a warm water pool (85 degrees of more) that is EXTREMELY helpful, not only for raising the temperature in your extremities but also for keeping the chronic pain patient's body in shape and lowering their overall pain level. 

- Soaking in warm water with Epsom Salts is very beneficial. You don't need fancy bath salts/oils but by using epsom salts your body absorbs the magnesium, which helps in restoring normal blood flow. 

- Using microwave moist-heating pads (the kind with beads inside) helps as well. 

What ideas have you tried that have helped? Share them here in the comments!

Have a great day everyone!

Peace, Keith

American RSDHope

CRPS RSD and ICE , Should it be used?

The normal course of physical therapy following an injury is to use ice to bring down inflammation. They usually recommend something along the lines of ice packs many times per day, for weeks at a time. In quite a few instances they will also use something called Hot/Cold Contrast Therapy. This is where they alternate applying heat and ice. 

For the typical pain patient recovering from the typical chronic pain injury these types of therapies can be very beneficial and have been used for many years. 

However, (you knew there was going to be a however didn't you?), CRPS is anything but typical. And the application of ice, even in small doses like the use of an ice pack, can have very negative consequences and if used continually for days and weeks the application of ice can actually increase the pain of the disease and accelerate the CRPS through the stages. 

How long have we known this?  Many years.

Does every physical therapy center out there know about this?  If not, they need to and should. The information has been out there, published in articles and medical journals, etc.  I will share some of that below so if you know of a Dr or therapist that is still using ice to treat CRPS/RSD patients you can share this with them so they can learn. 

Part of the problem comes in that the damage that gets done is not readily apparent. It isn't as if the ice application will make the patient scream out, like the "desensitization therapy" for instance. As a matter of fact in the very beginning it may actually "feel" good and in a weird way it sort of makes sense in your head to apply ice when your affected limb is full of burning pain!

So, let's look at why ice causes short and long term problems for CRPS patients and probable acceleration of the disease itself. 

There are two basic areas we will look at and I will try to break it down into layman's terms and also provide the links for those of you who would like more in-depth information on the subject.

1) Some of the symptoms of CRPS, such as pain, discoloration, and spasms, are due to a constriction of  the blood vessels. This causes a reduced blood flow to the extremities. many of you have seen the color show your feet/hands, legs/arms have put on where they turn dusky, purple, etc. and have felt the pain of the constriction as if your limb was being strangled, have felt the extreme coldness due to lack of blood flow, etc.  These are all partly due to constriction of the blood vessels. 

Now when you apply ice to that same affected limb you are constricting, shrinking, those blood vessels and reducing the flow of blood to your limb even further. 

2) The second and more important aspect to the application of ice is the damage done to the myelin sheath (fatty tissue insulating the large nerve fibers) . The best explanation I have seen written on it was done by Dr Hooshmand many years ago;

"As the ice freezes the large nerve fibers, causing freeze damage to the myelinated nerves, the patient develops sensory loss and pain due to permanent damage to the large sensory nerve fibers. This aggravates the RSD by adding sensory nerve pain of non-sympathetic origin to the initial thermal sensory pain of sympathetic origin.

As a result, Ice provides total anesthesia and relief of pain for several minute the same way as the hand becomes numb being exposed to snowballs in the winter. However, a few hours after the cessation of ice exposure, the pain recurs with vengeance due to reactive enlargement of blood vessels after the constriction of blood vessels due to exposure to ice.

This phenomenon causes excellent relief of pain with ice treatment followed by not only aggravation of pain, but damage to the nerve fibers adding sympathetic independent pain (SIP) to the original sympathetic mediated pain (SMP).

The end result is aggravation of the RSD and SIP resulting in failure of nerve blocks and then the patient is told, "You do not have RSD anymore because the nerve block did not help you and the phentolamine test proved that you do not have SMP or RSD".

In most RSD patients ice makes the condition worse and can cause denial of diagnosis and treatment for the patient."

The link to the complete article can be found by going to;

CRPS/RSD AND ICE

Also, RSD and ICE THERAPY? HOT/COLD CONTRAST? 

You can also read more about SIP (also called IMP or Independently Mediated Pain) and SMP by going to SMP OR IMP? WHAT IS THE DIFFERENCE

In the second ICE article it discusses this;

In stage I, the injured area shows hyperthermia (increased temperature) rather than hypothermia.This is because of a temporary shock to the sympathetic system not being able to preserve heat and to control any heat loss over the skin of the injured area. In a matter of a few weeks, the majority of such patients (over four-fifths of RSD patients) regain the function of the sympathetic system and develop cold skin over the skin surrounding the area of nerve damage. Such patients cannot tolerate ice. If anything, ice aggravates the disease and exaggerates the constriction of the blood vessels and hypothermia (coldness) of the extremity. Even in these patients, the small central area of nerve damage at the area of maximum brunt of the trauma, an area is left with total paralysis of the sympathetic function showing as a pin-point area of hyperthermia on thermography. In these patients which are the majority of RSD patients, ice application should be avoided by all means.

In one-fifth of the cases when hyperthermia persists for a few more weeks, the patient will continue to be intolerant of heat or ice.

In stages II and III, the extremity progressively develops more and more hypothermia due to persistence of the dysfunction of the sympathetic system.

Eventually, towards the end of stage III and beginning of stage IV, in some cases the hyperthermia has a tendency to recur. This phenomenon is in part due to the fact that the patient has had repeated sympathetic ganglion blocks. The repetitive, numerous sympathetic ganglion blocks cause what is called "virtual sympathectomy". This results in gradual hyperthermia of the extremity (warming of the extremity). Even though the extremity becomes warm due to the virtual permanent damage to the sympathetic system, the pain does not get any better. In these patients, again, heat should be avoided.

Regardless of which type of heat intolerance or cold intolerance the patient is dealing with, the so-called heat and cold challenge treatment does no good in RSD patients. It only confuses the diagnosis and treatment and it should be avoided.

In many patients, in stages II and III, in the same extremity, there are islands of sympathetic paralysis, (hyperthermia) and islands of marked hypothermia due to sympathetic nerve irritation. These are the cases that do not respond properly to sympathetic nerve blocks and are classified as SIP (sympathetically independent pain)."

What happens if there are repeated applications of ice and severe damage occurs? The patient can actually accelerate through the stages, so instead of being in stage one for six months where local blocks may give significant relief they are propelled forward into stage two or three where there is no relief at all from blocks. Not only is this discouraging to the patient and sometimes the Doctor, but in many cases the Doctor and/or deciding party (WC, Insurance Company, etc.) may say "If you aren't responding to blocks then you must not have CRPS/RSD".  Either not understanding the role that the application that the ice played, not knowing how severely damaging it could be, or not even having a clue that it was a factor at all. The patient is left without a correct diagnosis, many cases without an effective treatment, and now, has damaged nerves as well. 

Just one more reason (and there are quite a few) why blocks can work better with some people than others, better in some stages than others, and why we can never compare our pain to other patients pain. 

Hopefully, between what I have shared above and the links you will have a much better understanding of why the application of ice is not a good idea for CRPS patients and be able to share the information with your Drs and therapists. Besides the above links there are additional links on the website as well. 

Hope this helps!

Peace, Keith

American RSDHope

WE COME TO THE END OF THIS TREATMENT PROGRAM - WHAT HAVE WE LEARNED?

"If you want to live your whole life free from pain, you must become either a God or else a corpse". -Menander

Todays blog I seem driven by quotes. I have included so many in my talks over the years and have a passel of them (for you young folks under the age of 100, passel means a lot). I don't know why but most of the points I wanted to make in todays blog , every time I thought of what I wanted to say, up popped a quote in my head. 

For instance. 

When it comes to where we are in my treatment. we have reached a plateau. My pain, what is left of the CRPS portion, doesn't seem to want to go away. It apparently has grown too attached to me to leave. 

Am I shocked? Not really. When I had my low-dose ketamine treatments (2003 and 2007) even though I got into almost complete remission, about 85 to 90%, it never completely went away. I have had this disease for over 34 years now and it is full body. It has had a long time to sink its claws deep into every crack and crevice in every system, cell, and fiber of me. 

Am I disappointed? Absolutely. Every time I try a new treatment of medication I do so with the hope of being free of this monster. 

Will it set me back? Let me put it this way ... 

"Retreat, hell! We're just advancing in another direction."--Oliver Prince Smith

After all, we made great progress with the Hyperbaric treatment. Thanks to Dr Spiegel my CRPs pain is down significantly. Mainly I have the CRPS pain now in my left leg from my knee down to my foot, in my right foot, in my eyes and ears, and then of course the allodynia issue. But, if you had seen my pain chart when we started you would be amazed. My darkened areas, those places where my CRPS was, was pretty much everywhere; both legs all the way, both arms and hands, eyes, ears, face, and of course back, neck, and a few other places. 

So compare then to now!

I have also cut my meds down some as well. That in itself is a good thing as all of you know. I am so sick of taking medication. I have been on them for so many years now and even though I have regular tests on my liver and have blood-work done, I do worry about the effects of all of that.  Not to mention I am just, like many of you, a little over the side effects of some of these things; the tiredness, the sluggishness, the , sleep problems, and, well, other issues. 

But having said that ...

One of my favorite quote and one that fairly well describes me and well, I guess my stubbornness (I am a Taurus after all) is this quote attributed to Calvin Coolidge;

"Nothing in the world will take the place of persistence. Talent will not; nothing is more common than the unsuccessful person with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent."

So, like so many of you I forge ahead because I am too stubborn to turn around. I once was told that I was like a rhino. That they have tough skin and can't turn around, they can only charge forward, can't go sideways, something like that. I hope when they said "tough skin" they meant I was tough and not that my skin looks like a rhino's! Either way, that is what I am going with.

George Patton once said; "Success is how high you bounce when you hit bottom."

Some of us are fluffier than others and probably bounce a little more. (this is evidenced by anyone who has watched WIPEOUT on Fox-TV).  A silly show to be sure but a hoot to watch. 

Of course, there is always the alternate view as espoused by Homer in the Odyssey, "The lot of man - to suffer and die". 

Cheery guy. Unfortunately over the years I have met quite a few patients who feel this way. This disease has hit them, it isn't fair, their life is over; their Doctor told them they are the worst case he has ever seen so they are sure it is so and their live is surely over and they will never get better. They can no longer do what they did, are not who they once were, don't want to hear what they can be or what they might do in the future because they become so mired in what once was. 

At this point it isn't about the physical pain, it is about dealing with the emotional pain and the damage it has done to your psyche.  

So often patients focus on the past, they focus on what they have lost. 

"Never say of anything I have lost it, only say that I have given it back."--Epictetus

"We must embrace pain and burn it as fuel for our journey."--Kenji Miyazawa

I realize it isn't easy to focus on the future, to accept what has happened and accept the new reality. But until we do, we cannot move forward. Until we can do, we cannot hope to begin healing. 

When it comes to chronic pain, especially long-term chronic pain, we may have to give up some of our past in order to gain our future. But if we don't we will find ourselves mired in the past and unable to move forward. 

"Giving up doesn't always mean you are weak. Sometimes it means that you are strong enough to let go."--Anonymous

 Do more than just accept where you are. Move forward. Seek out information, find ways to decrease your pain, find ways to help others, seek out others and together form groups to help others who have to daily deal with chronic pain. 

"Many things which cannot be overcome when they are together, yield themselves up when taken little by little."--Plutarch

It is easy to sit on the sidelines, to let someone else do the work, form the group, gather the people together, form fundraisers, educate the medical community and public, and inform the school systems about our disease. It is much harder to participate, to be involved. To actually lead. Don't think for a minute that those who step into these leadership roles do so because their pain is less. They do it because they are driven to make a difference. 

"Conditions are never just right. People who delay action until all factors are favorable do nothing."--William Feather

The choice you get to make every day is what you will do today. Your pain will be there anyway, whether you sit and do nothing or whether you reach out and make a difference. You decide. It could make all the difference for you, and for many others. 

In the coming weeks I am going to begin a new blog, a new version of PAIN IS A FOUR LETTER WORD. It will be one for CRPS/RSD. Because so many people have responded positively to the information contained in tis blog when I discussed CRPS, I decided the need was there for one where I could pass along information, share new websites, updates from the website, answer questions sent in to us on the site, etc. 

I will put an announcement on the website in the WHAT'S NEW section about it so keep an eye out for it!

I want to thank Dr Spiegel of National Hyperbaric Oxygen Therapy for all his help in answering questions posed here by patients, and myself, in putting this blog together. I also want to thank Susan Rodrguez of Rapid Recovery Hyperbarics for her help along the way. 

I also want to thank everyone who wrote in, sending in their questions and comments along the way. They helped move the discussion along and provide some interesting questions and answers!

So in closing let me leave you with this thought from Pakenham Beatty;

"By your own soul, learn to live. If some men thwart you, take no heed. If some men hate you, have no care. Sing your song. Dream your dream. Hope your hope and pray your prayer."

Peace, Keith Orsini

American RSDHope

www.RSDHope.org

ONCE MORE INTO THE BREACH DEAR FRIENDS

IMMMMMM BACCCCKKKKKK!

Did you miss me? 

Just a little bit?

C'mon, you can admit it.  

the bad jokes, the dry sense of humor, the information thrown in with all of that? 

Ok, maybe not too much :)

After taking some time off to deal with hurricanes and to see what would happen if I took a couple of weeks off I will be going back to HBO Therapy tomorrow, Monday the 8th of September. 

How many treatments have I had now? Just under 7 weeks; 33 treatments altogether. Most of my treatments have lasted 90 minutes each, a few were 60 minutes. 

Many people have written to me asking what my protocol has been. I must stress that the exact protocol that Dr Spiegel and I put together for me was something he had never tried before.  So it would not be prudent for me to share the exact everyday protocol  because it isn't likely to be duplicated by whomever does your treatment.  

I will be back doing my daily blog beginning tomorrow, Monday. I hope you will join me.

Please send in any questions you have regarding the procedure, HBO therapy, the treatment overall, etc.  You can send them to keeths@mac.com or leave a comment here at the blog. 

If you have questions on CRPS I would be happy to try and answer them as well. 

Wish me continued luck and pray for me.

Peace, Keith 

LET ME PUT YOU ON HOLD FOR A MINUTE ...

Well it has been an interesting few days here in Florida and it should be an interesting week. 

For most of us here on the west coast Hurricane Fay turned into Tropical Storm Faux. In other parts of Florida, that originally never expected to see the storm are now bracing for heavy winds and rain, some already received up to 12 inches of rain from it. Weather is a strange thing.

We live on the coast here and quite a few people south us were put on voluntary evacuation, unless of course you live in a mobile home then you were told to RUN! RUN AWAY!  But better to err on the side of caution with these things these days. 

Seriously though, everyone else sort of prepared for a storm but mostly just prepared for a very heavy summer thunderstorm. I guess they are just used to such things and aren't phased by them anymore. Much the same way that we in the north had gotten blase' about Nor'easters; those blazing blizzards of snowstorms that rage in the winter.  Stock up on food, water, and then have simply go about your business as normal until something serious happens while watching the newly arrived scramble around buying everything in the stores that isn't named down, including nails.  

So, what did we end up with? So far all we got in our area, just north of Tampa, was a ten minute rain shower. The way this weird storm has run who knows where it is going but it appears to have gone away north; possibly coming back onto land around Jacksonville and maybe crossing the state and heading into the Gulf or shooting into GA/AL/MS .

But while we didn't get the heavy rain/winds of a hurricane we did get the ups and downs of the barometric pressure changes; which for me brings big changes in my pain picture. That is not unusual for CRPS and/or Fibromyalgia patients nor people with back problems. For me that is a trifecta!

Since it looks like we will be dealing with this storm system for another few days at least and we have been dealing with it for the last two, I knew that my pain levels would be all over the place as well, mostly very high. Between the fibromyalgia, the failed back syndrome, the sciatica, and what is left of the CRPS, as well as a few other things, I knew that my pain would more than likely be extremely high due to these barometric changes and strong weather patterns, with or without an actual hurricane. 

Why am I sharing this with you? Especially since most of you are probably saying out loud as you read this, "Big deal Keith, me too!" 

Well first of all, stop talking to the computer. Second, the reason I am sharing this is because after discussing this with Doctor Spiegel and realizing that because my pain would be up and down, mostly up, so we would not be able to accurately track my Hyperbaric Therapy this week, we decided instead of taking a couple of weeks off next after this week we would take this week and next week off and then go right back in. 

Did you follow all of that? 

No HBOT this week. None next week. I will be back in HBO Therapy the first week of September. 

To date I have had just under 7 weeks of HBOT, 34 sessions altogether. 

It will be very interesting to see how these weeks off go. Many patients report a decrease in pain when they take a break. That is what I am planning on! Plan your work, work your plan!

There was a quote, on a show I particularly like, that really stuck with me. It reminded me of how some of us deal with chronic pain and/or how we are told to deal with it. 

"Sometimes you can't control the outcome. Sometimes you have to look at the reality in front of you and accept it"

I would add "accept it and move forward". 

So I am putting the treatment on hold for two weeks. But I don't expect the healing to be put on hold :)

Peace, Keith 

HYPERBARIC OXYGEN THERAPY - PUTTING CRPS INTO REMISSION?

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?" 

On the Hi-Tech Hyperbaric Medical Center website, it states;

"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.

Interesting.

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 

HYPERBARIC OXYGEN TREATMENT - END OF WEEK FOUR

So today ends my fourth week of HBO Therapy. Actually Monday since we missed one day due to a holiday. After today that will be roughly 27 or so hours of HBOT, actually therapy at treatment depth (not counting the time it takes to descend and ascend).

Which brings me to a question someone asked me last week that I wasn't able to get to. 

What exactly does the dive entail? What is it like? How do you prepare? 

On the website for the Hyperbaric Oxygen Clinic of Sacramento website it explains this well;

The treatment process may be modified for different types of chambers, either the monoplace or the multi-place chamber. In the monoplace chamber, one person at a time is treated, whereas in the multiplace chamber where more than one patient is treated at the same time, with an attendant present in the chamber.  (I am being treated in a monoplace chamber)

Only 100% cotton gown, which is supplied, is permitted in the chamber. 

(This varies by clinic. At all clinics what you wear needs to be 100% cotton only but in some you can bring your own cotton clothing. For instance, I wear shorts and a tank top usually. )

No cosmetics, perfumes, deodorants, hair preparations, wigs or jewelry are worn during the treatments. Patients are advised not to take carbonated drinks or alcohol for at least four hours prior to each treatment, and that they should give up smoking and tobacco products, as these interfere with the body's ability to transport oxygen. 

Once inside the chamber, the patient will be experience the changing pressure which is the same as that felt in an airplane when ascending or landing. Prior to the treatment, the patient is instructed in techniques of equalizing the ear/sinus pressure by yawning, swallowing, or attempting to blow through the nose while holding it shut. During the treatment the individual will be breathing 100% oxygen, dispersing oxygen into the blood plasma and delivering up to 15 times as much oxygen to tissues as would breathing room air. The treatment length is 60 - 90 minutes, depending the diagnosis and the physician's determination of treatment. The acrylic walls allow for the trained technicians to closely monitor the patient, as well as providing comfortable viewing out of the chamber. From inside the chamber the patient can always communicate with the attending technician via intercom, as well as watch TV, listen to music, or just take a nap.

Yesterday, after my session, Jason Bingham came by Dr Spiegel's clinic for a tour. many of you have been to Jason's RSD BLOGSPOT where he shares all sorts of articles on RSD. He got to see the many chambers available there. 

So what is my latest update?

I have had a pretty good week. My full body CRPS seems to be in a serious state of flux. Many of the areas where it once was, it has retreated from and it seems to be concentrating more in the four extremities. It is too soon to really go beyond this description but we will see how everything feels by around mid-week next week. It does appear to be headed for a significant change right now though, the biggest so far. 

I have also noted a fairly significant change in the frequency and length of the muscle spasms in my arms and legs. I have had, despite some of the best meds, these spasms for many years, especially at night. Most of you probably have as well. Spasms in the muscles and blood vessels are one of the FOUR MAIN SYMPTOMS OF CRPS. It wasn't anything I hadn't learned to deal with but it could be painful at times and it was always annoying and kept me up or woke me up at night. But these past three nights my muscles spasms have pretty much stopped! I was also able to cut back on the medication I take for them without noticing an increase at all!

As I mentioned before, I would be thrilled to go into remission from this treatment but I would be almost as happy to get 50% remission, especially if I was able to cut my medications significantly in the process.  How sick are all of you of dealing with the side effects of the medications? More and more I have been looking to natural remedies where possible to help.

Speaking of which, some of you have asked about vitamins and I thought I had spoken of some here but I will again briefly. 

During the HBOT it is recommended that you take vitamin E and some form of B. Many clinics administer vitamin B injections; some before the treatment and some after. These will help replenish the body and speed healing during treatment. It is also recommended that pain patients as a general rule now seriously look at a few other vitamins/supplements such as; Vitamin D, magnesium, and Fish Oil. Many pain patients are found to be deficient especially in vitamin D.  Another one to look at that helps promote a more restful and healing sleep is melatonin; the fast-acting chewable or sublingual version rather than the caplet or pill.

ok, I am off to my session. Tomorrow I am going to visit the Orlando CRPS group for their first meeting!

Then collapse and sleep most of the weekend :)

peace, Keith 

BLURRINESS IS AN ISSUE - VARIED DEPTH DIVES ANYONE?

SORRY NO POST YESTERDAY - short post today.

My eyes, which are the original site, have been very painful the last few days and I have been experiencing blurriness in both eyes so typing isn't too easy. So this will be short too. Bear with me though ok? 

I am not quitting, I will continue and come out the other side. 

I have a question for those of you who have been through this before. It is one I have heard from a number of you about but I need more info on.

It is about varying the depth of the dives for CRPS patients after the third to fourth week of HBOT. 

Some patients have stated that once they hit the wall, once their pain actually started to get much worse before it improved which usually occurred around the third to fourth week of HBOT, that at their clinic they changed the treatment protocol at that point; especially full body CRPS patients. 

That instead of continuing the deeper dives that they had been doing they switched for a short time to shallower dives, to go after the sympathetic system if I understand it correctly. That the body is switching back to the central nerves instead of the sympathetic nerves, the signals are trying to re-route themselves to be sent along the correct pathways.

What ends up happening is what was affected last will go away first, and the first part of your body affected by CRPS will go away last. If I understand all of this correctly. 

I see it in my minds eye as a gallon jug of pain slowly draining away. The stuff on the bottom of the jug was put there first and will be the last to go. 

With full body, or systemic, CRPS it is made even more difficult because the disease is so entrenched, the bad pain pathways are so deeply embedded.

So, if you have been through the varied dives, especially if your clinic has done this on a regular basis, and/or yo have information you can share with me that I can share with everyone here, please email it to me at keeth@mac.com 

Ok, sorry so short but my eyes and hands and feet are a little rough today folks.

Thanks for understanding,

Keith 

HYPERBARIC OXYGEN THERAPY - END OF WEEK THREE

Ok guys, it is Saturday and the end of week three. 

Last weekend, I believe I stated that I thought this third week would be a big week. A week of some big changes. I thought I would hit the wall and I surely did. I also have been able to get over the wall and am coming down the other side. 

Have you seen the new version of the show AMERICAN GLADIATOR'S? At the end of the show they have to run a gauntlet of obstacles. The last thing they face, when their bodies are fairly exhausted, is having to climb up a downward moving treadmill and then crash through a wall. 

That is kind of how I feel. I have run the gauntlet, and Monday I hit the treadmill (or the Wall), and by Wednesday I was breaking through the wall. I still have a ways to go which I hope will happen over the course of the coming week, but I am considerably better today than I was on Monday/Tuesday. 

With some treatments there is an immediate result, good or bad.  Anyone going through this treatment has to look at it as if you are doing a marathon though and not a sprint. You have to understand from the outset that it is going to take however long it takes and you are going to stick with it to the end and beyond. Remember, sometimes the best results aren't seen for weeks afterwards.

How does HBOT actually work on CRPS?

Let me quote an article you can find on our website;

"Hyperbaric Oxygen Therapy (HBOT) is a new therapy for many individuals with CRPS/RSD. Interestingly, however, this therapy is not new at all."  (Doctor Allan Spiegel)

"Spiegel says that HBOT supersaturates tissues that have been deprived of oxygen because of the swelling of a limb. Specifically, saturation levels of oxygen in blood and tissues increase 10 to 20 times while in the chamber. Further, HBOT has a tendency to constrict vessels by about 15%, which causes a decrease in swelling from the edema present in most people with RSD. "With HBOT,"Spiegel says,"we are looking at long-term improvement, reduction in pain, improvement in sleep -- and reduction in depression, because pain causes depression."

Susan Rodriguez, a certified hyperbaric specialist from San Bernadino, California, "With RSD, pain is read through sensors in the sympathetic nervous system. (the sympathetic nervous system is what is activated in phantom limb pain, for example). "Hyperbaric Oxygen 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 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 the whole article by going to HYPERBARIC OXYGEN THERAPY, CAN IT RELIEVE YOUR PAIN? By Patricia McAdams.

So what are some of the things you should look for in a clinic? 

In that same article cited above they offer some tips;

Choose a reputable center for your treatment, where your therapists understand all the risks and take all the safety precautions necessary to avoid a problem. 

A reputable center will;

1) Be staffed by a physician and other healthcare professionals certified by the Hyperbaric and Undersea Medical Society.

2) Require a Doctor's prescription before giving therapy.

3) Have two or more staff members in the building at all times in the event one has an emergency. 

4)  Have strict rules about allowing nothing whatsoever in the chamber with the patient that could be combustible. 

I have added some new links to the American RSDHope website section on Hyperbaric Oxygen Therapy. Pop by and check it out. 

Now, to some questions. 

Some have asked about books regarding HBOT. Here is an excellent link;

HYPERBARIC CLINIC OF SACRAMENTO - BOOK LIST

Also,

WHAT ARE THE POSSIBLE SIDE EFFECTS OF HBOT?

Someone asked me what the contraindications are for HBOT;

WHAT THINGS/SITUATIONS/DISEASES/CONDITIONS can present a problem for HBOT?

I hope that brings me up to date. Feel free to drop me a line, add your comment below about HBOT, CRPS, or just say hi!

Peace, Keith 

HYPERBARIC TREATMENT, END OF WEEK TWO

Well, it is the end of week two. My pain has spiked a little in my extremities; hands and feet. My right arm is a little sore, I think from the injections though. My eyes are fairly the same, argghhhhhh. But otherwise I think there is some improvement. I will know more on Sunday I think, when I have missed two days of treatment. Although I shouldn't notice as big a difference this weekend as I did last weekend apparently. I am hopeful to see big difference next week, maybe some big ups and probably downs, that will mean I am near the big wall!

Some have asked what other disorders/conditions/diseases are indicated for Hyperbaric Oxygen Therapy. 

On Doctor Allan Spiegel's website, NATIONAL HYPERBARIC OXYGEN THERAPY , there is a very extensive listing. CRPS isn't mentioned there because there is an entire section devoted to it elsewhere on his site in the NEUROLOGICAL DISORDERS SECTION as well as in the RSD THERAPY section. 

Something else that has come up in recent days is the more than rare occurrence of RSD patients actually popping up with Lyme Disease. If you aren't familiar with the disease and/or its symptoms you might want to check it out. Some of them; neurological changes, such as memory issues, tingling in the hands/feet, swelling and pain in the joints, pain/weakness in the arms and legs, and many more. Some of those sound familiar guys? 

I doubt you will find anyone who treats patients with HBO that doesn't have a few stories of patients who come in with a diagnosis of RSD that end up testing positive for Lyme disease. Fortunately the treatment protocol is the same, maybe a few more treatments for the Lyme disease patients I am told. But otherwise it is basically the same treatment depth. 

I am probably driving Phil, the technician, and Dr Spiegel crazy with all the questions I ask. I am a naturally inquisitive person to begin with but when I undergo a treatment such as this, which is fairly unknown to most in our community despite a plethora of information available, I am even more in the face of the people performing the procedures. Not just for me but for all the people who come after me, who come to me with questions. 

I don't want to sound holier than thou but I take the trust of my pain community friends and family seriously. When people visit our website and read the information there I want them to be assured we have checked out the information thoroughly and stand by what we write.  The websites we refer people to are sites we have checked out. The people we work with in the pain community are dedicated to healing. 

Someone asked me yesterday what I was going to do if this procedure healed me completely, left me with zero pain? I said I hadn't really thought about it. I don't think they believed me. But it is the truth. I have been dealing with CRPS since I was 14. I had numerous breaks, tears, and bruises all growing up through sports. I got in the car accident in my early twenties and broke my back, among other things. Later, I developed Fibromyalgia. I have dealt with the eye issues/vision problems since I was 14 as well. 

I am not complaining, not at all. I am simply saying, I have dealt with pain for so long I am not really sure how I would handle not being in pain. I would like to know. I am praying it will happen to some degree, meaning whether it will be 90, 95, or even 100% pain-free I don't know but I will gladly take whatever I can get, every inch, every % I can get. Because the healthier I am, the more I can help others with their pain issues. I know it is my life's work, has been and will continue to be. 

I am trying to do everything they tell me to; eat the right stuff, rest as much as I can, take my vitamin E, D, and get my B vitamin injections. I try to swim as often as I can to keep my body active as well. Not doing laps or anything but just being in the water and staying limber. I love the water.

And I try to learn everything I can.

Ok, enough of this stuff.

Have a great weekend everyone! Go, enjoy, have fun, swim a little, rest a little, do something enjoyable, read a good book, learn something new, and share a good joke!

Peace, Keith

JULY 6TH - WAITING FOR MY NEXT TREATMENT

Good afternoon everyone! Well, as you can probably figure out I didn't just go lie down after my last entry and come right back. I laid down for a while, and then laid down some more, and then woke up at 6 am! It was great! It was weird, sleeping that much, but it was great! I am not used to it and it was definitely due to the HBO.

I spent the next day, July 4th, at the beach with friends. For all of my friends up north where the water is barely 65 degree's; it was a little rough. I had to force myself to get into the 87 degree gulf coast water, force myself to try and enjoy floating in the water and watching the dolphins cavorting around the sailboats and jet-ski's just off shore, to try and enjoy the perfect 90 degree, sunny, not-a-cloud-in-the-sky day. But as I remembered all of those cold days spent up north, all of those cold mornings having to walk through the newly fallen snow just to get to my car, how the below zero weather caused my CRPS pain to shoot sky-high, somehow I managed to enjoy myself.

The warm weather, the sunny days, and the warm water have all been wonderful for my CRPS, which was one of the main reasons we moved down to Florida from Maine. I am very grateful to my better half, Petra, for making the move for those reasons.

Ok, so what have the last few days been like without HBO? Because Friday was a holiday the clinic was closed so after four days of treatment I have taken three days off. I will resume my treatment, my fifth day of therapy, tomorrow, July 7th. 

If you had asked me on Thursday, as some did,  if I had begun to feel any pain relief I would have told you that I didn't think that there was any positive forward movement yet but I did notice there was some backward movement; which isn't unusual. I have had some issues with a little eye blurriness, and a little bit of a headache in the afternoon a couple of days but neither thing last long and neither are overly aggravating. Of course the treatment does make you fairly tired as well.

However! On Friday night I felt my pain increase and then again on Saturday and today. I know it wasn't due to being at the beach on Friday because I was very careful to not over-do, something I have a tendency to do. I also had a few people watching over me to ensure that didn't happen as well. And we went home early rather than stay and watch the fireworks because I knew if I stayed that I would be far too exhausted by the time we got home. 

So that only leaves one conclusion; the HBO must have started to give me some relief and the lack of HBO on Friday, Saturday, and Sunday! So while some people might be a little upset with feeling that additional pain these last few days I was thrilled with it because it told me that the HBO was working! How far we will be able to go with it, how much relief I will eventually get I don't know. But I am excited about the possibilities!

Now on to other business.

I haven't forgotten about the information I was getting to answer the question about the difference between the blow up units and the hard-sided units that most clinics use. I had hoped to have it by today but it wasn't sent to me. I will try and get it tomorrow. 

I do have a new article to share with you that answers a very important question; what about stopping the treatment early? Before the treatment series is scheduled to end? For instance, if you are set up at the clinic in the typical 20 or 30 treatment cycle, are there any possible problems with suddenly stopping after 10 or 15? 

Some may ask "Why would you stop in the first place?" 

Well, I happen to have the answer to that. Excellent question! Thanks for playing our game. We have some wonderful parting gifts for you.

What happens, as I may have discussed before, is that for many patient's their pain actually worsens before it gets better. For yet others, their pain level will go up and down during their treatment, especially in the beginning.  Unfortunately, some patients get to these points, these changes, and give up. They feel the HBOT isn't working and think,  why put myself through any more of this? 

For those of you who are going through it now or who are considering it in the future, remember,  we have to push through it. Finish the entire course of treatment. In some cases you may not see the entire positive results for weeks after you finish the therapy. Every session builds upon the last, and it is a long process. 

It isn't the same thing as watching a cut/wound heal on your arm, where you can monitor its' progress, see the healing take place in front of you. CRPS and fibromyalgia healing involves healing our nervous system, healing the way our inner body functions. It took a lot of time for our sympathetic nervous system to get "screwed up" (technical medical terminology) , give it the time it needs to heal properly. After all, if you give up, what are you going to do? Just go home and do nothing? Why not just finish off the few weeks left of therapy instead? 

So here is the article I promised. I know, a long way 'round. It is called "PERSONALITY CHANGE WITH HBOT" and you can read it just by clicking on it.

Something else I wanted to share, sorry for making this so long today, is a few tips to help make the after-effects of the HBO less likely to be a problem. 

It is important to remember that your diet plays a key role in maintaining your health when you are in chronic pain. This is especially true when you are undergoing a treatment such as HBO. One of the best ways to help with your diet is to follow the examples given in Doctor Hooshmand's, CHRONIC PAIN DIET, AKA, THE FOUR F'S DIET . You can read about the basics on our website and then click through to get to Dr Hooshmand's site where he explains not only what the Four F's are but also what foods to avoid.

Unfortunately the Four F's are not French Fries and deep-Fried Twinkies, and Fudge! 

Dr Hooshmand explains these in more depth but they are;

Fresh Fish, Fresh Fruit, Fowl, and Fresh Vegetables. He gives a list of foods to be avoided and a list of foods that are allowed.  

While many CRPS patients tend to have foods that they find increase or decrease their pain, many will be surprised to learn how accurate this list is. The foods-to-be-avoided list, are foods that tend to increase your pain. 

Lastly, I wanted to mention that when you are undergoing HBO Therapy, it helps if you remember to bring along some fruit because you need to eat right after your treatment, it is recommended that you eat within 30 minutes of exiting the chamber, at least an apple or something along those lines. Keep up a diet high in protein, low-carbs, and low-fat. 

You should also make sure not to drink caffeine four or five hours before treatment and it is even recommended to avoid caffeine altogether if possible, according to the chronic pain diet! 

You will notice a big difference! 

I will try to continue to pass on tips as the various Drs and Techs I talk with pass them on to me. 

I love hearing from everyone else who is also going through the treatment, keep the emails coming. I may not always be able to answer but I always read them.

Peace,

Keith 

DAY THREE - THE ADVENTURE CONTINUES!

It had been a cold and rainy night ... the wind was howling down through the hills as dawn broke over the horizon. My car crested the last hill and I spotted the Hyperbaric clinic in the distance. 

Ok, so it wasn't as dramatic as all that. This time of year it never gets below 65 degrees at night, and Florida's idea of a hill is a speed-bump and dawn actually breaks on the other coast. But it did rain a little last night and I did visit the clinic in the morning for my third treatment :) Besides, it sounds so much more exciting than "Ok, day three, I went to the clinic."

This morning the dive was even easier than the first two days. We achieved a depth of below 40 feet very easily and with very little effort on my part. Of course even on the first day my "effort" only consisted of pinching my nose and blowing out my cheeks a dozen and a half times or so while lying on my back watching a movie, but whew, it wasn't easy! After all, I also had to swallow a few times on the way back up. Ok, so I'm not likely to burn off the calories in a donut doing this but hey, it's my story.

So after my heroic effort achieving the treatment depth today I got to thinking about what I would share with you today. The answer came with a question I received from a fellow patient last night and an answer I got this morning from Susan Rodriguez of RAPID RECOVERY HYPERBARICS . (this is a link to her FAQ section). 

The question was regarding how long it would take before I would begin to notice a difference. The person wondered if all of the sudden, say on Day 12 or 16, for instance I would suddenly write "No pain finally today!" If it would be that dramatic or would it be a much more subtle thing, happening slowly over the course of treatment, or possibly not even be noticed for a few weeks after I finished my treatment? 

I happened to have gotten into a discussion about this very matter with both Susan and Doctor Spiegel. The concern, understandable, was that it is not really the type of treatment that you can write about daily and follow along a progression of healing. That some people may see the way it actually progresses and be put off the Treatment method because oftentimes patients will get worse before they get better; it is part of the healing process.  

I thought it important though for patients, and loved ones, to understand the process a little better, not just read about the results in a study, but to be able to have someone they could relate to, who they could follow along with. 

But we have to help you to understand how this treatment process works at the same time. Susan explained it well in her email to me and I will quote her here.

"HBOT is an accumulation of treatments. It works on the affected limb(s) by restoring circulation, which will then restore nerve function. When nerve function is restored it sometimes hurts. Picture a rope around your foot, the stages of nerve destruction are shooting pain, pins and needles, then nothing; it is numb. Take off the rope and you feel it all again, as it goes backwards. AND we are working on the brain because finally everyone agrees that RSD/CRPS is a malfunction of the brain with mixed signals. HBOT will allow these signals to normalize. "

"So we are working on several functions at once. This will make you tired, hungry, go through personality changes, etc. It will make you want to quit and not finish the course of treatment. " 

Susan asked me to stress that it takes at least 40 to 60 hours of treatments; some people a little more, some people a little less. The treatment times vary, mine for instance are 90 minutes long plus the time it takes to achieve depth and then come back up the the surface. Susan suggests that people simply think of this treatment as a 40 hour work week stretched out over a month or so. It is a great way to look at it because you have to commit to it, to understand that there will most likely come a point when your pain will actually get worse before it gets better, but you have to push through it anyway. 

That is easy to say, especially for someone who does not live with our pain every day. But I am telling you this, from someone who does live with it and has lived it every day for more than 3 decades. You just have to think; what is worse? a few weeks of more pain with the possible pay-off of greatly reduced or eliminated pain at the other end, or stopping the treatment early and having to forever wonder, "What if?" "What might have been, if only I hadn't stopped?" 

Like any other treatment out there, HBO isn't guaranteed to work for everyone. No treatment works for everyone with CRPS, just like no medication does. But the early numbers look very promising. 

I hope this helps to explain the process a little better, day by day.

Peace, Keith

FIRST TREATMENT UNDER MY BELT

Before I start I just want to say, the staff at National Hyperbaric Oxygen Therapy is fantastic. From the moment you arrive to the time that you leave they treat you like family and make sure you have everything you need and are as comfortable as possible. Dr Spiegel, Phil, and Marcia were all amazing today. Thank you!

As they slid my body into the Hyperbaric chamber I have to admit, I was a little nervous. I am very claustrophobic. They had offered me something to take the edge off and I took the smallest dose, just in case :)  

They recommended I close my eyes as I was rolled into the chamber and then open them once inside and said that "I wouldn't even notice". You know what? They were right!  I wasn't bothered at all by being in the chamber. 

At the facility I am having my treatment's done they use the Sechrist chambers  . These are individual chambers, meaning only one person at a time fits into them, as opposed to some facilities that use the multi-person chambers, such as the ones displayed on the HyperOx website  . 

I am sure that being in the multi-person chamber you definitely don't have to worry about claustrophobia but even the Sechrist unit that I was in, it was no big deal because it is all clear around you. It is sort of like being in a big glass tube. There is enough room to maneuver, to change position, shift from lying on your back to lying on either side, placing a pillow under your knees if you have back problems, propping up your head on a couple of pillows, etc.  While inside I just pictured myself on a long plane ride sitting in the window seat; where you are in a somewhat confined space but not unpleasant. 

Before I got in Phil, the Nurse/technician, asked me if I wanted to pick out a movie or I could watch live TV, or even listen to a book on tape. After a thorough explanation of the hand signals that he and I would use to communicate (in addition to the microphone/speaker set-up, he explained how the "dive" would go. I would slowly descend for a while, achieve the recommended depth for the first day, stay there for about 90 minutes, and then slowly ascend. He explained how I would need to breath, use my ears, mouth, nose, etc. all along the way to ensure there would be no ear pain or other issues. 

Phil was right alongside the tank the entire time I was descending and ascending making sure I was doing ok. It went very smoothly. My ears needed to be cleared quite a few times going down, which is normal, and there is a procedure for doing that which he made sure I knew how to do before I even entered the tank. 

The time I was actually "at depth" was, well, not any different than lying on my couch watching TV. Except for the fact that in my living room I don't normally have people walking by every five or ten minutes looking down at me checking to see if I am Ok. I guess that is a good thing, because that would be a little weird, ok, a lot weird.   

But I digress. 

So I sat at about 18' below sea level and watched the History Channel. All the while thinking ... "Could it really be this easy? Could it be this easy to getting better, to relieving my pain?" 

I realize that there will come a point in the treatment when I will actually get worse before I get better. This is an important thing to note because oftentimes this is when patients will give up on the HBO treatment, thinking it isn't working, how can it be if it is making me worse? But that is just the nature of the beast, the ay this treatment works. if you can hang on and push through that difficult time, that rough patch and make it through and keep going to the treatments, you will be rewarded in many, many cases with relief from your pain, symptoms, etc. 

So, over the course of the next four weeks or so I will try to relate my experiences to you, let you know some of what I experience, some things I have learned that might help those of you considering it, etc. 

Right now though I am exhausted. I am hoping and praying that what I have been told by many patients and Drs is true. That many patients end up getting an amazing nights sleep after their first HBO treatment! YEAH!  I remember sleeping through the night, well not really but I have heard stories about it. They seemed like wonderful stories of very lucky people. 

I remember something that Dr Spiegel said at a meeting the Palm Harbor/Tampa Bay CRPS Support group held a few weeks ago. He said that healthy people need to think back to a time in their lives when they went through a rough patch where they didn't sleep well for two or three nights. To remember what that did to them; made them irritable, cranky, groggy, made it difficult to concentrate/work, left them feeling exhausted, tired, and worn out. He explained how we all needed our REM or healing sleep in order to function properly.

Then he said to imagine not sleeping well for weeks, months, even years on end as chronic pain patients have to deal with. I have had this disease for 34 years as I said. I could use a good nights sleep :)

See you tomorrow,

Keith 

Just a few notes

I just wanted to make a few comments about the Hyperbaric before I begin.

For those of you who are unfamiliar with the treatment, and who will be following me here,  there tends to be a pattern that is important to note. Many patients start to feel better, then they sort of hit this wall where their symptoms and pain actually increase rather than decrease. This is an important and crucial point in the treatment process because it is often where some patients quit; feeling the treatment not only isn't working but is actually making them worse.

If they could only push past this spot, and where it comes depends on the patient, the medical history, treatment modality, length/depth of dives, etc., but if they could only push through this spot they usually achieve some amazing results.

That is my first point. If you read this and see that my pain starts to get worse, please stay tuned. I will stay the course, to see it through. 

The second point has to do with whether or not I am a good candidate to begin with. Who knows? I think most Drs who examine me for the first time would say I am a very tough case and one of the worst they have seen, despite the fact that some people who see me say "You don't look like you have CRPS?". Currently I am not in a wheelchair, although I did use one for a while. Currently I am not using a cane, although I did for many years. Currently I am not forced to spend all my days in bed, although like many of you there are days when it is a real struggle not to do so. Many people who see me would think I was "normal", those who are my friends and family and spend some time with mw know the truth, I have gotten much better at handling and hiding my pain. Plus, most people don't see our "down-time". 

As I mention in my bio, besides having full-body CRPS I also have Fibromyalgia, failed-back syndrome, peripheral neuropathy in my feet and legs, Uveitis, very bad eye problems (especially my left eye), Sjogren's Syndrome, and a few other minor issues. I have had quite a few surgeries from accidents over the years. In other words, I am not the ideal "clean" candidate as Doctor's like to say. But I thought it was important to try this treatment and share my experiences with others, the same way I did with the low-dose ketamine infusion. 

HBOT has such amazing potential for CRPS patients. It is non-invasive, it isn't very expensive compared to other treatment options, especially the implants, and if done in the correct environment it is a safe procedure. 

If you would like to learn more about how it works, you should stop by our website and check out the HBO Section. If you have already been through it yourself send me an email detailing your experiences so we can share them with others, especially if it was done in a facility with the hard-sided (chambers as opposed to the soft-sided home chambers). 

The section can be found by visiting AMERCIAN RSDHOPE HYPERBARIC OXYGEN TREATMENT

Thanks for reading!