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It’s a non-invasive, drug-free way of stimulating healing, treating a lot of diseases, and increasing the rate of healing but for some, HBOT is very much an alternative therapy, writes Tracey Porter.
Dr Malcolm Ware is in the business of healing.
So when The Vet Practice (TVP) veterinarian heard about a non-invasive, drug-free way of treating a significant number of animal diseases that also promised to speed up their recovery rate, he was eager to learn more.
Typically used in human medicine, hyperbaric oxygen therapy (HBOT) is commonly used to treat diseases such as decompression sicknesses, as well as non-healing wounds (especially diabetic ulcers), necrotising soft tissue infections, refractory osteomyelitis, compromised skin grafts, crush injuries and intracranial abscesses.
However, in recent years there has been growing interest in HBOT in veterinary circles as a means of curing a number of illnesses and diseases, particularly those related to inflammation, poisonous bites, arthritis and infected wounds.
The treatment involves the impacted animal being placed into an airtight chamber and being exposed to high levels of pure oxygen. The oxygen molecules are able to penetrate compromised tissues at a rate three to four times farther than normally diffused by red blood cells.
This oxygen can then be utilised by the pet’s body for vital functions related to healing.
While HBOT is becoming more widespread in veterinary medicine in several countries overseas including in the United States, Canada, Portugal, Singapore and Brazil, its uptake has not been as swift in Australia.
Currently there are only two known veterinary clinics with hyperbaric machines suitable for treating animals with HBOT here. The Brisbane Veterinary Specialist Centre (BVSC) became the first when it modified a human hyperbaric chamber for animal use.
Dr Darren Fry, BVSC’s lead internal medicine specialist, says he first became interested in HBOT for cats and dogs when a clinic he was working at overseas installed a hyperbaric chamber and began reporting “some very promising results”.
Because HBOT is known to improve oxygen delivery to tissues beyond that which can be delivered by red cells alone as it results in hyperoxygenation of the plasma, the treatment proved particularly successful in animals with poorly healing wounds or tissue grafts, crush injuries, fibrocartilaginous emboli and intervertebral disc disease, acute pancreatitis, severe anaemia and head trauma, he says.
At the time Dr Fry was investigating the use of HBOT, there were no specialised veterinary chambers available here, so BVSC paid $40,000 to secure a human chamber and adapted the single person ‘seat’ to accommodate cats and dogs.
Dr Fry says the main challenge he faced was when the clinic began considering how to deliver the oxygen to animals within the chamber.
“A key principle of HBOT is that the patient needs to be breathing higher than atmospheric levels of oxygen (preferably close to 100 per cent). In humans this is achieved by wearing a face mask that delivers 100 per cent oxygen.
“We looked at various devices to try to achieve this in cats and dogs but realised that the only real solution would be to fill the entire chamber with 100 per cent oxygen. The large amount of oxygen needed for this requires the use of a large commercial oxygen generator.”
The HBOT has been widely embraced by many clients and since being installed in 2012, Dr Fry’s clinic has administered nearly 2000 HBOT treatments.
In 2020 a second player joined the team when Dr Ware’s clinic, The Veterinary Practice in Whittlesea, became the first in the country to introduce a purpose-built hyperbaric chamber for treating animals.
To date more than 1500 animals have undergone treatment in the clinic’s $90,000 chamber, most of which have been for ailments from spinal trauma and fading puppy syndrome to inflammatory neurological disease.
Dr Ware says the advantage of HBOT over some traditional treatments is that it has the ability to potentiate the effects of some antibiotics and other drugs so that they are more effective.
It has a general anti-inflammatory effect through the whole body, he says.
“Because the oxygen is delivered under pressure it doesn’t just bind to the haemoglobin in the red cells, it ends up dissolved in the plasma in the bloodstream which allows for greater concentration of oxygen to move over longer concentration gradients to oxygenate more tissue.
“It also has the ability to stimulate the release of the body’s own stem cells and activates cells such as osteoclasts and chondrocytes.”
But while HBOT is an extremely safe treatment modality for cats and dogs, the same can’t be said for those responsible for operating the hyperbaric chambers.
With a combination of high pressures and high oxygen levels, the chambers are potentially very hazardous pieces of equipment. As such, both vets take extremely seriously their responsibilities for the health and welfare of staff charged with operating all machinery involved in veterinary hyperbaric medicine.
Dr Fry says as there are currently no official veterinary training programs in Australia for the use of HBOT equipment, BVSC designed an in-house training program for all staff.
“It is an absolute requirement that any staff involved in the use of the chamber must be trained and certified, ensuring they thoroughly know how to safely provide this specialised care,” he says.
Because Dr Ware’s clinic was able to purchase its equipment directly through its US manufacturer, to operate the HBOT safely, all his staff are required to undertake mandatory training followed by certification.
Dr Ware, who is also a member of the Veterinary Hyperbaric Association, says training is delivered online by the manufacturer through an approved instructor.
“In our practice most of the treatments are carried out by nurses or rehab assistants who have been certified. As the demand for HBOT grew we found we needed multiple certified staff to cover the bookings.
“There are days where we may have three to four HBOTs booked in and therefore need sufficient nurses on board to provide the treatments which allows us to stay up to date with updates and further developments in veterinary hyperbaric medicine.”
Dr Ware believes the investment he made to secure this innovative piece of equipment has been worth every cent.
“In terms of ROI—this machine has paid for itself virtually from month one. It has generated well above its purchase and associated set-up costs and demand has only increased.”
For his part, Dr Fry believes more education is needed before HBOT is recognised as a reliable complementary treatment for animal illness.
“The main use for our chamber has been to augment treatment options for our in-patients. However, we have also had referrals specifically for HBOT. Interestingly many of these referrals have been a result of human clinicians making inquiries with their veterinarians about the possibility of HBOT for their pet.
“It seems, for the moment, awareness of this treatment modality is much greater within the spheres of human than veterinary medicine. We aim to provide education to the veterinary community on the potential value of HBOT for many animal patients.”