HOW TO TREAT A FUNGAL INFECTION: Part II Hyperbaric Treatments

Todd in his 100% cotton scrubs all ready for his first hyperbaric chamber treatment on November 14, 2016.

Todd entering the Hyperbaric Chamber at Memorial Herman Hospital.

Part II: Hyperbaric Chamber Treatments

The second type of treatment for fungal infections is Hyperbaric Chamber Treatments.  MD Anderson does not have a hyperbaric chamber to use for this, but nearby Memorial-Herman Hospital has both single person "monoplace" hyperbaric chambers and a multi-person chamber. 

Many of you may have heard of scuba divers or people with carbon monoxide poisoning using these treatments, but they can also be used for wound care and fungal infections. (See link below).  The concept of using hyperbaric chambers to treat fungal infections is fairly recent.  In Jennifer Durgin's article, Investigating the Deadly Potential of a Common Fungus, early studies have found that "saturating the fungus and infected tissue with oxygen in a hyperbaric chamber stops the fungus from growing." (Durgin, 2014, n.p.).

The multi-person tank that Todd went is a blue 35 foot steel-like submarine tomb that can "dive" down 6 atmospheres and provides 100% oxygen to 1 - 12 patients inside via a astronaut-looking helmet.  Each dive takes about 2 hours and the Hyperbaric Center runs two groups everyday with one starting at 8:00 a.m. and the other in the afternoon between 1:30-2:00 p.m.  Since the tank is not at MD Anderson, Todd has to get there by transport ambulance.  So, he typically leaves at noon and doesn't get back until 4:30 p.m.  This makes the day very long for Todd. 

The nurse has a hard time getting in all his treatment for the day with him being gone 4 hours a day.  The nurse gives him his platelet transfusion in the morning after all the doctors round before he leaves. If he needs a blood transfusion, they have to wait to give him that until after he returns.  His chemo drug is given between 5-6:00 p.m.  His anti-fungal medication takes 4 hours to run, so they can't do that until the transfusion is done. That takes a couple of hours to run. The pre-medications for the antifungal starts at 8:30 p.m. and the actual antifungal, Ambisome goes from 9:00 p.m. - 1:00 a.m. The night nursing assistant comes in around midnight to get his weight and vitals. The night nurse comes in by 5:30 a.m. to take his vitals and draw his labs for the day.  The nursing assistant gets the morning vitals and the nurse gives him his morning meds by 8:30 a.m.  And it all starts again M-F. 

What Happens in the Chamber:

Picture of Todd in the tank with his oxygen

helmet on; taken through a port-hole window

from the outside looking in. 

The "drivers" and crew only take the tank down to 2 atmospheres or 33 feet below sea-level.  Luckily, Todd has scuba dived in the past, so the idea of diving and equalizing ear pressure on the way down was familiar to him. 

While in the tank, the patients can read, watch TV/movies, and even enjoy a snack when they take a break while inside.  An attendant inside makes sure there are no complications, like a patient suffering ear pain.  Todd is typically bored and looks forward to a good movie. 

Memorial Herman has had this large tank since March 2016.  Todd asked about the home models you can buy, and if they were any good.  Unfortunately, they don't have the diving technology to go deep enough to effect a positive experience.  Breathing 100% oxygen alone is not the key to the healing properties; it is breathing the 100% oxygen at the 2 atmospheric levels below sea level. 

The number of treatments are key to successful treatment.  Some patients, depending on the type of injury or illness, go into the chamber up to 40 days.  Todd's doctors decided that since Todd could only get treatments while being "in-patient," they would limit the number of treatments to 10.  We tried to do the treatments on an outpatient basis, but the insurance would not cover it!  Which makes no sense.  It would seem more expensive to pay for the ambulance transport from MD Anderson to Memorial Herman (just blocks apart) and back than to allow Todd to walk-in into Memorial Herman outpatient!

We were hoping to be done with the treatments done before Thanksgiving, but the multi-person tank and staff close on the weekends and were closed on Thanksgiving and the day after.  So, Todd's stay in the hospital had to be extended to Tuesday, November 29, 2016 to get all 10 days in.  However, today, Monday, November 28, someone dropped the ball, and the ambulance transport people NEVER CAME TO PICK UP TODD!  They usually arrive at Todd's room around noon or 12:30 p.m. at the latest.  I only went with Todd the first day, because all I can do there is sit around for two hours.  Today, I decided to go down and start our laundry.  So, when I came up to the room, I noticed Todd was still in his bed and it was after 12:30 p.m.!  I immediately went to the nurse to find out what the problem was.  She said she just got off the phone with them and that "someone" FORGOT TO SCHEDULE THE TRANSPORT, but they were going to try to get someone here.  Sadly, everyone realized about 1:00 p.m. that it was getting too late to get Todd there on time, so today's treatment had to be cancelled!

They need the patients there at least 30 minutes early so that they can don the 100% cotton scrubs they have to wear in the tank and so the nurses can take all the patients' vital signs before they go in.  Everyone has to wear the 100% cotton, because they can't risk having anything flammable in the tank since there is an increased risk of severe fires with all the 100% oxygen being pumped into the masks.  They have rules about what cannot be brought in the tank:

To make a long story short, they are going to reschedule Todd's missed treatment from today to the early 8:00 a.m. group on Wednesday morning, November 30, so that Todd can be back around noon and he can still get discharged that afternoon.

For more information:

Durgin, J.  Sept 9 2014.  "Investing the Deadly Potential of a Common Fungus." Geisel News Center.  Web.  Retrieved from:
http://geiselmed.dartmouth.edu/news/2014/investigating-the-deadly-potential-of-a-common-fungus/

Memorial Herman Hyperbaric Center Webpage. 2015.  Wound Care. Hyperbaric Oxygen Therapy.
http://www.memorialhermann.org/wound-care/hyperbaric-oxygen-therapy/