Brain injured veteran Ben Parkinson can now walk up to two miles a day after starting the controversial hyperbaric oxygen treatment. Cherrill Hicks talks to Prof Philip James, author of a new book on the subject
This post is on Healthwise
10:30AM GMT 16 Feb 2015
Paratrooper Ben Parkinson, who lost both legs in Afghanistan, carries the Olympic torch through his home town of Doncaster in 2012
Few of those who saw him will have forgotten the image of injured paratrooper Ben Parkinson carrying the Olympic torch in 2012, struggling courageously on prosthetic legs through his home town of Doncaster.
Parkinson was just 22 when a bomb blast in Afghanistan left him with devastating injuries in 2006. He lost both legs and suffered extensive damage to his spine, skull, pelvis, arms and brain - injuries he has been battling to overcome ever since.
But last week he started a controversial treatment. He and another injured veteran, Stephen Thomas, are undergoing Hyperbaric Oxygen Therapy, which involves breathing 100% pure oxygen at an atmospheric pressure up to twice as high as normal. The oxygen is delivered by mask in an enclosed chamber run by the Hyperbaric Oxygen Treatment Trust, in the grounds of the private Castle Craig Hospital south of Edinburgh. After just one session he says he is already feeling its benefits.
Most specialists would agree that some eight years after the event, no treatment is likely to make a difference to serious brain injury. But Professor Philip James, who is advising on Ben’s treatment, is optimistic.
“Ben has so far made an astonishing recovery and is a very courageous young man,” he says. “But he hasn’t recovered from his head injury. He gets severe fatigue, which I would think will certainly improve. His speech is barely understandable at times but at other times it is better and I would expect that to improve too.”
Paratrooper Ben Parkinson, who lost both legs aged just 22, meets Princess Anne
The course of treatment depends on the individual patient, explains Prof James. It can be extremely arduous and is no quick fix. Ben will probably have 20 one-hour sessions over the next month and then be reviewed.
Prof James, 73, emeritus professor of hyperbaric medicine at the University of Dundee, is one of the UK’s foremost experts in the subject, having spent most of his professional life involved in deep sea diving, where high levels of oxygen are routinely used for brain and spinal cord injuries.
His book, Oxygen and the Brain, which took him 20 years to write, was published at the end of last year . He passionately believes that hyperbaric oxygen therapy (HBOT), still regarded with suspicion by much of the medical establishment, can be used to improve the treatment of a range of disorders, from traumatic brain injury like Ben’s to multiple sclerosis (MS).
“Hyperbaric oxygen therapy is still regarded as quackery by many doctors because it is not taught in our medical schools” he says. “But it is simply a means of giving more of the oxygen we all breathe. We need to use more oxygen in medical practice and especially in the treatment of brain disorders, which remains in the dark ages.”
There is now overwhelming evidence from advanced imaging of brain injured patients that confirms the brain cells may not be dead but “sleeping” or dormant, rather, and can be revived after injury.
“A second important discovery is that stem cells that form in the brain as we grow in the womb are still present in our brains as adults and retain the ability to grow new nerve cells,” Prof James adds.
His book, which charts our understanding of the importance of oxygen, takes in the adventures of 19th century balloonists, vital work on the nature of gases by the Scottish physiologist J.S. Haldane, the pre-war popularity of compressed air baths, and the opening in Cleveland in 1928 of the renowned “hyperbaric hotel” for patients with a variety of conditions.
Prof Philip James, author of the book Oxygen and the Brain
Oxygen, he points out, is a key component of the natural healing process, although we seldom think of it that way. “The oxygen we breathe normally is involved in repairing and regenerating tissue all the time” he explains.
“However, if damage is too severe, sometimes oxygen in the air isn’t enough. All hyperbaric oxygenation does is use a higher concentration of oxygen.”
The science in his book is complex to say the least, but relieved by some remarkable individual stories, including that of Jessica McClure, the little girl from Texas who hit international headlines when she fell down a disused well in 1987 and whose blackened foot was saved from amputation after undergoing HBOT.
Then there is Randy McCloy, the sole survivor of the 2006 mining disaster in Sago, West Virginia, saved from carbon monoxide poisoning by HBOT.
Prof James is particularly forthright on the subject of carbon monoxide poisoning. It is one of the few conditions for which the NHS accepts hyperbaric oxygen is a valid treatment, yet few NHS hospitals have HBOT facilities, he says.
“This lack of provision means several hundred lives are lost to carbon monoxide poisoning every year,” he adds.Prof James’s involvement in diving medicine began 40 years ago when the discovery of North Sea oil was putting deep sea divers at risk of “the bends” – the painful, often dangerous decompression sickness caused by the change in pressure when a diver emerges from the water.
Divers need to breathe highly pressurised gases to match the high water pressure, but the reduction in this pressure when they return to the water’s surface means harmful gas bubbles may enter the circulation and damage the nervous system. Decompression sickness is the only area in medicine where hyperbaric oxygen therapy is recognised as the standard treatment.
It was Prof James’s work in the area of diver safety that led him to look at other areas where HBOT might be of benefit.
The pathology underlying decompression sickness occurs in many other kinds of brain disorders, he believes, including head injury, stroke and MS, a progressive disorder of the central nervous system. While many doctors consider MS to be an autoimmune disease (where the body’s immune system attacks the body’s own healthy tissues), Prof James is convinced it can be triggered by even minor external trauma. In a paper published by the Lancet in 1982, he argues that just as with the gas bubbles found in decompression sickness, tissue injury can cause microscopic fat droplets, known as emboli, to enter the circulation, damaging the blood-brain barrier and causing inflammation – universally recognised as the hallmark of MS.
Ben Parkinson, pictured before his injuries in Afghanistan in 2006
And just as HBOT can repair the blood-brain barrier in decompression sickness by allowing new blood vessels to grow, he believes it can similarly help in MS and other brain disorders.
“Of course, HBOT cannot cure patients who have established multiple sclerosis – by definition this means they already have multiple areas of scar tissue,” he says. But his research following 705 MS patients for 15 years, undertaken with Dr David Perrins, shows it can stabilise patients and put them in remission. MS is only one of the disorders Prof James believes can be alleviated with HBOT.
Others include head injuries, stroke and in other areas of the body, infections like pneumonia and sepsis, heart attacks, diabetic gangrene, ulcers, pressure sores and diabetic tissue damage.
Much of the rejection of hyperbaric oxygen therapy is rooted in fear he believes – “fear of the physics involved, the equipment, even fear of entering a pressure chamber.”
All oxygen is delivered under varying degrees of pressure, with the level depending on climate and geography. HBOT is just a way of delivering higher concentrations under higher pressure, he says.
“But until oxygen therapy is taught in our medical schools, doctors will continue to be uninformed of the critical importance of oxygen in healing,” he adds.
In recent decades, research has shown that changes in the level of oxygen in cells control thousands of our genes, from those governing the growth of new blood vessels in damaged tissue to the p53 gene that inhibits cancer.
“This has not made headlines,” says Prof James. “But it ranks alongside the discovery of the structure of DNA and is set to define a new era in the treatment of injury and disease.”
Oxygen And The Brain by Philip B James (Best Publishing Company £49.99) is available to order from Telegraph Books at £49.99 + £1.95 p&p. Call 0844 871 1515 or visit books.telegraph.co.uk
What is HBOT?
Hyperbaric oxygen therapy (HBOT) is the delivery of oxygen at a pressure greater than normal, resulting in a higher levels of oxygen dissolving in the patient’s blood plasma.
In the NHS, hyperbaric oxygen therapy is recognised as effective for the following medical emergencies: decompression sickness; gas embolism (gas bubbles in the blood vessels) and acute carbon monoxide positioning, in certain cases.
The NHS says there is insufficient evidence for the routine use of HBOT in other conditions.
However it says it will support the use HBOT for other conditions when these are part of an agreed clinical trial.
Standard oxygen therapy is given through a mask or nasal tubes at normal atmospheric pressure for both acute and chronic conditions
