Memories. Brings back memories!

As described by a 1970s member of the Loyal Order of Tank Tigers!

Another memorable group of stories brought back by the “re-discovery of HBO!” Actually HBO (hyperbaric oxygen.. not Home Box Office you TV addicts!! ) has been around a long time. I was simply fortunate enough to be on the cutting edge (we surgeons like hyperbole) of much of the HBO usage today. As a resident in general surgery at the largest USAF hospital at the time (1972-77) we residents had the BEST experience ever. Viet Nam unfortunately was feeding us many military members who had been injured “in country” - We were THE referral hospital for pediatric surgery in the USAF and only one of three military hospitals doing cardiac surgery for the USAF at the time. Round that out with rotations at the famous Brooke Army Medical Center burn unit and rotations at the University of Texas San Antonio Health Science Center with Dr. Brad Aust, and his crew.. we were covered up with huge learning opportunities. Add to that the “Berry Plan” and we had freshly minted superb young surgeons coming to be our staff (teachers) from Boston, NYC, LA, Birmingham, St Louis, Mayo Clinic, Houston, and the list goes on. Unlike many training programs - we were not taught “the _________ way” fit that in with “MGH or MAYO or Baylor or .. well you get what I mean” We learned ALL the different ways and were actually on the forefront of many “firsts” and papers in surgical nutrition, plastics, urology and vascular surgery diagnosis and surgical procedures. Oh yes, years later I can remember at Baylor Coll of Medicine presenting a surgical case and I mentioned I had placed a “needle catheter jejunostomy” - and one of the staff man present said “YOU did WHAT??” Since that technique hadn’t been invented at Baylor, I guess we didn’t count… so I just mentioned the 5-10 papers we had published in the surgical literature about it. He got quiet. Wilford Hall was great for surgical residency.. and Baylor was great for cardiac surgery program!!

Part of this amazing five year program in surgery involved (at the time) responsibilities and training at Brooks AFB - just down the “military Hiway” a short distance. Home to the then USAF School of Aerospace medicine. Brooks HBO had its own prestigious faculty led by Col. Jefferson C. Davis. What a brilliant mind and regrettably taken from us way too soon by malignant melanoma..

We all went through the hyperbaric instruction seminars and were granted a certificate for being a member of the Loyal order of Tank Tigers. Now why would the AF spend money on HBO? Let’s see, some of us may have heard about the bends in divers. You know,, go down 40-50, 100 feet and enjoy scuba diving in the Caymans and then jump on an airplane and fly home at a cabin altitude of 6000-8500 feet and all that circulating dissolved excess nitrogen boils out as micro bubbles and causes joint pain and sometimes even a “spinal cord hit” and you are paralyzed! Thus the bends. Even a pilot in a high performance airplane if breathing room air at sea level ( 29.92 inches ATM =1) can jump in his jet and climb to an altitude fast enough to get “bent.” We have solved much of that but yes it was reasonable for the USAF to have a chamber to treat the bends. Also treats Carbon Monoxide poisoning.. CO is 245 more attracted to hemoglobin than oxygen. Thus many “smoke inhalations” are bright red corpses killed by CO. Thus if the patient survives long enough to get in a chamber, we can flood them with oxygen. Or if a person gets gas gangrene (clostridium bacteria). the toxin proceeds upward rapidly, maybe an inch an hour or so and once again HBO can kill the “anaerobic” bacteria… they hate oxygen but thrive in devitalized tissue. Remember the old civil war treatment for early gangrene in a leg.. immediate amputation removes a limb and saves a life. If “truncal” gas gangrene it is usually curtains unless you have an HBO chamber nearby.

Needless to say- Brooks had a multiple place chamber that “inside observers” (think surgical resident doctors) could be inside the tank at the patients bedside to do “stuff”. Outside observers called the shots (no pun intended) so that a narcotized resident didn’t suddenly want to do some dangerous thing (because he was drunk on the excess nitrogen!!) Hint - that is why you scuba dive with a buddy and preferably as a group so you can be reminded to.. well it is a list of “thou shall nots”.. Like ascend faster than your exhaled bubbles are rising.

Lo and behold we found wounds healed faster in a high oxygen environment. Especially wounds related to major cancer surgery associated with irradiation. The Radiation doctors don’t like to admit it but radiation plays hell with wound healing and restriction of blood flow — (thus poor wound healing.) In the 1970s we found ourselves as residents surrounded by some fabulous USAF plastic surgeons and head and neck surgeons that needed our help with the cancer patients with wound problems.. by having the Tank Tigers dive them at Brooks AFB 15 miles down the road from WHMC at Lackland AFB.

Now in the 2020s we see this HBO modality is being used more and more. Realize that we had a huge multiple chamber but most HBO treatments today are given with what we called the “Sechrest” chamber, a single place tube of plastic or glass that allowed for HBO up to 3 atm of pressure (we could go to six at Brooks)- all new inside observers got a free ride to six atm so we could experience nitrogen narcosis at depth and see how stupid we got. Like a six pack of Lone Star beer drunk- with no hangover upon coming back to normal 1 atm air!

Eventually Brooks got smart - by video taping the stupidity. (frequent comment was -Nah I really didn’t do/say that) —Air Force also used the video taping on the centrifuge when I went back in the 1990s and did the flight surgeons course to get flight surgeon wings. Had to ride the centrifuge to nine Gs.. And or stop it if G-loc was happening.. G induced loss of consciousness…The subject would pass out, and his head would bounce around as outside observers stopped the centrifuge. We called it “Doing the funky chicken”— Needless to say I am telling the story and bragging a bit cause I didn’t do “The Chicken”.. chuckle. I do have the VHS tape proof but haven’t figured out how to make it into an mpeg.

But how is HBO being used today? Check this out….

Mercola.com: https://articles.mercola.com/sites/articles/archive/2022/05/08/hyperbaric-therapy.aspx?cid_medium=etaf&cid=share

This article by Mercola is well done. I learned a lot of new “stuff” regarding up regulation of genes even with atmospheric pressure change.. no oxygen enhancement needed.

Oh, need I add yes, that military 1970s surgical residency well qualified to be a major “contact sport” much like the DeBakey program in Houston.. But the good thing is as active duty military members we actually got “hazardous duty pay” cause we could have been seriously injured.. So thank you very much taxpayers for the extra 140 dollars a month we got during the months we dove.. Not flight pay.. hazardous duty pay. Some of my fellow residents read my substack and there might be a memory or two show up in comments worth a read!