Plenary Sessions

  • Thursday, June 27

     


    PRESIDENT'S ADDRESS

    8:00-8:30:


    Nicholas Bird, MD, FUHM

    BirdNicholas WEB NEW
    Overview
    : Provide an overview of activities, plans, and outcomes from initiatives carried out by UHMS home office, officers and committees. 

    Objectives:

    • Name two of the position statements published in the last year.
    • Describe what the UHMS has done to improve its editorial review process

    About Dr. Bird:  Dr. Nicholas Bird is a regional medical director for Duke Urgent Care and am board-certified in both family medicine and undersea and hyperbaric medicine. He split my time between clinical practice and administrative responsibilities, and he have a passion for improving health care delivery to optimize patient access, education and outcomes. Prior to joining the Duke medical staff, he was the chief medical officer and CEO of Divers Alert Network and an internationally recognized expert on diving injuries, accidents and medical treatment. Outside of work, he enjoy traveling, and diving the warm waters of the world. He has been a PADI SCUBA instructor for more than 25 years. He also enjoy reading Clive Cussler novels, cooking, and golfing, when time permits. He live in Durham with his wife, Kim. They have three children, a grandson, and a crazy Jack Russell terrier.


    Controversies in the Hyperbaric Management of Late Radiation Injuries

     
    8:30-9:00:


    Late Radiation Tissue Injury Below the Clavicles: Considerations with IMRT and the Fibroatrophic Model
    John Feldmeier, DO

    Feldmeier Pic OfficialIn this session, Dr. Feldmeier will join with Dr. Robert Marx to address several recent articles calling into question the role of hyperbaric oxygen in treating LRTI’s (Late Radiation Tissue Injuries). While Dr. Marx will concentrate on the application of Hyperbaric Oxygen to osteoradionecrosis (ORN) of the mandible and maxilla and soft tissue injuries of the head and neck, Dr. Feldmeier will concentrate on injuries to organs and tissues below the clavicle. Special emphasis will be given to radiation cystitis and proctitis. The technique of modern radiation therapy targeting including IMRT (Intensity Modulated Radiation) will be briefly discussed. A recently proclaimed and popular model of delayed radiation injury is called the Fibroatrophic Model. It de-emphasizes vascular damage as the major contributor to LRTI. This model will be discussed from 2 perspectives: 1. Its validity and 2. Even if accepted in part or in toto, how a strong case for the use of hyperbaric oxygen can be made. At the conclusion of both Dr. Marx’s and Dr. Feldmeier’s plenary sessions, a panel discussion will occur.

    About Dr. Feldmeier: Dr. Feldmeier received his D.O. degree from The Philadelphia College of Osteopathic Medicine in 1979 with USAF sponsorship and completed residency training in Radiation Oncology at the University of Texas Health Science Center at San Antonio, Texas in 1985. He received a fellowship certificate from the USAF Hyperbaric Medicine Fellowship Training Program at Brooks Air Force Base in San Antonio, Texas and was a staff physician there from 1980 to 1982. Dr. Feldmeier was simultaneously the Chief of Radiation Oncology and Chairman of the Hyperbaric Medicine Department at Wright-Patterson Air Force Base Medical Center in Dayton, Ohio before separating from the USAF in 1985. Dr. Feldmeier has served as the Chief of Radiation Oncology at the University of Texas Health Science Center in San Antonio, Grace Hospital in Detroit, MI and the Chairman of Radiation Oncology at the University of Toledo Medical Center from which he retired in 2013 with the award of Professor Emeritus. Dr. Feldmeier has authored numerous publications in both radiation oncology and hyperbaric medicine. He has been the editor of the Undersea & Hyperbaric Medical Society (UHMS) Hyperbaric Oxygen Therapy Committee Report. He served as review editor of Undersea and Hyperbaric Medicine. He is a Fellow of Undersea and Hyperbaric Medicine and Past- President of the UHMS. He currently co-chairs the UHMS Research Committee. He is a Fellow of the American College of Radiation Oncology.   He is a medical consultant to International ATMO. He is the only physician in the U.S. board certified in both Radiation Oncology and Undersea and Hyperbaric Medicine. 

     9:00-9:30:

    Answering the criticism and challenges to HBO2 in the treatment of radiated patients
    Robert Marx, DDS

    Marx 

     

     

    About Dr. Marx:  Robert E. Marx, DDS, is Professor of Surgery and Chief of the Division of Oral and Maxillofacial Surgery at the University of Miami Miller School of Medicine as well as Chief of Surgery at Jackson South Community Hospital in Miami. He is well known as an educator, researcher, and innovative surgeon. Dr. Marx has pioneered new concepts and treatments for pathologies of the oral and maxillofacial area as well as new techniques in reconstructive surgery, including stem cell therapies. 
         His many prestigious awards, including the Harry S. Archer Award, the William J. Giles Award, the Paul Bert Award, the Donald B. Osbon Award, and the Daniel Laskin Award, attest to his accomplishments and commitment to the field of oral and maxillofacial surgery. 
          His textbook “Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment” has won the American Medical Writers Associations Prestigious Book of the Year Award. His other textbooks, “Platelet Rich Plasma: Dental and Craniofacial Applications,” “Tissue Engineering,” “Oral and Intravenous Bisphosphonates Induced Osteonecrosis” and an “Atlas of Bone Harvesting” have been best sellers. He is also a writer of fiction medical mystery novels. His first publication “Deadly Prescription” is currently an Amazon best seller.

    9:30-10:00: Panel discussion


    Physiology and Science in Hyperbaric Medicine


    4:00-4:
    30:


    Stem cells and hyperbaric oxygen therapy
    Stephen Thom, MD

    Thom picThe first scientific papers reporting effects of hyperbaric oxygen therapy (HBOT) on stem cell biology were published just 12 years ago and now they number over 100. This presentation will summarize the latest data on stem cell physiological responses to HBOT. Oxygen acts as a critical regulator of stem cells, and HBOT has a variety of effects on stem cell mobilization dynamics, metabolism, engraftment, and can influence paracrine roles with tissue repair. Some effects appear with the initial HBOT exposure while others develop when repeated hyperoxia-normoxia cycling occurs. Mechanisms and data on clinical utilization will be presented, as well as current questions and future directions.

    About Dr. Thom: Dr. Thom received his MD and PhD (microbial physiology) degrees from the University of Rochester in 1981. He served as professor of emergency medicine and chief of hyperbaric medicine at the University of Pennsylvania for 27 years and in July 2013 took a position at University of Maryland. He is a practicing emergency medicine physician and also carries out research in several areas. He is lead/senior author on over 130 peer reviewed papers and 40 reviews or textbook chapters on oxygen and other gas toxicities. Research interests include the role of stem cells in diabetic wound healing and cell responses to hyperoxia, pathophysiology of decompression sickness, carbon dioxide and carbon monoxide (CO). His lab group was the first to describe vasculogenic stem cell mobilization by hyperbaric oxygen therapy and he currently directs projects to assess the role of stem cells in diabetic skin wound healing. He was president of the UHMS from 1996-1998, and chair of the hyperbaric oxygen therapy committee from 1991-1993.  Dr. Thom has been the recipient of the Albert R. Behnke award of the UHMS in 1996 and 2008, the Paul Bert award from UHMS in 2007, the Edgar End award of the Gulf Coast Chapter of the UHMS in 1988, and the C. Longoni award from the Italian Undersea and Hyperbaric Medical Society in 1998.

    4:30-5:00:

    Research that We Need to do in the Field of Hyperbaric Medicine and Some Thoughts on How to Achieve this Goal
    John Feldmeier, DO (Co-chairman of the UHMS Research Committee)

    Feldmeier Pic OfficialIt is no surprise to our membership that as a discipline, hyperbaric medicine has not achieved a consistently successful track record in accomplishing research to further advance the application of our treatment modality or even for that matter to firmly solidify those indications that we accept as “Approved.” CMS and commercial insurers are actively involved in removing re-imbursements for pharmaceuticals, devices and procedures unless their proponents can make a solid argument for their benefit based on good and adequate science. It is likely that payments for our clinical efforts are going to be put under even greater scrutiny unless new and corroborating science is done and published with a quality that is readily acceptable to payors and potential referring physicians alike. As a small field, we do not have the luxury of large sums of money available to support the conduct large research protocols involving randomized controlled trials. We can, however, learn from the major cooperative oncologic trial groups and employ registries to achieve the necessary quality of science. A number of promising new applications deserve scrutiny and some of our long-standing indications need better support. This talk will be designed to identify several areas where research must be done for the good of our patients and our discipline and will consider some methods by which these studies can be accomplished.

    About Dr. Feldmeier: Dr. Feldmeier received his D.O. degree from The Philadelphia College of Osteopathic Medicine in 1979 with USAF sponsorship and completed residency training in Radiation Oncology at the University of Texas Health Science Center at San Antonio, Texas in 1985. He received a fellowship certificate from the USAF Hyperbaric Medicine Fellowship Training Program at Brooks Air Force Base in San Antonio, Texas and was a staff physician there from 1980 to 1982. Dr. Feldmeier was simultaneously the Chief of Radiation Oncology and Chairman of the Hyperbaric Medicine Department at Wright-Patterson Air Force Base Medical Center in Dayton, Ohio before separating from the USAF in 1985. Dr. Feldmeier has served as the Chief of Radiation Oncology at the University of Texas Health Science Center in San Antonio, Grace Hospital in Detroit, MI and the Chairman of Radiation Oncology at the University of Toledo Medical Center from which he retired in 2013 with the award of Professor Emeritus. Dr. Feldmeier has authored numerous publications in both radiation oncology and hyperbaric medicine. He has been the editor of the Undersea & Hyperbaric Medical Society (UHMS) Hyperbaric Oxygen Therapy Committee Report. He served as review editor of Undersea and Hyperbaric Medicine. He is a Fellow of Undersea and Hyperbaric Medicine and Past- President of the UHMS. He currently co-chairs the UHMS Research Committee. He is a Fellow of the American College of Radiation Oncology.   He is a medical consultant to International ATMO. He is the only physician in the U.S. board certified in both Radiation Oncology and Undersea and Hyperbaric Medicine.

  • Friday, June 28


    DCI Theory & Mechanisms

     8:00-9:00:

    CNS Oxygen toxicity: Where are we now?
    Jay Dean, PhD

    Dean2Hyperbaric oxygen (HBO2) is breathed during hyperbaric oxygen therapy and during certain undersea pursuits in diving and submarine operations. What limits exposure to HBO2 in these situations is acute onset of central nervous system oxygen toxicity (CNS-OT) following a latent period of safe oxygen breathing. CNS-OT presents as various non-convulsive signs and symptoms (S/Sx), many of which appear to be of brainstem origin that involve cranial nerve nuclei, autonomic centers and cardiorespiratory centers, which ultimately spread to higher cortical centers and terminate in recurring bouts of generalized tonic-clonic seizures. The initial latent period makes breathing HBO2 practical in hyperbaric and undersea medicine; however, the safe latent period is highly variable between individuals and within the same individual on different days, making it difficult to predict onset of toxic indications. Consequently, currently accepted guidelines for safe HBO2 exposure in undersea medicine and HBO2 therapy are highly conservative. During this lecture, I will review the results of research on CNS-OT, focusing on work done during the past two decades on behalf of the Office of Naval Research (ONR) Undersea Medicine Program (one of four National Naval Responsibility Initiatives) and the Naval Sea Systems Command (NAVSEA). Topics that will be covered include the following: the pathophysiology of the S/Sx that define CNS-OT; conditions that increase the risk for developing acute toxic indications during exposure to HBO2; innovative animal (in vitro and in vivo) and human research methods adapted for use during HBO2 that have provided insight on the neural mechanisms underlying CNS-OT; brain regions that are thought to be involved in seizure genesis and propagation; and current strategies under investigation for predicting an impending seizure (“physiomarkers”) and delaying onset of CNS-OT (antiepileptic drug therapy, antiadrenergic drug therapy, ketone metabolic therapy and hyperbaric oxidative preconditioning) with the goal of longer and safer dives without impaired performance (author’s research funded by ONR Undersea Medicine).

    About Dr. Dean: Dr. Jay B. Dean is a professor of Molecular Pharmacology & Physiology at the University of South Florida in Tampa. He currently teaches respiratory physiology in the Morsani College of Medicine and directs the USF Hyperbaric Biomedical Research Laboratory, which is funded by the ONR’s Undersea Medicine Program to study the pathophysiology of CNS oxygen toxicity. Dean is a devoted historian of aeromedical research during World War II, a topic he has researched extensively since his days as a PhD graduate student at Ohio State. Dean hails from Mason, Michigan, and received his training from Central Michigan University (BS 1979, Biology), Michigan Technological University (MS 1981, Biol. Sci.), The Ohio State University (PhD 1986, Physiology), and did his postdoctoral training in neurophysiology and respiratory control at the University of North Carolina-Chapel Hill (1986-91). Jay lives in Land O’Lakes, Florida with his wife, Janet, who teaches biology and oceanography at Pasco Hernando State College.

    9:00-9:30: Navy dive operations: Lessons learned about planning, DCS prevention and treatment
    Pete Witucki, MD


    9:30-10:00:

    Wearable diving technology
    John Florian, PhD

     


    Altitude Decompression Sickness

    4:00-4:30: Combating flier’s “bends” during unpressurized flight and explosive decompression in World War II
    Jay Dean. PhD

    Dean2The air war of 1939-45 was a “physiological war” because the Allies sought extreme altitudes in unpressurized warplanes to gain the tactical advantage in aerial combat. How high? In 1940, the Allies predicted the air war; thus WWII would be won by the side that waged combat operations at 40,000 feet. Altitude flying and fighting at 40,000 feet became the goal that would inspire America’s aeromedical research program for the war’s duration.

    Accordingly, reducing the risk of decompression sickness (DCS) at altitudes above 30,000-35,000 feet in unpressurized aircraft became a major research challenge for the physiologists of the U.S. Army Air Forces (USAAF) and U.S. Navy (USN). In April 1944, America deployed its first pressurized bomber (Boeing B-29 Superfortress) in the Pacific theater of operations to alleviate the physiological problems caused by hypobaric pressure, anoxia and cold. Pressurized flight, however, created a new problem: Namely, it was unknown how aircrews would respond to explosive decompression at high altitude following structural failure of their ship’s pressure cabin (6.5 psig). Would the incidence of DCS increase compared to slower rates of decompression in unpressurized airplanes?

    In this lecture, Dr. Dean will revisit the research and mitigation strategies for dealing with “flier’s bends” or “aeroembolism” during unpressurized flight and following explosive decompression during pressurized flight. Topics covered include the following:

    • discovery of flier’s bends during altitude chamber “flights” by Dr. Harry G. Armstrong at Wright Field, Dayton, Ohio (1934-1938);
    • development of oxygen prebreathing (OPB) to “denitrogenate” prior to altitude flying above 30,000 feet in altitude chambers and aircraft (1938-1945: Wright Field Aero Medical Lab and Mayo Aero Medical Unit with Boeing and Lockheed Aircraft Companies);
    • Dr. Fred A. Hitchcock’s pioneering research on the physiology of explosive decompression (1941-45: The Ohio State University Laboratory of Aviation Physiology); and more.

    Ultimately, the air war of 1939-1945 would be mostly fought and won below 40,000 feet; however, the equipment and procedures developed during the war years were immediately available for higher altitude flight during the post-war jet era.

    About Dr. Dean: Dr. Jay B. Dean is a professor of Molecular Pharmacology & Physiology at the University of South Florida in Tampa. He currently teaches respiratory physiology in the Morsani College of Medicine and directs the USF Hyperbaric Biomedical Research Laboratory, which is funded by the ONR’s Undersea Medicine Program to study the pathophysiology of CNS oxygen toxicity. Dean is a devoted historian of aeromedical research during World War II, a topic he has researched extensively since his days as a PhD graduate student at Ohio State. Dean hails from Mason, Michigan, and received his training from Central Michigan University (BS 1979, Biology), Michigan Technological University (MS 1981, Biol. Sci.), The Ohio State University (PhD 1986, Physiology), and did his postdoctoral training in neurophysiology and respiratory control at the University of North Carolina-Chapel Hill (1986-91). Jay lives in Land O’Lakes, Florida with his wife, Janet, who teaches biology and oceanography at Pasco Hernando State College.

    4:30-5:00: USAF hypobaric exposures experience
    Marc Robins, DO

    RobinsDr. Robins will speak on DCS altitude current problems faced and U2 case reports recently collected.

    About Dr. Robins: Dr. Robins started his career in medicine working for the Ski Patrol in Southern Oregon at age 19 which soon led to employment as a nurses aide then as a Registered Nurse. Prior to medical school he worked as an RN in the Emergency Department at a level 1 Trauma Center, graduating with his Doctorate in Osteopathy in 1988. Receiving a Health Professions Scholarship to pay for Medical School he did his first Residency in Family Practice at the David Grant USAF Regional Medical Center at Travis AFB, California, and then a second Residency in Aerospace Medicine with Fellowship in Occupational Medicine and a Masters in Public Health from Harvard University School of Public Health. He was awarded the Malcom Grow Air Force Outstanding Flight Surgeon of the Year Award in 1995, and completed a 20-year career as an Air Force Flight Surgeon. His assignments included European Aeromedical Evacuation Squadron, and command positions for Fighter Base Aeromedical Squadrons and the High Altitude U2 program in Beale, California, commanding medical services in six major deployments and one Humanitarian Mission. Dr. Robins culminated his career as the US Aerospace Medicine Consultant to the Australian Defence Force Medical Chief (US Surgeon General equivalent), retiring as a Colonel. He attended the NOAA Dive Medical course in 2010 and maintains an avid interest in recreational scuba diving, certifying in 2003. He is a pilot, enjoys skiing, mountain biking, motorcycle riding and rock climbing.

     

  • Saturday, June 29


    The Regulatory And Reimbursement Challenges Facing Nations And How These Have Been Addressed

    8:00-8:25:

    Canada 
    Ken LeDez, MD

     

    8:25-8:50:

    United Kingdom
    Pieter Bothma, MD

    The infamous postcode lottery of obtaining funding for HBO depending on where you live, has been criticized widely. It also apply to other specialties including oncology where the most expensive medication was available in some areas and in many areas it was not.  While negotiating a new commissioning policy for HBO as a specialized service, NHS England agreed a block contract to treat the majority of the conditions that we prefer to treat. The policy was due to be completed in 1 to 2 years, but took seven years. This has now been replaced by the new commissioning policy which is a lot more restrictive.

    About Dr. Bothma: Dr. Bothma is a Consultant in Anaesthesia, Critical-care and Hyperbaric medicine. He is Medical director of the London hyperbaric unit operating at 2 sites: in London(Whipps Cross University Hospital) and in Great Yarmouth (James Paget University hospital). He has been involved with the clinical reference group negotiating with NHS England for the last 7 years about a new commissioning policy. He regards this  as the biggest investment of his time for the least benefit to anyone. He is currently chairman of the British Hyperbaric Association.

     

    8:50-9:15:

    United States
    Caroline Fife, MD

     

    9:15-9:40:

    Australia
    Michael Bennett, MD

     

    9:40-10:00:

    Panel discussion

     

     

     

    1:00-1:30:

    HBO2 and Inflammatory Bowel Disease Update
    Jay Buckey, MD

    Buckey

    This talk will cover new developments in the treatment of inflammatory bowel disease with hyperbaric oxygen. Inflammatory bowel disease involves both hypoxia and inflammation, and hyperbaric oxygen can have effects on both of those factors. Also, hyperbaric oxygen can affect the microbiome, which is another potential mechanism for HBO2’s effects in IBD.

    About Dr. Buckey:  Jay C. Buckey, MD is a Professor of Medicine at the Geisel School of Medicine at Dartmouth and the medical director of the Center for Hyperbaric Medicine at Dartmouth-Hitchcock Medical Center. 

    1:30-2:00:

    Thai dive rescue
    Richard Walker, MD

     


    Topics in Undersea and Hyperbaric Medicine

    4:00-4:30:

    Top articles in HBO2
    Fellow (TDB)

     

    4:30-5:00:

    Top articles in Undersea Medicine
    Fellow (TDB)