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An Overview of Lyme Disease and Hyperbaric Oxygen Therapy

Mitchell L. Hoggard and L. James Johnson

[I edited out lyme basics to focus on hyperbarics -JS]

Authors' Note:

This article is an overview of Lyme disease and hyperbaric oxygen (HBO) therapy. We acknowledge that the medical areas we explore can be complex and that any attempt to define and explain them in a way that is not overly technical can be incomplete and/or inadvertently confusing. We have attempted to be both clear and exact. Mitchell L. Hoggard is a pharmacist. He is also President and founder of the Chico Hyperbaric Center. All three of his children have received HBO therapy for Lyme disease. Mitchell Hoggard's son Ted was 14 years old when he took part in William Fife's HBO research study on Lyme disease (more on the study later). L. James Johnson, formerly a broadcast journalist, is now a marketing consultant. He has received extensive HBO therapy for Lyme disease.

We have written this article to focus attention on what medical science knows and what it does not know about Lyme disease and HBO therapy. A lack of clarity in the diagnosis and treatment of Lyme disease has impacted both of our lives and the lives of our families. Also, this article was written to be supportive to a patient's relationship with their physician -- not to take the place of that relationship.

Information on how to contact the authors follows this article.

Hyperbaric Oxygen (HBO) Therapy

HBO therapy is a medical treatment that uses the administration of 100 percent oxygen at controlled pressure (greater than sea level) for a prescribed amount of time -- usually 60 to 90 minutes. HBO therapy is commonly used to treat conditions such as burns and difficult or stubborn healing wounds.

HBO therapy increases the amount of oxygen in the body, which in turn causes several physiological changes that can result in accelerated healing. The basis for these changes is the fact that HBO therapy increases the amount of oxygen in the blood by up to 2000 percent, depending on the treatment depth. This, in turn, dramatically increases the amount of oxygen at the cellular level and creates other physiological changes. These changes can be extremely complex. One scientific research study indicates that Lyme bacteria are microaerophilic, or debilitated in high oxygen environments.

In the case of Lyme disease, William Fife, Ph. D., a Hyperbaric Medicine specialist at Texas A & M University (now retired), established the protocols for HBO treatment in his Texas A & M research project, to be discussed later. Dr. Fife's Lyme disease protocol calls for HBO therapy to be administered at 2.36 ATA (Atmospheres absolute), or equivalent to a depth of 45 feet below sea level. Each treatment lasts one hour and two treatments are prescribed each day, five days per week.

The total number of treatments given in each case varies. It is common to administer 30 to 60 treatments in the first phase of treatment. The question of further HBO therapy is then resolved after the patient's condition is reevaluated. However, many believe that if the patient has been impacted by the first phase of HBO therapy, such as by experiencing a Herxheimer reaction (this can help to confirm Lyme bacteria die-off), then a break of three to six weeks should be taken followed by another 30 to 60 HBO treatments. A physician can prescribe more sets of HBO therapy based on the patient's individual evaluation.


HBO therapy is a medical procedure and like any other medical procedure there can be risks. However, when HBO therapy is administered by trained health care individuals these risks are minimal. (As with any medical procedure, the evaluation and understanding of the current health status of the patient is of prime importance.)

Minor ear discomfort is the most common inconvenience related to HBO therapy. It is helpful to remember that the initial stage of each HBO treatment is similar to sitting in an aircraft while it descends. Like the airline passenger, the patient's ears have to adjust to a change in air pressure. The hyperbaric health care professional works with the patient or parent and teaches them various techniques on how to equalize pressure in the ears, such as swallowing.

If one cannot equalize the pressure in the ears, damage can occur to the eardrum. However, this is very rare. Some individuals who experience ear discomfort may require a procedure called a Myringotomy, or what is commonly called placing tubes in the ears. An ear, nose and throat specialist usually performs this outpatient procedure right in the doctor's office.

Other complications can occur if a patient has lung abnormalities such as emphysema. However, with proper evaluation prior to HBO treatment any concerns can be eliminated.

A Promising Therapy

Why does HBO therapy show promise in helping Lyme patients? First, we are reminded that Lyme bacteria are microaerophilic, or debilitated in high oxygen environments. Research by F. Austin demonstrated the effect of oxygen on the Lyme organism. The study suggests that the Bb organism is sensitive to high concentrations of oxygen at the cellular level, or what is termed, elevated tissue partial pressures. In other words, the Bb organism doesn't do well in a biological environment similar to that created in the body during HBO treatment. Once it was clinically determined that Lyme bacteria may be adversely affected by the conditions created in the body during HBO therapy, the next step was to conduct a more in-depth study. One such subjective study was completed in 1997 by William Fife, Ph. D. at the Texas A & M Hyperbaric Laboratory and approved by the Texas A & M University Review Board.

The results of the study were significant: improvement in approximately 85 percent of the 66 patients treated. Improvement is defined as a decrease or the elimination of symptoms. (See the outline of Dr. Fife's study, Effects of Hyperbaric Oxygen Therapy on Lyme Disease under the treatment section at www.hbotoday.com/treatment/lymedisease.shtml)

It is also notable that all of the study's participants were veterans of antibiotic therapy. These were adults and children who had tried and failed antibiotic therapy, including the big gun in the antibiotic arsenal: intravenous antibiotics. It appeared that the study had chosen the most difficult subjects to test. These were Lyme patients with chronic symptoms and most of them probably had nothing to lose. The fact that 85 percent of these Lyme patients showed improvement seems remarkable.

Other Benefits of HBO Therapy

There are other benefits of HBO therapy that may play a role in treating Lyme disease, but were not mentioned in the Texas A & M study. Some of these benefits are theoretical and not proven; others are well known and considered established fact in Hyperbaric Medicine. Many of these additional benefits are based on the belief that HBO therapy and antibiotic therapy work in a synergistic manner. In this context, synergistic is defined as the combination of both treatments (HBO therapy and antibiotic therapy) being greater than the effect of either one alone. First, let's review.

Earlier we discussed how antibiotics and the immune system might not be able to adversely affect (or kill) Lyme bacteria for two distinct reasons. First, it is believed that the Bb organism is able to switch from an active to a dormant (or sleeping mode) by coating itself in the body's protein. It is also believed that the Bb organism can hide in the body's cells. Both tactics may result in the immune system failing to react to the Bb organism as a foreign organism that should be destroyed. Some believe that this has the effect of neutralizing the body's defensive mechanisms and the offensive mechanisms employed by antibiotics.

Complicated Therapy

Lyme physicians take all of this relatively new knowledge about bacterial biology into account when deciding which antibiotic, or combination of antibiotics to prescribe. The above scenario suggests that, depending upon dosage, some classes of antibiotics such as penicillins and cephalosporins may not be able to eradicate Lyme bacteria from the body because they circulate mainly in the body's fluids and are incapable of entering cells where the Bb organism can reside. If true, this contradicts many current conservative antibiotic protocols for Lyme disease.

The good news is that other classes of antibiotics, such as macrolides (azithromycins such as Zithromax) are prescribed specifically to attack the Bb bacteria that may become established within the body's cells, along with killing Lyme bacteria residing outside the cells in deep tissue areas of the body.

It is important to recognize that this is a case in point where a shotgun approach to antibiotic therapy may be an effective tool in fighting Lyme disease. For example, a physician may prescribe a penicillin such as Amoxicillin, along with a macrolide such as Zithromax. The Amoxicillin stays mostly in the body's fluids and blood stream. Meanwhile, Zithromax not only penetrates the cell wall where the Bb organism is residing (and/or hiding), but it also penetrates deep tissue areas, which Lyme bacteria also inhabit. When Lyme bacteria move to deep tissue areas they have effectively moved away from normal blood flow and away from fluid-based antibiotics. Antibiotics such as Zithromax can help to counter this survival tactic.

Also, Amoxicillin is mainly bactericidal (remember, think ... homicidal), which means that it directly kills the Bb organism. Zithromax is a macrolide, which means that it can either be bactericidal or bacteriostatic (think ... manipulative) depending upon concentration levels. By prescribing these two antibiotics, physicians hope to increase the opportunities for killing as many bacteria as possible, and affecting Lyme bacteria in numerous and complex ways. Obviously, physicians prescribe many other combinations of antibiotics to combat the Bb organism.

Even though physicians can out-maneuver some of the Lyme bacterium's survival tactics -- such as using combinations of antibiotics -- there are those who believe that antibiotics probably cannot eliminate the Bb organism if it is in a dormant state. Again, if this is true, it has serious consequences for the diagnosis and treatment of chronic, persistent symptoms. Specifically, this means that conservative treatment protocols, which call for short-term courses of antibiotics, may actually prolong some cases of Lyme infection. If chronic Lyme symptoms are the result of an active, late-stage Lyme infection, any delay in full and comprehensive antibiotic treatment may have devastating results for the Lyme patient.

Adding HBO Therapy

Now we add HBO therapy to the mix. We previously stated that Dr. Fife's study suggests that the Bb organism is sensitive to elevated levels of oxygen at the cellular level. This is an environment similar to that created in the body during HBO therapy. Unfortunately, at this time we do not know much about HBO's effect on dormant Lyme bacteria. However, Fife's study conclusively showed that HBO therapy does have a significant and positive impact on a high percentage of Lyme patients who failed antibiotic therapy. The exact reasons why this is so are not clear.

It is interesting to note that some believe that HBO therapy can kill the Bb organism directly. This begs the question, "Can HBO therapy directly kill the Bb organism on its own?" It seems possible that the answer to this question may be yes. A positive response seems reasonable because Lyme patients who have undergone HBO therapy without taking antibiotics seem to have experienced a Herxheimer reaction during treatment. This suggests that HBO therapy alone was responsible for the bacteria die-off. If true, HBO therapy would indeed be capable of killing the Bb organism directly. Again, more research would be helpful.

Angiogenesis Plays a Role

HBO therapy facilitates angiogenesis. Angiogenesis is defined as the development of blood vessels in the body. This may become important in the treatment of Lyme disease because it is believed that Lyme bacteria effectively evade antibiotics by moving away from normal blood flow into tissue, organs and bone. Thus, the farther that the antibiotic can move into these areas through a more dense and extensive system of blood vessels, the greater the opportunity to kill the Bb organism. HBO therapy's facilitation of angiogenesis allows the antibiotic to potentially have a greater effect on Lyme bacteria by helping to move the antibiotic closer to those parts of the body where the bacteria may be residing.

Bacterial Cell Wall Penetration

There is emerging evidence that certain antibiotics may be more readily incorporated into the cell wall of the bacteria itself in the presence of elevated oxygen tension, which is an environment similar to that created in the body during HBO therapy. If true, this is a clear example of HBO therapy working in a synergistic manner with antibiotic therapy. In other words, the effectiveness of antibiotics to kill the Lyme organism is increased through the use of HBO therapy.

Research is currently being conducted that may indicate that the Bb organism can be killed by oxygen free radicals. Oxygen free radicals are produced during HBO therapy. The deeper the depth of treatment, the greater the number of free radicals produced. It is believed by many that oxygen free radicals have an antibiotic-like effect.

Finally, it is well understood that HBO therapy can enhance certain aspects of the body's natural immune system. This may play a significant and positive role for Lyme patients because their immune systems have probably been compromised over a long period of time as a result of persistent symptoms.

Further Research

The benefits of HBO therapy appear to be far reaching, as well as having particular significance for Lyme patients. However, further research would be helpful in establishing better diagnostic testing procedures for Lyme disease and precise protocols of treatment for HBO therapy. The former obviously includes a precise test to directly measure the presence of Lyme bacteria in the body, or absence thereof. The latter includes the ideal total number of HBO treatments (and their depth) necessary to treat Lyme disease. It would also be helpful to better understand the exact mechanism of action that occurs in HBO therapy. After all, Dr. Fife's study showed improvement in 85 percent of the 66 patients who were monitored during his Lyme disease/HBO therapy research study. Simply, it would be helpful to understand precisely why so many Lyme patients got better. In general, a better understanding of the Lyme bacterium will enable us to develop new and better methods of treating this devastating disease.

In Conclusion

This article has attempted to use current scientific knowledge to inquire into, and to speculate on possible explanations of why HBO therapy is helpful for some Lyme patients. As we stated earlier, just as the diagnosis and treatment of Lyme disease is "subjective, open to discussion, individualized, and often complex," we acknowledge that this article has been subjective and it should be open to question. However, we also feel that no stone should be left unturned in society's effort to understand a disease that has done the following three things:

  1. Devastated so many individual lives.
  2. Strongly impacted so many families.
  3. Afflicts an untold number of people around the world.

We know that antibiotic therapy helps some people who suffer from Lyme disease. We don't fully know why this is so. We also know that HBO therapy helps some people who suffer from Lyme disease. Again, we don't fully know why this occurs. In both cases we feel that it is important to learn why each of these treatments work for some people and not for others.

Thanks to:

Chico Hyperbaric Center
1074 East Ave., Suite O
Chico, CA 95926


Bank Towers, Tamiami Trail, Naples, FL
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