Is Oxygen Healing? Why Consider Hyperbaric Oxygen Therapy

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio:

Hi, everyone. Today I speak with Dr. Scott Sherr, who is a board certified internal medicine physician, and is also certified in hyperbaric oxygen therapy, which is what we will be discussing today. He graduated from UCLA undergrad and went to and graduated from the University of Maryland medical school. And his approach on HBOT (hyperbaric oxygen therapy) I found to be very interesting in that he doesn’t go necessarily right into the use of the therapy, but first ensures that someone is healthy enough to recover from, what we’ll discuss in a moment, is a hormetic stressor—a healthy stressor that causes your body to respond and become stronger in light of the stressor (akin to exercise strengthening a muscle, even though it stresses the muscle tissue during the exercise).

Dr Ruscio:

This was a very interesting conversation. And again, we discussed the appropriate use of HBOT or hyperbaric oxygen therapy, the myriad of benefits that this therapy can provide, and some clarifications, and advice on how to find a good clinic, the different types of units, and some of the protocols. And, as you’ll hear, this is one personal optimization experiment I’ve been wanting to run for a while. And now I feel with Scott’s counsel, I have enough information and education—borrowing from his brain essentially, and having him advise me through some of this stuff—to run a protocol myself to see if I can enhance my cognition, my recovery, my performance.

Dr Ruscio:

And so I’m excited to share this with you, whether you’re someone who is still struggling, you’ll have a better indication as when to consider using this therapy, or if you’re someone who has gotten through the brunt of their healthcare challenge and is now looking to optimize further, some specifics in terms of the ‘hows’ and the ‘whats’ in terms of the protocols. And, again with that, we will now go to the show with Dr. Scott Sherr. And this elaboration on hyperbaric oxygen therapy—what it is, why you should consider using it, and when you may want to be careful in that it may not be the right fit for you, or at least not at this time. And definitely something that I’m, again, quite interested and excited to experiment on myself. And I’m planning on doing so and maybe in a few months doing a part two with Scott and kind of sharing my experience. Okay. With that, we will now go to the show.

Dr Ruscio:

Hey, everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Michael Ruscio today here with Dr. Scott Sherr, and we are going to be talking about the high pressure therapy of hyperbaric oxygen. And this is something that, Scott, I’m selfishly wanting to pick your brain on. And also, of course, for our patients. And to discover better how this therapy may be able to help people. But, yeah. Welcome to the show. And, again, definitely looking forward to picking your brain, partially with some selfish motivations.

Dr Scott Sherr:

Well, that’s the best kind of podcast when you have a selfish motivation for having the guest. Right?

Dr Ruscio:

Right. Exactly.

Dr Scott Sherr:

Becomes more interesting for the people listening, I hope. But yeah, you’re funny by saying, “under pressure.” Whenever I give a lecture on hyperbaric therapy, I usually play that song. It’s the David Bowie and Freddie Mercury “Under Pressure.” And, I’ll also make some sort of reference to Vanilla Ice stealing it, usually on some level, and pretending that he didn’t. But after that happened, [had] to pay all his royalties to that song back to David Bowie. But yeah. Pressure. Pressure is the key. Yeah. Pressure is how hyperbaric therapy works and I’m happy to dive (as we talk about our chamber treatments as “dives” too) like dive into hyperbaric therapy in any which we way you would like.

Dr Ruscio:

Yeah. A lot of puns in this episode, guys.

Dr Scott Sherr:

So, so many. Oh my goodness. I’m going to stop.

Dr Ruscio:

Well, yeah. For people who haven’t even heard of hyperbaric therapy or hyperbaric oxygen, give us the synopsis of someone who is listening to this, might know what it is, and why they should even listen to a conversation about it.

Dr Scott Sherr:

Yeah. Sure. No problem. So hyperbaric therapy is defined as the combination of increased atmospheric pressure and increased, inspired oxygen. I like to take oxygen first because most people know that it’s kind of a big deal, this whole oxygen thing. And without it, we don’t live very long. And the reason for that is that oxygen’s the final electronic sector in your mitochondria, your organelle in your cells that make energy.

Dr Scott Sherr:

So without a steady supply of oxygen, most of us don’t live very long, as we all know. And so typically we have 21% oxygen at sea level. And that is all we need to maintain our physiologic function. We have these red blood cells in our body that have this thing called hemoglobin on them that bind the oxygen and each red blood cell can carry actually a shit ton of oxygen. The best way to look at this is if you put on a pulse oximeter. Everybody knows what a pulse ox is now. Before COVID nobody knew. But now everybody knows you have this thing you put on your finger. And if you put it on your finger, it’s going to measure somewhere between 98 (maybe 96-100%) oxygen saturation. And what that’s measuring is the amount of oxygen that’s being carried on your red blood cells. Okay. And so that’s pretty good. Most of us are doing a really job at sea level. Even here, when I’m here in Colorado, I’m at 16% oxygen, but I’m doing pretty well too. And the reason for that is that your red blood cells are the reason or the way you have what’s called your “oxygen carrying capacity.”

Dr Scott Sherr:

The more oxygen carrying capacity you have, the more ability you have to get oxygen to your tissues. Now, typically this oxygen carrying capacity is relegated to how many red blood cells that you have. And so when you’re at sea level, you have a certain amount of red blood cells. And when you go to altitude, you actually can get more red blood cells because your body stimulates more production when there’s less oxygen available. It’s a certain hormone called Epogen, which you probably know about very well and many cyclists and other athletes know about too because they can use this as an illegal drug and inject it and increase their red blood cell volume. And that increases your oxygen carrying capacity. So that’s typically the only way you can increase your oxygen carrying capacity is by increasing the number of red blood cells in circulation. But there’s another way actually, and that’s by adding increased atmospheric pressure.

Dr Scott Sherr:

So that’s the second piece of hypobaric therapies. We talked about oxygen. Now we talk about pressure. So in a hyperbaric environment, we simulate the pressure you would feel under a certain amount of seawater. We all know that water’s extremely heavy. It’s that heaviness that we can simulate in a hyperbaric environment. And that heaviness actually drives oxygen, not only on the red blood cells if there’s any sites left, but also in the liquid or the plasma of your bloodstream. The plasma of your bloodstream is kind of what gets things wherever they need to go in the body. It’s almost like a saline solution, if anybody has heard about that. It’s kind of like a saltwater solution where all your hormones and other cytokines and chemicals and everything else goes and gets from place to place.

Dr Scott Sherr:

And so there’s very little oxygen in that plasma at sea level. But when you pressurize a chamber, we use the only physics law that I promise that I’m going to talk about on this podcast called “Henry’s law.” And Henry’s law states that the more pressure you put on the gas, the more that gas is going to go into liquid form. And so as a result of increased atmospheric pressure, we drive more oxygen in circulation. So at two atmospheres of pressure, which is the equivalent of about 33 feet of seawater, you’re getting about 1200% more oxygen in circulation—which is about 12 times what you can get any other way.

Dr Scott Sherr:

So to sum up: hyperbaric therapy is a combination of increased, inspired oxygen (usually) and increased atmospheric pressure, always. And that increased atmospheric pressure is really the major driver of the increased oxygen load into the body, which causes all these cascades of events, both acutely and over the long term via epigenetic mechanisms (via changing how the DNA expresses various genes and expresses and suppresses various genes).

Dr Ruscio:

So one of the things I’m wondering here regarding the longterm carryover is, I was always under the impression, this is kind of like, what do they say, “live high and train low?” Is this the same sort of thing where you’re kind of forcing an adaptation via that mechanism? But it almost sounds like what you’re describing is the inverse of that because we’re replicating people going lower, if we count the sea as lower. So walk me through how we should be thinking about the longer term adaptation that people experience.

Dr Scott Sherr:

Yeah, sure. So immediately when you go into a hyperbaric environment, you have all this extra oxygen circulation. There’s any number of things that are happening during that time, which we can talk about if you’d like, but what happens over the longterm, over intermittent administration—but usually means daily for 60 to 90 minutes for a protocol, it could be five sessions, 20, 30, but usually around 20 or so—is when you have solidified epigenetic shifts in expression of genes that are responsible for growth, responsible for down-regulating inflammation, and responsible for preventing program cell death or apoptosis. So what you see over the longterm is you see new blood vessels that are growing in various areas.

Dr Scott Sherr:

You also have this initial oxygen stimulus that releases a whole bunch of stem cells from your bone marrow and then allows those bone-marrow-released stem cells to mature to various types of tissue around the body. There’s also a down regulation of all those inflammatory cytokines, like IL1, IL6, IL8, and TNF alpha, that are responsible for uncontrolled inflammation in people that have longterm auto immunity or also in people that have long term wounds or other types of issues, chronic infections that aren’t addressed because of the body’s dysregulation over time.

Dr Scott Sherr:

There’s also what looks like an increase in telomere length in some of the studies that have been shown that have been done, and a decrease in what are called senescent cells which are these cells—that I love the term—zombie cells, that’s what they’re known for known. And basically these are cells that increase in number as we get older and they cause potential inflammation, they’re associated with cancer and degenerate and other types of long term chronic issues. And so over the longterm this is what hyperbaric therapy seems to do, it basically, the way I like to think about it, Michael, is that it it’s a rebuilding of the architecture of tissue regenerating and revitalizing it. So it can happen from the ground up. It happens from the cellular structure up. So it really depends on the situation and the indication, but that’s really what the physiology is doing over the long term.

Dr Ruscio:

That’s fantastic. And especially if we’re getting less senescent cells, increased telomeres, it sounds like it’s kind of this bone marrow exercise, so to speak.

Dr Scott Sherr:

Yeah. It’s automatic stress to somebody, right?

Dr Ruscio:

Well said. Okay.

Dr Scott Sherr:

Yeah. And that’s also scary for people, right? But when you talk about the initial oxygen infusion, we’re talking about a high oxygen load. And that high oxygen load is actually reversing low oxygen state immediately. So if you’ve had an acute issue, acute trauma (like heart attacks, strokes), you’ve had spinal cord injury or limb trauma, or even if you have acute musculoskeletal strain even, if you can get more oxygen to the tissue immediately, you may prevent downstream death of tissue or significant injury of that tissue as well.

Dr Scott Sherr:

That’s the primary thing that’s happening for an acute issue. And that’s also why some people, especially if you’re pretty well optimized ahead of time, feel amazing their first two to three sessions. All of a sudden they have all this oxygen in their body, they just have all this energy, and they just feel so great. Even if they’ve had, you know, massive issues—we can talk about anything from concussions to even long COVID—that we’re seeing a lot of great responses to these days. And [there’s] some research coming out there and others, but that initial oxygen infusion is huge.

Dr Scott Sherr:

But the other piece of it is this oxidative load that’s happening because of the products of energy metabolism. And that’s how these epigenetic shifts are happening. So you have these reactive oxygen species in the body that, as a result of them increasing, create this stimulus for this shift in genetic expression. And at the same time, the body responds with an antioxidant surge, an antioxidant response. So that balances out after about 3-4 sessions, typically for most people as well (as long as, again, they’re relatively well optimized).

Dr Scott Sherr:

And so this leads into a different conversation, which is, you know, when is the best time to get into a hyperbaric chamber? And a lot of it depends on the acuity of your issue. Like if you have an acute issue, it’s almost like “don’t pass go, get into the chamber, it’s going to help optimize healing.” But if you have more of a chronic or longterm goal, it might be better to optimize your health and look at the ability to make energy effectively, the ability to get oxygen to where you want it to go, and also to detox well and all those other things that I know that are so important to your practice too.

Dr Ruscio:

And so this is interesting because one of the questions I was going to ask, knowing the bolstering of oxygen, if you will, is does this therapy increase oxidative stress? And it sounds like the answer to that is yes. But it’s a short term hormetic stressor, almost like saying, “well, exercise increases muscle tissue damage but we all know that exercise is a net benefit due to the recovery that the exercise leads to and the stronger coming back of the muscle fiber, so to speak.” So it’s sort of the same thing. [A] little different, but analogous here.

Dr Scott Sherr:

Yes, exactly. And it’s important to make that comparison. I do all the time to how hyperbaric therapies exercising your body, just like if you were doing exercise and getting that hormetic stress. But it’s also something that I learned really early on, Michael, is that it’s really important to understand the person in front of you that’s getting into the chamber because if they have chronic infections, if they have chronic autoimmunity, if they’re under high inflammatory load already, and you’re not looking at optimizing vitamins, minerals, nutrients, co-factor and energy metabolism, you can potentially not see that balancing of the oxidative load with that antioxidative response.

Dr Scott Sherr:

And so when I was initially in practice, I didn’t really think of this as much. This was back in 2015ish when I was getting really ramped up in hyperbaric medicine, actually 2013. And I was seeing patients that weren’t getting better. In fact, were getting worse. And so we had to like support them with antioxidants even before they went into the chamber, lyme patients especially, chronic auto immunity.

Dr Scott Sherr:

But then what I realized is I needed a new part of my practice that focused on that foundational thing, that foundational piece that really would augment the hyperbaric component. And that’s when I got involved with a nonprofit company that was being developed at the time called Health Optimization Medicine, which is founded by a friend and mentor of mine now, that was looking at this foundational approach to health that wasn’t really focused on disease or conditions, it was more, you know, root cause health versus root cause illness.

Dr Scott Sherr:

And it gave me the framework to really work with my hyperbaric patients in a much more foundational way to make sure…I often say that it’s not if hyperbaric therapy can be helpful for you, it’s just when it’s most appropriate. And so it really gave me the tools to be able to create more of a plan for people and a longterm sustainable health optimization plan really is what came out of it. And hyperbaric therapy was this supercharging, accelerating, optimizing further on top of that kind of thing.

Dr Ruscio:

Mm. And I’m so glad you’re making this point because a few of the conditions I was going to ask your opinion, regarding the merit that HBOT or hyperbaric oxygen therapy has was for chronic infection and for auto immunity. And I am curious to get your perspective. You partially answered the question there, which is if someone’s got a chronic cast of symptoms or illness or condition, you may want to lay some foundational work first, which makes complete sense, meaning they need to have the reserve to recover from the hermetic stressor.

Dr Ruscio:

And my fear is that people who have been suffering for a while, tend to turn to the most exotic therapies. And I include myself in this, by the way, for our audience, this is not a knock. This is something I have to kind of toggle back and forth between the patient in me. You know, in this case for me right now, it’s more so I want to perform better, but those are things that I’m grappling with. It used to be chronic brain fog and insomnia. But there’s always the, “I need to do insert exotic thing here.” And then the clinician voice answers back and says, “well, you know, have you satisfied all of the foundational items first?” So I just put that out there that it’s, I think, a normal human impetus is to want to jump to these things. But I’m so glad you’re making these points, Scott, which is that if you’re, let’s say suspecting or confirmed dealing with chronic Lyme, you may not want to jump here first until you’ve laid a little bit of a foundation.

Dr Scott Sherr:

Oh yeah. And I learned actually from Lyme patients first. The nurse that was the director of the facility that I became the medical director of in San Francisco in 2013 was a Lyme patient. And she had a lot of friends and a network that would come in and I realized very, very quickly that for Lyme patients, they can do really well in the chamber.

Dr Scott Sherr:

But the caveat to that is that they have to be about 60-70, maybe 80, percent better already to really benefit massively from the chamber. Because if they don’t, if they come in too early, it’s almost like their body’s just under too much stress already. And then if you’re killing bugs, which you can do at deeper pressures in the chamber, you’re causing all this inflammatory load and the body has a hard time actually taking care of it. And so I’ve worked with Lyme specialists all over the country, especially in San Francisco where I used to live, and we always were timing the hyperbaric exposure to when people were about at that level where they were about 60, 70% better. And that’s when we saw the best results.

Dr Scott Sherr:

And that’s oftentimes for a lot of different types of chronic infection and chronic auto immunity—if you really want to see longterm benefit from being in the chamber, getting to that point where you’ve been working with a practitioner, optimizing your health, looking at vitamins minerals, nutrients, gut health, hormones (all the stuff that you do and that I do in my practice using the health optimization medicine framework) that’s the foundation.

Dr Scott Sherr:

And that’s, that’s the hard part. And we all want that, “look at the squirrel” kind of thing, right? “Look at that. That’s fun. That’s fancy. That’s shiny.” And the chambers sure do fit that bill. Absolutely. But really, it’s funny, I mean, when people come and speak to me, Michael (and I consult with clinics all over the world using hyperbaric therapy), 80 or 90% of the time that I speak with them it’s not about hyperbaric therapy at all. It’s about all these other pieces that are so important. I feel to really give them a sustainable plan over the longterm.

Dr Scott Sherr:

I mean, sure I could just tell them to go into the chamber and, you know, hammers and nails. We know that situation, right. You have a therapy, you’re going to use it. And sometimes I’m not the most popular person in my field because of that, because I’m like, “well, maybe we shouldn’t put people in the chamber right away. Maybe we should do some of this stuff.” And I mean, it’s harder work from a clinic side, but it’s much more sustainable and longterm benefit for the patients.

Dr Ruscio:

Yeah. Well, I share that with you, in terms of antimicrobial therapy for gut issues is kind of the one thing that people want to jump to. And sometimes it’s challenging with the patient, “well, why aren’t we doing antimicrobials?” And it’s like, well, this may actually make you feel worse and this may be way overkill in terms of what we need to get your microbiota balanced. So yeah, I feel that with you, where sometimes you’re swimming against the current and it’s a little bit masochistic almost.

Dr Scott Sherr:

Yeah. I mean, and that’s what I usually try to frame for people is that the foundational work that I do and the foundational work that a lot of other practitioners like yourself are doing is the most important piece. Don’t come to me right away if you have a chronic issue with a lot of other medical issues that are ongoing, that are not being addressed, because I will probably say, “wait, let’s work on this part first and then come back to me and then we can use the chambers down the line.” For example, I’m working with a guy, nice guy, he’s a military veteran, right now and he had a lot of concussions and a lot of other chronic issues, brain fog related to that. But I really wanted to start with health optimization piece first and optimize his gut health.

Dr Scott Sherr:

So we have seven pillars of health optimization medicine: one is chronobiology, another one ETOX (which is the study of toxins in our environment), and another called bioenergetics (which is lightwater magnetism), gut health—which again, we were talking about prior to coming on, but some of that work is very similar and actually based on some of the framework that you’ve actually described in your work, which is great—we also use a pillar called metabolomics (which is the study of cellular metabolism and realtime cellular function), and epigenetics is the other one.

Dr Scott Sherr:

So I use all that in my Health Optimization Medicine plan for people. And then using that framework, we can build that foundation. And then three to six months later, I can get him into the chamber. And then that’s when he’s going to really benefit the most sustainably from that whole program.

Dr Ruscio:

Right. So let’s turn the conversation now to people who maybe fit that profile. Because I’m assuming there’s a subset of our audience who perhaps has gone through a myriad of health-improving interventions, maybe they’ve read “Healthy Gut, Healthy You,” and they feel like they have their health in pretty good working order. Or maybe they’re just a healthy person to begin with. And they’re looking to optimize. Where do you feel the most benefits is offered by hyperbaric oxygen? I know cognition comes up and probably energy. And also one of the things I’m curious about is both energy and cardiovascular performance, like getting my run time consistently or closer to Robert Abbot, who actually introduced us and has a ridiculously fast mile time. And I’m trying to not be like three minutes behind him, if possible.

Dr Scott Sherr:

I didn’t know that about Robert. That’s awesome. I didn’t know.

Dr Ruscio:

Yeah. He he’s quick. Yeah.

Dr Scott Sherr:

He looks like he could be quick. Okay. Alright. So I love this piece. I mean, so back in 2013 is when I started getting involved in the optimal performance, let’s call it the biohacking space for some people who know that term. I know it’s pretty common these days. And I knew from the beginning that the chambers were really great as this optimal, accelerator, synergizer tool. Because you get more oxygen in circulation almost anything’s going to work better, no matter what the tool might be, whether it be, if you have a complex chronic medical illness or if you’re looking to optimize.

Dr Scott Sherr:

And so what I found over the years, Michael, that there’s a lot of different ways to use it in the performance space. I think it’s easy to think about it in sort of two buckets: [one] being how can you use it right now, one time or three times to get a significant benefit? And then [two], how can you use it over a longer term to see long term benefit? So on the acute side or the one off or three off kinds of, hyperbaric sessions, I mean, certainly if you have a mild to moderate injury, any kind of injury, hyperbaric therapy’s going to help you heal faster. So you may get to the same place, but you might get there 20-70% faster. And that’s if you’re also needing a surgery, for example, it’s going to help you heal and recover from a surgery that same percentage range greater or faster as well. And it’s usually higher on that range the more optimized you are beforehand.

Dr Scott Sherr:

But even things like day-to-day muscle recovery from workouts. What I find when I work with most of my clients is that their recoveries go significantly up once they use the hyperbaric environment after doing a hard workout or doing a hard session, whatever they’re doing. In addition, you know, we’re also using the chambers for cognitive purposes, like you said. So this kind of goes a little bit into the types of chambers and we can talk about that in a minute, but we have different protocols for like cognitive performance as well. And that you can even see a significant benefit over 3-5 sessions, for example. And just doing it three to five days in a row. And so we’re also using it in that kind of way for things jet lag and just with a little bit of an energy boost if you’ve had a tough night and you’re not waking up feeling so good in the morning kind of thing.

Dr Scott Sherr:

And so from like an optimal performance perspective, it’s really a recovery tool mostly, I would say. I use it for optimal focus as well. I can use shorter protocols, like 30 minute sessions. You usually pair it with something like cold afterwards is a great way to kind of really give you a good burst of energy and oxygenation and feel great. So that’s the first, sort of the one-off or 3-5 session kind of thing. And over the longer term, like you’re talking about your VO2 max (which is your minute-to-minute ventilation of ability to utilize oxygen), there certainly seems to be a benefit for longer protocols. And we’re talking about probably 20 to 30 sessions in a row here. Monday through Friday, weekends off, because around that time is when you see angiogenesis (the new blood vessel formation)

Dr Scott Sherr:

So you’re getting more blood vessels around your heart and getting more blood vessels in your brain and getting more blood vessels in really everywhere. But the studies have been in genital functions. So erections, always a good topic, and then cardiac functions. So improving, VOT max and left ventricular injection fraction. And then with the brain, improving vascular flow in the brain as well.

Dr Ruscio:

Yeah, that makes a lot of sense. And I was thinking that one of the main ways likely cognition was boosted was either through increased blood perfusion or oxygen carrying to the brain or in this case, probably both via angiogenesis.

Dr Scott Sherr:

It’s both. Yeah. And then you also have the neuroplasticity piece too, which is interesting because there’s been some work that’s been done with people that are inside the chamber doing multitasking. So multitasking performance goes up inside of a hyperbaric environment. Not surprising because you have more oxygen to play with.

Dr Scott Sherr:

And what’s also interesting is that I usually pair hyperbaric therapy with other technologies and tools that are trying to help somebody. For example, one of the tools I use a lot in concussion would be neurofeedback. And what happens in neurofeedback is that you’re training the brain and making it work real hard. And then after you do neurofeedback, your brain is just sucking up oxygen. [It] wants to suck it up because it just used so much of it to use or try to work whatever neurofeedback we were just doing in training. And so the way I like to think about that—the word I use or the term I use—is called an oxygen debt. So if you can create an oxygen debt in the tissue, then more oxygen’s going to go to that particular place when you’re in the hyperbaric environment. So I’ll have people foam roll inside the hyperbaric chamber, I’ll have them do cognitive tasks inside the chamber.

Dr Scott Sherr:

If it’s a big chamber like a multi-place, where you can get multiple people in the same location, then those kinds of chambers you can actually do physical exercise or occupational speech therapy, physical therapy, those kinds of things as well.

Dr Ruscio:

Gotcha. Okay. I didn’t realize that the chambers got that big, but I guess you’re buying a more robust unit if you have a big center. That could make sense. So that’s interesting to know. I didn’t realize you could move around that much.

Dr Scott Sherr:

Yeah. So it depends. That’s a good segue just in the type of chambers for people. So there are basically three different types of chambers. There’s what’s called the multi-place chamber. These are not normally found in people’s houses or in many clinics, because they’re big and they can treat multiple people at the same time. So you usually find these kinds of chambers in places where acute care kinds of facilities in sort of, tertiary care facilities, because that’s where I initially got to experience hyperbaric therapy was in these kinds of facilities where they’re treating carbon monoxide poisoning, soft tissue infections—like necrotizing fasciitis, which is like flesh-eating bacteria (that’s the fun one)—and then other things like thermal burns and other sort of acute things. Also the bends or decompression illness, which is how hyperbaric therapy got started. It got started as a treatment for decompression illness, which is what happens when you come up too fast from being underneath the water as a diver or as a builder of a bridge, or something like that, for example. So that’s a multi place environment. They go to very deep pressures usually.

Dr Scott Sherr:

And then you have what’s called a monoplace environment. And you have medical-grade monoplace and you have what are called mild or soft-side of monoplace chambers. And so the medical-grade ones typically go to three atmospheres of pressure, which is the equivalent of about 66 feet of seawater. One nice little tidbit of that pressure. There’s been studies that show that at 3 ATA (or 66 feet of seawater), you can saturate so much oxygen in circulation that you no longer need any red blood cells to maintain physiologic function. And so, as a result of that, you can think of how we could use this in a trauma setting when you have acute hemorrhage or something like that and save people’s lives that are Jehovah’s witness. Just trying to get blood to them and those kinds of things.

Dr Scott Sherr:

So do you know the most famous monoplace chamber participant?

Dr Ruscio:

I’m assuming…Michael Jackson just pops into my head.

Dr Scott Sherr:

Okay. Yeah. Michael Jackson, you’re good. So you’re not too young. So mostly people, if they’ve been born before 1985 or so, like you, that’s the person you think of being in a hyperbaric environment. So he was in there for 3rd degree burns that he sustained after a Pepsi commercial accident back in the 80s, which you probably remember. But he donated the chamber to a burn unit afterwards. And he’s the most famous person that’s ever been in a monoplace.

Dr Scott Sherr:

Then the final type of chamber you have is called a mild unit. These are mild usually made of a nylon or like a polyurethane type of material. They go to less pressure, they have less oxygen. And these chambers are really, really kind of focused, what I would say is, on the neurologic side of hyperbaric therapy. So anyway, the mild units were really only set up initially for something called acute mountain sickness, which is you travel up high on a mountain, you get acute mountain sickness. These chambers can reverse that very quickly. But what we found over the years now is that hyperbaric therapy at these mild pressures is likely, still very beneficial for neurocognitive optimization, especially. And also probably general muscle recovery, jet lag, some of these other things that are good for people that don’t have too many medical issues, but are looking to sort of use it in more of an optimization strategy. So I have one of these at my house and I use it regularly. But, you know, for significant medical issues that are complex chronic medical issues, oftentimes we’re going to deeper pressures, from more systemic load of oxygen and the impact that’ll have.

Dr Ruscio:

And that was one of the questions I wanted to ask you. I was, when I first kind of caught wind of this or Rob kind of looped me in on how excited he is about this therapy, I immediately (being the budding biohacker that I am trying to optimize performance as much as possible) went online and said, “well, maybe I can buy one of these because with my schedule going somewhere, driving 20 minutes or so, and then having to be there for however long, and then driving back just makes it much more difficult to schedule and to do but maybe there’s an at home unit.” And I found one, I forget offhand…I think it was maybe three grand…It was reasonable. It wasn’t what I was thinking for some medical equipment. I’m assuming some of the monoplaces are probably very expensive, 20-30 grand, maybe. I’m guesstimating. But it sounds like the cheaper units are probably the mild units, as you said, and those are reasonably priced.

Dr Scott Sherr:

Yeah. There’s a pretty wide range. It’s a little bit on the wild west side, in the hyperbaric world at this point. And a lot of that has to do with regulations and the lack thereof. And then, as you know, from your world, there are people that will make certain claims that are just pretty baseless when it comes to what certain chambers can do and what certain chambers can’t. And so I tried to be kind of the voice of education here and what mile chambers can do and what they can’t do for example. And so, I mean, I think in my world, Michael, I think almost anybody can benefit from a mild unit. But there will be certain times when going to a deeper pressure might be more helpful or more therapeutic depending on what they have going on.

Dr Scott Sherr:

And so for optimal performance related reasons, for neurocognitive related reasons, I think, especially when integrated with other technologies, I think the mild units at the house can be great. The units that I use aren’t on that level of price range. Typically the companies that I work with are more on the $15-22,000 range for most people. And the reason for that is I try to go with companies that have a better track record on the market—more comfortable for patients to use and overall just longterm they just work better and they don’t have any issues over the longterm.

Dr Scott Sherr:

But the good thing also is what I’ve been trying to do over the last six months, actually over years, is look for other options for people so that they can also benefit from using the chambers but more on a rental type of model. Instead of having to purchase a chamber and pay all that money up front, they can do something where they’re paying for a three month rental of the chamber for a home unit, for example, seeing if they like it, if they’re benefiting from it, and then from there being able to decide whether they want to go ahead and buy like a lease to own type of model. So I’m working with a couple companies on that model right now, so that more people can potentially get the experience. And then certainly some people will only really benefit from, or would be more beneficial for them to go into, a hard shell unit and go and get medical-grade therapy too.

Dr Ruscio:

And your approach is totally reasonable. Before having someone well, firstly buy a crap unit—we want to avoid that obviously and we want to get them quality—but perhaps they will only need it for a short term or in that shorter term, when they’re doing the rental, they say, “wow, you know, this is worth some sort of five year payment plan due to the level of benefit that I’m experiencing.” I really love that approach.

Dr Scott Sherr:

Yeah. I’m really trying to make it more accessible because I really do feel that so many people can benefit from this particular technology. It’s so universal to healing, to optimizing, to feeling good on a day-to-day basis. And there is certainly some indications that over the long term maintenance hyperbaric therapy might be helpful. We don’t have a lot of data there as far as what that looks like and how best to use it. But in general, I do feel, especially if you have any chronic issues, I think that what I’ve often done is I’ll use the medical grade chambers initially for condition-based care. And then over the longterm, I’ll have people use the mild units to maintain that benefit that they’ve found that they had. If they’ve had a long term issue, like if you’ve had a stroke or if you’ve had a concussion and we’re not going to get you completely better but we can help you.

Dr Scott Sherr:

And I’ve had a lot of patients like this over time where they’ve had severe traumatic brain injuries or even moderate, and we get them significantly better, but they’re not completely better, then doing some sort of maintenance regimen can potentially be very beneficial for these kind of people. And that’s typically how I approach it. And I’m hoping that at some point soon we get more people that are getting more involved in the technology, getting more experience and also in a therapeutic way. And that’s the major challenge I have in the mild market, is a lot of people are getting chambers but they don’t know what to do with them. And then, you know, I speak to people, I consult all over the world and people will call me and tell me they have these chambers and they’re using it in all these crazy ways. I’m like, “oh no, no, no, we have to start over. Let’s start over please.”

Dr Ruscio:

And that was one of my next questions. Which is, are these protocols, are they highly distinct from, let’s say a cognitive optimization perspective as compared to an endurance performance perspective? Is there a lot of nuance? I’m assuming the biohacking is probably different than the more medical for specific condition. But what would you want people to know? I mean, you can probably talk for an hour on the nuances there, but what high level remarks would you give people regarding protocols?

Dr Scott Sherr:

Yeah, so I do a lot of training with clinics and I obviously speak to people all over the world about individualizing these kinds of protocols. So yeah, I have general principles that I go through for most people when I’m thinking about protocols. And I think the major delineation is understanding, as you were describing, is how how acute the issue is. If it’s an acute issue, we just want to get people into a chamber immediately or as quickly as possible so that we can really get them to heal faster. Because we know that’s what’s going to happen in the chamber.

Dr Scott Sherr:

If it’s a chronic issue, as we were describing earlier in our chat, I like to try to optimize health beforehand, if possible. Or refer to clinicians like yourself and others that can optimize health on that foundational level. And the other thing that I think about is the pressures. So as I was alluding to earlier, neurologic pressures tend to be more on the milder side. Typically what I would say is 1.3 to 2.0, which is about 10 to 33 feet of seawater in that range. And then more systemic pressures, deeper pressures between 2.0 and 2.4, for things that are more outside the central nervous system. There’s certainly crossover there. And there’s certainly there’s a nuance and there’s a spectrum there. It’s not like it’s black and white.

Dr Scott Sherr:

But in general when I’m thinking about protocols, I’m thinking about those factors and then the number of therapy sessions also depends on the acuity of the issue. The more acute, the less sessions you you need. And the more chronic or long term goal, the more sessions you’ll need to see a long term benefit from it. So there’s certainly nuance in protocols and this is why I really try to personalize this.

Dr Scott Sherr:

And then again, it’s not just about getting to the chamber. It’s what are you doing before you get in some of the laboratory testing and health practices and things like that? And then what are you actually doing inside the chamber? Which we talked a little bit about before. And then what are you doing after you get out? And what are you doing to either harness all that oxygen and work and do some boosting as a result of all that oxygen? Or, more commonly, is actually working on the detox side of things because as you’ve made all this energy and the products of energy metabolism, you’re then getting to help rid yourself or to detox from all that stuff at the same time. So that’s when some of the detox technologies will come into play, like saunas or sometimes I use pulse electromagnetic field technologies or vibration plates and all these other kinds of like lymphatic flow kinds of things at the same time. So long story short is that the protocol conversation is a longer one, but that’s the basics of what I look at.

Dr Ruscio:

And people, if they’re looking for a clinic locally is there a short list of red flags or green flags you would advise them on?

Dr Scott Sherr:

That’s a good question. So there are mild chamber facilities. There are facilities that just have mild units. And there are medical-grade facilities. These are chambers that usually will only have medical-grade chambers. And so you will hear from the medical-grade guys that the soft chambers do nothing. And you’ll hear from the soft chamber guys that the soft chambers do everything. And so what I often will tell people is that, number one, I try to understand where they’re at.

Dr Scott Sherr:

If they’re looking for optimal performance and recovery, then potentially the mild units would be all that they need to see some significant benefit. But if they’re looking for real systemic shifts, then typically the medical grade chambers are the way to go. That’s where most of the research has been done. And that’s where I will have people go. I mean, typically you want a medical director for these facilities, the medical-grade ones. You also want to have technicians outside your chambers that are watching you as you’re going through hyperbaric therapy.

Dr Scott Sherr:

And so that’s the basics of what I look for you. You always want to be careful like with any therapy. If you go in there and then they say this is going to help you with everything… I mean, certainly hyperbaric therapy is a foundational therapy. In some ways you’re getting more oxygen circulation. I know people all over the world and so I usually can help direct people to places where it would be best for them to get some really good treatment and good care. And I just try to have them look for: do they have somebody that they have technicians there? Do they have medical director? Are they focused on safety? Are they doing a consult with you beforehand to make sure that you’re safe to go into the chamber? And these are medical technologies, hyperbaric oxygen therapy is a prescribed technology. So you need to get a medical evaluation before you go in to make sure you’re safe too.

Dr Ruscio:

And do you do distance consulting to walk people through this, if they need at least some point of contact that they find reliable to help them then navigate into finding a clinic locally? Are you doing any sort of distance or telehealth consulting?

Dr Scott Sherr:

Yeah, so I have a virtual practice. It’s based on my website, DrScottSherr.com or the other name for it is integrativeHBOT.com. And so I’ve been, I set this up about four or five years ago and I will consult or educate or advocate for people all over the world. And I do it through my consulting, educating, and advocacy practice virtually. Yes. And that’s how I’ve gotten to learn about a lot of hyperbaric facilities all over the world. I also work with clinics that integrate hyperbaric therapy within their own practices. So I have clinics that I work with all over the US and also Australia and Dubai and other locations as well. And so I just, usually my goal with the clinics is to define the best ways to integrate hyperbaric therapy within the framework of the practice that they already have, for example. So there’s a recovery center in LA that I work with, that’s doing things very non-medically. And then I have a facility in Maine that I work with that’s a chiropractic neurologist that—he has, I think, seven or eight mild units—and does a lot of great work there using them in that context as well.

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Dr Ruscio:

I’m going to ask my question here as tactfully as possible, is there a high variance in the level of skill of the medical directors at these clinics? Or I guess what I’m trying to get at is how trusting should people be of the opinions that they get? Or should they maybe lean in the direction of having someone like you to have a second opinion to advise them? Because I’m assuming this is something that’s going to be very hard to do your research on. I’m assuming you go to the internet and the opinions vary probably even more wildly than the standard stuff, because this is a newer field. So what would you want people to know in this regard, if I can put you on the hot seat a little bit here?

Dr Scott Sherr:

Yeah. It’s a good question. I mean, I think that for most standard stuff that like that hyperbaric therapy is pretty well established for, the protocols are relatively straightforward. And it’s not difficult to get them in any reputable kind of facility. But if there’s nuance and there’s lots of other things going on, or even if it’s just more like a holistic approach you’re looking for, most hyperbaric facilities will not be able to give that to you because they are hyperbaric facilities. They’re interested in getting people into chambers. That’s what they do, right? So my feel for most people is if it’s an acute issue, like just find a chamber and heal faster in general. There’s very little downside and you can be supported. And there’s ways that I do that with my clients too. But in general, just reving up the healing process is going to do you well.

Dr Scott Sherr:

When it comes to a chronic long term issue, again, before you get into a hyperbaric environment, look at optimizing your health as best you can from a cellular perspective prior to going hyperbaric therapy is going to be your best bet. And when it comes to going to a facility and finding hyperbaric-rich practitioners that are really going to have a sense of how to work it in this chronic illness condition way, it’s going to be more challenging. There’s certainly some good docs out there that I work with. But they are few and far between. And there’s also facilities around the country now that have set up these shops in various towns all over the country that have no clue what they’re doing. I’ve had this experience where people will go in and there’s a—and no offense, I mean, we all need jobs—but there’s somebody that’s getting paid very little to run the hyperbaric chambers at these facilities and they have no idea what to do or what protocols that would be best.

Dr Scott Sherr:

You certainly can’t, especially in the mild units, it’s very difficult to hurt somebody in those because they’re very safe. But certainly it may not be as therapeutic as we would like it to be as a result of the lack of education. So I’ve been trying over the last several years, Michael, to get more education out there and to talk more about it. But certainly that’s something that I’m always running up against to some degree.

Dr Ruscio:

Sure. Yeah. And you make a good point, which is when people are looking into these clinics, have your eyes and ears open. You know, it’s probably pretty easy to see if the clinic seems like a chop shop as compared to someone like you were saying, like a chiropractic neurologist. We’ve had Dr. Titus Chiu on the podcast, who’s a chiropractic neurologist and he focuses on post concussion syndrome and similar neurological disorders. He has a degree of specialization there. You can tell he’s very attuned to that. So I’m assuming that clinic is probably going to impress you with the depth of their focus and the narrowness of what they’re focusing on, being brain disorders.

Dr Ruscio:

If you go somewhere where you’re in the waiting room and you’re seeing stuff about anti-aging medicine in one pamphlet, hyperbaric in another pamphlet, and lip injections in another, that might be a red flag that this clinic is just looking for things that patients are willing to buy and not necessarily focusing on something in particular. Which doesn’t mean that they’re bad people or have bad intentions, but you just want to know, if you’re a sensitive patient with a complex case, probably not for you. If you’re someone who’s in good shape and looking for a little optimization that may work.

Dr Scott Sherr:

That’s a good delineation. I think there’s a lot of clinics that I work with that have this kind of spa feel and have mild hyperbaric units. And they all do great. I mean, especially if they’re doing a good job screening people out in the beginning, understanding who best they can help and who they need to send on their way to either talk to me first or go to a medical grade facility, something like that. But I’m always very clear with the clinics that I work with, and the patients too, is that, “look I do think the hyperbaric environment would likely help you, but it may not be the right time yet. It may not be the right chamber.” We have to kind of just feel that nuance out. And some people are even more sensitive where you want to start at kind of milder pressures to work on the brain and neuroinflammation and then dive deeper.

Dr Scott Sherr:

And this is sometimes what we do in Lyme patients. We’ll start off in doing like mild pressure for neurologic inflammation, for brain-related focus and then go deeper to actually kill bugs as well. Which only happens at deeper pressures. So there’s sort need some nuances here, but in general I try to make it as simple as I can for people in the sense that, what do you have around you? Number one, right? In the sense of, what’s easy for you to do? What’s going to be too difficult? Because like you said, Mike, going to a facility is going to be too difficult for me with my lifestyle and my kids and my practice. So then you get a mild unit and use it in the ways that you can use it for example. And if you have a medical condition that really would benefit from going into a medical-grade unit, you either you make the time and you spend the money to do it, or you wait until you can.

Dr Ruscio:

Right. And that makes sense. And especially for people who might be considering this for more of a optimization/biohacking perspective, I’m glad that they have you as a resource, because I was hot to trot on this and I almost bought a unit that was about $3000 and it sounds like that may have been insufficient. Or at least it maybe had a higher risk of not delivering on the promise. And certainly we don’t want to spend…

Dr Scott Sherr:

Yeah. It wouldn’t have been very comfortable. The 3K ones are not very comfortable. That’s the thing. If you’re going to spend…the typical treatment length is between 60 and 90 minutes, you want to be comfortable in there. And especially if it’s something you’re doing regularly, so most of the chambers I use are more comfortable than [what] you’re going to find for that kind of price overall.

Dr Ruscio:

Right. Yeah. I mean and if you save money for something that’s not effective, that’s not a very good value. Which is what I try to help some patients understand is that sometimes you’re better off spending a little more money upfront and either working with a competent clinician or using a treatment that’s efficacious than going the discount route and just wasting that money almost completely.

Dr Scott Sherr:

Right. I often tell patients it’s an investment in their longterm health. And like we were talking about earlier, it’s hard for people to think in that context. It’s always about how can I get better now? And spending the money with… You know and I’m not in the business of giving out guarantees, of course too. How people are going to do. And of course I have also lots of patients that I’ve treated over the years, and I can tell you about those experiences, but the variability is still there as far as how people are going to do. But certainly it’s an investment. And whether you decide to go to a facility or do you get a chamber for your house, it’s going to going to be an investment. And it is something that you have to look at in context with the rest of everything that you have going on.

Dr Ruscio:

Well, this has been great. I mean, like I’ve said, I’ve been thinking about experimenting with an at-home unit and I’m going to pick your brain offline here regarding what unit I should get. Because I think it’s time for me to take the dive, I guess, here.

Dr Scott Sherr:

Nice work. Gotta bring it back to the puns.

Dr Ruscio:

I’m glad that we have introduced you to our audience so they have you as a resource. And would you again, remind people of your website and/or anywhere else you’d want to point them online?

Dr Scott Sherr:

Yeah, sure. So website is my name it’s DrScottSherr.com. And/or integrativeHBOT.com will also get you there. And that’s my telemedicine telepractice for educating, advocacy, and for speaking to people all over the world. I also have my foundational practice called Health Optimization Medicine and Practice. This is a practice that’s based on the work of a nonprofit that I also work with as well, that’s educating doctors and practitioners on a foundational approach health. And this is a seven-module essential certification that we’ve just developed and it’s out for practitioners, doctors, and non-doctors that are interested in taking it and integrating it into their practice. Like I’ve integrated it into mine as a hyperbaric clinician. And you can find that, the education, at homehope.org and my personal practice is at home-sf.co. But you can find me at DrScottSherr.com and ask me about that stuff too. So those are the main places, I think, at this point. Yeah.

Dr Ruscio:

Awesome. Well, Scott, thank you again. And especially for taking time away from your son who, obviously loves you very much.

Dr Scott Sherr:

He does. He’s just come home from school and wanted to give me a big hug. And I have to go give him another hug after we’re done.

Dr Ruscio:

He’ll be glad to have you have you out the office. Well, thank you again, Scott. Again, real pleasure and opened my eyes to this therapy and its utility and how to use it. So, really appreciate it.

Dr Scott Sherr:

My pleasure, Michael, it’s been a real pleasure being with you and thanks for having me.

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