Episode Transcript
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Jill Brook: Hello fellow POTS patients and beautiful people who care about POTS patients. I'm Jill Brook and today we are so lucky to interview Dr. Scott Sherr again about another non conventional therapy he is seeing help POTS patients. You may recall that Dr. Sherr spoke to us about methylene blue last week and today he's going to educate us about hyperbaric oxygen therapy.
I've been hearing about it helping long COVID patients and others as well, so I know I'm really excited for this discussion. Dr. Sherr is a board certified internal medicine physician certified to practice health optimization medicine. He's also a specialist in hyperbaric oxygen therapy. He's COO of Troscriptions, and he has a telehealth and in office medical practice in Colorado, where he sees a lot of complex patients, including those with POTS and related conditions.
Dr. Scott, thank you so much for coming back today.
Dr. Scott Sherr: My pleasure, Jill. Nice to see you [00:01:00] the following week. So we had a good time last time talking about methylene blue. I'm excited to talk about hyperbaric oxygen therapy this time around.
Jill Brook: Me too. I know that this is something that you have written a lot about, so you must believe in it. Now, I used to scuba dive before POTS was a thing in my life, and I always thought that hyperbaric oxygen chambers were for scuba divers who came up from the depths too fast. What, is this the same thing?
Can you just maybe start by saying like, what is a hyperbaric oxygen chamber?
Dr. Scott Sherr: So it's the same thing. So hyperbaric therapy was developed for diving or decompression illness, otherwise known as the bends back in the 1800s when they were building bridges. And then they had these workers that were sunk down underneath the surface of the ocean and they were digging out parts of the bridges.
They had these kind of elevator shafts that would bring them back up to the surface and they didn't know it at the time, but it was basically a hyperbaric environment. And what would happen is if people came up too fast, they could get very, very severe injuries. And that's what was called the bends.
People would be like bent over with [00:02:00] neurologic symptoms and, and some people would die. Like the actual architect of the Brooklyn Bridge was paralyzed because of decompression illness. And this is actually the time where they were figuring out what was going on with the gases that was causing this to happen.
And so hyperbaric therapy was developed to actually simulate being under a certain amount of seawater without being under the water because water is extremely heavy and it's that pressure that's very, very vital to understanding what hyperbaric therapy is. So if you look at the definitions of hyperbaric therapy, the definition of hyperbaric therapy is that you're combining increased inspired oxygen with increased atmospheric pressure.
So I was already alluding to pressure before, but we're gonna go back to that in a minute. So let's talk about oxygen, because oxygen's very important. Oxygen's what we have and what we're required to have to help us make energy. So if we don't have enough oxygen around, we don't make energy, and we know that's all bad, right?
So what oxygen is actually doing is actually it's called the final electron acceptor in your mitochondria. So it's allowing you to maintain electron flow. Maintain the [00:03:00] capacity for you to make energy. So as far as we understand it, I mean, oxygen is the most important molecule that we need for life really.
And, and that's actually true for the, for the majority of the types of species that are around and on, at least on this planet, right? And so when we're looking about increasing the amount of oxygen in circulation, we have to think about how oxygen is actually carried in the body. Oxygen should be carried by red blood cells.
So red blood cells are the cells that our body uses to carry oxygen from our lungs where we, you know, where we breathe, obviously the oxygen in, and then it goes through our, the rest of our system, through our vascular system, and gets to every place that it needs to go to maintain our physiologic function.
So, in the area you're breathing in sea level, you have about 21 percent oxygen in the air. If you come to Colorado and hang out with me, you have about 16 percent oxygen in the air because we're at 5, 000 feet elevation where I live. Okay. So oxygen percentage changes depending on how far away from sea level you are.
So you can imagine if you're out on Mount Everest, the highest place on earth, [00:04:00] you're going to have a very little amount of oxygen in the air. If you're in, the Dead Sea or at the Dead Sea, you're actually a thousand meters or about three thousand feet below sea level there. There's actually more oxygen in the air by density.
Okay, so we carry oxygen on red blood cells and most of us do a very good job of this without having to do a whole lot, right? So if you've measured a pulse ox on your finger you've measured somewhere between 96 and a hundred percent. This is how many sites on the red blood cells are bound by oxygen
once oxygen leaves the lungs and goes to the rest of the body. So there's not a huge amount more sites available for oxygen to bind under normal circumstances. Now, of course, if you have like emphysema or COPD or bad other pulmonary disease, you might require oxygen to stay at that level, but for the most part, most normal people, most people have normal oxygen saturations. How can you increase the amount of oxygen in circulation? You can increase the number of red blood cells in circulation. So the number of red blood cells you can increase by coming to altitude. So you can come hang out with me in Colorado for three months and you'll increase the number of red blood cells you have in [00:05:00] circulation.
That is typically by a hormone that's released called the epigen or EPO for short. People have heard of the word or the letters EPO, E P O before, because this is also the doping drug. This is the drug that cyclists and other performance enhancing athletes will use. It's illegal because it increases the number of red blood cells in circulation.
And then if you have more red blood cells, you can carry more oxygen. The other way you can increase you increase the number of red blood cells you have in circulation is actually by giving yourself a transfusion of red blood cells. You can do that like the packed red blood cell transfusion. The cool thing about hyperbaric therapy is that we're actually using that pressure that we were talking about to drive more oxygen, not only on those red blood cells, if there's any sites available, but also into the liquid or the plasma of your bloodstream.
And that plasma is kind of what carries everything in your bloodstream. Okay. Lots of different things in it, but mostly it's kind of like a water saline, a saline kind of solution. Okay. And so, there's very little oxygen in there at sea level, but we can drive up to 1200 percent more [00:06:00] oxygen into the body if we're increasing atmospheric pressure.
Okay. And so atmospheric pressure is that heaviness that we were talking about with the water and going below sea. So if you go 33 feet below sea level, this is what we call 2ATA in our nomenclature in hyperbaric therapy. All that water above you, if you look up above you, is very, very heavy. You don't feel that heaviness because you're, the density of water compared to the density of you, but but that water is extremely heavy, and we all know this kind of intuitively if you've, you know, remember this
really bad Titanic accident, people in this machine or the submarine that, you know, that basically collapsed under the pressure instead of getting to the Titanic, right? So this is the pressure of being under. So we can simulate that pressure and drive more oxygen circulation. So as a result of this increase inspired oxygen.
So you can increase inspired oxygen up from 21 percent to a hundred percent, and then you can increase atmospheric pressure typically to no more than about two, two and a half atmospheres at max, which is about 45 feet of seawater in a [00:07:00] chamber. You're driving a huge amount more oxygen in circulation, and that's where the power of hyperbaric therapy becomes or as a result of that.
Jill Brook: Okay. So that's really interesting, and the depth is interesting cause, cause I remember diving in 45 feet. It's not that deep. That's not like a terrible, like a dangerous dive. But it's enough to make a big difference. But another interesting thing that I'm hearing you say is that normally, under regular conditions, we would only have the red blood cells carry oxygen, but when you have hyperbaric oxygen therapy, you can just infuse oxygen into the plasma.
And I don't know if this is relevant at all, but I know that POTS patients, on average, are a little bit depleted in both red blood cells and plasma. So is that, I don't know, do you think that's relevant to any of this?
Dr. Scott Sherr: It can be because what happens in a hyperbaric chamber, so it's interesting. We had a different conversation about methylene [00:08:00] blue and nitric oxide. We're going to have a little bit of a nitric oxide conversation now. What hyperbaric therapy can do at least short term is that it actually causes a mild vasoconstriction and a nitric oxide depletion.
And so it has a similar effect. In irrespect of, of what actually methylene blue does by it will constrict blood vessels down and it will increase blood pressure a little bit, which, you know, at least that's a, that's a temporary thing that happens with, with hyperbaric therapy, but that is happening when it comes to looking at plasma volume and red blood cell number,
hyperbaric therapy is not going to change those things, okay, but it is going to supersaturate the plasma, the liquid, so that you are going to have more oxygen carrying capacity, so that you're going to feel better. And this just, this is actually not just it is temporary, but it's not like it's in a couple seconds and it's gone.
You'll see a benefit. So like if you're anemic, for example, if you have low amounts of red blood cells in circulation, you'll find that you will see a [00:09:00] significant difference 3-5 hours or sometimes even longer after getting out of a hyperbaric chamber, you will see a significant benefit even up to 24 hours later after getting out.
So, it's a temporary improvement there, but you see an improvement in plasma oxygenation. And as a result of that, you're going to get more energy capacity available to you and you're also going to have a mild vasoconstriction of those blood vessels as a result of hyperbaric therapy as well and a mild nitric oxide depletion.
So you're going to get some, those are some temporary benefits that you can see as a result of going into the chamber.
Jill Brook: And I was telling some patients that we were going to be talking about this and their questions were, if I'm already using oxygen because of sleep apnea or because they just wear an oxygen cannula on their nose, is that doing the same thing?
Dr. Scott Sherr: So the answer is no, right? Because if you're just using the oxygen on a face mask or a nasal cannula, you're not getting the [00:10:00] pressure associated with being in a hyperbaric environment. The pressure is so, so important because not only does it drive oxygen up to 1200 percent more in circulation, at the same time, Pressure itself has effects on your physiology, increasing lymphatic flow, increasing energy production on its own, optimizing your immune system in various ways, and so it's the pressure that's necessary for the oxygen to be able to get involved in as many processes as it's doing because it's getting to such high levels in the system.
So you just can't get the same effects with a facemask of oxygen. Now, if you already require oxygen, though, for another reason, like, so if you're on oxygen at night or during the day because you cannot maintain your oxygen levels in the body, even on your red blood cells, then in those cases, it could be potentially dangerous to go into a hyperbaric chamber.
Not always, but you have to be aware because most people think that the reason why we breathe is because of oxygen levels, but it's actually not the oxygen [00:11:00] levels that actually give us the stimulation to breathe. It's actually our carbon dioxide levels. And so if you have a requirement for oxygen, not always, but many of the times, you also have a dysregulation in your capacity to know when to breathe because the CO2 levels may be shifted.
So you have to be careful there. So if you have COPD and you require, or emphysema, and you require oxygen, if you have like a restrictive lung disease, a pulmonary disease where you require oxygen, even severe sleep apnea, where you're using oxygen at night, you have to be mindful that going to a chamber may not be safe for you.
But especially everybody but the sleep apnea people especially. In sleep apnea, I find that people that use hyperbaric therapy can see dramatic improvements in how they feel because if they have sleep apnea, getting low oxygen at night, oftentimes, and then getting a little bit of hyperoxygen or more oxygen in the system can, you know, have profound energetic benefits overall.
I've seen that, you know, countless times over the years.
Jill Brook: Interesting. Okay. [00:12:00] So what are you seeing in your patients who have POTS and or Mast Cell Activation Syndrome or autoimmunity or long COVID or all the stuff that kind of tends to go along with POTS?
Dr. Scott Sherr: So the key to understand what's happening in hyperbaric chambers is that we flooded the body with all this oxygen, like 1200 percent more oxygen, maybe less depending on what pressure you used. And we can talk about that as far as the distinction between different pressures and maybe where that's beneficial.
But in general, there is the acute infusion of all that oxygen, and then there's the long term benefits, what I would, what I would call like an oxygen protocol, where you're going in, or hyperbaric protocol, where you're going in for multiple treatments over multiple weeks, potentially. So initially what goes in, what happens in the chamber is if you initially have a reversal of low oxygen states.
So if you have like a reversal of low oxygen states, if you have low oxygen, tissue, you're going to be able to hyperoxygenate that tissue. This is really important, especially in people that have had heart attacks or strokes or or acute blockages in another location like a limb or something like that.
And then you have like a ischemia or low oxygen. You can reverse those [00:13:00] low oxygen states very, very quickly. And then also we have an immediate decrease in inflammation and swelling, which can be very important. We have an immediate increase in stem cell release. Stem cells are the baby cells in our body that can make new cells anywhere that they need to go.
You also have an immediate improvement in immune system function. So you have your immune system starting to optimize itself. You start like going to an area of infection, going to an area of injury, going to an area of trauma, and starting to recover and rebuild and start, you know, cleaning up that tissue.
We also have a significant improvement in the capacity to fight infection, especially infections that do not like high oxygen environments. And this is going to be important in POTS in a minute. And also it's improving lymphatic flow, so improving detoxification. That's all immediately what's happening.
Okay. Then long term after doing 20 hyperbaric sessions, five days a week for a month, maybe six weeks, up to eight weeks sometimes, or even a little bit longer, you're seeing what's called an epigenetic shift. So the ability for your DNA to express itself in more optimal ways, this is called your epigenetics.
This is what hyperbaric therapy [00:14:00] is doing. It works on at least 8, 000 different genes in the system. Improving growth, repair, decreasing inflammation. So you have new blood vessels that form in tissue that have been, that's been degenerated or infected or, you know, traumatically injured. You have decreased inflammatory markers like TNF alpha, IL1, IL6, and other ones that are involved in inflammatory cascades.
And you have these stem cells maturing into, into, into mature cells in areas that need them. New bone, new heart, new connective tissue, new, new cartilage, like you name it, we can make more of it in the chamber. And then you have the the optimizing of the mitochondria as well, which are our energy producing part of our cells which improves with hyperbaric therapy as well.
So amongst other things. To give you that sort of framework, now you're looking at a POTS patient, right? Somebody with positional hypotension and tachycardia, like where can they benefit? So certainly they can benefit from the, the, the the initial vasoconstriction and nitric oxide depletion that we talked about.
But that's [00:15:00] temporary. What's more interesting is going to be its role in inflammation and its role in infection, as well as mitochondrial optimization. So those are the three ways where hyperbaric therapy can be helpful, but, or, and, I should say, that the key though, and I think this is probably the key point that I always try, like, I try to make, is that I think that everybody can benefit from hyperbaric therapy at some point in their life.
It's not an if question, it's a when question. So it's important to understand that hyperbaric therapy on its own, would likely be only a temporary improvement in somebody that has POTS without doing more foundational work at looking at what's happening as to is anything else that we can do here to reverse or to improve some of the physiologies, so optimizing mitochondrial function, energy production, detoxification, gut function, stress, you know, relationships, [00:16:00] like, are there infections ongoing?
These things need to be addressed because the hyperbaric protocol will change depending on if there is an etiology, if there is a a reason for the POTS symptomatology. And so the most common thing that I've seen over the years with, with POTS patients is they're coming in, they're coming in as POTS is one of their main symptoms, but typically as a result of something like Lyme disease or like long COVID or chronic viral infection that's being, that's being addressed, then we can use hyperbaric therapy and see benefit.
But I would not say if somebody you know, Jill, if you call me tomorrow, I didn't know you, we were just talking the first time, like, Hey, Dr. Scott, I would, you know, I've had POTS for a while, I'm still not a whole lot better, I've tried a couple things, I really would like to try hyperbaric therapy, right?
This is something that doesn't happen all too infrequently for me. That's what happens all the time, is to not use a double negative. And then somebody's like, hey, can I use hyperbaric therapy? I'm like, hyperbaric therapy may be [00:17:00] helpful, but let's talk about what we can do here to help understand your physiologic processes, what's going on here, and what we can do to support that before getting into a hyperbaric chamber.
Jill Brook: Yeah, that makes a lot of sense. You mentioned gut function and I have heard a couple people hypothesize that going into a hyperbaric chamber might also help their gut function and they they felt like maybe it was helping their gut motility and, or maybe even like helping work on dysbiosis. Is there any reason to think that would be the case?
Dr. Scott Sherr: Yeah, a lot of the, we think a lot of the dysbiosis, a lot of the sort of, the, the other word for dysbiosis is basically that the gut microbiota, the gut ecosystem is not optimal in some way, but a lot of the suboptimal aspects of it are related to what are called anaerobic bugs, excuse me.
Anaerobic bugs are bugs that are that do not like high oxygen [00:18:00] environments. Okay, and so what is hyperbaric therapy but a high oxygen environment? So there's been a couple small studies looking at small intestinal bacterial overgrowth and hyperbaric therapy and seeing benefit there. And we think that's the reason is because what the hyperbaric therapy is going to do is flooding the body with more oxygen, including your intestinal system, is that you're going to have a decrease in the number of those organisms as it relates to being in a high oxygen environment.
So I've seen that. I have also seen it so where if you have a lot of gut inflammation, like, like the lining of the gut is inflamed, for example in somebody like with inflammatory bowel disease, like Crohn's or ulcerative colitis, we've seen significant benefit using hyperbaric therapy as a profound stimulus that decreases inflammation.
It's actually been shown, especially in that population, to be as powerful as steroids. Hyperbaric therapy would be as powerful as taking a steroid medication for those patients. So it can be very, very powerful as an anti inflammatory to give you that sense. And so it's an anti [00:19:00] inflammatory, it decreases inflammation, it's decreasing swelling, it's probably killing some of those bugs that do not like high oxygen environments.
It's also rebuilding the area with stem cells as well, colonic and small intestinal stem cells as well. Certainly, there could be benefit there but again, it's, I would, if somebody came to me tomorrow and said, I have SIBO, should I get into a hyperbaric chamber? I'd be like, no, do some other stuff. Let's do some other stuff first, like optimize your gut function.
And then, you know, then we can think about hyperbaric therapy down the road, right? Because hyperbaric therapy is expensive. It's not typically, if you have a chronic condition that's been going on for a while, like, like many people with POTS, you have to do many hyperbaric therapy sessions. So it's not like you go in once or twice, you're going in at minimum 20 sessions, five days a week.
And so that's a lot of time. That's a lot of money. And so you have to be thinking about like, is it the right time to go in? And so oftentimes in patients with chronic complex medical illness it's not usually not often the right time to go into the [00:20:00] chamber right away.
And this is a problem because, you know, I work in, in, in more of a consulting environment in the hyperbaric world. I don't own a hyperbaric clinic. I do have a hyperbaric company that does make chambers and technology. And I get in trouble with my own company because I often tell people, look, is, is it the right time to go into the chamber?
If you own a company, you own, you own a clinic, right, that has hyperbaric chambers. You want to fill them with patients that they come in, like give hyperbaric a try and see how it goes. And, and sometimes that can be really good. Sometimes it does work out, but oftentimes I've found that if, if it's a chronic complex medical issue like, like POTS can be, then it's usually a disservice to just say, Hey, go into the chamber right away.
As I say, Hey, what kind of doctor are you working with? Do you have an integrated provider? What kind of supplement regimen are you taking? Like, and and another important piece that I always ask is, how much better are you now? Are you at your worst ever or are you like 50 percent better? So I found that if you're at your worst ever, then hyperbaric therapy is not a good idea.
This is often going to make people [00:21:00] feel worse. Sometimes make them feel slightly better, but usually their symptoms will come back. I got burned in the beginning of my hyperbaric career because we were having a lot of Lyme patients that came in with, with POTS, for example, and they were, some of them were in wheelchairs.
They couldn't even walk and then trying to get into a chamber, they'd be down for the count for like three days and then try to get back in. It was just, it wasn't a good experience for them. And I came to realize that there's a lot more that we could do to help people and support them before getting into the chamber.
Jill Brook: So I know we have a lot of listeners, because they write in, who have had POTS for a long time, and they're already doing a lot of the diet supplements, lifestyle, they've tried a bunch of medications, they're on some ones that help, and they're kind of always in that mode of like, well, what else can I do? Is, is that the person who this would be right for?
Dr. Scott Sherr: What I would say is that, I would prefer to know if there was an underlying etiology or underlying reason for the POTS. Like if [00:22:00] somebody said to me they had a POTS because of chronic, like from long COVID, or they have POTS because they have Lyme disease, or they have POTS because they have adrenal insufficiency or whatever.
Like then it's like, well, then I know what kind of protocol to go for, right, because I'm like, okay, we have a Lyme protocol. We have, we have like long COVID protocols. We have we have adrenal protocols and things like that. It's not as easy for somebody to come into me and say that they have POTS and they want to get in the chamber.
So, you know, for me, it really just depends on the, the reason for POTS, if there is an etiology.
So if somebody came in and said, I have POTS, I don't know why. I have positional hypotension and tachycardia. This is bad. I've tried all these things. It's not getting better, but I am, I am better than I was. I don't know if I would go directly to hypobaric therapy because I don't think that. So if it did help, for example, it likely would be a temporary benefit.
Now, if it did help temporarily, could you use it sort of in a long term fashion in a kind of maintenance way to [00:23:00] sort of help with your symptoms? The answer is yes, absolutely. I mean, I did this with other kinds of conditions where you have like a chronic autoimmune presentation and, and that can be for POTS as well, right?
Where you have like an autoimmune presentation and you see significant benefit using hyperbaric therapy. Say you did 20 or 30 sessions, you know, like I feel fantastic. This is great. I would say if you have an autoimmune kind of condition where hyperbaric therapy is not likely, you know, quote unquote cure it, but just help mitigate the symptoms where then you can think, well, maybe I can go in the chamber three times a week or twice a week, kind of in perpetuity, kind of to maintain that benefit.
And so I have seen that. So that, that is a possibility as well.
Jill Brook: Okay, well, and I guess this brings us to, there's two kinds of hyperbaric chambers. There's the serious kind where you have to go into a professional clinic and, pay, and then there's the kind that some people are able to just put in their home. And I don't know if that kind does anything, but can you talk about the two kinds?
And like, does it ever make sense to [00:24:00] get one at home or is that just too mild to be useful or?
Dr. Scott Sherr: Yeah. Yeah. Good question. Yeah. So I have a mild hyperbaric chamber at my house and I do think they have benefits overall. The way to think about it is more on the pressure side. So if you're getting a chamber that goes to about 1. 5 atmospheres, which is the equivalent of about 15 to 20 feet of seawater, if you were looking above you, right, that's 15 to 20 feet of seawater pressure.
That's what's called a mild hyperbaric pressure range, and those are typically done, they can be done in hard chambers and medical chambers, but they can also be done in soft sided units or or units that are, you know, are that are not fully fully the same shape when you, when you, when you decompress and compress them.
So basically soft sided units, usually made of some sort of like a nylon or a polyurethane type of material. So you can find soft chambers in people's homes, as you said, and typically they go up to about 1. 5 atmospheres. And then medical grade chambers there are different, two different varieties. There is a a, what's called a monoplace chamber. So it's a single occupancy chamber, one person going in the chamber at [00:25:00] the same, at one time.
These typically go to about three atmospheres of pressure. This is the equivalent of 66 feet of seawater, and you'll find these on a lot of medical establishment facilities, outpatient facilities, wound care facilities, things like that. And those also can go to the milder pressures too. They can go to the 1. 5, they can go to those, but they're, they're typically used at the deeper pressures. And you have something called a multi place chamber. Multi place chambers are when multiple people can get treated all at the same time. These are usually used at academic institutions around the world. These are going to have like an attendant, somebody going in there
with the people that are in the chamber also using a diving location. So if you've had a diving injury, oftentimes it's a multi place type of place. And you have like a seat, you're seated in there, seated in there, and you have like an oxygen tank or mask on that's on your face that you're getting that way.
So in general, when it comes to looking at pressures and what they can do, we think the neurologic pressures, the one for the brain and the spinal cord, around 1. 3 to about 2. 0. Okay, and then for systemic, so outside the [00:26:00] central nervous system, you know, causing significant impact about 1. 8 to 2. 4 is like the major range that we use, sometimes deeper than that.
So as you can hear, as you can understand, there's a little bit of a crossover there where some people will significantly benefit from like a neurologic presentation at 1. 3, but other people with a neurologic presentation may not start benefiting until 1. 5 or 1. 8 atmospheres. So when it comes down to thinking about what kind of chamber would be most beneficial, you have to kind of think about where most of your symptoms are located, right?
If you have mostly neurologic symptoms, then a mild unit that goes to 1.3-1.5 can be very, very, very beneficial. If you have more systemic symptoms like, you know, muscle, muscle issues or chronic fatigue and you know, joint pain, you know, those kinds of things, it might be better to have a deeper pressure to see the benefit.
But there's some crossover there, right? So, like, I have seen some benefit, even at 1. 5, for some systemic related issues. But, in general, like, I think of the soft sided units, the ones that go up to about 1. 5, for, [00:27:00] like, neurocognitive optimization, and also for what I also call day to day operations. So if you're relatively healthy, looking to have a little bit of cognitive capacity, a little bit of muscle recovery, jet lag, overall performance gains, you can see significant benefits with chambers that go to 1. 5. If you have more of a systemic issue, if you have more of a chronic complex medical illness, I do recommend trying to potentially have a chamber that can go deeper so that you can potentially see if it, the deeper pressures may be more beneficial overall compared to the mild ones.
Jill Brook: And is this what your telepractice does? Do you talk to people and help them figure out?
Dr. Scott Sherr: Yes, I've been, I've been involved in hyperbaric medicine for the last decade and then over the last four or five years, I have a telemedicine consulting practice where I talk to people all over the world that are looking to use hyperbaric therapy in the context of their condition or their goals.
And, as I was kind of alluding to earlier, a lot of my conversation with people has nothing to do with hyperbaric medicine at all. It has a lot to do with what are the other things that might be beneficial [00:28:00] before even thinking about getting into hyperbaric chamber. And then, yeah, we discuss what type of chamber might be beneficial, soft chamber, hard chamber, which type of pressures, and if it's something that would be needed to be used
just short term, like if you think if it's something that we think that hyperbaric therapy could be helpful, just for like a small amount of time, or if it's something that might be like a longer term play, whether it might be something that, you know, do you, you might need to think about using more like a maintenance variety over time as well.
So, and that kind of depends, right? Depends on if we think we can completely heal up whatever's going on, or if it's something that we think we can help mitigate, but might still still be there and might require some maintenance to maintain that benefit.
Jill Brook: Interesting. Okay. So I know a lot of athletes like to have the mild hyperbaric chambers in their homes and they use it just to recover faster. Do you see POTS patients ever like having better exercise tolerance for using something like that?
Dr. Scott Sherr: Well, I mean, if you're, if you remember, we talked about a little bit earlier with increasing the amount of oxygen circulation, [00:29:00] increasing the amount of oxygen carrying capacity, you will find that people will have an increased performance gain after getting out of a chamber. Now, the key is typically you don't want to go too deep with these kinds of protocols where you're looking for just energy, because the other thing that happens when you go into a chamber is that you're getting all this oxygen in circulation.
You're creating all this, you're creating stress on the system too. Okay, especially the deeper you go. And so people, I think, understand that we make energy, right? We make energy that's called ATP. And when you're making ATP, you're also making other products. You're making carbon dioxide, which we breathe out, making water, but you're also making these small amount of reactive oxygen species, or free radicals. And these are signaling molecules, we need some of these, but too many of these can cause the system to start rusting and breaking down. And what happens with a lot of, you know, POTS patients and people with chronic inflammatory issues is that their capacity to neutralize this free radical amount, these, these free radicals in the [00:30:00] system becomes depleted, becomes more challenged.
And then in a hyperbaric environment, we're flooding the body with more oxygen, creating more oxidative stress, more free radicals. Now this, these are signaling molecules. This is why you have more stem cells. This is why you have the epigenetic changes in the genes that we talked about before, but you have to be able to be able to neutralize that, that, that that oxidative stress too.
And in POTS, many POTS patients, many patients with chronic complex medical conditions, their antioxidant levels are depleted. So it's really important you need to support those as they're going through hyperbaric experience, hyperbaric treatment. But the milder pressures, like your 1. 3, 1. 5s, they're going to cause some oxidative load, but they're not going to cause a huge amount compared to going to 2. 0. So if you're looking for just like a little bit of energy, like a little bit more umph, then using the milder pressures is likely better because you're not going to get the, the oxidative stress that's happening at the deeper pressures. So, but that may not be as therapeutic over the long term going to the [00:31:00] milder pressure because you're not getting the benefit of some of those epigenetic shifts that are happening, but you need to be more supported if you're going to go to a deeper pressure, because this is where I've seen people, you know, feel worse after getting out of hyperbaric environments if they're not being supported well.
Jill Brook: Okay. Yeah. No, I appreciate what a nuanced understanding you have of this, that it's not...
Dr. Scott Sherr: Yeah, yeah, I mean, I, what I often say is that if you have an acute issue, like an acute trauma, acute infection, acute like a trauma, even including surgery, for example, acute stress, hyperbaric therapy, three to five, sometimes even one hyperbaric session can have a huge effect at just accelerating the process of the body healing faster.
Okay, but if you have a chronic issue, it's been going on for long periods of time, you likely have depleted capacity to make that antioxidant reserve be available to having more stress in the system. You also likely have depleted capacity to make energy on its own. And this is why actually I'm very, very emphatic with the people that [00:32:00] communicate with me that have chronic issues, like, look, hyperbaric therapy may be helpful for you, but let's not do it right now.
Let's optimize your capacity to make energy. Let's optimize your capacity to neutralize the oxidative load that will happen inside of a hyperbaric environment. Now, you want that oxidative load, you want that stress, but you only want it for a short period of time until the body is able to compensate.
It's like exercise, right? When you exercise, you're causing stress on the system, but you're doing that so the body can compensate for that and build back so you can, you know, build bigger muscles or whatever. It's the same thing in a hyperbaric environment. So I often wait three or six months before people go into the chamber to ensure that they've optimized energy and detox at the very least.
And this is where Methylene Blue comes in a lot for me. And we talked about on our last podcast because Methylene Blue has the capacity to do both. It helps with making more energy, and it helps with detoxification. So I can support people that are interested in hyperbaric, in hyperbaric therapy by giving them Methylene Blue [00:33:00] in small doses as a way to support the system and allow them the capacity to actually harness all that oxygen, make more energy, and then detox from it in a more efficient way while we're doing the longer work of optimizing vitamins and minerals,
and nutrients, and gut health. And I have a whole program that I work with patients on called Health Optimization Medicine. This is a Health Optimization Medicine in Practice, or HomeHope for short, is a non profit organization training practitioners like me on how to optimize health in our patients, rather than treating disease specifically. You don't have to be a doctor to do it.
You can be a, you can be a health care practitioner of any type. But I use this framework when I work with anybody, but I also especially use this framework in as many patients with, that are looking to do hyperbaric therapy as, as possible because then I know that they're gonna be able to make energy effectively, and they're gonna be able to detox effectively.
And does this include to be able to do all these things, it's not just looking at supplementation, right? It's looking at dietary changes, looking at behavioral changes, looking at [00:34:00] lifestyle changes, like relationships, etc. Like stress in your environment, like all these things kind of play into it.
Jill Brook: Great. Great. Okay. So as an overall message, what I'm hearing is that it has, The capacity to do some amazing things, but you don't just jump into it. You talk to somebody like you who really understands it.
Dr. Scott Sherr: Yeah. And do it in the context of like, like a good example is I've seen a lot of patients over the years with Lyme disease. Okay. And so, if a patient with me, that comes that wants to talk to me, you know, communicates with me and says, Hey doc, I've heard that hyperbaric therapy is great for Lyme disease.
I want to get in the chamber. I'm like, well, first question is who is helping you with your Lyme disease, right? Who are you seeing that and they also have POTS, you know, there's a common combination, right? I said, well, who's helping you with your Lyme, right? And so if they're not having the experience of working with a Lyme literate physician, then I will be referring them to a Lyme literate doctor and saying, before we do hyperbaric medicine, you need to see a Lyme literate doc.
If you can, and just try to optimize what's going on there, address the Lyme. And then what we can do in the chamber is that we can address the [00:35:00] Lyme as well, using deeper pressures in the chamber, actually, to get a systemic benefit. But I may not start at a deeper pressure.
I would likely start at a milder pressure and then increase them slowly because, again, I'm worried about that oxidative stress, that free radical buildup that happens with the flooding of oxygen. But Lyme bugs do not like high oxygen environments, so we want to get that high oxygen environment. And then what?
We treat the Lyme disease, that gets better, the POTS gets better too, right? And then the same thing happens with long COVID these days, right? It's the same issue. If you have, if there is ongoing protein spike replication, we need to address that. If it's EBV with ongoing viral loads being high for Epstein Barr, like you want to address that as best you can with diet, supplementation, lifestyle, all the stuff that I know a lot of the people that are listening are doing.
But then you can use hyperbaric therapy as an augmenting strategy to work on the immune system, to work on inflammation, to work on mitochondrial function while you're doing that stuff. Right. So it's, it's, it's kind of like, you have [00:36:00] to think about how you're going to how you're going to stack things in various orders, right?
And then, you know, and then the timing, the temporal relationship within that as well. But, but within that context, I think that hyperbaric therapy can be very, very helpful. But yes, you're not, I don't I don't like people just running into chambers and, and unfortunately, there's a lot of facilities that you go to like, oh, just try hyperbaric therapy, see how it works for you.
And like, that's just not how you want to operate, you know, with, with this kind of technology. Because first of all, you don't want to go too deep and not feel good for like a week afterwards, which can happen. And second of all, you don't want to go in and, you know, waste your money, right? The mild units can be great.
You know, even you can, people can try those without a huge amount of worry. To be honest, sometimes like those mild units that go to 1. 3, 1. 5 can just give you like a little bit of energy, like a little bit of a cognitive boost. Okay, great. But if you do one or two sessions, it doesn't do anything for you,
it doesn't mean that hyperbaric therapy won't be helpful over the longterm either. So it's a matter of like understanding protocols, understanding the timing, what are you doing before, during, and after. And and the before is just so, so important, which [00:37:00] is like optimizing that energy production capacity.
And that's why I use a ton of Methylene Blue as well.
Jill Brook: Interesting. So the thing that's really sticking out in my mind is that you had said in some contexts that a hyperbaric oxygen chamber had done something as well as what's the nasty drug that is so anti inflammatory?
Dr. Scott Sherr: Steroids. Yeah.
Jill Brook: Steroids. Yes. So for those of us who on occasion in a bind have had to do steroids and they make us absolutely miserable and crazy this would be something we could maybe explore and see if...
Dr. Scott Sherr: Yeah. Yeah. I mean, it depends on why, why people would need steroids, right? In the sense of sometimes it's just better to take steroids. Okay. But but get, but hyperbaric therapy is very powerful there. So if you have significant inflammation, there is an option potentially to use hyperbaric therapy to mitigate that.
It just depends on what it is. Like if it's like, if it's an allergic reaction, for example, you have like [00:38:00] swelling, just take Prednisone, please. Like, because it's going to be, because I don't want people, you know, closing up their throat and not being able to breathe, right? But if it's like, it's like joint pain, or like if you have severe inflammation in the limb or something, and yeah, you could potentially think about using hyperbaric therapy to help mitigate some of that inflammation if you have time to use something like steroids in the process.
Jill Brook: Wow. Exciting exciting stuff. So I guess I know we just have a few moments with you. If somebody was interested in exploring this more with you, what does that look like? Like, is there a website they can go to?
Dr. Scott Sherr: So a couple things. So I created a company about four or five years ago called Onebase Health. The number one spelled out, onebase, one word, and Onebase Health. What it really is was kind of trying to create a mirror of my practice in, in, in, in trying to create an ecosystem for people to learn about hyperbaric therapy, to get education on not only hyperbaric therapy, but how you can integrate it with other tools, techniques, technology.
Eventually labs and [00:39:00] other practitioners and things like that too because my practice is an integrative practice. So if people are interested in working with me, it's my website is integrativeHBOT.com. So the word integrative and the letter is HBOT for hyperbaric oxygen therapy dotcom. I think you, you could just search my name, Dr.
Scott Sherr.com. I think that also works. I'm also on Instagram at Dr. Scott Sherr, D-R-S-C-O-T-T-S-H-E-R-R. But Onebase Health, the way it was developed was to create an ecosystem for patients that could really understand more about using the power of these technologies in a more integrative context.
And so we sell chambers, we have lights and saunas and cold plunges and things like that. But our main focus is creating sensor technology. That, that integrates with wearables, you know, so sensor technology that goes on your hyperbaric chamber, your lights, your sauna, your cold plunge, getting data from those things, and then wearable technology that you're wearing, like your Apple Watch, your, your Oura ring, like I'm wearing, or, you know, your Garmin whatever, and then being able to integrate all that, that data into a personalized plan for [00:40:00] you, depending on what your needs are.
Now, it's a wellness device. It's not going to give you medical, medical advice for POTS, for example. Right. But, that's what I'm for, that's what my consulting practice is for, and being able to navigate and integrate all these tools and technologies together. So, so yes, in short, OneBaseHealth. com is the company where we have chambers, and we have this technology, and this ecosystem we're developing.
My own personal practice is IntegrativeHBOT. com. Dr. Scott Sherr you can just Google me or email me. Search me and you can find me as well that way. And then my Instagram handle as well.
Jill Brook: Fantastic. Well, you're such a wealth of knowledge and we really appreciate that you are thinking outside of the box for those of us who have sort of tried all of the normal same old same old treatments and I just appreciate how, how much complexity you consider as you think about this stuff.
This is awesome. Anything else to say about this or shall we just send people to your websites in the show notes?
Dr. Scott Sherr: I think we've covered a lot here. It's my pleasure. I really do [00:41:00] appreciate the, the opportunity to speak about a very complex topic, but trying to make it so that it's, there's a runway or there's a there's a way to think about it in a context that I think could be very, very helpful, but just make sure that when you're thinking about hyperbaric therapy, use it in the context of more of an integrative strategy, almost always.
Jill Brook: Thanks a million, Dr. Scott. And hey listeners, that's all for today, but we'll be back again next week. So in the meantime, thank you for listening.
Remember you're not alone and please join us again soon.
