By: Nate Mickelberg
Dakota Medical Foundation
When Colleen Geraghty’s son woke up one-morning last year, he could barely open his eyes.
“He couldn’t even be near light,” says Geraghty, a Chicago-area mother of four. After an errant ball to the head at lacrosse practice the afternoon prior left her son feeling a little off, Geraghty spent the night monitoring his symptoms.
“I looked at his eyes, and they looked a little off but not enough to be alarming,” she recalls. “I asked him some questions, and he answered everything. He never threw up, never lost consciousness.”
She suspected it was a concussion but wasn’t sure until the following morning when the “tough, no-nonsense” 16-year-old needed sunglasses just to sit under the fluorescent lights of his pediatrician’s office. After his doctor confirmed it was, in fact, a concussion, Geraghty says they were basically sent home and told to let him rest in a dark room for as long as it took and that there was nothing else they could do.
She was given the same advice the year before when her then 8-year-old daughter spent more than three weeks recovering on the couch after an accidental kick to the head during a soccer game. Frustrated, she got on her computer and started doing some research.
“Not only was it a helpless (feeling),” Geraghty says, “I was just downright annoyed.”
She came across an area doctor who was taking a more proactive approach to concussions with something called hyperbaric oxygen treatment, or HBOT. By the next morning, she had her son in Dr. Daphne Denham’s suburban Chicago office to undergo the first of what would eventually be four hyperbaric treatments.
“When he went in, he rated his pain around a nine (on a scale of 0-10),” Geraghty says. “The condition he was in, I can’t imagine him being like that for multiple weeks. He didn’t want to be around sound, light, anything. He was sensitive to all of it. (During the first session), he was in for maybe an hour and ten minutes, and he came out laughing with his pain at a one or two.”
The most amazing part? By the end of the next week, he was fully back to his normal school and sports schedules.
What Is HBOT?
While HBOT is currently FDA-approved for 14 different medical conditions, including carbon monoxide poisoning and burns, its role in treating concussions is still being established. Right now, major insurance providers won’t pay for it.
HBOT is a one- to two-hour medical treatment during which a patient breathes 100 percent oxygen in what’s called a hyperbaric chamber. During “the dive,” the pressure in the chamber is increased to an amount that’s about the equivalent of riding in an airplane, and the result is a dramatic increase in the amount of oxygen in the patient’s blood. HBOT does three things, in particular:
1) It hyper-oxygenates tissue.
2) It resolves swelling.
3) It reduces inflammation.
Denham’s been treating wound-care patients with HBOT for more than a decade, and for the past three years, she’s successfully treated more than 150 concussion sufferers at her Northbrook, Illinois, practice. Trained as a general surgeon and as someone who’s seen significant brain injuries over the course of her career, she says her initial interest in HBOT was fueled by a desire to find a better way to treat head injuries.
Getting Proactive with Concussions
“Naysayers will say, ‘You’re treating patients who are going to get better and didn’t even need it.’ After seeing what I’ve seen, it makes me really wonder about this belief, that the vast majority of people just get better on their own,” says Denham, who cites a 2018 Centers for Disease Control report that found that at least 30 percent of patients who suffered a mild traumatic brain injury (concussion) still had persistent symptoms one month after the injury.
As Denham explains, the current standard of care for concussions in the United States is to recommend rest until a patient is symptom-free. There is, however, a growing movement to take a more proactive approach. In fact, just last year, the U.S. Department of Veterans Affairs announced it will offer HBOT as a treatment option for a small number of veterans with PTSD.
“No one is taking — at least in a uniform, large-scale way — what some have called the aggressive treatment approach instead of wait-and-see, where you treat the symptoms and manage the problems,” she explains. “It’s worked far better than I ever thought. What’s stuck with me most is when a kid comes in with minimal symptoms and then comes out and says, ‘Wow, I didn’t realize how bad I was. It’s that immediate. It’s that dramatic.
“My whole goal, from knowing what happens from injury to the next week, is to stop the injury progression. We’ve had some kids in for a treatment three to six hours after their concussion who will never know what extent their injury would’ve been because we were able to stop it. And eventually, that’s what I want: Concussion in Friday night football, you’re in the clinic at 8 or 9 o’clock Saturday morning.”
Details of the Concussion Care Initiative
It’s Denham’s frustration with some of the medical community’s laissez-faire attitude toward concussions that brought her to Fargo to open a hyperbaric clinic and help lead the recently announced Concussion Care Initiative with Fargo-based Dakota Medical Foundation.
The initiative, which kicks off this fall, seeks to improve the standard of care and access to treatment for people in the region who experience a concussion. It will focus on ensuring HBOT will be available free of charge to up to 100 local students participating in activities ranging from football to hockey to dance, with an ultimate goal of ensuring that all children participating in sports receive the most effective concussion treatment possible.
The initiative’s first step will be to conduct a pilot program and study, the goal of which is to gather data about concussion best-practices. Instead of thinking about how to manage concussions, Denham says, the goal is to find a way to treat them.
Denham’s state-of-the-art Healing with Hyperbarics clinic on 45th Street — the only one of its kind in Fargo-Moorhead — not only features four medical-grade hyperbaric chambers; it also has a separate room for eye-testing, which will be overseen by Grand Forks-based optometrist Dr. David Biberdorf. Eye-testing is an essential part of the concussion treatment protocol, Denham says, and since more than 85 percent of concussion patients have eye complaints, they’ll be using this eye-testing both pre- and post-concussion treatment.
The opportunity to be a part of this kind of cutting-edge study and to ensure a higher level of safety for players is something Fargo Shanley High School Head Football Coach Troy Mattern says he’s excited about.
“We just want to be proactive,” says Mattern, who’s going into his 19th year of coaching and his second season with Shanley. “Any time you’re talking about player safety and health, especially concussions, and being able to be on the forefront of it, we’re all on board for that. We want to show our parents and families that we take concussions seriously.
In contrast to an MRI, HBOT patients can watch TV and speak with people on the outside while undergoing treatment.
“This will document objectively the effectiveness of HBOT,” she says. “By performing pre- and post-treatment eye testing, we should be able to collect the objective evidence to support what we are observing subjectively. The opportunity we have in Fargo should completely change the discussion from concussion management to concussion treatment.”
A More Technical Look
at How HBOT Works
“Maybe down the road, hyperbaric could … get our kids symptom-free a lot quicker and back to play. And if something does happen, we have protocols or procedures in place that can help them get to where they’re not going to have long-lasting symptoms.”
Concussions and Our Region
The implications of concussions go far beyond the playing field, though. According to a recent CDC report surveying nearly 15,000 kids, approximately 15 percent of high school athletes experienced a concussion in the past year, and 6 percent suffered more than one. Another CDC report documents that nearly 15 percent of concussion sufferers needed academic help a year after their concussion. Yet another study found that people who suffered a traumatic brain injury before the age of five or between the ages of 16-25 have an increased risk for dependence on alcohol and drugs.
Looking at those numbers in the context of this region and the nearly 27,000 North Dakota high school student-athletes, that’s an opportunity to help more than 4,000
concussed kids in the 2018-19 school year. That’s a potentially significant impact.“What’s the (economic) cost (of concussions)?” asks Denham, who will produce monthly reports throughout the DMF concussion pilot, which will culminate in a final report in spring 2019. “I expect we’re going to find out that it’s cost-effective to treat all concussions, as we look at what North Dakota has spent on post-concussion education services, as well as addiction services.”
While a goal of successfully treating a larger number of kids is a given, Denham says her aim is to completely change the discussion around what concussion treatment looks like:
“We’ll be asking student-athletes: If you thought there was a treatment for a concussion and you weren’t going to be sentenced to your room in the dark for three months and could go back out and play, would you be more willing to say, ‘Hey I’m kind of goofy. It’s probably not that bad, but my brain’s worth it. Let me go get checked out and have treatment.’ Would you be more willing to report?”