Healing Under Pressure with Hyperbaric Oxygen Therapy w/ Nicole Garrett | The Holistic Pharmacy Podcast

0:00You are listening to the Global Network of Podcasters dedicated to the Pharmacy profession. Welcome to the Pharmacy Podcast Network. Hello everybody, welcome back to the Holistic Pharmacy Podcast. I have an amazing topic and guest for you today. So I'd like you to welcome Nicole Garrett to the show. She's the CEO of Under Pressure Hyperbarics at Premier Hyperbaric Oxygen Therapy Center in Beverly Hills recognized for its clinical-grade safety standards and results driven approach to wellness. With nearly two decades of experience, her career began as a commercial diver and dive medic, where she first learned the lifesaving applications of pressure and oxygen in extreme environments.

1:04Today, Nicole leads a multidisciplinary team at Under Pressure that supports surgical recovery, sports performance, chronic inflammation, and overall health optimization using hospital grade chambers and evidence aligned treatment plans. So Nicole, you're in the right place. My audience has not heard about Hyperbaric therapy yet from this show, but maybe they've heard about it in clinical practice. So I'm excited to dive in, no pun intended into this topic with you. And first, I want to ask what I ask everybody on the show, which is really about your origin story. And from your bio, it sounds like you had a very interesting way that you got into this type of work. So can you tell us a little bit about that? Yeah, I was, like I said, I was a commercial diver and a dive medic and was recruited to work at UCSD's trauma center, Hyperbaric Chamber. And that was because of all the dive medicine experience, dive medics are kind of like a paramedic, but instead of focusing on cardiac issues, we focus, we focus on dive injuries.

2:10Just to source and thesis decompression sickness, gas embolisms, those kind of things. And from the university, I went on to do open another satellite center for them. I did some traumatic brain injury research. And then I went to open a few hundred different hospital based clinics all over the country. And my frustration in doing that was seeing that all these high level hyperbaric centers were only treating the FDA approved indications, the same 12 to 14, depending on the state. And it just felt like we were missing the opportunity to increase research, bring this really valuable therapy to people that don't qualify for those very rigid standards. And so that's really what drove me to open under pressure. And because of my background, we are set up as a hospital grade clinic with the right equipment, fully trained staff. So we actually can build Medicare and insurance and treat those on label as they're called indications, but we can also do some more traumatic brain injury research and work with line patients and work with people who have some other modalities going on and even contribute to the research for that.

3:19Wow, amazing. Before we go any deeper into the science behind what type of therapy that this provides for people, I'd love to ask why specifically did you become a diver and then went on to become a medic like one got you into that work. I don't feel like I meet many divers in my line of work, especially probably not like underwater welding type work. I moved, I grew up in California, we moved to the Midwest and then I moved back as soon as I hit college and wanted to be a dolphin trainer at SeaWorld. And I got hired there and realized everyone's working two to three jobs to survive and it wasn't feasible and I literally opened up the newspaper one day and saw an ad for the commercial dive school. Well, that seems really cool. It's adjacent to what I was looking to do and just jumped in. So cool, amazing how sometimes life just throws you different opportunities that you hadn't expected.

4:20And it sounds like you've been able to run with this pretty far and wide and open up clinics and you know go from unlabeled to off label uses. So how did that all unfold for you and how did you continue to sing yes to those different opportunities that came up. Yeah, it was a lot of pushing the boundaries, a lot of asking for more, especially as I progressed up through the other companies. The other thing I've done throughout my career is I teach the UHMS and national board hyperbaric course. So that's really helped me keep a good network of physicians and kind of really help educate more and bring them to the market. And so when it was time for me to kind of make the jump. I had quite the role of ex of people to call and takes our current medical director, Dr. Sam Cohen today. We're actually opening our second clinic right now. I'm teaching another course and we'll open in a few weeks. So it's been a really fun journey and it's been a very atypical one. You know, starting with commercial diving, then doing research and then doing kind of the installation in front and side.

5:24So yeah, for sure. So what brought you into the research side of it and when did you first realize that there were a plethora of different off label uses that you can apply this to. I realized very early on there's a plethora of what they call off label uses. Actually in the US, there's 132 reasons to treat your dog or your cat and a hyperbaric chamber, but currently only 14 to put a human in. And you know, we are all mammals. We all use oxygen basically the same way. So that's just kind of limitations of our system. And that's what drove me to want to explore the more more off label. When you look at kind of what we call the mechanism of action. So what's actually making this work. If you look at hyperbarics, it's very simple. It's pressure and oxygen. We're just using the pressure. By putting you inside the hyperbaric chamber to dissolve the oxygen deeper in your tissues and then your body does all the work. And so as long as you're using those same mechanisms, they really do apply to a lot of things our body uses that got antibacterial properties, antiviral properties, really potent anti inflammatory.

6:33It's the only thing we have in medicine that grows new blood vessels. So when you look at healing almost any modality, if any of those things plug in, it's going to fit. It's going to be a good application for that. Yeah, that's a fun fact about the pets and the indications there. I had no idea that we were doing hyperbaric for pets. And I feel like even though it is adjacent to human care because of the whole insurance model that we use in the US. We're not sure or sometimes like completely different options are available in those kind of clinics that usually do a lot of cash services versus the more conventional model where it's all about prior authorizations and payers and it's just so complex that we don't even know sometimes of these alternative or complimentary therapies as they're called. It's available really and we just tell people, you know, here use your option, you know, your pill or your surgery, that's usually the most common thing that you'll get offered.

7:36And in the past I would say like 15 years, I started hearing about hyperbaric, but I still feel like it's not made it to mainstream. So I'm curious like what surprised you maybe or what continues to motivate you as far as the applications that you've seen and the health benefits that you've witnessed. Yeah, we constantly get surprised here when we're treating patients, a lot of times we'll treat a patient for one thing and they'll have other things going on. And they'll come back and say, look at this scan, like I didn't have to have this done this time because we've reversed some of that or glaucoma is a big one. We've had a couple patients now, you know, with glaucoma, your pressure and your eyes really high. They're constantly taking drops to bring that down. The hyperbaric chamber can reduce the inflammation, but we always thought that's kind of a temporary effect and be like taking your drops are going to need to come back tomorrow. And they say once you lose your vision from glaucoma, you usually get like a little pizza slice of vision loss.

8:39That's irreversible. We're having people come back with testing. I have more vision. I've kind of decreased that gap or my pressures are getting lower over time, even though this is the only thing I've done different. So that's just one example, but it's kind of why we're really enjoying having a little more liberty with what we treat and having a really close connection with our patients. And then we start to go, OK, let's reach out to some of these optimologists and see can we do some research with you and can we test a few patients and see if this should be done on a larger scale. So maybe one day it is approved for everyone. Amazing. Yeah. And have you seen a difference between the produces and the sort of off label that we've been talking about as far as either the awareness of patients or like where the payment comes in. And we've seen a little bit more about that. Yeah, the business side, if it's not one of the approved indications. We've seen in the last five or so years that some of the private insurances, there's no one to call it Medicare, at least in California.

9:46It's just kind of fee for service. It is what it is. Some of the private insurances are starting to use hyperbaric slightly outside the approved indications. It means the patients tried a number of things and they failed. And we do what's called up here to peer with one of the medical directors at the insurance company and say we think this will work because the mechanism of action is the same, these things have failed. And so for patients that really helps, it's important to know with hyperbaric oxygen therapy. It's not you're not doing one or two treatments. Think of it like a course of antibiotics. You're going to be coming in every day for 10, 20, 30, 40 days in a row. We are just giving you oxygen and your body has to kind of conduct all that healing on its own. It's a slow process. And so if you think about financing something like 40 treatments, it can be quite costly. So it's amazing that we're starting to see the evolution of at least some private pairs. But most everything is still cash as far as going outside those 14 indications.

10:46Yeah, makes sense and still great that they have that option. And it's not just kind of blocked off for them just because it's not approved yet by the scientific literature that's available. But clearly in practice, you're seeing amazing results. So you brought up a good point about how long lasting a treatment can be. So what is the sustainability or long-term maintenance plan with somebody that is going through hyperbaric? Yeah, that really depends on what we're treating. So if we're treating like a post surgical healing issue, you know, once we get you healed, you're done. You don't really usually ever need to come back. If we're in the same for kind of radiation injuries from cancer treatments, we're reversing the damage. The radiation often kills the blood vessels around the cancer as well as the cancer. So they have trouble healing. The tissue is really dense. If we can regrow those blood vessels and fix the problem, there's no need to come back.

11:46But if you're looking at something like diabetes and long-term diabetic wounds or some of the autoimmune diseases that can be more chronic. You're probably going to come back and do a series periodically. And each indication has a little bit different lifespan. There's a lot of research that's helped us figure out, okay, you're going to need to come back in six months. You may be good for two years. Or for lupus, for example, it's a really potent anti-inflammatory. So the start of a flare up, if we can get people in for like three treatments, we can prevent them from going to hospital on having to get on cortical sorids and get this super like this cascade of events from happening. But that's going to still happen every time you have a flare up. So it can prevent a lot of things, but you're still going to need to use this just like you would another tool when you have an incident. Yeah, yeah, totally. That makes sense. And so how often, like if you're in an active treatment stage, how often do you recommend typically a session?

12:46And can you tell us a little bit about that process? Yeah, so I'll describe the session first and then usually the frequency. So when you come in with us, the very first appointment, we're going to do a clearance. There are a few contraindications, hyperbarics. There's a couple of relative ones. So we go through all of that with you. Make sure that we don't have to make any alterations in your protocol. And then we determine the best treatment for you. And we just use we dose oxygen in the hyperbaric chamber with time and pressure. So the longer you're in there or the deeper you're in there. And each depth kind of has different physiological effects. If you think of something like bone, it's a really dense tissue. So for treating a bone infection or injury, we need to go a lot deeper. And you need to be another a little longer to get the oxygen to diffuse in that dense tissue. So we take those things into account. And then when you start the actual treatment itself, you're going to change into some hyperbaric approved scrubs. It is a chamber full of eye pressure oxygen. So we worry about fire. So we're going to take your cell phone. We're going to take your watch.

13:46We're going to try and take off all your jewelry. We're going to put you in the hyperbaric approved scrubs. And then we're going to put you in the hyperbaric chamber. When we start the compression phase, it's kind of like landing in an airplane. That's when patients will feel the pressure change on their ear. We would have already coached them on how to clear their ears. We can communicate with them the whole time because we have these clear acrylic chambers with a phone that connects. So we can talk to them if they're having trouble and pause treatment. Most people do great and don't have any issues. Once they get to their treatment depth, they hang out for one to two hours, depending upon what their protocol is. We do have a TV on the outside so they can watch TV and just relax. Your only job inside is to breathe. And then when we come back to the surface, it's like taking off in the airplane. Your ears will clear on their own. And as long as you're breathing like at a normal rate, that's all you have to do. As far as frequency. We have most patients start with either 10 or 20 treatments, unless you are looking at something like a severe bone infection or heavy radiation damage.

14:47And then we start with like 30 treatments. And then we have periodic check-ins to see how you're doing. Do we need to make adjustments? Should we extend your protocol? Should we change your depth? Those kind of things. Yeah, it makes sense. So you mentioned contract indications. And that's something that everybody probably in the audience is wondering about. Like, am I a good fit? So what would you say is not a good fit for hyperbaric? Yeah. The number one contract indication for hyperbarics is any untreated pneumothorax. So like a long issue if you've had a collapse long. If you've got a history of what they call blebs or any long issues, we usually have pulmonology clear you. Just to make sure we are changing pressures is simulating diving. So part of our clearance is a basic dive physical. And if we need to send out for advanced, we would. That's the biggest factor. After that, there are five medications that are relative contraindications. We can induce something called oxygen toxicity while you're in the hyperbaric chamber.

15:50And those medications can be part of that. So we will get your medication list and your history. Four of them are chemotherapy agents. So, you know, if we're working with any cancer patients, we're usually working with our oncologists anyways. And we just calculate the half-lifes. A lot of them, if you're going through cancer, it's actually really beneficial to get an hyperbaric chamber. It mitigates a lot of the side effects of chemotherapy. It can actually increase the potency of the chemo for the cancer, but protect your healthier cells. So a lot of times the oncologist can lower their dose a little bit and yet have it be more effective. But again, we need to figure out those doses in timing. Sometimes you need to take three or four days off after the infusion and then you can come back. After that, we really just worry about your ears. So we take a look at your ears. We see how they're clearing. I have had one patient that didn't have a used station, too, which is what you used to clear your ears. And so her ENT advised she not go under pressure because we could rupture her ears.

16:53If you have a cold or kind of sinus congestion, usually a good time to skip treatment until that clears up, just because you do need to be able to clear your ears and sinuses. So those are the main concerns we have with hyperbarics. Outside of that, everything's very manageable. Yeah, it's interesting when you mentioned about cancer and chemotherapy because when you said that, it helps you with angiogenesis or blood vessel growth. I was thinking who's active cancer contraindication. So it's interesting that it seems to be beneficial. It's the opposite. For a long time, they thought if you have cancer, absolutely not. And then they've done research and they've found that cancer really doesn't like oxygen. It does pull in a big blood supply. But if you look at like a slice of a tumor, most of those blood vessels is dead inside. And so when you put someone on a hyperbaric chamber, the cancer kind of opens up to try and get rid of the extra oxygen. And that's why if we can time it with your chemotherapy or radiation, it's extremely open.

17:53And then we can get those targeted therapies in. And certain cancers really hate oxygen. Some don't have much of a reaction. We have yet to find any that have increased growth with it. Wow, amazing. This is definitely probably a big breakthrough for people who haven't heard about this before. I am certainly very impressed. And definitely want to look into this more. And I'm curious, what is your overall message? Like if you can condense like your message or your vision, your passion for your work and from your clinical expertise. What do you wish more people knew about this? I wish they knew that it's an option for a lot of people. That it's an extremely non invasive with almost no side effects, other than those small chance of oxygen toxicity while you're inside. Therapy that can be very life changing.

18:53Most of our patients will come in with a direction of I have this thing I want to treat or I want to try and heal. And they fall in love with the therapy because it's just so beneficial. I mean, you're hyperoxygenating your entire body. So you may have just had knee surgery and you want to heal that faster. We treat a lot of athletes. I need to get back on the court. But you feel so good afterwards, your brain's functioning better, your sleeping better that you fall in love with this therapy. And it has so many other benefits. It's not something though. I like to stress that you do as a solo therapy almost ever. You want to do this in conjunction with your other therapies. The only time it's usually a solo therapy is if it's a decompression injury from diving. And then sometimes carbon monoxide. This is about all you can do to help treat some of that. Got it. That makes sense as well. And what is your vision for your company and growing this awareness or,

19:53you know, you mentioned opening up another clinic and you're here on this podcast. So like if you could get your message out further. Like what would that be and what would your invitation be for people? Yeah, I mean, my vision is to open more facilities. I really like partnering with doctors who want to add this to their practice as opposed to becoming like some stand alone. I've found that doing that and having this career. This is my 20th year this year. When you get to educate good members of the community, they help to educate the rest of the community. I think it's kind of like a grassroots way of getting the message out there and making it available. But also working with the local communities and not just coming in and being like a McDonald's for lack of better word on the corner. We want to enrich the community. We want to offer the therapy to a population that needs it and just make it accessible. And I think as we open more, we're also being more able to make it more affordable. Because like I said, you do usually need 30, 40 treatments to do a course.

20:58Yeah, I think that's something that a lot of us in the healing space, the practitioner space that are offering out of the box solution. Are innovating right now and thinking having to probably think outside the box around. Maybe something insurance is are not working with not covering. And this could be really beneficial for the patients. So how do we create systems and create ways that people can't afford these things that are probably a little bit more costly than, you know, getting like a generic medication. Let's say even if they had to pay out of pocket. So yeah, it's something that we definitely have to consider as business owners to make sure that a good thing is not a well kept secret, right. And people know about it and they have a way to work with it. Yeah, cool. So this has been super informative and I'd love to invite you to a rapid fire round to start to close up this episode.

21:59Okay. That's all right. Awesome. So my first question is if you wanted to give somebody one piece of advice about how to improve their quality of life right now, what would that be? Reduce your inflammation. And that could be through diet, that could be through exercise, that can even be through clean water. But if you can get your inflammation down, that seems to be the number one trigger for a lot of diseases to be able to take hold. Yeah, perfect. And I also like to think about it as like an intermediary right could be different root causes, but that's always like the path that they take and then they surface as different symptoms that we diagnose. Yeah, yeah. So question number two, what's a fun fact about yourself that maybe not many people are aware of? Fun fact would be in addition to the clinical hyperbaric site actually do hyperbaric operations for underground tunneling.

23:01So I was most recently part of putting the LA subway system in and working with the tunnel boring machines, they actually have to work under pressure a lot. So I bring in a whole team and we control the pressures. And if they have any injuries, we have to treat them under pressure. So we go inside under pressure and bring a whole group of medics. Wow. Yeah, we know pressure. Yes. And working with different things under pressure a little bit. And then last fun little question, what's your favorite meal to either cook or just have enjoy yourself? Favorite meal. I lost my mom a few years ago, unfortunately, to cancer and one of my favorite meals is one that we cooked as a family. It's a recipe from a friend and it's the Todd Orange beef and the spicy cucumber salad and it's just one of those. It's a delicious meal, but it also brings a lot of that comfort from childhood back.

24:02Yeah, I'm sorry for your loss and. Yeah, the meal and other different sensory ways that we remember our loved ones. It's really interesting how they could just. Like simultaneously in one instantaneously rather, they can just bring us back whether it's a scent. Or you know, something that we remember triggers a memory. So I love that for you. And yeah, the last question I have for you is how can people find out more and work with you or partner with you? Is it, you know, patient? Like patients have to reach out. Is it doctor referrals? Like what is the system that you have to reach out? Yeah, we take both patient and physicians, we have our own full medical director team. So everyone gets cleared here. So if you don't have your own prescription under pressure.com, you can find all of our info. If you're a physician that's looking to refer a patient or wants to learn more about hyperbarics, I do teach the full course. Just to help get everyone educated, make sure they know what they're prescribing and how to prescribe it.

25:05Anything on the website, you can get a hold of me and we can make it happen. Perfect. And then for those listeners that are outside of your local area of service, which is Beverly Hills, I believe. Yeah, how can they benefit from either the online education or how can they find a good clinic around them? Yeah, to work through a good clinic around you, you can do a web search for that kind of things are going to want to look for a hard sided chamber. You don't want to look for one that's got a national board stamp on it to make sure it's been proven safe for repeated pressurizations. If you think about like the Titan, there are some hyperbaric chambers that are being imported from other countries that we just don't know if they can withstand pressure daily, you know, constant compression. So make sure it's got a national board stamp. It's hard sided. It can go to at least two atmospheres and usually in pretty good hands. Amazing. Thank you so much, Nicole, for coming on and sharing about this amazing topic and great clinical therapeutic option for people that may not have been aware about it.

26:12And for the practitioners out there, definitely reach out to Nicole to find out more about her course. And yeah, I wish you a great day ahead. Thank you. Thanks for having me. Bye.