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HAMC continues pain management innovations

By Staff | Nov 29, 2019

The Heart of America Medical Center is continuing to innovate in pain management.

According to Dr. Ted Fogarty, a local physician and faculty member of the University of North Dakota’s School of Medicine, HAMC is the first critical access hospital to have used hyperbaric therapy in complex pain management.

Fogarty reported that in September, a team including Radiology Technician Kirk Seaver helped to provide one hour of mild hyperbaric air therapy to a patient with severe back pain who, at the time, wasn’t a candidate for an advanced image-guided steroid injection (due to safety issues for potential overuse of steroids). Fogarty brought his family’s own portable air/altitude chamber from Bismarck and directly supervised the device-based intervention. The patient experienced significantly-reduced pain levels for about four days.

Next year, Fogarty said HAMC has “great potential” to bring in a mild hyperbaric program for pain management as well as academic and executive wellness.

“Bringing in a hyperbaric program of any level into Rugby is going to be a big deal,” Fogarty said, “and that will happen in 2020 – whether it’s into the homes of Pierce County residents directly or formally through our evolving pain management and integrative medicine clinic.”

According to Fogarty, hyperbaric medicine improves energy levels in the body’s cells and provides more energy through the mitochondria inside them.

“My grain elevator pitch is this: It’s just a turbocharger for your cells. When you give those cells 4 psi of air, it’s similar to your snowmobile forcing 4 psi of air into the engine from a supercharger. The nerve cells are more tolerant of pain and they can go repair, fix and rebuild and figure these complex fence mending and injury issues out on their own,” said Fogarty.

Since April, Fogarty has joined Chelsey Wyatt, certified registered nurse anesthetist, in creating an advanced interventional orthopedics and neurology pain management service.

According to Fogarty, with the personnel and advances in medical technology in place at HAMC, Rugby has “this really wonderful opportunity to do world-class medicine.”

“Honestly, there’s no other place that I’ve seen in North Dakota that has a general surgeon, an interventional/diagnostic radiologist, and a CRNA with a growing pain management program all under one specialty practice roof. I have to believe our combined clinical experience in anesthesia, radiologic, and surgical practice does not exist anywhere else in the country in a system of the size of Heart of America Medical Center” said Fogarty.*

“We also have our technology team in radiology, which has a state of the art MRI scanner undergoing upgrades to accommodate larger patients. A wide-bore type scanner will better accommodate all of our patients, but in particular those in pain who are in need to imaging to document whether arthritis or nerve impingement is generating the pain.”

Fogarty said that with the state Legislature funding a research initiative for hyperbaric medicine, which District 6 Representative, hospital board member and Willow City farmer Dick Anderson penned in the most recent legislative session, the team at HAMC has an opportunity for funding for MRI-documented recovery of pediatric anoxic brain injury and acute concussion in young athletes.

Fogarty also said with another upgrade to the MRI scanner next year, HAMC may be able to prove white matter regrowth in patients with traumatic brain injuries (TBI).

“I don’t think anybody in this community actually recognizes how far ahead HAMC is in terms of technology advances for our patients and the collective years of practice knowledge that all of our medical team, anchored by Dr. Steve Schoneberg, has here,” said Fogarty. “This town has more potential and expertise than every other critical access hospital that I’ve ever read films in from Texas to Canada.”

Hyperbaric medicine is an approach Fogarty has been using for years in Bismarck in helping friends and family with degenerative arthritis.

Over the last 12 years, Fogarty’s hyperbaric and imaging research has been guided by Dr. Paul G. Harch’s experience at Louisiana State University in New Orleans. Fogarty describes his research approach as “artfully leveraging the modern living lab of the brain, functional brain imaging of MRI, SPECT (single-photon emission computerized tomography) and PET (positron emission tomography).”

In January, Fogarty and Harch published a case report on the use of PET imaging to document the recovery of brain metabolism in an Alzheimer’s patient, who showed significant reversal in cognitive decline.

Fogarty has also advised, from a statewide and national perspective, Sen. Kevin Cramer and his team of staffers on the evolving research from around the world regarding the use of hyperbaric chambers in post traumatic stress disorder and TBI.

In October 2017, Fogarty also met with Gov. Doug Burgum regarding hyperbaric therapy for brain-injured National Guard and uniformed service members.

In 2017, Fogarty and Harch developed what would later be referred to as the “Eden protocol.” The protocol stemmed from the case of Eden Carlson, a three-year-old who recovered brain volume and function following hyperbaric treatment for brain injuries sustained from drowning in a pool.

“It’s just been an incredible privilege and gift to be Dr. Harch’s imaging research colleague,” Fogarty said, adding that since then several dozen children in the U.S. have had the Eden protocol.

In 2012, Harch’s team published a Phase I safety trial at LSU for the use of hyperbaric medicine in veterans with PTSD and TBI in the Journal of Neurotrauma. The results of the trial saw the veterans show improvement in function and cognitive abilities, as well as statistically significant changes in brain metabolism-with Fogarty’s methodology-before, during and after 40 treatments, with each lasting one hour in duration. In a related study published in October 2017, veterans who were part of the study were also found to have shown decreases in suicidal ideation.

Fogarty and Harch’s first case publication was in 2009 on a Marine with a “devastating” brain injury. With Fogarty’s imaging documentation, the case report showed that hyperbaric treatment improved brain energy levels correlating to recovery of function, as documented by Harch and Drs. Keith Van Meter and Paul Staab at LSU.

Fogarty said the LSU team is working on more publications for veterans.

Fogarty said his mission, as a “noble cowboy” of research in hyperbaric medicine remains “in process.”

“Improvements for both research and clinical use purposes in this innovative field and practice of medicine – that’s my eternal goal. Teach, inform, improve, innovate and educate the public of the power of mitochondrial medicine as rendered through physics and biochemistry,” Fogarty said.

* Edited from print edition

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