Ed Nemeth tells his personal compelling story abut hyperbarics and how he discovered the benefits of HBOT. His exploration into HBOT led him to open his own clinics in Sacramento where he met and treated retired football player George Visger.

1. NFL Brain Injuries, Treatments & Medical Rights Ed Nemeth Rebecca’s Dad Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies

2. Who am I? The loving and faithful father of Rebecca, a severely disabled child! Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies

3. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Who am I? Rebecca’s Dad! Trained as a scientist - objective Researched nerve regeneration / plasticity Department of Neurobiology, University of Vermont Medical School Businessman / Entrepreneur - pragmatic

4. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Our Journey Birth, Death & Resuscitation

5. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Our JourneyComa

6. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Our Journey~~ The Journey! ~~

7. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Our Journey~~ The Journey! ~~

8. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Our Journey Hypberbaric Oxygen! Dismissed HBOT in 1998 Struggled to get help for Rebecca Mouth-to-mouth rescusitation 9 times 1-hour long static gran mal seizures monthly Bronchitis & pneumonia 6 times a year Weak, myriad challenging problems Then…. Surgical Neurology, vol 10 Oct. 78 Ischemic Penumbra reversed @ 7 years post injury HBOT “had to” work!

9. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies What we did! Went to Dr Neubauer’s HBOT Clinic in Florida For Hyperbaric Oxygen Therapies - HBOT 40 Sessions in 2 months July-August, 2000 Great immediate responses Horrible SPECT scans 2nd SPECT’s showed great response!

10. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Fantastic Changes! Went seizure and drug FREE for 6 years! Could maintain own body temp. at night! Pneumonias and bronchitis STOPPED! Feeding time dropped from: 1 hour 10 minutes to 20 minutes! Gained coordination (had NONE!)! Gained endurance and strength (had NONE!)!

12. Crosses blood brain barrier (BBB)

13. Binds to active neurons

14. Objective

15. View function, not structure

16. Compares CNS metabolism before & after HBOT

18. Crosses blood brain barrier (BBB)

19. Binds to active neurons

20. Objective

21. View function, not structure

22. Compares CNS metabolism before & after HBOT

23. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Clear Benefits - SPECT ScansPre HBOTPost 36 HBOT

24. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Clear Benefits - SPECT ScansPost 36 HBOTPost 4 Month Rest

25. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Clear Benefits - SPECT ScansPost 4 Month RestPost 32 HBOT (add’l)

26. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Clear Benefits - SPECT ScansPre HBOTPost 72 HBOT

27. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies HBO Effect on Blood O2 Content at 2.4 ATA HBOT delivers O2 = HbO2 desaturation HBOT creates high O2 gradient & O2 activity

28. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies DepthApplication 0 fsw; 1 ATA 16.5 fsw; 1.5 ATA 33 fsw; 2 ATA 49.5 fsw; 2.5 ATA 59.4 fsw; 2.8 ATA 66 fsw; 3 ATA 165 fsw; 6 ATA Sea level Chronic Brain Injury Burns Diabetic Wounds/Osteo CO Poisoning Acute Cyanide Poisoning Acute Decompression Illness

29. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies HBOT Mechanisms Multiple mechanisms Angiogenisis Neural re-activation * Normalization of oxygen deficit Re-establish neuronal metabolism Neuronal Regeneration Increase natural stem cells 800% * Ischemic penumbra is now accepted as the primary cause of deficits

30. How it works - 5,769+* ways* Oxygen-sensitive outcomes and gene expression in acute ischemic stroke. Rink C, Roy S, Khan M, Ananth P, Kuppusamy P, Sen CK, Khanna S. J Cereb Blood Flow Metab. 2010 Feb 10. Up-regulates growth factors Reduces edema Increases neuronal ATP Enhances Mitochondrial: Replication Energy Production (ATP) Promotes neural pathway growth Stimlates aging neurons Down-regulates inflammation Reduces reperfusion injury Indep. Football Veterans Conf. March 25, 2011

31. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies HBOT Benefits - SPECT Scans Pre HBOTPost 72 HBOT

32. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies HBOT Is Very Safe From a 10 year study of 1,505 patients receiving 52,758 2-hour HBOT sessions at 2.4 ATA once or twice daily. inability to equalize middle ear pressure 0.37% paranasal sinus blocks 0.09% confinement anxiety 0.05% oxygen convulsions 0.009% pulmonary oxygen toxicity 0.00% permanent ocular refractive changes 0.00%

34. 16,500 died from gastrointestinal bleeding taking NSAIDs (1997)

36. Hyperbaric Oxygen Therapies Different HBOT Chambers Mono-place Chamber

37. Different HBOT Chambers Home Chamber

39. Crosses blood brain barrier (BBB)

40. Binds to active neurons

41. Objective

42. View function, not structure

43. Compares CNS metabolism before & after HBOT

44. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies War Veteran TBI Before & After HBOT

45. NFL Player: TBI impact assessment Fibers passing through areas Area of Tissue change Enlarged Fiber Tract showing fibers from concussive event NFL football player with concussion Loss of about 2% of the fiber tracts in the region of the corpus callosum. Courtesy Dr. Walter Schneider, U Pittsburgh

46. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies NFL Veteran TBI Before HBOT

47. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies NFL Veteran TBI After HBOT

48. Case Presentation Alzheimer’s Disease Scan #1 Scan #2

49. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies

50. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Medicare Reimbursed IndicationsHBOT increases tissue O2 Compromised Skin (Acute traumatic peripheral ischemia) Compromised Skin Grafts Burns Chronic Refractory Osteomyelitis Diabetic Wounds Clostridial Myonecrosis (Gas Gangrene) Progressive Necrotizing Infection (Meleney’s Ulcer) Soft Tissue Radiation Necrosis Osteoradionecrosis Acute Peripheral Arterial Insufficiency (ulcers) Actinomycosis Acute Cyanide Poisoning Carbon Monoxide Poisoning (acute) Intravascular Gas Embolism Decompression Illness

51. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Non-healing Wounds 1 year mainstream medicine 26 HBOT’s later 50 HBOT’s later

52. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies HBOT for Burns Summary: ControlHBOT Burn (%) 48% 61.8% Days Hosp. 108 51.8 Surgeries 7.8 2.1 Costs $391k $215k Scarring (reduced 95%) Textbook on Hyperbaric Surgery Bakker MD, Cramer MD

54. W&I 14105.26;

55. Insurance Code 10123.195 Mandates reimbursement for FDA Approved, “off label” drugs, that meet specific criteria - HBOT qualifies under those criteria.

56. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement California SB 2046 “prohibits a health care service plan contract, and specified disability insurance policies, from limiting or excluding coverage for a drug on the basis that the drug is prescribed for a use different than the use for which the drug has been approved for marketing by the federal Food and Drug Administration (off-label use) if specified conditions are met, including that the drug prescribed is for the treatment of a life-threatening…chronic and seriously debilitating conditions.”

57. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement 1367.21. (a)…. provided that all of the following conditions have been met: (1) The drug is approved by the FDA.

58. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement 1367.21. (a)…. provided that all of the following conditions have been met: (2)(B) The drug : is prescribed by a physician for treatment of a debilitating condition, is medically necessary is on the plan formulary.

59. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement 1367.21. (a)…. provided that all of the following conditions have been met: (3) The drug has been recognized for treatment of that condition by one of the following: (D) Two articles from major peer reviewed medical journals supporting the proposed off-label use as safe and effective.

60. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement Two articles from major peer reviewed medical journals supporting the proposed off-label use as safe and effective. Golden ZL, Neubauer RA, Golden CJ, et al.: Improvement in cerebral metabol-ism in chronic brain injury after hyperbaric oxygen therapy. Int J Neurosci 2002, 112:119-131. Harch PG, Gottlieb SF, Van Meter KW, Staab P. HMPAO SPECT brain imaging and low pressure HBOT in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea & Hyperbaric Medicine, 1994; 21(Suppl):30. Harch PG, Fogarty EF, Staab PK, Van Meter K. Low pressure hyperbaric oxygen therapy and SPECT brain imaging in the treatment of blast-induced chronic traumatic brain injury (post-concussion syndrome) and post traumatic stress disorder: a case report. Cases J. 2009 Jun 9; 2:6538. Lin JW, Tsai JT, Lee LM, Lin CM, Hung CC, Hung KS, Chen WY, Wei L, Ko CP, Su YK, Chiu WT. Effect of hyperbaric oxygen on patients with traumatic brain injury. ActaNeurochir Suppl. 2008; 101:145–9.

61. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement Two articles from major peer reviewed medical journals supporting the proposed off-label use as safe and effective. Lin JW, Tsai JT, Lee LM, Lin CM, Hung CC, Hung KS, Chen WY, Wei L, Ko CP, Su YK, Chiu WT. Effect of hyperbaric oxygen on patients with traumatic brain injury. ActaNeurochir Suppl. 2008; 101:145–9. Low pressure hyperbaric oxygen therapy and SPECT brain imaging in the treatment of blast-induced chronic traumatic brain injury (post-concussion syndrome) and post traumatic stress disorder: a case report Paul G Harch, Edward F Fogarty, Paul K Staab and Keith Van Meter Neubauer RA, Gottlieb SF, Pevsner NH: Hyperbaric oxygen treatment of closed head injury. South Med J 1994, 87:933-936.

62. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement Two articles from major peer reviewed medical journals supporting the proposed off-label use as safe and effective. Palzur E, Zaaroor M, Vlodavsky E, Milman F, Soustiel JF. Neuroprotective effect of hyperbaric oxygen therapy in brain injury is mediated by preservation of mitochondrial membrane properties. Brain Res. 2008; 1221:126–33. Epub 2008 May 11. Rockswold SB, Rockswold GL, Defillo A. Hyperbaric oxygen in traumatic brain injury. Neurol Res. 2007; 29:162–72. Shi XY, Tang ZQ, Xiong B, Bao JX, Sun D, Zhang YQ, Yao Y. Cerebral perfusion SPECT imaging for assessment of the effect of hyperbaric oxygen therapy on patients with post brain injury neural status. Chin J Traumatol. 2003; 6:346–9.

63. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement Two articles from major peer reviewed medical journals supporting the proposed off-label use as safe and effective. Tinianow CL, Tinianow TK, Wilcox M. Effects of hyperbaric oxygen on focal brain contusions. Biomed SciInstrum. 2000; 36:275–81. UHM 2009, Vol. 36, No. 6 – Treatment of mild traumatic brain injury with hyperbaric oxygen 391 Case report: Treatment of mild traumatic brain injury with hyperbaric oxygen Colonel James K. Wright, Eddie Zant, Kevin Groom, Robert E. Schlegel, Kirby Gilliland

64. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies SB2046 Mandates HBOT Reimbursement California SB 2046 “A willful violation of the provisions governing health care service plans is a crime. ”

65. Indep. Football Veterans Conf. March 25, 2011 Hyperbaric Oxygen Therapies Rebecca Thanks you!