While the pharmaceutical industry powers ahead developing newer and increasingly complicated medications, a natural substance is experiencing a dramatic increase in popularity. The substance is pure oxygen, delivered into the body in such a way that it takes on the therapeutic qualities of a drug.

The air we breathe is usually only 20 per cent oxygen, and even if we were to breathe 100 per cent oxygen from a cylinder, as is fashionable in the oxygen cafes of Europe, we would still not get the therapeutic effects.

These effects are achieved by combining pure oxygen with pressure in a hyperbaric chamber – a chamber traditionally used to treat divers with the bends. In such a chamber, pressure can be increased to 2.4 atmospheres, which is the equivalent of being 14 metres under water. At such a pressure, it is possible for us to breathe 240 per cent oxygen.

This form of therapy is known as hyperbaric oxygenation therapy, or HBO. It is now accepted that such a rich flood of oxygen can help a myriad of bodily ailments. There are some conditions it has been proved conclusively to help, some for which there Ls anecdotal evidence that it may be effective, and some it may help.

In Australia people are now going into hyperbaric chambers for treatment of problem wounds, diabetic ulcers, osteomyelitis

(bone infection), radiation tissue damage, acutely blocked blood supply, gangrene, sudden deafness, sudden tinnitus (ringing in the ears), problems with blood supply to the eye and diving-related illnesses.

Such is the level of acceptance of the effectiveness of hyperbaric treatment that when it is provided in major hospitals it is rebatable on Medicare.

In some parts of the world, HBO is also used as a routine adjunct to cosmetic and plastic surgery. Advocates believe it can augment the healing process in patients having facelifts and laser facial peels.

Research is also suggesting that it can be helpful with certain sports injuries such as acute muscle injury and chronic tendon injury, although this has not yet been proved.

In Russia, there are labour wards that can instantly be turned into hyperbaric chambers. Usually the ward doors remain open, but if the baby goes into distress and appears to be deprived of oxygen, the doors are sealed and pressure is turned on.

During the past 5 years there has been a tremendous increase in interest in HBO in the USA, Europe, China and Japan. Australia has been a bit slower to follow the trend, but interest is picking up.

In Australia, there is a range of chambers. Some hospital chambers have more than one roomNind can accommodate wheelchairs and trolleys. Several small chambers exist in medical and paramedical practices around the country.

Hyperbaric medicine has come a long way since the late twenties, when it was so much in vogue in the USA that a hyperbaric hotel was built in Cleveland, Ohio. This steel-ball hotel, which could reach three atmospheres of pressure, had 72 rooms, a grand piano and luxury amenities. But pressure was all it provided, and in the absence of the oxygen, pressure is not therapeutic. The hotel was dismantled for scrap in World War II.

HBO has had several such false starts. In the seventies, for example, it was touted as a panacea that could ensure longevity and even cure impotence. This type of quackery set it back years. Today the status of HBO varies and in places such as the UK there are still very few hospital-based chambers.

One of the most notable achievements of HBO is that it can prevent amputations. People scheduled for amputations have tried it as a last resort and found their limbs saved. HBO accelerates healing. It works by reducing swelling, assisting the formation of granulation tissue (the healing tissue that fills a wound before the skin grows over it) and helping tiny blood vessels to grow into the damaged area. It also stimulates the growth of collagen – the connective tissue that strengthens the wound.

This therapy only works if the oxygen is inhaled. Over the years people have tried different delivery methods, such as blowing it onto wounds, but it has not been effective because the oxygen has to be dissolved in the blood. While HBO is not painful, its downside, apart from minor complications and some patients feeling claustrophobic, is that it is time-consuming. To heal a chronic wound a patient may have to spend 2 hours a day in the chamber for 5 or 6 days a week for up to 6 weeks.

But then, patients get to know each other and sit and read, watch television, play cards or chat. One very grateful 50-year-old man walked away from his stay in the chamber having avoided an amputation. He was a diabetic and had problems with circulation in his feet. Part of his foot had become gangrenous and he was on the list for an amputation below the knee.

With meticulous wound care and 5 weeks of HBO he was able to go home with his foot in a special shoe. He didn’t mind that it had taken so long! This sort of case is not uncommon.

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The older you get, the more spotty you become. As the years pass, expanses of skin that were once clear can become covered in a range of blemishes, dots, spots, moles and freckles. It’s hard to keep track of them all because it seems that new spots can emerge overnight. While most of the spots are harmless, there is always a risk that a melanoma is lurking among them.

Melanoma is one of the commonest cancers in Australia. On average, Australians have one chance in 25 of developing a melanoma before the age of 75. Although people know that early detection is crucial in preventing death from melanoma, most would find it difficult to distinguish a melanoma from moles and other spots.

Even doctors sometimes fail to recognise melanomas on their own faces. There are cases of doctors who have spent months carefully shaving around the melanoma on their cheeks without being aware of what it was they were seeing in the mirror. By the time they realised, their melanomas had become quite thick and advanced.

Older men are at higher risk. Although men over 50 constitute only 14 per cent of the population, they account for more than 50 per cent of deaths from melanoma. Every day, on average at least one older Australian man dies from melanoma. Often the figure is two men a day.

Part of the problem is that in men, melanoma usually develops on the back, shoulders or scalp, where the men can’t see it, let alone identify it.

Another complication is that men often have a nodular form of melanoma, which is more difficult to recognise than the usual form.

Apart from moles, as people age they often develop four other kinds of spots, the most common of which are solar keratoses. These are flaky spots caused when the skin over-repairs sun damage.

Seborrheic keratoses arise from oil glands in the skin and form dark, raised patches that resemble cowpats and look as if they can be flicked off.

Liver spots (lentigo) are the true ageing spots and are just large dark freckles.

There are small red spots too, known as cherry angiomas, which are malformations of little blood vessels. The only danger with these different spots is that a genuine melanoma might be mistaken for one of them.

Men at high risk should have their skin checked regularly. You are at high risk if you have a family or personal history of melanoma, have more than 100 ordinary moles on your body or have more than 50 irregularly shaped and coloured atypical moles.

A fair complexion, a tendency to burn rather than tan, the presence of freckles, light eye colour, light or red hair colour and a history of nonmelanoma skin cancer are also risk factors.

Following are descriptions of some characteristics that may help you identify a melanoma.

Compared to other spots, a melanoma often stands out like an ‘ugly duckling’. It can arise from clear skin or from an existing mole. Hair can grow from it early in its development. This hair-falls out when the melanoma gets deep enough to destroy the hair follicles. Usually, the change in a melanoma is minor and takes place over 2 to 6 months. It can itch, rarely bleeds and doesn’t hurt. Irregularity of colour is significant: a variety of colours in one lesion is a key feature of melanoma.

Doctors use the following ABCD+E system as a guide to detecting melanomas:

A stands for asymmetry.

B stands for the border, which is usually irregular.

C stands for colour, which is usually variegated.

D stands for diameter, which is usually greater than 6 mm when the melanoma is first diagnosed.

E stands for evaluation against surrounding moles – the melanoma should stand out.

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The search for a harder, stronger, more enduring erection has led numerous men directly into impotence. These men abused potency drugs without realising that they could end up with the opposite result – erections that were softer, weaker and didn’t endure.

Before Viagra was approved for use, the ‘leisure’ use of penile injections was alarming. Soon after injections became readily available, hospital casualty units began seeing cases of highly embarrassed men in pain who could find no way to make their erections go down.

If a man is perfectly potent, there is no point in his taking Viagra: it will not make him more of a man. Viagra works on biochemistry, and if biochemistry is in order, there is nothing for this drug to do: swallowing it is a waste of effort and money. Penile injections are different: if abused, they can do some serious damage.

Because Self-Injection Therapy (SIT) is, by definition, self-administered, it is easily overused. There are always a few clowns who think that if 1 ml is good, 2 ml will be much better. They go ahead and self-inject and then don’t know how to handle the consequences.

There have been reports of men who have obtained SIT illicitly and used it not because they were impotent but because They wanted to improve their sexual prowess. Wild expectations drove them to use bigger doses in the hope of getting bigger erections.

They ended up with extremely painful priapism. Such men typically don’t respond to warnings, don’t seek treatment and cause themselves permanent damage. While they may have been perfectly potent before they used the injections, they could become genuinely impotent alter abusing them.

Priapism can be profoundly painful. Often it is big-league pain that can only be relieved with narcotics.

Treated early, priapism is easily cured. However, it becomes problematic if men delay getting help. To let down an erection resulting from prolonged and untreated priapism, doctors have to stick a large needle into the shaft of the penis and draw out blood. They then have to re-inject the shaft with drugs. This can be dramatic.

If a man’s erection lasts for 4 hours, he should see a doctor. After 6 hours, he needs urgent attention. If an erection persists for more than 12 hours, there is a risk of permanent cell damage. The damage can be so extensive that injections may not work in the future and it may not be possible to implant a prosthesis. If treatment for priapism is delayed by more than 36 hours, the man will never regain normal erectile function.

In one well-known case, a 51-year-old man went to a hospital casualty unit 38 hours after injecting himself. His erection just would not go down. After two operations to achieve detumescence, he learnt he had permanently lost his erectile capability. There was so much internal scarring that nothing could be clone; even a prosthesis was out of the question. He had been in considerable pain, but embarrassment and the hope that his problem would resolve itself spontaneously had kept him from seeking help earlier.

The tragedy is that some men who end up with this damage never actually needed the injections in the first place. Men most at risk of priapism are those who have psychological impotence -men whose emotions inhibit their erections but whose physical erectile mechanism is normal. They have a good blood supply to the penis and so are supersensitive to the injections, which work by increasing blood flow. Physically they are fine, and their sexual difficulties could be treated in less invasive ways.

Although such men need counselling, they are often given injections at potency clinics because it’s quick and seems easier than talking about the issue for hours.

Men with premature ejaculation who are a bit anxious and perhaps not sure about their sexuality also go to these clinics and report erectile problems. Again, the short cut is to give them injections.

Men with neurogenic impotence – impotence resulting from spinal injuries or conditions such as multiple sclerosis – are also supersensitive to SIT because their blood supply is normal. While in their case injections are useful to ‘kick-start’ their erections, such men need very small doses.

Because SIT works by enabling blood flow to the penis to increase, it is useful for men whose arteries have narrowed or become blocked as a result of age or a disease such as diabetes. Once the blood flows in, the penis becomes engorged, and the veins kink and trap the blood to maintain engorgement. The erection does not disappear automatically alter climax. It lasts as long as the drug – usually from 20 minutes to an hour.

All men should be aware that if too much drug is administered, or the drug is used twice in a day or is used contrary to doctors’ instructions, priapism may result. When injection therapy is used judiciously, however, priapism is unusual.

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