OSU Medicine: Healing the Afflicted
In this issue of OSU Medicine:
OSU-CHS research examines how hyperbaric oxygen therapy helps heal combat beterans with traumatic brain injuries.
Story by Sean Kennedy
Dr. Paul Rock has seen the difference hyperbaric oxygen therapy can make for combat veterans with mild to moderate brain injuries.
“The damage from brain injuries can be far more devastating than physical pain, affecting a person’s ability to think and concentrate, the amount of sleep they get and even the way they interact with family and friends,” Rock says. “We have seen clinical evidence through our research that hyperbaric oxygen therapy can improve cognitive functions and assist with healing in individuals with these types of injuries.”
A former flight surgeon and internist in the Army, Rock has spent more than 30 years researching the benefits of oxygen pressure changes on the human body. He recently led a research study on how hyperbaric oxygen therapy might help veterans with persistent symptoms from mild to moderate traumatic brain injuries (MTBI) at the OSU Center for Aerospace and Hyperbaric Medicine, part of the OSU Center for Health Sciences in Tulsa.
“Our goal is to provide solid scientific research on the use of this type of therapy so that we know if it’s an effective way of treating traumatic brain injuries,” OSU-CHS President Kayse Shrum says. “There are limited proven treatments for veterans coming back from Afghanistan and Iraq with post-traumatic stress disorder and TBI, and we feel it is part of our duty to Oklahoma to find options for those who have served our country.”
The research at OSU-CHS has attracted national attention as more veterans return from Iraq and Afghanistan with brain injuries and post-traumatic stress disorder sustained in combat and from improvised explosive devices.
Symptoms of TBI
The terms to describe TBIs are usually in reference to the severity of the initial physical trauma that caused the injury. The do not always indicate the severity of the consequences of the injury.
Mild TBI, otherwise known as concussion, is the most difficult to diagnose. Patients’ recovery can be within minutes to hours. A small percentage has symptoms that may persist months or years. Symptoms of mild TBI include headache, dizziness, nausea and vomiting, trouble concentrating, memory problems and irritability.
Moderate TBI patients have the most clinical variability. There is usually loss of consciousness, from an hour to a day; there can be confusion for days to weeks; and mental or physical deficits can last months or be permanent.
Severe TBI could affect speech and cause, sensory, vision and cognitive deficits including difficulties with attention, memory, concentration and impulsiveness.
Oklahoma’s Secretary of Veteran Affairs Rita Aragon, a retired U.S. Air Force major general, sees the value of the OSU study. She has pushed in Oklahoma City and Washington, D.C., for additional
funding to find treatment options for veterans who currently have none.
“There are more than 17,000 diagnosed cases of veterans with TBI
in the state of Oklahoma alone,” Aragon says. “That’s a huge number. We want very much to begin, as aggressively as possible, to find treatment options for our veterans.”
Her message hit close to home for the members of the American Legion Post 259 in Braman, Okla. After learning about the OSU study from Aragon, members of the post decided to donate funds collected during their annual memorial poppy sales to the OSU Center
for Aerospace and Hyperbaric Medicine.
“We are dedicated to supporting the community and specifically our veterans and their families,” says Marv Sandbek, past commander of Post 259. “We wanted to keep our donation from the poppy sales in the state. The research going on at OSU-CHS caught our attention, and we are honored to contribute to the effort that will benefit our fellow veterans.”
The poppies are small crepe paper flowers typically sold on Memorial Day and Veterans Day. Post members raised more than $1,200, which they donated in December to support the MTBI study. They also asked other veterans organizations across the state to support the OSU study and efforts to find a treatment.
The experimental hyperbaric oxygen therapy for MTBI requires patients to breathe pure oxygen in a pressurized chamber. The increased pressure causes more oxygen to be dissolved into a person’s blood than would normally occur.
The Center for Medicare and Medicaid Services and many health-insurance plans have approved hyperbaric oxygen therapy to treat
13 diseases and conditions such as gangrene, decompression sickness and thermal-burn injuries. While the Food and Drug Administration hasn’t approved the therapy for the treatment of traumatic brain injuries, researchers are hopeful that continued studies will provide results needed to support its use for MTBI.
“It is very impressive to see the changes in the participants,” says
Dr. Johnny Stephens, assistant dean of research at OSU-CHS. “For some, it’s like a fog has been lifted from their head.”
OSU-CHS has just finished participation in a national study on the use of hyperbaric oxygen therapy for the treatment of traumatic brain injuries. More than 50 participants were included in the study at OSU.
A physician evaluated participants before starting and throughout the study to ensure their safety. During the treatments, technicians both inside and outside the hyperbaric chamber continually monitored participants.
Early results from the study suggest that hyperbaric oxygen therapy may have a positive effect on persistent symptoms of MTBI, PTSD, post-concussive syndrome, sleeplessness, cognitive malaise, depression and emotional control.
Rock and the Center for Aerospace and Hyperbaric Medicine at OSU-CHS are in the process of finalizing the procedures for another study that will provide more convincing evidence of the effects of hyperbaric oxygen therapy for the treatment of MTBI. The center already has a waiting list of volunteers willing to participate in the study. The new study will launch later this year.
Inside the Chamber
Experimental hyperbaric oxygen therapy at OSU for mild to moderate traumatic brain injuries requires patients to breathe 100 percent oxygen in a dive chamber, which is pressurized to the equivalent of being 16½ feet under water.
Patients “dive” for one hour a day for 40 to 80 days. The increased pressure causes about seven times more oxygen to be dissolved into the patient’s blood than would normally occur at sea level.
OSU Medicine partnership helps girls recover from abuse by militants.
Story by Lori Santine
After a week treating children and young women in war-torn Uganda last year, Luanne Vo returned to the OSU College of Osteopathic Medicine in Tulsa with a renewed passion for medicine.
“My time in Uganda solidified my desire to be a physician,” the second-year medical student says. “In just a week, my skills were put to the test. I quickly became comfortable working with patients and met many fascinating people who are full of joy, despite their awful past.”
As the college’s chapter president of Pros for Africa, Vo organizes summer medical trips for students to support the efforts of the Oklahoma City-based international aid nonprofit that connects professionals from all fields with ways to help children in Africa.
Through a partnership with Saint Monica’s Girls Vocational School, OSU medical students, residents and faculty will have more opportunities to work in Uganda by taking part in international medical rotations.
The rotations were announced during the 25th anniversary celebration of the Oklahoma College of Osteopathic Medicine and Surgery joining the OSU system. Saint Monica’s founder, Sister Rosemary Nyirumbe, was the featured guest for the commemoration.
“Research has shown that when a medical student completes an international clinical experience, it increases the probability they will pursue a career in a primary care area,” says OSU Center for Health Sciences President Kayse Shrum. “The experience also helps students improve diagnostic skills and become more empathetic and culturally sensitive physicians. Those attributes will benefit them as they begin careers in rural and underserved Oklahoma.”
The collaboration is an extension of the partnership that began with Pros for Africa co-founders Reggie and Rachelle Whitten, Nyirumbe and OSU-CHS.
“Our partnership with OSU Center for Health Sciences is strong,” Nyirumbe says. “Everyone at OSU has jumped on board to support the mission of Saint Monica’s.”
Nyirumbe works with girls abducted from their families and forced to serve as sex slaves for officers in Joseph Kony’s Lord’s Resistance Army. The LRA was forced out of Uganda in 2005 and since then has wreaked havoc in the Central African Republic, South Sudan and the Democratic Republic of Congo.
Kony is wanted by the International Criminal Court for alleged war crimes. The LRA became notorious for kidnapping children. Boys were forced to fight as soldiers. The rebels especially prized girls, as they could fight and be sex slaves.
Saint Monica’s is a refuge where these young women learn to sew clothes, grow food and learn a trade to support themselves and their families. Nyirumbe’s humanitarian efforts have garnered international praise and in 2007 the prestigious CNN Hero award.
“Sister Rosemary is a trained midwife and has delivered many babies,” says Shrum, who is also the faculty adviser for the Pros for Africa student chapter. “She knows better than most the importance of primary care and how critical quality health care is to life expectancy. Our students and faculty will benefit from working with her in Uganda.”
Vo is delighted that OSU has partnered with Saint Monica’s and that more OSU medical students will have the opportunity to complete international rotations in Uganda.
Sister Rosemary Nyirumbe and Reggie Whitten have written Sewing Hope. The book and a movie recount Nyirumbe’s work in Uganda and with Saint Monica’s.
Sewing Hope is available through sewinghope.com, Barnes & Noble, Barnes & Noble Nook and Amazon.
“Sister Rosemary is an amazing woman, full of energy and spirit,” Vo says. “After we returned from our previous trip to Uganda, we were able to share our experiences of working with the people at Saint Monica’s. Many of our classmates were discouraged about their lack of ability to experience Uganda. This partnership opens the door for more students to learn from her example and help the underserved people she loves.”
Once the specifics of the program are in place, Vo plans to return to Uganda on a rotation. Second-year medical student Anish Bhakta, who also went on the medical mission trip to Uganda last year, will complete a rotation there as well.
“I left Africa thinking that would be the last time I would be able to visit for a long time,” says Bhakta, treasurer of Pros for Africa. “That has since changed with the addition of the international rotation, and I’m excited our school is offering this opportunity. It will positively impact our education and also help the women and children at Saint Monica’s.”
OSU-CHS has also adopted Saint Monica’s as an international education partner, ensuring continued collaboration between OSU students, faculty and staff and the students in Uganda. The partnership also will enable international educational opportunities between Saint Monica’s students and children at Tulsa’s Eugene Field Elementary School, the university’s Partner
“Everyone at OSU-CHS is excited to launch this global partnership with Sister Rosemary and offering our students and faculty an international clinical experience in Uganda,” says Dr. Robin Dyer, president of the OSU-CHS Faculty Senate. “By adopting Saint Monica’s, we also will be opening the doors to further collaborative endeavors down the road.”
Plans are to begin offering the international rotations in Uganda later this year. In the meantime, a group of OSU-CHS students and faculty, through Pros for Africa, will complete another medical mission trip to Uganda in May.
“During our 25th anniversary celebration, more students were able to meet Sister Rosemary, and interest in supporting her work grew quickly,” Vo says. “They met a woman who is passionate about her work and desire to serve others but who also needs more help for Uganda. Many students have responded and want to add a rotation in Uganda to their training.”
Barnett named OSUMA CEO and Shrum appointed OSU-CHS president.
The OSU Center for Health Sciences recently underwent a leadership change, with Howard Barnett assuming the role of CEO of the OSU Medical Authority and Dr. Kayse Shrum succeeding Barnett as president of the medical school. The OSU/A&M Board of Regents approved the changes at the end of 2013.
The leadership roles of the two Tulsa campuses were consolidated under Barnett in 2010. Barnett, a longtime Tulsa attorney and businessman, was the chief negotiator for the OSU Medical Center Trust in its acquisition of the OSU Medical Center in 2008. Barnett remains president of OSU-Tulsa.
Shrum, a professor of pediatrics and an alumna of the OSU College of Osteopathic Medicine, was named OSU-CHS provost and dean at the college in 2011.
During her tenure, Shrum has focused on expanding the physician pipeline by increasing the number of students from rural Oklahoma who are interested in attending medical school. She has also overseen an overhaul of curriculum requirements for medical students, including the addition of a rural-medical track.
Shrum is also the first female to lead a medical school in Oklahoma. As president of OSU-CHS, she oversees the College of Osteopathic Medicine, the School of Biomedical Sciences, the School of Forensic Sciences and the School of Health Care Administration.
The OSU Medical Center was transferred from a Tulsa trust to an Oklahoma trust in December. The transfer was part of an agreement made with state lawmakers during the 2013 legislative session to provide $13 million for the medical center.
“OSU Medical Center has a statewide mission to train physicians for our state and provides vital medical services to people in rural and underserved areas of Oklahoma,” says Howard Barnett, OSU Medical Authority chief executive officer. “The change was necessitated by our need to further that mission and continue to provide training for medical students and graduates of the OSU Center for Health Sciences.”
Ownership of the OSU Medical Center building transferred from the OSU Medical Center Trust to the OSU Medical Authority, a state agency that is affiliated with the OSU Medical Trust. The Tulsa City Council voted to relinquish the city’s beneficiary interest in the medical center in October. The transaction was approved by Oklahoma Gov. Mary Fallin and state Attorney General Scott Pruitt.
Members of the OSU Medical Authority board are appointed by the governor, Senate president pro tempore and speaker of the House of Representatives or hold positions at the OSU Center for Health Sciences, the Oklahoma Health Care Authority or OSU Medical Center.
UPDATE: OSUMA announced at its meeting on March 31 the selection of Mercy Health System to manage the 249-bed medical center.
The OSU Medical Center is the nation’s largest osteopathic teaching hospital working directly with the Oklahoma State University College of Osteopathic Medicine to train approximately 150 primary care physicians annually. In addition, the hospital provides health care to the medically underserved population across northeast Oklahoma and provides nearly 1,000 jobs to the region. In the past year, the hospital served more than 45,000 individuals in the emergency room and 25,000 patient visits.
The selection starts negotiations between Mercy and OSU on a long-term management contract, which will include investments to modernize the facilities and upgrade operations at the medical center.