Tua Tagovailoa concussion: Florida neurologists encourage use of hyperbaric oxygen therapy

After suffering at least three concussions in three years, Miami Dolphins quarterback Tua Tagovailoa's future on the field appears uncertain.

While there are reports that Tagovailoa has decided not to retire, doctors everywhere are chiming in on the star signal-caller's latest brain injury suffered during last Thursday's loss to the Buffalo Bills that triggered the fencing posture, the second time that's happened.

One of the common threads is the discussion of hyperbaric oxygen therapy, a treatment commonly used for diabetic ulcers and physical injuries that is being lauded as the next big thing for helping the brain heal from traumatic injuries, such as concussions.

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What is hyperbaric oxygen therapy, and why does it help?

Hyperbaric oxygen therapy, or HBOT, is a therapeutic treatment that has existed for centuries.

Paul Johnson, a sports medicine and hyperbaric medical doctor who runs the Hyperbaric and Wound Healing Facility at Halifax Health Hospital in Daytona Beach, says that at its core, HBOT treatment can be broken down to two things.

"I'm using oxygen, which is a drug, and I'm using pressure," Johnson said. "There are plenty of studies of how pressure works at the genetic level on the body as a up-regulator of anti-inflammation, and it down-regulates the gene components that produce inflammation. I'm stimulating stem cells."

HBOT treatment for a concussion is accomplished through a medical-grade chamber that is pressurized with 100 percent pure oxygen. During treatment, a person lies down for approximately 90 minutes per session and thenacross a therapy regimen that could range from several days to several months and beyond, depending on the severity of the head trauma and the patient's medical history.

The allotted time allows for the chamber to achieve the desired pressure and then to return to normal levels during the therapy session.

Time is of the essence when handling the effects of head trauma. If left untreated, a patient suffering from cognitive and mental effects of a serious concussion can be more prone to trauma from future blows as well as mental illness and even suicide.

Studies have shown the sooner a patient with head trauma is treated with medical-grade hyperbaric oxygen therapy, there are fewer sessions in the chamber required for recovery or healing.

Daniel Kantor, President Emeritus of the Florida Society of Neurology, is one of many proponents of the positive clinical effects of HBOT, which has begun to overcome stigmas and outdated medical opinions in the journey from new-wave clinical trial to recognized modern therapy for head trauma.

"It's 100 percent oxygen, as opposed to us walking around breathing 21 percent," Kantor said. "But also, it's compressed, so it's like you're 30 to 50 feet underwater. And so it's pushing those oxygen molecules deeper into tissue, and that's why HBOT is used a lot in wound healing. Same thing here. If you get that oxygen deeper into his brain, that can only be a good thing.”

Doctors encouraging use of HBOT for immediate aid in concussion recovery

Any treatment Tagovailoa is receiving would be private and protected by health laws. While Kantor and Johnson are not involved in his treatment, they wouldn't be surprised if the Dolphins have a chamber for treatment of head trauma. Johnson said he knows multiple sports teams use the medical-grade chambers for a wide range of ailments.

When it comes to treating concussions, doctors are beginning to encourage the use of HBOT more than ever during their patients' recoveries.

"I do believe in it, especially if you do it early in what we call the sub-acute phase," said Dennys Reyes, vascular neurologist for the Delray Medical Center. "I'm a believer."

Reyes says that once a person goes through a standard of care that involves scans - at minimum, an MRI and EEG - for comparison, within a week, HBOT can be considered as a proven method of therapy.

“I certainly think it would help him get back to normal, back to a base-line faster," Kantor said. "Would it be the same amount of time? Possibly. Is it going to be longer? No."

One of the reasons that multiple doctors have begun to push for HBOT as a treatment for head trauma is to help the brain recover by increasing oxygen and reducing inflammation in an effort to preserve the health of neurons.

"Imagine somebody that gets repetitive injuries to the head," Reyes said. "It's probably going to trigger a faster death mechanism [for the neurons]. You might end up losing more brain neurons and develop conditions earlier -- speech problems, memory problems, even Parkinson's-like symptoms."

"If you were going to have them at the age of 80, guess what? Now it's going to happen at the age of 60 or maybe early 50s. That's also what we see with boxing."

There is anecdotal and hard scientific evidence that shows it can help.

"From the standpoint of a concussion, it's a wound," Johnson said. "It's a metabolic mismatch in the brain. When you come to the E.R. for chest pain, certain illnesses, wounds, and injuries, they put oxygen on you. So I'm using oxygen and pressure."

Daphne Denham has done studies showing that when HBOT is applied within the first week of head trauma, as little as two to three "dives" -- referring to when a patient undergoes a session in the chamber -- can resolve symptoms.

The Help Our Wounded (HOW) Foundation, a charitable organization based in Delray Beach, has treated a number of student-athletes who suffered concussions with HBOT, detailing a number of positive results.

What does another concussion mean for Tua?

Even if treatment with a hyperbaric oxygen chamber can help the Dolphins’ quarterback, it's still important to note that concussions affect everyone differently. As such, everyone heals from it differently, too.

"People have different tendencies toward concussions, and we don't fully understand that," Kantor said. "We don't understand why some people are more prone to it."

More: No one should tell Tua Tagovailoa what to do after concussion, say ESPN NFL analysts

In the case of a professional football player, the gladiatorial-like environment of play puts him at risk of anything ranging from sub-concussive to concussive hits on every play. But other factors can be at play, too - factors that range from someone's own injury history, their physical body make-up, to even genetics.

Johnson pointed out there are genetic components that may affect susceptibility and response to traumatic brain injury. Studies have pointed out that once someone suffers a traumatic brain injury such as a concussion, they are more likely to suffer symptoms from future hits.

"Everyone is different, and sometimes the mechanism of injury, the location where they hit their head can sometimes help with a diagnosis and planning a recovery and therapy phase," Johnson said. "The brain heals differently for everyone."

More: Tua Tagovailoa should consider retirement, says ex-Miami Dolphins teammate Ryan Fitzpatrick

In the case of Tagovailoa's latest concussion, Kantor described the hit taken as "acceleration and both linear and angular force."

"I've seen a lot of either current or retired players call for it being time for him to retire," Kantor said. "He's a grown man. I don't know if it's my job to call him to retire or not. But definitely, he's shown himself to be prone to concussions. He's shown that the concussions really seem to affect him neurologically."

For professional athletes such as Tagovailoa, any small lag in cognitive processing can mean a world of difference on a football field. Kantor asks the next time it's third-and-long and Tagovailoa has space in front of him, will he think twice about running? Will the ball come out of the pocket more quickly because of concern toward contact?

Either way, it's football, and hits are part of the game.

"Even though he does bounce back pretty quickly - at least that's what they tell us - the question is, when is his next one going to be?" Kantor said. "And concussions beget concussions. Once you have one, you're more likely to get the next one."

This article originally appeared on Palm Beach Post: Tua Tagovailoa injury spurs doctors to encourage hyperbaric oxygen therapy