The Business of Healing: Nicole Garrett on Hyperbarics, Trauma Recovery & Patient-Centered Care

Zane Myers (00:01)
Hi and welcome to another episode of The Holistic Entrepreneur and we have on today Nicole Garrett and she is the CEO of, is that your title CEO, owner, operator, all around, chief cook and bottle washer of Under Pressure, which does a lot of unique things, particularly centered around hyperbaric ⁓ treatment.

Nicole Garrett (00:16)
Yeah.

Zane Myers (00:29)
But then you do some other things too, and we'll get into all of those hopefully. But I want to ask you first, maybe how did you end up where you are right now with your business? It's not like a, well, most people don't say, okay, I'm going to go out and start a hyperbaric chamber business. So how did you end up there?

Nicole Garrett (00:49)
Yeah, I actually started out my career as a commercial diver and a dive medic and ⁓ pretty early on was recruited to work at a trauma center, UCSD's Hyperbaric Trauma Center. ⁓ Worked there for a few years, moved on to traumatic brain injury research with the Department of Defense and then moved on to a management company. Most hospitals actually don't

own or operate their hyperbaric centers, they outsource it because there's so many extra regulations. And so I went around opening up centers for hospitals all around the country. And out of that experience, I grew really frustrated with how narrow the bandwidth was for what we would treat with hyperbarics. You know, the mechanism of action for almost everything that we treat is the same, but they say that it only helps 12 to 14 things depending upon what state you're in. And so

Zane Myers (01:39)
Did that have to do

with the insurance reimbursement?

Nicole Garrett (01:42)
Insurance, also hospitals won't treat anything that's not in that narrow window. They stay kind of very rigid. So it wasn't even an option. Say you had a traumatic brain injury, which is one of the most heavily researched things out there to go get that treatment at a hospital. So that's really what drove me to open my own center. We opened it under pressure. It's hospital grade center. We use hospital grade chambers. We take Medicare. We take insurance. We also have cash options.

to bring that high level service, but to people who may not otherwise qualify.

Zane Myers (02:14)
So tell me about, ⁓ so I'm gonna go back, because I wanna find out about that. So you were a professional diver, and how did you get into that? I can see how the route went along, but I wanna go through it, just so you know, for my own curious.

Nicole Garrett (02:29)
Yeah, yeah.

I moved back to California. I grew up here and then family moved away and came back because I wanted to train dolphins at SeaWorld and realized you can't live on that salary. Everyone was working two to three jobs to do it. And I literally opened up the newspaper one day. It was that long ago and saw an ad for a dive school and was like, well, that's still in the water and looks really interesting. And I really loved it.

Zane Myers (02:45)
Yeah.

Nicole Garrett (02:56)
So commercial diver is like a hard hat underwater type welder job. ⁓ But I really enjoyed it and I, know, specializing in dive medicine, understanding how physics affects the body. And then really how far we've progressed even in the last 20 years I've been doing this on what hyperbarics can do has been pretty fascinating.

Zane Myers (03:17)
So ⁓ when you're in diving, that's immediately I thought, okay, now I understand how those things go together because you have the bends or other things that are similarly related to quickly going from one pressure to another pressure. And did you have an experience, maybe not personally, but somebody ⁓ in your diving experience that had something like that that got treated through hyperbarics?

Nicole Garrett (03:42)
Yeah, I mean, that's really the advantage of having a dive medic out on the boat. And we treated quite a few divers also at the university because it's really easy to dive in Tahiti where the water's clear and 70 degrees, but you dive in San Diego where it's 55 degrees and you can't see your hand in front of your face. And you're a lot more likely to get decompression sickness or have a panic incident. So we had quite a few of those where people would wake up in the chamber because

They were out from an embolism or severe decompression sickness. And usually the first response is, I don't need to be here, I'm fine. We're like, well, that's not quite how it works. You do need to be here. We're gonna be hanging out for the next six plus hours and we'll get you through it. ⁓

Zane Myers (04:20)
Yeah

Wow. you were there. So did you have medical experience before you went to the dive thing or did you end up just getting there because of the whole experience?

Nicole Garrett (04:40)
Yeah, I got there through the experience. I started with my EMT, then you go on to DMT, and then you kind of evolve your education as you need to.

Zane Myers (04:48)
How interesting.

then you started working in hospitals or helping hospitals. Was it just a progression from doing that? How did that go from dive to the next step in the thing?

Nicole Garrett (05:04)
Yeah, I, UCSD was looking for some experienced dive medics because they work with so much trauma. So they want that extra education. And, ⁓ I've, you know, I fell into that pretty well. I did some research with the department of defense on traumatic brain injuries for our military. And then after that, I moved on to a company, like I said, that, that open centers for hospitals and runs and operates them.

Zane Myers (05:10)
Mm-hmm.

Nicole Garrett (05:30)
So we would come in and do everything from the site survey to see where we can put the chambers if it meets safety specs, make sure we retrofit the rooms if need be for the various compliance things and then help them run and operate it. Like I said, most hospitals don't know how to manage that. There's so many extra regulations with Department of Transportation and ASME and PVHO that they're just like, don't know how to deal with that. And we really don't know how to help identify patients.

to get them the service. So we would teach the physicians and the staff the approved hyperbaric course so they're up to the right level of education and then help them manage it.

Zane Myers (06:11)
Hang on one second, I gotta turn something off, have.

I had a little heater there in my office. So I'm not so fortunate to live in Southern California, although I live in the Seattle area and my office is in the lower part of my house. And right now it's still kind of cool if I go and I look at my weather. So I don't know what it's like in where you are right now.

But for us outside, springtime can be kind of sketchy. And so it's 57 degrees and cloudy. It's not 57 in here, but I don't like it. It's not warm enough, so I have this heater in here. It makes too much noise. I don't know whether you wanted the whole thing. If you ask me what time it is, I probably will tell you how to build the watch. So you got into that, and then you went out on your

Nicole Garrett (06:58)
you

Zane Myers (07:05)
own, you're doing the same thing, or you're working consulting for the government or

Nicole Garrett (07:09)
No, so around 2018, just kind of, like I said, I reached peak frustration. I'd always wanted to open my own center, but I needed, think, that push of why are we not offering this to people? Why are we not treating other modalities? Why is this so hard to obtain? And called up my now medical director and said, look, I wanna do this. Will you be my medical director? And ⁓ he said, perfect timing. We wanna open a surgery center and don't know how to run.

this, but you've run centers for hospitals for the last 15 years, let's partner. And so that's what we did. We opened in 2020, so February 2020, really awesome time to open during COVID.

Zane Myers (07:51)
Yeah. And so how is the stress of doing that? Well, first of all, you probably have a lot of your own personal finances on the line. You must have gotten some investors or maybe the position is just all bootstrapped.

Nicole Garrett (08:07)
It was all bootstrapped. ⁓ I mean, I didn't take a paycheck or salary or make a dime for over six months, but ⁓ we made it work. And, you know, the business is very sustainable now. We're actually in construction on our second center. So we do have it figured out. And it was nice to be able to do it independently and not have investors and other people you have to answer to.

Because that was another driving factor of why I left my last company is they had sold out to an investment firm and you know, it became all about money and financials and not necessarily about patient outcomes. And that just wasn't the direction I wanted to live.

Zane Myers (08:32)
Mm-hmm.

So did you have some sleepless nights along in there in 2020? I still do, okay. As the entrepreneur.

Nicole Garrett (08:53)
we still do. We still do. I mean, you start out like, like you said, you're the, you're

the CEO slash plumber slash electrician slash ⁓ until you can afford to bring on more staff to get help and outsource that stuff. So

Zane Myers (09:01)
Yeah, everything.

Yep. So typically, ⁓ what's a typical day for you? I mean, there's probably no such thing, but you you come in in the morning and what time do you open?

Nicole Garrett (09:18)
We have run from 7 a.m. to 5 30 p.m.

Zane Myers (09:22)
no, you froze. there you go. Okay. ⁓ go ahead. You froze on my side, but you were going on your side.

Nicole Garrett (09:29)
⁓ So we open at 7 a.m. We run till about 5 30 p.m. I'm not in the office that entire time, but we have treatments running during that time. We've got a pretty big staff. We've got about 40 people on staff. So variability there.

Zane Myers (09:45)
So you're opening another

location and how far away is that?

Nicole Garrett (09:50)
It's only a few miles away. It's in what's referred to as the Triangle, the Golden Triangle.

Zane Myers (09:56)
So the reason why you opened up this new location is because you ran out of space then and you're only a few miles away.

Nicole Garrett (10:04)
Yeah, we have a really big surgical group that was sending us a lot of their patients. They specialize in ⁓ mastectomy and reconstructions with breast cancer, and those have a very high risk and failure rate. So they use the hyperbarics a lot to help mitigate that and believed in it so much they wanted to add it to their locations. So we're partnering with them to bring the high level hyperbaric service, not these kind of mild or

less than full grade chambers. ⁓ So we're basically going to make an extension of our home base.

Zane Myers (10:35)
Yeah.

Wow, so ⁓ this group that does a lot of mastectomies, tell me about ⁓ what's the difference between when you do a hyperbaric treatment after that kind of pretty dramatic surgery versus when you don't do.

Nicole Garrett (10:58)
Well, Beverly Hills in particular kind of pioneered the nipple sparing mastectomies. So if the cancer is not in the duct, we can save that. But what they do is they basically lift the skin off all the tissue, take away everything underneath, which includes all of the blood supply, and then set that skin back down on an implant. So it's got no existing blood supply. So it's pretty imperative to get them in the chamber. We keep that tissue alive.

And then we actually kickstart the growth of new blood vessels. Hyperbarics is one of the only things that will regrow new blood vessels in the body.

Zane Myers (11:30)
and this is not covered by insurance.

Nicole Garrett (11:34)
For mastectomy reconstruction, is if it gets to the point where there is some compromise, but they do wait until some of the tissue is dying. So a lot of times people will opt to pay cash ahead of time and prevent what's called a flat failure and prevent the scarring and repeated surgeries to do that. So it depends on where you come in on the process and whether or not insurance will cover and your specific insurance plan.

Zane Myers (11:38)
OK, good.

Right.

Well, that's a wonderful thing for women who have to undergo something which is so emotional and life-changing to be able to give them a lot better outcomes. I would think the only thing stopping anyone from doing that was just, I have the cash available to do it?

Nicole Garrett (12:27)
Yeah, yeah, and that's often a factor. I mean, we are definitely a lot more affordable than, you know, going to a hospital because we don't have that level of overhead, but it's never one treatment that you come in for. If we're regrowing new blood vessels and establishing a new blood supply, you're looking at 10 to 20, sometimes 30 treatments. So it can get cost prohibited.

Zane Myers (12:48)
So it's pretty expensive. And I don't want to ask you how much a treatment is, but in the range, like if you had something like that, what kind of range would you expect that to cost you?

Nicole Garrett (13:01)
Yeah, and like I said, it depends on the level of tissue degradation you may have. I mean, if everything's looking good, you just want to support the surgery. It may only be like $1,500. But if we are really trying to repair a failure or it's heading that direction, then we need to go longer in the chamber. We need to go deeper and you're going to need more treatments. And so all of that kind of starts to add up.

Zane Myers (13:07)
Mm-hmm.

Yeah.

Yep.

Okay, well when you're talking about your health, know, there's, that's one thing you can't get back. So, but I'm going on your site now and I'm looking at and I thought some of these things that I, know, air or gas embolism, that's really obvious. But the one thing I don't really think about is ⁓ oncology and radiation therapy ⁓ and ⁓ recovering from those. Those are really pretty traumatic things to you.

Nicole Garrett (13:33)
Yeah.

Zane Myers (13:56)
to go through. ⁓ I mean, some of the therapies that you go through. So we have a family member right now who's going through some pretty dramatic ⁓ chemo that, you know, and so tell me about how this would help with that kind of thing.

Nicole Garrett (14:16)
Yeah, so in the oncology world, they're doing a tremendous amount of research with hyperbarics. ⁓ Currently, insurance will pay for if you get radiation and the goal of radiation is to kill the blood supply.

Zane Myers (14:26)
So we seem to be having, ⁓

I mean, I know it's recording okay on your side, but it's not coming through. So the nice thing about.

I seem to be having, even though I know it's recording on your side, it's recording on my side, I seem to be having a little bit of an issue with you coming through, so I'm not able to keep up with the conversation that's going on here for some reason.

Nicole Garrett (14:51)
Yeah, it's probably it did this on my last call and I've not actually had this before. My first call was flawless this morning.

Zane Myers (14:57)
And I don't know

if it's the platform or if it's, I've never really had this instance before. So I'm gonna try something just for a second here, if you'll bear with me. I'm gonna disconnect and then I'm gonna reconnect and hopefully I'll stay on.

Okay, I reconnected. I don't know if it's me, you, or the platform. So go ahead and talk and let's see if it comes through.

For some reason, it's not working.

Nicole Garrett (15:20)
Hello.

Yeah, I can close those ones now, yeah.

Zane Myers (15:24)
Okay, so are you with me?

Nicole Garrett (15:26)
I'm with you.

Do you have me? Yeah, I'm here.

Zane Myers (15:27)
Are you there?

Nicole, I think

we have some sort of a technical glitch that's is plaguing us. And I'm not sure why. You're kind of frozen for me.

Nicole Garrett (15:37)
Yeah.

Zane Myers (15:41)
I'm going to try that.

Okay, now you're unfrozen. I'll just wait and see.

Are you there?

Nicole Garrett (15:46)
I'm here, but you are a little glitchy.

Zane Myers (15:50)
Okay, I'm glitchy. I think it's you. ⁓

Nicole Garrett (15:54)
No, I do think it's

probably my internet. Los Angeles has them. We have no cell signal here and well.

fastest internet you can buy is clearly working well.

Zane Myers (16:04)
Ha ha ha.

So we need to go to Europe and they have really fast internet there. I am wondering if I should, so it says it's still uploading. Continuously upload your hybrid. Okay, so I'm gonna just go ahead and store it in and let's see if we have any more interruptions. So I was talking to you about, ⁓ let's see here.

Nicole Garrett (16:08)
Yeah.

Zane Myers (16:32)
about ⁓ radiation oncology ⁓ treatment and using hyperbarics for that. Can you tell me about that?

Nicole Garrett (16:41)
So ⁓ radiation specifically, the goal of radiation is to kill the blood supply to the cancer in an effort to eradicate the cancer. And doing so, oftentimes the surrounding tissue can have a lot of damage. So the hyperbaric oxygen therapy will actually reverse that damage. So after you've done your treatment course of radiation, and if you still wait about six months and you're having trouble healing on that side, or you're having still bleeding from, you know, if it's proctitis or cystitis or something.

Zane Myers (16:54)
Mm-hmm.

Nicole Garrett (17:11)
You'll come do a treatment course with hyperbarics, usually 30 to 60 treatments. That is a pretty lengthy one. And we can regrow those blood vessels in those areas and reverse that damage.

Zane Myers (17:22)
And so does

that, ⁓ is that something that ⁓ is covered by insurance? that's good.

Nicole Garrett (17:29)
That is covered by insurance. ⁓ And

that's because, you know, it's been documented and known that the radiation side effects can happen. And so we can reverse that. In the chemotherapy oncological world, not yet covered by insurance, but heavily researched, they're finding that if you do the hyperbarics concurrently with your chemotherapy, that you can use a lower dose of chemotherapy. It's more effective on the cancer cells and you have less side effects.

because you're also using a lower dose, but it's kind of protective on your healthy cells. And so what's kind of happening is you're opening up the cancer with the oxygen and then the chemo gets right in there. And because really cancer doesn't like oxygen. Usually it takes about a 35 % deficit of oxygen to turn a cancer from a normal metabolic process to a cancerous process. So now it's using glucose or other means for energy.

Zane Myers (18:09)
Mm-hmm.

Nicole Garrett (18:26)
So you fill it full of oxygen and opens up trying to get rid of the extra oxygen because it doesn't know how to convert it and that lets the chemo come in. So that's not yet approved, but there's a ton of research coming out on it. And some people will elect to do those concurrently. And we are seeing much better results for those that are. And we always work with the oncologist at that time, because again, if we're using the hyperbarics and they need to lower the dose of chemo, we don't want to just surprise.

So we can currently have conversations with the oncologist as treatment progresses.

Zane Myers (18:55)
Yeah.

So have you considered, well I don't know whether, are you happy with where you are right now or have you considered opening up these centers around the country? Because it sounds like there's not a lot of this going on in that way. It's all hospital-based.

Nicole Garrett (19:14)
Yeah, so the goal is to open up across the country and really expand and I probably will go the investment route for there just so we can get the growth. There are a lot of smaller hyperbaric centers opening up, but most of them don't have the high level chambers. know, they're mild chambers, they're not going to give you the same results and they don't have the physicians on staff to kind of help manage that. Because like I said, a lot of most of the hyperbaric world, it's an adjunctive therapy for other things you're doing.

Zane Myers (19:22)
Mm-hmm.

Right.

Nicole Garrett (19:42)
So we want to coordinate care, so you're maximizing your benefits. We don't want to just throw you in and be like, well, you're done. That's not realistic.

Zane Myers (19:42)
Great.

So how do

you differentiate yourself? ⁓ if you went somewhere else, for instance, I see that the challenge, you kind of grew organically over a period of time and you had some physicians who knew you and knew what you did. So if you went somewhere else, ⁓ do you think it will be a challenge ⁓ to be able to demonstrate, we're not like the other guys?

these hyperbaric McDonald's for, know, that have these hyperbaric machines, these are, we're, have a clinical ⁓ approach to this, not a, it's not a, you know, we do suntans and hyperbaric chambers, which, you know, you kind of see out there. So how do you differentiate yourself in that way so that you kind of, you're educating not just the consumer, but also the physicians in the area?

Nicole Garrett (20:24)
Yeah.

That's exactly what it is. It's a lot of education. ⁓

the general pushback we get from the public is, it's only $100 down the street. I'm like, well, you are getting what you're paying for. ⁓ And even physicians, there's an educational component. mean, one of the things I do is teach the 40 hour UHMS course that allows them to go on to get certified, but they get one hour of hyperbaric education and med school. And so unless they rotate through residency in an area that has hyperbaric oxygen therapy,

or they're a diver, I mean, that's really kind of in and out. And they're not going to understand, you you dose with time and pressure and there's a minimum amount of pressure that has been shown to be effective. So you can't just put someone in at like 1.3 atmospheres or like seven to 10 PSI and expect to get results. Those results don't turn on until you're much deeper.

Zane Myers (21:38)
So if you have, you said UHMS course or certification, what's that?

Nicole Garrett (21:46)
Yeah, UHMS is the Undersea Hyperbaric Medical Society. ⁓ They're a sub-society of APMO, which is the Atmospheric Medical Society. So we're combined with ⁓ basically a lot of the NASA studies, because the physics of decompressing is the same whether you're decompressing from diving to sea level or from sea level to the atmosphere. So we share a lot of the same science. ⁓ so there is an accreditation course that

Zane Myers (22:01)
huh.

Yep.

Nicole Garrett (22:14)
All of our technicians go through nurses and physicians so they understand what they're prescribing and how it's working.

Zane Myers (22:23)
So if you were going to expand out, you'd probably pick a nearby market. Let's say would you probably go up the street to whatever, Santa Monica or out to Riverside or something like that. You'd probably stay close so you could kind of expand out. Or is this something you'd want to go up just Oakland or San Francisco, probably not Oakland, in Seattle and.

Nicole Garrett (22:48)
think that the goal would be to expand

nationwide. I mean, I get calls all the time for consulting all over. It's a time and resources for me. ⁓ So it better to kind of join in with the brand, make sure that they're following the set standards. So you are getting safe treatment, you're getting effective treatment, and we can co-market that way.

Zane Myers (22:58)
Mm-hmm. ⁓

Yeah, that sounds fantastic. So would you franchise that or would you just ⁓ maintain a part ownership, partnership kind of thing? You don't really know at this point.

Nicole Garrett (23:23)
Yeah, we'd

maintain a part ownership or partnership. I'm not looking to franchise. I think you run into risks of safety that way. and especially with hyperbarics, you really want to make sure your people are educated. They're not getting complacent and letting things in the chamber or trying to use the next cheapest chamber. That's not been proven, you know, safe, at least by us standards. Cause there's a lot of that right now.

Zane Myers (23:32)
Yes.

So I've had ⁓ hip replacements and I actually had multiple hip replacements, two hip replacements on the same side. ⁓ How would that, so and I had this just gigantic huge scar, it was a massive surgery ⁓ because I broke my femur. Anyway, so it was quite a big deal ⁓ and my recovery was horrible. I was in a wheelchair for like a month ⁓ and then it took me a long time to.

to recover and obviously I'm still have a certain, but I go out and play tennis and so forth. How could or could hyperbarics at this point, so that's been like eight or nine years ago, could hyperbarics at this point have any effect on my kind of remaining issues that I have with that?

Nicole Garrett (24:41)
Yeah, no, it absolutely could. I mean, the mechanism of action is kind of the same, whether you did it right away or now, obviously, the sooner you do it, the better. But we are using the pressure to dissolve oxygen in your tissues and your fluids. And bone tissue is very dense, very low oxygen. know, the marrow is about the only place we get it. So we use that extra pressure and we also use it for bone infections ⁓ to really drive that in there. But you're also getting really potent anti-inflammatory effects.

And the other thing we see a lot is a reduction in scar tissue. And that scar tissue is preventing movement. It's causing tension and tightness. So by getting that to loosen up by doing a series of treatments, you're going to have greater mobility. And then obviously the more you can move and use your hip, the healthier you can stay.

Zane Myers (25:11)
Hmm?

So I

also think of people who do, so I had a friend of mine who did stem cells treatment for joints. This would seem like it might have an effect on that as well.

Nicole Garrett (25:41)
Yeah, so hyperbarics in ⁓ by itself releases stem cells. There's kind some mechanisms of action on how that happens. But if you do an injection and you do hyperbarics right after, usually do three within the first 24 hours, you increase the uptake of those stem cells that you injected because you're keeping them alive while they find a home and start kind of going to work.

Zane Myers (25:46)
Mm-hmm.

Right. It sounds like there's not really a procedure or especially something invasive that doesn't have a potential benefit from ⁓ hyperbarics.

Nicole Garrett (26:16)
Yeah, I mean, the mechanism of action, your body uses oxygen for most of its processes. So we're just giving the body more tools to use and manipulating how we get it in there, and it will go to work. so. Yeah.

Zane Myers (26:28)
So let me take a cynic side ⁓ and

say, okay, well, yeah, I get in there and I get the ⁓ hyperbarics and then I get this ⁓ relief from whatever it was that I had, but ⁓ then I leave and it's not gonna do anything later.

Nicole Garrett (26:48)
So for some modalities, that's the case. And that's part of the reason we do a long consultation with people and really set their expectations on what's feasible and what's not. And there's oftentimes we turn people down because it's not the right fit. But for some, it does kind of have a long-term benefit. And so that's where you want to pick the modality. If you're just getting the anti-inflammatory effects, but you still need to correct the disease process, it's not gonna be a long-term fix. One thing we treat a lot is diabetic wounds.

Zane Myers (27:11)
Mm-hmm.

Nicole Garrett (27:15)
We can heal that wound and even revasculate the foot a little bit to keep the blood flow going in. But if you're going home and your sugars are really high and you're recrystallizing those blood vessels, that's not gonna be a long-term fix. Or for a lot of autoimmune diseases, we're starting to see really good benefits. The hyperbaric chamber will get the inflammation and that kind of storm down of that reaction, but you still have to find your triggers.

Zane Myers (27:19)
Yep.

Nicole Garrett (27:42)
we can find them a lot faster, say, unlike Crohn's disease. Instead of taking three, four months in elimination diets to try and find what you're allergic to or what's causing flare ups, we put you in the chamber. Within a couple days, we'll get all that inflammation down. And then now you find your trigger very quickly. And now you can eradicate the source. So, like, go ahead.

Zane Myers (27:58)
⁓

So go

ahead. Well, my question, so how would that work? And you were just about to tell me when I interrupted you. like if you have this issue with foods and you don't really know what it is that's triggering you. So you're saying ⁓ after the hyperbarics, your inflammation goes down and then you can evaluate which foods, how does that all work? ⁓

Nicole Garrett (28:26)
Yeah, we still, like I said, hyperbarics is most often an adjunctive therapy with other things you're doing, but it's a very useful tool with that, with Crohn's. I mean, it's an elimination diet that you have to do to figure out what is causing these big flare ups. But if you're so inflamed that it takes three, four months to get the inflammation down, how do you know if you ate that food, if you re-inflamed it and you're extending this process? If we can get the inflammation stopped in a couple of days.

⁓ then we can find your trigger very quickly.

Zane Myers (28:59)
Now we seem to be having an issue again.

Nicole Garrett (29:02)
I just saw the little thing on mine too.

Zane Myers (29:05)
I'm going to put it on stop for a second and then we'll start it up again.

Zane Myers (29:10)
Okay, so we went off the air. This is going to be in segments here. Hopefully we're going to still be recording okay. Thanks for your patience. I haven't really had this happen before, but that's okay. We just roll with it. So I was just mentioning that I had a healthcare background and I know of hypervibe. I knew of hypervibe because I had 30 years in the medical device business and I knew that that was really an effective tool for wound care.

⁓ And so I was aware of that, it's a logical thing that would work for all these other particular situations, but I wasn't aware of it until I just happened to run across you. And I find this fascinating.

Nicole Garrett (29:52)
Yeah.

Zane Myers (29:53)
So let me go back over and ask you specifically about some other, ⁓ this is one. ⁓ Carbon monoxide, I guess that shouldn't surprise me, but carbon monoxide poisoning. So if someone's in their house and they have ⁓ some sort of an issue with their gas stove, have you ever had patients like that?

Nicole Garrett (30:13)
We've had a few kind of what we call mass casualties where a school or a business will have ⁓ carbon monoxide poisoning. ⁓ The bigger challenge with carbon monoxide poisoning, so you're suffocating from the inside, the carbon monoxide attaches to your red blood cells and you can't get oxygen on there. And then it's about a six hour half-life. So for six hours, you're trying to get half that dose gone. If we put you in the hyperbaric chamber, we drop that to 20 minutes. But more importantly,

Zane Myers (30:25)
Mm-hmm.

Nicole Garrett (30:41)
your brain, your heart, your organs are now getting oxygen while we're disassociating it. Because we don't actually need your red blood cells when you're in the chamber at a deep enough depth. We could take them all out and make sure that we're supplementing with enough oxygen and your body will pull the oxygen out of your plasma. And so it's a really useful tool not just to eradicate the carbon monoxide now, but to prevent the long-term side effects and brain damage that comes with it.

Zane Myers (31:07)
So do you see, ⁓ as this develops, to me, it seems like it's like a revolutionary tool that's been out there, but it's been so expensive that ⁓ the insurance companies don't want to cover it because this is just one more thing that they're going to have to pay for. That's the way that they see it. ⁓ Do you see that ⁓ as this grows, and I think it would grow, I can't see why it wouldn't grow, that the cost of the equipment would go down because there's more

manufacturing going on or is it just it's just a costly thing?

Nicole Garrett (31:41)
The opposite has happened. As more manual. So there's a handful of devices made in the US that are fully PVHL, ASME, National Board stamp. They will actually weld that stamp on your chamber knowing it's been inspected and met the standards. There's 18 different chambers being imported into the country right now. None of them meet those standards. Some have had some not so good outcomes because of that, because they're not using the right materials.

Zane Myers (31:43)
⁓

Nicole Garrett (32:09)
But you would have thought that yes, that would create some competition and price would go down. It's not. The consistent manufacturers in the US have raised their prices. The other chambers are raising theirs to kind of meet the market. So the devices are getting more expensive.

Zane Myers (32:27)
But the other chambers, so it's really the US providers that are giving you the certified kinds of devices and the other ones are catch as catch can, know, maybe it'll work, hopefully it'll work and some are better than others but you really don't have any assurances.

Nicole Garrett (32:45)
Yeah,

some of them are at least 510K certified, which means they've at least filled out the FDA paperwork and can do low pressure treatments, but low pressure treatments only treat altitude sickness. So if you're trying to treat radiation injuries or regrow blood vessels or treat a bone, it's not enough pressure to do any of that. There's thousands and thousands of studies showing what depth you need to go to, and those devices aren't capable of that.

Zane Myers (32:49)
Mm-hmm.

Yep.

Nicole Garrett (33:13)
or they're capable but they haven't shown that they're safe in doing so. Because if you think of, ⁓ what was that thing called, the submersible that went down to the Titanic and imploded from the pressure, you're pressurizing and depressurizing this device constantly all day every day. So how is that material gonna deal with repeated stress?

Zane Myers (33:23)
Yeah, yeah.

Right, so you have a... So tell me, ⁓ if I go climb inside of a pressure of ⁓ one of your chambers, what's it like? So I see that you can see out through them. It's not like you're in there in a tomb. You can actually look out. So tell me, how do I feel when I'm inside there?

Nicole Garrett (33:56)
It feels similar to flying and that you're going to feel the pressure changes on your ears. It's the reverse of flying because we're adding air. It's kind of like landing in the airplanes. You're going to have to add air to your middle ears. And we teach, we give everyone a little tutorial on how to do that if they aren't already familiar. And then after that, you just get to hang out and breathe. We have a TV on the outside. It's very comfortable. We can talk to you the whole time.

Zane Myers (34:00)
Mm-hmm.

Nicole Garrett (34:19)
⁓ See if you need anything, but your only job is to breathe and the oxygen will do the work. And then when we come back to the surface, your ears will actually clear on their own. And you don't have to climb in and out of ours, our beds on little railings. So we just slide you in and out so you're nice and comfortable.

Zane Myers (34:35)
So you do the ear popping when you're in there? Or the...

Nicole Garrett (34:38)
Mm-hmm. Yep.

Yeah, the Valsalva is usually the most effective.

Zane Myers (34:44)
Yeah,

so yeah, I have a story about that, but I don't want to digress. So if I just sit in there for however long, depending on whatever it is that I'm trying to, or what you're trying to treat, will determine how long I need to be in there and how many times. And I can sit there and watch the big screen TV, or can I bring a book in and read a book, or how does that?

Nicole Garrett (35:08)
So in monoplace chambers, which we have coding states, you can't bring anything in, so no book, but the TV is on the outside, we have speakers on the inside. In multi-place chambers, if they have your exhaust going out, so it's not going into the ambient environment, you can usually bring a book. Yeah.

Zane Myers (35:24)
Okay. So

do you have both of those?

Nicole Garrett (35:27)
We currently just have monoplace chambers. Most people like to go in by themselves. So, multi-place, you're going in with a bunch of people. It's also like a flight. You all got to show up on time or we're leaving without you. So.

Zane Myers (35:33)
Hahaha

⁓ right, OK.

Yeah.

So can you change the channel? It's a silly question, but I just.

Nicole Garrett (35:45)
We know it's not a silly question because

the remote is battery powered and batteries are highly hazardous under pressure in high oxygen environments. You just let us know. We'll change the channel for you.

Zane Myers (35:54)
Yes.

So you probably have like DVRs or things like that to watch different shows for a long period of time or.

Nicole Garrett (36:08)
Yeah, with internet TV now you just buy all the apps. Netflix, Time, Hulu. Some people sleep, some people like to meditate in there. ⁓ A lot of people just pick a good show, it saves your spot and you can pick it up tomorrow in the same spot.

Zane Myers (36:12)
All right, yeah. So do a lot of people go to sleep?

So tell me ⁓ the most surprising patient story that you've had, or maybe one or two of them.

Nicole Garrett (36:36)
Well, we had a great case yesterday and I wish I would have taken the pre-picture and I just didn't, but ⁓ she came in, she had a mommy makeover and her belly button was mostly black. And they said, you're probably gonna lose it. Go try this hyperbaric thing. Unfortunately, her doctor said just one. And I was like, well, let's be realistic here. One treatment's not gonna regrow the blood vessels. Like you cut all the skin around it and reattached the belly button to some new skin. It's struggling.

Zane Myers (36:47)
Mm-hmm.

Nicole Garrett (37:04)
But I said, let's look at after treatment. And it came out and she was like, look, look, I'm so happy. It's all pink. It's all red. It's all. So that helps us know it's not dead yet. It was just severely suffering. We got the oxygen in there. We kickstarted that new growth and then she's going to need to come back for a few days. The tissue will tell us when to stop, but it was cute to see how excited she was that she's like, it's not going to die. And then another case would be when I was working at UCSD, actually we had a woman.

Zane Myers (37:26)
Hahaha

Nicole Garrett (37:33)
that was on a motorcycle and she kind of got the speed wobble. So she stood up the bike on the turn and hit the side railing and broke every bone on the right side of her body. And she had two young children. Her husband was in an active war zone and they actually flew him home because they didn't know if she was going to make it. And we, she came in every day for months and we were able to save her arm and her leg. And she came, I think she treated with us, started it twice a day.

Zane Myers (37:41)
Wow.

Nicole Garrett (38:03)
because the tissue was so badly damaged and a lot of times when the bones are crushed, you don't know if you're going to be able to save that. ⁓ So for about three months she came in and then she disappeared for a little while. And then about six months later she came walking in. So we were like, first of all, you're walking. ⁓ So it was really rewarding. Not only did she survive, but her quality of life got to maintain because we were able to save those appendages that were so severely damaged in that accident.

Zane Myers (38:32)
So it almost sounds like the hyperbarics are like the modern miracle. I mean, in many ways, they sound like a really a miracle treatment.

Nicole Garrett (38:43)
Yeah, I mean, it can appear that way with what it does, but like I said, it's just oxygen. We're just manipulating how we get it in your body and your body knows what to do with it. So in some ways, it's a very benign treatment. Other than the pressure changes, we got to worry about lung issues. A handful of medications can be a little bit problematic. ⁓ It's pretty safe.

Zane Myers (38:51)
Right.

Mm-hmm.

So tell me about the medications

that are problematic with that.

Nicole Garrett (39:07)
Yeah, so there are four chemotherapy agents that we need to calculate like half life on because they can cause either some cardio toxicity or you know some of them are there to destroy blood vessels so we don't want to be growing them at the same time. So we would pause therapy and this is why I say we usually work with the oncologist to make sure we have the right plan. And then another one is ⁓ medication that's used to help

Zane Myers (39:13)
Mm-hmm.

Right.

Nicole Garrett (39:32)
curb drinking for alcoholics and it can really lower your seizure threshold in the chamber.

Zane Myers (39:38)
So how do you market

your services now or do you even need to? know, it's because you're there in Beverly Hills and it seems like you're pretty well known in that community. you, like you have more business than you can handle at this particular juncture? I'm putting words in your mouth, but that was more like a question. Is that the way you are right now? You really don't have to market, I mean, unless you're going to be growing outside of the area?

Nicole Garrett (40:07)
No, we do some marketing. It's a lot of physician to physician marketing, ⁓ educating local physicians on how it can help their patients. ⁓ you know, we do have some social media stuff. I don't know how effective that is or isn't. ⁓ But, you know, if people are seeking out these services, we do tend to highest on the scale, which is good, but that's also because we are the most reputable.

Zane Myers (40:10)
Mm-hmm.

Hahaha

Well, if there's not a lot of you out there, then of course you do have to compete against the people who are pretending that like they have this but don't really. Is that true?

Nicole Garrett (40:46)
Yeah,

there's probably at least 30 other hyperbaric facilities in Los Angeles. ⁓ But besides UCLA, we are the only fully accredited center.

Zane Myers (40:57)
So how do you come out and say that? mean, it's like, if you pardon the phrase, it's a bitch lap. It's like, you can get out of here. You're not doing what we're doing. I mean, it's almost like you almost have to say it, but you can't say it. I mean, how do you deal with that? It's frustrating, I would imagine.

Nicole Garrett (41:15)
It's very frustrating. ⁓ You know, we do our best just through education on make sure we get a safe, effective chamber, make sure it's got that board stamp or you know, you're not guaranteed to get out. ⁓ You know, we can't verify that those foreign machines are made with the appropriate materials that aren't going to cause harm. And then also just educating on, you know, dosing with time and pressure.

It's not just a one and done or get in at, you know, half a PSI or five PSI and think it's, it's going to do anything for you. We end up getting a lot of patients from some of those other centers that are like, it's not working. I don't understand, or I didn't enjoy my experience. didn't feel safe. And so they kind of market for us. Honestly, ⁓ unintentionally. Yeah, but it's just a different caliber.

Zane Myers (41:39)
Mm-hmm.

Not intentionally, I'm sure.

So we're talking about the consumer in those cases, but are some of the physicians then not aware of the difference too?

Nicole Garrett (42:14)
Yeah, they're not. mean, like I said, they get about one hour of hyperbaric education in med school. So, and there's four years of med school. And then if they go on to residency and they actually have a chamber, they might start to get the actual education.

Zane Myers (42:26)
Mm-hmm.

Nicole Garrett (42:27)
on

it, but not every hospital or every residency program has that as an option. So they have very little knowledge on what it is. just go, you know, hyperbarics is working. The field is growing, the word's getting out there and they'll just say, okay, go, go get hyperbarics. But they'll just, they're not really giving people direction or, you know, making sure it's the right pressure, that kind of thing.

Zane Myers (42:41)
Yep.

Yeah. So let me just want to go through your site just one more time and see if something else really jumps out at me. Because I was going through it before and neurological and cognitive health, cardiovascular support, because you know about wound care, crush injury. We talked about that. Infection of skin and bone.

Vision loss, that's the one that I wanted to ask about, vision loss. So it says on here, vision loss, sudden painless in one eye, provide emergency oxygen therapy to help restore vision in acute cases of retinal artery occlusion. So describe that to me. That's fascinating.

Nicole Garrett (43:28)
It's, well, if you think of like a stroke or a little piece of plaque or a blood clot gets in the brain, the same thing can happen to your eye. And your eye has very little blood flow because if there's too much blood in it, you can't see. So if that little tiny vessel gets any kind of occlusion, it starts to die very fast. So we will put you in the chamber to keep your eye alive and save your vision while we're also using some antithromboletics or something to eradicate that blockage.

Zane Myers (43:34)
Mm-hmm.

Fascinating. So is there studies on that?

Nicole Garrett (43:56)
Yeah, there is

and depending upon your state insurance actually covers it too because there's been enough studies. It takes almost 10 years of research to get something approved as like a quality indication, sometimes more. So if it got that far, there's an overwhelming amount of evidence for insurance to say, okay, fine, we'll pay for it. Because they don't like to pay for things. Yeah. Yeah.

Zane Myers (44:09)
Great.

Yeah. Uncle already I give, we'll pay for it.

So this was great. I really wish, I hope that the first part of this podcast comes out because I think the topic was really, to me, really fascinating and interesting. You really educated me a lot about hyperbarics and the use for them. You know, I was just thinking wound care therapy and I really didn't know all this other stuff. So it was absolutely terrific.

Thanks a lot. So I think we'll just wind it up here. Hang on with me for a second. I'm going to press the stop button.

Nicole Garrett (44:43)
Yeah. Yep.