DR.WAGDY ELTAIAR

DR.WAGDY ELTAIAR

OZONE THERAPY

ByDr.Med.WAGDY EL Taiar

Ozone Therapy Expert

Member of international Ozone association

Manager for Almahmoud medical center

DR.WAGDY ELTAIAR

What is Ozone?

• Oxygen with 3 atoms O3

• Created by• O2 + Ultraviolet Rays• O2 + High Voltage (lightning)• O2 + Sea Waves

DR.WAGDY ELTAIAR

What is Ozone?

*Upper atmosphere… Ozone Layer

*Lower atmosphere … Reduce Hydrocarbons

DR.WAGDY ELTAIAR

History of Medical Ozone

• C. Lender 1870 (ozone purify the blood)• In Holland 1893 Water treatment with ozone

(now more than 3000 in the world)• War I 1914-1918 ozone used to treat

wounds, foot gangrene and effect of poisonous chlorine gas

DR.WAGDY ELTAIAR

History of Medical Ozone

• Dr.Otto Warburg awarded Noble Prize in Medicine in 1931 and in 1944 for his discovery of the basic cause of cancer in damaged cell respiration.

• In 1983 first International Medical Ozone Association conference was held in Washington

DR.WAGDY ELTAIAR

Approval of use of Ozone in Medicine

• After 130 years of usage it is approved in 22 countries: Germany, France, Italy, Russia, Romania, Poland, Bulgaria, Hungary, Czech Republic, Japan, Singapore, Cuba, Mexico, Britain and 25US states.

• In December 1999 approved in Egypt as an Adjuvant Therapy

DR.WAGDY ELTAIAR

Mode of Action of Ozone

• Inactivation of bacteria, viruses, fungi and protozoa:

– Disrupts the integrity of bacterial cell envelope through oxidation of the phospholipids and lipoproteins.

– Damages viral capsid and upsets reproductive cycle by disrupting virus-to-cell contact with peroxidation.

– Inhibits cell growth at certain stages in fungi

DR.WAGDY ELTAIAR

Mode of Action of Ozone

• Enhancement of Circulation:– Reduce clumping of red cells and restore its

flexibility and oxygen carrying ability.

– Arterial oxygen partial pressure increases and viscosity decreases leading to better tissue oxygenation

– Oxidizes plaque in arteries allowing removal of the breakdown products.

DR.WAGDY ELTAIAR

Mode of Action of Ozone

• Stimulation of oxygen metabolism:– Increases red blood cell glycolysis rate

stimulation of 2,3-diphosphoglycerate (2,3-DPG) increase of oxygen released to tissues.

– Activates Krebs cycle by enhancing oxidative carboxylation of pyruvate stimulating production of ATP.

DR.WAGDY ELTAIAR

Mode of Action of Ozone

• Stimulation of the production of the enzymes which act as a free radical scavengers and cell wall protectors:Glutathione Peroxidase, Catalase, and Superoxide Dismutase

• Production of Prostacycline vasodilatation.

DR.WAGDY ELTAIAR

Mode of Action of Ozone

• Dissolution of malignant tumors:– Ozone inhibits tumor metabolism, oxidizes the

outer lipid layer of malignant cells and destroys them through cell lysis

• Ozone increases the ability of phagocytes to kill tumor cells (by stimulation of conversion of arginine to citrulline, nitrite and nitrate by phagocytes)

DR.WAGDY ELTAIAR

Mode of Action of Ozone

• Activation of the immune system: stimulates production of

– Interferon

– Tumor necrosis factor (TNF)

– Interleukin 2

Reactive Oxygen Species (ROS)Medical ozone Peroxides

(at physiological pH < 8)easily penetrates cell membrane.e.g.: Hydrogen peroxide (H2O2).e.g.: Lipid peroxides.

in plasma “lipoproteins” in cell membrane[Polyunsaturated fatty acids]

HydroperoxidesDR.WAGDY ELTAIAR

Erythrocytes: ATP 2,3 DPG facilitates transfer of O2 to tissues

clumping - enhances blood flow. Mononuclear cells (monocytes - lymphocytes). Physiological release of cytokines. O3 modulates immune system.

Neutrophils. Platelets. Endothelial cells. Activates body’s own antioxidant and radical scavengers.

O3 Action: Activates cellular metabolism:

DR.WAGDY ELTAIAR

DR.WAGDY ELTAIAR

Conditions treated by Ozone

As ozone works on the cellular level so it can be used in many conditions and in different specialties

DR.WAGDY ELTAIAR

Conditions treated by Ozone

• Viral diseases e.g. Hepatitis, AIDS, Herpes Zoster

• Bacterial diseases e.g. infected wounds, diabetic foot, infected burns, chronic sinusitis

• Degenerative diseases and Disturbances of the immune system e.g. Rheumatic diseases and Rheumatoid disorders

DR.WAGDY ELTAIAR

Conditions treated by Ozone

• Exhaustion, nervous tension , pain in general• Vascular diseases e.g. atherosclerosis,

disturbances in peripheral blood circulation• Malignancy in combination with chemotherapy

and/or radiotherapy• Obesity and hyper-chlesterolaemia

And many other conditions (around 190 disease or medical problem)

DR.WAGDY ELTAIAR

DR.WAGDY ELTAIAR

OZONE

does Not Rule Out Classic Medicine

DR.WAGDY ELTAIAR

But OZONEHas Remarkable Results

# In Combination with Classic Medicine

# If Classic Medicine Can Not be used due to Ineffectiveness Or

Side-effects

DR.WAGDY ELTAIAR

Ozone side effects

In comparison to many other therapeutic modalities it has far less side effects

DR.WAGDY ELTAIAR

CONTRA-INDICATIONS

• Thyrotoxicosis

• Favism

DR.WAGDY ELTAIAR

CONTRA-APPLICATIONS

• Inhalational

• Direct Intravenous

DR.WAGDY ELTAIAR

OZONE THERAPY OZONE THERAPY in in

BACK PAINBACK PAIN

DR.WAGDY ELTAIAR

Conditions Treated

• Myalgia

• Muscle Spasm

• Disc Prolapse

• Fatigue and overexertion of Back muscles

DR.WAGDY ELTAIAR

Methods of Treatment

• Chemical Acupuncture in Pravertebral Muscle

• Intra-Discal injection

• Epidural injection

• Ozone Sauna

DR.WAGDY ELTAIAR

DR.WAGDY ELTAIAR

DR.WAGDY ELTAIAR

Chemical Acupuncture

• The iliac crests are palpated and transiliac line is determined to identify the L4 spinous process.

• The inter-spinous spaces are identified by selecting the space corresponding to the herniated disc.

• Roughly 2 cm are calculated bilaterally to the spinous process.

DR.WAGDY ELTAIAR

Chemical Acupuncture

• Once the needle is inserted through the fasciae, material is aspirated while holding the needle still and a 20 /ml of an oxygen-ozone mixture is injected very slowly up to a maximum of 10 ml per infiltration. Aspiration is repeated during infiltration (Tabaracci, 2001)

DR.WAGDY ELTAIAR

How does Ozone Injected Intra-muscularly Work?

• It infiltrates the muscle and in 24 hours some ozone moves towards the vertebral canal (as seen radiologically).

• Ozone dissolves into the interstitial water of the muscle and will generate H2O2, that will inhibit amyelinic fibers (C-nociceptors) and activates the anti-nociceptive system.

DR.WAGDY ELTAIAR

How does Ozone Injected Intra-muscularly Work?

• As occurs during acupuncture (Ceccherelli et al, 1995), the introduction of the needle, re-enforced by the pressure of O2-O3 induces strong inhibition of nociceptors, and prolonged due to H2O2

DR.WAGDY ELTAIAR

How does Ozone Injected Intra-muscularly Work?

• It is known that an algic stimulation of the skin and muscles can reduce pain through the mechanism of diffuse noxious inhibitory control (DNIC), that is why: the needle+H2O2+oxygen pressure can be translated into chemical acupuncture (Bocci, 1998)

DR.WAGDY ELTAIAR

Comparative Studies on Back Pain due to Disc Prolapse

• Paravertebral injection of O2-O3 – 75% satisfactory response

• Epidural injection with dexamethazone– 55% satisfactory response

• Paraverteral injection of bupivacaine 0.25%– 70% satisfactory response

(Gionovich et al. 2001)

DR.WAGDY ELTAIAR

Intra-Discal Injection

• Direct intradiscal injection of 3-10 ml of O2-O3 with conc. Of 20 g/ml.

• Several thousands of patients have been treated with a success rate of 54-86% (Alexandre et al. 1998,Jucopilla et al. 2000, Bonetti 2001 et al.,Fabris 2001 et al., Leonardi et al. 2001, Petralia et al. 2001)

DR.WAGDY ELTAIAR

How Intra-Discal Injection Works?

• Ozone dissolves in the interstitial water and reacts immediately generating a cascade of ROS, among which H2O2 and possibly hydroxyl radical OH, which is most reactive.

• The hydroxyl radical reacts with carbohydrates and amino-acids composing proteoglycans and collagen type I and type II, major components of the degenerate nucleus pulposus leading to its breakdown (McCord 1974,Curran et al. 1984,Hawkins et al. 1996,Bocci et al. 2001,Leanardi et al. 2001)

DR.WAGDY ELTAIAR

How Intra-Discal Injection Works?

• Consequently re-absorption of hydrolytic products and water may lead to progressive shrinkage and disappearance of of the herniated material

DR.WAGDY ELTAIAR

there is an MD Research on this topic been carried on, in Neurology Department in the Faculty of Medicine, Ain Shams University with promising results

DR.WAGDY ELTAIAR

Mechanisms

• Release of endorphins blocks transmission of the noxious signal to the thalamus and cortex

• Hypo-stimulation (elevation of the activation threshold) linked to the oxidative degeneration of C-nociceptors. H2O2 may act like capsaicin.

DR.WAGDY ELTAIAR

Mechanisms

• Activation of the descending nociceptive system.

• Simultaneous psychogenic stimulation of the central analgesic system induced by the gas injection (elicitation of a placebo effect).

DR.WAGDY ELTAIAR

Mechanisms

• The localized oxygenation and analgesia permit muscle relaxation and vasodilatation, and thus a reactivation of muscle metabolism, by favoring oxidation of lactate, neutralization of acidosis. Increased synthesis of ATP,Calcium reuptake and reabsorption of oedema.

DR.WAGDY ELTAIAR

Conclusion

• Results are remarkable

• Safe and less invasive

• Used widely in Italy with wonderful results in thousands of patients

• BUT

– Some of the mechanisms are postulations

– Not enough combined researches with rheumatology or orthopedic doctors

DR.WAGDY ELTAIAR

Conclusion

• The field is open for intensive researches to make use and settle down the benefit of OZONE in BACK PAIN, a safe, easy, effective, non-invasive, simple method.

DR.WAGDY ELTAIAR

Thank YouThank You