ODDS & ENDS

ACRONYMS - MEDICAL RELATED  what do they mean?????
 

The Circulatory System
The Circulatory System

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Subject: The Pulmonary-Cardiology Connection
"Don Martin" <nnmartin@MAIL.USMO.COM>
Just a few thoughts on some of the subjects we discuss often  and subjects that generate the most questions on our various Lists.....

Heart attacks (myocardial infarctions), ...CHF (congestive heart failure)....coronary artery disease.. strokes.....The latest buzz in medical circles is that one out of every two women will have heart attacks and die because Doctors mis-diagnose the symptoms in women and do not do EKGs (electro-cardiograms) or Echo-cardiograms as routinely for women as they do for men...Men are treated much more aggresively for Heart problems than are women.....

If you have a heart attack your heart can stop beating..You can die unless it starts beating again and quickly.....A heart attack generally occurs when a blockage in a coronary artery severely  restricts or cuts off the blood supply to a region of the heart. causing the heart muscle (myocardium) in that region to die from lack of oxygen......You can, and many people do survive a heart attack or several heart attacks....if they are diagnosed and treated quickly (generally within three hours).

If you are diagnosed with CHF, it does not mean you are going to have a heart attack or stroke. In my opinion you have a much better chance of living for a longer period of time,  (with a much better quality of life). with CHF, than with either a stroke or a heart attack.

Stress is one of the leading causes of heart problems, so is smoking, obesity, high cholesterol levels, and lack of exercise .....There are also additional causes.....(Remember this statement for later comparison with another)

COPDrs know that COPD leads to enlargement of the heart muscle on one or the other or both sides of the heart. That is because we must make our hearts work harder to keep oxygenated blood flowing to our organs in sufficient quantity to keep them working properly...(The exchange of gasses in our blood takes place between the millions of alveoli in our lungs and the capillaries that surround them).... This oxygenated blood first goes to the heart (which takes what it needs to keep working) It is then pumped to the other organs of the body through our blood stream.

Exacerbations of our SOB (shortness of breath) conditions are for the most part caused by stress. They are also complicated by smoking, high cholesterol levels, obesity, lack of exercise and other factors. (Remember I told you to remember that statement)  These exacerbations in turn cause our hearts to work harder until we can get our breathing back under control......We generally refer to these exacerbations as anxiety or panic attacks....

Stress occurs when we are in situations over which we feel we have no control. Stress causes our instinctive "fight or flight" responses to kick in and the adrenaline starts pumping into our systems and through our hearts...The heart pumps faster causing our lungs to try and respond to the need for more oxygen for the CO2 to O2 exchange ....the lungs respond by making our respiration rates go faster to try and get more oxygen......It is a vicious cycle and will not stop
until we get our respiration rates under control...By slowing our respiration rates we can exhale more of the old stale air trapped in our lungs and inhale more oxygen enriched air into our lungs to help with the exchange of gasses.

The one thing that caused 90 percent of our COPD conditions was smoking. We smoked because we were addicted true,  but smoking also reduced stress conditions for most of us.....Now that is "Irony" at it's best...If we had stopped smoking and  not reduced our stress we might have been diagnosed a lot sooner and started treatment quicker and not have progressed as far along with the lung damage as we did....That is probably why  many of us say that we got worse after we quit smoking....

Just my opinions of course and all of the normal disclaimers apply. So I got carried away and rambled on about several seemingly unrelated subjects??? Maybe, ...maybe not....

Breathe easy and for a long time.
Don Martin,(at the beautiful Lake of the Ozarks in Missouri)


ABG SAMPLE SITES............

Hello everyone,

I thought I'd continue the blood gas saga. I have seen many emails about the different sites that blood gases are taken, and a few questions about the choices. I myself have never taken a brachial artery sample, but I believe this is more because of my workplaces' preferences. It might be easier if you refer to the picture above.

If you can open up a second window and read the text below and see it with the picture, it might be handy. Ok, so here is some info on the blood gas sites.

Common sample sites

Radial Artery
The vessel of choice for puncture in the adult is the radial artery, which lies on the thumb side of the forearm. The radial artery, although
relatively small, is very accessible. The arm is convenient and the vessel is superficial and easy to palpate (feel for a pulse). The radial nerve and vein are not particularly close to the artery, and collateral circulation (i.e. a second arterial source) is usually good.
Nevertheless, radial artery puncture may still be painful if the puncture is deep and if the bone covering (periosteum is pierced).

Brachial Artery
When radial arteries are unsuitable for puncture, the brachial arteries should be considered. The brachial artery is the major artery of the
upper arm that divides into the radial and ulnar arteries just below the elbow. It  is a large vessel that can be palpated a short distance above the bend of the elbow on the internal surface of the arm where it passes over the humerus (funny bone).  The median nerve is closely parallel to the course of the brachial artery.  Puncture of the median nerve with associated pain may occur while brachial puncture is being attempted. Venous puncture may also occur inadvertently owing to the presence of significant large veins in this area. The brachial artery is the site of second choice because of the proximity of parallel nerve and veins (and lack of collateral circulation).

Femoral Artery
The femoral artery is the least desirable of the 3 described puncture sites.  Although its large diameter makes is an easy target, the vessel lies deep below the skin adjacent to the femoral nerve and vein. Most important, puncture of the femoral artery has been associated with serious complications. large quantities of blood may seep from this vessel and may go unnoticed because of its deep, inconspicuous location. Moreover, atherosclerotic plaques are common in this area; they may dislodge and lead to distal artery occlusion. patency of the femoral artery is vital because collateral circulation is almost nonexistent. Thus, puncture of the femoral artery is generally reserved for emergencies e.g. cardiac arrest; however, it may be the only option for the hypotensive patient who has poor peripheral pulses.

Ok, that is it. I hope it is helpful. Take care.  Mik  <grrreathaggis@HOTMAIL.COM>

Doctors Swept Up by Connected Consumers
The rising tide of consumerism in health care will determine which physicians sink or swim in the next few years, experts warn.  Already, patients armed with medical information from the Internet are demanding more involvement in their own health care. Studies show they are even willing to change doctors at the click of a mouse to get what they want.
In the past two years, half of America's 100 million households have chosen a new doctor, according to a study commissioned by VHA, a nationwide network of medical providers. Despite physicians' belief that managed care is to blame, patients actually cite dissatisfaction with their doctors as the top reason for switching, the study shows.
"The whole advent of consumerism is affecting the health care industry more than it realizes," said Peter J. Plantes, M.D., medical director for LaurusHealth, VHA's health information service.
Several forces are contributing to this trend, according to a recent report by PricewaterhouseCoopers (PWC), called "HealthCast 2010." Patients are paying a bigger share of their medical tab, which makes them more concerned about where the money goes. Consumers, too, are more educated about health care, collecting information from web sites and from drug companies'
advertisements. At the same time, consumers increasingly feel alienated by their medical providers, including physicians who spend less time with them.
A New Doctor-Patient Relationship However, the PWC report concludes that many providers and insurers are unprepared to deal with the growing ranks of empowered health consumers.Doctors need to reshape their practices to satisfy health consumers' demands, experts advise. Perhaps the most fundamental change will be accepting a shift in patient relationships, reflecting consumers' growing knowledge base and thus power, said David Chin, M.D., M.B.A., a PWC partner. A recent survey of physicians found that 80 percent have treated "Internet-positive" patients, he said, referring to approximately 25 million Americans who consult web sites for information prior to their doctor visit.
"For doctors who see patients as partners, it's not a problem," Dr. Chin said. He personally enjoys discussing issues with well-informed patients, he said. "They still accept that you're the doctor, and that your ability to interpret the information is at a different level than theirs," he said.
In fact, patients want their physician to help them filter the information available on thousands of web sites, particularly because it can be erroneous, said Rita Goldenberg, president of the Society of Healthcare Consumer Advocacy. Patients also want doctors to include them in decision-making, she said.
Medical competency is still a basic expectation, said Goldenberg, who heads anational group for patient representatives. But these days, consumers expect much more.
"They want their physician to listen to them and they want a relationship of trust," she said.
Statistics underscore her point. In the VHA study, the top reason consumers gave for being satisfied with their physician was quality communication --well above the ranking for quality of care.
"The number one thing people want is effective, personal communication," said Dr. Plantes.
Unfortunately, many physicians perform poorly in this area, he said.  According to the VHA data, 71 percent of consumers said they were given no literature or other information referrals at their last physician visit.
"Dry cleaners provide more information to their customers," Dr. Plantes said.
How to Meet Expectations Physicians can do several things to address consumers' expectations, experts say.
Get connected. A survey released last May by Healtheon Corp.(now Healtheon/WebMD) reported that 85 percent of physicians use the Internet regularly. In addition, 33 percent of physicians reported using email to communicate with patients, and nearly that many said they or their group sponsor a web site. However, actual usage may be difficult to measure. A study by Cybercitizen Health found that only 4 percent of online users had access to a physician's web site, and only 3 percent said they had email access. Half of the internet users surveyed expressed a desire for electronic access to their physician, and nearly a third of those said they would switch doctors to get it, said the study, conducted for the internet marketing group Cyber Dialog.
Experts agree that consumers expect their physicians to be Internet-literate.  They can't assess a physician's clinical abilities, Dr. Plantes points out, but they can determine if a physician is well-informed. "Patients respect seeing their physician linked to these up-to-date information sources," he said.
Consumers also are looking for providers who offer other electronic services, such as access to blood test results. "If I can do online banking, why can't I have a similar set of services via my doctor or hospital?" asked Graham Pallett, principal, Deloitte Consulting Health Care Practice.
Be a partner. Patients are highly motivated to understand their own medical conditions, and they may become even better informed about that slice of medicine than their own doctor, said Dr. Plantes. "Physicians should view patients as one of their strongest resources," he said.  Patient advocate Goldenberg stressed that patients increasingly want doctors to include them in decisions involving their own health. "Offering options is key," she said. Consumer groups encourage patients to be responsible partners, she added, by preparing for doctor visits and making joint decisions with their physician, rather than working independently.
Provide better information. In addition to communicating better with patients in the office, physicians need to provide printed materials or refer patients to the internet for further information, said Dr. Plantes. The first step is for physicians to become more Internet literate themselves, so they can assess the quality of various web sites and make recommendations. Research shows that Internet users really value physician referrals, he said.  Doctors also should become comfortable "surfing the web" to better know what their patients are doing, said Dr. Chin. He suggests doctors search the Internet for information about the 10 diagnoses they encounter most often. In addition, he said, doctors should consider how their own practice patterns compare with those recommended on the web. That way, they can either adjust their patterns or at least be able to explain the differences to patients.
Finally, physicians should not be shy about admitting their information limitations. When a patient asks an esoteric question, for example, Dr. Chin suggests responding, "I don't know, but I'm prepared to do the research and talk about it at a future time."
Improve access. Health consumers increasingly will demand better access to their doctors, studies predict. Many already are looking for practices that offer evening and weekend hours, said Dr. Plantes. Currently, only half of physicians offer either one. He suggests physicians look for ways to extend their hours via email services or 24-hour phone lines.
Get branded. Physicians will need help in meeting the growing demands of "e-health consumers," said consultant Pallett. "Doctors can't do it alone," he said.  Experts predict widespread "branding" in health care that will link providers and cultivate Patient loyalty. The PWC report draws a parallel to the airline industry, where consumers select an airline rather than an individual pilot.
"Doctors should look around to see who they'd want to partner with," Pallett said. Being part of an internet network will become a powerful marketing tool, experts said. Hospitals, health plans, medical associations and even independent web sites are enlisting physicians to become part of their e-networks. Consumers already can choose some physicians based on web profiles.
Still, experts advise physicians to be cautious about any Internet alliances, particularly regarding issues of patient confidentiality. But they also say physicians can no longer sit back and watch how the electronic environment evolves. Dr. Plantes divides physicians into three groups, relative to their internet experience: early adopters, followers, and conservative resistors.  The latter group will have a difficult time surviving, he predicts, and even the middle group better watch out.
"The tide of consumerism is moving so fast," he warned, "early adopters are going to capture the market."
ABG SAMPLE SITES............From:  just mika <grrreathaggis@HOTMAIL.COM>
 
Hello everyone,

I thought I'd continue the blood gas saga. I have seen many emails about the different sites that blood gases are taken, and a few questions about the choices. I myself have never taken a brachial artery sample, but I believe this is more because of my workplaces' preferences. It might be easier if you refer to the picture above.

If you can open up a second window and read the text below and see it with the picture, it might be handy. Ok, so here is some info on the blood gas sites.

Common sample sites

Radial Artery
The vessel of choice for puncture in the adult is the radial artery, which lies on the thumb side of the forearm. The radial artery, although
relatively small, is very accessible. The arm is convenient and the vessel is superficial and easy to palpate (feel for a pulse). The radial nerve and vein are not particularly close to the artery, and collateral circulation (i.e. a second arterial source) is usually good.
Nevertheless, radial artery puncture may still be painful if the puncture is deep and if the bone covering (periosteum is pierced).

Brachial Artery
When radial arteries are unsuitable for puncture, the brachial arteries should be considered. The brachial artery is the major artery of the
upper arm that divides into the radial and ulnar arteries just below the elbow. It  is a large vessel that can be palpated a short distance above the bend of the elbow on the internal surface of the arm where it passes over the humerus (funny bone).  The median nerve is closely parallel to the course of the brachial artery.  Puncture of the median nerve with associated pain may occur while brachial puncture is being attempted. Venous puncture may also occur inadvertently owing to the presence of significant large veins in this area. The brachial artery is the site of second choice because of the proximity of parallel nerve and veins (and lack of collateral circulation).

Femoral Artery
The femoral artery is the least desirable of the 3 described puncture sites.  Although its large diameter makes is an easy target, the vessel lies deep below the skin adjacent to the femoral nerve and vein. Most important, puncture of the femoral artery has been associated with serious complications. large quantities of blood may seep from this vessel and may go unnoticed because of its deep, inconspicuous location. Moreover, atherosclerotic plaques are common in this area; they may dislodge and lead to distal artery occlusion. patency of the femoral artery is vital because collateral circulation is almost nonexistent. Thus, puncture of the femoral artery is generally reserved for emergencies e.g. cardiac arrest; however, it may be the only option for the hypotensive patient who has poor peripheral pulses.


Ok, that is it. I hope it is helpful. Take care.   Mik  <grrreathaggis@HOTMAIL.COM>

ABG TESTING SITES

Radial Artery
The vessel of choice for puncture in the adult is the radial artery, which lies on the thumb side of the forearm. The radial artery, although relatively small, is very accessible. The arm is convenient and the vessel is superficial and easy to palpate (feel for a pulse). The radial nerve and vein are not particularly close to the artery, and collateral circulation (i.e. a second arterial source) is usually good. Nevertheless, radial artery puncture may still be painful if the puncture is deep and if the bone covering (periosteum is pierced).
Brachial Artery
When radial arteries are unsuitable for puncture, the brachial arteries should be considered. The brachial artery is the major artery of the upper arm that divides into the radial and ulnar arteries just below the elbow. It is a large vessel that can be palpated a short distance above the bend of the elbow on the internal surface of the arm where it passes over the humerus (funny bone).
The median nerve is closely parallel to the course of the brachial artery. Puncture of the median nerve with associated pain may occur while brachial puncture is being attempted. Venous puncture may also occur inadvertently owing to the presence of significant large veins in this area. The brachial artery is the site of second choice because of the proximity of parallel nerve and veins (and lack of collateral circulation).
Femoral Artery
The femoral artery is the least desirable of the 3 described puncture sites. Although its large diameter makes is an easy target, the vessel lies deep below the skin adjacent to the femoral nerve and vein. Most important, puncture of the femoral artery has been associated with serious complications. large quantities of blood may seep from this vessel and may go unnoticed because of its deep, inconspicuous location. Moreover, atherosclerotic plaques are common in this area; they may dislodge and lead to distal artery occlusion. patency of the femoral artery is vital because collateral circulation is almost nonexistent. Thus, puncture of the femoral artery is generally reserved for emergencies e.g. cardiac arrest; however, it may be the only option for the hypotensive patient who has poor peripheral pulses.


ABG

Arterial Blood Gasses are samples drawn from an artery (usually the radial near one's wrist)
which enables us to measure the following values


PH

The measurement of your arterial blood's acid-base balance. This "balance" is controlled by
several factors, but primarily metabolism and ventilation. If there is an imbalance with one or
the other or both, there will be a definite effect on the PH. The approximate "normal" range of
PH is 7.335 to 7.45, with 7.4 being the mean.
Values less than 7.4 are considered to be more "acidic",
while those greater than 7.4 are more basic or "alkaline".


PaCO2

Partial Pressure of Carbon Dioxide in arterial blood. This value is an indicator of how effectively
your lungs are able to RID themselves of a by-product of metabolism,
CO2.
The "normal" range for PaCO2 is 35 to 45 mm Hg.
Elevated values greater than 40-45 mainly indicate that the lungs are not able to rid themselves
of the CO2 ("thus you are a CO2 retainer").
May be evident in emphysema, where much of lungs are unable to effectively exchange gasses.


PaO2

Partial Pressure of Oxygen in arterial blood.
This is a measure of the actual amount of oxygen there is in your arterial blood.
The "normal" for PaO2 is generally greater than 75-80 mm Hg, relative to your age.
For the most part, it should be greater than 55-60 mm Hg, otherwise supplemental oxygen would
be indicated. (Note of caution: More is not always better.) For those on supplemental oxygen,
PLEASE CONTACT YOUR PHYSICIAN PRIOR TO INCREASING OXYGEN FLO.


ANTHRAX:

Be alert to any symptoms that could be anthrax and deal with them expeditiously. Only by early treatment can a fatal outcome be avoided in the case of inhalational anthrax.
So the problem is the symptoms are subtle, but the good thing is that unlike what had been suggested, even inhalational anthrax can be effectively and successfully treated if caught early after symptoms have begun. The essential problem for lay people and for physicians is sorting out anthrax (very very rare -- previously unheard of) from the very common (viral syndromes of various sorts including influenza).
First of all, it is important to seek medical attention early for any suspicious symtoms at all. In most instances, making an appointment a day or two later is too much delay for this illness, which, again, has to be diagnosed very early after the onset of symptoms for successful treatment. In general the hosptial ER is the right place to go.
Second, if you seek medical attention, you need to help your doctor who has never seen a case of anthrax, and possibly knows little or nothing about it.
Third, the symptoms are generally those like the flu, namely muscle aches, and fatigue. They may include a cough, and/or headache. There may be a low (minimal) fever, but early in the course of symptoms, a high fever does not seem to be characteristic.  So be alert to any such flu-like symptoms and don't wait for a fever to develop. As for just a runny nose, and nothing else, it seems that this alone would not suggest anthrax, and some believe
that a runny nose is not part of the picture at all.
Fourth, one good thing about influenza is that there are rapid tests to diagnose influenza. And although, one could always have flu and anthrax, normally patients don't have two diseases at once. So, if you feel like you have the flu, get a test for the flu and see if it is positive.
As far as the diagnosis of anthrax there seem to be some common features, as best I can tell from the three cases that I tried to learn about in detail.
First, the heart rate tends to be higher than normal, even in the absence of any good explanation (eg a high fever.) This would be anything higher than 100 at rest, for sure. It would not be a bad idea for people to have an idea of what their resting heart rate is normally.
Second, there are chest findings on x-ray, but they are quite subtle. They are lymph node enlargement of the mediastinum (central part of the chest), and pleural effusion (fluid in the chest). These may easily be missed by the average ER physician, so it is important that the chest x-ray be read by a radiologist promptly. So with any suspicion of inhalational anthrax, even without a cough, a chest x-ray is advisable.
Third, blood cultures tend to be positive, very early after the culture is taken (less than 12 hours instead of taking a day or two to grow out the bacteria).
It may be, although I am not sure, that a smear of the blood may actually be positive, showing anthrax bacteria. In other words just smearing the blood on a glass slide and staining it may reveal the bacilli. Usually, however, labs just plate out the blood to try to grow out bacteria.
Based on this, the way I think that a physician should approach any case where he/she feels anthrax may be a possibility would be to:
Check the vital signs and be suspicious about an unexplained tachycardia (higher than normal heart rate) in the context of flu like symptoms.
Do a smear of the blood immediately (that is not waiting for the blood culture results) and look for anthrax bacilli.
Do a blood culture and make sure that it gets plated out immediately, since if positive it will grow out fast.
Get a chest x-ray and look at it very carefully. Have a fully qualified radiologist review it. Get a CT scan of the chest looking for hilar adenopathy if there is any question.
Put the patient on antibiotics (cipro or doxycycline) pending the blood culture results.
I want everyone to have this type information. Actually, I feel a lot better knowing when to be suspicious and how to approach thecases.
Larry Ward
"L. A. Ward" <laward@capaccess.org>


BAROREFLEX FAILURE:  Baroreflex Failure: Often confused with efferent Autonomic Failure

BLOOD PRESSURE
Normal blood pressure in an adult is lower than 130 systolic, 85 diastolic. High blood pressure is
140 over 90 or above. Readings between those are considered borderline.
BRAIN DEATH CRITERIA:  Diagnostic Criteria for Brain Death Vary Worldwide
ST. PAUL, Minn. -- Since Harvard Medical School published its landmark criteria regarding clinical definition of "brain death" in 1968 (JAMA, 1968), diversity in these criteria has evolved worldwide. According to the first comprehensive survey of its kind, published in the January 2002 edition of Neurology, major differences in the procedures used to diagnose brain death in adults have been identified among the 80 countries that responded to the survey inquiries.

"Brain death," the expression for irreversible loss of brain function, is declared when brain stem reflexes, motor responses, and respiratory drive are absent after careful exclusion of confounding factors. While there is uniform agreement on the neurological examination used to determine brain death, this survey found considerable differences in the number of required physicians, mandated level of experience and academic rank of physicians, in specialty preferences, and in recommendations of confirmatory tests. Other striking variations in procedures included observation time from first diagnosis and methods of apnea testing.

"My objective was straightforward -- to survey brain death criteria in adults throughout the world," said study author Eelco Wijdicks, M.D., of the Department of Neurology, Mayo Medical Center, Rochester, Minn. Questions asked in the survey were:

1. What are the specific guidelines, mandatory qualifications of the physicians, number of physicians needed to declare brain death, time of observation and need for confirmatory laboratory tests?

2. Is there a legal provision of organ transplantation and brain death in your country?

Of the 80 countries responding, European, South American, and Asiatic countries were well represented. Brain death guidelines or code of practice were present in 70 of the 80 countries; official legal standards on organ donation were present in 55 of the 80 countries.

According to Wijdicks, "At a philosophical level, some may argue that these differences could have resulted from dissatisfaction with the original concept, and could also reflect cultural attitudes." This comparison of protocols mostly brings out differences in procedural matters, which could be a result of collective decisions by task forces. He notes that in many countries, the guidelines seem unnecessarily complicated. Wijdicks concludes with a recommendation that standardization should be considered.

The American Academy of Neurology, an association of more than 17,500 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. For more information about the
American Academy of Neurology, visit its web site at www.aan.com.


BREATHING PRACTICE:

Though this practice can be done any time of the day or night, it is especially beneficial in the morning, just before you get out of bed. This practice will help detoxify your inner organs. It will help center and energize you for the day ahead. Over a period of time, it will begin to transform your breathing, making it deeper and more harmonious.
1.  Lying on your back with your feet flat on the bed and your knees bent (pointing upward), follow your breathing    .....for a minute or two. See if you can sense which parts of your body your breath touches.
2.  Now rub your hands together until they are warm.
3.  Put your hands (one on top of the other) on your belly, and watch how your breathing responds.
4.  You may notice how your belly wants to expand as you inhale and retract as you exhale. Let this happen, but do ......not try to force it.
5.  If your belly seems tight, rub your hands together again until they are warm and then massage your belly for a .....couple of minutes, especially right around the outside edge of your belly button. Notice how your belly begins to .....soften and relax.
6.  Now put your hands on your belly again and just watch how this influences your breath. Do not try to do anything. .....Simply watch and enjoy as your belly begins to come to life, expanding as you inhale and retracting as you exhale.
7.  When you are ready to stop, sense your entire abdominal area, noting any special sensations of warmth or .....energy.  Let these sensations spread into all the cells of your belly all the way back to your spine.
-----------------
This simple practice can have many benefits, especially if you do it on a regular basis. Remember that you can try this practice at any time of the day or night, sitting, standing, lying down--whatever is most practical for you. It is also an excellent practice to work with whenever you are anxious or tense, since it will help relax you and center your energy.

I definately would reccomend this practice to all  as an "urge fighter" to combat desire for a cigarette.  Instead of giving into your urges and 'lighting up' do this breathing exercise.


BRONCHOSCOPY:
AMERICAN COLLEGE OF CHEST PHYSICIANS - Patient Education Guide  -The Atlas of Digital and Quantitative Bronchoscopy - WebMD Bronchoscopy - Related Infections and Pseudoinfections


BRONCHOSPASM:

Temporary narrowing of the bronchi (airways to the lung) caused by contraction of muscles in the lung walls
by inflammation of the lung lining or by combination of both. Contraction and relaxation of the airways is controlled by the autonomic
nervous system.  Contraction may also be caused by the release of substance during an allergic reaction.

When the airways are narrowed, flow of air out of the lungs causes wheezing or coughing.  The most common cause of bronchospasm
is asthma, though other causes include respiratory infection, chronic lung disease including emphysema and chronic bronchitis,
anaphylactic shock or an allergic reaction to chemicals.


CO2 RETENTIONA major problem with some COPD/Emphysema Patients

Subject:: "pure" COPD
Date:  Thu, 25 Nov 1999
From:  Mika nonoyama <Mnonoyam@WESTPARK.ORG>
 

When it comes to COPD, oxygen isn't always the problem. In my opinion it's the carbon dioxide that is more a problem. The body reacts to an elevated carbon dioxide level more sensitively than a lower oxygen level. When a person is having breathing problems, the elevated carbon dioxide is the "chemical" which triggers a faster larger breathing rate, heart rate etc.  There are 2 examples I can think of here. First is a non-COPD one: deep seadivers (no equipment). Some of you might notice that those people who dive for long periods of time go through a "ritual" before they go under. They start hyperventilating by taking large, deep, frequent breaths. The reason why they do this is to "blow off" their carbon dioxide so that it falls to a low level. When they dive, the carbon dioxide rises from a lower level, taking longer for it to elevate to the level that would trigger their brain to take a breath. This means they are able to hold their breath longer. The danger in this is the oxygen level may fall to a dangerous level in their body causing them to pass out (a problem when under water). They are not stimulated to take a breath because the carbon dioxide level is still not high enough. Oxygen
does serves to trigger breathing, but only when the levels are VERY low. The other example is COPD related. It is the "hypoxic drive". This is rare, and some physicians will argue this doesn't exist.  Almost all people who have COPD have elevated carbon dioxide already-levels that would cause people with healthy lungs to start breathing faster and bigger etc. In COPD, the body adjusts and "normalizes" to the high carbon dioxide. This means their "trigger" to breath faster (or breath PERIOD, in some cases) is shut off. The only trigger (or "drive") to breath is the oxygen level-what is known as the "hypoxic drive". If a person has a hypoxic drive and they are given excessive amounts oxygen, their oxygen level rises.  The body "thinks"  it is getting adequate oxygen while at the same time their carbon dioxide trigger is turned off. The end result is the person stops breathing sufficiently (sometime not at all). In order for them to start  breathing again, their oxygen must fall back down. While this is happening, their carbon dioxide rises even more,
causing the problems like hallucinations, confusion. To find the optimal level of oxygen for these people is often difficult.
But like I said these cases are rare. I have only seen this happen once.

What I'm saying is oxygen is not always a good meter for symptoms. As you noted in your email, you were very SOB even though your saturation was good. Most of your symptoms were probably due to the (1) carbon dioxide, (2) the airway obstruction or (30 the flattened diaphragm (hyperinflation). I'm not sure if this will help, but it might be handy to break up your Combivent doses. Why not take 4 puffs 2 times a day instead of 2 puffs 4 times a day. I think this would leave a more steady concentration of medication in your body throughout the day.  Please keep in mind, I'm NOT a doctor, you should consult your doctor before doing this.


Co2 Retention
 

Hi everybody - long time no see!
It appears a lot of copd'ers have misinformation about CO2 retention.  Only about 20% of copd'ers retain CO2 - and of those only about 10% are affected by the so called hypoxic drive.    As you know, only an ABG will tell you what your CO2 is. In a real medical "emergency" if you need oxygen, it's given - as much as it takes to bring your sats up, no matter what your CO2 is.  For instance if you're having a heart attack you NEED that extra oxygen. Intubation can deal with it if your drive to breath is depressed but much worse damage can be caused by withholding the proper amount of oxygen.  Many severe retainers do not feel increased shortness of breath; they're very comfortable with their situation, right up to unconsciousness.
Dusty


CO2 Retention/Headache
 

From a page at:  http://www.its-canada.com/reed/iaq/co2.htmAt relatively low levels carbon dioxide can cause an increase in pulse rate, breathing problems, headaches and abnormal fatigue. At higher concentration levels, the symptoms can include nausea, dizziness and vomiting, and at extremely high levels, loss of consciousness  Many of the symptoms are related to the fact that as carbon dioxide levels increase, oxygen levels decrease, thereby reducing the flow of oxygen to the brain.
ABG's
ph = 7.40 
pCO2=52 
pO2= 56 
on room air
personal numbers


Blood Types

O Positive.....1 person in 3...37.4%
O Negative.....1 person in 15...6.6%
A Positive.....1 person in 3...35.7%
A Negative.....1 person in 16...6.3%
B Positive.....1 person in 12...8.5%
B Negative.....1 person in 67...1.5%
B Positive....1 person in 29...3.4%
AB Negative....1 person in 167   .6%

The rarest type blood is the one that's not available when YOU need it!

 Whole blood is good for 35 days and red blood cells are good
for 42 days, BUT frozen RBCs are good for a year.

Bronchial Hygiene Therapy  A more common description of this unit by respiratory therapists is "methods to move mucus."

CHEST PHYSIOTHERAPY

1.   Determine presence of contraindications for use of chest physical therapy
2.   Determine which lung segment needs to be drained
3.  Position patient with the lung segment to be drained in uppermost position
4.  Use percussion with postural drainage by cupping hands and clapping the chest wall in rapid succession to produce a series of hollow sounds.
5. Use chest vibration in combination with postural drainage as appropriate
6.  Use an ultrasonic nebulizer as appropriate
7.  Use pillows to support patient in designated position
8.   Use aresol therapy as appropriate
9.  Monitor patient tolerance via SaO2, respiratory rhythm and rate, cardiac rhythm and rate, and comfort levels
10.   Administer bronchodilators as appropriate
11.  Administer mucokinetic agents as appropriate
12.  Monitor amount and type of sputum expectoration
13.  Encourage coughing during and following postural drainage


Cor Pulmonale:

Right ventricular heart failure due to pulmonary hypertension is called cor pulmonale.  The acute condition is an emergency arising from a sudden dilation of the right ventricle due to a pulmonary embolism.  Chronic cor pulmonale develops gradually and is a secondary condition resulting from damage to the pulmonary blood vessels associated with COPD and other lung diseases.  Congestive heart failure is described as an impaired pumping capacity of the heart associated with abnormal retention of fluids.  This can range from mild congestion to life threatening fluid overload and total heart failure.  Decreased cardiac output can also affect the kidneys by reducing their blood supply.  This, in turn, leads to a decreased filtration of the plasma which causes the body to retain additional fluids.
Left sided heart failure produces dyspnea (SOB) of varying intensity.  In early stages the SOB occurs during activity,
later it is while resting also, and in even later stages the patient must sit up to breathe.  Fluid retention, the other common symptom of left sided failure, can cause high blood pressure in the pulmonary vessels (pulmonary hypertension).  This pressure causes fluid to be forced into the tissue spaces of the lungs which can also lead to pulmonary edema.  So you see, we have come full circle.  Of course this is an overview of the relationship, but nothing is a forgone conclusion.  It does sound like your sister is getting trouble from both sides having diabetes and lung disease.  It is true that there is a finely tuned relationship between our heart and lungs, but not everyone with COPD will have heart failure.


Definations:
Carbon dioxide:  Abbreviated CO2, it is a waste product (the other being water) of energy metabolism.  It is important in maintaining proper blood acidity, and is the major regulator of ventilation.
Hypercapnia: Abnormally high quantities of carbon dioxide in arterial blood.
Hyperventilation: Breathing harder and faster than the body needs.  Because it removes carbon dioxide from the blood much faster than normal, hyperventilation is technically defined as subnormal carbon dioxide in the blood.
Hypoventilation:  the opposite of hyperventilation, it is ventilation that cannot supply the body's metabolic demand for oxygen or remove enough carbon dioxide.  It is technically defined as abnormally high carbon dioxide in arterial blood with subnormal oxygen content.
Hypoxemia:  Inadequate oxygen in the blood.
Oxygen:  Abbreviated O2, it is the gas that allows energy to be released from the food we eat.
Metabolism: is the process by which this happens.
Ventilation:  The amount of air that moves in and out of the lungs. It is usually measured for a given time period and recorded in liters per minute (called minute liters).  It is a delicate balance that it is all dependent upon staying in synchronization.


Doctor's visit:

The following is from Cecil Montgomery on 7/24/2000.
This is a subject that has been addressed in the past but I have not seen it surface lately and I thought it might be worth revisiting. Reason being that it could possibly save your life, at some point in time. For any of you that are not familiar with this it is a complete history that you develop yourself and always take it with you when you go on appointments and ER visits. The reason this is so important, is if you are alone or unconscious when you call 911, or whatever, the EMT's and medical personnel will have everything they need right there to treat you with.
Example, take 1 loose-leaf notebook, a set of index dividers and graph paper. The way I have mine set up is that I have a large red cross on the front and stenciled medical history. It never leaves my bedside unless I have an appointment. First Index,  Tab A, my durable power of attorney, listing of next of kin and medical support team with phone numbers.
Tab B, a complete listing of all my medications, when I take them, prescription #s and Drs. name that prescribed. Nurses really appreciate this saves all that writing.
Tab C, Peak flow chart, on graph paper, that I do everyday at the sam time and record.
Tab D, I am on diuretics so I have a preprinted calendar that I record my daily weight on at the same time everyday. Tab E, a record of my exercise daily and what type and how long, with heart rates and blood pressure.
Tab F, a record of all my Drs. visits and the questions that I had for him on those dates. If he says he will schedule something if I have not heard in a couple of weeks I call him. These questions are great reminders and keeps them on their toes.
You can find out more in detail on Bill Hordens website. That's where I set mine up from using it as an example. I have had some great comments on it from Nurses and Drs. Take care, Cecil/ARK


Extra Corporeal Membrane Oxygenation  E.C.M.A.

Edema:

The series design between right and left side of the heart has clearly been a successful design that has served mammals and
birds well.  One clear benefit is the ability to allow the right ventricle to perfuse the pulmonary circuit at relatively low
pressure while allowing the systemic circulation to generate the high pressure necessitated for a high flow velocity. The loss
of fluid from the blood in the lung would be severe if the pulmonary capillaries experienced high pressures and would result in a situation called pulmonary edema.

Historically, congestive heart failure has often beem misdiagnosed as right heart failure ("cor pulmonale" for those who like
latin). In reality the left ventricle is the ventricle that usually fails after a lifetime of working under much higher pressure than its
counterpart on the right side. The backup of blood that can be evidenced by visibly-extending neck veins is usually the result
of left-sided failure that causes blood to back up into the pulmonary circuit, the right side of the heart, and subsequently the
systemic veins.

Do you understand why pulmonary edema can result from left sided heart failure?

Can you envision the dilemma that a teleost fish must face (i.e. one ventricle with the gills and systemic circulation in series
with each other)?

Do you appreciate the problems faced by an elite aerobic athlete who may increase pulmonary blood flow 7-fold during an
event?  Is this not also akin to the problems faced by a person with COPD/Emphysema, To just breath normally?


Fingernails: IsWhat do they reveal about you? Your fingernails

Flutter Valve: sFlutter Valve Therapy

HEALTH FRAUD:

The FDA has published a long article on How to Spot Health Fraud in an issue of its FDA Consumer Magazine.


INFECTIONS:

Bacteria are really quite different from viruses. They are living organisms and usually (but not always) have cell walls. The cell wall is frequently what an antibiotic disrupts although you can also target other things like the metabolism (where is Steve Trost and his wonderful memory when you need him). Viruses take over your own machinery to reproduce
themselves. They are not technically living. You need to develop a vaccine to their proteins or a specific anti-viral drug to combat them and then the little buggers mutate their surface proteins a lot making this a very difficult thing to do.
Mucus color is one of the things doctors look at to try to decide if you have a bacterial infection. Is your mucus clear? Probably viral. Yellow-still probably viral but maybe not. Green- definitely bacterial and maybe even smelly. A fever can be an indicator of either but a high sustained fever usually indicates a bacterial infection. Jump in Suzie at any time. I
am not a doctor or nurse. So your fever, if not low grade and sustained would indicate a more likely bacterial infection.
Often viral infections are diagnosed simply by a process of elimination - it is not bacterial therefore it must be viral. Sometimes there are actual tests looking for surface antigens (proteins) that can tell you that you have a virus. Frequently,
now, DNA tests are run (for DNA viruses) to determine virus infections (with RNA you can use reverse transcriptase to
look at the genetic material of the virus).


MEDICAL EXPERIMENT Web site To Open WASHINGTON (AP)

Your doctor grimly announces there's no more chemotherapy to try for your pancreatic cancer. Or you heard a news blurb about an experimental Parkinson's drug but your physician isn't testing it so you're stumped. Or you'd desperately like a less toxic medicine for your child's rheumatoid arthritis.

 Scientists are conducting thousands of clinical trials in a quest to improve treatment of those and hundreds of other diseases, yet
 less than 5 percent of American patients enroll in such medical experiments.

One reason: It's incredibly difficult for sick patients to ferret out who's studying what and then wade through the scientific jargon to
determine if an experiment might help them or is too risky.

 Now the government is opening a database to help you become a medical guinea pig.  Click here for More information


MEDICAL  RENTAL

of wheelchairs and scooters all over the United States and Canada.  Their # is toll free 888-441-7575.  They will deliver and pickup at hotels, homes etc.  and the scooter can be disassembled and put into trunk of car - the heaviest part
being only about 40 pounds.  What a relief to have this service available.  Their # is toll free 888-441-7575.  They will deliver and
pickup at hotels, homes etc.


MUCUS ELIMINATION (OLIVIJA'S REMEDIES)
 

1.   Drink 8 or more glasses of water a day.
2.  Use a flutter valve as per instruction that comes with it.  The purchase and practiced use of this little device are quite productive in most people.  I have only heard a few say they got no results, but you do have to practice at this one though till you realize how to do it correctly.  You know like learning to whistle.  It doesn't work right untill you learn how to do it.
3.   Get another person to cup their hand like they were going to hold water in it and then firmly pat/tap your back and sides, around lung area, with special concern to stay away from kidney area.
4.   Hand held vibrator in all areas around lung to vibrate internally.  Sometimes you can even feel it breaking up the mucus.
5.   If you are the proud owner (like myself)  of a washing machine that vibrates all over the floor when your washload is unevenly distributed, during the spin cycle when it is vibrating all over the place, Sit on machine and feel those vibes. Can't you just feel the vibes breaking up the mucus and all you have to do now is clear your throat good and bring it all up. I am not kidding, this has worked for me when nothing else has.
6.   Any hot drink will loosen it also.  Lemon and honey included make no difference. and dairy will not make mucus that causes us problems.
7.   Always wear a close fitting t-shirt as extra insulation on lung area. yOU  have to keep cold out of chest area.
8.   Shower with pulsating spray, as hot as you can stand it on all areas of lung, front, back and sides.
9.   Wrap hot pad around chest while sleeping.  I use ace bandages to hold it in place. Periodically I turn it up or down as needed, if it gets to hot.
10.  Hot oil rubs or massages on lung area, front and back, in all lung area. rubbing areas with soft, firm circular motions and for like half hour to hour session.
11.  Soak 12 inch x 12 inch flannel squares in Castor oil. Then wrap completely around chest. It will take a few strips, depending on your size.  Then wrap plastic covering around your Castor oil soaked self. (I use plastic garbage bags.) then wrap heating pad around self on top of plastic bags.  Leave on at least a half hour.  Overnight is great if you can sleep like that.  Pulsating shower to clean off castor oil afterward.
12.  Refer to this site for Glyco-Thymoline use in different ways to eliminate mucus.  http://www.racingsmarter.com/congestion.htm
13.  Check out Airway Clearance Techniques Website for other methods of Mucus elimination.
ADDITIONS BY:
"Melissa Reta" <mooselungs@hotmail.com>
I have CF and coughed up a storm in the morning. What made it easier for me sometimes was to take a hot shower and get it steamy in the
bathroom. Bend at the waste and let it rip. The steam and gravity helped and when you are actually in the shower, you don't have to worry about where you are when the stuff comes out.


NASAL IRRIGATION

can be very helpful for patients with allergies, sinus problems, postnasal drip, and the common cold. It is sometimes possible to prevent early infection and worsening of nose symptoms by using this technique.

Make an irrigation solution out of salt, soda and warm water. Start with 1/2 cup of common table salt and 1/2 cup of baking soda and mix them together dry. Store it in a plastic food container or jelly jar with a lid, to keep it dry and clean. Each time you need to make up a solution, take about 1/4 to 1/2 teaspoon of the dry salt/soda mix and put it in a plastic glass, add about 1 cup of warm water. Buy a soft rubber bulb syringe (ear bulb syringe) at any drug store.  Stand by the sink and fill the bulb syringe with the irrigating solution. Squeeze the bulb to force the solution first into one nostril and then the other using mild to moderate force. Simply squirt the salt and soda solution into the nose and let it drip out. Blow your nose gently to clear the secretions. Repeat the process and clear again. (You may also use a Water Pik with a special nasal irrigator tip.) Clean the bulb syringe with a mild solution of bleach and water once a week. Now, this is the hard part! Squeeze the bulb again with mild to moderate force, and as you squirt the solution into your nose, sniffle it all the way back through your nose and into your throat. Use short, sniffing, snorting actions to get the water through. It will go back into the back of your throat and may make you want to gag; simply clear your throat, spit it out and repeat. When your nose is completely clear, blow and pat it dry. You may now use other nasal sprays, as prescribed by your doctor. Since your nose is now moist and clean, the sprays will not irritate and will provide better coverage and treatment.
Remember! NEVER blow your nose forcefully while holding it shut. This will build up pressure in your nose and sinuses and can be painful and dangerous. Just blow gently to clear the mucus and secretions from the nostrils. "Wash and spray twice a day."
Irrigate at least twice a day, in the morning and evening, followed by nasal sprays. For babies and young children, gently drop some water into the stuffy nose (no force), let it sit until the mucus has softened, and then suck it out with a bulb syringe, or clear it with a tissue. This procedure is especially useful when you have symptoms as described, but you may use it routinely to keep yourself from becoming congested. If the solutions stings or burns your nose, change the amount of salt and soda or the temperature of the water. Since this salt and soda solution resembles normal body fluids, it should feel completely neutral in your nose and should not cause irritation. In fact, the goal is to make your nose andsinuses feel better!

There is another recipe and an excellent discussion at this web site: Alkaline Saline Nasal Irrigating Solutions

NEBULIZERS (Ultrasonic Variety Only) Please note that the omron Ultrasonic MicroAir Nebulizer does not have a water chamber.  There are several brands
of ultrasonic nebulizers on the market.  Do not confuse one brand with another.


 


NEBULIZERS (Ultrasonic Variety Only)

Ultrasonic nebulizers are devices that produce a fine mist aerosol. The USN is used for humidification of the airways to mobilize secretions and to deliver solutions. The ultrasonic nebulizer basically consists of a:

1.radio frequency generator produces a radio signal to the transducer
2.a piezoelectric transducer converts electricity to sound waves
3.a reservoir or couplant chamber containing water smaller nebulizers may not have a couplant chamber.
4.a solution cup or nebulizer chamber
5.a blower fan

The ultrasonic nebulizer uses a piezoelectric transducer located in the couplant chamber of the unit. When electricity passes through the transducer it produces high frequency vibrations that are focused on the diaphragm of the water reservoir. The  vibrations are transferred through the water of the couplant chamber (or reservoir) to the solution cup or (nebulizer chamber) by a membrane. The water in the couplant chamber keeps the transducer cool during operation as well as transmit vibrations.

The vibrations hit the solution cup or nebulizer chamber that is located within the couplant chamber and breaks the water or medication into small particles that are usually within the 0.5 to 3 micron sized range. The frequency of the ultrasonic
nebulizer determines the size of the particles. Most models are preset at the factory at approximately 1.35 megacycles/sec.

The amplitude of the ultrasonic controls the volume of the aerosol output and ranges between 3 to 6 ml/min, being much
higher than the conventional jet nebulizer. A blower is attached to deliver the mist to the patient through large-bore tubing
and may deliver 20 to 30 L/min of air to the nebulizer cup. The ultrasonic has the highest output range of aqueous solution
without being heated of all the nebulizers. A constant level of solution is maintained in the nebulizer chamber through a
continuous feed attachment.

It is recommended by most that ultrasonic nebulizers not be used for delivering pharmacologically active medications like
bronchodilators, mucolytics, and antibiotics. These medications may not nebulize correctly and uniformly and may even
break down and be rendered ineffective during the process.

The advantages of using an ultrasonic nebulizer are that the aerosol delivery is not dependent on the airflow but on the
amplitude setting. Ultrasonics produce 100% relative humidity and can be run for extended periods of time when on a
continuous feed system. They are quiet to operate, produce a dense and uniform mist, and are easily cleaned.


NEBULIZERS (Ultrasonic Variety Only)

Hazards of ultrasonic nebulizer therapy include:

1.Overhydration
 2.Nosocomial infection transmission
 3.Bronchospasms
 4.Swelling of secretions and being unable to cough them out
 5.Electrical hazards
 6.Some devices may interfere with cardiac pacemakers
 7.Water collecting in the tubing obstructing the flow

 Troubleshooting and using the ultrasonic nebulizer:

1.Check for adequate fluid levels in the couplant chamber if mist is not sufficient.
2.Maintain adequate levels in the solution cup. If the levels are either too high or too low no aerosol will be produced.
3.Increase the amplitude (volume) control or check the filter for obstruction if mist is not sufficient.
4.Water should be drained from the large-bore tubing to prevent changes in the flow and FI02.
5.A kinked tubing or a float not working properly on the continuous water feed system will affect the aerosol output also.
6.Low flow rates will produce smaller particles and a higher mist density than higher flow rates.


NEBULIZER CARE AND TREATMENT OF OMRON MICRO-AIR
 

NOTE: The mesh cap is the most delicate part of the MICRO-Air. It is important not to directly touch the mesh cap.
.Follow the cleaning instructions to avoid damaging the mesh cap and keep it in good condition.


A. MESH CLEANING AFTER EVERY USE

1.  Turn the unit off. Remove the medication cup and rinse with water.
2.  With the medication cup off, nebulize all medication remaining in the mesh cap and transducer. When the aerosol mist
diminishes, turn the unit off.
3.  Pour a mixture of one part vinegar and three parts distilled water into the medication cup. NEBULIZE THIS MIXTURE
FOR 45 TO 60 seconds.
4.  Remove the medication cup and leave the unit on. Operate the unit until the aerosol mist diminishes.  Turn the unit off and
replace the micro cover.


B. MESH CLEANING DAILY

1.  Performsteps 1 through 4 from section A
2.  Remove the mesh capand soak in a vinegar/water solution for 10 to 15 minutes.
3.  Swish mesh cap in a bowl of warm water.  DO NOT rinse mesh cap directly under a faucet as this will cause damage.
4.  Place mesh cap back onto nebulizer and operate unit until the aerosol mist stops.  Quickly turn the unit off.  Replace the Micro cover.


C. WEEKLY CLEANING FOR DIFFICULT MEDICATIONS

1.  Perform steps 1 through 4 from section A
2.  Place mesh cap in a microwavable cup with one cup distilled water.
3.  microwave on high for 3 minutes
4.  Let sit in warm water for 30 minutes.
5.  Place mesh cap back on nebulizer and operate until the aerosol mist stops.   Turn unit off Replace the micro cover.


MICRO AIR NEBULIZER Clogging

For those of you that use the MICRO-air ultrasonic nrbulizer and have concerns about the cleaning of the
mesh cap which is the most delicate part of the MICRO-Air. It is important not to directly touch the mesh cap.
Follow the cleaning instructions to avoid damaging the mesh cap and keep it in good condition.
But if it does clog because of thick medications you are using, this is what I do.
I keep with the nebulizer a small bottle with an evedropper in it.  It contains 3 parts of distilled water and 1
part white vinegar.  When clogging occurs, empty medication from cup.  Rinse out cup and put in a couple
of drops of the vinegar and water mixture. Turn nebulizer on and let it mist through until you have used up the
couple of drops. Nebulizer should be unclogged and working fine as soon as the vinegar and water mixture starts
misting through the nebulizer. But use up the couple of drops to just make sure.
 If you fill the cup too full sometimes it will "flood."  But, if you just remove the medicine cup and leave it running it
will usually clear up in a second or three!


NEBULIZING AND PULSE-LIP BREATH TOGETHER WITH OMRON MICRO AIR NEBULIZER
 

One item I would like to share with you is the pulse lip breathing that can be done with the Omron Micro-Air Ultrasonic
Nebulizer.
I nebulize 4 or more times daily.  The one I do when I first arise and the one I do at 8 PM are the ones that I do my purse lip breatyhing with.
I attach the nose-face mask instead of the mouth piece to the nebulizer.  as I inhale through my nose to the count of 4, I have my finger holding down the on-button.  On the count of 4 I lift my finger which turns the nebulizer off and I turn my face and exhale through my lips to the count of 8. Then I return my finger to the on button and continue repeating the process until the all of the mixture is gone.   I use one atrovent mixed with one ventoline ampulet for this morning and evening ritual.
If you would like to try this pursed-lip breathing/nebulizing technique please discuss it with your doctor first and decide on what medication to use in the process.
This works very well for me.  But, I make no guarentees to anyone else's success as each of us is a universe unto ourselves.


OXYGEN

I began looking at the relationship between altitude above sea level and oxygen, and thought some of  you may also be interested.  The following Table comes from the report of the National Oxygen Treatment Trial..(Although these numbers apply only to healthy lungs, the differences are probably pretty applicable for us, too.  For example, I know when I travel from LA to Reno, a  rise of nearly 5000 feet, my SaO2 drops from 96 to 91 -  a drop of 5 points, exactly as predicted by the Table.     Frank NV
                ................................................................................OXYGEN AT ALTITUDE
MTR--
FEET
BP
PiO2
PaO2
PaCO2
 SaO
----
----
--- 
--- 
--- 
--- 
--- 
0
 0
760
149
94
41
97
1500
5000
630
122
66
39
92
2500
8000
564
108
60
37
89
3000
10000
523
100
53
36
85
3600
12000
483
91
52
35
83
4600
15000
412
76
44
32
75
5500
18000
379
69
40
29
71
6100
20000
349
63
38
21
65
7300
24000
290
52
34
16
50
8500
28000
250
42
--
--
--
9100
30000
226
37
--
--
--

 
Also Available is Oxygen tank information
Chart for the Oxygen Saturation vs Altitude curve
BP   = Barometric pressure
PIO2 = O2 pressure in alveoli
PaO2 = O2 pressure in blood
PaCO2= CO2 pressure in blood
SaO2 = % of red cells w/ O2 attached

Normal PaO2 is 80-100 depending on age
Planes are pressurized to 8000 feet
Without lung problems, PaO2 is 60 and SaO2 is 89 at 8000 feet. These are the minimum accepted values for humans.
With lung problems, your PaO2 and SaO2 can be much lower than these values.

Source: National Oxygen Treatment Trial, Dr Tom Petty, 1982.

OXYGEN AND OZONE THEORAPIES

Thanks to Pete Wilson for information on oxygen tanks

OXYGEN TANKS:
There are five cylinders typically used with portable oxygen systems. The smallest is the M-6 or B cylinder which is about the size and appearance of  a wine bottle. The other four have the same "footprint" as the E cylinder, which is the one you commonly see being trailed in a cart.
The shortest of these four is the ML6. [Your provider will probably not stock both the M-6 and ML6.] Next tallest is the M-9
(or C) cylinder, followed by the D cylinder. The E cylinder is the tallest.
Here is how much compressed oxygen and how long each will last under continuous flow of 2 Lpm:: M-6 = 164 L (2.5 hrs.), ML6 = 170 L (2.6 hrs.), M-9 = 248 L (4.1 hrs.), D = 425 L (7.05 hrs.), and E = 680 L (11.1 hrs.).
The E cylinder is designed for trailing in a cart. Only the most hardy of us would try to carry the D cylinder, so for most of us, really portable oxygen means using the M-6 (or ML6) or the M-9 cylinder.
The carrying weight, including the regulator, conserver, and carrying bag is about 5 lbs. for the M-6, 6 lbs. for the ML6, and 8 lbs. for the M-9, not including extra washers, connectors, battery, wrench, and copy of your prescription that you must carry, but also change, cell phone, etc. which you might carry. You can select a bag that hold the cylinder in a vertical position, a bag called "log" bags that allow the cylinder to be transported horizontally, or a bag which you can carry on your back. [Only the CR 50 requires a special bag.]
I am providing this so you can make an informed decision about the cylinder that is best for your life style. Do not let vanity get in the way. Do not try to carry a system that is too heavy for you. That will contribute to your breathlessness.
You should make your decision based on a combination of how much you can carry, if anything, and the duration you might expect from a cylinder. You need not select only one type. Your oxygen provider will provide you with more than one type. I have a friend who pulls an E cylinder one day and carries an M-6 on another day, depending on what he is doing.
Remember, the bottom line is that the portable oxygen system you choose provides you with the oxygen you need. Monitor your oxygen needs and report to your physician when you believe your equipment is not meeting those needs.


OXYGEN, ANYONE?
 

Did you know that one out of every three Americans now gets some form of cancer? This rate is similar in many countries.
It's a scary statistic.  But another, more optimistic statistic is this: athletes have a different ratio of contracting cancer-one out of every seven.  Why? Studies have shown that one of the reasons why athletes stay healthier is because they give their bloodstream more of its most vital element-oxygen-on an ongoing basis. They are stimulating their immune system by stimulating the movement of the lymph fluid, which acts as an internal vacuum cleaner. More oxygen in the cells means less irritants in the system.
Athletes get more oxygen because they don't just breathe, they breathe deeply. When you breathe deeply you can actually feel the benefit of receiving more oxygen.
Try this and see:
Inhale for one count (but don't just take a breath; take a quick, deep breath). Hold the breath for four counts. Then exhale for two counts. Repeat five times.
If you are not an athlete, or you do not get any regular aerobic exercise, here's a good breathing exercise that you can
incorporate into your life:
Starting from your abdomen, take a deep breathe in through your nose and count to seven as you inhale. Now hold your
breath for twenty-one counts (or as long as you can hold it). And then exhale slowly through your mouth for a count of
fourteen. Don't strain.  If the counts are too big, then start smaller and gradually work up to this level.
Do this ten times, three times a day, and just see what will happen to your energy level. It will explode! And your overall
health is likely to improve, as well.


OXYGEN DELIVERY SYSTEMS
HELiOS System

From:   Bradley, Ronda Z   [Ronda.Bradley@MKG.COM]
Sent:   Thursday, July 13, 2000 8:31 PM
Subject:        RE: Pulse Technology
All oxygen conserving devices work differently.  There are really 3 different types of conserving devices.  Pulsing devices deliver a fixed volume of oxygen in the first 200 milliseconds and then deliver no more oxygen.  Some pulsing devices give oxygen on every breath (Pulse Dose by DeVilbiss) and some only give the oxygen on every other breath (Oxylite by Chad).  The second type is called a Demand system.  This type begins delivering oxygen at the beginning of a breath and continues to provide continuous flow until you start breathing out (Victor unit).  The last type is a Hybrid system (CR50, HELiOS).  These types are a little of both.  They give a smaller pulse than do most pulsing units but also deliver oxygen until the patient breaths out.
The HELiOS gives a bolus of either 9,12, or 15 ml of oxygen (depending on the setting)at the beginning of every breath.  It then delivers a "tail flow" of oxygen until the patient begins to breath out.  The "tail flow" is at between 0.5-2 l/min depending on the setting.  (At the 3 setting the bolus is 15ml and tail is 1.5 l/min)  This delivery algorithm was devised both mathematically and from other studies performed in the past.  We also preformed some studies on patients at UCLA under the direction of Dr.Casaburi to look at how well patient saturated on HELiOS as compared to continuous flow with excellent results.  It was then that we decided to stick with this delivery for the H300 portable.  We know that not all patients have the same oxygen needs with a conserving device as with continuous flow.  In fact, it was estimated from one study (Resp Care Oct1999) that about 10% of patients can not tolerate any conserving device.
Patients should have pulse oximetry  with any changes in oxygen delivery source to ensure that they are maintaining oxygen saturation.  I also always ask patients to not get discouraged if the "setting" with the conserving device needs to be a little higher than that of continuous flow.  The goal is really to try and maintain oxygen saturation while saving oxygen to allow you to use a lighter oxygen source while increasing the time in which you can be out.  Therefore, no matter what the setting needs to be, as long as the portable is more manageable and allows for longer outings than with continuous flow, the goal has been obtained.
I hope that this information is helpful.
Ronda


OXYGEN-INDUCED CO2 RETENTION

Oxygen therapy
Old theory = loss of hypoxic resp. drive due to increase in PaO2
New theory = Decrease in alveolar ventilation with O2 therapy may be the result of an increased in deadspace due to changes in VA/Q distribution
                                        ---------------------
Common precipitating factors for acute CO2 retention in a patient with COPD are:

1. Sedatives
2. Alcohol
3. Alkalosis
4. Abolition of hypoxic drive


OXYGEN FOR YOUR SKIN:  Oxygen for Your Skin?

Postural Drainage Therapy (PDT) is a component of bronchial hygiene therapy. It consists of postural drainage, positioning, and turning and is sometimes accompanied by chest percussion and/or vibration.


Click and Print  Letter for Insurance Company to pay for pulse oxymeter  Get doctor to fill in spaces.

The Onyx (Model 9500)
Some Places on-line to purchase above item listed under 'Medical Equiptment' on  Bookmark Page

PULMONARY EMBOLISM

Which clinical clues and imaging tests can reliably detect or exclude Pulmonary Embolism?


PULSE RATE FORMULA FOR EXERCISE

220 minus your age. Multiply that number by 60 for minimum,
..............................................................by 70 for mid point,
..............................................................by 80 for maximum.
Midpoint is where you should maintain your heart rate for best workout.


PULSE OXYMETRY or SaO2 measurement

This is a non-invasive measure of one's oxygen saturation; that is, the amount of oxygen saturated
in one's hemoglobin in terms of a percentage.
This is not as accurate as the values obtained from an ABG and should only be used as a gauge of
one's oxygenation.
Normal ranges are between 95-100%. Supplemental oxygen is not generally instituted unless
SaO2 is less than 88-90% at rest










PULSE OXYGEN MANUAL with some editing:
 

The pulse oximeter shines red and infrared light through the tissue and detects the fluctuating signals caused by arterial blood pulses.  The ratio of the fluctuation of the red and infrared light signals received determines  the oxygen saturation content.
Conditions such as steady venous blood flow, skin thickness, finger nail thickness, etc., do not affect the saturation reading because they are constant and do not cause fluctuations.
Pulse oximeters use two different wavelengths of light (red and IR) providing the ability to determine one component of
blood.  The oximeter is calibrated to closely approximate functional oxygen saturation values.  These values will closely
approximate laboratory instrument function saturation values
IF THE DYSFUNCTIONAL HEMOGLOBIN SATURATION LEVELS ARE NEGLIGIBLE.
(caps mine for emphasis - so what is dysfunctional hemoglobin you ask).
If the dysfunctional hemoglobin is carboxyhemglobin (COHb or hemoglobinbound to carbon monoxide) or methemoglobin (MetHb), the difference between the oxygen saturation value displayed by the oximeter and the
oxygen saturation values determined by the laboratory insturment will be greater as the dysfunctional hemoglobin levels rise approximately in accordance with the following formulas:

SPO2 = O2Hb+COHb+MethHb
SaO2 = 100 (O2Hb/100-CoHb-MetHb)
where:
SpO2= pulseox determind and numerically displayed oxygen saturation in percent
O2Hb= fractional oxyhemoglobin saturation in percent
COHb= Carboxyhemoglobin saturation in percent
MethHb= Methemoglobin saturation in percent
SaO2= Functional oxygen saturation in percent
Example:
O2Hb=88
COHb=8
MetHb=2
SpO2=98
SaO2=97.78

IN CONCLUSION: yes the CO molecule binding to the hemoglobin molecule will cause an error in reading but it' negligible even if the dysfunctional values become really high, in which case you would really have a serious problem anyway.


Taken from the page at:  PFTs EXPLAINED FOR YOU
http://cf-web.mit.edu/info-zone/faq/sec-40.html

RESPIRATORY SYSTEM
RESPIRATORY SYSTEM DISEASES OF

SHINGLES   The Itching Sometimes Strikes Twice

SINUSITIS   New Guidelines Issued for Diagnosis and Treatment of Sinusitis

SKIN

VASELINE/ PETROLEUM on the lips or in the nose (Use of)

...1. Petroleum can cause the material that cannulas are composed of to break down and deteriorate.  2. A combination of petroleum and oxygen can cause combustion under certain circumstances... 3. Petroleum used on the lips or in the nose can be inhaled or leach into the lungs causing a serious and hard to treat "Lipiod  Pneumonia". Oily substances are difficult to impossible for natural excretions to remove from the lungs and sometimes surgery is required.  Water soluble ointments are much safer to use.
Special thanks for this article from Carolyn Brown <BrownTownUSA@webtv.net>
Other make-up ingredients that should be avoided for the same reasons or are more harmful than above are: Castor Oil, Polydecene, Caprylic/Capric Triglyceride, Candelilla Wax, Mineral Oil, Carnuaba Wax, Ozokerite, Ceresin, Tocopheryl
Acetate, BHT, Mica, Titanium Dioxide, Iron Oxides, Bismuth Oxychloride, Carmine.

Clinical:
Exogenous lipoid pneumonia is caused by chronic aspiration of mineral, vegetable, or animal oils present in food, or oil based medications (such as nose drops). Once in the alveolar space, the oily substances are emulsified by lung lipase, resulting in a foreign body reaction.
Predisposing conditions include neuromuscular disorders or structural abnormalities of the pharynx and/or esophagus. Clinically patients present with cough, shortness of breath, and mild fever. Lipoid pneumonia is a cause of chronic consolidation (other etiologies to consider for this finding include bronchoavleolar cell carcinoma, tuberculous pneumonia, and pseudolymphoma).

X-ray:
Radiographically, exogenous lipoid pneumonia is characterized by the presence of lower lobe consolidations, mixed alveolar and interstitial opacities, and ill-defined mass-like opacities. The consolidation has fat attenuation values (typically about minus 80) and this will aid in differentiation from other mass lesions. A "crazy-paving" pattern in which well defined areas of ground-glass attenuation are superimposed upon septal thickening has also been described (Ddx for this appearance includes: Pulmonary alveolar proteinosis and bronchoalveolar cell carcinoma).


Subject:  [COPD] Lipoid Pneumonia --- more info
 

From: Ernest and Carolyn Brown <BrownTownUSA@WEBTV.NET>
FROM:
Dr. Peter Gott's sydicated news medical Q & A  column.  This is a question that appeared in his column in the recent past.
QUESTION...."I was recently found to have a mass in my left lung. After an array of CT scans and other tests, I underwent a
biopsy. Apparently, the doctors expected to find lung cancer, and they were suprised that the biopsy showed lipoid pneumonia. What is this disease?"
ANSWER."While being swallowed, oil substances, most often mineral oil, which is present in some laxatives, sometimes trickle down the wrong tube and enter the trachea (windpipe), after which the stuff settles in lung tissue. There the oily material causes both acute and chronic inflammation, hence the name lipoid pneumonia.
This unusual condition was first discovered in 1925, when the use of petroleum-containing nasal medication was popular medical therapy.  Lipoid pneumonia continued to be a health problem until the 1950's; now it is a rarity. The most common cause of lipoid pneumonia these days is the aspiration of mineral, vegetable or animal oil--or use of nasal petroleum jelly. The condition has also been seen in people who use excessive quantities of lip balm.
Lipoid pneumonia causes cough and fever. The most successful treatment is surgical resection of the inflamed area."
Carolyn in MI

 
An experimental study of exogenous lipoid pneumonia
General Topics in Pulmonary Infections
Bronchogenic Carcinoma
How to Read--Honeycombing of the Lungs
Cancer diagnosis
JOURNAL OF CYTOLOGY
Can oil mist exposure at work cause lipoid pneumonia?
Lipoid Pneumonia
Case List by Disease Category
Lipoid pneumonia due to Squalene aspiration
Consumer Product Safty Commision
Lipoid Pneumonia in Lung Cancer
Disorders Complicated by LIPOID PNEUMONIA
Medical Q&A: Is castor oil OK to take for constipation?
Divorcing your Doctor
More Exogenous Lipoid Pneumonia
drug reactions can be recognized in the lung
Solitary Pulmonary Nodules
Exogenous lipoid pneumonia
 

THE VEST:  A new medical device program that could help U.S. veterans who live with respiratory diseases and conditions to breathe a little easier was announced this week. While the VA does not endorse products, it did approve Advanced Respiratory's offer to all 163 VA hospitals to try The Vest(TM) airway clearance system on a complementary basis. It can be used as a demo device to provide respiratory therapy to hospitalized patients. Advanced Respiratory will work with every interested U.S. veteran and his or her physician to provide a Vest system for a 60-day, in-home trial. The trial program will allow the patient and physician to assess whether the airway clearance therapy is improving the
patient's respiratory function. At the end of that period, they can choose to either submit a prescription for continued use, or return the device at no cost.

The most common respiratory condition for veterans is COPD (Chronic Obstructive Pulmonary Disease). COPD is an umbrella term that includes chronic bronchitis, emphysema, and sometimes an asthma component. While there is no cure, there are ways to treat the condition and improve quality of life. For more information on Advanced Respiratory's Veterans' Program, veterans may call 1-877-4VA-VEST (1-877-482-8378).

The Vest system is an airway clearance device that consists of an inflatable vest connected by hoses to a small air-pulse generator. The device rapidly inflates and deflates the vest, which oscillates the chest wall up to 25 times per second creating airflow within the lungs. This process moves mucus from the smaller airways toward the larger airways, where it can be cleared by coughing or suctioning. Article forwarded by ANM
Company's web site:   http://www.thevest.com
VA ACCEPTS OFFER TO PLACE THE VEST(TM) AIRWAY CLEARANCE SYSTEM IN ALL 163 VA
HOSPITALS AT NO CHARGE.  For full article: http://biz.yahoo.com/prnews/011102/mnf001_1.html

Subject:  The Vest

      From: "Glen Self" <glenself@cetlink.net>
        To:  "OLIVIJA GWYNNE" <o2@olivija.com>
Hi Olivija,
    The vest I use is provided as a rent for life type contract. The cost is $1,064.00 per month for 15 months and then it is yours for as long
as you live, but returns to the company at terminatin of use. I began using it Sept. 15, 2000.
     My doctor is at Carolina Respiratory Specialists in Charlotte, N.C. and it was prescribed for severe COPD (chronic bronchitis, acute
asthma, severe emphysema and bronchiectasis). It took a lot of work by the doctor to get the insurance to OK it. My insurance is under
my wife's group coverage as she is a local government employee it is South Carolina Blue Cross/Blue Shield State Plan.
     Hope this info is good for you.
Glen Self


Wheelchair Coverage
Manual Wheelchairs
Medicare Coverage Criteria
A standard wheelchair is covered if the patients condition is such that without the use of a wheelchair, he/shewould otherwise be bed or chair confined.
A standard hemi-wheelchair is covered when the patient requires a lower seat height (17" to 18") because of short stature or to enable the patient to place his/her  feet on the ground for propulsion.
A lightweight wheelchair is covered when:  1.the patient cannot self propel in a standard wheelchair using arms and/or legs, and 2.the patient can and does self-propel in a lightweight wheelchair.  A high strength lightweight wheelchair is covered when1.the patient self-propels the wheelchair while engaging in frequent activities that can not be performed in
a standard  or lightweight wheelchair, and/or
2.the patient requires a seat width, depth or height that can not be accommodated in a standard, lightweight or hemi-wheelchair, and spends at least two hours per day in the wheelchair .
A heavy duty wheelchair is covered if the patient weights more than 250 pounds or the patient has severe spasticity.
An extra heavy duty wheelchair is covered if the patient weights more than 300 pounds.
A custom wheelchair base is covered only if the feature is not available as an option to an already manufactured base.
Required Documentation: CMN
A certificate of medical necessity, which has been filled out, signed and dated by the physician, must be kept on file by the supplier.  The CMN for manual wheelchairs is HCFA Form 844.
Motorized / Power Wheelchair Base Medicare Coverage Criteria
A power wheelchair is covered when all of the following criteria are met:
The patient's condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined; And, the patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually; And, the patient is capable of safely operating the controls for the power wheelchair.
A patient who requires a power wheelchair is usually nonambulatory and has severe weakness of the upper extremities due to a neurologic, muscular or cardiopulmonary disease or condition.
Required Documentation: CMN.  The supplier must keep a certificate of medical necessity, which has been filled out, signed and dated by the physician, on file. Hope this explains a little; naturally the physician plays a BIG role.
Many rehabbers show up in medicare-supplied wheelchairs.  I've known some who were later "forced" (their word) to give them up when their physical conditioning improved.
The Importance of Water

WHY DRINK WATER?
 

What kinds of symptoms result from drinking too little water? Most commonly I see constipation, dry and itchy skin, acne, nose bleeds, repeated urinary tract infections, dry and unproductive coughs, constant sneezing, sinus pressure and headaches.

You might ask how a lack of water intake can cause this wide array of symptoms. Water is required by every cell in the body as nourishment and to remove wastes. When water becomes scarce, the body tries to limit the amount it loses through breathing, mucous production, urination, perspiration and bowel movements.

Several cups of water are lost daily through breathing because the lungs require humid air to do their work. In the winter when drier air prevails outside and heating systems (especially forced hot air and wood stoves) dry out the air inside, even more water is lost. It is estimated that on an average day in the fall, 3-4 cups of water are lost through breathing. On a cold, dry winter day as much as 2-3 more cups of water may be lost in this way. The body has to moisturize the air before it reaches the lungs and does so through the mucous membranes lining the nasal passages and the bronchi. As available fluid decreases, the mucous lining becomes drier. This in turn irritates the lungs, causing them to become more reactive to dust, mold particles, cigarette smoke and other irritants, and less resistant to viruses and bacteria. The result: dry cough and bronchitis.

The mucous membranes of our lungs and gut are an important component of our resistance to disease. They provide an effective barrier to bacteria, viruses and pollutants when intact. But a number of substances (such as aspirin) are known to harm this barrier. What is less well known is that a lack of water in the body makes the all important mucous less viscous and can cause constipation, irritable bowel syndrome and a slowed movement of the bowels contents. These problems in turn increase ones risk of other long term disease including hemorrhoids and colon cancer. The mucous lining in the sinus passages is similarly vital as a defense against disease. When it becomes drier, sinusitis, nose bleeds and allergic symptoms worsen.

Obviously, we all lose some water through urination and urination is required for the removal of various toxins from the body. When fluid volume is diminished, the ability of the body to remove toxins through urination is also diminished. It is a comon misunderstanding that the more water we drink, the harder it is on the kidneys. In fact, except for people with some uncommon kidney problems, the opposite is true. Water soluble toxins cannot be easily removed through the bowels, especially when a lack of water also causes constipation. These toxins then must be eliminated in other ways such as through the skin. The increase in body toxin levels can cause headaches and fatigue. The attempt by the body to remove excess levels of unwanted chemicals through the skin can cause acne and will aggravate eczema.

The easy solution to all these problems is to drink more water. Coffee, tea and soda all contain caffeine which is a known diuretic and will actually accentuate the symptoms of fluid loss. Fruit juices are more concentrated in sugar than your body's fluids and so the body will attempt to dilute them in the gut thereby causing a loss of water from other areas of the body. In the dry, hot air of winter and very hot days of summer, drink at least 10 glasses of water daily for optimal health. During the spring and fall, 8 glasses will suffice for most people, although those with inhalant allergies do best to drink as much water as possible. Pregnant women need to drink at least 50% more water daily than they would while not pregnant. People who exercise vigorously should add one glass of water for each 30 minutes of exercise. Herbal teas and diluted fruit juices (1/3 fruit juice to 2/3 water) can be substituted for some of the water. Drink one extra glass of water for each cup of coffee or black tea you have. Humidifying the air in the winter will help reduce water loss, but be careful to clean humidifiers daily to discourage bacteria or mold build up.

What type of water is best? Activated carbon or charcoal filtered water is probably the least expensive way to drink 'safe' water. The carbon filter removes most of the carcinogens and bacteria commonly found in drinking water. These filters are often very inexpensive and can be found in almost any department store. Distilled water has had all the metals (both harmful and helpful) removed. None of the flourinated and chlorinated hydrocarbons (coming from combining fertilizers and pesticides with flouride and chlorine) are removed. It is these hydrocarbons which are linked with the most health problems. Bottled spring waters may be healthy, but they are not yet required to be analyzed for chemical and bacterial levels.

Water can be a miracle cure for many common ailments. Try drinking some now and see if you don't feel better!

Dr. Jennifer Brett



 

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Last Edited 12-12-2002