Interesting remarks on damage from low oxygen

[Guest guest]

These are remarks from a respiratory therapist on emphysema.net that might be of some interest. I caution these are just one person's view and opinion, but they were in answer to a question about damage from inadequate saturation and when to start oxygen.

The 'damage' to the heart from low oxygen levels is not "direct", as in its having to function in an oxygen-deprived environment. Actually, the Kidneys, Liver, Pancreas and Heart function quite nicely until oxygen levels drop "S-E-V-E-R-E-L-Y" - - - like down below 40 mmHg pressure (Saturation less than 65 %). The brain does not fare so well, however! With low oxygen levels - - - especially chronically low levels, we see confusion, perception problems and changes in the tissues, among the affects. What causes the heart to function increasingly worse is what happens in the lungs when oxygen is below normal! The 'right' side of the heart pumps blood to/through the lungs. It is intended to function as a "low-pressure" system, with the normal blood pressure in the lungs being around 20/5 mmHg. (Compare that to the pressure in the 'rest' of your body [systemic blood pressure] that the 'left' side of your heart generates at 120/70mmHg, for instance.) The blood vessels within the lungs are extremely sensitive to changes in oxygen, when it drops below normal. They are also affected significantly by changes in the acidity/alkalinity of the blood. Unlike the 'systemic blood vessels', they are very minimally affected by changes in "vaso-active" substances like adrenalin and dopamine. So, if your oxygen drops below normal, the blood vessels within the lungs constrict. The lower the oxygen goes, the more and tighter they constrict. Higher pressure is required to push blood through constricted blood vessels than for relaxed/normal vessels, because of the increased resistance of the more narrow vessels to flow through them. So, when the oxygen level drops, the right side of the heart must pump with more force/pressure to get the blood through the lungs. If this occurs frequently and/or for prolonged periods of time AND 'over' a prolonged period of time, the right side of the heart - - - especially the ventricle - - - must add muscle mass to meet the load demand. As it increases muscle mass, the amount of blood it can hold and pump decreases because the chamber's 'space' is increasingly occupied with muscle mass. Further, because, unlike the skeletal muscles - - - which can build/bulk up and perform ever better as they increase in size and strength - - - the heart muscle does NOT function better when its mass increases. Indeed, it becomes like a 300-pound canary trying to fly! Its fat and floppy and sluggish in its performance. As circulation slows/decreases under the burden of increased resistance from the lungs, water begins to separate from the blood's plasma and leak out through the walls of the blood vessels. It is pushed 'in between' the tissues (what we call the third space) and elsewhere according to how much there is , gravity (ankle swelling) and the severity of compromise of heart function. This manifests as what you know as Congestive Heart Failure (CHF). Cor Pulmonale is CHF of COPD with some of the reason for increased pulmonary resistance to blood flow being the result of lost 'vasculature' (blood vessels), their having been destroyed as other lung tissue is destroyed (emphysema,. in particular) and also includes the feature of CHF. You ask about what damage might already be there and how bad it is by the time you are discovered to be hypoxic and prescribed oxygen? That is part and parcel of the controversy over starting use of supplemental oxygen 'sooner' than 'later' in the scheme of things. Some clinicians argue that the earlier that hypoxia is detected and oxygen therapy is instituted, the longer we can stave off the strain and damage to the heart and CHF/Cor Pulmonale. They surmise that it would translate into longer, healthier life for those with COPD and lower healthcare costs during that longer life. Others are not convinced that earlier intervention thwarts earlier damage sufficient to burden the currently over-burdened health care system with the costs associated with the increased utilization of oxygen therapy that would result from earlier intervention - - - at least not without empiric data to justify such a change. Doing studies to gather empiric data, one way or another are fraught with ethical difficulties. And, at this point, we don't have any empiric data to support the more costly route over that which has been established as the "acceptable" standard for M-A-N-Y years, now. So, there you have it, an explanation of the damage cycle from lack of oxygen to the lungs AND the dilemma of "when" it is 'b-e-s-t' to initiate oxygen therapy.

[Guest guest]

That is a very interesting article, Bruce and certainly something to "chew" on. My pulmodude is not opposed to oxygen for me at this point - he said he would write a prescription if I wanted. But he did not push it, either. An abbreviated six-minute round-the-office test showed my sats to drop from 97 to 91. Since this was not a true test (four minutes approx, and at a fairly slow pace), he seemed a little concerned, but not highly. I do think I will need to ask for a sleep test. When I awake in the mornings, I have such terribly dry mouth that I'm sure something is not quite right with my breathing overnight. As to exercise, he says that the best program I can be on is simply walking. I will be looking into getting a treadmill, since I live in the mountains and there are hardly any flat surfaces to walk on (and inclines just about kill me!) Thanks for all you do!Bruce Moreland wrote: These are remarks from a respiratory therapist on emphysema.net that might be of some interest. I caution these are just one person's view and opinion, but they were in answer to a question about damage from inadequate saturation and when to start oxygen. The 'damage' to the heart from low oxygen levels is not "direct", as in its having to function in an oxygen-deprived environment. Actually,

the Kidneys, Liver, Pancreas and Heart function quite nicely until oxygen levels drop "S-E-V-E-R-E-L-Y" - - - like down below 40 mmHg pressure (Saturation less than 65 %). The brain does not fare so well, however! With low oxygen levels - - - especially chronically low levels, we see confusion, perception problems and changes in the tissues, among the affects. What causes the heart to function increasingly worse is what happens in the lungs when oxygen is below normal! The 'right' side of the heart pumps blood to/through the lungs. It is intended to function as a "low-pressure" system, with the normal blood pressure in the lungs being around 20/5 mmHg. (Compare that to the pressure in the 'rest' of your body [systemic blood pressure] that the 'left' side of your heart generates at 120/70mmHg, for instance.) The blood vessels within the lungs are extremely sensitive to changes in

oxygen, when it drops below normal. They are also affected significantly by changes in the acidity/alkalinity of the blood. Unlike the 'systemic blood vessels', they are very minimally affected by changes in "vaso-active" substances like adrenalin and dopamine. So, if your oxygen drops below normal, the blood vessels within the lungs constrict. The lower the oxygen goes, the more and tighter they constrict. Higher pressure is required to push blood through constricted blood vessels than for relaxed/normal vessels, because of the increased resistance of the more narrow vessels to flow through them. So, when the oxygen level drops, the right side of the heart must pump with more force/pressure to get the blood through the lungs. If this occurs frequently and/or for prolonged periods of time AND 'over' a prolonged period of time, the right side of the heart - - - especially the ventricle - - - must add

muscle mass to meet the load demand. As it increases muscle mass, the amount of blood it can hold and pump decreases because the chamber's 'space' is increasingly occupied with muscle mass. Further, because, unlike the skeletal muscles - - - which can build/bulk up and perform ever better as they increase in size and strength - - - the heart muscle does NOT function better when its mass increases. Indeed, it becomes like a 300-pound canary trying to fly! Its fat and floppy and sluggish in its performance. As circulation slows/decreases under the burden of increased resistance from the lungs, water begins to separate from the blood's plasma and leak out through the walls of the blood vessels. It is pushed 'in between' the tissues (what we call the third space) and elsewhere according to how much there is , gravity (ankle swelling) and the severity of compromise of heart function. This manifests as what you

know as Congestive Heart Failure (CHF). Cor Pulmonale is CHF of COPD with some of the reason for increased pulmonary resistance to blood flow being the result of lost 'vasculature' (blood vessels), their having been destroyed as other lung tissue is destroyed (emphysema,. in particular) and also includes the feature of CHF. You ask about what damage might already be there and how bad it is by the time you are discovered to be hypoxic and prescribed oxygen? That is part and parcel of the controversy over starting use of supplemental oxygen 'sooner' than 'later' in the scheme of things. Some clinicians argue that the earlier that hypoxia is detected and oxygen therapy is instituted, the longer we can stave off the strain and damage to the heart and CHF/Cor Pulmonale. They surmise that it would translate into longer, healthier life for those with COPD and lower healthcare costs during that longer life.

Others are not convinced that earlier intervention thwarts earlier damage sufficient to burden the currently over-burdened health care system with the costs associated with the increased utilization of oxygen therapy that would result from earlier intervention - - - at least not without empiric data to justify such a change. Doing studies to gather empiric data, one way or another are fraught with ethical difficulties. And, at this point, we don't have any empiric data to support the more costly route over that which has been established as the "acceptable" standard for M-A-N-Y years, now. So, there you have it, an explanation of the damage cycle from lack of oxygen to the lungs AND the dilemma of "when" it is 'b-e-s-t' to initiate oxygen therapy. Barbara McDIPF, Sept 08Beautiful Western NC Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up. Galatians 6:9

[Guest guest]

> These are remarks from a respiratory therapist on emphysema.net that

might be of some interest. I caution these are just one person's view

and opinion, but they were in answer to a question about damage from

inadequate saturation and when to start oxygen.

> The 'damage' to the heart from low oxygen levels is not " direct " , as

in its having to function in an oxygen-deprived environment. Actually,

the Kidneys, Liver, Pancreas and Heart function quite nicely until

oxygen levels drop " S-E-V-E-R-E-L-Y " - - - like down below 40 mmHg

pressure (Saturation less than 65 %). The brain does not fare so well,

however! With low oxygen levels - - - especially chronically low levels,

we see confusion, perception problems and changes in the tissues, among

the affects.

>

> What causes the heart to function increasingly worse is what happens

in the lungs when oxygen is below normal! The 'right' side of the heart

pumps blood to/through the lungs. It is intended to function as a

" low-pressure " system, with the normal blood pressure in the lungs being

around 20/5 mmHg. (Compare that to the pressure in the 'rest' of your

body [systemic blood pressure] that the 'left' side of your heart

generates at 120/70mmHg, for instance.) The blood vessels within the

lungs are extremely sensitive to changes in oxygen, when it drops below

normal. They are also affected significantly by changes in the

acidity/alkalinity of the blood. Unlike the 'systemic blood vessels',

they are very minimally affected by changes in " vaso-active " substances

like adrenalin and dopamine.

>

> So, if your oxygen drops below normal, the blood vessels within the

lungs constrict. The lower the oxygen goes, the more and tighter they

constrict. Higher pressure is required to push blood through constricted

blood vessels than for relaxed/normal vessels, because of the increased

resistance of the more narrow vessels to flow through them. So, when the

oxygen level drops, the right side of the heart must pump with more

force/pressure to get the blood through the lungs. If this occurs

frequently and/or for prolonged periods of time AND 'over' a prolonged

period of time, the right side of the heart - - - especially the

ventricle - - - must add muscle mass to meet the load demand. As it

increases muscle mass, the amount of blood it can hold and pump

decreases because the chamber's 'space' is increasingly occupied with

muscle mass. Further, because, unlike the skeletal muscles - - - which

can build/bulk up and perform ever better as they increase in size and

strength

> - - - the heart muscle does NOT function better when its mass

increases. Indeed, it becomes like a 300-pound canary trying to fly! Its

fat and floppy and sluggish in its performance.

>

> As circulation slows/decreases under the burden of increased

resistance from the lungs, water begins to separate from the blood's

plasma and leak out through the walls of the blood vessels. It is pushed

'in between' the tissues (what we call the third space) and elsewhere

according to how much there is , gravity (ankle swelling) and the

severity of compromise of heart function. This manifests as what you

know as Congestive Heart Failure (CHF). Cor Pulmonale is CHF of COPD

with some of the reason for increased pulmonary resistance to blood flow

being the result of lost 'vasculature' (blood vessels), their having

been destroyed as other lung tissue is destroyed (emphysema,. in

particular) and also includes the feature of CHF.

>

> You ask about what damage might already be there and how bad it is by

the time you are discovered to be hypoxic and prescribed oxygen? That is

part and parcel of the controversy over starting use of supplemental

oxygen 'sooner' than 'later' in the scheme of things. Some clinicians

argue that the earlier that hypoxia is detected and oxygen therapy is

instituted, the longer we can stave off the strain and damage to the

heart and CHF/Cor Pulmonale. They surmise that it would translate into

longer, healthier life for those with COPD and lower healthcare costs

during that longer life. Others are not convinced that earlier

intervention thwarts earlier damage sufficient to burden the currently

over-burdened health care system with the costs associated with the

increased utilization of oxygen therapy that would result from earlier

intervention - - - at least not without empiric data to justify such a

change. Doing studies to gather empiric data, one way or another are

> fraught with ethical difficulties. And, at this point, we don't have

any empiric data to support the more costly route over that which has

been established as the " acceptable " standard for M-A-N-Y years, now.

>

> So, there you have it, an explanation of the damage cycle from lack of

oxygen to the lungs AND the dilemma of " when " it is 'b-e-s-t' to

initiate oxygen therapy.

>

>

>

>

>

> Barbara McD

> IPF, Sept 08

> Beautiful Western NC

>

>

>

> Let us not become weary in doing good, for at the proper time we will

reap a harvest if we do not give up. Galatians 6:9

>

[Guest guest]

Very well explained Bruce!!

I think this should be 'saved' somwher so it can be read again and

again

..

Thank you

-- In Breathe-Support , " Bruce Moreland "

wrote:

>

>

> These are remarks from a respiratory therapist on emphysema.net

that

> might be of some interest. I caution these are just one person's

view

> and opinion, but they were in answer to a question about damage

from

> inadequate saturation and when to start oxygen.

>

> The 'damage' to the heart from low oxygen levels is not " direct " ,

as in

> its having to function in an oxygen-deprived environment.

Actually, the

> Kidneys, Liver, Pancreas and Heart function quite nicely until

oxygen

> levels drop " S-E-V-E-R-E-L-Y " - - - like down below 40 mmHg

pressure

> (Saturation less than 65 %). The brain does not fare so well,

however!

> With low oxygen levels - - - especially chronically low levels, we

see

> confusion, perception problems and changes in the tissues, among

the

> affects.

>

> What causes the heart to function increasingly worse is what

happens in

> the lungs when oxygen is below normal! The 'right' side of the

heart

> pumps blood to/through the lungs. It is intended to function as a

> " low-pressure " system, with the normal blood pressure in the lungs

being

> around 20/5 mmHg. (Compare that to the pressure in the 'rest' of

your

> body [systemic blood pressure] that the 'left' side of your heart

> generates at 120/70mmHg, for instance.) The blood vessels within

the

> lungs are extremely sensitive to changes in oxygen, when it drops

below

> normal. They are also affected significantly by changes in the

> acidity/alkalinity of the blood. Unlike the 'systemic blood

vessels',

> they are very minimally affected by changes in " vaso-active "

substances

> like adrenalin and dopamine.

>

> So, if your oxygen drops below normal, the blood vessels within the

> lungs constrict. The lower the oxygen goes, the more and tighter

they

> constrict. Higher pressure is required to push blood through

> constricted blood vessels than for relaxed/normal vessels, because

of

> the increased resistance of the more narrow vessels to flow through

> them. So, when the oxygen level drops, the right side of the

heart

> must pump with more force/pressure to get the blood through the

lungs.

> If this occurs frequently and/or for prolonged periods of time AND

> 'over' a prolonged period of time, the right side of the heart - -

-

> especially the ventricle - - - must add muscle mass to meet the

load

> demand. As it increases muscle mass, the amount of blood it can

hold

> and pump decreases because the chamber's 'space' is increasingly

> occupied with muscle mass. Further, because, unlike the skeletal

> muscles - - - which can build/bulk up and perform ever better as

they

> increase in size and strength - - - the heart muscle does NOT

function

> better when its mass increases. Indeed, it becomes like a 300-

pound

> canary trying to fly! Its fat and floppy and sluggish in its

> performance.

>

> As circulation slows/decreases under the burden of increased

resistance

> from the lungs, water begins to separate from the blood's plasma

and

> leak out through the walls of the blood vessels. It is pushed 'in

> between' the tissues (what we call the third space) and elsewhere

> according to how much there is , gravity (ankle swelling) and the

> severity of compromise of heart function. This manifests as what

you

> know as Congestive Heart Failure (CHF). Cor Pulmonale is CHF of

COPD

> with some of the reason for increased pulmonary resistance to

blood flow

> being the result of lost 'vasculature' (blood vessels), their

having

> been destroyed as other lung tissue is destroyed (emphysema,. in

> particular) and also includes the feature of CHF.

>

> You ask about what damage might already be there and how bad it is

by

> the time you are discovered to be hypoxic and prescribed oxygen?

That

> is part and parcel of the controversy over starting use of

supplemental

> oxygen 'sooner' than 'later' in the scheme of things. Some

clinicians

> argue that the earlier that hypoxia is detected and oxygen therapy

is

> instituted, the longer we can stave off the strain and damage to

the

> heart and CHF/Cor Pulmonale. They surmise that it would translate

into

> longer, healthier life for those with COPD and lower healthcare

costs

> during that longer life. Others are not convinced that earlier

> intervention thwarts earlier damage sufficient to burden the

currently

> over-burdened health care system with the costs associated with the

> increased utilization of oxygen therapy that would result from

earlier

> intervention - - - at least not without empiric data to justify

such a

> change. Doing studies to gather empiric data, one way or another

are

> fraught with ethical difficulties. And, at this point, we don't

have

> any empiric data to support the more costly route over that which

has

> been established as the " acceptable " standard for M-A-N-Y years,

now.

>

> So, there you have it, an explanation of the damage cycle from

lack of

> oxygen to the lungs AND the dilemma of " when " it is 'b-e-s-t' to

> initiate oxygen therapy.

>

[Guest guest]

Geeta ... I frequently 'save' posts from Bruce. Information I will not remember down the road I'm sure...

I hope you are feeling better.

MamaSher, age 70. IPF 3-06, OR. NasturtiumsDon't fret about tomorrow, God is already there!

Re: Interesting remarks on damage from low oxygen

Very well explained Bruce!!I think this should be 'saved' somwher so it can be read again and again.Thank you-- In Breathe-Support , "Bruce Moreland" wrote:>> > These are remarks from a respiratory therapist on emphysema.net that> might be of some interest. I caution these are just one person's view> and opinion, but they were in answer to a question about damage from> inadequate saturation and when to start oxygen.> > The 'damage' to the heart from low oxygen levels is not "direct", as in> its having to function in an oxygen-deprived environment. Actually, the> Kidneys, Liver, Pancreas and Heart function quite nicely until oxygen> levels drop "S-E-V-E-R-E-L-Y" - - - like down below 40 mmHg pressure> (Saturation less than 65 %). The brain does not fare so well, however!> With low oxygen levels - - - especially chronically low levels, we see> confusion, perception problems and changes in the tissues, among the> affects.> > What causes the heart to function increasingly worse is what happens in> the lungs when oxygen is below normal! The 'right' side of the heart> pumps blood to/through the lungs. It is intended to function as a> "low-pressure" system, with the normal blood pressure in the lungs being> around 20/5 mmHg. (Compare that to the pressure in the 'rest' of your> body [systemic blood pressure] that the 'left' side of your heart> generates at 120/70mmHg, for instance.) The blood vessels within the> lungs are extremely sensitive to changes in oxygen, when it drops below> normal. They are also affected significantly by changes in the> acidity/alkalinity of the blood. Unlike the 'systemic blood vessels',> they are very minimally affected by changes in "vaso-active" substances> like adrenalin and dopamine.> > So, if your oxygen drops below normal, the blood vessels within the> lungs constrict. The lower the oxygen goes, the more and tighter they> constrict. Higher pressure is required to push blood through> constricted blood vessels than for relaxed/normal vessels, because of> the increased resistance of the more narrow vessels to flow through> them. So, when the oxygen level drops, the right side of the heart> must pump with more force/pressure to get the blood through the lungs. > If this occurs frequently and/or for prolonged periods of time AND> 'over' a prolonged period of time, the right side of the heart - --> especially the ventricle - - - must add muscle mass to meet the load> demand. As it increases muscle mass, the amount of blood it can hold> and pump decreases because the chamber's 'space' is increasingly> occupied with muscle mass. Further, because, unlike the skeletal> muscles - - - which can build/bulk up and perform ever better as they> increase in size and strength - - - the heart muscle does NOT function> better when its mass increases. Indeed, it becomes like a 300-pound> canary trying to fly! Its fat and floppy and sluggish in its> performance.> > As circulation slows/decreases under the burden of increased resistance> from the lungs, water begins to separate from the blood's plasma and> leak out through the walls of the blood vessels. It is pushed 'in> between' the tissues (what we call the third space) and elsewhere> according to how much there is , gravity (ankle swelling) and the> severity of compromise of heart function. This manifests as what you> know as Congestive Heart Failure (CHF). Cor Pulmonale is CHF of COPD> with some of the reason for increased pulmonary resistance to blood flow> being the result of lost 'vasculature' (blood vessels), their having> been destroyed as other lung tissue is destroyed (emphysema,. in> particular) and also includes the feature of CHF.> > You ask about what damage might already be there and how bad it is by> the time you are discovered to be hypoxic and prescribed oxygen? That> is part and parcel of the controversy over starting use of supplemental> oxygen 'sooner' than 'later' in the scheme of things. Some clinicians> argue that the earlier that hypoxia is detected and oxygen therapy is> instituted, the longer we can stave off the strain and damage to the> heart and CHF/Cor Pulmonale. They surmise that it would translate into> longer, healthier life for those with COPD and lower healthcare costs> during that longer life. Others are not convinced that earlier> intervention thwarts earlier damage sufficient to burden the currently> over-burdened health care system with the costs associated with the> increased utilization of oxygen therapy that would result from earlier> intervention - - - at least not without empiric data to justify such a> change. Doing studies to gather empiric data, one way or another are> fraught with ethical difficulties. And, at this point, we don't have> any empiric data to support the more costly route over that which has> been established as the "acceptable" standard for M-A-N-Y years, now.> > So, there you have it, an explanation of the damage cycle from lack of> oxygen to the lungs AND the dilemma of "when" it is 'b-e-s-t' to> initiate oxygen therapy.>

[Guest guest]

That is excellent information, Bruce. Thank you.Can one of the mods put that in file form for the page over on yahoo?jon-- Two wrongs don't make a right,but two 's make an airplane.