Re: low oxygen and newbies

[Guest guest]

Bruce,

I thought it was interesting that the one reason for not using oxygen early on is a money reason not a medical reason "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. " As a side note, I wonder if we should have some type of symptoms of low oxygen list for newbies. For myself I now my first indications are headaches and pains in my caves when waking. I never ever have swollen ankles and rarely cough. Happy day after Thaksgiving-

R. (52) Sarcoid/PF 3/2006 Carlsbad, California

Subject: Interesting remarks on damage from low oxygenTo: Breathe-Support Date: Saturday, November 29, 2008, 8:49 AM

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]

Glad you pointed that out too. Nothing said about it being detrimental

to use it earlier, just costly. I suspect my oxygen levels were pretty

much the same as at diagnosis for as much eighteen months prior. At

least as severe for six months and some significant issue for 12-18.

Biggest sign for me in retrospect was just inability to exercise and use

a treadmill, all attributed to being old, out of shape, and having

allergies. I was fatigued, easily winded. I'd had some signs for years

probably but who knows. My first six minute walk of my life I fell to

unsatisfactory levels. My first PFT's ever, my FVC was 44% and my FEV1

and TLC right around 50%. My first DLCO was 38%. I was put on

supplemental oxygen at diagnosis. I never knowingly went through the

stages of having PF but not needing oxygen. Looking back at previous

sleep studies, I'd had some low oxygen readings during sleep in 2004

that should have gotten attention but they were focused on sleep apnea,

which I don't have to a degree to be treated.

>

> From: Bruce Moreland brucemoreland@...

> Subject: Interesting remarks on damage from low

oxygen

> To: Breathe-Support

> Date: Saturday, November 29, 2008, 8:49 AM

>

>

>

>

>

>

>

> 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]

, Hi. before I was dx I would be working around the house and my legs would get so heavy I remember lunging to my chair in the living room so short of breath and didn't realize what a big problem I had. When I am getting low I get a really bad headache right in the front of my forehead. Have a Wonderful Sunday. I can't believe I can't go.. Oh how this disease is really becoming so much more that I thought it could. Prayer is needed.. Love & Prayers, PeggyFlorida,  IPF/UIP 2004"I believe that friends are quiet angels who lift us to our feet, when our wings have trouble remembering how to fly." 

[Guest guest]

Hi Princess,

I am praying! I miss church so much when I can't go. It always recharges me for the week. Next year you HAVE TO let everyone else do all the work. You are royalty afterall and that means you only have to sit pretty, eat bonbons and let the minions fan you. Love you- R. (52) Sarcoid/PF 3/2006 Carlsbad, California

Subject: Re: Re: low oxygen and newbiesTo: Breathe-Support Date: Saturday, November 29, 2008, 5:11 PM

, Hi. before I was dx I would be working around the house and my legs would get so heavy I remember

lunging to my chair in the living room so short of breath and didn't realize what a big problem I had. When I am getting low I get a really bad headache right in the front of my forehead.

Have a Wonderful Sunday. I can't believe I can't go.. Oh how this disease is really becoming so much more that I thought it could.

Prayer is needed..

Love & Prayers, Peggy

Florida, IPF/UIP 2004

"I believe that friends are quiet angels who lift us to our feet,

when our wings have trouble remembering how to fly."

[Guest guest]

Peggy - you will be in my prayers tonight, and tomorrow, and tomorrow, and tomorrow........ God bless. Bdenise randel wrote: Hi Princess, I am praying! I miss church so much when I can't go. It always recharges me for the week. Next year you HAVE TO let everyone else do all the work. You are royalty afterall and that means you only have to sit pretty, eat bonbons and let the minions fan you. Love you- R. (52) Sarcoid/PF 3/2006 Carlsbad, CaliforniaFrom: Peggy Subject: Re: Re: low oxygen and newbiesTo: Breathe-Support Date:

Saturday, November 29, 2008, 5:11 PM, Hi. before I was dx I would be working around the house and my legs would get so heavy I remember lunging to my chair in the living room so short of breath and didn't realize what a big problem I had. When I am getting low I get a really bad headache right in the front of my forehead. Have a Wonderful Sunday. I can't believe I can't go.. Oh how this disease is really becoming so much more that I thought it could. Prayer is needed..Love & Prayers, PeggyFlorida, IPF/UIP 2004"I believe that friends are quiet angels who lift us to our feet, when our wings have trouble remembering how to fly." 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