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Title: Dr & resp. tech. gave me diff instruction RE: Post by fun bobbi on Aug 20th, 2004, 11:50pm My Dr perscribed 10 litres/min for 10-20 min prn (as often as needed). The resp. technician said I only need enough so as not to let the bag deflate 5 or 6. After that she said it's just wasting o2. She also said that after you use the oxygen for a while the attacks won't come as often. Am I correct in assuming that she is TOTALLY out to lunch or is there some truth to it? What do most use for o2 therapy? |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by E-Double on Aug 21st, 2004, 12:12am on 08/20/04 at 23:50:18, fun bobbi wrote:
I personally turn my tank between 10-15 and just inhale as much as I can. I also turn off the tank inbetwenn breaths so I don't waste any. Seems to have "stretched" my tank. The one thing for me is that sometimes it will abort in just a few minutes while other times it may take 10-15minutes. That's up to your own noggin. Either way you have to tinker with it and you'll find the best way to abort with it. As far as it preventing the attacks... I don't know, you'll have to research that one but I think most will tell you unfortunately she is wrong. Several chronics around here that can only use Oxygen. That statement kinda answers that question ;) Very happy you were able to get it. Use it well & good luck. Eric |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by bluesunshine on Aug 21st, 2004, 12:24am hi fun bobbi, she maybe right because the reservoir is there to have O2 ready to breath, BUT you should do the experience yourself between 5-6L/min vs 10L/min. I also put tape on the holes and i never put on the mask with the elastic aroud my head, in case i fall asleep- i don't want to experience 100% O2 until the tank is empty. [smiley=worried.gif] |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by pubgirl on Aug 21st, 2004, 4:20am Hi again bobbi A few things. If you have a proper non-rebreather mask with the one way valves DO NOT tape over the holes (sorry blue sunshine, but that is really wrong, and applies only to people using a standard mask). These valves in the non-rebreather masks let the exhaled carbon dioxide out, which you do not want to rebreath. The reservoir bags in theory (and in practice for me) mean I can drop the flow rate and still get the same effect, but as e double says, you may need to play around with this a bit. Some of our sufferers who use the reservoir bag rebreather use at 9l/minute or less and are fine. I'm a coward so use at 12 or 10, then when the pain is gone, stay on for another 5minutes or so at a low level which I find helps prevent a 'rebound' later. I'm afraid the technician is talking a load of cobblers about 02 preventing attacks. It aborts them only, and some people find they can get a lower level attack a few hours later Hope this helps Wendy |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by don on Aug 21st, 2004, 9:25am Ask her where she got her medical degree and to stop giving erroneous information regarding treating CH. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by FZfan on Aug 21st, 2004, 10:20am The lpm is an arbitrary figure based on whether or not you deplete the reservior bag when you breath. 10 - 15 and sometimes 15-20 lpm is recommended here because we want to be sure you get some relief for your attacks. Yes some o2 may be wasted, but if you are new to using o2 and you use it at too low of a lpm rate, you are likely to write it off as an inneffective treatment. And so what if you do waste some o2? If it aborts the attack, who cares? Obviously we are all different with different lung capacities and breathing rythyms. Through experimentation you can find the "low end" on the lpm that works for you. Like pubgirl said though, this does require some degree of bravery because to find the low end, you have to find the level that doesn't work to know what the low end is. Here is something I did you can try to lessen the risks of playing around with the lpm setting. When you are not being attacked, practice breathing in front of a mirror and watch the bag. Breath the same way you would if you were being attacked. Starting at 15lpm, keep an eye on the bag and gradually turn down the pressure until the bag begins to deflate when you breath. Then turn the pressure back up slowly until the bag stays full, even during your deepest breath. Using this method I discovered I could set my reg at 10 lpm and never deflate the bag. This setting effectively aborts 80% of my attacks, which I believe is pretty much the norm for o2 therapy. Another thing I do is I press the mask hard against my face to make sure there is as little leakage as possible. If this is uncomfortable for you, then you would need a higher flow rate to overcome the small leaks. I also do what pubgirl does. I continue breathing the o2 for at least 5 more minutes after the attack aborts. And definitely cut or remove the elastic band. As bluesunshine said, this is a safety measure. Good luck with your o2. I hope it works as well for you as it does for me. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Kevin_M on Aug 21st, 2004, 10:30am on 08/20/04 at 23:50:18, fun bobbi wrote:
The doc is not out of line, this is not bad although personally I use it at 12Lpm. Quote:
Well now here, you find the level at which you need to breathe when you are awoken at night with it already getting up full steam. When that hits, again, I've found 12Lpm to just about fill the bag as I take a breath to empty it, that's ok for me, others will vary around that. But her adding that they won't come as often when you do this is not something I've even seen written anywhere and shows little knowledge of clusters. Oxygen is an abortive, not a preventative. Just abetting what has already been said here, and also saying again to cut the straps off the rebreather. Don't even take that chance. Good luck and welcome. Kevin M *edited* posted before reading FZFan, good tips there too, pressing mask tight. ;) |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Prense on Aug 21st, 2004, 11:32am on 08/21/04 at 04:20:15, pubgirl wrote:
Some companies will not put the other disk on the mask leaving the holes open (both ways). They claim this is for safety purposes... You can get a replacement disc from the medical supply store and put it over the open holes. It is hard to exhale when only one side is open...for that reason, I'd agree with not taping the open side. Hope that clarifies... Chris |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by bluesunshine on Aug 21st, 2004, 2:29pm fun bobbi, Sorry, pubgirl is right about not taping the holes. It is my mistake to not have mentionned that mine came with only one plastic disk- I taped the other side only,the one with no plastic disk. I asked the tech about it and they were all made the same (thought it was defective). FZfan, very good tips, thank you blue |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by mynm156 on Aug 26th, 2004, 3:39pm No She is not completely out to lunch. We already know that O2 is not a preventitive. However, in theory of the Non rebreather or NRB she IS correct. The NRB is considered a HIGH FLOW system. As Long as the bag does not deflate you ARE GETTING 100% O2 and as much as you can take in per breath. MYNM156 RESPIRATORY THERAPIST |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by floridian on Aug 26th, 2004, 4:46pm on 08/20/04 at 23:50:18, fun bobbi wrote:
Hyperbaric oxygen treatment might be able to break a cycle in some people. A study using two hyperbaric sessions found no effect, while a study using 14 hyperbaric sessions found a reduction in headaches and a change in serotonin function. Not sure if the high pressure is needed (2.5 times the normal atmosphere), there are lots of chronics that use oxygen daily and still get hit. Quote:
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Bob P on Aug 26th, 2004, 5:18pm The Tech is correct. Any more than whats needed to keep the abg inflated is a waste. I'm 6'4", 230 lbs. and I get by with 7-8 lpm just fine. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Kevin_M on Aug 26th, 2004, 7:05pm on 08/26/04 at 16:46:13, floridian wrote:
Hyperbaric Oxygen treatments are different and much more expensive treatments. I don't think it is related to breathing oxygen from a tank, but being put in a chamber of increased atmospheres of oxygen. That probably not be what the tech was refering to. Many professional athletes use hyperbaric treatments. It may help clusters, but the cost is too prohibitive and not covered by insurance for clusters. Kevin M |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Biker on Aug 26th, 2004, 8:08pm I use the welders O2, and at the first twinge of an onset, I crank it up pretty high. Sometimes, I hiperventalate I breath it in so fast. I have learned to let the O2 pressure inflate my lungs for me. Perhaps not the best thing to do, but it seems to help me. I have no idea what the flow rate is, but I am pretty sure its off the medical charts. When I begin to feel the CH ebb away, I lower the pressure quite a bit, and breathe normally. When the CH goes away, I lower it more, and breath easy for another 5 minutes or so. Sometimes, when Im lucky, I can stop the CH before it becomes painfull. You will find yourself experimenting with the set-up. It wont take long to discover what works for you. Good Luck. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Seiji on Aug 29th, 2004, 12:41am Bob P Thank you for your comment. I am a Resp Therapist and I suffer from CH I get by justfine with same flow as you. All you need is enough flow to keep bag inflated anything else is a waste. It depends on how fast and how deep you are breathing and also how well the mask fits. There are 2 masks that look alike the only difference is the little rubber flaps. One over the bag inside of the mask and one on the side of the mask. That one is a non-rebreather, the one without the flaps is a rebreather. Also you can not go to a medical equipment dealer and get just the flaps. In all my years in Resp Therapy I have never seen extra flaps for them. (28 years) easier to get a new mask then trying to get flaps. I know some of you think that if you breathe fast and deep it helps more, it does not. In fact think about it you hyperventilate that can cause you to get a headache too. That's my 2cents worth. I also know that what works on one person does not work on others. About 5 min and I abort an attack that's if I catch it very early. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by pubgirl on Aug 29th, 2004, 3:27am on 08/29/04 at 00:41:54, Seiji wrote:
Seiji Nice to have a respiratory therapist on the board, but do you actually know why it is believed that the 02 therapy works for cluster sufferers? It actually goes against all the good advice for any other kind of use of oxygen which is why doctors don't like it if they are ignorant. As usual I stand to be corrected, but as far as I know the aborting mechanism occurs BECAUSE we are flooding our bodies with " too much" oxygen and the brain then reacts by recognising danger and vasonconstricting. ergo, hyperventilating is GOOD not bad. Wendy |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by ex_pat_asia on Aug 29th, 2004, 7:32am on 08/29/04 at 03:27:25, pubgirl wrote:
Actually it isn't good. You may be aware that the sensation one has, if they are hyperventilating, is that they are not getting enough air. THere is a good reason for that. Altered CO2 levels may be interfering with oxygen saturation. "Oxygen inhalation is effective and relatively safe for the symptomatic treatment of cluster headache. I generally prescribe it as first-line treatment. The mechanism of action is unknown but probably involves a marked reduction in cerebral blood flow that results in concomitant pain reduction. Patients should be told to begin therapy at the onset of an attack by administering 100% oxygen through a face mask at a rate of 7 to 8 L/min for 10 to 15 minutes. A nasal cannula should not be used because nasal congestion may impede inhalation. Patients should assume a sitting position, either upright or leaning forward, and should avoid hyperventilation, which may limit oxygen saturation. References: Kudrow L. Response of cluster headache attacks to oxygen inhalation. Headache 1981;21(1):1-4 "Overbreathing* means bringing about carbon dioxide (CO2) deficit in the blood (i.e., hypocapnia) through excessive ventilation (increased “minute volume”) during rapid, deep, and dysrhythmic breathing, a condition that may result in debilitating short-term and long-term physical and psychological complaints and symptoms. The slight shifts in CO2 chemistry associated with overbreathing may cause physiological changes such as hypoxia (oxygen deficit), cerebral vasoconstriction (brain), coronary constriction (heart), blood and extracellular alkalosis (increased pH), cerebral glucose deficit, ischemia (localized anemia), buffer depletion (bicarbonates), bronchial constriction, gut constriction, calcium imbalance, magnesium deficiency, and muscle fatigue, spasm (tetany), and pain" What I conclude from this is that the steady deep rythmic breathing pattern is best. At the right flow rate and with the right equipment, you will reach Oxygen saturation relatively quickly with the bonus of a calming activity to boot. Rapid breathing is, by its nature, shallow. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Prense on Aug 29th, 2004, 9:19am on 08/29/04 at 07:32:28, ex_pat_asia wrote:
This doesn't seem possible to me with a non-rebreathing mask on. Exhalation is forced out the one way valves by the positive pressure of the O2 and the pressure used to exhale. The only place for that air to go is out the mask... or so it seems to me. Chris |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by pubgirl on Aug 29th, 2004, 2:05pm I know what the received information is and the usual advice r.e 02 use is but for me the argument is: Fast and deep versus Slow and deep My version says I get as much 02 into my system as fast as I can, maybe not as extreme as hyperventilation but This for me = fast and deep, i.e. overloading my body with oxygen as fast as I possibly can. Wendy |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by ex_pat_asia on Aug 29th, 2004, 6:46pm on 08/29/04 at 09:19:54, Prense wrote:
I think you might have a point here, that the non-rebreather tends to prevent fast, deep breathing which is a descriptor in hyperventilation. Maybe MYNM156 or Seiji could help us understand that better. Furthermore the 2nd quote in my post actually came from a web site that was about Hyperventilation as a medical problem and was not about headache. Here is some more info: Part of the explanation for HVS lies in the mechanics of breathing. Normal tidal volumes range from 35-45% of vital capacity at rest. Hyperinflation of the lungs beyond that level is resisted by the elastic recoil of the chest wall, and inspiratory volumes beyond this level are perceived as effort or dyspnea. Patients with HVS (hyperventilation) tend to breathe by using the upper thorax rather than the diaphragm, resulting in chronically overinflated lungs. When stress induces a need to take a deep breath, the deep breathing is perceived as dyspnea. The sensation of dyspnea creates anxiety, which encourages more deep breathing, and a vicious cycle is created. - Author: Edward Newton, MD, Vice-Chair, Associate Professor, Department of Emergency Medicine, Los Angeles County-University of Southern California Medical Center Quote:
Actually Wendy, no argument here. . Fast & Deep vs. Slow & Deep is somewhat semantical and subjective. My point was that hyperventilation would not be a good state for clusterheads as it appears to prevent Oxygen saturation in the blood. It looks like you concede that point. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Ueli on Aug 29th, 2004, 11:32pm If you fill the lungs with ordinary air (which contains 21% oxygen) and hold your breath for some time the oxygen transfer to the blood drops dramatically; as oxygen is absorbed it's fraction in the air remaining in the lungs goes well below the original 21%. Or in scientific terms, the partial oxygen pressures in the lung and in the blood approach each other and the exchange gets near zero. On the other hand, if you fill the lungs with pure oxygen, the O2 partial pressure remains constant at 100%. So, in principle you could hold the breath until all oxygen has passed to the blood and then the lung would be completely collapsed, like a shriveled dry plum. But we must consider the other part of breathing too, the exhaling of carbon dioxide CO2. Here the partial pressures have a gradient in the other direction as for oxygen. Fresh air contains 0.033% of CO2. The blood concentration is much higher and hence CO2 passes into the lung. If you hold your breath long enough the CO2 concentration in the lungs raises so high the exchange comes to a halt. Then the blood has too much CO2, and this is the usual signal to increase your breathing rate. But if you breathe very fast there is always a low CO2 concentration in the lungs and the blood can get rid of a lot of carbon dioxide, sometimes to much. Note, for the CO2 exchange it doesn't matter what the other gases in the lung are. Conclusions: 1.) For a clusterhead hyperventilating with plain air does increase the oxygen uptake slightly. But the drawback is that you exhale too much CO2, it's blood concentration is dropping below the optimal level, leading to the well known dizzy feeling. When you are on 100% oxygen then the breathing rate has only a marginal influence on the O2 uptake. So hyperventilating brings only the dizziness of too low CO2 in the blood. 2.) The most economic oxygen flow rate is when the bag deflates while breathing in, but never collapses completely. For me 8 l/m is enough while sitting. If I walk around (to make coffee) I go up to 10 l/m. PFNADs, Ueli [smiley=smokin.gif] |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Kevin_M on Aug 30th, 2004, 12:30am on 08/29/04 at 23:32:41, Ueli wrote:
Didn't understand hardly much there Ueli, but this is exactly how I've been gauging my use. 10Lpm seemed a touch slow getting the bag filled again, so I've preferred 12, and can get by on 10. Thanks again Ueli |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by ex_pat_asia on Aug 30th, 2004, 3:13am on 08/29/04 at 23:32:41, Ueli wrote:
This is a perfect summary for this discussion as far as I'm concerned. Thanks Ueli, Quote:
Kevin 12 is my prime setting also. However, in the office I have a second tank on which I have a bagless face mask. I find that the mask is a bit leaky if I don't mash it against my face. Instead, for comfort, I simply put a little more pressure as I hold it against my face and crank up the valve a couple of lpms to get the amount correct. PFDANs all |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Kevin_M on Aug 30th, 2004, 8:42am on 08/30/04 at 03:13:35, ex_pat_asia wrote:
I agree with you too ExPat, I commented when FZFan made mention of similar. I thought that was a good tip too that I had forgot to mention. FZFan quote from above: Quote:
:) Kevin M |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Seiji on Aug 30th, 2004, 9:42am For the average person the main stimulus to breathe is to blow off Co2. When you are hyperventilating, you blow off more Co2 than your body can produce. Breathing 100% O2 when you breathe faster you do not breathe 110% O2. I think the big thing for most people is a physiological thing with them. What I am saying is it helps to concentrate on something else like breathing. If you stop to think when some is trying to catch their breath you don’t tell them to breathe fast but breathe slow and deep. You get better gas exchange that way and that’s what you want. Now as to liter flow, if your mask fits snuggly around your face all you need is enough flow to keep the bag inflated. 8-10 lpm usually does that. But if you are breathing fast yes you will have to increase the flow. |
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Title: Re: Dr & resp. tech. gave me diff instruction Post by Bob P on Aug 30th, 2004, 10:13am My routine: Note - I have taped off the exhaust valves on the side of my mask because they were not sealing tight. I sit in a chair, leaning forward (not because that's what Kudrow says to do but this has always been my position for fighting attacks). Regulator set at 8 lpm. When bag is inflated I press the mask tight against my face, squeeze the bag and inhale. I then lift the bottom of the mask away from my face and exhale while the bag is refilling. When bag is refilled, I press the mask against my face and inhale again, etc. I adjust the regulator to have the bag filled when I am ready to inhale. This may be as low as 7 lpm. Usually takes 5-10 minutes to abort an attack and during that time it doesn't let the attack get above a 3 or 4. |
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