OK, hopefully one of the 02 experts can help me out here.

Please explain why anyone would need a regulator that goes past 15LPM if they have a proper mask with a large enough bag on it.

One of the things Ben used to preach, and I know was correct, was that once the large bag was filled, you could actually crank the delivery down a bit from 15 LPM and save on 02.

All you need is a rate high enough to supply pure 02 for every breath. There is a limit as to how much you can breath in.
I've been told that I have some of the largest lungs doctors have seen. It takes two xrays to view them. One of the top half and one of the bottom half. I only say this because I know *I* can't breath more than 15 LPM with a large bag and I could always turn it down once the bag was filled. I know as with everything else, we are all different, but...

Are you (the ones advocating a 25 LPM regulator) saying that some people need that or their large bag will eventually collapse from a lack of 02 at only 15 LPM?

thanks for any clarification,
Bobw

Some people use the hyper-ventilation method to abort, I'm assuming they're the ones who prefer the 25 LPM regulators. I've always used a demand regualtor so can't speak to the flow regulators.

Joe

Guiseppi wrote on Jan 31^st, 2009 at 12:28am:

Some people use the hyper-ventilation method to abort, Joe

Thanks Joe.

Does this supposedly help?
I've heard very little talk (maybe I miss it all) regarding proper breathing techniques when using the 02.
I've been told that people should be sitting, slightly forward without pressure on the back so the lungs can completely inflate, breath deep and then exhale completely. This would seem to keep the lungs filled with 02 longer and with a higher concentration of 02, than hyperventilating. I can understand trying to hyperventilate when breathing "air" but maybe someone can help me understand the logic of hyperventilating on pure 02. Seems to me that hyperventilating would leave the lungs empty more often than deep breathing.

Bobw

Bob.....

I'm much like you having a large lung capacity. I can easily out pull a 25 lpm flow much less a 15.

All I can say for sure is my abort times are shorter using a 25 vs. a 15. I'm sold on higher flow. YMMV of course.

B

Inhaling pure oxygen you could in principle hold your breath until all oxygen is absorbed and the lung collapses.

But there is another side of breathing: getting rid of carbon dioxide. Therefore, by breathing at a normal rate you ensure a normal CO₂ exchange.

By hyperventilating you exhale more CO₂ and the blood gets less acidic. The resulting higher PH-value of the blood helps the desired vasoconstriction, speeding up the abortive effect. That is what our expert Batch says.



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[quote][/quote]
Batch wrote on Jul 9^th, 2008 at 1:28pm:

My favorite topic... Oxygen Therapy as a cluster headache abortive…  Thank you Chuck…  I was hoping to be able to brief some of the following info at Dallas, but timing and the agenda just didn’t work out so here goes...  I’ll be able to reach more of you this way.   I've been doing more research and collecting additional data on abort times as they relate to oxygen flow rates, non-rebreather (NRB) masks, and carbon dioxide (CO2) buildup and how these factors impact the effectiveness of oxygen therapy to abort cluster headache attacks.  The buzzword is hyperventilation. In keeping with the standard disclaimer, I’ve provided the following for information purposes only.  See your doctor or neurologist for medical advice and treatment of your cluster headaches.  They’ll catch up with us at some point.       An oxygen flow rate of 12-15 liters/minute with a non-rebreather mask is a MUST on your prescription for oxygen therapy, as is the phrase, "AS NEEDED FOR CLUSTER HEADACHES." In practice, 15 liters/minute is the minimum effective oxygen flow rate used by most successful oxygen therapy users – the really successful oxygen therapy users have oxygen regulators capable of delivering 25 liters/minute or higher.  Any flow rate less than 15 liters/minute, for example at 7 to 9 liters/minute, can easily result in a build up of CO2 due to the increased physical activity associated with the cluster headache attack AND the restricted respiration rate caused by the non-rebreather mask.  All this results in a situation where you cannot achieve an abort with oxygen therapy when the respiration rate is constrained by using low oxygen flow rates administered with a non-rebreather mask. Although an oxygen flow rate of 7 to 9 liters/minute will easily result in a hemoglobin oxygen saturation at or near 100% under normal conditions, a respiration rate constrained to this flow rate by using a non-rebreather mask will result in a CO2 build up well above normal and displace or not leave room for oxygen molecules to attach to the hemoglobin in each red blood cell.  In short, while you may be getting more oxygen than normal at a flow rate of 7 to 9 liters/minute, the restricted respiration rate allows CO2 in the arterial blood steam to climb above normal levels. It gets worse…  It's not the lack of oxygen that controls the rate of respiration, it's the level of CO2.   During strenuous activity, CO2 builds up faster in the bloodstream than it can be expelled from the lungs at normal respiration rates.  As a result, chemical receptors in the body signal an increase in respiration to reduce CO2 levels, and you start gasping for breath panting like a big dog.   On top of that, CO2 is a powerful vasodilator.  As a cluster headache attack is associated with a dilation of the arteries and vascular structures around your trigeminal nerve, a buildup of CO2 above normal levels causes increased vascular dilation and that makes cluster headache attacks more painful and last longer.   CO2 is such a powerful a vasodilator that even a slight increase in CO2 above normal levels will totally negate and overpower the vasoconstriction (a cluster headache abortive mechanism) provided by breathing 100% oxygen.  As CO2 levels continue to build, you start having panic attacks and become even more animated generating more CO2.  It's a vicious cycle. The only way to prevent CO2 buildup during oxygen therapy is breathe at a rate faster than normal and with a greater tidal volume than normal.  This is called hyperventilation and requires a minimum oxygen flow rate of 25 liters/minute.   Preventing CO2 buildup may not be possible at high Kip-levels even with an oxygen flow rate of 15 liters/minute and a properly functioning non-rebreather mask.  A higher respiration rate (and oxygen flow rate) will be needed when cluster headache attacks rise above Kip-6 to Kip-7 on the pain scale. The normal adult respiration rate at rest is 15 to 18 respiration cycles/minute with an average of a half liter tidal volume.  Tidal volume is the volume of air inhaled and exhaled with each breath.  If you do the math, a flow rate of 7 to 9 liters/minute and a tidal volume of .5 liters, works out to a respiration rate of 14 to 18 cycles/minute.  At an oxygen flow rate of 15 liters/minute and a tidal volume of 1 liter, the respiration rate is 15 cycles/minute.  Again, even that respiration rate will be insufficient to cast off excess CO2 during a high Kip-level attack while you’re dancing around the room doing the tarantella (or Cha-Cha) and banging your head off the wall. At this point, I can hear some of you saying…  Who is this guy and what heck is he trying to tell us and why?   The answers are simple. I’m an old Navy fighter pilot with over 3000 hours flying Navy jets.  All of that flight time was spent breathing 100% oxygen continuously from takeoff to touch down on missions lasting over 2 hours and on some extended mission lasting up to 7 hours.  I can also guarantee you that I would routinely suck down that 100% oxygen at flow rates well above 30 liters/minute at high respiration rates.   I’m still here… so the safety of breathing that much 100% oxygen for periods of 2 hours or more is not an issue.  In fact, the US Navy has been requiring Navy and Marine Corps pilots flying tactical fixed-wing aircraft to breathe 100% oxygen from takeoff to touch down for over 60 years.       I’ve also been using oxygen therapy since I went chronic over 4 years ago and for the last two, at flow rates well above 15 liters/minute.  I’ve not used any other cluster headache medication except oxygen in the last 2 years and now routinely abort my attacks in two to three minutes. The message of this post is equally simple.  Hyperventilation with 100% oxygen is the key to successfully aborting cluster headache attacks.  Oxygen is good and CO2 is bad.   If you don’t believe me, watch the video of Chuck from the cluster headache documentary.  Pay close attention to the reservoir bag as it collapses completely with each breath he takes from his non-rebreather oxygen mask.  He was getting plenty of oxygen but he was unable to cast off excess CO2 with a high enough respiration rate due to the constrained oxygen flow rate.  That made the oxygen therapy ineffective and the very painful attack last far too long. Take care.  I'm only trying to help.  'Hope to see some of you in Dallas so I can show you how well properly administered oxygen therapy works. V/R, Batch

Also, setting up straight is thought to be better for getting complete inflation of the lungs.

Bob P and I have gone around on this. (He told me I was doing it wrong  ;D)

I too need double xrays, but I can easily outrun my 25LPM regulator and 3 liter bag without trying to hyperventilate - just by breathing fairly deeply and slowly.

Pete's write-up posted above, also presents interesting ideas with regards to CO2.

Marc

Pinkfloyd wrote on Jan 31^st, 2009 at 12:45am:

I've been told that people should be sitting, slightly forward without pressure on the back so the lungs can completely inflate, breath deep and then exhale completely.

Actually, Bob, leaning forward, while sitting, is a no-no.  Especially if you have, shall I politely say, a bit of extra padding in the belly (like I do).  What happens when you lean forward is that you restrict the diaphragm from pulling down fully, and getting full expansion of the lungs.  It is felt that standing, or leaning back into a semi reclining position allows the diaphragm its full expansion capabilities.  

I have no idea if my lungs are large or not, but I can easily empty a bag at the 15LPM flow.  You can actually see that on the video of my hit.  Ben had a good idea, with the larger bag, but, even if you had the larger bag, if the input flow rate is lower than your usage, you would still empty the bag.  It would just take a few more breaths, to empty the bag, than with the smaller bag.

I am like Joe, in that I use a demand valve system. Using the demand valve system, we have calculated that, during the hyperventilation stage of aborting, I am actually using approximately 60LPM.  Through testing and documenting my hits and abort times, using the 15LPM method, and then doing the same documentation using the demand valve, I was able to shorten my abort time from an average of 20 minutes to abort down to 4 minutes to abort.  Those were rather impressive improvements, I am sure you will agree!

So, in my mind, the higher flow rate is a must, for someone like me.  Now, I am not saying that everyone needs to go the higher flow rate.  Some get good control at 15 or even 8 LPM.  If those rates work for you, then that is fantastic!  Stay with the lower flow rates.

BUT, If you are one of the ones that say that oxygen therapy does not work for you, or it takes too long to abort, then you should try the higher flow rates.  It has had amazingly great results for many.

At the last convention, both BarbaraD and Linda Howell tried my demand valve to abort a hit.  Both of them just about fell off their chair, with shock, at how fast they were able to abort.  Now both of them have the system, and swear by it.  It has improved their quality of life, enormously, and that is what we are all trying to do, right?

Has my long winded diatribe helped explain it, Bob?  I would be happy to discuss it further, either here on on the phone, if you wish.

Chuck

I usually stand when I am using O2. If the pain level is high I can move around a bit. I use 25ltm. I also at times squash the bag in when I am full so I kind of baloon myself further. I also hyper. I turn down the flow rate every now and again to give myself a breather (excuse the pun).

Even though I do this O2 staves off the attack and after 20 mins I am nearly always left with a constant shadow which eventually comes back as a hit, generally twice a day. So for me O2 keeps it at bay.

Ellick.

Hey guys,
Thanks very much for the information. Clears up a few things for me and I hope a few others. (unless I'm the only one that wasn't paying attention)

Thanks again everyone,
Bobw
P.S. yes, it always bothered me to see Chuck's bag empty in the video. It would leave ME gasping for air.

I'm one of those people that O2 works sometimes... even when I hit it right away. I have a 15 LPM regulator, and I'm constantly hyperventilating inhaling the O2, as it is the only thing that will help. The more O2 the faster I inhale it works better. I routinely empty the bag, and could breathe more if the bag was bigger.

I'm going to look into an on demand valve and see how it works.

A 3-liter reservoir bag or a demand valve will both work wonders...  You'll never be sorry with a demand valve.

Take care,
V/R, Batch