I can't decipher how that relates to our flow rates, but good to know about the signs of O2 toxicity.

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And here's another that may explain why we get relief.

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-Chris

And what would be the reason you're so interested in pointing out how O2 might potentially harm us? Do you know how long you have to breathe pure O2 before it starts to do harm?

I'm sure it doesn't have anything to do with the fact that you're in the pharmaceutical business...

BREW:
WHAT??? Actually, it probably does have to do with the fact that I'm in the pharma business, knowing better than to take medical advice at face value. I think it's important for people to do their homework, regardless of the source of advice. I also think it's very important that people have as much information as possible, both good and bad.

I'm not sure what you think I would gain from this. I have only a personal stake in knowing what's going to potentially happen to my body. Sharing that info is important, as much as sharing the potential benefits of novel approaches so that people can make informed decisions.

I don't appreciate your personal attack any more than I appreciate your giving incomplete medical advice to people in need. There's no conspiracy of pharma, FDA, and local pharmacists to keep you from getting better. Get over that.

-Chris

p.s. according to the article, it takes 6-10 minutes before problems can occur.

Chris H wrote on Nov 7^th, 2010 at 10:50am:

BREW: WHAT??? Actually, it probably does have to do with the fact that I'm in the pharma business, knowing better than to take medical advice at face value. I think it's important for people to do their homework, regardless of the source of advice. I also think it's very important that people have as much information as possible, both good and bad. I'm not sure what you think I would gain from this. I have only a personal stake in knowing what's going to potentially happen to my body. Sharing that info is important, as much as sharing the potential benefits of novel approaches so that people can make informed decisions. I don't appreciate your personal attack any more than I appreciate your giving incomplete medical advice to people in need. There's no conspiracy of pharma, FDA, and local pharmacists to keep you from getting better. Get over that. -Chris p.s. according to the article, it takes 6-10 minutes before problems can occur.

         Then all our pilots in the military are dead.  RIP Batch.

              Potter

Pilots use oxygen above 10,000 feet. Atmospheric pressure at variuos levels above and below sea level play an important part in how the body demands O2.

Aviation Oxygen Mask

There are 3 different kinds of oxygen masks that are available for the pilots and crews who fly at high altitudes:
Continuous Flow Masks: These masks provide a continuous flow if oxygen to the person wearing the mask. These masks are equipped with a ‘rebreather’ bag that helps recycle parts of the exhaled air thereby saving oxygen. General aviation aircrafts flying above 12,500 MSL make use these types of masks
Diluter Demand Masks: These supply oxygen when the person wearing the mask inhales. Hence, an airtight seal is required between the mask and the face of the user. When the user inhales, a demand oxygen regulator opens up a valve and supplies the oxygen that is required at a particular altitude. An increase in the altitude also increases the amount of oxygen that is delivered to the user. These masks are used at altitude as high as 34,000 feet altitude.
Pressure Demand Masks: These masks also supply oxygen when the person wearing the mask inhales. These masks are used at altitudes higher than 34,000 feet and can force 100 percent oxygen into the lungs of the users. In this case, inhalation is simple because it is forced but the exhalation is a difficult process. The pilots are trained to use these masks in an altitude chamber.
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Military pilots stay on 100% O2 for hours at a time.

You need to do your homework, pal.

I'm not sure why you would think to scare potentially hundreds, if not thousands, of CH sufferers away from the best abortive we have that also has next to no side effects. Only you know the answer to that. But I will not sit idly by and let you get away with it.

ETA: One other thing - all of us here know how the FDA and big pharma has our best interests in mind.

Brew, What I'm hearing from you is that you prefer to provide only the information you want people to hear so they can't think for themselves, just do as you instruct. You know, when politicians try to discredit real information and start slinging mud, it turns my stomach a bit. I don't trust them anymore.

I'm not trying to keep anybody from using O2. I use it myself. I was simply doing some research before going for a higher flow regulator. I thought the info was of interest and thought others might as well. See, I don't assume people are idiots and just need to be given party line info.

By the way, I've done my homework, pal.

I find your posts offensive, which is counter to the guidelines for this board.

-Chris

I find your agenda offensive.

I'll hang my hat with the brain-damaged thousands here who have already found relief.

Go ahead - you can have the last word. Then I'm done with you.

That better be the last word. Both of your attacks have went past attacking the idea and now the attack has become personal.

Step away and chill out would be my recommendation. :)

!!!
it should be wrong attacking in another clusterhead just for raising a topic for discussion from info that already exist outthere.

i don't know much about what pilot really do and it's probably the first time i read some info about it and even if i can't quite understand it,to be honest i couldn't understand batch's too words which is the only opposite word i ve found on this.

the truth is that maybe there is some truth in articles as of course as there is in so many people's word on this that really works.

But the main thing i think it should be(as we are not pilots but clusterheads)that the whole internet flows with medical articles saying O2 works in rates 7-10 plm providing relief in 15 min on 70% percent of patients,very few on 15 plm(i think) and none for higher plms as i at least have seen around except here.

which makes  me wonder what the hell is going on

But in any case it should be wrong attacking another clusterhead not on his opinion but on himself as he has a personal 'interest' on this.
It's enough with the pain and suffering ch gives,noone has to be isolated in a community as this one which is very important for everyone.

in other words brew i think you are crossing some lines here ....but moderators and DJ should be responsible for saying so and not me.

Thanks Black for bringing a sense of good will to this. Aren't we here to discuss and learn? -Chris

I'm out.

Marc wrote on Nov 8^th, 2010 at 8:52am:

I didn't have time to read the Wiki this morning, but if says that damage of any kind occurs, in normal healthy adults from a few minutes at atmospheric pressures...........then it goes against everything that I've researched for many years. Many people miss important points in the articles that they read, like:  "at elevated pressures." I will read the article tonight, but until someone shows me some new research, I will stand behind what I know: - Short term use (15-20 minutes) of 100% oxygen at atmospheric pressure will not cause any damage to a healthy adult, at any flow rate that they can handle. - Long term exposure and/or exposure to high concentrations at elevated pressures (think like a hyperbaric chamber) have both been proven to have a whole list of serious dangers. - Babies and anyone with particular types of pulmonary problems have to carefully control exposure. Again, I will read the links provided but Chris, I suspect that it has the same old information and that you may have missed "at elevated pressure."  If there is indeed something new, I will be glad to join you in sounding the alarm! Marc

Thanks Marc.

              Potter

It is an interesting thing from this board- our coversations and discussions are not just for "us"- there are countless newbies who might stumble across this as the only post they will read. If this was that post, said newbies need to know that many, many folks have had relief from high flow O2 for YEARS with no side effects. I would not like them getting scared off from O2 treatment because of this post. Yes we can discuss it, and should, but those newbies also need us to not scare them off with our actions and words.

Newbies: we're all sweet cuddly pussycats, I SWEAR. (did they buy it? They bought it? Good good...) I kid of course. We're all different sorts in this family, but we are all here to help and learn, that is our unifying trait.

I'm In...  But only to clarify a few of the facts about breathing oxygen and to quell any worries about the safety of using oxygen therapy as an abortive for cluster headaches. 

The use of oxygen therapy as an abortive for cluster headaches is very safe...  Much more so than taking any of the far more invasive triptans as oxygen therapy has no lasting side effects if used properly.

Oxygen therapy is also a heck of a lot cheaper than triptans.  If used properly at a high enough flow rate, you own your own mask and regulator, with oxygen coming from an M-size oxygen cylinder, the cost per abort before insurance is $1.20 to $1.50.  It’s as low as 20 cents/abort with insurance co-pay.   On the other hand, 25mg to 50mg sumatriptan tablets run $7 to $9 each, a 5mg sumatriptan nasal spray applicator costs $32 and a sumatriptan SC Stat Pen injector costs $89 per shot.  Do the math...

Oxygen toxicity at normobaric (Sea Level) pressure is not really a problem for cluster headache sufferers who use oxygen therapy either.  An otherwise healthy adult would need to breathe 100% oxygen continuously at normobaric pressure (sea level) without any breaks breathing normal air for 10 to 12 hours to encounter the symptoms of oxygen toxicity. 

At a flow rate of 7 liters/minute, that would require an oxygen cylinder with over 5,000 liters of oxygen.

And, as the symptoms of oxygen toxicity are very similar to pneumonia where it becomes very painful to inhale, most of us would stop breathing the 100% oxygen at the first sign of breathing difficulties and switch to normal air long before incurring any lasting lung damage.

I'm an old Naval aviator and fighter pilot with over 3000 hours in jet fighters.  All of that flight time was spent breathing 100% oxygen from engine start and takeoff/cat shot to an arrested landing/trap aboard ship or field landing.  The average mission length was two hours and I have flown several extended missions that lasted 7 hours. I also routinely flew two and three of these two hour missions a day/night. 

I can also say that during actual and training air combat maneuvering where G-forces routinely get up to and exceed 6 Gs (six times the force of gravity), the work load is such that we inhale that 100% oxygen at flow rates greater than 50 liters/minute for several minutes at a time.

I accrued these flight hours over a 15 year period and passed my annual flight physicals with chest X-Rays for the entire 24 years I served as a Naval Officer...  I was also required to attend annual Aviation Physiology training that included an altitude chamber run every 4 years with a stop at 26,000 feet where we would take off our oxygen masks to intentionally experience hypoxia and then zoom up to a cabin pressure equal to 35,000 to 43,000 feet to experience pressure breathing where the oxygen regulator forced oxygen into our lungs to keep us conscious.

I've also used oxygen therapy at flow rates that support hyperventilation since 2004 and I'm still here at age 66.

All of my experiences breathing 100% oxygen can easily be considered anecdotal information.  The following isn't.

I've checked with Flight Surgeons and Aviation Physiologists at the Naval Safety Center, the Naval Aerospace Medical Institute, the Naval Air Systems Command, and NASA. None of them were able to cite any medical problems experienced by Naval Aviators or Astronauts associated with repeated exposures to breathing 100% oxygen. 

My contact at NAVAIRSYSCOM also indicated that there have been over 125,000 designated Naval Aviators with fighter and attack aviation warfare specialties since the early 1940s. All these pilots and aircrew also had to pass annual flight physicals just to stay flying.

Given the average Naval Aviator flies between 1500 and 3000 hours during his or her career in the Navy or Marine Corps, you could easily say this is the single largest ongoing retrospective study on the effects of repeated exposure to breathing 100% oxygen in history. 

What’s even more impressive is the fact that they have yet to find any long-term medical problems associated with repeated exposure to breathing 100% oxygen. 

Good people of Clusterville…  That is hardly anecdotal.

OPNAV Instruction 3710.7T states in section 8.2.4.3 Tactical Jet and Tactical Jet Training Aircraft.  “Oxygen shall be used by all occupants from takeoff to landing.”

You might want to ask yourself why the Navy would require these pilots and aircrew to breathe oxygen while flying fighter and attack aircraft costing more than $40 Million dollars each plus an additional Million dollars to train a Naval Aviator if oxygen represented a potential health hazard.

The only exception to the OPNAV 3710 mandatory requirement is the Blue Angels who have a waver for air shows where they don’t wear and oxygen mask as all of their shows are conducted well below 10,000 feet, but even they must wear an oxygen mask during cross-country flights above 10,000 feet to and from show sites.

The oxygen masks and mini-regulators we've used over the years and the versions that are in use today function very similar to the oxygen demand valves some of us use for cluster headaches.  The only difference is when you connect the oxygen hose to the aircraft oxygen supply and turn it on you also get a constant flow of 100% oxygen at around 15 liters/minute.  If the workload requires additional lung ventilation to expel excess CO2, the mini-regulator functions just like the demand valve delivering the additional oxygen on demand.  These regulators can also support peak flow rates up to 200 liters/minute.

Around 2004, the Navy started converting its fleet of F/A-18 aircraft from the 5 liter liquid oxygen (LOX) dewar flasks that delivered gaseous 100% oxygen through a LOX converter to the air crews over to an onboard oxygen generating system (OBOGS).  An OBOGS is like an oxygen concentrator on steroids.  It uses 17th stage bleed air from the jet engine compressor section to produce oxygen at high volume at an average of 93% purity by passing it through a molecular sieve pressure swing adsorption (PSA) system.  If you’re interested, the remaining 7% is Argon, an inert noble gas.

So…  I’ll say it again…  Breathing 100% oxygen as an abortive for cluster headaches is very safe.

Take care,

V/R, Batch

The O2 guru's have spoken.

            Potter

Batch and Marc, Thanks for chiming in here.

Keep in mind that I never said O2 was a problem, just evaluating risks.

Batch, I do have some questions for you.

Regarding the mandate that all naval aviation pilots don their oxygen mask from takeoff to landing. My understanding is that this normal operating procedure was not always in place and that previously there was a high incidence of hypoxia (insufficient oxygen). A study was performed and it was found that pilots were not donning their mask at altitude, therefore the hypoxia incidents. That prompted the new requirement to don the mask at takeoff.

The other thing I understand is that oxygen flow rates are altered during flight based on altitude. Below 8000 feet, the typical throughput is below 5lpm and is mixed with ambient air. The Blue Angels not requiring masks at all below 10,000 feet is I think a good example.

I could be misinformed, but that's what I've read. Don't hesitate to correct me on that... I've only picked it up from various aviation sites. So I guess my question is why they don't just pump you with 50 lpm right off the bat?

-Chris

i have a question with all these

what's the difference inbetween them you have spotted in ch using
1)15lpm
2)25lpm
3)45lpm
and finally at 60 lpm?

also what's your opinion in the medical studies
suggesting using 7-15 lpm with nrb mask bring relief in 70% of the patients in 15 min.
do you find it true,false according to your own experience?
 

Marc, I've gotten similar answers from the docs, which is why I've been researching. I'm always a little leery when the whole medical community seems to agree as though it was somewhere in their training but aren't really sure of the reasons. Likewise, it seems like a lot of people here have success at higher rates, but I haven't seen anything regarding the risks. Just saying it's either safe or unsafe without more info drives me to my own research. Experience says a lot, and there's a lot here which lends me to think that safe is the right answer...just not there yet. My brother lost a lung and his whole life changed (not due to o2, due to pulmonary embolism).

Black, I'm at 15lpm currently and it rarely works for me, even with the optimask. That's why I'm considering going up to 20-25 lpm.

-Chris

Black, just from what people on the board have posted, 15 LPM seems to work for a lot of people. But there is a group, maybe 20-25%??? for whom oxygen didn't work at all at the lower flows, and kicked butt at higher levels, hopefully a few of them will chime in here. I've always used a demand valve so no flow rate issues here.

Joe

I was always one of the lucky ones. I had mine set at 10 lpm and could knock most down in 10 minutes.

black wrote on Nov 8^th, 2010 at 4:40pm:

i have a question with all these what's the difference inbetween them you have spotted in ch using 1)15lpm 2)25lpm 3)45lpm and finally at 60 lpm? also what's your opinion in the medical studies suggesting using 7-15 lpm with nrb mask bring relief in 70% of the patients in 15 min. do you find it true,false according to your own experience?

Black,

The difference is the amount of O2 flow available to you.

My opinion on the medical studies using 7-15lpm were not done by clusterheads, but by medical people.  They may have been using clusterheads, but "bring relief" in those studies included ANY decrease in pain, not pain being gone.  I quit using it at 15 lpm because the amount of relief I got was not worth the effort and discomfort of feeling smothered for lack of air.  I fit their criteria for "bring relief" but it was a farce,  At 15 lpm I could bring a K8 to a K5 for about 15 minutes until the hit ended, but at 25 lpm I can take a K9 to K1-K0 in 5-8 mins.  That is what I call "bring relief"  Those studies pushing a limitation of 15 lpm are borderline criminal and are definitely anti-Hippocratic oath at the least.

JMHO  You may leave the O2 regulator down and suffer.  I'll take the relief.

Jerry

Marc wrote on Nov 8^th, 2010 at 3:51pm:

Chris, I think that standard training in the medical community really pushes "too much O2 is bad" - so people don't stop to think and try to understand our unique requirement for CH's. I can't even count the number of times doctors and nurses have said things like: "Wow, 45-60 lpm. Do you realize how bad that is for you?"  When I respond: "No, I don't think it is. Help me understand why you say that" Then they talk in circles for awhile before realizing that they can't give me a single reason to avoid using oxygen the way we do. By all means, keep researching and share what you find. Marc

Marc,

I think that fits in with the Dr that told a clusterhead he shouldn't use high flow oxygen because he might become addicted.  True story!

Jerry

Quote:

JMHO  You may leave the O2 regulator down and suffer.  I'll take the relief.

why would i want to do something like that?
i havent even come around such high plms and i am still working my luck with a concentrator for ecomical reasons as you already know.Meanwhile i am trying to understand the truth inbetween the contrasts i see.
you can do whatever you like as far as no one keeps stalking me around here with bad intentions and suspicion i am happy with that.
I am part of a community with mutual interest of his individuals trying to find my own way measuring at the same time all sort of informations.
thanks the rest for the answers and remind myself never to grow up becoming arrogant.

To Callico only: i am telling you this for the first and hopefully the last time.I DON'T APRECCIATE ANYONE ON MY TAIL.I am not here for your fun and entertainment pls bother someone else.I am in pain and chronic no kudzu works for me,haven't managed to abort in 5 min(i wish) thinking also to raise plm more to achieve nanoseconds.

so pls respect that.or at least try it if you can.

Black,  I think we have a lack of communication here.

                Potter

I'm with Potter. Having met Jerry, he's about the kindest man you could meet. I'm hoping this is just a mis communication....... :-/

Joe

I agree.

Black......Callico is not saying what you thought he was saying.

From what I am seeing Callico is not stalking you. Unless he is sending derogatory pm's to you which I know that he isn't.

We know English is not your first language and I have already seen a couple of times where you did not understand the content of what was being said.

Hang in there. No one is after you. :)

black wrote on Nov 8^th, 2010 at 7:18pm:

Quote: JMHO  You may leave the O2 regulator down and suffer.  I'll take the relief. why would i want to do something like that? i havent even come around such high plms and i am still working my luck with a concentrator for ecomical reasons as you already know.Meanwhile i am trying to understand the truth inbetween the contrasts i see. you can do whatever you like as far as no one keeps stalking me around here with bad intentions and suspicion i am happy with that. I am part of a community with mutual interest of his individuals trying to find my own way measuring at the same time all sort of informations. thanks the rest for the answers and remind myself never to grow up becoming arrogant. To Callico only: i am telling you this for the first and hopefully the last time.I DON'T APRECCIATE ANYONE ON MY TAIL.I am not here for your fun and entertainment pls bother someone else.I am in pain and chronic no kudzu works for me,haven't managed to abort in 5 min(i wish) thinking also to raise plm more to achieve nanoseconds. so pls respect that.or at least try it if you can.

Black,

I have never been on your tail.  YOU are the one who PM'ed me for info on Kudzu.  I did not force it on you, nor will I on anyone.  All I did in that case was to answer your questions ans share what worked for me.  What works for one does not work for all.  If you have paid attention at all to my posts I've always shared what I have experienced in well over 30 years of CH.  I don't claim to know it all, nor do I try to force it on anyone else. 

I've been noticing in your posts lately an antagonism to most anything anyone else has suggested to you.  You have been argumentative about whatever is suggested.  All I was saying in the post you misconstrued is based on the cumulative experience of nearly everyone on this board the higher the flow of O2 the faster the abort.  You wanted to argue that, hence I said "JMHO (Just My Humble Opinion) You may leave the O2 regulator down and suffer.  I'll take the relief."

What I was saying to you is simply this:  You make your choice and live with the consequences.  I'll make my choices and do the same.  Furthermore, I wash my hands of you.  No one can, nor will try, to force you do do anything.  If you don't want to follow our advice, so be it.  I'll be very careful to leave you out the nest time you ask.

Jerry

i apologise.Didn't understand JMHO at all and stood only on the sentence which sounds like this completely different.

But for the antagonism i know you have noticed such but no i don't persue such thing except having the benefit,the right of doubt and questiong trying to give judgement a better place which is a completely different thing.And to be honest i haven't raised not even half of the questions and topics i have.

in any case i apologise for any inconvience from everybody and you too callico and have given a lot of thinking about my presence here judging whether someone has benefited  from me or have been benefited too and didn't came up with anything more than as a simple guest just viewing could.
more harm than good is the truth in my case.

so take care and pf wishes everyone.

Callico, There may be some negative reaction to the message of take my (our) advise or suffer, to someone who is already suffering. Sounds cold, but I also know from your other posts that you probably didn't mean it to sound that way. Another point of view.

To all,

I think there's also a feeling of groupthink throughout this thread that makes a few, like me, who question things wonder a little bit about the mission of the site, as opposed to what it says on the home page. That is, a forum to feel welcome and share ideas and thoughts to further our understanding of CH. The negativity thrown at me about posting some information really surprised me, and it was not only tolerated but supported by other members. I do think there's a great body of experience here, but there's a lot more to learn.

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-Chris

I too have read info about O2 toxicity and given the amount of time a CH'er spends on the O2, toxicity is not likely to be an issue. 

As to the heated discussion here we all need to remember that in reading the written word we do not hear voice inflections and that can lead to misunderstandings.  This needs to be taken into account when reading posts.  Also just because someone disagrees with you doesn't mean that you are being slighted in anyway.   

I think that's well said, Ginger. We also need to take care when writing posts.

Generally, I would recommend that personal messages stay as PMs, not as posts in the forum.

This message is pointed toward the group, me included, not anyone in particular.

-Chris

Chris H wrote on Nov 9^th, 2010 at 1:13am:

Callico, There may be some negative reaction to the message of take my (our) advise or suffer, to someone who is already suffering. Sounds cold, but I also know from your other posts that you probably didn't mean it to sound that way. Another point of view. To all, I think there's also a feeling of groupthink throughout this thread that makes a few, like me, who question things wonder a little bit about the mission of the site, as opposed to what it says on the home page. That is, a forum to feel welcome and share ideas and thoughts to further our understanding of CH. The negativity thrown at me about posting some information really surprised me, and it was not only tolerated but supported by other members. I do think there's a great body of experience here, but there's a lot more to learn. Group think: START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE -Chris

        So you're allowed to think and make a shit post,  but we, and I assume you lumped me with the others,  aren't allowed to respond?

                 Potter

Potter, Response is what I was looking for. Personal attacks are inappropriate and non-productive.

A shit post? It's just information that's relevant to what we're doing. If you think it's bad information, say so, but include why you think so. Add value to the discussion otherwise it's just negative noise.

-Chris

Chris, as a moderator, I'm one of the people stuck with trying to decide when posts cross the line and turn to personal attacks. It's not a task we take lightly. If you had seen this board a few years ago, before we had moderators,  you'd have been correct in labeling it as a "groupthink" issue. Anyone posting anything contrary to what the "unspoken judges" felt to be the truth, was literally driven from the board. It was ugly.

I'm quick to caution people about labeling the "board's views and opinions," based on a single members', or even a few members responses. Stick around a while and you'll see 95% of the people here are good hearted people who are trying as best they know how to help. Ignore the other 5%, their power is built or destroyed based on the credibility you do or don't give them.

The other risk of course is of beating the horse, long after any sign of life is present! I think it's time to let this one die a natural death. The internet is a wild, unpredictable, public forum. Help us to make this board a good place to be.

Joe

Thanks Joe. I believe that. In a group like this, passionate about a common theme, with found solutions that have not come from the many many doctors we've all endured, there's always the risk of falling into a groupthink mentality. Coming into this fairly new to the site, it does feel that it may be creeping in. I encourage diversity of thought to the board in order to continue to learn.

This is actually a different horse than what we've been discussing, so it may wind out a bit more I expect. I can certainly end it here.

-Chris

I would like to address the "group think mentality" issue.  Just look at the number of registered members then compare that to the number of people that you percieve to be "after you". 

We are all individuals here, most of us are pretty ornory (myself included), because we are in pain and are frustrated because we genuinely care about the rest of the members of this community.  And quite frankly it tends to chap a person's ass when they try to help some one avoid this pain, and then have the chosen method demonized by the medical community that to me, has really shown how inept they are when it comes to actually treating our condition.  If it weren't for this board, I would have "pulled the plug" years ago.  But because of the things I've learned here and the things I've learned from people I've met through this medium, I have a reign on this thing and don't let it get me down. 

This place is about helping each other, it's not about one upping each other, some of us are quite protective of our family, and the term family is quite accurate.  We really are a group of well-informed, well-experienced, well-intentioned, loving, accepting, forgiving, and honest people, if you take the time to get to know us.

thomas - the quiet cousin who drinks too much at family gatherings and farts in the corner.  ;)

Great post Thomas! :)

Now go back to your corner.

thomas - the quiet cousin who drinks too much at family gatherings and farts in the corner

Damnit, I KNEW that was you...I took the heat for that! >:(

Joe

I Agree Nice Post Thomas!! 

Please, if you do have to let the methane flow stay in your corner  ;D

Black,

Apology accepted.  I'm sorry you didn't understand JMHO.. It is an acronym we use sometimes along with a few others.  If you go to the Main home page at the very beginning of this site you will find a list of a few of them.  Knowing English is not your first language I should have realized there was a misunderstanding and not jumped on you so hard, so an apology is needed on my end as well.  I was not feeling well and reacted badly.  No excuse, but I did.  Please in the future if you don't understand something I am saying ask, but please don't get the idea I, or mostly anyone else here, is getting on your case or trying to give you grief.  My estimation is that 99% of the time peoples posts are meant to be constructive, not hurtful.  To be honest, I don't NEED this site for the information any more.  Once in a while something new comes along, but I need to give back what I was given when I was at the point of suicide,  Now I've learned what works for me,and I want to share it with others to keep them from what I went through for almost 30 years of dealing with what the medical community wanted to give me in their ignorance.  Please hang around and keep learning.  Yes, we are passionate about some things, and I don't apologize for that.  Most of the time we know what we are talking about.  Sometimes we make mistakes, but we try hard not to.

Jerry

Well, I think I can safely say I've expressed my own orneriness. Comes with age and clusters. I look forward to working with this group and becoming part of the family if you'll have me. -Chris

Chris H wrote on Nov 9^th, 2010 at 8:58pm:

I look forward to working with this group and becoming part of the family if you'll have me. -Chris

Too late.  You already are.   ;)

Best,

George

Chris H wrote on Nov 9^th, 2010 at 8:58pm:

Well, I think I can safely say I've expressed my own orneriness. Comes with age and clusters. I look forward to working with this group and becoming part of the family if you'll have me. -Chris

George wrote on Nov 9^th, 2010 at 8:59pm:

Chris H wrote on Nov 9th, 2010 at 8:58pm: I look forward to working with this group and becoming part of the family if you'll have me. -Chris Too late.  You already are.   ;) Best, George

Indeed.

Chris,

Aviation experts and concerned pilots recognized the problem of hypoxia as early as 1917 when advances in aircraft engines pushed aircraft operating ceilings well above 10,000 feet.  The first use of supplemental oxygen by pilots occurred about that time.  It involved heavy iron cylinders filled with compressed oxygen and the method of delivery was a simple cylinder valve connected to a rubber tube fitted with a pipe stem the pilot held between his teeth.

A lot of innovative advances followed in short order after that most notably with the advent of the oxygen mask with inhalation and exhalation check valves.  However, all of the early oxygen masks were fed from constant flow regulators until 1942 when Navy and Army Air Corp aircraft were fitted with demand type oxygen regulators.

I’ve done some research on history of the oxygen demand valve regulators you might find interesting. The Auer Company developed the first demand type oxygen regulator in Germany in 1936. 

Coincidently, The first documented use of oxygen as an abortive for severe "migraine" attacks (read cluster headaches) as they were originally diagnosed, dates back to 1939 with work done by the Linde Air Products Co and the Mayo Clinic in Rochester, MN.  Yes, the Linde Air Products was a spinoff from the Linde Co in Germany and it’s known today as Linde LifeGas.

By 1941, the US observers had had ample opportunity to recover functioning examples of the new German Demand oxygen breathing regulators and masks from downed Luftwaffe aircraft. 

The apparent advantages the German system offered over the older continuous flow systems were immediately evident and the captured technology was quickly removed to the Wright Aeromedical and Engineering Labs for analysis in June of 1941.  By 1942 most US Navy, Marine Corps and Army Air Corps aviators were using derivations of the German design.

There were always a few cases over the years since then when idiots eager to exit the gene pool neglected to wear their oxygen masks when flying above 10,000 feet, but the initial requirements for supplemental oxygen were well established by 1920.

OPNAVINST 3710, also known as the Naval Air Training and Operating Procedure Standardization (NATOPS) Program that mandates the use of oxygen from takeoff to landing went into effect in 1964.  It superseded the Navy’s Bureau of Aeronautics instruction that dated back to 1917 and essentially stated the same requirement for supplemental oxygen on all flights above 10,000.

The use of diluter demand oxygen regulators began during WW II with the requirement for extended missions escorting bombers.  The compressed oxygen cylinders could not hold enough oxygen for these prolonged missions using 100% oxygen flow rates so they made a compromise using diluter demand mode from 10,000 to 20,000 feet when they would switch to 100% oxygen.  The liquid oxygen (LOX) system design also lifted from captured Luftwaffe Me-109s began entering service in US fighter and attack aircraft around 1945.

The initial requirement to use oxygen masks from takeoff to landing began when the first Jets entering service in 1945.  These fighter and attack aircraft used bleed air from the compressor section of the jet engines to pressurize the cockpit.  As the early jet engines utilized centrifugal flow compressors, they tended to leak engine oil from the bearings and suck in hydraulic fluid from small leaks in the plenum chamber.  As a result, the bleed air coming from the compressor sections frequently contained toxic fumes.

The single seat F-9F8 Cougars I flew in 1967 still had compressed oxygen cylinders and diluter demand oxygen regulators.  We were required to remove our oxygen masks during engine run-up to full power prior to takeoff to do a “Sniff Check” for fumes as part of the Take Off Check List.  All the other aircraft I flew after that including the TF-9F8, the T-2A/B/C, TA-4 Skyhawk, F-8 H/J Crusader and F-4B/N/J/S Phantoms were all configured with the standard 5 liter LOX dewars with converters and demand flow regulators that delivered 100% oxygen.

Answers to the questions about oxygen flow rates and the requirement for prescriptions for same would be humorous if the consequences weren’t so costly in terms of increased out of pocket costs, all to frequent delays, and suffering. 

It was cost avoidance that drove the medical insurance companies to lobby Congress and the FDA to make USP Oxygen a prescription item.  The only problem is it has backfired as more than 30% of the home oxygen costs can be directly attributed not to its purity testing or handling procedures, but to the regulatory expenses involve in patient compliance testing for oxygen saturation levels and the huge bureaucracy involved in administering it’s use.

I’ve spoken with top Navy Flight Surgeons and Aviation Physiologists at the Naval Aerospace Medical Institute (NAMI) in Pensacola, FL about the use of oxygen flow rates greater than 15 liters/minute. They claim that most primary care physicians and neurologists are not trained in aviation physiology or aerospace medicine so are basically clueless when it comes to the use of oxygen other than as a supplement during surgery or for COPD sufferers. 

Consequently, most US physicians/neurologists consider any flow rate above 7 to 9 liters/minute “High” so are hesitant to prescribe any higher flow rates.  They also look at you in surprise and disbelief when you ask for your oxygen therapy prescription to be written for a flow rate 15 to 25 liters/minute. 

The need to treat most medical conditions conservatively and lack of any gold standard (randomized, double-blind, placebo-controlled) clinical studies on oxygen flow rates greater than 12 liters/minute (see Goadsby’s 2006 study of oxygen therapy at 12 liters/minute published last January) also makes it difficult for PCPs or neurologists to justify prescribing oxygen flow rates of 15 liters/minute and higher.

Having said that, the most current standard of care for the acute treatment of cluster headache with 100% oxygen at a flow rate of 15 liters/minute as compiled and validated by the European Federation of Neurological Societies (EFNS), can be found at the following link: START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

I've met with Dr, Peter Sandor on several occasions regarding the use of oxygen therapy at flow rates that support hyperventilation for cluster headaches, and in July of this year with Dr. Arne May at UKE Hamburg on the same topic.  Both are convinced that when Dr. Todd Rozen completes his study of this method of oxygen therapy and publishes the results, it will make a substantial change in the way neurologists treat this disorder and in the research into the pathophysiology of the attack and abort mechanisms.

I've also met with Dr. Peter Goadsby who conducted the most recent study of oxygen therapy as an abortive for cluster headache to the gold standard.  It with the first major randomized double-blind placebo-controlled crossover trial comparing oxygen therapy versus placebo (forced air) for patients with cluster headache.  A summary of his study results can be found at the following link: START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

When you look at the success rate or efficacy of oxygen therapy at flow rates of 7 to 9 and up to 12 liters/minute as an abortive for cluster headaches, you usually see the 70% figure.  What you don’t see is why the efficacy is not higher than 70% or the relationship between headache pain levels and time to abort.

What we found in our informal proof of concept study of oxygen therapy at flow rates that support hyperventilation was a 99% efficacy (success rate) by all 7 participants (I didn’t count myself at 100%) and average abort times 2 to 3 times less than at a flow rate of 15 liters/minute.  We also found a very clear and direct correlation between pain levels and time to abort.  In short, a Kip-3 to Kip-4 cluster headache aborted in 3 to 4 minutes, and a Kip7 to Kip-8 cluster headache aborted in 8 to 12 minutes at flow rates that support hyperventilation.

In a side-by-side comparison, we found the average time to abort to a pain free state for pain levels 6 through 9 on the same 10-Point numerical pain scale using flow rates that support hyperventilation was 9 minutes with 100% effectiveness.  For a flow rate of 15 liters/minute the average abort time was 31 minutes with 52% effectiveness.

At this point I probably need to address why we need hyperventilation during oxygen therapy if we want fast and reliable aborts.  Hyperventilation is defined as ventilating the lungs with a greater volume of normal air or oxygen than needed.

For reference, the method of oxygen therapy many of us use involves voluntarily hyperventilating with 100% oxygen to attain respiratory alkalosis with symptoms of paresthesia and sustain it until the abort with complete cessation of cluster headache pain. 

The goal of this method of oxygen therapy is to abort both the excruciating pain and the triggering mechanism of a cluster headache as rapidly as safely as possible with a very high efficacy.  The mechanisms involved include hyperoxia, hypocapnia, and an elevated arterial pH as all three conditions stimulate the vasoconstriction associated with pathophysiology of an effective acute therapy in aborting the cluster headache. 

The elevated arterial pH carries the added benefit of the Bohr Effect, increasing hemoglobin's affinity for oxygen thereby super oxygenating blood flow to the brain, specifically to the affected vascular structures in and around the trigeminal nerves dilated by the cluster headache triggering mechanism.

If the level of physical activity increases such as doing the cluster dance, rocking back and forth, or banging your head against the wall or floor, you are working harder than sitting motionless. Under these levels of increased physical activity the level of CO2 production goes up…  and so does the respiration rate in order to maintain normal CO2 and arterial pH levels.

To put things in perspective, just because your respiration rate and tidal volume is higher during physical activity, it doesn’t mean you’re hyperventilating.  For example if you did jumping jacks for 30 seconds or ran up three to four flights of stairs, you would likely have a minute volume of lung ventilation equal to 50 liters.

A minute volume of respiration is equal to the amount of air or oxygen inhaled in one minute.  Even with this level of physical activity and a minute volume of 50 liters you wouldn’t be hyperventilating as this level of lung ventilation is “NORMAL” for that level of physical activity.  You would need a minute volume of 60 liters (an oxygen flow rate of 60 liters/minute) to be considered hyperventilating…

The direct relationship between increasing headache pain levels and increased time to abort to a pain free state suggests a possible quantitative relationship between cluster headache pain levels and the amount of CO2 removed from the bloodstream to achieve an abort. 

In other words, we suspect higher cluster headache pain levels are associated with progressively greater levels of vasodilation caused by the lower levels of arterial pH (higher levels of acid) and it takes progressively longer hyperventilating to pump out enough CO2 (carbonic acid) to elevate the arterial pH enough to trigger the vasoconstriction needed to abort a cluster headache and its triggering mechanism.

The dramatic drop in time to abort at each pain level when hyperventilating with an oxygen flow rate that supports hyperventilation suggests the lowering of PaCO2 levels made possible by this method of oxygen therapy plays a significant role in the efficacy and rapid nature of this abort mechanism.

We also suspect the reverse or opposite effect may be true if PaCO2 levels are too high due to restricted lung ventilation (too low an oxygen flow rate) and increased physical activity.  In other words, an abort with oxygen therapy may be prolonged or it may not be possible to abort the cluster headache with oxygen therapy if the flow rate is too low, the pain level is too high, and there is any physical activity during the oxygen therapy.  This could easily answer the question why the traditionally prescribed oxygen flow rate of 7 to 9 liters/minute and even up to 12 liters/minute is only 70% effective.

Hope this helps or at least provides some food for though…

Take care,

V/R, Batch

Batch, Thanks very much for taking the time to detail this out. Key takeaways that make a lot of sense to me are:

There are no sanctioned studies for higher flow rates, therefore docs don't prescribe. This makes sense because they manage their liability risk very carefully. I would add that there is probably little demand for higher volume studies other than CH, and CH is a very small population, so not much of a business case to conduct those studies. I assume Dr. Rosen is funded by grant or otherwise, because there's little to gain financially. What he's doing is in the interest of the patient.

It sounds like  increasing tidal volume (frequency and depth of breathing) of o2 intake also plays an important role in decreasing time to abort. This is likely where higher o2 volumes come into play. If I'm inhaling at 20 lpm and receiving o2 at 15 lpm, I'm not at 100% o2. If I'm inhaliing at 20lpm and receiving o2 at 25 lpm, I may hyperventilate and trigger vasoconstriction thereby reducing tension on the trigeminal nerve. Makes sense. I realize it's not quite that simple an equation.

One thing I'm unclear about is whether more or less o2 is actually delivered to the body and brain given the vasoconstriction and reduced blood flow. But maybe that's for another day.

-Chris

Batch,

Your last post is very informative.  All the biochemistry you are discussing makes it very understandable.  I completely understand why oxygen works to abort.  I saw no risk, which this entire thread was about, since the 100% oxygen is only used for short (less than 10 minutes) durations.  Thanks for interpreting all of the research. 

Chris H wrote on Nov 10^th, 2010 at 12:00pm:

Batch, Thanks very much for taking the time to detail this out. Key takeaways that make a lot of sense to me are: There are no sanctioned studies for higher flow rates, therefore docs don't prescribe. This makes sense because they manage their liability risk very carefully. I would add that there is probably little demand for higher volume studies other than CH, and CH is a very small population, so not much of a business case to conduct those studies. I assume Dr. Rosen is funded by grant or otherwise, because there's little to gain financially. What he's doing is in the interest of the patient. It sounds like  increasing tidal volume (frequency and depth of breathing) of o2 intake also plays an important role in decreasing time to abort. This is likely where higher o2 volumes come into play. If I'm inhaling at 20 lpm and receiving o2 at 15 lpm, I'm not at 100% o2. If I'm inhaliing at 20lpm and receiving o2 at 25 lpm, I may hyperventilate and trigger vasoconstriction thereby reducing tension on the trigeminal nerve. Makes sense. I realize it's not quite that simple an equation. One thing I'm unclear about is whether more or less o2 is actually delivered to the body and brain given the vasoconstriction and reduced blood flow. But maybe that's for another day. -Chris

BINGO!  Give that nice young man a Kewpie doll from the third shelf!  ;D

Chris, I think you got it.

Jerry

Chris,

You're mostly spot on with your analysis of my post.  I'm not at liberty to divulge the source of the funding for Dr. Rozen's study at this time, but I can say Michael Berger, Royce Fishman and I played a major role in making it available.

As to how much oxygen reaches the brain when hyperventilating with 100% oxygen, I've tried hyperventilating on room air to abort a cluster headache when trapped out away from my oxygen.  In short, I could stop the pain from growing higher by doing this, but not abort the attack until I added the 100% oxygen. 

The Bohr Effect of increasing hemoglobin's affinity for oxygen and hypocapnia associated with a lower arterial pH, both due to hyperventilating with 100% oxygen are important parts of the equation as they can account for an additional 11% arterial oxygen to the brain and a significantly higher level of vasoconstriction.  I might add that oxygen perfusion within the brain is also much higher when hyperventilating with 100% oxygen even with the increased vasoconstriction.

The following link provides additional information and answers for you.  It's a study published in the Canadian Journal of Anesthesia titled "The influence of arterial oxygenation on cerebral venous oxygen saturation during hyperventilation" conducted by B. F. Matta et al.

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

The study concludes: "It is likely that hypocapnia (casting off more CO2 than normal by hyperventilating with 100% oxygen), even at PaCO2 of 30 mmHg, results in cerebral vasoconstriction that exceeds any vasoconstrictive effect of normobaric hyperoxia."

Hope this helps.

Take care,

V/R, Batch

Thanks again Batch! Much appreciated. -Chris