What do you recommend? (POC)     Oct. 3, 2009
The following is a Q and A posted on COPD-ALERT, an online List-Serve. October 03, 2009

 I am struggling to get off oxygen in the daytime, the doctor said he would like for me to use it at night, as my breathing is more shallow at night. I was SOOOOOO happy when he said I could get off oxygen in as little as a month, I kind of forgot about the nighttime comment. Also, frankly, I don't see how I could exercise without oxygen, come to think of it.

So I will need to buy an oxygen concentrator, as the one I as renting is EXPENSIVE. So my questions are, of those who have their own, what is the best place to shop, what should I get, and how much should I spend? I am interested in one that is energy efficient, as my electric bill has also gone through the roof.

Any advice would be welcome. I read they need to be serviced. What does that entail? Also, where does one get the replacement things that go in the nose? I obviously haven't learned the nomenclature yet.
Anonymous

Vlady's reply:

All of us on oxygen have gone through a period of denial regarding our oxygen need. It is often very inconvenient to use supplementary oxygen, especially outside of one's home, unless you want to stay home rather than enjoy your life (quite a few of us have been on oxygen for many years and that did not stop us to get involved in a variety of activities outside of our homes). An oximeter (pulseox) is a very helpful little device that allows us to monitor our oxygen needs. A highly reputable one, Nonin's GO2 (http://www.go2nonin.com), does a great job.
Buying your own concentrator will require a doctor's prescription. There are very many choices, from stationary to portable ones that you can take with you. Among most reputable manufacturers you will find AirSep, Invacare, Phillips Respironics, DeVilbiss, Check for helpful information http://www.oxygenconcentrators.org and http://www.portablenebs.com/concentrator.htm (for prices you can check various Internet sites).

Remember that for use at night the recommended mode is CONTINUOUS FLOW.  Portable concentrators (that you can carry with you) offer mostly PULSE DOSE (our breathing at night is usually too shallow to use this mode)  --Vlady  (List owner: vlady@copd-alert.com)

You can find more information at the Group Yahoo home page: http://www.yahoogroups.com/group/COPD-ALERT

Please be aware that we offer information to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

OXYGEN IN OUR LIVES  May 13, 2009
Dick in Missouri"

Every single thing that we do requires Oxygen (O2). All the way from
running to sitting quietly and watching TV. The air around us is commonly
called Room Air (RA) and has that name whether it's inside or outdoors.
RA, in round numbers, is 21% O2. The rest of it is 78% Nitrogen and the
remaining 1% is Argon, Neon, Helium and other rare gasses. We're walking,
talking, thinking furnaces. The carbon (C) in our bodies combusts with
the O2 and makes Carbon Dioxide (CO2). Every single thing we do has an O2 demand. This is the source of energy that allows us to function. Any
muscular activity at all burns carbon (C) with O2. That includes minor
things like your heart beating and your brain thinking. There's a bigger
O2 demand to pick up a gallon of milk than there is to pick up a quart.

This is where our lungs come in. We have the wonderful capacity in our
lungs to take blood that is loaded with CO2 and swap the CO2 for O2. This
O2 rich blood is then delivered all over our body through arteries on
down to very fine capillaries. At the delivery point, the exchange goes the
other way and the veins returning the blood to our heart and lungs now
swap O2 for the CO2 that was formed as carbon burned. For people with
healthy lungs, RA has plenty of O2 to keep replenishing our blood with
the O2 needed to keep everything functioning.

The problem for most of you reading this message is that we don't have
healthy lungs. We have COPD. I won't go into a discussion about what COPD is. I just want to make this about the O2 situation.

Built into our body is a pretty sophisticated chemical laboratory. It
monitors a large number of things that happen as we go through the days
of our life. For now, let's just talk about O2. This lab constantly monitors
how much O2 there is in our blood. This is what we call our Sats or blood
saturation. If the concentration starts dropping, we start breathing
faster and deeper. This happens without giving it any conscious thought
and it works that way even for healthy people. At this point we can help
things out by doing Pursed Lip Breathing (PLB) which helps our lungs
discharge the CO2 that's been brought in and replace it with O2. Our
built in lab not only monitors the O2 content of the blood but takes action.
Blood supply is increased to what the body regards as important and
reduced to things that aren't regarded as important. On the important
list is the heart, brain, and other vital organs. On the unimportant list are
things like bladder control. Any of you with severe COPD has experienced this to one degree or another.

Now here's where supplementary O2 comes into the picture. If we get the
supplementary O2 from liquid O2, it's very nearly 100%. If we get it from
compressed O2 in a high pressure bottle, it's still very nearly 100%.

From a concentrator, it's more like 90-95%. A typical dose of supplementary
O2 is 2 liters per minute (lpm) but may be more or less as determined by
your doctor to suit your needs. At 2 lpm even with the high concentration of
O2 we're still breathing primarily RA (remember room air?) and the oxygen
that is delivered through the cannula in our nose blends with the RA and
boosts it from 21% to somewhere in the neighborhood of 23-24%. That
doesn't sound like much but for many of us it's enough to make a big
difference in our body functions. Getting more O2 is not necessarily better. Check with your doctor before increasing the flow of your supplementary O2.

A number you will often see mentioned is 88%. That's the saturation level
at which we can start experiencing damage to our vital organs. It doesn't
happen immediately but can be quite damaging over an extended period.
It's also the level at which Medicare will approve and pay for O2 therapy. O2
is not prescribed for us simply because the doctor likes us. It's prescribed because we need it.

Some people talk about and express concern over becoming addicted to O2.
We are born addicted to O2 and cannot live without it. Using supplementary
O2 will not increase our desire for more O2. The condition of our lungs may deteriorate and result in a need for more O2 but that is not an addiction.

If O2 has been prescribed for you and you're not using it, then you're
taking a chance on damaging any or all of the vital organs in your body.
Reprinted with permission of the COPD-Support Newsletter http://copd-support.com/"

Tour of Respiratory System     Dec 21, '08
Take a tour of the respiratory system to see how this process occurs.
-Nose and Nasal Cavity
-The Upper Respiratory system
-The Lower Respiratory System
-Inside the Lungs
-The Role of the Diaphragm
-The Process of Breathing.
http://copd.about.com/od/copd/ig/Respiratory-System.--RW/

NEW BOOK "From Both Ends of a Stethoscope"
                         By Thomas L. Petty, MD            Nov. 12, '08
COPD Awareness began on the day that Tom Petty entered the University
Colorado Medical School in 1954.
Dr. Tom takes us from his student days, through the development of Long Term Oxygen Therapy (LTOT). He introduces to some of his many patients and takes the reader along on his adventures--including a brush with foreign intrigue.
His own experiences as a patient serve as the basis of the final chapters;
‘What Went Wrong With Medicine?’ and ‘How to Thrive and Survive With
Medicine Today’.
To order a signed copy contact: TLPdoc@aol.com Tel: 303.996.0868
Or send a check for $17.00 for a postpaid & signed copy to:
Thomas L. Petty, MD
899 Logan St. Denver, CO 80203

10 Tips on Talking to Your Doc from COPD Digest, Summer 2004
by  Dr. Robert A. Sandhaus

 Do you feel tongue-tied when you walk into a doctor's office? Do you try
 to  carry on a conversation in English, but your physician  seems to be speaking Latin? You're not alone. Good health care begins with  good communication. Put the following tips into  practice the next time you talk with your doc.

 1. Think of your doc as your partner, not your boss. Modern health care
 requires you, as a patient, to become an equal partner in understanding
 and  treating your condition. You and your doctor must tackle health  problems  side by side, as a team.

 2. Be honest, and demand honesty in return. Still having trouble quitting
 smoking? Tell your doc! Can't quite get the hang of using the latest
 inhaler? Talk about it! If you want your doc to be straight with you, say
 so.

 3. Know your meds and report any problems. Every several visits, review
 all  your medications with your doctor to find out whether  you can reduce or eliminate any. Don't hesitate to ask about side effects  and interactions between drugs. Find out what changes to your medications  you should make on your own in response to changes in your condition.

 4. Discuss exercise. Keep up an exercise program, no matter how limited.
 Pulmonary rehabilitation has been shown to improve the health of people
 with  COPD.

 5. Report any sleep problems. People with COPD often have trouble
 sleeping.  Problems include breathing abnormalities and low oxygen levels. Symptoms of breathing problems during sleep include snoring, morning headache, daytime  sleepiness,  changes in personality and sex drive, and stopping breathing while asleep.

 6. Talk about any changes since your last visit. Unless you report changes
 in your health, your doc will assume you're doing exactly as you were the
 last time you visited. Keep your physician up to date every time.

 7. Insist on appropriate testing. Your doc will probably order
 sophisticated  pulmonary function testing and perhaps a high-resolution CT scan of your  lungs. If these words sound foreign to you, check with your doc about  ordering a scan. They are the best ways to diagnose and follow your COPD.

 8. Get tested for Alpha-1. As many as 1 out of every 30 people with COPD
 may  have alpha-1 antitrypsin deficiency (called simply "Alpha-1") and not know  it. Alpha-1 is a genetic condition that has a specific therapy distinct
 from  other therapies for COPD.  You can pass the genes for Alpha-1 to your kids.

 9. Know that your doc may feel as frustrated as you. Physicians are
 accustomed to treating a medical condition and curing it. COPD is a
 life-long diagnosis that currently has no cure.

 10. Insist that your doc listen. You must be able to talk about your
 problems and have confidence that your doc is listening. He or she should
 explain your diagnosis and treatment in ways that you can understand. If
 that's not the case, then perhaps a different doc would be better for you.

 Dr. Robert A. "Sandy" Sandhaus is professor of medicine at the National
 Jewish Medical and Research Center in Denver, Colorado, and clinical
 director of the Alpha-1 Foundation.

Article by the foremost expert on COPD.  September 2, 2008
 Dr. Petty was given a special award for his contributions to the pulmonary and critical care medicine at the annual American College of Chest Physicians conference in Chicago in 2007.
 http://www.nlhep.org/pdfs/history_of_copd.pdf

Oxygen on the Go!    August 30, 2008
by Rick Carter, PhD, MBA; James S. Williams, PhD; and Brian Tiep, MD
Smaller, lightweight oxygen devices give patients new freedom.
http://www.rtmagazine.com/issues/articles/2008-07_01.asp
Be a Smart Patient August 3, 2008
The Cleveland Clinic offers these suggestions on how to be a smart patient:
 http://www.everydayhealth.com/publicsite/news/view.aspx?id=617753&cen=--ALL--&pd=07/30/2008&xid=nl_EverydayHealthDigestiveHealth_20080803

Involuntary and Far from Innocuous:
         The Health Effects of Secondhand Smoke   July 9, 2008

Check out "Your Personal Oximeter: A Guide for Patients by Thomas L. Petty, M.D." at http://tinyurl.com/392uus    July 7, 2008

Doctor/patient communication 101

DO'S AND DON'TS

1. Realize that most doctors have appointment blocks of varying times.
Someone with a simple problem might get 10 minutes, while patients with a
more complex concern might reserve 20. If you think you'll need more time, tell the receptionist.

2. Demand specifics. If your doctor says, "You need to exercise more," ask
what would be the best activities for you and how often you should do them.
The same goes for diet - ask for specific types of foods to avoid or eat at
will.

3. Use technology to your advantage. Bring a tape recorder to appointments
so you can replay conversations later or use digital cameras to record
symptoms at home. But...

4. Turn off your cell phone. If you must have it on, only use it to deal
with emergencies.

5. Get to know your nurses and pharmacists. Your doctor isn't the only gold
mine of information about your health and treatments.

Don't...

1. Bring up a critical issue at the end of an appointment. Don't wait until
your doctor is getting ready to leave the room to mention that you've been
experiencing a little chest pain or feeling suicidal.

2. Be dishonest. If you haven't been taking your medicine regularly, admit
it. If you smoke three packs of cigarettes a day, don't tell your doctor you
only smoke one.

3. Stay quiet. If you don't understand something a doctor has said, ask
questions until you do. Also ask about the best times of day to call with
follow-up questions.

4. Assume that "no news is good news" on lab tests. If you don't hear
anything about a test, call and ask for someone to explain the results.

5. Be embarrassed. Easier said than done, of course, but doctors really have seen almost everything before.

http://www.dailypress.com/features/health/dp-2213sy0feb01,0,1299120.story