• Earmarked for the Chair in the Rehabilitative Sciences, we're funds received from William Gustafson, Jack Stevens and Barbara White who made her donation for the Chair in honor of Mary Burns. Mary sends her very humble thanks.
  • And we hear from Dr. Tom Petty, who writes to say, "Join the Long Beach 500 race now! We are fueling up to race to the finish line of the Long Beach 500. Don't take your foot off the accelerator! We need your support to reach our goal. We must establish the Rehabilitation Chair at Harbor to continue to learn more about dealing with COPD and related disorders. Get out your check book and send in your donation today. Help us Peak Out in our drive!"
  • The names of all contributors to this 500 club will be inscribed on a plaque to be hung in the Rehabilitation Center. They also will receive a certificate of participation suitable for framing, if they so wish.
  • The Long Beach 500 Club is off to a good start. Dr. Tom Petty, Dr. & Mrs. Richard Casaburi, Mary Burns, and The Women's Fellowship of the Neighborhood Church have each donated $500 and become members of the Long Beach 500 Club. Dr. Petty says "Let's all rally for the Rally!"
  • The Respiratory Rally for Research will be held at Long Beach Memorial Medical Center on June 22nd. Speakers will include Dr. Tom Petty, Dr. Rich Casaburi, Dr. Paul Selecky and Dr. Brian Tiep, all as famous as stand-up comedians as they are for their research. Mark the date on your calendar now and plan on joining us!

  • Jim writes that he has polycythemia from lung damage and low oxygen levels. He wants to know if improving his breathing techniques will help his polycythemia because he would rather not use oxygen. Good question. We have just spent pages talking about how good breathing techniques can keep you off oxygen for a few hours. Does that also apply to you?
  • What is polycythemia and what causes it? Polycythemia is an excess of red blood cells flowing through your body. When you have chronically low oxygen levels in your body it stimulates the bone marrow to produce more red blood cells. Why? Because red blood cells carry the oxygen from your lungs to the cells of your body. Since your oxygen level is low, the body tries to compensate by increasing the red blood cells. If you don't start using oxygen to stop this process the blood becomes too "thick" and you could even develop a stroke. In the old days, before we had oxygen, doctors bled patients or even used leeches to remove excess blood. Yuk. Oxygen is much more effective and less messy!
  • You are right in that certain breathing techniques such as pursed lip breathing, if done properly, can raise the level of oxygen while being done. However, this is not a long term substitute for supplemental oxygen. Your problem is not improper breathing, it is damaged lungs unable to properly absorb the oxygen that you breathe in. Do you know what the oxygen level in your blood is? If your blood gas shows a PO2 of 55 mmHg (or even 60 mmHg with polycythemia), or your oxygen saturation goes to 89% or less with the oximeter, you should be on supplemental oxygen.
  • Sometimes people with normal levels of oxygen during the day have obstructive sleep apnea, causing a very low level of oxygen at night. This also needs to be treated and requires special equipment to wear while sleeping, as well as supplemental oxygen.
  • Low oxygen levels over a long period of time can cause fatigue, depression, lack of energy and difficulty concentrating in addition to your polycythemia. Low oxygen also makes your heart work harder. It can even lower your IQ! Oxygen is a medication and can only be prescribed in specific amounts by your physician. If your doctor has recommended oxygen for you, you should not hesitate to start using it. In a few weeks we promise that you will feel much better!
  • The recent annual meeting of the California Society of Pulmonary Rehabilitation included a lecture on Asthma by Dr. Rajeev Venkayya, who is Assistant. Professor of Medicine at San Francisco General Hospital. We wish we could send you with an video cassette of this talk, complete with all the humor, but we'll have to be content with just a few of the highlights that you might find interesting.
  • Did you know that more than 12 million Americans have asthma, and over half of these over the age of 40? The incidence is rising and so is the mortality level, now at 5,000 deaths a year. What is so tragic, is that these are deaths that should not happen.
  • Asthma is characterized by reversible airway obstruction, airway inflammation, and increased airway responsiveness. The obstruction is measured by spirometry, and the FEV1 , the forced volume of air you can breathe out of your lungs in one second. But unlike COPD, the FEV1 changes greatly according to the amount of asthma symptoms at the time of testing.
  • Some common allergic triggers are animal danders, dust mites, molds, cockroaches and pollens. Three to 10% of asthmatics are aspirin-sensitive. That means that their asthma gets worse if they take aspirin or other NSAIDs. This type of sensitivity is often associated with nasal polyps.
  • In cough-variant asthma, the only symptom may be a cough, though this may progress to other manifestations. If the cough goes away with a trial of a bronchodilator, such as Albuterol, you've made the diagnosis.
  • Occupational asthma occurs in response to a substance(s) found in the workplace. This often causes a late asthmatic response, which may manifest itself hours after leaving work. High risk industries include working with platinum salts, gum acacia, and isocyanates, as well as animal handlers and bakers.
  • Exercise induced bronchospasm often occurs perhaps 5 or 10 minutes after stopping exercise and may be caused by drying of the airway mucosa, which results from rapid breathing of cool, dry air.
  • In all forms of asthma, airway inflammation causes airway changes which can result in permanent scaring if this inflation is left untreated. Incidentally, if you need to get up at night with your asthma more than 2 times a month you may be a candidate for better medications. If you have nighttime symptoms more than once a week, have daily symptoms, need daily use of short acting bronchodilators, and have exacerbations 2 times or more a week, you probably need to be on inhaled corticosteroids.
  • There is an early and late asthmatic response to allergens. The early response may occur almost immediately, in a matter of minutes. The late phase may occur 6 or 7 or even 8 hours after exposure.
  • Drug therapy for asthma includes bronchodilators: short acting beta-agonists, such as Albuterol, long acting beta-agonists used only twice a day, such as Salmeterol and anticholinergics, such as Ipatropium. Anti-inflammatory medications include inhaled and systemic corticosteroids, Cromolyn and Nedocromil, and leukotriene modifiers. Theophylline is rarely used these days.
  • Inhaled corticosteroids, are the most effective medications for the control of airway inflammation. They are much safer than prednisone (taken by mouth) for long term use and are considered safe in the pediatric population.
  • There is a lot more to say about asthma medications, but we can continue with that next month's April edition of the Second Wind, if you are interested.
  • Until then, stay well and
  • Remember to Rally for Research!
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