Hypocapnia Puns

Doing some research for a family member on CPAP. They use a ResMed Airsense 10 For Her machine in autoset mode, and have been having a consistent problem with the machine. They are woken up multiple times a night where the autoset has cranked up to 15+ and they have to rip the mask off because they physically can't breathe back against it.

Their sleep study indicated high prevalence of both obstructive and central sleep apnea. My working theory at the moment is that they are going in to central apnea, possibly due to hypocapnia, and the autoset is interpreting this as an obstructive event and ramping the pressure up.

Unfortunately, I'm not sure their doctor is very familiar with central apnea. One potential remediation I recommended was turning down the top pressure of the machine such that even if it mistriggered on a central apnea, it stayed within the bounds of working treatment. However, the doctor was hesitant to do this as they said if the machine ramps up to that, it must be because its needed.

Is there any documentation you guys know of that I can provide as a reference for the doctor about central apnea and autoset CPAP? I am finding some documentation from ResMed about the use of ASV algorithms to detect central apnea and alter treatment, but it appears this is only available in bipap machines, which they currently cannot afford. Also a lot of academic studies, but I have my doubts that the doctor will spend that much research time for one patient. I was hoping to find some kind of study summary or manufacturer engineering/setup guide that I could provide to the doctor so that they'd be able to see at least the basics fairly quickly.

A yoga meditation practice involves around seven to eight minutes of controlled breathing, slightly faster than would be natural, followed by a short chant and around the same period of quiet stillness/relaxation (with no specific breathing instructions).

The initial period of faster breathing would (presumably) reduce carbon dioxide levels in the blood, and cause a state of mild hypocapnia.

How would that affect the brain? Could this hypocapnia be responsible for the claimed benefits of the yoga breathing practice (relaxation, sense of detachment, euphoria etc.)?

Why are the lungs able to blow off excess CO2 but not able to bring O2 back up?

All ideas/responses/questions/votes for help with attention very much appreciated. Thank you!

This is seriously disrupting my life and making it very hard for me to work or leave the house. I have developed some agoraphobia and ticks which are worsening, and yes I am being professionally treated for these as well without much progress.

Their consensus is that while I can be offered tools they provide, a physiological cause may be in play and if so, until that is resolved we won't make much progress.

I am absolutely not attempting to replace my doctors as evidenced by continued workups below. Just looking for ideas that may be relevant to research and discuss with them.

History of thyroid cancer. Recent recurrence workup (details below) is negative, I am looking for other considerations.

42M, 170lb, 5'9" no unintentional weight changes. Northern European, SE USA.

No recreational drugs, non-smoker, 1 drink daily.

Labs out of range:

• co2 is between 20 and 21, mostly at 20 mmol/L range depends on lab, 20 or 22 LNL. This changed at after the increase of anxiety which I find curious as I do not hyperventilate or have substantial HR or BP increase, at least while awake. Previous norm was 25-27 very consistently.
• Abs Eos: 450 @ 2 months post change, currently 900 cells/uL, UNL 350 & 500 respectively. Despite other history, Eos have only been historically elevated during cancer, at approx 1100 with similar refs.
• B6 scheduled for HPP (have to stop supplement for 3 weeks). ALP is always around 21 U /L, LNL 36. Appears possibly hereditary, family has similar ALP.
• Tg is negative, however TgAb was increased Nov 2019 to Feb 2020 and now returned to negative.
• AG manual calc without P ranges around 11-12 and slightly lower (9-10) for Albumin adjusted but individual measures in range.

Primary Complaint:

Duration: 13 months

Substantial increase in panic and anxiety Oct 2019 & I am trying to figure out the cause of this change.

I understand that anxiety may be a chicken-egg situation and cause various physical manifestations, but my history of anxiety is due to physiological source - thyroid cancer.

Each time I have had the "something is wrong" type of anxiety change, metastasis has been found even if it's taken a while. I know my body and I know that something is wrong, I just don't know what yet. My doctors thought I was crazy when I kept saying that the first time, but a couple rounds of this and mets later they see th

I mean, wim seems a little nuts too... (Not to offend him, I love the guy, but maybe he has been injured in some way...?)

I'm really afraid to start practicing the method consistently for this reason :/

I don't want to step on anybody's toes here, but the amount of non-dad jokes here in this subreddit really annoys me. First of all, dad jokes CAN be NSFW, it clearly says so in the sub rules. Secondly, it doesn't automatically make it a dad joke if it's from a conversation between you and your child. Most importantly, the jokes that your CHILDREN tell YOU are not dad jokes. The point of a dad joke is that it's so cheesy only a dad who's trying to be funny would make such a joke. That's it. They are stupid plays on words, lame puns and so on. There has to be a clever pun or wordplay for it to be considered a dad joke.

Again, to all the fellow dads, I apologise if I'm sounding too harsh. But I just needed to get it off my chest.

I saw on the other thread how dismissive a lot of people are here about new research while obviously not even have proper information about it. Then I thought, its maybe because they are to ill to get the information, so I will provide some here. I'm not a native english speaker, so have mercy if it may sound weird.

Normal Coagulation Result

The thing is, the LC-patients also have normal test results. Microclots can't be find this way. They have to use a fluorescence microscope to show its there. Only researcher have such a tool and thats a problem. For doctors to see the microclots they could use a light microscope as well, but its tricky. There are two step-by-step instructions on Twitter, but how many physicians would listen? So we have to find a way for easier testing.

Normal Blood Oxygene

The hypoxia is in the tissues, not the blood. The clots hinder them to get there. So blood oxygene looks normal in most cases.

(I think that could also explain the air hunger some people have. Its like hyperventilation. The blood oxygene saturation is full, because a part of it don't find their way to the tissues and the instinct says you have to breath more, but it makes worse. You have to stop breathing for a short time, so the saturation can go a bit down and you feel better.)

The Treatment

Apparently, there was a bit of a confusion between the "Triple Anticoagulants Study" by Resia Pretorius in South Africa and the "HELP Apharesis Study" in Germany by Dr. Jäger and Dr. Asad Khan. Resia Pretorius came to Germany to help them, because they found the same microclots as she did. The HELP Apharesis had not the great effect in the beginning, because the clots came back to fast. With the additional anticoagulant treatment the outcome was much better.

Dr. Pretorius treatment is Clopidogrel 75mg and Aspirin 75mg once a day, Apixiban 5mg twice a day and Pantoprazole 40mg once a day (for stomach protection) for a month.

Do NOT take that medication on your own! It's dangerous. You'll need a competent doctor to monitor you to prevent harm like internal bleeding.

Further Research

Dr. Jennifer Curtin (USA) plans to look at microclots in LC- and MECFS-patients. LC-patients get a study with triple anticoagulants and if MECFS-patients have them too, they get the study too, afterwards.

Do your worst!

I'm surprised it hasn't decade.

For context I'm a Refuse Driver (Garbage man) & today I was on food waste. After I'd tipped I was checking the wagon for any defects when I spotted a lone pea balanced on the lifts.

I said "hey look, an escaPEA"

No one near me but it didn't half make me laugh for a good hour or so!

Edit: I can't believe how much this has blown up. Thank you everyone I've had a blast reading through the replies 😂

It really does, I swear!

They’re on standbi

Pilot on me!!

Nothing, he was gladiator.

I understand why using nonrebreathing masks to provide high-flow oxygen to patient’s is the “gold standard” for trauma patients (and many others if they “tolerate it”); but what about if a patient fell from around 20 feet, is presenting with Cushing’s triad (vitals are not crashing yet, but low 40s HR, elevated BP, and irregular RR but within normal range) and can speak to you? Would you opt for a nasal cannula so you can continue talking to your patient and assessing the airway? Also, at this point, if the patient vomits, do you consider the risk of aspiration by using a nonrebreather? Obviously you’re monitoring the patient and would be able to promptly provide suction (ideally), but if the patient if fully immobilized (as they should be), would you consider having an OPA and nonrebreather at the ready if the patient has sudden LOC or rapid decline in vitals? Or do you just go with the nonrebreather?

Apologies for the probably obvious answer to this - I’m in the final stretch of class and probably over analyzing EVERY PT scenario they’re throwing at us. We’re fortunate enough to do as many ride alongs as our schedules permit, which has been phenomenal in helping me synthesize the information and being hands on in the real world. I still keep over thinking the written patient scenarios, because I’m like well what else do I observe besides the vitals? Is the guy bleeding from his ears with two compound femur fractures? If that’s the case he’s getting high-flow via nonrebreather, no question. GIVE ME MORE INFORMATION 😂. Any insight would be super appreciated, and the answer is probably extremely obvious. Thanks for your patience!

Dad jokes are supposed to be jokes you can tell a kid and they will understand it and find it funny.

This sub is mostly just NSFW puns now.

If it needs a NSFW tag it's not a dad joke. There should just be a NSFW puns subreddit for that.

Edit* I'm not replying any longer and turning off notifications but to all those that say "no one cares", there sure are a lot of you arguing about it. Maybe I'm wrong but you people don't need to be rude about it. If you really don't care, don't comment.

When I got home, they were still there.

What did 0 say to 8 ?

" Nice Belt "

So What did 3 say to 8 ?

" Hey, you two stop making out "

I won't be doing that today!

[Removed]

This morning, my 4 year old daughter.

Daughter: I'm hungry

Me: nerves building, smile widening

Me: Hi hungry, I'm dad.

She had no idea what was going on but I finally did it.

Thank you all for listening.

You take away their little brooms

There hasn't been a post all year!

Why

It’s pronounced “Noel.”

After all his first name is No-vac

What, then, is Chinese rap?

Edit:

Notable mentions from the comments:

• Spanish/Swedish/Swiss/Serbian hits

• French/Finnish art

• Country/Canadian rap

• Chinese/Country/Canadian rock

• Turkish/Tunisian/Taiwanese rap

There hasn't been a single post this year!

(Happy 2022 from New Zealand)

Nothing, it just waved

Him: I can explain everything!

(It's his best joke yet I think)

Bob