Oxygen Smart

One of the most important things for a patient who needs supplemental oxygen, after breathing, is being able to stay mobile.  How much additional oxygen will depend on the severity of the pulmonary deficiency – some people need extra oxygen 2 to 3 hours a day, some at night, some only when exercising and others 24 hours a day.

Mobility and Supplemental Oxygen are two phrases that go hand in hand. An important part of life is being mobile, to move about, to lead active lives. Anyone who has to receive oxygen therapy should also be able to pursue the type of lifestyle he or she requires.  And one of the factors that help define life style is the degree of activity. People have different needs and different types of activity – what is important is to be able to recover that ability as much as possible. And this is where portable oxygen units come in.

What Types of Oxygen Units Are There?

There are 3 types of oxygen delivery systems for long term therapy patients and all three have portable options:

1. Compressed Oxygen Tanks – Aluminum tanks that contain pure oxygen in gas form. They are now much lighter and have a range of different sizes. Mobile tanks are those that weigh less than 5 pounds and portable one up to and around 17 pounds.
2. Liquid Oxygen Tanks – As name describes, these are tanks that hold liquid oxygen and are also lighter and come in different sizes.
3. Oxygen Concentrators – These are machines that extract oxygen from the surrounding air, redirecting it in a purer form to the user. Portable oxygen concentrators supply oxygen for much longer periods as they are not oxygen containers but oxygen suppliers. In other words they are limited not by the amount stored but by the power source. Portable ones can be plugged in and therefore extract oxygen from the surrounding air as long as the unit is receiving its power. Most POC’s have a rechargeable battery – depending on the make and model, this can last from 3 to 8 hours. (New alternatives are bound to be introduced as this is one of the major requirements of supplemental oxygen users).

The oxygen flow is regulated by a flow valve to the patient who receives the oxygen either through a nose cannula or a mask. Their are different types of valves – some provide oxygen at a continuous flow and others can be regulated. There are both positive and negative aspects. In constant flow rates the upside is that the patient is always receiving oxygen at a predetermined rate; the downside is that tanks last much less as oxygen is provided whether the patient is breathing in or out. For regulated valves the upside is that much less oxygen is wasted; the downside is that oxygen is provided at specific intervals that are not necessarily aligned to the actual intake. Having said all that many patients prefer regulated flow valves.

My stepfather nearly died from lung failure after an operation and as a result of this he has been prescribed with long term oxygen therapy. Thousands of people have to receive additional oxygen, for many reasons -the main one being as a result of smoking as in this case.  He stopped smoking nearly twenty years ago, but the damage was done and the crisis surfaced after surgery.

We are a close family and so have lived many of the ups and downs of this new stage in his life.  This has meant finding the equipment, coordinating refills for compressed oxygen tanks, deciding on the oxygen concentrators, pulse oximeters, delivery systems as well as a few crises.

The following is my take on the stages of living with supplemental oxygen, based on someone who needs a constant supply, 24 hours a day.

1. The Unknown
Shock, fear, tension. The unknown is a frightening place. There are mixed feelings – times when you feel heroic, when you feel small and lost, when you feel despair and when you feel hope.
You imagine that the changes that are coming into your life will be so limiting that you wander about the point of it all. It takes courage to say “yes” to life.
At this stage most of your waking thoughts revolve around oxygen and breathing. This includes having the equipment nearby, learning to use it, making sure you have reserves on hand, getting used to the nose cannula, learning to set the flow and reading your oxygen saturation.

2. Normality
You have been home for a time and you are managing day to day activities. You oxygen tanks are a permanent company. At this stage you are coping.
You are coping with the oxygen equipment, your home unit and your mobile unit.
Your social activities are coming back. You can drive, although you still worry about running out of your supply.

3. A better lifestyle: Portable oxygen concentrators.
This does make a great difference. Oxygen tanks have supplied you with oxygen for a couple of years now and though they have done a great job it is not easy to carry them around with you, to have them refilled continuously.
But (and this was some time ago) new designs in portable oxygen concentrators are now available.
If you travel by plane the battery option can give you 8 hours or more (depending on the oxygen flow and obviously the type of concentrator).
Long distance travel is now an option as other activities like going out at night with friends, to a restaurant, a cocktail party, a movie – just about anywhere.
Work-wise it also makes a difference. Meetings, long sessions, presentations and so on.
You can even exercise.

All in all, quality of life is higher and the most important part is that you are freer than before and this is perhaps the most important part, you feel free to pursue your life.

Over the last few weeks we have had a few crisis with my stepfather when his oxygen saturation level has dropped just at the end of a meal.  The worst was when rising he fainted and fell.

At the moment various things seem clear, although he is being monitored just the same.

I was present on two of the occasions, not the fainting spell, and did notice his lips were very dark (see  Blue Lips and Lack of Oxygen and Symptoms Of Lack Of Oxygen for more information) and when I mentioned this a quick check with his pulse oximeter confirmed the saturation level had gone down below 80%.

The main problem is that when he is eating and specifically chewing, he doesn’t breathe properly.  In fact he stops breathing for short spurts.  Nobody can breathe and swallow at the same time – you can try if you like but you will end with a coughing fit – but you can while chewing.

The answer to his problem is twofold:

1. Breathe consciously when chewing.  He has to practice and get into the habit.
2. While eating he has to increase his oxygen flow from 2 to 4.

He has two other problems.  His reduced saturation has also happened when he has had half a glass of wine.  Therefore no more wine.

Finally, he is really enjoys good conversation and he loves to talk.  So he has to spread this out.

If you, or someone close to you, has noticed something similar happening you must consult your doctor- it could be something completely different – but  we have found an answer and now these episodes have stopped.

Life for people needing extra oxygen used to be more complicated, to say the least.  Today you have home oxygen units such as oxygen concentrators or oxygen tanks as well as portable oxygen units that are making life easier.

At the same time just a few years ago anyone dependent on supplemental oxygen had to check their oxygen saturation levels directly with their doctor or in a clinic.  This has now changed with the advent of a digital finger pulse oximeter.

These are small devices that are placed on the tip of your finger and proceed to read the oxygen saturation in the blood.  The actual level of saturation, which in healthy people should be between 90 and 98%, will be identified by your physician.  (Some patients on long term oxygen therapy cannot reach these levels).

For years we have been able to take our temperature, to weigh ourselves and even read our blood pressure from the comfort of the home. Now we can also check our blood saturation levels and this is very good news for anyone on supplemental oxygen.

There are times when oxygen saturation drops in patients receiving external oxygen: this can be because of exertion, because of faulty passage ways in the oxygen supply, and many other reasons.

Whatever the case may be, a pulse oximeter is a very useful and practical device.

Many people on long term oxygen therapy (LTOT) are using more than one unit of oxygen supply as their days are filled with different activities.
Needing supplemental oxygen doesn’t mean having to be stuck at home.
You have the right to have an active lifestyle, whether it is for socializing, work, travel, pursuing hobbies, going shopping or whatever.  And this is because there are practical alternatives for your oxygen supply.
The freedom of movement, which most people take for granted, is possible with portable oxygen units, but then again you are not always on the move so choosing the combination of oxygen equipment always helps.
If you think about it this is self evident, for example:
- Simple things around the house and these could include getting dressed, going to the bathroom or getting ready for bed.  A small oxygen tank is much easier than having to set up a portable concentrator or the stationary unit you use.
- If you are going out shopping or visiting someone a portable concentrator that you can either plug in or use on batteries is probably the simplest alternative.
- For an extended period where you will not be moving around (and this could be at a desk working or for sleeping), the home stationary unit is perfect.
- Alternatively there are times when your activities are more demanding an you will be on the move or away from home for long periods of time.  This could be going out a social activities or even travel.  The portable oxygen concentrator or a portable tank are what you should be thinking about.  The main consideration here is the amount of time.
Although there isn’t a complete-self-contained-one-only solution for every conceivable activity, there are oxygen units that you can use according to the need.
And this doesn’t mean having a warehouse full of equipment.
Whatever the case may be, the cost of various units is an important factor so you should give this some thought.
Another important point is that whatever machine you use it must be able to provide you with the oxygen you require, at the rate you require it and for as long as you require it.
There are a few practical combinations of oxygen units and systems.  The ultimate combo should be based on your particular prescription, your lifestyle.
The following is one such combination that from personal experience works very well and is how my Dad set up his oxygen equipment combo:
Combo:  Home oxygen concentrator, a couple o portable oxygen tanks (compressed oxygen) and a portable concentrator (8 hour battery power option).
- The stationary concentrator is used both to refill the tanks and for sleeping.
- Portable Oxygen Tanks: As an emergency unit and everyday in the house when taking a shower or other very short periods of time.
- Portable Oxygen Concentrator:  This is his most used oxygen unit.  For a mobile lifestyle the size, weight and duration make it the most important oxygen supplying machine. He uses his portable concentrator during work, travel, ordinary driving, social meetings and most of the day.
There are other alternatives you can use based on the appropriate mix suitable for your life style and oxygen needs.
A starting  point for an oxygen system combo would have a stationary oxygen concentrator and a portable unit.
The combo presented above is used by an oxygen therapy patient that leads a very active social life, even though he requires oxygen 24/7.

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My previous post dealt with signs of oxygen deprivation one of which is lips and finger nails turning blue or purplish.

Well I had lunch today at my mother’s.  My dad (step father actually) arrived late and in a foul mood as traffic had been really bad.  As I sat across from  of him I noticed his lips were dark blue.  When I mentioned this to him he just replied (still in a bad mood) “What do you expect?”

So I suggested he check his oxygen saturation with his pulse oximeter.  And yes, it was way too low. (Below 70).

With an abrupt mood change he increased the flow rate and began to take more regular and deeper breaths.

The saturation level began to recover little by little and at the same time he started to explain that when he is eating and talking, his oxygen intake is reduced.  Basically because he breathes through his mouth and not his nose.

In short, you have to make sure you breathe correctly when engaging in conversation and when eating.  It is very easy to fall back into mouth air intake when doing either.  You can’t breathe and swallow at the same time, but you can while chewing – as long as you are conscious of it and retrain yourself to get rid of bad habits.

As for my Dad – my mother is now being more observant and understanding as she recently had a bad fright when he fainted during lunch.  Both are now being more careful.

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Sometimes patients that need supplemental oxygen are not aware when they are not receiving enough oxygen. This could be because of a kink in the tube, breathing through the mouth or even a mis-adjusted flow rate.  Whatever the reason those close to you should know the following signs of lack of oxygen so they can react appropriately.

• Lips or finger nail turn a bluish/purplish color. (I have noticed this one a few times with my father during lunch times).
• Slurry speech and slightly incoherent sentences.
• Headaches are also sometimes caused by lack of oxygen.
• Feeling drowsy and having trouble staying awake.
• Irregular breath, be it shallow, slow, or breathlessness.
• Feeling anxious.

The more people about you, who are aware of these signs – the better. One of the effects of oxygen deprivation is that the person lacking oxygen many times does not realize it and therefore needs someone else to point it out to them, or in extreme case to call the emergency services.

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