Too Much Water Could Be Harmful

Drinking two liters of water per day may not benefit most individuals and even could be harmful, investigators say.

At the Canadian Society of Nephrology annual meeting here, re-searchers from the University of Western Ontario, also in London, presented a study showing a significant correlation between excess urine production—which is usually caused by excess fluid intake—and proteinuria.

The large population-based study un-covered a fivefold higher risk of proteinuria among people with polyuria than among those with normal urine volume, even after taking into account such factors as age, sex, and estimated glomerular filtration rate.

If investigators replicate this finding, further research should be conducted to determine the renal consequences of drinking two liters of water per day, said lead investigator Jessica Sontrop, PhD, assistant professor in the department of epidemiology and biostatistics.

“Such a finding would have important implications, given the silent nature of kidney disease and the widespread, but unsubstantiated, belief that drinking eight glasses of water per day is healthy.”

http://www.renalandurologynews.com/too-much-water-could-be-harmful/...# 

Drinking too much water called latest threat to health

Canadian doctors are warning drinking too much water may cause loss of kidney function - something they discovered purely by accident.

The study is published in this week's issue of the Canadian Medical Association Journal.

"If you go on the Internet you'll get at least 500 hits on how healthy it is to drink as much water as humanly possible," Clark said. "Some health magazines recommend people drink a minimum of 12 to 15 glasses of fluid per day."

But Clark said flushing the kidneys doesn't help kidney function.

Even doctors believe the medical myth that people should drink at least eight glasses of water a day, according to an article published last month in the British Medical Journal, which traced the notion back to a 1945 recommendation from the U.S. Nutrition Council.

Ignored in the original statement was that most of the fluid people need is found in food, especially fruits and vegetables, the researchers said.

http://www.canada.com/montrealgazette/news/story.html?id=378f85de-2...

Are You Damaging Your Kidneys Without Knowing It?

Don’t force down 8-10 glasses of water per day unless your thirst dictates it

Your body is not a long plumbing tube that gets cleaner by forcing more water through it. Every time you drink water that your body doesn’t need, your kidneys are forced to spend energy to filter out this excess water. This filtration process puts significant burden on the tiny blood vessels that line your kidneys, which can contribute to the development of chronic kidney disease.

The amount of water that you need depends on a variety of factors. Eating lots of water-rich foods like vegetables and fruits decreases the amount of water you need to drink. Living in a warm climate, regular exercise, sweating, and eating salt all tend to increase your need to drink water. Ultimately, the amount of water you drink should be determined by your sense of thirst on a moment-to-moment basis.

http://drbenkim.com/articles-healthykidneys.html

Staying safely hydrated

Generally if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or light yellow urine a day, your fluid intake is probably adequate. If you're concerned about your fluid intake or have health issues, check with your doctor or a registered dietitian. He or she can help you determine the amount of water that's right for you.

To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. It's also a good idea to: Drink a glass of water or other calorie-free or low-calorie beverage with each meal and between each meal. Drink water before, during and after exercise.

Although uncommon, it is possible to drink too much water. When your kidneys are unable to excrete the excess water, the electrolyte (mineral) content of the blood is diluted, resulting in low sodium levels in the blood, a condition called hyponatremia.

http://www.mayoclinic.com/health/water/NU00283/NSECTIONGROUP=2

Need for Organ Donors. Sign up on Facebook!

Facebook to Provide Organ Donation Registration

Mark Zuckerberg, the founder of Facebook surprised users and the transplant community on May 1 by unveiling it will begin immediately asking users to upgrade its Timeline structure to check their organ donor status which will direct them to Donate Life America’s National Registration Page which will allow them to designate their decision to be an organ donor if they have not already done so.

Zuckerberg chose to make the stunning announcement in an exclusive interview with ABC News’ Robin Roberts on Good Morning America. “We think that people can really help spread awareness of organ donation and that they want to participate in this to their friends. And that can be a big part of helping to solve the crisis that’s out there,” Zuckerberg told Roberts. The process was launched simultaneously with Zuckerberg’s announcement allowing users in the US and the UK to add to their Facebook Timelines, that they are organ donors, and if the reader isn’t an organ donor, direct them to links that will take them to donor registries in their local area where they can enroll.

http://www.trannews.com/wordpress/wp-content/uploads/2013/01/e2013-...

Less than 1% of people in the U.S. (about 15,000-20,000) die in circumstances favorable for organ donation.

Understanding Death Before Donation

To understand organ donation and the shortage of organs for transplants, one needs to have a basic understanding of how people die and what impact it has on whether they can, in fact, be donors or not. Of the 2.2 million people who die in America each year, relatively few die under circumstances that make them medically eligible to be either organ donors or tissue donors.  

Brain Death and Organ Donation

Most deceased organ donors are brain dead. They have suffered complete and irreversible loss of all brain function and are clinically and legally dead. Mechanical ventilation and medications keeps their heart beating and blood flowing to their organs.

In the U.S., less than one percent – about 15,000-20,000 – of all deaths are brain deaths. These are usually patients who suffer an injury to the brain resulting from a trauma, stroke or lack of oxygen and are rushed to the hospital, where doctors aggressively work to save their lives but cannot.

Brain Dead is Dead. There is No “Recovery”

Brain death can be confusing, particularly for families who are confronted with the sudden death of someone they love because a brain dead person on a ventilator can feel warm to the touch and can look "alive." The heart is still beating and the ventilator is pushing oxygen and air into the lungs making the person's chest rise and fall.

Brain death can be confusing for families who are confronted with the sudden death of someone they love.

When this happens, some families expect that the person they love can simply be kept on the ventilator in hopes that their condition will improve. But to be brain dead is to be dead, and no improvement or recovery is possible. Defibrillators used to "shock" a heart may get it functioning again within the first several minutes after it stops. But there is no such method to jump-start or revive a brain that has been deprived of blood and whose cells have died.

Links

Useful links

LUPUS

Great info about Lupus which often causes lung problems
http://www.Lupuscheck.com

http://blaminglupus.com/category/blaming-lupus-blog

http://thebutterflyprojectfoundation.blogspot.com/


IPF
http://ipftoday.com/news

http://studynursing.blogspot.com/2009/10/pulmonary-symptoms.html

http://ipftoday.com/blog1/2013/06/12/may-24-2013-reflux-medicine-boosts-survival-in-lung-disease/

http://www.lung.org/lung-disease/copd/connect-with-others/better-breathers-clubs/ 

Patientslikeme.com.    A site to connect with other people with the same illness you are dealing with.

Nail clubbing ~ A sign of possible chronic pulmonary disease include clubbing, barrel chest (the increased anterior-posterior diameter of the chest present in some patients with emphysema), and pursed lip breathing. Clubbing is enlargement of the fingertips (or toes) due to proliferation of connective tissue between the fingernail and the bone. Diagnosis is based on an increase in the profile angle of the nail as it exits the finger (to > 176°) or on an increase in the phalangeal depth ratio (to > 1—see Fig. 1: Approach to the Patient With Pulmonary Symptoms: Measuring finger clubbing.). “Sponginess” of the nail bed beneath the cuticle also suggests clubbing. Clubbing is most commonly observed in patients with lung cancer but is an important sign of chronic pulmonary disease, such as cystic fibrosis and idiopathic pulmonary fibrosis; it also occurs (but less commonly) in cyanotic heart disease, chronic infection (eg, infective endocarditis), stroke, inflammatory bowel disease, and cirrhosis. Clubbing occasionally occurs with osteoarthropathy and periostitis (primary or hereditary hypertrophic osteoarthropathy); in this instance, clubbing may be accompanied by skin changes, such as hypertrophied skin on the dorsa of the hands (pachydermoperiostosis), seborrhea, and coarse facial features. Digital clubbing can also occur as a benign hereditary abnormality that can be distinguished from pathologic clubbing by the absence of pulmonary symptoms or disease and by the presence of clubbing from an early age (by patient report). Fig. 1 Measuring finger clubbing. The ratio of the anteroposterior diameter of the finger at the nail bed (a–b) to that at the distal interphalangeal joint (c–d) is a simple measurement of finger clubbing. It can be obtained readily and reproducibly with calipers. If the ratio is > 1, clubbing is present. Finger clubbing is also characterized by loss of the normal angle at the nail bed. Signs of possible chronic pulmonary disease include clubbing, barrel chest (the increased anterior-posterior diameter of the chest present in some patients with emphysema), and pursed lip breathing. Clubbing is enlargement of the fingertips (or toes) due to proliferation of connective tissue between the fingernail and the bone. Diagnosis is based on an increase in the profile angle of the nail as it exits the finger (to > 176°) or on an increase in the phalangeal depth ratio (to > 1—see Fig. 1: Approach to the Patient With Pulmonary Symptoms: Measuring finger clubbing.). “Sponginess” of the nail bed beneath the cuticle also suggests clubbing. Clubbing is most commonly observed in patients with lung cancer but is an important sign of chronic pulmonary disease, such as cystic fibrosis and idiopathic pulmonary fibrosis; it also occurs (but less commonly) in cyanotic heart disease, chronic infection (eg, infective endocarditis), stroke, inflammatory bowel disease, and cirrhosis. Clubbing occasionally occurs with osteoarthropathy and periostitis (primary or hereditary hypertrophic osteoarthropathy); in this instance, clubbing may be accompanied by skin changes, such as hypertrophied skin on the dorsa of the hands (pachydermoperiostosis), seborrhea, and coarse facial features. Digital clubbing can also occur as a benign hereditary abnormality that can be distinguished from pathologic clubbing by the absence of pulmonary symptoms or disease and by the presence of clubbing from an early age (by patient report). Fig. 1 Measuring finger clubbing. The ratio of the anteroposterior diameter of the finger at the nail bed (a–b) to that at the distal interphalangeal joint (c–d) is a simple measurement of finger clubbing. It can be obtained readily and reproducibly with calipers. If the ratio is > 1, clubbing is present. Finger clubbing is also characterized by loss of the normal angle at the nail bed. Signs of possible chronic pulmonary disease include clubbing, barrel chest (the increased anterior-posterior diameter of the chest present in some patients with emphysema), and pursed lip breathing. Clubbing is enlargement of the fingertips (or toes) due to proliferation of connective tissue between the fingernail and the bone. Diagnosis is based on an increase in the profile angle of the nail as it exits the finger (to > 176°) or on an increase in the phalangeal depth ratio (to > 1—see Fig. 1: Approach to the Patient With Pulmonary Symptoms: Measuring finger clubbing.). “Sponginess” of the nail bed beneath the cuticle also suggests clubbing. Clubbing is most commonly observed in patients with lung cancer but is an important sign of chronic pulmonary disease, such as cystic fibrosis and idiopathic pulmonary fibrosis; it also occurs (but less commonly) in cyanotic heart disease, chronic infection (eg, infective endocarditis), stroke, inflammatory bowel disease, and cirrhosis. Clubbing occasionally occurs with osteoarthropathy and periostitis (primary or hereditary hypertrophic osteoarthropathy); in this instance, clubbing may be accompanied by skin changes, such as hypertrophied skin on the dorsa of the hands (pachydermoperiostosis), seborrhea, and coarse facial features. Digital clubbing can also occur as a benign hereditary abnormality that can be distinguished from pathologic clubbing by the absence of pulmonary symptoms or disease and by the presence of clubbing from an early age (by patient report). Fig. 1 Measuring finger clubbing. The ratio of the anteroposterior diameter of the finger at the nail bed (a–b) to that at the distal interphalangeal joint (c–d) is a simple measurement of finger clubbing. It can be obtained readily and reproducibly with calipers. If the ratio is > 1, clubbing is present. Finger clubbing is also characterized by loss of the normal angle at the nail bed.

I noticed my nails changing a few years ago.  That along with swelled ankles, Renyards Syndrom (blue fingers) and heart palpatations should have indicated lung problems to my GP but all the symptoms were never mentioned at once.  They were little complaints that added up to end stage IPF.

I keep trying to post a picture but can't for some reason.
Look up the actress Megan Fox.  Her nails are clubbed.

If you put your fingers back to back your nails should touch from cuticle to tip.
If they curve away from each other and are puffy looking see a pulmonologist.

Portable oxygen concentrators My experience only

I have a hate, hate relationship with portable concentrators.
I originally thought it was my provider but it is also any machine
I have tried.  They are very sensative. DO NOT BUY A USED ONE!
If you do you will most likely regret it and end up paying for repairs
Which are horribly expensive IF you can even find someone to do them.

Two machine the provider lent me have had problems and
I have tried to buy four different used SeQuel Eclipse machines,
all of which have turned out to have problems.  I think it is because they sat still,
not being used for an extended time.  Two of them had "dried out"
I was told. Not sure exactly what that means but I was told the repair
cost was about $850.

If you are looking for a portable there are only four or five manufacturers.
Think about how and when you will use it.
I really wanted a very light weight one but none has continuous flow
as of 8/13.  Only the SeQuel Eclipse and Imogen Solo have that and
also go up to a pulse 6 setting.  If you need more oxygen when
you are moving one of these is the machine for you.
They each weigh just under  20 pounds when dragging extra batteries.
The batteries are almost $400 each so if you plan to do ANY plane travel
which involves changing planes you'll probably want the extra batteries.
Buy them when you buy the machine.  It is more economical.

Airlines want 1.5 times the battery life you'll need to get from your starting
point to ending point.  They don't want to hear that you can recharge at layovers.

The Spoon Theory by Christine Miserandino

Please take the time to read Christine Miserandino’s personal story and analogy of what it is like to live with sickness or disability.

 The Spoon Theory by Christine Miserandino www.butyoudontlooksick.com My best friend and I were in the diner, talking. As usual, it was very late and we were eating French fries with gravy. Like normal girls our age, we spent a lot of time in the diner while in college, and most of the time we spent talking about boys, music or trivial things, that seemed very important at the time. We never got serious about anything in particular and spent most of our time laughing. As I went to take some of my medicine with a snack as I usually did, she watched me with an awkward kind of stare, instead of continuing the conversation. She then asked me out of the blue what it felt like to have Lupus and be sick. I was shocked not only because she asked the random question, but also because I assumed she knew all there was to know about Lupus. She came to doctors with me, she saw me walk with a cane, and throw up in the bathroom. She had seen me cry in pain, what else was there to know? I started to ramble on about pills, and aches and pains, but she kept pursuing, and didn’t seem satisfied with my answers. I was a little surprised as being my roommate in college and friend for years; I thought she already knew the medical definition of Lupus. Then she looked at me with a face every sick person knows well, the face of pure curiosity about something no one healthy can truly understand. She asked what it felt like, not physically, but what it felt like to be me, to be sick. As I tried to gain my composure, I glanced around the table for help or guidance, or at least stall for time to think. I was trying to find the right words. How do I answer a question I never was able to answer for myself? How do I explain every detail of every day being effected, and give the emotions a sick person goes through with clarity. I could have given up, cracked a joke like I usually do, and changed the subject, but I remember thinking if I don’t try to explain this, how could I ever expect her to understand. If I can’t explain this to my best friend, how could I explain my world to anyone else? I had to at least try. At that moment, the spoon theory was born. I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said “Here you go, you have Lupus”. She looked at me slightly confused, as anyone would when they are being handed a bouquet of spoons. The cold metal spoons clanked in my hands, as I grouped them together and shoved them into her hands. I explained that the difference in being sick and being healthy is having to make choices or to consciously think about things when the rest of the world doesn’t have to. The healthy have the luxury of a life without choices, a gift most people take for granted. Most people start the day with unlimited amount of possibilities, and energy to do whatever they desire, especially young people. For the most part, they do not need to worry about the effects of their actions. So for my explanation, I used spoons to convey this point. I wanted something for her to actually hold, for me to then take away, since most people who get sick feel a “loss” of a life they once knew. If I was in control of taking away the spoons, then she would know what it feels like to have someone or something else, in this case Lupus, being in control. She grabbed the spoons with excitement. She didn’t understand what I was doing, but she is always up for a good time, so I guess she thought I was cracking a joke of some kind like I usually do when talking about touchy topics. Little did she know how serious I would become? I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of “spoons”. But when you have to now plan your day, you need to know exactly how many “spoons” you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons. She laughed and said she wanted more. I said no, and I knew right away that this little game would work, when she looked disappointed, and we hadn’t even started yet. I’ve wanted more “spoons” for years and haven’t found a way yet to get more, why should she? I also told her to always be conscious of how many she had, and not to drop them because she can never forget she has Lupus. I asked her to list off the tasks of her day, including the most simple. As, she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon. When she jumped right into getting ready for work as her first task of the morning, I cut her off and took away a spoon. I practically jumped down her throat. I said ” No! You don’t just get up. You have to crack open your eyes, and then realize you are late. You didn’t sleep well the night before. You have to crawl out of bed, and then you have to make your self something to eat before you can do anything else, because if you don’t, you can’t take your medicine, and if you don’t take your medicine you might as well give up all your spoons for today and tomorrow too.” I quickly took away a spoon and she realized she hasn’t even gotten dressed yet. Showering cost her spoon, just for washing her hair and shaving her legs. Reaching high and low that early in the morning could actually cost more than one spoon, but I figured I would give her a break; I didn’t want to scare her right away. Getting dressed was worth another spoon. I stopped her and broke down every task to show her how every little detail needs to be thought about. You cannot simply just throw clothes on when you are sick. I explained that I have to see what clothes I can physically put on, if my hands hurt that day buttons are out of the question. If I have bruises that day, I need to wear long sleeves, and if I have a fever I need a sweater to stay warm and so on. If my hair is falling out I need to spend more time to look presentable, and then you need to factor in another 5 minutes for feeling badly that it took you 2 hours to do all this. I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your “spoons” are gone, they are gone. Sometimes you can borrow against tomorrow’s “spoons”, but just think how hard tomorrow will be with less “spoons”. I also needed to explain that a person who is sick always lives with the looming thought that tomorrow may be the day that a cold comes, or an infection, or any number of things that could be very dangerous. So you do not want to run low on “spoons”, because you never know when you truly will need them. I didn’t want to depress her, but I needed to be realistic, and unfortunately being prepared for the worst is part of a real day for me. We went through the rest of the day, and she slowly learned that skipping lunch would cost her a spoon, as well as standing on a train, or even typing at her computer too long. She was forced to make choices and think about things differently. Hypothetically, she had to choose not to run errands, so that she could eat dinner that night. When we got to the end of her pretend day, she said she was hungry. I summarized that she had to eat dinner but she only had one spoon left. If she cooked, she wouldn’t have enough energy to clean the pots. If she went out for dinner, she might be too tired to drive home safely. Then I also explained, that I didn’t even bother to add into this game, that she was so nauseous, that cooking was probably out of the question anyway. So she decided to make soup, it was easy. I then said it is only 7pm, you have the rest of the night but maybe end up with one spoon, so you can do something fun, or clean your apartment, or do chores, but you can’t do it all. I rarely see her emotional, so when I saw her upset I knew maybe I was getting through to her. I didn’t want my friend to be upset, but at the same time I was happy to think finally maybe someone understood me a little bit. She had tears in her eyes and asked quietly “Christine, How do you do it? Do you really do this everyday?” I explained that some days were worse then others; some days I have more spoons then most. But I can never make it go away and I can’t forget about it, I always have to think about it. I handed her a spoon I had been holding in reserve. I said simply, “I have learned to live life with an extra spoon in my pocket, in reserve. You need to always be prepared.” Its hard, the hardest thing I ever had to learn is to slow down, and not do everything. I fight this to this day. I hate feeling left out, having to choose to stay home, or to not get things done that I want to. I wanted her to feel that frustration. I wanted her to understand, that everything everyone else does comes so easy, but for me it is one hundred little jobs in one. I need to think about the weather, my temperature that day, and the whole day’s plans before I can attack any one given thing. When other people can simply do things, I have to attack it and make a plan like I am strategizing a war. It is in that lifestyle, the difference between being sick and healthy. It is the beautiful ability to not think and just do. I miss that freedom. I miss never having to count “spoons”. After we were emotional and talked about this for a little while longer, I sensed she was sad. Maybe she finally understood. Maybe she realized that she never could truly and honestly say she understands. But at least now she might not complain so much when I can’t go out for dinner some nights, or when I never seem to make it to her house and she always has to drive to mine. I gave her a hug when we walked out of the diner. I had the one spoon in my hand and I said “Don’t worry. I see this as a blessing. I have been forced to think about everything I do. Do you know how many spoons people waste everyday? I don’t have room for wasted time, or wasted “spoons” and I chose to spend this time with you.” Ever since this night, I have used the spoon theory to explain my life to many people. In fact, my family and friends refer to spoons all the time. It has been a code word for what I can and cannot do. Once people understand the spoon theory they seem to understand me better, but I also think they live their life a little differently too. I think it isn’t just good for understanding Lupus, but anyone dealing with any disability or illness. Hopefully, they don’t take so much for granted or their life in general. I give a piece of myself, in every sense of the word when I do anything. It has become an inside joke. I have become famous for saying to people jokingly that they should feel special when I spend time with them, because they have one of my “spoons”. © Christine Miserandino *We have English, Spanish, French and Hebrew translations of “The Spoon Theory” available. - See more at: http://www.butyoudontlooksick.com/wpress/articles/written-by-christine/the-spoon-theory/#comments

The Vest

http://www.thevest.com/airway-clearance/impaired.asp.  



I used The Vest today at pulmonary therapy and I want one!   It was so much better than having someone pound on your back to loosen the junk in your lungs!
UPDATE:  I used the machine for a few months at home and it works great but my insurance company would not approve the full cost of use.   Even though I accepted delivery of the machine with the understanding that if insurance didn't cover it then they'd have to take it back, it turned into a problem with HillRom.  I repeatedly asked them to pick up the machine because I couldn't afford the almost $1200 per month charge.  They said I'd agreed to a payment plan which I hadn't.
Finally they sent a box for me to return it. They say I owe about $2300.  I disagree.  We'll have to see who kept better documentation.

Impaired Airway Clearance

When mucus secretion and mucus clearance are not in balance, excessive airway mucus can cause serious problems. This condition is called impaired airway clearance.

Excess, often sticky mucus may accumulate in the airways in conditions as varied as cystic fibrosis, cerebral palsy, and chronic obstructive pulmonary disease bronchiectasis. Retained secretions are a universal problem in people with artifical airways (tracheostomies) or those who depend on assisted ventilation.

As a consequence of retained mucus, breathing becomes labored. More energy and effort are required to take in vital oxygen and to exhale carbon dioxide. Although underlying causes are diverse, consequences are the same: vulnerable individuals are caught up in the vicious cycle of recurrent, ever-worsening episodes of inflammation, pulmonary infection, increased production of excess mucus, and airway obstruction, lung damage, and respiratory failure.

People at risk for impaired airway clearance have one or more of the following problems:

Ineffective Ciliary Clearance

Normal cilia beat in a coordinated unidirectional fashion to mobilize mucus and clear particulate matter from the airways. Damaged or poorly functioning cilia perform this function inadequately or not at all.

Ciliary impairment is associated with conditions including:

• Cystic fibrosis
• Primary ciliary dyskinesia
• Kartagener syndrome
• Status post heart-lung or lung transplantation
• Smoking or exposure to second-hand smoke

Excessive or Abnormal Mucus Production

Certain disorders and/or their treatments can cause excess mucus production and, in some cases, mucus that is abnormally thick and sticky. Large quantities of mucus, or mucus with altered physical properties, may overwhelm the mucociliary apparatus, inhibiting normal airway clearance.

Abnormal amounts of mucus with altered physical properties may imbe present in:

• Cystic fibrosis
• Bronchiectasis
• Asthma
• Chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis
• Mechanical ventilation

Impaired secretion clearance can occur as a result of any event or dysfunction that disrupts normal airway clearance mechanisms.

Ineffective Cough

Cough function may be weak or ineffective in diseases and conditions where:

• Diaphragm muscle weakness or spinal deformity diminishes ability to inhale
• Poor coordination of the expiratory muscles compromises expulsive force and mucus shearing.
• Poor coordination of the bulbar muscles impairs closure of the glottis and the ability to build up
  intrapleural pressure

Cough function is frequently impaired in:

• Neuromuscular diseases, such as muscular dystrophy, spinal muscular atrophy, and multiple sclerosis
• Neuromotor conditions including cerebral palsy, spinal cord injury, and severe traumatic brain injury
• Individuals who depend on mechanical ventilation
• Individuals who have received heart and/or lung transplants

Dysphagia/Aspiration/Gastroesophageal Reflux

Dysphagia, or difficulty in swallowing, is a consequence of anatomical abnormalities or weakness of the muscles associated with swallowing. Gastroesophageal reflux occurs when a defective lower esophageal sphincter allows stomach contents to surge backwards into the esophagus. Aspiration involves the inhalation of secretions, vomit, or foreign material into the lungs. Because saliva and gastric contents contain bacteria, aspiration introduces microorganisms into normally sterile airways.

Seizures

Seizures are disorders of cerebral function characterized by sudden, attacks of loss of consciousness and motor control. There is a risk of aspiration during seizures.

Conditions associated with dysphagia/aspiration/gastroesophageal reflux include:

• Neurologic and neuromuscular disorders including cerebral palsy and muscular dystrophy
• Seizures
• Developmental delay
• Disorders of the esophagus
• Endotracheal intubation and tracheostomy

Immobility

Some individuals are unable to exercise because of diminished exercise capacity, neuromuscular weakness or neuromotor dysfunction. As a result, they cannot maintain adequate aerobic capacity, chest 

bellows function, and lung volume.

Conditions associated with immobility include:

• Spinal cord injury, quadriplegia
• Severe cerebral palsy and/or developmental delay
• Advanced muscular dystrophy, spinal muscular atrophy, severe spina bifida
• Dependence upon assisted ventilation

Restrictive Lung Disease

Fixed or diminished lung volumes and vital capacities characterize restrictive lung disease. In conditions where respiratory muscles are weak or the spine and thorax are deformed, the ability to take a deep breath, to generate expiratory force, and to cough effectively are often affected.

Restrictive lung disease occurs commonly in:

• Muscular dystrophy
• Spina bifida
• Spinal muscular atrophy
• Severe cerebral palsy

Obstructive Lung Disease

Obstructive lung diseases include conditions where airway size is decreased as a result of structural changes,bronchospasm and/or excess mucus — limiting the ability to exhale.

Obstructive lung diseases include:

• Bronchiectasis
• Chronic Bronchitis
• Alpha₁-antitrypsin deficiency
• Asthma
• Cystic fibrosis
• Primary ciliary dyskinesia
• Kartagener syndrome

Learn more about airway clearance:

• What is Airway Clearance?
• Normal Airway Clearance
• The Need for Airway Clearance
• Vicious Cycle of Airway Clearance

High Altitude Simulation Test

High Altitude Simulation Test (HAST) is a test that can determine the need for supplemental oxygen in patients who are going to be traveling by air or at higher altitude.  If you have a chronic lung disease (COPD, emphysema, chronic bronchitis, severe asthma), and you are considering a trip by airplane, or a trip to a higher elevation, you may need this test.  If you are alread on supplemental oxygen, you may still need testing.  This is simply the safest and most accurate way to determine if you will need oxygen at higher altitudes, and exactly what level of oxygen keeps your oxygen saturation in the safe range.  The FAA regulates that airplanes maintain a cabin pressure of bewteen 8,000 to 10,000 feet above sea level.  Rather than get into barometric pressure and partial pressure of gasses, this simply means that available oxygen has just dropped by about 6% compared to sea level.  The air we breathe at sea level contains 21% oxygen, but when flying, or at elevations of 8,000 feet above sea level, the air now has about 15-16% oxygen (compaired to sea level).  In the past, we would simply guess based on a patient's oxygen saturation.  If a person had an oxygen saturation above 95%, they were good to go, if not, they may need some supplemental oxygen in-flight.  Many hospitals and pulmonary function labs now offer HAST to accurately determine the need for high altitude oxygen, as well as the exact amount that will keep patient's safe when flying or traveling at higher altitudes.  If you are already on home oxygen, testing can determine what level you will need in-flight.  The test can be done several different ways, but basically, a mixture of nitrogen and oxygen is delivered to the patient to simulate the available oxygen at high altitudes.  During this time, the patients vital signs are closely monitored, as is the oxygen saturation.  If the saturation drops below a set point, usually 85-88%, supplemental oxygen is titrated to keep the saturation in a predetermined range (usually 88-90%).  Some guidelines recommend other screening, such as a 6 minute walk, arterial blood gasses, and other testing to determine the need for HAST, but the bottom line is there is a better way than simply guessing and estimating the need and the amount of oxygen needed for lung patients who travel by air, or those who plan to travel to higher elevations. 

Pulmonary Function Tests from MedLinePlus

Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation.

How the Test is Performed

Spirometry measures airflow. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases. In a spirometry test, while you are sitting, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time.

For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. Sometimes you will be asked to inhale the substance or a medicine to see how it changes your test results.

Lung volume measurement can be done in two ways:

• The most accurate way is to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.
• Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. The concentration of the gas in a chamber attached to the tube is measured to estimate the lung volume.

To measure diffusion capacity, you breathe a harmless gas, called a tracer gas, for a very short time, often for only one breath. The concentration of the gas in the air you breathe out is measured. The difference in the amount of gas inhaled and exhaled measures how effectively gas travels from the lungs into the blood. This test allows the doctor to estimate how well the lungs move oxygen from the air into the bloodstream.

How to Prepare for the Test

Do not eat a heavy meal before the test. Do not smoke for 4 - 6 hours before the test. You'll get specific instructions if you need to stop using bronchodilators or inhaler medications. You may have to breathe in medication before or during the test.

How the Test Will Feel

Since the test involves some forced breathing and rapid breathing, you may have some temporary shortness of breath or lightheadedness. You breathe through a tight-fitting mouthpiece, and you'll have nose clips.

Why the Test is Performed

Pulmonary function tests are done to:

• Diagnose certain types of lung disease (such as asthma, bronchitis, and emphysema)
• Find the cause of shortness of breath
• Measure whether exposure to chemicals at work affects lung function
• Check lung function before someone has surgery

It also can be done to:

• Assess the effect of medication
• Measure progress in disease treatment

Normal Results

Normal values are based upon your age, height, ethnicity, and sex. Normal results are expressed as a percentage. A value is usually considered abnormal if it is less than 80% of your predicted value.

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

Different measurements that may be found on your report after spirometry include:

• Expiratory reserve volume (ERV)
• Forced vital capacity (FVC)
• Forced expiratory volume (FEV)
• Forced expiratory flow 25% to 75%
• Functional residual capacity (FRC)
• Maximum voluntary ventilation (MVV)
• Residual volume (RV)
• Peak expiratory flow (PEF).
• Slow vital capacity (SVC)
• Total lung capacity (TLC)

What Abnormal Results Mean

Abnormal results usually mean that you may have some chest or lung disease.

Some lung diseases (such as emphysema, asthma, chronic bronchitis, and infections) can make the lungs contain too much air and take longer to empty. These lung diseases are called obstructive lung disorders.

Other lung diseases make the lungs scarred and smaller so that they contain too little air and are poor at transferring oxygen into the blood. Examples of these types of illnesses include:

• Extreme overweight
• Fibrosis of the lungs
• Lung cancer
• Sarcoidosis and scleroderma

Risks

The risk is minimal for most people. There is a small risk of collapsed lung in people with a certain type of lung disease. The test should not be given to a person who has experienced a recent heart attack, or who has certain other types of heart disease.

Considerations

Your cooperation while performing the test is crucial in order to get accurate results. A poor seal around the mouthpiece of the spirometer can give poor results that can't be interpreted. Do not smoke before the test.

Alternative Names

PFTs; Spirometry; Spirogram; Lung function tests

References

Hegewald MJ, Crapo RO. Pulmonary function testing. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 24.

Reynolds HY. Respiratory structure and function: mechanisms and testing. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 85.

Update Date: 12/12/2011

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Air Travel With Oxygen

Airline Travel With Oxygen

Quick link: POC Information

Airline travel is available to persons who require in-flight supplemental oxygen. Negotiating the many obstacles, however, can be challenging. As an oxygen user it is your responsibility to make your own arrangements. Patience, perseverance and having the appropriate information available will help you plan your trip. A helpful tip: keep written information in front of you, note with whom you speak, and write down contact information. Airline policies are subject to change without notice. It is recommended that you notify the airline at the time of reservation and 48 hours before flight time that you will be flying with oxygen to verify its policy, and that you carry a copy of the policy and your oxygen prescription with your airline tickets while traveling.

ADVANCE PLANNING IS ESSENTIAL

Your trip begins with the airline. Each airline has its own policy for on-board oxygen transport and in-flight oxygen usage. You will need to contact the individual airline for their current policies regarding oxygen. For general information about traveling with oxygen, click on:www.airlineoxygencouncil.org. You must carry your prescription for oxygen and your Doctor's letter approving air travel with you at all times. Many of the airlines have their own airline specific medical form for your Doctor to fill out. These are generally good for one year. A helpful tip: keep your other medications, prescriptions and forms with you while traveling and not in your checked baggage.

You must carry your prescription for oxygen and your Doctor’s letter approving air travel with you at all times. Many of the airlines have their own airline specific medical form for your Doctor to fill out. These are generally good for one year. A helpful tip: keep your other medications, prescriptions and forms with you while traveling and not in your checked baggage.

Effective May 13, 2009 the Department of Transportation final rule "Nondiscrimination on the Basic of Disability in Air Travel" contains air carrier requirements regarding the use of respiratory assistive devices on aircraft. In the final DOT rule, section 382.133 generally requires that air carriers conducting passenger service must permit someone with a disability to use an FAA-approved portable oxygen concentrator (POC) on all flights (on aircraft originally designed to have a maximum passenger capacity of more than 19 seats) unless the device does not meet applicable FAA requirements for medical portable electronic devices and does not display a manufacturer’s label that indicates the device meets those FAA requirements.

There are now 21 portable oxygen concentrators approved by the FAA to carry on board your flight.Approved POCs include:

• AirSep Focus
• AirSep Freestyle 5
• AirSep FreeStyle
• AirSep LifeStyle
• Delphi RS-00400
• DeVilbiss iGo
• LifeChoice by Inova Labs
• LifeChoice Activox by Inova Labs
• Inogen One
• Inogen G2
• Inogen One G3
• International Biophysics Life Choice
• Invacare XPO2
• Invacare Solo 2
• Oxlife Independence
• Oxus RS-0400
• Precision Medical EasyPulse
• Respironics EverGo
• Respironics Simply Go
• Sequal
• SeQual SAROS

They can be stowed under the seat in front of you during flight and can be battery powered when not plugged into an electrical socket if available and the Airline allows. Remember: YOU must confirm with your airline carrier 48 hours prior to flight time that you will be bringing on board and using a POC.

NOTE: YOU ARE NOT ALLOWED TO USE ANY OTHER PERSONAL OXYGEN SYSTEMS ON BOARD. FILLED OXYGEN TANKS (LIQUID OR COMPRESSED GAS) CANNOT BE CHECKED AS BAGGAGE ON ANY AIRLINE. Some airlines may allow empty oxygen equipment to be stowed in baggage but it must be verified as empty and the regulator removed. Check with your airline ahead of time to see if they will allow empty systems/tanks as stowed or checked baggage.

Once you have decided on your oxygen needs, you will need to contact your oxygen provider to see if they can provide you with a POC approved for air travel. If not, you will have to rent or purchase one independently - see POC Information for more details. You will need sufficient battery power to cover pre-flight, in-flight and post-flight time. Remember you will need to arrive at the airport 1 – 2 hours ahead of your flight time. At Gate Check-in you must have battery power for at least 50% longer than your scheduled flying time. For example – if your flying time is 3 hours, you will need 4 ½ hours of battery power) You will need to cover your travel time to the airport, airport waiting time, your flight time and the time it will take you to deplane, pick up your checked baggage and travel to your final destination. Plan ahead for any possible delays. Non-Stop or direct flights will keep the battery time to a minimum.

The Department of Transportation (DOT) provides public tips on safe carriage of batteries and battery-powered devices such as medical equipment. For information on how to safely travel with oxygen equipment batteries, please visit the DOT web site.

You may want to contact your insurance carrier to determine coverage for your oxygen needs while traveling.

At the Airport you will need to pass through Airport Security. If you are traveling with an approved POC, that will need to be identified on the POC itself. All TSA approved oxygen systems can safely be x-rayed if requested. If you are traveling with a portable oxygen system, you will be allowed through the security area after inspection and may take the system to the gate. If the system is not an approved POC you may NOT be permitted to take it onto the airplane and will need someone with you to remove it from the airport. If you do not use an approved POC oxygen supply you will need to arrange for an oxygen supply at your destination. It is very important that you are familiar with the Transportation Security Administration (TSA) guidelines for “Travelers with Disabilities and Medical Conditions” before you go to the airport. Go the TSA website @ http://www.tsa.gov/traveler-information/travelers-disabilities-and-medical-conditions for this information.

The International Air Transport Association (IATA), of which virtually all US airlines with international routes are members, has a medical manual which includes forms and procedures for documenting medical conditions. Included is a FREMEC (frequent medical travelers medical card) from, which seems designed to streamline the medical clearance process across member airlines. The medical manual can be found here. The IATA site is www.iata.org.

Traveling with CPAP, Bi-Level Device or a Non-Invasive portable ventilator:

If your Physician requires you to travel with CPAP, Bi-Level Device or a Non-Invasive portable ventilator, here is an excellent resource to watch: Traveling with Trilogy: Taking it on the Road.

Other Modes of Travel With Oxygen

Traveling on Amtrak and Cruise Ships:

If you are traveling on an Amtrak train or want to take a cruise, check out these links for their policies and guidelines before booking your trip.

Amtrak: http://www.amtrak.com/accessible-travel-oxygen-equipment

Carnival Cruise Lines: http://www.carnival.com/legal/guests-special-requirements.aspx

Holland America: http://www.hollandamerica.com/assets/cruise-vacation-planning/AccessToExcellence.pdf

Royal Caribbean: http://www.royalcaribbean.com/allaboutcruising/accessibleseas/otherNeeds.do

Top Ships for Cruisers with Disabilities: http://www.cruisecritic.com/articles.cfm?ID=105

Please help us keep this list current. If you are aware of an updated policy, please contact us at:ExecOffice@homeoxygen.org

HAVE A GREAT TRIP!

Air Travel With Portable Oxygen Concentrators

What You Need to Know About Flying With POCs.     By Nancy Parode, About.com Guide

While the Air Carrier Access Act obliges air carriers in the U.S. to accommodate passengers with disabilities, there is no regulation requiring airlines to provide medical oxygen during flights. Oxygen is considered to be a hazardous material, and airlines will not allow passengers to carry it onto an airplane. While airlines may, if they wish, provide supplemental medical oxygen, most do not, and the few who do (American Airlines, United Airlines and Alaska Airlines, as of this writing) assess per-flight segment setup charges for oxygen service.

Airlines may, however, allow passengers to bring portable oxygen concentrators (POCs) onto airplanes, as explained in Federal Aviation Administration (FAA) Advisory Circular Number 120-95 and Special Federal Air Regulation (SFAR) 106. These documents spell out the requirements for POCs and explain what air carriers may and may not require from passengers who need supplemental medical oxygen during all or part of their flights.

If you are taking an international flight, you may need to comply with two sets of regulations – for example, U.S. and Canadian rules – and you should contact your airline to be sure you understand all the procedures you must follow.

Approved Portable Oxygen Concentrators

If you need supplemental medical oxygen and plan to fly, you'll need to make sure your POC is on the FAA's approved list, which is published in SFAR 106. As of January 7, 2009, the FAA has approved the following portable oxygen concentrators for in-flight use:

AirSep Lifestyle

AirSep Freestyle

Delphi RS-00400

Inogen One

Invacare XPO2

Respironics EverGo

SeQual Eclipse

Portable Oxygen Concentrator Use

While FAA regulations do not require that you tell your air carrier about your POC in advance, nearly all airlines ask you to notify them at least 48 hours before your flight that you intend to bring a POC onboard. Some air carriers, such as Southwest and JetBlue, also ask you to check in for your flight at least one hour before takeoff.

In order to bring your POC onto the airplane with you, you'll need to furnish a copy of a physician's statement to your airline. You should check with your airline to find out whether you'll need to use a special form. Most air carriers require the statement to be written on your doctor's letterhead. Some, like American, AirTran and Delta, expect you to use their form. If you're flying on a code share flight, be sure you know the procedures for both your ticketing airline and the air carrier actually operating your flight.

The physician's statement must include the following information:

A statement about your ability to see, hear and respond to the warning signals on your POC, which are typically flashing lights and audible alarms. You must be able to understand the warning alarms and respond to them without help.

A description of your oxygen requirements – do you need medical oxygen during the entire flight, or only under certain conditions?

A statement describing the maximum oxygen flow rate you require while the aircraft is in flight.

FAA regulations also describe where passengers using POCs may sit and where they must stow their POC. Passengers using POCs may not sit in exit rows, nor may their POCs block another passenger's access to seats or to the airplane's aisles. You must be able to see the alarm lights on your POC when it is stowed. Ideally, you should keep your POC under the seat in front of you.

Powering Your Portable Oxygen Concentrator

Air carriers are not required to let you plug your POC into the airplane's electrical system. You will need to plan ahead and bring enough batteries to power your POC for your entire flight, including gate time, taxi time, takeoff, in-air time and landing. Almost all U.S. air carriers require you to bring enough batteries to power your POC for 150 percent of "flight time," which includes every minute spent onboard the aircraft, plus an allowance for gate holds and other delays. You will need to contact your airline to find out what your flight time will be, add in a reasonable estimate for delays and transfer times, and multiply that time by 150 percent.

Extra batteries must be carefully packed in your carry-on luggage. You must ensure that the terminals on the batteries are taped or otherwise protected from coming in contact with other items in your bag. (Some batteries have recessed terminals, which do not need to be taped.) You will not be allowed to bring your batteries with you if they are not packed properly.

Your POC and extra batteries are considered medical devices. While they will need to be screened by TSA personnel, they will not count against your carry-on baggage allowance.

Renting Portable Oxygen Concentrators

Several companies rent FAA-approved portable oxygen concentrators. If your POC is not on the FAA-approved list, you may wish to bring it along for use at your destination and rent a POC to use in-flight. Two companies that rent FAA-approved portable oxygen concentrators in the U.S. are OxygenToGo and Advanced Aeromedical.

The Bottom Line

The secret to successful travel with a portable oxygen concentrator is advance planning. When you begin to research flights, take a look at each airline's POC requirements. Notify your air carrier that you intend to bring a POC with you as soon as you book your flight. Make sure you understand how soon before your flight your physician should write the required statement (United has particularly restrictive rules) and whether it has to be on letterhead or an airline-specific form. Check on the length of your flight and be generous with your estimate of possible delays, particularly in winter or during peak travel times, so you will bring enough batteries with you.

By planning ahead and preparing for delays, you'll be able to relax both during your flight and at your destination.