Monday, June 21, 2021

The Folly of Medical Hyperventilation

Medicine has made great progress abandoning harmful treatments since its accidental euthanization of President George Washington in 1799. But modern medical practitioners are still figuring out how to optimally treat many conditions.  

An Achilles' heel is a weakness in spite of overall strength, which can lead to downfall.

My stories of the Taxi Wars are of humanity's struggles against the machines we've created for ourselves. One of my common observations was of people who are not helped (and often harmed) by standard medical practices. While this post is not directly related to my experiences as a taxi driver, it is highly relevant to humanity's struggle against our Medical Machine.

Modern doctors sometimes decide their patient's tissues are low on oxygen and prescribe a supplement of pure oxygen. A little extra oxygen is sometimes helpful. But investigators have repeatedly confirmed this fundamental fact: oxygen in excess is always toxic

Hyperventilation is when someone breathes too rapidly. This causes too much carbon dioxide [CO2] to be expelled from the blood. As discussed below, medically-administered oxygen also removes too much CO2 from the patient's blood, resulting in Medical Hyperventilation

While certain patients may seem to initially benefit from oxygen therapy, the science is clear enough to this simple former taxi driver that I do everything I can to caution people to not let their doctors hyperventilate them to death. I further believe there are perfectly reasonable therapies for poor oxygen saturation levels that incorporate the antidote for oxygen toxicity and thereby prevent Medical Hyperventilation. The evidence for these positions is summarized below.

There is no polite way to point out to the medical guild that their cavalier use of pure oxygen is not so different from the bloodletting, calomel (mercury) and blister agents that were used to finish off President Washington. The media will not jump to the cause of holding Medicine to account for their anti-scientific use of oxygen. Alas, I offer a proposal for a distributed second-guessing of the medical industry's backwards practice. 

If enough of us inquire whether a hospital routinely assaults their patients with pure oxygen, the hospitals will hopefully stop harming patients with anti-treatments that  Paul Bert and J. Lorrain Smith precisely identified as harmful 143 and 122 years ago.

A Medical Poisoning Epidemic

Modern doctors' confusion about the  routine medical use of pure oxygen stems from their training, whereby they are conditioned to think their profession has 'best practices' figured out. As oxygen is essential to all animals' life processes, doctors assume patients with low levels of oxygen in their blood/tissues obviously need more oxygen.

Oxygen is essential for allowing our bodies to efficiently burn fuels to create chemical energy, ATP, through aerobic metabolism. Anaerobic metabolism refers to when bodies use fuel without oxygen to make ATP and lactic acid, but this is very inefficient: much less ATP results from anaerobic metabolism than oxidation. Aerobic glycolysis refers to inefficient oxygen-free metabolism that occurs even when there is adequate oxygen, and is the hallmark of the metabolism undertaken by cancerous tumors.

Advanced SCUBA divers sometime use air tanks with higher-than-atmospheric levels of oxygen to avoid decompression sickness and nitrogen narcosis. These divers are made aware of the amplified toxicity of oxygen at the high pressures experienced underwater, and are trained to watch for the symptoms of oxygen toxicity. 

Oxygen is toxic at normal atmospheric pressure too. 20th century science figured out that healthy people can tolerate a pure oxygen atmosphere for at least a day before they begin to experience overt adverse effects.  

The physiological principles at the core of the oxygen toxicity were conclusively established in a paper by J. Lorrain Smith, M.D., titled The Pathological Effects Due to Increase of Oxygen Tension in the Air Breathed (1899). This paper built on Paul Bert's 1878 findings that pure oxygen is toxic to animals' central nervous systems. These scientific findings -- that  oxygen in excess is toxic -- have been repeatedly confirmed and fleshed out over the past 250 years.

Modern Acknowledgement of Oxygen Poisoning

Consider this tweet from a Medical Doctor who specializes in treating tuberculosis, on his understanding of the predicament of trying to treat Acute Respiratory Distress Syndrome [ARDS] with backwards treatment: 

Click on the date for the full thread, which confirms that oxygen has been known to be toxic for 240+ years. Furthermore, the good doctor describes how ventilators are known to cause ARDS. Dr. Dickson's thread has pictures of the lungs of his laboratory mice that have been damaged with oxygen.

The term for the damage done by mechanical ventilation is Barotrauma - "physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with, the body, and the surrounding gas or fluid."

The treating doctor's predicament is that sometimes patients seem to benefit from a little extra oxygen. Patients whose lungs are somewhat dysfunctional (on account of fluid, COPD, etc) might have their complexion go from 'gray' to 'pink', suggesting to the doctor that the treatment is helpful. But supplemental oxygen is, at best, a fine line between "enough" and "too much", and over the long term (>24 hours?), patients possibly deteriorate from the supplemental oxygen that initially seemed to help. Researchers question benefits of long term oxygen therapy in COPD, for example.

How to Better Your Odds of Surviving a Hospitalization

snatch defeat from the jaws of victory: To fail, lose, or be defeated despite the appearance that one would be victorious, especially due to a mistake, error, or poor judgment. (An ironic reversal of the more common "snatch victory from the jaws of defeat.")

TaxiCabJesus' Hospital Survival Strategy #1: Oxygen in excess is toxic. For a better chance of surviving any hospitalization, don't let the doctors oxygenate you to death. Inquire of the medical team treating you if the oxygen they want to give you also has the antidote for Oxygen Toxicity.

TaxiCabJesus' Hospital Survival Strategy #2: While sometimes ventilation is necessary (neck surgery, etc), some kinds of ventilation are more traumatic than others. Ventilation has been found to not help with pneumonia (lung infections). If you have a lung infection, don't let the doctors ventilate you to death. 

The tragedy of oxygen toxicity is that a simple antidote for oxygen poisoning is available. This antidote allows supplemental oxygen to adequately treat dysfunctional lungs without causing oxygen poisoning. For a reason unknown to this lay taxi driver, this antidote for oxygen toxicity has fallen from common use.

The Antidote for Oxygen Poisoning

Doctors commonly know about the hazards of oxygen toxicity but seem to figure, "what else can we do when a patient's oxygen saturation is not as high as we think it should be?" Most the Profession has forgotten there is a specific simple antidote for the toxic properties of oxygen.

HYPERVENTILATION occurs when a person blows off too much carbon dioxide. Pure oxygen therapy also accelerates the removal of carbon dioxide from the patient's blood, thereby inducing Medical Hyperventilation.

If someone is hyperventilating for psychological reasons, they can be aided by placing a paper bag in front of their face. This allows the hyperventilator to rebreathe their carbon dioxide.  (Sometimes people hyperventilate because they're having a heart attack [for example], and need more than treatment with a paper bag.)

5% Carbon Dioxide added to pure oxygen allows the blood to retain an adequate amount of CO2. This mixture of gasses is called Carbogen, and reliably prevents medical hyperventilation.

Many studies have found treating patients with Carbongen (95% O2, 5% CO2) instead of pure oxygen allows the patients to benefit from supplemental oxygen without harming them. One study:

[...] growing research suggests that inhaling straight oxygen can actually harm the brain. For the first time, a new UCLA brain-imaging study reveals why. Published in the May 22 edition of Public Library of Science (PLoS) Medicine, the findings fly in the face of national guidelines for medical practice and recommend a new approach adding carbon dioxide to the gas mix to preserve brain function in patients.[...]

"Several brain areas responded to 100 percent oxygen by kicking the hypothalamus into overdrive," explained Harper. "The hypothalamus overreacted by dumping a massive flood of hormones and neurotransmitters into the bloodstream. These chemicals interfere with the heart's ability to pump blood and deliver oxygen -- the opposite effect you want when you're trying to resuscitate someone."

When the children inhaled the carbon dioxide-oxygen mix, the hypothalamus' hyperactivity vanished from the MRI scan.

"Adding carbon dioxide to the oxygen relaxed the blood vessels, allowed oxygen to reach the heart and brain, calmed the hypothalamus and slowed the release of dangerous chemicals," said Macey.

"Pure oxygen kindles the match that fuels a forest fire of harm to the body," said Harper. "But a little whiff of carbon dioxide makes it all go away."

Based on their findings, the researchers strongly encourage healthcare providers to add carbon dioxide to oxygen dispensation, especially when resuscitating infants or administering oxygen for more than a few minutes. The new direction could hold particular implications for patients of stroke, heart attack, carbon monoxide poisoning and any long-term oxygen therapy.

- Imaging Study Reveals How Pure Oxygen Harms The Brain (May 24, 2007) (Emphasis added)

The Various Causes of Low Oxygen

Two scientific principles are essential to understand how oxygen is transported in the body. Red blood cells use an iron-containing protein, hemoglobin, to transport oxygen. Under normal conditions 98.5% of the oxygen in the blood is carried by hemoglobin; 1.5% is dissolved in the blood.

The Bohr Effect is the observation that hemoglobin (in red blood cells) releases its cargo of oxygen in the presence of an acid such as carbon dioxide (or lactic acid). The Haldane Effect refers to the observation that high-oxygen environments (such as found in the lungs) trigger red blood cells to take up O2. 

CO2 is only partially transported by hemoglobin. CO2 is mostly transported in the blood, as carbonic acid and bicarbonate:Transport of Carbon Dioxide in the Blood. Medical Hyperventilation results in more than 1.5% of the O2 dissolving directly into the blood, where it causes problems via the mechanisms discussed below.

The percent of hemoglobin carrying oxygen is referred to as the oxygen saturation level. Pulse Oximeters are used to measure patients' oxygen saturation level. 

Having dysfunctional lungs -- due to fluid buildup, tar (from tobacco), scarring, etc -- reduces the available surface area for gas exchange. These are the patients that seem to benefit from treatment with pure supplemental oxygen, though they are probably harmed over the long term by this treatment. 

There are other causes of low blood oxygen saturation levels, besides having dysfunctional lungs.

Sometimes patients' blood oxygen saturation levels will decrease on account of "stress". One type of stress is exercise: when a persons' muscles use all the oxygen in their vicinity, they will switch to anaerobic metabolism for the time being, and catch up on oxygen later.

Stress feeds back on itself, amplifies stress, and worsens cells' ability to use oxygen to make ATP and carbon dioxide. When a person's body is stressed (due to exercises that use up more oxygen than can be delivered by the lungs, being malnourished, having an infection, emotional stress, etc), cells partially switch to fermenting sugar without oxygen, resulting in lactic acid instead of carbon dioxide. Lactic acid is disposed of when the liver converts it back into sugar (via the Cori Cycle).  

How To Shrink Your Arteries and Create Physiological Stress

Hyperventilation shrinks peripheral arteries: "The prime candidate mechanism for unintended hemodynamic effects of supplemental oxygen is coronary and systemic vasoconstriction." (The potential harm of oxygen therapy in medical emergencies)

When the arteries are constricted, inadequate blood is delivered to the brain and other tissues. The need for fuel does not go away, so cells deprived of blood will switch to anaerobic metabolism to make ATP and lactic acid. 

Lactic acid does trigger the release of O2 from red blood cells like CO2 does. It also binds to hemoglobin, but it doesn't bubble off in the lungs like CO2. Healthy bodies have lots of CO2 (in various forms). Unhealthy bodies have lots of lactic acid.

Runners commonly run out of oxygen. Their bodies partially switch to the anaerobic metabolism, and they experience lactic acid building up in their muscles as "cramps". As soon as the runner stops running, their body is able to supply adequate oxygen levels to their tissues, and their body is able to switch back to the aerobic metabolism.

tl/dr: Stress -> low CO2 -> constricted arteries -> lost ability to transport and use oxygen efficiently -> more stress. 

Oxygen Dominos: The Chain Reaction of Harm Resulting from Pure Oxygen Supplementation

Oxygen is a very reactive molecule - "a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as well as with other compounds".

The first avenue of harm of inhaled O2 is through Reactive Oxygen Species (aka Active Oxygen Forms). Our cells use antioxidants and Carbon Dioxide to contain the destructive effects of oxygen, but these defenses are overwhelmed by oxygen excess and Medical Hyperventilation.

Excess Oxygen displaces nitrogen in the lungs, thereby contributing to the collapse of the aveoli (the lungs' little air sacs).

There are three significant consequences of routine, excessive oxygen administration: nitrogen washout, oxygen toxicity and oxidative stress.

-Hyperoxia: Too much of a good thing. Three significant consequences of routine, excessive oxygen administration

Over-oxygenation accelerates the removal of CO2 from the blood. Low blood CO2 -- whether from regular hyperventilation or medical hyperventilation -- causes the arteries to shrink, impeding the delivery of oxygen to the tissues that need it. Tissues deprived of blood/O2 on account of arteries shrunken by CO2-deficient blood switch to anaerobic fermentation and release lactic acid into the blood. Lactic acid acidifies the blood more than CO2 but can't be released into the exhalations, and must later be processed by the liver.

I'm just a simple retired taxi driver, so I don't really grok (understand at an intuitive level) the biochemistry of blood gas exchange. But apparently neither do most modern medical professionals, even though they're certified to know better.

Publications on the Toxicity of Oxygen 

Oxygen Poisoning in Man was published in the British Medical Journal on May 17, 1947, and provides a review of what was then known about the toxicity of oxygen. 

NASA wrote a review in the 1964: Space-cabin Atmospheres: Oxygen toxicity. (NASA originally specified a mixed-gas atmosphere for the Apollo capsule, but that was too heavy, so they switched to an oxygen atmosphere. After the Apollo 1 fire the capsules were switched to have a normal atmospheric oxygen/nitrogen ratio at launch. This mixed atmosphere was gradually replaced with pure oxygen, but astronauts are generally healthy and therefore better able to withstand higher oxygen levels for longer periods of time. The lower pressure of the capsule in space made oxygen less toxic, and the CO2 scrubbers couldn't remove all the astronaut-generated CO2 instantaneously.)

Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis - "In acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes." (2018)

Medical professionals remind themselves that oxygen is toxic in excess:

Oxygen is vital to sustaining life. However, breathing oxygen at higher than normal partial pressure leads to hyperoxia and can cause oxygen toxicity or oxygen poisoning. The clinical settings in which oxygen toxicity occurs is predominantly divided into two groups; one in which the patient is exposed to very high concentrations of oxygen for a short duration, and the second where the patient is exposed to lower concentrations of oxygen but for a longer duration. These two cases can result in acute and chronic oxygen toxicity, respectively. The acute toxicity manifests generally with central nervous system (CNS) effects, while chronic toxicity has mainly pulmonary effects. Severe cases of oxygen toxicity can lead to cell damage and death. Those at particular risk for oxygen toxicity include hyperbaric oxygen therapy patients, patients exposed to prolonged high levels of oxygen, premature infants, and underwater divers.

- Oxygen Toxicity (last updated November 19 2020)

In recent years papers have been published about "Permissive hypercapnia", whereby doctors talk of the success they've had in not hyperventilating their patients and allowing slightly-higher levels of CO2 to build up in the patients' blood (search for this term over at scholar.google.com).


WHY DID MEDICINE FORGET ABOUT THE TOXICITY OF EXCESS OXYGEN AND THE IMPORTANCE OF CARBON DIOXIDE?

Wikipedia's references are sometimes more valuable than the articles themselves. From Reference #1 on the Bohr Effect:

The carbon dioxide pressure of the blood is therefore to be regarded as an important factor in the inner respiratory metabolism, which itself can be regulated by it in a very effective way. Furthermore our experiments help to explain different observations on the supporting effect of carbon dioxide in cases of oxygen lack: If one uses carbon dioxide in appropriate amounts, the oxygen uptake of the lungs will not be influenced, whereas the oxygen, that was taken up can be used more effectively throughout the body.

This is a 1997 translation of a paper published in German in 1904.

Many of the early scientific papers about gas exchange discussed the importance of Carbon Dioxide for health. Carbonic Acid in Medicine was published in 1905. This fundamental book guided the incorporation of CO2 into medical practice. By 1940 published medical texts discussed using Carbon Dioxide to stimulate breathing. NASA incorporated understandings about oxygen toxicity into the space program (link above). 

Then Science forgot? WHAT HAPPENED? I don't know.

I asked a retired firefighter (28 years in the field, starting in 1968 iirc) if they'd ever used Carbogen to revive their patients in the field. He was not familiar with this use of this technology to easily stimulate breathing in the comatose. But he said that more than once they'd stabilized a patient and successfully gotten them to the hospital, but later got word that their patient expired shortly after handoff to hospital care.

There should be no controversy about what is actually the best practice for helping patients with low oxygen saturation levels. But doctors all around the world are still implementing harmful treatments with pure oxygen, even for conditions where pure oxygen therapy is specifically contraindicated, in theory and from observations in the field.   

The Exhaust Port on Allopathic Medicine's Death Star

Allopathy was coined by the founder of homeopathy in 1810 as a derogatory term for his competitors, who commonly used bloodletting, calomel (mercury), the Materia Medica, and other not-very-helpful treatments for their patients. With little understanding as to the actual causes of their patient's symptoms, heroic allopathic treatments were not likely to be especially helpful. No matter how ineffective homeopathic remedies might be, nothing is worse than Allopaths' efforts to help their patients by bleeding them to death.

The heirs of heroic medicine's legacy adopted the Scientific Method in the late 1800's, and made great progress in figuring out how to improve health in the early 20th century. But while antibiotics and aspirin are useful, the idea of a pill for every condition has placed a stranglehold on medical progress. I have many stories of taxi passengers (circa 2012-2015) whose actual problems seem to have been missed by their medical providers. It's sorta easy to get someone to survive, but much harder to get them to thrive.

All too frequently, even in our modern age, doctors diagnose their patients but treat the diagnosis.

There will be no flood of emergency room/critical care doctors to this site, TaxiWars.org, who read this blog post and say, "OH MY GOODNESS GRACIOUS, I'VE BEEN OXYGENATING MY PATIENTS TO DEATH!", and, "I'll start to use Carbogen (95%/5% O2/CO2) immediately!" 

But if a bunch of us contact our local hospitals' insurance companies and ask if the hospital's emergency room is covered for the negligent use of pure oxygen to worsen their patient's conditions, maybe we'll get somewhere.

Form Letters

FORM LETTER ASKING HOSPITAL WHO THEIR INSURANCE COMPANY IS, AND IF THEY USE PURE OXYGEN OR OXYGEN WITH THE ANTIDOTE

FORM LETTER TO INSURANCE COMPANY THAT PROVIDES LIABILITY INSURANCE FOR YOUR LOCAL HOSPITAL

Spread the Word?

There's a lack of good information in our modern era, and we're often distracted with items that aren't actually important. Our modern information gatekeepers presumably mean well, and don't appreciate they've become the Ministry of Truth we were warned about. This post hopefully doesn't use any of the keywords that trigger Skynet's auto-cancel functionality...

Tell your friends that you've recently learned about the importance of not letting yourself get oxygenated to death.  Spread the word. The truth shall set us free.

The good news is that we have the technology to improve people's oxygen saturation levels without oxygenating them to death. With the right motivation, our medicalists can rapidly correct course and we'll have a new golden age of more effective medicine. 

Prasad's Law is the observations that medical goods and services that concentrate wealth can be paid for, while medical goods and services that disperse wealth are "unaffordable."  From the link, "[...] the true purpose of the U.S. healthcare system is by no means to supply medical care (although that is indeed the goal of many who work within it), but instead to serve one overarching purpose – to make money for capitalists."

Prasadic Medicine is when doctors do the most expensive thing possible, even when gentle simple medicine would suffice.

Gentle Medicine is the opposite of Prasadic Medicine. Gentle approaches to health are much more rational than magic-bullet-seeking medicine (modern heroic/allopathic medicine).

Advocating for Gentle Medicine with our local hospitals' insurance companies seems like a reasonable path to help our doctors and medical practitioners realize they can be much more effective for their patients.

Good news isn't enough to fix problems where one party to the transaction is profiteering. Print out the form letters and mail them to the insurance companies. We'll certainly get their attention.  😂😇

-TaxiCabJesus (a pseudonym)

June 21, 2021


(Below is a summary of this website.)

Background of TaxiWars.org

After eight days in my leased taxi I was having a good time, and started to blog about my passengers so I wouldn't forget their interesting stories. My username for that little website, "TaxiCabJesus", was inspired by user "Zombie Jesus Christ" (real name: Michael David Crawford). 

Zombie Jesus Christ aspired to help solve the worlds' problems. My posts as TaxiCabJesus were to share some of the little inconsequential things I'd do to help my random taxi passengers through their days. 

The other users at the blue website thought I was trolling Mr. Crawford. My video of the police helicopter deployed for the extraction of my one passenger from a sticky situation helped to convince that I was genuine. (Passenger Rescue / Passenger Rescue, Pt. II)

Zombie Jesus Christ was handicapped in his efforts to solve humanity's problems on account of his 'mental illness' (misdiagnosed as schizoaffective disorder). He'd poisoned himself by playing with mercury as a child, dropped out of Cal Tech on account of the emotional stress of witnessing a murder, and never got the help he actually needed. I eventually visited Zombie Jesus Christ when he was mickeyed up in the SLO county jail (California), and a few times after he'd been released. I last heard from Zombie Jesus Christ shortly before he self-terminated: his breathing was failing from his treatment with psychiatric drugs, and he realized he had no chance of recovering with the medical help he was able to get. In his final email Michael said he'd greatly appreciated my efforts on his behalf. 

The website that originally hosted my taxi diaries went offline a few years ago, as the founder had lost interest and didn't pay attention to the emails he'd received about his data center's planned move. Fortunately I'd saved my diaries, and have posted most of them to this website. 

Witness to Medical Profiteering

My very first taxi passenger was a middle-aged woman and her fiance. She was going for outpatient surgery; he was going to be helpful. She didn't have much to say; the fellow was friendly, and ... 'simple'.

As my months of taxi driving progressed, I decided our modern medical industry is a job project for taxi drivers, as the government sometimes spent more for me to take a patient to and from their appointment than the medical provider received for their services.

I later ran across the idea of Prasad’s Law, which posits healthcare is an exercise in wealth concentration: health insurance companies in the United States happily pay for fantastically-expensive but probably-won't-be-helpful interventions ("marginal and useless and mediocre drugs", endless screenings/imaging services, etc), but won't pay for things people actually need: adequate nursing staff, home health care, good nutrition, electric wheelchairs, etc.  (I suspect "health insurance" in other countries is typically more realistic, and does not pay for resource unlimited medicine.)

I have many more anecdotes of probable medical profiteering, but some of these aren't so politically-correct in our modern era, and I'd prefer to not get canceled. 

No comments:

Post a Comment