Is Paula OK?

Some people have written that they are concerned about Paula’s health.

Do not worry, we have a support team of doctors who know what to do if Paula ever gets sick.    We even put it in her medical file….because we were afraid they would forget.  We are in continual contact. 

Hopefully we have addressed your concerns about Paula.

The point that both Paula and I wish to make is that scientists do not know a lot about disordered breathing that is not conscious, that is involuntary, and that is due to mechanical issues- not the lung…..same as sleep apnea was not a “thing” till 1965.  

Now scientists understand about at least one major breathing disorder, as a result of investigating and discovering sleep apnea and scientists are still investigating how it affects alertness, cognition and blood gases and lots of new things. But there are still more [hidden] breathing disorders to unmask. And they most certainly will affect alertness, cognition and blood gases and long term health.

Abnormal respiratory rate despite normal lung function may be the next new thing in learning about disordered breathing that the patient cannot identify and no one knows about !  

We think that this should be investigated further. 

  By scientists in the future. 

 They should at least be curious about it. 

Paula is not the only one.   

How do we know whether others resuscitated at birth or at any time in their lives have mechanical injuries leading to unusual metabolism and unusual patterns of vital signs, including minute ventilation, like we accidentally found in Paula? We don’t.  No one does.   We have never measured their minute ventilation [tidal volume times respiratory rate].e have never taken their nonspecific signs seriously.

 That is why Paula’s case is significant beyond herself.

We think this is a fascinating thing to explore. 

It is only by accident that we even know about Paula’s breathing mechanics. [described in the earliest blogposts].

And too slow breathing was identified 100+ years ago in depressed and insane [delirious] patients who were cared for in asylums.   It has since been forgotten.   

Dr Emile Kraepelin, in the last century , identified this as an issue in thousands of his patients during the time they suffered attacks of bipolar depression.  He knew they had respiratory failure. He was a doctor and also knowledgeable in  evolutionary biology, and in zoology, and in  botany, and in experimental psychology and physics and  chemistry and mechanics. [you could do that back then- if you worked in a famous and renowned University- He was  a polymath and was trained by and worked with  Helmhotz and Wundt..]

He thought these patients  had a ventilatory defect.  Because they did.  And yet, they mostly did OK [except when challenged further by physical illness and even then they were mostly robust over the long term.

 Kraepelin himself was amazed even back then.  He did not have our modern scientific tools to figure out how they even remained alive, depressed or not

 Unfortunately these patients had a remitting/relapsing pattern of serious debilitating illness. 

 But they would recover spontaneously without treatment even after decades of illness.

And today in the 21st century we have treatments Kraepelin could have used on his sickest patients;  antibiotics, bronchodilators, CPAP, BPAP and SSRI’s [thought to help prevent SIDS in infants and also helps the liver regenerate faster and is key to control of bone metabolism [think spine and ribs and attachments in pump failure].  He surely would have investigated that.

One of the main physical signs of respiratory acidosis type 2 is altered mental status. 

Anyone with altered mental status should probably have their vital signs recorded and analyzed , especially minute ventilation. It is so easy to measure minute ventilation. Then maybe even arterial blood gas tests could be obtained [ even in outpatients ].

We think that patients with neurological problems and neuropsychiatric problems who develop altered mental and locomotor status and cognitive problems should definitely have their breathing rate and tidal volume assessed.  Why not?

We have no idea how many patients have become too weak or too deficient nutritionally or too crooked [bones shifting slightly,  affecting torso or neck or internal connective tissue and ventilatory mechanics]…. inhibiting their ability to properly move air in and out of their lungs, especially during  even minor further respiratory challenges.

This has never been studied.  Vital signs are vital to normal physical and mental function. The respiratory system with its respiratory pump mechanism is the “first responder” to any metabolic challenge.  Yet we do not bother to obtain minute ventilation???

 In the future we may discover that  many more patients than we realize may need supportive medical care to clear their symptoms and get them back to their baseline function.. 

 I am flabbergasted at the lack of curiosity of scientists and respiratory physiologists and doctors and thinkers. Paula and I have been discussing this for at least 20 years.

We wish we could bring back the likes of thinkers like Helmholtz, Wundt and Kraepelin and Darwin.

We hope we are making you think.   I hope you will help us to get your colleagues to think too.

And  do not worry about Paula- she is fine- she has lots of doctors and she has me.

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