“In the fields of observation chance favours only the prepared mind.” is a quote from Louis Pasteur ( 1822– 1895) French microbiologist and chemist. en.wikiquote.org/wiki/Chemist It was due to chance that we even found out about Paula! It was a happy accident! It was serendipity! It was right in front of us waiting to be found. [a second time]. It had important implications for what we thought we knew about being alive and well. Paula and I had never heard of bradypnea or the neural control of breathing. . It was not a visible or obvious thing. It required measurement, simple measurement! I have been friends with Paula for years and years and she seemed fine to me. If we hadn’t taken a first aid class for work, we would never have found out. This was a total surprise. If I hadn’t read Kraepelin’s studies on Manic Depressive Insanity, in my undergraduate years at University, I would not have known that he too uncovered “abnormal control of breathing” issues in patients ill with depressive insanity. [and mania, but that discussion will have to wait for a future blogpost – however, I think we have figured out why mania occurs]. Kraepelin was a master of observation and a huge fan of basic measurement. He measured the basic, vital signs of his insane patients to learn about their basic physiology and/or pathophysiology. Kraepelin learnt that some of these patients seemed to have neural problems limiting their ventilatory system. There were thousands of these patients. Along with abnormal vital signs, these patients had abnormal mood [anguish-distress, euphoria] plus inhibited motor activity or excitement of motor activity. The locomotor changes spited with changes to the pattern of abnormal vital signs. Kraepelin understood that abnormal vital signs were causing abnormal metabolism and abnormal mood and locomotor activity.
After that I found out that early respiratory researchers such as JS Haldane found that the range of respiratory rates in the normal healthy adult population was wider than we assume to be the case today, from as low as 3 breaths per minute at rest when awake [ like Paula] to as high as 30 breaths per minute at rest when awake. Why? What did this mean for those at the extremes of the range? How could they respond to metabolic or respiratory challenges if their breathing seemed so different?
I just finished reading a book called Happy Accidents; Serendipity in Major Medical Breakthroughs in the Twentieth Century by Morton Meyers MD. 2007,2011.
Dr Meyers explains that a lot of medical breakthroughs were discovered by chance, ignored at first, only to be rediscovered and explained decades after…..helped along by chance and pursued by prepared and curious and hardworking and persistent minds.
Dr Meyers tells us that “ discovery [often] requires serendipity but serendipity is not a chance event alone. It is a process in which a chance event is seized upon by a creative person who chooses to pay attention to the event, unravel its mystery and find a proper application for it.” from the Preface of Happy Accidents.
“Successful scientists may have the insight and creativity to recognize a “Eureka” moment when it happens, see the potential, and know what to do to take it to the next step.“from the Preface of Happy Accidents.
The Eureka moment for Paula and I occurred every day [ from the time we discovered her bradypnea] as we counted her ventilatory rate over and over during different times of the day. The Eureka moment occurred the we counted her ventilatory rate when she became unwell and found it did not change. The Eureka moment came when doctors reacted in fear, dismay and avoidance when we told them of her respiratory rate. The Eureka moment came when we got the Hexoskin shirt to measure her respiratory rate electronically for hours at a time while she read books and confirmed what we found just by counting her respirations with a stopwatch. The Eureka moment came when we realized that we had Paula’s tidal volume and it was completely normal at .5L. The Eureka moment came when we discovered how to multiply respiratory rate times tidal volume to obtain Paula’s Minute ventilation. [something which doctors do not measure anymore]. The Eureka moment came when we found that scientists and physiologists and doctors seemed to think that Paula’s minute ventilation of 1.5 L was incapable with life and with health. Since Paula and I got together for decades since the surprise finding of her Bradypnea [I think that this is what it is called in medical language], we knew that the current science was wrong because Paula was fine. This too was a Eureka moment.
We know that Paula’s very existence means that this serendipitous finding is important to understand. I know that we wonder every day with every discussion…how is it that Paula is alive? How is it that she is very well, fit, cheerful and thoughtful? How does her metabolism work? How has it adapted? What role does air and the movement of air in and out of the body have to do with mind, health and life?
We wonder every day. I look at Paula every day with wonderment.
Could it be that thousands of patients are sick and delirious because they, like Paula, cannot raise their fixed involuntary breathing rate in response to a respiratory stimulus either?
Why was Paula sick for a year and a half? Why has she gotten better and better over a ten year period, even though she still has bradypnea.
Why hasn’t she become sick again? Her breathing is still broken. Does it really have to do with the effect of the serotonin agonist she takes every day? We know that this medication does not change her neural breathing defect…..she is still breathing 3 breaths per minute at rest when awake. Is this serotonin agonist helping her metabolism adapt somehow?
We are not scientists and we cannot answer these questions. It seems that scientists cannot answer these questions either because they do not know or accept that we and Kraepelin discovered this neural ventilatory defect of injury in Paula and in thousands of others, in illness and in health.
If scientists and doctors begin to listen to what we found and what Kraepelin found, we might be able to add this to the number of Happy Accidents; Serendipity in Major Medical Breakthroughs in the Twenty-First Century.
We need to look at respiratory rate, tidal volume and minute ventilation in unmedicated patients with neurological illness, with major depression, with essential hypertension, with heart failure, etc….to see when hypercapnia is a factor and whether we can give supportive treatments for it.