Neighbourhood poverty affected Paula and directly impacted her health and her risk for major depression as an adult.
Paula was born in poverty in 1955 in Paris France. Her parents were poor and both suffered from crooked bones due to having had Rickets during childhood. The crooked pelvic bones of her mother caused considerable birthing problems during the birth of Paula. I discuss this further later on.
Paula’s father was a furrier and he had his workshop in his apartment where they lived. This was common at the time in Paris. The family lived in a poorly ventilated apartment zoned for industrial use. The family used a coke oven to heat the place. So Paula was conceived and born into a very polluted indoor space, exposed to many harmful chemicals.
At the age of 2 1/2, the family moved to Canada where the living conditions were much much better. The whole family became healthier. The father worked outside the home. There were no more dangerous furrier chemical pollutants There was no more home industrial workshop. . There was better, safer heating in the house. [Canada is very experienced with cold]……however, there were hidden physiological consequences that were to affect Paula as she became an adult…..which we will now describe….
Paula and I seemed to have stumbled onto a physiological puzzle. So far, the clinical researchers we have approached have no answers and get upset instead of curious. We hope you, our readers, will be inclined to be scientifically curious.
My friend Paula has an acquired or genetic injury limiting her ability to move air in and out of her body. And she had no idea. She is very healthy, very fit.
In the fields of science and medicine, accidental discoveries have often led to new ideas and to progress. And we made an accidental discovery regarding Paula at a basic first aid class around 20+ years ago. In that class, 20 years ago, respiratory rates were measured manually. The range of respiratory rates were very wide, from as low as 3 breaths per minute to as high as 30 breaths per minute- in normal healthy adults who attended [about 30 of us]. Apparently pioneer respiratory physiologists had discovered this also, in the 1940-50’s. It was always assumed that tidal volume made up the difference so an adult was always somehow exchanging 6-8 litres of air per minute. But we think that this may or may not be true.
Since that first aid class we now understand much more than we did then. We know that most modern doctors do not measure resting breathing rate. We think this is unfortunate.
Paula has a resting breathing rate of 3 breaths per minute with active exhaling. Her tidal volume is normal and has always been normal. As of 5 years ago her tidal volume was normal at .5 L [age 65 ]. This means her minute volume is 1.5 L per minute, something which frightens all her doctors.[they assume that this is incompatible with being alive]. Yet Paula is fine. Better than fine. And very smart.
Her PCO2 [partial pressure of carbon dioxide in the blood] ? No one knows because she is not sick. In Canada [and in most places, I think] arterial blood gases are only done on the critically ill and Paula is fine.
She does not seem prone to respiratory failure, even when sick. She gets sick the same as everyone else. She has recovered well from adult illness, like a cold, allergies, stomach flu, etc…She recovered well from her childhood illnesses [measles. whooping cough, chicken pox, croup, etc.].
She does not have asthma. Her lung x rays have always been normal. [between the ages of 20 and 30 she had a chronic barky cough so she had lots of x rays and lung function tests – all normal]. [turned out to be inflammation from chronic post nasal drip, flonase cured her after 3 months of treatment]
Paula has active exhaling at rest when awake. She thought everyone did.
Her work of breathing is considerable and involuntary. She thought this was normal.
She has no dyspnea, no shortness of breath [at rest, awake] and no sensation of air hunger [unless she voluntarily attempts to breath at a normal rate].
She is in great health today at age 65; normal 02 [pulse oximetry], normal HC03, normal cholesterol, normal routine blood tests, normal liver function, heart function, kidney function, and normal lung function. We know because her doctors gave her many tests to check that she was OK after we told them about her difficulty moving air in and out of her body. She cross country skis for a hobby in the winter. She sleeps very well. No sleep apnea.
Hence the puzzle. From her perspective, she asks why do others need to breathe at 12 breaths per minute ?
We think we have discovered the answer. Her achilles heel is exposure to indoor [usually] places that are poorly ventilated, overcrowded, moldy, and humid- especially if these spaces also are full of cooking fumes, and/or fumes/particles found in industrial workplaces or hardware stores. [dust and particles from lumber, fumes from rubber tires and the like, etc..]. Remember these are the interior housing conditions that she was exposed to when her mother carried her in the womb and during her first two years of life when the family lived in Paris France till they moved to Canada in 1957 [never mind her difficult entry into the world at her birth].
Paula simply does not have the ventilatory flexibility to deal well with further exposure to stuff that impedes her breathing even more.
I have no idea how you would ventilate a person like Paula if she were to become critically ill. You would not know that she needs 1.5 L of air per minute not 6-8L. We do not know what a normal PCO2 is for her.
Why is Paula like this?
We figured that out also. Paula was born not breathing- she was anoxic. She was suctioned [she’d swallowed meconium], resuscitated [exposed to hyperoxia] , and transfused [exposed to foreign [ adult ?] blood products and was completely normal from then on.
It is a great success story, really.
And, I think, this story teaches us about the enormous variety of strategies the nervous system can use to compensate for what I call, hidden “broken breathing”.
Paula and I are tired of being met with fear when scientists and doctors learn her story. We think that there are others like Paula and that they have not necessarily have done as well as Paula.
In the 1920’s Dr Emile Kraepelin measured the vital signs of patients in insane asylums.He found one group who also had abnormal resting breathing rates. There were no treatments for anything yet. He understood their anguish and distress to be from “too slow breathing” rates and found too fast and periodic breathing in the same patients when they suddenly flipped to euphoria, mania,psychosis, irritability and combativeness. Kraepelin understood that these poor patients could not compensate during a metabolic crisis. What fascinated Kraepelin was, despite these considerable limitations to their ventilatory systems, patients often had spontaneous recoveries and recovered their normal health and mental status – although it might take decades before they recovered. He was astonished that these were the only group to have periods of full recovery but also that there was no permanent brain damage in between attacks.
This today suggests lengthy episodes of hypercapnia.
Increased carbon dioxide in the blood and having difficulty exhaling it is known to cause mental confusion and most likely poor health. It would not be unusual in the 1900’s in Europe to suffer poor living conditions, exposing vulnerable young adults to environments with higher carbon dioxide in the air, perhaps causing stages of hypercapnia, the patterns of which are dictated by stable but abnormal resting breathing rates. Indeed, Kraepelin thought manic depressive patients to have defects, breathing defects. Because they did.
This is why Paula is significant. She is lucky . She is no longer exposed to poor living conditions . She has stayed healthy despite the risks of having a normal [for her] but depressed rate of breathing.
Her breathing rate does not go up normally when exercising, although when working very very hard physically it can rise the same as everyone [we think…we have no idea].
So we urge you to think about the complexities of respiratory acid base in a person such as Paula, in sickness and in health.
The brain and the nervous system are very practiced at dealing with a normal product of cell metabolism, such as carbon dioxide . Respiratory acidosis is common [for example during exercise, which is supposedly good for you.] . One does not usually drop dead during exercise even though more acids are produced and we still do not fully understand how.
Please think about this.
Paula exchanges 1.5 L of air per minute as a healthy, fit adult and may have done so all her adult life. We know for sure that this is true of the past 20-25 years since we measured her breathing rate in that basic first aid class.
We think that this is a general medical puzzle which concerns everyone. The neck and torso are easily injured at birth and throughout life and can have consequences for the control of movement of air in and out of the body. It is easy to break some of the many sensors involved with the ventilatory apparatus of the body.
Apparently the brain and the nervous system is able to handle respiratory acid base issues in surprising ways we know little about. Please feel free to forward this blogpost to people who are knowledgeable in comparative biology and like to think. Please share with other doctors and researchers interested in this exciting puzzle.
Please have people stay in touch with us, if they choose to learn more about the range of minute ventilation in healthy and in unmedicated patients with hypertension or neurological illness or neuropsychiatric illness or any organ failure at all.
We are signaling a “silent” physical sign, one which the patient will not be aware of [since respiratory rate at rest when awake is involuntary].
The pattern of vital signs [in unmedicated patients] may tell an important story of past injury at birth or afterwards which might determine what kind of illnesses the patient might develop as they age.
Paula did have a long episode of bipolar 2 depression or major depression when she was middle aged [around 40] and we discuss what we have been learning over the past 20 years. She has completely recovered and remembers what it was like to lose her mind.
[ To understand our ongoing ideas mind and loss of mind and the role of PCO2 and hypercapnia, please look at our post on *** a Potential two Step Marker for Bipolar Depressive Illness [to start] and our post on *** How to Save a Manic Depressive Life.
1] https://ofsoundmind.life/2020/11/09/we-have-a-2-step-marker-for-bipolar-illness/ We have a potential new 2 step biomarker for bipolar illness. Ventilatory issues and [hidden] hypercapnia can cause specific patterns of “odd behaviour”, mood and locomotor activity.
At the very least!
Paula and I have identified a ventilatory injury/defect in that I can be most clearly identified in the depressive stage of manic depressive insanity. Kraepelin seems to have identified the same injury/defect over 100+ years ago. This is what is guiding us to new research to connect the dots. It is a lot of fun. It is something that scientists can follow up on. And we think this will make a huge difference in the new updated understanding of the reversible syndrome of bipolar illness and its treatment. this is how we have gotten to learn about adenosine and its ability to inhibit respiration rate in the face of hypercapnia……to be continued.]