A Question for Clinical Researchers of Mind; I would like to know if you measure breathing rate at rest when awake in unmedicated patients at the start of their illness?
Let me explain why I think that this might be important.
This would be a non invasive start to learning about what the brain stem already knows that we MUST know in order to understand the handling of carbon dioxide in the blood.
Carbon dioxide [and water] is always and continually being produced in our blood, it is a normal product of cell metabolism. And the only way humans have to eliminate excess carbon dioxide in the blood is to exhale it. Exhaling is a passive process apparently, like letting air out of a balloon. It should take no work. Exhaling, for Paula, takes a lot of work…at rest , when awake, muscular work…her clothes cover up the work it takes for her to exhale and squeeze out every bit of air she can. She does this almost involuntarily; she is aware yet not aware…exhaling takes a lot of effort, work, maybe calories. She thinks this is normal breathing, she thinks everyone breaths the way she does. She found out she was dead wrong.
Paula has hidden ventilatory system injuries which make acid base regulation more difficult, especially carbon dioxide regulation in the blood.
I do not understand why we found out about Paula’s inability to raise her abnormally slow regular breathing at rest [in health] when awake ..accidentally, …only because we took a first aid class for work. Her lung function is normal [for her age] at .5 L per breath.
So this is not a pulmonary problem. Her lungs are very healthy. This is clearly a neural injury affecting the complex motor act of breathing. Interdisciplinary research is needed to further our scientific clinical knowledge of this “Broken Breathing” , as I like to call it, or ventilatory defect/injury [permanent] – take your pick.
The implications for heightened risk of future hypercapnic respiratory failure in patients with ventilatory defects/injury is clear.
Yet, no one [ neurologists, not even pulmonary specialists] measures respiratory rates at rest in neurology or any branch of medicine.
This despite the complex neural and motor act of breathing involving involving more than healthy lungs to be able to move air in and out of the body, this despitethe knowledge that the brain stem regulates the vital signs of RR,BP,HR,and body temperature to maintain homeostasis, especially normal PCO2 levels in the blood.
This despite carbon dioxide in the blood being a cerebral vasodilator. This despite the ease of carbon dioxide retention in humans, during illness or exposure to heightened levels of CO2 in poorly ventilated, overcrowded conditions with cheap heating and cooking fuels spewing out more CO2.
This despite the knowledge that carbon dioxide effects include mental confusion, distress, and even coma.
This despite that carbon dioxide is a NORMAL product of cell metabolism and the brain stem and the autonomic nervous system is practiced in dealing with it. This despite the knowledge that carbon dioxide in excess is a reversible intoxicant , a deliriant , and an asphyxiant, depending on abnormal levels in the blood.
This despite the knowledge that CO2 effects are reversible as long as you do not die.
This despite our modern 21st century tools which can offer brain saving supportive medical care and non invasive breathing support to potentially restore cardiovascular and mental status.
This hypothesis needs to be explored further.
I would like to tell you about one baby [Paula] who did not take her first breath at birth, was suctioned [she’d swallowed meconium] and was resuscitated [hyperoxia] and the needed to be transfused [adult blood products?] in 1955, Paris France. Her name is Paula, and we discovered by accident that her adult breathing rate is abnormal [in health] although her lungs are healthy. And she had no idea. She is 65 today. We converse everyday over coffee [by Zoom, now].
Accidental findings can lead researchers to discover things they would never have dreamed possible.
Please read more below; Paula and I are eager for researchers to know that hidden injuries can occur at birth or in early childhood that can interfere with the ability to manage respiratory acid base problems and that careful measurement of respiratory rate will unmask these injuries/defects in health and doctors should be aware of these defects/injuries when such people become sick, say with a virus, or when exposed to high levels of environmental CO2 or other chemicals.
Please read my email to infectious disease doctors voicing my concerns regarding hidden hypercapnic respiratory failure.
” I am interested in hidden hypercapnic respiratory failure.
I am not a doctor or a scientist but I have learnt a lot about my friend Paula. What I learnt may provide clues to the ongoing cardiovascular and neurological and neuropsychiatric problems post- COV-ID. [and will certainly be potentially useful in understanding other neurological, neuro-psychiatric and cardiovascular syndromes..]
Please let me explain. Paula and I took a first aid class for work. We were shown how to measure involuntary respiratory rate at rest when awake on each other. We were to lie down and relax and someone counted our respirations for one minute with a stopwatch. Watching people breath, lying down, it was easy to see who had significant active exhaling [which is not normal]. What was fascinating is that in a group of 30 healthy adults, the RANGE of respiratory rates were as low as 3 breaths [Paula] per minute to as high as 30. The average, of course, was around 12.
No one was aware of their own respiratory rate. It is involuntary at rest. Everyone in the class felt normal. But they weren’t all normal.I think that this is my point.
I think that people with too slow or too high respiratory rates at rest when awake, for whatever reason, will be at greater risk to the cardiovascular and neurological effects of respiratory insufficiency [and CO2 retention] and will not know it.And without a routine procedure to unmask such respiratory injuries/defects, we will not only do harm to these patients, but we will miss opportunities to help them move air in and out in times of further illness and injury and blood loss.
There is no reason for this in the 21st century.
My question to you is this; why are arterial blood gas studies not done on ambulatory patients with long term complications affecting the circulatory system and cognition and mood?
We have ABG’s. Yet no one uses them in clinical research to advance our knowledge of insidious and silent respiratory insufficiency which adult patients themselves cannot signal because this is part of basic vital signs orchestrated by the brainstem and the circulation, despite whatever previous injuries the person may have sustained over their lives.
I will give Paula as an example. We have been studying her for 20+ years when we realized that doctors were freaked out when they heard about what we found; this despite their many tests …[not ABG’s], they gave her to make sure she was not dead or dying. By the way, her HCO3 and her pulse oximetry are normal. Her doctors showed absolutely no scientific curiosity about the biological phenotype she represented [there are others like her] or what autonomic nervous system injuries she may have sustained over her life.
We found out…from her family…that due to circumstances of poverty and poor nutrition, housing, ventilation, exposure to chemicals from cooking and heating fuels [coke ovens were big in 1955 France to heat ones apartment], her Mom and Dad had had Rickets and her Mom had crooked lower body bones.
So she got stuck in the birth canal during her birth, was born not breathing [anoxic], was suctioned [swallowed meconium], was resuscitated [hyperoxia] and then transfused [probably adult blood products]..….She was perfect from then on….a medical miracle ….in 1955 Paris, France! Her lungs are completely normal and healthy. Her tidal volume is normal….5 L per breath….note it is not abnormally deep….it is simply normal….despite her too slow breathing rate.
And no one can explain that either!
Which makes it exceptionally significant to our scientific understanding of the complex motor act of breathing.
This probably explains her unique biology, and that of others who successfully survived injuries at birth or in early childhood.
The brainstem and autonomic nervous system controls everything in the body and can adjust in ways we cannot even imagine, all revealed easily, I think, by the vital signs, Respiratory rate, Heart rate, blood pressure, and body temperature during times of health and during times of illness. Some people will require extra help [modern supportive medical care] to recover because of past injuries/defects that nobody is aware of, including them.
This is to say that people can have respiratory defects or injuries and have no idea and will show no signs, except for a higher risk of carbon dioxide retention making full recovery from major illness or surgery more difficult for long periods of time.
Dr Emile Kraepelin found abnormal breathing rates in thousands of his patients during the different stages of unmedicated Manic Depressive Insanity in the 1900’s. He understood that these poor souls had respiratory defects. Despite this, the bipolar patients were the only ones in the asylums not only to survive, but to have long periods of remission where their physical and mental health was restored- without- as he put it, permanent brain damage.This is most likely because the effects of carbon dioxide retention are reversible [with supportive care or simply when the patient heals from a virus on their own. Without supportive medical care, the attacks could disable patients for decades…wasting large periods of their lives.
This happened to Paula long ago. She had a long episode of depressed mental status to go along with her depressed breathing. Retention of CO2 in the blood will cause a syndrome of anguish [dyspnea], mental confusion, disturbance of memory and dulling of cognition, and sympathetic activation [high blood pressure, high heart rate, murmurs, arrhythmias] during the hypercapnic episode. This is what Kraepelin described in his patients with too slow breathing during the period when their intellect and locomotor activity were depressed or inhibited.
We found out that Paul cannot raise her breathing rate , when exposed to high levels of indoor carbon dioxide or other pollutants, and she cannot raise her breathing rate when suffering from a virus and this puts her at a big disadvantage, doesn’t it?
We simply measured her respiratory rate like we were taught, during health and during that time she was ill, and this is how we found out that her breathing rate is not only too slow [respiratory depression] ; she cannot respond to chemical stressors. And no one but us [and Kraepelin] knows this. Because no one measures respiratory rate at rest when awake.
We even replicated this with a respiratory plethysmograph [in the form of a modern Hexoskin Shirt].
Her breathing rate is fixed at 3 breaths per minute, and only rises in response to locomotor activity [and even then it is still sluggish and abnormal] and to physical touch.
This suggests damage to nervous system sensors commanding muscle; most likely those in the neck and torso, I would think. [just guessing -needs study]
When she had that period of illness and cognitive impairment [from which she completely recovered..but it took a long time due to lack of any supportive medical care]…..she was unaware of breathing difficulties [and did not complain of any], had no visible shortness of breath, still had increased work of breathing- which no one noticed [as she does in health], BUT she experienced huge Anguish, Fear and Distress and did not know why. In early respiratory textbooks during the polio epidemic, this sensation of anguish was understood to be a form of DYSPNEA. Today, this has been forgotten. [it was widely known during the polio epidemic.
We think that she had retention of CO2 in the blood, which could have been measured by a arterial blood gas test, which is never given to delirious or demented or neuropsychiatric patients or neurological patients or even heart failure ambulatory patients , even as a scientific exploratory tool to understand more about carbon dioxide in the blood and the many ways the brain and the circualtion have of dealing with it because carbon dioxide is a NORMAL product of cell metabolism.
I am disappointed in the lack of scientific curiosity in the medical population.
If Paula ever gets sick again [G-d forbid] , she would want acid base studies to be done in order to be able to restore her cardiovascular and neurological health and to restore her cognitive abilities.
She would be furious if left to slowly die from a potentially reversible dementia in a psychiatric or neuropsychiatric or in a nursing home, without doctors investigating further.
So what if ABGs are a little risky, so is surgery….I do not understand….and I have been urging doctors to become interested in this ever since we found out about Paula.
And by the way, we suspect that the sensors of those people with the too high breathing rates have also been damaged, impeding their ability to lower their respiratory rate in response to chemical stressors.
Please let me know if you have any questions.
We think that this information will help you to better understand post covid symptoms , both neuropsychiatric, neurological, and cardiovascular and will help further our knowledge of our carbon based biology.
Please share this email.Please think about ABG’s as a scientific research tool.
Please let me know if you wish to look at our blog on Mind and Loss Of Mind…where we do out research and think our thoughts as they progress.
We have one brave pulmonologist/physiology professor teaching us respiratory physiology and he agrees that Paula’s existence provokes us to explore what we thought we understood but clearly don’t – because Nature is more clever than we are, it seems- and more creative too.
I hope you use this to learn more about how to help post covid patients with lingering neurological syndromes. Their lives will depend on it.
[by the way, serotonin agonists helped Paula to regain her mental status but it took a long time; we do think that it helps for the same reason [unknown] it may be useful in Sudden Infant Death Syndrome [if indeed it is].
Please share this blogpost with other clinical researchers!!!!!
Minds and Lives may depend on it.
Of Sound Mind 