First of all, who knew that respiratory rate could get stuck? [except for Kraepelin-who measure respiratory rate, blood pressure, heart rate and heart signs, and body temperature]. Certainly not Paula. And Paula’s own respiratory rate is stuck. And if she does not measure it, she still doesn’t know it. And neither would anyone. That is why Respiratory Rate is important to measure and understand. Control of breathing involves a normal range of respiratory rate. RR [RR means Respiratory Rate] is supposed to be able to respond to airway obstruction, exposure and exercise. Paula’s respiratory rate is unresponsive to increased CO2 , it seems, and is sluggish to rise, even in response to exercise. Her lungs are normal and her lung function same as the average person, no greater. Paula feels that her breathing is normal, she looks like her breathing is normal. She behaves normally, does not show distress but her minute ventilation when healthy is abnormal
Minute Ventilation; Show Results!!!!!!
Dr Emile Kraepelin, famous doctor, scientist, physiologist, biologist and psychiatrist found depressed respiratory rates in thousands of unmedicated bipolar depressive patients who became unable to care for themselves and could switch to restless, euphoric mania overnight-it seemed, after years of depressive bipolar inner distress. The pattern of breathing changed with manic attacks, becoming erratic and fast, with apneas. Kraepelin carried out these studies over a hundred years ago and tried to tell his psychiatric colleagues, but they would have none of it. And then, as now, his psychiatric colleagues refused to measure the basic vital signs of the respiratory rate, depth and pattern.
Paula had a single episode of bipolar depression, similar to what only Kraepelin describes, and no one thought to check her vital signs. Vital signs seem necessary to the health of the circulatory system. RR affects modulation of arousal state, modulation of normal products of cell metabolism,[ produced under different physical conditions : fever, hypothermia, infection, dehydration, injury, blood loss, etc..] modulation of biological stuff such as PaCO2 and water, modulation response to waste gas in indoor and outdoor air, and modulation of the circulation of blood [whatever its contents, normal or not] to the body tissues and to the brain.
What are Paula’s vital signs and state of arousal when she is well?
A] When well and behaving normally : *Her RR is stuck at ? breaths/minute . Goes up sluggishly[never normal] with locomotor activity. *Her Blood Pressure is normal. *Her heart works normally with a normal, regular Heart Rate. *Her Body Temperature is Normal. *Appetite and eating and thirst is normal *Her Circulation seems Normal. *And her Mood, Cognition, Speech and Behaviour are normal. *Her internal state of Arousal is Normal and her Sleep is Normal.
So Paula seems well adapted to being alive and functional [physiologically, physically and mentally], despite her very abnormal stuck breathing rate.
B] When Ill and behaving Abnormally – Sluggish and looking Depressed: *Her RR declines slightly to 2.5 breaths per minute. my measurements, dept [tidal volume unknown]. *Her Blood Pressure becomes very high. *Her heart does not function normally-there are arrhythmia’s, murmurs, spots of dullness to percussion, etc…and the heart rate is faster. *Her Body Temperature Declines [mild hypothermia]. *Is Disinclined to eat, drink liquids or cough or pee or poop or Speak *Her Circulation changes; Her hands, feet and lips become pale, cool and even blue. *And her Mood, Cognition Posture, Speech and Behaviour changes ; Mood plummets with Despair, Depression, Distress and Dread. Cognition is dulled. Posture is slumped. Speech is inhibited and tone is changed, quiet, strained. Behaviour is lethargic[ eg. staring blankly at walls, and anxious [mindless pacing], *Her Internal State of Arousal is extremely high [- cannot sleep well, cannot calm down, cannot think, cannot function, memory can be affected]
C] When Ill and Behaving Abnormally, – Manic Behaviour
*Her RR becomes erratic, fast, apneic, irregular. Can go as high as 30 breaths per minute at rest, or not, with apneas. my measurements, tidal volume not available]. *Her Blood Pressure remains high, but not as high as in sluggish state. *Her Heart Rate becomes slower than in sluggish state, with intermittent bradycardia. *Her Body Temperature Increases [mildly hyperthermic]. *Her Circulation Changes, Face is ruddy, circulation returns to extremities , *Eating is Intermittent, Pica is common, very abnormal eating behavior, very erratic. * And her Mood, Cognition, Posture, Speech and Behaviour Changes. – Mood is very abnormal: Mood is euphoric, intoxicated-like, labile [or not], irritable, even combative, Cognitive changes include retrograde *Memory Loss, Even more complex Cognitive Changes , Posture is restored, and Behavior is Disinhibited, reflex behavioral responses occurs too quickly with stimulus, Movement is abnormally fast and seems pressured, buoyant, speed and tone of speech is very abnormal, pressured-as if words spill out forcibly with air coming out out of control when mouth opens. Confabulation is common. *Her Internal Arousal State is very High, same as in the Lethargic State; arousal state is different, worse in that the need to sleep disappears completely. Cannot calm down, cannot think properly but thinks she can, cannot function but thinks she can, memory can be affected and she will not be aware,
Do these syndromes happen because of retention of changing amounts of carbon dioxide in the blood? Why these effects on circulation, and particularly on cerebral vasodilation ? Is hypercapnia [too much CO2 in the blood] from abnormal motor control of Respiratory Rate, the problem, as it does seem to be……in health and in illness?
We need more research. We need to be taking these syndromes very seriously. No one knows the answers, yet.
And meanwhile these patients suffer and neither they or anyone else, including and especially their doctors, know anything about the state of the feedback system controlling CO2 in the blood, because no one has done a basic workup of the vital signs of these patients as they become seriously ill.