NEED HELP FROM EXPERTS PLEASE

[Muse-Inc]

Article on edema: http://www.jabfm.org/cgi/content/full/19/2/148

Here's another one with some things that might help: http://articles.directorym.com/Edema-a852919.html

[roster]

i am 5'10" tall weigh 270, and 14% body fat, I have very little to loose, and YES I have had my levels of minerals and such checked, all OK, but thank you for the info, and I know nobody here can do anything but comment, YOU NEVER know there may be another out there that has exactly what I have, my docs here are practicing physicians, and do just that PRACTICE.............

Are you still taking anabolic-androgenic steroids? These are reasonably safe to take but only in prescribed doses with oversight from a good internist. As you know, overuse is quite common and can lead to health problems. They can also confuse physicians' diagnoses if the physicians are not aware of the amounts being taken.

Many of us like to express anger at the medical profession but at the end of the day this emotion hasn't moved our health forward. Improving our health takes rational management using what resources are available even if these are doctors who have shortcomings.

[Muffy]

i am 5'10" tall weigh 270, and 14% body fat, I have very little to loose, and YES I have had my levels of minerals and such checked, all OK, but thank you for the info, and I know nobody here can do anything but comment, YOU NEVER know there may be another out there that has exactly what I have, my docs here are practicing physicians, and do just that PRACTICE.............

Are you still taking anabolic-androgenic steroids? These are reasonably safe to take ...

As previously stated, the use of anabolic steroids is nearly always accompanied by denial. Athletes simply have no incentive to be publicly honest regarding this issue. The highest levels of competition are randomly tested at best with awards going to the largest and most defined persons in their class. Sadly, many competition sponsors and promoters feign ignorance on this topic while some surreptitiously supply steroids to their sponsored athletes. Professional athletes may be under the care of a physician who will monitor their blood levels for various signs of toxicity and organ failure. Drugs are then cycled in order to minimize the risk of organ failure and yet allow the athlete to maintain a heightened anabolic condition. Even while under the supervision of a physician however, many athletes have died in their quest for an enhanced competitive physique.

http://www.ergo-log.com/hearttransplant.html

http://sportsillustrated.cnn.com/vault/ ... /index.htm

http://www.isteroids.com/blog/how-to-%E ... -steroids/

http://www.mariostrong.com/articles/josephbaglio.html

Muffy

[roster]

Some of the legitimate and safe uses of anabolic steroids:

-In patients who have lost their testicles, steroids help preserve the men’s musculature as well as such secondary sex characteristics as body hair, deep voice, and sex drive. They are prescribed at safe levels and the patient is regularly monitored for unwanted side effects.

-Adolescent males with pituitary problems can be treated with anabolic steroids when they reach the appropriate age for puberty. Anabolic steroids are usually given for four to six months to initiate the growth spurt and development of secondary sex characteristics.

-After certain kinds of surgery and cancer, most patients experience a loss of muscle tissue. Anabolic steroids can be used in such cases, with exercise and diet, to promote the regaining of lean muscle tissue without serious side effects.

http://ezinearticles.com/?What-Are-the- ... &id=154494

[virgo RT]

wow sorry to hear about your medical problems. I am a Registered Respiratory Therapist licensed in Texas. It definately sounds like you need a bipap with and oxygention at 70% that is below what we like to see which is 92% and greater. Yes all cpap/bilevel are positive pressure and normally we do have a negative pressure in our lungs. so adding cpap does change pressures which does affect the heart. It is not so severe that we would not recomend cpap/bilevel unless the heart is compromised significatly. Edema is almost always due to decreased heart efficiency but can sometimes be due to medications. It is sad that our medical community is not able to work together better since one problem usually causes or affects another. My suggestion is find a group of doctors that has a hollistic approach or a group that has a pulmonologist and cardiologist working together. Or use your current doctors and ask there suggestion as to who they will work with or recommend to nail down a diagnoses. Another suggestion is in your pulmonary function testing did you have a dlco which is a test that checks how well the oxygen you breathe enters your blood. It is common for patients to have greats lung ability to breath in and out take in air and blow it all out on our test but the problem can some time be the thickness of the lung membrane and its ability to pass the air we breathe with oxygen to our blood. Which is a Dlco, most of the time need to be done in a hospital requires you to breath in specific gases to test for this.

hope this helps
yvette

[Sleepy Taz]

Virgo RT,

Not all DME RT's are as forthcoming as you portray your self to be. There is a lot of animosity here because the perception is that most DME suppliers are money hungry and do not think that people are smart enough to play a role in their own therapy. With this in mind comments from members of this forum should not be taken for how they seam. As a professional you can be of great service once it is understood what your intentions really are. Are you here to give sound advise or are you here to admonish forum members for helping their fellow man? (or woman!!! ) Another thing to remember is that many here are still sleep deprived which can lead to confrontational responses which you being the professional should be able to handle without berating another poster because they do not trust you. In time, if you are sincere the people here will see that you want to help and there will be no need for bickering. There are a lot of people here who have educated themselves about sleep apnea and Cpap therapy and if the medical community were smart they would gather information from this forum and use it to change the way sleep apnea patients conduct their therapy. Each user should get a data capable machine with software and training on how to manage pressures to maximize therapy just like when I prick my finger to test my blood sugar for diabetes. I have been doing this for 20 years and found this forum last May. My biggest question is why wasn't I informed by the medical professionals that I didn't have to struggle and good therapy was finding a proper fitting mask and keeping an eye on my AHI numbers? Sorry for the ramble but I thought it was needed.

[virgo RT]

your right i should have handled that better, but was just dumbfounded to be accused of being psuedo-concerned from a few lines. I am sincere in all my responses and there is no value in me not being sincere as none of these people are my patients and what you do or dont do does not affect me personally.

regards
yvette

[Sleepy Taz]

Please do not take this the wrong way as i believe we all can benefit from your experience.

[virgo RT]

unfortunatly im not sure how much longer i will be posting as this is my first day and i have had a beating from a number of your fellow users. accusing me of psuedo-concern, being high and mighty, and the latest my grammar skills. Really!!!

regards
yvette

[twokatmew]

unfortunatly im not sure how much longer i will be posting as this is my first day and i have had a beating from a number of your fellow users. accusing me of psuedo-concern, being high and mighty, and the latest my grammar skills. Really!!!

regards
yvette

Welcome, Yvette. Now I say, toughen up and get over it. If you stick around, perhaps you (and we) will benefit from your participation. There are grumps in every crowd. Surely you must experience this in your daily work....

[roster]

......... I am a Registered Respiratory Therapist licensed in Texas. It definately sounds like you need a bipap with and oxygention at 70% that is below what we like to see which is 92% and greater. ..........hope this helps
yvette

I am not sure that helps because you made typos that make your recommendations confusing and you misread daddycoop's posts. He said,

.......without the bipap my O2 sat. was 70% with bipap 92% ................

You can help me on another point since I have no medical training.

….. Yes all cpap/bilevel are positive pressure and normally we do have a negative pressure in our lungs. ………
yvette

From the training I had in physics, I do not see how one can exhale unless a positive pressure is created in the lungs. I believe that in healthy breathing the length of the exhale is about two times the length of the inhale. This translates to positive pressure in the lungs two-thirds of the time. So how from a medical professional's point of view can I grasp the concept that "normally we do have a negative pressure in our lungs".

Thanks,

[virgo RT]

i have been posting all day, defending myself and have really tired. so yes i have typos my apologies. i was only stating that yes because the oxygen with out the bipap is 70% he definately requires it and anything less than 92% is unsafe and not what we like to see in general. i hope that makes sense.

as for the negative pressure in our lungs, in order for us to be able to inhale air we have to have to pull a negative pressure by work of our diaphgram muscle. as with every thing in our body it works by a gradient. you have to think of our lungs like ballons. during cpap/bilevel pressure is forced into the lungs by a blower creating a positive pressure in the lungs. normal breathing we do not have anything blowing in our lungs so the way we expand and inhale is by work of the diaphgram pulling down under our lungs creating the negative pressure to draw in air like a syringe.

hope this makes sense. i am pretty tired so if it does not, ill try to explain again tomorrow when i've had my coffee.

best of luck

yvette

[roster]

i have been posting all day, defending myself and have really tired. so yes i have typos my apologies. i was only stating that yes because the oxygen with out the bipap is 70% he definately requires it and anything less than 92% is unsafe and not what we like to see in general. i hope that makes sense.

as for the negative pressure in our lungs, in order for us to be able to inhale air we have to have to pull a negative pressure by work of our diaphgram muscle. as with every thing in our body it works by a gradient. you have to think of our lungs like ballons. during cpap/bilevel pressure is forced into the lungs by a blower creating a positive pressure in the lungs. normal breathing we do not have anything blowing in our lungs so the way we expand and inhale is by work of the diaphgram pulling down under our lungs creating the negative pressure to draw in air like a syringe.

hope this makes sense. i am pretty tired so if it does not, ill try to explain again tomorrow when i've had my coffee.

best of luck

yvette

Get your coffee tomorrow because it doesn't make sense to me. Without a positive pressure in the lungs during exhalation .... well there will be no exhalation in my medically untrained way of understanding.

After that coffee, reread daddycoop's posts. He says (in broken English), " ..... 92% with BIPAP; 70% without BIPAP".

But anyway, bringing up the subject of his possible use of anabolic steroids may have run him off.

[Muffy]

Without a positive pressure in the lungs during exhalation .... well there will be no exhalation in my medically untrained way of understanding...

It is the natural tendency of the lung parenchyma to collapse, and a tendency of the rib cage to expand outward. This results in a constant negative pressure in the intrapleural space. As the diaphragm drops, a large negative pressure allows inspiration. Exhalation is passive, and should be considered "less negative". A positive pressure exhalation does not normally occur, unless someone has bronchospasm, is engaged in fairly hefty exercise, blowing out birthday candles, etc..

A good illustration of this concept can be seen in emphysematous patients, where lung parenchyma is destroyed, the expansion of the rib cage becomes the dominant force, and they take on the typical "barrel-chested" appearance.

Yet, "IMHO", that's not what's important here...

Muffy

[Muffy]

...because blood return to right heart is greatly aided by the negative pressure of inspiration, drawing blood into the intrathoracic cavity through the great vessels.

Back to "Man Who Talks Loud"'s initial point:

I am on a BIPAP now set at 12-19 with 3 diff and an auto. I was told by this DOC NOT TO USE my bipap anymore just use my nasal O2, he said this machine was putting a positive pressure in my lungs and the lungs were designed to operate on a NEGATIVE pressure and thus would make my heart work MORE?

In theory, an aggressive bilevel approach could reduce venous return by decreasing the inspiratory effort, and also decrease forward blood flow by compressing the pulmonary capillary bed. In normal folks, this doesn't happen. However, if we make the assumption that the physician isn't crazy, and his concern isn't with the treatment of sleep apnea (thus far, no objective data has been presented, so it is unknown what 'this guy really has, or if there's a combination of entities)(although I'll vote for combination) but rather, the treatment of cardiac failure, then that statement and approach would make a great deal of sense.

A look at the nocturnal oxygen saturation would give strong clues, searching for desaturations vs the whole baseline dropping out.

Also, a cardiopulmonary exercise test (CPX) may reveal important information.

Muffy.