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March 1999
Second Wind
Lomita, California
Dear Friends:
Today, we tend to take long term oxygen therapy, (LTOT), for granted. The Denver Group first did its pioneering
research with oxygen in COPD in 1965. But, it was not until 1970
that oxygen began to be prescribed in other cities. Our first
research was with liquid portable oxygen. Our original results
demonstrated a reduction in pressures in the right side of the
heart and reversal of excess blood production in response to the
oxygen deficit. The most impressive observation, however, was
the dramatically improved exercise capacity in our patients. We
had encouraged walking every day during the month before the oxygen
was started under research conditions. Our patients could not
do much exercise without oxygen even though they tried to increase
their exercise each day for an entire month. During the following
month when oxygen was given, most patients could increase their
exercise a great deal. They could walk more than a mile each day.
The reason for increased exercise ability was increased oxygen
for the heart muscle and increased oxygen in the blood, so that
together, the heart and blood could carry more oxygen to tissues,
including the skeletal muscles of the body. These are the factors
that deal with tissue oxygen transport.
Oxygen isn't energy.
It is at the end of the energy chain to receive electrons that
come from the burning of foodstuffs. It is this process, known
as aerobic metabolism, that results in high energy production,
which is termed bioenergetics. Much of the oxygen that we consume
goes to maintaining the structure and functions of cells and tissues.
When oxygen depravation is severe, tissues tend to break down.
We have recently learned that exercise, with
oxygen, not only improves exercise tolerance, it restores many
body functions, including brain function. Some patients gain muscle
mass. What is going on is improved oxygen delivery and bioenergetics,
so the tissues can repair themselves and function better than
without supplementary oxygen.
Today, many suppliers are providing oxygen
concentrators and E-cylinder for portability
in LTOT. They are doing this because they can make more money
than by providing liquid portable oxygen. E-cylinders are not
very convenient for exercise, as many people know. They may actually
limit the patient's ability to exercise.
Without exercise, tissue oxygen transfer is limited, and the reparative
process made possible by oxygen and exercise cannot take place.
For patients who are able to exercise, and who in fact participate
in exercise and pulmonary rehabilitation, liquid portable oxygen,
or small portable cylinders, easily carried by the patients, are
highly preferable. The oxygen supplier cannot change a doctor's
prescription. Doctors need to prescribe what is best for their
patients. Patients should know their rights, and demand a portable
system if they are able to ambulate, particularly outside of the
home, and participate in activities of daily living. Oxygen energizes
every cell in the body and restores and enhances the function
of the entire system.
I will be in touch next month.
Your friend,
Thomas Petty, MD
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