My granddaughter has given my husband a kit that delivers oxygen. (He has terminal cancer.) This is not pressurized oxygen such as scuba divers use. It is produced chemically. It comes in a nice little kit and has a very comfortable but snug fitting for over the patient's nose. It is used by people who travel by air now that bottled oxygen is no longer permitted. It is also used by mountain climbers.

He has chronic anemia, treated by iron tablets. Her idea is that if he is very tired, the oxygen 'boost' will be good for him.

Any ideas?

Well, it is a wonderful idea, but I am not sure it is all that practical, for this reason:

Red Blood cells carry oxygen .. if there aren't enough red blood cells, no amount of available oxygen is going to help because all of the cells are already in use carrying oxygen.

You need more red blood cells not more oxygen.

Does you husband smoke? The contaminants in cigarette smoke take up some of the "spaces" in the red blood cells that oxygen would sit in. Think of red blood cells like buses with seats. You want oxygen to sit in those seats, but if you smoke, other contaminants sit in those seats reducing how much oxygen is available for the body to use.

Thanks, Sher, sounds logical. No, he doesn't smoke, and I won't permit anyone to smoke around him. So far I've only had to speak to one person about that, most people have more sense.

Babs, the gadget you're describing sounds like an oxygen concentrator. Another home oxygen option is portable bottles of liquid oxygen.

I believe the concentrators force air through some sort of membrane having differential permeabilities to oxygen and nitrogen, producing a modest flow of concentrated oxygen, usually delivered to the patient via nasal prongs. The second law of thermodyamics requires a power supply -- in this case batteries to run the air compressor.

Most airlines permit oxygen concentrators if they will fit under the seat.

Because each breath gets diluted with surrounding room air at 21%, the effective inhaled oxygen concentration would be somewhere in the 25-50% range, depending on respiratory pattern and myriad other factors. With a tight-fitting nose mask the concentration will be at the higher end of that range. It will never approach 100% because the machine simply can't put out enough flow to supply an entire breath.

Unfortunately, if the underlying cause of fatigue is anemia then the oxygen boost won't help much. The culprit here is the S-shaped, highly non-linear oxygen-hemoglobin dissociation curve that describes how hemoglobin loads up on oxygen as the oxygen supply increases. In anemic patients the hemoglobin saturation is probably already close to 100% (fewer hemoglobin molecules competing for the same amount of oxygen), which is in the nearly horizontal tail to the upper right of the plot.

So Sher is right -- his hemoglobin is already maxed out.

The O2 apparatus will also dissolve additional oxygen directly into blood, but the increase is very slight unless you use a hyperbaric chamber. That's why we need hemoglobin to keep us alive -- it's very efficient at packaging, transporting, and delivering oxygen within the body.

Sher, you're right about cigarette smoke -- it displaces oxygen molecules from hemoglobin -- specifically carbon monoxide, which has over 200 times the affinity for hemoglobin as oxygen. It just chomps down and holds on, crowding out oxygen. For all the crud that's in cigarette smoke, carbon monoxide is the only component I know of that competes for the oxygen binding sites on hemoglobin -- but it's a doozy!

BTW, Babs, I am very sorry about your personal anguish in dealing with a dying loved one.

If his fatigue is from underlying lung disease (some combination of metastatic lesions, poor breathing effort due to muscle wasting, weakened ability to cough & clear secretions, etc.) then the supplemental O2 might be helpful. Regions of lung that are partly, but not completely, collapsed (producing what's known as venous admixture) can be quite responsive to small increases in inhaled oxygen levels.

Physiologically, oxygen can't hurt and might help (oxygen toxicity is not a concern at low concentrations), but if it's not helpful the tradeoff of expense and inconvenience may not be worth it.

So has he tried it yet? Did it help? 24 hours should be plenty of time to know if he'll feel better with oxygen. Good luck!

Actually the device is very simple. The delivery system is a sturdy 'bottle' about as big as a large thermos bottle. It's sturdy but not obviously as heavy and resistent to pressure as an oxygen tank. Empty, it only weighs about a pound or so, including a 'humidifier assembly' in the neck that bubbles the oxygen through water before it's delivered to the user's nose. Also there's a tube and mask that connects to the humidifier assembly.

You add 500 ml of tap water, first filling the humidifier chamber in the neck, then putting the rest into the bottom of the main chamber.

Then you open one container of the carbonate that bears the oxygen, about 300 g. of powder, and add it to the water in the main chamber.

Then you add the contents of another small sealed bottle, the catalyst, and tighten the cap on the main chamber.

Then you attach the mask tube onto the opening on the top of humidifier and place the mask over your nose.

We have not tested it yet but it's easy to see that if the pressure became a bit high for comfort, you can easily create a space between the skin and the mask to release surplus oxygen.

It only delivers fifteen minutes of oxygen per filling. There are spares if you need more oxygen, but you would need to interrupt oxygen delivery while you repeated the procedure described above. My granddaughter told me it is useful for people with C.O.P.D.

From what you say it sounds as if it will be useful if he should develop lung congestion or some such. It's his wish that he be at home as long as possible, so anything that makes him more comfortable is welcome. Right now his lungs are all right: it's colon cancer metastasized to liver. He had no symptoms until late November, and by then surgery was not an option.

Thank you for your compassionate message. Actually he assumes the burden of his illness and makes caring for him quite straightforward. I just have to give him his medications, take him to chemotherapy, and try to get him to eat enough. He still moves around, walks around the house, even goes outdoors sometimes to putter around at yard work. He always loved this time of year. My daughter planted the south deck with pots of daffodils and primroses so he can enjoy them through the glass without going outdoors on rainy days.

He has some pain now, but he says he can bear it. He is in no hurry to begin taking opiates. He can't take aspirin or ibuprofen because he's bleeding a bit into the bowel. I don't want him to take acetaminophen because it can cause liver damage, but I leave it to him to decide. So far he has not taken painkillers at all.

A whole blood transfusion helped, because it gave his oral iron medication a chance to kick in.

He is very brave and patient. He loves his music, so I have all of his favorites both in the bedroom and in the living room. He loves Sarah Brightman, and for night music, mostly Mozart. His mother was a trained singer, and German, so he loves lieder, too. Music is a great comfort to him.

I haven't told him yet, but I plan to get a kitten about two months old as a companion for MrNogoodBoyo who is about two years old. They will play and frisk around. He loves cats.

Bab
I am Director of A Hyperbaric Wound Care Clinic. Everyone here has given you excellent advice. Is the home oxygen tank not less expensive than the kit and deliver a higher concentration of oxygen. I’m really not familiar with the kits so that is why I am asking.
If his Hemoglobin is low and his serum iron is low, iron may help if he has a good reticulocyte count. Some people just can’t make blood because of an iron blocking problem. Some can’t absorb oral iron and need it in the form of a shot.
If you wanted to know if oxygen breathing would pick him up get him a hyperbaric treatment as a trial and see if he feels better after it and for about 2 hours after. If he doesn’t then oxygen is not going to help.
When we put a patient in the hyperbaric chamber and increase the pressure to 2 ATM we can increase the physically dissolved oxygen in the blood stream ten times the amount we have at sea level.

Thank you. Yes, I thought the advice was all well thought out and responsible.

I don't know how the costs compare. Neither his g.p. nor his oncologist mentioned oxygen, this was a gift from my granddaughter. Apparently it's approved by the U.S. Food & Drug admin. It was designed more for emergency use, e.g. someone with C.O.P.D. with narrowed airways.

He's very low today (he's scheduled for chemo tomorrow morning) and he won't eat, he just dozes in his chair with a heating pad and blankets all around. Also he seems to be confused. I'll try the oxygen this afternoon if he doesn't feel better within a couple of hours.

babs, I never should have doubted your assertion that the oxygen is produced chemically. I just hadn't heard of such a system, even while searching for the links I posted. Does it have a name? Note that carbonates are NOT mentioned with chemical oxygen generators such as those implicated in the crash of ValuJet 592.

scapel, welcome to AnswerPool What kind of medical red tape would someone have to go through for a 2-hour trial of hyperbaric oxygen? In Canada.

The brand name is emOx and it's available in Canada. The fine print on the label says the main ingredient is sodium percarbonate but does not name the catalyst. Claims to be non-explosive, not a fire hazard, non-toxic, etc. Mind you, I wouldn't want to use it too close to an open flame. I'll ask my granddaughter where she got it. She's in Vancouver.

"MrNogoodBoyo" Did you pick the name?
Thanks for the info on emOx.

Yes when we adopted him his name was Sam. But he had a certain nonchalance that reminded me of the Thomas character. "Nogood Boyo is 'up to no good in the wash-house."

I'll ask my g-daughter where she got hers. I need to know anyhow in case we need refills.

I gave him his first 15 minute treatment. It didn't make a noticeable difference in his condition.

He goes to hospital at 7:00 a.m. and I have a hunch he's bleeding again. So if the test confirms that, he may get another transfusion -- and chemo delayed for the third straight week. It's sad.

Perhpas the oxygen treatments will be useful later.

Professor,
I would have to sign them up. Insurance nor Medicare would recognize this as an indication.
I would ask the hospital to wave their charge and I would wave mine. I would just be interested in if it really helped or not. Of course if the patient is bleeding only blood replacement will help. Sometimes chemo patients get erythopoiten. (Epicrit??)

emOX
http://www.emox.co.za/
Thanks for the education. I would think that should be definitely more expensive than tank O2. emOX looks like it is for an emergency use only and about 15 min of O2.
The link didn't explain the chemical/physiological reaction.

"...ask the hospital to waive their charge..." In the US, you'd have to wait for them to stop laughing before they said no.

Erythropoiten (a hormone that stimulates the bone marrow to make more red cells) is marketed as Epogen or Procrit. It was quite precious until recombinant DNA came along, allowing it to be grown by bacteria in large vats.

From the emOx website:

quote:

This reaction is initiated by pouring approximately 450 ml of tap water into a 3-liter polypropylene cylinder into which 300 grams of sodium percarbonate and 7 grams of manganese catalyst have been placed.

The wikipedia article on sodium percarbonate says that:

quote:

It dissolves into water rapidly to release oxygen and provides powerful cleaning, bleaching, stain removal and deodorizing capabilities.

Quite the tidy stuff!

Babs, I think it's very heartening that your husband can take comfort in music.

Yes, Perf, that's his strength. He has always been a smell-the-roses kind of man. He's going to need it now.

His blood tests showed increased red and white blood counts but his weight loss continues. His oncologist says he can't take further chemotherapy unless we can stabilize his weight. He just doesn't get enough calories. His appetite is very poor. Yesterday he ate no food at all, just water and a small amount of juice.

So his oncologist says, no more water. Any liquids he takes should be loaded with calories, and taking food/liquid at least six times a day in small quantities. He wants me to offer him liquids every two hours during his waking hours.

This really scared me because I'm so used to the idea that pure water is good for the kidneys and, really, all organs. But the oncologist says that unless he can maintain his weight the chemotherapy must stop. The cancer would then progress much faster.

The chemotherapy treatment today was a weakened dosage. The next two weeks will be wait-and-see.

I spoke to the hospital dietician and she said give him full butterfat milk (we always use skim or 1%) and boost it with additional powdered skim milk. Also all the vitamin-enriched, hi-cal drinks such as the diet 'meal repleacement' stuff. Actually I got these for him in December, but he doesn't like them. So today I got things like infant formula supplements (trade name Similac) with added iron to incorporate into whole milk.

Right now I plan to give him small, frequent servings of:
- bananas
- custard, tapioca and yogurt foods, in small quantities
- arrowroot or oatmeal biscuits with tea and real cream
- Bolthouse smoothies and fruit and vegetable drinks
- milk with added Carnation instant breakfast powders
- Ensure (brand) tinned liquid 'meals'
- poached egg

This diet worries me because it has no roughage. But I understand the need to get his weight under control.

This has not worked well today. He only accepted one smoothie and one biscuit, and a few morsels of fresh papaya. He had to take two doses of anti-nausea meds (6 tablets).

I have got him scheduled for some massage therapy. His lack of exercise is starting to show in stiffening tendons etc.

My son-in-law and my daughter have brought him lots of comedy dvd's. (But he prefers music cd's.)

quote:

Originally posted by babthrower:
I have got him scheduled for some massage therapy. His lack of exercise is starting to show in stiffening tendons etc.
My son-in-law and my daughter have brought him lots of comedy dvd's. (But he prefers music cd's.)

Hi babs, you are doing all the right things!

It's good that your husband enjoys music and that he can take enjoyment in seeing and being with your cat. Human touch is also important for the sick.

One thing I wanted to add was that you too can give him gentle massages, between the scheduled therapies. I'm sure you already know this.

I do this for my son. His joints are very stiff, and he is unable to use his legs at all, but still has feeling in them.

His skin is dry, so I found that a preparation called Glaxal Base works really well.
I can massage him and moisturise at the same time. It has no perfume in it and isn't greasy. This is just a suggestion.

Take care, my thoughts are with the two of you.
dg

You know, it's weird, but I can sort of 'feel' the good vibrations coming from well-wishers. It's very comforting. I can't whine too much to my close friends and relatives because my husband is so well-liked that it saddens them. So I unload all my problems on you guys!

It does help to get it all out.

So than you, Sher, Perf, Scapel and DanceGirl, for your comforting posts.