By Carol Sieverling
Source : DFW CFS and FM Support group : http://www.dfwcfids.org/
This article is intenionally detailed and technical so those who wish to try this treatment can share it with their doctor. It is based on a taped conversation with Dr. Cheney and has been reviewed and edited by him.
Note—as of 01/25/05: The theory here is still solid, however, Dr. Cheney no longer recommends the rebreather mask.
There are three levels of addressing the problem:
1. The Weil breathing technique that can be used with any other technique, though obviously not simultaneously. It addresses the 2, 3 DPG levels.
2. Without any prescribed oxygen source, you can simply cup your hands over your mouth and nose and rebreath your expired carbon dioxide every so often.
3. You can get a script for oxygen and breath it and also do the hands over your nose and mouth periodically while breathing the oxygen.
The rebreathing of method 2 and 3 above addresses the respiratory alkalosis the blood pH problem that inhibits oxygen transport into the cells.
Direct all questions about this to Carol Sieverling.
Dr. Cheney recently began prescribing oxygen for patients with alkaline venus blood. Up to an hour of oxygen in the morning can provide half a day of significant improvement and numerous benefits. He has been seeing alkaline blood results in patients for years, but dismissed it as insignificant, based on his medical school training. His growing suspicion that it was a very significant factor was confirmed when a speaker at an international conference on fatigue in London began a presentation by announcing "Ladies and gentlemen, I'm here to tell you that CFS patients are alkalotic."
Blood alkalosis inhibits the transport of oxygen to tissues and organs, constricts the blood vessels, and lowers overall circulating blood volume. The putative cause of the alkalosis is the glutathione deficiency that is pervasive in CFIDS. Low glutathione causes an elevation in citrate, which in turn lowers a substance (2, 3 DPG) that controls the release of oxygen from the hemoglobin. Our blood could be full of oxygen, but without enough of this substance it cannot break free of the hemoglobin and get into the cells. This causes oxygen deprivation in the tissues (hypoxia), which makes the body switch over to anaerobic metabolism, and that produces tissue acidosis, which can be painful. The acidosis here is unusual because instead of generating a lot of carbon dioxide, it generates a lot of organic acids that stay inside the cell. The body compensates for tissue acidosis by increasing renal bicarbonate reabsorption, and developing tissue alkalosis.
This blood alkalosis is unusual in that Cheney usually sees venus blood pH values over 7.4 and urine pH values under 6.0. (Optimum venus pH values are 7.30 to 7.35.) When both blood alkalosis and urine acidosis are seen, it's a metabolic problem—not a psychogenic reaction to a needle stick. A blood pH above 7.4 shows impairment, and above 7.5 there is significant impairment—almost no oxygen transport at all. A urine organic acid test will also reveal this problem: elevated citrate and/or low 2-oxo-glutaric are markers.
The really terrible thing is the presence of a vicious cycle. The blood alkalosis further lowers the levels of 2, 3 DPG (inhibiting the release of oxygen), causing tissue hypoxia, which causes tissue acidosis and pain, which then causes blood alkalosis, which lowers 2, 3 DPG even further. And around and around we go.
The ultimate treatment for this situation is Immunocal or IMUPlus, the undenatured whey protein supplements that help restore glutathione. However, some patients cannot afford this, and it does not work on all patients. An immediate solution to the oxygen transport problem is to use a partial rebreather mask set at 35 to 40% FIO2 (Fraction of Inspired Oxygen), which requires a flow rate of about 10 liters per minute. Try to do an hour a day, broken into one, two or three sessions. You can do more than one hour a day, but do not do more than one hour at a time. Do not breathe heavily—breathe normally. Most CFS patients have headaches, and this can help those headaches. If the prescription is written for headaches, insurance may cover it. One hour of oxygen a day on a partial rebreather can run $75 to $100 a month.
Oxygen through nasal prongs will not work. Oxygen alone in a mask will not work. It has to be a partial rebreather mask, which has a bag attached. This allows you to rebreathe your expired carbon dioxide along with the oxygen that is flowing into the mask. Breathing increased levels of both CO2 and O2 at the same time is essential. The CO2 breaks the cycle. It corrects the alkalosis and frees the O2 in your blood to move into your cells. With proper functioning, vessels dilate and you start perfusing your brain and tissues, bringing out the toxins and bringing in the nutrients. Raising oxygen levels will also help kill off yeast and other pathogens. Lack of oxygen allows them to multiply.
It is important to the function of the rebreather that the bag contract and expand with the breathing cycle. It can fully expand when you exhale, but it must collapse when you inhale, though no more than two-thirds . It's not working properly otherwise. If the flow rate is too high (usually above 10 I.pm) the reservoir bag will remain expanded during the entire breathing cycle and there will be insufficient rebreathing of CO2. If the flow rate is too low, the reservoir bag will collapse fully when breathing in. It must not collapse more than two-thirds. if the bag will not collapse well, check for leakage around a poor fitting face mask. The openings on the mask near the nose can be left open, or fitted with the rubber disks that turn the openings into one-way valves. An open mask has less rebreathing potential. With one-way valves, the CO2 rebreathing potential is increased.
The speaker at the London fatigue conference sends his patients to breathing experts like Teresa Hale, who wrote Breathing Free. Most patients are walking around over breathing and thus becoming more alkaline. Learning to under breathe properly can help address the alkalinity of the blood and improve oxygenation.
Two problems can be seen in some patients on a rebreather mask.
1) Rapidly correcting blood alkalosis or overcorrecting (that is, acidosis) can provoke vasodilatation. If there is significant blood volume contraction some patients may become hypotensive and feel dizzy or faint. Taking oxygen lying down and expanding the blood volume with an isotonic electrolyte drink such as Gookinaid ERG (Electrolyte Replacement with Glucose), found at members.aol.com/Gookinaid 800.283.6505 can prevent this. Reducing the time spent on the mask rebreather will also address this problem.
2) Patients with a history of migraine may provoke a migraine in the moments just after going after going off the rebreather. Again, expanding blood volume and reducing the time on the rebreather can help with this side effect.
Read about The Weil breathing technique that Dr. Cheney now prefers to use with his patients.
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