Does Oxygen Addiction Exist?

Ok, I know, the joke’s on me. We’re ALL addicted to oxygen, after all it’s in 21% of the air we breathe (if this is not the case, please check your location, you may be on the wrong planet). We all need oxygen physiologically, but I’m talking about psychologically. There are those patients that know, I mean absolutely know, that oxygen seems to make their dyspnea better, even though a check of their pulse oximetry shows an oxygen saturation of one-hundred percent even when exercising. So back to my question, does this mean that they are psychologically addicted to oxygen, or does the supplemental oxygen actually fulfill an as yet unknown physiologic purpose?

Ever since two studies in the early 80’s (one which showed an  overall increased survival with oxygen use, and another which showed a benefit with continuous oxygen over nocturnal use), supplemental use of oxygen for people with low oxygen levels has been considered standard of care. The current cutoff for an acceptable level of oxygen in a stable patient is, in general, eighty-nine percent (though there are always exceptions, let’s be clear, that I am talking about ambulatory oxygen in otherwise stable patients, and not about a hospitalized patient who is having a heart attack). For the most part, insurance companies will not pay for ambulatory oxygen therapy unless it is documented that their oxygen hits the magic number of 88, as we know that’s when the hemoglobin saturation curve starts to fall down a steep cliff. Or perhaps it’s because that’s when the Dr. Brown’s Delorean takes off. Either, one, I can’t quite remember.

Anyway, as I was saying, there is no known benefit to using oxygen when the measured levels are normal. And come to think of it, I don’t know of any data showing beneficial effects of its use in those with COPD whose oxygen saturation drops only with exertion (a common scenario where it is prescribed). Yet, many patient often insist on the continuation of oxygen even after it is explained that it is no longer medically necessary. To date I know of no study that shows beneficial effects of adding ambulatory oxygen to people with normal oxygen levels. One study compared forced air with oxygen in people with normal oxygen levels and found no reductions of subjective dysnea. Currently, the LOTT study is underway to see if ambulatory oxygen may be beneficial in patients with COPD and low-normal levels of oxygen. In addition, there are possible negative effects of oxygen, including the possibility of carbon dioxide retention, potential oxygen toxicity, and the hazards of transporting  and storing the stuff. Not to mention the dangers of  having inflammable substance being used by a smoker.

However, in my experience, patients who really feel that the oxygen is helping them with dyspnea do not care about these ideas, and are resentful about their physician talking about discontinuing it. Given that there is no data to continue the use of supplemental oxygen in those with normal oxygen levels, does their insistence in fact represent a form of addiction? I often see patients who refuse oxygen because of their misconception that their body will ‘get used to it’ and that they will not be able to get off of it. Thus far, I have brushed aside these concerns as there is no known physiologic basis for this. I wonder if perhaps I should consider the possiblity that their bodies might not get used to it, but their brains might.

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One Man’s Enterprising Solution to Beat High Drug Costs.

And that solution is. . . to become a drug rep. A fake drug rep. And get access to all the free free brand name (no generics here) medications your heart desires. The story at Pharmalot states that a well dressed man:

“walked into a physician’s office in East Northport, New York, which is on Long Island, and helped himself to about $300 worth of drugs from a shelf after claiming he was a pharma sales rep.”

The man was apparently later caught. Perhaps he was sent to jail. I say send him to D.C., this may be the kind of creative thinking we need to reduce our health care costs!

See the full story here. And the follow up here.

A New Staging System for a Terminal Disease.

 strange-hairstyles-11

My dear readers, it is with great regret that I relay the news to you that your author has been diagnosed with a terminal, incurable affliction similar to what you see in the picture above. You may think I’m talking about simple male pattern baldness.  But no, this is much more spontaneous, insidious, and frankly morally shameful. Yes, ladies and gentlemen, it appears that I have the early stages of comb-over.

Continue reading “A New Staging System for a Terminal Disease.”

Welcome to the New Site!

Welcome to our new site, caduceusblog.com. After several months, of trying to tweak the previous site, I’ve decided to move the blog to a much simpler platform which will  be easier to use, and allow me to spend more time doing what I intended. . . writing!

Besides the new look, this site also features a facebook ‘like’ button which will accompany every article, and a separate comments section that will not link to your facebook page. Let me know what you think in the comments section, and feel free to contact me at deep@caduceusblog.com.

Candlelight Vigil

Please Join Our Candlelight Vigil.

We here at caduceusblog (though there’s only 2 of us) would like to take this opportunity to wish a speedy recovery to one of our readers who has caught a cold and is taking an antibiotic. This worries us, not out of any concern we have for our readers. It worries us because we only have 2 readers, and our statistician informs us that if one our readers dies, then our readership could be reduced by nearly fifty percent. So please join our candlelight vigil to pray for the speedy recovery of our poor stricken reader.

Happy Thanksgiving

Happy Thanksgiving!

We here at the Caduceuscloud (though there’s only two of us) would like to wish you, our dear reader (literally, we only have one reader), the happiest of Thanksgivings. As we count our many blessings during this special time of year, I feel that it’s important that I reflect on what is perhaps the most important blessing of all. . . that I am not a TSA agent. Continue reading “Happy Thanksgiving”