I see I wrote a bit earlier this year. I do remember wanting to comment on ‘why fentanyl is so dangerous’ because I kept hearing on the news the damage was because of the ‘potency’. That’s probably related in that users do not know how much they are taking, but that can be said about all street narcotics.

Read the post if you’re interested. Most things related to medicine have fairly straightforward explanations. Fentanyl is more lipid-soluble than heroin. Cancer cells stop recognizing other cells and start to invade beyond where normal cells go. Heart muscle dies if the oxygen, carried in the blood, cannot get to the heart in adequate supplies. We make it all sound complicated, but some knowledge will save your life someday. For example if you are using a drug from a new dealer, a new batch, or new anything, do not use it alone! If you absolutely can’t do that, use 10% of what the dealer recommended – or even less. I deally have narcan at your side, ready to use as a chaser if your chest feels stiff or if you feel overwhelming nausea. Yes, you might get ‘dopesick’…. but you will live for another day.

Then realize how dangerous that stuff is. The experts agree that precusors for fentanyl are sent from China to the cartels, who ship them through border-crossers in exchange for a ride or guide. Nobody is sending the stuff to be helpful — so protect youself

I wanted to write about respiratory alkalosis, but I have to be short today, in part because of respiratory alkalosis. If you haven’t heard the back story, go to fdlpsych.com and click on Absence, then come back.

In short, my chronic hypoxia and large dead space (which are areas of lung that get plenty of air when I breathe, but that don’t work like real lungs — because they are not receiving blood flow. In anesthesia that was called VQ mismatch, or dead space ventilation. You are breathing a half liter of air every 6 seconds, but only 2 liters, maybe less, go to functioning lung tissue.

That was my problem. Evolution or a higher power or both created an amazing machine in the human body. We have ‘reserve’ in almost all organ systems. Two kidneys so we don’t even notice the loss of one. Two lungs with plenty of excess capacity. Blood vessels that encircle the heart with tons of extra blood flow. Two brain henuspheres, although that is less ‘adaptive’ in humans that other species.

The problem with ‘reserve’ is that many illness are not noticeable until they are very advanced. Lung disease is like that in a huge way– a person can smoke awake almost the entire lung before getting COPD, when it is too late to be reversed. That sounds counter-adaptive, but evolution occurs over millions of years — not hundreds or thousands. Evolution still hasn’t close to learning about modern medical care. Maybe in a million years people will all have LESS reserve, as that might favor earlier diagnosis. Or maybe not. Nature will have to decide.

My reserve caused my diagnosis of pulmonary hypertension to take time to appear. Then suddenly it appeared in a big way. I was just talking with my sister, who said I looked more ‘dead’ each day over the past month. I certainly felt that way as I appealed the insurance company and waited for surgery.

My body tried to hold on by making me breathe much more frequently, to get more oxygen to working lung tissue. But that has limits and problems. One problem is that my rapid breathing ‘blew off’ much more CO2 than normal, causing my level of CO2 to drop to 27, rather than the normal 40. One would thing I can now just tell myself— stop breathing so fast!

Two problems. Patterns become engrained. But more importantly, If I simply slow to normal respiration now and let my CO2 build up, my blood becomes more acidic. I have less bicarnate on board to have a normal CO2 level without acidosis — which is a driver of breathing, anxiety, etc.

So I now have to retrain and re-adapt. I have to tolerate a little bit of acidosis, and ignore that drive to breathe. I just took a very short walk, and I realize I have a lot of work ahead.

I met several PTE patients today… a guy my same age from the Midwest who collapsed and was minutes from death when vacationing in the Caribbean.. A firefigher who had to be readmitted but is doing well now from down South. Nobody makes the first move except me…. and then they talk for an hour about how they got here. Who would have ever believed that pulmonary medicine would be interesting???

Finally, I spent the day reactivating the forum, and new questions and answers should be appearing on the right side of the page. And I believe I have the comment function working here. You are free to comment…. don’t use your real name since nothing is private any longer. I collect no data. Sometimes a site places cookies, but the only reason for that is because if I run ads, Google wants to know who buys what. Just refuse them.


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