Ventilator-Assisted Living©

Winter 2003, Vol. 17, No. 4

ISSN 1066-534X

Ventilator-Assisted Living is available with Membership.

Published quarterly in March, June, September and December.
Edited by Joan L. Headley (director@post-polio.org).


Read selected articles from this issue ...

A Change of Plans
Greg Franzen, St. Louis Design Services, Chesterfield, Missouri

Respiratory Effects of Common Medications
Charles Atwood, Jr., MD, FCCP, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Noninvasive Ventilation: A History of My Life
Jim Costello, Chairperson, Post-Polio Support Group, Dublin, Ireland

Ninth International Noninvasive Ventilation Conference: "From the ICU to Home," October 23-25, 2003, Orlando, Florida

Intimacy and Sexuality and Long-term Mechanical Ventilation:
Breathing Intimacy into Our Lives

Presentation by Linda Bieniek, CEAP, and Bill Miller

Assisted Living for Ventilator Users
Ashley Hoskins, Madonna Rehabilitation Hospital, Lincoln, Nebraska

Tracheostomy Tubes
Louie Boitano, MS, RRT, Northwest Assistive Breathing Center, Pulmonary Clinic,
University of Washington, Seattle, Washington
Sidebars: No More Inner Cannulas, Talking with Tracheostomy Ventilation

New Nasal Masks: Mirage Activa, ComfortGel, DeVilbiss FlexAire, Fisher & Paykel's HC405


A Change of Plans

Greg Franzen, St. Louis Design Services, Chesterfield, Missouri

It didn't seem like that bad of an idea at the time. After all, I was a good swimmer. I checked my environment. I tested my footing. I even waited 45 minutes after I ate before entering the water. It was the summer of '83, and my entire family was enjoying our annual vacation at our cottage in northern Wisconsin, relaxing in the sunshine, water skiing, fishing — the works.

I was sixteen and out of the corner of my eye, I was looking with great anticipation at my senior year of high school in Chesterfield, Missouri. I was captain of the varsity football team; the season was soon to start. I had thoughts of dating, Homecoming, college plans, and becoming an architect. But, oh, how quickly plans can change.

Finally, the moment came. I ran and dove off a neighbor's dock and quickly found myself under water unable to move or breathe. I had broken my neck and completely severed my spinal cord at the C3-4 level. But I didn't, I couldn't, have a proper realization of the magnitude of what happened. It soon became evident after I arrived at a hospital in Duluth, Minnesota, that I was going to be completely paralyzed from my neck down and would need to use a ventilator to breathe.

Spinal cord injuries bring an instantaneous life change. Instead of attending my senior year of high school, I spent 369 days in two different hospitals and in Rusk Rehabilitation at the University of Missouri Hospital in Columbia, Missouri. Instead of football, Homecoming, and plans to be an architect, there were IVs, a tracheostomy and LP3 ventilator, spinal fusions, a body weight drop from 175 pounds to 105 pounds, a chin-controlled wheelchair, and on and on. Yet, the Lord has good plans for our lives even when things look darkest, when our lives dramatically change.

Greg and associate at a job site.It's now been twenty years since those early days after my injury, and many blessings and surprises have occurred in my life. One surprise that seemed unlikely to occur was my dream of becoming an architect, but I graduated from the University of Columbia, Missouri, in 1990 with a degree in architecture.

I can't move my arms to sketch, to draw concept drawings, to build models of my client's structure, or to produce the construction documents. But this capability isn't a prerequisite for being a designer. What matters primarily is a desire to design, to be creative.

Through the use of computer technology, I'm drawing straighter lines, more accurate photo-realistic renderings, and more precise blueprints than I ever drew before my injury or even thought possible. How ironic.

I use a high-end computer workstation with high-end architectural software packages such as AutoCad and MicroStation to accomplish these tasks. To input, I use a mouthstick which I find far faster than voice input. I use a pencil or pen held in my mouth for space relationship analysis sketches that are used to simplify and amplify each project's design problems and solutions. And I have the opportunity to trudge around construction sites to assess progress and quality.

It's a bit odd and even funny at times for someone with a high cervical lesion and with hands that make good paperweights to enter another architect's office or to meet with a client for the first time. Some people still think one's arms and legs need to move to create something desirable and perfect.

Currently, my primary role in architecture is the design of custom homes and physical therapy clinics in a variety of places: Saint Louis, California and even China. I enjoy the design process and the ability to bring the architectural dreams of clients into a structural reality. It's terrific to be able to work in the profession I always hoped to work in. It seemed as though this would not be possible, but faith in the Lord has made all the difference in my life.


Respiratory Effects of Common Medications

Charles Atwood, Jr., MD, FCCP, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Many types of medications can cause respiratory problems in individuals with NMD who are generally more susceptible to respiratory side effects. A good rule of thumb for use of all medications is to start at the lowest possible dose and increase the dosage slowly. This is especially true of medications that may affect breathing.

Individuals with neuromuscular diseases (NMD) are particularly vulnerable to medications that can depress ventilation. Many people are familiar with certain well-known examples of this, e.g. the depressive effect that morphine and other potent narcotics have on breathing. The effects that other medications have on breathing are less well known. An informed individual can (and should) discuss the use of these medications with his or her physician.

Opiates. Opiates are a class of drug that includes commonly used narcotic painkillers such as morphine or demerol. Drugs such as oxycodone (OxyContin) and oral morphine (MS Contin) are commonly prescribed narcotic painkillers that have been associated with respiratory depression in a small number of cases. This class also includes medications that are less commonly thought of as opiates, such as propoxyphene (Darvon), a low-potency narcotic. Other opiates, such as hydrocodone (Vicodin, Lortab) are intermediate in their potency and their degree of respiratory side effect.

Opiates have diverse effects on the brain as pain medications. Potentially, any opiate medication can decrease breathing by depressing the respiratory center. The potency of the drug, the dose, and the experience of each person with narcotics are all important factors. Individuals with NMD are more vulnerable to narcotic-related respiratory depression because their respiratory system is already impaired.

In the past some anti-diarrheal preparations contained low doses of narcotics, but this is no longer the case. From a respiratory standpoint, the risk of toxicity from drugs such as loperamide (Imodium) and paregoric (diphenoxylate) is extremely low.

Sedatives and Hypnotics. Sedatives and hypnotics refer to medications used to facilitate sleep, muscle relaxation, and treatment of anxiety. The most commonly used medications in this category are benzodiazepines, such as Valium, Ativan, Restoril and Ambien. Benzodiazepines are central nervous system depressants. They vary somewhat in how much respiratory depression they can cause; however, in high enough doses, all may have some effect. Because these are very widely used drugs and individuals with NMD are vulnerable to depressed ventilation, caution is advised when using these medications. As in the case of opiates, patients vary widely in susceptibility to their effects. Prior experience with the drug (tolerance), the potency of the drug, and the dose taken are all-important factors to consider in determining risk of breathing depression from benzodiazepines.

Barbiturates. This class of drug is used much less now than in previous decades. Benzodiazepines have largely replaced barbiturates as sedatives and hypnotics because they have a greater safety profile than barbiturates. Examples of this class include phenobarbital, secobarbital and pentobarbital. The drugs are capable of significant central nervous system depression and therefore respiratory depression. Unless used carefully under close physician supervision, they should generally be avoided by individuals with NMD.

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