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Post-Polio Health (ISSN 1066-5331)

Vol. 15, No. 1, Winter 1999

The Air That I Breathe

Gary Presley, Aurora, Missouri

That which God manages with a diaphragm, a few muscles and involuntary muscle response can be mimicked satisfactorily by a Bantam positive-pressure machine. Noisy? Yes, and when I used one, I always had the problem of balancing the pressure to achieve sufficient ventilation with the nasal mask's tendency to plow a furrow in my nose.

Nevertheless, only an ingrate would begrudge the source of the air rippling down the hose – air meaning renewed health and vigor to some of us post-polio people. I gladly strapped on the little rascal each night. The noise and the intermittent sore nose assured me, "I'm still here." Thus, when the representative from LIFECARE (now Respironics) called about four years ago and suggested I change from the Bantam to the PLV-100, I was reluctant. Why leave behind the lively little machine that brought me back from respiratory collapse? I was addicted to the sound of the Bantam wheezing away into the night: I could not sleep without it.

I never asked, "Why did you pick me to volunteer?" I just assumed that one glance around our house – stacked with computers, ham radios, scanners – confirmed that I was a boy who never outgrew his toys. Moreover, I have always realized that technology means progress. The Bantam design dates back decades: support for its maintenance – parts and expertise – dwindles. I could see that I had to take the plunge sooner or later and switch to a readily serviceable machine.

After my doctor cleared the changeover, the representative, on his next trip to the Ozarks, hauled a PLV-100 in the door. One look confirmed we had moved into a fancier neighborhood in Gadgettown.

My Bantam had one pressure gauge, a toggle switch or two, a fuse and a rotary dial – simple and effective. The PLV-100, on the other hand, sports four LCD readouts, seven rotary switches and a pressure gauge. No denying that this technological overkill caused me to catch my breath, if you will pardon the reference. All this to blow a volume of 1200 to 1400 cubic centimeters of air up my nose sixteen times a minute while I sleep? The PLV-100 measures the air in volume rather than by pressure. That one factor – airflow being regulated by volume rather than by pressure – seems to be the fundamental difference. Thinking about the switch in that fashion helped me realize that the complex assortment of gauges and dials only mask the simplicity of the changeover.

I let the respiratory technician balance the gauges and explain their function. My job was to learn how much volume would make me comfortable and the rate at which I wanted it.

The first thing you'll notice is the PLV-100 is quieter than the Bantam. Personally, I took comfort in the mechanical wheeze and clunk of the Bantam, but others, like the people in your house, will appreciate the PLV-100's quieter mechanism. My wife does, I know. You will also appreciate the decreased wear and tear on your nose. I ran the Bantam at approximately 25 pounds of pressure to sleep comfortably. The PLV-100 delivers 1400 cc of air at about 15 pounds of pressure. That missing 10 pounds of air pressure allows my nose to wake up nearly as refreshed as the rest of me.

The first night following my switch-over went smoothly, although I would be deceitful to say that changing from a Bantam to a PLV-100 does not require a period of adjustment. Mine was short, mainly requiring me to understand that the lesser amount of pressure did not translate into a lesser amount of air. I had noticed a feeling of claustrophobia developing over the last several years, a trapped feeling amplified if I do not receive proper ventilation while lying in bed. No surprise then that the first minute or two of the changeover from a pressure ventilator to a volume ventilator left me feeling as if I was not getting an adequate amount of air down the hose, but the feeling lasted only a few minutes. After a night or two, even that initial feeling passed. I was "breathing" while asleep. I felt well rested and comfortable when I woke up in the morning.

My transition became a matter of relaxing into the rhythm of the PLV-100. I am a relatively light sleeper, and, even when I am resting well, I wake up two or three times a night. Despite my anxiety about the reduced pressure, I found I was resting properly and felt "ventilated" (for want of a better term) rather than out of breath when I woke up in the middle of the night. By the third night, the PLV-100 had become a member of the household. In fact, in the two instances when I have had trouble with the PLV-100 and been forced to rely on my spare Bantam, I found reacclimatizing myself to the Bantam more difficult than switching from the Bantam to the PLV-100. The PLV-100 is a practical improvement over the Bantam as well. It is smaller and built in a durable square case, complete with rack handles. It sports a front-face plug-in adapter for 12-volt emergency use. Better yet, it has an internal NiCad battery system that provides about one hour of operating time during power outages.

Do I miss the Bantam? No. Would I encourage Bantam users to switch to the PLV-100? Yes. Those two questions I can answer easily. The final question is harder: will it be difficult for a long-term Bantam user to make the switch?

I cannot answer for you. In my experience, I found the switch remarkably easy. Why? A positive attitude about positive pressure, I expect. The late effects of poliomyelitis are real, but I refused to listen, and found myself in the ICU suffering from the effects of improper ventilation. Nighttime positive pressure rescued me, and I began to understand that proper nighttime ventilation is my key to good health. Thus, I learned, and, when the PLV-100 was offered and its benefits explained, I believed.


The Switchover

Richard Wieler, Columbia, Missouri

My reason for switching from a pressure ventilator to a volume ventilator was simple: my doctor suggested it. In this respect, I have been very fortunate to have a physician with experience in dealing with chronic hypoventilation.

I had left assisted breathing far behind in 1956 after a year in a polio ward, graduating from the iron lung, the chest cuirass and the rocking bed. Twenty-five years later, the return was troubling. However, I had to return because of the inadequate exchange of gases during the night and the need to rest my weak diaphragm. Moreover, my sleep was very disturbed because of the buildup of carbon dioxide.

At first, I was refitted with a chest cuirass, which I used for several years, but it became apparent that the "shell" was no longer effective because of permanent scoliosis. A local physician suggested returning to the iron lung. No way! Then, I was introduced to pressure ventilation. Once I got used to the face mask, non-invasive ventilation with a pressure ventilator seemed to work well: I was finally getting a good night's rest and feeling refreshed in the morning.

Finally, after five years, I switched from pressure to volume ventilation because my doctor was still not satisfied with my test results. My arterial blood gases disclosed that my carbon dioxide readings were still too high. Since a pressure ventilator pushes air only to a preset level, the actual amount getting into the lungs can be lessened by any obstruction, including the tightening of the chest cavity during long periods of being prone. In my case, too, allergies presented a steady impediment. Colds were also a big problem because of the blockage of air passageways with sputum. On the other hand, a volume ventilator is set for a certain volume of air, regardless of the pressure. I spent one night in the hospital so that my doctor could set the adjustments on my PLV-100 volume ventilator using my blood gases to check the results. He set it to push out 1.05 liters of air fourteen times a minute. I spend nine hours a night on this setting, and my blood gases are checked periodically to be sure I am adequately ventilated, usually once a year.

The PLV-100 has the added feature of giving me a larger breath upon demand, activated by my consciously inhaling much like sighing. Although the unit is bigger than my old pressure ventilator and has more controls, it is easily mastered and very dependable. Breathing during the night is much smoother, and I have fewer colds because the volume ventilator insures more air and assists in coughing. Of course, the hunt to find a mask that fits perfectly continues, and will forever, I fear. However, the switch to the PLV-100 ventilator has been positive for me.