Whisper-Swivel Valve
Question:
I believe it was Thu, 20 Mar 1997 12:31:52 GMT, that I was overcome in surreal enlightenment, when whitesll@*REMOVETHIS*mindspring.com (Ed – Hide quoted text — Show quoted text -Whitesell) wrote: >>Ed: >>Though I’m sure you know your medical profession well, manifestations >>are obscure. For instance, the studies revealed that there were few >>observable warning indicators given for CO2 Rebreathing — such as >>demonstrably high PaCO2 or a significant change in respiration rate; >>however, adverse compensatory work-of-breathing was discerned with >>instrumentation. >Work of breathing is always increased with EPAP, the higher the EPAP >the more the increase…certainly more than was imposed by the whisper >swivel. (I am not saying the whisper swivel did not increase WOB, but >that it is insignificant when compared to that imposed by EPAP). >>But disregarding the unperceivable respiratory changes to the naked eye, >>as far as observable changes that any Respiratory Therapist could >>discern, before the observations were complete the following would have >>had to occur: >>1) The same study subject would have had to be tested on a Respironics >>brand CPAP, and then another brand without the Whisper Swivel, and all >>within a short time frame; >IMO, the brand name of the PAP machine is not relevant, just the use >of the whisper swivel…other brand masks are frequently used with >Respironics PAP units.
Ed: Okay, we can do it your way. You would then have to have the same study subject be tested on the Whisper Swivel verses without, and all within a short time frame. >>2) Since concurrent with CO2 Rebreathing is Oxygen Displacement, PaO2 >>nadirs would need to be compared between the two or more devices, along >>with PaCO2 levels. If hypoxia leading to oxygen lows of, say, 70% PaO2, >>could be resolved with the Respironics brand to, say, 85%, this might >>imply a complete success; however, such an improvement would not >>preclude that another brand could resolve hypoxia to, say, 90%. >CO2 re-breathing displaces more N2 than O2 because there is more N2 in >the circuit. One of the criteria for pressure titration is maintaining >PaO2 > 90%, that is why many people use O2 in conjunction with the >PAP. (By the way, EPAP or PEEP increases oxygenation all by itself).
The issue is not the ratio of each gas within the ambient atmosphere. Whether oxygen percentages are 20% or 80% of the atmosphere, a 50% reduction is still a 50% reduction (as an example). Furthermore, without studying the same patient on the Whisper Swivel versus without, and in a short time frame, we cannot preclude that oxygen- supplementation flow-rates could vary due to oxygen displacement by the Whisper Swivel Valve. >The purpose of the treatment is to reduce/eliminate the cessation of >obstructive airflow (obstructive apnea). CO2 is also used to treat >hypo-ventilation as it caused an increase in respiratory rate and >depth (tidal volume). Your study indicated the re-breathing was not >clinically significant…if it had been significant a respiratory >response would have been noted.
But the duty of medical treatment is to do the minimal necessary to alleviate the problem, and to do no harm. One study cited that the dangers of CO2 Rebreathing were not easily empirical, and, furthermore, it expressed a concern that the problems would be underestimated in everyday clinical settings. Hence, your overall passive opinions. There is a very much larger picture here that some are having difficulty grasping. Regardless of the degree of adverse consequences caused by the Whisper Swivel Valve — and our arguments have been over degree — the consequences are still adverse. Perhaps one could argue that a small "adverse" is better than a large "adverse", until you find that such adversity does not even have to be. In my opinion, there can be made no sound or substantive argument denying that the Whisper Swivel Valve is a compromise of the physiological efficiency — to whatever "degree" — of the respiration of the organism. An overkill. An exacerbator. A convoluter. It does harm. And that there is an ulterior motive for the instigation of this unnecessary adversity — namely, corporate maneuvering around patent law — leaves me virtually sick. I don’t know whether you have an incentive to ingratiate to readers the Whisper Swivel Valve with cheers and acclamations, but you have obviously never been compelled to use the gas trap, and your interpretation of the Hippocratic Oath is far different than mine. – Hide quoted text — Show quoted text ->It has been postulated that Leisure Suits may cause cancer in >laboratory mice if studied long enough! 
>I have never been a strong proponent of the whisper swivel itself, I >think it is overpriced. I would rather see them utilize a "Bias Flow >Port" (drill a hole) in the mask too, but I also don’t think the >whisper swivel is damaging. >>Doug >>************************************************************************ >>I was lying on the ground, with a sickly manifestation, >>but when I turned to medicine, it turned to the corporation. >>************************************************************************ >Ed Whitesell, RRT >white…@mindspring.com
***************************** IMHO Doug
Response:
Doug Ruth wrote: > Ed: snip > I don’t know whether you have an incentive to ingratiate to readers the > Whisper Swivel Valve with cheers and acclamations, but you have > obviously never been compelled to use the gas trap, and your > interpretation of the Hippocratic Oath is far different than mine.
Come on DouG! Personal slams are NOT appreciated on this newsgroup. Ed is entitled to his opinion as much as you are yours. Perhaps you own stock in ResMed or Healthdyne and are trying to damage Respironics? Is that your incentive? I’m kidding about that, but you can easily read that into your motivation. Personally I think you’ve been on this soap box too long (the whisper swivel valve). Can we change the subject? Dave — Dave Hargett Sleep Apnea Patient and Sleep Activist President, Elk Grove Village, IL A.W.A.K.E. Group Director, Illinois Patients, WAKE-UP AMERICA
Response:
On or about Sat, 05 Apr 1997 20:48:32 -0600, I can neither confirm or deny that Dave Hargett <dave_harg…@prodigy.net> wrote: – Hide quoted text — Show quoted text ->Doug Ruth wrote: >> I don’t know whether you have an incentive to ingratiate to readers the >> Whisper Swivel Valve with cheers and acclamations, but you have >> obviously never been compelled to use the gas trap, and your >> interpretation of the Hippocratic Oath is far different than mine. >Come on DouG! Personal slams are NOT appreciated on this newsgroup. Ed >is entitled to his opinion as much as you are yours. >Perhaps you own stock in ResMed or Healthdyne and are trying to damage >Respironics? Is that your incentive? I’m kidding about that, but you >can easily read that into your motivation. >Personally I think you’ve been on this soap box too long (the whisper >swivel valve). Can we change the subject? >Dave >– >Dave Hargett >Sleep Apnea Patient and Sleep Activist >President, Elk Grove Village, IL A.W.A.K.E. Group >Director, Illinois Patients, WAKE-UP AMERICA
****************************** Dave: I try and be respectful of posters to the group — as I hope they will be to me. I could concede that Ed had not been fully informed about the Whisper Swivel Valve, and, because of that possibility, my post may have seemed harsh. However, the fact is that if anyone attempts to defend an unhealthy medical device, while flying in the face of a higher caliber of professional literature, then a "hostile" response is actually called for, and appropriate. I appreciate your letting me know what my opinions may intimate. The fact is that I have no association with any other device manufacturer, and I will state this fact the next time I post the studies essay. I regret that you may not be pleased that I will be posting the information at regular intervals. You might consider placing me in your "kill file", though I will be sure and denote in the subject line that it is a repost. The information will be for perpetual newcomers to the group, and though you may not be using a Respironics device, others might wish to be fully informed should they have a choice of manufacturers for their CPAPs and Bilevel devices. In my opinion, this group is especially for those who have been recently informed they have a sleep disorder, and who are newly confronting all the apprehensions and obstacles that we first encountered. Sometimes there is a necessary blur between support and information. Information, after all, is support, and vice versa. As Dr. "Laura" says, you should be indifferent to incompetence, but lash out at evil. I’m lashing. Doug
Response:
Interesting. On the basis of some of the posts I have seen here, I stopped using my whisper swivel and went back to the original swivel and unblocked the holes in the mask. I certainly do feel better and have noticed a definite reduction in angina. I asked my cardiologist and the outfit that sold me the CPAP, but nobody had any opinion. I may try the whisper swivel again as a test. Bob On Wed, 19 Mar 1997 01:41:11 GMT, whitesll@*REMOVETHIS*mindspring.com – Hide quoted text — Show quoted text -(Ed Whitesell) wrote: >On Sat, 15 Mar 1997 18:05:55 GMT, hosp…@fullnet.net (Mary Lee >Warren) wrote: >>Somebody please tell me what I missed about the Whisper-Swivel Valve >>and carbon dioxide. Please? >Mary: >Much information has been posted to this newsgroup about the whisper >swivel. Most of this information is based on theory, not reality… >I have been working as a Respiratory Therapist for nearly 30 years. I >have been working with OSA and it’s related equipment for over 10 >years. I have worked in hospital and home care settings where CO2 and >O2 measurements were monitored on hundreds of patients and not one has >had a symptom producing problem using the whisper swivel. >I respect everyone’s right to share their opinion and encourage others >to participate on this subject. >I would refer you to your sleep physician and sleep lab for their >opinion. >Ed Whitesell, RRT >white…@mindspring.com
– Bob Seidel mail: bsei…@ipass.net webpage: http://www.ipass.net/~bseidel
Response:
I believe it was Wed, 19 Mar 1997 01:41:11 GMT, that I was overcome in surreal enlightenment, when whitesll@*REMOVETHIS*mindspring.com (Ed – Hide quoted text — Show quoted text -Whitesell) wrote: >Much information has been posted to this newsgroup about the whisper >swivel. Most of this information is based on theory, not reality… >I have been working as a Respiratory Therapist for nearly 30 years. I >have been working with OSA and it’s related equipment for over 10 >years. I have worked in hospital and home care settings where CO2 and >O2 measurements were monitored on hundreds of patients and not one has >had a symptom producing problem using the whisper swivel. >I respect everyone’s right to share their opinion and encourage others >to participate on this subject. >I would refer you to your sleep physician and sleep lab for their >opinion. >Ed Whitesell, RRT >white…@mindspring.com
****************************************** Ed: Though I’m sure you know your medical profession well, manifestations are obscure. For instance, the studies revealed that there were few observable warning indicators given for CO2 Rebreathing — such as demonstrably high PaCO2 or a significant change in respiration rate; however, adverse compensatory work-of-breathing was discerned with instrumentation. But disregarding the unperceivable respiratory changes to the naked eye, as far as observable changes that any Respiratory Therapist could discern, before the observations were complete the following would have had to occur: 1) The same study subject would have had to be tested on a Respironics brand CPAP, and then another brand without the Whisper Swivel, and all within a short time frame; 2) Since concurrent with CO2 Rebreathing is Oxygen Displacement, PaO2 nadirs would need to be compared between the two or more devices, along with PaCO2 levels. If hypoxia leading to oxygen lows of, say, 70% PaO2, could be resolved with the Respironics brand to, say, 85%, this might imply a complete success; however, such an improvement would not preclude that another brand could resolve hypoxia to, say, 90%. Doug ************************************************************************ I was lying on the ground, with a sickly manifestation, but when I turned to medicine, it turned to the corporation. ************************************************************************
Response:
I believe it was Thu, 20 Mar 1997 00:17:49 GMT, that I was overcome in surreal enlightenment, when bsei…@ipass.net (Bob Seidel) wrote: >Interesting. On the basis of some of the posts I have seen here, I >stopped using my whisper swivel and went back to the original swivel >and unblocked the holes in the mask. I certainly do feel better and >have noticed a definite reduction in angina. I asked my cardiologist >and the outfit that sold me the CPAP, but nobody had any opinion. I >may try the whisper swivel again as a test. >Bob Seidel
***************************** Bob: I would like to clarify something in your message. Any "original swivel" valve you are referring to, as my understanding exists, did not come from Respironics. You may have gotten some connector without leak vents from your medical supply house, but it was not any Respironic’s "leakless" version of their Whisper Swivel Valve. Based on my understanding, the Whisper Swivel is the ONLY Respironics connection between positive pressure device tubing and the Respironic’s masks. Furthermore, since the area of a circle (pi (3.14) times radius-squared) is a linear and not logarithmic function, since the typical, integral exhaust hole diameter in, for instance, a Healthdyne mask, is 4mm, and since the diameter of a manometer port on the Respironics mask is 2mm, you would need four manometer ports to be equivalent to the standard leak rate of masks with an integral wash-out-hole (actually, this would still not be accurate because the manometer ports are extended out in a hose-connecting "male-type" conduit 9mm long, thereby creating excess friction during airflow). It is interesting that you correlated CO2 rebreathing/oxygen displacement with angina. With two manometer ports opened on the Respironics mask, the somewhat reduced amounts of CO2 have displaced less oxygen than before; but whether you have access to all the oxygen you need or could get, no one knows for sure. Best wishes for your ongoing health. Doug
Response:
Somebody please tell me what I missed about the Whisper-Swivel Valve and carbon dioxide. Please?
Response:
I believe it was Sat, 15 Mar 1997 18:05:55 GMT, that I was overcome in surreal enlightenment, when hosp…@fullnet.net (Mary Lee Warren) wrote: >Somebody please tell me what I missed about the Whisper-Swivel Valve >and carbon dioxide. Please?
******************************** Mary: I hope you received it okay. One thing the post did not touch upon, which is in dire need of being addressed with the Respironics and its Whisper Swivel Valve, is the reductions in inspired oxygen due to the oxygen’s displacement by the rebreathed carbon dioxide. The extent of this loss of oxygen during the few important inhalations is now open to debate in local kindergartens. Its kind of like having to settle not only for more vinegar, but less wine . . . Doug
Response:
Doug, I did get both messages. I don’t know what’s wrong with my computer but when I try to answer e-mails, they don’t seem to go through. My son "fixed" my computer for me. <sigh> Anyhow, thanks for sending me the article. Mary Lee – Hide quoted text — Show quoted text -dr…@apeleon.net (Doug Ruth) wrote: >I believe it was Sat, 15 Mar 1997 18:05:55 GMT, that I was overcome in >surreal enlightenment, when hosp…@fullnet.net (Mary Lee Warren) wrote: >>Somebody please tell me what I missed about the Whisper-Swivel Valve >>and carbon dioxide. Please? >******************************** >Mary: >I hope you received it okay. One thing the post did not touch upon, >which is in dire need of being addressed with the Respironics and its >Whisper Swivel Valve, is the reductions in inspired oxygen due to the >oxygen’s displacement by the rebreathed carbon dioxide. The extent of >this loss of oxygen during the few important inhalations is now open to >debate in local kindergartens. >Its kind of like having to settle not only for more vinegar, but less >wine . . . >Doug
