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The South Side

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by

Michelle Bergman

on 22 April 2010

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Transcript of The South Side

Let me give you some perspective.... Michelle Bergman's Presentation:
"The South Side (or best route) to Understanding Hypoxemia" At Altitude the following changes are predicted: Of Altitude Sickness Caught on Camera...Not fun! Background Oxygen Needed for the survival of every cell!

BUT...

Hypoxia= Decrease in Partial Pressure of O2 (particularly lack of O2 reaching the tissues) "Prolonged Expiration"
Non-Passive?
Forced? Rationale for the study.. Supposed Benefits Validity of the Title & Argument Prolonged Expiration?
Live Low, Train High?
Do you gain any benefits? An Example... So.... Photo credits: 'horizon' by pierreyves @ flickr TABLE: Gas Pressures at Various Altitudes
LOCATION ALT. PB FIO2 PIO2PaCo2PAO2PaO2
Sea Level 0 760 .21 150 40 102 95
Cleveland 500 747 .21 147 40 99 92
Denver 5280 640 .21 125 34 84 77
Pikes's Peak 14114 450 .21 85 30 62 55
Mt. Everest 29028 253 .21 43 7.5 35 28

3. Leftward Shift of O2 dissociation curve. 5. Cerebral Arteries Constrict http://vam.anest.ufl.edu/simulations/alveolargasequation_simple.html
Review:
PaO2- the O2 dissolved in the plasma
SaO2- the % that the 4 heme sites to bind O2 on the hemoglobin are filled
CaO2- the # of oxygen molcules in the blood
CaO2= ({Hb}*1.34mlO2*SaO2)+(PaO2*.003ml O2/mm Hg/dl) Normal range for PaCO2 is 35-45 mmHg. A change in PaCo2 from normal ~40 mmHg, to 28 means?...

Either Hyperventilation
OR
Excess alveolar ventilation for the amount of CO2 Production (such as altitude!) The article I looked at dealt with with a technique called "Prolonged Expiration": At Low Altitude you can train harder! Think about it... Theortical benefits of training at altitude:
Improved Ventilation (or Similar to sea level VE)
Improved CaO2 in blood
Blood Flow and Oxygen Diffusion
RMR (same as at Sea Level
Increased erythropoetin Characteristics of:
Tibeans
Andean Indians
Tamarhumara population High Altitude:
Intensifies Physical Effort= can't train as long or as hard
No evidence for increases in RBC or [Hb] levels
No convincing evidence for improvements in VO2
Levine & Stray- Gundersen, 1997 However,
Altitude also:
Decreases CO
Decreases Blood Flow to Skeletal Muscles
Possible Immune Function Depression
Increased Tissue Damage mediated by oxidative stress
Bailey & Davies, 1997
I wish to raise several points which bring into question:
rationale for the study
supposed benefits
validity of the title
abysmal writing of the paper Abysmal Writing The final strike to a series of strikes against it's merit:
Artociously written
Many grammatical errors = Confusion
Discounts Scientific Data
Can create hypoxemia simply by holding your breath= low SaO2 too!
Voluntary reduction of Reduced Frequency Breathing is hard to control (Kapus, et al.)
No exposure to chronic or even acute hypoxic state
Preposterous statement to compare it with the effects of LLTH
Hypoxia limits training intensity, which in elite althetes may result in relative deconditioning. (Stray-Gunderson). Not best was to create a hypoxic envirnoment to utilize "Live Low, Train High? 1. Hyperventilation which is stimulated by.... 2. Respiratory Alkalosis 1.Should help increase driving pressure from alveoli to RBC
2. Increase the CaO2
3.Should help increase the driving force from the RBC to the skeletal muscles CO2 +H2O <--> H2CO3<-->HCO3-+H+ Favors the binding of oxygen to Hb in the lungs= increased O2 uptake 4. Increases PaO2 Decreases CO2, remember alveolar gas equation
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