Ryan DiesemThe Ryan Report

Home Oxygen Guru – The HO2G Pen

Ryan is leading a very busy life these days working, going to college to get his degree in Respiratory Therapy and becoming the “Dear Abby” to oxygen users! We thank him for his hard work and dedication. – Editor

Dear Ryan,

I realize that a small, shoulder-carried Portable Oxygen Concentrator (POC), is not in my future. I am on 4 LPM continuous while at home. I use large cylinders on 4 LPM pulse while away from the house for short periods of time. My oxygen supplier is undergoing some sort of reorganization or takeover. When I started with them, they had an office and warehouse facility15 minutes from my home – I would give them a 9 (out of 10) for both service and information. Now they have closed the local office except by appointment and although they claim to be able to lend you cost-free portable concentrators, they seem to know little about the units they carry. The one thing they assure me of is that all of their roll-around units perform fine, even when flying at 35,000 feet or higher altitudes. I would hate to be at that altitude and find that I have little or no oxygen. The machines that they mentioned on the phone were O2 Concepts Oxlife and Sequel Eclipse.

SeQual eQuinox

SeQual eQuinox POCCAIRE has announced they will discontinue manufacturing the SeQual eQuinox POC at the end of this year. The reason being they felt their Eclipse 5 POC provides the same clinical features, flow setting and functionality. The eQuinox is four pounds lighter than the 5 but is a higher cost to purchage.

Ryan Diesem is Research Manager at Valley Inspired Products, Apple Valley, MN. Contact Ryan at [email protected] com with questions or comments.

I would appreciate any light you can shed on this subject and value any recommendations you might make. John G. from PA

Hi, John, Even though you are at 35,000 feet in an airplane, the cabin pressure in the plane is typically equivalent to being at 8,000-10,000 feet. Most, if not all, portable oxygen concentrators should still operate relatively well.

EclipseRegarding the machines available to you, I would suggest the Eclipse over the Oxlife, though both probably should meet your needs. Your oxygen requirements as you describe them are such that you should not consider any other currently available device as they likely will not be able to produce enough oxygen to keep you saturated. The Eclipse and Oxlife have continuous flow settings (though only up to a setting of 3), so they could potentially act as your home unit when you get to your destination. Understand that when you fly, you will need to carry enough batteries to last one and a half times the length of your trip. I’m going to guess the trip is around 3 hours, so you would need enough batteries to last 4.5 hours. Since you would probably be using pulse settings, Oxlifeyou likely would need at least 2 batteries, and I usually recommend one more than that to ‘be safe’. If at all possible, use pulse flow settings when using battery power to prolong its life.

Either of these units, plus the batteries and accessories, are going to be a lot to haul. They are among largest size POCs, and with the weight of the unit, batteries, and accessories you could be toting around 20 pounds or more. They are on wheeled carts to make handling easier, but you may want to be prepared to ask for help getting the units to and from the plane.

It is disappointing but not at all surprising to hear of the reduction in service quality from your provider. This seems to be happening everywhere, unfortunately, with the primary excuse being that reimbursement payments to the providers from Medicare and other government supported services have been extremely and progressively reduced over the last ten years. When companies do cost analyses, typically the added services that are most beneficial to patients like education and delivery are the first to go. I don’t see this changing any time soon unfortunately, but it does seem that the message is getting out there and there may be some response and reaction sooner than later. But in the meantime, the type of service – or lack thereof really – that you are seeing is the ‘new norm’. It’s very unfortunate.

Hope this helps! Ryan

Dear Ryan,

I am always looking for ways to make my oxygen use easier for day to day outdoor activities and travel. I am oxygen dependent and require a 6 LPM flow rate. Continuous flow is best for me. I use a conserving device for my D & E tanks to get more time but also take a tank with a continuous flow regulator to supplement when my saturation levels drop. A few hour errand can require multiple tanks. A POC is not adequate for my needs. I owned the Inogen® High Flow G2 POC. My oxygen level would drop to the low 80s and sometimes high 70s. I gave it to a friend who uses it all the time with great results.

I recently learned of the Helios Liquid Oxygen portable unit. I have no idea if this would be a viable supplemental solution for my needs. Any insight you can provide would be greatly

Patient Access Survey

People for Quality Care published the results of their Patient Access Survey of over 1,000 people in 47 states. The conclusion is that things have to change and we need to let our elected officials know. The survey will provide information to policymakers and government agencies on the detrimental effects Medicare beneficiaries are experiencing as they try to access home medical equipment supplies and services under the Competitive Bidding program.

More than half of participants report problems accessing home equipment.

  • More than 1 in 3 have increased out-of-pocket expenses for the
  • Three in four oxygen users had a disruption in their oxygen
  • Nearly 1 in 10 report medical complications, hospital readmission or emergency care due to issue obtaining service and
  • An incredible 9 percent of case managers had problems getting people home equipment who are preparing to be dis- charged.

Visit www.peopleforqualitycare.org

appreciated for this or any other system or product. I want to get out more and stay active.

Also do you know if there are any tanks made of composite material that would be lighter than the 5 to 7 pound D & E tanks?

Thank you and best regards. P.M. of FL

 Ryan replies, Your experience is not surprising to me. I suspect that the nature of the oxygen delivery of the Inogen® device contributed to your low saturation levels – the Inogens (and all other pulse-only models of POCs) utilize what is called minute volume delivery. I could spend many para- graphs outlining this, but basically what you need to know is that as you are actively moving about and your breath rate increases to compensate, a minute volume delivery system like the Inogen® will actually reduce the pulse volume of oxygen you receive per breath. So even though you were at 6, when you needed the same or more oxygen because you were walking around and breathing faster, the device would actually give you less per breath, which negatively impacted your oxygenation. This is a common ‘feature’ of the majority of POCs, save for the larger POCs that also have continuous flow.

I am going to assume that you have not tried any of the larger, continuous flow POCs like the SeQual Eclipse, that are capable of delivering much larger pulses than the Inogen® units do at the same pulse setting. The Eclipse has settings that go as high as a 9 pulse and deliver a very large pulse volume, so the potential for use is there, though your needs at activity may even surpass its capabilities. It would also not be surprising if they couldn’t match your oxygen demands.

I would strongly recommend liquid oxygen as an option if it is available to you. Many providers no longer distribute liquid systems due to cost, but if this is an option for you, whether it is covered or you pay for it yourself, I do feel a liquid system

would give you a much better opportunity to be active for a longer period of time without the burden of a POC or cylinder system. However, I would not recommend the Helios for your needs. I do not think it would provide enough in either its pulse or continuous mode. You would want to look at a continuous flow portable with flow setting over 6 LPM like the CAIRE Hi Flow Stroller or CAIRE Companion T, both of which could last for a few hours at 6 LPM. With a liquid system would come the requirement to have the liquid base unit inside your home/garage, which would be used to fill your portable and would need to be refilled when the contents were used up.

One approach people have had success with is to get their doctor or pulmonologist to specifically prescribe a liquid base system and portable at the desired flow rate, even using the actual product name like “CAIRE Hi Flow Stroller for portable use” instead of the typical, generic “O2 at 2 LPM” prescription many oxygen users receive. This isn’t guaranteed to work, especially if there are no pro- viders that supply liquid in the area, but it would be a more concrete foundation for getting the equipment that would be most beneficial to you.

Regarding tanks and their makeup, the lightest ones are composite, but more often what is avail- able is made of aluminum or steel. You will know if you have an aluminum one versus a steel one if you try to place a magnet on it – it won’t stick to the aluminum. There are composite tanks avail- able, but they would be much more costly – like eight to ten times as much – and so the weight savings, about two pounds for an MD, may not be worth that cost. You can see some of these here: www.cramerdeckermedical.com/category.php?category_id=2

drawing of snowmanI hope this is helpful. Ryan

Happy holidays to all!