The last time I blogged about this particular case, he just learned to use the Capnotrainer to get his ETCO2 levels WNL, which in turn abolished his complaints during cervical rotation.
Both the patient and myself were confident he would be able to continue with this breathing pattern we went over for 45 minutes. He then went out of town and followed up some time last week. He said he felt better with the shallower breathing pattern; however, the thought of shallow breathing during supine lying, or even visualizing lying supine with shallow breathing made him recall having an MI. In turn, he gave up the newly learned breathing pattern and his complaints of minor to moderate "tightness" with cervical rotation persisted. State context is important and we often forget about that as clinicians with only a few courses in psychology.
We used the Capnotrainer again to get baselines. His baseline breathing pattern of about 15 bpm and deeper breaths was about 28 mmHg. This time, I let him use the waveform on the monitor as visual feedback, and he really played around with it, being an engineer and all around inquisitive guy. The first thing he tried was holding his breath several times, to see if the Capnotrainer gave a reading of 0 mmHg - it did. He then tried changing different aspects of his breath.
After about 10 minutes of practicing different patterns, his ETCO2 was 38 mmHg and climbing! I excitedly asked, "What are you doing?" His BPM was only 6-7. He stated he was taking as deep as a breath as he normally did, but doing so as slowly as possible. He was also taking longer pauses at the end of inhale and exhale. Raising the ETCO2 levels to between the normal values of 35-45 mmHg again abolished his complaints of any discomfort or moderate stiffness during cervical ROM. This was a great revelation for me as I now have another variable to instruct, different breathing rates. Below is a quick video showing the visual readout on the Capnotrainer with the large, slow breaths.
Keeping it Eclectic and learning all the time...
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