In December of 2009, with the passing of Thomas L Petty MD, the world of pulmonary medicine lost a true icon. Beginning with his graduation from medical school in 1958, Dr Tom (as many patients and colleagues affectionately knew him) enjoyed a career that spanned more than 5 decades. Fortunately for patients around the world, Dr Petty's career is rich with contributions advancing the art and science of pulmonary and critical care medicine.
Dr Petty has been credited variously as “the father of pulmonary medicine,” “the father of LTOT” (long-term oxygen therapy), and “the father of pulmonary rehabilitation.” Starting in 1965, when he first discovered the possibilities that new liquid-oxygen portable systems offered to those needing home and ambulatory oxygen, Petty elevated and promoted the medical management of COPD like no other before him or since. Additionally, in a paper that appeared in the fall 1967 issue of the Lancet, he and his surgical partner Dr David Ashbaugh were the first to describe the sequelae of ARDS. The face of critical care medicine and the provision of mechanical ventilation have not been the same since.
In the early 2000s, Dr Petty experienced health issues of his own—issues that in his words placed him on the other end of the stethoscope. This was Dr Petty's way of letting everyone know that he too was now a regular user of supplemental oxygen. Once again, another legacy was established: that of LTOT patient advocacy. As a result, today's LTOT users are much more aware of their numerous options for supplemental oxygen. There too is a growing awareness that for optimum effect, LTOT must prevent arterial desaturation (unintended or otherwise) not just some of the time, but all of the time. Success, in Dr Petty's opinion, depended upon knowledgeable LTOT users able to maximize their LTOT delivery options to maintain effective oxygenation under all conditions of use.
To nurture this growing patient-centric movement, in 2004 Dr Petty published his first book on the subject, Adventures of an Oxy-Phile,1 in which he proudly stated in the preface, “This book is written for and by patients who have learned to adapt to the need for supplemental oxygen. I hope it will serve thousands of patients and their families, as well as other students of oxygen.” I couldn't agree more. (Although the first edition of Adventures of an Oxy-Phile is out of print, a free copy can be downloaded from the Web site: www.drtompetty.org.)
The writing of the second edition, Adventures of an Oxy-Phile 2, commenced in full fervor by Dr Petty in August of 2009, during an extended period of wellness. Fortunately, the book was mostly complete by the time of his passing, and was easily brought to its final form by 3 life-long colleagues and close friends.
As with the first edition, Adventures of an Oxy-Phile 2, is more about LTOT users, although there is ample attention directed at the underlying science of continuous supplemental oxygen therapy. However, with the second edition—208 pages versus 96 for the first—there is considerably more material about both themes. In all, there are 20 chapters, 9 individual vignettes by LTOT users, and 11 chapters by acknowledged experts (four by Dr Petty himself) on various aspects directly related to providing LTOT in the United States and abroad.
Following a moving dedication and foreword, 2 invited commentaries from colleagues and friends, and a preface by the author himself, Adventures of an Oxy-Phile 2 begins with 4 chapters by Dr Petty, the first of which is a lay person's introduction to the need for oxygen. In chapter 2, Dr Petty discusses his personal experiences with oxygen, beginning in 1965, as an early investigator of the effect of ambulatory oxygen in minimizing the discomfort of altitude-induced hypoxia, to his status as an LTOT user. In chapter 3 he answers questions often asked by LTOT users. Chapter 4 is a reprint from the earlier edition, and is another lay person's introduction to the physiology of oxygen transport. Taken together, these first 4 chapters nicely set the table for what is to follow, including the manner in which each of the contributing experts present technical material.
Chapters 5 and 6 include the first 2 of the 9 personal anecdotes provided by LTOT users. In chapter 5 we learn how even a highly educated physician-patient can take a trip down the “river of denial” when faced with a diagnosis of COPD, and how he later had to learn to cope with oxygen. Chapter 6 offers a glimpse into just how far a resourceful retired engineer on LTOT would go to overcome obstacles encountered when initially trying to obtain the best delivery device for his needs in the United States, and then later, when retiring to Vancouver Island, trying to navigate the unknown Canadian Provincial Health Care System.
In chapter 7 a second expert offers a wonderful description of transtracheal LTOT. Following a thorough explanation of the ins and outs of transtracheal, including a balanced discussion of the potential advantages, disadvantages, and benefits, 4 patient testimonials from transtracheal users are presented. For readers interested in further pursuit of this topic, the contributing author graciously provided accompanying references.
Chapters 8 through 11 offer the reader 4 more personal anecdotes. First there is a story of how a newly diagnosed COPD patient with obstructive sleep apnea embarked on her “personal marathon” to maintain an active life despite her diseases, and how during that journey she gained so much from pulmonary rehabilitation and networking with patient groups. We also learn how her journey led her to transtracheal LTOT. Next there is the almost unbelievable story of an individual with a lifelong habit of brisk walking exercise receiving the diagnosis of COPD (secondary to bronchial obliterans), who now faced the reality of having to continue his passion for walking while using LTOT. Through sheer determination, by his own account, he has now walked in and completed 3 full marathons, over 20 half-marathons, and several 10-kilometer walks and 5-milers.
In chapter 10 we hear from a seasoned bike rider who simply refused to allow a diagnosis of COPD, with the resultant need for LTOT, to interfere with his long-held desire to bicycle across the United States. Next there is the odyssey of a politically active LTOT user who decided in 2006 to challenge the inherent difficulties of flying to Eastern Europe while using LTOT from 2 portable oxygen concentrators. No doubt his success had some influence on the Federal Aviation Administration's recent decision to permit the use of certain portable oxygen concentrators on all domestic United States air carriers.
In chapter 12 we hear from another expert, this time an acknowledged pulmonary rehabilitation specialist who went on to become a premier authority on arranging for the use of LTOT aboard cruise ships. Due to her unwavering efforts, what was once a virtual impossibility is now an everyday occurrence.
Chapters 13, 14, and 17 give us the final 3 testimonials, which deal with the genesis of several patient-advocacy groups, including the worldwide, Internet-based Emphysema Foundation for Our Right to Survive (EFFORTS). Lastly, we learn how 2 Italian LTOT users overcame obstacles to travel by train to an in-country conference on the quality of life for patients on oxygen.
Chapters 15, 16, 18, 19 and 20 give us the final 5 contributions by the experts. In chapter 15 we learn how home oxygen therapy started and is currently provided in Japan, and in chapter 16 we are treated to a similar history of LTOT in Poland. As one would expect, both authors pay a huge debt of gratitude to Dr Petty for his invaluable contributions in the 1980s as a visiting professor in Japan and for generously allowing Polish researchers to spend time with the Petty team at the University of Colorado in Denver.
Chapter 18 addresses the all-important role of the home respiratory therapist (RT) in optimizing LTOT outcomes. Authored by a highly regarded pulmonary rehabilitation RT, this chapter should be required reading for every RT, regardless of their site of practice. The author rightfully opines that many hospital-based RTs tend to view oxygen therapy as “routine” and are therefore not always included in its delivery. The unfortunate consequence of this passivity is that less than half of patients discharged following a COPD exacerbation receive LTOT to control baseline hypoxemia.2 No wonder the recidivism rate for COPD patients following hospital discharge is so alarmingly high.3
Chapter 19 should also be required reading for all RTs. The author, who in my opinion is clearly the most acknowledged expert in oxygen-conserving technology, takes the reader on a fact-filled journey into the confusing world of continuous versus intermittent oxygen flow. There is a special focus on the variables that must be considered to ensure that optimum oxygen saturation is the rule and not the exception, regardless of what flow pattern is employed by the LTOT equipment. Once again the need for all RTs to know and understand the possibilities and limitations of all LTOT delivery devices is underscored.
Chapter 20 completes the expert contributions and is authored by, again, one of the world's leading LTOT researchers. In this final chapter the reader gets an idea of where LTOT research is headed and the issues that investigators ought to focus on. There is no doubt that the science behind LTOT will continue to emerge, further validating this life-saving and cost-effective therapeutic intervention. The book ends with a list of LTOT resources, a glossary of terms, and an insightful biography of each contributing author.
This book is intended primarily for LTOT users, and I wholeheartedly recommend it as such. To that end, the 11 chapters by the contributing experts are written in plain prose that can easily be understood by most LTOT users. As one would expect, so too are the anecdotes from LTOT users. However, based upon my personal observations and experiences, the book would be a valuable resource for all RTs who care for patients with COPD and other chronic respiratory conditions requiring LTOT. The hospital-based RT would benefit from learning about the nuances (some subtle, some not so) of LTOT and the importance of ameliorating the life-threatening effects of chronic hypoxemia. Home-care RTs would also benefit, by sharing the LTOT user vignettes with their LTOT users, thereby enhancing how they manage and care for such patients. I also highly recommend the book for all RT education programs to help future RTs understand the vital role of LTOT in the care and management of COPD.
In the final analysis, Adventures of an Oxy-Phile 2 is a fitting tribute to a giant in the pulmonary community, who always placed his patients at the forefront. With the publication of this book, I'm pleased to note that Dr Petty's commitment to his patients will endure long after his passing.
Footnotes
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The author has disclosed no conflicts of interest.
- Copyright © 2011 by Daedalus Enterprises Inc.
References
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