Silent hypoxia is taking people’s lives.

The novel coronavirus, SARS-CoV-2, and the associated disease, COVID-19, have dire implications for infected patients’ respiratory systems. The novel coronavirus binds to receptors on the lung’s alveolar cells, which produce surfactant. Surfactant is a substance that breaks up surface tension of water within the alveoli, preventing the alveolar space from collapsing during exhalation. However, infection reduces surfactant production and the consequent collapse of air spaces, which reduces the bloodstream’s access to oxygen and can result in hypoxia. In some cases, infected patients can develop hypoxia without experiencing any breathlessness, a phenomenon known as “silent hypoxia.” (Levitan, 2020).

In addition to reduced oxygenation of the blood, coronavirus infection can result in a condition known as acute respiratory distress syndrome (ARDS). In ARDS, the virus activates white blood cells and promotes mass release of cytokines, which mediate inflammation and stimulate the leakage of fluid from the pulmonary vasculature. The cytokines increase the permeability of the air spaces, allowing the buildup of fluid within the air space. The buildup of fluid within the lungs also impairs the clearance of carbon dioxide and results in shortness of breath. Additionally, the immune response can contribute to the scarring of the lungs, which changes the compliance of the lungs, making them harder to inflate. According to a retrospective clinical study of 107 COVID patients from Wuhan, China, 78.9% of COVID-19 patients who succumbed to the virus had reported ARDS (Wang et al., 2020). Most ARDS patients would require supplementary oxygen and mechanical ventilation, further straining healthcare capacity during the pandemic.

As society continues to battle the pandemic, patients need accessible ways to monitor themselves for symptoms of COVID-19 and providers need more sources of data to determine the disease course in patients. As stated earlier, a patient may develop silent hypoxia before experiencing any traditional symptoms associated with COVID-19 or receiving a formal diagnosis. These silent hypoxic, unwitting COVID-19 patients could spread the virus to those around them or wait too long before seeing a healthcare provider. We need a continuous, user-centric oxygen monitoring platform to alert patients to their own silent hypoxia, notify their providers, and help patients receive aggressive care as soon as possible.

Technology may flatten the growth curve of COVID-19 cases.

Oximetry is the traditional way to measure blood oxygen levels. There are a variety of devices used to monitor blood oxygen saturation, represented by SpO2 metric, including the pulse oximeter, the finger adhesive, and devices that attach to the earlobe, toes, forehead, and nose. Oximetry can give readings within 2% of your actual blood oxygen levels and can therefore be reliably used as an indicator for such occurrences as hypoxemia or any sign of respiratory distress as long as it is used in concert with other patient assessment tools (Thoracic.org).

Existing oximeters, such as finger clips, are useful for patient assessment. However, sometimes they could be difficult to carry or use. Some of them are bulky like the Nonin Onyx and can fall out while transporting a patient or simply by going about our daily movements like getting up, sitting down, and wiggling our fingers. In addition, some patients may have a weak pulse, which can skew measurement results. Meanwhile, current wrist devices do not continuously monitor oxygen levels and warn patients. Instead, they only measure pulse and fitness-related measurements such as step count and sleep time. Additionally, wrist measurements of oxygen saturation are not always dependable. Regardless, hypoxic patients need smart, portable, and wearable oxygen monitoring devices that alarm users when their SpO2 levels drop below acceptable levels.

OxiWear improves traditional oximetry, marrying advances in technology with user comfort. The upcoming smart OxiWear Earbuds provide continuous earlobe SpO2 measurements, with data displayed on OxiWear’s wrist display. When patients’ SpO2 levels drop below acceptable levels, users will receive alarms. Patients are able to make a 911 call by clicking the button on OxiWear Wrist.

For patients with COVID-related silent hypoxia, OxiWear Earbuds will help inform them of their symptoms and seek assistance before their condition worsens. OxiWear’s technology could also supplement existing COVID diagnostics and encourage silent hypoxic patients who have not been diagnosed for COVID to seek testing.

Smart wearable oximeters and other technologies, such as deep learning diagnosis and big data mining, may bring hopes to flatten the growth curve of newly infected cases as well as preventing deaths- critical benchmarks for society’s ability to overcome this pandemic.

Grab your device now at igg.oxiwear.fitness

Click below to access the complete white paper on the importance of oxygen monitoring for COVID-19 patients.

Keeping up with COVID-19: An Oxygen-Sensing Approach

Works Cited

Keeping up with COVID-19: An Oxygen-Sensing Approach was originally published in Future Vision on Medium, where people are continuing the conversation by highlighting and responding to this story.

Some of you may already know me but most of you may not. I’m Shavini Fernando, the founder of OxiWear, an ear wearable device for continuous pulse ox monitoring and emergency alerting. But more than all that, I’m one out of those many millions of pulmonary hypertension patients.

As an entrepreneur, to date the biggest problem that I had was explaining to people what is pulmonary hypertension, that there are almost 50 million people in USA — and many millions around the world — who have this condition, and why continuous oxygen monitoring is important to them. People with lung diseases like pulmonary hypertension are prone for hypoxia.

I started developing a device based on my own life experience after facing 4 cardiac arrests and three strokes due to hypoxia and yet I still can’t convince people that this problem is huge. Why? Because it is a silent disease. Although I carry a portable oxygen concentrator with me everywhere due to the numerous episodes, not everyone wears oxygen. You might meet your uber driver suddenly showing you the oxygen concentrator they have under their car seat for an emergency which they don’t use all the time. But they likely won’t show it to you or anyone else unless you are someone like me who’s walking around with a visible oxygen concentrator.

But these days all I hear about is how COVID-19 patients end up with right heart failure due to a dangerous and potentially fatal condition known as acute respiratory distress syndrome (ARDS). Which is similar to what happens to the pulmonary hypertension patients. People with pulmonary hypertension die due to right heart failure.

So as a patient who is living with this let me explain how the lungs and the heart function in layman terms. The heart and the lungs always work side by side. The right heart receives all the deoxygenated blood from our body and sends it to the lungs where the lungs oxygenate them and send it to the left heart which then pumps it back to the body.

So, in our heart the left heart does most of the pumping thus it is made with more muscle to support the function. The right heart is not built for pumping blood into the lungs against much resistance, usually it is easy and the right heart is not particularly muscular because of this.

In a healthy lung we have air sacs — the ones that help oxygen pass through into our red blood cells. Oxygen within these air sacs (alveolus) travels into small blood vessels (capillaries) and into our red blood cells. To allow this, the walls of alveoli have to be very, very thin.

So, for any reason if these walls get thicker and there is damage to the vessels due to lung disease, this makes it harder for oxygen to get into the blood and increases the resistance to blood flow and increases the workload on the right heart, which is something it is not built to handle. So it starts to fail.

For patients with pulmonary hypertension what happens is they get pulmonary hypertension from either Idiopathically (IPAH) or as secondary disease due 30+ different other diseases such as COPD, Cystic fibrosis, Pulmonary Fibrosis, Sickle cell, scleroderma, HIV, Mitral valve disease, congenital heart defects etc. that causes their lung walls to thicken due to many reasons. The damage slows the blood flow through the lungs, and blood pressure in the lung arteries rises. As the right heart must then work harder to pump blood through the lungs, this extra effort eventually causes the heart muscle to become weak and fail.

The coronavirus also does something similar. The coronavirus damages both the wall and lining cells of the alveolus as well as the capillaries. The damage leads to thick and dysfunctional alveolar walls and damaged or destroyed capillaries. This leads to reduced oxygen delivery and increased workload on the right heart.

As someone who has faced 4 cardiac arrests and 3 hypoxic stokes, believe me when I say: It is not fun. Getting hypoxic and facing cardiac arrests is the worst feeling ever. If you want to know how it feels when you are starting to get pulmonary embolisms and how shortness of breath feels like, try breathing through a straw. That’s exactly how it feels when your heart can’t pump enough oxygen to the body. If you want to know how getting a cardiac arrest feels like, it’s like when someone chokes you or when you are drowning. YOU JUST CAN’T BREATHE. And it is no fun.

For the last 21 days I have locked myself in my apartment and get everything delivered. I wear gloves and a mask just to go out of my apartment to put the trash to the shoot. And when I come in, I put my clothes in the wash and clean all my exposed skin with soap. My kitchen sink is having a leak these days even for that I have kept a cup to collect water and keeps draining it but have not allowed anyone inside my apartment. You may think I’ve gone nuts. No, it’s because I know how serious this is and because I have been through this multiple times. I survived all that because I was able to crank up my oxygen in time and revive the heart before it’s too late. And because I have an enlarged right heart that has adjusted overtime to support my lung function. I do not want to end up in another ICU for multiple weeks.

If you have been through what all of us have, you would not take a step out of that apartment. If you are lucky enough to recover yes some of the damage is transient — but it is a BIG if. And you don’t know to what level your lungs are damaged even if you survive. Because unlike other organs, once the lungs have adjusted it is permanent, there’s no going back. If anyone wants to know what COVID-19 is from a PH patient’s eyes, it’s a fast track ticket to decompensation. But unlike for us who have got it overtime, getting it fast means your lungs cannot adjust, your heart can’t take that stress, and you end up in respiratory and right heart failure.

So by going out, not taking this seriously, and hanging out in crowds, you are risking your life and the lives of your loved ones at home who might end up getting the virus that you transported home from that crowd.

So as someone with a pulmonary disease, I want to share my wisdom:

• Stay at home as much as possible to save yourself and to save your loved ones who can be at high risk.
• How you know your lungs are adjusting is when your body oxygen levels start to fall abnormally. So, keep monitoring your SPO2 levels using a pulse oximeter. A finger cuff or a mobile application allows you to do that.
• If your oxygen level falls below 93% you need to call your doctor for advice or go to the nearest ER.
• If you are getting coughing symptoms and want to take cough syrups avoid taking cough syrups that contain pseudoephedrine and phenylephrine which could make things worse.

On a final note, I hope that we can all get through this as quickly and safely as we can. I hope after this whole pandemic is solved, investors and people would believe me when I say “pulmonary hypertension is a huge problem, there’s almost 50 million people in USA and many millions around the world with PH and continuous oxygen monitoring and getting help in time can save these people who die from hypoxia” without having to justify why not everyone wears a oxygen concentrator like me.

Please take this seriously. Stay at home and stay sane!

Grab your OxiWear device now on : igg.oxiwear.fitness

COVID-19 through the eyes of a Pulmonary Hypertension Patient. was originally published in Future Vision on Medium, where people are continuing the conversation by highlighting and responding to this story.

Life of a PH’er. A Dozen things you didn’t know.

In 2015 I was diagnosed with Eisenmenger Syndrome which caused Pulmonary Arterial hypertension (PAH); a silent disease that causes high blood pressure (hypertension) in the arteries of the lungs (pulmonary artery) for no apparent reason; a disease that causes shortness of breath, fatigues, elevated heart rate, blue-tinged lips, chest pain, and dizziness. Although there are therapies available to help ease the symptoms and make life more comfortable for sufferers, it is a disease where there is no cure.

I know, when you google for pulmonary hypertension or about me this is the sad description you get. But did you know that there’s more to this disease that you don’t know about? Which makes us quite rare!

1. Unlimited Supply of Viagra

Did you know that Viagra was actually found to treat high blood pressure in the lungs (pulmonary arterial hypertension)? Although the side effects got more popular… So yeah, most of us are on Viagra 20mg (or more) three times a day, along with another stronger vascular dilation medication. I know you must be wondering — does the viagra make us horny all the time? Well, I guess it doesn’t work with women that way. But keeps me wondering all the time how they treat men with PH? And I’m sure men must be initially wondering that the doctor got the wrong patient. So now you know who to reach next time you need your Viagra supply.

2. Blushing for No Reason

Since we are on Viagra and stronger vasodilators we blush without a reason. Yes our cheeks ears nose goes red like Rudolf without a warning. So Next time you see my ears cheeks nose all red, sorry guys i’m not blushing because of you or if you plan to ask “Looks like SOMEONE got some sun!”, Nope it’s the Viagra's effect on me.

3. Blue nails & Blue Lips — Who needs makeup or nail polish

So all of us who has pulmonary hypertension has a weak heart causing low blood oxygen saturation. When the amount of oxygen in our red blood cells is low our body parts can’t get the oxygen they need which makes our skin, fingernails and lips to turn in to a bluish color. So who needs to wear lipstick and nail polish when your lips and nails are naturally blue.

4. Heavy Periods

Most of us are on some kind of blood thinners to ease the blood flow in vessels. Which means more bleeding. If we have the slightest cut we bleed for days. And for women, bleeding is not just cuts we are due to bleed every month which results in heavy bleeding that sometimes so much we can get anaemic, and have low energy. It’s a unique struggle for those on blood thinners. So if you meet us at that time of the month you might feel like you visited a crime scene. So make sure not to judge.

5. No hot or Cold Showers or steam baths

Too much of Low blood pressure or high blood pressure is deadly for us. While the Cold showers increase our blood pressure the hot baths, spas and saunas help to decrease blood pressure by opening/relaxing the walls of blood vessels. So either one of those can cause us to pass out while having a shower, and may end up being the final bath we have. So it’s a NO for steaming hot showers for those for us who have PH, we will have to settle with only mildly warm water. I know its sucks right.

6. High Elevation — More intimidation

Did you know that air pressure is 30% lower at higher altitude due to the fact that the atmosphere is less dense — that means, the air molecules are farther apart. … So at high altitudes, the lower air pressure makes it more difficult for oxygen to enter our vascular systems causing oxygen deprivation. So for people like us who suffer from pulmonary hypertension, the lower oxygen in the lungs and the pulmonary arteries is quite deadly. So no more high elevations and flying for us. There goes my travelling/hippie life.

7. My bag is more expensive than your Prada.

Did you know our oxygen concentrators are more expensive than your Prada? Plus needs maintenance that costs about another Prada. And the best part is we don’t need an occasion to carry our expensive accessory as it is literally our expensive life partner, our lifeline who accompanies us everywhere. And guess what? They all have names too.

8. More Swelling than Pride

Most of us who have Pulmonary Hypertension has an enlarged right heart that struggles to pump blood around our body causing fluid retention and swelling. Salt and MSG makes it worse causing to retain more than a kilo of fluid overnight. So the more sodium we eat & the more we exert, the more fluid we retain causing us to swell more. Some of us end up having an significantly different weight when leaving the hospital after a dose of Diuretics.

9. We pee more than we drink

So as I mentioned earlier our disease causes our body to hold onto excess fluid. The fluid builds up and causes swelling in the ankles and legs, increased shortness of breath, fatigue, and sometimes chest discomfort for us. So to avoid this we are on Diuretics which make us pee more than we drink until all the excess fluid in the body is out of our system. Sometimes it makes me wonder how? Because I lose 2 kilos overnight from the diuretics when I only had two glasses of water the previous day. And a point to note; although we are normally slower than a tortoise, we can muster up a Usain-Bolt-like-sprint when we have to run to the loo. Which at times can be like every 30 minutes.

10. Tangled in real life

While some of us use the oxygen concentrators or tanks only when we are out and about some of us are tied to it 24X7. Whichever it is we all end up tangled in our own hose. It gets tangled on door knobs on our own clothes and accessories and we even trip and fall on our own oxygen hose. It is a bit hazardous but still it is our lifeline so we have no option but to untangle our selves.

11. I could have become a millionaire

… And the medical costs! Our medicine prices range between $10,000–$90,000 for a month. So without Health Insurance, I think we all would have a very short life. And even after insurance if we save all the expenses including co-pays and other expenses we could have easily become a millionaire in about 5 years time. Imagine if they scrap insurance for pre-existing conditions, and how many lives it will impact… It’s around 50 million people in the USA (who have Pulmonary Hypertension alone).

12. Oxygen saturation # lower than Tiger Woods best day on the golf course.

By default, our blood oxygen saturation is very low and when we walk talk or do the slightest activity the oxygen saturation falls much lower. But did you know that some of us can still function normally at 80% oxygen sat? Which is way lower than Tiger Woods best day on the golf course.

I’m sure that no one other than us PH’ers can beat us to this. If you can you are definitely are a Zebra like us or might be a Unicorn too. So next time you meet any of us you gotta know that you are meeting someone special because “We are Rare & We are Aware”.

Life of a PH’er . A Dozen things you didn’t know. was originally published in Future Vision on Medium, where people are continuing the conversation by highlighting and responding to this story.

OxiWear — How It All Started

I was misdiagnosed for 33 years. I was told I had asthma.

In September 2015 in Sri Lanka, I was trekking and I became short of breath and my friend said that my face was a blueish color. I was concerned so I went to the doctor to find out why. I will never forget that day, the doctor diagnosed me with a hole in my heart and severe Pulmonary Hypertension (PH), and told me that I had two years to live.

I moved to the US to get a second opinion from the world leading PH department at John Hopkins. The conclusion was that I needed both a heart and lung transplant. The average life expectancy after a lung and heart transplant is 5 years, because they need to weaken the immune system to do the procedure. The health risks are even higher for me because I have the Tuberculosis vaccine in my body. As a result, the doctors are trying to buy as much time as possible before I undergo a transplant. Fortunately, I am beating their expectations in the state of my health, and it’s already been over 3 years, when my life expectancy was 2. I am currently shooting for the stars and hoping 3D printed lungs can be available before I have get a transplant so I don’t have to weaken my immune system.

Upon arriving to the US, the doctors also told me that I would never be able to fly ever again and that meant I could not go home to Sri Lanka.

Despite this, I did not want my condition to define my life. I wanted to live it to the fullest, so I enrolled in a Masters of Communication, Culture and Technology at Georgetown University. I wanted to restart my life, study, and live like a everyday person. Importantly, I also wanted to create awareness of this silent disease I had.

I had one major challenge to living a normal life. Due to severe PH, my oxygen levels drop down to dangerous levels without me noticing.

One day while working at Georgetown in mid 2017, my colleague suddenly started screaming that my face was blue!

My oxygen levels had dropped without me noticing.

In a matter of minutes, my heart stopped…

Before my brain ran out of oxygen I was able to repeatedly hit my chest with my fist (performing self-CPR) which fortunately restarted my heartbeat. Because of that, I am here today.

This has actually happened to me on four separate occasions. I have had to revive my own heart on my own before I passed out from no oxygen supply to the brain.

After the incident at Georgetown in 2017, my doctors, family and community were questioning whether it was safe for me to live alone, work, and study at university. This was heartbreaking for me. I had just started my new life in the US, was finally living on my own, and I did not want to lose my independence.

I thought to myself constantly — if there was a way to know my oxygen levels at all times — I could know when they were falling, and when I needed to take action. Before it was too late.

I needed a wearable that could monitor my oxygen levels, alert me if they fall too low and allow me to get help on time.

Being a maker, software engineer and general tech person, I knew about all of the devices in the market. Unfortunately, there was nothing available that could help me. They either didn’t check my oxygen like Fitbit, or if they did measure oxygen, but were not wearable like my finger cuff (pulse-oximeter).

I knew I needed 3 essential functions:

1. Measure my oxygen levels.

2. Be wearable — so that it could be constantly monitoring and alert me if my oxygen fell too low.

3. Activate my emergency plan (and call 911) if something ever went wrong.

This is why I needed to create Oxiwear — a wearable on my ear that can could monitor my oxygen levels and allow me to get help on time.

I proposed the device to the PH specialists at John Hopkins, and they encouraged me to make it. They knew just how valuable something like that could be not just to me, but the entire PH community. And today, they are helping me to develop this device.

Currently, I am on the mission to do this. Not just for my own life, but for others in the PH community.

Since, starting OxiWear I have created a working prototype of the device. I have also now won pitch competitions and received grants which are helping me to fund the initial development costs of a more optimized version of the device. I am aiming to make the device smaller, and stylish. I don’t want it to look like a medical device, but like something I would want to wear. My goal is to make this available to use as soon as I can, so I can reduce my (and the PH community) insecurity through continuous oxygen monitoring.

I hope that you can join and follow my mission. Feel free to sign up for updates in my newsletter at OxiWear.com/news.

Grab your OxiWear device now on : igg.oxiwear.fitness

OxiWear — How It All Started was originally published in Future Vision on Medium, where people are continuing the conversation by highlighting and responding to this story.