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Andrew

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 #16 


Thank you everyone for the continued dialogue and fantastic insights and questions.

Juerg,

Is there a reason that the in depth description can not be shared on this forum for those of us interested in learning more on this topic?


Juerg Feldmann

Fortiori Design LLC
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 #17 
Here  2  otherr  TIP  5/1/5 .  This  where done   with a Portamon.  Yellow here is the tHb  . We    normally now  use  with MOXY  brown  for tHb  and  green  for SmO2.
 Thsi 2  exampels  just show you the different  reactions you may get when looking at tHb.

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Andrew

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 #18 
So, in the first case, there is a general trend to steady increasing values for tHb, both during the exercise modes, and the rest intervals, until the athlete hits the 1800 mark, then a "plateau" both during the interval and the rest interval, followed by the reverse trend in the final step. There is also a dramatic difference between the the high resting values and the much lower values during the "work" phase.

In the second case, the trend is very "flat", with almost no rise in tHb as a general trend, and even during the rest intervals compared the the "work" intervals. Another difference is that this trend continues completely through the the end of the test, despite the increasing dramatic swings in results for the SmO2 data.

Is case #1, is it possible to determine if the increasing tHb is a result of increasing tension leading to venous occlusion during the work period, or increased supply due to vasodilation? Or this there another explanation for this trend?

In case #2, the increasing swings in SmO2 values presumably are a result of the relatively stable supply pattern, and the increasing need for O2 at the muscular level. Does this indicate a general weakness in the "supply" of blood to the muscles due to a cardiac or vascular limitation, or am I missing something in this picture?
Juerg Feldmann

Fortiori Design LLC
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Posts: 1,530
 #19 

Andrew makes some great comments here, and that is exactly what we try to achieve in our basic  level seminars and with our feed backs we run in Europe with Swinco. We have  made the experience  , that  many NIRS users  look at the information very different  and than when we move into the second phase of actually using the   ideas  for training, we  experience the complete different  ideas   of  NIRS users  and what we do. So as in many   other fields the basic information and basic ideas  are crucial  to get    a  great discussion going.
 Andri is doing a great job in one by one  discussions  of tests like we showed here in the above examples.
 This are tests sent to him and than we go step by step through,  as  it starts  exactly as Andrew is doing it here with observation  before we  go to the  step of potential conclusions  based on just a NIRS /MOXY assessment.
First step is observation as Andrew did in his great comments, Observe without trying to make any conclusions. Once we are through this initial step we than can go further in combining the information's we gathered over years in combination with VO2 , Physio flow and lactate and see, whether the MOXY information in fact allows us to make some conclusions based on our observations.
The old idea : Unseen real and unreal seen.

Here some additional observations   on the above   two versions of a test feedback.
 Look at in the first one  not just tHb  ( tHb is  an indication of  delivery ) but look at  SmO2  ( purple   and in Portamon this is the Hb diff.  Hb diff is not  always identical  with SmO2   just in certain situation. In test 2  you see  SmO2  and  Hb diff  would be    more or less  exactly overlapping.
 Than look in test 2 and look and you see a  specific pattern in tHb  every second  rest you can see what?.
  We  where  showing this client,  that  delivery has to be looked  at from 2 points.  
  a) the "pump reaction "cardiac  reaction like SV  and EF %   but as well the   " piping system: ( blood vessels ) , where   muscle tension,  due to contraction,  or compression due to position or  clothing    and increase in blood volume in certain body  parts  can have an influence  in  delivery.
This is  another reason, why we  do not use  compression  sleeves  to  fix  MOXY or any  NIRS based device during activity . This may be okay for  non active lab testing  where  in the test area   no muscle contraction takes place  and no  joint motions.

Your new  MOXY order  will be   offered  with a new   option  on how to mount  MOXY  during a strength workout  or  as well during  other activities.

 tHb  is as well a great tool in  certain sports  to see, whether  body position in fact may inhibit  delivery  and as such recovery of  O2  levels.
  Very crucial in ice hockey goalies,  but as well when on the bench. Brian Kosak did  some incredible live demos  to Parents  and coaches  and athletes   to show the difference in recovery  in different positions on the bench. Att pic   is a demo to an athlete ( LA Kings  prospect  and farm team )  during a workout  on how   tHb  is changing. tHb is  a  very fast responder  as  on the other side  utilization is somewhat slower. So change in position can  influence  utilization  depending on the duration of this position.

 but as well in other sports   in the way of  positions.  In cycling  bike fitting is often based on   cameras  and    joint angles  and in  very few instances  it is based on physiological reactions to find a possible compromise.


So back to the great feedback
 Yes  great observation  and as you can see some additional points we  can get out of the observation.
  Again once we  go through the observation stage  we  than  can  start some ideas on  conclusions. If  people have VO2  equipment  and physio flow  like more and more centers seems to us , as well  still use  Lactate, than they can  base   and combine the observation with additional feed backs  from the other tools  and get  very often some surprisingly  feed backs   and  learn   to understand  why we talk about delivery  and utilization as well why we talk about  limiter and compensator.
  I got some  e mails back  from some of our  centers  working with Andri  and I see that they  do a great job in  observation and conclusion.( Not sure  whether it is Andri's great   skills to  get information over in English  or whether he  is just lucky  to have smart center owners  ha ha )
   From  10 feed backs  I have 9  arguing that in  picture test one  the increase in tHb is due to vasodilatation  and not due to   compression ,occlusion trends.
  All actually even  explained  and  justified  why.  So  for   all regular readers  this is your chance    to  NOT get educated as we do not like to  tell you what we see and  than people repeat  it. This is   an active    feedback thinking forum  and  lock at  all the  options  on why we  may get to the conclusion  on  vasodilatation  increase in tHb versus  occlusion compression  option  .
 In   case 2 : The suggestions  I got back are   from all centers the same. Great  delivery    system  with   great cardiac  and  vascular delivery,  Utilization  limitation   most likely  mitochondrial density  limitation. Key goal in this athlete,   angioneogenesis  and than  increase in mitochondrial density    8 - 12 weeks   followed by   3 -4 weeks retest  with  MOXY. Training  control over   tHb  zoning rather than over  SmO2  zoning.

 Fred  I hope with the new   software  you can see why  we can use tHb  so nicely now  to control workouts  live, whether it is a stretching program or a strength program or  any thing.
 Would you agree ?

 This leads  me to show you another test  sent to us  . It is  NOT a 5/1/5  TIP  it is a simple 5 min step test, here the 2 options of  zoning based on delivery tHb  or on utilization SmO2 we  got with the test  feedback.

 PIC   2 is  a Zoning  5 min step test based on SmO2  trend.
 Than  pic 3  is  Zoning based on  tHb trend  and pic 4  is a back up info  why tHb is zoning is this way. He used a second MOXY on a not involved  muscle  to back his tHb  zoning up.
 You guys are getting fancy  ( smile )

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fitbyfred

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 #20 
Juerg, hi, yes I'm very excited to start the week with the updated peripedal--I could see the tHb reactions from 10 m away from the biggest wall monitor. Trial gang in this weekend had some fun playing with tHb changes with basic weight lifting and occlusion making methods--clear, simple and fun. Thx for checking in on this and for the weekend brain workouts too.
FBF

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juergfeldmann

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 #21 
Here some feedback, as I got a few mails with the same question. There  is some confusion to the interesting feedback we had on the two examples  of a TIP. This is the question  or better feedback we got  from Andrew. the TEST WAS THE SECOND  SAMPLE  WHERE WE HAD A  RELATIVE  STABLE  ThB  WITH A SLIGHTLY  TREND IN INCREASE  OVER THE DURATION OF THE TEST AND  RELATIVE  SMALL CHANGES  AT THE 1 MIN REST PERIOD. if YOU LOOK CAREFULLY YOU SEE  CERTAINLY AT THE BEGINNING  EVERY SECOND REST A  INCREASE IN ThB. ( THIS WAS DELIBERATELY  PRODUCED TO GET SOME ADDITIONAL INFO ON THIS ATHLETES   ThB TREND

Here the feedback  we had:
" In case #2, the increasing swings in SmO2 values presumably are a result of the relatively stable supply pattern, and the increasing need for O2 at the muscular level. Does this indicate a C, or am I missing something in this picture?

This is a  great point  and If you look at the idea of 1 min rest you see the benefit of it.
As  Andrew points out, at the start of the 1 min rest we have an incredible increase in SmO2. This  could indicate, that a lot of O2 is used by the working muscles. At the moment we interrupt a homeostasis we  really here interrupt only the O2  demand of the working muscles. Meaning that at the moment we stop biking or running or any activity we  have an immediate  lower O2 demand.
But as we stop sudden the delivery system  do not  stop immediately as well, so thy keep  supplying the same amount of  O2  as  before  for  a  few more   seconds or time.
 THis  allows us to see, the overflow in O2   due to the supply overflow  but the   less demand of the muscles. If we combine this  with VO2 we  can see the difference in a certain amount even.
 Now   after 1 min  the delivery system drop their  delivery as  they  get the message, that IT IS NOT REALLY NEEDED.
 So HR CO  and VE will drop. Now  as we suddenly start again we have  for the repeat or the new load.
not the needed supply going , so we have to dig again in the " savings"  of O2  locally   and we see a  drop in SmO2  again as a sign  of the  amount of O2  needed  from the working muscles.
 The time lag of  the delivery will e  picked up somewhat later.
As you can see, this is NOT a  O2 deficit  it is a taking of O2  from the local storage  like tHb  and Mb.
So the  big or clear  up and donw of SmO2  indicates a  great delivery ability once it  is going.
 So  Andrew points that out as well at the start of his feedback see in red.
  Now the confusion  is :
 In case #2, the increasing swings in SmO2 values presumably are a result of the relatively stable supply pattern, and the increasing need for O2 at the muscular level. Does this indicate a general weakness in the "supply" of blood to the muscles due to a cardiac or vascular limitation, or am I missing something in this picture? 
 
 So the question is : If it is a stable delivery  why is it a weakness and based on what observation would this indicate a weakness ?
 I am not usre on this answer.
A cardiac weakness  would show a very different reaction as well a vascular limitation in  the direction of vascular density. So I am not sure either what it means  when we have a stable supply  which seems great if the supply over the whole test is stable despite increase in load  , so  not sure where we would see a weakness in the supply.

 We  have a  simple  information  exercise  in our  entry level seminars( basic  information )  for MOXY. Here  a repeater  for all who  used this already  and for new readers. See  att

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Andrew

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 #22 
Thank you Juerg for continuing to answer my simple questions...
The latest attached image gives a really clear picture of the nine different possible scenarios that are possible when viewing trends using Moxy data alone. Now, I just need to confirm the different possible causes of the nine situations. I have not been able to find an explanation to confirm my theories through my reading in the Moxy literature. Perhaps someone on this forum could direct me to the appropriate pages.

I would now like to try to explain why I thought the "stable" tHb was an indicator of a limitation in the case #2 above. We know that the body preferentially increases cardiac output and blood flow to working muscles that are being used to produce force. in this case, very little change occurred throughout the test itself. It is difficult for me to understand why there would be no increase in relative blood flow to the working muscle despite a clear demand for more oxygen, unless there was a limitation in blood flow for some reason. I had presumed there had to be some increase in HR and therefore cardiac output, and therefore added my question about a vascular limitation as a possible explanation.

So, I guess my question now would be, if you are suggesting there is no limitation in the cardiac/vascualar situation, why did the tHb not increase to help supply more oxygen, in order to help avoid the dramatic drop in smO2 values with each work interval?

And my follow up question would be; if the limitation in case #2 is in the peripheral system, with a lack of mitochondrial density, then how do we explain the dramatic drop in smO2 under increasing load. Is this not an indication of "good" oxygen utilization in the periphery? And is this not an indication of this athlete's ability to extract oxygen and use it through oxygen dependent pathways, which require mitochondria?

Obviously I am missing some key education, and I do hope Juerg or Andri will be coming to the Okanagan soon to share their insights with us.
Juerg Feldmann

Fortiori Design LLC
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Posts: 1,530
 #23 
Here just short some feedback  to Andrews  good points.
Case 2 
We know that the body preferentially increases cardiac output and blood flow to working muscles that are being used to produce force. in this case, very little change occurred throughout the test itself.

 Remember it is  a trend  and no absolute volume. But despite this limitation we can have a relative comparison  between the possible  tHb  volume change between  case 1  and case 2.
 Look at the left axis  and look the units. In both cases the  units  or amplitude  from a relative low tHb  level to a relative high tHb level are around 15 units.  So there is  more or less similar amount  of tHb changes. In case 2  due to the   same axis used  for Hb difference  the tHb  changes  occur optically much smaller but if you look at the  actual units  of change it is  surprisingly very similar  and it is doing exactly what Andrew  expected  an increase in tHb due to a higher CO. There is a fundamental difference in the tHb reaction during the load. That's why we have to look  at  rest  reaction and load reaction.

 to point    2  :
And my follow up question would be; if the limitation in case #2 is in the peripheral system, with a lack of mitochondrial density, then how do we explain the dramatic drop in smO2 under increasing load. Is this not an indication of "good" oxygen utilization in the periphery? And is this not an indication of this athlete's ability to extract oxygen and use it through oxygen dependent pathways, which require mitochondria?  A drop in SmO2  under increased load  can be a sign of a good mitochondrial density as  Andrew points out but it  can as well be a sign of a  poor delivery situation so O2  is used as mentioned  from the storage area. So in non of the case  did  we  speculate  on what may be the limiter  and or compensator. We just showed the very different behavior  you will experience when using NIRS . We  can see   that a lot of the feedback may not  come from the actual loading time but rather from the  change  or  what  you could call "interruption " of the load or homeostasis if there was a homeostasis.
 So  the point of a drop in SmO2  has to be looked upon the total picture  and not just  from a point of utilization  in  or on the mitochondrial level. Drop or in other words increase in O2 utilization  can be  created  by :
 Optimal mitochondrial activity.
Relative poor or insufficient delivery
Change in O2 affinity
 to name some of the more common reasons we can assess.

To the last point:
Obviously I am missing some key education, and I do hope Juerg or Andri will be coming to the Okanagan soon to share their insights with us.


Not  at all. We  have no  EDUCATION  as  this is  as  so often pointed out  the ability to repeat , what  somebody told you  you should repeat. What we  do here is  asking open questions  and really  have fun to get answers  back  from all different directions. This helps us  to keep improving in a  field , where we just start to touch some surface options in the long road of more future  bio marker assessment tools. We  are  far off  to understand  the  complex  world of  physiological systems  but with MOXY we are able to add a tool , which will give us the  chance to ask many more critical questions. Very often we  may not have an answer  yet. What we see is, that  the fundamental  basic ideas on how  to use MOXY or any NIRS equipment is  some kind of a baseline  to  be able  to have some common  discussion points.
 As  much  as I can remember  , we offered a  basic introduction course in BC  to different groups  and one as well in the Okanagan , when we  set up the 2014  schedule , but  got no interest. So we  may for sure  try in 2015  again , as we go along  now  with different courses in  Europe  and the USA  and most likely a few in eastern  Canada
Brian Kozak is just back  from Next Level coaching  from a  30 day  cross Canada  demo  and seminar schedule  and  the  respond  from the  game sport community is  surprisingly super positive. They all start to agree and understand, that  VO2  max  for a volley ball player tested on a bike is a great  money maker  for the tester but of minimal information for coaches  as well as  athletes.
 Same interesting  feedbacks  from Hockey , soccer, rugby , and even swimming.
 The fact , that LT is a non issue in this sports  make it much easier  to get in a  constructive dialog on how to improve physiological feed backs  from the sport field.
 We are well underway  to  be  able to offer a testing system , where  a coach or team is able to assess all member  at the same time  on a  sport field  so you can assess  your 20  person team in  less than 30 min  all together   with  the needed information to set interval and workouts, recovery  and  loading intensities.  Once we have 6 +-  teams  or centers  interested in this team package we will get going  including software  and  set up  and  schooling on how to use  and  assess and how  to try to get a  good  possibly interpretation going. Till then we keep gathering data's  and learn  all together as we do here.
 Summary. In  non of the  offered  assessment  do we have any indication given on what  is or may be limiter  and or compensator. We  just try to integrate  readers into a thinking process  with all what we  see or may have in mind. Theories than  can be tested    and moxy users  will often be surprised  how the common theory   does not fit the facts  we  may  see or find. Now we have to option. Bend  and  force the fact in our theory  or  rethink the current theory  as the facts  do  not support it.






Juerg Feldmann

Fortiori Design LLC
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Posts: 1,530
 #24 
Got  some  nice  respond  on the   above  discussion.
 Here in a picture  what I mean . This is an often occurring  reaction, when portamon 1.jpg  we use graphs  as  we  often  just look at the initial impression.
 The change in tHb in both cases  is pretty much  the same or  at least close to the same  in units. But remember the units  do not give an actual  volume.


Here the second  picture  and look  again the units. In fact the second picture  may have a slightly higher change in tHb


portamon 2.jpg 
 Than  one comment  I like to share  form a  MOXY user who starts  to really  understands  the reactions  and how to look    when   doing any interpretation.
 It  was the part of  :
  then how do we explain the dramatic drop in smO2 under increasing load. Is this not an indication of "good" oxygen utilization in the periphery?  
Yes this is one  possible reason of dropping SmO2.   Utilization  in the periphery.
  The additional options we  got  some suggestions in are:

  - A   poor  delivery  to the periphery  so  there is no other choice  but using what is there.  ( example occlusion )

- or  as  mentioned  as well a O2  diss curve shift to the right  which  allows a better  "utilization"  due to  shift in   affinity    so a potential  sign of a  Respiratory insufficiency in releasing of CO2.
  So this is when we look  at SmO2  and the  dramatical  drop.  . Than as  mentioned we  have to look  at tHb  and than combine. If you have HR  that is great  additional information. And yes  when you have a  VO2  data collection with CO2  you are even better on , less speculation more  info  and you add Physio flow  and you  have  even more  information.
  The key is  to  learn to  see trends  when using MOXY alone  so  anybody out there  can start  to have some indication.  This leads us  back to the start of this interesting discussion. 
 2  examples    without  any conclusion or  interpretation  and many of the regular readers where able to make some own   conclusions and or  getting some thoughts. Thanks s much for the feedback on here  as well as the  increasing  mail   we get  in our  discussions.
 I will show  some  responds  as usual later on here  as well.
 






Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #25 
Here  soem  eastern  egg  hunting  based on a  interesting comment we had :

 "The latest attached image gives a really clear picture of the nine different possible scenarios that are possible when viewing trends using Moxy data alone. Now, I just need to confirm the different possible causes of the nine situations"

 Here the  picture of the  9   versions we  often can see :

all options th.jpg 


In our  basic  introduction in MOXY which really is :
 VO2 +  CO x  (a-v) O2 difference in its true  words we show the above 9 options in the initial introduction.
It is  a live demo on a participant or  on all participants, if  all have a MOXY mounted.

CO  is  one part of the tHb trend  as the tHb trend is influenced by CO,  but as well CO  is influenced  by tHb if we  take tHb  as  a trend information of blood flow  ( Volume )

a-v O2  diff is really the live info on the SmO2  trend  and  the utilization trend.

 If  we look  this somewhat more complex    in the way we  may look VO2  than it looks  like this. In this  picture  you can find the different options , where a live MOXY info  can help us  to have more answers  on  ongoing questions.


VO2  brain.jpg 

For  all the reader, who could not make it to our   upcomming USA  east coast  seminar week , here a  short inside view into the first 15 min of the seminar.  This  are 15 min live  activities  to show how tHb  and SmO2  are  getting influenced  by different actions and activities.

 
t 15.JPG 
You most liley will find  any of the 9  different options in this  15 min summary. It is like where is  Waldo ???


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