Vacuum Bell User Guide Contents 1. 2. 3. 4. 5.

Warnings/contraindications Information about vacuum bell therapy and 3rd party links Setting up the unit Tips/troubleshooting/modifications Other treatments to use with the vacuum bell

1. Warnings/contraindications Vacuum bell therapy is an experimental idea. This is only a general summary of the relevant publications and information regarding pectus excavatum. The information in this user guide is derived from recent research publications, customer feedback, and personal experience. It may or may not pertain to your condition. Do not attempt anything in this guide without consulting your doctor first! This is very important because only your doctor can test for contraindications like Marfan syndrome. Use of this item without proper medical supervision can result in serious injury or even death. Nothing in this guide is intended to be medical advice for your specific condition nor can it replace the advice of your doctor.

2. Information Pectus Excavatum is caused by abnormal growth of the cartilage that connects the ribs to the sternum. This results in a sunken chest appearance. It is more common in males (3:1) and usually occurs in thinner individuals. In the past it was only correctable with surgery but the vacuum bell is designed to be an alternative to surgery. http://en.wikipedia.org/wiki/Pectus_excavatum The VB idea was originally developed in Europe but we have created our own design that significantly improves the suction, sealing, control, and comfort of the unit. Online support groups exist for individuals with PE. You may want to visit: http://www.pectusinfo.com/ o Search their community boards for info on vacuum bell units: http://www.pectusinfo.com/board/

Calculations: Atmospheric Pressure: ~700mmHg 1 psi (pounds/square inch)=50mmHg Maximum VB pressure difference: 114mmHg, (this is the max pump gauge reading you should ever have.) Our experience shows that larger pressures are not useful, 25-50mmHg is equally effective. Wearing the unit for a longer time at a lower pressure is more effective for long-term results.

Sample total force calculation for a 7.5 circle: Surface area of bell in inches*psi of vacuum=total force 7.5 3.14 ( ) 1 = 44 20 2

Notes on calculation:

The surface area is simply = The psi is the suction pump reading (50mmHg in our example) converted into psi. If the pressure were 100mmHg, then the psi would be 100mmHg/50=2psi.

3. Setup Use the Theraputty (in the plastic bag) to create a better seal. Roll it to about the thickness of a pencil or slightly smaller and then stick it on the silicone of the bell (the first few times it will not bond to the silicone well but it still forms an airtight seal). Push the bell towards your chest and suction out the air. For tips/troubleshooting on sealing the unit see the next section. To release the pressure: twist and then pull down on the red valve (gray pumps only).

Keep the pressure low the first few times you use the unit (the pressure gauge may not even read anything.) Gradually increase the pressure so that after using the item 10-20x you are at 25-50mmHg. Best results are from wearing the unit ~2hr/day (1hr AM, 1hr PM) at around 50mmHg. Keep an Excel sheet log of the dates/times/average pressures you used the unit at. We also recommend taking monthly photos (front, right+left sides, and looking upwards***) to track progress. It takes about 2 months to notice results, but it takes about 2 years for permanent results (the surgical procedures developed by Nuss requires wearing a bar for 2 years because the cartilage needs to be remodeled to the new shape).
***place the camera near your belly button and photo upwards, (caution, this angle will make your PE look worse than it is). Do this on both empty and full lungs.

4. Tips/troubleshooting Sealing the unit: It takes some practice to get the item to seal, everyones chest is different. Try using mouth suction before the pump, it is much faster (2000+mL lung volume vs 50mL pump) Press the bell down while suctioning You can see what areas dont seal by applying the unit (with Theraputty) and then removing it and looking for areas of putty that dont show skin/hair marksthey will need more putty to seal)
If you have large areas where the Theraputty does not contact your chest then you may need to modify the bell by adding silicone to those areas. I added about 0.5 of silicone to the top of my unit, it does not affect suction/force distribution/therapy results. We use something very similar to DuPont Silicone Caulk (you can find this a home depot for $5)

Less modification is better but if you still cannot get it to seal, it may require custom modification. Contact us for information on this. Release pressure with the red lever (twist and pull down)

Red chest: this is normal for the first few weeks. Mild red dots/blotches are not a concern unless you have blood clotting problems. They are not permanent and most go away in a few hours, all of them will go away after stopping the unit. Lower pressures cause less redness.

Pressure Release

Chest pain: most users find the unit quite comfortable although some feel slight pain where the bell contacts the chest (similar to a minor bruise). This is not a serious concern. However, deeper chest pain should not occur with this unit. If you experience this then lower the pressure and consult with your doctor. Chest hair: if you have a moderate/significant amount of chest hair then using the Theraputty may be painful. Try to seal the unit without it, consider replacing the Theraputty with more silicone or shaving if this becomes a significant problem. Other problems: let us know! We try to make these units as close to one-size-fits-all but that doesnt always work.

5. Other Suggestions Besides using the bell there are a few other therapies that also help push the chest wall outwards. Note: these are still preliminary ideas, if you find something that worked for you please email us (JimLPro@aol.com) with any advice and we will add your info to this guide. They include: Posture correction, Breathing exercises, and Strength training Posture correction: many people with PE have bad sitting posture. Try to avoid sitting in a hunchback position as this only increases the inward pressure on the sternum. Sit in a chair with you back straight, shoulders back and feet/legs on the floor. If possible, adjust your sleeping positing to avoid things like: lying on stomach, curling up in a ball (fetal position), etc. http://expectus.hubpages.com/hub/Pectus-Excavatum-Repair http://expectus.hubpages.com/hub/Pectus-Excavatum-Repair-Part-2 Breathing exercises: Lungs can generate a significant amount of outward force. Try things like: inhaling fully, breathing deeply, and trying to exhale into an empty plastic bottle (this really builds chest pressure). Doing breathing exercises during break times during your day can be very helpful. Side note: remember to increase chest pressure, not abdominal pressure Strength training: Many individuals with PE are underweight or below average. Many children have PE but as they go through adolescence it gradually goes awayexcept in thinner individuals. Thus we believe that adding a weightlifting program can help reduce PE. The most important thing is increasing back strength. This pulls your shoulders back and thus decreases the inwards pressure on the sternum. Exercises that strengthen the pectoralis major/minor may also help. Creating a strength training program should involve a few things: Increasing calorie intake for weight gain (specifically carbohydrates, and also some protein), if you are thin then this is more important than weight training. For myself I added a 4th meal of optimum nutritions brand serious mass and kept a daily calorie counter in Excel. Higher weights at lower repetitions (best for muscle/mass gain). Exercises such as: seated row, cable pulldown, shrugs, flys, bench press, and ab workout see http://www.exrx.net/Lists/Directory.html for a list of exercises For a complete workout see http://www.muscleandstrength.com/workouts/10-week-massbuilding-program.html (note: this is a bit too intense for first-timers. Try eliminating half of the exercises, only working out 3x/week)

Youve reached the end of our very condensed guide. As you can see PE treatment involves the vacuum bell and also lifestyle changes. These changes are important whether your goal is to reduce PE, eliminate PE, or simply live better.