Tag Archive for coughing

SOB

The first time I saw “SOB” written on some paperwork I was a little offended and slightly confused until I learned it was the abbreviation for short of breath. Right now, that seems to be all I am. I’m constantly huffing and puffing while trying to do really basic stuff. I haven’t been getting much work done. Last Saturday I felt sort of ok so I did some cleaning and picking up, but then spent all of Sunday in bed and this week I feel constantly tired and exhausted.

I’ve been talking to both of my lung doctors and I now have an upcoming echocardiogram scheduled. I think this will be the 4th one I’ve had. The first one was about six years ago and showed my right ventricle was enlarged. I started using a CPAP after that which has helped the right side of my heart to shrink back to normal, but every couple years the symptoms come back. This time seems worse than the others for me. A few weeks ago I went in for my PFTs and the numbers were actually 5% better than six months ago. It seems odd to have so much trouble breathing when my lung function hasn’t gotten worse. I’m hoping to find out something sooner than later because this is really cramping my lifestyle. Just going to a store and walking around is enough to tire me out and require me to lie down for a rest.

Summer 2013: ER Visit #6

Another week, another trip to the ER.  They’re really starting to know me there.

  • Our friend Haley got me checked in at the registration desk
  • The triage nurse remembered me
  • The nurse who got me into a room has seen me at least 3x this summer
  • The respiratory therapist has helped me 3x now I think
  • The x-ray tech has scanned my chest at least once before
  • Also recognized Dr Wilson who I’ve seen before and has an EXCELLENT bedside manner

So why aren’t you better yet?

This is an excellent question I’ve heard from a few people and have also asked myself.  This whole past week has been a rough one with asthma attacks on five days out of seven.  One was caused by 2nd hand cigarette smoke and the rest were allergy/weather related.  All five times this past week I’ve had to decide whether or not to go to the ER.  My peakflow numbers were at 50% or below, my oxygen saturation has been 89% to 93% pretty consistently, I’ve had trouble walking and moving around, and I’ve been mentally fuzzy.  These are all good reasons to seek medical attention.  Tonight was slightly different because my nights are usually bad between 10pm and 4am, and this time my symptoms fired up around 7pm.  I was short of breath, experiencing varying degrees of chest pain for different reasons, coughing, and my nebs were working but not lasting long.  These combined with my gut feeling of “it’s going to get much worse” in the next hours are what made the decision for me.

The ER was packed on arrival and we later found out that was the least busy it had been since 1pm.  Liz and I waited a little before being taken back, but we heard others being told there was a three and a half hour wait.  Fortunately I bring all my meds with me so I just hung out and nebbed until it was my turn.  I don’t know if it’s because they recognize me, I’ve been in so many times this summer or I’ve just learned how to communicate effectively…but lately I tend to get asked what I think should be done.

RT: Aw man, you’re back again??  So what do you think we should do?  Albuterol?  Duoneb?  Want some pulmicort?

I had just done an albuterol in the waiting room so we followed up with some duoneb.  It helped, but didn’t open me up much and I quickly regressed to where I was earlier.  I was glad this happened because it made a point as to why I’ve been nebbing 8 to 10 times a day and the relief just isn’t lasting.  They got me started on some salumedrol, as usual, and then followed up with a pulmicort neb.  Pulmicort is a steroid which addresses swelling in the airways and is different from bronchodilators, like albuterol and ventolin, which help address the muscles constricting around your airways.  This really helped to open my airways and allow me to breathe more deeply for a longer amount of time.  In the past I’ve had a combo inhaler (advair, symbicort, dulera, etc) along with another steroid inhaler acting as a booster for maintenance.  This summer I’ve been wondering if taking pulmicort or asmanex in addition to the dulera would help.  I’m adding this to my list of questions for the pulmonologist.

What next?

Lots of taking it easy, that’s what.  I’m working on some good questions for my lung doctor when i see him this week and am counting down the days to Pittsburgh.  I’m not expecting to be magically cured in Pennsylvania, but I am looking forward to another opinion and getting some of these tests done that have always been on the extreme/unnecessary list.  Maybe they’ll find something new and at the very least I’ll be contributing more data towards new treatments and understanding of how asthma functions.

I was glad to see the nebulized steroids make such a difference tonight.  That would probably do the trick for me at home when I’m up all night not being able to breathe deeply enough.  We also noticed my oxygen saturation dipping to 90% and below most of the time when not on 2L of supplemental oxygen.  This hasn’t really been as much of an issue before and I wonder if that means anything.  For now we’ve once again bumped up my prednisone taper and I need to return to the ER if things become bad enough to warrant another visit.  I also talk to my allergist about doubling my Xolair injections starting this month.  With allergies being so bad and mold season around the corner this might help me get a head start before leaves are falling and the combines are running.

Summer 2013: ER Trip #4

Tonight I have a success story because I wasn’t too much of an idiot.

Today was like most days for the past few weeks.  I went to bed early in the morning with a neb to take the edge off only to wake up a few hours later desperately needing more albuterol.  I then spent the rest of my day watching Netflix, taking care of some work stuff and doing more treatments every three hours or less.  Right around 4pm the treatment’s effectiveness seemed drastically reduced and I started dreading the idea of having to go back to the hospital AGAIN being I was just released on Tuesday.

I just wrote that long post on Asthma Acting and decided I better heed some of my own advice for a change.  It was time to get some data and seriously consider the best plan of action.  My oxygen saturation kept dipping down to low 90s and my PF numbers were consistently in the low 400s to mid 300s.  This meant it was time to go.  Granted I was no where near as bad as Sunday, but I could tell I was on the cusp of a hardcore attack if I didn’t nip it in the bud.

Liz asked her mom to come over and hang out while Chuck was sleeping, I packed up my gear and then we headed over to the hospital.  When we pulled up Liz noticed one of her friends was working registration who immediately helped me into a wheelchair and told someone else at the desk my name and info.  That in itself is a HUGE help cause it’s pretty hard to talk when your lungs are only pushing 30% capacity.

They wheeled me back and a nurse got me started on 2L oxygen, hooked me up to a pulse ox and heart monitor, and then attempted to start an IV and take some blood.  Little did I remember she was the one trying to start lines on my right arm just a few days ago.

Nurse: Hey, weren’t you here just a few days ago?

Me: Yeah…

Nurse: Man, you were really freaking us out!

Which actually reminded me of a short conversation with Jeff the nurse when he returned Tuesday morning after the “Josh Incident.”

Jeff: Dude, you were making me really nervous last night.

Me: Dude, I was making MYSELF nervous last night.

It’s true, I’ve seemed to have that effect on people throughout my whole asthma career because I usually wait too long to do something.  This night was totally different.  Instead of five people hovering over me for 2hrs and trying to figure out how to make it stop, we had a much calmer situation with fewer people scurrying around.  Unfortunately it took four tries to get an IV started again because when I can’t breathe my veins like to dive deep like the Red October avoiding depth charges.  I’m just glad they didn’t order any ABGs.

Soon the respiratory tech arrived and I’m sure you can imagine my relief it was not Josh, aka worst medical professional of the decade.  She listened to my lungs, had me create a PF baseline, asked what my personal best is, listened to my lungs, got me started on a double albuterol neb and then got some information out of my little black notebook with follow-up questions to Liz.  This woman was good.  As soon as she saw all my documentation and found out this was my fourth time this summer, immediately after a hospitalization, she knew I was on top of things.  She knew my airways were just hella tight.  She could tell what my cough was doing to everything and when one of the nurses said, “I don’t hear any wheezing,” the respiratory tech responded with, “his airways are too clamped down to even let him wheeze.”

YES!  SOMEONE KNOWS WHAT THEY’RE TALKING ABOUT!

After the double albuterol ended, we followed that up with some pulmicort and solumedrol.  Slowly, ever so slowly things started to open up.  Should I have stayed home?  No.  Was it the right thing to come in? Yes.  Did I avoid a possible re-admittance into the hospital?  Most likely.

So a few hours later we got to leave and I followed tradition by getting some Taco Bell on the way home.  This is also the most healthy I’ve ever been after leaving a hospital.  Even though I’m all jacked up on drugs right now and will be awake for a while, I’m no where near feeling as awful as I usually do.  Take it from me, the guy who freaks out the hospital staff – know your limits and go to the hospital when you’re supposed to.  The only real damage would be the bruises all over my arms from this week.

8 IV lines 2 ABGs 5 Blood draws

8 IV lines
2 ABGs
5 Blood draws

Candy for big kids

Remember way back in the day when you’d go to the doctor and get a sticker, sucker or what have you?  Well about about us big kids?  What do we get?  Tonight I found out what it takes to earn a Taco Bell Beefy Melt Burrito $5 Box.

  • 10 or so puffs on a rescue inhaler
  • 7 nebulizer treatments
  • 1 Z-pack
  • 85mg prednisone
  • a couple muscle relaxers
  • anti-anxiety medicine
  • codeine cough syrup
  • a 4hr coughing fit
  • continually turning purple
  • and my 3rd trip to the ER this year

Is it worth it?