Tag Archive for ER

Back in the Hospital

Well, it happened. After two years staying away, I ended up in the hospital for a tune-up. Four days and four nights kind of makes it sound like a vacation or resort reservation, but it wasn’t that fun. This time it was fairly simple, just good old asthma without other complications.

They did all kinds of blood tests to see if any clues came up as to the cause of my exacerbation. IgE levels were about 3x as high as usual so it was determined allergies were the culprit, of which I’ve been complaining for the past couple months. It was a lot of sitting around, neb treatments, IV steroids, and an occasional walk around the hospital floor. I was put into a double-occupancy room but spent almost the entire time by myself.

As usual, my first RT was Scott the sci-fi fan. For some reason every time I’m admitted he is on duty, remembers me, and we talk about the latest in science fiction shows and movies. I recognized a few other respiratory therapists, but none of the nurses. My local lung doctor came by every morning around 7:30 to check in with me and update notes. The hospitalist team quickly decided I had a “complicated and very advanced case of lung disease” and was going to let my lung doctor call the shots. I was glad because doctors unfamiliar with me tend to cut me loose early and I quickly relapse.

While there I got the usual questions and comments:

  • How many years did it take to grow your beard?
  • Are you always this chill?
  • Whoa, your water bottle is HUGE.
  • I LOVE your backpack!

I think my biggest fans were the nurse/tech pair who stuck me 9x before calling a phlebotomist in to draw blood. The phlebotomist walked in, drew the blood immediately, and then trash-talked the other nurses. It was pretty hilarious.

After a few days the hospitalist came by to update me and dispense some advice:

  • We have determined your severe asthma exacerbation was caused by your allergic asthma
  • Be sure to take your medicine when you go home
  • Maybe stay inside with the windows shut cause there are allergies outside

I could have stayed longer, but asked to go. The first day out is always tough, but I’m hoping to bounce back soon.

Summer 2014 ER Trip #4 and Hospital admission #1

A couple of months ago I ended up at the ER again short of breath, with chest pains, flaring allergies, and low oxygen.  They ended up keeping me a few days mostly because my o2 was in the 80s and my ABG came back not good.  I ended up connecting with a great hospitalist who looked through my medical history and really wanted to track down the root cause of my health issues.  She ran some tests and was in close contact with both of my lung doctors throughout the process.  After being released I saw my second pulmonologist out in PA, did more tests and it was determined I do not have asthma.

Even after a couple of months it feels weird to say that as it has been a big part of my life for the past 23 years or so.  I still have the breathing problems, but it was confirmed I do have vocal chord dysfunction (VCD) and my chords are pinching on exhale which really mimics asthma.  I was often asked if it was hard to breathe in, assuming VCD could be pinching my throat shut on inhale, but for me it was the other way around.  I was taken off a lot of medications and given a few new ones to take.  I’m still having a rough time with Fall allergies, the rotting leaves outside, and smoke outside.  I’m looking forward to winter when the outdoor allergens freeze and I’ll have a few months of better breathing.  Hopefully my health will be in much better control next year.

Summer 2014: ER Visit #3

Just as I had predicted the day before, it’s August and I’d probably end up having an ER trip.  I just didn’t think it’d be happening so soon.  Three days in a row I was exposed to some sort of smoke and the third time apparently worked.  A racetrack several miles away was having a special event that night where they were attempting to make as much carbon pollution as possible.  The result of said event made my entire neighborhood, several miles away, smell like burning tires.

I gave it almost a couple hours before deciding to throw in the towel and admit defeat on this one.  On the way, Liz said,

I’m sorry for making you go to the hospital.

She knows how much I don’t like going there, even though I get the help I need, because it tends to set me back a bit with work and other things.  For example, I’ve been awake close to 2 days now.  That’s what happens when I’m injected with solumedrol and my prednisone dose is greatly increased afterward.

We were surprised to see the place so empty on a Saturday night.  I never really have to wait, but that just means they get to me even faster.  Recently a friend of mine blogged about how emergency treatment protocols for asthma seem to have changed.  I’ve noticed some of the changes myself.  As usual I was having trouble talking clearly and being understood so Liz was able to answer a lot of questions for them.  I think this was the 4th time I had seen this particular respiratory tech, and she totally remembered me, so a lot of the initial questions were just confirming medical history and medications.

They checked on me fairly often because I wasn’t able to move a lot of air when I arrived, but the treatment was pretty identical to my other two trips this year.  One duoneb treatment, followed by listening to my lungs and checking O2 sat a while later, followed by 125mg solumedrol, see the doc, and then go from there.  I can always tell how much the doctor has read my chart by how the conversation goes with him or her.  I know this doctor hadn’t read much at all.  She told me I was moving more air, sounded ok, x-rays looked ok, and she was going to “send me home with steroids that’ll make me better in a couple days.”

I’m fairly familiar with prednisone as I’ve been taking it off and on for years.  In fact, I’ve been taking it every day for the past 15 months.  I’m also on every type of maintenance medication they give to asthmatics including xolair.  That and the fact I’m prednisone dependent gets me labeled as a severe asthmatic by many.  When doctors have read all this stuff they usually want to have a 10-15 minute conversation with me or longer.  They want to know how I’ve been recently, what I’ve tried, what works/doesn’t work, what brought on this exacerbation, symptoms, what I think we should do, do I think I should be admitted, have I heard of BT, etc, etc, etc.

So on this trip I got a few nebs, solumedrol, and was sent home after a few hours.  Some of my severe asthmatic friends liken this to a tune-up or oil change for your car.  You know, a quick maintenance sort of thing that needs to be done, and there are probably many other things you’d rather be doing instead.  I really hope I can stay on track with things for a while and not have to go back.  Things are really starting to ramp up right now with school starting soon and I kind of need to be around for stuff.

The funny part for me would have to be when the nurse was going through discharging papers with me and pointed out I was diagnosed with an asthma exacerbation followed by, “you probably know more about it than the paperwork…you probably know more about it than I do.”  Sounds like the nurse read through my chart.

Trying to out-Jedi the asthma

Last summer one of my problems with recovery included me trying to jump right back into my normal routine as soon as I could handle not being in bed all day.  While this may sound like a not smart thing to be doing, it made sense at the time because I was concerned about using up all my earned time too quickly and running out before the fiscal year was over.  This strategy caused me to use all my sick time, vacation time, FMLA time, and even had to miss a few additional days.  This summer I’m trying to channel Obi-Wan Kenobi and outsmart the chronic lung disease.

A couple weekends ago I piggybacked two ER visits and the doctors told me to stay home that following week of work.  I’ll be honest – that week was not a good one as I had several serious situations that could have easily landed me back at the hospital.  I showed up to work the next Monday, after staying home for a week, and made it through one day.  I seriously over-did things, watched my peakflow numbers drop to unnecessary levels and stayed home Tuesday and Wednesday.  Thursday rolled around and I had an important decision to make.  I could go back in for another day before the holiday weekend, or not be an idiot and just stay home.

I’m proud to say I chose the latter and actually gave myself some time to rest.  Yeah, I used up three sick days, but I can say with some confidence I probably avoided another week at home later this month.  I don’t know why it can be so hard to just be still and take it easy.  Fortunately I have The Dude to keep me company.

lebowski-opinion

Summer 2014: ER Visit #2

Looks like my spidey-sense proved right again.  In only 14 hours or so of not feeling any better whatsoever, Liz took me back to the Emergency Room where they took things a big more seriously this time.

dude-and-driver

Home sweet home, Mr L!

As usual, I was immediately taken back, and they got me immediately started on some nebs.  Because it hadn’t been that long since my last visit, the same respiratory technician was there to get things started.  Liz pointed out I don’t really wheeze, and the RT mentioned again that everything sounded fine.  Just like earlier that day though, when the doc took a listen it was immediately pointed out that I sounded EXTREMELY diminished.  I sometimes wish I knew how to identify all the different kinds of noises I make while breathing.  I also know that my perception of how I’m doing isn’t always what’s actually going on.

The RT was in and out pretty quickly as the trauma rooms seemed to be full of people in much more serious trouble.  Before my first neb was barely started, she was being called away to maybe intubate some poor soul a couple rooms down the hallway.  When it comes to medical stuff and waiting, I always remind myself they’re taking care of the worst-off first.  I’ve been that guy before with 6 people hovering over me for two hours while others have to wait.

The NP assigned to me was someone I don’t think I had met before.  She took great care of me and had a lot of great tips.  It reminded me of talking to Dr Wenzel’s nurse while at SARP last Fall.

  • Ask about updating vaccines with the resurgence of pertussis and other diseases
  • Piggybacking benadryl and allegra works a lot faster than zyrtec
  • Benadryl + pepcid can knock out allergy attacks pretty quickly, especially if your throat is tightening up
  • Look into lung strengthening

Another 125mg solumedrol IV push, and some magnesium sulfate via IV drip got things turned around for me.  The solumedrol was doing its thing, but my airways kept tightening up over time.  My oxygen saturation was constantly setting off the alarm bouncing between 88% and 91% most of the time.  In August or September last year there was talk of trying magnesium during an ER trip.  I was impressed with how quickly it seemed to work and much more deeply I could breathe afterward.  It actually kept me in good breaths for 12hrs after leaving the hospital.

They sent me home with orders to neb duoneb every 4x/day with albuterol in between.  My prednisone has been bumped up again with a slow taper down, and they threw in some levaquin for good measure.  There are a lot of people with nasty respiratory viruses at the moment and I like to play it safe.  I haven’t had pneumonia for almost 8 years now, but the thought of it still scares me.

This morning I went in for spirometry before drugging up.  I felt horrible and they wouldn’t let me go until my doc was paged and checked up on me.  Numbers were low and lung function diminished, but things weren’t bad.  They stressed to call them immediately if things worsen though.

Summer 2014: ER Visit #1

So it happened, and on the first day of summer no less.  For three months I was doing “OK” needing no more than one or two uses of albuterol a day until June arrived.  I’m trying to be proactive – I really am.  I made a point to go see my local pulmonologist a little over a week ago.  He agreed I was doing the right thing and bumped up my daily prednisone from 5mg/day to 40mg/day with a slow taper back down to 5.  The past week has sucked.

  • Every morning I wake up with peakflows around 60%
  • I’ve been spending every day at work in shoddily air conditioned offices, but am thankful I’m not having to be in the buildings with no air conditioning
  • Every night between 8pm and 1am things get bad for an hour or so
  • Every night/day things have been getting a little worse
  • After an hour in a hot conference room on Friday I started hardcore wheezing (wheezing is not a common symptom for me)

Last night things started going south around 9pm.  By midnight I had done three consecutive neb treatments in three hours w/o successfully getting my peakflows up above 350.  Liz ended up staying home with the kids and El Cuñado gave me a ride, being the awesome dude he is. As usual, I get there and they immediately put me into a room.  A nurse of some sort was in there and a respiratory tech came in right away to have a listen.  She declared my breaths sound ok, AKA no wheezing, and said they’d be right back to start some meds.

Two hours later the doc came in apologizing for the long wait and immediately told me there was a 50/50 chance I’m not going home because I’m hardly moving any air. I got the standard IV line, solumedrol push, blood tests, x-rays, and neb.  A couple more hours and the x-rays show no pneumonia, the blood tests are good, and my breathing has slightly improved.  Sound familiar?  So at this point the doc comes back and says normally he’d admit someone like me, but taking my history and rock-star-respiratory-system into account, he wants to send me home so I don’t accidentally pick up pneumonia or all the crazy viruses people keep sharing.  And as always, “come back if things start to get like this again.”

El Cuñado takes me home, peakflows are still at 350, I do a little more self-medicating and get a couple hours of sleep, later waking up a sweaty mess and needing more albuterol.  Sometimes I wish they’d just keep me at the hospital because I have a good feeling history will repeat itself.  If my sensible gut feeling proves right, I’d like to get a hold of someone via the physician’s answering service to tell me to head back in instead of wasting a lot of money to do what I could at home in a much more comfortable environment.

Now I just have to figure out what to do about work since I have no sick, vacation, nor FMLA time remaining with which to stay home and attempt to recover.  Next week’s forecast is once again hot and sweaty, and they still don’t have the AC fixed.

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 #5

Deciding To Go

This whole past week hasn’t been good with night time PF readings constantly dipping into the 300s.  My daily breathing treatment count slowly climbed to 10 by Thursday and I was once again being seriously asked if I needed to go to the hospital.  Of course I probably should have, but I really didn’t want to and had a case of the asthma-brain influencing my decisions.  I figured I’d go the cheap route and call my doctor yesterday morning to bump up my prednisone taper or something.  An email, I love that some doctor offices let you email them, to my primary care physician resulted in a quick reply that my doctor was not in today and suggested I contact my lung doctor.  While some might think I was blown off, the response was actually quite reasonable.  I still haven’t followed up with my lung doctor since I was hospitalized and they’re the ones that finally got me back on track in July before the drywall dust debacle at work last month.  So I left a message at my pulmonologist’s office, you can never actually get a person on the phone it seems, and waited.  I waited all day long and then ended up back in the ER.

It’s hard to describe, but unless I encounter a severe, unplanned trigger or circumstance – I can tell when I’m going to have a day bad enough to result in an hospital trip.  I kind of had that feeling Thursday and I definitely had that feeling Friday morning.  It’s that whole gut reaction thing.  I hadn’t slept for several days, but did get a couple hours sleep in mid-morning.  The sleep helps, but when you miss a scheduled breathing treatment, I’m not always sure which is worse.  Chuck and Liz got home just after 5 and Chuck really wanted me to play with her.  That’s about the time when the meds stopped keeping the symptoms at bay.  A good friend of ours brought over some amazing chili and corn bread for dinner.  We ate, Liz told me to go take more medicine, we hung out and watched some of The IT Crowd.  I was back into the cycle of PF at 400 or below, neb, get back up to 500ish and then slowly drop back down.  During this time I was noticing my O2 getting to 93, which isn’t bad, but also isn’t good, and when I’d start panting for no good reason I knew I had to keep an eye on things.

Around 11:00PM, PF values were at 350 and below.  I went ahead and told Liz and decided to re-evaluate myself at midnight.  An hour came and went.  I did everything I was supposed to and took all my meds, but my numbers were still the same.  It was time for ER trip #5.

I feel bad for Liz.  Yeah I have all the breathing problems, yeah I go for days without sleeping, yeah I’m on tons of drugs and am always getting stuck with needles – but I do all this while often getting to forget about normal day-to-day life.  Liz still has to go to work and teach, she ends up taking care of Chuck 90% of the time and that’s on top of everything else normal people do and take care of in their daily lives.  So while I’m feeling awful and need a ride to the Emergency Room, Liz, who is already tired, knows she’ll be up until at least 4am, will most likely be wrangling our daughter tomorrow AND has work obligations in the morning.  I think the Coen Brothers’ Nihilists say it best, “it’s not fair!”

Getting Treatment

Another quick PF check clocked me at 320, Liz’s mom came over to watch Chuck and I sloth’d my way to the car with asthma gear in hand.  Thunder had just started on our way out and I wondered how many other asthmatics we’d encounter.  With the high heat, insane ragweed/pollen counts and now a thunderstorm rolling in – I knew us lungers would be out in force.  The trip there was pretty easy since traffic dies way down after midnight.  When we pulled up to the ER entrance there was a less-than-smart citizen smoking a cigarette immediately next to the entrance.  While I would have loved to share my thoughts on all the no-smoking signs staring at the guy, I shuffled as quickly as I could into the building without breathing in the poison.  Before I knew it our friend from registration was telling a guy who I was cause she knows I can’t talk right when coming in.  I scribbled my name on a piece of paper, tried to answer a couple of questions to someone else, and they wheeled me back to a room.  Haley even came back later and got Liz some Subway.  All I have to say is it pays to know people.

Usually I get stalked back to the room by several people but today was the exception.  I lumbered off the wheelchair and onto the bed, was given a gown and the triage person left.  Remember me wondering how many other respiratory patients would be in there today?  Well there were a lot.  Ten minutes go by and someone from radiology showed up with a portable x-ray machine to perform a chest scan.  Liz told her it wasn’t really worth getting an x-ray right now because respiratory hadn’t even started meds yet.  I’ve had this happen before and when my airways are so tight, I can’t really breathe in enough for them to get a good image.  Five or ten minutes later you would have thought I’d just finished a marathon by the amount of sweat rolling off me because breathing can be hard work.  Another PF check showed me now at 260 so I decided to just start a breathing treatment of my own.  It really does pay to carry your own medicine with you.  Half way through my own meds, the room nurse came by assuming respiratory had started their thing from the noise of my nebulizer compressor.  She immediately put in another call to see where they were, got an IV started on the first try (last two trips took 4 pokes each), and set me up with 2L of oxygen.

The respiratory therapists, two this time, came by and were surprised to see me medicating myself.  They hooked me up with a couple duoneb treatments, listened to my lungs several times and relied on Liz for information.  Apparently I was really making their day because the main one announced they should go buy lotto tickets.

  • I knew my baseline, historical and current Peakflow information
  • I brought all my meds as well as had them listed on paper
  • I use a spacer
  • I’m compliant with my medications
  • I write down all meds taken and any circumstances surrounding my breathing
  • I had a fairly good idea of why today required me to come see them

They even asked if I had considered running a seminar on how to be a good asthma patient.  As usual one of the first comments was, “well I’m not really hearing any wheezing,” but they were surprised at how little air I was moving.  Liz quickly informed them of my general symptoms cause she’s awesome.  X-rays came back again to get that chest scan and Liz heard the therapists out in the hallway talking about how I don’t really “seem asthmatic” at first glance but I’m obviously a severe.  The respiratory therapists came back in to give me a 3rd treatment, but wanted my opinion on it since I had done nine in the previous 24 hrs and three more in the past hour.

RT: Here’s the deal, I think you could use another one, but I’m kind of concerned with your heart rate and the side effects.  What do you think?

Me: Let’s hold off for a bit and see what happens.  I’m already moving a lot more air.

After seeing my PF has gotten up to 450, they decide to go ahead and let me hold off for a while.

RT: We’ll check in with your doctor and see what he thinks.  I’d give you more medicine, but they only let me neb you 3x before a doctor gets involved…cause I’m just a lowly respiratory therapist.

Me: Yeah, and I’m just a lowly patient.

The Doctor

My doctor rolled in and right away I could tell there was something different.  On a rare occasion I encounter medical professionals too cool for school who want you to know they have it together.  They’ll say lots of big words, not really let you answer questions and walk out leaving you with more questions than before they arrived.  Dr C was not this kind of doctor, he was actually kind of awesome.  He had obviously looked through all my info.  He knew I had been there 4x prior, he knew I was on all the medications you would normally prescribe, and he knew I wasn’t your average asthmatic.  After discussing my medication, treatment and brief history the conversation quickly turned to something more interesting.

Doctor C: Have you guys by chance heard of RadioLab?

We then discussed that guy who gave himself tapeworms to cure his horrendous allergies and asthma.  While all three of us thought it was great the dude cured himself, Dr C wasn’t exactly endorsing the act of purchasing worms someone has harvested from their own feces.  After we had a good, well as much as I could muster, chuckle about infecting oneself parasites, the topic of conversation quickly switched to my Maxpedition Jumbo Versipack, aka the Asthma Bag.  I don’t know why all the medical people who see it thinks it’s so awesome.  Kind of makes me feel cool just to have it.  Doctor C picked it up and examined it thoroughly.  He really dug my setup.

So what to do…Doctor C was concerned with my O2 levels.  He also asked about other non-standard treatments they sometimes administer to avoid intubating.  My oxygen saturation usually registers pretty high in the 97-98% range.  After I had another breathing treatment and things settled down a bit, Doctor C took me off the nasal cannula to see who everything looked.  I did dip into the 80s briefly, but mostly stayed at or just above 92%, which was the defined line.  I was glad to not get admitted again.  I would guess we probably spent 20 minutes or more talking candidly with the doctor.  At no time was he acting like he needed to be somewhere else or one of his other patients in the ER that night was more important than me.  Interestingly I later popped his name into Facebook and discovered we not only graduated from the same university, we have cool Facebook friends in common.  Small world.

The Aftermath

One great observation the doctor made was when someone like myself is on prednisone, the taper really shouldn’t end until several days AFTER I’m doing well.  I did finally achieve that back in July but then had another setback with the construction dust flare-up.  So my taper’s back up to a “big boy” dose and I’m fairly confident I’ll be ok through the weekend until I can follow-up with my regular doctors.  The salumedrol is probably the most effective medicine I get at the hospital which I cannot give myself at home.  It’s a corticosteroid, similar to prednisone, administered through an IV.  I’ll be good for a couple days on that alone, and the extra oral prednisone should boost me the rest of the way.

This further cements in my mind the need to participate in an asthma research study.  I’m looking forward to beginning SARP III next month.  I’ve also been wondering if I should be nebulizing any other medications.  I’m already taking Spiriva, but maybe something like scheduled DuoNeb treatments supplemented with Albuterol treatments would be more effective?  Definitely something to talk about with the various doctors I’ll be seeing in the next few weeks.

Lastly I must mention the traditional drive through Taco Bell.  The hours of labored breathing can really work up an appetite.  I finally tried one of the new Fiery Doritos Locos Tacos.  The Nacho Cheese variety is pretty decent, but I was really disappointed with the Cool Ranch.  There just isn’t a strong taste to wow me into believing I’m eating an amazing Doritos-Taco Bell food combination.  To be fair Cool Ranch Doritos don’t exactly have an over-powering taste on their own, but I feel it should be stronger when combined with a taco.  The Fiery version takes the cake for me.  It has a big, bold flavor that improves upon the standard Nacho Cheese.

doritos_locos_tacos

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

ER Trip #3: Part 3

Part 3: House Arrest

After that harrowing experience last night I luckily bounced back mostly ok due to the salumedrol, regularly scheduled treatments and all my inhaler puffing.  My hospitalist came by again in the morning, with news from my pulmonologist, giving me the option to stay or go home.  As much as I love lying in a high-tech bed having meals and drugs brought to me on a constant basis, I decided to leave.  Their one condition was I’m under “house arrest” and to do as little as possible.

As soon as Jeff, same guy from previous day working another shift, was informed of my discharge he asked for some basic information in case the “customer satisfaction” people needed to contact me about my stay.  I gave him my phone number and Jeff went to find a wheelchair ride for me.  Just as we were about to go one of those customer liaison folks showed up asking me how my stay had been.  Liz and I briefly described the “Josh situation” and praised every other employee we encountered.

So here I am, at home, feeling awful, but awful in my own house.  I didn’t realize how much I wasn’t doing until I came home.  I just need to get up to grab a snack, refill my water, put a DVD into the player or retrieve something in the house.  They weren’t kidding about pretending like I’m still in the hospital.  This is my 5th round of anti-biotics for the summer and who knows how many prednisone tapers.  I’d really like to just kick the sickness for a month and take a break.  In order to do that I’m really going to have to pretend like I’m still lying in that fancy bed.

The good news is that my lungs performed in the hospital the exact same as when I’m at home managing my chronic lung disease on my own.  I was still needing 7-9 breathing treatments a day, my peakflow numbers were still low, my oxygen saturation behaved similarly and this was all under the care of professionals and being given supplemental oxygen.  As usual I get the feeling no one really knows what is going on other than my asthma is really bad again.  I have some follow up visits scheduled with the doctors and I hope I actually show some progress between now and then.  I also found out people are testing positive for Mono at work and others have had colds lingering on for weeks.  There’s no way I’m going back to work to just get sick again – especially if I’m not well.  I went ahead and emailed one of the SARP sites for more information with the hopes of applying.  I think something like this could be awesome for me and very interesting as well as informative.  For now I need to just stop moving around so much and try to get better.