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About COPD
Should I See A Dr? (A Checklist)
COPD - Latest Web Info & Research (links)
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Talking To Your Dr
What is a COPD Action Plan? NEW
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Ask the RRT
Ask The Respiratory Therapist YOUR Question
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Medicines
Know Your Meds - A Reference Guide for Canadians
Drug Names/Equivalents in Different Countries
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Are You Newly Diagnosed?
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Breathing
Anxiety & Pursed Lip Breathing (PLB) (Part 1)
NEWPursed Lip Breathing (Part 2)
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Breathing Tests (Understanding Them)
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Finger Pulse Oximeters
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Exercise
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Nutrition
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For COPD Caregivers & Support People
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Lung Transplant
Lung Transplant Ctrs in Canada
Meet Melody (pre transplant ) The Waiting
Post Transplant Q's &A's of Melody
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Recent COPD Questions for the RRT
Mark Mangus, Sr. BSRC, RRT, RPFT, FAARC
Note: The weekly cut-off day is Wednesday evening. If your questions are received "after" that day, they will appear in the following week's postings. Questions and answers are usually uploaded to this site by Sunday evening.
Previous Questions & Answers (2010) & (2011) of Mark Mangus, BSRC, RRT, RPFT, FAARC
archived by topic, alphabetically
Previous Questions and answers
of RRT Tracy Cushing, covering 2008 and 2009, have been archived by topic alphabetically.
Disclaimer: The responses supplied by Mr. Mangus to your question is intended solely as "general information" only and NOT diagnostic in any fashion. Mr. Mangus's answers are based on his understanding of your query and on his personal knowledge and training. As with anything of a medical nature you should ALWAYS check with your physician.
Current Questions & Answers
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May 13th, 2012 Unknown Reason for Breathing Problems (Possible Allergens) Also Cholesterol Discussion
Hi Mark,
NO copd, hopefully. Smoked in my youth, quit at age 24. now 59. haven't
been seriously sick in years 20 or so, except occasional lethargic
sensations. approx three years ago. started taking cholesterol meds.
pravistation, cholesterol in the 350's in spite of many years of exercise
and good diet. Hi Laura, It's tough to guess what may be going on, though, if they think it's allergies, I wonder if you have had a work-up for that - skin tests, etc? How about a PFT (pulmonary functions test)? Spirometry, pre- and post-bronchodilator might show airway reactivity - the symptom most commonly manifested with allergies. Chronic bronchitis could be another possibility. I'm intrigued that you began having symptoms after starting your new job. You spoke of "old files" and data transfer as your function. Are the records 'musty' or been in storage for long? Could you be reacting to something in the paper they're composed of? How's your cholesterol 'now' with the prevastatin? Is it normalized? How about your triglycerides? I ask because I had a severe problem with elevated cholesterol and triglycerides that I was able to normalize without using statins. For more than three years, now, I have taken high-dose Niacin (3000mg/day) - (had to work my way up to my current maintenance dose from very low dose over a period of months) plus higher-dose flax seed oil (3000mg/day). But, I dropped my cholesterol from almost 300 to about 110 and my triglycerides from almost 500 to the 90's on both AND my high-density lipoproteins (HDL) are almost double what they were when I started my regimen (in the 50's). Many statin preparations contain low-dose niacin. But, it is not always enough. AND, because of the discomfort of flushing, many folks abandon it quickly, rather than tough it out 'til it no longer occurs. (Flush-free Niacin is not nearly as effective as regular, sustained/prolonged release is). I didn't want to take statins because of the side effects that are so common with them - if I could avoid having to take them. And I'm so pleased with what my regimen has done for me and continues to do. If you can give me more to go on, I might have some suggestions for directions to point you in for further investigation and possibly even a possible reason for your troubles. Best Wishes, Mark Pulmonary Fibrosis
I have
Lung Fibrosis I was diagnosed aboutt 10 yrs ago. now getting worse, I am on
oxygen 24 - 7. The doctors I see do not seem to help me at all, just waiting
for the day I stop breathing. Hi Marjorie, I'm sorry to learn of your troubles. Pulmonary Fibrosis is a nasty problem for which we still have a paucity of tools to combat/treat. Pulmonary Hypertension is a condition that develops as pulm. fibrosis develops and advances. It is due to the accompanying hypoxia as it affects the heart, over time. Unfortunately, today, the most effective treatment to resolve pulm fibrosis is lung transplant. So, I think you're thinking correctly in your surmising that it may be worth pursuing. The sooner you find out if you're a candidate, the better, even if it will end up being some time before you actually need to undergo the procedure. Best Wishes, Mark |
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May 6th, 2012 Meds Sequence and Wheezing
Hi; just returning my question.l take symbicort
twice a day 2puffs each time plus half tab. unihyl,spirva once. Wheezing
still there. What l was asking they should put something in the meds that we
could taste and then we would know we are getting the dose. Do you agree?l
was shown how to take them but l still have breathing problems and wheezing.
Ventolin helps for a bit. My test showed l have 38 percent lung function.
Oxygen on finger test is at 92-94.ventolin l take 2 puffs 4 times a day.
TY for your time. Hi Doug, If your saturation "at rest" is running only 92 - 94 %, it is reasonably easy to predict that when you get up and move, it is dropping below 88 % and doing so fairly quickly. If you haven't had a 6 minute walk test, you should seek to have one done. You likely need oxygen for mobility and potentially, also for sleep. If you are taking Ventolin that many times a day, you could be taking your meds in a order that thwarts the effects of the bronchodilator medicine in the Symbicort. Be sure you are taking the Symbicort BEFORE you take an Ventolin, in the morning. Then wait at least 30 minutes before taking any Ventolin - IF you still need help. When the evening dose of Symbicort is due, be sure that you have NOT taken any Ventolin within the previous two hours. Ventolin binds to the same receptor sites within the lungs as does the Ventolin. If the Ventolin is taken too soon before Symbicort, the receptors cannot bind to it and it is shed from your body before having exerted any beneficial action. The spiriva should be taken within a few minutes after taking your morning Symbicort. I'm left wondering what your "post-bronchodilator" FEV-1 changes to on your PFT's. If a pre and post FEV-1 measurement hasn't been done, then, again, you should ask for at least one to be done - especially in view of the fact that you have wheezing. There could be other things going on with your lungs. But, these are some obvious starting points for you to consider acting on. Best Wishes, Mark COPD or a Bad Cold
I think I have a bad cold. I was sent for a chest x
ray my doc thinks I have mild Copd oxygen output was 94% on azythromycin.
What do you think? Nose is stuffy phlegm is clear Hi John, You could be right. Be sure to have your saturation checked after you recover from your bug to be sure that it returns to normal. Ask for a 6 minute walk test to be sure you are not dropping your oxygen during exertion. Best Wishes, Mark
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April 29, 2012 Nebulizing Meds
Can I use
Glutathione with a nebulizer and also use Symbicort? The Glutathione is
from a pharmacy in southern California. Each is to be taken twice a day. Hi Maureen, First let me be sure I understand what you're asking. You are asking about taking the two medications at the same time and concerned about any interaction between them, correct? You are NOT asking if it's OK to "nebulize" BOTH drugs, either separately or mixed together, correct? Symbicort is not suitable for nebulization, if that's what you were asking about. It must always be taken from its designated inhaler. Those points settled, you CAN take both medications without concern. They are completely different and do different things. One will not interfere with the other. And taking both is not going to put you at any risk of harm. Best Wishes, Mark Oxygen Desaturation..... Dangerous When?
Hi Mark Hi Philip, Needless to say, this is a carry-over question from the same issue discussed extensively over the last week on the EFFORTS list. So, I feel a bit "baited", here. The reason you will find no agreement or a definitive number as you lament not being able to find is because there simply IS NO SUCH NUMBER . . . at least not with the conditions you and others are bent on applying. It is simply NOT black and white! It is different for everyone and dependent upon many subtle factors of their own condition. As I explained the other day in a post on EFFORTS, the 88 % comes from the NOTT and BMS studies where it was selected as an arbitrary low point for purposes of delineating populations in the study groups and ascertaining survival with and without using supplemental oxygen and for how much of the time they used it. Again, I explained that even the 88 % or 85 % opined by many in yet other countries - or the 80 % set in one province of Canada as the lowest acceptable saturation without trying to correct it with supplemental oxygen is relative. Consider the inhabitants of the Andes or the Himalayas. They live NORMAL lives with saturations in the low 80's and aren't considered "hypoxic" until their saturation drops into the 70's. When we fly, our saturation drops to 87 % (I just measured mine during several flights to Las Vegas and San Francisco two weeks ago) and , while we may feel a bit tired and have less than stellar energy, we are fine for those short periods of time. I'm certainly not going to suffer and organ damage because of those several flights. And flight attendants and pilots and their crews withstand drops into the mid 80's daily as they fly for their livelihood. The fact is that what is "damaging" to a person is the long-term, repetitive drops in saturation in the face of having clinically significant lung disease and a vulnerable cardiac condition as a combination of influences. And it is not that their saturation drops to or below some magic number, because it drops to different lows at different times under different circumstances and influences of the moment. The answer to your "damage" question lies in the example that may be likened to a boxer who takes many punches to many places of different kinds and strengths and who after enduring so many over the course of several boxing rounds finally takes a final fall and passes out because he can't take any more punches. Now, you ask me: "Which punch was it that did him in?" I don't know. The last one is the one after which he fell. But, it took the cumulative effect of all the previous punches to lead to the culmination in that last punch. And so it is with desaturation. While you and so many others are trying to put conditions and numbers into a tidy and neat box, the contents of the box are like a glob of Jell-O that doesn't want to fit into the box and is too difficult to handle to tame and control it. So, the best I can do is to reiterate what you will repeatedly find when you do find the information in the literature, 85 to 88 % seems to be the most evidence-based range of lows below which long-term, repeated drops to and below will eventually result in permanent changes for the worse in cardiac function and pulmonary blood pressure increases. That's the best we can say and do. If it's not enough, I have to say: "I'm sorry!" Still, the 'general' recommendations we have to go by is to do your best to keep your saturation above 88 % as much of the time as is possible. 90 % or greater is the recommended 'minimum' target for 'sure' safety with higher saturations targeted for increased comfort. Best Regards, Mark Frequency of Ventolin Use
l use ventolin
like lm told and more when l walk is this ok? Should they put something in
symbicort and spiriva so we are getting the dose? TY Hi Doug, I'm afraid I don't quit understand what it is that you're asking. If you are taking Symbicort and Spiriva, then you should need ventolin ONLY in-between the Symbicrot doses and ONLY on an as needed basis.
You say you use your ventolin as you're told".
But, you don't say how often you've been told to take it OR under what
conditions you're supposed to take it. And, you say you take more when you
walk. So, it sounds to me like you're not taking your Symbicort (and
possibly also your Ventolin) properly, since it seems to require more than
is usually needed for normal doses under usual conditions. Can you write
back and tell me by what pattern you take your inhaled medications - times
and which ones when? Mark Treadmill Walking vs Outdoor Walking
Mark, Hi Doris, You're not splitting hairs. But, some of what you tell me causes me concern.
First,
when one works out in the gym, they chose things like the treadmill, cycles
and eliptical/step gliders, etc AND they generally work out quite
differently from how folks tend to work out in PR. While I've said that
walking on the level treadmill doesn't exactly match the work of moving your
body from point "a" to point "b" when walking outside, that doesn't mean
that you can't achieve comparability. Now with regard to saturation, it is NOT desirable to sustain your saturation at the 85 - 86 % you observe yours to be when walking outside. If you have supplemental oxygen available to use and are prescribed to use it, then you should use it. You should target keeping your saturation at or above 90 % during walking - whether it be indoors on a treadmill or outdoors on the natural terrain. That it comes up to 96 % when you stop (after 3 - 4 minutes) does not make sustaining 85 - 86 % during walking any healthier for you. Recovery time, contrary to what some will say, has NO bearing upon the adverse effect of sustaining saturations that are below an acceptable level of 88 % during exercise. So, my recommendation for you would be to exercise as vigorously as you can to raise your heart rate AND sustain an adequate saturation so as not to put yourself at risk for organ function compromise (mainly, your heart) in the long run. Best Wishes, Mark COPD & HOCM
I have
recently been diagnosed with COPD. I also have HOCM and I'm wondering how
they will affect each other. Hi Diane That is something I can't begin to speculate on. Your cardiologist and pulmonologist have infinitely better means to answer that question for you than I or anyone else could. I suspect that they will likely tell you that only time will tell. But, certainly, put your questions and concerns to them both! Best Wishes, Mark |
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April 22nd, 2012 Oxygen Level Query
Hi
Mark, my daughter suffers with FA ,she was taken to hospital a few days ago
where they found her blood pressure was low and her oxygen was at 8% ,and
said she could have slipped into a coma, I am so worried that this may
happen again now and we won’t b able to tell ,please help me understand this
,thanks Julie Hi Julie, I'm afraid you haven't provided enough information for me to help you at this time. As well, your relating of your daughter's oxygen level is not correct. No one can have an oxygen level of "8 %" and be alive, in any of the possible ways "8 %" could represent. I am not familiar with an abbreviation for a diagnosis of "FA". please spell out her diagnosis completely so that I will not misunderstand what it is she suffers from. If you can write back with the correct and more complete information I will be happy to try to provide some answers for you. Best Wishes, Mark Prednisone
How
bad is prednisone for flare ups of copd....my doc tries to keep me away from
them but yet that’s what opens me up to breath better....I’m already on all
the inhalers and a nebulizer Hi Allan, Prednisone is the drug we "love to hate". It DOES work very well to subdue symptoms and make the user feel better. But, it is a mixed blessing, as it suppresses your immunity, making you more susceptible to infection AND playing havoc with calcium distribution and use in the body, leading to susceptibility to loss of bone density and osteoporosis, if used too much for too long. And, how much is too much or too long is different for every individual, making determination of what is safe for a given individual very difficult to ascertain. That is why your doctor is hesitant to prescribe it very often. The trick is in being able to tolerate the symptoms that cannot be changed and to counter them with activity and exercise as well as good diet and life style/habits (like refraining from smoking, etc.) Pulmonary rehabilitation is of great help in learning to overcome and tolerate difficult breathing. Taking medications in the proper amount and sequence is another key to living well. If you are using your nebulizer with short-acting medications and then following it with long-acting versions, you are working against yourself to achieve effectiveness of the long-acting medications. AND you could be taking much more medication than you really need to because of the ineffective sequencing of your medications. So, simply being on all possible medications alone PLUS a nebulizer may not be as effective in reducing your symptoms/breathing difficulties as you might think. If you can tell me more, especially what medications you are taking and in what order/sequence/timing/interval you are taking them, I might be able to glean more of from what your difficulties may arise Best Wishes, Mark Good PFT Numbers, But Having Problems With Breathlessness
Dear Mark, Hi Con, With your pulmonary functions as good as they are and your FEV-1/FVC ratio still within normal limits (at > 70 %), you have extremely minimal obstruction and none that could possibly be considered clinically significant. The complain of not being able to take in a deep breath is relative and very subjective. You obviously can indeed take in plenty of deep breath with your FVC at 5.82 L! So your 'sensation' is a mis-fire in your brain. What causes folks who have clinically significant COPD to develop the sensation that they cannot get enough air in - a.k.a. a deep enough breath - is the fact that they are trapping so much air that they have no room for 'additional' air to be taken in. Their quest is to use pursed-lips breathing to help "EXHALE" more effectively so that on subsequent breaths, there will be enough room for MORE fresh air to come in. They need to 'make space' to accommodate a bigger breath. That is not your problem at all. In fact, there simply is no good reason for your sensation and therefore, no reasonable way to explain it aside from the possibility of some amount of airway remodeling resulting from the combined smoking and steroid inhaler use. Still, your changes are simply not enough to explain your breathlessness/complaint of not being able to take in a bigger breath. Inhalers will NOT do anything for you and should not even be a consideration. Try exhaling more deliberately and using pursed lips breathing to see if you notice any difference or improvement. Best wishes, Mark Smoking, Industrial Exposures & COPD
Mark; I
am questioning the band wagon approach to the medical and worker comp boards
insistence that COPD is only caused from cigarette smoking. Hi "R", COPD can indeed be caused by inhalation of asbestos and silica. Thermal injury to one's airways can result in a combined defect of restrictive AND obstructive lung disease. smoking history up to about 20 years for many is not enough history to presume as a primary cause of COPD when one is younger. You did not indicate how long you smoked, only that you've been quit for 20 years. Lastly, inhalation of the kinds of agents used in furniture restoration can cause either or both restrictive and/or obstructive lung diseases Unfortunately, with your history of several incidents that can cause COPD and a smoking history, it is virtually impossible to separate each factor to ascertain if and how much each might contribute to your COPD. Asbestos inhalation is dose-dependent, so requires significant and dense exposure for a short duration effect and moderate long-term exposure for a sustained effect. Silica is the same. Your inhalation injury from the fire should have been well-documented in order to determine what permanent damage was caused by it. Regular follow-up with x-rays/CT scans and especially, PFT;s would be necessary to gather that kind of evidence. So, if, on the surface your smoking history seems to be significant (> 20 pack-years - 1 pack/day X 20 years) then it is impossible to tease out the other influences. In any case, with your multiple exposure history and smoking on top of it, no one can reasonably or reasonably accurately estimate how much of your lung disease, if any was cause by what. Insofar as any neuropathy, only well-performed and sensitive tests of muscles and nerves could possibly detect any such affect on your condition and symptoms. I'm sorry to be unable to give you more specific information or answers. But, it's just not possible, based upon your history and from where I sit. Best Wishes, Mark Pulmonary Rehab Needed?
Mark, Hi Moe, First you are to be commended for exercising on your own. In my opinion, one can do most anything they wish - including the strenuous yoga positions - as you describe. Yes, breathing is restricted by the position. BUT, it presents an ideal opportunity to learn to control your breathing more with your 'abdomen' while in that position, despite the restriction. So, I would encourage you to continue. Since you are indeed exercising well on your own, it is hard to justify the expense of pulmonary rehabilitation, especially since you are able to be so vigorous as your condition currently allows. So, save the pulmonary rehabilitation for a future time when you may find you can no longer effectively control your symptoms and are less able to exercise so vigorously. The Internet and forums like copd-Canada provide ample opportunity to continue to learn more about your disease and how to live well with it. So, there is plenty of "expertise" to be gleaned through your own efforts and searches. Keep up the good work! Best Wishes, Mark Treadmill Walking vs Land Walking
Why is it
that I can walk on a treadmill with no problems, but when I walk off the
treadmill, e.g. outside or even in a mall, we become short of breath..nobody
seems able to answer this question. It's not just me...I have spoken to
others in my BreathWorks program and they have the same problem. Hi Norma, Yours is a common complaint that seems to be related to the fact that on a treadmill, with the belt coming to meet your feet, you don't do as much work at a given speed as you do when you move the mass of your body from 'point A' to 'point B' as when walking on land. Add to that terrain variations and the fact that you're also not able to "hang on" to rails, as on a treadmill and you have significantly more work when free-walking than when walking on a treadmill. If you were to add grade to the treadmill, you would see an increase in your work to breathe that compares to free-walking on land. I'm not recommending adding grade. Indeed, if you add anything. add speed until you reach your maximum comfortable walking speed (somewhere over 3 mph) Then add grade or interval increases and decreases in speed with an 'easy trot' when moving faster - all this ONLY if possible and tolerable. Just remember to make yourself breathe HARD when you walk on the treadmill so that it will better translate to similar work when free-walking on land. Best regards, Mark |
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April 8th, 2012 PFT Info Review
Hi, I have been
recently diagnosed with COPD as a "former cigarette smoker with wheeze" and
am trying to better understand my PFT numbers, specifically Hi Laura, Your PFT shows significant airflow limitation AND evidence of increased "resting lung volumes" indicating fairly significant COPD. As well, you also have a clinically significant response to bronchodilators (an 'asthma' component. So, I would say that you indeed NEED to continue the Advair and Spiriva, as they are exerting a significantly beneficial effect. I doubt that the results are erroneous, as such limitations as demonstrated on your PFT, while certainly subject to the potential to reflect acute illness, when present, are not going to change all that significantly from your baseline. That said, that you don't 'feel' all that limited is a GOOD thing! Being able to function - especially from a physical point of view - without significantly limiting breathing difficulties is your best news AND a factor with which you should be able to improve your breathing and function by adopting a regimen of exercise that will serve to keep you enjoying minimal functional limitations for some time to come. So, get out and exercise like mad and make yourself breathe HARD while doing it. Remember, working hard to breathe, though uncomfortable, will NOT harm you! It will serve you well to desensitize yourself to what lies ahead in the coming years. Your FEV-1 of 46 % while significantly reduced, is not low enough to produce significant symptoms during mild exertion. If you try to run a marathon, you will certainly feel the effects, though. Still, as others with similar airflow limitation have found, even running a marathon is not a possibility that is out of the question. I always remind folks that one with "normal" lung function who undergoes removal of one of their lungs is physically reduced to 50 % of their capacities as measured on a PFT. Yet, folks with one lung DO run marathons - though with having to do much more work to breathe while doing so. So, again, the bottom line is, you have plenty of lung capacity with which to work. Don't be afraid to use it! Best Wishes, Mark COPD & HOPE
Hi Mark, Hi Philip, I couldn't have said it all any better than you did. Hope MUST be an ingredient and an inspiring force in the life and mind of anyone with COPD - - - and many other chronic diseases, as wel, for that matter - - - if they are to survive and thrive in the face of the difficulties attendant with having those diseases. As well, we can't forget "purpose", which goes hand in hand with hope. If you haven't got a purpose for getting out of bed each morning and living life toward a positive end, then you are doomed, as well. While having worked with 'older folks' so much of my career, I can tell you of the warning signs I have come to recognize that bode poorly for folks' survival and thriving. When one loses their reason for living, hope goes with it. And even a chronologically young person can meet an earlier demise than would ever be likely. So, the message for all is to stay engaged/involved with life and living and realize that despite the troubles you may face in living life to the fullest, you have something to contribute to the world and a good reason to trudge on - even in the face of adversity when things get rough Thanks for reminding us of these important points! Best Regards, Mark Tech Smart Dose Regulator & the Importance of Exercise
Mark, Hi Lillian, The smart Dose 'should' indeed be able to deliver the oxygen you need. BUT, you can't rest on my guarantee, alone. Get one and check your oxygen saturation during all manner of activities so that you can learn what it does for you. Remember, no matter what device or system you use - if you find that your saturation drops significantly AND there is no better system out there for you, realize that your next option is to slow down or stop and rest as needed to recoup and keep your saturation within therapeutic (and comfortable) levels. Remember, also, that exercise and the improved conditioning that comes through doing it will also help you breathe better AND improve your body's efficiency at using the oxygen that you CAN get into your system with your 'frumpy' lungs! Best Wishes, Mark PFT Review - COPD?
Hello Mark, Once again I seek your advice this is
for my husband. He was a very heavy smoker but gave up when he was 50, now
he's 65. He got worried as when he was doing some very hard work awhile
back he felt he wasn't performing well and got tired quicker than usual, so
he saw my lung doctor who gave him a spirometry test. The results were very
good, I write them here: FVC 104.4 %, FEV1 102.3 %, FEV1 VC/MAX 106% PEF
129.5 %, FEF25 97.5 %. Now FEF50 57.6%, FEF75 42.7 %, MMEF/7.5/25
69.9%. I have written % as it's much easier. However the FEV1,FVC
PEF are excellent for someone who smoked for 35 years, and the doctor hasn't
given any treatment . However, he doesn’t' understand why the other
readings are so low, and indeed what these initials mean. He feels these
low % factors could be why he felt tiered when doing some very hard digging
(with pickaxe) Could you possibly explain to us the significance of low
reading of FEF50 FEF75 and MMEF, when everything else is so good. Thank you
very much. all the best, Valerie Hi Valerie, Your hubby's airflow is GREAT! And, accordingly, he has no evidence of 'clinically important' COPD. That said, when you get to looking at FEF at 50 and 75 %, you are looking at airflow in the small airways - where evidence of COPD first shows. AGAIN, that said, your hubby doesn't have changes significant enough to make the reductions in his small airway flow culpable in his complaints. The MMEF is simply a reflection (relationship) of the expiratory flows reflecting the individual measurements as a comparison. Much as I hate to suggest - your hubby is 65 years old. And slinging a pick axe and doing the hard work you describe SHOULD make a man tired - even a younger man. I would suggest that perhaps his expectations for himself and what he thinks he should 'easily' be able to do may be a bit inflated, when one considers age. That he can manage to do that kind of heavy labor AND 'only' get 'very tired' is GREAT and would likely make many younger men feel a bit wimpy. In any case, my bet is he'll be around for a long time and the likelihood of COPD becoming a significant difficulty in his life is quite doubtful. Indeed, I suspect, he is one of those lucky ones who has the 'good jeans' that allow him to be in that percentage of the population that can smoke heavily and yet NOT develop COPD. He needs to worry more about crossing the street in heavy traffic, playing golf in a thunder storm or getting shot by a jealous husband (or his lovely wife) (thoroughly kidding on that last one, of course!) before he needs to fear COPD as any likely part of his foreseeable future. So, tell him to keep slinging that pick axe AND exercise more for endurance-building, which will increase his tolerance of such strenuous activities! Best Wishes, Mark
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April 1st,
2012 Can You Recover from COPD?
Can my mom ever
recover from copd? Hi Heather, Would that I could wave the magic wand to make your mom better, that is simply NOT in the cards. COPD is a permanently damaging disease, irreversible at this time and progressive in nature. The best we can hope for once one is diagnosed, is changes in lifestyle, effective treatment for symptoms and complications to slow the rate of progression. It is very much a "move-it-or-lose-it" disease. That one regain as much health and function and become every diligent in exercising to gain and maintain strength and improve symptoms is absolutely imperative. It is also MUCH easier 'said' than 'done'! Because shortness and difficulty of breath and breathing are hallmark to the disease AND because challenging breathing with exercise and movement feel simply horrible as the disease progresses - and because such difficulties seem like they will harm one who continues to move while experiencing them - AND because those who care about the sufferer have difficulty watching the struggle, desiring to ease difficulties by doing more and more for them - there results a major hurdle to being able to effectively manage rate of progression with the singlemost effective means to doing so. So, your quest is to help your mother get moving and keep moving. She must learn that she CAN challenge her breathing, feel very bad doing so and still come out down the road in better shape than she was before AND in better shape than she would be if she didn't endure the difficulties of moving. Nutrition is of great importance to avoid dropping weight as time goe by, such that ideal body mass falls below 100 % of predicted for age, gender and height. Using medications and - when the time comes that it is evident that oxygen becomes a necessary intervention - using oxygen properly are the other major components for keeping the rate of progression in check. Keep asking questions and learning all you can. Your role in helping your mother do well in spite of her disease is a very important one, indeed! Best Wishes, Mark
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March 25, 2012 Mucus Problems
Hello Mark - Hi John, You didn't say if you are using Mucinex or other preparation of guaifenesin. If not, that might be worth trying. Many folks find NAC (N-Acetyl Cysteine) a nutritional supplement (over the counter) of benefit in helping to thin mucus for easier expectoration. Breathing steamy air (for those who can tolerate it) - as in a steamy bathroom - helps many folks to loosen and bring up mucus. There are other more 'robust' positive pressure - with and without vibration - devices like Acapella, Resistex and others. They exert a positive pressure - and in the case of Acapella, add vibration to your airways - during exhalation which helps to mechanically move mucus. What you describe using is the "flutter" valve. It is convenient, but doesn't exert a very forceful vibration. There are several devices that are of a higher level of effectiveness - and cost - that do a much better job of moving mucus. My first recommendation is one of two positive pressure devices. MetaNeb is a device that delivers an aerosol and two levels of pressurized vibration. It is convenient and easy to use and less expensive than the next device I recommend. IPV (Intrapulmonary Percussive Ventilator) is a more robust version of MetaNeb. It has a higher pressure and vibration capability and also delivers an aerosol with the vibration through positive pressure breathing. It is very effective, though expensive. And, while I think it is available in Canada, I don't know what the ability to get it covered by your health care benefits is. Many recommend high frequency chest wall oscillatory vibration using one of the three versions of 'vests' that are on the market. Personally, I don't like vest therapy (as much ballyhooed as it is most everywhere) as much as I like positive and negative ventilatory maneuvers provided by IPV, MetaNeb and the Hayek device (described in the next paragraph). But, if the vest were to be all you could get, it would suffice. A new device finally on the market in the USA, but long available in Europe is the Hayek chest curiass high-frequency ventilation device. It does pretty much the same thing as the IPV and MetaNeb, but does it with "negative" pressure on the outside of the chest wall, rather than exerting positive pressure against the airways internally, as with IPV. I don't know the availability of that device in Canada, either. It is VERY effective at moving mucus. One other intervention worth discussing with your doctor would be the use of 'nebulized hypertonic saline'. You breathe in saline that is about 7% concentration which pulls water into the mucus in your airways and thins it out. This is used in the bronchiectasis we see in Cystic Fibrosis, but has similar application in non-CF bronchiectasis. At the very least, if your wife is pounding your chest (percussion) then you should ALSO be using postural drainage - positioning your lungs so as to recruit gravity to help 'drain' your airways. There are lots of descriptions on-line for positions that would be effective for your needs. If you are not using postural drainage with the percussion she gives you, then you are missing a big - FREE - piece of the puzzle that can help improve your mucus movement, immediately. Be sure to do Postural Drainage and Percussion within 30 minutes after using your aerosol (nebulizer) medications for best mucus movement. I hope somewhere in these thoughts you find something to add to your regimen. If not, let me know and we'll see if we can think of yet others. Best Wishes, Mark
When Will Oxygen Be Required & What Does Moderate to Severe Mean?
Hello, Hi Terri, I'm afraid I can't very well answer your questions beyond a general response because the term "moderately severe" or its variation "moderate to severe" as used in your hubby's case, tells me nothing specific. Indeed, the days when "moderately severe" as a characterization or label for COPD was acceptable are LONG gone, having been replaced by a world-wide standardized severity grading system under GOLD (Global Initiative on Obstructive Lung Disease). GOLD classifies severity of COPD in "stages" - stages I, II, III, IV according to FEV-1 and FEV-1/FVC ratios derived from pulmonary functions tests. What will help is knowing what your husband's "FEV-1" measured on the pulmonary functions test (PFT) - a test he should have had done - that revealed his COPD diagnosis. If he has NOT had a PFT, then a return to the doctor who made the diagnosis would be in order to demand that the test be done. It is unconscionable to diagnose and treat someone who is said to have "moderately-severe COPD" without having first established the diagnosis with a properly performed PFT. If indeed he DID have a PFT, then you should call and ask what his FEV-1 and FVC measured on that test. There should be absolutely NO reason why they would hesitate to give those numbers to you. AND ALL COPD patients (IMO) should "know their numbers" (FEV-1 and FVC)! Some times a physician will run a CT scan and make the diagnosis from that. While a CT certainly "shows" the tissue changes of COPD, it in no way characterizes the "clinical" severity of the disease - a much more important and meaningful measure that tells us how well a person "functions" and is able to live life with their level of disease. COPD is a progressive disease. It will gradually worsen over the years. The key to keeping the rate of progression as slow as possible is "movement"! COPD is a "move it or lose it" disease. While moving can bring on significant breathing difficulties and symptoms, the trick is to learn that breathing hard and being VERY uncomfortable (1) will NOT hurt a person - even though it may FEEL like it will kill them (smile) and (2) will actually allow them to keep moving and functioning very well while improving the severity of breathing difficulties as they get in better shape and stay in that improved condition. Oxygen is most often not part of the picture until one's COPD has reached an extreme level of severity. An FEV-1 of less than 30 % is almost ALWAYS a necessity to see hypoxia (low oxygen levels in the blood) that requires oxygen therapy to correct. Often the FEV-1 is found to be much lower for oxygen to be necessary, though necessity for use of oxygen is NOT specifically or obligatorily tied to FEV-1, per se. So, if indeed your hubby falls into the category of "moderate to severe" as it 'used to be referred, he is still some years away from needing oxygen. You didn't say how old he is or anything about his history (especially that of smoking). So I am at a loss insofar as being able to ascertain anything that might be an influence of age. So, the bottom line is you have a lot of good questions that cannot be answered until and unless you gather and provide much more information. Feel free to come back and post your questions again once you have obtained the information I've suggested. Best Wishes, Mark COPD & Sinus Infections
Is there any
connection between COPD/Asthma and sinus infections. I was diagnosed with
COPD last year and was prescribed DAXAS in Hi Ron, While folks who have COPD often have problems with sinus infections, that they are necessarily caused by or a necessary part of having COPD is not established. Daxas does have some side effects of which rhinitis and sinusitis are included. Your doctor should be able to tell you if Daxas is suspect in your difficulties. As well a consult to an ENT specialist should be of help in discovering the cause of your difficulties and perhaps a good course of treatment. Don't simply stop the Daxas without first collaborating with your doctor(s) and looking for alternative solutions. Best Wishes, Mark Daxas
I have had asthma
for a number of years and was taking symbicort, singular and spiriva and
they allowed me to carry on with my life in a normal fashion. Things changed
last year, when I had pneumonia in January, later a viral infection that
lasted two months and in the spring I was experiencing difficulty breathing
with many panic attacks. In August I was put on Daxas and despite some bad
effects, my breathing improved. I have experienced insomnia and I am
presently taking trazodone with good sleep results. Since being on Daxas my
sinus's are mildly infected most of the time with a runny nose and nasal
congestion. Is this a common occurrence with Daxa`s. Hi Ron, Since this post seems to be an elaboration on a previous post describing the same problem(s) and somewhat the same questions, I'm going to assume that you are the same Ron who posted the previous question. If you are not one and the same person, I apologize for the erroneous assumption. But, my response to that query holds true here, as well. To answer your additional questions: Daxas is only one piece of the COPD management pie. As such, it does not hold any broad benefit or singular basis for COPD management, but rather works with the other pieces to produce an overall improvement in symptoms. With an FEV-1 of 51 % of predicted, you have PLENTY of lung capacity. Even though you may experience some hard breathing with exertion, you should strive to exercise despite the hard breathing. Indeed, you should target "achieving" significant windedness and work to breathe in order to improve your long term breathing and reduce the degree and impact of breathing difficulties and symptoms. To decide not to exercise because of some mild breathing difficulty can be the kiss of death over the long run. The more one avoids breathing hard with COPD, the faster it progresses and the sooner they die. That may sound harsh. But it's simple and it's true. Don't get caught in that trap! Best Wishes, Mark NAC
I see people
referring to NAC...what is it and what are its effects on COPD? Hi Heather, NAC is "N-Acetyl Cysteine". In the body, NAC acts as an antioxidant. In the lungs, it does two things that are of major benefit. It helps mobilize mucus for better clearance from the lungs. It also stimulates production of glutathione in the longs - an anti-inflammatory substance that decreases airway inflammation. It is sold as a nutritional supplement and is recommended in doses of 1200 - 1800 mg/day along with 1000 - 2000 mg vitamin C which helps prevent the metabolites (in this case 'salts') of NAC from forming kidney stones. It is generally a good thing for folks with COPD to consider using. Best Wishes, Mark Oxygen Eqpt & Usage
Mark, Hi Lillian, First, you say you live in Houston, TX, but suggest that medicine and medical practice are somehow not up to date or up to par, let alone comparable to Denver, CO. While Denver arguably has some world class lung facilities - and as Tom Petty played a large part in bring notoriety to Denver, his influence reaches far beyond Denver as a significant part of what we call the standard of care, today throughout the practice of pulmonary medicine. Another point to consider is that Denver is at a mile high altitude which makes having lung disease AND hypoxia especially difficult, since that altitude carries it's own inherent set of negative influences on one's breathing and oxygenation! Those who use oxygen require much more than those living closer to sea level like you in Houston and me in San Antonio! I would also remind you that Houston has some world class medical facilities and is no slouch in the medical field, by any means! That doesn't mean that those who serve you aren't up to par with the general level of practice in Houston. But, that is neither here nor there. You have available all the services and quality of service you need right there in Houston! So, let's see if we can help you with what information you need to obtain those quality services. If you are very thin, I am concerned that you are maintaining sufficient body mass to keep your disease progression and symptoms to the minimum possible. Check to see if your body mass meets predictions for "ideal body mass" for a person of your age, gender and weight. If you are not greater than 95 % (and it would be better to be at or over 100 %) of your ideal body mass, then you need to put on some weight. It is a common finding that folks who have advanced COPD (as indicated, especially in your case, by the need for oxygen 24/7) die sooner than they would if they had greater body mass AND they suffer worse symptoms during survival. So, consider what influence your "thinness" may be exerting on your symptoms and even your need for how much oxygen you use. If you need 5 liters of oxygen from your concentrator to maintain saturations in the 90's during exercise, then you surely need that equivalence when out and about using your portable oxygen system. It is obvious that the conserver you are using is NOT putting out nearly the equivalent of 5 L/min compared to continuous. In fact, there are only a few compressed gas conservers that can achieve that kind of output. You need to ask for them specifically by name/model and accept NOTHING different, as other simply will not compare or measure up. Puritan Bennett CR-50, Salter Labs O2Xpress and Inspired Technologies Smart Dose are really the only ones that can deliver the amount that you need. Ask for them and have your saturation measured during several minutes of walking and activities similar to shopping, etc. As well, understand that the size of the tank you use determines how long it will last. If you are using M-250 also called B-cylinders, you must understand that using as much oxygen as you do when walking, they will not last but a couple of hours. If you are walking then sitting for spells, be sure to turn DOWN the flow so as to stretch the supply for a longer duration. Try using C-cylinders and D-cylinders whenever possible. Even putting an E-cylinder on a cart and schlepping it along behind you will increase your supply duration. But, the natural and expected phenomenon of using the gas in the cylinder will result in the pressure drop you see to a point where you will not be able to get any more oxygen out of the tank simply because the pressure has dropped too low to power the delivery device. This is usually somewhere at or below 150 pounds pressure in the tank. So, the problem is NOT with the system or any malfunction. You are simply observing the results of having used up all the usable oxygen in the tank and need to be prepared to change it out for a full one so you can continue your away-from-home activities. You sound like you're working hard to keep yourself in the best shape you can. Keep up the good work. I hope this information will help you get a better portable oxygen system. Best Wishes, Mark Portable Oxygen Systems
Hi Mark...What do
you know about the Helios Oxygen systems? I want something very portable
and very light while getting more time out of the unit before refill is
needed.....I sure would also like continuous flow.....Let me know your
thoughts.....hope you are having a good holiday....Thanks....Heather Hi Heather, Everyone wants the lightest oxygen system possible that delivers the most oxygen and lasts for a long time and can -provide continuous flow. The fact is that unfortunately, this is truly one of those situations when you simply can't have your cake and eat it too! Helios 300 is under 5 pounds - very light weight, indeed. But is delivers ONLY pulsed oxygen - and not close to continuous flow equivalent, at that. It lasts forever (10 hours at setting 2), but does so by delivering a stingy amount of oxygen along the way. So, you get a long time of use, but are deprived of adequate oxygen while stretching the supply duration. Helios Marathon is a bit larger and heavier, but delivers up to 6 liters of continuous. The caveat is that at 6 liters continuous flow, you will use the supply in two hours. so you sacrifice duration for the continuous flow feature. With ANY liquid system (LOX), you will have to either return home for refills at intervals or carry a reservoir in your vehicle to refill from while out and about. Compressed gas cylinders offer some advantages in the categories you cite AND allow you to carry several cylinders for replenishment of supply without having to return to home base for refill, as with LOX. Now a good conserving device will help you stretch ANY compressed gas system to as long or longer than LOX systems while still providing plenty of oxygen to keep you well-saturated. Devices as I named for Lillian are those which I recommend for those who have significant oxygen demands during ambulation. Take a look at my response to her for those device names and models. Best Wishes, Mark Heredity
My sister and I
have both been diagnosed with Emphysema. She continued smoking and still has
not quit. I quit smoking 3 years before I was diagnosed with COPD. My sister
has recently been diagnosed with lung cancer and will off course be getting
treatment. Does this mean that I am likely to have lung cancer eventually
also? I am a 59 year old female and my sister is 61! Hi Linda, While heredity DOES play a significant role in who gets COPD and who doesn't and as you and your sister both have it suggests that heredity is at play in your family, that you will necessarily get cancer too, is not possible to predict or foresee. You quit smoking sooner, so "may" have less proclivity to develop it. At the same time, heredity could indeed play out such that you end up developing cancer somewhere down the line, too. No one can say one way or the other. All you can do is to continue to live as health and best as you can and stay as active as you can. Don't live your life fearing and behaving to avoid getting cancer. Live your life for the best each day can bring. That way, if you DO someday develop cancer, you won't have regrets for wasting your time in the meantime. Best Wishes, Mark Frequency of RT Visits
Hi Mark Hi Marie, It sounds like you are doing fine. I would suggest seeing who you think you need to see at intervals that "you" are most comfortable with. Keep up your exercise at the YMCA. Why not purchase an oximeter to measure your saturation under multiple conditions to be sure you do or do not need oxygen any longer. Oximeters are cheaper now than they've ever been, running as low as about $40! To simply stop using oxygen because you "feel" you don't need it is not a good idea as you could be desaturating to levels of concern during exertion and not feel it. Going by feeling is NOT a good method for determining when to use oxygen. Best Wishes, Mark
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March 4th, 2012 I Have Emphysema
I have been told
that I have emphysema and that there is nothing to do about the disease
except the usual puffers ? May I have your comments ,please ?? Hi Ken, To say that there is "nothing to do about the disease is a complete mischaracterization of the facts! While the "puffers" you speak about are mainstay of the inhaled medication management of symptoms of the disease, they are not the only medications that may be of value. At the same time, there is no 'magic bullet' that can stop the progression or reverse the tissue damage or the like. COPD (which includes chronic bronchitis and emphysema as predominant diagnoses under the umbrella term)is a progressively deteriorating disease, the rate of which can be slowed by proper nutrition, exercise and smoking cessation, among other things. Folks can easily live 20 and 30 or more years with COPD before it becomes bad enough to cause their demise. So, to say that there's nothing more than the puffers to do about COPD is simply wrong and short-sighted. Folks who sit around, do nothing and feel sorry for themselves will deteriorate rapidly and be miserable in their remaining time alive. That doesn't have to be. Indeed, next week, I am cruising the Caribbean for 10 days with the SeaPuffers - a group of folks who have advanced COPD who ALSO use oxygen therapy. They are FAR from giving up or even slowing down because of their now-advanced disease! So, it will be what you make of it - no more and no less! Best Wishes for a bright future DESPITE having COPD, Ken! Mark Oxyview Glasses
If you are using
pulse dose can you still get oxyview glasses or does it need to be
continuous? Hi Tom, The answer is: It all depends . . . " It depends upon which pulsed dose device you are using and how sensitive it is to being triggered by your inspiratory effort. If you contact the folks who make OxyView spectacles, they should be able to tell you, if you tell them what machine you use. If not, ask if you can demo a pair or get a guarantee for your money back if they don't work for you. I have known the makers of OxyView to be very accommodating and reasonable with their customers. Best Wishes, Mark Undetermined Diagnosis
Hi Hi Jean, I'm sorry to hear of your difficulties. Are you telling me that while your doctors have ruled out asthma as a problem, they have not given you ANY diagnosis? Have they mentioned bronchitis, or chronic bronchitis, since you speak of having lots of mucus production? Have they opined that perhaps your sinuses are culpable in your cough and mucus production - a fairly common occurrence in folks who have significant sinus illness? If your cough were dry and hacky, I'd suspect the potential for an interstitial diseased process, like pneumonitis of some kind or a collagen tissue disease or fibrosis process, or something. Those types of ailments are detectable using high-resolution CT scan. So, if you haven't had one of those, then that might be worth asking about. You say you've had the breathing tests. But, you didn't say what ANY of your numbers were. Do you know what your FEV-1, FVC and TLC and/or DLCO were found to be on that pulmonary functions test (PFT)? In the end, I can't tell you much of anything because you only vaguely described the testing you had done and didn't provide any "numbers" to tell me specifically, or in lingo "I" can understand what might be going on. In any case, it is safe to use inhalers for many, many years. Many folks have safely used inhalers - in some cases, the same ones - for well over 15 and 20 years. Best Wishes, Mark Working in a Manufacturing Plant
I have just been
diagnosed with copd, and I work in a furniture manufacturing plant with saws
sanders and other industrial size machines is it still possible to keep
working at that job, I haven't smoked cigarettes for about 7 years, thank
you. I'm 53 years old Hi Chris, There is no reason why you should give up your work, especially if you love doing it. You SHOULD and MUST take precautions to interrupt the exposure to the harmful inhalants you undoubtedly have taken into your lungs so as to minimize and further exposure or danger of reaction to inhaling those substances. Stay away from glues and varnishes in poorly ventilated areas. Wear a mask to filter out sawdust and small particles. so you don't continue to inhale them. They are your worst enemy, by far. Use your inhalers. Get plenty of exercise. Stay balanced in body mass and nutrition, Exercise to optimize your physical condition and stamina. Best Wishes, Mark |
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February
26, 2012 Alpha 1 Test
Can you explain the benefits of getting the Alpha
1 Anti-Trypsin-Deficiency blood test? I have also heard that a person should
look into having tests to check the functioning of the thyroid, especially,
if, as I do, have hypothyroidism and have had for years. Thank you, Dianne
Hi Dianne, Not too long ago, Aplpha-1-Antitryosin Deficiency Emphysema (the genetic form of Emphysema/COPD) was considered to be a fairly rare disease and one that not only did we not know much about, but had little ability to treat, short of drastic measures like lung transplant and enzyme replacement therapy. As our understanding grew AND we saw new, more effective treatments coming to market, we increasingly realized that the disease is far more prevalent than we had earlier thought, indeed, a LOT more prevalent. When the blood test to identify those with the defect became available, it was found to be easy to do, very accurate and not expensive (for most, it is free). It has become increasingly clear that the only responsible thing to do today when someone presents with COPD, especially which is primarily emphysema and also especially if (1) they have insufficient history to suggest predisposition to developing COPD (smoking history, certain occupational or environmental influences, etc) AND if they are under the age of 60 at diagnosis or advanced stage, then they should be tested for the disease. We know today that the sooner one is diagnosed, the better chance to treat and control it we have. As far as the thyroid test you ask about, it may be true that if you or someone in your family has thyroid disease, you have a history of thyroid dysfunction or you have symptoms suggestive of a thyroid disorder, you should get checked and perhaps with regularity to detect problems and monitor interventions. As far as one needing to check their thyroid function because of any connection to having COPD, I am not aware of any such correlation. Best Wishes, Mark Lung Condition Summary
I have severe copd condition, my lung capacity is
less than 50%. Hi Larry,
You told me lots of good information about you and
your condition. But, after reading it over a few times, I don't see a
question in there. Do you have a question for me regarding your condition
or anything within the information you provided? Best Regards, Mark COPD or Asthma?
My respiratory problems have GREATLY
increased since I underwent 2 yrs. of chemotherapy (Rituxan, Cytoxan,
Fludara) for Non-Hodgkin's Lymphoma (which is now in remission). Hi Don, According to your numbers, I don't see any evidence of Asthma OR COPD. at greater than 100 % of the two most important values measured (FEV1 & FVC) and inview of the other measures you reported (including the 69 % FEF 25-75) nothing even suggests reactive airways disease (asthma) OR COPD. So, I disagree with both diagnoses - especially in view of the CT scans and your history of exacerbation of your symptoms. First, with the numbers you have, you shouldn't be having any breathing difficulties that are generated by any influence of lung function. It is also possible that (1) you indeed have VERY MILD reactive airways disease that is absolutely 'normalized' by your medications or (2) your symptoms of difficulty breathing are a paradoxical response to the Advair which may be 'early-kill' or 'over-kill' for such mild disease, if it even exists. Now the CT findings and the fact that ALL of your bronchitis episodes have onset during the middle of immunosupression therapy for your cancer are highly suspicious for a combination of infectious response to 'opportunistic pathogens' ("bugs") AND the finding of interstitial pneumonitis and ground glass appearance screams of just that diagnosis. It also stands to reason why you feel better when you take prednisone. You have had enough episodes that your pneumonitis has likely become a permanent feature of your lung tissue profile. That being the case, you are subject to repeat bouts of bronchitis without need for immunosupression like that imposed during chemotherapy. It is not surprising that the oncologist shrugs it off. Those chemo agents (cytoxin, especially) are known to have an effect (interstitial pneumonitis and fibrosing changes) on the lungs. Unfortunately, this is one of those times where the benefit outweighs the risk as in your case, it has out your N-HL in remission - a very good thing. Ask your doctors about trying the following: stop the Advair for a few weeks. See what happens to your breathing. Use the prednisone for perhaps a bit longer and at low dose and then repeat your PRE and POST spirometry in a month and see how it looks. If your values drop be 20 % and you get a response of greater than 10 %, you will be able to say there is significant airway reactivity. BUT, if in the interim, you get to feeling and breathing better without the Advair, then the question becomes which is worse, a bit of airway reactivity that doesn't produce significant symptoms or enduring chronic amplified symptoms secondary to a medication that you arguably may not need to be taking. Best Wishes, Mark Very Severe COPD & Exercise
Hi Mark,I have severe copd.on 02 3yrs.I am 5 1yrs
old and have had copd for 5 yrs or longer quit smoking yr go .have trouble
walking, but you explained that to me last week. I go only 50 ft.Saw my
pulmonary Dr. last week.My fev1 has dropped to 11%i feel sick about that.I
thought I would of got better as last yr it was 17.Ithe Dr. said don't worry
about the numbers,worry about exercising .I do not go far. She said try to
go 3 times per day. I know I need to move it. I bought oximeter through
membership and keep an eye when on treadmill but my heart goes too
high.145.the Dr's never said anything about it high. It is between 115-120
when sitting. I am waiting ekg.Eating healty,fruits veggies fish etcMy
family Dr. put me on a lot of b vitamins and iron were low.Please help Sue
in Ontario I am scared if m fev goes lower, my Dr said we cant do any thing
about the numbers? Hi Susan It is clear that you have very severe COPD, with such a low FEV-1. Your numbers speak volumes to your symptoms and having great difficulty breathing, especially with movement. Nevertheless, it is imperative that you find a way to get moving more and keep moving DESPITE the breathing difficulties that moving elicit. That your resting heart rate is 110 and more says that your basic physical condition if very poor. That ADDS to your breathing difficulties and CASN be improved with better conditioning. But, as you well know, it is easier said than done. At the same time, NOTHING else will potentially improve your condition, symptoms and function. So, you must find a way to put your nose to the grindstone and learn to overcome the temptation to stop and or do nothing for fear of the breathing difficulties. It WON'T hurt you to breathe hard. And until and unless you can bring yourself to put up with the breathing difficulties AND keep moving, you cannot expect to have a chance to improve. It's a tall order, I realize. But, it is the ONLY way to a better life. Don't worry about the 145 heart rate unless if causes symptoms in and of itself that become dangerous. Talk to your doctor about that and what you should look for and avoid. Be sure to use PLENTY of oxygen when exercising. ANY drop in your oxygen level (say, below 93 %), will greatly amplify your breathing symptoms. So, as much as is possible, you should try to use enough to keep your saturation as high as possible so as to move as much and as long as possible at a spell. Best Wishes, Mark Pleural Pain
I have COPD. I was admitted to hospital with pneumonia. I was released
Feb. 7. I have completed the antibiotic and prednisone regime I was
prescribed. I take spiriva, advair and singulair for my condition. In
addition, I take zoloft, xalatan, and zopoclone. I am working to get well.
On or about Feb 12, I developed to a pain. It is a nagging pain that is
located in the location of my right breast and goes through to my back. The
pain at times is a catching pain that will cause me to utter out
involuntarily. I attended to my family physician Feb 16. he examined my
chest and said that it was clear, not rattling or wheezing . He believed
that the pain was cause by the pleura that was being disturbed and causing
the pain. When in hospital, I was visited by a respirologist in hospital
and he said I had a lot of damage to my right lung. I have a lot of tests
scheduled in May. Meanwhile, I am wondering if the pain I have now will
gradually subside or could it be something else. Hi Elaine, Your pain sounds pleruitic to me, too. All I can say is that we need to wait for you to complete those tests, as anything at this point would be wild speculation and not helpful with regard to anything you could or should be doing to help or avoid it. Let's see what the tests show. Best Wishes, Mark Spirometry Numbers Definitions
What do FEV1 and FEV5 mean? I notice you people using these
abbreviations and am stumped...is there somewhere I can go to get all this
translated? Someone has most likely already asked this but I am rather new
to the site..... Hi Heather, What you mean rather than FEV"5" is FEV"6". FEV6 is the same value by definition as FVC that you'll find in any set of references using FEV. FEV1 is a forced expiratory maneuver that measures how much air you can blow out with your most maximal effort in the first second of your exhalation, when the measurement maneuver is performed. For a good explanation of all the types of tests done to obtain an assessment of one's pulmonary function, go to the following link and peruse the site. For specific definitions and values of these two and other "spirometry" measurements, click on the link in the "spiromnetry" section that says "main article: Spirometry". This is actually one of those times when of all the references I perused looking for one that is easily understood by a novice and lay person, Wikipedia actually turns out to be better, IMHO. http://en.wikipedia.org/wiki/Pulmonary_function_test Best Wishes, Mark You might also want to try http://copdcanada.ca/pft_numbers.htm The Use of Fans Does a fan help? (Q extracted from the Message Board) And, can a COPD’er in fact breathe in their own CO2 enough when they’re laying/ sleeping (assuming their face isn’t covered with blankets) that it would have a negative effect? It has long been observed that a significant portion of the COPD population shows preference for air blowing at their face or simply circulating the air in the room. Indeed, the worse the person's FEV-1, the more they gravitate to fans as an adjunct (common observation among my professional colleagues and a good observation by the nurse mentioned by a respondent when she was in the hospital). What ever the reason for benefit - reduction of claustrophobic sensations, facial cooling, trigeminal nerve stimulation, etc., the fact remains that despite definitive evidence of source of benefit, the response from those who rely on the method is consistent: "reduction of dyspnea." The notion that CO2 plays a part may have some validity to it but most certainly NOT from any consideration of "stale air", lack of available oxygen or "re-breathing" exhaled air, as suggested by so many of the respondents. One needs to understand the physics and chemistry of air to realize the impossibility of re-breathing under all but some very specific conditions (like breathing into a bag, as has been used over the decades to help thwart panic attacks in those who suffer them from a cause of hyperventilation). The content of CO2 in the air is less than 1 % - virtually negligible, as a CO2 as high as 7.6 mmHg partial pressure would stimulate increased breathing in those with normal lung function (the 1 % threshold at sea level). CO2 levels coming out of the lungs are a little under 6 % with dissipation and, consequently, dissolution occurring in a matter of milliseconds. An example of the rapidity of dissolution is the respondent who was dysgenic in the "aisles of the grocery store, where air volume is monstrous compared to that in a closed car. Yet, when she got closer to the door, her anxiety and dyspnea became noticeably decreased. Yet no difference in available air volume occurred. Then, when she went and sat in the car, her dyspnea went away completely. That had everything to do with a psychological response to claustrophobia and nothing to do with air volume or availability of "fresh air" which necessarily was "LESS" in the car than ANYWHERE in the grocery store. The warm feelings, etc, she experienced when her anxiety level rose in the tall-shelved aisles was a sympathetic nervous response, NOT the result of lack of fresh air to breathe. That scenario exemplifies the strong effect that folks experience that can lead them to the erroneous conclusion that the force was 'real' and 'environmentally mediated', rather than what in fact occurs and is owing to psychological forces and influences. But, unless one had the covers in bed over their head, the chance for re-breathing significant amounts of exhaled air is simply impossible. The high collar sweaters and all, simply do not produce the effect cited by respondants. So, the question becomes: "How can CO2 potentially play a part in the equation?" As one with increasingly lower FEV-1 experiences dyspnea and breathes faster in their effort to overcome it (tachypnea), they tend to move to the phenomenon of "dynamic hyperinflation" which by its mechanical effect causes an increase in CO2 in the blood because of less efficient clearance of CO2 resulting from the dynamic hyperinflation. Saturation can be observed to decrease - not because oxygen levels drop, but because CO2 rises. When CO2 rises, its influence on the acidity of the blood cause saturation to drop from ventilation-related causes, NOT from oxygenation related causes (another example of how saturation measurements do not reflect ONLY the influences of the amount of oxygen in the blood). The abstract is good information and has the best presentation of valid evidence, though difficult to confirm. The contention with regard to the clinical practice guideline cited, that evidence is lacking to make the recommendation for using fans as a therapeutic intervention is just that: There isn't enough evidence to support a scientific basis to make the recommendation. That some like it and some can't stand it makes a case for a hard and fast recommendation unsupportable. So, in the end, the choice needs to be left to the user and justification or explanation left to remain a mystery. It is truly a situation where the adage applies: "If it feels good, DO IT!" |
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February 19, 2012 Unusual Oxygen Saturation Readings
Mark, Hi Lori, I am concerned about your reported symptoms and what measurements you also have been found to have. While a mean of 18 mmHg PA pressure may be normal, the fact that measures of systolic PA pressure are 48 - 50 is nevertheless abnormal and disturbing in themselves - also, especially in view of your elevated heart rate, shortness of breath and possible desaturation on exertion. First, there may be a problem with the quality of measurement when your physiotherapist uses the finger oximetry. You say that your fingers are not moving during the measurements that drop to 83 % and that motion is not a factor. BUT, you are not considering "circulation artifact" which results from the variation in blood flow to (all) your fingers during "gripping" of the treadmill handrail. The pressure exerted during gripping the rail impedes circulation to your fingers by compression of the 'palmer arch' AND digital arteries that branch off that arch. The observation of the alternating signal quality strength light between red and green suggests that circulation artifact may indeed be at play. As well, if your doctor did his/her measurements when you weren't gripping a hand rail, it would be no surprise that the same phenomenon didn't occur, back then. But, since that was a "few years ago", it likely has little, if any, bearing on what's going on today as a lot can change in your condition over a couple of years time. Next time your physiotherapist measures your saturation while you walk on the treadmill, release your grip and let your arm hang at your side. No movement, no gripping, as still as possible. See what happens then. If the signal strength light stays green AND your heart rate goes up AND your saturation goes down, then you need to report that to your doctor, again. With the fluctuations in PA pressures and their being elevated to 50 AND desaturation, tachycardia and tachypnea during exertion that are more than expected, you need to be evaluated further for pulmonary hypertension. AND, if that doesn't appear to be significant, then a diffusion study to see if you have a restrictive lung disorder should be considered and likely done. Another thing that might be worth considering doing during the right heart cath or at least during an echocardiogram would be to inject an IV dose of adenosine to simulate exercise and see it your PA pressures increase to more than 50 and/or your saturation drops with the increased cardiovascular stimulation. Ultimately, I don't think your pulmonary hypertension and lung difficulties have a direct bearing or effect upon the TIA/stroke situation. But, if you are over weight or have diabetes or systemic hypertension, those kinds of things will usually play a part in one's propensity towards cerebral-vascular problems. Consider those points in deciding if you have risk that can be reduced with regard to avoiding future cerebro-vascular incidents. Best Wishes, Mark
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February 12th,
2012 How Does Prednisone Work? Without being too technical….
Let’s say you’re on 50 mg of Pred per day for a week to help reduce inflammation and SOB.
I’m trying to grasp “how/why” Prednisone can increase a person’s FEV1. Is the increase “above” what their “normal” FEV1 is and does that always happen?
I realize it’s a “temporary” increase but how long does the increase usually last once you stop taking it?
Many thanks, J Prerdnisone is an anti-inflammatory medication. As such it reduces swelling in the airways. Less swelling means greater airway lumen. Greater airway lumen means easier air movement with less work. With COPD, the greater airway lumen also means less air-trapping. So, the net effect is an increase in FVC and FEV-1. The effect lasts as long as you are on the prednisone and while it may not hold after ceasing prednisone, some measure of the gain realized during the prednisone regimen "can" be retained. Best . . . Mark Stage IV COPD & Ativan for Anxiety
Good Morning Mark Hi Mitch,
You did just fine explaining your difficulties. While Ativan would not be 'my' favorite choice for anxiety control, it IS effective. It is also habit-forming. So, you suspicions are well-founded as are your concerns. At the same time, many of the anti-depressants/anxiolytics are habit-forming. So, it ends up being kind of a "pick your poison" dilemma. If Fred seems to be using what you fear is becoming an excessive amount of Ativan (look at the prescription to see what he "can take" as a regular amount and maximum), talk with him and especially with the prescribing doctor. If it becomes a significant concern insofar as how much he's requiring, then his doctor can consider other medications with less consequences. Buspirone is a non-addictive anxiolytic. But, it doesn't always work too great for some folks. And in ALL folks, it must be taken for several days to build up a blood level that is effective for the individual. It "can" be taken along with drugs like Ativan which can then be weaned down or phased out once the Buspirone has reached stable effectiveness.
In the meantime, try to work with him to exert conscious effort to control daily anxiety so that his need for medication is minimized. And, be sure he doesn't run out on his inhalers again!
Best Wishes,
Mark
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February 5th,
2012 The Best Place to Live with COPD
I know each person
with copd/emphysema has a different set of symptoms, so a lot depends on
that. However, I'm looking at different areas to possibly relocate to and
there is a lot of conflicting information on the internet. Hi Moe, The question you ask comes up quite often. I'm afraid that I simply don't have an answer for you. That is also why you are finding so much confusing and contradictory information when you search the internet. The fact is, there is no "ideal" location for those with chronic lung disease because their sensitivities vary so much. My usual advice to folks is, it you don't like where you live, pick a few locations where you think you might like to live. Visit those locations for at least a week - preferably during those segments of the year when you might be most sensitive to climatic and seasonal influences that affect folks' breathing and symptoms. If you find a place that seems to strike your fancy, go there a couple of times at different times of year and make sure they are better suited to your needs, as best you can. In any case, I recommend AGAINST jumping and moving without careful investigation an taking what may seem a lot of time (a year or so) to make a better educated decision. Best Wishes, Mark
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January 29th, 2012 Spirometry Results Reviewed
Spirometry test: I
had this test today at work. I took the test twice. First set of results
were FVC 5.90 FEV1 1.97 FEV1% .33 . 2nd set of results were FVC 6.08 FEV1
2.13 FEV1% .35.
Hi Rick,
First, it sounds like you had a ‘screening test’ to identify those who
should be evaluated further for “potential” problems with lung disease. The
veracity of that test you underwent is dependent upon the skill of the
person who conducted it, the integrity of the spirometer they used and its
calibration and the quality of your effort. Missing in your information
that is key for my ability to interpret your numbers is your height. If you
are 6’4” (193 cm) tall, then 223 lbs (101.3Kg) is not bad. But, if you are
5’6” (167.6 cm), then your weight could play a significant role in reducing
your FEV-1. It is your FEV-1 that appears, on first glance, to be
significantly reduced and presenting suggestion that you may have airways
disease of some kind. But, not knowing how tall you are makes such
assessment impossible, from where I sit. As well, that you say you snore is
in itself a worrisome problem and can lead to reactive airways disease among
other problems if indeed a clinically significant problem – like having the
presence of obstructive sleep apnea.
In any case, you SHOULD follow up with your doctor. Have a more controlled and better quality PFT (pulmonary functions test) done that repeats those measurements (3 times, each) after inhaling some bronchodilator medicine. If you produce the same results AND have reversibility, then you have some degree of ‘asthma’ which can likely be treated and controlled. You should also request a sleep study to determine if you have sleep apnea. If you do, then getting that treated and controlled is imperative as it can cause high blood pressure, heart disease, diabetes and obesity, in and of itself!
Best Wishes,
Mark
Condensation when Nebulizing
Dear Mark, Hi Madeline,
Most often, those drops are condensation of the nebulized fluid. Because they are mixed with a lot of air bubbles (too small to see with the naked eye), they make the fluid appear to be white in color. The solution turns white for the same reason. As solution is taken up into the nebulizing mechanisms and “smashed” against the ‘baffle’ to break drops up into minute droplets which can then travel to the depths of your lungs, they fall back into the solution and make it appear to be a white color.
Now, if the solution were to change consistency (become thicker or ‘slimy’) that could be due to mucus flowing back into the nebulizer. While I would say it is unlikely, it’s not impossible.
In any case, the effectiveness of the solution shouldn’t be changed by what you observe. Be sure to clean your nebulizer (rinse with water and air dry) after each treatment and thoroughly wash it at least once a week with soap and water and a disinfecting agent (dilute vinegar or very dilute bleach or commercial disinfecting product made specifically for inhaled medication devices [quaternary ammonia, for instance]).
Best Wishes,
Mark
Hi Mark, Desaturation & Oxygen Needs Hi Philip, No apology needed! I think you’ll likely beat that horse for some time to come as you think of yet new and different – or just different angles of consideration to approach it with questions. And, who knows, there are likely other folks who might be wondering the same things that you wonder about. So, let’s go for it! What you have discovered about PLB is precisely what we say is one of the potential benefits of using the technique. And, you are absolutely correct, when it doesn’t work to improve your oxygen, you are indeed in “a bit of trouble”! At that point, you need to use oxygen to raise your saturation – IF it has dropped to or below qualifying levels. I suspect you are correct in your assessment that you probably don’t need to worry about needing oxygen on a daily or continuous basis for a long time to come. With the desaturation you have reported under ONLY extreme exertional conditions, it may be sooner than you might think. But, I would be surprised if it is any sooner than two years. And even then, it would likely be only for sleep and exercise/exertion where you must get pretty vigorous/intense. Best Regards, Mark COPD - General Information & Understanding Hi Mark,
I have written to you a couple of times now about my mild COPD. I am on Seretide 500 powder inhaler. What type inhaler is this? I was on a purple spray one last year. Does it take a few weeks to get in your system? I am breathing a lot better, now. Was the shock of being told I have mild COPD (that) sent me a bit over the edge as I have never smoked. Am blowing regular 450 on peak flow. Am 56. But, now I have started a treadmill, running about a mile and a half with ease. Can this COPD ever get better, or am I doomed to go downhill? Also, I have Herpes. Been told this gives you flu-like symptoms. Can my spirometry test be wrong? I hear someone got told they had COPD then went for a second opinion which said they never had asthma. I also have been doing breathing exercises, breathing in ‘til I can’t breathe in no more, hold for a second, then breathe out with pursed lips and get every drop of air out my lungs. I feel a bit light-headed at the very end of breathing out. Is this normal? Also, sometimes I sneeze when I do exercises, getting a bit of sputum up. Is this sputum badness out of my lungs getting’ spat out good for your lungs? Do you think there will ever be a cure for COPD or anything to stop it getting worse? With better medication? Also, I was getting over a chest infection when I had spirometry test. I was diagnosed with asthma when I was 21. I had a lot of chest infections. Then I worked out all my life, Karate, weights. I never have too much fatty stuff. I eat fruit. My doctor said don’t worry, we got it in time. Is he just trying to make me feel better. When you tell people they have emphysema, they say, oh that’s bad. My nan died of that. So, you can see my concern. Thanks for your answers. Paul
Hi Paul,
You continue to be very concerned about your possible lung disease, though you don’t seem to appreciate that if you can “run” on the treadmill, especially for a mile and a half, that you are in pretty darned good shape DESPITE your COPD. Now you didn’t say if you ‘actually’ RUN. So, if you are walking very slowly for that mile and a half, that is a different story. If you are doing that mile and a half in less than 30 minutes, then you are walking briskly. If you actually run, then you should be covering that mile and a half in about 10 minutes or less.
Once one had COPD, the NEVER get rid of it. If they take good care of themselves – and it sounds like you are doing just that AND doing it well – then they usually see very little progression of their disease even over many years in the future. So, you should expect to stay in good shape and be able to do most anything you want to do for many years to come. Just because a loved one died from COPD doesn’t mean that you will automatically do the same thing! Many people have mild COPD for the last half of their life and die of OTHER causes, not from the COPD. It seems like you should be able to expect to do the same! So, I don’t think your doctor is just trying to make you feel better and is not telling you the truth. He is right – you SHOULD b e fine for many years to come if you keep doing all the right things.
A cure for COPD is something we all dream about. But, I suspect it is a long way in the future. In the mean time, we need to work hard to prevent it and to treat it with the best tools we have until a cure is found. In ANY case, I would urge you to stop worrying! You should be in good shape for a long time to come!
Best Wishes,
Mark
Exercise Concerns, Longevity and Hope
Hi Mark, Hi Sue, There's ALWAYS hope! That is the one thing you should NOT give up on! Have you been tested for Alpha-1-Antitrypsin-Deficiency Emphysema? You are too young, comparatively speaking to have developed COPD so severe - even with a significant smoking history. So you should ask your doctor to help you get tested. I don't know about Canada, but, here in the USA, it is a "free" test! And it is easy to do, in terms of collecting the necessary specimen. When one has COPD severe enough to cause hypoxia AND they become significantly limited in their level of activity, they get "out of shape", though it might come on slowly and insidiously. When they DO get up and move, beyond their oxygen dropping if not adequately supplemented, their heart rate will expectedly increase in the manner which you describe. That, in itself, is not a problem If you continue to exercise, despite the high heart rate, keeping your exercise "intensity" appropriately low enough not to invoke problematic consequences, yet high enough to allow for conditioning to occur, then you will see that over time, it will come down to much lower levels AND will not jump as high with increasingly more intense exercise. If you are walking too fast on the treadmill or if you have it on ANY incline, it is not surprising that you play out so soon. You should be sticking to a low speed that allows you to go up to 30 minutes, NON-STOP, before increasing the speed. Then you should NOT add any grade until you can walk for at least 30 minutes at a speed of about 3 mph. That may take you months to achieve. It is good that you are getting started in Pulmonary Rehab. Hopefully that will set you on a better path of regaining conditioning and health. I doubt the EKG will show anything that isn't already known. But, you should be getting one annually, if not more often, anyway, as part of your routine health screening. You didn't mention any inhaled medications you use. Hopefully, you are on a combination of inhalers that fits your very low FEV1 (17 %). At that low a level, you are in serious shape, but, again, NOT without hope to improve a LOT. Is lung transplant something you would consider - or available as an option for you? In the end, no one can say that you will or will not see 60. There is much you can do that you are on track to get under way. That and time will tell. Work on living - NOT on avoiding dying! Best wishes, Mark |
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January 22nd, 2012 Quitting Smoking & Will the Numbers Improve
Hello, Hi Sandra, Yes, you ARE in the "mild" range of COPD. Congrats on quitting smoking! Don't expect much change in your FEV1 - at least not this soon - if any change will be forthcoming. At 78 % you are still very high in pulmonary mechanics and shouldn't have any significant symptoms from your COPD. Over time, you should notice even better breathing. Keep active! Eat healthy! Get plenty of rest for your needs. And you should be in great shape for a long time to come! Best Wishes, Mark What is Atrovent? What is Atrovent
hfa Spray q i d Wht is it for ? Atrovent is one of the two primarily administered "bronchodilator" medications. They relax your bronchial tubes and improve your ability to move air into and out from your lungs with less work. It is from the class of medications called "anticholinergics". Atrovent is usually paired with another complimentary - but different-acting - bronchodilator from the "beta-agonist" class. Each does what it does through a different mechanism or "pathway". So, one is not necessarily a 'replacement' or 'substitute' for the other. But, together they work better than each one can alone to produce an overall improvement in your breathing. The most common beta agonist used/prescribed is 'albuterol'. You may likely be prescribed BOTH medications to be taken close together for best effect. Best Regards, Mark Low Iron, Tight Chest Hi Mark; I wrote
to you a week ago about my mild copd. This week my chest was a bit
tight and I have
been having panic attacks thinking about it. I don't want to be on
oxygen in
a wheelchair; cant stop thinking about it. I went to the
hospital on Saturday because my
chest was tight, had x-ray, came up clear. Had blood tests said my
iron count
was 9 and a bit should be 13 in a man. I was diagnosed as a anemic last
year my
count was a 7; felt terrible couldn't really work or do much with out
getting
tired. I went on iron tablets in August and they worked; felt good, doc said
come of them and I did but when I had a blood test in the hospital it was a 9 so
I am losing iron. Also I was told I had a hiatus hernia. I use to get heart burn;
don't get it much now but hospital said its probably my worrying about copd
that's making my chest tight. It's not too bad this week; after
x-ray was clear. I got copd mild; never smoked. Can my working as a tree surgeon caused it
with the pollen as I did have asthma when I started job. Was in job for 20
year; s just want to breath easy. Also I blow 450 to 500 on meter
blower may b 400 when I get up when my chest is easy and clear I blow a 500
am 56 years old, always watched what I eat, and work out with weights. Could it
b because my iron is low that I am chesty? Hi Paul,
No one can tell you "why" you develop COPD when you are not a
smoker. Most likely, 'we believe' it is related to heredity and triggered
by histories like you seem to have - your asthma and working with the trees,
though they likely are not the source of a significant factor or problem any
more than having had asthma for some years. BUT, with the peak flows you
report, you don't seem to have any 'clinically significant' affect from it -
500 ml being an excellent peak flow. Even 400 is very good! Asthmatics
who have problems are down around 250 and less! You should actually be most concerned about your iron deficiency and get that corrected. It is of much more immediate concern than ANY concern you have about lung disease. And it can do more to make you feel bad - AND contribute to any difficulty breathing and/or chest tightness you are feeling! Realize that iron carries oxygen in our body. If your body senses that it is not getting enough oxygen, it will signal to you to do more work to bring in more oxygen. THAT more than any COPD you might have can be the cause of any breathing symptoms you now have, including the tight chest, though worry and panic can easily play a big part, too. Above all, keep foremost in your mind the fact that folks with half the lung function you have - who have MUCH MORE advanced lung disease/COPD than you now have or are likely to progress to in the next MANY years - are able to be VERY active, don't yet require oxygen and are far from needing a wheelchair. You need to read more about the disease to learn where your fears can be misplaced. Until folks' FV-1 drops to less than 30 % of what it should normally be - a LONG time off in your future - they don't have limitations that present significant difficulties in their lives. If you live each day worrying about what is predictably many years - even decades - off in the future, you will miss so much of living and everything that is good in life. Don't WASTE your life living like that! You likely don't have enough lung disease to worry about what you are spending lots of time and emotion worrying about NOW. You may likely NEVER reach a point where COPD becomes a primary ailment and limitation in your life. As I said in an earlier response, STAY ACTIVE! Eat well and get the rest you need - and QUIT WORRYING - and you'll live a long and happy life without problems with lung disease! If you have a little bit of asthma along the way, keep it controlled and at bay and you shouldn't have any significant difficulties. Best Wishes, Mark Can a Person Tell if They're Retaining CO2? Assuming a person isn’t a usual retainer, Is there any way for a patient to know, or tell that they’re starting to retain CO2. (Not as an on-going issue but something that can crop up) If there is a way to tell, is there anything a person can do to minimize or avert it? Thanks Scott Hi Scott, The only way to know if you retain CO2 is to directly measure it. That can be done with a device that measure the air you exhale. It measures how much CO2 is in your exhaled gas at the END of your exhalation. A blood gas is an "invasive" but the most accurate means to measure your CO2. Not unless other clinical information suggests that you 'might' be at risk for CO2-retention, would we/I recommend getting one done. Folks rarely begin retaining CO2 before their FEV1 drops below 30 % of predicted. Even then, many don't begin retaining until it drops progressively below 20 % of predicted. If one develops pulmonary hypertension, their tendency to retain CO2 will be enhanced at the high FEV-1's, but, still most often below the 30 % line. CO2-retention doesn't "crop up" as a usual and/or 'short-lived' problem. In advanced COPD it is a response/result of the physical damage to the lungs that results in chronic hyperinflation, as we see it in advanced emphysema. So, you are thinking off the mark if you think that you can develop it as a short-lived or passing ailment. Once there, it is there for the duration. There is NOTHING you can do to "avert it" or "prevent it" or "minimize it" or "make it go away", once it's there. CO2 can "acutely" increase because of sudden respiratory compromise. That is an emergency and it is obvious that those who experiences it are very ill and in trouble. We call that occurrence "Acute Respiratory Failure" and jump on with rapid intervention to resolve it. That is not something you should spend time worrying about as it is rare. Again, the only way to "know" that you retain CO2 is to measure it. You should NOT worry if you might be entering the realm of chronic CO2-retention until and unless your lung disease is WELL-advanced and you are struggling to do simple daily activities. Even when CO2-retention DOES occur, it is not a problem that needs resolution! It is actually a 'positive' adjustment that the body makes to contend with the poor ventilation that goes with well-advanced COPD. Once there, to try to make it go away or be less would actually mess up bodily functions rather than provide any positive effect or improvement. Best Wishes, Mark
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January 15th, 2012 COPD or a Fungal Infection
My father came in contact with some serious fungus
two years ago while helping a friend clean out the basement of a flooded
cottage. Doctors won't acknowledge or entertain the fact that it's a fungus
in the lungs and sinuses they keep saying and treating him like he has
asthma or COPD. I have read many things and he has become his own doctor
for approx.2 years now. He has been in and out of hospitals half a dozen
times due to not being able to breathe. Doctors fill him up with
Prednisone, Antibiotics and symbicort or Advair. He had severe allergic
reactions to symbicort and advair while in hospital so Doctors finally
realized these two medications could not be used to assist him in his
breathing. The breathing difficulty subsides after approx.two weeks stay in
the hospital because the prednisone and antibiotics are only suppressing the
symptoms (which are asthma like) of the fungus. I have read many forums and
all the people discussing their symptoms are exactly like my
Father...sinuses fill up with mucous, nose drips clear liquid, lungs fill up
with mucous, when he is able to clear his lungs, it's clear, frothy mucous
that's being expelled occasionally with little "fungus plug like
substances". He even went as far as purchasing his own monitor to track his
oxygen level and heart rate. This week, he is fighting for breath, oxygen
level staying mid to low 80's up to 90 or 91. He is petrified to go back to
the hospital because they just want to fill him up with drugs to cover up
the symptoms and get him home. He has limited his diet extremely, no
sugars, anti fungal products galore, he is doing everything possible as I
said he has researched a lot and has become his own "doctor". I am at a
loss! We don't know what to do...my Father has asked me to type up his Will
and Power of Attorney to prepare for the worst. My Father feels that if he
had oxygen at home, he might be able to fight this fungus naturally, (oxygen
gives him the strength to expel the mucous) but no Doctor will agree to
prescribe oxygen Hi Cindy, I'm sorry to read of your father's difficulties and frustrations. But, my first impression is that he is on the wrong track with his insistence that he is suffering from a fungus. While I can't say one way or another, from where I sit, that he "doesn't" suffer from a long-term fungal infection, I 'can' say that from a clinical standpoint that the likelihood is remote, at best. Had it been a fungal infection, evidence more than what you have related - and much more meaningful - would long ago have become apparent. Much of his problems can be argued to result from a combination of his rejection of appropriate treatment for his breathing difficulties and - perhaps even more so - from self-treatment with substances that can easily be worsening, if not outright causing his symptoms. I am very curious to know what his "severer allergic reactions" were to Advair and Symbicort. Can you describe them more specifically for me? I am further suspicious of the potential for a fungus to be at fault since prednisone suppresses immunity such that fungi and other opportunistic pathogens have an "easier" time causing symptoms. Were the prednisone simply temporarily suppressing any fungal influences, they should come back with a vengeance within 72 hours after his last dose at the hospital. Then again, if he takes long-term/maintenance prednisone, his symptoms could (and should) be continually suppressed, so the notion of a fungal infection - especially lasting this long without being more readily detectable by now - is highly unlikely. The worst part of his situation is that by rejecting the assessment and interventions of the medical team he is entrusted to AND by self-medicating with all manner of anti-fungal supplements, he is fostering the more rapid worsening of his COPD. If he is truly observing desaturation with his pulse oximeter, he should take it with him to the doctor and demonstrate his observations. You don't say if he has had pulmonary functions tests or what any of his measurements might be. So I have no 'objective' information upon which to determine where he is in his lung disease process. Oxygen, or use of oxygen will lend "NO" 'specific' assistance to fighting a fungal infection - naturally or otherwise. His thoughts on that are misplaced. BUT, with the desaturation you describe, it suggests he is in an advanced state of his COPD and would definitely benefit both from a health and a functional standpoint, from the use of oxygen. In most locations in Canada, the requirements for needing supplemental oxygen are the same as here in the US. By those means, he seems to qualify without question. So, push for it - and push HARD! That is about all I can tell you at this point. There is one other test that 'might' settle the question of the presence of fungus. If he has not had his sputum 'cultured' for the presence of fungal organisms, that is a simple enough test to do and won't break the health care system bank. If he has suspicious or inconclusive results, a bronchoscopy to obtain deeper-residing specimens can often provide the definitive answer. You might ask his doctor about those two possibilities. In any case, you simply CANNOT say that you are seeing "fungus plug-like substances" in expelled secretions. Mucus plugs are mucus plugs, regardless of contents or origin. There is nothing beyond specific colours or odors that can indicate the presence of one kind of bacteria or another. And those colours and odors are VERY specific to each pathogen that produces or emits them. I fear that his rejection of qualified medical assessment and opinions and insistence upon his problem being a fungal infection AND the rejection of interventions that can certainly provide significant benefit in favor of those his is concocting from his lay resources are both responsible for his rocky course (several exacerbations and admissions) over these past two years AND his inability to get satisfactory collaboration from his medical professionals. At some point, they too become frustrated and take on an attitude of "What's the use? He won't listen to what we have to say or suggest." Perhaps you all need to sit down together and sort out all the questions, suspicions and frustrations that are interfering with your ability to find effective relief and improvement in his condition. Otherwise, I fear that sadly, you may be giving attention to his will sooner than is necessary. Please step back and give thought to the possibility that he is wrong and that his medical team have a better idea of what is going on and what should be done. But, also push for oxygen in the meantime, as I described. Best Wishes, Mark How Bad is my COPD? Hi
Mark; I live in the uk am a very
young 56 kept in shape all my life when I left school at 15 worked at a car
components grinding the left over asbestos of the car brake shoe to glue a
new one on no mask on was only in the job 1 week was not doing the grinding
of shoes all day just now and again then in 1977 started work as a tree
surgeon and developed a cold that lasted 4 a year had breathing problems was
told I had asthma I have never smoked done this job 4 20 years then after
that got finished up done a bit of car spraying on off as hobby was on
ventolin inhalers then in sep this year had breathing teats done in my local
hospital test said I have mild copd am very worried thinking am going to die
soon I have been around smokers 4 years passive do u think the asbestos has
caused this or passive smoking I am on a powdered inhaler now they r very
good keep my lungs easy to breath I can walk up 10 floors my legs do get bit
tired round the 6 floor when I get to the tenth floor my lungs sort of burn
will I get all the stages of copd then die at the last stage I feel ok on
the inhalers my doc says I don't have asthma now but mild copd and not to
worry Hi Paul, I suspect that you are worrying way too much about the disease and your future, as well as a lot of things in your past that have little if anything to do with any COPD you might now have or the course you can expect it to take in many years of your future. The simple fact that you can climb those many flights of stairs tells me that ANY lung disease you may 'now' have is not "clinically significant"> Your asbestos exposure was not enough to present concern for that type of lung disease. Your other activities - including exposure to second hand smoke - are not significant enough to play a meaningful role in development of "problematic COPD" or other lung disease. My bet is that you have a better chance of meeting your demise in any number of other accidental ways LONG before you'll succumb to lung disease. Just keep active and as vigorous as you are now and I'll look forward to reading your posts to COPD-Canada 20, 30 and more years down the road - that is IF "I" can still read and pay attention! Best Wishes, Mark Follow Up From Last Week (January 8th Q's & A's) First of all thank you so much for answering my previous questions.
Susan
Hi Mark, Hi Susan, I'm going to respond to this question and the one that follows since they were apparently duplicate posts from you, sent at different times, this one with more detailed information. Your PA is correct that the HbgCO you reported should not be responsible for your complaints. It's GREAT that you have quit smoking. THAT should go far towards allowing your CO levels to return to normal for a non-smoker. Have you considered that it is a frequent response for someone to experience symptoms of depression when quitting smoking? One of the advantages of Welbutrin and Chantix are their anti-depressive action which helps combat the problem when quitting tobacco consumption. Your complaints are suspicious for mild depression, though I can only offer that as a possibility and speculation from where I sit. While it seems that your doctor wants only to address your pulmonary problems - and seems to be addressing them in a reasonable manner as best I can ascertain, perhaps you should see a cardiologist for an EKG, if you are concerned there might be a cardiac problem - and in view of your MVP problem. It is possible you have reached a point in your life when you need a medication to assist in correction of difficulties that might be developing in relation to that problem. It wouldn't hurt to rule it out, anyway, even if all it does is set your mind better at ease. It is possible you are overly concerned about your condition at this point. Yet, if there is something going on that needs attention, you would do well to learn that sooner than later, too. Think about seeking further opinion from others. Best Wishes, Mark As COPD Progresses, is Oxygen Inevitable?
Hi Mark. As always, thanks for all your help, and my personal best to you and your family Philip Hi Philip, While we have had the "no two cases are alike" discussion before - in which I have contended that while there may be individual quirks much of the time, the pattern and progression, as well as the symptoms and defects have MUCH in common among individuals, the notion of the condition "exactly alike" does not speak much to the issue as a whole. The answer to your question about the inevitability of need for supplemental oxygen therapy is essentially: "Yes." Most all folks whose COPD continues to advance to the more severe side of the disease end up requiring supplemental oxygen therapy. You, yourself, might be in need of it down the line as evidenced by your mild, but nevertheless persistent decreases in oxygen. All you can do is do your best to stay in the best shape and pay close attention to optimizing your lifestyle to keep progression on a slow pace. Who knows, you might even succumb to something else - many years down the road - and long before you reach a point of needing LTOT. That would be my hope for you, any way! Best wishes, Mark Lung Scarring
Hi , my husband was told my the specialist that he
has some old scars in his lungs and if she were to write a diagnosis it
would be pulmonary fibrosis. My husband is 33 years old... He was never
exposed to anything and was never a smoker. He doesn't have any symptoms and
has normal pulmonary function test. I am wondering if you can help. Hi Dahlia, I would go out on a limb, based upon what you have told me, and say that your young hubby has nothing to worry about with regard to lung disease. Folks are often found to have scarring in their lungs that plays no part in their health picture. If he feels fine and has normal pulmonary function, then that should be all you need to know to feel confident that he is OK and has a bright future in terms of lung function. You didn't say why or how the finding of the scarring came about. So, I don't know if he was having problems that resulted in the test being done that found the scarring. But, if it was an incidental finding, then he should chalk it up to just that - an incidental finding. If his follow-up in 6 months finds nothing new or of concern, and he continues to be without symptoms of concern, then I would think that further interval follow-up should not require more than a look at him and maybe an x-ray every several years. Best wishes, Mark
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January 8th, 2012 Exercise (Treadmill) Goal and Oxygen Question
Hi Mark.....This is
my first time to ask a question so I should give some background.....I was
diagnosed with COPD in 2000 and was able to do most hings in my life for
quite a few years....in the past couple of years though my life has become
more restricted.....I use Spiriva and Advair and also take recently turned
it up to 3l.....I now live in an area where there is no respiratory
therapist so have a question... I walk on the treadmill at a pace of 2mph
for 30 minutes a day....usually....I find if the air pressure is low I
struggle to do 20 or 25 minutes.....I am wondering if I should strive to go
further faster and what should my goal be? I should add that I am 71 years
old.....please let me know if you have ideas.. Thank you! and Happy New
year!! Hi Heather, You are doing well and on the right track to maximize what lung function you retain. Indeed, you should strive to go further faster. If 30 minutes is going to be your choice of maximum duration, you should work to increase toward 3 - 3.5 mph. Ad 'interval' walking at some point, wherein you jump the speed be 0.5 - 0.7 mph - abruptly - and maintain the increased speed until you become as winded as you can stand. sustain that windedness for a minute or two at which point you will drop the speed - again, abruptly - back to the lower level to 'recover' while continuing to walk - RATHER THAN stopping, altogether to rest. You may have to drop your lower speed in order to maximize the approach. So, say, for instance, you start at 2.0 mph and jump to 2.7 for your fast interval. The drop back to 2.0 for recovery. It will seem slower when you drop back down to it - a good thing, as you want to keep moving while allowing yourself to regain more comfortable breathing. As you do that more and more, you will see your fast interval increase. When you get to where your fast interval is 20 of the 30 minutes (approximately) increase both speeds and work to increase the fast interval. Over time (perhaps as much as a couple of months, you will see your overall speed increase to where maybe, 2.8 is your low speed, while 3.5 is your fast speed. At that point, you can maintain those speed differences and add o1 or 2 % grade for the fast intervals, dropping the grade back to 0 for the recovery periods. The most important factor in the mix will be to maintain the best oxygenation you can during your walking exercise. You say you now use 3 L. You may find you need 5 liters for exercise and to stay above 90 % saturation. Be sure you have enough oxygen to supply your needs AND monitor your oxygen saturation with a personal oximeter. If you don't currently have one, you can get a good one for $100 or a bit less. Check out the Nonin line of oximeters Look them up on-line) (I have no financial interest in Nonin. I just think it's about the best available.) Let us know how you do over time. Best Wishes, Mark (Note: You can also purchase a finger pulse oximeter from FaCT Canada in British Columbia starting at $59.95 if you're a COPD Canada Patient Network Member. This also includes the carrying case and free shipping Finger Pulse Oximeters) Lung Volume Increase Question(s)
Hi Mark, I had
childhood allergies and Asthma. Nothing really significant that I didn't
live with. I worked a as a Firefighter of 30 years and retired 2 and 1/2
years ago. One of the reasons I retired is because I couldn't t do the
physical demands anymore. my breathing was getting worse and I had a few
scary moments. I took in a lot of smoke over the years. I never smoked
cigarettes. I see a Pulmonologists every 6months. My AM regimen is Spiriva,
Advair, 1 81 mg aspirin, and 1 , 10 mg Loretadine, with about 16 ounces of
water. I'm on 2 lpm of oxygen at night time for sleep hypoxia. Obviously I
have COPD. my blood work has been good. I stay active as I can. Sometimes I
have to work every breath to keep breathing. I use albuterol 2 or 3 x's a
month as needed. I use a nebulizer every few months or so as needed. My PFT
says I have the lungs of an 80 year old. OH yea, I'm 58 years old. I use a
Netty pot every am with a baking soda and canning salt solution to cleanse
my sinuses. I gat a bad cold and or flu every year at least a couple of
times that require antibiotics. My PFT 2'xs ago showed that I lost 700 cc's
of lung volume, however through hard work, and following my orders I gained
back 200 cc's of volume. My question is there anything I' missing? Can I
increase my lung volume through any specific exercises . How about breathing
exercises. Are there any food supplements or herbs that are recommended?
Thank You Bill Hi Bill, There is nothing you can do to increase your lung volumes, per se. They will fluctuate up and down in accordance with your exacerbations (colds, bronchitis events, etc). Walking exercise is very good to maintain your best pulmonary function within the limitations you now have. You are a tough guy as exemplified by the difficulty breathing that your report during activity. While it's not fun or comfortable to sustain hard breathing work, if is a MUST to survive and thrive. AND, breathing hard, while it may 'seem' like it will 'do you in' is not a bad thing and WON'T hurt you AS LONG AS your oxygen saturation is > or = 90 % during those periods of activity. So, if you don't have an oximeter, it would be a great idea to purchase one. I have recommended Nonin as a source for a choice of several that are very good. See my response to Heather for more information. Staying on top of your condition - with attention to exacerbations as soon as possible is a must for continued good management of your disease. You are a young guy, at 58, to have such severe COPD. But, with your fire-fighter history, it unfortunately, is no great surprise. It is sad that you suffer these consequences for your many years of saving lives and property. I hope your community is appropriately appreciative and supportive of your sacrifice! Many folks are finding additional benefit from adding NAC (N-Acetyl Cysteine) to their medication regimen. It has anti-inflammatory and mucus thinning benefit. It can be purchased over the counter and should be taken 1200 mg once a day, up to 2400 mg (1200 mg, twice a day) during bouts of bronchitis and colds) Taks an addition 1000 - 2000 mg of vitamin C with the NAC which helps thwart the formation of kidney stones in some folks who take NAC (very rare occurrence/complication). Other than those suggestions, the key to survival and staying in the best shape possible is to KEEP MOVING! Exercise is of critical importance. With that, adequate oxygenations a must to prevent damage to your heart over time. You now use oxygen at night for sleep hypoxia. I would wager that if you desaturate during sleep, you also desaturate with exertion. And it may not take much exertion to produce dangerous drops in your oxygen level. So, be sure to check out that factor as soon as possible so you can address and correct it as soon as possible, too. Best Wishes, Mark Breathing Test Explanations & COPD Understanding (2 parts) I was diagnosed with severe COPD/Emphysema in October of this year. On my 1st pulmonary doctor visit on December 8th, 2011, my ABG's were :pH 7.49, PCO2 36.0, PO2 79.0, HCO3 27.2, BE 4.2, Hb 13.7, SaO2 97.5, HbCO 6.9. FIO2 21.00. I was diagnosed with Acute Pleurisy & Chronic Bronchitis, Dyspnea, COPD w/ALE (don't know what ALE means), COPD severe, Emphysema, nicotine addiction, cigarette abuse. The physician stated that I was to return on the following Monday (5 days later) & if HbCO values remained the same he would admit me to the hospital. He started me on Bactrin DS BID, Prednisone 40 mg 4 x day, Tessalone Pearls PRN, Musinex BID, hold Advair and use DuoNebs QID, continue with Xanax and Trazadone..
Hi Mark, Answer to part 1 - Susan, I hope you have quit smoking. The CO will remain elevated in folks who continue to smoke. The only other cause of chronically elevated CO is exposure to heavy traffic, as in the city where lots of care exhaust is breathed in, or in jobs where CO is infused into the air from combustion or other chemical reactions that emit CO. Your blood gas actually shows modest "hyperventilation", often seen with various lung disease conditions and in response to low oxygen. But, your oxygen level isn't significantly decreased to explain why that phenomenon is occurring in you. Yet, if you are continuing to smoke, it could be from your body's response to the elevated CO. In any case, the 8.2 CO and the question of continued tobacco use remain a question for me as you didn't include that in your information. I don't know what the ALE means, either, unless it's your doctor's abbreviation for "Acute Lung Exacerbation". Ask him what it means. I don't think your necessarily need a second opinion. You need to know from your doctor what you should be doing to reduce your symptoms and improve your health and function within the limitations you cannot change. If you are not confident with your current doctor's care or skills, that would be an indication to seek a second opinion. But, you didn't allude to any concerns of that type. So, it is up to you to decide. Even then, you need to have a specific objective in seeking another assessment and opinion. If you don't fully know what your current doctor wants you to do, then another doctor won't be in any better position to second guess the first one. Part 2 answer - Your PFT's show a combination of obstructive (COPD) and possibly restrictive elements to your lung disease. Your ability to diffuse oxygen is reduced at 33 % which, when combined with the elevated CO adds up to explain your low paCO2 on your blood gas. It doesn't help much with advising you on what to do. Again, the question still hangs about the tobacco use and the cause for the 8.2 CO level. Answer that and we may have better direction to go in terms of advice. Best Wishes, Mark
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Archived (Alphabetically Arranged) Questions & Answers for 2011, Mark Mangus, BSRC, RRT, RPFT, FAARC
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