AI and O2 sats all over the map

[Der Biermeister]

I've posted a lot on here in the last couple of months about my AI condition.

I recently purchased a fingertip pulse oximeter so that I can benchmark my oxygen saturation percentages at various activities. I used it this morning while heading to a meeting place to go for a motorcycle ride with 3 other friends. Like a trial run yesterday, I felt ok riding, mostly because of the airflow around my face, etc. However, I was shocked to learn that my SpO2 percentage was in the mid-80s (as most of you know, normal is mid-90s). Just like a person with COPD much of being comfortable has to do with lung position, etc. If I am leaning forward and over some, my SpO2 can get up to 95%. Laying back in an easy chair puts it below 90. So .... the position I sit on my bike has now proven to be detrimental to good blood oxygenation.

I got to the meeting place and told my friends to escort me home. I am not going to screw around with this - especially riding a mc. SpO2 levels in the mid-80s could (I believe) cause me to pass out, especially if I tried to ride any long distance. So, I've taken what is probably my last ride for the rest of the year.

On the bright side - and like I recently posted, I've lost a ton of weight already, and with new meds, my bp readings would make a teenager jealous. Maybe - just maybe -- all this will start to gel for me soon and my SpO2 levels will begin to climb. (My cardio holds out hope). If not, surgery probably in November.

Let's just say, this has not been the best of summers or fall. I had to give up sailing two months ago because of this, and now the bike - just at the beginning of my favorite time of the year. But I know I am preaching to the choir. I am just a bit down tonight.

One question though about an AVR. Assuming a successful surgery, and of course assuming this all has been caught in time, will my O2 percentages really get back to normal?

DB

 

[RCB]

I would have the meter checked. If your levels fell to Mid 80s, my guess would be you wouldn't need a meter to tell you that.

After the surgery you should absolutely expect your levels to go up, barring any post-surgical complications.

Good job on the weight loss

 

[Nancy]

I'm going to say yes to you DB. Joe, with all his terrible problems including both lung and heart, has an oxygen level in the mid 90s, with room air.

But your doctor really has to look into your potential PH and address that. That alone could lower your sats.

Watch your CHF too, and keep it well under control.

 

[Der Biermeister]

I'm going to say yes to you DB. Joe, with all his terrible problems including both lung and heart, has an oxygen level in the mid 90s, with room air.

But your doctor really has to look into your potential PH and address that. That alone could lower your sats.

Watch your CHF too, and keep it well under control.

Hi Nancy - I've moved up my 2nd echo to be done in 10 days. Then a week or so later I see my cardio.

I will be asking for a copy of the report from the Pulmonary specialist. Which means I want to focus still on the PH, especially that the Pulmonary doc told me it was "secondary". He based that on this back-pressure of 30 that was discovered during the cath.

This time, the echo is being done at the doctor's office. (They are a large cardio group). Just curious, but will they focus more on the troubled areas this time, or do they just go through a standard sequence?

 

[CCRN]

o2 sat

o2 sat

I would have the meter checked. If your levels fell to Mid 80s, my guess would be you wouldn't need a meter to tell you that.

After the surgery you should absolutely expect your levels to go up, barring any post-surgical complications.

Good job on the weight loss

I agree. If you were walking around with saO2 in the low 80s you would be feeling it. Most people with healthy lungs and no other problems have an O2 sat of 96-98. If your fingers are cold those things don't always read right.

 

[BAV Pt's daughter]

I agree. If you were walking around with saO2 in the low 80s you would be feeling it. Most people with healthy lungs and no other problems have an O2 sat of 96-98. If your fingers are cold those things don't always read right.

Meters do not respond to cold, clammy extremeties. They also tend to be picky about fingernail polish (not that you were wearing any ) You can use fingers, toes, or your ears. If ever you get a freaky reading, try once or twice more, always in a different location before you freak out. Try taking it to the doc's office first and have them check it against theirs. Maybe it needs to be recalibrated. If you just got it, just send it on back if its not reading accurately, but check it against another one first, and always double check your own reading against another site first.

 

[Mary]

DB,
My respiratory therapist husband has a few thoughts about your readings. He suggest checking your oximeter pulse reading with what you get if you do it yourself. If the two readings differ, then the pulse oximeter is probably faulty.

His other thought is that a motorcycle is a poor place to be trying to get an O2 sat reading. If you're gripping the motorcycle handles, the blood flow is decreased and you won't get an accurate percentage. In addition, even the shaking of the motorcycle can throw off the accuracy.

The good news is he doesn't think the problem originates with your riding the motorcycle; the problem is trying to use your pulse oximeter while riding.

 

[Ross]

When I drop to 87-86, I feel almost panicky to get back to my O2 line. At 84 I am panicking.

 

[Der Biermeister]

DB,
My respiratory therapist husband has a few thoughts about your readings. He suggest checking your oximeter pulse reading with what you get if you do it yourself. If the two readings differ, then the pulse oximeter is probably faulty.

His other thought is that a motorcycle is a poor place to be trying to get an O2 sat reading. If you're gripping the motorcycle handles, the blood flow is decreased and you won't get an accurate percentage. In addition, even the shaking of the motorcycle can throw off the accuracy.

The good news is he doesn't think the problem originates with your riding the motorcycle; the problem is trying to use your pulse oximeter while riding.

Thanks Mary
Some new info - I've just heard from my sleep doc yesterday regarding the sleep study done two weeks ago. My normal CPAP pressure is doing ok with apneas, but I am now also diagnosed with Hypoventilation. I can't believe this, but my de-sats were dropping into the 60s during the study and that was with 2 liters of O2. With my weight - this appears to be what is called Obesity Hypoventilation Syndrome, however I have recently lost 24 lbs in the last 2 months (down to 273) and I would think stuff like that would be improving. (I am studily losing on a low sodium/low fat diet, and my goal is another 50 lbs). What bothers me a lot is that when I was in the hospital 2 months ago (and of course weighed 24 lbs heavier), they also checked my de-sats during the night when I was using my own CPAP and mask. I was on 1 liter of O2 and my de-sats sometimes went below 90 but nothing like the 60s the sleep lab got. Anyway, I tend to believe the sleep doc because I feel so rotten and just have zero energy or exercise capability. With de-sats that low, it is a vicious circle, and of course dangerous, with all my organs and plays havoc with my bp, which I need to get down to help with my Pulmonary Hypertension.

My sleep doc upped my O2 last night to 4 liters going into my CPAP. I slept pretty good, but of course have no idea what my de-sats were.

My sleep doc contacted my cardiologist today and he wants to see me tomorrow morning. So .... things are happening.
DB

 

[Nancy]

DB-

Reducing your overall bloodpressure will help a little with the PH, but it will not eliminate the PH, even if your BP is normal. PH and body BP are two different things.

 

[Der Biermeister]

DB-

Reducing your overall bloodpressure will help a little with the PH, but it will not eliminate the PH, even if your BP is normal. PH and body BP are two different things.

Nancy -- things are moving quite fast now. Since I saw the pulmonary expert and also got results back from the sleep lab - and both checked in with my cardiologist - he had me come in yesterday for a visit. And this is what they are zeroing in on.

My Hypoventilation, that was just discovered in the sleep study is related to the AI - as us just about everything else. I have a lot of leg edema during the day and of course severe dypsnea -- all pointing towards CHF. The only difference is that my heart itself is in pretty good shape (or it was two months ago). So the AI and its back-pressure is loading up fluids behind my lungs and into my legs and also resulting in the "mild" pulmonary hypertension.

My cardiologist decided to cancel the regular echocardiogram next Wed and instead I will be having a TEE. So, I am going to know a lot more after that is done. Do I need to worry that this procedure is going to hurt or make me gag?

Not sure if I mentioned this ... but the recent results of my sleep study showed me with Hypoventilation - my de-sats going down into the 60s at night. Which of course is not unlike what happens with sleep apnea. My normal pressure setting was ok at 12 and apneas were very few, but the Hypoventilation still prevailed. They even tried switching to bi-PAP, which did nothing. So ... at home here, my sleep doc has increased my O2 from 2.5 liters up to 4 liters going into my CPAP. I have to say ... after 3 nights of this, I am sleeping MUCH better and actually have a bit more energy during the day.
DB

 

[Nancy]

Joe has had many TEEs. They have been OK, with the exception of one which was being done by a rookie. That guy didn't use enough numbing stuff or twilight stuff, messed around way too long until what he did give Joe wore off, and it was a disaster.

Joe doesn't complain about anything, but he did with this one. And I'm quite sure he had some throat damage as a result.

So-o-o my mantra to you is to ask if the guy doing the procedure has done many, and if he would please put you as far out as he can and still do the procedure, and tell him to use enough numbing stuff.

The experts can get the whole thing done easily and fast. The rookies-well--don't let them practice on you.

 

[Der Biermeister]

Joe has had many TEEs. They have been OK, with the exception of one which was being done by a rookie. That guy didn't use enough numbing stuff or twilight stuff, messed around way too long until what he did give Joe wore off, and it was a disaster.

Joe doesn't complain about anything, but he did with this one. And I'm quite sure he had some throat damage as a result.

So-o-o my mantra to you is to ask if the guy doing the procedure has done many, and if he would please put you as far out as he can and still do the procedure, and tell him to use enough numbing stuff.

The experts can get the whole thing done easily and fast. The rookies-well--don't let them practice on you.

will do - thanks

 

[Der Biermeister]

I've turned the corner.

Since they diagnosed this Hypoventilation, I've been on increased O2 at night and getting GREAT sleep -- 3 nights of 7 hours, and last night 8 hours.
With the added diuretic he gave me, I lost 6 lbs of fluids yesterday. Needless to say, I could really tell that I was breathing much better yesterday AND had more strength and energy. So, other than having to stay close to the head for most of the day, I am feeling like a human being for the first time in a long time. Quite remarkable to be able to breath and simply not have to think about it.

Still going in for my TEE on Wed. That will give me my long-term outlook on what's going to happen. Anyway - it's been a good two weeks for me, starting with finding out I did NOT have any pulmonary fibrosis.
DB