Anxiety Issues

[deboz]

Hi All, as those of you that have read my previous posts will know my dad had an avr and a single bypass and he is now two weeks post op. He was recovering at an amazing pace and off the vent by 24hrs, which considering his empyhsema was a great surprise. He returned home last Saturday and said he was felling great, no pain at all and had even started eating well and walking. But unfortunately four days ago that all fell in a big heap. By Wednesday he was having great trouble breathing and had to call for an ambulance. It turns out that he has contracted a chest infection and this will now set him back terribly. He has been admitted to hospital and he is taking that much medication he rattles He has been on a Bipap machine and is on an oxygen humidifier Due to the infection his heart started to beat irregular, but that appears to be under control now and is sitting on a comfortable 76 bpm when resting, an echo has shown that the new valve and all surrounding areas are peforming well. But what my question here is that he has developed the worst anxiety i have ever seen, when he is really short of breath and has real difficulty breathing, he becomes very anxious, stating that he cant get any air and he is dying, and he shakes and appears to be totally out of control and no matter how much convincing he is given that if he slows his breathing he will get by he does not respond until given a morphine shot to slowly calm him. He has himself that worked up he does not like to be left alone at night in case he is short of breath and cant explain to the duty nurse what medication he is in need of, he is panicking when given medication that he is going to be given the wrong meds and makes the nursing staff double check and as such i have been staying the night with him at the hospital as he is sure he is not going to make it through the night. My Dad has never been anxious, stressed or suffered from any form of depression. He is undergoing a terrible time trying to breath and is unable to move off his chair even so it is not a pleasant experience for him, however he has been in this position before with his emphysema and not displayed this sort of anxiety. Does anyone know if this is normal after OHS and what is the best course of management for it? I think once his chest infection clears a little he may be a bit better but after seeing him i really think this anxiety issue will stay with him a bit longer. What does one do in a case like this? Is this a part of post op behaviour?

 

[aussigal]

I think it is pretty normal to be so anxious in his situation....many of us will admit to wanting to call in the Doctor whenever we felt an odd heartbeat soon after OHS. It sounds like your Dad is experiencing a more intense anxiety possibly because of his breathing issues. Maybe there is a nurse or counsellor available at the hospital who can help him through this. It took me a month or so to start to feel less anxious about my health...its quite an ordeal your dad has gone through let alone having this infection on top.

I hope he is over the infection and back home real soon.

 

[Ross]

I can relate to this well. I felt the same way and did the samethings. It's a God awful feeling to be sucking in air and not feeling like you even took a breath. I'm not sure that Doctors understand it either. Heck one nurse grabbed the oximeter and shoved it in my face saying, "Look your 94% saturated and you are breathing". Tell you what, the way I felt was that meter should be showing 0! About all they can do is give him Ativan or similiar and ride this out. It's not what I would want, but that's what they did for me and in all honesty, I still suffer periods of feeling like that. It is enough to make you anxious and want to tear open windows, turn on the AC anything to feel like your breathing.

Be sure he's not lying flat on his back. I guarantee he'll go nuts if he is. Sitting up slightly helped, but not to the point of putting pressure on the diaphragm.

 

[ALCapshaw2]

Irregular Heartbeats (usually Atrial Fibrilation) after surgery are pretty common. Combine that with Breathing problems and his behavior is understandable, even if counterproductive.

Ross's comment about sitting up (raise the back of the hospital bed) makes sense. FLUID retention in the Lungs is worse when laying flat and would exacerbate ALL of his problems / issues.

Hopefully his fears and behaviors will improve as his medical issues are resolved. I can certainly understand his fear of being left alone and having to rely on the care of strangers with those problems. Are there other family members who could share in keeping him company until he is out of danger?

'AL Capshaw'

 

[Mary]

I can't find the citation, but I read an article in a respiratory journal that said some people experience extreme shortness of breath even if therir oxygen saturation is 95% or higher. So he may be receiving enough oxygen, but his body doesn't recognize it.
I would insist upon discussing this with his physician, and pressing for more oxygen to be administered (if it is). If not, I'd ask to have it started and see if that helps.
This is a good place to mention head of bed placement. I don't think many of us realize that patients who are on the vent are suppose to have the head of their beds elevated at a given angle (can't remember what it is offhand). This is one of the checks that they do to see how well the ICU is in compliance with guidelines. They actually walk through the ICU, and check to make sure the head of the bed is elevated, and if it's not, it's reported. In some hospitals, they post this above the bed so family members will be aware of it and report it to the nursing staff if it's not done.
I know your dad's not on a ventilator, but I imagine, as Al and Ross said, that his head should always be elevated.
Good luck and best wishes to both you and your father.

 

[Nancy]

When Joe couldn't breathe well, they gave him Ativan to help calm him down. He was on oxygen 24/7 and still could not move around much because he was short of breath. I am sure not being able to breathe would make anyone anxious.

Hopefully when the chest infection gets better, the breathing issues will improve.

About all you can do for him right now is to watch over him as you have been doing. It will be intense, but you love him and he loves you and trusts that you will do the right things for him when he cannot manage.

I know I am a real witch on this subject, but medical mistakes can happen, and they usually happen when there is no family there (for some odd reason ) I think his fears are something to take seriously, and I am speaking as a long term caregiver. Just be his guardian angel right now and watch everything.

I know how you feel. God Bless

 

[Ross]

I can't find the citation, but I read an article in a respiratory journal that said some people experience extreme shortness of breath even if therir oxygen saturation is 95% or higher. So he may be receiving enough oxygen, but his body doesn't recognize it.

Mary please find it if possible. I want it too. They treated me like I was nuts and it was very real to me. I'm still having problems to this day like that. Talking to a psychologist about having no air is like....Well forget what its like. I did not appreciate being left with the feeling that I was crazy when these episodes happened and I'm 100% sure this is the case with this gentleman too.

 

[briansmom]

I'm going to third the Ativan. I think it is especially hard on a person to go back in. Your dad probably had himself psyched up for the first surgery and then this bump hit him hard and he just can't wrap his emotions around it. My son had the hardest time with his pacemaker surgery that was 3 or 4 days after his OHS. There is just so much a person can take and then they get tired both physically and emotionally. I think having someone with him most of the time will also reassure him.

 

[Mary]

Mary please find it if possible. I want it too. They treated me like I was nuts and it was very real to me. I'm still having problems to this day like that. Talking to a psychologist about having no air is like....Well forget what its like. I did not appreciate being left with the feeling that I was crazy when these episodes happened and I'm 100% sure this is the case with this gentleman too.

I haven't found the particular study I was referring to, but I did find many articles stating that O2 levels were not predictors of dyspnea (feeling that one can't breathe). Here is one excerpt and the link. http://www.mywhatever.com/cifwriter/library/70/4942.html


I learned that CO2 build-up and oxygen deprivation were the critical factors that result in dyspnea. Although undoubtedly important in keeping the body alive, their importance in the experience of dyspnea has been exaggerated. If an oxygen saturation monitor is attached to a dyspneic runner at the end of a race, it will register normal. This reveals an important clinical pearl: oxygen saturation is insensitive in identifying patients with dyspnea. That is, one cannot rely on the oxygen saturation to tell who is dyspneic. Patients can be very dyspneic with normal saturations. Of course, patients with low oxygen saturations (below 90%) are far more likely to be dyspneic than are patients with normal saturations. However, oxygen saturation also lacks specificity as a predictor of dyspnea; many patients with low oxygen saturations (for example, patients with chronic lung disease or those who live at high altitude) will not be dyspneic, especially at rest. Studies have suggested that hypoxia correlates best with exertional dyspnea and poor exercise tolerance. Conversely, oxygen therapy has been shown to be a most helpful method to relieve exertional dyspnea and improve exercise tolerance. Studies have been mixed in testing the relief of rest dyspnea associated with hypoxia with oxygen therapy.62,63 Oxygen levels are excellent indicators of changing pulmonary physiology. The implications of the lack of sensitivity and specificity of oxygen saturation in identifying dyspnea are profound. As with pain, we lack a "scanner" for dyspnea that can reliably identify who is short of breath. We have no choice but to ask if dyspnea is present, or at least look for signs of distress that might suggest dyspnea, such as rapid respirations or a look of panic. In fact, the oxygen saturation meter can cause dyspnea by inducing panic and fear in patients, family, and clinicians as the saturation number falls (often accompanied by an ominously lower-pitched beeping tone).

Palliative Care Note
Oxygen saturation cannot be depended upon to identify dyspnea. Patient report or signs of agitation or anxiety are the best means of identifying dyspnea.
Elevations in carbon dioxide levels appear to stimulate dyspnea more than do low oxygen levels. Elevated partial pressure of arterial carbon dioxide (PaCO2) levels have been found to be an independent stimulus of dyspnea.64 However, increased respiratory drive does not necessarily result in dyspnea if it occurs unimpeded. Patients with certain forms of increased respiratory drive, such as diabetic ketoacidosis and pregnancy, may not experience dyspnea. What does cause dyspnea is an imbalance between the perceived need to breathe and the perceived ability to breathe. Elevated PaCO2 levels may be one among a number of factors that contribute to the brain's perception of a need to breathe.

 

[Ross]

Thank you! It proves that it is not just in my head. I'm fine so long as I'm not moving, but get me walking and almost immediately dyspnea hits. Whether I have the Oxygen cranked or not, the feeling of no air exchange is present and it physically drags you down too.

 

[Philip B]

Depression Stuff

Depression Stuff

The staff at my cardiologist's office told me that depression issues are common with OHS patients. They had some kind of betting pool going on me. My recovery was moving along so well, some members of the staff thought I might be in the small percentage of their patients who didn't get tagged by depression. Basically, they referred to what hit me as a form of post-traumatic stress syndrome.

Anxiety was never an issue for me, but judging from previous member posts it sounds like others have dealt with it.

-Philip

 

[deboz]

Ativan

Ativan

Hi All, thanks so much for your answers, i dont have a lot of time to reply as i have to get back to the hospital, but one thing i would really like to know is what is Ativan" that several of you have mentioned? I am in Australia so i was wondering if it is what we call Ventolin over here. Because he is unable to take Ventolin but i have heard that there is a similar medication but no one can tell me the name of it. Maybe this is it? Would appreciate it if any one could let me know.

 

[Dina]

Ativan is lorazepam , in the Benzodiazepine class ,antianxiety, sedative , anti-convulsant and is in the same category as valium . It can be helpful but is also very addictive. Small amounts for short periods ,I think, are called for with alot of people.
When I went into A. Flutter, I was terribly short of breath with a heart rate
of 210, they had to give me Ativan in addition to my antiarrhythmics, and it was helpful. I still get a prescription for it(.5mg) ,but only use it when I really need it.

 

[Nancy]

Forgot to mention another thing that can cause agitation and anxiety when in the hospital and particularly the Intensive Care Unit. It is something called ICU psychosis or ICU syndrome.

I know that Joe had it a few times.

It is caused by medications combined with illness, unfamiliar surroundings, loss of pruvacy, loss of "self" and loss of the time element. In the ICU time is irrelevant and things go on 24 hours of the day and night. The patient can become very disoriented, anxious and might act strangely as a result.

This does go away when things improve, and life gets a little more familiar.

Someone recommend bringing in small things from home like scrapbooks, picture albums, a favorite book that you can read to the person, etc. Joe loved the newspaper and I would bring it in and read to him. He also liked to try simple crosswords. I had to give a lot of hints. Even just talking to the person like it was just another day, telling them what has been going on at home, or holding their hand or doing some minor grooming for them.

I guess the aim is to try to make them feel more normal in a very abnormal environment.

 

[designlady]

Mary you are an angel!

Mary you are an angel!

Mary...

Thanks so much for sending that information and then a link! I am back in the hospital with pneumonia but the doctors keep telling me I CAN breath because my O2 sat is 94-97. However I CAN'T breath! Finally VALIDATION!!!
You are the one MARY!

Designlady
Jane

 

[deboz]

Thanks everyone

Thanks everyone

Well i finally have a minute to reply to all the posts re my question, and i would like to say thanks to everyone who took the time to post, this site really is a great help and comfort to peoplel like me. Some of you mentioned to make sure he was elevated, which he definitely is as he cant lay down and has been sitting in a large recliner type chair for days, this is the only way he can rest due to his breathing. So that is not an issue apart from the fact that everytime there is a change of shift of the nursing staff they walk in and say "oh are you ready to get into the bed" Meaning that it appears that they havent read the notes that say he cant lie down. This is one of the things that causes him to get very anxious, as he is aware that the staff dont appear to be reading his reports and will attempt to make him do what he cant do. He has an allergic reaction to ventolin and is petrified that one of the nurses are going to give him the ventolin nebuliser when he is having breathing difficulties and as Nancy said , medical mistakes do happen when there are no family about. One amusing point out of the whole issue is when he was admitted to the emergency department one nurse that was seeing over him saw the bandage on the area where the pacer wires had been and the scar from the OHS and asked if he had cut himself No wonder he doesnt want to be left alone. And as a lot of you have said, his oxygen levels are in the mid 90's which makes a lot of staff feel that there is no reason why he should think he can breathe. Anyway progress is being made and the chest infection is slowly clearing up, he is still very anxious and likes to have someone with him, especially of a night time, but from what you have all said here it appears that can be par for the course. As far as the OHS goes though, if he wasnt in a coronary care unit you would think that he was only being treated for a chest infection, he shows absolutely no signs of having had an AVR, he can cough, lift his arms and has not taken any pain killers at all. How good is that? The only issues once he has recovered from the chest infection may be the anxiety will hang around a little i think but with everyones advice here i know better now how to handle it . Thanks everyone.

 

[ALCapshaw2]

GOOD GRIEF !

With "care" like that, no wonder he is afraid of the staff.

Do you have what we call "Patient Advocates" in the hospitals in Australia? Be sure his Surgeon and the 'Charge Nurse' and maybe even the floor's Nurse Manager' are aware of the 'issues' at shift change.

The rooms at my local hospital have printed signs in them telling patients and their families to SPEAK UP if there is a problem. They realize that oversights can occur and encourage patients and families to 'sound the alarm' if they sense that something is wrong.

Keep up your Guard!!

'AL Capshaw'

 

[Ross]

There is Ventolin and then there is Albuterol. He may or may not tolerate Albuterol, but run it past the Doc. There is yet another that I cannot remember that they gave me as an aersol inhalation treatment. None of them seemed to help much. Sorry I don't have any magic bullets for this. I'm still having problems with it to this day and no, I cannot lay flat on my back or I'll go nuts in seconds. I can't sleep and have been thinking about making a chair my bed lately.

His hospital treatment sounds almost exactly what I went through. Evil things happen at night in ICU's. (Like the night nurse coming in, putting my bed down so I was laying flat, then unplugged the bed so I couldn't adjust it and told me to go to sleep!) I can't stress enough for a member of the family to always stay with the patient. We need your support, understanding, love, and basically we are dependent upon you for our survival around so called professionals.

 

[Mary]

Mary...

Thanks so much for sending that information and then a link! I am back in the hospital with pneumonia but the doctors keep telling me I CAN breath because my O2 sat is 94-97. However I CAN'T breath! Finally VALIDATION!!!
You are the one MARY!

Designlady
Jane

Jane,
I read your post to my husband, and his response was, "She needs to find a new doctor."
He's worked in respiratory therapy since 1973, 30+ years in Critical Care, and is now a Clinical specialist/educator. His feeling is this is basic respiratory knowledge that your doctor is missing.
Is there any chance you could find another doctor or see a pulmonologist?

 

[Nancy]

"Even though that pulmonologist did smirk at me, he understood that my dyspnea was real."

Gosh, I hate reading something like that! What a smart alecky guy! How dare he smirk at someone's discomfort!

Better he should doing some research into the nature of the problems.

I have seen my poor husband struggling to breathe, and have had the same stupid responses, "Your oxygen sats are high enough, you absolutely don't have a problem!" And some of them actually took his oxygen away to see what would happen. Well, I can tell you what happened. Some bloodwork and testing could have revealed much more than just playing around ahd "seeing what would happen".It just tore me up.

And, yes he could not lie down at all. He eventually had to sleep sitting up. That became a problem also because so much sitting developed a bed sore near the coccyx. And that was terrible. Then he couldn't sit, nor could he lie down.

I hate to say this, but of all of Joe's doctors, I found the pulmonologists (plural) to be the least competent. And those were the ones in critical care.

They never could seem to figure out anything, and really didn't care that he couldn't breathe.

I just don't get it.