Oxygen and other breathing issues

[Der Biermeister]

I have moderate AI, with most other parts of the heart in what appears to be adequate condition (see THE WAITING GAME ..... thread below for complete test results).

I've been home from the hospital one week today, whereby my cardiologist is attempting to treat me with meds. I am unsure of this course of action, primarily because the only change in my medications over what I've taking for years, is a more potent diuretic (Bumex). Currently, I am at least 65 lbs overweight. I had lost approximately 20 lbs since last November via a walking program. I suspect that part of my doctors plan to get me back to "normal" is real weight loss. I am following the diet restrictions but for me to lose significant weight, I need to exercise via a good walking program (which I've done successfully before). Kind of a catch-22 here though, as I can't even hardly walk across the room right now. Which leads me to my chief complaint (actually my only one now), that of SOB. I consider it to be severe, compared to two weeks ago before I ended up in the hospital - others, including doctors might look at it as only being a moderate problem as I have no cyanosis, or any other outward appearing indication of a problem. I breath ok when sitting at rest. Walking, even short distances leaves me breathless. No improvement in the one week at home, even though I've lost another 4 lbs. (Also lost 4 lbs for the 5 days in the hospital).

I have had Sleep Apnea for many years, treated with CPAP machine.

I was constantly on O2 in the hospital, even supplementing into my CPAP. The pulmonary specialist in the hospital prescribed 2.5L for my CPAP at home. This I am doing. But I've had such difficulty in breathing while trying to gel to sleep, that I've notched the O2 up to 3.0 L. So, whenever I try to sleep at night or napping, I am using my CPAP with O2.

Am I becoming dependent on the oxygen? And during the day when I do not have any O2 running into me, would this partially explain why I am breathless and seemingly not making any progress?

 

[Ross]

What you ask does not come with an easy answer. Have you had any pulmonary function testing done by a pulmonologist? If so, did you happen to get a copy of the report?

Shortness of breath is normal after surgery, but it does seem you have an abnormal amount of it. It could be anything from water around the heart and or lungs to a partially paralyzed diaphragm from surgery or even a lung condition that wasn't apparent until after surgery.

Best thing to do is get a PFT and let a Lung specialist check into it.

 

[Der Biermeister]

What you ask does not come with an easy answer. Have you had any pulmonary function testing done by a pulmonologist? If so, did you happen to get a copy of the report?

Shortness of breath is normal after surgery, but it does seem you have an abnormal amount of it. It could be anything from water around the heart and or lungs to a partially paralyzed diaphragm from surgery or even a lung condition that wasn't apparent until after surgery.

Best thing to do is get a PFT and let a Lung specialist check into it.

Ross - My cardiologist brought in a pulmonary specialist while I was in the hospital. One thing he wanted was a Cat-scan (with contrast) of, I guess it was the entire chest area. Primarily they were looking for any kind of blood clot. Nothing of any significance found re clots or anything else for that matter.

I go back to the cardiologist on Wed. Now that I am armed with boo-koo documentation, I'm not leaving without some kind of course of action that makes sense to me.
Thanks
DB

 

[Ross]

There is another test besides PFT and Catscan. A lung scan...they inject a dye in combo with a breathable gas that shows any lung deterioration or disease. It may be premature to go that route, but if need be, bring it up.

 

[Mary]

I ran this question past my husband who's been in respiratory care for 30+ years. He says at his hospital they would run a desaturation study (walking while on a pulse oximeter) to see if your oxygen level drops while walking.

You may need another nocturnal CPAP study run to see if the oxygen or the pressure on the CPAP machine needs to be adjusted. It's possible if the pressures were increased, you wouldn't need an increase in O2.

The SOB could be due to your AI, your lungs, your excess weight and/or the lack of exercise you're experiencing. It could be one of these, or a combination of all.

Ross,
He also says that the spiral high resolution CAT scan is one of the better diagnostic tools to use for detecting lung structure abnormalities (blebs, chronic bronchitis, pleural effusions, etc.) The test you mention sounds like a ventilation perfusion scan and isn't considered as useful as it was before the development of the high resolution CAT scan. So you shouldn't have to undergo that one ever again!

 

[Der Biermeister]

I ran this question past my husband who's been in respiratory care for 30+ years. He says at his hospital they would run a desaturation study (walking while on a pulse oximeter) to see if your oxygen level drops while walking.

You may need another nocturnal CPAP study run to see if the oxygen or the pressure on the CPAP machine needs to be adjusted. It's possible if the pressures were increased, you wouldn't need an increase in O2.

The SOB could be due to your AI, your lungs, your excess weight and/or the lack of exercise you're experiencing. It could be one of these, or a combination of all.

Ross,
He also says that the spiral high resolution CAT scan is one of the better diagnostic tools to use for detecting lung structure abnormalities (blebs, chronic bronchitis, pleural effusions, etc.) The test you mention sounds like a ventilation perfusion scan and isn't considered as useful as it was before the development of the high resolution CAT scan. So you shouldn't have to undergo that one ever again!

Mary - actually I've already done some of what you suggest. They did a walking de-sat on me just before I was released. I stayed at 90. Resting in a chair, I was 95 while taking deeper breaths. Prior days, I was lower than that -- for instance, right after I got admitted, I was around 85 just laying in bed.

My final night in the hospital, the pulmonary doc did a CPAP study to check for my de-sats. 15% of the time I fell below 90% and that was with 2.0L O2.

A few days ago, I borrowed a sleep lab home-study unit, which measures de-sats, ekg, mouth and nose respirations, and any apneas or hyponeas. I was primarily interested in making sure I am now staying above 90% during sleep. I just called a couple of hours ago and got the results. I basically stayed somewhat level in the mid-90s the whole period I was under test (3 hours).

When I picked this machine up on Wed, I also had them check my walking de-sats and resting in chair. I was 92 while walking and in the chair I was 95-96 with just normal breathing. So, I am inching my way back up - but I still feel NO better -- just as breathless. I should also inform that I've had anxiety issues in the past - but nothing in the last couple of years. I suspect that -- right now -- I am suffering a bit from that too. I keep medicine on hand and just began a low dose.

 

[geebee]

I know this sounds pretty simple but I didn't think of it for me and suffered for a couple of weeks so I am going to "throw it out there".

I have been having problems with SOB for a few weeks and automatically assumed it was heart related. I had an echo (what a mess, another story altogether) and made a lot of complaints to my cardio. He said everything seemed pretty good and suggested I might just be out of shape.

I didn't buy that answer and kept seeking. My S/O, after listening to my symptoms, suggested an asthma related reaction to smog. He had Primatene spray here and I took a VERY small inhalation (sprayed it a couple of inches away from my mouth and inhaled much less than someone normally would).

Lo and behold, my SOB went away and the "tight band feeling" around my chest went away. Turns out I have "allergic asthma" to things like smog and mold.

Just some thoughts.