tag:blogger.com,1999:blog-204531212024-02-20T15:17:08.439-05:00Retired Mechanical Engineer in CanadaSr Citizen, Bulbar Polio Survivor, Hockey Fan and Roman Catholic.
Have dealt with the late effects of polio since 1996.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.comBlogger31125tag:blogger.com,1999:blog-20453121.post-50206673021707344162015-12-18T12:49:00.000-05:002015-12-18T13:41:07.821-05:00From Mar 28 to April 3, 2015, I was admitted in hospital for 7 days with pneumonia where I was given antibiotics by IV. I was in a private room as I was in isolation for 5 of the 7 days. On discharge, I was told I had to have oxygen full time at 1.5 L/M at rest and 3 L/M for forced exertion.<br />
At home I have an oxygen making machine or concentrator and pumping station to fill up my own tanks. Each tank last 2.75 hours. I always carry two oxygen tanks in the basket of my walker when I go out to shopping centre, doctor appointments and etc.<br />
<br />Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com1tag:blogger.com,1999:blog-20453121.post-65349884741946075152014-01-15T18:10:00.000-05:002014-01-15T18:10:51.429-05:00My appointment with my respirologist on Jan 14/14My lung function test revealed that my FEV1 increased from 19 (A year and a half ago) to 35. This was an awesome improvement. Last time My FEV1 was 35 was in 2009.
I underwent a blind test where I walked for six minutes on Compressed Air and another six minute walk on 4 litres per minute flow of Oxygen. The comparison of results were not great enough to be used as evidence with my insurance company. However My respirologist will write my insurance company telling why I need oxygen on forced exertion. At rest I am fine.
I told my respirologist that my Inguinal hernia was acting up and the results of an ultrasound test convinced my GP to refer me to a General Surgeon.
My respirologist said there was no way he wanted me to have this surgery as it would be very painful and I would not be able to tolerate the effects of the strong pain medicine on my breathing. If the hernia was incarcerated and my life was at risk, then he would give his consent.
I asked him if I could fly and he said I could with a portable Oxygen concentrator otherwise my oxygen blood saturation level would decrease to 80 which is not good.
My next appointment would be in a year from now.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-6785880535125984262014-01-09T09:44:00.000-05:002014-01-09T09:44:37.476-05:00Was prescribed Oxygen for forced exertion (walking) on Nov 4/13 by my GP, Dated Nov 4/13 I have been very short of breath over the last year so my general practitioner prescribe oxygen for me, to be used only during forced exertion (walking).
I am fine at rest as my oxygen saturation level is between 92 and 94 percent.
On forced exertion, it has gone down to 85 percent.
The proof that oxygen helped me was when I went to a shopping and walked without stopping for one half hour with my walker. This feat I have not been able to do for over a year.
Unfortunately, I have to pay for it out of pocket as I do not qualify to have it subsidized by by the provincial assistive devices program (ADP). It cost me $ 398.00 per month or 4 4,728 per year.
Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-3825691186346520392012-06-04T19:18:00.001-05:002012-06-04T19:19:16.793-05:00<b>MY HOSPITALIZATION AT QCH FOR FOUR DAYS: MAY 19-23/12 WITH COPD EXACERBATION AND PNEUMONIA
BY PETER C ELLIS</b>
Dated June 5/12
<b>SYMPTOMS</b> Very short of breath, wheezing and difficulty walking. Oxygen level 88 % CHEST xray revealed pneumonia in upper right lung
<b>DROPLET</b> for 3 days in a private room Isolation
<b>MEDICATIONS</b> 50 mg Presidone daily through a syringe and Ceftriaxone 1000 mg every 24 hrs by IV
<b>PUFFERS</b>: Spiriva once daily, four puffs of Ventolin every four hrs, four puffs of Atrovent every four hours, Advair 500 mgs twice daily
<b>FEED</b>: I500 mg Isosource 1.5 three times daily Will see dietitican on June 8 at QCH as outpatient for Resource 2 feed (Higher calorie feed)
<b>HOME MEDICATIONS ON DISCHARGE</b>: Antibiotic Cefuroxime 500 mg tablet twice daily for ten days. Continue 50mg Predisone daily for seven days and puffers as in hospital for seven days.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-44566508168022121192012-05-17T10:26:00.000-05:002012-05-17T10:29:24.116-05:00APOINTMENT WITH DRS D MCKIM AND DE BOUR AT THE REHABILITATION CENTRE ON MAY 15/12 BY PETER C ELLIS<b>APOINTMENT WITH DRS D MCKIM AND DE BOUR
AT THE REHABILITATION CENTRE ON MAY 15/12<b>
BY PETER C ELLIS
SUMMARY : Main point of discussion was to find out what I would want done if I got very sick again like in 2009 and had to go to Emergency to be admitted to hospital.
MY DECISION is to go on the ventilator for a week and if there was no hope of me recovering, My wish is for them to stop treatment, ending my days on earth. Dr Mckim conveyed my wishes to my wife too.
POINTS I CONSIDERED IN MAKING ABOVE DECISION:
-My lung condition has further deteriorated as compared to when I was admitted to the Queensway Carleton Hospital for six weeks from Aug 8 to Sept 17/2009.
-My FEV! dropped 5 % from 35 % to 27 % of normal in 3 years.
(FEV! - Now is 27 % of normal)
(FEV1 - in Aug 2009 was 35 % of normal)
-The possibility in having to be on a trac and on a ventilator for the rest of my life if I got very sick again, did not appeal to me at all.
-My Shortness of Breath and Wheezing is much worse
now than in 2009.
-Walking and other physical exertion is more difficult now.
-My present oxygen level in the blood is 91 % instead of my normal 94 %.
DR”S IMMEDIATE RECOMMENDATIONS
-
- Increase Advair amount from 250 to 500 mcg
- Will admit me to the pulmonary physio dept for exercise to increase my long volumes: Thread Mill, Bicycling, etc twice a week as an outpatient.
- Next fall, Drs will put me on antibiotics to take on Mon. Wed. and Fri for the rest of my life to fight in infection in my lungs.
- Drs. took a sample of my sputum which was green.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-91570282018913314662012-03-31T15:36:00.006-05:002012-03-31T16:09:24.178-05:00COPD EXACERBATION, MARCH 29, 2012<span style="font-weight:bold;">SYMPTOMS</span> :<br /><br />Coughing during the day and at night in bed, short of breath and lots of infamation in my chest.<br />Blood oxygen saturation level: 91 %<br /><br /><span style="font-weight:bold;">PRESCRIBED MEDICINE</span>S:<br /><br />1. <span style="font-weight:bold;">ANTIBIOTIC</span>: Teva-Levofloxacin 750 mg. Take one daily after food for seven days<br /><br />2.<span style="font-weight:bold;"> PREDNISONE 50mg</span>: Take one daily after food for inflamation.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com1tag:blogger.com,1999:blog-20453121.post-61619529668948918102012-03-31T15:31:00.003-05:002012-03-31T16:12:27.032-05:00PEG TUBE SITE RELOCATION, MARCH 31,2012<span style="font-weight:bold;">MY PEG TUBE RELOCATION TO ANOTHER SITE </span><br />BY Peter C Ellis, Age 75, Dated March 31, 2012<br /><br /><span style="font-weight:bold;">REASON FOR NEW SITE</span>:<span style="font-weight:bold;"><br /></span><br />My six year old PEG TUBE stoma was leaking off and on for four months, became infected and herniated for the second time within a year and popped out of its existing location on Jan 22/12. I went to Emergency immediately Sunday night, slept there overnite <br /><br /><span style="font-weight:bold;">SURGERY: </span> <br /><br />On Monday Jan 23/12 my gastroenterologist installed a new Peg Tube in a new site as old site was infected. My gastroenterologist used a children’s endoscopy scope because of my severe weakened post polio pharyngeal muscles. I then had x-rays done to verify there weren’t any perforations.<br /><br /><span style="font-weight:bold;">CARE OF EXISTING SIX YEAR OLD STOMA:</span><br /><br />After being burned on my outer skin by my stomach acid coming through the old infected stoma for twelve days while feeding through the new site , I had a home care stoma specialized nurse come home to see me on Feb 3/12. She Installed a pouch over it to collect any further drainage. On Feb 10/12, the collecting pouch was removed.<br /><br />Today my old stoma has completely healed and is closed.<br /><br /><span style="font-weight:bold;">LESSONS TO BE LEARNED FROM MY EXPERIENCE:</span><br /><br />Make sure you have a pouch installed over existing stoma immediately after the surgery to collect the drainage to avoid the very painful stinging and burning of your outer skin like I had for twelve days.<br /><br /><span style="font-weight:bold;">MAINTENANCE OF MY NEW STOMA:</span><br /><br />I change the gauze once every morning on rising, Cleanse the wound with saline solution, apply Calmoseptine pink cream with a cotton tip applicator, and cover it up with a new gauze. <br /><br /><span style="font-weight:bold;">CARE OF SKIN BURNS AROUND OLD STOMA</span>: Apply Calmoseptine pink cream.<br /><br />Signed: Peter C EllisPeter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-51753092018444940832011-07-22T16:59:00.003-05:002011-07-22T18:09:29.339-05:00Chart showing deteriation of My lung Function from 1998 to 2011 owing to COPD and late effects of polio<span style="font-weight:bold;">DATE</span> <span style="font-weight:bold;">FEV1 (L) % of Normal</span> <span style="font-weight:bold;">FVC (L) % of Normal</span> <span style="font-weight:bold;">Oygen</span> <br /> <br />Jul-11 0.99 29% 3.00 64% 93-94 % <br />Jan-11 1.09 31% 2.97 61% 96% <br /> <br />Apr-10 1.01 29% 2.54 53% 92 % Ax <br />Jul-10 0.97 28% 2.88 61% 92% Ax <br /> <br />Nov-09 1.31 37% 2.85 59% 92 % Ax <br />Jan-09 1.26 35% 3.03 63% 92% Ax <br /> <br />May-08 1.28 36% 3.18 65% 91 % AX <br /> <br />Nov-07 1.49 42% 3.53 72% 92 % Ax <br />May-07 1.20 33% 3.04 62% 92% Ax <br /> <br />Nov-05 1.25 33% 3.42 72% 91 % AX <br /> <br />Jan-04 1.47 38% 4.09 85% <br /> 91 % AX <br />Oct-03 1.38 36% 3.21 68% 91 % AX <br /> <br />Jul-98 2.19 66% 3.4 71% 91 % AX <br /> <br /> <br /><span style="font-weight:bold;">SUMMARY:</span><br /><br /> Amount of air expired in the first second (FEV1) has deteriorated from 66 % of <br />normal to 29 % of normal or in 13 years. Today I get short of breath if I do<br />physical exertion.<br /> My total expired air volume has decreased from 71 % of normal to 64 % of normal<br />in 13 years.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-65168238561980898522011-04-19T12:42:00.004-05:002012-03-31T16:15:08.561-05:00COPD exacerbation in mid March 2011My blood oxygen levels decreased to 90 and I was coughing more than normal. Had chest sounded by GP and chest x-ray but he did not think I had aspriration pneumonia. Was put on antibiotics for seven days.<br /><span style="font-weight:bold;">PROGNOSIS</span>: COPD exacerbation<br /><span style="font-weight:bold;">HIGH RISK</span>: I am a very high risk to get aspiration pneumonia.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-67093307013528342792011-04-19T12:34:00.002-05:002011-04-19T12:42:07.340-05:00My Walking ProgramFor the last nine months I have been walking almost every day in two different shopping centres in Ottawa, Ontario, Bayshore and Carlingwood Mall. It has really paid dividends for me. My balance, endurance, leg strength and lung function all have improved greatly. My blood oxygen levels increased from 92 to to 96.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-72688670096051294252011-04-19T12:16:00.003-05:002011-04-19T12:34:25.025-05:00Crushed T-11 and L-1 vertebrae in April, 2008 during an accidental fall in the bath tubOn easter weekend, April 2008 I accidently fell in the bottom of the bath tub and my spine absorbed the whole shock of the fall, crushing two vertebra T-11 and L-1. I was on morphine for three weeks at home. This was most painful and it took me nine months to a year to recover. I had 3 months of physiotherapy comprising tens treatments, hot packs, stretching and accupuncture. It did not help me at all. Went back to my chiropractor and he got me back to normal. From the day of this accident, I was prescribed and a tall Nexus walker in which I use all the time. Dated April 19, 2011.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-30897554524563867302010-10-06T16:14:00.002-05:002010-10-06T16:40:22.222-05:00Aspiration Pneumonia diagnosed in June, 2010<span style="font-weight:bold;">In June, 2010</span> I was diagnosed with aspiration pneumonia, which was confirmed by chest X-Ray. My GP put me on one strong antibiotic for ten days called <span style="font-weight:bold;">Teva-Levoflaxacin</span>. I took three 250 mgs tablets three times daily for a total of <span style="font-weight:bold;">750 mgs daily</span>. It really helped me and I have been fine since then.<br /><br />I also had my yearly<span style="font-weight:bold;"> Chest CT scan </span>in June and saw <span style="font-weight:bold;">my respirologist in mid July</span> to find out that my bronchiectasis is getting worse and will continue to get worse because of all the previous infections, eight aspiration pneumonias and damage already done in my lungs.<br /><br />However for the last month and a half I have been going to two different shopping malls to<span style="font-weight:bold;"> walk with my walker over 1-1/2 kms dail</span>y, which I never did before.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-82629927139502480372010-03-23T16:12:00.003-05:002010-03-23T16:24:27.321-05:00Came down with aspiration pneumonia in late February, 2010In late February and early March of 2010, I was diagnosed by chest x-ray that I have aspiration pneumonia and was put on Cyprofloxin antibiotic for ten days and then was given two different antibiotics for another ten days, Mylan-Clarithromycin and Ratio-Axlavulanate. The latter two gave me diarreha and so I was tested for C-difficile. Will have another chest x-ray in six weeks.<br />CAUSE : I aspirated my saliva into my lungs as I have not eaten orally since Dec 2008.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com1tag:blogger.com,1999:blog-20453121.post-69155985786372149352009-12-04T14:49:00.006-05:002009-12-17T11:24:11.204-05:00My six week hospitalization for a lung infection and pneumonia from August 8 to Sept 17, 2009For the first two weeks I was in Intensive care (ICU), was intubated for six days with ventilator and in induced coma where a respiratory therapist suctioned the mucus from my lungs. I lost 60 to 70 % of my strength.<br /><br />The third week was spent on the medicine floor.<br /><br />The fourth, fifth and sixth weeks were spent in Rehabilitation where I regained enough strength through exercises to be discharged to go home. I was on oxygen and antibiotics for five weeks. I really never thought I would get out of hospital during the first week in Rehab. I had two CT lung scans and one chest x-ray. I am almost back to normal now.<br /><br />I have been walking with a walker since I fell in my bath tub and crushed L1 vertebrae last April. It has been six months since I fell and I am still having difficulties with my back. Had physio and am now going to my chiropractor twice a week. Had a total body bone scan and a lower back scan recently. Results of scan revealed that Vertebrae L1 has decreased in height by one half which makes me lean forward most of the time owing to the wedge effect of L1.<div><br /></div>Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-62161321049826195762009-03-28T14:53:00.002-05:002009-12-17T11:56:22.749-05:00My Dressing supplies used to take care of my PEG Tube StominaMY DRESSING SUPPLIES FOR PEG TUBE STOMINA<br />BY: PC Ellis March 18, 2009<br />1. Medicom 2 in x 2 in all gauze sponges, 100 % cotton, 12 ply REF NO. 3002, <a href="http://www.medicom.ca/">http://www.medicom.ca</a><br />2. Dukal non-sterile gauze sponges, 2 in x 2 in.- 12 ply Ref no. 2128 <a href="http://www.dukal.com/">http://www.dukal.com</a> Dukal Corp. % Plant Ave., Hauppauge, NY 11788, tel no 631-6563800<br />3. Dukal 4 in x 4 in non sterile gauze sponges, 100% cotton – 8 ply Ref No. 4084 same as above info<br />4. TopplerSterile Drain Swabs 3 in by 3 in Ref No M12507 Made by Johnson & Johnson<br />5. Flexi-trak Anchoring device for catheters and tubes, 1-1/2 in by 4 in Ref No 0003-0374-40 Made by ConvaTec, Montreal , Qc 1-800-465-6302 Numero de commande 37449<br />6. Hypafix 5 cm by 10 m low allergy dressing retention sheet (tape) Ref No 71443-01 made by BSN medical GmbH in Hamburg, Germany<br />7. Micropore Surgical Tape 1 in by 10 yd Hypoallergenic Ref no 1530-1 Made by 3M Health Care, St.Paul, MN 55144-1000 USA 1-800-228-3957<br />8. Non-Sterile Cotton Tipped Aplicators, 3 in wood shaft<br />9. 500 ml Baxter 0.9 % Sodium Choride Irrigation solution Ref No JF7633 Made by Baxter Corp., Toronto Ontario<div>10 Dec, 2009: I am now using SeaSorb (made from sea weed) to protect the opening in my stomach which acts as a wick to soak up the discharge and am changing it once a day. Have home care nursing coming in twice a week.</div>Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-22714100345027136202009-03-28T14:50:00.000-05:002009-03-28T14:51:43.546-05:00My Enternal Fedding Supplies that I useMY ENTERAL FEEDING SUPPLIES Mar 17, 2009 BY Peter C Ellis<br />1. COMPAT 1000 ml Vinyl Gravity Feed Bag with preattached Enternal Delivery Gravity tubing . Ref No 199216 MADE BY NESTLES at http://<a href="http://www.nestlenutrition.com/us">www.nestlenutrition.com/us</a> Toll free no 1-877-DEVICE-8. Covered by Ontario ADP.<br />2. KENDALL KANGAROO 1000 ml Vinyl Gravity Feed Bag with preattached Enteral gravity feed tubing, ref no. 8884702500 MADE BY TYCO Healthcare Group, Mansfield, MA Toll free no 1-800-962-9888 at <a href="http://www.tycohealthcare.com/">http://www.tycohealthcare.com</a>. Covered by Ontario ADP.<br />3. COMPAT: 500 ml rigid feeding container with preattached Enteral gravity delivery tubing Ref no 8884702500 Made by NOVARTIS Nutrition Corporation in Minnepolis , Min., USA DISCONTINUED IN CANADA but still can be purchased in the USA at my expense<br />4. 60 ML KENDALL Syringe with tip cap ref no 1186000777 MADE BY TYCO Healthcare Group, Mansfield, MA Toll free no 1-800-962-9888 at <a href="http://www.tycohealthcare.com/">http://www.tycohealthcare.com</a>. Covered by Ontario ADP.<br />5. KENDALL Female lock connector tip for 60 ml syringe, ref no. 275008 MADE BY TYCO Healthcare Group, Mansfield, MA Toll free no 1-800-962-9888 at <a href="http://www.tycohealthcare.com/">http://www.tycohealthcare.com</a>. Covered by Ontario ADP.<br />6. 35 ML KENDALL Monoject Syringe with catheter tip. Ref no 1183500888 MADE BY TYCO Healthcare Group, Mansfield, MA Toll free no 1-800-962-9888 at <a href="http://www.tycohealthcare.com/">http://www.tycohealthcare.com</a>. Covered by Ontario ADP.<br />7. KENDALL ENTRISTAR (Y ADAPTER) PEG ENTERAL CONNECTOR, Ref No 8884-752042 MADE BY TYCO Healthcare Group, Mansfield, MA Toll free no 1-800-962-9888 at http://<a href="http://www.tycohealthcare.com/">www.tycohealthcare.com</a>.. Covered by Ontario ADP.<br />8. COMPAT Universal Y Port Adapter with Stretch-Lok Strap Ref No 087503 Made by NOVARTIS Nutrition Corporation in Minnepolis , Min., USA DISCONTINUED IN CANADA but still can be purchased in the USA at my expense<br />9. KENDALL KANGAROO Y-Site Extension Set Ref No. 8884705008 MADE BY TYCO Healthcare Group, Mansfield, MA Toll free no 1-800-962-9888 at http://www.tycohealthcare.com Covered by Ontario ADP.<br /><br />ADP: Ontario Assistive Devices ProgramPeter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-15739852030606992962009-03-28T14:30:00.001-05:002009-03-28T14:32:01.952-05:00Results of my Thoraic CT Scan on Dec 3, 2008SUMMARY of RESULTS of LUNG CT SCAN on Dec 3 at QCH Feb 28, 2009<br />As told to me by Dr.E Kyrillos at The Family Medicine Clinic on Feb 20, 2009<br />GENERAL:<br />1 There is a cyst at the apex of segments 5 and 6 of the liver. The remainder of liver is unremarkable.<br />2 At the upper pole of right Kidney, there is a 1.9 cm lesion<br />3 In left lower lobe there is a 5 mm nodular density<br />4 In right lower lobe, there is a irregular speculated 1.2 cm mass and adjacent to this is a 6 mm nodule<br />OPINION :<br />There are 2 new irregular masses in lower lobe of right lung that were not present in prior CT Scan of July, 2008. Could be related to a typical infection such as MAI, However Neoplasm in not excluded therefore follow up CT Scan is recommended in 3 months (March)<br />Ultrasound test on right kidney is recommended to check or confirm that the lesion is not a solid renal mass<br />BATERIA FROM SPUTEM SAMPLE on Feb 20, 2009 revealed bacteria called PSEUDOMONAS AERUGINOSA<br />This bacteria can only be treated with five different antibiotics according to Dr Kyrillos<br />Was prescribed APO-CIPROFLOX 750 MG or Ciprofloxacin HCL 750 MG om Fed 26.<br />FOLLOW UP APPOINTMENT with DR E Kyrilos is to be made after next CT Scan and Ultrasound test on right kidney.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-77591893740077575392009-03-28T14:24:00.002-05:002015-01-24T16:44:26.156-05:00OC HOSPITAL STAY from Dec 7 to Dec 11, 2008QCHospital Stay from Dec 7 to Dec 11, 2008<br />
<br />
PNEUMONIA Taken by ambulance from my home to hospital early Sunday morning.<br />
<br />
ADMITTED by Dr. S. Morrin, M.D.,F.R.C.P.(C) Internal Medicine, Hematology on Monday after spending day and night in Emergency. Was discharged on Thursday.<br />
<br />
OXYGEN Was on oxygen for 4 days. O2 level on admittance was 88 % and when I left was 92 % while on oxygen O2 levels were 97 %<br />
Took blood sample from artery to see if I was eligible for home oxygen and the respiratory therapist in hospital advised me not to have it at home.<br />
<br />
CHEST XRAY in hospital on Dec 8<br />
<br />
ANTIBIOTIC: 750 mgs of LEVAQUIN once daily in morning for 15 days total including 5 days in hospital<br />
<br />
PHYSIOTHERAPY: Had chest physio to help me cough up and will have more treatments as an outpatient to teach my wife how to do this.<br />
<br />
SPUTUM : Abundance of thick stringy white froth and very little yellow mucus<br />
<br />
LUNG HYGIENE at home: Steam vaporizer with acapella<br />
<br />
FOLLOWUP CT SCAN Ordered by Dr j Lemelin and was done on Dec 3 at QCH<br />
Previous one was on July 18th at General Hospital. Have not been told results of it.<br />
<br />
DIETITIAN REFERRAL I want to be referred to Bernice Wood, dietitian of ParaMed at 613-728-7080. Who has looked after me since I first had my Peg Rube installed 2-3/4 years ago.<br />
Since hospitalization , I made a decision not to have anything orally again. Everything will go through my PEG Tube ie Vitamins, all medicines and all nourishment.<br />
I am taking in 1800 calories a day or six cans a day. I am really suppose to have 2100 calories a day. I have lost 10 pounds since hospitalization.<br />
I have decided to not to take anything orally as before: pint of beer, Aero dark chocolate bar because I have had 2 pneumonia within 6 months of each other.<br />
<br />
MOUTH HYGEINE: Saw Speech language pathologist in hospital and she stressed good oral hygiene. Brushing my teeth twice a day and scraping my tongue. : Had bed side swallowing test in hospital <br />
<br />
SPUTUM COLOUR Green. PLEASE test my sputum for infection.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-81816501539098043422008-05-13T12:27:00.002-05:002008-05-13T12:49:26.291-05:00Pneumonia and Resulting Lung function TestsLast April 25, 2008 I had chest x-rays done and was prescribed antibiotics for seven days because I could hardly breathe and was coughing up yellow and green mucus. I was told to puff my ventolin four times daily for 3 days , 2 puffs per treatment or 8 puffs per day as well as take my spiriva once daily and flovent twice daily. Now I am coughing up only yellow mucus. Green mucus is a sign of infection and I had a very low grade fever for one and a half weeks.<div><br /></div><div>I have been off the antibiotics for 2 weeks now and I am feeling much better. </div><div><br /></div><div>Yesterday on May 12, 2008 I saw my respirologist and he read my chest x-rays taken on April 25, 2008 and informed me that I had pneumonia in the lower right lobe and that my lung function had decreased 6 percent from 8 months ago. My oxygen levels were still at 88 % as compared to 93 %, 8 months ago.</div><div><br /></div><div>I will see him in one month for reevaluation and he is considering i be tested fot my oxygens levels during a sleep study. I may be a canditate for CPAP or BIPAP.</div><div><br /></div>Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com1tag:blogger.com,1999:blog-20453121.post-64670016284687914772008-05-13T12:20:00.002-05:002008-05-13T12:27:11.643-05:00Physiotherapy for lower back and Lung EducationLast fall from Nov. 2007 to Jan 2008 I had 3 months of physio at the Rehabilitation Centre, together mixed with some lung education regarding the Anatomy of our Breathing and COPD Disease Management. Articles on these subjects have been posted below for your reference.<div><br /></div>Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-3250563230168383952008-05-13T11:57:00.005-05:002010-03-23T17:09:27.837-05:00COPD DISEASE MANAGEMENTCOPD DISEASE MANAGEMENT <br />C.O.P.D. stands for Chronic Obstructive Pulmonary Disease<br />It is a collective term used to cover the following conditions:<br />Emphysema:<br />Damaged air sacs (Alveoli) that can result in hypoventilation of the lungs. This is most commonly found seen in people with smoking history<br />Chronic Bronchitis:<br />Cough productive of sputum for at least 3 months and at least 2 years in a row. Caused by chronic irritation of the airways (bronchi and bronchioles). This is an an imflamatory problem which is also related to a smoking history problem<br />Asthma:<br />Hyper-reactive airways Breathing airways become extra sensitive and react to certain irritants which cause them to tlghten or constrict with acute episodes, thus can lead to inflammation. <br />Most people have a component of each of these conditions-The result is that the flow of air in and especially out of the lungs is obstructed.<br />Causes of Obstruction:<br />1) INFECTION - Phlegm blocks the airways<br />2) INFLAMMATION - The lining of the airways becomes irritated and swollen which makes the airway narrower. The irritation causes the production of white, frothy sputum.<br />3) BRONCHOSPASM - -The muscles which surround the airways tighten or constrict in response to the inhaled irritant.<br />With Chronic Obstructive Pulmonary Disease, one may suffer from 1 or all 3 of these obstructive causes. All can cause you to feel short of breath (SOB)<br />1-INFECTION Infection is caused by an organism that can be either viral or bacterial.<br />VIRAL BACTERIAL<br />Presence of warning signs:-- Usually absence of warning signs; mild cold/flu symptoms such as headache, sudden onset sneezing, muscle and joint aches.<br />Signs and Symptoms of full blown infection<br />- cough, fatigue, maybe fever - cough, fatigue, maybe fever<br />- shortness of breath(SOB) - shortness of breath(SOB)<br />- change in amount of sputum production - change in amount of sputum Production<br />- color of sputum (yellow, green or brown) - color of sputum (yellow, green or brown)<br />NO CURE, but often given antibiotics to Treated with antibiotics to prevent an additional bacterial infection from occurring.<br />Infections are spread from person to person most commonly by direct contact of the hands to eyes or nose. <br />REVENTION IS THE BEST MEDICINE<br />HAND WASHING<br />To prevent infection, the best defense is hand-washing This should be done with soap<br />and water for at least 30 seconds or with a waterless antibacterial alcoholic rinse. Make a point of<br />washing thumb and index fingers. As well, use a paper towel to turn off taps and open bathroom<br />doorknobs to avoid reinfection through contaminated surfaces.<br />* AVOID INFECTED PEOPLE IN CLOSE QUARTERS<br />* GET THE FLU SHOT EVERY YEAR (protects from common viruses of the season)<br />* GET THE PNEUMOCOCCAL VACCINE (protects from serious bacterium that cause infection)<br />Every time you get a bad infection you risk damaging your lungs further due to scarring Any respiratory infection can turn into pneumonia. If you suffer from C.O.P.D., you cannot afford to lose healthy lung tissue so you must act quickly to get treatment from your doctor.<br />Treatment for Infections - ANTIBIOTICS<br />* Make sure to take your antibiotics as directed by your doctor or pharmacist.<br />Some are taken with food, some are not.<br />* Take your antibiotics for the full time period that is prescribed even if you feel better before that.<br />Example of a 10 day prescription<br />You should be feeling somewhat better should be clear feel 100% better<br />If not, call Dr.<br />Day 3 Day 8 Day 10<br />SIDE EFFECTS of antibiotics:<br /><br />* Nausea, cramps, diarrhea (because drugs are killing off normal healthy bacteria in your system)<br />* Yeast overgrowth : fuzzy coated tongue, canker sores, red rash perineal region, vaginal infection<br />You may be able to prevent or control these symptoms by eating plain yogurt or taking acidophilus capsules<br />ALLERGIC REACTION to antibiotics:<br />* Red, itchy rash or hives - STOP medication and call your doctor for a change in antibiotic<br />- Get a medic alert bracelet<br />* swelling of the tongue, itchy, burning of the tongue, -» Call ambulance or 911 EMERGENCY<br />trouble breathing<br />WHEN YOU ARE SICK WITH AN INFECTION:<br />/Stay at home and get plenty of rest (but don't stay in bed for 24 hours)<br />/Stop your exercise or endurance routine (approximately 1 week)<br />/Increase your fluid intake. Avoid caffeine, since it is a diuretic<br />/Increase the frequency of your lung hygiene program<br />Thoracic mobility exercises, deep breathing, steaming, devices, controlled<br />coughing)<br />*When you are feeling better, start your exercise training again gradually<br />2-INFLAMMATION<br />This is the primary cause of bronchitis. It is our bodies immune response to an irritant.<br />Many different things can cause irritation to the airways:<br />Infectious organisms, causing infectious bronchitis (will then need antibiotic)<br />Other irritants: Smoke<br />Chemicals<br />Dust <br />Animals, etc.<br />Inflammation of the airways causes them to: become swollen, produce extra mucus<br />damage the cilia (small hairs which help to move mucus up and out of the lungs)<br />SYMPTOMS of INFLAMMATION:<br />© increased shortness of breath<br />© frothy, white sputum<br />© increased wet cough and wheezing<br />© fatigue<br />MEDICATIONS for INFLAMATION :ANTI-INFLAMMATORIES<br />STEROIDS 1) inhaled steroid or "puffers": flovent, pulmicort, Qvar, vanceril<br />2) pills / IV (prednisone)<br />NON-STEROID: tilade<br />Side Effects of STEROIDS:<br />1) inhaled : thrush in the mouth and throat<br />Prevent by proper rinsing and spitting with water, followed by drinking a few sips of water.<br />2) pills/IV : fluid retention, weight gain, diabetes, osteoporosis, easy <br />bruising, steroid myopathy (muscle wasting)<br />3-BRONCHOSPASM<br />WHAT IT IS<br />When hyper reactive airways respond to irritants, the muscles surrounding the airways tighten and squeeze, causing the airway to become more narrow or constrict.<br />Irritants which may cause Bronchospasm:<br />smoke<br />cold air, windy air<br />perfumes, strong household cleaners<br />rapid movement of air (this may happen with exercise at a higher intensity level)<br />SYMPTOMS OF BRONCHOSPASM:<br />Sudden onset of:<br />Shortness of breath<br />Wheezing<br />Dry, hacking cough<br />PREVENTION:<br />avoid known irritants<br />cover your nose and mouth with a silk or cotton scarf when out in cold or windy weather<br />breathe through the nose rather than the mouth<br />The nose: 1) filters 2) warms 3) humidifies the air<br />MEDICATIONS FOR BRONCHOSPASM: BRONCHODILATORS<br />1) Short acting bronchodilators: Ventolin<br />Combivent (also has long-acting)<br />Atrovent<br />2) Long, slow acting bronchodilators: Serevent, Oxeze, Accolate<br />A preventative bronchoconstrictors) Combivent (also has short-acting)<br />Spiriva-only medication specific for COPD<br />*** Wait at least 1 to 2 minutes<br />*** Wait at least 1 to 2 minutes between each puff of medication<br />*** If you are taking both bronchodilator and steroid puffers, take your fast acting <br />bronchodilator first, then wait 10 to 15 minutes before you take the steroid<br />SIDE EFFECTS of BRONCHODILATORS:<br />- increased heart rate, trembling, jitteryfeeling<br />AEROCHAMBER<br />For all of your inhaler medications (Metered dose inhalers), you should be using an aerochamber to maximize the effectiveness of the medication. <br />Posted by Peter Ellis at Tuesday, May 13, 2008 1 comments <br />ANATOMY of the RESPIRATORY SYSTEM<br />SKELETON<br /> RIBS: 12 in total (2 are floating)<br /> Protects the lungs and heart<br />STERUM: Breast Bone at front of the chest<br />Costo-sterum and costo-vertebral joints: where the ribs meet the sternum at the front and the vertebrae in the back<br /> SCAPULAR: complex (shoulder blade): attaches to the back of the rib cage<br />IMPACT OF PROBLEMS WITH THE SKELETON<br />The joints of the rib cage (costo-sternal and costo-vertebral) can become irritated with repetitive coughing. You may experience pain in the front of your chest or at the back where the joints are.. If you experience a sudden onset of severe pain, this pain may indicate rib fracture. You should ask your doctor so she/he can provide with proper pain management. You may be at risk of rib fracture if you are know to have osteoporosis or if you have prolonged courses of steroids (Prednizone).<br />To avoid rib fracture or irritated joints, you should practise controlled coughing techniques.<br />If your ribs are stiff due to your lung disease and (air trapping), you will need to do some thoracic mobility exercises to maintain movement you have or try to improve it.<br />Pursed exhalation creates positive pressure in the lung to prevent air trapping.<br />MUSCLES OF RESPIRATION:<br />1. DIAPHRAGM: Main muscle of breathing. Repsonsible for 60 to 80 percent of the work during inspiration. Domed shaped. Creates negative pressure in lung to bring air in.<br /><br />2. INTERCOSTALS: Small muscles located in between each ribs. Responsible for 40 percent of the air intake during inhalation<br />3 ACCESSORY MUSCLES: muscles of the neck, not designed to work all the time. Used by people with lung disease when in distress or because they havedeveloped poor breathing pattern.<br />HOW WE BREATHE: The normal ratio of breathing is 1:2, inspiration/expiration. For example, if you breathe in for 2 seconds you should breathe out in 4 seconds. <br />When we breathe in, inspiration or inhalation<br />-The diaphragm contracts and shortens which flattens it. It allows more space for the lungs to expand.<br />-The intercostals contract which makes the ribs move out and up in a “Bucket handle” swinging movement.<br />When we breathe out, expiration or exhalation<br />-The diaphragm passively returns to its dome shape.<br />-The intercostals relax and allow the ribs to return to their starting position.<br />-The abdominal muscles help to push the air out during forced expiration. This happens when doing your flow tests or when coughing. If you use your abdominal muscles all the time, as some people with lung disease do, the muscles get tired which leaves you fatigued.<br />-People with emphysema have a slow and prolonged forced expiration.<br />Impact of problems with muscles of breathing<br />-Harder to breathe when carrying heavy parcels because the muscles in your arms and chest are being used to lift instead of helping you breathe properly. What are the possible solutions to this problem? Cary lighter loads, use a cart, get your groceries delivered, let you legs do more of the work when lifting from the floor. These tips should make it easier on your breathing and on your heart.<br />-Obstacles that can make breathing more difficult: obesity, pregnancy, a large meal, bloating, and poor posture.<br />All of theses can push up on your diaphragm and don’t allow it to flatten out on inspiration, The lungs don’t have as much room to expand thus making you short of breath.<br />How position can affect your diaphragm<br />Lying flat on your spine (supine):<br />-The resting level of the diaphragm rises up towards the lungs.<br />-Gravity pulls down on the ribs, making it harder to move them up.<br />- The organs are pushed up towards the diaphragm and it makes it more difficult to breathe.<br />Solution: Lie with pillows positioned under the upper back and head<br />Sitting :<br />-Gravity helps the diaphragm flatten out by pulling down on it.<br />-Better position for breathing as long as your back is supported and shoulders relaxed.<br />ORGANS:<br />Heart: Located between the lungs in the centre of the chest and to the left. Pumps the blood throughout the body.<br />Lungs : There are two lungs, the right has three lobes and the left has two lobes. The air comes into the lungs through the nose or mouth, travels down the trachea which divides into the left and right bronchus into the respective lungs. Each bronchus then divides into smaller bronchi which become bronchioles and finally the alveoli (air sacs). This is where the air exchange happens. The capillaries’ (Tiny blood vessels) surround the alveoli, the fresh oxygen comes in and the carbon dioxide is exhaled out.<br />Inside the bronchus and bronchioles are the cilia. Their job is to.help any secretions move up and out of the respiratory system. They are in constant movement. This movement is affected by any toxic substance inhaled into the lings including cigarette smoke. If the cilia are do not work properly, the secretions tend to pool in the lungs and may cause an infection or an inflammation. Once they are damaged, it is permanent The cilea do not regrow.. <br />ENDURANCE TRAINING<br />ENDURANCE or AEROBIC training means:<br />Exercising at a low intensity for a long duration while using large muscle groups. The exercise should be comfortable and enjoyable. Examples include walking and biking.<br />The goal in doing endurance exercise is to train your muscles to be more efficient, or better, at using oxygen. The end result will make physical activities feel easier and allow you to do more.<br />Normal Responses during exercise: Increased heart rate, Increased breathing rate and mild increase of shortness of breath.<br />For endurance training, you should be in an appropriate “Training Zone” This can be monitored by the following :<br />Heart rate (your age-related traing zone)<br />Shortness of breath (2 – 4 out of 10 on the SOB scale, or 2 above resting level)<br />The talk test (you can still talk during exercise)<br />HOW OFTEN ?? The goal will be to achieve 20 to 30 minutes, 5 days a week<br />HOW LONG?? Forever !!!!! “If you don’t keep it, you lose it”<br />We also aim to deisgn your exercise program so that it is specific to functional needs and goals. For example, if your goal is to be able to walk up a hill to get to church, we will train you to walk using an incline on the treadmill. Training only on a bicyle in this case would not necessarily allow you to fully reach your goal.<br />PRECAUTIONS with endurance training:<br />Chest, arm or jaw pain or pressure<br />Unexplained swelling in your legs<br />Increased SOB or bad lung infection<br />Increased blood pressure<br />If you have a dramatic change in your medical condition as above, or are hospitalized, consult your physiotherapist or doctor before resuming exercise.<br />Posted by Peter Ellis at Tuesday, May 13, 2008 0 comments <br />Sunday, December 24, 2006<br />Corticosteroid Induced Osteopenia <br />Last October of 2006, I had a bone density scan of my lower spine, left hip and left wrist because I have been on a Flovent (a corticosteroid) for the last ten years for my COPD and bronchiectasis.<br />Last December, my GP told me that the bone density scan showed my bones were thin and I was at moderate risk for bone breakage!<br />My GP then prescibed Didrocal medicine! I take one tablet with a glass of water every evening before going to bed!<br />My respirologist warned me 8 yrs ago that one side effect of 250 mcg of Flovent was osteoporosis! I will start this calcium therapy treatment next Monday, Dec 26, 2006.<br />All I can say now it was a good thing that I had a bone density scan. <br />Posted by Peter Ellis at Sunday, December 24, 2006 2 comments <br />Friday, June 30, 2006Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com4tag:blogger.com,1999:blog-20453121.post-64500460693240875912008-05-13T11:56:00.001-05:002008-05-13T11:56:54.213-05:00<p class="MsoNormal" align="center" style="text-align:center"><u><span style="font-size:16.0pt;line-height:115%;font-family:"Arial","sans-serif"">ANATOMY of the RESPIRATORY SYSTEM<o:p></o:p></span></u></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><u><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">SKELETON<o:p></o:p></span></u></b></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif""><span style="mso-tab-count:1"> </span><b style="mso-bidi-font-weight:normal">RIBS</b>:<span style="mso-spacerun:yes"> </span>12 in total (2 are floating)<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif""><span style="mso-tab-count:2"> </span>Protects the lings and heart<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:36.0pt"><b style="mso-bidi-font-weight: normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">STERUM</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">:<span style="mso-spacerun:yes"> </span>Breast Bone at front of the chest<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:36.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">Costo-sterum and costo-vertebral joints: where the ribs meet the sternum at the<span style="mso-tab-count:1"> </span>front and the vertebrae in the back<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif""><span style="mso-tab-count:1"> </span><b style="mso-bidi-font-weight:normal">SCAPULAR</b>:<span style="mso-spacerun:yes"> </span>complex (shoulder blade): attaches to the back of the rib cage<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><u><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">IMPACT OF PROBLEMS WITH THE SKELETON<o:p></o:p></span></u></b></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">The joints of the rib cage (costo-sternal and costo-vertebral) can become irritated with repetitive coughing.<span style="mso-spacerun:yes"> </span>You may experience pain in the front of your chest or at the back where the joints are..<span style="mso-spacerun:yes"> </span>If you experience a sudden onset of severe pain, this pain may indicate rib fracture. You should ask your doctor so she/he can provide with proper pain management. You may be at risk of rib fracture if you are know to have osteoporosis or if you have prolonged courses of steroids (Prednizone).<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">To avoid rib fracture or irritated joints, you should practise controlled coughing techniques.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">If your ribs are stiff due to your lung disease and (air trapping), you will need to do some thoracic mobility exercises to maintain movement you have or try to improve it.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">Pursed exhalation creates positive pressure in the lung to prevent air trapping.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><u><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">MUSCLES OF RESPIRATION</span></u></b><span style="font-size:12.0pt;line-height:115%; font-family:"Arial","sans-serif"">:<o:p></o:p></span></p> <p class="MsoListParagraphCxSpFirst" style="text-indent:-18.0pt;mso-list:l0 level1 lfo1"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"; mso-fareast-font-family:Arial"><span style="mso-list:Ignore">1.<span style="font:7.0pt "Times New Roman""> </span></span></span><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height: 115%;font-family:"Arial","sans-serif"">DIAPHRAGM:</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif""> Main muscle of breathing. Repsonsible for 60 to 80 percent of the work during inspiration.<span style="mso-spacerun:yes"> </span>Domed shaped. Creates negative pressure in lung to bring air in.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpLast" style="text-indent:-18.0pt;mso-list:l0 level1 lfo1"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"; mso-fareast-font-family:Arial"><span style="mso-list:Ignore">2.<span style="font:7.0pt "Times New Roman""> </span></span></span><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height: 115%;font-family:"Arial","sans-serif"">INTERCOSTALS:</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif""><span style="mso-spacerun:yes"> </span>Small muscles located in between each ribs. Responsible for 40 percent of the air intake during inhalation<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><b style="mso-bidi-font-weight: normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">3<span style="mso-spacerun:yes"> </span>ACCESSORY MUSCLES</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">:<span style="mso-spacerun:yes"> </span>muscles of the neck, not designed to work all the <o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">time. Used by people with ling disease when in distress or because they have<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">developed poor breathing pattern.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><u><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">HOW WE BREATHE</span></u></b><span style="font-size:12.0pt;line-height:115%; font-family:"Arial","sans-serif"">:<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">The normal ratio of breathing is 1:2, inspiration/expiration. For example, if uou breathe in for 2 seconds you should breathe out in 4 seconds.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><b style="mso-bidi-font-weight: normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">When we breathe in,<span style="mso-spacerun:yes"> </span>inspiration<span style="mso-spacerun:yes"> </span>or inhalation<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">-The diaphragm contracts and shortens which flattens it. It allows more space for the lungs to expand.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">-The intercostals contract which makes the ribs move out and up in a “Bucket handle” swinging movement.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><b style="mso-bidi-font-weight: normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">When we breathe out, expiration or exhalation<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">-The diaphragm passively returns to its dome shape.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">-The intercostals relax and allow the ribs to return to their starting position.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">-The abdominal muscles help to push the air out during forced expiration. This happens when doing your flow tests or when coughing.<span style="mso-spacerun:yes"> </span>If you use your abdominal muscles all the time, as some people with lung disease do, the muscles get tired which leaves you fatigued.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><span style="font-size:12.0pt; line-height:115%;font-family:"Arial","sans-serif"">-People with emphysema have a slow and prolonged forced expiration.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:18.0pt"><b style="mso-bidi-font-weight: normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Impact of problems with muscles of breathing<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-indent:18.0pt"><b style="mso-bidi-font-weight: normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">-</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Harder to breathe when carrying heavy parcels because the muscles in your arms and chest are being used to lift instead of helping you breathe properly. What are the possible solutions to this problem?<span style="mso-spacerun:yes"> </span>Cary lighter loads, use a cart, get your groceries delivered, let you legs do more of the work when lifting from the floor.<span style="mso-spacerun:yes"> </span>These tips should make it easier on your breathing and on your heart.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">-Obstacles that can make breathing more difficult:<span style="mso-spacerun:yes"> </span>obesity, pregnancy, a large meal, bloating, and poor posture.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">All of theses can push up on your diaphragm and don’t allow it to flatten out on inspiration, The lungs don’t have as much room to expand thus making you short of breath.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">How position can affect your diaphragm<o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Lying flat on your spine (supine)</span></b><span style="font-size:12.0pt;line-height: 115%;font-family:"Arial","sans-serif"">:<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">-The resting level of the diaphragm rises up towards the lungs.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">-Gravity pulls down on the ribs, making it harder to move them up.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">- The organs are pushed up towards the diaphragm and it makes it more difficult to breathe.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Solution</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">: Lie with pillows positioned under the upper back and head<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Sitting</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif""> :<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">-Gravity helps the diaphragm flatten out by pulling down on it.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">-Better position for breathing as long as your back is supported and shoulders relaxed.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">ORGANS</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">:<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Heart:</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif""><span style="mso-spacerun:yes"> </span>Located between the lungs in the centre of the chest and to the left. Pumps <span style="mso-spacerun:yes"> </span>the blood <span style="mso-spacerun:yes"> </span>throughout <span style="mso-spacerun:yes"> </span>the <span style="mso-spacerun:yes"> </span>body.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Lungs :</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif""><span style="mso-spacerun:yes"> </span>There are two lungs, the right has three lobes and the left has two lobes. The air comes into the lungs through the nose or mouth, travels down the trachea which divides into the left and right bronchus into the respective lungs.<span style="mso-spacerun:yes"> </span>Each bronchus then divides into smaller bronchi which become bronchioles and finally the alveoli (air sacs).<span style="mso-spacerun:yes"> </span>This is where the air exchange happens.<span style="mso-spacerun:yes"> </span>The capillaries’ (Tiny blood vessels) surround the alveoli, the fresh oxygen comes in and the carbon dioxide is exhaled out.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">Inside the bronchus and bronchioles are the cilia.<span style="mso-spacerun:yes"> </span>Their job is to.help any secretions move up and out of the<span style="mso-spacerun:yes"> </span>respiratory system.<span style="mso-spacerun:yes"> </span>They are in constant movement.<span style="mso-spacerun:yes"> </span>This movement is affected by any toxic substance inhaled into the lings including cigarette smoke. If the cilia are do not work properly, the secretions tend to pool in the lungs and may cause an infection or an inflammation.<span style="mso-spacerun:yes"> </span>Once they are damaged, it is permanent<span style="mso-spacerun:yes"> </span>The cilea do not regrow.. <o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><u><span style="font-size:14.0pt;line-height:115%;font-family:"Arial","sans-serif"">ENDURANCE TRAINING<o:p></o:p></span></u></b></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">ENDURANCE or AEROBIC training means:<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">Exercising at <b style="mso-bidi-font-weight:normal">a low intensity</b> for <b style="mso-bidi-font-weight:normal">a long duration</b> while using large muscle groups. The exercise should be comfortable and enjoyable. Examples include walking and biking.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">The goal in doing endurance exercise is to train your muscles to be more efficient, or better, at using oxygen. The end result will make physical activities feel easier and allow you to do more.<o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Normal Responses during exercise</span></b><span style="font-size:12.0pt;line-height: 115%;font-family:"Arial","sans-serif"">:<span style="mso-spacerun:yes"> </span>Increased heart rate, Increased breathing rate and mild increase of shortness of breath.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">For endurance training, you should be in an appropriate <b style="mso-bidi-font-weight:normal">“Training Zone”<span style="mso-spacerun:yes"> </span></b>This can be monitored by the following :<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Heart rate</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif""> (your age-related traing zone)<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Shortness of breath</span></b><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif""> (2 – 4 out of 10 on the SOB scale, or 2 above resting level)<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">The talk test</span></b><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif""> (you can still talk during exercise)<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">HOW OFTEN ??</span></b><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif""><span style="mso-spacerun:yes"> </span>The goal will be to achieve 20 to 30 minutes, 5 days a week<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">HOW LONG??<span style="mso-spacerun:yes"> </span>Forever !!!!!</span></b><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif""><span style="mso-spacerun:yes"> </span>“If you don’t keep it, you lose it”<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%;font-family: "Arial","sans-serif"">We also aim to deisgnyour exercise program so that it is specific to functional needs and goals.<span style="mso-spacerun:yes"> </span>For example, if your goal is to be able to walk up a hill to get to church, we will train you to walk using an incline on the treadmill. Training only on a bicyle in this case would not necessarily allow you to fully reach yout goal.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><u><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">PRECAUTIONS with endurance training</span></u></b><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">:<o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Chest, arm or jaw pain or pressure<o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Unexplained swelling in your legs<o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Increased SOB or bad lung infection<o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">Increased blood pressure<o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"">If you have a dramatic change in your medical condition as above, or are hospitalized, consult your physiotherapist or doctor before resuming exercise.<o:p></o:p></span></b></p>Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com1tag:blogger.com,1999:blog-20453121.post-1166987741400855042006-12-24T13:53:00.000-05:002007-02-23T14:27:09.089-05:00Corticosteroid Induced OsteopeniaLast October of 2006, I had a bone density scan of my lower spine, left hip and left wrist because I have been on a Flovent (a corticosteroid) for the last ten years for my COPD and bronchiectasis.<br /><br />Last December, my GP told me that the bone density scan showed my bones were thin and I was at moderate risk for bone breakage!<br /><br />My GP then prescibed Didrocal medicine! I take one tablet with a glass of water every evening before going to bed!<br /><br />My respirologist warned me 8 yrs ago that one side effect of 250 mcg of Flovent was osteoporosis! I will start this calcium therapy treatment next Monday, Dec 26, 2006.<br />All I can say now it was a good thing that I had a bone density scan.Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-1151683632745634662006-06-30T11:03:00.000-05:002006-09-02T12:47:15.586-05:00PEG Tube Insertion June 8, 2006<p class="MsoNormal" style="TEXT-ALIGN: center" align="center"><b><u><span style="font-family:Arial;">PEG TUBE INSERTION</span></u></b><b><u><span style="font-family:Arial;"><?xml:namespace prefix = o /><o:p></o:p></span></u></b></p><p class="MsoNormal" style="TEXT-ALIGN: center" align="center"><b><span style="font-family:Arial;">(Percutaneous Endoscopic Gastrostomy)</span></b><b><span style="font-family:Arial;"><o:p></o:p></span></b></p><p class="MsoNormal" style="TEXT-ALIGN: center" align="center"><?xml:namespace prefix = st1 /><st1:date month="6" day="29" year="2006"><span style="font-family:Arial;">Dated: June 29, 2006</span></st1:date><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal" style="TEXT-ALIGN: center" align="center"><span style="font-family:Arial;">by Peter C Ellis</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal" style="TEXT-ALIGN: center" align="center"><a href="mailto:pcellis2001@rogers.com">pcellis2001@rogers.com</a></p><p class="MsoNormal"><b><u><span style="font-family:Arial;">MY DECISION</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">Two months ago, I decided it was best for my health to have a PEG (percutaneous endoscopic gastrostomy) feeding tube installed into my stomach. I told my wife at that time that if I continue to eat orally and aspirate food into my lungs I was just asking for trouble. My decision was based on the risks and complications that could or would develop (as explained to me from my respirologist, physiatrist, speech language pathologist and my GP) if I was to get aspiration pneumonia. </span><b><span style="font-family:Arial;">The solution became very evident.</span></b><span style="font-family:Arial;"> </span><b><i><span style="font-family:Arial;">I just have to stop eating orally permanently, stop the aspiration of food into my lungs and get a PEG tube</span></i></b><span style="font-family:Arial;">. This means that I would not eat orally again for thr rest of my life time.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p>The above medical professionals who have looked after me for last ten years, all collectively, insisted that I had to have a PEG tube </span><b><span style="font-family:Arial;">now</span></b><span style="font-family:Arial;">. I resisted their advice for a year but finally two months ago, I agreed and accepted their position. </span><b><span style="font-family:Arial;">The PEG insertion was done on </span></b><st1:date month="6" day="8" year="2006"><b><span style="font-family:Arial;">June 8, 2006</span></b></st1:date><b><span style="font-family:Arial;"> by a gastroenterologist</span></b><span style="font-family:Arial;">. Three days later it became infected and my surgeon prescribed antibiotics for ten days. The infection has now gone and the hole into my stomach (stoma) has started to heal.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><span style="font-family:Arial;">My reasoning for getting a PEG tube was based on the following logic</span></b><span style="font-family:Arial;">: Owing to the fact that I have chronic obstructive pulmonary disease </span><b><span style="font-family:Arial;">(COPD)</span></b><span style="font-family:Arial;"> and that </span><b><span style="font-family:Arial;">my forced expiratory capacity,</span></b><span style="font-family:Arial;"> a year ago, </span><b><span style="font-family:Arial;">in the first second (FEV1)</span></b><span style="font-family:Arial;"> </span><b><span style="font-family:Arial;">was 34% of normal</span></b><b><span style="font-family:Arial;">. </span></b><span style="font-family:Arial;">This</span><b><span style="font-family:Arial;"> </span></b><span style="font-family:Arial;">is complicated by my bronchiectasis. I was told that I would not have much reserve lung capacity to fight pneumonia. In the last ten years, </span><b><span style="font-family:Arial;">my FEV1 reading has decreased by 2% per year</span></b><span style="font-family:Arial;">. Today, I expect it to around 32% of normal. I believe when FEV1 is below 25%, one will then require oxygen. On July 19</span><sup><span style="font-family:Arial;">th</span></sup><span style="font-family:Arial;">., I have an appointment to see my respirologist at the Rehabilitation Centre on </span><st1:street><st1:address><span style="font-family:Arial;">Smythe Road</span></st1:address></st1:street><span style="font-family:Arial;">.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p>I have had </span><b><span style="font-family:Arial;">bronchiectasis for seven years</span></b><span style="font-family:Arial;">, a disease that is caused by aspiration of foreign particles into one's lungs. Three years ago I had respiratory physiotherapy which taught me lung hygiene and coughing strategies in how to clear my lungs of mucus which I carry out every day. </span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><u><span style="font-family:Arial;">LIFE STYLE CHANGE</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">Two and one half weeks later, I have really found out that living with a PEG tube is a </span><b><span style="font-family:Arial;">huge life style change. It has really curtailed my daily activities</span></b><span style="font-family:Arial;"><span style="font-size:0;"> </span>as I have to </span><b><span style="font-family:Arial;">spend four hours a day</span></b><span style="font-family:Arial;"> </span><b><span style="font-family:Arial;">connected up to my<span style="font-size:0;"> </span>500 ml<span style="font-size:0;"> </span>feeding bag </span></b><span style="font-family:Arial;">on the </span><b><span style="font-family:Arial;">I.V. pole using 400 ml/hr Kangaroo pump</span></b><span style="font-family:Arial;">. I have four feedings a day, each one lasting one hour where I consume 375 ml of formula or 450 calories. I estimate that </span><b><span style="font-family:Arial;">I spend another hour in doing preparation work</span></b><span style="font-family:Arial;"> as follows: putting new dressings around the stoma; flushing my PEG tube with water, using a 35 cc syringe, before and after each feeding; filling the feeding bag with formula and priming the feed tube lines with formula; etc. </span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><u><span style="font-family:Arial;">FORMULA</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">After </span><b><span style="font-family:Arial;">three home visits </span></b><span style="font-family:Arial;">and discussion, my </span><b><span style="font-family:Arial;">dietitian</span></b><span style="font-family:Arial;"><span style="font-size:0;"> </span>decided<span style="font-size:0;"> </span>that I will require </span><b><span style="font-family:Arial;">2,100 calories a day</span></b><span style="font-family:Arial;">, based on my present weight of 186 lbs. and height of 6 ft and 1-1/2 ins to sustain myself. Because I was taking a teaspoon of </span><b><span style="font-family:Arial;">Metamucil</span></b><span style="font-family:Arial;"> with water every night when I was eating orally, my dietitian concluded that I would need </span><b><span style="font-family:Arial;">fibre </span></b><span style="font-family:Arial;">in the formula. </span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p>My dietitian then recommended<span style="font-size:0;"> </span></span><b><span style="font-family:Arial;">Novartis Isosource HN with fibre having 1.2 calories per ml. </span></b><span style="font-family:Arial;">I have to take </span><b><span style="font-family:Arial;">six (350 ml) cans (300 cals) of formula each day to make up 1,800 calories. </span></b><span style="font-family:Arial;">The </span><b><span style="font-family:Arial;">remaining balance of</span></b><span style="font-family:Arial;"> </span><b><span style="font-family:Arial;">300 calories </span></b><span style="font-family:Arial;">is to be made up from either having </span><b><span style="font-family:Arial;">two Novaritis thickened juice containers (237 ml) and 160 cals each (nectar consistency), or a pudding and thickened pint of beer.</span></b><span style="font-family:Arial;"> This means </span><b><span style="font-family:Arial;">that I have to have four feedings a day</span></b><span style="font-family:Arial;">, </span><b><span style="font-family:Arial;">each lasting an hour.</span></b><span style="font-family:Arial;"> </span><b><span style="font-family:Arial;">I find this very time consuming!!</span></b><b><span style="font-family:Arial;"><o:p></o:p></span></b></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><span style="font-family:Arial;">I am not allowed to drink orally any liquid</span></b><span style="font-family:Arial;"> unless it is thickened up to nectar consistency with </span><b><span style="font-family:Arial;">Novartis thickening powder</span></b><span style="font-family:Arial;">.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><b><span style="font-family:Arial;"><o:p></o:p></span><u><span style="font-family:Arial;">HOME CARE NURSING</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">For the first two weeks, a home care nurse came to my home daily. Now, she comes only twice a week on mondays and thursdays. They </span><b><span style="font-family:Arial;">look after all my medical home care needs</span></b><span style="font-family:Arial;"> such as </span><b><span style="font-family:Arial;">tube feeding supplies</span></b><span style="font-family:Arial;">, </span><b><span style="font-family:Arial;">stoma cleaning medical supplies</span></b><span style="font-family:Arial;"> and my well being.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p>Yesterday, I asked my nurse to order me</span><b><span style="font-family:Arial;"> some 500 ml gravity feed bags</span></b><span style="font-family:Arial;"> because my bulbar polio friend in Toronto who has had a PEG tube for a year now, says </span><b><span style="font-family:Arial;">that it only takes her ¾ hr. to feed herself 500 ml by gravity feed with only three feedings a day as compared to my four</span></b><span style="font-family:Arial;">. </span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p>My dietitian then agreed that I should try using gravity feed bags. Based on three 500 ml feedings a day, I could expect to save at least one hour in the beginning if I tolerated it. Gradually I would try to lower the feeding time to three quarters of an hour. My time connected up to the I.V pole would then be 2 and ¼ hours as compared to 4 hours, a savings of 1-3/4 hours.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><u><span style="font-family:Arial;">TUBE FEEDING SUPPLIES</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">Comprise of one I.V. Pole, one Kangaroo Enterable feeding pump rated at 400 ml max per hour, one Kangaroo Pump set easy cap closure 500 ml feeding bag with delivery tubing and twenty five Sterile Softpack 35 cc Catheter Tip Syringes for flushing.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><b><span style="font-family:Arial;"><o:p></o:p></span><u><span style="font-family:Arial;">STOMA MEDICAL CLEANING SUPPLIES</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">Comprise the following: Cotton tip applicators, 2x2 in Topper Drain swabs, surgical tape, gloves, Flex-Trak Anchors, bottle of saline irrigation solution, hydrogen peroxide, etc.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><st1:state><st1:place><b><u><span style="TEXT-TRANSFORM: uppercase;font-family:Arial;" >Ontario</span></u></b></st1:place></st1:state><b><u><span style="TEXT-TRANSFORM: uppercase;font-family:Arial;" >'s Heath and Long-Term Care Program--Assistive Devices Plan (ADP)</span></u></b><b><u><span style="TEXT-TRANSFORM: uppercase;font-family:Arial;" ><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">The Ontario ADP will cover the cost of an enteral feeding pump only for people who are on continuous feeding for six or more hours a day. I guess I am out of luck!</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><st1:state><st1:place><b><u><span style="TEXT-TRANSFORM: uppercase;font-family:Arial;" >Ontario</span></u></b></st1:place></st1:state><b><u><span style="TEXT-TRANSFORM: uppercase;font-family:Arial;" >'s Heath and Long-Term Care Program—NUTRITION PRODUCTS</span></u></b><b><u><span style="TEXT-TRANSFORM: uppercase;font-family:Arial;" ><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">The Ontario Drug Benefit Plan (ODB) will cover the costs of my expenses for my </span><b><span style="font-family:Arial;">Isosource HN with fibre 1.2 once I get a prescription for it from my doctor.</span></b><span style="font-family:Arial;"> My dietition has filled out and Ontario Drug Benefit Application form and faxed it to my GP last Monday. Tomorrow I have an appointment with my GP to discuss this further.<span style="font-size:0;"> </span></span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><u><span style="font-family:Arial;">THE NEXT DAY</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">Well, when I saw my GP, </span><b><span style="font-family:Arial;"><span style="font-size:0;"></span></span></b><b><span style="font-family:Arial;">s</span></b><b><span style="font-family:Arial;">he </span></b><b><span style="font-family:Arial;">immediately </span></b><b><span style="font-family:Arial;">filled out and signed The </span></b><st1:state><st1:place><b><span style="font-family:Arial;">Ontario</span></b></st1:place></st1:state><b><span style="font-family:Arial;"> Drug Plan Nutrition Products form</span></b><span style="font-family:Arial;"> which I then gave to </span><b><span style="font-family:Arial;">my pharmacist</span></b><span style="font-family:Arial;"> with a </span><b><span style="font-family:Arial;">prescription for 240 days for my Isosource HN with fibre 1.2</span></b><span style="font-family:Arial;">. Instead of paying $ 60.00 for one case of 24 cans I will only pay $ 6.11 for ten cases of 24 cans which is actually worth $ 600.00 without a prescription. My pharmacy will deliver 10 cases to me on Friday afternoon.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><u><span style="font-family:Arial;">TODAY’S </span></u></b><b><u><span style="font-family:Arial;">TUBE FEEDINGS</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">I am now </span><b><span style="font-family:Arial;">on three tube feedings a day taking in 500</span></b><b><span style="font-family:Arial;"> </span></b><b><span style="font-family:Arial;">mls per feeding in 1hr 20 minutes for each feeding</span></b><span style="font-family:Arial;">.<span style="font-size:0;"> </span>I like this much better.<span style="font-size:0;"> </span>I will also try using gravity feed bags next week where I hope to reduce each feeding down to one hour. I have now regained 4 pounds and weigh 182 lbs. My nurse is coming only once a week.</span><span style="font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span style="font-family:Arial;"><o:p></o:p></span><b><u><span style="font-family:Arial;">AN UNFORTUNATE INCIDENT</span></u></b><b><u><span style="font-family:Arial;"><o:p></o:p></span></u></b></p><p class="MsoNormal"><span style="font-family:Arial;">Two days ago when I getting out of my car, the external cap or plug which closes the PEG tube to the outside came off and all hell broke loose. All the contents in my stomach came rushing out the tube and soiled my underwear, shorts, socks and shoes. Now I use a paper clip with gauze to clamp the tube. This is part of the learning process. The same thing happened to my bulbar polio friend in </span><st1:city><st1:place><span style="font-family:Arial;">Toronto</span></st1:place></st1:city><span style="font-family:Arial;"> while she was sleeping in bed. My nurse has ordered some gaget that will prevent this from happening again.</span></p><p class="MsoNormal"><span style="font-family:Arial;"><strong>JULY the 9th. UPDATE</strong>:</span></p><p class="MsoNormal"><span style="font-family:Arial;">I am down to three feedings a day, each taking between 3/4 to 1 hour, using gravity feed bags instead of the Kangaroo feed pump bags.</span></p>Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0tag:blogger.com,1999:blog-20453121.post-1136318466866052272006-01-03T15:01:00.000-05:002006-01-03T15:01:52.803-05:00My appointment with the Respirologist<strong></strong><strong></strong><br /><strong><u><span style="font-family:Arial;">Spirometry Results</span></u></strong><br /><ol><li><strong><span style="font-family:Arial;">Values were lower today as compared to those on Jan 14, 2004</span></strong></li><br /><li><strong><span style="font-family:Arial;"> Actual FEV1 (L) today was 1.25 L as compared to 1.47L It decreased from 38% of normal to 33% of normal</span></strong></li><br /><li><strong><span style="font-family:Arial;">Actual FVC (L) today was 3.42 L as compared to 4.09 L. It decreased from 85 % of normal to 72%</span></strong></li><br /><li><strong><span style="font-family:Arial;">FEV1/FVC (%) today was 37% as compared to 36% .</span></strong></li><br /><li><strong><span style="font-family:Arial;">FEF 25-75% (L/Sec) today was 0.44 as compared to 0.40. It increased from 11 % of normal to 12%.</span></strong></li><br /><li><strong><span style="font-family:Arial;">FEP Max (L/sec) today was 51% of normal as compared to 61% .</span></strong></li><br /><li><strong><span style="font-family:Arial;">Expiratory Time (sec) today was 10.16 sec as compared to 13.73 sec.</span></strong></li></ol><strong><u><span style="font-family:Arial;">My conclusions</span></u></strong><br /><ol><li><strong><span style="font-family:Arial;">There are three different processes going on that are contributing</span></strong></li></ol><strong><span style="font-family:Arial;">to my poor lung condition</span></strong><br /><ul><br /><li><strong><span style="font-family:Arial;">Aspiration owing to my moderate to severe swallowing difficulties which has caused my bronchiectasis.</span></strong></li><br /><li><strong><span style="font-family:Arial;">Bronchiectasis lung condition makes you more susceptible in getting lung infections.</span></strong></li><br /><li><strong><span style="font-family:Arial;">My COPD caused by my prior 12 yrs of heavy smoking has limited my reserve lung capacity to fight pneumonias as compared to a normal person and will further decrease an amount every year to a point where I will require oxygen.</span></strong></li><br /><li><strong><span style="font-family:Arial;">My ability to fight and recover from pneumonias will further decrease accordingly as my FEV1 decreases or as my reserve lung function decreases.</span></strong></li><br /><li><strong><span style="font-family:Arial;">The conclusion to be drawn from all this is if I get pneumonia the resulting consequence could be quite severe as compared to a normal person.</span></strong></li><br /><li><strong><span style="font-family:Arial;">The unfortunate reality for a person with COPD lung disease is that every year the spirometry results decrease . Your well being gets worse. You get shorter of breath and ones ability to fight pneumonias gets worse. The need to be on oxygen gets higher.</span></strong></li><br /><li><strong><span style="font-family:Arial;">The FEV1 reading will decrease by 5 % of normal every year. Below 25% things get worse and one’s ability to fight pnuemonia gets worse.</span></strong></li></ul><strong><u><span style="font-family:Arial;">TUBE FEEDING</span></u></strong><br /><strong><span style="font-family:Arial;">There are three medical professionals recommending a JPEG tube at this time: my Speech Language Pathologist , my physiatist and my respirologist. They are two against it , my gastroenterolgist and myself.</span></strong><br /><strong><u><span style="font-family:Arial;">ANTIBIOTIC PRESCRIPTION</span></u></strong><br /><strong><span style="font-family:Arial;">My respirologist filled out a prescription and I am to fill it out when I feel the need arises Ie: more shortness of breath, fever, the colour of my sputum changes from yellow to green and difficulty in coughing and breathing.</span></strong><br /><strong><u><span style="font-family:Arial;">LUNG HYGEINE</span></u></strong><br /><strong><span style="font-family:Arial;">Is the most important thing that I can do for my lungs</span></strong><br /><strong><u><span style="font-family:Arial;">PROGNOSIS</span></u></strong><br /><strong><span style="font-family:Arial;">My respirologist stressed that my gasterenterologist does not know my complete story as to whether or not I should have a feeding tube.</span></strong><br /><strong><span style="font-family:Arial;">My COPD will get worse every year and eventually I will have to be on oxygen. The downward slope of my COPD deterioration has been normal as compared to other people who have COPD.</span></strong>Peter C Ellishttp://www.blogger.com/profile/14163622667469360054noreply@blogger.com0