SYMPTOMS :
Coughing during the day and at night in bed, short of breath and lots of infamation in my chest.
Blood oxygen saturation level: 91 %
PRESCRIBED MEDICINES:
1. ANTIBIOTIC: Teva-Levofloxacin 750 mg. Take one daily after food for seven days
2. PREDNISONE 50mg: Take one daily after food for inflamation.
Saturday, March 31, 2012
PEG TUBE SITE RELOCATION, MARCH 31,2012
MY PEG TUBE RELOCATION TO ANOTHER SITE
BY Peter C Ellis, Age 75, Dated March 31, 2012
REASON FOR NEW SITE:
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
SURGERY:
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.
CARE OF EXISTING SIX YEAR OLD STOMA:
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.
Today my old stoma has completely healed and is closed.
LESSONS TO BE LEARNED FROM MY EXPERIENCE:
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.
MAINTENANCE OF MY NEW STOMA:
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.
CARE OF SKIN BURNS AROUND OLD STOMA: Apply Calmoseptine pink cream.
Signed: Peter C Ellis
BY Peter C Ellis, Age 75, Dated March 31, 2012
REASON FOR NEW SITE:
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
SURGERY:
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.
CARE OF EXISTING SIX YEAR OLD STOMA:
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.
Today my old stoma has completely healed and is closed.
LESSONS TO BE LEARNED FROM MY EXPERIENCE:
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.
MAINTENANCE OF MY NEW STOMA:
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.
CARE OF SKIN BURNS AROUND OLD STOMA: Apply Calmoseptine pink cream.
Signed: Peter C Ellis
Friday, July 22, 2011
Chart showing deteriation of My lung Function from 1998 to 2011 owing to COPD and late effects of polio
DATE FEV1 (L) % of Normal FVC (L) % of Normal Oygen
Jul-11 0.99 29% 3.00 64% 93-94 %
Jan-11 1.09 31% 2.97 61% 96%
Apr-10 1.01 29% 2.54 53% 92 % Ax
Jul-10 0.97 28% 2.88 61% 92% Ax
Nov-09 1.31 37% 2.85 59% 92 % Ax
Jan-09 1.26 35% 3.03 63% 92% Ax
May-08 1.28 36% 3.18 65% 91 % AX
Nov-07 1.49 42% 3.53 72% 92 % Ax
May-07 1.20 33% 3.04 62% 92% Ax
Nov-05 1.25 33% 3.42 72% 91 % AX
Jan-04 1.47 38% 4.09 85%
91 % AX
Oct-03 1.38 36% 3.21 68% 91 % AX
Jul-98 2.19 66% 3.4 71% 91 % AX
SUMMARY:
Amount of air expired in the first second (FEV1) has deteriorated from 66 % of
normal to 29 % of normal or in 13 years. Today I get short of breath if I do
physical exertion.
My total expired air volume has decreased from 71 % of normal to 64 % of normal
in 13 years.
Jul-11 0.99 29% 3.00 64% 93-94 %
Jan-11 1.09 31% 2.97 61% 96%
Apr-10 1.01 29% 2.54 53% 92 % Ax
Jul-10 0.97 28% 2.88 61% 92% Ax
Nov-09 1.31 37% 2.85 59% 92 % Ax
Jan-09 1.26 35% 3.03 63% 92% Ax
May-08 1.28 36% 3.18 65% 91 % AX
Nov-07 1.49 42% 3.53 72% 92 % Ax
May-07 1.20 33% 3.04 62% 92% Ax
Nov-05 1.25 33% 3.42 72% 91 % AX
Jan-04 1.47 38% 4.09 85%
91 % AX
Oct-03 1.38 36% 3.21 68% 91 % AX
Jul-98 2.19 66% 3.4 71% 91 % AX
SUMMARY:
Amount of air expired in the first second (FEV1) has deteriorated from 66 % of
normal to 29 % of normal or in 13 years. Today I get short of breath if I do
physical exertion.
My total expired air volume has decreased from 71 % of normal to 64 % of normal
in 13 years.
Tuesday, April 19, 2011
COPD exacerbation in mid March 2011
My 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.
PROGNOSIS: COPD exacerbation
HIGH RISK: I am a very high risk to get aspiration pneumonia.
PROGNOSIS: COPD exacerbation
HIGH RISK: I am a very high risk to get aspiration pneumonia.
My Walking Program
For 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.
Crushed T-11 and L-1 vertebrae in April, 2008 during an accidental fall in the bath tub
On 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.
Wednesday, October 06, 2010
Aspiration Pneumonia diagnosed in June, 2010
In June, 2010 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 Teva-Levoflaxacin. I took three 250 mgs tablets three times daily for a total of 750 mgs daily. It really helped me and I have been fine since then.
I also had my yearly Chest CT scan in June and saw my respirologist in mid July 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.
However for the last month and a half I have been going to two different shopping malls to walk with my walker over 1-1/2 kms daily, which I never did before.
I also had my yearly Chest CT scan in June and saw my respirologist in mid July 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.
However for the last month and a half I have been going to two different shopping malls to walk with my walker over 1-1/2 kms daily, which I never did before.
Tuesday, March 23, 2010
Came down with aspiration pneumonia in late February, 2010
In 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.
CAUSE : I aspirated my saliva into my lungs as I have not eaten orally since Dec 2008.
CAUSE : I aspirated my saliva into my lungs as I have not eaten orally since Dec 2008.
Friday, December 04, 2009
My six week hospitalization for a lung infection and pneumonia from August 8 to Sept 17, 2009
For 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.
The third week was spent on the medicine floor.
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.
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.
The third week was spent on the medicine floor.
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.
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.
Saturday, March 28, 2009
My Dressing supplies used to take care of my PEG Tube Stomina
MY DRESSING SUPPLIES FOR PEG TUBE STOMINA
BY: PC Ellis March 18, 2009
1. Medicom 2 in x 2 in all gauze sponges, 100 % cotton, 12 ply REF NO. 3002, http://www.medicom.ca
2. Dukal non-sterile gauze sponges, 2 in x 2 in.- 12 ply Ref no. 2128 http://www.dukal.com Dukal Corp. % Plant Ave., Hauppauge, NY 11788, tel no 631-6563800
3. Dukal 4 in x 4 in non sterile gauze sponges, 100% cotton – 8 ply Ref No. 4084 same as above info
4. TopplerSterile Drain Swabs 3 in by 3 in Ref No M12507 Made by Johnson & Johnson
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
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
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
8. Non-Sterile Cotton Tipped Aplicators, 3 in wood shaft
9. 500 ml Baxter 0.9 % Sodium Choride Irrigation solution Ref No JF7633 Made by Baxter Corp., Toronto Ontario
BY: PC Ellis March 18, 2009
1. Medicom 2 in x 2 in all gauze sponges, 100 % cotton, 12 ply REF NO. 3002, http://www.medicom.ca
2. Dukal non-sterile gauze sponges, 2 in x 2 in.- 12 ply Ref no. 2128 http://www.dukal.com Dukal Corp. % Plant Ave., Hauppauge, NY 11788, tel no 631-6563800
3. Dukal 4 in x 4 in non sterile gauze sponges, 100% cotton – 8 ply Ref No. 4084 same as above info
4. TopplerSterile Drain Swabs 3 in by 3 in Ref No M12507 Made by Johnson & Johnson
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
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
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
8. Non-Sterile Cotton Tipped Aplicators, 3 in wood shaft
9. 500 ml Baxter 0.9 % Sodium Choride Irrigation solution Ref No JF7633 Made by Baxter Corp., Toronto Ontario
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.
My Enternal Fedding Supplies that I use
MY ENTERAL FEEDING SUPPLIES Mar 17, 2009 BY Peter C Ellis
1. COMPAT 1000 ml Vinyl Gravity Feed Bag with preattached Enternal Delivery Gravity tubing . Ref No 199216 MADE BY NESTLES at http://www.nestlenutrition.com/us Toll free no 1-877-DEVICE-8. Covered by Ontario ADP.
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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://www.tycohealthcare.com.. Covered by Ontario ADP.
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
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.
ADP: Ontario Assistive Devices Program
1. COMPAT 1000 ml Vinyl Gravity Feed Bag with preattached Enternal Delivery Gravity tubing . Ref No 199216 MADE BY NESTLES at http://www.nestlenutrition.com/us Toll free no 1-877-DEVICE-8. Covered by Ontario ADP.
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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 http://www.tycohealthcare.com. Covered by Ontario ADP.
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://www.tycohealthcare.com.. Covered by Ontario ADP.
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
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.
ADP: Ontario Assistive Devices Program
Results of my Thoraic CT Scan on Dec 3, 2008
SUMMARY of RESULTS of LUNG CT SCAN on Dec 3 at QCH Feb 28, 2009
As told to me by Dr.E Kyrillos at The Family Medicine Clinic on Feb 20, 2009
GENERAL:
1 There is a cyst at the apex of segments 5 and 6 of the liver. The remainder of liver is unremarkable.
2 At the upper pole of right Kidney, there is a 1.9 cm lesion
3 In left lower lobe there is a 5 mm nodular density
4 In right lower lobe, there is a irregular speculated 1.2 cm mass and adjacent to this is a 6 mm nodule
OPINION :
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)
Ultrasound test on right kidney is recommended to check or confirm that the lesion is not a solid renal mass
BATERIA FROM SPUTEM SAMPLE on Feb 20, 2009 revealed bacteria called PSEUDOMONAS AERUGINOSA
This bacteria can only be treated with five different antibiotics according to Dr Kyrillos
Was prescribed APO-CIPROFLOX 750 MG or Ciprofloxacin HCL 750 MG om Fed 26.
FOLLOW UP APPOINTMENT with DR E Kyrilos is to be made after next CT Scan and Ultrasound test on right kidney.
As told to me by Dr.E Kyrillos at The Family Medicine Clinic on Feb 20, 2009
GENERAL:
1 There is a cyst at the apex of segments 5 and 6 of the liver. The remainder of liver is unremarkable.
2 At the upper pole of right Kidney, there is a 1.9 cm lesion
3 In left lower lobe there is a 5 mm nodular density
4 In right lower lobe, there is a irregular speculated 1.2 cm mass and adjacent to this is a 6 mm nodule
OPINION :
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)
Ultrasound test on right kidney is recommended to check or confirm that the lesion is not a solid renal mass
BATERIA FROM SPUTEM SAMPLE on Feb 20, 2009 revealed bacteria called PSEUDOMONAS AERUGINOSA
This bacteria can only be treated with five different antibiotics according to Dr Kyrillos
Was prescribed APO-CIPROFLOX 750 MG or Ciprofloxacin HCL 750 MG om Fed 26.
FOLLOW UP APPOINTMENT with DR E Kyrilos is to be made after next CT Scan and Ultrasound test on right kidney.
OC HOSPITAL STAY from Dec 7 to Dec 11, 2008
QCHospital Stay from Dec 7 to Dec 11, 2008
PNEUMONIA Taken by ambulance from my home to hospital early Sunday morning.
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.
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 %
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.
CHEST XRAY in hospital on Dec 8
ANTIBIOTIC: 750 mgs of LEVAQUIN once daily in morning for 15 days total including 5 days in hospital
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.
SPUTUM : Abundance of thick stringy white froth and very little yellow mucus
LUNG HYGIENE at home: Steam vaporizer with acapella
FOLLOWUP CT SCAN Ordered by Dr j Lemelin and was done on Dec 3 at QCH
Previous one was on July 18th at General Hospital. Have not been told results of it.
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.
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.
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.
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.
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
SPUTUM COLOUR Green. PLEASE test my sputum for infection.
PNEUMONIA Taken by ambulance from my home to hospital early Sunday morning.
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.
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 %
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.
CHEST XRAY in hospital on Dec 8
ANTIBIOTIC: 750 mgs of LEVAQUIN once daily in morning for 15 days total including 5 days in hospital
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.
SPUTUM : Abundance of thick stringy white froth and very little yellow mucus
LUNG HYGIENE at home: Steam vaporizer with acapella
FOLLOWUP CT SCAN Ordered by Dr j Lemelin and was done on Dec 3 at QCH
Previous one was on July 18th at General Hospital. Have not been told results of it.
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.
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.
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.
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.
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
SPUTUM COLOUR Green. PLEASE test my sputum for infection.
Tuesday, May 13, 2008
Pneumonia and Resulting Lung function Tests
Last 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.
I have been off the antibiotics for 2 weeks now and I am feeling much better.
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.
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.
Physiotherapy for lower back and Lung Education
Last 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.
COPD DISEASE MANAGEMENT
COPD DISEASE MANAGEMENT
C.O.P.D. stands for Chronic Obstructive Pulmonary Disease
It is a collective term used to cover the following conditions:
Emphysema:
Damaged air sacs (Alveoli) that can result in hypoventilation of the lungs. This is most commonly found seen in people with smoking history
Chronic Bronchitis:
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
Asthma:
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.
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.
Causes of Obstruction:
1) INFECTION - Phlegm blocks the airways
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.
3) BRONCHOSPASM - -The muscles which surround the airways tighten or constrict in response to the inhaled irritant.
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)
1-INFECTION Infection is caused by an organism that can be either viral or bacterial.
VIRAL BACTERIAL
Presence of warning signs:-- Usually absence of warning signs; mild cold/flu symptoms such as headache, sudden onset sneezing, muscle and joint aches.
Signs and Symptoms of full blown infection
- cough, fatigue, maybe fever - cough, fatigue, maybe fever
- shortness of breath(SOB) - shortness of breath(SOB)
- change in amount of sputum production - change in amount of sputum Production
- color of sputum (yellow, green or brown) - color of sputum (yellow, green or brown)
NO CURE, but often given antibiotics to Treated with antibiotics to prevent an additional bacterial infection from occurring.
Infections are spread from person to person most commonly by direct contact of the hands to eyes or nose.
REVENTION IS THE BEST MEDICINE
HAND WASHING
To prevent infection, the best defense is hand-washing This should be done with soap
and water for at least 30 seconds or with a waterless antibacterial alcoholic rinse. Make a point of
washing thumb and index fingers. As well, use a paper towel to turn off taps and open bathroom
doorknobs to avoid reinfection through contaminated surfaces.
* AVOID INFECTED PEOPLE IN CLOSE QUARTERS
* GET THE FLU SHOT EVERY YEAR (protects from common viruses of the season)
* GET THE PNEUMOCOCCAL VACCINE (protects from serious bacterium that cause infection)
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.
Treatment for Infections - ANTIBIOTICS
* Make sure to take your antibiotics as directed by your doctor or pharmacist.
Some are taken with food, some are not.
* Take your antibiotics for the full time period that is prescribed even if you feel better before that.
Example of a 10 day prescription
You should be feeling somewhat better should be clear feel 100% better
If not, call Dr.
Day 3 Day 8 Day 10
SIDE EFFECTS of antibiotics:
* Nausea, cramps, diarrhea (because drugs are killing off normal healthy bacteria in your system)
* Yeast overgrowth : fuzzy coated tongue, canker sores, red rash perineal region, vaginal infection
You may be able to prevent or control these symptoms by eating plain yogurt or taking acidophilus capsules
ALLERGIC REACTION to antibiotics:
* Red, itchy rash or hives - STOP medication and call your doctor for a change in antibiotic
- Get a medic alert bracelet
* swelling of the tongue, itchy, burning of the tongue, -» Call ambulance or 911 EMERGENCY
trouble breathing
WHEN YOU ARE SICK WITH AN INFECTION:
/Stay at home and get plenty of rest (but don't stay in bed for 24 hours)
/Stop your exercise or endurance routine (approximately 1 week)
/Increase your fluid intake. Avoid caffeine, since it is a diuretic
/Increase the frequency of your lung hygiene program
Thoracic mobility exercises, deep breathing, steaming, devices, controlled
coughing)
*When you are feeling better, start your exercise training again gradually
2-INFLAMMATION
This is the primary cause of bronchitis. It is our bodies immune response to an irritant.
Many different things can cause irritation to the airways:
Infectious organisms, causing infectious bronchitis (will then need antibiotic)
Other irritants: Smoke
Chemicals
Dust
Animals, etc.
Inflammation of the airways causes them to: become swollen, produce extra mucus
damage the cilia (small hairs which help to move mucus up and out of the lungs)
SYMPTOMS of INFLAMMATION:
© increased shortness of breath
© frothy, white sputum
© increased wet cough and wheezing
© fatigue
MEDICATIONS for INFLAMATION :ANTI-INFLAMMATORIES
STEROIDS 1) inhaled steroid or "puffers": flovent, pulmicort, Qvar, vanceril
2) pills / IV (prednisone)
NON-STEROID: tilade
Side Effects of STEROIDS:
1) inhaled : thrush in the mouth and throat
Prevent by proper rinsing and spitting with water, followed by drinking a few sips of water.
2) pills/IV : fluid retention, weight gain, diabetes, osteoporosis, easy
bruising, steroid myopathy (muscle wasting)
3-BRONCHOSPASM
WHAT IT IS
When hyper reactive airways respond to irritants, the muscles surrounding the airways tighten and squeeze, causing the airway to become more narrow or constrict.
Irritants which may cause Bronchospasm:
smoke
cold air, windy air
perfumes, strong household cleaners
rapid movement of air (this may happen with exercise at a higher intensity level)
SYMPTOMS OF BRONCHOSPASM:
Sudden onset of:
Shortness of breath
Wheezing
Dry, hacking cough
PREVENTION:
avoid known irritants
cover your nose and mouth with a silk or cotton scarf when out in cold or windy weather
breathe through the nose rather than the mouth
The nose: 1) filters 2) warms 3) humidifies the air
MEDICATIONS FOR BRONCHOSPASM: BRONCHODILATORS
1) Short acting bronchodilators: Ventolin
Combivent (also has long-acting)
Atrovent
2) Long, slow acting bronchodilators: Serevent, Oxeze, Accolate
A preventative bronchoconstrictors) Combivent (also has short-acting)
Spiriva-only medication specific for COPD
*** Wait at least 1 to 2 minutes
*** Wait at least 1 to 2 minutes between each puff of medication
*** If you are taking both bronchodilator and steroid puffers, take your fast acting
bronchodilator first, then wait 10 to 15 minutes before you take the steroid
SIDE EFFECTS of BRONCHODILATORS:
- increased heart rate, trembling, jitteryfeeling
AEROCHAMBER
For all of your inhaler medications (Metered dose inhalers), you should be using an aerochamber to maximize the effectiveness of the medication.
Posted by Peter Ellis at Tuesday, May 13, 2008 1 comments
ANATOMY of the RESPIRATORY SYSTEM
SKELETON
RIBS: 12 in total (2 are floating)
Protects the lungs and heart
STERUM: Breast Bone at front of the chest
Costo-sterum and costo-vertebral joints: where the ribs meet the sternum at the front and the vertebrae in the back
SCAPULAR: complex (shoulder blade): attaches to the back of the rib cage
IMPACT OF PROBLEMS WITH THE SKELETON
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).
To avoid rib fracture or irritated joints, you should practise controlled coughing techniques.
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.
Pursed exhalation creates positive pressure in the lung to prevent air trapping.
MUSCLES OF RESPIRATION:
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.
2. INTERCOSTALS: Small muscles located in between each ribs. Responsible for 40 percent of the air intake during inhalation
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.
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.
When we breathe in, inspiration or inhalation
-The diaphragm contracts and shortens which flattens it. It allows more space for the lungs to expand.
-The intercostals contract which makes the ribs move out and up in a “Bucket handle” swinging movement.
When we breathe out, expiration or exhalation
-The diaphragm passively returns to its dome shape.
-The intercostals relax and allow the ribs to return to their starting position.
-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.
-People with emphysema have a slow and prolonged forced expiration.
Impact of problems with muscles of breathing
-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.
-Obstacles that can make breathing more difficult: obesity, pregnancy, a large meal, bloating, and poor posture.
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.
How position can affect your diaphragm
Lying flat on your spine (supine):
-The resting level of the diaphragm rises up towards the lungs.
-Gravity pulls down on the ribs, making it harder to move them up.
- The organs are pushed up towards the diaphragm and it makes it more difficult to breathe.
Solution: Lie with pillows positioned under the upper back and head
Sitting :
-Gravity helps the diaphragm flatten out by pulling down on it.
-Better position for breathing as long as your back is supported and shoulders relaxed.
ORGANS:
Heart: Located between the lungs in the centre of the chest and to the left. Pumps the blood throughout the body.
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.
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..
ENDURANCE TRAINING
ENDURANCE or AEROBIC training means:
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.
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.
Normal Responses during exercise: Increased heart rate, Increased breathing rate and mild increase of shortness of breath.
For endurance training, you should be in an appropriate “Training Zone” This can be monitored by the following :
Heart rate (your age-related traing zone)
Shortness of breath (2 – 4 out of 10 on the SOB scale, or 2 above resting level)
The talk test (you can still talk during exercise)
HOW OFTEN ?? The goal will be to achieve 20 to 30 minutes, 5 days a week
HOW LONG?? Forever !!!!! “If you don’t keep it, you lose it”
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.
PRECAUTIONS with endurance training:
Chest, arm or jaw pain or pressure
Unexplained swelling in your legs
Increased SOB or bad lung infection
Increased blood pressure
If you have a dramatic change in your medical condition as above, or are hospitalized, consult your physiotherapist or doctor before resuming exercise.
Posted by Peter Ellis at Tuesday, May 13, 2008 0 comments
Sunday, December 24, 2006
Corticosteroid Induced Osteopenia
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.
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!
My GP then prescibed Didrocal medicine! I take one tablet with a glass of water every evening before going to bed!
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.
All I can say now it was a good thing that I had a bone density scan.
Posted by Peter Ellis at Sunday, December 24, 2006 2 comments
Friday, June 30, 2006
C.O.P.D. stands for Chronic Obstructive Pulmonary Disease
It is a collective term used to cover the following conditions:
Emphysema:
Damaged air sacs (Alveoli) that can result in hypoventilation of the lungs. This is most commonly found seen in people with smoking history
Chronic Bronchitis:
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
Asthma:
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.
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.
Causes of Obstruction:
1) INFECTION - Phlegm blocks the airways
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.
3) BRONCHOSPASM - -The muscles which surround the airways tighten or constrict in response to the inhaled irritant.
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)
1-INFECTION Infection is caused by an organism that can be either viral or bacterial.
VIRAL BACTERIAL
Presence of warning signs:-- Usually absence of warning signs; mild cold/flu symptoms such as headache, sudden onset sneezing, muscle and joint aches.
Signs and Symptoms of full blown infection
- cough, fatigue, maybe fever - cough, fatigue, maybe fever
- shortness of breath(SOB) - shortness of breath(SOB)
- change in amount of sputum production - change in amount of sputum Production
- color of sputum (yellow, green or brown) - color of sputum (yellow, green or brown)
NO CURE, but often given antibiotics to Treated with antibiotics to prevent an additional bacterial infection from occurring.
Infections are spread from person to person most commonly by direct contact of the hands to eyes or nose.
REVENTION IS THE BEST MEDICINE
HAND WASHING
To prevent infection, the best defense is hand-washing This should be done with soap
and water for at least 30 seconds or with a waterless antibacterial alcoholic rinse. Make a point of
washing thumb and index fingers. As well, use a paper towel to turn off taps and open bathroom
doorknobs to avoid reinfection through contaminated surfaces.
* AVOID INFECTED PEOPLE IN CLOSE QUARTERS
* GET THE FLU SHOT EVERY YEAR (protects from common viruses of the season)
* GET THE PNEUMOCOCCAL VACCINE (protects from serious bacterium that cause infection)
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.
Treatment for Infections - ANTIBIOTICS
* Make sure to take your antibiotics as directed by your doctor or pharmacist.
Some are taken with food, some are not.
* Take your antibiotics for the full time period that is prescribed even if you feel better before that.
Example of a 10 day prescription
You should be feeling somewhat better should be clear feel 100% better
If not, call Dr.
Day 3 Day 8 Day 10
SIDE EFFECTS of antibiotics:
* Nausea, cramps, diarrhea (because drugs are killing off normal healthy bacteria in your system)
* Yeast overgrowth : fuzzy coated tongue, canker sores, red rash perineal region, vaginal infection
You may be able to prevent or control these symptoms by eating plain yogurt or taking acidophilus capsules
ALLERGIC REACTION to antibiotics:
* Red, itchy rash or hives - STOP medication and call your doctor for a change in antibiotic
- Get a medic alert bracelet
* swelling of the tongue, itchy, burning of the tongue, -» Call ambulance or 911 EMERGENCY
trouble breathing
WHEN YOU ARE SICK WITH AN INFECTION:
/Stay at home and get plenty of rest (but don't stay in bed for 24 hours)
/Stop your exercise or endurance routine (approximately 1 week)
/Increase your fluid intake. Avoid caffeine, since it is a diuretic
/Increase the frequency of your lung hygiene program
Thoracic mobility exercises, deep breathing, steaming, devices, controlled
coughing)
*When you are feeling better, start your exercise training again gradually
2-INFLAMMATION
This is the primary cause of bronchitis. It is our bodies immune response to an irritant.
Many different things can cause irritation to the airways:
Infectious organisms, causing infectious bronchitis (will then need antibiotic)
Other irritants: Smoke
Chemicals
Dust
Animals, etc.
Inflammation of the airways causes them to: become swollen, produce extra mucus
damage the cilia (small hairs which help to move mucus up and out of the lungs)
SYMPTOMS of INFLAMMATION:
© increased shortness of breath
© frothy, white sputum
© increased wet cough and wheezing
© fatigue
MEDICATIONS for INFLAMATION :ANTI-INFLAMMATORIES
STEROIDS 1) inhaled steroid or "puffers": flovent, pulmicort, Qvar, vanceril
2) pills / IV (prednisone)
NON-STEROID: tilade
Side Effects of STEROIDS:
1) inhaled : thrush in the mouth and throat
Prevent by proper rinsing and spitting with water, followed by drinking a few sips of water.
2) pills/IV : fluid retention, weight gain, diabetes, osteoporosis, easy
bruising, steroid myopathy (muscle wasting)
3-BRONCHOSPASM
WHAT IT IS
When hyper reactive airways respond to irritants, the muscles surrounding the airways tighten and squeeze, causing the airway to become more narrow or constrict.
Irritants which may cause Bronchospasm:
smoke
cold air, windy air
perfumes, strong household cleaners
rapid movement of air (this may happen with exercise at a higher intensity level)
SYMPTOMS OF BRONCHOSPASM:
Sudden onset of:
Shortness of breath
Wheezing
Dry, hacking cough
PREVENTION:
avoid known irritants
cover your nose and mouth with a silk or cotton scarf when out in cold or windy weather
breathe through the nose rather than the mouth
The nose: 1) filters 2) warms 3) humidifies the air
MEDICATIONS FOR BRONCHOSPASM: BRONCHODILATORS
1) Short acting bronchodilators: Ventolin
Combivent (also has long-acting)
Atrovent
2) Long, slow acting bronchodilators: Serevent, Oxeze, Accolate
A preventative bronchoconstrictors) Combivent (also has short-acting)
Spiriva-only medication specific for COPD
*** Wait at least 1 to 2 minutes
*** Wait at least 1 to 2 minutes between each puff of medication
*** If you are taking both bronchodilator and steroid puffers, take your fast acting
bronchodilator first, then wait 10 to 15 minutes before you take the steroid
SIDE EFFECTS of BRONCHODILATORS:
- increased heart rate, trembling, jitteryfeeling
AEROCHAMBER
For all of your inhaler medications (Metered dose inhalers), you should be using an aerochamber to maximize the effectiveness of the medication.
Posted by Peter Ellis at Tuesday, May 13, 2008 1 comments
ANATOMY of the RESPIRATORY SYSTEM
SKELETON
RIBS: 12 in total (2 are floating)
Protects the lungs and heart
STERUM: Breast Bone at front of the chest
Costo-sterum and costo-vertebral joints: where the ribs meet the sternum at the front and the vertebrae in the back
SCAPULAR: complex (shoulder blade): attaches to the back of the rib cage
IMPACT OF PROBLEMS WITH THE SKELETON
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).
To avoid rib fracture or irritated joints, you should practise controlled coughing techniques.
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.
Pursed exhalation creates positive pressure in the lung to prevent air trapping.
MUSCLES OF RESPIRATION:
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.
2. INTERCOSTALS: Small muscles located in between each ribs. Responsible for 40 percent of the air intake during inhalation
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.
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.
When we breathe in, inspiration or inhalation
-The diaphragm contracts and shortens which flattens it. It allows more space for the lungs to expand.
-The intercostals contract which makes the ribs move out and up in a “Bucket handle” swinging movement.
When we breathe out, expiration or exhalation
-The diaphragm passively returns to its dome shape.
-The intercostals relax and allow the ribs to return to their starting position.
-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.
-People with emphysema have a slow and prolonged forced expiration.
Impact of problems with muscles of breathing
-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.
-Obstacles that can make breathing more difficult: obesity, pregnancy, a large meal, bloating, and poor posture.
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.
How position can affect your diaphragm
Lying flat on your spine (supine):
-The resting level of the diaphragm rises up towards the lungs.
-Gravity pulls down on the ribs, making it harder to move them up.
- The organs are pushed up towards the diaphragm and it makes it more difficult to breathe.
Solution: Lie with pillows positioned under the upper back and head
Sitting :
-Gravity helps the diaphragm flatten out by pulling down on it.
-Better position for breathing as long as your back is supported and shoulders relaxed.
ORGANS:
Heart: Located between the lungs in the centre of the chest and to the left. Pumps the blood throughout the body.
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.
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..
ENDURANCE TRAINING
ENDURANCE or AEROBIC training means:
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.
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.
Normal Responses during exercise: Increased heart rate, Increased breathing rate and mild increase of shortness of breath.
For endurance training, you should be in an appropriate “Training Zone” This can be monitored by the following :
Heart rate (your age-related traing zone)
Shortness of breath (2 – 4 out of 10 on the SOB scale, or 2 above resting level)
The talk test (you can still talk during exercise)
HOW OFTEN ?? The goal will be to achieve 20 to 30 minutes, 5 days a week
HOW LONG?? Forever !!!!! “If you don’t keep it, you lose it”
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.
PRECAUTIONS with endurance training:
Chest, arm or jaw pain or pressure
Unexplained swelling in your legs
Increased SOB or bad lung infection
Increased blood pressure
If you have a dramatic change in your medical condition as above, or are hospitalized, consult your physiotherapist or doctor before resuming exercise.
Posted by Peter Ellis at Tuesday, May 13, 2008 0 comments
Sunday, December 24, 2006
Corticosteroid Induced Osteopenia
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.
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!
My GP then prescibed Didrocal medicine! I take one tablet with a glass of water every evening before going to bed!
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.
All I can say now it was a good thing that I had a bone density scan.
Posted by Peter Ellis at Sunday, December 24, 2006 2 comments
Friday, June 30, 2006
ANATOMY of the RESPIRATORY SYSTEM
SKELETON
RIBS: 12 in total (2 are floating)
Protects the lings and heart
STERUM: Breast Bone at front of the chest
Costo-sterum and costo-vertebral joints: where the ribs meet the sternum at the front and the vertebrae in the back
SCAPULAR: complex (shoulder blade): attaches to the back of the rib cage
IMPACT OF PROBLEMS WITH THE SKELETON
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).
To avoid rib fracture or irritated joints, you should practise controlled coughing techniques.
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.
Pursed exhalation creates positive pressure in the lung to prevent air trapping.
MUSCLES OF RESPIRATION:
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.
2. INTERCOSTALS: Small muscles located in between each ribs. Responsible for 40 percent of the air intake during inhalation
3 ACCESSORY MUSCLES: muscles of the neck, not designed to work all the
time. Used by people with ling disease when in distress or because they have
developed poor breathing pattern.
HOW WE BREATHE:
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.
When we breathe in, inspiration or inhalation
-The diaphragm contracts and shortens which flattens it. It allows more space for the lungs to expand.
-The intercostals contract which makes the ribs move out and up in a “Bucket handle” swinging movement.
When we breathe out, expiration or exhalation
-The diaphragm passively returns to its dome shape.
-The intercostals relax and allow the ribs to return to their starting position.
-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.
-People with emphysema have a slow and prolonged forced expiration.
Impact of problems with muscles of breathing
-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.
-Obstacles that can make breathing more difficult: obesity, pregnancy, a large meal, bloating, and poor posture.
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.
How position can affect your diaphragm
Lying flat on your spine (supine):
-The resting level of the diaphragm rises up towards the lungs.
-Gravity pulls down on the ribs, making it harder to move them up.
- The organs are pushed up towards the diaphragm and it makes it more difficult to breathe.
Solution: Lie with pillows positioned under the upper back and head
Sitting :
-Gravity helps the diaphragm flatten out by pulling down on it.
-Better position for breathing as long as your back is supported and shoulders relaxed.
ORGANS:
Heart: Located between the lungs in the centre of the chest and to the left. Pumps the blood throughout the body.
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.
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..
ENDURANCE TRAINING
ENDURANCE or AEROBIC training means:
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.
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.
Normal Responses during exercise: Increased heart rate, Increased breathing rate and mild increase of shortness of breath.
For endurance training, you should be in an appropriate “Training Zone” This can be monitored by the following :
Heart rate (your age-related traing zone)
Shortness of breath (2 – 4 out of 10 on the SOB scale, or 2 above resting level)
The talk test (you can still talk during exercise)
HOW OFTEN ?? The goal will be to achieve 20 to 30 minutes, 5 days a week
HOW LONG?? Forever !!!!! “If you don’t keep it, you lose it”
We also aim to deisgnyour 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 yout goal.
PRECAUTIONS with endurance training:
Chest, arm or jaw pain or pressure
Unexplained swelling in your legs
Increased SOB or bad lung infection
Increased blood pressure
If you have a dramatic change in your medical condition as above, or are hospitalized, consult your physiotherapist or doctor before resuming exercise.
Sunday, December 24, 2006
Corticosteroid Induced Osteopenia
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.
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!
My GP then prescibed Didrocal medicine! I take one tablet with a glass of water every evening before going to bed!
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.
All I can say now it was a good thing that I had a bone density scan.
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!
My GP then prescibed Didrocal medicine! I take one tablet with a glass of water every evening before going to bed!
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.
All I can say now it was a good thing that I had a bone density scan.
Friday, June 30, 2006
PEG Tube Insertion June 8, 2006
PEG TUBE INSERTION
(Percutaneous Endoscopic Gastrostomy)
by Peter C Ellis
MY DECISION
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. The solution became very evident. I just have to stop eating orally permanently, stop the aspiration of food into my lungs and get a PEG tube. This means that I would not eat orally again for thr rest of my life time.
Two and one half weeks later, I have really found out that living with a PEG tube is a huge life style change. It has really curtailed my daily activities as I have to spend four hours a day connected up to my 500 ml feeding bag on the I.V. pole using 400 ml/hr Kangaroo pump. I have four feedings a day, each one lasting one hour where I consume 375 ml of formula or 450 calories. I estimate that I spend another hour in doing preparation work 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.
After three home visits and discussion, my dietitian decided that I will require 2,100 calories a day, 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 Metamucil with water every night when I was eating orally, my dietitian concluded that I would need fibre in the formula.
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 look after all my medical home care needs such as tube feeding supplies, stoma cleaning medical supplies and my well being.
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.
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.
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!
The Ontario Drug Benefit Plan (ODB) will cover the costs of my expenses for my Isosource HN with fibre 1.2 once I get a prescription for it from my doctor. 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.
Well, when I saw my GP, she immediately filled out and signed The
I am now on three tube feedings a day taking in 500 mls per feeding in 1hr 20 minutes for each feeding. I like this much better. 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.
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
JULY the 9th. UPDATE:
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.
Tuesday, January 03, 2006
My appointment with the Respirologist
Spirometry Results
- Values were lower today as compared to those on Jan 14, 2004
- Actual FEV1 (L) today was 1.25 L as compared to 1.47L It decreased from 38% of normal to 33% of normal
- Actual FVC (L) today was 3.42 L as compared to 4.09 L. It decreased from 85 % of normal to 72%
- FEV1/FVC (%) today was 37% as compared to 36% .
- FEF 25-75% (L/Sec) today was 0.44 as compared to 0.40. It increased from 11 % of normal to 12%.
- FEP Max (L/sec) today was 51% of normal as compared to 61% .
- Expiratory Time (sec) today was 10.16 sec as compared to 13.73 sec.
- There are three different processes going on that are contributing
- Aspiration owing to my moderate to severe swallowing difficulties which has caused my bronchiectasis.
- Bronchiectasis lung condition makes you more susceptible in getting lung infections.
- 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.
- My ability to fight and recover from pneumonias will further decrease accordingly as my FEV1 decreases or as my reserve lung function decreases.
- 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.
- 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.
- 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.
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.
ANTIBIOTIC PRESCRIPTION
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.
LUNG HYGEINE
Is the most important thing that I can do for my lungs
PROGNOSIS
My respirologist stressed that my gasterenterologist does not know my complete story as to whether or not I should have a feeding tube.
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.
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