Thursday, April 8, 2010

Asthma ER Tales Part II: Treating the Asthma but Missing the Big Picture in 2010

You can read Part I of this saga here. I know these are kind of long posts. Sorry about that! If you read them at all, I will happily give you a gold star.

So after the dreaded realization that I could not avoid the ER, I put on my big girl panties and went to the ER. My husband came home early from work and dropped me off at the ER. He then returned home with our toddler as I didn't want her subjected to the ER--with as sick as she has been the last thing I wanted was to expose her to anything else. And the last thing I needed was to try and toddler wrangle while sick.

I choose the ER at the hospital where my pulmonologist worked. I learned in 2006, it does me no good to go to an ER where my doctors don't have privileges (in 2006 my independent lone practitioner primary care doc wanted me hospitalized--once I finally got in to see her-- but had zero hospital privileges anywhere, which complicated things immensely). However, this new-to-me ER was the county hospital that serves the jail, prison, and prostitutes of the area.

Someday I will tell you a funny story about how my pulmonologist saw me in a satellite office that was actually an STD clinic for prostitutes. I was the only asthmatic in the waiting room, everyone else was a working girl. They all assumed I was too. There were some interesting comments directed toward me that I didn't understand until my pulmonologist explained the whole STD clinic thing. I now see her at the main campus, which is nowhere near as entertaining.

So, you know, I was kind of nervous--above and beyond my baggage from 2006--about what kind of ER experience this was going to be.

I signed in and they buzzed me back where I wandered in a maze of corridors not knowing where to go. The guy at the front desk had told me, but I wasn't really processing much at that point. I finally stopped and told a nurse, "I'm lost."

She got me into a room. Listened to my lungs for a split second, ran out without a word and came back lickety split with 3 albuterol and 1 atrovent vials. I've never had a nebulizer treatment so fast. I don't think I'd been in the ER for even 10 minutes at that point.

That treatment was the best thing that had happened to me in a week. I want to find that nurse and kiss her. Except she probably wouldn't like it. (She probably hasn't been to the STD clinic either, which you haven't lived until you been in an STD clinic with a bunch of hookers and you're the odd one out.)

They got me hooked up to a pulse ox. I have no idea what the O2 sat was, but the ER doc popped in and patted me on the shoulder and pronounced "You are not going home today."

I had no idea what that meant. In fact, I was thinking "We'll see about that, buddy." I mean, we hadn't done a chest xray, the nebulizer treatment wasn't even half way through, it seemed kind of premature to tell me I was in for it. Heck he hadn't even listened to my lungs himself!

I'm a little foggy on the rest of the details. So the narrative that follows is not necessarily in order or even all that accurate. I had a chest xray and was surprised at how hard it was to raise my arms and hold my breathe. I was also puzzled at how the nebulizer (my second treatment) was working even though I was in a hallway and not plugged into the wall. Trying to figure that out kept my mind busy for a long time. There was a heart ultrasound to check for fluid that involved 3 different medical students ramming my liver with the ultrasound wand. (Tip for the medical students, make sure you use enough goop. More goop is better. Really. YOU NEED MORE GOOP!)

I had dressed in a gown, but forgot to take off my pants as requested (that pesky brain-not-working thing) and was mortified to learn I hadn't followed the directions of the ER doc who was being so nice to me. I asked the ER doc to please let the pulmonologist know I was there and he did.

Then he came back, looked at my unshaven legs, and said I had some blood work that had him worried about a pulmonary embolism. So off I went to CT. This was all done, I think, within the first hour. Very fast. I look back at it and think, really? I was that sick? I didn't think I was that sick. I really just came in for a chest xray.

My pulmonologist was not on consult but sent someone down. An intern? A resident? I don't know. He was very sweet. Then a nurse showed up and asked if I would participate in a genetic study to see if I'm missing DNA that makes me less sensitive to asthma meds. I consented. The doctor managing that study (apparently a Big Name in asthma--I think the nurse said something like "Father of Asthma") came down to see me.

I was breathing better, but his attempts at jovial humor went waaaaaay over my head and he had to dumb it down for me. I knew I was 'missing' nuances and not following along really well, but there wasn't much I could do. I was still not talking much, more pantomiming and saving the words for when I absolutely had to speak.

The pulmonlogists were okay with sending me home, but having learned in 2006 that if I'm gunky and wheezy I'm not going to improve, I spoke up. I advocated for myself! For the first time ever! Yay! I said, "I've been here before. There's too much stuff in my lungs. If you send me home, I'll be back."

I know I asked for Atrovent at home and was told that was not appropriate for home care. I wanted to argue, but let it drop. Not enough air for it.

They had started antibiotics, but then stopped them. This was all virus and I knew it and they eventually figured that out too. I was told I would be on prednisone for a month and to expect recovery to take that long. My horror must have shown on my face because I got a kind pat on the arm and a "You won't be this bad the whole time."

So they transferred me to a room and my pulmonologist came down to say hello--she is such a sweetheart. My husband came by with dinner and the toddler. I snuggled with her and found it deeply comforting to have her warm body against mine, inhaling her baby scent.

I then spent every 2 hours after that doing nebulizer treatments and watching my O2 (because it beeped which made it hard to ignore) bounce from 95 to 90 and then, by the 6th or 7th treatment, from 95 up to 100. It was miserable. I didn't sleep but I knew I had to do it. The nurses kept offering to let me skip a treatment so I could sleep, but I shook my head no. If I'd been up for a long discussion I would have said "I am not here to sleep. I am here to kill this motherfucking wheeze. Thank you."

I was discharged the next morning. I was still wheezing, still gunky. My O2 was good, but the peak flow was not hot. The whole exercise bumped me up a level in health, but did not completely break the episode. I actually am still using the nebulizer almost 10 days after being discharged and have had peak flows drop down to 350 or 400 (my normal is 600-650). Fortunately, the nebulizer is keeping everything in check.

There was one complicating factor in this whole episode that was missed by everyone, including myself until the very end. And it almost sent me back to the ER.

I'll cover that in Part III.

Oh, and the one big surprise from this whole thing? Learning I have a growth in/on my lung.

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