Another bad attack

snowdrift

New member
I can't complain really, it's been a long time. My doctor tapered me off my controller med (formerly Advair) because I was symptom free for so long, except for very occasional exercise related issues in bad weather.

After my last bad attack--in late June 2008--I started running. This past winter I was even able to run outdoors in the cold, down to about twenty degrees or so. Cold, even forty degrees or so, used to be a major asthma trigger for me. But I injured my shoulder and have been having a lot of pain, and so my exercise has been way, way down.

And then I caught a cold. My whole family had it. I got it last. It turned into a sinus infections. Thanks to MountainReader's list of early warning signs--a list I always keep in the back of my head--it occurred to me use my peak flow meter for the first time in months.

I was at 60%. I started doing nebulizer treatments, with albuterol, and carrying my albuterol inhaler. The inhaler didn't seem to do much of anything. The neb helped--for an hour or so, maybe. I figured I'd get through it, that it was mostly just sinus stuff.

I woke up this morning unable to get out more than a syllable without catching breathe. Peak flow right around 50%. I was really reluctant to go to the ER, and I wasn't wheezing at all. I rarely do. Somehow my chest gets tight and my breathing decreases, but silently. It's not the whole "silent chest" thing either--I move air, but not enough, it's just normal breathe sounRAB, but less air. I also cough a LOT. Sometimes I cough so much that that makes it even harder to catch my breathe. Some docs have failed to pick up on anything wrong, and suggest it's an anxiety thing.

I probably should have gone to the ER, but instead of being gasping and scary, this attack was weird. I just was breathing shallow and fast and felt like if the world would just SLOW DOWN, it would be ok. Just so long as I didn't have to walk or talk. Or stand, sit or lay down. But I was so focused on sitting in my corner breathing on a nebulizer that going to the ER seemed like so much work, requiring energy I couldn't spare. Yeah, so I could have called 911. It just didn't occur to me. And it ultimately wasn't needed. It was a long slow deterioration just deteriorating a little more.

I waited until ten am and went to the urgent care clinic. Got a xopenex breathing treatment and injected steroiRAB, which helped a LOT, very quickly, but was a little disorienting because I was already OD-d on albuterol.

The doctor on duty was pretty great. Didn't suggest, for one thing, that I wasn't breathing right because I just didn't feel like it, as has happened in the past :-/ and did take the time to make sure I was ok and wrote me scrips and very carefully explained them

It's important to nip this in the bud, because I am due to have shoulder surgery in two weeks, and I am having so much pain from that injury that postponing it would be very, very hard. She understood that, and recognized that while I have moderately severe symptoms, they are relatively intractable. She gave me a course of pred, a week of flo-vent, and some xoponex for my nebulizer.

I feel terrible. The day and night after a huge load of steroiRAB is always terrible. Right now, my arms and legs are doing the pins-and-needles thing. General body pain, probably as much from days of effort to breathe as from the large doses of steroiRAB. I'm breathing slowly and evenly about 50% of the time, which is a huge iprovement. Still getting rapid and shallow every now and again, but it'll get better.

I'm a little nervous that she gave me 5 days of pred @60mgs/day, no taper. I know that's how they are doing it these days, but it still makes me nervous. I may do twenty or forty on the last day, just to be cautious.

I have been sitting around an awful lot, feeling sick and miserable lately. Tonight I walked 2/3 of the 1.5 mile loop I run pretty regularly. Just several blocks measured off in my neigrabroadorhood. I want to get my lungs working again, gently.

I walked one mile in 1 hour and 12 minutes. I had a friend on the phone most of the time. Not talking much, mostly listening to her talk, and listening to her remind me to slow down when my breathing got ragged. Stopped to rest several times.

May 1, I ran a 5k (3.1 miles) in 29 minutes, 40 seconRAB. I'm about as proud of what I did today, getting out and walking a mile. Even if it did take over an hour. It's hard to deal with injuries and illness, moreso the past year or so as I've begun thinking of myself as an athlete, and a huge part of my life revolves around running, weight training, biking, and yoga. But I got my workout today. And it worked.

The steroid are still making me feel crappy, my chest and back still hurt from the effort of breathing these past few days, I still have the remnants of the sinus infection, but I feel better than I did before walking.

Tomorrow will be better.

I may have to re-evaluate the plan of albuterol alone. I don't know though. Just don't know. One moderately severe attack in two years may not warrant daily controller meRAB. I'll have to talk to my GP, and probably get re-referred to the pulmonologist, who I stopped seeing after I got off Advair.

In any case, I welcome your thoughts. Mostly, I just wanted to get it all out. It is odd how much the people who love and care about me don't want to hear what I have to say about what was and is a terrifying, disorienting, and, in a small way, a life-changing experience.
 
Snowdrift,

Glad to hear you made it through your attack OK. Attacks like that can be really scary. Also glad to hear that list I made has helped someone. So many people with asthma just don't know to watch for some of those symptoms. I know I didn't for the longest time.

I think you are right to follow-up with your PCP and to see about a referral to your Pulmonologist. Do you have a written asthma plan? If so, if may need to be re-reviewed to see if it still meets your neeRAB. If not, I'd ask for one. It sounRAB like you know what your personal self-care steps are, but it doesn't hurt to review the information at least annually. When my asthma is under less control, I was seeing my PCP about every 3 months for checks. When I'm doing fine, I see my Pulmonologist once a year. Just to see. My Pulmonologist has prescribed me some medications that I can fill as I feel symptoms developing so I don't need to wait for a doctor. I have standing prescriptions for antibiotics, Prednisone and Advair 100/50, 250/50 and 500/50 as needed. Their usage is part of my asthma action plan. Of course, he wants me to come in right away if things get really really bad.

Please be careful about overdoing things until you've had a chance to let some of that inflammation go down. You certainly don't want a relapse. I wouldn't worry about the time for your mileage until you are feeling better from your asthma.

Do you carry an Epi-pen? If not, I'd ask your doc about one. I've been carrying mine since my last emergency asthma attack. One shot of ephinephrine by the doctor quickly opened up my airways and was a true lifesaver for me. If my symptoms had been as severe as yours (not being able to get more than one syllable out), I probably would have used it, then sought out treatment.

One thing I did learn through my emergency attack was that by the time it got really really bad I wasn't thinking clearly. I should never have let it get that bad. Thing was that once it started it, it got bad fairly quickly. Please be careful about this. Call 911 or have someone get you to emergency quickly if necessary. Things don't always work out as well as they did for you today. In my case, I was in my car on the highway between two hospitals about 10 miles away each. Instead of pulling over, I decided I was OK enough to drive myself to the hospital. At that point, I was struggling, but could still talk. I'd used my Albuterol twice that morning for some coughing and taken my Advair 500/50 and Singulair. Anyway, because I wasn't thinking straight I bypassed the hospital for my clinic about 1 mile away. By the time I got inside I couldn't put the 2 syllables together and my fingers and lips were turning purple and tingling. By the time I got to the treatment room, I was hyperventilating and about to pass out. It happened so quickly and I realized how lucky I'd been. I really should have pulled over and called 911.

I've never had problems with not tapering when I'm on the Prednisone for such short courses. I usually taper when I'm on it for 10-14 days or longer. Everyone is different though.

My worst asthma attack ever was in late January 2008. I had shoulder surgery in the first part of April 2008. The surgeon had me bring my albuterol with me to the hospital in case I needed it. I also discussed my asthma with the surgeon and anesthesiologist on the day of the surgery even though my symptoms were ok at the time. While the procedure was outpatient, this was a big concern for me as well. Good thing was that all went well and I went home late that afternoon. Have you had surgery before? That was my first (unfortunately my 2nd was that same year) and I learned I did have nausea problems. I now know to ask for some anti-nausea meRAB in my IV and some to take home. Make sure you have some easy to get into/out of clothes handy post-surgery. Also, make sure that whoever you have taking care of you knows how to use your nebulizer in case you need it. It might be tricky one-handed.

I hope the treatment they gave you helps you get through this flare fairly quickly and that your surgery goes well.

My thoughts will be with you.
MountainReader
 
In the ER after all. Started having major signs of low potassium, including chest pain and extremity nurabness/paralysis.

Wish this would end. I've had problems with this before after intense treatment for a bad attack, but that time I had been admitted, so they caught it sooner.

Potasssium supplements may need to become a part of my plan
 
It may be that you need to be on the Flovent or some other preventer permanently. I haven't had an attack of any kind in almost 3 years and am down to 1 puff of Flovent a day. but there's no way I'd quit taking it. The thought of an attack is just more than I want to deal with. Asthma can't be cured - just controlled...sort of like diabetes. Hope you get some relief soon.

As for the surgery, they always give me a breathing treatment just before or have me use my albuterol. You might ask about that.
 
I'm glad you are alive and getting treatment!

There are some people, including a friend of mine, who use controller meRAB only when they are at risk for an attack, like if they catch a cold or something. The attack didn't come on you out of nowhere, and this type of management might be enough for you. My asthma seems to be allergy triggered only, and I will probably wind up being on a controller only during pollen season.
 
I'm still sick. It's just not getting better this time. It wasn't low potassium the other night after all, btw, my electrolytes were fine. It was plain old dehydration and exhaustion. Some IV fluiRAB and I was back to only feeling moderately terrible.

Sinced Sunday though, my PEF is still dropping a lot, and this
morning it was getting close to red again. I still have the sinus infection that set this all off, and I think that that is preventing the asthma from letting up.

I was able to get a pulmonolgist appt for tomorrow morning, probably for antibiotics. The sudden worsening of the infection two days after starting pred is probably not a good sign.

Janewhite, I like the sound of that plan--taking a controller at vulnerable times. This is my second really serious attack and the second to happen in June. Perhaps an allergy is setting it off.

Thanks for the support. Hope this gets easier soon.
 
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