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A. Schuyler, NP
A. Schuyler, NP, Nurse Practitioner
Category: Health
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Experience:  Board Certified NP, MS, RN. Private practice & hospitalist
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45yro F 5 85lbs Diagnoses of COPD/Emphsema, and 2 fractured

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45yro F 5' 85lbs Diagnoses of COPD/Emphsema, and 2 fractured ribs confirmed by None Scan. History of 2pk a day cigarettes for 25 yrs, currently down to 6 cigarettes per day. No drug or alcohol use. Prescribed home oxgen therapy 2 weeks ago. I have severe shortness of breath even with the oxgen. I can't do anything physical such as simple household duties. I take breathing treatments 5-6 times per day and use a Albuterol inhaler. Last LFT was 14 months ago and was told I was only breathing 29% of lung capacity. I have been in the hospital 5 times since February 17. They keep me 3-4 days giving me IV steroids and IV antibiotics and breathing treatments. My life the past 90 days has consisted of me sitting on my bed. I feel better when discharged but after 48 hours of being home I'm fighting for every breath I can get. I know I have to stop smoking so please don't preach on that. I don't believe 5-6 cigarettes is the cause of not being able to breathe.
QUESTION: Why would I still be severely short of breath using the home Oxgen. I'm desperate for answers or referrals. I went from super mom 24/7 to almost bed ridden. The doctors only tell me it is going to take time to recover. I have no appetite and the doctor said the rib fractures were from the stress of me trying to breathe. The Dr said I was
burning calories while sitting from trying to breathe. Can anyone help me?
I need a Dr who can assist me on how to get back on my feet and communicate with the doctors. Renea, Houston Texas
Submitted: 1 year ago.
Category: Health
Expert:  A. Schuyler, NP replied 1 year ago.

Hello,

Answers provided are for informational use only and do not confer patient-provider relationship. My name is XXXXX XXXXX X will help you.

 

I'm sorry to hear of your problems. With lung function below 30% you have the most severe stage of COPD with respiratory failure. Not only can your lungs not get enough oxygen, but they have a problem getting rid of carbon dioxide. That is why you have the feeling of not getting enough air even though you are on oxygen. It is also why you have more infections requiring IV antibiotics.

 

The name of the medication used in cancer patients to improve appetite is megestrol acetate (i.e. Megace®). It helps the appetite for many people. The very act of breathing for you expends many, many calories so it is important to take in as much food as you can. Many small meals a day, and/or Boost or Ensure supplements can help. You also need the extra calories to promote bone healing.

 

I know you said don't wnat to hear about quitting smoking even a few cigarettes a day, but every cigarette affects your breathing by decreasing lung function. It also increases carbon monoxide in the body. Smoking provides no benefit to one's health and much harm. Enough said.

 

Has your pulmonologist discussed long term solutions? Are you a candidate for a lung transplant? I know you aren't as long as you smoke, but have you had this discussion with him or her?

 

Please let me know if you have questions?

 

 

Best regards,

 

Schuyler

 

 

Customer: replied 1 year ago.
The medication you stated in your reply was included in my medical history that I sent with my question. I stated I had taken Megace for 3 months and there was no difference in my appetite. I can't believe there would only be one option for people who don't have an appetite. I have tried every supplemental drink on the market. Very hard to swallow without gagging of bad taste even with adding chocolate ice cream or syrup. Yes the Dr did say I was a candidate for a lung transplant but as you stated not being a smoker. I would never except to get on a list being a smoker. I'm trying very hard to quit and I can't smoke wearing oxgen so I hope to be a non smoker by next week at the rate I'm going. I'm getting severe headachedaes which I have never had a problem with. I'm assuming it is from nicotine withdrawals. I was hoping to hear after I quit smoking I would be a candidate for pulmonary rehab and somehow recover to my previous health status back in February. I don't know what to think of my pulmonary doctor not telling me with my results of the LFT I was at the last stage. The only thing he did was give me 2 different inhalers that he said he didn't think we're going to work because I had only what 20% of patients with COPD had which was Emphysema. He said the holes couldn't repair themselves like others. I asked for a rx for Chantix and he said he could not prescribe it only a General Practitioner. It took me 3 months to get an apt with one on my insurance. Went to see her and she wouldn't prescribe it either. I had no clue she was a DO and did not approve of the Chantix. I settled for the Nicotrolla and the rest is history. I have tried everything on the market including prescription. I can't wait to tell everyone I'm a non smoker. I'm not clear if my question was answered or not. Of course Im going to pay the time you have invested . I wish I had a closer relationship with my Dr. If I did I feel like he would of told me a year ago you have the last stage of COPD and to stop smoking ASAP! Yes I have tried over the past 15 months but nothing like I have in the last 75 days. I just need to sit down with the Dr and write down a plan A and B.. Yes to all your comments on lung transplant. The biggest problem we have had is with our insurance company. I have done a lot of hurry up and waiting. Thank you for your time and hope to connect again.
Expert:  A. Schuyler, NP replied 1 year ago.

Hello again, Renea,

 

It is a relief to me to hear that you will be a lung transplant candidate once the smoking problem is licked, and it sounds like you are well on your way to that goal.

 

It saddens me that you haven't had the benefit of a good relationship with your pulmonary physician or your primary. You should have been told immediately just how grave a lung function of less than 30% is. Smoking cessation, using all tools at medicine's disposal, is one of the first steps in someone with poor lung function. How sad that you couldn't get the help you so desperately needed at the outset. I am sorry that your providers let you down.

 

Megace is the main drug prescribed for appetite improvement. That is actually a side effect of the drug (sort of like using Benadryl to get a good night's sleep. Benadryl is actually an antihistamine for allergies and the sleepiness is a side effect.). Nothing says it has to be Boost or Ensure if you don't like the taste. They are just easy for people to keep around. I personally abhor the taste as well. Anything you enjoy can be substituted. Making your own milkshake is fine. A scoop of protein powder from the pharmacy can't hurt.

 

If you like ice cream, then eat it as often as you like. Same for anything dense in calories that you like the taste of. This is one of the few times in one's life when it is good to eat whatever you want. You need the calories. Peanut butter (if you aren't allergic) is one of the highest calorie foods available, containing abuot 200 calories in just 2 tablespoons. Other nuts are also high in calories (almonds, pecans, walnuts, cashews). Dark chocolate is also good if you like sweets. Just one extra sandwich (add a slice of cheese for an extra 100 calories) a day adds 500 calories to your daily intake.

 

Fruit juices are higher in calories and less filling than the fruit, so it's better to drink 6-8 orange juice than to eat an orange. Pop it in the blender with orange sherbet or some vanilla ice cream if you like.

 

All pastas are fairly high in calories, regardless of the sauce. Whole wheat will give added fiber. Rich sauces (Alfredo, carbonara) add to the calorie load.

 

Among other high calorie foods are avocados, beans/legumes (not green beans), whole fat dairy, fatty fish like salmon and tuna, red meats, and potatoes. The omega-3 fatty acids in fish oils are thought to decrease inflammation and in some people improve appetite.

 

I'll keep my fingers crossed that you reach your goal of being smoke-free in the next week or two so you can get on the lung transplant list. Transplant is really the solution for you, since your physician is correct that the lungs are too far gone to repair themselves by the time your lung function is less than 30%.

 

Warm regards,

 

Schuyler

 

 

 

Customer: replied 1 year ago.
Thank you for all the information. My mom passed away three years ago at the ago of sixty with inflammatory carcinoma. I'm 46 and never really understood how short life really was until she passed. I have four children 3 that still live at home 18,14,10. The oldest is 24 and in medical school the 18 year old wants to go to law school. My husband and I are also disappointed with the group of doctors that I have. I'm hoping to talk to the insurance company and see if I can change doctors. My husband wanted to know if any of the doctors from this site worked as a liaison? We need someone that would advise us on medical and non-medical decisions. I never wanted to believe this but day by day it becomes more clear.
"You can live as long as you can afford it"
Expert:  A. Schuyler, NP replied 1 year ago.

Hello, Renea,

 

None of us here work directly with customers. All of your personal information is hidden. We don't even know who you are, or where you're from and that is for your protection as well as ours.

 

Talk to your insurance company and tell them exactly what you've told me. They have the duty to find you someone more competent both for your primary provider and your pulmonologist. If there is a pulmonologist associated with a medical school or large hospital center, that would be the ideal situation. I realize that you may not live near such a facility, so it may not be possible. Practitioners associated with medical schools are truly up to date on the latest and greatest, and state-supported schools also participate in more insurance programs that many for-profit hospitals do. Of course, if this doesn't work out. then it sounds like any change of provider would be for the better.

 

 

Kind regards,

 

Schuyler

 

Customer: replied 1 year ago.
Thank you for the information. I do think there is a need for anyone to seek another's opinion. When you go for a second opinion the Dr seems to be more guarded with his answers and any details. This is my first time to use this service. I do think others would pay a one time fee or a monthly fee to have access to the doctor that replied to your question. I haven't searched the Internet for that type of service but I hope to find one. I can't imagine my insurance company helping out at all unless they raised my premium! Thanks for all your time and answers.
Expert:  A. Schuyler, NP replied 1 year ago.

You're so very welcome.

 

You might be surprised at your insurance company's response to your dissatisfaction. You'll never know unless you try.

 

Since it is illegal to diagnose anything without seeing a patient in person, it will be difficult to find exactly what you are looking for online. Just Answer is here to answer your requests for information but we cannot treat you, or prescribe for you, because that is illegal in every civilized country in the world.

 

Best regards,

 

Schuyler

 

A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 14855
Experience: Board Certified NP, MS, RN. Private practice & hospitalist
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