Bob went to his regular pulmonary rehab class today and did 40 minutes on the machine. They hook him up to a tank of oxygen when he gets on the machine. He has three more classes to go.
After lunch we went to the cardiologist's office for the ICD check. The tech confirmed that Bob had had an episode of atrial fibrillation the day we went to Costco. After the ICD check we went to the car (which we had parked near Dr. Beck's office because there was no space in front of the bldg. where the ICD check was done) and I read a magazine while Bob took a nap. He was pretty tired from the 40 min. on the machine in addition to the warm up and cool down exercises.
Later we got out of the car and walked the short distance to Dr. Beck's office. Dr. Beck had a written message about Bob's oxygen need from one of the staff at the rehab class. After some questioning by Dr. Beck, it turns out that Bob (and I) had misinterpreted some information given out about inhaler use. Further questioning of Bob by Dr. B revealed that, after the class about maintenance and rescue use of inhalers, Bob quit using his inhaler as a maintenance device and only used it as a rescue device.
So Dr. Beck gave Bob a different inhaler (Symbicort) to use as a maintenance device and he will continue to use the Combivent inhaler as a rescue device. Bob is to go back in a month to discuss the results of using the Symbicort which is to be used 1 puff twice a day (every 12 hours). Dr. Beck also wants Bob to be on oxygen whenever he exercises at/from home. Since one of the guys in Bob's class, Pete, is on oxygen full time and comes to class with a small tank in a back pack Dr. Beck wants Bob to talk to Pete about the supplier of his oxygen to see if Bob would like to use the same supplier. So Bob will talk to Pete and then get back to Dr. Beck so that Dr. Beck can call A supplier and make arrangements for Bob to have oxygen here at home. He can use the oxygen when he takes out the garbage cans and brings them back in or goes for a walk or uses the machines at the senior center for exercise.
Ever since the episode at Costco, Bob has been wearing a waist pack in which he carries the Combivent inhaler and a few other items.
About 6:30 tonight Dr. Galli called to tell us the results of the ICD check. He confirmed the episode of atrial fibrillation and indicated that it was at a lower level than other episodes. He said that nothing can be done about it and it will happen again. This was a minor/shorter episode compared with some of his previous incidents where he went to the emergency room.
Bob has an oximeter that he uses frequently to check his oxygen level. Recently, after he had made sure all the doors were locked before we went to bed, he took a reading with the meter. His oxygen level was 88. It needs to be 90 or above. So it doesn't take much moving around for him to get too low on oxygen.
Thursday, February 25, 2010
Friday, February 19, 2010
The 6 Minute Walk
As you all know, Bob is enrolled in the 8 week Pulmonary Rehab class at El Camino Hospital. The class started on Tues. Jan. 12 and is held on Tuesday and Thursday each week. However, Tues. this week was the annual Cardio Pulmonary lunch at Michael's Restaurant at Shorline so the class will be extended to the 9th Tuesday so that they have a total of 16 classes.
A couple of weeks ago when Bob and I went to Costco, he got extremely winded pushing a grocery cart from the parking lot into the store. When he got into the store he pushed the cart to one side and leaned over the cart catching his breath. One of the staff wanted to help and said he could sit on one of the motorized carts. Bob declined and said he would be OK and continued to lean on the cart. In retrospect, he should have had his Combivent Inhaler with him and used it. After he caught his breath I led him to a place where he could sit down while I picked up the items we had gone there for. When we got home he tried taking his blood pressure and, at first, neither of the 2 devices would give him a BP reading. The 1st one just kept giving him the "Error" message. The other one finally gave a reading of 148/143 which is not reasonable. So he waited a while and finally got a reading in his normal range.
Since he keeps a log of his exercise activities for the class, he noted on the log that he had had a problem with his breathing and had therefore not done as much exercise as recommended. When he took the log to class apparently the staff wanted to know all about it and subsequently notified his pulmonologist, Dr. Beck, and his cardioologist, Dr. Galli because both offices called Bob here at home. So we set up an appointment with the Pulmonology Lab at El Camino hospital for him to have this "6 minute walk test" at 11 this morning. When I set up the appt. they indicated that the whole thing would take about 20 min. Since Dr. Galli's office did not call until about 5:30 Friday evening, the woman who called asked us to call on Tuesday to set up an appt. for an ICD check.
So Bob had me take him in for the 6 min. walk test. Since we were early they started the test about 5 min. early. The staff lady put an oximeter on Bob's finger. The meter was attached to a pack that she then put around his neck and resting on his chest and off they went. When 20 minutes had passed and they had not returned, I figured that they had probably had to put him on oxygen. Sure enough, when they showed up he was pulling an oxygen tank behind him and had the tubing attached to his nose. He sat down next to me in the lobby and the staff lady went in the back and had a male staff member (Thomas) come out to talk to Bob.
In the course of the conversation Bob revealed that in bed at night his fingers frequently get all tingly. Thomas indicated that tingling in the fingers is one sign of insufficient oxygen in the blood. Then Bob told him about the leg cramps that he had been getting at night but that he had been having less of a problem with them since he had been taking the rehab class. Thomas told him that a build up of lactic acid in the legs, caused by less circulation, was probably the cause of the cramps. He explained that, if the level of oxygen in the body gets too low, the system pumps less blood to the extremities and more blood to the vital organs so that the vital organs get the oxygen that they need. So lactic acid builds up in the extremities because the blood is not moving adequately. Thomas will inform Dr. Beck's partner of the results of the test since Dr. Beck is out of town until next Monday.
Next Thursday Bob has an appt. in the afternoon to see Dr. Beck and an appt. at Dr. Galli's office for an ICD check. It is highly likely that the episode at Costco involved some atrial fibrillation since neither blood pressure cuff wanted to give a BP reading until after Bob had been sitting in the chair for an extended period of time. The ICD check will tell them if there was atrial fibrillation involved.
Before we headed to the hospital for the 6 min. walk test, Bob had commented that he was feeling better today than he usually feels.
Prior to the Costco episode Bob had ordered an oximeter for home use and he has been checking his blood oxygen level a lot.
After Bob sees the doctors next Thursday I will do another post.
A couple of weeks ago when Bob and I went to Costco, he got extremely winded pushing a grocery cart from the parking lot into the store. When he got into the store he pushed the cart to one side and leaned over the cart catching his breath. One of the staff wanted to help and said he could sit on one of the motorized carts. Bob declined and said he would be OK and continued to lean on the cart. In retrospect, he should have had his Combivent Inhaler with him and used it. After he caught his breath I led him to a place where he could sit down while I picked up the items we had gone there for. When we got home he tried taking his blood pressure and, at first, neither of the 2 devices would give him a BP reading. The 1st one just kept giving him the "Error" message. The other one finally gave a reading of 148/143 which is not reasonable. So he waited a while and finally got a reading in his normal range.
Since he keeps a log of his exercise activities for the class, he noted on the log that he had had a problem with his breathing and had therefore not done as much exercise as recommended. When he took the log to class apparently the staff wanted to know all about it and subsequently notified his pulmonologist, Dr. Beck, and his cardioologist, Dr. Galli because both offices called Bob here at home. So we set up an appointment with the Pulmonology Lab at El Camino hospital for him to have this "6 minute walk test" at 11 this morning. When I set up the appt. they indicated that the whole thing would take about 20 min. Since Dr. Galli's office did not call until about 5:30 Friday evening, the woman who called asked us to call on Tuesday to set up an appt. for an ICD check.
So Bob had me take him in for the 6 min. walk test. Since we were early they started the test about 5 min. early. The staff lady put an oximeter on Bob's finger. The meter was attached to a pack that she then put around his neck and resting on his chest and off they went. When 20 minutes had passed and they had not returned, I figured that they had probably had to put him on oxygen. Sure enough, when they showed up he was pulling an oxygen tank behind him and had the tubing attached to his nose. He sat down next to me in the lobby and the staff lady went in the back and had a male staff member (Thomas) come out to talk to Bob.
In the course of the conversation Bob revealed that in bed at night his fingers frequently get all tingly. Thomas indicated that tingling in the fingers is one sign of insufficient oxygen in the blood. Then Bob told him about the leg cramps that he had been getting at night but that he had been having less of a problem with them since he had been taking the rehab class. Thomas told him that a build up of lactic acid in the legs, caused by less circulation, was probably the cause of the cramps. He explained that, if the level of oxygen in the body gets too low, the system pumps less blood to the extremities and more blood to the vital organs so that the vital organs get the oxygen that they need. So lactic acid builds up in the extremities because the blood is not moving adequately. Thomas will inform Dr. Beck's partner of the results of the test since Dr. Beck is out of town until next Monday.
Next Thursday Bob has an appt. in the afternoon to see Dr. Beck and an appt. at Dr. Galli's office for an ICD check. It is highly likely that the episode at Costco involved some atrial fibrillation since neither blood pressure cuff wanted to give a BP reading until after Bob had been sitting in the chair for an extended period of time. The ICD check will tell them if there was atrial fibrillation involved.
Before we headed to the hospital for the 6 min. walk test, Bob had commented that he was feeling better today than he usually feels.
Prior to the Costco episode Bob had ordered an oximeter for home use and he has been checking his blood oxygen level a lot.
After Bob sees the doctors next Thursday I will do another post.
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