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Trouble with weather
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Laura0711 posted:
I'm having a lot of trouble right now. I think part of it is the very weird weather we are having here in South Dakota. We are having 20 degree swings from day to day for example on Wed. it was 70 degrees and on Thanksgiving it was in the 20s with very strong winds and snow. Today I've been doing nebs every 3-4 hours and only being able to sleep laying down for 2-3 hours at a time. I'm having trouble not only with my asthma but also with my migraines which I've been getting severe headaches every time a pressure system moves through the area which this year is like every other day.

I don't know if should go in to my doctor my peak flows are in my low yellow and red zones.right now it seems like the nebs are working. I know my PCP is very relucant to put me on Pred. because I have Avascular Necrois in my hips from being on so much Pred in the past. Neither my PCP or my Pulmo will give me an action plan even though I have my PCP every time I have problems with my asthma and I ask my Pulmo every time I see him which is every 6 months. I don't know why they won't give me an action plan because all I do now is guess as to what to do, when to go see my doc, when to go in to the ER etc.

I know I'm complaing a little but I need to get this off my chest and it always helps to talk to others who understand what I'm going through.

Thanks,
Laura
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amcate responded:
I'm unsure of why they won't give you an action plan either, unless there is not a good option and they don't want to tell you to do something that will hurt you and then be held responsible. I'm just guessing. Normally the allergists folks will give an action plan.

Thankfully, all I've experienced from pred is weight gain and constant lectures from physicians about it. In my case, a low yellow means to start prednisone...anything below 65% peak flow or when the rescue meds aren't lasting the full 4 hours. The allergist told me to piggy back DuoNeb, Xopenex, DuoNeb if the nebulizer isn't working well, and if I have to do it more than twice in a 24 hour period, then go to the hospital.

But that's my plan....I don't know you at all or other medical conditions you have. Have you been to an allergist?
 
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bresky responded:
Hi I am sorry for taking so long to respond. It is very frustrating when no one gives u an action plan. It took until my 3rd specialist to get one and even then it isn't the clearest. I usually do what I feel works from experience. If I am in the yellow zone for more than 3 days and am symptomatic I will go into see my family doctor. If I am in red zone and unable to speak I go to the ER.
My action plan deals with symbicort I increase it to 2 puffs 4 times a day and when I am back in the green zone for 2 days decrease it to 3 times a day then 2 times a day. I also utilize atrovent puffer every 4-6 hours and ventolin as needed. Could u take a form in with you when u see your pulmo next time?
I am from Manitoba so I understand the weather changes I have been struggling with them to it is very frustrating and not many people understand. Hope u feel better soon.
Bre
 
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amcate replied to bresky's response:
I normally also vary things somewhat from the formal action plan in accordance with my experience as well, which is why the allergist gives me a stash of pred. I guess he trusts he, and I've seen the same guy for 8 or 9 years now.

The National Heart, Lung, and Blood institute put out a very explicit action plan a number of years ago. It is from the National Asthma Education and Prevention Program NIH publication 97-4053. Basically, you are green zone if no symptoms and peak flow more than 80%. If you have symptoms or peak flow 50-80% of personal best, then you add rescue drugs 2 puffs or 4 puffs every 20 minutes for up to an hour or one neb treatment. If you have to do this for an hour to get things good again and peak flow above 80%, but they return to normal, then you are in a high yellow zone. You double the inhaled corticosteroids for 7-10 days and take rescue meds every 4 hours the first 2 days. If it fails to return to a green zone after one hour, then you are in a low yellow zone and you take more rescue meds and start prednisone. Red zone is for very severe symptoms, peak flow less than 50% or symptoms are the same or get worse after 24 hours in the yellow zone. Go to ER/urgent care if you remain in red zone 15 minutes after rescue meds (which are double the normal dose in a red zone case). Anyway, I'm just mentioning it in case it helps Laura.
 
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Laura0711 replied to amcate's response:
amcate,

Thanks for the info. I will look up the page you are talking about and take it with me when I see my Pulmo next time I go in.

Thanks,

Laura
 
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amcate replied to Laura0711's response:
No problem. It is an action plan from about 10 years ago, so hopefully you can find it. I've heard in the USA they've changed some recommendations since then, but you can't teach an old dog new tricks. I prefer to stay with what I know.
 
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Laura0711 replied to amcate's response:
Hi Amcate,

I had no trouble finding it and the last two days have been bad for me with my asthma acting up a lot. Last night I didn't get to bed until about 3 am and tonight I was woken up with shortness of breath at 1 am. I have been sort of following the action plan for now and I might make an appoinment to see my pcp tomorrow if I don't get better tonight.

Thanks,

Laura
 
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amcate replied to Laura0711's response:
I'm glad you could find it and your following up with the PCP. I have normally found Allergy, Asthma, and Immunology folks to be better with asthma than a PCP, but in your case it's complicated because the avascular necrosis.

In the first few years of having asthma, I didn't like the action plans they gave me as they were too vague and I didn't have the experience to know how to judge it. I liked this action plan since it's so explicit and it bases what you should do on the response you're getting from the rescue drugs. It was much easier for me to understand and follow. I think the current recommendation in the USA are more aggressive with starting prednisone earlier, though...but this action plan gets a person in the ballpark.

Good luck tomorrow.
 
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Laura0711 replied to amcate's response:
Hi Amcate,

I've been getting worse over the last 3 days with my peak flows being down in 100-200's and doing nebs every 2-3 hours. I left a message for my Dr. today and talked to her about what is going on. She deceied to put me on 50mg of Pred for 5 days. Hopefully this helps knock it down but if not I'm suppose to see her.

Laura
 
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amcate replied to Laura0711's response:
Disclaimer: I am not a doctor, a nurse, or have any license that would legally allow me to give professional advice. This is from my own experience with my own asthma. I also don't have any diseases that prednisone caused or could make worse, other than emotional stuff with the pred side effects. In your case, you have avascular necrosis, so it could be different for you.

I don't know what your personal best is, so I'm assuming the predicted values here, which my guess is still puts you pretty low percentage wise. Also, the nebs aren't lasting 4 hours it sounds.

If it were me, I would have already started prednisone because in my experience taking some early on helps prevent me from having to take a lot later one when I'm more severe. For me, 50 mg for 5 days is not enough. Of course, my allergist once said I was "steroid resistant", but actually they do work, I just have to take large doses.

I don't know if you're the same, though. Anyway, hope you get to feeling better.
 
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wdove53 replied to amcate's response:
I am definitnely weather affected to a degree I near hybernate. Very depressing. Only my Dr's understand it. I am allergic to the environment and so have major episodes. in certain areas.
 
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wdove53 replied to wdove53's response:
I have started on oxygen which helps now. I use symbicort, spiriva, singular and prednisone and the breathing is terrible. I no longer can take the pred because it affects me emotionally and i lost all my support system. problem is my O2 Sat remains 97 - 100 but on exam there is no air exchange. I find I get depressed. The whether affects me. Stores with odors is difficult. the perfumes or carpets I just can't breath and require my oxygen. It is some support to hear others going through similar things.
 
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amcate replied to wdove53's response:
I can understand about the pred affecting a person emotionally. I'm on day 5 of a burst, and for some reason lungs aren't responding as beautifully as they should. Mind has not been good, but I can still function. I'm in the green zone, but barely (normally I'll be at 90% of personal best or better with pred). So, I'm trying to decide if I should go off of it tomorrow or not, but probably will. Anyway, it is a difficult thing especially when others don't understand....take care of yourself.


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