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Old 02-04-2013, 08:44 PM   #1
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A complete novice... :(

So, here's my story. I work in a Stable first off. Last Thursday (1/31) I went to go to the hay barn with our mule to get hay for the evening. It was bitterly cold and since the hay is in an enclosed building I'm sure the dust didn't help. I have been on Singulair for probably just under 6-8 months. I also have an inhaler for when I start to wheeze. (Proair) Last Thursday when I came back from getting hay I noticed my respiratory rate increased. I have not been told I have asthma, at least not yet. Anyways I tried to work through the fast breathing rate to get hay put in all the stalls. As I got through about 75% of the barn my breathing rate did not improve and I started to feel my chest tighten and it began to hurt. I started to panic because by now I was having a really hard time breathing. At this time I was the only one in the barn. Everyone else that was there was in the arena, which was a good 100 feet away. To me that seemed like a long way.

A border came around the corner and his wife helped me to the lounge, but I side tracked into the tack room as that's where my inhaler was. I sat down on the trunk and tried to focus on relaxing and calming myself down. I at this time was still breathing too fast to take a puff of my inhaler and one of the instructors went to go get someone to help me. When she came she also tried to get me to relax and slow my breathing. She literally had her hand on the phone ready to call for an ambulance, but I was by then able to take a puff of my inhaler which put her at ease. The first puff didn't help so I managed to take a second one. They helped me upstairs into the viewing area which had a fireplace and was much warmer than the barn. It took me a good hour until my breathing rate returned to a manageable rate where I could drive home.

The next day I went back to work but got through two stalls and felt my chest tighten slightly so I decided to call it a day and call the doctor. I saw him about 3 hours later and he diagnosed the episode as a broncho-spasm. Now I'm on Advair 100/50 and have a peak flow meter.

For me my "green zone" is above 450, my "yellow zone" is between 250 and 450, and my "red zone" is below 250. At the office my doctor did walk me through a treatment of the advair seeing that my peak flow while there was 350 and below. The day after I took my first two doses of my advair my peak flow raised from 350 to 430 being my best for the day. I have been measuring my peak flow twice a day seeing I can get close to the "green zone" but still can't manage to cross it.

The past two days though my peak flow dropped back down to around the 350 range. I do have a slight cough and my dad was just diagnosed a couple days ago with bronchitis. I hope I'm not getting his cold. That's why I haven't called my doctor yet. I go back for follow up on the 20th. I guess where i'm going with this is, is this concerning enough to give my doctor a call? I don't feel horrible, but I do have a minor cough. I have just started having respiratory issues again about 6-8 months ago so I'm still new to this whole scary ride. So I'm not sure exactly what this is and when to call my doctor or go to the ER if need be.

Yes, I probably should have gone last Thursday to the hospital. The lady helping me did say my lips turned blue at one point. But after getting into the viewing area they returned to normal. Also with it being my first attack I have read that a trip to the ER would have been a good idea.

Anyways I guess I'm looking for any advice as to anything in this subject since I'm not familiar with the whole breathing problems area. Should I wait til I go back to see my doctor to tell him about the lower peak flow reading? Should I just keep an eye on it and if it doesn't get better then call? I'm completely unsure of what to do. I don't want to call him if the peak flow reading gets better after a few days, because maybe I am getting the starts of a cold. Again I have no idea.

Seeing as that was my very first attack and I cannot predict when they are going to happen I have been wearing masks at work. But again I was able to go a couple of months without using my inhaler. Being so unpredictable I can't judge when I'm going to have troubles. Any advice would be much appreciated. Again I have not been diagnosed with asthma, but I'm starting to wonder.

 
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Old 02-05-2013, 04:14 AM   #2
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Re: A complete novice... :(

I'm sorry they haven't talked with you about premedicating. This is using your rescue inhaler before a cardio event. So, I think you should be doing 2 puffs, 60 seconds apart (standard premedicating routine) 15 minutes before you do any cardio activity and working the hay would qualify as that. I jog and I have to premedicate. Next, unless you are a large build woman, I think 450 is a little high for a green zone. I'm lucky if I can get close to 350 - 5'2, 110 pounds.

And lastly, are you seeing a pulmonologist or your regular doctor? I would find a pulmo and get an asthma assessment. You may need different meds or a different protocol.

Hope this helps.

 
Old 02-05-2013, 06:11 AM   #3
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Re: A complete novice... :(

Titchou,

Thank you for your reply. You are right my doctor has not talked to me about premedicating. I will definietly talk to him about that and i will ask about a recommendation for a pulmonologist. About the peak flow, i am definitely not a big built woman. Actually since i started at the stable doing 40 hours actually dropped from 112 to 92. I have almost reached 450, but that was obviously before my peak flow started to drop. Again I definitely want to thank you for the reply. I really do appreciate the information! I will certainly do some further investigating.

Last edited by xenagurl20; 02-05-2013 at 06:12 AM. Reason: posted twice

 
Old 02-05-2013, 06:51 AM   #4
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Re: A complete novice... :(

Many Drs seem to "dance around" the diagnosis of asthma, which is often called reactive airway disease. It involves inflammation, bronchospasm (tightening of the bronchial tubes), increased mucus production and cough, shortness of breath, tightness in chest and is typically aggravated by 1. exposure to allergens 2. exposure to cold air 3. strenuous exercise 4. increased humidity, wind (carries pollen and stirs up dust) 5. respiratory viruses or bacterial infections

In your situation you were exposed to the hay (perhaps you are allergic to it), dust, cold and increased exercise. Wearing a mask does help(warms air and filters the dust, pollen, mold) and premedicating as Titchou suggested. In the long run, this may be a hazardous job for you. Any chance of changing positions to lessen your exposure? I would suggest seeing an allergist to see what inhalants you are allergic to, as horses could even be a possibility. Also, pick up an oxygen saturation meter for your fingertip, available at most drugstores, so you can check your oxygen level when you are having an attack. It should be over 96 if at sea level, 94 or over if at high altitude, like 5000 ft or above. Below 88 should be treated with oxygen, below 80 is pretty darned low and enough to make you turn blue. You should have baseline pulmonary function tests done and be seeing a pulmonologist. Anytime your cough produces mucus that is not clear/white, you should call Dr., as you probably have an infection needing antibiotics, as it will turn into bronchitis. Hope this helps, and you should ask for a diagnosis (expect asthma). Also, getting a pneumonia vaccine will help protect you against pneumonia and bronchitis.

Last edited by ladybud; 02-05-2013 at 06:57 AM. Reason: added last sentence

 
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Old 02-05-2013, 07:32 AM   #5
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Re: A complete novice... :(

Quote:
Originally Posted by ladybud View Post
Many Drs seem to "dance around" the diagnosis of asthma, which is often called reactive airway disease. It involves inflammation, bronchospasm (tightening of the bronchial tubes), increased mucus production and cough, shortness of breath, tightness in chest and is typically aggravated by 1. exposure to allergens 2. exposure to cold air 3. strenuous exercise 4. increased humidity, wind (carries pollen and stirs up dust) 5. respiratory viruses or bacterial infections

In your situation you were exposed to the hay (perhaps you are allergic to it), dust, cold and increased exercise. Wearing a mask does help(warms air and filters the dust, pollen, mold) and premedicating as Titchou suggested. In the long run, this may be a hazardous job for you. Any chance of changing positions to lessen your exposure? I would suggest seeing an allergist to see what inhalants you are allergic to, as horses could even be a possibility. Also, pick up an oxygen saturation meter for your fingertip, available at most drugstores, so you can check your oxygen level when you are having an attack. It should be over 96 if at sea level, 94 or over if at high altitude, like 5000 ft or above. Below 88 should be treated with oxygen, below 80 is pretty darned low and enough to make you turn blue. You should have baseline pulmonary function tests done and be seeing a pulmonologist. Anytime your cough produces mucus that is not clear/white, you should call Dr., as you probably have an infection needing antibiotics, as it will turn into bronchitis. Hope this helps, and you should ask for a diagnosis (expect asthma). Also, getting a pneumonia vaccine will help protect you against pneumonia and bronchitis.
Sadly having both parents in or have been in the medical field they always tell me that I'm obsessing so over the years I have become afraid to bring up specialists afraid of getting an overreacting result. I still live with them even though I'm 25 and can make my own decisions. I think they think I obsess because I do my own research, because I want to know what the doctor is talking about. I hate to feel left in the dust but I don't use the research as a diagnosis. My parents as difficult as they can be in the area is why I have resorted to this website, because it seems like going to them is not an option. They have never supported me medically and always told me to take an ibuprofen and I'll be fine. In the past though I have been right about when I needed to see a doctor and have proved them wrong, but that only happens once in a great while. Also when I do go to Walgreens or CVS for some medical item I feel like I need to hide it from them otherwise I'd be getting this long winded lecture about why I don't need it. So reading responses to posts that I find concerning is very comforting. It's a sad and vicious cycle.

I also have a degree in Equine Studies which turned out to be my passion, I guess in that matter I will be wearing masks for the rest of my life. LOL I will most definitely talk to my physician about further testing and I will look into getting an oxygen saturation meter. I have thought about seeing an allergist in the past and since the subject has been brought up here I will certainly talk to my doctor!

With the attack last Thursday the breathing issue seemed to jump from breathing really fast to not being able to breathe well at all. I have had episodes in the past where I would cough uncontrollably and then wheeze, but this one was different. I have had to use my inhaler in the past when I would start to cough really bad before it got worse, but premedicating sounds like it's something I will need to start doing.

I know I have said it a lot in just the past few posts, but I REALLY do appreciate all the help. It gives me more insight into others experiences and helps me to think deeper about what needs to be done. I have always found medicine to be interesting and I help my mom who is a trauma nurse going for her Masters to become a Nurse Practitioner during November when she holds her ATLS (advance trauma life support) courses and I have a blast. It makes for a long weekend, but listening to the instructors teach the different subjects and situations is just fascinating. Again THANK YOU! I will keep posting as I find out more and I will look into having some of these new actions looked into.

 
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Old 02-13-2013, 12:08 PM   #6
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Re: A complete novice... :(

I think you need lung function testing to get a clear diagnosis. Your post struck home for me cause I had a situation where I was diagnosed with asthma, but it was not asthma. It was profound allergy to my birds which caused asthma like symptoms.

When I was trying to sort out what was wrong I read about a lot of lung issues and yours sounds a little like one I studied called "farmer's lung". Your significant weight loss in particular caught my eye. It's one of the symptoms, and not an asthma symptom very often.

Please look into this as it might be quite important that you remove yourself from the barn environment, even though I know that could be hard.

FYI, My sister keeps horses and was recently delivered moldy hay. She tried to sort out the good from the bad hay and developed a nasty cough from it. However, she does not have asthma and it went away once she got rid of all that hay.

Please check it out cause it's important.

 
Old 02-14-2013, 05:54 PM   #7
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Re: A complete novice... :(

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I think you need lung function testing to get a clear diagnosis. Your post struck home for me cause I had a situation where I was diagnosed with asthma, but it was not asthma. It was profound allergy to my birds which caused asthma like symptoms.

When I was trying to sort out what was wrong I read about a lot of lung issues and yours sounds a little like one I studied called "farmer's lung". Your significant weight loss in particular caught my eye. It's one of the symptoms, and not an asthma symptom very often.

Please look into this as it might be quite important that you remove yourself from the barn environment, even though I know that could be hard.

FYI, My sister keeps horses and was recently delivered moldy hay. She tried to sort out the good from the bad hay and developed a nasty cough from it. However, she does not have asthma and it went away once she got rid of all that hay.

Please check it out cause it's important.
I will surely do some research on the issue. Funny name...too. I was maybe thinking the weight loss was probably because of all the work I was doing. I'm still eating 3 meals a day, but yea the weight loss was something I noticed too in how strange it was in how fast I lost it.

I do have a doctor appointment coming up next Wednesday so I will post on how that went. I will bring up the subject of seeing a specialist, doing a pulmonary function test, and maybe seeing an allergist. It's just so weird in how the respiratory stuff just appeared last year and is so spontaneous and unpredictable. I will make up a list of questions to bring with me for my visit and I will post his responses too so my posts can stay updated. I just want to get to the bottom of this. Specialists visits or not depending on my doctor's recommendations. I want to be healthy again! LOL

 
Old 02-20-2013, 10:09 AM   #8
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Re: A complete novice... :(

So here's an update. Over the course of the month my peak flow reads have been pretty consistent and have stuck around in the yellow range. My doctor decided to up my Advair dose to the next stronger dose so instead of 100/50 he has me up to 250/50. He wants me to continue with my peak flow reads and come back for another follow up in two weeks. He thinks that since it's just mild and not super serious he wants to see if the increased dose makes a difference before he goes for any other testing.

 
Old 02-22-2013, 07:01 AM   #9
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Re: A complete novice... :(

Ok, so the follow up on (Wednesday 2/20) went well. I work at the stables Thursday through Monday and went to work on Thursday. I got through a couple of stalls and then it started to feel like someone was sitting on my chest. I did my peak flow this morning as usual around 8 and noticed that my read red 350 which is right in the middle of my "yellow zone" I took a few minutes as the sensation began to check it again around 11:30. I performed three reads as instructed and noticed my peak flow had dropped down between 300 and 350. I also noticed that my nose was running like a faucet, which wasn't helping my breathing problems. I took a puff of my inhaler and tried to press on with stalls. At around 12:30 the pressure had not gone away and I was actually starting to feel a little dizzy. I went again to go get my property manager who helped me the first time I had that bronchospasm and he helped me get inside and I called my doctor's office. I was scheduled another office visit (Thursday 2/21). When I went in my O2 read 99%, so my doctor's next move was to schedule a Pulmonary Function Test. Just to make sure this is Asthma we are dealing with otherwise he said we shouldn't be treating whatever this is this aggressively. He also sent in a prescription for Prednisone. Along with the prescription he upped my Advair dose to 250/50 and told me to stop taking the Advair a week before the scheduled Pulmonary Function Test.

Now I'm at home for the next two days recovering and as long as I feel better I can go back on (Sunday 2/24). I'm just waiting for the doctor's office to call so I can get the Function Test set up.

I thought I was taking all the precautions to not have this happen again. I was wearing my face mask as I was working, but again no such luck. I really gotta get this figured out. After all this "drama" I really hope it is something so as usual I didn't have to go through all this for nothing....

 
Old 02-22-2013, 07:47 AM   #10
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Re: A complete novice... :(

I agree - do the lung function testing and see what's what before you just pile on medications. Yes the prednisone will work but it is NOT something you want to take unless you really, really have to. You may not have asthma. I didn't, and my first diagnosis said I did but I do not. What you don't want is to end up scarring your lungs (the small air sacs called alveoli) which can be permanent.

Your descriptions suggest that barn work may not be something that is right for you.

 
Old 02-22-2013, 07:49 AM   #11
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Re: A complete novice... :(

If you are highly sensitive to the hay, mold, horses or dust, a mask won't keep it all out of your nose and lungs. It may have been worse without it though. Glad the PFT are scheduled. The Prednisone works well and fast so you should be breathing easier.

 
Old 02-22-2013, 10:47 AM   #12
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Re: A complete novice... :(

except prednisone is a steroid , and if you DO have any mycotoxins in your body the streoid will feed them !

 
Old 02-22-2013, 03:49 PM   #13
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Re: A complete novice... :(

I assume you have had a recent chest xray? If your cough is productive at all the Dr could order fungal cultures, bacterial cultures. Are your symptoms GONE when you aren't in the barn, around the hay, etc? If so, that would indicate more of an allergy or sensitivity. Obviously feeling sick, fever, coughing up yellow-green stuff would all indicate infection. Has a CBC been done to check for infection and look at eosinophils? Eos are often high in asthma/allergies with the rest of the CBC normal.

 
Old 03-10-2013, 06:41 PM   #14
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Re: A complete novice... :(

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I assume you have had a recent chest xray? If your cough is productive at all the Dr could order fungal cultures, bacterial cultures. Are your symptoms GONE when you aren't in the barn, around the hay, etc? If so, that would indicate more of an allergy or sensitivity. Obviously feeling sick, fever, coughing up yellow-green stuff would all indicate infection. Has a CBC been done to check for infection and look at eosinophils? Eos are often high in asthma/allergies with the rest of the CBC normal.
In the beginning my doctor was going to order a chest x-ray, but wanted to check my peak flow reads instead. After seeing that I needed a treatment that day the first day I went in he opted not to do the chest x-ray. I have had a history of having the wheezing at home, but that was in 2011. That was when I first went to my doctor about the wheezing and coughing spells. That was when he first put me on the Singular and Pro Air.

Being off the Advair for about 5 days now I do still have a cough in the morning most, but then it seems to go away after a little bit. But yea so far ta the barn I've been doing ok. This is what I hate though. It is so unpredictable and frustrating because when I finally do have a flare up it catches me off guard.

When he pulled lab work off of me when I passed out a couple of months ago my CBC's were within the normal range. Actually to tell you the truth my EO% said it was abnormally low. out of 1.00-3.00 being normal my levels were 0.40.

But yea the PFT's are scheduled for this upcoming Wednesday (3/13) and so far I have been Advair free for 5 days. I have noticed the usual runny nose with clear discharge, and a morning cough, and some increased sneezing both at home and at the barn, but otherwise I've been holding up ok. \

I have asked a few questions and have gotten some answers that I wanted to get answers to, but I have to wait til after the test to see if I can continue to work at the stables. Oh, when going to get hay and stuff even though I go get it once a week I have been wearing a face mask even though it might not help and have been doing good. I guess we will see what the PFT's show when the test results come back. My doctor wants to find out if this is some sort of restrictive, obstructive, or what kind of difficulties this is. I just hope he can give me a clearance to continue to work at the barn. Even though it might not be in my best interest it is one of my biggest passions. It would kill me to give it up... *crosses fingers*

 
Old 03-22-2013, 04:22 PM   #15
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Re: A complete novice... :(

Alright, the results are in and they are not what I expected them to be. I went in and talked to my family physician. He came in and told me that my PFT's were good. He told me that the source of my problems are caused by anxiety. I never knew that a high level of anxiety could come to the cause of respiratory problems. I scheduled an appointment with my psychiatrist for next week as my family physician told me to do so ASAP.

So I guess that's the end of that mystery. Now it's time to seek a recovery plan and get back to living life. On the upside yes, I may have some allergies at the stables, but they are not the root of my respiratory problems which means they are not to blame to prevent me from working at the barn. I sure hope though that with some medications the anxiety issues will ease and make living life easier.

 
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