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Post by Ouch on May 30, 2007 20:11:32 GMT -5
Oh yes, I was actually going to suggest that myself, it slipped my mind, those respiratory exercise devices (the spirometer) are quite useful...they oftentimes give them to many post-operative patients (depending on the procedure). They actually have some with happy faces too .
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Post by DrH on May 31, 2007 8:24:38 GMT -5
I suggested Tony go and see his MD, to make the actual clinical diagnosis of pneumonia, as someone pointed out on line all a physician can do is offer advice based on a patients description of symptoms. If it is a pneumonia a simple chest x-ray and blood work up should be conclusive, and if it is a bacterial pneumonia, a course of antibiotics. Physical therapy is also indicated in patients with decreased respiratory function and capacity to get the secretions in the lungs moving since as i mentioned previously stasis causes a host of problems. I recently attended a congress where an American study published some statics on how many people consult the Internet regarding their specific complaints before going to see their physicians, the numbers where alarming, however the percentages of the general public actually self diagnosing themselves correctly was still low enough to keep us our jobs. Funny thing is, Dr H, for a c5c6 SCI, I have a very strong Diaphragm and get lots of movement and exercise, as I push and do workouts, but when I get a bug like this, it's no match...I really need those other muscles you mentioned. I'm not sure I actually reached the Pneumonia level, but I was definitely headed that way. BTW, I doc has never ordered a chest x-ray...I just grab antibiotics, and run! AB....just knowing you were out teasing dudes in your BLACK bikini on the beach this weekend makes all the horrible suffering I did worth it!!! hehe Thank you, Val, mi querida...quiero estar en tus brazos de noche!! jaja The continuing dilemma of young blood versus old. Today medicine is so dynamic that we physicians have to make a concerted effort to keep up to date with new guidelines and treatments, its up to the individual in terms of the patient care he wants to offer. I would lean to wards younger doctors being most informed, and more willing to keep updated with current medicine. To a lesser extent clinical experience can only come from adding years of clinical exposure to knowledge. Tony, since your physician knows your personal medical history and is aware of your susceptibility to get respiratory infections so thus based on anamnesis alone he diagnosis and treats you is also normal, its also an extra expense to request an chest x-ray if you are able to make a positive clinical diagnosis without it. So, in my opinion he is not at fault. If say however there is a change to the frequency and intensity of and character of your respiratory infections further investigations are more warranted. Your diaphragm has compensated for the lack of complete inter-costal muscle use(the muscles in between your ribs that make your chest wall expand) so in your normal everyday activities including your regular exercise ,you are able to respire efficiently. However any infection or inflammatory process with in the airways will increase the work of breathing (the mucus plugs affect the oxygen diffusion into the blood stream) and thus the already compensated diaphragm is put under strain, for having to work harder since the brain is sending it messages that there is a smaller amounts of oxygen diffusion taking place, and diaphragm which also needs oxygen is thus receiving less oxygen than normal in turn, its a vicious cycle. Often you may find if you prop yourself up on some pillows when lying down so that you are say 45 + degrees upright you may actually be able to breath a little better. Think of your lungs as a bottle with a little water left in the bottom (the water being the mucus in the lungs). If you put the bottle flat down instead of upright the water at the bottom spreads over the entire side surface of the bottle (taking up more bottle surface area than when the bottle was upright.) Hence the mucus in the lungs when lying down occupies more lung surface area than when you would be sitting up. This is the reasoning for putting patient semi upright position during respiratory insufficiency.
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Post by E on May 31, 2007 8:39:21 GMT -5
Loving this conversation, by the way.
I'd like to ask, if you don't mind answering Dr. H (and I understand your guest status), are you also a devotee?
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Post by Pony on May 31, 2007 15:34:41 GMT -5
The continuing dilemma of young blood versus old. Today medicine is so dynamic that we physicians have to make a concerted effort to keep up to date with new guidelines and treatments, its up to the individual in terms of the patient care he wants to offer. I would lean to wards younger doctors being most informed, and more willing to keep updated with current medicine. To a lesser extent clinical experience can only come from adding years of clinical exposure to knowledge. Tony, since your physician knows your personal medical history and is aware of your susceptibility to get respiratory infections so thus based on anamnesis alone he diagnosis and treats you is also normal, its also an extra expense to request an chest x-ray if you are able to make a positive clinical diagnosis without it. So, in my opinion he is not at fault. If say however there is a change to the frequency and intensity of and character of your respiratory infections further investigations are more warranted. Your diaphragm has compensated for the lack of complete inter-costal muscle use(the muscles in between your ribs that make your chest wall expand) so in your normal everyday activities including your regular exercise ,you are able to respire efficiently. However any infection or inflammatory process with in the airways will increase the work of breathing (the mucus plugs affect the oxygen diffusion into the blood stream) and thus the already compensated diaphragm is put under strain, for having to work harder since the brain is sending it messages that there is a smaller amounts of oxygen diffusion taking place, and diaphragm which also needs oxygen is thus receiving less oxygen than normal in turn, its a vicious cycle. Often you may find if you prop yourself up on some pillows when lying down so that you are say 45 + degrees upright you may actually be able to breath a little better. Think of your lungs as a bottle with a little water left in the bottom (the water being the mucus in the lungs). If you put the bottle flat down instead of upright the water at the bottom spreads over the entire side surface of the bottle (taking up more bottle surface area than when the bottle was upright.) Hence the mucus in the lungs when lying down occupies more lung surface area than when you would be sitting up. This is the reasoning for putting patient semi upright position during respiratory insufficiency. Dr H....i went to my Doc today because last night was one of the worse nights I've had, (incredible production of loose mucus and constant hard coughing) and yesterday, and I really thought I was getting much better. I explained to him about the lack of "inter-costal muscles" that you mentioned, and I could see that he was impressed with my knowledge. lol Sorry, I didn't give you the credit!! lol He gave me Advair to relax Brochial spasms and another round of antibiotics.
As for sleeping upright, i haven't slept lying horizontal in over a week, no way to do it without drowning, but I only do that half the night under normal conditions. It's just more comfortable for me, and I have a hospital bed, so it's easy.
It's mysterious that a Doc would be on here, but I just want to thank you again for giving me so much useful info. It's helped more than you know.
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Post by Pony on May 31, 2007 15:46:34 GMT -5
AB...my Diaphragm is the strongest for c5c6 coz of all the singing I've done in the days. It was an incredible workout for a quad to sing difficult rock songs for 4-hour gigs. I even have a hard time i did it. I also do something I've never heard a quad do. I wear an abdominal binder around my quad belly, pulling it in, giving my Diaphragm stronger ability. If I go without that binder, my speaking power is dramatically less, and I get worn out very quickly. Actually, singing is completely out without the binder. It also gives me better posture and stability to my frame.
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Post by Ouch on May 31, 2007 15:54:02 GMT -5
Hmm...although I'm not a 'quad', I had never given thought to using a 'binder'-like device while performing myself...something like that might improve my range (not vocal, but distance) now that I think of it.
Hope those meds., etc. will get ya' better, hate to hear you feelin' worse!
...and I agree, this conversation involving this third-party medical professional (or at least someone with medical expertise) is quite interesting. Always nice to have a Paradevo Physician on hand.
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Post by Triassic on May 31, 2007 18:14:40 GMT -5
I might add that in person Tony does not seem like a quad; much more like a para...
I'm curious about Dr. H too. I get a masculine impression. But I could be wrong...
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Post by dolly on May 31, 2007 23:43:44 GMT -5
i had the pleasure ( ) of meeting an attractive doctor on wheels quite recently at work. he is a general practitioner and no, i was not his patient. i was very excited and feeling rather bold until his fiancee showed up. typical of my luck. lol anyway, he seemed to be a very low level quad as his hands seemed functional but very slightly impaired. sigh...
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Post by another doc on May 31, 2007 23:56:43 GMT -5
As for sleeping upright, i haven't slept lying horizontal in over a week, no way to do it without drowning, but I only do that half the night under normal conditions. It's just more comfortable for me, and I have a hospital bed, so it's easy. Actually, when you're not sick, it should be easier for a quad to breathe while lying horizontal. The reason for this is that when you're lying flat, your abdominal contents are pressing on your diaphragm and give you a little help in emptying the air from your lungs. Wearing that abdominal binder has the same effect as lying flat.
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Post by DrH on Jun 1, 2007 4:25:58 GMT -5
Tony, Advair is a combination drug, consisting of an agent to relax the smooth muscle in your airways thereby opening them up, and the other agent a steroid which acts as an anti inflammatory to the airways.
If you are compliant with the medication, rest enough and keep hydrated I'm positive you will feel better in no time.
Glad to have been able to help in terms of understanding your condition, I welcome any more questions anyone has regarding anything medical.
I would however prefer to remain as anonymous as possible on this board for the time being.
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Post by Pony on Jun 1, 2007 9:10:49 GMT -5
Well, I'm ECSTATIC to say I finally got a decent night's sleep last night, as my lungs weren't perfect, but eases off enough that I could sleep. I had to drive to Tampa last night, and I was dead when I got home, but I could tell after a few minutes of getting in bed I was going to get sleep. This Bronchitis stuff is incredible, but it's finally subsiding. Dr H...you're fine staying anonymous - that way I can picture you some gorgeously smart female doc with dark thick hair, red lipstick, serious dark penetrating eyes behind conservative, yet fashionable glasses, reading my chart with sleek tanned legs crossed. As for sitting up sleeping, when I'm not sick, I break up the night...1/2 sitting up, 1/2 lying flat. Maybe it's my way of changing weight on organs, or it could be psychological for control. Lying flat gets old without turning, and I feel less in control, if that makes any sense.
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Post by Ouch on Jun 1, 2007 11:55:35 GMT -5
I also got a 'masculine' impression like Tri too, but you have a great imagination, Tony lol . Actually I know someone personally who is a wheeling doctor, I s'pose they're not as rare as it would seem...I heard there was some big ruckus about a triple amputee getting M.D. title as well in recent news.
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Post by mrjefffurz on Jun 1, 2007 17:01:17 GMT -5
i never had any lung/breathing issues until i moved here but,,,this yr doesnt count cuz of all the antibioyix ive been on) ive had at least 3 cases of bronchitis,,,the 1st cpl yrs i would try to just get over it until it became pneumonia,,,now i go in right away,,,a shot ot 2 of rocephin & a z-pack or round of levaquin plus a steriod regimen and some nebulizer treatments & its kicked...my dude roomy has been hackin up a lung for 6 weeks & had several antibiotic treatments that have done zero...i dunno which drugs he's had but i know he hasnt had shots, steroids, or breathing treatments...i hope u r able to get over this w/o seeing the doc, tony but given the breathing issues we crips have i,,,personallly...wont take a chance anymore...good vibes sent your direction...
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Post by Ouch on Jun 1, 2007 19:52:03 GMT -5
...they use Rocephin for Bronchitis...? Hmm...hope I don't ever get it then...I'm allergic to that...
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Post by BA on Jun 1, 2007 20:38:20 GMT -5
Rocephin is a dinosaur of a drug. Reconstitue from powder with lidocaine and it hurts a LITTLE less.... or in the case of an SCI, will send you into a few spasms.
I am certain there are quite a few medical people on this board. Some who choose to remain quite discreet, which is understandable, given the nature of the profession.
I have met only one wheeling doc. A psychiatrist... who was loonier than a tune and then some.
And Tony, if you take Advair, please rinse your mouth out after you use it.. and I mean rinse it very well. Lots of people get "thrush" (oral yeast infection) from this med.
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