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Suffering from Sleep apnea and COPD - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Lung and Chest disorders
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   I am status post-Hodgkins, treated with MOPP/ABDD, diagnosed with pulmonary hypertension (mild) and left ventricular diastolic dysfunction (significant) in April 2006.
User :   In December 2008, I had an episode of mental confusion and high blood pressure
Doctor :   ok
User :   Since that time I have begun nocturnal oxygen therapy.
Doctor :   ok
User :   I have been diagnosed mildly hypoxic, both daytime and nighttime.
Doctor :   ok
User :   I have these episodes where I cannot be awakened,
User :   either by noise, shaking, having water poured on me, pain stimulus applied
User :   And after the episodes I am generally ill for several days
Doctor :   what are the current medication that you are taking? when was your last complete health check up?
User :   And I have been having memory loss associated with these episodes.
User :   I take Lasix 40 mg,
User :   Lotrel 5-10mg
User :   Aspirin 325 mg
User :   Claritin 10mg
User :   Zoloft 150mg
Doctor :   the episodes that you are having where you cannot be awakened could be due to apnea.
User :   Tenormin 50mg
User :   That's all.
User :   Yes, I have been diagnosed with moderate obstructive sleep apnea
User :   My husband is a physician
Doctor :   which causes transient loss of consiousness.
User :   How transient?
Doctor :   has EEG been done after any of these episodes to look for brain function abnormality?
User :   No
Doctor :   it could vary from 5 minutes or more
User :   The last episode I had lasted a long time, they put oxygen up to 5L/min and it still took 45 minutes to awaken me
Doctor :   what treatment has been given for your moderate obstructive sleep apnea
User :   CPAP
Doctor :   has the cause for obstruction made out?
User :   But I cannot use it because I cannot breathe out with the mask on.
Doctor :   ok
User :   I am overweight, so I'm sure that's part of it. I've had pulmonary function studies several times
User :   due to treatment with Bleomycin
User :   And the last one showed very low ERV, RV, and one other one I can't remember right this minute, but an expiratory value
Doctor :   i would suggest you to get an EEG done for the apnic episodes to make sure there are no higher level functions affected since you take more than 5-10 minutes to be awakened
Doctor :   have you consulted with a pulmonologist ad neurologist for your symptoms?
User :   Would an EEG have to be done right after the episodes to have value?
Doctor :   yes, EEG should be done within 12 hours of the episode or atleast within 24 hours of last episode
User :   I have a pulmonologist, yes, and he does not know. My pulse oximetry shows on average 200+ oxygen desaturation events within a 12 hour period (awake and asleep), but never low enough to cause unconsciousness and never long enough either
User :   Okay, because I had an EEG during the sleep study, which was normal.
User :   Pulmonary doctor says pulmonary hypertension could be contributing.
Doctor :   ok. i suggest you to consult a neurologist and take EEG after you have any apnic episode
Doctor :   yes, partly it could contribute, but the duration of your last episode is worrysome
User :   I had a PET scan recently, and there was nothing abnormal in my brain area. Okay, if I am breathing during these episodes, would it simply be that I went unconscious and then started breathing?
User :   And apparently I never actually quit breathing, but I understand that a very slow respiration rate counts as apneic.
Doctor :   if you would like, you can take a second opinion from one of our panel specialists and then proced with discussion with your treating doctor about your next steps for treatment
User :   My sleep study doctor says my respiration rate goes down to 6-8 per minute.
User :   Would night sweats be linked to apneic episodes?
Doctor :   yes, that can be counted as apnic, you might be stopping the breathing, due to which you become unconscious but as a protective mechanism, body restarts breathing but not at a conscious level.
Doctor :   night sweats are more linked to pulmonary hypertension, though they could also be a symptom of apnea
Doctor :   since your PET scan came back normal for brain, there is no need to worry about the metastasis there
Doctor :   was a whole body PET scan done anytime after the treatment of hodgkins?
User :   Okay. They are not the drenching sweats like with cancer, I don't think, but they are pretty significant. I did have a whole body PET scan, 3 weeks ago. Had several lymph nodes test "hot" and I have a soft tissue mass in my left lower lobe that was too small to tell yet
User :   Nodes were on average 1cm with SUV values ranging from 4 to 8.
Doctor :   ok, then the 'hot' nodes need to be monitored
Doctor :   consult our panel neurologist
User :   Right. If they were not lymph nodes, would be easier, but since they are, could be inflammatory. Okay, I will talk to neurologist, thank you.
Doctor :   visit this link to consult our panel oncologist
User :   Is there a way to go back to the first one? I can't quite tell.
Doctor :   i am sorry i did not understand. Could tel me what you meant in your last question? where do you want to go back to?
Doctor :   are you there?
User :   Yes, sorry.
User :   I wasn't sure how that second opinion worked,
User :   I guess it's an e-mail thing?
Doctor :   ok. this works like this: you have both an e-mail and phone option
Doctor :   in both you need to write your query and send along with your reports copies
User :   Ahh, I see. Pretty cool.
User :   I have been gathering all my medical records so we can look at a start to finish picture.
Doctor :   and if you opt for e-mail answer, then specialist replies you via e-mail
User :   I didn't realize until I got my records I was diagnosed with COPD in 2006 as well.
Doctor :   if you want to opt for the phone call, then the specialist call you up at scheduled time (you dont need to spend on the call).
Doctor :   and he discusses the query and reports with you for any length of time
Doctor :   untill all your queries are answered
Doctor :   he may ask you to provide extra details or reports if required
Doctor :   have you followed what I have said?
User :   Well, it would be pretty interesting if you guys figured out what's wrong after all this time! I was scheduled to go to hospital in December, but there was a baby due in the family at the time and I had to cancel. Yes, I understand, it's very neat.
Doctor :   gathering all your records copies might help to organise in chronological order to try and figure out what has been happening to you
User :   Exactly, yes.
Doctor :   so if we have your copies of reports we can put it together as per the date
Doctor :   and then correakte whats been going on
Doctor :   *correlate
User :   Okay, I will get them scanned and get a packet together. I think my 15 minutes of questions is about up, so thank you very much. I will keep up with it.
Doctor :   and proceed with the second opinion with specialists as required be it neurologist, pulmonologist or oncologist OR all the three together as depending on your case
User :   It probably would take at least two of them. :)
Doctor :   sure you can get back to us anytime when you have gathered all reports and have them put together in a bit chronological order from start til now
Doctor :   and we will see what can be done
User :   Okay, thank you very much.
Doctor :   please get back to us if you have any further queries
User :   I will. This is a very cool service.
Doctor :   you can also contact our customer care support if you need further help technically to send the reports
User :   I can't get most of my doctors to listen to me tell my symptoms start to finish. :)
User :   Okay.
Doctor :   we are there to help you 24/7. you can discuss all your queries at length with us
Doctor :   antime
Doctor :   *anytime
User :   I will be back!
Doctor :   sure. thanks for consulting me. bye for now.
User :   I laugh because I can't get my husband to listen start to finish --
User :   Bye.
Doctor :   you can be assured that we and our doctors team will listen to all your queries and answer them to the best of their capacity and experience
Doctor :   thanks for consulting me. bye for now.
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