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Dr. Andrew Rynne

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Suggest treatment for severe COPD and alcoholic issues

Answered by
Dr.
Dr. Rudina Balliu

General & Family Physician

Practicing since :2015

Answered : 420 Questions

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Posted on Tue, 14 Mar 2017 in Lung and Chest disorders
Question: My husband has moderate/severe COPD and alcohol issues (35-40 years binge drinking several times a week). He also smokes 20-40 cigarettes a day. Whenever he drinks, he will consume between 24-100 12 oz beers in the course of 2-3 days. His feet and ankles promptly swell up to twice the size of normal and stay that way until 24 hours or so after a binge. Do you think this is more likely to be backing of fluids due to CHF or alcoholic cardiomyopathy or from the COPD? Additional info: patient lies to or minimizes alcohol and other issues to doctor.
doctor
Answered by Dr. Rudina Balliu 3 hours later
Brief Answer:
Alcohol consumption keep damagin his heart

Detailed Answer:
Hello! Thank you for using Health Care Magic.
I have gone through your question and I understand your concern.

This could be a sign of right ventricular failure of the heart , liver disfunction (chirrosis),COPD.
All the condition that your husband has may contribute to the ankles edema.

From all these condition it could be more likely due to back up fluid from congestive heart failure caused by alcoholic cardiomyopathy.
Alcohol has made his heart muscles weak so the heart can not pomp the blood in a normal way leading to congestive heart failure (both left and right ventricular failure ) and make the CHF worsen when he keep drinking .CHF and alcohol cardiomyopathy are connected with each other.

The COPD may play another extra role in the back up fluid in his leg (damage the right ventricule of the heart .)
Smoking not only worsen the COPD but may cause coronary heart disease.
He needs to stop alcohol immediately otherwise he will keep damage his heart, liver ...stop smoking , reduce salt intake , take medication that the doctor that prescribed regularly.

Wish your husband good health.
Please let me know if you have any further questions, I will be happy to help .

Take Care !
Dr Balliu.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Rudina Balliu 1 hour later
The Chest CT scan at the ER came back as no evidence of heart failure, although I have heard of people having "normal" chest CT scans when they did indeed have CHF. Is this something you have seen? Is it possible that the scan is unable to detect evidence while in fact it exists?
doctor
Answered by Dr. Rudina Balliu 33 hours later
Brief Answer:
CT usually is accurate

Detailed Answer:
Hello again! Sorry for my late reply.
Thank you for the extra information.

Usually we don't use a simple CT-scan to check for heart failure , we use heart ultrasound so we can have a better picture of the heart.

If there is a heart failure -yes CT scan may show sign of it also COPD ,and Cardiomyopathy .This examinations will not be accurate if they could not see the heart during the examination(techinal reason..)
It's important to know when did your husband do the the CT -scan , did he have the edema before the examination ? If the edema started after the examination he needs to do an Heart ultrasound to confirm the diagnosis possible heart failure (cardiomyopathy ). If he had edema before the examination it could be more to liver problems or kidney problem .
I would suggest to do a heart ultrasound, check his liver (blood test ), check the kidney again according to these result we can have a proper diagnosis.

Take Care !

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rudina Balliu 6 hours later
Th CT scan was in December, looking for a pulmonary embolism. His D Dimer level was very high. There was a pleural effusion, and visible thickening of the bronchial walls. Subbclavian steal syndrome was noted. The creatinine levels noted were within normal range, less than 2. Which indicates normal kidney function if I understood correctly. At his pulmonologist appointment recommended by the ER, he was diagnosed with COPD (FEV1 55% and 91 oxygen saturation) Patient has increased mucous, mostly clearish or yellowish, chronic cough and cannot lie flat easily. Lying flat causes cough quickly, not after several hours. There is evidence, or at least indication that there is mild abdominal ascites.
Trying to help him at home, I have researched many of his symptoms and come up with possible COPD, Alcoholic cardiomyopathy/CHF and cirrhosis. Since it is unlikely for me to get him to the doctor again, untill he lands in the hospital, I am trying to figure out how to best keep in in optimum health as long as I can, with the understanding that he will not quit smoking or drinking untill poor health demands it.
The pitting edema with excessive alcohol consumption has been going on for about a year. Maybe a little more.
doctor
Answered by Dr. Rudina Balliu 6 hours later
Brief Answer:
He needs to be examined to start a proper treatment

Detailed Answer:
Hello again!
Thank you for the extra information.
According to symptoms and the FEV1 could be moderate COPD.
The kidney yes it's ok.

Please write me all the symptoms that your husband may have so I can help you to clear the ideas that you have by answering the question below.
The D dimer and swollen legs could be also (besides heart failure)a sign of Deep ven thrombosis ( in this case the swollen legs may be related to varicous vein ), did the doctor examine the legs about that?

Did the doctor in December examine the pleural effusion ?what did he say?Sometimes patient with COPD are vulnerable for pulmonary infection that could be a reason of pleural effusion besides the heart failure.Did the doctor treat the pleural effusion?
Does your husband take any drugs for COPD(inhalation or pills )?
How is his blood pressure ?
Why do you think is Cirrosis? How were the liver function test (ALT/AST,bilirubine,GGT, albumin ...)that are very important to confirm the diagnosis of liver failure, does he have yellow skin , itchy skin, and other symptoms that you probably saw in the internet?
Does he has breathing problems ?fever?

He needs to do the extra examinations to confirm the diagnosis or at least to be seen by a doctor for at least a physical examination, can you ask the doctor to come home?.

Menwhile advice him to Avoid alcohol ( try to help him to be in contact with alcohol,if you can), smoking , fatty food, fried food (Eat boiled food ), reduce salt intake , when he sleeps out him some pillows under his neck so will be easy for him to get out the secretion from the lungs.Can you give to him some Chinese therapy (15-60min/day) will also help to get rid of the secretion.Using Carbocisteine/N-acetilcisteine.Do small walks every day .Taking a diuretic will help the edema .

Take Care!




Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Rudina Balliu 1 hour later
I am just learning about all this, so please bear with me as I am getting information a bit at a time as I learn. The doctor has not treated the pleural effusion, which I found surprising, as I did not think it would go away on its own. Blood pressure was very high while sick, but has now returned to normal/near normal (120/130 over 70 or 80). I think perhaps he was having a COPD exacerbation when he went to the doctor, who sent him to the ER for the D-Dimer.
These are a full list of symtoms:
fatigue
occasional weakness
short of breath on exertion
occasional short of breath while resting
severe shortness of breath while carrying any objects
itchy skin
pitting edema in feet, ankles and sometimes hands
mild nail clubbing (has been present 20+ years)
orthopnea
frequent morning headaches
chronic cough
excessive mucous
occasional severe abdominal pain
occasional pleuritic pain
My husband has slept on the couch for 10 years, using the armrest as a prop, as he cannot lie flat. There is some sleep apnea type breathing problems, his chest will pump a few times with no inhale or exhale, followed by a gasping breath. I do not think liver function test were done. There is no jaundice. The pulmonologist gave him Breo, but he does not use it, says it doesn't help anything.
The doctor has not actually seen the swelling in his feet/ankles as it usually diminishes within about 24 hours of a binge.
doctor
Answered by Dr. Rudina Balliu 22 hours later
Brief Answer:
Need to do full evaluation

Detailed Answer:
Hello again!
I read carefully all the symptoms you described me and he really need to go to a local doctor for the examinations.
Yes probably acute exacerbation of COPD may have been the reason he went to the hospital first time .If the pleural effusion was too little it can go by itself but since I was not the treating doctor I can't say nothing else according to the pleural effusion.

Sleep apnea and COPD usually are associated with each other .He need to do a sleeping test and a physical examination to his neck to confirm the sleeping apnea and start the treatment ( possible equipment).
Breo (fluticasone/vilanterol ) it's good for chronic use could be common with a short acting b2 inhaler in case of acute symptoms.
He is suffering from low Oxygen (nail clubbing,dispnea) the ortopnea could be a sign of pleural effusion.
All these medication will help him but if he keep smoking and don't take the medication he will not make any improvement just will make him worse and worse .He will keep having the cough dispnea and all other symptoms , his heart will be worse ( alcohol and COPD)
Usually the liver test function (ALT/AST at least) are done together with other blood test ( creatinine ..)

Please make him go to the hospital to do the examinations (physical examination-hear the lungs ,examine the legs ,hear the heart ..., Lung-Xray,heart ultrasound, blood test to check liver function,other blood test) only if we know what is really wrong with him(confirm ) the doctor can give him the proper help. If he does not go to a local doctor can't do to much to help him.

Hope all this help .
Wish your husband good health.


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Rudina Balliu 4 hours later
Thank you so much for answering my questions and providing so much information. My husband's follow-up appointment was today with the pulmonologist. His FEV1 has decreased to 47 or 49%. I think I will follow your advice and see if I can get him to get some more testing done. The only question I have for you right now is that Breo has a warning for persons with milk allergies, and my husband is lactose intolerant. Should he still take it?
doctor
Answered by Dr. Rudina Balliu 12 hours later
Brief Answer:
Hello , here is a clarification

Detailed Answer:
Hello again!
Happy to know that you managed to take him to the doctor .
I want to clarify that:milk allergy and lactose intolerance are not the same thing , are totally different thing .Allergy is a reaction if the body (imune system against an allergen (milk ) , lactose intolerance is when the patient don't have an enzyme in the gastrointestinal to break up lactose into small ingredients and in this case the patient have diarrhea , bloating , gass after consuming lactose product (milk).So does he has allergy or lactose intolerance or both ?
If he has milk allergy he should not take Breo.

If she has lactose intolerance how severe is that ( his body can't accept at all drinking milk?)


Take Care .
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Rudina Balliu 14 minutes later
Just an intolerance that manifests as mild gastrointestinal discomfort, gas and diarrhea.
doctor
Answered by Dr. Rudina Balliu 21 minutes later
Brief Answer:
Thank you!

Detailed Answer:
Has a mild lactose intolerance.
I think he can use it, he will take it only once/day and the amount of lactose that the drug contain is very low and some patient tolerate that .

Try to avoid medication from the stomach do not swallow, Use it properly ( inhale ) so the drug goes to the lung .Gargle the throat with water after using the inhaler .
If he can't tolerate you can stop and ask the doctor to give him another drug that does not contain lactose.

Above answer was peer-reviewed by : Dr. Prasad
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