First Hospitalization for asthma in nearly a year

My Hospital face…..

If you’ve been following my posts these past few months, you’re probably aware that I’ve been able to make it through an entire year without a hospitalization for asthma… quite an accomplishment for me. In fact, in my 68 years of existence, it hasn’t happened before. Presumably Fasenra is the driver behind this bout of good luck. Prior to this year I was averaging a hospitalization every two months and an intubation every 4 months… it was really bad.

Well, that winning streak came to an end a couple of weeks ago when I suffered an exacerbation that I just couldn’t manage at home anymore. Nebs weren’t working, steroids weren’t working, nothing was working. On top of that I was desatting, which I rarely do. With my symptoms getting worse and prospects for a miracle turn around looking grim, I knew it was time to head to the hospital.

I arrived there in the early evening, and like so many times before, the ER was packed…literally standing room only. Thanks to an efficient triage system at UCSF they called me right in. If I remember correctly, my BP at the time was 220/120 and my room air O2 saturation 81%. Within seconds of taking my vital signs, the triage nurse called a respiratory code and I was whisked into the #2 resuscitation room, one that I’m very familiar with. I would estimate that 10-12 people rushed into the room, hooking me up to monitors, putting IVs in, drawing blood, doing EKGs and Xrays and trying to listening to my chest. In less than 2 minutes I was hooked up to continuous nebs and Bipap.

The first few hours in the ER were bumpy. I would go from feeling moderately tight and wheezing to not being able to move air at all. They watched me closely for respiratory fatigue, did repeated ABGs ( actually VBGs because of my occluded radial arteries) and increased my Albuterol dose to 20mg/hr . They also added Mag sulfate and gave me small doses of fentanyl for air hunger.

Following a succession of rounds by the various attending and resident Physicians, they determined that I should be monitored and treated in the ICU. There were of course, no beds available at the time in any of the Intensive care units, so they kept me in the ER. 7 hours later a bed finally did become available and I was moved upstairs..

Its now 7 am and after 12 hours of continuous Albuterol and Bipap, I was breathing well enough to do a trial off of the Bipap to see how I would do. We also switched from continuous nebs to regular neb treatments every couple of hours, as my heart rate was running in the high 120s ( my normal heart rate is 56). So far, so good, and for the rest of the day I continued to do well.

The following morning I was actually feeling well enough to ask to be discharged, but because I was still desaturating into the low 80’s when off the oxygen, we all agreed that I should probably stay in the hospital a little longer, but could be transferred out of the ICU into one of the step down units. Later that afternoon I was moved to the Transitional Care Unit on the 14th fl.

It was really nice to have some privacy and my very own bathroom. I was feeling pretty good and was eager to go home the following day. Then overnight into and the morning hours I starting getting progressively more short of breath and I could tell that I was starting to rebound. I got so tired I needed to go back on continuous nebs and possibly Bipap. Because the TCU doesn’t allow rescue Bipap in it’s unit, and feeling uneasy about my worsening symptoms, the RN taking care of me called the hospital’s rapid response team in to access me. These guys are great, but from there things spiraled downhill and before I knew it one of the anesthesiologists showed up at my bedside with an ET tube in his hand. I thought, oh shit, here we go again. Is this going to be intubation #56? At this point I was so tired of breathing I think I said, do whatever you need to do.

Next thing I know, Im back in the ICU with 20 people hovering over me again ready to intubate, when the attending ICU Physician comes in and decides to hold off for a few minutes to see if some Precedex might help. Because my blood gasses had improved somewhat since being moved back to the ICU and because inserting a breathing could make my glottic stenosis worse, he wanted to wait a little longer see if the drug might mellow me out a little by reducing any anxiety that could be making my breathing worse. Anyway, before I knew it the drug was in my system and I suddenly became very paranoid and delusional. As short of breath as I was, I was able to yell at people, demanding that they let me go home. In my mind they were keeping me captive. This is just the opposite of how the drug works on most people. Of course I have to be the odd one.

I don’t know how many hours passed, but the following morning I woke up still in the ICU but breathing better again. I also awoke to an Iron infusion running to into my port. I’m guessing it was because I was anemic. Now in my right mind and trying to figure out what had happened, I remember telling the nurses and doctors…” I just wanna go home!” A couple hours later I got my wish and was discharged directly from the ICU. I left the hospital better than when I came in, but I was still quite short of breath and still very pissed off about the Precedex situation. I’ve had problems with this drug before and Im convinced they knew that it, but gave it to me anyway.

Ive now been home for 5 days now, and while its going to take some time physically, emotionally I’m in a much better place than I was when I left the hospital. After talking with different doctors who were present and after reading some the medical notes, I have a better understanding of why things happened the way they did in the ICU. Basically it was a hectic environment with some miscommunication thrown in. Hard for me to stay mad when the outcome is that I avoided another intubation. I guess the issue is, is it better to suffer through a bout of horrible delirium or risk the side effects of repeated intubations? Unfortunately, no real good options here.

Next up is a patient care conference with the key players to discuss what went wrong during this admission and perhaps come up with an agreeable care plan for me the next I’m in one of the units. I think anyone with complicated medical issues should have something like this in place. No doubt I can be a challenging patient at times, having a care plan up front should make everyone’s life a little easier. We’ll see if it works, but Im not looking to test it out anytime soon. Hopefully I can stay out of the hospital for another year, wouldn’t that be something?

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