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Lowering O2 Sats...a puzzlement
For many years my O2 sat was 98%. I am 63 now with pure autonomic failure and my sat has been consistently around 97% this year. My only problem flaring of late has been dysphasia and I have had some extra coughing while eating for some time now. My only med changes in the past few months has been switching a synthetic thyroid med to Armour which has free T3 and free T4, adding WelChol, a sequesterant to the niacin I take for familial high cholesterol....and lowering my aspirin (post strokes) from 325 mg. to 162 mg because with WelChol and aspirin I was getting increased bruising. Brusing is gone now. I have added vitaman D for a deficiency. I also had some ibuprofen for foot pain the last few days.
I noted last dr. visit my sat was 93% and I was surprised as it has never been that low. I was in his office today for a foot injury. My sat was 90%. My lungs are clear. My breathing is normal. I was not coughing at the time. I was sitting in a chair quite relaxed.
My question is has anyone here in the dysautonomia community had drops in their O2 sats like this without any apparent respiratory problems? If so what was the cause? As far as I know lack of oxygen or lack of perfusion would be the only instances you would see this but for the life of me I can't figure out what could be the reason.
I have not noted any skipped beats of late or arrhythmia.
Just as an aside I do know that 90% is still within normal range. The point is it is not normal for me.
What could cause this? Marie
I noted last dr. visit my sat was 93% and I was surprised as it has never been that low. I was in his office today for a foot injury. My sat was 90%. My lungs are clear. My breathing is normal. I was not coughing at the time. I was sitting in a chair quite relaxed.
My question is has anyone here in the dysautonomia community had drops in their O2 sats like this without any apparent respiratory problems? If so what was the cause? As far as I know lack of oxygen or lack of perfusion would be the only instances you would see this but for the life of me I can't figure out what could be the reason.
I have not noted any skipped beats of late or arrhythmia.
Just as an aside I do know that 90% is still within normal range. The point is it is not normal for me.
What could cause this? Marie
Best Answer
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The finger nail polish does need to be a darker color and I personally have never had a problem getting a reading on patients regardless of polish or not. But my first year of Nursing school I had to do a 5 page report on Pulse oxmitry machines and explain how they worked, problems that can occur, ect... So, when I read your post little tidbits came flooding back to me and I shared. Funny how things you learn, you never think you will need to know or that you will remember, can come back to you when least expected. :)
Hope some of the information was helpful. I think that with no resp symptoms, it would be most likely just another one of those odd little things one can run across with dysautonomia. I wouldn't worry to much about it unless symptoms start to arise.
The finger nail polish does need to be a darker color and I personally have never had a problem getting a reading on patients regardless of polish or not. But my first year of Nursing school I had to do a 5 page report on Pulse oxmitry machines and explain how they worked, problems that can occur, ect... So, when I read your post little tidbits came flooding back to me and I shared. Funny how things you learn, you never think you will need to know or that you will remember, can come back to you when least expected. :)
Hope some of the information was helpful. I think that with no resp symptoms, it would be most likely just another one of those odd little things one can run across with dysautonomia. I wouldn't worry to much about it unless symptoms start to arise.
Ladies, thanks for all the excellent ideas and suggestions! I love this forum and truly appreciate every one of you. I think you have given me enough clues to be able to sleuth this out next visit or at least narrow it down considerably.
My thoughts initially were similar, Beema36. If my BP could vary, and my heart innervation and pulse can vary because of dysautonomia then maybe it is possible the O2 sat could vary too. I just had not ever heard anyone talk of such a thing so I wanted to throw that out there. I also would like to figure out the exact why.
Being in the midst of changing meds and dosages that seemed suspect as well. Then there is the oximiter itself. As a technician I am always suspect of machinery...;)
That said Lilmissposey8088's list reminded me of the nail polish factor. I always thought it was the colored type like bright red that was a problem. Maybe not. I did not have any on during the 93% reading but I had on clear when the 90% reading was done. I do know my hands were not cold either time and I did switch fingers the 2nd time. By the way, I used to use a ben gay on patients fingers to bring the blood to the surface if their fingers were too cold. That list is golden, and thanks for sending, it really summarizes a lot of factors that could lower sats. I think # 1 and #2 perhaps the most compelling in my case due to the fact I do have a history of Raynaud's. At times, tho not at the time of the readings I have had a finger or an entire hand turn icey cold and white.
I also wanted to say a "hello" to lilmissposey8088 as we have not talked before. I note we both have pink flowers to represent us so maybe you are a gardener too..:)
Heiferly, thanks for your very creative educated guesses! You never disappoint. Your personal examples reinforce the idea that in fact the low perfusion we experience in having dysautonomia for any number of reasons can make a difference in an O2 reading. That is helpful to me as I was not sure others were having sat falls at times too.
So again, thanks for all the suggestions. They have been helpful. I will let you all know if and when I find out any more although it will probably be a few weeks. Marie
My thoughts initially were similar, Beema36. If my BP could vary, and my heart innervation and pulse can vary because of dysautonomia then maybe it is possible the O2 sat could vary too. I just had not ever heard anyone talk of such a thing so I wanted to throw that out there. I also would like to figure out the exact why.
Being in the midst of changing meds and dosages that seemed suspect as well. Then there is the oximiter itself. As a technician I am always suspect of machinery...;)
That said Lilmissposey8088's list reminded me of the nail polish factor. I always thought it was the colored type like bright red that was a problem. Maybe not. I did not have any on during the 93% reading but I had on clear when the 90% reading was done. I do know my hands were not cold either time and I did switch fingers the 2nd time. By the way, I used to use a ben gay on patients fingers to bring the blood to the surface if their fingers were too cold. That list is golden, and thanks for sending, it really summarizes a lot of factors that could lower sats. I think # 1 and #2 perhaps the most compelling in my case due to the fact I do have a history of Raynaud's. At times, tho not at the time of the readings I have had a finger or an entire hand turn icey cold and white.
I also wanted to say a "hello" to lilmissposey8088 as we have not talked before. I note we both have pink flowers to represent us so maybe you are a gardener too..:)
Heiferly, thanks for your very creative educated guesses! You never disappoint. Your personal examples reinforce the idea that in fact the low perfusion we experience in having dysautonomia for any number of reasons can make a difference in an O2 reading. That is helpful to me as I was not sure others were having sat falls at times too.
So again, thanks for all the suggestions. They have been helpful. I will let you all know if and when I find out any more although it will probably be a few weeks. Marie
Hey you!
A couple thoughts I have, all guesses:
1. My sat used to go down on pulse ox when I did PT at certain times, and it didn't necessarily correlate with shortness of breath, though it often WOULD correlate to light-headedness. I don't think the oxygen SATURATION in my blood was actually decreasing, I think I was approaching a faint, with the physiological changes in circulation that accompany that and the pulse ox was getting "confused" by those. Namely, I think localized hypovolemia (such as the body's inability to properly maintain upper-body perfusion, thus leading to a faint) is a "confounding variable" of sorts that makes them unreliable.
2. I have reduced peripheral pulses such that you frequently can't even get an accurate pulse (sometimes none at all!) in my wrists these days. Doctors and nurses rely solely on my apical now. If I don't have reliable enough blood flow in my wrists to take a pulse, I'm skeptical that a pulse ox on my finger can always get reliable readings; if there's too much peripheral clamp-down, it won't work. Vasoconstrictors (such as midodrine) can contribute to this as can the body's own tendency to shunt blood to the vital organs when a shortage is perceived (such as when pooling is occurring in the legs and abdominal bed and there's a struggle to get enough perfusion for the heart, lungs, and brain).
I know from a friend who is a surgical step-down nurse that those tape-on pulse ox sensors can be put in other places besides fingers, such as on earlobes. If there is concern that fingers aren't giving a good reading, perhaps there is an alternate place on the body that could give a better reading, or an alternate test that could better assess to double-check that your actual oxygen saturation is holding steady. It's possible that it's actually a bad reading.
If it is a drop in oxygen saturation, there are medications that can help with this aspect. Halbashes is the member of our forum that first comes to my mind, as she is on respiratory meds. However, I'm almost certain she's *symptomatic* with the respiratory stuff so I would definitely pursue further testing before thinking about treatment.
A couple thoughts I have, all guesses:
1. My sat used to go down on pulse ox when I did PT at certain times, and it didn't necessarily correlate with shortness of breath, though it often WOULD correlate to light-headedness. I don't think the oxygen SATURATION in my blood was actually decreasing, I think I was approaching a faint, with the physiological changes in circulation that accompany that and the pulse ox was getting "confused" by those. Namely, I think localized hypovolemia (such as the body's inability to properly maintain upper-body perfusion, thus leading to a faint) is a "confounding variable" of sorts that makes them unreliable.
2. I have reduced peripheral pulses such that you frequently can't even get an accurate pulse (sometimes none at all!) in my wrists these days. Doctors and nurses rely solely on my apical now. If I don't have reliable enough blood flow in my wrists to take a pulse, I'm skeptical that a pulse ox on my finger can always get reliable readings; if there's too much peripheral clamp-down, it won't work. Vasoconstrictors (such as midodrine) can contribute to this as can the body's own tendency to shunt blood to the vital organs when a shortage is perceived (such as when pooling is occurring in the legs and abdominal bed and there's a struggle to get enough perfusion for the heart, lungs, and brain).
I know from a friend who is a surgical step-down nurse that those tape-on pulse ox sensors can be put in other places besides fingers, such as on earlobes. If there is concern that fingers aren't giving a good reading, perhaps there is an alternate place on the body that could give a better reading, or an alternate test that could better assess to double-check that your actual oxygen saturation is holding steady. It's possible that it's actually a bad reading.
If it is a drop in oxygen saturation, there are medications that can help with this aspect. Halbashes is the member of our forum that first comes to my mind, as she is on respiratory meds. However, I'm almost certain she's *symptomatic* with the respiratory stuff so I would definitely pursue further testing before thinking about treatment.
I know that sometimes finger nail polish can decrease O2 readings or just decreased circulation on your hand or finger at the time. Try warming up your hands before your next reading and maybe the results will be better. Or use a different hand/finger? In clinicals we would sometimes have problem getting accurate readings because of this. Also Pulse oximetry works by bouncing a laser of of the surface of red blood cells and anemia can cause lower readings. Have you had a CBC blood check done recently? Might be a bit anemic.
Marie- testing oximeter is.excellent.idea. I am wondering if.it may be another part of.dysautonomia too. It would make sense as it affects our other functions so y not.our O2? U might check with pharmacy and see if.they think one.of your new Meds could be a factor.
I am sure u will get some good info from members with way more experience with dysautonomia.
I will be interested in this answer too.:)
Beema
I am sure u will get some good info from members with way more experience with dysautonomia.
I will be interested in this answer too.:)
Beema
It is always nice to see you on here beema36. :) I have had a downward trend measured twice weeks apart under different circumstances which to me says there is some reason and it makes me want to understand why. My past experience says it is not normal and has to have a cause. I want to understand the physiology of this. I have had a certain amt. of experience with acid base physiology and oximetry I am just coming up blank on this.
My thought was it might be something related to the dysautonomia...or perhaps the thyroid med or other medication. My experience in patients with sudden drops in sat were with things like penumonia or pulmonary emboli but I would always see shortness of breath and would auscultate an area with decreased air exchange with the latter. Those are not symptoms I am having....so I thought with my newness to dysautonomia I may be missing something basic others have experienced.
I like the fact this forum allows us to throw out things for all to look at to take advantage of other's experiences and I have gotten some really good perspective here from others. To be sure I am not needing reassurance so much as enlightenment as to why this could occur.
Maybe I should be suspect of the oximetry! Next time I am in the office or in another one I will have them test it with two different machines or have them test two different people to make sure it is not the instrument. Just a thought! Marie
My thought was it might be something related to the dysautonomia...or perhaps the thyroid med or other medication. My experience in patients with sudden drops in sat were with things like penumonia or pulmonary emboli but I would always see shortness of breath and would auscultate an area with decreased air exchange with the latter. Those are not symptoms I am having....so I thought with my newness to dysautonomia I may be missing something basic others have experienced.
I like the fact this forum allows us to throw out things for all to look at to take advantage of other's experiences and I have gotten some really good perspective here from others. To be sure I am not needing reassurance so much as enlightenment as to why this could occur.
Maybe I should be suspect of the oximetry! Next time I am in the office or in another one I will have them test it with two different machines or have them test two different people to make sure it is not the instrument. Just a thought! Marie
Were u in any pain? I know that can cause O2 sats to be lower. Was your Dr concerned? When I was working in ICU as an RN I know O2 sats fluctuated for no apparent reason but if.they were within normal limits and pt was not in any distress they weren't a concern.
Know this.doesn't give u an answer and hope someone smarter than me me figures it out but in my opinion I don't think its anything to worry about. Will be interested to hear what others say.
Hope your footsteps ok.
Know this.doesn't give u an answer and hope someone smarter than me me figures it out but in my opinion I don't think its anything to worry about. Will be interested to hear what others say.
Hope your footsteps ok.
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In the following situations the pulse oximeter readings may not be accurate:
1. A reduction in peripheral pulsatile blood flow produced by peripheral vasoconstriction (hypovolaemia, severe hypotension, cold, cardiac failure, some cardiac arrhythmias) or peripheral vascular disease. These result in an inadequate signal for analysis.
2. Venous congestion, particularly when caused by tricuspid regurgitation, may produce venous pulsations which may produce low readings with ear probes. Venous congestion of the limb may affect readings as can a badly positioned probe. When readings are lower than expected it is worth repositioning the probe. In general, however, if the waveform on the flow trace is good, then the reading will be accurate.
3. Bright overhead lights in theatre may cause the oximeter to be inaccurate, and the signal may be interrupted by surgical diathermy. Shivering may cause difficulties in picking up an adequate signal.
4. Pulse oximetry cannot distinguish between different forms of haemoglobin. Carbo-xyhaemoglobin (haemoglobin combined with carbon monoxide) is registered as 90% oxygenated haemoglobin and 10% desaturated haemoglobin - therefore the oximeter will overestimate the saturation. The presence of methaemoglobin will prevent the oximeter working accurately and the readings will tend towards 85%, regardless of the true saturation.
5. When methylene blue is used in surgery to the parathyroids or to treat methaemoglobinaemia a shortlived reduction in saturation estimations is registered.
6. Nail varnish may cause falsely low readings.
Hope this is helpful!!!