Evening Episodes

[concerned granddaughter]

My grandmother is 72 and was diagnosed with Emphysema two years ago.  She also has congestive heart failure.  She quit smoking, attends Rehab 3 times a week, eats healthy, and uses oxygen only at night on 2.  She's very active.  She takes care of her 96-year old mother and she babysits for my 2 girls one day a week.  She has been having these episodes at night where she gets short of breath, she then panics and my grandfather has to call 911. In June, she was admitted to the hospital because of this.  She had filled up with fluid.  Her Cardiologist, Pulmonologist, and Family doctor worked together and decided to change her medications and started treating her with Zoloft and Xanax for anxiety and depression.  This seemed to be working and she was doing pretty good and felt good.  Then in July she had another episode in the middle of the night.  They called 911 she ended up back in the hospital and this time she had to be put on the ventilator because her organs were under too much stress.  It was taken out the next day.  Her heart medication was changed, and the pulmonologist suggested she see a psychologist to help her deal with the fear and anxiety.  She's been feeling good again and has started going back to Rehab again.  My questions are Do you think the Psychologist will help?  Are these episodes just part of the disease?  Can you suggest any other treatment?

[National Jewish]

Your grandmother’s episodes can certainly be part of the emphysema or the congestive heart failure (CHF) or the combination of both of these diseases.  Since she uses oxygen only at night it may be that her oxygen level is low only during sleep.  A low oxygen level can affect both the lungs and the heart.  This can cause shortness of breath.  Oximetry can be used to check your grandmother’s oxygen level while she sleeps through the night.  This device uses a sensor that clips to the finger or earlobe to measure the oxygen saturation of the blood.  An arterial blood gas is another way that your grandmother’s oxygen level can be checked.  This would be most informative when done as soon as possible after one of these episodes.

It is understandable that your grandmother is scared when she can’t breathe.  This is a common problem for people with emphysema.  The panic feeling that follows can make the breathing more difficult causing the cycle to continue.  Diaphragmatic breathing and relaxation techniques help to break this cycle.  This may be especially helpful between the time that your grandfather calls 911 and help arrives.  When your grandmother can’t get her breath your grandfather can coach her so she is calm and can breathe easier.

Diaphragmatic breathing is a technique that may help your grandmother move more air in and out of her lungs.  This helps decrease shortness of breath.  Here are the instructions:
·Breathe in slowly and deeply through your nose.
·While you breathe in, count 1, 2 and push your stomach out.
·Place your hand on your stomach so you can feel your stomach    going out.  This promotes the use of your diaphragm and your lower respiratory muscles.
·Breathe out slowly and deeply through your mouth.
·While you slowly breathe out all the way, count 1, 2, 3, 4 and let your stomach relax.  You can feel your stomach going in with your hand.

Your grandmother should talk to the psychologist to learn the relaxation techniques that will help her most.  It is great that she has quit smoking and is going to rehabilitation!

[1!2@3#]

It could just be that she has a minor breathing problem, but when she realizes that she can't breathe very well she starts to panic and possibly hyperventalates, which would make her breathing far worse.  Maybe by seeing the pschologist she will be able to not panic when she has an episode.