Note: I’ve been up since 03.30 and can barely function, so there might be some typos I’ve missed.
Among the notional causes of my Pulmonary Oedema, none of which have proven valid in the long term, was one which has proven to be the culprit. Quite early on I suspected acid reflux might be the cause, but dismissed it out of hand as there was absolutely no evidence to support it. Until now.
Woke at 03.30 last night barely able to breathe and – this was new – my nose was streaming with semi-solid white gunk. If you’ve seen a film of a turtle laying eggs – a mucus stream interspersed with white blobs – that’ll give you a good idea. Half asleep, hypoxic, and unable to think clearly, it scared the crap out of me.
I beat a hasty retreat to the living room, sat in my wheelchair (fortuitously it keeps me in the right position), hammered my inhalers and chugged several doses of codeine linctus. Eventually things quietened down and I dozed, fitfully, for a while (my chair isn’t really designed for sleeping).
When I finally resurfaced I had my answer.
The mystery white crap had been cottage cheese, pushed up into my nasal passages by acid reflux. Some, clearly, had also got into my lungs to set off another bout of PO. Had it all got into my lungs I seriously doubt I’d be sitting here now. Aspirating liquid is dangerous enough; given the state of my lungs, aspirating a semi-solid like cottage cheese could easily have killed me.
So acid reflux actually is the cause – but what can I do about it? Very little. I already take a drug to prevent it happening, have done for many years, so why has it become so dangerous?
One factor is the position in which I sleep – sitting up, as I can’t breathe lying down. Then I elevate my legs – and therein lies the problem. Elevating my legs puts pressure on my abdomen, so much so that some nights it makes it hard to breathe, and I have to lower them somewhat. Clearly it also exacerbates acid reflux. Not a lot, obviously, until now (it doesn’t take a lot to screw up my lungs – gastric acid is very destructive), but it’s been dismissed as a cause as I had no evidence for it.
Last night, though, enough of my stomach contents were ejected to show up as “normal” vomit. Mystery solved.
And the question is being asked, now I know what’s causing PO, is it avoidable? The simple answer is no.
Take last night. With that wonderful thing, hindsight, the problem, then, was probably exacerbated by my taking my late-night meds a little too late, so that the relevant drug – Omeprazole – would have barely been in my system in time.
That can be changed by bringing it forward.
Solids in my stomach, late at night, are an obvious danger, which rules out cottage cheese for my supper. I can’t sleep on an empty stomach, though, so unless that proves problematic, I’ll stick with a glass of sherry. At least if that comes back, and it doesn’t normally, it’ll do less harm than solids.
Acid reflux isn’t preventable as it’s part and parcel of the COPD package, and largely unpredictable. I’d never have thought that cottage cheese, eaten for its soothing qualities, would ever turn on me. There are drugs that will reduce the risk, but I’m already taking one. I can double the dose – see if that works.
That, and avoiding things I know cause a problem – just cottage cheese so far, and adding to that list means suffering further attacks, which is downright dangerous.
There is, I’m afraid, no simple answer, though I can start, also, by not elevating my legs. It does bugger all anyway!
Note: When I abandoned my bed at 03.30 ish the usual ulcer pain struck in seconds. I got into my wheelchair quickly, intending to take a dose of Oramorph, when I realised the pain was fading without it. Obviously – though it didn’t dawn on me at the time – my midnight dose was still in my system but here I am, at 09.30, three hours past my normal time, and I still haven’t needed it.
This lends weight to my theory that if I can transfer directly from bed to chair it will reduce my pain. There’s a lot of work involved to make that possible – which is why I haven’t done it yet, and I doubt I’ll be in any condition to do it today, but it has to be a priority.