Self-medication in Pulmonary Oedema…

For some years I have been experiencing bouts of Pulmonary Oedema, though I had no idea that’s what it was, I just put it down to more COPD buggeration** – until the day it almost killed me.

**It’s primarily a symptom of heart failure, which I also have.

At that point, once I got out of hospital, I asked my GP to prescribe Salbutamol and Atrovent nebules, as that’s what the paramedics and the hospital use, my idea being to nip the moderate attacks in the bud and, hopefully, prevent severe attacks either hospitalising me or killing me. It took 8 months and another emergency hospital admission before that was successful.

There’s a difference of opinion between two respiratory teams, under different consultants, in hospital (the team I saw in August last year, and the recent one) as to whether these attacks actually are P.O. (hey, if it looks like a duck, walks like a duck, and quacks like a duck, it’s a bloody duck!), but I was told, in no uncertain terms that, whatever it is, it will kill me sooner or later,** and at that point I pressed my GP again for the drugs because, even if it’s not P.O., it responds to the same treatment. This time I got them.

**And trust me, this is not a good way to go.

This morning, I woke to the all too familiar signs of a P.O. attack (extreme difficulty breathing, rapid respiration, coughing frothy sputum. No blood this time, but that’s normal. Blood doesn’t always put in an appearance.

I fired up my neb, and as I’d hoped, it shut down the attack before it really had time to develop. I still felt like shit, but at least I could breathe and I’m not in hospital.

So far so good. But normally these attacks develop in my sleep and, by the time I’m awake I’m deep into a crisis. So, one thing I learned today is that my neb needs to be permanently set up, just needing the nebules’ contents to be loaded. I was lucky today, it wasn’t a severe attack so I was able to set up my neb from scratch (it’s not a big job but, when breathing is almost impossible, it can assume the proportions of the Augean Stables).

And, of course, I don’t yet know how effective this would be in the event of a severe attack but, as I said, both paramedics and A&E do this routinely, and it stabilises me quickly, as does the injection of hydrocortisone (I take it orally at home, an additional 30mg has been taken this morning). I do have an injection kit for emergencies, but I also have a severe needle phobia, so orally it is. I do realise that orally is slower but in the absence of someone to handle the injection, it’s what I have.

And now, a caveat. Self-medication isn’t for everyone. And, I can hear you there, at the back, muttering “Arrogant bastard! If he can do it so can I,”. Well, maybe so – if you can stay calm in the face of a frankly dangerous personal crisis. Not everyone can. And even those who can usually cope can occasionally come unstuck. I know I have.

Why? Simple, Pulmonary Oedema is terrifying – even if you’re not, it does feel as if you are dying. I admit that in the grip of a full-blown attack that puts me in hospital, I can panic. BUT – now I have the means to control it, it will (hopefully), help me to stay calm. Especially as I will have my neb set up ready to have the drugs loaded. Treatment can start within a couple of minutes. Do not be tempted to load the drugs in advance, just in case, they’ll deteriorate. It only takes a few seconds to pop the tops and squeeze them into the chamber.

And if you’re new to nebulised drugs, be aware that the side-effects you get from your inhalers will be ramped up, especially the tremor and elevated heart rate. They can be scary, but they’ll pass.

The moisture also loosens sputum, making it feel, for a while, as if you’re trying to compensate for a world shortage, so in A&E and, if admitted, on the ward, insist on a sputum pot – you don’t want to swallow this toxic crap.

It goes without saying that you should always have one at home. I use a Bonne Maman conserve jar as the interior is perfectly smooth (no shoulder, or nooks and crannies), and easy to wash and sterilise (I use Milton). I also put a tiny drop of Listerine in the bottom to mask the smell (sputum can stink, especially if infected**). Apologies to those of you who don’t have COPD, heart failure, or Pulmonary Oedema and are grossed out by this but, for those of us who do, it’s what we have to live with.

**Changes in smell and taste is how I’m able to diagnose an infection as much as a week before it would be apparent to a doctor listening to my lungs and, by so doing, can treat it with antibiotics and knock it down before it really gets a hold. Or I could, at least. The company from whom I bought my antibiotics, in Vanuatu, in the Pacific, was destroyed by the recent cyclone.

Note: I took one neb of Salbutamol and one of Atrovent at about 08.00 this morning (Friday). I’d already taken my inhalers (Salbutamol, Clenil Modulite 250mcg, and Serevent), half an hour earlier. I didn’t need any more until 23.00. There’s a very clear lesson to be learned from that but I know from experience that convincing my GP will be an uphill battle.