reduced effort tolerance

I heard that phrase, for the first time, when I went to see a doctor to complain about feeling like I wasn't getting enough oxygen: I inhale, but the air I breathe in doesn't seem to have enough oxygen in it, I remember saying. Turns out I was right. And after telling her that that's how I felt when I walked up even a slight slope, that's what she said I was displaying: Reduced effort tolerance.

Every day, I walk. Sometimes slowly, sometimes more briskly. And, I walk for about an hour. A full 60 minutes, to the beat of a playlist I've created on Spotify.

Today, I decided to check my oxygen levels while I walked briskly, to a playlist I've named Trippin'

In the mornings, at the start of my walking-in-circles, my oxygen level hovers around 95 - 96%.

But after about a half hour of walking, it drops to this:

I am not uncomfortable, because I can still keep pace with the beat, and it's pretty brisk.

After a while, I notice that the oxygen level drops:

It dropped from this:

. . .  and then to 91%  - which I had no opportunity to grab a shot of. At this point, I'm usually a tad panicked by the continued beeping, and I'm doing my Pursed Lip Breathing exercises, and trying to bring up my oxygen.

And I succeed! Yay! The level climbs back to about 94% and even goes up to 95-6% as I walk and breathe. 

After the hour of exercise, my levels improve while I slow down and rest, and eventually, they are at this:

And with continued cooling down and breathing, it climbs to this:

. . . which is actually better than what I usually start out with!

So, this is how I walk-in-circles, every day. Whether I'm feeling good, or feeling shitty, I get off my arse, and tell myself it is time to walk. If it's a not-so-good day, and I'm feeling tired, I walk slowly (to my playlist named, sLoW); if I feel all right, I walk to Tripping. Sometimes, I start out on sLoW and then feel better and change it up. Sometimes, I start out fast, and decide it is just too much, and switch it down to sLoW. Occasionally, I just want to sing, and then, I'll play something with which I can sing along, and just be happy.

I try to hit at least 7k steps during that 60 minutes of walking. Sometimes, it's less, but most times, it's more.

why nothing about our LUNGS?

Here's a reply to a question about the lungs, from my Support Group.

"In Pulmonary Arterial Hypertension (PAH) lung tissue damage occurs inside the capillaries and arteries so it is microscopic. The endothelium, the lining of the arteries, is damaged. There is no test to directly measure this damage so it’s of no use to look at lung tissue and risk the surgery necessary to obtain samples.

What affects the lungs also affects the heart and, in PAH heart damage is secondary but it is the heart damage that kills us. So doctors do tests on the heart instead.

During a heart catherisation, doctors measure the pressure in the pulmonary artery and that gives them a good idea of what is happening to the other arteries in the lung. Doctors only want to do tests that can measure disease progression and be as non-invasive as possible. They could biopsy pieces of lung tissue and that would be of scientific interest, but it would yield no useful information about the progression of your disease, and of how your lungs are reacting to treatment.

Oxygen

Below - notes on an article I'm reading, in Pulmonary Hypertension News, here.

Oxygen saturation, measured by either ABG (arterial blood gas) or pulse oximetry, is considered normal when it is 95 percent or above. Values of 90 or less indicate the need for supplemental oxygen. Usually, a 6-minute-walk test will determine further if oxygen is needed.

How well or how poorly we breathe is affected by:

• cardiovascular health
• level of conditioning (or deconditioning)
• medications
• emotional state
• weather
• and, other factors

Sometimes, our pulse oximetry says we're good, but we feel SOB. Then, we need to stop what we're doing, assume the position (make a triangular frame with arms outstretched and supporting you) and do PLB (pursed-lip breathing). If you need to, take an inhaler - for me, it would be 2 puffs of ventolin. 

Supplemental oxygen, if the readings are good, will not help this kind of SOB.

If the ABG and pulse oximeter say that oxygen levels are low? TAKE THE OXYGEN!

'Hypoxia, even in the absence of significant shortness of breath, increases your risk of coronary insufficiency/ischemia, arrhythmia, pulmonary hypertension, and heart failure, among other potential hazards to your health'.

My pulse oximeter looks like this.

How often to measure our oxygen? 

More frequently at the start - until familiar with what our needs are, and what our readings are at rest and during activity.

Vaccinations

Had my flu shot this month, at SunMed. Next one due in March next year.

It worked well for the last year, and kept us both flu-free. Yay.

I was vaccinated for Pneumonia last year - 2018. It needs to be repeated every five years. I had the PCV13.  So, the next one should be in 2023.

What Types of Pneumococcal Vaccines Are There?

• Pneumococcal conjugate vaccine (PCV13 or Prevnar 13^®)
• Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23^®)

From my reading, PH patients should get both the vaccines. They should be given one year apart.

dealing with shortness of breath (SOB)

Webinar 3: with Dr Noah Greenspan

Notes:

Our cardio-pulmonary system/respiratory system works better with exercise: Heart, lung, muscles - all improve with exercise.

Pursed-lip breathing: In for 2, Out for 4.

Feeling shortness of breath?

1. Stop what you're doing, and say: I know what to do here: evaluate the situation.

2. Close the chain*

3. If the situation is bad: Do a Recovery from SOB technique.

    If the situation is not too bad: Do a controlled breathing technique.

The diaphragm is central to breathing. It contracts, creates negative pressure, and allows are to enter and inflate the lungs. So, diaphragmatic breathing is the way to go.

Diaphragmatic breathing:

Involves breathing in through the nose, while making sure that the abdomen rises (rather than the best).

Pursed-lip breathing:

Breathe in through the nose, and let air out via just a little slit of the mouth s-l-o-w-l-y.

Inhale for 2 counts; exhale for 4 counts

Inhale for 3 counts; exhale for 6 counts

Or inhale for a few counts; exhale till you feel all the air is expelled

Open chain activities - brushing hair, washing hair, hands over head - these tax our breath, because it is hard for the diaphragm to contract fully.

*Closed-chain activity - rest hands on table, or knees if sitting, lean on a wall - allows the diaphragm to contract and allows lungs to inflate well.

Potassium and food

Taken from here.

Foods to add to your diet

Foods are considered low in potassium if they contain 200 milligrams (mg) or less per serving.

Some low-potassium foods include:

• berries, such as strawberries and blueberries
• apples
• grapefruit
• pineapple
• cranberries and cranberry juice
• cauliflower
• broccoli
• eggplant
• green beans
• white rice
• white pasta
• white bread
• salmon

Foods to limit or avoid

Foods are considered high in potassium if they contain more than 200 mg per serving. These should be eaten in very small quantities, or avoided completely.

Limit high-potassium foods such as:

• bananas
• avocados
• raisins
• prunes and prune juice
• oranges and orange Juice
• tomatoes, tomato juice, and tomato sauce
• lentils
• spinach
• Brussels sprouts
• split peas
• potatoes (regular and sweet)
• pumpkin
• dried apricots
• brown or wild rice
• whole wheat products, including pasta and bread
• milk
• bran products
• low-sodium cheese
• nuts
• beef
• chicken
• tuna

How to leach potassium from fruits and vegetables

If you can, swap canned fruits and vegetables for their fresh or frozen counterparts. The potassium in canned goods leaches into the water or juice in the can. If you use this juice in your meal or drink it, it can cause a spike in your potassium levels.

The juice usually has a high salt content, which will cause the body to hold onto water. This can lead to complications with your kidneys. This is also true of meat juice, so be sure to avoid this, too.

Foods with low potassium

Foods with low levels of potassium

Grains	Foods prepared with white flour (eg, pasta, bread), white rice
Beverages	Non-dairy creamer, fruit punch, drink mixes (eg, Kool-Aid), tea (<2 cups or 16 ounces per day), coffee (<1 cup or 8 ounces per day)
Sweets	Angel or yellow cake, pies without chocolate or high-potassium fruit, cookies without nuts or chocolate
Fruits	Apples (1), apple juice, applesauce, apricots (canned), blackberries, blueberries, cherries, cranberries, fruit cocktail (drained), grapes, grape juice, grapefruit (½), mandarin oranges, peaches (½ fresh or ½ cup canned), pears (1 small fresh or ½ cup canned), pineapple and juice, plums (1 whole), raspberries, strawberries, tangerine (1 whole), watermelon (1 cup), lemons
Vegetables	Alfalfa sprouts, asparagus (6 spears), green or wax beans, cabbage (cooked), carrots (cooked), cauliflower, celery (1 stalk), corn (½ fresh ear or ½ cup), cucumber, eggplant, kale, iceberg lettuce, mushrooms (fresh), okra, onions, parsley, green peas, green peppers, radish, rhubarb, water chestnuts (canned, drained), watercress, spinach (raw, 1 cup), squash (yellow), zucchini, scallions, turnips, turnip greens
Proteins	Chicken, turkey (3 ounces), tuna, eggs, baloney, shrimp (all 1 ounce), unsalted peanut butter (1 tablespoon)
Dairy products	Cheddar or swiss cheese (1 ounce), cottage cheese (½ cup)
Nuts, seeds, and legumes	Macadamia nuts, pecans, cashews, walnuts, almonds, peanuts, sesame seeds, sunflower or pumpkin seeds, chia seeds, flax seeds (all 1 ounce)

Unless noted, one serving is ½ cup (4 ounces). These foods have a low level of potassium (less than 200 mg potassium per serving on average). Be sure to measure the portion sizes of each food and calculate the total amount in each meal to maintain your low-potassium diet (eg, average of 2000 mg potassium per day).

feeling blessed

This is a copy of my post to Facebook, on 21 September 2018:

I've been in and out of ERs and hospitals for close to a month. Had two operations that should've been fairly straightforward, but became high-risk because of my underlying IPAH - Idiopathic Pulmonary Arterial Hypertension, a terminal illness of the lungs, that affects the heart. I'm blessed to have come through it all so well because of my brilliant doctors at UMSC (University Malaya Specialist Centre), and the support of my husband and two children. I'm feeling good now, and fingers crossed, I'm discharged tomorrow. So I'll be back soon. I've missed you guys 😘

Pursed-lip breathing

Pursed Lip Breathing Helps Reduce Stress and Anxiety

Read the full article here.

Excerpt: "This way of breathing reduces the number of breaths you take by slowing your breathing. This keeps your airways open longer, allowing more air to flow in and out of your lungs. It also strengthens your respiratory muscles. Simply breathe in through your nose with your mouth closed and breathe out at least twice as long through tightly-pressed (pursed) lips. I breathe in for a count of two, and out for a count of four. You can use pursed lip breathing when you are short of breath to get your breathing back under control and calm yourself down."

do not stand at my grave and weep

by 

Mary Elizabeth Frye