hypoxic episodes--What do I do after them??

Hi everyone...I'll do an update at a later time, but I wanted to ask all of your advice. While my severe sleep apnea is considered "well controlled" most of the time, I have hypoxic episodes every once in awhile. I've had a few overnight oximetry tests that show a pattern that I am well controlled for hours, then can destat badly, and then I go back to well controlled. The doctors, even the University of Michigan, cannot figure out why I have these hypoxic episodes, as my heart and everything is doing great. It does seem to be connected to when I have rapid weight loss. I had an episode last night. and I have lost 29 lbs. in 5 weeks, because I had lap-band surgery.

I had been sleeping for about 4 hours, and woke up to go to the bathroom. When I got to the bathroom, I had shortness of breath, coughing, a racing heart beat, numb hands and pain on my right side (I was sleeping on the right side). I started sweating and feeling like I was going to pass out. I quickly grabbed the nasal cannula for my supplemental oxygen, and cranked it up to 5 liters, and laid back down. It took about 45 minutes to feel "okay". I got up and packed my bipap, reports, etc. and went to the ER.

The doctor was decent, and ordered blood tests and and EKG ( I later found out both were normal). Like after my "episodes" last fall, nobody could get blood out of me. I lost count of how many times I was stuck. The nurse said the blood would "flush" when the needle went in, but then the blood would contract back into my body, so nothing came out. This has happened numerous times in the fall too. Only 10 days ago, I had a blood test with no problems, in and out in 2 minutes, so this has to be related to hypoxia.

Do any of you have similar experiences with hypoxic episodes??? I respect all of you, so I woulld also appreciate any thoughts/theories why this might go on... And lastly, what do I do afterwards?? I am thinking at least I need to go walking or some type of exercise to try to get some oxygen back into my body. Any other ideas on how to deal with the effects of hypoxic episode??

Thanks so much, Lovey (Laurie)

lovey wrote:Hi everyone...I'll do an update at a later time, but I wanted to ask all of your advice. While my severe sleep apnea is considered "well controlled" most of the time, I have hypoxic episodes every once in awhile. I've had a few overnight oximetry tests that show a pattern that I am well controlled for hours, then can destat badly, and then I go back to well controlled. The doctors, even the University of Michigan, cannot figure out why I have these hypoxic episodes, as my heart and everything is doing great. It does seem to be connected to when I have rapid weight loss. I had an episode last night. and I have lost 29 lbs. in 5 weeks, because I had lap-band surgery.

I had been sleeping for about 4 hours, and woke up to go to the bathroom. When I got to the bathroom, I had shortness of breath, coughing, a racing heart beat, numb hands and pain on my right side (I was sleeping on the right side). I started sweating and feeling like I was going to pass out. I quickly grabbed the nasal cannula for my supplemental oxygen, and cranked it up to 5 liters, and laid back down. It took about 45 minutes to feel "okay". I got up and packed my bipap, reports, etc. and went to the ER.

The doctor was decent, and ordered blood tests and and EKG ( I later found out both were normal). Like after my "episodes" last fall, nobody could get blood out of me. I lost count of how many times I was stuck. The nurse said the blood would "flush" when the needle went in, but then the blood would contract back into my body, so nothing came out. This has happened numerous times in the fall too. Only 10 days ago, I had a blood test with no problems, in and out in 2 minutes, so this has to be related to hypoxia.

Do any of you have similar experiences with hypoxic episodes??? I respect all of you, so I woulld also appreciate any thoughts/theories why this might go on... And lastly, what do I do afterwards?? I am thinking at least I need to go walking or some type of exercise to try to get some oxygen back into my body. Any other ideas on how to deal with the effects of hypoxic episode??

Thanks so much, Lovey (Laurie)

I don't know much about medicine, myself. But I have a feeling it would be very difficult for anyone to give a helpful comment on that information without a complete examination and your complete medical file with your complete history (including family history) right in front of them. So you may not get many direct comments in this thread.

That being said . . .

In my opinion, based on the information you gave, I would have gone to the ER, too. When you mention going to the bathroom in the middle of the night and heart racing and numbness (regardless of the side) shortness of breath, sweating, feeling like passing out, etc., that sets off a lot of alarms. (Going to the bathroom at night is particularly hard on the heart sometimes.) Add in the surgery and the meds and the weight loss and, well, there are too many variables to figure in. Anxiety and panic and shallow breathing can do those things. But so can heart trouble.

If it was me, I would discuss all my concerns in depth with my doctors, and I might even ask about whether they thought my history and circumstances could indicate the advisability of a 24-hr Holter monitor.

jeff

That is a good point...that I need more monitoring, i.e. a holter monitor or a pulse oxygen with alarm. I just finished up a long letter to my doctors and specialists that I am going to fax them soon, so I'll add that maybe I need these too. Thanks for reminding me. Two, three, twenty heads are better than one!

P.S. I forgot to mention, I got crappy care in the ER again. They didn't even do a pulse oxygen level or give me oxygen at any time. I am going to sick the bariatric surgeon and the sleep lab guy on the ER docs... Ugghh. I can't even get decent care when I show up in the ER...it's happened before... Ugghh.

The Holter would be worn for one day so they could see what the heart does that one day. Sometimes helpful. Sometimes not. But it might be worth asking about it. Being told why it isn't necessary, if it isn't, might be comforting to hear. But it would be worth bringing it up either way, in my very unprofessional opinion.

Good ER docs have highly trained instincts and may recognize good/bad blood O2 at a glance, or by smell, or by tea leaves, or however they do it.

But I would think the bariatric people would likely want to be in the loop on your experience.

Be cooperative. Or at least give the appearance of being so. It is in your best interests.

Hope it goes well.

jeff

I am very polite and professional, just not always with you guys!! My bariatric surgeon and I made a formal complaint against the hospital for my care with the lap-band surgery. First they closed a floor to save money, and put me, a post-surgical patient in with a woman with active pneumonia. My mucus flinging roommate had 6 loud visitors for over 6 hours, and crowded me into about 1/4 of the room. They didn't follow any of the surgeon's orders as far as ambulation, etc. They prepared me for the wrong medical test the next day, and overdosed me on one medication. And I had the bad luck of being stuck in the elevator between floors just after surgery for 1 1/2 hours, because a main fuse of the elevator blew...but this was just bad luck on my part.

Right now, all the bariatric surgeon has to do is mention my name, especially to the hospital's CEO, and he gets every improvement he wants in a jiffy!! So he will not be happy that it was again me getting crappy care (and that the ER has a pattern of it),so that will hopefully get some changes done to the ER fast. The sleep guy is just backup....

lovey,
my wife had the lat band surgeryin november and is doing well. about 45 #so far. i went with her to the bariatric doc and asked a lot of questions . she wanted the bypass and i talked her into the band. one of the things the doc stressed is the amount per week of loss should be 2 to 3 lbs.yours is at about double that!!!

no i'm no doc but see your bariatric doc. have him get the blood tests and anything else you need. are you taking your supplements? eating enough?enough fluids including protien drinks? i suspect you are loosing too fast and it is messing up your metabolism. that is not good.

pinch your skin and see how long it takes to reurn it's color from the white .if it takes more than a couple of seconds you are probably dehydrated. and need fluids. are you taking diaretics(water pills)?

see your doc and tell them everything even if you think it's not important. i had a friend who's kid ate dirt. doc recognized right away and tested for iron deficency- and he had it!

good luck

fuzzy96 wrote:lovey,
my wife had the lat band surgeryin november and is doing well. about 45 #so far. i went with her to the bariatric doc and asked a lot of questions . she wanted the bypass and i talked her into the band. one of the things the doc stressed is the amount per week of loss should be 2 to 3 lbs.yours is at about double that!!!

no i'm no doc but see your bariatric doc. have him get the blood tests and anything else you need. are you taking your supplements? eating enough?enough fluids including protien drinks? i suspect you are loosing too fast and it is messing up your metabolism. that is not good.

pinch your skin and see how long it takes to reurn it's color from the white .if it takes more than a couple of seconds you are probably dehydrated. and need fluids. are you taking diaretics(water pills)?

see your doc and tell them everything even if you think it's not important. i had a friend who's kid ate dirt. doc recognized right away and tested for iron deficency- and he had it!

good luck

I saw the bariatric doctor and the dietician 2 weeks ago, and they were concerned about my diet at first when they saw the amount of weight loss. But the dietician checked my diet, and found it too have the right amount of calories and great nutrition and supplements. I did write a note tonight to the bariatric surgeon and the nutritionist asking though if given the hypoxic episode, we need to slow down my weight loss and add some calories back. I'll take those calories straight as high fructose corn syrup!!! I did have blood tests ten days ago by my primary doctor, and the only one that was off was liver enzymes were slightly elevated. I am on diuretics, and did have a few problems, but I thought it was under control. The ER labs came back that I was not dehydrated though. Perhaps tomorrow, when I hear from the doctors themselves, they'll order more lab comprehensive lab work. It is also strange, that when I have an hypoxic episode, they can't get any blood out of me. Last night, it took 35 minutes, and I lost count how many times the nurse stuck me. But 10 days before when they took blood it took no time at all, and was a normal draw. So somthing is amiss, that they are missing.

My heart is supposed to not be the problem, according to the local cardiologists and the University of Michigan. I've had many cardiac tests that show it actually has improved in the last few years, which is a rarity with sleep apnea. They can't find any functional problems with it right now...it looks like a "normal" heart now when they have done echocardiogram's etc. The University of Michigan think the hypoxic episodes are due to the sleep apnea.

I don't know, but it is scary to have these, anyways. Hopefully, they will try to figure more out, and hopefully get the University of Michigan involved again. It dumbfounds everyone, because with weight loss, there are supposed to be less problems with sleep apnea!!! It also seems to level itself out after awhile...my system gets itself back into "balance" quickly. I'm taking precautionary measures such as packing my old cpap to take to the hospital, with my records and prescriptions. I've put more stuff by my bed, such as a blood glucose meter, etc. so I can check these during an episode. I'm asking my neighbors if they might be willing to take me to the ER in the middle of the night, so that I could get to the hospital quicker. And there is always 911. But also I need to take some serious thought into whether it is safe for me to live alone anymore. It's bad timing, because my "life" other than my health it is better if I stay in the situation I am. Not fun, Lovey

I'm just kind of thinking out load here, but maybe it could help.

Our fat cells hold lots of stuff in them. Some of the most toxic substances are fat soluble, things like solvents, heavy metals, plasticizers, other bad guys for the body. When you lose weight really rapidly, the toxins stored in the fat cells can dump into the blood stream at a rate that your liver cannot handle (the liver enzymes might elevate.)

I am extremely sensitive to solvent exposures. I found this out because I was having repeated cycles of waking in the night, with very elevated heart rate, nausea, dizziness, and panic. It turned out the oil painting class I was taking exposed me to levels of airborne solvents that my body couldn't handle. During the night, when the liver was trying to clear it from my system, everything would go into overdrive. If you google solvent toxicity you may find those symptoms listed.

When I stopped attending the class, the night time events stopped happening. Unfortunately, some of the things most likely to cause this are hard to test for, so it may not be easy to prove this, in your case. But I would do whatever I could to slow down your weight loss, and possibly see if there is anything you can do to support your body's ability to detoxify, especially your liver.

You know, thinking about it, my friend who lost weight quickly had the same problem. She felt that it was stored toxins coming "alive" that made her in pain and sick when she was losing. It's not a bad theory. And since my liver enzymes are elevated, it might be a sign that something is going on. Plus I have something like 15 prescriptions (I haven't counted lately) and my metabolism is going through major changes and something there might be out of whack. Plus all the new supplements, protein powders, etc. Definitely, you might be on to something...

Unfortunately, I left messages with all three of my doctors and specialists, and faxed them a letter, yet not one of them replied today. I don't feel well, not myself, and at times have felt lightheaded today. I do think I also need some comprehensive blood work in the next few days. Hopefully, my docs will get their acts together by tomorrow. If not, I might call the University of Michigan in Ann Arbor, who saw me in March. Sometimes the care here in southwestern Michigan sucks
Thanks, Lovey

15 prescriptions! Ouch. The prescriptions can also store in fat cells. They have found everything, from drugs taken years ago to heavy metals, in fat storage. It is one of the ways the body protects itself. It stores the icky stuff in the fat, taking it out of blood circulation.

Till your doctors call, be sure you drink enough water, and make sure your bowels are functioning. That will help move as much as possible through kidneys and bowels. And try to slow down that weight loss! I hope they have some good ideas for you. Take care!