Some of you regulars will notice a slight change in the title of my post, but it really isn’t a big deal, just a better description of the content of my post. I have not had a single doctor’s appointment this week, I haven’t made a future appointment this week, and I don’t see the need. This coming Monday is my next regularly scheduled appt with Doc Head, and because it is a regular thing, no need to dwell on it. That’s all that’s on my table medically for me. This week has been a 3 week, for a couple of days I almost went to a 2.5, but I have settled in on 3. For the curious, both physical and mental aspects were the driving factor towards pushing the week to a 2.5. As I sit here resting and doing my purse lipped breathing my O2 level is 95 percent. My heart rate is 98, temperature is in the normal range, and my weight still too damn much, but is working ever so slowly in a downward trend.
This week’s word is a phrase; Stages of COPD. I don’t know if I have ever really qualified the stages of COPD, I might have made mention of them, but I don’t believe I have specifically address these. Being quite honest, none of my friends or fellow bloggers have asked the question, either out of politeness, or concern for my feeling, or concerned about how the answer might impact the asker. Hopefully this will help provide a better understanding. I am going to start out with “book” definition of the term, as I am in a habit of doing then I will address the Stages of COPD as they have impacted me, and I will try to shed light on when I passed thru a stage to my knowledge. I am also going to speak briefly on “end stage” COPD, and will provide a link to the site that I worked from.
I have chosen the EMedTV website, (http://copd.emedtv.com/copd/copd-stages) for the “book” definition because it seemed the simplest to convey and understand. Of course I have cherry picked the definition for the purpose of this post, but you can go directly to the site posted about to get the “complete” definition. Most of the others (and I have added links for a couple of them) go into great detail about FEV1 and its relationship to “normal,” as the baseline for the stage. The problem as I see it is; the sum total of all of us equals the “normal,” where very few of us actually equal the “normal.” How is that for left-handed logic?
COPD Stages – The four stages of COPD are “at risk,” mild, moderate, and severe. In order to determine if someone has this condition and which stage he or she is in, a healthcare provider generally uses a breathing test called spirometry. (Spirometry is the most sensitive and commonly used test of lung functions. It can detect COPD long before you have significant symptoms.) The symptoms vary for each of the stages, but generally include increasing amounts of coughing, sputum production, and difficulty breathing.
What Are the Stages of COPD? Based on the spirometry test, your doctor can determine if you have COPD and how severe it is. The stages are listed below:
Ø At risk
Ø Mild COPD
Ø Moderate COPD
At Risk — In the at-risk stage, the breathing test is normal, but there is a possibility of developing COPD. Mild symptoms of the condition include a chronic cough and sputum production.
Mild COPD — In the mild stage, the breathing test shows mild airflow limitation. Symptoms may include a chronic cough and sputum production. At this stage of COPD, you may not be aware that airflow in your lungs is reduced.
Moderate COPD –- In the moderate stage, the breathing test shows a worsening airflow limitation. Usually, the symptoms have increased. Shortness of breath usually develops when working hard, walking fast, or doing other brisk activity. At this stage, a person usually seeks medical attention.
Severe COPD — In the severe stage of COPD, the breathing test shows severe airflow limitation. A person is short of breath after just a little activity. With very severe COPD, complications like respiratory failure or signs of right-sided heart failure may develop. At this stage, the quality of life is greatly impaired and the worsening symptoms may be life threatening.
Another link is from Caring.com which I have found to be another useful site for COPD related information.
Another site which I have found helpful in my research is About.com, here is a link directly to COPD grades (formally stages)
So ends the technical aspect of my post. I will now relate the more personal aspects of stages of COPD and my journey thru them. And as a preference I will refer to them as stages, it seems more fitting than calling them grades. Grades I always seem to think I could improve with some effort, but stages just seem to me to be points.
The first stage is defined as “At risk.” My earliest recollection of being told I was “at risk” was sometime in the 1979-80 timeframe. As far as I am concerned “at risk” shouldn’t even be considered a stage. I think we were all born at risk, some of us by the environment we grew up in, some of us by smoking, some of by the environment we worked in during our careers, even some of us by the very makeup of our bodies, are “at risk.” Add to this the fact that the symptoms are so weak, so minor, that they can easily be ignored, makes being “at risk,” a non-issue. I can only speak for me but as a reformed smoker I am also sure that the first 293 times a doctor told me I was “at risk” I am sure in my mind he or she was talking about being “at risk” of developing lung cancer. Way back then the medical definition of COPD had not even been developed or offered as a diagnosis, most of us were told it might be asthma or emphysema, or we could have been told it was a combination of those. But it wasn’t COPD and it wasn’t terminal. I suspect that even today 01/24/14, if someone goes into a Doctor’s office and are told they are “at risk” (as defined above) of developing COPD. They walk out the door going “oh okay, we will see what happens.” For me, I had been going thru the “at risk” stage for years, and paying it no mind.
I think I completely skip the “mild stage” and migrated directly into the “Moderate stage” of COPD. I believe it must have been sometime in the mid 80’s that I took my first spirometer test, (the link is below) with the results showing mild airflow issues which I immediately attributed to smoking, and closed my ears to my doctor. At this point I was a bit overweight, and had been riding a desk for a long time, and was still smoking 2 or 3 packs of cigarettes a day.
But the reality was I was just ignoring the writing on the wall. But one of the medical issues I was having, were all too frequent bouts of bronchitis. From 1993 thru 2004, I must have had bronchitis at least 12 to 15 times. By the time I got settled in here in Florida and had my first spirometry test in a decade that my bronchitis had graduated to chronic bronchitis. I started taking medicines specifically designed to help and aid respiratory issues. It started time nebulized drugs (Dulneb), a rescue inhaler, and the continued use of Theophylline (as much as 600mg 2x now 200mg 2X). Other than being short of breath all the time (which I attributed to being so overweight) there were no real symptoms impacting my life or world. But in July 2006 things changed quite rapidly. I developed a Bi-lateral Pulmonary Embolism, which focus attention on my lungs. As a result I was faced with a harsh reality. I had some serious respiratory issues, and to my great surprise it wasn’t cancer.
After I recovered from the embolism, I had a series of tests including a spirometer and sleep tests. The sleep test revealed I suffered from sleep apnea, and restless leg syndrome, but with the use of the Cpap machine that seems to have stopped and I do rest better. But the spirometer test and numerous x-rays revealed scar tissue (from all the bouts of bronchitis) throughout my lungs and significant worsening of the airflow thru the lungs. Now I was on the program, my diagnosis had not been defined as COPD but chronic bronchitis, the medications I was taking doubled and frequency of nebulizing went from 2 to 4 times daily. In the past I had been half ass in my approach to using the nebulizer and the Advair, but now I started using them religiously. I was now also put on oxygen at night when I slept.
My movement to the Severe Stage of COPD came rapidly. In March of 2008 I was hospitalized for having an anxiety attack, tests revealed I had 2 blocked arteries to the heart, and bypass surgery was needed. The bypass surgery was a great success. During recovery, while still in ICU, a hole developed in my left lung behind my heart. The team of doctors waited a week to see if the hole would heal itself, it didn’t, and I went back into surgery. When I came out of surgery I was on a ventilator, my memory is quite shaky here, but I have been told by more than one, that not only did I pull the ventilator out once, but I did it a second time. From that point forward I was restrained to keep from pulling it out again. After a couple of weeks (or so) on the ventilator, I was successfully weaned from ventilator. I woke up in the intensive care ward, still violently ill, and fighting. But complicating matters was the fact that I now had a Tracheostomy (see link below). It wasn’t a pleasant surprise, but at least I woke. After I learned the trick to talking, I asked the doctor how long he thought I would have to deal with this and he said maybe forever. Well he wasn’t correct after 2 weeks the trach was removed, and I was breathing on my own again. I was finally discharged from the hospital in late May 2008. But now I was on oxygen 24/7/365, and have been ever since. I was officially diagnosed with COPD in July of 2008 and that when the decent down the ladder began.
For those interested in keeping score my FEV1 is 39. I meet most of the criteria for the Severe stage of COPD, but thankfully I have no heart related problems. I have been plugging along at this stage for almost 6 years, yes it is sometimes difficult, but smiling I am here and I am pretty active, but most importantly I am full of life. Yes it has been a fight, but one that I willingly partake every day. If you learn anything from this, learn to fight; learn to not give up or in.
This is getting extremely long, and I was going to add the technical definition of “End Stage” and my comments, but I think I will wait until next week. Of course if you have any comments, thoughts, questions or concerns please ask them. Take care and I hope you have a great weekend. GO BRONCO’s – Bill (I am pulling for the Bronco’s because my beloved Redskins suck)