Can having cough cause respiratory failure?

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Erika, I sent you an e-mail in re settings.

If the breaths are coming too fast from the BiPAP because of the coughing disrupting the timing, there is no harm and a great deal of benefit in re-synching so she can actually use it.
 
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Erika,
I am certain you are sick with concern and in no way do I want to suggest anything as substitute for evaluation by a medical professional, but I did want to share what happened to my husband and what has worked for now.

My husband struggles with the the cough and secretIons periodically. Back in September we had an ER trip because of a sudden onset cough from what appeared to be a cold. There was little the hospital was able to do, but it did seem that moving him via ambulance, using the hospital suction and general jostling around helped clear him up a bit and with consultation from the doc we worked out a cocktail that has worked. Like you, I was constantly worried about his lungs and pneumonia, but although the coughing episodes have recurred several times, his lungs are clear and the nurse and docs say that the mucous is primarily in his throat, low but not in his lungs.

The key was to minimize the secretions. We use a combination of otc decongestant, cough medicine with only guaifenesin, transdermal patch and prescription pill to reduce secretions, Ativan when the cough episodes increase and the esophageal spasms ramp up, positioning in a recliner and adjusting the settings on the bipap as needed and of course the cough assist.

I say all this only because when I started discussing the problem of coughing up the secretions specifically with the ER doc, he was able to assess thoughtfully talk with us about some otc options and then give us some sound advice and guidance to help get these episodes under control. Also when working with the respiratory therapist to adjust the bipap settings. It's really helpful if she can say things like .... ' I need a deeper, shallower, slower, or faster breath.' Additionally, I have found that our ALS clinic neurologist is great about speaking to our local docs and talking them through some possible alternatives. I would put a call in to your ALS clinic and see if they have some ideas too and who they might be able to talk to where your mom is visiting.

Don't panic, and I know because the loss of voice and how bad the cough sounds, it is easy to do. Hopefully you will be able to get the coughing episodes under control and she will be able to rest and recover and return home soon.

Thinking of you,
Tracy
 
Erika, who supplied the BIPAP? They may have an RT on staff who can help answer some of your questions. Some RTs aren't very ALS-literate, but some RTs really know their stuff and like helping people with tough questions.

Thank you so much Dave! I haven't been able to get a hold of her RT and the assistant wasn't much help. I did just speak to the RT you messaged me about. I'm on my cell phone I don't know how to message back . This all feels unreal...I'm trying to get my mom help and thinking how hard this must be for her while wrapping Christmas presents and making dinner.

Laurie, I forwarded your message to my sister, she's going to see if the RT that went the other time is available today.

She'll be seeing the neurologist this evening to c where we go from here. Her lungs are clear and secretions and phlegm have decreased, but she is so tired. Can't finish mouthing 3 words together. The latest symptom development is that she feels like she's got little bone stuck in her throat. She doesn't but it bothers her. Can this be her esophagus loosing strength as well?
 
Thank you guys I'm overwhelmed by the support I find here. She will be seeing the neurologist this evening. In the mean time my sister is just trying to keep her confortable and hydrated. Laurie, you are a special kind of angel I tell ya! Hoping my sister gets those setting quickly.

I'll be back tonight I hope with a more positive update. Mil gracias!!!
-Erika
 
I'm just so sorry you're both having to go through this but the CALS here and Nikki have so much experience with these things, they are a gift.

Anything is made worse by stress so my suggestion might sound way out there but it helped my back pain and spasms between my ribs. If your mom is in a recliner, see if someone there can give her a gentle foot and calf massage with warm cream. The power of the human touch and the relaxing benefit of massage cannot be underestimated.

The advantage of getting to a hospital is that they can do an arterial blood gas measure to see her true numbers and do it STAT.

You're both in my prayers.
 
They hace to decide whether to vent her or not. I'm so mad!! He isn't giving her hospice options he's just pushing this.! They're in the process of cleaning out food and secretions from her lungs. Then give her some oxygen and then keep her over night. When is it OK to give her oxygen?? I though this was a no no..

If she is stabilized, can she fly back? She wants to fly back but Dr says airlines won't allow her. She scared and is looking to me for answers. I don't know!! I feel like if they can stabilize her, she should come and at least get some comfort and meds from hospice. But I don't know that she would make it. What a nightmare!! I promised her I would do what ever it took to keep her comfortable when breathing became an issue...I kind of know what to do here, but no clue what to do there!!! My mamma, I don't want her to suffer...
 
So she has an aspiration pneumonia? How are they cleaning her out? Is she having a bronchoscopy? It seems as if she has a shot of getting better( maybe down a notch from where she was) with aggressive treatment. If she had decent quality of life before and is not ready to go you might want to see what happens in the next few days before hospice is considered.

I would ask if they are thinking temporary vent? It is always a concern with PALS that they won't be able to get off once started. Can she be trialed on her bipap?

Oxygen is a worry because of the possibility of co2 retention but her oxygen levels may be low. If they monitor closely and assist ventilation it may be the best thing if so.

She does sound far too ill to travel just now but if this is acute illness she might be able to later.

I am sorry this is so hard. Is the nurse relative with her
 
With a doctor's note certifying non-contagious disease and status suitable for air travel, and someone with her, she can generally fly, though if she looks acutely ill, the airlines can reject her. In a wheelchair, she will board early and deplane last.

The other concern with flying is at altitude, if she falls asleep, her body will have to work harder to breathe and you would want her to have her BiPAP anyway (which is permitted with a tag of medical equipment).

I don't know who's where, but are bus and train options, with a companion, an option, if no one can drive her or it's too far?

But of course I agree, no one should travel in an unstable condition.
 
Kim, thank you for your suggestion to massage my moms feet. You're right, human touch issomething we don't always think about but oh how it can sooth fear and tension.

I don't know the name, but they stuck a tube down her throat to suction out the food and secretions. Mom says not much came out but they do this again inn a while. She on antibiotics too. My sister says she looks better and is now able to breath through her nose.
My cousin the nurse just got there. God bless her! They're going to discuss both options with her.

She keeps telling her she want to come back to the US. Looking for tickets just in case. Would the bipap help her in her flight even though she needs a vent? Flying is the only option since there is no train that comes here and it would take 24hrs to drive here without stopping for too long and at a decent pace. The flight is around 2hrs long. She'd be traveling with my dad and sister.

If she decides against the vent, and can't come back, how long does she have? Should I fly down now?
 
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Yes, the BiPAP would help during a flight (or any other time).

If she has aspiration pneumonia and it was caught in time, she could have a good while yet. But we don't really know how her breathing was just before and where it will end up after this acute episode, if indeed that's what it is.
 
I hope she is doing better today and that your cousin can give you some insight into how things really are. It would be great to have her back home for her and you and for medical care from her regular doctors but you don't want to have her flying until it is safe If something happened mid flight it would be catastrophic
 
She is still at the hospital and haven't done more except for cleaning her again, giving her oxygen and monitoring her. they can discharge her today but if nothing is done she will just end up at the hospital having to be auctioned again in a day or 2. They want to to trach her so that my sister is able to suction her at home. She just want to be well enough to fly back. She want to know if they trach her can she travel?

They tell her if she gets it it would be easier to clear her throat and they would sent her home with oxygen until the oxygen doesnt work for her, then palliative meds would start. But what if her lungs give out a week from then? Is the procedure worth it? She want to get it just so she can come here, but I don't know if that's a possibility. Also I would think a paleontologist would have checked her but they don't see the need.

Suggestions?
 
Yikes, Erika. Out of my realm here and I will let others more versed in this side of things comment and offer suggestions. I just wanted to say you all are in my thoughts and prayers and I am so sorry that you are having to do this from a distance. Sending you all positive vibes.
Tracy
 
Is she really that old that her doctor is a paleontologist???!!! Noun: The study of ancient fossils.

I hope you could laugh at that.

It is so, so frustrating to be a cargiver. I hope you'll keep giving us reports on thi
 
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