Eva Bristow - Status


Eva Bristow

URL: http://www.kyphilom.com/www/med/eva0119.htm
web page by Duane Bristow
and
http://www.kyphilom.com/www/med/eva19647.htm
Medical Record by Duane Bristow

Demographics

Eva Bristow
73 Old Cowan School Road
Albany, KY 42602
606 387-5884 & 606 306-3521

Date Of Birth: 11-09-1946
Sex: female
Height: 5' 3"

Spouse: Duane Bristow
email: duane@kyphilom.com

Status 01-20-17:

At the end of September 2016, Eva Bristow was a 69 (almost 70) year old female who had had a lumpectomy followed by radiation and chemotherapy for breast cancer in 2004 and now was diagnosed with rheumatoid arthritis and pulmonary hypertension and bronchiectasis. The cancer treatments had resulted in ongoing gastrointestinal problems and low grade anemia. She also was overweight and was very sleepy during the day and complained of restless legs at night and had hypertension and a low level of type II diabetes probably caused by use of steriods for her rheumatoid arthritis. She also had bladder problems (interstitial cystitis) and her cholesterol levels were high. She was using a nebulizer twice a day with Brovana and Budesonide to alleviate breathing problems due to the bronchiectasis as prescribed by her pulmonologist. She had noticed sinus problems and some back pain and coughing which she attributed to the nebulizer treatments.

Beginning at the end of September 2016, she noticed pressure in her chest and abdomen and more than usual difficulty breathing and weight gain as well as increased heart rate.

Her weights were as follows:

May 11, 2016 - 215
Sep 30, 2016 - 224
Oct 19, 2016 - 229
Nov 09, 2016 - 233
Nov 15, 2016 - 235
Nov 23, 2016 - 245
Dec 01, 2016 - 247
Dec 12, 2016 - 248
Dec 29, 2016 - 244
Jan 19, 2017 - 246
Jan 24, 2017 - 242
Feb  9, 2017 - 239
Feb 14, 2017 - 238
Mar 20, 2017 - 236
Apr 11, 2017 - 235

Her Blood Pressures were:

May 11, 2016 - 100/52
Sep 30, 2016 - 153/84 pulse 97
Oct 19, 2016 - 140/72
Nov 09, 2016 - 134/70 pulse 106
Nov 15, 2016 - 148/81 pulse 96
Nov 23, 2016 - 143/81
Dec 01, 2016 - 132/64
Dec 12, 2016 - 155/92
Dec 29, 2016 - 137/72
Jan 19, 2017 - 151/88
Jan 24, 2017 - 140/80
Feb  9, 2017 - 150/80 pulse 81
Feb 14, 2017 - 177/89 pulse 110
Mar 20, 2017 - 123/77 pulse 89
Apr 11, 2017 - 157/89 

In the first two weeks of October she was given two injections of 20 mg. Lasix for assumed fluid retention.

On Nov. 9, Eva went to Dr. Cherry (family doctor, internist) for her coughing and fluid retention. Dr. Cherry found a high potassium blood level (5.7) and recommended that she taper off using 200 mg aldactone per day for fluid retention and get a ventolin inhaler for breathing problems. She did a chest and stomach x-ray and an EKG and scheduled ultrasounds for Nov. 18 as well as a check of blood potassium levels.

Although they had not done so before, after Eva stopped using the aldactone, her legs, ankles and feet swelled to the point that the skin was stretched tight and she could not wear most of her pants or shoes. By December 16, they had swelled so much that the skin ruptured and fluid began leaking from her legs.

On December 1, 2016 Dr. Cherry told Eva that the ultrasounds of her Pelvis, Thyroid and Abdomen did not show fluid retention but they did show a nodule on the left lobe of the thyroid and thickening in the lining of the uterus. She wants Dr. Sloan in Lexington to do a biospy of the thyroid and Dr. Nall (gynecologist) wants Eva to have a D and C for what is probably a benign polyp in the uterine wall. At that point the blood potassium level had returned to normal. A CT scan that day did not show any mass in the abdomen. Dr. Cherry started Eva on 80 mg lasix daily plus potassium supplements for her fluid retention in her legs and feet.

Also on Dec. 1st a Basic Metabolic Panel blood test showed everything normal except glucose which was 151.

An echocardiogram and BNP test showed nothing abnormal as far as heart function.

12-07-16-1 - Transthoracic Echocardiogram Report

On Dec. 15, 2016 Dr. Ahmed (pulmonologist) says he can now hear wheezing when Eva breathes which was not present on Nov. 15. She was put on Prednisone and Spriva.

On Dec. 19, due to her legs leaking fluid Eva was put on Bumetanide 2 mg. instead of lasix for fluid retention in her lower extremities.

On January 19, 2017 Dr. Ahmed said that the breathing test indicated that the lungs were functioning normally but were unable to fully expand probably due to some unexplained pressure in the chest. He thought a CT scan of the chest was needed but, for some reason, did not order one. He also said that the sleep study page 1 and page 2 and page 3 indicated that Eva does have sleep apnea and needs to be using a CPAP machine. for two months and then see him to evaluate whether it has helped her breathing and pressure and swelling of the feet and legs. He also told her to discontinue use of albuterol and brovana and budesonide in the nebulizer and only use the rescue inhaler, Ventolin, as needed for breathing problems.


January 20, 2017 - Eva caught a cold.
January 24, 2017 - Visit with Dr. Cherry. She said to discontinue other medications for fluid and potassium pills and start aldactone at 25 mg per day and monitor both fluid retention and K blood level after two weeks to consider slowly increasing the dosage hoping to reduce fluid without increasing blood potassium level. She also will set up an appointment with Dr. Sloan in Lexington. She said she will review Dr. Ahmed's recommendations about anesthesia for a D&C to be performed by Dr. Bruner (gynecologist).
January 26, 2017 - Eva got a chest X-Ray at the local Fast Pace Urgent Care clinic which found chest congestion due to her cold and a nurse-practioner there prescribed levofloxacin 750 mg for two weeks - antibiotics to prevent pneumonia.
From January 29 to Feb. 8 Eva had flare ups of her rheumatoid arthritis in both her hands. Since she hadn't had a problem with arthritis since October and usually is not bothered by it in the winter we attributed this episode to stress from the cold and chest and sinus congestion she has had since about January 20. We also considered the possibility that the flare up could have been caused by use of the levofloxacin since the arthritis pain started just two days after she began taking the levofloxacin. As instructed previously by Dr. Lewis (DO, rheumatologist) she took 5 mg. Prednisone 3 times daily for this condition.
January 31, 2017 - Eva quit using her nebulizer and began using her CPAP machine at night as instructed by Dr. Ahmed. Without the nebulizer she had more trouble breathing the next morning so I called Dr. Ahmed's office for instructions. I was told by the person on the phone there that she would ask Dr. Ahmed when he came in at 1:00 and call me back. No one ever returned the call so Eva went back to using the nebulizer with Albuterol treatment followed an hour later by Brovana twice a day.
February 7, 2017 - Eva got a chest CT scan.

February 9, 2017 - Dr. Lewis prescribed hydrocodone for pain and gave Eva the option of going back on Methotrexate in addition to Cimzia.

February 9, 2017 - Dr. Cherry says Eva's recent chest CT scan showed nothing new and her potassium level is within normal range and the swelling in her legs and feet has decreased some. Her weight was 239, BP 150/80, pulse 81 and blood oxygen at 98%.

February 14, 2017 - Dr. Smith (pulmonologist) performed a 6 minute walking test in which Eva's blood oxygen level remained constant. He also did lab work page 1 and page 2 and ordered a ventilation/perfusion lung scan and an overnight sleep study later at the Somerset Hospital. Weight 238, BP 177/89, pulse 110, blood oxygen 98%.

March 3, 2017 - Eva had a ventilation/perfusion lung scan and a chest X- Ray at the Lake Cumberland Hospital at Somerset.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Summary 03-01-17:

At the end of September 2016, Eva Bristow was a 69 (almost 70) year old female who had had a lumpectomy followed by radiation and chemotherapy for breast cancer in 2004 and now was diagnosed with rheumatoid arthritis and pulmonary hypertension and bronchiectasis. The cancer treatments had resulted in ongoing gastrointestinal problems and low grade anemia. She also was overweight and was very sleepy during the day and complained of restless legs at night and had hypertension and a low level of type II diabetes probably caused by use of steriods for her rheumatoid arthritis. She also had bladder problems (interstitial cystitis) and her cholesterol levels were high. She was using a nebulizer twice a day with Brovana and Budesonide to alleviate breathing problems due to the bronchiectasis as prescribed by her pulmonologist. She had noticed sinus problems and some back pain and coughing which she attributed to the nebulizer treatments.

Beginning at the end of September 2016, she noticed pressure in her chest and abdomen and more than usual difficulty breathing and weight gain as well as increased heart rate.

Questions:

What is causing the pressure on Eva's lungs that is causing her breathing problems?

Eva is still extremely sleepy during the days most days even after using the CPAP and seeming to sleep well. Why is this? Dr. Sandra K. Schuldheisz, (pulmonologist) said that there is a switch in the brain that turns sleep on and off and Eva may need medication to regulate this function?

After five months (October 2016 through February 2017) of breathing problems and legs and ankles swelling and daytime sleepiness and collections of the data and test results below and seeing eight doctors, my wife, Eva, still has to live with extreme shortness of breath, sleepiness, and swollen legs and feet.

During those five months her diuretic medications including aldatone, lasix, and bumetanide were adjusted and traded out with each other.

She was given a ventolin inhaler as well as spriva for a month and albuterol to use with her nebulizer.

It was discovered that she had a thyroid nodule for which she was referred to a thyroid specialist and that she had a thickening in the lining of the uterus for which she was referred to a gynecologist for a D&C.

She took a course of levofloxacin 750 mg for two weeks due to lung congestion caused by a cold.

She took prednisone at various times for both arthritis flare-ups and for breathing problems.

She began using a CPAP machine while sleeping at night.

The only treatments she was given for her problems were the ventolin and albuterol additions to her breathing treatments and use of the CPAP machine which did not seem to help.

March 31, 2017 - Dr. Smith's office called to say that Dr. Smith said that Eva had mild cases of pulmonary hypertension, bronchiectasis and sleep apnea as well as diastolic dysfunction meaning that because the heart walls are stiff and thickened due to age and HBP the heart does not expand and contract as it should. He says the treatment protocol for Eva's condition is limiting salt intake to 1500 mg per day or less and use of a CPAP machine when sleeping. It seems that this condition can cause difficulty breathing as well as edema.

April 11, 2017 - Dr. Sloan at Lexington did an ultra sound of Eva's thyroid and found three nodules on each of which he did biospies and all of which were found to be benign. Weight 235. BP 157/89.

Tests and labs: