pulmonary fibrosis

[Fred Habacht]

can anyone familiar with this condition share any information?

Thanks

Fred

[Joco]

Everyone I know of who developed Obstructive (COPD) or Restrictive (pulmonary fibrosis) had to move to sea level to be able to breathe better. Both are fatal diseases but the patients lasted longer with higher oxygen at sea level.

[purplebeads]

www.nhlbi.nih.gov/health/health.../copd/‎

This is a good resource...National Institute of Health

[lcscats]

You are at 5000ft or 1600 meters. You have 15% less oxygen in the air (3% per thousand feet elevation). Now it is like living in Denver. Normal folks compensate by having more red blood cells with less oxygen in each cell so it works out. You need to do research and talk to your health care providers to see if this is an issue. It might be it might not be depending on each person. By the way your car unless it has a turbo/supercharger has 15% less oxygen to burn so HP is down also.

[simpsca]

Fred I'm so sorry to hear this is the diagnosis.

[Fred Habacht]

Thank you....the doctor you sent us to was truly unique and very helpful....even if his bedside manner was nonexistent.

[simpsca]

Sent you a PM about a second opinion?

[ShanConshue]

PULMONARY FIBROSIS (PF) DESCRIBES A CONDITION in which the lung tissue becomes thickened, stiff, and scarred. The medical terminology used to describe this scar tissue is fibrosis. The alveoli (air sacs) and the blood vessels within the lungs are responsible for delivering oxygen to the body, including the brain, heart, and other organs. All of the body’s functions depend upon delivery of a steady supply of oxygen. As lung tissue becomes scarred and thicker, it is more difficult for the lungs to transfer oxygen into the bloodstream. As a result, the brain, heart, and other organs do not get the oxygen they need to function properly. Typical standards of care may include prescription therapies, supplemental oxygen, pulmonary rehabilitation, lung transplantation, and/or referral for clinical trial participation. Lung transplantation remains the most viable course of treatment to extend the lives of those with IPF; this option should be discussed with your physician.

For some patients, depending upon their specific type of PF, medications may stabilize their disease and there may be a benefit to continuing usage. Further, some of these medications may be prescribed to manage symptoms when a patient has an acute exacerbation or period of worsening. Medications may be used alone or in combination.

I would suggest a second opinion, of course, as this is a big diagnosis. Many different tests are used in combination to come to this diagnosis such as: chest xray, pulmonary function test, arterial blood gas, bronchoscopy, ECHO, plureal lavage, and exercise function tests, and a surgical lung biopsy.

A doctor that is familiar with the disease and the latest treatment option is the best choice.

[Fred Habacht]

There is always a good and a bad to any situation.

We were talked into going with Met Life Health Insurance some four years ago. After shopping all offers we moved over to the Bellon agency. We had no prior conditions and really didn't know how our claim might be handled. Andre Bellon has offered to meet us or go with us to any location that is necessary. He has shown sincere warmth and real friendship.....whatever it takes to help us has been his motto and he has more than kept his word.

Think about an unexpected illness or accident where all your assets would not be enough to save or help you....and then you see that you have partners that will pick up the expense with no hesitation.

MY mother used to repeat the story of the Happy Grasshopper that made no preparation for the future....we all need to plan for an unplanned event. This forum is supposed to help or try to help ex-pats. Please hear this call! Get insurance anywhere you can...we certainly are glad we were pushed into getting it and pushed into keeping the policies.

FRED

[sm1mex]

I agree with Fred. I also use Bellon and he has helped me many times with illnesses and hospitalizations. I am now facing another hospitalization and Andre is already preparing for me insurance wise.

[Yo1]

My brother-in-law died of pulmonary fibrosis from environmental exposure. He lived for 10 years after the diagnosis. That time span was unusual as he qualified for an experimental chemo-like drug study through the Veterans Adm. that extended his life by many years.

Good luck!!

[RVGRINGO]

I have suffered from COPD for the last decade, or more, and am currently tied to my oxygen concentrator, following the third hospitalization in a year for other matters; gastro and cardio. Using supplemental oxygen does help in healing from those surgeries, but COPD is not curable. The symptoms, however, can be treated to provide relief. Mine include Spiriva, Ambroxol and various rescue inhalers. I occasionally use a nebulizer in the event of a concurrent cold, etc. I am under the care of Dr. Valenzuela (gastroenterologist) and Dr. Briseño (cardiologist) at Integrity Clinic, and have been helped greatly by both. They are caring, patient physicians who coordinate my treatments for the best outcomes.

My COPD is primarily chronic bronchitis and emphysema as a result of smoking for some 43 years. Yes, even though I quit in 1999, it can come back to bite you later.

Whenever I have spent a week at the beach (sea level), I did not experience any improvement and was still unable to walk more than a block. Now, I cannot even do more than half the length of the house. If someone wants to buy the house, I might try sea level for an extended period, but would doubt that it would be a noticeable difference; trading dry stress-free climate for heat and humidity. Nor would I like to be far from my trusted physicians. The only dry seaside place that might be OK is La Paz, BCS.

[Joco]

The people I know who moved to sea level on doctor's orders so they could breathe better, moved inland to dry, non humid areas like in Texas, New Mexico or Arizona. I don't think anyone moved to a beach because the humidity would probably defeat whatever benefit there is to being at sea level. You might try it again in a non-humid area.

[Fred Habacht]

RV.....thanks for the most helpful answer. We will have a consultation with Dr. Briseno and we are looking into changing our current GP because mistakes were made in the diagnosis and wasted a lot of time and money. We do not plan to move from Mexico or to lower altitude if it is all possible....no doctor has suggested that kind of a solution and with modern equipment we don't consider that advice would be necessary.

[Fred Habacht]

RV...can you share who your GP is?

[RVGRINGO]

Other than an occasional visit to Dr. Lastra over the years, I really do not have a GP. With many years of association with hospitals and being an old science type, I tend to know what type of specialist I might need, and seem to have always been able to sniff out the good ones, studiously avoiding the charlatans, incompetents or inept choices. So far, so good.

Stop by any time you want to chat.

[Dr.Sam]

RV.....thanks for the most helpful answer. We will have a consultation with Dr. Briseno and we are looking into changing our current GP because mistakes were made in the diagnosis and wasted a lot of time and money. We do not plan to move from Mexico or to lower altitude if it is all possible....no doctor has suggested that kind of a solution and with modern equipment we don't consider that advice would be necessary.

Hello Barbara/Fred and all.

Forgive me if I have not read every message on this thread. I have just caught the last few comments, and want to just add a few things.

• How do you know you have pulmonary fibrosis? Based on symptoms? Medical Exams? Biopsy?
• Do you know, or have an idea, what the cause is (this can tell you how fast it will progress)?

At this point, if you do indeed have it, you will need to do two things. One is slow the progression (what is your plan? Do you know the side effects of whatever you will take to control the progression?) The other thing that you will need to do, at some point, is compensate for the defect in gas (oxygen and CO2) exchange. This is what seems to be discussed here so far, as in Icscats´ post. Icscats is referring to Boyles Law, but it is not that simple.

"You are at 5000ft or 1600 meters. You have 15% less oxygen in the air (3% per thousand feet elevation). Now it is like living in Denver. Normal folks compensate by having more red blood cells with less oxygen in each cell so it works out. You need to do research and talk to your health care providers to see if this is an issue. It might be it might not be depending on each person. By the way your car unless it has a turbo/supercharger has 15% less oxygen to burn so HP is down also."

We are at about 1.6 km elevation. That is correct. The 15% part is somewhat correct if it refers to "available" oxygen. The percentage of oxygen at sea level is 20.95%... but so is the percent of oxygen at the top of any mountain. At sea level, and in Chapala, we have 20.95% oxygen, however, the actual number of oxygen molecules is less, but so are all the gas molecules. Humans do not share all the same features of an engine, but some. We cannot have turbos, but we can have oxygen (just as a car can have N2O), we can open the airways with beta agonists (just as a car can have a longer duration and higher lift cam, high flow intake manifild, and larger intake valves). However, humans can do much more in the area of compensation than a car engine can becuase biochemistry is more complex than regular organic chemistry.

So, if we consider Boyles law (effects on gas expansion vs. pressure (P1V1 = P2V2), we have to consider all the gas laws that affect the bioavailability of oxygen. Bypassing Charles' law about temperature affecting the volume of gas, and Henry’s law about dissolved gassed in liquid; we can go straight to Dalton's law about the effects about altitude and oxygen availability.

• Simply stated, we need oxygen, and under pressure to breathe. If we have too much air (mix of O2, CO2, Nitrogen, etc) pressure, we cannot exhale CO2. If we lack air pressure, we cannot saturate our blood enough with oxygen (around 7km of altitude is an equilibrium at which the O2 stops going into the blood, and starts going from the blood to the air instead).
• Normal physiologic function occurs from a range (excluding below sea level) from sea level to 12,000 feet (2.27 miles, 3.66 km). Any problem you have at sea level, can be worse at high altitude, but there are more considerations than just this.
• Temperature, pH, and biological compensation are factors:

• 

Then there are biologic adaptations such as with 2,3-Bisphosphoglycerate:

Then, the big question, when everything is considered how much oxygen do you need to function? Here is a great informative quote from Linda D. Pendleton about flight physiology: "In a normal, healthy individual, sea level pressure is sufficient to cause the blood leaving the lungs to be almost totally (97%) saturated with oxygen. At 10,000 feet the saturation has dropped to almost 90% -- still sufficient for nearly all usual life functions. An oxygen saturation of 93% is considered by medical folks to be the low limit of normal functioning. On top of Pike's Peak (about 14,500 feet and 438 mm Hg atmospheric pressure) the oxygen saturation has dropped to about 80%. Many people, if left in this rarefied air for some period, will develop mountain or altitude sickness: vertigo, nausea, weakness, hyperpnea (increased breathing), incoordination, slowed thinking, dimmed vision and increased heart rate. At 25,000 feet the oxygen saturation is only 55% and consciousness is lost. (Note that the partial pressure of oxygen in alveolar air at 25,000 feet is 14% of 281.8 mm Hg or 39.5 mm Hg -- slightly less than that normally found in venous blood returning from the tissues."

She refers to lower saturation from higher elevation, but the same can happen from pulmonary disease. The effects and the percentages are what are interesting. Keep in mind, she does not address compensation which is a huge factor in pulmonary disease. However, we can agree that if you can stay above 90%, or even high 80s, you can function. How you do that depends. First, controlling the damage to the lungs so they can do it themselves. Later, if necessary, increase the amount (%) of oxygen you have available, by one or more of many options.

First step: Be 100% sure you have pulmonary fibrosis.

Step two: Control the progression the best you can, but the least amount of side effects.

Step 3: compensate when it needs to be done.

[Fred Habacht]

Thanks Sam!

[simpsca]

Other than an occasional visit to Dr. Lastra over the years, I really do not have a GP. With many years of association with hospitals and being an old science type, I tend to know what type of specialist I might need, and seem to have always been able to sniff out the good ones, studiously avoiding the charlatans, incompetents or inept choices. So far, so good.

Stop by any time you want to chat.

Question - you say you can find the specialist doctors when you need them. Do you have a pulmonologist you go to? I have severe asthma and go to one in Guadalajara and in the US but am wondering who you found to help you.

[RVGRINGO]

I do not have a pulmonologist, but do have access to one through Dr. Briseño, should we decide to consult.

[lcscats]

Thanks Dr. I had no idea the body compensates that way. Cars can't and thus I assumed the 15% number for our altitude applied to our bodies for newbies to this altitude. How fast do these changes occur? Overtime or fairly rapidly?

[Dr.Sam]

Thanks Dr. I had no idea the body compensates that way. Cars can't and thus I assumed the 15% number for our altitude applied to our bodies for newbies to this altitude. How fast do these changes occur? Overtime or fairly rapidly?

• Some changes are rapid. For example, increased heart rate can occur in seconds. Changing where blood flows also compensates, but these are not true adaptation, only short-term compensations.
• 2,3-Bisphosphoglyceric acid / 2,3-Bisphosphoglycerate / 2,3-BPG production seems to take between 6 to 24 hours. This substance allows the red blood cells to "unload" the oxigen easier within the body.
• Increased red blood cell production takes weeks (up to 8 weeks).

[Dr.Santiago]

I have found that the patients I've seen with a COPD exacerbation reported to do much better after some fine-tuning with their meds. I found that some developed allergies to local environmental allergens (which they thought was their COPD acting up) but were much improved after addressing the underlying causes. If you feel some SOB (Shortness of Breath) you should go see your healthcare provider. Although you may think it's "pulmonary fibrosis" or a a COPD exacerbation, it's important to rule causes that may put your well-being at risk.