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Respiratory Therapist/have to go back again to the doc


QUESTION: hey its me again, hope you remember, maybe you have the older posts ? ..


And ONE DAY after i finished, i started to cough again, at first not that bad, but gradually got worse then the chest got tight again BASICALLY BACK TO THE SAME SHIT, IM SO MAD!
... now make note that during the meds i got better. I could breathe and chest felt good but now the coughing and tight chest is back again.

When it came back was not coughing up any green or yellow BUT !!!
Yesterday woke up not feeling good, felt little feverish, slight tingle sore throat ... the kinda that feels its about to get worse but it never did and so i took my temp which was 99.3

the throat issue went away and so did my fever-ish (I TOOK SHIT LOADS of VITAMIN C, OREGANOL, PEROXIDE IN THE EAR and GARGLE, i mean took everything i could to stop the fever or throat from getting worse.

Last might was really bad so i did an ALBUTAROL TREATMENT which helped .. I was able to relax so from all the hardcore coughing ... BUT, after hour and half it started up again ... I could not sleep so i took another treatment at about 7 amn today and that helped and i slept for awhile and now im going to the doc

Today woke up with that feverish feeling TEMP 99.4 and again my chest is tight the cough is there and guess what, today i coughed up the weirdest gross yellowish looking crap kinda stringy looks really alien like

I wish i would have sent this to you couple days ago so that i had your response and thoughts on the matter before i went to the doc ... by the time you get this i will be at the doc

please send me your thoughts

im not a smoker but as a DJ
have worked many time over my lifetime
in smokey bars clubs etc..
Was not working in smoke place for long time BUT
the last time i worked IN ONE was last year
i worked Aug 2012 to Oct 2013
it was a new place with poor smoke eaters
it just hovered all over the place, it took me
2 months to get use to working there.
NOW i left that place in Oct. 2013
and have not been in one since then.

I tell you this because my whole getting tight chest back in Jan was so sudden ... Remember i woke up and boom tight chest ... nothing built up to it ... i just happened out of the blue

ANSWER: Sorry to hear you are having such a tough time getting rid of this infection. From the sound of it you are in a tug of war with this thing.  It has been a couple of days since you went to the doctor again so I hope things have gotten better since then.

It is all about balance and what tips the scale in either direction.  When something seems to hit us out of the blue it is usually either  a very virulent infection that may  difficult to get rid of under the best circumstances  or  that  we may have susceptible gaps in our immune protection  and are not able to readily and adequately mount an appropriate response and thus wobble back and forth with getting better and worse.

It is plausible that chronic exposure to smoke in your job has had an affect on your immune system.  Most people do not actually "get used" to smoke but  may just become desensitized to the awareness of adverse effects which can produce damage to  immune  and organ systems  The effects  on the immune system may go more or less unnoticed until something draws attention to it; usually some sort of health challenge.  The effects are not necessarily permanent especially in shorter term exposures but may take some time to normalize.

Considering that there are at least 5,300 chemicals known to be present in cigarette smoke in addition to any number of bacteria and bacterial toxins, fungi and mycotoxins, viral agents etc. it is a wonder tolerate it as well as we do.  Even just the small smoke particles alone are enough to damage the lungs and immune system.  You can get all of this, and more, from secondhand smoke.  That's why it is so important to avoid it.

Also,  sometimes during an infection,  pockets of infection form  that can harbor some organisms  and can  keep the infection present at some level and possibly initiate a recurrence. Your  thick, tenacious sputum (which may sometimes be made worse by some decongestants) makes the offending organisms and byproducts difficult to remove  and more difficult for antibiotics to work as effectively, assuming they are appropriately targeted to your situation in the first place. If they are not, they may actually suppress your good bacteria while not helping to keep the bad bacteria in check which would tend to worsen the situation. The other thing is that while steroids often make people feel better, and do help in many cases, they also may mask ongoing problems because they reduce inflammatory effects so you feel better; but, since they do this by interfering with immune response there is some potential for  worsening infection or acquiring new infections, especially with long-term use. It is a catch-22 with some of these medicines in that what makes them effective can also render them harmful in some situations.  That is  one reason  I said previously that you might feel better when you were not actually as well as you thought so not to overdo it too soon.  These factors may or may not apply to your particular situation but the potential for these effects  is something to keep in mind.  

In order to set the balance back in your favor you need to be able to remove or otherwise neutralize  the offending agents and  other irritants and reduce the inflammation effectively to support your immune system in its effort to help you recover. You no doubt have quite a bit of inflammation at this point so even after you clear the infection it is likely to take some time to subside entirely.  In addition to whatever your doctor prescribed and recommended be sure to remember  to drink plenty of fluids, especially water (not cold)  and soothing teas, not sugared drinks or alcohol or other drinks or food that will negatively impact your immune system. This will help to liquefy your secretions so you can get rid of them more easily and help your immune system do its job and work more  in concert with the supplements (vitamin C, and other supportive measures)  or medications you may be taking. You can also use a humidifier to help rehydrate your airways. And of course, deep breathing exercises, done properly and consistently, are very beneficial. These are all things you have heard before, I know.

I told you before that the body gives us messages that are not always easy to interpret; I think yours was saying HELP! Be patient and persistent in your efforts to harmonize and protect your immune system so it can get you back to good and  keep you healthy.


---------- FOLLOW-UP ----------

Bronchial Casts
Bronchial Casts  
QUESTION: hello,

well i always do teas, eat as best as possible, organic, fresh etc...
ive not worked in smoky environments since Oct and hope i never have to.

Ok so i went to the doc, he took xray and he said the xray looked all looks good and clear (they will send it to be read) ... but again said it came out clear and then mentioned some kind of bronchitis.

then he said im prescribing another round of steroids (METHLPREDNISOLONE)
and then said Im gonna also give you an antibiotic that i normally give my patients with pneumonia ... I then asked him WHY would you do that if my xray came out fine and you told me i dont have pneumonia?
He said I think this is the best course since you sound really bad.
And yes i sounded horrible, the breathing sounds were bad tight chest etc...

I asked if should be using an inhaler like Advair etc.. he said it would not hurt and gave me 30 day sample of DULERA (have not started using it and might not)


When i get home and wait for the pharmacy to call me that the meds are ready i started doing research on the antibiotic he prescribed and Stephanie let me tell you. I research all the time meds i take, and i know there are risks to everything, I GET THAT ... but i have never read a side effects report as LONG and as BAD DANGEROUS as this one

... Im talking about LEVAQUINN

There is even a facebook page of people that suffered/still suffering from levaquinn and other FLUOROQUINOLONE antibiotics like CIPRO,
check it out.

... it has a FDA BLACK BOX and that was a long fight to get that on

bottom line im taking a chance on that one so i call the doc back and I told him i dont feel comfortable taking this one and I want Azithromicin

(i was told by another doc one time that Azithromicin kills the both kinds of bacteria that trigger asthma)

So he agreed and called it in for me and yesterday was my first day on the meds and i feel great .. yeah i know im aware of what these meds are all about but i did need something ... NOW HERE IS WHERE I LEARNED MORE.

What i forgot to mention this last time is that i started coughing up these weird alien gross looking STRINGY things and i even took pics of them (SEE PIC) ... and i took them for the Doc could see them ... After long research i found out they are called BRONCHIAL CASTS and they call the disease PLASTIC BRONCHITIS

Now mine are not as big as some ive seen but its been a non stop event. Every time i cough one comes out maybe two ... i read that the violent coughing sucks them up the airwaves and comes out ... its not been fun.

I know there have been bronchial scopes done on people to remove them and they start to feel better .. mine come out ok ... its just that it seems there a lot i guess ... Yeah the meds are opening up the airways as my albutarol treatments help ... the air in Dallas right now is super dry so im coughing gasping for some humidity and yes i have the humidifier.

So far not many being coughed up but like you said the steroids are helping but could also be masking ... So i guess i need to hope that the ZPAK does some help as i did not find WHAT if anything besides removal kills these Bronchial Casts

I will keep my immune system going as best i can and if think of anything or find out anything please respond and thanks again.

im confused
so antihistamines make mucus worse?
and also decongestants ?


Yes, I can tell that you use due diligence in learning about your health problems and the medications and supportive measures that may be beneficial. I think it is important to know as much about your health and the things you can do to recover and maintain it. And it is important to communicate with your doctor as you did and let them know your thoughts and concerns so you can participate in your care as you can both learn from the experience.
And, I think it is reasonable for you to want to use an antibiotic with the least potential for harmful side effects that is effective for your situation

As for  drying effects on mucus, anti-histamines are  more generally recognized as having effects on drying and thickening although decongestants may  have some indirect effects;  and, together they may have some overlapping effects that can enhance the negative potential (as well as the positive).  The key word is “can”; not all anti-histamine produtcs are the same and these  effects  are experienced by everyone but there is some potential depending on other factors, and some people are more susceptible to these effects. In cases where mucus becomes thicker, tenacious and more difficult to manage, while using anti-histamines or a combination product the potential for these induced  effects should be considered. (Sorry, I confused the issue by using “decongestants”  instead of anti-histamines  but I was actually thinking more about combination products).

Yes, bronchial casts can look alien.  They can result from inflammatory processes and lack of adequate airway hydration among other things. They are essentially compacted garbage that literally sticks to the airways and can mold  into the image of whatever part of the airway it happens to be. While casts are not technically alive,  they  often contain inflammatory cells and, like garbage, can harbor microorganisms capable of causing infection and further inflammation. The only way to get rid of them is to cough them out (or otherwise remove them as you said)  and stop production, that is,  rehydrate the airways adequately, and stop or greatly reduce the ongoing inflammation. Hopefully your current treatment will help with this.
If you are coughing up less it may because you have less to cough up now.

If you are not considerably better after this treatment, or get worse, -  you might want to consider consulting a pulmonologist  - other than financially, of course,  it would not hurt to have an assessment done and determine what treatment  if any, would be best for you. Just a thought.

I was glad to hear you were feeling better  and hope this continues. Let me know how things turn out if you get a chance.


---------- FOLLOW-UP ----------

QUESTION: i finished the Azithromicin today and will take my last methlypred tomorrow.

the doc did say he would send me to a pulmonologist if i dont get better.

Which leads me to this ... My chest still kinda light wheeze as i breath and im still coughing ... past 2 days more so ... if i try laughing even a  subtle laugh i start a coughing fit ... i am doing my albutarol treatments as i have the machine for it/and meds.

FYY ... i never started the Dulera, i dont know why ... i mean the DOC never told me at first to take it ... ONLY after i asked him if i should try some inhaler and he said WELL IT WOULDNT HURT ... its a 30 day sample dose and wonder if i should take it ???

I guess i wanted to see how the mythelpred would work on its own at first and it has worked ...

so after 2 bouts of different antibiotics and 2 bouts of oral steroids i damn hope this stops ... yeah ive had a 4 month cough before and it ddi go away but that was just a cough and not lung issues like now ...

I dont wanna keep taking more of that stuff again and so soon ... i mean this was my first time ever doing two bouts of those meds so close together.

Hi Joe,

Thanks for the update.

Just remember that it takes time to heal inflammatory damage, especially if it is severe or prolonged. You will not necessarily be perfectly well by the time your medications are finished.  Sometimes, the healing process takes longer than expected for a number of reasons we have already discussed.  So it is important to keep monitoring your progress, as you are doing, and if you feel that your coughing or other symptoms have worsened or adequate progress in not being made, you may want to consult with a specialist as your doctor indicated might be necessary.  

Continue to take care of yourself and stay positive. I believe if we see ourselves well, and support this vision, the process is more holistic and helps to maintain a healthier, more resilient balance.

I will keep you in my thoughts.


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Stephanie Tyrrell


Respiratory Therapy is a very diverse field encompassing many specialty areas. I have experience in many of these areas and I am willing to answer any question I feel competent to answer within the scope of my experience in the following areas: neonatal ICU and transport, pulmonary rehabilitation, sleep studies, BiPAP/CPAP therapy, Holter monitoring, EKG, ventilator management, chronic and acute respiratory diseases,(i.e. COPD, asthma, restrictive disease, ARDS (acute respiratory distress syndrome), pneumonia, etc) and therapeutics, arterial blood gases, and others. Please see my profile under Experience for a full listing of areas of experience.


I have worked in respiratory therapy for over 25 years in all facets of patient care including level 4 neonatal ICU and neonatal transport, Director of Cardiopulmonary, community health fairs and networking, staff therapist, pulmonary rehabilitation, sleep studies and BiPAP/CPAP therapy, Holter monitoring, EKG, cardiac clinics, pre and post cardiac surgery education and patient care, emergency and long-term ventilator management, chronic diseases such as COPD, asthma, cystic fibrosis; acute respiratory distress syndrome, emergency room, home and nursing home respiratory care. I also provided temporary staff to area hospitals through an allied health business I owned and managed, while also working as a staff therapist for the business.

Certified Respiratory Therapist, Registered Respiratory Therapist, Licensed RT, NRP ((Neonatal Resuscitation Program) certified, BS Biology/Botany, MS Environmental Sciences - Toxicology

Past/Present Clients
Thousands of in-patient and out-patient clients in the hospitals I was/am employed by as well as a number of local hospitals that utilized the services of my allied health business. I currently work as a respiratory therapist at a general hospital and a rehabilitation hospital.

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