Oxygen level readings in the ER?

[peachychou123]

My POTS symptoms have worsened this month, I've been to the emergency room 4 times in the last two weeks and the doctor ended up ordering another chest CT scan, due to increasing chest pain, dizziness, and some shortness of breath. Thankfully my tests have come back normal so far.

However, one weird thing that scared me is that during each ER visit, after an hour or two laying in the ER bed, the oximeter beeped loudly. I'd look at the monitor and see that the oximeter was giving readings of 80's or even the late 70's, then would climb back up to 100 after a few minutes. I asked the nurse about this each time. Two nurses suggested the oximeter was falling off my finger. I'm pretty sure it wasn't? One suggested it was because I was slumped on the bed and that might be affecting my spo2 levels. Hmm. But why did it happen 3 other times too? One even suggested my nails were too long!

My hands weren't cold. I suppose it's possible that my fingers weren't getting much perfusion, seeing as I was laying down with my knees raised and so I had my hand sitting vertical on top of my lap. I don't have Reynaud's and my extremity perfusion isn't great. but it's not that bad either, y'know? But it also happened when I was seated and the nurse actually thought there was something wrong with the oximeter. The normal lung CT is reassuring. But I still don't understand why I was getting these pulse oximetry readings, or why they follow this pattern of normal for a couple hours, sudden dip for a couple minutes, then normal again.

I have to say these episodes scared me. My fingers weren't blue or anything and I didn't pass out. But I was experiencing dizziness. I feel like no doctor or nurse bothered taking these things into account, maybe because I'm only 25? I don't think I've ever witnessed a reading that low. I'm hoping it really was just some kind of oximeter error, but the similarities about the situation each time are strange, and if the hospital equipment gave inaccurate readings, they wouldn't be using it, right?

I'm already anxious and this has really set my anxiety off again!

[Pistol]

When I am in the ER or hospital the pulse-ox frequently does that due to movement. It can loose good contact with your skin just from moving your fingers or hands and  - yes, long fingernails CAN do that. The sensors are very sensitive. My beepers often go off and the monitor show low O2 but repositioning it always reflects the correct levels again. The nurses and doctors know to tell the difference, there are certain symptoms with true low O2 readings. If they were concerned about true hypoxia they would order arterial blood gases. I would trust the ER staff - they know what they are doing and they are aware of the alarms. Next time it happens and you are worried talk directly to the doc about your concerns. You can always ask for arterial blood gas ( very painful though ). 

[StayAtHomeMom]

I remember mine doing that once while in the ER. It was a long time ago. I remember thinking it was weird because I am usually high 90s. My got to low 80s. I was also drifting to sleep because of the late hour and honestly they use the sensors that are tape and I think my finger just gets sweaty. The ER staff didn't seem concerned. All my pulmonary tests have come out normal and the quick checking at the doctors offices also show normal so if I were you I wouldn't worry too much.

I would mention to your regular doctor if it bothers you though. 

[peachychou123]

Thank you guys. I'm trying to figure that if the nurses weren't too concerned, I should not be either. I wasn't aware that so many factors can affect these oximeter readings. My anxiety is at a high and I just had another panic attack tonight. I will talk to my GP about it as I really need to get a grip on the constant worrying. I'm driving myself nuts.

[Peter Charlton]

I noticed this when I was in the cardiac ward, oximeter alarm constantly going because of my oxygen levels, despite what I did with my finger.

Now this was one of the first Dysautonomia systems I got from the day they put me on Beta Blockers for my VT, the feeling of breathlessness, as if I had to remember to breath, I even started forgetting to breathe whilst asleep, waking with nightmares of suffocation. Its one of the things the Autonomic Nervous System does, detect carbon dioxide and oxygen levels, and get you to breathe appropriately.

So, in my efforts to get health professionals to actually investigate me, rather than fobbing me off with "its anxiety", I bought my own oximeter.

Despite having stopped taking beta blockers many months previously, you can see my oxygen levels to be around 85% for half of the night.

Then April of this year, something changed in me, I got far fewer palpitations, no longer had the feeling of breathlessness or the nightmares, the year long cough I got from Sotalol stopped, and my blood oxygen has never gone below that red line for long again, even though I am using the same meter with the same fingers, so differently something was happening.

Pre and post April graphs for you.

 

[peachychou123]

36 minutes ago, Peter Charlton said:

I noticed this when I was in the cardiac ward, oximeter alarm constantly going because of my oxygen levels, despite what I did with my finger.

Now this was one of the first Dysautonomia systems I got from the day they put me on Beta Blockers for my VT, the feeling of breathlessness, as if I had to remember to breath, I even started forgetting to breathe whilst asleep, waking with nightmares of suffocation. Its one of the things the Autonomic Nervous System does, detect carbon dioxide and oxygen levels, and get you to breathe appropriately.

 So, in my efforts to get health professionals to actually investigate me, rather than fobbing me off with "its anxiety", I bought my own oximeter.

Despite having stopped taking beta blockers many months previously, you can see my oxygen levels to be around 85% for half of the night.

Then April of this year, something changed in me, I got far fewer palpitations, no longer had the feeling of breathlessness or the nightmares, the year long cough I got from Sotalol stopped, and my blood oxygen has never gone below that red line for long again, even though I am using the same meter with the same fingers, so differently something was happening.

 Pre and post April graphs for you.

 

Wow, that's very interesting and I'm sorry the doctors wouldn't listen to you, but I'm glad your spo2 levels have since increased. I know a lot of people who describe feeling as if they have to remember to breathe when they're on beta blockers. I was actually talking to a young ER doctor and when I mentioned beta blockers he said he wasn't a fan of them as a first line of treatment because they have a lot of long term side effects especially when used in the long run. I have also heard certain arrhythmias can make it hard for the oximeter to get a decent reading. Are you currently on any other meds and did you find they helped?

[Peter Charlton]

9 hours ago, peachychou123 said:

Wow, that's very interesting and I'm sorry the doctors wouldn't listen to you, but I'm glad your spo2 levels have since increased. I know a lot of people who describe feeling as if they have to remember to breathe when they're on beta blockers. I was actually talking to a young ER doctor and when I mentioned beta blockers he said he wasn't a fan of them as a first line of treatment because they have a lot of long term side effects especially when used in the long run. I have also heard certain arrhythmias can make it hard for the oximeter to get a decent reading. Are you currently on any other meds and did you find they helped?

I am not on any meds, last med was Sotalol in March 17, just for a few days as it gave me a horrendous cough that lasted for a year. Prior to that I had been on Bisoprolol to which it was said I had an anaphylactic reaction, apart from the cough, all my Dysautonomia symptoms arrived with the taking of Bisoprolol and some have remained for 21 months now.

I can understand that arrhythmias can make it hard to get a reading, but that wouldn't explain the jumping awake because I forgot to breathe or the suffocating nightmares. 

Can you remember what the "long term side effects" where and if they go away? Whilst the cough and breathing and palpitations seem to have resolved spontaneously back in this April, the exhaustion, brain fog, balance issues, feeling drunk when standing up, have all remained. The feeling full after eating just a small amount seems to be in the process of getting better. 

[peachychou123]

8 hours ago, Peter Charlton said:

I am not on any meds, last med was Sotalol in March 17, just for a few days as it gave me a horrendous cough that lasted for a year. Prior to that I had been on Bisoprolol to which it was said I had an anaphylactic reaction, apart from the cough, all my Dysautonomia symptoms arrived with the taking of Bisoprolol and some have remained for 21 months now.

I can understand that arrhythmias can make it hard to get a reading, but that wouldn't explain the jumping awake because I forgot to breathe or the suffocating nightmares. 

Can you remember what the "long term side effects" where and if they go away? Whilst the cough and breathing and palpitations seem to have resolved spontaneously back in this April, the exhaustion, brain fog, balance issues, feeling drunk when standing up, have all remained. The feeling full after eating just a small amount seems to be in the process of getting better. 

He didn't specify what the long term side effects were, but there are lots of studies which have shown they are linked to developing type 2 diabetes, some people can also develop rebound tachycardia or high blood pressure after stopping them, and certain types of angina can be worsened by them. Also I believe that the non-selective beta blockers have an effect on the CNS, so it's definitely possible they contributed to your POTS. Some people's nervous systems are much more sensitive to medications than other people's.

I was actually on propranolol for 4 years and it helped my tachycardia, dizziness and lightheadedness a lot, but I came off them about 6 months ago because I was worried about developing diabetes. I do wonder if I am experiencing some kind of rebound effect from stopping them, since my POTS symptoms have worsened, and the beta blockers no longer help my lightheadedness.

I have been advised by my doctor to go back on them for anxiety, and have taken a couple tablets since, but not for a week or two now. I already take other medications and don't want to pop more pills unless necessary.

My doctors do not seem interested, and I am feeling very frustrated and anxious about all these symptoms.

Have you been diagnosed with sleep apnea and received any supplemental oxygen?

Has anything been done about your VT or did it resolve itself?

[Pistol]

@peachychou123 - you mention in your last post that you were feeling better on propranolol but stopped because you were worried about developing diabetes and your POTS got worse since then. Here is a question: did you discuss stopping the BB with your doctor and did you stop according to his schedule? ( You must stop them very slowly and gradually under the supervision of an MD ). And also - did you experience actual high blood sugars that led you to believe you should be concerned about diabetes or was it something you felt might happen if you continue the BB? 

[peachychou123]

1 hour ago, Pistol said:

@peachychou123 - you mention in your last post that you were feeling better on propranolol but stopped because you were worried about developing diabetes and your POTS got worse since then. Here is a question: did you discuss stopping the BB with your doctor and did you stop according to his schedule? ( You must stop them very slowly and gradually under the supervision of an MD ). And also - did you experience actual high blood sugars that led you to believe you should be concerned about diabetes or was it something you felt might happen if you continue the BB? 

Yes I discussed it with my doctor and I weaned off them very gradually, cutting my dose down very slowly over a period of months. I was feeling fine without them for around 6 months, and then in early October, after a viral illness, my symptoms worsened. So I can't say for sure if it had anything to do with the beta blockers, really. It was only after taking them for years that I found out about these rebound effects.

They also caused me to gain weight and I developed some symptoms of insulin resistance with them which in turn made me feel worse and more symptomatic after meals, so that's why I stopped. My doctor wants me to go back on them for the tachycardia and anxiety,  but I am looking to discuss alternative medications besides BB's with him.

[Peter Charlton]

6 hours ago, peachychou123 said:

My doctors do not seem interested, and I am feeling very frustrated and anxious about all these symptoms.

Have you been diagnosed with sleep apnea and received any supplemental oxygen?

Has anything been done about your VT or did it resolve itself?

By the time the slow wheels of the NHS got in motion, my oxygen levels, whilst said to be low, were not the problem they were. 

My VT was cured with an ablation April 2017

Quite some years ago, they put me on SSRis for depression, did absolutely nothing for said claimed depression, but, not that I am an anxious person in the first place, but those SSRis made me lose any anxiety I might have had. Quite dangerous really as they made me feel indestructible whilst riding my motorcycle through heavy London traffic.

[StayAtHomeMom]

16 hours ago, peachychou123 said:

Yes I discussed it with my doctor and I weaned off them very gradually, cutting my dose down very slowly over a period of months. I was feeling fine without them for around 6 months, and then in early October, after a viral illness, my symptoms worsened. So I can't say for sure if it had anything to do with the beta blockers, really. It was only after taking them for years that I found out about these rebound effects.

They also caused me to gain weight and I developed some symptoms of insulin resistance with them which in turn made me feel worse and more symptomatic after meals, so that's why I stopped. My doctor wants me to go back on them for the tachycardia and anxiety,  but I am looking to discuss alternative medications besides BB's with him.

What about other beta blockers? I know propranolol is the go to, but metoperlol works better for me. 

[peachychou123]

59 minutes ago, StayAtHomeMom said:

What about other beta blockers? I know propranolol is the go to, but metoperlol works better for me. 

I will look into this one. Thanks!