?Asbestosis, anyone?

[minkydog]

My mother was exposed to asbestosis for years while my father worked in the shipyard boilers. She washed his asbestos-laden clothes for 20 years. She has known she has some asbestosis for some time, but is hasn't given her any problems.

Recently, Mother was diagnosed with COPD due to the asbestosis. She is a non-smoker and lives in a smoke-free environment. SHe was put on Spiriva and Advair, but subsequently had trouble with the Advair and it was stopped. In June she was diagnosed with type 2 diabetes. Three weeks ago she was found to have atrial fibrillation. So she feels like everything is going to hell in a hand-basket. I'm wondering if there is a correlation. Pulmonary/cardiac is not my field. I'm a peds nurse--we don't deal with asbestosis so much.

If you are familiar with asbestosis, can you tell me whether the heart arrhythmia could be caused by asbestosis? Do you think it would be wise to get her an attorney? My dad sued for damages while he was fighting the mesothelioma, which helped him pay for his medical care. We filed a Wrongful Death suit after my father died, too.

If asbestosis is causing COPD and possibly the heart arrhythmia, I'm inclined to pursue this aggressively. I won't say it's not about the money--it's totally about the money. My mother is a widow living on a fixed income. Her medical bills are high and she has trouble buying her multiple meds. So if I can help her get some money, I will certainly do that.

Any takers?

 

[NotUrsula]

PubMed is your friend: http://ajrccm.atsjournals.org/cgi/content/full/170/6/691
http://pats.atsjournals.org/cgi/content/full/5/4/543

Has she got an actual confirmed diagnosis of asbestosis? From what I know of secondary asbestos exposure situations, it's pretty rare to get it just from household exposure to the clothing/skin of someone who is occupationally exposed. (And I do have the same situation in my family. My Aunt's husband died of occupational mesothelioma as well -- he was a plumber and was exposed through most of their 46-year marriage. She doesn't have any pulmonary symptoms, however -- she's 94 and healthy as a horse.)

 

[Disney Doll]

Sometimes the respiratory meds can cause funky heart rates...I'd check the Spiriva side effects.

According to this:

http://www.drugs.com/sfx/spiriva-side-effects.html

afib is a side effect of Spiriva.

 

[DawnCt1]

She would need to inhale the fibers to get asbestosis, but who knows that dust your dad was covered with when he came home. Has she had a B-read chest xray? For "her" its a regular chest Xray, but there are only so many radiologists certified to o a B-read. It is to check for asbestos related injury/illnesses. If her physician isn't familiar with it, you could find an Occupational Health physician who would be more than familiar with it and direct her to the appropriate radiologist. I think that it would be helpful to know if she indeed could be affected or if she is having other issues with her heart and lungs.

 

[minkydog]

She would need to inhale the fibers to get asbestosis, but who knows that dust your dad was covered with when he came home. Has she had a B-read chest xray? For "her" its a regular chest Xray, but there are only so many radiologists certified to o a B-read. It is to check for asbestos related injury/illnesses. If her physician isn't familiar with it, you could find an Occupational Health physician who would be more than familiar with it and direct her to the appropriate radiologist. I think that it would be helpful to know if she indeed could be affected or if she is having other issues with her heart and lungs.

good suggestions. I don't know if she had a B-read CXR. She has known about the asbestosis for the past 15 years, but it's never caused a problem.

Mother is pretty sure that the Advair is what precipitated the a-fib. It started right after she started using it. She stopped the Advair within a week, but the a-fib remains. The Spiriva doesn't seem to be causing problems, though.

I think her problems are all related to her chronic health issues. She's 76, has CHF, severe sleep apnea(uses CPAP), diabetes, hypertension, peripheral neuropathy, and she has no thyroid(lost to cancer). Mother is really resisting all her diagnoses--you know, if I don't acknowledge them do they really exist? (um, DUH. ) I just wondered how much of a part the asbestosis might be playing in the whole scheme of things.

 

[shy little mouse]

good suggestions. I don't know if she had a B-read CXR. She has known about the asbestosis for the past 15 years, but it's never caused a problem.

Mother is pretty sure that the Advair is what precipitated the a-fib. It started right after she started using it. She stopped the Advair within a week, but the a-fib remains. The Spiriva doesn't seem to be causing problems, though.

I think her problems are all related to her chronic health issues. She's 76, has CHF, severe sleep apnea(uses CPAP), diabetes, hypertension, peripheral neuropathy, and she has no thyroid(lost to cancer). Mother is really resisting all her diagnoses--you know, if I don't acknowledge them do they really exist? (um, DUH. ) I just wondered how much of a part the asbestosis might be playing in the whole scheme of things.

The respiratory meds could cause Afib, but more than likely the culprit is her CHF. If she had increased fluid volume on an already weak heart, it could definitely put her into fib. Honestly, I would pin the fib on that rather than asbestosis. I saw in your other post that she also has a GI bleed secondary to coumadin and ASA. She really needs a GI consult and a scope to determine if anticoagulation is contraindicated for her. Is her rate controlled? The big danger is throwing a clot, but you already know that. What is her EF like, and is she compliant with her CHF regimen? You probably don't know all the answers to these questions, living some distance away, but it gives you some things to look into. (And yes, I am a cardiac/vascular RN).

It is hard having a sick mom. I think you had talked about advanced directives on the other thread. It is a good time to get one in place BEFORE you need it. It was a really difficult conversation to have with my mom after her diagnosis.

 

[Pea-n-Me]

Well again, a possible vice versa situation. Often it's the AFib that causes CHF because of loss of atrial kick. Once again, restoration of normal rythm (via cardioversion) will correct this (and eliminate the need for anticoagulation). Generally, that would be a major aim of treatment.

I would also want to know whether she has systolic or diastolic dysfunction and how whichever she has is going to be managed. For this, I'd want to talk directly with someone from her team. If you approach it as a "I want us all to be on the same page" type of thing, her team, I'm sure, will be quite happy to have you involved, as a goal for all people with CHF is to help them learn to take care of themselves at home and avoid readmissions, and family support is often a crucial part of someone's success. (I realize you will need to have your Mom go along with this due to HIPPA guidelines; however, if she winds up in the hospital and becomes very ill, you will become involved anyway so it might as well be sooner than later. In fact, it behooves you to get to know her team now. BTW, does she have a cardiologist she's working with?)

Without seeing your Mom's exact history, it's hard to say specifically what role her COPD/asbestosis plays in her health and disease management. But in general, it is a contraindication for medications like beta blockers and amiodarone which many people take to help manage their AF/CHF so that's unfortunate. (BTW, does your Mom smoke?)

CHF in many people can be managed pretty well. But it takes a valiant effort on the part of the patient (and family) and the (entire) team working together. Because once people understand what it is they have to do to take care of themselves and actually do it, they feel a lot better and their symptoms are drastically lessened.

You're doing well, hang in there. I hope you can at least scratch the surface of this when you visit. The approach you take, given your Mom's personality and your relationship, will have to be pretty well thought out ahead of time. It'll give you something to ponder on the way down there. If she sees it as a control thing, she's probably likely to buck you. If she sees it as, you're willing to help her get her health under better management so she can live a longer and better quality life, than maybe she's more likely to go along with it, I dunno. Absolutely hugely challenging, either way, but maybe baby steps might be the way to go. Good luck.

 

[teskak]

Aussie chiming in here where asbestos diseases are a huge (and growing) problem. My father worked extensively with asbestos as a builder and also dealing with it as insulation on brake linings etc. We were fortunate he died before the mesothelioma could take effect - but when making initial statements to our Asbestos diseases society they confirmed instances where the wife's only exposure was to washing spouse's clothes or even just inhaling residual fibres on his hair from sharing a bed at night.

My inclination would be to look at pursuing this matter.

 

[LuvOrlando]

Those breathing medications can cause bad heart palpitations. My DS once went to the nurse with chest pain from Albuterol when he was around 6 and it scared me terribly. BUT, when I raised this concern to my Dr. he told me pointedly, not being able to breathe is a more imminent threat to his life than chest pain. Take the medicine. Thank God he has never had another episode... I hope it stays that way.

My DS is on Advair 230 for maintainance and it works, but frankly the Pulmicort taken with a nebulizer machine works much better.

As an aside, medicine doses in older adults sometimes need to be modified because their livers do not always process the meds properly. As a result, the medication lingers in the blood longer than in younger healthy adults and can become toxic easily (same goes for little kids). If your Mom is thin, as in frail, and or has any liver problems this should be discussed with the Dr. If you don't know if this is the case, if it was me, I would push for liver function tests and blood level tests if possible. Then discuss possibly finding lower theraputic doses for your Mom. We're not all the same and sometimes the standard just doesn't work for you.

Most important, since these breathing medications are strong stimulants make sure your Mom does not compound the effect with more stimulants. Make sure she cuts off absolutely all caffeine consumption. This includes coffee, tea (green tea has caffeine), diet sodas, regular sodas. Luckily you can find almost every product in a caffeine free formula today. Also, all decongestants, most migraine medications like Excedrin migraine, diet pills and most 24 hour allergy formulas have stimulant effects and these should be dropped as well.

 

[shy little mouse]

Pea, you are absolutely right that afib can cause or exacerbate CHF, but the reason I thought maybe the opposite was in effect was because minky is stating that the afib is a new issue, and that her mom has been diagnosed with CHF in the past. Maybe she has had intermittent afib in the past that has been undiagnosed, but this time she went into an rvr???? I think she had also stated that her mom was a non-smoker. The bottom line is that she needs to go to a doctor's appointment (you would hope cardiology is on her case) and get some information, if that is acceptable to her mom. And I agree, that it will be challenging!

 

[minkydog]

The respiratory meds could cause Afib, but more than likely the culprit is her CHF. If she had increased fluid volume on an already weak heart, it could definitely put her into fib. Honestly, I would pin the fib on that rather than asbestosis. I saw in your other post that she also has a GI bleed secondary to coumadin and ASA. She really needs a GI consult and a scope to determine if anticoagulation is contraindicated for her. Is her rate controlled? The big danger is throwing a clot, but you already know that. What is her EF like, and is she compliant with her CHF regimen? You probably don't know all the answers to these questions, living some distance away, but it gives you some things to look into. (And yes, I am a cardiac/vascular RN).

It is hard having a sick mom. I think you had talked about advanced directives on the other thread. It is a good time to get one in place BEFORE you need it. It was a really difficult conversation to have with my mom after her diagnosis.

I am absolutely a believer in having that advance directive! When my father was so sick and dying of mesothelioma he wouldn't make out the AD. He didn't want to give to control to anyone. Finally, he got so bad they had to perform surgery to make a pericardial window to relieve his severe pericarditis. He said he was 'ready to go." Knowing my dad, and knowing that he really wasn't ready to give up, I pointed out to him that there are things worse than dying---like having a stroke and be left unable to tell anyone what he wanted. I told him that without an AD in place they would be obligated to full resuscitation should he throw a clot on the table (which is exactly what happened to my step-dad!). That really sobered him up. He didn't want mechanical ventilation, he wanted to be DNR. Okay, dad, let's make it happen. The team came in, interviewed him separately(*to make sure I wasn't bullying him into anything) and the deed was done. Dad was so relieved! He told me that he hadn't realized how anxious it was making him to have to "keep all the balls in the air" by himself. After his funeral, my DH & I did OUR advance directives.

Pea, you are absolutely right that afib can cause or exacerbate CHF, but the reason I thought maybe the opposite was in effect was because minky is stating that the afib is a new issue, and that her mom has been diagnosed with CHF in the past. Maybe she has had intermittent afib in the past that has been undiagnosed, but this time she went into an rvr???? I think she had also stated that her mom was a non-smoker. The bottom line is that she needs to go to a doctor's appointment (you would hope cardiology is on her case) and get some information, if that is acceptable to her mom. And I agree, that it will be challenging!

You are correct. Mother has been a life-long non-smoker. She was diagnosed with "a little" CHF last summer. In January she had a routine checkup which included EKG and there was no evidence of a-fib then. She had a recent echo but she doesn't know the results. I'll ask some questions when we see the cardiologist Monday.

It is not my intention to ride in on my white horse and save the day. I don't want to wrench control out of her hands. I just want to come alongside her and help her find her direction, because it seems to me that she's lost her way right now. I want Mother to know how concerned my siblings and i are, that even though she might *think* she's handling the situation on her own, she needs to keep at least one of us in the loop in case of an emergency. It doesn't have to be a pride issue, it's practicality. Hopefully she'll see it that way. I plan to make my case from her doggy's and kitty's point of view--if she is unprepared they could suffer harm. And if that doesn't work, I'll drag out my handicapped son Christian!

 

[Pea-n-Me]

Pea, you are absolutely right that afib can cause or exacerbate CHF, but the reason I thought maybe the opposite was in effect was because minky is stating that the afib is a new issue, and that her mom has been diagnosed with CHF in the past. Maybe she has had intermittent afib in the past that has been undiagnosed, but this time she went into an rvr????

I know. I'm just saying that sometimes it can be one of those things that you never really know which came first (like I mentioned on the other thread). She could have been in AFib paroxysmally but it was never picked up on ECG. Either way, though, it would help to get back into a normal rythm.