Home Alone

by Lisa the GP

Years ago I had (human) influenza, and developed a secondary bacterial pneumonia. I live alone, and these are a few of the things that I wish I had done to make my stay in bed easier. When you start getting symptoms, before you go to bed,

1) Put a large water supply on one nightstand. Large as in one of those 10 gallon collapsable plastic water cubes with a spigot commonly used for camping. Put more than one unbreakable cup next to it. You may not want to reach down for one if you drop it, not for reasons of hygiene but because of the effort required.

2) Put two boxes of facial tissues on the other, with a big trash can beneath.

3) Consider putting a barf container next to the trash can. Use a plastic trash-can liner that you can tie shut after use to control odor. Put a couple of extra bags under the tissue boxes. Intestinal problems are not usual in influenza, but coughing fits can send you retching, and bird flu does have potential to cause gastrointestinal problems.

4) Put all your medications on the water table. Don’t forget the ones you may ordinarily take, such as medications for diabetes or blood pressure, in addition to any prescribed flu treatments. Also include over the counter medications for symptoms, such as ibuprofen, cough suppressant, etc. If there are any medications recommended by authorities during an epidemic, include those. (I can imagine that if the bird flu has a lot of gastrointestinal involvement then the health department might recommend ‘electrolyte replacement’ of the kind used to treat cholera, for example.) Include any vitamins you usually take.

5) Put a few cans of a meal replacement drink within reach.

6) Consider a container that may be used for human waste in case you are too weak to walk to the restroom. Use something that can be closed in case you do not have strength to empty it for a day or more.

7) If you have a walker or a cane, put it by the bedside so that you can use it if you feel weak.

8) If you have a tv in the room, put the controls within reach of the bed. Plus a few other mental distractions, like books or a game-boy, though you probably won’t be awake much to use them.

9) Have a working phone within reach. Do not rely on any telephone that requires a power adapter (something that plugs into the power outlet in the wall). If the power goes out your phone is useless. Every home should have at least one phone that only plugs into the telephone jack on your wall, a separate system from your power. I keep a backup phone that even has caller ID (operates off batteries) that plugs directly into the telephone jack.

10) Have extra blankets (in case of power outage) and pillows within reach. Pillows are key because if you develop pneumonia you will want to remain sitting up so that fluid collects in the lower part of your lungs and leaves the upper parts with less fluid so that you can still breathe. (Note that this is different from when people have difficulty breathing due to ARDS in the hospital, when they are on a respirator; with forced air the most important thing is to make all the airways of equal resistance and so in that situation people try to arrange patients to be flat and even prone part of the day.)

11) If you have sleep apnea and use a CPAP machine, talk to your doctor (by phone) about using it while awake or whether any settings need to be adjusted. In a hospital, CPAP is sometimes used for respiratory support short of an actual respirator (vent)--but with supplemental oxygen.

12) If you are female, put feminine protection products (pads) at hand, though your illness will probably throw your cycle off.

13) Have a clock in sight. Make sure the alarm is switched off.

14) I imagine during a pandemic that a battery-operated radio and flashlight within reach would be important in case the power cuts out. I hope you bought new batteries before the outbreak started!

While ill, you may try to do an ordinary activity (walk to the restroom) and suddenly find yourself out of breath as though you have run a sprint. This is a serious symptom that should at the least prompt a call to your doctor or other professional. Meanwhile remember that being out of breath is a combination of how much oxygen you get into your circulation and how quickly you use it up. Move slowly so that you do not exceed your ability to exchange oxygen. (Okay, technically, the sense of breathlessness comes from how much carbon dioxide accumulates, but this is close enough.) Sometimes an inability to catch your breath is due to an inability to exhale and make the lungs ready for the next breath; exhaling with your hand over your mouth creates something called ‘positive end expiratory pressure’ (PEEP) which can help keep inflamed airways open, allowing the lungs to exhale more completely (asthmatics and people with emphasema have this problem, which is why old smokers sometimes breathe through pursed lips). The important thing is to try not to panic, because panic will raise your use of oxygen and make the situation worse.

I’m giving this information as a stop-gap to use until you are able to talk to a professional, not as a substitute for that consultation. If you cannot take more than a few slow steps without being breathless then you are probably *well* past admittable to a hospital for oxygen and should go to one if there is space (call for a pick up). If no services are available then you will have to limit activity and do not lie flat—remain sitting when awake and asleep. Use the pillows to brace yourself.

Another cause of sudden breathlessness is that, when you are immobile for more than a day, you can develop blood clots in your legs that may break loose and lodge in your lungs. This is called a pulmonary embolus (PE), and it can range in severity from hardly noticable to instant death. Hence my advice to at least phone a professional if you become breathless from what should be ordinary exertion. You can reduce (not eliminate) your risk of a PE by getting up and moving for at least a few minutes every day, or by clenching the muscles of your legs in bed every time you are awake and think of it. However if you have pneumonia these actions may make you breathless by causing your activity to exceed your oxygen delivery. But you knew being sick sucks, right?

Good luck, and may you not have to be sick without help.

Page last modified on July 17, 2006, at 03:27 PM by pogge