Debra, Start by bringing this quote in to the ER. It's from the book "Neuromuscular Junction Disorders: Diagnosis and Treatment" by Dr. Matthew Meriggioli, Dr. James F. Howard, Jr. and Dr. C. Michel Harper. It explains why what MGers have is NOT anxiety.
“Arterial blood gas measurements are a relatively
insensitive measure of impending respiratory
decompensation in MG since the initial changes are
consistent with hyperventilation and are usually
attributed to anxiety. By the time CO2 retention
occurs, the respiratory muscles have already
begun to decompensate.”
Decompensate in this quote means weakening. You know doctors, they can't use simple words.
Your ER doctors are jaded and need reeducating, in my opinion. What other drugs are you on? You HAVE TO inform the ER of everything you are taking, even over the counter drugs. The very fact that you didn't say something about Tramadol may make them suspect you of "using." ER docs are always on the lookout for drug users. Sad but true. A mix of things could be harming you as well. And you shouldn't have oxygen until they do an ABG because being on it skews the results. I don't think you needed oxygen either but they should have walked you around with an oximeter to know for sure. Shortness of breath can be caused by a number of things, not only MG.
They should've, at the very least, done basic spirometry and MIP and MEP. You can't tell by looking how someone with MG is. Can they tell by looking if someone has a broken bone or sepsis?
Well, if the bone is sticking out through the skin they can.
Tramadol is an opiate and is highly addictive. It is also hard to withdraw from. Have you read the drug insert? That's the problem with the prescribing of drugs. Doctors don't read the inserts and neither do patients. You need to read it BEFORE you get it. Some drugs are very hard to get off of. Long term use of drugs like this are not good for MGers. Most doctors will tell a patient to switch to Tylenol or Ibuprofen as quickly as possible after surgery.
Tramadol also inhibits both nicotinic and muscarinic acetylcholine receptors. When you try to go off of the drug, you are not only getting bad withdrawal effects but may be getting a "surge" of acetylcholine. You need an expert to help you withdraw from the drug and it may need to be done in a hospital setting. Withdrawal from these drugs can have seriously harmful effects on your body and should not be pooh-poohed by anyone. Here's a little light reading for you.
http://www.mayoclinic.com/health/dru...before%2Dusing
http://www.mayoclinic.com/health/dru...side%2Deffects
http://ajp.psychiatryonline.org/cgi/...ll/161/12/2326
http://www.ionchannels.org/showabstr...?pmid=12010769
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1573343/
http://www.ionchannels.org/showabstr...?pmid=17380034
It's not "fun" to do all the reading about the drugs you're taking but it's absolutely necessary. Like how some drugs cannot be taken with grapefruit. You need to know these things.
Your neuro needs to be in the loop on this. He should've recommended you transition off of Tramadol quickly after the thymectomy. No, I'm not a doctor but this drug is not good for MGers on a long term basis.
Mrs. D. could speak to this better. It doesn't take long at all for the body to become addicted to an opiate. They have ways to help you go off of one. So ask to be referred to a pain expert to help you with this, okay? To do it on your own is dangerous at this point.
If you can't take a breath in or out, can't swallow or are overall weaker, or suddenly weaker, go to the ER or dial 911. I hope you get help soon.
Annie