Tag Archive for allergies

Back in the Hospital

Well, it happened. After two years staying away, I ended up in the hospital for a tune-up. Four days and four nights kind of makes it sound like a vacation or resort reservation, but it wasn’t that fun. This time it was fairly simple, just good old asthma without other complications.

They did all kinds of blood tests to see if any clues came up as to the cause of my exacerbation. IgE levels were about 3x as high as usual so it was determined allergies were the culprit, of which I’ve been complaining for the past couple months. It was a lot of sitting around, neb treatments, IV steroids, and an occasional walk around the hospital floor. I was put into a double-occupancy room but spent almost the entire time by myself.

As usual, my first RT was Scott the sci-fi fan. For some reason every time I’m admitted he is on duty, remembers me, and we talk about the latest in science fiction shows and movies. I recognized a few other respiratory therapists, but none of the nurses. My local lung doctor came by every morning around 7:30 to check in with me and update notes. The hospitalist team quickly decided I had a “complicated and very advanced case of lung disease” and was going to let my lung doctor call the shots. I was glad because doctors unfamiliar with me tend to cut me loose early and I quickly relapse.

While there I got the usual questions and comments:

  • How many years did it take to grow your beard?
  • Are you always this chill?
  • Whoa, your water bottle is HUGE.
  • I LOVE your backpack!

I think my biggest fans were the nurse/tech pair who stuck me 9x before calling a phlebotomist in to draw blood. The phlebotomist walked in, drew the blood immediately, and then trash-talked the other nurses. It was pretty hilarious.

After a few days the hospitalist came by to update me and dispense some advice:

  • We have determined your severe asthma exacerbation was caused by your allergic asthma
  • Be sure to take your medicine when you go home
  • Maybe stay inside with the windows shut cause there are allergies outside

I could have stayed longer, but asked to go. The first day out is always tough, but I’m hoping to bounce back soon.

Prednisone Burst

My lung doc finally gave in and subscribed me some prednisone today. I’ve been feeling bad for about a week. The weather is changing, allergies are bad, one of my kids is kind of sick, and they’ve started harvesting corn. It could be just one, several, or all of those reasons why I’m having trouble breathing. Monday my blood-oxygen saturation kept dipping below 90%, and every day this week my PeakFlow numbers have been steadily dropping. While I really dislike systemic steroids and their side-effects, Liz reminded me it could be worse.

The last time I was admitted to the hospital I had been on 80mg of predisone daily. They gave me two, 120mg IV injections of solumedrol, and then admitted me into a room where they showed up every 6 hours for another 120mg of solumedrol. Some of the side-effects include:

  • It made me a little crazy
  • I became temporarily diabetic and required insulin
  • I retained water and gained weight
  • I developed cataracts
  • I lost muscle tone
  • I couldn’t sleep
  • My hands cramped up
  • My cognitive abilities were diminished
  • I got cranky and moody
  • My vision became blurry at times (probably due to the increased blood sugar levels)
  • My face became round and puffy
  • I lost my appetite

I had been on prednisone for most of the previous 2 years leading up to this hospitalization. When you’ve been on prednisone that long, you can’t just quit. You must be tapered off because your body is somewhat dependent on it. I’m not sure exactly when I developed hypothyroidism, but it was sometime after this long period of time on the medicine. If you want to see a long list of known effects, check them out here.

One of my lung doctors has told me multiple times the prednisone would kill me before the asthma if I couldn’t find a better way to treat my asthma. I’m happy to say this is only the second time in the past 6 months I’ve had to resort to this treatment. I’m hoping the short burst will get me back on my feet.

It’s been feeling a lot like August

August is always my worst month of the year. It’s hot and humid, ragweed flourishes, and I tend to get sick. This summer has been the usual with plenty of missed days, CPAP time, and breathing treatments.

My daughter picked up a cold the first or second day back at school and shared it with the family. It’s been awful. I just finished a z-pack and some prednisone, but still aren’t feeling great so my doc had me do bloodwork and chest x-rays to see what’s going on. In the past, I’ve just gotten stronger and stronger anitbiotics until the sickness goes away or I’ve ended up admitted. I appreciate the attempts to make sure it’s a bacterial infection before the unnecessary use of more medicine.

In a couple days I’ll go in for my echo. One of my lung docs wants me to be re-evaluated for pulmonary hypertension. My right ventricle was enlarged on my first echo back in 2010. I’ve had two since then showing things to be normal, which has been attributed to my strict adherence to CPAP therapy. Lately I’m always short of breath, my chest hurts, my blood pressure is often higher than normal, and there are a few other signs that need to be ruled out. I’d really love them to find something, anything. For years it has always felt like there’s something not yet diagnosed. If they found something, I could at least be treated for it and maybe not feel like crap all the time. I’d love to do normal things again.

Weird allergic reaction

I’ve heard people overly complain about a sunburn itching before and thought they were being ridiculous. It’s just a sunburn, how bad could it be?

I got my Xolair injections this week as usual. I’ve never had a reaction before and when my arms started itching, I assumed that light sunburn from the weekend must be peeling.

  • Thirty minutes later Solarcaine seemed to make it worse.
  • Thirty minutes later two Benadryl and ice packs weren’t working
  • An hour later thirty minutes in a cold shower did little to make it better

I called my doctor’s office and spoke to the respiratory therapist who had administered the shots. She thought my symptoms sounded odd and asked for a call back number so she could track down my doctor. By this time the itching had spread from the sunburn area to my entire back, arms, chest, hands, and legs. It felt like I was being bit all over by an army of ants. I say this having been swarmed by an angry ant hill as a kid once. I couldn’t sit still. My arms were shaking. My doctor said he was fairly certain this was not from Xolair and to try some antihistamines.

I take Allegra every day, and had taken two Benadryl 3 hours or so earlier, so I took two more. This took the edge off the itching. I could finally sit still and not twitch. I had never experienced something like this before so I googled insane sunburn itch and discovered other people describing similar situations. The best remedy seemed to be strong ant-histamines. A couple hours later I decided to take two more Benadryl and put my CPAP on so I wouldn’t quite breathing after passing out.

Six freaking Benadryl. I’m pretty sure you’re not supposed to take that much, but that’s what it took to finally make my body stop itching. I passed out for 14 hours or so, my AHI was 6x higher than normal, and I was groggy all the next day, but it seemed to do the trick.

I’ve decided to stop judging people for complaining about itchy sunburn.

Pulmonary Hypertension

I’m a weird case. Doctors have always had trouble trying to figure out exactly why I have trouble breathing. The allergies have always been quite obvious; both asthma and allergies are prevalent in my family. After years of moving around and trying to find doctors who believed me, they also discovered I have:

  • Hiatal Hernia (from a two-year chronic cough a doctor didn’t want to treat)
  • GERD (from the hiatal hernia)
  • Obstructive Sleep Apnea (from my tongue that covers half of my airway, the giant tonsils, and other weirdness in my airway)
  • Vocal Chord Dysfunction
  • Left Hemidiaphragm that doesn’t move
  • Anxiety because not being able to breathe well for 25 years makes you anxious

Last year restrictive lung disease started appearing on my breathing tests. Lately I’ve been short of breath often from walking up stairs, doing normal things like making the bed, and occasionally my oxygen drops into the 80s for a while.

While telling one of my lung docs about my symptoms, it was mentioned I should be assessed for pulmonary hypertension (PH) with a possible cardiac follow-up. So I’ve been reading up on this rare lung disease, and of course most of the symptoms seem to match up with what I’ve been experiencing. The only problem is those same symptoms can match up to a lot of conditions. I don’t want to have PH, but if that’s what ails me, it could be treated.

I’ve been in this situation before where a doctor thinks they may have it figured out. At one point everyone was certain I had allergic bronchopulmonary aspergillosis. I’m very allergic to aspergillus mold, and I had all the symptoms expect the one where you cough up oddly shaped chunks of phlegm. Over the years I’ve been told I might/probably have:

  • a fungal mass in my lungs
  • chronic bronchitis
  • COPD
  • right-heart failure

…to name a few. I’ve even been told I don’t have asthma and was taken off all maintenance medications only to go back on them 6 months later.

Last month my jaw started hurting, I talked to my dentist, and was referred to a TMJ specialist who told me my jaw is causing a lot of my breathing issues by sitting back too far and pinching my airway. I’m willing to look into this, but am not willing to pay the $2500 upfront. I’m currently in negotiations with my insurance company for a pre-certification to cover it.

So in the meantime I will not get my hopes up, I will not let the internet convince me of a diagnosis, and I will wait to hear from my doctors.

Trying to become more healthy

My allergies have been terrible, similar to everyone else around me, but thankfully my breathing hasn’t been extremely bad. I still have my ups and downs, but it’s not constant struggling to breathe like some summers have been. I saw my lung specialist in Pittsburgh last week and mentioned my periodic bouts with low blood-oxygen saturation so I get to do a cardiopulmonary test in November. That is basically riding a bike while they take blood from an artery (Arterial Blood Gas test or ABG) to see how much oxygen and carbon dioxide is in there. This is more accurate than a pulse oximeter which is placed on a finger. Sometimes ABGs make me a little anxious because the first 2 or 3 I had were a bit traumatic. Blood is generally taken from your wrist, and if you get an amateur phlebotomist doing it…your wrist is going to hurt like hell for a month or so. These days respiratory technicians do this type of procedure and tend to do an excellent job…I just always remember those first, bad experiences.

I’ve done a little research on the cardiopulmonary test, and have talked to a respiratory tech friend of mine about it. It’ll be good to have this done because if I have any problems during the test, they can pinpoint the reason whether it be heart, lungs, or I’m just out of shape. Back in 2011 and 2012 there were two times I was told I could be experiencing heart failure, pulmonary hypertension, or pulmonary arterial hypertension. It ended up being a combination of the right side of my heart enlarged a bit, poorly controlled obstructive sleep apnea, and poorly controlled asthma.

So with all this in mind, my short/long-term goal at the moment is to work on my general health.

  1. Sleep regularly – I’m notorious for staying awake for days at a time or sleeping for hours and hours. Usually this involves bad asthma flares and high doses of prednisone. Other times I happen to be awake and need to watch just one more episode of the current show I’ve been binging. I’d probably do a little better if I had a more regular sleep schedule and got up at a regular time in the morning, whether or not I feel ok.
  2. Drink less pop – Caffeine does wonders for me at times with the side effects of not breathing well and some of the medications I’m on. The problem is I don’t like coffee or tea, and pop/soda is full of sugar. Drinking water isn’t a problem for me, I just enjoy a Mt Dew or several when the mood strikes me. In the past few weeks I’ve been switching to diet Mt Dew and Dr Pepper or sticking to water. I don’t think I need to cut it out entirely, but I could do with more moderation in this area.
  3. Exercise more – There have been times in my life where I probably exercised a bit too much coupled with active, manual labor. Nowadays I have a desk job, and sometimes I work at home which means even less walking. I do enjoy riding a stationary bike which allows me to exercise inside, avoiding outdoor allergens. For now I’d like to get back to riding 5 times a week.
  4. Be mindful of what I’m eating – I’m not an advocate of “dieting.” My personal experience, and data from clinical research shows drastic dieting rarely results in long-term results. I need to be able to eat things I like while still making healthy choices. i got a free app on my phone called MyFitnessPal. I can scan bar codes or keyword search for food items, and the app tracks all the calories and nutritional information. You can track your weight, log workouts, set goals, and receive reminders. There are also periodic challenges if that helps motivate you. One feature I find particularly cool is data from Google Fit syncs with this app to add calories burned from exercise to the equation.

So with all of this, hopefully I’ll lose some of the weight I’ve put on in the past 3 years from prednisone, a hypothyroid, and sedentary life style. Anything I can do to improve my cardiovascular health is also a bonus for my breathing issues. After a couple weeks I’ve dropped a few pounds. If I can make this a habit and keep with it, I’m excited to see where I’ll be in six months.

Twitterpated Trees

After receiving my Xolair injections this morning, I popped on over to the office to talk with my boss about projects and said hi to a few co-workers. One was asking me what I do to handle the tree allergies going on right now. “Wellllll,” I said, “I use…”

  • Allegra and Zyrtec
  • Maintenance nasal spray (Fluticasone Propionate)
  • Emergency nasal spray (Azelastine)
  • Eye drops (Pataday)
  • Singulair
  • Sinus rinses
  • And occasionally Benadryl

I also have epi-pens I carry around, but have never had to use them. I actually hadn’t noticed the allergies much until a few days ago. I think it was because I had been inside some much and our in-home babysitter had the doors open. By the end of the day my nose was constantly running, and my eyes were itching. Not too bad in the grand scheme of things.

Sinus Rinsing

Rinsing my sinuses has been a major game-changer for me, but I know it doesn’t work for everyone. I prefer the Neti squeeze bottles over the traditional Neti Pot as I can control the water pressure going through my sinuses. It’s important to use filtered or distilled water. There have been reported cases of people getting nasty stuff in their sinuses from using tainted water. Just be safe.

I’ve also heard stories of people getting or prolonging sinus infections from rinsing their sinuses. This hasn’t been a problem for me, but definitely talk to your doctor if you have questions. I always put my head down in the sink and blow my nose on both sides a few times, tipping my head side to side, to get all the water out. When I first started doing this about 5 years ago, I would have water randomly come out of my sinuses. This method of getting the water out has eliminated the problem.

I buy my sinus rinse supplies in “bulk” off Amazon. I get two bottles and 250 packets at a time.

sinus_rinse

It ends up being much cheaper than running to a pharmacy, especially since most places seem to only carry the bottles pre-filled with saline and a few extra packets. It’s a waste of money if you ask me.

The one other thing I’ve found very valuable is a drying stand, if you’re rinsing your sinuses regularly. This’ll help everything to dry out in between uses.

If you’re looking for OTC eye drops, my friend says Alaway is the brand to try. It can also help to check Pollen.com, or get one of the many apps for your smartphone, so you know what to expect. It’s kind of like checking the weather in a hopefully non-compulsive way. Sometimes just knowing how bad it might be can cause a little anxiety.

Face Masks

Lastly, I sometimes wear a mask outside. I wanted to get one of those skull masks like you see special forces guys wearing in action films, but those things don’t really work with beards.313b4525fbe42e9301e3a4c284ee8f10

I ended up getting a boring, washable, plain black one. It’s thicker than the paper ones you get at the doctor’s office if you have a cough and fever. It can also be a little harder to breathe through, but it stays on my face well and makes a noticeable difference. It’s good for wearing on planes as well.

Just remember to take it off before entering a gas station/convenience store or a bank. They get kind of weird about dudes in masks.

Took a trip and I didn’t get sick

Last week I wasn’t feeling too great because farmers were harvesting the soybeans around my house. The process puts an inordinate amount of dust and particulates into the air effectively making it “hard to breathe.” I hid inside Monday through Wednesday, and Friday Liz and I headed up to Michigan to hang out with friends for the weekend.

As usual, I had more medical stuff packed than non-medical stuff – even with me taking my laptop and a stack of books. We stayed in a big, rental house on Lake Michigan. It was one of those places with a steep driveway, and a steep set of stairs to get to the main floor. Once inside, all the bedrooms were either on the 2nd or 3rd floor. I was miraculously able to carry our stuff up from the car.

While there, Liz and I took a trip down to the beach which basically meant climbing down the hill we “went up” to get to the house, and then climbing back up. Once again I was able to do it without any adverse side effects. While there, my allergies were definitely bothering me and it seemed like the house either had some mold or tons of dust in it. A few puffs on the ol inhaler kept me in tip-top shape.

Today I am sitting in my room watching Back to the Future while typing this. A few hours after arriving back home the effects of all the harvesting kicked back in. I’m hoping I’ll be well enough to go outside again. The wheezing and shortness of breath really wears on you after a while.

No hospital trips this summer

Summer is officially over, and it smells like Fall outside. I made it through with no hospitalizations nor trips to the Emergency Room. This is slightly epic for me as this hasn’t happened for years. I’ve still had a rough time, did some steroids, did 5 courses of steroids, and missed a chunk of work. My doc asked me to take probiotics to help my digestive system recover from all the meds.

I’ve never taken a probiotic before and I’ve always heard how most of them are scammy. I asked my doc what she would recommend and was told to check out Align or Florstor. I was pleased to learn they don’t require refrigeration, and was able to get a generic at CVS.

Overall I feel like I’m doing better and have high hopes for this Fall and coming Winter. I also picked up a digital peak flow meter last week that shows FEV1. I’ve give some thoughts on it soon.

Another methacholine challenge

Methacholine challenges are not fun at all. They usually take about an hour and consist of breathing in methacholine, which causes a reaction in asthmatics, and seeing what happens. After each dose, spirometry is done to see how the patient’s breathing if faring. If your lung function reduces by 20% or more, you’re asthmatic.

I have now done four of these tests. Two of them have been negative, and two have been positive. Last week, my test was definitely positive. I don’t see my doc for a few weeks, but I assume he’ll agree with the results. Since my previous methacholine challenge last fall, I have been off all asthma maintenance meds. I was also off allergy meds for roughly two weeks this time. While asthma isn’t a preferred diagnosis to have, it definitely uncomplicates things.

Since the test I’ve been able to go back on all my meds, and I’ve started using Dulera again. I’m tracking peakflow numbers during this month and I’m guessing they’ll be trending upward. I think I was overmedicated on asthma meds for a very long time with other things going untreated or under-treated. It would be really awesome if my health could stabilize and I not end up in the hospital this summer.