Status Update: Dec. 8, 2013

Something occurred to me today about this tight throat issue.  I had respiratory problems in April, and again in Sept.  Both of those times are the start of two different allergy seasons in Minnesota; pollen in the spring, and ragweed in the fall.  Pet allergies can aggravate those allergies, especially the fall ones, as dust/pet dander buildup is worse during the dry season.  I'm allergic to pollen, ragweed, and dust.  In Tucson I had pollen reactions (just about everyone does) but I haven't really been exposed to ragweed in some years  So in Sept. during some hacking respiratory problems, I saw a physician's assistant in my primary care office who prescribed flonaise (a topical nasal steroid spray), ProAir (Albuterol inhalant) and a daily allergy pill (I've been using Claritin).

Okay, so today I began to wonder if the effect of these things was causing excessive drying of my nasal passages to the point where I feel that tightening of my throat just under my jaw, resulting in occasional twinges up my ears.  I see the next doc (an endocrinologist) on Wed., but between now and then I'm going to stop all three of these things and see what happens.  I was told it could take a couple of weeks for the nasal steroid to kick in, so I'm not sure how fast it will wear off, but I'm going to find out.  I think from an allergy perspective, it's a good time to try this as we've had unusually low temps in the last week (0-10 centigrade and sometimes lower at night).  The pets are the only real issue remaining,  and I'll continue with the nasal irrigation as that's never caused me any problems, and in fact always seemed to help before I started the other things.

The throat symptom, by the way, wasn't present when I first had the allergy symptoms, but has developed since then.  Tonight I reread the pharmaceutical info on the Flonaise and found that a common side-effect is dizzyness and slight headaches - both of which I've had quite a bit of in the last month (which is partially why we were looking at my heart).  But now that that seems not to be an issue, I wonder about the allergy drugs, esp. the steroid, or the steroid in conjunction with the other things.  The paperwork did say allergy reactions were possible but rare, and though they mention swelling in face, lips, tongue, they didn't say throat.  Still close enough for me to test out the theory.

I'll update in a day or two.

Status Update: Dec. 6, 2013 (2 of 2)

I forgot to describe the stress echocardiogram test in my first post, so here it is now:

Stress Echocardiogram:

Test Prep:

They wire you up to a heart monitor, with sticky pads on your chest and under your breasts.  The leads are attached to a unit worn around your waist, and from there fed to the EKG unit to read the data.  They read your blood pressure and oxygen levels and an initial EKG to get a baseline.

Echocardiogram:

They take a images of your heart using the same equipment as used for an ultrasound - gel and 'joystick' to get the image, which they (and you) can see as it's being done.  They find your arteries and get images of them from the side and front, holding your breath, and breathing normally.  This part of the test sets a baseline heart-function at rest.

Stress Test:

This part of the test takes place on the treadmill.  You start walking at a moderate pace, with no incline, then they begin to incline the tread.  While you're walking they're recording your EKG readings.  They also take your blood pressure reading while you're walking.  During this first phase, they ask how you'd define your shortness of breath - minor, moderate, severe, etc.  My heart-rate went up like it usually does when I'm doing weight-bearing cardio, and after 5 minutes of increasing incline to the treadmill my answer was 'moderate'.  I think the duration of this phase of the test is mapped against either the patient's heart-rate (an absolute number or a % above the baseline) or to the moderate degree of shortness of breath.  Unfortunately I didn't ask so I can't supply that here.  I'll ask later and put in an update though.  Whatever the point of measure is, they continue to increase the treadmill incline until this state is reached.

The last phase of the test, once the first level is reached, is to increase the speed of the treadmill to a rapid pace, but below jogging.  You only have to do this for 30 seconds, and I managed it, but I identified my shortness of breath as severe during this time.

Echocardiogram:

As soon as the 30 seconds are up during the last phase of the stress test, you immediately lay on your side and they quickly repeat the echocardiogram, this time to get heart functions under stress.

They continue to run the EKG until your heart-rate returns to the baseline level.  Mine took about 12 minutes.  The doctor reviewed the test results, then discussed them with me.  As I said in the first post, he said my heart looks great, even though I got up to a high rate and experienced shortness of breath relatively quickly.

In short, the stress test is pretty easy to do, and doesn't really take very long.  You could spend up to an hour or even an hour and a half on the test protocol, but most of that time will either be prep (relatively short) or waiting for return to baseline state and then the doctor's review.  Mine was scheduled for 9:15 am, they got me in on time, and I was done my 10:15, so my full test time was 1 hour, with about 12-15 of that on the actual test.

Here's my PAG (Pain Assessment Grid) for this test:

Test X – 12/6/13	Type	Rating	Duration
Preparation (sticky pads)	NA	0 (no pain)	1 min.
Echocardiogram (at rest and after stress test)	NA	0	3 min. x 2
Stress Test (phase I)	Shortness of Breath	6*	5 min.
Stress Test (phase II)	Shortness of Breath	9*	30 sec.

* Note that usually the rating represents the amount of pain experienced, but in this case, there is primarily a rating on degree of shortness of breath, with 0 = none, and 10 = Extreme.  Shortness of breath on the extreme end is distressing, but I don't categorize it as pain.  That may of course be different for others.  Of course if you have a heart condition, I suppose it's possible that the response you have during this test might include other symptoms than simply shortness of breath.  They also ask if you're feeling suddenly weak overall, or in your legs.  I suppose this would not be unexpected if you were having blood flow issues, especially to your extremities, during the stress portion of the test.

Okay, more later.

Status Update: Dec. 6, 2013

Medical stuff on-going, but a few things done:

So while trying to figure out my primary symptoms (high heart-rate on standing vs sitting, pressure on my neck/throat at times), my doc has set up several different tests and studies.  Some were covered before, but there have been two more since:

1. 24 hour Holter Monitor - done
2. Stress test/Echocardiogram - done

I haven't seen the results from the Holter monitor (which monitors heart function continuously - in this case for 24 hours), but I'm going to assume they're going to come back fine because I passed the stress test with flying colors.  The cardiologist said my heart looks beautiful.

See, it is what's inside that counts!

He said that hearts speed up under standing vs sitting conditions and that mine did to a greater extent than what was average (it got up to 166 during the test) but that it looked fine.  I do have to continue doing what I have been, which is choosing my work-out routine so that I don't let my heart-rate get too high (out of the fat-burning zone and into the anaerobic zone), which means slow pace/resistance and longer duration than for most people.

Which still leaves the question of the tightness on my throat.  It doesn't happen all the time.  Some days it hardly ever appears.  On the days it does, it's usually at its worst in the evening.  It's relieved when reclining or laying down.  Now that my heart doesn't appear to be an issue, I'm back to thinking it might be related to my lungs.  I suppose we'll be looking more closely at asthma, emphysema, and chronic bronchitis.  I'm not a smoker, and never have been, but if I do have a problem in this area it could either be genetic, or a side-effect of the transplant (chemo drugs can damage the delicate tissues of your lungs and bronchial passages).

The last issue to come up is from my most recent lab-work compared to the last two since April.  My creatinine numbers (kidney function) have never really fallen back into the normal range (but once) post-transplant, and the number for the last three tests have incrementally increased.  So I'm sure my doc will be looking at this.  Who knows, maybe it's causing the throat tightness.

That's it for now.  More coming when it's in.

Writing news: I finished the most recent drafts of books 1 and 2 of my 4-book series, and both are in now to a professional editor for analysis.  I may end up doing one more draft on each based on their feedback, but I think I'm going to be able to say they're DONE very soon now.  I'm about to start book 3 but am just finishing up a bit more plot detail in the outlines.  Writing is a great way to spend the winter in Minnesota!

Status Update: Nov. 30, 2013

Hiya everyone!  And for those in the US who celebrate it, Happy Thanksgiving!

I've was looking at some of the entries from this last spring, and was reminded that I experienced respiratory problems, dizziness, shortness of breath, and throat swelling then, too.  Ultimately it went away and the assumption was that those symptoms were caused by a drug allergy, and I stopped taking that particular new drug.

However now that I've had another bout of the same symptoms I have to question whether it was an actual drug allergy at all.  Of course the symptoms could be related to environmental allergies (pollen in the spring and ragweed in the fall, augmented by the fact that I have two cats), but we just don't know.  As you saw in my last post, I'm currently working with my doc to figure it out.

I posted some blood pressure data I was collected but I'm not going to post all of it because I collected 150 data points!  The purpose of it was to see if my home bp unit correlated to the doctor's reading of my bp, and to see if there were specific times (of day, sitting or standing, etc.) when the symptoms were worse, and when it might be reflected in my bp and/or heart-rate.  Here's a non-numbers summary of my at-home readings:

1. My blood pressure sitting* is on the low end of the good range (106/68 on average).
2. My blood pressure standing** is about 15 points higher than sitting, but still perfectly fine (119/83).
3. My heart-rate when sitting is fine (83).
4. My heart-rate on standing is very high (129 on average, with some numbers up to 145).

*Sitting usually means with my feet elevated in a reclining chair.
** Standing usually means after a short period (5-10 minutes) of easy activity.

And here were the other tests run to figure out why this accelerated heart-rate on standing:

1. EKG - Normal
2. Chest X-Ray - Normal
3. Overnight Oxygen Study - No signs of sleep apnea
4. Pulmonary Diagnostic - excellent result (those 4 months of swimming 1 kilometer 3x per week has paid off in increased lung power).
5. Thyroid evaluation (scheduled for 12/11/2013)

I saw my doc to review the data to date, and his next focus is on my - eek! - heart.  I'm going to wear a monitor for two days that will be like running a continuous EKG to see if there are random or specific times when my heart goes to a tachyia rhythm (accelerates out of the blue).

The doc can listen to your heart in the office, and take an EKG, but these are just snap-shots in time, and don't give a pattern of occurrence.  Of course since I seem to have had episodes like this in the past that were there for a while, then gone, there's no assurance it will show up in the two-day test.  If nothing shows up, they'll have to do a more detailed evaluation with a heart specialist in order to either pin down the cause, or at least to eliminate it from the list.

It's so ironic that as time passes post-transplant I've undergone periods of euphoria (always following the all-clear on a recent PET scan) to periods of anxiety (any time symptoms of any sort appears and my imagination runs wild).  Now I get to add things besides cancer to the anxiety list!  Oh well, I guess that's just life.  Still, it's so irritating!

Okay, so I'll pick up the monitor early this week, wear it for two days, then turn it in so the data can be downloaded and sent to my doc.  On the 11th I'll see the endocrinologist so he can evaluate my thyroid to see if it's playing a part (the recent blood work indicates it's not, but he'll do a lot more stuff, no doubt).  My recent blood-work all looks pretty good, as a matter of fact, but there are some things that blood-work doesn't catch, and my doctor isn't going to ignore a racing heart.  I remember that early on, before my Lymphoma was diagnosed I had episodes of tachycardia, and that they were finally correlated to a hyperthyroid (fast) condition, which ultimately converted to a hypothyroid condition (slow).  I now take medicine to speed up my thyroid, but so far my numbers are in the acceptable range.  We'll see if that pans out over a more exhaustive test.

I don't have a fitness update for the month, since I avoided exercise during this time.  I had a doctor's appt. the day after Thanksgiving and my weight was up 3 lbs!  However it was 3 lbs. lower a week before, so hopefully that's just a Thanksgiving eating marathon swing that will disappear over the next week or so.  Luckily my doc has told me that I can start up my exercise routine again, but only in a moderate way, and to stop if I start feelings the effects of a racing heart.  Swimming is probably perfect, but I think I'll stick to my recumbent bike for the moment, and avoid going out in the cold for the time-being, till the other tests are done.

Oh yeah, my monthly INR (for blood thinner protocol) was perfect, at 2.5, so no changes there.

Okay, another update to follow soon!

Status Update: Nov. 19, 2013

From my 11/14 list of things to do before my follow up visit with my primary care doc:

1. EKG - done (looks normal)
2. Chest X-Ray - done (looks normal, but results not finalized yet)
3. Overnight oxygen readings - done (data will be transferred to my doc when I return the device)
4. Blood Pressure and Heart Rate readings - on-going (see data below).
5. Pulmonary Diagnostic - Scheduled for Thursday, Nov. 21
6. Calibration of my home/wrist BP unit - when I meet with my doc on 11/29
7. Endocrinologist appt - Dec. 11, 2013

I've been taking multiple blood pressure and heart rate readings each day for the past week, and will continue to do that until I meet with my doc on 11/29.

A 'good' BP reading is 120/80 (systolic/diastolic) and on my home device I'm commonly getting 97+/-10 systolic, and 65+/-5 diastolic now.  If my home/wrist unit is reading accurate or high, this is definitely a problem, since my readings are 20 points lower than average.

Either my home/wrist unit is really reading wrong, or my BP is too low.  In order to compare to someone else, I've had my mom read hers on my unit a couple times a day.  She has chronic low blood pressure, but her readings are higher than normal on this unit (higher than at the docs), and yet also higher than mine.  This indicates to me that a) my device isn't accurate (it's reading high), and b) my BP may actually be lower than the reading shows, which is definitely a problem.

Another big problem is that my resting heart rate is fine (80-90) but my standing heart rate is high (125-145).  This would explain why I'm getting dizzy and short of breath upon standing/walking, etc.  The other symptom I'm commonly experiencing is a tightness in my throat, from under my chin, through the curve of my throat.

I'm hoping that a change to my current BP med (either in type or dose) will address all of these problems.

I'll update again within a couple of days as more data is collected - most likely after the Pulmonary diagnostic so that I can tell you about that test during this cycle.

Here's my blood pressure and heart-rate data collected so far:

Notes:	1. Several readings are those of my mother to use in comparing/contrasting to my own, and the
	calibration of the home/wrist unit.  My mother has low blood pressure problems, and has had
	several medical incidences that required urgent care, the emergency room, and hospital.
	2. Standing = after activity, Sitting = usually with my feet up in a reclining chair.
	Time	BP	HR	Comments
11/13/2013	10:00	125/85D	105	Standing
	12:00	110/70	75	Sitting
	17:15	111/66	71	Sitting
	17:30	107/72	78	Sitting
Mom:	17:30	125/80	95	she's typically 110/60-70 (w/low bp problems)
	18:30	125/78	83	Sitting
	20:00	135/77	134	Standing
11/14/2013	8:00	?	high	Note: Waking up, I could feel my heart beating pretty fast.
	8:25	104/84	120	Standing	Morning chores
	9:30	127/82	76	After coffee
Mom:	9:45	110/83	93	After climbing stairs
	12:56	134/79	78	Standing
	16:50	99/79	80	Arm/wrist sl. Lower than heart
	16:50	127/68	78	Arm/wrist raised to heart level
	16:50	129/66	75	Arm/wrist raised to heart level
Mom:	18:30	126/82	105	Much higher than her norm
	20:50	109/69	80	Sitting
Note:	Generally sitting for me is in a reclining chair with my feet elevated.
Note:	If it's reading high on mom's then it's prob. Reading high on mine.
	Mom typically has low bp, and was in ER once because hers tends to lower when she's active,
	when she's standing, etc.  She's typically 100/60, HR=82-83 at the docs.
11/15/2013	8:30	124/72	77	Standing	but took test sitting (after morning chores)
	9:50	101/69	77	Sitting
Mom:	9:50	106/76	105	Sitting
Mom:	11:00	97/66	90	Sitting
	11:00	114/70	82	Sitting
	19:30	104/62	82	Sitting	Usually take my bp med in the AM, but forgot till 17:30
	21:30	106/69	80	Sitting
Note:	The tightness in my throat/neck usually gets worse toward evening.
Question:	Is Pulmonary Hypertension a possibility?  My symptoms and readings are in line with it,
	including the hyper-sensitive/sore/bruised-feeling legs.
11/16/2013	9:50	108/81	145	Standing	Morning chores, took Flonaise & ProAir after reading.
	10:00	103/62	73	Sitting	10 minutes rest time from last, standing reading.
Mom:	10:10	99/71	110	Standing
	12:15	110/71	91	Sitting
	16:45	129/76	96	Standing	Tightening of the throat appearing late in the afternoon
	18:45				Used Flonaise - tightness in throat reduced.
	18:55	103/67	86	Sitting	After Flonaise
	20:15	109/70	82	Sitting
	21:40	136/76	92	Standing
11/17/2013	8:50	125/94	137	Standing	Morning chores
	9:00	107/71	78	Sitting	Used Flonaise and ProAir after reading
	9:15	97/75	80	Sitting	15 minutes after Flonaise and ProAir
	9:50	98/73	79	Sitting	Finished first hour cycle
Mom:	10:00	107/58	70	Standing	(sat to do reading)
	13:15	99/60	82	Sitting
Mom:	14:15	100/78	104	Sitting
	14:50	130/87	133	Standing	Slight tightening throat, slight headache.
	17:00	99/69	83	Sitting	Symptoms of 14:50 dissipating now.
	18:00	108/69	85	Sitting	Took daily Warfarin (5 ml.)
	20:00	101/66	86	Sitting	Took evening Flonaise and ProAir after reading.
	20:15	111/65	87	Sitting
	21:00	102/71	89	Sitting
	23:20	102/68	83	Sitting
11/18/2013	1:00	107/68	81	Sitting	Throat feeling tighter, slight headache.
	9:40	131/86	133	Standing	Morning chores
	9:50	107/69	80	Sitting	Used Flonaise and ProAir after reading
	10:10	97/69	88	Sitting	20 minutes after Flonaise and ProAir
	10:40	103/70	87	Sitting	Finished first hour cycle
	11:05	130/81	132	Standing	Post-shower and dressing
Mom:	11:05	100/66	96	Sitting
	11:25	106/70	96	Sitting	Left to run errands, grocery shop, etc. after.
	13:10	Errorx10	V. Fast	Standing	Couldn't get a reading - too high/low for home unit?
	13:20	101/70	109	Sitting	Finally able to get a reading after sitting for 5-10 min.
	14:00	97/66	93	Sitting	Used ProAir after reading
	14:05	98/65	90	Sitting	5 minutes after ProAir
	16:00	108/62	86	Sitting	~20 minutes after eating.
	18:00	107/75	91	Sitting
Mom:	19:50	107/80	95	Sitting	from standing
	20:20	105/70	92	Sitting	Used Flonaise and ProAir after reading
	20:30	98/62	90	Sitting	10 minutes after Flonaise and ProAir
11/18/2013	8:30	113/80	123	Standing	Morning chores (out of Claritin)
	8:50	97/65	83	Sitting	Used Flonaise and ProAir after reading
	9:05	98/61	83	Sitting	15 minutes after Flonaise and ProAir
	9:30	87/67	78	Sitting	Finished first hour cycle
	10:10	101/71	84	Sitting
	11:40	97/61	91	Sitting	Tightness under chin/curve of throat
	14:10	98/67	80	Sitting	~20 minutes after eating, used ProAir after reading.
	14:50	99/66	87	Sitting	Still tight under chin/throat.

Status Update: Nov. 14, 2013

Health Update

I've continued to have some respiratory problems - tightness of my throat, shortness of breath, dizziness upon standing, so I called my oncologist.  She wanted me to see my primary care physician, with an eye toward having my thyroid re-evaluated.  During that meeting we reviewed my symptoms, and though he had a good/low bp, he noted my heart rate was fast.  I told him that was happening when I was active but not sitting, which was, along with the respiratory issues, why I'd curtailed exercising.

The area he immediately keyed in on was my blood pressure.  He thinks it's possible my bp medication is over-dosed.  Apparently a lowish (even good/normal low) combined with fast heart rate can point to this.  So here's the course of action:

1. I have a home bp wrist unit.  I've been taking multiple readings over the last two days and will continue this for the next two weeks, taking readings both at rest (sitting) and active/standing, noting the bp, heart rate, date, time, condition, etc.  At the end of two weeks he'll review this data and correlate my home unit to his office one.
2. He had an EKG done in the office (I don't know the results of that yet, but since it was yesterday I assume it wasn't bad, otherwise I'd have a call asking me to come back in.
3. He sent me for a chest x-ray, which I also did yesterday.  I don't have the results of this yet either.
4. I'm going to pick up an oxygen unit at a medical sleep center on Monday.  It will be programmed to read my oxygen levels throughout the day and night for 24 hours.  I'll return in on Tuesday, and they will immediately download the data and send it to my doc.
5. They're going to set up an appt. for me to have a pulmonary diagnostic test (more on this below).
6. I'll be getting a referral to an endocrinologist to follow up with the thyroid issue.

Pulmonary Diagnostic

I've had the pulmonary diagnostic test both pre-transplant and post-transplant, and describe the test in those sections (see the pages listed to the right side of the home page if you'd like to review the test in detail).

In short, you sit in a both and seal your mouth around a tube that measures your pulmonary abilities while you breath out under controlled conditions.  They use several patterns you have to replicate as seen on a screen inside the booth.  The very first time I did this test they took an arterial blood sample.  Most everyone has experienced blood draws for lab work, but this is typically venal blood - from a vein.  Taking blood from an artery is not fun.  They generally do it at your wrist, and they have to deep and often probe a bit to get in.  The needle is large, and there are a lot of nerves in that area.  It was one of my least pleasant tests, but luckily I only had to do it once.  I hope they won't need that piece again, since they have my baseline and some follow-up tests for comparison.

At any rate, my post-transplant tests were all lower than the baseline, which was expected early on, since pulminary function would decrease with a new immune system, and hopefully stabilize as the immune system grows and health is regained.  There is a general expectation that it will come back near to the baseline level eventually.  We'll see if it's near the baseline this time.

Endocrinologist

I detailed my thyroid history early on in the early pages where I discussed my history prior to and during diagnosis.  For the 8 months I was feeling progressively more and more sick, prior to diagnosis, my thyroid was working in overdrive.  During a 4 month time period I lost over 70 pounds, averaging 3-4 pounds a week.  If you ever experience this degree of weight loss, you will know it is not normal!  This is, at least in part, why I've been happy with a slow but steady weight loss.  As much as I want to lose weight, I never want to lose weight at that rate again.  As long as my progress is reasonable, and matched to my own efforts, I can fairly comfortably conclude that the weight loss is a healthy one, and not indicative of disease.

At any rate, they diagnosed my hyperthyroidism at the same time as they diagnosed the lymphoma - both on the heels of the pulminary embolism diagnosis.  I immediately started chemo, and medication to treat my fast thyroid.  However it turns out that the 8 months of the progressively worsening hyper-condition meant that my thyroid was stressed and beginning to burn out.  It slowed, and then moved into the hypo condition, resulting in an even bigger weight gain than the proceeding weight loss before they had the treatment set and stabilized.  I've been under the hypothyroid protocol ever since then, to artificially speed up my thyroid.  I've been on this medication ever since that time.

My doc drew blood yesterday, and had the three thyroid tests run: TSH, T3, T4.  The first two were in range, but the T4 was out of range high.  I think the range is something like 7-12.5, and I was at 14.5.  I haven't heard from him on this, whether it's significant or not, in light of the other two in-range readings, but I'm sure it's something we'll discuss, or at least I will with an endocrinologist specialist.

Blood Pressure/Heart Rate Readings

When I quote this data in my fitness updates, it's generally from my home/wrist unit.  Generally these devices aren't really accurate, but I use it primarily to keep track of trends, since I assume that it may be consistent, even if it's not accurate (consistently low or consistently high, but showing a real trend-line for any changes).  We're now going to find out how accurate it is, and therefore where my blood pressure really is.

Generally my readings have been low during the dozen or so readings taken in the last two days (low good).  However I definitely had a low heart rate when sitting, and a high one upon standing.  I also measured my mothers bp several times for comparison.   She's very small, and has had low bp all her life, and in fact sometimes has the problems associated with low bp.  Her readings were higher than mine.  This may indicate my unit is not only not reading accurately, but is reading high.  If my measurements are actually higher than my real bp, my doc may be right, and my actual bp is too low.  Once we figure this out he can adjust my medication downward.  It's lucky for me there is an easy fix - if this is the problem.  I'm hoping it is, as reduced medication AND a problem solved are two very good things!

So for now, no exercise, but continue doing the above.  My next INR reading (blood thinner level) is scheduled for Nov. 27th, and on that date I think I'll be meeting with my Primary care physician again to review all the data.  He should have it all with the exception of (possibly) the pulminary diagnostic.  I'm quite sure I also will not have met with an endocrinologist yet, as those specialists usually have quite full schedules and new patients are often out a ways.  We'll see.  Here is my blood pressure and heart-rate data so far, from my home/wrist unit:

My readings

125/85  105 (doc's office, after walking the corridors)
110/70  75 (home - sitting)
111/66  71 (home - sitting)
107/72  78 (home - sitting)
125/78  83 (home - sitting)
135/77  134 (home - standing)
104/84  105 (home - standing)
127/82  76 (home - sitting)
134/79  80 (home - standing)
99/79  80 (home - sitting)
127/68  78 (home - sitting)
109/69  80 (home - sitting)

My mom's readings (for comparison):

125/80  95
110/83  93
126/82  105

In the doc's office, my mom's bp is generally 110/65 (sometimes lower), so on average the home readings have been high for her.  With a few exceptions, my readings are lower than hers, and definitely show a big difference in heart-rate between sitting and standing.  I can't wait to resolve this, as a fast heart-rate is distressing and exhausting.  Luckily I've been busy writing, which is a sitting activity.

Can't wait to resolve this issue!  I should have another entry before the month is out.

Status Update: Nov. 1, 2013 (2 of 2 - Viewers by Country)

Willkommen, Bienvenue, Welcome!

Here is my monthly update for country viewers.  The latest addition is Georgia - welcome, Georgia!  The continent missing is still South America!

1. USA
2. Germany
3. Russia
4. United Kingdom
5. Canada
6. Romania
7. India
8. Ukraine
9. Sweden
10. France
11. United Arab Emirates
12. China
13. Netherlands
14. Ireland
15. Poland
16. Australia
17. Israel
18. Turkey
19. Serbia
20. Japan
21. Malaysia
22. Indonesia
23. Georgia

Ciao for now!

Status Update: October - December, 2013

1. Nov. 1, 2013
2. Nov. 1, 2013 (2 of 2) - Welcome Georgia!
3. Nov. 14, 2013
4. Nov. 19, 2013
5. Nov. 30, 2013
6. Dec. 6, 2013
7. Dec. 6, 2013 (2 of 2)
8. Dec. 8, 2013

Status Update: Nov. 1, 2013

Another bad month for exercise, with almost the exact same profile as October, but I still lost a couple of pounds, so not a complete loss:

Fitness Summary for Sept, 2013

Exercise days: 5 days out of 30 (an average of 1.2 days/week)
Lap Swimming: 3 days (10 laps/60 minutes = 1000 meters/60 minutes, pace = 6.00*)
Land based/Bike: 2 days (8 miles/50 minutes)
Water/Land ratio: 60/40
October Weight Loss: 2 lbs.
Total Weight Loss: 15 lbs.
Avg. Blood Pressure: I forgot to measure my bp in October!  Nov. 1: 115/73
Resting Pulse-Rate: Nov. 1: 72
INR: 2.4 (range on blood-thinners is 2.0-3.0)
Glucose: 93 (<100 is target)

I had my monthly INR reading yesterday, and asked them to run a glucose test as well.  I did this because a month ago my oncologist did some labwork, and my glucose was a bit on the high side (113).  It never has been before (it's always been in the 90's) and there's a strong presence of diabetes in my family tree, so I asked for a retest this month to keep on top of things.  I fasted for this one (as you should) but hadn't for the one before, since it wasn't planned.  Luckily my reading came in at where it's always been, a very safe 93.  And even though I completely forgot to measure my blood pressure and heart-rate in Oct. the test taken today looks very good (see above).

October started with some of the respiratory issues hanging on from September, but they mostly cleared up as the month went on, so I can't blame them for most of the lack of exercise.  The real reason is that I had a very prolific month writing, and was very distracted from almost everything else.  I'm going to update that part later in this post.  Things I'm still doing for the respiratory/allergy problems:

1. Taking a 24-hour non-decongestant allergy tablet (1x daily)
2. Nasal irrigation daily (reduced from 2x to 1x daily, but 2x is always better)
3. Topical steroid nasal spray (reduced from 2x to 1x daily)
4. Albuterol inhaler (reduced from 4x to 2x daily)

The ragweed allergy season should end sometime this month, and then I'll try to go without the allergy tablet.  The problems could persist since I have cats, and the dry winter season is a problem for dust and pet allergies - we'll see what happens.

Writing Update:

Many of you know that I'm writing a children's series.  The series will span 4 years of time, with the primary characters starting out at the top end of the Middle Grade level (ages 11-12), and ending with them solidly in the Young Adult level (ages 15-16).  Because of this progression, I'm identifying it as a MG/YA/Cross-over.  This means I'm hoping the story will draw in a wide-span of readers, ranging ranging from high middle grade through young adult, with some incursion into the adult readers (due to the history/mystery elements of the story).

Books 1 and 2 are finished, however I spent the last few weeks working on what I hope is the last draft of both.  That draft is finished on book 1, and should be finished on book 2 in about 3 days.  Here's the interesting part: The last draft of book 2 should be the third draft, but the last draft of book 1 is the 17th!  Here's why:

I got the idea for the series when I first became sick, and the first draft of book 1 was written when I was experiencing some extreme brain-fuzz symptoms from chemo.  Additionally and to be honest, I had some bad writing habits that needed to be fixed.  Over the course of the 3-4 years that followed I did many drafts trying to address the many issues I thought the first draft had.  Here are some of the major changes made:

1. Reduced the core group of young characters from 8 to 6 to 5 (took 3 drafts).
2. Reduced the expository/descriptive scenes, cutting the word count by 40k (3 drafts).
3. Revised the writing to make it a more active (as opposed to passive) 3rd person voice.
4. Revised the writing to include more action scenes and dialogue (several drafts).
5. Revised the scenes where I'd deviated from the main character's POV (point of view).
6. Revised the plot structure to match a 3-act drama structure, including new elements.
7. Switched from US std. units to metric (with some caveats).
8. A whole bunch of other misc. stuff.

In short, although the basic plot remains pretty much the same, the draft 1 manuscript doesn't look anything at all like the draft 17 manuscript!  The story, down to all dramatic details, has been completely and drastically rewritten.

A better way of delineating the different drafts would have resulted in a smaller number, but I often counted editing and polishing drafts separately, when I should have included them in the revision and rewrite drafts.  Here's what a draft should constitute, in my opinion:

1. Original or revised (in some significant way) material.
2. Editing.
3. Polishing.

I suppose if I had counted the drafts this way from the start, I would have ended up with a number closer to 10-12.  That's still a lot of drafts for one work, though!

Here's an interesting tidbit: The average published author writes 4 books before they get published.  This means that a writer who is good enough to get published, usually has to write 3 or so weak novels before they refine their craft to be publishable.  Since 2-4 drafts is not unusual in a well-written novel, this means they've probably gone through somewhere between 8 and 16 drafts on the 4 books in total.  Those are learning curves.  If they weren't, the author likely wouldn't get that 4th novel published.

Strangely enough this puts me right in the average profile, except that I wrote '10-12' drafts on the same single story, rather than 2-4 drafts on 4 different stories.  I made a conscious decision to do that for 2 reasons:

1. I had already done a lot of world building, setting up the back-history of the series, and the details of each of the 4 books, as well as two related series (a prequel and a sequel - in fact I already have 1/3rd of book 1 of the prequel written).
2. I was fairly sure what my weaknesses were and wanted to eliminate them one-by-one, and see the results in one story, where the differences would stand out more clearly with each subsequent manuscript.

These last drafts for books 1 and 2 took into account feedback from 4 entities:

1. A professional editor.
2. One of my critique group members (he reviewed both full manuscripts).
3. My primary care physician (a big Harry Potter fan - he reviewed both full manuscripts).
4. My own notes.

Here's something interesting.  After spending much of the first 16 drafts taking material out, in the last draft I'm actually increasing the word count a little.  I knew I had far too much descriptive and expository narrative initially, and that it made my story-telling too passive, so the early draft objectives were largely focused on reducing this.  I think I did it so well, that I pared the book down a bit further than it should ideally be, based on a few of the insights from those above.  The material added back in clarifies and illuminates, but keeps the pace moving quickly.  I think I finally found the right medium!

Anyway, with 2 books essentially done, I'm now preparing to write the first draft of book 3.  My 3-act, detailed chapter outline is done, but I'm going to do one more rework of that to make sure I have everything there for continuity with the first 2 books, as well as for continuity for the final book that follows.  Each book has a puzzle and mystery to be solved, and in that way each book stands alone, but each of the puzzles are put together at the end, for the over-arching plot of the series.

I was hoping to get the final drafts of books 1 and 2 done, along with the final research and outline for book 3, so that I could start writing book 3 as a NaNoWriMo project.  For those of you unfamiliar with this, NaNoWriMo stands for National Novel Writing Month, and takes place every November.  It's a project for jump-starting novels, especially for authors who have a hard time gaining momentum and keeping it going on their work.  I've never taken part in it, but I would have, in an unofficial way at least, had I been ready.  I still have a few days of final draft work to do, however, as well as perhaps 1-2 weeks of additional research and outline work on book 3, which means I won't be writing the first draft of book 3 in Nov. unfortunately.  I hope to do this in December, though, if all goes well, so I suppose I can consider this December my very own NaNoWriMo project.

Here's one of the things I learned during the 17 drafts I did on book 1 that has been hugely helpful to me; Doing a detailed, chapter-by-chapter outline, based on the 3-act dramatic structure, has allowed me to do the first draft very quickly.  In fact once I finally had an outline system down that worked for me (during one of my book 1 drafts), I was able to complete a chapter a day on the first draft of book 2.  Not only did I complete the full first draft manuscript in just under 1 month (it has 29 chapters), it was in excellent shape for a first draft.  So far feedback on it has been very good - most think it's better and tighter than book 1, which is why I'm fairly certain the 3rd draft I'm currently on will be my last.  So it's unfortunate that I couldn't make the November NaNoWriMo deadline, as I think I could have finished the first draft of book 3 in that month.

Oh well, November or December - not much of a difference.  The important part is getting it right, and as book 4 (the final book) will be more complex than the others, as multiple threads come together for the over-arching conclusion, it's important that everything is correctly staged in books 1, 2, and 3.  In other words, it's more important to do it right, than do it fast.

Okay, that's my update for today.  I'll be back with more health, fitness and writing status updates throughout the month!

Status Update: Sept. 30, 2013

This month was an exercise waste-land for me due to respiratory problems, but I still lost a couple of pounds, so not a complete loss:

Fitness Summary for Sept, 2013

Exercise days: 5 days out of 30 (an average of 1.2 days/week - all on the front end of the month)
Lap Swimming: 3 days (10 laps/60 minutes = 1000 meters/60 minutes, pace = 6.00*)
Land based/Bike: 2 days (8 miles/50 minutes)
Water/Land ratio: 60/40
September Weight Loss: 2 lbs.
Total Weight Loss: 13 lbs.
Avg. Blood Pressure: 115/75 (very good!)
Resting Pulse-Rate: ~70 (which is very good for me)

* I finally had to stop swimming, as it really stressed my already stressed respiratory system - I had to stop at the end of each lane to hack and cough, and sometimes I'd start to freak out in the middle of a lap because the urge to cough again was so overwhelming (you can't do that while immersion breathing!).

The good news is twofold: I lost 2 pounds (probably because my appetite is down a bit from the health issues) and the treatment prescribed seems to be working and my respiratory issues are getting under control.  The bronchitis is almost gone, and so is the cough.  I'm pretty sure allergies (ragweed and dust) are the culprits.  Today I'll be dusting and vacuuming like crazy to get the dust and pet dander out of the air, to see if it helps calm down the allergy symptoms further.  I'll be re-starting my exercise program fresh tomorrow - fingers crossed that October goes well.  Oh, and I'll definitely be making nasal irrigation a daily protocol, regardless of allergy season, because it really seems to have a huge impact.

I was hoping to start a walking program using my Nordic Poles in Sept., but given the outdoor allergy conditions I had to push that back.  Maybe this will be the month.  If so, it will be a topic I cover in one of this month's entries.

Status Update: Sept. 20, 2013 (2 of 2: Nasal Irrigation)

Okay, as promised here is a more detailed piece on nasal irrigation.  I discussed this long ago in my blog, but considering that cold and flu season is approaching, and since allergies are on the rise around the world, I figured the topic was worth a re-visit.

Nasal irrigation is essentially rinsing your nasal passages and sinuses clear of mucus.  The human body can make a lot of mucus in one day - I think I read it can be up to a liter!  This mucus can do a number of things that can cause sinusitis and other respiratory problems.  Here are a few:

1. Impact sinus to cause headaches and inflammation.
2. Hold pollen and other allergy particles in the very place where they will be most able to irritate.
3. Result in post-nasal drip down your throat to cause a persistent and chronic cough.

People who have constant sinus issues often suffer with them throughout their lives, and the effects multiply as the years pass.  The treatment for these issues is sort of white or black - with surgery at the extreme end, and not much else on the spectrum.  Nasal irrigation is a simple hygiene technique that can keep these problems at bay.  It is highly recommended by credible sources, such as the Mayo Clinic.  They even have a video on their website that shows a parent how to teach a child as young as 2 this technique - that's how valuable they consider it.

Nasal irrigation is done by pouring a saline solution into one nostril and allowing it to course through the sinus cavities and out the other nostril.  The saline solution should be tepid/room temp. and can be administered by gravity (neti pot) or a under pressure (a squeeze bottle).  It's really, really simple to do, and if you suffer from allergies or sinusitis I highly recommend it - you'll feel 500% better once you start doing it.  Apparently this is a very common hygiene technique practiced across India, and has saved all kinds of medical expenses for a population that largely cannot afford medical treatments.

The equipment needed:

Neti pot or nasal squeeze bottle (usually has an angled tip)
Filtered or distilled water
Salt (non-iodized)
Baking soda (optional)

Saline Solution:

1 Quart drinking water (if it's not good for drinking, don't use it)
1 - 2 teaspoons non-iodized salt
1/4 - 1/2 teaspoon baking soda (optional)

I make a quart of saline solution at a time, and pour it off into an 8 oz. squeeze bottle twice a day.  Sometimes I do 16 oz. during each session, if my allergies are particularly bothersome.

The salt of course makes the water a saline solution.  The salt ions will grab onto the mucus and flush it out of your nasal passages.  The baking soda is only necessary if the salt solution alone is a little too harsh on your nasal passages (it moderates the pH slightly).  If you have this problem, either keep your salt level on the low side (1 t. per quart of water) or add a small amount of the baking soda (or both).  I only use salt in my saline solution.

You can also buy prepackaged salt/soda, which is pretty convenient, but really an unnecessary expense.  If you buy the packages, read them to make sure you add the correct amount.  I believe most are made for an 8 or 16 oz. water portion.

If you make the solution as you use it, start with tepid or warm water if able.  If you prepare a larger amount ahead of time, let the squeeze bottle rest in a warm water bath for a few minutes to take off any chill - otherwise it may be irritating to your nasal passages.

Technique:

Note: I'll include three very short videos below so you can see how simple this process really is.

1. Prepare your tepid/warm saline solution and/or pour off your prepared solution into the neti pot or squeeze bottle.
2. Tilt your head to the right, over the sink, and insert the spout in your left nostril, making sure your nostril is sealed around the spout.  Pour or squeeze half of the solution out.
3. Breathe through your mouth, or simply say 'ahh' to close off your throat to the water.
4. Water should immediately come out of your right nostril.  Use half your solution, then lightly blow your nose (don't block off one side) to drain out the solution.
5. Tilt your head to the left, insert the spout in your right nostril, and repeat (water will flow out of your left nostril).
6. Blow your nose - gently!  I often repeat this cycle using 2 oz. of water each time (from my 8 oz. squeeze bottle) to clear everything out.
7. Do it in the morning and the evening - like brushing your teeth.  In the evening, try to do it at least an hour before you go to bed, so any lingering solution doesn't become part of post-nasal drip down your throat.
8. Always rinse your neti pot or bottle and tip with hot water after each use.

Now here are three great videos to show the technique:

Here's the basic, gravity-flow neti pot (you can purchase these in a well-stocked drug store, like Walgreens):

The squeeze bottle in the bottom video is the one I use, and I also keep a backup supply of prepackaged saline salts for when I don't prepare my own saline solution.  I have both an 8 oz and 4 oz. bottle, but always use the 8 oz. one.  Because the tip is angled, you really don't have to tilt your head:

Try this simple procedure - you'll be hooked the first time out!

Status Update: Sept. 20, 2013

Health Update

I saw my oncologist yesterday to go over several issues:

1. Tingling in my left leg, from the top of the foot up through the ankle to mid-shin.
2. A bruise below my right knee, with a small bump beneath it.
3. Shortness of breath and persistent cough with tightness in my throat.

1. The tingling essentially goes up to the spot where I had some tissue removed two years ago for a biopsy.  It came back negative (after several tests), but has always been a tender area, and always shows up as a slight hot spot on the subsequent PET scans.  However the remaining hard bump has never gotten any bigger, and the hot spot remains essentially small and unchanged.  My oncologist thinks the tingling I'm experiencing now may be a combination of the muscle work-out from exercising, along with the possibility that a nerve was pinched or damaged in that spot during the initial biopsy.  I'll probably just have to live with it, but as she doesn't think it's a sign of returning cancer, that's perfectly fine with me.  It's just a periodic irritant and doesn't really affect me in any way.

2. The bruise mark near my knee has diminished, but there's still a tender bump beneath it.  My oncologist said she didn't think it was lymphoma, but instead just a small piece of fatty tissue.  In short, she didn't think I was showing any signs of restaging cancer, and was fine with going another six months, barring any significant changes, before I see her again.  In March we'll decide if it's necessary to schedule any additional tests, like a PET scan, but if nothing changes between now and then, we probably won't do anything.  This is a pretty big deal as I've now essentially reached the 3-year post-transplant milestone and am cruising toward the 5-year mark.  I feel like I may have passed a critical point, so yay!

She did take blood for a lab work-up, which she'll compare to a similar sample in six months.  The results came in on my computer a few hours after the blood was drawn, and all but two tests are in the correct range.  My creatinine (a measure of kidney function) is a bit high.  Two of the last four tests taken in the last year have been in range, and two have been slightly out of range on the high side.  This reading was high for the first two years post-transplant, but is slowly but surely working its way into range.  My doc isn't worried about it, at any rate.

The second number on the high side is my glucose reading, at 120 (the range goes from 85-106, and usually I'm in the mid-90's).  This is a number that should be watched for early signs of diabetes, which runs in my family.  When my dad was diagnosed with diabetes in his 30's, the high end of the range was nearer to 120, but they've tightened in up in the last few decades.  Strangely enough, despite my weight problems, I've always had a low glucose reading, and no other signs of diabetes, except for the neuropathy in my feet (and now along the front of my lower left shin).  The neuropathy quite clearly originated with the chemo treatments, though, and have not, so far, been related to any signs of diabetes.  With this one high reading I will definitely be keeping an eye on this, especially during the March labwork.  One thing may explain the high reading yesterday, and that is that the labwork wasn't prescheduled, so I didn't fast before it, which is generally required for an accurate glucose test.  I was literally drinking a mug of coffee with creamer in it as I went to the docs, so that could have played a part in my reading.  I'll still be watching it though.

3. As updated earlier, I saw my primary care doc a week ago, and she thought the respiratory/cough issues were related to bronchitis and allergies.  I've read a few comments about some extreme cases of bronchitis and early season colds recently, so I'm hopeful that explains item number 3.  It's been severe enough to essentially curtail all but a couple days of exercise this month, since I have trouble with sufficient lung power, especially when swimming laps.  I'm afraid this month is a loss for me in terms of my exercise program, but after a week of treatment (nasal irrigation, topical nasal steroid, allergy pills and albuterol/ProAir inhalent) along with a climate shift to cooler, less humid conditions, the symptoms are slowly but surely diminishing.  Hopefully October will be a much better month for me.  The first freeze may spell the end of ragweed season, so fingers crossed for that!.  This does remind me to schedule a flu shot in early Oct. during my next INR reading, though, as I already feel like I've gone through almost three weeks of a very bad cold and/or flu.  The cough is so persistent and hard that I've strained some muscles along my back, and my throat is raw.  It's been a very uncomfortable couple of weeks, and I am so looking forward to this going away!

The good news, though, is that my oncologist doesn't think this is anything to be concerned about from a cancer standpoint, and is having me continue to work with my primary care doc on it.  I just hope I can get back on track with my exercise by October!

I'm going to put up another post today or tomorrow on nasal irrigation, as promised, so keep an eye peeled for it.  Also, if you're able to do it, and have no philosophical opposition to it, it's time to schedule your annual flu shot!

Status Update: Sept. 15, 2013

Respiratory Issue

So I saw my Primary Care Physician on Thursday (okay, he was out of the office, but I saw another general practitioner from that office).  She listened to my lungs and said 'good news - they're clear'.  But she could tell from the sound of my cough that something further up (throat area) was happening, and after discussing a few things, she said she thought it was a bronchial issue, set off by allergies (ragweed is particularly bad here in Minnesota right now).

Okay, a couple of things.  I was diagnosed with several environmental allergies decades ago - pollen, ragweed, mold, and dust.  For 2 years in the late 70's I took monthly shots for them, but I became acclimated and didn't need the shots after that.  When I moved to Arizona, my pollen allergy came back with a vengeance.  Desert cactus bloom all year-round, and that, combined with the dry air, means pollen's always in the air, and in your nose.  I treated it by over-the-counter meds like Claritin when it was particularly irritating.  I wasn't bothered with ragweed there, but I did have some bronchial problems post-transplant.  In a post written last year I discussed a lung issue I had for several weeks.  When I stood up it was like my bronchial passages just squeezed closed.  Even walking a few feet was exhausting, because my breathing immediately became labored.

Since shortness of breath is something all cancer patients watch for, my oncologist ran all the normal tests (PET scan, etc.) but they came back clear.  Finally he said he really couldn't account for it, with perhaps one idea - a very small percent of infants sometimes exhibit diffused respiratory problems in their first few years, and usually they were attributed to their new immune system, and cleared up on their own.  Of course as a stem-cell transplant recipient, I have a new immune system, so he thought it was possible I was falling into that rare-infant category.  He gave me a script for anti-biotics, and within a week, the symptoms were gone.

This sort of feels like that, but it also feels like allergies.  I think there are definitely allergy things going on, but am also wondering if I've just developed a tendency to bronchial issues as a result of either the transplant or the chemo itself.  I'll be meeting with my Minnesota oncologist this Thursday and will review with her.

But here's what my PCP prescribed:

1. A topical nasal steroid spray (one spray in each nostril, 2x daily).
2. 24 hour, non-decongestant over-the-counter allergy pill (like Claritin - 1x daily).
3. Albuterol inhaler (two puffs, 4x daily).
4. Nasal irrigation (1-2x daily).

I've been doing all of the above now for 3+ days, and the symptoms have been reduced a bit, but are not gone.  I did manage to swim my laps yesterday, and again it took me about 5 minutes longer than usual (I had to stop at the end of each lane to get the coughs out of my system).  If indeed the ragweed allergy is the primary cause of all of this, that should end with the first freeze, which should come sometime within the next 4-6 weeks.  For the first time in my life I'm hoping for an early winter, or at least the end of the ragweed season.

I did ask about the steroid, since I absolutely didn't want any of side-effects of the steroid meds, but she told me it was topical, and had no internal biological effects.  It's supposed to dry out any pockets of mucus in your nasal system.  Nasal irrigation does the same thing, and I used to do this regularly in Arizona, but hadn't been doing it much in the last year.  I was prescribed an albuterol inhalant back in Arizona, and she rewrote that script for me again.  I did it in an earlier post, but I think I'll review nasal irrigation again in my next post - perhaps tomorrow.

I'll post again, maybe twice in the next week or so; once on nasal irrigation, and an update after my oncologist appointment.

eta: I added a 20th country to my viewers list - Japan.  It's funny because I was just telling my mother how I had readers from the far east, the middle east, eastern and western Europe, as well as North America, but hadn't seen any from Japan.  Now they're on the list!

Status Update: Sept. 11, 2013

Well the respiratory issues I've been having sort of hit a peak in the last two days.  By last night I was pretty sure that I had some fluid in at least one lung, based on the rasping sound I could hear while breathing, as well as the cough.  Despite that, I went swimming today, and here's why: Swimming laps causes you to breath deeply and that causes your lungs to open completely, which can give your body a chance to drain any fluids collecting at the bottom portion of your lungs.

I swim 4 different strokes during each lap; breast-stroke for first quarter, freestyle for second quarter, full back-stroke for third quarter, and alternating back-stroke for last quarter.  During most of those strokes, but especially during the full back-stroke (both arms in sync) I could easily hear the sounds from my lungs, and there was definitely some rasping and rumbling from what I think is the left lobe.  I've had pneumonia 4-5 times since my original diagnosis, and have gotten pretty good at recognizing the early signs of respiratory problems, and sometimes cutting them off at the pass.

It took me a full hour to swim my 10 laps, instead of 50 minutes, because it was considerably more work this time.  The good news is that it seemed to hit a peak between laps 5 and 6, and then began to improve.  I felt much better by the end, and again after 3 - 10 minute rounds in the sauna.  This sauna is dry-heat, not steam, so I hoped it would help me get rid of any moisture in my lungs as well.  The cough is still there, but it's better than it was last night and this morning.  I think I'll go swimming again tomorrow, instead of using the bike as planned, to try and route this before it turns into something bigger, like full-blown pneumonia.

I go in to my primary care physician tomorrow for my monthly INR check (for blood thinner level) and to my oncologist for a review on the 19th.  If the problem is still hanging on, I'll no doubt do a course of antibiotics.  This is the time to practice deep-breathing techniques via the spirometer (discussed earlier) or in my case, by swimming laps.  As long as I still feel a bit better tomorrow morning, I'll swim again on Thursday, bike on Friday, then swim again on Saturday.  Hopefully I can nip this thing in the bud.

I'd ordered a new lap-suit and when I got home it had arrived.  This is great because my old one had too much lycra in it, and that doesn't hold up well under chlorine - it was about to give out.  For you lap swimmers out there, a good chlorine and stretch-resistant fiber is Polyester or a PET mix.  Suits made with these fabrics (as opposed to lycra and spandex) can last 10-20 times longer, which is a big deal when you're lap-swimming regularly.  I bought it in a slightly smaller size than I currently am, hoping it will be usable for 4-6 months.  We'll see.

I'll update the lung status again later this week.

Status Update: Sept. 8, 2013 (2 of 2)

Willkommen, Bienvenue, Welcome!

This is an updated list (first posted back in July) of countries where viewers are from.  The newest I've seen (this week) are from Turkey and Serbia, for a total of 19 or more so far (since the top 10 list at any given time leaves some off, there may be more).

eta: Added Japan and Malaysia for a total of 21 countries.
eta: Added Indonesia on 9/30/2013 for a total of 22 countries.

The continent missing is South America!

1. USA
2. Germany
3. Russia
4. United Kingdom
5. Canada
6. Romania
7. India
8. Ukraine
9. Sweden
10. France
11. United Arab Emirates
12. China
13. Netherlands
14. Ireland
15. Poland
16. Australia
17. Israel
18. Turkey
19. Serbia
20. Japan (added 9/15/13)
21. Malaysia (added on 9/26/13)
22. Indonesia (added on 9/30/13)

Ciao for now!

Status Update: Sept. 8, 2013 (1 of 2)

I'm late, but finally getting caught up.  Another couple of rl things kept me on the low end of my exercise target (at just below 4 days/week).  I was out of town over the Labor Day holiday, and so am going to have another low end of range month in Sept.  I'm thinking that maybe instead of a 4-6 days/week range, I should go with the more common 3-5 days/week range, and save myself some angst.  Here's my update for last month (fitness and health status, August, 2013), along with a segment on bariatric gastric surgery, and it's lap-band sister-procedure.

Fitness Update for August, 2013

Exercise days: 17 days out of 31 (an average of 3.84 days/week)
Lap Swimming: 9 days (10 laps/50 minutes = 1000 meters/50 minutes, pace = 5.00)
Land based/Bike: 8 days (8 miles/46-48 minutes - closing in on a 45 min. pace or 10 miles/hour)
Water/Land ratio: 0.53/0.47 (~50/50)
August Weight Loss: 3 lbs.
Total Weight Loss: 11 lbs.
Avg. Blood Pressure: 115/75 (very good!)
Resting Pulse-Rate: ~70 (which is very good for me)

Still holding steady at 3 lbs. weight loss per month on average.  It's slow progress, at about 0.75 lbs. per week, but it's going in the right direction.  I wish it would move up to 1.0-1.5 lbs/week, but I can live with it.  After many years of gaining weight, dieting, losing weight, gaining weight, I firmly believe that the slow and steady progress is the one that may break the weight loss/weight gain cycle.  My personality favors the journey over the destination, so as much as I'd love to reach my end-goal faster, I think I'll just try to enjoy the smaller milestones along the way.  If it stays at this pace, it will take me over 3 years to meet my goal, but I guess that means it's a lifestyle change, and not just a short-term program.

Health Update for August, 2013

I've had a few more aches and pains than normal this month, along with one bruise/bump that has been there longer than it probably should, so I've made an appt. with my Oncologist for Sept. 18 to go over a few things.  I know that after several rounds of chemo, most people's muscles, bones, etc. get more sensitive, and I do bruise more easily now.  I had one on my forearm from where a swimmer caught me with their heel when straying out of their lane, and it lasted for 2 months!  I think it actually was hard enough to bruise the bone.

I've also had some respiratory issues recently, so that's always a reason to get checked out.  The humidity's been high, though, and that is always a prime cause for that - your lungs have to work much harder when the air is heavy with water, and it's a lot easier to get pneumonia.  My lung power is definitely improving from the exercise, but the humidity has interjected a counter-balancing influence in the last couple of weeks.  The center where I swim was closed this last week for the yearly maintenance, and tomorrow I'll swim for the first time in over a week - we'll see how my lung power and pace hold up after that break.

Bariatric Surgery Trivia

Did you know that only 1-2% of people succeed in keeping their weight off using traditional diets?  Bariatric and lap-band surgery, however, have a 70% or greater success rate.  That is a dramatic difference, and that's why I'm including a segment on it in my entry today.

Bariatric surgery is a procedure where the stomach is separated (into a small pouch), sometimes with additional reconfiguring of the upper intestine.  It's pretty extreme surgery, and has extreme results, both good and bad.  On the good side you can lose weight very fast (maybe 80-100 pounds in six months), but on the bad side your ability to process nutritional elements can be negatively affected.  This surgery is only considered if you have 100 or more pounds to lose.

There is a less extreme procedure called lap-banding, which is fairly new, but now becoming far more common.  Instead of surgically separating your stomach, and possibly intestines, a synthetic band is slipped around the upper end of the stomach, creating a small pouch.  There's a line attached to the band which ends in a small port, which is attached just beneath your skin.  Like a porta-cath for delivery of chemo, this port can easily be accessed by a needle through the skin.  A water (saline?) solution can be injected or removed from the line, thus tightening or loosening the band.  This would allow more or less food in, as required for nutritional and weight loss purposes.  The band is implanted via laproscopic incisions, which means it's generally considered a far more safe form of surgery.

Both of these procedures cause your brain to sense that your stomach is full far earlier than when your whole stomach was being used.  This means it won't send hunger signals to you as often or dramatically as happens in a regular diet, and that means there's a decent chance that you can a) lose all your weight, and b) keep it off.

Here's the difference between these two procedures in terms of weight loss: With Bariatric surgery you could lose 50% or more of your target weight loss goal in 6-12 months, with the remaining weight loss (for a total of 75% or better) within 3 years.  Lap-band surgery is slower in the first year, but still can hit your 75% or better goal within 3 years.  If you have 120 pounds to lose, you'll probably lose 40/40/40 pounds a year for 3 years via the lap-band procedure, whereas it might be 80/20/20 for full bariatric surgery.  That means your gratification is delivered far quicker with the full bariatric gastric procedure, and lets face it, most of us want to see those results immediately.  Still, I tend to think the slow but steady lap-band progress makes the most sense for long-term success, as instant gratification has a history of questionable to bad long-term results.

Full bariatric surgery is an expensive and sometimes dangerous procedure, while lap-band surgery is both less expensive and less dangerous.  It can cost as little as $20,000, and your surgeon may allow the procedure even if your weight-loss goal is less than 100 pounds.  There are even companies that offer financial loans for this procedure, as it often is not covered by medical insurance.

I would love to have the lap-band procedure, but no way am I taking out a $20K loan for it, and even if I could, they might not allow it with my recent medical history.  This is why I'm generally focusing on exercise (energy output) over dieting (calorie intake), since it's likely to have a longer-term impact, even though it will take longer to reach my goal.

Onward and upward (make that downward, scale-wise!).