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!).