Sunday, December 8, 2013

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.

Friday, December 6, 2013

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!