Wednesday, August 8, 2012

on breathing

With great anticipation, I headed off to the pulmonologist yesterday afternoon for a round of breathing tests.  I revisited my allergist last week for a somewhat timely check-up, and he prescribed me a different round of treatment based on all my whining about breathing still being so hard.  However, I held off from getting those filled until my appointment yesterday, mostly to avoid wasting money on a prescription that I might only use for a few days.

I was told not to take any of my normal meds the morning of the test, and to avoid chocolate and caffeine.  Because of this, I took my first workout that included fast running in about four months into the gym and did it on the treadmill.  I was still wheezing quite a bit by the time I hit the final mile, and I felt confident that I had junked up my lungs pretty well for my appointment.

The test was quite a bit different from the "blow into this tube" test that I've taken at the allergist's office.  I was connected to a big machine that was hooked up to oxygen and maybe something else, and I did a series of breathing tests while attached - big breath and blow out hard, lots of little fast breaths, holding my breath, etc.  The tests weren't just testing lung function, but instead were testing many little things like how much oxygen was absorbed from my lungs into my blood, the actual capacity of my lungs, and my rate of inhalation and exhalation.  After the first round of tests, the technician hooked me up to a breathing machine that pumped high-test albuterol (magic breathing medicine) into my lungs for about five minutes while she frowned at the big string numbers the machine spat out.  Once the albuterol was in, I repeated the round of tests.

After all of this was done, I had a normal work-up - height (5 feet 5 & 3/4 inches, annoying), weight (don't tell me I just ate lunch), resting pulse (42), pulse ox (99), and blood pressure (100/60) - plus a detailed history of all the things I like to complain about (several pages long).  My symptoms, for those who are interested (hi mom!), are most prominent in the summer.  After about 10-15 minutes of running, even at an easy pace, I feel a sharp tightness in my chest, right at the midpoint of my sternum.  I'll start wheezing pretty hard a few minutes later.  Running harder/faster makes it show up sooner.  Once running is over, I'll cough pretty hard the rest of the day.  During the winter, hard or long efforts won't reproduce the mid-run symptoms, but I will spend a lot of the day coughing.  I'm also extremely congested, all the time, despite my allergy meds (Singulair and Allegra-D), living with an air filter machine, vacuuming up puppy hair every day, etc.  

I talked to the doctor for a bit and he decided to give me a chest x-ray just to make sure I had a heart nothing bizarre was going on that they might have missed.  After that, it was time for the "consult" part of the appointment.

The good news is that nothing weird is going on.  My x-ray looked fine and while my breathing test numbers were bad, they weren't horrifically bad.  More "appropriate" when compared to my symptoms.  After taking the albuterol, my numbers improved a bit, although I didn't feel any different (except light-headed from all the extra breathing).  So other than some standard asthma, nothing weird is going on, I'm not missing a lung or about to collapse because my heart is in my stomach.

The bad news, of course, is that the asthma is bad and isn't being controlled or corrected by the drugs I am on.  But that's fairly easy to fix.  The doctor told me to stick with the Singulair, prescribed a nasal spray (gross), a maintenance inhaler (AdVair) and a rescue inhaler (albuterol).  He said that the maintenance inhaler was the strongest dose of steroids, and he is hoping that settles down all of my symptoms.  However, he was also careful to tell me that there are a lot of meds available for asthma and it might take trial-and-error until we find the right one.  I've got a month on these drugs and then I go back for another test to see where things are.  He said it will probably take 10-14 days before I start improving.  

So, I'm encouraged.  I've had a rescue inhaler for two years now (prescribed by my allergist after he initially diagnosed me with asthma last year) but have never really felt any relief from it.  The pulmonologist told me that could be because of how inflamed my lungs are, and that once the steroids start working, the albuterol may also start making me feel better.  I'm very committed to taking everything exactly as prescribed, but I also realize that the period of time it takes for all the drugs to kick in also may coincide with summer coming to a close, which is generally when I start feeling some relief anyway.  Sigh.

He also did mention that exercise-induced or aggravated asthma is particularly difficult to deal with here in DC because the air quality is so poor on a regular basis, especially in the summer.  I also got a chance to ask him about all the reading I've been doing about dairy as related to exercise-induced asthma.  His opinion was that he does not believe, based on current research, that the two are connected but giving up dairy certainly wouldn't hurt me and I was welcome to try it.  And if it does make me feel better, to stick with it, but he felt more strongly that treating it with a maintenance drug instead of merely the allergy drugs plus a rescue inhaler was going to help me feel better sooner.  I'd call it cautious skepticism but not taking anything off the table, and that might be enough for me to give it a try.  My RD buddy told me that it would probably take about a month to feel differently based on dietary changes, so I'm going to think about it some more and then decide.  I'm concerned about changing too many things at once, because then I won't be able to easily pinpoint the change that made a difference, but the link between dairy and breathing problems makes sense to me (I am not a scientist so don't listen to me).  

I am interested in hearing from anyone who has dealt with asthma as an athlete and how you have handled it.  My doctor works with plenty of athletes and told me that it is manageable once we find the right combination (don't despair, little pony!).  I'm particularly curious to find out if you think a diet change of any sort (dairy, gluten, meat, oreos) has made a significant difference in your health, so please, drop me a comment and let me know!

20 comments:

  1. I don't have any advice, but even without asthma, the DC air messes with me every summer. And if you decide to go dairy free, let's talk. I had to do it when both of my boys were babies, so I can give you some tips/recipes/suggestions.

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  2. I haven't taken advair, but have heard good things. Adding nasonex, the yucky nasal steroid to my singular has made the biggest difference. If I can keep from getting all inflamed and flared up in the first place then the other stuff does work better. Hope you find the same to be true also. I'm curious about the dairy thing, but I'll be damned if I ever think about giving up my precious DoubleStuf!!

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  3. I'd stick with the dairy free plan. I run with a friend who has had experimental bronchial thermoplasty. It fundamentally cured his asthma since he no longer requires treatment which used to include daily medication. However, he carries a rescue inhaler just in case even though he's over 5 years post operative. Chris says the procedure changed his life from not being able to ever compete in sports to now running marathons. His quality of life is a million times better.

    Because the treatment is experimental, most medical insurers will not cover the "surgery". Not even our Canadian socialized medicine.

    http://www.aetna.com/cpb/medical/data/700_799/0744.html

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  4. I have many friends with asthma who control it with Advair. They carry inhalers for really bad moments, but most of them rarely need a puff. None of them are affected by the asthma while they train and race in the NoVa area.
    I have also heard folks talk about the inhaler being more effective if they use it with a spacer.

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  5. I'm only saying this cause you asked... and take it with a grain of salt, because luckily I've never had any issues with breathing, asthma, etc. BUT... I have pretty much given up dairy and I am sooooo much less mucus-y and congested. and when I do have dairy... (once a week I'll have cheese on a burrito and/or an ice cream)... I wake up the next day with a sore throat and congestion.

    .shrug.

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  6. Just so you know, Duke and UNC have to of the best non-Ivy league medical schools in the country, and most of the doctors here went to Duke or UNC. and our guest room is open anytime you want to come down for a visit.

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  7. Sounds like you are in good hands and I hope your new meds work!!!! I went gluten free just for Ironman training last year and stuck with it cause I felt better but none of that was breathing related. Maybe you should move to Boulder!!!! ;p

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  8. As you know, I have to work through my breathing issues as well, and good drugs make a huge difference. I only use my current drugs on hard days, due to concerns about side effects, and it feels like training at altitude on the days I don't use them.

    The list of endurance athletes with allergies/asthma is a very long one, so we're all in good company.

    WRT nutrition, I have cut out both gluten and dairy with very good results, but I'm not sure how much it's helped my asthma...

    I have both EIA and acid reflux,so I have broncho constriction triggered by two things: a) reaction to airway stress/allergies (the EIA) and b) reaction to stomach acid bubbling up. Eliminating dairy and gluten did fantastic things for my digestive ills, and eliminated one cause of my breathing issues (the acid reflux). But I can't say whether it helped with the EIA.

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  9. My asthma and allergies improved dramatically when I left the East Coast - especially once I got out of DC. Steroids + albuterol = very happy lungs, at least for me. Just beware that albuterol and caffeine aren't always a happy mix.

    My NP suggested I experiment with cutting dairy when my asthma gets particularly bad, but I've gone through all the food tests, and I know I'm not allergic to it so I haven't bothered. If you do go that route, I'm interested to know how it works.

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  10. For what it's worth, I've had a long history of breathing troubles that got aggravated since I've started running. In general it would be a cough induced within 5 minutes of running, plus bouts of chronic cough lasting 1-2 months after a minor cold. After many years of doctors scratching their heads (I didn't do any of the tests you did though, they thought it wasn't bad enough) it was diagnosed as Reactive Airway Disease which is pretty much the same thing as asthma, but aggravated by an allergic response. For me, I found that cold AC combined with perfume would trigger it right away. D'uh, I was wearing perfume every day. Then we moved onto the perfumes in cars, house etc. Everything that is sold to "make your environment smell nice" would trigger it. I was living inside a bubble full of allergens which may have just made things worse over the years. Now that I eliminated all sources of "chemical smell" and stay away from the car AC, I am feeling much better. Just my 2c, in case you are also exposed to these things but may not have made the connection.

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  11. Your history and symptoms are exactly like mine. Once I added Nasonex and Advair (lifesaver!) to my Singulair, I rarely need the albuteral at all and my spirometry tests were awesome after only 6 months. On bad allergy days I will sometimes take albuteral before I run, but lately haven't had to do so. I really did not want to take Advair but it helped change my sleep, workouts and daily life for the better.

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  12. Great post, been wanting to talk about this for awhile and nice to see another view point...

    I went to the doctor last year to do some lung test and he asked me if I ACTUALLY did all the races I said I did, he said my levels were NOT those of an athlete. He was the worse bedside manner doctor and he told me to go on an inhaler. I decided to not race during heat and humidity versus an inhaler. However, I would like to go to another doctor and ask for a re-do of the test.

    I also gave up dairy and going GF so before every race and I give it up as best as I can for an entire week - for a half ironman I did 2 weeks. I don't know if it works or not or if it is just a placebo effect but I did feel better. I also have limited my dairy and gluten significantly since prior years and have experienced better running in the heat and humidity. That being said I couldn't go longer than 3 miles on Sunday without feeling like I couldn't breathe and then did 7 miles yesterday (less humidity) like I was walking through the park.

    I have been in and out of the plant-based diet, I haven't seen an effect of meat/fish so I think the dairy/GF is the best way to go. Just my opinion and I take allergy meds. I am not ready to go straight to an inhaler unless I get another test.

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  13. Your story here sounds pretty familiar to me- I had breathing issues on and off (though not anymore!) several years ago and was on advair (the strongest dose) for several months trying to get the inflammation down, etc. It was always worst for me after I got sick- any sort of flu almost always ended up in my lungs and I couldn't breathe and I'd have to go back to advair for several months. And I know this is going to sound crazy but I've heard stories from others so I know I'm not the only one... you want know what cured me? Being pregnant. It was so weird but after I got pregnant my breathing problems just completely and immediately disappeared. I do not pretend to know what that's about but I know our bodies go through big changes when they're growing babies and the one thing that really got all better was my lungs. So there you go! Have a baby and see if your breathing problems disappear? ;)

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    1. It may have something to do with the increased blood volume during pregnancy. Many athletes have come back stronger and better post pregnancy due to a number of factors, and this is believed to be one of them.

      Me- moving from flat ole VA to the Wasatch Mts. left my husband warning me, "you'll need to adjust to the altitude." Um... I've been fine the entire time and even with some long hikes and drives in the mts., all has been well.

      Who knows... just a thought.

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  14. I too have asthma, not as bad as yours, but it definitely sucks.

    I went to a naturopath 1.5 years ago because, despite all my swimming, cycling and running I still felt like crap and it was all a struggle because I couldn't breathe. I sounded like a 90-year-old emphysema patient. I found out I was allergic to dairy. Long story short, I was as a kid, but somehow got to eat all the cheese and drink all the milk I wanted. Could explain why I never became a track star.

    So I cut out dairy. It was and still is so hard - I LOVE cheese. Anyway, within a few months I no longer sounded like a 90-year-old emphysema patient when I ran or climbed the stairs. I also posted PBs all season.

    Now, when I do eat dairy I can feel it right away - breathing is nearly impossible.

    The good news is Oreos are nothing but chemical goodness, no dairy in them whatsoever! Eat up!
    Good luck

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  15. As someone who recently dropped dairy as part of a plant-based diet, I would definitely recommend cutting dairy out! Even a recent Harvard study (not influenced by lobbyists in any way) cut dairy out of the USDA's "healthy eating plate" for numerous reasons. We are the only mammals that drink milk after infancy! Just some food for thought.

    http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/pyramid/index.html

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  16. Hmm...still seems like the dairy-free camp has a strong voice! ;) I hear what you're saying about only changing a few things at once, but either way you've got nothing to lose (aside from cheesy meals...). If you give up dairy AND you're on the meds AND you feel better...win? My sis was on Advair and Singulair for YEARS (chronic asthma) and suddenly just decided to stop taking it. Her air quality in ABQ is different, for sure, but not "better" (dry, high altitude). She said she feels no different, and if anything feels better just not having a dependency on meds. Something to think about....

    And your RD-buddy is always up for helping as needed. :)

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  17. I was diagnosed with asthma after contracting some hellish virus in Beijing in January 2011. From January until March 2011 my lung function was at about 60%, improving to about 70-75% by July 2011 (yes I did a cycle training camp and the Bay Swim with not much breathing power - where there's a will...) I was given a brown inhaler (beclonmetasone diprorionate) to use twice daily -- this is steroid daily anti-inflammation stuff, and I was given a blue inhaler (salamol - again steroids) to use in pre-race/emergency (although I've never had an attack so it's pre-race for me). I infrequently used them, and in January 2012 my function had improved to 80% (O2 absorption inhale is back to 90% and exhale at 110% norms) so I was discharged from regular hospital monitoring

    From January I resolved to use the brown inhaler religiously. It has truly helped my comfort while running in particular but also on longer higher effort rides. And in my last race (the one where I raced with broken ribs) my breathing felt good (except for the ribs).

    I have done dairy free at certain points of my life. It has made me less mucus-y for sure. But right now I am not dairy-free. I just time things so that I am not heavy on milk products before hard sessions. I don't have much anyway, maybe a splash in milk, occassionally a yoghurt. You'll find what works best for you in time. And in the meantime my suggestion is to track the reactions you have to what you eat combined with what your training is. It will help you to fine tune.

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  18. That should be more catchier than the first impression.
    Lyxol Live

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