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Thursday, October 02, 2008

Testing, testing... more tests to come.

I had my appointment with a respiratory specialist yesterday. When I got the appointment, I was told it could take up to two hours. I found myself wondering what they heck was going to be done to me for two hours!

It turned out they meant I might have to *wait* up to two hours for my appointment. It's a very busy office, it turns out. My appointment was just a consultation.

One of the things the dr. did was go over past test results with me. I had some X-rays done and, as expected, everything came back normal. Whatever it is that's causing my cough, it doesn't show up on X-rays.

The X-rays had been quick and easy - I spent more time in the waiting room than getting the X-rays done, and I didn't have long to wait.

The breathing tests, on the other hand, were a lot less fun. I got to sit in this little glass booth and breath into a hose (while wearing a nose clip) in different ways. The hardest one was when the tech had to shut me in and had me do these short little puffs that made my cheeks go in and out. Part way through, she shut the air off, and I had to keep puffing, as if I were still breathing. Except I had no air. I was supposed to keep doing this until she told me to stop, and it was all I could do not to rip the mouthpiece off and gasp for air before she did.

Now, one of the things that triggers my cough is deep breathing, or anything that puts pressure on my breathing, like laughing and singing. Which means I normally tend to breath shallow now. It's something I don't even think about. During the test, I had to do a lot of deep breathing, holding the breath, exhaling as hard as I could for as long as I could - in other words, doing all sorts of things that trigger my cough. I even had to puff on an inhaler, just like the ones asthmatics use, which irritated things even more. By the end of the test, I would start coughing part way through the tests (right into the hose... ew). The tech started giving me longer and longer times between tests so I could recover.

So picture me going over the test results with the respiratory specialist. He starts off saying how everything was normal, except for two tests. These measured lung capacity. According to the tests, my lungs can hold less air than they should. He then told me it was because...

wait for it... can you guess?

... of "the obesity."

That's right. My lungs hold less air because I'm fat.

When I saw the number, I asked him if these two tests were done at the end or at the beginning of the series. He told me they were at the end. So I told him about how, by the end of the testing, I was coughing badly *because* of the test themselves. We'd already discussed what my cough was like, what the triggers were, etc.

He pretty much ignored me. He said something about how this was normal for people with obesity. Then moved on because my lung capacity has nothing to do with my coughing. Meanwhile, he listened to my lungs (nothing unusual there, either) and went over a few more thing.

Towards the end, he started dictating a letter to my GP, stopping along the way to ask me more questions, the answers to which he'd include in the letter.

I did have an eyebrow raising moment over one of his questions. He asked me if I ever found myself out of breath if I take "3 or 4 flights of stairs." I don't know *anyone* that doesn't get out of breath after taking 3 or 4 flights of stairs! Just as an example, at work we have to take a lot of stairs. Going from the staff area on the lowest level to the hall at the upper level, while being only 3 floors, means taking 5 sets of stairs. Pretty much everyone is at least a little out of breath just with those. Throw in walking about half a mile of hallways and another ...

... oops. I just realized, I miscounted. It's 5 flights of stairs between the middle and top floors. So counting the stairs between the middle and lowest level, it's 7 flights total.

Then there's the hallways in between. This is NOT a small complex, and the elevators are to be used with freight only.

Yeah, after all that, we're all out of breath. I do have a harder time than others, I admit that. My cardio sucks. With my damaged knees and feet, I avoid stairs as much as possible. Up isn't too bad, but down is often precarious. Never mind painful, too!

So when he asked about being out of breath after taking "3 or 4 flights of stairs," I told him yes, because I have bad knees and I'm not in as good shape as I should be, and that being out of breath does sometimes trigger the coughing (if I breath really shallow, I can sometimes prevent the coughing from starting - which makes it harder for me to get my breath back).

Unfortunately, with his earlier comment about "the obesity," I am now suspicious that he's going to blame my "bad knees" on my being fat. I never got a chance to tell him *why* my knees are bad. If he's blaming my low lung capacity on being fat, even though I was having coughing fits *during* the tests, and ALL other tests came back showing my lungs are normal, it's a pretty easy assumption to think he's blaming other things on my size, too.

In fact, I partly suspect that my size is why sleep apnea is one of the things I'm going to be tested for. When he started asking me questions about snoring, being tired during the day (sometimes yes, sometimes no), I told him that my husband has severe sleep apnea, so we are very much aware of apnea. I do snore - loudly - but I don't stop breathing. He wants a reading of my oxygen levels as I sleep, though. He did do a quick check with the machine on his desk - my oxygen levels were at 97%, which is where it should be. My heart rate was good, too, which I was a bit surprised by. While my blood pressure is usually normal, my heart rate tends to be high.

I'm really hoping I'm wrong about my suspicions, though.

Now we're on to the next step. All the usual suspects are rules out. No asthma, acid reflux, allergies, etc. can be blamed for my cough. Along with the apnea test, I'm going to have another special X-ray done, this time with barium (oh, joy. I had several barium X-rays done back in Manitoba. The fizzy one down the throat was must unpleasant). I'm going to get a CAT scan done eventually - whoever's doing the scan will contact me directly about that. Oh, and yes, they'll be looking into my lungs directly. I've got a date at a local hospital to have things stuck down my tracea. I've already asked my husband to book that day off work, as I'm going to be drugged up for that one and will need help getting home.

There's another test I'm not remembering. The nurse said she'd call me with an appointment when she had one for me. There were so many different tests, I've lost track, and I don't have paperwork for all of them.

Well, at least two of them are this month, and I can make the appointment for the barium X-rays whenever I want.

I sometimes wonder if all this is worth it. It's just a cough, right? It's not that much of a problem, is it? *sigh* I have to keep reminding myself that a cough that last years really ought to be taken seriously. Easy enough to remember when I'm having one of my bad spells, but not when it's just that little tickle behind my sternum - an annoyance, but not much more.

That and I really hate having to wonder if a doctor is taking me seriously or not because I'm fat.


  1. Anonymous4:52 PM

    Hello, speaking as a doctor, please don't distrust your doctor for saying that your obesity lowers your total lung capacity. It might not have anything to do with your cough, but total lung capacity and functional reserve volume are significantly reduced by obesity. Check any pulmonary or anesthesiology text. One easy thing that I'm sure already has been asked: You're not taking blood pressure medicine like enalipril, lisinopril, any other "-pril," are you? Hope you feel better.

  2. Has your doctor ruled out exertion-induced asthma? That's what I have, and have had it for years also. When I laugh too much, or walk while carrying something heavy, I end up coughing. Sometimes the cough is so bad that I feel like I'm hacking up a lung. The doctor who originally diagnosed me with exertion-induced asthma prescribed an inhaler to be used before I exercise or do anything that requires any kind of extra exertion (stairs are counted in that). I also used it during coughing fits caused by laughter. The doctor told me my weight had nothing to do with the asthma, that even thin people have it. So that could be something you need to have checked out (I would think that would have been indicated by your lung function at the end of the tests, and why that doctor didn't consider it at all is beyond me, unless he didn't bother to even consider it simply because of your size).

  3. Dr. Anonymous: If he were my GP with full knowledge of my medical history, then I would take him seriously. Since he'd never met be before, he'd just finished going over a whole serious of test results that showed my lungs and lung function is fine in all other respects, *and* he simply dismissed me when I pointed out that I was coughing during that portion of the test, I have every reason to be suspicious and distrustful.

    As a doctor, I really hope you don't assume your fat patients have certain problems just because a text book says they should. Frankly, I'm tired of having doctors act all surprised because my blood pressure is normal, I don't have diabetes, thyroid problems, cholesterol problems, or any of the other problems we fat people supposedly all have. I sure as hell don't appreciate having an issue I've gone to a doctor for being "pre-diagnosed" as being caused by my size, which has happened before. I'm also tired of the "yeah, right" look when I tell them that I do have a balanced diet, and I really do get exercise - my cardio might suck, but things like 3+ mile walks are the norm for me. Believe me, I have reason to be suspicious and distrustful. Finding a doctor that doesn't pre-judge me by my size is gold to me, which is why I really appreciate my GP.

    As for meds, I'm not on any prescription meds at all, and only take painkillers (acetaminophen) for my post-traumatic OA.

    And thanks for the well wishes. :-)

    vests44: He didn't bring it up because it was already eliminated. I've been tested twice now for various types of asthma. I was even given an inhaler after my first series of tests a few years back, just to see if it might help (it made the cough worse).

    Exercise itself does not cause a coughing fit for me. Deep breathing does. But then, so does a chill breeze. Crap - I forgot to mention that to him.

    One of the things I wish we'd discussed, together with the triggers, is what treatments I've found help. I intended to, but never got a chance. When I do have one of my coughing fits - I totally know what you mean about hacking up a lung!!! - keeping my upper back warm helps a lot. When it's really bad, warming my chest and throat helps, too.

    I had a good day today, actually. I worked a 9 hour shift and did those !%@#$@# stairs - all 7 flights - several times, and not one coughing fit. :-D Just the usual cough here and there that I always have. It's actually been a while since I've had an all out coughing fit. *keeps fingers crossed*

  4. Anonymous8:59 PM

    If I might make a suggestion, as a nurse. An often overlooked problem (and often denied by docs) that sounds much as you describe is a reactive airway problem, a form of asthma. It's very common in children especially after upper respiratory infections or allergies, but so many doctors don't think of it in adults. It's not treated with inhalers. I would recommend a consult with an experienced allergist who works with asthmatics.

  5. Thanks for the heads-up, Anon 8:59. I've seen an allergist already, and the asthma specialist I'd seen during the same time period specialized in asthma patients (mostly children) with allergies. Specialists seem to wear a lot of hats, sometimes! *L*

    As for the reactive airway, I did a bit of searching. It seems to be a problematic diagnosis in some cases. In more specific diagnosis of RADS, it specifically mentions problems occurring withing 24 hours of high-dose exposure to an airway irritant, which as far as I can remember, I've never had happen to me. Some of the other indicators, such as wheezing and sputum production, I just don't have.

    More reasons why so many doctors are scratching their heads over my cough. :-/

  6. Good luck with all the tests. I would imagine it is frustrating not finding something that can be done so far to stop the cough. I had the down the throat test awhile back. I had twilight instead of being completely out and it worked out well, just a little scratchy throat after. I am glad all the other tests came back normal so far.

  7. Anonymous5:48 PM

    Personally, I think you doctor is an idiot!!! Not all fat people have reduced lung capacity, he should read _Big Fat Lies_ by Glen Gaessar. Doctors use obesity as a catch all excuse when they don't have the answers. I live in Chicago too and have breathing problems do to allergies. Funny I was heavier in Calif, yet had NO breathing problems here. It is the high levels of Chicago pollution that is doing it. I would love to know who your doctor is so I NEVER go to him because I flat out would not put up with that!!!!!
    Djenki Barzo for the heads up! (My Polish spelling is as bad as my pronounciationj!!! 6 weeks of Polish ad I learned one word

    S Sanders, MA

    p.s. I weigh about 230, live on a 4th floor walk up, and I hardly get out of breath at all. Am in far better shape than some of my thinner neighbors and guests.

  8. for anon 5:48pm

    I don't know that I'd call him an idiot - he seems to know what he's doing otherwise. I'm reserving judgment for now. If it becomes and issue, I'm going to ask my GP to refer me to someone else.

    On the other hand, it may be a wake up call for him; that he's jumping to conclusions based on personal prejudice. Better that it happen with me, where it doesn't matter as much (he'd already dismissed it as not having anything to do with my cough), than with someone who's health might be compromised by his assumptions.

    I doubt you'll ever have to worry about seeing him, though - unless you plan to be moving to the Canadian Prairies some time soon. ;-)

    Dang - I'd love to be able to do stairs without getting winded again! Heck, I'd love be be able to do stairs without wondering if my knees will suddenly decide to bend the wrong way, or simply give out. LOL


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