A Stumbling Start – 2013

Wow. It’s been a while. My last post was from my very first day of a doctor ordered hiatus from running due to tendonitis and plantar fascitis. Through January and February I worked with Vanessa Bowers at Commonwealth Orthopedic Associates. To rehab my bum ankle. I had a plan. There was action I could take. I didn’t miss a visit and faithfully performed my prescribed PT exercises at home. I was optimistic that my 2013 race plans would come off without a hitch.

Meanwhile, I was swimming. I contracted for 3 months of swim coaching with Endurance Multisport swim coach Erica Sheckler. I’ve swam more in the first 3 months of 2013 than all of last year in total. More importantly, my swims were meaningful and becoming more efficient with each session. By the end of February we were beginning to ramp up intensity and distance.

On February 22nd I visited Dr. Frombach again and got the all-clear to start running again. What an exciting day! I had even taken the day off partially to accomodate my doctor appointment and also to attend the Greater Philadelphia Outdoor show in Oaks, PA. Halfway through the show I noticed a sniffle, then a sneeze, and the the achey feeling that could only mean the nasty cold that has been going around work had finally caught up with me. Great. Day one of being allowed to run and I’m sick.

That weekend was spent hunkered down under a blanket with a box of tissues, a hot drink, and evening doses of Nyquil. Fortunately, the cold passed fairly quickly with most symptoms disappearing in a few days. Throughout my life, I have always gotten what I called asthma-like symptoms for a couple days after a cold. It is that feeling of not being able to get a full breath. This had happened at random since I was a child and normally passed in a day or two and almost always associated with a cold or allergy event. The last time it happened was about 3 weeks before the Philadelphia Marathon. I was worried it would not clear up in time for the race as it seemed to linger on. About the time I was ready to make a call to the family doctor, it went away and I forgot about it. But now, after this cold, the symptoms came back. No worries. In a day or two they’ll be gone. Okay, maybe a week. I shortened or cancelled one workout or another waiting for the symptoms to clear. More than once I made the hour drive to Allentown for group swim & coaching only to find I couldn’t really swim. I like to be able to breathe when I swim. I’m sorta funny that way.

I called the family doctor, Dr. Rauenzahn, and she prescribed an albuterol inhaler. I used it every 4 hours for a week. I looked forward to that 4 hours being up and hoping that this time it would work and that I could get a breath. I longed to fill my lungs. Just once. But nothing doing. So after a week I called Dr. Rauenzahn back and explained we were getting nowhere. She called in a prescription for QVar which is an inhaled corticosteroid. Okay. So we’ll give that a try. Two puffs twice a day. Continue to use the albuterol as a rescue inhaler as needed. After another week . . nothing. I hadn’t had a full breath of air in so long I forgot what it felt like. As you can imagine this is a little distressing. Even more so when you are planning a 50+ mile triathlon in a little over a month and a half-ironman in 2+ months. Swimming was nearly impossible. I could run slowly and ride the bike on the trainer at a moderate pace. That was it. Still no air. The low point was taking a morning spin class at the gym and having to sit down and spin easy during a moderate climb all the while wearing my Eagleman Half-Ironman shirt.

After another week, I called Dr. Rauenzahn again. “We’ve got to do something. This can’t go on”. At this point, I’d exploded way too many times at my wonderful wife when all she had done was ask a basic question. I was miserable at work. I was miserable at home. I wanted to breathe. Dr. Rauenzahn wasted no time: Get a chest x-ray now. Yes Ma’am. The chest X-Ray showed clear but slightly over-inflated lungs. Dr. Rauenzahn and I began discussion that perhaps there could be an allergy involved. I’d never had an allergy test. So I was referred to Dr. Edward Skorpinski of the Allergy & Asthma Center of Wyomissing. “Yes please. I’d like to schedule an appointment as soon as possible. Yes. Now is good”.

Dr. Skorpinski was very friendly and got right down to business. I was suspicious of a peanut allergy and we began the allergy tests immediately. Have you ever had an allergy test? They should give you a free back scratcher with them? Basically, they drop a whole bunch of concentrated allergens in liquid form on your back and then take something like a lancet and scratch you. You know quickly if you have an allergy because suddenly your back itches and burns as if you laid down on a cactus covered with poison ivy. Needless to say I had some allergies. Nothing major or surprising except that I can’t get a cat. I was severely allergic to cat dander. Hmmm. I had two cats as a kid. Maybe that explains some of the on-going sinus issues I had back then. Anywho . . where was I? Oh . . so cat dander, tree pollen, grass pollen, mold spores, and dust mites. All fairly common. They then take all the ones that didn’t react an inject them. This is SURE to create a reaction if you have even a minor allergy. But I had none. (There is still hope of getting a dog.)

So what next? Off to take the pulmonary test. Interesting device custom made for runners & triathletes because it gives you instant performance feedback. You basically take a deep breath, put your mouth on a mouthpiece that looks like a hair dryer, blow out as hard as you can and keep blowing out until the test administrator says “suck it in” and then you suck in as hard as you can (and believe me you really want to at that point). So I repeated the test 3 times then went back to the room.

After a few minutes, Dr. Skorpinski reappeared with an albuterol inhaler in his hand. He asked me to show him how I use it. i did which is just like in the directions. He then changed that and basically had me hold it two finger widths from my mouth. He demonstrated using a practice inhaler. He showed what happens when you don’t do it right and you lose more than half the medicine. Hmmmm. He had me take 4 puffs his way. We waited 10 minutes and then did the pulmonary test again. He then reviewed the results. My lungs were 111% in size which he said is good. He explained that it is all genetic. You can’t really do anything to increase lung size. It is just what you were born with and that that was really good for someone who likes endurance sports. But the number that was of interest for us was the one that showed the percentage of air exhaled in the first second (the big exhale at the beginning). I don’t know the name exactly. I’m sure it is on this explanation somewhere. Before the albuterol I was at 74%. He said that along with the slightly over-inflated lungs from the X-Ray were classic asthma symptoms that the albuterol and normal asthma medications should help. After the 4 puffs using the doc’s technique, I hit 99% (a new PR!) on the re-test. More evidence that were were dealing with straight-up asthma. Physically, I was feeling better. I had now taken the first full breaths I had had in weeks. Okay, I’m listening.

Dr. Skorpinski took me off the QVar which didn’t really agree with me and put me on Advair instead. He gave me a sample to try that would last two weeks followed by a prescription and a request to see him again in a month. I left there feeling elated and the best I had felt since February.

For the next few days, I woke up a new person. I could BREATHE! Throughout the day I found myself taking deep breaths just because I could. It was pure heaven to feel my lungs fill up. Then, a week later at the end of the work day, suddenly, I couldn’t breathe again. Oh no. Okay, try the albuterol. I hadn’t touched it in a week. I was still taking the advair regularly. Just a puff or two should do. Nothing. Okay, give it time. Wednesday was as if nothing was ever fixed. I was back to constantly gasping trying to get that elusive breath. My spirit crashed. I thought I was over this. Throughout the day my mood got lower and lower and lower. The ankle issues I could do something about. There was a game plan. For this I could do nothing. It was as if at a moment’s notice years worth of race training meant nothing. Not only couldn’t I do something as simple as swim a few laps or run an easy 5k, I couldn’t even walk quickly to a meeting without being out of breath. Mentally, I crashed. I whined and moaned on Facebook about my situation lolling about in a pool of self-pity. Wednesday night, desperate for a breath I grabbed the albuterol and took 4 solid puffs and went to bed. Thursday morning, I used the Advair. Then, suddenly, I could breathe. Each ensuing day it got better. Yes, now and then I needed an puff of albuterol but I got some workouts in. What is better, once I amped up the intensity and got my heart rate up, the symptoms went away and stayed away for hours. This all culminated Sunday when I went out and put in 6 sub-8 minute miles and felt GREAT never once having the burning lung feeling liked I’d been in an all-out sprint.

This morning I was conservatively hopeful. Overall I felt much better, but once in a while that slight empty breath feeling would occur, then just as quickly it was gone. Coach Erica must have read my whining and sent me a “gimme” workout which I completed this morning. Lots of short intervals with some rests.

When I got to work I made the decision to talk to Dr. Skorpinski one more time to make sure we were on the right course. I called the office before refilling the Advair which was due today. I called the office and they got me in this afternoon which is what I was hoping for. He listened to my story and my 2 nightmarish days last week and then did a quick examination. He reassured me we are on the right track. I was going to have a bad day now and then but he firmly believes  the Advair at the current dose is right. At this point, I think so too. Last week I was frustrated (and in all honesty a little scared) and just wanted to breathe. But I do think I am headed back to good health. Of course, I filled the Advair today and may need to sell my new bike to be able to afford it!!!! But that is another story.

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