Friday, October 30, 2009

Differential Diagnosis II : Lungs of a 90 Year Old

Apparently what I'm going through is all the pre-House-episode stuff that the patient goes through before they get to be treated by House's illustrious team.

The steriods worked great, when I was taking them three and four times a day. See, you get a blister-pack, with how many pills you are supposed to take and when. You start out with about 8 pills a day and gradually back off, taking one pill the last day. Of course, the steriods also caused me to feel alittle manic, with bouncing off the walls energy, but I kept reminding myself of how I got the energy and that I'd pay later, in sleep and perhaps depression, which helped. But on the night before the last day, I started coughing again. And despite supposably being better than Prilosec, the Nexium wasn't making a noticable difference. I was back to where I'd been before. My biggest comfort was that at least I knew I wasn't contagious and my coughing couldn't make my uncle, or any other member of my family, sick. I was resigned to the fact that the cough was here to stay.

I did, however, have a slight shift in thinking, if not a full blown change of heart. A friend of mine, who I know is very aware of how his own body looks, but doesn't limit the kinds of food he eats, brought up that he just cut back his portion sizes when he started to feel like he was putting on a few pounds. It meant that he could still enjoy any kind of food he wanted to, just not as much, though he'd always save the rest for a later meal or share it with someone else. This would also be very helpful for me, since I've overeaten to the point of being ill several times over this past summer and fall. So I decided then that I'd really try to eat less, control my portions, and not drink so much soda, which is really just empty calories, no matter how much I love it.

I expected a disheartening but uneventful follow-up appointment. But the Physicians Assistant brought up the chest x-ray and a breathing test, just to be sure. I agreed, though I was pretty sure that it was going to come back all clean and she'd tell me to lose weight and change my diet. But that was not the case. The chest x-ray was fine, unless the doctor finds something that was hiding under my nipple piercings. It was the breathing test that came back with more troubling results. The PA told me that I had the lungs of a 90 year old. Now, I've done a bit of internet research and "lung age" seems to be less a diagnostic explanation and more something that sounds scary and is used to scary smokers into quitting smoking, because you put it in terms someone can understand. Now, that doesn't mean that it's wrong or untrue. I think she wanted to convey in real-world terms how bad my breathing and lungs seem from their tests, so that I'll be more likely to go the distance in going to see a pulmonologist, who she is hoping will be able to tell me what is wrong with me, despite the fact that I don't have insurance and would have to come up with the money on my own. I think if I wasn't on the lithium, I would have cried right there in the exam room.

I am already in the process of setting up an appointment with a pulmonologist at a local university hospital that my uncle's boyfriend has been able to set up payment plans with, in the hopes that it will be easy for me to do the same thing. The hospital's pulmonology division is currently waiting to get my records from the primary care doctor, then they'll call me to make an appointment time. That was the PA's main treatment plan, though she also gave me a sample of Symbicort, which is for COPD and asthma, and she says should help. She promises to try to get more samples for me. As for the previous push to lose weight, etc, that seems to not be as important now, at least until I get a more firm diagnosis. She must have overlooked that I'm on lithium when I was there for my first appointment, because, when she did mention weight loss this time, she told me that, because I was on lithium, it would be more difficult that usual, so I shouldn't feel too bad if I can't really lose weight, though losing weight and being more active will always help and I should still change what I eat, at least to help manage the acid reflux.

The hardest part right now is the waiting and not knowing. I don't know what is wrong or why or what caused it or what to do about it. I don't know what it will cost to treat it. One thing that is kinda driving me crazy right now is that everything I see online attributes almost all of these things to smoking, but I just can't imagine that the small amount of smoking I've done in my life has done this much damage, especially when compared to regular smokers my age and older, who don't have similar problems yet. Yes, I'm aware that ANY amount of smoking will do some damage to your lungs. But not this much from that little. Then again, Christopher Reeves' wife died from lung cancer and she never smoked a day in her life. (Not to say that I think I have cancer. I absolutely do not think I have cancer.) But this is where your mind goes while you are waiting for an answer. Especially when you know that few doctors are as brilliant as House, not that you have the money to pay him.

Wednesday, October 07, 2009

Differential Diagnosis

In July, I developed strep. Yep, in the middle of summer, during a period where I saw very few people, I somehow developed strep. It wouldn't have been as big of a deal, but my stomach didn't like the antibiotics. Even once the strep was gone, I still had a weezy cough that cough medicine and mucinex didn't really help. The cough reminded me alot of the cough that I had before I went on medication for acid reflux, so I thought that my esophagus might have just gotten extra-more-irritated during the stomach vs. antibiotics battle and began to take a larger dose of over-the-counter generic prilosec than I had previously. (I was also thinking that my recent weight gain probably wasn't helping either.) That didn't seem to help though. I was still coughing, with weezing on and off. I didn't really want to do anything about it, mostly because I felt like it was mostly psychosomatic, a symptom of the larger depression while staying alone at my grandma's house. I didn't want to spend a bunch of money that we don't really have only to be told it was in my head. But my mom was worried that it was contagious and that I might make my immuno-compromised uncle sick, so I went back to the walk-in clinic where I'd been treated for strep. The nurse practitioner there told me that it was bronchitis and to go to a doctor for a chest x-ray if I wasn't better at the end of the antibiotics that she was going to prescribe. On the one hand, I felt... vindicated? because she was telling me that it wasn't all in my head. It wasn't even because I was overweight. It was just being sick. On the other hand, I might be contagious and/or it might be something, or turn into something, serious.

But I was optimistic. I took the antibiotics. On the first day, I felt great. No weezing. No cough. Second day, I still felt fine. After 24 hours, I was no longer contagious, so I could leave the isolation of my grandma's house and go home. But, alas, it was just the placebo effect. By the night of my third day on the antibiotics, I was back to the weezing and coughing. Of course, I felt decent during the daytime, so I didn't take advantage of any doctor's office hours, for a few days. Eventually, though, it was getting ridiculous. Last night, just taking a small bag of trash outside from the basement had me reaching for an inhaler. Plus, once again, if I'm going to help my uncle during his chemo, I have to be well myself, or at least not contagious, so today I went to the doctor. A real doctor, not a walk-in clinic. Well, kinda. All I could get on short notice was a physician's assistant at my former primary care doctor's office, but still.

And..... the diagnosis is...... I'm fat. Ok, well, thankfully the PA didn't say that. But because I haven't had a fever with the cough, it's not an infection, thus neither bronchitis nor contagious. She was fairly sure that it was just severe irritation of the esophagus. She gave me a prescription of a steriod, to help with my breathing, though it will make me a crazy hyper tweeker for the next several days. She also gave me samples of nexium, namebrand and all. Her theory is that I'll only need a protein pump inhibitor, like nexium, for a bit, until my esophagus heals, then I should be able to 'manage' my acid reflux by "eating a proper diet, maintaining a healthy weight, and avoiding things that irritate it, like caffeine, alcohol, tobacco, spicy foods, acidic foods, etc [or everything good]." I have a follow up in three weeks, so we'll see what happens then, but.... Well, I'll write a later post about what I am thinking about all the dieting and not being fat issues. I just hope this really is what is wrong with me and I start feeling better. I guess I'll worry about the rest as it comes along. But this feels like the lamest episode of House ever.