Wednesday, 16 December 2015
Do sick people think they are well?
After a series of breathing problems this summer, the GP suggested I might have asthma.
But I recovered. For three months after the summer, there were no problems. I was back to running, and racing.
During that time I took a mannitol challenge. This is a test where you inhale increasing concentrations of mannitol (a sugar like substance), until you have difficulty breathing. I inhaled up to the highest concentration without a response. This suggested that my lungs were not overly sensitive, as they are in asthma. Still, the test is not definitive.
All during those three months, I took two puffs of my steroid inhaler in the morning and in the evening. After a while, this seemed unnecessary, but I thought I'd continue until I was told to stop by the consultant. I recorded my peak flow each morning and evening, and these remained in the 500s.
I had a meeting with a lung consultant two weeks ago. I felt that this was probably superfluous, but it had taken a while for this appointment to be scheduled, so I wanted to hear what he had to say.
He asked how I was feeling and I told him I was fine.
He suggested, as I suspected, that I reduce the steroid inhaler dose to one puff in the morning and evening, and then come off of it altogether.
I asked if perhaps it really wasn't asthma, and that I'd just had bad luck with some chest infections.
He thought that was possible, but the pattern of my peak flow reading from my last bad patch looked like the an asthma response. Also, I'd responded well to steroids. Three times.
In any event, I was to see how things went with a lower dose of the inhaler, and then without it.
One puff every morning and evening went fine. Again, no problems.
And then I stopped using the inhaler altogether.
The first sign of a problem came after my track session last week.
We did a warm up, then a hard mile, 2 x 800s, and 3 x 200s on a cold, rainy night.
When I arrived home, I was coughing. My wife noticed.
Still, I felt well. On Friday night I noticed just a slight wheeze during the night. Again, because I was feeling well, I didn't think this was anything.
My parkrun on Saturday morning was fine, if a little slower than expected.
On Saturday night, I was out a bit late for the running club's Christmas dinner. That night, again, there was a little wheezing, but it had been a full night, and I'd walked home from the pub.
On Sunday night the wheezing was clear. On Monday, I recorded my lowest peak flow (450) for three months.
On Tuesday it was 430.
I called the consultant.
He listened to my symptoms. He also told me that my blood tests had come back, and that I did not have any allergies. However, my eosinophils (white blood cells) were elevated.
With the reappearance of symptoms following my cessation of the inhaler, and my elevated eosinophils, he was confident in his diagnosis: asthma.
I was to go back on the inhaler immediately.
For three months I had begun to believe that my previous breathing problems were in the past. I was well. But a few days without medication revealed that this was not the case. And I wondered if this was the case for other conditions. If you are feeling good, it is hard to believe that anything is wrong.
The days are very short now. The other morning, at 8:30, it was still largely dark outside when I took a photo of the back garden