Military asthma

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ninjasm
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Date Joined Mar 2014
Total Posts : 62
   Posted 3/4/2014 6:32 AM (GMT -6)   
I am searching advice on best medical care to request and questions I should be asking.

Sometime after two deployments to Iraq my allergies went from annoying and unmedicated to crushing and still very symptomatic with medication. My allergist told me that many of my symptoms are from asthma. I've been working with my regular doc and spirometry has shown diminished capacities - but below accepted asthma thresholds. He has not pushed back and said I do not have asthma and agrees that most of my symptoms are definitely asthma. My Army docs have actually been really good - they have seen me over and over and have referred me to every specialist I have requested. I have not been tested after getting onto a treadmill or after being administered the unpronounceable allergic gas.

Related Meds -

Allegra - once in AM
Singulair - once in PM
Symbicort - two puffs twice a day
Nexium - once in AM
Rescue enhaler - everytime before I workout and sometimes after
I have predisone in case things get worse - never taken

When I have issues it is primarily a grating and hacking cough for hours after my heart rate goes up at times it is as minor as I feel an endless need to clear my throat for hours. Obviously this is an impact on staying in physical shape and makes it very difficult to work out. But this also happens if I laugh - to the point where I am afraid to laugh and try to avoid it (which is very contrary to my personality). I also have issue after sex too - afterward I often can not get to sleep for hours while the coughing or the annoying throat clearing thing is going on. That combined with the sleep issues I will about describe have basically destroyed my wife's and my sex life - she's a fantastic lady and will stick by me no matter what - but sex being rare is truly crap on a marriage. It would be more simple if we didn't have two kids and weren't stuck on waiting for them to go to bed. If it's coughing or the throat clearing - an amazing headache almost always follows.

I have much more trouble laying down. I usually sleep on the couch where I can keep myself much more propped up - and where I know I am also not waking my wife up in addition to myself. I wake up in the night choking frequently - sounds like sleep apnea... the first sleep study showed no apnea... but also showed so little sleep that they sent me to a second study. I do not have results from the second study - but since they didn't come into the room in the middle of the night and put a mask on me, they must not have observed apnea.

Sleeping is just awful.

I am always tired. My face always looks like a raccoon with black eyes. The days of me being a motivated and energetic go-getter are past. I now have issues with anxiety and depression.

I have trouble describing my symptoms in an appropriate manner. I am absent some of the more common asthma type issues - I've never wheezed - I've never stopped breathing - I've never gone to an emergency room. I am not convinced that asthma is the correct word for what I have - I definitely have something though. This has been awful for work - I have missed a lot of work for medical in the last year - not just appointments - but also for having a deviated septum corrected and my gallbladder removed. I have been labeled 'the sick guy' in a job where I'm supposed to be a tough Soldier. The doctors have said if my diagnosis gets much further than what it is now they might have their hands tied and have to put me to a medical board (which would risk separation from service). I really don't care though - I'm making my health a priority.

I was an earthmover in Iraq - we weren't just in the dust, we made the dust. There's plenty of research and articles out there about how bad the dust in Iraq is - particularly with heavy metals.

Any advice from your own experience as a patient or a practitioner as to what care I should be requesting and questions I should be asking would be really appreciated! Thanks!

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 3/7/2014 5:46 AM (GMT -6)   
Nothing?

kazbern
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Date Joined May 2010
Total Posts : 8384
   Posted 3/7/2014 8:16 AM (GMT -6)   
This isn't a very active forum.

Just have a moment to suggest that you drop singulair and switch to Pulmicort. Not every drug works for everyone. If you are not getting adequate management from one drug you should switch.

I have cough variant asthma, too, and except for the first couple of years I haven't every had problems with a peak flow test. I know when my inflammation is bad enough to treat but it won't show up on an office breathing test.

The best criteria I've heard from my DRs about when to use my maintenance inhaler is if I have to use my rescue inhaler more than three times per week. Since my allergies are seasonal, I end up needing my pulmicort for a few months in spring and fall, and otherwise I'm fine. I have learned to be especially careful about respiratory illnesses - if I get a cold I immediately increase my pulmicort dose until the cold is gone gone gone.

You might consider adding a sinus lavage to your evening. Get saline sinus stuff by NeilMed from any pharmacy and hopefully that will help you sleep better. You might also try using your rescue inhaler 30 minutes before you lie down.
*******************
50 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day)generic Colazal (96 pills/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), psyllium (1/2T daily), mesalamine enema as needed. Gluten free as of 5/30/11. Colonoscopy found no evidence of inflammation on 8/16/1

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 3/7/2014 9:48 AM (GMT -6)   
Maybe a switch from the nexium to protonics, protonics is an older stomach medicine for GERD and it works better for me. also elevate the head of your bed at night should help. I got an adjustable base a few years ago and it works wonders, if you can ask your doctor for orders(prescription) for an adjustable bed base then you do not have to pay taxes on it...
Write down what you wrote on here or what you would like to talk to your doctor's about and take it with you, so that you have a plan when you visit with your doctor's...I also would get tongue tied with doctors as well and finally started writing an outline of questions and the doctor's always like that because then I got my questions answered.
Also, nebulizer meds might help...Many well wishes and God Bless you, My husband is retire USAF.
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

Gods love in action
Regular Member


Date Joined Feb 2014
Total Posts : 52
   Posted 3/7/2014 11:32 AM (GMT -6)   
Sorry you didn't get more responses. This may sound strange, but my experience is with horses. A lot if our cutting edge treatments in humans come out of the race/show horse world, like the best lung, joint, digestive supplements/treatments available. When horses are in stabled environment, they are exposed to massive amounts of dust, and depending on their geographic location, this dust can contain fungus spores that can reek havoc, like in the desert of the American southwest, coccidioidomycosis, or cocci is caused by the soil-dwelling fungus, Coccidioides immitis, aka Valley Fever. You need to find the "why" inside your lungs to get the best treatment. You need to see a pulmonary specialist who will do biopsies, AND when a lung biopsy is considered, a surgical thoracoscopic biopsy should be obtained, as transbronchial lung biopsies are generally inadequate for diagnosis. Also, since your condition was acquired as the result of military service, you should apply for military VA disability payments, be sure to include all medical paperwork from the military and civilian (you must request copies). Make sure everything is filled out completely, send certified mail, KEEP COPIES of EVERYTHING! The VA can help you with this, you give them a limited power of attorney. NOTE: They will mishandle your request ( entire process should only take six months), so after the six months of runaround, write your eldest, most influential state senator. You will include copies of all VA correspondence, and medical records in the package. Here is the KEY! In the letter, at the end, request that your senator investigate the mishandling of your VA disability claim!! This will force them to process the claim, or go before a Congressional investigative committee! I have helped many other veterans, and wish you the very best!

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 3/7/2014 12:13 PM (GMT -6)   
Thank you both. I just got back from seeing my doc and receiving some sleep study results. very little apnea... but just an overall 'bad' at sleeping - even when asleep. At my request we are starting treatment very gradually - trying some melatonin... I am also adding valerian root. I specifically did NOT want to go to prescription meds right away.

At my request I am being sent to a pulmonologist. The doc wanted to also send me to a GI specialist to look into reflux.

kazbern
Veteran Member


Date Joined May 2010
Total Posts : 8384
   Posted 3/7/2014 2:22 PM (GMT -6)   
I think your choice to avoid prescription meds is inappropriate and I hope the pulminologist is able to convince you of this. Asthma is a serious illness that needs to be managed. If you don't manage it you will get worse. People die from asthma.
*******************
50 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day)generic Colazal (96 pills/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), psyllium (1/2T daily), mesalamine enema as needed. Gluten free as of 5/30/11. Colonoscopy found no evidence of inflammation on 8/16/1

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 3/7/2014 2:37 PM (GMT -6)   
kazbern - I take a BUNCH of prescription meds for my asthma. It's the perscription sleep aides that I'm avoiding!

kazbern
Veteran Member


Date Joined May 2010
Total Posts : 8384
   Posted 3/7/2014 2:51 PM (GMT -6)   
Ah. yes, I get that. Hopefully the melatonin will help you. Maybe some targeted therapy on learning relaxation methods, too, plus increasing exercise? Although I know you wrote your asthma bugs you when you work out.

I think if you can get control over the coughing (good idea to check for reflux, please try the sinus wash) you will feel a lot better.
*******************
50 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day)generic Colazal (96 pills/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), psyllium (1/2T daily), mesalamine enema as needed. Gluten free as of 5/30/11. Colonoscopy found no evidence of inflammation on 8/16/1

Joan M
Veteran Member


Date Joined Jan 2006
Total Posts : 2052
   Posted 3/7/2014 4:18 PM (GMT -6)   
There is a exercise induced asthma. Try to think about what might have triggered the upsurge of your asthma. Can you eliminate this. Have you seen an allergist? Did you know that some foods trigger asthma?

This is a very serious disease. I thought I was just a depressed mess (never did have anxiety with it) but found that asthma robbed me of my breathing. This caused me to be sluggish and always wanting to sleep, etc. Also want to point out that pain can alter your energy level a great deal.

Keep up with the meds and your idea of melatonin is good. It would be worth your while to consult with an allergist as well as the pulmonologist, etc.

Best wishes

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 3/7/2014 4:29 PM (GMT -6)   
You still might want to try elevating your bed at night to see if that can help...do not know if your doing that, wishing you well and the pulmonologist might be the doctor you need ...keep us posted on this...
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 3/10/2014 11:28 AM (GMT -6)   
Joan and Chat - we're on the same page. The bed is elevated... and I have been with an allergist for years and am receiving immunotherapy. I will be seeing a pulmo and GI specialist after the paper-wrok goes through!

Over the weekend my symptoms have been much lighter to not-existent (I'm still taking all of my reg. allergy and asthma drugs though) - to the place where I start questioning 'is this all in my head.' I know it's not - but it is easy to start doubting with an ebb and flow condition like asthma or allergies!

kazbern
Veteran Member


Date Joined May 2010
Total Posts : 8384
   Posted 3/10/2014 12:08 PM (GMT -6)   
Yes, these things come and go pretty fast.

The whole thing with you being unable to laugh without coughing, or do exercise - it's all your asthma. I would say that you are not adequately controlled if you still have these issues.

Have you taken oral steroids to treat your asthma in the past?

I had an intractable asthma flare both times I was pregnant and had to use oral steroids to get it under control. Each time a 5 day burst was sufficient.

My dad has worse asthma than me and also takes a beta blocker to control a-fib. He has a heck of a time controlling his asthma and has had to go on steroid burst packs back-to-back a few times during high allergy season.

If you try a dose of oral steroids use your laughing or exercising as a test of whether your asthma is controlled well.
*******************
50 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day)generic Colazal (96 pills/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), psyllium (1/2T daily), mesalamine enema as needed. Gluten free as of 5/30/11. Colonoscopy found no evidence of inflammation on 8/16/1

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 3/10/2014 6:30 PM (GMT -6)   
Keep on your meds even when your in good control as they are working and giving you relief, someday you might catch a break and will be able to get off your medications. Asthma is that one thing that can trick you, so just keep with what your doing until you see the specialists...
Never for a moment think this is in your head...Asthma is very real and needs to be taken seriously even on good days.
Keep us posted on what the specialists says...finger's crossed for you. Could be cold air was a big trigger for you, cold weather is a huge flair for me and as it warms up some that could be why your improving, but extreme heat can also be a trigger...
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

Joan M
Veteran Member


Date Joined Jan 2006
Total Posts : 2052
   Posted 3/10/2014 8:30 PM (GMT -6)   
I saw "heavy metals" on the list of bad things to be exposed. I was exposed to chemicals as a typesetter for years, living in NYC and Ho, Tx plus involved in an industrial accident. Figure the pollution in Iraq must have been unreal.

Make sure you discuss heavy metals with the pulmonologist. Take care of yourself as best you can. Asthma is not a psychological illness and can be quite serious.

best wishes to all

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 3/28/2014 10:11 AM (GMT -6)   
I met with both the pulmonologist and the GI doc.
The GI is positive that I have severe acid reflux and that it is causing all of my asthma symtoms. He later did a scope that showed just about everything from my throat down to the duodenum is inflammed. We've upped my Nexium to morning and evening and have put me on a restricted diet by food type and time of day made a bunch of typical GERD changes like raising the head of the bed type of thing. I have felt some relief from this - still the nagging hacking cough at all times. Still exhausted when waking up. He even blames my uncontrolled GERD for my resent gallbladder removal!
The pulmonologist thought that GERD would explain most of my symtoms as well. I did not tell her the GI said the same thing. She is being thorough and I am going back in late April for the meth. challenge. My understanding is that a negative responce to the enhaled drugs COMPLETELY rules out asthma. Generally my spriometry readings are on the low side of normal - abnormal readings have been rare. I am also getting a full chest CAT scan the same day. Heck - by the time the meth challenge comes around I will have been on double dosages of Nexium and a special diet for long enough it should be pretty easy to tell if my asthma-like symptoms are GERD related or not.
The army doc that sees all of the asthma cases is not convinced that my symptoms are 100% GERD and believes there is asthma contributing. I'll be seeing him again after I am complete with all of the follow-up testing with the civilian pulmonologist. He said at that time we have to start talking about a permanent profile since I am on high dosages of inhaled steroroids. From the sounds of it, the doses I am at now would require a profile that would trigger a board for the Army to decide if I can continue my 11 year career.

kazbern
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Date Joined May 2010
Total Posts : 8384
   Posted 3/28/2014 10:22 AM (GMT -6)   
Great to see such a thorough review is underway.

Any discussion with the GI about trying another ppi if Nexium isn't doing the trick?

Hope the dietary changes and elevated pillow will resolve a lot of this too.
*******************
50 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day)generic Colazal (96 pills/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), psyllium (1/2T daily), mesalamine enema as needed. Gluten free as of 5/30/11. Colonoscopy found no evidence of inflammation on 8/16/1

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 3/28/2014 11:51 AM (GMT -6)   
I have a follow-up with the GI in a couple of weeks.

I have a constant hickup/spasm thing followed by belching (every couple of minutes or so) that still just keeps on keeping on.

My concern is that maybe its something in addtion to GERD...

and also a concern is if my meth. challenge is negative could other repspiratory issues be causing my constant throat clearing/coughing type symptoms.

jujub
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Date Joined Mar 2003
Total Posts : 10407
   Posted 3/28/2014 12:43 PM (GMT -6)   
I just saw your post, and your symptoms sound very much like mine were. It can be hard to diagnose, it took about a year to sort it out for me - GERD vs asthma. Mine turned out to be cough-variant asthma.

If your respiratory tract is also chronically irritated from aspiration, you may need to continue on some bronchodilators until that can heal. Glad to see you finally have some answers and hope you'll soon be feeling better. That not being able to sleep because you cough every time you lie down is the pits.
Thyroid forum moderator

Ulcerative colitis since 2001, starting 8th year of remission with Remicade.
Inflammatory osteoarthritis; osteonecrosis from steroids
Grave's disease treated with radioactive iodine and now on Levothyroxine.
Type II diabetes induced by steroids.
Eczema, darn it!

"It's always something." ~ Rosanne Rosannadanna

kazbern
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Date Joined May 2010
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   Posted 3/28/2014 2:12 PM (GMT -6)   
The hiccup and belching thing would be typical for me in a reflux flare. I encourage you to talk to your GI about getting better control over that. My daughter tried a bunch of different ppis before finally settling on Dexilant. She took 60 mg/day for almost six months before she felt well enough to start weaning. Sometimes one type of ppi will work better than another. Call your GI.
 
If you haven't done this already, please go over to the GERD forum and start asking questions over there.
*******************
50 yrs old, IBD diagnosis in spring '01. Proctitis, gastritis, ileitis.
Currently taking Pentasa (3g/day)generic Colazal (96 pills/day), Sulfazine (1.5 g/day), Prevacid, folic acid, vit. D (2K iu), flax seed oil (2 tsp/day), psyllium (1/2T daily), mesalamine enema as needed. Gluten free as of 5/30/11. Colonoscopy found no evidence of inflammation on 8/16/1

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 3/31/2014 2:28 PM (GMT -6)   
Judy - I am curious about your similar symptoms you described. What symptoms and testing in particular led to the cough-variant asthma diagnosis? I've been off of my various asthma drugs for about a week now and am getting worse every day. I really am not seeing much as far as improvement with my medication and lifestyle changes for GERD after a week.

I was able to move up my next round of asthma testing, including meth challenge and CAT scans, to late next week. Looking forward to that for hopefully a little more resolution - and to get back onto the meds and stop coughing every eight seconds!

jujub
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Date Joined Mar 2003
Total Posts : 10407
   Posted 3/31/2014 3:43 PM (GMT -6)   
I started with a cough after a cold. It just wouldn't go away - a dry, barking cough that would become paroxysmal in nature, sometimes continuing until I vomited. At night, it would start up as soon as I laid down and never stop. In order for both my husband and me to get any sleep, I started sleeping in my recliner chair.

First diagnosis was post-URI respiratory distress syndrome. It kept on and on. My very good primary care doctor treated with courses of Prednisone (which helped until I went off the Pred), cough suppressants, etc. Finally one day when I was there she heard wheezing and gave me a nebulizer treatment in the office. Voila! No more cough for several hours. At that point she diagnosed asthma and referred me to a very good allergist.

Swallowing studies were negative for reflux, spirometry was normal, but morning meter readings were lower than normal. Allergy skin tests were negative (as they had been years before when I was tested for respiratory allergies), and I was diagnosed with cough-variant asthma and non-IGE mediated allergic symptoms. Apparently this is fairly common in those of us who have autoimmune disorders. What that meant is that, while I had all the miseries of asthma, allergy shots wouldn't help me.

We worked our way through all the antihistamines and all the specific asthma treatments. The combination that finally worked for me is Zyrtec daily and Advair twice a day. I also have a rescue inhaler which I rarely have to use. The zyrtec helps with the nasal allergy symptoms. If I miss the Advair for a couple of days, the barking cough will start again.

I've found that I'm generally triggered by any large concentration of particulates in the air - pollen, molds, smoke, dust - and by very cold air. I'm generally in really good control, use my rescue inhaler maybe once or twice a year. (Usually in the fall, when some people still burn leaves and the smoke will really send me into spasms of coughing and wheezing.)

Don't know if this sounds like you, but I thought it might be a part of your picture.
Thyroid forum moderator

Ulcerative colitis since 2001, starting 8th year of remission with Remicade.
Inflammatory osteoarthritis; osteonecrosis from steroids
Grave's disease treated with radioactive iodine and now on Levothyroxine.
Type II diabetes induced by steroids.
Eczema, darn it!

"It's always something." ~ Rosanne Rosannadanna

ninjasm
Regular Member


Date Joined Mar 2014
Total Posts : 62
   Posted 5/19/2014 9:18 AM (GMT -6)   
After about 45 days of two 40 mg Nexium a day and extensive diet changes my chronic cough is almost completely gone. Trouble is the nexium is causing a whole host of other symptoms... just another step in the Escher stairs of trying to get to feeling better!

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 5/19/2014 11:52 AM (GMT -6)   
I'm on 1- 40 mg of protonics as I couldn't tolerate nexxium...always take my medication early in the morning before I truly wake up, hubby brings it to me at 5 a.m. and I go back to sleep...but yes these medications for the stomach some have more side effects than others...I wonder why they did try you on a different stomach med before they just up it...cabbage and cabbage juice can help acid reflux, but add it in slowly...very slowly...
Maybe some black licorice could be of help for you...just becareful as it can cause high blood pressure if you have that...
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

Joan M
Veteran Member


Date Joined Jan 2006
Total Posts : 2052
   Posted 5/24/2014 8:14 PM (GMT -6)   
I have had allergic asthma for over 30 years. I am sure I have asthma. I had borderline reflux and did not worry about it very much. Became very sick with a stomach type virus and started belching a lot and then could not breathe.

Being an asthmatic for so long, I am really tired of dealing with doctors so I figured it was just another virus/asthma mess. It turned out that now I have a very mild case of Barrett's. I absolutely love fruit and eat lots of veggies too. I like milk products but avoid meat. I do eat it sometimes.

Soda is meaningless to me, as is alcohol and cigarettes. I do drink coffee though. I like iced herbal tea or hot herbal tea in the winter.

Now I am trying to lower my pain med to 7.5 and taking 300 milligrams of Rantindine (spelling) at night. I take 40 mg of omeprazol and wait 20 minutes to 30 hour and then eat and take the 7.5 pain med.

Have VERY SEVERE arthritis and the whole thing makes me tired, pain, asthma and worry.

Doc said that the barrett's does not go away but it is very mild. Hope it does not get worse.

take care everybody ... both of these things (asthma and barrett's) are serious and deserve our best efforts.
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