The Score So Far (Health & Fitness)

[_Res Ipsa]

Have you seen an ENT specialist? For some reason I think a chronic cough could be related to sinus drainage; my sister was a ENT tech and shared various stories about people's ailments...

- Doc

Currently seeing a pulmonologist. Had my sinuses drilled 30 years ago, which worked wonders for infections. Current diagnosis is something like atypically presenting asthma. Just finished up fighting with my heath insurer over coverage, so there should be a miracle inhaler waiting for me at the pharmacy any minute now. Fingers crossed.

[_Jersey Girl]

Hi, it's your stalker.

According to one of my trusty maps, I think you're more than half way to Katahdin.


https://www.summitpost.org/appalachian- ... art/593282


It's possible I'm totally brain fried from calculating some other stuff over here for hours on end, all. day. long. (kmn), so don't take that as gospel.


Here's the other map I use to stalk follow your guys' journey. It's got the elevations and everything.


https://nps.maps.arcgis.com/apps/webapp ... d25453e4e0

If anyone wants to follow Cam and Mrs. Cam's journey, try those maps. Come stalk with me.

[_Jersey Girl]

Have you seen an ENT specialist? For some reason I think a chronic cough could be related to sinus drainage; my sister was a ENT tech and shared various stories about people's ailments...

- Doc

Currently seeing a pulmonologist. Had my sinuses drilled 30 years ago, which worked wonders for infections. Current diagnosis is something like atypically presenting asthma. Just finished up fighting with my heath insurer over coverage, so there should be a miracle inhaler waiting for me at the pharmacy any minute now. Fingers crossed.

Do you know what kind of inhaler you are getting?

[_Res Ipsa]

It’s beclomethasone dipropionate. You have any experience with it?

[_Jersey Girl]

It’s beclomethasone dipropionate. You have any experience with it?

I lost my whole entire reply! Damn! Back on the horse...

No, I don't. I can tell you a couple of things though. If you were using an albuterol inhaler prior, that itself could have been causing you problems. I will tell you why.

There are 4 types of albuterol inhalers: Ventolin HFA, Proventil HFA, Xopenex HFA and Proair HFA.

I was prescribed the Proair HFA about 5 years ago for seasonal allergies. In the past year or so, I found I was using it more and more and more and more until I was blowing through one inhaler per month! I thought I developed asthma, COPD, reactive airway or some other wasting disease. I was in a cycle of coughing and using the inhaler every 2 hours. I kid you not!

Guess what it was? The propellant in 3 of those (including Proair HFA) is ethanol. Ethanol can CONSTRICT the airway. I was allergic to it in the anaphylaxis sense. The only one that doesn't use ethanol is the Ventolin inhaler.

Since I packed up my research and took it to my health care professional, had a lung function test that proved I was okay, and requested a switch to Ventolin, I have gone off all allergy meds. I only use Zyrtec and Ventolin on occasion. I can breathe freely and my singing voice has come back. It's amazing.

I was better in 2-3 days once the irritation in my airway was resolved.

I can tell you that your new inhaler contains a corticosteroid. Those can cause bone loss when used regularly and long term. If you are having to use it regularly, it might be advisable to have a DXA scan and a follow on scan in two years just to see how that is going. You don't want to end up with some other crappy diagnosis down the road. I know tons of people (all ages) in that situation from one of the support groups that I work on. It's a long story. I'm totally fine but it took me 3 years (of stress and hell) to find out I was totally fine so I stayed with the group to help others avoid the same situation that happened to me. Again, it's a long story not worth the telling right now.

But...think about if you were using one of those 3 albuterol inhalers because it could have easily been the cause of your pulmonary distress.

[_Res Ipsa]

Jersey Girl,

Thanks so much for typing all that information (twice)! They had me try an albuterol inhaler back at the beginning of this saga with no effect. Tried several other things, including Montelukast, an oral steroid, a couple other things. What really set it off was smoke from forest fires last summer. I'd had a low-grade, occasional cough for a while, but the smoke sent it into overdrive. And it never ramped back down after the air cleared.

The doc says they see this in adults who had sinus and ear infections in younger days. I had the sinus infections.

Good news is I think the cough has lessened and no sign of bad side effects. Thanks for the bone density advice. I'll talk with my doc at my next visit.

[_Jersey Girl]

Jersey Girl,

Thanks so much for typing all that information (twice)! They had me try an albuterol inhaler back at the beginning of this saga with no effect. Tried several other things, including Montelukast, an oral steroid, a couple other things. What really set it off was smoke from forest fires last summer. I'd had a low-grade, occasional cough for a while, but the smoke sent it into overdrive. And it never ramped back down after the air cleared.

The doc says they see this in adults who had sinus and ear infections in younger days. I had the sinus infections.

Good news is I think the cough has lessened and no sign of bad side effects. Thanks for the bone density advice. I'll talk with my doc at my next visit.

Bone loss is listed as a possible side effect of the inhaler you have been prescribed. It's a feature of corticosteroid use. If I were you, I'd push for a baseline DXA just so you have a starting place and know, that if/when you do have a baseline scan done, you will likely be measured against females in the normative data base in the scanner software, if the data base is NHANES--I know I'm speaking Greek right now but I do know what I'm talking about. It's a far more complicated process than what docs would lead you to believe. Thus my 4 years of stress and hell, with thank God, light at the end of the tunnel and no reason for concern.

So what you do with the scan, is do a follow on 2 years later, and that is what helps you to track your bone density. Should you discover that you are losing bone on account of your meds, there is a series of blood labs you can do to pinpoint what is happening inside your bones. I have that list and that's mostly what resolved the question about my own bones in addition to the fact that the DXA scanner cannot accurately read my bone density. That's another issue altogether and probably doesn't apply to you if you are of average height. If you are very tall or small, it applies.

And by the way, if you are located in real life where I think you are, you have a world class expert in bone loss in your area. If you'd like that information tell me where you want me to put it. You could just do a baseline with her and know you are in good hands should the need to address bone loss arise. If I put the contact information here, the location will go up with it.

Her work (and that of another world class expert) was pivotal in locating the light at the end of my own tunnel. In other words, she knows her subject.

[_Res Ipsa]

Thanks for checking, but I’m fine with you posting the doc’s information. I’m in the Seattle area. I saw the bone loss information in the package information, but it sounds like I need to be more pro active than I thought. Thanks for all the information and advice.

[_Jersey Girl]

Thanks for checking, but I’m fine with you posting the doc’s information. I’m in the Seattle area. I saw the bone loss information in the package information, but it sounds like I need to be more pro active than I thought. Thanks for all the information and advice.

See? This is one of the things I do when I say I work online for support groups. I've been doing this one for 5 years. I don't like giving details publicly but I'll do it to help someone else. I do it nearly every day of my life.

Never let your GP, NP, or PA to evaluate you for bone density issues. What they actually do is allow the scanner report to diagnose you. They don't know what they are doing. They don't know the history of the DXA scanners and how medications evolved over time along with the scanners, they don't know how the WHO determined what constitutes bone thinning vs bone density loss. They don't understand the values they are reading so they go with a particular score found on the report and advise meds. They do not understand the inner workings of the scanners, margins for error (LSC tests), calibration issues and software updates, or any other damn thing. Trust me, they do not.

I could tell you case after case, and even my own case is proof positive that this is true. You do NOT want that.

You want a good baseline scan with a doc who knows precisely what they are doing regarding your individual health history and scans results, and then a good follow on scan by the same facility on the same machine two years later.

Docs who eval and treat patients for bone loss are endocrinologists, rheumatologists, and nephrologists.

I'm giving you a well known and highly regarded expert here:

Dr. Susan M. Ott
Internal medicine - nephrology
4245 Roosevelt Way NE Florida 2, Seattle, Washington 98105
(206) 598 - 4288

Her work regarding densitometry and short stature adults, and the work of the world class expert that I see saved my sanity.

I will drive my point home so you get a referral to her and keep her on your medical team.

Had I listened to the so-called diagnosis and medical advice of my then (now fired) healthcare professional 5 years ago, by the time I had finally learned my stuff via Dr. Ott's study, my online participation, personal research, and saw the expert that I do see now...I would have shown up at his office on year 4 of a medication that carries with it a window of 3-5 years when one can take it safely because somewhere inside that window, the medication itself can cause the very fractures that you are trying to prevent---and with no way to test when you've reached that threshold. That is to say, I could have been in a hospital by that time suffering from debilitating spontaneous femur fractures instead of out and about, enjoying my life, and working out like I do now.

As it stood at the time, I walked into his office 4 years later knowing what I was talking about and he said so. ;-)

And get this, the 2 sets of scans that I had originally done 2 years apart? They both contained errors, not the least of which was that one of them was measuring and comparing the WRONG vertebrae (it matters!), and my healthcare professional (now fired) at the time (who got paid for reviewing them) didn't even notice it. Nor did she understand that my results (the scores she based her diagnosis on) can never be accurate on account of my height and would be the same issue were I a very tall person.

Don't mess around with this. You need to take your new inhaler as prescribed. You also need to just shoot over to Dr. Ott and get a baseline and just discuss with her, so you don't get caught up in a giant medical cluster some years down the road. If you need to use regularly your inhaler, she can help you avoid the cluster.

I'm not trying to scare you. I'm trying head you off at the pass and save you from going through the miserable crap that I've seen hundreds upon hundreds of patients go through because their docs didn't pay sufficient attention to--corticosteroids, steroids (pred) eating disorders, hyperparathyroidism, cancer meds, malabsorption issues, pregnancy/lactation, kidney problems--all of these and other things-- that can cause humans to lose bone mass.

I regularly recommend Dr. Ott to patients in the area. Go see her, get it done, and get it out of the way. And let her run these baseline labs on you if she will:

PTH Intact
Bone Specific Alkaline Phosphatase
Vitamin D25 Hydroxy
C-Telopeptide (CTX)
Osteocalcin
Celiac Disease Panel
Immunofixation IFE/PE
Sed Rate Westergren
Phosphorous
Total Calcium
Preopetide Type 1 Collagen (P1NP)

Greek right?

[_Jersey Girl]

Thanks for letting me post her information publicly. I always have in the back of my mind that someone "out there" might be reading and could use the information that we post about. This is another issue that I've become a strong and vocal advocate for (driven by a combination of gratitude, compassion, and outrage about the crappy inferior practices I've seen happen to myself and others) so it matters to me to get it "out there" because it might matter to someone else. I'm well versed in medication options as well, if anyone needs to know about that at some point, jump into my PM's or the thread and I'll give you a hand with it.