Wednesday was interesting and frustrating and part was beautiful.
The beautiful part was arriving at the Kingston, Washington ferry dock early. I took photographs of the quite gorgeous light display while I waited for the 6:25 ferry.
On the other side, I drove to Swedish Hospital, Cherry Hill. There I had another set of pulmonary function tests. The technician was very good. She said that since I have a normal forced vital capacity it does not look like asthma. However, a ratio was at 64% of normal, which is related to small airways.
“Have you had allergy testing?” she asks, “And a methacholine challenge?”
“Yes,” I say. “Both. In 2014. No allergies at all and the methacholine was negative.”
“Hmmmm.” she says.
Afterwards we call pulmonary. I have an appointment on this next Wednesday but we call and ask if there is a cancellation and I can get seen today, since I am two hours from home already.
Yes, there is, but I have to hurry to Issaquah, Washington.
There is an accident on the I90 bridge, so I do not think I will make it. But I am there by ten and the pulmonologist will see me. I check in, fill out paperwork, wait, go in the room, a medical assistant asks questions.
The pulmonologist comes in. He is nice and is able to pull up the chest CT from 2012, two of them since the first one “couldn’t rule out cancer”. Since I am referred for hypoxia without a clear cause, he questions me about my heart. Echocardiogram, zio patch (2), bubble study, yeah, it has all been normal. I describe getting sick and tachycardic and hypoxic and coughing.
“Do you cough anything up?”
“Do you cough now?”
“Yes, if I exercise or get tired.”
He is like many physician specialists that I have seen. He has a number of pulmonary diagnoses, or boxes. Emphysema, COPD, lung cancer, bronchiectasis, chronic bronchitis, the progressive muscular disorders. All of those are ruled out in the past. So he puts me in the asthma box.
“I thought asthma was ruled out with the methacholine.” I say.
“Well, you have SOMETHING going on in the lower airways, and it was present in the 2021 and the 2012 pulmonary function tests. Maybe an asthma medicine will help.”
I mention ME-CFS and my muscles not working right, but he only deals with lungs. He won’t say a word about those disorders.
Sigh. I do not get the improvement with albuterol that diagnoses asthma on the pfts and never have. The formal reading of the pfts is that I do not meet criteria for asthma but there is something in the lower airways.
Monsters, maybe? I’ll try the inhaler, though with skepticism. Antibodies seem like a better guess, but antibodies are outside this pulmonologist’s set of boxes.
The photograph is from Swedish, Cherry Hill, bird’s eye view from the balcony.
Good news/bad news. The good news, I know everything about what’s in my box. The bad news, I ignore everything outside of my box. I have a friend who is an orthopedic surgeon in Alaska. I knew him as an excellent resident in our large teaching hospital and asked him why he didn’t accept the offer I was certain he had gotten from us. His answer – “I didn’t want to have to specialize in the outside corner of the left knee.”
It seems there’s just a lot of weird stuff that even good docs aren’t aware of.
There is still a lot we don’t know.
Dealing with hyper specialization is frustrating. I do noses, but not throats. I do hips but not knees, and I do lunges but not muscles. I think as far back as the Asclepiad and Hippocratic practitioners there was some understanding that things were interrelated. So why are we so broken down into little boxes after all these thousands of years?
I don’t know. Seems silly to me, which is why I chose Family Medicine.