Thursday, February 7, 2019

Three Beautiful Things 02/06/19: Immunosuppression and Bronchiectasis, Pulmonary Tests, Chunk of Snow-Ice and Cash Stout

1. Today, I turned medical attention from my right eye to my damaged lungs. Because I've had two cases of pneumonia, the first, toxic pneumonia back in 1973 as a result of inhaling a high volume of sulfur dioxide and heavy metal dust in an accident at the Zinc Plant and the second, back in 2009, when I contracted a "normal" case of bacterial pneumonia in Eugene, the Sacred Heart Transplant Center wanted me checked out by pulmonologist before putting me on the transplant list. (I've been working on getting listed since late October.)

I am understanding better why the Sacred Heart Transplant Team is concerned about my history with these pneumonias. If I should received a kidney transplant, the process requires the inducing of immunosuppression to help the survival of the transplanted organ. At the same time that immunosuppression has a positive purpose, it also leaves a person susceptible to opportunistic infections. It's why I had major dental work done in November. My bite was such that it was cutting into the roof of my mouth, a possible cause of infection. That's fixed now.

So, back in 2016, when I first was listed for a transplant at the University of Maryland, I had a chest X-ray and the radiologist didn't like what he saw in the bottom of my lungs and ordered a CT scan and this scan confirmed the presence of bronchiectasis (brawn key ECK tuh sis) in my lungs' lower region.

Back in 2015, nothing came of this discovery. It didn't get me booted off the U of Maryland transplant list. No doctor at U of Maryland nor my primary care physician in Maryland seemed at all concerned about the presence of bronchiectasis in my lungs.

The Sacred Heart team, however, wants this checked out before I'm listed (or not) for a transplant.

That's why I drove on roads free of snow and ice today over to the North Idaho Lung and Asthma Center for some pulmonary testing and a consultation with pulmonologist Dr. Robert Scoggins.

2. My visit began with a series of breathing tests that involved various levels of intense drawing of deep breaths, blowing into a machine, panting into a machine, and variations on that theme. I worked with a calm and calming nurse and these procedures went very well.

After a while, Dr. Scoggins and I went over the results. Nothing in the test results led the doctor to prescribe me an inhaler. In fact, while my lung capacity and the other things they measured are not 100%, things looked, to quote both the doctor and the nurse, pretty good.

By looking at an X-ray I had done back in October, however, Dr. Scoggins could see, and he showed me, the evidence of the bronchiectasis in my lungs.

The good news: I don't have recurrent infections. I don't have symptoms. I do not have a persistent cough. I am not hacking up phlegm, a very good sign. Dr. Scoggins concluded that my pulmonary function is good and not a barrier to transplant. He also concluded that the bronchiectasis is no doubt related to infection when I was younger (like when I got gassed at the Zinc Plant) and should not be a barrier to transplant, although immunosuppression could increase my risk of infection.

Dr. Scoggins decided an appropriate response to my situation was, in his words, to overreact a bit, so I will be having another CT scan done of my chest so he can make a further assessment.
I left this appointment hopeful.

I knew I'd been carrying this infection in my lungs for about forty-six years now and Dr. Scoggins helped me understand it better and helped me understand it in relation to a possible transplant.

So, for now, I'll have the CT scan done, meet with Dr. Scoggins again, and see if his assessment remains the same -- that these pulmonary problems should not be a barrier to transplant.

By the way, here's what does make me cough: anxiety and nervousness. I told Dr. Scoggins this and he assured me that this is true for a lot of people -- it's not unusual.

Oh! Just before my pulmonary testing began, the office of nephrologist Dr. Kristie Jones called me to briefly report on the blood work I had done last Thursday. My kidney function is stable at 16%, my other numbers either look good or are stable, and Dr. Jones doesn't need to see me before the March appointment we already have scheduled.

This news was a relief.

3. On my way to my appointments, I was hurtling west on I-90 about eight miles outside CdA when suddenly, in my lane, a good sized chunk of snow, and, as it turned out, ice appeared. I didn't know in the split second I had to decide what to do if there was traffic to my left in the passing lane, so rather than swerve to the left, I hit the snow-ice chunk. The impact knocked the Sube off kilter for a few seconds as I veered to the left, but I got the car immediately straightened out and continued to CdA.

I arrived in CdA early for my appointment and had decided to enjoy a bowl of Chicken Pho at Pho Tanh and as I eased up the 4th Street exit ramp and made my way to the cafe's parking lot, something was rubbing against the front tire on the driver's side. I looked once I got parked and, indeed, some plastic material in the wheel well had been knocked down by me hitting the snow-ice chunk and I put it back in place. After my soup, while driving to the clinic, the noise persisted.

I went to Les Schwab after my pulmonary appointments and was relieved to see that an employee there drove the Sube back out of the garage a short time after he went in.

He told me that it was that plastic stuff rubbing against the tire. He put it back in place, making me think I hadn't gotten it all when I did the same thing earlier. He checked out other things under the Sube and said it all looked good and I was ready to go. He didn't charge me for his efforts and I returned to Kellogg with a free mind and with better eyesight: I drove all the way home without my glasses on and I am convinced my vision at night is better in my right eye.

I was a little rattled about the snow-ice incident and having the car checked at Les Schwab. (In fact, it made me cough!) I hadn't had a beer for over ten days. I love going to Slate Creek in CdA, so I stopped in to have a pint of Everybody's Brewing Cash Stout Oatmeal Stout, yakked a bit with Danica, an owner of Slate Creek, and felt much better as I made my way home on clear roads with the Sube in good shape and my nerves calmed a bit by that delicious pint of beer. 

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