Thought I would share what a visit is like with my doctor (also venting). This is kind of typical, especially when we are concerned about something or want a change/adjustment/whatever. If we just come in, check in, get out and get our meds, we have no real issue.
I want to preface this by saying that this doctor came with very good reviews. He is one of the top pulmonary/lung specialists for asthma in all of Japan. He has given lectures, taught most other doctors, lots of books, awards, etc etc. I am guessing he is around 50-60 years of age, his son also has a practice (I think). My husband didn't choose this guy lightly. He is also the only nearest practitioner for...well, miles. The next one is about a 2 hour drive--ONE way. To be on insurance, we have to go as often as the doctor feels is necessary, or every month for refill reasons or something like (I am a little uncertain of the details). There is a large hospital in the big city a little closer that calls in specialists from the prefecture--but that means we have a good chance of running into him again. Talk about embarrassing. If we go somewhere else, we burn a bridge--and I am not willing to do that just yet. We may still seek a second opinion just for the second opinion, though. Japan is also really weird on the hierarchy thing within the medical system, and there is a very tight in-bed going on between insurance, pharmacy and the doctors. AS you can see, this is very complex. So there is a little background. Been going to this guy for about five years now, I think.
Okay, so I go in yesterday feeling not so hot. My peak flow was around 570--a good number for me--but I was feeling. Something. My breathing was slow, but shallow. Inhale was less than exhale, but the exhale was pretty long. Extending the exhale or shallowing my breath didn't help, but I got some relief from my reliever. So I let the doctor know that I wasn't feeling to good. Then, I decided to ask, in my broken Japanese, why I can have asthmatic symptoms even though my peak flow was good. I also asked him about why I can wake up feeling like I run a marathon or did hard exercise in the middle of the night.
Now, I know the answers to these. Between a good book, lots of online articles, and forums like this website, I know that the former is due to small airways acting up while larger ones are still okay. I took choir and singing for years--my breath control is awesome, even if my lung functions are lacking. I also know that the sleeping thing is basically me having a flare in the middle of the night and sleeping through it. But I wanted to see what the doctor said. I guess you could call it a small test. I also tried to make this clear that I have noticed this for YEARS, not just recently. I think that got lost in translation.
For the former, about high peak flow but options--he did this...hmm, good question thing. He didn't have an answer. He took out the SpO2 device to check my oxygen. On my device at home, I usually stick at 98 and occasionally dip to 97. I almost never go to 99. There is a 1 point difference between the doctor and mind. His says 99 for my 98. Today, it said 100--so he said hyperventilation. For both questions. ::insert eye roll here::
I know that arguing won't do anything, but I tried to let him know that I really don't have any hyperventilation feelings. It is *different*. My breath may be shallow, but it is really really slow. No headache, no tingling--and my breath only quickens when I do stuff. I wanted to explain in more detail, but that was the best I could do.
So he says, okay--we how about we do a spirometer and pulmonary test. Yay. I don't know how to explain all the tests. Basically, the first is some kind of breath control (something I have always done pretty easily). You blow in and maintain your breath so that the marker is in the green zone. There was another inhale/exhale test. Then I put my mouth around this device that did a weird pulsing. That always feels weird, I hate it. Then I did some more in and out breaths. These had a up-down graph (up for inhale, down for exhale) and a spiral. I did notice that on this one, there was a number up in the right hand corner that--i think--said temperature. The number was something like 29--well, over 20 and under 30--this will be important in a minute. Anyway, needless to say, doing the test was rough. I had to take a LOT of breaks, and I coughed horrible after we finished (and a few times between takes during this final bit). then I got a breathing medicine thing. Not sure what it is--you hold this little glass vial and inhale a kind of steam. This stuff usually helps a lot.
In we go. The doctor says that my lung functions have improved greatly over the last year! Yay! Well, I am hesitant. I really want him to do this in the winter, when I am really bad. But I didn't say anything at this time. I think he said the other tests indicated a slight hyperventilation And then--
Now this is where that temperature thing is important. He looked at that number and basically was like--wow, something IS going on here. This is too high. It is usually only like that when there is some allergen irritating the lungs. So he explains that I am basically sitting on a volcano. The allergen hasn't fully manifested as an allergic reaction, but it is close. This is probably why I felt like crap.
You have no idea how badly I wanted to say "See, I TOLD you so. I told you something was wrong and it wasn't hyperventilation!"
So he took some blood to send to a lab to check for what the allergy might be and set me up on an IV plus a pred for the next couple of days to keep it under control.
Of course, a wonderful long-time friend asked an important question that I didn't even think about--why a blood test? Why didn't he do a prick test, or if he isn't an allergist (which he isn't) why not refer you? Excellent question. I don't have the answer. But if we don't get a good answer from the blood work, or even if we do, we will probably refer ourselves if he doesn't.
Right now, there are a couple of possibly candidates for the allergen. First up, and highest on the suspect list, is my dog. We got him almost two years ago and I didn't show any issues until recently. Had dogs and cats all my life, so this becoming an allergy would really really suck. I love animals. Another possibility is the left over stirring of dust and mold spores from the remodel. Lower on the list are things like pollen and whatnot. I also went on a long trip around Japan with my mother--so something could have come in from that. Dunno.
Meanwhile, we are adjusting how I interact with my dog until we get a clear idea of how to deal with this. I wear a mask with him, we are increasing vacuuming, I have a smock to wear when playing/interacting with him, no more upstairs for him, and we willy try to increase his brushing. Also, wash hands a lot.
We will find out for sure what the blood results are next week. Then we will go from there. But yeah, this is the kind of battle I have to fight. Having a monopoly like this is horrible--no accountability, no need to stay up on the latest research, etc, and no choices for the patients. He may be good for old people who are used to the traditional: he is a doctor, no questions, just do what he says. Not good for someone like me who, the only reason I was found to have asthma was because I ASKED to be tested. Seems like I have to be in charge here instead of the doctor :/
Right now, I am feeling pretty good--but the last few days I seem to go down-hill in the evening, so we will see how I am later today after classes and whatnot. Luckily, I only have four classes today with a free afternoon.
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