OK…If I get sick, it’s all your fault! ……… just kidding. Thanks everyone for your input

!

You know, I could easily lock myself up in an air tight plastic bubble for the next two months until the Boston marathon rolls around, but experience with this disease has taught me that no matter what I do to avoid getting sick, if my lungs wanna act-up…their gonna act-up.
So, after carefully weighing all the pros and cons, and assuming that I’m breathing well enough to travel in a couple weeks, this is where I’ll be on the morning of March 22nd………along with 100,000 other manics.

And this is where I’ll be that afternoon…….

I think that as long as I don’t over do it during the marathon, that I’ll be OK for Boston. The bulk of my training has already been completed, so in a worst case scenario ( ie…if I were to get sick during or immediately following my trip to Italy), Id still have about 4 weeks to recover and get my s**t together before B day.

With that issue resolved, I can re focus my attention on my upcoming Roman adventure. In addition to Rome and the surrounding communities, I’m also gonna head south, just past Naples for a day to see the ruins at Pompeii grifulvin and Herculaneum

• does coumadin dissolve blood clots

If I have enough time , I also want to take the Mt Vesuvius human growth hormone and tmj accutane sideaffects statistics hiking tour around the rim of Volcano.

I had planned to write a post about my nebulizer treatment routine, but then I thought….what the heck,  I’ll just video it!
Its  spontaneous , unedited and kinda lame, but it’s the real deal and it’s what I have to do at least 6 times a day. ( recorded on 1-28-2009)

Seems to be the new theme around here. Do a long training walk……get sick. ( by sick I mean an asthma exacerbation)

Thursday I did the second to the last of my really long training walks for the Boston and Rome marathons (18.1 miles to be exact), and now, a day later, I’m having a tough time keeping my peak flows out of the red zone. For the first time in a long time, my FEV1

nirvana-all apologies rape me download paxil birth defects cases

clomid jcb actually dipped below 30%. Ive managed to hold my own by increasing my neb treatments to every 1-2 hours , but Ive been huffing and puffing just walking around my house. Funny how I can walk 18 miles one day, and then have a hard time walking 18 feet

the next.

Maybe I over did it, though I’ll be damed if I know how. I felt fine during most of the walk , and to play it cautious , I even walked slower than usual and took half a dozen 3 minute rest breaks along the way. Total time to finish the walk was 4:58 . Other than the noticeable humidity in the air and the smell of fresh cut grass near Crissy field (which can sometimes set me off), overall Id say my breathing was better than average. If anything, it was my arms, legs and feet that were really starting to bother me near the end of the walk.

There are probably numerous environmental and intrinsic factors at play here that are causing me to flare-up after these long walks, but I think the reality is, my disease is simply catching up with me. My lung function and my tolerance for strenuous exercise is declining , and short of a bilateral lung transplant, there’s nothing that will change that. All the more the reason I suppose,to do these upcoming races while I’m still able.

I was asking my friend Mike how he trains for a marathon. His response was, that it takes too much out of him to do traditional mileage building and training walks, so instead, he does core strengthening ( pilates) and a few stair climbs races. Hmmm, maybe he’s on to something. Maybe that’s why he doesn’t have as many breathing flare-ups as I do. Geese, I’d love not to have to do training walks for months on end and risk dying every time I train for a marathon, but there’s no way on earth I would have the endurance or the breath to finish one if I didn’t train the way I currently do. Still, I wonder if the means justifies the end..( or something like that) Oddly, I seem to get sick after almost every training walk , but I’ve only gotten sick one time after finishing an actual marathon.

Btw, here’s a Google Map I plotted out of my 18 mile walk. I like this route because it gives you a little bit of everything. City streets, views of the bay, park paths, vistas from the Golden Gate bridge and just the right amount of hills and straight aways.
To take a virtual tour of my course, click on “view larger map”, zoom in anywhere along the purple course line and use the street view feature to see what I see when I walk this course.
Happy Training!

Finally, a possible explanation of what’s been causing the numbness and pain in my right arm, hand and shoulder.  After more than a year of seeing different specialists and doing what seems like a million tests , it turns that I have something called Thoracic Outlet Syndrome…or TOS for short. 
In a nutshell , because of my anatomy I have a lot over developed muscles in my neck and shoulders that are pinching some nerves and arteries that run through the area, making my right arm and hand numb and making my neck muscles hurt all the time. Lifting weights at the gym was actually making it worse, which would explain why I always felt crappy after working out.
A really cool Sports Medicine doctor at UCSF made the diagnosis last week.  Kind of a relief to finally know whats been going on.  For a while there I didn’t think they’d ever get to the bottom of this.

The plan for now , is to treat it conservatively with Physical Therapy . They want me to go to PT twice a week for 6 weeks , then they’ll re-evaluate. If it doesn’t get better, there are other options, including surgery to cut away some of the muscle( yea..right )
Hopefully the Physical therapy will help and I’ll be able to resume some upper body strengthening in the future,  but for now it looks like the only exercising I’ll be doing is walking and stretching…..It’s always something huh.

best prices on imitrex injection

• hgh pen

Earlier this week I got a chance to sit down with my Pulmonologists to discuss the problem Ive been having with these acute flare-ups that seem to develop a couple hours after doing my longer walks. (Sorry, this post has a lot of medical respiratory jargon in it, but I couldn’t find a way around it)

The thing that seems to perplex everyone the most , is why the delay in onset of symptoms? Why are these exacerbations occurring several hours AFTER the exercise event. These types of flare-ups seem to be more characteristic of an allergic response than exercise induced asthma. Made even more baffling when you consider the reason I walk along the waterfront in the first place, is to avoid the inland landscape that I’m definitely allergic to.

One of the theories being floated, is that I’m not getting the appropriate anticholinergic response or coverage I should be getting from all the Atrovent I take ( Atrovent works differently then Albuterol). They think it’s possible that I’m either immune to, or that the effect of the drug is wearing off long before I finish these longer walks. A possible explanation as to why my asthma symptoms don’t surface during the walk itself , is because vigorous exercise triggers what is known as a “sympathetic response” …..the release of bronchodialator type chemicals into the blood stream that actually helps dilate the airways in asthmatics. When the exercise seizes, so does this bronchodialating effect, and all of a sudden…I have a problem breathing. (You’d think it would be the other way around.)

To test some of these theories, they’re actually going to devise a special exercise stress test to see whats going on with my lungs in real time AFTER I finish a long walk . I’ve done several exercise tests in the past , on a bike in the lab, but because I can walk such far distances without a problem, they have never been able to induce an asthmatic response in the time allowed . For this new experiment, I’m actually going walk 15 miles along my normal route on the San Francisco waterfront ( including crossing the Golden Gate bridge) and will end the walk at the doors of the UCSF airway research clinic.
As soon as I walk through those doors, their going to do a series of pulmonary function tests spaced over several hours, in hopes that they can catch any delayed symptoms or exacerbation that might occur and If my peak flows bottom out, at least I’ll be in the right place.

They haven’t told me yet, what they hope to achieve with the data they collect , other than possibly increasing my daily doses of Atrovent, but I think this will be a worth while experiment and I appreciate all the effort that my doctors and the researchers at UCSF are putting forth in trying to solve this problem.

You know , despite all the incredible things Ive accomplished through fitness and exercise, no one has ever never been able to solve the mystery as to why I sometimes get critically ill after walking. What causes it , what are the triggers, why does it happen?
Five years ago , the answer to that question would have been ” You’re crazy for doing what you’re doing…or…You’re disease is too advance… or… You’re over doing it! ” and the recommendation would have been…” Stop training for marathons” .
Well, times have sure changed. I think through all my achievements and of proving people wrong time and time again, that Ive actually gained the respect of these scientists. Now instead of telling me to stop doing marathons, they’re actually encouraging me!

One of the biggest reasons people with severe asthma or chronic lung disease don’t exercise in the first place, is for fear that they will become even more short of breath. The truth is, if you don’t exercise regularly, you risk becoming so de-conditioned that it actually gets harder to breath. Hopefully, small experiments like this will shed some light on possible solutions.

Because I’m in the middle of training for the next marathon, we’re trying to work out the logistics and the best day in which to schedule the test. I’ll be sure to post more about this experiment in the coming weeks.

Here are just a few of the wonderful people who take care of me on a regular basis and who are involved in cutting edge asthma research:

Here’s a picture of some of the UCSF clinical airway researchers ( and muah) taken a couple of years ago in Golden Gate park for the ALA’s asthma annual walk.

OK, I’m starting to get a little frustrated. Ive been doing everything by the book in training for the upcoming marathon in March, but it seems that my body has other plans.

It was an absolutely gorgeous Saturday morning and a perfect day for walking in San Francisco, but once again, a couple hours after finishing the walk ( 13 miles this time), my lungs decided to protest by clamping down really tight and putting me through another evening of hell . Within just 2 hours of completing the 3.5 hour walk, my peaks flows dropped from 350 to 130. It took a full 24 hours of back to back neb treatments and an epi-pen shot just to get me back into my yellow zone. As I write this post my PF is back up to 290 ( which is still 80 below my baseline), and I’m still very SOB.

I hesitate in calling this event “exercise induced” , because generally , exercise induced asthma flare-ups occur during the exercise , not after it. I did feel a little tighter than usual at the beginning of the walk and probably used my inhalers more than the normal for me , but I didn’t feel so short of breath that I had to stop at any point. I was actually having more problems with the muscle pain in my shoulders and neck than with my breathing. In a way , I think Ive become so conditioned to being short of breath when I exert myself for long periods, that I don’t sense the decline in my lung function until it reaches a dangerous level.
This sensory disconnect, if you will, is starting to get really problematic for me. If only there was a way I could more accurately judge how tight I’m getting in advance, perhaps I could prevent some of these flare-ups from progressing . I’ve even considered taking a peak flow meter along on my walks, but I’m not sure how useful the results would be, since my breathing pattern would be affected by the exercise even if I was breathing OK .

It’s no secret to the people who read my blog that I have a tendency to “over do it” when it come walking, and that sometimes this over zealousness can lead to bouts of hyperinflation and air trapping after the event. But, these most recent post walk flare-ups seem to come out of the blue with symptoms that intensify very rapidly. First I’ll feel a little SOB, then I’ll start wheezing diffusely, and then my PFs will totally bottom out …all within a matter of minutes! Basically a full pledged , bronchospastic, classic text book asthma attack. I don’t like this one bit.

So I guess the big question is, am I gonna have go through this every time I do a long walk from now on ? or were these last two episodes just flukes?
So far, Ive been lucky and have turned around without having to hightail it to the ER , but next time who knows. And if I’m getting this sick after only 13 miles, whats gonna happen after 26 miles? It’s a kind of a scary thought when you consider that my next 26 miler is supposed to take place 6,000 miles from home.

My next scheduled walk is supposed to be 10 miler next weekend, followed a 15 miler the week after. Assuming I’m breathing well enough to walk by then, I think the 15 miler will be the deal breaker as to whether or not I will (or should) walk Rome this year.

Here’s some phone pics from the happier part of the day. (Hard to believe that there was an attack brewing).

• big hits of mid america soma

• paxil cr 12.5 mg

• vegas physician list las ultracet