Tag Archives: swimming

A review of today’s appointments

I have a lot to update you guys on! Today has been hectic!

It started off with a rheumatology appointment at 9.30. I was super nervous about this appointment because I didn’t feel that my joints were as controlled as I would have liked even though my morning stiffness had improved and I am able to exercise now [I am training for a 5K 3 times a week, and I swim twice a week] as my joints still hurt and swell, I still have bilateral achilles tendonitis, both my MCL and LCL in my knees are still playing up and I am absolutely knackered. I was worried that my Rheumy would suggest an immunosuppressant [AKA methotrexate or azathioprine] and I was worried about the implications of this on my course and placement as I will be on an infectious disease ward on placement… but thankfully things have turned out for the better and right now I do not need to go on any sort of immunosuppressive therapies [although I was warned that this could change]. I don’t even need to change medications! I had struggled with fluid in my left knee throughout February but thankfully taking Naproxen twice a day [rather than as needed] every day has sorted that and I am happy to report that my rheumatologist found no inflammation or fluid in any of my joints!!! *Cue the happy dance* I also found out that I don’t have any inflammatory markers or auto-antibodies in my blood! First time in 5 years I haven’t had antibodies in my blood guys! This is big!!!

However, we did find that I have lost a significant amount of movement in my right ankle and I have experiences catching/locking in that ankle so the plan for now is to stay on Naproxen and Plaquenil/Hydroxychloroquine at the same dose [400mg a day] for another 4 months, get an MRI on my ankle to see if it is a mechanical or inflammatory issue, continue with my achilles tendonitis exercises, get bloods done and follow up in 4 months.

The nurse I had today was absolutely brilliant, I only had 5 tubes of blood taken today and the nurse remembered me as the girl who usually gets 8 taken… I feel that I must have a bit of a reputation. We had some great banter together, and swapped some funny patient stories about what we experienced on placement, or in her case, in work. I feel that people like her really make your day. My rheumatology clinic can be really depressing, no one wants to be there and you can feel the dread hanging in the air as you sit there surrounded by [mainly] elderly people, or worried parents of younger children/teenagers, but as soon as this nurse walks into the room it really lifts the atmosphere and lets everyone have a little chuckle… Things like that are important.

Me and mum then had to rush up to my university accommodation [about 50 miles from the hospital] so that she could get back down to go to work… and the road was full of lorry’s so that delayed our progress because a lot of them thought they were powerful enough to overtake each other, when they really weren’t. But I got up here in plenty of time to make my asthma annual review.

This was my 3rd asthma annual review… that’s crazy right? I got diagnosed nearly 3 years ago, it really doesn’t seem that long. This is my first asthma review since I moved to university and it was my first asthma review with my new asthma nurse, in fact it was the first time I have met my new asthma nurse so I was quite nervous. But I shouldn’t have been, the appointment went very well. I explained that I felt that I am well controlled [with the exception of a little episode the other week, as a result of having a drink with ice in it] but my big problem is exercise. I find that exercise sets my asthma off quite a lot and I feel that it is preventing me from getting to my full potential during exercise. So we discussed my treatment options, I am already on a combination inhaler so I am to increase that on days that I exercise [although she didn’t tell me how much to increase it by… I’ll probably take an extra puff on the morning and night], I can also pre-medicate with more Ventolin than I do already… She also phoned the GP in my practice who specialises in asthma who advised that I should have a trial of Singulair [AKA Montelukast], so I have to pick up my prescription tomorrow and try it for a month. And then I have to see my asthma nurse in April to see how I am getting on. My asthma nurse prescribed the brand of Singulair rather than the generic, Montelukast, which turns out has to be ordered in [I checked at 3 pharmacies] because it is 14 times more expensive than the generic… If this works I hope she will start prescribing the generic because it is crazy expensive! We aren’t sure if Singulair will help me because I do not have allergic asthma but we decided that if we don’t try it then we will never know, and if it does help, then it was an easy fix.

Every asthma review I’ve had has resulted in a load of follow-up appointments and changes to treatment plans so I am hoping that this won’t end up getting too complicated. I just want to be able to exercise when I want without worrying about having to plan it out with increases in meds on certain days and not on others… Is that too much to ask? Apparently it is… although if it works then I will take it. I have a feeling that we may end up increasing my Flutiform to the 250/10 inhaler in the future if this doesn’t work because I am exercising about 5 days a week now so I will have an increased inhaler dosage for 5 out of 7 days every week… It might just be easier, and cheaper, to have an inhaler with a higher dosage, but we shall cross that bridge when, and if, we come to it.

Right now I am super aware of how many prescriptions I have, I am currently up to 5 [or 6 if you include paracetamol] because it isn’t only going to cost me a lot as soon as I turn 19 [even with a pre-payment certificate] but it is costing the NHS a huge amount too… It’s a shame there isn’t an easy fix out there right now. Of course, I can exercise inside when it is cold but that only helps so much, I still get symptoms… and it probably won’t be any easier in the summer since humidity sets me off too. It’s annoying that the point I get to a point where my joints will allow me to exercise, my asthma kicks up a fuss!

Adios accuhaler, welcome back evohaler!

This morning I had an appointment with my asthma nurse mainly to get my flu jab but also to discuss a few other issues I have been having.

First of all we talked about my peak flow and although she had a few issues with certain things such as the “pretty significant morning dip” and the two asthma attacks I had a week or so ago and the symptoms I still get fairly often we agreed that I am doing a LOT better than I was last time I saw her. And there is a significant difference in my ventolin usage since we increased my dose of Symbicort to 3 inhalations twice a day…

My home people flow this morning was 340 which was done at 7AM and by 9AM my peak flow was 360 (of course there is a variable in the peak flow device used) but that is the highest peak flow I have seen on a morning in a long while so I was pleased with that! I’m slightly (too) excited to see what this evenings peak flow will be.

She asked me what I think my major triggers are now and although they haven’t really changed I still feel that since increasing my dose of Symbicort has enabled me to work better when I am teaching swimming as I can actually speak in full sentences by the end of the session. But I feel that that I still haven’t grasped how to deal with weather changes and how they affect my asthma, particularly thunder storms. I still struggle during sudden thunder storms to control my asthma in a way that I am comfortable, I mean no asthma symptoms are comfortable but if I can avoid having an attack then I’m happy.

About a month ago, I was having issues with my heart palpitations while I was taking Symbicort, particularly since the palpitations would wake me up at night and I would get them frequently throughout the day, and so I spoke to the nurse about this. She said I was using a lot of ventolin that weekend in addition to Symbicort which didn’t really answer my question since I stopped the Symbicort because of the palpitations and then was struggling with my asthma because of missing the Symbicort and ended up need ventolin. But I guess since I haven’t had palpitations for a good month, it is just something to be aware of in the future.

I didn’t mention the wheezing issues I had last night. For those of you who don’t follow the MyLungsMyLife Facebook page, I posted about how I was just about to get to sleep when my lungs decided that they were going to start wheezing out of no where. So I ended up needing ventolin and staying up till 12 just incase my lungs decided to wheeze again. It is odd that I started wheezing though because it is so uncharacteristic to start wheezing before I cough, but then asthma can be unpredictable so I should be expecting the unexpected. But I mean apart from needing my ventolin a few times a week at most and a couple of attacks a month, I do feel really good. So I told her that I wouldn’t mind trying to lower my dose of Symbicort and she agreed that, that would be fine. She also said that she can see from my peak flow diary that I know what to do, when to increase my dose and when to lower it again even though I don’t have any sort of official plan and so that she is going to give me “free-reign” on dosing my Symbicort myself which I think is pretty cool, although I do that anyway.

I do absolutely love my peak flow diary, and I find it super helpful in tracking how my asthma has been and I write what has triggered each attack/exacerbation and why I have increased my dose etc so because it was so apparent to her that I do like to track my asthma (apparently other patients aren’t as good as keeping it up to date) she gave me another peak flow diary, despite the fact that I still have 8 months left on the one I am using right now. She had ran out of the official Asthma UK diaries so I got a generic NHS one but hey, it’s still good!

20131104-192058.jpg

I also asked if I could switch back to the normal ventolin MDI for a few reasons really:
1) I can’t take a ventolin accuhaler on pool side in case it gets wet
2) during an attack it is hard to breathe in deeply enough to get all the medication out and it is also hard to hold your breath for long enough, whereas when using and MDI and spacer you can use tidal breathing
3) the accuhaler is REALLY loud, especially to use in a quiet room
4) I am sick and tired of people asking me what on earth I am using… Clearly people haven’t seen many accuhalers around

So the nurse prescribed me a ventolin MDI and put it on my repeat prescription. She said that I didn’t need to get a new spacer as the one I have is only just over a year old and so, in theory, should still work. So it is adios accuhaler and a welcome back to the evohaler!

20131104-193143.jpg

And then I decorated it with some sheep Sellotape (my apologies for the slightly over exposed picture)

20131104-193348.jpg

To be honest, I wasn’t totally sure if I would be prescribed ventolin as my prescription says salbutamol which is the medication in ventolin (ventolin is the brand name) but a few people I know who have has salbutamol on their prescription have been given salamol at the pharmacy which is the generic version of ventolin. And I’m an pretty sure that it would have been fine but a) salamol is smaller than ventolin and so is harder to use, especially with stiff, sore and swollen hands and b) I wasn’t sure that the delivery system would be the same but as my friend GG assures me, the delivery system is the same and plus it doesn’t matter if you are going to use a spacer.

But anyway when I was at the pharmacy I asked if Salbutamol meant I was going to get ventolin or salamol, to which the pharmacist replied that ventolin IS salbutamol. But then again salbutamol IS also salamol, and that’s what I said… She looked pretty miffed with me, apparently pharmacists don’t like patients to correct them.

Anyway that was today’s events… I don’t need to be seen by the asthma nurse again until around May unless I am having issues that I can’t fix by upping my Symbicort. I did forget to mention about my hiccups but I haven’t had any since last week, so maybe that was just a phase.

Symbicort and heart palpitations

Over the last few weeks I have been getting more and more heart palpitations (when your heart rate become more noticeable). For me my heart rate doesn’t go very fast, maybe around 120bpm but each beat is so strong it feels like my heart is going to jump out of my chest. (I also get tachycardia where my heart goes pretty fast, 200bpm or higher but this post is only on the palpitations).

So last weekend I woke up in the middle of the night with palpitations which is a first for me and that really freaked me out. I have had more palpitations since I increased the Symbicort to 3 puffs a day so I figured it can’t hurt to miss one dose and see what happens. So I missed my morning dose and although I was still getting palpitations they weren’t as bad as before.

My peak flow is a fairly good indication of if I am going to have an attack (unless I end up coming into contact with a trigger I didn’t anticipate) and my peak flow was hanging around 350 even after a missed dose and my lungs were feeling good. So I figured that I would still be okay to miss another dose.

I missed 3 doses of my Symbicort in total. That’s 900mcg of budesonide (steroid) and 54mcg of formoterol (LABA). Quite a lot if you think about it. I can usually feel it if I miss or am late with my Symbicort but I didn’t really feel it until the evening of the next day. My peak flow was around 300 by that time which isn’t terrible, about 65-75% of my best depending what you class as my best (I still think 450 is my best but my asthma nurse thinks 400 is my best). So I decided it was time to start taking the Symbicort again. And since then I haven’t had too many issues with palpitations!

I am still pretty certain that the Symbicort was playing a role in the palpitations by I think extreme stress was the major factor in the palpitations and it was just made worse by the Symbicort.

I am due for an appointment with my asthma nurse this month and there are a few things I would like to discuss with her:
1) what should I do if i get these palpitations again?
2) I really want to go back onto normal ventolin MDI inhalers rather than my DPI that I am on now

20130930-180153.jpg
3) I am wanting to trial a prescription antihistamine for when I go swimming or teaching at a swimming pool to see if it will help with the skin reaction and asthma issues triggered by the chlorine
4) and of course, I need to get my flu jab!

Running on empty

I feel like I am literally running on empty. When I get tired I tend to act really hyper, which I think is a last ditch effort on my body’s account to try to wake me up a bit. But I think I am way beyond that point now.

Last week I pushed myself way to far and it all started because I didn’t give myself a chance to recover on Wednesday, which was a pretty hectic day for me. I mean, I woke up and did all the usual stuff then walked just over 6.5K to my friends house, then from hers to my old secondary school and spent an hour or so messing about with a cricket ball which was really lovely. And then I went pretty much straight from my old school to my swimming club where there was a swimming gala going on. I was supposed to be going in the water to fish out any struggling swimmers but then I ended up being switched to time keeping (basically timing how fast the swimmer is). So that meant that I was on my feet for another 3 hours. By the time I got home I was so stiff, I was kind of shocked because it had been quite a good day joint wise but then I had pushed myself right to the limit.

Thursday was slightly less busy but I decided to go to St. John cadets in the evening which lasts 2 hours and again I was shattered and stiff by the time I came home.

Then on Friday, I had another really busy day. It was my first university open day visit. I went to see Northumbria University and their physiotherapy department. And although the university and everything were really great, I had to do loads of walking and I was on my feet for nearly 7 hours which was really tough and it really did send my hip into a flare. I was kind of expecting to flare but I thought it would be my knee rather than my hip, although my knee joined in after a while too.

On Saturday I got invited back to my old secondary school to help with a sports morning for the kids who will be joining the school in September. I’ve been going to this morning for the last 4, maybe even 5 years and I absolutely love it. But every year I regret doing so much and think that the next year I will take it easy, which I never actually do. So the morning was only a couple of hours from 10.00 till 12.00 but I ended up being there from 9.00 till 12.30. And that really took a lot of energy that I didn’t really have, but I guess there is a price for being dedicated.

Saturday was also my brothers birthday and so I wanted to make him a birthday cake, I made him a monkey cake (I think it looked more like Mr. Potato Head from Toy Story, but my Bro seemed to like it). So that meant I was standing for another 2 hours (baking and decorating). And then my Mum needed to go shopping with me so I could get my Dad’s birthday present so that was even more walking!

Today, I had work this morning, which is where I have to teach kids to swim but I am in the water with them so I can make sure they are safe. So that took one and a half hours, although it leaves me pretty much incapacitated for a few hours afterwards. And then this evening my parents decided it would be a good idea to go for a family swim. I mean I am shattered and I have already been swimming (at least in a swimming pool) once today. So that has drained my energy levels to almost empty. In fact, I feel like I am running on empty.

Normally after a hectic week like that I would have a little while to recover but next week is even busier:

Monday – York St. John open day from 10 till 3 although I am up at 6.45 to get there on time. Then get home at about 4.30ish. Then go swimming coaching for an hour at 6pm.

Tuesday – I have a General Health Appointment at the GP surgery so I can get on and do some of my college work for August. I also have my driving lesson! Woo!

Wednesday – I’m really excited for Wednesday since I am going to Alton Towers, a big theme park, for the day. Although this is going to be a massive drain on my energy resources.

Thursday – I have a child protection course for my swimming club, despite me just completing one for St. John’s and then I go straight from the course to St. John cadets.

Friday – I have another course but this one is to help me write my personal statement. Unfortunately this is an all day course and it is going to take a lot of energy to concentrate.

Saturday – I have another university open day, at the University of Bradford and then I get back at 4ish and have a BBQ to go to, which should be fun! And also my Grandparents are coming down from Scotland which is also really exciting.

Sunday – Sunday is a quiet day, I have my work in the morning for an hour and a half, and I have managed to get my self into an arrangement with my brother where I have to go and help him choose a phone that he can buy with his birthday money, although he has a sneaky habit of “forgetting” his money so I have to pay for some of it.

So that is a summary of this busy week and the next really hectic week. And as a result, I feel like have no energy at all. I don’t think I have been this lethargic before, all I want to do is sleep. Every chance I get, I fall asleep, which is kind of scary because I never used to get that much sleep but now I can’t function without a lot of extra naps.

12 of 12 June 2013

Here is my 12 of 12 for June, it is basically 12 pictures that summarise my day. This is a bit late but, better to have it late than never 🙂

20130614-091142.jpg
Bedroom – woke up late this morning, which adds to all the stress of getting ready for college

20130614-094455.jpg
bedroom – my left knee is pretty sore today, and I think it looks a bit different to normal but I’m not sure, it might just be normal. I’m still trying to get to grips with noticing the signs of inflammation when my joints are bad. So this picture is mainly for my rheumy and physio but I thought I would include it since it technically is part of my 12 of 12.

20130614-091301.jpg
Bedroom – after getting up late, I managed to have a shower, get changed, have breakfast and take meds by 7.30! Must have been the fastest I’ve ever got ready .

20130614-092007.jpg
Bedroom – picture of my train ticket! I got this ticket at 13.28 and I had to get the train at 13.30 at the other end of the station. I ended up running for the train with people looking at me like I was silly.

20130614-091638.jpg
Living room – it took me about an hour and a half to get home from college, with a lot of stress, so I thought I’d treat myself to a chocolate cake

20130614-092428.jpg
Bedroom – with all the exam stress I hadn’t had time to tidy up my room so I decided that today is the time to tidy it! [please no comments about how messy my room is, I know :)]

20130614-092655.jpg
bedroom again! – look how tidy it is! And it only took me half an hour. I’ve put all the papers in folders depending on subject, cleared up my desk and my i also tidied my shelf!

20130614-093121.jpg
Bedroom also – and then I decided to Hoover and dust everything since dust isn’t exactly good for the lungs.

20130614-094159.jpg
Also in the Living room – I always try to drink a lot before I go coaching, especially because it is so hot on pool side which means it is really easy to get dehydrated.

20130614-093451.jpg
Living room wearing my trainers, I’m about to go and coach swimming for 3 hours and these trainers dry really quickly since I always come out soaking wet despite me not actually going in the water.

20130614-094050.jpg
Living room – my leg decided to spontaneously spring a leak!

20130614-095227.jpg
bedroom so this is my last picture for June 2013’s 12 of 12, the humidity and the chlorine in the pool environment has clearly taken its toll on my lungs since my peak flow is down again.

And that’s it guys! My June 12 of 12. This year is going really quickly, it’s kind if scary. In the coming week I am going to be starting to write my personal statement and get things ready for my university application. That really scares me!

Swimming and asthma

Okay so I wrote a little about this in my triggers post here. But I wanted to do an individual post on this as there isn’t much information about chlorine allergies on the internet.

So I used to swim competitively for about 4 maybe 5 years and I never really experienced any issues with chlorine apart from one time when lifeguards seriously over chlorinated the pool and everybody was coughing.

In February 2012 I started working at a swimming pool teaching kids how to swim and I couldn’t understand why pretty much as soon as got on poolside I would start coughing and within ten minutes be wheezing real bad, I can cope with coughing and wheezing but what really scared me was just how short of breath I was, after an hour I could hardly even talk in full sentences. This was one of the main reasons why I went back to the doctors and got diagnosed with asthma.

I told my asthma nurse my problem in July and she said it was quite rare but she thought I was allergic to chlorine. So I was given a ventolin inhaler which has improved my symptoms but it still only gives me about 10 minutes of relief, and that’s even when I have been taking my inhaled steroids and LABA. So I have decided that on the 30th, when I next see my asthma nurse I’m going to see if there is anything else I can take in addition to help improve my symptoms further, even half an hours’ worth of relief would make a huge difference. If there is nothing she can give me I think I will have to stop swimming and teaching swimming.

Every time I visit a pool, my peak flow drops to around 55% or thereabouts, that means my peak flow hits 55% 4 days a week, alright its only there for about 2 hours but it is still hits 55%. This is dangerous and it has been going on for too long so unless I can control it, I’m going to have to find a new hobby and a new job.