May 6, 2009

Unexpected hope

Saw an otolaryngologist today about my breathing issues, fully steeling myself to hear the dreaded "You're fine, you just have a little rhinitis!" answer that has been my wont for the past several years. Didn't get that answer. Said ENT guy stuffed a transnasal flexible laryngoscope up my nose, had me lean forward, and said "Ohhhh yeah." Then slid it back out and said matter-of-factly "Your airway is compromised. It looks like a textbook case of acid reflux."


I said "But I don't have any heartburn, or any stomach ache, or..."

He shook his head. "No. You're quite heavy, and the weight on your stomach at night from your abdomen 'squeezes' the stomach and forces small amounts of reflux back up into your throat. They're not acidic enough or plentiful enough to eat through the mucusoidal sheathing, but they're more than enough to cause edema just below your vocal cords. You have fairly severe swelling of the airway below the larynx, and it's more than enough to cause you breathing problems at night. Coupled with a rhinitis-aggravated post-nasal drip-" -aha, I KNEW he'd get rhinitis into it somewhere- "-that's enough to cause you your continuous throat-clearing attempts and general breathing issues during the day."

I thought about that for a second. "Would this have an impact on my trying to exercise?"

"Oh, yeah. You're not going to get enough oxygen, and you're going to get tired and experience aching and perhaps feelings of dread very very quickly due to inadequate airflow."

(Feelings of dread?) "Oh. Because, yeah, that's what happens when I try to exercise. After maybe thirty seconds."

"Yep. We're going to put you on a massive course of antacids. We can't stop the reflux, but we can lower its acidity to lower the swelling. Hopefully that will be enough to allow you to actually exercise and start reducing your weight. Then that, in turn, will lower and maybe stop the reflux entirely, which should produce more improvement."

I sat there for a second. "I've been feeling like a useless failure because I can't work out, and thought I was just a fat shit."

"Well, you are fat." (At least he didn't say shit.) "But your weight gain past a certain point, the point where you really would normally have started working out, is quite possibly due to this vicious circle - your airway becomes constricted, and even before it would start causing you daytime discomfort, it starts interrupting your sleep via your sleep apnea getting worse. So you're not getting restful sleep. And one of the primary consequences of that, long-term, is weight gain. Which makes everything worse."

"So should I try to exercise again with the pills?"

"No! Not yet. Your blood oxygen is probably low at this point. Not enough to cause overt symptoms, but enough to screw you up and cause cardio stress if you try to work out. Take the pills for a month, then come back and we'll see if your airway has opened. If it has, I'm guessing you'll already have more energy, and we'll clear you for exercise."

Holy shit. Maybe this isn't just because I'm a fat shit and there's no way to break the cycle. Tomorrow, I retrieve some horse-choker antacid pills, and in 4 weeks...maybe...maybe.

Here's hoping. Posted by jbz at May 6, 2009 11:42 PM | TrackBack


J.B. this is an Ockham's razor situation, there is a simpler explanation to this. Your doctor may be right, but he is making too many assumptions. The simpler explanation is that you need to burn more than you eat. Either you eat less or exercise more, or both. You seem to be trapped in the "cannot-exercise-because-im-fat-so-i-dont-burn-enough-calories" circle.
The only way of getting out of the circle is by changing habits, not by doing a 1-month diet or by trying to exercise like crazy.
Eat less fat, less carbohydrates, and be a little bit hungry every time you go to bed. Then start with very soft exercise. Then eat less. Then exercise more. Then eat less. Then exercise more..... You really need to believe in yourself to do this, and not stick to a doctor's opinion based on several hypothesis one of top of the other. Its the only way out, believe your buddy.

Posted by: Enrique at May 21, 2009 6:35 AM

Getting medical advice is much like tech support: you often have to keep calling back until you stumble across someone who can diagnose the problem.

Also, in the truisms department: it's never lupus, but when you visit an otolaryngologist it's *always* reflux. However this is the only reflux diagnosis I've read which actually sounds convincing.

Posted by: daren at May 7, 2009 1:52 PM
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