Nov 17

Went to see the doctor this morn. at 9am; also, last night, I read
some relevant pages in the Complete Home Medical Guide [Columbia
University College of Physicians and Surgeons] I got a few days ago, a
Consumers Reports (Consumers Union, really) publication.

From pages 506-507 on Air Pollution:

"[Air pollution results in:] ... Increasing numbers of people become
ill with chronic respiratory disease. Ozone and nitrous oxide have
been shown in experiments to induce changes in the lungs similar to
those seen in emphysema. It is considered one of the risk factors
responsible -- along with cigarette smoking, recurrent infections, or
occupational lung hazard exposure -- for chronic bronchitis,
emphysema, and other chronic lung disease."
[Excerpts from description of Emphysema, p. 493, is reproduced below]

"[another item from the "Air pollution results in" list:] Irritation
of the eyes, nose, and throat and changes in behavior and heart
function. Ozone, the major component of smog, irritates the pharynx
and trachea, causing a burning sensation in the upper part of the
chest. Increased concentration of carbon monoxide in the blood have
been shown to reduce attention; inhalation of airborne lead in
sizable amounts can give rise to neurological changes"

The first "bingo:" I had had a burning feeling in my chest, on and
off, at Chicago. When one doesn't have problems, one doesn't worry
about them, so only because I made a mental note to monitor whether I
had had any shortness of breath while in Mass. was I able to conclude
that the answer was no (or, much much less, to the point of not being
felt, at least for a while, in comparison); I didn't do the same with
the "burning sensation" esp.ly since it was occasional, not daily.
But I'm pretty sure I didn't have it in Mass. I don't have it now, but
my whole throat/lungs/etc situation is now different (more below) with
acute/severe shortness of breath, chest pains, and heart pounding upon
any physical exertion, even much walking, general weakness etc.

From page 493 on Emphysema:

"...Emphysema develops slowly. Slight MORNING and EVENING difficulty
in breathing may be followed sometime later with the beginnings o f
interference in activities. A SHORT WALK may be enough to bring on
BREATHLESSNESS; walking UP STAIRS is DIFFICULT. Eventually, as the
lungs become less and less able to carry out inhaling, exhaling, and
gas exchange, there may come a point when EVERY BREATH requires A
MAJOR EFFORT and the patient is disabled and unable to carry out
normal activities."

The words in CAPS are the one which rang bells; the last two are only
partially true, but getting there; every few minutes I have to sigh
now, and conversation is more difficult [see below]

The heart problems were enough for even my mother to ask (more
politely than my advisor) whether it could be "psychosomatic" to which
I replied, expletives deleted, that there is obviously a strain on the
heart under such breathing circumstances as I was under. A final quote
from the Medical Guide, just following the above quote:

"Shortness of breath is the symptom that most commonly prompts a
person to seek medical attention. The patient may mistake the problems
for asthma or heart disease. In fact, emphysema may lead to serious
cardiovascular problems. Because the disease interferes with the
passage of blood through the lungs and into the circulation, the heart
must work harder. It may enlarge and eventually lead to heart
failure."

Below my wonderful doctor says I don't have emphysema; note, however,
that the air pollution section said "Ozone and nitrous oxide have been
shown in experiments to induce CHANGES IN THE LUNGS SIMILAR to those
seen in EMPHYSEMA" so that it is reasonable to conjecture that the
last quoted excerpt, which describes emphysema's effects on the heart
etc, may well apply at least partially to someone experiencing this
"smog-physema"

------------------------------------------------------------------

Went to doctor. Computers are down, so can't get my record. As usual,
actual app't starts at least 15 minutes after schedule, but you are
rushed out, not overtime. Blood pressure taken, ok. Weight taken, 125
with sneakers -- I'm usually 128-130 w/out clothes. Give short sharp
blow of air through cylinder test. High 500's, then twice 600. Best
out of three is counted: 600. They don't say if test is for volume or
volume/time ("force") of exhale.

Doctor asks for history. Constant shortness of breath. Started the day
I returned to Chicago, etc. May have forgotten to mention chest pains,
which I did tell him over the phone two days prior, Thurs. Did tell
him, as my Cc of form says "any exertion causes his heart to race.
Told of Oct 17/18 night attack, his notes say "has been bothered by
heart rate since that time" which is not accurate; it's been worse
since that time, but I've only started to notice the heart problems,
roughly 2-3 weeks ago.

Listens to my breathing. Its fine. My voice is actually affected by
the phlegm and whatever else so I'm quite hoarse when speaking, which
he doesn't address. But my breathing is fine. He listens next to my
heart. Its no longer racing from several exertions which happened
while in the hospital waiting room, but still noticeably fast; I can
hear it as he listens. He knows he can't lie to my face; he says my
heart rate is: "reasonable." What an adjective. Why doesn't he just
say that it's noticeably fast, but not so fast that he's about to rush
me to the emergency room or rush himself to conclusions.  No, he says
my heart rate is, "reasonable"

During my description of the symptoms, I had to sigh vigorously
several times after any string of long sentences.

At any rate, annoyed by all the "psychosomatic" bullshit and his
manner as well, I said [calmly, as it was physically difficult to get
worked up] that if he wanted to measure [part of my condition] he
could put me on one of those electrocardiogram treads. Well, he says,
in case I have something else, like hyper-thyroid something or anemia,
that would be dangerous.

I briefly take out Complete Home Medical book, which I briefly
mentioned earlier, and turn to pollution and emphysema pages to show
him what similar symptoms I saw. Doc gets very defensive. I "haven't
been listening" he says (re: air flow test shows I "can't" have
emphysema), then starts a new sentence quickly, "...[that/which]
wasn't your fault, since..." [didn't hear the end; maybe there wasn't
one], as he realizes how rude he just sounded. I explain I wasn't
trying to make a diagnosis, just to find similar situations to get a
better understanding of what I have/am experiencing. Well, he says, he
could turn to another page in the book and find similar descriptions
under diff't diseases. Like what? Like the thyroid and anemia stuff he
just prescribed tests for, he answers, as he now actually opens the
door to make sure I get the idea...

The app't then ends quickly, him reasonably politely but essentially
rushing me out of there; he gives me forms to give secretaries for
some blood tests; the sheet says test for the thyroid and anemia.
Computers are down, so can't take them now (need some patient ID) so I
can drop in any time next week.

Now, we know that this stuff started the day I came to Chicago [and
got much worse than ever before during Oct-present], and these tests
are to test completely different things [unless anemia caused by the
smog-physema?] but nothing to investigate the obvious, still left
unaddressed. You get the feeling someone can take their tests for
something like two years before they finally(?) mention/conclude air
pollution (or "allergy" to) all the while killing oneself living
there. Do I want to go to these quacks for this BS, and have blood
removed, which I've been sensitive all my life to small quantities
being removed, now in my weak condition? I'm not sure I will go...

Postscript:
==========

My Cc: of the form shows his notes under "Physical Exam"; these read:

"Peak Flow 600
  No murmurs save for ? [word looks like "if"] MVP [or MUP]. Chest
clear to PeA [?]. No fine tremor -- no palpable thyroid enlargement"

End of "Physical Exam"

He didn't mention anything about this "save for ?" business to me at
all. BTW, someone next to me in the computer room just asked me
whether I was [...]; he's a med student and thought I was maybe
entering patient histories into some database. At any rate I asked him
if he know what this MVP/MUP is, and after about a full minute of
thought (looking at the form) he still wasn't sure; probably some
non-standard/private abbrev. The mystery goes on.

By the way, my doctor, Dr. Jones, is the head of UHS, University
Health Service Here. But don't worry, my advisor who along with
"psychosomatic" has been caught quite a few times by my research to
have asserted things, as he if knew for sure, which are simply false,
and he's the Chair of one of the most prestigious mathematics
departments in the country. And George Bush is the "head of the free
world." Don't worry, I'm just indulging; my bitterness will go away, I
promise, if/when I make it out of here alive and recuperate physically
once in New England. The damage may well take years to be undone, and
even then only partially, perhaps, as Paul Sally's story reminds us.

Harel

Today deep sigh every 5-10 minutes, with some pain. Stairs, long
walks, tire heart, which speeds. Mom may yet U-HAUL with me to N.E.
next Thurs/Fri; need to get back to her; if not, plane ticket outta
here as soon I possible (...promised to teach till Thx-giving
break)

******************************************************************

LATER: Meg Armstrong, quite sympathetic.
Then: don't drink milk -- but I've always done this
Then: ...
Finally: You are being tense [senses my reaction] "I'm saying this as
a friend" and "I find it hard to believe [heart problems started up so
quickly]" (so do I!) Maybe I'm dreaming tense dreams, hence waking up
this way (she did say XXX (rel.ly trivial) heart condition causes
waking up w/racing heart; she did also mention low blood pressure re
heart racing after climbing stairs. Geez Looeez, doesn't intelligence
suffice to realize this is something I never had before, ergo low
blood pressure [which, incidentally my mother does, and I, repeated
measurements showed, don't] et al just don't cut it as explanations??)
I leave, I can't deal w/another straw, not again. She very flustered,
but phony anger in "you're being very selfish ... doing this to
yourself and your parents"

This was Mon Nov 19

Saw May next day.
Never sorry, never admit wrong, can't say "I don't know," like math
like life. And then, when politely I say for around a *year* I had
suspected tension to be cause of shortness of breath (used to be much
milder), finally realized that's not it, after definitely being
relaxed, situation getting worse, etc, plus mentioning how shortness
came back the very night of my returning to Chicago. "[Well], ... [life]
in Chicago [there's more pressure]" Thank you.  Meg's reasoning above
brilliant in comparison.