Never Heard of It

Happy Thursday!

I had a needle jammed in my neck today.

No, there wasn’t a mishap at work. This was actually an anticipated and welcomed event—a treatment for one of Carey’s Crazy Conditions. To wrap up the month of August, I will tell you about two of them, as one leads to the other…

From October 2013-October 2014, I had bronchitis FIVE times. Some folks, when they feel a cold coming on, feel it all in the sinuses. ANY type of cold/infection would go right to my chest. This is not something I wanted to harass my PCP about, since I knew the symptoms by heart and could just buzz on into an urgent care and get my Levaquin (antibiotic), steroids, and nebulizer treatment. A very kind nurse practitioner decided to look at my history while I was there for visit number five and said, “Hey, you have been treated for bronchitis five times at this location since October of last year. Has anyone ever mentioned asthma to you?” Yep, it was time to bother my PCP. I was diagnosed with exercise and allergy induced asthma, put on allergy meds and Singulair, given an Albuterol inhaler, and I went 8 years without a single cough. Amazing!

Asthma is not my crazy condition, so keep your pants on!

Exerting myself outside has always been a challenge and always created what I would call my “cardio cough." I would use my inhaler before and after exercising outside, have a little cough most of the day, and it would subside by the evening time. March of 2020 was a special time for ALL, but for me, it marked the month that Carey’s “cardio cough” went off the chain. There was one day after my outdoor exercise that my cough just wouldn’t go away. It got progressively worse over the next few days, to the point where I called my boss and told him, through pretty much constant coughing, that although I had NO other COVID symptoms, people would not appreciate me being at work if I cannot stop coughing. I was unable to expel air in conversation without tremendous coughing unless I was sucking on a cough drop. But the second that cough drop dissolved, you knew it because the coughing immediately resumed. I opened my mouth to begin speaking to my PCP during a zoom appointment and about 90 seconds of coughing is all that came out. When I finally caught my breath, he said, “Are you done? I think I know what the problem is.” And all I could think is, “I paid him to stare at me on my computer screen.”

Reactive Airway Disease. THERE’S the crazy.

I had never heard of it. So of course, I did my research. In a nutshell, it’s kind of the fibromyalgia of the respiratory world. Some doctors believe it doesn’t really exist and that it’s a diagnosis given when you cannot figure out what is going on. My PCP said it’s a diagnosis he gives when someone’s allergy/exercise induced asthma goes rogue. Exercise or allergens create inflammation in the bronchioles in the lungs, and they get really small and tight, so sometimes it creates wheezing and difficulty breathing. I was definitely having some shortness of breath, but it was related to excessive coughing. That coughing would irritate the bronchioles/airway, and the airway itself would get irritated and become inflamed. I would cough in response to the inflamed airway which causes more inflammation and more coughing…do you see the vicious cycle that illustrates the name of this “disease?” I was given a long steroid taper and another inhaler (for maintenance, not for “rescue” like Albuterol) called Symbicort, and let me tell you, it worked MIRACLES. I was able to do ANYTHING I wanted to outside, and I didn’t even have to deal with my little cardio cough! I didn’t even have to use my Albuterol inhaler anymore. Heat? Humidity? Pollen? You all suck, but BRING IT!

Fast forward to mid-May, I head out for some jog/walk intervals with my BFF. The weather was perfect—60 degrees. Dry (you don’t get may dry days in Maryland!) It was 7am, so the sun wasn’t sizzling my skin yet. We finished the four miles with no issues; however, I suddenly felt my little cardio cough come on for the first time since I started using my Symbicort Inhaler. Hmm. Strange. I used my Albuterol inhaler, and the cardio cough went away in a couple of hours. The pollen count was high. Tomorrow I would use my Albuterol before and after my run.

I couldn’t believe it. The next day was identical to the first. Two perfect days in a row don’t happen in Maryland either! BFF and I were excited. We started our run, and we were only ¾ mile into our four-mile trail when suddenly, it felt as if something grabbed my trachea (windpipe) with its fist and squeezed. I stopped immediately and told my friend that I was willing to walk but couldn’t run at that point. 24 hours later, I was calling my PCP for another steroid taper, and my little sassy self was demanding to know what it was that punched a hole in my Symbicort miracle. COULD. NOT. STOP. COUGHING. I continued the meds I was on, but that commenced three months of complete misery for me that included a month of steroids, an additional inhaler (Spiriva), chest CT to rule out foreign objects or tuberculosis, leaving work for nebulizer treatments, antibiotics (steroids inhibit the immune system and I was susceptible to infections. Yay…) a home nebulizer that I took to work and used three times a day, and, NO LIE, 13 bags of Ricola cough drops. I pulled intercostal (between ribs) and abdominal muscles and threw out my back. When my PCP used everything in his arsenal and was unsuccessful, he referred me to a pulmonologist.

I was sent in for pulmonary function tests (PFTs) before my zoom appointment with the physician. When I met with him and could barely get through the conversation, he was very surprised.

“HOW long have you been doing this?”

“Eight weeks now, sir.”

He indicated the PFTs showed a possible obstruction.

THANK GOODNESS! Not that I was hoping for a grim diagnosis, but I was excited at the potential that something could actually be REMOVED and stop all this nonsense.

He set me up for an urgent neck CT and was able to get me into an otolaryngologist (ok, ok. An ENT. This is just fun to say!) at John’s Hopkins Hospital…in FIVE days. Must be nice to have clout.

I ugly cried at work when the neck CT was negative. I was a brave girl when the ENT squirted lidocaine up my right nostril and then snaked a camera up there and dangled it in the back of my throat to get a look at my vocal cords. (Fun tidbit: Coughing is a vocal cord activity. Sometimes there are nodules that grow on them that trigger a cough reflex.)  I only gagged 3 times when that camera brushed the back of my tongue. Yay me. And I ugly cried yet again when everything was…you got it…normal. BUT, you know that most diagnoses come from ruling things out and seeing what’s left, correct? Since everything was normal, there was only one place to go—the nervous system.

Neurogenic cough. Crazy X100!!

Basically, my nervous system has been overstimulated. I have coughed SO much that I have taught my nervous system that it’s the latest fad and cool thing to do. So now what?

I have returned to Hopkin’s for two 20 second procedures—nerve blocks in the right and left superior laryngeal nerves in my neck, five weeks apart. Today was the second nerve block-this time on left side where lidocaine and steroids are injected into the nerve and say KNOCK IT OFF! I am blown away that such a quick procedure that feels like a bee sting makes such a significant difference. After the first injection, I had 70% less coughing by the time I got out TO THE PARKING LOT. I cried when I got out there, (yes, I cry a lot. Haha…) this time with relief. And I was a completely different person when I saw the ENT today, who is like…12 years old, I swear. Anyhow, with a name like Dr. Simon Best, I knew I was in good hands. And I am optimistic that the coughing will completely go away within the next few weeks.

There you have it! Vertigo, Tennis Elbow, Reactive Airway Disease, Neurogenic Cough. How many crazy conditions do YOU have? My birthday month is coming to a close, and my crown will be gently packed away until next August when I celebrate me. All. Over. Again. Hehe. What crazy conditions do YOU have? Don’t be afraid to do what it takes, whether it’s a home nebulizer, surgery, or a needle in the neck, to help you to…

Be Well!