Monday, November 06, 2006

Whiny Health Crap

Yes, a little bit more of it.

A quote from a journal of mine, concerning the continuing physical struggles:

"A lot of it is due to the fact that I've started working out again. My body's demands for oxygen and other blood carried nutrients increase, though they don't get them! Tests have always revealed a heightened level of whatever felt was [lacking], though the surrounding tissues still lack - the answer? They're not moving out of the blood." - Book X, pp13-14 (emphasis in original)

The ambiguous pronouns refer to both those specific compounds or gases desired and transmitted by blood, and pockets of tissue intended to receive them (not in that order). Not well written, I'll admit; also not the first time I'd postulated the theory, but it's one of the earlier occurrences I can find in writing.

It also happens to be dated November 22nd, 1998: A momentous day in its own right, since later that afternoon I would meet my future wife.

The "tests" to which I made reference were an arterial blood gas (ABG) sample and a cardio-pulmonary stress workup which were done nearly a year prior, before I moved out of Washington State. The results specifically showed physical deconditioning in that the stressed systems exhibited a switch over to anaerobic activity at only the 70th percentile of the bell curve for my age group and lifestyle; the ABG indicated superb oxygenation, however. I'm not sure what the pH levels were, but knowing what I do now I'd love to go back and get my hands on the figures to see.

These two facts seemed to me to contradict one another - why would I fall back to anaerobic metabolism under marked exertion while the materials to support continued aerobic performance were abundantly available?

The Dr., who I never felt was really listening to me (likely under pressure from family to dismiss the issue), just told me I was out of shape and that was the end. This, despite the fact that at the time I was a svelte 145 lbs with lean muscular build (obviously no bulk at that weight, which was possibly too light - but also had a phenomenal general metabolism, so gaining weight was difficult) who had been at peak capability in several high-demand activities up until 18 months before, and only sought medical advice because I found my stamina inexplicably waning. I was not out of shape.

So instead I formulated the theory stated above - that something wasn't working quite right in the periphery. I knew what I was experiencing, and that it was abnormal - but ran out of money and insurance in the move to Utah, and had to let the matter drop. Later, after marrying someone wonderful who also happened to work for the largest insurance provider in the state, I was able to look at things a little more.

The tests were repeated, although the ABG failed this time (technician goof). It was also augmented with echocardiograms, both resting and stressed, and a lung capacity and nuclear perfusion scan. The results in this case were similar, but the same party did not score them together. The answers where given to me as, "we suspect reduced cardiac output" and "your heart is just fine - and your lungs are almost off the charts." I interpreted this to mean that though physically underperforming (the reduced output), there wasn't a good explanation for it.

It was not until working with my current Dr., who pulled the results and added them together for a more comprehensive evaluation, that the answer becomes clear: the stress test measures output gases (hose strapped to the face) as a secondary indicator of heart stroke volume. If the left ventricle does its job right, the freshly oxygenated blood is sent coursing throughout the body to be picked up by those areas in need. This (obviously) increases in frequency and volume under stress, which is why good exercise gets the heart up. In my case, the measured gases indicated that not enough oxygen was being taken up. This was originally interpreted to mean that the delivery mechanism wasn't fulfilling the requirements, thus the diagnosis of insufficient stroke volume.

Viewed in concert with the stress echocardiogram, which specifically measured those parameters in a precise and targeted fashion, this is not the case: the heart does its duty well. Good oxygenated blood is getting where it needs to. The answer, then?

I was right: the periphery is failing to make use of the available materials, and there aren't many things which can cause that. All this time spent looking for other answers has helped to weed out and reduce some manifest symptoms, but the original condition is still what I'd suspected. And this time, I have a Dr. who agrees with me - not because of my tale of woe and long-suffering theories, but by reaching an identical conclusion through separate analysis.

After starting the CPAP therapy a few months ago, to reduce the fractured REM from mild apnea, I was able to concentrate better and found myself more able to be physically active. Together with the proton-pump inhibitor (which satisfied the acid reflux which you may recall was causing referred chest pain) I had some exercise tolerance back. I used it to its fullest, running through every kata I'd ever been taught until perfectly drenched with sweat. I didn't much remember sweating back in the days near the end of my good activity before, and it was pleasant to go through it again and again, daily.

This lasted 2 1/2 months before the amount of sweat began to be reduced, and instead of feeling invigorated I became groggy massively fatigued immediately, followed by an affected night and even into the next day. I've had to trail off again in order to avoid triggering those episodes which I could only manage through frequent naps last time.

Going back to the recent conclusions, this is because systemic metabolism has increased once again beyond the body's ability to supply for that demand. The harder I work now, the worse I'll feel.

Next up we'll be looking at those few things that can cause this particular coincidence of symptoms. My guess is the post-exertional malaise has a flavor of metabolic acidosis to it (which is why I'd love to see the pH levels in earlier tests), caused by the output of cellular metabolism switching to glucose for energy instead of relying on the ATP output of the mitochondria (which require oxygen to do their work properly), in turn because the mitochondria are malfunctioning. The two concomitant conditions (metabolic acidosis and mitochondiral cytosis) are capable of producing exactly the scenarios I endure, and correspond to the available data.

Another option would be some neurological factor that's causing temperature dysregulation et al, but there are other indicators in those cases which would be expected to be present that have never been manifest (no ultra-dramatic sudden onset of muscle weakness, no visual disturbances). Which is good, because the ones capable of doing what I am experiencing might be some precursor for MS (not too keen on that idea).

I'm going to place my bet on abstract mitochondrial myopathy for now, and let you know how it turns out.

This text is in need of editing, but I don't plan to do it. Too much else to take care of.

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