Back to exercising :)

Just a quick post tonight.  I went to Curves and did a full workout today.  I managed it quite well.

I came home and did a few chores in the kitchen and then all of a sudden a ton of bricks hit me and I was exhausted!  LOL  I am not sure if it was over-doing yesterday, or the workout today, or both.

I managed to play in the pool a little while with Layla and had dinner with Bill and Britt.  I skinned and soaked chicken legs in BBQ sauce today and Bill BBQ-d them tonight.  He bought a new smoker so he could use good wood and not gas or chemicals thinking it would be more natural and better for me.  Well, it ran me out of the pool and out of the back yard into the house. 

The smoke just about did me in.  Any way, we had a good day.  I am tired and off to bed.  Back to Curves tomorrow.

Dr. Visit and brighter outlook

I had an appointment this morning with my Primary Care Doctor.  I took Brittney along so she could be my memory and to have someone else there to hear things I may not have picked up.  (a good idea I highly suggest to anyone who suffers a disease and many doctors trips)

First I lost 5 pounds since my last visit at the beginning of the month.  :)
She took out my stitches and gave me the go-ahead to resume exercise.  Very good news! 

Then she sat and chatted with me.  I love this about her.  She takes time with me to listen to what has been going on health wise.  She listens to my ideas about why I may be acting or feeling a certain way.  She answers all my questions and Brittney's questions.  If she is not sure, she looks things up online to find out perhaps a better treatment plan for me, or a better medication.  She pulls up my cardiologist's report, my current blood work, the notes pertaining to my last ER visit.  She is just awesome and very thorough and that to me is SO important.

I had mentioned in a blog not long ago that I have been going through some family issues.  Well, Bill and I were considering separating and I was just heart broken.  We finally talked things through and have decided we love each other too much to not be together.
Anyway... he mentioned that he thought these hospital ER visits of mine were me being overly dramatic and needing attention.  OH MY GOD.  I was so pissed off I couldn't see straight.  How could a man who has been with me everyday for the last 30 years think so poorly of me? 
So... my appointment today, which I took Brittney to... was partly so I could have a witness come back and discuss with her dad how this is a very real part of Copd.  Not only that but the pain that I have she thinks is (I can't remember the word for it) the small air sacks rupturing.  She said that this happens in a decent sized group of patients with the severity of emphysema that I have.  She said even though they checked at the hospital for ruptures the smaller ones would not show up.  And, they would be VERY painful.

She gave me a medication plan to follow the next time one of these attacks starts.  Right now I am currently taking an anti-inflammatory drug to help me with my fibromyalgia and back pain.
Her plan of attack in emergencies is this....
To have and use only during these attacks toradol.  Use it ONLY for 5 days.  During this time I have to not take the meloxicam I am using now.  Then also take 1-2 Clonazepam which I am taking now and it is a anti-anxiety drug.  I am using it at night for my restless leg syndrome. 

And, she wants me in the mean time to take hydrocodone daily to manage my lung pain and keep me leveled out, especially going back to exercising.

So... that is the plan.  And, Brittney explained to Bill that this is a real medical issue that is caused by my Copd and not just in my head or made up.  ,,l,, that is me flipping the finger to Bill! :)

Oh, my cholesterol is high and if I can't bring it down it is high enough 161 that I could be put on medication for it.  So, she reminded me ... NO ANIMAL PRODUCTS ie: cheese, butter, milk and red meat.  Stick to chicken and white meat turkey and fish and plants.  Lots of fresh fruits and veggies. 

Bill just sighed.  LoL  He said that he will stick to this with me and once in a while make a casserole or buy a steak or make gravy.
I told him that for a while anyway until I can get used to doing without my favorites, I need to not have big blocks of cheese in the frig, and ice cream or sherbet in the freezer, or bacon.

I will be O.K.  It made me feel a little proud of myself when she told me that she is so happy with me.  That most people who are diagnosed with the severity of a disease as I have don't follow doctors instructions and try to better themselves.  Most of her patients she said even do without their oxygen and they do NOT exercise.  So... I am trying.  I want to live.  I don't want to lay down and die.  I have seen this disease in the end of life and it's scary!  Suffocation is scary!!  Being on a ventilator is terrible.  That is the reality of the end of this disease.  I hope before I get there they will just let me take a shot of a few medications and "put me to sleep".  They do have assisted suicide here in Oregon.  That is one thing our government and citizens did that I really like. 

So, I am off to the grocery store to buy plants that I can eat!  LOL
I feel better.  My outlook is brighter.  I have lost that heaviness that I felt for a couple weeks. 

Panic Attacks

Managing COPD Panic Attacks



Panic attacks are very common in COPD patients, and it's terrifying to lose one's breath. But there are ways to confront the fear and head off panic.
By Dennis Thompson Jr.Medically reviewed by Lindsey Marcellin, MD, MPH

Panic attack is a truly frightening experience: Your chest tightens, your heart starts racing, and you may feel a chill run down your spine. But if you’re living with chronic obstructive pulmonary disease (COPD), a panic attack can feel even worse because you already have a hard time breathing, and the sensation of your breath quickening can add to the scare.


Patients with COPD are much more likely to experience regular panic attacks than the general public. Doctors estimate that the prevalence of full-fledged panic disorder is as much as 10 times greater in COPD patients than in the overall population.


These panic attacks are not harmless. Beyond the fright and misery it provokes in patients, panic disorder can create considerable interference in a person's COPD treatment and management. COPD patients who experience frequent panic attacks report more pulmonary disease symptoms, have a worse quality of life, use more medical treatments, and are more frequently hospitalized, research has found.


Panic Attacks and COPD Management


A panic attack involves an intense and sudden surge of fear that grips a person seemingly out of nowhere, and without warning. The fear that grips the person is far out of proportion to whatever prompted it, and may not be related to any particular incident. Panic attacks pass within a matter of minutes, as the human body cannot maintain such a hypervigilant "fight or flight" response for long periods of time, but recurring attacks can continue for hours.


COPD patients develop panic disorder most likely because shortness-of-breath episodes are so terrifying. Their minds learn to misinterpret potential signs of these episodes as actual signs, creating a feedback loop that results in panic.


Symptoms of a panic attack include:
*Pounding, skipping, or racing heartbeat
*Difficulty breathing
*Chest tightness and pain
*Lightheadedness or dizziness
*Nausea or stomach cramps
*Cold sweats
*Trembling and shaking
*Sudden chills or hot flashes
*Tingling in your extremities
*Fear of imminent death or other disastrous outcome


Panic attacks are terrible for proper COPD treatment. The hyperventilation that often accompanies a panic attack creates rapid and shallow breathing, which reduces the ability of the lungs to take in and process oxygen, and thus worsens any COPD symptoms a patient might be experiencing.


How to Deal With Panic Attacks


COPD management must include a plan for dealing with panic attacks and panic disorder. Researchers have found that the best treatment involves cognitive-behavioral therapy, in which a therapist helps the COPD patient learn the subtle body signals that can either create or foretell a panic attack. The therapist also teaches the patient coping strategies, so he can head off an imminent panic attack. Studies have found that cognitive-behavioral therapy can prevent the development or slow the progress of panic disorders in COPD patients.


If you are a COPD patient and find yourself in the grip of a panic attack, you should:


*Relax. Try to take a step back and realize that your symptoms, while frightening, are an overreaction to a situation that is not dangerous.
*Be realistic. Remain in the present, paying attention to what is actually taking place rather than speculating on what might happen.
*Find a distraction. Distract yourself with some simple task like reciting a poem or list, counting backward, or squeezing your hands together.
*Accept the anxiety. Face the fear and accept it rather than fight it, allowing the time to pass.
*Judging the fear on a scale of 1 to 10, notice that even the highest levels of fear retreat within a matter of seconds. Other useful coping mechanisms for panic attacks include the use of:


*Relaxation methods. Learn several relaxation techniques, which can help you calm down before the panic cycle can take hold.
*Medications. These can include anti-anxiety drugs or antidepressants.Find some support.
*Locate support groups, where you can learn successful coping skills from other people who experience frequent panic attacks.

Patients receiving COPD treatment need to learn how to handle panic attacks. Once they’ve done so, they will be much better equipped for dealing with their condition.

I have had better days

I have struggled the last couple days.  Family issues and I used to be able to handle it better than I can now.  Now I get so flustered that I just strike out.  I have opened my mouth when I shouldn't have, and kept quiet when I should have spoken up. 

This is not normal for me.  Normally I can handle this.  It may not always be easy but I have always been able to deal with it. 

This has just left me feeling so alone and down.  Not depression down, just a heavy heart down.  A feeling like even typing my hands are heavy... like I just am getting to the point of no return. 

I am sure this is all so cryptic and I am sorry for that.  I am not going to air dirty laundry again. 

I remember when I first got diagnosed and Bill and I got divorced.  I was convinced things would change.  Everyone told me it takes more than a piece of paper to change things. 

Well, fooled me... it wasn't the divorce that changed things, it was me.  This disease and me.  I have changed.  I no longer can tolerate things.  I can no longer wait for life to come to me.  I speak my mind now.  I let those I love know I do, and what I want for them and their future. 

Bill pretty much thinks that my dieting is useless.  That me working out at Curves is better than me being on a diet and watching my food.  Well, Bill is tired of eating chicken and ground turkey and veggies.  I tell him to go buy his beef or whatever and cook it, but don't push it on me. 
I haven't cooked in a week, since I was in the hospital last Thursday. 
Bill has cooked everyday.  Steak, potatoes, butter, rolls.  That's just an example.  I am being sabotaged by the one I look to the most for support.

This is silly.  I am my own person.  I CAN say no.  I do have the capability to feed myself.  I can push away food, it is not shoved down my throat.  But, it's cooked, and there, and so good.

After these stitches come out and I get back to Curves, I will also start my eating plan again.  Lean meats, veggies, fruits, water. 
I am like watching a slow train wreck... I have the best of intentions to lose weight.  I just seem to have this ability to short stop myself.  I have to find my focus. 

Layla is spending the night tonight.  We had a great afternoon/evening.  She was swimming in the pool and I was throwing weighted rings so she could go down and pick them up.  I wasn't going to get it because of my stitches, but it was warm and she wanted me to play so...I jumped in clothes and all.  We swam for about an hour then came in and I red her some books, we watched silly T.V. and she is out like a light.  I love the child.  She is going through a sassy stage and I am trying to be firm with her when she says smart mouth things or shows attitude that she picked up from her friends.  Tonight I was downstairs doing laundry and she wanted ice cream and I had said no... so at the top of the stairs I hear... "I never get to have anything, jeeze".  So, I hollered for her to come downstairs.  I asked her to sit her bum on the stair and look at me.  I held her little cheeks so she was sure to look at me and I told her "Grandma doesn't put up with smart mouths or disrespectful talk".  Of course she started crying so I had her go sit out on the back deck until she wanted to come back in the house and apologize to me and act like a good little girl. 
Whew!  She just takes it out of me.  I am too old or lack the patience anymore to deal with that. 

Any way, this has not been one of my best weeks.  I am really struggling with breathing, pain in my chest, this incision on my side that is sore, family stuff and being down in the dumps.  I am hoping things get better quickly.

My daily Medications

A simple, short post tonight.  A picture is worth a thousand somethings or others!  LoL  Told you my head isn't screwed on right lately!

2 Years ago I didn't have any medication to take.  I even refused pain meds after a failed back surgery because I hated taking pills so bad. 

This is one day now.  And, some of these medications I take twice a day.

Now, if you'll excuse me it's time to take my meds and go to bed. I still am not 100%. Bill and I went to Veterans Park this morning and I pushed myself as far as I could and didn't even get a mile in. There is just this stabbing pain in my left lung and with exertion it gets worse.


Until tomorrow friends................



COPD is a progressive and incurable disease

COPD the 3rd leading cause of death

Last updated: Thursday, June 30, 2011



Between 1998 and 2009 there was no significant decline in cases of the often deadly ailment known as chronic obstructive pulmonary disease (COPD), and the burden of the disease has shifted from men to women, a new report finds.


By 2009, 11.8 million Americans aged 18 and over suffered from the progressive respiratory illness - about one in every 20 adults, according to the report from the US Centers for Disease Control and Prevention. Just over 6% of women now have COPD, the study found, compared to just over 4% of men.


"COPD is now the third leading cause of death, behind heart disease and cancer," said lead author Dr. Lara J. Akinbami, a medical officer in the Office of Analysis and Epidemiology at the CDC's National Center for Health Statistics. COPD "has replaced stroke, which was the third leading cause of death," she said. "That is mainly because stroke has dramatically declined."


The new report also finds COPD disproportionately affecting the poor and smokers. The latter finding is not surprising, since smoking is a prime risk factor for COPD.


COPD and smoking


COPD, which generally consists of chronic bronchitis or emphysema, is a progressive disease that causes increasing damage to the lungs, making breathing difficult. Most COPD is caused by chronic exposure to lung irritants such as cigarette smoke, but it can also be caused by long-term exposure to other environmental toxins.


The relative increase of COPD among women is largely due to more women taking up smoking in the 1970s and 1980s, Akinbami believes. These women are only now entering a time when the symptoms of COPD start to appear.


Akinbami hopes that with fewer people smoking today vs. decades past, there will be fewer cases of COPD in the future. In that sense, COPD largely is a preventable condition, she said.


In addition to smoking, other environmental risk factors include exposure to toxic fumes at work. There is also a genetic component that can raise the risk, Akinbami said. In addition, the CDC report noted that diet and recurrent infections may play a role.


The CDC team also found strong ethnic and geographical disparities in COPD. For example, COPD was more common among Puerto Ricans and whites than among blacks and Mexican Americans.


COPD was also more common among adults living below the poverty level (8.3%) than among those whose income is at least 200% above the poverty level (4.3%).


And there were big differences region-to-region. The rate of COPD was almost twice as high in the East South Central states (7.5%) vs. the Pacific states (3.9%), according to the report.


No cure for COPD


COPD is a progressive and incurable disease. However, progress has been made in treating the symptoms of the disease, which can at least improve a patient's quality of life. This report found that the rate of hospitalizations for COPD fell among both men and women during the study period, the CDC noted. However, the death rate from COPD dropped only for men.


"Although you can't cure it once you have it, getting diagnosed early and receiving treatment can really help prevent a lot of the complications and ease the symptoms," Akinbami said.


Commenting on the report, Dr E. Neil Schachter, a professor of pulmonary, critical care and sleep medicine at Mount Sinai School of Medicine and director of the Mount Sinai COPD Program in New York City, said that "this has been developing of the last 15 years - that COPD is a major health hazard."


"COPD is the only growing disease among the major diseases that kill people," noted Schachter, who is also a professor of pediatrics and preventive medicine.


Right now, he said, doctors can only treat COPD symptoms - mainly difficulties in breathing - and there is no way to stop progression or reverse the lung damage the disease has already caused.


Schachter said he expects to rates of COPD climb even higher. "There is a 20 to 30 year lag from the time someone starts smoking and COPD symptoms appear and we are still working with a generation of the 70's and 80's." he said.


In addition, although the number of American adults who smoke has dropped to a new low of 20%, the U.S. population has grown, so in real terms there are about the same number of people smoking today as in the late 1960's, Schachter said. "We are pretty much treading water here," he said.


There are still as many a 70 million smokers - 25% of whom are going to develop COPD, Schachter said.


Dr Norman H. Edelman, professor of preventive medicine, internal medicine, physiology and biophysics at Stony Brook University, NY and chief medical officer of the American Lung Association, added that, "the very little progress in treatment of COPD is quite troubling. This could be related to the much less money spent on research than for cancer and cardiovascular disease," he said.

Spiriva showing a troubling pattern of serious heart risks.

Breathe Deeply: Spiriva Studies Show Troubling Pattern Of Serious Heart Risks, If You Know Where To Look

By Ed Silverman // July 14th, 2011 // 11:25 am

Last month, a widely publicized study raised concerns about the safety of the blockbuster Spiriva inhaler that is used to treat chronic obstructive pulmonary disease. The meta-analysis published in the British Medical Journal found that, when administered in the mist form known as Respimat, there was a 52 percent increase in mortality risk compared with a placebo.
Not surprisingly, Boehringer Ingelheim, which makes the inhaler, disagreed. And in disputing the findings, the drugmaker made a point of saying the results were not based on new clinical evidence and that the meta-analysis relied on already publicly available data. BI also maintained that “robust evidence” has also been published about the safety of the older, powder version known as HandiHaler (read the statement).

Specifically, Boehringer pointed to a trio of published studies, including a pooled analysis, which were offered as evidence that Spiriva - a $4.3 billion global seller - has not only been proven safe, but also reduces the risk of cardiovascular events and cardiovascular deaths. This is important because patients suffering from COPD are, generally, older and more likely to have compromised cardiovascular systems. Just the same, BI says that safety and risks are already reflected in product labeling.

However, a review of numerous published studies, briefing documents filed with the FDA and company synopses that are generally posted on the Boehringer web site tell a slightly different story, one that raises questions about the extent to which the drugmaker has willingly shared all the available data about cardiovascular events and just how difficult it can be to identify and access some of this data.

A common thread running through these various papers, including those cited by Boehringer in its press release, indicates that serious cardiovascular events, notably serious cases of tachyarrhythmia and angina, often appear at higher rates than when compared with a placebo or another drug. And the thread actually extends back as far as the fall of 2002, according to sources who have examined Spiriva data, but with one exception, asked not to be named.

In September of that year, an FDA advisory panel reviewed the Spiriva HandiHaler, which was up for agency approval. At the same time, a group of researchers published a follow-up to their 1994 paper, which was called the Lung Health Study and was funded by the National Institutes of Health, concerning Atrovent, a short-acting version of Spiriva. Their analysis found deaths and hospitalizations were more common among patients on the drug (see this).

“This has been a 10-year cover-up,” says Sonal Singh, an assistant professor at the Johns Hopkins University School of Medicine and a co-author of the recent BMJ meta-analysis. “There is a signal here for certain subgroups (of patients). But who are they and why are they experiencing these events? The signals have not been pursued by Boehringer. They’ve played hide and seek with the data.”

A great deal is at stake for all involved. Last year, Spiriva HandiHaler rang up more than $2 billion in US sales and garnered 61 percent of the market for anticholinergic drugs, according to IMS Health. The showing underscores the importance of the treatment to the drugmaker and to the large numbers of people who are prescribed the medication. The implication is that millions of Spiriva patients may be vulnerable to serious cardiovascular risks.

Meanwhile, the US labeling for HandiHaler has never been updated to reflect serious cardiovascular risk, although these events appear in various studies (Respimat has not been approved in the US, but is available in other countries). Yet experts who reviewed the studies say excess risks have been masked by the use of composite events, which Boehringer uses to suggest its inhalers actually reduce cardiovascular risk.

Here is another common thread - the studies were funded by Boehringer – and, in some cases, also by Pfizer, which co-markets Spiriva. And many of the authors were either Boehringer employees or have worked for the drugmaker as a consultant or advisory board member, or received research grants. As an example, one paper, which has been used to tout Spiriva safety and was published last year in the Chest journal, reviewed 30 Respimat and HandiHaler studies and concluded the drug was associated with a reduced risk in cardiovascular death and events.  The study was funded by both drugmakers and the authors either worked for Boehringer or had other financial ties.

For its part, Boehringer maintains that certain adverse event data in some trials may not have been captured immediately due to the nature of clinical trial work, especially in some of the older studies, but more information is actively sought as the research focus narrows and additional evidence is gathered. “As we learn more about the compound,” says John Smith, a senior vice president of clinical research and medical affairs at Boehringer, “there is more granularity available in later studies.”

“When you look at trials, things are going to shift around.There is an ebb and flow in clinical trials…And that’s one of the reasons why we don’t have precise answers. And that’s why we put multiple trials together and come up with hypotheses and then do a trial to answer that,” he continues. “I think we are fulfilling our commitment to patients and prescribers to collect information and give them the best possible information to make decisions.”

As for the FDA, the agency pointed to a January 2010 health alert that reiterated an earlier alert from 2008 that data does not suggest that Spiriva – specifically, the HandiHaler – increased the risk of stroke, heart attack, or death from a cardiovascular cause (see this). However, the agency declined to make someone available to discuss the various studies cited here.

So which studies merit scrutiny? With help from experts, we reviewed various studies published over the past several years of both the Spiriva HandiHaler and Respimat versions and compared specific data - incidence rates, rate ratios - for cardiovascular events found on the FDA and Boehringer web sites. The average clinician, however, is unlikely to know that some of this material exists or where to find it. Moreover, the details appear nuanced unless the studies are examined as a group.

Let’s start in 2002 and peek on page 10 of the FDA briefing document that was used to review Spiriva HandiHaler before it was approved (look here). The overview refers to six pivotal clinical studies and found that, “in the one-year, placebo-controlled studies, five of the seven deaths among (Spiriva) patients, but only one of the seven deaths in placebo patients, were attributable to cardiac ischemia or arrhythmia. And “there were subtle indications that (Spiriva) may be associated with an increased frequency of adverse cardiac effects, specifically in the category of heart rate and rhythm disorders.”

In 2007, a study published in the Canadian Respiratory Journal comparing HandiHaler with placebo did not mention any cardiovascular events, although patients who experienced a myocardial infarction within the previous six months or a cardiac arrhythmia requiring medication were excluded (read here). The study was funded by Boehringer and Pfizer, and the authors worked for the drugmakers as speakers or advisory board members.

Then turn to an unpublished version of the same study from 2005 that appears on the Boehringer web site, which states that “there were 3 percent of patients in the (Spiriva) group reporting serious cardiac disorders compared with 2.6 percent in the placebo group. Of these, the majority of cardiac events were comparable between the two groups, with the exception of myocardial infarction, which occurred in 1 percent of patients in the (Spiriva) group and 0.3 percent in the placebo group.”

In 2008, a widely cited study called UPLIFT was published in The New England Journal of Medicine that compared the HandiHaler with placebo. The study concluded that there was a reduction in cardiac adverse events associated with Spiriva HandiHaler, although a table showed the relative risks – 1.44 for serious angina and 1.25 for cardiac failure (here is the abstract).

However, a more specific breakout appears in the FDA briefing materials for the 2009 advisory panel that was held to review Spiriva Respimat – a table on page 115 shows that the incidence rate for atrial tachycardia was 0.08 compared with placebo and 0.08 again for tachyarrhythmia compared with 0.02 percent for placebo. (Again, the authors were either Boehringer employees or had financial ties to the drugmaker.)

“There’s often way more data from an FDA briefing document, for instance, such as various reviews the company sends in, all kinds of analysis, but sometimes companies don’t want to tell people that,” says Sid Wolfe, who heads Public Citizen Health Research and sat on the 2009 FDA advisory panel that reviewed the safety of the HandiHaler, although he was not asked to review the studies mentioned here. “This kind of discrepancy is unfortunate and is not exactly in the public interest, but it happens.”

So why was there more info in the FDA briefing document?

Smith says this: “The FDA briefing document is impacted by questions we’ve been asked and ongoing dialogue we have with the agency during an ongoing review period. An article may not have all the answers you’re looking for to limit words or figures or pre-specified analyses. I can understand where you’re looking for two different documents addressing the same things and they don’t look identical, but there are different audiences in different forums.”

And how does he explain the angina results? “What’s important to understand is that, while it may seem appropriate to put angina and mycocardial infaction together, they are actually different. In some studies where these are all bucketed together, there may not be the sort of granularity…In earlier trials, they may have been aggregated. Over time, they tend to get split out more.”

However, it is worth noting that in the Chest paper published last year, angina and MI are grouped together. In a more recently published study called POET, which we will get to further down below, both MI and angina are elevated, but broken out.

Meanwhile, a June 2009 synopsis from the Boehringer web site discusses a subgroup analysis and indicates that for fatal events, there was a higher rate ratio for Spiriva in patients with a history of cardiac disease - 4.03 – or arrhythmia at baseline - 8.61. And while the rate ratio for a composite endpoint of major cardiovascular events was balanced in patients with known cardiac disease (0.99), the endpoint was unbalanced for patients with known arrhythmia at baseline (1.72).

We asked Smith why there was more detail in the hard-to-find synopsis. His response: “The distinction was that this was an exploratory analysis and was not pre-specified in the protocol. As a rule, for publication, journals just rely on pre-specified analysis and table displays, and things that are exploratory are just hypotheses that require confirmation.”

Also worth noting is a table on page 158 of a 292-page briefing document submitted by Boehringer for the November 2009 FDA panel meeting (see here). This data is from an unpublished epidemiologic study called THIN-II and, like the POET study, compared Spiriva with a long-acting beta agonist and for certain cardiovascular events, such as atrial fibrillation, cardiac arrest and heart failure, Spiriva showed lower incidence and hazard ratios. But for angina, myocardial infarction, tachycardia and stroke, the Boehringer inhaler displayed higher ratios. As an example, the hazard ratio for stroke was 1.49 and was 1.38 for angina.

Meanwhile, a study published in Respiratory Medicine in 2010, which compared the Respimat inhaler to a placebo, notes that “tachycardia has not been observed in this or other Tiotropium (Spiriva) trials. But again, the table on page 115 from this FDA briefing document, which was reviewed during the 2009 FDA advisory panel meeting to discuss Spiriva safety, shows in the largest Boehringer clinical trial to date that there was a relative risk of 8 atrial tachycardia compared with placebo. The assertion in the journal is contradictory.

The same study in Respiratory Medicine also notes the incidence rate of cardiac disorders was 0.51 percent on Respimat versus 0.22 percent for placebo. The rate ratio was 2.27 percent. (Here is the abstract). The authors, by the way, were either Boehringer employees or received fees from the drugmaker for speaking or consulting, or advisory board work.

Then there was a study that was published this past March in The New England Journal of Medicine. Called POET, the study made little mention of cardiovascular events, except for a table showing a 1.12 rate ratio for patients using Spiriva HandiHaler compared with those using the Serevent inhaler sold by GlaxoSmithKline (here is the abstract). The supplemental appendix, meanwhile, shows a 1.5 rate ratio for myocardial infarction – and a 0.55 percent incidence rate for the HandiHaler compared with 0.37 percent for Serevent.

Then visit ClinicalTrials.gov, where the listing of serious adverse events offers a more nuanced but serious picture. Here are some comparisons showing risks for patients on Spiriva versus Serevent…

For angina pectoris, 0.24 percent of Spiriva patients were at risk vs. 0.14 percent for Serevent;

For unstable angina, both products showed a 0.05 percent risk;

For post-farction angina, 1 percent of Spiriva patients were at risk vs 0 percent for Serevent;

For myocardial ischemia, 0.3 percent of Spiriva patients vs. 0.16 percent for Serevent;

For acute MI, 0.08 percent of Spiriva patients vs. 0.03 percent for Serevent patients;

For myocardial infarction, 0.54 percent of Spiriva patients vs. 0.35 percent of Serevent users.

The POET study, by the way, also excluded patients with a history of myocardial infarction within the year prior to entering the study, those with cardiac arrhythmia that required medical or surgical treatment and patients with severe cardiovascular disorders. “In doing a clinicial trial, a company may exclude patients who are likely to have an adverse reaction, because these would make the results look worse,” says Public Citizen’s Wolfe.

We asked Smith how these cardiovascular events can be explained when people with these backgrounds are not included in the study. Smith’s response: “Generally, for these clinical studies it’s easier to identify actual clinical events to put in exclusion criteria.” He went on to describe the patient population, but did not directly address the question.

As to why the information found on ClinicalTrials.gov was not published in the actual journal, he says such decisions are “driven by editorial policy and discussions between authors and journal editors and where things are placed is not something we have specific policy on.” Although, the study was funded by Boehringer and Pfizer, and most of the authors have financial ties to Boehringer in the form of consulting and lecture fees or research grants. This suggests the drugmakers had an opportunity to communicate with the editors about such decisions.

Then there is an unpublished pooled analysis of six clinical trials comparing Respimat with a placebo, which was completed in February 2010 and undertaken to evaluate fatal events. This analysis was found on the Boehringer web site and the results indicated an imbalance in mortality in patients with known cardiac rhythm disorders at randomization – the rate ratio was 3.42 (read here).

Another pooled analysis was published in the International Journal of COPD in October 2009, and this was cited in the recent Boehringer press release that was issued after the BMJ meta-analysis was released. The study, which was conducted by researchers who were either Boehringer employees or did work as consultants to the drugmaker, concluded that the Spiriva HandiHaler did not show an increased risk for death or cardiovascular morbidity. A table, however, indicates that Spiriva HandiHaler yielded a higher rate than placebo for supraventricular tachycardia. Rates for angina were not presented.

Another trial that was not sponsored by BI conform to the pattern. One was published in the American Journal of Respiratory and Critical Care Medicine in 2008 and was funded by Glaxo, which compared Serevent with HandiHaler. Table 4 showed 19 cases of cardiac disorder with Spiriva compared with nine for Serevent. And the top five most commonly reported serious adverse events that began during treatment were cardiac disorders, with 34 among Spiriva users and 13 among Serevent users.

And a study published earlier this year in Respiratory Medicine -which compared the recently approved COPD drug from Novartis with Serevent, showed Spiriva patients had a higher rate of serious adverse events, such as arrhythmia and cardiac failure than those on the other meds or placebo.

The FDA, Singh says, has failed to sufficiently follow up. “The regulators have not been asking the right questions, because there’s no inconsistency in all this data. But in some patients, tachyarrhythmia and angina can lead to cardiac death and other serious cardiac events,” says Singh, who also co-authored a 2008 meta-analysis that also found an increased risk of serious cardiovascular events, including death, heart attack and stroke. “This is an important public health question, because millions of people are using Spiriva and may be susceptible to one of these outcomes.”

Time to heal

The joke was on me today.  Remember I said last night that I had a doctors appointment today.  Well, I did.  But, I had just ASSUMED that it was a follow up to my emergency room trip on Thursday.  (thinking about it now, how could it have been a follow up if I didn't tell my doctor I was at the hospital in the first place?  Duh!!) 

Well, I show up and am sitting in the waiting area like normal.  A nurse I didn't recognize came out and called my name.  I stood up and followed her ... thinking maybe my doctors assistant wasn't there today.  Nope, we took a wrong turn and then another turn into a surgical room?  I just blindly followed.  I finally asked her what I was here for?  She said to have a cyst removed. 

A light bulb went on and I remember way back in the cobwebs of my memory that she had sent a request to my insurance company for approval.  Evidently someone had forgot to tell me and just scheduled the appointment.  Not that it really mattered to me, I can roll with the punches.  I just wasn't expecting to be laying on a metal table being injected with lidocaine and being cut open.  O.K., it was 5 stitches.  LoL  But, on top of struggling to feel normal again with this Pleurisy and now having to be careful of not sleeping on this incision for a couple days, and No Exercising, or Trampoline-ing for at least a week.  The stitches come out in a week so after that appointment she will give me the go-ahead to start working out again, both with the incision and the Pleurisy.

I asked Bill tonight if we could start going down to Veterans Park again in the mornings and let me walk the circle there.  It's lovely by the lake.   Last year we used to walk it every morning.  So, at least I will be getting some exercise.
I am tired of taking it easy.  I have days where I am forced to do that anyway, so when I feel strong and wanting to fight through this, to be hobbled is tough.
I don't know easy.  Easy makes me frustrated and left with a feeling of failing.  For two years I have had this attitude to fight.  I am afraid if I let myself step off and "take it easy" I won't get my fight back.  It almost makes me fearful and wanting to cry. 

I know I have said this before, but I have got up on days where I didn't feel good and I walked, or jumped, or went to Weight Watchers, or just got up.  I have worked out when I felt like taking a nap.  I have gotten showered and dressed when I wanted to stay in my pajama's and hide away.  I have went to the store and felt the looks and heard the remarks and I pushed forward with my head up. 

I have this momentum going.  Always push forward.  So, I will look at this like it is... it's time to heal and get strong again.  It's not time to lay around and eat.  No No No.  It's time to set small goals, like walking every morning.  Like eating good healthy meals and snacks, and drinking all of the water, and watching the sugar intake.  It's time to take all my meds and if I am tired then sleep, take naps.
Yep, that's what this is ... time to heal.

Looking back to last years blog

I was looking back at last years blog for this time in July. 
I had such hope and promise.  I haven't felt like that in a very long time.  As I take a look inward, it seems I have turned bitter.  I haven't felt joy for a long time.  There are moments, like when I look at Layla's sweet face, or watch Brittney graduate with honors.  But, actual joy not so much.  I am used to this cannula wrapped around my face.  I only get irritated when it gets caught on something or the dog runs across it and it rips off my face.  Other than that I don't actually realize it's on. 

It just seems like there was a positive tone that seems lacking these days. 

This year I had my thyroid surgery, I also had my breast lumpectomy.  Getting those done and out of the way is a big thing.  I don't have to wonder or worry about that, and it's nice to have things get taken care of.

There are those things that have not been dealt with and who could blame my doctor.  I have so many things going wrong all at one time.  She is making a list and dealing with the most important things first.

My Fibromyalgia seems to have been left untreated for the most part.  I don't know though, I forget why I am taking most of these pills so there could be something in there to help ease the pain.  I know my joints just hurt.  This time of year when it gets warm I wake up and walking on my feet is like walking on broken bones.  My knees hurt, my fingers are sore and my hips and back just ache.  I know this is much worse in the warmer weather. 

Of course my breathing seems much more labored now.  Even doing simple things leaves me panting.  I find it harder to go places only because there usually is a lot of walking involved and carrying my O2 tank gets heavy and uncomfortable.  What can I say ... it is progressing.  I have had 4 or 5 trips to the hospital just in the last 4 or 5 months.  Mainly because my chest gets heavy and my breathing is difficult and any time that happens I get sharp pains when I breathe. 

I have worked harder the last 12 months to keep active.  It seems also though I have been trying to lose the same 30 pounds all year.  I am hoping I can find a way to get my focus back.  I know I have talked a lot about it.  I have been my own cheerleader.  I just need to hear my words and trust myself. 

I will give myself a pat on the back as far as keeping to my exercising.  I still have my little trampoline and now Curves.  Of course I haven't been to Curves since last Wednesday, but I will be back soon.  I just need to regain some strength after this Pleurisy thing.  It has really zapped me. 

As for my wanting to get out and about.  Well, that didn't happen.  We did take a trip to Bend for a memorial for mom and a chance for me to spend a few days with my brother.  But there is so much I want to do.  I want to go to the coast for a weekend and walk in the sand.  I want to rent a cabin and go fishing for a week or heck, even a weekend.  I want to take Layla to Disneyland while I can still enjoy it with her.  These things are not very expensive or take a lot of planning. 

I think about the stages of Emphysema some times.  I really don't try and dwell on them.  But, looking back over this year in my blogs I can see a definite progression.  Not much... but worse just the same.  I can see where after 6 or 8 years of this progression how people could just give up and give in.  It really is a daily struggle not only to stay strong and just breathe, but even to keep a somewhat positive outlook and to want to continue fighting this disease.  It is exhausting at times. 

That's why I think keeping some kind of exercise is necessary.  If I stop moving, I will not last long.  The stronger I can keep my "core" the better chance I will have to fight this and stave off the worst of it for a much later date.

I have my follow up doctors appointment tomorrow afternoon.  I will get on here tomorrow night and let you know how it goes. 

Now... Layla is snuggled in my bed, I am going to join her and call it a night.

Still resting

So, pretty much since Thursday I have been in bed.  I am sick of ... being sick, not feeling well, in pain, on pain meds, getting moody because this is a set back.  This has to be one of the most painful things I have been through.  Or at least the most consistent pain with no relief.

This is the information sheet they sent home from the hospital with me on Thursday.

Pleurisy
What you should know:
* The pleura (PLOOR-AH) are thin layers of tissue that form a two-layered lining around the lungs.  One layer of the pleura rests directly on the lungs.  The other layer rests on the chest wall.  Between these layers, there is a small amount of pleural (PLOO-RAL) fluid.  This fluid helps your lungs move easily as you breathe.
* Pleurisy (PLOOR-I-SEE) is when the lining of the lungs becomes inflamed (irritated and swollen).  This causes the two layers of the pleura to rub together when the lungs move during breathing.  Sometimes extra fluid collects in the space between the pleural layers.  When there is too much fluid between the layers that line the lungs, it is called pleural effusion (e-FU-Zhun).  Pleurisy can happen with or without pleural effusion.  If you have pleurisy, you may need medicines to decrease pain and inflammation, or to treat an infection.

There you go.  That is Pleurisy in a nut shell.  All I know is ... I don't want it again, or any more! 

I know it's time to move again.  I cannot lay around this much without paying the price for it.  Losing weight and relying on Bill in the kitchen is impossible!  I am not knocking him... he babies me and buys me things like ... M&M's ... Sherbet.  He cooks with gravy and butter.  You know.... comfort food.  Well, I am about as comfortable as one can get and still fit into my clothes.

I have an appointment with my Primary Care Dr. on Tuesday.  I will hold off activity until then to get an all clear.  I am feeling really worthless. 

I don't make a very good patient.  I am getting a peek into the future and know that I have to fight with everything I have to not be like this for a long long time.  I have had pneumonia a couple times and it was not as painful as this, and didn't leave me feeling quite as weak and useless.  I don't like the pain medication, but I will use it.  If this is to be a set back, when I am able I want to be able to come back full force.  I miss exercising.  I want to get back on the diet track.  I just want to get back up.

Until later............. I'll be resting.

Emergency rooms and dogs under the covers

By 1:30 in the afternoon yesterday I was in the emergency room.  I had first called my primary care doctor and they were out to lunch, next I called my pulmonologist and the phone for his nurse went straight to voice mail.  Then I called Bill and no answer.  I tried to call Britt and no answer.  My next call was to the neighbor, then 911.  Bill called me back and I told him I needed him to take me to the hospital that I was in terrible pain and it was getting increasingly hard to breath.

They of course put 2 I.V.'s in ... one on the back of my hand for meds and one on the other arm further up so a bigger needle could be used to run dye through for the CT scan that was for sure to come.

I am not knocking the Dr.'s or nursing staff there.  I understand their job and need to rule things out.  I told them this was not a cardiac event.  That the pain was in my lower left lung and it felt like a stabbing, burning pain every time I inhaled.  I also told them that I was getting lightheaded when I would stand up.

After 6+ hours they released me home with the diagnoses of Pleurisy and two new prescriptions.

 Ketorolac is used to relieve moderately severe pain, usually after surgery. Ketorolac is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation. Ketorolac comes as a tablet to take by mouth. It is usually taken every 4 to 6 hours ...

 Oxycodone is used to relieve moderate to severe pain. Oxycodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

I came home took my meds and slept, waking only briefly a few times to adjust my position.  Today it seems my chest is tight and the pain is still there.  So, I didn't do much.  I had Bill move my mattress to the living room so I could be a veggie and watch our Big T.V. and not feel like I was locked away.  To me that's the worse part of being in bed is the feeling that the world is passing me by.
So... of course I had to convince the dogs that this was my resting place and not theirs.  Megan (our biggest baby dog .. part Sharpei and part Malamute) thought her place was under the covers.  LoL




Britt's dog Foster is the miniature Australian Shepard and Megan is under my comforter




Dori our Pit being the best girl and not on my bed




Megan the princess again. 

I promised to take the weekend slowly and lay around.  But, I asked the doctor before I left the emergency room if I could exercise soon and he told me as soon as I felt well enough... sure.  Of course taking it slow and stopping if the pain reoccurs.  I made it a point to ask in front of Bill because he is always so eager to point to my working out.
I am hoping Monday I can get back to Curves.  We'll see.

Chest pain

I had a terrible night.  I woke up 4 times with lung pain.  This pain is bad enough to wake me out of a sound sleep and sit straight up. 
It hasn't left today.  I thought that if I got up, took my meds and inhalers, and did a little stretching it may help.  Nope.  I vacuumed and made a few dishes for dinner tonight and it is worse.  Most the time I can do breathing exercises and it will go away or lessen.  Nope.

So, I called my Pulmonologist and left a message with his nurse to please return my call and help me with this pain. 

In the meantime I thought I would blog.  I am afraid to lay down, it makes the pain so much worse. 
Bill is over helping Brittney and Fernando with a plumbing issue so here I am. 

I need to go deal with this somehow... I am just getting more uncomfortable.

Stem Cell Discussion

I woke up this morning and already the air was thick.  It was only about 75 but the thunder heads were rolling in.  We never actually had a thunder storm today but all day the air was heavy.  Even Bill made a comment that it was like soup outside.

I had the appointment with the Doctor about the possibility of getting stem cell treatments, and they said he would call between 3:00 and 5:00.. 
It occurred to me that they were probably talking about Eastern Time so that would be Noon to 2:00 p.m. my time. 

As it was he called about 1:30 my time.  He did most of the talking .... explaining that this would be a 3 to 4 day process.  First they administer a drug that makes my stem cells happy and healthy.  Then they harvest them from my blood.  If those aren't good enough then they would take the stem cells from my bone marrow.  The stem cells are then looked at to make sure they are good and then the last day I would go in and have them infused into my blood and lung tissue. 

They will attach themselves to whatever they find damaged and repair it.  He said within 6 to 9 months I should see results.  Some people will be able to come off O2 during the day, others at night.  Some patients can do without their inhaled medication.

I asked him if he was affiliated with a hospital and he said no, this is done out of his clinic in Sarasota Florida.  He said that insurance will not cover this and the base cost is $5,700.00.  That does not count airfare or hotels and transportation.  He also mentioned because I would be coming from across the United States that he would most likely give me additional cells.  Then give me 9 months worth of medication afterward.  I would still be able to take all of my medication and none of this would effect my meds or present treatment.  There is of course no certainty. 

So I told him I would talk this over with my doctors and then I would call them back.  Most likely in August.

It's a lot to think about.  It's a lot of money for something that may or may not work.  Or is that the skeptic in me?  The coward who would prefer to stick my head in the sand and pretend that everything will be alright.  There is something to be said for denial.  I don't know.  I will sleep on it a few nights and talk to my doctor.  I want to check out this program and the doctor himself.  That's where I think my doctors can help me, tell me how to check on a program like this, and the doctor.

I was about to call it a day and go hide my head in a pillow, when I finally talked myself into going to Curves (which I really, really didn't want to).  I didn't want to miss a day.  I wasn't sure how my lungs would hold up with the air being so bad.  As it turned out, I did just fine. 

I had to give myself a pat on the back.  I REALLY didn't want to go workout.  I feel like if I just go every day I will be keeping my core strong, and will eventually begin to lose inches again.

Any how... I am tired.  Mentally exhausted from worrying about the stem cell stuff.  Why?  Because on a daily basis I can almost talk myself out of feeling sick or damaged.  Yes, I have a cannula around my face, and yes I have pain in my chest (the list goes on) ... but when you live with something everyday it becomes normal. 

Goodnight.

Stem Cell Doctor's Appointment

Not long ago I posted about a stem cell article I had read.  I think I also posted that I submitted my medical information to see if I would qualify for their program. 

Today I got a call and the woman on the other end said she was from Dr. ______'s office confirming my appointment with him tomorrow between 3:00 and 5:00.  I said... which Doctor?  She explained that this was in regards to the stem cell program.  Ahh! 

I really don't know what to expect.  If I recall this Doctor and his program is in Florida.  I am in Oregon ... that is an entire United States between us. 
I will post what I find out.

That's about all I can communicate tonight.  I took my meds really early because I was sure it was about an hour and half later than it really was... I have been struggling to stay awake every since. 

Until tomorrow....................

Chest Pain and Whining

I am sick and tired of being damaged.  I yearn for the days when I could walk around my yard without worrying how long I was without oxygen.  The days when I wouldn't panic if I had a ache or pain.  Today again twice the center of my chest had such a pain it caused me to halt in my tracks.  It took my breath away, and made me grip my chest like someone having a heart attack.  Of course, it's not a heart attack.  I have learned from experience.  I am not sure if it is costrochondritis or not ... what I am certain of is that it is the worst pain I have ever felt.  (maybe child birth would give it a run for the money)

Bill was pissed at me most of the day because he built a railing on our front porch and after he finished it I told him I didn't like it and asked if he could just change it a little?  How could I!! 
So, during my pains... I retired to my bedroom and sat gripping my chest and working on slow breathing and taking pain meds.  Feeling sorry for myself because he wasn't there to help me, and with my stubbornness I would not dare share with him my pain or need for help.

I don't do well with sympathy from strangers, and surely not from Bill when we are fighting.  We really don't even fight.  He just stomps around and I apologize for anything to keep the peace.  And, if by chance I stand my ground then we have an actual fight.  I can't do those anymore... I don't have the stamina or the passion I used to.

This is me being not so bright.......
If I tell Bill or Brittney that I have been having chest pain again they will insist it is because I started Curves.  If not Brittney, then I am sure Bill will.  He was convinced last time that it was because I was using the trampoline. 
So... In order for me to do the things I want to do, I keep this to myself.  I will talk to my Pulmonologist about it or my Cardiologist, I have an appointment with both of them in August. 

As for the pain, it seems to relax with pain meds.  It doesn't go away, it always is there lingering in the background.  With every deep breath it stabs me.  I have even learned how to take short shallow breaths while exercising.  I told you... not too bright am I?  Don't answer that!

I just want my health back.  Smoking took so much from me.  The people who make excuses to continue to smoke irritate me.  Had I quit when I first noticed signs I could have slowed or even stopped this disease from gripping me.  I knew for years that with exertion I would be out of breath.  I knew my cough was getting worse.  I knew that I was sitting on the side lines watching my family do all kinds of things because I was out of breath. 
Guess I showed me! 

Boy, a lot of whining tonight.  Sorry about that.

A bad shopping trip

Not much has been going on.  I am working on my attitude, trying to manage a positive outlook.  God, it's hard this time. 

My energy level is low and even wanting to do something I have to talk myself into getting up off my butt. 
Today I went grocery shopping.  Bill was doing projects around the house and I felt useless, so I decided to go.  I usually don't like shopping alone, especially if I am going to be a while.  Today, again ... for the second time now I ran out of O2 in the middle of shopping.  I had just changed the tank last night and should have had plenty of air in it. 

Anyway... realizing I had two choices ... to either stash my cart and walk all the way out to the car to change tanks ... or... finish shopping as quickly as I can and get to the car and home.

I, like last time opted for the continue shopping choice.  WRONG.  I got so tense and panic stricken that it made it worse.  Normally I can go 10 or 15 minutes without O2, but that is sitting on my butt at home and not walking through a store.  While I am up and active, my oxygen saturation drops rather quickly.  Any how... a bad experience.  And, a lesson learned.  Next time, leave the cart, go to the car and replace tanks and then finish shopping.

Someone asked me today how I manage to go to Curves and be on oxygen?  It made me wonder if people think I am a little crazy to think I can do these things?  Even people in the stores look at me like I should be in a cart.  I figured out how to get in our pool with my O2 ... I just connect the long tubing on my cannula and hop in.  I can float around and still breath!  lol

Yard Pictures and bad air

I am still struggling to get through this bout of depression.  It isn't bad, but I know it's just there under the surface, behind this face that smiles and says everything is O.K..   I think some of it is the frustration of wanting to do so much more, but my body refuses to obey my orders. 

Our air quality has been in the dangerous zone and I can tell.  We are getting into the summer heat.  We are at 4200 ft elevation so when we are in the 90's it's HOT.  Normally our summers are only 2 months and so very few people here have central air.  We have 3 window air conditioners that we try and cool the entire house with.  Most of the time it's fine, but once it gets above 90 really nothing helps.

Between the heat and the air I just feel wiped out.  I also just started taking another dose of my heart medication around noon, and that seems to make me really slow down.  They told me not to worry about taking my blood pressure for a couple days but to watch for signs of extreme low blood pressure.

I finished planting the pots and containers in the front yard.  I still have a few to do for the back deck.  Our yard when it gets fully fluffed out from the winter is really very pretty.  It reminds me of pictures of my Grandma's English Garden.  Her plants were beautiful and overflowing into each other, with paths.  That must be my style.  My yard is anything but edged and manicured.

That's what has been occupying my days lately.  That and the Casey Anthony trail, which I am done with.  I waisted far too much of my days watching that.

Well, I am off to bed.  Layla is spending the night and if I don't stake a claim to part of the bed I may as well forget it.  For some reason she searches me out and sleeps wrapped around me.  I am one of those who always liked to sleep untouched.  I never was a very good cuddle-er.

O.K. meds are working, time for bed.  More later...............

Depression and Pain

I am here.  Sorry I missed a few days.  We didn't do much on the 4th, worked in the yard a little and that's about all.  Actually, Bill worked in the yard and I planted some more pots and containers.  Just doing that wiped me out.

We put up the pool and I have been enjoying that in the late afternoon and evening.  It is not heated and we have only had a few days of warm weather so it's still pretty cold.  I will love having it here this year though.

Bill is working on both sides of the house.  In the front he removed thatch that we had covering our front porch and lowered the roof about 6 inches.  He is putting up metal roofing over it.  That will be so much nicer.  He also removed all the privacy screen we had there so seeing it opened up kind of makes me feel like we are in a fish bowl. 
In the back yard he plans to rebuild the deck and replace some of the boards and re figure it. 
And, then near the end of the summer we plan to repaint.  Right now it is green.  I want it pale yellow with brown and white trim.  It is such a big job just to prep it to be painted.  Lots of scraping and windows to do. 
He will have to find help because I just can't do much anymore.

I went to Curves again today.  So far I haven't missed a day.  Still twice around.  I am being better about watching my food again.  Smaller portions and no eating bad things late.  Lot's of fruit and veggies.

I seem to be slipping a little into depression.  I just have to force myself to do anything.  The mornings I shame myself into going to Curves, I come home and do what I have to and then sit in my chair nearly asleep.  I have little energy, and have been going to bed around 8:00. 
I am just finding it hard to find the positive in most things right now. 

I am waking up again in the night because of lung pain.  I move around a little and toss and turn and eventually go back to sleep.  It's maddening.  The doctor told me to take extra medication when this happens.  I did in the beginning, but now I just hold on and wait for it to be over.  Sometimes it's touch and go whether I can hold on and not take pain meds.  It's just that the meds make me so dopey.  They are fine going to bed, but when I take them early in the morning hours then I don't wake up, or get up feeling tired and sleepy. 
I am not sure if my inhalers need to be increased or maybe this will just be the norm for me for now?  I have an appointment with my Pulmonologist in August, I'll talk to him about this. 

So... It's after 8:00 and I am barely holding my head up.  I am off to bed. 

Why I love Avocado's

(One of my favorite breakfasts is to toast a English Muffin or Bagel and Spread Avocado on it.  :)  It is simply sinful but good for me! 

Obviously avocado is a fruit that grows and not every avocado fruit is going to grow to the same size or weight so here we are going to provide some averages when providing the information on calories in avocado.


■In 100g of raw avocado fruit there are approximately 160 calories


■In 1 ounce of raw avocado fruit there are approximately 45 calories


■In an 8 ounce cup of pureed raw avocado fruit there are approximately 370 calories



Nutritional values of avocado


Having seen how many calories are in an avocado we will now look at some of the other nutritional benefits of the avocado fruit:


As with the calories in avocado these are approximations.


■We know that in 100 grams of raw avocado there is 160 calories.


■There are 17 grams of carbohydrate in 100 grams of raw avocado.


■There are 1.9 grams of protein in 100 grams of raw avocado. For more information on protein rich foods please click here.


■There are 17.5 grams of fat in 100 grams of raw avocado.


■There is no cholesterol in avocados, in fact studies have shown avocado to be beneficial in lowering blood cholesterol.


■There is 3.4 grams of fibre in 100 grams of raw avocado.


■There is 6 milligrams of sodium in 100 grams of raw avocado.


■There are 485 milligrams of potassium in 100 grams of raw avocado.


■There are 12 milligrams of calcium in 100 grams of raw avocado.


■Avocados are rich in vitamins B, C, E, K and also folic acid.


The above clearly highlights that there are much more interesting nutritional facts about the avocado than just the answer to the question 'how many calories does an avocado have?'


The avocado has one of the highest oil contents of all fruits and they are also very high in monosaturates. As you will see above it is a rich source of potassium which is a useful mineral that helps the body to maintain a healthy blood pressure. It has a higher level of potassium content than the banana which is synonymous with being high in potassium.


The monosaturated fat that avocados hold is believed to assist in speeding up your metabolism as it can increase your metabolic rate, the high amount of fat in avocados will satisfy your hunger and prevent you from eating unnecessarily which is also positive for your metabolism and any diet plan that you may be on. As if you came to this site only wanting to know how many calories are in an avocado?


The avocado is a fruit that has a high fat content in comparison to many other fruits such as the banana. It is often used in both savoury and sweet dishes due to the fact that it's taste is not expressively sweet. The avocado is often eaten by vegetarians as the fat content is a positive substitute to that derived from meat and other things that they do not eat. As far as fruits go the avocado is quite high in calories, however all in all it is one of the healthiest fruits that you can get your hands on due to it's rich nutrient content.


Three quarters of the calories in avocado come from the fat content and most of this fat is monosaturated fat, this type of fat is referred to as 'good fat' so please do not let this put you off enjoying this lovely fruit.


On the whole we can see that avocados are good for you, the fat content is high but this is good fat and the only downfall is perhaps that there are excessive calories in avocado.

Summer time came today

I forget the symptoms of Copd.  Symptoms like not tolerating weather changes.  We didn't have a Spring.  It went from freezing temps to rain and frost warnings, to 90 next week.  Summer is here and I didn't have time to climatize.  I went to the store today with Layla and walking outside just took my breath away. 
I went to Curves today and did my 2 rounds.  I worked a little harder.  I have to say the last time I went to Weight Watchers I weighed in at 192 pounds.  Today at Curves I got on the scales and I weighed 195.  NO 
I don't want gain this back.  So, now I am going to try and re-devote myself to weight loss.  I am sure that these work outs will show inches lost after a month.  They weigh and measure once a month ... I'll keep you posted.  Now that I weighed today, I think every Friday I will weigh and that way I can adjust if I need to.

Bill and Brittney worked all day to get the pool set up.  Finally at 2:30 we started filling it up and by 7:00 tonight it was about half way full.  lol  I will get up in the morning and turn on the water to finish.  Bill is getting out our deck and patio furniture and he wants to build our deck out around the pool.  Great idea I think.  Even though it is above ground ( 15' x 4.5') and we will need to take it down in the winter, it will be worth it to have it up for the few months we can.

I still need to go to the nursery and get some more flowers for my planters and pots.  :)  I love to play in the dirt.  I can't do much with my big gardens, but I can plant and fuss with pots and planters.