Further adventures in medicine

Background: I’ve been a bit short of breath for some time, but with stretches of phenomenally hot days (starting back on a day in May when it was 110 F in downtown Palo Alto), things got dramatically worse. The nephrologist at first thought it might be connected to my reduced kidney function (there’s a complex story of possible connections there), and then the cardiologist was quite sure the problem was with my heart, probably the coronary arteries, and ordered up a series of scans and tests. (I’ve endured a great deal of doctoring, with lots more to come: cataract surgery starts on the 27th.)

In there were heart CT scans, which showed nothing that would explain my shortness of breath. Nobody was particularly concerned about my lungs, however, since they sounded so great on stethoscopic examination. But a chest CT scan, done on August 29th, however, showed two things:

Calcified granuloma in the right lower lobe. Areas of subsegmental atelectasis, especially right lower lobe.

I will explain. In any case: spirometry and a pulmonologist’s appointment on the 25th.

From Wikipedia:

Granuloma is an inflammation found in many diseases. It is a collection of immune cells known as histiocytes (macrophages). Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate. Such substances include infectious organisms including bacteria and fungi, as well as other materials such as keratin and suture fragments.

Then from MedicineNet:

Because it usually takes some time for calcium to be deposited in a granuloma, it is generally assumed that a calcified granuloma is an old granuloma, or an old area of inflammation. For example, a calcified granuloma in the lung may be due to tuberculosis contracted years earlier that is now inactive and dormant.

Then from Wikipedia on atelectasis, which in my case is partial and on the right:

Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. It may affect part or all of a lung. It is usually unilateral. It is a condition where the alveoli are deflated down to little or no volume, as distinct from pulmonary consolidation, in which they are filled with liquid. It is often called a collapsed lung, although that term may also refer to pneumothorax.

It is a very common finding in chest x-rays and other radiological studies, and may be caused by normal exhalation or by various medical conditions. Although frequently described as a collapse of lung tissue, atelectasis is not synonymous with a pneumothorax, which is a more specific condition that features atelectasis. Acute atelectasis may occur as a post-operative complication or as a result of surfactant deficiency.

… The term uses combining forms of atel– + ectasis, from Greek: ἀτελής, “incomplete” + ἔκτασις, “extension”.

A dramatic demonstration a while ago, in my Saturday exercise class, when the instructor had us do a stretching exercise that involves sweeping one arm across the chest. No problem sweeping my left arm across. Then I did the right arm; my face turned bright red, I felt like I was on fire, and I was suddenly gasping for breath. Great consternation in the class.

That’s one exercise I’ve never done since. It now seems that the problem was that the move compressed my right lung, so further reducing its airflow.

(I might have been able to work out that the problem was my lungs, not my heart, by reasoning from first principles. My sex life is essentially sedentary, so there’s not much demand on my lungs, but there is of course a big demand on my heart. I might have noticed that sex is completely unproblematic. That’s personally gratifying, but also diagnostically useful.)

Now working on expanding my lung capacity, mostly by walking more and more (though I have to stop to catch my breath every block or so).

Now: off to Enhance Fitness (as the Y’s exercise program calls itself)…




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