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Cattle ranches and asthma

 
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Anonymous
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PostPosted: Mon Mar 30, 2009 1:30 pm GMT +0000    Post subject: Cattle ranches and asthma Reply with quote

I'm wondering if it is healthy to race Bar-H and Warda. They just kick me in the ass and give me an emphysema-like bad cough post race (Bar-H lasted a week although the worst was the first 24-36 hours) with some nasty yellow chunks (I hope no one is reading this at lunch). Not to mention the whole burning tight chest thing. Warda last year is what got me to go to the pulmonologist in the first place.

I take Advair and threw in some Proventil for Warda. However, it seems to be the cows. I don't think the allergist tests you for cows or cow poop or whatever the X factor is. I know the campfire smoke doesn't help, but I am never this bad at any of the other races.

Does this mean I should skip these races I like or should I not be blaming the cows?

Thanks
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JoeC
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PostPosted: Mon Mar 30, 2009 6:49 pm GMT +0000    Post subject: Reply with quote

I've raced Bar H, Waco and Warda and had the same symptoms you described after Bar H and Warda...and I do not have asthma.
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The Bike Doc
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Location: Corpus Christi and Warda, Texas

PostPosted: Tue Mar 31, 2009 5:24 am GMT +0000    Post subject: Reply with quote

Knobby Toes:

Your asthma may be triggering from some environmental allergen associated with cattle ranches. It could be cattle dander but unlikely unless you go petting the cattle when you are at the ranches or you go into enclosed areas where cattle are kept such as dairy barns. As Bar-H and Bluff Creek Ranch are open range cattle raches, cattle dander being the trigger is very unlikely. More likely, it would be due to mold that will be in higher concentrations in surface dirt from the "fertilizer" that is present on the ground from the cattle leavings (polite term for cow & bull poop) and gets kicked up into the air by all the knobby tires rolling over them. Visit with your doctor about your asthma symptoms and your asthma controler (preventive) medication usage. I find in my Pulmonology practice, the most common causes of poor asthma control in order of frequency: 1. inconsistent dosing of inhlaed asthma controller (preventative) medications like Advair, Symbicort, Pulmicort, Flovent, Q-VAR, Azmacort, Alvesco, 2. incorrect inhaler technique, 3. going too long between refills of metered dose inhalers that do not have dose counters, 4. ongoing exposure to tobacco smoke either first hand or second hand.

If your doctor is not comfortable in aggressively pursuing optimal asthma control for you, ask for a referral to a Board Certified Pulmonologist, who can help you achieve optimal asthma control. I find that even in my most allergic patients, I can get their asthma under good control with agressive, appropriately and consistently delivered asthma controller (preventive) medications.

Joe C:

Don't be so quick is saying you do not have asthma. If you are getting the same type of respiratory symptoms as KnobbyToes, you may also have asthma that has not yet been diagnosed and you would benefit from an evaluation by a Board Certified Pulmonologist and getting pulmonary function tests performed to look for evidence of asthma. If you are then diagnosed, correctly, with asthma, you, too, will benefit from appropriate asthma controller (preventive) therapy. Asthma is grossly underdiagnosed by primary care providers. At best, it is picked up by primary care providers in only about half the patients who have the disease. When careful histories and validated asthma screening questionaires are used, the diagnosis of asthma will doubles or tripple based on several well done clinical studies.

BTW: 1. I have asthma
2. I am a Board Certified Pulmonologist

Thanks,
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chriskoob
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PostPosted: Tue Mar 31, 2009 8:48 pm GMT +0000    Post subject: Reply with quote

In the last few races, which were on cattle ranches , I had coughing fits after I completed the races. I never assumed it was the cattle ranch. I always assumed it was due to racing in cold air conditions. Bar H was really cold, and the sport race at Warda was cold too.

I had a major coughing fit after the race at Bar H, where it was really cold. At Warda, just a little bit of coughing. It was cold, but not as cold as Bar H. I mentioned this to my doctor one time and she offered to prescribe an inhaler, but I passed on the offer. I always assumed this was a normal response and there was no need to take anything for it.

Is this normal? Is there a know relationship between air temperature and breathing issues after or during sporting events?

Thanks
Chris
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The Bike Doc
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PostPosted: Wed Apr 01, 2009 7:36 am GMT +0000    Post subject: Reply with quote

chriskoob:

This is not normal. Just look at your fellow racers who were not coughing after the same races. They are normal, you and I are Abby Normal. Cough induced by exercise in cold air is symptom of asthma. The underlying pathology that triggers this coughing is airway inflammation, making the airway hyper responsive to irritants such as cold air. Visit with your doctor about your symptoms. If your doctor only wants to give you pre-exercise bronchodilator such as albuterol, get a referral to a Pulmonologist who likely will recommend starting a low dose inhaled anti-iinflammatory medication to suppress the inflammation in the airway and treat the true underlying pathalogy of your symptoms.

Thanks,
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Anonymous
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PostPosted: Thu Apr 02, 2009 10:18 am GMT +0000    Post subject: mooooo Reply with quote

Doc, thanks.

My doc is:
Board Certification: American Board of Internal Medicine; American Board of Internal Medicine, Subspecialty Pulmonary Disease; American Board of Internal Medicine, Subspecialty Critical Care Medicine

Cold is a trigger for me for sure, and I can't stand smoke of any kind. Cattle and cold are a one-two punch, but I was fine at Waco which was fairly cool, but warmer than the other two.

Before Advair HFA (dosage 230/21 which I am using with one of those spacers) I had problems with wheezing and squeaking a lot when working really hard, that seems to be mostly gone. Advair diskus didn't seem to work for me at all but this is working better. I had to start keeping a tally of usage on a piece of paper, so I am working on that problem (e.g. 120 doses are now up, because you're right you can't tell).

Umm, so I am guilty of not taking 2 puffs 2x a day every day -- I have to do that, eh? I have been pretty regular during racing season. I still have the cough which I seemed to make worse by riding Reimers yesterday.

So do I go back to my doc and tell him, well, the wheezing is better but I'm coughing badly? And what is the yellow phlegm stuff that looks like a nose infection except it is coughed up? And I'm not sick, both times it came right after a race and went away after a week (except Bar-H I had time to recover from).

When they did lung function tests on me they said I looked pretty normal but something about breathing rapidly caused things to look weird. Although I'm not sure how you emulate triggers in an office? I just did what they said to do, but it's been long enough I don't remember very well.

Thanks for your advice and I hope these posts help others, sounds like it might. I had no idea I even had asthma until I talked to my allergist and he almost burst out laughing because I described textbook symptoms -- cold weather felt like half a lung until 30-40 minutes passed and I felt better, the wheezing, coughing, etc.

One of my problems with the short term meds is I can't keep them temperature controlled and I'm not sure they work that well at all.
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The Bike Doc
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Location: Corpus Christi and Warda, Texas

PostPosted: Thu Apr 02, 2009 6:25 pm GMT +0000    Post subject: Reply with quote

KnobbyToes:

It is good you are being managed by a Pulmonologist. If your spacer is not an Aerochamber Plus or an Aerochamber Max, you are not getting optimal delivery of the inhaler medications. These Aerochamber models consistently deliver the greatest amount of medication to the lower airways compared to several other models on the market. There are several look alike models out there but they do not have the antistatic material for the spacer. I exclusively prescribe the Aerochamber (I do not work for the company or get endorsement money, I use them because they are the best). It is what I use for my family members who have asthma and myself.

Technique in delivery is important it is a eight step process:
1. Place inhaler in spacer
2. Shake up your inhaler for 5 seconds
3. Exhale completely
4. Place spacer mouth piece in mouth, trigger inhaler
5. Inhale slowly and deeply as full as you can
6. Hold breath for 10 seconds
7. Exhale
Repeat steps 2-7 for each subsequent dose.
8. Rinse mouth out after dosing with inhaled steroid (Advair in your case). I have my patients do the inhaled steroid (controller medication) before they brush their teeth. Teeth brushing and rinsing and spitting get rid of any residual in the mouth.

You may have a component of chronic bronchitis with your asthma. The coughing and sputum production are characteristic of this. You may benefit from therapies to help thin you sputum and make it easier to clear. I also have chronic bronchitis with my asthma. What I have found that works well for me in clearing my thick sputum is to take a 7% hypertonic saline nebulized treatment (5mls) once a day when I am well and twice a day with respiratory infections. It makes a world of difference in helping me clear the phlegm and go the rest of the day and night without having coughing fits bringing up that thick gummy phlegm. Visit further with your pulmonologist.

Thanks for the feed back,
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AKA: The Bike Doc
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Anonymous
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PostPosted: Fri Apr 10, 2009 10:53 am GMT +0000    Post subject: saw the doc Reply with quote

So his response was basically "don't do that" -- even better was the accidental pun, "steer clear". While funny, that sucks. If I avoid all the cattle races that leaves zero margin for error and I LIKE bar-h, warda and comfort. And I really don't want to become a roadie or move.

Because it happens immediately after the race he says it's like BLAH lung, (farmer's lung, cold miner's lung, etc.) I am really sensitive to it and the more I expose myself to it the worst my reaction could be. Sad He used to be in Michigan and saw a lot of farmer's lung so he said I should be glad it isn't my livelihood.

I'm just glad I didn't do the 6 hour race at warda.

So is that it ... avoid the trigger? Moldy hay or whatever it might be. Sad
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The Bike Doc
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Location: Corpus Christi and Warda, Texas

PostPosted: Fri Apr 10, 2009 4:30 pm GMT +0000    Post subject: Reply with quote

Knobby Toes:
It may be and easy out to blame on the cows. All three races you mention are in areas that have a lot of mountain juniper (common name cedar) and it is in the spring time that they pollinate heavily. Now if you live in an area with mountain juniper, and do not have symptoms at home then this is not likely the culprit. If it is allergy induced you may benefit from taking an antihistamine daily for a week before the racing in the areas where you flare. Over the counter Tavist (clemastine) 1.34mg twice daily, Zyrtec (cetirizine) 10mg once daily are good options. (Claritin [loratidine] is one of the least effective antihistamines so I do not recommend it routinely for most people though it does work for some). You should avoid any allergy medication that contains bromphenarimine which can trigger bronchospasms (Schuller DE. “Adverse effects of brompheniramine on pulmonary function in a subset of asthmatic children.” J Allergy Clin Immunol. 1983; 72(2):175-179).

If these maneuvers do not work, visit again with your pulmonologist. There are other disorders that mimic asthma, called hypersensitivity pneumonitis, that are triggered by inhaling certain airborne allergens in sensitized individuals. Farmer's lung is an example of this. The treatment of choice is what your Pulmonologist recommended, avoidance of the allergen. This can lead to reversal of the symptoms, but they will recur on future exporsures.

Thanks,
_________________
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AKA: The Bike Doc
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Anonymous
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PostPosted: Fri Apr 10, 2009 4:40 pm GMT +0000    Post subject: allergens Reply with quote

The weird thing is I just finished 5 years of allergy shots, I take Flonase.

I pre-rode Warda ok, but it's the race pace stuff that gets me. Ditto for Bar-H. I was ok at Waco. I don't remember having any problems at Comfort, we shall see.

Sigh, I don't like the ending of this story.
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Anonymous
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PostPosted: Sun Apr 19, 2009 6:26 pm GMT +0000    Post subject: Reply with quote

i had the same problem at warda this year as well. my throat started burning and i had a hard time breathing and it continued for days. went to see my doctor and he is sending me for a pulmonary function test this next week. can't wait to have this problem fixed. good luck to everyone else having breathing issues. breathing is NOT overrated, i'll just say!
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Katastrophe
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PostPosted: Tue Apr 21, 2009 3:44 pm GMT +0000    Post subject: Reply with quote

Nasonex and Claritin D keep me breathing in Texas through Cedar season & anytime molds are high.
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