Mo Bloggin'

A little o' this, a little o' that

Archive for the month “September, 2016”

Hypersensitivity pneumonitis – lung thing part 3

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Some mornings it’s just hard to leave for work.  Looking at the NE corner of the property.

So a quick (I promise) recap.  This all started in November 2014 and has been a roller coaster ride of symptoms and medical care ever since.  After my initial diagnosis (now revised) and treatment, I was feeling good by September of 2015.  In late November 2015 some of the symptoms returned (shortness of breath, primarily).  I managed this until late February of 2016 with ibuprofen, until I needed more help.  I saw the specialist in March and began a regimen of prednisone.  A lot of it to start, then tapered down after 10 days, then tapered again after 30 days.  But still a high dose.  I’ve been on this dose since April and have been feeling good, with breathing back to normal and heart rate also returning to normal (since my lungs are working, my heart doesn’t have to hit overdrive to pump more blood in an effort to oxygenize).

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Groot the kiwi vine trying to swallow the front porch.

Allergy testing last year showed I have no allergies – no surprise there – but the specialist, in drilling in on the hypersensitivity pneumonitis rediagnosis, performed antigen testing (IgG vs. IgE), which showed I was reacting to bird feces and proteins, as well as a couple of molds, so my particular brand of hypersensitivity pneumonitis (HP) points to Bird Fanciers Lung (there are dozens of versions).  I was told I needed to remove chickens from my environment, as well as my two parakeets (cage birds), and clean the house thoroughly.  The molds are likely ones I’ve run into with the hay I feed the sheep.  Antigen reactions are essentially allergies, but manifest differently (in my case there was absolutely no coughing, runny nose or sneezing typical of allergies).

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The days are getting decidedly shorter.  After getting home from work in the evenings I barely have time to do the evening chores before darkness falls.  So sad. 😦

I saw the doctor again in late May, when I repeated my tests and did well (breath tests as well as a walking test to see how well oxygenated my blood stayed with exercise).  The doctor was pleased with my progress, and very happy to hear I had rehomed the parakeets, but because I still had the chickens, and she was concerned I needed more time on the medication, we stayed at the same dose of prednisone.  I told her I would hire help to get the chicken coop thoroughly cleaned out and let the flock “attrition out” – the birds are aging and not worth anything, so not easy to rehome (there are 21 of them right now).  I lost one over the summer, but of course they seem to be feeling spry, even if they’re not laying much on the expensive organic feed I give them.

My next appointment with her was September 1st.  In that 5 month period (April to September) I have gained weight.  A lot of weight.  This, of course, is a common side effect of the prednisone – one of many – and this time around it seems to be the main one for me.  I have an appetite like a lumberjack.  I’m not hungry all the time, but when I get hungry it’s hungry-bear hungry, and it takes a lot to be sated.  Like, half a large pizza. Or an embarrassingly large portion of a whole roast chicken.  I tell myself I’m going to moderate my eating, but when I get hungry and the food is in front of me, well, I don’t have much restraint.  I don’t quite check out mentally, but the thought of moderation is dismissed entirely.  Leftovers are a thing of the past.  I’ve been bursting out of all my clothes, and have had to buy new things—in a size I’ve never worn in my life—so I have something to wear that isn’t embarrassingly tight, not to mention uncomfortable.  I’ve resigned myself to this weight gain for now, knowing the prednisone is necessary for my lungs, but there are moments of shame and self-consciousness at how I look.  Now any breathing problems I have are from inactivity, and trying to increase my exercise has been difficult: I’m assuming it’s because of the extra weight, but my ankle (old injury) has been giving me trouble for the past couple of months, so even a walk with the dogs has been off the docket.  I can’t tell you how frustrating this is, because even with all my whinging I am still grateful for my mostly good health. And on the positive side, we have reduced my prednisone by half in the past two weeks.  Yes!  With the appetite becoming more manageable it’s time for a weight loss diet!  Wee!

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I took down a small maple over the weekend.  The sheep love the leaves and tender bark.

I’ve been slowly coming around to the idea of giving up the chickens.  I haven’t hired anyone to help with cleaning yet, mostly due to financial reasons (keeping up with medical bills, frankly).  So the dry, dusty summer, with the hens happily fluffing their feathers in numerous dusty bowls they create under the cedar trees, then the dogs walking through that, or lying in it, then coming to curl up in bed with me…well, I’ve got my head in the sand on the whole issue.  I let the hens free roam, but probably shouldn’t. In thinking about giving them up, I think about why I keep them; indeed, why I’ve been keeping them for most of my life (since 1982). I want to produce as much of my own food as possible, and have a little more control over this aspect of my life.  But I also know part of the reason I keep them is for the bucolic calm they exude, and coming home after a stressful day at work to watch my little farm at work is soothing to me. And although chicken TV has slowly been supplanted by sheep TV and honeybee TV, I still like having them, and the eggs they give me. With the sheep and the bees it’s a little easier to lie in the grass next to them (the chicken run is too grubby-gross to lie in or even next to).  They are enormously entertaining though, and, as with all my animals, knowing they are happy and enjoying a good chicken life is deeply satisfying, even fulfilling, to me.

After the visit with the pulmonary specialist earlier this month, and discussing the situation in more detail with her, I realize I have to do this.  I’m still very reluctant, and if I think about it too much I get a little teary.  I am simultaneously frustrated by the whole situation.  I have kept chickens for 35 years now, and had the parakeets for the past 15 years.  Why all of a sudden am I having problems?  There is no answer to this, of course, and it’s not unheard of or even uncommon, as a situation.  I guess what goes hand-in-hand with this is frustration is the worry: what if I get rid of the chickens and still have problems? What then? I don’t want this to be a slow elimination of everything I love most in life. I can’t get any traction with my vaccine theory, but I do think this is a factor in the initiation of this whole issue.  While I’m not “anti-vax” I am anti over-vaccination, and the bundling of vaccines.  A tetanus shot I received in early November 2014 came bundled with two unnecessary (to me at the time) vaccines: pertussis and diphtheria.  Within 3 weeks the symptoms of HP began – probably sooner, I just didn’t realize it – and by the end of November I was one very sick puppy.

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The leaves are turning color and beginning to fall.  It seems too soon. I’m not ready.

I still think this is a “perfect storm” situation. And I know it’s done, and there’s no going back (“that ship has sailed, Mo”), but part of me wants to know.  Because maybe, eventually, and maybe it will take moving off this farm to a new location, I will be able to not worry about this anymore.  I believe the combination of the moldy hay I was running into at the time (purchased a ton of hay that year – the guy who delivered it said it came out of Oregon; it was some of the dirtiest/dustiest hay I’ve ever encountered) and the hit to my immune system from these unnecessary vaccines (the tetanus wasn’t really needed either – for the situation nor was I due, but with the animals/farm I know it’s a good one to keep up to date so I consented when I should have refused), added to a little normal life stress and a strenuous (and thoroughly enjoyed) day hike 8 days later, well, it all added up to a baseball bat to my immune system that I’m still recovering from.  I will never, ever (ever!) again allow myself to be vaccinated with three immunizations in one injection.  I will continue to refuse the annual flu vaccine (never had it, never will) even though my pulmonologist recommended it at my recent visit.  No, that’s not one I’ll do, I told her, emphasizing “I am NEVER sick.”  She looked at me with just enough of a pause that I burst out laughing.  She laughed a bit too.  And said she would nevertheless continue to recommend it to me, given my diagnosis.  But really, I don’t get colds – my last cold was in 2012 – and aside from this issue, I’m healthy and strong.  And once I get this thing figured out, I intend to sty that way.img1041Gratuitous cuteness: Eloise, a.k.a. El, ‘weesa, or Pudge.  The only one of the three cats that will regularly brave sleeping in bed with me and the three dogs.  Heart her to bits.

No birdz allowed – lung stuff part deux

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Another glorious Pacific Northwest summer is winding to an end. They are always too short.

Continued from previous post:
So I left the specialist’s office that day in March with a couple prescriptions – one for oxygen at home, and one for steroids (prednisone) – both of which I’d used a year earlier, and both of which I didn’t want to do, although they help immensely. I knew the oxygen use would be short-lived, as once the prednisone kicked in and inflammation was neutralized, I no longer needed it. While its benefit is huge in that 10 – 14 day time frame, I just didn’t want to deal with it (both the admittance that I needed it nor the growling, hissing activity of the oxygen concentrator, not to mention the medical rental of the machine, although this experience/company was MUCH better than last year’s). And, after all was said and done, I spent over $630 on the rental (insurance only covers so much)  for the 10 days of use, because the doctor wouldn’t okay its return until she saw me again…in May. I would have done better to purchase one of my own at that cost!

A few weeks after my visit we got the antigen tests back. And while most everything was in range (they test for a variety of typically encountered organisms) there were a couple of molds that were moderately out of range (high) and two others that I just didn’t expect: pigeon droppings, and pigeon feathers and proteins. Which, of course, means all avian. (I’d tested negative for bird allergies last year.) The doctor knew I had chickens (we’d discussed them with the sheep) and she flatly said I had to get rid of them. I was dismayed, not really understanding if they were outside why I had to get rid of them. I live on acreage. There are birds EVERYwhere. And geez, I’ve been keeping chickens pretty much my whole life (a continuous flock since 1981). But what she didn’t know, and I of course then shared with her, is that I also had a couple of parakeets in the house. And these two, I realized, I would definitely have to place. Dang.

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Of course these results, combined with the review/reassessment of my prior tests and procedures/pathology (done elsewhere) by the UW pathologists, confirmed the rediagnosis from sarcoidosis to hypersensitivity pneumonitis. The doctor was very clear that I had to get the birds out, and once they were out, a deep cleaning of the house (wall washing, floors, furniture, etc.) that I was NOT, under any circumstances (even with my fancy respirator mask) to do myself.  Okay, but… “Have some friends come over to do this for you.”  Um, no. I would hire someone before I asked my friends to do a deep clean on my house.

The first thing I did was take the parakeets, Hugh and Cate, to the vet. I was going to give them away, probably via a Craigslist ad, but wanted to be sure they were healthy before I did so.  Hugh was dealing with some kind of mite or lice infestation – not horrible, but his feathers had looked a little rough for the past 8 months or so (I’d treated with mite control, using the vet’s recommended protocol, to no discernable improvement). Cate looked fine, so maybe there was something else going on with Hugh?  Sure enough, lab work showed he had some elevated kidney values, moving towards gout (who knew?). And here is where my angels helped me out. As the vet relayed the information about Hugh’s bloodwork and recommended treatment (and expense – I’d already spent over $200 for their checkup and lab tests) – fluids once a day for a week, retest blood work and re-evaluate treatment – I was simultaneously trying to digest the information and figure out what to do. She knew of my health situation, as I’d explained it to her/the clinic when I brought Hugh and Cate in for the exam, and then she very kindly and graciously offered me a solution. If I wanted to, I could sign Hugh over to the clinic, releasing ownership and entrusting his care and eventual adoption placement to them. I hesitated, thinking of Hugh – while he wasn’t a bird I’d handled regularly I still felt affection for him and of course responsible for his well-being. I’d had him for 8 years and he was a cheerful, beautiful little guy. But I knew the treatment he needed was outside my ability at that point, and I didn’t want to place him with the hope that whoever adopted him would do the right thing with his care (nor was it fair to place a sick bird with anyone). What was best for him was to sign him over to a place where he could get the care he needed. I brought him in a week or so later. The vet, Dr. Carter, gave me a hug as I signed the papers and said goodbye. I mostly held it together until I got in the car to leave, and then had to dig around in my glove box for a tissue to wipe the tears away so I could see to drive home.

For Cate, now alone, an equally miraculous solution occurred. She and Hugh weren’t bonded, and in separating them she actually seemed happier. They never fought, but they never seemed to hit it off (I’d had her about 3 or 4 years). The weekend after I placed Hugh with the vet, I went to a local spring fair with a friend who also raises Shetland sheep. It was a great chance for her and I to catch up on the drive down, and go see the sheep and fleeces, and booths from sheep farmers and wool vendors, plus chat with other sheep people we both knew. She asked about my health update as we drove back home that day, and I gave her the whole long story of the new doctor and findings all the way to the need to place the parakeets. As I yakked away, she began texting a coworker whose son was an animal lover and had recently said he wanted a parakeet. I didn’t even notice she was texting until she told me about this possible home being available. The coworker texted back that they had already gotten a parakeet, but said they would think about taking Cate too.  From the description, it sounded like a wonderful home, and I sent photos of Cate along with a description of her personality. It turns out the boy, aged 10 or 12, had wanted an all yellow parakeet, and was thrilled to see Cate was exactly what he was looking for. “It’s kismet,” he told his mother, who contacted my friend to let her know they’d take Cate. The boy renamed her Mango, which I just love.

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The badly placed kiwi vine (here when I moved in) once again trying to take over the front porch. I’ve lopped off nearly as much as you see here. I need to transplant him. I call him Groot.

So my house was parakeet-less for the first time in 10 years or more, and it was eerily quiet. But I knew it was for the best and it seemed miraculous that both birds were placed almost effortlessly into situations that were perfect for them. I cleaned up the area they’d been in, vacuuming well and wiping down the wall and windowsill where I’d kept the cage, and of course moving the cage out to the garage (and hosing it down outside first). Next on the agenda was testing my environment for toxins in the form of molds and bacteria.

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The plum tree was laden with its ping pong ball plums this year, the branches groaning under the weight.  The dogs and the sheep have been enjoying them.

I contacted one of the companies on the list the clinic had sent me. The fellow there, Payam Fallah, was a wealth of information, and we discussed my antigen test results and the animals I have here. Like my doctor, he too was a dog lover, which felt good.  Both of them not only understood the dog connection, they both confirmed that dogs/cats rarely are an issue in these cases. Payam also has a tortoise (I’d shared that my menagerie includes a box turtle), and we had a good discussion about our mutual love of animals. Again, this was reassuring – I didn’t want my animals to be automatic targets for removal because of an overall dislike of animals by the professionals I was dealing with.  He sent me sterile swabs/kits for me to take samples in my house. He told me that taking swabs in my detached garage – where I store the sheep’s hay (and the mold inherent therein, which I believe to be one of the major factors in the original manifestation of this health issue) – is pointless, as there are so many molds in the environment/outdoors. Okay…

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My sheep maintenance in my fancy new “deck chair” (sheep restraining tool) wasn’t as easy as I’d hoped.  The Shetlands are squirmy, and Trixie, above, probably the worst of the lot.

So I took four samples: one in the bathroom, one in the bedroom, one in my office, and one in the main room of living room/kitchen/“dining” (my house is tiny; this last area, at roughly 500 square feet, encompasses half of it).  A week later he emailed me the results.  Which basically said my little house was fine.  The highest mold readings were in the bathroom (duh), but a) the mold count wasn’t astronomical and b) the molds were not the ones that showed up on my antigen tests. The bedroom, where I was most concerned (for the crawlspace underneath), had a big fat doughnut for results. Which was good. Despite the fact that I sleep in a pile with the dogs (and a brave feline or two) every night, and the crawlspace was an unknown quantity (can’t access), absolutely nothing showed on the swab I took from a wall sconce above my pillow. Thankyoujesus.

I still want to do a swab in the garage, and maybe I still will (have one left, and spreading out the cost is a good thing too – out of pocket, it’s $40 each swab to see if anything grows). But the house is fine.

Now to figure out the chickens…

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