Lately my body has decided that it’s suddenly allergic to all kinds of things! It tells me not to eat wheat, rice, corn, oats, or dairy. Great. Being Vegetarian…this has forced me to eat more fruits. I’ve discovered the more fruits I eat, the better I feel. This was really put to the test recently after another flair up of my old friend pericarditis. This is a viral thing that causes the lining of the heart to swell and leaves you in extreme pain, not only at exertion of any kind, but also upon moving or even just trying to breathe. This is my fourth time playing host to the lovely pericarditis, and the normal course of action is to take 1000mg of Ibuprofen per day. Ibuprofen is an anti-inflammatory drug that over time can really wreak havoc on your liver and kidneys. Plus with this crazy allergy thing, I can’t take over-the-counter stuff now cause more than likely, I’m now allergic to it! So what’s one to do? My solution this time was to eat.

I got a list of all the best anti-inflammatory foods from the net…

Blueberries, Ginger, Turmeric, Grapes, Avocado, Lemons, Limes, Broccoli, Basil, Walnuts, Mint, Raspberries, Cherries, Kale……and tonnes more! check here

So I went off all cooked food immediately. For most of my calories, I drank Innocent Acai Berri Superfoods smoothies. I ate tonnes of blueberries and grapes, drank fresh ginger and turmeric tea (much better than it sounds) and for dinner each evening I’d have fresh veggies with lots of hummus.

Mind you after 4 times with this thing…I know how much the first week sucks. You can only take very shallow breaths, and forget walking up and down stairs. Just turning over in bed can make you cry. It’s horrible! I started on this diet the first day and in 24 hours my pain was reduced by 50%. 36 hours brought a 75% reduction in pain. By day three I was breathing pretty normally and had little to no pain. By day 4 the pain and the symptoms were GONE. I stayed on it for 7 days just to be sure and then started gradually adding back in one cooked meal per day. (usually lunch) I am still only eating fruits for breakfast as I want to bombard my cells with anti-oxidants first thing in the morning. I feel really amazing.

The absolute best way to protect yourself from illness is to eat the right foods. Ignore the propaganda. Foods have a PROFOUND effect on your health. Try replacing your morning muesli with grapes and blueberries for one week and see how you feel. I’m living proof!

xoxo

The ER doctor looked down at me with a look of half-doubt. He double-checked the piece of paper in his hands.

“Mr. Markel, your quick test came back positive for a heart attack; we need to prep you for the cath lab now.”

What followed was a flurry of activity and words as the nurses reclined my stretcher back until I was looking up at the ceiling.

“Did you give him aspirin yet?”

“Did you call your family? Are they on the way?”

“We’re going to shave you so the doctor can do the heart cath.”

“Can you rate your pain on a scale of one to ten for me, please?”

“Put this under your tongue; it’s going to dissolve and feel tingly.”

“His pulse is getting low.”

“Everything’s going to be OK, Mr. Markel; we’ll take care of you.”

“Time is muscle.”

I laid there, passive and helpless, while the ER techs shaved my pelvis and administered medications. A tech yanked the twelve wires that had been attached to my body and wheeled the EKG machine out of the room. They added an IV tube to both arms and worked at a rapid pace while I tried to make sense of everything. I’d been given painkillers, but my chest still ached.

Before they completed everything and began moving me through the hospital, my family arrived. My wife looked more worried than I’d ever seen before. The kids didn’t know what to make of all the activity. I remember holding their hands and giving them hugs, telling them everything was going to be all right. I remember giving my wife a kiss before they sent her into the waiting room to stand by while the procedure was administered.

And I remember my thoughts.

I’m only 30. I can’t be having a heart attack.

I’m not ready to leave yet.

She needs me.

I just taught Joshua how to play catch yesterday.

We’re just getting started.

I should have come to the hospital earlier.

Who’s going to take care of them if this is serious?

It wasn’t long after they left that I was being wheeled through the hospital, flat on my back, desperately trying to see what was going on. The destination was a very white room, with monitors on one side and lots of steel machinery overhead. Nurses picked me up using a cold backboard and deposited me on an even colder table while they reassured me that I was going to be OK.

They applied a sterile drape and warned me not to touch my own body so I wouldn’t contaminate myself. My arms dropped below the table into metal sleeves while the nurses sterilized my lower half. The doctor entered the room and began pushing on my right leg, trying to find the right entry point, and then inserted a guide wire into my artery and up my body, right to my heart.

I even saw it on one of the monitors.

NINETY MINUTES EARLIER

I rolled over in bed, waking with a start. Groggily, I looked over at the clock on my nightstand to see that it was only three in the morning. I hadn’t felt very well for the previous few days, but wondered wearily why I wasn’t getting good sleep—I’d felt better before going to bed.

Swinging my legs over the side of the bed, I sat up slowly. It felt like I’d slept with too much weight on one arm. I coughed and realized that my chest was sore. It felt like muscle soreness, but it didn’t go away when I stretched or rubbed at it. After some time and some concern from my wife, I got up and began walking back and forth to see if it would relieve the pain, but had no luck, so I sat back down on the bed again.

A large thunderclap earlier in the night had sent my two girls running for cover into our room, so I had to maneuver around the older one to find a spot. It was still storming rather fiercely.

Many minutes later, and after some questioning from my wife, I realized that the pain wasn’t going away – and it wasn’t a sore muscle. Something was wrong. I was breaking out into sweats and didn’t know what to do about it. I finally told Amanda that we should drive to the hospital to have it checked out. She roused the children and herded them into the van, still in their pajamas, while I dumped myself into the passenger seat and tried to stay calm on the way there.

I walked into the ER and told the desk nurse that I’d been having chest pains for the last ninety minutes.

NINETY MINUTES LATER

I laid in the cath recovery area, groggy from the sedative they’d had to administer before completing the catheterization. I was waiting for a hospital room to become available in the intermediate ICU so the doctors could keep me on a heart monitor and watch for more trouble. I had to keep my right leg perfectly straight and my head down for two hours after the procedure.

My family had been in to see me again. The children were still worried, but my wife looked much less concerned than the last time I’d seen her. My pastor was in with them and we prayed for healing and for comfort. I’d never been visited by one of my pastors in the hospital before.

I’d never been in the hospital before at all.

I still didn’t know what to think about what had happened. The cardiologist had assured me while in the cath lab that I had definitely not had a heart attack; the blood vessels serving my heart were completely clear. What had happened was an inflammation of the area surrounding my heart, making it more difficult for my heart to do its job properly. It presented exactly the same as a heart attack would have.

There were obviously some remaining concerns. I was still being hooked up to an EKG on a regular basis to capture my heart rhythms. There were still nurses paying constant attention to me, and it was clear I was going to be in the hospital for at least a short while. It wasn’t much longer that I was wheeled into my room and hooked up to my portable heart monitor.

I was also served a rather unpleasant breakfast.

ONE WEEK LATER

I was released from the hospital after three days of heart monitoring and blood tests. The doctors told me that my heart function was affected during the event, down to less than fifty per cent of normal. I’m home now and settling back into my regular routine as much as I can. I take a couple of heart medications and a couple of antibiotics to keep everything running smoothly. The word is that my recovery is going to take a few months to be complete; I won’t know more until I see the doctors again in a couple of weeks.

They say it was a combination of inflammation of the sac around the heart and of the heart muscle itself. Pericarditis and myocarditis. I looked those up and realized that people can die from these things. I’m supposed to be on guard for any chest pains or trouble breathing – next time, I won’t wait as long to go to the ER.

I get out and walk with my family for at least twenty minutes each day, and tomorrow I try to get back to practicing fielding grounders with my son. My wife and I celebrated our ninth wedding anniversary on Tuesday, perhaps more thankful than in previous years that we’re still together.

I consciously eat less and hope that within a few weeks I’ll see the scale read less than 300 pounds for the first time in far too many months. I’m acutely aware that what I experienced a week ago could have killed me and have no desire to repeat the experience again any time soon. My weight didn’t have anything to do with this particular problem, but it’s something I can control in the future.

The kids don’t fully grasp the gravity of the situation, but they are definitely happy to have me back home and on my feet again. It’s a good feeling.

I’m happy to be up and about again – and to have friends and family such as mine. I find that I did not understand terror or helplessness until that night, but afterwards I learned of the depths of my relationships with others. It was, above all, a humbling experience.

Here’s to a swift recovery.

So today I stayed home from work, called my general practitioner, and got an 11:10 appointment. They gave me an EKG, blinked at it, and sent me to a cardiologist at Banner Heart Hospital. They gave me another EKG, blinked more knowingly at it, and explained.

The symptoms point to pericarditis and/or pleurisy. Follow the links for more info, but basically those conditions are inflammation of the muscles around the heart or around the lungs, which makes the heart’s beating motion bump into stuff it shouldn’t bump into or the expanding lungs bump into stuff they shouldn’t bump into, hence the crampy pain. It’s usually caused by a virus of some sort, or the beginnings of pneumonia. The doctor told me to take Aleve (naproxen specifically, it’s the type of pain killer that helps with this sort of thing that ibuprofen and acetaminophen don’t help with) and I should see a cessation of the symptoms fairly quickly.

Then the doctor said, “However, separate from your current issue is something else that you need to be aware of.” That made me sit up and listen, boy howdy. The EKG revealed that I have something called “short PR interval“, which have nothing to do with the symptoms I’m feeling at the moment. I’ll explain it as it was explained to me – basically the electrical current that passes through/over/whatever the atrium of the heart gets slowed by a resistor type thingy as it passes through/over/whatever the ventricle of the heart. That’s why you get a double bump-bump of the heart – the atrium fills first as a reservoir, then the ventricle fills. Because electrical current travels so fast over an area as small as the heart, there needs to be something to slow things down between the two heart parts. Apparently MY electrical wiring is such that the current from the atrium to the ventricle isn’t slowed as much as it should be slowed, which results in a heartbeat that can get set to racing very easily. To the tune of, like, 220 beats per minute (my resting HR is 68, by the way). My doctor gave me a print-out of my EKG to show to medical professionals if I ever experience that racing heartbeat and need to go to the ER. Because it’s much easier to hand them that so they can go, “Oh, I see,” instead of me trying to ‘splain.

It hasn’t happened to me yet, though I did notice that I can’t keep my heartbeat in the “optimal” range of 130 to 150 BPM when I work out – it’s usually up around 165 and I’m not even pushing myself. The doc was unsurprised when I passed this observation on to him. As long as my heart beat returns to normal speed in a reasonable amount of time (which it does) then I should have nothing to worry about. Again, he said, “Just something to be aware of.”

Noted.

So, an adventure filled day, but now Bill and I are having a couple of beers and listening to music and he’s upbeat and dancing around and making me laugh. Because he takes care of my heart-parts just as well, if not better than, any cardiologist ever could.

Pain and Depression can go hand in hand

When it comes to chronic disease, we all have setbacks. Since last Wednesday I’ve been experiencing a flare. It’s honestly the first that I’ve had in a very long time that was quite this bad. It could be due to stress or medications or both. Compared to how I used to feel before alternative medications, this flare is a breeze. I can still lift my shoulders, tie my shoes and walk without wincing. Flares can vary so you never know what you’re going to get. For me, having Rheumatoid Arthritis can sometimes feel less of a joint disease and more of a systemic disease. For those of you that don’t know, RA can affect the organs just as much as the joints and it can mimic other diseases like Lupus.  I can see what’s happening to my joints….my fingers get more swollen than usual, but when it comes to my organs I can only guess what’s happening.

These last few days I’ve been getting up in the morning and feeling like I’ve smoked a pack of cigarettes. I don’t even know what that would feel like but I’m guessing this feeling is similar. There’s a sense of congestion and heaviness, accompanied with some discomfort to breathing especially if I bend over and especially when I first get up. Just like my joints, this feeling lessens as the day goes on. There are times that it feels like my heart is beating harder or having trouble….could it be Pericarditis? I simply don’t know. And there are moments when my sides have dull aches as if someing inside me is a bit more swollen than normal. Times like these I can only guess what’s going on. Without insurance, there is no way of knowing without going to the doctor and paying an arm and a leg.  Seeing that I can barely afford my supplements on my own, I simply can’t afford a doctor’s visit. Besides, I know the answer to the problem…..reduce the inflammation in my body and everything will be solved, including my sour mood.

If only it were that easy. I could take some Prednisone which sits in my cupboard. But after a year of trying to get off that stuff, no thanks. I’d rather not feel even more moody than I already feel which is what Prednisone would do to me.  Flares are bound to happen from time to time. I have been lucky to avoid having a flare for the past six months or so. I’m also lucky that this one isn’t all that bad. When I did have a doctor I had the same complaints: chest pain and congestion, rib pain, organ pain, and just about everything and everywhere hurt. Knowing that I have the least amount of pains now that I don’t have a doctor, it makes it all the more simpler to not worry and just keep going on with my life. A flare will eventually subside.

Extreme tiredness is another problem that accompanies most chronic diseases. It doesn’t seem to matter how many hours of sleep I get, I’m still tired. I can say however, the more I sleep, generally the less pain I wake up with. Depression is the other thing that pulls me down. People close to me try to perk me up and they say, “Don’t let yourself get depressed.” It’s hard to have that kind of self control. You go to lift something and you realize you don’t have the strength. You plan a day of activities to realize you don’t have the energy. You have aches and pains and have no way of relieving them. People want to spend time with you but you don’t want to spend time with them…..you are at a loss for words and feel like you might fall asleep in their presence. You find yourself stuttering. You spend more than your share of time in the bathroom to accomplish nothing. (Inflammation of the intestines can make you very constipated). People cook you food and you barely eat. I think faking the way I really feel takes its toll and adds to the depression. People ask on the phone, “How are you doing?” You answer, “Fine and how are you?” But the real answer would depress other people. “I feel extremely tired and sad that my weekend was taken away from me.” People don’t want to hear that so you hold it in and take one for the team, the chronically ill team that is.

What’s it like to have a chronic disease? Well, honestly it really takes it’s toll on your body and spirit,  especially when you’re going through a flare. The pain, the medications, the tiredness….none of it is easy. I can say that since I’ve been treating myself with alternative medications I feel WAY better than before, when I was on chemotherapy drugs and steroids. But even this path isn’t easy for reasons like expense, feeling alone on this particular path, and the amount of pills I have to take can be annoying and tiring.

At first I thought twice about writing an entry like this. After all, it can make people feel uncomfortable. But then I thought, why can’t I just be honest? Why spare other people and hold in these emotions?  Is this too much information? Perhaps it is but I don’t care. At least you know when you come to my blog you’ll get the truth and the real me.  Thanks to all out there, who visit.  You are my support and I appreciate you.

La pericarditis es la inflamación de una membrana que rodea el corazón y que se llama pericardio(peri=alrededor, cardio=corazón). Esta membrana está formada por 2 hojas, una está adherida a la superficie del corazón y, entre las dos, hay un espacio con una pequeña cantidad de líquido que evita el roce de ambas.

SÍNTOMAS:

Según su causa pueden aparecer de forma brusca o solapada. La más importante es un dolor en el tórax por detrás del esternón que puede extenderse hacia la parte alta del vientre,brazo y hombro izquierdos, cuello y espalda, aumenta con la respiración profunda y la tos, es más intenso al acostarse y se alivia al sentarse.

COMPLICACIONES:

La inflamación del pericardio produce un derrame entre sus dos hojas, que si es copioso, obstaculiza la dilatación del corazón, sobre todo de las aurículas, pues sus paredes son menos gruesas. Este trastorno se conoce como taponamiento cardíaco, ocasionando tos y aumento del ahogo. Este último disminuye si el paciente se sienta con el tronco inclinado sobre las rodillas , pues esta posición desplaza el derrame hasta la pared del toráx.

En algunas pericarditis, las dos hojas se endurecen mucho, formando como una coraza que aprisiona el corazón, dificultando su dilatación y su contracción, por lo que disminuye la cantidad de sangre que expulsa. Debido a ello la sensación de ahogo aumenta y la sangre se estanca en las venas antes de llegar al corazón.

CAUSAS:

La más frecuente suele ser por la infección de diversos virus. Las pericarditis pueden complicar algunas enfermedades como la insuficiencia renal, el infarto de miocardio o ciertas enfermedades reumáticas. También es posible que aparezca como consecuencia de la radioterapia o de algunos medicamentos.

TRATAMIENTO:

Las producidas por virus se curan con reposo y aspirina u otros inflamatorios. Las producidas por bacterias con un buen tratamiento antibiótico. Si existe un derrame importante es necesario vaciar el pericardio por medio de una punción y si está endurecido, puede ser necesaria una operación para liberar el corazón.

Fuentes:

http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000182.htm

http://es.wikipedia.org/wiki/Pericarditis

Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. Its symptoms vary greatly, but the disease primarily affect the lungs. Occasionally, other organs are affected. This form of the disease is called disseminated histoplasmosis, and it can be fatal if untreated.

Can anyone get histoplasmosis?

Yes. Positive histoplasmin skin tests occur in as many as 80% of the people living in areas where H. capsulatum is common, such as the eastern and central United States. Infants, young children, and older persons, in particular those with chronic lung disease are at increased risk for severe disease. Disseminated disease is more frequently seen in people with cancer, AIDS or other forms of immunosuppression.

How is someone infected with H. capsulatum?

H. capsulatum grows in soil and material contaminated with bat or bird droppings. Spores become airborne when contaminated soil is disturbed. Breathing the spores causes infection. The disease is not transmitted from an infected person to someone else.

What are the symptoms of histoplasmosis?

Most infected persons have no apparent ill effects. The acute respiratory disease is characterized by respiratory symptoms, a general ill feeling, fever, chest pains, and a dry or nonproductive cough. Distinct patterns may be seen on a chest x-ray. Chronic lung disease resembles tuberculosis and can worsen over months or years. The disseminated form is fatal unless treated.

When do symptoms start?

If symptoms occur, they will start within 3 to 17 days after exposure; the average is 10 days.

Is histoplasmosis treatable?

Yes. Antifungal medications are used to treat severe cases of acute histoplasmosis and all cases of chronic and disseminated disease. Mild disease usually resolves without treatment. Past infection results in partial protection against ill effects if reinfected.

Where is H. capsulatum found?

H. capsulatum is found throughout the world and is endemic in certain areas of the United States. The fungus has been found in poultry house litter, caves, areas harboring bats, and in bird roosts.

What can be done to prevent histoplasmosis?

It is not practical to test or decontaminate most sites that may be contaminated with H. capsulatum, but the following precautions can be taken to reduce a person’s risk of exposure:

Avoid areas that may harbor the fungus, e.g., accumulations of bird or bat droppings.

Centers for Disease Control and Prevention

Histoplasmosis

Definition

Every year, hundreds of thousands of people worldwide get a lung disease called histoplasmosis. It’s transmitted through airborne spores that you breathe into your lungs when you work in or around soil that contains a fungus called Histoplasma capsulatum. Farmers, landscapers, construction workers and people who have contact with bird or bat droppings are especially at risk for histoplasmosis.

Most people with histoplasmosis never develop signs and symptoms and aren’t aware they have the infection. But for some people — primarily infants and those with compromised immune systems — histoplasmosis can be serious.

Effective treatments are available for even the most severe forms of histoplasmosis. But these therapies often involve extensive hospital stays and can cause serious side effects. That’s why it’s important for people with compromised immune systems to avoid exposure to histoplasmosis.

Symptoms

Several tpes of histoplasmosis exist, ranging from mild to life-threatening. The most benign form produces no signs or symptoms, but severe infections can cause serious problems throughout your body as well as in your lungs. When signs and symptoms do occur, they usually appear three to 17 days after exposure.

Mild to moderate cases

Asymptomatic primary histoplasmosis. This is the most common form of histoplasmosis and usually causes no signs or symptoms in otherwise healthy people who become infected. The only sign of infection may be small scars in the lungs. In that case, special radiologic testing can usually confirm that nodules aren’t cancerous.

Acute symptomatic pulmonary histoplasmosis.

This form of histoplasmosis tends to occur in otherwise healthy people who have had intense exposure to H. capsulatum. Because the severity of the disease depends on the number of fungus spores inhaled, reactions may range from a brief period of not feeling well to serious illness. Typical signs and symptoms include:

Fever
Headache
Dry cough
Chills
Chest pain
Weight loss
Sweats

In some cases, arthritis or pericarditis — an inflammation of the sac that surrounds the heart — may develop weeks or months after the initial infection. These problems aren’t a sign that the infection has spread outside your lungs. Instead, they develop because your immune system responds to the fungus with an unusual amount of inflammation.

On the other end of the spectrum, people who have inhaled a large number of spores may develop severe acute pulmonary syndrome, a potentially life-threatening condition in which breathing becomes difficult. Acute pulmonary syndrome is frequently referred to as spelunker’s lung because it often occurs after intense exposure to bat excrement stirred up by explorers in caves.

Moderate to severe

Chronic pulmonary histoplasmosis. This type of histoplasmosis usually affects people with an underlying lung disease such as emphysema. It’s most common in white, middle-aged men. The disease is chronic and if left untreated may progress to disabling lung problems. Signs and symptoms include:

Fatigue
Fever
Night sweats
A cough that may bring up blood

Disseminated histoplasmosis.

Occurring primarily in infants and people with compromised immune systems, disseminated histoplasmosis can affect nearly any part of the body, including your eyes, liver, bone marrow, skin, adrenal glands and intestinal tract. Untreated disseminated histoplasmosis is usually fatal. Depending on which organs are affected, people with this form of the disease may develop:

Anemia
Pneumonia
Pericarditis
Meningitis
Adrenal insufficiency
Ulcers of the mouth, tongue or intestinal tract

Causes

Histoplasma capsulatum is primarily found in the temperate regions of the world and is the most common fungus in the United States. It’s endemic in the Ohio, Missouri and Mississippi river valleys, where the great majority of people have been exposed.

The fungus thrives in damp soil that’s rich in organic material, especially the droppings from birds and bats. For that reason, it’s particularly common in chicken and pigeon coops, old barns, caves and parks.

Birds themselves aren’t infected with histoplasmosis — their body temperature is too high — but they can carry H. capsulatum on their feathers, and their droppings support the growth of the fungus. Birds commonly kept as pets, such as canaries and parakeets, aren’t affected. And although bats, which have a lower body temperature, can be infected, you can’t get histoplasmosis from a bat or from another person.

Instead, you develop histoplasmosis when you inhale the reproductive cells (spores) of the fungus. The spores are extremely light and float into the air when dirt or other contaminated material is disturbed. That’s why a high number of cases occur in farmers, landscapers, construction workers, spelunkers and people living near construction sites.

Histoplasmosis and your lungs

Because the spores of H. capsulatum are microscopic in size, they can easily enter your lungs and settle in the small air sacs. There, the spores are trapped by macrophages — immune system cells that attack foreign organisms. The macrophages carry the spores to lymph nodes in your chest, where they continue to multiply. This may lead to inflammation, scarring and calcium deposits. In cases of heavy infection, the lymph nodes may become so enlarged that they obstruct your esophagus or your lungs’ airways.

Most often, however, you’re not likely to have noticeable signs and symptoms, and the infection clears on its own without treatment. But if your immune system isn’t able to eliminate the spores, they can enter your bloodstream and travel to other parts of your body. In that case, you may develop a variety of severe problems that can be fatal if not diagnosed and treated quickly.

Risk factors

Anyone exposed to H. capsulatum is likely to become infected. People who inhale a huge number of spores — those who work with heavily infected soil or have close contact with bats, for example — are more likely to develop signs and symptoms.

Most at risk of infection

Farmers
Poultry keepers, especially when cleaning chicken coops, pigeon roosts, and bat-infested barns or lofts
Construction workers, especially those who work around old buildings with roosting birds
Landscapers and gardeners
People involved in building roads
People who monitor bird populations or who have contact with bats or bat caves
Archeologists
Geologists

Most at risk of severe infection

Because their immune systems are weakened, the following people are most likely to develop disseminated histoplasmosis, the more serious form of the disease:

Infants and very young children.
Older adults. The risk of disseminated histoplasmosis increases with age.
HIV-positive people or those with AIDS.

People receiving chemotherapy or long-term treatment with corticosteroid drugs such as prednisone.
People who have had organ transplants and are taking anti-rejection medications.

When to seek medical advice

Contact your doctor if you live in an area where histoplasmosis is common and you develop chest pain, cough and a fever. Although many illnesses cause similar signs and symptoms, your doctor may want to test you for the presence of H. capsulatum. If your immune system has been weakened by illness or medications, seek medical care immediately.

Tests and diagnosis

Histoplasmosis can cause a variety of signs and symptoms, many of which resemble those of other illnesses. For that reason, it can be particularly challenging to diagnose. Complicating the matter further is the large number of tests available for detecting the presence of the fungus — each of which has some limitations.

These tests include:

Fungal culture. This is considered the gold standard for confirming a diagnosis of histoplasmosis. During the test, a small amount of blood, sputum or tissue from your lymph nodes, lung or bone marrow is placed on a medium that enhances the growth of fungus and then checked for the presence of H. capsulatum. The drawback is the time it takes for the fungus to grow — two to four weeks and sometimes up to 12 weeks. For that reason, it’s not a good choice in cases of disseminated disease where delayed treatment may prove fatal.

Fungal stain. In this test, a tissue sample, which may be taken from sutum, bone marrow, your lungs or a skin sore, is stained with dye and examined under a microscope. The accuracy of the test depends on the type of sample obtained and the skill and experience of the examiner. Other organisms can resemble H. capsulatum under the microscope, so confirmation with another test is desirable if an organism resembling H. capsulatum is identified.

Serology. This test examines blood for antigens and antibodies. It’s a quick and fairly accurate way of detecting disseminated histoplasmosis as well as chronic or mild cases of the disease. But false-negative results are a problem, especially in people who have compromised immune systems or are infected with other types of fungi. The test can also be positive in people who live in endemic areas and have had past exposure to H. capsulatum, even though their current symptoms may be due to something else.

Depending on your signs and symptoms and the severity of your illness, your doctor may recommend other tests, such as:

Chest X-ray. Although not normally used to diagnose histoplasmosis, an ordinary chest X-ray can show inflammation and damage in your lungs.

Computerized tomography (CT). This X-ray technique produces more detailed images than do standard X-rays. CT can be especially helpful for detecting complications from histoplasmosis.

Bronchoscopy. Your doctor may use this test to help establish a diagnosis of histoplasmosis if the disease hasn’t already been confirmed by a fungal culture, stain or serology test. During the procedure, your doctor examines your windpipe (trachea) and the air passages leading to your lungs using a thin, lighted tube (endoscope). A small sample of tissue (biopsy) can be taken through the endoscope.

Complications

Histoplasmosis can cause a number of serious complications, even in otherwise healthy people. For infants, older adults and people with compromised immune systems, the potential problems are often life-threatening.

Complications of acute and chronic pulmonary histoplasmosis

Enlarged lymph nodes. Most people with histoplasmosis have some involvement with the lymph nodes in the central part of the chest. This region lies between your lungs and contains the trachea, esophagus, heart and many small lymph nodes. In a small percentage of people with acute pulmonary histoplasmosis, the lymph nodes may enlarge enough to obstruct the airways or esophagus, making it difficult to breathe or swallow. Sometimes the pulmonary arteries and veins — the large blood vessels in the lungs — also may be blocked.

Fibrosing mediastinitis. A rare but severe late complication of histoplasmosis, fibrosing mediastinitis occurs when scar tissue from lymph nodes in the chest invades and blocks adjoining structures, especially the esophagus and large blood vessels. Signs and symptoms, such as a cough that brings up blood, chest pain and breathlessness, usually don’t appear until the disease is quite advanced. When structures in both lungs are affected, fibrosing mediastinitis can be life-threatening.

Pericarditis. This is inflammation of the pericardium, the sac that surrounds your heart. Normally, this sac contains a small amount of fluid. But when the pericardium becomes inflamed, the amount of fluid in the sac may increase. This can interfere with the heart’s ability to pump blood efficiently. Pericarditis that occurs as a complication of histoplasmosis usually results from inflammation in nearby lymph nodes, rather than from infection of the pericardium itself.

Arthritis. Joint inflammation, often in conjunction with a skin rash (erythema nodosum), is a common complication of acute pulmonary histoplasmosis. Women are far more likely to be affected than are men. Although the arthritis may persist for months, it usually clears on its own or after a brief course of nonsteroidal anti-inflammatory drugs.

Complications of disseminated histoplasmosis

Disseminated histoplasmosis can affect almost any organ system in your body, leading to a number of serious and potentially fatal complications. Some of these include:

Adrenal insufficiency. Your adrenal glands, which are located just above your kidneys, produce hormones that give instructions to virtually every organ and tissue in your body. When the glands don’t provide enough of these hormones, serious, and potentially life-threatening, problems can occur. Untreated adrenal insufficiency (Addison’s disease) is fatal.

Meningitis. An infection and inflammation of the membranes (meninges) and fluid (cerebrospinal fluid) surrounding your brain and spinal cord, meningitis can be life-threatening. The disease usually strikes suddenly, often with a high fever, severe headache and vomiting. As it progresses, the brain swells and may begin to bleed. Meningitis is fatal in a small percentage of cases. As a complication of histoplasmosis, meningitis occurs primarily in people with compromised immune systems, although it occasionally develops in otherwise healthy people.

Mayo Clinic

Treatments and drugs

Treatment usually isn’t necessary if you have a mild case of acute histoplasmosis. But if your symptoms are severe or you have the chronic or disseminated forms of the disease, you’ll likely need treatment with one or more antifungal medications — most often amphotericin B (Fungizone IV) and itraconazole (Sporanox). The specific drug and the length of treatment depend on the type and severity of your illness as well as on your overall health.

In general, one of several formulations of amphotericin B is the initial treatment of choice for people with disseminated histoplasmosis or severe disease. But because these drugs can be toxic to the kidneys and must be administered intravenously, doctors usually switch to itraconazole within a few days to a few weeks, depending on how your condition improves. Corticosteroids are also sometimes given initially if you have severe respiratory disease and difficulty maintaining oxygen levels in your bloodstream.

Itraconazole alone may be effective in mild cases of disseminated histoplasmosis as well as in chronic pulmonary disease. Although itraconazole doesn’t work as quickly as amphotericin B, it has fewer side effects and can be taken in pill form. While using this medication, you may experience headache, dizziness, nausea, vomiting or diarrhea, but these symptoms often go away over time. If you have a history of liver or kidney problems, or another lung disease, you’ll need to be monitored closely during treatment.

If you’re not a candidate for itraconazole or can’t tolerate the medication, your doctor may prescribe fluconazole (Diflucan), another antifungal drug. Fluconazole isn’t as effective as itraconazole, however, and you’re more likely to experience a relapse with this medication.

Prevention

It’s difficult to prevent exposure to the fungus that causes histoplasmosis, especially in parts of the country where the disease is widespread. Even so, these steps can help reduce the risk of infection:

Spray contaminated soil. Before you work in or dig soil that’s likely to harbor H. capsulatum, spray it thoroughly with water. This can help prevent spores from being released into the air. Spraying chicken coops and barns before cleaning them also can reduce your risk.

Use an effective face mask. This is the best way to protect yourself from soil-borne organisms if you must work in contaminated areas or in caves known to harbor bats. The National Institute for Occupational Safety and Health (NIOSH) recommends using Part 84 particulate respirators certified by NIOSH.

Note: Especially At Risk Groups:

is a partial list of occupations and hobbies with risks for exposure to H. capsulatum spores. Appropriate exposure precautions should be taken by these people and others whenever contaminated soil, bat droppings, or bird manure are disturbed.

• Bridge inspector or painter
• Chimney cleaner
• Construction worker
• Demolition worker
• Farmer
• Gardener
• Heating and air-conditioning system installer or service person
• Microbiology laboratory worker
• Pest control worker
• Restorer of historic or abandoned buildings
• Roofer
• Spelunker (cave explorer)

If someone who engages in these activities develops flu-like symptoms days or even weeks after disturbing material that might be contaminated with H. capsulatum, and the illness worsens rather than subsides after a few days, medical care should be sought and the health care provider informed about the exposure.

Histoplasmin skin test:

A person can learn from a histoplasmin skin test whether he or she has been previously infected by H. capsulatum. This test, similar to a tuberculin skin test, is available at many physicians’ offices and medical clinics. A histoplasmin skin test becomes positive 2 to 4 weeks after a person is infected by H. capsulatum, and repeated tests will usually give positive results for the rest of the person’s life. A previous infection by H. capsulatum can provide partial protection against ill effects if a person is reinfected. Since a positive skin test does not mean that a person is completely protected against ill effects, appropriate exposure precautions should be taken regardless of a worker’s skin-test status. Furthermore, while histoplasmin skin test information is useful to epidemiologists, a positive skin test does not help diagnose acute histoplasmosis, unless a previous skin test is known to have been negative.

Endemic and areas of distribution

I was admitted to hospital on Friday with chest pain, hacking cough, shortness of breath and severe tachycardia. Being a cancer patient with a low immune system due to chemo they took it all quite seriously and admitted me. I had a chest x-ray which came back clear (thank goodness) so it wasn’t pneumonia, an ECG, numerous arterial blood gases (very painful, not at the time but the bruise left from having a needle in the radial artery is spectacular), IV fluids to rehydrate me and try and bring my pulse down, on constant oxygen as my saturated oxygen levels were only 90% on arrival and constant observations.

They discharged me on Sunday with the diagnosis of a viral chest infection which has led to pleurisy and pericarditis. I’m on antibiotics to ensure nothing bacterial is growing in me and non-steroidal anti-inflammatories which is the treatment for pericarditis.

However, on Monday night I was coughing badly and couldn’t catch my breath again. In turn I fainted and cracked my head open so ended up in A&E again. It’s been glued and steri-stripped but they decided to look into the cough/breathlessness/chest pain again. This meant another chest x-ray, more bloods, another set of blood gases, another ECG and more sitting around until they determined it wasn’t a blood clot or anything sinister.

Back at home now and determined to stay here for a while. The cough is easing but the chest pain is still sore and occasionally catching my breath is hard. I have bruised wrists from the blood gases, a bruised head from cracking it open and bruised elbows/hands from having blood taken and venflons put in and out. In short, I look distinctly un-sexy.

Ruth

Yes, my one and only symptom—sporadic inflammation around my heart—was sometimes a symptom of lupus and other autoimmune diseases, but that alone was not enough to say I had any of them. My blood tests for the biggies continued to turn up nothing. But the fact that my heart pain had returned after pregnancy did mean my body was doing something to cause it. Steroids had been keeping it at bay, but, what with their laundry list of icky side effects, I had to switch to something new.

So, my doctor put me on a gradual prednisone taper and started me on a new drug to stop my body from attacking its own cells and causing inflammation. It would take three months to kick in, but both she and the pediatrician said it would be OK to breast-feed while taking it, and, with few side effects, I could be on it for a long time if necessary.

When I stepped outside the doctor’s office, I felt a weight floating off of me, and I felt like I was floating down the street. Sure, what I would have preferred is for this whole mess to have been related only to pregnancy and that I could be totally normal now. But, next to that, I’d take not having a major autoimmune disease and being able to control whatever is going on with me with a drug that won’t stop me from breast-feeding and which I can safely take for a long time.

I whipped out my cell phone and shared the good news with my parents who were as elated as I was. But I wanted to tell my husband, David, in person. He had been in the trenches with me for every moment of this battle against an unknown enemy. I couldn’t wait to tell him that even though that enemy still didn’t have a face, we now knew it wasn’t a major threat.

And there was one last hurdle to clear before truly breathing a sigh of relief. My cardiologist had scheduled a cardiac MRI to take an intimate look at my ticker and make sure that the inflammation hadn’t done any damage.

But, for now, it felt so good to take one small levitated step for Katekind.

(PHOTO: ISTOCKPHOTO)

Recent posts by Kate Rope:

He was 26-years-old and too sick to work. For months the young man you’re about to meet suffered from a disease called pericarditis. It’s a heart condition that doctors at Mayo Clinic say can be difficult to diagnose, often hard to treat and very challenging for many of the people who suffer from it. The key to recovery is getting the right treatment and getting it quickly.

Be careful with her heart!

Unbreak My Heart singer Toni Braxton was rushed to a Las Vegas hospital after her show Monday night at the Flamingo.

The reason for her hospital visit has not been disclosed.

But, hospital officials said she is in good condition.

Braxton does have a heart condition called pericarditis, an inflammation of the sac surrounding the heart.

Could her trip to the hospital be heart related?

Get back on your feet soon, Toni!

This is how I am now.  My blood pressure is borderline, on the low side.  My legs are very swollen.  I can walk slowly to my kitchen or front door, but I can’t stand up very long once I get there.  The sciatica has resolved (“the least of your worries” said my doc) a good bit, so the pain with position change is much better.  These years with lupus fatigue have trained me well for coping with this low output state.  I am cooking and doing laundry sitting on a stool, and just a little at a time.  I’m conserving steps by combining errands to the kitchen, garage, etc.  I’m only driving to the doc and the appointments for tests that are set up next week.  I am keeping my feet up when I knit or play on the computer or read. 

My first test is a 24-hour urine collection.  They gave me a big orange jug to bring home, along with a hat-shaped collection cup that goes in the toilet.  I pee, I pour it in the jug, the jug goes on ice.  Peeing never seems like much until they add in a bunch of rigamarole like this.  I’m tempted to do something bizarre with my collection, like decorate the jug.  Restrain me, someone!  This is a dangerous frame of mind.  I had blood drawn to go with this, and I’ll have more drawn Monday when I take it back. 

Next week, the echocardiogram.  I actually like those.  They put the slippery stuff on your chest, then use an ultrasound probe to look at all the structures in your heart.  You can measure the heart chambers and valves, see how well the walls of the heart are moving when it contracts, and see if any valves are leaking.  You can also see if there is fluid or scar tissue around the heart, like you might expect with pericarditis.  The pictures are on a monitor right beside you so you can see what the tech sees.  Fun. 

I am being very, very careful with salt right now.  It’s a bummer, because I can’t enjoy the stuff you usually do when you’re sick, like calling all your friends and saying “feed me!”  That’s okay.  I just enjoyed my homemade chicken and tomato and pea salad (low salt canned peas, of course).  On tv a female doc is telling an FBI agent she could use a scotch.  I can’t do that, either.  Actually, I don’t know what scotch tastes like, but if I wanted a beer, that would not be a good choice.  Alcohol depresses cardiac function. 

I had a long talk with my daughter this morning.  She enjoyed her birthday and the experience of making her own toga for a sorority gathering.  Evidently there’s a youtube video to help us out with that.  Doubt if I’ll need it any time soon.  Anyway, my daughter is a sharp young woman.  She asked all the right questions.  She understands what we both have to do.  I’ve talked to all my sisters, too.  

Enough of contemplating this.  I finished an adorable hat yesterday.  I was sitting next to a bin of yarn leftovers, and a ball of deep red Araucania Magallanes and a ball of Noro Silk Garden caught my eye.  Suddenly it struck me that they belonged together.  They were just untamed enough that they needed to make a nubby textured hat, so I knitted them with a seed-stitch band then a woven-appearing box pattern.   

        Sometimes the intense, wildly varied colors in a skein of Noro call me to unify them a bit by combining them with a solid color.  The deep red works well pulled with the multicolored yarn, and the color changes are still vivid and linear.  This was the goal in another piece where I combined two strands of lime green Noro solid (Iroha) with a multicolored strand of Silk Garden.    I think this is a good way to use color if you have cold feet.  When things seem too bright and wild for you, try pulling a strand of the brighter, wilder  yarn with something more muted that will calm it down and provide a consistent backdrop for all that color.  Don’t I sound like someone on HGTV?  I do love decorating shows.

I wasn’t trying to distract you or myself from the obvious bad stuff that is going on.  But I am a blessed woman, with wonderful people and happenings in my life, and that should be the note we end on.  Thanks for the prayers and jokes.  Equally effective.

Peace!

The labor and delivery nurses welcomed us with a warmth that made me want to cry (some more). At last someone was taking my pain seriously, besides my husband, who was now so sleep-deprived and stressed out that he resembled a Guantanamo detainee. I spent the next three days in a comfortable private delivery room. Sure, we had a VCR and pullout bed for David, but it was the six-hour doses of painkilling Percocet that made a girl never want to leave.

Day 1: The leading contender became gallstones after an ultrasound tech decided my gallbladder looks enlarged. This could necessitate removing it. Surgery during pregnancy didn’t sound too good. I hoped for another conclusion and was booked for an MRI the next day.

Day 2: The GI doc stopped in to reiterate that he didn’t think it was heartburn but had no idea what it could be. He hoped the MRI would reveal something. The OBs came by to chime in that they too were stumped. At the end of the day a diminutive cardiologist with an enchanting bedside manner visited me. She doubted the pericarditis theory but ordered an ultrasound to be thorough.

Day 3: The friendly ultrasound tech pulled up another of those 2-D pictures of my heart on the screen. I didn’t look or ask any questions because I didn’t know what I was more afraid of—finding out what was wrong or finding out that they still didn’t know what was wrong. In the meantime, was it time for my next Percocet?

The only enjoyable moments were the periodic Sprout checks when a nurse hooked me up to an electric fetal monitor to listen to her heart and see if she was moving. Man, was she moving. As she somersaulted in her little home, it registered as static on the machine. I sounded like a car radio on a country road. I loved it.

And then, in a moment, it was over. Two OBs descended on my room to say they had found fluid around my heart and lungs. Turns out I’d had untreated pericarditis all along. By then it was so bad that fluid had seeped into the swollen space and my lungs were inflamed and fluid-coated too. There was a chance that I had an autoimmune disorder like lupus, and I needed to see a rheumatologist. I cried. A lot. Fluid around your heart is scary. Fluid around your lungs, even more so. The word lupus is positively petrifying.

The only good news? For now my doctors would treat me with ibuprofen. Though it’s not usually recommended for women in pregnancy and there is some controversy as to its safety, my doctors felt that at this stage the benefits outweighed any potential risks. Within two hours of gulping some down, the pain I had been living with for three weeks was 65% better. I went home.

See all posts by Kate Rope.
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