Wednesday, April 24, 2013

Allergies after cancer treatment

This spring I have had two bouts of an interesting phenotype.  Each bout was the same:  I would awaken one morning with swollen, itchy hands and feet; the itchiness would travel toward but never reach my torso; the itchiness would come and go for several days before finally subsiding.  I assumed that this was an allergic reaction to some undetermined allergen, but since I had no prior allergies I thought I'd do a bit of internet research.

Naturally, Google came up with all sorts of horrible things that could cause swollen, itchy hands and feet.  One of them included various blood cancers, which I know could be a side effect of my chemotherapy.  I therefore called Dr. Oncologist.  She assured me that my recent bloodwork (February    2013) looked fantastic.  She also assured me that this was neither a normal thing nor something that I should tolerate, and she referred me to an allergist.

Dr. Allergist was the most amusing doctor I have ever had.  He had numerous anecdotes and jokes, and I laughed even though I was probably the millionth patient to hear them.  Interestingly, he virtually ignored my swollen appendages.  Instead he focused on the breathing-related answers that I put on the intake questionnaire.   

Breathing issues, you might ask?  Ever since radiation therapy I have had a few breathing-related issues.  For example, I awake every morning with a deep cough.  It ebbs and flows in its severity, so I never thought much about it.  Also, I occasionally have a hard time catching my breath.  Sometimes it  happens during exertion so I chock it up to being out of shape and having permanent lung damage.  But sometimes it happens during rest, such as when reading aloud to the girls.  Also, it is inconsistent.  I often go weeks and weeks being totally fine, then have a spell of hard breathing.  I had discussed all of this with Dr. Oncologist, and she said that she'd order a chest x-ray if it was continuing at my next visit.    

Enter Dr. Allergist.  My breathing issues were unintentionally aired to Dr. Allergist because he had a lengthy questionnaire to be filled out for the first appointment.  Many of the questions pertained to breathing.  Apparently many of my answers to the breathing questions were out of the ordinary, and he focused most of the visit on my breathing issues rather than my itchy appendage issues.

I was tested for reactivity to numerous allergens and we discovered that I am allergic to cats, dogs, mold, and tree pollen.  These discoveries explain everything entirely.  My breathing problems were most severe during the drought last August (mold spores in the air!) and now (springtime is tree pollen time!), and each episode of itchy hands and feet correlate with cuddling my dad's new kittens (I'll miss you, kitties!).

Additionally, I was diagnosed with mild asthma.  This is actually an unfair diagnosis because it is merely the word to define the manifestation of the allergic response.  I have allergies, and they cause an asthma condition.  Presumably if I control the allergies, I will control the asthma.

The result of all of this is that I have two different inhalers and an allergy medicine.  This was a lot to acquire at one time, but I am getting the hang of figuring out how frequently I need to use the stuff.  I hate taking any allergy pill (they all mess with my head in one way or another), but if I take a certain one at night it's not so bad.  And I shouldn't have to take it all the time.  Just in the spring, or whenever my symptoms are bad.

Dr. Allergy did not think that any of these new things are a result of my cancer treatments.  I agree with him that folks can develop allergies at any time in their lives, and that a person's allergies can change at any time in their lives.  But I will note that cancer treatment, including indirect treatments of side-effects via numerous antibiotic therapies, altered my formerly healthy gut bacterial community.  And I will also note that changes in the gut bacterial community influence the immune response in the lungs, and that asthma is one such immune response in the lungs.  My gut microbiota underwent catastrophic changes that are likely still affecting my overall health, including these new allergy and asthma diagnoses.  I am but one patient in an uncontrolled, heavily biased study, so these comments are simply comments and not to be taken as facts.  

On a happy note, Dr. Allergy did sign me up for a chest X-ray, and my lungs look glorious.  No signs of  cancer or anything else unusual.  That gave me a sigh of relief.  No inhaler can cure the chest tightness that comes from the fear of cancer recurrence or metastasis.  That single x-ray film obliterated my fear and gave the inhaler a chance to succeed.  With clean lungs on my mind and a week of asthma treatment under my belt, I can finally take that deep breath that's been eluding me for so long.