What Effect On Our Lungs Does Se Asia Have?

[labik]

Have lived in Asia for 8 straight years, 5 of those in SE Asia (VN, Thailand, and Cambodia). No smoking and only light drinking (a beer or two at most)

I have noticed a low capacity in my breathing. Walking up a flight of 10 or 12 stairs has me winded with hands on hips - locals staring at me like I'm strange. And get this - I jog! Have been for the last 3 months, and did so every year in the past. I've noticed that I am winded and breathing heavily not :30 seconds after I start running (breathe in and breathe back out every two steps, which is like a 'maximum' pace for most people) after only a half lap around a track (200m or so).

Although I feel good about getting out there and jogging, my run times are horrendous compared to just a decade ago - my lap times have almost doubled. I'm 40 and feel I shouldn't be much different than when I was 25, but walking up the 12 stairs in my building should have me feeling good, not panting.

Any one have any insightful knowledge on just what the air here in SE Asia can do to us? How extensive is it? Really this destructive, or should it only have a minimal effect? If it is my lungs, can they be rebuilt, or is it like the liver in that the damage is 'irreversible?'

I did a google search but mostly found literature that is geared towards smokers.

[meatboy]

20years down the coal mines in uk,i only suffered in bkk.the air quality is bad,but in time i started to suffer back home but did nothing,then 2007 i had double by pass and a new heart valve.so i would go and get your blood pressure checked and your colesteral for starters,the docter should have a pump to test your lungs as well.

[Thanyaburi Mac]

Recommend you visit your local hospital and get a quick and easy, and cheap, spirometry test.

http://www.nhlbi.nih.gov/health/dci/Diseases/lft/lft_types.html

FYI, at 60+, I came down with Adult Onset Asthma, a real surprise to me, I'd always figured asthma was a kid's disease.

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Asthma_in_adults?open

FYI, I quit smoking back in 1986, moved out of Bangkok 15 years ago to Thanyaburi, used to be largely rice field and orchards out here, now lots of moobans, but still no polution.

Happily the asthma is well under control via a 2x a day snort of Symbicort.

Mac

[MAJIC]

Yes I know exactly how you are suffering,

You need to get yourself checked out, good International Hospitals have computerised lung Capacity Testing Equipment.

Considering the Humidity,the Heat,and the Dust,and the ease of picking up Chest Infections,through airborne Bugs( which could be your problem) and for elderly people,Bangkok traffic fumes,would most certainly have an adverse effect on someone with Chest problems.

Thailand may not be the best place to live in,for you.

In the UK,with cleaner air,and no excessive heat problems I feel ten times better.

Edited July 8, 2011 by MAJIC

[Sheryl]

It is not necessarily your lungs per se. Could well be your heart. Indeed in a non-smoker with no history of pulmonary disease that is the most likely cause.

Shortness of breath on exertion is often an early sign of congestive heart failure. Other signs include swelling of the feet/ankles after standing for some time and getting up more often than usual during the night to pee, but shortness of breath after heavy exercise will occur before even before these.

It is imperative that you see a doctor at once. Diagnostic work up should include Chest Xray and Stress Test. If these are all negative then consult a pulmonologist for specialized tests of pulmonary function as other posters mentioned, but I'd start with these.

[Atmos]

I developed adult onset asthma in late teens, spent 25 years on daily inhalers for prevention and cure, apart from the years I worked in Australia (am from NZ) when it would fade away after a few months of acclimatisation; would rate myself as well above average fitness throughout adult life, competitive distance swimmer and triathlete at national level, but never far from a Ventolin inhaler etc.

I have not used an inhaler/had any threat of asthma in almost 3 years of Thailand/Malaysia/Cambodia. The climate agrees with me. Note I'm not/never lived in Bangkok - coastal Phuket, rural Sa Kaeo now on the coast of Chanthaburi. No industry, no fumes . . . for the OP I'd suggest a thorough medical check-up - I wouldn't blame the air, an hopefully have you back running at full speed.

Good health!

[Thanyaburi Mac]

I developed adult onset asthma in late teens, spent 25 years on daily inhalers for prevention and cure, apart from the years I worked in Australia (am from NZ) when it would fade away after a few months of acclimatisation; would rate myself as well above average fitness throughout adult life, competitive distance swimmer and triathlete at national level, but never far from a Ventolin inhaler etc.

I have not used an inhaler/had any threat of asthma in almost 3 years of Thailand/Malaysia/Cambodia. The climate agrees with me. Note I'm not/never lived in Bangkok - coastal Phuket, rural Sa Kaeo now on the coast of Chanthaburi. No industry, no fumes . . . for the OP I'd suggest a thorough medical check-up - I wouldn't blame the air, an hopefully have you back running at full speed.

Good health!

Atmos

A bit off topic here, but what mountain and lake is that photo of? Looks a bit like this one, Mt Hood from Trillium Lake, in Oregon.

Mac

[Atmos]

Hi - thanks for noticing!

it is Mount Taranaki, 25km from my hometown in New Zealand. A nice cone from that angle, but different from the side. Your one is a very good likeness!

Mt Taranaki (formerly Mt Egmont) has 'doubled for Japan's Mt Fuki - most recently in the Tom Cruise movie The Last Samurai which was filmed in the Taranaki province.

[alantheembalmer]

I don't want to give you the willies, but the symptoms you describe sound very much like the ones my friend had, particularly the problem with the stairs. She went to her GP in England who treated her for 4 months for asthma, with no noticable improvement. He didn't seem interested in investigating further, and she subsequently died of pulmonary thrombosis at the age of 44. I would get it checked out as a matter of urgency.

Good luck

Alan

[labik]

Hi folks, OP here.

Sorry I took awhile to respond, but I wanted to watch the situation more before just posting at random.

First, thanks for the replies, I read every last one of them and typed in every last term that was offered. Since then I've now been focusing more on the heart than lungs, as was mentioned above. It seems some of the symptoms indicate the heart, but others don't. Shallow breathing at night - yes, swollen feet and ankles - no. Having to use the toilet in the middle of the night - I used to get that a few years ago (until I switched coffee brands), but not now.

When I am awake, such as sitting upright or light walking around the house, I have timed my inhale/exhale breathing to be at about 7 to 8 per minute. (Is this about the same for everyone?) But when I sleep, I frequently wake up in the middle of the night, and have timed my breathing on numerous occasions to be about 14 to 16, so basically double. That means very shallow and faster breathing with almost no pause in between, but there doesn't seem to be any particularly increased heart rate. Anyhow, the very shallow breathing at night is a concern, uncomfortable, and wakes me up... Of the reading I did, it says that blood flows through the lungs, but when your heart isn't doing it's job, the lungs tend to fill up because that blood doesn't flow back out, meaning increasingly shallow breaths due to filled lungs.

It would appear such is the case for me except I'm not sure, because I have yawned a few times, or else forced myself to resume deep breathing (with effort) while laying down and was able to get myself back to long, deep breathing. The fact that the yawns easily 'reset' my breathing makes me wonder if my lungs really are filled with blood as is stated. It seems they wouldn't be, and filled lungs I assume would hamper a person's yawn, and that isn't the case.

Anyhow my situation has slightly improved over the last month. I've been exercising less mainly due to work and a slightly irritated back. That means I eat less calories, which means I've actually lost a few pounds, which is easier on the frame. I still get the heavy breathing on the stairs, but not quite as bad as before. Psychologically I've been completely forcing myself to 'take it easy' and pretty much refuse to get stressed about anything at all.

Perhaps I should have mentioned that I have been living in Phnom Penh. The transition here from Bangkok has been one of stress, perhaps even more. That might indicate more pressure on the heart, but as of now not sure. This weeked I am planning to get into any clinic I can and inquire about heart testing. I already stopped by one place a few nights ago and another yesterday that I saw while passing by on the road, but got mostly blank stares from the staff at each place and had no choice but to give up and walk out, so no progress as of yet. The term I've read of is 'ecg/ekg', so that looks like the best test to aim for, I assume. That and 'blood pressure', but I don't know how important it is, so hopefully the hospitals will know everything. My confidence is not high being in the true third world, with little english and lower standards. Also, I am of low salary and no health insurance, so I am hoping to keep costs to a minimum (i.e. $10 for a basic or 20 to 30 for a full checkup.)

If anyone has a recommendation for here in Phnom Penh of a place I would be checked out fairly well at lower costs, that would help. There's a small chance I may make it up to Bangkok later this month. In that situation, perhaps there are affordable options that could be recommended in BKK as well. The two names that I saw around on this forum were: Thai Nakharin Hospital Bangna, and St. Louis Hospital on Sathorn. Any more recs appreciated. Will try to update my situation another time. Thanks.

[Sheryl]

What you need is a basic physical plus stress test .

In Phnom Penh, the only viable option really is Royal Rattanak, and while its reputation for costing the earth is valid in terms of inpatient charges, their physical check up packages aren't bad. You can get a package that includes Stress Test for $140

http://www.royalrattanakhospital.com/news_detail.php?id=130#, you're not likely to get it for any less in Thailand.

If you can't swing even that price you can probably reduce it a bit by getting basic blood work done directly at Biomed labs (Kampuchea Krom) and then asking for the stress test only at Rattanak but I think the savings will be small in exchange for time and hassle.

[labik]

Did an EKG at a local clinic on Sunday for $10 and also got a blood pressure.

Got no English consultation but the printout says "normal ECG" and "Normal sinus rhythm". There were bar graph lines and also several numbers on bottom and side, such as "qrs, qt/qtc, pp/rr" and so on, but have no clue what they mean. Thought it was too fast - he did two readings and both were within a minute, probably :10 or :15 seconds each... The blood pressure reading is written as TA: 114, 71 and P: 66, of which I assume means 114/71 and perhaps P means my heart rate (?). A quick look online says those readings are fine as long as under 120/80.

Thank you for the Royal Rattanac link. Took myself up there and talked with a nurse, got a pamphlet, standard is indeed $140 but they were highly recommending of their $300 packages. I'd be a lot happier if it were $50 to $75. It isn't so much the money in as much as the feeling I'll get when all my results are "normal and in perfectly good health" and the specialist doctor is absolutely clueless over my other indications, much like what happened at two different clinics when I went to Bumrungrad BKK in 2009 (eyes and skin). Spent the money and got no real help.

On a stress test are the doctors going to be really thorough and responsive and push me to a very fast pace (i.e. over 160 to 170 beats per minute)?

[Sheryl]

An EKG doesn't tell you anything unless you are in the throes of an acute heart attack (MI) which obviously does not apply to you. You need a stress test, as mentioned before. A cardiologist will administer the test and run you as fast as you can tolerate (unless they see danger signs before that). It's a standard procedure. If you don't want to spring for the $140 package you could ask about the cost of a stress test alone. (Or get the $140, it's good value IMO. Ignore their sales pitch re the $300 package).

Yes, the P is pulse. Your BP and pulse were normal. Of course that is at rest and your shortness of breath is on exertion, so it doesn't really tell much. During a stress test your heart rate, BP and heart rhythm (on EKG) will be monitored continually as the level of physical exertion is ratcheted up. If you have shortness of breath on exertion this should certainly produce it at which point the cardiologist will be able to see what is happening in terms of P, BP, cardiac rhythm and myocardial oxygen supply (problems show up on the EKG) while you are exerting and short of breath, and this in turn will indicate whether or not here is an underlying cardiac cause.

[labik]

Ok thanks for explaining that. Next time I have a day off I'll go back up to the hospital and ask more questions, if their test indeed looks thorough and stringent then I might give it a shot, will see...

[FBN]

At minimum, a simple chest X-ray will tell you if your heart is enlarged or not and if there is any fluid in the lungs; if the heart shadow is larger than half the diameter of the chest, it is enlarged and you may be in early congestive cardiac failure. You definitely describe all the classic signs and symptoms.

ECG's, unless the failure is due to a rhythm problem, will not deliver any diagnosis. If you are in early CCF, you will probably not be able to do a stress test to a degree that will be diagnostic for underlying coronary artery problems as well..

[labik]

OP here again. Looks like I'm finally going to give this a go. I put it all off for a few months as work was giving me more than enough to think about. Now with the holidays, think I'm going to do it.

FBN, thanks for that. Did a google search "chest x ray in heart failure" after reading your post, and some of the pics show a clearly larger heart on those people. I'm thinking that I am probably going to go with the whole program -- perhaps my own heart, if indeed beginning failure, might only be slightly larger and I wouldn't notice it. Not sure, myself.

Stopped at Rattanak today here in Cambodia. Problem is, their doctor is out of the country and won't be back until middle January. Apparently I would be able to still do the test any time this week, apparently be given all of the results, but would not (?) get any consultation until he gets back. The guy at the front desk, a Thai, didn't make it all that clear as he was understandably busy with phones and papers. Wondering if I should just postpone again. Anyhow with the holidays here, I really should get this done.

They have the "Silver Plus" plan at $140, or the "Royal Heart" package at $120. Not sure which one is better for me. One diff I spotted is that Silver Plus does a stool examination, whereas the Royal Heart does not. Otoh, the Royal heart checks the Kidney, the Silver does not.

Questions. On the info packet, and the guy I talked to, said no alcohol at least 72 hours before exam for the Lipid Checkup (cholesterol?). I think I had two beers on Tuesday night, nothing more. Still alright to do a test on Thursday morning? Also, info says no food or drink (except sips) 8 hours before test. Not even a small bowl of oats or a few slices of bread? No coffee?

Anyhow, should be giving this a go soon.

[Sheryl]

No food before the tests = NO FOOD. No bread, no oats, no juices, nothing except possibly small sips of plain water and better not even that.

The affected blood work is usually done first thing so that you can then eat right afterwards and many places provide a breakfast coupon as part of the package.

Re the alcohol and lipids, to be on the safe side wait till Friday AM if you can. Odds are Thursday would be OK (about 36 hours) but if your liver enzymes then come back elevated you'd have to repeat it again so why not just wait another day.

I can't comment on the Royal heart vs Silver Plus without knowing what they each contain. I think -- not sure -- that what they call Silver plus is what is shown on their website in which case it is being offered at half price ($60 vs. $120) through 31 December. It is adequate in terms of blood work but does not include the cardiac tests you need (stress test). Possibly this is what the "Royal Heart" Package has although I would expect more than a $20 difference for it.( A plain EKG is not adequate).

You may do best to just get the Silver Package (especially if it is at half price) and then "add on" a stress tests. That has to be conducted by a cardiologist. If it's the cardiologist is who is on leave now (they only have one, a Pakistani who trained in Russia and China) , you could go ahead and get the basic physical and then make an appointment to see the cardiologist & get a stress test when he's back, having all the other results in hand at that point will be a help.

[labik]

Took the advice to delay another day. I believe the special 50% off program they're offering, called "Healthy Life Checkup" I think, may not have an exercise / stress test in it. Also, when I was at the reception yesterday it appears the 50% off is only for that program, not the silver plus (still $140), unless there's something they weren't telling me. To be honest, I didn't get a good feel yesterday anyhow (short answers, phone more important than me even though I waited, quite unclear).

It looks like both the Silver Plus and the Royal Heart have the exercise stress test. Apparently only minor differences, silver plus does Ultrasound Upper abdomen and stool sample, whereas Royal Heart does plasma glucose instead, from what I can tell.

By the way, does "physical examination by a cardiologist" mean with the doctor himself, or someone else? I'd prefer to knock out everything tomorrow, then have the holiday to take it easy, perhaps come back in January to talk only. Hopefully having printouts and an x-ray would allow me to easily research it from there until he's back.

[Sheryl]

If the package says ":physical check up with a cardiologist" then presumably that is what it means.

In any case the stress tests itself has to be performed by a cardiologist or at least a physician with training in it. And the results are immediate.

I am sure any check-up package will include a fasting glucose.

It sounds like the main difference between these 2 packages is the ultrasound of the upper abdomen. This is of value if you have risk factors for liver disease (heavy drinking, hepatitis in the past etc) otherwise usually not.

[labik]

Went to Royal Rattanac and did the "Royal Heart" option. As expected doctor is out until mid-Jan so I did all except exercise test and EKG, which I'll do later.

Got a single chest x-ray. Will attach two copies here, first one standard, second one big in case of closer look. Hope I do this right.

I'll also post the paperwork results next. Any feedback appreciated.

urls:

http://imgur.com/3lpiB

http://imgur.com/1DnoT

[labik]

Sorry the pics looks so big.

Here's the remaining data I received. If anyone has any info or feedback, appreciated.

Urine Examination

Color:....................: Deep yellow

Transparency.......: Slightly turbid

Chemical Examination

Specific gravity......: 1.01

pH..........................: 7.0

protein, glucose, ketone, bilirubin blood, urobilinogen, nitrate, leucocytes are all "Negative"

Microscopic Examination

WBC........................: 1-2 Cells/HPF

RBC.........................: 0-1 Cells/HPF

Squamous cells.........: 3-5 Cells/HPF

Bladder Cells............: 0-1 Cells/HPF

RBC morphology.......: Normal RBC

Amorphous................: 2+

Bacteria.....................: Few of Cocci Form

Mucous thread...........: Few

Haematology

Complete blood count

WBC Count 5.59 10^3/mm3

RBC Coun t 5.55 10^6/mm3

Hemoglobin (Hb) 16.1 g/dl

Hematocrit (HCT) 45.8 %

MCV 82.5 fL

MCH 29.0 pg

MCHC 35.2 g/dL

RDW 13.6 %

Platelet Count 184 10^3/mm3

MPV 8.9 fL

Neutrophils 3578 /mm3

Lymphocytes 1520 /mm3

Monocytes 291 /mm3

Eosinophils 129 /mm3

Basophil 73 /mm3

WBC Differential Count

Neutrophils 64.0 %

Lymphocytes 27.2 %

Monocytes 5.2 %

Eosinophils 2.3 %

Basophil 1.3 %

Morphology

Platelet Smear: Platelets adequate

RBC Morphology: No significant morphological abnormality seen

BIOCHEMISTRY

Glucose.................................: 91 mg/dl

Cholesterol...........................: 191 mg/dL

HDL-Cholesterol....................: 57 mg/dL

Uric Acid................................: 7.7 H mg/dL

Creatinine..............................: 0.85 mg/dL

ALT (Alanine Transaminase) : 25 U/L

LDL-Cholesterol (Direct).......: 133 H mg/dL

Triglyceride............................: 68 mg/dL

The paper says the the LDL-Cholesterol and the Uric Acid is a little higher than normal, not sure what it means or if the beers I had on Tuesday night had any effect.

[Sheryl]

There should be a report on the Xray from a radiologist, please post same.

I take it no EKG or stress tests done?

[labik]

No, there was absolutely no consultation on anything. Not terribly professional, in my opinion.

Off topic, but I was under the impression thaivisa automatically shrinks all pictures with the option to click it for full size. Doesn't seem to happen here.

Anyhow, until middle January, this is all I have, which leaves me back to square one as I don't know what to make of it. The xray guy seems to be nothing more than a button pusher. I don't understand why they couldn't have at least a substitute doctor to help out until the main one is back. It seems the entire world operates on their one sole doctor, leaving the patient with a handful of indecipherable documents.

[Sheryl]

It doesn't require a consultation to get a radiology (Xray) report, the doctor never even sees you, just reads the film and issues a short report of the findings - often just a sentence or two.

Suggest you go back to the hospital and request this. It's got nothing to do with the cardiologist being in or out, and is a stabndard part of the results of any physical checkup.

While the cardiologist will also look at the films himself it is good to have a radiologists's interpretation. They may catch things a cardiologist wouldn't, especially if it is anything not cardiac related.

[Sheryl]

P.S. I am assuming you are not in any acute distress right now.

If you are (or become so, i.e. seriously short of breath) then in the absence of the cardiologist at Royal rattanak i would suiggest going to either:

1. Aurora Hospital (Polyclinique Aurore - http://www.yellowpages-cambodia.com/listings/kh1941

2. Sen Sok Hospital Dr. Sarak Phally (Professor of cardiology at the local medical school) http://www.sensokiuh.com/contact-us/hospital-contacts.html

Being sure to bring the Xray films with you

otherwise wait for the cardiologist at rattanak