Two years ago, if memory serves, I consulted a lung specialist and got this asthma inhaler, brand name Airomir (active drug salbutamol). It’s a kind of dust or fine powder that I breathe in as deeply as I can, then hold my breath for a while before slowly breathing out. It is supposed to keep the bronchi open. In exercise asthma, there are the twin problems of increased mucus and constriction of the muscles around the bronchi. Airomir keeps the muscles from squeezing together the airways. I don’t think it has any effect on the increased mucus production, but that alone should not be much of a problem.

On Wednesday, I got a “mini-attack” a couple days before the stress test of the heart. At the time, the stress test of the mind was at its height, as I was fighting the programming from my early childhood that told me that I would die if I ever exerted myself. It was something I had come to believe deeply before I was old enough to understand what was going on. And not believe in a theoretical sense, the way most people believe in a religion: I had felt the struggle to breathe many, many times in my early childhood. Those years were like sleeping with your bed standing at the edge of a bottomless chasm. If I dreamed of running, I might or might not survive the night. (Obviously I did survive, or I would not be here to write about it. Not every kid with asthma did, not back then at least.)

Anyway, I used the Airomir inhaler on Wednesday a couple hours before the stress test, and it went well enough. We even tested my lung function after the stress test and it was normal for my age, which it has never been before. So it seemed like a very good thing. I did not use it yesterday, but today I took a puff right after I had come home and checked my pulse.

My pulse was around average, so I was looking forward to finally jogging some more. Yesterday I had to walk most of the way and only jog a little, because my bronchi started to act up when I jogged enough to get a little winded. Today I would not have that problem. What could possibly go wrong? (You know when I say that, something did.)

I drank a cup or so of water and probiotic milk, put on a light shirt and my new running shoes, and set off. Airomir is supposed to be taken about 15 minutes before exercise, ideally, although it can also be taken after symptoms appear. It is more effective to use it beforehand, though, and you don’t really want asthma symptoms if you can avoid them. Now it only took a couple minutes or so before I went outside, but I walked at a normal speed for the first 1o minutes or so, as planned. At this point I was reaching the edge of the town proper, taking a road out along the river. I was looking forward to finally stretching my legs.

That was when my pulse started rising.

Not a full-scale tachycardia attack, like I’ve had four times earlier this spring. It was just that my pulse was faster than it should have been from just walking fast. Normally it is in the range 115-120 at this point, but now it rose to 125 and up toward 130. That is not really a problem, but it was unexpected. I did almost no jogging, and the pulse still increased. After half an hour it was constantly over 130 when walking at a comfortable speed, neither fast nor slow. I slowed down and the pulse did not continue to rise, but I did not get any serious jogging done at all. It was just a 70 minute stroll, really. But my legs felt as tired as if I had moved much faster, too. It was not just my heart. Weird.

Did the Airomir trigger this strangeness? My pulse had been perfectly normal before I started.

The only way to find out is to experiment with and without Airomir some more days. Hopefully there will be plenty of days yet to do so.

Fast pulse is listed as one of the more common side effects (more than 1% of users), but so is restlessness and nervousness, so I would suspect the three of them to be mentally induced side effects (nocebo). As it happens, I did not read the side effects until after I came home. Coughing is also listed, and I did that too, but not really more than I did yesterday. I am not really surprised that I would be coughing after inhaling powder, anyway. It is not something I would normally do.

I was not looking forward to the stress test of my heart. I mean, I thought it would be useful, but I was scared. I have never exerted myself after I realized early in my childhood that this was what triggered my asthma. I was probably born with the asthma, because it manifested as soon as I began running around as a toddler, at the age of 2-3. There were no asthma inhalers in rural Norway at the time, and the old doctor gave me half a chance to survive to adulthood, according to my parents. So naturally much of the conditioning to never exert myself must have started early, before I could even speak fluently, much less think rationally. It must have been drilled into me in a prerational, perhaps even preverbal, mode.

It is in light of this that you must see my feelings as I was approaching the moment of what, to my subconscious, was the Deadly Sin. Every time as a small scared boy I fought to draw each breath, I knew that it was my punishment for having run or jumped or done something unruly. In grade school I had finally overcome this tendency, and around the age of ten it began to disappear even from my dreams. For something like 45 years I have held back, always held back, always restrained myself, for more than 40 years I have done this even in my dreams. And now I was about to go against all that. I was scared. As I came to work, I already had a bronchial cough, eerily similar to the one that often started my asthma attacks. My body was already reacting to the crime I was going to commit two hours later. My heart was pounding, my hands were unsteady and my knees were weak. Even though I logically knew that I would probably survive, I did not feel it. And I was not sure what my chances were, after 45 years of never getting really winded, and rarely breaking a sweat (except in summer).

I had brought my Aeromir inhaler (is that a word play on Boromir? Seriously, Aeromir??) and used it at the mentally induced asthma approach. Well, it may have been some other irritation of the bronchi,  I guess, but the timing suggests it was at least to some degree nocebo (the opposite of placebo). Eventually my bronchi loosened up. The effect lasts something like 3 hours, supposedly, so it was still active when I went to the heart specialist. I was in doubt as whether to take a second dose (it says 1-2) but went with just the first.

After sending a mail to the heir of the Chaos Node, I was called in to the doctor. I undressed my upper body and the nurse fastened a couple electrodes on me, then told me to lie down on a bench. I was going to get an ultrasound of my heart and large blood vessels first. The doctor arrived and greeted me. He was an older man, looking to be in his 60es, and from the west coast of Norway from his dialect.  He got a call on his mobile phone at this point and I waited for some minutes, surprised by how much calmer I felt now that I was actually there.

The doctor came back. We talked about my medical history briefly, and a bit about my work. Since I have a pretty wide Non Disclosure Agreement about my work, I am not at liberty to tell you much about that. I told him a little more – they have even more non-disclosure regulations than we have, after all.

The doctor next brought out a small ultrasound microphone thing which he put some gel on. Once the ultrasound was developed, we got our first indication that something was not wrong. He magnified a picture of the throat arteries and showed how small and smooth the plaques were. There were plaques, you see, in the expected places. But they seemed to belong to someone a little younger than me. Or in other words, they were smaller and smoother than you might expect from someone my age. Good news for a start!

Next: The dreaded exercise bike! By now I got electrodes all over my upper body again, and then sat up on the bike. We started at a workload where I just barely had to force myself to keep the correct number of rotations. While we talked, he gradually increased the load. I found it hard to continue the conversation, and I could feel my heart beating faster, but not exactly how fast. To my delight, the asthma did not trigger. Eventually he let me stop. By then I had definitely exerted myself further than I had done for 45 years, but not to the point of collapse as I had expected. Beside being tired in my legs, I was just a bit winded. I was very much alive and seemingly unhurt. I was also amazed.

The doctor was now even more elated than he had been after the ultrasound. It turns out that my max pulse is also a little over the normal, my blood pressure is within normal range, and the electric functions of the heart are all working excellently. In fact, it seems that I have the circulatory system like someone a bit younger than myself. The doctor, surely in jest, said I could run “Birken”, a tough Norwegian ski (winter) and bike (summer) marathon.

We also did a breathing test before the Aeromir wore off, and it showed normal lung function.

The doctor has no answer to what causes the tachycardia (racing heart) episodes I have written about. Since we did not trigger one this time, and not while I wore the Holter monitor, and since my heart is unusually regular, we still have no clue. What he does think, however, is that with a heart like this I will not take any damage from the occasional tachycardia. Unless they last for days, I can just wait them out. My heart has enough capacity to keep doing this for many decades yet.

He also does not see anything suspicious with my low resting pulse. It is not the result of failing electrical activity, but of a strong heart, high oxygen uptake and low blood pressure. My pulse fits right in with the rest of the measurements.

His parting words were “Now get out of here and up in the trees!” I am not going to take that literally, but  out on the road, on the other hand…

***

I came out from the doctor’s office, and summer had come to Kristiansand. It felt much hotter than it had when I went downtown, and the sun was baking from a clear blue sky. It was as if nature itself celebrated with its Viewpoint Character. While we did have some freak warm days in March, they were nothing like this. It was as warm as summer. I have no idea how long it will last, but it amused me that it seemed to have come while I was seeing the doctor.

It did not get any less hot from me half running much of the way back to work, I guess. And later in the day doing the same thing again as I looked for a new pair of jogging shoes before going home. The old ones are really old, and there’s the pair that I can only use for short stretches until they stretch to fit my feet… they are just a little too small. So I have alternated between the old pair and the walking shoes, and walking shoes just don’t cut it even while walking for an hour on asphalt and concrete. There is no way I could use them for running. I should reserve them for work. I went to G-sport first, but they did not have my size, so they asked me to try Intersport. Not only did they have an exact fit, but it was on sale, a bit over half price but still a very good buy. They are called “Mizuno” something, which sounds Japanese, but they fit my huge feet anyway.

When I came home, it did not take long before I thought of trying the shoes. But when I put on my pulse watch, my pulse was almost 20 beats above the usual. I am not sure if I am carrying an infection somewhere, or whether it is the after-effect of the exertion earlier today. It is true that my pulse usually is like this if I have gone beyond the usual in some way, done a new type of exercise or something. Also I usually get stiff and sore the next day, which would be tomorrow. I am OK with that. I shall be happy if I even have a tomorrow. I did expect to survive, but I actually did not feel sure. It was nice of my body to wait for me for 45 years! Don’t try this at home, kids. Get your asthma medication while you are young.

On the bright side, my asthma has kept me from discovering my superpowers while I was still young and might have been tempted to become some kind of athlete. That would totally have wrecked my life, I am sure. By now, I think I shall be able to contain that temptation!

That said, I burned some 500 calories today anyway. Because I could!

Was planning to walk for half an hour or an hour, but got a headache and decided to rest up for the stress test tomorrow. I wonder if it is a sign of drying out a little, although I think that would usually cause me to feel weak and dizzy when getting up. But I still have diarrhea. I cooked a cup of water and added a little salt and Pepsi (for the sugar). Did not taste particularly good, but drinkable, and it seems to have calmed my stomach a bit.

Tomorrow, as advertised repeatedly, is the stress test of my heart (meaning I will exercise hard and the doctor will see how it performs under pressure. Not stress like work stress, not that I have much of that.)

So today I destroyed my own beautiful hypothesis that lack of sugar is what makes me tired. I bought a new blood sugar measuring device. Thanks to some grotesque logic of the market, you can get the starter kit quite cheaply (99 NOK, or close enough to $20), but buying needles and test strips later is expensive. It is entirely possible that it would be cheaper to just buy new starter packs each time, destroying the environment in the process. -_-

Be that as it may, I tested my blood sugar after I came home from work. It showed 6.1 mmol/l, or 110 mg/dl for my American friends (who are more likely to have blood sugar problems anyway). I walked for an hour without eating or drinking anything except a glass of water and a lick of salt. When I stopped (from a beginning headache, which disappeared shortly) my blood sugar was 6.3 mmol/l, or 113.5 mg/dl. In other words, an hour of energetic walking had raised my blood sugar marginally.

At work, I eat yogurt from time to time, approximately a liter (a quarter of a gallon) over the course of the workday. I also drink a little Pepsi from time to time, about two glasses over the course of the workday. I was not big on large meals even before the current condition of my intestines. So it seems reasonable that my body pretty much has removed any excess sugar an hour after I leave work, and just above 6 (or 110) is more or less my natural level, which I will keep unless I drink one of those glucose solutions again or, on the other hand, work to exhaustion. I guess it really is true that the blood sugar is not low until you start going jelly-like in the knees. This is extremely rare for me, although last time I moved it actually happened.

In any case, this blood sugar is harmless. It is above average, but most people are either above or below average, obviously. It is unlikely to have any effect whatsoever on my health. Other things require more attention. And even then, as they say: “It is the one you don’t see that gets you.” Evidently the sugar is not that one.

EDIT: Looking back, I realize I never said it was a lack of sugar. Rather I said that maybe the liver was adding some signal molecules when giving up sugar. Perhaps it is a kind of warning, like a beep-beep when your fuel is getting low. That would certainly be consistent with the observation.

I have a circuit that I can walk energetically and it takes just over half an hour. So I decided to follow up on the previous two days of experimenting by walking one round, drinking a glass of Pepsi, walking another round and so on until I got tired anyway. That way I would find out how much of the tiredness came from lack of sugar, if that is what does it. Actually it could be the water, or the tiny amount of caffeine, or even the short break. But anyway, I would find out how far I could walk on Pepsi.

This did not come to pass. When I stopped by after the first half hour, my digestion was too upset to drink Pepsi. And after ten minutes of the second round, my pulse approached 130 instead of 120, so I stopped and went home.

Perhaps it is the water after all. I still absorb only part of the liquid I ingest, to put it delicately. It is enough for daily life, work and even moderate exercise. I am not getting dehydrated (dried out) like you can get from cholera, dysentery and many other diseases that settle in the digestive tract. So I have mostly stopped whining, but that does not mean I am getting better. It is still the same as when I was still taking the clindamycine. I could probably live out the rest of my natural lifespan on yogurt and probiotic milk drink, and a little salt and vitamins. Not the most exciting diet, but it is alright. And realistically I don’t think this will last all that long. But for now, I better show respect for my digestion.