and told me I had scored far above the norm. In March, I did another treadmill test using the Bruce protocol—a maximal exercise test where the patient works to complete exhaustion running on a treadmill as the speed and incline are increased every three minutes. Following the test, the junior doctor on the team thought I could have a problem not getting enough blood to my heart. He suggested I might be a candidate to have a stent inserted into one of my arteries.
The cardiac team decided that I should undergo another test that takes a picture of my beating heart. In December, I had an Echo 20 PW Spectral Doppler heart exam that revealed no significant problems with my heart muscle. The test showed my heart was in good condition—a fact they attributed, in part, to my history as a runner. Once the tests concluded, the senior cardiologist announced that the team reached consensus that my breathing problems were not likely to be caused by my heart. They encouraged me to look for other explanations.
Could It Be My Lungs?
Later in December, my family doctor connected me with a pulmonologist. She tested my lung capacity and found it above average. We discussed the possibility that I might be suffering from exercise-induced asthma or stress-induced asthma. I was doubtful of the first diagnosis because the problem arose only when running and not when doing other exercises. I was concerned that a diagnosis of stress-induced asthma could be correct, as I was feeling some stress managing three companies, traveling extensively, and writing one or two books every year.
My pulmonologist prescribed an inhaler to use just before exercising to see if it made it easier for me to breathe. I started to use it and sensed that it was having only minor impact. My estimate was that it improved my breathing by 10 percent at most. I was prescribed a steroid-based inhaler to deal with my baseline condition as well as a different inhaler to use just before running. Over the course of the next two years, seven different asthma inhalers (first Proventil, then Symbicort and Flovent, followed by Advair, Serevent, Alvesco, and Dulera) were prescribed (see Figure 2).
Figure 2. Three of the Many Inhalers Prescribed by Doctors
Symbicort, and possibly Flovent, caused my skin to break out in a “medicinal rash.” Little red dots started to appear on my legs and lower trunk. After using the inhalants, the itching was so severe that I could sense it within the soles of my feet and inside the palms of my hands. I went to a dermatologist, who took a biopsy and determined the dots to be a strange form of psoriasis. A patch test established that I had a contact allergy to budesonide, a potent corticosteroid and anti-inflammatory agent found in medicines used to treat asthma, including Symbicort. Other inhalants caused my skin to itch less. I was prescribed a steroid-based anti-itch cream to make the itching more tolerable.
My pulmonologist was puzzled. She did some research to test the hypothesis that I was having an allergic reaction to something in the solvents or suspensions in the inhalers that contained the medication. She failed to identify any such element, however. I continued to use the Alvesco inhaler, which caused the least adverse reaction.
Both my family doctor and my pulmonologist were recreational runners. At one point in my treatment, I suggested that we do a three-mile run together on the weekend, and they could observe how I reacted. Both doctors liked the concept, but, unbeknownst to me, when I proposed some dates, I learned that one of the doctors was a few months pregnant. Although we all agreed the concept had promise, we were not able to make it happen.
Maybe It’s Allergies
In January 2011, I went to see our family allergy doctor. My son has a history of allergies. When we took him to the doctor at age four to test him for allergies, he tested positive to 80 percent of the substances. He spent his early life getting allergy shots and continually struggling with asthma, despite being a star forward on a Division One team in the National Capital Soccer League. So, the hypothesis I wanted to test was whether he and I shared some of the same allergies.
My allergy doctor and her senior partner ordered the standard skin prick tests. They came back showing that my only reaction was to some grasses. The fact that I was allergic to some grasses came as no surprise. I had been wearing leggings as a runner for years to guard against that problem as we often ran through high grass. I told the doctors about my experiences with the pulmonologist and the difficulties I had with some of the asthma medications. She prescribed Singulair, an anti-asthma tablet, and continued me on Serevent and Alvesco.
By April, my allergy doctors concluded the medications were not having much effect. They proposed I try a recently developed medication called Xolair. This required a visit to the doctor’s office for regular injections. Qualifying for Xolair treatments was a convoluted process. It took over half a year before I could begin my twice-monthly injections.
Moving to the Gold Standard
I told my pulmonologist I seemed to be making little progress. I hoped the Xolair treatments would be the magic solution, but I was skeptical. While we waited for the Xolair treatments to begin, we decided to take the bull by the horns. She arranged for me to see the head of the Asthma and Allergy Center at one of the best nationally acclaimed hospitals in the country.
At our first meeting, the head of the center ordered the standard set of skin prick and blood tests. I told him in advance what the results would be, but he said the center needed to do its own tests. My prediction was mostly correct. I tested positive for the same grasses, recorded a small positive reaction to cockroaches, and negative for everything else. Thankfully, my house and office showed no trace of cockroaches. Allergic reactions to grasses and cockroaches were rejected as contributing to my breathing problems.
The head of the center prescribed Proventil to use when I ran and suggested I conduct a series of self-tests. In phase one of this experiment, he asked me to measure my lung capacity twice a day using a spirometer (a tube you blow into to measure lung capacity) to establish a baseline (see Figure 3). I continued to record data for several weeks, entering all the results on an Excel spreadsheet and periodically emailing the results to the doctor.
| Pherson Peak Flow Readings, August–September 2011 | ||||
| Date | Time | First Reading | Second Reading | Comment |
| 25 August | 0910 | 480 | 500 | Walking to work in WDC |
| 26 August | 0900 | 470 | 480 | Walking to work |
| 28 August | 1206 | 320 | 330 | After 1 hour on elliptical |
| 2130 | 300 | 350 | After dinner | |
| 29 August | 0813 | 370 | 400 | Short trip to Arizona |
| 30 August | 0940 | 530 | 470 | |
| 2200 | 440 | 480 | ||
| 31 August | 0715 | 400 | 410 | |
| 2000 | 540 | 460 | ||
| 1 September | 0715 | 450 | 420 | |
| 2200 | 500 | 480 | After 1 hour on elliptical | |
| 2 September | 0645 | 400 | 480 | Return to WDC |
| 1045 | 440 | 400 | ||
| 3 September | 1100 | 440 | 420 | Before hiking |
| 1730 | 480 | 460 | ||
| 4 September | 1100 | 500 | 480 | After exercise |
| 2300 | 530 | 480 | ||
| 5 September | 1000 | 510 | 420 | Before exercise |
| 2300 | 610 | 530 | ||
| Average reading | 458 | 445 |
Figure 3. Establishing a Baseline for My Lung Capacity
In phase two, I took the spirometer with me to record my lung capacity every time I ran. My doctor asked me to run until I had to stop and record the time, then record the time when I started to run again, run again until I had to stop and record the time, and repeat this process over the course of the run. At this point in my
