Lung Doctors! And what to avoid!

The city that I was living in is a little on the small side, somewhere around 80,000 people, and it had only one pneumonology group with three doctors. I made an appointment to see one and had to wait a month, the appointment was for the second Friday of May. I already related that we weren't too impressed with this guy, and when I got sick the following week, we found out that he was out for two weeks.

I don't begrudge a person taking vacation. Doctors certainly earn it. But we got some "I don't think this guy is what we're looking for" vibes from our initial meeting, and they quickly ramped up in amplitude.

He looked at the x-rays by holding them up to an overhead light, not by using a light table, and shuffled through them quickly. This did not inspire confidence. Then, despite the signs throughout the building and our exam rooms asking people to turn off their cell phones, he took two calls during my time with him. Respect goes both ways: if you want us to turn off our phones, you should turn off yours. Now, I fully respect that some people have to leave theirs on, and a doctor certainly falls in to that category. I was frequently on call and had to be reachable, so when I was at movies I'd leave my phone on vibrate and hang it around my neck. And if I ever had to take a call where people had an expectation of not being disturbed by cells, I left the room.

He didn't. Both calls did not seem medical-related, which greatly added to my wife's frustration with this guy. Still, we respected his opinion and followed his advice, picking up a nebulizer and another couple fistfuls of meds.

He was brusque, he interrupted us constantly as we're trying to explain things, and he kept steering the diagnosis towards severe asthma rather than pneumonia. And I will admit that the meds did improve my condition for the third and fourth pneumonias, so obviously asthma did have something to do with it.

But we didn't stay with this turkey long.

As I said, the third pneumonia started possibly the day after I saw this guy and I couldn't see him. When I had my fourth pneumonia, my regular doctor told me to either see my lung doctor or go to the emergency room. That was more than a little frightening, so we called the doctor to see why he wanted the ER involved as I was feeling a little better, it was nothing more than he'd gotten the radiologist report back on the x-rays and wanted a confirmation. So he wanted it verified either by my lung doctor or the ER.

I call the lung doctor and am told I can't see him this week as he's at the hospital. I ask if I can see one of the other two doctors in the practice. And this is the point at which we fired him: I was told that to see one of the other doctors that it would be a new patient intake and it would take a month to see one of them.

They have three doctors in one practice. And they don't share patients between them.

Bye bye, don't let the door hit you in the butt on the way out.

I canceled my follow-up appointment with him and will never set foot in that office again.


We went to the ER, explained to them that we needed a confirming examination. They did blood work and a CT scan and confirmed my pneumonia, all to the tune of a lot more money than we would have liked to spend. They also agreed with my doctor saying that having a bronchoscopy would be a logical next step.


A little more background info. At that time, I was living in Las Cruces, NM. The next closest bigger city is El Paso, TX, about 40-50 miles east. I look up lung practices on my insurance plan's web site and find one that has an office off the interstate on the west side of town, which is very convenient for coming from Las Cruces. I call them and go through my history of four pneumonias and that I probably need a bronchoscopy, and I cap it all off by asking what's the soonest I could get in and see anyone? The say "How about tomorrow morning at 9:30?"

I was gobsmacked. Needless to say, I took the appointment.


The next day I drove to El Paso and met the doctor. Unfortunately the imaging center that did my previous x-rays mis-filed mine, so I had no images to show him, but I did have copies of all of my blood work. He shot another pair of x-rays (front and side) and confirmed that I still had pneumonia. Apparently pneumonia that doesn't put you in the hospital takes about a week to clear to the point that you're reasonably functional, at least that's been my case in these four bouts. But it actually takes around six weeks(!) to completely clear! (Which, upon reflection, means that my fourth pneumonia overlapped with my third: the third had not completely cleared before the fourth hit)

He is an excellent doctor and actually discusses things with you, very different diagnostic approach. In the end he agreed that a bronchoscopy was the next logical step. I asked him how soon we could do it, and he replied "How about tomorrow morning?"

Cue gobsmacking music.

I could not believe this! Either I was the luckiest twit in the world and had fallen in to a scheduling hole that permitted this, or I had finally found a practice that was properly staffed that they could see people and help them promptly.

Sadly I could not do the bronchoscopy the next day. This procedure requires what they call conscious sedation, and I could not drive afterwards. My wife was out of town and wouldn't be back until the following week, so we scheduled it for then.

Conscious sedation is a bit of a misnomer. It isn't as deep a sedation as if you were having major abdominal surgery or hip replacement or something, but you're not really conscious for the procedure. For all practical purposes, you're fully sedated.


If you ever find yourself needing a lung doctor in El Paso, drop me an email and I'll be quite happy to recommend this guy to you.


That's enough for now, more later.

Primary Immunodeficiency vs Acquired Immunodeficiency

I have a diagnosis of hypogammaglobulinemia, meaning that my body doesn't produce enough gamma globulin to keep my immune system functioning. This is an immune deficiency. HIV/AIDS is an immune deficiency. The difference is that AIDS is an acquired immune deficiency, you get it through sex or blood (Isaac Asimov, the science fiction writer, died of AIDS: look it up. He had heart surgery when the blood supply of the United States was tainted.)

What I have is probably a primary immunodeficiency, meaning it's genetic and that I've had it since birth. My mom says I was kinda sick as a child and had measles twice, I can't really say that I remember that. I didn't think I was overly sick: I tended to get bad colds 2-3 times a year, typically when the semester started and you were exposed to all sorts of additional germs. It was probably a symptom for what I have.

A primary ID is not transmitted sexually, though it's possible that if I had kids they would run a risk of having it.

There's also secondary ID, in this case something is causing the ID, like splenolymphoma or something like that. There is actually an advantage in SID in that frequently when the underlying cause is resolved, your immune system may recover.

Obviously a secondary ID cannot be transmitted sexually.

We currently don't know specifically whether what I have is primary or secondary, we should be getting more information on that soon as I had a PET/CT scan last week.

There's probably more types of ID than these three, but I really don't feel the need to dig further at this time.

Welcome to Primary Immunodeficiency!

This blog comes as a result of me having a very interesting first half of the year. For a bit of background, I'm a 47 year old male living in southern New Mexico.

And I had pneumonia four times this year.

In this blog, I'm going to talk about what I have and what my treatment is like.

So me and pneumonia.

It started in February. In November I was diagnosed with severe carpal tunnel in both wrists and the decision was made to operate. The first operation was in February, and though painful, it was endurable. The stitches stay in for two weeks and you're out of work until they're removed, which happened on a Wednesday. I went back to work Thursday, worked Friday, and on Monday I had pneumonia.

Out of work for a week. Chest x-rays. Bloodwork. Antibiotics.

Next week: worked half-time or less. Very tired and weak, but feeling progressively stronger. The following week had me back working full-time, but still tired and weak. Follow-up x-ray and bloodwork shows me being back to health.

Pneumonia number two was in April. This time it was the week before my second carpal tunnel operation. Fortunately it cleared before the operation and it went along as scheduled. Same routine: out of work for a week, then out of work for two weeks because of the operation. At least this time the recovery overlapped.

My doctor said to go to a lung specialist. I make the appointment, but since I'm a new patient, it's a month away and set for early May. The day roles around and we meet with the guy and are thoroughly unimpressed. He looks at my x-rays by holding them up to the light and claims he doesn't see any evidence of pneumonia in the February x-rays. This disagrees with the two radiologists who thought I had pneumonia, not to mention the bloodwork that showed definite bacterial infection. My wife and I are decidedly not impressed with this guy: he says I had bad bronchitis and that bronchial plugs were responsible for my illness and caused the fever.

Well, that was on a Friday and we scheduled a lung function test for the following Monday. At which point I was sick and running a fever. I still show up for the test, though I explain to the technician that I am ill, and she thinks that's a good thing because we'll see how bad my lungs are when I'm ill. She also tells me that the doctor is not in the office today.

Well, that sucks. I go back to my doctor, he's pretty sure that it's pneumonia again based on characteristics and listening to my lungs. But this time we don't do an x-ray as I've already had EIGHT chest x-rays at this point, so he just puts me on antibiotics and tells me to take the week off and to call my lung doctor.

I call my lung doctor, and I'm told that he is out of the office. FOR TWO WEEKS. It would have been nice for him to tell us that when we were there the previous Friday! I ask to see one of his partners as there are three pneumonologists in that practice and I'm told that I can't because one is covering the hospital that week and the other is unavailable. Grrr....


Well, once again, it's take the week off, go back to work the following week at half-time, etc.


I get better, until three weeks later and....


Pneumonia number four!


When I made the appointment to see the lung doctor, I also made an appointment to see an immunologist as there was obviously something seriously wrong with me. My wife started researching recurrent pneumonia and found some interesting stuff, and later in June I got in to see the immunologist.

Initially we weren't impressed as he was pursuing the angle of allergies. You see, a lot of immunologists are also allergists. And like the lung doctor wanting to blame everything on asthma, he had a bit of a hobbyhorse to ride. But he was more responsive than the lung doctor was, and he ordered the test that my wife wanted run: an IgP panel, which shows your gamma globulin levels.

Gamma globulin is vital to the proper function of your immune system. Mine were in the gutter, far below the minimum levels.


Obviously I had a problem.