Question: Hi, 4 weeks ago I returned from a trip overseas and had difficulty swimming normally. I could barely swim two 25 meter lengths when I normally do 12 to 16 25 meter lengths before taking a break. I had noticed swollen lymph nodes for a month, or so prior to the trip. I would say at the beginning of April. I live in XXXXXXX where the pollen count has been extremely high this spring. The date I noticed the difficulty swimming normally was 4/27, after I returned from the trip. I believe the breathing difficulties became noticeable late on the trip though and the pollen count was very high where I went as well. I am 61 years of age and people typically guess my age in my mid to late 40’s. I am 5 11’ with an athlete build and I swim between 1.5 and 2 miles a day. I was swimming normally in the weeks leading up to the trip and even during the vacation, I found a pool and swam normally many days and did not notice a problem breathing. I did notice a breathing issue toward the end of the trip when walking quickly, carrying luggage etc. I really noticed it, as I mentioned, when I returned home on 4/27 and could only do 2 lengths. This scared me. One or two years ago, I am not sure when, I had issues when swimming in the Spring; yet on that occasion my wind returned to normal in a week, or so. This time, my wind when swimming is coming back much more slowly. For example roughly a week after 4/27 I was able to do 4 lengths without discomfort. I then decided to go to low pollen environments just to test things and I think it helped. I also began taking Zyrtec and Flonase at the recommendation of a friend and after taking those once a day for 3, or 4 days I was able to do 8 lengths, so I thought I was improving. I then decided to come to Florida for a week; because the pollen count is very low here. I also took the medications I mentioned twice a day for 48 hours 3 days ago and the next day I was able to swim 16 lengths without stopping. I felt as good, or better than ever that day which was 5/23. I was very happy thinking the low pollen environment was helping me and that if I improved that much on those medications I probably did not have a serious health issue. The day afterwards, I just took the medication once in a 24 hour period and I only did 12 lengths. Then this evening. I only felt comfortable doing 4-6. This was after a nap, I was tired and almost didn’t swim; yet I wanted to test myself. Now I am worried again. It seems as though, whenever I take the medication I mentioned, twice a day, I can feel my lungs open and if I do not take it, or take it less; I feel constricted in my upper chest area. I also had pain in my gums and throat and I was coughing up nasty phlegm a week, or so ago, so I began an antibiotic that was just slightly expired (2 months past). The throat and gums are healing and I no longer have much of a cough or phlegm at all and my lymph nodes are not nearly as swollen; yet I am concerned that I swim so well when taking the medication I mentioned twice a day and not as well when I do not. I also had Pulminary Sarcoidosis in my 30’s that went away on its own a year later. Naturally, when I could not swim normally all of a sudden 4 weeks ago it scared me. I am also having anxiety on and off about this intermittently. Some days, when my lungs feel open I tell myself I am fine, tonight I was already tired and almost didn’t swim; yet I did and could not do nearly as well. I wonder if the anxiety is effecting my breathing, or it is a condition helped by the medication. My question is this, why was I swimming almost normally 2 weeks before the trip (I think the pollen in April just before I left had a slight effect and then 4 weeks later I began having so much trouble? Why does this condition improve so much when I take those medications twice a day for 48 hours and then when I reduce the medications to just once a day my wind is not as good? I have never taken these medications at all until a few weeks ago and it has been on and off during the last 2weeks. I have never been diagnosed with allergies; yet as I remember I have felt constriction in my chest during the spring months intermittently for years. I should point out that my oxygen saturation at rest is 98, my respiration rate is 11 to 12 breaths a minute and my heart rate is roughly 65-67 beats per minute when I am not anxious about this. What are the most likely possibilities? Thank you, I really need advice right now.

Additionally, These difficulties just began a month ago. Why do you think my swimming respiration gets better after taking Zyrtec and Flonase? What conditions would those 2 medications improve and what conditions would they not help with? When this has happened before I recovered. Do you think this is most likely: a. allergic asthma/allergic inflammation, b. allergic asthma/allergic inflammation with an accompanying bacteria infection, c. allergic asthma/allergic inflammation with an accompanying bacterial infection along with a return of Sarcodosis, d. something worse? I realize you cannot definitively diagnose my situation; yet based on your impressions from what I have shared, what condition is most consistent with the information I have given.

Thank you, I am in Florida and been removed from the pollen for around 72 hours. I remember years ago I was tested for allergies and I am allergic to dust and mold. I do not remember is I was diagnosed with a pollen allergy. Would you recommend seeing an allergst. Also, most importantly, now long can it take for my airways to return to normal after leaving the pollen if I am allergic to it; which I believe I am. I was in the middle of it for 2 months.

Thank you, I have a feeling the Zyrtec is having the biggest impact. I have only been taking it on an off for the last few weeks. There was one 48 hours period, 5/21-5/22 where I took the Zyrtec and Flonase twice a day (the recommended dosage) and the next day I swam as well, or better than ever. (16 lengths) Then I backed it off to just once a day and still swam well compared to a month ago; yet not as well as 6 weeks ago. Do you think this rules out the “current possibility” of Pulmonary Fibrosis, or COPD. As I type this, I have discontinued both medications and I am getting ready to go swim and see how it goes. I do appreciate your time. Thank you

Thank you, I just swam 16 lengths in a row, my normal distance, without having taken the medications for 48 hours. I was quite surprised. This was the first in a month I have been able to come close to doing this. I think coming to Florida and getting away from the pollen really helped. This is the first time in a month that I have felt normal and I am quite relieved. I appreciate your advise and I plan to see an Alergist and a Pulmonologist. Still, an allergic reaction to being exposed to very high pollen for 2 months seems most likely. I know what to do going forward. I wish you the best.
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