Dear Marion,

Thank you for your letter with your description of the
baby owls, your comments on religious issues, your
comments on Mr. Strauss-Kahn, and your report about
your breathing and your tiredness.  The medical issues
seem to me most important. I want to address them first.
I'll comment on the other points you raise in my letter
next Tuesday.

Physicians customarily distinguish symptoms attributable
to "organic disease" from "it's all in your head" symptoms
which they call "functional". To my mind, that's not a
helpful distinction, since everything one experiences has
a mental and a physical component; the two are reciprocally
interrelated, and are usually causative, one of the other. 

I can't tell from your letter whether your intermittent
rapid breathing is an expression of dyspnea - shortness
of breath for lack of oxygen, or hyperventilation from
subconscious concerns about oxygen deficiency. But I
suspect from your letter that you are anxious; and you
have reason to be, having been told that you (may) have CLL.
In my experience the cause of hyperventilation (as distinct
from dyspnea or shortness of breath) is usually anxiety.
Hyperventilation in turn brings about hypocapnea which
adds to the discomfort, augments the symptoms and increases
the anxiety. (The classical treatment for hyperventilation
is to ask the patient to breathe into a plastic bag, to
recover the carbon dioxide which is essential for metabolism.)

What should you do?  It would seem reasonable to me to
postpone that decision until your consultation with
Dr. Jahagirdar, on June 1, to tell him about your intermittent
weakness and shortness of breath and ask him advise you and
Dr. Skarda about what additional diagnostic tests, if any,
should be done.

It would be irresponsible of me, at this juncture, to
express any opinion, if only because the clinical information
I have is very sketchy. I'm not sure it would be helpful,
but if you wished, I would be pleased to talk with Dr. Skarda
(or one of her assisants) and/or with Dr. Jahagirdar after
he has examined you. As you know, I don't want to intrude
or meddle, but I'm prepared to involve myself in your
medical problems to whatever degree you wished. In that
case, we should begin by talking on the telephone. If you
wished, you could call me at 276-388-3111 at anytime, or if
you were to set an hour by e-mail beforehand, I would keep
the telephone line free for your call. But of course, if
that's more involvement than you want, I'm not offended.

Jochen