Dear Marion,

Our letters crossing in the mail gives me a welcome opportunity
to write yet again. I forwarded your letter to Klemens who has
had much occasion to think about the effect of intravenous contrast
media on the kidneys. There is also the issue of altered sensitivity
to intravenous dye in the context of CLL. Before extending your
elbow for the injection, ask your hematologist, ask the radiologist,
maybe even ask Google.

As always, my interest in medical problems is disproportionate to
my relative lack of knowledge and experience.
From this and previous letters, I infer a number of possibly
unrelated questions. As you read my comments, please keep my
ignorance in mind.

1 CLL
2. dyspnea
3. ?sleep apnea
4. ?adult asthma
5. ?albuterol inhaler
6. ?steroid inhaler
7. ?disease of the aorta
8. ?risk of flying
9. ?risk of acute medical problem while in France

2. Distinguish between
a) shortness of breath which is only uncomfortable and makes
you anxious, but does not impair physical funtions, -
this I would NOT treat with an inhaler, and
b) shortness of breath which severely limits your activity,
i.e. keeps you from walking, from climbing stairs, from lying
flat in bed, - this I would try to treat with an albuterol
inhaler, or with oral medication other than steroid. 
It's my belief that the only risk of short term steroid inhaler use
is lowering resistance to incipient infection such as pneumonia,
but that continued use of a steroid inhaler may cause (or unmask)
open angle glaucoma - usually but not always reversible on cessation
of steroid use, and will if used long enough cause cataract formation.
Eye surgeons are not interested in preseventing cataracts. They want
to operate on them. It seems likely to me that protracted use of
a steroid inhaler may also unmask (or cause) Type 2 diabetes.
In any event, the inhaled steroid, while it affects the respiratory
tract most directly, is also absorbed and affects other parts of the body.
Into my evaluation of the pulmonologist's advice, I would factor his
failure to acknowledge the risk of inhaled steroids.
3. The examinations for sleep apnea are not dangerous,
neither is the treatment. However, it's my impression that the
diagnosis is (sophisticated) guesswork. My approach would be
"empirical". If there's suggestion of sleep apnea, why not get
the positive pressure breathing apparatus. If using it makes
you feel better, the diagnosis is confirmed; if it seems not to
be worth the trouble, the diagnosis is in doubt.
4. Not having seen or heard you wheeze, I reserve judgment about
your having asthma. The significance of asthma might be its 
being caused by avoidable allergens. I would be open minded
and observant.
7. About a CT scan for possible aortic disease, I would be conservative,
not only because of possible toxicity of the dye, but because of the
unknown effect of a substantial amount of radiation on CLL.
The amount of radiation delivered in the course of CT scan is substantial.
While high dose radiation is used to treat accumulations of
lymphocytes e.g. in the spleen, it seems possible that low dose
radiation might stimulate lymphocyte production. At minimum I'd
ask the hematologist. I would also have the existing X-rays 
evaluated by one or more radiologists for advice concerning
the benefits of additional imaging at this time.
8. The airlines have much experience with passengers who have
respiratory impairment. I would find out whether one must
arrange for supplemental oxygen prior to departure, or whether,
if needed, it would be available in flight. Since you have
had only episodes of mild shortness of breath, the risk of
a life-threatening attack of asthma in flight seems to me to
be small, - but I don't know.
9. One of the reasons Margaret and I no longer travel abroad is
concern about being incapacitated - and hospitalized  and trapped -
by acute illness in a foreign culture. I'm not suggesting you
should scrap your visit to France, - on the contrary, I think you
should go; but if I put myself in your place, I would want to have
some idea to whom I would turn for help and advice if overtaken
by sudden, severe illness, - and of course about the adequacy of
medical insurance coverage.

Jochen