Thursday, January 21, 2016

Breo is great... or is it???

What if.. what if... what if the side effects of the medicines used to control your breathing aren't worth it. What if... What if... what if something that has been ailing you for years isn't caused by aging, or by some other chronic condition, but is just a side effect of some medicine you've been taking for years.

Worded another way: Surely all those medicines you're on are helping you breathe easier, but are they worth it.  Are the side effects simply causing another problem that is making your life more difficult.

This is a tough thing to think about, but it's worth thinking about.  I mean, as a respiratory therapist, I brush off claims by doctors that ventolin has side effects.  I brush off concerns that albuterol caused that lady in room 212 to jump into atrial fibrilation.  I tell doctors all the time that it's just a coincidence, that ventolin won't do it.

But what if I'm wrong? What if everything we know about asthma medicines is wrong? What if all the other problems that ail us are (ahem!!!) caused by the very medicines that are helping us.

Let me just give you an example, For the past year I have been shaking almost uncontrollably every time I attend a code in the ER. I usually am able to prevent others from noticing by stabilizing my hand on some surface. I'm able to draw ABGs in such situations simply by taking my time and drawing the blood until my hand calms down.

Recently a doctor questioned me.  He even went as far to tease me by saying, "So, do you have a drinking problem?" Now, he was joking.  But it still is bothersome to some degree?

So, theories abound my mind.  Is it that I drink too much coffee?  Well, I've been drinking coffee since 2010, and it never did this to me before.  Is it aging? I know my mom and grandma suffer from anxiety, and it seemed to get worse as they aged.  So is that happening to me? Is this just genetics?

Now that I think about it, I also suffered from a few bouts of some sort of abnormal rhythm. I never told my wife about it because I didn't want to concern her.  Or, better yet, I didn't think it was that big of a deal. But, if it was the Breo...????

Yes, it is true that my mom, dad, and a couple of my brothers suffer from shaky hands. So, the idea that this is genetics has crossed my mind.  So this is what I was thinking two days ago as I laid on my bed to take a nap.  And then, voila, an idea crossed my mind that had never occurred to me before: Maybe, just maybe, it's the BREO.

I have bragged about this medicine up and down.  I was on Advair before Breo, and Advair worked great with negligible side effects. So when I switched to Breo, it never even occurred to me that there would be side effects. So there was a bias to Breo.

I tried Symbicort and Dulera before that, and there was no bias.  Within days of both medicines I noticed that I was increasingly jittery.  In fact, I remember a coworker made fun of me one day when I was trialing Symbicort, and I quit taking it the next day and went back on Breo.

So, that said, why did it take me over a year to realize Breo was doing the same thing.  Bias, I say. I held a b bias to Breo. I was no better than a biased journalist. Bias accomplishes nothing other than a repeat of stupidity and failure.

My theory now is that my body is overflowing with adrenaline due to the Breo, the ventolin, the coffee, and the natural increase in adrenaline at a code.

So now I'm trialing no Breo. It's on day 3 now and I can tell a remarkable difference. Surely I can't breathe as well, but, man, I just couldn't go on feeling so jittery.  It was stressing me out. I'll give it a few more days, and if I continue to feel more normal sans Breo, a call to the doctor to change to Flovent will be imminent.

Will keep you posted on how this experiment goes.  Yes, I do know I'm going against all expert advice, including my own, to never change your medicine on your own without doctor approval.  But sometimes you just gotta do what you gotta do.

Monday, December 21, 2015

Happy New Year's Day

Well, not really. But I'm pretending it is so I can start eating better...

I explained yesterday how I'm getting back on the John for Life treadmill. That's actually not completely true.  I have been exercising on a regular basis since July.  I actually lost 20 pounds within the next two months.  The problem is that, once the kids started school, my diet took a back seat.  So, the truth is, I'm actually getting back on the diet. It's the diet I've been sucking at. 

But, like I said, it's the diet, I think, that gets screwed up when you work swing shift.  Now that I'm on all days I'm hoping I should be able to stick to my diet better.  I mean, I know it's going to be a lot of work, but hopefully it should be somewhat easier now.  

So, the good news is I'm not terribly out of shape. It's not like I'm starting from scratch.  I just need to motivate myself to avoid the chips, the cookies, the cakes and the pies.  And this is hard -- another excuse -- when you have kids and they get to eat normal. 

That said, today is my New Year's day.  Today is the day I'm getting back on the workout and eat healthy wagon, rather than waiting for 2016 to get here. If I don't do this I'm probably going to gain five more pounds before I start, and that would not be good.  

Sunday, December 20, 2015

Back on the John for Life treadmill

So I'm sitting on the couch all pumped up to watch the Lions (I'm a dedicated fan), only to realize they don't play at their usual 1 p.m. time slot.  In fact, they don't play at all today: they play on Monday night. Yes, they have played well enough lately to deserve this prime time slot. 

Anyway, that said, I've decided I'm going to start my New Year's Resolution a week early.  I figure this should work considering I work on Christmas anyway. And, of course, as usual, my resolution once again this year is to lose 50 pounds. That should put me at 170 pounds. So you can do the math to determine what I weight now. 

I've done this before, believe it or not.  Of course having children does not bode well for maintaining weight loss.  That's my excuse. Another viable excuse I have is that I have been working the swing shift for the past five years. That's done now. I am working only day shifts now.  I have never worked the day shift full time before.  I am finding it's very nice. 

I actually have another viable excuse that I have never mentioned to anyone outside this post, and this is the fact that I'm on a small, chronic dose of steroids. Sure it's inhaled, but enough gets to your system to cause certain side effects, like an increased appetite. 

That said, I think that just working that swing shift made it very hard to stick to any diet. According to Alice Burron at nursetogether.com: 
There are many hormones that are affected by sleep, and most of them control our appetite, fat, carbohydrate metabolism and the growth of lean muscle.
The kicker here is that every time I lost weight in the past I did so while working night shift.  Still, I think that swing day, the one day a week I worked nights, really wore me out more than working nights regularly.  When your body gets used to working days, and then you have to quick turn around and stay up all night, I think that messes up your body, making it harder to stick to any diet.

I found this to be true nearly every week, as I'd eat good Monday to Thursday, and then tank on Friday after working Thursday night.  Of course, maybe this is just one big excuse.  So be it.  It's a New Year starting today.  It's back to the John for Life.

Saturday, December 19, 2015

The Confounding Asthma Information Packet

I just got this package in the mail from my health insurance called, "Welcome to our Asthma Program."  It came complete with tips on managing my asthma symptoms, what triggers to be aware of, and the importance of avoiding triggers, It also comes with tips on how asthma is treated, and a 
copy of my very own Asthma Action Plan I can work on with my doctor.  

I don't know what to think when I get this kind of stuff.  I mean, a part of me thinks it's good, considering most asthmatics could benefit from this kind of wisdom.  But a part of me, the part that took over when I received the pamphlet, wanted to make fun of it.  And, of course, this is what I did. I mean, this is just public relations junk as far as I'm concerned.  Allow me to explain. 

1.  Avoiding Triggers.  Here I'm encouraged to work with my doctor to learn my triggers, and then to avoid them.  Yeah, it's easier said than done.  Here they say if I'm allergic to dust mites I'm supposed to allergy proof my home.  Well, this would be fine and dandy if they'd be willing to pay for the things they suggest, like air conditioning.  I'd love to have it.  Maybe they'd like to come and remodel my basement to to get rid of the dust mite infestation down there.  I should stay indoors when the pollen counts are high, they say.  So, what do they want me to do, live in a bubble in the spring, summer and fall.  Fat chance that's going to happen.  

2  Signs your asthma could be better controlled.  
  • Do you have nighttime symptoms more than twice a month
  • Do you need quick-relief medicine more than two times a week? 
  • Do you need more than two canisters of quick-relief medication a year?
Yes, yes, and yes!  Those are my answers.  So they recommend: "If you answered 'yes' to any of these questions, your asthma may not be as well controlled as it could be.  Talk to your health care team about bla bla bla. 

You see why I hate this stuff.  I hate the criteria that you have poorly controlled asthma based on how often you have symptoms and how often you use your inhaler.  I'm already on all the best controller medicines in the world, I already try to avoid my triggers, but, for the sake of God I HAVE SEVERE ALLERGIC ASTHMA. MY ASTHMA CANNOT BE TREATED THE SAME WAY TYPICAL ASTHMATICS ARE TREATED, AND CONTROL FOR ME IS WHAT THEY SAY IT SHOULDN'T. 

I think the whole notion of asthma guidelines are going to change very soon.  I think gone are the days -- or leaving are the days -- when all asthmatica are treated the same.  I think asthma subtypes are going to be further defined, and asthma guidelines created for each subtype.  For instance, my subtype is Severe Allergic Asthma. 

Truly, the only medicine I'm not taking that might benefit me is Xolair, and my doctor has never even suggested I try it.  Still, I'm not even sure my health insurance, the same one that is so concerned about me that it sends me this generic asthma information packet, would put out the $3,000 needed to cover each dose. I mean, they already don't want to pay for Advair and Breo. So, I suppose they care so long as they don't have to pay for it. 

Thursday, November 12, 2015

400 B.C.: Did Hippocrates recognize allergies?

While hay fever was not mentioned until the 19th century, and allergies not defined until the 20th century, the signs and symptoms of allergies were well known to physicians of the ancient world.  Perhaps the first allusion to this was by Hippocrates during the 5th century.

Claude Lenfantt, in his introduction to the book "The Immunological Basis of Asthma, quotes Hippocrates as saying: 
Cheese does not harm all men alike, some can eat their fill of it without the slightest hurt, nay, those it agrees with are wonderfully strengthened thereby.  Others come off badly.  So the constitution of these men differ, and the difference lies in the constituent of the body which is hostile to cheese, and is roused and stirred to action under its influence. (1, page introduction)
Since Hippocrates probably obtained his medical wisdom from his ancestors, who were probably teachers at the Asclepion at Cos, we can probably surmise that physicians going back to the early ancient world observed the symptoms of allergies.

Surely allergies caused grief and suffering for those afflicted with it, this would have been minor compared to all the diseases that plagued the ancient world.  So allergies, even more so than asthma, was essentially ignored by the medical community.  The symptoms were probably recognized and brushed aside as catarrh, or the common cold.

References:

  1. Lenfant, Claude, author of introduction, Bart Lambrecht, Henk Hoogsteden, Zuzana Diamant, editors, "The Immunological Basis of Asthma," Lung Biology of Health and Disease, Volume 174, Claude Lenfant, executive editor, 2003, New York, Marcel Dekker, Inc. 

Saturday, October 17, 2015

What's it like to have asthma, part 54

In response to my post, "What's it like to have asthma," a friend of mine sent me the following description of how she describes what it's like.
I have taught classes on what it is like to not be able to breathe well, and this demonstration seems to get my audience attention. inhale deeply and let half of the air out, then inhale again and let half of the air out, then do it again. I have never gotten beyond the third breath before my classes starting saying, "oh my gosh, I had no idea,
I think that's pretty good. To this I responded.
And not only does asthma feel like that, but your breath doesn't come back for several hours, even after hitting on your inhaler hundreds of times, or taking 3-4 breathing treatments. You have to sit in front of the TV, panicked to some extent, until your breath comes back. Then a sort of euphoria takes place. You never truly know what euphoria is like until you can't breathe, and then you can breathe.

But asthma is more than just being short of breath, it's knowing that if you do certain things, you will get short of breath. It's knowing you cannot really be normal. It's knowing you can't do what you want to do without consequences. Yes, I could talk about this ad nauseum, which is why I started my asthma blog.
This is how good asthma quotes come about.  Right there I amazed myself:
 You never truly know what euphoria is like until you can't breathe, and then you can breathe. 
So, how do you describe what it's like to have asthma?

 

Friday, October 16, 2015

Wow! I could not describe my symptoms

So, I finally broke down and called my doctor's office.  I said, "Dr. A. told me he would write a prescription for a steroid pack any time I needed one.  So I need one."

The nurse said, "Well, Dr. A. is not in today. I'd have to have Dr. K. help you. It would be his decision."  

Shit, I thought.  That pretty much blows that idea.  No other doctor understands my asthma like Dr. A. I pretty much knew my attempt to get a steroid pack was doomed.


The nurse said, "Can you describe your symptoms?"

Okay, so I have been an asthmatic for 45 years, and a respiratory therapist for 18, and I couldn't answer this question.  I knew if I said the words short of breath, the doctor would assume the worse and tell me to go to the ER.  He would do this for liability reasons, more than anything else. 

What I wanted to say was, "Listen, I've had this disease 45 years, and if I say I need a steroid pack have the doctor write me a damn prescription for a steroid pack."

Okay, but that wouldn't do it.  Look, if I thought I was bad enough to go to the ER I would go to the ER. Let's get that off the table.  I do not need to go to the emergency room.  What I"m feeling is cold-like symptoms with minor shortness of breath, but just enough to think I should do something.  I should have just said that, but I didn't.  

After stalling quite a bit here, I finally said, "Well, I'm.... I.... I'm using my inhaler more than usual."

She asked, "Are you short of breath?"

What the f((& do you mean, am I short of breath?  If I wasn't short of breath I wouldn't be calling you. You see, my problem here is that if I say I'm short of breath, the doctor will certainly assume the worse.  So I tried to avoid saying I'm short of breath.  But, for lack of a better way of explaining myself, I said, "I'm short of breath.  But not bad enough to go to the ER.  I just need a steroid pack to get over this shit."

"So, how do you feel?" She repeated the question. "Are you having chest pain?"

Isn't that the question of all questions.  If I answer yes to this I am doomed.  "No."  It was the truth. 

"Are you short of breath?"  

"Well, yeah, but not bad enough to go to the ER."  I'm just feeling uncomfortable.  So, how the hell do you explain to a doctor who does not know you that you need a steroid pack but you are not sick enough to go to the emergency room.  You can't.  I knew it. 

"Any other symptoms."

"Look, I'm having allergy problems.  That's what it is.  I'm short of breath because of my allergies."  In retrospect, I wish I would have said I have a cold and colds often lead to further complications for me.  I need a steroid pack to nip it in the bud.  But I'm not good at thinking on my feet that way.  These ideas only come to me in retrospect.  Unfortunately, we can't live our lives in retrospect.  

She said, "Well, as you know, Dr. A. is not in the office.  I'll run your concerns by Dr. K. and we'll see what he says."

I thought, "Well, we pretty much know what that's going to be: "Go to the ER!" Which I will not do by the way. That last thing I need is to spend three hours in the ER to have a doctor tell me what I already know and give me the medicine I already know I need. 

Now, I'm not faulting the nurse here.  She was just the middle person, and she did an awesome job screening me.  The turned the tables on me, forcing me to explain how I felt, and I blew it.  Still, it didn't matter what I said. In the end, the result was going to be the same regardless. 

If Dr. A was in the office, however, this line of questioning never would have occurred. This, my friends, is modern day medicine. Because of all the lawsuits, doctors will not just write random prescriptions for patients that are not theirs, even if they know you. 

One thing I was extremely impressed with was the rapid response.  Less than five minutes later the nurse called.  

"Hello!" I said, miming enthusiasm. 

"Is this John?"

"Yes it is."

"Dr. K. said you need to go to the ER."  

Shocking.  Well, not shocking, considering it's exactly what I expected.  "Okay, that's what I figured he'd say.  But I'm not going to the ER.  I don't need the ER."

"Oh, okay, that's your choice."

"All I need is a steroid pack to get over this shit.  I will just wait to talk to Dr. A. on Monday. But thank you for trying."

This was kind of funny, because she didn't know what to say to that.  I concluded by saying, "Thank you very much for your time.  Have a good day."

"You too."  

You too.  Yeah, what else was she to say.  It's not like she could say, "Have fun suffering with your asthma."  No, she said the politically correct thing. She'll report back to Dr. K., tell him what I said, what no other patient would dare say, and he will say, "Well, that's his decision."  

Personally, I don't blame Dr. K. at all.  I in no way was expecting him to write me the prescription.  In fact, I would have been shocked had he done it.  However, this gives me the idea that I should tell Dr. A. to talk with Dr. K. about me, and let him know that it's okay to write a prescription for a steroid pack should John call for one.  

Anyway, bottom line here:  I have been an asthmatic for 45 years, and a respiratory therapist for 18, and I couldn't answer this question: "Can you describe your symptoms?"

In my defense, I worked third shift last night, so have only had 4 hours sleep in the past 24 hours. Not that it should matter.  In my defense, trying to explain how you feel to a doctor that is not your doctor through a mediator is not easy. In fact, if Dr. K. just looked at me he'd know I did not need an ER.  But, 'tis the way it is.