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.


  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. 

Wednesday, October 14, 2015

My Double Whammy Asthma

So, after 45 years of living with asthma, and 20 years of being a respiratory therapist, I believe I can finally describe what makes my asthma so different than others.  For most of my life my doctors told me I had asthma, or brittle asthma, or high risk asthma. In recent years my asthma friends have tried to convince me I have a sub-type of asthma called Severe Asthma.  All of these descriptions of my disease are either incomplete or inaccurate.  So allow me to explain. 

First, allow me to say that I do not have Severe Asthma.  This is an asthma subtype that consists of about 10 percent of asthmatics who take all their asthma controller medicines exactly as prescribed yet still have difficult to control asthma.  Severe Asthma means you have a double whammy of chronic airway inflammation, making your airways hypersensitive to asthma triggers, and airway remodeling, making your airways chronically narrowed.  This is not unlike what occurs in patients with chronic bronchitis, or COPD.  In fact, it is Severe Asthma that is most commonly associated with COPD, and might sometimes result in a diagnosis of Asthma/ COPD Overlap Syndrome.

My friend Stephen Gaudet does have this form of Double Whammy Asthma.  However, after years of thinking I had this, I can tell you that I do not.  For one thing, as my doctor confirmed to me during a recent appointment, if I had this it would show on my pulmonary function tests.  My FEV1 would be lower than 80%.  This is not the case, as my FEV1 is consistently 80% or better, even on a bad asthma day.  This means that I do not have airway remodeling.  I do not have Severe Asthma. I do not have COPD.

The fact that my asthma responds very well to traditional asthma medicines, particularly corticosteroids, is further confirmation that I do not have Severe Asthma.  

Okay, so good, then what the heck do I have.  What subtype of asthma do I have? While I do not have Severe Asthma per se, I still do have severe asthma, or more severe asthma than your typical asthmatic.  I have severe asthma because I too have a Double Whammy Asthma, but my double whammy is the asthma subtype Allergic Asthma.  My double Whammy is chronic underlying airway inflammation and allergies.  

This is what makes my asthma hardluck; this is what makes my asthma more difficult to control even though I am very compliant with all my asthma medicines; it's what makes my asthma difficult to control even though I make a gallant effort to avoid my asthma triggers.  It's because it is next to impossible to avoid all of my asthma triggers.  It's not possible to avoid getting colds.  It's impossible to avoid inhaling pollen.  It's impossible to avoid inhaling dust mites from time to time.  

So my Double Whammy is chronic underlying inflammation and allergies.  Chronic exposure to the things that are innocuous to most people causes an abnormal immune response inside my body that caused by airways to become inflamed.  Because I was chronically exposed to these allergens, this inflammation became permanent.  That is what asthma is: permanent or chronic underlying airway inflammation.  

In turn, this makes my airway not only over sensitive to my allergens, but also over sensitive to colds, strong emotions, exercise, and strong smells.  Unlike with the Severe Asthma subtype, asthma controller medicines do help me a great deal, and make it so that my asthma is well controlled on most days.  Still, either because the underlying inflammation in my lungs is so severe, or because the abnormal immune response in my body is so exaggerated, even slight exposure to my asthma triggers causes the allergy and asthma responses.

Let me give you an example.  Every day I take one puff of Breo.  This helps reduce airway inflammation so my asthma is controlled on a good day.  In fact, it works so well, that on most days, I do not need my rescue medicine.  On most days, I can live a normal life.  But not really.

Let me give you a further example of why I say not really.  Actually, I give examples of this all the time on this blog.  Normal people can go into their basements and move boxes around.  I do this because I want to clean and organize my basement, and I'm exposed to dust mites.  I have a severe allergy attack. The allergy attack leads to a full blown asthma attack.  I am down for the count. Not only does this cause an asthma attack, I usually have to deal with the ramifications of it for weeks afterwords.  And, in the future, I'm afraid to go into my basement. I have to avoid it, even though I don't want to.  This, as I described recently, is what I sometimes refer to asthma frustration.

You see, all of this combined is what makes my asthma more severe than others.  I have, what you might say, is called hardluck asthma because I have severe allergies to go with my asthma. I have my own Double Whammy. I have severe asthma, or more severe asthma than most people, because I have Allergic Asthma. This is why I can still describe myself as having Hardluck Asthma.  

Thursday, October 08, 2015

The Asthma Dilemma

So my breath is back after my misadventure yesterday.  I can still feel the crud in my chest.  I can still smell the mold and the dust inside my nose, but I can breathe.  Yeah, if I take a deep breath I can feel the crud.  I still get a little tight every few hours or so.  But at least now albuterol gives me the relief I so yearned during the attack.

I really have nothing else constructive to report, I just figured that after my post yesterday I ought to follow it up with an I-feel-better-post.  Okay, so, "I feel better."  

As I noted before, I do not feel sorry for myself.  However, that doesn't mean I don't get frustrated. It's kind of like in politics.  When liberals get their way some conservatives get depressed.  Or when conservatives get their way, some liberals get depressed.  I don't get depressed.  I get mad.  I get angry.  But I don't get depressed about that kind of stuff; stuff you have no control over.  That's how it is when my asthma is acting up.  I don't get depressed about it.  I don't develop a "Oh, woah is me" complex.  I get mad, if I react at all.

Actually, I'm pretty adept at dealing with asthma attacks.  I'm pretty adept at preventing them too.  I know if I don't go around my triggers I can live a relatively normal life with it.  The intervals between episodes can be very long if I avoid my triggers.  The problem lies in the fact that there are things I want to do, love to do, that I know I can't.  

Let me provide an example. Let's say I am a character in a book.  Usually, a chapter goes like this. 
  • Want.  The character wants something
  • Obstacle. Something stands in the way, either physical or psychological.
  • Action. The character does something to try to get around the obstacle.
  • Resolution. The character succeeds or does not succeed.  
So this is me in chapter 555 of my life.
  • Want.  A clean and organized basement
  • Obstacle.  Dust and mold on nearly everything in the basement.  No one else knows what I want done.  No one else is willing to do the work. 
  • Action.  I know I can do it.  So I move the boxes and organizes things the way I want. 
  • Resolution.  Task complete.  Asthma attack is the result.  So that's the cliffhanger, and the reason to read the next chapter. 
Now we are in chapter 556 of my life.
  • Want.  To breathe normal again.
  • Obstacle. My airways are inflamed and I don't seem to get immediate relief from medicine.
  • Action.  To wait it out. To try to find things to occupy my mind with until my breath comes back.  I watch a movie.  I also take albuterol, lots of it.  I take 2-3 benadryl.  I drink a few beers to take the edge off the dyspnea.  
  • Resolution.  My breath comes back slowly over time.  By 2 a.m. I am comfortable enough. I fall asleep.
So now what do I do. You see, that's a dilemma.  My baseball cards are in the basement.  My weights are in the basement.  Do I dare go back down there.  You see, chapter 557 is set up nicely here. You see, I'm frustrated.  

And then there's the frustration of what to do to fix the basement so I can breathe down there.  You see, do I just deal with it.  Or do I try to convince people who don't have asthma, who don't know what it's like, that I need to allergy proof it.  To me this is important. But to people who don't have asthma, it's not important. That's what you call an asthma dilemma.

The asthma dilemma is how you deal with it.  The asthma dilemma is how you deal with how others react, or, more likely, don't react to it.

How do you do the things you enjoy when you know doing them triggers an asthma attack, at least if what you want to do (baseball cards, workout) are in the basement you are allergic to.  The dilemma is how you convince others that money needs to be spend allergy proofing the  basement, or buying an allergy proof house. That's the asthma dilemma. 

A discussion with my son about asthma

So I'm having an asthma attack when my older son Jordan comes home from soccer practice.  I said, "Hi, Jordan, I'm having an asthma attack now."

He said, "Oh, that's not good."  

"Well," I said, "It's my own fault.  I got brave and did something I enjoy in the basement.  Now I must pay the consequences.  That's what it's like having asthma." 

He said something I don't remember what it was.  I said, "If I didn't tell you I was having trouble breathing you'd never know." 

"Yeah," he said, "You look normal." 

I said, "That's a talent I have. I have had this disease so long I just take it in stride. Anyone else was feeling like I do now and they'd be in the emergency room."

He said, "That's a pretty good talent."  

I said, "Is it?"

Yeah!  That was the end of the discussion.  A sort of dry silence filled the air.

Wednesday, October 07, 2015

Asthma Frustration

My plan for today was to finish organizing, cleaning, and decorating my man cave in the basement. It all started out all fine and dandy until I lost my breath. So now I"m sitting on the couch, probably appearing to others like I normally do. They don't have it, so they don't know what it's like. And that's fine with me, I don't want them to know what it's like. 

Okay, so I'm on to treatment #2 now.  My breath has not come back. Let's see if I can explain the feeling. At rest I feel pressure in my chest. In my face I feel the inflammation.  Actually, what I feel in my chest is probably the inflammation too.  It's the allergic response in full gear. My eyes, face, throat, and airways are all inflamed.  It kind of gives me an itchy, burning feeling at rest. 

Okay, so I take in a deep breath, and it comes in all the way, although at about the 1/2 way mark it comes in slow and difficult. This is actually a good asthma attack compared to some I had as a kid when I could only take in half a breath.  However, it feels pretty crappy to say the least.  

Still, my daughter Laney plays on the floor with a ball.  She is tossing it into the air, and smiling as she does so.  My son wants me to look at the game he's playing on the Kindle.  They are completely oblivious to how miserable I feel. I like it that way. 

Interestingly, as I wrote in my post "What it's like to have asthma," my wife failed to react when I told her I was having trouble breathing. Even though I explained to her before what it's like, she doesn't have it, so she forgot. So there's no empathy from her.  In fact, she seemed to be annoyed with me. 

I'm not judging or criticizing her, it's just an observation as an asthmatic.  It's normal for her to not have empathy for me, as she has never been short of breath before, and therefore there is no way for her to even conceive of what it's like for me right now. 

Okay, treatment #3.  I do not feel any better still.  I did take a benadryl, so hopefully it will relieve some of the inflammation soon and help with my breathing.  Usually it works pretty well for asthma attacks like this that are caused by allergies. The problem is I will probably be really tired when they kick it. This will pretty much ruin the rest of my night.

My goal for tonight was to create a collage on my wall with some old baseball cards I found.  I figured that would be a fun way to end my day.  I will have to tackle that project on some other day, perhaps on a day that I didn't decide to clean up the kids dress clothes.  You know, if you have allergic asthma, you probably would be better off just leaving the family room in the basement a mess.  It's better to have a messy basement than not to be able to breath.  However, on the other hand, it does look nice.

I did say to my wife last time this happened.  I was already feeling crappy last Sunday, so I decided to clean the basement.  I became severely dyspneic, kind of like I am now. I was starting to feel panicky (although I looked as cool and calm as I am now, a talent I have), and I said to her, "Yep.  This is what happens when I do something I enjoy."

It's true.  When I do things I enjoy, I have asthma attacks. No, I'm not feeling sorry for myself.  I never feel sorry for myself.  I usually find ways to deal with it, as I'm doing now writing this. Usually these thoughts go through my head and don't get written down, so this is kind of neat for you to be reading this. But still, if you don't have it, even though you are reading this, you won't know what it's really like to have asthma.

Sorry, but if you don't have it, you cannot conceive what it's like.  You can even live with a severe asthmatic like my wife and children do, and you still will have no clue what it's like. It's more than just being short of breath. It's sitting on the couch being on treatment #3 and not one other person in the house even notices.

No one can conceive of the idea that, even if I really want to go into the basement again tonight, I will not be able to do it.  I will be stuck up here. If my wife weren't going to work tonight she'd probably think I was being lazy. Well, I'm not.  I want to do something.  I can't.  I'm stuck in a body that looks normal.  But, as you know now, I can't breathe....

Okay, I'm going for a walk outside to see if that will help.  Fresh air sometimes helps in that way... Cool and calm, my kids singing, I leave the living room...

Back.  Maybe I feel a little better.  Yeah, I must feel better.  Now I'm going through the pissed off phase.  I want to finish my project in the basement. Nope.  Can't do it. I'm gonna have to sit here on the couch until my breath comes back.  And when it does, I will not be able to go into the basement for a 3rd time today.  I can't do that again.

Neat.  My kids play on.  They have no clue how I feel.  Actually, my wife wouldn't either if I hadn't told her. That's one of the things I've learned I have to do as an asthmatic: when I feel bad I have to tell someone. I have to tell the people around me.  I have to say something, even though I feel stupid doing it, because... well, what if I did stop breathing because of my asthma. What if... It has never happened and probably never will... to me, asthma isn't something that will kill me.  It's basically just something that annoys me, and forces me to live a simple life in an allergy free environment.  If only I could avoid brave moments like today and quit going into my basement.

Of course now I'm feeling like crap and am having an adrenaline rush from all that ventolin.  You know what would be nice is if I could just poke one of my sons epi pens into my right thigh.  That would give me my breath back in , oh, about 5 minutes.  Then I'd be good as new.  But I won't do that.  I don't dare.

You know another thing that sucks is I probably shouldn't have a beer tonight, feeling like I do.  In the slim likelihood this doesn't get better and I need to go to the ER, any alcohol buzz would make the decision to go all that harder.  Plus alcohol dries out the lungs, and that could make things worse for me. However, on the other hand, the alcohol might also take away some of the feeling of air hunger I'm feeling about now.

I will report back once my breath comes back.  6:28 p.m.  I will be back.