1200-1600: Asthma in ancient Korea

If you were an asthmatic living in Ancient Korea you would have had to wait until the 13th century before you had any options available to you other than folk medicine.  

Folk medicine was basic philosophies and treatments of various disease processes handed down from generation to generation to anyone interested in learning them.  Remedies usually consisted of simple things such as concocting herbal remedies, applying ointments, drinking teas, or soothing massages.  (1)

It was around the 12th and 13th centuries when medical philosophies of Traditional Chinese Medicine started to influence Korean physicians, which were recorded in various Chinese texts.  Yet the first medical texts in Korea simply consisted of compilations of folk medicine, which up to this time was passed on only by word of mouth

It was in 1236 that all the folk medicine of the day was compiled into one treaties called "Hyang-yak kugup  pang" or "Emergency Remedies of Folk Medicine."  It's the oldest medical texts written by a Korean. (2)

At about the same time several other such treaties were compiled, including "Samhwaja hyangyak pang," or "Folk Remedies of Samhwaja."This was mainly a diagnostic guide.  (3)

All the medical wisdom from these books were compiled in 1433 into "Hyangyak chipsong pang," or "Compilations of Native Korean Prescriptions."  (4) Two centuries later, in 1610,  Korean philosopher Ho Chun compiled all the medical wisdom up to his time in "Tongui pogam," or "Exemplar of Korean Medicine."  (5)

Mark Jackson, in his book "On Asthma:  The Biography," explains that Korean physicians believed asthma-like symptoms or coughing were caused by excessive eating, fear and shock.  While folk medicine was the original treatment for any ailment, various remedies from Chinese medical texts worked their way into Korean medicine. (6)

While Traditional Chinese Medicine influenced Korean medicine, Korean texts were likewise respected in China.  It wasn't until the 18th century that Eastern and Western civilizations shared medical wisdom.  

Click here for more asthma history.

References:

1. WebMD,  http://dictionary.webmd.com/terms/folk-medicine
2. Lee, Ki-baik, "A New History of Korea," 1984, Korea, page 171
3. Lee, ibid, page 171
4. Lee, ibid, page 171
5. Jackson, Mark, "Asthma: The Biography," 2006, New York, page 43
6. Jackson, ibid, page page 43

314-240 B.C.: Erasistratus founds school of anatomy

Erasistratus (315-240 A.D.)

Ancient Greek and Roman life was so pleasurable that for the first time in human existence there was time to sit back and enjoy the finer things in life; to ask questions; seek for truths; devise theories; and learn.  

Men became smarter in all walks of life, including medicine.  At first medical theories were formed based on keen observation, and ultimately new ideas were created based on experience, such as actually cutting open a human to see what was inside, and see what various diseases did to the human body.

Erasistratis of Chios lived about 315-240 B.C. and is known by history as an anatomist and founder of the School of Anatomy at Alexandria, Egypt.  He is generally known to follow the methods of Hippocrates before him, yet his work would later influence Galen.

Erasistratus was an anatomist who was so accurate at describing the human body that many of his descriptions are still used to this day.  However, it wasn't until the writings of Galen some 350 years later that his descriptions were introduced to the medical world.  (1)

One significant contribution to medicine and our history of asthma is the discovery by Erasistratus of the valves of the heart.  Hippocrates had earlier noted the heart could not be diseased, but Erasistratus thought otherwise. 

However, while he conducted his research it was believed the arteries contained air not blood.  Blood wasn't described until the days of Galen. 

This is significant to our history of asthma because over the next 2,000 years it would be learned that heart failure mimicks true asthma and was ultimately reclassified not as asthma per se but cardiac asthma.  Cardiac asthma is now referred to as heart failure.

Another interesting thing about the life of Erastistratis is that, while he may not have known it at the time, his life marked the beginning of the fall of the once great empire that was Rome.  In our study of the history of asthma Erasistatis is our last significant figure representing medicine in the Ancient Greek and Roman eras.

Click here for more asthma history.

References: 

1. Parr, Bartholomew Par, M.D., "The London Medical Dictionary," 1809, London, Vol. 1, pagegs 425-5 

500 A.D. Asthma in Ancient Japan

Fuiwara no teika ( (1162-1241)

If you lived with asthma in ancient Korea and Japan your asthma may have been recognized, yet treatment would have been mainly supportive.  It wasn't until the 6th century A.D. that Chinese medical ideals -- mainly in the form of the Nei Ching -- spread to these nations.

Chinese medicine was referred to as canpo in Japan, and asthma-like symptoms were referred to as zensoku as early as 700 A.D.  (1)

The most famous asthmatic in Ancient Japan was Fujiwara no Teika who is considered one of the most famous poets in Japanese history.  Legend has it that his poems became well read due to his cordial relationship with the Emporor Go-Toba (1180-1239).

Japanese children learned early that there were 404 different kinds of illnesses, and they learned of the various herbal formulas used as remedies, most of them indigenous to the region.  One interesting remedy for asthma was by eating a potion containing earthworms dried under the sun, cooled and then boiled.

Most asthma remedies were similar to what was recommended by Traditional Chinese Medicine.  So prior to the 6th century Japanese asthmatics would have been recognized although there wasn't much anyone could do other than offer support.

Yet if you were afflicted with breathing difficulties in the 6th century you would have had available to you many of the same treatments available to Chinese asthmatics, including Ma Huang, a very efficient bronchodilator.

Click here for more asthma history.

References:

1. Jackson, Mark, "Asthma: A biography," 2006, New York, page...

25 BC-50 AD: Celcus spearheads quest to define asthma

So what would life be like for us asthmatics at the time of Jesus?  From my investigations into this era I'd imagine the best remedy might simply be to tough it out, as many of the recommended remedies seem like they'd be worse than the disease.

Aurelius Cornelius Celsus

The second century A.D. was a very "fruitful era of literature and philosophy."  (1)  It is for this reason we have resources available to help us learn what was known about asthma at that time and the remedies to treat it.  Among those influential in our quest to investigate the history of asthma are Pliney the Elder, Seneca the Younger and Aurelius Cornelius Celsus.

I will write about Pliney and Seneca later, yet for this post I would like to introduce you to Celsus, who was born of respectable parents, was well learned, and shared with us his wisdom through his many writings.  He was a philosopher, physician, surgeon and a pharmacist.  One author noted him to be so skilled at his crafts that he was "second to none." (2)

His writings are also known to be "diligent" and "attentive," yet many future biographers and historians have debated as to whether he really practiced what he preached.  Some speculate that he never was a surgeon, let alone a physician.  (3)

Celsus was born in Greece in 25 B.C.  He was a stoic, which meant he did not believe in an after life.  As an arch opponent of Christianity he wrote "The True Word," which was a well read attack on Christianity, a new philosophy in that era.

He wrote several other books as well, such as "A Treaties on Agriculture" and "A Treaties on Military Tactics."  Yet what history most remembers him for is his "Treaties on Medicine."  It is thanks to this work that we gain our first look at asthma during the time of Jesus.

As a medical writer Celsus emulated Hippocrates, and parts of his books are word per word transcriptions from the "Hippocratic Corpus."  In fact, Celsus did this so often that one later author, Nicholas Mondaris, referred to him as the "Ape of Hippocrates." (4)

Treaties on Medicine

Yet he incorporated into his book the latest wisdom of his day, plus some of his own ideas.  This is clearly evident in his writings on asthma.

When asthma was first defined by Hippocrates in 400 B.C., it was often difficult to distinguish between the causes of dyspnea, and therefore they were grouped under the umbrella term asthma. Thus, all that caused dyspnea were referred to as asthma.

Celsus, on the other hand, believed asthma was more than just dyspnea, and for this reason he provided us with our first description of asthma as more than simply a blanket term. 

Celsus believed there were three thoracic disorders that resulted in difficulty of breathing, and they varied by their "degree of violence":

1. Dyspnea:  Moderate, unsuffocative breathing without a wheeze; it's chronic
2. Orthopnea:  Breathing only takes place in an erect position; it's acute
3. Asthma:  Vehement breathing that is sonorous and wheezing; it's acute (5)

He was also the first to describe asthma as a specific condition involving constriction of the air passages in the lungs, and he was likewise the first to describe a wheeze.  He described an attack of asthma this way:

(Asthma is caused by)  the narrow passage by which the breath escapes, it comes out with a whistle; there is pain in the chest and praecordia, at times even in the shoulder blades, sometimes subsiding, then returning; to these there is added a slight cough."

His remedies were barbaric, and may have included any of the following:

1. Blood letting (common remedy for just about any ailment)
2. Milk (to relax the bowels)
3. Purging of the bowels with enemas (clysters) or injections if necessary
4. Hydromel (honey diluted in water
5. Head must be kept high in bed
6. Thorax relieved by fomentations (warm, moist medicincal compress)
7. Thorax relieved by hot cataplasms (a heated medical dressing, either dry or moist)
8. Malagma (lotion or salve) or iris ointment after fomentations and cataplasms (these act as emollients to soften skin to make chest movements easier)
9. Hydromel as a drink (mixture of water and honey)
10. Bruised root of capers has been boiled
11. Nitre or white cresses fried, bruised, then mixed up with honey and given as electuary (oral, by mouth)
12. Honey, galbanum, and turpentine resin boiled together and, when they are coalesced to the size of a bean, dissolved under the tongue daily
13. Impure sulfur or southernwood triturated together in a glass of wine and sipped warm
14. Fox's liver dried, hardened and pounded into a powder and sprinkled on a drink (such as wine)
15. Eating the fresh, roasted lungs of a fox (but you can't cook it with iron utensils)
16. Gruels (watery porridge) and mild food
17. Light austere wine
18. Sometimes a vomit (Emetics)
19. Anything that promotes urine (diuretics make you pee, but they probably believed they were full of poisons that caused the humors to be imbalanced)
20. Gentle walking (nothing more)
21. Massage (he referred to it as friction; it's done to move poisons around the body to balance the humors and to make breathing easier) (6)

While some of Celsus's remedies were later proven to have medical significance, most were simply palliative, and some were downright barbaric.  Still, Celsus's ideas were studied and followed for many years after his death.

We asthmatics should be thankful to Celsus for spearheading -- although he didn't know it at the time -- a 3,000 year effort to define asthma as a disease of its own. You can decide for yourself if you'd have been satisfied with his remedies for your asthma...

... or if you'd have rather just stayed home and suffered.  Let me know what you think.

References:

1. Celsus, Aurelius Cornelius, "De Medicina," translated by L. Targa, London, pages xiiv-xxiii, "The Life of Cornelius Aurelius Celsus," by J. Rhodius and translated from Almeloveen's Lugduni Batavorum, page xxi, xxii
2. Celsus, ibid, page xvii
3. Parr, Bartholomew Par, M.D., "The London Medical Dictionary," 1809, London, Vol. 1, pagegs 425-5 
4. Celsis, op cit, page
5. Celsis, op cit, pages 259-61
6. Celsis, op cit, pages 259-61

62 B.C.: Seneca the asthma philosopher

"What in fact makes people who are morally unenlightened by the experience of physical distress is their failure to acquire the habit of contentment with the spirit.  They have instead been preoccupied by the body.. so do not go out of your way to make your troubles any more tiresome than they are and burden yourself with fretting."  Seneca

Like the writings of Pliney the Elder, Seneca's writings became well read, and Seneca became one of the most well known philosophers.  In one of his letters to Lucilius, a friend and correspondent of Seneca's, Seneca provided a description of asthma, although he doesn't use the term asthma.

 Sculpture of Seneca by Puerta de Almodóvar in Córdoba, Spain

From his 54th letter to his friend Lucius (who also had asthma and catarrh), we get Seneca's description of asthma from "On Asthma and Death" as translated by Richard M. Gummere:

My ill health had allowed me a long furlough, when suddenly it resumed the attack.  "what kind of ill-health?" you say.  And you surely have a right to ask; for it is true that no kind is unknown to me.  But I have been consigned, so to speak, to one special ailment.  I do not know why I should call it by its Greek name; for it is well enough described as "shortness of breath."  It's attack is of very brief duration, like that of a squall at sea; it usually ends within an hour.  Who indeed could breathe his last for long?  I have passed through all the ills and dangers of the flesh; but nothing seems to me more troublesome than this.  And naturally so; for anything else may be called illness; but this is a sort of continued 'last gasp.'  Hence physicians call it 'practising how to die."  For some day the breath will succeed in doing what it has so often essayed (breath will succeed in doing what it is supposed to do). 

In letter 65 he wrote about his and his friend Lucius's catarrh*:

"I am all the more sorry to hear about your constant catarrh, and the spells of feverishness that go with it when it becomes protracted to the point of being chronic, because this kind of ill health is something I have experienced myself.  In its early stages I refused to let it bother me, being still young enough to adapt a defiant attitude to sickness and put up with hardships, but eventually I succumbed to it altogether.  Reduced to a state of complete emaciation, I had arrived at a point where the catahhral discharges were virtually carrying me away with them altogether.  On many an occasion I felt the urge to cut my life short there and then, and was only held back by the thoughts of my father who had been the kindest of fathers to me and was then in his old age.  Having in mind now how bravely I was capable of bearing the loss, I commanded myself to live.  There are times when even to live an act of bravery."

This was probably saying a lot back then, because I can imagine living in a state of shortness of breath.  And I can imagine this coupled with the misery of allergies on top of that.

Yet I cannot imagine what those two ailments would be like when there was no cure and no remedy that really provided any relief.  It must have been pure hell to live like that.  I can understand how he might be compelled to think about just ending the misery right "there and then."

Yet life is special, and there are few who get to enjoy this special gift.  Seneca realized this.  He used his father to provide himself the courage to go on. 

In letter 65 he described to his friend Lucius and what he did to survive the attacks of asthma and catarrh*. 

"Let me tell you the things that provided me consolation in those days, telling you to begin with that the thoughts which brought me this peace of mind had all the effects of medical treatment.  Comforting thoughts contribute to a person's cure; anything which raises his spirit benefits him physically as well.  It was my Stoic studies that really saved me.  For the fact I was able to leave my bed and was restored to health I give the credit to philosophy.  I owe her -- and it is the least of my obligations to her -- my life.  But my friends also made a considerable contribution to my health.  I found a great deal of relief in their cheering remarks, in the hours they spent at my bedside and in their conversations with me.  There is nothing, my good Lucius, quite like the devotion of one's friends for supporting one in illness and restoring one to health, and for dispelling one's anticipation of dread and death.  I even came to feel that I could not really die when these were the people I would leave surviving me, or perhaps I should say I came to think I would continue to live because of them, if not among them; for it seemed to me that in death I would not be passing on my spirit to them.  These things gave me the willingness to help my own recovery and endure all the pain.  It is quite pathetic, after all, if one has put the will to die behind one, to be without the will to life.

Another remedy he later adds "is to turn your mind to other thoughts and in that way get away from your suffering.  Call to mind things which you have done that have been upright and courteous; run over in your mind the finest parts that have been played.  And cast your memory over the things you have most admired."

No potions.  No magic.  No herbs.  Seneca might have been one of the first asthma experts to recommend, mainly due to his own experiences, the importance of relaxing to control your asthma.
Click here for more asthma history.

*Campbell, Robin, Lucius Annaeus Seneca, "Letters from a Stoic: Epistulae morales ad Lucilium, " Penguin, 1969, letter LXXVII.

"There then are your remedies." 

1281-1348: Xi defines asthma for China

The next person to make a significant impact on the flow of asthma wisdom through Ancient China was InZhu Dan Xi (also known as Zhu Zhenheng). 

He lived from 1281-1348 A.D, and was born to a medical family.  He believed his family received poor medical care when he was young, and therefore became determined to learn about medicine.  (1)

He believed over indulgence depleted the essence of yin and caused chronic diseases.  His most significant recommendation was temperance. (2)

He continued to describe diseases as an imbalance of the humors as was described in the Nei Ching some 2,000 years earlier, and as described in Ancient Egypt and Western Civilizations.

InZhu Dan Xi (1281-1348)

Xi is often regarded as the first Chinese physician to provide a modern description of asthma.  He combined chuan and Xiao to come up with chuan xiao, which many historians believe is similar to the Western world's description of asthma. (3)

From this time on Chinese physicians believed Chuan xiao was caused by an imbalance of yin and yang, which are polar opposites, and "obstruction to the flow of Qi by phlegm in the airways,  according to Mark Jackson in his book "Asthma: The Biography."

Ma Huang continued to be a common therapy for the treatment of any respiratory ailments along with "Qi supporting" liquorice and gypsum decoction, "Yin syndrome asthma was treated with Yin Returning elixer."  (4)

Since Ma Huang was a much better bronchodilator than any western treatment for asthma, Chinese asthmatics had it at least a little better off than their contemporaries in the rest of the world, or so one might imagine.

Click here for more asthma history.

References:  

1. Beijing Medical Museum of TCM
2. "Chu Tan-chi [Zhu Danxi/Zhu Zhenheng; 1280-1358 A.D.," Chinese Medicine History,  http://www.taijichinesemedicine.com/zhudanxi.htm
3. Jackson, Mark, "Asthma: The Biography," 1998, New York, page 41
4. Jackson, ibid, page 41

150-219: The Chinese Sage of Medicine

Zhang at work

If you had asthma in China prior to the 3rd century A.D. your doctor may have recommend a remedy of drinking a bitter tasting tea made from dried stems of the Ma Huang plant.

This remedy made your breathing better, and your cough often subsided too.  The trick was your physician would have to remember it and the formula to concoct it.

You see, there were few books with medical wisdom for your physician to reference.  Most medical knowledge, especially regarding herbal remedies, were passed on from one generation to the next to anyone who wanted to learn about it.

This all changed around 220 A.D., and it all changed because of a war that causes a virus to strike the village of a man named Zang Zhong Jing (also known as Zhang Ji).

Legend has it  he was 50 when two-thirds of his village died of a fever in a short span of ten years, and that inspired him to become an expert on ancient medical text, such as the Nei Ching  and the Hippocratic Corpus.

This resulted in him writing a medical book that helped shape Chinese medicine, and resulted in him becoming well known to the Chinese medical community by giving birth to Traditional Chinese Medicine. (1)

His book was called "Shanghan Zabing Lun" which translates in English to "Treatise on Cold Pathogenic and Miscellaneous Diseases."  It's a compilation of the medical wisdom from all those who lived before him.

Yet his book was lost in a war, and was not available until 1065 when the rulers of China saw a need for these old books and formed the Bureau for Collation of Medical Books of the Song Dynasty.  Wang Shu-He collected what he could of Zhang's writings and recompiled them into two books he called the "Shang Lun," which translates into "Treaties on Cold Induced Fevers."

The two books were:

• Shan Han Lun (On Cold Damage), a compilation of herbal remedies to treat infectious diseases that cause a fever
• Jinkui Yaolue (Essential Prescriptions of the Golden Coffer), which records his clinical experiences

 These books describe methods of diagnosing, treating, and monitoring the effect of treatment. He recommended the importance of using the pulse not only to diagnose as Huang Ti recommended 1000 years earlier in his book "Nei Ching," but to monitor the course of treatment.

He was also the first to mention artificial respiration.  And he also  recommended forcing water down a person's throat who attempted suicide by poisoning to bring up the poison, and this is a technique similar to what is used in hospitals today. (3)

Like Hippocrates, Zhung recommended against the practice of physicians taking advantage of patient  naivety for the purpose of making a profit.  He noted that some physicians concocted bogus formulas and sold them as viable remedies.  He berated this practice and encouraged good medical ethics.  

So his books were very helpful to Chinese physicians and their patients.  Yet of most importance were the formulas he calculated for collecting and concocting herbal remedies for many of the ailments of his day, especially those that are contagious and cause fevers like what wiped out his village.

One of the neatest things about Zhang's herbal formulas is that many are still used to this day, and many have even been proven by science to be effective remedies.  This includes as description of asthma-like symptoms in Jinkui Yaolue and a formula for creating a remedy using Ma Huang. He described breathlessness or panting as chuan, and wheezing as xiao. (2)

His works have earned him the respect of Chinese Historians as one of the best physicians of all time, so much so that he's often referred to as the sage of medicine.  Actually some consider him to be a god, and others believe his existence was merely a legend.

While revered in China, his works also influenced and forever changed the way medicine was practiced in Japan, Korea, Vietnam and Mongolia.  Many of his formulas for herbal remedies are still used as effective treatment for many ailments, and many have even been proven effective by modern scientists.  

He's such a significant "legend" that his books continue to be required readings for any student of Traditional Chinese Medicine.  (4)

(Considering this fame, little is known about his life, nor exact dates associated with his life.  It's estimated he lived from 150-219 A.D, yet many historians continue to debate these dates.)

Click here for more asthma history.

1. Selin, Helaine, ed., "Encyclopedia of the History of Science, Technology, and Medicine in Non-Western Cultures," 1997, Netherlands, page 893
2. Jackson, Mark, "Asthma: The Biography," 1998, New York, page 41
3. Selin, Op. Cit, page page 893
4. "Chinese Herbal Formulas and Application," chapter 1, page 31

100 A.D.: Asthma in Ancient India

If you lived with asthma in India during the first century your illness would have been recognized by physicians, who -- if you had access to them -- would prescribe a variety teas and inhalants to ease your suffering.

Ayurveda was a school of medicine in Ancient India and Sri Lanka.  The Caraka Samhita is a a two volume medical book compiled by Caraka, physician to the King Kanishka in Sanskrit around the first century A.D.  The book is full of descriptions of diseases and remedies supposedly from the Hindu god Brahma to the Vedic sage Atreya.  (1)

Indian mixing a remedy from the Caraka Samhita (a)

It provides a description of Tamaka Swasa, with swasa meaning breathlessness.  It's a condition that closely resembles our modern description of asthma such as wheezing, shortness of breath, increased phlegm and coughing (kawa).  When severe it may result in sweating, trouble lying down and trouble speaking.  (2)

Tamaka Swasa is believed to be caused by cooling of the body that results in an imbalance of the bodily humors that ultimately results in excessive phlegm that blocks the air passages.  (3)

The condition was believed to be aggravated by cooler or humid environments.  Some foods, such as milk, was believed to increased phlegm and may also have contributed to worsening asthma.

Recommended treatment mainly consisted of methods to balance the humors and warm the body, and might have included:

• Steam
• Inhaled Cinnamon
• Castor bean oil
• An insect resin
• Tumeric
• Arsenics
• Inhaling strammonium (belladona) 
• Herbal ointments  (4)
• Leaves of Camellia sinensis served as a tea
• Adhatoda visaca 

Datura and strammonium would have given the asthmatic some relief from an attack. It was dried, crushed, stuffed into pipes, and the smoke would be inhaled.  This remedy was introduced to the modern world in the early 19th century and became a popular asthma remedy mainly in the form of asthma cigarettes.

In 1888 the mild bronchodilator theophylline was derived from the Camellia Sinensis.  Theophylline was proven to benefit asthma in the 1950s and became a top line asthma remedy in the 1970s and 80s.

Adhotoda visaca is a shrub that stinks so bad goats won't go near it, hence the name was derived from the term for goat, adu.  The leaves, roots or flowers of the plant were fixed in various forms and used to improve a cough and help with phlegm expectoration.  It therefore was used to help remove excessive phlegm from the body to balance the humors. (5)

Ayurvic advice for asthmatics may also have included an improved diet, adequate sleep, rest, exercise and massage to ease the mind.  It was believed relaxation and improved social and living conditions enhanced the healing process.

Ayurvic medicine is a philosophy of medicine that has continued to modern times in India adn , although with many advances.  Many of the treatments recommended, particularly yoga, are still considered to be an alternative therapy for treating asthma to this day.

Click here for more asthma history.

References:

1. Jackson, Mark, "Asthma: The Biography," 2009, New York, page 44
2. Brenner, Barry E, "Emergency Medicine," 1999, page 2
3. Hahn, Mark, Marcia C. Inhorn, "Anthropology and public health:  Bridging differences in culture and society," 2009, New York, page 80
4. Brenner Barry E, op. cit., page 2
5. Premila, M.S., "Ayurvic Herbs," 2006, page 86

Photo:

• (a)  AyurvedaDosha copyright 2011 from aruvedadosha.com

My asthma used to anger my mom

My daughter's experience with the asthma beast last night reminded me of my own childhood experience. 

My wife made a neat observation:  "Some parents might actually be annoyed when their daughter woke up at midnight coughing and crying and acting restless.  They might have been annoyed because they wouldn't have known their child was having an asthma attack.  They might have thought their daughter was just being a brat and keeping her parents up."

I think my wife was surprised by my response.  I said, "I think that happened to me.  With no disrespect to my parents because they weren't medical professionals and they didn't have asthma.  But my mom used to wake me up when I was coughing and make me lie on my side.  Then I'd fall asleep and an hour or so later she'd be waking me up again because I was coughing.  She'd make me lie on my side. It got to the point that to this day I can't sleep lying on my back.  She had no clue my coughing was probably due to asthma.  I couldn't breathe and she was mad at me.

"I will never let that happen to any child of mine.  I don't want my two asthmatic daughters to have that scar."

I tried to discuss this with my mom once in a matter of fact way and she outright denied it.  She might honestly not remember.  And she might have done so in a completely innocent matter.

 It doesn't matter to me.  I was just curious.  I have an awesome mom and she was always there.  So I don't mean to make my mom look bad.  It's just something that she did that left a scar.  Yet it's something neat to write about. 

If any of my fellow asthmatic followers ever had a similar experience please leave a comment below. 

My 3 YO daughter's second asthma attack

So my reserved 3 YO daughter was fine when I came home from work last night, yet right around bed time she started coughing, retracting and with my stethoscope I heart inspiratory and experiatory wheezes.  She was tight and her words were short and choppy. 

I gave her a treatment.  It benefited her, yet she was still tight with wheezes.  I had a distinct feeling it was going to be a long night.  An hour later she was distinctly bad again and I gave another treatment.  She fell asleep in my arms, and when I set her in bed he head bobbed up and down on the pillow from her bodies effort to suck in air. 

Remembering my experience sitting up all night suffering from asthma and my parents not realizing what it was, I didn't want my daughter to go through the same thing.  So I didn't think I'd fall asleep.  Yet I must have.  At 11:30 I was awake and heard no coughing.  For a moment I though we had made the right decision not to go to the ER.  Yet then the coughing started.  Then...

"Mommy and Daddy," she yelled in a panicked voice.  I picked her up and she was unhappy I was around.  She was agitated.  She didn't know what she wanted.  She was retracting and audibly wheezing.  It was an easy call.  My wife got out of bed, snuggled our daughter in the recliner, and we made the decision it was time to go in for another steroid shot.

This time one of our regular doctors was working.  She was great. Here's what she charted:

child tends to have wheezing and over the past few weeks has been wheezing more frequently and was on oral steroids at one point.  over the past 2 nights she has been wheezing to the point of requiring breathing txs at home.  tonight she took pulmicort for the first time and this seemed to make the wheezing worse.  mom brought in for further eval. due to her sob.  dad has a hx of severe asthma and is a resp therapist at the hospital here. FREQUENT NONPRODUCTIVE COUGH, DIFFICULTY BREATHING.  Seen by pediatrician earlier in day for same reason.  active/playful/smiles, age appropriate attention, good eye contact, no apparent distress, not irritable, not lethargic Temperature: 98.6, Heart Rate: 140, Respiratory Rate: 48, Pulse Oximetry: 97, Weight: 28 (unable to get vitals previous visit).  x-ray normal.  child given 2 xopenex nebs upon arrival and decadron im.  after third neb child was much improved.  she had a p ox of 97% on ra and was talking well.  retractions were gone.  will give prelone for home and discussed close follow up.  scripts:  Prednisolone (Prelone) 15 Mg/5 Ml Syp  25 Mg OR DAILY (note:  Errors are the doctors.  I did not correct grammatical errors).

This doctor is one of our regulars and she also has kids, so that helped a great deal.  My daughter must have sensed she was a good person, because she actually let her assess her.  This just goes to show that if you're good in your approach you can even get the most reserved kids to cooperate in the ER.  Common sense, you know, goes a long way.

The doctor also said that decadron has a tendency to last longer than solumedrol, sometimes up to three days.  She said that's why she prefers to use it with kids, especially kids who don't like to take nasty taking prednisone pills. 

At 3 a.m. my wife arrived home and she went to bed while I stayed up with my sweety.  HM was hyped up from all the medicine and was marching around the living room chanting a hundred words a minute.  Finally she asked me if I'd lay down with her, and before my head hit the pillow next to hers she was sound asleep. 

Today she was back to normal.  This was a much better ER experience than three weeks ago.  It shows how smooth things can go when you respect the parent.  Or, it shows how smooth things can go when the parents and doctor use common sense.

My 3 YO daughter's first asthma attack

So I picked up my daughter's medical records today from her ER visit On Nov. 27.  My wife took her -- my little reserved 3-year-old -- to the ER that day because of an exacerbation of asthma.  It was clear to me it was asthma, although I can tell from what the arrogant and condescending doctor wrote she didn't necessarily agree.

Here's what the doctor wrote on the chart::

"Child has had cough and difficulty breathing for two weeks.  Mother is RN and father Respiratory therapist and they have been giving her xopenex and albuterol every two hours at home since 0300 today.  She has not been diagnosed with asthma.  Mother states "she hates people." Mother has called their pediatrician and report was called to ED to avoid drawing blood on the child.

"Duoneb times two and worked to get cooperation to take steroid.  After second neb still with wheeze inspiratory (scant) and full exp cycle.  CXR neg.  Solumedrol given IM and RX pediapred and atrovent for home.  Mom is RN and Dad is resp therapist.  They have home nebulizer and expressed preference to continue treatment at home.

Responds well to DuoNeb howevr still wheezing.  Added steroid and to send home on Albuterol and Atrovent neb and PO Pediapred.

I think it's pretty clear the doctor was irritated my daughters pediatrician called with recommendations on how to treat my daughter.   It was actually more us than our pediatrician.  My wife and I are minimalists, and we know by our clinical experience that ER doctors have to order a bunch of stuff just to cover their butts. 

Figuring my daughter's asthma is similar to mine, she didn't need a bunch of labs and an IV.  All she needed was the steroids.  I also had this distinct feeling this doctor wanted to admit my daughter too.  The doctor was also not one of our regular doctors, which may explain the poor attitude. 

And guess what.  The steroids worked great.

Related links:  My daughter's asthma attack and the arrogant doctor

The truth shall make your asthma better

I was on the job as an RT at Shoreline for only three months when I had an asthma attack so bad I was taking treatments every hour.  I went to the ER and was admitted.  

Sahara was a coworker of mine.  She took care of me when I was a kid, and I was looking forward to her coming to visit me.  After I was a patient for several days she finally came, and instead of sympathizing with me she lectured me instead.  She said:

"You did this to your self.  Every time I see you you're eating a Big Mac or a Whopper and you keep gaining weight.  You take poor care of your health and that's why this happened.  You did this to yourself."

I was so ticked at her I couldn't wait for her to get out of my room. I told my other coworkers about what she said and they agreed she was a jerk.   I barely spoke to her the next two years unless I was giving report.  Yet eight months after that lecture I started working out.  I also started eating well.  I lost 35 pounds and was feeling great. 

Since then I've continued to try to eat well and exercise and since then my asthma has been much improved.  So improved, as a matter of fact, that I haven't spend a day as an inpatient for asthma since that visit.

So that got me to thinking:  Sahara did me a favor by lecturing me.  Instead of sympathizing with me and allowing me to continue on the wrong path she took the bold step and told me I was a fool for the way I was living.

This goes to that old saying that the truth hurts before it makes you better.  For the lecture that set me on a path to becoming a Gallant asthmatic, I thank you Sahara.  Thanks Sahara.  

Thanks to my Brother Bobby

My brother Bobby once told me I was a useless piece of skin because I was sitting on the couch one afternoon when he wanted me to play baseball.  "Come on, Rick, we need one more person."

I wouldn't budge.  What he didn't know because I wouldn't tell him was that I didn't want to play because I was sick and tired of not being able to breath.  I was feeling sorry for myself that I had asthma. 

A few years later, however, I didn't give him a chance to say such a thing to me.  I played football even during an asthma attack.  I even remember it was Thanksgiving and I kept running in every 5-10 minutes during the second half to use my nebulizer.  

And while you might thing that was stupid of me, I thank him for that.  Instead of allowing me to use my asthma as an excuse he encouraged me to do something.  Because of him I became competitive. Thanks to him I stayed active, something we asthmatics should all do.

Thanks, Bob, you moron.  

Is it LAZY or ASTHMA?

My brother called me a worthless piece of lazy skin once because I couldn't play football with him.  Yet little did he know I was sitting on the couch watching TV because I couldn't breathe.  That was over 30 years ago.

Mom and I sat in a Chinese restaurant with two steaming hot cups of tea between us.  She said, "You were a good kid.  The only thing I remember getting mad at you about was your messy room."

We laughed as we reminisced about some of our fights.  Once mom took an entire drawer and dumped it onto my floor.  She wouldn't let me leave the room until the entire thing was clean.  I wish now that she would have taken a picture of it, because you wouldn't be able to see any surfaces.

When we were finished laughing I reminded mom of one other moment I remember better than all those fights.  "We were sitting at the kitchen bar after dinner.  Dad and my brothers were gone, so it was just you and me.  You said, 'John, I've decided I shouldn't get mad at you about your room anymore.  I was thinking that you spend more time in your room because you have asthma.  Instead of hanging out with your friends and your dad you become involved in creative projects in your room.  You draw and collect baseball cards.  Creative people are messy.'  You said that, and it meant a lot to me.'"

"I said that," she said, smiling.

"Yeah," I said, "And then you yelled at me about my messy room again."  We laughed.  

I think my mom had a point.  Even now as I look around at my desk I see a clutter of papers.  My desk at work is clutters, so it my car and so is my locker.  They aren't filled with a bunch of junk, they are filled with papers and books and things I've written ideas on for writing.  

There's this old saying:  A cluttered desk equals a cluttered mind.  Instead of doing things I've filled my mind with clutter.  In a way, I wonder if this is the reason so many asthmatics report being anxious.  The more you think the more you have to worry about.  Asthmatics tend to do a lot of time thinking.

There are times I feel lazy.  I have felt lazy the past two weeks since I had an asthma attack cleaning my basement.  I am afraid to participate in any cleaning activity, so my house is sort of a disorganized mess. So instead of cleaning I spend my time here on this blog.  

There's another saying that my dad used to say a lot when we were kids.  He said that if it weren't for lazy people nothing would ever get invented.  An example he gave was Louis Sands, a local lumbering millionaire who lived in the late 19th century and early 20th.  

He made a fortune chopping down trees and floating them down the river to the Louis Sands sawmill.    He had a sleigh he rode in the winter and he didn't want to get out of the sleigh to open the gate to his mansion on 5th street.  So he invented this thing where as soon as the sleigh rode over this ramp the gate automatically opened.  It, in essence, was the first garage door opener.

He invented it because he was too lazy to get out of his sleigh.  Yes indeed, lazy has produced a ton of inventions.  The horse carriage was invented by a person who was too lazy to walk, and so was the car.  The airplane was invented by someone too lazy to drive.  The lighter was invented by someone too lazy to take the effort to light a match.

So lazy isn't so bad after all.  Lazy has made the world a better place for everyone.  So the next time someone calls you lazy, just remind them of all the good things that have come about because of lazy people.

I jokingly reminded my brother of what he said to me 30 years ago and he apologized.

"Yet you were right about one thing," I said, "You were right that I am lazy.  I'm a lazy asthmatic.  And that's not such a bad thing."

Reminders...

Reminders are good...

• You still have asthma, it's just been in hybernation
• Your daughter still won't take her asthma medicines, which your reminded of as she starts wheezing and coughing again
• You still like working nights even though you've been on days the past two years
• Your boss is not your best friend, even though she's been kissing your butt lately
• Christmas shopping isn't easy, even though you knew what to buy months ago

Is worsening asthma linked to anxiety?

So I've noticed increased asthma symptoms lately.  In October I had a pretty severe asthma attack at hunting camp and I've had two since that time.  Of course my daughter and two of my coworker friends have been having trouble too lately, so perhaps there's something in the air.

Yet something else I've been thinking about also lately is there's been an increase amount of stress in my life too.  Now that I'm working days my job is twice as hard, and the workload is triple of what it is when I work nights. 

There's also been a lot of pressure from my boss to do all these extra projects, such as I'm a Neonatal Resuscitation teacher and I'm a member of the Keystone Committee.  Plus I'm a commissioner on the local township commission and I was -- by default -- nominated as the chairman.  So there's a lot of stress there.

Now is it all a coincidence that my asthma started acting up as all this stress stacked up?  That's possible.  Yet there is also a ton of evidence that links increased stress and anxiety with asthma I can't help thinking about it.

A case in point was mentioned by Andrew Harver and Harry Kotses in their book "Asthma, Health and Society," (2010, New York, page 315).  They mention several studies that link asthma with anxiety and depression, and that link increased stress with worsening asthma.

I've mentioned on this blog a few times that I'm not afraid to say I have social phobia.  I've been diagnosed on more than one occasion with anxiety disorders.  I've been treated too.  Something I'd like to delve into at some point in the future is my medical records where my psychologist when I was a kid wrote how I had anxiety and how it made my asthma worse.

If you met me you may never know it.  I'm not the kind of person who sits in a corner.  Obviously, otherwise I wouldn't have been elected to the commission, and I wouldnt be chair.  And I wouldn't be able to be a teacher in front of classes.  Perhaps therapy helped me there. Or perhaps common sense helps me there. 

Now I wouldn't want to bore you with the details nor embarrass myself for that matter, yet I think this is significant because these studies match up almost to a tee with my own experience with asthma and anxiety and stress and depression.  Coincidence?  Perhaps.  Yet I think the evidence is stacked too high to ignore it. 

And of course there's no way of knowing whether increased stress and anxiety results in worse asthma or the other way around.  Yet I'm digressing.  I'd like to get back to the book I mentioned above and the studies. 

I'm just going to quote the book here and then I'll leave it at that and you can tell me what you think. Of course we know that the link between asthma and psychosocial disorders goes all the way back to written records way back in 200 B.C. 

"The late 19th century and early 20th century William Osler viewed asthma as a 'neurotic affection' in which imbalances of the nervous system and emotional factors played a fundamental role.  Since then a growing # of studies have provided evidence of a link between various psychosocial factors and asthma. Data from both clinical and community settings suggest that psychiatric disorders, and mood and anxiety disorders in particular, are disproportionately more prevalent among asthmatics relative to the general population.  Point prevalence rates of anxiety disorders (eg. panic disorders, general anxiety disorder and social phobia) and mood disorders (eg. major and minor depression disorder) are especially high among asthmatics, ranging from 16-25 percent for anxiety disorders.  One recent study indicated 31% of asthmatics meet criteria for one or more current mood (20%) or anxiety (23%) disorder.  Rates of certain disorders (i.e. panic disorders and major depressive disorder) are as much as six times more prevalent among asthmatics relative to the general population. 

He also notes the following:

• Studies also link increased psychological stress to increased asthma morbidity
• Studies observed symptoms of anxiety and depression have been associated with increased asthma severity, increased use of ER visits, increased symptom reporting, poorer PFTs, and lengthier hospital stays
• Increased anxiety results in poorer adherence to medicine, etc. (this was my problem back when I was admitted to the asthma hospital in 1985)

Henry Hyde Salter was a doctor who wrote several articles and a book in the mid 19th century, and he was convinced that certain stimuli (dust, stress, etc.) stimulated the obdulla oblongota and a message was sent down the pneumogastric nerve to the bronchiole muscles causing them to spasm.  This was why he termed asthma a nervous disorder.  He made this theory mainstream.

The nervous asthma theory made it through great medical minds like William Henry Osler and Frances M. Rackemann, and wasn't debunked until the late 1950s.  Still it was followed by many doctors until the 1980s. 

Yet I still believe there is some truth to the asthma neurosis theory.  I denied it when I was 15 and my psychologist told me I had an anxiety disorder.  I denied anxiety.  I denied it all.  Yet the wiser 40 YO me knows better.  I'm convinced the allergic response doesn't just cause inflammation of the air passages, that it also causes inflammation somewhere in the brain that results in anxiety, social phobia and/or depression.

That's the Rick Frea theory.  Increased inflammation in anywhere, when it lasts long enough, becomes permanent.  This is what asthma is, so experts now beleive.  So could there also be inflammation somewhere in the brain?  We don't know? 

I do PFTs on myself every month at work for fun.  I've noticed my FEV1 had dropped some in the past year, the same time stress has increased.  If you look at the flow volume loop you can see the obstructive pattern on expiratory portion of the loop.  So is this a result exposure to too many other asthma triggers like dust and campfires, or is there some phychosocial issue going on?

I may be way off base and you can tell me so if you want.  Yet it's interesting anyway. It's just a frivolous though perhaps. 

How to get kids to take systemic steroids?

Now I certainly hope you didn't click on this post thinking I was going to provide tips on how to get your kids to take their medicine.  This post is exactly the opposite.  If anything, I'm seeking advice.

Yet I don't think there really is any way to coax a three-year-old to take a steroid liquid, or a steroid pill, both of which taste -- to put it into the words of my daughter Mrs. L. -- "Yucky!"

The steroid shot worked the best.  That shot cured her.  On Monday she took the liquid.  On Tuesday she said it was, "Yucky!"  Yet she drank it.  On the third day she refused.  On the 4th day she refused. 

It's not like you can force a liquid down a kid's throat, because they have the ability to spit.  Then there's the concept of traumatizing a kid.  I'm of the belief if you force a medicine down their throats you'll compromise any future effort to get them to trust you to take any medicine. 

Yet I could be wrong.  I probably am wrong.  What I do know is during her nap today she was coughing again, something she hadn't been doing since the shot on Sunday.  And when she woke up she was wheezing and tight.  And she willfully took a breathing treatment, something she only does when she needs one.

So that brings us back to the steroid.  How do you get a kid to take a steroid?  Dave the pharmacist is going to give us some steroid pills, and the idea is maybe we can crush them and put them in Mrs. L's applesauce. 

Yet Mrs. L. is a light and picky eater.  Hm mm.   We'll just have to wait until this plays itself out.  It would be all the easier if some asthmatic dad didn't give the girl his bad asthma genes.