The Asthma Conundrum

Right now a cool, refreshing, even soporific, breeze is blowing through the open window to my left. The temperature is, according to Weather.com, 75 degrees with a humidity of 51%, which is ideal for any asthmatic let alone any person.

The temperature is so perfect that you could either bundle up under the covers and feel comfortable that way, or you could lay stark naked with the windows open and feel comfortable that way too. I mean it's just awesome weather (Yet don't tell that to my mother, because I'm certain she has the heat on right now).

So you'd think that at 03:45 in the morning, and since the weather is so "perfect" as I describe it, that I'd be sound asleep like a baby. Yet unfortunately that's not the case. It's not the case because -- and unfortunately for us allergy sufferers -- along with this great weather also comes what some experts describe as one of the worse fall allergy seasons in a long time.

Fall is already described by the experts as a bad time for allergies. If you don't believe me, and do and want to learn more, you can check out a post like this one.

Yes this article explains that it will be worse in 2011. The article, by Megan Moore at News Channel 10, "Allergy Sufferers Brace For Rough Season," explains that 2011 might be one of the worse allergy seasons because of all the rain we've had lately. The more rain, she explains, the more ragweed. The more ragweed, the worse off allergy sufferers -- like me -- will have it.

So that might explain why I've been up the past seven days at 3:45 a.m. amid a pile of used and unused tissues watching TV or, as I'm doing now, blogging. I've also been going through antihistamines like Lays potato chips to the point the wife is probably going to start lecturing me about abusing them.

It's says Claritin should only be used once a day, but I'm finding the only way I can make it through the day is by using it twice a day, and supplementing it with a benadryl before bed. The benadryl makes sure I at least get a couple hours sleep.

The kicker her is my allergies feel fine for most of the day, unless I'm near my asthma triggers, of which are present in large degrees under my bed, in the closets under and over boxes, and in my man cave in the basement. If I move boxes, or shuffle through old clothes, I'm done for the day. Which basically means I'm reserved to playing chess with my son, or memory games with my daughter, which I suppose isn't so bad.

Which sucks.

So, you may be wondering, how does this effect my asthma? Well, that's the conundrum. You see, I don't think my asthma will ever put me in the hospital again. We can get into that discussion later, but it's more of a Nemesis and burden than something I fear will end my life.

By this I mean it causes me bronchospasm, and some air trapping, but not enough to prevent me from doing my daily chores, at least considering I have a job indoors, in the air conditioning, and my asthma nor my allergies rarely bothers me when I'm working. It's just when I'm exposed to those dreaded asthma triggers -- the dog gone rag weed, molds, fungus, and pollens.

And you can't avoid them. They are everywhere. They are ubiquitous.

So I can feel the asthma right now. I can feel the little bronchospasms in my chest, which kind of feels tight. Yet I can take in a normal breath, and my peak flows are normal. Plus I rode 2 miles on the bike yesterday and my asthma didn't bother me. Yet still I'd estimate I went through about half an Albuterol in the past 48 hours.

Hence, you have the asthma conundrum. I could go to my doctor complaining of my symptoms, he'd do PFTs on me (I did one on myself the other day at work ant my FEV1 was 80%, which is good), and he'd find nothing out of the ordinary.

I don't have an infection, nor a cold. Yet here I am using as much Ventolin as I did 12 years ago when I had my last hospital stay and my last time on a steroid pack. Yes, believe it or not, it's been that long. Not saying I haven't needed one in the past 12 years, I've just fought through the few troubled spots with the meds I have here at my home.

Of course self treating myself might be something some of you new to asthma might frown upon, or any doctors reading this might frown upon, or perhaps my own doctor would frown upon, yet if you've had asthma the way I've had it for 40 years now, you wouldn't think twice about it.

If you new me the way my parents, brothers, wife and children do, you wouldn't think twice about it either. It's not like someone wants to call his doctor every time he has to cross a mole hill. You wouldn't think twice when you saw me puffing every 30 minutes through the course of the past 48 hours, gradually puffing out the contents of my Albuterol into my airways.

Which is why when I went to a family picnic on Sunday I had to set my plate on the table as I was putting food on it, lest someone might have observed how unsteady my hand was.

As I make my way through work today not one of my patients will notice their respiratory therapist has asthma, because there will be no symptoms of it other than the shaky stethoscope upon their backs. I'll be fine at work. It's allergy free.

And as I'm sitting at the desk charting, and my doctor sits down next to me to interpret his EKGs at around 10 a.m., I probably won't even think about asking him for his advice. Because, quite frankly, I don't think there's anything he can do even if he wanted to.

My asthma is treated, and I think that's why this doesn't end me up in the hospital like it might have 12 years ago. Yet there's still no cure for the allergies. And yes, I did go through the allergy shot thing, and I have gone through allergists as you can see one such experience here.

Okay, so now you might be thinking: why doesn't he just shut the windows and allergy proof his house? Great question. And I've already thought of that. Money is the reason. Plus, consider that last year I only needed my air conditioner one time in July, as July 2009 offered only one plus 80 degree day. In 2010 there were 20 days when the temperature exceeded 80 degrees.

If every year was like 2010 it would be an easy decision to splurge and pay the $1500 to put in central air. Yet with four kids, $1500 must be spent wisely, especially considering my 2 older kids are already wearing braces. And when those come off I'll have to pay for college.

My man cave is also the unfinished part of the basement. So you can get me there too. Yet if you want to loan me the money to finish it I'd be more than happy to finish it off. My email is above and my password for paypal is my email address.

So you see, in the ideal world allergies would go the same way I wish mosquitoes would go. In the ideal world the windows would be shut and some air filter system on. Yet air filter systems cost money.

Funny thing is, though, that even if I had air right now, there's no need for it. I'm reassured by that by the cool, refreshing breeze wafting over me as I type. I love it. I love it except for the ragweed wafting over my nares, some entering....

Hence you have the asthma conundrum. Or should I call it the allergy conundrum.

Playing the game

I'm sure anyone who has asthma, including you, has heard of the game of asthma. The game, as I define it, goes something like this: You do what you can to be normal, and take the risk that you will be normal in the process.

The risks involved: the allergy and asthma beast might find you.

As much as we like to say it doesn't happen, asthma and allergies can and do effect our lives. Not as though it's that big a deal, but my mother invited me to spend the night at her home so all of her children could be together for one night.

In theory that would be awesome. It would be like old times. Actually, it would be like new times since we didn't sit and drink wine, whiskey and beer with mom and dad when we were kids, yet mom and dad and we kids are like chums now-a-days. It's neat how that happens.

I remember dad telling me that his best friend in his adulthood was none other than his own dad. They shared a business together, golfed together, and hung out together. It's just neat to come to the realization that the same has happened between me and my parents.

Yet just the thought of spending the night at my mother's home brings back memories of back when my asthma was not in control, and I'd wake up at night sniffling, sneezing and wheezing. It wasn't until I went to college and only had trouble on the weekends when I returned home for the weekend that I caught on that I just might be allergic to my mom's house.

So however nice it would be to be normal and just pack up my kids and go to mom's house, I don't think it's going to happen. I think it would be better just to stay home and sit out on the neighbor's back porch socializing and then return to my own bed when it's time.

We asthma experts often say that if you have your asthma under control you should be able to live a normal active life. Actually that's not totally true. You will have to make sacrifices. You will, as in the case with me, have to choose between whether you want to take risks or whether you want to stay in the confines of your own allergy proof home.

I think it was Bill Clinton who coined the phrase, "It depends on what the definition of is is." I think in the asthma world the correct phrase would be: "It depends on what the definition of normal is." What is normal?

To a male in my family, normal is socializing. Normal is sitting among friends, smoking a cigarette, and having a few drinks. Normal is packing up your things and visiting your brother when the opportunity strikes. Normal is playing sports. Normal is working in a factory, or in a car lot redolent of gas fumes, or....

So, after the lifestyle change that was necessary to get my asthma under control, what I have here in the blogosphere is the new normal. Yet it's not the normal. I'm happy and content in my new home, tucked in with my wife and kids, yet it would be even better if I could leave on a whim without having to worry about dust mites, and molds, and "do I have enough ventolin."

In a way it kind of sucks. It would be nice just to drop what I'm doing on a dime and just go somewhere. Yet when you have asthma, and worse allergies, you often have to think twice.

Unless you enjoy playing the game. The game, however, got old for me. I played it for many years, and I tired of it.

unfortunate asthmatics

I guess I'm not too surprised that most asthmatics don't take their medicine as prescribed, as my doctor hinted at in this post. Honestly, there was a time when yours truly wasn't the best asthmatic patient either. Yet why does it have to be this way?

So if your doctor prescribes for you to take Advair to control your asthma, why would you not take it. Better yet, If you quit taking your asthma controller meds once you start feeling better, does this make you a goofus asthmatic?

My regular readers know the goofus asthmatic, as he is the asthmatic who is lazy, or who does everything wrong. He fails to take his medicine as prescribed, and he ultimately ends up back in the emergency room.

Yet, does lack of wisdom, and lack of a good asthma doctor, make the patient a goofus asthmatic. Truly, I don't think so. I can even give you a reason I think this way. Actually, I think the reason is doctors. I think poor education. I think unfortunate asthmatic.

There you have it, another asthma type. The Unfortunate asthmatic is the asthmatic who would be a gallant asthmatic if only he knew better; if only he were better instructed by his physician; and if only his doctor was on his case when he didn't take his medicine.

A recent study performed by researchers at Henry Ford Hospital in Detroit shows that, "patients are more likely to routinely take inhaled corticosteroids (ICS) for asthma control when physicians kept close watch over their medication use and reviewed detailed electronic prescription information, including how often patients fill their prescriptions and the estimated number of days each prescription would last."

The researchers also noted that: "Unfortunately, overall patient adherence to ICS medication is poor, accounting for an estimated 60 percent of asthma hospitalizations. So it's important, as we move forward with health care reform, to look for more effective ways to make sure patients stay with their prescription regimens."

This sounds like common sense that a doctor would follow their patients, yet I know from my own personal experience that even the best asthma doctors do not necessarily follow their patients outside the hospital unless a patient ends up sick or something.

I'm not saying doctors are bad, by no means am I doing that. And the way doctors are rushed by too many patients may actually encourage them to want to get the patient out of the office as quick as they can so they can move on to the next patient.

Still, it only seems like common sense if every doctor would follow the guidelines set forth in this post, they would all be gallant asthma doctors.

For example, your doctor should know what medicines you are on, how often you are using your medicine, and should always ask how your asthma has been the past 2 weeks. If your doctor notices you are not taking your medicine, then you ought to get a lashing. Well, not really, but he should ask to see you.

And, essentially, doctors who were allowed to keep track of their patients prescriptions, so that if you weren't taking your Advair he could make you aware of how important it is that you take your Advair especially when you are feeling well.

Sure there might come a time when you no longer need your asthma controller medicines, yet your doctor ought to tell you that chances are if you have asthma you will probably have to take these medicines the rest of your life -- not just until you feel better.

In a sense, asthma medicines are like blood pressure medicines: you need to take them exactly as prescribed. Yet it appears that not only do most asthma doctors not think of it this way, neither do patients. Yet, it's hard to get patients to be compliant when the doctor isn't.

So, henceforth, we have the unfortunate asthmatic: The asthmatic who quits taking his asthma medicines because he starts feeling better. He does this because his doctor, or other medical professional, has not properly educated him on the importance of taking asthma controller medicines especially when you are feeling well.

Unfortunate asthmatics may give the appearance of goofus asthmatics, or sometimer asthmatics, or even poor patient asthmatics. Yet in reality, they are the victims of poor education more so than anything.

And, quite frankly, I'm not sure what an be done about this. Doctors are not lazy, they are simply busy and humble, and don't want to be overbearing.

Yet, perhaps, as this study shows, if doctors are able to follow their patients medicine usage, perhaps they can better stay in touch with what their patients are doing, and take the time to educate.