This has nothing to do with asthma, yet I'm going to report it off to you anyway. I had a 2-year-old kid I was just scheduled to give a breathing treatment. He was actually diagnosed with pneumonia, and doesn't need the treatment, but that's beside the point.
The reason I mention this here is because the kid, when I entered the room, was crying. He kept saying over and over, "Mommy! Mommy!" Yes. He wanted his mommy. He wanted the one person he is most attached to. And yet, she was no where to be found. Once the child was admitted, she went home.
So, after I gave my treatment, I sat with the kid. I put on a cartoon on the TV, and I talked to him. It took a while, but I eventually had him calmed down. Then I sat with him for a while, as he snuggled with his little stuffed puppy.
This kind of reminded me of when I was two and my parents left me in a hospital all alone. Yes, I was 2 years old in 1972, and my parents left me alone. There was a policy back then that parents weren't allowed to stay in the hospital after hours, so once visiting hours were over, they had to go home.
I remember a room where a bunch of hospital cribs, which were actually metal cages, were all lined up. I was put in one, and the side was raised. I remember standing up, all sad, as my mom and dad said good-bye. I remember them slowly walking to the door, looking back, and then exiting the door.
I also remember mom and dad looking in the little slit of a window on the door. They stood there a while, and then left. I was sad. I remember the nurses coming in every once in a while to put something in my bottom. I didn't know it then, but it was probably the temperature probe.
I was in the hospital because I had bad eyes, and the doctor was going to operate in the morning. I had a wandering eye, and the doctor had to tighten a muscle or something. Surgery may not be needed for this in 2010, or if it is, it would be an out patient procedure, but back in 1972 I had to stay the night for whatever reason.
I remember after the surgery, having a patch over my eye. I kept trying to take it off, so the doctors actually wrapped my head so I couldn't do it. I also remember leaving the hospital. I don't remember mom being there, but she probably was. She probably stayed in the hospital to do paper work or something while dad took us kids out to the car.
I remember my older brother Bobby, my younger brother David walking along side me. I was in a wheelchair, being pushed by dad, or, perhaps if my memory fails me, maybe it was a nurse. Regardless, I remember my brothers (one or both) wanting to ride in the chair, and dad saying something like, "Rick's the sick one. He gets to ride in the chair today."
I remember the car. It was a station wagon with brown and white wooden side panels. That's the memory. That's how I remember it. And, yes, I was only two.
I told my memory to my mom once when I was a 10 or so, and she confirmed it. Yet, I brought it up a few years ago to her, and she said what I described was not how it was. She said my brothers wouldn't have been there, and stuff like that. However, I think my memory is accurate, as it happened to me, and mom didn't have a need to remember it the way I did.
Anyway, sitting there with this kid kind of reminded me of this episode, when I was a kid left all alone in the hospital. It's episodes like this that give me empathy for kids, especially kids that are left alone by their parents in a hospital, and the kid is all sad.
The kid was calm, staring at me, the ceiling, and occasionally getting lost in the movements of the cartoon on the TV, and I was hesitant to leave him all alone. Yet, remembering that I tolerated it somehow when I was a kid, I was certain this kid would do just fine. Perhaps, as it may have done me, strengthening him somehow.
Monday, February 15, 2010
Friday, February 12, 2010
Unique Asthma and common sense
I've been lucky all my life to have doctors who pretty much let me do what I want. While I've had pharmacists question my inhaler use in the past, I have never had a doctor tell me to quit using it so much.
Now I'm not saying my doctors aren't concerned, just that I've been fortunate to have doctors that understand that not all asthmatics fit into the "guidelines." Sure most asthmatics shouldn't need to use their rescue inhaler more often than once or twice in a two week period, but some asthmatics -- like me and perhaps you -- need it more often.
I wrote about how I was a bronchodilatoraholic (well, I suppose, once you're a bronchodilatoraholic you always are) once or twice on my other blogs, and I have had people email me to tell me my asthma is out of control if I use it as much as I claim. When, in fact, my asthma is controlled. Thus, rescue inhaler frequency isn't always an indicator of asthma control.
My family members who have seen my asthma first hand (my wife, my mom and dad when I was growing up, my brothers, grandparents, uncles and aunts, coworkers and the like) never question that I'm taking my inhaler. They never say things like, "Golly gee, don't you think you're using that a bit much!"
In fact, my doctors are the same. It's called common sense. Like with any other thing in life, nothing goes according to the plan. You can't go to doctor school expecting every time you have an asthmatic you can give the exact same analysis, the same medicine, and expect the same results. Why? Because in the real world, people have unique asthma
And, thankfully, people in my life, including my doctors, have always had a certain level of common sense not to make me feel uncomfortable about my inhaler overuse, my bronchodilatoraholism. However, I usually don't give them the chance, since puffing was usually done in private.
Today I couldn't care less, but when I was a kid I felt stupid enough using that darn thing. I wrote about it recently on this blog how carrying that thing in my pocket in itself was embarrassing. And, to use it in front of people, only generated looks and questions I didn't want to deal with.
So, understanding that perhaps, my doctor never questioned me. Perhaps the common sense part of his brain understood that Rick Frea has unique asthma. He has asthma that does not fit into the textbook.
And, when you have unique asthma, you need to treat it in a unique way. When you're short of breath, you test that rescue inhaler more often than you should. Then you realize the relief you get from it is worth any side effects that might transpire (Side effects are pretty minimal anyway).
Thankfully, most of the doctors I've had are wise to this fact. Considering I'm the worst asthmatic most of my doctors (minus the doctor's I had at the asthma hospital) ever treated, I often wonder how they obtained such patience with my asthma.
Common sense, people. It comes down to common sense. Either you have it or you don't, because it cannot be taught.
Now I'm not saying my doctors aren't concerned, just that I've been fortunate to have doctors that understand that not all asthmatics fit into the "guidelines." Sure most asthmatics shouldn't need to use their rescue inhaler more often than once or twice in a two week period, but some asthmatics -- like me and perhaps you -- need it more often.
I wrote about how I was a bronchodilatoraholic (well, I suppose, once you're a bronchodilatoraholic you always are) once or twice on my other blogs, and I have had people email me to tell me my asthma is out of control if I use it as much as I claim. When, in fact, my asthma is controlled. Thus, rescue inhaler frequency isn't always an indicator of asthma control.
My family members who have seen my asthma first hand (my wife, my mom and dad when I was growing up, my brothers, grandparents, uncles and aunts, coworkers and the like) never question that I'm taking my inhaler. They never say things like, "Golly gee, don't you think you're using that a bit much!"
In fact, my doctors are the same. It's called common sense. Like with any other thing in life, nothing goes according to the plan. You can't go to doctor school expecting every time you have an asthmatic you can give the exact same analysis, the same medicine, and expect the same results. Why? Because in the real world, people have unique asthma
And, thankfully, people in my life, including my doctors, have always had a certain level of common sense not to make me feel uncomfortable about my inhaler overuse, my bronchodilatoraholism. However, I usually don't give them the chance, since puffing was usually done in private.
Today I couldn't care less, but when I was a kid I felt stupid enough using that darn thing. I wrote about it recently on this blog how carrying that thing in my pocket in itself was embarrassing. And, to use it in front of people, only generated looks and questions I didn't want to deal with.
So, understanding that perhaps, my doctor never questioned me. Perhaps the common sense part of his brain understood that Rick Frea has unique asthma. He has asthma that does not fit into the textbook.
And, when you have unique asthma, you need to treat it in a unique way. When you're short of breath, you test that rescue inhaler more often than you should. Then you realize the relief you get from it is worth any side effects that might transpire (Side effects are pretty minimal anyway).
Thankfully, most of the doctors I've had are wise to this fact. Considering I'm the worst asthmatic most of my doctors (minus the doctor's I had at the asthma hospital) ever treated, I often wonder how they obtained such patience with my asthma.
Common sense, people. It comes down to common sense. Either you have it or you don't, because it cannot be taught.
Wednesday, February 10, 2010
Allergies suck worse than asthma
I have had asthma and allergies my entire life. While I bet many asthmatics might disagree with me on this, I think having allergies is far worse than having asthma.
Yes, I did say that. I think allergies suck. Asthma is actually easier to control than allergies. Even after I was on Advair and finally had my asthma under control, the allergies continued to irritate the crap out of me.
Sure there are allergy shots, but those things did nothing for me but sting my arm once a week for three years.
Sure there were antihystamines and decongestants and nasal sprays, but if I'm around one of my allergens, those only took the edge off of that annoying feeling you get in your sinuses and nose. You sneeze. You get a runny nose. You feel down right miserable.
I'd rather have an asthma attack. A worse case scenerio for asthma is you have to go to the ER. Yet, even in the ER, there is nothing they can do for allergy symptoms.
This did change, however, with the invention of Singulair. Man that drug is awesome - for me anyway. Advair really helps too. Now I can actually be around something I'm allergic to and survive -- like during this flare up.
With Singulair my asthma flares still occur if I'm exposed to my allergens, although the flares are not near as bad as they used to be.
Yes, I did say that. I think allergies suck. Asthma is actually easier to control than allergies. Even after I was on Advair and finally had my asthma under control, the allergies continued to irritate the crap out of me.
Sure there are allergy shots, but those things did nothing for me but sting my arm once a week for three years.
Sure there were antihystamines and decongestants and nasal sprays, but if I'm around one of my allergens, those only took the edge off of that annoying feeling you get in your sinuses and nose. You sneeze. You get a runny nose. You feel down right miserable.
I'd rather have an asthma attack. A worse case scenerio for asthma is you have to go to the ER. Yet, even in the ER, there is nothing they can do for allergy symptoms.
This did change, however, with the invention of Singulair. Man that drug is awesome - for me anyway. Advair really helps too. Now I can actually be around something I'm allergic to and survive -- like during this flare up.
With Singulair my asthma flares still occur if I'm exposed to my allergens, although the flares are not near as bad as they used to be.
Monday, February 08, 2010
Extra-Allergy Perception (EAP)
I'm sure you've heard of extrasensory perception (ESP). Well, what I have is EAP, or extra-allergy perception. When you have allergic-asthma as long as I have, this is a skill you develop.
Okay, so I suppose you're wondering what EAP is. Well, it's the ability to know when something around you is one of your allergy triggers. It's the ability to know what places you need to avoid.
Actually, it's quite a neat skill. As far as I know, I'm the only person alive with this skill.
I'll give you an example. As I enter another person's home, I can "sense" as soon as I walk in if that person has a dog. And I know I need to either get out, or prepare myself for an allergy or asthma attack.
As I enter my dad's cabin, for example, I can sense that there are a lot of dust mites and molds, and that I must not stay long. I also get this feeling as I enter certain homes.
My EAP is pretty accurate too. For example, when I went to Florida a few years ago, my wife wanted to spend the night at her cousins. Well, as soon as I entered that house I had this feeling I was going to have trouble. I told her I was going to have a rough night.
"Oh, you'll be fine. It's all in your head," she said.
Voila, at bedtime, my allergies and early warning signs showed their ugly faces. I was puffing on my inhaler all night, and I was tired the entire next day.
When I got to my parents home the next day I received no such sensation. I knew I'd be safe during the rest of the vacation.
My allergies are so bad, that I find it better not to plan on spending the nights at relatives or friends, and to pay for a nice hotel room instead. Of course that brings up another issue. Cheap hotel rooms are a gamble when you have allergies as bad as I do, and is why I include this as one of my 11 tips for traveling with asthma.
I think one of the reason's I developed EAP is because I grew up with this disease. I think if I had developed it as an adult, I never would have developed this skill, and my EAP never would have had a chance to develop and flourish.
Likewise, due to the fact asthma wisdom and meds were primitive when I was growing up compared with all we know today, I had many asthma and allergy experiences during my life. Because asthma wisdom has improved, I doubt there would be many new cases of EAP -- assuming I'm not the only one with this skill.
However, whether you have EAP or not, it's always a good idea to premedicate yourself with allergy medicines prior to visiting someone else's home for the first time. Or, another viable alternative is avoidance.
Okay, so I suppose you're wondering what EAP is. Well, it's the ability to know when something around you is one of your allergy triggers. It's the ability to know what places you need to avoid.
Actually, it's quite a neat skill. As far as I know, I'm the only person alive with this skill.
I'll give you an example. As I enter another person's home, I can "sense" as soon as I walk in if that person has a dog. And I know I need to either get out, or prepare myself for an allergy or asthma attack.
As I enter my dad's cabin, for example, I can sense that there are a lot of dust mites and molds, and that I must not stay long. I also get this feeling as I enter certain homes.
My EAP is pretty accurate too. For example, when I went to Florida a few years ago, my wife wanted to spend the night at her cousins. Well, as soon as I entered that house I had this feeling I was going to have trouble. I told her I was going to have a rough night.
"Oh, you'll be fine. It's all in your head," she said.
Voila, at bedtime, my allergies and early warning signs showed their ugly faces. I was puffing on my inhaler all night, and I was tired the entire next day.
When I got to my parents home the next day I received no such sensation. I knew I'd be safe during the rest of the vacation.
My allergies are so bad, that I find it better not to plan on spending the nights at relatives or friends, and to pay for a nice hotel room instead. Of course that brings up another issue. Cheap hotel rooms are a gamble when you have allergies as bad as I do, and is why I include this as one of my 11 tips for traveling with asthma.
I think one of the reason's I developed EAP is because I grew up with this disease. I think if I had developed it as an adult, I never would have developed this skill, and my EAP never would have had a chance to develop and flourish.
Likewise, due to the fact asthma wisdom and meds were primitive when I was growing up compared with all we know today, I had many asthma and allergy experiences during my life. Because asthma wisdom has improved, I doubt there would be many new cases of EAP -- assuming I'm not the only one with this skill.
However, whether you have EAP or not, it's always a good idea to premedicate yourself with allergy medicines prior to visiting someone else's home for the first time. Or, another viable alternative is avoidance.
Saturday, February 06, 2010
My unique asthma flares
I'm having a rare asthma flare up today. The reason is because I hired someone to make a new bedroom in the basement for my son, and all the sawdust, and dust mites being spewed up through the vents is killing me.
Well, it probably doesn't help that I've been cleaning the upstairs bedrooms, but that's done now. Keep in mind I'm not as bad as I would be if I weren't on all these great new controller meds, although I can definitely notice my early warning signs:
Well, it probably doesn't help that I've been cleaning the upstairs bedrooms, but that's done now. Keep in mind I'm not as bad as I would be if I weren't on all these great new controller meds, although I can definitely notice my early warning signs:
- Tight chest
- Itching feeling in neck area
- exhaustion
- Urge to sneeze
- Nasal congestion
- Runny nose
- gut feeling
- Ventolin isn't working
- Can smell all the allergins in the air (a unique skill I have. More on this later)
Now, I've been meaning to talk about this for a while, but my asthma is unique in that no matter how I feel my peak flows do not change. For example, I just blew into my peak flow meter, and my PEFR was 690. Keep in mind my personal best is 730, so 690 puts me right in my normal range.
In fact, as I track my peak flows, I've noted feeling mild or "undetectable" shortness of breath on days when I've blown a 650, which is in my green range, and I've noted breathing normal on mornings I've blown as low as 550, which is in my yellow range.
This was not true when I was a kid. However, as an adult, my PEFR is not representative of how I feel. In fact, back in 1998 when my asthma was so bad I could barely take in a half a breath, and ended up in the ER, and later admitted for 10 days, my PEFR was over 700 for the entire stay. Go figure that out.
The Asthma Guidelines do note, however, that both symptom monitoring and peak flow monitoring are equally effective. The only problem with symptom monitoring is it's hard to really know it's time to give up and go to the ER (No, I'm not even close to that point, but I'm just saying).
If you monitor peak flows, and you blow a 60% of your personal best (for me that would be 438 or less), then you know you better take action quick and get better, or get your lungs to the ER.
Of course, whichever method you use, it's always hard to make the decision to go to the ER. It's easier to be modest and try to treat it yourself. It was this thinking that prompted me to write "Having asthma symptoms? Here's five tips to help you decide what to do."
So, needless to say, I have to monitor my symptoms as opposed to my PEFR. Now I still continue to monitor my PEFRs in a peak flow flowsheet I created (you can link to it here) just in case, although I do tend to slack in this area.
It's for this reason I'm usually relegated to being observant to my early warning signs as a cue that I need to stop whatever I'm doing and take action. However, still, that is easier said than done, especially when you're involved in a task you're enjoying.
Wednesday, February 03, 2010
Time released meds great for asthma compliance
So asthma used to suck worse than it does today. Of course before 1903 there was no epi, and before the 1950s no inhalers and nebulizers. Yet, in the 1980s there were so many asthma meds that being compliant was a daily battle.
If you want a good example of what I'm writing about, click here. I was on so many meds back in 1985 that I was taking some asthma medicine at least every four hours. While it got better by 1998, I was still taking meds every four hours. Theophylline was every 8 hours, Azmacort was 4 puffs every 4 hours during the day, and plus there were a few others mixed in.
Finally in 1998 Flovent came along. It was a stronger inhaled corticosteroid and was only needed twice a day. That solved the problem of the Azmacort. I actually liked the taste of Azmacort, but there was no way I was going to lug that big thing around with me. So, basically, the only times I took it were when I so happened to be home.
My point here is, that asthmatics today should be very happy. I was a little slow getting on this train, but in 2007 I was finally started on Advair. Actually, I was introduced to Serevent CFC back in 1998, but the side effects were too great. Advair, however, made my life so much easier. That's 2 puffs a day. One puff when you brush your teeth in the morning, and one puff when you brush your teeth in the evening. That's it.
I remember just before I was admitted to the asthma hospital in 1985 my doctor put me on a time delayed theophylline pill -- the first of its kind -- so I only had to take it twice a day. My doctor at the asthma hospital said those time delayed pills were a bad idea, and he put me back on the 300 mg dose every 8 hours.
I guess he was a little behind the times, as it was 25 years later most asthma controller meds are on a time released system. The time released system allows for asthma meds to be taken twice a day and that's it. It's great.
If you want a good example of what I'm writing about, click here. I was on so many meds back in 1985 that I was taking some asthma medicine at least every four hours. While it got better by 1998, I was still taking meds every four hours. Theophylline was every 8 hours, Azmacort was 4 puffs every 4 hours during the day, and plus there were a few others mixed in.
Finally in 1998 Flovent came along. It was a stronger inhaled corticosteroid and was only needed twice a day. That solved the problem of the Azmacort. I actually liked the taste of Azmacort, but there was no way I was going to lug that big thing around with me. So, basically, the only times I took it were when I so happened to be home.
My point here is, that asthmatics today should be very happy. I was a little slow getting on this train, but in 2007 I was finally started on Advair. Actually, I was introduced to Serevent CFC back in 1998, but the side effects were too great. Advair, however, made my life so much easier. That's 2 puffs a day. One puff when you brush your teeth in the morning, and one puff when you brush your teeth in the evening. That's it.
I remember just before I was admitted to the asthma hospital in 1985 my doctor put me on a time delayed theophylline pill -- the first of its kind -- so I only had to take it twice a day. My doctor at the asthma hospital said those time delayed pills were a bad idea, and he put me back on the 300 mg dose every 8 hours.
I guess he was a little behind the times, as it was 25 years later most asthma controller meds are on a time released system. The time released system allows for asthma meds to be taken twice a day and that's it. It's great.
Monday, February 01, 2010
Doctors
I can think of few people more intimidating, or blunt, than some doctors. It's not that they don't care, because if they didn't care they wouldn't be doctors. It's that they become so rushed, so irritated with stupid people (understandably so), that they end up treating all people the same.Definitely most doctors aren't this way. Most are are patient and good communicators. I have seen both types from a professional standpoint, and personal standpoint. Thankfully most of my doctors have been the good kind, yet I've definitely had a few doctors I was not happy with. And I work with a few too.
I've had patients, too, complain to me that, "My doctor didn't let me get a word in edge wise. He explained nothing. I don't even know why I'm in the hospital."
I have empathy for these patients, because I had one doctor who was such a prick he would treat me like I was the stupidest lot on earth. He'd tell me what I was going to do, and it didn't matter what I thought. Literally, he made me feel like the idiot he was treating me as.
Of course I was seeing him because for some reason in 1995 my asthma took a turn for the worse after several years of behaving, and he was a pulmonologist who was highly recommended by a friend. Plus I was in a new town with a new job.
I got to the point I'd rather have no doctor than a doctor who treated me like that. So I fired him. I went the next three years without a doctor, moved to Shoreline where I got my recent job, and the process of moving (and the flu) landed me admitted here at Shoreline in Feb. of 1998 for the first time since I was discharged from NJH.
Ironically, the day before I was admitted in 1998 I had an appointment with an Internist I worked with here at Shoreline Medical. I chose this doctor because he
seemed to be normal. And I chose an Internist because there are no Pulmonologists nor allergists where I live, and I didn't want to travel. And I certainly didn't want to see a family doctor and gamble that he knew how to manage asthma.
So, the very first thing I said to my new doctor (We'll call him Dr. Breath) was this: "Look, I'm the kind of patient who likes to have control. I study asthma, I know all the new meds, and I want a say in my therapy. Likewise, I want you and I to work as a team to managing my asthma. I can't handle another doctor like my last one. Talking to him was like talking to a brick wall."
Funny thing was, Dr. Breath did his residency with my previous doctor, so he knew him well. "Hey," Dr. Breath said. "I'm fine with that. And I know he can be a hard doctor."
And from there we launched a positive doctor/patient relationship. He provides his wisdom and expertise, and I provide my experience and my asthma expertise. I never over rule him. And, when I come up with an idea, I usually lead him on so he thinks it was his idea. That's fine. I don't need credit.
So, here is my advice to all asthmatics, and anyone who has a chronic illness and has to see doctors on a regular basis:
- Respect your doctor, yet don't let him intimidate you.
- Know you are the boss, not your doctor.
- If you and your doctor don't click, hire a new one.
- If you question the care you're given, ask for a referral
- Make him take the time to answer your questions
- Come with a list of questions and recommendations (on paper if necessary)
- Do not leave his office unless all your questions are answered, and he responds to your recommendations.
- Do not let him leave the office if you are not satisfied.
- And remember, no question is dumb if you do your research and are prepared
Keep in mind here that doctors are busy, and they have a day stacked with many appointments, and they get paid by the appointment, not by how much time they spend with each patient. So a rushed doctor is often a blunt doctor. No disrespect meant, that's just the way it is.
Some people like this. Some people prefer a doctor to take charge. Yet, if you're the kind of person like me who is wise to his condition and wants to be a part of the therapy, then it's up to you to find a doctor who fits your personality type, and fits your agenda.
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