The decision to work out

Staying in shape is a lifelong battle. No matter who you are, or where you work, you'll have to deal with life forces and stress. As I wrote about yesterday, the first time I realized I needed to do something was during my brother Dan's wedding where I barely fit into my tux and felt like a bloated pig.

Of course that wedding was back in the mid 1990s. A few years later I went to hunting camp and got blitzed. Of course the next morning my asthma was acting up. Of course the dust and molds at the cabin were one thing, but what I didn't realize back then was that beer has stuff in it that can irritate asthma and allergies. It also dries out your lungs. At some point in the near future I'll publish a post I wrote about that.

As I wrote yesterday, there are certain moments in life that separate the wise from the not so wise. A wise person will notice the weight gain, and decide to stop it. The wise man will notice the dyspnea with any exertion, the gloominess that goes with weight gain, and the sluggishness.

Of course having asthma the decision was a little easier for me. I knew if I kept up this pace, I would be dead. I was creating a breeding ground for the asthma beast.

So, feeling a bit hung over and bloated, my best friend Sammy called me up and said that since I was home anyway I ought to go with her and about 10 other friends from work at the health club for a good workout.

I hesitated, but I ended up going. The workout was terrible. For the next week I couldn't even move. Yet, I went back every day the next week with the group. I rode the bike, and pumped weights in what was some sort of weight lifting class.

Before we knew it, Sammy and I had dropped weight. Sammy was looking slim. I had gone from a bloated 218 to a cozy180, and I felt as though I could now glide up steps at work and down the halls. The asthma was never better.

Of course this was the first time we both experienced the down side of working out: How to you maintain the weight loss? Hmmm, I wonder how many people have that problem?

From fries and burgers to chicken and veggies

In high school I was a stick; a pathetic 150. I was likewise small and skinny in college. I remember being so hungry one Sunday in my dorm that I ordered a large pizza and ate the whole thing in one sitting, and was still hungry. Then I went to the store and got a 24 pack of beer and chugged it down with my friends. I did all this, and I never gained a pound.

I had the metabolism I yearn for right now. I had a meal plan that allowed me to go to the cafeteria any time I wanted, and I took full advantage of it. I was in the cafeteria after nearly every class, and meal times.

During the summers I worked at an A&W in Shoreline, Michigan, and when the boss wasn't looking I'd slip fries and burgers into my mouth. One day I bet I ate about 5-6 large boxes of fries, and 2-3 burgers, some cheese sticks, mushrooms and throw in a few other odds and ends. I bet I ended up eating thousands of calories per day when I worked there, and never gained a pound.

I played sports with my brothers, but, relatively speaking, didn't exercise any more than I do today. And I never gained a pound.

Of course it should be noted here I was a late developer. My dad was this way too, so I can't blame it entirely on the asthma. So I don't think I stopped growing until I was about 24. And, as you might guess, it was at the age of 24 where all this started to catch up to me. As is the case with most people, when I stopped growing up I started growing out.

Suddenly my friends noticed a gut, and teased me about it. Of course they had no right to judge, because there was a similar bulge on the front of them too. I think this is a part of life we all experience. We eat and eat and eat and eat and eat and never gain wait, and then we continue eating at the same pace, only to have it all of a sudden catch up with us.

Here is where you separate the dummies from the wise people. A wise person will notice that something is inherently wrong and try to stop it. I wasn't FAT by any means, I was merely very out of shape, winded, felt bloated all the time, and was a whopping 220 pounds. I felt miserable.

The final straw was in 1994 when my little brother got married and I felt miserable in that tux. Looking at pictures of me in at that wedding I don't even recognize myself. I see a pathetic moron with no self esteem who was fat. Well, I'll say I was fat because if you look at the body mass index calculator I was obese.

My asthma was bad too then. It really wasn't terrible, yet because I was so out of shape I got winded easy, and this irritated my already inflamed air passages. And considering I was going through one of my goofus asthma phases, my asthma was a bit out of control. I was using my rescue inhaler more often than I should.

Fast forward a few years to 1998. I waddled through RT school feeling fat. And now I'm working at Shoreline in the pool. And one of my best friends, Sammy (also an asthmatic, I never did write about her yet did I. Hmmm, note to self) finally talked me into joining her and other co-workers at the health club.

Initially I hated the idea. But soon I was no longer eating fast food every day but was eating chicken and veggies instead.

Body for life and the greatest vacation ever

The first time I did the bodyforlife program to lose weight and get into shape was during the run-up to my Wedding which was to be on May 18, 2002. For this event, I ended up losing 35 pounds in less than 12 weeks. It was a major success. I went from 215 to 180.

So as I look over at our wedding picture, I'm looking great, and so is my wife. The problem with that diet was that after my wedding we went on a four day cruise where we left Miami on day #1, went to Key west, Cozumel, and then back to Miami. This was the best vacation of my life; of both of our lives.

One of the neat things about this cruise is everything was all inclusive, including the food. And food there was lots of it. There was food everywhere. There were buffets that were open 24-7, and then there were many restaurants, and also places for fancy dining.

I remember getting up one day and eating breakfast, having brunch and then lunch, and then lunch-dinner, then snack, then dinner, then after dinner snacks, then snack again, then snack again, and then midnight meal, and then getting back to our rooms and ordering room service just because it was available and it was free.

At about 1:30 a.m. my wife and I were startled by the sound of the door bell. Barely able to muster the strength, I got up and opened the door. "Yes!" I mumbled. A well groomed guy was carrying bags. "You ordered room service?"

"Ah!" I mumbled again. "Yeah, I guess we did." I shut the door, and turned to my wife, "Get up, honey! It's time to eat again."

She smiled. For the next hour we ate.

By the end of this glorious vacation I had gained 10 pounds. In retrospect, I would do it all over again. Only, if I did, I would get down to 170 pounds instead of 180.

Theophylin no longer top line asthma med

In 1976 my pediatrician started prescribing liquid theophylline Sustaire to control my asthma. I remember my mom feeding me that stuff with a teaspoon, and it tasted nasty. For the next 30 years I would end up chronically dependent on this stuff.

In the 1860s Dr. Henry Hyde Salter wrote a book, "On Asthma," where he recommended strong coffee and tea to help control hardluck asthma. In fact, this was occasionally tried by a young asthmatic Teddy Roosevelt.

Salter may have known coffee was a member of the xanthine family, but he probably didn't know the xanthines are mild bronchodilators (they dilate the air passages in your lungs). This wasn't proven until 1921, and by 1922 theophylline suppositories were used to treat asthma.

Amimophylline is the IV version of theophylline, and was first used in 1937. If you were admitted to a hospital with asthma between 1950 and 1990, chances are you had this running in your IV at some point. I know from my medical records I did.

The bronchodilator effects from caffeine are very suttle compared to Theophylline, which was first extracted from tea leaves in 1888 by a german scientist. It wasn't until 1950, however, that it was approved for use as a bronchodilator. For the next 4 decades it was a top line therapy for treating asthma and COPD.

The problem with theophylline was that it had a very narrow therapeutic level. Too low and it didn't do anything, yet if your theophylline level was too high (as in greater than 20) there were toxic effects, such as vomiting and even death. So you had to have your blood level checked frequently.

Another problem with this drug is it only lasted in your system 4 hours, so I had to take it every 8 hours or my levels dipped in the middle of the day causing asthma symptoms. Once as a kid I had a 24 hour theophylline study done, and had to have my blood drawn every few hours. It wasn't so bad, though, because they put a line in my hand to draw from.

My doctor told me in 1995 that the normal dose he prescribes is 300mg twice a day. I required 600mg twice a day, and somehow that still kept me under the toxic level. (I wonder how many cups of coffe that's equivelent to.)

In the early 1980s theophylline was determined to be "less efficacious" than anticholinergic medicines like Atropine when it comes to dilating bronchioles, yet it wasn't until the 21st century that it faded away as a top line asthma drug.

Many doctors were staunch defenders of this medicine because it worked so well for them for so many years. I was a staunch defender of it because my body became dependent on it to the point that when I forgot to take a pill I would have the worse asthma attacks ever.

Perhaps some of my fellow asthmatics will empathise with me. A good example of this was when I forgot to take my theophylline for three days when I was busy in college in 1988. Absent this bronchodilator my lungs freaked out. My chin became itchy, my chest burned, and my mucus production increased almost to the point I felt I might choke.

My room mate Frank walked in on me and I must have been a sorry sight all frogged up on the edge of my chair, grunting with each expiration, tears in my eyes, misting nebulizer clipped between my teeth.

"Do I need to take you to the ER," he said.

"NO! I'll be fine," I grunted.

"You look like you're gonna die."

"NO!" I insisted. I had just popped a Theo-Dur pill dry. I knew from past experience it would take about 20 minutes before my breath started coming back.

The Albuterol treatment was useless during one of these attacks, however I always took one. When I was really little and this happened I'd go to the ER, but at some point in my asthmatic life I learned the difference between a regular asthma attack and one induced by a low theophylin level.

"Give me ten more minutes," I grunted, "If I still look like I'm going to die, drag me to the ER." Feeling helpless I'm sure, he stood by and watched as I suffered.

Then, right on cue, I felt the mucus letting up; the chest tickling feeling letting go, and my breath coming back. First came a quarter breath, then a half a breath five minutes later, and finally... "Ahhhhh, man it feels good to breathe."

That's why I was such a staunch defendent of this medicine, and was vexed to learn Theodur was no longer made, and I had to swallow generic theophylline horse pills instead.

The problem with theohylin is it's a systemic drug with some undesirable systemic side effects. The thinking used to be if you need it for a chronic lung condition you need it, because some minor side effects are far better than suffering or dying from asthma.

Most side effects, though, are generally mild. Some are similar to when you take caffeine, such as irritibility, insomnia, nervousness and jitters. Since Xanthines are also mild diuretics, it might cause you to pee more. It can also irritate the lining of your stomach.

To some extent, I've experienced all of these side effects. However, the one that bothered me the most was an irritated stomach that I attributed to this medicine, and why I wanted to get off it.

I approached my doctor about getting off theophylin, and he said, "It's neat you bring this up, because when I started as a doctor nearly every one of my asthma patients were on theophylin, and now you're one of only two."

In the past Theophylin was a top line bronchodilator usually used in conjunction with corticosteroids. New long term bronchodilators with fewer side effects have replaced theophylin, they are called Serevent & Formoterol, and are usually given in conjuction with the inhaled corticosteroids Flovent and Pulmicort respectively in the popular medicines Advair and Symbicort.

My doctor said, "You've been on theophylin so long, and it seems to work so well for you, I'd hate to tinker with it."

"One attempt, doc" I said. "I just want to make one last attempt at getting off it. If it doesn't work, it doesn't work."

We decided on a very, very slow wean. In fact, the wean took a full year to complete. And it worked. On January 31, 2007, I took that last pill. And, just in case (as if in tribute to an old friend), I left an unopened prescription bottle of theophylin in the medicine cabinet just in case. It's still there to this day, a daily reminder of what used to be.

So while Teddy Roosevelt guzzled cups of coffee praying it would help him catch his breath, scientists gave asthmatics theophylin in the 1950s. Now, with even greater advancements in asthma medicine, theophylin is little needed today.

(For a doctor's perspective on theophylin click here).

New study backs up the hygeine hypothesis

I wrote a while back about the hygiene hypothesis and how exposing a baby with the asthma gene to certain bacteria while his immune system is developing in the first few weeks of life may prevent asthma. Likewise, lack of exposure may actually cause asthma.

In my recent search of the Internet I found this explains that bacteria present in house dust mites may determine if a child in that house develops asthma. They explain that recent research shows household dust mite actually holds "diverse" amounts of bacteria.

Likewise, "bacterial populations are greatly impacted by the presence of dogs and cats and whether or not children attend day care." Of course we have hypothesised that exposure to day care centers and dogs and cats diminishes the chances of a child getting asthma.

The article also notes that "Additionally, dust samples collected from homes of infants, with or without pets and varying day care attendance, showed differences in dust bacteria were linked with asthma development in children."

Slowly but surely the pieces of the asthma puzzle are coming together.

My experience with Singulair

So Advair worked wonders in helping me finally obtain good control of my asthma (as I wrote about here). Now it was time to get those dreaded allergies under control.

All my life there just seemed to be nothing available to control allergies. When I was really little my doctor wouldn't let me take anything for allergies, because on the box it said, "Do not take if you have asthma."

As I look back I think how stupid that was. There were many miserable nights for me because of that stupid wisdom. Later I was allowed to use antihistamines, although they did little good.

Pretty much the only thing that worked for allergies was avoidance. Yet it was hard to stay away from my brother's house, my friend's home, and the cabin where the guys hung out. It was no fun to avoid those places, yet that was often the only option, unless I wanted to take risks (which I often did).

And the boxes I set in the basement of my new home three years earlier were still sitting down there, because every time I tackled that job the allergies would strike, and quite often that also lead to an asthma attack (although now less severe due to Advair).

So along came Claritin. And then along came Singulair. Yet, because I didn't complain enough about my allergies to my doctor, these meds were around several years before I tried them.

One day, late 1997, this topic just happened to come up while I was having a friendly discussion with a doctor friend of mine at work. He said, "I think you definitely should be on Singulair. In fact, I think every asthmatic should be on Singulair."

I went home and researched the medicine. Of course I already knew that 70% of asthmatics have both allergies and asthma, and that quite often these allergies trigger asthma. So, if scientists could come up with a medicine to stop the allergy response, then they could control asthma.

Scientists also know that during an allergic reaction a chemical called leukotriene is released. This chemical causes bronchospasm. Finally, in 1998, after spending millions of dollars and 63 years researching leukotrienes and working on a way to block their release, Singulair was approved by the FDA.

Singulair has an active ingredient in it called Montelukast sodium, which blocks the action of leukotriene, thus preventing allergies, and preventing bronchospasm caused by allergies, and, in turn, preventing asthma.

So, new asthma wisdom in hand, I had a nice discussion with my asthma doctor during my next visit. He was skeptical at first. He asked me if I tried over the counter antihistamines like Drixoral or Clariton. I said I tried them all to no avail. "Nothing EVER worked," I said, "And I can't go through one more spring feeling miserable. I just can't!

He said he was "cautious" about starting me on newly released medicine. He didn't want his patients to be a guinea pig. But, being open minded, he said, "I'll let you try it for a month."

"Doc, " I said, "I think you should let me try it at least through spring. If I can make it through spring without having miserable allergies, I'll know this medicine is working."

Finally March arrived -- no allergies. April arrived -- no allergies. May arrived -- no allergies. June, July, August... No allergies at all that summer. In fact, I haven't had allergy symptoms at all since I started taking this asthma/allergy miracle medicine in January of 2008.

Obviously all medicines come with a risk of developing some side effects, but I developed none. Thank God, because allergies held me back for the first 38 years of my life. Not anymore! Now, with the combination of Advair and Singulair, I actually feel like a normal person for the first time in my life.

I have talked with doctors that say every asthmatic should be on Advair, and every allergic/asthmatic should be on Singulair.

By the way, another advantage I've come to enjoy regarding Singulair is it works well to prevent exercise induced bronchospasm. Now, thanks to Advair and Singulair, I'm actually able to run.

So, if you're an asthmatic and allergies continue to hold you back despite your best efforts, I highly recommend you talk to your doctor about Singulair.

Now, keep in mind that what works for me won't necessarily work for every asthmatic. Singulair is simply another option for us asthmatics to try. Thankfully, for me, it worked like a charm.

My experience with Serevent

I've decided in this post to share my experience with the long acting beta adrenergic Serevent. Perhaps there's some asthmatic somewhere who might benefit from my story here.

I guess you can say that even though I've always been a gallant asthmatic for the most part, I was also a hard luck asthmatic up until about 2005. That is: no matter what medicines I was on my asthma was still not controlled (although it didn't stop me from doing much).

As a quick review here, Serevent is a long acting bronchodilator that should be taken twice daily for chronic asthma. It is a time released medicine that does an excellent job of preventing bronchospasm from occurring and thus it works to PREVENT asthma.

Actually, based on studies, the FDA now recommends if you need Serevent to control your asthma you should also be using an inhaled corticosteroid (like Flovent) to control chronic inflammation. This didn't really apply to me, though, as I was already on flovent.

Actually, if you need serevent, you might as well take Advair, which is a combination inhaler with both Serevent and Flovent in it. Another similar medicine is Symbicort.

In 1998 I was still on the same asthma preventative meds I took way back in 1985. I was taking Azmacort four puffs four times a day, I was on Theophylline 600 mg twice a day, and I had a Ventolin inhaler which was prescribed for me to used whenever I needed it.

I actually used my Ventolin quite frequently, and one would last anywhere from a week to a month. My asthma never stopped me from living a normal life, although avoiding my asthma triggers was sometimes a challenge.

So, basically here it was 1998 and I was still on pretty much the same meds antiquated asthma meds I was on in 1985, which you can see here. After I graduated from respiratory school, I moved to my current home, and in the process of moving, dust mites and molds hit me hard and I ended up the the hospital for 10 days.

Once I was feeling better I discussed with my doctor about trying some more updated asthma meds. He advised that I try Severent and Flovent. The Flovent worked great, especially since I only had to take it twice a day as opposed to the 4 puffs 4 times a day I was taking with Azmacort.

The Serevent, on the other hand, made me so jittery I could hardly function at work (it was hard to draw blood, one of my favorite duties). So after a couple weeks I quit taking it.

Actually, I moved into my current home in 2004, and in 2007 many of the boxes still sat unopened in my basement. Every time I went down there I'd have an allergy/asthma attack.

In the meantime I talked to asthmatic friend who said since she started taking Advair she no longer feels like she even had asthma. So I talked with my doctor again about trying Advair. However, AGAIN, I got very jittery and had to quit taking it.

I think the reason I was having such a hard time with the Serevent was because I was using so much Ventolin. So I decided to try something on my own. I decided that I would SLOWLY decrease my use of Ventolin at the same time I weaned myself onto the Sevevent (Advair).

What I did was I took one puff of Advair every other day for a month. Then I took one puff a day for a month. Then I started taking it once in the morning and once at night, the recommended frequency.

It worked. By weaning myself onto the Advair the Serevent was SLOWLY introduced into my body. And, as the LABA started taking effect, I needed less and less Ventolin.

Finally I felt like a normal person. In fact, my asthma was better than it ever was in my life. Still, though, I wasn't able to clean my basement due to chronic allergies, and this is where Singulair comes into play (I'll get into that in my next post).

Advair brought upon a major change in my life. Honesty, for the first time in my life I felt I had control of my asthma. Advair is simply a "miracle" medicine. And, if I hadn't worked with my doctor on weaning myself onto it, my asthma would still be "controlled" by 1980s standards -- and that's no longer acceptable.

My point by sharing this experience is twofold. One, if you are doing everything you can to control your asthma and it's still not controlled, research other asthma meds, especially the newer ones, and discuss with your doctor your options.

Two, sometimes you may need to get creative with new meds, and you need to give it a chance to work. If you tried it once and had a bad experience like I did, try it again later. If all else fails, slowly wean yourself off the old medicine, and onto the new. Be patient, and hope for the best.

If I wasn't patient like this, I'd still be those old medicines and my asthma wouldn't be as controlled as it is now. Another neat thing about Advair and Singulair is they allowed me to wean myself off Theophylline, of which I was chronically dependent on for 30 years (also an upcoming post).

Despite my header, I no longer consider myself a hard luck asthmatic. Likewise, thanks to Advair, I no longer consider myself a bronchodilatoraholic either because I hardly ever use my Ventolin Rescue inhaler anymore. And that, to me, is major progress