Deciding to go to the ER isn't an easy decision

I was having an email discussion recently with one of my asthma friends. She was telling me how she was reading my post, "Having asthma symptoms? Here's five tips to help you decide what to do," and started laughing when she read #3 on my list: go to the er if... you find yourself using your inhaler more than recommended.

I bet most asthmatics use their inhaler more often than recommended from time to time, and some of us more often than that. In fact, I think we asthmatics, along with some COPDers, and some cystic Fibrosisers, invented rescue inhaler overuse. And no, I'm not referring to abuse either. Yet, if you'd like, you can call us bronchodilatoraholics, which I wrote about here and here.

But, when you're referring to recommended, who'se recommendation are THEY talking about anyway. Are you talking about the recommendation of your doctor, or of the so called asthma experts or guidelines?

The asthma guidelines say if you use your rescue inhaler more often than 2-3 times in a two week period, your asthma is not in control and you should seek doctor consultation. Yet the guidelines also say that "control" may be different from one patient to the next. My doctor "recommends" I use my inhaler when I need it because I know my asthma better than anyone else -- which I do and always have (although I need it less often at the time being).

So, normal bronchodilator usage for me might not be normal for you. For example, I use my rescue inhaler 2-4 times in a day, while you might normally use yours 2-4 times in a two week period. So, by my definition, you should go to the ER if you are using it more than YOUR normal.
That was one of my better posts because I basically wrote that one to myself as well as other asthmatics. I don't find myself with bad asthma anymore, especially since I became a Gallant Asthmatic. Yet, I'm not really a Gallant Asthmatic -- I'm not perfect. Although what I am is the best asthmatic I can be. I oughta add that to the asthma types list.

It's funny how you could be an RT, a lawyer, an asthma expert, and whatever, and STILL have trouble making the decision to go to the ER. Yet being on the receiving end, working in an ER, I have never seen an asthmatic made fun of because he came in. Usually we herald asthmatics for coming in instead of waiting.

Although, my friend corrected me that the reason she hates going to the ER is because in her past she's been treated poorly. She said "made fun of" is a poor choice of words, that "whiners, or hysterics, or whatever" is more appropriate. She said many hospital workers treat everyone as though they are whiners and drug seekers and the like.

Although she did describe one vacation when she spent a night in a cabin near the small town I live in, and she had a good experience.

We do get our fair share of bad patients in the ER where I work. I would guesstimate that about 50% of patients don't need to be in an ER, and about 20% are whiners and hysterics and your drug seekers.

Although I couldn't imagine treating all patients as though they were. Yet sometimes it's hard to tell the normal folks from the whacky patients. Although if they're that bad in your ER, I guess I can understand why you wouldn't want to go there.

I'd like to think smaller hospitals would treat their patients better, especially considering we need to make money, and treating all patients like they are idiots wouldn't be a good way to do that. Larger hospitals have a steady flow of income that smaller hospitals don't have.

So why is it we have so much trouble deciding? I know: we're normal. Although by that philosophy, am I implying asthmatics who don't hesitate, who don't second guess themselves, are abnormal? Well, not really.

Super peripheral vision

My eye doctor told me during our last appointment that one of his past patients had the surgery to fix his wandering eye, and when he realized what it did to him he was pissed.

That's right, he got his eyes fixed and he was ticked off. That's because he was a football player, and he was a running back. Before his eye surgery he had super vision. While he wasn't able to focus in on what was right in front of him, he could see peripherally like a super hero -- like no one else.

After his surgery he lost this super peripheral vision, and it effected his game. I've noticed for quite a while I've had super peripheral vision, although I don't think I'll mind losing it. As of right now, I find that I'm unable to see in 3D like most people do.

In fact, the other day I was playing catch with my son and for the first time I saw double. I saw two Jordan's. This only happened because I worked the night before and was really tired -- yet I didn't like it. I had to quit. I didn't want to get donked in the head because I couldn't decide which Jordan was tossing the ball.

I'm working now, and I don't imagine I'll want to sleep much tomorrow. So I wonder if that double vision beast will return. To be honest, it's really not that big a deal. Although it's going to be nice once it's corrected.

At least writing positively like this gets my mind off the anxiety that I'm going to have my eye cut open. Believe it or not I actually watched the video of the surgery as you can see here. Eeek, don't watch it if you're actually gonna have this surgery like I did. It just ads to the anxiety of having surgery.

It's really not that big of a deal. I've had it done three times already, although the last one lasted 25 years. If this one lasts 25 years I'll be good to go. If not I'm gonna just deal with it, because this is the last time I'm going through with this. I've had enough interventions already in my short 40 years.

Basically it results in one day with my eyes shut with a good dose of phenergan and vicodin in my system. I had to ask for the phenergan because post op nausea is something that I've experienced in the past, and I think nausea was worse than actual pain or discomfort.

Pretty soon my super vision will be neutralized, and probably for the better.

Strabismus: The case of the wandering eye

I have a post coming up on one of my blogs soon about how asthma is not just a disease of the lungs, but a disease that effects the entire body.

For example, to go with my asthma I also been diagnosed with allergies, rhinitis, sinusitis, ear infections, conjunctivitis, GERD, deviated nasal septum, and even strabismus. In my case, as you can see from the picture, I have Walleyes. Actually, only one of my eyes appears to be out of alignment, and my doctor refers to it as exotropy (one eye wanders away from the nose).

Many of the above you can easily associate with asthma. The deviated septum is a greater stretch, although studies have shown asthmatics with allergies have a tendency to pick up sinusitus and rhinitis often, and the constant inflammation and irritation and rubbing often results in a nasal crease and, you guessed it, deviated septums.

Of course that problem was repaired long ago. Another problem that was repaired long ago and has made a comeback is strabismus. This is where my brain has lost contact with my eyeballs. My brain only has the ability to focus from one eye, and the other eye sort of drifts off, thus the common nickname wandering eye or lazy eye.

A better way of explaining it is to picture the front wheel bearings of a car. Your eyes, like your front tires, turn in unison as you move the steering wheel. If the left wheel is crooked, and you straighten it out, the right tire will be crooked. That's about how my eyes work.

The major problem with strabismus is the ability to focus. My doctor has actually said my vision for each eye is great for my age (20/20), yet I do not have the ability to focus. I have no depth perception. I have lost my ability to see in 3D. And, when I'm tired, I see double. This happened just last evening when I was playing catch with my son. I had to quit before I got donked on the head.

VisionRX.com describes strabismus in this way:

Strabismus is a functional defect where the eyes are misaligned and point in different directions. The brain’s ability to see three-dimensional objects depends on proper alignment of the eyes. When both eyes are properly aligned and aimed at the same target, the visual portion of the brain fuses the forms into a single image. When one eye turns inward, outward, upward, or downward, two different pictures are sent to the brain. This causes loss of depth perception and binocular vision. The turned eye may be straight at times, and the misalignment may come and go. Strabismus occurs in about 4 percent of all children in the United States, equally in males and females, and is sometimes hereditary. The condition can also develop later in life.

In young children with any form of strabismus, the brain may learn to ignore the misaligned eye’s image and see only the image from the best-seeing eye. This is called amblyopia, or lazy eye, and results in a loss of depth perception. When an adult develops strabismus, double vision sometimes occurs because the brain has already been trained to receive images from both eyes and cannot ignore the image from the turned eye.

Actually, I find that I sometimes see double, especially when I'm tired. Yet I also see out of one eye at a time. This is probably because I have had bouts of strabismus my entire life. I've had surgery to correct it three times before now. (July 1, 2010, was my 4th corrective surgery)

I first started noticing this a while back when I was doing breathing treatments and when I squirted the vial of medicine into the cup I kept missing the cup. Then one morning I dished out scrambled eggs, and I missed all the plates.

Harmless things, yet if your driving and all of a sudden you see a tree in the middle of the road, that's not so good. This occurs because while I'm looking at the road with my dominant left eye, my right eye is busy looking at the trees along the right side of the car. My brain picks up what both eyes are seeing, and thus the tree in the middle of the road that ain't there.

Now this has yet to pose a problem, as I just keep driving knowing the tree is not really there. Yet you can see how this might pose a problem. Plus what I just described is a rare and worse case scenario. Although it has occurred for split seconds.

Ironically, this has not effected my ability to draw blood gases. This is because as I'm getting ready to poke I concentrate hard and focus. My ABG success rate remains high until after 6 a.m. at which time it drops to a 90% success rate. At least that's how I've always explained it to my co-workers.

Now you might be saying: what is the connection between strabismus and asthma? Well, there is no proven link. Although from my review of historical text I've observed many asthmatics also have eye trouble.

Now this is not based on science, yet I would hypothesize as to whether all the bouts of conjunctivitis, and all the bouts of rhinitis (which is hay fever) have effected my eyes. Kind of like the way the deviated septum may have occurred due to constant rubbing of my nose, the crooked eye may be the result of constant rubbing of my eyes.

Despite my non scientific theory of what causes asthma, here is what strabismus.org has to say about the cause of strabismus:

"Many things and/or events can cause a strabismus. They include genetics, inappropriate development of the "fusion center" of the brain, problems with the controlled center of the brain, injuries to muscles or nerves or other problems involving the muscles or nerves. Surprisingly, most cases of strabismus are not a result of a muscle problem, but are due to the control system -- the brain."

Of course I can't see this fact disproving my theory that rubbing of the eyes can cause strabismus. After all, rubbing is some form of "injury" to the muscles or nerves.

Or, according to lasereyecenter.com, it's caused by, "unequal pulling of muscles on one side of the eye or a paralysis of the ocular muscles." This definition also doesn't disprove my theory.

I remember when I was a kid having this same surgery when I was 2 in 1972, 10 in 1980 and 15 in 1985. I can't remember which eye was operated on those times, yet I remember parts if not all of them -- including when I was 2 believe it or not.

I remember my parents were not allowed to stay, and I remember having to sleep in a crib and I remember my parents saying goodbye. I also remember leaving the hospital in a wheelchair and my brothers saying, "Why can't I ride in the chair?"

Back when I was about 8 or 9 I remember walking with one eye shut all the time. Now, as an adult, as I do the same thing, I realize why I do this. It's the same as my tree in the middle of the road example above. When it's really sunny out, you focus on the ground before you, and face away from the sun as to not get the glare. Yet, while my left eye does this, the other is facing the sun. Hence, this eye is shut.

I do this instinctively. I discussed this with my doctor, and he said walking around with one eye shut is the first sign of strabismus in kids.

In my review of this disease, I've learned that other famous people had it, including Abraham Lincoln. I knew he and I had to have something in common other than being great thinkers.

So, in a few weeks, I'm going to have this fixed for the 4th time. I'm not excited about it, although I'm looking forward to seeing right. So if I disappear from the blogsphere for a while in the first few weeks of July, now you know why.

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Follow my strabismus surgery journey:

• The strabismus surgery
• Stabismus day #2
• Stabismus day #3
• Stabismus day #4
• Stabismus day 7-10
• Stabismus surgery: was it worth it?

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.

Too exhausted to look for puffer

I'm sure I'm not the only asthmatic to wake up in the middle of the night short of breath and not have a clue where his four Albuterol inhalers are, yet be too exhausted to get out of bed to look for them.

That's the situation I found myself in last night. After working all week, and working out when I wasn't working, and chasing kids around when I wasn't doing any of those two, I was perhaps more exhausted last evening than I remember being since I started working day shift last January.

In fact, I was so pooped out last night I went to bed at 7 p.m. without even taking any of my medicine. I actually lied down intending to watch the Tigers, yet I don't remember what happened as I fell asleep from pure exhaustion.

So I think Inhaler Gremlin has been at my house. I think it feasts on inhalers that are sitting around. Hell, it feeds on inhalers that are brand new and not even out of the package yet.

Anyway, if I had gotten out of bed I would have found one on the table next to the couch. For some reason the Gremlin didn't eat that one. Yet I didn't get up, and despite my discomfort fell back asleep.

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.

Do most asthmatics avoid Advair like the plague?

Perhaps one of my fellow asthmatics can help me out with this one. I recently saw a new asthma doctor, and, when I asked to have my prescriptions refilled he said, "You like Advair?"

"Yes! I love it!" I said.

"Wow! You're one of the few asthmatics who can stand it!"

"What!"

"Yeah. Most of my other patients hate that medicine." I will assume that he is also referring to any medicine like Advair too, such as symbicort.

"What do they take for their asthma then."

He smirked and said, "Well, nothing. They come in every 6 months complaining of asthma problems."

"Interesting," I said. The conversation moved on from there, although the idea that Advair was as unpopular as he was saying is still wobbling around in my mind, hence this post. I guess the naive person inside my head "assumed" if there's a medicine that works as well as Advair and Symbicort do to control asthma, that most asthmatics would at least try to like it.

Although, according to doctor Axel, that's not the case. Yet I think one of the reasons this threw me off guard is because my old doctor, Dr. Best, told me the opposite: "Most of my patients love Advair."

It's interesting the different perspective a doctor can have on a medicine. Yet this latest discussion about Advair has me wondering: do most asthmatics remain ignorant and continue to have

I wonder, though, if most asthmatics hate Advair if it has to do with the long-acting beta adrenergic medicine (Serevent) in it. I wrote here how it actually took me 10 years to get used to Serevent, and that I actually had to wean myself onto Advair.

Yet I don't think most doctors think about weaning onto a medicine, and when a patient says they can't take it, that's the end of the discussion. Yet I will contend, if you have uncontrolled asthma, Advair may just be the key and you should wean yourself onto it. You should try gallantly to get your body used to the stuff.

So, facts confirm Advair works wonders for asthma. Yet, is it a fact that most asthmatics continue to avoid Advair (and Symbicort) like the plague? If you have any greater wisdom on this cue your wisdom into the comments below or email me. .