To pee or to breathe, that is the question

So yesterday I wrote about the asthma conundrum. Well here's another asthma conundrum. What do you do if you just arrived at home, your asthma is really, really bad, and you also have to pee like a horse? What do you do? Do you take a treatment first, or do you take care of your breathing?

The wise person says take care of the ABCs of resuscitation first: Airway, breathing, circulation. Yet when I was a kid faced with this dilemma once upon a time, it was a race to the toilet. I hovered over it, braced the back lid to support my high shoulders, and whizzed for an agonizingly long time. Tears flushed my eyes, my chest burned, air was hardly available, yet there was a job to be done.

I think of this every time we have a difficult breather come in who says, "I have to pee real bad," and we say, "Just let it go. Once we get you breathing better we can clean it up."

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.

History of asthma

So I've been reading a lot of old texts about asthma in an attempt to learn about the evolution of this disease. At some point I plan to share what I've learned, but that will be a job for the winter months when there's more time for writing (or so one would hope). So that's coming to Hardluck Asthma at some point in the future.

In the meantime, I would like to send my readers to a great site I found that has a neat time line that details the history of asthma. I have to say it's pretty cool. Here's the site. Enjoy.

When you're done viewing the timeline, check out the inhalatorium. When you're done with that you can read Mark Jackson's book, "Asthma: A biography." It's really cool too.

Asthma institutions for asthmatic kids

So I've been studying the history of asthma, and recently I've been reading "Asthma: The Biography," by Mark Jackson. I found it interesting to note that back in the 1940s a "radical" method of removing asthmatic children from the home became a somewhat common treatment for asthma, especially those with difficult to manage asthma.

I find this interesting, because one of the Institutions where asthmatics were sent when separated from their homes was National Jewish Hospital in Denver.

On page 145 he writes the following:

"Others suggested the more radical measure of removing asthmatic children from supposedly emotionally disordered homes. Parentectomy (literally, cutting out the parent), as it became known, was pioneered during the 1940s by the American allergist M. Murray Peshkin, who established the Jewish National Home for Asthmatic Children in Denver (later the Children's Asthma Research Institute and Hospital). in order to treat children with intractable asthma. Separation from the home environment offered both reduced exposure to physical allergens and escape from the 'asthmatogenic emotional climate which existed in the child's own home'. According to Peshkin's reports, residence in the institution at Denver led to substantial or complete relief from asthma in 99% of children."

Of course back in the 1940s asthma experts were split between three basic theories:

1. Asthma was a disease of inflammation and bronchospasm
2. Asthma was a psychosomatic disorder
3. Both 1 and 2 above might be somehow involved in asthma

I have to agree that they were right, that absent the medicines we now have in 2010, removing many asthmatics from the home may have been very beneficial to them. I can completely understand that 99% of these asthmatic children may have benefited from being removed from home allergens and home stress.

When I was a patient at National Jewish in 1985 my asthma was much better controlled in the clean hospital environment as compared to at home, where mom and dad weren't interested in making many changes to my benefit. It's not that they didn't want me to breathe better, but changes come at a cost.

I found later in life that my asthma was much better controlled when I moved away to college. I found my asthma was even better controlled as soon as I stepped foot in an air conditioned building, or even an air conditioned hospital.

I know it must not have been fun to be plucked from your parents. I know personally, because in 1985 I spent six months at National Jewish. Yet that most kids noted improved asthma is in a way proof that controlling your environment, making needed changes to clean your home to get rid of asthma triggers, is an integral part of good asthma control.

And while asthma is no longer believed to be "caused" by emotions, emotions can act as an asthma trigger. And therefore, removal of children from stressful homes, where there is normal anxiety, can be of benefit to the child asthmatic.

In Britain open air schools were set up for asthmatic children "in rural or coastal settings or were temporarily relocated to settlements in mountainous areas of Europe..."

Then Jackson added:

"Although some American asthmatics later denounced parentectomy as 'one of the most shameful treatments foisted on the sufferers of any disease,' life in open-air schools was not universally detested by the children themselves: many of the children sent to schools in the countryside around Birmingham in England during the first half of the twentieth century remember their their time with some affection: '
As a child I suffered from bronchial asthma and was sent to Marsh Hill, which I enjoyed very much.' "

Interesting hey? Sick kids being plucked from their homes and liking it. Believe it or not I can understand it completely.

I remember being nervous about going to NJH, yet I knew it was going to help me get better. And I was nervous that I was going to 2-May when I thought I would get to go home, yet I later wrote in my journal, "2-May turned out to be a really nice place. I really like it here."

Thus, leaving Denver for me was almost as sad as leaving my family to go to Denver. Those I met in Denver had become my new family, and good friends.

Plus I was able to breathe well while there, and they provided me with the skills to breathe well when I was back at home.

My disadvantage is your advantage

You know what sucks most about having asthma. It's not being able to fix things around the house. It's not being able to build a wall and to put up drywall and finish it off myself. It's not being able to build things with wood.

I often joke with my friends that I can fix people who can't breath but I can't fix anything at home.

It's not like I don't know how to do carpentry work, it's my body won't let me. As soon as I get all the stuff and get set up, and as soon as I touch the wood my skin breaks out in hives and the asthma acts up. Actually, the allergies act up more so than the asthma. And that's even with all the high tech asthma and allergy stuff available today.

So I have to hire people to do jobs around the house most men should be able to do, and enjoy doing. When I have other people doing jobs I think I should be doing it feels, to me, like an attack on my manhood.

My dad owned a ton of apartments, and he'd give me a job to rip out carpet or something. I'd do it because it's a fun job. Yet even though I wore a mask, I still had to step outside every few minutes to wipe my dose and sdeeze.

The same happened as he was trying to teach me how to lay carpet, or do other projects. My bothers learned a lot from dad, and now they build things in their homes all the time, things I wish I could do.

So I was never able to finish a project working with my dad. If asthma sucks in any way shape or form in my opinion, that's where it sucks most for me. It's not even so much the asthma per se, but the allergies. I can handle the asthma. The allergies prevent me from doing carpentry work. The allergies suck the most.

I want to finish the basement. Yet I can't because if I did that I'd have to hire out the job. If I could do it I'd go to the store and do it right now because I have the week off. I can do it at 1/10th the cost too.

Well, that's just life.

However, my disadvantage is your advantage. Because I can't do that project, I spent much of my time here instead. Hence, I've become an asthma expert and writer of sorts -- a benefit of having asthma I suppose.

Is all asthma genetic? Somehow I think not

I've written in various posts that I believe you must have the asthma gene in order to have asthma. Yet based on recent articles and studies I've read, I'm now thinking it may be possible to get asthma (or something similar to it) even if you don't have the asthma gene.

Consider exercise induced asthma (EIA). Scientists now claim that EIA is no longer a proper diagnosis, as EIB is more like it, or exercise induced bronchospasm. They say this because some people who do not have asthma may have EIA, or more properly EIB.

As I note in this post, " The best definition I could find (about EIB) came from this post at AAAAI.org, which notes exercise doesn't necessarily "cause" asthma, but that "hyperventilation (fast breathing) associated with exercise cools and dries the upper and lower airway resulting in the release of histamine and other substances that produce the bronchospasm (spasming of the muscles in the air passages in your lungs)."

Later I wrote the following, "Actually, according to Dr. Christopher Randolph, a clinical professor at Yale University who was interviewed by The New York Time's, EIA is not quite the same as asthma. He notes the "'preferred term' in the scientific community for exercise-induced asthma is exercise-induced bronchoconstriction, or EIB."

The idea here is that even if you don't have the asthma gene, and you are constantly irritating your airway with fast, rapid breathing in cool, dry air, you may be damaging your lungs long term.

This is also evidence in an upcoming post I will release soon about Occupational Asthma. With occupational asthma, it is believed that if you are exposed to the same chemicals day in and day out, your body may develop a sensitivity to is even if you don't have the asthma gene. The end result in non-asthma gene occupational asthma.

Say you are born premature with an immature immune system. Many of these kids are predisposed to get asthma.

A virus called respiratory syncicial virus (RSV) is a bug that most children are exposed to. So, in the first three months of life many scientists believe your immune system is developing, and if you're exposed to the RSV bug, and this causes you to develop RSV pneumonia, this may cause lung damage that may make these kids at increased risk for developing asthma whether they have the asthma gene or not.

So, say you are born premature and you are exposed to RSV. Now you have an even greater risk of getting asthma, whether you have the gene or not.

Other studies have me leaning this way, such as studies that show you have an 80% chance of developing asthma if you are born by c-section as opposed to vaginal delivery. Or studies that show athletes have a 40% greater chance of getting asthma later in life as opposed to non athletes.

Or, as I noted in this post, "What I also found stunning was that this article from the New York Times noted half of all cross country skiers, and 17 percent of Olympic-level distance runners, have been diagnosed with EIA. Likewise, according to the American Academy of Allergy, Asthma and Immunology (AAAAI.org), 23 percent of all olympians have EIA."

So, since it's expected that only 10% of the population has the asthma gene, and 80% of those who are born by c-section get asthma, then you have to assume, or surmise, that many of that 80% do not have the asthma gene.

Or am I missing something. What do you think? Discuss.

Does Advair cause weight gain?

This is something that has been discussed a lot in asthma communities, as you can see here and here and here and here and here and here. Yet there has been very little documented evidence as to whether it is true or not.

Someone askes me this question here, and my answer was a quick, "Studies have shown that if you rinse your mouth out really well after using your Advair inhaler systemic side effects are very rare."

Yet considering the broad discussions on this topic, I'm now wondering if I was wrong. Is it possible that Advair does cause weight gain.

Asthma.emedtv.com notes that while weight gain was not listed among the side effects of Advair during initial testing, many asthmatics on Advair have noted weight gain. So perhaps further testing on this is merited.

I know I have seen some websites note that the higher dose (500/50) of Advair have been linked to increased side effects, even if you rinse your mouth after each use.

Yet most studies show that if you rinse your mouth well after using the lower dose of Advair (250/50) side effects are rare. So, this makes me wonder if I might be correct, and perhaps all those folks complaining of Advair weight gain were either on the higher dose, or not rinsing.

Still, for some reason that doesn't seem plausible.

Another consideration that might cause weight gain for some who take Advair, and this is listed as a possible side effect, is possible fluid retention. Now this may lead to weight gain. Of course fluid retention is also a complication of illnesses such as heart failure, so if you have this then you ought to be calling your doctor.

As far as my experience with weight gain and Advair, in the past when I did the Body For Life diet I lost up to 40 pounds in one 12 week period. Yet recently I only lost 20 in 20 weeks. Now this could be age catching up to me, or the fact I didn't stick to the diet as well as I did in the past.

Yet, and this idea crossed my mind, it could be that I am now on Advair. When I lost 40 pounds in 2002 to when I was trying to get in shape for my wedding, I was not on Advair. And, chances are, I was not the most compliant with my Flovent. So the level of steroids in my blood may be higher now than then.

However, I am only speculating. My weight loss has been slow as compared to in the past. Other folks on Advair who exercise have also noted a similar slow weight loss, or none at all. So I'm not alone in thinking this way.

Yet any of us who choose to blame the Advair may simply be trying to come up with an excuse for being overweight. I'm not blaming the Advair at all, just curious. Yet I have observed that I am constantly hungry. Is this genetics or Advair? Hard to know for sure. No studies have been done.

So what do you think? What is your experience with Advair and weight gain? Are there studies out there I'm not aware of? Discuss.