Ear wax and infections

It's seems as though the asthma body leads us from one ailment to another.  If it's not asthma its hay fever.  If it's not hay fever it's a wandering eye.  If it's not burning flat feet it's a headache due to sinus problems.  If it's not that it's an ear ache and a sense of fullness in an ear or two.

That was my most recent problem.  My right ear has felt full the past several months.  I actually saw my doctor a couple weeks ago and that was the only day my ear wasn't bothering me, and for some reason he didn't check my nose and ears.  

Yet yesterday my ear totally plugged off, a headache raged through my head, and the ringing was terribly annoying.  Plus I was working.  Then I decided I couldn't stand it no more so I wandered down to the ER clinic room and asked a PA if she'd do me a favor and check my ears.

I have a history of wax buildup in my ears, and I have a history of ear infections too.  Yes, I know otitis media is a disease that kids get, but I get it too.  I remember as a kid getting ear aches so bad I couldn't stand.  I don't have that problem any more, yet the sense of fullness is equally annoying.

A few years ago an ER doctor found that I had an ear infection and gave me a prescription of antibiotics.  It's nice to have doctor friends this way.  This time, however, the PA said I had an impaction in my.  She asked a nurse to flush my ear pro bono.  Yes, it's nice to work in a hospital sometimes.  

Walking back to the RT cave I could hear sounds I didn't even know existed, and that I didn't hear on the way to the ER clinic.  It was so nice to have my hearing back.

All she did really was flush my ears out with warm water.  She put the warm water into a syringe and squirted it into my ear.  It felt funny but good.  The excess water dripped into a basin.  It's probably a remedy you could do yourself at home.  

Yet I suppose so long as I have access to such good friends at work why would I need to do such a thing myself. Yes, working in a hospital is nice.  

My review of Dulera, Symbicort

I will never shut the door on future experiments with newer asthma medicines based on past experience.  I once rejected Serevent, yet Advair ultimately rid me of my infestation of hardluck asthma.  Yet my recent trial with Dulera didn't go so well, and I ended it.

The problem I encountered was not with the steroid but with the long acting beta adrenergic Foracort.  While it was nice that Foracort was quicker acting as a rescue medicine, it made my heart pound like Alupent used to make my heart pound back in the 1980s.

There were some nights back in the 1980s where I'd use my Alupent before bed and my heart would pound so hard I was afraid I wouldn't wake in the morning.  When I started using the Albuterol inhaler in 1985 and Albuterol nebulizer solution in 1991 this feeling ended.

Yet Formoterol brought it back.  There were a few nights, and mornings, after taking Dulera that my heart pounded.  I never once had that feeling with Advair.  So I decided I could no longer take it.  

I like to think Dulera and Symbicort are basically the same medicine because the LABA is the same in each one (Foracort).  

I also would like to add here that other than the occasional heart pounding the Foracort caused, I felt really safe using any of these LABAs. I have taken extra puffs from time to time with good results as far as my asthma is concerned.  It's a great medicine and it's safe.

I like to think the black box warnings are wrong and basically scare people away from using good medicines.  So long as you use them as prescribed, and so long as you treat your asthma appropriately and don't think your Advair or Symbicort or Dulera will cure your exacerbation, I think you'll be okay.

The first time I tried Advair I basically had to wean myself onto it, and that may be what I have to do with Dulera. Only Advair works so well for me I don't see any point in doing that at this time. However, if you have hardluck asthma and are looking for a good asthma medicine, I highly recommend you try one of the above named medicines.  

Don't give up if you don't get immediate results or if the side effects hit you. Try one and if it doesn't work try another.  Wean yourself onto them slowly while you wean yourself off extra puffs of your ventolin.  You may find that after using a combination inhaler for a few weeks that your ventolin usage declines, and your side effects go away.

That's my advice.  What's yours????

Let'

1840: Is asthma just emphysema?

Even though it had been proven by Dr. Charles J.B. Williams in his 1840 experiments, Dr. George Budd continued to deny that bronchospasm had anything to do with asthma.

Yet there may have been some bias here. He had done experiments on his own, and even made "Remarks on Emhysema of the Lungs" in 1839.

As Dr. J. B. Berkart notes in his book, "On Asthma: It's Pathology and Treatment," Budd repeated Williams experiments and failed to repeat the results. Budd "therefore, rejected the theory of a bronchial spasm, and even doubted whether the circular fibres were muscular, as alleged."

The thing about reading about this in their original works and by the original authors, is that when I was reading about the description of emphysema I was confused. After a while I realized that my problem was because I was going by today's definition of emphysema and not the 19th century definition.

Today we define emphysema as loss of lung tissue that causes air to be trapped in the lungs, and this results in a barrel chest appearance. In the 19th century emphysema was simply air trapping.


Berkhart (page 26) describes how one doctor (Dr. Longet?):

"not only confirmed in the main the results obtained by Williams, but added that in his experiments irritation of teh pneumogastric nerve always produced spasmodic contraction of the brnchi, whereas section of the nerve led to emphysema... since section of the vagus causes emphysema, i.e., distension of the air vesicles, there must be muscular fibres which, if liable to paralysis, are liable also to spasm."

So you see, emphysema is air trapping. It's air being trapped in the lungs due to narrowing of the bronchioles (air passages in the lungs).

What both Williams and Budd may have failed to observe was that they were both onto something. Emphysema (air trapping) is secondary to bronchospasm. Yet it may have taken a few more years to juxtapose these ideas.

The long walk of death

I don't know if this is a figment of my imagination or not, yet I have a memory from my stay at National Jewish where all of us kids were in the gym at the Kunsberg School and our assignment was to run around the gym until we couldn't breathe.

I almost want to say this really happened.  I don't remember how long I was there before we did this, although I almost want to think we did this more than once.  Was it done once a month?  I don't know.  I have no way of finding out.

I remember having a discussion with our PE instructor, or whomever was in charge of us during this test.  Yet I remember this person telling us that this was a test to see how well our current medicine regime was working.  We'd premedicate if that was indicated, and then we'd start running.

Some of us dropped right away.  The first time I did this I made it one or two laps and I was out.  Of course I could be wrong about this too, yet I also remember sitting on the bench and the PE instructor not allowing me to go up to 7-Goodman to get a treatment.  He also wouldn't give me a puff of the Albuterol inhaler either.

I remember someone getting me a glass of warm water.  That's what we were supposed to do during an attack.  And I remember other kids having asthma attacks, and some of them just kept running.  They kept running and running.  Yet it's all a blur.  It's a blur because all I could think of was my breathing.  I was in a panic.  I had to go upstairs.

It must have been just after I was approved to participate in PE, maybe within the first month of my stay.  So either it was late January or early February.  I remember I got so bad I was panicky and the PE instructor told one of my peers to show me up to 7-Goodman.  I knew the way, but we weren't allowed to go on our own during an attack.  That was rule #1.

So I finally made it to 7-Goodman thanks to my good friend Sari (last name long forgotten), and the nurse, whomever it was, refused to give me a breathing treatment.  She said my wheeze was in my throat.  My wheeze was often in my throat, and I was still short of breath.  Yet she refused to give me a treatment on the grounds my wheeze was in my throat.

You see, whether you got a treatment was often at the discretion of the nurse on duty, or if we were off campus the PE instructor with the Albuterol inhaler.  If you were having an attack you had no control.  You had to do whatever that person wanted.  But this time I was panicky. 

She kept telling me to sit and to relax and to concentrate on my breathing.  And I got ticked at her and told her to shut up and give me my treatment.  I just want to breathe.  Yet she refused.  Finally some other nurse got tired of seeing me suffer and she intervened and I finally got my treatment. 

The mean nurse kept telling me to concentrate on my breathing, yet I couldn't even get a tenth of my breath in.  I literally thought I was going to die that day.  I had many attacks in my life, and yet that day, at the asthma hospital that was supposed to help me, I thought I was going to die.

Yet I survived. 

A month later the same thing happened, only this time my asthma was more stable.  This time I lasted two laps instead of one.  And this time the PE instructor let me upstairs right away with Sari leading me.  And this time I got a treatment right away.

Yes, that's right.  When an asthmatic says he needs a treatment he needs one.  That should have been rule #1. Yet  don't remember ever having to go through that again.  And even after I was discharged from NJH in July, and after I started school at home the next fall, I was excused from participating in gym class.

Yet I never had to endure that short walk of death ever again. I imagine after failing it twice -- literally -- the asthma experts at NJH learned that running was not for this hardluck asthmatic.  I don't know if it was a scheduled run by my doctor or what.  That part of my medical records was destroyed. All I have is the shortened version.

This memory kind of reminds me of Stephen Kings The Long Walk.  It's a story where these kids enter a run and if you slow down you get a warning.  If you get three warnings you are shot in the head.  Only one winner. 

Well, the winter of 1985 at National Jewish I was among the first out.  I wish there was someone I could talk to to learn more about this memory.  It doesn't matter so much anymore, I'm just curious.

Study justifies weight gain

I was just talking with my wife the other night about how ever since I've been taking Dulera all I want to do is eat.  She said I was full of crap.  Yet a new study I just learned about today may prove me right.  Only it may not have been so much the Dulera but allergies that caused me to gain weight.

Researchers at Yale university studied the effects of antihistamines and determined that people who took them were heavier than those who didn't take them.  Of course the researchers were quick to note the study does not confirm whether obesity lends people to worse allergies or if antihistamines actually cause weight gain.

Yet it's still interesting.  I'm also not implying I'm obese, yet I often find myself gaining weight this time of year.  I used to attribute it to lack of exercise because I tend to spend a little more time sitting outside drinking beer and cooking delicious foods on the grill as opposed to exercising.  This study might provide me with an even better excuse.

However, as I look back on my childhood, when I was thin as a stick, I still had horrid allergies and no weight gain.  Yet my metabolism was better then to, so that might explain why there was no weight gain at that time.  Yet I'm speculating.

It's interesting.  And yes it's just one study.

Sneaking away from the asthma hospital

Unlike most patients of 2-May, patients of 7-Goodman had to have permission to leave the floor -- except at night.  At night we kids had free roam of the entire hospital, and all the tunnels.  You could have a lot of fun with all the available stomping grounds under National Jewish.

The usual culprits were my room mate Eric, a girl named Trisha and whatever friend she decided to drag along, and whatever kid Eric decided to drag along.  After Sean was admitted he and Eric became good friends, and the usually 7-Goodman sneak-a-way team. 

Those who were participating got their pajamas on, curled up in their beds, and turned out the light.  Then the radios were turned on.  Back home I was used to sleeping in the silence, so I hated the radio being on all night.  I actually complained about it during weekly group, and to my counselor, but nothing was ever done.  So I dropped it.  Yet then, by mere chance, I discovered the real reason for the tunes.

With Madonna's Material Girl playing softly, I watched as Eric shifted out of bed and into the next room.  I heard some whispering and then silence.  After a few minutes I hopped out of bed and peered around the corner.  Through the flickering light produced from a small black and white TV I saw the back of a shoe and the watched as Marti replaced the drop ceiling and curled back into his bed.

That was last night.  This night -- coincidentally -- Material Girl was on the radio again as I peered into the next room.  Willie, a portly black kid from Chicago who was wearing all long-johns, was facing opposite me and performing his famous break dance moves.

I learned by now the sneak-aways occurred right around eleven, long enough after the 9:30 p.m. bedtime that most of us would be sleeping -- at least us kids most likely to snitch.  Yet I don't think the sneak-away-kids realized this, yet to snitch would instantly place a kid on the outcast list, and the rest of your stay would be pure hell. 

So they'd wait till the rest of us were sleeping to reduce the snitch risk yet mainly they waited for the 11 pm.m nursing shift change when the nurses were giving report.  Their talking, and the sound of music, muffled out any noise -- ideally it did anyway.  I never slept through the sneak-a-ways because I was a light sleeper, yet I never revealed my position.

The operation went quick.  It went like this:

11:00 Marti would stand on his bed.  Marti's bed worked best because it was snug up to the wall, and there were no wires or pipes above the drop ceiling.  Jeff would hop out of his bed and onto Marti's, and Marti would hop off.  Jeff was the tallest so he'd stand on the bed and help any participators up.

 Karl was a cool, very intelligent black kid from Atlanta.  He was a 7-Goodman patient the longest when I arrived, and he earned a private room and a TV.  While I never saw him sneak away, he'd bring out his TV just for the light. 

So under the flickering black and white light of the TV I watched -- my head peering around the corner --as Jeff stood on the bed and assisted Eric and then Sean -- the only time I ever saw him without his race cap in those early days, so his hair was astray in his face -- climb up, using the edge of the brick wall for support. 

Obviously you couldn't walk on the drop ceiling, so the kids walked along the tops of the walls.  I heard a story of a kid who fell through about five years earlier, giving away our secret.  Yet that was long ago, and hopefully forgotten. 

11:03 Jeff replaces the drop ceiling and climbs into his bed.  Karl grabs his TV and returns it to his room.  In an hour there would be a light tap over Marti's bed.  Jeff would assist in helping the kids climb down.

The girls would sneak away too, and sometimes they'd meet up with a kid or two from 2-May in some hidden cove under the buildings.  A cigarette would be smoked, and perhaps even a joint of marijuana. Either that or a trip to the store across the street was in order.

After I was admitted to 2-May I learned it was easier to sneak away from that floor.  The kids waited until the nurses were asleep and sneak out the slip of a window and walk along the edge of the building to where there was a hill. They'd jump off and have their way. 

The problem with sneaking away from 2-May is they didn't have access to the 7-Goodman elevator to the basement and the tunnels, so they had to have their fun outside. 

One night I was exceptionally tired and studying for an exam when I turned and saw my friend Gary in the window.  I was startled and let out a scream.  Gary rushed away, just in time so the nurse who came in to check on me didn't see him.  Yet it didnt' matter.  The gig was up.  It took me a long time to live that down.  I never snitched, yet I know Gary was busted when the counselors did a room check.

So needless to say I was on the do-not-trust list.  I did get off it eventually, but not because Gary decided to speak to me again.  The reason was because at an asthma institution patients come, and patients get discharged.  Thankfully for me Gary's stay wasn't long.

Back when I was on 7-Goodman there was one time I almost slipped up.  I was in the front rear seat of the National Jewish van.  The van was packed with kids.  PE instructor Charlene was driving, and PE instructor Jeff was in the passenger seat.  As we the van moved down E. Colfax Avenue the NJH complex was to our right, yet to our left was the old and empty National Asthma Center building.

I said, "It would be cool to walk around that building some night."

Charlene turned and gave me a dark stare, as well did the other kids.  I was wasn't thinking at all about sneaking away to that place, I just love history.  Yet it was this incident that made me aware of another nightly journey was to that old building. 

I can tell this story now because I've heard 7-Goodman and 2-May have since been closed.  I imagine the liability and stress of taking care of teens was part of it.  Yet I imagine improved asthma wisdom was probably the main reason for the closure.