What happens after you press publish?

Your question:  So you've been blogging for a long time now.  You have more than three blogs you seem to keep up to date.  What do you do after you publish a post?  Do you tweet it immediately?  Do you continue to edit? Do you admire your work? 

My humble answer:  Great question.  First of all I think it should be known I write because I love to write.  I love my blogs because they are the few things in my life I feel I have complete control over (most of the time anyway).  Yet another interesting thing about the way I write blog posts is I rarely write the same day something is posted.  Usually I get in a writing mood one day a week, or two, or three.  It's on those days where I sit and write all the ideas that have piled up in my head.  Often during the course of the week I take notes as I'm working.  Sometimes I come up with ideas when taking a shower, or when I wake up in the night, and I take notes.  So one day a week I sit down and create posts.  Then I set them to be scheduled for a certain date. 

There is this sense of pride when I look at my blog and read my daily post.  I usually do reread it to make sure it's saying what I intend, although usually by the time it's published that job (and any editing) is completed.  Although quite often these days, in the hustle and bustle of life, I am too busy to get a chance to admire my work.  So you can see, for this reason mistakes may be made.  In essence, in this way, I may actually write something I might intend to one day take out so I don't get in trouble by what I say, or don't offend.  If I had an editor this would be his job. 

Another neat thing about blogging is many bloggers like to promote their blog posts through emails (spam), Facebook or Twitter.  I do some of this, but for the most part I like my writing to stand on it's own.  I believe if something I write is worth reading people will find it on their own. 

I love my blog and I'm proud of my work.  Usually I just leave it at that.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Dear 18 year old me

Today as part of my effort to participate in HHBPM 30 health posts in 30 days I will write a letter to my 18 year old self.

Dear Rick Frea


11-3-2011


Hi.  I am the future you.  Through the magic of the Wellsphere Time-iMail machine I have been told this letter will be distributed to you on your 18th birthday.  I've decided this would be a great opportunity for me to provide you with some tips.

First of all, call National Jewish Health and send for your medical records.  This is important because in the future you will want to write about your story, and you will require your medical records. 

Your future self -- that's me -- sent for these records, yet all he received was 34 paraphrased pages. NJH destroys your medical records after 25 years, so don't wait.  Send for them now before they are destroyed.

Another thing I want you to do right now is sit down and write your asthma story while it is still fresh in your head.  Don't worry about grammar and spelling and style, just write down your story.  You can sandpaper your story in the future, because you will become a pretty darn good writer. 

Also, make a copy of your story "Escapes from the Lost."  I say this because by the time you turn 24 you will lose this story and have to rely on your memory to rewrite it in the future.  Make a copy now and put it someplace safe.

Don't worry so much about your dreams that have yet to be answered.  Yet keep praying and don't be afraid to step out of your comfort zone.  Likewise, don't worry about what people think about you.  Be yourself and be happy with who you are.

Other than that, I'm not going to give you any further tips because both the good things and the bad things that happen in your life make you -- me -- who I am.  You will use your experiences -- the good and the bad -- to create some great writings.  Be yourself, have fun, and rest assured your most important prayers -- like the ones you made at NJH -- will come true.

Your friend:


Riok Frea

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

1649-1734: Floyer redefines asthma, upholds supernatural

Sir John Floyer

The early 17th century centered around a struggle by Western men who were losing their enchantment with the old world and increasing curiosities about the truth obtained by scientific progress and thought. John Floyer was born into this world in 1649 and he rejected it.

In fact, it was because he rejected it that he became one of the most interesting and popular personalities of his generation. He put forth a defense against modern logic and a defense for Ancient ideas, yet at the same time he provided a stunningly accurate description of asthma based on his own experience and experimentation

Floyer lived at about the same time as Jean Baptiste van Helmont and Thomas Willis, yet it was Floyer's ideas regarding asthma that were more readily accepted by his generation. The reason was partly because Floyer had asthma and he used his own experiences to describe the disease.  Yet also because he disregarded science and accepted old superstitions that were popular, while the other two endorsed science.

It's true.  Floyer rejected the ideas of van Helmont and Wilson and other "quacks" because they "know little of Anatomy, and the Nature of Animal Humours."  Likewise, Floyer accepted the ideas set forth by Hippocrates and Galen that all diseases were caused by some external poison that caused an imbalance of the humors:  black bile, yellow bile, phlegm and blood. (1)

Floyer's Treaties of the Asthma (a)

Since this was the accepted dogma of the day -- the paradigm that mankind was stuck in at the time -- Floyer's ideas were much easier for other physicians to accept.  

Floyer was born in 1649 in the small town of Staffordshire, England, the same year as the execution of Charles I.  He suffered from asthma as a child and through much of his adulthood, and it was because of this he would later take up the study of this disease. (2)

He received his medical degree from Oxford in 1680.  Shortly thereafter he returned to Lichfield which was only a few short miles from his birthplace and became an important member of the British society, and he was even knighted by James II in 1686. (3)


He was an ardent supporter of cold water bathing, and in n 1701 he published "A History of Cold Bathing: Both Ancient and Modern." He would often recommend this book to his many patients including his asthmatic patients. (4)

In 1682 Andreas Cleyer's Specimen medicinae Sinicae introduced the West to the ancient Chinese method of counting a pulse to diagnose diseases.  Floyer liked this idea, and he expanded it and made taking a pulse a routine task when assessing a patient. (5)

To make the task easier he invented a "pulse watch" that had a second hand that ran for one minute.  Alex Sakula, "Sir John Floyer's A Treatise on Asthma (1698)," wrote that one of the reasons this "pulse watch" was so important for his study was because he believed that each disease was associated with a specific pulse. (6)

He wrote about his watch in "The Physician's Pulse Watch" volume 1, in 1707.  You can read about it in more detail here.  The pulse watch was advanced many times even during Floyer's own life, and it soon became a popular site to see your neighborhood physician with a pocket watch. The practice of taking vitals, a pulse and respiratory rate, became commonplace.

The art of watching the hands of a watch revolve is often attributed to Sir John Floyer.

When it came to asthma, Floyer was not a fan of  modern remedies for asthma that were prescribed by other physicians of his day, such as Van Helmont and Wilson.  In fact, he flat out rejected many of them, and instead preferred the more supernatural remedies such as those proposed by Hippocrates and Galen.

Yet while he preferred the supernatural, he's also the first asthma expert to make the case for asthma as a separate disease from other lung disorders. He makes this case in his 1698 book A Treatise of the Asthma.

In this book Floyer described respiration as "preparing the blood or air vessels by tumours or by injury to the muscles of respiration or to the 'spirits, moving those Muscles.'"  He describes asthma this way:

When the Muscles labour much for Inspiration and Expiration, through some Obstruction, or compression of the Bronchia, &c. we properly call this a Difficulty of Breath: But if this difficulty be by the Constriction of the Bronchia, 'tis properly the periodic Asthma: And if the Constriction be great, it is with Wheezing; but if less, the Wheezing is not so evident; the Pulse being stopt in the Asthma Fit, the Respiration is Rare."

Then he described two forms of asthma:

1.  Continued:  Dyspnea was the result of other diseases such as dropsy, empyema, tubercles in the lungs, thoracic tumors, abdominal tumors, and spinal conditions such as scoliosis.  He used continued the way we use chronic, meaning that the "asthma" is always there.  We now know this is not really asthma but other conditions, such as chronic bronchitis.

Regarding this, 18th century physician Michael Ryan quoted Floyer:

When te asthma continues for some months, it is a true pulmonic asthma, and depends on some disease in the breast, as dropsy, tubercle, absess, which compress the bronchia; and till that evident cause be removed, it is impossible to cure the asthma fits."  (8, page 8)

2.  Periodic:  This is bronchial constriction due to "windy spirits" occurring after fevers, catarrh (nasal inflammation, allergies, hay fever, colds), and hypochondriacal fits (nerves) or as what he referred to as "flatulent slimey cacochymia, which is bred in the Stomach."

Floyer described his own asthma as periodic, and it is this type of asthma that covers the majority of his Treaties on Asthma.  Floyer noted that continued asthma is known to take the life of the asthmatic, yet most people with periodic asthma lived a normal life span.  However, periodic asthma did take a life from time to time.

A little less than 100 years later, Dr. Henry Hyde Salter would further refine Floyer's asthma definition using empirical knowledge known to him, and he referred to pure asthma as periodic in nature, and continued asthma as asthma associated with some type of organic changes, such as chronic bronchitis or enlarged heart.

Floyer became the first to describe seasonal asthma.  Floyer wrote how he kept a "diary of his disease, out of what I can give a more true Account than if I had now recollected what has long since passed."

He observed that he never had any problem with his asthma while he was at Oxford, yet when he returned to Staffordshire he "usually visited with a severe Fit or two.  The air of a Town makes the Fits more severe when they happen; but I do not think the Asthmatic so much expos'd to the Accident of the Weather in a City, as in the Country."

He noted that his asthma was worse in the summer than winter, and worse during "the change of the moon."  Barometric pressure can also affect asthma, he proposed, and that is why he recommended changes in weather as a probable cause of asthma.

So he may have been the first to notice the benefits of certain types of air in causing asthma, an idea Salter would later embellish upon.  Such observations may have lead to the later recommendation for asthmatics to move to other areas in order to treat and cure it.

He may also have been the first to describe how tobacco fumes from smoking cigarettes may trigger an asthma attack, yet his reasoning for this is quite supernatural:

"During the Fit of the Asthma, the Smoak of Tobacco is so offensive that it very much straitens the Breath, if it be smoaked the first Day of theFit, and much endangers a Suffocation. There are many Asthmatics that cannot bear the smell of it; therefore its Foetor is injurious any time, its Heat thickens the Phlegm and rerefies their aerial Spirits, making them restless; all the good it can do is to discuss the Windiness after the Fit abates, and to help the coughing up of Phlegm."

Floyer may have been among the first to note that very few people die of an asthma attack, and that between such attacks the asthmatic can live a relatively normal life.  He wrote:

"I have met with some Asthmatics who have been so for Fifty years, as they informed me, and yet in tolerable Health without any considerable Decay of their Lungs, or Disability to perform their usual Employments; which I oft reflect on to encourage my patients, and myself, who yet can study, walk, ride, and follow my Employment, eat, drink, and sleep, as well as ever I could; neither am I yet sensible of any Decay in my Lungs."

Alex Sakula noted that while Floyer's acceptance of Galanic principles would later be proven false, "his treatise shows that he was familiar with the multifactorial basis of asthma -- heredity, occupation, atmospheric pollution, hypersensitivity, infection, exercise, and psychological influences."

Because his theories about medicine were more readily accepted by society in the 17th century, Floyers is often given credit as the first to define asthma as a disease of it's own, more specifically as a disease of bronchospasm, even while this wasn't true.  Regardless, he did play a significant part in defining asthma.

Floyers would die on February 1, 1734, yet his teachings would be studied by physicians for the next hundred years, and his practice of measuring a pulse and respiratory rate became a common medical practice that is still used to this day.

Further reading:

1. Floyer's asthma symptoms, triggers and remedies by clicking here. 
2. Floyer establishes spasmotic theory of asthma (will be published 4/17/14)

Click here for more asthma history.

References:

1. pending
2. pending
3. pending
4. pending
5. pending
6. Sakula, Alex "John Floyer:  A Treaties on Asthma," Thorax, 1984, 39: 248-254
7. Floyers, John, "A Treaties on Asthma," 1698, London, pages
8. Ryan, Michael, "Observations on the history of asthma, in which the propriety of using the cold bath in that disorder is fully considered," 1793, London, printed by G.G. J. and J. Robinson of Paternoster-Row

My asthma TV show

In my dream world my characters Joe Goofus and Jake Gallant will be the stars of a new cartoon aptly titled Hardluck Asthma: The adventures of Joe Goofus and Jake Gallant.

It will be both a fun and educational cartoon on Nickelodeon featuring the voices of Michael J. Fox and Jake Gallant and yours truly as the voice of Joe Goofus.  I figured most of us are more realistically goofus asthmatics, and therefore I insisted on being the asthma goofus.

The cartoon features the two contrasting characters, both boys, who both have hardluck asthma.  The premise of the cartoon is one or both of the boys faces an obstacle regarding his asthma, and goofus usually makes some decision that gets him into trouble.  Sometimes the decision is irresponsible, yet quite often it's doing something that any normal kid might do.

Jake Gallant usually makes the "perfect" decision, although he still has trouble with his asthma.  In the cartoon he usually takes on the role of trying to help Joe decide what to do when he faces his consequences of his decisions, such as the decision to rake leaves or to go to hunting camp with his dad even though he knows both those things usually lead to an asthma attack.

In my favorite episode Joe Goofus has a test at school, and in order to not have to take the test he doesn't take his controller medicines for a week and runs outside in the cold.  In this way he becomes the Actor Asthmatic, or the asthmatics who fakes his asthma our of convenience.

Jake Gallant and Joe Goofus primary function is to teach children that they are not alone in living with asthma, and teach them basic skills on how to live with this disease.  It also focuses on teaching kids what to do and what not to do in order to prevent asthma symptoms.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

My future asthma book

I do see a book in my future.  I've started three books, and some day I plan to put them together and get them published.  I have a nonfiction book and a fiction book I'm working on.  Yet my nonfiction book would be relevant to to this blog because it's about asthma.  

I've already written chapters of my book on the RT Cave and at MyAsthmaCentral.  I've been trying to write about every aspect of asthma in a pithy (short and sweet) fashion.  Some day I'd like to take my writings and put them together in a simple, easy to read book.  

I want my asthma story to be in the book, yet I don't want that to be the main focus.  I simply want to show how I suffered from the disease, how I survived, and how asthma made me what I am today.  Yes, you can live a normal life and have asthma too. 

Yet I also want to make asthma an easy disease to understand?  What is asthma?  What causes it?  What triggers an attack?  What's the history of asthma?  

Here is an idea I've created for my future book jacket.  It actually comes from one of my posts:

Living through an asthma attack is never fun.  The good news is asthma can be controlled, and you can live a normal life with it.  That in mind, and since we have to live with it anyway, no point in saying, "Why me?"

Based on my experience from being a lifelong asthmatic, I have discovered seven benefits of having asthma  -- and no, I am not referring to using it to get out of gym class or work.  

I have also used my professional and personal experience to create eleven different types of asthmatics, such as the Jake the gallant asthmatic and Joe the goofus asthmatic.  You might be like Joe, yet chances are you might find you have more in common with Mr. Goofus than you think.

Hardluck Asthma  provides the inside scoop of what it's like to live with asthma, and how you too can cope with this disease.  Besides, it's also good to know that you are not alone in having to deal with asthma. 

One thing I'm not so good at is creating titles for my future book.  Here are some ideas I have:

• My Hardluck Asthma Story
• Living with asthma
• How to have fun with asthma
• The truth about asthma
• An asthma guide:  How to survive asthma
• How asthma benefited my life
• Fun with Asthma:  A definition, a history, a life

Those are just some ideas, yet I'm not sure I like any of them.  If you have any ideas let me know in the comments below.  If you have an idea for a book, let me know about that too in the comments below.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

1621-1675:Willis narrows asthma definition

In the 19th century Dr. Samuel Gee (1839-1911) made a gallant effort to update the definition of asthma for physicians during his era.  He wrote fondly of Dr. Thomas Willis (1671-1675), giving him credit as "innovator of the doctrines of the ancients." (1)

Gee described, in 1899, that prior to the 17th century asthma was considered "any kind of panting, gasping, pursy breathing such as follows on running on exertion." (1)

Back then asthma was considered to be a disease caused by the spirits. Yet in 1678 Thomas described asthma as o"obstruction of bronchi by thick humors, swelling of their walls and obstruction from without." (2)
By these words Dr. Gee gave credit to Dr. Willis for the evolution of asthma as more than simply a disease of dyspnea and wheezing.  Other doctors may have helped to advance the definition (such as Dr. van Helmont), yet it was Dr. Willis who made asthma a unique illness in and of its own, such as Tuberculosis and Epilepsy are unique illnesses treated with unique remedies.

"Hence," Gee wrote, "Asthma and dyspnea were synonyms for most of the older physicians.  A few, such as Celsus (25 B.C.-50 A.D.), signified by asthma the highest degree of dyspnea, but this was all; asthma was never regarded as a special sort of dyspnea." (1)

For Gee, ancient definitions of asthma from Hippocrates to Galen to van Helmont were inaccurate until we get to Thomas Willis of the 17th century.  In Willis's book  "Rational Pharmaceutic," which was published the same year as his death in 1675,  Willis explained that all ancient and modern physicians up to his time acknowledged only one kind of asthma, and this was pneumatic asthma.

Gee explained that pneumatic asthma was described by Willis as when the lungs are "obstructed or not open enough."  Gee wrote that the ancients regarded all asthma as "pneumatic and dependent on bronchial obstruction." (1)

He said the ancient definition of asthma is of little value in modern times (for Gee modern times would be 1899).  Yet, "It is interesting to note that those most conservative of people, the illiterate, continue to use the word in the sense of Hippocrates and Galen." (1)

However, we must note that it was illegal for the Ancient Greeks and Romans to dissect human bodies, and even in the 17th century it was very risky to publish ideas that opposed the beliefs of the church or ruling parties (hence the publishing of Willis's works posthumously).  Plus societies tend to be stubborn to new ideas change.

We see this often as we follow the history of science, medicine, and asthma.  It's perhaps this stubborness of mankind that we can give credit for the slowness to which the term asthma was defined, and why it took until 1901 for good asthma medicine to be discovered.

Orville Harry Brown, in his 1917 book, explained that Willis attributed to the cause of asthma "as some humor in the blood. (5, page 27).

Ernst Shmiegelow, in his 1890 book, said Willis may have been one of the first to explore the idea of the diaphragm as being the cause of asthma, and therefore may also be the creator of the diaphragmatic theory of asthma.  (6, page 4)

Gee said Willis described three forms of asthma: (1, page 817)

1. Pneumatic Asthma:  Dyspnea is a result of air passages in the lungs being obstructed or not open enough
2. Convulsive Asthma:  The primary fault of dyspnea comes from the lungs themselves, "in the moving fibres or muscular coats of the air vessels or in the diaphragm and muscles of the chest or in the nerves of the lungs and chest or of the origin of those nerves in the brain."
3. Mixed Asthma:  Both pneumatic and convulsive.

Gee said that in defining convulsive asthma, Willis pondered all the theories before his time and incorporated them into his newly defined convulsive asthma, which "was soon laid hold of.  The term 'asthma' came to be reserved for the exclusive denomination of that form of the disease which was believed to be spasmotic; and this is the sense in which the word is still used by most parsons even in our own day."  (1)

I must continue to remind my readers that nervous asthma was generally thought to be synonymous with spasmotic or convulsive asthma.  By this the medical community believed the the fit of asthma was caused by nervous pathways from the brain as a result of something exciting these nervous pathways.

Barry Brenner, in 1999, said Willis also made an "association between food, emotion, heredity, and asthma."    In fact, it was in 1672 that Willis described emotion as bringing about an asthma attack.  (3)

Way back in the 12th century Maimonides described asthma as a nocturnal disease when studying the disease in Saladin's son.   In the 17th century there were many references to asthma as a nocturnal disease, and this was once again mentioned by Willis who, according to T.J.H. Clark, "in his 1987 book Diurnal Rhythm of Asthma," "blamed the heat of the bed as the cause of nocturnal asthma and he advised leaving the bed and sleeping in a chair.  By contrast, Maimonides recommended celibacy." (4)

Even though he wasn't the first to write about asthma as being caused by the mind, Willis is given credit, perhaps due to his vast writings on the subject.  And while the nervous theory of asthma grew in popularity among the medial community during the 18th century, and grew roots in the 19th century, not all physicians supported it.

Perhaps one of his first opponents was Giovanni Batttista Morgagni (1682-1771). He disagreed with Willis that asthma was a nervous disorder, instead he believed that asthma was caused by "concretions (masses) in the bronchial tubes." He believed this because he found "extravasated serum in the vessicles of the lungs in most cases."  (5, page 27)

Albrecht von Haller (1708-1777) believed that "the normal act of expiration hindered the flow of blood through the lungs," and "demonstrated that the lungs contracted when concentrated acid was applied to it."  (5, page 27)

William Herberden (1710-1801) defined "convulsive asthma" the way angina pectoris was later defined: as chest pain or discomfort due to activity or stress. (5, page 27)

Varnier (name and lifespan unknown to me) believed "irritating fluids or fumes forced into the lungs cause contraction therof."  (5, page 27)

Varnier, however, was also among the first physicians to prove by his experiments that muscles that wrap around the bronchial tubes contract, and this is the cause for the symptoms of asthma.

So at the time Willis's theory was just one of many theories regarding the cause of asthma.  Still, it was his nervous theory of asthma that was grabbed by the medical community and grew roots in the minds of physicians.  These roots would grow so deep that even after his theory was disproved in the mid-20th century, it still held sway.

While many before him described asthma as nervous, Willis is often given credit for bringing the idea to the attention of the medical community.  He is given credit for the nervous theory of asthma.

Further reading:

1. The evolution of the nervous theory of asthma (not yet written)

Click here for more asthma history.

References:

1. Gee, Samuel, "Bronchitis, Pulmonary Emphysema, and Asthma,", Lancet, March 25, 1899, page 817
2. Salvi, Sundeep S., "Is Asthma Really Due to a Polarized T Cell Response Toward a helper T-Cell Type 2 Phenotype," American Journal of Respiratory and Critical Care Medicine, Oct. 15, 2001, vol. 164, no. 8, pages 1343-6
3. Brenner, Barry, "Emergency Medicine," 1999, New York, page 6 (Brenner wrote 
4. Clark, T.J.H., "Diurnal Rhythm of Asthma," (American College of Chest Physicians), 1987,  page 1375
5. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
6. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
7. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1921, 3rd edition, Philadelphia and London, W.B Saunders Company
8. Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London,  Longman, Rees, Orme, Brown, Green, and Longman; Ramadge discusses Thomas Willis's views on asthma on pages 93-94.  He also mentions him various other times in his book. 

Why is sputum produced during asthma attack?

Your question:  Why is sputum produced during an asthma attack?

My humble answer:  An asthma attack occurs because you inhale something that your immune system responds to, such as dust mites, mold, cockroach urine, chemicals, etc.  One part of this response is to cause your goblet cells to secrete mucus in order to trap the invading microbes.  As the disease progresses you may even develop an abnormally large amount of goblet cells.  So when you have an asthma attack mucus may be excessive.  

One of the interesting things about asthma sputum is it is usually sterile and white, as I explain here.