I'm a writer not an activist

I do not consider myself to be a health activist.  I am a blogger and that's it.  I share my opinions.  I like to consider myself a person who thinks of ideas that other people can act on.  I would consider myself a philosopher if anything. 

If I was an activist, however, I would change the health care industry to where the costs were lower and health care was affordable to everyone, including those -- especially those -- who do not work.

I hate it when an asthmatic comes to me and say he can't afford his asthma medicine, and therefore he ends up with unfortunate asthma, which is asthma as a result of not being able to afford asthma medicine. 

Advair is one of the best asthma medicines in the world (and Symbicort and Dulera). These medicines work to prevent asthma, yet they cost over $100 if you don't have insurance.  They cost over $30 with insurance.

The reason medicine like Advair cost so much has nothing to do with the pharmaceutical industry, so I hate it when people come up with solutions that involve fixing prices.  That's not the solution.  Al that will do is punish the people who create the medicine that we so much need. 

If we consider pure economics 101, if the demand of a product goes up, and the supply stays the same, the price will go up.  This is what has happened to the healthcare industry.  In the 1960s when there were no government regulations on the healthcare industry people could see a doctor and pay for it out of pocket.

Yet since then many government regulations have been made, and welfare has been created.  What this did is make health care free for many people.  When something is free what do people do?  They take advantage of it.  So, instead of staying home and dealing with a simple cold on their own, these folks inundate emergency rooms.

Yet what's free to one person someone still has to pay for, and the people who pay for it are the rest of us who use health care services.  Every time we go to the ER, for example, we not only pay for our visit but we pay for those who got it for free.  Thus, we are paying more than what should be the market price.

Likewise, as the supply of patients increases due to government programs and regulations (hospitals aren't allowed to turn any patient down), and the number of nurses and doctors stays the same, the price of this care will go up to those who pay. It's simple economics 101.

I would like to create a health care system where everyone can go to the hospital and be able to at least somewhat afford it.  Surely we should take care of the people who truly need medical services -- including those who can't afford it.  But government involvement in the health care industry has resulted in skyrocketing prices.  I would like to stop this.

5 things that have changed my life

Your humble question:  What are five things that have changed your life?  For the better?  For worse? 

My humble answer:  This is a great question.  I'm going to focus on things that changed my life for the better.  Some of the things I list here may have been very difficult events, and even horrible events at the time, yet in the end they all resulted in changing me for the better.

1.  Horible asthma:  As a kid I endured many long and agonizing nights suffering from hardluck asthma.  Many days were spend in ERs and hospital beds.  Yet I took it in stride as best I could, and in the end it made me what I am today.  I actually wrote about it here and here. 

2.  National Jewish Health:  By January 1985 my asthma became so bad I was admitted to National Jewish Hospital/ National Asthma Center (now National Jewish Health) for six whole months.  It was fun at times, yet often very challenging.  It was events that occurred here that made me what I am today, especially all my talks with counselors and physiologists. 

3.  Getting fired:  I was hired as a journalist at a small town newspaper.  It was my lifetime dream to become a journalist because I loved to write, yet once I got this job it was like my mind went blank.  It didn't help that I was fresh out of school and I was in charge of the newspaper.  In essence I was hired to do a job that was way over my head, and after three months I was let go.  That event hit my confidence hard, yet in retrospect it was that event that made lead me to the job I was meant for -- a respiratory therapist.

4.  Getting a job as an RT:  If it weren't for all the events above I never would have become an RT.  In a way, getting a job of respiratory therapist was my fate -- respiratory fate.  It was because of this job that I met my wife.  It was through this job I created this blog.  It was through this job that I created a wonderful family and group of friends. 

5.  Meeting my wife:  I always wanted to write, yet even though I had tons of time I never did.  Then I met my wife, got a job as an RT, had kids, and even though I had hardly any time, with her encouragement, I created my blogs.  My wife disciplined me.  She made me the modest RT. 

So there you have it.  It was those five events that made me who I am.  If it werent' for bad asthma as a kid I never would have spent time at National Jewish.  If not for that experience I never would have become an RT.  If I never would have become an RT I never would have met my wife, and my blogs never would have come to be.

How does smoking effect bronchodilators?

Your humble question:  How does smoking effect bronchodilators?

My humble answer:  Smoking will have no effect on how a bronchodilator (like Albuterol and Xopenex) works.  However, smoking can make asthma worse, and smoking can also do further damage to your lungs and cause and worsen COPD.  So if your smoking further damages your lungs, this may make it so the albuterol has less effect, or may make managing your lung disease more difficult.  

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