The truth shall make your asthma better

I was on the job as an RT at Shoreline for only three months when I had an asthma attack so bad I was taking treatments every hour.  I went to the ER and was admitted.  

Sahara was a coworker of mine.  She took care of me when I was a kid, and I was looking forward to her coming to visit me.  After I was a patient for several days she finally came, and instead of sympathizing with me she lectured me instead.  She said:

"You did this to your self.  Every time I see you you're eating a Big Mac or a Whopper and you keep gaining weight.  You take poor care of your health and that's why this happened.  You did this to yourself."

I was so ticked at her I couldn't wait for her to get out of my room. I told my other coworkers about what she said and they agreed she was a jerk.   I barely spoke to her the next two years unless I was giving report.  Yet eight months after that lecture I started working out.  I also started eating well.  I lost 35 pounds and was feeling great. 

Since then I've continued to try to eat well and exercise and since then my asthma has been much improved.  So improved, as a matter of fact, that I haven't spend a day as an inpatient for asthma since that visit.

So that got me to thinking:  Sahara did me a favor by lecturing me.  Instead of sympathizing with me and allowing me to continue on the wrong path she took the bold step and told me I was a fool for the way I was living.

This goes to that old saying that the truth hurts before it makes you better.  For the lecture that set me on a path to becoming a Gallant asthmatic, I thank you Sahara.  Thanks Sahara.  

Thanks to my Brother Bobby

My brother Bobby once told me I was a useless piece of skin because I was sitting on the couch one afternoon when he wanted me to play baseball.  "Come on, Rick, we need one more person."

I wouldn't budge.  What he didn't know because I wouldn't tell him was that I didn't want to play because I was sick and tired of not being able to breath.  I was feeling sorry for myself that I had asthma. 

A few years later, however, I didn't give him a chance to say such a thing to me.  I played football even during an asthma attack.  I even remember it was Thanksgiving and I kept running in every 5-10 minutes during the second half to use my nebulizer.  

And while you might thing that was stupid of me, I thank him for that.  Instead of allowing me to use my asthma as an excuse he encouraged me to do something.  Because of him I became competitive. Thanks to him I stayed active, something we asthmatics should all do.

Thanks, Bob, you moron.  

Is it LAZY or ASTHMA?

My brother called me a worthless piece of lazy skin once because I couldn't play football with him.  Yet little did he know I was sitting on the couch watching TV because I couldn't breathe.  That was over 30 years ago.

Mom and I sat in a Chinese restaurant with two steaming hot cups of tea between us.  She said, "You were a good kid.  The only thing I remember getting mad at you about was your messy room."

We laughed as we reminisced about some of our fights.  Once mom took an entire drawer and dumped it onto my floor.  She wouldn't let me leave the room until the entire thing was clean.  I wish now that she would have taken a picture of it, because you wouldn't be able to see any surfaces.

When we were finished laughing I reminded mom of one other moment I remember better than all those fights.  "We were sitting at the kitchen bar after dinner.  Dad and my brothers were gone, so it was just you and me.  You said, 'John, I've decided I shouldn't get mad at you about your room anymore.  I was thinking that you spend more time in your room because you have asthma.  Instead of hanging out with your friends and your dad you become involved in creative projects in your room.  You draw and collect baseball cards.  Creative people are messy.'  You said that, and it meant a lot to me.'"

"I said that," she said, smiling.

"Yeah," I said, "And then you yelled at me about my messy room again."  We laughed.  

I think my mom had a point.  Even now as I look around at my desk I see a clutter of papers.  My desk at work is clutters, so it my car and so is my locker.  They aren't filled with a bunch of junk, they are filled with papers and books and things I've written ideas on for writing.  

There's this old saying:  A cluttered desk equals a cluttered mind.  Instead of doing things I've filled my mind with clutter.  In a way, I wonder if this is the reason so many asthmatics report being anxious.  The more you think the more you have to worry about.  Asthmatics tend to do a lot of time thinking.

There are times I feel lazy.  I have felt lazy the past two weeks since I had an asthma attack cleaning my basement.  I am afraid to participate in any cleaning activity, so my house is sort of a disorganized mess. So instead of cleaning I spend my time here on this blog.  

There's another saying that my dad used to say a lot when we were kids.  He said that if it weren't for lazy people nothing would ever get invented.  An example he gave was Louis Sands, a local lumbering millionaire who lived in the late 19th century and early 20th.  

He made a fortune chopping down trees and floating them down the river to the Louis Sands sawmill.    He had a sleigh he rode in the winter and he didn't want to get out of the sleigh to open the gate to his mansion on 5th street.  So he invented this thing where as soon as the sleigh rode over this ramp the gate automatically opened.  It, in essence, was the first garage door opener.

He invented it because he was too lazy to get out of his sleigh.  Yes indeed, lazy has produced a ton of inventions.  The horse carriage was invented by a person who was too lazy to walk, and so was the car.  The airplane was invented by someone too lazy to drive.  The lighter was invented by someone too lazy to take the effort to light a match.

So lazy isn't so bad after all.  Lazy has made the world a better place for everyone.  So the next time someone calls you lazy, just remind them of all the good things that have come about because of lazy people.

I jokingly reminded my brother of what he said to me 30 years ago and he apologized.

"Yet you were right about one thing," I said, "You were right that I am lazy.  I'm a lazy asthmatic.  And that's not such a bad thing."

Reminders...

Reminders are good...

• You still have asthma, it's just been in hybernation
• Your daughter still won't take her asthma medicines, which your reminded of as she starts wheezing and coughing again
• You still like working nights even though you've been on days the past two years
• Your boss is not your best friend, even though she's been kissing your butt lately
• Christmas shopping isn't easy, even though you knew what to buy months ago

Is worsening asthma linked to anxiety?

So I've noticed increased asthma symptoms lately.  In October I had a pretty severe asthma attack at hunting camp and I've had two since that time.  Of course my daughter and two of my coworker friends have been having trouble too lately, so perhaps there's something in the air.

Yet something else I've been thinking about also lately is there's been an increase amount of stress in my life too.  Now that I'm working days my job is twice as hard, and the workload is triple of what it is when I work nights. 

There's also been a lot of pressure from my boss to do all these extra projects, such as I'm a Neonatal Resuscitation teacher and I'm a member of the Keystone Committee.  Plus I'm a commissioner on the local township commission and I was -- by default -- nominated as the chairman.  So there's a lot of stress there.

Now is it all a coincidence that my asthma started acting up as all this stress stacked up?  That's possible.  Yet there is also a ton of evidence that links increased stress and anxiety with asthma I can't help thinking about it.

A case in point was mentioned by Andrew Harver and Harry Kotses in their book "Asthma, Health and Society," (2010, New York, page 315).  They mention several studies that link asthma with anxiety and depression, and that link increased stress with worsening asthma.

I've mentioned on this blog a few times that I'm not afraid to say I have social phobia.  I've been diagnosed on more than one occasion with anxiety disorders.  I've been treated too.  Something I'd like to delve into at some point in the future is my medical records where my psychologist when I was a kid wrote how I had anxiety and how it made my asthma worse.

If you met me you may never know it.  I'm not the kind of person who sits in a corner.  Obviously, otherwise I wouldn't have been elected to the commission, and I wouldnt be chair.  And I wouldn't be able to be a teacher in front of classes.  Perhaps therapy helped me there. Or perhaps common sense helps me there. 

Now I wouldn't want to bore you with the details nor embarrass myself for that matter, yet I think this is significant because these studies match up almost to a tee with my own experience with asthma and anxiety and stress and depression.  Coincidence?  Perhaps.  Yet I think the evidence is stacked too high to ignore it. 

And of course there's no way of knowing whether increased stress and anxiety results in worse asthma or the other way around.  Yet I'm digressing.  I'd like to get back to the book I mentioned above and the studies. 

I'm just going to quote the book here and then I'll leave it at that and you can tell me what you think. Of course we know that the link between asthma and psychosocial disorders goes all the way back to written records way back in 200 B.C. 

"The late 19th century and early 20th century William Osler viewed asthma as a 'neurotic affection' in which imbalances of the nervous system and emotional factors played a fundamental role.  Since then a growing # of studies have provided evidence of a link between various psychosocial factors and asthma. Data from both clinical and community settings suggest that psychiatric disorders, and mood and anxiety disorders in particular, are disproportionately more prevalent among asthmatics relative to the general population.  Point prevalence rates of anxiety disorders (eg. panic disorders, general anxiety disorder and social phobia) and mood disorders (eg. major and minor depression disorder) are especially high among asthmatics, ranging from 16-25 percent for anxiety disorders.  One recent study indicated 31% of asthmatics meet criteria for one or more current mood (20%) or anxiety (23%) disorder.  Rates of certain disorders (i.e. panic disorders and major depressive disorder) are as much as six times more prevalent among asthmatics relative to the general population. 

He also notes the following:

• Studies also link increased psychological stress to increased asthma morbidity
• Studies observed symptoms of anxiety and depression have been associated with increased asthma severity, increased use of ER visits, increased symptom reporting, poorer PFTs, and lengthier hospital stays
• Increased anxiety results in poorer adherence to medicine, etc. (this was my problem back when I was admitted to the asthma hospital in 1985)

Henry Hyde Salter was a doctor who wrote several articles and a book in the mid 19th century, and he was convinced that certain stimuli (dust, stress, etc.) stimulated the obdulla oblongota and a message was sent down the pneumogastric nerve to the bronchiole muscles causing them to spasm.  This was why he termed asthma a nervous disorder.  He made this theory mainstream.

The nervous asthma theory made it through great medical minds like William Henry Osler and Frances M. Rackemann, and wasn't debunked until the late 1950s.  Still it was followed by many doctors until the 1980s. 

Yet I still believe there is some truth to the asthma neurosis theory.  I denied it when I was 15 and my psychologist told me I had an anxiety disorder.  I denied anxiety.  I denied it all.  Yet the wiser 40 YO me knows better.  I'm convinced the allergic response doesn't just cause inflammation of the air passages, that it also causes inflammation somewhere in the brain that results in anxiety, social phobia and/or depression.

That's the Rick Frea theory.  Increased inflammation in anywhere, when it lasts long enough, becomes permanent.  This is what asthma is, so experts now beleive.  So could there also be inflammation somewhere in the brain?  We don't know? 

I do PFTs on myself every month at work for fun.  I've noticed my FEV1 had dropped some in the past year, the same time stress has increased.  If you look at the flow volume loop you can see the obstructive pattern on expiratory portion of the loop.  So is this a result exposure to too many other asthma triggers like dust and campfires, or is there some phychosocial issue going on?

I may be way off base and you can tell me so if you want.  Yet it's interesting anyway. It's just a frivolous though perhaps. 

How to get kids to take systemic steroids?

Now I certainly hope you didn't click on this post thinking I was going to provide tips on how to get your kids to take their medicine.  This post is exactly the opposite.  If anything, I'm seeking advice.

Yet I don't think there really is any way to coax a three-year-old to take a steroid liquid, or a steroid pill, both of which taste -- to put it into the words of my daughter Mrs. L. -- "Yucky!"

The steroid shot worked the best.  That shot cured her.  On Monday she took the liquid.  On Tuesday she said it was, "Yucky!"  Yet she drank it.  On the third day she refused.  On the 4th day she refused. 

It's not like you can force a liquid down a kid's throat, because they have the ability to spit.  Then there's the concept of traumatizing a kid.  I'm of the belief if you force a medicine down their throats you'll compromise any future effort to get them to trust you to take any medicine. 

Yet I could be wrong.  I probably am wrong.  What I do know is during her nap today she was coughing again, something she hadn't been doing since the shot on Sunday.  And when she woke up she was wheezing and tight.  And she willfully took a breathing treatment, something she only does when she needs one.

So that brings us back to the steroid.  How do you get a kid to take a steroid?  Dave the pharmacist is going to give us some steroid pills, and the idea is maybe we can crush them and put them in Mrs. L's applesauce. 

Yet Mrs. L. is a light and picky eater.  Hm mm.   We'll just have to wait until this plays itself out.  It would be all the easier if some asthmatic dad didn't give the girl his bad asthma genes.

My daughter's asthma attack, and the arrogant doctor

My daughter, Mrs. L, all three years of her, was introduced to the asthma beast this past week.  She required a breathing treatment a few weeks ago and it worked like a charm.  Yet last weekend the asthma beast struck with a vengeance.

She woke up in the night coughing.  I gave her a breathing treatment and it seemed to work.  Yet the next night she was up crying.  I entered her room and she was sitting up in bed.  It didn't take much convincing for her to let me carry her to the living room.

The nebulizer -- the community nebulizer for my family -- was already set up next to the recliner I set in with her.  I grabbed an amp of Albuterol and squirted it in, and revved the machine to life.  You can always tell when a kid benefits from a bronchodilator because she sits through it. 

Yet the treatment did little to relieve her coughing.  I sat up with her for an hour watching some old cartoon I can't even recall what it was.  Quite frankly I don't think she did either.  In fact, we didn't even have the sound on.  The vision of a toon was all that was needed to placate my daughter.

I was emotionally into this, because I could remember vividly sitting up in bed all night long when I was a kid not being able to breathe, and my parents had no clue.  It's not like they didn't care, they just didn't know.  I didn't want my child to have that scar, so I doted her.

The next day, Sunday, my wife or I had to give her a breathing treatment every few hours.  She probably could have used one more frequently.  Yet it was enough for us to realize she needed more than bronchodilators:  she needed systemic steroids.

Her doctor was out of town, so that posed a problem.  If she was in town we would have called her and she would have written a script for prednisone.  She knows me and my wife.  She knows I'm an RT and a lifelong asthmatic.  She knows we have a pharmacy here and everything except steroids to keep an asthmatic full of fresh air.  Yet she was out of town.

Dr. B. is a new doctor and I've worked with her enough to be impressed with her.  Yet she said she wasn't familiar with Mrs. L enough to just prescribe something over the phone.  So she recommended we take her to the ER. 

This posed a dilemma. Surely we had no problem taking her to the ER, but my wife and I both know that a trip to the doctor's office usually results in an assessment and a quit treatment of the cause of the problem.  Then you go home and that's that.  You get better. 

Yet if you go to the ER they have to do a bunch of stuff just to cover the butt of the doctor.  Labs will be drawn, an x-ray will be given, and an IV will be put in.  We mentioned this to Dr. B. and she said she'd call the ER doctor with her recommendation.

Great!  Or so we though.  The ER doctor was pissed that Dr. B called her.  The ER doctor was condescending and arrogant to my wife.  She said something like, "It doesn't matter what your doctor said.  I'm here and I'm assessing your daughter.  I have to do what I think is needed.  Dr. B. is not here."

My wife said she wanted to walk out the door right there.  If her daughter didn't need the steroids right now that's what she would have done.  And this is the hospital I work at.  The nurses tried to take a pulse ox on my daughter's food, and my daughter said, "Go away!  Leave me alone!"

My wife said, "Why don't you guys leave and I'll get a pulse on on her finger."

Yet they insisted on getting a pulse ox on her foot.  Here my daughter, my shy daughter who is deathly afraid of people, has five nurses holding her down to get a pulse ox.  My daughter cried and fought vehemently. Good for her.  I wish she would have fought harder.

The doctor peeked her head in at this time and said, "Well, she's crying.  So she must be breathing fine."  My wife responded, "Wait for her to stop crying and you'll see she's retracting and her fingers are blue."

The doctor left.  The nurses left.  My wife got a pulse ox reading in about 2 seconds once they were out of the room.  My daughters oxygen saturation of 82%.  That's not good.  And this all happened in triage.  When she finally got to her room my wife had to fight off the impulse of the doctor to insist an IV and labs be drawn.  Yet my wife stubbornly resisted.  I am proud of her.  "All she needs is steroids," my wife insisted.

The doctor was pissed.  She listened to Mrs. L. with her stethoscope.  She said, "She's wheezing.  She has inspiratory and expiratory wheezes.  Inspiratory wheezes are the worse kind.  You should have come in sooner.  If you need to give treatments every two hours you need to come to the ER."

My wife rebutted her comment:  "We did come to the ER."  And she probably thought, "You dumbF#$@!"  I know my wife thought that because I know my wife.  Yet I bet that doctor would doubt me. 

The doctor prescribed a steroid drink, and my wife said Mrs. L. won't drink it.  The doctor said, "We'll mix it up in a pop and she won't even know the difference."  My wife said, "She's never had a pop in her life, so she probably won't even know what pop is.  She won't drink that."

So you can see this made for an interesting visit.  Finally my wife said, "She's not going to drink this stuff.  Let's just give her the shot and get it over with."  Five nurses held Mrs. L. down, and she didn't even fight.  Later that night she said to me at home, "Daddy, I got a shot and I didn't even cry."  She smiled.  She smiled because she knew the shot made her better. 

Yet. Steroids work on asthmatics in my family.  We don't need labs and xrays and IVs and all that unnecessary stuff.  Surely if the steroids didn't work you can look for something else. 

My wife said the nurses were great.  Later I talked to one of these nurses about that doctor, and she said the doctor has to cover her butt.  Yet I said, "A doctor should also respect the wishes of the parent.  A parent knows her child more than a doctor does.  Not to disrespect the wisdom of that doctor, yet she really needs to respect the parents, especially when the parents are a nurse, and an RT who is a lifelong asthmatic.  It's not like there's no experience here.  We're not your typical ignorant parents."

This is exactly the reason I never go to the ER when my asthma acts up.  The last time I was an ER patient they took me off my theophylline and almost killed me.  Eight days later a different doctor put me back on my theophylline and I miraculously got better.  So if you have asthma, and you know what works for you, and the doctor wants to do something totally different, who's right? 

That steroid shot gave my daughter almost instant relief.  She ran around the living room that night the way I'm accustomed to seeing her, all happy and cheerful.  In the end, that's what's most important.  As far as the rotten ER doctor, she was a rental doctor and both my wife and Dr.B. reported her arrogance to the powers that be.