1940-1970: The decline and return of TB x

By the 1940s there were a variety of antibiotics that allowed physicians to control most cases of tuberculosis. For patients that seek medical attention and follow the prescription of their physician, tuberculosis can be controlled and even cured. By 1969 it seemed that the disease had been conquered, and attention was diverted from it.

It seems to be normal for human beings to forget that of which they do not see. When we don't have a war for a while, we tend to assume one will never occur again and we cut our military spending. When a war occurs, we usually aren't prepared. The same can be said of disease. When we go years without a plague, we assume the disease is cured. When the plague strikes, we aren't prepared. A perfect example of this is the Spanish Flu of 1918.  

There was a friend of mine who often said that we ought to have a war every ten years so we don't forget that freedom comes with a price. We should have a plague every so often so that we don't take these diseases for granted. Surely we don't want wars or plagues, but my friend had a valid point.

By the 1930s and 40s sulfa drugs and antibiotics were discovered as a means of treating infection. These and other medicines allowed physicians to effectively treat and even cure tuberculosis. This decade saw a rapid decline in the number of tuberculosis patients.  

According to Elaine Landau, in her 1995 book "Tuberculosis:"

As late as 1969, the federal government was still channeling annually more than $20 million in TB project grants to local clinics and hospitals throughout the nation. But the declining TB rate made people feel that the crisis was over. So when the government began giving blocks of aid to states and municipalities to be used at the areas' discretion, the funding generally was not expended for TB controll. 

As time passed,countless successful TB programs were dismantled. In New York City alone, more than one thousand beds formerly reserved for TB patients were eliminated from municipal hospitals. Although outpatient services were supposed to be established to ensure the disease's continued decline, these were never made available. Instead, funding was diverted to meet more immediate needs. As one physician who's treated numerous TB victims described the situation, "We knew how to cure it. We had it in our hands. But we dropped the ball. (1, page 3, 4)

Once the "ball was dropped" it was difficult to pick it up again. Organizations with the ability to provide methods of preventing the spread of such diseases, such as the Centers for Disease Control and Prevention (CDC), were not provided with enough funds to effectively perform this task. (1, page 34)

In 1989 a plan was made to provide the CDC with $30 to $34 million dollars to create a TB control plan. Yet the plan was never made "because each year that it was proposed, the White House eliminated its funding from the budget." A similar plan was proposed in 1993 to offer $484 million for TB prevention, but the budget was cut by the Clinton administration to $124 million before it was sent to Congress. So the return of a disease that once ravaged a nation was greatly ignored by Reagan, Bush and Clinton. (1, page 35)

What may have opened the eyes of the government was the AIDS epidemic that struck during the 1980s. Studies showed that with weakened immune systems, up to 50 percent of AIDS victims were developing tuberculosis, and were unable to fight it off. This is one reason tuberculosis spread through prisons and homeless shelters rather fast, particularly in cities like New York "where nearly one-fifth of prison inmates have TB, but none of the jails have separately ventilated cells for contagious cases." (1, page 35-37)

To make matters worse the TB bacteria has the ability to mutate to create drug resistant strains. This occurs when people who are given antibiotics, which are proven to cure TB if used properly, were not taking the antibiotics once they started feeling better. Effective treatment usually takes 6-9 months, but many would stop taking it within weeks.

Landau also said that "this is actually worse than not taking any medication at all, because over a period of time the illness no longer responds to any form of medication, and they have, in fact, dissipated the drug's effectiveness... Unfortunately, significant numbers of people have misused their medication this way. The tendency to do so appears to cut across racial, class, and economic lines." (1, page 39)

Studies show that up to 50 percent of TB patients do not take their medicine as prescribed, and that 14.1 percent of TB cases responded poorly to TB medicines. Studies also showed that TB resistant strains have a 50 percent mortality rate. (1, page 39-40)

References:

1. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Toronto and Sydney, Franklin Watts 

1865?: Dr. Nelson's inhaler

Nelson Inhaler with glass mouthpiece

By the mid 19th century various methods were invented for the inhalation of medications through steam.  One such device was the Nelson inhaler, which ultimately became one of the most popular inhalation devices.

Spencer Thomson described the inhaler in his 1866 book "A dictionary of domestic medicine and household surgery."  He said:

Dr. Nelson's improved earthenware inhaler, an apparatus for the inhalation of  ether, chloroform, henbane, creosote, vinegar, etc., in affections of the throat and bronchial tubes, asthma, consumption, etc. (6, page lii)

John M. Scudder described it in his 1867 book "On the use of medicated inhalations, in the treatment of diseases of the respiratory organs."  He writes:

 "The most efficient apparatus for the inhalation either for simple steam or of medicated vapors... It is constructed of earthenware, and, in addition to its complete adaption to the purpose for which it is intended, possesses the triple recommendation of cleanliness, portability, and cheapness."  (1, page 22)

The inhaler is manufactured by Maw & Son of Aldersgate St., which was later changed to Maw, Son, and Thompson.  Dr. Nelson's name with directions were on the side of the inhaler.   The inhaler was commonly sold and used for many years, sold by various manufacturers who made slight adjustments to the design.  (2, page 258)

The Nelson inhaler was called "New and Improved," perhaps because of the unique design and that it's small and relatively portable compared to other inhalers, or tea pots.  Below is a news clip from the February 11, 1865, edition of the Medical Times and Gazette:  (3, page 160)

1700-1900: Influenza wreaks havoc

The beast that we now call influenza went on a brief hiatus during the 18th century, yet that vacation did not last long.  During the 19th century the best woke up and started wreaking havoc once more.  It showed it's devastating symptoms again and again (1, page 33)...

• 1729-30
• 1732-1733
• 1781-1782

From this century on the influenza beast would show up at least three times every decade, causing havoc all across the globe.  Surely few people died, yet the misery it created, and the fear that you could die, disrupted cultures and economies world wide.  Like the beast consumption, the beast influenza was a beast that affected nearly every person in the civilized world.  

The cause of these frequently occurring pandemics was the industrial revolution.  Where most people once lived and worked on isolated farms, occasionally making their ways to cities, the industrial revolution caused many people to move to the cities, and to work in crowded, poorly ventilated areas.  This created a breeding ground for the spread of airborne germs, such as influenza and tuberculosis.  

Once you caught influenza, the germ was expelled every time you exhaled.  Making it worse, it was expelled in large numbers every time you coughed or sneezed.  If you weren't covering your mouth, which most people probably did not, you were coughing and sneezing thousands, if not millions, of tiny germs into the air.  In in close proximity, anyone could inhale those germs, quickly spreading it from one person to another.  

Influenza set up shop in any person it could.  It did not care what your age was, nor your color.  It didn't care what sex you were, nor your economic status.  If you inhaled it, it went to word wreaking havoc inside your body.  It causes your body's immune system to stake out an all out attack, and the result is inflammation of your respiratory tract that results in:

• Fever
• Achy muscles
• Chills
• Sweats
• Dry, hacking cough
• Fatigue
• Nasal congestion

The disease affected nearly everyone.  It, along with consumption, forced many men and women to become humble.  These diseases were the will of god, and an ignorant society had no way of knowing what to do to prevent one from getting sick.  You simply had to go on about your business and hope for the best.  

It wreaked havoc again in the 19th century, in (1, page 33)...

• 1830-31
• 1833
• 1889-90

It didn't stop there, as it struck again in 1918-1920.  This is the influenza outbreak that we read about the most often, mainly because it was the most recent outbreak.  Many of our grandparents were affected, so in all likely hood your genetic line was exposed to one strain of the disease or another  

So once our bodies fight off one strain of influenza it vanishes.  A society is humbled after the devastation, and many experts write about what had just happened, using a variety of different names to describe the "plague" or "pandemic" or "epidemic."  They use a variety of different names to describe the symptoms of the beast that ravaged the world.  

Yet as soon as a new strain was introduced, it found it's way into a human body, and began, once again, to wreak havoc.  As you traveled from one area to another, the germ went with you.  

References:

1. Kelly, Evelyn B., PhD and Claire Wilson, Claire Wilson, "Investigating influenza and Bird Flu: Real facts and real lives," 2011, Enslow Publishers, U.S., Chapter 2, "The History of Influenza," pages 29-47

Further reading:

1. Hopkirk, Arthur F., "Influenza: It's History, Nature, Cause and Treatment," 1914, New York, Charles Scribner and Sons
2. Kuszewski, K, L. Brydak, "The epidemiology and history of influenza," Biomed & Pharmacother, 2000; 54: 188-95
3. herer check this out too

1778: The Mudge Patented Pewter Inhaler

In 1778 Dr. John Mudge introduced to the world the first mass producible inhaler.  He described it in his 1778 bo0k, "A Radical and Expeditious Cure for A Catarrhous Cough." Please refer to figure #3 as this one is the one in the book that Mudge is referring to.

---

The Mudge Inhaler with mouthpiece missing (figure 1)

Figure I: THE Inhaler, as it appears when fitted for use; except that the Grating (a), which then ought to cover the hole, is now turned back, to shew the opening into the Valve.

Figure II:  A Section of the Cover; in which is shewn the construction of the Cork Valve (b)% and also the conical part (c), into which the flexible Tube (d) is fixed.

 A Section of the Cover; in which is shewn the construction of the Cork Valve (b)% and also the conical part (c), into which the flexible Tube (d) is fixed.

When the Inhaler, which holds about a pint, after being three parts filled with hot water, Is fixed at the arm-pit under the bedcloaths, the end of the Tube (e) is to be applied to the mouth; the air, in the act of inspiration, inspiration, then rushes into the Apertures (f), and passing through the hollow handle, and afterwards into a hole in the lower part where it is soldered to the body, and therefore cannot be represented, it rises through the hot water, and is received into the lungs,. impregnated with vapour. In expiration, the contents of the lungs are discharged upon the surface of the water; and instead of forcing the water back through the hollow handle, the air escapes by lifting the round light Cork. Valve (b)J so as to settle upon the surface of the body, under the bed-cloaths. 

Plate from Mudge's book (figure 2)

Thus the whole act of respiration is performed, without ever removing the instrument from the mouth.

The flexible part of the Tube (d) is about fix inches long, fitted with a wooden mouthpiece (e) at one end, and a part (g) of the fame materials at the other, to be received into the Cone (c) on the cover. This flexible tube is made by winding a long slip of silk oil-(kin oil'skin over a spiral brass wire. This should be then covered with one of the fame size, of thin silk, and both be secured by strong sewing silk wound spirally round them. Some length and degree of flexibility is necessary to this tube, for the fake of a convenient accommodation to the mouth when the head is laid on the pillow

Care should be taken by the workman, that the cover should be made so as to fit very exactly; or, if k does not do so, the defect should be remedied by winding a piece of cotton wick, or some such contrivance, round the rim underneath the cover, so as to make it airtight. The Cork, likewise, which forms the Valve, should be made, for the above reason, as round as possible. It is also necessary to remark, that the area of the holes, on the upper part of the handle, taken together; the size of the hole in the lower part of the handle, which opens into the Inhaler; the opening of the conical Valve itself; and that in the mouthpiece, as well as the cavity or inside of the flexible Tube, should be all equally large, and of such dimensions, as to equal the size of both nostrils taken together: in short, they should be, severally, so large, as not only not to obstruct each other, but that respiration may be performed through them with no more labour than is exerted in ordinary breathing.

   It is necessary to observe, that care should be taken, when the Inhaler is in use, that the ingress and egress of the air through the holes on the top of the handle, and those in the grating on the cover, should not be interrupted by the bed-cloaths.

Indications:  Dr. Mudge recommended the inhaler for catarrhous cough.  

Medications:  Opium, Benzoil, Camphor, other

Purchase:  The inhalers are to be purchased of fW. Barnes  Pewterer, No. 157, Fleet-Street, by particular Appointment of the Author.  

A sample of a 19th century version of Mudge's Inhaler (It is rare to find one with an intact mouthpiece)(figure 3)

Reference:  

1. Mudge, John, "A radical and expeditious cure for a recent catarrhous cough: preceded by some observations on respiration with occasional and practical remarks on some other diseases of the lungs," 2nd edition, 1779 (original edition was in 1778), London, printed by E. Allen, Fleet Street, from the opening pages of the book.  

1985: The flow of 2-may

Life was different on 2-May than it was on 7-Goodman.  After the first two weeks passed, and after my depression, I wrote in my journal: 

"Actually, 2-May is better than 7-Goodman in that you are able to move around the hospital more, and you can even get passes easier to go off campus, even by yourself.  It's much more like real life.  We can go outside to ride bikes, and we can even ride our bikes to the park across the street, something we did nearly every weekend.  We can also go to the store across the street, something I don't generally do.  The rule here is in order to leave the campus you have to have an adult escort, which isn't hard to do. While on 7-Goodman you had to get permission from one of the nurses to leave 7-Goodman, on 2-May all you have to do is sign out and you get to go wherever you want.  So it's much easier to visit 7-Goodman when you live on 2-May, than it is to visit 2-May when you live on 7-Goodman.  And considering the kids on both floors are the same age, most of our activities were done together, so many of us have friends in both places."

For a while I forgot about my friends on 2nd or 3rd Goodman (or maybe it was 4-Goodman), and one day I went over there to visit my COPD friends.  The guy was discharged, but my lady friend was still there.  Now that I was on 2-May I visited her more often.  I didn't spend as much time with the nurses there anymore, I just spent time with this patient.  I have no memory of what his name was.  In fact, I don't know that I ever knew it, as remembering names is not one of my strengths, never has been.

As the weather warmed up we spent more and more time outside.  We rode bikes, rode them to the park, and we played baseball.  I had a friend on 7-Goodman who was a couple years younger than me.  His name was Jeff, and he was from Chicago.  My other friend, Tim, was discharged to home, so now I spent all my free time with Jeff.  He was an avid Cub fan, perhaps as good of a fan as I as a Tiger fan. We went outside to play catch nearly every day.  I made my way to level 4 on 2-May, so I was able to escort him to outside.  I usually had to go up to 7-Goodman and sign out with him from there, unless his mother as visiting.  If she was there, she'd sit on the picnic tables outside and watch us.

These were the same picnic tables mom had me sit on one day and she cut my hair during one of her visits.  She was too cheap to take me to a barber.  I remember being embarrassed that my mom cut my hair, and I never let her do it again.

There was another kid who was from New York, and his name was Chico.  I think he used that name because he loved Chicago.  He was a unique kid, who looked and acted like a Hippy.  He even listened to music from the 60s.  He was different, but for some reason he was hanging around me when mom visited with her sister Clara, and mom invited Chico to go with us.  It was a nice day as we went to the Capital of Denver, and walked around a park downtown.  It was one of the nicest days of the year so far.  I remember lying in the grass with Chico, mom, and Clara and staring at the blue sky.  I closed my eyes and thought of how nice it was to be off campus with my mom and my aunt.  I wished I could just go home with mom.  But my counselors and psychologist didn't think I was ready.

And that sets up a post about my psychologist named Casey and my Counselors.  I loved my counselors, but I hated Casey.  Yet as I reminisce, I'd like to

1985: The flow of 7-Goodman

I wrote in my journal on my second day at National Jewish that "the only thing that makes this place seem like a hospital are that the nurses and doctors wear stethoscopes over their shoulders."  The seemed to have gone out of their way to make our stay at the asthma hospital as much like home as possible.  

Our day was highly structured, and I'm confident the reason for this was to keep us busy so we didn't get homesick and so we didn't get into trouble.  I remember being homesick quite a bit the first week, but there was so much to do there was little time to think about it.  And before you knew it, you were so comfortable around the place, with the people, that it was as much as home as your home was.  

Most of our morning medicines were due at 6:00, and we had a half hour leeway.  That meant we had to take our medicine between 5:30 and 6:30.  The first day I woke up at 6:00 and had to wait in line for the nebulizer, and I got into trouble because I didn't get my treatment finished before the deadline.  

Plus I was a little nervous around all the kids, most of whom I didn't know yet, so I opted from then on out to get up at 5:30.  This turned out to be great, because it was just me and one other kid who got up that early.  It also allowed me time to get to know the night shift nurses, one of whom was Pat, who would later become a major asset for me.  

Then breakfast came.  There was no TV in the main lounge room of 7-Goodman, so if you wanted to watch TV you had to go into the south room.  Most of the kids didn't go into the TV room before school, and I was one of them.  As soon as I was done with breakfast I left for school.  One of the rules of 7-Goodman is any time you leave the floor you had to sign out, and we had the "buddy system" rule:  you had to go with someone.  

I had to follow this rule because I was on the bottom level, level one, of the behavioral chart, because all new patients had to start there.  Once I made my way to level four I could be a leader, and I could sign out and go places myself.  That was one of the incentives of good behavior.  Once I made my way to level four I was one of the kids sought out when one of the newer kids wanted to leave 7-Goodman.

So we went to school and traveled through the tunnels under the campus.  The Kunsburg school was in another building, but thanks to the tunnel we never had to go outside.  Although we could go outside if we wanted, so long as we didn't leave the campus.  I think it was around February it got so cold, a blizzard struck, that we were ordered not to go outside  This was because cold air is a major contributor to asthma.  

After school we had free time.  This was when we sat around the tables in the lounge and did homework.  I usually took this time to sit in my room and write in my journal.  Okay, so I used some of it to do homework, although I wasn't the most disciplined person with my homework.  However, as time went on Mr. Rose spent a lot of time working with me during school hours, and I ended up getting all As on my last report card for the year.  That was something I did only once before, and it was in the sixth grade, and only because Mr. Anderson spend a lot of time with me.  

Of course there were other things we could do.  We could watch TV in the TV room.  We could play pool.  We could socialize (something I wasn't good at and still am still not).  Or we could scuffle, something that didn't elude me.  

Around 5:00 p.m. it was dinner time.  I remember sitting around some evenings starving and waiting for dinner to arrive.  And most of the meals were pretty good. Earlier in the week the nurses usually sat down with us and let us pick what we wanted for each meal during the weak.  Sometimes I didn't like any of the choices, but most of the time it was pretty good.  

Oh, and of course we had to remember when our medicine was due and go to the nurses station.  I supposed the nurses station was the only other thing in here that made the place look like a hospital.  Yet the nurses were very friendly, so that kind of offset the setting.  

Most of the patients didn't like Lee, but I really liked her. She was a nurse who was really strict, although she loved to give hugs.  I think I liked that she was strict, and I really enjoyed her as my nurse.  I guess I just needed that.  And boy did I love her hugs.  I remember the three biggest hugs she ever gave were when I was lonely after my mom left, when I was supposed to go to 2-May, and when I was going home.  Of all the nurses I thought I'd miss, Lee was one of them.  

My nurse was Kathy.  She's the one who sat down with me to make a list of my medicine and added the new ones and crossed off the old ones.  She created a list of all these and what times they are due.  It was her job to make sure I took my medicine.  It was her job to make sure I understood all my medicine.  She created a variety of note cards, and on each one she listed: the medicine, brand name, generic name, side effects, action, doses, frequency, and why I was taking it.  It was my job to memorize all of them.  My incentive was a trip to Dairy Queen, compliments of her.  

After dinner we had free time again until about 6:30 or 7:00 when we had to go back to the school and to either the gym or the pool.  In the gym we started with stretches, and then 20 minutes of aerobics.  We were encouraged to keep our legs moving, no matter what activity we did, whether it was basketball, volley ball, kick ball, or whatever else we did.  After aerobics were played a game of something, if that game wasn't incorporated into the aerobics session.  

On other days we went to the pool and had a vigorous workout.  We were told that pools were the ideal place for asthmatics to exercise because you could get a workout just my trudging through the water.  I remember one of the activities we did for aerobics was race back and forth, and I always lost because I was among the smallest kids.  Although I was always worn out by the end.  

At first my asthma would act up during aerobic activities, although as my asthma got under better control I was able to participate more freely.  Although I was encouraged to pace myself, I was scolded if I didn't work hard enough.  They pushed you to the limits regardless of how bad your asthma was, and excuses were never excepted.  However, they also made sure you took a time out when your asthma was acting up.  

We walked down the tunnels back to 7-Goodman, usually too worn out and tired to complain.  Back on 7-Goodman we took our nighttime medicines and then we had free time until bedtime.  I think bedtime was 9 or 9:30 unless you were on the higher levels, than I think it was 10:00.  This was a time that we participated in various activities, which included playing games with the nurses.  They would take time out from their busy schedule to play games.  One common one we played was spoons.  I can't remember how to play this game, but I know it sure was fun.  

Another thing the nurses did was stage activities for us.  I remember some of the kids participated in an talent contest, and the girls sang, "Girls just wanna have fun."  They were good, and I had no choice but to vote for them even though I was cheering for the guys.  The nurses also held an occasional meeting where officers were chosen.  I remember one time I ran for president, and lost in a close election.  Because I lost I have no idea what the role of officers was, beside representing us kids when rules and discipline was made.  

Then it was time for either studying, TV or bed.  I remember sitting in the TV room with Tim.  He was my best friend while I was on 7-Goodman.  He was 18, and he loved science fiction.  One of the shows we watched most often were old episodes of Dr. Who, or any old TV show.  He knew all the old actors, and perhaps it was him who got me interested in movies and such.  We also sat around and played chess, and he beat me nearly every game.  He was pretty smart  

I don't know what ever came of him.  I remember on the way to an out of town adventure, on the bus, I sat next to him, and listened to him tell of his dreams for his life.  He said that he was working on the fourth Star Wars movie.  He had the story all worked out in his head.  Plus there as another movie had made up in his head that he told me about.  I'll have to look it up and write it down here.  I Googled that movie recently, and never found it.  I also looked in the credits of the fourth episode of Star Wars to see if I could find his name.  I never found it.  

The first two weeks on seven Goodman were the busiest, as this was when you had to go for all the testing, and meet your social worker, psychologist, and all the other people who do all the tests. Of course you also had to meet all the nurses, PE instructors, nurses assistants (like Pat on nights) and all the asthmatic kids.  After that you started to feel more comfortable, and the place started to feel more like home.  Tests were less often, and you could be a normal kid doing normal things.  

I remember I would leave 7-Goodman at times to go walking around with my friend Dean.  We were both good Christians, so we looked for a church.  We were told there was one somewhere on campus.  We also looked for a workout room, considering we were on steroids we might as well work out.  

At some point I had to sell tickets for something.  Later on in life, and perhaps before 7-Goodman, this was something I'd hate to do.  But at the asthma hospital it allowed me an excuse to get away.  It gave me something to do.  I don't remember what the tickets were for, but I remember one of the places I made my way to was the adult section of the hospital.  I remember spending time with the nurses there, and they made me feel really comfortable.  So later on I would make special trips just to visit them.  Sometimes, if they were slow, we would play games.

There were a couple patients there, both on oxygen.  As I look back I think they were COPD patients, the same type of patient I take care of today.  I got to know them really well, and I would often travel down to (was it 7-Goodman or 3-Goodman) visit them.  I remember that every time I'd walk into their rooms they would smile.  They loved to see me.  Whenever I was feeling sad I would go to visit them and every time I'd leave in a better mood.  

References:

1. Frea, Rick, "My Stay at National Jewish Hospital, "1985, Denver, Colorado

20 years later I realize my dad was right about asthma dyspnea

When I was about 18 I became very winded after playing a game of basketball.  I sat down on a chair next to my dad, leaned forward with my palms resting on my knees to keep my shoulders high to breathe, and I said, "I'm out of shape."  My dad, being the sound and reasonable man he is, said, "You are not out of shape; you have asthma."

"Dad," I said, once I caught my breath.  "I'm this way because I haven't exercised in a while."

He said, "I never exercise, and I don't get that winded.  You're that way because you have asthma."

Now, let's fast forward to 2012.  I'm really out of shape now, and I feel like a fat, bloated pig sometimes.  When I get this way I almost always feel dyspneic to some degree.  I, therefore, blamed my asthma on being out of shape.  In other words, I completely forgot what my dad had said.

Last weekend, however, my asthma got really bad, and I needed to be placed on systemic steroids.  Now that they have kicked in and I am still on a high dose, I am still out of shape, and I do not feel dyspneic all the time.  It was sitting around thinking of this that I remembered what my dad said: "You are not out of shape; you have asthma."

It took over 20 years for what my dad said 20 years ago to sink in.  All these years I've been exercising just so I could breathe better.  When I was in good shape, I breathed good.  When I was not in good shape, my breathing got bad. But my dad's point was that I shouldn't have to exercise just to breathe normal; your breathing should always be normal. 

Talking to a great asthmatic friend (Mr. (Dr.)Stephen Gaudet, he reminded me that the reason that I'm probably a little short of breath all the time is because I have bronchospasm and air trapping in the smallest air passages probably all the time.  For this reason, my steroid inhalers can't get that deep to help get rid of this inflammation.  For this reason, my peak flows, even my PFTs, can be relatively normal even when I feel mildly short of breath.

The reason I'm thinking of this now is that I'm just as out of shape today as I was last week when I started getting sick.  I am not dyspniec with any bit of exertion, thinking I'm that way due to being out of shape.  Instead, I just feel normal.  Now, surely I still get short of breath every few hours and require my rescue medicine, but I do not, at present, feel out of shape out of breath (have I lost you yet?)

Now, even though I have not done one iota of exercise the past week, I do not feel out of shape dyspnea, even to a light degree, with exertion.  I go up and down stairs, and I feel fine.  I run a short distance, and I feel fine.  My asthma might act up a bit at times, but I don't feel that out of shape dyspnea. 

So was my dad right?  I'm thinking that he was.  He's not even a medical person, and he figured that out way over 20 years ago.  I guess the reason I denied his brilliant idea was because I have never lived a day in my life with normal lungs, in shape or out of shape, and my dad has.  My dad is one of those lucky guys who has smoked his entire life, and has managed to breathe easy his entire life.  Great man he is.

I'm not worried about my dad's ego going up a notch because he's ego free as I am.