Archive for May 2013

Acute flare-up Day 29

My efforts to post daily have been thwarted by another asthma flare up.  Fortunately I’ve stayed out of the hospital so far this calendar year, but there were a couple times in the past weeks that I should have visited the ER.  I’m currently on my second round of prednisone and feel like I’m riding the Crazy Train.  The good news is I’m actually starting to feel better and I’m lucky enough to have a job that allows me to do work from home.  If you’re also suffering from asthma right now, here are some tips to get better more quickly.

  • Rest – it can be hard to just do nothing, but sometimes that’s what you need to do.  It’s not always possible to stay home from work or have someone else take care of things, but try to at least slow down.
  • Lots of fluids – water is important by itself, but can really help make a difference for asthmatics.
  • Avoid irritants and allergens – try staying in doors and limit outdoor activities.
  • Seek medical attention if necessary – when my oxygen saturation gets low, I acquire something called “asthma brain.”  I can’t seem to think clearly and make poor decisions.  Make sure there’s someone around to check up on you and don’t be a hero.  See the doctor if necessary.

I’m hoping to make a full recovery soon because I have a film festival to attend in July.  The Dude abides.

Asthma Intervention

I’ve watched nine seasons of A&E’s Emmy award winning show Intervention.  I know I’m no expert, but I’ve learned a lot about controlled substances and how you’re supposed to interact with addicts.  If I were to personify my lung disease and participate in an intervention for its downward spiraling life choices, the first episode that comes to mind is Allison** who huffed compressed air.

 

I'M WALKING ON SUNSHINE!

I’M WALKING ON SUNSHINE!

 

Dear Asthma,

I’m here today because I love you and care about you.  The happiest day of my life was when my doctor diagnosed me with lung disease and prescribed some inhalers.  I felt almost instant relief and had an excuse to why I constantly felt like crap and why people thought I was always in a bad mood.  You gave me an immense amount of trouble all through high school, but we made amends and had a good run during college.  Seven years ago your bad choices came back and started severely limiting my quality of life.  This is why I want you to accept this wonderful gift we have to offer you today.

Asthma, your addiction has affected me in the following ways:

Towlie Getting High on Computer Duster

  • Every time I make fun of someone on TV or in a movie who is only bench pressing 95-115lbs, you remind me I haven’t been to the gym in a year.
  • If I laugh too hard at something hilarious, you give me a coughing fit.  Stoicism is harder than it looks.
  • I used to love blowing stuff up.  Remember that one winter we buried all those firecrackers in snowbanks and watched them soar?  You’ve made me so reactive to any smoke I can’t even attend a bonfire or stand next to a cookout most days.
  • You ruin vacations and holidays.  Last year you made me so sick at a film festival they gave me an award for hardest traveled.
  • I spend 25% of my net pay on you for doctors, treatments and prescription drugs.  That doesn’t even account for all the Mt Dew and Dr Pepper.
  • I carry a bag full of medicine everywhere I go and my friends call it a man-purse behind my back.
  • At night you give me sharp pains in my left lung and make it hard to breathe.  I often stay up all night watching Netflix.  You had my sleep patterns so messed up in 2010, I completed a 28 movie marathon in less than two days.
  • And I’m not even able to regularly post on my blog every week!

What happened Asthma?  You used to be cool.  Yeah you held me back a bit, but the medicine always kept me going.  I care about you, Asthma.  This is why we’re providing you an opportunity to…

Asthma bolts for the door while the moderator sends the film crew to chase it into the hotel parking lot.  We should have seen this coming.

**Cause we all know Asthma would mimic the Mad Hatter

Breo Ellipta approved

About a month ago I found an article saying the FDA was favorably looking at a new drug called Breo Ellipta.  It appears they’ve approved it so it’s just a matter of time before someone you know will be on it.  It is important to note this has not been approved for treating asthma.  The other big Asthma/COPD players are Advair and Symbicort.  I think Dulera has only been approved for Asthma.

The one big difference I noticed about Breo Ellipta is the once a day dosage, similar to Spiriva.  Most combo inhalers require twice a day doses and patients often have a hard time following doctor’s orders.  I still haven’t seen a picture of what Breo Ellipta looks like, but am guessing I’ll see a poster soon enough in a doctor’s office.

Random Access Memory

If you weren’t already aware, Daft Punk’s new album is available for streaming through iTunes.  I’ve been a huge fan of the group since the 90s and was excited to get a peek at their new music before the official release date.  I’ve seen people complaining about the new album, but doesn’t this always happen when fans become more attached to a few songs than the artist’s entire work?  If you’re interested in this new album, definitely check out the free preview before spending your money.

Hospital charge masters

If you’ve ever spent time in an Emergency Room, Emergency Department or have been admitted into a hospital – you’ve probably heard of something called a charge master.  Every time I hear charge masters mentioned, I think of that South Park episodes where they made fun of Mormon history.  There is neither rhyme nor reason as to what hospitals charge.  I think they have several of those 32-sided dice which they roll and then multiply by a magic number.  It’s ludicrous.

If you didn’t notice last week, the federal Centers for Medicare and Medicaid released the amounts hospitals across the nation charge for the 100 most common treatments and procedures.  I’m not sure which is more shocking – the disparity between prices charged by hospitals or the almost impossible task of actually figuring out what those charges are.  This is one of several major issues with the American health care system that is more concerned with making money than treating and healing the sick or promoting wellness.  If only medical emergencies were such that you could decide what is wrong with you, find the most cost effective hospital and then seek treatment.  Many Americans shudder at the thought of everyone moving to Medicare/Medicaid, but at least then everyone would be charged the same, regulated price.

Oh, you have asthma?

I was co-teaching a seminar the other day in a disgustingly dirty room.  It’s supposed to be the crown jewel of the business college, but I was almost afraid to touch anything.  The allergies and asthma almost immediately revved up and I knew the day might be a long one.  Later in the morning I took a puff off an inhaler from the back of the room and heard one of the attendees say, “…you have asthma?”  “Oh great,” I thought and braced myself for some friendly advice.

Me: Yeah

Lady: Do you have it bad?

Me: Somewhat bad

Lady: I have some breathing problems.  I technically don’t have asthma, but my allergies are bad enough it’s as if I do.  Do you have allergies as well?

Me: Yeah, pollen’s already getting bad this year.

Lady: So do you take medicine regularly?

Me: Yeah, I’m on 13 medications (waiting for that advice on how to be instantly healed)

Lady: I’m on a bunch of stuff too.  I had to have most of a lung removed…

Me: Oh wow! (my eyes probably got big here)

Lady:..there was a tumor and stuff.  Anyway, I feel fine most of the time but my kids always let me know when I’m working too hard.

Me: I know exactly what you mean.

Well that conversation went in an entirely different direction than I thought it would.  Sometimes my thinking is a bit too uptight when it comes to chats about my health.  I felt as though I met a kindred spirit that day.  Someone else with a bad lung who sits in the back row during presentations.

My Bike

At one point in my life I used to say I was an athlete.  I started lifting when I began playing football and for 15 or 16 glorious years I spent a lot of time lifting heavy things and doing cardio.  At my peak I was able to bench press 175% of my body weight and had serious trouble finding dress shirts our suit coats that fit.  Eventually my asthma started becoming a real issue again, I had a bad case of pneumonia, and an even worse moldy apartment experience followed by a toxic work environment.  Things never really got better for me and over the past eight years I’ve slowly been able to less and less physically.  It’s really, really frustrating.

Last year my special lady friend bought me a bike for my birthday.  It sits in my office and I watch TV episodes or movies while riding it.  This tiny bit of exercise that would have seemed miniscule to my 25 year old self is probably one of several things keeping me out of the hospital these days.  I can ride it whenever I want and as much as I want.  It’s the perfect solution to my outdoor allergies and asthma flare-ups.

Sunny SF-B901

The bike isn’t fancy – there’s a seat, peddles and a heavy fly wheel.  I never know how fast or far I’ve ridden, but I really don’t care.  All I’m wanting to do is ride for X minutes.  The heavy fly wheel ensures some momentum and the toe clips allow you to power the bike constantly.  The seat may be adjusted both horizontally and vertically, and the handlebar height may be adjusted.  It is important to properly adjust your bike for comfort and proper riding technique.  At first the saddle, proper term for the seat, seemed quite uncomfortable and I was considering purchasing a more cushioned replacement.  All I needed to do was break it in and occasionally use some chamois cream to prevent chafing.

This bike is better than anything I’ve ever ridden in a gym.  I have averaged 30min or more, three times a week, for the past nine months and there are no signs of wear and tear.  Spending more than $100 on an exercise bike might seem silly, but I can guarantee something cheap wouldn’t last long.

Exercise is important for everyone, but essential for those of us suffering from lung disease.  I love Billy the Kid‘s dialog in Young Guns (1988) where he’s talking about have to challenge himself every day.  You never really stay the same, you’re either getting better or worse.  This can be directly applied to your lung function.  Whether you walk, ride a bike, swim or find some other form of staying active – just do something.  Your lung doctor and your health will thank you for it.

Popcorn

I am passionate about popcorn.  My mom bought me a hot air popper before I left for college, but I soon found it to be too much work in my quest to be more Dude-like.  I quickly gave up and switched to the microwave stuff.  Not too long after I found the demi-god of microwave popcorn and its name was Pop Weaver.

pop-weaver-butter-24

This love affair lasted for years until I decided to start experimenting with popcorn.  That’s right, I busted out my saucepan, bought some popcorn and started doing it from scratch.

The oil you choose to cook your popcorn is important.  Vegetable oil tastes cheap, olive oil tastes fruity, canola oil tastes good but is bad for the environment and peanut oil is king.  Here’s the general recipe I use.

Ingredients:

  • 1/4 cup of oil
  • 1/2 cup of popcorn kernels
  • sea salt for taste

Directions:

  1. Put the oil in a medium-sized saucepan with a couple kernels and cook on medium-high heat.
  2. After the kernels pop, add the rest of the popcorn.
  3. Shake periodically and make sure the steam has a way to get out of the pan.
  4. Place popcorn into a large bowl and season with sea salt.

It’s pretty simple.  Just don’t forget to put the lid on or your popcorn will go all over the kitchen, stick to the measurements and don’t let the popcorn burn.  It’s simple but delicious.  You should give it a try some time.

popcorn

Hot sauce

I like spicy food.  My wife thinks I’ve burned the heat receptors off my tongue because I have no reasonable gauge for how spicy things are.  A few years ago my buddy Bill sent me a recipe for basic hot sauce and since then I’ve altered it a bit.

Jalapeño Hot Sauce Recipe

  • 1 teaspoon vegetable oil
  • 3/4 teaspoon salt
  • 20 fresh jalapeño chiles, sliced
  • 2 cups water
  • 3 cloves garlic, minced
  • 1 cup distilled white vinegar
  • 1/2 cup onion, minced

Directions

  1. In a medium glass or enamel lined sauce pan over high heat, combine oil, peppers, garlic, onion and salt; saute for 4 minutes. Add the water and cook for 20 minutes, stirring often. Remove from heat and allow mixture to cool to room temperature.
  2. Transfer the mixture to a food processor and puree until smooth. With the processor running, slowly add the vinegar.
  3. Pour into a sterilized jar with a tight lid. This sauce will keep for 6 months when stored in the refrigerator.

Recipe Source – http://allrecipes.com/Recipe/Jalapeno-Hot-Sauce/Detail.aspx

Here’s what I made the other day…

Ingredients:

  • 2 Tablespoons vegetable oil
  • 1 1/2 teaspoons salt
  • 6 cloves garlic, pressed
  • 1/2 large onion, chopped
  • 25 habaneros, sliced
  • 10 serranos, sliced
  • 5 “spicy red chiles” (I think they were Fresnos)
  • Oregano (maybe 4T or 5T)
  • Cumin (about 3T)
  • 1/2 cup white distilled vinegar
  • 3 cups water

Directions:

  1. Combine the oil, salt, garlic, onions and chiles in a saucepan.  Add oregano and cumin for taste. Sauté the chiles for 5min or so to soften up.
  2. Add the water and bring to a boil, then simmer for 20min.
  3. After the mixture cools, pour into a blender and liquefy.  Slowly add the vinegar while blending.
  4. Soak a tortilla chip and give it a whirl.

Like I said before, I’m not the guy to ask if something is hot or not.  This sauce leaves my mouth tingling for a good eight minutes, but has some great flavor.  When I’ve made this in the past, it tends to get hotter the longer it sits.  I’m sure Alton Brown knows the chemical reasons behind it.  If this cocktail of hotness is too much, feel free to substitute any other chiles.  My main goal in a hot sauce is to have something that tastes good.  If your hot sauce tastes awful, it’ll ruin your food and that’s not good eats.

Lung update

I had the pleasure of performing a pulmonary function test (PFT), chilling with my lung doc and getting chest x-rays Wednesday.  A PFT can feel like running a marathon while sitting in a chair with a tube coming out of your mouth.  I’d much rather go running than do these things, but you get used to them.  At one point in my life I was having to do PFTs every few weeks and sometimes multiple times in a single doctor visit.

If you’ve never done a PFT or are going to and wonder what happens, I’ll give you the cliff notes.

  • Your weight and height should be measured
  • You sit in a chair
  • Some clips are put on your nose so you’re only breathing through your mouth
  • You’ll be asked to breathe into a tube at varying rates, take a deep breath and hold it, etc

I’ve had some doctors give me a “PFT” which consisted of me simply exhaling into a tube.  To me this just seems like a Peak Flow meter.  The important thing to remember when doing one of these is to play it cool like the Fonz.  If you’re uptight and try to fight it, you’ll just have to repeat everything.

pft-results

Once you’re done there will be different numbers your doctor will go over with you.  The easiest value for me to understand is the FEV1/FVC ratio.  Based on your age, height and weight there’s be an expected ratio compared to how you actually performed.  FEV stands for forced expiratory volume and FEV1 is the most air you can breathe out in one second.  FVC stands for forced vital capacity or the most air you can exhale after inhaling as much as possible.

Like everything else, there are multiple ways to interpret this ratio, but if you’re within 80%-120% of expected, things are supposed to be normal.  The hard thing for some doctors to realize is “your normal” may have nothing to do with textbook normal.  Over the past 6 years I’ve gone from 135% to about 95%.  I’m still “normal,” but have lost 40% of my lung function and it keeps decreasing every time it’s measured.

The good news is that I am coughing less, wheezing less and hurting less when breathing.  I feel like I’ve been able to do more in the past six months than I have in the past couple years.  I can’t really say I feel good, but things aren’t nearly as bad as last fall.