Archive for August 2013

ER Trip #3: Part 3

Part 3: House Arrest

After that harrowing experience last night I luckily bounced back mostly ok due to the salumedrol, regularly scheduled treatments and all my inhaler puffing.  My hospitalist came by again in the morning, with news from my pulmonologist, giving me the option to stay or go home.  As much as I love lying in a high-tech bed having meals and drugs brought to me on a constant basis, I decided to leave.  Their one condition was I’m under “house arrest” and to do as little as possible.

As soon as Jeff, same guy from previous day working another shift, was informed of my discharge he asked for some basic information in case the “customer satisfaction” people needed to contact me about my stay.  I gave him my phone number and Jeff went to find a wheelchair ride for me.  Just as we were about to go one of those customer liaison folks showed up asking me how my stay had been.  Liz and I briefly described the “Josh situation” and praised every other employee we encountered.

So here I am, at home, feeling awful, but awful in my own house.  I didn’t realize how much I wasn’t doing until I came home.  I just need to get up to grab a snack, refill my water, put a DVD into the player or retrieve something in the house.  They weren’t kidding about pretending like I’m still in the hospital.  This is my 5th round of anti-biotics for the summer and who knows how many prednisone tapers.  I’d really like to just kick the sickness for a month and take a break.  In order to do that I’m really going to have to pretend like I’m still lying in that fancy bed.

The good news is that my lungs performed in the hospital the exact same as when I’m at home managing my chronic lung disease on my own.  I was still needing 7-9 breathing treatments a day, my peakflow numbers were still low, my oxygen saturation behaved similarly and this was all under the care of professionals and being given supplemental oxygen.  As usual I get the feeling no one really knows what is going on other than my asthma is really bad again.  I have some follow up visits scheduled with the doctors and I hope I actually show some progress between now and then.  I also found out people are testing positive for Mono at work and others have had colds lingering on for weeks.  There’s no way I’m going back to work to just get sick again – especially if I’m not well.  I went ahead and emailed one of the SARP sites for more information with the hopes of applying.  I think something like this could be awesome for me and very interesting as well as informative.  For now I need to just stop moving around so much and try to get better.

ER Trip #3: Part 2

Part 2: The Respiratory Therapist

**After initially writing this, Liz told me some of the timeline was off during my attack.  I’ve modified the times to reflect what Liz wrote down as things were happening.

After I was settled into a room upstairs my nurse was smart enough to ask how long it had been since my last meal.  I had been feeling a little hungry, looked at the clock and realized 14 hours had passed since that slice of left-over pizza.  They offered me graham crackers and a TV dinner, but Liz needed to go pick up my CPAP from home and hit up Taco Bell drive through for me because she’s awesome.

My first respiratory therapist was great.  It turned out he’s REALLY into sci-fi television and movies and there happened to be a Farscape marathon playing.  He took the time to get to know me a bit, got a sense of my asthma history, suggested a few things, etc.  I have a huge list of medications and of course the admitting doctor didn’t order all of them.  They even substituted Advair 250/50 for Dulera 200/10, but I knew the dosage was way too small.  Mr awesome RT just went ahead and fixed that for me in the computer.  When I asked about other medications I’m supposed to be taking I was told all medications legally have to be ordered by the attending physician, brought up from the pharmacy and administered by a nurse.  This is about the time RT #1 closed my curtain and said he’d be back in 10 minutes (wink wink).  Upon returning he also noticed a 3rd ABG had been ordered which would be my third in less than 12 hours.  He wasn’t interested in putting a 3rd hole in my wrist and I wasn’t interested in receiving one so that was also fixed.

My second respiratory therapist hated using the computer system and wasn’t interested in a Stargate vs Battlestar Galactica discussion, but she was had been treating lungers like myself for thirty years so I couldn’t really hold that against her.  She knows how to take care of her patients.  Lorraine talked to us too about all kinds of stuff and made sure I had everything I needed.  Even though I was prescribed treatments every four hours, she was checking up on me every two hours which is when I actually needed them.  Towards the end of her shift I was definitely feeling the need for another boost around 5pm.  I thought they were coming back at 6:00pm, was having some asthma-brain, but they actually weren’t scheduled until 7:00pm.  Asthma-brain is this weird thing where you get a little fuzzy due to the lack of air.  Liz kept telling me to call the nurses and eventually by 5:30pm we had called and were told they could be there by 6:00pm if that was ok.  I agreed, I didn’t think things were that bad, but knew I really needed it by 6:00pm

In the meantime my hospitalist, the physician assigned to you while you’re in the hospital, came by to check on me.  He could easily tell I wasn’t in good shape and wondered where that breathing treatment was.  We told him it was on the way, he put in an order for some salumedrol and then doubled checked my prednisone dosage.

Six o’clock came and went.  By 6:05pm I was starting to enter the serious-respiratory-distress-zone.  Liz inquired again where my medicine was.  The message was “soon,” but respiratory therapist number three, Josh, didn’t show up until around 6:15pm.  At this point in time I was starting the same type of coughing fit which sent me to the ER in the first place.  My airways were constricted allowing no more than 30% capacity in whenever I breathed and that dull/searing pain was surging through my chest like an Etch a Sketch drawing my lung structure.  In my 22 years of officially having asthma, and regularly scaring people with my attacks, this is what I would call a time for action.  Josh walked into the room looking like he was hung over, and proceeded to spend the next five minutes standing in front of the computer while everyone in the hallway could once again hear me breathing.

Liz: “Could you please get him started on that breathing treatment?  He really needs it.”

Josh: “I just got here ten minutes ago…”

Josh continued to meander across the room at a glacial pace, eventually giving me that treatment around 6:30pm.  All this really did was open my airways enough so I could start wheezing which made me cough more, made my lungs hurt more and as a result made my airways constrict more.  If you’ve ever been in ER/hospital situations they ask you about pain levels on a scale of 0 or 1 to 10.  Low end is obviously nothing or very little and 10 would be someone stealing a kidney without first slipping a rufi in your drink.  I was around the 7/10 level, coughing horribly, wheezing in between ragged breaths, as red as a tomato, crying and thrashing about in the bed.  This is when Josh decided his job was done and started slowing walking out the door announcing he’d be back in four hours.  As absurd as this sounded neither of us did anything as he sauntered out.  Liz quickly found my main nurse, Jeff, appraised him of the situation and asked to get Josh back for a follow-up treatment.  Jeff and Jen, the nurses were changing shifts, got him on the phone and were told…

Josh: I’m not allowed to give him anymore medicine.  I can try to ask my supervisor about it I guess.”

…and refused to come back to my room.  Now I know I can’t expect everyone to adhere to the Marine Corp’s motto of not leaving a man behind, but in two decades of receiving treatment in hospitals, emergency rooms, training rooms and doctor’s offices –  I’ve never seen, experienced nor heard of a respiratory therapist walking out of the room while their patient is going into a full-blown asthma attack.  Jeff and Jen were under strict orders to defer any pulmonary issue to the respiratory therapist on duty and at first weren’t sure to do.  So Liz and I basically took over and “suggested” a plan of action.

  1. Liz got my asthma bag, which Jeff and Jen thought was awesome, out of the corner so I could use my own rescue medications.  At this point I didn’t care about the rule and Jeff also said to feel free and take any of my own meds since it was clear Josh couldn’t do his job.
  2. Liz had Jen check on the salumedrol ordered by my hospitalist.
  3. I asked for some tussionex or cough syrup to control this outrageous coughing which doesn’t stop until it’s suppressed.

Six puffs later on my inhaler got my airways to quit closing and traded the thrashing for shaking.  In the meantime Jeff got me back onto 2L of oxygen, you know – one of those things a respiratory therapist might think to do, and talked with my hospitalist about what to do next.  Someone found Josh, made him come give me another breathing treatment, and I eventually got the salumedrol and tussionex.

Jeff and Jen came back in around 6:45pm to check on me and see what was going on.  I could almost sort of talk, and Liz and I proceeded to inform the nurses about Josh’s performance, what happened, what could have happened if I had not used my own meds, and that we didn’t want Josh back in my room.  Neither Jeff nor Jen did anything to defend the guy and were extremely apologetic.  Jeff’s shift was long over and he had to take off so Jen finished up and went out the door to the main desk in the ward where she immediately began ranting to a co-worker about Josh.  I wasn’t the first person to complain about this guy.

Even though I didn’t want to see this slacker’s face again, Josh was the only person available so I still had to receive my breathing treatments from him through 4am.  Every time he came into the room I eyeballed him.  Instead of acting like a sullen teenager he now called me, “sir,” and bookend-ed everything with a please and thank you.  There were times when I did need extra meds in between the scheduled treatments, but I just puffed on my inhaler because I had zero confidence in Josh doing anything correctly.  The guy didn’t know how to properly get a reading from a pulse oximeter and most of the times he tried listening to my lungs his stethoscope was sitting on top of the heart monitor patches.  To be fair Josh was probably nervous and or scared about what had happened, but there’s no reason my well being should be put in that kind of danger while in a hospital.  It was as if he was following an imaginary checklist of what to do and I was presenting a scenario not covered on his how-to-administer-a-breathing-treatment cheat sheet.  Jen kept coming back to check on me and apologized several times for everything that had happened even though none of it was her fault.  I’m just glad I didn’t end up worse than I was after all was said and done.

ER Trip #3: Part 1

Part 1: I asked to go to the hospital

This past weekend was a bit of a bad one for me.  I was asked, “Do you need to go to the hospital” more than usual and for good reasons.  I wasn’t feeling very good at all Sunday morning, and this was even after sleeping for almost 9 hours.  We had planned to go see a movie and I was determined to do it no matter what.  I did a neb treatment, packed up my EDC bag and we headed out the door.  Elysium (2013) was great and I highly recommend seeing it.  Neil Blomkamp really knows how to address social issues.  During the film I opted for some rescue inhaler puffs instead of busting out my nebuilzer and I did another treatment during the credits before leaving.  We went home and I immediately started another treatment.  I know some people’s guts don’t always steer them well, but I tend to know what’s going to happen when my asthma flares up.  This time I knew I was going to end up in the hospital.

As I continued to feel worse I decided to tell my friend, Andy the paramedic, what was going on because he always has a funny way of telling me what to do.  About the same time I was filing Liz in on the situation and told her I probably need to head into the hospital.  I usually avoid going at all costs, but Andy reminded me the longer I wait to go, the longer I end up staying.  Liz got some work stuff together, I packed up all my meds and documentation, and we headed out the door.  I don’t know if it’s all in my head, but whenever I finally decide to get help, it’s like I finally let my body act and react like I’m in respiratory distress.  That 15 minute drive to the hospital always seems to take longer than usually driving to that part of town, and of course the shortness of breath and coughing continued to worsen.

I often hear people complaining about going to the ER or the Emergency Department.  They tell stories about waiting in line to check in at the front desk, sitting in the waiting room for hours to be seen and never quite satisfied with the speed of service or attention to detail.  I’ve never experienced that before, well…maybe once.  As usual I wasn’t even halfway to the desk and someone was rushing to get me a wheelchair.  Liz got them some basic information to get things going and I was immediately wheeled back to a room where four, maybe five, people got to work.  Two people were trying to get an IVs started on my arms and were successful on the fourth attempt with an 18 gauge.  Seems like whenever I’m bad the veins like to hide.  A third person was talking about “bagging me” while getting some neb meds going but fortunately they didn’t end up putting me on a respirator.  They pumped me up with salumedrol and ativan to get things calmed down and gave me cough syrup to try and suppress that horrible dry cough of mine.  As soon as things got slightly better I received my first ABG and then we waited to see what happened.  Once things got under control they ordered a 2nd ABG to compare numbers.  Arterial blood gas tests are when they take blood out of an artery instead of a vein meaning they stick a needle into your wrist and try to not gouge too many nerves.  At least this respiratory therapist knew what she was doing and was quite patient about waiting until she was certain what has happening.

The doctor overseeing me was the same one from our last visit there and she recognized us right away.  I’ve obviously been back in the area long enough because ER staff recognize me again.  She was aware of and remembered my issues – I’m pretty sure that helped get things under control more quickly.  Bloodwork, X-rays, CT scan, etc were ordered.  Around this time a couple of the nurses popped their heads in and said, “Hey – I can’t hear you breathing any more!”  That’s usually a good sign.  The test results all came back as expected.  The X-rays showed no fluid or ambiguous masses and the CT came back with evidence of air trapping and small airway disease.  While I wasn’t nearly quite as bad as when I arrived, things weren’t quite good enough to let me loose after 7 hours and they decided to admit me for observation.

Inhaler posters

For the past 20 years or so of dealing with asthma I’ve been acutely aware of the posters in doctor offices showing off the latest and greatest inhalers for respiratory patients.  For the past 15 years or so every time I see one, I recognize most of the medications by sight/color and have been prescribed pretty much every one at some point in time.

A month or two ago I had the idea it would be cool to find a current inhaler poster and hang it in our office at home.  A few searches on Google led me to the Minnesota Department of Health’s web site where they have downloadable posters for you to print as you see fit.  I love that Minnesota is doing this and wish other states were doing the same.

MedsLetterSized_Page_1 MedsLetterSized_Page_2

Do you need to go to the hospital?

This is the question my loving wife has been asking me about 1-4 times per day for the past….3 months or so.  I was telling a friend just the other day I’ll know this summer of asthma hell will be over when I haven’t heard “the question” for a few days.

This summer all started back in May when I had what I’d call a “flare up.”  One thing led to another, I caught a few bugs, overdid it way too many times, encountered drywall dust from construction in my workplace and I keep hearing this is the worst allergy season ever.  Just this past week I was starting to get better and then took a turn for the worse with a fever.  The doctors thought I might have pneumonia, which scares the crap out of me, but fortunately the chest x-rays came back clear.  That probably sounds like great news, which it is, but I’m still on Levaquin, more prednisone, doing 7-9 nebulizer treatments a day and generally feeling like crap on top of my 13 other maintenance and emergency medications and treatments.

Today marks day 62 of prednisone this summer and went something like this…

  • I actually felt tired around 3am and got about 5hours of sleep – first time I’ve slept in about three days.
  • Upon waking up and feeling proud that I’m no longer a zombie, I immediately realize I haven’t had a neb treatment in 5 hours and feel like I’m chasing symptoms all morning.
  • By around 2pm things start evening out and I’m actually able to walk around the house without feeling like I’m going to fall over and try to entertain my daughter to give my wife a break.
  • Dinner time rolls around and some family stopped by to eat with us.  I was starting to feel a little lousy but wanted to make the effort to sit at the table for a meal ( you know, just like in the Spiriva commercials!).
  • After dinner I started to help clean up, take care of dishes, etc when I started to feel bad.  My wife told me if I needed to take a break to do so.  I lounged on the couch and tried to chill.  This is when I realized my pulse was around 105 and my O2 sat was at 93% so I did another neb.
  • Fast forward about 45 minutes and for apparently no reason I’m at 88-89%, PF is at 320 and my pulse is a solid 115 all while I’m about as chill as a Buddha statue.

Now here is one of those several times where I was asked, “Do you need to go to the hospital?”  The normal answer would be, “yes please,” but I’m not normal.  For some reason I have to live on the edge…that and I don’t always make good decisions when I can’t breathe.  In the back of my mind I had a feeling this wouldn’t last too long, and thankfully it didn’t.  I also just hate going to the ER cause it’s never fun and it’s like I’m admitting defeat.  After about 90min I was able to stabilize myself into the 93% range and my PF was up in the 400s – not great but also not in the need to go to the ER realm.

So tonight I’m once again out on the couch watching movies (Alien anthology tonight) as I continue monitoring my numbers and promising to wake up Liz  if things get bad.  I did happen to come across a cool blog with lots of great stories which is giving me something to do.  I’m not nearly as bad as Stephen, but I can definitely relate.  It’s not often I come across people on the internet writing candidly about severe asthma and always appreciate it when others are wiling to share their stories.

New research on cat/dog allergies

New research has shown why some of us humans react so strongly to cat and dog allergens.  Up until this point it wasn’t exactly understood what the big deal was.  Well we now know what the big deal is – LPS being present with cat protein Fel d 1 and the TLR4 receptor signaling DEFCON 1.

Yeah….I have no idea what I just said.  You better check out the actual article to find out more –