A triple decker sandwich is generally defined as a sandwich containing three slices, or decks, of bread. Some would argue a three-slice sandwich is only double-decked, but that’s just like their opinion, man. This type of sandwich is always a good option when you want to have extra ingredients on the inside but are worried about the sandwich being too thick or flimsy for flipping. This method reduces the amount of toppings in between the bread slices while maximizing the surface area for cheese to bond the bread and toppings together.
Three slices whole wheat bread
Colby Jack cheese
Prepare your ingredients, slice your cheese and butter your bread. One on my slices had a hole in the middle already so that automatically became my middle slice. I like to preheat my pan to help the cooking process. I also put my Colby Jack on the bottom half because I’m going to cook the bottom section longer than the top and this cheese will take longer to melt than the American.
Getting this kind of sandwich flipped over, or any grilled cheese for that matter, can be a bit tricky. You need to turn it over quickly with spilling the sandwich’s contents as well as make sure your bread layers don’t become misaligned creating a leaning tower of cheesy bread. Here are a few tips.
Pre-heat your pan to decrease total cooking time
Make sure your bottom bread layer is “set” and the cheese has melted before flipping
Slow-cooking longer is always a better idea than high heat for a quick meal
If your sandwich is in danger of falling apart, lift up your sandwich with a spatula, place the pan upside-down on top of your sandwich, and then flip the entire thing over in a controlled manner while holding firmly with pan and spatula
That’s how I easily got to this
Now the only thing left to do is cook through your bottom layer and eat. I often prefer ketchup with mine. I call it the poor man’s tomato soup.
P.S. – If you’re looking for a good beverage to pair with this sandwich, I highly suggest some Dr Pepper with fresh lime, or lime juice.
Another week, another trip to the ER. They’re really starting to know me there.
Our friend Haley got me checked in at the registration desk
The triage nurse remembered me
The nurse who got me into a room has seen me at least 3x this summer
The respiratory therapist has helped me 3x now I think
The x-ray tech has scanned my chest at least once before
Also recognized Dr Wilson who I’ve seen before and has an EXCELLENT bedside manner
So why aren’t you better yet?
This is an excellent question I’ve heard from a few people and have also asked myself. This whole past week has been a rough one with asthma attacks on five days out of seven. One was caused by 2nd hand cigarette smoke and the rest were allergy/weather related. All five times this past week I’ve had to decide whether or not to go to the ER. My peakflow numbers were at 50% or below, my oxygen saturation has been 89% to 93% pretty consistently, I’ve had trouble walking and moving around, and I’ve been mentally fuzzy. These are all good reasons to seek medical attention. Tonight was slightly different because my nights are usually bad between 10pm and 4am, and this time my symptoms fired up around 7pm. I was short of breath, experiencing varying degrees of chest pain for different reasons, coughing, and my nebs were working but not lasting long. These combined with my gut feeling of “it’s going to get much worse” in the next hours are what made the decision for me.
The ER was packed on arrival and we later found out that was the least busy it had been since 1pm. Liz and I waited a little before being taken back, but we heard others being told there was a three and a half hour wait. Fortunately I bring all my meds with me so I just hung out and nebbed until it was my turn. I don’t know if it’s because they recognize me, I’ve been in so many times this summer or I’ve just learned how to communicate effectively…but lately I tend to get asked what I think should be done.
RT: Aw man, you’re back again?? So what do you think we should do? Albuterol? Duoneb? Want some pulmicort?
I had just done an albuterol in the waiting room so we followed up with some duoneb. It helped, but didn’t open me up much and I quickly regressed to where I was earlier. I was glad this happened because it made a point as to why I’ve been nebbing 8 to 10 times a day and the relief just isn’t lasting. They got me started on some salumedrol, as usual, and then followed up with a pulmicort neb. Pulmicort is a steroid which addresses swelling in the airways and is different from bronchodilators, like albuterol and ventolin, which help address the muscles constricting around your airways. This really helped to open my airways and allow me to breathe more deeply for a longer amount of time. In the past I’ve had a combo inhaler (advair, symbicort, dulera, etc) along with another steroid inhaler acting as a booster for maintenance. This summer I’ve been wondering if taking pulmicort or asmanex in addition to the dulera would help. I’m adding this to my list of questions for the pulmonologist.
Lots of taking it easy, that’s what. I’m working on some good questions for my lung doctor when i see him this week and am counting down the days to Pittsburgh. I’m not expecting to be magically cured in Pennsylvania, but I am looking forward to another opinion and getting some of these tests done that have always been on the extreme/unnecessary list. Maybe they’ll find something new and at the very least I’ll be contributing more data towards new treatments and understanding of how asthma functions.
I was glad to see the nebulized steroids make such a difference tonight. That would probably do the trick for me at home when I’m up all night not being able to breathe deeply enough. We also noticed my oxygen saturation dipping to 90% and below most of the time when not on 2L of supplemental oxygen. This hasn’t really been as much of an issue before and I wonder if that means anything. For now we’ve once again bumped up my prednisone taper and I need to return to the ER if things become bad enough to warrant another visit. I also talk to my allergist about doubling my Xolair injections starting this month. With allergies being so bad and mold season around the corner this might help me get a head start before leaves are falling and the combines are running.
At the end of Season 2 Half Sack is killed while trying to prevent the Irish from kidnapping Abel and Gemma has been setup by Agent Stahl. If you think things really heated up between Seasons 1 and 2, just wait until you watch Season 3.
This season can really be broken into two halves. One part takes place in Charming and the other in Ireland. I’d say there’s probably equal amount of excitement taking place in both locations as the older Hale takes a stronger hand at his conniving politics after his brother’s, Deputy Hale, tragic death in a drive-by shooting. There is friction between between the Sons and other gangs as usual and the DEA, led by Agent Stahl, is still trying to take the down the club. In Ireland the Sons are trying to track down Abel, Jax’s son, and end up discovering a whole other mess of corruption and deceit among their Irish brothers and the IRA.
One notable performance to point out is Hal Holbrook as Nate Madock, Gemma’s father. We see him in a few episodes towards the beginning of the season as Gemma’s mother is dead and she’s checking in on him to make sure he’s OK. His mind is going he mistakes Tig as an intruder during Gemma’s visit.
After most of the Sons decide to skip bail and head across the pond there’s a noticeable change in the theme music. On one hand this is nice to signify the location change, but I really prefer the original arrangement. SAMCRO teams up with their counterparts in Ireland who happen to include one of the Original 9. They seem to hit roadblocks in every direction though trying to find out where Abel is and who has him.
Back in the states the Sons have worked out their differences with the Mayans and team up to stop a rogue Mayan patchover who is single-handedly attempting to take down both clubs. At one point he even kidnaps Tara in an attempt to turn the Sons against the Mayans. Cooler heads prevail and all ends well…mostly well.
If you already disliked Agent Stahl you’re really going to hate her in Season 3. She’s about as bad as dirty cops can be as she manipulates both business and personal relationships to her advantage. She forces Jax to make a deal with her and then rats him out to the club in the end. We all know what happens to snitches, but you’ll have to watch to get the details. I can’t give everything away here.
While in Ireland we discover some important background history about Jax, Gemma and John Teller. In some ways it almost plays out like a soap opera. History really seems to be repeating itself as Jax is becoming his father and Tara slowly begins to be the new Gemma. This will be much more apparent after Season 4.
Piney is still my favorite character as he stands on the sidelines and offers words of wisdom when necessary. It’s interesting to see Jax and Opie really come into their own as the young blood in the club. We get a few more prospects and Happy continues to be…well, happy. If you have yet to watch Season 4, be prepared for the Sons to come home and start focusing on their domestic troubles again. There’s never a dull moment.
It’s easy to believe a lot of what you see on TV and in the movie theater until you come across something with which you have personal experience and say, “what the….” I first remember one of these instances sitting in the living room watching who knows what when a woman on TV was giving birth and my mother thought it was ridiculous. There was probably a lot of unnecessary sweat, screaming and flailing going on there. I just remember my mom thinking it was over-dramatized. I think the same can be said for asthma. At least 25 million Americans are diagnosed with asthma (“Asthma at a Glance,” National Center for Environmental Health, U.S. CDC, 1999) and COPD is currently the 4th leading cause of death in the US (Mannino and Kin, 2006). You’d think people would be more informed about lung disease and what it looks like. This also makes me wonder who is consulting with these writers, directors and producers as to exactly how actors should act in these scenes. To be fair, some portrayals are supposed to be over the top and exaggerated, but how is the average, free-breathing, entertainment-connoisseur supposed to know that?
Portrayals I find inaccurate, annoying, and what have you:
I have often seen asthma exaggerated, blown out of proportion, and not treated seriously in films and on TV. Children with asthma are often picked on, made fun of, ridiculed and seen as less than normal. They can’t go outside, participate in gym class, breathe normally, talk normally or do what they want in life. Their disease, condition, symptoms or even medication are used at plot points or MacGuffins, instead of just being a part of who they are. Even in the show Lost, the character Shannon has pretty convincing asthma, but it’s really just a ploy to find her medicine than anything else.
Mikey in The Goonies (1985) – way too many puffs on an OTC inhaler and later tosses it when he no longer wants it. Apparently I’m not the only one who recognizes this:
Uncle Junior in The Sopranos (1999) – OSA and his CPAP, can no one help him get his mask on properly?
Bobby Elvis in Sons of Anarchy (2008) – constantly trying to buy those “crazy expensive” albuterol inhalers, not to mention your average rescue inhaler has roughly 200 puffs in it.
Bobby – That dealer, she got that albuterol?
Piney – Probably.
Bobby – Tiki’s going through three inhalers a week…
Stevie on Malcolm in the Middle (2000) – overplayed wheezing and shortness of breath. Sorry about the poor quality of videos here. The first is a scene from an episode and the second is the actor, Craig Traylor, leaving a phone message as “Stevie.”
Morgan in Signs (2002) – suffers from an asthma attack without medicine while his father tries to help him through it.
Thomas in Black Hawk Down (2001) – soldier uses his inhaler before heading out on a mission, and yes I know there are questions to be asked about his active duty status.
Bob from Up in the Air (2009) – man loses his job and wants to know how he’ll care for his daughter without insurance. I really dig J.K. Simmons’ righteous anger here.
Barry in Sidekicks (1992) – teen with severe asthma manages his symptoms through a regulated exercise program.
So what’s wrong with asthma in pop culture?
I’m fairly certain there is no lack of education and information available about asthma. The problem is people seeking it out or stumbling across it. Unfortunately the main way people learn about things that aren’t in their face is through TV and film where asthmatics are generally depicted as:
Why asthma? Why did you select any life-threatening condition or the character, Carl Wheezer? Is asthma funnier than heart disease, diabetes, epilepsy, or AIDS?
There is nothing funny about growing up with asthma, a condition that robs children of oxygen, limits physical activity, and requires responsible use of inhaled medications and avoidance of allergens and irritants.
Was the character intended to educate children and the public about asthma?
If so, your efforts backfired.
Jimmy Neutron perpetuates the painful myth that children with asthma are emotional wimps that tend to overuse inhaled medications when faced with excitement.
It may not seem like a big deal, but these cartoons are both educating children on their limits and expected lifestyle AS WELL AS educating non-asthmatics on the appropriate response and treatment of those suffering with the disease. This includes other children, parents, teachers, family members and anyone else an asthmatic might deal with on a daily basis or run into only once. If this still doesn’t seem like a big deal, I’d like to point out several articles where two children and an adult find themselves in need of emergency care.
Personally I think we need to encourage children to make goals and support them in achieving those goals. I was told as a child I could do whatever I wanted and played football even though I suffer from severe asthma and severe summer/fall allergies. Instead of creating ridiculous, debilitating characters why not celebrate our fellow asthmatics who have proved they accomplish their goals. Asthma obviously didn’t keep Martin Scorsese from winning 111 film awards including an Oscar for Best Director on Hugo (2011). Here’s a short list of a few other famous people you might recognize.
John F Kennedy
Louis “Studs” Terkel
Ludwig von Beethoven
Peter the Great
Rev Jesse Jackson
William Tecumseh Sherman
So what can we do? I’ve decided to start blogging more to share my story and experiences. In just the past few weeks I’ve already been contacted by friends, family and strangers saying they’ve benefited from or learned something from things I’ve shared. I’m committed to be on the lookout for fellow asthmatics in need of assistance out in the world and taking action when necessary. I’m also looking to point out and share good examples of asthma in pop culture that will further asthma education around the world. In fact, there’s some buzz about a new movie, Asthma (????), directed by Jake Hoffman and starring Krysten Ritter from Breaking Bad.
If Sons of Anarchy: Season 1 was about introducing characters and getting a sense of background, season 2 was definitely about hard times and revenge. After setting the scene and giving us a good idea of what SAMCRO is going through, a new player comes to town and tries to rule with an iron fist. Did we mention this fist is connected to a suit and tie?
Adam Arkin and Henry Rollins are the two new boys in town. I always have to laugh a little when I see Rollins on TV. If you’re not sure who he is, Rollins fronted punk bands Black Flag and the Rollins Band. While having never seen nor talked to Henry, I get the idea he considers himself a badass. This tends to creep up in every role I’ve seen him act. He also plays the part in other aspects of his public life in his books, gig as a radio DJ, and speaking engagements. Adam Arkin, son of Alan Arkin, has always done well in stuff I’ve seen. I loved his recent role in the Coen Brothers’ A Serious Man, and in the TV show Life. He does a great job playing both businessman and scumbag.
Two other actors I have to say I’ve been impressed with are Charlie Hunnam and Ryan Hurst. These two guys are playing very different and original roles from what I’ve seen the do. I often see men and women playing “type cast” roles over and over. While this can be good for a while, I wish I could see what they’re really capable of. Neither of these actors disappoint.
When I think of Hunnam, two roles immediately come to mind: Undeclared(A Judd Apatow masterpiece that followed up Freaks and Geeks) and Nicholas Nickleby. I’ve never actually seen the 2nd, but he’s on the cover and it’s one of those things I’m just aware of. In Undeclared Hunnam plays the foreign college student whom all the girls fawn over due to his accent. He was no where near a bad boy, more like an Abercrombie boy. Chalire did start to get more “thug” with his role in Green Street Hooligans, a film about soccer/football fans in the UK, but it was still no where near Jax Teller, Vice President of SAMCRO. This guy is the quintessential American outlaw, even though he’s from England. I was almost surprised to spot him the first time I caught an episode playing at the gym. I practically took a double-take. I never would have guessed Hunnam could grow a bear and start riding a motorcycle like he owned it, let alone handle a gun. I might actually be afraid of this dude in real life.
Now to Hurst – here’s a guy who’s best known in my mind for playing a high school football player in Remember the Titans and the bumbling idiot in The Ladykillers (2004). Here’s another guy who changed his whole demeanor for a role. Besides the fact he’s already huge and really could kick your ass, Hurst completed modified his look, voice, and person. No more passiveness, no more mister nice guy; I would definitely fear Opie Winston. He’s come a long way from the deaf soldier in Saving Private Ryan, the high school athlete in “Titans,” the timid sergeant in We Were Soldiers, and the idiot trying to pull off a heist in The Ladykillers. I can’t wait to see what roles he takes next.
So plot-wise I said this season was all about hard times and revenge. We meet a few new characters, several die, and others are left dealing with the pieces. You probably know by now biker gangs motorcycle clubs do not rely on the police to take care of them. In one scene a member tells Clay if it had been his wife, there would already be six charters halfway to town by now. Fortunately the club has a good working-relationship with Charming law enforcement. SAMCRO doesn’t take aggression or turf infringement lightly, so if you enjoy a good fight spiced with some Cold War era revenge, this is the season for you.
First off, if you don’t like Parks and Rec, please start. It’s a great show and we’ll have so much more to talk about. If you haven’t already seen these, here are five clips totaling about 20min of outtakes from season 5. May or may not be work appropriate for ya, but that is now our concern, dude.
I once had an Eastern European pulmonologist who spoke with an awesome accent and reminded me of Olek Krupa in The Italian Job (2003). He was a very nice and caring doctor, but I had this feeling I should never cross him. Back in 2007 I was in his office for the who-knows-time after another exacerbation. This time I had come home to the smell of smoke outside, the local school still burns their trash, had an asthma attack and barely made it into the house.
Have you ever thought about getting one of those bubbles to live in? You know, like that Bubble Boy movie?
Of course he was joking, but my doctor had a point. Between my seasonal allergies and hyper-reactive airways, it sometimes wasn’t and still isn’t worth going outside certain days. While living in a “bubble” or working in a “clean room” environment would probably be key for me and many others, it isn’t plausible, feasible or realistic. The important things to focus on are identifying what to avoid and when to stay inside.
Allergies come in both the indoor and outdoor varieties. Sometimes it’s easy to know what will cause you an allergic reaction, but it never hurts to see an allergist and be tested if this is a significant problem for you. I’m allergic to most local trees, grasses, ragweed, dust, dust mites, most molds/fungi and cats. Realistically I can encounter any of these inside or outside depending on the situation. I’ve had to identify homes of friends and family I cannot visit, stores and buildings I cannot enter – there’s even a movie theater in town I don’t frequent because there’s either dust, water damage or mold in there. We keep our doors and windows shut during most of the year, run our air conditioning and have a True HEPA filter that helps to keep the air clean. Be sure to keep your furnace filter changed and stay on top of all your duct filters as well. Cleaning can be a chicken-and-egg situation if dust is an issue. Obviously stirring up dust by cleaning will aggravate your condition, but waiting too long to do it, or avoiding it completely, will just add to the amount of dust in your home making you sick.
Irritants are different than allergies, but can still make you feel just as bad when encountering them Examples can include:
Smoke – wood, trash, tobacco, etc. These all contain various particulates, chemicals and other “stuff” that can irritate and inflame your upper/lower respiratory system.
Smog and air pollution – while this problem is often confined to heavily populated areas, it can travel or become worse when combined with weather.
Strong odors – perfumes and colognes, cleaning chemicals/supplies, cooking smells, sewage, body odor, insect sprays, industrial glue, paint, etc
Particulates – tiny particles in the air such as chemicals sprayed on crops, dusts and powders, soot, etc. These tiny particles of matter can be either solid or liquid and exist in the atmosphere.
Weather – I’m including weather separately below, but wanted to point out thunderstorms can often bring unwanted guests in the form of allergens, pollutants, particulates and anything else that was stirred up on its path from Point A to you.
Weather changes and patterns show up in the form of cold winter air, hot summer air, humidity, pressure changes, etc. I have friends whose worst time is Winter with the cold air, but I can have just as much trouble with the heat and humidity in the summer. The important thing to know what affects you and how prepare.
Cold and flu season can be hard to avoid in public places and work when simple cold and viruses seem like no big deal to people. A pesky cold for an average Joe is like bronchitis for us, and bronchitis for them can be like pneumonia for us. I’ve never found a great way to breach this with co-workers, but it’s about the same as just being out in public. Try not to constantly touch your face, wash your hands, and avoid the coughing/sneezing zones if possible.
So last night I was feeling “ok” and almost forgetting I had been in the hospital just two days prior. The idea was brought up to go get some ice cream at a local place in town and that seemed like a great idea. It was neither hot nor humid outside, pollen and mold counts weren’t too bad, and I had been staying on top of my breathing treatments. So we drove the 5 miles, got our ice cream and took some seats on the picnic tables farthest from the ice cream hut. This is mainly to avoid anyone who may start smoking in line or in their cars immediately next to the building with their windows open.
Not too long later I caught a couple whiffs of smoke but it was pretty infrequent. I’m guessing we were 40 yards away or so from the building, but there was a light breeze bringing anything from that direction our way. Liz wanted to know if I should leave, but it wasn’t constant and I decided to stay. Right about the time we were ready to leave, there was more smoke and Liz decided we needed to get out of there. It’s a good thing she’s around to notice this kind of stuff because by the time I got into the car I was already losing my voice and hurting to breathe. Two albuterol nebs later I was back up to about 430 on the PF and hovering at 92% O2 saturation. I spent the next 7 hours doing treatments before I could finally fall asleep and have been completely exhausted all day. This is what it’s like to be a severe asthmatic. All I wanted was some ice cream and the people smoking weren’t even smoking in a non-smoking area or anywhere near me. It’s just what we have to deal with on a regular basis.
Whether you take just one daily medication, several maintenance medications or only rescue medications – timing can be key.
Every morning I pop three pills, use a maintenance combo inhaler, and a nasal spray. Many days I also use my rescue inhaler or take a breathing treatment to open my airways for my inhaled corticosteroids to be more effective, and most of the summer I’ve also been taking anti-biotics and/or oral prednisone. In the evening I take another pill, use a long-acting bronchodilator and another dose of my inhaled combo inhaler. Over the course of taking maintenance medications for 20 years or so I have not always been great about sticking to a strict schedule, but I’m working to improve that.
Taking medicine both “when I wake up” and “before I go to bed” are a great idea but in reality I don’t wake up or go to bed at the same time every day. Some days I’m up at 6am and others I may not get up until 10am. Night time is the same with me going to bed anywhere from 10pm to 3am or later. While this may not seem like a big deal, most of my medications are on a 12hr or 24hr schedule and I already suffer from nocturnal asthma symptoms so making sure my symptoms are appropriately covered by my medication is key.
I wake up at 6:30am and take my medication at 6:45am. I get ready for work, head out and arrive back home around 5:45pm. I help to prepare dinner, play with Chuck, we go through her bedtime routines, I watch some TV and get ready for bed around 11:30pm. I take my medication at midnight and repeat basically the same schedule the next day.
You probably noticed I should have taken my evening doses of medication around 6:30pm-7:00pm, but instead waiting until midnight which was 6 hours too late. Additionally, I’m taking another dose of medicine six to seven hours later effectively skewing the appropriate levels of medicine that should be in my body at any given time. Fortunately I’m not dealing with dangerous levels of drugs here, but this could cause issues depending on what you’re taking.
This summer with all my extra exacerbations I’ve been attempting to stay on a better schedule for my medication. I’ve typically been taking my meds between 6am and 9am and depending on when I took my morning doses, I match that same time at night. While this hasn’t magically “cured” me, I have noticed a reduction in my nighttime symptoms.
Another change I’ve made is when I’m taking breathing treatments. Usually these are as needed or “PRN” is a term/abbreviation you’ve probably seen written down. Because I’m taking more than six every day I’ve been scheduling these treatments every four hours and supplementing in between with extras when necessary. Many chronic asthmatics try to be heroes or gallant, waiting too long to really do anything timely for a variety of reasons. I can’t afford to be the hero anymore, I just need to take my medicine to prevent an upcoming attack, even if I feel fine, as well as respond to symptoms early and not waiting.
How do we stay on task?
Basically you need to find something that works for you. Setting an alarm on your watch or cell phone is something easy to try. Some may find scheduling medications around their schedule easier to handle, or getting someone to remind them. One thing I do is carry all my medication with me so no matter what happens I can always take it no matter where I am. If I have to take my second dose of Dulera at 7pm, I need to have it with me no matter if I plan on being home then or not. It’s not worth it to wait too long and then spend the next few days recovering due to unforeseen circumstances.
If you’re not sure when you should be taking your meds, or how often, this is a great question to ask your doctor at next visit, or contact their office in the near future to ask the nurse on duty. It’s also a good idea to double check you are taking your medication properly as well as on time. Do you use a spacer with your inhalers? Is it necessary to use a spacer? Are you rinsing your mouth with water after steroid inhalers? Are you using your nasal spray properly? If you’re compliant with your treatment but not doing it properly, this can be just as bad as not doing it at all.