Archive for June 2014

Prednisone cataracts

Last summer after I was in the hospital for a few days, I noticed my eye sight was a little weird.  I had several ideas…the not sleeping and insane allergies gunking up my contact lenses seemed to be the best reason.  I also knew the crazy amounts of prednisone I was taking could possible be jacking up my blood sugar.  It turns out I was getting cataracts.

About a month ago I had my yearly checkup with the eye doc and found out for sure.  I didn’t even really think about the prednisone being a possibility, but the eye doc was certain.  There are six common causes for cataracts and one of them includes the long-term use of corticosteroids.

At face-value this would seem like a major bummer, but it definitely could be worse.  The good news is cataract surgery is quite effectively and not a huge deal like it used to be.  For now I just need to get stronger contact lenses and check in with the doc to make sure they don’t get worse.  At the moment they aren’t severe enough to warrant any immediate action.

One thing I did appreciate was my eye doc stressing to continue taking my medicine.  Obviously breathing is important and it’s not worth risking my pulmonary health over my eyesight.  There really wasn’t a chance of me stopping my medication, but I know a few who would freak out and do just that.

Hospital Recovery

So once you’ve gotten bad enough and have given into the Dark Side, admitted defeat, or were just plain taken to the hospital against your own will..what happens afterward?  Getting back to normal can be just as hard as the exacerbation which got you there.  In some ways you have to not be stupid and in other ways you just need to be a little smart.  Here are some things I’ve figured out the easy way and hard way.

Stay on top of your meds.  Even though you most likely feel craptastic after getting out of the slammer (aka the hospital) you’re most likely feeling somewhat better because of all those intravenous steroids they pumped into you.  This past Monday I had 350mg of steroids along with an IV magnesium sulfate drip and was hobbling on sunshine for about 12hrs.  They instructed me to nebulize duoneb no fewer than 4x/day and take extra albuterol if needed.  I thought I was doing alright, I even nebbed some albuterol in the lobby while waiting for a ride home to get a jumpstart on things.  Twelve hours later though I was gasping for air, sitting on my bed, and attempting to get some medicine into my airways with Liz threatening to call 911.  Don’t worry, it all ended well, you just gotta stay on top of things.

Use the buddy system.  I just mentioned Liz threatening to call 911.  In a way, it’s her two-edged sword of seeing just how bad I am while also being prepared to get me some help.  I have a major aversion to ambulance rides so this kind of threat will perk up my responsiveness especially if her cell phone is in hand.  Seriously though, make sure someone is checking up on you and that you can readily get a hold of someone if you need to.  If you’re breathing is bad enough, you might not be able to tell a 911 operator what you need and cell phones don’t always easily tell emergency medical services where to find you.

Keep yourself busy.  This may sound easier than it really is, and mental health is a must.  Sometimes I’m awake for days with no end in sight, or just by myself for hours and hours at a time.  Find a hobby, write a blog, watch movies, read books, knit scarves, build models, repair a toaster, or add HBO to your TV line-up and watch all their original series.  Whatever it is that interests you, make sure you have something to do.

Stay active.  Take this one with a grain of salt, but my point is to not become too lethargic and lose what cardiovascular fitness you had before all this started.  I’ve had weeks where I’ve only gotten out of bed for bathroom breaks and showers before.  I understand when you’re pretty limited in your activity.  No matter how bad I am though, I try to make sure I push myself a little every day.  Sometimes that means walking to the mailbox to send those Netflix DVDs back or just sitting on the couch instead of lying in bed.  Sometimes that means cooking a meal and doing my laundry, and some days all I can really accomplish is going to the doctor and then back home.  Just be sure to not lie around all day every day, and have some attainable goals in mind for getting back to the usual stuff.

Find a community.  With any chronic illness, it can be hard to relate to your healthy friends, and it can be hard for your friends to relate to you.  You need to find some friends to complain to, commiserate with, attain advice from, and share your experiences with.  You might check with your doctor’s office, local hospital, or American Lung Association for any support groups.  You might find a group on your social media of choice, or you might even have a group of friends already with whom you can talk.

Don’t be afraid to call your doctor.  I hate going to the hospital and being in the hospital, but it’s even worse if I have to go back.  Similarly to staying on top of your meds, keep an eye on my peakflow numbers, oxygen saturation, when and what medication you’re taking, your general symptoms, and your gut feeling.  Worst case scenario is you’ll call your doctor’s office or the answering service and be told it sounds like you’re ok for now.  The real worst case is you not doing anything and ending up back in the hospital, or lying on the ground in your house trying to crawl to wherever you left one of the 5 inhalers and 3 nebulizers.

What tips do you have?  What has worked for you?  I’m always looking for more tips and tricks to getting back to normal as quickly as possible.

Summer 2014: ER Visit #2

Looks like my spidey-sense proved right again.  In only 14 hours or so of not feeling any better whatsoever, Liz took me back to the Emergency Room where they took things a big more seriously this time.

dude-and-driver

Home sweet home, Mr L!

As usual, I was immediately taken back, and they got me immediately started on some nebs.  Because it hadn’t been that long since my last visit, the same respiratory technician was there to get things started.  Liz pointed out I don’t really wheeze, and the RT mentioned again that everything sounded fine.  Just like earlier that day though, when the doc took a listen it was immediately pointed out that I sounded EXTREMELY diminished.  I sometimes wish I knew how to identify all the different kinds of noises I make while breathing.  I also know that my perception of how I’m doing isn’t always what’s actually going on.

The RT was in and out pretty quickly as the trauma rooms seemed to be full of people in much more serious trouble.  Before my first neb was barely started, she was being called away to maybe intubate some poor soul a couple rooms down the hallway.  When it comes to medical stuff and waiting, I always remind myself they’re taking care of the worst-off first.  I’ve been that guy before with 6 people hovering over me for two hours while others have to wait.

The NP assigned to me was someone I don’t think I had met before.  She took great care of me and had a lot of great tips.  It reminded me of talking to Dr Wenzel’s nurse while at SARP last Fall.

  • Ask about updating vaccines with the resurgence of pertussis and other diseases
  • Piggybacking benadryl and allegra works a lot faster than zyrtec
  • Benadryl + pepcid can knock out allergy attacks pretty quickly, especially if your throat is tightening up
  • Look into lung strengthening

Another 125mg solumedrol IV push, and some magnesium sulfate via IV drip got things turned around for me.  The solumedrol was doing its thing, but my airways kept tightening up over time.  My oxygen saturation was constantly setting off the alarm bouncing between 88% and 91% most of the time.  In August or September last year there was talk of trying magnesium during an ER trip.  I was impressed with how quickly it seemed to work and much more deeply I could breathe afterward.  It actually kept me in good breaths for 12hrs after leaving the hospital.

They sent me home with orders to neb duoneb every 4x/day with albuterol in between.  My prednisone has been bumped up again with a slow taper down, and they threw in some levaquin for good measure.  There are a lot of people with nasty respiratory viruses at the moment and I like to play it safe.  I haven’t had pneumonia for almost 8 years now, but the thought of it still scares me.

This morning I went in for spirometry before drugging up.  I felt horrible and they wouldn’t let me go until my doc was paged and checked up on me.  Numbers were low and lung function diminished, but things weren’t bad.  They stressed to call them immediately if things worsen though.

So long, Maxair

Shortly after being diagnosed with asthma I was given a proventil inhaler, which didn’t always seem to work, followed by a maxair inhaler.  Albuterol, or albuterol sulfate, is probably the most commonly prescribed medication for those with respiratory problems.  Maxair is slightly different – pirbuterol acetate, and it did a slightly better job for me.  They eventually came out with an auto-inhaler model that was sort of an inhaler-spacer hybrid.  I loved Maxair.  Maxair has served me well these past two decades plus change, but the United States Environmental Protection Agency deemed CFCs, the process of getting that wonderful drug out of the canister and into my air sacs, harmful to the environment, therefore banning all inhalers using them.

proventil

Proventil inhaler

maxair

Maxair inhaler

maxair-autohaler

Maxair Autohaler

The result has been an entire new line of inhalers using HFAs to propel the medication in combination with new deployment devices containing counters and new copyrights, trademarks, and what have you.  This is one of the big reasons medicine costs so much in this country.

If you search the web, you’ll find many official and non-official documented gripes against these new inhalers.  Everything from rescue inhalers to steroid and combination maintenance inhalers have switched methods.  If you really hate them, your other option is the powder based, inhaled meds, but those aren’t an option for everything.

I recently had to switch from Maxair to Proair, and while I was fully prepared to HATE IT, I’m actually enjoying it.  The reason would be the extra thing I’m carrying everywhere.

Asthma-Aerochamber

That’s a spacer.  You pop the inhaler into one end, puff-puff goes the magic dragon, and then you suck all that glorious, airway-opening magic into your mouth through the other end.  Spacers are key to proper metered-dose-inhaler (MDI) use.  If you are taking a daily steroid, LABA or combo inhaler you really need to be using a spacer.  You can cheat on them with rescue meds cause you’re most likely in a pinch, but let me repeat that.

USE A SPACER

In addition to properly inhaling your new, unwanted medicine – keeping your tools clean is also important.  Similar to cleaning out your nebulizer, you need to clean your spacer.  Your MDIs probably also suggest some sort of regular rinsing/cleaning as well.  The good news is all you have to do is rinse them out or drop them into some warm soapy water for a soak.

Summer 2014: ER Visit #1

So it happened, and on the first day of summer no less.  For three months I was doing “OK” needing no more than one or two uses of albuterol a day until June arrived.  I’m trying to be proactive – I really am.  I made a point to go see my local pulmonologist a little over a week ago.  He agreed I was doing the right thing and bumped up my daily prednisone from 5mg/day to 40mg/day with a slow taper back down to 5.  The past week has sucked.

  • Every morning I wake up with peakflows around 60%
  • I’ve been spending every day at work in shoddily air conditioned offices, but am thankful I’m not having to be in the buildings with no air conditioning
  • Every night between 8pm and 1am things get bad for an hour or so
  • Every night/day things have been getting a little worse
  • After an hour in a hot conference room on Friday I started hardcore wheezing (wheezing is not a common symptom for me)

Last night things started going south around 9pm.  By midnight I had done three consecutive neb treatments in three hours w/o successfully getting my peakflows up above 350.  Liz ended up staying home with the kids and El Cuñado gave me a ride, being the awesome dude he is. As usual, I get there and they immediately put me into a room.  A nurse of some sort was in there and a respiratory tech came in right away to have a listen.  She declared my breaths sound ok, AKA no wheezing, and said they’d be right back to start some meds.

Two hours later the doc came in apologizing for the long wait and immediately told me there was a 50/50 chance I’m not going home because I’m hardly moving any air. I got the standard IV line, solumedrol push, blood tests, x-rays, and neb.  A couple more hours and the x-rays show no pneumonia, the blood tests are good, and my breathing has slightly improved.  Sound familiar?  So at this point the doc comes back and says normally he’d admit someone like me, but taking my history and rock-star-respiratory-system into account, he wants to send me home so I don’t accidentally pick up pneumonia or all the crazy viruses people keep sharing.  And as always, “come back if things start to get like this again.”

El Cuñado takes me home, peakflows are still at 350, I do a little more self-medicating and get a couple hours of sleep, later waking up a sweaty mess and needing more albuterol.  Sometimes I wish they’d just keep me at the hospital because I have a good feeling history will repeat itself.  If my sensible gut feeling proves right, I’d like to get a hold of someone via the physician’s answering service to tell me to head back in instead of wasting a lot of money to do what I could at home in a much more comfortable environment.

Now I just have to figure out what to do about work since I have no sick, vacation, nor FMLA time remaining with which to stay home and attempt to recover.  Next week’s forecast is once again hot and sweaty, and they still don’t have the AC fixed.

Hudson Made: Beard and Shave

The hair on your face needs to be washed just like the hair on your head.  I’ve used shampoo from time to time, but that usually results in dry skin, “beard dandruff,” split ends, and annoyance.  Often I can skirt this problem by just thoroughly rinsing it out in the shower, but eventually that doesn’t cut it either.  On top of this all, I live in an area with hard water and this can add to the flakiness as well.

For the past month or so I’ve been cleaning my beard on Saturdays with Hudson Made: Citron Neroli Beard & Shave Soap.  I was hesitant at first to try this seeing one bar of soap costs just over $20 for 3.5oz.  The reviews were amazing though, and I decided to give it a whirl.  I am also leaving the soap in a container by the sink so as not to lose any by attrition in the shower.

Hudson Made: Citron Beard Soap

The first time I tried the soap I ran a little water through my beard, lathered up a little bit of soap on my hands, and then applied it to my face.  The soap didn’t really lather up much at all, which was surprising because the most common comment about this soap was the insane amount of lather it generated.

The following week I thoroughly soaked my beard at the sink and made sure to use warm water.  This time instead of trying to lather soap on my hands, I dipped the soap under the water and then immediately rubbed it across my beard.  The amount of lather generated was impressive.  This soap can double as shaving soap, you know – the kind you mix up in a little mug with a brush.  After making sure my entire beard is soaped up and massaged a bit, I can either rinse it out at the sink or take a shower.

Another type of soap many people suggest trying is pine tar soap.  I’m quite hesitant to use it because I’ve heard it smells like a wet campfire.  Call me cautious, but that would probably irritate my eyes, sinuses, airways, or just make the bathroom reek.  This soap is made with cedar and citrus essential oils, and isn’t overly strong.  Another concern I had was the scent of whatever soap I started using could be an overpowering scent on my face all day.  That hasn’t even remotely been a problem.  If I cup my hand over my mouth and nose, and breathe in, I can kind of smell the soap for a day – and that’s it.

One other benefit to soaping up my beard once a week is it helps with CPAP beard.  Some people exhibit a bad case of “bed head” upon awaking.  I tend to get CPAP beard from the straps of my mask pressing against my face all night.  Rinsing my beard out in the shower, applying a little beard oil and combing it in the morning mostly keeps it in shape.  It just looks slightly more disheveled day after day by the end of the week though and the deep cleaning gets it back to normal.

After one-two months of use I can hardly tell the soap has even been used.  I wouldn’t be surprised if this lasts me a year.  I’d like to try out some other soaps because I have found some in the $10 or less range, but I’ll probably wait until this current bar is much more used before purchasing something else.

Asthma statistics by state

I came across this article from nerdwallet the other day showing:

  • 2012 Adult Self-Reported Asthma Prevalence Rate (%) by State
  • Lifetime Adult Self-Reported Asthma Prevalence Rate (%) by State

I find it interesting that none of the places I’ve lived are in the top states, yet they are neighboring state are places I like to visit.

I wonder if states with high rates of asthma contain environments that are good or bad for asthmatics.  One would think there’s something in the state causing asthma, but maybe it’s a good place for asthmatics to live and that’s why they are there.

With the new regulations for coal burning plants recently unveiled by the EPA and President Obama, it sickens me both literally and figuratively that people are immediately fighting against them because the regulations could affect jobs.  I received a newsletter from a state senator stating just that because for some reason WE CAN’T FIGURE OUT HOW TO ADAPT BY 2030.  I wrote back telling him this is ridiculous and we should be more concerned about the millions of people suffering from respiratory related illnesses than some jobs we can plan and adapt for between now and the next 15 years.

Supposedly this data comes from the CDC, but I’ve had a hard time finding the actual data the article references.  I’d appreciate a link if anyone finds it.

 

 

Summer is back

As a kid summer was my favorite time of year as I got to spend most of my time outside.  It was often full of runny noses, sneezing, and watery eyes…but I had fun nonetheless.  Last summer was my worst asthma-allergy season ever, but I’m really hoping to not repeat it even though they say it’s another record year for pollen.

My week days generally consist of:

  • Waking up at 6AM and feeling awful
  • Turning off my alarm at 6:30
  • Checking my peakflow to see I’m once again at 60-70% or worse
  • Use my nebulizer before taking my morning maintenance meds so I don’t just cough all my Dulera out
  • More lying around waiting for the meds to kick in while constantly checking the time
  • Eventually forcing myself out of bed to get ready for work
  • I then roll into work later than I should but not too late to be a problem
  • Re-check my PF numbers and decide if I need more albuterol after I’m settled
  • Try to act like I feel ok all day
  • Stay late to make up for arriving late
  • Go home, take some meds, lie down for an hour, and remind myself it was a good idea to take a break from grad school for the summer
  • Help out as I can with dinner and getting the kids into bed
  • Ride my bike slowly, really slowly, or not at all
  • Take more meds
  • Try to get some sleep before it’s time to turn my alarm off again

Weekends are more of the same with me trying to rest up enough so I’m not too tired on Monday, and don’t start my week badly.  Liz asks me off an on if I need to go to the hospital, but I’m slightly more than determined not to because I can’t afford to miss work.