Tag Archive for attack

Is that a combine in the field?

I spent last week in the hospital. It’s Fall, the weather is changing, mold counts are rising, ragweed season was rough, and farmers are out in the fields harvesting their crops. It’s always the perfect storm of things to induce inflammation in my airways.

It started off with an asthma attack. I was in the garage riding my spin bike one night when I hit a wall after 15 minutes. I backed off, slowed down, and figured things would soon get back to “normal.” Things did not get back to normal. I started myself on some standby prednisone and talked to my lung doctor when things didn’t completely improve. I restarted the prednisone, but it wasn’t enough. One the way to an urgent clinic I got a flat tire. Urgent clinic told me I had to go to the hospital, and the doctor in the ER admitted me after 125mg of solumedrol and some duoneb seemingly had no effect.

This is the first time I have been admitted not in the middle of an active attack where I felt like I was in distress. The ER doctor was going to admit me as soon as I got there, but I wanted to try some standard treatment first. After that it was three days of 240 mg solumedrol before tapering down to 60 mg of prednisone and getting out of there.

Right now I feel like I’m struggling. Doing everything for yourself is harder than it looks, and I’ve come down with bronchitis as well. Here’s hoping the medicine works and I can fully recover without relapsing.

Asthma Attacks

It’s past 2am and as usual I’m extremely exhausted without being tired at all.  Does that sound crazy?  Well it should.  All the prednisone, breathing treatments, and low peakflow numbers don’t help either, but it’s least it’s not 5:30am yet like last night.

Asthma attacks are kind of hard to explain to someone who has never experienced one.  Another reason why they are difficult to define is because in ways they are different for everyone, not to mention the severity with which one suffers from asthma or reacts to particular triggers also varies.  To break it down into simple terms, that really apply to everyone, during an asthma attack your airways constrict and swell making it hard to breath.  Some people cough, some people wheeze, and there is a plethora of other symptoms or signs that may pop up specific to individuals.  Attacks, flare-ups, or exacerbations can last minutes, hours or days.  The important thing is to take them seriously and not let them get out of control.

When I was younger the asthma was still an almost daily thing for me, but it wasn’t like I was taking rescue meds on a daily basis.  Thanks to some of the record keeping I perform on my health (DOCTORS LOVE THIS) I can look back and see how things have gotten better or worse over time.  As a kid I would need rescue meds on a somewhat regular basis during certain parts of the year, but in the past 16 months or so I’ve had fewer than 10 days when I did not need rescue inhalers or nebulized breathing treatments.  On the days where I did need them I was doing anywhere from a couple inhaler puffs or one treatment, up to 12+ treatments in one day.

I’ve been out of the hospital for a full week and am doing much better, but I’m still having a “bad moment” at least every other day.  Last Saturday morning was the worst so far and I got myself into a situation where I was actually worried about myself.  I’ve been working through that morning off and on in my brain looking for things I did wrong or things I could improve next time.  I thought I’d share cause this is serious stuff.

My day actually started out not so bad.  I woke up not gasping for air, played some games on my phone, and was staying home with Chuck while Liz and Neville took care of some morning errands.  The two of them took off and I went about my Saturday ritual of soaping the beard and getting ready for my day.  Chuck was out in the living room holding Chewbacca the guinea pig and watching TV.  After I was ready and dressed, Chuck and I had plans to cook some sausage for breakfast.

I came out from the back of the house ready to start cooking and Chuck asks me where Chewie went, who was now laughing at us from underneath the couch.  Hindsight, being as awesome as it is, would have told me to just let the wookie win, but for some reason I felt the need to get it put away; not allowing him to defecate and micturate upon our carpet.  Ten to fifteen minutes later I was still on the ground with my face pressed into the carpet trying to get that loveable pet out from the couch when I realized I had made a serious mistake.

I should have just let the guinea pig hide under the couch for an hour.

Plan B went into effect as I let the wookie win and started setting up my living room neb for some albuterol around 9am.  I didn’t check any numbers but I knew being down in the carpet had gotten my allergies started which was now triggering my asthma.  Another ten minutes later and my treatment was over, but I wasn’t really feeling much better.  In fact, I was feeling worse.  This is when I started texting Liz to complain about the situation and decided to go find some benadryl at the other end of the house.

I left my phone on the coffee table and lumbered back to the master bathroom where I looked and looked but for some reason couldn’t find the benadryl in plain sight.

Probably after 70 seconds or so I gave up I started stumbling back into the master bedroom and basically collapsed onto my bed.  Over the next 30 minutes as I felt my airways become more and more tight, I tried to get up at least 5 times, only to fall back over.  Eventually I was able to get up enough to setup another nebulizer treatment with my bedroom nebuilzer that was less than three feet away the whole time.  My peakflow was down to 300 (yes this is go-to-hospital for me),put my pulse oximeter onto my finger, and watched my o2 levels desaturate down to 80%.

All of this was occurring while my four year old was watching a movie 10 yards away and I had no way to communicate with anyone because my phone was in the other room and I could neither sit up nor walk to retrieve it.

After my second neb in 30 min my PF was up to 340 and I made it back into the living room to grab some zyrtec and my phone.  Of course Liz hadn’t heard anything from me in 45 min or so and was really wondering what my status was.  I gave her a quick update, and continued to watch my o2 levels bounce between 83% and 88%.  That’s about the time I put a ton of nasal spray up my nose to help curb the allergies, put my CPAP on and hoped for the best.  This was feeling a lot like when both of my lungs partially collapsed last summer.  The difference being I was in a hospital then with two IVs in my arms, and hooked up to 6L of oxygen with 6 nurses, doctors and technicians staring at me.  Last Saturday I was all on my own with nothing but continuous positive airway pressure (CPAP), standard rescue meds, and a cell phone without the ability to talk loudly or clearly.

At some point during this Chuck decided to come join me in the bedroom and watch some TV on the bed.  I kinda knew she was there but was also a bit oblivious to what she was doing.  I ended up falling asleep and after a couple hours of forcing my airways open, my o2 levels were back up to 93%-94%.  While asleep I had a dream two of my medic friends, Andy and Art, were yelling at me to wake up which was about the time Liz got home and was checking on me.

What did I learn?

As crazy as it seems after the fact to verbalize I was seriously short of breath and constantly falling over while failing to take any medicine, in the moment I never think I’m that bad.  I’m the kind of person who discovered early on I can do most things I put my mind to.  This probably isn’t the best thing to have figured out with my asthma, but because of it and a great pulmonolgist as a kid – I kind of developed an attitude of invincibility.

  • I need to keep my phone on me at all times, especially if I’m on my own and in bad shape.
  • I should have quit trying to grab the rodent and just given up sooner.
  • I should have grabbed one of my MDI and taken 4 to 6 quick puffs, with a spacer, to help out in the middle of everything.
  • I probably should have asked Liz to get home immediately.
  • I maybe should have gotten to the nearest hospital ASAP.

This is not what asthma is for many, but this is what asthma is for me.  It’s dangerous, unpredictable, sneaky, and (at times) concerning (for me).  I know there are plenty of people out there who worry for me and about me on a semi-regular basis.  I have amazing friends and great family who are constantly looking out for me and bending backwards to include me when it’d be easier to just let me be.  I’ve basically come to the realization that I’m lucky, blessed, or whatever you want to call it.  I’ve had many close calls where I somehow work through another asthmatic situation one way or another.  Even after 23 years since being diagnosed I’m still learning more about what this disease is, how it affects me, and how I can attempt to keep it under control.  It’s a life-long learning process.

If you have asthma yourself, try not to be stupid like me and get yourself into these situations.  If you are often around someone with asthma, try to recognize symptoms and signs for when they need help.  Liz has figured out what I look like, things I do, ways I act, etc that mean I’m in trouble.  Sometimes I’m clued in and other times I am not.  It’s important to stay calm, as hard as it is, while trying to work through an attack.  Sometimes people don’t take me seriously because I appear too chill.  It really helps though if you can relax just a little bit.

keep-calm-and-wheeze-on

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.

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.