Tag Archive for nebulizer

May is Asthma Awareness Month

May is asthma awareness month. My sister likes to celebrate her birthday for an entire month, so I’ve been trying to share all month about asthma on facebook, twitter, and instagram.

My month has been ok. My little dude ended up in the ER with bronchiolitis again. As time goes on, his breathing resembles mine more and more. Fortunately it’s very episodic for him and only flares up every few months. A few duonebs, some pulmicort, and prednisone fixed him up. It’s interesting to watch him expend as much energy as possible all the time. Even when he’s having trouble breathing, he’ll move and move and move until he ends up lying on the floor.

Speaking of “lying on the floor,” I had a “moment” myself a few days ago. I wasn’t feeling too great and was lying down while the kids watched a movie. The little dude was pretty active, like a spider monkey, as usual. He was kind of climbing on me, and before I knew it, he was jumping on my chest. That triggered some major coughing and wheezing which ended in me crawling towards my medicine, getting too worn out, and lying on the floor for a long time. I was eventually able to get to my meds and noticed my oxygen was 85%. In the moment, these sorts of incidents don’t seem like a huge deal. Afterward, they do seem a bit more serious. I know I’d be exponentially more concerned if I witnessed this happening to someone else.

A couple nebs, magnesium, allergy meds, five hours on CPAP, and some more albuterol had me mostly ok in 24hrs. I should have used an epipen or gotten help. That’s easy to now, but in the moment all i can think about is, “I don’t want to go to the hospital.”

At the moment I’m outside of Pittsburgh and will be visiting my other lung doctor at UPMC tomorrow. It’ll be interesting to see where my PFTs are at and things have changed or stayed the same. A year ago I found out I have idiopathic restrictive lung disease on top of everything else. It’d be really cool if things were better.

Am I the only one that has to pack three times as much medical stuff than clothes on trips? I feel a bit ridiculous sometimes, but I assure you it’s all necessary.

TriggerNeb reusable nebulizer set

I just got an email from JustNebulizers.com about a new neb set they offer. Is it just me, or are they making breathing treatments more and more like smoking a hooka?

TriggerNeb Reusable Nebulizer Kit: http://youtu.be/bcOUaD3LQFE

Nebulizer Cleaning and Maintenance Part 2

A couple months ago while I was talking to a SARP research nurse, she was asking me a bunch of questions about medication, triggers, experiences, etc.  We started talking about nebulizers and she asked how I clean mine.  I said I rinse/wash them once a day and then once a week clean them in vinegar.  While this was the preferred method for “deep cleaning” your equipment, there has been some recent research that shows soapy water is actually more effective.

So I’ve switched from buying giant jugs of white, distilled vinegar to putting my nebulizer pieces into a plastic bowl and letting them soak in hot, soapy water for about an hour.  I’ve had people tell me they can’t wash their nebs in vinegar because then it tastes like vinegar or they feel like they’re inhaling vinegar fumes.  I’ve never had that happen, but I would also thoroughly rinse everything after the vinegar soak.

Nebulizer parts

Unfortunately this doesn’t work for my CPAP cushions because our dish soap is anti-bacterial which breaks down the silicone or whatever the comfort gel blue is made of.  I still use liquid baby soap for that.  No matter how you clean your durable medical equipment, the important thing is to actually clean it.  Using a dirty nebulizer isn’t going to help you at all.  I’ve seen old parts with mold in them, and if you happen to be sick with something bacterial or viral, you might be re-infecting yourself.  It’s kind of like what they say about getting a new toothbrush after you’ve been sick.

Summer 2013: ER Visit #6

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.

What next?

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.

Asthma bag to the rescue

For years I’ve been carrying asthma-related things everywhere I go.  At first it was an inhaler or two in a pocket which eventually upgraded into a backpack, and now is my Maxpedition Jumbo Versipack.  I need many more things than a pocket or two on my pants can carry and putting everything into an easy bag with both a handle and shoulder strap makes it all the more easier.  I went to my main doctor today to follow up from the hospital trips last week and the nurse wasn’t sure where their pulse oximeter was.  Lo and behold I keep one with me at all times so she used it instead.

My man-bag, asthma-purse, asthma-bag, satchel, what-have-you regularly contains:

Maxepedition Jumbo Versipack Khaki/Foliage

Maxepedition Jumbo Versipack Khaki/Foliage

  • Maxpedition Jumbo Versipack
    • Pari Trek S nebulizer with AC adapter, car adapter and battery pack
    • Pari LC Sprint Nebulizer with wing-tip tubing
    • Albuterol .083% nebulizer solution
    • Peakflow meter
    • Nonin 9590 pulse oximeter
    • Cetirizine (Zyrtec)
    • Patanase
    • Current and last year’s asthma journals
    • Bandana
    • Pocket knife
    • CRKT large spork
    • Sunglasses in hard clamshell case
    • Black and blue ballpoint pens
    • iPad VGA and HDMI connectors
Contents of my asthma bag

Contents of my asthma bag

So this is what I’m lugging around all the time and my bag is by no means stuffed.  There’s always room to stash some business papers, grab a couple notebooks or even slide an iPad3 into one of the pockets.  Obviously I’d need to take a couple things out to go through TSA, but overall it’s something easy to always have ready and take with me.

Nebulizer cleaning and maintenance

Update: Check out Nebulizer Cleaning and Maintenance Part 2

I throw around the terms nebulizer, neb, treatment and breathing treatment often on this blog and thought it might be a good idea to explain what they are and how to maintain them.

Breathing treatment:

A breathing treatment consists of inhaling a liquid medication, similar to what’s inside an inhaler, through a nebulizer that is attached to air, oxygen or an air compressor.  The “air” moves through a tube into the nebulizer which then turns the liquid medicine into a fine mist.  It used to be this type of medication took up to 20 minutes to complete.  Today with technological advancements breathing treatments can take as few as 15 inhalations or a few minutes.  For some people this is a more effective way to receive the medicine.  Improperly used inhalers leave most of the medicine on your tongue or the back of your throat instead of down in your lungs where it needs to be.  Others sometimes find a treatment more soothing on their throat than conventional inhalers.  The only real drawbacks are size, portability and power – but you can buy air compressors today that are the size of a couple decks of cards and many have options for battery packs and car adapters as well as the standard AC adapter to plug into an electrical outlet.

Nebulizers:

Nebulizers can come in many shapes and sizes.  Here is what I would call a classic example that I used to see in hospitals and doctor offices all the time.  I started using them in the 90s at home.

nebuilzer_classicYou’ll notice tubing, the nebulizer cup with mouthpiece and an extra tube.  The extra tube is attached opposite the mouthpiece to help channel the air you exhale.  These nebulizers are disposable.  They aren’t meant to be used for days, months or years (yeah, I used one for a couple years once without ever properly cleaning it) – and they should be rinsed after every use.

Eventually I started seeing nebulizers more like this where you can set them to dispense medicine only when inhaling or they blow wide open like the above example.  Depending on the situation you may need one or the other, plus it’s always nice to have options.

aeroeclipse-r-ban-reusable-breath-actuated-nebulizerThis is what I have most often seen/used in hospitals the past few years.  This nebulizer is an Aeroclipse R BAN reusable breath actuated nebulizer.  The breath actuated part is useful to make sure the patient gets all the medication.  As before, this should be rinsed out after each use as long as you’re not in an acute situation where you’re needing frequent treatments.  It’s even dishwasher safe as long as you put it on the top shelf.  Ever since I bought my first Pari Trek S compressor that came with the Pari LC Sprint nebulizers, I’ve been using those on both my Trek S and my old school Devilbiss Pulmo-aide.

pari_lc_sprint_reusable_nebulizer_kit_with_tubing_primary_205

This comes with wing-tip tubing, I think that means extra fancy like the leather shoes my grandpa loves, a mouthpiece and is basically breath actuated similar to the previous nebuilzer.  The LC Sprint should be replaced every six months and Pari provides a sticker to slap onto your compressor which lets you know when six months is up.

Cleaning your nebulizer:

While cleaning your nebulizer probably makes sense, I know many people who do not.  Besides the regular sterilization or clean arguments, you should remember that anything you breathe in through this apparatus is going straight to your lungs.  It’s  probably not a great idea to give yourself a cold, bronchitis or pneumonia from your medical equipment.  A standard cleaning can include a quick rinse with water and air drying, cleaning with hot soapy water, placing on the top shelf of your dishwasher (only if dishwasher safe) or deep cleaning with a solution.

Since I’ve been doing anywhere from 7-11 treatments a day I don’t always rinse the nebulizer after every use, but I make sure it happens at least once a day.  I also clean my nebulizers in a water/vinegar solution to kill everything off.  I’m extremely allergic to most molds and fungi in my region of the world and these are two things which can easily grow and thrive in the moist environment of a nebulizer.  In fact, if you have problems with mold at home, vinegar is what you need to clean and kill it.  Many use bleach which just “bleaches” the color out of the fungus/mold and spreads it around.  It’ll just grow back in a matter of time and the patch will be bigger.  To do this deep cleaning, I dismantle my nebulizer into its four pieces, place them into a mixing bowl, and do a 1:1 or 2:1 ratio of water and white distilled vinegar.  After the pieces soak for an hour I rinse them thoroughly, let them dry and I’m good to go.  If your nebulizer is not dried out and you need to do a treatment, just let the air run through it for 15 seconds or so and that should do the trick.

Replacing your nebulizers:

Once you have a good handle on cleaning your nebulizers, another thing to think about is when to replace them.  I do treatments all the time and really need to adhere to a standard replacement schedule.  Pari suggests swapping out my LC Sprints every six months.  To make this easy on myself I throw out my nebulizers, I keep one at home and a second in my EDC bag, on January 1 and July 1 of every year.  That way I don’t have to remember exactly when I started using them.  For those of you who might use your nebulizer much less frequently, once a month or maybe a few times a year, replacing your nebulizer probably isn’t that big of a deal as long as you make sure they stay clean.

One other often overlooked part in the nebulizer system is the air filter.  Similar to keeping your nebulizer clean so you’re not making yourself sick, all air compressors have an air filter somewhere that has a replacement schedule and should be followed as well.  Before I looked into this kind of stuff I had one nebulizer whose air filter wasn’t replaced for 6 years.  Luckily when I finally took it out the thing wasn’t crusted and disgusting, but I really should have been changing that out every six months just like my nebulizer.

Where do I buy this stuff?

There are different places where you can purchase equipment.  Some like to use durable medical equipment companies.  I’ve never had too much luck with them.  These companies often carry the minimum amount of options for inventory purposes and often will not special order.  I recently bought a new nebulizer/compressor kit and the durable medical company didn’t even let me choose what they were going to sell me.  I ended up buying online from JustNebulizers.com as I’ve been doing for some time.  They often have sales, I’m always receiving coupons by email and if I buy in bulk I get a discount.  Once I had a problem with my order and a quick phone call took care of everything.  Their customer service is great.  Buying online usually means you need to submit a form to your insurance for reimbursement or to have the amount added to your deductible.  While this may seem like a pain, I’m actually costing my insurance company and me less by buying them on my own AND I actually use what I want.  If patients need to be compliant with their treatment, it helps if they don’t hate it.

If you end up in the ER, hospital or doctor office receiving treatments often, just ask to take the nebulizer with you.  They won’t give you the compressor, but after you leave they’re just going to throw away the tube and neb cup.  Might as well get some use out of it at home.

Also, if you spend a decent amount on health care every year, you should save receipts and keep track of how much you spend on all this stuff.  Itemizing your medical expenses can save you a lot of money on taxes depending on your situation.

Summer 2013: ER Trip #4

Tonight I have a success story because I wasn’t too much of an idiot.

Today was like most days for the past few weeks.  I went to bed early in the morning with a neb to take the edge off only to wake up a few hours later desperately needing more albuterol.  I then spent the rest of my day watching Netflix, taking care of some work stuff and doing more treatments every three hours or less.  Right around 4pm the treatment’s effectiveness seemed drastically reduced and I started dreading the idea of having to go back to the hospital AGAIN being I was just released on Tuesday.

I just wrote that long post on Asthma Acting and decided I better heed some of my own advice for a change.  It was time to get some data and seriously consider the best plan of action.  My oxygen saturation kept dipping down to low 90s and my PF numbers were consistently in the low 400s to mid 300s.  This meant it was time to go.  Granted I was no where near as bad as Sunday, but I could tell I was on the cusp of a hardcore attack if I didn’t nip it in the bud.

Liz asked her mom to come over and hang out while Chuck was sleeping, I packed up my gear and then we headed over to the hospital.  When we pulled up Liz noticed one of her friends was working registration who immediately helped me into a wheelchair and told someone else at the desk my name and info.  That in itself is a HUGE help cause it’s pretty hard to talk when your lungs are only pushing 30% capacity.

They wheeled me back and a nurse got me started on 2L oxygen, hooked me up to a pulse ox and heart monitor, and then attempted to start an IV and take some blood.  Little did I remember she was the one trying to start lines on my right arm just a few days ago.

Nurse: Hey, weren’t you here just a few days ago?

Me: Yeah…

Nurse: Man, you were really freaking us out!

Which actually reminded me of a short conversation with Jeff the nurse when he returned Tuesday morning after the “Josh Incident.”

Jeff: Dude, you were making me really nervous last night.

Me: Dude, I was making MYSELF nervous last night.

It’s true, I’ve seemed to have that effect on people throughout my whole asthma career because I usually wait too long to do something.  This night was totally different.  Instead of five people hovering over me for 2hrs and trying to figure out how to make it stop, we had a much calmer situation with fewer people scurrying around.  Unfortunately it took four tries to get an IV started again because when I can’t breathe my veins like to dive deep like the Red October avoiding depth charges.  I’m just glad they didn’t order any ABGs.

Soon the respiratory tech arrived and I’m sure you can imagine my relief it was not Josh, aka worst medical professional of the decade.  She listened to my lungs, had me create a PF baseline, asked what my personal best is, listened to my lungs, got me started on a double albuterol neb and then got some information out of my little black notebook with follow-up questions to Liz.  This woman was good.  As soon as she saw all my documentation and found out this was my fourth time this summer, immediately after a hospitalization, she knew I was on top of things.  She knew my airways were just hella tight.  She could tell what my cough was doing to everything and when one of the nurses said, “I don’t hear any wheezing,” the respiratory tech responded with, “his airways are too clamped down to even let him wheeze.”

YES!  SOMEONE KNOWS WHAT THEY’RE TALKING ABOUT!

After the double albuterol ended, we followed that up with some pulmicort and solumedrol.  Slowly, ever so slowly things started to open up.  Should I have stayed home?  No.  Was it the right thing to come in? Yes.  Did I avoid a possible re-admittance into the hospital?  Most likely.

So a few hours later we got to leave and I followed tradition by getting some Taco Bell on the way home.  This is also the most healthy I’ve ever been after leaving a hospital.  Even though I’m all jacked up on drugs right now and will be awake for a while, I’m no where near feeling as awful as I usually do.  Take it from me, the guy who freaks out the hospital staff – know your limits and go to the hospital when you’re supposed to.  The only real damage would be the bruises all over my arms from this week.

8 IV lines 2 ABGs 5 Blood draws

8 IV lines
2 ABGs
5 Blood draws

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.

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.

Another ER visit

This summer is truly turning into record breaking asthma for me.  As of today:

  • I have 22 days of prednisone under my belt with another 27 on the way
  • Two courses of anti-biotics
  • Two ER visits
  • Four PCP visits
  • Three Pulmonology visits
  • One Allergist visit
  • About 120 nebulizer treatments

Wednesday was brutal outside.  The temperature hit at least 90F with humidity to add to the heat index.  I know the heat index isn’t “real” but it sure does affect people like myself with pulmonary conditions.  I’ve been trying to figure out a better parking solution at work because the closest lot with my level of parking access is 880 walking yards away.  When I’m feeling ok, that mile of walking every day is great, but I’m not ok right now.  Ironically my doctor wrote a letter asking for a parking accommodation and later that day I ended up in the ER due to an exacerbation from walking around campus.

Trips to the emergency room or emergency department are never enjoyed or wanted.  I fancy myself as “tough,” never think I’m that bad and in the moment usually suffer from “asthma brain” fueled by a lack of oxygen.  It’s good to have someone around to make the decision for you or easily identifiable metrics defined to know when to go.  Walking around outside that day was causing my lungs to ache with every breathe which eventually led to dull, then sharp pain.  Around 6:30pm I’d rank my inhalation pain around 7/10, was shaking uncontrollably and had tears streaming down my face.  And that’s ok cause strong men also cry…right?

Whenever I recount stories like this, they sound ridiculous and of course I would try to force someone else to seek medical attention if they were in my situation.  What I had going through my head that night were things like:

  • There’s no way it can last that much longer
  • I’ve been worse before (it’s true)
  • I’d rather wait to incur more medical costs until after 7/1 when I have more FSA funds to pay for it
  • I’ll be ok

My wife started threatening to call an ambulance, and while I do respect all my paramedic friends, I hate taking ambulance rides.  Eventually I agreed to go if she would drive me, and she did.  I had already done four nebulizer treatments at home that day and by the time I finally went to the ER, my pain had dropped from 7/10 to about 4/10.  With the heat, humidity and thunderstorms, the ER was packed, however, since I’m a bit of a frequent flyer they recognized me when we walked in the door and let me cut in line.  As they were wheeling me to a room I began to notice all the people standing/sitting in the hallways being treated so I was grateful for a bed.  They got started on me right away with the standard tests.  The “asthma” wasn’t bad, I just wanted to punch a wall every time I breathed.

The respiratory tech was a good one that night.  Instead of answering a bunch of questions, I handed over my notebook which is when they start taking me seriously.  I’m basically on high doses of every type of maintenance and rescue medication in addition to the anti-biotics and prednisone I’ve been taking.  The attending physician ordered blood work, a chest xray and the dreaded ABG.  This was the first time a respiratory tech performed a blood gas test on me, usually they bring in a phlebotomist and it goes horribly.  This dude got it right away and I can actually move my wrist – major bonus.

Unsurprisingly they didn’t find anything out of the ordinary, well that is from what’s already known, they got me patched up and sent me home.  They did pump me full of morphine though which really made it easier to breathe.  I’m sure Rick James would tell us it’s one hell of a drug, but that’s a bit rhetorical.  At this point my body is just too tired, stressed and worn out from 6 weeks of asthma and not sleeping.  I need to start seriously looking out for myself the rest of the summer to avoid any more complications.  I sometimes joke about people dying from asthma, but it’s true.  I’m fortunate enough to have a special lady friend looking out for me, a good team of doctors and a boss who is accommodating.  I don’t know how I became so lucky some days.