Just got paroled after spending another 5 days in the hospital. Gonna need an extended period of time to recuperate and reassess my priorities.

Yes, there’s actually more to my life than asthma attacks and marathon walks… I’m also a Respiratory Care Practitioner .

In order to legally practice Respiratory care in the State of California, you have to be licensed by the state , and in order to maintain your license , you have to renew it every two years . To renew your license you have to take continuing educations courses ( CEU’s) relevant to Respiratory Care and pay a $250 renewal fee.

What makes this a tough call for me, is that because of my asthma, I can no longer work as an RT (not many employers will hire someone who’s in the hospital every month), and because of that , I don’t really need my license anymore. $250 bucks every two years, plus the fees associated with the continued education requirements is a lot of money when you live on a shoestring. I could do a lot of other things with that money.
On the other hand, Ive been licensed continuously since the law went into effect back in 1985… nearly 23 years ago. I feel like a Respiratory pioneer of sorts. It’s hard to let go of a title which you’ve spend your entire adult life making a living on.
If I let my license elapse or retire it , and decide later that I wanted it back, I would have to start all over from scratch, which means digging up old college transcripts, getting background checks done , taking proficiency exams , etc etc. Im’ too old to go through that crap again.
So I guess in away, its less stressful just to bite the bullet, complete the required CEU’s, fork out the dough and get renewed.

They mail the forms out early, but I still have until September to make a final decision in which I will mostly likely renew, but I’m also pretty sure that this will be the last one I’ll do. By the time the next renewal deadline rolls around , and assuming I’m still alive, I’ll be 56 years old. By then I’m pretty sure I can let it go.

A lot of people ask me, ” Did you become an RT because of your asthma?” The answer is …yes and no. Let’s just say that having asthma made it alot easier for me to relate to my patients. On the other side of that, being an RT doesn’t always make it easier to be a patient.

PS….Speaking of patients, today I’m going to become one again. They’re nervous about my low PFs and my persistent symptoms during past week, so today they’re re-admitting me to the hospital. Hopefully , it will only be a short visit.

Rick, the author of the Respiratory Therapy Cave , wrote to me the other day talking about what it was like growing up with severe asthma. One of the things he mentioned that I thought was kinda funny, was how he used to sleep with an inhaler under his pillow. Boy, can I relate to that. To this day I still sleep with an inhaler under my pillow.

Ever see the movie the 1954 classic “The Lost Weekend” with Ray Milland who plays a hopeless alcoholic? Well, it got me to thinking. Short of keeping one on a string dangling outside a window or hiding one in the chandelier for safekeeping, Ive got Albuterol inhalers laying around just about every where.They’re all over my house. Under the couch, under my bed ( tons of them under my bed). Ive got them in my car, in my partners car. I even have a few in my travel luggage. Occasional I’ll find one in the jacket pockets of clothes I haven’t worn in months. I don’t really “stash” or hide them , at least not conscientiously , they just seem to accumulate .

It’s important to note that I don’t abuse the drug (though I probably use more than I should.) When I was young it was a different story. I’d, sometimes go through an entire inhaler in less than 3 days . And we’re not talking about the the newer,much safer beta agonist drugs like Albuterol, were talking about the heart pounding over-the counter concoctions like Primatine mist. Seems like my life revolved around having enough inhaler medicine to get me through the day ( and more important, the night.) We were so poor, sometimes my friends would shoplift the stuff because they couldn’t stand to see me suffer.

After using bronchodialator type inhalers for 50 years, I’ve developed quite a tolerance. Nowadays, I get more relief by inhaling the drugs through the nebulizer instead of the MDIs. A mixture of Albuterol and Atrovent 4-6 times a day, and as needed, seems to works the best. I still use the inhalers , but mostly for their convenience and portability. They’re still very handy during for my walks.

So anyway to satisfy my curiosity, today I scoured my house to take inventory….. and this is what I found:

Me and my buddy, Frank ( lab director)

On Monday I did , what I hope was the last of the “poke and prod Steve” tests for the year. This particular study was designed to see how exercise effects my lung function, specifically my airway resistance ( in lay terms…does exercise cause my breathing passages to constrict? ). They decided to use the bike for this test because it gave them more precise data on the workload they were subjecting me to. They also allowed me to use my inhalers as much as I needed to during the testing, which is something new.

From start to finish, the test took about 2 hours. I was able to stay on the bike for just over 20 minutes and achieved a maximum work load of 110 watts. By comparison, last years test I only lasted 10 minutes on the bike, but was able to get to 120 watts. If you’ve never done a stress test on a bike, it’s kinda like riding up the side of a mountain in high gear. Anyways, at around the 20 minute mark, it was getting extremely hard to breath and pedal, and my blood pressure got so high that they decided stop the test. I was so nauseated, it was all I could do , not to puke.

So, what was the result? I wont know until they sift through all the data, but from what little I could gather, it’s not the duration of exercise that seems to set me off…it’s the intensity! I’ll post the final results when I get them.

Looking good after 10 minutes on the Bike ( I wont show you what I looked like after 20 minutes)

Had my bi monthly follow up visit at the UCSF Chest Clinic on Wednesday. This is the latest plan:

1. Asthma Care Plan –We tweaked my current asthma action plan whereby I won’t come into the hospital for treatment unless my peak flows drops below 250 and remains there for more than 24hours. The way it was written before, it would have me coming into the hospital every other week. We also changed the Peak flow threshold for bumping up my steroids from 340 to 290.

2. Anti Leukotrienes– They added Zileuton ( Zyflo ER) to my drug regime . Zileuton is an anti leukotriene inhibitor used to treat asthma and severe allergies. I’m already taking Singulair which is also anti -leukotriene drug, but it uses a different pathway to block leukotrienes ( Btw…leukotrienes are kinda like really potent histamines that can cause bronchospasm.) There is some evidence that taking both drugs together, may offer better receptor blocking for patients with difficult to control asthma . The only downside ,is that Zileuton comes in a horse pill ( 600mg.) Fortunately, they now have a time release version that you only have to take twice a day.

3. Antibiotics– Because I take steroids everyday which lowers my immune system, they also want me to start taking Septra ( antibiotic) everyday, to prevent me from contracting pneumocystis pneumonia ( No, I don’t have HIV) . Coming down with that type of pneumonia in someone with my lung function, would kill even superman. Unfortunately continuous use of Septra can cause some pretty nasty skin rashes.

4. FeNO –They’re going to start checking my exhaled Nitric Oxide levels every couple of months when I come in for my PFTs. A high level of exhaled NO is an indicator for airway inflammation and is a good tool to use for adjusting an asthmatics prednisone dosage. My most recent NO was 12.5 ( normal.) which would indicate that there is no need to increase my steroids at this time.
5. Effects of Exercise–I’m scheduled to have a repeat exercise stress test done. They want to see definitively, if I have an “exercise induced ” component to my disease, or if I’m experiencing excessive air trapping , or both conditions, when I exert myself. They can do this by hooking me up to a pulmonary function machine and monitoring my airway resistance continuously while I’m on the treadmill. If my airway resistance increases as the test progresses, that would be a strong indication that my air passages are narrowing and therefore I’m experiencing exercise induced bronchospasm. Hopefully this will solve the mystery as to whether or not, too much exertion is detrimental for a certain asthmatic I know. ( wouldn’t that be the pits!) If you’ve ever done this type of test before, then you know they’re not very fun. They basically exercise you until you puke or you pass out. Ohhh I can hardly wait.
6. Acid Reflux—Though I don’t have any symptoms of heartburn or acid reflux disease ( GERD), a high percentage of difficult asthmatics apparently have it , and don’t know it. The problems is that it can make your asthma worse if left untreated. So, next month they’re going to cram a tube down my nose into my esophagus and leave it there for 24 hours to measure the acid down there. I’m betting that I don’t have reflux, but Ive agreed to do this, to put and end to this issue once and for all.
7. The Rome Marathon –All of my Pulmonologists are dead against me doing this marathon. Citing the uncertainty of how my lungs will tolerate the local climate, the 15 hour flight over and back, the air quality in Rome, and the availability of specialty care if I should need it. My response……..I’d rather die than live in a bubble!

After taking Xolair injections for a full 12 months, the verdicts in…..It’s not helping me.
In fact, I’ve been sicker this year than in most.
We gave it a good try, but at a thousand dollars a pop, I can’t really can’t justify continuing the injections. It’s one of those drugs that seems to work wonders for some, but does nothing for others.

Oh well, just have to wait to see what’s next to come down the asthma treatment pipeline.