All this buzz about inhalers ,nebulizers and hospitals , got me to thinking of various situations, in which Ive been involved.

Not always practicing what I preach.
As I’m sure Rick would agree, It’s a not always easy being a Respiratory Therapist/Asthmatic. Many times, what you’ve learned as a health professional is at odds with how you deal with your own disease. I cant tell you how many times Ive gone to the ER to instruct a patient on the “correct” way to use their inhaler and spacer, only to turn around a few minutes later and take a few puffs off my own inhaler with complete disregard for technique… or even a spacer for that matter!

RT/Patient
Imagine, you have a really bad asthma flare-up, you’re admitted to the hospital, and first words you hear out of peoples mouths is….” So I heard you’re an RT! ” or ” So , is this why you decided to become an RT?”
I don’t know why, but when I’m the patient, I prefer that the medical staff taking care of me not know that I’m an RT. It just seems to make things more awkward. I think mainly because you can sometimes sense that the people taking care of you, are a little uneasy or let’s say.. not too thrilled about the idea of taking care of an RT/patient.
On the plus side though, I’m sure it keeps the staff on their toes. You can pretty much bet that everything is going to be done by the book. For example: With every single breathing treatment, you’re also going to get; pre & post breath sounds (listening to your lungs with a stethoscope before and after breathing treatments) pre & post oximetry (checking you oxygen saturations) , pre & post PFs, (checking your PFs before and after your treatments)… etc etc. Many times Ill try to put the RT’s at ease by telling them… its OK ..You don’t have to hover over me..my breath sounds haven’t changed in the last hour. Just give me the neb. Go ahead and do another patient while I do my own neb ( a big no-no by the way).
But you know what the most awkward moment usually is? It’s when they need to do an ABG ( arterial blood gas) on you. Even if they don’t show it, you can tell they’re sweating bullets hoping like crazy to hit that artery on the first poke.Nothing more frustrating for an RT, than missing a bounding pulse ( been there–done that).
Come to think of it, the only time I’m treated like a “regular” patient is when I’m intubated (you can’t really talk back). They’re going to suction you no matter what. And when it’s time for you to breath on you’re own ( cpap trial or t-piece) ..they’re ruthless.
Of course when you’ve been admitted to the hospital as many times as I have, its almost impossible for people not to know……its all over my medical records.

MDI Protocol
The last time I was hospitalized, they put me on a continuous Albuterol neb at 20mg/hr. (In case you don’t know, that’s the equivalent of 8 Albuterol treatments PER HOUR! .) And to make the medication work even better, they nebulized it with Heliox . As is pretty typical, they kept me on the continuous neb for about 96 hours. Thats’ around 736 Albuterol treatments in just a 4 day period ! Though my potassium always drops big time, amazingly, my heart rate never gets that high, maybe to about 120-130…(but that’s another blog post).
The point is, when they finally transfered me out of ICU over to the step-down unit, the hospital’s respiratory care protocol kicked in and I was switched from a continuous neb ( which was now at 10mg/hr ), to an Albuterol inhaler of 2-4 puffs Q6 prn. That’s a pretty drastic cut. Needless to say, it didn’t work and a couple hours later I re-flared almost ended up back in the unit.
They ended up putting me back on nebulized treatments , this time Q2 ( every 2 hrs) as needed , which I remained on until discharge. Which brings me to another point. One of things RT’s hate the most (though they may not admit it), is having to give neb treatments to a patient every 2 hours…especially at night. Knowing this, I try to tough it out for as long as I could so dont have to bother them as often.
In the good old days, if they trusted you, and you were physically able, they would leave extra meds at your bedside and let you do your own neb treatments.

No major major complaints for the time being, but as always on the asthma front, there’s some good news and then there’s some not so good news. Here’s the latest:

Ive been in my “green” breathing zone pretty much steadily now for the last 6-7 weeks and Ive been off the prednisone for almost 5 weeks! That’s a very good thing, because it means Ive been able to exercise more. And when I’m able to exercise more, everything in my life seems to go better.

On the not so good side of things, Ive been requiring more frequent nebulized Albuterol treatments. It used to be that on a good day, I could go 6 to 8 hours in between breathing treatments….now, it’s more like 3 or 4 hours! It used to also be, that when I’d wake up in the middle of the night short of breath, I could take a couple hits off the inhaler and get enough relief to fall back a sleep. Now when I wake up, I’m so SOB that the inhaler just doesn’t cut it . Instead, I have to get out of bed and take a neb treatment.

I don’t think this increased need for bronchodialtors can be totally blamed on stopping the prednisone, as this was happening even when I was taking prednisone on a daily basis. More than likely, there are several factors including; a more acute perception of respiratory discomfort, a decline in overall lung function, and the erratic bronchospastic nature of my airways. Believe me, there’s nothing worse than waking up in the middle of the night, gasping for air because your air passages decide to clamp up! This happens to me almost every night.

I should also mention that I don’t buy the argument that Albuterol inhalers are just as effective in delivering medication to the lungs as nebulizers. Granted, many, if not most people out there, don’t use their inhalers properly. But no matter how good or bad your technique is with an MDI and spacer, you have to enough lung function to inhale the drug into your lungs. With mild shortness of breath it’s no big deal, but when you’re tight as a drum, that’s a different story. I guess the key is not letting yourself get that SOB in the first place ( but that’s another post).

What Ive tried to do recently when I feel the need for a treatment, is to limit myself to 10-12 breaths on the machine and then wait a few minutes and re-check my peak flows. If my PFs improve even minimally, I’ll discontinue the treatment and do some mental imagery until I “feel” better. When I take treatments in the middle of the night, I’ll take as few as 5 or 6 breaths, so that I don’t wake up completely. I don’t get total relief, but because I’m still half asleep, it’s enough where I’m able to stumble back to bed and hopefully doze back off.

Fellow blogger and lung challenged marathoner featured on the CBS evening news.

Be sure to check out his blog @ Live to run, run to live

Can you believe I’ve had 118 arterial blood gases (ABG’s) drawn in just a 3 year period??

Without getting too medical on you , an arterial blood gas sample (ABG), is simply a type of blood test that is done when it’s necessary to measure the amount of oxygen ( PO2) , carbon dioxide ( PCO2) and Ph ( the acidity ) and a few other things in the blood collected from an artery. During a severe asthma exacerbation , the actual struggle to breath ( what they call “work of breathing”), can cause the CO2 in the blood to increase to dangerous levels. If the attack becomes severe enough, the body( lungs) can’t eliminate the CO2 fast enough and the blood then becomes acidic ( low Ph) … not a good thing) The point where the body is no able longer compensate effectively, is called “Respiratory Failure”. Trust me..you don’t want to be in respiratory failure.

Of course that 118 number doesn’t represent the actual number of punctures into my radial artery. If that were the case , my wrist would have fallen off my now. Some of those samples actually came from arterial catheters that were placed in my artery during different hospitalizations. I estimate that about 50 of the 118 ABG samples sent to the lab, were taken from an art-line. That still leaves a whopping 68 individual punctures in my poor wrists!

Unlike regular blood draws from a vein, ABG blood samples are not only harder to get (you can’t really see an artery like you can a vein), but they can be quite painful as well. So, if the doctors think they’re gonna to need to get frequent and/or multiple arterial blood samples, they will usually place an arterial catheter directly into the artery and then draw the sample from that. They can also attach a transducer to that catheter which allows them to monitor your blood pressure directly from the source! Pretty cool actually ! In total, I think I’ve had about 10 arterial lines inserted in just the past 5 years. In any case…a 118 blood gas samples….is a lot of blood gas samples! It might even be a record for an asthmatic.

Oh..and at $250 a crack, that’s about 25 grand just for this single blood test. See, I told you I was expensive.

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…..Well, not exactly. I’m still getting my fix through steroid inhalers, but as far as the prednisone goes…..I’m totally off it ! ( at least for the time being.) I was on a low dose of it continuously for 14 months, but decided to stop, as it didn’t seem to prevent the more severe flare-ups.

It’s now been a full 2 weeks since I tapered off that poison, and so far, so good .My adrenals seems to be working fine, doing what they’re supposed to do. My peak flow readings, though a little lower overall, seem to be less wobbly (variable) and have been consistently in the green zone. My dyspnea level has been for the most part…mild. About the only negative thing I can think of, is that my neck and back and shoulder pain have increased 10 fold , but that was to be expected . Too me though, pain is the lesser of the two evils and I can deal with that.

I guess only time will tell how this is all going to effect me. One things for sure, from now on I’m only taking the drug when I get really really sick, and then, just long enough to recover.

Again with the disclaimer…This is a personal choice I made after discussing it with my doctors.

The bills have been tallied.  During these past 12 months,  I’ve managed to rack-up an astounding $492,338.53 in hospital bills. Add to that, all the outpatient clinic charges, prescription costs and so on, and we”re easily over the half million dollar mark.  That’’s pretty scary.

Did you know , that a single day in the Intensive Care Unit at UCSF medical center in San Francisco, now runs almost $16,000. For that price you get the Nurses, Physicians and a monitored bed.  Everything else is charged separately! Even If you’re lucky enough not to need the ICU, a bed in the step down unit will still cost you $5,000 a day.  I think a regular semi-private room on the medical ward goes for around $2000. I’m not sure , because Ive never actually stayed in a regular hospital room. They always put me in ICU or TCU (whether I think I need it or not.)

I’m extremely fortunate (at least for the time being), that I have good medical insurance and don’t have to pay the bill, but looking though the itemized charges, I quickly found over $50,000 in billing errors and/or charges for stuff I never received!   For example…$150 for a pediatric airway adapter?? ( I don”t even know what that is) How about $600.00 for Bipap masks when I wasn’t even on Bipap? One of my favorites though , is $ 900.00 for a bottle of Flonase. You know…nasal spray? And how about the legitimate charges; $190.00 for a single nebulizer treatment. $500 per day for Oxygen, $200 for a single blood gas, or how about $3000 per day if you need a ventilator? I wonder if the insurance companies ever bother to scrutinize these line- by- line charges? I know they have contracted rates with the hospital and end up paying less than 10 cents on the dollar anyway, so maybe it doesn’t matter to them. I’m just floored every time I receive a hospital bill. How on earth do people with serious health problems survive without insurance?