OK, I never actually said I wasn’t going to do Boston. What I said, is that a victory seemed unlikely. By victory of course, I meant finishing the race in the allotted time. Well, I may not finish the race, but that doesn’t mean I can’t start it. So ready or not, on April 19th, I’ll be taking my place at the starting line in Hopkinton Massachusetts for the 114 th running ( or in my case, walking) of the Boston Marathon. Heck, I get psyched just seeing my name on the entry list ( Stephen Gaudet)

Because Ive had so many lung delays and hospital stays (oh..that rhymes) in the last 3 months, I now have less than 8 weeks in total to train and prepare for this race, making this the most ambitious fitness goal Ive ever set for myself. I’m just hoping that the severe asthma flare-ups will leave me alone long enough so I can get some serious training in.

I may be crazy, but I’m not stupid. I know that due to my declining lung function over the last year, that my chances of finishing this race are slim, but this is something I really need to do , while I’m at least still partially able to. I’m not going to push myself to the brink of death like I did last year. I will walk hard, long and give it my best, but if the work of breathing gets to be too much, I’ll withdraw from the race. If I don’t finish the race it won’t be the end of the world (because Ive already done it once), but if I don’t at least attempt it, I think I would regret it for the rest for my life. So,with health permitting, from now until April 10th, I will be in full time training mode for the Boston marathon.

For some self inspiration, here I am ( in the blue shirt) at the 21 mile mark( 33.7 km) at last years race. The crowds on the course have thinned out dramatically (and not only because we’re at the back of the pack). What a lot of people forget, is that out of 25,000 people who started the race, more that 3000 people didn’t finish it ! (and 99.9% of those people were healthy I’m sure). Many of them became causalities of Heartbreak hill 3 miles behind me. So don’t it over until the fat asthmatic lady says it is

Suffice it to say, I wasn’t exactly a happy camper when I wrote that last post about my little prison stint. At the time, I was roided out of my mind and still very sick. Dr W helped me get through this awful time by reassuring me that what anguish I was experiencing, was a normal response after suffering such a severe flare up, and that my complaints were not really unique. (darn…seems the only thing unique about me, is the number of times Ive been intubated)

But what a difference a few extra days can make. I think it was Thursday that I finally ” Turned the corner “. As happens so many times when I think I’ll never recover from a severe exacerbation, I just woke up one morning, and all of sudden… I was breathing better and feeling better! It’s as if whatever was causing my lungs to act up in the first place, just burned itself out and left my body.

It’s astonishing how fast the transformation can happen too… One minute you’re feeing crappy, the next you’re feeling fine. This probably sounds strange, but for a while there it actually felt kinda weird to be breathing easy. All day yesterday I caught myself conscientiously trying to analyze my own breathing to see if indeed I was breathing normal…or I was imagining it. No wheeze, no difficulty exhaling, no discomfort…just normal breathing! So weird, but so appreciated. Id give anything to be able to breath like this all the time. Healthy people take their breathing for granted.

So with this most recent revelation, and after having survived literally dozens of these types of exacerbations, I put all my observations together and made a list. Ive been able to identify 6 distinct phases that I go through during the recovery phase of a severe asthma exacerbation that required a hospital admission.

Just for fun we’ll call it ” Anatomy of the recuperative phase following a hospitalization for asthma” . The word hospitalization is important here, because the recovery phase from a severe exacerbation that did not require hospitalization, doesn’t seem to follow the same pattern.

Here’s the list in the order of occurrence. Can anyone else relate or add to this?

So that’s my asthma recovery check list. I think every physician and RT who takes care of asthmatics should familiarize themselves with this list to get a better insight as to what we go through AFTER we get out of the hospital.

Wanna learn to walk faster than most runners run?

There’s only limited space left for this one, so reserve your spot today! Whether you’re a Newbie or a National champion of the sport, come and learn to racewalk from one of the best racewalking coaches in the world!

Join ME for an awesome weekend of racewalking fun in Tiburon, California. Dave rarely gets to SF bay area, so don’t miss this one. ( Bet you didn’t know racewalking was an Olympic sport? )

Thanks everyone for your support and especially to Kerri and Dr Wensel for staying in close contact during my 98th hospitalization. Thanks also to ALL the wonderful nurses who took care of me..You guys are awesome! Most of all, thank you to my dear Douglas who goes through hell every time I get sick. I’m so sorry I put him through this. Yes, living with a brittle asthmatic is definitely not for wimps.

Im starting to sound like a broken record with these hospital reports, but no kidding, this flare-up was no picnic. It ranks up there as one of the worse on record for me. On a scale of 1-10, probably an 8 or 9. I was pretty sick there for a while and was starting to have doubts as to whether I was actually going to pull through it. But it seems I have more lives than all my kitty cats put together and will apparently live to do this all over again sometime the future ( I just hope it’s not the near future).
Not sure what the trigger was this time, but I’m guessing that the cold I had from the previous hospitalization never quite went away. ( walking in the rain last week probably didn’t help either)

The primary problem this time, and what usually happens when I get really sick like this, is something called CO2 retention. The act (or work) of breathing becomes so hard, that the level of CO2 in my blood climbs really high ( what they call respiratory failure). I was in failure for 4 days with PCO2s ranging from 38 to 70 (when breathing at a rate of 50, that’s not good) My lungs get so tight, that I can’t move any air…I don’t even wheeze! When you listen to my lungs ,you can’t hear any air moving.

Because of all the problems I experienced with lack of sedation while I was on the ventilator the last time, I chose not to be intubated this time ( probably a mistake,because it would have immediately lowered my Co2). Instead , we relied mostly on cont alb nebs, bipap, and steroids to reduce my CO2 indirectly. Thanks to a call put out to Dr Wenzel ( who btw, was in London England at the time), a huge increase in my steroids was ordered along with a few other strategies she recommended, seemed to set the stage for my eventual improvement. Finally on the 3rd day with the increased steroids on board, my lungs started opening up , my work of breathing decreased, and my CO2 started to fall. By day #4 my PCO2 was back to normal and I was starting to wheeze again ( a good thing) . Ironically, while all this was all going on, I found out that there was actually a world-wide shortage of propofol. So even if I chose to be intubated, they would have probably used an alternative sedative agent. Weird huh

On day # 5 I was stable enough to be transferred out of the ICU to the step down unit where I continued to improve. On day #7 I was bugging them to let me go home. On day #8 I was paroled.

This time around I thought Id do something different and post some of the good pictures instead of the bad ones. Of course, I still have to include my battle scars pics. I must have been stabbed 50 times just to gain access to 2 functional IVs and one arterial line. My arms look like black,blue and green swiss cheese and are really really sore.

Today, Im breathing a little better, though my lungs sound like a washing machine during the wash cycle. Course and wet sounding wheezes that you can hear from across the street. Again, this is a good thing and means that my lungs are opening up. The danger is not quite over, as there is a possibility that I could rebound during the next few days, but I think for the most part, I’m over the proverbial hump. In any event, I can already tell that recovering from this exacerbation is going to be slow and difficult process.

This may not come as a big shock to everyone, but these recent flares have taken such a toll on my body, that a Boston victory seems unlikely. There’s just not enough time to regain the training Ive lost. Having said that, I’m not going to let asthma stop me from doing what I love. Boston may, or may not happen. We’ll just have to wait and see.

Just one final thought…..Though I may look happy in the pictures above, it was all for the camera. I’m a ham, no doubt, but I’m also human. These recent exacerbations( 3 hospitalizations in 3 months) have left me incredibly frustrated and down on myself. Steroid induced or not, right now I’m in a pretty deep depression that I’m not sure how long will take to climb out of. I’m not really sure that I even wanna continue blogging about my disease. I hate to be selfish, but lately, just the word “asthma” or the thoughts it provokes, make me wanna run and hide. If I seem slow to respond or update, please bare with me. Thank you everyone for being such good friends. We have built a huge community around our disease and are getting the word out. You should all be very proud.

Postscript 2-7-2010; I had no idea I would strike such a chord with my friends over my comment about not wanting to blog about my asthma anymore.
Don’t worry, I will definitely continue to blog and post on asthma support sites. Maybe not as often , and maybe not focusing as much on my own asthma, but I will definitely keep everyone up to date on what’s happening in my crazy world. I’m just really burnt out right now and I need to focus my attention on things other than my own breathing. Ive been blogging about my asthma and my declining health for 5 continuous years now. I don’t want to be one of those people who chronicles their own death(as noble as that may be). I need to start paying more homage to my idol, the King of the ballad , Mr Manilow. (I haven’t even seen his new show at the Paris Vegas yet.)
So NO worries…. I’m not going away, my life is way too fascinating to keep all to myself

Sorry for the silence. This one kinda snuck up on me. I ended up in the slammer very very sick, but am starting to improve.
I’ll write more after I get home. (It’s really difficult to type when you have a ton of IVs in your hands and arms).

Thanks for the cards,calls and wishes.

Ever since I got out of the hospital for this last flare-up, Ive been noticing that when I take deep breaths in, I can hear (and feel) a slight inspiratory wheeze or airy sound coming from somewhere in my throat. More bothersome than the sound, I can actually feel some resistance as well. It feels like I’m breathing through a narrowed tube.

At first I thought that because I was weaning off the pred too fast, that my airways were rebelling by tightening up, but this sensation feels different than regular bronchospasm. Although very mild, it feels more like a permanent constricture in, or around the area of my vocal cords.

Well , after a week of trying to rule out possible causes, it finally dawned on me….. I probably have some kind of Tracheal Stenosis” or a vocal cord injury, related to my last intubation. I spoke with Dr W and she totally agreed with my assessment. An ENT doctor will have to look down my throat with a scope to confirm whether this is actually the problem, but I’m pretty confident it is. My only question is, is it my vocal cords that are jacked up, or is there some narrowing of the upper airway itself, and more important, can it be fixed?

From what little I know about this subject from working as an RT, Tracheal Stenosis is basically a narrowing of the trachea , either above or below the glottis, and is usually due to trauma caused when an Endotracheal tube is inserted in your windpipe ( Intubation).Although modern ET tubes are designed to be gentle on the airways, the physical presence of the breathing tube in your airway, can still cause damage and scarring to the surrounding tissue. The result, is swelling and/or thickening of that portion of the airway. The amount of time that the ET tube is in your airway is an important factor, as you’re more likely to develop a stenosis if you were intubated for a long period. But, that’s not always the case, especially when you’ve been intubated as many times as I have.

Up till now, this has been little more than an annoyance ,which only bothers me when I try to take a deep breath in. I am a little concerned however, that this could turn into a very serious problem the next time I have a major flare, so I just as soon get it checked and corrected as soon as possible.