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Use Me !

The marathon walking–severely asthmatic–RT is in the house and is ready to take your questions.

New for this year I’m introducing a new a feature I call “USE ME”, where I answer your questions relating to respiratory therapy, asthma, lung disease, fitness walking or just about anything else you think I might be able to answer in the form of a blog post. The only caveat being that I can’t diagnosis specific medical medical conditions.

What makes me such a know it all in these areas?

Well, I’m a licensed and registered respiratory therapist of 33 years, a life-long severe asthmatic, a sought after lab rat and a 7 time marathoner finisher. I’m also pretty good at explaining medical/technical things in a way that non-medical people can understand.

So cmon, what are you waiting for. Take advantage of me, pick my brain…USE ME !!! I’m sure there are questions you’ve always wanted to ask . No question is too silly.

You can write me privately with your questions or leave them in the comment section. I’ll try to answer as many as I can and post them here on a bi-monthly basis.

Incidentally ….Do you know what the most common Google search phrases are that brings people to my site? #1 is “Hospital Bills” followed by “Recovering from severe asthma exacerbation” And lastly ” Can you have a high O2 sat during an asthma flare? ( Of course you can, asthma is a disease of the airways, not the alveoli). The most searched image from my blog is a photo of me gorked out on Propofol while on the ventilator.Go figure

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32 thoughts on “Use Me !

  1. I think I found you on a google for 'asthma exacerbation' and 'marathon', because i was totally in the dumps about an exacerbation that I thought was going to knock me out of a half-mara, AGAIN. I'm actually flaring right now, but it's not as bad as last time…so far. My Dr doesn't want to keep me on pred but I'm wondering if I should talk to her about a low dose, because if I can be on pred and exercise, I think that's actually preferable to not being on pred and having random flares that keep me from working out.

    1. Youre correct Heather. It\’s easier on your body when you stay on low dose prednisone for extended versus doing high dose bursts with quick taper. Having said that, even low dose pred can cause serious side effects in the long run. The danger I see in staying on any dose of pred, is that your body gets used to it, so that when you flare, you require more and more of the drug to stabilize. Unless you have constant symptoms and/or your inhaled steroids aren\’t working, Id stay away from pred.
      Thanks for the question !

  2. LOVE this new feature, I can't wait to see what it conjures up! [I mean, you and I know that I ask you enough questions as is, eh? ;)]

    Also, I love the lab coat-runners-baseball cap-stethoscope combo [like on skype that day]. Priceless.

    So… in light of our discussion on SARP–wanna tell me why many asthmatics have lower PFs in the morning? I know it's not just me.

    1. It\’s called \” Diurnal Variation\”. (basically the widening and narrowing of our airways as measured in 12 hour intervals) There are theories as to why this occurs, but no one really knows for sure. Some think it has to do with the hyper-reactivity of the airways and the effects epinephrine in the blood.. Btw, this happens non-asthmatics as well, but is much more noticeable in asthmatics. Personally, I think it has something to do with sleep itself ( or lack of)

    1. Air-trapping does not cause pain (there are no pain receptors in lung tissue itself), but it does cause a sense of breathlessness if it gets severe. If youre experiencing pain during breathing, theres something else going on. The pain could be from the lining of the lung ( the pleura) or the muscles in between the ribs, or nerve irritation from somewhere else.
      Thanks for the question!

  3. Judging by the never ending stream of comments I gave my Dr yesterday at the hospital, I am sure I will run a few by you from time to time.

    For instance can they gauge if my Bronch is getting worse without nuking me with yet another CT scan-they are assuming it is as I have much increased sputum these days and more long standing infections, but I just don't want yet another high dose of radiation so we are going to hold off of the CT if we can!

    Great idea to utilize your talents. I'm so pleased for you!

    xx

    1. Hi Sus, By bronch , do you mean your airways ( bronchials?) Other than CT, the only way to look inside your airways is via a bronch ( bronchoscopy). Bronchoscopy is much more riskier than CT and sometimes they have to use fluoroscopy ,but I understand your concern.

      Dexa scans also emit low level xrays, but again, the benefits outweigh the risks. You should be getting a dexa scan at least every 2 years because of your pred use.

      1. I didn't explain well did I? Bronch means Bronchiectasis-they think it is worsening which is why I should have another CT but we must get my Dexa done first as I haven't had one since Dec 08 and it showed 29% decline in the hip, 15% in the lumbar.

        Got my Pred to baseline today 10mg. Fingers crossed. It's been a long time weaning! xx

            1. Yes I do. I think it\’s a part of having this disease and also of growing older. Inhaling too much albuterol can also lower your K+. When I receive continuous albuterol in the hospital I get cardiac arrhythmias due to low K+

  4. How do you know when you need to go the ER? I can never tell. Once I felt intensily tight, and short of breath and was in my redzone, when I went to the ER , Doc Said I wasnt that bad, Another time I was wheezing a little , but i didnt feel I was that bad. My sister dragged me to the ER and I was put on bipap, and lectured by all the doctors to take my asthma seriously, what gives?

    1. I totally agree with you . It\’s frustrating and that\’s why it\’s important that people ( doctors included ) be better educated about this disease. That\’s what we are trying to do with research programs like SARP.

      Of course the best advise is to never end up in a position where you get that sick. But if youve been diagnosed with asthma ( not vocal cord disorder) and are getting progressively short of breath ( flaring) and your rescue meds aren\’t working and your pfs are truly in your red-zone, that\’s when you should go to the ER..sooner rather than later! If they give you the run around or belittle you, go to another hospital if youre able to and report that facility to your insurance provider. It\’s unacceptable for an ER physician or any medical person to downplay your symptoms without explaining why they think so.

      My hunch is that when you were examined in the ER, your breath sounds weren\’t that bad or maybe your O2 sats were normal or maybe you appear to calm ..who knows.
      I wrote a post about this earlier, but O2 sats typically don\’t drop in asthmatics until it\’s too late and not all asthmatics wheeze.

      As far as \”not feeling\” real bad and then ending up in the hospital and getting blamed for not coming in earlier, Ive been listening to that nonsense for 50 years. Just let it go in one ear and out the other.

      One thing that might help, is to alert your primary care doc or pulmonologist before going to the ER , or better yet, have your doctor notify the ER in advance.

      Thanks for the question

  5. Hi Stephen, I have another question for you if thats ok. What does air trapping feel like? and how do you know if your air-trapping?

    1. Ive done many posts on what air-trapping feels like, but basically it feels like you can\’t exhale properly, which then makes you feel short of breath. For me it feels like someone is sitting on my chest just enough where it\’s difficult to breath, but not so bad that I feel like Im suffocating to death.

      To get an idea of what this feels like. Take a normal size breath in , hold it a second, then slowly exhale only have of it. Then take another full breath in and exhale only half again. See how long you can keep that up.

      While not a true emergency in and of it self, air -trapping can make you feel miserable. If it gets bad enough or is combined with worsening inflammation or bronchospasm it can have serious consequences.

      One way you can tell if your shortness of breath is caused by air -trapping vs airway narrowing, is to check you peak flows when you\’re short of breath. If your pfs are normal or near normal, then chances are the discomfort you are feeling is do to air-trapping. Another way to distinguish air-trapping from bronchospasm, is that you probably wont be wheezing at the time and your breath sounds will be clear.

      Air-trapping ( also known as Dynamic Hyperinflation) is usually occurs in more severe chronic asthma, but id the hallmark of COPD and Emphysema. It usually occurs when the smaller airways loose their structural elasticity and/or become clogged with mucus. Air-trapping can be measured via lung volumes ( ie PFTS) and on special CT scans.

      It\’s a frustrating condition because you can feel totally crappy and breathless, yet all your vital signs can be normal. To make it even more frustrating, most physicians don\’t have a clue as to what air -trapping is.

      Thx for the question!

  6. I love this feature, Steve! I have really tight and sore muscles in my upper back on days when I'm having trouble breathing, and sometimes I can feel it even before I really feel my asthma symptoms.

    Do you think it's just the asthma's doing or could I be doing something funny with breathing or posture? It's something I'd like to avoid! Treating the asthma symptoms and using a heating pad helps, when I have access to one.

    1. Hi Danielle, Id say its your posture and/or the over-use of muscles that arent designed for breathing. We call it \”tripoding\”. When youre leaning forward, shoulders hunched and using your arms to hold you up.

      I have the same problem ,but with me the pain is in my shoulder and neck muscles.
      I have an unconsciousness habit of shrugging my shoulders when I breath .( I do this because my diaphragm doesnt work as well as it should.) Anyway, the result is constant muscle pain in those areas.

      It\’s really important that you learn to breath without moving your shoulders on inspiration. (Learn to breath abdominally.)

      Thx for the question.

      1. Yep, I'm guilty of tripoding when things get tough. But you're giving me hope, this is stuff I can pay attention to and work on. Thanks!

        My mom always called it tripoding, I thought it was another term she made up… turns out she actually knew something!

  7. I wanted to let you know that it has been almost 12 months since I have had to be hospitalized for an Asthma Flare. That is the first time that has happened in almost five years.

    I have had to get IV steroids but the hospital I went to adminstered them in the ER. A few other flares I managed to get under control at home.

    When I realized that it has been that long since I had to be hospitalized for an Asthma Flare I did a little happy dance.

  8. 2yrs WOOOOHOOOO 2 yrs today since i've had to take any prednison(the devil) just wanted share with you well 2yrs ago today dr said all of my labs looked really good??? and she would see would see me in 3 months i got mad and said i would see her in 12 ?????s i said you just told me every thing was normal HELLO it's not normal to weigh 350lbs be so swollen can't breath and feel like shit ever minute well she gave me some synthroid 1.0 well first week i was in hawaii and thought i felt better cuz i was at sea level?????? well then i came home to salt lake still felt good now it's been 2 yrs and love to get up in the morning finally startin to lose a little but wouldn't care if i felt this good????? also off the advair and singular only use theophylin and albuteral???? your ?????? thyroid is in normal range and always was??? woooo hooo again i'll have a glass a wine and toast to you thanks for being my friend and answering my ???s through the yr marsh wooo hooooo

      1. stephen my thyroid was normal too???? thats why it took 52 yrs to get any???? had thyroid checked last week and it’s still in normal range??? now i get my thyroid from alldaychemist it cost me 6.05 for 100 day supply ????? startin to walk a little and still feel great i’ll never catch up too you but at least i’m UP AND OUT HAVE A GREAT DAY MARSH

    1. I suppose it\’s possible to have an increased HR due to air trapping, though it\’s usually the other way around. In general though, just the increased work of breathing associated with an asthma flare can cause your HR to go up, but Ive never heard of an asthmatic being put on oxygen for that unless they have some kind of heart problem or have sleep apnea problems as well. If youre not hypoxic, supplemental oxygen probably wont do much. Please keep me posted.

  9. Whenever I go to the doctors office he checks my peak flow. However it is different from what I have at home, it measure the FEV1 I'm guessing. Because, then he says I'm breathing 2 litres when I'm feeling good and (1.5-1.7) litres when I'm feeling bad. What does that mean exactly? he never really explains that

    1. Like you said, it depends on the type of meter they use. Most meters read in \”Liters per minute\”. If your good reading is 2.0 and your bad reading is 1.5 then your yellow zone is probably 1.5 . Your red zone would probably be around 1.25

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