First, a couple Happy Pictures.

Had a wonderful time in Italy. Was there just short of 3 weeks and despite any fears I may have had about how my lungs might react to the stresses of travel, I actually experienced better than average breathing the entire time I was there. I don’t know if was the ultra clean air of the Swiss Alps or that of Europe in general, but instead of my usual 4-6 neb a day regimen here at home, I only needed 1-2 per day while there. I didn’t even need any neb treatments during the 11 hour flights or the long airport layovers.

During the week I spent in Rome, which tends to be a little more humid and polluted, no problems either. Walking up and down steep hills and steps…no problem. Maybe I was distracted by all the sights and sounds, but I was actually shocked by how well I was breathing. The last time I visited Italy, no problems either. I think Italian air is good for me.

It wasn’t until just after the marathon on my last day in Italy, that I experienced any significant breathing problems during my travels, but this was expected. Any type of prolonged physical exertion tends to exacerbate my asthma, so I knew that the symptoms I was experiencing were probably exercise or “marathon-induced” and wasn’t alarmed about it. However, out of an abundance of caution I moved my departure back home by a day, just in case things got out of hand.

I was on a plane less than 16 hours after completing the marathon. And except for a sudden mini attack, which was triggered by the overpowering scents wafting from the perfume counters located at Heathrow Airport’s terminal 5, I managed to make it the rest of the way home just using my inhaler and one epi pen stick to reverse the bronchospasm from the perfume reaction.

Like with all overseas trips, the first few days upon returning home I experienced quite a bit of fatigue and jetlag. Again, no biggie. This happens all the time and thought this is just normal post travel fatigue. Ah, but then a few days later March 25th came around and it was obvious there was more going on than just an asthma flare.

Ah, but the quality of the flare that has been been going on almost a week and which I assumed was caused by walking the marathon, was changing. By that I mean, it didn’t feel like my typical or “usual” kind of asthma flare. I felt more tired than usual and was also coughing a lot, which I rarely do. Despite loading up on steroids and increasing my neb treatments it just kept getting harder and harder to breath. Even though I had consistently tested negative for COVID, knowing that I was in close contact with lots people on the trip and might have picked up a flu bug, I figured I better not mess around anymore and decided to go to the ER.

Unlike the last time I was in this hospital back in November, the ER was actually empty and I was able to get into the resus room really fast. They treated this exacerbation like they always do, with lot of Albuterol, Bipap and Mag Sulfate. Though with the Albuterol shortage it was a little more difficult to set up a continuous neb.

Because I was coughing a lot and had just traveled overseas, they decided to swab me for multiple respiratory pathogens. Everything came back negative on the initial panels, including COVID for the umpteenth time. Then this showed showed up……

Turns out I was experiencing a severe RSV infection that was making my asthma worse. Next thing I know Im in a negative pressure isolation room in ICU fighting even harder to breath.

So here’s the deal with the RSV cold virus, it’s everywhere and for most people doesn’t cause any problems. That all changes if you’re immunocompromised, which most steroid -dependent asthmatics are. It also tends to affect babies and those over 60 years of age with chronic lung problems. Now we’re talking about a virus that can make you very sick and potentially kill you. It was all starting to make sense now as to why I was coughing so much and why I felt so congested. It was the RSV virus that probably triggered my asthma flare or at the very least, was making it much worse. Im guessing I caught it on the plane, but who knows?

Anyways, in addition to all the asthma meds, they also started me on two 2 different antibiotics and the antiviral drug, Ribavirin . Despite those interventions along with cont Albuterol and Bipap, I continued to fatigue and was intubated the next day.

I don’t remember waking up, but apparently I was extubated 3 days later and then developed the usual post extubation delirium which lasted several days. That part I do remember. God I wish that would stop happening. It turns me into an hallucinating lunatic and makes its really difficult for the Nursing staff to deal with me. It’s like living in a nightmare you cant wake from. Everything seems real, but its not. Anyways, later that week I was transferred to the step down unit and became less loopy , but then my asthma rebounded with a vengeance and I ended up back in the ICU. Another round of delirium pursued, this time without an intubation proceeding it ( which is new) then a couple days later I snapped out of it. Same theme as previous pchosis , I was being kidnapped or held hostage, experienced people being executed, the same crazy stuff. It’s awful.

Respiratory wise I was stable enough to be returned to the stepdown unit, but there were no beds available, so I ended up spending an additional day in the ICU. Finally a bed opened up on the 6th floor where I stayed for the next few days until my discharge home.

In total, this Asthma /RSV combo cost me 17 days in the Hospital, a 17 lb weight loss, another intubation, more psychosis and to this day, 3 and a half weeks later, my nose is still dripping like a faucet, my lungs are still congested and Im coughing non stop. This bug is no joke. Thankfully, there’s word of a new vaccine on the horizon. If you’re at risk for RSV I would definitely consider vaccination when it becomes available.

Finally, Because of all that had happened during this hospitalization and I think partly out of desperation I asked the Lung Transplant team to re-assess my case. They indeed came to see at bedside and the short answer was… No! You’re too sick and even if you had a transplantable diagnosis,( asthma is not a transplantable diagnosis) you probably wouldn’t survive the surgery…..blah, blah, blah. To make sure both sides had a chance to fully voice their opinions on the subject, we got together again the day after I got out of the hospital.

The results of that meeting were much clearer and on point, but the same. The fact is, just like the first time I went through this back in 2017, Asthma, no matter how severe, is not a diagnosis for lung transplant. Not because Asthma doesn’t kill, but because death from asthma is hard to predict. I totally get it. I was told by my own doctors 20 years ago that I would probably not live to reach my 50’s. Im 68 now. The rule for anyone considering transplant is that death must be imminent within 1-2 years of listing. You simply cant say that with asthma. Even if my asthma became so severe that I became ventilator dependent, there would be no benefit to transplant me because the outcome would be the same. I might be able to come off the ventilator, but a lifetime of rejection drugs, endless hospital visits, bronchoscopies, skin and other cancers, I would just be exchanging one set of problems for another. At 68 years old point, what’s the point? So, knowing all the ins and outs Im totally happy with the decision for no further Transplant work ups. Lung Transplant is now officially off the table and I couldn’t be more at piece with that decision.

On a much lighter note, as I entered the Hospital and the various units, I was repeatedly greeted with “Hey, you’re the guy who completed the Rome Marathon last week”.
Turns out that one of the doctors I met during a previous hospital admission and whom I had sent a photo and email of my success in the race, shared it with his collogues and from there it kind of went viral throughout the facility. Everybody had heard about it. I thought it was pretty cool. Not wanting to brag or anything, I made sure to point out to everyone that this was actually my 3rd Rome marathon and showed them this picture.

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