You are currently browsing the tag archive for the 'medications' tag.
I’ve been bouncing around the respiratory clinic for the past week, conferring with my pulmonologist and getting full PFTs and simple bloods done. I also checked in with my gp this week. And the concensus is: it would be best for my asthma control if I had full control of my prednisone usage. In other words, I get a nice fat supply of steroids and decide when I need them.
Woah. This is different. In the past, I have had one course on hand to use in a pinch, like if I was travelling or something. The conditions are that I have to see my pulmo regularly (which I already do) and tell him exactly how I’m adjusting my treatment. The plan here is to sidestep the germy walk-in clinic and hopefully avoid emerg altogether. In case you didn’t know: I’m NOT on prednisone longterm, but I have an exacerbation every 1-2 months that requires treatment with oral steroids. For the past couple years I have averaged 9-10 courses a year. When I say it like that, it sounds shocking. This is TOO MUCH PREDNISONE and I wish it wasn’t like this but the flares come and avoiding taking it only lands me in the ER. That is not where I like to be.
I am kind of wary, will I know how to use it appropriately? Am I a responsible enough patient to be given full control? My pulmo says yes but I have my doubts. True, I know a lot about asthma and I certainly am used to how my own asthma presents itself. I was teaching the med student in the clinic a thing or 2 today. Poor guy was only second year and was sooo confused about asthma meds.
Here’s hoping I just stay well and won’t have to make too many executive decisions.
It is really difficult to define and describe both the notions of asthma control and severity. I think it’s difficult for patients to articulate what their level of control is, and it’s also difficult for physicians to assess it in their office. In addition, people can be bothered to varying degrees by the symptoms they are experiencing. A new asthmatic will (appropriately) be distressed by mild bronchospasm whereas the most seasoned asthmatics can carry on with severe breathlessness.
There are several guidelines out there which aim to define asthma control in an objective way. Some measure by how many times a bronchodilator is used in a week, or how many ventolin puffers are used per year. Other measures include days of missed school/work, frequency of unscheduled doctor visits/ ER visits, etc. There are all good things to assess, but no one criterion will give the whole picture. Asthmatics are just too darned variable!
I think that most asthmatics have skewed perceptions of how they are doing. We see ourselves as less sick or more in control than we actually are. That’s human nature and that’s how it goes for most things, not just illness. As bad as the bad times are, they can be forgotten when considering the big picture. I’m trying to take an honest look at how my asthma has been recently, just for kicks.
When I saw my doctor last week, I said that things were good, that’s what I would say if I saw him today. When he was asking me his questions, I could tell that he was less than satisfied with my answers.
Despite feeling good overall, I still need my ventolin every day. On some days, I will need it frequently, and if I’m running, you can bet I’ll be using it a lot. Do I wake up at night with asthma symptoms? Yes, especially if I’ve exercised that day, but that doesn’t mean I’m having a “bad night” every night. And YES, my asthma did get out of control last week, to the point where my inhaled medications were not helping and I had to resort to prednisone. BUT the point is that I took the pred early-on-ish and I had my asthma back in control within 2 days (this is a good thing).
I’m not a short-sighted-silly, and I’m not stuck in denial. I know, when I think hard on it, that these are not signs of mild asthma, nor signs of asthma which is particularly well-controlled. I know that your average family doctor wouldn’t be too pleased when presented with the above. But the thing is, I feel like my asthma is good right now, I really do. I’m living a really normal life, doing everything I want to do, and I AM RUNNING. So I’m not fussed about it, I’m in control.
This brings me to my next point: the runnning. I feel great when I run, the adrenaline I get from it is beyond compare and my body is thanking me a thousand times over. But I still get tight, I still cough and I go through a lot of ventolin. As I said above, it also makes my nighttime symptoms a bit worse. The gist I get from people is that they assume that now that I can run, I must not have asthma symptoms any more. I have told a few people that I do in fact feel my asthma get worse in the hours after a run, and their response seems to be then why the heck do it???
Cause I can. Plain and simple. I told myself I could do it, tried it, and realized that I can do it. I seem to have asthma symptoms whether or not I’m physically active, so I might as well take the route that is actually good for my body.
So, all these convoluted ramblings to say that my personal perception of my asthma at this point in time is that it is actually quite good. Also, I love to run.
I picked up my race t-shirt and bib!! The race is tomorrow and I’m really excited.
Hélène is my grandmother, by the way. She died of breast cancer when my dad was 18, at age 51. When I picked up my race pack, I looked at the t-shirt and bibs and had an unexpected wave of weepiness (maybe prednisone induced, I’ll get to this in a sec). Leading up to this run, I was thinking of it as a run, as a way to assess how I’m coming along with my running and how my lungs are holding up to it. Then I realized that this is a community event too, actually a damned big national community event, and that we’re all running for one reason. So many people have been touched by breast cancer, and everybody’s running for someone.
And while I hesitate to call the loss of my grandmother *my* loss, since I never met her, it kills me to think that if she had gotten sick 20 years later, she may have been a survivor. Then, my dad would have had his mother through his young adulthood, my grandpa probably wouldn’t have gotten so f-ing messed up, and I would have had the chance at a relationship with a very special (so I’m told) woman. So now that I am holding my “hope” t-shirt in my hands, I’m finding it a little overwhelming. I know that tomorrow, with everybody in their goofy pink race attire, will be even more overwhelming, but I’m sure that it will be in a good way.
Kerri is doing the Run for the Cure too, in her own city. Go Kerri! Steve of BreathinStephen is doing a half marathon in San Jose tomorrow. You rock Steve! I can’t wait to hear about how your guys’ day goes.
OK, so now on to my health, which has taken a turn for the worse in the past 24 hours. I got worse and worse from about 2:30 on yesterday afternoon, peaking at about 10 PM. I had a very hard time sleeping but fortunately I was able to sleep in some this morning. I was having trouble functioning this morning and feeling really really tight, so I cracked open a bottle of prednisone. I’m obviously in a hurry to feel better so I didn’t hesitate too much with it; I could hardly walk to the bathroom when I woke up. I told myself if there was no improvement by mid-morning I would go to urgent care and get some nebs into me. But I’ve been feeling much less tight for the past hour or so. I ran this plan by my friend XE, which helped tremendously. Thanks girl!
I’m still planning to do the run, as long as I feel well enough to run in the morning. If not, I’ll walk it. If I feel really bad, I’ll skip it and probably go to the doctor seeing as it will be 24 after starting pred. BUT, I’m still planning on running!!! I’m just really trying to get those lungs open today so that tomorrow will be fantabulous. Wish me luck! I AM being smart so please don’t worry.
Kerri’s blog has got quite the discussion going, under the comments section of her latest post. The topic? Prednisone, and home nebulizers, and differences in practices between countries. If you’ve got experiences to share, do join in!
Hi everyone, I’m here to tell you that the asthma drug Singulair was developed my Merck Frosst in none other than the Canadian city of Montreal! I thought you’d all like to know this piece of trivia. Also, the mont in Montelukast, the drug’s generic name, is a little homage to the city. How about that?
There’s actually a large billboard outside the Merck building in Montreal underlining this fact.
I’ve heard people with chronic health issues say things like “I hate my disease, but given the chance, I don’t know if I’d get rid of it”. So, OK, I get where you’re coming from. I know that hardships help you grow, and make you appreciate life so much more. And I know that living with something like that for a long time can start to define you and become a part of your personality. Yes, yes and yes.
My take on the hypothetical “if you could take it all away…” situation is that my asthma is not the end of the world and I certainly can cope but if my fairy godmother came along, I would say YES! I’m thinking of all the possibilities here. I could get a good night’s sleep every night, I could wake up and feel like an actual human being in the mornings, I could dance and run without having an excuse not to, I wouldn’t have to take (and pay for) so many meds, I could go anywhere without having to run the list of potential triggers through my head. And most of all, there would be none of this life-threatening asthma episode stuff, no more scaring myself and everyone around me. Doesn’t all that seem like a good enough reason?
Of course, I can also appreciate the parts of having asthma that have been good for me. Number 1 is that if I hadn’t known what it’s like, I would never have learned to appreciate being able to run like the wind. Now, when I’m healthy, I’m extra-happy, and my smile shows it. I try to remember everything else about my health that is good, like having full mobility, no muscle or joint pain, no stomach issues, no headaches or neuro problems. Hey, I’m a healthy girl.
The other thing that’s been good, and which I really do appreciate is that I have a pretty good angle on what it’s like to be a patient and that will help me very much in my career. I’ve met a lot of doctors and I know which ones are able to communicate effectively and compassionately and I’m starting to model myself after these people.
So yes, every cloud has a silver lining! But I could still really do without the asthma attacks.
My 2 cents for the day, a little peek into my crazy brain. I’m away for the weekend, have a good one!
It’s true, and I finally figured it out. Because when you’re down, prednisone is there saying “Hi, I’m prednisone. I can help you breathe real quick. You’d like that, wouldn’t you? All you need to do is give me your sanity and your judgement for about a week. Oh, and we’ll throw your stomach into knots, and don’t forget the hot flashes to remind you where I come from. Yeesss”
And when you are breathless and weary, and you think how hard you have been working, that seems like an acceptable trade-off. Anything for a little respite. 24 hours later when your breathing has improved so wonderfully and dramatically, it still seems like you got the better end of the deal. 72 hours later, when your brain is reeling but your eyes are glazed over and you could cry at the drop of a hat, you just want to throw those stupid little pills out the car window and drive over them many many times.
There’s a reason Breathin’ Stephen calls it the evil candy.
Did I mention that at my Tuesday doctor’s visit I was told to increase my symbicort dose? Well I was, although that’s no big deal. One side effect of the med (the formoterol part) is hypokalemia, or low potassium. I don’t know the mechanism by which this happens, but it does.
The only noticeable part of that for me is the wicked spazzy muscle cramps. I get them in my feet, achilles, calves and in my hip creases. They really hurt, and they can be somewhat awkward when I am sitting in a packed lecture hall.
It wasn’t a huge increase, so I should be acclimated to it in a few days. In the meantime, I am eating bananas like there is no tomorrow.
The more meds you take the more you have to think of reactions, interactions, etc etc etc. That’s why I always get this impending sense of doom when I’m told to add on another med. It’s so hard to keep track sometimes and to know what is causing what. Ah drugs, can’t live with ‘em, can’t live without ‘em.
Here’s a rundown of what my appointments were like today, for those interested. First off was allergy testing. The actual skinprick didn’t show anything out of the ordinary, just the regular dust mite, tree pollen, animal dander etc etc etc. I wasn’t tested for food allergies today, and while I can’t think of any foods I’m suspicious of, I would hate to miss a food allergy, especially since most foods are pretty easily cut out of your diet. I still need to go do my IgE test, which will determine a potential next step in treatment, as well as blood tests for specific moulds, which I have a feeling will show something. The allergist was very good, and had many suggestions for the actual treatment of the asthma itself. He gave me some free symbicort samples, yay. He also thinks I should use alvesco as an add-on steroid as opposed to pulmicort. Apparently it has less side effects, and he was all like ” I *heart* alvesco” and then he gave me a free sample. Ok then.
It seemed it was just me and the senior COPDers in clinic today. Oh how I miss going to the Children’s Hospital, where I could sit and watch Dora the Explorer in the waiting room. The pulmonologist and I hit it off really well. First I had to go downstairs to do spirometry. I did a good job! I couldn’t see the actual numbers so I can’t say for sure, but I peeked at the computer screen and my curve looked *perfect*. The RT who had me do the PFTs was so friendly! But then the nurse was all like “It says on your chart that we are doing medicated spirometry today, and that won’t give us a good enough idea of what shape your lungs are in and you should really try to go off your meds before your appointment and blah blah blah”. And I was all like “Well I have been having a very hard time breathing lately and I sort of have this life that I have to live so there was no way I was going to spend my weekend flaring so that I could prove I have crappy lungs”. Except I said it much more politely, OF COURSE. But then the doctor came in and he was great. The charts from my last ER visits were all in my file so he could read them right then and that really helped to give him a good idea of what my attacks are like. Remember how I said that I only went to the ER once last spring? Yeah, well apparently I showed up there THREE times. The notes were right there on my chart, so there was no denying it. Sooo, how could I not have remembered that??
This doctor is a fan of peak flows, so he wants me to keep a peak flow diary for the next month. So, I actually have to go out and buy a peak flow meter that is not for children, as I believe I have outgrown my pediatric one. I go again to see him the day before I leave for home, which is actually kind of a bummer but I think the pfs will give us something to go on so this is a good thing. Then I go home and transfer everything to my doctor there for 4 months. Never a dull moment, I suppose.
Now, I must madly study for my biology lab final tonight. After that is done, I will feel much much better. Sorry for the ramble on!
Now that springtime has rolled around again, I am starting to think more about what this time was like for me last year. The return of the itchiness in my throat and lungs as well as the tight and twitchy chest makes the memory quite fresh, actually. Last spring was a particularly bad time for me and the lungs and I really am desperate to avoid repeating the same events.
Springtime back home was actually one of my better breathing seasons, and I was usually a relatively happy camper during March and April. The temperature was just right for my lungs, and the pollen count was never very high because of the arid climate. Springtime in my university city caught me totally offguard last year. I was utterly unprepared and somehow never fathomed that I might run into problems.
Early in April I had a nasty attack following a day spent being active outdoors and I had to resort to prednisone to stabilize it. After coming off the prednisone, I rapidly deteriorated again. I wasn’t too fazed at first, but it was getting to be quite disruptive, and it was the end of the semester and I coming up on exams.
One morning I woke early and just didn’t feel right. I can’t explain it, but some attacks just feel different and you know that you are going to end up needing help, probably sooner rather than later. I told my aunt that morning that “I feel like I usually feel when something really bad’s going to happen”. She had to go to work, but stuck the phone in my hand, stuck her cellphone on her hip and told me to get help right when I needed it. I spent the entire morning sitting in one spot, desperately trying not to move, because not moving was the only thing that was keeping me from going into a total attack. My aunt came home at lunch to check on me and when she found me in that chair she carted me right off to the clinic. At the clinic I saw my least favourite doctor (the one who listens to my chest through layers and layers of clothing), who sent me off with a perscription for prednisone. I went back home and settled back on my chair, the trip had made me worse. My aunt asked me if I could try eating dinner with them, I remember we were having penne. I only ate one noodle, and I specifically remember the effort of bringing it to my mouth and chewing on it being what sent me over the edge. I actually dropped my fork, and my aunt and I looked at each other and it was agreed that we had to go pronto. We get to the ER, and my aunt explains what’s happening. I sit down in the triage chair and promptly clamp up and fall forward. I was brought to resuscitation, given epinephrine, IV steroids, O2 and all the rest. I don’t remember the real rush-y part. The next thing I do remember is being sooo shaky from so many nebs that my aunt needed to bring the water cup to my mouth because I couldn’t even hold it for myself. I was also too shaky to blow my own nose, hold my own neb etc etc etc. I stayed in that night and the next. I had an exam to write the day after I got home (I think. I remember it was Determinants of Health, the easiest exam ever so that was lucky).
I can’t say I really felt better after getting home from the hospital. I think I was more stable, but I still felt very breathless and I was soooo tired. Yet, I still managed to write every single one of my exams and do well, which still baffles me to this day.I actually did have a blog at the time, but it was more a blog about being a med-student wannabe, and I was determined not to go on and on about my asthma; I think I only mentioned it a couple of times. This blog is quite a change of pace then! I went to the clinic for nebs a couple of times and had a couple of questionable attacks but I stayed out of the hospital. Whether or not I would actually be well enough to get home by plane was a real question, but I did make it back on the day I had planned to. Boy, were my parents glad to see me that day. They had been soooo worried, and rightly so.
Upon getting back home, I started to breathe much easier, but then I got a chest infection. Which is totally weird because it was May and well, that just never happens to me. So that put me behind a little bit but after that I recovered quite well. I didn’t have near as many attacks at home and generally felt better, and was using way less medication. After a week’s recuperating period, I started my lab job, which I loved.
So, you see why I am not really looking forward to the next couple of weeks. I enjoy the weather and everything, but I can already feel that I may be heading down the same road. That is why I’ve got all this hope that all my appointments on Tuesday will amount to something and one of the doctors will have a brilliant idea and we can get something together that will help me avoid this whole situation. Yes?
