Do you know what inhaler you are on?

I have just been reading a blog post on Asth.ma [a blog by an Asthma Researcher at Harvard] about how a lot of people don’t know the names or doses of their inhalers whereas they often know the names of the other medications that they take e.g. Enbrel, or Methotrexate. And it has really got me thinking about 3 conversations I have had in the past couple of weeks.

A few days after I had moved up to uni I found out that one of my flatmates has asthma, and being naturally inquisitive I asked her if she was on any sort of preventer inhalers, to which she replied that she was on the purple one… I knew she meant Seretide/Advair and I didn’t really think that much of it because so many people know their inhalers by colour rather than by their actual name that I wasn’t that concerned. I wasn’t even that concerned when I found out that she didn’t even know the dose of her inhaler, but I could see just by looking at it that she was on the 125/25 Seretide inhaler. The next week I had 2 similar conversations with two other people from uni, both of which had asthma severe enough to be on an inhaler corticosteroid combined with a LABA [Long acting beta antagonist]. One girl identified her inhaler as being red and white – meaning that she took Symbicort, but she didn’t know if she was on the 100/6, 200/6 or 400/12 dose, and the other said that her preventer inhaler began with an “R”… We later identified her inhaler as the new Relvar Ellipta inhaler using google.

At the time I didn’t think that much of it, but if either one of these 3 people has any sort of emergency or ends up in a situation where they need to identify their inhalers they are going to have a really tough time. 2 of them didn’t even understand why they were moved off of Clenil [AKA the brown inhaler] and onto an inhaler containing both an corticosteroid and LABA… They both said that their doctors/asthma nurses had said they need to take something stronger but hadn’t gone into any detail about what the “something stronger” was. Am I the only one who finds this remotely worrying? Absolutely not, and the point was well highlighted by Dr. Wu.

Personally, in addition to my Ventolin, I almost always carry my asthma medication card in my wallet/purse [anyone can order a card from the Asthma UK website, here] which, gives details on all of my asthma medications. This including the name of my medications, the dosage, how much I take, when I take it and there is also a column for extra information… For example, since I have been prescribed both the 125/5 and 50/5 doses of Flutiform, I have written that I would take the 125/5 if I am yellow zoning, and I have written these zones in too. This means that although I know what medication I take, by name, if I was ever in a situation that meant that I could not talk then health care professionals do not need to mess about trying to find what medications I am on. This also helps when I see my GP or asthma nurse because we are able to discuss medications in full rather than getting confused with all the different colours…

[Note: I do admit to using the colours to identify inhalers in some situations but this is purely to help people understand which inhalers I am talking about, and I would not do this unless I thought necessary to aid understanding]

Freshers’ flu

So I am heading into my third week at uni and so far it has been a blast. I have made new friends, and [thankfully] I have settled in really well. I am quite lucky in the fact that I have always been very independent and I was ready to move out, so this transition, though scary as it was to begin with, has actually been really good for me.

I have been going out a lot with my flatmates and other people on my course, and it has been excellent fun, although it has been very tiring, especially for someone with [self diagnosed] insomnia because I can’t sleep during the day unless I am ill, and I wake up early on a morning so my average hourly sleep was about 4 hours during the first week of uni… Thankfully now it has increased to about 5 or 6 so I am not constantly knackered. However, the lack of sleep in addition to mixing with new people, living with new people, and partying a lot made me more vulnerable to illness and I have ended up coming down with what only can be described as, the dreaded, Freshers’ flu…

It all started last Saturday when I was feeling a little bit off, and I didn’t really want to talk to anyone or to eat anything. I kept getting spells of being boiling hot then freezing cold… but I decided that I would be fine and I went out that night anyway. BIG MISTAKE… Those of you who know me, will know the details of the events that night but for those who don’t, lets just say that you should try to think rationally, and be responsible even when you are drunk. I did a stupid thing that night that very nearly put me in hospital and it ended up with my asthma control being chucked out the window. Every since then I have been fighting to get my asthma under control: bumping up my Flutiform to 3 puffs twice a day, then up to 4 puffs twice a day [so I was essentially taking the equivalent of 20 puffs on the brown Clenil inhaler]… and I was still needing quite a lot of Ventolin throughout the day. Being the person that I am, I figured that I could cope with it and that I would be fine after a couple of days, which I was also wrong about. I had a constant temperature from Saturday through to Tuesday, my asthma just didn’t get better [but it didn't get worse either, thankfully] and my usual asthma cough became a lot deeper and very productive… essentially I developed a chest infection.

I am registered with a new doctor up here, but I didn’t think I was bad enough to go and see what they said because I have had things like this before and I have always gotten over them after a few days. I spoke to my Mum and she agreed that I should wait and see what happens. Well it got worse, thats what happened. I woke up at about 3am on Tuesday feeling sick to my stomach and wheezing up a storm. I was incredibly short of breath and coughing up massive amounts of disgusting stuff [sorry if that was TMI] and my chest was really tight. I was feeling so ill that I couldn’t even stand up and I had to crawl to the bathroom, which thankfully is only a metre or two away from my bed. When you feel that ill and you have a temperature it is very difficult to think clearly and it is also very difficult to stay calm… my initial thought was that I needed an ambulance, but then I thought that I was so out of breath I probably wouldn’t be able to speak down the phone, so my next thought was that I needed my inhaler… Thinking back, I don’t think I was ill enough to need an ambulance, especially as I hadn’t actually tried my inhaler and in pure panic had crawled straight to the bathroom… My inhaler did work after quite a few hits, I stopped counting after 10 but it was definitely under 20 puffs total and my lungs were responding. Then I thought that I should tell my Mum to come and pick me up and we could go to urgent care to get some antibiotics, but then I figured that since I was breathing a lot easier I could wait until the morning as I didn’t think that Mum would appreciate the wake-up call… but thinking back, that was probably a bad idea as no one knew that I was feeling so ill. Somewhere in that situation I briefly thought of crawling down the corridor to wake up my flatmates so they could get help… but I decided against that too. However, if this ever happens again [and this is advice to all of my readers too] I definitely suggest that you let someone know, because things might not turn out so well… And generally when you are thinking you need an ambulance, you do need one.In the UK there is a service that allows you to text the emergency services if you are in a situation where you find you cannot speak for one reason or another, however you do have to register your phone first before you do this. [PLEASE SEE HERE FOR DETAILS]. I am actually kicking myself looking back because I should have told someone but my brain doesn’t work that well when I have a temperature and so I didn’t think clearly about what could happen.

It’s over a week since I first got sick and I am improving dramatically… The secretions in my chest are a lot thinner and easier to move when I cough although, I am still coughing more that I would like to, my wheezing has been at a minimal for the last couple of days, I am sleeping a lot better, my temperature has been normal for quite a while now except from a little episode yesterday. On the whole I am feeling significantly better, but I would not like to repeat any of that again.

A busy few weeks

My life has been pretty hectic recently. I found out I was going to go to university about a week ago (on the 14th) which I really wasn’t expecting based on how I thought my exams had gone, so I hadn’t bought anything that I needed. For any of you who have moved away to go to Uni, you’ll have some idea of what it is like to find out that you have to get 6 freaking pages of stuff [i.e student essentials] in 4 weeks… and for those of you who don’t it’s super stressful, exciting, nerve-wracking and really expensive! This week I have had to pay out over £500 for necessary things including the deposit on my accommodation, the gym, Uni essentials including pots and pans, bedding, towels and bathroom stuff, and my Gym membership. It’s been crazy expensive week, but thankfully I think I have got almost everything I need to move out, so the next few weeks shouldn’t be that expensive. I have a new found respect for anyone who has ever had to move out and get new stuff because it is far more difficult than I expected!

I am also happy to report that I am back on track with my asthma meds… I took an impromptu break from Flutiform and relied solely on Ventolin for a few weeks which was a stupid thing to do and was a result of the massive amounts of stress I was under from certain events going on in my personal life… I have now either resolved or come to terms with these issues and I am feeling a lot happier. However, my lungs are still hating on me for leaving them without a controller med for a while and so I have had to up my dose of Flutiform back to the 125/5 inhaler but I shouldn’t complain because it was my fault. I am hoping that in a few weeks everything will settle back down to normal, but if not I shall just phone my nurse and ask her to change my repeat prescription back to the 125/5. And that has also reminded me that I need to book in for my flu jab! GET YOUR FLU JAB GUYS! There is no point getting ill if there were steps that you could have taken to reduce the risk.

Now onto the hip… I think I mentioned that my bursitis has come back in my hip, or maybe I didn’t. I am incredibly tired right now because I haven’t slept well in about 2 weeks because of my bursitis and it is affecting my memory so I can’t actually remember if I have told you about my hip. So in short, my bursitis came back about 2 weeks ago after no problems since the end of June when I had a burst of pred. There was a few low points last week where I was feeling really sick because of the pain but thankfully I wasn’t actually sick. I am now considering my options for treating the bursitis again and as far as I can tell I have 5 options:

  1. Continue treating with 1000mg of Naproxen a day, and 1000mg of Paracetamol PRN/every 4 hours, and Ice
  2. See my GP and ask about a burst of pred or a cortisone injection
  3. See a private physiotherapist
  4. Phone my Rheumy
  5. Do a combination

So Option 1 is what I have been doing for the last 2 weeks and although it’s preferable to doing nothing, I am still having a lot of pain and my hip is still warm to touch (except from right after I have iced). As for Option 2, I am feeling particularly self conscious about the way I look right now so pred is definitely out of the question but I might be up for a cortisone injection into the bursa if the GP can guarantee that it will at least help a bit. Option 3 is out of the question, but it was something that my Mum brought up in the middle of the night when I was still wide awake and intercepted her on the landing when she was going to get a drink of water… I have looked at the prices of the private physiotherapists around here and they are all far too expensive, and there is no guarantee that it will help. You may be wondering why I didn’t think about NHS physios, and whilst every physio I have had has been awesome, the waiting time is really long and I just don’t have the time, or the patience, to wait. Option 4 was another idea that my Mum had, again in the middle of the night, but since I have an appointment on the 17th of November [the appointment letter came this week, along with a letter saying that I DO NOT HAVE LUPUS] I might just try and wait it out. The Rheumy also said to phone her if I was flaring but this technically isn’t a flare… or at least, I don’t class it as a flare. Option 5 seems like the best option, there is no way I am going to let my GP take me off Naproxen since it’s the first time in years that my joints have felt relatively good, with the exception of my hip, but I don’t feel like I can carry on with just Naproxen and Paracetamol, as much as I hate to admit it, so I guess I might see about the cortisone injection… Especially because I have read that a cortisone injection could “permanently resolve” the bursitis, which after 2 years would be excellent!

I have been planning/thinking about some more posts that I could do and I may have also found another person to write us a guest post, which I am very excited about… and I also need to ask Justin of Haika Clothing to do another interview with me to tell us about the progress he has made [I am currently saving up to buy some more of his awesome shirts, and $5 of every purchase goes to an asthma charity!]. For more frequent updates check out my Facebook page.

Bad Asthmatic

If anyone has read Rick Frea’s blog on HealthCentral (see here) you will be familiar with the list of personality types (see here)that Rick has come across in his work as a Respiratory Therapist. When I was first diagnosed I found this post extremely useful in helping me to become the best asthma patient I could be.

I used to be what Rick describes as a “Phlegmatic Asthmatic” which is someone who is characterised as remaining calm even when they are having trouble breathing. Although I am a stress-head, I have found that I am able to remain calm in situations such as asthma attacks and other medical situations such as seizures (I have a family member with Epilepsy) which has significantly, especially when the situation is classed as an emergency. However, more recently I am kind of ashamed to admit that I have not kept up with my asthma treatments and my mental attitude was not what it should be. I have had a slightly self-destructive attitude recently, which is my response to what is going on in my life and I haven’t taken Flutiform in a few weeks. No, that doesn’t mean that my asthma is fine with nothing. In fact the opposite has happened and I have had to use Ventolin a lot recently but that is my fault. I basically went from a person with relatively good control over my asthma, to someone who had control similar to when I was first diagnosed before the LABA which was upsetting,  but it still took me till my friends gave me a kick up the backside to get back on track. I have a family member and a close friend who are both very ill and I was too busy worrying about them and looking for clinical trials to think about my health, and it wasn’t till my friend pointed out that being ill myself would not help the situation at all.

I also owe everyone who has helped me out over the past few weeks a big thank you, especially Elizabeth, GG, and my group of girlfriends who I love to bits! I am back on track with my asthma treatments as of yesterday and I am feeling better despite still struggling with my good ol’ asthma cough. I am going to be a Phlegmatic Asthmatic again as opposed to the Goofus Asthmatic that I have become.

Here’s to the future

It has been ages since my last post and I do apologise for that. Those of you who know me personally will know that I have been having a tough time recently, both physically and mentally. Part of my lack of posts is a result of my going on holiday with my family which was totally awesome… but it was slightly overshadowed by the fact that someone close to me is incredibly ill and that we have no idea what is going to happen in the near future. I am not good with dealing with situations like this, and my way of coping is ignoring what is happening rather than facing it head on. The future is uncertain for everyone whether you are ill or not, and that stresses me out even more because I need some stability in my life but right now my life is anything but stable. When it comes to medical things, I like to know the plan and the back-up plan but in this case there is not a back-up plan, and I can’t tell you how much that scares me. This friend is not the only one who is ill but she is the sickest.

On Thursday I find out whether I get into University or not, and instead of being worried about whether I am going to uni to study the course I want to study, I am worried about staying home since my relationship with my family is less than perfect right now. Everything that has been going on in my life has resulted in me acting totally out of character and pushing the people who care about me further and further away, until it has gotten to the point where my family is literally at breaking point. As it turns out, when I am under this much stress I’m not always a nice person.

I haven’t been sleeping well recently… which is saying something because I don’t usually sleep that well but maybe when Thursday has come I will be happier because I will at least have some direction in my life and I will know what I will be doing in the next year academically, but until then my life doesn’t really have any clear direction.

I’m finding it very difficult to keep this post going and I’m finding it hard to say how I am feeling in a way that other people can understand and I think that is a result of my mind being such a crazy tangle of emotions that I really don’t know how I feel. I am hoping that come Thursday, that my stress levels will have reduced enough for me to make sense of my head so I can leave the place where I am at right now and just move ahead with life rather than feeling stuck. Here’s to the future!

I’m lost

I finished my pred burst over a week ago and I can’t really explain how good it was to go 2 weeks with hardly any pain. I have had chronic bursitis in my hip for 2 years, and this is the first time in 2 years that it hasn’t hurt at all, even when I prod it. Of course the pred is starting to wear off and the usual aches and pains are coming back which is disappointing because I was hoping that I could get longer… I have had bad joints for the best part of a decade, and this is the first time since then that something has touched the pain… It is hard to explain how good it feels when you are used to an average of 2-3 hours of morning stiffness that suddenly with the help of 8 tiny tablets that you only get 15 minutes… That is less than 10% of what I am used to.

The pred started to wear off earlier this week, and my morning stiffness now lasts between 1.5 and 2 hours, which is still an improvement but after seeing that I could only have 15 minutes of morning stiffness, I’m not that impressed. The question is, what should I do now? I don’t have any active inflammation, but my joints are getting sorer, and they are getting stiffer… I don’t know whether I should try and see my GP and see what he says because I don’t want to let my joints get to where they were before. But there isn’t an awful lot that my GP can do in all honesty because, 1, I am refusing to take pred again unless I really need it and 2, he seems unwilling to prescribe any other NSAID except from Ibuprofen despite the fact I am supposed to be taking Indometacin long term… He even tried to tell my that Ibuprofen was EXACTLY the same time as Indometacin, which I find is quite patronising. They are in the same drug class, and they work with the same aim, but they are NOT the same medication.

So I wondered whether I should phone my Rheumy, who believes there is something going on but neither has the motivation or time to try and find out what that is… She told me to phone for an appointment when I am flaring, which I am not but then is pred helps maybe she should know that? Could that give us a clue to what is going on?

I would phone my Physio, but since I was 18 last month I am not actually under the care of any physiotherapist anymore… Which makes the whole hydrotherapy situation significantly more difficult because I don’t have anyone trying to sort it out for me. To sum up what has happened with hydrotherapy… I was referred in January 2014, I was approved in May 2014 and nothing has happened since despite many phone calls and one visit. The receptionists have tried their best but it seems like there is nothing anyone can/is willing to do and so it looks like I won’t be getting hydrotherapy. Or even if I was suddenly offered a place for hydrotherapy, I won’t be able to go now because I don’t have 6 weeks clear in my timetable for my 6 sessions… I’m not too upset about hydro because I had a feeling right from the start that I wouldn’t get it, what I am upset about is that I have been repeatedly told that I will get hydro which is a flat out lie, because no one can be bothered to do anything. It would have made my life significantly easier if they had told me that I couldn’t get hydro right from the start so I wouldn’t have spent literally hours on the phone trying to sort it all out.

So now I am lost. Actually scratch that… I have always been lost in this NHS system, that’s why it takes me 6 months to get blood test results and the results of my scans, and that is why it took me 17 months to get an appointment with my Rheumy which are supposed to take place every 6 months, and that is why I don’t know who to go to now… because I am totally lost in this fricken system. And if I do actually get into University to do Physiotherapy, I swear that my patients will be treated better than what I have been treated, and I shall make sure that they are not lost.

The wonders of Flutiform

Every time I see my asthma nurse it feels like my asthma plan is getting more and more confusing. Recently my lungs have been good! I have only been in the pool environment once in the past couple of months which is probably a large contributory in the fact that I have only had one (pretty scary) attack since I started Flutiform in March. My asthma nurse and I discussed how much my asthma is affecting me, and compared to before I am doing really well, my Ventolin usage is right down, I have hardly any nighttime symptoms and my peak flow is relatively stable. So we decided that we can reduce my Flutiform dosage from 125/5 2 puffs twice a day, to 50/5 two puffs twice a day… Now, we do recognise that dropping my total daily dosage of Fluticasone (the steroid component of Flutiform) from 500mcg (equivalent to 1000mcg Beclomethasone) of  to 200mcg (equivalent to 400mcg of Beclomethasone) is quite a drop and we have no idea how my lungs are going to react since the last time we attempted to reduce an inhaler I ended up having an attack. But right now I feel confident that my lungs are up to this reduction, and so I am going to give it a go.

I asked the nurse what I was supposed to do if I started yellow zoning, or having issues so we decided that whilst my main inhaler will be the 50/5 I will also have the 125/5 on my prescription and I will start that inhaler for a few weeks when I start having issues. So this means that I will have 2 different doses of Flutiform to work with which makes my asthma plan a lot more flexible but it also makes it somewhat more confusing. However we have decided that if I feel like I need the 125/5 instead of the 50/5 then I can ring in and she will move me onto the 125/5 fully.

We also discussed why we thought Symbicort was making me cough, and  the nurse agreed with my GP that the dry powder was causing paradoxical bronchospasms and that I shouldn’t try another dry powder inhaler… which is a shame because I did prefer the dry powder inhalers delivery system but if it makes me sick, I’m going to give it a wide berth.

I also explained that I am possibly going to university in September and that I am slightly concerned about prescription costs and having everything sorted for university. Apparently I can get an exemption form so I wouldn’t have to pay for prescriptions until the end of university, which means I don’t have to worry about prescription costs until then. And my asthma nurse is also organising me to go in for my flu jab at the start of September so I will be covered. And she also said to start looking for a GP surgery in the city where I will be staying as soon as I know that I will be going to university.  So now I’m feeling relatively relaxed about the whole thing because I know what is going to happen.

There aren’t many words to describe how happy I am about this reduction in steroid dose, this is the first time I have actually had a reduction in dosage… We attempted to reduce Symbicort before but that just went wrong straight away but I am feeling so much better than I did when we tried to reduce the Symbicort so I’m feeling pretty confident that this will work… and if it doesn’t, we have a plan for that too.