Question:

Thankyou, thankyou and thankyou again Chris, Hacky, Colin, Scooby, Michael and Dr. Mayo. A standing ovation is definitely in order. Chilla

Response:

– Hide quoted text — Show quoted text – Hi, In my problems with asthma an important part was played by the fear of suffocation.  Then I cottoned onto Buteyko and found that reduced breathing and acting anti-intuitively brought relief and the slow but steady disappearance of classical symptoms such as attacks, objective shortness of breath and wheeze. Now a new publication has gone even further and proposed that hypercapnia, i. e. above normal carbon dioxide levels in the body may be curative, whereas we all thought that hypercapnia could be the cause of death in status asthmaticus.  See: Lancet 1999 Oct 9;354(9186):1283-6 Carbon dioxide and the critically ill–too little of a good thing? Laffey JG, Kavanagh BP [Medline record in process] Permissive hypercapnia (acceptance of raised concentrations of carbon dioxide in mechanically ventilated patients) may be associated with increased survival as a result of less ventilator-associated lung injury. Conversely, hypocapnia is associated with many acute illnesses (eg, asthma, systemic inflammatory response syndrome, pulmonary oedema), and is thought to reflect underlying hyperventilation. Accumulating clinical and basic scientific evidence points to an active role for carbon dioxide in organ injury, in which raised concentrations of carbon dioxide are protective, and low concentrations are injurious. We hypothesise that therapeutic hypercapnia might be tested in severely ill patients to see whether supplemental carbon dioxide could reduce the adverse effects of hypocapnia and promote the beneficial effects of hypercapnia. Such an approach could also expand our understanding of the pathogenesis of disorders in which hypocapnia is a constitutive element. The authors write: "Although hypocapnia [low carbon dioxide] has been assumed to occur as a consequence of many disorders (eg. asthma, systemic inflammatory response syndrome, high-altitutde pulmonary oedema, and ventilator induced lung injury), we propose that hypocapnic alkalosis may be pathogenic.  We propose a potentially novel strategy – therapeutic hypercapnia – whereby hypercapnia could be intentionally produced in critically ill  patients to provide organ protection." "Acute injury can be caused by hyperventilation: hyperventilation causes hypocapnic alkalosis…….hypocapnia and hyperventilation may be independent causes of bronchopulmonary dysplasia" "Long-term neurological sequalae from exposure to extreme altitude are associated not with exposure to low oxygen concentration, but rather with the generations of extremely low PaCO2 [low carbon dioxide]" In view of this paper Buteyko’s theory that constriction of the airways in asthma is a protective strategy of the body to stop undue loss of carbon dioxide seems all the more plausible, more especially because the attitudes on this ng.  If the orthodox interpretation of constriction as the primary target for therapy were correct, there would surely be a different atmosphere without so many detractors and doubters on the one hand and so many almost militant defenders of orthodoxy on the other hand. The Lancet article is of course mainly concerned with emergency medicine, but the insights would seem to apply to an even greater extent for the everyday situation of an asthmatic. It is interesting to note that one paper (Am. Rev. Respir. Dis 1974; 110: 25-33) cited draws attention to a lack of carbon dioxide in an asthmatic as causing increase in airway resistance. Even earlier papers are cited in it dealing with the increase in resistance due to hyperventilation. If it had not been due to the dominating thought of possible suffocation in asthma, a breath therapy based on reduction of the respiratory rate might well have been proposed and used thirty years ago. Couldn’t advocates of orthodox asthma treatment say openly what their views on hypocapnia in asthma are? Cheers, peace and good health, Richard Friedel

Permissive hypercapnea is a method of artificial mechanical ventilation designed to reduce the effects of either hyperinflation or high machine generated pressures (the debate continues) on the lung. This effect (the volume/pressure) causes further damage to the lungs. I agree with the previous responders that this has nothing to do with asthma, and is a method for mechanical ventilation in the ICU, which requires strong sedation and chemical paralysis. P. Mayo, MD, FCCP

Response:

Hi, In my problems with asthma an important part was played by the fear of suffocation.  Then I cottoned onto Buteyko and found that reduced breathing and acting anti-intuitively brought relief and the slow but steady disappearance of classical symptoms such as attacks, objective shortness of breath and wheeze.

These symptoms sound more like hyperventilation syndrome than asthma. P.S. I take it that you did not read the article you posted.  It was about mechanically ventilated patients – not people breathing on their own. It appears that this mistake was made as a result of your habit of picking articles for a supposed support of a certain position.  A compounding factor is the fact that you know nothing about asthma – which causes you to have a difficult time in determining whether an article is or is not relevant. "Usenet is like a herd of performing elephants with diarrhea — massive, diffucult to redirect, awe-inspiring, entertaining, and a source of mind boggling amounts of excrement when you least expect it." Gene Spafford 1992

Response:

Without even having wasted my time reading this article, i will shed a little light on the medical use of "permissive hypercapnia". Essentially many old folks who suffer from COPD and asthma may well be breathing on a hypoxic drive.  This drive is not a primary drive, but rather a drive that develops secondary to chronic elevated CO2 levels which in turn is secondary to inneffective ventilation.  This inneffective ventilation is casued from several factors, destruction of lung tissue and alveolar surfaces and walls, loss of elasticity of the chest wall and muscles themselves, and in some cases obesity plays a role.  Note that a LOW CO2 IS NOT A FACTOR. When attempting to ventilate these patient successfully we sometimes will see one who has elevated ventilating pressures despite all that we are doing.  This elevation can lead to further lung damage by, and of itself.  Thus, in this case, the trend has been in allowing smaller tdal volumes and lower rates to allow a reduction in intrathoracic pressures.  This reduction in volume and rate then also equals a decreased minute ventilation (the amount of gas moved in a minute’s time). Another use is with weaning attempts.  A patient maintained at a normal CO2 level will not readily wean from the ventilator if they are physiologically used to an elevated CO2 level.  The trick her is then to allow the patient to seek his or her own "norm" and thereby "force" the brain to once again send the signals to breathe.  I have seen many patients that were so overventilated for "their" physiological condition, that I put them in CPAP mode and watched them just sit there without breathing for a couple minutes as their CO2 rose….and then voila’….they once again began breathing and went on to being extubated and doing well. permissive hypercapnia can only be accomplished under controlled ventilation, and has NOTHING to do with asthmatics.  As I have stated many time before, if a lack of CO2 were the problem, then i would NEVER need to place any of my patients on a vent, nor would any asthmatic ever suffer respiratory failure…..as their attack progressed, and ventilation failed, their CO2 would rise thereby "curing" the problem….but alas it does not, will not, nor could it ever be so. Go back and try to learn a little about the damn disease before you embarass yourself further. Scooby RCP, EMT-P Perinatal-Pediatric Respiratory Specialist This mail is a natural product.  The slight variations in spelling and grammar enhance its individual character and beauty and in no way are to be considered flaws or defects.

Response:

Now a new publication has gone even further and proposed that hypercapnia See: Lancet 1999 Oct 9;354(9186):1283-6 Carbon dioxide and the critically ill–too little of a good thing?

Decided to check your reference. http://www.thelancet.com/newlancet/sub/issues/vol354no9186/menu_NOD1…. The Lancet Interactive The Journal Editorial and reviews Review    Seminar: Influenza    Hypothesis: Carbon dioxide and the critically ill–too little of a good thing?    Viewpoint: Continuum of palliative care: lessons from caring for children infected with HIV-1    Viewpoint: Decline in child health in rural Papua New Guinea When you were writing your proof, why did you leave out the point that this paper is a "Hypothesis"?      hypothesis: a tentative assumption                  made in order to draw out                  and test its logical or empirical consequences You said the authors said, "We hypothesise that therapeutic hypercapnia might be tested".  So you are aware that you’re attempting to prove a point with an untested assumption. Correct logical form:         This fact, proves this theory. Incorrect:         This assumption, proves this theory. Care to post the entire article?

Response:

In my problems with asthma an important part was played by the fear of suffocation.  Then I cottoned onto Buteyko and found that reduced breathing and acting anti-intuitively brought relief and the slow but steady disappearance of classical symptoms such as attacks, objective shortness of breath and wheeze. Now a new publication has gone even further and proposed that hypercapnia, i. e. above normal carbon dioxide levels in the body may be curative, whereas we all thought that hypercapnia could be the cause of death in status asthmaticus.  See: Lancet 1999 Oct 9;354(9186):1283-6

Well, he is specifically looking at patients on ventilators, and the relationship between permitting higher CO2 levels and ventilator-induced injury.  This is a very specific, and somewhat uncommon, medical treatment.  His more general focus is the critically ill, not the chronic asthmatic.  Although he proposes the possibility of this being related to asthma, he presents absolutely no data to substantiate it having a role in chronic asthma. And, death in asthma results from too little O2, not too much CO2. In view of this paper Buteyko’s theory that constriction of the airways in asthma is a protective strategy of the body to stop undue loss of carbon dioxide seems all the more plausible,

No it doesn’t.  First, the authors were speculating WAY beyond their data set; second, they proposed that work needed to be done, not that they already knew the answer. Chris Owens

Response:

Hi, In my problems with asthma an important part was played by the fear of suffocation.  Then I cottoned onto Buteyko and found that reduced breathing and acting anti-intuitively brought relief and the slow but steady disappearance of classical symptoms such as attacks, objective shortness of breath and wheeze. Now a new publication has gone even further and proposed that hypercapnia, i. e. above normal carbon dioxide levels in the body may be curative, whereas we all thought that hypercapnia could be the cause of death in status asthmaticus.  See: Lancet 1999 Oct 9;354(9186):1283-6 Carbon dioxide and the critically ill–too little of a good thing? Laffey JG, Kavanagh BP [Medline record in process] Permissive hypercapnia (acceptance of raised concentrations of carbon dioxide in mechanically ventilated patients) may be associated with increased survival as a result of less ventilator-associated lung injury. Conversely, hypocapnia is associated with many acute illnesses (eg, asthma, systemic inflammatory response syndrome, pulmonary oedema), and is thought to reflect underlying hyperventilation. Accumulating clinical and basic scientific evidence points to an active role for carbon dioxide in organ injury, in which raised concentrations of carbon dioxide are protective, and low concentrations are injurious. We hypothesise that therapeutic hypercapnia might be tested in severely ill patients to see whether supplemental carbon dioxide could reduce the adverse effects of hypocapnia and promote the beneficial effects of hypercapnia. Such an approach could also expand our understanding of the pathogenesis of disorders in which hypocapnia is a constitutive element. The authors write: "Although hypocapnia [low carbon dioxide] has been assumed to occur as a consequence of many disorders (eg. asthma, systemic inflammatory response syndrome, high-altitutde pulmonary oedema, and ventilator induced lung injury), we propose that hypocapnic alkalosis may be pathogenic.  We propose a potentially novel strategy – therapeutic hypercapnia – whereby hypercapnia could be intentionally produced in critically ill  patients to provide organ protection." "Acute injury can be caused by hyperventilation: hyperventilation causes hypocapnic alkalosis…….hypocapnia and hyperventilation may be independent causes of bronchopulmonary dysplasia" "Long-term neurological sequalae from exposure to extreme altitude are associated not with exposure to low oxygen concentration, but rather with the generations of extremely low PaCO2 [low carbon dioxide]" In view of this paper Buteyko’s theory that constriction of the airways in asthma is a protective strategy of the body to stop undue loss of carbon dioxide seems all the more plausible, more especially because the attitudes on this ng.  If the orthodox interpretation of constriction as the primary target for therapy were correct, there would surely be a different atmosphere without so many detractors and doubters on the one hand and so many almost militant defenders of orthodoxy on the other hand. The Lancet article is of course mainly concerned with emergency medicine, but the insights would seem to apply to an even greater extent for the everyday situation of an asthmatic. It is interesting to note that one paper (Am. Rev. Respir. Dis 1974; 110: 25-33) cited draws attention to a lack of carbon dioxide in an asthmatic as causing increase in airway resistance. Even earlier papers are cited in it dealing with the increase in resistance due to hyperventilation. If it had not been due to the dominating thought of possible suffocation in asthma, a breath therapy based on reduction of the respiratory rate might well have been proposed and used thirty years ago. Couldn’t advocates of orthodox asthma treatment say openly what their views on hypocapnia in asthma are? Cheers, peace and good health, Richard Friedel

Response:

Question:

      About 4 hours after retiring I am up with     a coughing congestion.        It is not something that is treatable with   albuterol (my only inhalant) and I can breath    uncontricted.  

      My first guess would be dust mites, too.  However, I wouldn’t rule out other causes, especioally if you have no ordinary allergy signs such as stuffy nose, etc.       I found out that I have acid reflux, which can contribute to nighttime attacks because that is when, as you are lying flat, the reflux can make it all the way up the esophagus and dribble into the lungs as you breathe.  An endoscopy would be a conclusive test for this condition, which has been linked to nighttime asthma       I currently take Prevacid 2x/day for the reflux – the important dose being at bedtime.  But also useful (and cheaper) is raising the head of the bed a couple of inches (simply adding pillows can cause neckache and you can move off during sleep). Kat   ^^< A good traveler has no fixed plans and is not intent on arriving. – Lao Tzu, 570-490 BCE

Response:

WRT the subject – I only get night-time problems if I am really ill – whilst I have the habit of waking at night there is a big difference between being awake and being OK, and having asthma problems. The wakefulness is partly never gone from when I developed asthma and was woken by the coughing, and the cats waking me.  And also the time when I woke deeply worried every night about finances. <snip  Is there a deterioration of function at a particular   age?  My doc. said I would be losing lung ‘capacity’ from now on. Undertreated asthma can produce a condition called ‘airways remodeling’ which results in a permanent and un treatable reduction in airways function.

I think of ‘airways remodelling’ as ’scarring’ which makes quite clear it’s undesirability. <snip PS hope the snips worked out OK…. — Surfer!

Response:

    I take a maintenance dosage of 5 mg prednisone tablet       2x/day.   I guess both my meds. are rescue med.s as     I use ‘em when needed.        if I use more than is advised, I get called in for a checkup.

If you are on 10mg a day of oral prednisone then you really need to be under the care of an asthma specialist.  Oral prednisone is the drug of last resort for controlling asthma. "Usenet is like a herd of performing elephants with diarrhea — massive, diffucult to redirect, awe-inspiring, entertaining, and a source of mind boggling amounts of excrement when you least expect it." Gene Spafford 1992

Response:

 Is there a deterioration of function at a particular   age?  My doc. said I would be losing lung ‘capacity’ from now on. Your asthma isn’t under control; you need to go back to your doctor and work out a reasonable management plan.  Typically that includes an inhaled steroid as a maintenance medication and albuterol as a rescue med. Chris Owens

     I take a maintenance dosage of 5 mg prednisone tablet        2x/day.   I guess both my meds. are rescue med.s as      I use ‘em when needed.         if I use more than is advised, I get called in for a checkup.    lon

Response:

     It is not something that is treatable with   albuterol (my only inhalant) and I can breath    uncontricted.  

You need to get to a doctor and put on an asthma treatment program. It appears that your asthma is badly out of control. Remember that albuterol only treats asthma symptoms.  You need to get treatment for the asthma itself. Get on the phone and tell your doctor:  "My asthma is badly out of control, I need to see you today."  Is there a deterioration of function at a particular   age?  My doc. said I would be losing lung ‘capacity’ from now on.

Undertreated asthma can produce a condition called ‘airways remodeling’ which results in a permanent and un treatable reduction in airways function. You need to drop this doctor and get seen by an asthma specialist. When you see your doctor (Tomorrow!) tell him that you need a referral to an asthma specialist. "Usenet is like a herd of performing elephants with diarrhea — massive, diffucult to redirect, awe-inspiring, entertaining, and a source of mind boggling amounts of excrement when you least expect it." Gene Spafford 1992

Response:

   These days I am not getting a night’s sleep one in ten:        About 4 hours after retiring I am up with      a coughing congestion.         It is not something that is treatable with    albuterol (my only inhalant) and I can breath     uncontricted.       But it seems that I am congested in that period of time and      coughing begins.  Sometimes just the sitting up with    feet on the floor provides some relief.     This can happen more than once a night but usually    happens about midway in the period after retiring. I am 52.  I’ve had the illness since infancy so I’ve had    all kinds of symptoms.  In my adult life, I have   been encountering more symptoms now (1-2 years)   than an extended period in which I thought the symptoms and their severity from childhood had dissipated.   Is there a deterioration of function at a particular    age?  My doc. said I would be losing lung ‘capacity’  from now on. Anyway, that’s the story. lon

Response:

It could be dust mites in your bed & bedroom are triggering your attack. I slept a lot better and my head and chest were a lot clearer when I "cleaned up" my environment – got a HEPA filter for the bedroom, put dust mite barriers around the pillows and sheets, washed blankets once a week.  Also, when you vacuum and dust your bedroom, make sure your bedding is covering the mattress – wait an hour, for the dust to settle, and then throw bedding into the washer. I got immediate results when I did this. Chris – Hide quoted text — Show quoted text –    These days I am not getting a night’s sleep one in ten:        About 4 hours after retiring I am up with      a coughing congestion.       It is not something that is treatable with    albuterol (my only inhalant) and I can breath     uncontricted.

Response:

– Hide quoted text — Show quoted text –   These days I am not getting a night’s sleep one in ten:       About 4 hours after retiring I am up with     a coughing congestion.        It is not something that is treatable with   albuterol (my only inhalant) and I can breath    uncontricted.      But it seems that I am congested in that period of time and     coughing begins.  Sometimes just the sitting up with   feet on the floor provides some relief.    This can happen more than once a night but usually   happens about midway in the period after retiring. I am 52.  I’ve had the illness since infancy so I’ve had   all kinds of symptoms.  In my adult life, I have  been encountering more symptoms now (1-2 years)  than an extended period in which I thought the symptoms and their severity from childhood had dissipated.  Is there a deterioration of function at a particular   age?  My doc. said I would be losing lung ‘capacity’ from now on.

Your asthma isn’t under control; you need to go back to your doctor and work out a reasonable management plan.  Typically that includes an inhaled steroid as a maintenance medication and albuterol as a rescue med. Chris Owens

Response:

Question:

- Hide quoted text — Show quoted text – Yep–I’ve been diagnosed with asthma.  Went to see the allergist this morning.  Went through all kinds of tests and came home with a virtual drugstore. Me, the med-phobic.  <snipped for space Sorry Iris, but this sounds like a case of medication overkill to me. Just IMO. I don’t know how bad your allergies and asthma are, but this seems like an awful lot of medication to be taking. Just questioning…. Jen

Well, I do a lot of questioning too. I question whether I had the asthma and it caused the panic. Or did I have the panic all along?  I remember two years ago, before the panic set in, I was on the stairmaster doing my usual morning routine.  I got off and couldn’t breathe.  It was pretty scary.  Shortly after that I had the same thing happen to me in the spring after my morning run.  That was when I gave up exercise.  Went to the doc (this was in VA) and they diagnosed asthma.  Gave me an inhaler (Proventil) that made me jump out of my skin.  I figured they were out of their minds and just suffered through it.  But I always felt like I couldn;t really breathe and this got worse and worse, leading to agoraphobia, until I sought help last Christmas.  Spring rolls around this year and I’m coughing like a bandit since March.  Last night I woke up coughing so hard I vomited, then couldn’t breathe. I had asked my regular doc for a referral to an allergy specialist.  They tested me for just about everything today and came up negative, but said when I come back next week for the arm test, things could change.  I flunked the peak flow test. So I don’t know what to believe or who to believe anymore.  Maybe I have both–asthma and panic disorder.  Maybe I just have severe seasonal allergies. Maybe I have exercise induced asthma.  I just don’t know.  I wish someone could definitely tell me what the hell was going on. Iris (depressed) —

Response:

sorry about the asthma (sp) . i feel one ilness is enough. you crack me up, staring at your pills. we should have a contest . i take 11 pills a day. anne

Response:

sorry about the asthma (sp) . i feel one ilness is enough. you crack me up, staring at your pills. we should have a contest . i take 11 pills a day. anne

Well, I only take 3 pills a day for the panic thing, but if you count my two oral inhalers and one nasal inhalers, times the 3-4 times/day I have to use them, let’s see that’s 12? Iris —

Response:

<snipped for space Personally, I’ve received the best advice from doctors who specialize or have asthma themselves.  Many doctors today still don’t know much about it.  Shop around.

Excellent advice John. You’re right. Many docs are really ignorant when it comes to asthma and allergies and especially the newer treatments. Regards, Jen

Response:

Yep–I’ve been diagnosed with asthma.  Went to see the allergist this morning.  Went through all kinds of tests and came home with a virtual drugstore. Me, the med-phobic.  I told him how I was afraid of meds, particularly anything that was going to make me jittery, like Proventil, so they gave me something called MaxAir, which they said was gentler. Have I taken it yet?  Hell no, I’m still staring at it!  Then I ahve something called Pulmacort, which probably is pretty innocuous, and Nasalcort, which I’ve taken before, but I need to take at night.

I’ve lived with allergies and allergy induced asthma for many years. Meds you have been given are standard the Proventil is for immediate relief in case of an attack – normally used only as needed, not on a regular basis.  Don’t know Plumacort but bet is it an inhaled steriod like Asthmacort (which I take).  These are to prevent bronchial inflamation which has recently been shown to contribute to asthma.   My asthma is bad enough I also take allergy shots (which have worked wonderfully well), and take Serevent twice a day (is a long lasting asthma preventative).  None of these medications should make you jittery.  Many older medicines made you walk three feet off the ground, but these should not. Personally, I’ve received the best advice from doctors who specialize or have asthma themselves.  Many doctors today still don’t know much about it.  Shop around. I’m not and MD, just lived with it for 50 years and raised several kids with it.   JEB Just my opinions and experience, others will differ.

Response:

Iris, (and Jeb) the treatment (medications) you have been given to combat your asthma symptoms are the most current in treatment. Inhalers ( one for rescue, one for long term relief and one for inflammation) are the common practice, today. Sure, there can be side effects, but they’re generally minimal, and pass over time. Panic and anxiety attacks often include a feeling of not being able to take in a deep breath. While your asthma treatment won’t cure your panic, getting your symptoms under control may help in relieving your anxieties about that part of it. Please, take your meds as directed. jimi

Response:

<snipped for space So I don’t know what to believe or who to believe anymore.  Maybe I have both–asthma and panic disorder.  Maybe I just have severe seasonal allergies. Maybe I have exercise induced asthma.  I just don’t know.  I wish someone could definitely tell me what the hell was going on.

Sorry you’re depressed Iris. Personally, I would bet on the seasonal allergies and exercise induced asthma, judging by what you said in your post. I have read that taking a large dose of vitamin C (1000mg or so) just prior to exercise helps to reduce the possibility of exercise induced asthma. I do it all the time. I always take my C before heading to the gym. So far, so good. Somtimes these things just tend to work themselves out over time too. The other thing you should look at is what has changed in your environment recently that could account for an increase in these attacks?  New carpet, fresh paint, new pet, etc. etc. Sometimes the simple answers are the right ones. (Doctors tend to forget this…they look for zebras when they should be looking for horses! ) Anyway, there are a lot of ways to treat asthma and allergies that don’t rely on allopathic medicine. Some of them work quite well, in my experience. Just for the record! Best Wishes & Peace to You, Jen

Response:

Yep–I’ve been diagnosed with asthma.  Went to see the allergist this morning.  Went through all kinds of tests and came home with a virtual drugstore. Me, the med-phobic.  I told him how I was afraid of meds, particularly anything that was going to make me jittery, like Proventil, so they gave me something called MaxAir, which they said was gentler. Have I taken it yet?  Hell no, I’m still staring at it!  Then I ahve something called Pulmacort, which probably is pretty innocuous, and Nasalcort, which I’ve taken before, but I need to take at night. Sigh.  More fears to overcome. Iris —

Response:

Yep–I’ve been diagnosed with asthma.  Went to see the allergist this morning.  Went through all kinds of tests and came home with a virtual drugstore. Me, the med-phobic.  <snipped for space

Sorry Iris, but this sounds like a case of medication overkill to me. Just IMO. I don’t know how bad your allergies and asthma are, but this seems like an awful lot of medication to be taking. Just questioning…. Jen

Response:

Hi Everyone…yup it’s really true, I’m officially nuts.  Got diagnosed yesterday with chronic depression, GAD and social phobia kind of panic disorder.  I haven’t decided if that makes me feel better or worse…I can’t tell myself "It’s not so bad, I’m  really ok" anymore, but OTH I can post with abandon to you all now!!  I got taken off of Paxil (hurray!) and put on Prozac and  Xanax.  I sure hope that works better.  Did anyone else battle this demon for years and THEN get some help?  I’ve been like this for over 20 yrs., and sometimes I can’t imagine it to be possible to feel any other way…can’t remember ever feeling good. Michelle…still hopeful anyway!

Response:

On 02-Jul-98 20:05:48, Michelle Hunt wrote about "It’s Official" Hi Everyone…yup it’s really true, I’m officially nuts.  Got diagnosed yesterday with chronic depression, GAD and social phobia kind of panic disorder.  I haven’t decided if that makes me feel better or worse…I can’t tell myself "It’s not so bad, I’m  really ok" anymore, but OTH I can post with abandon to you all now!!  I got taken off of Paxil (hurray!) and put on Prozac and  Xanax.  I sure hope that works better.  Did anyone else battle

this demon for years and THEN get some help?  I’ve been like this for over

20 yrs., and sometimes I can’t imagine it to be possible to feel any other way…can’t remember ever feeling good.

Same here, Michelle; with SP, anxiety and depression. But Paxil *worked* for me. Michelle…still hopeful anyway!

Regards. Sylvain Van der Walde. (Male resident of London, England, UK).

Response:

Hi Everyone…yup it’s really true, I’m officially nuts.  Got diagnosed yesterday with chronic depression, GAD and social phobia kind of panic disorder.  I haven’t decided if that makes me feel better or worse…I can’t tell myself "It’s not so bad, I’m  really ok" anymore, but OTH I can post with abandon to you all now!!  I got taken off of Paxil (hurray!) and put on Prozac and  Xanax.  I sure hope that works better.  

Ummm… not sure whether it’s quite the done thing to congratulate someone on their diagnosis but.. why the hell not? Congratulations All joking aside, knowing more or less precisely what is wrong can be hugely helpful and is, for many of us, the real start of recovery. I hope it is for you Did anyone else battle this demon for years and THEN get some help?  I’ve been like this for over 20 yrs., and sometimes I can’t imagine it to be possible to feel any other way…can’t remember ever feeling good.

Oh, heavens, yes! Quite a few of us here have been in that position, in fact. In my own case I had stumbled around knowing what was wrong with me but not being able to get the treatment I needed, until some of the good people here persuaded me to nag my doctor to let me try Xanax (almost unobtainable here in the UK). since when my recovery has progressed in leaps and bounds – it’s been an astonishing process Michelle…still hopeful anyway!

Justifiably, I hope! — Gary Cooper

Response:

Michelle Hunt schreef: Hi Everyone…yup it’s really true, I’m officially nuts.  Got diagnosed yesterday with chronic depression, GAD and social phobia kind of panic disorder.  I haven’t decided if that makes me feel better or worse…I can’t tell myself "It’s not so bad, I’m  really ok" anymore, but OTH I can post with abandon to you all now!!  I got taken off of Paxil (hurray!) and put on Prozac and  Xanax.  I sure hope that works better.  Did anyone else battle this demon for years and THEN get some help?  I’ve been like this for over 20 yrs., and sometimes I can’t imagine it to be possible to feel any other way…can’t remember ever feeling good. Michelle…still hopeful anyway!

  Hi Michelle! I have to disappoint you. You’re not *nuts*, you have a chemical imbalance which seems to be a chronic disease with many. I’m sure that when the Prozac kicks in (at first it may produce a worsening of symptoms but don’t worry too much about that – Xanax will take care of that anyway; just give it two months before evaluating it) you’ll feel better than you have for 20 years. IMO, FWIW, YMMV and all that sort of thing. Philip

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- Hide quoted text — Show quoted text -Hi Everyone…yup it’s really true, I’m officially nuts.  Got diagnosed yesterday with chronic depression, GAD and social phobia kind of panic disorder.  I haven’t decided if that makes me feel better or worse…I can’t tell myself "It’s not so bad, I’m  really ok" anymore, but OTH I can post with abandon to you all now!!  I got taken off of Paxil (hurray!) and put on Prozac and  Xanax.  I sure hope that works better.  Did anyone else battle this demon for years and THEN get some help?  I’ve been like this for over 20 yrs., and sometimes I can’t imagine it to be possible to feel any other way…can’t remember ever feeling good. Michelle…still hopeful anyway!

Hi Michells, I have had panic disorder,depression since I was 2 years old, I am now 30, almost 31, dont tell anyone, I think that it is great that you have been diagnosed and now know what you are dealing with and luckily you are dealing with a life threatning illness.  I am sad however, that there are so many people like us and how little is being done presently in the research area of this illness, they (scientist & doctors) seem to think, "give him or her a pill and all will be well with the world" attitude really stinks but for the moment all we can do is educate ourselves and work on our own happiness.  My suggestion is for you to look out your window everyday and be blessed that we have the trees and the bird and the sky, I love the stars, it is the only time I feel really free of the illness. I can look up there and feel like I am part of it and nothing to worry about.  But, also, keep a journal and everyday, make sure you write down at least 3 good things that happened that day and if you cant think of any, make one happen….DONT WRITE ANYTHING NEGATIVE. call it a happy journal. also, get a file folder and put in it, good pictures of family and friends or of yourself that make you feel good, along with momentos such as cards or a note someone wrote to you or something a child gave to you and keep it with the journal, then when you find your having a bad day, look at it, read it. last but not least and this is very important, when you wake up and walk into your bathroom look in the mirror and say something good about yourself even if you think your lying to yourself, eventually, you will feel better

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snipped Hi Michells, I have had panic disorder,depression since I was 2 years old, I am now 30, almost 31, dont tell anyone, I think that it is great that you have been diagnosed and now know what you are dealing with and luckily you are dealing with a life threatning illness.  I am sad however, that there are so many people like us and how little is being done presently in the research area of this illness, they (scientist & doctors) seem to think, "give him or her a pill and all will be well with the world" attitude really stinks but for the moment all we can do is educate ourselves and work on our own happiness. snipped

I think you are being a little harsh. The brain is a very complex organ, over 10 billion cells each with potentially 10E28 connections to other neurons, and 6 major neurotransmitters + several minor ones. Understanding how all that works isn’t easy, trying to correct malfunctions nearly impossible. However, despite the difficulties progress is being made. New drugs have recently become available and new ones are in development. The are also some non drug therapies in development that show promise, especially TMS (Transcranial Magnetic Stimulation). I don’t know what the situation is in your area, but where I live the last specialist mental hospital will close in a few months, which illustrates just how much progress has/is being made in mental health. Compared to other medical fields mental health is doing far better, I haven’t heard of any hospitals being closed because cancer etc. is no longer a problem, and they still haven’t cured the common cold and thats got to be easier than curing a malfunctioning brain! Ian    ian<<atdragoncon<dotnet

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Hi Everyone…yup it’s really true, I’m officially nuts.  Got diagnosed yesterday with chronic depression, GAD and social phobia kind of panic disorder.  I haven’t decided if that makes me feel better or worse…I can’t tell myself "It’s not so bad, I’m  really ok" anymore, but OTH I can post with abandon to you all now!!  I got taken off of Paxil (hurray!) and put on Prozac and  Xanax.  I sure hope that works better.  Did anyone else battle this demon for years and THEN get some help?  I’ve been like this for over 20 yrs., and sometimes I can’t imagine it to be possible to feel any other way…can’t remember ever feeling good. Michelle…still hopeful anyway!

I used to think I was crazy.  Why else would I suddenly become terrified, have trouble breathing, feel detached from my surroundings, and not be able to understand those sounds people made (words).   Now, I know I have an illness, and other people have it, too.  I’m sorry that anyone has it, but I’m also glad I’m not the only one.  I hid this damn thing from everyone, for 20? years.  I didn’t want to be locked up. Now I am getting treatment.  Life is getting better, in fits and starts.   Kiesha Van Dyke To e-mail, remove ** from address.

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Question:

"Pycnogenol, a.k.a. Revenol, is a substance that has been mentioned in misc.health.diabetes as an aid/cure for several diabetic complications. Pycnogenol is a bioflavanoid, also identified as an oligomeric proanthocyanidin (OPC) and a procyanidin, which is found in the bark of conifers, specifically the maritime pine (_Pinus maritima_) and the Canadian spruce (_Tsuga canadensis_) and in grape seeds. The substance was patented in the US (patent 4,698,360) in 1985 by J. Masquelier of France. Pycnogenol is sold on several web sites in addition to health food stores. The web sites are set up in a pyramid scheme with the claims of quick riches for new distributors. Most of the sales pitches rely on first-person "testimonials". Some pitches include a list of published scientific studies that, according to the pitch, support the claims of the ad. In the following sections I examine the sales claims, investigate the ad’s publication list, and establish a bottom line. Written by Laura Clift. (refs) point to "pycnogenol references" section. All bioflavanoids are anti-oxidants (1,8,9) and may effect capillary hyperpermeability (8,9), inflammations (3,8), and edemas (8). However, there is no bioflavanoid deficiency condition, and they have "no accepted preventive or therapeutic role in vascular purpura, hypertension, degenerative vascular disease, rheumatic fever, arthritis, cancer, or any other condition" (9). This was as of 1988; no mention of bioflavanoids is made in the 1994 edition of this reference. Most pycnogenol studies and/or claims come from the early 70’s to mid 80’s. Promising starts are never followed up on. Most later studies seem negative (both pycnogenol and bioflavanoids), especially about the oral route. With all but one study performed in rodents, there is a very definite lack of information on how this substance acts in humans and what possible side-effects it produces. The sales pitch seems to be taken from the 1985 patent. Filing a medical patent doesn’t mean the substance is thoroughly studied and its applications are determined. A patent is filed when preliminary studies look promising and you try to come up with every possibly use for the compound, no matter how far out in left field it may be. If you do not hold the patent for the application, someone else could conceivably use your compound for that application and owe you nothing or a very reduced royalty. In short, patent claims have no medical significance." Caveat emptor, Ellis – Hide quoted text — Show quoted text – Please excuse my ignorance, but can you please explain what OPC’s and pycnogenols are?  Some of us are new to asthma and could use the clarification. I have read a few articles on the effect of OPC’s/Pycnogenols on Asthma.  One user quote’s that his asthma improved so much that he could literally throw away is inhalers, ventolin and steroid. Has anyone had any similar experiences.  What dosage? Any herbs help in Asthma treatment?

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I seem to remember that a few years ago probably more there was a lot of people discussing a bioflaviniod from the japanese yew tree that was supposed to have some remarkable effects on a whole range of disorders. some people were even saying that it could be used effectively against cancer.. Of course all the "experts" started howling thier usual bit about quackery etc. as soon as they got wind of it ….A few years later one of the larger drug companies came out with a *remarkably* effective new drug to be used on uterine cancer….it was an extract from the bark of the japanese yew… Coincidence?? Cheers  Gerhardt

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I found 95% relief from the use of a good quality digestive enzyme that contains Amylase, Protease, Lactase, Lipase and Cellulase with meals, and the use of a new super antioxidant that is thousands of times more powerful than anything else on the market and is completely safe and non-toxic.  In fact, it will actually detox your system.  I went to a meeting last month with a number of Medical Doctors that are using this super antioxidant in their practice and the wide number of health benefits that they are experiencing is amazing.  I used to need asthmaCort and Ventalin for asthma attacks, but since using using these natural products I haven’t had to use them at all.  You can find the enzymes at a health Food store.  The one I’m using is Source Naturals– Essential Daily Enzymes. Here is a web site for the antioxidant:  http://expage.com/page/microhydrin I hope you find natural relief—all the side effects with medication are so undesirable. Let me know if you have any questions that I might be able to help with. Mike Stewart

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I found 95% relief from the use of a good quality digestive enzyme that contains Amylase, Protease, Lactase, Lipase and Cellulase with meals, and the use of a new super antioxidant that is thousands of times more powerful than anything else on the market and is completely safe and non-toxic.

Can you provide the results of the safety testing that was done on this?  If you are claiming "completely safe" and cannot back it up with actual tests to confirm this, you are engaged in fraudulent advertising. You are also implying that your product will help asthma. It is against the law to make such a claim unless you can support the claim with evidence that your product meets the esatblished standards for safety and effectivness. BTW, by thier very nature it is impossible for any antioxidant to be "completely safe."

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I have read a few articles on the effect of OPC’s/Pycnogenols on Asthma.  One user quote’s that his asthma improved so much that he could literally throw away is inhalers, ventolin and steroid. Has anyone had any similar experiences.  What dosage? Any herbs help in Asthma treatment?

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I have read a few articles on the effect of OPC’s/Pycnogenols on Asthma.  One user quote’s that his asthma improved so much that he could literally throw away is inhalers, ventolin and steroid. Has anyone had any similar experiences.  What dosage? Any herbs help in Asthma treatment?

Yes, OPCs do offer great relief for asthma and many other ailments. OPCs do not cure, but do boost the immune system and combat free radical damage.  I’ve never known anyone that has thrown away their inhaler forever.  They do keep one around just in case.  As they are taking a good OPC (most are crap) they haven’t needed an inhaler. I’ll send info if you complete the Health Awareness Survey at http://www.globalserve.net/~munkey/biz/has.html (will snail-mail info to US and Canada only… web based info otherwise) Joel (to email, delete "-antispam" from email address)

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Please excuse my ignorance, but can you please explain what OPC’s and pycnogenols are?  Some of us are new to asthma and could use the clarification. Thanks – – Hide quoted text — Show quoted text – I have read a few articles on the effect of OPC’s/Pycnogenols on Asthma.  One user quote’s that his asthma improved so much that he could literally throw away is inhalers, ventolin and steroid. Has anyone had any similar experiences.  What dosage? Any herbs help in Asthma treatment?

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Question:

Actually, I never head to the emergency room with my son without first calling my doctor’s office. They always (24 hours a day) have a nurse available for consultation and a doctor on call. They ALWAYS tell me to get to the ER immediately — "We don’t mess around when kids are having trouble breathing. They get worse fast." I know that’s what they’ll say, but then I have a record of checking in for approval so there are no questions later. Mary – Hide quoted text — Show quoted text – In the US, in the state of NY, the ER must attempt contact with the patient’s private physician in order to determine whether the patient is to be addmited or not.  At that point it is entirely at the discretion of one’s own doctor whether and when to cease medical care, and to order how it is to proceed.   In NY, ER’s subscribe to this practise most willingly, none want to risk the possibility of subsequent malpractise litigation.   The first question asked by the ER is "What insurance do you have?",  the second is "Who is your doctor?" Then it is determined the extent of one’s incapacity. To receive the best care, make certain to apprise your own doctor of your ER visit as soon as possible, if not by yourself, then instruct somebody else to do so in your behalf. Sheldon

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- Hide quoted text — Show quoted text – Make sure they know you’ve spent time in an ICU for asthma. My son has been sent home from the ER too soon — only to boomerang back a few hours later. A triage doctor once told me there was nothing wrong with my son because he couldn’t hear wheezing (as I watched the retractions at his collarbone and between his ribs, and the use of his stomach muscles to breathe…). I told him my son rarely wheezes, and insisted that the pediatrician check him out. My son ended up admitted for two days of intensive treatment. Now, we always head to a certain hospital where the first question is, "Have you been *admitted* in the past for asthma treatment?" When you answer "yes" there are no more silly questions. Mary

In the US, in the state of NY, the ER must attempt contact with the patient’s private physician in order to determine whether the patient is to be addmited or not.  At that point it is entirely at the discretion of one’s own doctor whether and when to cease medical care, and to order how it is to proceed.   In NY, ER’s subscribe to this practise most willingly, none want to risk the possibility of subsequent malpractise litigation.   The first question asked by the ER is "What insurance do you have?",  the second is "Who is your doctor?" Then it is determined the extent of one’s incapacity.   To receive the best care, make certain to apprise your own doctor of your ER visit as soon as possible, if not by yourself, then instruct somebody else to do so in your behalf. Sheldon – Hide quoted text — Show quoted text – Can anyone give  suggestions for dealing with ER doctors and staff who are unfamiliar with the less common types of asthma.  My asthma does not tend to manifest as audible wheezing.  I often begin to cough, and as the attack progresses the lungs actually sound clear as they are shutting down.  Twice I have been in the ER with peak flows well under 50%, and even with reduced oxygen levels, and the doctor has insisted there is nothing wrong and sent me home — just because he did not hear wheezing.   I am educated enough to question the decision and give my opinion, but don’t seem to have the magic words to alter their decisions. This trip, things basically worked out and I came out of the attack by the middle of the next day (mostly, am still on slightly shaky ground) but the first time I almost ended up on a respirator and spent 4 days in ICU, where I was admitted by my pulmonary physician within 12 hours of discharge.

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: Can anyone give  suggestions for dealing with ER doctors and staff who : are unfamiliar with the less common types of asthma.  My asthma does : not tend to manifest as audible wheezing.  I often begin to cough, and : as the attack progresses the lungs actually sound clear as they are : shutting down.  Twice I have been in the ER with peak flows well under : 50%, and even with reduced oxygen levels, and the doctor has insisted : there is nothing wrong and sent me home — just because he did not : hear wheezing.   I am educated enough to question the decision and : give my opinion, but don’t seem to have the magic words to alter their : decisions.   Hi Linda,                         That’s frightening.  Have you considered carrying a letter from your pulmonary physician with you?  Then you could show them something with the "magic words" of another physician – in my experience, some doctors assign very little weight to the opinions/knowledge of a patient, but are ready and willing to listen to other doctors.  It might be worth a try. — Linda McIver                             — "The moral of the story is that if you go away in order to get away from it all, make sure you tie it down before you leave"         – Andrew McIver

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Can anyone give  suggestions for dealing with ER doctors and staff who are unfamiliar with the less common types of asthma.  My asthma does not tend to manifest as audible wheezing.  I often begin to cough, and as the attack progresses the lungs actually sound clear as they are shutting down.  Twice I have been in the ER with peak flows well under 50%, and even with reduced oxygen levels, and the doctor has insisted there is nothing wrong and sent me home — just because he did not hear wheezing.   I am educated enough to question the decision and give my opinion, but don’t seem to have the magic words to alter their decisions.

Fortunately my expierence (last Saturday in fact) was completely different.  I also have cough-variant asthma but the ER staff recognised what was going on immedeatly (as far as I can tell the moment I walked in the door). I guess this depends on just how good the doctors and nurses are.  Unfortunately, just because somebody has the title ‘MD’ or ‘RN’ does not gurantee that they really know what they are doing.

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Make sure they know you’ve spent time in an ICU for asthma. My son has been sent home from the ER too soon — only to boomerang back a few hours later. A triage doctor once told me there was nothing wrong with my son because he couldn’t hear wheezing (as I watched the retractions at his collarbone and between his ribs, and the use of his stomach muscles to breathe…). I told him my son rarely wheezes, and insisted that the pediatrician check him out. My son ended up admitted for two days of intensive treatment. Now, we always head to a certain hospital where the first question is, "Have you been *admitted* in the past for asthma treatment?" When you answer "yes" there are no more silly questions. Mary – Hide quoted text — Show quoted text – Can anyone give  suggestions for dealing with ER doctors and staff who are unfamiliar with the less common types of asthma.  My asthma does not tend to manifest as audible wheezing.  I often begin to cough, and as the attack progresses the lungs actually sound clear as they are shutting down.  Twice I have been in the ER with peak flows well under 50%, and even with reduced oxygen levels, and the doctor has insisted there is nothing wrong and sent me home — just because he did not hear wheezing.   I am educated enough to question the decision and give my opinion, but don’t seem to have the magic words to alter their decisions. This trip, things basically worked out and I came out of the attack by the middle of the next day (mostly, am still on slightly shaky ground) but the first time I almost ended up on a respirator and spent 4 days in ICU, where I was admitted by my pulmonary physician within 12 hours of discharge.

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Hi, Linda, I’m an ICU nurse who often winds up having to work in the ER.  (I’m asthmatic, too). The phrases  1)" I’m (very) short of breath"                             2) " I’m not responding to my  rescue                                    inhaler, Ventolin"(or whichever)                              3)"my peak flows are down 50%"                               4)  "this is what happened the last time                                     I was in the ICU for asthma" should prod any E.R. doctor into at least a Ventolin treatment. Explain and re-explain your condition. Emphasize the phrases "short of breath" and " I can’t breathe very well."  If you’re frightened and anxious, say so. Tell them " I NEED a breathing treatment"(if that’s what you’re after).  Ask for another doctor; ask for another nurse if you don’t you don’t have a  helpful one.  Ask for "the charge nurse." If you have your lungs listened to by the respiratory therapist , get them on your side .  You might say to the doctor something like"I feel you are endangering my health and safety by not treating my condition, asthma, which is well documented.  Are you going to pay my hospital bills if I wind up in the ICU _again_!." A bit of a scare tactic, but if it reflects how you feel, say it.  It’s what I would do.  When and if they ask you to leave say" I don’t feel safe leaving" or "I don’t think I’ll feel safe driving home until my condition is treated." And don’t leave if you do not feel safe and feel you " need help now."  If you are TRULY in a bad situation, and a hospital is not treating it, you can call 911 from the unhelpful ER’s waiting room and get EMS to take you to another area hospital, if there is one.  I don’t think the EMS can legally refuse, so don’t let them talk you out of it.  This way you can be monitored while you are enroute to a hopefully more helpful situation.  Do not be by yourself if your airway is in danger of  serious compromise.  This is the strategy I would follow. I hope you never need this advice, and I hope you can stay out of the ER, period. See about getting a home nebulizer (I’ve got one) Cultivate a relationship with a helpful ER. Do the other things suggested on this thread. You ask a very good question.   Peace and Good Health Cindy D. – Hide quoted text — Show quoted text – Can anyone give  suggestions for dealing with ER doctors and staff who are unfamiliar with the less common types of asthma.  My asthma does not tend to manifest as audible wheezing.  I often begin to cough, and as the attack progresses the lungs actually sound clear as they are shutting down.  Twice I have been in the ER with peak flows well under 50%, and even with reduced oxygen levels, and the doctor has insisted there is nothing wrong and sent me home — just because he did not hear wheezing.   I am educated enough to question the decision and give my opinion, but don’t seem to have the magic words to alter their decisions.   This trip, things basically worked out and I came out of the attack by the middle of the next day (mostly, am still on slightly shaky ground) but the first time I almost ended up on a respirator and spent 4 days in ICU, where I was admitted by my pulmonary physician within 12 hours of discharge.   Suggestions greatly appreciated. Thanks. Linda

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- Hide quoted text — Show quoted text – Can anyone give  suggestions for dealing with ER doctors and staff who are unfamiliar with the less common types of asthma.  My asthma does not tend to manifest as audible wheezing.  I often begin to cough, and as the attack progresses the lungs actually sound clear as they are shutting down.  Twice I have been in the ER with peak flows well under 50%, and even with reduced oxygen levels, and the doctor has insisted there is nothing wrong and sent me home — just because he did not hear wheezing.   I am educated enough to question the decision and give my opinion, but don’t seem to have the magic words to alter their decisions. This trip, things basically worked out and I came out of the attack by the middle of the next day (mostly, am still on slightly shaky ground) but the first time I almost ended up on a respirator and spent 4 days in ICU, where I was admitted by my pulmonary physician within 12 hours of discharge. Linda

Many asthmatics are able to avoid trips to ER by monitoring peak flows at home, and using an Action Plan to adjust meds when peak flow drops. Typically, green zone is 80% personal best, yellow zone is 50-80% of personal best, and red zone is <50%. In the yellow zone, inhaled steroids are typically doubled and albuterol used as needed. In the red zone, inhaled steroids may be doubled again and/or oral steroids started. Here is a link from EPR2: http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/comp3/… Figure 3-8. Management of Asthma Exacerbations: Home Treatment I realize home treatment of exacerbations doesn’t work in all cases. Wearing a Medic-Alert necklace or bracelet, should help. The admitting doctor should be familiar with your case (I have to call my doctor before going to ER, if possible) Generally to release you from ER, they want your lung function to be 70% and oxygen 90%. For lung function <50% they should eventuallyadmit you to the hospital. For 50-70%, it depends. See:

http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/comp3/… Figure 3-11. Management of Asthma Exacerbations: Emergency Department and Hospital-Based Care In my only experience in ER in ‘89 I had the opposite problem. They didn’t want to let me go. I was there for 7 hr with 4 neb treatments and IV aminophylline and steroids. I finally faked no wheezing  by breathing shallowly, so I could get out of there. Ellis

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Can anyone give  suggestions for dealing with ER doctors and staff who are unfamiliar with the less common types of asthma.  My asthma does not tend to manifest as audible wheezing.  I often begin to cough, and as the attack progresses the lungs actually sound clear as they are shutting down.  Twice I have been in the ER with peak flows well under 50%, and even with reduced oxygen levels, and the doctor has insisted there is nothing wrong and sent me home — just because he did not hear wheezing.   I am educated enough to question the decision and give my opinion, but don’t seem to have the magic words to alter their decisions.   This trip, things basically worked out and I came out of the attack by the middle of the next day (mostly, am still on slightly shaky ground) but the first time I almost ended up on a respirator and spent 4 days in ICU, where I was admitted by my pulmonary physician within 12 hours of discharge.   Suggestions greatly appreciated. Thanks. Linda

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Can anyone give  suggestions for dealing with ER doctors and staff who are unfamiliar with the less common types of asthma.  

Sure: Carry a note from your physician.  They won’t listen to you, but they might listen to another doctor (since that would make them more liable for a malpractice suit.) Medalert bracelets with "call doctor for instructions" might also help. Scott T."his is also why I have a home neb.  It’ll get me help faster than some ERs."

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Try having your own doctor write you a note to keep in your pocket – then you can give it to the ER when you get there.  Or get a medic alert bracelet, and make sure the info that you do not wheeze gets in their files.  When the doctor questions you, you can refer him or her to either the note or the medic alert people, so that he has confirmation of the situation. I don’t wheeze either, and everytime I see a new nurse at the infirmary here on campus, I make sure they understand that I don’t wheeze, I mostly just cough.  If they can’t understand that, I ask for another nurse  - but those encounters usually aren’t emergencies. hope that helps. janet

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Question:

<<…since when did insurance companies start dictating to doctors. Well, since most insurance companies use a mail-order pharmacy for long-term meds (steroids definitely fit into this category!) and there are 3 major mail-order pharmacies that have 80% of the market and they *own* pharmaceutical companies, it behooves them to have as many people as possible buying their drugs.

Wait?  You mean Walgreen’s owns Schering, or Glaxo-Welcome or any of the other *publicly traded* drug manufacturers???  I don’t think so.  Hell, I’ve got stock in some of them.   If you mean they order enough medications to *demand price cuts* you are correct.  Uh, this is a bad thing? As for private pharmacies, pharmaceutical companies offer "rebates" (read "kickbacks") to pharmacists who change prescriptions to a similar drug made by their company. Consumers and doctors are the only ones who can put a stop to this. Insist that *no* substitutions be made when your prescriptions are filled and let your doctor know what’s going on.

Look, any pharmacist caught taking such a kickback would end up in jail and lose their professional license.  Watch what you accuse people of, it can be taken as slander or libel.  Just don’t ever attach a specific name to that statement.  No, I’m not a pharmacist. Hosptals routinely make substitutions in medications where it is clinically equivalent.  Maybe they don’t stock the med ordered or maybe they have two 25mg tabs when a 50 mg tab was ordered.  I use generic meds whenever and wherever feasible (and no, with some things like heart meds I *don’t* think it is feasible). The doctors do know what is going on. The rest of my story about the insurance companies demanding that doctors prescribe certain medications will perhaps clear up some of this.   They have gone so far as to do studies on the cost of treating asthma patients.  It seems that all those trips to the ER by folks just using Albuterol are damned expensive.  The insurance companies have a vested interest in seeing that you are healthy enough to *stay out of ER and save them money*.  They can do this if you are *properly treated for asthma in the first place*.   Thus they now have teams of people who will track such things, locate the patient and provide home health care to educate the patient on compliance with their doctor’s prescribed treatment.  THIS IS A GOOD THING!!!!!!  It keeps people healthy and gives them access to healthcare professionals who know what they are doing and have the time to spend with the patient to make sure they understand how to control their asthma. Loki

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Ellis,   Can you direct me to these "expert panel reports" that you quote? bill

Downloadable ‘1997 Asthma Treatment Guidlines’ (Adobe Acrobat format): http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm HTML version of the ‘97 Guidelines: http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/guidel… ‘Reply to’ address changed to foil email spammers.

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- Hide quoted text — Show quoted text – Ellis,   Can you direct me to these "expert panel reports" that you quote? bill Downloadable ‘1997 Asthma Treatment Guidlines’ (Adobe Acrobat format): http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm HTML version of the ‘97 Guidelines: http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/guidel… ‘Reply to’ address changed to foil email spammers.

Thanks  again bill

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- Hide quoted text — Show quoted text – My last experience was radioactive breathing tests BTW…what is a radioactive breathing test? …someone help out here… I don’t know about Cats4jane, but in my case:     a) Red blood cells tagged with radioactive materials and reinjected into the blood(stream) for a scan of the heart/lungs while exercising.     b) Radioactive gas inhaled and a passive scan done of the lungs/airways.     c) Radioactive material injected into the blood(stream) for a passive CT scan of the lungs.

Oh, duh. I wasn’t thinking… a "V/Q scan", (V=ventilation{airflow}/Q=perfusion{blood flow})THAT is want she was talking about…sorry never heard anyone say radioactive breathing test…but you are most certainly correct…it is a "radioactively breathing test".   A V/Q scan is a procedure most often used to rule out a pulmonary embolus.  The raido active gas in the lungs and the radioactive tag on the RBCs will show if there is any flaw in the air flow in the lungs(closed/filled alveoli) or any flaw in the blood flow(pulmonary embolus) bill

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- Hide quoted text — Show quoted text – Per new asthma guidelines (Expert Panel Report 2), if you need to use your bronchodilator inhaler (Ventolin) more than once a day, its time to add or increase inhaled steroids like Vanceril. Ellis Ellis,    Can you direct me to these "expert panel reports" that you quote? bill Sure, see: http://www.ama-assn.org/special/asthma/treatmnt/treatmnt.htm  Guidelines for the Diagnosis and Management of Asthma National  Asthma Education and Prevention Program Expert Panel Report II,  National Heart, Lung and Blood Institute February 1997 Also see: http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm Expert Panel Report II (PDF format) Ellis

Thank you bill

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Have been able to breath deep but feel like gorilla sitting on chest.  Called Doctor and said to increase frequency of preventil.  I did and feel bit better after 3 days but still feel like I have to breath in a lot to get at least a feeling of enough air.  Really don’t want to go to emergency ( blood gas tests are the pits).  AM slowly beefling better but…..when is enough enough to go to emergency and what do they do there?  My last experience was radioactive breathing tests and 5 blood gases.  They told me to try to relax.  Are they kidding? janeo

If increasing Proventill isnt working, you need inhaled steroids…this is a common and accepted practice.   BTW…what is a radioactive breathing test? bill

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- Hide quoted text — Show quoted text – Per new asthma guidelines (Expert Panel Report 2), if you need to use your bronchodilator inhaler (Ventolin) more than once a day, its time to add or increase inhaled steroids like Vanceril. The same guidelines recommend the use of a Peak Flow Meter at home to monitor lung function; the Mini-Wright and Assess are common brands. They cost about $30 from the pharmacy. You determine your personal best reading when your asthma is well controlled. Then if peak flow drops into yellow zone (50-80% of personal best), you increase meds, usually double the inhaled steroids and use Ventolin as needed. If it drops into red zone (<50%) its time to call the doctor and consider whether to go to the emergency room. Ellis

Ellis,    Can you direct me to these "expert panel reports" that you quote? bill

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- Hide quoted text — Show quoted text – If increasing Proventill isnt working, you need inhaled steroids…this is a common and accepted practice. BTW…what is a radioactive breathing test? bill I was talking to a pulmonologist the other day and he said the most interesting thing. He said that "these days not treating asthma with some form of inhaled steroids amounts to malpractice".  It seems the HMO folks and insurance companies agree.  He actually gets lists of patients from HMO’s that he has seen and if they haven’t filled prescriptions for the meds the HMO thinks are necessary to control asthma they yell at the doctor for not prescribing them.  It seems he *was* prescribing them but the patients didn’t fill the prescriptions! I think more discussion of the effects of treatment with inhaled steroids is warrented here. Loki

   Yup, it is so funny, last year all the doctors starting ordering MDI steroids to their post CABG (coronary artery bypass graft)(open heart surgery)(well not technically open heart surgery)patients…anyway…I asked why and they said that the insurance companies wanted them to start using them!!! It takes a week or two to start taking effect and these patients only use them for three days, this does not make any medical sense…since when did insurance companies start dictating to doctors.    Guys/Gals write your congressmen/women.  The government is doing funny things with your health, dont let them get away with it! bill

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If increasing Proventill isnt working, you need inhaled steroids…this is a common and accepted practice. BTW…what is a radioactive breathing test? bill

I was talking to a pulmonologist the other day and he said the most interesting thing. He said that "these days not treating asthma with some form of inhaled steroids amounts to malpractice".  It seems the HMO folks and insurance companies agree.  He actually gets lists of patients from HMO’s that he has seen and if they haven’t filled prescriptions for the meds the HMO thinks are necessary to control asthma they yell at the doctor for not prescribing them.  It seems he *was* prescribing them but the patients didn’t fill the prescriptions! I think more discussion of the effects of treatment with inhaled steroids is warrented here. Loki

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Per new asthma guidelines (Expert Panel Report 2), if you need to use your bronchodilator inhaler (Ventolin) more than once a day, its time to add or increase inhaled steroids like Vanceril. Ellis Ellis,    Can you direct me to these "expert panel reports" that you quote? bill

Sure, see: http://www.ama-assn.org/special/asthma/treatmnt/treatmnt.htm  Guidelines for the Diagnosis and Management of Asthma National  Asthma Education and Prevention Program Expert Panel Report II,  National Heart, Lung and Blood Institute February 1997 Also see: http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm Expert Panel Report II (PDF format) Ellis

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I immediately identifed with your message. One of my frustrations with asthma treament, especially for acute episodes, is the doctors’ apparent skepticism regarding your level of breathlessness. I have had more than one ER trip end with a doctor telling me he’s "not worried" about my breathing, while I’m still feeling like I can’t catch my breath. My opinion is that a little oxygen and inhaled bronchodilators never hurt anyone, especially under direct medical supervision.  Why not provide this relatively simple and inexpensive treatment, then decide what else to do or not do. Tim

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I don’t think there’s any mystery here… if you’re having asthma episodes that aren’t being relieved with your prescribed bronchodilator, or your using your inhaler without effect, many times in an hour… or you experience chest pain and diziness with your asthma symptoms…GET TO THE HOSPITAL! Forget peak flows, forget breathing exercizes, forget everything… get to the hospital. Period. Something is wrong, your meds aren’t working and your peak flow readings at this point don’t mean a hill of beans. Get the emergency care, which is usually a nebulizer form of albuterol and a steroid shot…then follow up with your regular doctor. I’m sure he/she will say you did the right thing.

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I always wonder that too.  The last time I got sick, the doctor said to increase the steroid, and keep using my MaxAir, but I still had times where I’d wake up in the middle of the night coughing and short of breath, and my peak flow had dropped from 79% when I went to bed to 70% and it took a long time for the MaxAir to help.  When I called the on call Dr.  the next day, his response was that I didn’t sound that bad over the phone, and to keep taking the medicine the way my doctor had said. As I understand it, the 2 major reasons to go to the ER are (1) your rescue medicine doesn’t work; or (2) your peak flow drops below 50%. Are there other times where an ER visit is appropriate?  Neither of my doctors have ever really given me any direction on this – when I ask what to do if I get worse, they either say to call them and they’ll give me something else, or they say to increase the steroid inhaler. And when I ask what if I keep getting worse, the response is generally along the lines of we’ll worry about that later or that won’t happen. Any thoughts? – Hide quoted text — Show quoted text -Have been able to breath deep but feel like gorilla sitting on chest.  Called Doctor and said to increase frequency of preventil.  I did and feel bit better after 3 days but still feel like I have to breath in a lot to get at least a feeling of enough air.  Really don’t want to go to emergency ( blood gas tests are the pits).  AM slowly beefling better but…..when is enough enough to go to emergency and what do they do there?  My last experience was radioactive breathing tests and 5 blood gases.  They told me to try to relax.  Are they kidding? janeo

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Do not be afraid of gas tests. When properly done, you almost feel nothing.

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If you are experiencing other symptoms, (i.e. dizzyness, nausea, vomitting, weakness, pain radiating to extremities) get to the hospital. If your symptoms are isolated to a respiratory distress, increase your use of your (most likely) ventolin(albuterol) inhaler. Being afraid of the ER is not healthy if it keeps you away when you need it. If you need it and don’t go, you only hurt yourself in the long run. People still die from asthma. – Hide quoted text — Show quoted text – Have been able to breath deep but feel like gorilla sitting on chest.  Called Doctor and said to increase frequency of preventil.  I did and feel bit better after 3 days but still feel like I have to breath in a lot to get at least a feeling of enough air.  Really don’t want to go to emergency ( blood gas tests are the pits).  AM slowly beefling better but…..when is enough enough to go to emergency and what do they do there?  My last experience was radioactive breathing tests and 5 blood gases.  They told me to try to relax.  Are they kidding? janeo

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when is enough enough to go to emergency and what do they do there?

If your asthma is that severe that you wonder if it is an emergency, you may need to change your approach. First, a way of measuring your breathing performance might be in order. A peak flow meter can help you do this at home. This is a device that measures how fast you can expel air. The worse your asthma, the lower the reading. Your doctor may have the latest sample pack from the makers of Vanceril Double Strength, which includes a sample of the drug, a videotape, instructions, and a free peak flow meter. My doctor gave me one of these so I could have a peak flow meter to measure how well my treatment was going. Your doctor usually will give you the safe, caution, and danger zones, points on the scale that tell you if you need to be concerned. For me, 500 (liters per minute) is O.K., 300 to 500 would be caution, and below 300 I should be using my nebulizer (more on that in a moment.) The next thing to add, if you are having serious problems with asthma, is a nebulizer. This is a device that has a small (like an aquarium pump) compressor to supply air into a chamber that mixes air into a mixture of saline and Proventil (or other bronchodilator), atomizing it into tiny droplets that you breath in through a mouthpiece or mask. This takes 10-15 minutes with my nebulizer, and it delivers a lot more medicine into your airways. A side effect is feeling jittery, but it’s better to breathe than avoid this side effect. You actually will sleep better, even feeling like you have a lot of caffeine in your body, than you would having trouble breathing. This, like your Proventil inhaler, is for short-term management of your asthma. If you normally use your inhaler more than twice per week, you should consider the next level of treatment. It sounds like you should be something to treat the underlying symptoms of your asthma. This would include inhaled corticosteroids like Flovent (which I use and have had good results with,) Asthmacort, Venceril (available now in double strength,) Beclovent, and others. This treats the inflammation in the lungs and helps prevent your symptoms, or make them less severe. This means that you would be less dependent on your inhaler, which has some serious possible long-term side effects (with frequent use,) mostly on the heart. For asthma that does not respond to anything else (sometimes it just happens to get worse over the period of a day or days,) oral steroids are normally used to get you through the crisis. They begin to show results in hours, are usually taken for a week, and, hopefully, your asthma will then respond to your Proventil when you have an attack. I used to have a pack of Methylprednisone tablets as a backup medication, but have not had an attack that would not respond to my nebulizer for years. Your doctor might want you to have these on standby, or at least, have a prescription ready for filling, with instructions on when to use them and if you should call your doctor when you have to use this medicine. When you get emergency room treatment, they usually administer epinephrine (adrenaline) to open the lungs. While it feels great (I had it once) it is not what you want to rely upon, because, if your body gets immune to its effects, you will have possibly no last resort left. This is why over the counter drugs like Primatene and Bronchaid inhalers are downright dangerous. They are short-acting, tend to be needed much more often than recommended, and get your body used to epinephrine. Use of a peak flow meter sounds like what you need to add to your program of asthma management right now. It can help your doctor know just how bad or good your condition is, and how well it responds to different medications. Donald Hellen (Note: Anti-Spam Measure… remove the "1" in front of our address to reply by email.)

Response:

Per new asthma guidelines (Expert Panel Report 2), if you need to use your bronchodilator inhaler (Ventolin) more than once a day, its time to add or increase inhaled steroids like Vanceril. The same guidelines recommend the use of a Peak Flow Meter at home to monitor lung function; the Mini-Wright and Assess are common brands. They cost about $30 from the pharmacy. You determine your personal best reading when your asthma is well controlled. Then if peak flow drops into yellow zone (50-80% of personal best), you increase meds, usually double the inhaled steroids and use Ventolin as needed. If it drops into red zone (<50%) its time to call the doctor and consider whether to go to the emergency room. Ellis

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Do you have a nebulizer?  If you do, use that, it usually works for me.  If you don’t have one ask you doctor about getting one.  As far as going to the hospital I can’t really help you there.  I paid a visit to the ER just 2 weeks ago.  I was running and all of a sudden I couldn’t breath.  They gave me one treatment of what I think was alupent in the nebulizer and then another one an hour later and I was fine.  I have never had radioactive breathing tests, or blood gases, so I can’t help you there either.  If I were you though I would go tomorrow if you still are having trouble.  Better to be safe and live then say don’t worry about it and collapse from lack of oxygen.  Hope you feel better. Drew Lawrence

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Have been able to breath deep but feel like gorilla sitting on chest.  Called Doctor and said to increase frequency of preventil.  I did and feel bit better after 3 days but still feel like I have to breath in a lot to get at least a feeling of enough air.  Really don’t want to go to emergency ( blood gas tests are the pits).  AM slowly beefling better but…..when is enough enough to go to emergency and what do they do there?  My last experience was radioactive breathing tests and 5 blood gases.  They told me to try to relax.  Are they kidding? janeo

The new AMA guidelines for asthma diagnosis and treatment are very helpful in deciding when to step up treatment, based on your own peak flow performance. The steps are arranged in chart form and are very easy to understand. They describe what you should be doing up to a point, and what the emergency room should be doing depending on your response to treatment. There are also charts for the asthmatic patient to fill out to develop a personal treatment plan. You might print all these out and discuss them with your doctor. http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/guideli n.htm

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Have been able to breath deep but feel like gorilla sitting on chest.  Called Doctor and said to increase frequency of preventil.  I did and feel bit better after 3 days but still feel like I have to breath in a lot to get at least a feeling of enough air.  Really don’t want to go to emergency ( blood gas tests are the pits).  AM slowly beefling better but…..when is enough enough to go to emergency and what do they do there?  My last experience was radioactive breathing tests and 5 blood gases.  They told me to try to relax.  Are they kidding? janeo

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Question:

Thank You Dr. Rodgers for telling these people the truth.  To say that chiropractic doesn’t improve the health of asthmatics is absolutely insane.  No MEDICAL study will support the role of chiropractic care for any ailment, they study the role of DRUGS!  People you are responsible for your health and if you are just going by what your medical doctor is telling you then get prepared for a lifetime of alternating drug therapies.  By the way ,  it was a nurse that made me question my M.D.’s, not a chiropractor…..

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Thank You Dr. Rodgers for telling these people the truth.  To say that chiropractic doesn’t improve the health of asthmatics is absolutely insane.  No MEDICAL study will support the role of chiropractic care for any ailment, they study the role of DRUGS!

What about a placebo-controled, blinded study that compared the effectivness of chiropratic treatment of asthma vs. placebo. I found this study.  And it was not about drugs either. The reason that drugs are the treatment of choice in asthma treatment is Because They Have Been Proven To Be Effective! I challange you to provide any peer-reviewed, scientific study in which chiropratic treatment was compared to placebo in a blinded trail where the researchers concluded that chiropatic treatment was a safe and effective treatment for asthma.

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: I challange you to provide any peer-reviewed, scientific study in which : chiropratic treatment was compared to placebo in a blinded trail where the : researchers concluded that chiropatic treatment was a safe and effective : treatment for asthma. I am prepared to wager that it is safe in that it will not in itself cause any harm (assuming that one does not stop normal asthma treatment). Effectiveness, I would only be prepared to wager against :-). Cheers, Kin Hoong

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Question:

Hi from Denmark, There have been some threads about alternative treamtment of asthma and other upper resperitory illnesses. I have been working with alternative medicine for many years, and of course oriental medicine can be applied here, including herbology, dietary changes and acupuncture. I have used classic acupuncture, laserpuncture (wrote the first book on it in 1976) and electroacupuncture, in connection with herbal and energy therapy. You can find more info on herbology and acupuncture on healthy.net which also has an email service called "Ask Dr. Tom" Another www source is hotwired.com which hosts "Ask Dr. Weil" Another source is the various acupuncture schools and groups on the net–stick to the ones which have real M.D.’s from real Universities–there are also quacks on the net! regards Scott Hill biophysicist research director, Danish S.P.R.

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My 3

Question:

Hi, I keep reading these news.msg

Question:

i am trying to make some decisions about how to best improve my chances of avoiding major asthma attacks during the next few months.   normally, i must admit, i am somewhat blase about the whole thing, but i have recently moved (to northern california!  it is beautiful!  i highly recommend it!) and unfortunately when i left my old job i left my health insurance too.  i was wondering if anyone had any opinions and/or recommendations about specific brands and models of air filtering systems and vacuum cleaners – they all sound wonderful in their ads, of course, but i would greatly value any input i were to receive from anyone with personal experience with the products. i have never posted to a newsgroup before, so i am not clear on whether i should ask for responses to be posted here or e-mailed directly to me – either would be great! thanks a lot, cassidy

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- Hide quoted text — Show quoted text – i am trying to make some decisions about how to best improve my chances of avoiding major asthma attacks during the next few months. normally, i must admit, i am somewhat blase about the whole thing, but i have recently moved (to northern california!  it is beautiful!  i highly recommend it!) and unfortunately when i left my old job i left my health insurance too.  i was wondering if anyone had any opinions and/or recommendations about specific brands and models of air filtering systems and vacuum cleaners – they all sound wonderful in their ads, of course, but i would greatly value any input i were to receive from anyone with personal experience with the products. i have never posted to a newsgroup before, so i am not clear on whether i should ask for responses to be posted here or e-mailed directly to me – either would be great! thanks a lot, cassidy

We offer several lines (3) of ultra violet air probe sanitizers which are proving to be the best air sanitizing product on the market. If this interests you please email, call me, or visit our website. We also offer air sampling and can aid in all aspects of HVAC/IAQ. — Sincerely, William J. Parlapiano III SVP Marketing/Info Systems/COO Mechanical Systems Maintenance Inc. Come Visit our HVAC/IAQ website at:                                       http://members.aol.com/msmi1800/wwwpages Ultra Germicidal Air Probe Sanitizer website at:   http://members.aol.com/ugaps Web Design Services website at:                       http://members.aol.com/desimage Our office phone is 518-237-1800 Our office fax and voice mail system is 518-237-6042 "Why walk with the turkeys when you can soar with the eagles!"   B.S. George

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- Hide quoted text — Show quoted text –  i am trying to make some decisions about how to best improve my  chances of avoiding major asthma attacks during the next few months.    normally, i must admit, i am somewhat blase about the whole thing, but  i have recently moved (to northern california!  it is beautiful!  i  highly recommend it!) and unfortunately when i left my old job i left  my health insurance too.  i was wondering if anyone had any opinions  and/or recommendations about specific brands and models of air  filtering systems and vacuum cleaners – they all sound wonderful in  their ads, of course, but i would greatly value any input i were to  receive from anyone with personal experience with the products.  i have never posted to a newsgroup before, so i am not clear on  whether i should ask for responses to be posted here or e-mailed  directly to me – either would be great!

As you can see by some of the followups, you have just opened yourself up to all sorts to promotions and snake oil peddlers. Your best bet is to contact your doctor and discuss prevention programs that are best suited to your needs and your type/severity of asthma. There are general trends, but nobody on the net can give you an appropriate treatment plan. A prevention plan may include measures to take to reduce controllable allergens (if allergies are a part of your asthma), and may include seasonal and/or continuous use of medications (typically inhalers) directed at reducing the inflamation that leads to bronchospasm and also medications to treat active bronchospasm. Good luck, and remember to take any ‘net advice with a grain of salt (no, I’m not prescribing and asthma treatment here and only after you’ve discussed it with your doc. — Mark Feblowitz,   GTE Laboratories Inc., 40 Sylvan Rd.  Waltham, MA 02254

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