Mr. Asthma

Question:

>Dear Ali, >I have been a Respiratory Therapist for the last 26 years. During this >time I have seen "The Best Bronchodilators on the Market" come and go, >as they fall out of favor. When someone asks me, what is the best >bronchodilator on the market? My reply is "the one you are currently >NOT on!". As with all medications, your body will build a tolerance to >such things as proventil/ventolin. Have your physician write you an >order for Alupent or Breathine. I think a change of the Beta 2 end of >your treament regimen may be the solution you are looking for. >As for the coughing it goes like this: If your cough is productive, >let it be and rid your lungs of the mucus, however if you have a dry >hacky cough, then you need to take a codeine based anti-tussive. Dry >hacky coughs are nothing more than bronchospasms waiting to happen. >Dont suffer!

I have cough variant asthma.  The primary symptom is a dry nonproductive cough.  When this happens it is relieved by using my bronchodilator.   It’s a terrible responsibility – but somebody has to be the Americans.

Response:

Is there an asthma nurse connected to your Drs surgery ? I have found them to be very helpful both with testing and advise. good luck.. Sheila. – Hide quoted text — Show quoted text – >Thanks for any help >Ali– >"Forget yourself for others and Others will not forget you >Before you buy.

Response:

Dear Ali, I have been a Respiratory Therapist for the last 26 years. During this time I have seen "The Best Bronchodilators on the Market" come and go, as they fall out of favor. When someone asks me, what is the best bronchodilator on the market? My reply is "the one you are currently NOT on!". As with all medications, your body will build a tolerance to such things as proventil/ventolin. Have your physician write you an order for Alupent or Breathine. I think a change of the Beta 2 end of your treament regimen may be the solution you are looking for. As for the coughing it goes like this: If your cough is productive, let it be and rid your lungs of the mucus, however if you have a dry hacky cough, then you need to take a codeine based anti-tussive. Dry hacky coughs are nothing more than bronchospasms waiting to happen. Dont suffer! I hope this helps, Sincerely, Louis Jimenez RRT, CHT – Hide quoted text — Show quoted text – > Hi I am new to the group and was wondering what is good to help with >an asthma attack when your inhalers don’t work and the coughing won’t >stop and neither will the congestion I am currently on serevent,flovent >and proventil >Thanks for any help >Ali– >"Forget yourself for others and Others will not forget you >Before you buy.

Response:

Hi, Please tell me what are the "specific" tests for asthma?  I had breathing tests but am wondering if there are other tests I wasn’t given for some reason. Thanks – Hide quoted text — Show quoted text -> The problem is that the asthma specialist is hardwired to diagnose > asthma, and the GERD specialist is hardwired to diagnose GERD.  No real > harm (other than lost time/money) in the GERD diagnosis, since the > treatment is relatively benign, but the treatment for asthma can be > debilitating and even life-threatening in its own right, especially if > there is another problem underlying the symptoms that is in need of > treatment. > But there are very specific and sensitive tests/criteria for diagnosing > asthma. This takes much if not all of the subjectivity out of the > diagnosis.

Response:

- Hide quoted text — Show quoted text -> >  Hi I am new to the group and was wondering what is good to help with > > an asthma attack when your inhalers don’t work and the coughing won’t > > stop and neither will the congestion I am currently on serevent,flovent > > and proventil > Maybe you don’t have asthma.  Has your lung function been measured? > I’d suggest getting a second opinion, but NOT from an asthma > specialist.  (But stay away from GERD specialists as well, or you’ll end > up being diagnosed with GERD.) > Who will measure his pulmonary function? Why not get a second opinion from > an asthma expert? Are you saying that if for example I go to a diabetes > specialist this week than I will be diagnosed as having diabetes? I don’t > get it, the vast majority of the time I see a doctor, they tell me my > little complaints are nothing to worry about and forget about them. I feel > that I have never been over-treated (although at times I wonder if too > many studies have been done, but that is also a function of fear of > lawsuits) > Pulmonary function tests, and methacholine challenges do not lie. GERD is > more difficult to accurately diagnose so a trial of antacids would not be > unreasonable.

The problem is that the asthma specialist is hardwired to diagnose asthma, and the GERD specialist is hardwired to diagnose GERD.  No real harm (other than lost time/money) in the GERD diagnosis, since the treatment is relatively benign, but the treatment for asthma can be debilitating and even life-threatening in its own right, especially if there is another problem underlying the symptoms that is in need of treatment.

Response:

> > The problem is that the asthma specialist is hardwired to diagnose > asthma, and the GERD specialist is hardwired to diagnose GERD.  No real > harm (other than lost time/money) in the GERD diagnosis, since the > treatment is relatively benign, but the treatment for asthma can be > debilitating and even life-threatening in its own right, especially if > there is another problem underlying the symptoms that is in need of > treatment. > But there are very specific and sensitive tests/criteria for diagnosing > asthma. This takes much if not all of the subjectivity out of the > diagnosis.

Yes, but they are not used as often as you’d think, plus they may simply diagnose an inactive condition unrelated to the primary problem.

Response:

> Yea but by your logic, if he really ahs asthma, he will get the wrong > diagnosis by the non-asthma doctor.

If you have a broken leg any doc can diagnose it.  If you have a pain in your leg joint things are less clear.  If you have a problem that is not clear cut, i.e. "Hey, doc, I’m all the time short of breath," you can get the results alluded to.  When I talked to the cardiologist he very matter of factly attributed the SOB to side effects of hypertension medications.  When I talked to the pulmonologist he actually laughed at that that idea. It is well known that when you own a hammer all the world is in need of hammering. If you don’t play the bagpies you will probably not be aware of all the opportunities to play bagpipes that are all around you; I just got off the phone with a guy who wants piping done. Therefore, if you have a clear and classical case of asthma maybe everyone can get it right, otherwise, you can get the wrong diagnosis from the wrong speialist.

Response:

Sounds a lot like Bronchitis, due to the cough and the congestion. That requires a doctor and an antibiodic.

– Hide quoted text — Show quoted text -> Hi I am new to the group and was wondering what is good to help with > an asthma attack when your inhalers don’t work and the coughing won’t > stop and neither will the congestion I am currently on serevent,flovent > and proventil > Thanks for any help > Ali– > "Forget yourself for others and Others will not forget you > Before you buy.

Response:

- Hide quoted text — Show quoted text -> > Yea but by your logic, if he really ahs asthma, he will get the wrong > > diagnosis by the non-asthma doctor. > If you have a broken leg any doc can diagnose it.  If you have a pain in > your leg joint things are less clear.  If you have a problem that is not > clear cut, i.e. "Hey, doc, I’m all the time short of breath," you can get > the results alluded to.  When I talked to the cardiologist he very matter of > factly attributed the SOB to side effects of hypertension medications.  When > I talked to the pulmonologist he actually laughed at that that idea. It is > well known that when you own a hammer all the world is in need of hammering. > If you don’t play the bagpies you will probably not be aware of all the > opportunities to play bagpipes that are all around you; I just got off the > phone with a guy who wants piping done. > Therefore, if you have a clear and classical case of asthma maybe everyone > can get it right, otherwise, you can get the wrong diagnosis from the wrong > speialist. > I’ll state it again, there are tests that are very objective and reliable > for diagnosing asthma, the asthma doctor is most likely to do these tests, > interpret the results and state whether you have or are unlikely to have > asthma based on the results. Because it is not a clear-cut diagnosis when > based only on symptoms and examination is exactly why an asthma doctor is > best equipped to rule-in or rule-out a diagnosis of asthma. I would prefer > this to the uncertainty and trial and error approach of many family > practitioners. You assume that there are no objective criteria when you > make the above statement.

But note that the "objective" tests sometimes give ambiguous results, plus a "positive" on such a test does not prove that a current syndrome is due to asthma — the asthma could be dormant.  And, given what the dear Dr feels are clear symptoms of asthma and/or a history suggestive of it, he may not give the tests at all. I had a condition that was "diagnosed" as asthma by one of the senior doctors at a well-known Midwest clinic.  I received a lung function test (that was apparently ambiguous), but no "challenge" test. Turned out it was not asthma but an abscess on my epiglottis that was causing my problems.  But before I figured that out I had to suffer being "treated" for asthma, a process that provoked severe asthma symptoms on top of the problems I already had.  I wasn’t treated for the epiglottitus, a condition that could easily have been fatal.

Response:

> Hi I am new to the group and was wondering what is good to help with >an asthma attack when your inhalers don’t work and the coughing won’t >stop and neither will the congestion I am currently on serevent,flovent >and proventil

Best thing you can do is go back to your doctor and tell him about the problems.  If he is unable to solve them, ask fro a referral to an asthma specialist. It’s a terrible responsibility – but somebody has to be the Americans.

Response:

 Hi I am new to the group and was wondering what is good to help with an asthma attack when your inhalers don’t work and the coughing won’t stop and neither will the congestion I am currently on serevent,flovent and proventil Thanks for any help Ali– "Forget yourself for others and Others will not forget you Before you buy.

Response:

>  Hi I am new to the group and was wondering what is good to help with > an asthma attack when your inhalers don’t work and the coughing won’t > stop and neither will the congestion I am currently on serevent,flovent > and proventil

Maybe you don’t have asthma.  Has your lung function been measured? I’d suggest getting a second opinion, but NOT from an asthma specialist.  (But stay away from GERD specialists as well, or you’ll end up being diagnosed with GERD.)

Response:

>  Hi I am new to the group and was wondering what is good to help with > an asthma attack when your inhalers don’t work and the coughing won’t > stop and neither will the congestion I am currently on serevent,flovent > and proventil > Thanks for any help > Ali– > "Forget yourself for others and Others will not forget you > Before you buy.

Generally speaking, if your rescue inhaler (proventil or serevent, I think) isn’t rescuing you, you need to check in with your doctor and find out what’s wrong. That said, I have heard that if you don’t have an inhaler handy or need some more help with an attack (not an acute one, no time then), caffeine in the form of chocolate, coffee, etc. might help relax the airways. I’ve not really seen any proof of this though, does anyone else know if this is reliable? —  Karen Ingraffea  "I might be a coward; I’m afraid of what I might find out…" -(The Mighty Mighty Bosstones) The Impression That I Get "All things being equal, you lose." -Anon

Response:

>  Why not get a second opinion from > an asthma expert? Are you saying that if for example I go to a diabetes > specialist this week than I will be diagnosed as having diabetes? I don’t > get it, the vast majority of the time I see a doctor, they tell me my > little complaints are nothing to worry about and forget about them.

    Actually the point is very well taken.  I consulted a cardiologist and was diagnosed with a heart problem; I say a pulmonologist and was diagnosed with a lung problem; I saw a GP and was told I was out of shape.  People tend to use the hammer they have.  Cest la vie.     It is certaily awkward to have to decide between the diagnoses of two specialists, but having tried both treatments I think the pulmonologist is, perhaps, on the better track.  (Sond effect: pulmonologist patting his own chest while smiling.)

Response:

- Hide quoted text — Show quoted text ->  Hi I am new to the group and was wondering what is good to help with > an asthma attack when your inhalers don’t work and the coughing won’t > stop and neither will the congestion I am currently on serevent,flovent > and proventil > Thanks for any help > Ali– > "Forget yourself for others and Others will not forget you > Before you buy. > Generally speaking, if your rescue inhaler (proventil or serevent, I think) > isn’t rescuing you, you need to check in with your doctor and find out > what’s wrong. That said, I have heard that if you don’t have an inhaler > handy or need some more help with an attack (not an acute one, no time > then), caffeine in the form of chocolate, coffee, etc. might help relax the > airways. I’ve not really seen any proof of this though, does anyone else > know if this is reliable?

I find chocolate causes a slight problem for me, if I’m predisposed to be congested.  I don’t think this is caffeine, but other chemicals in the chocolate.  Coffee does seem to help slightly, possibly both because of the caffeine and the effects of the warmth. But one thing that isn’t clear here is whether the problem is coughing or SOB.  If it’s coughing, and there is not a severe SOB problem, I would question the asthma diagnosis, especially since the inhalers don’t help.  More likely to be a low grade infection or a reaction to something in the air.

Response:

I am presently shooting a Darton exel bow right handed…I have a left dominate eye…I have never been able to get great groups and have always been plagued with my groups drifting to the right about six inches no matter how much I chase them with the pins….I finally went to a peep sight(I used to shoot only with a kisser buttton)(I shoot with a winn release) that helped but still I have to force myself to shoot with my right eye….One more thing that is a pain when a deer walks by! I think that I am going to go and get a left handed bow….Now here is my ques?   Can I switch my riser out on my bow for a left handed riser by swapping the limbs end for end?  If I can, does anyone know a source for a used Darton Excel riser?  I have developed immense respect for the quality and the service of darton company and want to stay with them for my next bow….If I cant get a riser for this bow does anyone recommend a model of Darton bow that is reliable and a good performer?  I am not looking for a barn burner that I have to worry about going out of tune every time I hit a bump on the way out to my stand or to a 3-D shoot….Just a reliable shooter with some modern performance….

Response:

I would contact Darton and tell them what you just told us.  If they have a left handed riser, I bet they would fix it for you or could tell you what riser would work.  There customer service is pretty good. Terry

Response:

Hi! Sorry to intrude, but I