Puffing

The first Monday of the month and the last Monday of Respirology.

Actually, I quite like Respirology. The consult service is busy, but I have legitimately learned a lot and am now less afraid to mess (constructively) with people’s puffers when they are admitted to me in the future.

I also quite like Medical Mondays. Check out other medically affiliated blogs at the link on the image below.

Since it is the second to last day of resp, I thought I would share this lovely image.

Image from pinterest.com.

I remember seeing this episode and laughing hysterically.

It is so true.

People have no clue how to use their puffers. And they think they do. And they often can’t figure out why they aren’t getting better. But it is often because something isn’t being done right. And often this is because nobody asked and nobody taught.

I know this from both sides of the hypothetical office.

I have been on puffers off and on since I was about 9. I am one of those weirdos that did not have childhood asthma in the wheezy since toddlerhood kind of ways. I developed asthma in my late kid years.

I finally gained control of my asthma when I was in my 20s.

I have CONSISTENTLY PROPERLY used my puffers never.

Okay, never isn’t a fair term. I have used them consistently and properly, but not for more than a few months at a time.

I had a puffer for the odd “chest infection” as a tween. I never had an aerochamber. We figured out how it worked by reading the instructions.

One time, I was prescribed a turbuhaler. That is a puffer that has a powder you suck in. There is no puff of aerosol. We couldn’t figure out why we couldn’t taste or see it (this is before the days of Google, boys and girls), so I took a good 20 hits of puffer before we figured it out.

Google would have shown me this… Instead of just the words on the tube. And helpful tidbits like you shouldn’t taste or see anything. Image from theasthmacenter.org.

I was first given an aerochamber at 14. By this point, my breathing issues were beyond asthma and got into this weird laryngeal spasm thing, so that not only did I wheeze, but I had stridor because I didn’t keep my airway open right any more for some reason that is still beyond me (and probably at least partly psychosomatic).

What 14 year old who audibly wheezes and hacks wants to add to her awesomeness by carrying an aerochamber everywhere?

Not this one.

So, I used it at home and no where else.

It took years of titrations, allergy shots and finally growing up enough to see the greatness of not being sick all the time to finally establish good asthma control. If I had actually used the darn puffers properly all the time, it might have been quicker. Maybe not because there was other stuff at play, but maybe.

Instead, I would take them until I felt well, then I would forget them most of the time until got a cold, which would then linger forever because my airways hated me. That is when I would start taking them properly again.

Now, I have an action plan. I have that figured out with lots of medical education, doctors orders and real experience.

I don’t always follow it. I miss days of my steroid inhaler sometimes. That usually comes back to bite me. I forget to restart my seasonal asthma/allergy medication when Spring comes (seriously, I just realized this now). My aerochamber (that I have had for an indeterminate period of time) has a crack in it (I will get a new one next time I see the doctor), so I confess, I haven’t been using it. And I also confess I never carry it with me.

So, if I, the doctor suck at managing my respiratory illness, I know that  most patients are probably kind of like me too. That being said, I think it is doable.

I mean, it is where your priorities are at…. Breathing is good. The problem is that when you feel good and a problem doesn’t flare that instant, you don’t always think (for instance, I would never skip my migraine prophylaxis because 1 or 2 missed doses and I am out for the count for a day).

What I am pointing out is that puffers are inconvenient. Moreso than taking a pill. If you have an aerochamber, they are bulky, need to be washed and don’t fit in a nice purse (especially if you are me and like to carry a book).

The directions for puffers are variable. Often, I see people who don’t understand why their directions are different from the ones on the bottle and different from their friend. They get mixed up. People don’t understand that one is to keep you well long term and another is for emergencies only.

And don’t even get me started on proper use.

One of the docs I work with said that he suspects 75% of people prescribed puffers don’t use them properly. Mind you probably 20 or 25% of those people don’t use them properly because they don’t actually need them (that is a rant for another day). I’d believe it.

Today, I saw someone grab their puffer from their bedside table and try to use it without the aerochamber with me, the resident working for the lung specialists, standing right there!

I put it together and showed her how it worked. She had never seen it used that way before. Mind you, it had a mask because this person had such bad respiratory distress taking a single deep breath and holding for 10 seconds was out of the question. But, until then, that is what the person tried to do, but couldn’t do.

Image from asthma.ca

That is why I ask how you use your puffers.

Because I don’t always do it right, but I want you to do it right. I like it when people show me up and do everything to a tea and rattle off the proper timing and dosing. But, when you don’t know, I show you.

You can’t get better if you don’t get appropriate drug.

That message is as much for me as it is the other millions of people with respiratory disease.

But seriously, if you would up here looking for advice on how to take your puffer… GO SEE YOUR DOCTOR!

My new favourite morbid parody

It still isn’t Spring outside.

This week so far, the Respirology consult service I am covering has seen 11 new consults.  And, we’re following about 18 inpatients.

I have physics for the first time in weeks with the instructor who actually expects me to know stuff.  And the other resident is on vacation somewhere warm and is thus leaving me to fend for myself on my own.

To make me happy, I will share the song… The terribly morbid and kind of horrifying parody of a song I quite love.

The original song is “Do You Want To Build a Snowman?” from the movie Frozen.  

I know, there are a million parodies.  Yes, there are.  But I have only listened to a couple and  I feel like it will be tough to top this one… At least for me.

The parody is “Do You Want To Hide a Body?”  Yes.  True story.  What better to sing and laugh about on a crazy day?

I am a bit of a terrible person.

Listen to it to the very end to get the full effect of the morbid funny and epic creepy.