Worsening of asthma symptoms
After three weeks of exhausting travel across the country, my work brought me to California’s Imperial Valley. This county has some of the worst air quality in the country. We took a tour of the dried-up Salton Sea, which is polluted by runoff pesticides from local farms and is saltier than the Pacific Ocean. Biologists tell us the winds are allowing water from the bottom of the sea to rise and release the gas hydrogen sulfide, causing a rotten egg smell. After 30 minutes of visiting this area, I could feel my chest tighten. This was Wednesday afternoon.
I have cough-variant asthma, meaning my main symptom is coughing versus wheezing. The cough started Thursday morning, but I managed to drive several hours to the airport and fly home, spending a few hours in the office. I was using my quick-relief inhaler a lot, even though it had expired two months ago. The inhaler wasn’t helping much. By Friday night I was in serious distress and considering calling 911. I talked myself out of that, not wanting to wake my neighbors or upset my dog. I also had a migraine and was trying to manage my pounding head and nausea along with struggling to breathe. I felt “too sick” to get dressed and take an ambulance ride. I want to clarify that was not a smart move; when you think it’s time to call 911, it is time to call 911.
The best way I can describe how my lungs felt is like this: You know how when you lift weights, climb stairs or run until your muscles shake, ache and burn? And you just must stop? That’s how my lungs felt. They were on fire and shaking and just completely exhausted. It felt like they wanted to give up, to just take a break from breathing. Except you can’t stop breathing. You must force yourself to keep those lungs working. It’s hard. And scary. Very scary.
Finally, after surviving one of the worst nights of my life, I pulled myself together and went to the ED. While checking in I experienced what most of us with asthma experience; an ED staff that seems to know nothing about asthma. When I said I was there because I was in the middle of a three-day asthma attack, the woman at registration asked, “So, what does that mean? Are you just having shortness of breath?” Um, yes, you can say that, but it’s an understatement. Over at triage the nurse knew a little more but felt I was ok because she couldn’t hear any wheezing. All asthmatics do not wheeze! Since my oxygen level was only 90 (normal readings are between 95 and 100, so 90 is low) I was brought to a room immediately.
The doctor listened to my upper airways, also saying he didn’t hear any wheezing. I could barely talk and could not stop coughing. My core was so sore from the relentless cough. I tried to explain while gasping for air that my cough-variant asthma presented differently, and I asked for a respiratory therapist. Instead, the nurse came in. She also placed the stethoscope on my chest and upper back, stating she couldn’t hear any wheezing. I reminded her that asthma is a disease of the lower airways, and she needed to listen lower. She put the stethoscope ¾ down my back and said, “Oh, yeah, I can definitely hear something is wrong.” Thank goodness; a medical professional finally believes I’m having a serious asthma episode. Maybe now I can be treated.
I was given three back-to-back breathing treatments and oral steroids. I immediately felt my lungs relax and the burning sensation went away. After a few hours, I was sent home with more oral steroids, a new quick-relief inhaler, and a controller medication.
Value of self-advocacy
I was reminded how hard it is to advocate for yourself when you are in distress. Especially if you don’t have someone who can come and advocate for you. I had to fight to get the medical staff to believe I was having an asthma episode and for the proper treatment, was able to do so because asthma education is my career. As a certified asthma educator (AE-C) I could use my credentials to fight for what I needed. I worry about those who do not have a voice or an advocate to ensure they are receiving the medical care they need and deserve.
This experience has renewed my passion and mission to continue to educate clinicians in how to provide national asthma guidelines-based care. I have a lot of work to do.
We live with asthma, and we are the experts in what we need to manage our disease. What suggestions do you have to improve the care we receive from our medical providers? Share them in the comments and I’ll include them in my provider trainings!
Follow me on twitter at @asthmachef for tips on living and eating well with asthma.