Treatment Options: When Things Go Differently Than Expected

Today, I had a follow up with my doctor that did not go as planned. It was weird and awkward, I was off my game. I had come in with a game plan but it quickly fell off the rails. I was greeted at the exam room, with a friendly "hello", however it quickly deteriorated to, "I am going to be honest, I don't have any other options for you". Insert the sound of screeching tires and I tried to put the brakes. What just happened? We had a planned follow up to discuss some abnormal sputum results. More on that in a moment. Suddenly, I felt like I was in patient detention and in line for the principal's office. This was not a good start to this conversation. My heart sank and I suddenly needed to get this conversation back on track. I went through my mental checklist:

• doctors are people too, maybe they are having a bad day
• I am a patient and I am valuable to this conversation
• get our my list if questions
• take a breath, I have got this!

I stayed with the conversation but tried to circle back to the list of questions I had prepared for this follow up. The plan sort of went out the window and I still felt that the conversation was a bit hostile but, it did soften and I stood my ground in a way that I felt empowered but still offered compassion and benefit of a doubt. Healthcare require a village and they were part of mine. I let them fully recap my case and then asked a bunch of questions. I had very specific questions about the next steps in my treatment plans and what rising eosinophils levels meant for my care. Sometimes, when one thing gets better, another goes haywire. Asthma is very heterogeneous. Things can change in a moments notice and as I have heard a doctor or two say, they have no two patients that are exactly a like.

One of the great aspects of my doctor's is that he is pretty thorough as a researcher and he took me through what my numbers meant. Essentially, it was a recap of what the normal range of blood and sputum eosinophils are. They are considered be sputum eosinophils of 3% or less and blood eosinophils of 150 cells/ml.¹ I have been tracking my eosinophils for a while, I am one of those asthmatics that has a high eosinophilic components, prednisone dependent to keep them in check.

It looked like my eosinophils, those pesky cells were elevated, even though there was hope and speculation that they should not be raised due to how well I had be doing. It had come back on a previous induced sputum, even though the repeat test now showed normal levels. There did not seem to be much rhyme or reason for this change. I had been well noncontrolled and I felt like this was another asthma surprise coming at me. It looks like quirks like this can just happen, researchers are working hard to discover more about inflammation pathways, cytokines and their role in asthma. Till then I am being closely monitored.