Beating Asthma Available at Smashwords

Just wanted to pass along a quick note to let you know that Beating Asthma is now available at Smashwords. If you’re interested in the book, you can even download a couple of chapters before purchasing it! If you like it, you can buy the full version.

Check it out here!

Be kind to yourself!

Dr. A

Beaten by Asthma: The tragic death of Anthony Shadid

Shadid filed by moonlight and satellite modem on a hotel rooftop in Najaf, Iraq, in 2003. (Bill O'Leary/Washington Post)

From what I have learned of New York Times journalist Anthony Shadid, I might surmise that he would meet his end violently during some danger-ridden venture in pursuit of a news story directly from people affected by conflicts in the Middle East. Over the course of his career as an international journalist, he he had been shot, held hostage, beaten, threatened, and Lord knows what else. Relentlessly pursuing the truth, not from behind the safety of a desk somewhere, but from the scene itself, he was always in the thick of the fight. In the classic sense, he was all about “boots on the ground” journalism. Mr. Shadid received two Pulitzer prizes for his work, and was nominated for a third this year. He seemed larger than life, but by all reports he was a humble, dedicated father, son, and husband.

On February 16th this year, Anthony Shadid died, not from bullets or violence, but from asthma.

He was returning to Turkey from a perilous journey into Syria on assignment for the New York Times. It was known that he had asthma, but it is unclear to me how severe. We know from his father that he was highly allergic to horses. We know that those who secreted him into Syria from Turkey and back used horses. Tyler Hicks, an award-winning photographer who accompanied him on this trip, reported that he seemed to have some initial asthma symptoms after the first night of contact with the horses, but these seemed to resolve. Several days later his asthma problems again intensified, and he collapsed. Attempts by Mr. Hicks to resuscitate him failed, and he died along the long lonely trail home.

What can we learn from this tragic story? Just as he sought to inform and teach his readers about current events during life, Anthony informs and reinforces several important points for us to remember about asthma after his death. They are:

  • For those with allergic asthma, every attempt should be made to avoid offending allergens. Prevention by avoiding allergens is a cornerstone of asthma treatment.
  • The asthma action plan needs to be individualized. For those who travel to isolated locations without close medical support, consideration should be given to carrying a course of oral steroids, such as Prednisone, so that more aggressive treatment can begin as soon as possible if needed.
  • A close collaborative relationship with a physician who both understands asthma and your unique needs gives life to your asthma action plan.

Thankfully, death from asthma is rare compared to deaths from heart disease, cancer, and other illnesses, but it still can and does occur, 11 times each day in the United States. Anthony Shadid’s untimely death is a painful reminder of this.

My condolences go out to his family, and, thank you Anthony for informing us, even after you are gone.

I Was Constantly Fighting for Air

Erich S., a patient of Dr. Apaliski, suffered from severe seasonal and cat dander allergies. As he fought his allergies, Erich was unable to sleep through the night. “I was constnatly fighting for air,” he said.

Dr. Apaliski defined a three-prong approach to beat Erich’s asthma:

  1. Erich was to avoid all direct with cat dander, washing before bed to eliminate all daily irritants.
  2. Erich’s bedroom had to become a cat and dust free zone.
  3. Erich was to adopt a routine of breathing treatments, as well as a rescue inhaler when needed.

The three-prog approached worked and Erich’s breathing normalized!

Erich summed up his treatment by saying,

Dr. Apaliski listened closely to my situation and studied my allergy test results to determine the cause and or causes of my reactions and then we worked together to see which treatments worked best to beat my asthma.   I continue to follow the regiment and treatment that works and through follow up visits with Dr. Apaliski we continue to adjust treatment as needed to maintain optimum breathing.

Asthma treatment: LABA’s should not be used alone!

Study: Asthma drugs raise risk of complications in children

When used alone, the asthma medications known as long-acting beta-agonists are associated with an increased risk of serious complications, new research indicates.

*This headline appeared in USA Today Online over the past several days. Similar headlines have recently appeared elsewhere in the media.

Should you be frightened?

I don’t think so, and here’s why.

First of all, this is not really “new research”, not in the purest sense. It is a statistical review of a lot of clinical trials (research studies) using asthma medications that have all been done in the past. The “researchers” are looking at many trial results that were obtained in the past and trying to increase the power of conclusions that may be drawn from combining a lot of diverse data. It (meta-analysis) can be helpful, but, in this case it does not really tell us anything new.

Why?

Well, the standard of care in treating asthma for at least the past 3-5 years has been to not use LABA (long acting bronchodilators or beta agonists) alone as the sole treatment agent for asthma because of the increased risk of complications when this is done. (these LABA drugs are salmeterol and formoterol)

In this same article a physician from Children’s Hospital of Pittsburgh really sums it up well when she states:

“It looks like LABA alone may not be the right treatment for the pediatric population, and we don’t use it alone.” said Dr. Allyson Larkin, an assistant professor of pediatrics in the division of pulmonary medicine, allergy and immunology at Children’s Hospital of Pittsburgh.* (emphasis added)

So, what is my point to all this?

Good question! I have a few points.

Here they are:

First, while headlines are sometimes intended to make it appear that the sky is falling, more often than not there is little reason to run for shelter! It is essential to learn more before drawing conclusions from a sensational headline.

Second, as always, I also think it is wise to never make any sudden unilateral decisions about changing your medication regimen without speaking to your physician partner in care first!

And, lastly, if you are being treated by a physician who has you using LABA alone, find an allergist (an asthma specialist) for evaluation!**

Be kind to yourself!

Controlled asthma always makes me smile!

I love what I get to do every day as a physician. I would do it all again if I had to choose.

Surgeons get to see the results of their work rather quickly. The appendix is inflammed, the patient is in pain, they remove the appendix and the patient is healed (most often). Quick, right? As a medical specialist, the results of my interactions take time, and multiple steps must take place, from correct diagnosis, correct treatment and my patients following the treatment plan we develop together.

When successful, it feels good, especially for those who have been suffering, sometimes for long periods of time.

So, today I wanted to share a success story with you.
I have been taking care of someone for several months now who has had a troubling cough for over 10 years. It annoyed him (and his wife!). Sleep interrupted by a spouse coughing is troublesome for both parties. We treated some infection in the sinuses, the cough persisted. We then started him on a combination inhaler, Dulera, which is used for the treatment of asthma.

Well, I saw him today for a follow-up office visit. Great news. The cough is gone for 2 months now! Sleeping well, no need for ‘cough medicine’. He is very happy and so is his wife. He thanked me for my help, and as he was leaving, he shook his head and said, “doc, thanks, for 10 years I was coughing like that”. As you probably know, not all asthma wheezes, and cough may be the only way it is manifested. He is a good example of that lesson.

As he left the office both he and I had big smiles on our faces. Controlled asthma always makes me smile!

The Yellow Zone in Your Asthma Action Plan. Proceed with Caution!

The most commonly used iteration of the asthma action plan today is the traffic signal system. In this scheme, as your peak flow falls and asthma symptoms rise, you move from controlled to uncontrolled asthma, and you find yourself in the green, yellow or red zone. Each zone contains its own action steps.
It may seem like a lot of information, so I wanted to look at it with the idea of distilling its most important aspects. As I thought about, I realized that it all boils down to one key question, and that is this:

What actions will you take when you find yourself in the yellow zone?

Am I oversimplifying? I don’t believe that I am. Think through this with me, if you will.

In the green zone, life is good. Asthma is controlled. Your peak flow is 80% or better of your personal best, and no asthma symptoms are present. The only action necessary is to continue to do what you are doing, taking any daily medications as prescribed, and continue to monitor yourself. As with the green traffic signal, green means go!

The red zone, similarly, requires little thinking. You are in distress. Your peak flow is less than 50% of your personal best. You are very short of breath, your bronchodilator medications don’t help, and you probably have trouble walking and talking. Your lips or fingernails may be blue or discolored (due to lack of oxygen). As with the red traffic signal, stop!

In addition to taking your bronchodilator medication, you need medical attention. Now. Immediately. And the best way to do this is usually to call 911. Not much thinking needed, this is the time for rapid action. To delay action means to risk death.

Although a sudden asthma “attack” can move you from the green zone immediately into the red zone, this is not the usual case. Typically you will find yourself in the yellow zone first, and this is why the question I posed earlier is so important.

Again, what actions will you take in the yellow zone?

As with the yellow traffic signal, you must proceed with caution. This part of your asthma action plan must be well thought out beforehand, and executed without delay. First you must recognize that a problem is beginning. When you enter the yellow zone, quite likely your asthma “attack” is in its earliest stages. Your peak flow falls between 50% and 80% of your personal best. Cough, wheeze, chest tightness, or shortness of breath is present. You may be waking up at night due to asthma, and you can do some, but not all, of your usual activities. Once you recognize the yellow zone, you take action. (If you are in the presence of one of your asthma triggers, get away from it). Taking 2 puffs of your bronchodilator (albuterol or levalbuterol) or using your nebulizer is the first action step. If you quickly return to the green zone, great, follow your green zone actions. If you don’t go to green, your next actions are very important. You really should plan these ahead of time with your physician. Different options are available. One approach would be to take your bronchodilator inhaler or nebulizer every 20 minutes for an hour and then reassess. If you return to the green zone continue green zone actions. If not, notify your physician. She or he may have you start a course of oral corticosteroids to help. (I like to see my asthma patients in the office if they find themselves in the yellow zone for a day or two at the longest). If at any time you worsen (i.e. Red zone), you must then take the red zone actions without delay.

I hope my points about the importance of the steps you take in the yellow zone are of some help. The green and red zone actions are pretty straightforward. The yellow zones in asthma, just like the yellow traffic signal means, “caution”, proceed with care.

Be kind to yourself!

Category Archives: Uncategorized

Beating Asthma Available at Smashwords

Just wanted to pass along a quick note to let you know that Beating Asthma is now available at Smashwords. If you’re interested in the book, you can even download a couple of chapters before purchasing it! If you like it, you can buy the full version.

Check it out here!

Be kind to yourself!

Dr. A

Posted in Uncategorized | Comments Off on Beating Asthma Available at Smashwords

Beaten by Asthma: The tragic death of Anthony Shadid

Shadid filed by moonlight and satellite modem on a hotel rooftop in Najaf, Iraq, in 2003. (Bill O'Leary/Washington Post)

From what I have learned of New York Times journalist Anthony Shadid, I might surmise that he would meet his end violently during some danger-ridden venture in pursuit of a news story directly from people affected by conflicts in the Middle East. Over the course of his career as an international journalist, he he had been shot, held hostage, beaten, threatened, and Lord knows what else. Relentlessly pursuing the truth, not from behind the safety of a desk somewhere, but from the scene itself, he was always in the thick of the fight. In the classic sense, he was all about “boots on the ground” journalism. Mr. Shadid received two Pulitzer prizes for his work, and was nominated for a third this year. He seemed larger than life, but by all reports he was a humble, dedicated father, son, and husband.

On February 16th this year, Anthony Shadid died, not from bullets or violence, but from asthma.

He was returning to Turkey from a perilous journey into Syria on assignment for the New York Times. It was known that he had asthma, but it is unclear to me how severe. We know from his father that he was highly allergic to horses. We know that those who secreted him into Syria from Turkey and back used horses. Tyler Hicks, an award-winning photographer who accompanied him on this trip, reported that he seemed to have some initial asthma symptoms after the first night of contact with the horses, but these seemed to resolve. Several days later his asthma problems again intensified, and he collapsed. Attempts by Mr. Hicks to resuscitate him failed, and he died along the long lonely trail home.

What can we learn from this tragic story? Just as he sought to inform and teach his readers about current events during life, Anthony informs and reinforces several important points for us to remember about asthma after his death. They are:

  • For those with allergic asthma, every attempt should be made to avoid offending allergens. Prevention by avoiding allergens is a cornerstone of asthma treatment.
  • The asthma action plan needs to be individualized. For those who travel to isolated locations without close medical support, consideration should be given to carrying a course of oral steroids, such as Prednisone, so that more aggressive treatment can begin as soon as possible if needed.
  • A close collaborative relationship with a physician who both understands asthma and your unique needs gives life to your asthma action plan.

Thankfully, death from asthma is rare compared to deaths from heart disease, cancer, and other illnesses, but it still can and does occur, 11 times each day in the United States. Anthony Shadid’s untimely death is a painful reminder of this.

My condolences go out to his family, and, thank you Anthony for informing us, even after you are gone.

Posted in asthma, Breaking news, Prevention, Uncategorized | Comments Off on Beaten by Asthma: The tragic death of Anthony Shadid

I Was Constantly Fighting for Air

Erich S., a patient of Dr. Apaliski, suffered from severe seasonal and cat dander allergies. As he fought his allergies, Erich was unable to sleep through the night. “I was constnatly fighting for air,” he said.

Dr. Apaliski defined a three-prong approach to beat Erich’s asthma:

  1. Erich was to avoid all direct with cat dander, washing before bed to eliminate all daily irritants.
  2. Erich’s bedroom had to become a cat and dust free zone.
  3. Erich was to adopt a routine of breathing treatments, as well as a rescue inhaler when needed.

The three-prog approached worked and Erich’s breathing normalized!

Erich summed up his treatment by saying,

Dr. Apaliski listened closely to my situation and studied my allergy test results to determine the cause and or causes of my reactions and then we worked together to see which treatments worked best to beat my asthma.   I continue to follow the regiment and treatment that works and through follow up visits with Dr. Apaliski we continue to adjust treatment as needed to maintain optimum breathing.

Posted in asthma, Goals, Patient Stories, Uncategorized | Comments Off on I Was Constantly Fighting for Air