The modest asthmatic

Yesterday we discussed rare and irresponsible Actor Asthmatic. Today I would like to bring light to the Doubting Thomas Asthmatic.

Most RTs and RNs can recognize them as soon as they walk into the door. Usually they are men who come to the ER with their wives because, "she made me come in. I didn't even want to be here. I'm fine."

Then you listen to them and they have all the tel-tale signs of asthma. We really shouldn't limit Doubting Thomas's to just asthma either, as we know there are a ton more COPD and chest pain patients who are simply too modest to come into the ER.

There's a saying we like to use in the ER where I work, "The modest patient stayed home with chest pain and died."

Over on my asthma blog I wrote about the modest patient, of which we aptly titled the Doubting Thomas. For more information about the Doubting Thomas click here and I will morph you over to my other blog.

The Doubting Thomas Asthmatics
by Rick Frea Wednesday, November 19, 2008
See the accompanying comic!

Thomas was the apostle who did not believe Jesus had been resurrected. According to the Bible, (John 20:24-29) he was not convinced until he actually saw and felt the scars of Jesus.

Since then, anyone who refuses to believe something without direct physical proof is called a Doubting Thomas. And, therefore, an asthmatic that refuses to believe he has asthma is rightfully dubbed a Doubting Thomas.

Believe it or not, I've seen my fair share of these folks in my 11 years as an RT. It's neat, because they will come into the ER for an unrelated reason, the doctor will listen to them and order a breathing treatment, and then I enter the patient's room thinking I'm going to do another breathing treatment just because the doctor didn't know what else to do.

Just recently I had a pudgy, balding male named Carl, mid 30s, lying supine on the ER bed. He appeared to be breathing normally. I gave him my usual line, "Hi. I'm Rick from Respiratory Therapy. Are you having trouble breathing?"

"No," he said, "I feel fine."

"Okay, so why am I giving you a breathing treatment," I think to myself. Then I say, "How come you came to the ER tonight?"

"Um... because I was just not feeling right. I also have a little chest pain."

I pulled my stethoscope from my lab coat and pressed the bell on the patient's anterior chest. I hear wheezes. "Can you please sit up so I can listen to your back?" I listen to his back. "You definitely have wheezes in there. Do you have asthma?"

"Not that I know."

I hand the patient a nebulizer that I had already filled with one amp of albuterol.

"What's this for?" The patient looked at me awkwardly.

"This is for people with breathing trouble," I said, "The doctor thinks it might help you breathe better."

"Well, I'll take it, but I'm not having trouble breathing."

I plug the nebulizer tubing to the flowmeter and the neb sputters to life, releasing its cool white mist into the room, and hand it to the patient who spends several minutes inhaling the mist.

I stand coolly by until the nebulizer sputters, a tell-tale sign that it's finished. I turn off the flowmeter, and pluck the nebulizer from the patient's mouth. "So, how do you feel now?"

"You know what?" he said, taking in a deep breath and smiling, "I think I feel great. Wow! I don't think I've ever felt this good in my life."

Ah, and that last sentence -- "I have never felt this good in my life"-- following a bronchodilator breathing treatment -- is a tell-tale sign of a Doubting Thomas asthmatic.

"I bet you've been short-of-breath for days and you didn't even know it." If you ever hear an RT or doctor ask this question, you know he is thinking Doubting Thomas.

"Actually," the patient said, "I've had this regular cough for years, especially after exercising. It got so bad I had to quit exercising a few months ago. I just thought being a little short-of-breath was a normal part of aging."

Bingo! That last sentence confirmed it for me: This man is definitely a Doubting Thomas.

"You should never have trouble breathing," I said. "If you do you should always see your doctor, because there's no reason anyone should ever have to suffer this day and age."

"What will my doctor do?" Carl asked.

"First of all, the ER doctor is going to prescribe a rescue inhaler that works just as well as the breathing treatment you just had. You can use it up to every 4-6 hours for asthma symptoms.

"Then he's going to recommend you see your family physician so to get you on an asthma management plan that's right for you. This plan may include prescribing long term relief medications that actually work to prevent asthma."

The New York Times wrote a story, "Asthma Medications: Not a Clear Advantage," about former Olympian gold medal swimmer Dara Tores. She had all the classic signs of asthma, even a family history, and yet she chose to ignore the signs.

One day a friend told her she had all the classic signs of asthma, and she went to the doctor. Once on all the right asthma medicines and her asthma was controlled, the article states, she realized "how much, and how needlessly, she had been suffering."

Carl was lucky his asthma was discovered before he had a life threatening attack. If you think you are a Doubting Thomas like Carl, don't wait until something really bad happens before getting help.

The first key to getting help is admitting you have a problem. The second key is to see a qualified asthma physician and getting yourself on a program to manage your asthma.

According to the Gospel of John, after Thomas touched the scars of Jesus, he professed his love of Jesus and was later known as Thomas the believer.

Similarly, any Doubting Thomas who faces his illness, seeks to learn the truth, and is treated accordingly, will no longer "needlessly" suffer.