Asthma rule #1: Take your Singulair as ordered

I know (I know-I know) asthma experts like me preach you should never tinker with your medicine. And I know (I know-I know) we preach you should always take your medicine exactly as prescribed by your doctor.

But I did it anyway. I decided that Singulair is way too expensive at $30 per month, or $1 a pill. And that is with insurance. For those who don't have insurance you get 30 pills for $79, which comes to about $2.63 per pill.

Either way, that's a lot of money. And since there are no generic Singulair type medicines available, my insurance requires me to pay a certain percentage of the actual cost. Otherwise, for prescriptions that are reasonably priced I pay a $10 co-pay.

So, in order to try to spread out my prescription over two months, I decided that since I was feeling so well I'd take a pill every other day instead of every day. For the first month this seemed to be working quite well and I thought I was on to something.

But then over this past weekend it hit me. Thankfully I didn't have trouble with my asthma (thanks to Advair), but I did have a major case of the eye itches, sneezes, and runny nose.

Of course this could have been a coincidence, as it is true that many experts note that Singulair is not an antihystamine to stop the symptoms I describe, but a leukotriene blocker intended to block allergies from causing bronchospasm.

Yet I'm quick to attribute this to my Singulair trial, especially considering last spring I showed no symptoms of allergies for the first time in my entire life.

Some people who don't have as severe of allergies as me (I'm allergic to pretty much everything outdoors) may be able to get by taking a pill every other day, but that strategy won't work for me -- at least during the spring season.

I know (I know-I know) I shouldn't tinker with my medicine, but on occasion I find this is a good thing to do, for no other reason than to prove to yourself that the medicines you are on are working great, as opposed to just assuming (as some doctors do).

It's kind of a checks and balance system I like to use. So now I'm back to taking it every day, despite the high price.

I imagine some of you guideline followers might email me a "Smack!" or a "Kick" in the rump for doing something so stupid. Go ahead and do so, because I deserve it.

"Achoooooooo!"

He's refusing the one thing that would save her

"Hello, Mr. Smith?" Dr. Vanity was a heavy set man, messy dark hair on the sides, balding on top. As I looked down at him I could see sweat beads running down his scalp, which was the irony about it all considering it was snowing and blowing outside and I was wearing my lab coat because I was freezing.

"This is Dr. Steven Vanity from Shoreline Medical...

"Yep... Yes... that's what I wanted to talk to you about. Yep... Well, her hemoglobin has been about 6 for the past two weeks, but she seems to be taking a turn for the... yep... yeah... and that's what I wanted to talk to you about...

"You see, her hemoglobin has dropped now to 5. She has a temperature of 102 right now, and we're having trouble keeping it down. I hate to say this to you, but she's taking a backward step here, and, really, the only thing that's going to help her is if we give her some blood..."

He leaned back in his chair. He took a deep breath, wiped his brow. "I'm just to the point there's not much I can do for her if we don't give her blood....

"Hello... Hello..." He set the receiver down. He turned to look at me. "Well, I guess he wanted none of that."

"What, did he hang up on you," I said.

"Yep." He puckered his lip, wiped his brow again. "I told him she needed blood for me even to have a chance to save her, and he said, 'okay,' and hung up."

"Well, I guess you document that and do your best."

"It's unfortunate," he said, swinging his chair around and setting his feet on an empty chair. He wiped his brow again. "I really like that lady. I'd hate to see her go. She's only 51. She's young enough her body would have a fighting chance if only we could use the tools we have."

I placed my hands in my pockets, twiddling a vial of Ventolin in my pocket, and said nothing. The doctor sighed. That about says it all.

"My hands are tied," he said.

The admins tried to make us RTs automatons

"The first topic of discussion," Gary, our department head, said to start the meeting, "is what you are going to have to say for now on when you go to do a breathing treatment."

I rolled my eyes. Looking around the room, I observed many eyes rolling.

"Now who's going to volunteer to work on this?"

"I will," Dale, one of my co-workers said, raising his hand.

Well, this ought to be interesting, I thought. Dale wasn't just the biggest complainer about useless breathing treatments, but the biggest joker about it.

At the next meeting, Gary asked Dale if he had a program prepared.

"I sure do," Dale said.

"Go ahead."

"You walk into a room," Dale said, "and you say, 'Hi, my name is Dale, I have your before breakfast peace pipe here. Are you short-of-breath?"

Everybody, including Gary laughed.

"What do we say after the treatment?" Gary asked.

Dale said, "Well, after the treatment you ask them if the treatment improved their work-of-breathing."

"Simple enough." Gary glanced at his clipboard. "But what should we say seriously

Without hesitation, Dale shot back, "I am being serious."

Needless to day, Dales presentation was changed by the next meeting. This is what Gary came up with after verifying the patient:

"Hi, my name is ________. What I am going to do is give you a breathing treatment (explain procedure). Do you have any questions? (answer questions and perform procedure) Thank you for letting me give you a breathing treatment. Is there anything I can get for you? I will see you again at approximately ________ for your next treatment. Thank you."

I watched as Dale's jaw dropped. "You want us to say that?"

"Yes," Gary said.

"What about asking the patient if he is short-of-breath?"

"You can ask that if you want, but you don't have to. Breathing treatments are given for more reasons than just for shortness-of-breath."

There was some grumbling in the room. I looked at Dale and he looked at me: we were both thinking the same thing, "How idiotic." Neither one of us said any more. We just wanted the meeting to be over.
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This happened about eight years ago, when I was still new at this game and still working mostly days in the pool.

Likewise, we were told we had to stick to this, and that the admins would be hiding behind curtains listening to make sure RTs and RN were sticking to their respective programs.

And, needless to say, I followed this line for a few weeks, only because I feared someone might be listening to me. Finally I decided the spiel wasn't working for me, and I went back to my old routine. I was a bit nervous about this, however.

"I feel like an automaton giving that speech," I told Dale one day, "The patients probably think we are a bunch of robots."

"I never do it."

"You don't."

"Hell no. It's not personalized."

"So, what do you say then," I asked.

"Hey, I have your before breakfast peacepipe here?"

I laughed.

They may have had good intentions with the automaton speech as parts of it are well intended, and it's probably still on the records, but it was dumb.

The admins must have realized their folly, for they have never brought it up again.