Finding — And Catching — Your Breath

Okay, winter, you can move along any time now please. We’re all done here. The groundhog said you were on your way out. So, pack up your ice and snow and arctic wind chill factor and germs, and take a hike. Okay? You listening to me?? Guess not…

I started a draft of this post last week, and dubbed it “Catching My Breath.” Then a friend of mine published a post to her blog today by the same name, with a great graphic of a person running after her detached head with a butterfly net!! I had to laugh. Seems we’ve all been feeling a tad ‘under the weather’ these days, in more ways than one. I’ve been battling a respiratory infection — actually, I suspect it’s been more like two or three rolled into one — for the past month. I caught the stupid thing from the nurses at a local nursing home I visit for work. Yes, they should not have been working, and yes, they did wear their masks and wash their hands and don their gloves, but if they’d all stayed out of work for as long as they really needed to, there would have been no one left to take care of their patients. So, really, there was almost no avoiding it.

The whole panoply of symptoms have accompanied this puppy — fevers, aches, runny nose, sneezing, congestion, wheezing, sore throat, first a dry cough, then a wet cough, then bronchitis, then asthma, now a dry cough again, and more asthma. Oh, and fatigue, naturally. I’ve spent entire days in bed, been out sick from work and/or rearranged my patients for days when I could be upright without blowing my nose every five minutes or coughing my germs into the atmosphere. I’ve gobbled anti-inflammatories; guzzled cough medicine, soup and hot tea; inhaled Flovent and Albuterol; and stomached not one but two antibiotics, the second in the form of the most vile-tasting, enormous pills I’ve ever had to swallow. I have only one left to take, thank heaven, and I’ve learned to disguise the taste by swallowing it in a large spoonful of yogurt, which also helps keep the damn thing from destroying all my intestinal flora. Bloody hell. Literally.

Perhaps my finest accomplishment this past month is that I haven’t passed this thing onto any of my patients. Proper hand-washing actually does work, ladies and gentlemen. In any case, the most ironic thing about all of this is that I’ve had several patients with serious pulmonary disorders, so I’ve been monitoring their vital signs, listening to their lungs a lot, counting their breathing rates, measuring their oxygen saturation, ordering tubing and nasal cannula for their oxygen tanks, and giving them breathing lessons. Hah!

Breathing lessons…we all need them these days. Not to beat a dead horse, but I must point out — again — that before I had breast cancer, and subjected my right chest to the destructive radioactive vagaries of a linear accelerator, I had not had a bad cold of any sort for probably about fifteen years. By the end of week two of radiation, I developed a whopping sinus infection. Six months later, I developed what would turn out to be chronic asthma, the most common feature of which is a feeling of tightness over your chest and a persistent and occasionally phlegmy cough. At first, I just chalked up my symptoms to seasonal allergies. But when they didn’t abate, I finally got a “suspicious” chest X-ray, followed by a chest CT scan, which showed an area of radiation scarring on the pleural covering of my right lung. “Your symptoms are asthma,” my local pulmonologist told me. Duh. In my job, I teach patients to cope with asthma and lung disorders every day. But it never occurred to me that my stubborn cough meant that I had asthma myself. Sigh. Again. Had it as a kid, but outgrew it. Well, at least I already knew all the tricks of the trade. The post-radiation asthma largely resolved, but since then, I’ve had more colds and sore throats and coughing fits than I ever had in the several decades before cancer. And now, thanks to this latest respiratory misery, I’ve got bronchial asthma again. Radiation, the gift that keeps on giving.

So, with tongue gently planted in cheek, I thought I would pass on some of my professional knowledge, because I suspect a lot of you have been coughing, sneezing, and feeling congested and wheezy yourselves. The photo next to this paragraph is an Albuteral inhaler with a home-made spacer. If you find yourself with a cough that’s not succumbing to cough medicine or decongestants, you might have bronchitis and if you do, you ought to ask your doctor about getting an inhaler. That persistent cough most likely indicates that your bronchial tube is inflamed and unhappy. Your bronchial tube is a sturdy, flexible bifurcating organ lined with muscle, and when it gets overworked by the need to cough up a lot of phlegm for instance, that muscle, like any other overworked muscle, can go into spasms. And bronchospasms are the hallmark of bronchial asthma. Which means it gets harder to take a full breath, which means it gets harder to cough up the phlegm that’s dripping from your infected sinuses, which means your bronchitis could even turn into pneumonia. Bronchodilators are inhalant medicines that help calm the bronchospasms and the inflammation, and allow you to breathe more easily. A lot of people think that asthma first manifests as a fit of gasping. Wrong. Coughing and coughing and coughing is the first warning sign. If you get past the point where you are merely coughing and you actually start gasping, you may need to be in the hospital, my friend.

This is a photo of an Albuteral inhaler with a plastic spacer, just like the one I have sitting on my desk right now. When you get a prescription for an inhaler, you don’t automatically get a spacer with it, and you have to pay for it yourself if you want one. The reason you should want one is that your inhaler won’t work very well without one. Why? Well, from The Asthma & Allergy Network comes this useful explanation of what usually happens when you use a Metered Dose Inhaler, or MDI, without a spacer: “If you feel it touch your tongue, Splash your cheeks or spray your gums….If you wonder, ‘Did I get that puff?’ An MDI is not enough…” In other words, an inhaler is a liquid medicine contained in a little aerosol container, so when you squeeze it out, the liquid is turned into droplets by the aerosol. The only problem is that if you just stick the open end of it in your mouth and suck it in, there’s not enough space between it and your mouth to allow those droplets to spread out and turn into a breathable mist. So, what you get is a little cloud of wet droplets, which land on your tongue, instead of traveling down your windpipe and into your bronchial tube where you need it. In order to give those droplets enough room to spread out and turn into a mist, they need more space. Hence, you need to put a spacer between the inhaler and your mouth.

You would not believe how many people have used inhalers for years and don’t know this. They may as well have squirted their inhalers into the toilet for all the good they were doing. Well, I guess that’s why I have job security. I won’t type out my usual patient lecture about all this, but I will include a link here to a PDF that spells out how to use a spacer and thus actually get that bronchodilator medicine down into your lungs: How to Use a Spacer with your Inhaler. If you don’t want to spend the twenty or a hundred bucks to buy one of the damn things, never fear. That photo above of the homemade spacer with the blue Albuterol inhaler depicts the kind of thing I often do with my home care patients. You don’t even need to get that fancy. You can fold a regular piece of paper into quarters, roll it into a tube of about an inch and a half in diameter, tape it, stick the inhaler mouthpiece at one end, put your mouth over the other end, and go to town. An empty toilet paper roll works nicely, too. The main thing is to follow the directions in the PDF to the letter. You need to shake the inhaler vigorously first, take your first puff through the spacer, and hold it in for at least 5 seconds, 10 if you can manage it. It’s good to stand up to do this, because your lungs actually go all the way to the bottom of your rib cage, and if you’re sitting in a chair and slouching, you won’t be able to inhale all the way down into them. The next very key thing is that you need to WAIT AT LEAST A FULL MINUTE before taking the second puff. People never do this, so I’m always exhorting my patients to look at a clock and make sure that an entire minute goes by before they suck in the next puff. This is because that first puff needs time to get your bronchial tube to relax, and open things up a little, so that when you take the second puff, you should be able to take a fuller breath and thus get the medicine more completely into all those starving little alveoli that haven’t seen oxygen in days.

My last piece of advice is simple: Take the damn medicine as directed, for goodness’ sake!!! If the prescription instructions say you should use your inhaler 4 times daily, then by god, use it 4 times daily, not 3, not 2, not when you feel like it, not after you’ve sloughed it off because you can breathe again and waited until you have your next coughing fit. I really should hand out neon green signs with big black letters saying, “TAKE AS DIRECTED.” It would save me from having to repeat myself. If I had a dollar for every time I’ve had to tell someone to take their medicine as directed, and why they should take their medicine as directed, I’d be living in a chateau in southern France by now, and wouldn’t have spent the last two months shoveling snow, chopping ice, and enduring this damn respiratory infection.

One final note, to bring this discussion back to cancer survivorship. If you’ve had radiation or chemo or hormone therapy, please, please, please make sure you get your doctors to check your heart and lungs and cholesterol and circulation regularly to make sure they’re all working properly. If you’ve had a lot of colds and/or coughs, see a pulmonologist and get checked out. Some forms of chemo can damage your heart. Hormone therapy can compromise your circulation and cause blood clots in your circulatory vessels or your lungs. Radiation on or near the chest, sternum, neck or armpit can cause pulmonary fibrosis that doesn’t develop right away, but sneaks up months after treatment. It can also cause permanent fibrotic changes, i.e., scar tissue, in the muscles in those areas, and in the tissue that covers lungs and other organs. And surgery itself leaves us open to developing scar tissue, infections, damage to lymphatic vessels, and adhesions of every stripe that can inhibit your ability to move and fill your lungs.

Spring is coming. I promise. Do me a favor in the meantime and take good care of yourself, so that when it arrives, you can spread your wings and breathe, baby, breathe.

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This entry was written by Kathi, posted on Monday, February 21, 2011 at 09:02 pm, filed under Chemotherapy-IV & Oral, Fatigue, Health & Healthcare, My Work Life, Radiation, Survivorship and tagged , , , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

7 Responses to “Finding — And Catching — Your Breath”

  1. Great article!

    Another piece of advice. Don’t let your PCP tell you have asthma – get a referral to a pulmonologist. My Dh developed bronchitis after a case of pneumonia. His PCP was ready to stick him on asthma medicine (for life), so my husband got a referral and a proper diagnosis. No asthma, just bronchitis, no need for long term medication.

  2. Well, I’ve had asthma off & on since I was a kid, allergy related. I outgrew it, then it came back after I witnessed a house fire about 20 years ago & inhaled a lot of smoke. It comes & goes. It was the pulmonologist who said it came back, after the damn radiation scarring…sigh. But I don’t have it all the time. Just comes on with bronchitis, then lingers for a while.

  3. Oh Kathi I do hope you feel better soon !!!! Spring IS just around the corner. I have become obsessive about counting how many bulbs I see coming up every time I go outside. (Perhaps I need to get a life mmmm?) And they keep coming up!!!

  4. This is a really informative posting. I try hard not to think about the permanent damage chemo and radiation and surgery and aromasin and….well you get the point….caused me. It’s really hard because cancer patients are not made aware of the aftermath of cancer treatment.

    Outstanding posting. I’m glad I found your blog.

  5. Thanks, Beth! Welcome.

  6. Wow, Kathi. You are a wealth of information. But, chronic asthma resulting from scarring on your lung from radiation treatment? I’ve never even seen that listed as a possible side effect! How many ongoing side effects plague people after treatment? How many aren’t even counted as side effects?

  7. Gayle, there have been research studies finding increased incidence of bronchial infection and pneumonia after breast cancer radiation. And one result of bronchitis or pneumonia can be a temporary or recurring asthma, i.e. bronchospasm. Here are a couple of PDFs: The first is a discussion of the overall research about pleural and pulmonary changes after radiation (I have pleural scarring, and one radiologist thought I might have some pulmonary fibrosis), This one is a case study,; and this is a small study of five women between 49 and 77 who had pneumonia after breast cancer radiation, It’s a poorly-researched area, in my opinion. There are quite a number of discussion threads on about post-rads respiratory problems, and even on FB among friends of mine, who have had a series of bad colds, coughs, bronchities, asthma, etc. after radiation, and end up needing inhalers forever afterward. I remember in our radiation group thread on bco, several of us came down with severe respiratory infections while we were getting radiation. And yet there continues to be a great deal of denial among radiation oncologists themselves that any of these problems have anything to do with radiation therapy. Grrr.

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