When You Wish Upon A Star Wars

I entered the room and stood silently at the foot of his bed, watching him breathe. He was hooked to a small ventilator that is connected to a mask covering his face with straps around his head, that he looked like a jet fighter pilot. Beside the bed was his father and his mother who were obviously distraught, yet trying to hold off tears.

Luke* (not his real name) was one of our ICU patients. Even though he was only in his 20’s, he had his fair share of surgeries and hospitalizations than many patients in a geriatric floor combined.

He had a genetic disorder that prevents the development of various organ system. This affects the skeletal system giving them a peculiar look and stature, that some people coin the term FLK syndrome: Funny-Looking Kid. Though for me, there’s nothing funny at all. This disorder also causes heart defects, and can involve other organs like the lungs, liver, gastrointestinal tract, lymphatic and blood system. Even so some people with this genetic disorder could live to adulthood, some would succumb to this disease early in life.

Luke had a number of surgeries to fix his heart problem, and other procedures too many to recall. He had been treated in well-known hospitals like Mayo Clinic, for his disease. But despite of all the technology and medical interventions, his body continued to betray him.

For the last several months he had been in and out of the hospital, usually staying for several weeks at a time, including ICU stay. I have taken care of him a number of times in the past.

In spite of his illness, Luke tried to live his life as “normal” as possible. His family gave him the opportunities and the best care they could. His mother, who was a patient of mine too, had the genetic disorder as well, albeit with a milder manifestation, thus I knew the family well.

One thing I learned, was that Luke likes Star Wars, even though the first Star Wars movie came out more than a decade before he was born. Yeah, he was a fan of this movie genre, just like the rest of us, I guess.

In this last hospital admission, Luke came in with a lung infection causing respiratory failure, requiring intubation and mechanical ventilation. He came on Thanksgiving Day.

After several days in our ICU, we were able to extubate (take out the endotracheal tube) him, only to place him on a non-invasive positive pressure ventilator (NIPPV) with a face mask, as he cannot breathe on his own. This is like a CPAP machine. At least he can stay awake and not be sedated on the non-invasive ventilator, and he can speak as well. He can only tolerate a limited time off the NIPPV, and had to be hooked right back on it. He would not survive without it.

As I watched him with his “jet-fighter mask” with his bed as his vessel, what came to mind was that in a cruel twist of fate, this kid who likes Star Wars, now breathes like Darth Vader: whoooh….poooh, whoooh…..poooh, whoooh…..poooh. Every breath, there’s a gush of pressurized air coming out of the ventilator and through his mask.

After one holiday, another one is approaching. Christmas is just around the corner. And Luke remains in the hospital, ventilator-dependent, with no clear sight that he’ll get better. He knows it, and his family knows it. Luke’s days here on earth is numbered.

With wishful thinking, maybe he can linger a little longer to see the new Star Wars movie which he was looking forward to seeing for the longest time. But how? Him in the hospital? On a ventilator?

But wait, isn’t it Christmas season after all?

Wish granted!

After making elaborate arrangements and collaboration, Luke and his family will be going to a movie theater, to be accompanied by some medical staff, for a special private showing of the “Star Wars: The Force Awakens,” when it opens this weekend.

After that trip to the theater, Luke will be going home for Christmas with his family, on hospice care. No more hospitals. No more ventilators. No more pain.

Perhaps he could stay home until Christmas. But if not, Luke could soar into the heavens and once and for all, walk on stars. His final home.

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(*name intentionally changed for privacy)

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Update 12/22/15: after posting this story here, I learned that our patient was featured in the local news. See link here.

 

 

Running, Asthma and Darth Vader

Do you like running? But do you run out of breath and sound like Darth Vader when you run? Maybe you have asthma.

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Recently my cousin, who is a budding journalist in the Philippines, asked me questions on the subject of asthma and running, knowing that I am a lung specialist as well as a runner. He said that he was writing it for a fitness website. I would like to share them here.

1. How does asthma affect people? What does it do to their bodies?

Asthma is a condition in which there’s two main components, (1) narrowing of bronchial airways (bronchoconstriction) and (2) swelling (inflammation) causing edema and production of extra mucus. These can cause the difficulty breathing and wheezing, making you sound like Darth Vader. These attacks can be intermittent and reversible, and triggered by exposure to certain allergens.

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2. Can everybody have asthma?

No. It is most likely genetic or familial predisposition that leads to one’s having asthma. For example, there are certain triggers that can cause an asthmatic attack, like house dust mite, but not all people will react to it. It is like an allergic reaction, where a predisposed person’s immune system overreact to the trigger.

So if you have asthma, you can partly blame your parents and the genes they passed on to you.

I’m not sure if Luke Skywalker have asthma too (“Luke, I am your father” – Darth Vader).

3. What are the common causes of asthma?

There is a wide gamut of asthma triggers and can differ from person to person:

A. Inhaled allergens – like house dust mite, pollen, cockroaches (I hate cockroaches), indoor and outdoor fungi/mold, pet dander (I feel sorry for pet-lovers if their beloved pet cause them their asthma attacks).

B. Respiratory infections – common cold and other viruses, or bacterial infections

C. Inhaled respiratory irritant – cigarette smoke, pollution and smog (like in Manila!), certain chemicals like volatile gases that can be at the work place, and even (cheap?) perfume. If you have a co-worker that has a body odor, you can tell them to take a shower for it can trigger your asthma. Just kidding.

D. Hormonal fluctuations – like in pre-menstrual and menstrual period in women; it can be part of pre-menstrual syndrome!

E. Medications – like beta blockers (metoprolol) that is use as an antihypertensive or in heart patients.

F. Physical activity – exercise

G. Emotional state – anxiety, sudden upsets. Yes being dumped by your girlfriend can cause an asthma attack!

H. Temperature and weather – cold air, hot humid air, wet conditions (which can increase respiratory allergens in the air).

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4. What are the symptoms of asthma?

Most common symptom of asthma is difficulty in breathing, with sensation of chest tightness. You feel like you have a rubber band around your chest. When more severe, wheezing ensues. If really severe, it can lead to respiratory failure. A persistent cough can be a symptom of asthma as well, which is from the constriction of the airways.

5. Can it be prevented?

Yes. Avoiding the triggers as what I mentioned above. Also by using medications such as inhalers, especially the inhaled corticosteroid that kind of stabilizes the membranes of the respiratory tract of an asthmatic, so it won’t be so reactive. This lessen the attacks.

6. What’s the cure for asthma?

No cure for asthma. If you have it, most likely you’ll have it for life. Sorry Darth Vader. But we can control or minimize the symptom or lessen the attacks through avoidance of triggers and through medications. Asthmatics can do whatever they want and can live a “normal” life if their asthma is well-controlled.

7. Can running trigger asthma?

Yes. As any other form of exercise can.

8. Can a person still run if he/she is an asthmatic?

Yes. Even though exercise is a potential asthma trigger, it should NOT be avoided.

9. Can running help a person fight asthma then?

Yes. Aerobic exercise strengthens the cardiovascular system and may lessen the sensitivity to asthma triggers.

However, it is important for persons with asthma who are not in a regular pattern of exercise to build-up their activity level slowly to minimize the risk of inducing asthma. Also, if exercise is your asthma trigger, use your “rescue” inhaler (like albuterol meter-dose-inhaler) 5 -10 minutes before you exercise to preempt the attack. And if you have an attack while exercising, you can use the inhaler again.

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Jackie Joyner-Kersee, an Olympic medalist, uses an inhaler after running

10. Can a person run if he/she has an asthmatic attack or episode?

Yes and no. If the asthma attack is pretty mild, you may be able to endure it. However if the attack is significant that you’re wheezing, I would recommend to take it easy for that day.

11. How long should a person run after he recovered from an asthmatic attack?

No fast rules. You can sense when you’re ready. Listen to your body.

12. What’s your advice to people with asthma who wants to enjoy running?

Continue running. But you may want to run when it is not so hot and humid, (or too cold if you’re not in the Philippines). Or run in areas not so polluted or smoggy. That is maybe doing it early in the morning.

Also avoid stray dogs. Not because it can trigger your asthma, but it can chase you!

13. What should runners with asthma remember during their runs?

Have your rescue inhaler handy during your runs. It easily fits in even the smallest pocket of a running shorts anyway.

If there’s a lot of dogs in your area, you can carry a pepper spray too to ward them off. Just don’t mistake it for your inhaler!

And most importantly, have fun!

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This is how to defeat asthma and Darth Vader.

(*photos from the net)