My Iron Lungs II
After 30 years of Asthma, I can begin to breathe easier.
2016 marks my 30th anniversary of being diagnosed with Asthma. I’m celebrating.
For some back-story, let’s consult the first edition of this entry, written back in 2012:
I watched in horror as a venerable army of stuffed animals were trucked out of my bedroom and to an undisclosed location, never to be seen by me again.
Pollen should be avoided. Basements became troublesome. Exercise with caution. Beware around dogs and cats. Watch yourself in the great outdoors. Don’t get yourself all wound up. You don’t know what mold is yet, but you will know it by the sound of your wheeze. And, for the love of all that’s holy, be careful in the cold. Here’s a cable-knit scarf. Wrap it around your head and don’t, under any circumstances, take it off. This is your life. Or … as much of it as your lungs will allow you to live.
Pick-up games of football were awesome when you sat yourself out on first and second down to avoid over-exertion. Staring longingly at the snowball fights your friends on camping trips would hold from the comfort of a warm cabin with hot chocolate was another favorite pastime. Birthday parties where you needed to hide in the bathroom in self-imposed timeout with only an inhaler and your tears to keep you company were a welcome reprieve, as well.
This morning I had my semi-annual lung function test at the pulmonary doctor’s office, where they take a chest CT scan, run me through a variety of breathing exercises and listen with a stethoscope to determine just how gravely doomed I am and estimate how many years I’ve left to live.
The numbers from the tests, as expected, weren’t great. Diagnosis: Asthma. A normal lung for a man my age can breathe out 3.64L of air (almost a gallon) in one second. I can breathe out 2.37L, about 65% of average, which is to say demonstrably terrible for a man my age — if I was over 40, they’d check me for COPD — but about right in line with my normal.
Between three and six seconds of a forced exhale, the average man my age can breathe out another 3.96L of air. I can breathe out 1.30L. That’s 32% of average, and if I was over 40 and smoked three packs a day, you would swear I have emphysema. Scary for most humans. Standard for me. You’d tell me I had a couple good years left and dope me up with a long-term cocktail of steroids, oxygen tanks and the shit they peddle in those commercials with the elephant to keep me alive as long as humanly possible.
That’s the bad news.
The good news came from the CT scan. The doctor told me that my lungs, aside from the smallest of airways, are perfectly clear. Not inflamed. Not constricted. Not scarred. Not obstructed. No bronchial thickening or allergic sinusitis. Nothing. And I hadn’t taken my medicine in 24 hours. It is the first time in my life (I think), and in the seven years in particular since I started seeing lung doctors, that I had been given the seal of approval.
Imagine your lungs like an upside-down tree. Your trachea is the trunk, your bronchial tubes are the big branches, your bronchi are the smaller branches, and they keep deviating out from that until you get to the leaves — which are the air sacs. My Asthma is now 100% contained within the twigs. My leaves are green and lush (my Oxygen concentration is at 98–99%, which is normal, and, also, this means I, again, do not have emphysema) and the branches are all healthy and thriving.
And there was more good news. My Asthmatic coughing has subsided and been replaced by the more subtle weak cough caused by laryngopharyngeal reflux disease, which is caused by inhaled corticosteroids that I use to keep the Asthma at bay. It’s caused by stomach acid leaking into the top of the trachea. This is far less serious. I have no wheezing. I haven’t had an honest-to-god Asthma attack — I should asterisk this with a bold when I have been able to afford my medicine and take it regularly, ahem, summer of 2012 — since 2002. I have Advair (2002–2014) and Symbicort (2014-present) to thank for that. The attacks I have are so mild and short-lived that they do not even require me using Albuterol, which is just one of the many drugs I’ve taken to beat my Asthma back.
The small airways are where Symbicort has its limits. The particles are too large to reach into the small airways. Imagine trying to shove an African Elephant into your bathroom. And so that’s where the fire still burns. This manifests itself in me getting winded walking up stairs, or doing CrossFit, or bending over to tie my shoes (my spare tire around my waist doesn’t help with that, either.) But the fire is contained. A controlled burn. One that my doctor seems totally convinced I can live with for reasons I’ll get into later.
Dymista, my nasal spray, has essentially eliminated my allergies — aside from shots of Fireball, which make me sneeze uncontrollably for three minutes.
And Singulair (which is a pill and so I often forget to take it) has been a long run’s best friend … as it keeps my small airways open juuuuuuust enough to keep me from running out of breath (too quickly) but not enough to notice in day-to-day life.
About that running … there is no doubt that running has helped bring me back from the brink. Since 2014, I’ve run three half-marathons, a 10-mile race, and two 10Ks. And those are just the races. I’ve also biked 50 miles twice. And all that has done something magical — it has taken my lung capacity to new heights. In 2012, my IC (the sum of the amount of air I can breathe in and out and the amount of air trapped in my small airways) was 72% of normal. Today, it stands at 105%. I can breathe out, in sum total, a 100% normal amount of air. It takes me a while — again, because of my small airways — but it gets out there. Because I run, I have lung capacity, which allows me to run farther, which allows me to breathe more air in and out. And, until today, I have never been able to say that.
And, you know what else has helped? Singing. Anyone who has heard me sing knows how loud, how long, and how intense I can hold a note. There isn’t a soul alive with (airquotes) “my lungs” who could be able to do all that if the air wasn’t there. The basic numbers say it isn’t. But now we know — it is.
There are some medicines I can take that will dig deeper into my lungs and destroy the fire in the small airways — there’s prednisone (not optimal long-term because holy god the side-effects like bone atrophy and organ failure), I could take a crazy dose of singulair (not recommended because of drowsiness), or I could try new drugs just released from clinical trials like Qvar or Alvesco. But I don’t need to. In seven years, my small airways haven’t gotten any worse. And there are new drugs in clinical trials that could be the magic bullet to fix the entire airway — not just the big and medium stuff. The hope is out there, that in short bursts, my lungs could function like a normal pair of lungs. This is the first day I can say that.
And, on Sunday, I will run 13 miles. Not for a race. But to prepare for the coming race season. A 10-miler and a half-marathon in November. And, then, a 5K, a 10K, a half-marathon and my first ever full marathon in January. On four consecutive days. Sounds crazy, right?
That’s what my doctor said this morning.
“With the numbers you have on this paper, you should be hyperventilating, and taking your rescue inhaler six times a day, and in the ER all the time.” He paused. “These numbers don’t tell the whole story.”
They don’t. Because since I started marathon training, my resting heart rate has dropped 31 BPM. I’ve lost 15 pounds. And my lungs — well, most of them, anyway — have opened up. They’re not losing steam at inopportune times. They’re not degenerating. They’re healthy. They’re (am I jinxing myself here?) normal.
Who knows where I’ll be at the end of running season. I have two more half-marathons in January and February, and a 10-miler and a 10K in April. Could my asthma — now finally beaten to a hapless shell of its former self with a cocktail of nasal sprays and inhaled steroids and intense cardio endurance training — have finally lost the war its been fighting so well for so long?
It’s too tantalizing to think. But I’m breathing. And as long as I can do that, well, I’m going to keep fighting the good fight. Because — in as astonishing of a development as I can remember in the past 30 years — I appear to be winning.
This calls for a cigar.
