Thursday, December 17, 2015

Symbicort

A few posts ago I said I would blog about some the medications I am currently taking. I am starting with Symbicort. Here is the Symbicort turbohaler.  I have used this medication every day for many years. I consider it the basic treatment for my asthma - although I do take other drugs as well.


It is very easy to take Symbicort since you don't have to spray it or use a chamber (spacer). You just turn the bottom to load the powder, put it between your lips, and the inhale it directly. Wait about 10 seconds and do the next one. Never shake the turbohaler. You must always rinse your mouth afterwards to prevent thrush.

drugs.com says: "Symbicort contains a combination of budesonide and formoterol. Budesonide is a steroid that reduces inflammation in the body. Formoterol is a bronchodilator that relaxes muscles in the airways to improve breathing." In other words, Symbicort is both a reliever and controller in one. 
They also say "Symbicort is used to prevent bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD). For people with asthma: Symbicort is for use only if asthma is severe or is not well-controlled on other long-term asthma medicines. " So far, that's me.

Symbicort has some side-effects which you can check out at drugs.com plus other websites.  Most are not  serious - but occasionally Symbicort will actually make asthma much worse.  I mainly seem to get a dry mouth and a hoarse voice. Sometimes I think it makes me a bit jittery.

Most people take Symbicort a couple of inhalations twice a day for a total of 4 inhalations. I did this for many years. My new specialist prescribed a larger does - actually 4 inhalations 4 times a day - a total of 16 a day. That means I go through one turbohaler a week. Since they cost about $100.00 each, I am very fortunate to have Blue Cross Insurance which covers most of the cost.

Symbicort has absolutely no taste and does not work immediately - so you have to just trust that it is working also keep track of when you take it. I keep a written record every time I take it - though that is not always possible if I am away from home. Because I take it so often and it has no taste or immediate effect, if I don't make a note I sometimes can't remember if I have just taken it or not. If that happens I generally take 2 puffs - which means I have either taken 2 or 6. 6 is the maximum you should take at any time.

The other asthma medications I currently take are Xolair injections once a month, spiriva - 2 inhalations every morning, and occasional prednsone bursts if things get out of hand. I also take pulmicort for my sinuses.

I am very satisfied with how my asthma has improved now that I am taking fluconazole for my candida infection. It is the only medication besides prednisone which I can actually see has a result. My peak flows are excellent and I can do any level of exercise the rest of me is fit enough to do. I am working really hard to get stronger and more agile and hoping that one day I may be able to reduce even Symbicort which I have been taking for so long.
 

Monday, December 14, 2015

Skating without candida

I am even better today than yesterday. I skated relatively fast  for about an hour this morning. I never felt out of breath or shakey. I didn't cough all day. I thought - this must be how an athlete feels.

Now I've got the hang of skating forward I have to get back to skating backward. It's all about building up the necessary muscles, developing muscle memory, and getting a better sense of balance.  Takes a bit or courage and lots of practicing. Too bad there will be 2 week break in the schedule over the  Christmas holidays. Oh well, as long as my breathing is OK I can get it back again.

I felt so fine, I decided to look up candida on Wikipedia.  Here is a picture of candida albicans:



Thanks to "Candida albicans" by Y tambe - Y tambe's file. Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:Candida_albicans.jpg#/media/File:Candida_albicans.jpg

It's sort of how I imagined it - though I don't know if I actually have that strain and even if I do I hope it is no longer there. It's actually quite a nice design - almost like a bridal bouquet.. Maybe I'll do a heavily textured all white painting based on it. Yes, I think I might. I haven't done any painting a for a few days and it's time to get back to it. I could use the beading gel to make the little yeast cells.

Saturday, December 12, 2015

Enter the FODMAP diet!

My asthma symptoms have improved so much it is hardly worth mentioning them. I finished my prednisone burst a couple of days ago and am now just taking fluconazole for the yeast in my lungs, sinuses and ears - plus my usual symbicort, spiriva, pulmicort. My breathing is great - peak flow above 400 even in the morning.

For good or bad, I'm at the post-prednisone stage where I start thinking that I need something exciting to happen. When my asthma symptoms are moderate or bad, I'm too pooped to do very much. After then end of  a prednisone burst, I start feeling like I want to do something fun like go on a trip. Unfortunately my private travel insurance won't cover me until 90 days without prednisone. So I either have to stay in Canada (where travel in the winter is not that enticing) or get a new kind of insurance.

Enter the FODMAP diet to make life interesting. 

Mike has suffered from irritable bowel syndrome (IBS) most of his life. His approach was to "keep calm and deny it" but he was often pretty miserable. Since stress is related - having to deal with my asthma ups and downs was not helpful.

A couple of months ago, on a ferry trip to see a specialist in Vancouver, I found a book called "GUT" which seemed to explain what was happening. IBS is not just in your head. It is a functional disease of the gastro-intestinal tract. Unlike celiac and Crohn's, there is no structural damage - but the system frequently malfunctions causing pain, bloating, and diarrhea (including unpredictable "explosions.") and sometimes constipation.

The book recommended eliminating gluten. Things improved a lot. It suggested eliminating dairy. Things seemed even better. But -  Mike's resulting diet was leading straight to a heart attack and I was stuck finishing up all those nut-burgers I had previously bought. I'm big on lots of vegetables and fruits, not too much meat, and lots of fibre. Mike was eating bacon and eggs with chia bread for breakfast and steak or chops for dinner.Scarey.

We went to our GP. He suggested Mike try the FODMAP diet. This diet is gluten free and lactose free - so we were part way there. But it also limits the kinds of fruits, vegetables, nuts, etc.that a person with IBS should eat. It based on the concept that IBS results from fermentation of high fructose foods in the large intestine. Life is a bit more complicated with the FODMAP and our grocery shopping has become a voyage of exploration. But I think it's pretty hopeful - almost like a new adventure.

At the end of Mike's appointment, our GP asked how I was doing. After I had described the candida, he commented, "You're moldy!" I like that guy.


Today is wet and windy. A couple of weeks ago we could see the moon through our trees - beautiful.

Tuesday, December 8, 2015

Day #7 of prednisone burst

Today was the last day of my 7 day prednisone burst. My symptoms are about the same as yesterday - a little bit of coughing and phlegm but a peak flow of over 400 and generally feeling good.

I went ice skating this morning. I was a little shakey from the prednisone - but I persevered and eventually got my balance well enough to skate round and round the rink for an hour. I got a lot of exercise and had a good time. Almost everyone who skates in the mornings is retired and hence over 55. Most of us complain about how hard it is to keep up our skill level let alone improve. I think it's the fear factor. We don't want to fall. However, I know it also improves balance because I can now stand on one foot considerably longer than I could a few weeks ago. (Yes, I do it in stores when I'm waiting to pay. No spirals though. Maybe one day.)

At our NAPA phone meeting yesterday one of the members mentioned she has asthma with tremors - almost like Parkinsons - caused by her asthma meds. This sounds really unpleasant.  I only get shakey  with prednisone. It's not something I ever associated with asthma before.

The other thing I do most days is paint with acrylics.  Here is a portrait I just finished. Everyone seems to like it so I am thrilled.



Monday, December 7, 2015

Day #6 - hit 400

Today I finally got my peak flow back up to over 400. The last time I got to this level was during my last fluconazole prescription. I am very happy to have made it. My phlegms seem to have turned much lighter and fewer - which is also a positive change.

I keep a chart of my peak flows. Here it is:


Although I think technique affects my peak flow reading - I also think that it is accurate enough to help me keep check on how my asthma is doing. I usually take a reading  3-4 times a day. I do at least 3 blows into the meter each time and record the highest number. I'm always much lower in the morning and  highest in the afternoon. I don't know why this is as it applies no matter how sick or well I am.  The zigzaggy line show the high and low for each day. You can see on the far right that I got over the 400 line. The short blue line below is my 7 day prednisone burst. The main thing the chart does is show trends.

I use a day planner to record when i take my meds and what my peak flow readings are. I transfer the info to the chart periodically. I take my chart with me when I see my specialist and he says it's helpful. I think it confirms the pulmonary function test done before my appointment. I highly recommend anyone with asthma keep a peak flow chart and use it to inform your action plan.

This morning I went ice-skating at the Nanaimo Ice Centre. I'm not a very good skater these days but I enjoy it. Our winters in Nanaimo are often rainy and dark - so skating in an indoor rink is a good way to get the exercise and socialize. Since I'm retired I can do pretty much whatever I want and skating is one of those things. I was less out of breath today than last week which was a very good thing.

I also participated in a National Asthma Patients Alliance phone meeting today. It was very well organized and run. No technical difficulties. Since I like to write, I offered to do a first draft of a revision to our Code of Conduct and Roles and Responsibilties.One of our big upcoming projects will be a Fair Pharmacare compaign - very important for everyone especially people with a chronic illness and lots of prescriptions.

Well, I haven't blogged about symbicort yet - but I will. I currently take 16 inhalations a day - so it is a big part of my managing my asthma.

Sunday, December 6, 2015

Day # 5

I was going to write about symbicort today - but will do that next time. Today I wanted to blog  about how I am doing with my current prednisone burst. Yesterday I felt like I didn't make much improvement. I still coughed. My peak flow (how much air I can blow out on my peak flow meter) did not go up and I didn't feel the slightest emotional high. It was so rainy and dark all day that I only went for a short walk (though I did do my bands workout and that was fine)  I think one of the reasons I didn't have a sense of an emotional high was that I didn't drink any coffee or tea that day. A daily cup of coffee at breakfast and tea at lunch gives more emotional punch to the prednisone - though I don't think it  makes it any more effective.

Today I had coffee and tea - and definitely felt hyper in the afternoon. I was energized but not in a totally good way. Even though it was another wet dark day I went for a half hour walk with lots of hills. Walking helped me calm down enough to work on a painting I am touching up. I like it now and hope it doesn't look too prednisonie when I finish this burst..

Today I was better than yesterday. My peak flow  was higher than it has been - though I still haven't made it to 400 - which is what I have come to think of as my new green zone.  Prior to being referred to my specialist at Providence I had seldom seen a peak flow of more than 400. So, after doing the math, my previous specialist  agreed that my green zone was just 320. My old red zone, when I needed to take prednisone, was 200. One whole day with a peak flow of under 200 activated the prednisone part of my action plan. It is hard to imagine how exhausted I was when my peak flow was that low. Coffee was pretty helpful then - it gave me a boost.

Two more prednisone days - I hope I hit 400 tomorrow. Then hopefully the fluconazole will kick in.

Saturday, December 5, 2015

Fluconazole and yeast

Today I am writing a bit about fluconazole -  an anti-fungal medication that comes in the form of small pink tablets. It is currently in short supply - so I was only able to get 18 days worth though I will likely be taking it for months.

Unfortunately I'm not feeling as well today as I was yesterday. I have a headache which really hurts when I cough. I think I've caught a bug from Mike. It is a very wet dark day - so although I did my weight training with bands I don't think I'll take the dog for a long walk. She doesn't like the wind and the rain.

Back to fluconazole - When I saw my specialist in Vancouver in September, he told me that during the summer the lab had found candida in my lungs - a yeast infection that might be at the root of my asthma. The lab had allowed the culture to grow for 12 weeks - enough time for the candida to show up. He said candida is in the air. We all breath it all the time and it doesn't bother most of us. But I am sensitive to it.

I think he also said it may have set up colonies in my lungs - maybe in the parts weakened by bronchiectasis. Antibiotics and steroids are known to encourage fungal infections and I have taken a lot of those.

We now know that our bodies live in symbiosis with our microbiome of other living creatures - bacterias, viruses, fungi. They don't take up much space but are almost everywhere in our body. The majority are in our large intestine helping with food digestion and our immune system. There are so many of them that they have a total of more DNA than we do.  Many of them help us. Some of them harm us. Some of them are idle bystanders.  Sometimes a harmelss one gets into the wrong place and becomes harmful. When one group gets wiped out, another group moves in. In other words the candida probably moved in when the good bacteria in my lungs were killed off by anti-biotics. Fluconazole is one of the medications that is designed to kill candida.

So - in September and October I took 8 weeks of fluconazole. Nothing seemed to happen at first but after a couple of weeks my breathing improved, I had more energy and coughed less. However, when I finished the eight weeks, I dropped back down again. So at my November visit, my specialist prescribed another regime of fluconazole to go along with my week-long prednisone burst.

Once again I looked it up on the internet. According to drugs.com "Fluconazole is used for treating and preventing certain yeast and fungal infections. It may also be used for other conditions as determined by your doctor. Fluconazole is an azole antifungal. It kills sensitive fungi by interfering with the formation of the fungal cell membrane." This web item doesn't say much more - except to point out all the truly awful side-effects and drug interactions. Don't read it! My view is, that if a knowledgeable doctor prescribes something, you should just take it. If things seem to go sideways, tell your doctor and they'll find something more suitable.

I could not find much mainstream information on the relationship between asthma and candida on the internet. I did find a dubious site by someone called  Dr McComb.  He is not associated with a recognized research centre, he is opposed to the usual anti-fungals, and he sells his own drugs online. He suggests big changes to the diet. Only brown rice, meat (not pork), eggs, fresh fruits (not oranges), frozen fruit (not blueberries) and vegetables. I'm  giving him a miss. In fact even looking at his website goes against my normal guide for internet safety -  there is a lot of harmful misinformation out there.

So I'll take fluconazole to kill of the candida until my next appointment in 3 months - unless the lab samples I produced on Tuesday show something else.


This is Symbicort - easy to inhale - no spacer needed. Since I am on a role writing about all the pharmaceuticals I take, I think I'll write my next posts on Symbicort, Spiriva, Xolair, and Pulmicort.

Friday, December 4, 2015

Prednisone Burst

I thought I would blog briefly about my experience with prednisone bursts. A prednisone burst is a  week or two of taking a medication called prednisone. It is intended to reduce the symptoms of asthma for a period of time. Unfortunately it is not a cure and, like all medications, it does have side effects. But it usually reduces the symptoms significantly at least for a while.

I'm currently on day #3 of a one week 20 mg burst. I think it is working because I am already feeling better and hardly ever cough. I've taken quite a few prednisone bursts for my asthma over the years. I call it being "in the zone." My main side effect is becoming pretty hyper and optimistic - which has led me to creating this blog and not something to complain about.

Prednisone comes in the form of small tablets which you need to take with food. It is fairly inexpensive as far as pharmaceuticals go. There is lots of useful information about prednisone on the internet. I consult mainstream sites such as drugs.com, webmd, the mayo clinic. The Canadian Asthma Society is very reliable but it currently does not seem to have much on prednisone. Here is what some of these sites say:

drugs.com:  "Prednisone is a corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system." The item  mainly focuses on the long-term use of small doses ( 2 mg or less per day for weeks or even years) for a whole variety of illnesses. I've known several people who took this prescription. My mother was one of them. Although this dosage can be used for asthma, I've never taken long-term prednisone - only short bursts. The article lists the many possible side effects of long-term use. Don't read it - it will scare you death. The most common side effects of long-term use seem to be weakening of the bones and susceptibility to infection.Your best precautions are taking calcium and avoiding sick people.

webmd.com:  "If you have serious worsening of asthma symptoms (an asthma attack), your doctor may prescribe a brief course of oral steroids such as prednisone. Oral steroids may also be prescribed when your asthma symptoms worsen but you do not require hospitalization.... Oral prednisone is a systemic steroid. That means that after taking prednisone by mouth (orally), it is absorbed in the body, unlike inhaled steroids (anti-inflammatory asthma inhalers) that go straight to the lungs." webmd says that short bursts are fairly safe. The main negative effects are:

My current prednisone burst of 20 mg a day for a week is quite mild compared to the one I had last May. I took 50 mg a day for a week and then smaller doses for another week to taper off. That May 2015 burst made me pretty crazy. I had enough energy to light up a whole city! My body actually shook and I couldn't stop talking. Nonetheless, Mike and I went RVing and boating and mostly had an excellent time. After a few days of treatment I could do all sorts of activities - like long hikes and swimming off the boat. Prior to the burst, I could hardly walk a block and coughed incessantly.


Here we are  rafted to our friends' big sailboat in early June. Unfortunately, as always seems to happen, the good effects eventually wore off so I'm back in the zone again. This time my severe asthma specialist intervened early so I am taking a smaller dose.

My GP calls prednisone "the drug of last resort." It does not make you better but it does lessen symptoms of an inflammatory disease for a period of time. I sometimes think of it as an "evil princess" who makes you feel so good - but just for a while - while she works her evil magic on the rest of you. On the other hand, a friend I met through the National Asthma Patients Alliance told me that his most recent prednisone burst had been no more help than a dead fish on his head. Other people say it makes them to feel depressed. It's different for everyone and, actually, different every time you take it..

The great thing about this prednisone burst is that I also have a new possible diagnosis for what is causing my asthma - candida yeast in my lungs. So I am also taking an anti-fungal medication to hopefully treat this condition. I must admit I'm very hopeful and I don't think it is just the prednisone talking.  More about my experience with the anti-yeast drug fluconazole next time.

Thursday, December 3, 2015

A new asthma blog

I am starting this blog about my experiences living with severe asthma. A fellow member of the National Asthma Patient Alliance (Canada) suggested that I do this because first hand information about severe asthma is hard to come by. I'm fortunate to have a top notch specialist at Providence Health Care in Vancouver - so I think my information is pretty reliable. My experiences, of course, is what I make of what is going on. It is complicated and a bit of a roller coaster ride.

First: What is severe asthma? Google says "Severe asthma is a type of asthma that affects a very small number of people with asthma (around four per cent). Someone with severe asthma has difficulty breathing almost all of the time, and often has serious asthma attacks." Apparently there are about 250,000 people in Canada who have severe asthma. It doesn't usually kill you but it makes life miserable.

Second: How did it happen? I didn't always have asthma. You can check out my asthma story on my Chuckling Chimes website. The main points are:
  • I was fist diagnosed with asthma in my late 40s. It started with a virus, a year of coughing, a pulmonary function test,and voila "You have asthma." Oh yes. you also have nasal polyps, chronic sinusitis and eustachian tube dysfunction. And later - "You have bronchiectasis but it won't kill you."
  • I took every kind of medicine available - salbutamol, thophylline, singulaire, prednisone, and many many antibiotics. Now I also take symbicort, spiriva and xolair plus pulmicort for my sinuses.
  • Despite all this good medicine, my asthma would "exascerbate" every few years. I would not have a big frightening attack. Instead - over the course of a month or two -  I would gradually go down hill - wheezing, coughing. spitting, trouble walking up hills, coughing at night. Sometimes I would barely  have the energy to eat. My eustachian tubes would become effused and I would be quite deaf. A prednisone burst (a high dose for a couple weeks) would greatly improve my symptoms. But then I would go down again.
Third: What's new? Why have I started this blog? I was recently diagnosed as having candida yeast in my lungs. The lab specimen took 12 weeks to produce the candida - only a great asthma researcher would have waited that long.  Candida may be the clue as to why, despite everything I am doing to manage my severe asthma, I am sick again. Yesterday I started a modest prednisone burst (one week at 20 mg) and a long course of anti-fungals - mylan fluconazole. Prednisone generally works well for me - though it makes me a little hyper - so I'm letting out some of that extra energy in this new blog. More details tomorrow.