I got a comment asking about the 'you don't have asthma' curse, so I thought I would dedicate a post to it.
Asthma is an incredibly common disease but it is also very strange. Well, the asthma isn't strange, it's pretty consistent, the doctors are strange.
First, asthma is a "diagnosis of exclusion" which means the patient has to let the doctor work through a long list of other diagnoses before they'll officially confer the title of asthma.
However, this title is non-transferable.
Go to another doctor or even an ER and suddenly you don't have asthma. Actually, you are a transvestite crack whore with a foreign object up your rectum who is trying to score narcotics--at least that is how you will be treated, with very serious suspicion.
Therapy may be suggested. Never mind you can't breathe well enough to talk.
I believe the official doctor motto of medical stupidity is 'if you haven't wheezed for me personally, then you don't have asthma.'
Which kind of turns asthma into an absurd performance art.
If you can't be sick in the right way, right in front of the doctor, you will be denied treatment. If you don't retest or do what the doctor needs you to do to consign a diagnosis, you will be denied treatment. Even if your medical records are right there in front of them.
Of course there are exceptions, because not every doctor is an idiot, but quite frequently you will be left hanging on the thin thread of oxygen you are subsisting on until the doctor can prove, to their satisfaction, that you really do need a nebulizer treatment or an Advair prescription.
Because as we all know, those drugs are worse than heroin with super dangerous side effects that can kill you in a nanosecond, right? And response to treatment is in no way diagnostic, right? (Except for kids, pediatricians do consider positive response to bronchodilators as indicative of asthma, but I guess that all changes once you hit 18 and start your career as a transvestite crackwhore.)
The other thing that is weird is a methacholine challenge (when properly done) will confirm asthma so I'm not even clear on why it is still a diagnosis of exclusion. My understanding is diagnoses of exclusion are reserved for illnesses that can't be readily tested for. Asthma has a diagnostic test.
Here is a brief list of the times I have run into the 'you don't have asthma curse.'
1. Multiple ER visits. My favorite is the ER doctor who actually had asthma himself but was skeptical about me. He drew an arterial blood gas the old fashioned way to be sure (no pulse ox for me! I'm a lousy crackwhore, remember?). I had to wait until he got the lab results back before he would allow me an albuterol treatment. It was a long wait.
When I was 18, I ended up in a Children's Hospital ER after visiting the boyfriend's family who never cleaned their house and had wads of animal hair in every corner (which I was allergic too). I was so tight, there wasn't enough air movement to wheeze. They didn't think I had asthma (All asthmatics are pathological liars!) and grudgingly gave me a nebulizer treatment after which I wheezed profusely as my airways opened. "OH, you DO have asthma," were the doctor's exact words and inflection.They were so surprised!
As if asthma is the Yeti of medicine. Often talked about, but never seen.
2.The asshole allergist who years ago saw me as a patient and had no problem with the idea that I had asthma. Saw her again 2 years ago in a different health system and suddenly I didn't have asthma and she wasn't going to prescribe my medications despite having all my records. I had to BEG for medication. She also screwed up the methacholine challenge and I had to raise holy hell with the HMO.
She is no longer employed there. I like to think I had something to do with it (but probably not).
3.The pulmonologist who screamed at me "Who said you had asthma? Who gave you a nebulizer?" Asshole. After my pulmonary function tests came back, he shut the f*ck up because my airways were down by 50% and you can't fake those tests.
I could go on, but you get the point, right?
What enables this curse?
1. Inability to recognize that patients can have good air movement even if the patient has lost their small airways. This happens to me a lot. Thing is if you've lost the small airways and don't do something, you're going to lose the big ones too. Better for everyone to keep that from happening.
2.Crappy peak flow meters in ERs and doctor's offices that don't provide good data.
3. Not using pulmonary function testing in the ER. This could actually be a profit center for ERs. There are so many asthmatics I can see this being a win-win for everyone and the information provided is so much better than what you get from the crappy peak flow meter. Someone should do a study.
4.Doctors who expect asthma to conform to some preconceived notion of what asthma is and not understanding that asthma varies from person to person.
5.Seeing so many transvestite crack whores with things up their rectums who want narcotics, that doctors can't see anything else.
6.During office visits, doctors who don't read the damn patient file and review previous lung function testing and other empirical data that is diagnostic of asthma.
7.Doctors who believe if there's no wheeze, there's no asthma. You can be too tight to wheeze. It's in the medical literature, it's documented. Not sure why doctors aren't aware of it.
8.Patients who can't breathe well enough, in emergency situations, to advocate for themselves.
I think that about covers it. Do you have anything to add?
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