January 2020 archive

A welcome change in the federal “smoking age”.

https://www.cnn.com/2019/12/27/health/us-tobacco-age-21-trnd/index.html

For those of you who don’t already know, the federal “smoking age” was raised to twenty-one years of age in the United States in December. To be able to buy any product containing tobacco (or to legally be able to use it), you need to be twenty-one years of age, which is a deviation from the prior age of eighteen. This is a change that I welcome, although I wish that cigarettes would not be sold at all due to the fact that they are a known carcinogen and contribute greatly to the incidences of lung cancer that we see, particularly in later life. As I’ve said in previous posts, if people insist on wanting to… consume, or imbibe, nicotine, there have to be safer ways to bring it into their bodies than smoking cigarettes given the comparatively astronomically high rates of lung cancer that occur as an almost direct result of years, or even decades, worth of smoking.

Humorously, given my experience with smokers, I have never thought that marijuana has been the “gateway drug”. In individuals who have been susceptible to it, I have thought that cigarettes have been. But I understand the pathophysiology behind addiction better than at least many other people out there, and I’ve seen how addictive nicotine can be and has been in at least three people that I have known in person so far.

Although this might put addicted smokers in a bind who are over the age of eighteen but under the age of twenty-one given that they will no longer legally be allowed to smoke, I see this change in law being nothing but for the best(, as do I look forward to a day when cigarettes are no longer manufactured to begin with).

I never thought I would say this, but…

My asthma is actually somewhat better now than it was several years ago.

Comparatively, that is. For me. I’m aware that my asthma is also worse than other people’s.

Probably many other people’s if you want to get down to brass tacks and be honest about it.

A few years ago, I was at a place where I needed to take prednisone roughly every month and a half without fail… and there were some stints when I needed to take it every three weeks. It was my primary disabling diagnosis. I got short of breath doing simple things around the house, and any real form of exercise was out of the question. Friends of mine used to joke, with my permission, that I would be lucky to make it to forty… except that wasn’t entirely a joke as much as it was all of us honestly hoping that something would not trigger a fatal asthma attack in me before I actually turned forty years old, let alone anytime soon — in, say, the next several months. I had to have conversations with people that knew me in person about what I would want done if I were to be found unconscious as a result of a severe asthma attack, how far they would want medical professionals to go to attempt to save me (did I want to be ventilated? how long did I want to be left on the ventilator?) if the absolute worst were to happen. It was no big deal that I frequently had coughing attacks and coughed up at least a handful of mucus as a result of them and then could breathe better for a time. But sometime between then and now, something gradually changed. Just a bit.

As my migraines progressively got more frequent, and more severe, my asthma dialed it back. Just a bit.

Almost in lockstep.

Exercise still leaves me absolutely winded, and exerting myself too much is still something that I have to pay for in spades if I actually do it, and I still do have to nebulize fairly frequently, but for some reason, I am not quite where I was at a few years ago. I am still not quite sure why that is. With the black humor that I like to use to cope with just about everything, I like to joke around and say that enough people prayed for me not to die of a fatal asthma attack that now, instead, I have severe migraines to deal with. I managed to live long enough to have another problem to deal with. (And maybe that’s actually the truth.) I’m not at an actual place where I have to worry about whether or not I will need to be intubated as a result of an asthma attack.

It’s still really annoying to have to deal with, but we’re not quite there any more.

Readers who have severe asthma, or any severe, disabling diagnosis will understand what I mean here.

I’ve fallen off of the wagon, folks. See?

Monster was this manies when I fell off of the wagon of borderline veganism. This manies, folks!

Prior to my first pregnancy, my diet had… evolved through absolutely no conscious thought of my own to something that was borderline vegan, all through personal taste preferences. Knowing where the various things on my plate had originated from was enough to make me not want to eat some of them, particularly those in the dairy food group. But when I found out that I was pregnant for the first time, I knew that I needed to eat a more diversified diet to meet my body’s increased demand for more calories, minerals, and nutrients, as well as to meet the needs of my growing unborn child’s… and surprisingly, it was not that difficult to find various ways to do so. But after he was born, I never picked my previous diet back up, and by the time that I found out that I was pregnant with Bub, there was no diet to change, as my diet continued to be omnivorous. But when I decided that I was done having children, I began to give modifying my diet back to what it had been prior to either pregnancy some thought. And that’s something that I continue to give some thought to, balancing the need to model eating a diversified diet for my autistic children against eating the things that I want to eat, as I could honestly go without consuming food with cow’s milk in it and eating meat for the rest of my life and not miss either one of those things. The only thing that I think I might miss is eating eggs, but I’ve heard that there are great egg substitutes… so I might be able to enjoyably eat those.

On top of that, being someone who needs steroids for her asthma almost at whim, being able to eat less foods that tend to “go bad” quicker (dairy and meat tend to do this, but especially meat) is appealing to me for that reason as well. These are also foods that tend to cause me the most gastrointestinal upset when I am ping-ponging off of prednisone, especially in combination with other migraine medications I may need.

That said, I suppose that it wouldn’t hurt to begin looking back into various substitutes for things out there…

Prior authorization drills are fun.

And by “fun”, what I really mean to say is “attempts by insurance companies to gatekeep patients away from necessary medications, attempting to justify not wanting to pay to cover them”. What happens is:

· your doctor decides that you need a medication, and prescribes it
· that prescription is given to your pharmacy
· your pharmacy attempts to fill that prescription for you
· this script is presented to your insurance for coverage
· insurance denies coverage of this script
· they request that your doctor fill out forms attesting to your need for it
· your doctor has to fill out forms stating that yes, you need this medication
· these forms are sent to your insurance to approve
· if approved, your insurance authorizes your pharmacy to fill the script
· you are able to pick up your medication from the pharmacy

Basically, it’s a really snarky, underhanded, “but do you really need the medication?”.

A few medications that I take require this, and they require documentation that I have tried to take other medications and that they have not worked on me to be submitted… every twelve months.. for my insurance to continue to approve these prior authorization forms (as though these medications that I have tried in the past will suddenly, miraculously work on me one day) so that I can continue taking necessary medication…

To say “it’s a hassle” might be understatement of the year, and we are only in January. But it’s the truth.

Thanks but no thanks, cigarettes.

Given my family’s… history of having smokers in it, some people are surprised by the fact that I’ve never touched a cigarette in my life, at least until they find out how severe my asthma is. Some of them are still surprised that I haven’t “managed to find a way to smoke”, as though nicotine is this powerful of a drug. Having no prior history with it, having never smoked in my life, I can’t say either way. And I never intend to have history with it, having seen my own grandmother and mother smoke to the point that they came down with lung cancer, then metastatic lung cancer, then die as a result of it. Some people may think that I’m being a bit blunt saying that, but it is what it is — my mother cared for her own mother, who died from lung cancer, did not stop smoking, came down with metastatic lung cancer herself, did not seem to mind that smoking had heavily contributed to this, and died not seeming to mind. I fully intend on breaking this cycle.

To be honest, I’ve never understood the allure behind something that is a known carcinogen and life shortener. With things like caffeine, there isn’t the drastically increased risk of cancer — there isn’t the surgeon general’s warning, the black box label. There’s only the admonishment that children shouldn’t be drinking it, and the advisement that you should only consume so much of it in a twenty-four hour period (as well as the fact that children should not be drinking energy drinks, which I wholeheartedly agree with, as well as guidance on the consumption of energy drinks within a twenty-four hour period… and as an adult who doesn’t mind the occasional energy drink due to their taste, that is also something else that I actually agree on). If something is a known carcinogen and will shorten my life by my repeated consumption of it, that’s not something that I am even willing to start putting in my body, especially when the risk of cancer drastically increases with use over time, as we’ve seen with cigarettes. And I have family history on my side.

And as I’ve mentioned in here, I’ve also got the “gift” of shoddy lung function, which would not help matters out at all. Knowing my luck, I would develop cancer even sooner, worsen my lung function even quicker, and be even worse the wear for it… and who would that effect? My children. Regardless of their ages, that would affect my children. And I know this now. Why would I even bother doing this to myself if I know all this now?

Maybe I’m a bit naïve (which I would rather happily be), but is nicotine really worth all of this?

Are cigarettes worth coming down with cancer and shortening one’s life by years, maybe even decades?

Are they really?

Quite frankly, I’m aghast that another popular way of delivering nicotine still hasn’t managed to be marketed given that lung cancer is a leading cause of death. The least we can do is find a safer way to imbibe nicotine.

And given what has been on the news about vaping, so far it’s not really the safest alternative.

Quitters never win, and winners never… uh…

Back when I was in high school, attempting to participate in sports while my coaches (and, as it would later turn out, my gym teacher) turned a blind eye to the asthma symptoms that I was blatantly exhibiting, my cross-country team was working on “gearing up” for the mile that almost all of us would “master” running. As it turned out, I would be one of the very few students, if not the only student, that would not ever succeed in running the mile — not only were the symptoms of asthma that I were blatantly exhibiting being ignored to the tune of no one even bothering to tell my parents that I had them or was struggling to perform in athletics or physical education, but during my first, last, and only run, I stopped to help a friend of mine that had tripped over a hidden pit, spraining her ankle in the process. Because both of us had stopped, we were disqualified. My cross-country coach insisted that all of us would “be successful” in running the mile if only we would get over the “mental block” that must have prevented us from doing it, and it still incenses me that not a single adult in a position of power even stopped to recognize the symptoms of asthma that I had been exhibiting, let alone give my parents a phone call to let them know. As mentioned in previous entries, my parents would not find out for more than a decade that my coaches and gym teachers had either turned a blind eye to them or intentionally ignored them. This was another reason that I just hated my high school…

I say this like I do because one of the things that I had wanted to do, and would like to do if my health would allow it, is run. But it is one of the things that my lungs will, full stop, not allow me to do. There’s absolutely no way that my lungs would ever allow me to do that. They have made it abundantly clear over the years that there is no training, or “getting over the mental block”, to successfully run. My asthma is too severe — especially my exercise-induced asthma — to oxygenate my muscles to allow me to run. There absolutely is no training my lungs, my body, or my mind to successfully run any meaningful distance other than an incredibly short one if I have to grab Bub if he makes an elopement attempt. There are no marathons. And that’s something that I have had to make peace with, time and time again, every time that I think about it. But again, for my coaches — in the positions of power that they were in — not to have done something about my asthma, even if it were to recognize that attempting to participate in athletics was not something that I should do, still angers me to this day when I think about it. My school really should have done better.

There was no “mental block” to get over when the problem was a disease that was never going away.

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