Thank you for joining us for this week’s blog to follow the story of Mr. P…

It’s a late Christmas Eve in the office and my Mission of Infusing Hope is starting…

Sitting with Mr. and Mrs. P, I shared that the fact that his shaky hands and head (tremors) were likely due to a combination of 1) anxiety and 2) using a lot of albuterol. See, albuterol is a beta agonist — it revs up the sympathetic nervous system, which causes this fight or flight response.

Proper Medication Regimen

I then explained how using his regular (long-acting maintenance) inhalers with proper technique — twice a day, every single day — would make him feel better over the course of a few days to a few weeks. This will happen even if Mr. P doesn’t feel like they’re helping him when he occasionally takes them.

I continued to say that having the long-acting medications in his system will then reduce his need for albuterol. In turn, he will feel both less shaky and anxious.

Simply put, albuterol will work better for him if he uses it only when he is really short of breath.

I instructed him to 1) only take two to three puffs with a spacer device and 2) wait 30 to 60 seconds between each puff to get the most medicine into his lungs.

Know what? Mr. P actually agreed to wear his oxygen at all times except when he was smoking.

I Really Want To Quit Smoking

Then, he admitted that he really wanted to quit smoking and had tried.

We discussed his starting the medicine of bupropion, which was originally approved to treat depression. One of its side effects is that a significant percentage of patients receiving this medicine in the clinical trials stop smoking.

We also used nicotine replacement therapy (patches, gum, and lozenges) and briefly talked about non-pharmacological and behavioral techniques to make it easier for Mr. P to quit smoking.

Mr. P did absolutely refuse my wanting to refer him for smoking cessation counseling. He said he would not go. So, I provided a hotline phone number to support him in his quit attempts.

Since I was concerned about his safety, I asked if he felt like hurting himself or anyone else. He answered, “Most of the time I wish I was dead. But I’m too scared and I wouldn’t hurt myself or anyone else on purpose.”

A Moment Of Hope

I closed our visit by telling both the patient and his wife that I cared about them, I saw how miserable they both were, and I really believed that the next few months and even the next year would be much better for them.

I asked if they could come back to see me in a month and they agreed.

*Know what? I placed them in an overbooked clinic slot. Perhaps I didn’t think this hope would continue.

Please read next week’s blog to discover what happens next for Mr. P…