Thank you for joining us for this week’s blog for the conclusion of the story of Mr. P…
It’s now one month after that late Christmas Eve in the office. Let’s see return to this Mission of Infusing Hope…
Yes, Mr. P and his wife arrive for the appointment one month later.
The Follow Up Visit
This time, he was wearing his oxygen, had a nicotine patch on his arm, was chewing nicotine gum, and no longer smelled of cigarette smoke. He was less shaky and proudly reported that he hadn’t missed a dose of his long-acting inhalers since his last visit.
Mrs. P said her husband was only using his albuterol about 12 to 16 puffs per day, instead of six puffs every one to two hours.
She continued to share that they were now talking to each other, working more as a team, and both felt more hopeful.
We all knew, though, that there was a long journey ahead for them.
Over the next visits, I steadily gained their trust and convinced Mr. P to follow these recommended therapies:
- slowly increase his physical activity
- take supplemental nutrition
- join a Better Breather’s Club
- reduce his prednisone dose in order to taper completely off this medicine
NOTE: A systemic corticosteroid such as prednisone is ONLY useful for two types of patients – 1) those with COPD who are acutely ill with an acute exacerbation of COPD for a short course (usually five to seven days) and 2) those with poorly controlled COPD with associated asthma (so-called Asthma-COPD Overlap Syndrome or ACOS).
Many patients treated with an oral corticosteroid chronically (more than a month) find it extremely difficult to get off the medicine. This is partly due to 1) their belief that they need the medicine and 2) the nagging aches and pains that the low-dose prednisone helps.
However, the side effects and harm in patients with COPD from chronically taking steroids are significant. These include cataracts, mood changes, insomnia, easy bruising, and thinning bones from osteoporosis and fractures.
A Surprise at Cracker Barrel
When I last saw Mr. P and his wife in August – now eight months after our first appointment — he was more compliant with all of his therapy. He had gained a little weight, regularly used his supplemental oxygen, no longer smoked, and used his albuterol less frequently.
Then, I had quite a surprise three months later at Thanksgiving when I was waiting at Cracker Barrel with my family for a table.
I suddenly found myself in the embrace of strange arms and against a man’s shoulder with a voice proudly exclaiming, “Dr. Sandra Adams — This is the young lady who saved my life and our marriage!” (Yes, I was young back then.)
When he let go of me, I saw it was Mr. P.
He was with his wife, children, and other family members. Mr. P continued to share how much both his life and marriage had changed in the last year and how much happier and satisfying his life was now.
Well, it was not easy, but by working hard, having an open mind, and working as a team, Mr. and Mrs. P had a much-improved life!
On that Thanksgiving Day, Mr. P was finally off prednisone, using his albuterol only about two to four puffs per day, getting stronger, and walking without his wheelchair.
He was still wearing portable oxygen, but he was no longer smoking and used all of his medications appropriately. He said that he felt less depressed and anxious and that his overall quality of life had dramatically improved.
Key Points: I believe that many healthcare professionals – as well as nearly everyone who cares for others – often fall into a trap of feeling hopeless and nihilistic about any possibility of change.
Sometimes it feels hopeless to even try to help facilitate changes in behavior when some people are so stubborn and their conditions are so poorly controlled.
Now, every time I start having feeling hopeless, I think about Mr. and Mrs. P.
This renews my resolve to try to affect positive changes in people’s lives, to once again have a Mission of Infusing Hope.