Backgound: My parents were both heavy smokers. My dad died of COPD as a result of life-long smoking, while a patient in a southern Illinois mental hospital (for dypsomania), a place right out of One Flew Over the Cuckoo’s Nest. He was 55.
My mom died of cancer at age 83 in 2002. She had quit smoking when she was 65, but the last several years of her life was tethered to an oxygen tank by severe emphysema.
Fast-forward to 2006 and my pre-op physical for an eye surgery related to glaucoma. The doc says, “Ever had a spirometry?” “Nope.” “Well, you’re gonna have one now.” Very simple, really — you exhale as fast and as long as you can (minimum, 6 seconds) — into this handheld computer that instantly shows the volume of exhaled air against time. If the curve is is convex upward or flat, good on you. If it’s noticeably concave downward, you have some sort of COPD, not so good.
The doc says, “You have emphysema, and not mild, either: moderate.” “OK,” I say, “my mom had emphysema, although she died of cancer, so I know there are two more degrees of the condition, severe and dead. She was on oxygen the last couple years of her life, and she richly hated having to deal with it. I also understand that if I quit smoking now, the progress of my lung disease will slow down, not quite to a stop, but very likely, since I’m now 71, I will die of something other than COPD.” “Right,” he said.
So I had the operation (separate story) and a week later, February 9, 2006, I had my last cig (Camel straights, you better believe…). There is a Dr. Fiore at Madison’s UW Hospitals, reportedly the leading expert on smoking cessation. His program is much more complicated than this, but two of its main tenets are (a) a mild tranquilizer and (b) during the transition period (up to a year), a nicotine replacement — gum, patches or nasal spray.
I knew I wouldn’t opt for the gum, and in 1995 I had tried the patches, to which I was wildly allergic. So it came down to the nasal spray, which astounded me: one spritz in each nostril and whammo, you’re fixed in about one second. I really can’t account for this, but for some reason, I soon quit the tranquilizer and, even sooner, the nasal spray.
As near as I can tell, the real motivator was that I was in fact chronically short of breath. I had an inhaler (Albuterol, a bronchodilator), which provided some relief for several months. Then came a much more graphic episode. Over the course of four days, I felt like I was somehow steadily losing ground in terms of vitality, almost tangibly slowing down, not because I wanted to but because I was steadily getting weaker. By the fourth day, a Sunday, it occurred to me for the first time: I am dying, if this goes on, I won’t last a week.
Monday morning first thing, I was at Internal Medicine. My own doctor was not in clinic that day, so I saw someone else. She told me her mother had died of emphysema and it was the worst. “So,” she said, “the first thing we’re going to try is better drugs. Instead of Albuterol, we’ll use Combivent, which adds an anti-inflammatory to the bronchodilator. That’s for quick-response needs. We’ll also use a different inhaler (Advair 250/50) that provides a long-acting corticosteroid, fluticasone, and a long-acting dialator, salmeterol.” These drugs can have serious side-effects (sudden death being one), but so far so good. By trial and error I determined that I would be OK with one dose of Advair daily rather than the prescribed two.
Five years, five months, and 20 days, and counting…
