This is not the lady referred to in this posting

Doctoring has been quiet recently as all the patients seem to be frantically working in their fields. But there have been some interesting problems to solve recently.

Asthma is usually such a satisfying condition to treat. Patients want instant success and the blue “reliever” inhaler does that. But many people need to have a brown “preventer” inhaler, a steroid, which takes much longer to act. Clinical improvement can be so slow that it is imperceptible to the patient, so they often stop using the brown inhaler.

Proof of the pudding is in the blowing – into a Wright Peak Flow Meter. This measures the fastest rate you can blow air out of your lungs. I can manage a rate of 650 litres per minute on a good day, but I know how to use the Peak Flow Meter. Most patients are too timid. They do a weak puff and the gauge barely moves. The patient needs to be able to blow into the meter reliably, so we can measure airflow scientifically, to demonstrate any improvement.

You have to be bold. “Blow your socks off!” I say to patients. No one wears socks here, so that phrase doesn’t work.

“Imagine you are hold a lighted match between your finger and thumb, with your arm outstretched and you are trying to blow out the flame,” is another of my stock phrases.

Again, this gets lost in translation. “Why wouldn’t I just drop the match, or bring it closer?”

A mature lady with life long asthma saw me in clinic last week. She didn’t think the brown inhaler helped. Her airways were not responding to the blue inhaler as well as they had been doing. I wanted to get her to use the Peak Flow Meter properly and spent ten minutes demonstrating, getting her to try, asking a nurse to explain to her, but she just wasn’t blowing properly. Some readings were 100, others 150. She should have been able to manage twice that. These would be the readings of someone needing an ambulance.

I was just about to give up when she opened her mouth and removed a massive clump of chewed betel nut that she had been keeping hidden between gum and cheek. No wonder she couldn’t blow reliably. At least she didn’t ruin the meter by spraying the masticated remains down the barrel. Sometimes, you just have to laugh.


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