Steroid inhalers and voice range


[vocal chords with fungal infection]

Like many people with asthma, I use a steroid inhaler
regularly. But the cold I had in early October led to a very
bad flare-up of the asthma, and I’ve been taking the maximum number of puffs a day
ever since, which is quite a lot longer than I’ve ever taken
that much before.

I was wondering when I was going to be able to stop, but not
thinking very much about it. But then I started practicing the
pieces I’m going to be singing on the
December 17 concert
, making a point of starting on the
correct pitch, and I found that my range was down by quite a bit
from what it normally is, and I was having troubly hitting the D
2 D’s above middle C, and even feeling uncomfortable with the B
above middle C.

It occurred to me that I had heard about there being side
effects from prolonged use of the inhalers, so I googled
it
, and sure enough, there was not only scholarly writing,
but pictures like the one above.

The writing was reassuring about the problems going away if you
stop the inhaler, although a little vague about the time
frame.

So I’m not taking the inhaler any more, and hoping for the
best, and vocalizing very carefully before I practice. It’s not
really quite time to stop, so I’m having some trouble sleeping
at night.

I’m wondering if my regular steroid use is part of why my voice
in general
is so much lower than it was when I was younger. In college I
started out on Second Soprano, and then switched to First Alto.
Now I’m definitely a Second Alto, and lots of choirs would
probably be better off with me on First Tenor, if they weren’t
so prejudiced about female tenors.

I hope I get the alto range back in time to sing the D’s and
E’s on the concert. If not, we need to cut a couple of things
to make the program the right lenghth, and if those pieces
aren’t the right ones to cut, I can play them on recorder. I
will discuss this with my doctor, but it sounds from the google
search like switching from one kind of inhaler to another
doesn’t help.

I also read this
article
in the New York Times, about people who have learned
a breathing technique that lets them use less of no steroid
inhalers. I’ve been trying it informally, but haven’t sent the
Buteyko Center
any money for real instruction.

Plans for the month

I have the major pieces of what I’ve been meaning to do on the
websites done, although I’d still like to have better searching
for pieces on SerpentPublications.org
and better graphic design both places.

But the big thing that happens in the near future is a lot of
more “formal” entertaining than I do the rest of the year.
There’s the family Thanksgiving dinner, which happens at my place
and includes some friends who like having a family dinner but
their families are too far away. Then there’s the Christmas
party, which this year will probably be December 20, which is
usually the largest number of people in my apartment at one time.
And two months later, some time around February 25, is my birthday
party.

Because I have the band over every week, and we sit around
eating and drinking and socializing after the rehearsal, my public
rooms stay superficially more combobulated than they would
otherwise, but it’s still a good thing to get some real
housecleaning done this time of year.

So that’s what I’m planning to spend some of my copious spare
time on this month. There’s a woman who claims to do
environmentally friendly carpet cleaning that I might call, and I
could try to hang the handmade quilts I inherited from Bonnie, and
recover the chairs with stains or rips in their covers, and maybe
do something about the sofa cushions.

This is not to mention the upstairs cleaning. If I got rid of
all the obsolete or non-working computer junk, there might be room
to unfold the futon in the computer room. And I’d feel more like
brewing if the room the brewing stuff is stored in had the stuff
decreased or arranged better so that I could get to the stuff more
than 4 feet from the door.

Of course, housecleaning of any kind would be less difficult to
contemplate if my lungs weren’t still in reactive mode after that
cold I had a month ago. So maybe it will be the website
improvements that happen after all.

I’m back, and what’s next

I seem to have returned to the land of the living — I woke up
this morning wanting to get out of bed and walk the dog. I then
did a reasonable imitation of my usual morning routine, and still
don’t feel like it’s quite time to go back to bed.

As far as what the diagnosis is, since it’s getting better and
not worse, I don’t see any need to burden the medical care system
with this problem, so you’re going to have to put up with my lay
diagnosis. I was running a fever for a good bit of Saturday and
most of Sunday, so I would normally call it flu, not a cold.

Because people have been worrying about flu lately, I’ve been
just saying it’s a cold. I’m not someone who’s ever had the kind
of cold a lot of people get where it slows them down for a week or
even longer, but they never run a fever or get into a state where
they should clearly be in bed. I suspect that this isn’t because
I’m immune to those viruses; I suspect it’s because the virus that
gives some poeple a stuffed up head but not much else for a week
gives me a fever and a stuffed up head for a couple of days.

But if it is flu, I had the regular flu vaccine 2 weeks ago.
So it’s either a regular flu virus that got in under the wire
before my immunity took hold (or even got a little bit of help
from the virus in the vaccine), or a flu strain that isn’t in the
regular virus. In which case, it’s entirely possible that it’s
H1N1. But if so, I don’t seem to be one of the people that H1N1
kills.

What I would have been doing if I hadn’t been in bed

I have to move the laymusic.org site from the old
ISP (hostrocket) to the
new ISP (dreamhost). Note
that this isn’t in any way a criticism of hostrocket as a host if
it meets your needs. I acquired the dreamhost account when I
desperately needed a way to move a bunch of mailman
mailing lists to a new place. They’d been hosted on my home
machine when I had my internet connection from speakeasy, and this wasn’t
going to work when I started connecting with comcast.

Hostrocket doesn’t offer mailman, and while I could probably
have managed to move the mailman lists to what they offer instead,
the non-technical people who’ve been administering some of the
mailman lists would have had a lot of trouble, and I thought that
even for my purposes, mailman was better. So I found a coupon
code that gave me the first year of dreamhost hosting for very
little money. Last Spring I moved the music publishing part of
the site to dreamhost, and now I’m moving the rest of it, before
I owe hostrocket for another year.

Just moving the existing site to a place on dreamhost and
pointing the laymusic dns to the new place would be easy, but what
I’m trying to do is to move the pieces that should be on this site
and that I want to maintain
into the laymusic wordpress installation, and then I’ll just have
a pointer to the old stuff for historical reasons.

The job is a bit less tedious than it might be because of the
wordpresslib
program that adds files to the wordpress media library. I may
write a version of that that creates a post from the part of a file between
certain markers. But mostly it’s tedious because it involves
doing minimal updating of a lot of stuff that could use major
rewriting, but that would be major thinking, and that isn’t going
to happen before October 15.

What I wanted to yell at the President

I watched the address to the joint session of Congress a couple
of weeks ago with a friend. In general, I really like watching
Obama speak, because it’s such a relief to have a President who
isn’t embarrassing me with every sentence out of his mouth.

But there was one point when I was talking back to the TV
screen. It was after he’d talked about how he and everybody else
in the country could design a system from scratch that would work
better than the one we have, but he believed that we could get
more done by building on the system we have.

So then he said, “We will place a limit on how much you can be
charged for out-of-pocket expenses, because in the United States
of America, no one should go broke because they get sick.” I
remarked to my friend, “So how is that incremental?” At the time,
and until I just looked at the text of the speech, I believed he
actually had used the word incremental.

The reason I’ve continued to think about this off and on for
the last two weeks is that I think that really is the reason
health care reform has been so hard to get. There really isn’t a
consensus in this country that no one should go broke because they
get sick.

This is why, although it was a well-delivered speech, the polls
all found that it didn’t convince anyone. People who believe that
they won’t go broke when they get sick because they’ve done the
right things all their lives, and that the people who will go
broke are lazy and improvident, want to hear why this new system
isn’t going to cause them to go broke because other people get
sick. And the President did say that, but not in a way that anyone
really believes.

The reason I understand this better than President Obama does
isn’t because I’m a better politician than he is. It’s because
he’s spent his life doing what the system says he should do and I
haven’t. I know people who really believe that I should go broke
when I get sick because I retired at the age of 50. They don’t
say it in such crude language, but their disapproval of someone
making that choice says it for them.

So the right way to pitch the reform shouldn’t be telling sad
stories about the people who go broke because of the present
system. It should be making the point that the present system
is in fact making you go broke because other people get sick,
and spending money differently will make you go less broke as
well as making them get less sick. I don’t say I know how to do
that, but I can see that that isn’t what the President is trying
to do.

Read the other stuff I’ve written this morning

Once again, it’s almost lunchtime on Wednesday, and I’ve been
writing all morning, and I don’t feel the necessity of writing a
blog post to keep my hand in as a writer, so you can read the
other stuff I’ve written.

Not the emails

I will spare you the emails I wrote to the person I’m trying to
schedule a December concert with, and to the condo association about
the time and date of the proposed meeting, although there was a
lot of thought that went into how to word those.

Comment on another blog

Reading my RSS feeds before breakfast, I found that Phil
Greenspun has been writing a long article about health care
reform, which expresses a lot of the same frustrations I feel
about the current discussion, but missed a couple of points I’m
frustrated about, so I
wrote him a comment. Actually, the page that comes up when you
say you want to comment strongly suggests that you might rather
write an email if you aren’t sure your ideas will still be
interesting in two years, so I originally wrote him an email, but
he emailed me back suggesting I post it as a comment, so I did.
When you read the article,
mine might still be the second comment, or if you only want to
read the comment, you can go to my
comment space
and see the health care comment, plus an
anti-Verizon diatribe I wrote last winter.

Posts on my own blogs

I wrote a report
on last night’s band meeting.

For the meeting, I had as usual transcribed a new piece, and we
found a bad mistake in a previous transcription, so there’s a post
on the Serpent
Publications blog
about those things.

RIP, Senator Kennedy

I’ve been thinking quite a bit about Ted Kennedy since he died
a couple of days ago. I grew up in Massachusetts, so via the
miracle of television, he’s spent a lot of time in my living room,
even though I didn’t know him personally, and I only remember once when
we were in the same (large) room together.

Many other people have been analyzing how his work in the
senate shaped America as we know it today. I’ll just tell you a
couple of personal stories.

Chapaquiddick

The speech he gave where he offered to resign is the other
television event I remember from the summer of 1969, besides the
moon landing.
It was a well-delivered speech, and an effective piece of persuasive
writing. The person who is usually credited with writing it,
Theodore Sorenson, was proposed as head of the CIA in the Carter
administration, but the appointment was withdrawn. I remember one
of the arguments against it being that he had written that speech,
which may have contained some lies, and certainly didn’t tell the
whole truth. At the time, I was surprised that the opposition
would have been stated that way, since I don’t see how never
having told a lie or suppressed a truth can possibly be a
qualification for being head of an intelligence agency.

Money from an insurance company

The only time I actually called on him for help as a
constituent, his staff was quite effective. I had been using what
was then called Harvard Community Health Plan (HCHP), one
of the original
manged care organizations, for my health care for about 15 years.
I had been fairly satisfied with the care I’d received, but once I
became a contractor and no longer had my coverage paid for by my
employer, I found dealing with their billing organization
increasingly annoying. The last straw was when they wrote that
they were cancelling my policy because they hadn’t gotten my check
on time. (It had actually crossed that letter in the mail.)

I went into a frenzy of letter writing, and wrote to their
billing that they
weren’t cancelling me, I was cancelling them, and wrote letters to
the two doctors I had a relationship with explaining what was
happening.

When they didn’t return the check I’d sent after a month or
so, I wrote to Senator Kennedy, explaining the situation. In
fact, I was more concerned that he be aware that individuals were
having this kind of problem retaining coverage than that he get me
my check. I had both a diabetes and an asthma diagnosis at this
point, and I suspected HCHP of cherry-picking, and also of not
really wanting to deal with billing individuals. His office sprang into action and called both the
HCHP billing office and the Massachusetts Insurance
Commission.

Less than a week after writing that letter, on the same day I got a letter in
the regular mail from Senator Kennedy’s office saying what they’d
done, and how I should follow up if I didn’t receive my check in a
week, and an express delivery of the check from HCHP.

Cancer diagnosis

I heard of Senator Kennedy’s cancer diagnosis while I was on my
way to pick up Bonnie’s
belongings from the hospice two days after she died. I remember
wondering how much difference it would make that he was richer,
more powerful, and maybe more knowledgeable about the health care
system than Bonnie had been.

The answer seems to be quite
a lot.
He was getting out of bed most days until the actual
day he died; he was at home with his family and friends and dogs
until the end; and while the brain surgery did affect his vision
and motor skills, he continued to do what he loved doing,
including sailing and writing letters until almost the very end.

Of course, it may well have been just the luck of the draw that
his surgery left him relatively unimpaired and Bonnie’s left her
unable to speak or move her left side, but it may well also have been a
difference in quality of care. If it happens to me, I hope I get
closer to the kind Kennedy got than the kind Bonnie got.

Massachusetts health care

There’s an article on slate.com
this morning called
Bringing Down the House: The
sobering lessons of health reform in Massachusetts
. Slate
is a large organization, and some of the writing is a lot better
than others. This one isn’t one of their better efforts.

The gist of the article is:

The expensive Massachusetts plan is not well-designed to systematically improve anyone’s health. Instead, it’s a superficial effort to clear the uninsured from the books and then clumsily limit further costs by discouraging care.

In the heat of the moment, I posted this comment:

I think this article ignores the managed care option. I’m sure the discussion of up-front costs and copays is true for some plan that’s available, and it may be the cheapest per month, but my impression is that the purpose of the current cost structure is to drive people to managed care. This gives them hefty copayments for some expensive services, but makes routine preventative care practically free.

My own plan (one of the subsidized ones) has more copays than some
really poor people have, but the choice for the mother whose
baby has a fever would be between paying a $50 copay for the
emergency room and waiting for the doctor’s office to be open
and paying a $5 copay.

Thinking about it while walking the dog, I realized that a
better criticism of the article would be to point out how divorced
from any facts the author’s thesis was. If you want to argue
that a given system discourages care, shouldn’t you feel that you
have to present some statistics that show less care is being used
under the current system than under the previous system?

I’m not an expert, but certainly there have been reports in the
press suggesting the opposite — for instance, that the number of
primary care providers (PCPs) accepting new patients has dropped because
all the people who have insurance now and didn’t before have
signed up for a PCP and are using him or her.

My personal experience of the new Massachusetts system has been
pretty good, once I gave up on figuring out how to apply for the
subsidized care myself and got the social worker at the clinic I
go to to help me.

There are several major things wrong with health care in
Massachusetts, but the insurance requirement discouraging use of
health care really isn’t one of them.