On Learning How To Breathe More Easily
Every once in a while I take a break from my very time-consuming twin hobbies of neurosis and obsession to remember how fortunate we are. I was reading back through some old columns (and marveling at the amount of navel gazing you people put up with), when I hit the one about our first visit to the emergency room, three-and-a-half years ago. And the whole terrifying experience came rushing back.
I’d blocked out exactly how those nights felt: the long minutes of standing over Josie’s crib, counting breaths, wondering if I should stuff her in the Bjorn and head over to Beth Israel. I’d forgotten the look of terror and betrayal on her little face as I held her down on the X-ray machine. I’ll never forget the Bad Mommy Moment of watching her in her too-big hospital gown, holding her onesie in her fist and rubbing it against her cheek, trying to comfort herself — because I’d forgotten to bring her beloved stuffed bear.
But that was a long time ago. Like 5 million other American kids under the age of 18, Josie has asthma. For a bunch of days every year, she wheezes so hard that she can barely move. But most of the time, she’s just fine. Believe me, I know how lucky we are. We’re lucky our child has a condition that’s manageable; lucky we can afford decent health care; lucky we don’t live in the South Bronx, where one study found that hospitalization rates for asthma are 21 times higher than those in wealthier parts of the city, and where the rate of death from asthma is about three times the national average.
And we’re lucky we have Dr. Ehrlich. I knew I liked him the first time we met, when Josie was 2. He spoke to her seriously and treated her like an actual person. And as he spoke, he casually took the barrette out of her hair and placed it in his own. He completed the exam with a pink grosgrain ribbon in his slight Jewfro, nodding sagely, making no reference to his new and festive accessory. Josie was hypnotized. I also liked how reassuring he was. When tears sprang to my eyes as I looked at the test results showing that Josie was massively allergic to our cat, Sebastian, he looked at my face and said kindly, “Don’t worry, I’m not going to tell you to get rid of the cat. No one would listen to me, anyway.” And I liked it when he predicted she’d outgrow the asthma entirely. “I’m not gonna make a lot of money on this kid,” he said, mock-regretful.
Ehrlich started her on a little bit of inhaled steroid as a preventative measure, paired with albuterol whenever she was actually wheezing. The medicines were delivered through a nebulizer, which we all called “the nebbie.” We got a cute dragon-face mask for it on the Internet. She was scared of the machine at first, but quickly learned that it made her feel better, and so she cooperated during treatments, even crying out “Nebbie! Nebbie!” when she was wheezing. Unfortunately, the albuterol turned her into a raving, tantrumming, moody, sleepless, wired lunatic. (I mean, more than usual.) So Ehrlich switched her to Xopenex, a medicine that is albuterol’s more genteel, refined cousin — albuterol without the rusting truck propped up in its weedy front yard. We found a travel version of the nebulizer that wasn’t the size of a small car, so we could travel more easily. Then both of Josie’s medicines came out as inhalers as opposed to liquids to drip into a machine, so we could dispense with the nebbie entirely. Now she uses an inhaler with an accordionlike spacer that collapses when she inhales and expands when she exhales. She finds it a terrific game to inhale as slowly as possible, as instructed by Ehrlich, so that the spacer doesn’t emit any whistling noise. It’s as challenging as playing Toontown! Plus we’ve shaved 15 minutes off her bedtime routine, freeing up ample time for her to demand yet another chapter of “The Boxcar Children,” the most mind-numbing series of books ever written. (Thanks a lot, Ehrlich.)
Seriously, Josie’s experience as the daughter of an asthmatic and a former asthmatic (Jonathan nicknamed her “Wheezy Jefferson”) got me thinking: Do we Jews have more asthma than the general population? Are we just more neurotic about our health, so that our asthma is more commonly diagnosed? Are we wealthier, so that we’re more likely to pursue treatment? Are we statistically more likely to be suburban neat-freaks obsessed with Swiffering and Lysoling every germ into oblivion, thereby destroying our immune system’s ability to fight infection by not giving it any appetizers to nosh on? (This is what’s known as “the hygiene hypothesis,” or in Ehrlich’s words, “the pound of dirt theory.”) Are asthma rates among Jews rising, the way they seem to be in the general population? (In children ages 5 to 14, for instance, the rate of death from asthma almost doubled between 1980 and 1993.) Or have we already achieved anxious-doctor-visit saturation?
You can understand why I spent three days talking to experts and Googling like a madwoman. I learned that we’ll probably never know the answers to most of my questions. How would you control for all the factors, environmental and hereditary, that play a role? How could you tease apart correlation and causation?
The first thing I tried to find out was whether Jews had rates of asthma that are different from those of the general population. A 2002 study in Chest, the journal of the American College of Chest Physicians, looked at the death rates from asthma among different ethnic groups in Israel between 1980 and 1997. Conclusion: no difference in the asthma death rate between Jews and Arabs. Another 2002 study, this one in the European Respiratory Journal, found that the prevalence of asthma and asthma symptoms in the area that the researchers called Palestine was much lower than the rate in Israel (or, uh, the rest of Israel, depending on your perspective — boy, is this language loaded!) or in other developed countries. An April 2000 article in the European Respiratory Journal looked at the prevalence and severity of asthma in 12,918 young teenagers in Israel. The researchers found significantly higher rates of asthma in Jews compared with Arabs. These ethnic differences persisted after controlling for sex, district of residence and level of urbanization. (Really? Can researchers also control for anxious parents who report the tiniest chest sound as wheezing? Or for who chooses to participate in medical studies?)
Anyway, on the surface it does seem like the Jews are a wheezier lot. But we’re nowhere near the ethnic or racial group most harmed by asthma in this country. That would be African Americans, whose asthma rate is almost 38% higher than that of whites. Is that
number so high because African Americans receive worse health care than other groups? Because they often live in poorer communities and urban areas with more exposure to such environmental allergens as truck exhaust, cockroach droppings, cigarette smoke, inadequately vented stoves and heaters? Is there a genetic component here? In Israel as well as in America, black people suffer more from asthma; studies say that Ethiopian Jews have much higher asthma rates than non-Ethiopian Jews. But again, who can say why? Are Ethiopian Jews simply predisposed to asthma? Can we blame the crowded dorms and rundown hotels where they lived after arriving in Israel? Old dust-mite-filled mattresses and pillows donated by well-meaning citizens? What about the Ethiopians’ current jobs? Are they exposed to more workplace toxins and allergens than your average non-Ethiopian Jew? Many Ethiopian Jews were treated for parasites when they arrived, and have elevated levels of a certain kind of white blood cell, a kind that shows up whenever allergic reactions like those in asthma take place. There’s a theory that asthma is caused by a screw-up in the protective response to parasites… so could the process of curing the Ethiopians’ parasites somehow have triggered asthma? Do you think I’d keep asking questions if I had any answers?
All I can do is go back to my own small world (navel gazing, yet again). A year after Josie tested massively allergic to Sebastian (and Ehrlich advised us to keep the door to her room closed and try to prevent her from rubbing her face in his fur, which was about as easy as trying to keep Tom Cruise from jumping on couches and screaming like a banshee), Josie was retested. Lo and behold, her cat allergy had utterly disappeared. Today, Sebastian has sadly met his eternal reward, but now we have Yoyo (more formally known as Miss Sparkles Yoyodyne). There’s a theory that pet exposure at an early age prevents all kinds of allergies. I could riff on the many possibilities for why this might be, but have I not been boring enough today? For now, let’s just say we’re thrilled to have a new kitty, a preschooler who breathes easily most of the time, a toddler who shows no sign of allergies or asthma, and good health we know enough to be grateful for. Ptui, ptui. (Oh, don’t bother wiping that up. Didn’t I mention the hygiene hypothesis?)
Write to Marjorie at [email protected].
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