Thursday 11th April 1991   Morning surgery 11:20

“Despite being younger and giving up smoking a few years ago, Emrys Evans is quite a lot further along the road than his brother, Eifion.” My Dad had just finished examining Emrys.
“I don’t think being asthmatic has helped.” Emrys said. He was slightly breathless just talking.
“No,” Dad turned to us, “Emrys has been quite a bad asthmatic since he was a child. Asthma and smoking don’t mix. Emrys is really struggling with his breathing, now. He cannot manage anything more than the slightest slope and, even on the flat, he is much slower than his wife and grandchildren.”
“My grandchildren get very annoyed. They don’t want to go shopping with me any more.”
“He is already on 3 inhalers and we have been thinking about adding a tablet,” my Dad continued.
“I don’t know if I fancy the tablets, Dr Dennis. Don’t they cause a lot of side effects?”
“Some patients get side effects but the majority don’t. I think it is worth a try if it helps your breathing. What are the common side effects of aminophylline, Dylan?”
“Nausea, diarrhoea, headache, irritability, sleep problems, palpitations, low potassium, convulsions . . . . . .”
“Very good, Dylan, but I just wanted the more important ones not the whole list. You are going to put him off the idea of taking them completely.”
“I’m sorry, Dr Dennis.” Dylan looked at the floor. Dilys raised her eyebrows.
“Don’t worry, Dylan. Now, Mr Evans has had to go into hospital twice in the last 12 months because of his chest. He is coming to see me every couple of months. I think it is fair to say that we are getting to know each other quite well. You could almost consider us friends.”
“I don’t like wasting your time, doctor.”
“You’re not wasting my time, Emrys. Your chest is pretty bad these days. We expect to see a lot of our chronic bronchitics as they deteriorate.”
Emrys frowned.
“I suppose that our next big conversation will be oxygen,” my Dad continued. That’s always an important step. Do you think Emrys is ready for oxygen yet, Dilys?”
“No, Dr Dennis. His colour is still quite good and he seems to be managing. You would want to get his oxygen levels checked in the hospital, first.”
“Excellent! We tend to give oxygen if patients have persistently low blood oxygen levels. Do you know how many hours a day the patient needs to use the oxygen for?”
“16?” Dilys wasn’t sure.
“It’s 15 hours, Dr Dennis.” Dylan corrected Dilys a bit too enthusiastically.
“Shut up, Dylan! I don’t think one hour is going to make much difference.”
“You are probably right, Dilys, but if we follow the official line, oxygen needs to be used for 15 hours every day. They say, if you do that, it makes you live longer. However, it’s quite a commitment. Most patients see it as a last resort. As you say, I don’t think Mr Evans has quite reached that stage.”

“Let’s try the aminophylline tablets. If they don’t help or you get side effects, you can stop them.”

Not quite ready for oxygen.
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