by NADIA ARANDJELOVIC

Watching as your child struggles with asthma can be emotional and stressful for most parents, but an asthma diagnosis doesn’t have to signal panic. 

The Royal Gazette spoke to two mothers who’ve found ways to help their children manage the illness, from diet changes, to proper medicine use and community support. They share their experience and offer tips to help other parents. 

Janice Mullings-George 

Working as a nurse full-time proved to be a lifeline for mother of two, Janice Mullings-George. Both her daughters have serious asthma and allergies that have resulted in frequent hospital visits and constant maintenance. 

The last serious attack happened just after Easter in April 2021. The family had gone out for a walk along the Railway Trail when the girls spotted some Easter lilies nearby. 

“I should have known better, but it happened so quickly and was an immediate trigger for my girls,” said Mrs Mullings-George. “They both started coughing and sneezing and before we knew it, we had to get them to the hospital.” After being admitted to the emergency room, the girls, aged three and seven, were given nebulizers and kept under close watch. 

Asthma is an illness that runs in the family for both Mrs Mullings-George and her husband, which is why they focus a lot of their efforts on daily prevention. “Whenever I enter a space, the first thing I do is scan the environment to make sure there’s nothing that could trigger the girls’ asthma,” she said. “I have to make sure that I dust often and the bedsheets and teddy bears have to be washed with hot water to kill mites. Teddy bears can also be put in the freezer to kill dust mites.” 

Mrs Mullings-George’s girls also suffer with severe eczema – the two conditions can often go hand in hand. Interestingly, she decided to get certified in those specialty nursing areas even before having children of her own, after seeing her sister in and out of hospital with asthma as a child. 

While there are many challenges in managing her daughters’ condition, Mrs Mullings-George admitted she’s thankful for the support system around her, including her husband, paediatrician, Dr Sylvanus Nawab, family, friends, godparents, teachers and neighbours. Together, their goal has been to keep the girls out of hospital as much as possible. 

For her eldest child, this involves daily use of the orange inhaler, which contains fluticasone to reduce swelling and inflammation of the airways and makes breathing easier; as well as diet changes to remove food allergies, like nuts and dairy, from the girls’ diet. 

This combination has made a noticeable difference, especially during cold and flu season. 

“I’ve tried to reinvent my entire menu,” Mrs Mullings-George explained. “If we’re going out to eat, it can be a challenge but even the people closest to us know to always check for certain allergens that can trigger reactive airways and cause the mucus buildup in the lungs.” 

She encouraged any other parent of a child with asthma to make sure they have conversations with their child about the illness and teach them how to use their spacers and inhalers. “We’ve taught them what signs to look out for so they’ll know to say ‘Mommy, my chest feels tight’,” she said. 

“I’ve talked them through what we need to do and the importance of making sure they avoid their triggers. We also have these amazing bands that they wear on the wrists showing what they’re allergic to, so if they’re out with friends they can see what their allergies are. We also empower our kids to speak up, if they’re out at a restaurant for instance. If people around them are aware, we can do a good job at staying on top of it.” 

Tyrika Caisey 

For Tyrika Caisey, her eldest child Keyara started experiencing asthma signs as early as age two. While doctors won’t formally diagnose asthma until a child turns five, Mrs Caisey recalls spending many nights at the hospital while her toddler was on a ventilator. 

By the time Keyara reached primary school, they were spending at least one week at the hospital twice a year – every spring and autumn – due to the change in weather and environmental factors like pollen. That’s when the youngster was officially diagnosed with asthma. 

“It was a very scary time for us as a family,” Mrs Caisey said. “For me, looking at my child and not being able to actually help her was tough. She once had to have an IV put in, but because she wouldn’t keep still the doctor actually busted her blood vessel trying to insert it. She was screaming and it was a really rough experience for all of us.” 

Thankfully, her daughter, now age 13, seems to have her asthma under control; she hasn’t had any major flare-ups in the past four or five years. Mrs Caisey said they were able to manage symptoms with daily use of the orange ‘preventer’ inhaler both morning and at night. 

When Keyara was younger there were some rough nights, Mrs Caisey recalled. “If her wheezing got really bad, I wouldn’t be able to sleep. I was constantly going in to check on her to see if she was breathing. I would look at her neck to see if it was severely dented in when she tried to take a breath. That was my sign ‘Okay, we need hospital intervention’.” 

Mrs Caisey encouraged parents to advocate for their children. She also suggested keeping track of each hospital visit and asking the doctor or nurse for your child’s oxygen levels. “If it drops below 90 that means they’re not getting sufficient oxygen. You definitely have to pay attention. I never leave the hospital without being satisfied that I know her oxygen is at a good level and that she’s breathing normally,” she said. 

The mum-of-two also suggested parents should listen out while talking to their children. If they’re gasping for air after every other word that’s a sign something isn’t right. “You need a lot of patience and should take the initiative to research asthma so you know what signs to look out for.” 

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Asthma can’t be cured, but it can be controlled and those who suffer from sensitive airways can lead as healthy a life as anyone else if they know what to do. 

Asthma nurses Liz Boden and Tracy Nash of Open Airways guide us through the different steps every asthma sufferer can take to keep their condition under control. 

What is asthma? 

The first step to controlling asthma is to understand exactly what it is. 

Asthma is a condition affecting the airways – the small tubes that carry air in and out of the lungs. If you have asthma, your airways are extra sensitive. This means when you come into contact with something you are allergic to, or a ‘trigger’ that irritates your airways, they will become narrower, making it harder to breathe. The muscles around the airways tighten. The lining becomes inflamed and swollen. Sticky mucous is often produced. 

The symptoms of asthma are: 

• Coughing 
• Wheezing 
• Shortness of breath 
• Tightness in the chest 

Not everyone will get all of these symptoms. Asthma varies from day to day and person to person. It may also come and go throughout your life. 

Asthma Action Plan 

Because asthma varies from person to person, everyone who has asthma needs to have their own personal asthma action plan. 

Copies of the form are kept with your doctor, in the case of a child, their school, and at home. It includes your personal triggers and, if seasonal, when they happen. 

It includes a green, amber and red traffic light system for what medication you need to take; how much you need to take and how often. Amber and red includes what medication you need to take on top of this, if your asthma flares up and, in the case of the latter, when to go straight to the hospital emergency room. 

The plan needs to be completed in partnership with your doctor or asthma nurse. Open Airways can also help you complete your action plan free of charge. 

Medical Steps – Know How to Take Your Treatment 

Take your preventer every day. Preventer inhalers are usually orange, brown or purple and they make your airways less sensitive. 

For adults and children over 12 years old, an alternative to the traditional preventer inhaler is Symbicort, which is a SMART (single maintenance and relief therapy) inhaler which works as both a preventer and also a relief inhaler. 

Be prepared! Never leave home without your relief inhaler, which is usually the blue one containing Ventolin. Ventolin should only be used in emergencies. If you are using it on a regular basis, your asthma is not well-controlled. 

All children and adults who use a metered dose inhaler should use a spacer. If they find it difficult, ask an asthma expert to teach them how to use it. 

Non-Medical Steps 

Know what your triggers are and avoid the ones you can. Triggers can include dust-mites, stuffed toys, pollen and grass, mould, pets, sprays and perfumes, air pollution and colds. 

Avoid too many stuffed toys, carpet in bedrooms, old pillows or mattresses, cleaning sprays or aerosols, air-fresheners, Easter lilies, smoke and walking along busy roads. 

Improve your environment by having a new pillow every year, using microfibre cloths and water to clean your home, opening windows every day, having green houseplants, washing your hands regularly and asking your doctor about a flu shot. 

For further information or assistance, visit www.openairways. com or call 232-0264. 

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by Vejay Steede

Allergies can be crippling. They are lifestyle conditions that limit sufferers in many severe and sublime ways. While many allergies are mild seasonal concerns, or involve simply avoiding certain foods or atmospheric conditions, others can be deadly, life-altering afflictions. 

According to the allergy experts at medlineplus.gov, “an allergy is a reaction by your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are pollen, dust mites, mould spores, pet dander, food, insect stings and medicines. 

Normally, your immune system fights germs. It is your body’s defence system. In most allergic reactions however, it is responding to a false alarm.

Of course, all common allergens are present in Bermuda, so Bermudians suffer from allergies just as frequently and intensely as people from all over the world. Our symptoms and treatments are the same as those that exist in the wider world and our local experts know how to deal with flare-ups as well as long term treatments. 

Local expert, Nurse Jutta Harvey, R.N., B.S.N. informed us that “the most common allergic problems that we see at the Allergy Clinic of Bermuda are the following: nose (rhinitis) – runny, sneezy, itchy nose and/or nasal congestion; sinus congestion; eyes (allergic conjunctivitis) – watery, puffy, red, itchy eyes; asthma; skin – eczema, hives, itching; digestive – diarrhoea, bloating, nausea, vomiting. We also see and treat bee sting allergy and medication allergy.” 

While treatments are widely available in Bermuda, Nurse Harvey puts education and prevention at the top of the list of effective ways to reduce allergy flare-ups. 

“Education regarding avoidance of allergic triggers is primary. Secondly, medication can be very helpful. The most common categories of allergy medication are antihistamines and anti-inflammatories – these come as tablets, liquids, creams, eye drops, nose sprays and inhalers. There are certain medications called monoclonal antibodies that are very effective against allergies, but are not easily available in Bermuda due to extremely high cost and limited accessibility.” 

Not all allergies can be controlled by simple medications alone. Some allergies require intensive procedures to eliminate the root causes of dangerous reactions to everyday triggers. Nurse Harvey outlines one such thorough treatment: 

“The most intensive treatment for allergies is allergen desensitisation. This is commonly commenced following allergy testing, which determines to what a person is allergic, and how allergic they are. Then, by giving the person tiny doses of what they are allergic to in a controlled fashion, a person can, in fact, become less allergic. Although very effective, it is not a quick fix; benefits usually start within a few months of treatment, and the entire course of treatment may take three to five years.” 

While it’s good to know that Bermudians living with allergies have relief available, they still have to navigate their daily lives with caution and a heightened sensitivity to their surroundings. On how allergies affect patients’ daily lives, Nurse Harvey disclosed: 

“Allergies affect people’s daily lives in several ways. Some reactions are dramatic and life-threatening (anaphylaxis). This sometimes occurs with bee stings, foods and/or medication. If a patient has an allergy to any of these, it is required that the person carry an Epi-Pen. In the case of bee stings, one should consider allergen desensitization, which can be lifesaving. 

“The more common allergies of rhinitis, asthma and eczema are not as dramatic. However, they can still have a major impact on a person’s quality of life. Allergy patients must endure disruption of sleep, fatigue from relentless symptoms or perhaps as a side effect of the allergy medication, loss of work days or school days or loss of productivity at work or school, and an inability to participate in certain activities; for example, outdoor activities during pollen season may be uncomfortable without medication. Lastly, untreated allergies may contribute to recurrent sinus infections or asthma.” 

Having to avoid going outside during the spring can be highly frustrating in Bermuda; not to mention not being able to enjoy wonderful foods such as nuts, dairy or shellfish. Then there’s the need to allergy-proof your surroundings, especially your home. 

The experts at the Mayo Clinic recommend that allergy sufferers use allergy-proofing techniques such as using dust-mite proof pillow cases and mattress covers, removing carpets from your home, using washable curtains made of plain cotton or synthetic fabric, choosing easy-to-clean chairs, dressers and nightstands made of leather, wood, metal or plastic, avoiding upholstered furniture and removing items that collect dust, like knickknacks, tabletop ornaments, books and magazines to create an allergen-free abode. 

There are dozens of measures that allergy sufferers can take to protect themselves from the misery of allergic reaction flare-ups at home. Storing toys, stuffed animals, and games in plastic bins, keeping windows closed and using air-conditioners during pollen season, washing curtains in hot water regularly, and using air filters. The Mayo Clinic recommends choosing an air filter that has a small-particle or HEPA filter, and adjusting your air filter so that it directs clean air toward your head when you sleep. 

Temperature control is also vital for allergy sufferers. “Hot, humid houses are breeding grounds for dust mites and mould. Maintain the temperature between 68 F (20 C) and 72 F (22 C) and keep relative humidity no higher than 50 percent. Clean or replace small-particle filters in central heating and cooling systems and in room air conditioners at least once a month.” 

Finally, keeping pests at bay is of paramount importance to allergy sufferers. “Control cockroaches and mice with inexpensive traps from the hardware store. If that’s not effective, hire a professional exterminator. To remove allergy-triggering insect and mouse residue, thoroughly vacuum carpeting and wash hard surfaces. To prevent re-infestation, seal cracks or other possible entryways.” 

It’s clear that controlling your environment is necessary to avoid common allergy flare-ups. However, in the living of daily life, when controlling the environment is not really practical, it’s good to know that other options exist. 

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No matter how disciplined you are about taking your asthma medication and avoiding your triggers, you can still be struck by an asthma attack. 

An asthma attack happens when your airway lining starts to swell, the muscles tighten and mucous is secreted. Asthma attacks are often associated with viral infections such as the common cold and flu. 

When this happens, it can be terrifying, which is why it is so important to have a completed Asthma Action Plan. Not only will doctors have immediate access to all your asthma information, but it means you will likely recognise the signs of an attack straight away, know what to do and therefore won’t panic. Panicking makes an attack worse. 

What happens when asthma attacks and what should you do? 

Nurses Liz Boden and Tracy Nash of asthma charity, Open Airways, explained the signs, symptoms and immediate actions to take… as well as what not to do. 

Signs you are having an asthma attack are: 

• Incessant coughing and a quick reliever inhaler isn’t helpful 
• Wheezing 
• Shortness of breath 
• Tightness in the chest 

When this happens, you must do the following: 

1. Sit upright and loosen any tight clothing around the neck. 
2. Take 4 separate puffs of your emergency or reliever inhaler, which is usually the blue one. 
3. The most effective way to do this is to shake the inhaler, put one puff into a spacer then take four long deep breaths in and out keeping the spacer in your mouth. Repeat until four puffs have been taken. 
4. Alternatively, for adults and children over 12 years old, take two separate doses of a Symbicort combination inhaler. 
5. Wait four minutes. If there is no improvement, repeat the four puffs in step 2 or take one more dose of the Symbicort inhaler. 
6. If there is still no improvement, it’s time to call your doctor or go to the hospital emergency room. 
7. Continue to take your reliever inhaler on the way to the hospital. 

If you are suffering from a severe asthma attack, however, don’t wait. Call 911 immediately. 

Signs of a severe asthma attack are: 

• Distress 
• Lips or finger tips turning blue 
• You have trouble talking and finishing sentences 
• Your reliever inhaler is not working 

In an emergency, never use Dulera (blue), Seretide (purple), Becotide (brown) or Flixotide (orange) inhalers. These are preventative inhalers and will not help when you are having an asthma attack. 

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Bermudians are no strangers to asthma. The condition, classified as a lung disease, has been present within these shores for centuries, and patients who live with it typically suffer from childhood right through to old age. 

The presence of allergies in an asthma patient will often exacerbate the disease, making living with asthma even more miserable. Unfortunately, allergies and asthma often occur together. 

According to the Mayo Clinic, “the same substances that trigger your hay fever symptoms, such as pollen, dust mites and pet dander, may also cause asthma signs and symptoms. In some people, skin or food allergies can cause asthma symptoms. This is called allergic asthma or allergy-induced asthma.” 

Dr. James T. C. Li, M.D., Ph.D., a Mayo Clinic allergy specialist, breaks down the process by which an allergic reaction may cause asthma symptoms in patients: 

“An allergic response occurs when immune system proteins (antibodies) mistakenly identify a harmless substance such as tree pollen, as an invader. In an attempt to protect your body from the substance, antibodies bind to the allergen. 

“The chemicals released by your immune system lead to allergy signs and symptoms, such as nasal congestion, runny nose, itchy eyes or skin reactions. For some people, this same reaction also affects the lungs and airways, leading to asthma symptoms.” 

Asthma and allergies look very similar and both can make the essential act of breathing far more onerous than you’d like it to be. 

Local pediatrician extraordinaire, Dr. Sylvanus Nawab, MD, FAAP, asserts that “there are different subtypes of asthma, with most of the early onset types associated with allergic rhinitis and atopy in general. 

“Allergies to cats, dust mites, and grass pollen, which is frequent in Bermuda, can also be associated with the onset of Asthma.” 

“Others are also triggered by viruses, so keeping viral exposure low helps. Viral induced asthma, though transient, can make susceptible allergy induced asthmatics worse. There are treatments for allergies and asthma but they all have to be tailored to every patient’s needs.” 

Reducing exposure to offending particles and viruses will help prevent and, or relieve asthma flare ups, but that often means limiting one’s quality of life quite a bit. 

Nurse Jutta Harvey of the Allergy Clinic of Bermuda, speaking more broadly about asthma, added: “Asthma can be triggered by multiple factors. Exercise, infections like a cold, weather, or irritants such as vapours, sprays, powders, fragrances, and smoke. 

Another trigger for asthma is allergies. One connection between asthma and allergies is that they are both inflammatory processes. 

“In asthma, the inflammation is in the lining of the lower breathing tubes and the lungs. In allergies of the nose (rhinitis) the inflammation is in the nose and upper airways. The lining of the nose and lungs, called the mucous membrane, gets swollen, red, and twisted with production of extra mucous. The upper and lower airways are obviously connected, from the nose to the throat, down through the breathing tubes, trachea and bronchi, and the lungs. So, the pathway from the nose to the lungs is one long tube, lined with the same membrane; whatever affects the nose can also affect the lungs.” 

Honing in on specific causes of allergy and asthma flare ups, nurse Harvey continued: “The most common allergic trigger for asthma is the components of dust, which are dust mites, cockroaches, pet dander, and mould. Another trigger may be pollen from grasses, trees or weeds. On occasion certain food allergies may trigger asthma.” 

Unfortunately, Bermuda is teeming with all of the components of dust mentioned by Nurse Harvey above, so avoiding these often microscopic particles completely may be impossible at times, especially when you don’t even know they’re near. 

Knowledge is key for controlling asthma and allergies. Nurse Harvey cites Open Airways and the Allergy Clinic of Bermuda, as well as some doctor’s offices as places where education on controlling asthma and allergies can be found, saying these places, “have qualified asthma educators that have the time and expertise to guide people in asthma care.” 

The process of controlling asthma and allergies may not be so easy, however, and it will require considerable care and attention. Nurse Harvey outlines the process: “It is important to identify what triggers asthma by means of clinical observation, discussion, and, or allergy testing. 

“Then, avoidance of offending allergic triggers, whether they be environmental or dietary. Some triggers are relatively obvious and easy to avoid. Others, such as mould are not so obvious and need a bigger effort to control. Assessing and repairing leaks, assuring adequate air exchange, and climate control, such as well-maintained air conditioners and dehumidifiers can help. 

“Also, minimise airborne irritants. It is well understood that smoke exposure has a negative effect on health; but also, air fresheners, perfumes, and colognes – thought to be pleasant by some people – are dreadful triggers for people with asthma and allergies. Just as smoking is banned from certain spaces, the same consideration should be given to providing fragrance free areas.” 

Treatments that do not involve simple avoidance of triggering particles are available for asthma and allergy sufferers. Nurse Harvey provides further advice on medications available for patients in Bermuda: 

“Beyond environmental control, many people need medications to control their asthma. Historically, asthmatics have felt reliant on their blue pump as their rescue inhaler to open the lungs. However, the latest asthma guidelines indicate that equal, if not more, emphasis should be placed on the ongoing inflammatory part of asthma. 

“The blue pump provides no relief from inflammation. One needs to have a combination inhaler that has anti-inflammatory properties, as well as opening up the lungs. The current recommendation is an inhaler called Symbicort, which requires a prescription. People who only have a blue pump should call their doctors office to review their medications.” 

So, yes, asthma does go hand-in-hand with certain allergies; but both can be treated, and controlled, with vigilance and care. Breathing is not an option, so please, do all you can to learn how to best keep doing it. 

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by NADIA ARANDJELOVIC 

Betty Lambert has always been an extremely active person. In total, she’s competed in seven Bermuda Day Half Marathon Derbys and cycled multiple times from Somerset to St. George’s in the Bermuda End to End event. It came as a huge surprise then, when she started to experience asthma symptoms for the first time as an adult – in her late 50s. “I’m an outside person and take part in as many physical activities as I can, so I never dreamt that this would happen to me,” the 63-year-old said. 

When Ms Lambert started experiencing breathing problems for the first time four or five years ago, she was diagnosed with having bronchospasms – that’s the tightening of the muscles that line the airways in the lungs causing wheezing and frequent coughing. “It seemed to happen every springtime,” she explained. “I would have these bronchospasms and would need a cough suppressant, plenty of water, and rest to feel better.” 

A long-time educator, Ms Lambert said before the bronchospasms began, she’d rarely if ever call in sick. But for two or three years, she noticed that every springtime there was a pattern with her having to miss work. Then in May 2020, just after the beginning of the Covid-19 pandemic, things took a turn for the worse. The coughing grew more severe this time and she was struggling much harder to breathe. 

“At first I was in denial,” Ms Lambert said. “Usually when we breathe, we don’t even think about it, the breath just goes into the lungs. But this time, no matter how hard I tried, the breath just wasn’t going in. I tried to ignore it and change positions and how I was laying down, but nothing worked.” 

Her normal doctor was overseas and Ms Lambert didn’t feel comfortable going to the hospital due to her fears of catching the Coronavirus. However, on that occasion, her breathing got so bad she had no other choice but to pay a visit to the emergency room at King Edward VII Memorial Hospital. After being released she found the additional medical support and interventions she was looking for. “I was in a crisis and didn’t know it,” she said. “I had promised Liz Boden (from asthma charity, Open Airways) that I’d go to the hospital to get help and I wanted to live up to my promise.” 

Ms Lambert’s advice for any other adults who suddenly experience asthma symptoms is: get as much support as possible. She credits professionals like Ms Boden, Nurse Debbie Barboza, and Dr Kim Foley, a local pulmonologist, for helping her get on a medication regimen – something she’s been sticking to for over 18 months now. Without their support and them advocating on her behalf, she might not be alive today, she said. “I hope people reading my story would see there’s life after a health scare. It can get better and you can manage it.” 

Betty Lambert’s tips for other adult asthma sufferers are: 

Stick to your medication regime. For Ms Lambert that includes using her pump in the morning and night. She carries her medications with her everywhere she goes and credits them with why she hasn’t had any major incidents in the last year. 

Take small steps to improve your overall health. Though a normally physically active person, Ms Lambert noticed in recent years her cholesterol levels had become high. “That should have been a red flag because high cholesterol can affect your heart, which can impact your lungs and breathing.” She started researching and talking to her physician about ways to reduce cholesterol and has been steadily reducing that in recent months through diet and exercise. 

Eat more whole foods. Ms Lambert says that part of her asthma management plan includes eating a largely plant-based diet. She’s already lost 17lbs by cutting out red meat and hot dogs, which are high in saturated fat and sodium; as well as by reducing the amount of packaged and processed foods she consumes. Additionally, she tries to eat more fresh vegetables and chooses wholegrain breads, instead of the white alternative. “Oatmeal has become my best friend for breakfast,” she said. “Whenever I’m preparing food or grocery shopping, I have to think: is there a better choice for me? I always remember a professor saying that the heart and the lungs are married. I never paid much attention to it before, but now I try to be aware of how my heart health could be affecting my lungs.” 

Lean on any support. Since being diagnosed with asthma, Ms Lambert has had a lot of support. One programme she was able to take part in is Dr. Hans Diehl’s Complete Health Improvement Programme (CHIP), which is facilitated by local health professional Nurse Beverly Howell. Designed to provide expert support and accountability for people looking to take charge of their health, the programme helped Ms Lambert ease her way back into exercising including cycling and power walking. She also keeps a journal now to chart her diet and exercise regime. 

The post Living with Asthma – AN ADULT’S STORY appeared first on RG Magazines.

by Annabel Cooper

 Asthma is prolific throughout Bermuda and left untreated is a debilitating and life-threatening condition. The good news however is that it is 100 percent treatable. But what if you don’t know how? Or, what if you do, but can’t afford a preventative inhaler? 

For 25 years Open Airways has been dedicated to educating Bermuda’s residents about asthma and how to live a healthy life with it, while also providing financial and physical support to sufferers and their families. 

Asthma nurse, Liz Boden, a life-long asthma sufferer herself, founded the charity in 1997 because there was a great need for asthma support throughout Bermuda, and her husband, an accountant, told her she couldn’t afford to keep giving equipment away for free. 

When the charity opened its bank account however, it was with a grand total of $6.75, donated by a young boy called Christopher Pullen. He had overheard Ms Boden saying that some of the children she helped didn’t even have proper beds and that was one reason why their asthma was so bad. He earned the money doing odd jobs at home. 

Community and corporate support since then has improved their bank balance allowing them to do considerably more than just provide free medication and equipment. 

In addition to Ms Boden, nurse Tracy Nash is director of asthma education, and Mary Ellen Ewles, is director of operations. 

Open Airways may be a small organisation, but with an estimated one in five children and one in ten adults suffering from asthma in Bermuda, the impact they make is huge. 

To save money, the charity doesn’t have physical offices. Instead, nurses Boden and Nash either work from home and offer video consultations, or go out into the community in their ‘Azmobile’, to fulfil a multitude of programmes, workshops and in-person consultations. 

They go to schools to teach their Asthma Education Programme and also run ‘lunch and learn’ workshops, summer camp workshops, pre-school workshops and attend various health fairs where they offer asthma education and prevention, and follow-up consultations when necessary. 

Their well-established ‘Pillows for Prevention’ programme provides every primary school child that has asthma with a new pillow each year. The aim is to establish a life-long habit of replacing your pillow annually. 

Their Spacer Distribution Programme provides spacer devices to asthma sufferers of all ages who use inhalers, to ensure inhaled medication is getting into the airways properly. A spacer device is attached to the inhaler’s mouthpiece, making it easier to use. 

Open Airways’ number one priority is to help everyone who suffers from sensitive airways, no matter their circumstances and in order to control asthma and prevent an attack, the mantra, said Ms Boden, is “take your preventer every day to keep your asthma away”. 

Preventers and other asthma medications are expensive however, as is insurance, but their medication assistance programme helps anyone who is unemployed, uninsured or under-insured. It includes free consultations and then Open Airways pays for their prescribed medications. 

“This was something we pivoted to when Covid struck,” explains Ms Nash. “We needed to make sure that people had their inhalers and we knew a lot of people couldn’t afford them and they were struggling and would try and get by without them.” 

Instead of handing the inhalers out, they arrange for patients to pick up three months’ worth at a time from the pharmacy. “They still have to see their doctor and get their prescription and we step in at the pharmacy level,” she continued. “We have an account with the pharmacy so they could charge Open Airways.” Three months’ worth means patients must check in so the nurses can ensure they are taking their preventative inhaler every day. 

“They’re all taking it because they can afford it now,” added Ms Boden. “Many people never had an idea that they could have controlled asthma.” 

Occasionally, patients will try and give their inhalers back believing their asthma is cured before the nurses explain that their asthma is ‘better’ because they are taking their preventer every morning and night. There is no cure for asthma, yet. 

Previously, people would simply have managed as best they could, which would ultimately result in a trip to the hospital emergency room. “We’ve got the admissions to the hospital down by 83 percent,” said Ms Boden. 

As part of their service, the nurses might also visit patients’ homes and assess them for asthma triggers. 

Triggers include allergens such as mould, mildew, dust mites, year-round high pollen count, cockroaches, grass and some pets. The cold virus is also a major trigger. 

Other triggers include ‘indoor air pollution’ such as cigarette smoke, household cleaning products and plug in air fresheners or sprays. “People in Bermuda love their sprays,” said Ms Boden. “They come into a house, they think it smells, so what do they do? Febreeze. They irritate sensitive airways. 

“We teach them that there’s ‘free breeze’ outside. Open the window! Ventilation is very important.” 

To help in this respect, Open Airways gives away free microfibre cloths and teaches how to dust with just that, or a bit of water on the cloth. Where necessary, they may also arrange for new pillows and mattresses. 

An important step is to help asthma sufferers develop their own personal action plan, including what inhalers to use, how to deal with their triggers and how to recognise if their asthma is getting worse. 

“We have this traffic light system,” explained Ms Nash. “You have a green area of things to do when things are good. You have your orange area where you maybe increase your treatment because your asthma’s flaring up a bit and then you have the red area where you’ve got to go and seek emergency help.” 

Because they are such a small team, Open Airways extends its reach by training healthcare professionals including nurses, doctors, physiotherapists and pharmacists, and because of this diploma programme has built up an island-wide network of asthma-trained experts. 

When someone at one end of the island needs help but the nurses are at the other, they simply ring their closest contact to that emergency. 

“By training healthcare professionals who work all over Bermuda, we know people are getting good care where ever they go,” Ms Boden explained, giving the example of a lady who’d called her earlier that morning. 

“She was having an asthma flare up and had lost her spacer,” she said. “She lives in Somerset. I was able to call Caesar’s pharmacy. We have trained the superb owner, Cheryl Martins. We provide them with free spacers so Cheryl will be able to assess her, give her a spacer and then I told her she must go to the clinic.” 

The Asthma Clinic at the hospital is run by another of Open Airways’ diploma graduates, Debbie Barboza. 

The Open Airways team has helped thousands of people in their 25-year journey, but the need never goes away. 

“Our biggest challenge is reaching people and teaching people,” said Ms Boden. “Asthma is very common, disrupting, disabling, potentially life threatening. It’s treatable. Medication is safe and effective. Everything we do is free. We’re passionate about making lasting change to people’s lives. 

For more information about Open Airways, visit openairways. com or call 232-0264. 

The post Opening Bermuda’s Airways appeared first on RG Magazines.

 Vaccines are more relevant in the global consciousness today than they have been for many years. Prior to COVID-19 triggering a mad scramble for effective vaccines to alleviate the current strain on the international healthcare industry, however, perhaps the most controversial debate around vaccines concerned their connection to autism in children. 

Essentially, there was a suggestion that early childhood vaccines had a large role in the development of autism in children. The story of this theory is an interesting one, and the debate has been comprehensively shut down by the worldwide medical fraternity in the years since it was presented. 

The story now is more about the dangers of wild speculation and the damage that conspiracy theories and fantastical suggestion can do to human lives. This is a brief synopsis of the debate; its origins, debunking, and why we need to stop allowing irrational paranoia to inform life altering decisions. 

The connection between vaccines and autism was first hypothesized by British gastroenterologist Andrew Wakefield, who published a study suggesting that the measles, mumps, rubella (MMR) vaccine was increasing autism in British children. The 1998 paper was published in The Lancet, a prestigious medical journal, and immediately triggered widespread fear amongst parents with young children. 

“The paper itself later was officially labelled “fraud” by England’s General Medical Counsel, but it triggered a lot of debate over the safety of the vaccine which continues to this day. 

“The paper’s findings led other doctors to do their own research into the link between the MMR vaccine and autism. At least 12 follow-up studies were done. None found any evidence the vaccine caused autism. 

“An investigation into the 1998 study also uncovered a number of problems with how it was conducted. The journal that published it eventually retracted it. That meant the publication no longer stood by the results. 

“In 2010, the General Medical Counsel declared that the paper was not only based on bad science, but was deliberate fraud and falsifications by the head researchers, Dr Andrew Wakefield and revoked his medical license. Investigators learned that a lawyer looking for a link between the vaccine and autism had paid Wakefield more than £435,000 (equal to more than a half-million dollars).” (webmd. com, reviewed by Dan Bennan, MD, 2020) 

None of these details alleviated parent fears at the time, so several major studies were conducted to determine a link between vaccines and autism. None of the studies found evidence of any link at all. 

One major study was commissioned by the World Health Organization (WHO), which is described here: “WHO, based on the recommendation of its advisory body the Global Advisory Committee on Vaccine Safety (GACVS), commissioned a literature review by an independent researcher of the risk of autism associated with MMR vaccine. The existing studies did not show evidence of an association between the risk of autism or autistic disorders and MMR vaccine. 

“Based on the extensive review presented, GACVS concluded that no evidence existed of a causal association between MMR vaccine and autism or autistic disorders. The Committee expressed its belief that the matter would likely be clarified by an improved understanding of the causes of autism.” 

The fact that the debate continues to drag on in some quarters is probably due more to the fact that the true causes of autism remain a mystery than any actual evidence connecting vaccines to Autism Spectrum Disorder (ASD). It has been an easy rallying point for the anti-vaccine faction, and no amount of rational, science-based evidence will completely eradicate some brands of irrational thinking. 

Local paediatrician extraordinaire, Dr Sylvanus Nowab sums the debate up like this: “There is no proven evidence that any vaccines cause autism. There is a developmental stage between 15- 18 months when children start to develop more socially and increase verbal expression. That period coincides in the western world with when they get their MMR (measles mumps and rubella vaccine). 

“So, kids who haven’t been diagnosed earlier with autism show their delay, then the anti-vaccine camp says that was caused by vaccines. When you look at other places like India and Africa, children get these vaccines earlier and more and the incidence of autism is not higher.” 

Still, without a strong determinant of what causes autism, the anti-vaccine camp will continue to hold on to their hypothesis. The danger is clear when you consider that lowering immunization rates have already caused an increase in previously controlled diseases in young American children. 

“Researchers now link falling immunization rates to recent resurgences of vaccine-preventable diseases. In 2010, California saw 9,120 cases of whooping cough, more than any year since the whooping cough vaccine was introduced in the 1940s. Ten infants too young to be vaccinated died of whooping cough during the outbreak. The CDC warns that events like these will become more frequent and harder to control if vaccination rates continue to fall. 

“Fears over the safety of vaccines are understandable. The CDC vaccination schedule calls for children to receive up to 14 inoculations by the age of six – many of them vaccines developed within the last twenty years. Many parents distrust these vaccines, worried about the potential for risks and long-term side effects. Research, however, shows that most of our biggest fears about vaccinations are unfounded.” (publichealth.org, 2021) 

In essence, humanity has developed vaccines to immunize against life threatening diseases, made these lifesaving medicines readily available, and some folks have formed irrational anti-vaccine theories and put themselves and their communities at severe, undue risk. Can you imagine your infant child dying of a disease that humanity had eradicated through immunization because persons in your community refused to get vaccinated? It’s a bona fide tragedy that this can happen. 

Recent studies have identified symptoms of ASD in children well before they receive the MMR vaccine, which further debunks the myth that vaccines cause autism. Dr Nowab asserts that, “Autism is multi-factorial. Genetics play a role. Early detection and early intervention are key.” 

Indeed, research is now emerging with evidence that ASD develops in utero, which completely removes vaccinations from the equation. So, in conclusion, here’s a comprehensive closing statement from webmd. com (reviewed by Dan Brennan, MD, 2020): “The research is clear: Vaccines don’t cause autism.” 

The post THE RESEARCH IS CLEAR: Vaccines Do NOT Cause Autism! appeared first on RG Magazines.

Being from and in Bermuda is a gift – our people, this place and how both interact with one another leads to the kind of life millions of folks from around the world are willing to save for months to experience for days. 

However, our island’s gifts do not exempt us from being saddled with the type of distinct, lasting challenges that our population must confront and overcome to maximize opportunity, equality, and freedom for all. Autism and its impact on children and the families that need and love them is one of those challenges. Based on the experience and guidance shared with this writer by two Bermudian parents of Bermudian children with autism, this challenge is one that requires more work, effort, and resources for and from us all to do better by this uniquely vulnerable group. 

According to Autism Speaks, one of the world’s leading autism advocacy and support organizations, autism spectrum disorder (ASD) describes a wide range of conditions that can be largely characterized as difficulties with managing speech and nonverbal communication, social skills, and repetitive behaviours. The American Center for Disease Control estimates that autism impacts around every fiftieth child in the US, numbers that local experts believe are broadly replicated here in Bermuda. 

Ordinarily, indications of autism appear between the age of 2 or 3 but some developmental delays can appear as early as 18 months – the good news is that the earlier autism is identified, the earlier intervention can occur which increases the likelihood of positive outcomes later in life. 

However, this is where the lived experience of two local parents of children with autism – both uniquely equipped to make particularly well informed, useful observations – makes it plain that there’s much work to be done before those improved outcomes will be more universally available in Bermuda. 

As the former president of BASE (Bermuda Autism Support and Education) and a father of a child with autism, Anthony Peets is deeply familiar with the range of services and support available to the families in Bermuda who have been directly impacted by ASD. Mr Peets shared that the two main Early Intervention support services on island [BASE and Tomorrow’s Voices] provide essential help but accessing it can be cost prohibitive for families without the financial resources to meet the existing fee structure. State support, according to Mr Peets is “stretched, and not as extensive when it comes to the many hours of early intervention typically required and the variety of therapeutic modalities offered.” 

Additionally, on-island diagnosis can take years which leads many parents to seek medical intervention and guidance overseas if their insurance covers it. Additional support services like speech, occupational therapy and one-on-one engagement are expensive, particularly when coupled with the hundreds of recommended hours of best practice intervention. Consequently, as Mr Peets puts it, “parents do what they can”. 

Shelita Jones is one parent who has done what she can. She and her husband Dwight moved their family to the United Kingdom to ensure that her eldest son would receive careful, comprehensive support for his ASD while in school – a non-negotiable priority that was painfully underlined by their experience in the system here in Bermuda. Mrs Jones told me that there is a “devastating lack of understanding regarding autism.” This was demonstrated throughout her son’s entire formal educational experience, from nursery through the completion of primary school. She said that his challenges were distinct and noticeable from the beginning, but his behavioural issues were presented to her as the result of parenting flaws – that he was simultaneously spoiled and neglected, sufficiently so to justify having Social Services sent to their home to investigate. 

Mrs Jones shared that his diagnosis at seven and her son being moved to the island’s first in-school autism program helped immeasurably, principally due to the empathy and care demonstrated by the teachers and staff (which included, co-incidentally, Mr Peets as school counsellor). However, the extreme isolation and frustration she felt during his youngest years were impossible to shake loose. 

“No one was willing to help, and I spent most of that time trying to hide my struggles in the fear of being judged. I was left to trust my gut and instinct when it came to raising him,” she revealed. 

As a result of her experiences, Mrs Jones was left unable to believe that any school in Bermuda – public or private – could meet her son’s needs and relocated to the UK. Since that transition, he has graduated high school, enrolled in college pursuing a post-secondary music qualification and, in a word, thrived. 

Both Mr Peets and Mrs Jones have identified that parental engagement, commitment, and advocacy are key to ensuring that children with autism are holistically cared for. Mr Peets shared that “a major area of impact is to ENSURE that the LEAST RESTRICTIVE learning environment is engaged when children on the spectrum become of tertiary school age. Engaging with typically developing peers is major for our kids on the spectrum and early education and fostering the embrace of typical peers is so helpful.” 

There’s much more that Bermuda can do to provide resources and support for children with autism and their families – the cost of intervention can be staggering, with millions of dollars required from diagnosis to adulthood. However, as Mr Peets made clear, some of the most impactful changes are entirely determined by each of us as individuals. “It is imperative, as you will not live forever, to decide what it is that is important for your kid’s survival. Focus on strengths, focus on the things you feel are just imperative, let no ONE tell you that things are not possible.” 

Mrs Jones is just as explicit, saying “Stop name-calling these children and mislabelling them as rude, hard to deal with, or weird. A piece of paper changes nothing if you do nothing for the challenges. So, if the solution is not a piece of paper but some type of intervention, then do that. Intervene!” 

This is a challenge that we can overcome, if we choose to ensure that Bermuda’s gifts are available to everyone from this place – particularly those with ASD. 

The post Bermuda’s Score with ASD appeared first on RG Magazines.