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Love the one you're with

My father has a barn with a rodent problem, 35 miles from the city. He is always on the lookout for a good ratter.

"Be sure to tell your father that one of the cats caught a large rat the other day," my mother said last week.
"Which one?"
"I don't know. So he has to take both."

My mother is allergic to cats now, too. She always assumed she wasn't allergic to animals. So did I, although it was quite dramatic when my cat allergy was identified. I had debilitating symptoms, severe enough to prevent me from working. That was the flare-up that demanded attention; my asthma had been bad enough that I sought medical care for quite some time beforehand.

My mother assiduously managed my asthma from at least my adolescence, but I don't remember taking it seriously. I rode bikes or went running or whatever I was into at the time. I could never be depended on to carry an inhaler. A trial on extended-release oral theophylline was an even greater failure than a rescue inhaler: both made me feel worse than the symptoms themselves. The theophylline made me feel downright sick.

Just after the Persian Gulf War, I had a serious respiratory illness, possibly the 'flu, although the urge to refer to it simply as Gulf War syndrome has never worn off. I was off work for a long time. I remember being sick for two weeks. When I went back to work, I felt like I'd lost a lung.

I saw an allergist who didn't work me up for allergies at all. He treated me for something called intrinsic (or nonallergic) asthma, not unreasonable since I reported sensitivity to cigarette smoke and a recent respiratory illness. (One alternative diagnosis is "allergic asthma," which is probably what I have had throughout my life.) His treatment involved starting me with a tapered course of steroid pills to help clear the junk that had accumulated in my lungs. He put me on daily steroid for asthma, too, but I couldn't comply. It involved an enormous inhaler that offered all the charm of sucking air out of a bicycle tire. Inhalers are like that, but this one required four puffs four times a day. I elected to live with my symptoms.

The symptoms were severe compared to what I was used to, but they didn't elicit overwhelming sympathy. My mother's then-clinic treated patients with cystic fibrosis, a genetic disorder with a number of effects, including massive reduction in lung function. I stopped by her clinic to have a tech administer a quick lung-function test and emerged dejected, with measurements that reflected a 33-percent drop from previous results. My mother suggested I at least wait until I left the clinic to complain, surrounded as I was by people whose lung function tested out, best case, at about 33 percent of mine.

Even in my damaged state, I still had lung function roughly equal to normal for a person of my size and age. My symptoms were bad enough to make me complain but not bad enough to make me comply. It would be another five years before my allergy crisis motivated me to keep allergy relievers in the apartment, and a decade before I'd use asthma medication on a regular basis.


Doctors have always been more interested in my asthma than I have. I've been prescribed inhaled steroid and rescue inhalers regularly by every primary care physician. I've been offered peak-flow meters so I can monitor my lung function at home. I find it a little silly, in some ways more so since I started taking it more seriously myself and monitoring my condition.

I signed up for a study last year, and I have a visit every month or two. On some visits, I answer questions. On others, I have extensive, sometimes unpleasant monitoring tests. On all visits, I have spirometry, a careful measurement of the same functions I had tested in my mother's clinic more than a decade ago. I use two compounds twice a day, and I don't know whether either is medication or placebo. For one brief phase of the study, I was on open-label medications to bring me up to presumably my best lung function and compare my status then to my status in other phases of the study. I'm back on the study drugs, and I can't tell whether what I'm taking is different.

I am a Good Patient. My compliance is not perfect, because real life intervenes, but I answer their questions thoughtfully and accurately, to the best of my ability. I follow directions and refrain from using allergy medications and caffeine before my visits, even though caffeine in particular is so routine for me that this can result in comical levels of effort. I have had an exquisite cup of hot chocolate raised to my lips and then realized I couldn't drink it, have made a whole breakfast and had to sacrifice the fresh-brewed pot of tea for water. This sounds trivial but trivial indulgences are the hardest to deny.

I am laughably serious about the outcome measures, and I follow the directions literally and with such focus on each step that I often need to be prompted throughout, even with procedures that I have by now done dozens of times. "Ah, a doctor's daughter," said the principal investigator, watching my spirometry readings over my shoulder one morning. The curves for each of the three tries their protocol requires were nearly identical, the numbers within less than 1% of each other.

My athletic performance has improved this year, and maybe it's due to the attention effect. I manage to forget my spirometry results from visit to visit. I let them collect their data and don't second-guess my progress. I enjoy the approval they almost reflexively give me as I report no emergency room visits, no night-time wakings due to asthma symptoms, no uses of the open-label medication issued to me in case of a sudden escalation of my symptoms. It's so fast to do my questionnaire, they say, and my curves are so repeatable. ("Nice curves!" that same physician allowed himself to say, and I laughed, the good daughter.)


I was catless almost long enough for my apartment to become clear of cat allergen. I noticed some improvement right away. My previous cat had the thickest, silkiest fur of any cat I've ever touched, and it coated everything. Even if it had not itself been coated with allergen, the sheer volume of it would surely have irritated the strongest respiratory tract. Every hair was a delivery system for a biological weapon both stable and sticky. Though diminishing, my continuing reactions were enough to remind me how significant, if not strictly serious, my allergy is.

I sneezed and teared for several days a couple of days after bringing the kitten home. It hasn't dissuaded me, of course. It's motivated me to keep exposing him to water; clean-water baths made a difference whenever I made sure my cat had them regularly, and I won't waste this opportunity to train a new and pliant feline mind to expect them. I use my air cleaner every day now, although I turned it off before I brought him home so as not to scare him right away with a hissing object in the very middle of his new home.

It was being at my mother's house that made me take my allergies more seriously, and my mother's new diagnosis seems to underscore the petty perils of life here. The only asthma attack I have ever had that was severe enough to send me in search of a rescue inhaler was in this house just over a year ago, in the room I continue to sleep in when I stay here. My attack did not actually wake me, but when I did wake up, I found I could not breathe normally without coughing and that I could not speak.

There's cats here, and I'm a cat person. Who couldn't see that coming? But these cats avoid me, and while I've never fully accepted that, in this house I am not (as I am in my apartment) sharing my pillow with a cat. These are potent cats, poisonous and unusually so, compared to their cousins. They spend almost all their time outside, but in the house they rain down a torrent of symptoms even in the complacent.

If there is one thing I have learned, it is that I never learn. When I see one of these toxic cats snoozing, I drift over, unthinking, to pet her. I pick her up and let her allergen-laden fur come away on my shirt. I know what's coming, and still I reach out, as if their unwitting theft of my breath is a cry for help, an act inviting my forgiveness and affection. If they sit still long enough to be touched, they begin to purr. I feel rewarded even as I start to wheeze.

August 19, 2002