Today, in the epic battle to bring my asthma under control, I started treatment with Xolair, which I mentioned in my last blog entry.  I had originally thought that the Xolair would kick in immediately and I’d be able to go jogging through a pollen-rich cornfield shouting out, “Come and get me, allergens!” this afternoon, but alas, that is not to be.  Instead, it takes about a month, according to my immunologist, to reduce the bloodstream levels of IgE measurably, and another month or so after that before the asthmatic symptoms noticeably reduce.

Something else I was confused about: apparently there is an increased risk of malignant cancers in people taking Xolair — 0.5% incidence in people taking the treatment, vs. 0.2% in the placebo group.  There’s a part of me which can’t help but worry over the increased odds (because that’s how I am), but intellectually I know that 0.5% chance of getting malignant cancer is still 99.5% chance of not (and anyone who knows more about statistics than I do who knows otherwise, please let me live in my delusion).  And, of course, Xolair is just a couple of shots; nothing at all exciting about it.

So, I guess we’ll find out in a few months whether this is going to work out or not.

Stay tuned.

Just about every asthmatic I’ve spoken to over the past couple of months agrees that this past year has been one of the worst.  My pulmonologist/immunologist corroborates that, and says that he’s seen far more urgent flareups this year than normal.

In a way, this is reassuring, because it means that I’m not alone in what appears to be this permanent flareup I’ve had since June.  On the other hand, it really doesn’t alleviate my symptoms.  I haven’t had a good strong breath for weeks, and I’m constantly coughing and wheezing.  I’m pretty fed up with it.  At least I can work from home so I haven’t had to use any sick time.

My doctor’s frustrated as well, because at this point I’m pretty much maxed out on therapeutic drugs.  I’ve got the maximum strength of Advair, I’m taking Singulair, plenty of Albuterol, and Aciphex (a drug used to treat GERD, because sometimes mild GERD can, even if no symptoms are reported, cause an asthmatic flareup).  And yet I’m continuing to wheeze.

There’s one more option on the horizon: Xolair, a relatively new drug developed by Genentech.  Xolair operates by going in and neutralizing Immunoglobulin-E (IGE), a protein which is associated with allergies.  IGE is almost always found in high levels in people suffering from allergies (though the presence of high levels of IGE does not necessarily mean you have severe allergies), and people with low levels of bloodstream IGE very rarely suffer from allergic symptoms (again, a high correlation, not a guarantee).  Despite plenty of research, no real purpose has been found for IGE in the immune system.  Early research indicated that IGE might be important in the body’s immunological response to parasitic infection, or in the early detection of certain kinds of cancer, but more recent research seems to contradict these results (in brief, people with allergies don’t have any lower incidence of cancer or parasitic infections than people without allergies).  My pulmonologist already has about a dozen people on Xolair, and it’s provided substantial improvement without any adverse side effects.  Said improvement is usually very quick, too.

The downside is that because it’s a new therapy, Xolair isn’t covered by many health insurance companies, is extremely expensive (about $15,000/year), and has to be delivered by subcutaneous injection.  Fortunately, my health insurance plan will cover it, provided that the patient has a sufficiently high level of IGE in the bloodstream (and my bloodtest shows a much, much higher level than most people; mine was about 350, while most people have less than 10 — and I’m afraid I have no idea what the unit of measurement is).  And I’m so used to shots that this won’t bother me at all (my mom sometimes jokes that I’ve had so many IV’s due to asthma that I’ve got track marks).

The manufacturer has already approved my taking the drug, so all that has to be done is for my doctor to send the necessary paperwork to my health insurance company.  If all goes well, approval should come within the next couple of days.

Here’s hoping that the Xolair really works.  I’m sick of being unable to breathe.  And I’m seriously worried that my asthma will prevent me from being able to go to Dragon*Con (or at least from having a good time while I’m there).

This past Sunday, still stuck in Riverside and still feeling kind of sick, I decided to track down the local public library and update my collection of California public library cards (yes, I’m a nerd in some ways… my wife and my mother and all of my co-workers appear to agree). I found myself in the Mission Inn district of downtown Riverside. Turning left on Mission Inn off of Lime, I found myself on a street lined with old stone buildings, and knew that I had to park here in front of the Civic Auditorium. It was too amazing to pass up.

I know that a man alone in a strange town is supposed to get into trouble by tracking down the bars or something like that, but I don’t seem to be very good at that. Instead, I track down museums. And bookstores. And libraries. Even when I was wandering around Ireland and the United Kingdom, I was always drawn to these sights; the bars and taverns in York were cool, but the Cathedral and the bookshops were cooler. I know. I’m a nerd. And when I’m traveling for Benthic Creatures, the same thing happens. Most of my co-workers went off to tour some wineries and go wine-tasting, but I wasn’t up to it. So here I was. In the historic downtown of Riverside, California.

The building next to the Civic Auditorium was an art museum, but it, unfortunately, was closed on Sundays. That made me sad, but across the street was a place with the potential to be more interesting: the municipal museum of Riverside, with a special exhibit on the entomology of the area. That, I couldn’t pass up. I went inside, learned all about the plants and animals that are native to Riverside County, saw some of the fossils that have been dug up in this area, some basketwork by some of the Native Americans from this area (amazing… I had never really payed much attention to how tightly woven the grasses can be in a Native American basket, or how intricate the designs could be, and I was enthralled), and learned all about orange growing in the area.

Orange growing is a big thing here in Riverside. A Really Big Thing.

There was an entire exhibit devoted to oranges. How they’re grown. How they’re harvested. How they’re marketed. One wall was exclusively devoted to the history of the Sunkist Growers’ Association. And there was an exhibit of a local historian’s collection of advertising signs for oranges.

You can’t get enough oranges. Or orange marketing.

I also found the library, of course. Most of the county libraries I’ve been to have been much more impressive than the town library where I live, and Riverside’s was no exception. While the library in Modesto had an impressive computer section, Riverside’s library had a very impressive collection of government documents. I browsed through it for awhile, glancing at local soil reports from 1897, naval reports from the Revolutionary War, county census reports from 1922, and so on. Some of the books were in great shape, some were falling apart in my hands. I couldn’t help myself; I spent about an hour just in that one section. Then I spent an hour sitting at one of the study desks, working on a paper for my management theory class.

After the library, I found probably the best part of the Mission Inn district: Downtowne Books. It was one of those cool old bookstores, cooler than anything I’ve seen since Wigtown, Scotland. The shelves were old, stable but bending under the weight of so many books. Hardbound books rested comfortably on the same shelves next to ancient paperbacks. The inventory was so overstocked that books lay in neat rows on the floors at the base of the shelves, and in piles around tables and chairs. The floors were wooden, and creaked under my weight as I explored and browsed for another good hour or so.

I had a good conversation with one of the owners; she told me that she and her sister had bought the bookstore almost on a whim a few months before, and we talked about bookstores we’d been to in other countries. She agreed that she would need to take a trip to Wigtown in Scotland and pass it off as a business expense. I eventually walked out of there with a Spanish text, a copy of Sir Gawain and the Green Knight, and a copy of The Wind in the Willows for Jennifer.

All in all, a good day.

Of course, it was afternoon by now, and the bronchitis that’s been lurking in my lungs was starting to get to me, so I knew I had to get back to my hotel room to finish my paper. On the way back, I decided to stop at the grocery store and get some food for the upcoming week. The produce section at this store was huge! And dominating over the plums, the apples, and bananas, the carrots, and everything else, were the oranges!

Of course! Oranges! The amazing and glorious oranges of Riverside County, so splendour-filled that they deserved an entire room at the municipal library!

And they were all so… small.

It was like walking into a room filled with piles and piles of orange marbles. Or mothballs. Or gumdrops. I bought some tangelos (my favorite) and took them back to my hotel room. I opened one, began to peel, and found that it was almost all peel; there was barely any fruit inside of the thing at all.

I began to wonder if all the citrus from Riverside was like this. Riverside, so famed for its amazing oranges, seems to be able to produce these marble-sized fruits of nothing but peel.

I picked up my Spanish book and began to browse through it, peeled another tangelo, and enjoyed a small slice of irony.

Have I mentioned how strangely eerie it is to find yourself alone in an crowded emergency room in a strange city, having been delivered there by an overly chatty taxi driver (”And here is the part of town is where all the PROSTITUTES are!” he announced at one point, with a strong sense of civic pride, “And the DRUG DEALERS, too!”)? Yeah, it’s pretty weird. And the next morning I called my co-workers to let them know that I wasn’t going to be able to work that day. And for the next three days — Wednesday, Thursday, and Friday — I stayed in my hotel room, pretty much cooped up, sick, and with little human contact.

Thus began my descent into Hell. Well… Purgatory, at least.

I’m not much of a television watcher. When I’m at home, I watch exactly two television shows a week with regularity (Buffy the Vampire Slayer and ER, if you must know), and then maybe the occasional sitcom or episode of Enterprise to remind me of how far the franchise has fallen. I guess when I’m at home, it’s easy to find company with the cats or with Jennifer or with nearby friends and family.

But since I’ve been sick in my hotel room all week, my contact with other human beings has been minimal at best. I’ve learned the name of the room service guy (Victor); the maid (Gabriela, and she speaks Portuguese, so I can’t even talk to her); and the front desk clerk (Rochelle). But my interactions with them are limited. I have e-mail conversations with Jennifer and an occasional IM with my mom and other members of my family, but I really like to see faces; I need actual human contact, or I get kind of… weird. Pet cats and pet dogs get weird without regular human contact, and so do I.

And so I started watching a lot of television. Lots.

First thing, I refuse to watch talk shows. They are of absolutely no interest to me; the plots are contrived, the characterization weak and thin, and resolution is almost always lacking. Besides, how often can I take seriously the saga of young girls who dress up as boys and, at their father’s insistence, then try to seduce their mothers? Not often.

But I made some important discoveries about syndicated television in Riverside. On Wednesday, the first day of my confinement, I discovered that The Simpsons is on FOUR TIMES A DAY! Woo hoo! And so I made note of it: “The Simpsons: 5 on UPN affiliate, 6 and 7 on Fox affiliate, and 11 on Fox affilate”. This was heaven-worthy.

I also discovered that TBS shows a long block of recent sitcoms starting at about 11 a.m. or so. I could watch three back-to-back episodes of Roseann, and I did. TBS was showing the last season, and I really wanted to watch the final episode which I had missed when the series was new, the episode where Dan Connor dies (I think). They were almost there… but on Friday, when I was expecting the last episode, they instead showed a repeat from an earlier season. I was so mad, I could have kicked the television and written an angry letter to TBS. What the hell was up with that? It was the biggest disappointment of the week!

Anyway, right after the 90 minutes of Roseanne, there’s a full hour of The Drew Carey show, which I like because I identify on some bizarre level with Drew Carey’s character. When I get sick, I get emotional (I remember being really sick once — I think with my last bout with pneumonia — and watching the episode of The Simpsons where Lisa runs away, and nearly bawling at the scene where Homer goes and tries to play her saxophone because he misses her), and in the episode where Drew loses his girlfiend again, I got kind of bleary-eyed.

“Right,” I said to myself at that point. “Time for some human contact.”

I’d already been to the doctor that day, who listened to my lungs and pronounced me reasonably healthy and worthy of record levels of Prednisone (ugh). Not much chance for conversation with him (”Say, doc, how’s the family?” “No time, this is Riverside, I’ve got two hundred kids with colds and a prostitute with a broken arm to treat!”). The room service guy wouldn’t be on shift until 5. I was at a loss, so I finally settled for writing an e-mail to my co-workers saying that I’d be able to go into work for the Saturday round of mollusk training.

I spoke with one of my co-workers by IM later that evening. “Hey, I have a work release from my doctor saying return to full duty. Do you want that?” “Um… sure. Seems like a shame to let it go to waste, I guess.” (Apparently, work releases are not part of this company’s policy, unlike other places I’ve worked at. Here you just kind of come back to work whenever you feel like it.)

And so yesterday I finally made it back to work. The morning was fine, but I admit I started feeling worn out around noon. I spent the rest of the day mostly sitting and helping the Spanish speaking mollusks with their paperwork, which was fine. When the day was over, we all left.

Of course, it wasn’t until I got back to the hotel that I realized I’d left my full medicine bag back at the training site. Five phone calls, four barnacles, and an hour later I was back in the locked building, getting all of my medicines out, explaining to the barnacles that this was not representative of how Benthic Creatures employees generally behaved. They understood because they knew I’d been sick and kind of out of it, and none of them seemed all that put out (the people here are all very nice).

My co-workers had plans for dinner last night, of course. I wanted to go with them, but by then I was wiped and decided I just wanted to go back to my hotel room, get some room service and chat with Victor, and crash in front of the television some more.

Don’t get me wrong: I did do a lot of reading and a lot of work on Lucien this week. But the television was on most of the time (I even discovered that the TV has a sleep function on it!), and that’s what constituted almost all of my human interaction this past week.

Amazing what a little virus and a little solitary confinement will do to you.