So little thing that I learned recently; under the FDA, drug manufacturers are not required to disclose presence of major allergens in their products. While most medications do not contain gluten-containing ingredients, if you have any food allergy you need to make sure it's on file with your pharmacy, and speak with your pharmacist to find out how they flag for allergens in their system. Sometimes you may need to contact the manufacturer--if so, have the drug NDC (National Drug Code)# on hand, as they often need that to look it up. You can get this information (as well as manufactuer name) from your pharmacy.

So. No lie buuuut wow. Your work is well done. What other aus would you tackle if you had the time?? Inquiring minds need to know babe.

Aw, thank-you so much babe! I’m glad you enjoy my works.

Hm, other aus I would tackle (like I for real don’t have enough already LOL) if I had the time and inclination? Welp, there are quite a few tbh. I’ll throw down some of them, but don’t expect to see these any time soon. I have so many half-ass docs I need to finish already, you know?

But here’s a few of them:

- Civilian CEO Au, in which Tim becomes the CEO of Drake Industries and realizes how shady the business practices are. His clean-up attempt means he makes multiple enemies and pretty much gets his ass in danger. Cue some very understanding vigilantes saving his bacon on multiple occasions. And why are the wards of Bruce Wayne showing a sudden interest in WE’s competitor?? (Eventual smut, identity porn, and angst are a must.)

- Alien!Tim Au: Crash landing on Earth, meeting the Teen Titans is more than Tim was hoping for when his ship started malfunctioning close to Earth’s orbit. Word around the galaxy is how bad ass the Justice League is, so most thought human kind is mostly super beings of immense power. Some cute discoveries (how had no one introduced him to pizza before? It’s odd looking but tasty), some crime fighting with alien tech, and learning how humans “make love” with the team captain, Robin! (This one might be fun to do a one-shot or something some day)

- Self-Indulgent Identity Porn Au: what if Tim Drake took it upon himself to find people to train him so he could become a vigilante like Batman and Robin? A world where Tim didn’t go to Dick or Bruce to become a vigilante, but still gets training so he can try to stop Batman from destroying himself after the death of his second Robin. “Batman needs a Robin,” the masked kid tells him softly, “and I’m sorry I can’t be that for you. But what I can do is help you stop destroying yourself. I can help you save Gotham if you let me.” “I can’t have another kid’s death on my hands,” the exhausted vigilante sounds broken, gloved hands lying limp by his sides while the kid is bandaging the bleeding wounds in his abdomen. “Whatever happens is on my head, not yours. I know your Robin died, but I’m sure as hell not him.” What Batman doesn’t know about Sparrow? He’s literally the kid next door.  (I just want to write an au where Tim takes his vigilante career in his own hands, and gets attention from villains and heroes alike when he’s training to become an associate of the Batman.)

- Talon!Tim au: I know, I KNOW. I’ve written short things about Tim taken by the Court of Owls to become the next Talon when the Court failed to get Dick, but I’d really like to explore this idea more. The aftermath after he breaks the Court’s brainwashing more specifically. How does he find a new normal after everything he’s been through?  - Irresistible Omega Tim: Also something I’ve kind of explored when babes brought this up in Asks. I did a post about babe’s idea of Tim holding down Gotham after B gets lost in time here, but I’d really like to take something like this and make it about Dick and Dami coming back to Gotham after some hard talks and soul-searching (basically Dick refusing to let Dami go back to the League of Assassins, dragging him back to Gotham with the argument that Dami would be dishonoring Bruce’s memory and etc.) to find Tim exhausted and beat the hell up after weeks of patrolling on his own.  Not to mention Tim presented while they were gone, so now there’s that.  I want Tim to have a relationship with young Dami that’s positive, with an understanding Tim since he knows Dami’s an abused kid with a horrific background, and Dami doesn’t know what to do with Omega coddling (eventually he sinks into it tho) and Pack Alpha Dick fairly salivating to take care of their Pack Omega. Jay, Cass, and Steph wander in once Tim presents because Omega are the glue of the Pack, and just! Baddies taking an interest in Robin even though he wears scent blockers and suppressants and everything, but Smut, discovery, family, and supportive everyone ever.  The fandom damn well needs this. - Yet another idea for irresistible Tim: What if! Babes, what if, Tim presented during that reunion with Kon after he came back from the dead and B was still lost in time? When Tim called him “Clone Boy” and took off the cowl. Just WHAT IF HE PRESENTED RIGHT THEN? What if Kon, an Alpha because Lex wanted an Alpha heir or whatever, could literally scent the stress and strain on Tim the moment the cowl comes off, can tell everything about Tim’s mental state right at that moment because he’s one of the few people Tim implicitly trusts, is dying inside because he knows he won’t be able to sway Tim away from “the Mission” unless his bestie is literally bleeding out... until Tim starts sweating and swaying, eyes going dazed, scent getting...sweeter? (Ugh, this Tim so battered and beaten down after all the fuckery with Ra’s and losing his spleen, and broken by losing his place as Robin, and just when he’s ready to throw in the towel, when he’s so fucking broken, he fucking presents. After pretty much figuring he’d be just a Beta, no, no, he’s a rare male Omega. A male Omega that smells like everything any Alpha could ever want. Tim glances up when he feels hot all over, even with the cold air on the rooftop passing over them, sees the way Kon’s pupils dilate.  “Kon?” “I need you to come with me,” is abruptly out of his best friend’s mouth, “you’re going to take a break from this Batman hunt and come with me, T.” “Wh-What?” “Don’t worry. I’ll take care of you, promise.”

So. SO yeah. Those are a few :D

Not Just My Pride (Yes I’ve Been Black, But When I Come Back You’ll know)

i'm writing a chaptered hartwin fic, eggsy's in rehab for the 3 time, and he meets a caring Dr Hart, and maybe, just maybe, eggsy can get clean this time. getting dr hart to go on a date after he gets out would just be a bonus. not betaed at all i'm just putting this here because i want it somewhere, and i'm not even ready to put the first chapter on ao3. i don't even know what rating this'll end up being in the end. eggsy experince in rehab is a lot like what i went through when i went. i sucked, i hates it, and it worked for a long time. i relaped, and today is my 7th day sober, so i thought i would post what i'm working on. anyway here ya go - When Eggsy wakes up that morning, he coulnd’t remember where he was, and how he got there. Truthfully, he was used to that feeling, but this time he swore he knew, and when the nurse walked in, brightly smiling at him, it came to him quickly. Rehab. He was in rehab. He had agreed to it as a joke yesterday, to get his mates Ryan and Jamal off his ass, but apparently, this was not a joke. It was real, and he was livid.”I’m not supposed to be here,” he got out, voice rough for disuss and sleep. “Aye, that’s what everyone says love, give it a few days to settle in, it’s gonna be a hell of a shock at first. Time for vitals dear.” He allowed her to do them, knowing fighting back wa useless, plus there was much more on his mind currently. “When do I see the doctor?” Honestly, at twenty five, Eggsy had already had a few court-appointed stays at rehab under his belt. Twenty-eight days of clean and sober living, and then he can get back to doing what he wants, allbeit a little more carefully for awhile. He learned during his first stay, if you just go with the program, that it keeps people off your arse, so he does that, even if the first stages of junk sickness are creeping up, he still stays calm. “Later in the morning dear, think you can handle a but of toast?” He nods, and watches her leave. Good, now he can have his little freak-out, seeing as he doesn’t remember even checking in here, and has no clue where here is, and what’s it’s name. That’s a new one even for him, really. Got fucked up and went and checked himself into care. Nice one, he tells himself. He gets out of bed, glad that he has sleep clothes on at the very least, and looks at the meger set of drawers, yup, all his stuff is there, folded and put away. Seconds later a breakfast tray is brought to his room, which speaking off, is a room for just him. Any other place he’s been to had at least two more people crammed in a small room. Looks like he’s in a nice place, one he simply can’t afford. He’ll bring that up to the doctor when he seems them, to ask for early release. He nibbles his toast, add a bit of milk to his luke warm tea, and drains the cup quickly, wishing he had more. HE has the start of on hell of a migraine, right behind his eyes, and if he can’t have some roxy to snort, he might as well try to help it with a bit of tea he figures. He’s left alone, something else he finds strange, while he goes through what he has and pulls on some jeans and a polo, sits back on the bed, and waits. That’s when he notices the tremor in his hand, and he swears to himself. Eggsy figures he’s been asleep for at least two days, enough time for all the shit he took before coming here to leave his system, and the dull throbbing behind his eyes to start really making it’s presence know. BEfore he can get the nerve to leave his room to ask for something for the pain, and orderly has arived, asking for him to come along, time to see Dr Hart, and best to hurry up, yeah? Oh yeah, Eggsy thinks, hurry along, trying not to vomit on his feet as he walks. Eggsy doesn’t look around, doesn’t take notice of his suroundings to get a feel of where he’s at, he just want’s to get where he’s going, and die in peace, thank you very much. They get there quickly, blessedly quick, where he slinks down in the waiting room chair, the orderly beside him. He hears the name try to strike up a conversation, and finally Eggsy through him a look, and goes back to his own private hell. Junk sickness has set in, and all he wants in life is one sweet blessed tramadol at this point, to calm the pain, to make is bearable. He hears the office door open, and, if Eggsy where feeling any better, he’s perk up some, because jesus fuck, he’s exactly the type bloke Eggsy goes for. Tall, beautiful, posh, and utterly out of his leage. He almost smiles when he stands up, following Dr Hart’s motions, and takes a set on the chaise lounger in the corner of the room, curling up quickly. “Hate to tell ya this bruv, but I don’t have the money to be in a place this nice, yeah? Might as well send me on home now, ok?” Eggsy looks up when Dr Hart laughs at him, not unkindly, but still, the tosser actually is laughing at him, “Eggsy we don’t turn people away based on that here, but that was a worthy try. Tell me, how do you feel?” Eggsy groans, “The fuck you mean, how do I feel, I’m going through junk sickness cause you all let me fucking sleep it off, instead of making me stay away so I could take something to help this, yeah? I feel like I’m dying,” he whines, deep in his chest, as a back spasm hits him. “Eggsy you were passed out for two days, we tried to wake up several times, and you wouldn’t respond. We had a heart moniter on you until this morning. After seeing your blood test results this morning, I’m utterly surpirsed that’s all that happens. Most people who take that much oxycotin and ativan, with whisky chaser die. However, I can give you something now, if you like.” Eggsy just nods his head quickly, hoping they hurry up with the old standby of tramadol and beta blockers quickly. Which, even more surpirsing, if exactly what Dr Hart does. It’s not much, it’s a low dose of each, and he has to swallow them, but before he’s taken back to his room he hears the doctor say, “Same time tomorrow Eggsy, and it would help if you went to your first meeting today as well.” It takes an hour for the meds to start working, and even then it’s just a sickly sweet amount, just enough to stop the shake, but not enough to stop anything else. He feels like he has the flu, and really just wants to go back to bed, when, for some reason, he leaves his room, goes to the nurses station, and asks what time and where at the NA meetings. Apparently it’s already three in the afternoon, and one just started, and if he was quiet, he could slip in. So, he follows he nurse down the hall, to the left, and opens the doors to a meeting already in place, and everyone quickly looks at him as he slids into a chair in the back. He’s been to loads of meetings, so he doesn’t really listen. He knows that talking about the fucked up stuff you did high off your ass, boasting while sounding ashamed is somehow supposed to help, but for the life of him Eggsy doesn’t really understand the point. He turns out most shares, clapping when they’re done, stands to say the serity prayers, and just goes back to his room. That’s when it hits him, he’s stuck here Sure, for a couple of more days they’ll give him a little bit to ween him off, not to shock his abused system anymote than it has to be, and then he really be stuck here, sober He’s terrified, because he knows this is a means to an end, really. He said he would do this when his mates, his mum and little sister all begged him to go, to try again, so he did. He didn’t actually mean he would go to rehab. Yet here he was. He was too tired to think about it, about the hard amount of partying he did before they shoved him in a cab and gave the cabbie the name St Hope’s Place, just right outside of Canden Markets. He was too busy enjoy not feeling anything. If he really thinks about it, he doesn’t remember signing himself in at all, or bring brought to his room. Things he should ask the nurse up at the station for, but then he remembers Dr Hart saying any one else would have overdosed, and then he decides, he truly doesn’t want to know how he got inside, into the room. He really doesn’t want to remember anything, at all. All he really wants is to get out of her, go back to his flat, find the bottle of roxy he got hidden in the top of his closet, crush up and snort them, and sleep for another two days. And, yet again, it hits him, if he’s here, that means someone’s paid for him to be here, and if anything, Eggsy doesn’t want them to waste their money on a lost cause like him, but, he supposes, while he’s hee, he might as well give it a shot, who knows, maybe this time it’ll stick. There’s always a first time for everything, Eggsy figures, why would getting sober, going straight and getting his life together be any different?

The Writer's Guide to Asthma Part 2: Treating Asthma at Home

(This post is Part 2 in a series on Asthma for Writers.)

In Part 1 we covered [the fundamentals of asthma] — what it is, and why it’s so devastating for so many people.

Today we’re going to go through some of the more common, run-of-the-mill or home treatments for asthma. (Next time we’ll go into the prehospital, emergency department, and ICU care of severe asthma attacks!)

There are four main fronts of battling asthma, each of which may be an extremely important aspect of asthma care for your characters. So let’s dig in!

Trigger Prevention

The best asthma attack is the one that never happens. Asthmatics who have specific triggers are best off avoiding those triggers in the first place.

While this isn’t so sexy from a writer’s perspective, it’s an important part of the way asthmatics might think in their lives. For example, asthmatics who love animals may stay away from animals; they may force friends or family who smoke to do it outside and may constantly be shifting to be upwind of the smoker if they’re out with them; they may stay indoors to avoid pollen and ragweed.

Frequent cleaning may be important, particularly if the character is triggered by dust or pet dander. HEPA filters help clear the air for the asthmatic character and prevent particle-triggered attacks.

There are a number of preventative medications, too, which fall into the categories below.

Preventative Medications

Steroids, particularly glucocorticoids, can be extremely helpful in preventing asthma. These include medications like fluticasone (Flovent), which comes as an inhaler. (The same medication is also a popular nasal spray for allergies.)

It’s important to realize that your character can’t reach for a steroid during an attack and think that it’s going to cure their exacerbation. Steroids take hours to kick in, even those given emergently by medical staff.

Leukotriene blockers, such as monteleukast (Singulair), are important adjunctive medications, and many asthmatics find that taking a leukotriene blocker is enough to control their asthma. Monteleukast is a tablet taken once a day.

Many asthmatics must also take daily doses of albuterol, or combination medications such as CombiVent or DuoNeb, which are both discussed below.

Oh, one last thing. Methyxanthines (methyl-zan-theenz) are a small, but helpful, class of medication — and a natural ingredient in coffee. Coffee helps asthma a little bit.

This PSA has been brought to you by Asthmatics Justifying Our Coffee Habits™

Attack Meds: Bronchodilators

Medications taken during an asthma exacerbation are helpful because they help stop the escalation of inflammation and relieve the bronchoconstriction.

Particularly, bronchodilators do a great job of directly opening up inflammation, with one major caveat that we’ll discuss in a moment.

The primary category of bronchodilators are a group of medications called beta agonists, which means that they affect the B1 and B2 receptors. (B1 increases heart rate; B2 causes bronchodilation.)

Far and away the most popular medication for this is albuterol (known as salbutamol in the UK and in some other countries). Albuterol is primarily a B2 agonist (meaning it activates the B2 receptors), but it does have some B1 properties, meaning that those taking it can feel their heart rates climb and have their hands begin to shake.

Levalbuterol, popularly known by a trade name Xopenex (Zoh-pen-ex), is another medication your asthmatic character might take, particularly if it’s the 90s. Xopenex is supposed to be more B2 selective, meaning it has less effects on the heart. But it’s also extremely expensive by comparison; albuterol might cost less than $20 for an inhaler, while Xopenex can be hundreds of dollars a month. They’re about equally effective, which is why Xopenex isn’t very popular.

Albuterol, which is also known by the trade names ProAir, Ventolin, and Proventil, is given one of two ways:

By inhaler.

The character will purse their lips around the port of the inhaler, press the medication bottle, and the medication will puff out; they’ll inhale at the same time to get the medicine into their lungs. They’re encouraged to breathe deeply.

Some characters may have spacers with their inhalers; these are essentially a small accordion that the character can inhale through, which will mean that they don’t have to time their breath to the triggering of the medication. This is very helpful for kids. I personally dislike them, but that’s me.

By nebulizer. Scroll back up to the top of this post. You see the happy monkey with the mask on his face and the little medication chamber below? That’s a nebulizer mask setup. Monkey, or monkey’s parent/friend/nurse/hopscotch partner, will open a small packet of medication, squeeze the liquid into the medication chamber, and start a pump that will force air through the nebulizer. The liquid bubbles as the gas goes through it, and the medication disburses into the air, which the character breathes in.

The significant downside to inhaled asthma medication is this: it has to get through the constriction in order to help. The bronchioles are tight and air flow is reduced, but in order to help, the medication has to travel through the constricted passages into the alveolus of the lung, so that it can enter the bloodstream. The portion of the medication that simply sits on the surface of the airway is actually completely useless. So the character may be too constricted for these to help much. (Foreshadowing for the next post!)

Attack Meds: Anticholinergics

The other main category of medication for acute asthma attack is the anticholinergic. The typical medication for this is one called ipratropium bromide, better known as Atrovent. Atrovent helps dry up the secretions that asthma produces, which makes it easier for air to be exchanged.

Attack Meds in Harmony

So if you take the bronchodilator albuterol, and the anticholinergic ipratropium bromide, and you mix it up into one asthma-kicking bundle, you get a great one-two punch. One opens up the passages, the other dries them out, and the character can feel mighty better, mighty fast.

This pair of medications is known as CombiVent or DuoNeb, and is the go-to asthma treatment at the time of this writing for acute exacerbations.

But What If That’s Not Enough?

Next time on Asthma For Writers, we’re going to take a dive into the world of asthma from the acute care perspective: EMS and hospital admission. We’ll talk about injected medications, steroids will make a reprisal, and we’ll talk about the Bad Day version of asthma: status asthmaticus.

Thanks so much for reading! I know many of my readers are asthmatic. Did I do a good job describing your home care? Is there anything I didn’t think of? Drop a comment and let me know!

xoxo, Aunt Scripty

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The Writer’s Guide to Asthma Part 2: Treating Asthma at Home was originally published on ScriptMedicBlog.com