Doctors and asthma

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DitherDither's picture
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Doctors and asthma

Howdy!

I have another asthma question for those whose Blossoms deal with it. Rache is in the middle of a pretty bad attack. It came on suddenly, we started treating it as usual, but it got no better during the night, so we took him to the pedi this morning.

He was retracting pretty badly -- the worst I've seen since he was diagnosed. His oxygen level was 90, and his respiration rate was 44. So, not good, but not freak-out mode, IMO. His spirits were good, which is unusual for him. He's dramatic when sick. They have him 2 back-to-back treatments, and he improved a bit -- 93-94 for oxygen, 40 for respiratory.

The pedi, though, basically wanted to admit him to the hospital for 48 hours for IV steroids. This seemed a bit over-the-top to me. Would your pedi do the same? How quickly do they talk hospital? He's been in the hospital once, when he had his first episode. I talked her out of it, saying it was too much money, and I thought unnecessary. So, as a compromise, he's getting steroid shots, followed by oral steroids. He's had one, and we go back at 2:30 today for the second. It was incredibly painful for him --- he was gritting his teeth and clenching his jaw. Awful and sad. I'm dreading going back. Anyone else have experience with these? Why would the pedi recommend the hospital over two shots?

Also, the pedi wants to up his medicine -- doubling his pulmicort. And adding singulair. Again, this seems excessive. I'm worried about over-medicating, esp with steroids. And adding something else. This is only the second 'big' episode he's had in a year, so it seems to me his asthma is more or less under control. But the pedi basically said, 'no, we need something new.' I'm just not sure what to think. I do think it's time to see a specialist, as we haven't up to now.

I basically feel like my head is spinning! I'm not sure what to think, feeling like the pedi is over-reacting, but not wanting to take chances with asthma. Thanks so much for letting me vent, and for any advice!

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I dont have much experience with an asthma attack, but Singular is a preventative. It opens up the airways, and from what I understand, helps prevent attacks........Zack (who is now 13) was on it when he was a toddler for his bad allergies. I loved it.

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I don't have much time to answer this because I am at work but I just wanted to give you some input!

First of all :bigarmhug: for an attack right now! I dread every fall/winter season change because I know it is going to be bad, or really bad for Landon.

If Landon would have went to the Pedi with an O2 stat of 90 they probably would have admitted him as well. I know it seems easier to just get the steroid shot, but we can't even leave the hospital until his o2 leavels are 95 (at the lowest). The steroid shots are awful Sad Landon had his through his IV on Saturday so thankfully (in a weird way) he didn't have to get the shot. Either way they open up the lungs immediately and do what the medication can't. The long term goal though is to regulate with medicine, so you don't need the steroid shot.

Now for the medicine. Landon has moved on from the pulmicort to the flovent 110mg inhaler. It is a special inhaler for children so you puff the inhaler and he has 6 breaths to take that gives him the medicine (pulmicort but called flovent in the inhaler form basically). The pulmonologist just upped this last week so he gets 2 puffs (10 breaths) in the morning and 2 at night as well, plus a singulair 4 mg tablet(he takes every nigth ..it is a pink chewable and he likes it.. easy and he has been on it since he was 2). The key is to be consistent. Having stable medication is going to be the best prevention for attacks (usually).

Now, I know he has only had a few attacks (a few too many though). Have they been the same time of year? Weater? Exercise? When he does have an attack my best bet for you is to do the albuterol always first before the pulmicort. The albuterol will open the lungs up, and if he has been already on the pulmicort it will get into his lungs better after the albuterol gets through.

Landon made it a year without a steroid shot (until this past weekend) and that was a huge accomplishment for him.

This is probably all over the place but I need to get back to work lol! I will be back so if you have any questions just shoot away!

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Thanks so much for your help! We just got back from the dr., and he didn't even have to get the second shot. Yay! We'lll just be starting the oral steroid tonight. And we talked about going to a specialist, so hopefully we can get an appt before too long, esp since baby #3 could make an appearance sometime soon! And we're going to keep the pulmicort the same, but add the singlulair. Not too thrilled about an extra $35 a month out of our budget, but what can you do?

"PaulaJoFSU" wrote:

If Landon would have went to the Pedi with an O2 stat of 90 they probably would have admitted him as well. I know it seems easier to just get the steroid shot, but we can't even leave the hospital until his o2 leavels are 95 (at the lowest)

This is good to know...at least my pedi wasn't over-reacting. Sometimes I feel like she is quick to jump the gun with things. I was looking a bit online, and it seems that 92 is when most people admit to the hospital. In some ways it makes me think maybe I should have followed her advice, although the shot seemed to work. Partly I just hate our hospital. It sucks. We live in the country, and it's just not the best care. The people on the pedi wing don't even seem to like children. Our last experience there was not good.

"PaulaJoFSU" wrote:

The key is to be consistent. Having stable medication is going to be the best prevention for attacks (usually).

We do need to get better about this. While we are 98% consistent, we do let the pulmicort drop some nights if we're out late. It's not very often, but it does happen. I think this whole episode serves as a good reminder to be more consistent!

"PaulaJoFSU" wrote:

Now, I know he has only had a few attacks (a few too many though). Have they been the same time of year? Weater? Exercise? When he does have an attack my best bet for you is to do the albuterol always first before the pulmicort. The albuterol will open the lungs up, and if he has been already on the pulmicort it will get into his lungs better after the albuterol gets through.

His attacks are mostly in the fall / winter, and come on with colds. No allergies so far, usually just a cough and stuffy nose that we start treating with albuterol to prevent an attack. Is this pretty much what you do?

A year into this, I still feel like there is so much to learn. Our pedi was saying that, ideally, the pulmicort should make it so that he doesn't have to use the albuterol much at all, or never. Since he's been using the albuterol at least every 4-6 weeks in cooler weather , she says his asthma isn't controlled. I don't see how it would be possible to never use albuterol, given that kids get colds. Even she said a healthy kids gets about 10 a year. This just doesn't make sense to me, how can the goal be to never use the rescue medicine? Then I asked her if we were jumping the gun giving it at every cold, and she said no. So confused.....

Is Landon on oral steroids very often? I think Rache has had them maybe 3-4 times this part year, not including now.

Also, for the singulair....does Landon have allergies that trigger his asthma? I guess I've always assumed the singulair was for that, but maybe it's just to open the airways in general? If rache doesn't have allergies, should he be on it? Will it be of any benefit?

Wow...this post was a book! I hope it's not too rambling.... Thanks for reading if you got this far. And PaulaJo...you are so awesome. I feel like you are a wealth of knowledge! Smile

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I have no experience, Jax has mild asthma and we've never had o2 saturation below 97%, and haven't had an 'attack' yet. I do know from when my dad was in the hospital, an o2 sat of 90 is really into crisis mode. I don't think your Dr was over reacting in the least.

:bighugs: to you for having to go through this with #3's arrival so soon.

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"luangwa" wrote:

I have no experience, Jax has mild asthma and we've never had o2 saturation below 97%, and haven't had an 'attack' yet. I do know from when my dad was in the hospital, an o2 sat of 90 is really into crisis mode. I don't think your Dr was over reacting in the least.

:bighugs: to you for having to go through this with #3's arrival so soon.

The more I'm reading and talking to people.....I realizing that I may have 'under'-reacted. Sad I had no idea that 90 was considered so low. When he was first admitted, back in Oct. 10, his o2 was 87, so I guess I had assumed anything in the 90s was okay. I remember once taking him to the ER (this was last Dec) for an attack, and his o2 was 95ish, and the whole staff seemed pissed that we'd brought him in. Like 'why are you here -- he's fine.' (Did I mention how much I HATE our local hospital?) I wish our pedi would explain more....I feel like I ask questions, but not always the right ones. On one hand I'm so, so happy to be home tonight and not in the hospital, with a boy who is feeling so much better. But, on the other hand, now that I know how low a 90 is....I wonder if I should have followed the pedi's initial advice. I'm always second-guessing myself....ahhh....motherhood!

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My philosophy is no harm no foul, KWIM? He responded well to one steroid shot, so you apparently made the right call. I think if your Doc hadn't thought the shots would work quick enough, then he probably would have stressed how very low a 90 o2 sat really was. Don't beat yourself up over what you didn't know. It's ok.

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I agree with Mel, don't beat yourself up! I am still learning and things are still changing with Landon each time something happens. It is always something lol!

I tried to multi quote but it isn't working or my brain isn't functioning enough to use it correctly lol so here we go..

Our hospital isn't the greatest either. Actually, I called and filed a complaint today on the nursing staff for this weekend. The best thing you can do is be informed. The pulmonologist really did that for me. A whole new level of knowledge and information.

Does he take the pulmicort in the nebulizer? Do you think he would do an inhaler easier? When the pulmonologist perscribed the inhaler I was worried, but it is SOOOO EASY and quick and gets the job done.

Landon doesn't have allergies either so the singulair doesn't have to go with that. He is really weather based too, and a cold is usually a first on set..although not necessarily. They say to take it at night too.

I am going to write up our asthma action plan when I have time just so you can see when we go into the yellow zone, and when he needs to go in.

ok we just got home for our xmas party and i still have more to say..ahh..i;ll be back

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Ok, here is his action plan! I think it is nice to have.. especially when Landon falls into the yellow zone to stay in that zone for 7-10 days is not something I always did. Also, last time we were at the pulmonologist I told them that he has a pretty consistent cough, which is why they upped his flovent to 2 puffs 2 times a day instead of 1 puff 2 times a day.

I have been all over with my pulmicort and flovent because after winter it is like he doesn't need it.. and well I get lazy. I have found though, the more consistent I am even if his asthma isn't acting up at all the less and less I need the albuterol. His asthma is much more managed. This year up to last weekend has been pretty controlled compared to the last two, but I am still learning lol!

Before I went to the pulmonologist Landon was in the ER and hospitalized more times than any child should. Steroid shots the whole bit. The goal with asthma is to have the steroids as last minute, not something you want/need/get. So, if I follow my action plan and he gets to red regardless then obviously they will give him what is needed...but I just need to be intune with it.

Our Action Plan: Just updated last week


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Thank you so, so much for posting the action plan! It was interesting to see that he could still use the rescue meds 2x and be in the green zone. Yesterday my pedi made it sound like it was possible to never use them....this makes me feel a bit better. And it makes more sense!

We got an appt. with the pulmonologist for next week! I'm pretty thrilled about that. It's an hour and a half away, but we'll just make it a day in the big city. Again, thank you so much! It's so good to have a resource like this. DH use to tease me about posting on here....but now I think he understands how great it can be. Smile

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That would be the yellow zone Wink The 2 puffs is his inhaler! If we have to use any rescue medication it is automatically in the yellow zone!

I am so glad you got an appointment and so soon!!!! AWESOME!!!!!!!!!!! I drive an hour to get to ours too...but it is worth it!

Can't wait to hear about your appt! Keep me updated!

How is he doing by the way?

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Oops...that's what I get for trying to read with two wild children hopping on me. My concentration skills are not so good right now. :rolleyes:

He is doing okay...thanks for asking! He was wound up all day, I guess from the meds. (Another reason I hate them!) But at least he was happy and cheerful. I'd say he actually is making a quick recovery this time. We'll probably keep him home from playschool tomorrow, and try to keep him quiet. (Easier said than done!) And I will definitely update after we go to the new dr. I still can't believe they worked us in so quickly. I'm just hoping this baby holds out....Rache was born at 37 weeks...which I'll be the day before the appt. Yikes!