Flu, in hindsight

So, now that everyone is back at camp/daycare, I have this to say about the summer flu....

It wasn't so bad.

Oz was VERY sick for a day. Then he was kinda sick for a day. Then he was fine, but had to stay home for four more days. He had one really bad asthma flare on the tail end of it (coughed til he threw up), but we've had worse.

B ran a fever, but never got very sick.

All in all, while it sucked having the flu in July, I think this was a pretty mild strain. Certainly no worse than what they faced in November, and not nearly as bad as the strain B caught in January of 2004.

So...all the hype about H1N1. Just hype. Granted, the Tamiflu may have had a greater impact than I'm giving it credit for, but really... I don't think this is as bad a flu as the media made it out to be.

Starting Tamiflu

So...quick update...went to the pulmonologist today. (She's at the hospital, so we had to wear masks. Horrible!)

She's sure ENOUGH that Oz has flu that she prescribed Tamiflu. And if he's not better by Thursday, she wants a chest X-ray.

Sigh.

He seemed more energetic today, but still not eating much (a little Kraft macaroni and cheese at dinner, that's about it)... but still running around 102 and looking pretty poo-ey.

I'll keep ya posted.

Oz might have the flu

MIGHT have the flu.

After a mild flare yesterday, my monkey woke up with 102 - and ran that fever all day long. He didn't complain of a sore throat, but did complain that his legs hurt and his head hurt, and occasionally that his stomach hurt. He could barely keep his eyes open all day.

At daycare, of the 70 kids or so enrolled, an alleged 23 were absent. A few tested positive for strep, a few had suspected flu cases. The Board of Health called while I was there dropping Ig off.

I took Oz to the doctor, and after waiting an hour, he tested negative for strep and negative for flu...HOWEVER, the rapid flu test has a 25% false negative rate. The doctor thought his symptoms looked enough like the flu that she's not allowing him to return to daycare until Monday. (And that's the date she put on the note he needs to go back!)

She also wants me to call the PP to see if they want him to go on Tamiflu, before the final flu test comes back from the lab.

I'll one-up them on that: I'll take him to the PP. Given his history of pneumonia, I think I want him to be seen. Especially the way he's coughing right now!

Perioral Dermatitis - from Comments

Got this comment from Lauren about Perioral Dermatitis:

Aimee, I found your site while looking for a possible link between discontinuing Flovent and my son's rash around his mouth appearing a day later. Your blog entry and the comments by others were the only information I could find about perioral dermatitis caused by flovent or stopping flovent. Have you had any more experiences with it since your post?

The pediatrician and the allergist both had never experienced anything like it. He got a topical antibiotic cream and I suspected it wouldn't work after reading your blog, but gave the doctor the benefit of the doubt. It actually mostly cleared up with the cream, but then rebounded quickly as soon as he stopped using it. He's now back to using the cream plus on an oral antibiotic. I'm wondering if we should be reporting this to the drug company (GSK) since it seems to be an undocumented side effect that doctors have no idea about.

So, yeah - periorial dermatitis can DEFINITELY be caused by Flovent, or any inhaled steroid. I'm surprised that more pulmonologists don't talk about it!! #1 son had it so bad, it was terrible. It made him so sad - it looked like had terrible acne. And we had to go to several doctors before received an accurate diagnosis and treatment. One doctor referred to it as "steroid acne," which I think is accurate - but didn't prescribe a strong enough treatment.

Ultimately, it required a three-week course of SERIOUS oral antibiotics and a topical antibiotic gel. It's pretty serious stuff.

Lauren - I'm in support of your approaching GSK with this one. It should be listed as a side effect.

Thanks for bringing the topic back up. I'm sure there are plenty of other moms out there who could use this info

For Erica: Yes to Flovent!

Got this via comments:

hi, I have a 2 year old that was recently diagnosed with asthma They put her on pulmicort and she does fine with it, my problem is she HATES to sit there and take the medicine. It seems to take forever!!! So my doctor said I could put her on flovent and take it through the inhaler, I am kinda scared about switching her. I hate the fact that she has to take medicine anyway, but switching makes me nervous. Have you ever used it? What do you think?? Thanks so much for your time, Erica

Flovent is essentially the same medication as Pulmicort, but it's delivered via an Metered Dose Inhaler (MDI) instead of a nubulizer. You'll need a spacer, like Vortex or an Aerochamber, but it's easy to use and takes about fifteen seconds to administer!

One tip: Flovent can cause thrush, so we always do our meds immediately before brushing our teeth. It's just become part of the AM/PM routine at my house, and compliance is not even an issue. (Talking with the mask on is....)

I'm sure you'll do really well with the switch. Good luck, Erica!

Superintendent Apparently Harrassed Over H1N1 Scare. Poor Guy.

When you live in an upscale suburb, you get to know how the parents can be. Let's just say, I wouldn't want to be a teacher in my town. The "catch more flies with honey" strategy isn't a popular one. The "I'll sue your ass!" strategy definitely has more takers around here.

So...I can't say I was surprised when I got this email last night from the Superintendent of Schools. You'll recall he sent out an initial email yesterday announcing a single case of swine flu.  Another email, confirming that yes, in fact, it was just ONE case followed shortly. And then, God bless him, he sent this out last night: 

Dear Parents/Guardians:

Many parents/guardians have contacted my office and the schools seeking additional information regarding the student who has been diagnosed with H1N1 influenza and the risk to students throughout the district. More specifically, an e-mail is being circulated amongst the parent community claiming many more H1N1 influenza cases and I feel it is critical that I address the concerns contained within that e-mail.

As stated before, and confirmed by the <> Health Department, only one child within all of our schools has been diagnosed and confirmed with the H1N1 influenza virus. This student, along with other students in our secondary schools, attended a religious retreat over the Memorial Day weekend. It was learned Thursday evening, from parents of other students who attended the same religious retreat, that other students have subsequently experienced flu-like symptoms. As of this e-mail, we have heard from one other parent whose children are being tested for H1N1 influenza after one of their children tested positive for Type A influenza. The results of that test, for H1N1, are not available.

H1N1 influenza is a Type A strain of influenza and it is estimated that there is a 75% chance Type A influenza will test positive as H1N1 influenza. Flu-like symptoms include fever, headache, exhaustion, dry cough, sore throat, runny or stuffy nose, muscle aches, and stomach ailments such as nausea, vomiting, and diarrhea.

To date, neither the Health Department, the Department of Health and Senior Services, or the Centers for Disease Control and Prevention recommend school closures. It is important to remember that unless we all remain in our homes, there is no sure way to prevent transmission. We are all susceptible by going to the mall, a restaurant, a movie theatre, a youth retreat or other public place. There is no definitive information that school closure prevents the spread of H1N1 influenza.

Health professionals are learning more about H1N1 influenza every day, and most believe that the longest survival rate of the virus on any surface is eight hours or less. This means that H1N1 influenza virus cannot survive overnight in any building or in any of our schools.

If your child develops flu-like symptoms you should contact your primary care physician and your school nurse. If your child is symptomatic, you should keep them and their siblings home from school. I encourage all of us to exercise proper hygiene and most importantly washing our hands. It is important that this is reiterated to your children at home. It will help reinforce what they are learning in school.

It is has not been recommended, by local and State health officials, that we close our schools. Public Schools remains vigilant in ensuring the safety of our students. We will continue to monitor and assess any abnormal absentee rates and keep you apprised of any important information. We will continue to evaluate and be diligent with regard to possible cases of H1N1 influenza. Rumors regarding students exhibiting flu-like symptoms must be confirmed and I encourage you to contact your child's school nurse if you feel you have information about a student/family that is not being reported.

Rather than frequent e-mails regarding this issue, we will be updating our website, www.townshop.org, with any other information regarding our schools and H1N1 influenza.

Sincerely,

Superintendent of Schools

Think the guy was harrassed much yesterday? Sheesh!

H1N1 in our school. Should I be worried?

I just got an email from the superintendent of our school district. 

Dear Parents/Guardians:

 We have just received word that the test results from the student who attended the religious retreat last weekend were positive for the H1N1 influenza.  As my email stated last evening, the ill student did not attend school this week.  We are happy to report that the student is feeling much better and is resting at home.  

Some students from the trip, who were not exhibiting any symptoms, did come to school on Tuesday morning, however they were sent home as soon as we were alerted of the possible exposure.  The rest of the students who were on the trip, along with their siblings, were kept out of school for 72 hours;  24 hours longer than the advised incubation period of 48 hours.  No other students from this trip have exhibited any symptoms and the incubation period was over on Tuesday.

 We are working in conjunction with the (local)Health Department and are following all of the tracking and precautionary measures advised by them and the State Health Department.  The number one advisory from both health departments is strict hand washing.  However, we do encourage parents/guardians to educate themselves about the H1N1 influenza and the best resource is the Center for Disease Control and Prevention website, www.cdc.gov.

(Our local) Public Schools (have) taken and will continue to take every step necessary to ensure the health and safety of its students and staff.  As always, a parent/guardian has the choice to keep their child home from school;  however, please be advised that regular attendance procedures apply.

 If you have any questions please feel free to contact your school nurse.

Sincerely,

 

XXX

Superintendent of Schools

 I should probably, as the mother of an asthmatic child in the district, be more concerned...but I'm not. It's the flu. Its a weird summery flu that comes from pigs, but it's the flu. B's allergic to eggs and can't be vaccinated anyway, so it's really no greater risk than any other flu.

Semantic Pragmatic Disorder

Holy S**t! This is it - this is my Ig!  Check it out: http://www.brighttots.com/Semantic_pragmatic_disorder

Spring Asthma Update

Hey, all - just checking in. It's been quiet on the blog, I know, but believe me...not so much at home!

While we've kept the asthma at bay well enough, sons #1 and #3 have had horrible allergies this season (ironic, since #2 is the only one with diagnosed allergies).  I really need to get them both to the peds - runny noses, wet coughs, all kinds of icky booger nastiness. #1 is 7 now and really uncomfortable. He's getting a little relief with Zyrtec, but not nearly enough.

More time consuming and concerning has been the story of #3, our little Ig, now 3.5 years old. As my longtime readers know, #1 son has Aspergers Syndrome, a mild form of autism. (He's 100% mainstreamed at school, doing beautifully and has absolutely no disciplinary issues.  He's a gift and a blessing in every way.) So we have some experience with developmental concerns. And we think Ig has some kind of developmental delay. We're not sure what, but we're trying to get answers.

The last few months of my life have been spent (apart from changing jobs and restarting my singing career at night - another story!) trying to get help for Ig. This has involved a long process with the school district's Child Study Team, several unreturned calls to the nearest Child Development Center (finally got an appointment - in August) and a visit with a family therapist...along with many tears and a lot of shouting.

Ig is a beautiful little soul, but so difficult that he's thrown off the balance we had as a family. He obstinate, combative, and prone to tantrums. He has no impulse control whatsoever, which concerns me every single waking moment (he WILL run out the door of the daycare center and into the driveway. He WILL leave the house while I shower) and he is immune to discipline. What concerns me most though are his communication skills.  He's not capable of any kind of meaningful conversation - only  brief, immediate chats about what we're doing in that moment. And I'm concerned that a lot of what he does say is echolalia.

Because I can't modify his behavior, I've modified mine. When I shower, I put on his favorite TV  show and bolt the doors.  (I plan to put a latch up high on the door, as well.) I park at the back of the daycare center, so the car can butt up to the sidewalk, instead of having to cross the parking lot and driveway to get to the door. I choose weekend activities for which he doesn't necessarily have to stay put or stay quiet - like going to our local zoo. (We went twice this weekend!)  He needs to have his own story at bed time, so I have to read twice as much (one story for B and Oz, one for Ig) so I can keep the routine we've had for him since infancy.  

And I've given up on getting him to sit and eat at dinner time. We try to eat as a family as much as possible, but Ig won't sit  (or eat) for more than a few minutes, so I just have a safe activity lined up for him when he leaves the table.

It's exhausting. And it's not fair to B and Oz. Ig requires so much of my time and attention that I worry that the two older boys are missing out - or worse, feeling like I love Ig more than them. I'm desperate to find out what's going on with him so he can get the help he needs - and so I can pull my family back together.

So...at least the asthma's been under control, right?

Civilization as the Cause of Asthma - Amazing Article

I just happened across this astounding article on the Atlantic Online - absolutely had to share it with you! It's from 2000, but still incredibly relevant and eye-opening. Here's a quote:

Martinez, who came to the United States after launching his career in asthma research, is one of a number of specialists who believe that modern life may be responsible for the developed world's asthma rates -- but in a very unexpected
way. It is not tobacco smoke or pollution that is at the heart of the problem, these specialists believe, but modern hygiene practices and antibiotics that foreclose the need for the young immune system to tackle microbial and parasitic challenges. "Just as you need to use your eyes to develop sight and your legs to develop the muscles to walk," Martinez said, "your immune system develops through its experience. By legitimately protecting our kids from dangerous infections we may have kept parts of their immune systems from maturing."

This could explain why children in the developing world, who are repeatedly infected by bacteria and parasites, are unlikely to contract asthma, whereas children in the developed world, who are inoculated against infectious diseases and frequently given antibiotics, are contracting asthma in ever greater numbers. (Martinez quoted estimates that an astonishing 40 percent of children in the United States are given antibiotics for a period of a month or more in their first year of life.)

Read on. Have your thoughts provoked.

Special AccuClean Air Filtration Offer from Mom Central

So...I got a call from Mom Central last week. While I'm a marketer by trade, I don't typically use this blog to promote stuff, but the material they asked me to post is 100% relevant and helpful. And admittedly, I'm kinda flattered to be on their radar!

They're working with American Standard (yes, the toilet people) to share info about allergy and flu prevention - and to give you a chance to win their AccuClean whole home air filtration system.

Since allergy season is pretty much here (at least in NJ. Does it ever LEAVE NJ?) But yeah - we're just about reaching those days when our cars are blanketed in a fine layer of yellow dust. (Pollen, people. I'm talking about pollen!)

Staying in doesn't help much either. According to Mom Central, it turns out that indoor air is four to five times more polluted than outdoor air, of particular concern because most of us spend as much as 90% of our time indoors (and we wonder why obesity's a problem? Sheesh!), according to the U.S. Environmental Protection Agency. So keeping our home’s indoor air quality high ensures that our kids (and even we) will be able to breathe more easily and suffer fewer symptoms during allergy and flu season.

American Standard's Heating & Air Conditioning’s AccuClean™ whole home air filtration system can makethe air in your house virtually pollution-free. (It attaches to your existing furnace or air handler, so there's no major renovation required to install it.) AccuClean removes allergens from the air in every room of the house, not like plug-in air cleaners that work in only one room. It removes 99.98% of all allergens in your house. It also removes more than 99% of the common flu virus, which I didn't honestly know air filters could even do. And apparently, it's pretty easy to clean, too. You just vaccuum it.

Hannah Keeley, one of Mom Central's consulting principals and founder of www.TotalMom.com, has been working closely with American Standard Heating & Air Conditioning over the past two years and has met with moms who have experienced, firsthand, the difference AccuClean can make in families’ homes and lives. Hannah shared this with us:

Keeping the dirt and dust out of your house is easier said than done, and cleaning every day is simply not an option for today’s busy families. AccuClean prevents unwanted dust and dander from continually circulating in your home, ensuring the indoor air your family breathes is cleaner and healthier.

Mom Central asked me to post this special offer for Kansas City, MO and Charlotte, NC families. Click the links below for more information and a chance to win a system for your home.

• Kansas City link
• Charlotte, NC link

I'm actually going to look into this too -- our pulmonologist won't let us use humidifiers, so maybe this is a good option for us to have more breathable air in our house.

Everyday Health on Inhaled Steroids

Since posts on this topic are always catalysts for comments and lively discussion, I thought I'd share this one. Everyday Health answers this question:

"My son has been on steroids for asthma since he was 18 months old. He has been on Flovent since March 2006, one puff twice a day, 110 mg. He turned three on June 9, 2006. I have two questions: Are there any studies that show long-term effects of taking this steroid other than affecting growth? Could Flovent be causing him to be hyper? He is a very busy, active boy."

The answer, by an asthma specialist, might make you feel a little better about keeping your kids on Flovent or Pulmicort.

My take (as always): I hate the stuff as much as the rest of you, but it does tend to keep my kids out of the hospital. If helping them breathe means their a little more active and a little shorter...I'll take it!

Chest tightness? S**t, maybe I DO have asthma!

So...I think I've mentioned this in previous posts, but I've been sick since before Thanksgiving. I've had a dry, chesty-cough, and I had a pretty crazy flue-like thing just before Christmas.

Turns out I've had a very persistent sinus infection, which has triggered reactive airways. The cough is really only present at night, or when I hit a blast of cold air. Or eat/drink something really cold. Or encounter a strong scent or fumes.

I'm on my second course of antibiotics (had to cut the first short when I had an allergic reaction!) and albuterol as needed.

But here's the thing: I've seen what albuterol can do to my kids, so I use it pretty conservatively. I have to be coughing a lot to take out the MDI (ProAir HFA).

But right now, I'm coughing less, but my chest feels really tight. I was trying to determine earlier if it was from the pec workout I did yesterday, heartburn, or actual tightness in my airways.

I think it is actually respiratory - and it's kinda creeping me out!! I'm going to buckle down and take some albuterol. We'll see if it helps!

Tracy's Question: When the Asthma Action Plan Needs Revision

Tracy posted this question to a post, and I thought it was worth adressing front and center:

"I am new, but desperate to find some advice. My 4 year old has asthma and has been on albuterol, pulmicort, singulair, and prednisone for a few years on and off. His 6 year old sister brought a cough/cold home from school last week and now he is battling it. All of the parents of asthma children know that when they get a cold/cough...it's SOO much worse for them over other children. I'm at my wits end, he is coughing and coughing for days now. The doctor told me to do the regular routine...albuterol/pulmicort in his machine. It doesn't seem to be helping, he has made himself vomit 2 times from his coughing attacks. It's now Saturday night, 6:30 pm and he's coughing nonstop. He isn't wheezing, but his breathing is fast. The cough is the worst, and I don't seem to be getting much help from his doctor.

Any advice on how to help the cough even a little bit other than his albuterol/ pulmicort/ prednisone. I feel like I'm overmedicating him today. I'm so stressed, he can't stop coughing. I'm not sure if it's time for a trip to the ER, but not sure what else they can do for him, we have all the meds right here, it just doesn't seem to be helping. "

I don't know if it's documented anywhere, but I swear some kids develop a resistance to albuterol.

So here are my questions for Tracy, right off the bat: Are you seeing a regular pediatrician, or do you see a pediatric pulmonologist or asthma/allergy specialist? If you read this blog regularly (and considering you came in via a post from 2005, I'm guessing you might!) you know how important I believe this is: Pediatric pulmonologist just "get" pediatric asthma better than pediatricians do. We have seen our pediatrician and been told our child was "moving air well," then seen the PP a few hours later - only to be promptly sent for a chest x-ray!

Question 2 for Tracy: When did you last have your action plan updated? It may be that your son has outgrown his current dosages, or needs stronger meds. Our middle guy is fine on Flovent 44 for the summer, but needs to be on Flovent 110 this time of year. Last year, we bumped him to the 220 for the winter months.

When it comes to the emergency meds, I always have albuterol and Xopenex stockpiled, but have found that when things get really dire, we need DuoNeb and Combivent, as well, which are stronger. (I don't know if they're typically prescribed for kids, as they seem to be COPD meds, but they definitely take care of those evil coughing fits.)

I've also been lucky enough to have a great PP with a great staff. They know I've learned to treat mountains as mountains and molehills as molehills (it took a few years...), so they've empowered me to take certain measures at home. If things are really bad, I'm allowed to administer three doses of albuterol 30 minutes apart. If there's no relief from that, we either go straight into the office, or straight to the emergency room. Note - DO NOT do this without the permission of your own doctor. I will only take these measures after calling the office and checking in first!

One more trick we keep up our sleeve: Dimetapp. If your doctor allows it, we find that this alleviates coughing caused by upper respiratory symptoms. It's not a cough supressant, so it's OK for asthmatic kids to take. Bonus: Helps them sleep, too!

So, Tracy, I hope this is helpful. I'm frequently in your shoes, and I know what you're going through. Of my three boys, Oz, my 4 YO, is currently the worst asthmatic. He will cough until he gags. Sometimes, he can't get through a sentence without coughing. It's awful, and I will do whatever I can to make it stop.

We've had a good winter so far, but he has started coughing today - and I'm visiting my in-laws in Canada without the nebulizer, so I hope I didn't just jinx myself.

Please feel free to respond via comments or email.

Do I have asthma, too?

I've had a cough for about 3.5 weeks now, and I went to the Minute Clinic (LOVE the Minute Clinic!) for a second time. The cough had gone from clearly a "tickle" to something that sounds a little more dry and chest-y.

In a nutshell, the nurse practictioner at the clinic said that the only reason anyone would have a cough that long would be either chronic sinusitis or exercise-induced asthma. So I plan to follow up with my doctor this week. (OK, I plan to find a *new* doctor and then follow up.) The NP can't really treat asthma, so she just continued the treatment for acute bronchitis, which was my previous dx.

I did a little research, and it really sounds like I have cough-variant asthma. I wake up fine, but after walking from my car to my office in the cold air, alongside a major highway, I'm hacking up a lung by the time I get to my desk. Seems like cold air and fumes are my big triggers.

I got my very own albuterol HFA. Pretty crazy.

Truthfully, I'm a little skeptical about the diagnosis. But on the other hand, I grew up in a house with two smokers - my mom smoked a pack a day in our broadloom-covered house for the 21 years I lived at home. My brother was just diagnosed with asthma. And let's not forget that I live in New Jersey!!!

Funny PS - my mom was far more skeptical about the dx. She gets coughs all the time, she tells me. Coughs that are triggered by cold, and coughs that make her cough til she gags, like I do. But it's just a cough, she says. It's not asthma!!

...this from the woman who STILL smokes a pack a day and NEVER goes to the doctor for anything!!!

Health Day: Acetaminophen Linked to Childhood Asthma

I have to laugh when I think about all the things linked to pediatric asthma. Seems like we moms can't do ANYTHING right! Now even Tylenol is a culprit in the pediatric asthma epidemic!!

According to Health Day:

Children given acetaminophen during the first year of life to reduce fever are more likely to develop asthma later on, a new study finds....

"If this association is causative, it would suggest that acetaminophen use is a risk factor for asthma and may explain the asthma has become more common," said lead researcher Dr. Richard Beasley, from the Medical Research Institute of New Zealand in Wellington.

Since this study can't definitively say that acetaminophen is a cause of asthma, its use for children shouldn't be changed, Beasley added. "Acetaminophen is the preferred drug for relief of pain and fever in childhood," he said.

Just remember, Moms: Everything you do is wrong.

Sigh.