Anyone use ProAir?

I'm out of Ventolin and had to start using ProAir over the last few weeks. I swear, I can never tell if I'm actually getting anything out of that inhaler. Is it just me?

My doctor said something this morning about it being a lighter mist or something... I thought it was just that the spray mechanism was crappy and didn't work half the time! Per the ProAir site:

ProAir® HFA delivers medicine in a warmer, lower-impact, longer-duration plume.4-6

...so I guess the feeling of getting little-to-no mist is intentional!

Interested in hearing how others like ProAir vs. Ventolin and other MDIs.  (For me, the counter is reason enough to prefer Ventolin, honestly.)

New Specialist; PFT Log

So... we started seeing an asthma and allergy specialist last week for Ozzy. We love our pulmonologist, but she has two kids now, and her hours are very limited. Combine that with the fact that she's based at a hospital 20 minutes away (pay for parking, wait forever, etc.) the new local specialist is a winner.

We saw him for the first time this past week, since we were running out of our Flovent 110, and he was very thorough. I was interviewed, Oz was examined, which I expected - but he also did scratch tests and spirometry on the first visit. He also gave us a peak flow meter, and on that first day, Oz blew a 280.

Ozzy's meds were changed slightly, due to the fact that (a) he's done really well this winter and (b) this doctor doesn't like using spacers and masks - he thinks the kids don't get enough medication this way. So Oz was switched to a Flovent 100 discus (half the dose, yea!!) and a MaxAir instant inhaler. He seems to do really well with the new "delivery systems." I'm happy to not have to shell out for or clean spacers, myself!

Of course he got sick over the weekend and started flaring. The cough isn't bad, but it's a cough, and his only other symptom is fever. (B also has a fever with no other symptoms.)

On Saturday, I decided to check peak flow. It was 200. I gave him the MaxAir, and it went up to 225.

Today, with 102 fever, I checked again. He's barely hitting 200.

I guess I'll check him again later, and we'll see how he is. This meter doesn't have "zones," but he's down by a good 25 percent - assuming 280 was a good number for him. He only had the one test when he was healthy.

Probably worth a call to check in.

Mom's Asthma: Question for you guys

Hi, all -

As I enter my first full season as a newly-diagnosed asthmatic, I have a few questions for you. As you know, I took myself off Symbicort this spring - I just felt ill from that stuff. I intend to find a new pulmonologist soon and look at some different meds.

Anyway, this past week, everyone in my office, on the bus, apparently in most of lower Manhattan, has had a violent, horrible-sounding cough. Seriously, I thought my boss was going to break a rib in the office, the way he was coughing.

Yesterday, when I woke up, I felt run down and a little "fluffy-headed." I had a very slight fever. I'd been feeling a little tightness in my chest the day before, but not enough to make me think this was asthma-related.

Today I have the same feelings...fatigue, a little tightness, but no fever. Is this the start of a flare? What should I be doing?

Thanks for your tips!

PS - the kids have been doing well. B's had some bad allergies, but no major flares. Oz has been doing really well...but I'm terrified that I've caught whatever horrible illness the folks around me at work have, and that one of the boys (Oz, particularly) will end up in the ER again.

They're all getting flu shots in the morning!

Off Symbicort - and Surviving

Quick update - Last month, I went off Symbicort.

While it may have been helping, I couldn't shake the feeling that, at least in warm weather, my asthma really isn't that bad. And with the improving weather, I felt crappier than ever AND I was getting yeast infections, a pleasure I haven't experienced in a good 10 years. (BLECCH.)

So I took myself off the Symbicort, making sure to always carry an albuterol MDI. And you know what? I've been fine. I'm also avoiding processed foods, exercising every day and trying to drink plenty of water. I still don't get enough sleep, but I don't expect I'll ever get that!!

Come fall, I'll find a new pulmonologist and make sure I'm set up for the cold weather. But for now, I feel OK. I barely need the MDI - even though I'm now in the city every day in 90+ degree weather.

Please don't let it be pneumonia. Please don't let it be pneumonia. Please...

Home with the two younger boys today. Ig started coughing over the weekend, started running low-grade on Sunday. He's 99.3 now, but his cough is awful. He has to draw in a huge, narrow breath, and then he lets out this long spell of deep, resonant, slightly muffled-sounding coughs. He only weighs about 40 pounds, so they seem to take over his entire little body.

Oz had his usual dry, asthma for a few days, and we were giving him albuterol, but yesterday he really needed a neb before school. At 1:30, he was sent home from school. His teacher said he hadn't been himself all day - too quiet, low on energy. When the nurse called for us to pick him up, she said he was running about 99.

He needed a neb the second he got home, and he was running 99.9.  Overnight, he was coughing his head off, of course, and I had to give him albuterol and ibuprofen overnight. He was over 102 at 5:30 this AM.

Ig was up a lot overnight, too. I gave him Dimetapp.

This morning, Oz's cough was soooo bad. I gave him a neb of Xopenex, but less than an hour later his was still coughing violently, so I gave him another neb - DuoNeb this time. The DuoNeb has alwasy worked well for us, but it really hasn't slowed the coughing today.

The sound of the cough is different since that neb - it sounds more resonant. Maybe it's loosened up a bit? I can't say for sure, but it sounds AWFUL. And he's still coughing til he gags, pretty much.

This is NOT going to be a fun day. This seems so similar to what we went through in January with the pneumonias - I'm just praying this isn't the same thing!

I'm calling the doctor as soon as they open at 8:30 ET. I'll let you know how it goes.

Asthma/Allergy Update - me, B and Oz

So, lately our house has been feeling a little...small. It's a great house - a ranch with a full walk-out basement. Not a stitch of carpet anywhere, and we've kept it fairly upholstery free. (If you're asthmatic, you know that the first thing you look for in a house is hardwood and/or tile!)

We have three bedrooms...and three kids. The two oldest boys love sharing a room with a bunk bed, and Ig has his own room. But the living space is very close to the bedrooms, and while we've made the basement into a bright and fun rec room, the kids don't spend a ton of time down there.

....which is why we've been hitting open houses on weekends. We're not sure we're serious about moving, but we're curious to see what's out there. Plus, we're having some "issues" with our town's special education programs, and they may well be insurmountable, so we may well have to move, once we find a town that's more willing to provide necessary  services for Ig. But that's another post for another day.

So, to my point. We went to an open house on Sunday, and in addition to having two cats, they also had loads of potpourri to hide the cat smell. And loads of broadloom. As soon as we walked in, I took two puffs of albuterol.

After checking out the house (beautiful curb appeal, bad corner, weird downstairs floor plan), we headed home. Within five minutes, I was coughing hard enough to gag. More albuterol.  Then I was OK for the rest of the day...but the next morning, I felt like I'd swallowed a Nerf ball, and it had lodged somewhere between my throat and chest. Not a nice sensation. And my chest hurt, too. I wasn't sure if it was asthma-related, indigestion, or just muscular.

I'm much better today, but realizing that I have a lot to learn about my triggers and the severity of each trigger.  A few sips of ice water got me going today! I need to start documenting what they are. Also, I need to see about getting a spare inhaler.  Right now I have one that I keep in the bathroom, and one I carry with me, but my purse MDI only has a few puffs left on it. Will they give you an RX for spare?

In other news, B tried eggs today for the first time since he was a baby. He had a moderate allergy, and they used to make him vomit. Last time he had them, just a few years ago, his face went bright red and he had a headache. He's always afraid to eat them - as well as mayo, French toast, and anything else "eggy."

But today, he had a little bit of my hard-boiled egg - just a few bites of white and yolk, and he's been perfectly fine.

But Ozzy's been coughing ever since. Go figure.

Mom's Asthma - Symbicort

Another quickie update -

While the Asmanex did stop the coughing, mostly, I had a heavy feeling in my chest and just didn't feel well overall. I almost felt like there was a wet sponge wedged under my sternum, and it sort of pulsated or spasmed before I started coughing. Ick.

I called the doctor's office when I ran out of the Asmanex, and told them I wasn't feeling that much better. They gave me a sample of Symbicort, which I've been on  before.

It's only been a few days, and while I'm coughing a bit more, I feel SO much better overall.The only downside is that I keep losing my voice.

For other people, this might not be a big deal but (surprise!) I sing professionally and am booked every Friday this month. I had to cancel last week, because I couldn't get through two songs, and I'm supposed to sing four. During rehearsal, I was so winded after my first number, I could barely get through the less challenging second song. Singing, after all, does rely heavily on breath support.

When I asked the doctor about the laryngitis - which seemed to occur after every presentation I gave, or any time I spoke for 10 minutes at a time or longer - he said it was probably from the Symbicort. So, in addition to rinsing my mouth after taking the stuff (which you should do after taking ANY inhaled steroid), I am now gargling. It's very feminine and appealing, I assure you.

So...hopefully we're on the right path now. I'm looking forward to feeling better soon!

Update on Mom's Asthma

Two quick things:

• First of all, I doubled my Asmanex dose, so now I'm doing two puffs in the AM and in the PM.Within 48 hours of dose-doubling, my cough pretty much stopped completely - despite the fact that I seem to have a head cold. Pretty impressive. Still need albuterol from time to time (like right now, in fact), but sooooo much better!
• Secondly, I found this article on cough-variant asthma, and it's seems 100% like what I've got. Cold air and strong smells are definitely among my biggest triggers, and I don't think I've ever wheezed.

The timing for the sudden improvement is pretty fortuitous. I have a singing gig every Friday night in March, and I was in no shape to perform. The big concern: My accompanist has about 5,000 cats, and his whole house does kinda reek of cat pee. Should make for a fun rehearsal. I'll definitely bring the MDI!

Peak Flow Today

About 430. And no coughing. Hmmm.....

Coughing has just about stopped...

...just like the doctor said! He said Saturday, and it's Sunday, and I'm not coughing!!

Peak flow: Just over 400. Still lower than it should be.

Mom's Peak Flow Meter

OK, so I got my peak flow meter today.

Here are my benchmarks:

I should be around 471 if I'm healthy, according the chart that came with the meter. (It's a PDF)

I'm blowing about 400 right now. Would we make that....yellow?

Admittedly, I was still questioning whether this asthma or chronic post nasal drip (I *love* denial! And I never had reason to believe that I was asthmatic) but I guess daily peak flow tests will make me a believer.

If I'm anywhere near 465 two weeks from now, I'll buy into the diagnosis.

Meanwhile, I'll try to remember to post my scores every day.

I have asthma.

I was diagnosed by a pulmonologist yesterday.

I think I caught it from my kids. ;-)

To Med, or not to Med?

Hi, all!

I'm happy to say, things have been quiet around here (apart from autism-related behavioral stuff, that is) - no one's coughing right now. Ig even made it through a nasty side infection without a single neb! But alas, it's flu season, so I'm cautious with my optimism.

This just came in via comments, and I thought I should address it, since it's definitely an evergreen topic.

Great blog! I found you by wandering around looking for a comparison of albuterol and xopenex. My DD (5) had a cough and a fever for four days so I took her to see the Ped, who promptly prescribed albuterol inhaler and antibiotics.

I freaked out (my kids have never had prescription meds for anything ever before) and decided NOT to follow Ped's suggestion, hoping that Ped was just CYA and DD could kick it on her own.

Well, fast forward three days and DD is weezing. Now, I'm reconsidering but a friend suggested Xopenex instead. *throws hands up* When I read your blog and the experience of the other parents, I get so frustrated because it seems like once you start, there's no getting off the moving sidewalk of meds. However, DD is miserable and I just want her to get better. *sigh*

First of all, WOW - I can't believe your kids have never been on prescription meds before. That's awesome!

But...y'know what? I think you should consider listening to your pediatrician and starting them. Respiratory illnesses (especially during this particularly creepy flu season) can become very serious, and albuterol - or Xopenex - will help your child breathe more easily.

While they may make her hyper, please remember that your child is probably having difficulty breathing if she's wheezing and coughing. For young kids - heck, even for US! - this is a scary situation. Fast-acting inhalers like albuterol and Xopenex will help her feel better right away. (And if you delay starting the meds, you end up having to put her on Orapred. Horrible!)

I totally get the idea of not completely trusting your docs, believe me - there's tons of research that shows that doctors will prescribe antibiotics and other meds because they think patients expect them. (A direct result of DTC advertising, but that's a whole 'nother kettle of fish...) My peds know that I often won't fill certain prescriptions they write for my kids (like antibiotics for minor illnesses that may be viral). At least not right away.

But with respiratory stuff, I don't take chances. There's too much room for something to go horribly wrong. I've taken my kids to the ER far too many times to risk it.

In a perfect world, you'll have pediatricians that you trust with your kids lives - literally. But if you question a respiratory diagnosis, find a pediatric pulmonologist or an asthma and allergy specialist.

In this case, please don't wait. If you're questioning the diagnosis, see that specialist ASAP.

And granted, I'm not a doctor or a medical professional or any kind, but as the mother of three asthmatic kids, I hope you'll start the nebs while you consider your options. There are no known long-term side effects to albuterol or Xopenex, and they'll literally help your daughter breathe easier.

Best of luck to you and your little girl. Please feel free to email me or continue our conversation via comments. And apologies if I sound sanctimonious at all - I don't mean to!

BTW, definitely check out the Mothers of Asthmatics site. It's a GREAT resource.

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?

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!

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.

Asthma in Children and the Fear of Pulmicort

New Question - Just In:

HELP!!!!! My son is 7, was dx w/ asthma this past winter after a lifetime of treating what different ped's "thought" were simply nasal infections with antibiotics. We have recently went from zyrtec, to oral steroids, now on to pulmicort, albuterol and Singulair. I am VERY afraid as my son is already a sensitive and emotional boy. It sounds like the pulmicort is simply a BAD med??? Does anyone have any homeopathic advice on treating asthma? My mom is permanently disabled from medications that were not properly tested and monitored...I am in search of help, not more hurt!!! - Tammy

Tammy, I'm *not* a doctor, but I have a few insights I can share from experience:

First of all, many of us who have used Pulmicort and Flovent (same med essentially, delivered differently) have found that Flovent may tend to have less "roid rage"-type side effects.

Personally - and I do have sensitive boys - I haven't seen any negative behavioral effects from the steroids. (At least not that I remember!) Certainly albuterol has them bouncing off the walls, but I give Xopenex as often as I can to aovid that.

I can tell you that it works - WELL. For children with asthma acute enough to require daily inhaled steroids, there aren't many alternatives. None of us likes the fact that our kids are taking steroids every day, but it certainly beats the alternative of not being able to breathe!!

The best recommendation I can give you, though, is SEE A SPECIALIST. If you've read this blog at all, you'll know that I love my pediatricians. But when it comes to asthma-related issues, I call the pulmonologist first, then make a courtesy call to the regular peds to keep them in the loop. Pediatric pulmonologists know more about asthma than general pediatricians do, and understand the subtleties, the latest meds, and so much more than any other doctor.

If there are no pediatric pulmos in your area, look for an allergy and asthma specialist.

On the holistic side, I know many parents who have seen benefit from taking their kids off dairy. Others have seen a lot of success with sinus washes (now sold as "netti pots" at your local CVS) particularly if their kids' asthma is typically triggered by upper respiratory infections.

Again, I'm not a doctor or medical professional of any kind, but this is my best mom-to-mom advice.

I would also refer you to the Asthma-Parents group on Yahoo, which has been a great resource for me over the years. Two other sites:

• http://www.breatherville.org/ - the site of Mothers of Asthmatics, which also provides discounts on nebulizers and other equipment, among many other resources; and
• http://www.lungusa.org/ - the American Lung Association, which has great newsletters.

Hope this is helpful. Best of luck, Tammy!

Speaking of working mothers' guilt...Daycare Drama

I'm switching the little boys' daycare this week. The one they've been in was B's third, but he's in 1st grade now -- and this is the only daycare the two little guys have ever known. So you can imagine how grueling a decision this has been.

The place was really nice for the first few months we were there. I should have known, when the director who showed me the place departed on our first day there, (departed *for good*, I should add) that the outlook might not have been good. And now, four directors later, I can say that it was, at times, very good. But right now, it sucks.

After the last director left, the new one, Miss R. came in very quickly. Rob and I call her "Miss America" because she literally comes to work with pageant hair and full makeup - including eyelashes. She's built like a beauty queen, too, and loves to wear tasteful, expensive-looking, very fitted clothing to show it off.

Miss R looks very professional, but she - like the rest of the staff - is very young, with no children of her own. She's concerned with things like ratios, and classroom supplies. She loves the cute kids, but hasn't an inkling what it's like to leave your children with strangers every day.

So, needless to say, she's part of the problem. She hires young staff, doesn't announce when they leave, doesn't announce when new staff joins, and doesn't communicate well with parents. When I talk to her about concerns I have, I often feel like there's a language barrier or something. I can practically see everything I say fly right over her perfectly styled head.

Turnover is a problem, too. Half the time, someone I've never met is handing my kids to me at the end of the day. There's only one teacher who's been there as long as we have.

That's the background. Here are the actuals:

1. Frequently, when I drop Ig off, his room is over ratio. Now, if this place didn't already push state limits, it probably wouldn't be such a big deal. But on a GOOD day, there are two very young women with 14 2.5 year old. I can barely manage 1 two-year old. But seven? So if there are 16 kids in there, I will wait until kids and teachers are shuffled appropriately and I can feel safe leaving my son. The waiting makes Ig uneasy and me late for work. And it's an ongoing issue.

2. When I pick up, the boys will sometimes be together in one room, with a teacher I barely know watching tiny little Ig with a bunch of older 4YOs. Which wouldn't be so bad if the teacher was actually watching and if Ig weren't so tiny and immature for his age.

3. On 3 separate occasions, Ig has come home with no pullup and no undies. Funny the first time, downright concerning by the third. He doesn't have tear-away pullup. He has to take offf his pants and undies to do this. Which means he's got to be alone in the bathroom for close to five minutes to accomplish this task. And did I mention that he slipped in the bathroom and had to get stitches a few months ago?

4. Ozzy had an asthma flare last week. I would have kept him home if I had any flexibility at work, but I coudln't. So I nebbed him up and sent him to daycare with an alubterol MDI. I filled out all the forms for him to get the meds....and he didn't. They forgot to give him his 4 o'clock dose. They. Forgot. To. Give. Him. Asthma. Meds.

...and that was the final straw.

So I'm moving them away from their friends to a nearby center. The new place is about half the size and family-owned. It's clean. And Ig's room has 8 boys and two *mature* caregivers. Ozzy's room has three teachers; one of them is the owner.

I feel good about the move, but it's a LOT more money...at a time when no one has a LOT more money for everything. And it's disruptive to all of us.

I wish this wasn't a necessary step, but I don't think our current childcare situation is repairable. Miss America takes responsibilty for nothing. She blamed Ig for the diaper removal. While her business manager admitted to forgetting Ozzy's medicine, she lied to corporate -- and essentially blamed Ozzy for lying about the missed dosed! She blamed the teachers for Ig's stitches and the business manager for the ratio issues. I can't work with someone who can't own their mistakes. Doesn't she realize that her staff is reflection of herself? That if she were on "The Apprentice," the Donald would have sacked her ass?

Hopefully, the kids and I will be happier at the new center. Ig's been very clingy at drop-off lately - a new behavior for him, probably sympomatic of the chaos he has to deal with once I leave.

As my co-worker so aptly put it, "It's OK to *miss* your kids while you're at work, but you can't *worry* about them."

Ain't it the truth?