Separation Anxiety Nightmare

Not much to do with asthma here, but I have to share this....

Little B, who just turned 4, has been going through THE WORST separation anxiety phase over the last few weeks. I mean, hysterically screaming and clinging to my leg every morning when I drop him off. It's been a total nightmare! Each day when I drop him off, I'm scared to death he's going to trigger an attack, because he has had his worst attacks after night terrors. And the hysteria's pretty similar.

Meanwhile, his 17-month-old brother actually toddles down the hall to his classroom practically by himself each morning, and barely says goodbye!

At first I thought this started because he had an attack coming on. Now I'm not sure if there's an underlying school-related problem (his teachers assure me it's not, and he's had no specific complaints) or if it's somehow related to my pregnancy. We did go through something similar with my last pregnancy, when he was two, and he does seem to be going through some weird oedipal phase right now.

I just can't wait till this is over. Or we find out what's REALLY going on.

Aid for Katrina Victims

I know this has nothing to do with my blog, but it has to matter to everyone.

Please donate whatever you can to the Red Cross. There are still thousands of people - adults, kids, seniors - stranded in the hardest-hit areas, just waiting to be rescued, to get food and water. If you can do anything to help, please do.

Asthma? Or just sinuses?

We went to the peds. pulm. yesterday for a checkup, which is, in itself, somewhat miraculous. We've never been able to do one of those because every time I'd schedule one, my son would have an attack and we'd end up having a sick visit instead.

We actually stopped scheduling checkups because it seemed to be a jinx!

So, it was a good sign that we actually made it to a checkup yesterday. He's coughing a little bit, but fortunately, it seems to be more of an upper than lower respiratory issue at the moment.

He does seem to have his second sinus infection of the season, though, which is a bit worrying. We recently finished our non-refillable Nasonex prescription, and I wonder how much that has to do with it. (I did get a new Rx for it.) And he just wrapped up a course of Amoxicillin about 14 days ago.

If the congestion continues for another week (it's been about one week now), she's going to send him for a CT scan. He probably needs it, but I shudder to think what's going to happen if they find something. He's already had his adenoids out, so what would the next thing be? How traumatic, painful and horrible will it be? What more do I need to put this kid through???

I guess for now, I'm just glad the infections haven't triggered asthma attacks as they've done in the past. But are chronic sinus infections -- even if they're not life-threatening-- any better for a four-year-old' s quality of life than chronic asthma?

Asthma-Vaccination Connection?

Anyone who reads this blog knows how I love to blame anyone and anything within reach for my son's asthma....

I just found this on BabyCenter, an article exploring the possibility of a connection.

Then I found this article, discounting a connection between the pertussis vaccine and asthma. (Which also led me to this great resource.)

And then I found this article, which says a connection between childhood vaccines and atopic conditions (including asthma) is unlikely -- but doesn't discount it entirely.

Here's one from the Vaccine Education Center at Children's Hospital of Philadelphia. Guess what it says?

By far the most compelling one is here. You need a medical dictionary and possibly an interpreter to get through the whole thing, but here's the executive summary:

Background: A few previous studies have suggested that childhood vaccines, particularly whole cell pertussis vaccine, may increase the risk of asthma. We evaluated the suggested association between childhood vaccinations and risk of asthma.

Methods: Cohort study involving 167 240 children who were enrolled in 4
large health maintenance organizations during 1991 to 1997, with follow-up from
birth until at least 18 months to a maximum of 6 years of age. Vaccinations were
ascertained through computerized immunization tracking systems, and onset of
asthma was identified through computerized data on medical care encounters and
medication dispensings.

Results: In the study 18 407 children (11.0%) developed asthma, with a
median age at onset of 11 months. The relative risks (95% confidence intervals) of asthma were: 0.92 (0.83 to 1.02) for diphtheria, tetanus and whole cell pertussis vaccine; 1.09 (0.9 to 1.23) for oral polio vaccine; 0.97 (0.91 to 1.04) for measles, mumps and rubella (MMR) vaccine; 1.18 (1.02 to 1.36) for Haemophilus influenzae type b (Hib); and 1.20 (1.13 to 1.27) for hepatitis B vaccine. The Hib result was not consistent across health maintenance organizations. In a subanalysis restricted to children who had at least 2 medical care encounters during their first year, the relative risks decreased to 1.07 (0.71 to 1.60) for Hib and 1.09 (0.88 to 1.34) for hepatitis B vaccine.

Conclusion: There is no association between diphtheria, tetanus and whole cell pertussis vaccine, oral polio vaccine or measles, mumps and rubella vaccine and the risk of asthma. The weak associations for Hib and hepatitis B vaccines seem to be at least partially accounted for by health care utilization or information bias.

Question for you guys -- Breathing better on one side?

Quick question for my loyal consituents: Because of the congestion noted in my last posts, of course I was in the boys' room every few hours last night, checking their resp rates. (Don't even tell me you don't do this!!)

I noticed that #1 son was at 24 breaths per minute when sleeping on his right side, but that his rate was significantly increased when he slept on the left.

I'll definitely ask the peds. pulm. about this on Thursday, but I can't help but speculate. Does one lung function better than the other? Is there congestion or are there constricted airways on one side only? Or is it just nasal congestion?

Love to hear from you if you've experienced this or even if you just care to make some moderately educated speculation....

Congested Again -- Seeing Doctor Thurs.

A week after we finished antibiotics for a sinus infection (BOTH boys) they're both congested again. I think I can fairly blame this on my parents who came back from a "jaunt" in Russia with persistent, nasty colds.

My four-year-old isn't coughing (yet) but was showing off some nasty blood-tinged mucus by the end of the day yesterday. Pretty nasty!!! The baby, on the other hand, is coughing a LOT.

Just to be safe, I started albuterol last night. I also gave him Dimetapp before bed.

We'll see. #1 Son is due for a checkup with the pulmonologist anyway, so I'm taking him Thursday afternoon.

Annual Checkup

FYI, we had checkups for both boys yesterday -- 4 year for the big one, 15 month for the baby. All is well, fortunately!

But asthma boy is definitely a little runty! He's 25th percentile all around. It's fine; he's definitely healthy. But I can't help but wonder if it's due to the inhaled steroids.

This is a kid who was literally off the growth charts until just after his first birthday. (He wore a size 24mo outfit to his first birthday party.) Now he's a little peanut.

I can't worry about it too much. I'm sure I've heard his doctor say that once they're off the Flovent (or whatever corticosteroid they're on) they actually "catch up," making up for the growth they may have missed.

It sounds weird, but I'm sure I've heard it. Maybe I'll troll for confirmation data.

Anyway, I'll deal with short. Heck, I'm only 5'2"! I'd rather have him breathing than tall!!!

Cheryl's Pulmicort Question

From the comments gallery:

Well, we're going to see our peds allergist next week to see whether we go back
to Pulmicort. I'm bummed -- the Singulair is soooo much easier on all of us.
But I'm wondering if I'm overreacting. Do your kids cough and if so, how
much and how often, on a regular basis? It's probably crazy to think we
could eliminate his cough entirely, but then parenting is pretty much crazy
as it is. Also, tell me about Flovent vs. Pulmicort. How old do you need to
be to use it -- with a MDI and spacer, right? I'm just so tired of strugglng
with a daily nebulizer treatment!!!! Cheryl

From my experience (disclaimer: NOT a doctor, just an asthma mom!): My son coughs occasionally. When he develops a cough, it will start with the occasional evening cough. He'll maybe cough 5 times a day between 6:00PM and 7:30AM. We'll usually start him on albuterol 2-3 times per day, and we're often able to head things off. But not always.

We switched him from Pulmicort to Flovent ages ago, when he ceased to cooperate with the nebulizer. Flovent's the same medication, but used with and MDI and spacer - just as you noted. We started him on it around the time he turned two, maybe even a little before then.

He's been on Flovent 220 most of the time since then, although he's back to 110 right now. We've never experienced any noticeable side effects, but we'd love to get him off the stuff someday. There is a possibility of stunted growth, and he is kinda small... Lots of other parents have found that their children are irritable when on Flovent, same as with Pulmicort.

And working with the MDI/spacer is really easy, once they're used to it. It takes about 15 seconds, and we need to do two puffs, twice daily. Just make sure your doctor gives you a demo in the office, and that you're comfortable doing it by the time you leave.

It has been a miracle, though. His asthma has been remarkably better since we started the stuff. His peds. pulm. is pretty sure it's kept him out of the hospital a bunch of times. In fact, we made it all of last winter without a single pneumonia or trip to the ER.

BTW, Cheryl -- he's on Flovent AND Singulair. And for us, that's really been the "silver bullet."

Everyone else -- please chime in with your thoughts and experiences!!!

Per Barbara's Comment: On DuoNeb

Thanks to everyone for your comments on the last post. I really appreciate your views and questions!

Barbara -- regarding your DuoNeb question...

Would any of you reading this know if DUONEB can cause sinus problems??? My
father is in bad shape and his ENT doc is a major a** and dont seem to care
since his insurance ends on 8-25. So he seems to think that the duoneb might
have caused him sinus infection (that drains into his lungs) after he had to use
his nebulizer with a mask. And believe me, he went thru all the possible
traetments and the doctor (not ENT) says he dont know whatelse to do. Any
suggestions?? Would really appreciate it....

I do know that DuoNeb is NASTY stuff. My son needs that and/or its MDI companion, Combivent, when his attacks are bad, but even our peds. pulm. tries to limit the amount he gets. It's never more than every other dose (alternating w/ albuterol) and never more than a 36-hour course.

You can find info on the side effects of DuoNeb here, at Drugs.com, and at DuoNeb's own site. I didn't see anything about sinus infections as a side effect. (I did some quick news searches, too.)Asthma attacks were listed as a side effect though...

HUH?

You might want to try posting on the asthma boards at About.com and yes, BabyCenter. There are some really knowledgeable folks who know wayyy more than me. Some of them are even medical professionals, which I certainly am not. There's also tons of great info at Breatherville.org and the American Lung Association's site.

Good luck with your Dad. I hope you're able to get the information you need -- and of course, the treatment, to get him well.

(Also, special thanks to Cheryl and littleguysmommy for your advice & support. You guys rule!)

Another Post on the Singulair Debate

Just FYI -- another Mom chimed in on the Singulair debate mentioned in my last post. "AsiaMommy" is more to the point and less obnoxious than I am, but she seems to be following the same idea.

Thanks to all of you for your comments -- I really appreciate hearing other voices out here!

Not only is it comforting to know that someone's reading all this stuff....but I feel like I'm not so crazy after all!!!

The Great Singulair Debate

Dear readers, you all know what a horrible loudmouth I can be. How awful. How opinionated. It's kind of who I am -- and why I started a blog.

But you also know how passionate I am about pediatric asthma. The kernel of what I believe on this front is:

• That every asthmatic child should have both a great pediatrican and an even better pediatric pulmonologist; and...
• That every asthmatic child needs an appropriate, adhered-to asthma action plan. Be it albuterol when symptoms occur, inhaled corticosteroids seasonally, whatever. The kids just need action plans, and the parents need to understand them.

So...when I go to the message boards I frequent (usually on About.com and/or BabyCenter) I usually repeat those mantras pretty much ad-nauseum. I get really scared when I see posts by parents who have taken their kids off Pulmicort because of the side effects. I mean, it's fine if you've talked to your peds. pulm. and they're monitoring everything, but you can't just *take your kid off Pulmicort* if they need it! If they need maintenance meds, they need them!!

Okay, so what was my point here. My point was that I've gotten into a somewhat heated debate on BabyCenter with someone who's taken her child off Singulair. In my usual, big-mouthed way, I posted what I knew about Singulair's side effects (not much -- haven't seen anything alarming), and just urged her - and anyone else reading - to get an updated action plan from their doc.

Well, perhaps I should just stick to blogging. I've really annoyed this woman. She may even hate me. (Which sucks. I hate having bad karma out there!) But I do really worry about this stuff. If a child needs maintenance meds, they need them!!! Her child was exhibiting aggressive behavior as a result of the Singulair. It's listed as a secondary side effect, and I can totally see why you'd want to switch meds if your kid went psycho from their asthma meds. But I just wanted to make sure her peds. pulm. was supervising this.

So...okay. I'm venting. But I feel really bad about ticking this woman off so much! We all only want what's best for our kids, natch.

She did say she had some info on long-term effects of Singulair, so I'm interested in seeing those -- and I'll definitely share them if she does.

Anyway, you can view the whole thing here. As always I welcome your comments, especially if you've got something on Singulair.

And if your advice is to stay off the boards and stick to blogging...ugh. Consider me advised!

AsthmaFactor.org - A Big Pile of Poop

Did I once, back in May, actually recommend http://www.asthmafactor.org/?

Where was my brain? What was I thinking?? Was it the pregnancy hormone wreaking havoc on my intelligence???

The site is nothing but a bunch of hoo-ha. They're pushing some BS dairy-free diet and some truly risky advice for naive asthmatics. Headlines like, "Asthma is a false disease caused by chronic dehydration and body's drought management efforts, says doctor" are DANGEROUS.

Want REAL advice on asthma? If you're an asthma mom, visit http://www.breatherville.org, the official site of the AANMA and Mothers of Asthmatics.

Ugh. I'm so embarassed that I ever linked to that site in anything that may have appeared to be an endorsement. Apologies!!!

He's 4 today.

Hard to believe I gave birth to that little monkey four years ago. Sometimes it seems like yesterday, sometimes it seems like a decade ago.

I'm so lucky to have that kid. With the problems I'm having with this pregnancy, I'm more aware of that than ever.

But I've always been grateful for this boy. He is so unique, so sweet, so special. Always creative, orginal and eager to please, he's unlike my expectations of a four-year-old boy. He's not the dirty-faced tree-climber I'd expected. My son is affectionate and almost weird with his intelligence and uncanny memory.

This is a boy who can name half a dozen poisonous snakes (and their habitats) without blinking or pausing. I imagine, if pressed, he could tell you if their venom is a neurotoxin or hemotoxin. He can tell you the make and model of 90% percent of the Hot Wheels in his extensive collection, who gave the car to him, when, and under what circumstances. It's quite shocking, the things he remembers.

When I drop him off at daycare in the morning, I give him a quick goodbye before making his brother comfortable in the infant room. And on my way out, at his orders, I must go return to Pre-K to deliver his "kiss, hug and high-5." He's very particular about this.

He never hesitates to say "I love you," and will drop whatever he's doing if I ask him for a hug or kiss. If his baby brother kisses him, he kisses back or just smiles.

The happiest part of my day is when I put him to bed at night. At that point, we sit in bed together and we talk. We talk about the baby in my tummy, what's going on at school the next day, the snake we saw on TV, whatever. But we chat, and it's lovely. And, of course, we snuggle. (I always tell my husband, snuggles with my boys are "my happy place." Nothing could be more gorgeous.)

My son is a very, very special boy. I am truly blessed by having this child in my life.

May his birthday be full of fun and joy, and this next year be blissful and HEALTHY.

Asthma News: Advair Stays on Market, Florida Covers Pulmicort

Two key news stories y'all should be up on:

FDA panel recommends asthma drugs remain on market

A Food and Drug Administration advisory committee unanimously recommended
Wednesday that three asthma medications, one of which is GlaxoSmithKline's
top-selling drug, remain on the market. But the committee urged more research to
determine whether the medications might actually worsen asthma in certain
patients.
The FDA had asked the panel to review the safety of Glaxo's
Serevent and blockbuster Advair — a combination product containing Serevent and
a corticosteroid — and Novartis' Foradil, which belongs to the same class of
drugs as Serevent.

Medicaid to pay for asthma drug mistakenly left off list
The children's drug was not included until doctors and parents complained.

TALLAHASSEE -- Florida's Medicaid program will begin paying for an asthma medicine needed by thousands of children, responding to a mistake that had left the drug off a new list of covered medications.Under a new law that took effect this month, the Medicaid program redrew its list of drugs it will pay for, in most cases only putting on the list drugs made by companies that will give the state a bulk discount.

Doctors can get approval to prescribe off the list -- but some have said it can be a cumbersome task and could be dangerous because doctors may first try drugs on the list that may not work on that particular patient.

When the new list was drawn up, an asthma treatment for children called Pulmicort Respules was left off, meaning doctors who wanted to prescribe it would have to get prior approval.

Can you imagine if Pulmicort wasn't covered? I swear, we would have been on welfare if we'd had to pay for that every month!

To My Anonymous Commenter - Please Be Careful!

Thanks so much for your comment last week -- but I have to post a reply.

I'm so happy that reflexology is working so well for your son, but please, please, please - continue to see a pediatric pulmonlogist.

Asthma is a tricky, tricky illness, and not one to be taken lightly.

As the daughter of a pharmacist, I'm particularly cautious about overmedicating my kids. I question every prescription (to the great dismay of my doctors), and they're well aware of the fact that I often will not fill the scripts they give me for antibiotics. Not right away anyway.

But I've learned not to mess around with asthma. Despite the possible negative effects of inhaled corticosteroids and albuterol, I know that these are the drugs that help my little boy breathe.

This child is the absolute love of my life, and I've seen him suffer too much. I've seen him hooked up to a nasal canula with oxygen being pumped into his lungs, and it's something I never, ever want to have to see again.

I'm aware that Flovent and/or Pulimicort could stunt his growth. I know Albuterol makes him cranky and flighty, that Orapred makes him unbearable, as do Combivent and DuoNeb. (But really, I'd rather he be short than struggling to breathe, if it has to be a choice.)

But I also know that Flovent and Pulmicort have kept him out of the ER many, many times. That Albuterol has helped us prevent what could have been a very serious attack. That Orapred has sidetracked hospitalization from pneumonia. And that Combivent and DuoNeb may have actually saved his life.

That said, you can see why I don't mess around. I've had the good fortune to find a pediatric pulmonologist I trust as well as I trust my best friend. She understands my reluctance to increase (and at times, decrease) the drugs on his action plan. She supports my efforts to try non-medical, non-traditional alternatives to medications -- while continuing his prescribed maintenance medications. I respect that she wants my baby to have normal childhood. We have a great relationship.

I hope you find the same. Find a doctor who's open to your desire to ultimately get your son off medication.

But please, please, stay in touch with your doctor and keep your son on his maintenance meds until your doctor advises you that it's okay to change routines.

I don't work for the drug companies -- I'm just speaking from my heart and my experience.

Best of luck to you both.

Update: The Cough Continues

Not as bad, though. We've still got the congestion (over a week now) but he's only really coughing at night and in the morning. So we're back to where we were in the spring, really.

I'll keep an eye on the congestion, though...Thank goodness I started this blog. Now I know it's only been a little over a week. (Naturally, I never write this stuff down like I'm supposed to.)

But things seem to be pretty well under control, so I won't bother calling the doctors yet. We'll see. If he's still this stuffed up a week from now - or Friday, even - I'll assume it's a sinus infection.

Still, this summer's been good so far. Historically, he gets sick on his birthday (we had to cancel his party two years ago because he had almost 105, Strep, and an asthma attack). We've got two weeks, so I'll stay vigilant!!!!

When it comes to asthma, Mother knows best

Man, can I call it or what?

Friday night, he started coughing again, so I gave him Albuterol before bed.

Same deal Saturday night.

Sunday morning, there was more coughing, accompanied by some LOVELY green mucus. So, more Albuterol, in the morning, at lunchtime, and at bedtime.

He also decided not to eat yesterday. Just wasn't hungry.

I'm going to go out on a limb and say that the kid's coming down with something. And not to say "I told you so," but I did predict this last week.

While it sucks that my son is sick again (although we have had a great summer so far), I do have to admit, it's nice to always be right about one thing.

Symptoms Again - Waiting it Out

It's ever-so-subtle, but the Asthma Mom learns to be sensitive to the onset of an attack even at its earliest stages. We're like lionesses in the savannah, listening to prey rustling in the grass half a mile away. I swear, we're just that attuned.

Little B started coughing again just before the holiday. Not a lot, just 2 or three times a day, very early in the morning or around bedtime. It's a little bit "junky" sounding, but not too bad. But it's there. It's a cough.

And over the weekend, he was uncharasterically whiney and clingy. He's usually not an annoying kid, which really, is saying a lot for a preschooler! But really, he's generally an easy going, sweet boy. While he certainly *can* be a little annoying atg times, he usually doesn't get on my nerves the way he did over the past few days.

Now granted. That could be me. I'm wrapping up the first trimester of this surprise pregnancy, and let's just say it's not making the most graceful exit.

So yes, it could have been my dramatically reduced patience, but I think a lot of it was him. Add to that the fact that I found him in bed, under the covers at 11:00 in the morning on Saturday (this from The Boy Who Would Not Nap), and I'd wager that he's not feeling well.

We'll wait and see. We lionnesses have a fair amount of patience (especially in the second trimester).

Nasonex - A small miracle

I can't believe what a difference the Nasonex is making. For the first time in half a year, my kid can breathe through his nose, doesn't snore, and can pronounce all of his consonants correctly.

Why didn't we have the opportunity to try this sooner???

We don't have any refills, so we'll see if there's a change for the worse when we run out. Then I can call the peds. and beg for more!

Meanhwile, we're doing OK on the Flovent 110. He's still got that "junky" cough at night and in the AM, but overall, he's doing really well.

Keep your fingers crossed!

Asthma Update

So Dad and #1 son just got back from the pulmonologist. Our doc is still on maternity leave, so they saw the chief of the practice and an intern.

To my surprise, they said that we're doing everything right, and sometimes he'll have attacks.

Now, call me crazy, but this kid went almost a year without an attack until they lowered his Flovent. And before that, he never had an attack unless he had some other kind of infection or virus.

Now he's had two attacks in two weeks. He's on two additional medications.

I know I'm doing everything right. My question is....are they???

I'm not asking them to necessarily put him back on the higher dose of Flovent, I just want an answer I can trust and believe in. I'm not sure I need the pat on the back anymore. I just want reassurance that my son's asthma is under control.

Right now, I don't think it is. And I'm half expecting him to have another attack within the next few weeks.