Meet GeckoCap, The Newest, Coolest Tool for Asthma Compliance

Last month, the folks at GeckoCap contacted me in response to my post about how to get your kid to actually take their maintenance meds.  I went to their site to see what the heck a GeckoCap was,  and was actually pretty blown away. This product is SUPER-COOL, and I'm pretty sure it will work.

Rather than explain it, I interviewed GeckoCap's Founder and CTO, Mark Maalouf. Here's what he told me:

1.     What is the Gecko Cap and who will it help?

GeckoCap is a small, glowing device that fits on top of inhalers. First, it helps children with asthma develop proper habits. Children often forget to take their maintenance inhalers as prescribed [REALLY?], and with time this often leads to more usage of the rescue inhaler, missed activities with friends, and perhaps even missed school days. The GeckoCap glows as a reminder when the inhaler should be used based on the prescription, and every time it is used the information is sent to an online account. Children have their own dashboard where they can keep track of how well they’re doing - see the next question for more on this!

GeckoCap helps parents too. I’m sure you’ll agree that it’s very difficult to keep track of if and when your child is taking their medication. It’s even more difficult when they’re bouncing around between school, visiting friends, on field trips, or between two homes. Parents have their own dashboards where they can track how well their child is doing. They also get reminders/notifications for things like a prescription running low as well as alerts when the rescue inhaler is used. These alerts prompt the parents for the reason behind the rescue inhaler usage (sports, weather …) so you can finally get real data to look for trends. Parents can also easily see the history and create reports. How often do you go to your child’s physician and can’t comfortably answer the question about their inhaler compliance?

2.     Explain the whole gamification thing to me.

We are working with child psychologists to figure out how to really change behavior for the better. For the younger children, this includes their very own dashboard with a cute avatar that changes moods based on how well they’re doing. Children also get rewarded with points and badges for things like taking their maintenance inhaler properly several days in a row. Parents get points too for things like entering the trigger for the rescue inhaler usage, and they can assign these points to their child. Parents can choose what the points mean in the house (perhaps the child can redeem them for an extra piece of dessert!), but we are also working on some partnerships to redeem points for real things like gifts.

3.     Do I need to get my kid an iPad for this to be successful?

No! Without getting too technical, the cap sends and receives data to a smartphone or tablet which has Bluetooth 4.0 (this includes the iPhone 4S, iPhone 5, and newer iPad and Android devices). That device then sends the data to the internet.

What this means is that you need at least one device like that in the home for the GeckoCap to work, but it does not have to be with your child. If they are at school all day and use the cap, the data will automatically be sync’d when they get back home and are close enough to your iPad. The only benefit of having your child carry around their own smartphone or tablet is that the updates and notifications will occur more frequently, rather than when your child gets back home.

4.     Does it work with all MDIs?

That’s the plan! We are working with industrial designers right now to finalize the version that will be sold, and one of the most important design goals is for the GeckoCap to fit on all MDIs. We’re tinkering with a couple of ways to do this best.

5.     Where can I get one and how much will it cost?

Glad you asked, because we just launched a campaign to pre-sell GeckoCap. We’re aiming for it to be available in September, and for a limited time you can pre-purchase one for $39. That campaign site has a lot more information too, please check it out!

6.     One last question: Why did you decide to create this thing? What's the back story?

To make a long story short, the team and concept behind GeckoCap were formed at a healthcare-related competition at MIT in 2012. One of the founders has a young child with asthma and another is a physician, so GeckoCap grew naturally out of that partnership. Among several other features, the original concept tested peak flow, provided a GPS tracking system to alert users of high risk locations, and had a spacer. It ended up winning first prize at the competition, and since then the concept was refined and simplified from a jack-of-all-trades product to a simpler and more consumer-friendly one.

I'm very excited about the GeckoCap, and definitely plan to try it out. I'm so glad that someone's thinking creatively about the issues that affect our kids. These are technologies I use frequently in my marketing/PR career....I never thought I'd be using them to manage the kids' asthma! Based on the early buzz GeckoCap is getting and how well it was received at CES this year, I'm thinking this is going to be bigger than musical toothbrushes!

Xopenex Comment - "It makes my daughter sad all the time!"

Just wanted to address the comment that came in from a mom who's daughter cries all the time since starting on Xopenex....

I'm sorry I didn't mention it sooner, but please call your doctor about this! Meds shouldn't change our kids' personalities!!  Ask your doctor for a suitable substitute for rescue meds. Sometimes a different brand of albuterol or levalbuterol can make a difference - but definitely ask your practitioner.

I hope this helps! I know it's a simple response, but it's really the only answer!

I hope you're able to resolve this soon, and that your little girl is back to her happy little self in no time!

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.

Doubling the Asmanex

Just a quickie update - Peak flow hasn't exceeded 420, and I've been coughing my HEAD OFF.

The pulmonologist told me to try doubling the Asmanex - 2 puffs in the AM, 2 at night.

Hope it works, because I'm actually *sore* from coughing.

...quick question for you more experienced asthmatics...does the cough ever start with an itch or tickle in your throat? I'm congested today, and the cough seems to start there, but then it's pretty convulsive and nonstop, and I typically end up (embarassignly) gagging. Horrible!!!

That was dumb.

I was doing so well... until Monday night. I thought the kitchen smelled funny, so I lit a scented candle.

And then I wondered why the Asmanex and albuterol weren't working anymore. Oh...because, apparently, vanilla-scented candles are a trigger for me.

I haven't broken 410 on the peak flow meter since Monday, but at least the coughing is starting to let up again....

I'll learn!

Albuterol vs. Xopenex - the debate continues!

Three years ago, I posted an article that stirred up huge debate regarding the value of Xopenex vs. Albuterol.

Amazing how many comments that post still gets!! I thought I'd bring it back to top of the blog to see who else wanted to weigh in.

Here's the original post.

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?

Utter Madness - But We're All OK

I've been the absentee blogger lately, I know...

In a nutshell, I left the job I've loved for four years and started someplace new. That was about 7 weeks ago now.

The new job is fine -- I have a decent life/work balance, which is critical for me. Obviously.

It is taking a long time to get ramped up though, which is frustrating. I don't really have a budget for my online marketing programs, and the two guys I work with, who have complimentary positions, are very, very smart, and very, very busy. So I feel kind of stupid and lazy right now. It's a little challenging.

At home, I'm still getting used to the routine of the new job. Different commute. Different stress level...scared to be late or to ask to work from home...but I do both anyway...

The kids are doing well regardless. I'm definitely yelling at them a little less. The stress of the new job is a heck of a lot lower than the stress of the old job as it was petering out.

The old job was so wonderful...loved every minute of it until the company was acquired. Then it was something like watching a beloved grandparent succumb to Alzheimers. Everything you love, all the memories just dying away, until you don't recognize each other anymore. I'm writing in a rush right now...but you get the idea. It was painful and horrible, but I know the company I loved really doesn't exist anymore. And I don't recognize -or trust - what's grown in its place.

So those last few weeks, with a new boss and a new CEO, were VERY stressful, and I felt like I was losing patience with the boys a lot in the morning. I'm not, by nature, a yeller, so it was weird for all of us to have me screaming at them (especially Ozzy, who's just going through a PHASE right now).

Things are quieter now, but it's still challenging. And I dont' feel like I have time for anything at all these days. By the time I've gotten those three guys off to bed, I want to go lie down myself!!

Anyway...enough about me! Here's the deal with the guys:

• Ozzy: Coughing. I went to on my first business trip in a while - and my first plane ride in 8 years! - this past week, and of course he had a flare. I got called on my cell phone mid-meeting in Atlanta...he was being sent home from daycare because he was coughing so much! I called the husband and made sure he understood the action plan. Then called every two hours to check in. Sounds like it was a rough day or two, and he's still coughing at night, but he's doing OK overall. He was dropped from Flovent 110 to 44 about two weeks ago, and taken off Singular, so we'll evaluate the meds situation if he's not better in a few days.
• B: Still coughing a bit. It's been about three weeks now, and he's doing MUCH better. Oddly, he's on Augmentin right now for (of all things) a severely infected hangnail. (So gross...) I suspect the cough is from a lingering sinus infection, so the Augementin would clear that up, if I'm right.
• Ig: Bad diapers, a few sleepless nights, and digging in the right ear. Could we be en route to another ear infection? If so, we're down for new tubes AND an adenoidectomy. We'll see...

I *may* have heard a cough from Ig this morning, and he did insist on taking his blankee to daycare today. Never a good sign.

Sorry for the very long and poorly (quickly!) written post, but gosh it feels good to bring you up to speed!

Pulmicort 'Roid Rage - response to question in comments

This came in today via comments:

I'm not sure I'm typing in the correct spot... I'm new at this. I was hoping to find some answers to a question I had concerning my son. I was wondering if you have heard of any children becoming aggressive or violent from the medicine Pulmicort? My son just turned 3 and since on Pulmicort has been exhibiting some very violent behaviors. Maybe just hit at the same time???? who knows? Do you have any advice or help?

I've been fortunate to have never experienced this, but I've definitely heard about it before.

Pulmicort is a steroid, and sometimes kids will react to it the same way grownups react to, say, anabolic steroids.

While some parents are OK if their kids "occasionally kick the dog," as one mom so quaintly put it, so long as they can breathe, sometimes the behaviors are a lot more extreme and hard to live with.

I've heard, on the Asthma-Parents Yahoo group, that other parents have seen better results simply by switching steroids. So ask your doctor if Flovent or Qvar is an option for child. Ad there's an added bonus: Being a "Flovent Mom" myself, I can assure you that administering a metered-dose inhaler (or MDI) twice a day is a LOT easier than holding a three-year-old down for a nebulizer treatment every single day.

Singular is another commonly-used maintenance med for preschoolers. I've rarely heard of adverse reactions from it, but it does work differently than inhaled corticosteroids like Pulmicort and Flovent, so it may not be right for your son's needs. In fact, my kids have needed to be on both Flovent AND Singular during peak season.

So...I hope this helps. Definitely talk to your doctor about alternatives. You shouldn't have to live with a psychotic preschooler when there are other options available.

Other parents, please feel free to share your experiences and wisdom!

Thursday Night at the Pulmonologist

So... here's the quick roundup:

• B - Doing GREAT! He actually completed the Peak Flow Test (PFT) and did great! Dr. W said she would have been happy if he'd been over 80% -- and he actually surpassed 100% (He still improved after abuterol, but whatever.) He is not going back on Flovent this fall, at least not at this point. :-)
• Oz - Doing well, but staying on Flovent 110 and Singulair. We'll keep watching him.
• Ig - With the cyanotic episodes and overall dodgy health, we're starting Flovent 44 again now.

For a change, BETTER than I'd anticipated. I'm so excited about B!! No meds!!! Whoopeee!!!
Now all I have to pay for (for B) are the $500 orthotics, which our insurance wont' cover.

Two on Albuterol

Quick update -- Ig has another ear infection, and I suspect he may have brochiolitis too. He's mouth-breathing and it sounds a little labored. He's happy, though. At least, he's happy til 4:00 AM.

Ozzy's just been off. Coughing since last week, lots of green goo, and yesterday, he complained that his chest hurt. That is, he said his tummy hurt, but he pointed to his chest.

Both are on albuterol. I'm tapering Oz down, since we seem to have gotten ahead of his flare. Ig's only 16 months old, though, so I'm taking him to the doctor in the AM. (Regular peds -- we see the pulmonologist on Thursday afternoon.)

Keep ya posted.

Levalbuterol (Xopenex) No Better Than Albuterol, Says Public Citizen/ WorstPills.org

Hah! Guess they've never had to deal with kids on albuterol. (For the uninitiated, you may as well give them a twelve pack of Red Bull and a couple of Hersey bars....)

Levalbuterol Is No More Effective Than Older, Cheaper Asthma Drugs and Should Not Be Used, Public Citizen Advises on WorstPills.org
“Worst Pills, Best Pills” Subscribers Receive Life-Saving Warnings About Dangerous Drugs Before They Are Removed From the Market

WASHINGTON, D.C. –Levalbuterol HFA (Xopenex HFA) inhalers are no more effective than older, less expensive drugs used to treat asthma and other diseases and should not be used by consumers, Public Citizen writes in a new February posting on its WorstPills.org Web site. The consumer advocacy organization cited information published in the March 2006 issue of Medical Letter on Drugs and Therapeutics.

In 2005, Americans filled more than 2.2 million prescriptions for levalbuterol at a cost of more than $293 million. Marketed by Sepracor Inc., levalbuterol has the same atomic components as the asthma drug albuterol, which has been on the market longer and costs less. The difference is that, while albuterol has both of the two mirror images of the molecule, levalbuterol has only one. Levalbuterol is available in two forms, Xenopex [SIC]HFA, a pocket-sized inhaler approved by the Food and Drug Administration (FDA) in March 2005, and Xenopex, a liquid drug approved in 1999 that is converted to a fine mist when passed through a device called a nebulizer. Levalbuterol is short-acting and is used to relieve symptoms experienced during an asthma attack. In 1999, Public Citizen placed levalbuterol on its “Do Not Use” list of drugs because there was – and still is not – any compelling evidence that levalbuterol is safer or more effective than albuterol.

“Creating a drug that is nearly identical in nature to a drug that is already in existence and then marketing it as a ‘new’ or ‘breakthrough’ drug is a strategy that neither helps consumers nor produces better drugs,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “In marketing levalbuterol as such, the manufacturer is manipulating patients into unnecessarily paying hefty prices.”...

Again, I say the value of Xopenex is not the effectiveness of the drug -- we know it's equal to the cheaper, generic albuterol in that way. But the side effects...where albuterol has the kids bouncing off the walls (especially lovely if they're already on oral steroids) levalbuterol yields negligible negative effects.

To be able to give your asthmatic child a neb at 2:00 AM and know that they'll actually be able to sleep after that is worth the higher copay.

Ig has Croup - allegedly

Saw the peds today -- Ig was up last night coughing so badly, B and I were both freaking out a little. We finally woke him up at around midnight to give him a neb of Xopenex.

This morning I brought him in. It's Saturday, and we were probably among the last patients on what seemed like a very busy day, so she did seem like she was rushing a bit. And I'll confess upfront (and I've said this MANY times before on this blog) while I love my peds, I don't trust them when it comes to determining the clarity of my kids' lungs during the infant/toddler years.

Anyway, she listened to my concerns (low-grade fever, cough, ear pain, etc.), and checked the baby out. She said his ear looked better, so she thought the Omnicef was working -- but based on what I told her, she suspected croup. Now, she didn't hear him cough. And - shocker - she said his chest sounded good.

She wants me to keep up the nebs, and she gave me a box of Pulmicort. I reminded her that he was on Flovent already (fair enough, the pulmo prescribed that), and she said we might want to replace the Flovent with the Pulmicort for now.

Ummm...will one Respule be the same as his regular dose of Flovent 110? She didn't say... I'll cut her some slack. Just this once. I'm a frequent flyer, and she was in a hurry.

She did point out that he'd been in for an ear infection once monthly for the last five months, and that we should follow up with the ENT.

Great. So in the next month, Ig will be visiting the Pediatric Pulmonologist, a Pediatric Cardiologist, and a Pediatric Otolaryngologist. Thank God for health insurance.

No Flu (I don't think) and Iggy's Ear

So, I'm feeling a lot better today, and while I haven't taken my temperature since I woke up, I don't think I have a fever. So...phew.

Ig, on the other hand...not so good. I took him to the peds for his millionth ear infection on Tuesday and we started him on Omnicef. The deal was, if the Omnicef didn't work, we'd have to talk to an ENT about treatment. (read: TUBES)

So we're on the fourth day of treatment, and I've finally brought him back to daycare, and they call me less than two hours after dropoff to tell me that he's running 100.5. Yes, that's a low-grade fever, but four days into an broad-spectrum antibiotic, should there be ANY fever? I think not.

He's also had two rough nights in a row. Wednesday he was up screaming bloody murder every two hours. Last night, he was up at about 1:00 screaming. I gave him some Dimetapp (mostly because he was coughing -- and I couldn't remember when I'd given him Motrin) and a cup of water -- which he sucked back like he hadn't seen fluids in a year.

Both nights were better than Tuesday when he spiked up to 104.9.

Spoke to the peds today, and they said that the antibiotic could take another day or two to kick in (yeah, right...) but that if he had another rough night, they'd see him tomorrow morning.

Ah, nothing like the pediatrician's office on a Saturday!

(Did I mention the hideous cough, by the way? We'll be talking about that with the doc, too. I've been giving him albuterol twice a day.)

Iggy is a NIGHTMARE on Flovent

11-month-old Ig is a demon on Flovent. Man, I thought that kid was a bad sleeper before...on Flovent, he has learned how to scream. So now, when he wakes up at 3:00AM, he doesn't just cry....he shrieks for more than an hour.

He was tenacious before, now he's downright impossible when he gets his mind set on something. (For example, he started self-feeding on Thursday...now I'm not even "allowed" to feed him.)

Good thing he's still so snuggly and cute!!

And yes, I can bitch and moan about it til the cows come home, but ultimately, I'm happy the medication exists that can help my child BREATHE.