Sam's health/asthma insight needed/I hate insurance companies

[samsmamma]

Well, I took sam to the ped today. They did a few tests to indicate that he is really wheezy and basically called it a viral asthma-ish type thing. Of course my first thought was - I nursed the kid for almost 3 years, he can't have anything asthma-ish. of course, I live in a neighborhood with one of the highest astham rates in the city, so anything is possible. Well, the long and short of it is that the doc told us not to worry, but we have to put him on an inhaler for about 10 days and see what happens. if it clears right up, it's just one of those things. if it clears up but the next time he gets a cold he gets the same cough, then we need to think about treating it more aggressively and preventatively. he said there is nothing environmental we need to deal with at this point. I'm thinking, roaches, dust, who knows what - there is a lot of construction in my building right now...do I need to move to a different neighborhood?

Well, whatever, I pretty much get over it and go to fill the scrip. Well, the albuterol is covered - but the thingy we need to put it on to deliver it isn't! So what's up with that - insurance will cover the drug, but if you actually want to give it to the kid, you need to shell out mad money. So instead of being like $20 at the pahrmacy, I just had to pay almost $90 that I don't have. I'm going to try to fight it based on standard of care - again, what's the point of giving the meds if there is no way to administer them? But I am so pissed.

And of course, i'm worried about Sam now. Hopefully this will just take care of itself, but now I'm going to be thinking about it every day he's at the playground, etc.

I'm not a happy mama right now.

Anyone have any experience with this stuff?

[shelbean91]

There are other forms of albuterol (liquid, pill, inhaler) but for a child his age, the nebulizer is probably the best way to get the med into his lungs. I has to take the albuterol pills and had horrible side effects (terrible, terrible nightmares).

An alternative to a nebulizer (I'm assuming that's what you had) is using a spacer. If he can breathe in when you're telling him (close his nose) you could use a spacer, often times dr offices have freebies to give out. A spacer is a chamber that you pump the inhaler into and then breathe in, so you don't have to so closely time the pump of med with the breath in.

If it is asthma, the dust from construction could very well be a part of it.

[flyingspaghettimama]

We were told the exact same thing about two months ago - the pediatrician said she heard wheezy asthma-like sounds in her chest (accompanying a long cold and cough) and that we should look into asthma treatment if it continued again this winter or wasn't better in a week without treatment; although she'd give us a prescription if we liked. We did not take any inhalant prescription, and she's absolutely fine. Sometimes kids just get junky, wheezy coughs. Did they do a pulse ox to see if he is getting enough oxygen despite his cold/cough? This is what helped me not to worry and decide not to take any medication for her. They just put their finger in a little trough to see how the oxygen is flowing.

However, on the inhalant and etc - last year I had some fairly bad bronchial obstruction and inflammation and got a free Advair from the doctor. It was very helpful and super cool - it's an all-in-one dispenser and medication, a purple disk-like thing. Albuterol gives me wicked headaches, and Advair seemed much less intense and lower-dose than Albuterol. I'm not sure if this is the case though.

[shelbean91]

Advair is a completely different med than albuterol. Albuterol is a fast acting bronchodilator. Advair is a combo of 2 meds, fluticasone propionate and salmeterol, one of which is an inhaled steroid and the other is a long lasting bronchodilator. Albuterol would be considered the emergency med, Advair the preventative med.

Erica- if you don't want to use the meds, try using steam. Also, sometimes caffiene helps relieve the symptoms, though you may not like the side effects of caffiene.

[flyingspaghettimama]

Yes - I didn't mean to imply they were the same thing. It's just what my doc suggested when I said I was having a hard time breathing without coughing madly at certain times, as an alternate to Albuterol. It worked very well for me, but I don't have asthma.

[shelbean91]

Originally Posted by flyingspaghettimama

Yes - I didn't mean to imply they were the same thing. It's just what my doc suggested when I said I was having a hard time breathing without coughing madly at certain times, as an alternate to Albuterol. It worked very well for me, but I don't have asthma.

Yeah- I've noticed that more often they are prescribing traditional 'asthma' meds for bronchitis and cough- since the symptoms are often the same. It is nice to be able to breathe, isn't it? Advair was the best thing for me, b/c prior to it being introduced, there were separate inhalers w/the same med, which meant 2 copays- Advair was basically a 2 in 1 for me, 2 meds for one copay.

I didn't mean to say you thought they were the same thing, just clarifying a bit. (It's one of the few things I know quite a bit about, since I've had asthma since I was 10).

[gingerstar]

Sams mamma - My older daughter was diagnosed with asthma at 4 yo, after years of "croup", and my response was similar to yours - I nursed this child for more than three years!! Isn't that supposed to help?!? But, maybe it did - maybe that is why she was diagn. @ 4, not at a year, or something. Also, I don't know if you or Sam's daddy have a family history of asthma, but I just read about a study which indicates asthma is linked thru the paternal genes - and I found out (after my DD's diagnosis, thank you in-laws, ) that my husband's father's family is FULL of asthma, for generations....
And it might be too late, but some medical supply places rent the nebulizers, if you are just trying to see if it helps - but it sounds like you already paid out. For a little one, the nebulizer is much much more effective than an inhaler, even with a spacer, even with a spacer w/a mask. We are just now (she is 7 1/2) switching to inhalers, and if she is sick (which is the leading cause of asthma attacks) or during bad allergy times, I still prefer to use the nebulizer, because it is so much more effective.
There is a great website http://www.njc.org/ which is the National Jewish Medical and Research Center, the leading place in the country for asthma and other breathing problems, and they have a wonderful amount of info. Also, feel free to PM me if you would like to discuss any of this further - I have been in your shoes! My daughter does very well now, it is just part of our life.
Of course, I wish you the best news - that it turn out to be just a viral thing and he may not actually have asthma at all!
Best wishes....
Sharon

[flapjack]

. Gotta go- was going to post an essay, but the kids are having a meltdown. Don't panic, you're doing everything right.

[flapjack]

Okay: the essay. You know Isaac has asthma, right? Well, when he started with croup (age 3) and asthma (age 4) my initial reaction was, "why us?" We did everything right, breastfeeding, sought homoeopathic and holistic treatments for his eczema and milk allergies to prevent it going inwards and becoming asthma, everything you could possibly do.
I think that saved his life.
There are a LOT of positives in your situation: it sounds like the wheezing episodes are related to illness rather than exercise or lifestyle function, which is like Isaac. This means it may have a much smaller impact on his life than it might otherwise have done: basically, when Isaac gets ill, he gets really ill, but when he's not he's normal.

Albuterol is the same drug that Isaac uses as a reliever (we call it salbutamol over here)- it's been around for ages and is the safest on the market. The big problem is that it does change behaviour as well and can make children appear hyperactive. I'd disagree with the pp: there's research to suggest that nebulisers are actually less efficient at delivering medication than a spacer, and spacers also have the psychological advantage of letting a child actually DO something rather than just having to sit still for 5 minutes. Also, spacers are portable: an important factor if it turns out he starts to get wheezy after exercise. We also use a reliever medication and oral prednisolone to get him through attacks without hospitalisation: touch wood, you'll never come to this.
Oxygen saturation levels (that thing with the red light going through the finger ) are useful things to know, but a tough kid can have levels of 98-99% yet their chest may be recessing when they breathe and their pulse may be accelerated. You need to look at everything overall. Also, look at the whole picture: diet (Isaac eats 13 portions of fruit and vegetables a day) and exercise play a part as well. Feel free to PM me if you think it'll help.
I suppose the big question is: what's your gut instinct telling you?

[samsmamma]

I may very well PM a few of you but some of the questions are similar so I thought I'd start there.

They did do the pulse ox finger thingy and the number was 97. I don't know what that means. I guess it means his lungs are working at 97% instead of 100%?

I'm not sure about the difference between the spacer and the mask. What we do is put the mask over his face and give one squirt of the inhaler and he just takes about 5 breaths or so and then we are done. But - he hates it. Totally makes him cry. I think the taste of the propellant bothers him. So of course I feel like the stress of the inhaler makes him cough more because it makes him cry.

Fact is, he's got an awful cough with this cold and nothing was working at all. DH even asked - did we vaccinate him for whopping cough? (yes - because it is a problem in our neighborhood because of many adult carriers...) So my instinct told me to take him to the dr anyway and DH agreed, and we actually saw a dr not a nurse practitioner - as soon as they heard his cough they sent the doc in. But I'm interested in the comment that they are prescribing asthma meds for more and more colds. I wonder what the long term effects of these are. I suppose that if you are just using it once it's not that big a deal, but if we need to do this on a regular basis, what is it going to do to him body?

I also agree that it made him kind of hyper and weird last night, and I just didn't have the energy for it.

So what else can I say. He typically gets 1-2 bad colds a year and other little ones just because we are around other kids. His nose is horribly congested and I think now it scares him to blow his nose because it makes him cough and he doesn't want to cough. The albuterol definitely seemed to help him sleep last night - he did come into my bed around 1, but no 2 hour coughing fits, so that is a good thing. And I just gave him a dose when we woke up this AM and after a few coughs, things have been pretty quiet, so that is good.

The doc's gut is that this is just virally related and that it will go away. My mom was diagnosed with asthma pretty late in life but that is the only asthma in the family. (though I wonder about dh sometimes because he smoked for years and years and years).

Not to be gross, but there is definitely a problem with roaches in our neighborhood, though in our building it is not a problem during the winter (we're on the top floor - its too cold for them to come up here). We have not exterminated because we didn't want all the chemicals in the apartment. Btu of course the construction they are doing means there are more of them out and about in the halls and the walls, but it's not like our apartment is roach infested - like some of the buildings and like probably the places where some of his friends live. Ew, that whole topic grosses me out, I have roach issues from when I was growing up. Save that for a most disgusting things ever thread. We're not on a major route for garbage trucks coming through. We could do a better job of getting rid of dust. We are also thinking about an ionizer to help clean the air and we heard good things about cold air humidifiers. Anyone have any insight on those?

I just want him to feel better. HIs appetite was much better last night, so I imagine he must be feeling a little better, but I just feel so bad hearing the cough and then seeing him get so upset over the inhaler and everything.

And tomorrow will be the day I write my scathing letter to the insurance company.

Thanks for the continued feedback.

[flapjack]

Which way up does he sleep? On his tummy, or on his back? If it's on his back or his side then you can give the inhaler while he's asleep (the mask thingummy is called a spacer over here)- just count ten breaths. I don't like doing it- it feels dishonest, but sometimes it's necessary. Also, counting backwards from 10 works with Isaac, especially if you then run around playing Thunderbirds (yes, I'm mad.) Give him a drink afterwards- apparently inhalers taste all spicy (Isaac says this a lot.)
The pulse oxy thing means that his blood contains 97% of the available oxygen- it's an indication of how he's coping, ie pretty well.
Good luck: I know it's tough.