Giving thanks...for Flovent and Nebulizers

Thanksgiving's almost here, and - like last year - Oz has RSV again. At least I'm pretty sure it's RSV. We're leaving for the peds. pulmo. in 20 minutes, so I'll know for sure later.

So...yea. Once again, I'll be rushing home from my plate of side dishes (hi, lifelong veg) to administer nebulizer treatments every 3 hours around the clock.

But really, I am thankful. I'm thankful that after over four years of dealing with asthmatic babies, I finally feel like I know what I'm doing. I fearlessly administer Xopenex at the first sign of a cough, and add DuoNeb every 3 hours if things start going south. I no longer feel compelled to go to the ER every time someone's cough spirals out of control. I don't even need to see the PP *every* time one of the boys is sick.

Don't get me wrong -- I still go when we need to. I just don't PANIC anymore.

I'm also thankful that not one of my boys has required hospitalization since 2002. Let's hope I can be thankful for that again next year. :-)

...one final note: Apologies for the two month hiatus. So busy with work and three kids, and big B's Asperger's Syndrome has consumed a good deal of my maternal concern. There may be another blog in that one.

causes of autism |migraine |arthritis |diagnosing asthma |copd |

Iggy's on Flovent

Forgot to mention this in the last post...but yes, my 11-month-old is now on Flovent 44. Not surprising considering:

• He was born in respiratory distress and spent his first 24 hours in the NICU
• He turned blue when he was about 4 months old (he was fine)
• He has had three illnesses involving serious coughs in the last 9 months, including the one last week

And to my friend who was asking about an alternative to Pulmicort, ask your doctor about Flovent and QVar, which are both in metered-dose inhalers (MDIs) rather than administered via nebulizer. Much faster, easier, and child-friendlier.

seasonal asthma |asthma test |allergic asthma |eye allergies |lung cancer symptoms |

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.)

pediatric asthma |information about asthma |asthma test |allergies |sleep apnea |

Iggy's Mystery Illness

So, by now you may have noticed (if I've kept up-to-date with my posting, that is) that Iggy gets sick every two weeks. Every other Friday, I work from home because he's running a fever, coughing, has an ear infection, a stomach virus...something exciting like that.

This week's illness is just WEIRD. He has "the cough", but I only hear it a few times a day. Per the doctor, who - by the way - now thinks I'm completely neurotic, his ears are clear, his throat's only a little red, and his chest is clear. And he's negative for Strep. He's had little or no fever in the morning for the past few days, but he's gone up to 102+ at night. His diapers have been nothing short of repulsive -- but normal in number.

During the day, he's irritable and lethargic. My normally sweet, cuddly boy is grumpy and tantrum-prone. He's not eating well, he's not playing...he'd rather snuggle than toddle aorund, but after a while, he'll start crying and writhing -- then he won't let you put him down, or continue to hold him, or put him in his crib. Not without screaming.

So...knowing that there've been cases of mono and flu in the area, I'm wondering if either of these could be a possibility.

Does anyone have any thoughts, ideas, suggestions, experiences to share? I could definitely use some advice, and I don't feel like I have my pediatrician's attention right now.

BTW, we're in the NY Metro area, if that helps.

infant asthma symptoms |sinus headache |new asthma medications |asthma disease |allergy induced asthma |

Swimming Bad for Infants' Lungs?

Just saw this article in the ALA Weekly Breather, which I rarely get to read anymore. It's so good, though -- I highly recommend that newsletter to all parents of asthmatic kids.

Anyway, here's the article. Have to say I'm not a big fan of teaching anyone younger than 3 to swim -- no one that unstable walking should be near a pool without a vigilant grownup nearby anyway!!

Infant Swimming: Chlorine Lung Risk?...WebMD Medical News reported on June 4, 2007 that infant swimming lessons may lead to problems with children's lung development and possibly make asthma more likely, a new study suggests. The researchers included Alfred Bernard, PhD, of the public health department at Catholic University of Louvain in Brussels, Belgium. They studied 341 Belgian schoolchildren who were about 11 years old, on average. The children provided blood samples and had their lung health tested. Bernard's team noted that 43 of the children had taken infant swimming lessons in indoor pools. The researchers also noted other lung health hazards, including maternal smoking during pregnancy and exposure to secondhand smoke. The lungs of children who had had infant swimming lessons appeared to be predisposed to developing asthma and recurrent bronchitis, according to the study, which appears in Pediatrics.

For the full article: click here.

childhood asthma |information about asthma |pediatric asthma guidelines |allergies |asthma facts |

Iggy's Sick

Yesterday, when I dropped Ig off at daycare, I noticed his friend Jack had a croup-y sounding cough. Jack's a first baby, and his very sweet mom often asks me for advice. I told the caregivers in the room that they should keep an eye on Jack and watch his breathing at naptime. His cough, to me, sounded a little like bronchiolitis.

I mentioned this to my husband last night at bedtime, after telling him that I had given Ig albuterol again.

Naturally, when we woke up this morning (Ig slept right through!), Ig felt a little warm to me. I took his temp - 100.6. Not SUCH a big deal, since he ALWAYS seems to be running a low temp. But was getting cranky, so I gave him some ibuprofen.

Then I noticed, as I was changing him, that he seemed to be breathing a little fast, almost panting. He had some crusted mucus under his nose (also kind of a standard look lately), so I figured it might just be upper respiratorty stuff, but I gave him some albuterol anyway. Hey, our action plan says, "at first sign of a cold."

And THEN, about an hour later, I noticed a steady stream of green goo coming out of his nose. Awesome.

So...I'm refreshing my memory on the symptoms of bronchiolitis (so paranoid, I know) and keeping a close eye.

Meanwhile, I gave him some Dimetapp and put him down for an early nap. $10 he wakes up with a cough and AT LEAST 101.5. Can't seem to get a break with their health this summer...

UPDATE: In fact, Iggy woke up with 102.6, but no cough. He was fever-free by Sunday, but the green goo still lingers.

asthma help |skin allergies |asthma air purifier |wheezing |pollen allergy |

Everyone's Coughing

...it's the "in" thing to do!

Ig's been coughing for days, a croupy sounding number that rips through my heart every time I hear it. (He actually asks for his medicine. He's 22 months old, and he asks me for "ap-icine." How sad is that?)

Oz is doing better, but still coughing at night. Looser than it was, thank goodness.

I'll be unreachable, working a trade show Monday and Tuesday, so I hope they're OK by the time the weekend's over.

food allergies |asthma in infants |mold allergy |allergy medication |allergy induced asthma |

'Roid Rage in Your Asthmatic Child

Every now and then, I get a comment like the one I just got from Tami. She's got a son with severe asthma who needs to be on Pulmicort or Flovent, but goes a little psycho when he's on the stuff.

It's a horrible situation to be in. Unfortunately, steroids are considered the strongest weapon in our anti-asthma arsenals. And as a message board buddy once put it, she'd rather have a kids who "kicks the dog" but can breathe than one who's in the ER every other week.

I think we'd all have HAPPY kids who can breathe.

At the end of the day, when we're not happy with the results we're getting from our doctors, the first checkpoint should be other doctors. I realize that some of my friends here don't have the luxury of being in major metro areas like me, but if you can find another pediatric pulmonologist or asthma/allergy specialist, get there. If you've only been dealing with your regular peds -- take the 2 hour drive to see the specialist. You'll never regret it.

Tami, I don't know what other meds your son is on, but you sound smart and I imagine you've been asking all the right questions and tried lots of different things. We're doing well with Flovent, but I know others who've seen positive changes by switching to Qvar and other brands of similar steroids. Maybe your son can do Singulair instead of steroids? Worth asking...

We've got lots of smart moms around here -- I'm sure someone can offer grounded, sensible advice. (Ahem!)

One note on the eczema -- there's a boy in my kids' daycare who had THE WORST eczema I've ever seen. He was constantly scabbed and bleeding. So sad! Recently, I noticed a drastic improvement, and I asked his parents about it. Would you believe their miracle cure was VASELINE? That's right -- they switched dermatologists, and the new doctor recommended that they bathe him every day (seriously!) and coat him with Vaseline within 2 minutes of getting out of the tub (and barely drying him off) to seal in the moisture.

Worth a shot, right? (With your doctor's permission, natch!)

allergy shots |asthma in infants |toddler asthma symptoms |allergy treatment |living with asthma |

Over Albuterol - We're Reaching Straight for the Combivent

B started coughing slightly a few nights ago...so slightly that I (bad mommy!) didn't bother starting albuterol.

Well, ha-ha and me (and pity on him!) he was coughing so badly last night that he was begging me for Dimetapp! I had given him 2 puffs of albuterol, and then 30 minutes later, another 2 puffs, but it hadn't worked. He was coughing his head of most of the night.

Today, when I picked him up from school, he was coughing a bit. It wasn't alarming in frequency, but it sounded SO BAD.

When we got home, I couldn't find the nebulizer, so I gave him two puffs of Combivent.

I swear, he's coughed maybe twice since then.

I'll look back, and I'm willing to bet I've written this before, but giving this kid albuterol is a waste of a perfectly good pharmaceutical. It just doesn't work on him anymore.

I called the PP for a refill, but I'm not sure if they were able to get it to the pharmacy because I called late...I probably have enough to get through the weekend. Just.

asthma medicines |arthritis |antihistamine |signs of asthma in children |occupational asthma |

NJ's New Mandatory Vaccine: Mama's Angry All Over Again

It's not that I'm against vaccines...I'm not. I think a lot of vaccines are necessary. Polio, for example. Mumps. Measles.

What I have a problem with is vaccinating kids for EVERYTHING. And worse yet, FORCING me to have my kids vaccinated for everything.

Let's give this some context. I'm the mother of a child on the autistic spectrum, as well as three asthmatic boys.

While there's no 100% ideal link between vaccines and autism, there is enough circumstantial evidence - and enough questions have arisen - to give me pause. For one thing, look at the rise in autism diagnoses in recent years. (And sorry - no, I don't believe it's all because of the new diagnostic criteria.)

First of all, why in the world was anything even remotely related to mercury used to bind any vaccines? And no, it's not in the MMR anymore - but is still in the flu vaccines. Seriously.

We'll recall any toy with lead-based paint on the outside chance our kid might chew on it, but we'll inject thimerosal directly into our kids' bloodstreams.

Can someone explain this to me?

Secondly, have you looked at the American vaccine schedule lately? 10 different vaccines before a child's first birthday. Does that seem a little extreme? The UK requires THREE.

But who has the bigger pharma lobby, I wonder?

This just drives me CRAZY.

Now New Jersey, my lovely home state, is requiring me to vaccinate my kids against the flu, as well other illnesses including whooping cough and meningitis.

But let's think back to last year. Anyone remember flu vaccine recalls? How abou the the year before. And hey - didn't Merck just recall the Hib vaccine?

At the end of the day, here's how I feel.

• I will absolutely vaccinate my kids for diseases that pose a dire risk to them and to the public -- Measles, Polio, etc.
• I will not vaccinate my children with predictive vaccines that may or may not be safe or carefully tested.
• I will not allow my children to be injected with vaccines bound with thimerasol.
• I do not think it's necessary to vaccinate my children for non-life-threatening illnesses they're perfectly capable of fighting on their own, like chicken pox.
• I protest the compulsory vaccination of 9-year-old girls for sexually transmitted diseases.
• I DEMAND that vaccinations not be mandatory because pharmaceutical companies have enough money and power to lobby to make it so.

I'm tired, and this may or may not make sense...honestly, I'm not a freak, I'm not a conspiracy theorist. I'm the mom of a child with an autistic spectrum disorder, of three asthmatic boys, who has a LOT of dangerous questions.

pediatric asthma guidelines |acne |allergy medicine |chronic obstructive pulmonary disease |asthma websites |

Jennifer's Question on RSV/Asthma

Had to post this one -- probably a lot of this, now that it's Flu/RSV season:

Hello,
I came across you blog by searching google for asthma treatments. My son 8 months tomorrow has had RSV once and now pneumonia twice. This since early December.My head is spinning thinking that this is potentially a lifetime problem. He is on Orapred now with albuterol Not to mention Amox. for an EI. He was on singulair after the first bout with pneumonia. I thought it was working, but then he came down with a cold and within a day it was in his lungs. The dr. is going to switch him to pulmicort now I just have so many questions. I was wondering if you could perhaps help me or just talk me through it

OK...so the best advice any parent of an asthmatic child can give you is find a pediatric pulmonologist or asthma/allergy specialist, if you haven't already. Pediatricians are generally wonderful, but because asthma - particularly in a child as young as yours - can be VERY subtle, a specialist (if you have access to one) is the way to go.

I've found that finding the right combination of meds is an exercise in trial and error, even with the best doctor. I admit surprise that your son wasn't put on Flovent or Pulmicort from the start, but all docs have their own preferences.

It could be that your son will be what seems like a LOT of medication for a while. My oldest was best on Flovent 220, Singular and Nasonex when he was 2-4 years old. I've never met a mom who was happy about all this maintenance medication, but the good news is, it typically is NOT a permanent situation.

B was on a ton of medication for a year or so before we were able to lower the Flovent and phase out the Nasonex. And once we took his adenoids out (sinus infections were his biggest trigger) we were able to phase out the Flovent as well.

Now he's just on Singular, and has maybe two asthma flares a year -- and they've been mild ones, too.

My other guys are still on Flovent, but comparatively low doses, and they're doing well so far.

I do think that our PP is more aggressive with medication than others, but it seems to have worked will for my boys.

One resource I highly recommend is the Allergy and Asthma Network. You can call them directly with your questions and concerns. (They also offer discounts on medical equipment - definitely a bonus!)

asthma control |asthma wheezing |infertility |child asthma |asthma in young children |

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!

asthma nebulizer |over the counter asthma medication |allergy asthma symptoms |asthma facts |asthma cures |

Ig's Ears

As good as my pediatricians are, sometimes they're in a rush. They've got a busy practice.

Today, I got one of the docs to slow down and read the file.

Ig, as it turns out, DOES have another ear infection. Dr. G listened to my reports about Ig's two weeks of low-grade fever and persistent cough (upper respiratory, thankfully). She flipped through his file and noted that we'd had a rough time pretty much since New Year's. Lots of coughing, fevers, plenty of ear infections. I'm not exaggerating when I tell you the kid was there every two weeks.

She prescribed a 10-day course of Omnicef, but recommended we keep him on for two full weeks if he's not completely symptom-free.

She also recommended that we see the ENT again, since he's had so many ear infections. Hopefully we won't need tubes again. Although, we all slept a lot better when he had them!

asthma medications |allergies |asthma in young children |childhood asthma symptoms |natural asthma relief |

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!

acne |asthma symptoms in children |asthma relief |copd symptoms |naturopathic medicine |

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?

sinus headache |allergy medication |asthma information |allergy asthma |allergies and asthma |

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

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

"I am new, but desperate to find some advice. My 4 year old has asthma and has been on albuterol, pulmicort, singulair, and prednisone for a few years on and off. His 6 year old sister brought a cough/cold home from school last week and now he is battling it. All of the parents of asthmasymptoms2011.blogspot.com/" title="asthma children">asthma children know that when they get a cold/cough...it's SOO much worse for them over other children. I'm at my wits end, he is coughing and coughing for days now. The doctor told me to do the regular routine...albuterol/pulmicort in his machine. It doesn't seem to be helping, he has made himself vomit 2 times from his coughing attacks. It's now Saturday night, 6:30 pm and he's coughing nonstop. He isn't wheezing, but his breathing is fast. The cough is the worst, and I don't seem to be getting much help from his doctor.

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

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

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

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

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

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

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

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

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

Please feel free to respond via comments or email.

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Quick Note: Ig's Pneumonia

Just a quick update: Ig developed pneumonia the day we left Canada for home. (We go to Canada for the holidays every year - in-laws are in Ontario.)

He's fine - didn't even need any nebs. Never mind that his fever hit 104.8 on New Year's Day!

Isn't it ironic? The kid who spent his first day of life in respiratory distress in the NICU is the kid with the strongest lungs! Fever started Thursday, and he'll be back in preschool tomorrow.

For the record, I believe this is pneumonia #6 for the mama.

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And the pneumonia just keeps on comin'!

Update -

Sent Oz back to school yesterday. He'd been fine all weekend, and practically bouncing of the walls. He couldn't wait to get out!

When he came home, he immediately lay down on the sofa and fell asleep.

That is NOT like my Oz.

When I checked, he was running 100.8 and complaining of pain in his chest and a headache.

I put him to bed early, but he woke up shortly after crying hysterically - he was completely incomprehensible. Then he threw up all over my bed. Then he fell asleep again.

Next time he woke up, not an hour later, the screaming resumed. He was in pain, scared - I don't even know what. I started to warm up the car so I could take him to the ER.  But by the time I came back in, he was asleep again.

I'd spoken to the doctor twice by this time. She warned me that it could either be an effusion or a mucus plug. (eeeeuwwww.)

He made it through the night after that. He was laboring to breathe a bit, but his respiratory rate was OK.

This morning, we had to go back to the doctor, of course. And of course, we were sent for another chest X-ray.

The results? The Zithromax he'd been taking wasn't working. The pneumonia had actually gotten worse! WTF??!!!

So... while it may actually be a viral pneumonia, we're starting Omnicef tonight.

Wish us luck.  We're back to the pulmonologist next week.

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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.

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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!

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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!

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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 |treatments for asthma |asthma meds |asthma action plan |depression |

Kids' Diagnosis and Note on ProAir

We saw my *least* fave pediatrician in the group. She diagnosed both boys with sinus infections, and said their lungs were clear. She said it might be viral, but she wanted to start antibiotics anyway.

I'm going to wait 24 hours before starting.

I'm also going to take Oz to the pulmonologist.

I don't believe in taking antibiotics for everything. If you're not SURE it's bacterial, why do antibiotics? Why risk developing resistance? Although I'd hate to put Oz at risk for another pneumonia...Would I be doing that? And Ig seems to be completely on the mend already.  Thoughts?

I did show her our barely functioning ProAir inhaler, too. She said they know it's an issue, and they've got calls into the manufacturer. She said to insist on either Ventolin or Proventil next time, although I'd be just as happy with the Warwick generic. But glad I said something.

I wonder if I can return the two ProAir MDIs I have for another brand...?

****
Update: Went to the pulmonologist, who sent us for a chest X-ray. It was clear! Looks like we're definitely sinus infection/ asthma flare. The PP wants us to start the Biaxin, so I guess we will.

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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!

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Oz is OK

The pediatric pulmonologist tells me I'm as good as an ER. When Oz was having a flare this morning -- so much coughing he couldn't even speak -- I started doing nebs every two hours. I alternated Xopenex and DuoNeb and called her office for backup.

By the time we got to her office at 2:30, he was hardly coughing anymore. By the time we left, he was singing in the car all the way home.

Still doing nebs every 2-3 hours today, and we'll reduce to every 3-4 tomorrow.

But first, we'll see how tonight goes.

BTW, did I mention I've barely seen my office in the last week? I've been working from home since Iggy got sick last Monday. Only *slightly* stir crazy. :-)

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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.

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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.)

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Iggy's Mystery Illness

So, by now you may have noticed (if I've kept up-to-date with my posting, that is) that Iggy gets sick every two weeks. Every other Friday, I work from home because he's running a fever, coughing, has an ear infection, a stomach virus...something exciting like that.

This week's illness is just WEIRD. He has "the cough", but I only hear it a few times a day. Per the doctor, who - by the way - now thinks I'm completely neurotic, his ears are clear, his throat's only a little red, and his chest is clear. And he's negative for Strep. He's had little or no fever in the morning for the past few days, but he's gone up to 102+ at night. His diapers have been nothing short of repulsive -- but normal in number.

During the day, he's irritable and lethargic. My normally sweet, cuddly boy is grumpy and tantrum-prone. He's not eating well, he's not playing...he'd rather snuggle than toddle aorund, but after a while, he'll start crying and writhing -- then he won't let you put him down, or continue to hold him, or put him in his crib. Not without screaming.

So...knowing that there've been cases of mono and flu in the area, I'm wondering if either of these could be a possibility.

Does anyone have any thoughts, ideas, suggestions, experiences to share? I could definitely use some advice, and I don't feel like I have my pediatrician's attention right now.

BTW, we're in the NY Metro area, if that helps.

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Swimming Bad for Infants' Lungs?

Just saw this article in the ALA Weekly Breather, which I rarely get to read anymore. It's so good, though -- I highly recommend that newsletter to all parents of asthmatic kids.

Anyway, here's the article. Have to say I'm not a big fan of teaching anyone younger than 3 to swim -- no one that unstable walking should be near a pool without a vigilant grownup nearby anyway!!

Infant Swimming: Chlorine Lung Risk?...WebMD Medical News reported on June 4, 2007 that infant swimming lessons may lead to problems with children's lung development and possibly make asthma more likely, a new study suggests. The researchers included Alfred Bernard, PhD, of the public health department at Catholic University of Louvain in Brussels, Belgium. They studied 341 Belgian schoolchildren who were about 11 years old, on average. The children provided blood samples and had their lung health tested. Bernard's team noted that 43 of the children had taken infant swimming lessons in indoor pools. The researchers also noted other lung health hazards, including maternal smoking during pregnancy and exposure to secondhand smoke. The lungs of children who had had infant swimming lessons appeared to be predisposed to developing asthma and recurrent bronchitis, according to the study, which appears in Pediatrics.

For the full article: click here.

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Iggy's Sick

Yesterday, when I dropped Ig off at daycare, I noticed his friend Jack had a croup-y sounding cough. Jack's a first baby, and his very sweet mom often asks me for advice. I told the caregivers in the room that they should keep an eye on Jack and watch his breathing at naptime. His cough, to me, sounded a little like bronchiolitis.

I mentioned this to my husband last night at bedtime, after telling him that I had given Ig albuterol again.

Naturally, when we woke up this morning (Ig slept right through!), Ig felt a little warm to me. I took his temp - 100.6. Not SUCH a big deal, since he ALWAYS seems to be running a low temp. But was getting cranky, so I gave him some ibuprofen.

Then I noticed, as I was changing him, that he seemed to be breathing a little fast, almost panting. He had some crusted mucus under his nose (also kind of a standard look lately), so I figured it might just be upper respiratorty stuff, but I gave him some albuterol anyway. Hey, our action plan says, "at first sign of a cold."

And THEN, about an hour later, I noticed a steady stream of green goo coming out of his nose. Awesome.

So...I'm refreshing my memory on the symptoms of bronchiolitis (so paranoid, I know) and keeping a close eye.

Meanwhile, I gave him some Dimetapp and put him down for an early nap. $10 he wakes up with a cough and AT LEAST 101.5. Can't seem to get a break with their health this summer...

UPDATE: In fact, Iggy woke up with 102.6, but no cough. He was fever-free by Sunday, but the green goo still lingers.

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'Roid Rage in Your Asthmatic Child

Every now and then, I get a comment like the one I just got from Tami. She's got a son with severe asthma who needs to be on Pulmicort or Flovent, but goes a little psycho when he's on the stuff.

It's a horrible situation to be in. Unfortunately, steroids are considered the strongest weapon in our anti-asthma arsenals. And as a message board buddy once put it, she'd rather have a kids who "kicks the dog" but can breathe than one who's in the ER every other week.

I think we'd all have HAPPY kids who can breathe.

At the end of the day, when we're not happy with the results we're getting from our doctors, the first checkpoint should be other doctors. I realize that some of my friends here don't have the luxury of being in major metro areas like me, but if you can find another pediatric pulmonologist or asthma/allergy specialist, get there. If you've only been dealing with your regular peds -- take the 2 hour drive to see the specialist. You'll never regret it.

Tami, I don't know what other meds your son is on, but you sound smart and I imagine you've been asking all the right questions and tried lots of different things. We're doing well with Flovent, but I know others who've seen positive changes by switching to Qvar and other brands of similar steroids. Maybe your son can do Singulair instead of steroids? Worth asking...

We've got lots of smart moms around here -- I'm sure someone can offer grounded, sensible advice. (Ahem!)

One note on the eczema -- there's a boy in my kids' daycare who had THE WORST eczema I've ever seen. He was constantly scabbed and bleeding. So sad! Recently, I noticed a drastic improvement, and I asked his parents about it. Would you believe their miracle cure was VASELINE? That's right -- they switched dermatologists, and the new doctor recommended that they bathe him every day (seriously!) and coat him with Vaseline within 2 minutes of getting out of the tub (and barely drying him off) to seal in the moisture.

Worth a shot, right? (With your doctor's permission, natch!)

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Over Albuterol - We're Reaching Straight for the Combivent

B started coughing slightly a few nights ago...so slightly that I (bad mommy!) didn't bother starting albuterol.

Well, ha-ha and me (and pity on him!) he was coughing so badly last night that he was begging me for Dimetapp! I had given him 2 puffs of albuterol, and then 30 minutes later, another 2 puffs, but it hadn't worked. He was coughing his head of most of the night.

Today, when I picked him up from school, he was coughing a bit. It wasn't alarming in frequency, but it sounded SO BAD.

When we got home, I couldn't find the nebulizer, so I gave him two puffs of Combivent.

I swear, he's coughed maybe twice since then.

I'll look back, and I'm willing to bet I've written this before, but giving this kid albuterol is a waste of a perfectly good pharmaceutical. It just doesn't work on him anymore.

I called the PP for a refill, but I'm not sure if they were able to get it to the pharmacy because I called late...I probably have enough to get through the weekend. Just.

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Everyone's Coughing

...it's the "in" thing to do!

Ig's been coughing for days, a croupy sounding number that rips through my heart every time I hear it. (He actually asks for his medicine. He's 22 months old, and he asks me for "ap-icine." How sad is that?)

Oz is doing better, but still coughing at night. Looser than it was, thank goodness.

I'll be unreachable, working a trade show Monday and Tuesday, so I hope they're OK by the time the weekend's over.

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NJ's New Mandatory Vaccine: Mama's Angry All Over Again

It's not that I'm against vaccines...I'm not. I think a lot of vaccines are necessary. Polio, for example. Mumps. Measles.

What I have a problem with is vaccinating kids for EVERYTHING. And worse yet, FORCING me to have my kids vaccinated for everything.

Let's give this some context. I'm the mother of a child on the autistic spectrum, as well as three asthmatic boys.

While there's no 100% ideal link between vaccines and autism, there is enough circumstantial evidence - and enough questions have arisen - to give me pause. For one thing, look at the rise in autism diagnoses in recent years. (And sorry - no, I don't believe it's all because of the new diagnostic criteria.)

First of all, why in the world was anything even remotely related to mercury used to bind any vaccines? And no, it's not in the MMR anymore - but is still in the flu vaccines. Seriously.

We'll recall any toy with lead-based paint on the outside chance our kid might chew on it, but we'll inject thimerosal directly into our kids' bloodstreams.

Can someone explain this to me?

Secondly, have you looked at the American vaccine schedule lately? 10 different vaccines before a child's first birthday. Does that seem a little extreme? The UK requires THREE.

But who has the bigger pharma lobby, I wonder?

This just drives me CRAZY.

Now New Jersey, my lovely home state, is requiring me to vaccinate my kids against the flu, as well other illnesses including whooping cough and meningitis.

But let's think back to last year. Anyone remember flu vaccine recalls? How abou the the year before. And hey - didn't Merck just recall the Hib vaccine?

At the end of the day, here's how I feel.

• I will absolutely vaccinate my kids for diseases that pose a dire risk to them and to the public -- Measles, Polio, etc.
• I will not vaccinate my children with predictive vaccines that may or may not be safe or carefully tested.
• I will not allow my children to be injected with vaccines bound with thimerasol.
• I do not think it's necessary to vaccinate my children for non-life-threatening illnesses they're perfectly capable of fighting on their own, like chicken pox.
• I protest the compulsory vaccination of 9-year-old girls for sexually transmitted diseases.
• I DEMAND that vaccinations not be mandatory because pharmaceutical companies have enough money and power to lobby to make it so.

I'm tired, and this may or may not make sense...honestly, I'm not a freak, I'm not a conspiracy theorist. I'm the mom of a child with an autistic spectrum disorder, of three asthmatic boys, who has a LOT of dangerous questions.

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Jennifer's Question on RSV/Asthma

Had to post this one -- probably a lot of this, now that it's Flu/RSV season:

Hello,
I came across you blog by searching google for asthma treatments. My son 8 months tomorrow has had RSV once and now pneumonia twice. This since early December.My head is spinning thinking that this is potentially a lifetime problem. He is on Orapred now with albuterol Not to mention Amox. for an EI. He was on singulair after the first bout with pneumonia. I thought it was working, but then he came down with a cold and within a day it was in his lungs. The dr. is going to switch him to pulmicort now I just have so many questions. I was wondering if you could perhaps help me or just talk me through it

OK...so the best advice any parent of an asthmatic child can give you is find a pediatric pulmonologist or asthma/allergy specialist, if you haven't already. Pediatricians are generally wonderful, but because asthma - particularly in a child as young as yours - can be VERY subtle, a specialist (if you have access to one) is the way to go.

I've found that finding the right combination of meds is an exercise in trial and error, even with the best doctor. I admit surprise that your son wasn't put on Flovent or Pulmicort from the start, but all docs have their own preferences.

It could be that your son will be what seems like a LOT of medication for a while. My oldest was best on Flovent 220, Singular and Nasonex when he was 2-4 years old. I've never met a mom who was happy about all this maintenance medication, but the good news is, it typically is NOT a permanent situation.

B was on a ton of medication for a year or so before we were able to lower the Flovent and phase out the Nasonex. And once we took his adenoids out (sinus infections were his biggest trigger) we were able to phase out the Flovent as well.

Now he's just on Singular, and has maybe two asthma flares a year -- and they've been mild ones, too.

My other guys are still on Flovent, but comparatively low doses, and they're doing well so far.

I do think that our PP is more aggressive with medication than others, but it seems to have worked will for my boys.

One resource I highly recommend is the Allergy and Asthma Network. You can call them directly with your questions and concerns. (They also offer discounts on medical equipment - definitely a bonus!)

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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!

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Ig's Ears

As good as my pediatricians are, sometimes they're in a rush. They've got a busy practice.

Today, I got one of the docs to slow down and read the file.

Ig, as it turns out, DOES have another ear infection. Dr. G listened to my reports about Ig's two weeks of low-grade fever and persistent cough (upper respiratory, thankfully). She flipped through his file and noted that we'd had a rough time pretty much since New Year's. Lots of coughing, fevers, plenty of ear infections. I'm not exaggerating when I tell you the kid was there every two weeks.

She prescribed a 10-day course of Omnicef, but recommended we keep him on for two full weeks if he's not completely symptom-free.

She also recommended that we see the ENT again, since he's had so many ear infections. Hopefully we won't need tubes again. Although, we all slept a lot better when he had them!

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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!

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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?

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