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Follow-up on reactive airways

 
I wanted to post an update on how things are going with O's reactive airways. Our pediatrician is now calling it asthma. They don't officially diagnose asthma until 24-months; O has just reached 23-months and showing every sign of being an asthmatic. For several months now, we've had a routine: Pulmicort via nebulizer in the morning and at night. It takes about 12 minutes to give him his Pulmicort in the nebulizer-- each time, 12 minutes in the morning and 12 minutes at night. He only needed to go on the Orapred once last fall since starting the daily regulator, early in the fall. He was eligible for the Synagis vaccine this year (woo hoo!); he's had 4 of the 5 vaccines. Thankfully he avoided catching many colds. We had a string of runny noses starting around Thanksgiving, nothing much more than that. Knock on wood, we haven't caught stomach flu yet this year either. But then O came down with a cough at the end of February. The cough wasn't too bad; his twin brother C caught it as well and was fine. O's cough hit his chest and got him wheezing. I brought him into the pediatrician since it really started sounding bad on a Friday (always a Friday, never a Monday when the pediatrician is open!). She told me what to do if his breathing started getting out of control and went over the asthma treatment plan with me again. We went into the weekend feeling pretty good, though a little nervous. Saturday O needed Albuterol about every 6 hours. Sunday he needed them more than that, every 4-5 hours. By Monday, he sounded the same after Albuterol as he did before. I called on Monday and he was started on Orapred that day. He used Albuterol Monday, every 4-5 hours, and on Tuesday, every 6 plus hours, while taking the Orapred and his daily regulator, Pulmicort. I was so nervous that he would need to go to the hospital since he was still using Albuterol. Thankfully, thankfully, thankfully he sounded much better by Wednesday; he used no Albuterol on Wednesday or on Thursday.

Even more nerve-wracking is this was the week I needed to have my D&C (read my blog post "Miscarriage") and so he was left with his baby-sitters. I hated leaving him. I knew I needed to take care of myself, but I wanted to watch him, make sure he was breathing okay. What really made me nervous was that he would have an attack. One of the big problems he was having was that his cough would make him cry; once he started crying, he couldn't catch his breath, which made him cough and cry more; he was having retractions that pulled at his collarbone. He wasn't eating or napping. He would sit in my lap and wheeze. My heart broke leaving him on Wednesday to go to the hospital. Logically, I felt good knowing that he had already had two days of Orapred and that he needed less Albuterol on Tuesday than he did on Monday. Emotionally, I thought of him sitting in my lap wheezing, knowing how quickly things can change, from my own experience with asthma and from what the doctors have told me about reactive airways in toddlers. I don't think I could have left him with the sitter, if not for the fact that our baby-sitters also have asthma. They are comfortable taking care of him and know what to watch for. I had my phone with me as long as I could; my husband had his phone on him the whole time. We got home from the hospital around noon and O was doing great.

On day #5 of the Orapred, I brought O in for a follow-up on his breathing. His oxygen levels were awesome and his lungs sounded great. We had a trip planned (ready my blog post "Let it be") and she asked if we wanted inhalers too, for travelling. So now he has Pulmicort in nebulizer and inhaler form. He already had Albuterol in nebulizer and inhaler form; we keep an Albuterol inhaler and aero chamber in our diaper bag along with his Asthma management plan. This works out great because mornings are a little difficult for us. This morning we had a lot going on and used the Pulmicort inhaler with the aero chamber. Occasionally we miss the morning Pulmicort because it is so hard to get D to preschool, get the boys dressed, and do the nebulizer. We don't miss it very often because O does well sitting with it on his face if I am in the room with him, telling him "sit" or "hold still" if he starts knocking his mask off. But now with the inhaler, we won't ever miss it.

On most days, I do the first Pulmicort nebulizer treatment after dropping D off at school. Some days we have to do it before D goes to school; those days are rough. We do the second treatment at night, before bed. We try to have it finished 10-15 minutes before they go to bed so we have time for teeth brushing at prayers. During the nightly Pulmicort we read stories and watch Jeopardy or Wheel of Fortune. The days that he needs Albuterol, I do my best to time the treatments. They make him jittery, wired. I try to do them 45 minutes before he goes to sleep or eat. Sometimes he will still nap immediately after doing an Albuterol treatment. Some days he will still eat after doing a treatment. Most of the time, he just wants to run in circles or rock back and forth in his high chair after doing Albuterol. I try to give him some time to get the "sillies" out, as we call them. The bad times are when the Albuterol doesn't affect him much and he still wants to sit afterwards. That is when he is really struggling, like this last time he went on Orapred. He still just wanted to sit in my lap after the Albuterol. The Orapred can upset his stomach. I try to give that to him an hour or so after he's eaten, so he has a full tummy and it has had time to settle. I don't know how much this all helps. I don't know if I time things in a way that helps him. Maybe it makes me feel that I'm helping.

Since the first time he went on Orapred was right when he started his daily regulator, Pulmicort, and he only had to go on Orapred once after that, our doctor wants to keep him on the Pulmicort. She says if he has another episode like this, we may need to think of changing his medications. Obviously we are praying that doesn't happen, not now. But, for now, we are doing well.

Previous blog posts about O's reactive airways:

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