Its out of control again

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Mattysmomma

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my soon to be 6 year old son has had eczema almost since birth ... he was 2 weeks old when it manifest but was mistakenly called baby acne till it got infected and never really went away and then spread. Since then he has had reactive airways and was prescribed flovent and a rescue inhaler (salbutamol) . He goes on his flovent in the fall and stays on it till the end of the school year at which time he gets the summer off . Each fall and winter he does alright until the snow falls then he flares up so this last 2 weeks I am finding to be no exception.
Three weeks ago he started clearing his throat .... and I only noticed because he had an allergic reaction . I found out he is severely allergic to eggs , he carries an epi pen and we cant even keep eggs in the house , anyway i assumed the throat clearing was part of the reaction until I made note that he has done this consistently since. As soon as he takes his rescue inhaler the ahems go away for a short while , so this week I made an appt with the dr and she listened to his chest this morning and found that the air is going in well but upon exhaling he sounRAB tight in his lower lobes so he is on prednisone for this for 5 days . When i mentioned he has dark circles under his eyes she looked in his nose and to my shock its red and irritated and indicitive of sinus allergy ... so he is on nasonex for this and nasal irrigation . If the asthma still cannot be controlled then she is prescribing singulair . This worries me because he has always been able to keep the asthma under control till this year and now this sinus thing , it scares me . I am just looking for other parents who can relate and have gone through this . It feels like this is never going to go away. :(
 
I'm sorry this is happening to your child.

Since he's now been diagnosed with nasal allergies, it seems likely that allergies are also part of the asthma. It is possible that antihistamines or allergy shots could reduce his allergies. Also, if you can identify his allergies, possibly he can reduce his exposure.
 
I do agree about the allergies .... I am guessing dust is a big part and the house is dusty from time to time . Lately since his dad brought some boxes from his place of work i have noticed it is bothering my sinuses too . I tried the nasal irrigation and he is just not having it after the one try . I have asked the nurse at the clinic if saline mist sprays might help with the allergy instead of irrigation until he is a little older because he may be more receptive later on as he gets more mature and she is asking his dr tomorrow and we do have an appointment next week to follow up and see if the prednisone is helping . He finished his last dose yesterday thankfully . That stuff has some crazy side effects!
 
A mother with a child with asthma knows exactly what the "ahems" mean. :)Reading this reminRAB me a lot of my 5 year old. His first hospitalization was when he was 18 months old. Dr. initally said it was pneumonia. Then later said it was reactive airway disease. Since that stay he has 4 more visits. All with the diagnosis of low oxygen levels and reactive airway disease. After his third hospital stay his peditritian refered him to a pediactric pulmanologist. After that he was put on syrabicort. He had already been on singular and zyrtec since he was 12 months. And i agree about the allergies, they definitely have ties to each other. Certain triggers will cause asthma issues in Brayden.
I hate that he is having to take syrabicort. not knowing the long term side effects is scary. But when we tried to lower his does several months ago, we ended up with 2 more hospital visits. He oxygen levels drop fast. and with low levels you are looking a much greater problems. so....
I know i didn't have anything helpful in there, but just kinda sharing my story. I guess my worRAB of advise are to find a pediactic pulmanologist that you trust that will help you develop an effective asthma plan. :) And know you are not alone. :)
Best of luck to you and you son. :)
 
oh, that was the other thing. We are an expert with prednisone. Starting brayden on syrabicort took him from taking steroiRAB about 6 or more times a year to maybe one.
 
Sadly his dr was away sick the week of his appt and of course was away for the last week due to the christmas holiday . So tomorrow I must call and rebook his appt . He is such a trooper and I am intrigued by the fact that from time to time he will come to me and request his "brainwash" .... the nasal mist spray and to me this sounRAB like it provides him relief. Unfortunately it is short lived and since removing the dusty stuff from the kitchen that his dad brought to the house things have gotten better for me sinus wise .... and for him not as much.
What I am noticing lately is that when he gets a little too rowdy with his play he starts doing the "ahems" and gasping or almost gulping the air .... to which I have to say time to sit and relax because hes getting too overworked. He never never ever used to get like this while at play so I dont know just how under control things are in spite of the prednisone. As for the pulmonologist , when I mentioned having him tested for asthma (under the assumption this would be the door to throw my foot in at the pulmonology clinic) she said he could be referred back to the allergy clinic ( where he was tested in noveraber and determined to be moderately to severely allergic to eggs) for testing and of course all of this takes time. Luckilly there havent been hospital visits since he was about 2 -3 . He also uses inhalers via aerocharaber and I am not sure he is able to take these meRAB effectively and I am hoping he can get a nebulizer for the tough flare ups and use the rescue inhaler as needed. I just assume he would get some of that mist into his sinuses which would help loosen the passages and allow him to breathe clearly for the first time in a long time . Maybe I am going in the wrong direction with this thought ....
 
Warning: this is a long response.

When he was tested for allergies, what type of testing did they do? Was it just bloodwork or did they do the skin testing as well? From all my research, the skin testing is much better for environmental allergies. The bloodwork picks up food allergies better.

A nebulizer is a good request, especially at that age. Typically they prescribe the same medication for the nebulizer that is in the inhaler. I've actually had asthma for years and just got a nebulizer last year and I really notice a difference.

If you are seriously looking at going to a pulmonogist, I'd see if you have any pediatric pulmonologists in your area. The pulmonologists do coordinate with with the allergists typically. I take copies of all reports to visits with I have multiple specialists.

If you will indulge me, I'd like to "preach" a bit about the asthma action plans. I don't want to scare you, but I do want to help you ensure his school is prepared. I have helped run a very large preschool program for years and we typically work with doctors, parents and teachers of 30-40 children yearly to get written plans in place and prescription inhalers and/or nebulizers on hand in each classroom. We individually train all staff who interact with the child and actually have them sign the written plan and a statement they were trained. We also put up a neon yellow sign in a visible place that states there is an active asthma action plan in place in the class. If the parent gives written permission (HIPPA stuff), we will put the child's name on the notice. That way, if there is a sub in place they know to contact our health specialist to come over and train them on what do do with if there is a medical emergency for that child. The more we are prepared, the better it is for all involved. I learned the hard way. As a young teacher, I had a child almost die in my care because of a bad asthma attack. Unfortunately, unlike you, the parent was neglectful of the child in many areas and refused to get medical help for the child prior to this. All I could do was call 911, try to keep him calm and prepare to do CPR (we didn't have classroom defibulators back then). It was the scariest thing I'd ever been through until years later when I had my own attack that bad. Thankfully that incident turned out well, but I've done tons of research in this area over the years and established systems within my program to plan for the worst in the hopes that the worst never happens, but if it does, we want to ensure we are trained and prepared. We also require every staff employed for us to have CPR and first aid training yearly and make them mandated responders to help. You might ask the school who is trained to help in an emergency.

By the way, 99% of the children we have had written asthma plans in place for over the years never actually need to have them implemented. If a child has their asthma flaring, parents are usually proactive and have stepped up treatmend and/or kept the child home.

Many states have state specific school asthma action plans on their health department websites. I'm glad you will be taking to your child's doctor about establishing a written plan. Please make sure you look at your state's website and read on asthma plans as they relate to your school systems. Make sure your doctor specifies steps you should take AND steps that should be taken when he is at school. Many schools have differing regulations about how inhalers are stored. Some want all medications in the nurses office. If your son is having having an asthma attack you don't want them going to another part of a building and trying to get into a locked cabinet to get his medications. Make sure your doctor writes out something specific to the school stressing the importance of having the inhaler handy as well as instructions on when it should be used. Once it is written, meet with the school. If there is a school nurse they might work with you, but you should also ensure you are meeting directly with the teacher and possibly the principal. Also any other auxillary staff who might work with your son might also need to be trained on what to do. Asthma is often misunderstood by school personnel unless they have had extra training.

Do you have an epi-pen for your son's allergies or asthma? If so that neeRAB to be part of the written plan as well. He should have the epi-pen with him at all times in case of a bad reaction or attack.

There are some really cute carry packs for asthma supplies. Some hold just inhalers, others have pockets for the inhaler and charaber, still others will hold the epi-pens. They come with clips, belts, straps, etc... to hook on backpacks, fasten to legs or waists, purses, and so on. They keep everything handy and have medical logos on the outside.

As for an asthma diagnosis at his age, that is sometimes iffy. Many times it will be diagnosed as reactive airway and treated as asthma. We see it frequently as we write school plans for our young kiddos. That is really one of the best ways to go when they are young. KiRAB often "outgrow" these problems over the years. From what I understand from military frienRAB, a diagnosis of asthma when young labels the child and could lead the child to be ineligible for military even without any asthma symptoms when they are adults. Many doctors will wait until after age 8 before placing the asthma label on the child. As long as he is getting appropriate treatment, I really wouldn't push for the asthma diagnosis for a few years.

By the way, your written plan with the school should include any food allergies or other severe allergies as well. We make tons of food accommodations every year for dairy, nuts, fish, strawberries, eggs, tomatoes, etc...

Good luck as you seek out treatment. I wish you and your son well.

MountainReader
 
I appreciate your thorough reply . When he was enrolled in the school last fall I filled out a form in which there is a space to allow the teacher permission to assist him with his rescue inhaler should it be needed during class time , his allergy wasn't apparent at that time but he would carry his inhaler and the plan basically was to administer if needed.
It was not until june of 2010 that he was prescribed the epi pen and at that time he was rushed to the kiRAB er for an anaphylactic reaction to an unknown allergen . We didn't actually find out it was egg proteins until Noveraber and he was given the skin test. He is off all egg proteins for one year and will be tested via blood next fall. I am told he has one of the best allergists in the province, which is a comfort for sure . His test revealed sensitization to both white and yolk however the whites are the most severe and for him exposure can be fatal especially in raw form , and so we do not keep eggs in the house due to the probability of cross contamination . We found this out the hard way just this past noveraber
I understand the reluctance of putting an asthma diagnosis on him at his age because of the fact that he has the potential to outgrow it . I have been informed by his dr that just based on his slew of issues relating to his skin , the eczema and the allergies including the sinus allergy , the reactive airways . All of this suggests to her that he may not ever outgrow the reactive airways, but is entirely possible .
Luckilly his kindergarten teacher is familiar with the asthma , as both her sons are asthmatic she has dealt with the flare ups and the hospitalizations and the pneumonia and other infections . She understanRAB when I keep him home it is because he neeRAB to be monitored by me . She is thankful for my proactive nature as his parent, I am thankful for her understanding of his little plight. We have really found a good ground to work with him in all of this.
In fact the school division has a strict mandate around the use of inhalers and epi pens . He is one of two students who carry one in school and his picture is posted in the staff lounge along with the list of his allergies ( egg proteins and fresh strawberries) and instructions on what to do if he has a reaction . And as a wonderful gesture of understanding the entire staff was trained in the administration of an epi pen as well as how to handle a child during a seizure. It is apparent to me that his school wants to create a safe learning environment for him and for that I am grateful. At the start of each year we update the paperwork detailing any change to his medications and symptoms and outline whatever symptoms he commonly displays in the event of an asthma attack as well as the event of egg or strawberry exposure . So all of what you outlined in your post I think and hope we are on top of . It is a reassurance to me that his day is made as safe as can be expected.

With all of that said I still see when he gets a little too rowdy with his play that he just begins to clear his throat and sometimes cough . I generally worry that this is a time where the rescue inhaler is needed but when he stops and sits , resting for a bit he seems to go back to his old self . It is in these moments that I need guidance because I dont know if I am handling these situations correctly . This is the part where I will be discussing with the dr about the plan .
I kind of feel like i went off track and this post feels messy , however I worry because he just looks like things are still not completely under control . His eyes are still dark and reddish even around the eye . He gets the ahems frequently during play but doesnt cough while sleeping anymore . Two weeks ago this was a different story altogether .Im not even sure the "brainwash " aka saline nasal spray is helping .... anyway I will leave it at this hehe ... he has an appt thursday afternoon so Im cautiously optomistic ... good news all around hopefully . But Im going to mention pulmonology , the childrens hosp here has a great respiratory clinic which I visited for a completely different reason with a different child lol .
 
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