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Old 10-08-2002, 10:34 AM   #1
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Bonnie1327 HB User
Unhappy Four year old /Asthma/Allergists

Please help. My four year old daughter has been diagnosed with asthma since she was a year old. She has had five hospital stays always at the end of December with the exception of being hospitalized last month(September). Each time they diagonise pneumonia with asthma.
The problem is her oxygen levels. The doctors battle to raise it over 87 for days.
She is on Pulmicort twice a day, albuterol when needed, and orapred (all this is usually in the winter).
She has been going to an Allergist since July of this year. According to him her scratch test reveals allergy's for 75 out of 88 items tested. Alot of the test revealed 4's (highest).
This September hospital stay was after a month of two allergy shots twice a week.
I am not very happy with her doctor since he did not visit her within the five days she was in the hospital.
She had a follow up visit with him a week after she was released and he rushed us out of his office. I did
have a change to ask about xopenex vs albuteral. He said it did not matter to him which one I gave her. I told him I had researched xopenex and it was proven to have fewer side affects. He said thats fine.
My husband is furious with this doctor. After some thought I have noticed his office is full of things he told me to get rid of in my home. He has dingy carpet, books all over the place, dusty files, and the examing table has the same dingy pillow on it.
I know I am going on endlessly but I am at my witts end.
What I want to know is can her asthma be something else, is allergy shots going to help the asthma, and I know I should get another Allergist but should I also send her to a pulmonoligist?


Please someone help!



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Old 10-08-2002, 03:07 PM   #2
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Allergy shots can help the allergies that will trigger an asthmatic response. Allergic reactions release chemicals that cause an inflammatory response in the part of the body that is exposed to the allergen -- eyes turn red and become inflamed, noses run, sinuses swell, and we all knows what happens to an asthmatic's lungs.

There is a vaccine against the most common strains of pneumonia and the flu where I live. I'm not sure if such a thing exists where you live, but if I were you I'd inquire into it.

Xopenex and Albuterol like your Dr. said don't really make a difference -- some people have found traditional albuterol can have some funky side effects, but for most people they're not a really big deal. Xopenex is expensive, and considering how expensive medicare is in the states, if you have insurance, go for it. It's given by nebulizer like her pulmicort.

When she goes out in the winter make sure she wears a scarf or a face mask of some sort to make sure she is breathing warm, humidified air. Breathing cold air not only causes bronchoconstriction but can also weaken the immune system by shocking the body.

Her doctor might be a busy man; but with a daughter hospitalized so much (especially a little one on pred! poor thing!) you SHOULD ask for a referral to a pulmonologist. I'll bet that one of the larger hospitals in your area has an asthma clinic where they do things like pulmonary function testing and where you can have a consultation with a pulmonologist. He'll be more well-versed on which drugs to give her. And since everything is done by referral and appointment (whereas family doctors are usually more likely to take walk-ins) you shouldn't feel bad at all asking him to schedule for a certain amount of time. Have a list of questions ready, especially about the allergy shots. Yes, they should help.

At her age, it's unlikely her asthma is anything else. The thing about asthma is there's probably a hundred different sorts, caused by a hundred different allergens, sensitivities, pathologies and idiopathies. Allergist shmallergist, a pulmonologist will be able to better direct your allergist where to go and what to do when he gets there.

The fact that a pulmonologist will likely work within the hospital means it'll be easier for him to visit your daughter should she be hospitalized; If I were you I wouldn't blame the doctor for not visiting your daughter in the hospital if he doesn't work there.

 
Old 10-09-2002, 09:48 AM   #3
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Thanks for responding. I guess I am unhappy with her Allergists and should/will look for another one. As for the Pulmonologists thanks for the advice. The doctors were going to call in a Pulmonoligists last month if her oxygen levels stayed down one more day. Instead they did go up so they released her. My husband and I both feel we should have insisted they call one before releasing her.
I will be looking for a Pulmonoligists ASAP!

Thanks so much

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Old 10-09-2002, 03:30 PM   #4
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as somebody who's worked within a hospital I can tell you it's an absolute pain in the *** to call somebody in from outside the hospital or outside the emergency unit if there's no pulmonologist on call. They have their own **** to take care of a lot of the time and they usually just have a resident who's possibly taking specialization at the time, they're still competent doctors for the most part but specialization takes so much extra time, and being on call sucks...

 
Old 10-09-2002, 07:40 PM   #5
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I dont agree with the thought that at her age its not anything else.

My 7 year-old was diagnosed with CF at age 6,she had no digestive symptoms at all....My 12 year-old was diagnosed Monday with CF,she has GI issues mainly.

I would demand testing for other lung issues.

Reflux,Aspiration,CF,Sinus problems,immune defiency and asoorted other things.

I wouldn't settle for just asthma until tests were run to rule other things out,no matter how minute the chance.

Bronchoscopy,Chest CT scan,at 4 PFTs might be able to be done,sweat test,etc...A pediatric pulmonologist will be better suited to rule other things out or in.

Just like there are variants of asthma,there are variants of CF...My 7y has no GI problems,only lung problems....my 12y has both with the majority GI

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Old 10-11-2002, 04:17 PM   #6
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Uhh.

Well I said it's unlikely her asthma is anything else. I didn't say it wasn't anything else.

I agree with you on scheduling her for the PFTs. However, having seen bronchoscopy done, I wouldn't recommend scheduling your child for one unless you absolutely need it. I wouldn't want to go through that personally, and putting my child through it would be something I would never even consider unless the problem they were suspecting was something they desperately needed to do. Like if they found a mass on a CXR and thought it was lung cancer. Otherwise, take a hike, the lot of you! Four years old and you want them to do a bronchoscopy on her? Have you ever seen a bronchoscopy done?! They're not pleasant! And if it's unnecessary? What then?

CF doesn't explain away a positive skin test to how-many-allergens, same with GERD and reflux. Sinus problems can be precipitated by allergens. Asthma is a problem almost opposite immunodeficiency, they could test her blood for WBC count but my guess is it would come back elevated.

PFTs can't be done reliably until the child is old enough to decently follow instructions. I've done them on a six year old with rather craptastic results, though some five year olds could be mature enough to do it. I'd draw the line at four years old; for the FVC maneuver, at least, anyway.

Sweat test, sure, whatever suits your fancy. Do the asthma drugs work? There's your clincher! I hate this assumption that asthma doesn't exist in children; if they're not old enough to have pfts then it has to be something else.

Bonnie, Once she's about five or six, it's up to your discretion but you should probably send her for PFTs. Your pulmonologist will know abouts when she's old enough and mature enough to understand and follow the directions properly. Until then, I'd avoid treating her to a bronchoscopy; they're a suitably barbaric procedure in an adult, let alone a child...

 
Old 10-11-2002, 07:48 PM   #7
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Oh I think we have an attitude problem,don't we.I think you need to stop pretending your a doctor.

Yes I have seen a bronchoscopy,my 17 month old had one.And while its not pleasant I would do it over in a heart-beat if it would give me answers.

My 7 year-old,the one with CF does have a lot of allergies.Anybody can have allergies,even people with other illnesses(DUH!),my other daughter with CF has food allergies and suspected enviromental ones.

And to add to it,asthma meds help both my CF kids,you know they are used to treat other lung diseases.

A sweat test is a very painless test and I would want to rule it out,since earlier treatment can slow progression way down.

Reflux can cause aspiration which can be identified on a bronchoscopy.

Honestly tests may not be pleasant but if they can save my kids life or prolong it,then its a small trade off.

I really think you don't like the fact that someone other than you is giving advice on this board and has a differing opinion.

Cassidy mommy to
Ashleigh(CF,diabetes,Peanut allergy),Noah(mild asthma),Skylar(CF,asthma,multiple allergies,IgG2 defiency),Meredith(RAD?,Hypotonia,hydroc ephalous
seizures,dev delays),McKenna(Healthy),Delaney(Healthy )

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"Theres 2 things I've learned"1.Theres a God and 2 I'm not Him"
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Old 10-11-2002, 07:49 PM   #8
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Immune defiencies and asthma/respiratory problems/allergies often go hand in hand.

IgE is is most often associated with asthma and allergies while IgG,IgM,IgA have to do with other stuff.A WBC won't do squat in diagnosing a true immune defiency,to do that IgG,IgM,IgA,IgE have to be checked and their subclasses.Beyond that giving the pneumovax and waiting so long and then checking for I believe antibodies is the best way to go.

Something is not right with this mothers child and you are telling her its asthma,not to seek other causes....well I won't way what that makes me think about you.

[This message has been edited by rugratsmomma (edited 10-11-2002).]
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Old 10-11-2002, 08:51 PM   #9
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I find bronchoscopy to be a decidedly unpleasant way to diagnose reflux, I believe in peds they tend to use the slightly less painful barium swallow.

I never ruled out the sweat test. In fact, I remember saying go ahead, go for it. I never ruled out blood tests, I said for immunity disorders one could do a WBC and I'll add antibody tests, it just sucks one can't do half the tests that give the definitive results (like PFTs) until somebody's older... Like a methacholine challenge. Especially considering IgE is necessary for WBC to rise, if in the presence of a pneumonia organism (in which case they love to identify and isolate the organism) her WBC is not elevated at all that's a really good indication of an immunodeficiency.

CF won't show on a methacholine challenge, I wouldn't bet on a child being able to do the FVC maneuver required for the methacholine challenge ... properly ... until they were older than 6.

Perhaps I got a bit flabberghasted when you mentioned bronchoscopy to diagnose problems other than asthma. Bronchoscopy is not supposed to be a routine procedure. It could cause a lot of problems if she did have asthma, because the poking around could cause some extreme bronchospasm.

I really appreciate your note about my attitude problem. After having watched adults hack over a bronchoscope I would try my best to make sure it was a last resort for a kid.

A lot of drugs given for asthma are immunosuppressive, things like pulmicort... when stuff like IV steroids quit working, they've done testing with other immunosuppressive drugs as they've found the asthmatic inflammatory reaction has a lot to do with certain cells, not just the immunoglobulin E. Things like eosinophils, substances like histamines and leukotrienes. They've done studies using chemotherapy drugs on asthmatics to depress their immune system enough so their asthma would quit bothering them; so don't tell me all asthmatics have a depressed immune system.

If you want to make a comment about how terrible a person I am for telling her it's probably asthma, because if you think I'm telling her it could ONLY be asthma then you're twisting my words. I told her that's the most likely story and a pulmonologist would know more. A pulmonologist sees thousands of cases of GERD in pediatrics and would have a better idea of what that would look like. I never told her not to seek other causes, I told her to seek somebody who knows what they're talking about.

I think you're annoyed there's somebody else here who's a little bit informed. I don't think it's wise to tell her to demand a bronchoscopy unless her pulmonologist sends the kid for CXR and says OK maybe let's do a CT and then sees something on the CT to check for with a bronchoscopy. The bronchoscopy thing really ****** me off, nothing else, simply because you can diagnose almost anything short of lung cancer without doing a bronchoscopy. It should be a last resort, when you have absolutely no idea what's going on. It shouldn't be something that's demanded.

I'm not telling her not to seek other causes, I think you're overlooking the fact that this is an asthma board, and she said her kid had been diagnosed with asthma, I'm giving her the benefit of the doubt here. It's an asthma board. If she posts here saying her child has asthma, I'm going to assume her child has asthma, and it does not denote an attitude problem for me to say that.

[This message has been edited by wrin (edited 10-12-2002).]

[This message has been edited by wrin (edited 10-12-2002).]

 
Old 10-14-2002, 10:45 AM   #10
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Thanks All,

I will take all into consideration. She just got a flu shot and pneumonia shot on Saturday.

My husband and I are discussing a Pulmonoligists.
Can't hurt.

Thanks so much,
Bonnie
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