Don't Treat My Baby's Asthma Like It's a Zit on a Teenager

09/18/2009

Spend a morning in the ER of an average city hospital, and you'll likely see a lot of asthma. I sure did, recently, when I rushed my three-year old, T-Rex, to a local D.C. hospital for an acute asthma attack. He was wheezing and panting, and I couldn't drive there fast enough (yes, I made an illegal left on red).

By the time we got to the ER's intake tech, I was freaking out so much I was panting almost as much as T-Rex.

“HOLD up,” said the tech, typing languidly. She cast a sideways glance, sighed. “Let me guess. Asthma?”

“Yes, he was coughing all night and it just kept getting worse and…”

“HOLD up. I know I know. All day it’s been all asthma all the time around here.”

She wasn’t kidding. We were herded into the ER’s sizable asthma unit, where a nurse resembling Frau Blücher from Young Frankenstein strapped a mask onto T-Rex’s face, flipped the nebulizer switch, and marched off.

Over the next two hours, Frau Blücher dispatched a steady stream of hacking kids to similar treatment. Meanwhile, three doctors on the unit spent most of their time pecking on computers. Occasionally, one of them would scurry up, prod T-Rex, mumble something, and sprint back to the doc station for more typing.

It took cart-wheels and shrieking like Howard Dean, but I finally managed to flag down one of the doctors during his drive-by. In the nanosecond I knew I had, I asked if they were going to give T-Rex systemic steroids, which go into the bloodstream instead of just the lungs and had stopped a previous attack like this in its tracks.

He eyed me suspiciously and blathered something about checking with the other doctors. It was right about then that I realized we were on the ER asthma assembly line—a 24/7, mechanized operation—and weren’t supposed to break protocol.

 
Now, I could make a number of statements about what this automation says about our health-care system. I could lament the fact that doctors spend most of their time doing data entry for legal CYA, instead of treating patients like people. I could note that some nurses are so jaded by patients using the ER as primary care that they’ve forgotten their bedside manners. But. I’m not going to go there.

So, here’s where I’m going: It’s sad that asthma has become so common that ERs treat it like it’s no big thing—“all asthma, all the time, just give 'em the regular treatment.” Asthma rates have more than doubled in the past 25 years. And as incidence has grown, so has casualness. But the exact opposite should be happening.

 
First, we need more emphasis on stopping asthma before it starts. Studies show that urban kids are at higher risk for the disease because of more exposure to irritants like pollution, cockroaches, and indoor dust. But they also show that in neighborhoods with more trees, fewer kids have asthma. So let’s plant more trees and cut pollution (think walking, public transportation, and carbon caps)!

Second, when kids do have a serious asthma attack, let’s not treat it like it’s no big whoop. Actually it is. Too many people—5,000 each year—die from this disease. And kids who were preemies (like T-Rex) are at even higher risk for problems.
 

So if you’re a health-care professional, I don’t care if you’re seeing T-Rex on Jupiter or in an ER, please take the bleeping time to find out his medical history. And please don't treat his asthma attack like it’s a zit on a teenager.

Because, getting back to his story (and not to sound too vindicated here, but hey, why not), the systemic steroids I requested turned out to be exactly what he needed. It took several foot-stomping trips to the doc station to make sure they were ordered, and to then verify that they'd been given.

But, along with the hour-long nebulizer treatment with rescue meds, the steroids eased T-Rex's breathing after just two hours. Of course, we were kept in the ER another two hours, no doubt also for legal CYA. I tried to warn the staff that this was not a good idea because once T-Rex is bored, you are screwed.

 
They just ignored me; I don't think they got it. But they sure did later, when T-Rex began harassing other patients, using his chair as a trampoline, and swinging on his heart-monitor line. I didn’t do anything. I just waited.

"Do NOT jump off your chair," scolded Frau Blücher as she strode past.

What T-Rex did next was truly masterful. I really have to hand it to him.

He climbed right back on his chair, wound himself up for take-off, then yelled full-volume at the doc station as he jumped: "LET ME OUT OF HERE!  NOW!!!"

We were discharged with in five minutes, steroids refill in hand.

Comments

[Susan]

What an appalling ER experience! Is your son on maintenance medication? This is the kind of treatment that supposedly can prevent the acute attack your son had. (My son was on them for a few years.) Also, do you see an asthma specialist?

Sounds like your son might've been reacting to the breathing treatment, which can make anyone a bit hyper, as well as the boredom. Good luck. :)

[Katie]

Sadly, I don't find this story surprising at all. I think T-Rex's sentiments at the end fit the whole ER experience exactly :-)

[cyberchonriacmom]

Agree with you that it's sadly not surprising, Katie.

Susan, we don't have him on the regular maintenance inhaled steroids because of the potential tie to growth issues. I know there are several sides to that debate, though. What is your take on it?

What we do right now is use the albuterol (rescue med) with both nebulizer and inhaler if we see the first sign of asthma. and mostly it's worked fine.

the problems have happened when T-Rex gets a cold. That just seems to set him off!

we have a regular ped that T-Rex sees, but your suggestion about going to an asthma specialist is a good one. did you take your son to a specialist?

[penny]

Yesterday I had at my house a 7-year-old guest whose mother listed all the child's allergies when she brought her over: mainly dairy products and tree nuts, but also some pollens, mould, etc. She said an allergist had tested her kid and, on checking her breathing, had found she was functioning at only 70% lung capacity even though she was not showing obvious signs of asthma at the time. The allergist warned the mom that if the child continued to function at this capacity, she may never regain full functioning of the lungs. She now takes Advair (I think that was the name), Singulair, and Claritin regularly, and carries an inhaler with her wherever she goes. Have you had T-Rex tested by an allergist to find out what brings on the asthma attacks and to check the functioning of his lungs? He may need to take meds regularly.

[lil]

That's a scary picture you paint - docs pecking on computers like a bunch of secretaries and assembly-line asthma therapy. That's not the kind of thing they show on ER (the TV show) is it?

[Jaelithe]

Can I bring T-Rex with me the next time I have to go to the ER? He sounds like he would make an excellent patient advocate.

I once had a hospital send my son by ambulance to a pediatric specialty ER because they thought he might have an intussusception (which, for those of you who have never had the lovely experience of hearing your child might have one, is essentially a tangling up of the small intestine). He needed an emergency exam and they did not have the proper equipment at the local hospital.

We waited for eight hours at the pediatric hospital with my child in screaming abdominal pain for the first four. Luckily for us, he either never had an intussusception or it turned out to be one of the rare ones that resolve themselves, because other than repeat a couple of blood tests the previous hospital had done and check his temperature, the ped ER did NOTHING for my son. They did not do the tests we had been sent there for. I verbally accosted wandering doctors and nurses to no avail.

They finally just discharged us a few hours after my kid stopped screaming. And then sent us a big fat bill for all that nothing they did.

[RabbleBabble]

Forty years ago when I was a little kid, no one really understood asthma. It wasn't commonplace, and being a disease that isn't visible, all too many people were convinced it was just in my head. Even my dad, an otherwise loving and wonderful parent, didn't get it -- he smoked and thought that if he opened a window, I would be okay. I don't mind the automated treatment at today's ER. I find it comforting that they know so easily what to do. And at least they don't think I'm nuts.

[Amy]

T-Rex was brilliant!

My asthmatic, who BTW almost died at two weeks old from a respiratory virus, went in for pneumonia. The doc thought he had juvenile diabetes. Ruled it out. But didn't treat what we went in for. He was SOOOO SICK! I wanted to deck her. We carried him in, even sicker, two days later and got him on all kinds of treatments and meds. Dumbasses.

[Cyberchondriacmom]

I just think that these medical professional need to be sure to listen to the parent because the parent knows their child's history better than anyone else. Sure, the doc is the medical expert. But medical expertise is pretty much useless if you also don't have the proper context. That said, I realize it's not all docs' fault that they aren't taking the necessary time, especially in an ER situation, to get all that necessary info because of all the legal red tape they are now required to deal with instead of actually doing what they were originally intended to do: see patients.
OK, stepping off my soapbox now.

[Cyberchondriacmom]

OK, check this out -- new study finds that gut worms (ie hookworms) could help prevent, treat asthma: http://esciencenews.com/articles/2009/09/28/gut.worms.may.protect.against.house.dust.mite.allergy.

Ummm, not exactly the asthma solution I was seeking for T-Rex.