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Wednesday, December 29, 2010

Using oxygen

Using oxygen for asthma

Of the 12 times Kitty and Son #2 have been hospitalized for asthma, they have all included oxygen. Yet there are different ways it is administered.

I was reminded of this when Hubby was telling me about being in the hospital last week with a family member. Because of our many experiences with oxygen, he noticed that the family member's oxygen rate was only at 89%. It should be closer to 98%. This family member was sleeping, and was using a nasal cannula (a thin tube with a small nozel that fits inside each nostril). Hubby noticed the family member was breathing through their mouth, instead of their nose, so the nasal cannula wasn't helping. Hubby notified the nurse and asked her to switch the family member to an oxygen mask. I love my Hubby, what a great guy! This ended up being a better delivery system, since the mask covers the nose and mouth.

Sounds simple, right? Well, the nasal cannula and oxygen mask are used for different levels of oxygen use. The mask is usually used when patients are on a higher delivery of oxgyen, around 6 liters or above. The nasal cannula can be used for less than that. It depends on how many liters of oxygen you're on as to whether you get the mask or cannula.

Usually, when one of the kids were admitted, they would be first put on a high delivery of oxygen (6 liters) and thus the mask. Later, they try to wean the kids down by giving less oxgen every day, and then switch them to the cannula.

A few things to keep in mind is that even with pediatric sized cannulas, they can be really irritating and cause problems. We have had times when the respiratory therapist snip the tubes, so they're a bit smaller and don't go as far up the kid's nostrils.

Also, with oxygen blowing up your nose day after day, there's a good chance of getting a bloody nose. Not a good thing when you have tiny tubes trying to shoot oxygen up the nostril. So you can ask your nurse for a 'bubbler'. It's a tiny water filled box that they can attach to the oxygen tubing. It literally bubbles and sends a small amount of moisture into the oxygen to help moisturize the inside of the nose.

If you do have to be sent home with a tank (I always hated that......) there are several options. They have tiny little portable tanks that fit in a holder and can be slung on the shoulder if you need to go out. An oxygen concentrator is used if you are going to be on oxygen for a longer period of time. It concentrates regular room air, turning it into oxygen. Also, there are the regular old tanks.

Of course there are precautions around oxygen. I remember the nurses wouldn't let the kids use any Chapstick, because it was petroleum based and could spark a fire. Great. Also, no open flames - scented candles or smoking - not that we smoke. Apparently some people do that are on oxygen!

Anyway, if you ever need to be on oxygen, there's a few hints. It's not as scary as it seems, and it is ever so helpful when you can actually breathe! I'm a little picky when it comes to breathing and my kids.....I like it when they can breathe.

Happy breathing.

Monday, December 27, 2010

Nothing under the bed



Tip #3


One thing I have learned is that if you have allergies and asthma, it is best to not store anything under the bed. Sounds terrible, doesn't it? (What am I supposed to do with all that junk now?!)

And if you ask Son #1, he would say, "Oh great! I've have not one, but two parents that are clean freaks!"

Well, I'm not as bad as some people (when it comes to cleaning) but I try to narrow down what triggers a case of sneezing and wheezing. And stuff shoved under the bed seems to be one of them.

When was the last time you cleaned anything out from under your bed? Be honest......the last time you moved? And then you were forced to clean it up?

Granted, it is a great place to put things. Out of the way, you don't trip over anything, great hiding place, but the last time you had to retrieve something from under the bed, how was it? Full of dust? Did you sneeze and cough?

That's one of the biggest dust magnets there is, so the rule in our house is 'nothing goes under the bed'! And, from looking at the photo, you can see how easy it is to vacuum under there and keep it clean. If you have ever woken up with a stuffy nose or itchy eyes, this could be one of the reasons. Or if you wake up sneezing at night, which Kitty does frequently, that could also be from the pile of dust you're sleeping on top of.

When the kids were younger, we used to have a long, shallow plastic box with a lid that went under the bed to store things in. Some companies make special containers that are made to go under the bed. At least that way, it is all sealed up in one container, but we found that too much dust accumulated on the lid and it was annoying to pull out every week when I vacuumed under the beds.

So, pick what works for you. If you have a smaller apartment or home, you may have to use the special sized under bed storage box. If you do, make sure you pull it out and vacuum under the bed and keep the lid clean and dust free.

If you have more room, try to not to use the area under the bed for storage. (This was also a tip from Asthma Doctor, so I can blame it on him when the kids complain that there's no space to store things......)

Just one idea to make life a little easier as My life as an Asthma Mom continues-

Wednesday, December 22, 2010

Asthma advocate

Want to be an Asthma Advocate?

I always perk up when I hear about something that has to do with asthma. Do you want to help out in your kid's school and teach people about asthma? It's actually fun!

The Utah Department of Health's Asthma Advocate program offers a chance to get involved in your community. Asthma Advocates come up with ideas and take them into local schools. You are encouraged to be as creative as you would like, based on what interests you. You can let the schools and students know about resources that are available about asthma. You get to work it around your own schedule, which is great for all of us busy multi taskers.

The Utah Department of Health will provide a free 3 hour training, and even provide lunch.

If you want more information, contact Kelli Baxter at (801) 538-6595 or email her at kabaxter@utah.gov. She also has a blog at http://asthmadvocate.blogspot.com

There's all sorts of fun things out there, I even found some fun video games that teach about asthma that I'll blog about later.

If should blog on Friday for Flashback Friday, but if not - then have a Merry Christmas!

Monday, December 20, 2010

Stress as a trigger

Stress as a trigger

I was going to put another tip in here today about how we changed our home. But, we had a little family emergency last night.

We are particularly worried about one elderly family member who is in the hospital caring for their spouse. The reason for our concern is that the care giver has asthma, and stress can actually trigger an asthma attack. I wasn't even thinking about that last night as we were discussing the situation with our kids. But Son #1 brought it up.

We were worried about the care giver's coping skills, you never know how people will react in an emergency. Son #1 said, "I hope she's okay and doesn't get so stressed out that she has an asthma attack". Oh yeah, that.

Belly breathing is a great exercise if that happens. I know it's the last thing you want to think about. But you can put one hand on your stomach and one on your chest, then you breathe slowly in through your nose, and out through your mouth. I usually do it 5 times in a row.

You need to take care of yourself. Otherwise, you won't be any good to any one around you if they have to deal with two patients instead of one.

Asthma is so strange, because there are so many triggers and it affects everyone so differently. There is no one size fits all set of triggers and treatment plans.

So, if you happen to find yourself in an emergency, remember belly breathing. Take deep breaths and make sure you have your inhaler with you just in case. The last thing you need in an emergency is an unexpected asthma attack.

Friday, December 17, 2010

Flash back - fires

Flash back Friday- fires

There's a beautiful historic building across the street from me that is on fire. I saw the news coverage this morning during breakfast. The area here is swarming with people taking photos. It's freezing cold outside, and the area smells of smoke.

I can smell a little bit of smoke in the main part of the building where I am, I am watching through a window.

It's a shame to see beautiful architecture lost to fire, we're all hoping if can be saved and renovated. I'm not so sure.

But I am lucky to be able to watch it from inside another building. If the cold didn't trigger my asthma, the smoke definitely would. It always makes me a little uneasy.

Smoke from a forest fires several years ago blanketed the valley where we live and almost cost Son #2 his life. It all happened so fast. He was outside playing with friends, and we didn't notice how smoky it was. You know little kids-if they're have fun, they won't come in for anything, even to use the bathroom. So, when I saw that he was outside at the neighbors, I quickly brought him in. Then the coughing started. He seemed to do well after breathing treatments, but then he wanted to go outside later and 'help' with 4th of July fireworks. The coughing started again, but this time it didn't quit, no matter how many treatments we did.

We decided we better head to the emergency department, and we got there just in time. He ended up not only on oxygen and a steroid IV, but also a heart monitor. That's when you know they're really bad, when they have the leeds and wires all over their chest. That means the doctors are afraid they're going to stop breathing and go into cardiac arrest.

I think I was in shock at the time. That's the one problem with asthma, it can go from bad to worse (or deadly) very quickly. You have to be so careful. It was a close call, and we were really scared for his life. Luckily, he made it.

I am still afraid of smoke, so I will stay inside my building where it's safe and smoke free. Asthma and smoke are a deadly combination. It makes me shudder to think about it.

Stay safe everyone, and be careful.

Wednesday, December 15, 2010

Tip #2 - floors


Tip #2

So, as much as my historic home drives me crazy because there is always something leaking, flooding, shorting out, breaking, etc. There is one up side- original wood floors.

We had to rip out all the carpet when we moved in and Hubby refinished the entire upstairs, which had wood floors. (You can rent all the equipment at hardware stores). Hubby looked with satisfaction at his handwork and declared, "We could play a great game of basketball in here!"

I love my wood floors, especially for allergies and asthma. They're easy to clean, plus I can actually see the dirt and dust bunnies. Helllllooooo vacuum! Yes, I am a little strange. I love to vacuum. There's something about the monotonous work of vacuuming. My canister vac (equipped with a hepa filter of course) allows me to vacuum the area rugs, then flip a switch and use it on the wood floors. Then I switch attachments on the nozzle, and can clean all the edges of the rooms. Told you I was a little strange. It's rewarding to suck up all the dust and crumbs, then empty out the vacuum canister and see all the junk I just sucked up. It feels so much cleaner.

Of course, not everyone can have wood floors. They are expensive if you need to install them. My in laws live in the south west, where tile floors are common.

I know that for us, anything that I can get rid of in our house (that is causing problems) will help with asthma. Asthma Doc always said that medicine is a 'band aid' approach. You need to get to the root of the problem. What are your triggers? What is causing problems for you in your home? You can take all the medicine you want, but if you have things in your home that are causing problems, it's an uphill battle.

So, look around. See if you can determine your triggers in your home. And I'll keep blogging about things we've done. They may or may not work for you, you can pick and choose something to try.
Good luck!

Monday, December 13, 2010

Making your home allergy/asthma proof - tip#1


How do you make your home allergy/asthma proof? Tip#1

I was listening to a presentation the other day about asthma by two pharmacists. I'm not suggesting you disagree with someone with medical training, but I will anyway.

Someone asked him if you should change things in your home to make it more allergy/asthma proof. He said no. He has a family member with asthma, and he had removed his carpet and replaced them with wood floors. But he said it would be too expensive for most people.

I think he missed the boat. There are a lot of things you can do to make your home better. The first is the photo you see here. Take your shoes off! This is the view from my front door. And if you come to visit, your shoes had better be in there.

This didn't cost much, you can find baskets at any craft store. Or use a big plastic box, whatever works for you. As a designer, mine has to coordinate with my room.....

So, what's the big deal about wearing shoes in a house? Well, everywhere you have been during the day (think public bathroom, walking through leaves and dirt, stores, work, parking lots etc.) is all on the bottom of your shoes. And that is now being tracked across your floor. Nasty stuff on them- including dirt, mold, fungi, chemicals from the lawn, etc, etc. The first 8-10 steps you take wipes all of that nasty stuff all over your carpets and floor. Now imagine if you have kids sitting or crawling around on the same floor.

The reason I think the pharmacist missed the boat on this, is because he said to just keep taking your asthma medicine. Asthma Doctor always told me that using emergency inhalers is just a band aid approach. You have to find out what is causing the problem first. So, if you can make your house a little cleaner and safer for allergies/asthma. And therefore have less inflammation in the lungs, causing less asthma attacks or problems, why not do it?

I'll keep posting tips here that we've learned over the last decade. Stay tuned!

Friday, December 10, 2010

Flash back diagnosis

I was thinking about when Son #2 was diagnosed with asthma. It was his first time in the hospital when the respiratory therapist told us he had asthma. I still remember the shock, thinking 'wait a minute!' I already took him to the pediatrician clutching my wrinkled little article about asthma out of a parenting magazine. Something just didn't seem right. I still felt unsettled when the doctor said there was nothing wrong with him.

The day he was admitted, I took him to the doctor because he had a cold and was sick and coughing. But his color was really off, he looked very pale, had purple circles under his eyes, and his lips were a burgundy color. I just felt something wasn't quite right. So, off we went to the doctor's office. The physician's assistant came in first, then suddenly the room filled with the head doctor and a couple of nurses. I remember Son #2 seemed very sleepy. He couldn't even sit up right when they were doing a breathing treatment, so I had to hold him.

They quickly said I needed to take him to the hospital. Luckily, the doctor's office is connected to the back of the hospital, so if was a quick drive to the front of the building. I still remember calling Hubby at work. He said, "What do you mean they're putting him in the hospital? Why?" All I knew is that he was having a hard time breathing.

Boy, were we in for a new chapter of our lives! He's been admitted 8 times for asthma since then, Kitty has been in 4 times. If I only knew then what I know now......

Trust your instinct and keep pushing. You know your children best. If you feel like there is something wrong, keep searching for answers.

I remember telling the respiratory therapist that I had already visited the doctor to see if Son #2 had asthma, and he had said no. In the 30 pages of information the respiratory therapist printed out for me about asthma, one of the articles had talked about asthma being called the 'hysterical mother's syndrome'. Mothers would be up all night with sick kids, take them to the doctor first thing in the morning, and they would be fine.

Now I know cold air affects them, getting up and walking out to the car affects them. Their oxygen levels do in fact drop during the night when the kids are relaxed and sleeping.

So, I've said it before, but if you think something is wrong, be persistant. I've been told the kids are okay, only to have them admitted to the hospital 4 hours later. Keep a sharp eye on them and get a second opinion. We, as mothers, are our kid's best defense.

Wednesday, December 8, 2010

Water leak


Success!

I think Hubby may have finally fixed the mysterious leaking washing machine. I spent time laying on my stomach on top of the washing machine, with a flashlight trained on the pipes to see if I could isolate the leak. How hard can it be? Very difficult, it turns out. I gave up at one point.

Then, as I was running a load through the washing machine, I heard a loud splash. Both Son #2 and I looked at each other, said "Uh oh" and simultaneously and jumped up to check the washing machine. Still puzzled. I had Hubby take a photo of the pipes and head over to the plumbing supply store and to see if they could help him figure out the problem.

They suggested there may be a blockage and recommended a product to clean out the pipes. He had already tested that theory, he stuck the garden hose down the pipe and turned it on full force. No blockage. He actually figured it out on his own, he deduced that there was an airlock in the pipe at one point of the cycle. He replaced a hose, and problem fixed.

I was hoping to get the hole (caused by water damage) fixed in my kitchen wall before now. It's so attractive. But of more concern is mold. With the experience we had in our old house with mold, I'm a little wary.

So, we're waiting to make sure one of the 2 x 4's in the wall is completely dried out. Hubby also cut out all the damaged wall board and will replace that. We just happen to have a can of 'Kilz' from other water damaged walls (from other leaks). It is a special primer that blocks moisture and mold growth. So, we'll paint the wall with that first, then a new coat of a warm, sunny yellow paint for the kitchen.
I found a resource on line about mold clean up, it's on the EPA (Environmental Protection Agency) website. You can cut and paste this into your browser.
http://www.epa.gov/mold/moldbasics.html

Anyway, I hope no one else is having water leaks. If so, get it cleaned up-fast! The longer it sits and leaks, the more chance there is for mold. Not what you need if you have asthma. Just one more thing for me to watch out for on my quest to keep my kids healthy with their asthma.....

Monday, December 6, 2010

Christmas trees

Christmas trees - real or fake?

Well, it's that time of year. Kitty was so excited to put up the Christmas tree, that we did it the day after Thanksgiving. Sorry, I only celebrate one holiday at a time. So, she had to wait.

But, do you get a real Christmas tree, or a fake one? We used to get real trees when the kids were little. But we noticed non stop sneezing and coughing. That was when the kids were first diagnosed with asthma. And since the kids have multiple triggers (basically, they're allergic to anything that's alive). Trees, bushes, flowers, grass, dogs, cats, horses.

Oh, I exaggerate. There is one animal that Kitty isn't allergic. Shot Nurse was laughing when she said there was one animal that didn't show up on Kitty's scratch test (skin test to see what you are allergic to). A rat. She said we could get a pet rat! Very funny. Not happening.

So, I know it takes the fun out of Christmas, having a fake Christmas tree. It's one of the wonderful smells. Along with the gingerbread house and sugar cookies. But, what do you do?

Listen to the kids sneeze and cough for a month? Or get a fake tree? As an interior designer, I like authentic flowers, plants and trees. None of those silk plants in my house. Except for the tree. Grumble, grumble.

But, you do what you have to as parents. It looks amazing, and no one is sneezing or wheezing.

I hope you all have fun putting up your Christmas tree, whether it's real or fake. If you're lucky enough to have a real one- fabulous! If not, you can join me in being grateful I don't have a bunch of dead needles to clean up every week.

Happy decorating!

Friday, December 3, 2010

Flash back - triggers

Flash Back Friday - triggers

F
lashback is just from this week. I had another asthma attack, this one on Wednesday night.

Problem is, I can't for the life of me figure out what set it off.

I remember sneezing quite a bit, and my family laughing and saying, "are you done yet?"but instead of answering, I just sneezed some more. Then I started coughing, and coughing, and coughing. I could feel my chest tightening up, then started coughing up mucus. Fun times!

So, as I was sitting on the couch in my big furry bathrobe, I had to try to think back to what I had just done. I changed clothes in my room, washed my face, then went in and retrieved a book from my nightstand.

That was it. I had to analyze each action. Anything in the bathroom that would have set it off? How about the nightstand? Was it too dusty? I remember the curtain catching on my bathrobe as I passed. Hhmm, it was the 'winter curtains' I had in the store room. I had changed my bed set to put the winter colored bed set and curtains up. Could it be that the curtains that were stored downstairs were too dusty? I usually wash them before I put them back up, but they were stored in between a couple of comforters, so they should have been protected.

Was there something else I missed? What could have set it off?

Sometimes the most frustrating thing about asthma is trying to figure out what sets off an asthma attack. I've had one while I was shopping for a baby present in a national retail store (where I've shopped for years without any problems). I had one at the hardware store this summer (where we shop frequently, because something is always in need of repair in our historic home).

So why do I have an asthma attack there one day, but not another? It's hard to determine cause and effect. And it can be unnerving, because asthma attacks can be swift and hard hitting.

This week was one of those, where I was coughing so hard I almost threw up. 'Calm'. I told myself, try to deep breath. 'Settle down.' Anxiety can make asthma attacks worse. You can't breath, so you panic, then the panic makes the asthma worse.

Everything turned out okay, but I'm still puzzled as to what caused it. Oh well, that's life with asthma.


Monday, November 29, 2010

Medication changes

Medication changes

As I was using my asthma disc the other day, it dawned on my that my asthma has been pretty good lately. Hhmm.

I was looking over the 'step wise' approach listed in the national guidelines a couple of weeks ago.
I know one of the recommendations is to 'step down' medications if your asthma has been in control for 3 months. I think I'll set an appointment with Asthma Doc. I'm on a combination medication right now. Sometimes people can step down to just an inhaled corticosteroid. (Check with your doctor! They're the experts!)

I'm wondering, as I look out the window at the snow and cold if this is a good time to step down. This is going into flu season (and pneumonia season for us!) Plus cold weather is a big trigger for me. Shoveling snow yesterday didn't help the lungs much.

That's the thing about asthma, for us anyway, it requires constant tinkering with medication. By far the worse time for me is spring and summer, even with allergy medicine, we're all constantly sneezing. And then that leads to that tight chest feeling.

But in summer, we don't usually have to worry about influenza and pneumonia. Of the 12 times the kids were hospitalized for asthma, all of them were for complications with pneumonia.

I have to take Kitty for her weekly allergy shots on Friday anyway, I might as well set an appointment for myself with Asthma Doc. At least it will save me a trip. Mother/daughter bonding time (although she would prefer a trip to the mall). Maybe we'll have to do something fun after seeing Asthma Doc. Shopping anyone?

Monday, November 22, 2010

Water damage

More water damage

I say more water damage, because almost exactly when we signed on the dotted line for the house we're in now, things started going wrong.

We've had numerous floods in the basement, things shorting out, have nearly started fires with electrical problems, gas line leaks, etc etc. Looks like the washing machine is leaking now. I saw a puddle under the washer last week, hubby AKA 'fix it guy' worked on things for a while and we thought we had it fixed.

Then Saturday, I noticed a bubble in the paint on the kitchen wall (located next to the laundry room. ) I knew that wasn't good, and as I was feeling the wall to see if there were any soft spots, my hand went right through the wall. Yep, definite soft spot!

So, here we go again. I have this natural aversion to water damage and mold. In our previous house, we had a leak in the roof over our sun room. It took 3 months to fix. They had to tear the wall down to the cinderblock, then sand it, bleach it, and use a negative air pressure machine to reduce the moisture. Then resand and rebleach the walls. They had to tear out part of the ceiling and replace most of the roof. I loved seeing that part of the house sealed off in plastic and workmen coming and going in biohazard suits. We even got a picture of the biohazard symbol on the door to the sunroom - a warning to those entering the house that way.

It was just about the time Kitty had just been released from the hospital for the 4th or 5th time after a bout with pneumonia. I can't help but thinking the black mold in the sunroom had an effect on her. Mold is a definite trigger for asthma, and we had plenty of it.

So, here we go again. I have been known to be a little agressive in tearing down wet plaster to prevent mold growing. Hey, I'll do anything to protect my kids.

So, you all can have fun shopping this weekend, we'll be fixing our kitchen and laundry room walls! We'll be shopping too though, at the hardware store. Looks like the kitchen is going to get a new coat of paint once we get the wall done. So much for a relaxing weekend.

Friday, November 19, 2010

Traveling with asthma




Many of you may be traveling during the holidays. The first thing I pack is all of the kid's medications and equipment. The last thing I want is to get stuck somewhere without the nebulizer.

The last time we went on vacation, we packed all the maintenance medication, emergency medication and nebulizer. The only thing we forgot was the liquid fever reducer medicine and cough medicine. And of course, we ended up needing it. It's common to think "'we won't need that". But when you're on vacation, it's difficult to try to find a store, especially when you're in a strange place and don't know where things are located. So, now we pack everything, and if we don't need it, that's okay. I believe in Murphy's law (if something can go wrong, it will). So, I use my own logic and pack everything, thinking if I bring it, I won't need it. If I don't pack it, I will be kicking myself because I'll need it.

This spring when we were traveling, we didn't have cough medicine, Kitty was sick, and she kept us up ALL night long.

Years ago, when we went to Disneyland, I took all the medications, nebulizer, and oxygen saturation monitor with us. When we went to the first aid building to check them in (so we didn't have to carry them around all day). The nurse said, "are you sure you're going to need all that?" I said, "You never know, my kids have been known to have asthma attacks at the most inconvenient times, and they've been hospitalized 12 different times. In fact, Son #2 has almost stopped breathing and came close to being intubated several times." Silence. Then an "Oooohhhh" from the nurse.

You know your kids best, and you know what medications you need to bring when traveling. Asthma never picks a 'good time' to present itself. The unpredictability is what drives me crazy.

I also check the location of clinics and hospitals before we get to our destination, "just in case...." I make sure I have our insurance card for help if we need treatment out of state. The last thing you want after a vacation is a medical bill from out of state that isn't covered.

So, after I'm all packed and prepared, it's time to enjoy the holidays. Bring on the relatives!

Tuesday, November 16, 2010

Open Airways

Open Airways


I'm volunteering with American Lung Association and teaching an Open Airways class at Kitty's elementary school. It's a 6 week class that teaches kids age 8-11 how to manage their asthma.

It's really fun, I know most of the kids from volunteering at the school and working there for a few years. Since everyone with asthma is different, it's been fun to go over triggers, when to take their inhaler, how to get help, how to use your inhaler, etc.

I hope it helps the school nurse, since she has so many schools to cover, she's only available on Thursday mornings for a few hours. So I tell the kids "if you're going to have an asthma attack, make sure you do it Thursday mornings!" Only kidding, things never work out that tidy, do they? With the unpredictable nature of asthma, who knows when an attack will hit.

This way, they know they're not alone - other kids in the school have asthma and deal with the same things they do. In teaching them about asthma and managing it, it should help them feel more in control and not panic when they need to use their inhaler.

If there are any parents that are interested, I'm sure they teach it in all states, with the same training manual and poster book.

Tomorrow is the last day, the kids get certificates of achievement and some delicious treats. (Making sure the treats are nut free). And I get the satisfaction of knowing I'm helping them and making a difference in their lives. Check it if you're interested in teaching in your area!


Anyway, just another fun way to help other people and make a difference!

Friday, November 12, 2010

Plan ahead

Flash Back Friday - plan ahead!

I think it's important to remember that asthma can be unpredictable. I can remember one particular time when we thought we would take Son #2 to the Er "just to get some chest x-rays and make sure he was okay"

An hour later, I was standing in his hospital room in the Pediatrics wing, wearing a skirt and high heels. I hadn't thought to change after work, because I was certain he would be treated and released from the Emergency Department. Well, that's what I get for doing my own thinking.

I had to ask the nurse for a set of scrubs and some slippers that I could sleep in. They also brought a toothbrush and toothpaste-they were very nice about it.

But, since that time, I have learned to plan ahead. If I'm really worried about Son #2 or Kitty, I quickly change into a pair of workout pants, long sleeve t-shirt, sports bra, and socks with sneakers. The perfect outfit to sleep in next to the kid's hospital bed, and still be be presentable when the staff comes in to check on him (and when people come to visit)

I also have a rather large purse, so I throw in a water bottle, granola bars, trail mix, fruit and gum. I hate leaving the kid's bedside when they're in the hospital, so I try to bring everything I might need. I also grab a few magazines. Some days can be REALLY long when you have a son or daughter in the hospital. I also make sure my cell phone is charged up so I can text people.

Of course you also need to grab whatever their comfort thing is during that time- blanket, stuffed animal, portable CD player and favorite CD they listen to to go to sleep (or older kids can bring their MP3 player or Ipod.)

You may think, "oh, I don't need to bring anything, I'll be back home in a couple of hours". Well, just in case things don't go as well as planned, remember the Boy Scout motto "Be prepared".

Having a child in the hospital is an incredibly stressful time, and you can feel quite helpless. But when I bring my own water, snacks, and something to keep me busy, I feel a little more in control. I don't have to press the call light and ask the nurse for a glass of juice or a few crackers. They're much to busy to worry about that. And I feel like I have what I need, so we can hunker down in the room and pass the day watching movies, playing games or sleeping.

So, I hope none of you ever need to use this advice. But do plan for the unexpected. You will be so glad you have prepared and won't feel so much like a deer caught in the headlights. Asthma can be unpredictable, but we at least we can control our reaction to it. Good luck!

Wednesday, November 10, 2010

Could be worse

Things Could Always Be Worse

I
was watching the video "Ever After" the other and there's a great line from Anjelica Houston. She is the deliciously evil step mother who says to Cinderella (Drew Barrymore), "We must'nt feel sorry for ourselves, must we? No matter how bad things get, they can ALWAYS (insert shrill trill of the tongue sound) get worse"

That has been our mantra. I sometimes have people ask if we think "why me?". It always surprises me when people say that. No we don't say 'why me?'.

I'm a fixer. Like most women, when something's wrong, I want to fix it. So, when we're in the doctor's office or pharmacy, or I'm pacing the floor because one of the kids is really bad with their asthma, I think 'how can I fix this?'

Sometimes it means multiple breathing treatments with the nebulizer, sometimes I know we need to start Prednisone (again.....), sometimes one of the kids will need a shot of Decadron (steroid injection). Sometimes I know we need the hospital with a steroid IV and oxygen.

Don't get me wrong, there are days that I think 'can I just have one day without worrying about the kid's asthma?!'

But, through it all, I have the Best Hubby In The World, and amazing friends who get us through. We've had countless dinners delivered, cookies baked, prescriptions picked up from the pharmacy, goodie bags dropped off for me with Dr. Pepper, chocolate and Interior Design magazines.

But also is the knowledge that we'll get through this. Not everyone gets through their various medical problems. Some people become became disabled, have surgeries, chemo, radiation, etc. Or don't survive at all.

So, things could always be worse. I try to remember that, even on the bad days. Remarkably, it has brought us closer as a family because it is essential that we rely on each other during the emergencies. And we all have to pick up the slack and jump in and help.

All in all, we'll get through the bad days with asthma, we always do. And 'we mustn't feel sorry for ourselves, must we? No matter how bad things get, they can always be worse!'



Thursday, November 4, 2010

Compliance issues

ROTFLMBO

As the kids would say, "rolling on the floor laughing my bumb off!" (For those of you who are confused, look at the last post which was authored by Son #2.

Okay, I should act like an adult, but that was my response to Son #2 talking about compliance with his asthma medications. Let's face it, I'm a nag. I have to be. Especially when he is on a course of Prednisone, I have to make sure he is taking the correct dose morning and night. That's not a medication where you can afford to miss a dose - from what I know, it affects your adrenal gland. And that can cause some major problems if you stop taking it suddenly. It's important to take it EXACTLY as the doctor prescribes, including tapering off the medication.

As for maintenance medication, I feel like I'm always watching to see that the kids take it. If their disc or spacer & inhaler are in the exact same position on the kitchen counter for a day or two, I know they're not taking their medicine. It's hard to get the kids to do anything on a regular basis, and all kids want to cut corners. (I tell them "nice try, but you can't skip brushing your teeth and chew gum instead"). The shower? That includes using soap and shampoo.

They know the importance of taking their medication, even more important now since Kitty and Son #2 are sick (still....). But they have to be motivated to do it, and I'm not sure how to get them intrinsically motivated. I tell them they have to do this on their own, I'm not going to follow them to college and say "Oh yoo hooo! Honey! Are you being good and taking your asthma medication?!"

For now, I guess I'll keep nagging. Our pile of maintenance medications are in a decorative container on the counter, so when I take my disc, I look to see where theirs are. Then I know if they're taking their medication or not. Some people recommend putting medication by their toothbrush in the bathroom, so when they brush their teeth, they'll see their asthma medication and take it. But- if they're not brushing their teeth- or being like most kids and seeming not to notice that its there, it won't work. Just like the pile of clothing on their floor in their room that they literally walk on top of to get to the bathroom. Why is it that they can't stop and pick them up? And why can't they remember to take their medication every day?

We also have a job chart, with medication listed on each day. But it doesn't help if they don't look at the job chart.

So, in short. I feel like the kids aren't compliant, and how to get them to be compliant is the question of the hour.

Until it is solved, I get to keep nagging. Part of my Life as an Asthma Mom....

Saturday, October 30, 2010

#2 posting

This #2 writing under my mother's account. She asked me to write about how I feel about asthma, seeing as how it's easier for me just to write about having asthma instead of telling my mother everything and having her write it, heh.

So to start, I'm answering some questions, and I'll try to throw in anything else I feel someone may need.

#1. How do I react to having asthma?

Well, to be honest, it sucks. I hate it with the all the burning passion of 10,000 Twilight fans. But, I realize there are people with worse problems than me, and I know several of them (i.e. diabetes). There are some times when I wish that I didn't have it (I'd be insane not to), but most of the time I just kinda accept it and move on.

#2. Do I ever ask "why me?"

Sometimes. It's not too often, but most of the time it comes from having to miss certain events that I could attend otherwise, such as a Scout activity where we'd be going somewhere cold, and I had been having problems with asthma. Every winter it happens, and I get annoyed. But, again, there are worse problems, so I try to keep it in perspective.

#3. Am I compliant in taking medicine?

Yeah. It's not hard or annoying to take my medicine, and it doesn't taste bad (well, it doesn't have a flavor at all, which is kinda nice). Sometimes I don't want to take it, but generally that is when it is 3:00 in the morning and I don't want to get up and have a treatment. Most of the time however, I'm the one that get's my medicine, instead of waiting for my mom to say something about it. It isn't hard, and it is beneficial. Win-win situation.

#4. I'll be rolling all the Social questions into this one.

My friends know about it, and often they see me having trouble. But the great thing is, they never scorn or shun me because of it (could be most of my friends aren't exactly athletes...). They all knew about it within days of meeting me, just because it is so prevalent, but so far it hasn't pushed anyone away.

My friends and family are very supportive. I've had times where my friends and I will be doing something and I'll get an asthma attack. During those times, my friends will suggest to go inside and get my medicine. They understand and support.

I believe that is everything. If you have anything else, just ask. Son #2

Well, there you have it. That's Son #2 with the severe asthma, sharing about what it's like. If anyone has any other questions, please let us know! - Andrea

Friday, October 29, 2010

Insurance companies

Insurance companies!

Don't get me wrong, I love my insurance company - except for a few little details. They seem to treat asthma as a one size fits all disease, which of course it's not.

Their medical board has decided to no longer cover Xopenex (levalbuterol). It's more expensive than Albuterol, so of course they want everyone to use the cheaper version.

Son #2 (severe asthmatic) is sick again. Asthma Doctor was out of the office, so we went to the Pediatrician. He sort of squinted his eyes at Son #2 and said, "I know how he is, we better start him on Prednisone." I looked at our medical file in his hands, it must have been close to 3 inches thick! He's on to us....

He knows he has to be agressive in treating Son #2. The only problem is his Xopenex inhaler and nebulizer vials have just expired. And insurance is no longer covering them. Pediatrician suggested I call the pharmacies and ask for the cash price. A Xopenex inhaler will be $58, the vials for the nebulizer will run $130.

So, now what? They can write a letter to the insurance company and ask them to reconsider and cover this medication for Son #2, since Albuterol is not effective on him. But where do I come up with $188? I also need to get the Prednisone prescription filled, luckily that's cheap. Add to that a Z-pack prescription. (Plus $25 for the Pediatrician visit) I also need a refill on my Advair disc, as does Kitty for her Advair.

And I wonder where all my money goes?!

At least insurance is still covering his Xolair prescriptions - it used to be $1000 a month, but that's what it was when Son #2 started receiving injections almost 3 years ago, I'm sure the price has gone up since then.

Anyone else have fun with their insurance company? And what do you do? I think I'll take a deep breath and hand over my debit card from my flex plan. (We set aside thousands of pre tax dollars every year from insurance to pay for co-pays and presciptions). But we always end up using the money before our year is up. We usually spend it all in 4 or 5 months.

But, as I always tell the kids, "things can always be worse"! We'll figure it out. Even if we have to cut back on the grocery budget and eat 'creatively' until the next paycheck.

Well, time to finish last minute preparations for Halloween. And of course tomorrow night I'll be checking Son #2's candy, to make sure he didn't get anything with tree nuts in it. Fun times!

Monday, October 25, 2010

Stress and asthma

Stress and asthma

I just read an interesting little paragraph in Reader's Digest magazine. It was talking about a new book that had come out, called Stress Less: The New Science That Shows Women How to Rejuvenate The Body and Mind, by Thea Singer.

The article talks about repeated stress, and how most people know that it puts them at higher risk of multiple diseases. But here's the quote that caught my eye, "What we didn't know till now was that it actually physically ages us - all the way down to the DNA in our cells...Chronic stress literally gnaws at our DNA- it's tips or "telomeres" to be precise- speeding up the rate at which our cells age by an alarming ten years or more." YIKES!

I had heard that research years ago on one of the national news stations, but it's good to hear as a reminder.

So, what do we do as asthma moms? Find what works for you to relieve stress:
* lunch out with friends
* movie night with hubby or friends
* watching a funny movie
* getting a massage
* getting a pedicure or manicure
* chatting online with friends or on the phone
* deep breathing, relaxation exercises, guided visualization
* etc, etc

Everyone's different, you need to do whatever helps you relax. We have to take care of ourselves because who else will? And we need to be healthy and happy if we're going to take care of our kids and asthma problems.

I have 2 sick kids at home with asthma, I think I'll do my relaxation CD tonight. Ahhhh......

Monday, October 18, 2010

Another asthma attack

Another asthma attack


This time it wasn't me, it was Son #2. I have to rewind a little.

I don't go to the salon that often, but my naturally curly hair is getting a little wild, so I decided it was time for a trim. I had an hour where I thought I could fit in a trip to the salon.

Well, no sooner was I under the sink and had a sudsy head, then my cell phone started to ring. I apologized and told the stylist I needed to check my phone because my kids have asthma. (I was sure it was Hubby calling, or a friend but thought I better check just to make sure). But, alas it was Son #2. Once in a while, he will send a text from school during lunch if he needs something. This was a phone call I missed, so I knew something was up.

I called him back, and he was having problems and some weird symptoms. So, now what? I'm sitting in a cape with dripping wet hair. He is pretty good at mangaging his symptoms, (he's in high school) so I told him that if he didn't feel better after using his inhaler, to call our neighbor (who is like a 2nd grandma) or his grandma or grandpa to come pick him up. At the beginning of the school year, I always list 4 or 5 people, besides Hubby and I, on the form that allows someone to check him out of school.

Luckily, Neighbor was home and could pick him up. What do you do if a son or daughter has an asthma attack and you are in a meeting/ can't leave/ don't hear your cell phone, etc?

Make sure you have plenty of people around who know what to do and can 'pinch hit' for you. Many friends and neighbors know about our kid's asthma. They know what to do, where the kid's medication is kept, and who and where the Asthma Doctor's office is.

We also have a letter on file in case Grandma or Neighbor needs to take them to the doctor if we're out of town.

Everything turned out fine today, but you never know what can happen. It's nice to know that I'm not alone in this battle against asthma. Make sure you have help as well.

Wednesday, October 13, 2010

Asthma mom

Life with kids with asthma!

Well, I was wondering if any moms would comment, I know the blog is new and getting up and going.

Some of the things I find in common with other moms is that asthma really controls all aspects of your life. You can plan a vacation, night out, family outing, etc - and all that can go out the window when one of the kids has an asthma attack or is sick with a respiratory infection.

I still have times that when I hear my kids cough, my heart starts pounding. I say, "Who's coughing?!" Sometimes the kids will say "Mom, chill! I just swallowed wrong!" Other times, I can see by the worried look on their face that something is seriously wrong.

Things aren't as bad now, but when they were little, I would have to carefully screen who came over to the house to play. A friend with a runny nose? Coughing? Sneezing? I would have to call the parent and say, "please come get your child." I would try to explain that a cold to a 'normal' person is just that, a cold. For someone with asthma, it often times can turn into pneumonia. In fact, almost all of my kid's 12 hospitalizations (for #2 Son and Kitty) were due to pneumonia.

Once we started having repeated hospitalizations, and my friends could see first hand how sick the kids were, then they 'got it'. Not everyone does. They would say, 'can junior come over and play? he has a runny nose?' I would thank them profusely for letting me know junior was sick and ask if we could postpone it a week until they were better.

My number one job as a parent is to protect my kids from all harm. You find out during that time who your friends really are. Some people support you, others think you are a hypochondriac. But they most likely haven't been pacing the floor night after night with a sick kid. Doing nebulizer treatments, watching for retraction, using the oxygen saturation monitor. It's a strange world.

Let's hope this winter goes a bit better. And for all you moms out there, your kids come first. A few people may get their feelings hurt, but better that then your kids ending up in the hospital because you didn't want to offend another parent.

Friday, October 8, 2010

Moms

Calling all moms!

I would like to hear from any moms of kids with asthma. I would like to hear your stories of dealing with your kids.

I was visiting with two friends the other day whose kids have asthma, we found that we were all experienceing similar things with asthma and our kids. I would like to hear what you think and feel.

Do you feel uneasy when the kids start a runny nose, thinking 'I know what's coming next, asthma problems!'

Do you sound like a paranoid, hypochondriac mom that won't let other kids come over to play if they are sick? (We don't want our kids sick again). And do other moms understand why we worry? Do they think we're over reacting?

Feeling unsure about 'should I take the kids to the asthma specialist now? wait? start their prednisone?'

Should I skip the doctor and go straight to the emergency room?

Why did the kids end up in the hospital again? Do you rack your brain to see if there's something you could have done differently?

Please comment and tell me your story. It helps to know that we're not alone, and we're all experiencing similiar stories.

I look forward to hearing them!

Monday, October 4, 2010

Vitamin D

Vitamin D again.

Well, test results are in for Son #2, looks like he is way below where he should be for his Vitamin D level. Average numbers are between 30-60, he's below 30. It can only be diagnosed from a blood draw, but not a bad test if you can handle getting pricked by a needle.

Asthma Doctor recommends a Vitamin D supplement twice a day for Son #2. We are also having him spend as much time outside as possible. This should be an all around 'win' for my pale son who rarely sees the light of day. What?! Leave the computer and World of Warcraft?!

For the record-we don't allow computer play on school days, and limit the time on weekends. But he also likes to read, but he can read outside, right?

It will be interesting to see what happens, this is the newest research in asthma-the link to deficiency in Vitamin D. If it can slow down the 'remodeling' in his lungs (scar tissue building up from repeated inflammation). At least that's the way I understand it. I would like to keep what lung capacity he has.

Maybe I should start him on the bagpipes like Son #1. Talk about hot air! He's full of it and his lung capacity is almost double what Son #2 has. Hhmm, more than one way to skin a cat. A new therapy for improving lung capacity? It's worth a shot!

Tuesday, September 28, 2010

Just call me professor

Just call me professor.

I'm guest lecturing about asthma in a class at a local university. I have all the supplies packed, nebulizer, peak flow meters, inhalers, discs, emergency medicine for the nebulizer, Epi pen, etc.

I was looking up the latest stats, it's a little surprising what they are.

According to Asthma and Allergy Foundation of America,

Every day in the US:

* 40,000 people miss school or work due to asthma
* 30,000 people have an asthma attack
* 5,000 people visit the emergency room due to asthma
* 1,000 people are admitted to the hospital due to asthma
* 11 people die from asthma

I never want to fall in that last statistic. However, we've been in the first four statistics numerous times.

It will be interesting to see what this class thinks about asthma, if I can just get them to understand what happens physically during an asthma attack, what can trigger it, how to treat it, and how serious it can be, I'll think it's well worth my time. I think people really down play asthma "just give them their inhaler and they'll be fine". But we all know it's not that easy.

I'm bringing 11 of the boy's plastic army guys for my visual aid. I'm going to set them up at the beginning of the lecture, them knock them over at the end to symbolize how many people will die today from an asthma attack. It's a sobering thought.

So, off I go to guest lecture. Maybe they'll bring an apple for the teacher.

Wednesday, September 22, 2010

Vitamin D affecting asthma?

So we're at Asthma Doctor's office last week getting #2 son's Xolair shot. For those of you who have never heard of Xolair, it's for patients with moderate to severe asthma whose asthma is uncontrollable by traditional treatment plans.

My pale son, who likes to read and play computer is being asked by Asthma Doctor if we should check his Vitamin D level. Hmm, what makes him think that might be low? The fact that he spends little time in the sun?! It seems that those with low levels of Vitamin D are at higher risk for severe asthma symptoms. I'm all in favor of anything that can reduce his symptoms. It's not unusual for him to suddenly drop 150 points on his peak flow meter during an asthma attack.

It's been 2 1/2 years since he's been in the hospital, that's the longest he's gone without being admitted. They may have to give away our corner suite in pediatrics to someone else.

It's amazing what little things can affect asthma. #2 Son also suffers from acid reflux, which can also trigger problems with asthma.

We'll see what the lab report shows for his Vitamin D level. In the meantime, I'll have to tell him to put down the book, turn off the computer and go see the outside world. You know, the one that has sunlight and fresh air. Wish me luck.

Monday, September 20, 2010

smoke and asthma

There's a fire about 15-20 miles away. It was making us really nervous, we were wondering if the smoke would get to our house.

We could smell smoke from another fire that's about 100 miles away, but the smoke has drifted up here. The moon looked really pretty last night, but the smoke is unnerving. I made sure all the windows were closed and the air conditioner was on.

Smoke from a fire about 10 years ago put #2 Son in the hospital, on oxygen, IV steroids and on a heart monitor. Why the heart monitor? To give them a little advanced warning because they were waiting for him to "crash", then he would have been on a ventilator- on life support.

So smoke makes me very nervous. I was watching the live news casts last night wondering how the people near the fire were doing, especially those with asthma.

If you had to be evacuated from your house and had just minutes to grab a few things, what would you take? It makes you stop and think. Amongst the photo albums, I would make sure I would have the nebulizer and all the asthma medication.

Wednesday, September 15, 2010

Neti pots



 Neti pots. Neti whats?!

Ever try one? They look like a tiny plastic magic lamp or a squatty squeeze bottle with a pointed lid with a hole in it.

What is it for? It's for all of us plagued by allergies, it's a tool used with a saline rinse that cleans out your sinuses. Isn't that exciting? Well, not really- but necessary.

Sinus infections are really common for those with allergies, and they can trigger asthma attacks. Asthma Doctor said that Neti pots are as effective at antibiotics at clearing up sinus infections. (and since antiobiotics are overprescribed and their overuse is causing antibiotic resistant bacterias......)

You simply fill the neti pot with warm STERILE water and a packet of saline solution, you lean over the sink and squirt it up one nostril, tilt your head, and let it run out the other side. Then you switch nostrils. It's like jumping into a swimming pool without plugging your nose! It makes your eyes water and your nose run. But it's amazingly effective.

Sometimes when you've tried other options over and over again, you get frustrated and are willing to try anything. So, if you're at that point, you might consider a Neti pot. They're sold at most drug stores and are not that expensive. Remember to use sterile or distilled water each time. There have been rare cases of infections from contaminated water that led to brain infections. *shudder*

If you decide to try it, good luck and keep a box of tissues handy!

Friday, September 10, 2010

Suggestions?

Any suggestions of things you want to hear about?

I can happily blog away about 10 years of experiences, some good and some bad.

But is there anything anyone wanted to hear about? Any questions? Confusion?

There's a lot out there when it comes to asthma, and everyone seems to have different experiences. So, if you want to hear about something, feel free to leave a comment!

Otherwise, I'll just keep blogging-

Tuesday, September 7, 2010

Achoo! 1st cold of the school year

Well, here we go again. Achoo! Achoo! Achoo! Sore throats, running noses and coughing.

I was hoping at first that it was just allergies and that something in the pollen count was REALLY high, no such luck. The sore throat started, and I thought here we go.

I need to crack down again with my germiphobe precautions. I noticed Hubby and Kitty and I are all using the same tube of toothpaste. Great way to spread germs. I usually use separate tubes of toothpaste for each of us. Guess it's a little late for that for this cold.

And the toothbrushes are getting thrown out and fresh ones are replacing them once the cold is over. (You don't want to use old germ filled toothbrushes)

Also, I keep all the toothbrushes on separate shelves in the bathroom. (And NOT by the sink. I've heard that over spray from the toilet can spread over 5 feet in the bathroom - I don't know about you but I would rather not have toilet water on my toothbrush) Also, when kids wash their hands, they drip water and suds all over-including your toothbrush.

I also wash the hand towels at least once a week. And give each person their own hand towels to use- everyone can have a different color.

I don't mean to sound paranoid, but I heard two pediatricians talking the other day. And they said that about two weeks after school starts, their offices are flooded with sick kids. I would like to stay out of doctor's offices, thank you. And especially out of the hospital.

Since most of you with asthma know that a cold is seldom a simple cold, usually with asthma it goes into bronchitis or pneumonia.

So, it's better to be safe than sorry. All right kids, new toothpaste tubes and toothbrushes are getting passed out after school! Exciting, isn't it?!! Asthma is so much fun!

Friday, September 3, 2010

Putting things in perspective

This week, I was lucky enough to join a friend whose daughter was receiving her wish from Make A Wish foundation. The staff there showed us how the kids decide on a wish, then go inside a tower with a waterfall in the middle of the room to place their wish in a capsule.

Some kids wish for trips to Disneyworld or Hawaii. Others want a puppy or a laptop. One cute little toddler wanted his room to look like a fire station.

But the hardest part on reading the stories of these children and teenagers is to see why they were there in the first place. Some wish recipients had bone cancer, brain tumors, cystic fibrosis, leukemia, etc. Some stories ended by listing the child's death date. Yes, my kids all have asthma, but they're still alive! Don't get me wrong-asthma can be deadly as I was reminded of last month when "48 Hours" news reporter Harold Dow died of an asthma attack while driving his car. They found his inhaler on the floor of the car.

Here's the link -I hope it works. If not, just google "Harold Dow". You'll also find pages of stories of other people who have died of asthma attacks. http://www.nypost.com/p/entertainment/tv/hours_star_died_of_asthma_zdJQJcIRK6FpwMXO7T8D5H

Anytime your kids are suffering, it can break your heart. Asthma is a chronic, life long disease for most people. I tell people my main goal with my kid's asthma is to keep them alive. People laugh, but it's true. But no matter how bad things get, (12 hospitalizations for asthma during a 3 or 4 years period) they can always be worse. Having a child with asthma doesn't compare to having a child with bone cancer, leukemia, brain tumors, cystic fibrosis, etc. My hats go off to those parents. And it makes me look at my own life and keep things in perspective.

And to Make A Wish Foundation-keep up the good work! You are making the last days for some of these children their happiest days.

Friday, August 27, 2010

Flash Back -flu shot

I'm glad it's not this time last year when the big Swine Flu or H1N1 was hitting the news! There seemed to be a lot of panic and school closings going on. And since asthma complicates any respiratory infection, I was very worried about my kids. (They've already been hospitalized 12 times thanks to asthma)

They kept mentioning the high risk groups to get immunized, which included pregnant women and also chronic disease. But seldom did they say the actual word "asthma". I even had someone from a health department say, "asthma? you're not in the high risk category". Oh YES WE ARE!

The Assistant Surgeon General was in town recently speaking about immunizations. I heard her several times refer to people with asthma as being high risk and needing immunizations. She also cautioned that they not get the nasal spray, but instead the injection.

Since the nasal spray is a live inactivated virus, it's not recommended for people with weakened immune systems or asthma. And you need to check with your doctor if you have recently been on steroids, because that can impair your immune system for a time. apparently, the H1N1 vaccine is combined with the annual flu shot this year, so that's good news. That means one shot for most of us, but I think they're still recommending children under 9 receive 2 doses. So ask your doctor or local health department.

I'm hoping there aren't lines this year for the flu shot-last year we waited for 2 hours. But I knew my kids would absolutely end up being hospitalized if they contracted the flu.

So, roll up your sleeves, take a deep breath and get that flu shot. Be a good example for your kids, go first and put on a happy face. Then afterwards, take them out for ice cream as a reward for getting their flu shot!

Friday, August 20, 2010

Anaphylactic shock

To follow up on the last post, I cautioned that you must stay 20 minutes after every allergy injection. There is a possibility of anaphylactic shock since you are getting injections of what you are allergic to.

The ONE TIME we left early, #1 Son had anaphylactic shock. #2 Son was already in the hospital with pneumonia and asthma, and we had gone to do allergy shots with #1 Son and Kitty. We were going to get shots, grab some pizza and head to the hospital. HA!

We told Wonderful Shot Nurse that we weren't going to stay, but were headed back to the hospital. She assured us we would be fine. Then Murphy's Law stepped in. We were a block away when #1 Son started coughing and said he thought something was wrong. I looked in the rear view mirror and saw #1 Son with a bright red face, glassy and bulging eyes and a swollen neck. Uh oh.

I did a quick U-turn and called Wonderful Shot Nurse who was waiting for us as I sped back. She had the epinephrine injection ready, and a breathing treatment set up. She calmly injected him and made small talk while the medicine did its job. She stayed with us for 2 hours after the office closed, to make sure he was stable. She gave us a prescription for an epi-pen since people can have a rebound anaphylactic shock episode 2 hours after the initial onset and treatment.

Meanwhile, Hubby is calling my cell phone wondering what's taking so long for the pizza. I breathlessly said "anaphylactic shock, can't talk". To make matters worse, while we were at the pharmacy getting the epi pen, Kitty left her favorite stuffed animal there!

We made it to the hospital about 3 hours later, I was so shaken up that we ended up ordering pizza to be delivered there. As we munched away, I remember feeling grateful for modern medicine, and that both our sons were still alive.

Wednesday, August 18, 2010

Allergy shots

Allergy shots (immunotherapy) is a great option for a lot of people. Sometimes, even on daily allergy medicine, it doesn't relieve your symptoms. You or your kids may still be sneezing and wheezing.

To be tested for allergies, you must be off all allergy medicine for a week before the test so the antihistamine doesn't mask the results. Usually, the office will pick an off season time for the testing. The first time we tried, #1 son couldn't go a whole week without an antihistamine. He actually broke out in hives because his allergies were so bad, so we scheduled the next try for November.

The kids start by laying on their stomach while our Wonderful Shot Nurse starts the test. She marks multiple rows and columns on the kids back with pen, that shows her where to administer the serum. It's not a needle, but a sharp scratch on the back that introduces the serum under the skin. The kids need to lay still for 2o minutes, not easy with an itchy back. We would usually have the kids bring their Gameboy to keep them busy.

The Wonderful Shot Nurse checks every 5 minutes, to make sure the kids aren't having a reaction and to see how big the welts are. Each column is in order, she can tell what they're allergic to by just looking at each area. After 20 minutes, she measures the welts-that determines what they're allergic to and what to add to their serum. The best part is when she rubs their back with an anti-itch cream.

Once the serum comes in, you start allergy shots twice a week (one injection in each arm or 4 injections per week). It's a MUST to stay 20 minutes after each injection. Since you are being injected with what you are allergic to, there is a possibility of anaphylaxis. You monitor the size of the welts on your arm, that determines when you are able to move to once a week injections.

It's a long process, it takes anywhere from 3 to 5 years. But having your body slowly build up a tolerance to what you are allergic to is worth it. You don't have to take antihistamines for the rest of your life!

Monday, August 16, 2010

Beware of hardware stores

Who would have thought just running through the hardware store with Hubby would cause an asthma attack?!

As a trained Interior Designer, a hardware store to me is like a kid in a candy store. Oooh, love that flooring! Hey, is that a new style of vanity for the bathroom? Nice mirror......

So, I am usually accompanied by Hubby so I don't drag home any new project for him. This time we were in the lumber area, getting wood for some faux paneling we were installing. I immediately started sneezing and coughing and my chest tightened up. This store was out of the size of boards we needed, so we had to drive across town to the other hardware store. Repeat sneezing, coughing and tight chest scenario. Only this time, I had to grab onto a display to catch myself because I was coughing so hard.

I managed to gasp out 'must leave' as I staggered toward the exit. The cashier was eyeing me as passed by her (who could miss that cough and stagger?!)

Fresh air outside! But alas, no inhaler in my purse. ( Like most women, I use multiple purses, it depends on which outfit I'm wearing as to which purse I grab. But I took the wrong one-no inhaler!) It seemed like a long drive home but as soon as I used some Albuterol, the cough instantly stopped. Although I still had a lot of mucus and irritated lungs for the rest of the day. But good asthma medication is worth it's weight in gold! I usually have different inhalers stashed in various places in cases an asthma attack hits. I'm always worried about the kids needing one, but what good is a mom who isn't breathing?! I need to take care of myself as well! Maybe I'll get a little chocolate while I'm at the store getting my new inhaler.......

Friday, August 13, 2010

Flash-back Friday- coming home on oxygen





Does anybody like using oxygen at home after your kids have been discharged from the hospital?

I'm can't remember how many times the kids were discharged on oxygen, but it always made me nervous. Sometimes, they can discharge a patient if all they need is oxygen or they can stay for another day or two in the hospital. There's nothing like being back home in our own beds! And there can be other risks of picking up infections in the hospital-I don't want the kids coming home with any infection they didn't already have!

By the end of the hospitalization, the kids are pretty hyper from the steroid IV. Once they get home, they're still a little crazy. They want to run around the house, but usually get to the end of the oxygen tubing and are yanked back like a dog who has reached the end of his chain. It's hard to keep a straight face when that happens.

If one of the kids was going to be on oxygen for a while, they gave us an oxygen "concentrator" instead of using tanks. It turns room air into oxygen by concentrating it. That way, they're not coming out all the time with a new tank. They can also bring a travel size tank so you can take that when the kids have to go back to the doctor for a follow up appointment.

It's amazing the things you can learn over the years (and things you wish you didn't have to know about.) Here's hoping the kids don't start getting sick again now that school is about to start! I do not want to know how germ infested the classrooms can be.

Wednesday, August 11, 2010

Great minds think alike!

I was surprised to see this post on my Facebook page. Looks like great minds think alike! I think I just posted something about getting my kids ready for back to school with asthma. The Utah Asthma Program has a list of things to do to get the kids ready for school.


http://health.utah.gov/asthma/schools/backtoschool.html

They listed the Self Administration Form so the kids can carry their inhaler with them. I know our school nurses send one every year that we fill out and mail back. If your school nurse doesn't, there's a form on the website. There's also a link to the Utah bill that allows students to carry their inhaler with them at all times in the school (if the parents think they can self-administer their inhaler)

They also have an Asthma Action Plan link, you can fill that out with your doctor so the school knows what to do if your student has an asthma attack.

I saw several programs also listed that will train the staff at the school (what does an asthma look like, what should they do to treat it, when to call for help, etc)

Has anyone ever had an experience of their child having an asthma attack at school? Did the staff know what to do? Was the school nurse available?

Monday, August 9, 2010

Whew! Close one on allergies!

It's a good thing we've taught #2 Son to carefully check labels.

Last night, he went to get some ice cream after dinner, we had bought a ice cream with candy bars mixed in. It looked chocolately and delicious!

He came into the living room, holding up the carton by one hand (like a waiter carrying a tray) and said, "good thing I just read the ingredients on this before I took a spoonful."

Listed right there on the side were almonds, tree nuts! His worst enemy. Known to cause anaphylaxis for #2 Son.

It didn't even dawn on me that a candy bar ice cream would have almonds. Some mom I am!There goes my Mother Of The Year Award (again) ha ha. Ice cream with Snickers doesn't worry me because they're peanuts, but tree nuts mixed in candy bars are another story.

Sure, I'm supposed to protect my kids, not buy something that is going to give them anaphylaxis. Although, come to think of it-Hubby was the one who picked out this flavor. I'll be more careful next time. Even ice cream can cause problems!

Let your guard down once and this is what can happen. Good thing we've trained #2 Son as a back up label checker!

Friday, August 6, 2010

Flash back Friday- hospital birthday

So, what are the odds of being in the hospital on your birthday? Well, Kitty ended up there one year.

We were planning her birthday party and had sent out all the invites when she started getting sick. (#2 son was also sick and already in the hospital) Then Kitty started coughing and wheezing. Not unusual for an illness to travel through the family, especially one full of people with asthma.

She was admitted a day later, and I just sat down and cried. Then I thought, now what?! Two kids in the hospital, one with a birthday in a couple of days.

Enter One Very Cool Child Life Specialist. She said, "We'll just have the party here!" I didn't know you could do that! So she had us pick out a theme, pulled together decorations and party favors, and set up a room. I called all the parents, who met us at the hospital, then security took up the elevator into the secured area. I told Abby we were going to go for a walk with her tank to 'get another chest x-ray'. We opened the door to the room and everyone yelled 'surprise'. She glared at me and said, "This isn't the x-ray room!" (How many kids know what the x-ray room looks like at the hospital?!)

I had to admit that Mommy told a little lie to get her down to the room, and that all of her friends were here to surprise her for her birthday. I am so impressed with the nurses and One Very Cool Child Life Specialist. They pulled off a great party for one tired, very sick little girl tethered to her oxygen tank. They also decorated her room and brought presents! Even her teacher from school came to visit and brought a tiny little cake.

It's amazing how we can get through times like this, thanks to friends, family, and One Very Cool Child Life Specialist.

Wednesday, August 4, 2010

Back to school






Yikes! It's that time already?!

I haven't done any shopping yet as far as clothes and school supplies. I should probably get started.

But I did just get the kid's Asthma Action Plans filled out by Asthma Doctor and mailed back to the school nurse. She thanks me profusely for actually taking the time to fill them out and return them. She said she is frustrated because she can send out 120 requests every school year, and usually gets 10 of them returned. If you have a child with a medical condition, wouldn't you want the faculty and staff to know they are asthmatic (or diabetic, have seizures, etc?!) How is the faculty or staff supposed to take care of my son or daughter if they don't know what medical condition they have, or what medicine to give them? I'm not about to leave that up to chance!

I want the kid's Asthma Action Plans filled out so that if I'm not around, their teachers will know what to do. In our school district, the nurse has a heavy school load and visits our school for about 3 hours a week, usually Thursday morning. So I tell the kids if they are going to have an asthma attack, be sure and time it during those hours. Just kidding!

We're usually on our own, I'm on of those moms who takes my cell phone everywhere I go. More than once I've had to take the nebulizer to school because #2 Son (with severe asthma) can't breathe deep enough to use his inhaler.

I'll also be checking last year's back packs for their asthma medication pouch. I need to see if the inhalers or epi pens have expired. In our state, if you have a "medication authorization form" filled out and signed by the parent and doctor, it is legal for students to carry their inhaler with them at all times. (Like I want their inhaler locked up in the office if they're out on the field during gym and have an asthma attack and need their inhaler!?)

I also need to check and make sure their spacer and peak flow meter are clean and packed.

Once I get those important things packed, then I'll start worrying about pens and pencils. And of course the perfect outfits for the kids.



I'll also have to visit with each and every teacher to make sure they know the kids have asthma, what to do if they have an asthma attack, and leave me cell number with them.

Monday, August 2, 2010

Cleaning carpet

Ah, cleaning carpet. It's about as much fun as getting the tires balanced and rotated on the minivan (next on my list).

Luckily, the main living floor of our house has wood floors, which are recommended for people with asthma. I can keep them quite clean, because I can see all the dirt, dust bunnies and food particles that have dropped. And with teenagers around, they can get dirty in a hurry.

The downstairs level is another story. With another living room, dining room and kitchen, the downstairs gets a lot of use. This weekend #1 Son had a Star Wars movie marathon. There was a great group of college aged kids over and they weren't too messy. But with all the previous stains we decided to bite the bullet and get the carpets cleaned.

Our downstairs has Berber carpet, the unique smooth carpet seems to trap lest dirt and gunk than a 'pile' carpet. We've had the carpet cleaned in the past, but it still looks dirty. So we're trying a new system that uses a specially formulated hot water that is supposed to leave the carpet drier. The carpet cleaners claim they don't flood the carpet with water and soap, so there's no residue left behind. Apparently, that's what causes problems when the water and soap don't get sucked back out and instead is left down in the carpet. (Great breeding ground for all sorts of fun things). So we'll see how this system works. And I passed on the spray protect-ant. Even with the kids at the movie, I don't want anything sprayed on the carpet that could cause an asthma attack.

It will be interesting to see if this makes a difference with their allergies and asthma. Every little thing I can do to make the house a little cleaner helps, right?

Anyone else have any fun carpet cleaning stories? Has it seemed to help your asthma?

Friday, July 30, 2010

Flash back Friday- VCD

VCD stands for Vocal Cord Dysfunction and it's one of those conditions that can be confused with asthma. Sometimes, when the severe asthma is uncontrollable on medication, they look at VCD.

#2 Son was evaluated for this, once again more fun at the hospital! He LOVED having a probe stuck up his nose as they watched his vocal chords during speech patterns. Nasal endoscopies are a great way to start the week!

His vocal folds turned out to be normal, but for many people it is an answer as to why they are displaying symptoms of asthma, yet not responding to normal asthma medications. Some people are needlessly taking asthma medication when in reality, it is a problem with their vocal folds.

Once again, diagnosis can be confusing. We are lucky to have a great asthma doctor who carefully ruled out all other possibilities before deciding on a treatment plan for #2 Son. He does have severe asthma and that is why he does Xolaire injections.

But do a little research and carefully consult with your doctor. Asthma isn't all cut and dried and can have other things that contribute. Ah, thank you genetics. Once again, we are genetically defective, I want a refund!

Wednesday, July 28, 2010

Xolair



(photo from www.xolair.com)


I'm surprised about how many people have never heard of Xolair . Of course, it's a small percentage of the people with asthma that actually need it. Since only 5-10% of people with asthma have severe asthma, many people are unaware of Xolair.




From what I have learned so far in lay-people terms, Xolair is an "IgE inhibitor". There are different immunoglobulins in the body, but "E" is associated with allergic responses. Apparently, there are little 'mast cell' (they look like little prickly balls) in the body that are filled with histamine granules. When an allergic reaction starts, those mast cells break open and the histamine is released, thus starting the allergic response. We all know what that looks like, swelling, sneezing, coughing, etc.




Rather than treating an allergic reaction (with anithistamines), Xolair is supposed to stop that allergic reaction from taking place at the cellular level.




With #2 Son's severe asthma, we were unable to keep him stable, even after Advair, Singulair, Zyrtec and 5 year's worth of allergy shots. Despite all that, he would still end up on Prednisone (oral steroids), followed by Decadron (injectible steroids), and then finally in the hospital. Then we started oxygen and IV steroids. It was getting a little old.




Our insurance company probably hates us already, and certainly doesn't want to pay $1000 a month for Xolair (our co-pay is $150). But I have this weird thing about wanting to keep my kids alive, call me crazy.



Now my heart doesn't skip as many beats when he gets sick and his peak flow drops 100 points, I know I can give him a breathing treatment and he'll respond like 'a normal kid'. Usually, he would be admitted to Pediatrics at the hospital within two days.



I hope none of you never need to use this, it's a last resort. But when all else fails, it does help keep your child alive. File it away for future reference, just in case.....

Monday, July 26, 2010

Pioneer day & triggers

It was nice to celebrate Pioneer Day with the kids this weekend. One of the cities close by hosts a pioneer celebration in the park, and it has a lot of fun activities.


#1 Son and Kitty had fun competing in a log sawing competition, followed by carving 'petroglyphs' at the Native American Village. Surrounding the park were several activities which Kitty rolled her eyes about (apparently she is getting too cool to participate in kiddie activities). We didn't hunt for the Sheriff, put her in the jail, pan for gold or participate in the watermelon eating contest.

I made sure we gave a wide berth to the station that was hosting a "needle in a haystack hunt"-just walking by all the piles of hay with kids clawing through them was enough to make us start sneezing.

Then Kitty spied the miniature ponies from across the park. She dragged us over there, but oh, what a shame, the line was too long! What a disappointment! We also told her that it looked like it was just the little kids who were riding on the miniature ponies. And lucky us, there was also a petting zoo. Great. More hay and dander. As I saw her eyeing the animals I distracted her by saying, "I know it's not pioneer food, but I think I saw a pizza stand on the other side of the park!"

Shameless, I know. But you've got to know what diversion tactics work for which kid. Of course she did bat her eyes and give me her biggest smile while sweetly asking if we could get a pony for the backyard. (Ongoing joke) Sure! Let's get two so he has a friend!

It would be nice to be able to go somewhere without always scanning the surroundings to make sure there wasn't anything that was going to set off someone's asthma. At least #2 son wasn't with us, so I didn't have to scan all the food for tree nuts!

Ah, my life as an asthma mom......

Friday, July 23, 2010

Flash-back Friday - terminology

If there's one thing I've learned over the past 10 years, it's to know asthma terminology. It helps immensely when I am at the ER to be able to say, "He's asthmatic, his peak flow is usually 350-right now it's 200." Knowing your kid's peak flow gives them a concrete reading, rather than just saying "he's having a hard time breathing".

We're also lucky enough to be able to use a friend's oxygen saturation monitor. So I can also say, "their oxygen level is reading at 89 on my sat monitor" (you should be be closer to 100). They usually admit the kids to the hospital if their oxygen level is at 89 or lower.

I tell them not to bother looking for retraction, because my son suffers from air trapping and experiences the 'barrel chest'. Retraction is when they are trying so hard to breath that they use all their accessory muscles, usually sucking in the skin surrounding the chest when they breath. You can see the skin suck in along the collar bone, and in the 'u' shaped bone at the base of the neck. You can also 'count the ribs' because the skin sucks in between the ribs.

You should of course know what maintenance medications they're on and what doses. Also, include any rescue medications, or if they are on oral steroids now or have received a steroid injection.

I also always let them know how many time the kids have been admitted to the hospital too, so they know if I'm there, it's serious!

So, use that terminology- tell them peak flow readings, sat levels, retraction, maintenance medications and rescue medications. I also usually tell them, "I know I'm in over my head, they need oxygen and solumedrol" (IV steroids). Plus round-the-clock nursing care & respiratory therapists who get paid to stay up all night and monitor them.

Hopefully none of you have kids who end up being admitted to the hospital, but if you are in the traige area, be sure to use all the terminology you know so they listen to you and get you in quickly!

Wednesday, July 21, 2010

Air quality

It's been really dry lately, I think we've had a trace of rain all month. (Of course just enough to dirty hubby's just-washed-truck)

Call me crazy, but when you can "see" the air your breathing -or cut it with a knife- that's not good. I have felt a difference in my chest, and I have a friend who's wheezing can be heard across the room! Our local news stations list red, yellow, and green air quality days. So we adjust our schedule and avoid being outside in the heat of the day.

I exercise in the morning or late evening, when the ozone levels aren't as high. We've also found LOTS of things to do indoors. In fact, we've seen a lot of movies lately.

But hey, it's summer and the kids are out of school. I need to minimize any risk I can. Since asthma triggers can accumulate, I don't need to start with a base of dirty air making my lungs inflamed, then add a few pollen irritants, and top it off with a respiratory infection. Sometimes that's the straw that 'breaks the camel's back'. So if I can cut out one thing that's going to cause problems with the asthma, I will.

So enjoy a movie! And pass the popcorn.

Monday, July 19, 2010

Prescriptions - "that's how much?!!!"






I thought this cartoon was hilarious, it's from my daily calendar. I know how this lady feels, I almost passed out when I went to get Kitty's prescription refilled last week.

I had switched to a warehouse pharmacy, hoping they would be less expensive. They weren't.

When the pharmacy tech rang up Kitty's prescription, she said "that will be $92". I said "no, no, no, that's not right. It's always $32." I was sure they had made a mistake. She helpfully asked if I had a new deductible or if the new insurance year was just starting for us. DOH! (insert Homer Simpson inflection.) Yes, it was technically a new insurance year (never mind that it's July). Like most normal people, my new year starts in January-silly me.

So, it was $96 for a one month supply. Now, all 3 of the kids take multiple medications for allergies and asthma, I haven't needed any other refills yet. I'm cringing thinking of the thought of another $96 refill.

We did discover some co-pay assistance. #2 son receives injections once a month for his severe asthma-a cool $1000 a pop. Our copay is $150 per month (cough, cough). We found a very helpful website that lists co-pay assistance called Needy Meds, luckily we were able to find a foundation that offers co-pay assistance for his particular inject-able medication. http://www.needymeds.org/ I wish we had known about this earlier, it's worth checking out especially if you have multiple people in your family taking medications for chronic diseases.

Guess I'll go through the cupboard and take stock of what prescriptions need to be refilled. * Sigh * Oh well, it keeps the kids alive, right?! That's all that matters!

Friday, July 16, 2010

Flashback 4th-cont'd

I needed to add a little to last weeks' Flash Back Friday. Writing about #2's ICU admission took awhile, but wait! there's more!

When #2 was in ICU in pediatrics, it was my hubby's turn to stay at the hospital and I was at home with #1 son and Kitty. We had a bad night when someone tried to break into the house. Kitty was crying, so I got up to check on her during the night and heard a distinctive slam of the front screen door. (Our clergy leader had warned all of the neighbors of several attempted house break-ins and to be aware) So my heart was racing as I grabbed Kitty out of her crib and ran across the house to check on #1 son-who was sound asleep. I heard some rustling in the lilac bushes by his window, so I called 911.

I was crying so hard the dispatcher could hardly understand me, but I did manage to get out that one son was at the hospital, and I was home alone with the other two kids. When the officers arrived, they couldn't find the suspect, and they asked me if there was someone who could stay the night to help me feel better. It was a great excuse for my father-in-law to ride over on his Honda Goldwing and he then spent a fitful night trying to sleep on the couch.

I called my hubby at the hospital ( note: hospital operator will not patch you through to a room after 10pm unless it's an emergency-which it was)

So for the rest of the hospitalization, I spent the nights at the hospital where I knew I was safe.

Then Kitty became sick and couldn't stop throwing up and having diarrhea. So I took her to the pediatrician in the morning (after he had done rounds at the hospital and had already seen #2 son.) She continued to have problems (now I know to ask for anti-nausea medication!)

When #2 was discharged, I took him home where Hubby watched him. I put Kitty in the car and took her back down to the pediatrician, where she was admitted to the hospital with dehydration. The nurses did a double take when they saw me and said, "WHAT are you doing here?!" I had such fond memories of Pediatrics, we couldn't bear to leave! Ya, right!

So, we spent another 4 days at the hospital with Kitty on an IV, she was so sick it took that long to re-hydrate her.

What did we learn that LONG week? That even during ICU hospitalizations, it is important to keep an eye on the other kids as well. Just because one of them is sick doesn't mean that we can only focus on that particular kid. Also important is to follow your gut instinct as a mom. Even though the pediatrican said we would just have to ride it out and to keep trying to give Kitty fluids and she would be okay, I knew something was wrong. So I kept going back until they figured out what it was and admitted her. Many times I'll say, "something's wrong, I just can't put my finger on it". And the doctor seems to take extra time and listens. Trust that gut instinct as a parent!

Wednesday, July 14, 2010

BIG tonsils and asthma

So what do BIG tonsils have to do with asthma? Well, a lot if you can't get much air past the tonsils to get to your lungs.

Kitty and #2 son both have big tonsils. In fact, the doctor said, "those things are huge! You could go bowling with them!"

#2 son had his tonsils a few years ago during Christmas break. It's really fun when you run out of liquid Lortab and have to drive around on Christmas day trying to find liquid Advil and Tylenol. We did manage to find one 24 hour drug store open on Christmas day-it was funny to watch all the customers trying to find last minute presents!

Back to Kitty-her tonsils are so big that they were almost touching. That causes her to snore quite loudly. Sometimes we have to get up during the night and roll her over so she stops snoring. She was sick again this Spring and she kept all of us up during our vacation. In fact, she snored so loudly, she woke up her half-deaf grandpa! He was quite surprised that someone snored louder than he does!

The tonsillectomy and adenoid removal was a quick operation, but a long recovery. It's been two weeks now and she said, "I'm really tired of ice cream for breakfast, can I try something else?" It seems like the ice maker on the fridge has been working over time to keep up with her ice chip consumption.

We're hoping this surgery will help her the next time she gets sick so that she can breathe a little easier. It seemed to help #2 son when he had his tonsils and adenoids out. When the hospital sends the bill, I think I'll just tell them to put it on my tab!