plansrme Posted October 22, 2014 Share Posted October 22, 2014 My 16 yo is coughing up blood. TMI? Maybe, but she's coughing a LOT. The after-hours dr last Tuesday (the night before the PSAT) gave her a breathing treatment and a three-day prescription for prednisone. That helped, but the cough was back with a vengeance yesterday. She called us to pick her up from the gym (she drives herself) last night because she was coughing up blood. She at least used to have a touch of asthma, but before this fall, she had not had a flare-up in years. The pediatrician (this was our last visit to him--he was an a** to her) made her cry because he was making her breathe deeply when it hurt--a lot, apparently--to do so. All he offered was to keep using albuterol and a steroid inhaler around the clock, which she was already doing without success. This has been going on for weeks, but it has been substantially worse the last ten days or so. Oh, and the chest x-ray was normal. Dr. Asshat says it is a respiratory virus and could take weeks to get over. So, what does Dr. Hive suggest? This is what we have tried: *She is drinking thyme tea as we speak. The jury is out on whether it is helping. *I am picking up a new supply of N-acetyl cysteine today. I have recommended this several times on this board, but ours apparently expired in 2011. Oops. *She used Nyquil last night to get to sleep. First time ever, but it did eventually work. She obviously can't walk around swigging Nyquil, though. *She eats tons of high-antioxidant veggies. She will sit down and eat red bell peppers like they are apples. She went to class yesterday with blueberry stains on her fingers. *She laughed, but we did the Vick's vapo-rub on the feet last night. No apparent effect. She is a gymnast and really needs to not be out for weeks. I need her to stop coughing and for her lungs/bronchial tubes to heal. So what have you got? I'll try anything short of blood sacrifices, and even then it might depend upon whose blood we're talking about. . .. Quote Link to comment Share on other sites More sharing options...
Seasider Posted October 22, 2014 Share Posted October 22, 2014 Coughing up blood? I've had kids with asthma on nebulizers, steroids, preventative treatments - I've never had one coughing up blood. I consider it a big red flag. Call the doc right away and if he seems unconcerned, get an immediate second opinion or go to the ER. Maybe others will tell you this is not uncommon, but it would have me quite worried. Quote Link to comment Share on other sites More sharing options...
Chris in VA Posted October 22, 2014 Share Posted October 22, 2014 I'd take her to another Dr, to be honest. Quote Link to comment Share on other sites More sharing options...
Paige Posted October 22, 2014 Share Posted October 22, 2014 I'd take her back as well. Have they checked for whooping cough or the enterovirus going around? Quote Link to comment Share on other sites More sharing options...
Artichoke Posted October 22, 2014 Share Posted October 22, 2014 I'd take her to the ER for swifter treatment from a different doctor. Do you have a children's hospital in your area? Is there a possibility that she could have H1N1 flu? Extreme coughing can be one of its symptoms. Quote Link to comment Share on other sites More sharing options...
momto10blessings Posted October 22, 2014 Share Posted October 22, 2014 Take her to another doctor. Definitely. Quote Link to comment Share on other sites More sharing options...
plansrme Posted October 22, 2014 Author Share Posted October 22, 2014 She has had h1n1 already. No fever. I am not actually worried about the blood except as a sign of intense coughing. The ped appt was just today. Quote Link to comment Share on other sites More sharing options...
Twolittleboys Posted October 22, 2014 Share Posted October 22, 2014 I also would take her to see another doctor. Coughing up blood sounds pretty serious and it does appear the pediatrician doesn't have a good handle on her cough. Doctors can miss stuff so I would get a second opinion. Quote Link to comment Share on other sites More sharing options...
blondeviolin Posted October 22, 2014 Share Posted October 22, 2014 Is it bloody sputum or blood from coughing? Two different things. Both still concerning. I'd ask for a second opinion. Quote Link to comment Share on other sites More sharing options...
chiguirre Posted October 22, 2014 Share Posted October 22, 2014 Coughing up blood would have me running to the ER... However, I had a horrible bout of coughing from a virus that was going around (according to the doctor who didn't prescribe anything). The only thing that helped me control the coughing fits was chewing gum. It works much better than cough drops. I hope she feels better soon. Having "the virus that's going around" cause awful symptoms but nothing that a doctor can put a finger on and diagnose is the worst. Quote Link to comment Share on other sites More sharing options...
TeenagerMom Posted October 22, 2014 Share Posted October 22, 2014 Mucinex DM is the only thing that works for me when I get like that. Quote Link to comment Share on other sites More sharing options...
City Mouse Posted October 22, 2014 Share Posted October 22, 2014 My DH had whooping cough as an adult. His only symptom was crazy uncontrollable coughing. It took several return trips and elimination of other possible causes before he got that diagnosis. I hate to think off all the people he could have possibly spread it to in that time. Quote Link to comment Share on other sites More sharing options...
plansrme Posted October 22, 2014 Author Share Posted October 22, 2014 My DH had whooping cough as an adult. His only symptom was crazy uncontrollable coughing. It took several return trips and elimination of other possible causes before he got that diagnosis. I hate to think off all the people he could have possibly spread it to in that time. Do adults not have the whooping sound? How was it treated? Quote Link to comment Share on other sites More sharing options...
maize Posted October 22, 2014 Share Posted October 22, 2014 Viral bronchitis can cause a cough that lingers for weeks. I'm so sorry your DD is having such a hard time, and would definitely get her to another dr Quote Link to comment Share on other sites More sharing options...
clementine Posted October 22, 2014 Share Posted October 22, 2014 I had whooping cough a few years ago. It was literally 100 days of coughing. I was not without a cough drop in my mouth during waking hours. I had to make sure you couldn't overdose on them. :confused1: I thought I had broken a rib during, but I was just bruised. Have you tried a strong cough drop? It wasn't a whooping sound and the cough wasn't really productive - just a powerful cough that wracks your whole body & you can't catch your breath. Scary. Quote Link to comment Share on other sites More sharing options...
plansrme Posted October 22, 2014 Author Share Posted October 22, 2014 Viral bronchitis can cause a cough that lingers for weeks. I'm so sorry your DD is having such a hard time, and would definitely get her to another dr And in my heart of hearts, this is what I think it is. If so, the NAC should help. She just has to stop coughing long enough for her poor little bronchial tubes to heal. Quote Link to comment Share on other sites More sharing options...
plansrme Posted October 22, 2014 Author Share Posted October 22, 2014 Is it bloody sputum or blood from coughing? Two different things. Both still concerning. I'd ask for a second opinion. I do not know, but it came during a massive coughing fit brought on by working out at the gym, so it sounds to me like just broken blood vessels from the intensity of the cough. Quote Link to comment Share on other sites More sharing options...
TammyinTN Posted October 22, 2014 Share Posted October 22, 2014 If it were me...if I couldn't get her seen by a new doctor today, we would be in the ER. Quote Link to comment Share on other sites More sharing options...
Stacia Posted October 22, 2014 Share Posted October 22, 2014 :grouphug: Quote Link to comment Share on other sites More sharing options...
justamouse Posted October 22, 2014 Share Posted October 22, 2014 I'm with the other doctor folks. Can you sign for codeine cough syrup behind the counter? And should she really be working out like that if she's that sick? Quote Link to comment Share on other sites More sharing options...
fraidycat Posted October 22, 2014 Share Posted October 22, 2014 Far infrared sauna. Get her into one, ASAP. Call around to spas/health centers in your area. I have a portable far infrared heat dome ($1,000ish). I would go into debt to replace it if it ever broke. It's the first thing we use if someone has a cold/virus. Oh here's something interesting: http://www.amazon.com/Infrared-Portable-Foldable-Sauna-Detox/dp/B002POAYDW/ref=sr_1_2?ie=UTF8&qid=1414013939&sr=8-2&keywords=portable+far+infrared+sauna Way cheaper than mine, too! Quote Link to comment Share on other sites More sharing options...
Mrs Mungo Posted October 22, 2014 Share Posted October 22, 2014 Did the doctor do a chest x-Ray? If not, I would go to the ER. The codeine really does help ease coughs, if you haven't been given a cough syrup with codeine. Quote Link to comment Share on other sites More sharing options...
City Mouse Posted October 22, 2014 Share Posted October 22, 2014 Do adults not have the whooping sound? How was it treated? No, he did not have the whooping sound that little kids have. All they did was treat the symptoms- with some codine cough syrup and maybe an inhaler of some thing. Quote Link to comment Share on other sites More sharing options...
plansrme Posted October 23, 2014 Author Share Posted October 23, 2014 I'm with the other doctor folks. Can you sign for codeine cough syrup behind the counter? And should she really be working out like that if she's that sick? She was not that bad before practice yesterday. She is not practicing tonight, of course. Far infrared sauna. Get her into one, ASAP. Call around to spas/health centers in your area. I have a portable far infrared heat dome ($1,000ish). I would go into debt to replace it if it ever broke. It's the first thing we use if someone has a cold/virus. Oh here's something interesting: http://www.amazon.com/Infrared-Portable-Foldable-Sauna-Detox/dp/B002POAYDW/ref=sr_1_2?ie=UTF8&qid=1414013939&sr=8-2&keywords=portable+far+infrared+sauna Way cheaper than mine, too! Wow, I've never heard of that. Will look into it. Did the doctor do a chest x-Ray? If not, I would go to the ER. The codeine really does help ease coughs, if you haven't been given a cough syrup with codeine. Chest x-ray was normal. If she is not making progress tomorrow, I will ask about this or find another doctor. I kind of hate to send my 16 yo (well, she will be 17 tomorrow--that is probably worse) into a new doctor, though, and ask for codeine. I'm sure that wouldn't look suspicious. . .. Thanks to everyone who has responded. I replenished my stock of NAC, found some leftover doxycycline (or however that is spelled) from acne treatment (it didn't help the acne) and made her drink some thyme tea, and her cough had calmed down as of about three hours ago. It is definitely less frequent and less alarming in its intensity. She had to go to campus tonight to take a mid-term, so I haven't seen her since, but I am hoping she'll still be better when she gets home. I threatened her with turmeric, which someone on this board recommended eons ago, so possibly I scared it out of her. Whatever it takes! Quote Link to comment Share on other sites More sharing options...
Storygirl Posted October 23, 2014 Share Posted October 23, 2014 When I get sick, I always acquire a terrible hacking cough that lasts for months. Months. I've never coughed up blood, but my coughing can leave me bending over, gasping for breath, and having dry heaves. It's not pretty. What helps: 1) Taking codeine at night so that I can sleep. My doc has prescribed the kind of cough medicine with both codeine and a decongestant. Trouble is, the decongestant is a stimulant and keeps me from sleeping, so I have to specify a prescription for the codeine-only kind. 2) Taking cold medicine during the day, because the cough can be caused by or exacerbated by post-nasal drip. 3) Using an inhaler during coughing attacks 4) Delsym is the best over the counter cough medicine I've found. 5) Decrease stress and get as much sleep as possible. I hope you find something that works for her. I would suggest taking her to the urgent care, and I wouldn't hesitate to ask for the codeine. Quote Link to comment Share on other sites More sharing options...
Ottakee Posted October 23, 2014 Share Posted October 23, 2014 I had a terrible asthma attack. I couldn't stop coughing either. The doctor gave me an inhaled steroid---Symbicort to use twice a day with a spacer Albuterol inhaler to use with spacer 5 day steroid burst Allegra 180mg daily for allergies Flonase nasal spray twice a day---post nasal drip was a big issue even though I wasn't so congested I had a peak flow meter and had to monitor my peak flows (how much air you can move). If you don't have one of those, that would be good to get. If her levels are in the red zone (they give you a chart based on age/gender/height) then it is time for ER or at least a doctor ASAP. Yellow zone that isn't getting better means doctor ASAP. Did they check her O2 level? We have an at home oximeter as well as my daughter has had asthma. Even with all of that, it took over a week for me to really get better and stop coughing. The doctor though had me come back for a re check a week later. I have not been that bad in almost 30 years. I am the type of person that sees the doctor for a yearly physical ever other year or so and never takes meds. The allergies this year totally wiped me out. That was in May and I am still on the inhaler at 1/2 the dose (1 puff instead of 2) and the nasal spray for a few more weeks until we have cold, cold weather hit. if her doctor does not have a good plan and she has any trouble breathing I would certainly see another doctor for a comprehensive treatment plan. Quote Link to comment Share on other sites More sharing options...
MiMi 4under3 Posted October 23, 2014 Share Posted October 23, 2014 You say she's a gymnast. Is the hand chalk/powder irritating her lungs?? That may explain the chronic and severe nature of the cough. Quote Link to comment Share on other sites More sharing options...
LMV Posted October 23, 2014 Share Posted October 23, 2014 Eclectic Thoughts: -If she is really still coughing up blood then I would take her to the ED. That is hemoptysis and can be a medical emergency! -Adding in some leftover antibiotics is usually a bad idea because in most cases they aren't targeted to the bacteria in question so are less likely to be helpful but still but the child at risk of associated C.difficile, allergies/anaphylaxis, and other associated side effects without much, or any, benefit. Additionally if you complete less than a full course then you are also potentially setting yourself up to select for resistant organisms. -From your description this cough sounds bronchospastic. You might want to ask about an Albuterol Inhaler. [i swear I'm not just typing this because I think cough syrup with codeine causes more harm than good in at least 90% of clinical scenarios. I never prescribe it but somehow it seems like I get to deal with all the disasters that result from others prescribing it when I'm working in the ED.] -If you have had Pertussis in your community then it would be reasonable for someone to send a DFA for that. This is one scenario where I do believe Azithromycin is truly the drug of choice and because you really need to start antibiotics in the first week or so to get clinical benefit this is also a scenario where I will prescribe antibiotics for what is likely bronchitis if the DFA is negative. -Someone else's suggestion that chalk dust has led to a hypersensitivity pneumonitis is certainly possible (although hopefully not the answer) and if symptoms persist then further evaluation, PFTs, +/- pulmonology referral would be a good plan. Good Luck! I hope she feels better soon! Quote Link to comment Share on other sites More sharing options...
StephanieZ Posted October 23, 2014 Share Posted October 23, 2014 First off, I would get her in to a new doctor within the next day. If you can't get her in to an allergist/asthma doctor or a wonderful PCP, then take her to the best ER/Urgent care facility in your region. (In our case, we have an urgent care associated with our teaching hospital . . . If I only had a typical doc-in-a-box urgent care, I would go to the ER of the best hospital instead.) Once she is assessed by an excellent doctor, then, if you are still convinced this is a "simple" respiratory virus (maybe pertussis? was she fully vaccinated? Can you get it that young if you were? I know I got it at 40, and that is common as the vaccines wane as we age . . .), then, I'd insist on a narcotic based cough syrup for at least at-bedtime relief from the coughing. The hycocan syrup is what I am generally familiar with, but I think there are some other variations. The key is that it is an opiate or opiod and it really WORKS. It is a million times better than anything else. It is a narcotic. You don't want to take it daily for weeks, especially not round the clock, as you'll get addicted physically and then have withdrawal when you stop. (I learned this after my bout with whooping cough. No real big deal, just a bit of nausea when I suddenly stopped when the cough let up, but when I took it in the future for more than a few days, I was careful to wean off it gradually reducing my dose over a few days instead of stopping abruptly.) You don't want to drive, etc, while taking it. The first doses, you should take small doses to measure sensitivity. Many doctors are resistant to prescribing narcotics for obvious reasons, but I really believe that occasional use of appropriate narcotics is very helpful and very worthwhile. If you can't sleep for weeks due to pain and coughing, then you are not going to get better, may get complications, and you are going to suffer and not function at all. When I had whooping cough, I took it at bedtime and a second dose when the first wore off about 5 hours later (IIRC, it was labeled for 4 hr dosing).) That allowed me to sleep mostly uninterrupted for 8-10 hours. During the day, the cough isn't as bad, I cough some, sip tea, and take steamy showers. Also, the respite from the awful coughing helps avoid the terrible muscular soreness that can develop in your chest, etc, from the coughing. (((Hugs))) and I hope you find a good doctor very fast!! Quote Link to comment Share on other sites More sharing options...
applethyme Posted October 23, 2014 Share Posted October 23, 2014 Leftover antibiotics are never, ever, ever a good idea. If she is coughing up blood then please take her to the ED. Quote Link to comment Share on other sites More sharing options...
StephanieZ Posted October 23, 2014 Share Posted October 23, 2014 Eclectic Thoughts: -If she is really still coughing up blood then I would take her to the ED. That is hemoptysis and can be a medical emergency! -Adding in some leftover antibiotics is usually a bad idea because in most cases they aren't targeted to the bacteria in question so are less likely to be helpful but still but the child at risk of associated C.difficile, allergies/anaphylaxis, and other associated side effects without much, or any, benefit. Additionally if you complete less than a full course then you are also potentially setting yourself up to select for resistant organisms. -From your description this cough sounds bronchospastic. You might want to ask about an Albuterol Inhaler. [i swear I'm not just typing this because I think cough syrup with codeine causes more harm than good in at least 90% of clinical scenarios. I never prescribe it but somehow it seems like I get to deal with all the disasters that result from others prescribing it when I'm working in the ED.] -If you have had Pertussis in your community then it would be reasonable for someone to send a DFA for that. This is one scenario where I do believe Azithromycin is truly the drug of choice and because you really need to start antibiotics in the first week or so to get clinical benefit this is also a scenario where I will prescribe antibiotics for what is likely bronchitis if the DFA is negative. -Someone else's suggestion that chalk dust has led to a hypersensitivity pneumonitis is certainly possible (although hopefully not the answer) and if symptoms persist then further evaluation, PFTs, +/- pulmonology referral would be a good plan. Good Luck! I hope she feels better soon! Thanks for this info. Can you tell me about the complications/negatives you see from narcotic cough syrup use? I know it can depress the respiratory system, and I know it is addictive. I know I am not addiction prone, and I am really cautious about duration and frequency of use for any prescribed narcotic, just to be sure. So, I am not concerned about addiction for myself in these situations. About the respiratory depression, I know that is an inherent effect of the med, and I know there is a theoretical risk of just not breathing and dying, if, for instance, you take too much, are particularly sensitive, have otherwise compromised health . . . Do you see normally-healthy people who are using it moderately as prescribed for appropriate severe coughing having problems? I just can't tell you the relief it has given me when I have had lengthy respiratory viruses/pertussis/whatever they were. The agony of not sleeping for days-weeks in severe pain and coughing constantly, even to gagging/vomiting from coughing . . . is really, truly awful. I'd rate it 8/10 on the pain scale for sure. It's not the first hours or days that get you, but at day 5, day 10, day 12 . . . I am pretty sure I'd have ended up in an ER repeatedly if I hadn't had the hycodan for nighttime use. (I am also asthmatic, adult onset, and I have and do use Albuterol when I am sick, FWIW.) Personally, this is a rare problem for me. I haven't had an upper respiratory thing in about 5 years, but I keep hycodan in the medicine cabinet, hoarding it from one illness to the next, as I never would want to be without it, lol. I'd definitely want to know what risks are involved, so please do share if you can. Thanks! Quote Link to comment Share on other sites More sharing options...
Freckles Posted October 23, 2014 Share Posted October 23, 2014 I've had viral bronchitis for the last three weeks. I'm still coughing. I had nine days of steroids and an inhaler. Clear chest x-ray even though I couldn't breathe. They did blood work to rule out whooping cough and did a D-Dimer to rule out a blood clot. She really needs to rest, gymnastics is not going to help at this point. I'm still exhausted by the end of the day. I hope she feels better soon. Quote Link to comment Share on other sites More sharing options...
Katy Posted October 23, 2014 Share Posted October 23, 2014 Nursing background, not a doctor, but here are my thoughts. Sometimes walking pneumonia (mycoplasma variety) doesn't initially show up in an x-ray, and the symptoms are worse in people with a history of bad allergies or asthma. Coughing up blood is a sign that something is seriously wrong, likely pneumonia, though it's also possible it's a bleeding sinus infection or something else. I'd take her to the emergency room. If she's a gymnast she's probably got a pretty high pain tolerance and tends to be stoic at the doctor. She needs to look as miserable as she is. I'd want a blood test to rule out whooping cough, and if they can't definitively say what is wrong, an antibiotic that will also treat mycoplasma, whatever inhalers work for her, and a prescription for codeine cough syrup. Quote Link to comment Share on other sites More sharing options...
Okra Posted October 23, 2014 Share Posted October 23, 2014 I notice most people saying a second opinion is worth your time. I agree also. A second opinion can be an excellent idea. Quote Link to comment Share on other sites More sharing options...
LMV Posted October 23, 2014 Share Posted October 23, 2014 Thanks for this info. Can you tell me about the complications/negatives you see from narcotic cough syrup use? I know it can depress the respiratory system, and I know it is addictive. -Codeine is a pro-drug so it is converted to morphine. The how fast, and how much, of this is dependent on individual genetic make up and it can be hard to predict. In some cases "ultrametabolizers" have suffered death and respiratory arrest with theoretically safe doses. This is even more of a concern with children (although the OP's daughter is admittedly approaching adult physiology). -The sedation and respiratory depression are more of an issue if you are dealing with someone who already has some degree of impaired pulmonary function and or impaired alveolar gas exchange. I've intubated "overdose" patients who were really probably much more of misusing pain medicine on top of an underlying pneumonia than a true overdose (ie. if they had taken the same thing and not been sick they probably wouldn't have ended up unresponsive). -The potential for addiction, and misuse/abuse of the prescription concerns you mentioned are valid. -There are growing concerns (and literature to back them up) about cardiac toxicity with codeine. -Some of the FM folk in our area love Phenergan with Codeine which adds in the concern for dystonic reactions and additional respiratory depression on top of this. -Then there is the issue that coughing is actually part of the pulmonary toilet process. When we artificially suppress coughing we increase the likelihood of pneumonia, pulmonary effusions, and empyemas. I admit that the last reason is probably the main reason I am unlikely to prescribe cough syrups from the ED. I do use Albuterol if it is bronchospasm [i also stress to parents that getting up with the kid and doing treatments at night may just be their reality for the next few days---I say this from a position of experience because we have two children at home now with asthma and two of our older kids would push their asthma over the edge when they were sick so DH and I have done and will do a lot of this ourselves] and I will use Tessalon for irritant cough in appropriate patients. I also recommend using honey at bedtime (and don't laugh this is actually an evidence based suggestion) for kids who are over a year [below that there is a concern for botulism]. Really it all comes down to risk. I would definitely try honey and an albuterol treatment thirty minutes before bed before considering anything else. Quote Link to comment Share on other sites More sharing options...
plansrme Posted October 23, 2014 Author Share Posted October 23, 2014 Please update us how she is doing. I don't know what worked, but something did. She took her exam tonight, came home in good cheer and is sleeping quietly now. Of course she did not have gym today, so I am hardly declaring her healed, but she no longer sounds anything like she did last night or earlier today. She had another cup of thyme tea, another dose of NAC, the same albuterol and Flovent inhalers she's been using and a second dose of my highly-controversial stash of illicit antibiotics (not expired, and I do have a full course of them). Something in that mix plus, no doubt, not having the exertion of gym, seems to have helped tremendously. This has been an interesting thread for me, and I appreciate everyone's input and points of view. As for pertussis, I would not have thought of that, but I checked, and she just had an updated Dtap in August, so I think she should be in the clear. Also, everything I read said that steam would help pertussis, and steam actually makes her cough worse. Does that mean anything? The only time I heard her cough tonight was while she was in the shower. Now I need to find another dr. for my kids. This one has outgrown the ped anyway, but he was such a jerk to her today that I am not taking any of my kids back to him. He got angry with me because I wouldn't let him give her the HPV vaccine. She is coughing enough to make the building shake (possibly a slight exaggeration), and he is arguing with me over the HPV??? Seriously, we're going to discuss that NOW? And then he made her cry. I could have slapped him. Thanks again, everyone, for the input. Fingers crossed that she is on the mend. Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted October 23, 2014 Share Posted October 23, 2014 If she has reactive airway disease then exercise can exacerbate it. I would talk to a doctor specifically about that. Quote Link to comment Share on other sites More sharing options...
justamouse Posted October 23, 2014 Share Posted October 23, 2014 She was not that bad before practice yesterday. She is not practicing tonight, of course. Wow, I've never heard of that. Will look into it. Chest x-ray was normal. If she is not making progress tomorrow, I will ask about this or find another doctor. I kind of hate to send my 16 yo (well, she will be 17 tomorrow--that is probably worse) into a new doctor, though, and ask for codeine. I'm sure that wouldn't look suspicious. . .. Thanks to everyone who has responded. I replenished my stock of NAC, found some leftover doxycycline (or however that is spelled) from acne treatment (it didn't help the acne) and made her drink some thyme tea, and her cough had calmed down as of about three hours ago. It is definitely less frequent and less alarming in its intensity. She had to go to campus tonight to take a mid-term, so I haven't seen her since, but I am hoping she'll still be better when she gets home. I threatened her with turmeric, which someone on this board recommended eons ago, so possibly I scared it out of her. Whatever it takes! You don't have to ask the Dr for it, you should be able to walk into the drug store and get it. It's behind the counter, and you do have to sign for it. Just like sudafed. Quote Link to comment Share on other sites More sharing options...
Ellie Posted October 23, 2014 Share Posted October 23, 2014 Has she tried a spoonful of honey? Or mixing honey with her tea? I have read before that honey can be as effective as cough syrup. Hope she feels better soon! I was going to suggest this. :-) Even hot water with honey, and maybe a little lemon juice, might help. Quote Link to comment Share on other sites More sharing options...
klmama Posted October 23, 2014 Share Posted October 23, 2014 I'm glad she's doing better. Since you mentioned steam making her cough worse, it makes me think she's having sinus drainage that she isn't aware of. You might try having her use a Netipot to rinse her sinuses. With my dc, a bad cough almost always benefits from that. If her cough continues and lasts, especially with episodes of doubling over while coughing, another possibility is Para pertussis; it's like a mild to moderate case of pertussis, but it's caused by a different organism that isn't protected against by the usual pertussis vaccinations. Sometimes people get that and seem fine while they sleep, but as soon as they wake it starts up again; the illness lasts for several months, although between coughing people can seem just fine. I hope that's not what this is and that it's just sinus drainage! Quote Link to comment Share on other sites More sharing options...
Slartibartfast Posted October 23, 2014 Share Posted October 23, 2014 If I thought my Dr was an Asshat I would be seeing a different one. I am glad she is doing better. Quote Link to comment Share on other sites More sharing options...
StephanieZ Posted October 23, 2014 Share Posted October 23, 2014 -Codeine is a pro-drug so it is converted to morphine. The how fast, and how much, of this is dependent on individual genetic make up and it can be hard to predict. In some cases "ultrametabolizers" have suffered death and respiratory arrest with theoretically safe doses. This is even more of a concern with children (although the OP's daughter is admittedly approaching adult physiology). -The sedation and respiratory depression are more of an issue if you are dealing with someone who already has some degree of impaired pulmonary function and or impaired alveolar gas exchange. I've intubated "overdose" patients who were really probably much more of misusing pain medicine on top of an underlying pneumonia than a true overdose (ie. if they had taken the same thing and not been sick they probably wouldn't have ended up unresponsive). -The potential for addiction, and misuse/abuse of the prescription concerns you mentioned are valid. -There are growing concerns (and literature to back them up) about cardiac toxicity with codeine. -Some of the FM folk in our area love Phenergan with Codeine which adds in the concern for dystonic reactions and additional respiratory depression on top of this. -Then there is the issue that coughing is actually part of the pulmonary toilet process. When we artificially suppress coughing we increase the likelihood of pneumonia, pulmonary effusions, and empyemas. I admit that the last reason is probably the main reason I am unlikely to prescribe cough syrups from the ED. I do use Albuterol if it is bronchospasm [i also stress to parents that getting up with the kid and doing treatments at night may just be their reality for the next few days---I say this from a position of experience because we have two children at home now with asthma and two of our older kids would push their asthma over the edge when they were sick so DH and I have done and will do a lot of this ourselves] and I will use Tessalon for irritant cough in appropriate patients. I also recommend using honey at bedtime (and don't laugh this is actually an evidence based suggestion) for kids who are over a year [below that there is a concern for botulism]. Really it all comes down to risk. I would definitely try honey and an albuterol treatment thirty minutes before bed before considering anything else. Thank you for sharing your knowledge! I really appreciate it! Makes sense, especially in the ED since you can't have the relationship with a patient that a PCP would hopefully have. I know that in my case, my doctors tend to be very long term family relationships -- with multiple family members seeing the same doctor for many years -- so I think that makes it a bit more comfortable for the DR to RX narcotics on occasion, as s/he knows enough about us to know we aren't at substantial risk for abusing drugs and also knows our medical history very well. (My RXes have generally been things like a 10 day RX every couple-to-many years . . .for a couple very different narcotics, so clearly no pattern of abuse, especially since in the case of the anti-anxiety med I've used for dental/etc work, I generally have 90% of the small bottle still on hand, expired, when I ask for a refill a couple years later.) I have known at least one person who was a substance abuser who sought and received narcotics through EDs time and time again, eventually contributing to his death, so I totally respect and support an ED being very hesitant to RX drugs with high abuse potential. I was so frustrated by the EDs who repeatedly gave my relative drugs even though it was incredibly obvious he abused them. They'd keep him for a day or two then send him with a few days meds . . . just enough to get him out of their hair until next time. So frustrating as a (distant) relative, and I am sure the Drs involved were utterly frustrated. (To be clear, I don't fault the Drs! It was a horrible situation for them, as he did have authentic pain and serious health issues . . . and he was also at least a bit crazy and fairly scary . . . and had money and insurance . . . and was scary . . . I just mention the story as a sideways validation of an ER doctor's valid resistance to RXing addictive medications for any purpose if avoidable.) Anyway, thanks again for sharing your expertise! Quote Link to comment Share on other sites More sharing options...
Incognito Posted October 23, 2014 Share Posted October 23, 2014 I know you said she's doing better, but thought I'd throw in that for me, those throat sprays help - something suppressing the reflex to clear the back of my throat, I think. So it's a cheap, easy try if the coughing doesn't go away. Quote Link to comment Share on other sites More sharing options...
NoPlaceLikeHome Posted October 23, 2014 Share Posted October 23, 2014 Do adults not have the whooping sound? How was it treated? Yes!Adults can and do get whooping cough especially now that many are forgoing the vaccines which IMHO is a very bad idea. Please have them rule out whooping cough. Please see a pulmonologist too. Quote Link to comment Share on other sites More sharing options...
NoPlaceLikeHome Posted October 23, 2014 Share Posted October 23, 2014 I don't know what worked, but something did. She took her exam tonight, came home in good cheer and is sleeping quietly now. Of course she did not have gym today, so I am hardly declaring her healed, but she no longer sounds anything like she did last night or earlier today. She had another cup of thyme tea, another dose of NAC, the same albuterol and Flovent inhalers she's been using and a second dose of my highly-controversial stash of illicit antibiotics (not expired, and I do have a full course of them). Something in that mix plus, no doubt, not having the exertion of gym, seems to have helped tremendously. This has been an interesting thread for me, and I appreciate everyone's input and points of view. As for pertussis, I would not have thought of that, but I checked, and she just had an updated Dtap in August, so I think she should be in the clear. Also, everything I read said that steam would help pertussis, and steam actually makes her cough worse. Does that mean anything? The only time I heard her cough tonight was while she was in the shower. Now I need to find another dr. for my kids. This one has outgrown the ped anyway, but he was such a jerk to her today that I am not taking any of my kids back to him. He got angry with me because I wouldn't let him give her the HPV vaccine. She is coughing enough to make the building shake (possibly a slight exaggeration), and he is arguing with me over the HPV??? Seriously, we're going to discuss that NOW? And then he made her cry. I could have slapped him. Thanks again, everyone, for the input. Fingers crossed that she is on the mend. I would not assume that she would be in the clear since she recently had the vaccine.I would definitely ask the doctor since if I am not mistaken not everyone gets 100% immunity from vaccines. For example, I had the hepatitis B vaccine series twice and I am not immune. Is the vaccine still worthwhile? You bet since it allows for herd immunity and usually affords protection from the disease. Quote Link to comment Share on other sites More sharing options...
Katy Posted October 23, 2014 Share Posted October 23, 2014 If she's doing better you likely don't need the codeine cough syrup, but it works very well when you are coughing so much that you can't get any sleep. For future reference, in local pharmacies you might be able to get it over the counter like sudafed, but most larger chains don't sell it without a prescription because of abuse reasons. Plus, with an RX you likely get an insurance discount. Quote Link to comment Share on other sites More sharing options...
swimmermom3 Posted October 23, 2014 Share Posted October 23, 2014 And in my heart of hearts, this is what I think it is. If so, the NAC should help. She just has to stop coughing long enough for her poor little bronchial tubes to heal. I have had bronchitis a few times, but have never coughed up blood. She does need to have that checked by another doctor. Cough drops aren't strong enough to deal with that kind of cough. If the blood isn't a sign of something more serious, she'll need some kind of narcotic cough syrup. As long as she is coughing that hard, the bronchial tubes stay inflamed and you're right, she can't heal. Good luck to you both, but please, please follow up on this. That kind of coughing can be terrifying as an adult if you can't get your breath, but as an adult you are the one making the choices about what you do about it. Your daughter has no choice; it's up to you. Quote Link to comment Share on other sites More sharing options...
swimmermom3 Posted October 23, 2014 Share Posted October 23, 2014 -Codeine is a pro-drug so it is converted to morphine. The how fast, and how much, of this is dependent on individual genetic make up and it can be hard to predict. In some cases "ultrametabolizers" have suffered death and respiratory arrest with theoretically safe doses. This is even more of a concern with children (although the OP's daughter is admittedly approaching adult physiology). -The sedation and respiratory depression are more of an issue if you are dealing with someone who already has some degree of impaired pulmonary function and or impaired alveolar gas exchange. I've intubated "overdose" patients who were really probably much more of misusing pain medicine on top of an underlying pneumonia than a true overdose (ie. if they had taken the same thing and not been sick they probably wouldn't have ended up unresponsive). -The potential for addiction, and misuse/abuse of the prescription concerns you mentioned are valid. -There are growing concerns (and literature to back them up) about cardiac toxicity with codeine. -Some of the FM folk in our area love Phenergan with Codeine which adds in the concern for dystonic reactions and additional respiratory depression on top of this. -Then there is the issue that coughing is actually part of the pulmonary toilet process. When we artificially suppress coughing we increase the likelihood of pneumonia, pulmonary effusions, and empyemas. I admit that the last reason is probably the main reason I am unlikely to prescribe cough syrups from the ED. I do use Albuterol if it is bronchospasm [i also stress to parents that getting up with the kid and doing treatments at night may just be their reality for the next few days---I say this from a position of experience because we have two children at home now with asthma and two of our older kids would push their asthma over the edge when they were sick so DH and I have done and will do a lot of this ourselves] and I will use Tessalon for irritant cough in appropriate patients. I also recommend using honey at bedtime (and don't laugh this is actually an evidence based suggestion) for kids who are over a year [below that there is a concern for botulism]. Really it all comes down to risk. I would definitely try honey and an albuterol treatment thirty minutes before bed before considering anything else. Thank you very much for the explanation. Like Stephanie, I have been up all night with the never-ending cough even with Flovent and Albuterol on board. After a week of no sleep and near-constant coughing, it can be enough to about send you over the edge. I didn't know that codeine is converted to morphine, although that makes sense. I had morphine once after surgery and asked that it be in my chart that I not be given it again. I preferred the pain to the experience. This info will make me rethink accepting the codeine prescription. I was given Tessalon (the little pearls, right?) for the first time this March and it was definitely helpful. Quote Link to comment Share on other sites More sharing options...
Mrs Mungo Posted October 23, 2014 Share Posted October 23, 2014 I was given Tessalon (the little pearls, right?) for the first time this March and it was definitely helpful. Oh yes, that stuff can help a lot too. Quote Link to comment Share on other sites More sharing options...
plansrme Posted October 24, 2014 Author Share Posted October 24, 2014 It is official: my daughter is the toughest person I know. She insisted on going to gym tonight because it is her birthday, and her little gym friends would be disappointed if she did not. I am at the gym at the end of a four-hour practice (I brought cupcakes), and she is still at it. She looks tired but is still at it. Quote Link to comment Share on other sites More sharing options...
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