Dd18 has doc appt. at 3pm - need advice now please

[Kathleen in VA]

Dd18 has been coughing since the week before Thanksgiving. She had the same problem in April/May. I took her to an allergist then and he said she was allergic to a bunch of stuff - dust, pollen, typical allergies. We were to start her on weekly shots but at the time didn't have an extra car for me to drive her to the doctor for them. Because I had no way to get her the shots I just forgot all about them and now she is experiencing the same sort of cough - relentless dry hacking.

 

We have a second car now (dear nephew GAVE us his Ford Taurus!!!) but it will be a week or more before she can start the shots because it takes that long to set it all up.

 

I took her to the GP a little over a week ago. He said she has allergy induced asthma and put her on a Flovent inhaler. He told her to stop taking Clairitin D and to take Zyrtec D instead. We started those the same day. She is still coughing and says she feels worse.

 

I called the GP and set up another appointment for this afternoon but I don't know exactly what to say to him.

 

I need to know what to ask him. Is there a more aggressive approach to licking this cough? Are there remedies, medications she could try that he has not mentioned? Does anyone here have any suggestions for what I should say to him? He is going to ask about the allergy shots (he did last time) so I will be able to say that we've got the ball rolling about that, but I want to know if he can do anything now.

 

Thanks!

[Perry]

Well, first I'd have her tested for pertussis. There are numerous outbreaks around the country. My kids had it, and my son is still coughing after 6 weeks.

[Mosaicmind]

My son does the same thing although I don't know if it's allergy induced asthma because unless he's on his flovent year round he is coughing like that. It took being put on prednisone for him to kick the cough and get better. At the first sign of cough we would have him use his nebulizer every 4hrs and his inhaler when it got better.

 

Does she have a fever? Is the cough keeping her up at night? How does her chest sound? All these will play into what needs to be done.

[MariannNOVA]

Ds10 had something similar here about three weeks ago. He was given his xoponex inhaler, a zithromax pack (5 days of abx), and a pill to stop the cough (benzonotate - 100mg - take as needed no more than 3X a day - he only took one a day for two days and then the cough was gone). The pediatrician had told us the week prior that it was allergy and he should take the zyrtec. We did with no improvement. I took him to the family practice that I use, and the doc was wonderful -- Z-pack, inhaler, cough suppressant -- 36 hours later, he was good as new.

 

FamPrx doc said it was bronchitis -- frankly, I am sick of going to the pediatrician and walking out with nothing more than "there's nothing we can do about this."

[Kathleen in VA]

Well, first I'd have her tested for pertussis. There are numerous outbreaks around the country. My kids had it, and my son is still coughing after 6 weeks.

 

She had pertussis when she was 3 1/2 - it lasted 6 month! It went through our whole church like wildfire. Can she get that again?

 

My son does the same thing although I don't know if it's allergy induced asthma because unless he's on his flovent year round he is coughing like that. It took being put on prednisone for him to kick the cough and get better. At the first sign of cough we would have him use his nebulizer every 4hrs and his inhaler when it got better.

 

Does she have a fever? Is the cough keeping her up at night? How does her chest sound? All these will play into what needs to be done.

 

When you say nebulizer, do you mean with albuterol? Can she do that and the Flovent inhaler at the same time?

 

She does not have a fever. The coughing sometimes keeps her up at night - lately she has slept more and coughed less at night. What am I listening for in her chest?

 

I am going to ask the Dr. about prednisone. Thanks.

[Kathleen in VA]

Ds10 had something similar here about three weeks ago. He was given his xoponex inhaler, a zithromax pack (5 days of abx), and a pill to stop the cough (benzonotate - 100mg - take as needed no more than 3X a day - he only took one a day for two days and then the cough was gone). The pediatrician had told us the week prior that it was allergy and he should take the zyrtec. We did with no improvement. I took him to the family practice that I use, and the doc was wonderful -- Z-pack, inhaler, cough suppressant -- 36 hours later, he was good as new.

 

FamPrx doc said it was bronchitis -- frankly, I am sick of going to the pediatrician and walking out with nothing more than "there's nothing we can do about this."

 

Thanks, Mariann. I copied and pasted these medications into a text document to take to the doctor.

[Perry]

She had pertussis when she was 3 1/2 - it lasted 6 month! It went through our whole church like wildfire. Can she get that again?

 

Yes, definitely. Immunity wears off, generally lasting 4-10 years, whether from the vaccine or natural infection.

 

There is a vaccine available for teens and adults now.

[MariannNOVA]

 

 

When you say nebulizer, do you mean with albuterol? Can she do that and the Flovent inhaler at the same time?

 

We typically only do one or the other and we gave up the nebulizer some years ago.

She does not have a fever. The coughing sometimes keeps her up at night - lately she has slept more and coughed less at night. What am I listening for in her chest?

 

I am going to ask the Dr. about prednisone. Thanks.

 

Ds did not have a fever either - that's why the peds office wouldn't do anything. When I listen to ds' chest (and I am usually listening for a wheeze) I put my ear to his back, have him stand straight and breathe in and out through his mouth - I listen for any sound other than a 'clean' rush of air.........it's hard to describe -- a rusty spring being pressed down on, a creaky sound, a raspy sound. Ask your doc to let you listen today so you will know what you are listening for.

 

 

[Beach Mom]

You haven't by chance put up a real Christmas tree recently have you? This can be a trigger for allergy induced asthma. It took us several years to figure out that DS was allergic to pine trees.

 

In our experience allergy induced asthma can be tough to get under control because there are so many potential triggers. The good news is you can grow out of it as late as your mid 20s.

 

Good luck finding a solution, that coughing is tough to deal with.:grouphug:

[StephanieZ]

Consider. . .

 

+ Pertussis (whooping cough). It is surprisingly common.

 

+ Reflux - induced asthma/cough. It is often missed. I had this, and did not have typical heartburn symptoms. Try going on pepcid once a day for a week & see if it makes a difference. If it does help, then discuss further with the doctor for long term plan.

 

+ I love narcotic (hydrocodone or codeine) based cough syrup for use at night when I have a bad cough b/c it is the only thing that actually works, but it is addictive physically, so you have to be careful to taper it if you are on it for more than a week or so. . . and avoid it if you have a history of (or concern about) addiction issues. I have never had a doctor OFFER these, lol, but I've had them prescribed many times over the years upon request. The doctors KNOW they're the only thing that actually works, but I think they are reluctant to introduce narcotics since they are not absolutely necessary. But, if the cough keeps you from sleeping a decent night's sleep for weeks on end, it becomes truly essential to have some relief at night. I only use it at night, and only when the cough is very bad & keeping me from sleeping. . . Just be smart about it, taper dose over 3-4 days when the cough ends to avoid withdrawl (yuck, nausea) symptoms. FWIW, these meds are very cheap and generic, so cost should not be an issue.

[Kathleen in VA]

You haven't by chance put up a real Christmas tree recently have you? This can be a trigger for allergy induced asthma. It took us several years to figure out that DS was allergic to pine trees.

 

In our experience allergy induced asthma can be tough to get under control because there are so many potential triggers. The good news is you can grow out of it as late as your mid 20s.

 

Good luck finding a solution, that coughing is tough to deal with.:grouphug:

 

No tree. She did paint her room though - I wonder if the fumes from the paint are playing into this at all.

 

Consider. . .

 

+ Pertussis (whooping cough). It is surprisingly common.

 

+ Reflux - induced asthma/cough. It is often missed. I had this, and did not have typical heartburn symptoms. Try going on pepcid once a day for a week & see if it makes a difference. If it does help, then discuss further with the doctor for long term plan.

 

+ I love narcotic (hydrocodone or codeine) based cough syrup for use at night when I have a bad cough b/c it is the only thing that actually works, but it is addictive physically, so you have to be careful to taper it if you are on it for more than a week or so. . . and avoid it if you have a history of (or concern about) addiction issues. I have never had a doctor OFFER these, lol, but I've had them prescribed many times over the years upon request. The doctors KNOW they're the only thing that actually works, but I think they are reluctant to introduce narcotics since they are not absolutely necessary. But, if the cough keeps you from sleeping a decent night's sleep for weeks on end, it becomes truly essential to have some relief at night. I only use it at night, and only when the cough is very bad & keeping me from sleeping. . . Just be smart about it, taper dose over 3-4 days when the cough ends to avoid withdrawl (yuck, nausea) symptoms. FWIW, these meds are very cheap and generic, so cost should not be an issue.

 

She has had pertussis - I will ask about that since Perry says she could get it again. It's just that this cough is absolutely nothing like the cough she had with pertussis. She's not vomiting with this cough. With pertussis, she was fine all through the day and then at night she got to coughing so violently she would throw up - it lasted the whole night through. This is less violent - just a constant day and night dry hack.

 

I am going to ask for the narcotics! This girl needs some sleep!!!

[Tess in the Burbs]

I get that cough every winter and it takes weeks to go away for me every time. Using the flovent should help but it's going to be a week or even two before it truly feels like it's getting better. :grouphug:

 

I hate that cough, sorry she's dealing with this.

[sheryl]

Hi Kathleen, I have a feeling this will be too late, but my initial response was perhaps a form of asthma.

 

If I understand correctly; you had an allergist give her a "full" allergy test? Either scratch test or blood test?

 

The D is for decongestant. Is her nose runny? Of course you know, as you're a Mom with older teens, that a runny nose will produce a cough. Also, when a cough "gets stuck" or becomes habitual (a muscle or something gets stuck like a broken record and repeats again and again) then a different med may be in order to "relax" that muscle (or whatever it is) and break the cycle.

 

If the allergy test was not full or complete, I might ask for that. Also, have them just look around in there. If they would need to do a scope or endoscope that may be prudent.

 

These are all guesses based on my allergies that lasted for years and in 2 states (I don't have them now). Also, from what is suggested for my dd...although mostly for different reasons. The only similarity may be acide reflux that may cause coughing.

 

Sorry I couldn't really help. Hope all goes well...update as you can.

 

:grouphug: Sheryl <><

[littlebug42]

Flovent is not an immediate result type of medication. It can take a couple of weeks for it to actually work. My daughter is on it year round now and it prevents these coughing episodes with her.

 

When the coughing has flared though (pre-Flovent), she would usually require a breathing treatment (nebulizer) at the docs office and then a 7-10 day course of prednisone with a xoponex inhaler to calm it down. BTW- my daughter refuses to take Zyrtec because she says it makes her feel bad. She does better with the Claritin.

[mcconnellboys]

I've been put on steroid inhalers or dose packs in past for a cough that would not end....

[Amy in KS]

Yes, you can do flovent and albuterol at the same time. Flovent is a preventative and Albuterol is a rescue inhaler. When my son and I are at our worst, we have to do both at the same time (mostly at night). Also, I would ask for a round of prednisone (steroid) to help with inflammation if you have been doing albuterol for several days without relief. You might also have the doctor swab for strep or consider whether it could be pneumonia. Both could be keeping the adenoids swollen and cause coughing.

 

Claritin D works far better than zyrtec for us, but we are the exception. If Zyrtec doesn't work, they will try numerous others. It's kind of a guessing game. I would stay away from Allegra with a teen if possible because it has a fairly common side effect of depression.

 

You might inquire about the nasal cortisteroids as an allergy preventative (flovent, etc). They are used in conjunction with the antihistamines and work very well. If all else fails, they might go to Advair.

[jplain]

Ditto the suggestion to request testing for pertussis.

 

Is she taking vitamin D? Most of us don't get enough vitamin D from the sun, unless we spend a lot of time in mid-day sun without sunscreen, and it isn't something you can get enough of from food.

 

My dad's chronic dry cough of over a decade went away completely after he started supplementing vitamin D. He'd previously been diagnosed with allergies and/or reactive airways. He also reduced simple carbs (sugar, pasta, bread, rice, potatoes, etc.), and that may have helped with any chronic inflammation, but he believe the vitamin D made the biggest difference.

 

If that sounds like something she should try, you'd probably want to go wtih 2-5K IU per day, taken in the form of an oil-based gelatin cap. No chalky white pills, as they're not absorbed effectively. Ideally vitamin D is taken with a meal that contains fat.

Edited December 13, 2010 by jplain

[Amy in KS]

Oh, and you might ask him to rule out a sinus infection.

[justasque]

Clean like crazy, frequently. Avoid any mold or mildew, or anywhere that is or has been damp or flooded. Vacuum everywhere. Wash sheets on hot. Remove feather pillows and replace with synthetic. Vacuum mattress. Declutter her room; remove anything that catches or holds dust. Clean or better yet remove carpets. Think about anywhere she goes regularly - is she feeling sicker after going to a certain place?

 

Make her rest.

[katilac]

Eh, I wouldn't mess with a GP at this point, he is not likely to tell you anything different. If it's bad enough for her to see someone before beginning the shots, take her to an ENT, and he'll be able to check for sinus and lots of other things. They are very familiar with most of your possibilities: allergy, sinus, bronchitis, etc. etc. They can also advise you better on which meds to mix and match for good results.

[LizzyBee]

Is there a more aggressive approach to licking this cough? Are there remedies, medications she could try that he has not mentioned? Does anyone here have any suggestions for what I should say to him? He is going to ask about the allergy shots (he did last time) so I will be able to say that we've got the ball rolling about that, but I want to know if he can do anything now.

 

Thanks!

 

Flovent is a controller, right? Does she have a rescue inhaler (albuterol, ventilin)? If not, she needs one.

 

And if she keeps getting worse instead of better while on asthma meds, she needs to have a course of prednisone.

[Kathleen in VA]

We're back! He changed the inhaler to Advair and said to go ahead and do the nebulizer with the albuterol. He also prescribed a heavy-duty cough suppressant. He did not put her on prednisone which kind of irked me, but I'm going to see how the albuterol works and maybe that will be all she needs.

 

I was going to skip the GP altogether and first called a pulmonary specialist (the same doctor who took care of my dh when he had double pneumonia), but the first appointment I could get was for December 27th! I went ahead and made the appt. just in case we ended up needing it so if these meds don't work, I think I'll go ahead and see the pulmonary dr.

 

Thanks for all the advice - I appreciate all your thoughts on this.

[mcconnellboys]

The albuterol always worked great for me. Hope it does for her, too....

[Unicorn.]

We're back! He changed the inhaler to Advair and said to go ahead and do the nebulizer with the albuterol. He also prescribed a heavy-duty cough suppressant. He did not put her on prednisone which kind of irked me, but I'm going to see how the albuterol works and maybe that will be all she needs.

 

I was going to skip the GP altogether and first called a pulmonary specialist (the same doctor who took care of my dh when he had double pneumonia), but the first appointment I could get was for December 27th! I went ahead and made the appt. just in case we ended up needing it so if these meds don't work, I think I'll go ahead and see the pulmonary dr.

 

Thanks for all the advice - I appreciate all your thoughts on this.

 

He didn't give her prednisone, because the advair has a steroid in it. It would be like double dosing. The advair was the only thing that worked w/ my bronchitis- but it did make me itch! If it were me, I would keep the appt w/ the pulmonologist, just to have her checked for asthma. It can't hurt. I hope she feels better soon!

[Hannah C.]

About pertussis - I had an awful case of it when I was four years old (thankfully I don't remember it.) I got a dry, hacking, lingering cough when I was 15, and my mother is fairly certain that was a second round of pertussis, though it was never confirmed by a doctor. So testing for pertussis may be worth it. Does the coughing seem to be connected to any stimulus or place, or is it just fairly constant? Hopefully the new meds work and you won't need to answer any of these questions!

[MariannNOVA]

We're back! He changed the inhaler to Advair and said to go ahead and do the nebulizer with the albuterol. He also prescribed a heavy-duty cough suppressant. He did not put her on prednisone which kind of irked me, but I'm going to see how the albuterol works and maybe that will be all she needs.

 

I was going to skip the GP altogether and first called a pulmonary specialist (the same doctor who took care of my dh when he had double pneumonia), but the first appointment I could get was for December 27th! I went ahead and made the appt. just in case we ended up needing it so if these meds don't work, I think I'll go ahead and see the pulmonary dr.

 

Thanks for all the advice - I appreciate all your thoughts on this.

 

Both ds and I have had success with what I have highlighted in red -- praying that it does the trick for your dd. I think you were wise to make the appt for the 27th just in case - you can always cancel.:grouphug:

[Mosaicmind]

The advair does have steroid in it so no need for prednisone. But, we do use flovent, albuterol inhaler and nebulizer when his cough is really bad. YES all three. It is all we can do to keep him from getting pneumonia. I don't want to go to advair only because we did that with older ds and because the steroid is an immunosuppressant then he got pneumonia alot while on it because he was so suseptible. Advair even says that on it's warning label.

[Kathleen in VA]

The advair does have steroid in it so no need for prednisone. But, we do use flovent, albuterol inhaler and nebulizer when his cough is really bad. YES all three. It is all we can do to keep him from getting pneumonia. I don't want to go to advair only because we did that with older ds and because the steroid is an immunosuppressant then he got pneumonia alot while on it because he was so suseptible. Advair even says that on it's warning label.

 

Thanks for the heads up about advair being a immunosuppressant - I wouldn't have even read the warning label.

 

Both ds and I have had success with what I have highlighted in red -- praying that it does the trick for your dd. I think you were wise to make the appt for the 27th just in case - you can always cancel.:grouphug:

 

 

This is very encouraging - thanks.:)

 

He didn't give her prednisone, because the advair has a steroid in it. It would be like double dosing. The advair was the only thing that worked w/ my bronchitis- but it did make me itch! If it were me, I would keep the appt w/ the pulmonologist, just to have her checked for asthma. It can't hurt. I hope she feels better soon!

 

See, I didn't know advair was a steroid - shows you how much I know! So that makes me feel better too.

 

About pertussis - I had an awful case of it when I was four years old (thankfully I don't remember it.) I got a dry, hacking, lingering cough when I was 15, and my mother is fairly certain that was a second round of pertussis, though it was never confirmed by a doctor. So testing for pertussis may be worth it. Does the coughing seem to be connected to any stimulus or place, or is it just fairly constant? Hopefully the new meds work and you won't need to answer any of these questions!

 

Yes, dd18 had a very bad case of it when she was 3 1/2 going on 4. I forgot to ask about that when we were there. He did ask if she was bringing anything up or vomiting and he asked if she coughed all day fairly consistently or just at night. I think he might have been thinking it could be pertussis but dismissed it when she told him it was fairly consistent throught the day. If she's still coughing on the 27th, I will definitely ask the pulmonologist about it.

 

Thanks for all the replies. I'm learning a lot.

[Hannah C.]

One more thing -- the last time I had an awful cough, I was given steroid shots. Somehow, I missed the memo about how steroids can cause menstrual cycle changes, and was very, very freaked out when my cycle changed dramatically after being incredibly constant for years! So be aware that this is a possible side effect. I wouldn't want your dd to be surprised like I was or experience the unneeded stress and doctor's appointments!

[Kathleen in VA]

One more thing -- the last time I had an awful cough, I was given steroid shots. Somehow, I missed the memo about how steroids can cause menstrual cycle changes, and was very, very freaked out when my cycle changed dramatically after being incredibly constant for years! So be aware that this is a possible side effect. I wouldn't want your dd to be surprised like I was or experience the unneeded stress and doctor's appointments!

 

Thanks for the heads up, Hannah. Glad to know that now, just in case.

[Mosaicmind]

I hope she gets some sleep tonite and you too. Even though ds is 16, when he is up coughing like that I don't sleep either. One thing I would do when I had a really bad cough and could not sleep was to have hot tea with rum or whiskey and lemon in it. Yes, it helped and I even had this while pregnant with one of my dc because the dr ordered me to. I have been half-tempted to try that with ds when his cough was so bad.