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Asthma ?!? Really???


LisaKinVA
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So, two of my kids have been to an allergist, and he's saying they have asthma.

 

Neither of these kids have ever had an asthmatic episode...EVER (oldest is 13). Oldest started having some wheezing in the pool (which is why our ped referred to the allergist), but she didn't suspect asthma -- thought it was vocal chord dysfunction, or the pool chemicals triggering something. They say he's so "fit" it hasn't been a problem, but now they want him to take preventive medications, even though he has NO SYMPTOMS. He's a very active kid...UGH.

 

I'm having a hard time being rational about this, because it seems so very irrational. I don't want my "very healthy, fit kid" to take medication every day unless it's truly warranted.

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Asthma doesn't always sound like asthma. Meaning there are some typical and common symptoms, symptoms of attack, and uncommon symptoms. It could be that your allergist is hearing something that you wouldn't normally think of as asthma and that's where the dx is coming from. If your kid had some wheezing in the pool and your ped suspected pool chemical could trigger it, and then your allergist said "asthma", I'd start considering that the kid has asthma. Most kids who has asthma, have it from allergies. Just something to think about.

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My son has never had a traditional asthma attack and is very active. He has definite permanent scarring in his lungs. Asthma (which is sortof a general name for lung disease) does not always present the way you think it should. I would start the preventative and schedule an appointment with a pulmonologist.

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Asthma doesn't always sound like asthma. Meaning there are some typical and common symptoms, symptoms of attack, and uncommon symptoms. It could be that your allergist is hearing something that you wouldn't normally think of as asthma and that's where the dx is coming from. If your kid had some wheezing in the pool and your ped suspected pool chemical could trigger it, and then your allergist said "asthma", I'd start considering that the kid has asthma. Most kids who has asthma, have it from allergies. Just something to think about.

 

But, they said he doesn't have allergies...If they said a chemically-induced asthma, I could accept that. But, they say he doesn't. How did he get to the ripe old age of 13 and never have this come up? He's had pneumonia twice in his life...and a few colds...he even swam for 2 years competitively without any symptoms of anything. I'm just :willy_nilly:

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A family member was kind of a skeptic about a few of us having asthma we started charting oldest's morning peak flows. Although he had respectable capacity before, his peak flows improved about 30%. (Mine more than doubled.)

 

I ONLY have wheezing episodes around cats. Oldest only ever coughs (never wheezes). Two of my other kids are traditional asthmatics. We are all dealing with chronic lung inflammation (asthma), and we all need maintenance meds to keep that inflammation down....and occasionally we need albuterol to help us out of a crisis.

 

Get a second opinion if you'd like, but start the meds.

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He's had pneumonia twice in his life...

 

This is actually the sort of thing that is a possible indicator of uncontrolled asthma. Most kids do not get pneumonia. Yes, get a second opinion, definitely see a pulmonologist. But, adjust your thinking on what it means to have asthma. All of the commercials for my son's medications have old people in them. Obviously, my son is not elderly. That doesn't mean he does not need the meds. The media had put something in your mind about asthma that is not true.

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Ds15 has asthma that does not typically present. He's only been informally diagnosed in the last 2 years. He's also quite fit, does and does not cough or wheeze. He is more prone to lung infections than the others. Yes, the meds do help him quite a bit. Dh also has asthma that didn't give him any trouble for many years because he's so active. As he's aged, it's more problematic.

 

Hang in there. A second opinion may be a good idea. Or try the meds for a bit and see if he reports any improvement.

 

One of my others was diagnosed with asthma. The meds were not helpful. Turns out he had extremely large adenoids. Surgery was his answer.

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This is actually the sort of thing that is a possible indicator of uncontrolled asthma. Most kids do not get pneumonia. Yes, get a second opinion, definitely see a pulmonologist. But, adjust your thinking on what it means to have asthma. All of the commercials for my son's medications have old people in them. Obviously, my son is not elderly. That doesn't mean he does not need the meds. The media had put something in your mind about asthma that is not true.

 

 

Well, then all my kids need to see the allergist, because every one of them had the same pneumonia (caught it from each other)...and I've had it more times than I can count. I had it twice, and bronchitis in between, before I was 2 years old...we moved to CA and I never had it again...until we moved to GA/FL/VA/AR...

 

Since this is all written down, I know I'm probably coming across as snarky...I'm not trying to be snarky -- just having a very difficult time coming to terms with this idea. I've got an appointment for him with the pediatrician in 3 hours. He was just seen by his ped. last week...they didn't do any real lung function testing (stress), and essentially just "heard" something in his breathing that his pediatrician has missed for 13 years. My son is confused, too. I'm not confusing asthma (in kids) with old people. We have friends who have kids with asthma... but my son is just "so fit" that he doesn't have symptoms...but he has asthma that needs regular medication? This is going to take awhile...

 

ETA: If this were my younger son, whose had pneumonia 2x, and been sent to the ER 3x, due to fever-induced stridor/croup, and admitted once...I'd probably say, "well, definitely possible." But, the ER/hospital/pediatrician have all said it's due to his smaller-than-normal trachea, which swells (he moves plenty of air, it just sounds HORRIBLE, and I can't tell if it's bad or his normal reaction, so we act like it's bad, I give him the nebulizer, etc. and take him in if we can't get it to calm down. Each time, he's been fine O2 wise-- just sounded horrible).

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I am sensitive to some pool chemicals and chlorine smell gives me a migraine. I had what doctors call "childhood" asthma which cleared up and then adult asthma. There are young children on inhalers and it takes time to get the right medicine and the right dosage. I used to fly with my inhalers, never had problems at customs. Get a second opinion and get whatever it is under control. It is not worth going unmedicated and risking ER visits if it is asthma.

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My oldest wasn't diagnosed with asthma until she was almost 13 years old. I was skeptical at first, but the meds made a huge difference in areas we weren't even aware she was struggling.

 

Did they perform a pulmonary function test?

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Ds15 has asthma that does not typically present. He's only been informally diagnosed in the last 2 years. He's also quite fit, does and does not cough or wheeze. He is more prone to lung infections than the others. Yes, the meds do help him quite a bit. Dh also has asthma that didn't give him any trouble for many years because he's so active. As he's aged, it's more problematic.

 

Hang in there. A second opinion may be a good idea. Or try the meds for a bit and see if he reports any improvement.

 

One of my others was diagnosed with asthma. The meds were not helpful. Turns out he had extremely large adenoids. Surgery was his answer.

 

 

Thank you for this... we're taking him to the pediatrician, and will go from there. Large adenoids are definitely present in two of my kids ;) -- I just don't want some permanent dx that is potentially wrong to follow him around and prevent him from doing things he enjoys/wants to do for the rest of his life. I don't want to give a kid who is really fit and healthy medications all the time without cause. I'm not against giving medications when needed, will treat a high fever, etc. but over-use of medications is something I try to prevent.

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My oldest wasn't diagnosed with asthma until she was almost 13 years old. I was skeptical at first, but the meds made a huge difference in areas we weren't even aware she was struggling.

 

Did they perform a pulmonary function test?

 

Yes...I believe he did...could you tell me what areas improved for your 13yo? My son said he didn't notice any difference post-meds.

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Well, then all my kids need to see the allergist, because every one of them had the same pneumonia (caught it from each other)...and I've had it more times than I can count. I had it twice, and bronchitis in between, before I was 2 years old...we moved to CA and I never had it again...until we moved to GA/FL/VA/AR...

 

I would not mess with an allergist. I would take everyone to a pulmonologist. My son's pulmonologist did lung function tests on my other two children when he first started seeing ds. This would absolutely be a reasonable action. Lung function tests are the reason you need to be referred to a pulmonologist.

 

Since this is all written down, I know I'm probably coming across as snarky...I'm not trying to be snarky -- just having a very difficult time coming to terms with this idea. I've got an appointment for him with the pediatrician in 3 hours. He was just seen by his ped. last week...they didn't do any real lung function testing (stress), and essentially just "heard" something in his breathing that his pediatrician has missed for 13 years.

 

That "something" could be the result of cumulative permanent damage over time due to uncontrolled asthma. That is exactly how my son was first diagnosed with a lung issue. He has bronchiectasis, which is something a good (experienced) doctor can hear, it is the result of damage over time.

 

My son is confused, too. I'm not confusing asthma (in kids) with old people. We have friends who have kids with asthma...

 

Sorry, I am clearly not communicating clearly. I was saying my son (who is 12) takes a medication. The medication's commercials feature elderly people. That might give people an impression about the types of people who take that medication. Your experiences with commercials, friends whose kids have asthma, etc have given you an impression of what asthma *should* look like. It does not always look like that. That is what I am saying. Does that make sense?

 

but my son is just "so fit" that he doesn't have symptoms...but he has asthma that needs regular medication? This is going to take awhile...

 

I understand. BTDT. My ds is very healthy *except* for the times he is sick enough to wind up in the hospital. And he has permanent scarring in his lungs because his lung disease was uncontrolled (and outwardly symptomless) for so long.

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Yes...I believe he did...could you tell me what areas improved for your 13yo? My son said he didn't notice any difference post-meds.

 

The biggest improvement was her coughing. I didn't realize that was a big sign, but with meds we rarely hear it anymore.

 

She also realized (only after using meds) that she was getting too winded and tight in the chest while running or doing other strenuous exercise. She's had the same experience playing her french horn. She had no idea she could do better. It had all been normal for her and she didn't know it could be different.

 

She's eating and sleeping better, and has more energy now. She was getting cranky mid-week once she started public school and I thought it was due to not being able to sleep in, but after starting her asthma meds she hops us before her alarm even goes off and she's hardly ever cranky anymore mid-week.

 

She was on meds for about a month before she noticed things really getting better. Her coughing stopped almost immediately but the other things took a bit for her to notice.

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Medical conditions do not always present as advertised on tv. :/

 

I and some of my kids can have very bad asthma control without any wheezing or acting like they are struggling for air.

 

Not having good air flow can be the cause of any or all of these at various times:

 

Being tired

Slow growth

Slow thinking and memory lapses (much like when you are extremely tired)

Coughing without having a cold

Chest pressure

Occasional nausea for no reason

 

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Thank you Mrs. Mungo... yes I do have a general idea of what "asthma" should look like, and I'm sure that's part of it. FWIW, this son has never been sick enough (with anything) to wind up in the hospital. I'm meeting with his pediatrician this afternoon and will bring up the pulmonologist referral. I don't want to *not* do something that is warranted, but I've been told things before that were very inaccurate when doctors didn't actually LISTEN to me, and just went with the SOP (in one case, I wound up with double pneumonia while 7mos. pregnant, after being told to "tough it out."). I didn't take him, my husband did...otherwise I'm sure I would have been asking all sorts of questions (which is why I'm handling the follow-ups).

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Medical conditions do not always present as advertised on tv. :/

 

I and some of my kids can have very bad asthma control without any wheezing or acting like they are struggling for air.

 

Not having good air flow can be the cause of any or all of these at various times:

 

Being tired

Slow growth

Slow thinking and memory lapses (much like when you are extremely tired)

Coughing without having a cold

Chest pressure

Occasional nausea for no reason

 

He has trouble getting out of bed in the morning (typical 13yo)...but not tired during the day.

Growth has been steady (on his chart)

Not sure about the slow thinking... doesn't seem that way.

No coughing

No chest pressure

No nausea.

 

But, I'll bring this stuff up :D

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Thank you Mrs. Mungo... yes I do have a general idea of what "asthma" should look like, and I'm sure that's part of it. FWIW, this son has never been sick enough (with anything) to wind up in the hospital. I'm meeting with his pediatrician this afternoon and will bring up the pulmonologist referral. I don't want to *not* do something that is warranted, but I've been told things before that were very inaccurate when doctors didn't actually LISTEN to me, and just went with the SOP (in one case, I wound up with double pneumonia while 7mos. pregnant, after being told to "tough it out."). I didn't take him, my husband did...otherwise I'm sure I would have been asking all sorts of questions (which is why I'm handling the follow-ups).

 

I understand. I really do. :) In no way am I suggesting that you should simply accept this diagnosis and say, "well, this is our life now." I am suggesting you see a pulmonologist, a lung doctor who will have more resources and tests available than the pediatrician or allergist (we see all three).

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My kid has asthma. It manifests itself through cough only when he has a cold. I always thought asthma looked like it often does on TV, a child choking without air, but in doesn't.

Did you test for dust mites? Apparently the majority of people with asthma have dust mite allergies.

I would definitely get a second opinion.

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UPDATE -- DS did NOT have a pulmonary function test (which is what we requested), apparently, they only do a simple breathing test...and then refer (however, when we brought the issue up initially with our ped. last week, she expressly ORDERED a pulmonary function test to look for (a) vocal chord dysfunction or (B) exercise-induced asthma (which she didn't think it was, based upon his history). SO...knowing that, I'm pretty certain she will refer us directly to a pulmonologist today, and stop pussy-footing around. I know that simple breathing test is wrong about 30% of the time...which makes me think the allergist is just trying to be "safe." DS also had a full battery of skin tests -- all were negative -- no allergies.

 

I know I'm really wigging out, because, to me, this is a HUGE issue for me to miss. I pay attention to my kids...I do...and if I missed a kid with asthma all his life? (that's what the allergist said, he's had it his *whole* life), what else have I missed? If this kid has asthma...ALL of my kids need to be seen (and probably me, too). I'm the one with all of long, long history of lung problems...and no one has ever suggested to me that I might have asthma (I was a very active kid...swimming, running, football, baseball...too). I have to leave in about 30 minutes. Thank you all, though...

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My kid has asthma. It manifests itself through cough only when he has a cold. I always thought asthma looked like it often does on TV, a child choking without air, but in doesn't.

Did you test for dust mites? Apparently the majority of people with asthma have dust mite allergies.

I would definitely get a second opinion.

 

Question: How do you differentiate between a "normal" cough kids get with a cold, and an asthma cough? I know how to tell a bronchitis/pneumonia cough from a regular cough...

 

No. He is not allergic to dust mites.

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I would be uncertain too in that situation. I have two asthmatics now. My other son just presented with cough variant asthma after a round of pneumonia this fall. However, you got an asthma diagnosis without proper testing for asthma. I'm glad you're going to see pulmonology.

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UPDATE -- DS did NOT have a pulmonary function test (which is what we requested), apparently, they only do a simple breathing test...and then refer (however, when we brought the issue up initially with our ped. last week, she expressly ORDERED a pulmonary function test to look for (a) vocal chord dysfunction or (B) exercise-induced asthma (which she didn't think it was, based upon his history). SO...knowing that, I'm pretty certain she will refer us directly to a pulmonologist today, and stop pussy-footing around. I know that simple breathing test is wrong about 30% of the time...which makes me think the allergist is just trying to be "safe." DS also had a full battery of skin tests -- all were negative -- no allergies.

 

I have never seen an allergist (and we have seen a few in different states) who had the ability to do PFTs in his office. You generally need to see a pulmonologist for that. PFTs require a roomful of equipment. Did the allergist do a peak flow or something? That doesn't check for obstructions or anything like that.

 

I know I'm really wigging out, because, to me, this is a HUGE issue for me to miss. I pay attention to my kids...I do...and if I missed a kid with asthma all his life? (that's what the allergist said, he's had it his *whole* life), what else have I missed? If this kid has asthma...ALL of my kids need to be seen (and probably me, too). I'm the one with all of long, long history of lung problems...and no one has ever suggested to me that I might have asthma (I was a very active kid...swimming, running, football, baseball...too). I have to leave in about 30 minutes. Thank you all, though...

 

I agree that everyone should probably be seen. Hopefully, the allergist is wrong. But, an actual lung specialist will be able to give you so much more information! :)

 

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I have never seen an allergist (and we have seen a few in different states) who had the ability to do PFTs in his office. You generally need to see a pulmonologist for that. PFTs require a roomful of equipment. Did the allergist do a peak flow or something? That doesn't check for obstructions or anything like that.

 

 

 

I agree that everyone should probably be seen. Hopefully, the allergist is wrong. But, an actual lung specialist will be able to give you so much more information! :)

 

Yes...it was a peak-flow test. I'll talk to the ped. about the pulmonologist. Just kinda chaps me, that we called and asked for a specific test, and they didn't bother to mention that they couldn't do that, or wouldn't refer for it for at least a month. UGH. I feel stooopid.

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So, two of my kids have been to an allergist, and he's saying they have asthma.

 

Neither of these kids have ever had an asthmatic episode...EVER (oldest is 13). Oldest started having some wheezing in the pool (which is why our ped referred to the allergist), but she didn't suspect asthma -- thought it was vocal chord dysfunction, or the pool chemicals triggering something. They say he's so "fit" it hasn't been a problem, but now they want him to take preventive medications, even though he has NO SYMPTOMS. He's a very active kid...UGH.

 

I'm having a hard time being rational about this, because it seems so very irrational. I don't want my "very healthy, fit kid" to take medication every day unless it's truly warranted.

 

Wow. They want to put him on medication when he's never had an episode? Why was he at the allergist in the first place? That wheezing in the pool? Lots of people react badly to chlorine.

 

I have had many allergic reactions to things like perfume and this label has been bandied about. It got better recently. I actually think it was related to a roof leak we had for awhile, because it began resolving slowly after it was repaired.

 

I don't know what happens if they tell you to do it and you don't. I've never had that happen. You can refuse anything for yourself, but with your kids, it's a different matter.

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My son has asthma, and has never wheezed, or presented in a "typical" asthma attack type episode. He has allergies, but not to dust mites. He sometimes has the asthma cough, but not always. Typically, his asthma "symptoms" are anxiety, irritability, progressing to a terrible feeling of doom, really. He sometimes feels "mad" without knowing why. These episodes are well documented as asthma re: peak flow readings and response to inhalers. Recognizing his breathing issues is an art, a difficult one. We've had 3 opinions on this, so we are quite sure, plus the input of various ER docs when DS has been hospitalized for pneumonia. All of this to say that I have had to seriously adjust my ideas of what asthma symptoms look like. I could have posted the same thread a few years ago - asthma??? Really???

 

Glad you are already on the second opinion route. Get as much info as you can, and definitely get some pulmonary testing. It will give you more answers.

 

For us, preventative meds clearly make a difference - we do daily peak flow readings, and can see a clear difference. There are behavioral results, better energy, better sleep, less night waking, and a ton of other things I see that make a difference. I worry about permanent scarring impacting him later, so whatever we can do to prevent that is good. I think I worry more about that - that in not adequately treating him his life will be limited later - than I do about any limitation treating his asthma now would place on him. Does that make sense? Treating him now opens his life up. I don't take the meds lightly either, but when it comes to breathing - well, we have to breathe. In your shoes, I'd want another opinion, and pulmonary testing, of course. But once you've got that, if he needs meds - at least you'll be able to make choices with all the info.

 

FWIW, chlorine suddenly began setting off DS's asthma attacks last year. This after years of swimming. Bizarre. Allergist says it's not uncommon, and it may or may not be the chlorine - could be any pool chemical. Ugh. Outdoor pools are somewhat better than enclosed pools.

 

Hoping you get good, solid answers soon. It is frustrating, and such a shock to hear that this might have been going on for some time. Please don't think you missed it, if it turns out he has asthma. There are some things that simply present in unusual ways, and it sounds like your kiddo's asthma, if it is asthma, is one of them. If my DS did not have allergies, we'd likely have missed his asthma, too.

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I know I'm really wigging out, because, to me, this is a HUGE issue for me to miss. I pay attention to my kids...I do...and if I missed a kid with asthma all his life?

Parents miss medical stuff all the time. It doesn't mean you are a bad parent. We just view things through a different lense.

My child was recently dx with a big medical issue. Now, in my defense, I had tried to get it dx when child was younger but first doctor said it was autism (sent us for screening, came back negative) and second doctor pushed for OCD screening. My gut feeling was correct, but I didn't push harder earlier because doctors didn't see what I was seeing, so I thought it must not be all that serious. Both doctors ended up being very wrong and sent us down the wrong path for years; they didn't step back to look at all the other pieces of the dx that I had no idea would even be related. Failure to thrive as an infant related to eye surgery in a young child related to repetitive hand motions in a pre-teen? But they were very much related in my child's case.

I really hope it doesn't make me a bad parent for not catching it early. Child has never missed a well-child visit - I would really have expected a doctor to have picked up on it at some point if it was really such a big medical concern.

 

Re: Asthma

My child was dx with asthma as a toddler. He is now a pre-teen and has never had a 'classic' asthma attack or what one would define and recognize as asthma.

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Can I just reassure you that you haven't been missing anything. I was an avid swimmer as a young kid, and I was known to have allergies. As I grew older, and didn't live in the pool, it eventually became obvious that I have asthma. The first pulmonologist I went to said something to my parents about the fact that I couldn't have picked a better exercise for an asthmatic, swimming was ideal. The pulmonologist believes I was always asthmatic. I only wheeze when I am in real trouble, it is my last symptom, and usually means IV steroids or hospitalization.

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Question: How do you differentiate between a "normal" cough kids get with a cold, and an asthma cough? I know how to tell a bronchitis/pneumonia cough from a regular cough...

 

No. He is not allergic to dust mites.

Great news on dust mites.

 

Usually breathing becomes heavier and I can hear the whizzing, although not always. Albuterol always eases the breathing.

Also, when he is coughing, it's as if something is in his throat and he is trying to get rid of it. I hope I am making sense.

Our doctor said that asthma is diagnosed after at least two whizzing incidents, so basically if he gets sick and every time there is some accompanying whizzing, it's asthma.

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Can I just reassure you that you haven't been missing anything. I was an avid swimmer as a young kid, and I was known to have allergies. As I grew older, and didn't live in the pool, it eventually became obvious that I have asthma. The first pulmonologist I went to said something to my parents about the fact that I couldn't have picked a better exercise for an asthmatic, swimming was ideal. The pulmonologist believes I was always asthmatic. I only wheeze when I am in real trouble, it is my last symptom, and usually means IV steroids or hospitalization.

We switched from indoor to outdoor pool. Have you seen this?

http://pediatrics.jwatch.org/cgi/content/full/2011/323/1

I an no longer figure out what is what.

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But, they said he doesn't have allergies...If they said a chemically-induced asthma, I could accept that. But, they say he doesn't. How did he get to the ripe old age of 13 and never have this come up? He's had pneumonia twice in his life...and a few colds...he even swam for 2 years competitively without any symptoms of anything. I'm just :willy_nilly:

 

I didn't get diagnosed with asthma until I was 33 years old. I had it long before that but was instead diagnosed with things like bronchitis and walking pneumonia. I did not have full blown wheezing until I was much older. The doctor said if I'd been diagnosed at a younger age, and taken preventative meds, much of the damage could have been prevented.

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So...long story short, while he has indications of asthma (ped. talked to allergist), it is a 13% "lower than normal" and 30% reversible -- meaning there is nothing one could notice on a routine check (unless something triggers is). So...for four weeks, take the meds...come back, repeat the test and go from there. I'm going to compare it to vision...he's got 20-25 nearsightedness, most people won't notice a difference in their vision. So...anyhow, my son is in no immediate danger. He's probably just fine without medication, but because it seems readily reversible, they'd like to take this approach and see if he improves. Who knows...maybe he'll turn into a superstar student because of it ;). I've calmed down a bit.

 

Okay, I have to leave again ... for the weekend.

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Please do not confuse having asthma with "not being fit." One can be a star athlete and still have asthma. If your child has it, it does not mean giving up things he enjoys. It may mean some maintenance meds and watching other symptoms, but it does not mean becoming sedentary. My niece has been on asthma meds since she was a toddler. She is a top athlete at her high school. Although her asthma has been pretty severe at times, she has never let it stop her. Her biggest issue is hugging her dad if he comes in from the soybean fields - she is allergic to soy.

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Yes...it was a peak-flow test. I'll talk to the ped. about the pulmonologist. Just kinda chaps me, that we called and asked for a specific test, and they didn't bother to mention that they couldn't do that, or wouldn't refer for it for at least a month. UGH. I feel stooopid.

 

 

(((hugs)))

 

You aren't stupid and you aren't obvious to your kid. It never hurts to have a second opinion.

 

Much as we want to know everything about our kids, they are endless founts of new territory.

 

Unless they have really bad uncontrollable asthma, it's highly likely it will upset their life or affect any future endeavors.

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We switched from indoor to outdoor pool. Have you seen this?

http://pediatrics.jw...full/2011/323/1

I an no longer figure out what is what.

 

 

Whether indoor or outdoor pool, I am still sensitive to chlorine. Chlorinated water stink my eyes and I haven't found a comfortable pair of goggles. Usually the pools are chlorinated on mondays. Even hotel pools seems to be most often chlorinated on mondays. I just avoid going to pools on the early part of the week. My doctors all recommended swimming for asthma.

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We switched from indoor to outdoor pool. Have you seen this?

http://pediatrics.jw...full/2011/323/1

I an no longer figure out what is what.

 

I had not seen that but I am not surprised. I used to swim outdoors as a kid, indoors in my teens (competitively), and I now swim outdoors in the summer and indoors the rest of the year. Our local Y uses saltwater chlorination so add that into the mix. :)

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