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Almost 3 years in to Covid I ought to know but don’t


MEmama
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DS texted last night that he has a fever of 102 and blood oxygen of 94. He reports experiencing moderate to severe asthma attacks. Today he can’t stay awake long enough to take a Covid test. How worried should I be? 

Keep in mind he’s also in a mental health crisis and is unable to do any extra steps. If he doesn’t have tests he probably can’t manage to ask a roommate to pick some up for him.

Whether it’s Covid or flu, what kind of help does he need? Or can I reassure myself that lots of sleep is enough?

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8 minutes ago, Kassia said:

Also, do you have contact info for anyone he's friends with there or anyone who can help?  A roommate, university housing, etc.?  Is there a university health center (I don't know if he's on campus)?

Seconding this.  I know the feeling of having a sick kid overseas 😞   Very stressful.

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Do you think that the 'can't stay awake long enough to take a covid test' is from the illness or the mental health issue?  I'm asking mainly because that seems more concerning than the other things, which could go with covid or any number of respiratory viruses.  We had mild covid at our house, but my brother had delta, my 80something inlaws had it a year ago, and my 70something parents just had covid 2 weeks ago and while people had fevers, coughs, and extreme fatigue there wasn't anybody who couldn't stay awake for 15 minutes.  

Everybody got better with normal virus care - lots of fluids, lots of sleep, and OTC fever reducers and temperate baths or showers, etc.  Can he manage to make himself drink fluids?  Is there somebody who can make a store run and bring him juice, gatorade, chicken soup, or whatever fluid he's most likely to want when sick?  I'd focus more on those sorts of treatments than the covid test, although if the asthma attacks are a problem then I'd focus on that - we don't have that particular complication in my family so I don't have any advice there.  

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I’m so sorry. I don’t have any helpful advice, but I hate that he is so sick, and I know how difficult it is to be far away and not able to do anything. I hope that you are able to find a way to help in some way. I do know that my preemie son (now an adult) has always slept a ton when he was really sick. When he was overseas he got really sick and I received a worried call from those in charge because he was sleeping so much. It was just how his body handled being that sick. ((((Hugs))))

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8 minutes ago, Clemsondana said:

I'd focus more on those sorts of treatments than the covid test, although if the asthma attacks are a problem then I'd focus on that - we don't have that particular complication in my family so I don't have any advice there.  

My asthma attacks tend to trigger high fevers. I would need the nebulizer treatment for those. My brother would sleep through a fever so need someone else to take his temp every few hours. The higher the fever the sleepier he gets. I can’t sleep with a fever but I could have a fever of 38.5 degrees C and not realize. 

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33 minutes ago, Kassia said:

Does his university have EMT services or anything like that where they will go directly to him
 

I'm so sorry about the worry when you are so far away.  😞 I hope he's okay and feels better soon. 

Does he need an EMT based on the above symptoms? I wish I knew more but he’s not responding to my texts so he’s probably sleeping.

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Just now, MEmama said:

Does he need an EMT based on the above symptoms? I wish I knew more but he’s not responding to my texts so he’s probably sleeping.

If he's in a dorm, I'd start with the RA or whoever is in charge of the dorm.  Whether they get involved directly or call somebody else, they'll likely know what to do.  If he's not in a dorm, maybe somebody in student life or campus health could give you some direction.  

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36 minutes ago, Kassia said:

Also, do you have contact info for anyone he's friends with there or anyone who can help?  A roommate, university housing, etc.?  Is there a university health center (I don't know if he's on campus)?

I don’t have contact information for any of his friends. I wanted to get at it for least one when we were recently there, but I’m unsure how much of his mental health stuff he’s disclosed so I didn’t want to overreach. I’m past that now, though. There is a possibility DH can sleuth out a roommates info tonight.

There is a university health center but they won’t see anyone with Covid. I don’t think he can manage to walk over there right now anyway.

28 minutes ago, Arcadia said:

Is he in university dorm? Do you have the contact for the resident fellow? If not does the dorm have an admin office you can call? They should be able to send someone to check on him and pass him a test kit. 

He is in university housing but I don’t think they have RAs like they do here. There must be an admin office though

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5 minutes ago, MEmama said:

Does he need an EMT based on the above symptoms? I wish I knew more but he’s not responding to my texts so he’s probably sleeping.

I don't know but the severe asthma attacks and not being able to wake up would really concern me and I think better safe than sorry.  My dd's school has their own university EMT service so it wouldn't be like calling an ambulance but I don't know what services your ds' school provides. 

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Just now, MEmama said:

 

He is in university housing but I don’t think they have RAs like they do here. There must be an admin office though

Yes, I would definitely contact university housing to tell them your concerns - at least the physical issues if you don't want to disclose mental ones.

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20 minutes ago, Clemsondana said:

Do you think that the 'can't stay awake long enough to take a covid test' is from the illness or the mental health issue?  I'm asking mainly because that seems more concerning than the other things, which could go with covid or any number of respiratory viruses.  We had mild covid at our house, but my brother had delta, my 80something inlaws had it a year ago, and my 70something parents just had covid 2 weeks ago and while people had fevers, coughs, and extreme fatigue there wasn't anybody who couldn't stay awake for 15 minutes.  

Everybody got better with normal virus care - lots of fluids, lots of sleep, and OTC fever reducers and temperate baths or showers, etc.  Can he manage to make himself drink fluids?  Is there somebody who can make a store run and bring him juice, gatorade, chicken soup, or whatever fluid he's most likely to want when sick?  I'd focus more on those sorts of treatments than the covid test, although if the asthma attacks are a problem then I'd focus on that - we don't have that particular complication in my family so I don't have any advice there.  

I’d guess both? He does shut down when he’s crisis mode and I can’t even imagine his anxiety levels right now. But 102 is really high for him, he was never one to get fevers as a kid.
 

He is autistic and notoriously bad at understanding how sick he is or being able to express his symptoms well, so it’s extra difficult for me to guess when I can’t even see him. 

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10 minutes ago, Arcadia said:

My asthma attacks tend to trigger high fevers. I would need the nebulizer treatment for those. My brother would sleep through a fever so need someone else to take his temp every few hours. The higher the fever the sleepier he gets. I can’t sleep with a fever but I could have a fever of 38.5 degrees C and not realize. 

He doesn’t have a nebulizer, just his inhalers. Are they typically available over the counter or through the doctor? Sorry if it’s a dumb question, I’m not thinking too clearly.

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6 minutes ago, Kassia said:

I don't know but the severe asthma attacks and not being able to wake up would really concern me and I think better safe than sorry.  My dd's school has their own university EMT service so it wouldn't be like calling an ambulance but I don't know what services your ds' school provides. 

Thanks. I’ll wait to hear back from him and if the attacks are still bad I’ll look into that. He’s soooo unreliable at being able to describe how he’s feeling; he could be on the verge of death and insist he’s fine—and really believe it. 

 

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The where they are available question depends on the country. In the US, the medicines to be nebulized are by prescription. Our nebulizer came from the durable medicine pharmacy, but there are pocket nebulizers you can buy on Amazon. I squeeze a vial of medicine into the medicine cup of the machine and it is put into vapor for me to breathe. 
 

My pulmonologist said the strength of what I nebulize is something on the order of 30x an inhaler puff, fwiw. 
 

Edited by prairiewindmomma
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16 minutes ago, MEmama said:

 

There is a university health center but they won’t see anyone with Covid. I don’t think he can manage to walk over there right now anyway.

He is in university housing but I don’t think they have RAs like they do here. There must be an admin office though

If you can’t get through to the admin office, call the university health center and they should have protocols on what to do. My college was in Asia and if someone did not respond to heavy knocking on their dorm door, the master key would be used by a staff to make sure the student isn’t unconscious. The staff also have the non emergency EMT number to call.

10 minutes ago, MEmama said:

He doesn’t have a nebulizer, just his inhalers. Are they typically available over the counter or through the doctor? Sorry if it’s a dumb question, I’m not thinking too clearly.

Nebulizers are typically ordered by the doctors for patients who need them regularly. I only need them at most a few times a year so I go to my general practitioner or urgent care. My friend’s son was issued one for home use.

ETA: university health service would be able to issue him a nebulizer machine and the medication to use. 

Edited by Arcadia
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Fwiw, I can never ask my quirky kids how they feel. There is not enough interoception there to get an accurate answer, especially if anxiety and shutdowns are also a factor. The default needs to be to be seen by a medical professional or someone else (a trusted adult) because they aren’t a reliable reporter for themselves. 

A high temperature isn’t concerning, at all. It’s good that the body wants to burn this out. Not breathing well is a big problem. 

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He needs to be seen ASAP. I would have a friend take him to the ER or call an ambulance. Do not delay.

 ETA actually I would just call an ambulance. If he had a severe asthma attack en route, the friend might not know what to do and an inhaler is not going to cut it. The sleepiness might be simple fatigue, but could also be a sign of serious illness. 

Edited by WTM
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Does he have a formal asthma action plan that he can follow?

In general, "severe asthma attacks" plus 02 sat below baseline = needs emergency assessment.

I wouldn't fuss about finding a nebulizer.  Nebulizer use is somewhat cultural.  We don't use them much here anymore, even for emergency treatment in hospitals.  We use metered-dose inhalers plus holding chamber instead, and scale up the number of puffs as appropriate/clinically indicated.  The data show that metered-dose inhaler plus holding chamber, dry particle inhaler, and nebulizer are all about equivalent with respect to lung deposition (in non-tracheostomy patients).  Nebs also increase the risk of infectious illness to others, because they aerosolize the patient's own secretions/droplets on expiration.

If he doesn't have a written asthma plan, maybe consider requesting one from his healthcare team when he's next home.  It makes crisis decision-making much easier when there are written, prescribed parameters with clear steps to take for each.  Especially useful when far from home.

Hugs to you.  It's hard when they are away from home.

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Good advice here from folks more familiar than I am with asthma, which is priority #1.

Hydration, meds to reduce fever if it nears 103, and getting drinks or soup that he will eat to his dorm room would be next. Fevers involve metabolic processes that burn through H2O, so it's easy to get seriously dehydrated. If he's sleeping all day and doesn't have the bandwidth to take care of himself, is there a way to let him know he really really needs to drink regularly, maybe set a regular alarm or reminder to finish a whole drink? 

It's okay if he doesn't feel like eating much, but hydration is super important. 

Once again sending solidarity and support for having college students at a distance with health issues. Dd has been sick twice this semester despite masking in classes and campus buildings, and it's rough. 

 

 

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54 minutes ago, WTM said:

He needs to be seen ASAP. I would have a friend take him to the ER or call an ambulance. Do not delay.

 ETA actually I would just call an ambulance. If he had a severe asthma attack en route, the friend might not know what to do and an inhaler is not going to cut it. The sleepiness might be simple fatigue, but could also be a sign of serious illness. 

I wish it was this clear though.
 

He truly isn’t able to express his symptoms or severity well (we’ve had some stunned doctors. When he was diagnosed with asthma he’d been throwing up for days from coughing, told the doctor he felt just fine when asked, and when she did her thing she was like dude you have severe asthma and need help NOW!). It’s made understanding his health issues and mental health issues extremely challenging. I don’t have any idea how he would describe a severe attack, over a panic attack (also possible) or just lots of coughing. His understanding of baseline is really skewed.

Edited by MEmama
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4 minutes ago, MEmama said:

I wish it was this clear though.
 

He truly isn’t able to express his symptoms or severity well (we’ve had some stunned doctors. When he was diagnosed with asthma he’d been throwing up for days him from coughing, told the doctor he felt just fine when asked, and when she did her thing she was like dude you have severe asthma and need help NOW!). It’s made understanding his health issues and mental health issues extremely challenging. I don’t have any idea how he would describe a severe attack, over a panic attack (also possible) or just lots of coughing. His understanding of baseline is really skewed.

All the more reason for a formal asthma action plan.  A peak flow meter and pulse oximeter can help with objectivity, and be incorporated into the plan.

You do have one objective data point (02 sat) to compare with baseline, which is telling you something, I think.

 

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5 minutes ago, wathe said:

All the more reason for a formal asthma action plan.  A peak flow meter and pulse oximeter can help with objectivity, and be incorporated into the plan.

You do have one objective data point (02 sat) to compare with baseline, which is telling you something, I think.

 

I just remembered he does have an action plan. I’ll pull it out— thanks for the reminder. 

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26 minutes ago, MEmama said:

. I don’t have any idea how he would describe a severe attack, over a panic attack (also possible) or just lots of coughing. His understanding of baseline is really skewed.

He needs to be seen. I would really call his university health service hotline.

My severe asthma attack leads to a panic attack because you feel so out of control. 

8 minutes ago, MEmama said:

I just remembered he does have an action plan. I’ll pull it out— thanks for the reminder. 

Does his university health service have a copy? I know when I am sick I sound like a caffeine deprived person so it is better for me to have everything on file with my university health service.

Edited by Arcadia
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2 minutes ago, Arcadia said:

He needs to be seen. I would really call his university health service hotline.

My severe asthma attack leads to a panic attack because you feel so out of control. 

Does his university health service have a copy? I know when I am sick I sound like a caffeine deprived person so it is better for me to have everything on file with my university health service.

He has a copy but there’s zero chance he’d be able to find it right now.

His experience with the health center ended in disaster (due to his anxiety, not the center itself) and I didn’t think to have him take a copy for his file. I’ll figure out how to remedy that next time I’m there, that’s a good idea. 

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If he’s not a reliable reporter, he shouldn’t be the one deciding whether he is “sick enough”, but he can look at data or be screened by uni health center.

He can look at his 02 sat rate.

He can check his peak flow, to see if it has dropped more than 20% (or whatever his asthma action plan is).

He can see if he is coughing to throwing up, or coughing constantly, or bark coughing. 

He can see if his albuterol inhaler is providing relief for at least four hours.

For my kids, if the answer to any of those is “no” = be seen at urgent care. I have a little coaching script they go through of how they present themselves: “My name is x, and according to my asthma action plan I am supposed to be seen because of a, b or c.”  The key is getting to the point where any medical professional puts a stethoscope on my kid because once they hear the lungs, it’s pretty dang clear things are not good, iykwim. 
 

ETA: I have one kid who won’t go to be seen by themselves. Do they have a trusted roommate or friend who could go with them and answer questions if need be? Or will they take their phone and let you FaceTime in? It’s ok to need an advocate.
 

 

Edited by prairiewindmomma
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Poor thing! Asthma plus anxiety is a horrible combination! One seems to feed the other! I agree with others who say he should be seen. I know that means more stress, but high fevers and low O2 are nothing to mess around with. If he goes to an urgent care/ER, they should be able to give him a nebulizer treatment and order him a nebulizer and meds for home use, which will mean *less* stress down the road because he will be able to just keep some vials of albuterol on hand and not have to go somewhere for a treatment. 
 

Can you keep him on the phone long enough for him to do the swab part of a Covid test, then let him doze and call him back when it’s time to check the strip? 
 

Hugs to you! It must be extremely stressful for you trying to help him navigate health care from across an ocean!

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If I didn’t remember wrong your son is in Ireland.

https://www2.hse.ie/conditions/asthma/asthma-attacks/

What to do if you have an asthma attack

If you think you're having an asthma attack:

  1. Sit upright (don't lie down) and try to take slow, steady breaths. Try to remain calm, as panicking will make things worse.
  2. Take 1 puff of your reliever inhaler (usually blue) every 30 to 60 seconds, up to a maximum of 10 puffs.
  3. Call 112 or 999 for an ambulance if you don't have your inhaler with you, you feel worse despite using your inhaler, you don't feel better after taking 10 puffs or you're worried at any point.
  4. If the ambulance hasn't arrived within 15 minutes, repeat step 2.

Never be frightened of calling for help in an emergency.

Try to take the details of your medicines or your personal asthma action plan with you to hospital if possible.

If your symptoms improve and you don't need to call 112 or 999, get an urgent appointment to see your GP.

Download an asthma action plan from Asthma Ireland (PDF, 330KB, 2 pages)

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50 minutes ago, MEmama said:

I just remembered he does have an action plan. I’ll pull it out— thanks for the reminder. 

 

38 minutes ago, MEmama said:

He has a copy but there’s zero chance he’d be able to find it right now.

His experience with the health center ended in disaster (due to his anxiety, not the center itself) and I didn’t think to have him take a copy for his file. I’ll figure out how to remedy that next time I’m there, that’s a good idea. 

Any chance you could send a digital copy to the health center, if he can’t find it? Or to whoever seems like the best person to help him over there?

Edited by Innisfree
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Someone needs to go check on him. Contact housing. There has to be a way for someone to put eyes on him. If that means an ambulance. so be it.  If his oxygen gets too low for short periods of time, it can affect cognitive function. If it gets really low, or moderately low for extended periods of time, it can have permanent effects. 

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2 hours ago, MEmama said:

He has a copy but there’s zero chance he’d be able to find it right now.

His experience with the health center ended in disaster (due to his anxiety, not the center itself) and I didn’t think to have him take a copy for his file. I’ll figure out how to remedy that next time I’m there, that’s a good idea. 

Send him a digital copy by WhatsApp, email, whatever. 
He probably has an account for the university health portal to upload vaccination records and other medical information. Depending on how things are set up there, you might be able to email university heath services and have them upload to his account. 

If he is using an iPhone, you might want to have the medication information (drugs, allergies) and doctors information (including email address) updated on the Medical ID. I don’t know what is the Android equivalent. 

https://support.apple.com/guide/iphone/set-up-and-view-your-medical-id-iph08022b192/16.0/ios/16.0

Edited by Arcadia
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I would be concerened about dehydration. I got sick my first few weeks at college and had a fever and couldn't stop throwing up and without my parents there I just didn't know enough to keep drinking/sipping anyway. I ended up calling my dad delirious on the phone and he drove up (took him 2 hours when ususally it's a 3 hour drive) and he took me to the ER where I got an IV and they said if he'd waited another day we might have had a very different outcome.

I will pray for your son and for you!

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3 hours ago, MEmama said:

I wish it was this clear though.
 

He truly isn’t able to express his symptoms or severity well (we’ve had some stunned doctors. When he was diagnosed with asthma he’d been throwing up for days from coughing, told the doctor he felt just fine when asked, and when she did her thing she was like dude you have severe asthma and need help NOW!). It’s made understanding his health issues and mental health issues extremely challenging. I don’t have any idea how he would describe a severe attack, over a panic attack (also possible) or just lots of coughing. His understanding of baseline is really skewed.

Gently, because it sounds like you’ve been through a lot with him — It actually is crystal clear from a strictly medical standpoint. The story you told raises red flags in my medical mind.  If he cannot clearly advocate for himself, that’s all the more reason to seek care. I would not avoid seeking necessary evaluation just because he might not be able to clearly relate his symptoms.   At the ER, they will be able to conduct objective tests — repeat O2 sat, labs to see if he’s working so hard to breath that he’s throwing off his acid-base balance, peak flow, etc.  Based on what you describe, there’s no way I would rely on run of the mill inhalers unless he had been thoroughly evaluated and had a rock solid action plan.

I’d have no qualms about putting on my paternalistic side and swooping in to help my child in this scenario. 

If you need to, you can try calling ahead to the ED and asking to speak with the triage nurse. You can explain a bit of his history, potential pitfalls in assessing him (ie that he might downplay his symptoms or not be able to clearly relate them), etc. Not all ERs will be super easy to talk to (some may refuse to talk to you), but it’s something you could try if you’re worried and can’t find other ways to support him on short notice.

Edited by WTM
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46 minutes ago, Catwoman said:

@MEmama  How soon can you get there? In your shoes, I would be on my way to the airport right now. 

Sending lots of hugs and healing thoughts his way! This is so scary, and the combination of Covid, asthma, and the mental health issues is extremely concerning. 

Thank you. DH is looking at tickets—it’s extremely unusual for him to be this worried.

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1 hour ago, Starr said:

https://my.clevelandclinic.org/health/diagnostics/22447-blood-oxygen-level

I found some info. It's so hard having them far away.

Super helpful—thank you!

The asthma plan he has here is really basic and doesn’t include vital information, so I’ll make sure it gets updated when he’s home. For now, I sent him the link so he has something useful and clear that he can refer to when describing his symptoms.

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9 minutes ago, WTM said:

Gently, because it sounds like you’ve been through a lot with him — It actually is crystal clear from a strictly medical standpoint. The story you told raises red flags in my medical mind.  If he cannot clearly advocate for himself, that’s all the more reason to seek care. I would not avoid seeking necessary evaluation just because he might not be able to clearly relate his symptoms.   At the ER, they will be able to conduct objective tests — repeat O2 sat, labs to see if he’s working so hard to breath that he’s throwing off his acid-base balance, peak flow, etc.  Based on what you describe, there’s no way I would rely on run of the mill inhalers unless he had been thoroughly evaluated and had a rock solid action plan.

I’d have no qualms about putting on my paternalistic side and swooping in to help my child in this scenario. Best case, it’s a cold and he needs to sleep it off, worst case, it can be life or death.

If you need to, you can try calling ahead to the ED and asking to speak with the triage nurse. You can explain a bit of his history, potential pitfalls in assessing him (ie that he might downplay his symptoms or not be able to clearly relate them), etc. Not all ERs will be super easy to talk to (some may refuse to talk to you), but it’s something you could try if you’re worried and can’t find other ways to support him on short notice.

Thank you, I needed to hear all of this. 
 

His current blood oxygen is 91, so it’s gone down quite a bit. Walking the 6 steps between his bed and the bathroom to refill his water bottle caused him to cough and throw up (mucous) for several minutes; he finally made it back to bed but is too exhausted to reach to the far end for a Covid test.

His good friend (who lives in the apartment) is aware he’s sick, so at least he has someone around. DS feels like an ambulance and ER is an overreaction, but obviously he’s not a good judge. Of course it’s after hours there and the clinic is closed. I did let him know if the numbers go down any further he’ll need to be seen ASAP. He reported a high heart rate, even several minutes after he got back to bed. Idk the number vs his baseline though.

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3 minutes ago, MEmama said:

Thank you, I needed to hear all of this. 
 

His current blood oxygen is 91, so it’s gone down quite a bit. Walking the 6 steps between his bed and the bathroom to refill his water bottle caused him to cough and throw up (mucous) for several minutes; he finally made it back to bed but is too exhausted to reach to the far end for a Covid test.

His good friend (who lives in the apartment) is aware he’s sick, so at least he has someone around. DS feels like an ambulance and ER is an overreaction, but obviously he’s not a good judge. Of course it’s after hours there and the clinic is closed. I did let him know if the numbers go down any further he’ll need to be seen ASAP. He reported a high heart rate, even several minutes after he got back to bed. Idk the number vs his baseline though.

No, he needs to go now. I’m so sorry - I’m not trying to incite panic, But he needs to be seen. His sat is down to 91 in a few hours. He is so short of breath he can barely walk.  Can the good friend accompany him to the ER if he’s afraid of going alone?  It;s so much easier for MDs to treat things before TSHTF.  If he ends up being fine and it felt like an overreaction, it would still have been the right thing to do.

Edited by WTM
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1 hour ago, Momto6inIN said:

I would be concerened about dehydration. I got sick my first few weeks at college and had a fever and couldn't stop throwing up and without my parents there I just didn't know enough to keep drinking/sipping anyway. I ended up calling my dad delirious on the phone and he drove up (took him 2 hours when ususally it's a 3 hour drive) and he took me to the ER where I got an IV and they said if he'd waited another day we might have had a very different outcome.

I will pray for your son and for you!

Thank you.

He is drinking water, thankfully, though probably not a lot since getting out of bed is hard. He keeps a giant water bottle next to him at all times so at least he shouldn’t have to get up to refill often. I’ll be sure to keep reminding him; it’s hard to drink enough with a fever.

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3 minutes ago, Catwoman said:

I think going there is the right thing to do. You and/or your dh need to be there and see him with your own eyes. 

I agree. And maybe while you’re there, maybe you can pull a friend or two aside and give them your/ your dh’s cell numbers. You don’t have to tell them anything about his mental health issues or anything private. Just tell them *you’re* a worrier, and would they just keep an eye on him for *you*. “You know how stubborn teenagers can be about healthcare!” *wink, wink*

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4 minutes ago, WTM said:

No, he needs to go now. I’m so sorry - I’m not trying to incite panic, But he needs to be seen. His sat is down to 91 in a few hours. He is so short of breath he can barely walk.  Can the good friend accompany him to the ER if he’s afraid of going alone?  It;s so much easier for MDs to treat things before TSHTF. 

Thank you for being my voice of reason.

Apparently he fell back asleep— he’s only been able to stay awake for a few minutes at a time. I sleuthed up his roommates contact info and will have him check in while I figure out next steps.

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