Thursday, December 15, 2005

The Neverending Cough

The Neverending Cough
Stacey Greenberg

I was a “good girl” growing up. I did what I was told for the most part and didn’t ask a lot of questions. In college I quickly learned that the way to get good grades was to tell the professor exactly what s/he wanted to hear. I was a “go with the flow” kind of person with very few expectations.

But when I got pregnant, something changed. I started questioning everything. I’m sure it is a typical maternal response, but I found my newfound inquisitive-ness somewhat thrilling. Formerly unused parts of my brain started to flutter and tingle, much like the baby growing in my belly. I shocked a lot of my friends and family by having a homebirth, not vaccinating, and doing other things that aren’t deemed mainstream.

I was lucky to find a family doctor who supported the homebirth midwives and parents who chose not to vaccinate their children. Between Dr. Cool and the information (and people) I found on the Internet, questioning authority soon became second nature to me—especially when it came to my children’s health.

This summer, after weeks of coughing fits, combined with what came to be known as the “cough/puke maneuver,” my three-year-old son was diagnosed with asthma. I was devastated. We have no family history of asthma. I am the anti-smoking Nazi. Second-hand smoke does not come near my offspring. However, we do have several pets and my husband discovered unknown mounds of dust lurking under large pieces of furniture.

Dr. Cool decided to treat Satchel aggressively with a steroid shot and Singulair, but after a few weeks of taking it, I didn’t see much improvement. The fact that Satchel wasn’t getting any better made me a little crazy. I had Warren take him in to see Dr. Cool again, but he ended up seeing the nurse practitioner instead. He came home with a prescription for a decongestant and an antibiotic. Frustrated, I emailed Dr. Cool.

Hi Dr. Cool,

You diagnosed Satchel with asthma, gave him a steroid shot and handed me several samples of Singulair. When they ran out, you called in a prescription for me, even though I expressed concerns about whether it was working. You asked me to try it for a few more weeks and keep a chart. I did both.

Satchel has continued to cough and even wake up in the middle of the night and vomit several times a week. He also vomits in the evening and in the morning. There is a coughing fit followed by vomit at least once every other day, if not more. He does not seem to be gasping for air when he coughs, but the cough will not go away. Sometimes he makes some really bizarre noises while coughing.

Warren brought him in yesterday. Erin said she heard no wheezing and prescribed a decongestant and an antibiotic. He doesn't appear sick and has not slowed down in any way over 8+ weeks. I would think if he had a bacterial infection, it would have worsened over the past few months.

I am really frustrated and I just want my child to stop coughing and puking everyday. Please advise.

Thank you,

I would be frustrated also. The antibiotics are a good idea for such a difficult situation. I would finish that course. Get my nurse to help set you up for chest X-ray if he has not had one. I think he will need to see an allergist or a pediatric pulmonary specialist after the x-ray, even if it is normal. It sounds more like asthma than anything, but should have been responsive to our aggressive therapy.
Dr. Cool

Dr. Cool,
Thanks. I will call and set up an appointment for an X-ray. Should I give him the decongestant or go back to the Singulair?

I like giving him the decongestant, the antibiotic and the Singulair. But, if you see the allergist or pulmonologist, discontinue all meds for four days before appt.
Dr. Cool

I really didn’t like the idea of pumping my three-year-old full of multiple, possibly unnecessary, medications. I called the allergist, who was very nice. He said I should go to the pulmonary specialist first. He gave me a name, number, and offered to call on my behalf if I couldn’t get an appointment within the week. I was quite pleased until he said, “Has your son had his DPT shot?” When I said no, Dr. Vaccine replied, “Well then, we really need to get him in fast.”

That freaked me out enough to google “diptheria” and “pertussis.” After reading a few pages, I was 100% convinced that Satchel had pertussis (a.k.a. whooping cough). Instead of freaking out, I was elated. Now, most people might expect a mother to be upset by the news that her offspring has whooping cough. Not me. The smoking gun, I thought. Now we can cure him!

I called Warren to tell him the good news. “It’s whooping cough,” I told him happily. “We’re off to the pulmonary specialist now.” I felt like Super Mom. I fought for answers until I found one and now I have a same day appointment with a specialist! I thought.

After filling out numerous forms, taking various tests, and talking to a number of nurses, Satchel and I busied ourselves wiping each other with sterile alcohol swabs until Dr. Lung walked in and asked, “So what brings you here today?”

“Whooping cough,” I happily announced.

Dr. Lung looked skeptical. “Is he up to date on his vaccinations?”

“He hasn’t had any vaccinations,” I chirped.

Dr. Lung looked wary. “Why not?” he asked.

Uh-oh. I put on my I'm a serious, smart mom face. “My husband and I chose not to vaccinate our children for various reasons with the support of our pediatrician, Dr. Cool,” I said.

His face relaxed a little. “Ok, let me take a look,” he said. He listened to Satchel’s breathing, looked in his mouth and ears, etc. “How long has he been coughing?” he asked.

“Three months,” I said. And then I went through the whole game of “is it asthma or is it an infection” that I’d been playing at Dr. Cool’s.

He listened patiently and then asked, “Is anyone else in the house sick? Is there a family history of asthma?”

“No and no,” I said.

“Whooping cough usually only lasts a couple of weeks,” he said. “And everyone in the house would have it.”

My face fell.

“But, I don’t think he has asthma either. I don’t hear any wheezing.” That cheered me up a bit.

“I can just look at his face and tell you it is allergies. See these dark circles under his eyes?” he asked. I nodded. I always thought of the dark circles as shadows cast by Satchel’s impossibly long eyelashes. “We call those ‘allergy shiners.’ And he has a lot of mucous draining down his throat—enough to make him cough and even vomit.”

Next we had a discussion about whether or not Satchel would allow me to shoot a nasal spray up his nostrils once a day. Then Dr. Lung said he was going to prescribe an antibiotic. “Why?” I asked.

“We know it isn’t whooping cough, but just in case it is, Zithromax will zap it.”

“Ok, so you ‘know’ it isn’t whooping cough, but you want to treat it anyway?” I asked.

He nodded. “I’m also prescribing Zyrtec for allergies.”

“Then can he stop taking the Singulair?” I asked.

“Well, I wouldn’t go that far,” he said. “Let’s get him well and then we’ll start taking away medicines.”

“Ok, thanks,” I said looking for the exit, tallying the medications I was supposed to give my 35 pound child in my head. I dutifully dropped off the prescriptions at the pharmacy, but I told myself that I would get more information before actually giving any of it to Satchel.

I called my boyfriend, Dr. Vaccine, and set up an appointment for the next week. "It's not pertussis," I dejectedly told him, "Or asthma," I added a bit more perkily.
I entered into an email debate with Dr. Cool and tried desperately to get him to say Satchel didn't need to take all of the medications, but he didn't. (Even though I liked questioning authority, I also like to appear cooperative.) After much back and forth I finally wrote him and reminded him of his earlier email that said, “But, if you see the allergist or pulmonologist, discontinue all meds for four days before appt.”

I talked to my doctor friend, my midwife friend, and other parents who all seemed to agree that I had amassed an awful lot of medications for Satchel’s cough.

“Definitely don’t give him the antibiotics,” they all advised.

Something inside me still believed it might be whooping cough so I decided to give Satchel the antibiotics anyway. Then a funny thing happened. Satchel stopped coughing and puking and really seemed fine. I was thrilled and confused. By the time our appointment with the allergist rolled around, I wondered if we really needed to go. Since he had been so nice on the phone, I opted to take Satchel “just in case.”
Dr. Vaccine's office was full of extremely nice people who didn’t make us wait at all. I was actually startled by how fast Dr. Vaccine came in the examination room. The nurse conducted the allergy test and the entire staff was amazed at how calmly Satchel handled being poked 20+ times with a stick.

We discovered that Satchel had an extremely mild reaction to mold and dust. Dr. Vaccine suggested covering our mattress and pillows with a special cover and then, like Dr. Lung, prescribed Nasonex and Zyrtec. (To his credit he did say the Singulair seemed unnecessary at this point.) This time I didn’t even bother dropping off the prescriptions.

I feel good about not blindly accepting the asthma diagnosis and not dispersing unnecessary medications, but I wonder if all of my questioning did more harm than good. I dragged Satchel to six different appointments with three different doctors and then didn’t listen to anything any of them told me. The only thing I did listen to was the “it isn’t asthma” part, which I guess is all I really wanted to hear in the first place.

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