Mr. Asthma

Question:

I am very frustrated and concerned. My daughter went to college 1200 miles away. She is  steroid dependent.  As I posted here before we got her set up with a very good Dr. The problem is she does not understand the importance of communicating with him.  She has been to the health center 2x this week and both times had her steroid dose greatly increasedI called and talked to her Dr. about this and then insisted she call herself.  They insisted she come on, but she has tests all day tomorrow.  Now she is very upset and says she never wants to go back and is only going to please me. I feel she needs to be following up with them.  I feel she needs to be treated by a specialist for her asthma and am afraid she let herself get into real trouble.  I just don’t know how to handle this, since I may be pushing her away, and she will no longer communicate with me on this subject……ANY ideas????

Response:

> I am very frustrated and concerned. My daughter went to college 1200 miles > away. She is  steroid dependent.  As I posted here before we got her set up > with a very good Dr. The problem is she does not understand the importance of > communicating with him.  She has been to the health center 2x this week and > both times had her steroid dose greatly increasedI called and talked to her Dr. > about this and then insisted she call herself.  They insisted she come on, but > she has tests all day tomorrow.  Now she is very upset and says she never wants > to go back and is only going to please me. I feel she needs to be following up > with them.  I feel she needs to be treated by a specialist for her asthma and > am afraid she let herself get into real trouble.  I just don’t know how to > handle this, since I may be pushing her away, and she will no longer > communicate with me on this subject……ANY ideas????

I agree she should certainly be under the care of a specialist–but do you have any idea why she doesn’t want to go back to the one that was chosen and prefers to go to the health center?  Maybe the answer is another doctor? zg

Response:

>under the care of a specialist–but do >you have any idea why she doesn’t want to go back to the one that was >chosen and prefers to go to the health center?  Maybe the answer is >another doctor?

convenience….and she thinks she has it under control. She says there isn’t time. She only has to walk across the street from her dorm, and actually wouldn’t have gone the first time she did except her coach sent her.

Response:

> I am very frustrated and concerned. My daughter went to college 1200 miles > away. She is  steroid dependent.  As I posted here before we got her set up > with a very good Dr. The problem is she does not understand the importance of > communicating with him.  She has been to the health center 2x this week and > both times had her steroid dose greatly increasedI called and talked to her Dr. > about this and then insisted she call herself.  They insisted she come on, but > she has tests all day tomorrow.  Now she is very upset and says she never wants > to go back and is only going to please me. I feel she needs to be following up > with them.  I feel she needs to be treated by a specialist for her asthma and > am afraid she let herself get into real trouble.  I just don’t know how to > handle this, since I may be pushing her away, and she will no longer > communicate with me on this subject……ANY ideas????

Has she received training on how to manage her exacerbations, from her specialist? Current asthma treatment guidelines are to give the patient an ‘Action Plan’ to manage their asthma drugs based on peak flow readings and symptoms. Typically when in Yellow Zone, to use albuterol as needed and increase inhaled steroids. In the Red Zone to start or increase oral steroids. http://www.ama-assn.org/special/asthma/treatmnt/updates/patient.htm  Patient Asthma Action Plans Most patients should be able to manage their own ‘Yellow Zone’ exacerbations, and only need medical help for ‘Red Zone’ ones. If getting exercise induced asthma, needs to learn to pretreat with albuterol; and not overdo the exercise. Of course she should be getting her medical treatment from an asthma specialist who has her medical history, unless a life threatening exacerbation requires emergency care. She might need to reduce her class load, so as to have time to see the specialist when needed. And learn how to deal with exacerbations during test times; the instructor should allow a make up test with a medical excuse. Some clinics offer asthma management education courses to help patients learn how to deal with the asthma. Ellis

Response:

My suggestion is to let her sort this out. She will eventually decide that breathing is a lot better than not breathing. I don’t mean to offend you but maybe she is away at school and not wanting her parents to "interfere". Maybe she wants her independence. It probably won’t do any good to nag her……let her come to her own terms on this thing. As a person who has suffered from asthma for years I can say that it does get exhausting dealing with it. Maybe she is at the point where she doesn’t want to deal with it and is going to have to be forced. My suggestion would be to let her figure this one out on her own. Denise Indianapolis

– Hide quoted text — Show quoted text -> I am very frustrated and concerned. My daughter went to college 1200 miles > away. She is  steroid dependent.  As I posted here before we got her set up > with a very good Dr. The problem is she does not understand the importance of > communicating with him.  She has been to the health center 2x this week and > both times had her steroid dose greatly increasedI called and talked to her Dr. > about this and then insisted she call herself.  They insisted she come on, but > she has tests all day tomorrow.  Now she is very upset and says she never wants > to go back and is only going to please me. I feel she needs to be following up > with them.  I feel she needs to be treated by a specialist for her asthma and > am afraid she let herself get into real trouble.  I just don’t know how to > handle this, since I may be pushing her away, and she will no longer > communicate with me on this subject……ANY ideas????

Response:

Hi. I agree whit Denise, you can’t force her, you can’t push her. She’s old enough to decide if she want to take care of her health. Sometimes children need to touch the flames to feel the burn! Be there to support when she will get back to mom whit a few tearsdrop…. Wow! What a good mom she have! Bye, AT – Hide quoted text — Show quoted text -> My suggestion is to let her sort this out. She will eventually decide that > breathing is a lot better than not breathing. I don’t mean to offend you but > maybe she is away at school and not wanting her parents to "interfere". > Maybe she wants her independence. It probably won’t do any good to nag > her……let her come to her own terms on this thing. As a person who has > suffered from asthma for years I can say that it does get exhausting dealing > with it. Maybe she is at the point where she doesn’t want to deal with it > and is going to have to be forced. My suggestion would be to let her figure > this one out on her own. > Denise > Indianapolis > I am very frustrated and concerned. My daughter went to college 1200 miles > away. She is  steroid dependent.  As I posted here before we got her set > up > with a very good Dr. The problem is she does not understand the importance > of > communicating with him.  She has been to the health center 2x this week > and > both times had her steroid dose greatly increasedI called and talked to > her Dr. > about this and then insisted she call herself.  They insisted she come on, > but > she has tests all day tomorrow.  Now she is very upset and says she never > wants > to go back and is only going to please me. I feel she needs to be > following up > with them.  I feel she needs to be treated by a specialist for her asthma > and > am afraid she let herself get into real trouble.  I just don’t know how to > handle this, since I may be pushing her away, and she will no longer > communicate with me on this subject……ANY ideas????

Response:

>I don’t mean to offend you but >maybe she is away at school and not wanting her parents to "interfere".

I am not offended..I am sure this is what she wants……but at what cost?? >Maybe she is at the point where she doesn’t want to deal with it >and is going to have to be forced

She has been at this point several times, but  it didn’t make it go away.  And the fact that she told me about it made me feel she was not totally agreeable that she should ignore it.  I am going to worry when sher tells me rthat she is taking 96mg of medrol a day for several days when I know she has a dr. that is unfamiliar with her.  However, I am glad that she did get help..even if she was forced to do so.

Response:

I can’t blame you for worrying….but you can’t MAKE her do anything……hopefully she will come around and see it is easier to do small things on a regular basis as opposed to all the drama. Denise

– Hide quoted text — Show quoted text ->I don’t mean to offend you but >maybe she is away at school and not wanting her parents to "interfere". > I am not offended..I am sure this is what she wants……but at what cost?? >Maybe she is at the point where she doesn’t want to deal with it >and is going to have to be forced > She has been at this point several times, but  it didn’t make it go away. And > the fact that she told me about it made me feel she was not totally agreeable > that she should ignore it.  I am going to worry when sher tells me rthat she is > taking 96mg of medrol a day for several days when I know she has a dr. that is > unfamiliar with her.  However, I am glad that she did get help..even if she was > forced to do so.

Response:

– Hide quoted text — Show quoted text ->I don’t mean to offend you but >maybe she is away at school and not wanting her parents to "interfere". > I am not offended..I am sure this is what she wants……but at what cost?? >Maybe she is at the point where she doesn’t want to deal with it >and is going to have to be forced > She has been at this point several times, but  it didn’t make it go away.  And > the fact that she told me about it made me feel she was not totally agreeable > that she should ignore it.  I am going to worry when sher tells me rthat she is > taking 96mg of medrol a day for several days when I know she has a dr. that is > unfamiliar with her.  However, I am glad that she did get help..even if she was > forced to do so.

The intransigence of ones children is usually cured with parenthood. I have lived long enough to gloat. Galleyleo

Response:

If she is anything like me when I was young and asthmatic, she’s probably in denial.  At that young age, she doesn’t like having asthma or the steroids. They make you want to eat anything you can get your hands on and as a girl in college, the stigma of being asthmatic and eating a lot may embarrass her.  My experience with some people without asthma, especially younger people,  is that they are suspicious that asthma is a psychosomatic disease. What she has to learn is that if she keeps the asthma under control she doesn’t need as high a dose of steroids, she can control her appetite and no one needs to know she has asthma.  Maybe I’m way off base, but that was the way I was when I was in college and I had to learn it on my own because it’s not something anyone tells you.  Hopefully this may shed some light on the problem.   Good luck,   Wayne

Response:

>If she is anything like me when I was young and asthmatic, she’s probably in >denial.

I feel very sure that she is in denial..being an athlete, she is in great shape otherwise but does say the hunger from the steroids is awful. I think she looks at it as a weakness..and thinks people will see it as a flaw. She waits too long to aknowledge a prob. then she ends up needing high dose to get it under control. I was upset to hear that she was on 104mg of medrol a day for a few days ..then began to slow taper.  Hopefully she will learn.Too many people smoking around campus is also a prob. for her.

Response:

The way my parents dealt with me was when I was on my own and in college, I was responsible for getting myself to the doctor.  I had weekly allergy shots and if I missed them, the doctor and nurses reminded me of that.  It came down to pride.  I didn’t like having to explain to my doctors why I missed an appointment or shot.  They have a way of making you feel really stupid.  Perhaps you need to find an allergist or pulmonologist near her school who can give her more dedicated attention than that of the health center.  Also I don’t know how qualified they are to treat her.  If she is steroid dependent, she needs a specialist.  Sadly her misbehavior is something that you cannot do much about and she will have to learn how to deal with asthma on her own.  Hopefully without any tragedies.  It took me a long time to conform.  I’m still known as the "non-conforming-patient" at my doctor’s office.(at 36 years old!)  I’m slowly coming around but I do make it to the appointments and have learned better than most how to control my asthma.  Mainly because I don’t want to go to the doctor and don’t like to advertise my asthma.  She’ll come around, it just make take a few bouts in the ring.

– Hide quoted text — Show quoted text ->If she is anything like me when I was young and asthmatic, she’s probably in >denial. > I feel very sure that she is in denial..being an athlete, she is in great shape > otherwise but does say the hunger from the steroids is awful. I think she looks > at it as a weakness..and thinks people will see it as a flaw. She waits too > long to aknowledge a prob. then she ends up needing high dose to get it under > control. I was upset to hear that she was on 104mg of medrol a day for a few > days ..then began to slow taper.  Hopefully she will learn.Too many people > smoking around campus is also a prob. for her.

Response:

>Perhaps you need to find an allergist or pulmonologist near her >school who can give her more dedicated attention than that of the health >center.  Also I don’t know how qualified they are to treat her.

She has an allergist..that she doesn’t take the time to see…I think the nurse tried to make her aware of the importance when she finally called.  Also the Health center is sending her to a pulmo.  Thanks for the support.

Response:

Sheesh….unless you want to go enroll and be her roomie looks like she has left you no choices! Hard-headed people suffer….ask me, I know!! Took me a while too figure out that ignoring this was useless. She will come around. Denise Indianapolis

– Hide quoted text — Show quoted text ->Perhaps you need to find an allergist or pulmonologist near her >school who can give her more dedicated attention than that of the health >center.  Also I don’t know how qualified they are to treat her. > She has an allergist..that she doesn’t take the time to see…I think the nurse > tried to make her aware of the importance when she finally called.  Also the > Health center is sending her to a pulmo.  Thanks for the support.

Response:

The only thing left to suggest is a Aradigm Smartmist device.  That is if they are available.  I had one that my doctor gave me to use.  It is a small hand-held computer which you use for peak flows and inhalations.  There is a chamber on it for placing your inhaler so it monitors and distributes the medication in a controlled manner.  There is also an attachment that you use to do peakflows.  All the information is stored in memory (no. of peak flows, inhalations and results).  The doctor downloads the information into his computer using Aradigm software and then prints out the results in graph format, similar to spirometries.  There are no secrets.  If you misbehave, they know it and if you conform they know it.  It also gives the doctor information that is useful instead of information that may be exaggerated.

Response:

>The only thing left to suggest is a Aradigm Smartmist device.  That is if >they are available

hmmm.  Haven’t heard of this. Where would i find info on it???

Response:

>hmmm.  Haven’t heard of this. Where would i find info on it???

2nd. the motion.

Response:

I’ve never used the website, but the address is  http://www.aradigm.com.  I looked and there was no information about the specific device (Smartmist) I told you about.  You could probably email them to get some information, or go to one of these websites.  The 2nd one seems real good and has details about the Smartmist device.  My initial impression was that it is real useful until my non-compliant self realized that I couldn’t fudge the numbers.  I think they originally designed it for children!  But my doctor was given 3 to hand out to patients for a trial basis and feedback.  It seems that they are going to release it to the general public through a prescription.  http://www.docguide.com/dg.nsf/PrintPrint/155BA0D0376AC570852565A0005… http://www.pslgroup.com/dg/57a46.htm

Response:

>My initial impression was that it is real >useful until my non-compliant self realized that I couldn’t fudge the >numbers.

I would think this would make it useful.  Why would you want to fudge the numbers???

Response:

Well, I do not like going to the doctor, and if he thinks I am doing well, the less I have to go see him.  Of course my doctor knows this and has accused me of rounding up.  Over the years I have also learned to take care of my asthma, but sometimes not as well as my doctor would like me to.  I also don’t like the tedium of writing down the peak flow results.  That is one nice thing about the Smartmist, no writing.  It records everything for you (time, date, results).  The other drawback is that it doesn’t accept the new Advair diskus.  It does accept the Proventil, Flovent an Serevent inhalers.  Maybe they’ll design one for the Advair, although I don’t know how the machine can activate the inhaler.

– Hide quoted text — Show quoted text ->My initial impression was that it is real >useful until my non-compliant self realized that I couldn’t fudge the >numbers. > I would think this would make it useful.  Why would you want to fudge the > numbers???

Response: