At the end of one of my favorite movies of all time, The Muppets Take Manhattan, Kermit realizes that what the show really needs is more frogs and bears and chickens and things. The current question at the Staton home is whether or not we might need less. :(
Week before last, Julian had a wee cold/virus which left him with a gunky nose and a little cough. But by Sunday the cough had increased and his breaths-per-minute were up. There was no wheezing, but he was panting, much like a dog in the summer (but without his tongue hanging out;) We had albuterol left from the last go-round so we gave him a treatment that night and again Monday morning. He was already scheduled for a "well child" visit on Monday morning, so we kept a close eye on him and kept our 10:00 appointment. Of course we didn't do the well child visit (which would have included shots/jabs) but Dr. Martin took a close listen to Julian's chest and back and looked at his ears. He definitely had an ear infection, but his breathing issues were perplexing because he wasn't wheezing at all. She ordered a chest x-ray to check for pneaumonia so the boy and I headed over to the imaging center.
Julian did great for the x-ray-- much better than the 3-adults-holding-him-down situation at the hospital in February!! The really really good news is that the chest x-ray came back clear. In fact his lungs were beautifully, perfectly clear and open. After talking with Dr. Martin we decided to keep up the albuterol plus the oral antibiotic for the ear infection.
Tuesday was a little more distressing, as Julian continued to pant, but still with no wheezing. Julian and I stayed home from school and tried to take it easy. By Wednesday morning we still hadn't seen as much improvement as we had expected to see. Jonathan was ready to go to the ER. We called in to Dr. Martin's office and she ordered up the inhaled steroid, plus the oral steroid to have on hand just in case. We started the inhaled steroid right away. Julian does not do well on the oral steroid. It causes us to have a Satan Staton on our hands. He stays in tantrum mode with a hair trigger and his aggression is amazing. It's an incredible personality shift. Because of this we decided to start with just the inhaled steroid and keep a close eye on him. Wednesday night was better.
On Thursday we thought he was improving, but he had worsened by lunch time. We bit the bullet and gave him the first dose of oral steroids just after lunch. Because his worst behavior seems to peak about an hour after administration, we gave him the dose at the beginning of his nap. By mid-afternoon Julian's respirations were up and he had a fever. Aargh. So we went back to Dr. Martin's office for a thorough check-over.
The good news-- still-- is that there's no pneaumonia. And he is moving air into his lungs. He did exhibit for her the cough that has been keeping all of us up at night. And the thing is-- sigh-- it's an asthma cough, dry and tight. One thing Dr. Martin mentioned is that asthmatic folks usually have really beautiful, clear chest x-rays because their lungs are hyper-expanded, looking for air! Turns out there is a type of asthma that has only a cough as the symptom, cough-variant asthma. However, she has seen him wheeze before and has also seen him retract, so either way, my baby now has a diagnosis of asthma.
Now we are in the middle of a five day course of oral steroids, in addition to the two inhaled drugs plus the antibiotic for his ears. Julian's mood and behavior are incredible on this medicine, so if you hear wailing and gnashing of teeth coming from our house, think twice before you step inside. ;) Or at least bring some holy water to arm yourself.
Both of his severe episodes have taken place after being exposed to new types of animals. The first time he was around baby chickens and the second time we visited Yellow River Game Ranch, where he was around lots of chickens and deer and rabbits and goats and sheep. The funny thing is that he's been around those chickens lots of times since the first time, with no reaction. Perhaps it's just the introduction of new allergens that boosts his little system into overdrive. That's what we'll try to sort out in the near future. For now we'll continue this course of treatment then go back for a follow up to discuss ongoing treatment and management. It is very likely he'll grow out of this but for now it looks like we'll be taking a nebulizer with us everywhere we go.
Beth