American Health Stories and a Personal Update

Two links this morning, in lieu of actual content:

8 Reasons for Chronic Coughing
Asthma and allergies hit the number-one spot, of course, but there are seven more. Via the American Lung Association.

Obama’s Health Care Stories
This is a new tool at BarackObama.com that allows Americans to upload their experiences with the insurance industry and medical care in the United States. Some of the stories are pretty hard to hard. If there’s anyone out there who still doesn’t think our health care system needs changed - badly - this site could change their minds about the reform itself, if not this administration’s plan for doing so. I’m thinking about adding my own experience.

As for me: Still job-hunting, still freelancing, still playing chauffeur to the girls because driving them to their friends’ houses and free days at the Denver museums and summer concerts in the park is far more affordable than summer camp, which is just not in the budget until I’m working full-time. Therefore:

Regular posting to resume: Someday.

Asthma Steroids and the Cytokine Storm

From Marie in the comments:

Taken from http://www.newsday.com, speaking about cases in New York City:

“The most common risk factor detected among confirmed swine flu cases in the city has been asthma, health officials said.

Last week, the agency also reported 567 swine flu hospitalizations occurring in the city’s five boroughs.

Citywide, at least 79 percent of the swine flu patients have been younger than 50 and nearly 46 percent have been younger than 18, health officials said. Typically, the very young and the elderly are hardest hit by influenza.”

At least they are finally admitting asthma is a significant risk factor. I regularly read the NYC online news and I know a lot of people were very frustrated by the way health officials were refusing to be specific about the risk factors. They kept hinting that the people who died had multiple health conditions and were debilitated, which was generally not the case.

I still don’t know what to do about the steroid use issue. Will it hurt you by depressing your immune response and making you vulnerable to pneumonia if you have the flu or help you by preventing an over-reaction of the immune system (the cytokine storm)? If anyone can get a straight answer to that please post it here.

How about it, Asthma Mom readers? Should the swine flu enter your community, neighborhood, or household, do you plan to stick with the regular maintenance steroids - or even oral steroids, should a severe flare warrant them - both to keep flare symptoms down and reduce the chance of a cytokine storm? Or are you afraid steroid-induced immune system suppression coupled with the swine flu would increase the risk of pneumonia too much?

Or do you have no idea what I’m talking about?

Here’s a quick primer on the cytokine storm. Basically, it’s believed to be the reason why the 1918 influenza (and probably SARS and avian flu as well) was so deadly and seemed to target young, healthy adults. In reaction to the unknown new virus, their healthy immune systems flooded the body with so many inflammatory mediators (cytokines), the lungs flooded and they died from that reaction rather than the flu itself.

I haven’t yet read anything that states doctors are seeing this reaction in swine flu patients. If you have, send me a source please.

Either way, what Marie and I are wondering: flares aside, are asthma steroids a good or bad idea with this swine flu going around?

Because steroids suppress the immune system, which we’re guessing would help prevent the cytokine storm.

But steroids suppress the immune system, which - especially during a severe respiratory illness like influenza - ups the risk of pneumonia.

Which is the bigger risk?

AG has an appointment with her pediatrician soon, and I’ll be asking this question and posting the response I get here. In the meantime, f you’ve got any insight please leave a comment or send me an email, and I’ll share that, too.

Swine Flu, Asthma and Australia

Some new information has come out on swine flu and asthma recently, and although it affects those in the southern hemisphere more than my part of the world right now, I’m signal-boosting for everyone because it contains some good information.

Namely, the National Asthma Council Australia has issued a flu alert for all the asthma sufferers on the continent. The group was motivated to do so by this New York report showing 80% of swine flu hospitalizations in that city occurred because of underlying medical conditions, with asthma the highest risk factor at 41%.

Those numbers, along with the fact that Australians and other southern hemisphere folks are entering the typical winter cold and flu season - which already carries higher risks for asthmatics even without a pandemic - are prompting the alert, which recommends this preventative step:

Whether you are sick or not - if you have asthma and have not seen your GP in the last six months it is important you make an immediate appointment with your doctor to check the functioning and health of your lungs. Check with your GP that you are prescribed the right treatment, that you can use your inhaler correctly and that your current lung function is good. If this is all in order and you have a written asthma action plan that will guide you through any deterioration, you should be confident that you are prepared for a potentially difficult winter flu season,” said Associate Professor Matthew Peters, Respiratory Physician, Head of Respiratory Medicine at Concord Hospital, Sydney. - National Asthma Council Australia

That strikes me as excellent advice for those of us in the middle of summer, too. The time to check up on my daughter’s lung function and fine hone her maintenance and action plans is now, in June, before we enter the fall cold and flu season in the middle of a pandemic. I don’t know about you guys, but I’m making an appointment for AG sooner rather than later.

Singulair to Carry Psychiatric Precaution Now

With the recent deluge of swine flu and whiny job search posts here, let’s switch gears for a moment.

Remember all the press about Singulair, moodiness, depression, and suicide a year or so ago? Now the FDA has announced Singulair and the other leukotriene modifiers (Accolate, Zyflo) will contain a precaution about these neuropsychiatric symptoms.

Does this mean the FDA found evidence of a link between the medicine and suicidal thoughts in its review?

Not really. But:

In the clinical trial data submitted by manufacturers, neuropsychiatric events were not commonly observed, the FDA said. However, according to the agency, the available data were limited because the trials were not designed to look for neuropsychiatric events. - NewsInferno.com

For asthma parents, this news doesn’t really change anything. As usual, if you have any questions about your kid’s medication you should A) talk to your pediatrician and/or specialist and B) carefully observe your child for any side effects whenever she starts taking a new prescription.

Swine Flu and Asthma

A compilation of posts, from most to least recent:

The Deadly Cytokine Storm

Alert Issued for Australians with Asthma

WHO Announces Pandemic

Panic vs. Worry

Prevention and Flu (Any Flu)

My Original Swine Flu Post on Not Freaking Out

H1N1 Probably a Pandemic After Today

Edited 06/11-09 to add: Yep, it’s a pandemic.

The World Health Organization is expected to declare a level 6 alert, meaning a swine flu pandemic, today.

Besides not panicking, the main thing to remember in light of this (hypothetical/near future) WHO development is that calling H1N1 a “pandemic” has more to do with the spread of the disease than its severity. While most people have experienced mild symptoms and needed no hospitalization with this strain, at the same time it’s popped up in 74 countries now.

In fact, according to that link in my first sentence, authorities’ fears over the swine flu have more to do with overwhelming the medical system than with the actual severity of symptoms. Plus, the declaration will/would amp up vaccination production and containment efforts.

And if you need any more reasons to choose preparation and rationality over panic, here’s another swine flu article for you, and this one involves a gun.

Asthma Headlines: Swine Flu, Yoga, Obesity

The American Lung Association has created a swine flu page.

As long suspected, yoga appears to help asthma, but (and this is key) only in conjunction with - and not in lieu of - regular maintenance medications.

Finally, while obesity doesn’t appear to make asthma symptoms worse, it can affect the way the body reacts to asthma medications.

On this Economy and My Story: Some Lists

When AG was around 15 months old, I left my full-time job for what was meant to be the first few years of her young childhood. This was in the spring of 2000. I had graduated from college in the spring of 1998, so I had not traveled a terribly long distance down the career path yet. I didn’t leave my job doing development work for a south Florida private school - designing, writing, and editing print materials for fundraising and public relations, basically - for the reasons you might expect, either.

Which is to say, at this point in her life AG had not been diagnosed with asthma yet. While my daughter’s health was not great, as a new mother with little experience of babies, I didn’t recognize it as not great. She got sick often; her colds lasted for weeks and sometimes even a month; and we had taken her to the ER for respiratory health for the first time at 10 months, on the Millennial New Year’s Eve. Yep, we spent the biggest First Night we are likely ever to see at All Children’s Hospital in St. Petersburg, Florida.

Still, though. Life with AG did not strike us as abnormal because Mr. Asthma Mom and I did not actually know what constituted normal for a baby’s health. None of our friends had children yet, and we lived hours (in my case) and states (in his) away from our immediate families.

My thinking on leaving the world of work, then, was your typical kid vs. job reasoning: my career could wait a few years, but AG would never be this young again. When my daughter is grown and I am older, I thought, wouldn’t I miss this time with her? Probably yes, I thought, and although Mr. Asthma Mom and I did not have much money but had acquired plenty of debt while putting ourselves through college, what we did have was the freedom to live on just his salary. One benefit of having children when you’re young and poor - not that I’m advocating it unless you are a glutton for financial punishment and willing to bear the loneliness of young parenthood in a world that’s moved on to thirtysomething pregnancies, primarily - is that you’re not already locked into a huge mortgage or a hefty car payment chosen when you were single, career-minded, and able to spend freely without budgeting much. (Also, I spent a few hours each weekend tutoring and doing some freelance proofreading work to bring in some extra income, Mr. Asthma Mom worked crazy hard to increase his earning power during those early years, and Mr. and Mrs. Asthma Mom-In-Law very graciously paid off the largest student loan in our past, but those are all separate stories.)

Approximately one year and a few misdiagnosed severe flares later, the pediatrician finally figured out that AG had asthma and prescribed nebulizer treatments of albuterol and Pulmicort. And I discovered I was pregnant (I wanted to be) with the embryo that would become AG’s Steadfast Sidekick. Which is key to this particular story in the sense that even after diagnosis, I remained a stay-at-home parent for reasons other than my daughter’s lung health. Full-time care for two children is cost prohibitive, for one. The other reason? I didn’t want to go back to work when AG would attend preschool, as originally planned, because that would require putting her sister in daycare as a newborn.

So I made the decision before giving birth to the Sidekick in December 2001, but by then it was obvious AG’s health remained too problematic for preschool, anyway. We know this, because we actually tried to put her there a few hours each day. Several times, we tried preschool, and she ended up in emergency care - despite home nebulizer treatments - each time. Her symptoms and flares worsened as her baby sister grew, and the whole situation led to my homeschooling AG for kindergarten after her particularly vicious bout with pneumonia and a weeklong hospital stay on oxygen which, frankly, probably scared me more than her.

Now fast-forward to August 2005. A good position opened up for Mr. Asthma Mom in north Florida, along the Gulf Coast. Where I had lived for many years. Where Mr. Asthma Mom and I went to college, married, and had AG. Where we moved away from 6 years before, when AG was just two months-old.

Moving back made sense to us for a couple of reasons. My mother lived and taught elementary school there, and I felt confident enough in AG’s improved health and now-controlled asthma to stop homeschooling and start sending her to public school for the first time. I felt even better knowing she could attend her grandma’s school.

Plus, we were tired. Really bone-deep tired and weary from the physical and emotional costs of having a baby just out of college, moving 8 hours across the state with a two month-old, and nursing that child through some pretty serious health problems while adding a second child to our young family. Our move back to the sleepy, Southern town where much of my family lived appealed to that part of us that ached for life to be just a teeny bit easier.

I hesitate to call that move a mistake since we probably would’ve never ended up here in Denver had we not gone back to the Florida Panhandle first, but living there forced my return to that elusive career path several steps backward. Picture it: AG started first grade and thrived, her healthy 3 year-old sister could go to preschool, and I felt beyond ready to return to a full-time position.

Except this tiny town had no openings in a decent (read: clean, not scary) preschool for the Steadfast Sidekick.

Except an opening wouldn’t have mattered, anyway, because this place also had no jobs.

I could therefore accept work as a cashier at Target or in some similar capacity - honest jobs, yes, but a move that, piggybacked onto my years as a stay-at-home mom, would do me no resume favors, or continue to stay home and start freelancing. So I did 3 things:

1. I started freelance writing.
2. I started this blog.
3. I started complaining to Mr. Asthma Mom, daily, that we needed to move - yes, again - only this time to a place where we could:

1. Make a permanent home.
2. Give our children better opportunities.
3. Help me return to my career full-time, finally.

Now fast-forward one last time:

1. I’m now only 33 years-old, but the days of pregnancy, babyhood, and raising very small children are behind me.
2. I live in a wondrous, beautiful place with many more places to work and better pay at those places.
3. AG and the Steadfast Sidekick both attend school full-time now (entering fifth and second grades in August), limiting our daycare costs to summers only.
4. Mr. and Mrs. Asthma-Mom-In-Law live here, so we have family back-up for kid emergencies.

But:

1. The economy tanked.
2. Many companies are in the middle of a hiring freeze.
3. Those that are hiring are doing so internally. Not one, but three separate jobs that I am qualified and/or well-suited for have gone to in-house employees and/or temps recently, and I know one of those positions went to someone underqualified for the work. Which is fine, and even understandable. I would hang onto my job, too, if I had one right now, and as an employee I would certainly hope my company consider advancing me rather than hiring from outside. Of course I understand.

However and therefore:

1. I’m still freelancing.
2. At the same time, I’m conducting a job search that is hugely time-intensive and could drag out for as long as this recession does.
3. And the girls’ school just let out for the summer.

It’s a ridiculous situation, no?

Or maybe it’s only ridiculous if you know me in real life. I spent years proofreading, polishing, and teaching English grammar at my university, and I’ve worked in everything from desktop publishing to radio sales and promotions to Internet writing, research, and editing in “real life.” And I want to work full-time again. I miss it. Yes, we have two kids headed to college in 8 and 11 years, respectively, but more than financial need even is my need/desire to get back to the life and plans put on hold by an unexpected baby and her unexpected health problems in my twenties.

But there’s no accounting for a terrible economic climate, and this recession isn’t personal even though it sure feels that way lately.

My point?
(Yes! I actually have one.)

You may have noticed a severe reduction in posts here at the Blog of Inferior Breathing lately. Their current once-a-week frequency will continue for the near future because right now and for all those reasons listed above, my job search takes priority. Believe me, I’m hoping it won’t last long.

A Few Words About Panic and the Swine Flu

My recent posts on the swine flu have racked up higher traffic numbers than anything else I’ve posted lately, and as a result, I’ve been getting an awful lot of emails and comments questioning whether I’m panicked now even if I wasn’t before, whether I should be if I’m still not, and whether all the other asthma parents out there should panic, too.

Here’s the thing.

When I write that I’m not panicking about the swine flu, that doesn’t mean I’m not worrying about it. And that doesn’t mean you shouldn’t practice a little constructive worrying yourself.

Of course we should. Our kids work harder to breathe on any given day, anyway, so it’s scary to parent a child with respiratory problems during flu outbreaks (of any kind) and in the middle of possible pandemics. But panicking over the swine flu will not help me take care of my asthma kid, will not protect her during an outbreak or a pandemic, and will affect the way I think and react during a time when I most need to do both.

I’m worried about the swine flu, yes, but there is a vast difference between worry and panic.

True panic takes several largish steps beyond worry. Here’s the MedicineNet.com definition of panic:

A sudden strong feeling of fear that prevents reasonable thought or action.

That word “reasonable,” that’s important. Panic is sudden terror to an inhibiting degree, the kind of terror that keeps you from making sound, rational choices or taking helpful, positive steps. You don’t want to be doing this during a health scare for your child.

Let me tell you a little story about panic.

When AG was younger and her asthma was both more severe and poorly controlled, for years - years - I couldn’t count on her sleeping through the night without needing a nebulizer treatment or two and/or a trip to the ER, whenever she was flaring. The lack of sleep and the devastating knowledge that any night had the potential to end up the same way - she and I on the couch, trying to force her breathing into normal patterns - took a toll on my ability to think rationally about her asthma. Because, as you may well know yourself, when your firstborn child has never breathed dependably, it starts to feel like she never will. And in my case, that hopeless view of AG’s future health was the first sign of how I’d start reacting to the very worst of her flares: by panicking.

Panic explains the way that, for no reason I can explain, I couldn’t bring myself to drive our daughter to the hospital or acute care clinic in the middle of those nights. Lacking the control I desperately wanted of her bronchial passages, I would reach that crucial moment of powerlessness, where her asthma flares spiraled beyond any therapy I could give at home. The point where I could not help my child, no matter how much I wanted to. Every time, the terror of that knowledge turned into a debilitating panic.

It was unspoken between Mr. Asthma Mom and I that if our kid needed to see a doctor in the middle of the night, he’d be the one taking her. I Just.Couldn’t.Do.It. Logically, the hospital should have been the one place I did want to go, a safe haven full of the meds and equipment and therapists she needed. Instead, once AG started up with the intense coughing and rapid, shallow breathing, panic over my lack of control turned me into a quivering pile of mom jelly, helpless and terrified.

It didn’t make sense. I had health insurance. I lived near good hospitals. I owned a car and knew how to drive it. There is no good reason why taking her to the ER should have loomed so fearfully in my mind, but panic doesn’t make sense. That’s why it’s so destructive.

So, please:

Don’t misinterpret my writings on the swine flu. I am worried. I’m right to be, and so are you. Because this outbreak will hopefully fade away quietly, but other influenza outbreaks are inevitable. Even the normal seasonal flu that pops up every year is worth our worry, since influenza carries the very real danger of pneumonia for asthma kids. Worrying is helpful.

However, I’ve made the very conscious choice not to panic, being more than familiar with its outcome: emotional and motivational paralysis. The inability to take action will not help during the swine flu outbreak, a possible pandemic, or any other future pandemics or health-threatening situations.

Should you worry about the swine flu if you have a child with asthma?
Absolutely.

Should you panic about it?
Absolutely not.

To that end, I’m saved this post as a static swine flu page in the left sidebar. Below, you’ll find my own posts on the swine flu as well as links to good information on other sites. One of the best advantages of a blog is that commenters often offer valuable insight and information themselves, so don’t miss the suggestions some Asthma Mom readers have made, either.

My Posts

My Original Swine Flu Article: On Not Freaking Out, 1918 vs. 2009, and Good Resources
What I’m Doing for Prevention/Preparation

Swine Flu Links

Washington Post: The Vaccine
The New York Times: Predictions, Protection and Prevention
Time: 5 Burning Questions About Swine Flu

AAFA: 2009 Spring Allergy Capitals

The Asthma and Allergy Foundation of America released this year’s Spring Allergy Capitals, with the top 3 slots all in the usual mid-South. My area just makes the list of 100, clocking in at 92. You can see all 100 cities on this pdf, but check out the top 5 allergy capitals:

1. Louisville, KY
2. Knoxville, TN
3. Charlotte, NC
4. Madison, WI
5. Wichita, KS