Longing for October

A week ago, I was gushing over how happy I was to make it through October and into November. But, I TAKE IT ALL BACK. November's not proving to be any better than October was. I mean, it started out innocently enough: Saturday we went trick-or-treating, and Sunday, we went to the harvest festival at a nearby church. But, on Monday, we woke up to a Pink P in breathing distress.

For those of you who don't deal with asthma, let me explain how this works. Pink always takes a "maintenance medicine" that is basically an inhaled corticosteroid. When she is healthy and doesn't seem to be fighting with her allergies (which we treat daily with allergy meds), she is "in the green." Those days, she just takes her maintenance and allergy meds and is on her merry way.

Adult and children's peak flow meters.

On days when she seems to be under the weather or developing a cold, we make sure to check her peak flow rate using a peak flow meter (a hand-held device that measures how well your lungs can expel air). Over the course of several visits to the pulmonologist, we have been able to determine that Pink's "normal" peak flow range is anything over 160. Her "yellow" or warning range is 100-160, and anything under 100 is her danger zone. Without fail, on days when I notice she's getting a cold, her peak flow falls into the yellow, and we have to enact her asthma action plan.

Example of zones with necessary actions. Image from allergybegone.com

Pink's action plan requires us to start using her "emergency inhaler" (albuterol) when she's in the yellow in order to get the asthma under control. When Pink is in the yellow zone, she gets this every four hours while she's awake. Normally, now that we know the signs, we're able to give her a few doses of her emergency medication and get her symptoms under control. So, that's good.

The trouble is that sometimes we have days like last Monday. When Pink went to bed on Sunday, she had a bit of nasal congestion but no signs of any kinds of respiratory issues. When she woke up on Monday, though, she was clearly struggling with her asthma. Her peak flow rate was well into the red at 75 and her pulse ox was down to 94. We gave her the emergency inhaler and waited to see how she responded. Because the flare she was having seemed pretty bad, we followed that with a dose of the albuterol through her nebulizer. Thankfully, after the second treatment, she was back into the green (pulse ox 99%) and feeling fine, so we sent her to school with a note for her teacher and the school nurse to keep a close eye on her.

I didn't hear from the nurse until 2:15 p.m. By that time, I was convinced that Pink's asthma episode had been triggered by the smoke from the bonfire at the harvest festival. While we didn't go anywhere near the fire, the smoke from it blew straight from the church's lot into our neighborhood, filling the air with a thick haze. Pink wasn't in the smoke that long--just long enough for us to walk from our house to the other side of the church--and she seemed fine when she went to sleep, but given how fast the episode came on, I'm sure that was trigger. The school nurse called right before putting Pink on the bus home to let me know she was coughing. (For Pink, the cough is our biggest initial clue that she's having a full-on asthma attack.) I was puzzled as to what might have triggered the cough at school until the nurse told me that someone was burning leaves at a house next to the playground. [I foresee two letter rants, coming soon to a blog near you: "Dear Local Church with Your Stupid Bonfire" (Sky wants to call it "How Can You Call Yourself Life Church When You're Trying to Kill My Sister?") and "Dear Person Burning Leaves Instead of Bagging Them."]

#childhoodasthmasucks

When Pink got home, she still seemed okay, but we followed through with another albuterol nebulizer treatment. Within an hour, she needed another one, so I called the pulmonologist because when the emergency medicine starts not to work, you have call the pulmonologist. I got through to his nurse just before they left for the day, and they told me to take her to the ER. Well, techincally, they told me to wait 20 minutes, give her another albuterol treatment, and if that didn't work, take her to the ER, but when we get to that stage, I know what's coming next.

So, while Pink had her fourth treatment in less than 2 hours, I started getting our stuff ready for a hospital stay. The nearest hospital is 20 minutes away, and I didn't want Ren to have to drag the boys out to the hospital in the middle of the night to bring clothes to us.

When we got to the ER, the guy at check-in told me the wait could be over three hours, but when the triage lady saw Pink, she got her into a room stat! Pink's pulse ox was at 92% despite five back-to-back treatments (the pulmonologist told me to give her 2 extra puffs on the inhaler to hold her over for the ride). By this time, Pink was experiencing retractions, her nostrils were flaring, and she was panting as if she'd just run a 100 meter dash. They did what they always do at the ER--gave her a double shot of asthma meds and a dose of prednisone. And, once her pulse ox seemed to be holding at about 96%, they sent us home.

The next morning, she woke up deeper in the red than she'd been the day before. We decided to keep her home from school and watch her. I went to work to try to get a few things done before the inevitable trip back to the hospital. It looked briefly like the meds might work, but 90 minutes later, we were on our way to the ER again. Pink was finally admitted around 2 pm (or approximately 5 hours after we got to the ER for the second time).

The number that matters. When the oxygen saturation level is below 95, it's time to start worrying.

Honestly, the only thing they can do in the hospital that we can't do well at home is constantly monitor her vital signs. After 36 hours of not being able to get the asthma under control, I was glad they were keeping her for observation, even if it meant a sleepless night starting at this monitor while lying on the most uncomfortable reclining chair on the planet. Because she was on so much albuterol, Pink's heart rate was off the charts, and despite all the meds, she still spent a night hovering at 92% oxygen saturation. For the record, it's really hard not to obsess about that number when you're lying awake next to your kid in the hospital.

Here's the thing about asthma attacks: they don't look like you expect them to and once they start, sometimes there is very little you can do to stop them. With Pink, the attacks come on very subtly and sometimes very unexpectedly. She never comes to us gasping for air. There is never any drama. In fact, we have to be really paying attention to realize what is happening. The first time she had an asthma attack, we made her go through the entire night struggling to breath, and by the next morning, she could barely stand. When Ren got her to the ER, her pulse ox was 89%, and she had to stay for three nights. (That's still my worst parenting moment ever, even though I know I didn't know any better.) Now, I'd like to believe we are pretty vigilant. Even so, despite our best efforts, there are still attacks that get ahead of us and just can't be stopped.

After a night in the hospital and her third dose of prednisone, Pink finally turned the corner, and 50 hours after it started, we were home and life was back to "normal." I wish I could end here with a pithy quote or some kind of sage advice, but these asthma episodes are terrifying. So, mostly this November has started by reminding me that childhood asthma really, really sucks. Oh, and, that parenting isn't for the weak at heart.