My son – what would you do?

Question:

> We are a support group. Some people seem to thing that ’support’ > means affirmation with what you want to do. It is not. > We are giving you the best advice possible.

At the risk of prolonging this dialogue beyond its usefulness, I do appreciate the advice you are all giving me. I am not asking for affirmation of what I "want" to do. I came asking questions, and I would have appreciated more even-tempered answers in place of "you are risking your son’s life." I resent, vehemently, the suggestion that I am not taking proper care of my child. I have undertaken a task which no one has asked me, including my son’s doctor, has asked me to undertake. His asthma or potential asthma is receiving more attention than it ever did in the past. No one on this newsgroup has sufficient information to determine whether or not my son has asthma; my son’s doctor and parents are in the best position to make that call. We came asking for help, and I thank you all for providing it. >I _did_ largely outgrow my problems. I know we’re now throwing around >quotes about being stupid and making mistaken assumptions based on >experience, but without stooping to trying to prove my intelligence, I >don’t think it’s fair to throw out the baby with the bath water. Some >people, me included, do have pretty miserable childhoods and turn out to >be reasonably healthy adults. In particular consider this: > You were lucky. Untreated asthma can result in irreversible airways > damage. And you did not ‘outgrow’ your problems – your asthma went > into remission.

Again, armchair diagnosis. A few conditionals would be appropriate here. A sweeping mistrust of my doctor and my son’s doctor is simply uncalled for. > FYI, the lesson I learned about not always trusting experience was > paid for in human blood – not all of it my own.

I am sorry to hear that, but I respectfully ask that you not project your own experiences upon me and my family. >If I didn’t exercise, I would be merely another allergy sufferer. My >asthma, such as it is, has never been life-threatening. However often >my bronchial passage clog up, they never clog up enough to be >life-threatening. Am I so wrong for not seeking treatment earlier in >life? And am I so wrong for considering my son’s situation might be >much like my own? Put another way, not every person who demonstrates >symptoms of asthma actually has asthma. And not everyone sees their >symptoms remain unchanged from childhood through puberty and into >adulthood – mine changed quite a bit. > You have not had a life-threatening attack so far. You cannot assume > that is trend is going to continue. Nor can you predict that your son > will be as lucky as you have been. (If there is anything ‘lucky’ > about being forced to go without proper medical care for a medical > condition that kills with grim regularity.)

I cannot disagree with these statements. But please realize that I’m here because I’m concerned, not because I’m trying to do nothing. > It appears that you were lucky and have no permanent airways damage.

Damage is a relative term. It is well within the realm of possibility, albeit unproveable at this point in time, that if I had received more or better treatment earlier in my life my pulmonary function would be signficantly better than it is now. My situation is much like my son’s – my lungs are the weak point in all my physical activity and I am a very active person. Every time I’ve tried new medication which helped me, my performances in all my athletic endeavors have improved. It is, to be frank, frustrating to know that I could perhaps win age-group trophies at my local road races if only I could breath better. Like I said, damage is a relative thing. In my case, the damage may have taken me from the level of an athlete of some potential to being an also-ran, but it may be damage, nonetheless. > Are you willing to take the same gamble with your son?

No, I am not, which is why his condition will receive much more attention than mine did, beginning with my inquiries here. >I resent the assumptions being made here. My son’s doctor is someone >for whom I have the highest respect and, not so parenthetically, someone >who has a great deal of dislike for managed care and who has removed >himself from most, but not all, of it. > You can resent the implication all you desire. But the fact of the > matter is that your child is not getting proper medical care.

Again, this is armchair diagnosis. > Your son needs to be evaluated by an asthma specialist.

I will suggest this to my son’s doctor – I have not suggested it before, and I will suggest it in strong terms. When and if the pediatrician refuses – I will cross that bridge when I come to it. – Hide quoted text — Show quoted text ->I had the worst asthma attack of my life when I was 45 but only after >training myself to a level of exercise in outdoor running that I’d never >attempted even when I was 20 years younger. Yes, I had what was >absolutely a real asthma attack, but if I simply avoided running that >hard outdoors, I could avoid ever needing any sort of inhaled stimulant, >bronchiodilator, steroid, or other medicine. I choose not to be so >limited and therefore to take medication for my condition, but let’s >allow for the existence of people who have asthmatic symptoms but are >not in dire peril. I realize this may not apply to most of you reading >this newsgroup, but it applies to me, it applies to everyone in both my >immediate family and that of my wife, and I strongly suspect it applies >to my son as well. I am ready, willing, and able to encourage my >pediatrician to send my son to a specialist, but why is everyone here so >quick to jump to conclusions? > What makes you so sure that you are _not_ in dire peril?

A meteor may strike me dead when I walk out the front door as well. I trust my own sense of my health, and that of my doctor as well. I am not untreated for my condition, let me remind you, just not treated to the satisfaction of some here. I will bow out of the conversation at this point in time as I don’t feel I have more to ask nor do I have anything else to contribute. I am having my own annual physical in a few days; shortly thereafter I will be speaking with my son’s doctor. I will report back to the group on what we find out about both of us when I have more information. Thank you all for your input. Your sentiments are strongly felt and they have been clearly heard. -S- – Hide quoted text — Show quoted text ->Perhaps I should have said a bit more about my son’s physical condition >- he is the fastest runner in his entire grade at school. He went to >the state junior olympic 18 months ago and, with no training at all, >placed well enough to advance to the regionals, an option he declined >because it would have meant missing a friend’s birthday party. He has >an adult black belt in Tae Kwan Do, achieved shortly after his eighth >birthday. He plays baseball, soccer, basketball, and any other sport he >chooses. Does this sound like the typical asthmatic profile to you? > There is not such thing as a ‘typical’ asthmatic. > — > "We are fighting today for security, for progress, > and for peace, not only for ourselves but for all > men, not only for one generation but for all > generations. We are fighting to cleanse the world > of ancient evils, ancient ills." > Franklin Delano Rosevelt > State of the Union Address – 1942

Response:

[[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] > than it ever did in the past. No one on this newsgroup has sufficient > information to determine whether or not my son has asthma; my son’s > doctor and parents are in the best position to make that call. We came > asking for help, and I thank you all for providing it. > Again, armchair diagnosis. A few conditionals would be appropriate > here.

These excerpts suggest that you are judging the entire group by what you least like about one participant. I will contest the conclusion you have reached by quoting an early answer to your initial question, which included "I worry that treating him at this age will somehow prevent his body from better adapting to his weaknesses." This is a mystical concept, and has no real-life correlate. If your son has asthma, and you have not given us information establishing that he does, ignoring it may lead to irreversible damage in his airway. A trial of Serevent is not completely out of line, but will not give you the kind of information you need, and may well be misleading. It sounds as though your son needs pulmonary function testing, of at least the most basic type. This is not difficult, is not painful or invasive, and should be able to clarify his breathing status; then you can begin to think about his adjustment to the condition and about its treatment. Larry

Response:

>At the risk of prolonging this dialogue beyond its usefulness, I do >appreciate the advice you are all giving me. I am not asking for >affirmation of what I "want" to do. I came asking questions, and I >would have appreciated more even-tempered answers in place of "you are >risking your son’s life." I resent, vehemently, the suggestion that I >am not taking proper care of my child. I have undertaken a task which >no one has asked me, including my son’s doctor, has asked me to >undertake. His asthma or potential asthma is receiving more attention >than it ever did in the past. No one on this newsgroup has sufficient >information to determine whether or not my son has asthma; my son’s >doctor and parents are in the best position to make that call. We came >asking for help, and I thank you all for providing it.

You need to stop reacting emotionally to what you are being told. — "We are fighting today for security, for progress, and for peace, not only for ourselves but for all men, not only for one generation but for all generations. We are fighting to cleanse the world of ancient evils, ancient ills." Franklin Delano Rosevelt State of the Union Address – 1942

Response:

- Hide quoted text — Show quoted text -> There is no scientific evidence that an asthmatic’s body can "adapt" to > his condition. > I suffered miserably as a child with I-still-don’t-know what. I missed > 20-30 days of school due to illness each year and even when I went back > my pockets were stuffed with handkerchiefs and tissues and even those > wouldn’t get me through a full school day. In retrospect, I think my > problems were largely due to allergies – allergies which, combined with > a mild case of asthma, kept me in near-constant distress in my sinuses > and my lungs. > I _did_ largely outgrow my problems.

No doubt. But I don’t consider "growth" to be "adaptation." As you grew to adulthood, your airway and respiratory capacity increased, and so you’re not as bothered by your symptoms anymore. Additionally, with successive respiratory infections, your immune system developed immunity to more and more of them. (That’s why adults get fewer colds than kids.) Yes, that growth process can reduce the severity of symptoms in many young asthmatics. But it has *nothing* to do with any regimen you are proposing. It’s like saying that a young child will eventually "adapt" to being able to reach to the top of tall cabinets. Sure he will–he will (hopefully) grow to be the height of a normal adult. And exercises aren’t going to help the kid grow any faster. Now the question you *originally* raised was: > I worry that treating him at this age will somehow prevent > his body from better adapting to his weaknesses.

Why don’t you discuss your concerns with your pediatrician? I’m sure he will tell you that there is no scientific evidence that treating your son for asthma will impair this natural "growth" process from taking place. If your son can "outgrow" his symptoms like you did, then his need for medication may be reduced. But the medication won’t prevent his "outgrowing" his symptoms, if his natural constitution enables him to do that. Asthma specialists do want their patients to exercise. But they don’t consider that a substitute for good asthma treatment. > If I didn’t exercise, I would be merely another allergy sufferer.

I don’t consider "exercise" to be "adaptation" either. It’s just part of good asthma management. If you know that you are allergic to certain pollens, then you learn to avoid them. Consciously. That’s not "adaptation". Asthma specialists want their patients to exercise. But they don’t consider exercise a sufficient treatment for asthma. > My > asthma, such as it is, has never been life-threatening. However often > my bronchial passage clog up, they never clog up enough to be > life-threatening. Am I so wrong for not seeking treatment earlier in > life? And am I so wrong for considering my son’s situation might be > much like my own?

But what I don’t understand is: WHY do you want your son to retrace the same steps you took in life? If your pediatrician (or an asthma specialist you consult) can allay your fears about asthma treatment somehow impairing your son’s ability to "adapt", why not then take advantage of the best that modern medicine has to offer today? Just because your symptoms were never life-threatening, and got better as you grew to adulthood, that doesn’t mean your son will be more or less lucky than you. It’s all a random throw of the genetic dice. And even if he could be, why should he have to go thru *any* of the suffering that you went thru as a child? You say you were pretty miserable as a kid. Now that we have inhaled steroids and other meds, that kind of suffering is avoidable. There’s no reason for your son to go thru asthma attacks just because you did. > You need to take your son to an asthma specialist. He can prescribe > steroid inhalers, suggest allergy tests, etc., all things that a > pediatrician may not be knowledgeable enough to do. I’m surprised your > pediatrician hasn’t referred your son to an asthma specialist already. > I’m beginning to smell a "managed care" rat here. > I resent the assumptions being made here. My son’s doctor is someone > for whom I have the highest respect….

My concern is for your SON, who should be getting the best possible diagnosis and treatment. AFAIK, prescribing Serevent only (in the absence of a definitive diagnosis, no less) is not consistent with modern asthma treatment protocol. That’s my only concern here. > You have already observed a pattern — shortness of breath during > allergy seasons. That needs to be investigated. Otherwise you are > running a risk that a really bad attack could occur at some point. > I had the worst asthma attack of my life when I was 45 but only after > training myself to a level of exercise in outdoor running that I’d never > attempted even when I was 20 years younger. Yes, I had what was > absolutely a real asthma attack, but if I simply avoided running that > hard outdoors, I could avoid ever needing any sort of inhaled stimulant, > bronchiodilator, steroid, or other medicine.

First, that proves that you never totally "outgrew" asthma. And if you had been on adequate medication, you might not have gotten that attack at all. Second, PLEASE explain to me why you want your son to retrace the exact same steps that you did. Third, as I said, your son might get an even worse asthma attack someday. THERE IS NO WAY TO PREDICT THAT IN ADVANCE. Yes, there are professional athletes with asthma. But a couple of them have DIED of sudden asthma attacks–like that football player (forgot his name). Even those athletes are under care of physicians, and they never forget that they still have asthma. Denial is dangerous. > I realize this may not apply to most of you reading > this newsgroup, but it applies to me, it applies to everyone in both my > immediate family and that of my wife, and I strongly suspect it applies > to my son as well. I am ready, willing, and able to encourage my > pediatrician to send my son to a specialist, but why is everyone here so > quick to jump to conclusions?

I am not "jumping to conclusions" about anything. Your son has recurrent symptoms that should be investigated., and a proper diagnosis made. No matter what chronic condition it turns out to be, it should be treated with the best that modern medicine has to offer. That’s all. > Perhaps I should have said a bit more about my son’s physical condition > – he is the fastest runner in his entire grade at school. He went to > the state junior olympic 18 months ago and, with no training at all, > placed well enough to advance to the regionals, an option he declined > because it would have meant missing a friend’s birthday party. He has > an adult black belt in Tae Kwan Do, achieved shortly after his eighth > birthday. He plays baseball, soccer, basketball, and any other sport he > chooses. Does this sound like the typical asthmatic profile to you?

There is no "typical asthmatic profile." You seem to have this stereotype that all asthmatics are wimps or semi-invalids who just sit around all day and don’t do anything strenuous because they’re afraid of attacks. That’s not what asthma is all about. Some Olympic athletes have asthma. Some professional sports figures have asthma. But they NEVER forget that they have it just because they’re physically fit. They take meds, they go for tests, and they manage their asthma. Having a chronic illness is not a cause for shame or embarrassment. — Steven D. Litvintchouk

Response:

> > Since you said a history of asthma and allergies runs in your family, get > your son evaluated by an asthma specialist. Anything otherwise would be > paramount to negligence. A guy I went to college with had undiagnosed > asthma, and died from his first attack. > Enough said. > No, not enough said. There is no history of asthma in my family except > in me. There is a history of persistent sinus and ear problems, and > allergies. That’s an important distinction. I am the first one in > either my family or my wife’s to be diagnosed with asthma.

AFAIK, if you have been officially diagnosed with asthma, then there is roughly a 25% probability that your son has it too. — Steven D. Litvintchouk

Response:

> > You were lucky. Untreated asthma can result in irreversible airways > damage. And you did not ‘outgrow’ your problems – your asthma went > into remission. > Again, armchair diagnosis. A few conditionals would be appropriate > here.

OK, wait a minute. Colin’s choice of words could have been better–obviously he doesn’t know you. But Colin is quoting what medical science has established beyond a reasonable doubt–ASTHMA *NEVER* GOES AWAY. NEVER. (By "asthma" I mean the underlying inflammation and propensity to bronchospasm.) Even in asthmatics who are asymptomatic, sensitive medical tests (like methacholine challenge) will show they still have it. And that means that the potential for an acute attack is always there. Basically, the bottom line is that asthma is a potentially life-threatening condition. Someone can have it and feel OK, and walk around with it. Until one day, some asthma trigger (possibly an allergen they were only exposed to once or twice in their entire lives) causes a severe attack, which can be fatal. Lots of chronic illnesses are like that, unfortunately. High blood pressure can cause no acute symptoms whatsoever for years. But left untreated, one day the person can get a heart attack or stroke. "But I feel just fine" are, too often, tragically famous last words. You are doing the right thing in following up your son’s symptoms. Hopefully a proper diagnosis can be made soon. Good luck and best wishes to you both. — Steven D. Litvintchouk

Response:

snip >No, not enough said. There is no history of asthma in my family except >in me. There is a history of persistent sinus and ear problems, and >allergies. That’s an important distinction. I am the first one in >either my family or my wife’s to be diagnosed with asthma.

Sigh. That’s a significant enough family history of atopic (allergic) problems to warrant taking asthma seriously and aggressively treating it. Asthma can be allergic or nonallergic. The asthma in my family is all atopic, allergic asthma. jrw

Response:

-good stuff snipped – thank you for posting it. – Hide quoted text — Show quoted text -> My > asthma, such as it is, has never been life-threatening. However often > my bronchial passage clog up, they never clog up enough to be > life-threatening. Am I so wrong for not seeking treatment earlier in > life? And am I so wrong for considering my son’s situation might be > much like my own? > But what I don’t understand is: WHY do you want your son to retrace the > same steps you took in life? If your pediatrician (or an asthma > specialist you consult) can allay your fears about asthma treatment > somehow impairing your son’s ability to "adapt", why not then take > advantage of the best that modern medicine has to offer today? > Just because your symptoms were never life-threatening, and got better > as you grew to adulthood, that doesn’t mean your son will be more or > less lucky than you. It’s all a random throw of the genetic dice. And > even if he could be, why should he have to go thru *any* of the > suffering that you went thru as a child? You say you were pretty > miserable as a kid. Now that we have inhaled steroids and other meds, > that kind of suffering is avoidable. There’s no reason for your son to > go thru asthma attacks just because you did.

-snip- I don’t want my son to retrace my steps, and your point it well taken. My observation, one I can’t help making, is that he is doing so much better at his age, and has done so much better until this age, than I did as a child. But, as I look at the situation more carefully, I become convinced that his underlying asthma and allergies are probably largely the same as mine – the difference is that my wife and I have already taken much better care of him than my parents did of me. We have always encouraged him to be active, we have fed him better, and I think the amount of exercise he gets, compared to the zero amount I got, is probably what accounts for most of his success in spite of his asthmatic symptoms. I thank you, Stephen, and everyone else for their genuine concern. As I said, I am going to take the attitude that charity starts at home and be firm with my own physician at my annual check-up the day after tomorrow. And I will be calling my son’s pediatrician tomorrow morning to discuss my son’s situation and ask for a referral to an asthma specialist for him. I will post a message back here in a few days with the current status of my and my son’s treatment. By the way, today I became convinced of Serevent’s inadequacy for me. I switched from near daily, sometimes twice daily use of an Albuterol inhaler to Serevent last Fall, when my season of hard running was already over. I’ve started running hard again and have already needed to take Albuterol after a run twice in the last month. Serevent does work – it has allowed my to increase the pace of my easy runs, but it has not helped alleviate asthma symptoms when the going gets tough, and that’s what I will address with my doctor tomorrow. That and asking to take this "gold standard" test several people here have referred to. Again, thanks very much. -S-

Response:

> Since you said a history of asthma and allergies runs in your family, get > your son evaluated by an asthma specialist. Anything otherwise would be > paramount to negligence. A guy I went to college with had undiagnosed > asthma, and died from his first attack. > Enough said.

No, not enough said. There is no history of asthma in my family except in me. There is a history of persistent sinus and ear problems, and allergies. That’s an important distinction. I am the first one in either my family or my wife’s to be diagnosed with asthma. -S-

Response:

>> Since you said a history of asthma and allergies runs in your family, get > your son evaluated by an asthma specialist. Anything otherwise would be > paramount to negligence. A guy I went to college with had undiagnosed > asthma, and died from his first attack. > Enough said. >No, not enough said. There is no history of asthma in my family except >in me. There is a history of persistent sinus and ear problems, and >allergies. That’s an important distinction. I am the first one in >either my family or my wife’s to be diagnosed with asthma.

Which means that you now have a history of asthma in your family. — "We are fighting today for security, for progress, and for peace, not only for ourselves but for all men, not only for one generation but for all generations. We are fighting to cleanse the world of ancient evils, ancient ills." Franklin Delano Rosevelt State of the Union Address – 1942

Response:

You have asthma, there is now a history of asthma in your family. It does not matter that you are the first one in your family, your son needs to be elvauated by an asthma specialist. Sue

Response:

– Hide quoted text — Show quoted text -> > My quandry: I worry that treating him at this age will somehow prevent > > his body from better adapting to his weaknesses. I’d like to know if > > there’s any basis in fact for this kind of thinking – if there’s not, I > > want to get him started right away on treatment. > There is no scientific evidence that an asthmatic’s body can "adapt" to > his condition. >Steven, I’ve picked your message to reply to but all the replies here >share the same sentiment, and that sentiment is one I’m not wholly in >agreement with. Please hear me out.

We are a support group. Some people seem to thing that ’support’ means affirmation with what you want to do. It is not. We are giving you the best advice possible. >I _did_ largely outgrow my problems. I know we’re now throwing around >quotes about being stupid and making mistaken assumptions based on >experience, but without stooping to trying to prove my intelligence, I >don’t think it’s fair to throw out the baby with the bath water. Some >people, me included, do have pretty miserable childhoods and turn out to >be reasonably healthy adults. In particular consider this:

You were lucky. Untreated asthma can result in irreversible airways damage. And you did not ‘outgrow’ your problems – your asthma went into remission. FYI, the lesson I learned about not always trusting experience was paid for in human blood – not all of it my own. >If I didn’t exercise, I would be merely another allergy sufferer. My >asthma, such as it is, has never been life-threatening. However often >my bronchial passage clog up, they never clog up enough to be >life-threatening. Am I so wrong for not seeking treatment earlier in >life? And am I so wrong for considering my son’s situation might be >much like my own? Put another way, not every person who demonstrates >symptoms of asthma actually has asthma. And not everyone sees their >symptoms remain unchanged from childhood through puberty and into >adulthood – mine changed quite a bit.

You have not had a life-threatening attack so far. You cannot assume that is trend is going to continue. Nor can you predict that your son will be as lucky as you have been. (If there is anything ‘lucky’ about being forced to go without proper medical care for a medical condition that kills with grim regularity.) It appears that you were lucky and have no permanent airways damage. Are you willing to take the same gamble with your son? >I resent the assumptions being made here. My son’s doctor is someone >for whom I have the highest respect and, not so parenthetically, someone >who has a great deal of dislike for managed care and who has removed >himself from most, but not all, of it.

You can resent the implication all you desire. But the fact of the matter is that your child is not getting proper medical care. Your son needs to be evaluated by an asthma specialist. >I had the worst asthma attack of my life when I was 45 but only after >training myself to a level of exercise in outdoor running that I’d never >attempted even when I was 20 years younger. Yes, I had what was >absolutely a real asthma attack, but if I simply avoided running that >hard outdoors, I could avoid ever needing any sort of inhaled stimulant, >bronchiodilator, steroid, or other medicine. I choose not to be so >limited and therefore to take medication for my condition, but let’s >allow for the existence of people who have asthmatic symptoms but are >not in dire peril. I realize this may not apply to most of you reading >this newsgroup, but it applies to me, it applies to everyone in both my >immediate family and that of my wife, and I strongly suspect it applies >to my son as well. I am ready, willing, and able to encourage my >pediatrician to send my son to a specialist, but why is everyone here so >quick to jump to conclusions?

What makes you so sure that you are _not_ in dire peril? >Perhaps I should have said a bit more about my son’s physical condition >- he is the fastest runner in his entire grade at school. He went to >the state junior olympic 18 months ago and, with no training at all, >placed well enough to advance to the regionals, an option he declined >because it would have meant missing a friend’s birthday party. He has >an adult black belt in Tae Kwan Do, achieved shortly after his eighth >birthday. He plays baseball, soccer, basketball, and any other sport he >chooses. Does this sound like the typical asthmatic profile to you?

There is not such thing as a ‘typical’ asthmatic. — "We are fighting today for security, for progress, and for peace, not only for ourselves but for all men, not only for one generation but for all generations. We are fighting to cleanse the world of ancient evils, ancient ills." Franklin Delano Rosevelt State of the Union Address – 1942

Response:

Steve Freides giggled madly while writing:

(childhood suffering from allergies and mild asthma snipped) > I _did_ largely outgrow my problems. I know we’re now throwing around > quotes about being stupid and making mistaken assumptions based on > experience, but without stooping to trying to prove my intelligence, I > don’t think it’s fair to throw out the baby with the bath water. Some > people, me included, do have pretty miserable childhoods and turn out > to be reasonably healthy adults. In particular consider this:

and many people have pretty miserable childhoods and go into remission in their teens… only for it to come back with a vengeance later in life. > If I didn’t exercise, I would be merely another allergy sufferer. My > asthma, such as it is, has never been life-threatening. However often > my bronchial passage clog up, they never clog up enough to be > life-threatening. Am I so wrong for not seeking treatment earlier in > life? And am I so wrong for considering my son’s situation might be > much like my own? Put another way, not every person who demonstrates > symptoms of asthma actually has asthma. And not everyone sees their > symptoms remain unchanged from childhood through puberty and into > adulthood – mine changed quite a bit.

if you didn’t exercise you would be a person who doesn’t exersise who still has asthma, however mild. your choice to not seek treatment for yourself earlier is just that: your choice. you have to live with the consequences, which may or may not include airways remodelling from the inflammation which is at the root of the disease. if you choose not to seek further treatment for your son (i’d suggest at least pulmonary function tests, getting a rescue inhaler for him just in case, and possibly a methacholine challenge that would determine conclusively whether or not he really is asthmatic) /he/ will have to live with the consequences. do you want to take that gamble with your child’s future? and yes… not everyone sees their symptoms remain unchanged from childhood through puberty and into adulthood. mine seemed to have gone into remission in my early teens… then it came back, significantly worse, in my mid teens. i was not treated until i was about 16. just a counter-point. > Perhaps I should have said a bit more about my son’s physical > condition – he is the fastest runner in his entire grade at school. > He went to the state junior olympic 18 months ago and, with no > training at all, placed well enough to advance to the regionals, an > option he declined because it would have meant missing a friend’s > birthday party. He has an adult black belt in Tae Kwan Do, achieved > shortly after his eighth birthday. He plays baseball, soccer, > basketball, and any other sport he chooses. Does this sound like the > typical asthmatic profile to you?

pretty close, yes. not all asthma is exersise-induced, after all, and he shouldn’t have any symptoms unless he’s actually having an attack. Best of luck on making the right choices for the health of your son. Paige — throw the baby out with the bathwater to e-mail me.

Response:

<snipped for space> – Hide quoted text — Show quoted text -> I had the worst asthma attack of my life when I was 45 but only after > training myself to a level of exercise in outdoor running that I’d never > attempted even when I was 20 years younger. Yes, I had what was > absolutely a real asthma attack, but if I simply avoided running that > hard outdoors, I could avoid ever needing any sort of inhaled stimulant, > bronchiodilator, steroid, or other medicine. I choose not to be so > limited and therefore to take medication for my condition, but let’s > allow for the existence of people who have asthmatic symptoms but are > not in dire peril. I realize this may not apply to most of you reading > this newsgroup, but it applies to me, it applies to everyone in both my > immediate family and that of my wife, and I strongly suspect it applies > to my son as well. I am ready, willing, and able to encourage my > pediatrician to send my son to a specialist, but why is everyone here so > quick to jump to conclusions? > Perhaps I should have said a bit more about my son’s physical condition > – he is the fastest runner in his entire grade at school. He went to > the state junior olympic 18 months ago and, with no training at all, > placed well enough to advance to the regionals, an option he declined > because it would have meant missing a friend’s birthday party. He has > an adult black belt in Tae Kwan Do, achieved shortly after his eighth > birthday. He plays baseball, soccer, basketball, and any other sport he > chooses. Does this sound like the typical asthmatic profile to you?

Since you said a history of asthma and allergies runs in your family, get your son evaluated by an asthma specialist. Anything otherwise would be paramount to negligence. A guy I went to college with had undiagnosed asthma, and died from his first attack. Enough said. Aaron

Response:

> > My quandry: I worry that treating him at this age will somehow prevent > his body from better adapting to his weaknesses. I’d like to know if > there’s any basis in fact for this kind of thinking – if there’s not, I > want to get him started right away on treatment. > There is no scientific evidence that an asthmatic’s body can "adapt" to > his condition.

Steven, I’ve picked your message to reply to but all the replies here share the same sentiment, and that sentiment is one I’m not wholly in agreement with. Please hear me out. I suffered miserably as a child with I-still-don’t-know what. I missed 20-30 days of school due to illness each year and even when I went back my pockets were stuffed with handkerchiefs and tissues and even those wouldn’t get me through a full school day. In retrospect, I think my problems were largely due to allergies – allergies which, combined with a mild case of asthma, kept me in near-constant distress in my sinuses and my lungs. I _did_ largely outgrow my problems. I know we’re now throwing around quotes about being stupid and making mistaken assumptions based on experience, but without stooping to trying to prove my intelligence, I don’t think it’s fair to throw out the baby with the bath water. Some people, me included, do have pretty miserable childhoods and turn out to be reasonably healthy adults. In particular consider this: If I didn’t exercise, I would be merely another allergy sufferer. My asthma, such as it is, has never been life-threatening. However often my bronchial passage clog up, they never clog up enough to be life-threatening. Am I so wrong for not seeking treatment earlier in life? And am I so wrong for considering my son’s situation might be much like my own? Put another way, not every person who demonstrates symptoms of asthma actually has asthma. And not everyone sees their symptoms remain unchanged from childhood through puberty and into adulthood – mine changed quite a bit. > When I took him for his annual checkup 6 months ago and discussed all > this with his pediatrician, the doctor offered to prescribe Serevent to > see if it would help him as its helped me, and I feel his pediatrician > is ready, willing, and able to be responsible participant in this > process if we elect to go forward with it. > You need to take your son to an asthma specialist. He can prescribe > steroid inhalers, suggest allergy tests, etc., all things that a > pediatrician may not be knowledgeable enough to do. I’m surprised your > pediatrician hasn’t referred your son to an asthma specialist already. > I’m beginning to smell a "managed care" rat here.

I resent the assumptions being made here. My son’s doctor is someone for whom I have the highest respect and, not so parenthetically, someone who has a great deal of dislike for managed care and who has removed himself from most, but not all, of it. > "Well, it doesn’t really bother him all the time, he seems so strong > most of the time, so what if he runs out of breath?" – is this really OK > thinking or should we be seeking treatment, or at least should we wait > it out until he’s into or past puberty? > You have already observed a pattern — shortness of breath during > allergy seasons. That needs to be investigated. Otherwise you are > running a risk that a really bad attack could occur at some point.

I had the worst asthma attack of my life when I was 45 but only after training myself to a level of exercise in outdoor running that I’d never attempted even when I was 20 years younger. Yes, I had what was absolutely a real asthma attack, but if I simply avoided running that hard outdoors, I could avoid ever needing any sort of inhaled stimulant, bronchiodilator, steroid, or other medicine. I choose not to be so limited and therefore to take medication for my condition, but let’s allow for the existence of people who have asthmatic symptoms but are not in dire peril. I realize this may not apply to most of you reading this newsgroup, but it applies to me, it applies to everyone in both my immediate family and that of my wife, and I strongly suspect it applies to my son as well. I am ready, willing, and able to encourage my pediatrician to send my son to a specialist, but why is everyone here so quick to jump to conclusions? Perhaps I should have said a bit more about my son’s physical condition – he is the fastest runner in his entire grade at school. He went to the state junior olympic 18 months ago and, with no training at all, placed well enough to advance to the regionals, an option he declined because it would have meant missing a friend’s birthday party. He has an adult black belt in Tae Kwan Do, achieved shortly after his eighth birthday. He plays baseball, soccer, basketball, and any other sport he chooses. Does this sound like the typical asthmatic profile to you? > If there are any diagnostic procedures that would provide conclusive > evidence of the need for treatment (anyone else read the piece on > evidentiary (sp?) medicine in the NY times last weekend?), I would very > much appreciate a brief description of what the tests are and what > common results might suggest as treatment. > An asthma specialist can order pulmonary function tests, allergy tests, > etc. The "gold standard" test for asthma is the methacholine challenge > test. These tests will indicate how well your son is actually > breathing, with objective data. A good asthma specialist can tell if > your son has asthma, and if so, just how severe it currently is.

This is helpful information – thank you. > With today’s test technologies, there is no reason for asthma to go > undiagnosed.

I agree, and that’s why I’m here trying to learn more so that I can be an educated participant in my own and my son’s care. I will ask my pediatrician about seeing a specialist in asthma and allergies. -S- – Hide quoted text — Show quoted text -> — > Steven D. Litvintchouk

Response:

I was diagnosed at 36. my whole life i thought i was a wimp because i couldn’t exercise like other people. now i find out i would have with proper treatment, that i was actually working harder than them. GET HIM HELP! My life would have been very different, and i would have been in shape.

– Hide quoted text — Show quoted text -> My background (because I know some of this is genetic): I suffered with > asthma and allergies for most of my adult life before asking for > treatment at age 45 two years ago. My asthma is relatively mild, > definitely made worse by allergies and exercise and I exercise alot. I > now take Nasonex, Allegra, and Serevent, and will be discussing Advair > and/or Flovent with my doctor at my annual physical next week. What I > can do still suffers during days like today when it’s misting and cool > outside, or when it’s very hot, but I’m hugely improved overall, > healthier, happier, and looking forward to continueing the saga of > experimentation with different medications under my doctor’s care. > My son: I see much of myself in my 9-1/2 year old son. He gets out of > breath regularly, especially during the Spring and Fall allergy seasons, > when running. He’s very frustrated that he can’t hold his breath under > water for nearly as long as his friends but he’s otherwise a good > swimmer who’s in the pool every weekend at our local YMCA. The parallel > I see between us is that he can sprint when running just fine but he has > trouble with an truly aerobic activity, e.g., holding a moderate pace > for any length of time. The pool is where is shows up the most, and > yesterday he was fit to be tied, so frustrated that he simply can’t get > enough air into his lungs to carry him more than a few feet underwater. > Whenever he stops, if you ask him why, he’ll just shrug – nothing hurts, > nothing is tired, he’s panting and just can’t get enough air into him. > He’s also, like I am and many of you are, I’m sure, very sensitive to > smells. > My quandry: I worry that treating him at this age will somehow prevent > his body from better adapting to his weaknesses. I’d like to know if > there’s any basis in fact for this kind of thinking – if there’s not, I > want to get him started right away on treatment. > When I took him for his annual checkup 6 months ago and discussed all > this with his pediatrician, the doctor offered to prescribe Serevent to > see if it would help him as its helped me, and I feel his pediatrician > is ready, willing, and able to be responsible participant in this > process if we elect to go forward with it. > "Well, it doesn’t really bother him all the time, he seems so strong > most of the time, so what if he runs out of breath?" – is this really OK > thinking or should we be seeking treatment, or at least should we wait > it out until he’s into or past puberty? > If there are any diagnostic procedures that would provide conclusive > evidence of the need for treatment (anyone else read the piece on > evidentiary (sp?) medicine in the NY times last weekend?), I would very > much appreciate a brief description of what the tests are and what > common results might suggest as treatment. > Many thanks in advance. > -S-

Response:

> My quandry: I worry that treating him at this age will somehow prevent > his body from better adapting to his weaknesses. I’d like to know if > there’s any basis in fact for this kind of thinking – if there’s not, I > want to get him started right away on treatment.

There is no scientific evidence that an asthmatic’s body can "adapt" to his condition. > When I took him for his annual checkup 6 months ago and discussed all > this with his pediatrician, the doctor offered to prescribe Serevent to > see if it would help him as its helped me, and I feel his pediatrician > is ready, willing, and able to be responsible participant in this > process if we elect to go forward with it.

You need to take your son to an asthma specialist. He can prescribe steroid inhalers, suggest allergy tests, etc., all things that a pediatrician may not be knowledgeable enough to do. I’m surprised your pediatrician hasn’t referred your son to an asthma specialist already. I’m beginning to smell a "managed care" rat here. > "Well, it doesn’t really bother him all the time, he seems so strong > most of the time, so what if he runs out of breath?" – is this really OK > thinking or should we be seeking treatment, or at least should we wait > it out until he’s into or past puberty?

You have already observed a pattern — shortness of breath during allergy seasons. That needs to be investigated. Otherwise you are running a risk that a really bad attack could occur at some point. > If there are any diagnostic procedures that would provide conclusive > evidence of the need for treatment (anyone else read the piece on > evidentiary (sp?) medicine in the NY times last weekend?), I would very > much appreciate a brief description of what the tests are and what > common results might suggest as treatment.

An asthma specialist can order pulmonary function tests, allergy tests, etc. The "gold standard" test for asthma is the methacholine challenge test. These tests will indicate how well your son is actually breathing, with objective data. A good asthma specialist can tell if your son has asthma, and if so, just how severe it currently is. With today’s test technologies, there is no reason for asthma to go undiagnosed. — Steven D. Litvintchouk

Response:

> >When I took him for his annual checkup 6 months ago and discussed all >this with his pediatrician, the doctor offered to prescribe Serevent to >see if it would help him as its helped me, and I feel his pediatrician >is ready, willing, and able to be responsible participant in this >process if we elect to go forward with it. > Find a better doctor. Serevent is not intended to be used as a > primary asthma medication.

Until asthma tests and any other needed tests can be scheduled, it might have been a good idea to prescribe a "rescue inhaler" to keep on hand just in case. Albuterol. Not Serevent. — Steven D. Litvintchouk

Response:

>My background (because I know some of this is genetic): I suffered with >asthma and allergies for most of my adult life before asking for >treatment at age 45 two years ago. My asthma is relatively mild, >definitely made worse by allergies and exercise and I exercise alot. I >now take Nasonex, Allegra, and Serevent, and will be discussing Advair >and/or Flovent with my doctor at my annual physical next week. What I >can do still suffers during days like today when it’s misting and cool >outside, or when it’s very hot, but I’m hugely improved overall, >healthier, happier, and looking forward to continueing the saga of >experimentation with different medications under my doctor’s care.

You need to be discussing adding an anti-inflammitory medication. Serevent only treats asthma symptoms – not the inflammation that causes asthma attacks. >My quandry: I worry that treating him at this age will somehow prevent >his body from better adapting to his weaknesses. I’d like to know if >there’s any basis in fact for this kind of thinking – if there’s not, I >want to get him started right away on treatment.

First of all – his body will not adapt. Get him to a better doctor than the one you have now and get his asthma under treatment. >When I took him for his annual checkup 6 months ago and discussed all >this with his pediatrician, the doctor offered to prescribe Serevent to >see if it would help him as its helped me, and I feel his pediatrician >is ready, willing, and able to be responsible participant in this >process if we elect to go forward with it.

Find a better doctor. Serevent is not intended to be used as a primary asthma medication. >"Well, it doesn’t really bother him all the time, he seems so strong >most of the time, so what if he runs out of breath?" – is this really OK >thinking or should we be seeking treatment, or at least should we wait >it out until he’s into or past puberty?

<sarcasm mode on> Why don’t you just wait until he is in ICU on life support from a serious asthma attack? <sarcasm mode off> Every year asthma _kills_ 5,500 people in the US alone. With current treatment options, every one of those deaths are considered to be preventible by the medical community. >If there are any diagnostic procedures that would provide conclusive >evidence of the need for treatment (anyone else read the piece on >evidentiary (sp?) medicine in the NY times last weekend?), I would very >much appreciate a brief description of what the tests are and what >common results might suggest as treatment.

Get a referral to a doctor who specializes in asthma. — "We are fighting today for security, for progress, and for peace, not only for ourselves but for all men, not only for one generation but for all generations. We are fighting to cleanse the world of ancient evils, ancient ills." Franklin Delano Rosevelt State of the Union Address – 1942

Response:

This is a mystical concept, and has no real-life correlate. If your son has asthma, and you have not given us information establishing that he does, ignoring it may lead to irreversible damage in his airway. A trial of Serevant is not completely out of line, but will not give you the kind of information you need, and may well be misleading. It sounds as though your son needs pulmonary function testing, of at least the most basic type. This is not difficult, is not painful or invasive, and should be able to clarify his breathing status; then you can begin to think about his adjustment to the condition and about its treatment. Larry

Response:

Wow! I cannot understnad the concept of not getting him treatment. To think his body will adapt is really bizarre…….and you know, honestly, can border on the criminal, as in neglect. So, get that child to a doctor. I have had asthma my entire life. OLYMPIC athletes have asthma, many swimmers do. Get that child to a doctor. Good lord. Denise — Cowards die many times before their deaths; The valiant never taste of death but once. -Shakespeare-

Response:

My background (because I know some of this is genetic): I suffered with asthma and allergies for most of my adult life before asking for treatment at age 45 two years ago. My asthma is relatively mild, definitely made worse by allergies and exercise and I exercise alot. I now take Nasonex, Allegra, and Serevent, and will be discussing Advair and/or Flovent with my doctor at my annual physical next week. What I can do still suffers during days like today when it’s misting and cool outside, or when it’s very hot, but I’m hugely improved overall, healthier, happier, and looking forward to continueing the saga of experimentation with different medications under my doctor’s care. My son: I see much of myself in my 9-1/2 year old son. He gets out of breath regularly, especially during the Spring and Fall allergy seasons, when running. He’s very frustrated that he can’t hold his breath under water for nearly as long as his friends but he’s otherwise a good swimmer who’s in the pool every weekend at our local YMCA. The parallel I see between us is that he can sprint when running just fine but he has trouble with an truly aerobic activity, e.g., holding a moderate pace for any length of time. The pool is where is shows up the most, and yesterday he was fit to be tied, so frustrated that he simply can’t get enough air into his lungs to carry him more than a few feet underwater. Whenever he stops, if you ask him why, he’ll just shrug – nothing hurts, nothing is tired, he’s panting and just can’t get enough air into him. He’s also, like I am and many of you are, I’m sure, very sensitive to smells. My quandry: I worry that treating him at this age will somehow prevent his body from better adapting to his weaknesses. I’d like to know if there’s any basis in fact for this kind of thinking – if there’s not, I want to get him started right away on treatment. When I took him for his annual checkup 6 months ago and discussed all this with his pediatrician, the doctor offered to prescribe Serevent to see if it would help him as its helped me, and I feel his pediatrician is ready, willing, and able to be responsible participant in this process if we elect to go forward with it. "Well, it doesn’t really bother him all the time, he seems so strong most of the time, so what if he runs out of breath?" – is this really OK thinking or should we be seeking treatment, or at least should we wait it out until he’s into or past puberty? If there are any diagnostic procedures that would provide conclusive evidence of the need for treatment (anyone else read the piece on evidentiary (sp?) medicine in the NY times last weekend?), I would very much appreciate a brief description of what the tests are and what common results might suggest as treatment. Many thanks in advance. -S-

Mr. Asthma

Knows everything about Asthma

Bronchial Asthma

My son – what would you do?

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