Wednesday, October 10, 2012

The origins of the Man Cold

Callum has bronchiolitis for the second time. This case seems worse than the previous case, because that time it took me ages to figure out that he might have something more serious than a cold, and even when I did bring him to the pediatrician, I and the nurses still thought that it might be nothing.

But this time, when he started wheezing, I could tell immediately. He had a cold for a few days, just run-of-the-mill, and then Monday night, shortly after we returned home from North Carolina, he started whistling when he breathed. We put him to bed and instead of sleeping through the night like usual, he woke screaming at 2:30 a.m., and then starting at 4 a.m. he woke up wailing every half hour for the rest of the night. There was nothing we could really do for him, other than try ibuprofen in case his ears or throat were bothering him (spoiler alert: they weren't, and the ibuprofen didn't help at all). Then when he woke up we saw that he was really working hard to breathe. He was grunting with every breath and his stomach was caving in as he breathed (which I have since learned is called retracting). He was also still whistling and rasping as he breathed. I called the pediatrician on the dot of 8 and hustled him in for a sick visit later that morning.

I felt good about how I handled the situation this time. I immediately recognized that he was wheezing, compared to last time where the pediatrician had to show me the stomach retractions to point out that he was wheezing (though the wheezing was much, much more subtle last time, and pretty much nobody could have missed it this time). I didn't panic and I wasn't really worried, but I knew he needed care right away. I double-checked our nebulizer to make sure we hadn't lost any parts before we went in, in case I needed to ask for replacements at the doctor's office. We knew what to do to try to help until we could get him to the doctor, putting a humidifier in his room and encouraging fluid intake and generally soothing and cuddling and trying to help him relax. Seeing how hard he was working to breathe made me feel really sorry for him, and sorry that I couldn't help him more, but I wasn't freaking out or anything, because I knew as soon as he could get a breathing treatment he would feel much better.

The doctor was great. We brought him in and his pulse ox was low (mid-80s) and the doctor came right in and listened to him wheeze and grunt and watched his stomach and checked his lungs with the stethoscope and told me that he was in respiratory distress and needed albuterol right then, and that if he didn't respond to the albuterol or if his pulse ox went any lower we would need to take him to the hospital for oxygen. So, you know, nobody wants to hear a doctor suggest that their kid might need to go to the hospital, but even then it was just for oxygen, you know? It wasn't like he required immediate life-saving care.

Anyway, I figured we would have to do an in-office nebulizer treatment like we did the previous time, but instead the doctor went and got an inhaler! With a canister attached and a face mask attached to that so that the meds would only come out when Callum actually breathed in. And I held him down and pinned his arms and he screamed and thrashed and the doctor gave him four good puffs of the albuterol and held the mask over his face until he stopped holding his breath and breathed in a few good times, and then in literally under a minute, he was better. The grunting and retractions stopped and his breathing slowed way down (it had been 60 breaths per minute instead of the desired 40) and he visibly relaxed, and then the doctor checked his pulse ox again and it had gone up to the low 90s.

(Only then did the doctor tell me that the one possible side effect of albuterol is hyperactivity, and that within a few minutes he might be totally bouncing off the walls, but luckily it turned out that it doesn't seem to have that effect on Callum. If anything it actually seems to make him sleepy.)

It was pretty impressive to see how quickly he responded to the albuterol, and especially when the doctor then told me that lots of kids don't respond to it at all, or not nearly as well, and emphasized again that if that had been the case we would have been on our way to the hospital. But since we were lucky and he did respond, the doctor observed him for a few more minutes, checked his lungs again, prescribed an oral steroid, gave us many instructions about albuterol and the inhaler and the steroids, told us that given how well Callum had responded to the albuterol, he wasn't at all concerned that this would become more serious, and sent us home.

Where Torsten immediately began to coddle him. Which: not a bad thing! A very good thing! Very sweet to see how he was being cuddled and soothed and told how poor he was and on and on. And especially when two hours later, he went back into respiratory distress complete with grunting and retractions, all while lying limply on the floor, and I was still at the pharmacy waiting for them to finally get the meds ready so we didn't actually have any albuterol on hand yet to give him, it's nice that his dad was there.

(The second albuterol treatment did the trick, by the way, and while he's gotten somewhat wheezy a few times since then, he hasn't gone back into distress, and he's seemed much happier and more comfortable, and he took a three-hour nap yesterday and slept through the night last night, so it seems like he's improving and hopefully the oral steroids will kick in soon and he'll stop needing the albuterol. Also, OMG I am so glad we have an inhaler now instead of the nebulizer. He HATES it as much as he hated the nebulizer, but it only takes 30 seconds instead of 10-15 minutes. WIN. Also, I'm so grateful to have albuterol on hand, and really glad that the doctor made an offhand comment about how we should travel with it in the future--I am totally taking it with us on our massive Europe trip at the holidays, when we will be on many planes and in the middle of RSV season and in foreign countries where I don't even want to think about how complicated it would be to try to use our health insurance, but I totally wouldn't have thought of packing the albuterol if the doctor hadn't mentioned it.)

Anyway, the reason I originally set out to write this post wasn't even to describe all the details of what is, really, just a typical childhood disease (at least for a kid with sensitive lungs like Callum) and not all that big a deal. It was really to point out that while Callum has been a champ throughout the whole thing, Torsten has basically been doing everything in his power to give this kid a total Man Cold. Last night, for example. Callum had woken up from his massive nap, had another albuterol treatment, and was in a GREAT mood. Perky, happy, running around, playing with all his toys, babbling and talking, full of energy. And as a result, he made a giant mess with his toys. Our general policy is that before he goes to bed, he then has to help clean up any messes he's made (with our assistance, obviously, so we won't be there all night). He's very good at this and actually likes doing it. He will pick up all his toys and put them on shelves and in bins, and then he will walk around the room peering in corners and under furniture to see if he missed anything. (Yes, it is as cute as it sounds.)

But last night, Torsten took Callum to bed and then I walked into the living room to discover that the place was still a disaster area. So when Torsten came in, I asked him why he hadn't had Callum clean up like usual, and he said, "Oh, he was too sick to clean up." Despite the fact that he clearly wasn't too sick to make the damn mess in the first place.

The child is one year old and his father is already teaching him how to have a Man Cold. We are all screwed.

7 comments:

Swistle said...

I had to give nebulizer treatments in the daycare where I worked, so I feel empathetic relief for you that he can now do the inhaler instead!

I love "and told how poor he was"---cute AND funny!

Saly said...

Love this! It made me laugh!

d e v a n said...

I'm glad he's feeling a bit better! So THAT's how man colds come about! haha

Alison said...

Please note that Europe has such reasonable health care (I am intentionally not saying "progressive" - it's reasonable and should be this way here without having to progress to that point) that I doubt you would need to deal with health insurance over there if you didn't have the albuterol with you - they would probably examine him, write you a prescription, and 5 minutes and 5 dollars or so later you'd be on your merry way!

Emily said...

Ugh, I'm so glad that he's doing better. Glad you recognized it and got him to the doctor when you did!

And yes, the man cold. B even gets the slightest inkling that someone around him is sick and he's all of a sudden out of commission. Thomas is already following suit.

KT said...

Thought you would enjoy this video on the "man cold" someone posted on my last blog: http://youtu.be/VbmbMSrsZVQ.

Elizabeth said...

I hate that he was so sick, but I love that I can picture this SO easily and clearly!