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Medical Forum / Diseases and Disorders / Asthma / December 2003hello
I decided to subscribe to this group to find more information, and possibly support. We are in the process of gaining custody of my stepson. He has asthma, and his mother has been a complicating influence in his life. Along with the asthma medication, she has had him on a pharmacy of ADHD drugs, sleeping pills, and growth hormones. We honestly don't feel he needs half of the garbage that he came here with. Last year, he came to our home with welts on his back from a coathanger, (not the first evidence of abuse, but my saga with child protection services is another story). This was also the first time he'd ever shown up with a nebulizer. Before that, I had never seen one before, so I was a little surprised at all the tubes, parts, and vials that he came with. A couple days after he got here, his breathing problems became worse, and the medicine in the vials (albuterol, I found out later) did nothing to help. I took him to the emergency room (his father was working), where I was chewed out by doctors for not knowing what medications he was taking. It's difficult to keep track, even more so than keeping track of the team of doctors his mother has taken him to. After we left the hospital and went home, I relayed my story to a friend, who asked me if I'd checked the expiration date on his medicine. I didn't know there were even any markings until they explained where to look, at which point I discovered that the medication had expired 6 months prior. Anyhow, to make a longer story brief, after 5 months with us, the district attorney refused to press charges for the assault, and child protective services said it was my stepson's fault his mother beat him. We had no choice but to return him. A month ago, she assaulted another child and is likely to go to jail for felony injury to a child. This time when he showed up, his inhaler was 2 years expired. He said that his mom had picked up an inhaler for him, but she needed it for herself and she promised to replace it but she never did. We've learned that she signed an advanced directive on him. She also has signed statements that she does not have one on herself. People have been suggesting that she might have been intentionally giving him expired medication when we get him expecting us to not know how to take care of him, and that he could end up killed through our inexperience. You'd have to know her to understand. I never knew evil until I met her. I know almost nothing about asthma. I now have an urgent need to understand as much as possible in order to do the right thing by this child. I have an appointment with a doctor this week in an attempt to get him off as much of these drugs (he hasn't been taking his ADHD meds or sleeping pills or Zoloft for the last month) as possible, but I also feel I have to know what more I can do to protect him while we're hopefully in the final processes of gaining full custody. Anything this group can tell me would be exceedingly helpful. If you're still reading this, I apologize for the length, but I felt it important to give you a small amount of history so you don't feel I'm some sort of idiot for not knowing. Thanks. >I know almost nothing about asthma. I now have an urgent need to understand >as much as possible in order to do the right thing by this child. I have an [quoted text clipped - 3 lines] >can do to protect him while we're hopefully in the final processes of >gaining full custody. Basically the symptoms of asthma are the same as the symptoms of bronchitis. I your post you mentioned two medications which I assume are an albuterol inhaler and nebulized albuterol. These medications are designed to reverse the symptoms of an asthma attack. Asthma is an inflammatory disease of the airways and current medical practice is to prevent asthma attacks from occurring by treating the underlying inflammation. If your son has a nebulizer and an inhaler then he should also be on some form of medication to control the underlying disease process and minimize the need for albuterol. You are taking the correct first step by getting him seen by a doctor. "...there is always a well-known solution to every human problem--neat, plausible, and wrong." H. L. Mencken > Basically the symptoms of asthma are the same as the symptoms of > bronchitis. I your post you mentioned two medications which I assume [quoted text clipped - 8 lines] > > You are taking the correct first step by getting him seen by a doctor. I appreciate that. Yes, both times it was albuterol, and I know that's not the only prescribed reason. Right now he's got an advair disc, although the pharmacy said he'd never had a prescription filled for it. I don't know if she could have filled it somewhere else, but the fact that it's not with the same pharmacy as all the others gives me reason to be concerned. It's difficult to know what he was taking for what condition. The list for the past year includes Xopenex, prednisone, adderall, augmentin, remeron, cephalexin, mirtazapine, singulair, zyrtec, and zoloft. These prescriptions are coming from 5 different doctors. Hopefully, having one doctor will help us to decipher and reduce the number of medications he's on. He hasn't taken the Adderall, zoloft, or remeron for the past month, and his teachers are all saying that they aren't having a problem with his behavior. Neither are we. I almost forgot to mention the growth hormones. Again, we think there is an underlying cause for this "need" for him to be on this. His mother had him put on ADHD meds when he was 2 and he tends to lose weight when he's in her care. We argue more for malnutrition than for a growth problem. She, on the other hand, keeps talking about basketball and football. Not that she (or my husband) are very tall people anyways. > > Basically the symptoms of asthma are the same as the symptoms of > > bronchitis. I your post you mentioned two medications which I assume [quoted text clipped - 24 lines] > for the past month, and his teachers are all saying that they aren't having > a problem with his behavior. Neither are we. ... > Hopefully, having one doctor will help us to decipher and reduce the number > of medications he's on. He hasn't taken the Adderall, zoloft, or remeron > for the past month, and his teachers are all saying that they aren't having > a problem with his behavior. Neither are we. One thought on the behaviour meds. Not everyone wheezes or gasps audibly during an asthma attack. However, other externally perceptible symptoms can include irritability, restlessness, anxiety (leading to the original "sense of nameless dread"), melancholy and lassitude, often in progression. It strikes me that these symptoms might be perceived as attention or mood disorders, depending on how they were presented to the physician. Best luck! L > One thought on the behaviour meds. Not everyone wheezes or gasps > audibly during an asthma attack. However, other externally [quoted text clipped - 6 lines] > Best luck! > L They were presented to the physician by a psychotic attention-starved madwoman when he was 2 years old. It's a little extreme to put a child on these drugs because he bites another child at daycare, but then it always seemed to me that these were more like the symptoms of a child lashing out from a stressful home environment to me. The asthma is real. I had to take him to the ER last year, and it was presented to me that he wouldn't have had to go if she had given us current medication, instead of albuterol that had expired 6 months prior. I had to have a friend explain to me how to even FIND the expiration date, and I suspect that the expired medication was intentional in light of the advanced directive she signed for him, as well as our suspicions about life insurance policies. Again, this isn't a disease I have any experience with. She might have been counting on me not knowing when to take him to the ER. > ... > > Hopefully, having one doctor will help us to decipher and reduce the number [quoted text clipped - 12 lines] > Best luck! > L Hi Lara, This stuff about irritability etc. sounds to me like "patient bashing" or even a sort of witch hunt by some budding psychologist, anxious to prey on asthmatics by showing that they are the cause of their own misery because of a basic mental condition. If you read the studies at http://www.i-breathe.com/thb12/Incentiv.htm and also http://www.bfe.org/protocol/pro10eng.htm you will see that it is the asthmatic trauma which leads to the helplessness and bewilderment. My experience of attacks of asthma was not only the effort of "breathing through a straw" as stated in popular accounts, but, a thousand times worse, was the humiliating feeling that every breath, which should be invigorating, was making me steadily worse and annihilating me. Psychologists may well lean over backwards when trying to understand some other traumas with empathy and doing their "debriefing", but when it comes to asthma trauma is taboo. They get more money therapizing patients to overcome a dislike of cortisone. The promise of Dr. Peper in the above studies is that "effortless diaphragmatic breathing" will overcome wheezing (i. e. act as a natural bronchodilator) and other asthma symptoms. It seems to work, although if a serious medical condition like asthma is going to be treated, any treatment is going to have a powerful effect and may backfire in some respect or other so that a medical doctor should be consulted. The elements of the Peper method seem to me to be: 1) Awareness of dysfunctional breathing in asthma. "An individual suffering from bronchial asthma will normally tend to tighten the muscles controlling the dimensions of the bronchial passages as a sort of involuntary reaction to the individual's difficulty in breathing." (Dr. Brian Tiep). 2) Somehow relax to stop this. Peper does this using muscle sensors, but I guess it is possible in some other way, like waiting till you are feeling fine due to clear sea air or the like. 3) Now simply move your tummy in an out without the feeling that you are drawing in air through the lungs. The lungs are simply deactivated. Keep your rib cage still. Now note that with patience you can in fact breathe just by more or less fooling around with your belly. 4) Do the maneuver to turn off a wheeze as he recommends to gain confidence. 5) Train this manner of breathing, more especially to get a large capacity. Peper does this with an incentive spirometer, but I find exercise works quite well. You end up with a feeling of a large inflatable ball somewhere in your belly which turns off asthma symptoms and more particularly turns off the feeling that air is being sucked into your chest on inhaling. 6) Showing that asthma may be reversed by breathing should obviously cure the trauma. I do figure that this is at least food for thought and reasonably safe. Dr. Peper seems to be a competent scientist. As regards the idea that an asthmatic is the cause of his own misery, people may quite easily slip into breathing in a disordered manner without any asthma. It seems that such breathing may be a ultimate cause of mean remarks and jokes (and also weird psychological theories), without anybody taking the trouble to see things analytically. If dysfunctional breathing (like when it is heard during mouth breathing) is noticed, why can't others, who breathe silently, be obliging enough to show people how they do it? Since when are offensive jokes supposed to be a cure for trauma? I guess a large proportion of asthmatics have never experienced and attack and may not be at risk in this way, but the sort of fear mongering by some and the prospect of lifelong medication may do a lot of mischief. Richard Friedel >Hi Lara, >The promise of Dr. Peper in the above studies is that "effortless >diaphragmatic breathing" will overcome wheezing (i. e. act as a [quoted text clipped - 3 lines] >backfire in some respect or other so that a medical doctor should be >consulted. Please note. This is not accepted by the medical community and is not consistent with current scientific understanding of how the disease process of asthma operates. "...there is always a well-known solution to every human problem--neat, plausible, and wrong." H. L. Mencken > >Hi Lara, > [quoted text clipped - 9 lines] > consistent with current scientific understanding of how the disease > process of asthma operates. Having regard to Peper's work the understanding of "of how the disease process of asthma operates" must surely be that an asthmatic has a self-destructive breathing habit, tensing his chest muscles and airways. Obviously at first blush reliever drug treatment for relaxation would seem appropriate, but in the long run this tends to make things worse. In ignoring the Peper approach the medical community disqualifies itself. I personally do not, unlike some, need a belief in this part of medical thinking for my identity. Healthy breathing is much more important. If the MC keeps on telling asthmatics that asthma is due to allergens and other factors but is not due to the habit of tensing chest muscles and bronchi, then this would be unethical. Trials of reliever medication could be called health robbery, because they simply serve to reinforce the tested persons in their belief that tenseness cannot be overcome by natural breathing tactics. What more proof do you need that asthma is in the mind? "...there is always a well-known solution to every human problem--neat, plausible, and wrong." H. L. Mencken Sounds like you are doing lip service to a principle you do not believe in. Lets all hope that Peper has accomplished something more than a very small step forward in asthma treatment. Richard Friedel >Having regard to Peper's work the understanding of "of how the disease >process of asthma operates" must surely be that an asthmatic has a >self-destructive breathing habit, tensing his chest muscles and >airways. The problem is that this theory is not consistent with what we already know about asthma. Since the disease process of asthma has been proven, intellectual honesty requires that you either modify your theory to conform with fact, or discard it altogether. >If the MC keeps on telling asthmatics that asthma is due to allergens >and other factors but is not due to the habit of tensing chest muscles >and bronchi, then this would be unethical. This would be ethical because it is based on fact. The process from allergen exposure to asthma attack can be described from start to finish at a chemical reaction level. "...there is always a well-known solution to every human problem--neat, plausible, and wrong." H. L. Mencken > >Having regard to Peper's work the understanding of "of how the disease > >process of asthma operates" must surely be that an asthmatic has a [quoted text clipped - 17 lines] > human problem--neat, plausible, and wrong." > H. L. Mencken Since the cause of asthma is not known - result of Google search with: "cause of asthma" unknown any new theory must be welcome. Dr. Peper is co-author/author of around 20 Medlined studies. Let people judge his description of the disease for themselfves (http://www.i-breathe.com/thb12/Incentiv.htm) Could it be that your secret agenda is showing that asthma is not on the mind? Maybe such an admission would lead to dismissal from the Army. Peper talks about conditioned reflexes, which is not the same as being nuts. Respectfully, Richard Friedel "You medical people will have more lives to answer for in the other world than even we generals." - Napoleon Bonaparte > Since the cause of asthma is not known - result of Google search with: > > "cause of asthma" > unknown I've seen you say this often and I always thought it was a bit implausible. I finally got around to trying it and the search returned 1,700,000 citations. -- CBI, MD > > Since the cause of asthma is not known - result of Google search with: > > [quoted text clipped - 4 lines] > I finally got around to trying it and the search returned 1,700,000 > citations. The items listed in a Google search typically have statements that the cause is unknown. Thre were 978 items in all. Regards > > > Since the cause of asthma is not known - result of Google search with: > > > [quoted text clipped - 7 lines] > The items listed in a Google search typically have statements that the > cause is unknown. Thre were 978 items in all. Regards So out of 1.7 million that come up with "cause of asthma" 978 mention that it is unknown. Seems that you are on the wrong side of the gap. Typically, they do describe causes. That is because quite a bit of what causes asthma is known (and quite a bit isn't). Since we really don't understand anything down to the quantum mechanical level you are applying an unfair standard to asthma (unless you mean to extoll the Socratic view that no knowledge is truly possible). I know of no credible source that will simply state that the cause of asthma is unknown and leave it at that. Generally, what they will say is that there are aspects that we do not (yet) understand - which is not quite the same thing.  SignatureCBI, MD > > > "Richard Friedel" <s3e0101@mailin.lrz-muenchen.de> wrote in message ........... > Typically, they do describe causes. That is because quite a bit of > what causes asthma is known (and quite a bit isn't). Since we really [quoted text clipped - 5 lines] > there are aspects that we do not (yet) understand - which is not quite > the same thing. SignatureCBI, MD There are ongoing debates about the cause of asthma and people are having constantly to be told that it is not due to environmental factors. While one can say that the cause of diabetes is not known there has not been a catastrophic rise in the incidence of that ailment. Peper with his different, scholarly approach to asthma http://www.i-breathe.com/thb12/Incentiv.htm and http://www.bfe.org/protocol/pro10eng.htm disserves consideration. 1) Peper is plausible. He has around 20 Medlined articles to his name as author/coauthor. His picture of asthma as being fraught with subtle psychological effects - like thinking about wheezing causing wheezing is surely what everybody with a detailed knowledge of the disease knows. The biomedical model cannot really apply with such somatizing effects. 2) Peper shows that wheeze can be turned off by diaphragmatic breathing. This would be completely contrary to standard asthma thinking. Give proper proof of reproducibility this would be a revolution for patients. "Paradigm shift" would be more than a trite, worn out slogan. 3) Therefore, if Peper is correct, inflammation as a cause of asthma would have to be differently presented. On the thread "support groups" you also wrote: "But you didn't answer my question about how often an asthma attack is severe enough to cause low oxygen levels but not other signs of distress." I have no idea, but could you climb down from your world of eristic quips (Socratic approach and quantum physics) and advise on Peper's and others' work on diaphragmatic breathing as a doctor (Latin = teacher)? It is said that the patient should push his belly in and out without really producing a breathing feeling (which he as an asthmatic or bronchitic will not perceive correctly anyway) but noting that he does not get short of breath. Peper recommends the use of an incentive spirometer for turning belly pushing into healthy breathing. It would be obvious to use physiotherapeutic latex band for developing belly pushing/diaphragmatic breathing by using it as tight kummerbund or sash. Would this be harmful in the long run? Richard Friedel > There are ongoing debates about the cause of asthma Which is not to say that causes are not understood. It is just that it is a complex issue and there are probably several different factors that apply variably to different people. > and people are > having constantly to be told that it is not due to environmental > factors. I'm not sure who is saying that. > While one can say that the cause of diabetes is not known I would say that our knowledge of "the cause(s)" of diabetes is an analagous situation. > there has not been a catastrophic rise in the incidence of that > ailment. Huh? Do you want to take another try at that one? > Peper with his different, scholarly approach to asthma I've critiqued Peper recently on this group. Anyone who is interested and cares to look it up should be able. No need to rehash it again so soon. -- CBI, MD > > There are ongoing debates about the cause of asthma > [quoted text clipped - 5 lines] > > having constantly to be told that it is not due to environmental > > factors. Take a look at www.phpab.org/asthma%20report/asthma.pdf about there being an epidemic One should obviously scrutinize statements like "asthma has to be based on treatment of inflammation of the airways". Why should there be no natural factor decreasing inflammation, like diaphragmatic breathing? Is it really too much of a holier than thou attitude to be condescending about docs' professional blindness? In medical school they were indoctrinated about the power of medication, like I got cultishly indoctrinated about the superiority of artificial fertilizers when I studied agriculture. The public believes in medication. The asthma situation is relativized by there being a diabetes epidemic as well, but this is not going to help you in poo-pooing the idea that asthma is out of control and that the biomedical approach is not perfect for diseases with substantial somatization.. À propos diabetes. I just heard a young mother lamenting about the diabetes diagnosis on her 10 year old son. Her grasping at a straw, namely CAM and more specially irrational use of herbs, was so heart rendering. Her fanaticism came partly from the her feeling that medicine is ideological and that there is a vast amount of iatrogenic effects. She may not have had a head for details of diabetes etiology, but she could probably assess docs' motives and lack of wisdom as well as anybody. Evidence based medicine has got to be made more plausible to the masses. This young mother and thousands like her can surely only be helped by orthodox medicine disowning things like hormone replacement therapy and excessive, doctrinaire use of pharmaceuticals for asthma, however promising they might seem in the long run. This is a political issue. Richard Friedel |
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