Asthma Attacks! (and BF+medication questions) Very long

Hi everyone!

I've just been rereading posts about Barbara's recent severe asthma
attack because I googled for 'Advair', and those were apparently the
only threads that mentioned it -- so I'm guessing the hazards of
taking it while breastfeeding are not as serious as the insert says
("DO NOT BREASTFEED WHILE TAKING THIS MEDICATION") or someone would
have posted about it separately...? Anyway, between Barbara's
experience and my daughter's recent experience, (much more on that
below), I basically rushed to the Dr. and ended up prescribed Advair
and Singulair, which are working wonderfully. It's the first couple
of weeks in a year that I haven't used my albuterol inhaler at least 5
times a week. But, yesterday I got the Rx filled because the samples
I was given are almost gone. And the Advair has the big warnng from
the pharmacist. I don't know what to do.

My Dr. knows I'm still nursing, and he's out of town, so I can't call
him just now, and I want to keep taking this medicine, because it's
helping so much. But, I obviously don't want to be hurting my
daughter. Does anyone have any info about the safety of taking Advair
while nursing? If it makes a difference, my daughter is 27 months old,
and nursing no more than 2 times a day. And my prescription is the
100/50 strength.

The other thing I wanted to post about was Solana's recent experience
that was scarily similar to Barbara's, only I (yeah, the mom with
asthma herself) didn't realize it until it was nearly too late.

My older daughter Sage has had wheezing episodes a few times, and we
were told she had reactive airway disorder. She has an albuterol
inhaler with a spacer and the ped told us that if Solana ever wheezed,
which she wouldn't be surprised about, just have her use the inhaler.
This spring, Solana got bronchiolitis, and she refused to use the
inhaler, and we needed to take her to the ER for breathing treatments,
which she responded to in a couple of tries. She hadn't been 'sick'
with the bronchiolitis prior to the wheezing, but she did have a cold
type illness afterward, which we were told was the virus that made her
wheeze. We were also given a nebulizer 'just in case'.

When I say she refused to use the inhaler, I don't mean she just said
no. She was hitting us and fighting and screaming, and in danger, we
thought, of injuring herself (she has a bleeding disorder, too, so we
have to be very careful when she's fighting us). It took several
residents, nurses, and a respiratory therapist to get her to take the
treatments in the ER.

So, we went home with the nebulizer and some albuterol, and stopped
worrying, because they said it was the bronchiolitis.

Near the end of June, I was suposed to go boating with my in laws, and
Mike was going to have the girls for the day. I ended up calling and
cancelling at the last minute because while she wasn't 'sick', Solana
seemed very fussy, and I was confused and worried about her (and Mike
dealing well all day on his own). She sounded a little bit wheezy,
but nothing major, and it was obscured by the crying. I tried to have
her take the inhaler, but again, it was impossible. We tried to use
the nebulizer but she screamed so much she was getting worse, I
thought. So we went about our day, attending a party for her cousin
and letting her rest in the bedroom at the party. She kept crying
though, so when it was time (4 hours later), we took her home and
tried the medicine again. She cried more each time we tried. It was
getting to dinner time by then, so she ate, but wouldn't rest anymore,
just fussed. It wasn't full out crying, just whiny and annoying, I
felt at the time. We thought she might be getting ready to cut her 2
year molars.

After dinner, we tried the medicines one more time and she kept the
mask on for a few minutes but then continued crying. I called the
Ped, to see what I should do medication-wise (time to wait, etc..) and
while I was waiting to get a callback, Solana lay down in the living
room and went to sleep. It was the quietest she'd been all day, and I
had a minute to think, and realized I should count her breaths, and
look for retractions (what we'd been told to do with Sage, years ago).
Well, she was retracting pretty seriously between her ribs, and she
was breathing over 70 times a minute. So then I got scared. The Dr.
called back and of course I knew I'd have to go to the ER.

So, in probably the dumbest move I made all day, I got bags of toys
and books together for the girls and put them in the car, and stopped
for snacks on the way to the ER -- I was feeling bad for Sage, because
it's no fun going to the ER for your sister all the time! Solana woke
up in the car, but wouldn't eat or drink, and just kept whining. We
got to the ER and luckily got a great parking spot, so I didn't have
far to walk with them, and we came around the corner into the waiting
area, walking over to triage, because I know the drill -- we spend a
lot of time in the peds ER. I'm carrying a wailing Solana and a
dufflebag of amusements, Sage is trailing with her own bag, face
covered in chocolate ...

The triage nurse comes *running* out of triage, grabs Solana and says
'this baby can't breathe!?' half question, half command. She ran into
the triage room, weighed Solana, yelled to a nearby EMT "This baby's
going to crash!" and we all ran into the ER. Apparently she hit a
button or something because by the time we got to the room (about 20
feet in), there were 2 respiratory therapists, a bunch of nurses, a
couple of Dr.s, and some residents, plus the triage nurse and the EMT,
and me and Solana. They practically tossed her on the table and
started treatments immediately. It took most of those people to hold
her down, and Sage and I just stood there, in shock, I think.

I had no idea she was in that bad of shape. Obviously -- or I
wouldn't have waited so long to bring her in, stopped to pack a bag,
or get snacks, etc... I was so frightened. She didn't crash, but I
was stunned to find out she was even in danger of doing so. She wasn't
even wheezing at all. Apparently, her lungs were so constricted, she
didn't even have enough air to wheeze. And the fact that the nurse
heard her crying from another room and it sounded bad enough that she
ran and grabbed her. Scary. I had no idea what to listen for, even.

We ended up in the ER for the 6 allowed treatments, but she didn't
need to be ventilated. However, the treatments did improve her, but
not enough. She needed to be admitted to the hospital. We ended up
there for almost 5 days, I only left for about an hour, twice, when
Mike was able to sit with her. It was terrifying, and she had
treatments every 2 hours for several days, which was hard. She never
improved as much as they'd hoped, so they think/thought she had
bronchiolitis again, in addition to asthma. They kept asking me how
long she's had asthma, and what her medications were, and I kept
saying 'I wasn't aware that she did have asthma!' It's not like I'm
some slacker mom who wouldn't give her medicine!

I got several lessons on asthma, and she was sent home with 7 meds a
day (4 zopenex, 1 pulmicort, 1 prednisone and 1 singulair). The
Singulair is the only one we're still doing, and she's fine. After
that initial string of meds, she's only needed the nebulizer twice,
and both times she asked for it before I noticed she was short of
breath, and she takes it without a problem now! While we were in the
hospital, Sage stayed with my parents, lucklily my Mom could take off
work for 4 days, and Mike ended up needing help from his sister to
clean up our house which flooded terribly the second night we were
gone. I sure don't want to have to do that again, and I'm glad I know
what to look for in the future

I think this is the longest post I've ever written, but with all the
asthma talk around here, I thought some people might be interested.
Turns out having asthma yourself doesn't necessarily mean you can
detect an attack in someone else!

Tina.

"Tina" wrote in message
om...

I think this is the longest post I've ever written, but with all the
asthma talk around here, I thought some people might be interested.
Turns out having asthma yourself doesn't necessarily mean you can
detect an attack in someone else!

Oh Tina what a horrible fright! Thanks for sharing. Its always good to
hear from you, and I hope you get your med situation straightened out as
well.


--
Rhiannon
Madison Sophia - 9/6/01
Owen Grady - 6/23/03

Tina wrote:
Hi everyone!

I've just been rereading posts about Barbara's recent severe asthma
attack because I googled for 'Advair', and those were apparently the
only threads that mentioned it -- so I'm guessing the hazards of
taking it while breastfeeding are not as serious as the insert says
("DO NOT BREASTFEED WHILE TAKING THIS MEDICATION") or someone would
have posted about it separately...?

Advair is fluticasone and salmeterol.

Fluticasone is an L3. "When instilled intranasally, the absolute
bioavailability is less than 2%, so vitrually none of the dose instilled in
absorbed systemically. Oral absorption following inhaled fluticasone is
approximately 30%, although amlmost instant first-pass absorption virtually
eliminates plasma levels of fluticasone." "With the above oral and systemic
bioavailability, and rapid first-pass uptake by the liver, it is not liekly
that milk levels will be clinically relevant, even with rather high doses."

Salmeterol is an L2. "Maternal plasma levels of salmeterol after inhaled
administration are very low or undetectable." No reports of use in lactating
women are available, though, so I would guess that's a large part of the
reasoning behind the big old CYA on the insert.


Does anyone have any info about the safety of taking Advair
while nursing? If it makes a difference, my daughter is 27 months old,
and nursing no more than 2 times a day. And my prescription is the
100/50 strength.


Based on the data from Hale's book that I quoted above, and especially based
on Solana being older and nursing infrequently, I'd consider it to be fine.
I wouldn't hesitate to use it.

I'm glad that Solana's OK. So sorry you all had to go through that scary
experience!

--
iphigenia
www.tristyn.net
"i have heard the mermaids singing, each to each.
i do not think that they will sing to me."

"She's A Goddess" wrote in message news:5iO8b.334262$Oz4.123076@rwcrnsc54...
"Tina" wrote in message
om...

I think this is the longest post I've ever written, but with all the
asthma talk around here, I thought some people might be interested.
Turns out having asthma yourself doesn't necessarily mean you can
detect an attack in someone else!

Oh Tina what a horrible fright! Thanks for sharing. Its always good to
hear from you, and I hope you get your med situation straightened out as
well.

Good to hear from you, too! I'm trying to keep up with posts here
more, and I hope I'll be catching up even more in the future!

Tina.

I'm glad your daughter is okay!

I wanted to mention that for somewhat older kids (probably ages 5 and
older), if you go to: http://www.starbright.org/ you can order a free
CDROM game that teaches about asthma. When I first heard about it I
expected it wouldn't be a very interesting game but hey, it was free. Our
younger daughter has asthma and she was 6 years old when she played it the
first time and it *really* went a long way towards changing her attitude
about having asthma. Kids play the game to defeat asthma "villians" such as
"The Mold Mob" and "Smokita" by identifying asthma triggers and answering
asthma questions. She has had a flare-up the past few days so played the
game again yesterday and came out and demonstrated how the game says to use
the peak flow meter. She gets really tired of checking her peak flow so
sometimes she doesn't exactly give it her best effort.

BTW, the Starbright also has a free game for kids with diabetes and a comic
book for kids with burn injuries.

Lynda

(Kate R) wrote in message . com...
(Tina) wrote in message . com...
Hi everyone!

Hi Tina!

I've been thinking about you. How did your move go?


Hi Kate! I've been thinking about you all, too! Is everything still
improving, I hope? The move's gone pretty well. We haven't sold the
old place yet, but we're optimistic. I don't wish we lived in a
different market, 'cause we'd never be able to afford this new house,
but I do wish we could count on our house selling faster here! We've
got one room still all boxy, and the garage is full of stuff, but
otherwise, we're good!

The
Singulair is the only one we're still doing, and she's fine. After
that initial string of meds, she's only needed the nebulizer twice,
and both times she asked for it before I noticed she was short of
breath, and she takes it without a problem now!

I'm sorry that Solana had such a bad first time reaction. It must
have been very frightening. I was lucky because Lucas had bronchitis
that we were already monitoring when his first attack precipitated an
emergency visit to our pediatrician.

Lucas takes flovent twice a day and singulair. Right now he's been
taking albuterol 3X a day, but it's allergy season. He asks for his
huff-n-puffer when he begins to cough. It's amazing what those two
year olds can do, isn't it?


It is amazing. Solana calls everything 'coughs', even when she's not
coughing, but I know now to give her the nebulizer with her zopenex
when she says she has coughs. Is flovent a pill or an inhaled med?
It's amazing to me how similar our kids health is, at least as far as
symptoms go. I still wonder if we shouldn't be pursuing the GI stuff
further with Solana. She's putting on weight, but not a ton, really,
and I hope we know all that's going on with her.

I hope that YOU feel better too and that everything up there is
settling into a schedule. Maybe y'all will have a frost soon which
might help the allergies/asthma. We probably won't have one until
sometime in November.


I know -- frost! Allergies are much worse down near you, I know from
experience. I hope I can get everything I want planted at this new
place before the ground freezes totally, that's my worry!

Kate R

I'll email you when I get the new stuff set up here, so we can catch
up some more!

Tina.

"Circe" wrote in message news:Ksk9b.35831$n94.19656@fed1read04...
"Tina" wrote in message
om...
I've just been rereading posts about Barbara's recent severe asthma
attack because I googled for 'Advair', and those were apparently the
only threads that mentioned it -- so I'm guessing the hazards of
taking it while breastfeeding are not as serious as the insert says
("DO NOT BREASTFEED WHILE TAKING THIS MEDICATION")
or someone would have posted about it separately...?

Iphigenia already did a Hale's lookup for you, but I just wanted to say that
practically ANY medication has that warning on the insert. Heck, bottles of
OTC meds that are perfectly safe for *babies* to take (e.g. Sudafed) often
have labels that tell you not to take them without checking with a doctor if
you're nursing! All the doctors I've ever had have assured me that inhaled
steroids and the like are considerably safer, all things considered, than
anything I could take orally, simply because they are delivered right where
they're needed and less of them get into the bloodstream as a result.


Thanks. I was also guessing that since she was on practically the
same thing herself, it would be less of an issue if she got trace
amounts than maybe some other kid. I don't know.


Anyway, between Barbara's
experience and my daughter's recent experience, (much more on that
below), I basically rushed to the Dr. and ended up prescribed Advair
and Singulair, which are working wonderfully. It's the first couple
of weeks in a year that I haven't used my albuterol inhaler at least 5
times a week.

Wow, that's great. You were *way* too symptomatic before, that's for
certain. The current guidelines are that you shouldn't be symptomatic more
than 2-3 times per week with no more than one night waking due to asthma.
Glad to hear the Advair/Singulair combo is working for you. So far, it
doesn't seem I need Singulair. I have had perfect asthma control since
leaving the hospital on Advair alone.


That Adviar is great stuff. My sister-in-law reports excellent
results, too. I didn't even realize how many problems I was having
until Solana was in the hospital, and I mentioned it to one of her
Dr.s, and she was appalled. Your experience spurred me to get into
the hematologist and then the pulmonologist, too! (And it was hard
for me to tell what was a night waking due to asthma, and what was due
to kids crying
-- I didn't even know that was a symptom until the pulm. asked me!)

Does anyone have any info about the safety of taking Advair
while nursing? If it makes a difference, my daughter is 27 months old,
and nursing no more than 2 times a day. And my prescription is the
100/50 strength.

FWIW, Vernon still nurses often at 18 months old (I couldn't tell you
exactly how many times a day, but it's *way* more than 2!) and I'm taking
250/50 twice a day (though next time I see the pulmonologist, we'll discuss
trying to step down to 100/50). I haven't seen any evidence that it's doing
anything weird to him!


Thanks.

The triage nurse comes *running* out of triage, grabs Solana and says
'this baby can't breathe!?' half question, half command. She ran into
the triage room, weighed Solana, yelled to a nearby EMT "This baby's
going to crash!" and we all ran into the ER. Apparently she hit a
button or something because by the time we got to the room (about 20
feet in), there were 2 respiratory therapists, a bunch of nurses, a
couple of Dr.s, and some residents, plus the triage nurse and the EMT,
and me and Solana. They practically tossed her on the table and
started treatments immediately. It took most of those people to hold
her down, and Sage and I just stood there, in shock, I think.

I had no idea she was in that bad of shape. Obviously -- or I
wouldn't have waited so long to bring her in, stopped to pack a bag,
or get snacks, etc... I was so frightened. She didn't crash, but I
was stunned to find out she was even in danger of doing so. She wasn't
even wheezing at all. Apparently, her lungs were so constricted, she
didn't even have enough air to wheeze. And the fact that the nurse
heard her crying from another room and it sounded bad enough that she
ran and grabbed her. Scary. I had no idea what to listen for, even.

Oh, Tina, how frightening! I actually think it would be *worse* to watch
your child go through something like this than to go through it yourself.
Don't beat yourself up too much over not recognizing how serious it had
gotten, though. It can be *very* hard to judge. And I have to tell you I
think it's amazing that a child with lung constriction that severe could cry
at all; when I had my attack, I could barely speak let alone cry. So I don't
find it surprising that you didn't think it was as bad as it was.


I don't know if it could be worse. You *were* in arrest! It's
amazing (I won't beat myself up), mostly because I always thought
wheezing would be the symptom to look for. And even though I've had
attacks where I had a hard time speaking, I was too worried about
taking my meds to notice that I wasn't wheezing anymore, but I know
now I was probably the same way Solana was, beyond wheezing.

It is great that she could cry. She's a weird one, she doesn't fuss
until things are really bad, most times, but then she's as loud as can
be! She and our whole family are lucky she has such lungpower, and
can throw such a good tantrum, no matter what!

I'm glad she's doing better now, though, and that she's more receptive to
the nebulizer treatments. {{{{{Hugs}}}}} all around!
--

Thanks so much!

Tina.



Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
See us at http://photos.yahoo.com/guavaln

This week's special at the English Language Butcher Shop:
"No parking passed this sign" -- hotel parking lot sign

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

"Lynda Seehusen" wrote in message ...
I'm glad your daughter is okay!

I wanted to mention that for somewhat older kids (probably ages 5 and
older), if you go to: http://www.starbright.org/ you can order a free
CDROM game that teaches about asthma. When I first heard about it I
expected it wouldn't be a very interesting game but hey, it was free. Our
younger daughter has asthma and she was 6 years old when she played it the
first time and it *really* went a long way towards changing her attitude
about having asthma. Kids play the game to defeat asthma "villians" such as
"The Mold Mob" and "Smokita" by identifying asthma triggers and answering
asthma questions. She has had a flare-up the past few days so played the
game again yesterday and came out and demonstrated how the game says to use
the peak flow meter. She gets really tired of checking her peak flow so
sometimes she doesn't exactly give it her best effort.

BTW, the Starbright also has a free game for kids with diabetes and a comic
book for kids with burn injuries.

Lynda


Thanks alot! That sounds neat, and both of my girls would love it,
I'm sure! We'll check it out!

Tina.

(Tina) wrote in message . com...


Hi Kate! I've been thinking about you all, too! Is everything still
improving, I hope? The move's gone pretty well. We haven't sold the
old place yet, but we're optimistic. I don't wish we lived in a
different market, 'cause we'd never be able to afford this new house,
but I do wish we could count on our house selling faster here! We've
got one room still all boxy, and the garage is full of stuff, but
otherwise, we're good!

Well, if it makes you feel better, we still have stuff we haven't
unpacked and we moved here in July 2001. I really need to start
getting rid of stuff. Lucas isn't a baby anymore, and we really don't
need baby equipment to haul around as we move every 3-5 years. We
will be moving (probably) in a year to 18 months. I'm not looking
forward to it. We hope to stay in our diocese, but we could end up
moving far, far away.


It is amazing. Solana calls everything 'coughs', even when she's not
coughing, but I know now to give her the nebulizer with her zopenex
when she says she has coughs. Is flovent a pill or an inhaled med?
It's amazing to me how similar our kids health is, at least as far as
symptoms go. I still wonder if we shouldn't be pursuing the GI stuff
further with Solana. She's putting on weight, but not a ton, really,
and I hope we know all that's going on with her.

Flovent is inhaled. He uses a spacer.

It is strange that our kids sound like health twins. They are even
similar ages! Maybe we're related and don't even know it.

Lucas is most definitely gaining weight. You can't see all of his
bones anymore. Three weeks after we started his diet, I needed to buy
him new shoes! We have chilly mornings and his 12 month old pants are
finally too short. Unfortunately, the waist fits, so moving up in
size is going to mean I alter everything. We'll find out on the 16th
of October how much official weight he has gained.

I know -- frost! Allergies are much worse down near you, I know from
experience. I hope I can get everything I want planted at this new
place before the ground freezes totally, that's my worry!

It was 82 here yesterday. DH is starting to complain about mowing the
lawn.

I'll email you when I get the new stuff set up here, so we can catch
up some more!

Okay, great! I'm looking forward to more of a chat!

Kate R.

PS--I've been following your other thread. I'm glad that Solana was
fine. We've been lucky in that all of our ER visits have been during
slow times.

(Kate R) wrote in message . com...

Well, if it makes you feel better, we still have stuff we haven't
unpacked and we moved here in July 2001. I really need to start
getting rid of stuff. Lucas isn't a baby anymore, and we really don't
need baby equipment to haul around as we move every 3-5 years. We
will be moving (probably) in a year to 18 months. I'm not looking
forward to it. We hope to stay in our diocese, but we could end up
moving far, far away.


Well, I know about the box thing. We were in our old house for three
years (almost exactly) and plenty of stuff got moved here that wasn't
unpacked to begin with. If we'd have had more time, I surely would
have gone through and gotten rid of most of it. But now we get to
join in with a street/garage sale to get rid of it! I'm very afraid
that if I sell/give away all the baby stuff we'll get 'surprised'!
(Well, not afraid, but it would be annoying to repurchase everything.
I'm keeping the cloth diapers and about 10 onesies, no matter what!)


It is amazing. Solana calls everything 'coughs', even when she's not
coughing, but I know now to give her the nebulizer with her zopenex
when she says she has coughs. Is flovent a pill or an inhaled med?
It's amazing to me how similar our kids health is, at least as far as
symptoms go. I still wonder if we shouldn't be pursuing the GI stuff
further with Solana. She's putting on weight, but not a ton, really,
and I hope we know all that's going on with her.

Flovent is inhaled. He uses a spacer.

It is strange that our kids sound like health twins. They are even
similar ages! Maybe we're related and don't even know it.


You don't know how right you might be ... (I'm adopted)

Lucas is most definitely gaining weight. You can't see all of his
bones anymore. Three weeks after we started his diet, I needed to buy
him new shoes! We have chilly mornings and his 12 month old pants are
finally too short. Unfortunately, the waist fits, so moving up in
size is going to mean I alter everything. We'll find out on the 16th
of October how much official weight he has gained.


Oh, that's great! My mom got upset with me a few weeks ago when I
sent the girls to spend the night and I packed Solana some 12 month
clothes. Apparently my mom feels guilty, like we're not clothing her
properly if the size is a year younger than the baby! But they fit,
mostly! Lana gained about 3 pounds over the last visit (4-5 months?).
She feels *heavy*. I saw a dad tonight at dinner carrying what was
probably a normal sized 6-ish month old baby in a carseat carrier, and
I gasped. My kids were walking when they were half that size!

I know -- frost! Allergies are much worse down near you, I know from
experience. I hope I can get everything I want planted at this new
place before the ground freezes totally, that's my worry!

It was 82 here yesterday. DH is starting to complain about mowing the
lawn.


A friend visited today and asked why we had the air conditioning on --
we leave it set to go on at whatever temp. (I can't remember, I think
75), and I hadn't even opened a door or window -- it was about 60
outside! Hooray!

I'll email you when I get the new stuff set up here, so we can catch
up some more!

Okay, great! I'm looking forward to more of a chat!

Kate R.

PS--I've been following your other thread. I'm glad that Solana was
fine. We've been lucky in that all of our ER visits have been during
slow times.

That is lucky. Thanks for following all my travails. It's about the
only communication I'm making lately -- a couple of usenet posts.
Pretty sad, but at least people know what's going on!

Talk to you soon,

Tina.