Sunday, February 13, 2011

A Persistent Mom

As I wrote about in my previous blog, being a patient advocate is very important.  It affects you and your family member’s health.  Be the strongest advocate you can be.  After I wrote the blog on patient advocacy, I remembered a patient’s mom I came across who beautifully exemplified this idea.
I was working in a rural health clinic seeing all sorts of patients from 2 week old newborns up to 90 year old senior citizens.  One afternoon I walked into the exam room to find a new mom with her 6 week old son who needed to be seen. 
            “Hi, I’m Sharon, I’m a physician assistant, how can I help you?”
            “I’m Amber and this is my son, Colton.  He’s 6 weeks old yesterday.  I’ve brought him into the ER 2 weeks ago for wheezing and they gave him a nebulizer treatment and sent him home.  I’ve had him into see one of the local family physicians here in town last week for wheezing again and again they just gave him a nebulizer treatment and sent me home with him.  He just keeps wheezing and coughing.  He’s not sleeping very well because he starts to wheeze.  I know he has asthma, just like the rest of his family does and he needs to be on daily nebulizers for it, not just every once in a while.”
            “Okay, what did the family physician’s office tell you was his problem?”
            “They told me that he has reactive airway disease and that he’ll grow out of it, not to worry about it, they see it a lot in little kids.  But he doesn’t just have reactive airway disease, I know, he has asthma instead.”
            “Alright, well seeing that I can hear he’s wheezing again, let me go get the nebulizer and give him a treatment, then we can talk further.  Okay?”
            After starting Colton on his albuterol nebulizer I started asking Amber some more questions. 
            “When did you first notice that Colton was having problems with breathing, was it two weeks ago, just prior to the ER visit?
            “Yes.  But then he started wheezing again a few days after the ER visit and I gave him one of my nebulizer treatments and that really helped him out.  Then I brought him into see the family physician last week because he was wheezing yet again.  They weren’t helpful, all they did was give him another nebulizer treatment.” 
“Okay, go on.”
“Then a few days ago I had to give him another one of my nebulizer treatments at home because he was wheezing again.  And now in the last 2 days he’s started to cough and wheeze.  I know he has asthma just like the rest of his family does, why doesn’t anyone believe me?  This isn’t something he’ll grow out of, none of the rest of us have.”
“Alright, who else in your family has asthma?”
“I do, my other son who is 5 has it, as does my sister and my Dad.  Colton also has an aunt on his Dad’s side who has it.”
“I’d say that’s a pretty strong family history of asthma.”
“That’s why I know this isn’t just ‘reactive airway disease’, he’s got asthma and I need him to be on a nebulizer every day for it, not just when he wheezes on occasion.  Even when he’s not wheezing, I can tell that he’s not sleeping as soundly as he should because he’s coughing.  And when you’re little like this using the nebulizer is the only way to get the asthma medication down into his lungs.”
“Well you’re right about that.  Using an inhaler would be worthless with a newborn.  Why don’t you tell me about your pregnancy, did you have any problems with it?
            “No, my pregnancy was normal.  I had only one asthma exacerbation during it, and I had to be switched over to advair for four weeks for it, but then I went back to usual long acting inhaler I use every 12 hours.  I went into labor at 39 weeks and delivered Colton 4 hours later vaginally.   He was 7 lbs at birth and 20 inches long.” 
“What else is in Colton’s family history besides asthma, any diabetes, high blood pressure, cancer, or anything else?”
“Well, I think my husband said that his grandparents both died of some sort of cancer.  My in-laws are fine, I think my husband’s father has high blood pressure though.  My husband has one sister who has asthma.   He doesn’t have any other siblings.  As I said, my Dad also has asthma as does my sister.  My mom is fine, my brother is fine.”
“Okay, well it looks as though the nebulizer is almost done.  So let me listen to Colton’s lungs.”  With that I took my stethoscope and placed it on Colton’s small chest and listened to him breathing in and out without any of the noticeable wheezing sounds I had heard just earlier.  After I finished listening to his heart sounds and feeling his small abdomen I turned my attention back to Amber who by that time was looking right into Colton’s eyes and cooing at him.
I reached over and turned off the nebulizer treatment for Colton and took the tubing and face mask from Amber’s hands. 
“Okay, Amber let’s try this.  I’ll give you a prescription for Colton to receive a nebulizer treatment at home twice a day.  Why don’t you do it right before his morning nap and right before he goes to bed at night.  Let’s see how well that works.  Keep an eye on any wheezing or coughing you notice and let me know the next time you bring him in.  Will that work?”
“Yes, thank you, finally someone believes me!”
One month later I saw Colton back in for a clinic follow-up.  He was a happy baby, eating and growing normally.  His mother says that his wheezing was gone, he was only coughing whenever she forgot to give him one of twice daily nebulizer treatments.  Then she would notice he would start coughing within a few hours of her missing a treatment.   Other than that he’s was a happy, bubbly little boy, presently with a big grin on his face. 


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