marydell: My hand holding a medusa head sculpture (by me) that's missing its snakes (Default)
[personal profile] marydell
So we took Charlie to my/his allergist/asthma specialist, and she listened to his lungs and switched up the plan a bit.  She said not to give him the singulair or the pulmacort right now, because those are to prevent a problem and right now he's already having a problem.  She said to keep him on the antibiotic, give him more frequent breathing treatments (nebulized xopanex), and start prednisone right away.  In a week we're going back and at that point she'll evaluate him for asthma, but she said there's no point in trying to diagnose it when he's in the middle of a respiratory infection. 

If she does diagnose asthma, she said she'll probably put him on once-a-day pulmacort for 6 weeks or so, and then take him off it again, which will get him through the winter.  She said parents prefer to start with singulair because it's a chewable tablet whereas pulmacort is nebulized, but singulair only prevents one type of asthma whereas pulmacort prevents all types. So she always starts with pulmacort and only adds singulair if the asthma isn't controlled with just pulmacort.  It is SO WEIRD to have a doctor explain the whole rationale for prescribing stuff, seriously.  Also with the prednisone she said there are two types, liquid and a quick-dissolve tablet.  The tablet is more expensive but the liquid can cause an upset stomach, so which would we prefer her to prescribe? OUR CHOICE. 

At the same time she's not touchy feely at all, and she was like, "here, he should take this first prednisone tablet immediately, oh, you're nervous about giving him prednisone because of a possible rebound eczema flareup when he finishes taking it? Well, if he doesn't take it he's going to end up in the hospital, so how about you give him this right now.  You have cream for the eczema, right? so shut up, mom."  Not in those exact words, of course, but that was the basic idea.

So we have a followup with her in a week, and a followup with the regular pediatrician in a week, and that gives us time to find a nice way to tell the regular pediatrician "uh, we only sort of did what you said and we mostly totally went to another doctor, but we still love you, sorry!" 

Date: 2010-12-31 05:48 pm (UTC)
From: [identity profile] shweta-narayan.livejournal.com
Just fyi, there's singulair information that is not really well known even within the medical community.

Most asthma docs I've had say "Yeah it prevents just one type of asthma" but the very best one I've ever had (Joanne Blessing-Moore @ Stanford, who is a researcher and has All The Statistics and works mostly on children), says that actually even on people who don't see overt effects from singulair, it cuts respiratory complications and hospitalizations down. (Er, she gave me percentages vs control but that was last year, so I have forgotten numbers. But they were over 50%.)

But yeah, preventative not cure. So once Charlie's better, it may be worth considering putting him back on the singulair "like it's a vitamin", in Dr. B-M's words.

Whups correction!

Date: 2010-12-31 06:00 pm (UTC)
From: [identity profile] shweta-narayan.livejournal.com
[livejournal.com profile] elsmi says no they were smaller than 50%.

I must be misremembering cause they were unusually large for statistics so my brain inflated them :)

Re: Whups correction!

Date: 2010-12-31 06:12 pm (UTC)
From: [identity profile] shweta-narayan.livejournal.com
Or maybe I just misunderstood what [livejournal.com profile] elsmi said to me, that seems most likely now...

He says I'm... not sure. my memory is like "I think at *least* one of them was less than 50%. Or, maybe not".

Re: Whups correction!

Date: 2010-12-31 06:12 pm (UTC)
From: [identity profile] marydell.livejournal.com
If Charlie had to be hospitalized with any regularity, any statistic over 10% would seem pretty significant to me, I think. And allergy & atopy have so many unmeasurable mechanisms embedded in them, I can completely believe that singulair does some odd secret thing outside of its purported affect.

Re: Whups correction!

Date: 2010-12-31 06:14 pm (UTC)
From: [identity profile] shweta-narayan.livejournal.com
I should ask her for these papers and do a public information post. She has told me So Much. In just 2 visits.

Re: Whups correction!

Date: 2010-12-31 06:27 pm (UTC)
From: [identity profile] marydell.livejournal.com
Ooo, yeah, I would love to read all that stuff.

Date: 2010-12-31 06:07 pm (UTC)
From: [identity profile] marydell.livejournal.com
Oh, thanks, good to know! I love my singulair but the side effects in kids can be really bad, depending on the kid (mental state effects, mainly). I've been lucky in not having any side effects myself, other than sticker shock at the size of the copay.

I'm hoping Charlie's not truly asthmatic (yet) and this is just a reactive flarey thing from RSV or another virus. Asthma doc says it's pretty much inevitable that he'll develop asthma, based on how bad his eczema is, if not now then around age 4 when environmental allergies tend to kick in. She is a pessimist, though :)

Date: 2010-12-31 06:10 pm (UTC)
From: [identity profile] shweta-narayan.livejournal.com
Oh right, you said in the previous post about mental effects, I just forgot (headfuzz). And yeah, it wouldn't be worth those! :)

Hugs you you guys and get-better-soon vibes to Charlie!

Date: 2010-12-31 06:17 pm (UTC)
From: [identity profile] marydell.livejournal.com
I was nervous when I started taking it because I'm used to reading side effect lists like "upset stomach, headaches, blurred vision" and the singulair list is like "sleepwalking, hallucinations, suicidal ideation" !!! Only in a small percentage of takers but still a little startling.

Thanks for the vibes and hugs - Charlie's feeling a lot better this morning, no coughing fits overnight. And he's all hyper from the xopanex and extra obstinate from the prednisone, so it'll be like having a genetically-related-to-us kid for a few days, which is weird but entertaining (our families have ADHD all up and down the tree).

Hope you're doing well despite the headfuzz!

Date: 2010-12-31 06:41 pm (UTC)
curmudgn: (Default)
From: [personal profile] curmudgn
Even worse than Singulair co-pays are the Advair co-pays--as much as $75 a refill!

Mmm . . . thinking out loud from 50 years of personal asthma experience here . . . what about Symbicort instead?

Date: 2010-12-31 07:20 pm (UTC)
From: [identity profile] marydell.livejournal.com
Singulair is a non-steroid drug--it blocks an allergic reaction in the lungs--so I take it year-round and am taking a steroid called Alvesco ($50/month copay) for the wintertime. Advair is two drugs in one, right? So that must be why they can charge 2x as much for it. I think my mom takes that one because she has worse asthma than mine, plus COPD and emphysemia.

The kiddie inhaled steroid that's being considered for Charlie (pulmicort) appears to be one of the two drugs in Symbicort.

The craziest asthma drug cost thing has got to be how they can re-patent the drug whenever they design a new inhaler. Grr!

Date: 2011-01-01 07:14 pm (UTC)
curmudgn: Churchy LaFemme from Pogo as a witch doctor (Health)
From: [personal profile] curmudgn
Yes, Advair is a combination of Serevent and Flovent and still under patent. I'm on a 500 mcg/50mcg dose, which is fairly high.

Yes, Pulmicort is one of the two drugs in Symbicort (the other one is Foradil). Like Advair, Symbicort combines a ß2 agonist with an inhaled steroid, and the beta agonist is supposed to reduce the increased risk of death posed by using the steroid alone.

And I'm not surprised the makers can re-patent when they change the inhaler; that counts as an improvement to the delivery mechanism and is hence patentable. I don't think it's morally justified, but it is legal.

Date: 2010-12-31 06:35 pm (UTC)
From: [identity profile] cakmpls.livejournal.com
It is SO WEIRD to have a doctor explain the whole rationale for prescribing stuff, seriously.

Wow, most of our medical people have always done that. We have been SO fortunate in this area.

Date: 2010-12-31 10:27 pm (UTC)
From: [identity profile] trinker.livejournal.com
I am *so* glad you have a wonderful asthma/allergy specialist.

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