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Asthma specialist? NY, ASAP



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amother


 

Post Sun, Sep 21 2014, 1:11 am
3 year old DD seems to have asthma attacks triggered by colds. She doesn't get colds terribly often I think, but they do happen several times a year despite efforts to stay clean and healthy. Maybe we need an immunologist to help with the colds, too? Anyway, I want someone more than her general pediatrician to have a look at this because it seems to get more severe each time and I'm worried that we're not treating it well enough. After it happened a few times the doctor said to use a nebulizer at the first sign of anything instead of waiting for full blown wheezing attack. But the last couple of times we did that and the full attack came anyway. Plus, the effects of the nebulizer seem to wear off way too soon. She had a cold the last few days and this morning I thought she was breathing uneasily in her sleep, so woke her up to do nebulizer around 5 AM. At 9 AM her breathing was so bad and her heart was racing so we called Hatzolah - only 4 hours after the treatment, and it might have been bad even before but I didn't know because I was still sleeping! Then at the ER they gave her more albuterol plus steroids in a nebulizer and oral prednisone, and yet when they came back from the hospital (DH had taken her) she seemed to be breathing heavily either still or again. But they said she was good to go and didn't need another treatment until dinnertime, so I uneasily waited it out but tried to keep her calm (she gets hyper from steroids) yet even with mostly sitting activities her breathing still seemed heavy and fast. So she had another nebulizer at suppertime, and they said she didn't need another one until tomorrow unless she is coughing in middle of the night. Well, she wasn't coughing but when I went to check on her at midnight her stomach was heaving in and out so hard that I gave it to her and almost thought of calling Hatzolah again. It is so freaky! But B"H the nebulizer seemed to help. Only now I am afraid to go to sleep because I'm worried that she could have breathing difficulty again at any time.

This is really scary to me because of how bad it seems and because it involves breathing, which is like kinda important to life... I really wonder if we should be doing something different to avoid these recurring problems and especially the ER part, if it's going to happen practically every time she gets sick it seems silly to wait for the crisis, call hatzolah, spend the day in the ER... every single time.

So, basically, what I want to know is if anyone knows a good dr for asthma in the NY area. Preferably one who takes medicaid managed care plans but willing to consider out of pocket for an expert if I can't find one covered. Preferably also someone I can get an appointment with within the next day or two so they can see her during an episode instead of just talking about it theoretically or waiting for a next time.
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Six boyz




 
 
    
 

Post Sun, Sep 21 2014, 1:18 am
what medicine are you putting into the neb.? Give her the nebulizer every 4 hours ,even when shes sleeping.
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amother


 

Post Sun, Sep 21 2014, 1:25 am
Albuterol. We were told every 6 hours for starters, she seems to need more, no idea how long this will last, and I'd really have someone look at her situation personally and figure out how to attack this so we don't spend so much time in the ER or wondering if we should be in the ER...
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Six boyz




 
 
    
 

Post Sun, Sep 21 2014, 1:36 am
IF the wheezing is bad albuteral can wear off after 4 hours. If she is still wheezing in between treatments, then its pretty bad. I would give my kids a double dose of albuteral.
meaning give once the neb. and wait couple of minutes , if the wheezing didnt get better give again.
BTW steroids by mouth, takes 24 hrs to work, and needs to be taken for3-5 days
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Jeanette




 
 
    
 

Post Sun, Sep 21 2014, 1:40 am
Your daughter should really be on a daily inhaled corticosteroid like QVAR or Flovent. The dose is tiny compared to what is in the oral prednisone and it is designed to go directly into the lungs so the systemic effect is minimal.

Last edited by Jeanette on Wed, Jul 29 2020, 9:24 am; edited 1 time in total
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Six boyz




 
 
    
 

Post Sun, Sep 21 2014, 1:48 am
YOU did the right thing by going to the ER. Wheezing has to be treated.
Dr. Marcus at miamonidies clinic, is very good. They are closed on Sundays. If you call and say that your daughter has difficulty breathing, they might give you an appt. for the same day. if not with him then with one of the nurses. The tel. number is 718-2836280
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amother


 

Post Sun, Sep 21 2014, 1:48 am
six boyz, the wheezing did get better right away with the albuterol, it just doesn't last very long before it starts getting worse again. And thanks for trying but I'm really not looking for medical advice here, just a recommendation of someone who can give qualified, personalized care.

And Banging head about steroids taking 24 hours to work; they don't even take 15 minutes to make her hyper!! I sent a lethargic, half-alive child off with Hatzolah and got back a chirpy, giddy birdy still breathing fast but unable to tell whether it was from asthma or from running around like a maniac. They did rx it to continue for I think 3 or 4 days... this is gonna be fun (hyper = happy albeit dangerous, but it always comes with a crash) Banging head

Jeanette, yes I was wondering if maybe a specialist would know what kind of inhaler or other preventive care would be appropriate here. Can you post the name of your specialist here?
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Jeanette




 
 
    
 

Post Sun, Sep 21 2014, 1:53 am
edit

Last edited by Jeanette on Wed, Jul 29 2020, 9:24 am; edited 1 time in total
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amother


 

Post Sun, Sep 21 2014, 2:10 am
I know we did right going to the ER, the question is should we have gone sooner - well she was breathing somewhat heavily, but we can never seem to tell when she's wheezing because it's deep in her chest only the dr's seem to be able to hear it. Where do you cross over from huffing and puffing from a bad cold to having "difficulty breathing." And then there's wondering if we should go BACK to the ER, after all we were just there and they sent us home saying it's all OK now and just continue the nebulizer, does that mean that whatever way she's breathing now is OK? Did it get worse since then? Can spend the whole night watching the child breathe. Great for your lifestyle, I tell you... Also the question of whether we could have done something before to prevent her from needing the ER at all.

Thanks for recommending dr's. Will make some calls...
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Lillian




 
 
    
 

Post Sun, Sep 21 2014, 4:16 am
Dr. Mayer Kattan In Columbia Presbyterian 212-305-5122
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anonymrs




 
 
    
 

Post Sun, Sep 21 2014, 7:03 am
Six hours is way too long. She should be getting the nebulizer every 2-4 hours, depending on symptoms. She should also probably be taking Pulmicort in the nebulizer twice a day. It's an inhaled low-dose steroid. At this point, due to the severity, she may also need a 5 day course of oral steroids, such as Prelone, to help get her breathing back under control.

It doesn't sounds like your dc has asthma on a regular basis but if this happens frequently, you may want to discuss with your doctor keeping her on a preventive medication such as Singulair.

Dr. Burstin has been tremendously helpful to us with these type of issues for many years. He will help you create a plan suited to your child to prevent her from having future emergencies.

http://pediatrics.med.nyu.edu/.....rstin

Feel free to PM me.
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Rodent




 
 
    
 

Post Sun, Sep 21 2014, 8:44 am
For reference, my son's asthma plan states that if he needs ventolin (albuterol) more often than 3 hourly to go to the hospital. It isn't given by nebuliser to little kids here though, they prefer a puffer with spacer (6 puffs -- 1 puff/4-6 breaths at a time). He is on a preventer now (Singulair) after many instances like your child. Since he started it he has never had an attack (I on the other hand had one last week, back on a preventer here too).
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treetop12




 
 
    
 

Post Mon, Sep 22 2014, 8:18 am
Firstly, it's really good that you are being proactive and insisting on seeing a specialist. Pediatricians can deal with an acute breathing issue but will rarely place a child on something long term. I have 2 children who have asthma, with my first one, it was literally 9 months of being on a nightmare roller coaster. Constant flare ups, etc. My pediatrician at the time kept insisting that he could treat him. I ended up switching pediatricians and one of the first my new doctor did was send us to a wonderful pulmonolgist (asthma specialist).
We learned all about prevention and DS was put on singulair and allergy meds, Qvar/Flovent and albuterol as needed. We received a full education on how to handle asthma and BH my DS asthma is well controlled after 6 plus years. We know his triggers and start him on albuterol and pumicourt (meds like Qvar) in the nebulizer twice a day and increase if necessary. My son 4 years younger also developed asthma as an infant and we knew the signs and were able to deal with him easily without all the pressure and issues. Most asthma attacks can be prevented and controlled if you follow your doctor's plan.
Regarding the oral steroids, they are a necessary evil as we like to refer to them. The goal is to only use them in extreme cases and not regularly. Meds like Qvar or Pumicourt are much better to use regularly, however, it just takes time for the body to respond to them...

Sorry for my long post, I can feel your frustration but just know that by seeing the right doctor the asthma will BEH be taken care of and prevented which is the key.
Hatzlacha and please feel free to PM me if you have any specific questions.
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anonymrs




 
 
    
 

Post Mon, Sep 22 2014, 1:51 pm
Rodent wrote:
For reference, my son's asthma plan states that if he needs ventolin (albuterol) more often than 3 hourly to go to the hospital. It isn't given by nebuliser to little kids here though, they prefer a puffer with spacer (6 puffs -- 1 puff/4-6 breaths at a time). He is on a preventer now (Singulair) after many instances like your child. Since he started it he has never had an attack (I on the other hand had one last week, back on a preventer here too).


This is interesting. Have you ever used a nebulizer for him? In my experience, the puffer/spacer method was completely ineffective.
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