CP/QF Crazy: That Time Isaac Anderson's Asthma nearly killed him...

 While surfing around looking for issues within CP/QF adherents, home schooling done badly and international adoptions gone wrong, I frequently hit a random post that has some major issues that need to be addressed. 

Steven and Zsuzsanna Anderson are a CP/QF couple with ten children ranging from 16 years to a newborn son.  They hold repugnant beliefs involving homosexuality being a capital crime and got in the news cycle every 18 months or so by proclaiming that killing Obama would be godly.  They've never made the connection that the two of them would have been completely bankrupted by the major medical interventions needed during Boaz and Jachim's pregnancy if the nation-wide, one-time open enrollment plan for ACA / Obamacare hadn't lined up with the point where doctors realized that Boaz and Jachim shared a placenta causing twin-to-twin transfusion syndrome (TTTS).  In spite of heroic medical efforts, Jachim died before birth but Boaz was saved and is now a healthy toddler.

When Zsuzsanna's last home birth delivery reached transition and the baby's head failed to engage in the pelvis, she realized the danger of a prolapsed cord and transferred to a hospital where she delivered a healthy little boy.

The two of them use modern medicine - but Zsuzsanna has a strong belief in her powers as a natural healer.  I have no problem with people trying home remedies; I do it myself - but I am also aware that certain problems need prompt medical intervention especially when the nervous system, cardiovascular system or respiratory system are involved.

Apparently, Isaac, her second son, had a cough for a few days in the spring when he was 8 followed by wheezing.  His mom took him to an urgent care to be checked out where they diagnosed him with "illness-induced asthma" according to Zsuzsanna.  This is her description of his treatment:

However, it was very mild, so after one breathing treatment right there, he was sent home with an inhaler so use for the next few days until he was completely over his symptoms.

I have a mild case of asthma that is triggered by vigorous exercise, upper respiratory infections, and some chemicals.   I find Zsuzsanna's description of his medical plan on release very odd.  An urgent care would prescribe a rescue inhaler for a kid with pollen-induced asthma - but they would also be very clear that the patient needs to follow up with their primary care provider to create a care plan.  A doctor would probably want him on an anti-allergy drug during the time of year he was exposed to pollen as well as using his rescue inhaler a certain number of times a day.  Equally importantly, the Anderson's would receive additional information about signs of early and late respiratory distress and instructions on how often to use the rescue inhaler for each.

Over the next three years, Isaac gets what his parents assume is a cold that is text-book allergies roughly a week before his birthday.

In 2012,  Isaac gets his yearly cold and his mom realizes that he's allergic to pollen.  She attempts to deal with the issue at home:

So, for the next couple of days, I kept Isaac indoors, and he seemed fine as long as he stayed away from the front door. He kept coughing in the evenings, but there was little to no wheezing, and his eyes were not watery. Still, I insisted on him using his inhaler whenever the coughing started, as well as treating him with herbs that control asthma, and coughing.

This is one of those times where consultation with a doctor would have been helpful.

Isaac is so reactive to a local pollen that he's having issues when he's close to the outdoors; even if he wasn't dealing with asthma, there are options available for tamping down allergic reactions.  I wasn't much older than him when I was on a first-generation anti-allergy medication called Tavist during the spring.  Tavist made me feel like a zombie but it kept allergy symptoms under control.  Modern anti-allergy drugs are much less sedating and poor Isaac wouldn't be trapped indoors all the time.

Both coughing and wheezing are signs of early respiratory distress.  For people with asthma, this triggers a different cycle of medications.  For me, I am to use my inhaler every 6 hours and call a doctor if I am still in early distress after 24 hours.   Asthma medication are taken through inhalation and become less effective during an asthma attack because air flow through the lungs is impeded.  For Isaac, using his inhaler only in the evenings when he's coughing is like using a lid to put out a grease fire instead of avoiding the fire in the first place.

There is one more issue: that inhaler is OLD.  Inhalers need to be replaced yearly (at least) and there is a procedure that varies by brand for what needs to be done to "reactivate" the inhaler if it hasn't been used in more than 14 days.  Not only is the medication being used at a less-than-ideal time, he's probably not getting anywhere near a full dose.

By Wednesday, Isaac is doing better so Zsuzsanna lets him go outside Thursday morning for a short time.  By that night, he's in trouble:

As the evening wore on, Isaac didn't really show much change, but his cough and breathing were concerning. I spent a good hour calling every single pediatric urgent care, as well as every regular urgent care within a 30-mile radius, to see if any had wait times that were not in the 2-3 hour range. Apparently, this is RSV season, and all waiting rooms were full. I knew the ER would be even worse, and did not think Isaac was sick enough for them to triage him and get him in quickly. It was basically a toss up between what would be worse - waiting to see the regular doc in the morning, or dragging him out in the cold night for hours. Isaac was insistent that he was fine, just not able to fall asleep.

I'm not a doctor - and there's not a ton of medical info in the blog post - but Isaac sounds like he's moving from early respiratory distress - which is things like an occasional cough/wheeze, inability to fall asleep, and retractions of the lower rib cage- into late respiratory distress.   Late respiratory distress is miserable; the person is coughing or wheezing all the time, trying to ease breathing through postural support like sitting with their arms resting on the legs and neck extended, and using abdominal, chest wall and neck muscles to try and breathe.   It's physically and emotionally exhausting - and needs urgent medical treatment.

By the time Mrs. Anderson starts calling local medical clinics, Isaac's attack been untreated for a few hours after a few days of minimally effective home treatments.  She eventually finds a clinic that has a 1-hour wait time, gets someone to watch the other 5 kids and takes him in.

By the time they arrive at the urgent care clinic, Isaac is in respiratory failure which is a medical emergency.

Upon arriving at the urgent care, they immediately took his pulse oxygen levels when I told them about his breathing and wheezing. It was low, so we were taken to a room right away, and seen by the pediatrician within a couple of minutes. He explained that the situation was worse than it appeared, and that they would do a breathing treatment right there, but he didn't think it would improve Isaac enough to be able to go home.

Two breathing treatments later, Isaac still was not able to maintain adequate oxygen levels without the supplemental oxygen, and we were told he needed to transfer to the hospital for continued treatment. The children's hospital was about 8 miles away, so I could not even take him there myself in the van, the clinic said it needed to be a medical transfer so he could continue receiving oxygen during the trip.

Respiratory distress is a sign that the respiratory system is struggling to work effectively. When respiratory distress is left untreated, it can lead to respiratory failure which is when the body can no longer adequately keep oxygen levels in the body at above 90% saturation. 

The weird thing about respiratory failure is that most of the miserable symptoms of early and late respiratory distress disappear.  You stop hacking and can lay down again - but that's because the body is frantically redirecting oxygen to the brain, heart and lungs and doesn't have energy to waste on coughing and being upright.  Respiratory failure is deeply scary in a child because it is the leading cause of cardiac arrest in children; the body tries to prioritize where to send oxygen, but eventually there is so little oxygen that organs start to shut down.

Isaac was a very sick pre-teen.   One emergency breathing treatment means that they gave him a large inhaled dose of asthma medication in a nebulizer over 10-15 minutes.  After a single nebulizer treatment, I've always felt like I've drank way too much caffeine and my hands shook like leaves - but my lungs were as clear as a bell.  (But then, I've always sought treatment promptly when I was moving into late distress.)  He received two treatments at the clinic and still need oxygen support.

The reason Zsuzsanna couldn't transport herself has to do with the fact that if Isaac went off of oxygen even for a short period the inflammation in his lungs would worsen markedly.  This would make it even harder to stop the asthma attack when he arrived at the ER.

Once at the hospital, they continued breathing treatments and oxygen for several hours in the pediatric ER in hopes of being able to release us by Friday morning. However, while Isaac's lungs began sounding better again fairly quickly, his oxygen levels would dip too low anytime he went off the oxygen. We were transferred to a room by early Friday morning.

By Friday afternoon, he finally started showing great improvement, and was able to get off all oxygen by Friday evening. During the day, my mother-in-law and I kept taking turns staying with him, and caring for the other children at the house. By Friday evening, my husband had arrived back home, and he was the one to spend that night at the hospital with him. Saturday morning, the doctor said he was well enough to go home, and we were released around noon.

Isaac's long recovery time was a side-effect of not effectively treating his asthma attack for hours.  The coughing and wheezing is caused by constriction of airways in the lungs.  That disappeared as the airways opened again - but he still had inflammation in the alveoli of the lungs where gas exchange happens.  Swollen alveoli can't exchange oxygen and carbon dioxide as well so Isaac needed supplemental oxygen to keep his blood oxygen levels up until his lungs healed.

The good news is that the Andersons had scheduled an appointment with a pediatrician for a follow-up appointment.  With any luck, Isaac has a real medical plan in place to deal with his asthma.