1930-1950: The rise of the asthmatic institution x

Figure 1 -- NJH patients receiving sunlight exposure treatment

Thanks to better care, improved diets and good hygiene, the number of tuberculosis patients declined significantly during the 1930s. National Jewish Hospital at Denver and National Home for Jewish Children in Denver continued to stay open mainly because the doors to these hospitals were open to people with other diseases besides just tuberculosis, particularly asthmatics having trouble managing their asthma at home.   (1, page 115)

In the 1940s the number of tuberculosis patients was generally higher than those with other diseases, like asthma.  However, the number of asthma patients at the institution was on the rise.  And, for the most part, the goal for people with chronic lung diseases was to seek the cool, dry climate of Colorado for improved breathing.  So both asthmatics and TB patients received open air treatment (see figure 1).

Figure 2 --Children playing on swings at the National Home
 for Jewish Children, 1936 (6)

Likewise, patients who got better were provided the "added bonus of rehabilitation, social and education programs.  The education programs were intended to equip patients, who often came from lives of poverty, to function more effectively, in the world outside of the hospital."

Now, before I get into the rise of asthma patients at these hospitals, you have to understand the common thinking about asthma in this era.  First of all, asthma was a much rarer disease at this time, so it didn't get even close to the type of limelight that a deadly disease like tuberculosis got.

During most of the 19th century the two most prominent theories about asthma were that it was a neurotic disorder that resulted in airway constriction and shortness of breath.  This theory continued to be prevalent until it was disproved in the 1940s, and even then it held sway. So for the most part, if you had asthma, it was because you were a nervous person. This wasn't the only theory, but it was among the more prominent.

Another theory that became prominent around the turn of the 20th century was that asthma was also caused by allergies.  So while asthma was a nervous disorder, it was believed many cases were associated with allergies.  Many asthmatics got allergy testing to show they had allergies, and it was determined that some unknown substance in allergens -- like dust mites -- was causing asthma.  What it was no one knew, but some asthma experts believed this might lead to a cure for asthma.

In the meantime, many parents of severe asthmatics failed to understand the need to remove their children from asthma triggers, and so their asthma never got better.  They also failed to remove their children from their neurotic triggers, so, again, their asthma never got better.  Since asthma was much more rare back then than it is today, there was no push to better educate asthmatics, parents of asthmatic children, nor their doctors.

Regardless, the main theory regarding asthma in the 1940s was that it was a nervous disorder, or, as some called it, a psychosomatic disorder. It was all in your head.  Physicians heard stories by concerned mothers that when their asthmatic child went with the guys to do guy things the wheezing started.  So the logical conclusion made by these doctors was that these children were suffering from separation anxiety.  They were having asthma because they longed for their mothers.  For this reason they needed psychological help to be cured of their asthma.

As an asthmatic myself I can kind of understand this theory.  I remember not being able to do normal things with my brothers and dad, and when I did them I was a major burden on them more so than anything else. I remember my dad driving over an hour from hunting camp just to take me back home to mom because I couldn't breathe.  So ultimately I learned it was better for me just to stay home with my mom, where I became close to her.  So now it looks to others as though I'm overly attached to my mother, and when I go hang out with the guys I have separation anxiety, and this results in asthma.

Of course I really wasn't having separation anxiety, nor were any of these other kids back in the 1940s.  The truth is when they hung out with their dads and brothers they, like me thirty or forty years later, were doing things that made them get close up with their allergens.  Dad would take us deep into the woods to cut down trees, and he'd have us kids haul and stack the wood.  He'd come home and burn the wood, creating chimney smoke.  He'd take us to hunting camp, where allergens were galore.  And then when I was back at home my asthma would miraculously get better.

There were also many experts who believed the birth of a new brother could also result in worsening asthma, and this is exactly what happened to me on January 26, 1971 when my brother David was born.  So I suppose these experts might assume my asthma was a suppressed cry for my mother, who was providing all her attention to my little brother.  My physicians may not have thought this when I was suffering from asthma, yet this was the kind of thinking that persisted in the  1940s and 1950s and 1960s, and I'm sure  -- I'm positive -residue from these theories radiated into the 1970s and 1980s. I'm certain some of it affected me when I was a patient at NJH/NAC in 1985.

At first there weren't many asthmatics at these hospitals, mainly because, as noted, asthma was pretty rare in the 1940s. However, it was around this time Dr. M. Murray Peshkin, medical director for the National home for Jewish Children, observed a trend among asthmatic children at the hospital, and he postulated a theory based on his observation that would cause a spike in asthmatic children admitted to asthma hospitals around the nation.

What he observed was there were about 10 percent of asthmatic children who never got better at home, even when he personally visited their homes to make sure they were perfectly clean and antiseptic with no trace of any known allergen.  (2) He observed that as soon as being admitted to his hospital many of these children became immediately better. He observed that 99 percent of the chidlren treated this way had 'substantial or complete relief' of symptoms, according to his own reports. (3, page 145)

He concluded the reason for this was that once admitted to the hospital those children were away from both the stress of home life and away from the allergens at their homes.  So he proposed the idea of the "Parentectomy."  This basically means that children with severe asthma non-responsive to home treatment are removed from their homes, removed from their parents, and admitted to one of the many asthma hospitals around the nation.

So plucking the asthmatic and placing them in hospitals like National Jewish for one or two years was a growing trend throughout the 1940s and 50s, according to George Travis in his 1976 book, "Chronic Illness in Children."  He described that these hospitals worked on the "assumption that severe, intractable asthma stems from the family environment, and thereby removes the child from the parents from one to two years." (4, page 170)

Travis notes that there were some "interesting studies," and I might add, very credible studies, at very credible institution like National Jewish performed that proved the psychosomatic theory of asthma.  (4, page 170)  So it was only fitting that this theory, that began almost two thousand years earlier on some accounts, continued to reign prominent in the medical community. 

So this began the rise of the asthma institution.  It also resulted in some name changes:  In 1953 National Home for Jewish Children was changed to Jewish National Home for Asthmatic Children at Denver.  In 1957 the name was changed again to Children's Asthma Research Institute & Hospital (CARIH), and in 1973 to National Asthma Center.

References:

1. Minton, Gregg, "Breathing Space,"
2. Wamboldt, Fredrick S. "Asthma Theory and Practice: It's Not Too Simple," April 2, 2008,
3. Jackson, Mark, "Asthma: A Biography,"
4. Travis, George, "Chronic Illness in Children," 1976, California, Stanford University Press
5. "Clinical History: The Early Years," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/, accessed 11/7/12
6. Photo from Penrose Library, http://lib-anubis.cair.du.edu/About/collections/SpecialCollections/NAC/index.cfm, accessed 11/8/12

Severe and Complex allergy Syndrome (SCAS)

I think most people forget that there's more to asthma than just asthma.  I get people emailing me all the time saying stuff like: You know, if you're using your inhaler more than 2 times in a two week period you don't have asthma control."  I'd like to take those people and smack them right up alongside the face.  Ha, that actually felt good saying.  

Seriously, folks, I think that many people get caught in the flux that all cases of asthma are the same, and they aren't.  I think the asthma guidelines, which created the above definition of control, were describing "pure asthma," or asthma not complicated with anything else.  

Yet most asthma is complicated.  Most asthmatics have something else.  For example, 75 percent of asthmatics have allergies.  When this happens you have extrinsic asthma.  That's what I have.  I have extrinsic asthma.  When I was a kid this was ignored.  Even at National Jewish Health I was diagnosed with "High Risk Asthma."  I think even that definition comes with a flaw.  It ignores the general cause of my asthma: allergies.  

My point of this post is I think most of my doctors ignore the fact that the main cause of my asthma is not asthma, it's allergies.  I think if I had pure asthma it would be generally controlled.  But those dog gone allergies pop up, and wham!!!  When there's a bad allergy season, which it has been the past year, wham!!!

So for the 9 year period from 2002 to 2010 my asthma was great.  But then it took a turn for the worse.  I told my doctor this, and his goal, up to this point, has been to increase my steroids.  Yes, I'm not on Advair 500, which is the severe asthma dose.  Surely this helps, but the asthma is still there, hovering over me like a Japanese suicide pilot on a WWI American Ship in the Atlantic.  

The best example I can give of this was back in 1995 I saw an allergist, and he said, "We're going to do some allergy testing on you."  I said, "No, I don't want to do that again.  All it does is make me itch like crazy because I'm allergic to everything."  He said, "No one is allergic to everything."  I said, "Well, I am."  He said, "No one is!"

Well, as he was performing the test, and as my back was itching like crazy, he said, "Well, I guess you were right.  You are allergic to EVERYTHING! Wow, I've never seen this before."  

So my last doctor had me trial Singulair.  On my own, and based on my own research, I decided to take Singulair and and Claritin every day to treat my allergies, or to try to allay the damage.  Yet my new doctor told me to quit taking Singulair because he hasn't seen it do any good.  Then Wham!!!  So I put myself back on the allergy medicine.  

I also told my doctor I can't clean my house, I can't mow the lawn, I can't go to hunting camp, and he said, "Why not?"  Yes, it's frustrating.  The thing is, my current doctor is the smartest doctor I've ever had, seriously.  He knows his stuff.  So when I told him I put myself back on Singulair, he said, "Okay, whatever works for you."  

"Well, I'm not saying it works for me at all.  I'm saying we asthmatics are stubborn, and when we perceive something's working we like to stick with it."  Still, the main reason I have severe asthma, I think, is because I have severe and complex allergy syndrome, a diagnosis I just made up.  It forces me to do this as opposed to normal things.  While I enjoy doing this, I don't think people understand that I'm not lazy, I just can't do those things.  And it's frustrating.  

It's also frustrating that it's nearly impossible to get people to understand allergies.  Just watching a show like iCarly where they keep making fun of the kids with allergies ads to my frustration.  We live in a society where allergy ridden people are freaks.  And this is funny since we live in a supposed anti-bullying society

When I was 12 I decided I wasn't normal

Bell Curve of Intelligence

I was probably about eleven when I realized I wasn't normal.  Before that time I thought it was normal to not be able to breathe when other people were having fun; to have to remember your medicine before leaving the house; to have to pace yourself when playing sports or otherwise doing things normal kids do, like playing in tents made of old, dusty blankets stored in the dusty basement.

When I did these normal things, I felt abnormal.  My chest would burn, my chin itch, and my breath, well, my breath wasn't very good.  To get air in I had to suck it in, and before I was twelve I thought this was normal.  Before I was twelve I didn't understand why everyone else was having fun at grandma and grandpas house and I wasn't.  At twelve I realized I couldn't roller skate in the basement, and I realized I couldn't, or shouldn't, sleep in the bed by the fireplace in the same room my grandpa slept in. When I was twelve I realized I couldn't play football -- or shouldn't, because I did -- on Thanksgiving day when the snow was blowing and so too was smoke from the wood stove billowing out the chimney.  Yes, while all these things were normal, they made me not be able to breathe, which was, I decided when I was twelve, not normal.

It was also when I was 12 I decided I had a special gift that no one else had, a gift that made me special, and a gift I must never share with anyone.  I can share the product of the gift, yet I can never share the gift.  You see, if you are gifted, if you have a gift that makes you abnormal, you share it at your own risk.  When you share it with others, when you tell them your secret, you will be treated as a quack.  Yet I wasn't a quack, and I'm still not a quack.  Although, I contest, I am not normal (although, and this is a discussion for a later post, normal is also subjective).  

Since most people are normal, I decided I wasn't able to communicate with them my gift.  You see, normal people think of normal things.  Normal people have no incentive to think about deeper, inert things.  Normal people have no incentive to think about how other people feel.  Normal people aren't able to receive telepathic messages from other people.  Normal people have no need to think about any one else but themselves and their family and their survival.  Yet when you have a disease like asthma, you're forced to live different and think different.  You are forced to make changes.  

So I had a gift, and the gift was born out of my asthma.  You see, because I had asthma, and because I was not normal as noted above, I was forced to live my life like abnormal people life their lives.  I, thus, was forced to make changes.  I had to stay inside when the other guys were playing, or hunting, or camping, or what guys do.  I was forced to stay inside and read and think.  I was forced to reach into a deeper part of my mind.  

And anyone who has asthma knows, it's nearly impossible to get people who don't have your disease to understand what it's like to live with a disease.  Even to this day, even though my dad sat with me hundreds of hours in hospital rooms watching me suffer with asthma, he still has no clue that I am forced to be different.  Even though I've told him a thousand times the past year -- 20 years after the last time he sat in an ER room with me -- that I cannot go to hunting camp anymore because there are too many allergens out there, he still keeps begging me to go.  He is normal, and he is able to have fun out there without having to worry about his asthma (do I have my inhaler? do I have a clean pillow case? how will I get home if I can't breathe, etc.).  So he has no clue what it's like when you're not normal.  

I think the best way of describing what it's like to be abnormal is to describe the bell curve of intelligence.  Now, I'm not implying I'm intelligent the way you're thinking, no I do not have a 200 IQ.  No I'm not any smarter, per se, than you are.  Because I don't see intelligence that way.  I believe that we are all smart in our own way.  While you may have the highest IQ in the world, you may not be intelligent when it comes to asthma, or you may be clueless how to write.  You see, we all have a different level of intelligence.  My gift is my ability to think of things, and to write.  You may find this awkward me saying this, but I cannot communicate by words the way I communicate here.  Rush Limbaugh is a good verbal communicator, and in that way he's word smart.  I'm writing smart.  So that's what I mean.  

So let me describe this bell curve.  You take the people at the top who have the highest IQs, and you take those on the bottom with the lowest IQs, and you toss them out.  These we consider rare IQ scores, or abnormally gifted and abnormally stupid people.  Or, perhaps these scores were errors.  Either way, you toss them out.  That gives us a means.  So by using this bell curve, I can describe what I'm discussing in this post.  No, I do not have a high IQ. But, if you use this curve to show asthma intelligence, or writing intelligence, then you can see what I'm describing.  Most people I know have no clue what I'm talking about when I'm talking about asthma.  Most people I talk to are ignorant about asthma.  So, in this way, I MUST be in the top half of the bell curve that was tossed out.  I say this because there has to be a mean, and if I'm in the mean and everyone else in the mean is stupid, then there would be no mean.  So that can't be so, so I MUST be in the top of the bell curve.  

When it comes to gossip intelligence, or people smarts, I'd be in the bottom portion of the bell curve.  I'm not people smart at all.  So I'm gifted.  And most of you guys reading this probably think I'm nuts, that I'm a quack for thinking this way.  Or, you probably think I'm being arrogant.  That's not the case either.  I do, however, have an uncanny interest in history, respiratory therapy, philosophy, writing, and politics.  I find few people enjoy the same interests.  I'm abnormal.  And when you're abnormal living in a world with normal people, you just keep your mouth shut about it, although I'm breaking that rule here.  Yet it was my asthma that made me this way.  So perhaps you can see why I like to tell people asthma was a gift from God.  If it weren't for my asthma I wouldn't have this gift, and you wouldn't know me.

My asthma used to anger my mom

My daughter's experience with the asthma beast last night reminded me of my own childhood experience. 

My wife made a neat observation:  "Some parents might actually be annoyed when their daughter woke up at midnight coughing and crying and acting restless.  They might have been annoyed because they wouldn't have known their child was having an asthma attack.  They might have thought their daughter was just being a brat and keeping her parents up."

I think my wife was surprised by my response.  I said, "I think that happened to me.  With no disrespect to my parents because they weren't medical professionals and they didn't have asthma.  But my mom used to wake me up when I was coughing and make me lie on my side.  Then I'd fall asleep and an hour or so later she'd be waking me up again because I was coughing.  She'd make me lie on my side. It got to the point that to this day I can't sleep lying on my back.  She had no clue my coughing was probably due to asthma.  I couldn't breathe and she was mad at me.

"I will never let that happen to any child of mine.  I don't want my two asthmatic daughters to have that scar."

I tried to discuss this with my mom once in a matter of fact way and she outright denied it.  She might honestly not remember.  And she might have done so in a completely innocent matter.

 It doesn't matter to me.  I was just curious.  I have an awesome mom and she was always there.  So I don't mean to make my mom look bad.  It's just something that she did that left a scar.  Yet it's something neat to write about. 

If any of my fellow asthmatic followers ever had a similar experience please leave a comment below. 

Is worsening asthma linked to anxiety?

So I've noticed increased asthma symptoms lately.  In October I had a pretty severe asthma attack at hunting camp and I've had two since that time.  Of course my daughter and two of my coworker friends have been having trouble too lately, so perhaps there's something in the air.

Yet something else I've been thinking about also lately is there's been an increase amount of stress in my life too.  Now that I'm working days my job is twice as hard, and the workload is triple of what it is when I work nights. 

There's also been a lot of pressure from my boss to do all these extra projects, such as I'm a Neonatal Resuscitation teacher and I'm a member of the Keystone Committee.  Plus I'm a commissioner on the local township commission and I was -- by default -- nominated as the chairman.  So there's a lot of stress there.

Now is it all a coincidence that my asthma started acting up as all this stress stacked up?  That's possible.  Yet there is also a ton of evidence that links increased stress and anxiety with asthma I can't help thinking about it.

A case in point was mentioned by Andrew Harver and Harry Kotses in their book "Asthma, Health and Society," (2010, New York, page 315).  They mention several studies that link asthma with anxiety and depression, and that link increased stress with worsening asthma.

I've mentioned on this blog a few times that I'm not afraid to say I have social phobia.  I've been diagnosed on more than one occasion with anxiety disorders.  I've been treated too.  Something I'd like to delve into at some point in the future is my medical records where my psychologist when I was a kid wrote how I had anxiety and how it made my asthma worse.

If you met me you may never know it.  I'm not the kind of person who sits in a corner.  Obviously, otherwise I wouldn't have been elected to the commission, and I wouldnt be chair.  And I wouldn't be able to be a teacher in front of classes.  Perhaps therapy helped me there. Or perhaps common sense helps me there. 

Now I wouldn't want to bore you with the details nor embarrass myself for that matter, yet I think this is significant because these studies match up almost to a tee with my own experience with asthma and anxiety and stress and depression.  Coincidence?  Perhaps.  Yet I think the evidence is stacked too high to ignore it. 

And of course there's no way of knowing whether increased stress and anxiety results in worse asthma or the other way around.  Yet I'm digressing.  I'd like to get back to the book I mentioned above and the studies. 

I'm just going to quote the book here and then I'll leave it at that and you can tell me what you think. Of course we know that the link between asthma and psychosocial disorders goes all the way back to written records way back in 200 B.C. 

"The late 19th century and early 20th century William Osler viewed asthma as a 'neurotic affection' in which imbalances of the nervous system and emotional factors played a fundamental role.  Since then a growing # of studies have provided evidence of a link between various psychosocial factors and asthma. Data from both clinical and community settings suggest that psychiatric disorders, and mood and anxiety disorders in particular, are disproportionately more prevalent among asthmatics relative to the general population.  Point prevalence rates of anxiety disorders (eg. panic disorders, general anxiety disorder and social phobia) and mood disorders (eg. major and minor depression disorder) are especially high among asthmatics, ranging from 16-25 percent for anxiety disorders.  One recent study indicated 31% of asthmatics meet criteria for one or more current mood (20%) or anxiety (23%) disorder.  Rates of certain disorders (i.e. panic disorders and major depressive disorder) are as much as six times more prevalent among asthmatics relative to the general population. 

He also notes the following:

• Studies also link increased psychological stress to increased asthma morbidity
• Studies observed symptoms of anxiety and depression have been associated with increased asthma severity, increased use of ER visits, increased symptom reporting, poorer PFTs, and lengthier hospital stays
• Increased anxiety results in poorer adherence to medicine, etc. (this was my problem back when I was admitted to the asthma hospital in 1985)

Henry Hyde Salter was a doctor who wrote several articles and a book in the mid 19th century, and he was convinced that certain stimuli (dust, stress, etc.) stimulated the obdulla oblongota and a message was sent down the pneumogastric nerve to the bronchiole muscles causing them to spasm.  This was why he termed asthma a nervous disorder.  He made this theory mainstream.

The nervous asthma theory made it through great medical minds like William Henry Osler and Frances M. Rackemann, and wasn't debunked until the late 1950s.  Still it was followed by many doctors until the 1980s. 

Yet I still believe there is some truth to the asthma neurosis theory.  I denied it when I was 15 and my psychologist told me I had an anxiety disorder.  I denied anxiety.  I denied it all.  Yet the wiser 40 YO me knows better.  I'm convinced the allergic response doesn't just cause inflammation of the air passages, that it also causes inflammation somewhere in the brain that results in anxiety, social phobia and/or depression.

That's the Rick Frea theory.  Increased inflammation in anywhere, when it lasts long enough, becomes permanent.  This is what asthma is, so experts now beleive.  So could there also be inflammation somewhere in the brain?  We don't know? 

I do PFTs on myself every month at work for fun.  I've noticed my FEV1 had dropped some in the past year, the same time stress has increased.  If you look at the flow volume loop you can see the obstructive pattern on expiratory portion of the loop.  So is this a result exposure to too many other asthma triggers like dust and campfires, or is there some phychosocial issue going on?

I may be way off base and you can tell me so if you want.  Yet it's interesting anyway. It's just a frivolous though perhaps. 

My daughter's asthma attack, and the arrogant doctor

My daughter, Mrs. L, all three years of her, was introduced to the asthma beast this past week.  She required a breathing treatment a few weeks ago and it worked like a charm.  Yet last weekend the asthma beast struck with a vengeance.

She woke up in the night coughing.  I gave her a breathing treatment and it seemed to work.  Yet the next night she was up crying.  I entered her room and she was sitting up in bed.  It didn't take much convincing for her to let me carry her to the living room.

The nebulizer -- the community nebulizer for my family -- was already set up next to the recliner I set in with her.  I grabbed an amp of Albuterol and squirted it in, and revved the machine to life.  You can always tell when a kid benefits from a bronchodilator because she sits through it. 

Yet the treatment did little to relieve her coughing.  I sat up with her for an hour watching some old cartoon I can't even recall what it was.  Quite frankly I don't think she did either.  In fact, we didn't even have the sound on.  The vision of a toon was all that was needed to placate my daughter.

I was emotionally into this, because I could remember vividly sitting up in bed all night long when I was a kid not being able to breathe, and my parents had no clue.  It's not like they didn't care, they just didn't know.  I didn't want my child to have that scar, so I doted her.

The next day, Sunday, my wife or I had to give her a breathing treatment every few hours.  She probably could have used one more frequently.  Yet it was enough for us to realize she needed more than bronchodilators:  she needed systemic steroids.

Her doctor was out of town, so that posed a problem.  If she was in town we would have called her and she would have written a script for prednisone.  She knows me and my wife.  She knows I'm an RT and a lifelong asthmatic.  She knows we have a pharmacy here and everything except steroids to keep an asthmatic full of fresh air.  Yet she was out of town.

Dr. B. is a new doctor and I've worked with her enough to be impressed with her.  Yet she said she wasn't familiar with Mrs. L enough to just prescribe something over the phone.  So she recommended we take her to the ER. 

This posed a dilemma. Surely we had no problem taking her to the ER, but my wife and I both know that a trip to the doctor's office usually results in an assessment and a quit treatment of the cause of the problem.  Then you go home and that's that.  You get better. 

Yet if you go to the ER they have to do a bunch of stuff just to cover the butt of the doctor.  Labs will be drawn, an x-ray will be given, and an IV will be put in.  We mentioned this to Dr. B. and she said she'd call the ER doctor with her recommendation.

Great!  Or so we though.  The ER doctor was pissed that Dr. B called her.  The ER doctor was condescending and arrogant to my wife.  She said something like, "It doesn't matter what your doctor said.  I'm here and I'm assessing your daughter.  I have to do what I think is needed.  Dr. B. is not here."

My wife said she wanted to walk out the door right there.  If her daughter didn't need the steroids right now that's what she would have done.  And this is the hospital I work at.  The nurses tried to take a pulse ox on my daughter's food, and my daughter said, "Go away!  Leave me alone!"

My wife said, "Why don't you guys leave and I'll get a pulse on on her finger."

Yet they insisted on getting a pulse ox on her foot.  Here my daughter, my shy daughter who is deathly afraid of people, has five nurses holding her down to get a pulse ox.  My daughter cried and fought vehemently. Good for her.  I wish she would have fought harder.

The doctor peeked her head in at this time and said, "Well, she's crying.  So she must be breathing fine."  My wife responded, "Wait for her to stop crying and you'll see she's retracting and her fingers are blue."

The doctor left.  The nurses left.  My wife got a pulse ox reading in about 2 seconds once they were out of the room.  My daughters oxygen saturation of 82%.  That's not good.  And this all happened in triage.  When she finally got to her room my wife had to fight off the impulse of the doctor to insist an IV and labs be drawn.  Yet my wife stubbornly resisted.  I am proud of her.  "All she needs is steroids," my wife insisted.

The doctor was pissed.  She listened to Mrs. L. with her stethoscope.  She said, "She's wheezing.  She has inspiratory and expiratory wheezes.  Inspiratory wheezes are the worse kind.  You should have come in sooner.  If you need to give treatments every two hours you need to come to the ER."

My wife rebutted her comment:  "We did come to the ER."  And she probably thought, "You dumbF#$@!"  I know my wife thought that because I know my wife.  Yet I bet that doctor would doubt me. 

The doctor prescribed a steroid drink, and my wife said Mrs. L. won't drink it.  The doctor said, "We'll mix it up in a pop and she won't even know the difference."  My wife said, "She's never had a pop in her life, so she probably won't even know what pop is.  She won't drink that."

So you can see this made for an interesting visit.  Finally my wife said, "She's not going to drink this stuff.  Let's just give her the shot and get it over with."  Five nurses held Mrs. L. down, and she didn't even fight.  Later that night she said to me at home, "Daddy, I got a shot and I didn't even cry."  She smiled.  She smiled because she knew the shot made her better. 

Yet. Steroids work on asthmatics in my family.  We don't need labs and xrays and IVs and all that unnecessary stuff.  Surely if the steroids didn't work you can look for something else. 

My wife said the nurses were great.  Later I talked to one of these nurses about that doctor, and she said the doctor has to cover her butt.  Yet I said, "A doctor should also respect the wishes of the parent.  A parent knows her child more than a doctor does.  Not to disrespect the wisdom of that doctor, yet she really needs to respect the parents, especially when the parents are a nurse, and an RT who is a lifelong asthmatic.  It's not like there's no experience here.  We're not your typical ignorant parents."

This is exactly the reason I never go to the ER when my asthma acts up.  The last time I was an ER patient they took me off my theophylline and almost killed me.  Eight days later a different doctor put me back on my theophylline and I miraculously got better.  So if you have asthma, and you know what works for you, and the doctor wants to do something totally different, who's right? 

That steroid shot gave my daughter almost instant relief.  She ran around the living room that night the way I'm accustomed to seeing her, all happy and cheerful.  In the end, that's what's most important.  As far as the rotten ER doctor, she was a rental doctor and both my wife and Dr.B. reported her arrogance to the powers that be.