I ask again - am I a fool?

K

kitomd21

New member
Here we go again...DD has had a cough for the past few days...honestly, should I put her on antibiotics with every cough she gets in life? Is it wrong to give her a chance to fight it without antibiotics? We've upped her CPT from two sessions to three or four sessions with nebulized saline during the entire 25 min vest session. She only nebs Pulmozyme during her evening session.

Her cough is intermittent...perhaps a few coughs/hour. They are productive coughs and she isn't waking up at night with a cough nor having coughing fits. No fever...sinus congestion was pretty severe a couple of days ago but is mostly resolved. I don't believe the cough is worsening.

What are your thoughts? Try to let her clear this on her own? Call her doctor if the symptoms worsen? She seems to be getting better (i.e., decreased sinus congestion)...no wheezing...no labored breathing...I'm no expert at listening to lung fields, but I don't hear crackles with my stethoscope...
 
K

kitomd21

New member
Here we go again...DD has had a cough for the past few days...honestly, should I put her on antibiotics with every cough she gets in life? Is it wrong to give her a chance to fight it without antibiotics? We've upped her CPT from two sessions to three or four sessions with nebulized saline during the entire 25 min vest session. She only nebs Pulmozyme during her evening session.

Her cough is intermittent...perhaps a few coughs/hour. They are productive coughs and she isn't waking up at night with a cough nor having coughing fits. No fever...sinus congestion was pretty severe a couple of days ago but is mostly resolved. I don't believe the cough is worsening.

What are your thoughts? Try to let her clear this on her own? Call her doctor if the symptoms worsen? She seems to be getting better (i.e., decreased sinus congestion)...no wheezing...no labored breathing...I'm no expert at listening to lung fields, but I don't hear crackles with my stethoscope...
 
K

kitomd21

New member
Here we go again...DD has had a cough for the past few days...honestly, should I put her on antibiotics with every cough she gets in life? Is it wrong to give her a chance to fight it without antibiotics? We've upped her CPT from two sessions to three or four sessions with nebulized saline during the entire 25 min vest session. She only nebs Pulmozyme during her evening session.
<br />
<br />Her cough is intermittent...perhaps a few coughs/hour. They are productive coughs and she isn't waking up at night with a cough nor having coughing fits. No fever...sinus congestion was pretty severe a couple of days ago but is mostly resolved. I don't believe the cough is worsening.
<br />
<br />What are your thoughts? Try to let her clear this on her own? Call her doctor if the symptoms worsen? She seems to be getting better (i.e., decreased sinus congestion)...no wheezing...no labored breathing...I'm no expert at listening to lung fields, but I don't hear crackles with my stethoscope...
<br />
<br />
 
H

hmw

New member
No, you aren't a fool. <img src="i/expressions/face-icon-small-wink.gif" border="0"> Increasing treatments is the best 'first' thing to do when they develop signs of illness and you are doing that. Is she using albuterol at all or only the HTS? Sometimes when sick they need increased bronchodilator as well to help keep things open.

No, she won't necessarily need abx for every cough she ever gets. <img src="i/expressions/face-icon-small-smile.gif" border="0"> Now not a med expert here so all this is just my opinion... but I think you are doing the right thing by increasing treatments and noting her symptoms and giving her a chance to improve before taking things further. It then just becomes a matter of how long to let things go before the dr needs to step in. At this point you ARE kind of in that 'gray zone' where things aren't really bad but aren't really great either. Since some of it has improved (upper airway congestion) and the rest has at least not worsened, it may be ok to keep watching with increased tx for a bit longer. But if at any point you feel things are getting worse- it would be time to call. Assuming her baseline is essentially no cough, if she is still coughing at the same rate that she is now- no worse, but still no better either- I'd probably check in on Monday to see what they'd like you to do. When you do call though, make sure you give a good all-around clinical picture- appetite, sleep, play, mood, as well as the obvious stuff like congestion, cough, fever, stools, etc. That is important in helping them decide how to handle it.


Hope Ellie is doing better soon! <img src="i/expressions/rose.gif" border="0">
 
H

hmw

New member
No, you aren't a fool. <img src="i/expressions/face-icon-small-wink.gif" border="0"> Increasing treatments is the best 'first' thing to do when they develop signs of illness and you are doing that. Is she using albuterol at all or only the HTS? Sometimes when sick they need increased bronchodilator as well to help keep things open.

No, she won't necessarily need abx for every cough she ever gets. <img src="i/expressions/face-icon-small-smile.gif" border="0"> Now not a med expert here so all this is just my opinion... but I think you are doing the right thing by increasing treatments and noting her symptoms and giving her a chance to improve before taking things further. It then just becomes a matter of how long to let things go before the dr needs to step in. At this point you ARE kind of in that 'gray zone' where things aren't really bad but aren't really great either. Since some of it has improved (upper airway congestion) and the rest has at least not worsened, it may be ok to keep watching with increased tx for a bit longer. But if at any point you feel things are getting worse- it would be time to call. Assuming her baseline is essentially no cough, if she is still coughing at the same rate that she is now- no worse, but still no better either- I'd probably check in on Monday to see what they'd like you to do. When you do call though, make sure you give a good all-around clinical picture- appetite, sleep, play, mood, as well as the obvious stuff like congestion, cough, fever, stools, etc. That is important in helping them decide how to handle it.


Hope Ellie is doing better soon! <img src="i/expressions/rose.gif" border="0">
 
H

hmw

New member
No, you aren't a fool. <img src="i/expressions/face-icon-small-wink.gif" border="0"> Increasing treatments is the best 'first' thing to do when they develop signs of illness and you are doing that. Is she using albuterol at all or only the HTS? Sometimes when sick they need increased bronchodilator as well to help keep things open.
<br />
<br />No, she won't necessarily need abx for every cough she ever gets. <img src="i/expressions/face-icon-small-smile.gif" border="0"> Now not a med expert here so all this is just my opinion... but I think you are doing the right thing by increasing treatments and noting her symptoms and giving her a chance to improve before taking things further. It then just becomes a matter of how long to let things go before the dr needs to step in. At this point you ARE kind of in that 'gray zone' where things aren't really bad but aren't really great either. Since some of it has improved (upper airway congestion) and the rest has at least not worsened, it may be ok to keep watching with increased tx for a bit longer. But if at any point you feel things are getting worse- it would be time to call. Assuming her baseline is essentially no cough, if she is still coughing at the same rate that she is now- no worse, but still no better either- I'd probably check in on Monday to see what they'd like you to do. When you do call though, make sure you give a good all-around clinical picture- appetite, sleep, play, mood, as well as the obvious stuff like congestion, cough, fever, stools, etc. That is important in helping them decide how to handle it.
<br />
<br />
<br />Hope Ellie is doing better soon! <img src="i/expressions/rose.gif" border="0">
 
K

kitomd21

New member
Thanks...yes, she has an albuterol inhaler that we use prior to treatments. We're only using normal saline at this point along with Pulmozyme. Her doctor didn't advise it - it's just something I decided couldn't hurt while she's sick. "Gray zone" is a perfect way to describe this! We're still so new to recognizing her symptoms or how her body will generally react to a common cold. This is her first true cough since diagnosis. We've had a couple of ill family members these past couple of weeks. We knew it would happen eventually. <img src="i/expressions/face-icon-small-sad.gif" border="0"> I'll only let it go a couple more days and let you know how she does.

Dad just took her in our bounce house and she coughed a bit afterward...got things moving! <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
K

kitomd21

New member
Thanks...yes, she has an albuterol inhaler that we use prior to treatments. We're only using normal saline at this point along with Pulmozyme. Her doctor didn't advise it - it's just something I decided couldn't hurt while she's sick. "Gray zone" is a perfect way to describe this! We're still so new to recognizing her symptoms or how her body will generally react to a common cold. This is her first true cough since diagnosis. We've had a couple of ill family members these past couple of weeks. We knew it would happen eventually. <img src="i/expressions/face-icon-small-sad.gif" border="0"> I'll only let it go a couple more days and let you know how she does.

Dad just took her in our bounce house and she coughed a bit afterward...got things moving! <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
K

kitomd21

New member
Thanks...yes, she has an albuterol inhaler that we use prior to treatments. We're only using normal saline at this point along with Pulmozyme. Her doctor didn't advise it - it's just something I decided couldn't hurt while she's sick. "Gray zone" is a perfect way to describe this! We're still so new to recognizing her symptoms or how her body will generally react to a common cold. This is her first true cough since diagnosis. We've had a couple of ill family members these past couple of weeks. We knew it would happen eventually. <img src="i/expressions/face-icon-small-sad.gif" border="0"> I'll only let it go a couple more days and let you know how she does.
<br />
<br />Dad just took her in our bounce house and she coughed a bit afterward...got things moving! <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
Y

ymikhale

New member
i usually wait for a few days before calling the doctor. my dd's baseline is no cough, so coughing a few times an hour would seem a lot to me if it lasts and there is no sign of improvement. I don't know if it is an option for you, but i try to culture her when she is sick even if there is no cough. In my experience, the bacteria can overgrow before you know it and you might not even see any symptoms at that point.
 
Y

ymikhale

New member
i usually wait for a few days before calling the doctor. my dd's baseline is no cough, so coughing a few times an hour would seem a lot to me if it lasts and there is no sign of improvement. I don't know if it is an option for you, but i try to culture her when she is sick even if there is no cough. In my experience, the bacteria can overgrow before you know it and you might not even see any symptoms at that point.
 
Y

ymikhale

New member
i usually wait for a few days before calling the doctor. my dd's baseline is no cough, so coughing a few times an hour would seem a lot to me if it lasts and there is no sign of improvement. I don't know if it is an option for you, but i try to culture her when she is sick even if there is no cough. In my experience, the bacteria can overgrow before you know it and you might not even see any symptoms at that point.
 
K

kitomd21

New member
I felt that her cough was getting worse yesterday, so we took her to an urgent care center as they were the only place open which could fill an antibiotic rx. Her on-call CF NP said she should be on abx if a cough lasts more than two days (which I've heard before...but wanted to try to kick this on our own). My husband took her in where the doctor asked "how long has she had CF"? Lovely. He listened to her lungs and said they sounded clear - which fascinates me because she has a horrible cough. He didn't want to prescribe antibiotics and my husband fought him on it...finally, after much debate over amoxicillin or zithromycin, the doctor agreed to prescribe zithromycin.
 
K

kitomd21

New member
I felt that her cough was getting worse yesterday, so we took her to an urgent care center as they were the only place open which could fill an antibiotic rx. Her on-call CF NP said she should be on abx if a cough lasts more than two days (which I've heard before...but wanted to try to kick this on our own). My husband took her in where the doctor asked "how long has she had CF"? Lovely. He listened to her lungs and said they sounded clear - which fascinates me because she has a horrible cough. He didn't want to prescribe antibiotics and my husband fought him on it...finally, after much debate over amoxicillin or zithromycin, the doctor agreed to prescribe zithromycin.
 
K

kitomd21

New member
I felt that her cough was getting worse yesterday, so we took her to an urgent care center as they were the only place open which could fill an antibiotic rx. Her on-call CF NP said she should be on abx if a cough lasts more than two days (which I've heard before...but wanted to try to kick this on our own). My husband took her in where the doctor asked "how long has she had CF"? Lovely. He listened to her lungs and said they sounded clear - which fascinates me because she has a horrible cough. He didn't want to prescribe antibiotics and my husband fought him on it...finally, after much debate over amoxicillin or zithromycin, the doctor agreed to prescribe zithromycin.
 
H

hmw

New member
Does her CF center not have someone on call over the weekend? One of our CF drs is on call 24/7, including weekends and holidays and if Emily is sick they will discuss what is going on over the phone in detail, and prescribe (call it in to our pharmacy) if they feel her symptoms warrant it. They are the ones with access to her culture results and can rx the appropriate abx and are most likely to prescribe an appropriate course (many peds will only give a week or whatever, nowhere near what our kids need to kick an exacerbation.)

I'm sorry you had to deal with a walk-in center that was not well-informed about CF. Even our ped is reluctant to deal with any of Emily's issues that are connected in even the loosest of ways to her CF, and I would MUCH prefer having her CF team manage her illnesses. I cannot even imagine what kind of care she'd get from a walk-in center who'd never seen her before. In a desperate situation w/ no other option, I'd (in our situation) take her to the ER at her children's hospital where they could access her records before taking her to an urgent care.
 
H

hmw

New member
Does her CF center not have someone on call over the weekend? One of our CF drs is on call 24/7, including weekends and holidays and if Emily is sick they will discuss what is going on over the phone in detail, and prescribe (call it in to our pharmacy) if they feel her symptoms warrant it. They are the ones with access to her culture results and can rx the appropriate abx and are most likely to prescribe an appropriate course (many peds will only give a week or whatever, nowhere near what our kids need to kick an exacerbation.)

I'm sorry you had to deal with a walk-in center that was not well-informed about CF. Even our ped is reluctant to deal with any of Emily's issues that are connected in even the loosest of ways to her CF, and I would MUCH prefer having her CF team manage her illnesses. I cannot even imagine what kind of care she'd get from a walk-in center who'd never seen her before. In a desperate situation w/ no other option, I'd (in our situation) take her to the ER at her children's hospital where they could access her records before taking her to an urgent care.
 
You must log in or register to reply here.
Top