Deciding to stop taking/giving a medication

@DrewDad,

Quote:

Factors associated with an increased risk of death from asthma in children include:

* Previous life-threatening episodes of asthma
* Lack of adequate and ongoing health care. (Most likely the reason for the higher fatalities rates in minority children.)
* Significant behavioral problems
* Underestimating the severity of an acute attack poses the greatest threat. Unfortunately, one study of children found that nearly 40% of them were unaware of asthmatic symptoms when they occurred.

I may be a little hypersensitive on this issue. Both my wife and sister-in-law have had to go to the emergency room for asthma, Yaya has asthma, and I had a 30-year old colleague (and new mom) die from an asthma attack a few years ago.

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The asthma thing is kind of wierd. Mo has a history of pretty serious resperatory problems that go back before he lived with us. He was diagnosed with asthma about 4 years ago, went through an inhaler, used some steroids, etc. We refilled the prescription to have enough inhalers in all the critical locations -- school, each car, home, purse, backpack. They've never been touched. I don't know what to think about asthma.

I know he has some screwball thing with his nose (from a catscan, again, before he lived with us)... like one nostril doesn't hook up right. I think I need to visit the wayback machine and see if we can get that updated because I think it complicates all this allergy/breathing stuff.

We're pretty careful with Mo's health. I appreciate the reminders.

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So I'm not saying it WAS the meds causing the problems but -- the last time he took them was Wednesday night and while I can't say there has been a 180 degree change in his attitude I'll give him a 124 or so.

I complemented him on his jolly mood yesterday and he said "Yeah.... I just don't feel so mad today..."

-- so I'm not saying it WASN'T the meds.

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@boomerang,

Montelukast (Singulair)

Quote:

What special precautions should I follow?

Before taking montelukast,

* tell your doctor and pharmacist if you are allergic to montelukast or any other medications.
* tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention phenobarbital and rifampin (Rifadin, Rimactane). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
* tell your doctor if you have or have ever had liver disease.
* tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking montelukast, call your doctor.
* you should know that your mental health may change in unexpected ways while you are taking montelukast. You should call your doctor right away if you experience any of the following symptoms: agitation, aggressive behavior, anxiety, irritability, unusual dreams, hallucinations (seeing things or hearing voices that do not exist), depression, difficulty falling asleep or staying sleep, restlessness, sleep walking, suicidal thoughts or actions (thinking about harming or killing yourself or planning or trying to do so), or tremor (uncontrollable shaking of a part of the body). Your doctor will decide if you should continue taking montelukast.
* if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent mental retardation), you should know that the chewable tablets contain aspartame that forms phenylalanine.

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@boomerang,

boomerang wrote:

We're pretty careful with Mo's health. I appreciate the reminders.

I had no intention of implying that you aren't; I just have a hair up my butt about asthma, since many people don't understand how quickly it can strike. Sounds like you have it under control.

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@boomerang,

Good grief this is timely!!

I'm actively investigating this very question.

Most of you know the story of sozlet's problems with congestion and resulting ear problems. She had several surgeries in May of 2009 because of severe negative pressure in her right eardrum. That was pulling the eardrum in towards her middle ear, to the point where it was a) very stretched out and b) touching the bones of her middle ear. Which is very bad.

She did very well when the tubes were still in and functioning.

The tube in her right ear recently came out, and the eardrum healed. The negative pressure is happening again.

While she's been tested extensively for allergies, none have yet been found. However she "acts" allergic -- there is a lot of swelling in her sinuses, which causes the Eustachian tube to close up. The closed Eustachian tube is the cause of ear problems, including the current negative pressure, which is worrisome.

I got a referral for an allergist to pursue the allergy angle again. We saw her last week. She did tests, again nothing specific was found. She thinks that sozlet may have a chemical sensitivity rather than an allergy per se -- that regular pollutants irritate her tissues and cause a reaction that parallels allergic reactions.

I had only been expecting allergy testing and so was surprised when she asked where my pharmacy is and prescribed Nasonex.

I said er um and explained that we hadn't had a good experience with Nasonex. It made her moody and short-tempered and also didn't seem to really solve the underlying problems. It's not something I wanted to do again unless it's really necessary.

She said Oh OK, let's do Flonase then. She said that often if one doesn't work well, the other is better.

She also said that they are both steroids but they're topical and so are not absorbed into the system and so they don't have side effects of mood changes etc. Hmm. That really wasn't our experience.

She just kind of rattled on after the Flonase part though, and made a follow-up appt.

I've had an email exchange with her office, trying to narrow down how important it is to do this.

One thing with us is that the swelling is the issue, not the mucus per se, so saline lavage doesn't get at the core issue.

I don't want sozlet to have serious ear problems. If this needs to be done to allow her Eustachian tube to do its job, fine, we'll go there.

But I'm in active research mode re: Flonase/ Nasonex and am not super enthused.

And whatever she has is an all-year thing, so if starts taking it and it serves the purpose, she'd have to take it indefinitely, which also gives me pause.

But as of right now I haven't come to any conclusions. Will be reading with interest.

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@sozobe,

Oh and one other thing recommended that we are doing is getting a HEPA filter for her room. Got the same one the doc has in her office for about $40 on Amazon.

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@DrewDad,

I knew you weren't being critical of me, DrewDad. I do appreciate the reminder. Mr. B took Mo motorcycle riding today and made sure he had a fresh inhaler before they left. I probably should have had Mo take a Claritin.

Like I said earlier, I really like our doctor, but I feel that my side effect concerns were kind of brushed off. I saw mention on one site that said to contact the FDA if you thought the medicine had side effects. I wonder if I should call....

I just don't know which medicine might have caused the problem.

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@sozobe,

Quote:

She also said that they are both steroids but they're topical and so are not absorbed into the system and so they don't have side effects of mood changes etc. Hmm. That really wasn't our experience.

Seriously? Is something you squirt up your nose considered "topical"? Does that mean I can snort cocaine every day and not worry about side effects? Are cigarettes "topical"? Do you know what she meant when she said that? I really am curious.

I will say that the medicines worked amazingly well on Mo's allergies. He wasn't congested at all while taking them. It was a real relief for him.

After taking this break I wouldn't mind trying them one at a time to see what works, and what might have caused the side effects.

Still, if it was the medicine causing the problems I don't want to go back there. His behavior was EXTREME. He would get so mad his body would lock up and he'd shake. Later he would cry and be inconsolable. Earlier this week he became downright dangerous to himself and to others. That's when I started looking at EVERYTHING that was going on.

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@boomerang,

It just dawned on me - have you a good pharmacist? Maybe it is a drug interaction that occurs..
Although I suppose that companies would have that indicated in the fine print.

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@sozobe,

sozobe wrote:

Oh and one other thing recommended that we are doing is getting a HEPA filter for her room. Got the same one the doc has in her office for about $40 on Amazon.

I don't know how old Sozlet is, but my childhood was kind of one long ear infection. My pediatrician told my mom that my eustachian tube was probably funny shaped so that it took up contaminants into my ear from my mouth.

So this may or may not be related to Sozlet, but one thing I learned was: NEVER blow my nose. Blowing my nose would shoot stuff into the tube. For me, putting any kind of medication in my nose made things worse. I learned to clear my sinuses by laying on one side, then switching to the other, back and forth ... the mucous would eventually collect on one side so I could breathe out of the other nostril.

Though my eardrums burst occasionally (never had any tubes), my hearing wasn't effected.

I had severe spring-time, dust, and cat allergies. All were dealt with by eliminating the allergens as much as possible from my environment. I grew out of the allergies and the ear-infections around the age of 14.

But I'm still religious about using Swim-Ear after swimming, and I'm still very careful not to build up pressure if I blow my nose.

Oh one last thing just in the caution department... ear infections can lead to meningitis. Now that I work in a hospital, I know why my pediatrician gave me all those penicillin shots. Bone up on the signs of meningitis... sorry I don't remember them off the top of my head except swelling behind the ear is one early sign. WebMD is pretty reliable for that kind of thing... also discuss with an ENT.. ear/nose/throat specialist if you get the chance. It's not something to fear, just be aware of.

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@sozobe,

As a kid back in the stone age (the late '50's and '60's) I used to have chronic ear aches and ear infections, swollen sinuses and other similar allergy symptoms. What finally resolved it all was a thorough exam by a dentist who discovered I had tiny fractures in most of my teeth and some of the newly sprouting adult teeth were becoming impacted. He pulled a couple teeth to make space in my crowded mouth and also did a lot of plaster work with silver filling material to help strengthen my teeth.

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@Arjuna,

Quote:

I learned to clear my sinuses by laying on one side, then switching to the other, back and forth ... the mucous would eventually collect on one side so I could breathe out of the other nostril.

I have to do that nearly every night. My sinuses can be crystal clear when I go to sleep and then one nostril will be completely stuffed up and unbreathable until I roll over to allow it to drain out to the other side. I try not to blow my nose either. If I do, I wait until I'm in the shower and have inhaled a lot of steam to loosen things up so it doesn't take much effort to blow it out.

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@Arjuna,

Interesting that you mention 14! That just came up when I was talking to the allergist -- I relayed that my husband told me that he couldn't breathe through his nose until he was 14. Externally, they have the same nose (in pictures of him as a kid and her now it's an exact match), so internally they may have similar things going on.

My daughter is almost 10.

She hasn't actually had that many ear infections... a BUNCH very close together (probably a single one that never completely resolved) when she started preschool, then occasional (~ 1 a year) for a few years, then we had a good long reprieve of a couple-few years, then bam another ear infection. But the surgery wasn't because of the infections but because of the negative pressure. (Fluid in the middle ear that then recedes, but since there isn't appropriate airflow there is negative pressure as it recedes.)

Mucus really isn't her main issue at this point -- it's negligible. The main problem is the swelling of the sinus area which swells the Eustachian tube shut (pressure from the outside of the tube).

I'm very aware of meningitis danger sings but thanks. We see an ENT regularly (next appt. is later this month, I'm thinking of delaying the Flonase until I've talked to him).

Interesting about the teeth, Butrflynet. Sozlet goes to the dentist every 6 months and has an orthodontist and I think the fractures would be noticed but who knows. She definitely has crowding (getting braces soon, yes they do it early these days).

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@boomerang,

boomerang wrote:

Seriously? Is something you squirt up your nose considered "topical"? Does that mean I can snort cocaine every day and not worry about side effects? Are cigarettes "topical"? Do you know what she meant when she said that? I really am curious.

I know what you mean. Evidently it's vs. injection for example. I guess cocaine does do its stuff topically too, I mean it has an effect if you rub it on your gums, right? But I really think there was a pretty clear cause and effect, mood-wise, when sozlet took Nasonex.

Also E.G. took Flonase (generic version) and stopped specifically because it made him feel so hyper and aggressive.

So I'm really not buying "it never affects mood/ personality." I'd believe that it's individual (i.e. that for many people there are no ill effects), but not that it never happens.

I take Advair this time of year btw (same stuff but inhaler rather than nose-squirter) and it doesn't seem to affect my mood much. Definitely helps with my allergies.

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@sozobe,

Yea, I see the point of the steroid then. Excellent about the ENT. I hope they can come up with something to open things up.

Butterflynet: yes, I also have that. What is it about laying down?

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Deciding to stop taking/giving a medication

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