It's Not So RAD

As I noted in a recent blog post, Adam hasn't been feeling so hot. Last week what originally seemed like a cold resulted in what seemed like Bronchitis and mucus in the chest. After steroids, antibiotics and breathing treatments, he wasn't looking much better by Monday morning, and spent the entire day screaming to be in Tiffany's arms. The daycare called about 4 so I left work to get him, and when I got there he was contently being held by Ms. America... until I got a hold of him. The second I touched him, he had to let me know how terrible he was feeling in short, screeching, loud bursts of screams which told me he was obviously in pain and that something wasn't right.

I had to force him into the car seat because he didn't want to get in, and for a few seconds thought I wasn't going to be able to do it (The kid is freaking strong). He screamed all the way home and as we walked into the house and while we were in the house... and I was 5 seconds from putting him back in the car and going to the ER. The only thing that stopped me was the knowledge that he was so upset I would never get him in the car seat. Plus, Shannon was nearly home from work. I called him frantically, with Adam screaming in the background, begging him to hurry home as fast as he could so we could figure out what to do next.

After a huge glass of apple juice and a dose of Advil, Adam started to calm down and was much better by the time Shannon got home 10 minutes later. But I made an appointment for Tuesday afternoon anyway and Shannon took him to see Dr. Kim (another doctor in the practice who is also not our regular pediatrician). Dr. Kim noticed two brand new ear infections, prescribed stronger antibiotics, and told us to continue the Xopenex breathing treatments. He also mentioned that he suspected Reactive Airway Disease (RAD), and that Dr. Thomas, on the previous appointment on Friday, had written the same thing on his chart.

Since I had never heard of RAD, I googled it briefly in the short amount of time that I could find between a busy week at work and a very needy baby at home, and saw that it is a vague way of saying that your toddler has asthmatic symptoms that could or could not indicate chronic asthma. Basically, it looks like asthma, but because he's so young, there's really no way to know and it's not smart to just go ahead and diagnose it at this age.

I had to admit that I was not surprised, and had in fact been suspecting the same only one week before he got this simple common cold that he couldn't shake, even with antibiotics. Since his bouts with frequent sinus infections last year followed by pretty serious cases of RSV and pneumonia, I had started to notice that that daily allergy meds weren't really clearing his cough and that his breathing was raspy always, for no reason. I also noted early on that the constant breathing treatments we had been prescribed over the last year really weren't doing much to improve it when he was really feeling bad.

The rest of the day Tuesday was not so great, but on Wednesday, he woke up cheerful, he stayed pretty cheerful, and he even was a pleasure Wednesday night -- not quite back to himself, but much better than he had been. (Minus the painful bedtime routine once again). We suspected the new antibiotics were helping his ear infections. Even with the improvement, I sent an email to our regular pediatrician for her advice, and after the events of the following morning, I was glad I did.

Here, Horsie, I bet you feel as bad as I do. I'll share my paci.

Yay, much better!

"This is your nose, and this is my nose." (notice Horsie didn't get the paci for too long)

Okay, we'll take turns...

4:30 am Thursday morning. Adam woke up screaming and Shannon went in to try to calm him and get him to go back to sleep with no luck - about 30 minutes later I came in to take my shift (like anyone sleeps when the screaming starts anyway) and the screaming only got worse when I walked in. I tried for about 10 minutes, but my ears were ringing. So I gave up, and went to lie on the couch and let him watch Little Einsteins. I drifted off once and was punished for that with a plastic golf club to the shoulder . . . so I started another episode . . . I drifted off again and later got a sippy cup to the nose. But when I got onto him about it, he looked at me with these sad puppy dog eyes and didn't cry. He just looked sad.

Shannon took him to daycare and when they left Adam lost it because he has had a case of the "I-NEED-to-be-with-Mom-or-I-will scream-like-someone-is-trying-to-murder-me" for the last week, and in the process, disrupted his breathing so much that Shannon drove around the block a few times before going to daycare because he just couldn't bear to drop him off when he was feeling that bad.

Dr. Han responded to my email with some detail about why they had suspected RAD and suggested that we see the pediatric pulmonologist for tests and allergy blood tests (she said that blood tests are usually not very reliable at his age for allergy diagnosis but that considering the circumstances it might not be smart to wait; and since we have the "HAPPIEST baby," clearly something was wrong). I wrote her back and told her I definitely wanted to move on to the next step, and immediately. They called within 45 minutes to schedule an appointment with Dr. Schochet's office (the guy who recommended the swallow study about 9 months ago) at 1:30.

I checked in with Tiffany all morning, who said that his breathing never really improved and that she had to take a moment after Shannon dropped Adam off because seeing him like that broke her heart . . . and she held him in her arms today the entire time he napped also (I can't say enough how thankful I am for Tiffany. The word "Thankful" doesn't even do it justice).

Long story well . . . a little less long . . . Shannon took Adam to the pulmonologist (Dr. Lie) who said that the steroid/antibiotic medication he had been on over the weekend can cause babies to be overly emotional, which may explain why Adam has been so clingy and sensitive lately. He also said that it was clear that Adam was struggling to overcome even the slightest cold, that he hated the term RAD, and that he would classify Adam's symptoms as asthmatic reactions. So we are going to treat it that way for now and see if it works out.

He gave us 3 different kinds of inhaler solution and instructed us to get a "puffer" (so Adam can take the inhalation solution). No more breathing treatments in the nebulizer for a while -- instead of spending 30 minutes to an hour a day on long, painful breathing treatments, we are doing two puffs (20 seconds each) of the inhaler twice a day for three weeks and then going back for a follow up to see if that is helping the situation.

And here's the thing... after a half day at school, after an afternoon at the doctor's office, and after coming home (medium-happy) and having a leisurely glass of juice while Shannon ran out to the pharmacy to get our new assortment of Adam-supplies, Adam sat on the couch next to me and breathed as heavily as an out-of-shape adult who just took a jog around the block.

Relaxing after the doctor appointment today

Oh mom, the camera AGAIN?!

When Shannon came back, we gave him two puffs (which he thought was fun), and within about 30 minutes could see an incredible improvement in his breathing AND his mood. He even let Shannon put him to bed... quickly... and without a fight.

All three of us are exhausted. Outside of work, daycare, doctor's appointments and sleeping badly, in the last week and a half we've faced the emotional stress of a cold, bronchitis, teething, ear infections, steroids that caused uber sensitivity, chronic hacking cough, RAD, and breathing episodes similar to asthma attacks.

I have a feeling that in a month from now I will look back on this last year and think how silly it was that we spent so much time fighting through breathing treatments that never truly worked. Oh, the things we learn from experience as a parent...

So now my emotions are again conflicted. I had hoped and hoped that he did not have asthma and still hold on optimistically to the thought that he may grow out of it or that his "asthmatic reactions" are not in fact asthma. It was not a diagnosis in any way, only a new attempt at treating the problem. On the other hand, I see that he felt better so quickly after trying out the inhaler and am relieved we finally have a way to take control of the situation. So yet again, I am torn between concern and relief. My relief is winning.

But tonight maybe we will all get some rest (finally). Maybe in the morning I will be able to take a shower without a miserable baby banging on the shower door, crying uncontrollably. Maybe we will get back on track with getting rid of the pacifiers (again) and get comfortable sleeping in the big boy bed. And mostly... maybe we will have a happy day tomorrow.