New, confused, seeking clarification

Hi, Im hoping I can get some clarification.  Its late, and Ill call the doctor tomorrow, but Ill ask you all anyway.  My 8 year old daughter has asthma, and we recently changed doctors, and he talked to me about O2 sat numbers. We live way up in the mountains, and my daughters usually at about 92-94, but he wasnt satisfied and said it needs to be above 93.  My other daughter is consistently higher, but shes not asthmatic.  I am supposed to give her Ventolin if shes at 89 or 90…well she's at 90 but shes asleep.  Doesnt her O2 go down normally when she sleeps?  Also, her peak flow meter reading was great.  I hadnt really been checking her with the pulse oximeter regularly because her peak flow meter had shown her consistently strong for several days.  I dont know what the right response is, and frankly, Im just worried sick about her all the time.  Just when I think shes doing okay, that she's stable, that its going to be fine…something happens that turns everything upside down.  I dont want to over react when she seems fine, but I dont want to ignore the instructions either.  And I dont understand the instructions…what is the cut-off?  Am I supposed to base it on the peak flow meter or the pulse oximeter?  I need it in writing, Im too stressed to try to remember.  I hate asthma, it makes me so scared I could just cry. 

Ok.  I dont really expect anyone to advise me tonight, but it helped to let it all out.  Ill go check her again and make a decision about waking her up and starting Ventolin.  Thanks all.  


Comments 9

  • Kathy P

    Hugs and welcome. It's hard to be worried about a child. I don't know how much variance there are in the readings. I often take best out of three and use different fingers.Is there an after hours number you could call? Does she use an inhaler or a nebulizer? Would there be a way to give her the med without waking her up – thinking if she uses a mask.Hang in there and I hope you can get some rest. I know you are worried about your child.

  • Shea

    That is a tough one. My asthma wakes me up sometimes and I will go straight to my inhaler and then go back to bed. Sometimes I even dream about having an asthma attack and then wake up having one. I can imagine itd be scary with your child !! (My son is 6 so I understand the worrying). I kniw you already made your decision and I am too late, but I just wanted to say that I think either way youd be OK. If her asthma is bad enough she will wake up from sleep. Now I guess its important she know to seek you out and wake you up– but most kids will to their parents. If you wake her up and give her tge inhaler, that is not going to hurt– she will fall back asleep and youll ger some sleep too. Im not sure the rates or anything like that–but you are right– more written instruction from the doctor makes situations like these easier sometimes! 

  • K8sMom2002

    Hugs and , Mama … I do hope that you are seeing some improvement and that you were able to talk to your doc. 

    Could you talk to your doc about the different things that could affect a pulse ox reading? Things like living at high altitude, the amount of light that the pulse ox is exposed to, differences in skin pigmentation, motion/restlessness, body temp and the "fit" of the pulse ox?

    And could you ask if you could "calibrate" your pulse ox against the doctor's? It could be like a set of scales: your doctor's may be slightly more accurate or give a slightly different reading. 

    As for waking her up, it was always a back and forth question when DD was little: do I wake her up or let her sleep? So I asked our doc, and he gave me detailed instructions about when I should let her sleep and when I should wake her up. If he told me to wake her up, then I did. 

    O2 sats do tend to drop at night at rest, so that's something that you want to clarify with your doc. If she's low anyway during the day, then that nightly drop (if it happens with her) could be what her doc is worried about.

    It sounds like you had been pretty good about writing down and logging her O2 and her peak flow readings. Let us know what the doc says … and big

  • Mama

    Wow, thank you all so much!  I have to explain, without revealing too much personal information, that we live outside of the US, so our health care has been sketchy, sometimes.  We try to get the kids the best care we can and keep up with their medicines, but it's expensive (I have another child who needs a medicine that costs a couple hundred US dollars each month, but that is a different topic unrelated to asthma.)  But there's times when I know I would make different decisions if we were in different circumstances.  

    At the beginning of March, on a Saturday morning, she had been doing so well for months and months that I mentioned to my husband we could talk to the doctor about getting her off her maintenance meds (symbicort).  THAT DAY she began to get a virus of some kind, and her sister, too.  By Sunday night I was so stressed because she was so miserable with fever and coughing, we took her to the ER.  We checked my pulse oximeter against the hospitals, and they were the same.  She was still at 92 O2 and they said she'd developed an ear infection so she started a variety of medicines to make her feel better and and antibiotic.  By Monday morning, I was sick myself and it was all I could do to keep her medicines on schedule.  Tuesday I took my other daughter to the doctor.  Pneumonia.  I made appointments for the following day for myself and my son, as we were all absolutely miserable, fevers, coughing, laying down all day.  When I needed to give my daughter medicine at 10:30 pm Tuesday night, I realized I hadn't been keeping up with her peak flow meter, just the prescribed medicines at the times they were prescribed, along with care of everyone else.  I put the pulse oximeter on her finger as she slept.  69.  Sometimes it went up to the low 70s.  She wasn't struggling.  She wasn't blue.  There was no persistent coughing or wheezing that I could hear.  She had had serious asthma episodes before and they were nothing like this child sleeping in my bedroom.  I changed the batteries, but the reading was the same.  I phoned her doctor but there was no answer, so I followed an old action plan I had made him work out for me, and woke her up and started working on it.  She was in the 80s pretty quick, and when she breathed in deeply she would go up to the 90s, but it was a horrible night.  I had her at the doctor at 7:30 in the morning.  Of course I was in trouble for not bringing her to the ER, but I'd just had her there and we are uninsured, so I'd kind of already spent all our money on that and medicines for her and her sister.  Also I knew the doctor could see her at 7:30 because I'd just made appoinments for myself and my son and they'd offered us the time.  I figured I'd evaluate after the 2 hour regimen and see where we were, go in to the ER if it wasn't working.  So we prayed and watched and of course did lots of Ventolin.  Of course I regret it now, in hindsight, but I was so sick. She seems okay, thanks be to God.  She recovered quickly with her steroids and a couple of inhaled medicines, and we're still on her Symbicort.  She missed a week of school and a month of her sport.

    But there are experiences like that that make you a frazzled mess later on.  You second guess yourself and don't trust yourself later.  And you're filled with guilt.  So last night, what I didn't include in my panicky post, is that she said to me, "I feel tired.  Not sleepy tired, but running tired."  All kinds of warning flags went up in my mind and I was totally nervous after that.  Nervous breakdown is more like it.  After I posted I went in and checked her and her heart rate was lower and her oxygen reading was 91, although it did bounce around up and down a little but, I felt satisfied we were okay.  This morning she was at 94-96, so I guess all is well, still.  I will postpone the doctors visit because it's scheduled for later this week anyway.  I will make him write it all down, night time, day time, pulse oximeter, peak flow, percentages, telephone numbers, the whole ball of wax.  I'm a nervous wreck and I need better instructions.  

    Whew, sorry about the super long post.  I appreciate the encouragement.  It seems like there is a really wonderful community here.  And I am enjoying reading the posts and responses from the point of view of asthma sufferers, instead of only thinking of it as a moms.  It makes me take a long view of this instead of the short view I've been working from.  

    Thanks a million.


  • Pljohns

    Welcome to the board Mama-I can't imagine how scary that was/is for you to deal with.  I'm fortunate that neither of my kids have any health issues at all-I'm the only one with asthma.  

    You will find this is an amazing group of people who can give you tons of support and suggestions and we have different experiences.  Feel free to post new topics/questions or replies to existing ones-we welcome anything.  I hope your DD stays OK and you can get everything in writing from the doctor later this week.

  • K8sMom2002

    Yikes on not having good insurance and having to make choices like that. It sounds like you are doing the best that you can in the circumstances, and that you are willing to learn and improve each response. That's all any of us can ever hope to do.

    When we know better, we do better. Way to go, Mama! I especially like what you said here:

    Mama posted:

    I will make him write it all down, night time, day time, pulse oximeter, peak flow, percentages, telephone numbers, the whole ball of wax.  I'm a nervous wreck and I need better instructions.   

    I like how you have looked at this in ways that can improve the situation and your own peace of mind — good for you! 

  • Shea

    @Mama, yikes on that scary incident a while back when she was sleeping and her pulse ox was so low.. I just imagined if she wasnt getting enough oxygen she would wake up– but when on other meds and sick maybe that all played a role. 

    I think your plan to talk to the doctor to get clearer instructions sounds perfect. Also maybe you could ask him if there are sny prescription savings programs or if he has sample inhalers even–in the past I have been helped out with meds in that way by doctors. 

    Hope your little one is doing well!