Monday, May 31, 2010

compare and contrast: asthma in three scenes, and a reading list

scene one:
boy whines, mom looks up from cooking and replies. Boy wails. Slinks up stairs and flops onto bed. Mom pauses, considers, and walks up the stairs. Finds boy flat on his back, arms spread wide. Watches his ribs expand upwards and outwards, as if his mouth was a lacrosse stick, swooping, arcing, then netting the ball.

scene two:
boy looks dubious, blows into peak flow meter. Mom cajoles, grins, dares him to beat the results. He does. She raises an eyebrow. Rising to the challenge, boy offers to beat even that. He does. Mom high fives him, as he sinks back down onto the bed. Arms spread and ribs resume their push up, arc out, up, arc out, a net grasping at elusive air as mom notes: 35% below standard peak flow score.

scene three:
distastefully, boy clamps his mouth on the inhaler's spacer tube. Pssshhhhhht. Ten hippopotomuses tango past. Psssshhhhhht. Another ten hippos, foxtrotting. Boy blinks. Mom freezes, uncertain whether she is hoping for success (tool that works!) or failure (crazy mommy invented data = fake diagnosis!). Boy grins, jumps up and down. Shows a certain Mister Checkers how the twist really oughtta be done.

Mom slathers a grin on, and joins boy, who offers some suggestions on just how to coordinate hips and knees.

Right, then. We have a diagnosis.

After a kick to the stomach chat with Dr. Allergy about the rates of kids with asthma, misdiagnosed with ADHD, or anxiety disorders, etc (guilt, guilt, guilt, anyone?), it is past time for some reading. Here's what I'm looking at (and regretting the good old days of grad school, when I could read more than just abstracts!):
Asthma history and presentation, which points out that "Pediatric asthma and psychiatric mimics require special attention to prevent misdiagnosis." Oh, you are so right. And,

Psychological considerations of the child with asthma, which suggests that "The link between asthma and psychiatric illness, however, is often underappreciated by many pediatric and child mental health professionals." And may have a point, starting with quality of life, and continuing down the path of chronic illness = risk factor for psychiatric somethings. Sigh. And then,
which offers a thought not entirely relevant to the Eldest, but still intriguing; "Children's attentional abilities had more of a bearing on their symptom monitoring abilities than their IQ estimates and psychological symptoms." Oh. Well, that makes sense.

And the jeez, I want to see THAT! abstract, Children's illness drawings and asthma symptom awareness, which points out that girls are more in touch with their physical *and* psychological feelings. Um. Alas, but this may be so.

Sweltering and cursing the system that assumes that any consumer that wants to read this stuff has, necessarily, oodles of cash to drop ($31 per article, available for TWENTY-FOUR HOURS? wtf?), I'm off to take refuge in children's books. Like the cheery (but vaguely written) Abby's Asthma and the Big Race.

This appears to be a story for the knowledgeable asthma child-parent dyad, and it's a pleasant vehicle for its message: kids with asthma can be athletic. As an educational device, however, the book doesn't go much farther. The text assumes that we know about allergens as triggers, that moving from cold to hot rooms can trigger asthma attacks, and that we can identify the school nurse as not knowing enough about asthma - why else would she discourage Abby from running in the big race? I'd love to have seen Abby's rebellion against these skeptics, but I'm willing to concede on the ways that too much information can clutter and drag on a narrative.

And I'll forgive much for the letter at the back, written by an allergist at CHOP, who notes that 10% of the recent American Olympic team has asthma. The Eldest loved that....and speculated happily on why this might be so.

(he thinks they're all adrenaline junkies. FYI.)


Jen said...

It's probable that if you pop by your local library you can from a computer *in* the library access the relevant articles for free. If not, stop by MIT and use one of their on-campus machines. IIRC (> 5 yo info) you don't need to input an ID number to access subscription online resources from an on-campus machine. The librarians can probably help you. Ditto if you head over the G-zang at Brandeis, which will be closer to your daily runaround.

Rachel said...

...and if those suggestions don't work, email me the cites and I'll look them up on my brandeis account and email them back to you.