weight loss during pregnancy stories | Reactive airways

weight loss during pregnancy stories

Here we are... Asthma Management Plan in hand for one of our toddlers. Last February, O had a severe case of RSV that put him in the PICU for four days. Shortly afterwards, we were seen by an asthma/allergy doctor who told us that O has "reactive airways." We actually had not noticed his retractions, induced by simply walking around the room. She asked, "Does he always breathe like that?" She was very helpful and put him on Singulair, but I left that appointment feeling like a horrible mother. The big question running over and over again through my mind, "How did I miss that?" He stayed on Singulair for a couple months, into the summer. We-- thank the Lord!-- managed to avoid catching any summer colds. The summer passed easily and O finished his prescription on Singulair. I watched his breathing and didnt feel that it was "out of control." I still noticed those retractions, but they didnt seem that bad. Maybe he was doing fine?

September came and the weather cooled. Our boys caught their first cold of the season two weeks ago. It passed around between us, a mild cold that only caused congestion. While our preschooler and C seemed to have caught it and moved on, it settled in Os chest. He was up two nights ago coughing intensely, the next day he started wheezing, and that afternoon he started retracting. Always a good natured child, he smiled and giggled all through that night, snuggling in bed with my husband and I while we nervously watched him labor. Yesterday morning I brought him into the pediatrician for a breathing treatment. His oxygen levels were still good (the color never changed in his face and he wasnt lethargic or we would have been at the childrens ER in a heartbeat!), but his retractions were intense. The breathing treatment helped and we discussed what I should do at home. Our CPNP gave me the option of an Albuterol inhaler or the nebulizer. As an (adult) asthmatic, I know how and am comfortable administering a breathing treatment with the inhaler. I even had given my oldest breathing treatments that way when he was a toddler, thus I chose the inhaler.

That evening his wheezing became much more intense. His retractions really picked up. I gave him a breathing treatment via inhaler with a child-sized spacer and it went okay. He wasnt fond of me holding him down, but he did take the required dose. Off he toddled, wheezing less but still retracting. My forehead furrowed... what should we do? He slept fitfully through the night. I heard him cough and toss and turn. I listened and each time he managed to fall back asleep. I worried through the night. Is he in there struggling? Sleeping? Is he okay?

This morning his wheezing was back in full force. I wrestled with him through a breathing treatment. He saw the inhaler and took off running, apparently no longer curious about the bears on the side of the spacer. I made him an appointment with the pediatrician to possibly get another breathing treatment and to discuss our options. I worried about the rest of the cold season. Would we end up back in the PICU? Or continue coming to the pediatrician every time he gets a cold, like we did last season even on Singulair? Where do we go from here? I felt like Singulair wouldnt be enough, but that what we were doing (nothing) wasnt covering it. And, for a number of reasons, I wanted to see a different asthma/allergy specialist. We saw a different doctor in the practice since it was a last minute appointment and our CPNP was unavailable. However, our CPNP met with the doctor before our appointment and filled her in on everything. Our doctor walked into the appointment fully knowing Os story and had reviewed his chart. Instead of spending the appointment filling her in on his past medical history, she knew his history with RSV already and about his history of wheezing, as well yesterdays appointment. We spent time discussing family history and really listening to Os lungs. She confirmed the reactive airways diagnosis, stating that it is really difficult to say that a 17-month old definitely has asthma. Although, considering our family history and Os personal history, she would guess that this isnt something he will outgrow. Regardless, we need to treat it now. And so we wrote a treatment plan for Os reactive airways.

Yesterday when O came into the pediatrician for breathing treatments he was in the "Red zone." Today he is in the "Yellow zone." We want him to be in the "Green zone." Here are his medications for each zone, each given through a nebulizer unless stated otherwise:

• When he is in the "Green zone," he will only take Pulmicort twice a day. Symptoms in the "Green zone:" breathing is good; no cough or wheeze; can work and play.
• In the "Yellow zone," he may need 2 puffs of his Albuterol inhaler through the spacer. Within an hour he can take a dose every 20 minutes, up to 3 doses, if we are out of the house. If we are home, an Albuterol treatment with the nebulizer. After the hour, if his symptoms keep improving, he can continue taking puffs from his inhaler every 4-8 hours, if needed. She said that if were to come down with a cold, we could use Orapred, a corticosteroid, for 5 days. This is more effective in managing a flare-up than bursts of Albuterol, which is a bronchodilator. Symptoms in the "Yellow zone:" coughing, wheezing, tight chest, wakes up at night.
• The "Red zone" means trouble. Starting with the symptoms: medicine is not helping, breathing is hard and fast, nose opens wide, cant walk, ribs show, cant talk well. We continue with the Albuterol and Orapred. We contact our doctor and see what she recommends, or we call 911. She said, if we follow our action plan, that usually we will be calling 911 instead of the pediatricians office because we will have followed all the steps they would recommend. We dont want to be in the "Red zone."

We had to do an Albuterol treatment this evening, our first at home. O started retracting and wheezing, his nose started flaring some, and he could not catch his breath. I whipped out the nebulizer and set everything up. At first he wasnt happy. The breathing treatments in the hospital for his RSV were very quiet. With a nebulizer, the machine is loud. He didnt like it at the pediatricians office and he didnt like it at home. I held him in a cradle hold so he couldnt turn his head away from me and sang him "Beautiful Boy," a favorite of ours. He calmed down by the end of it. The nebulizer treatment took about 10 minutes, as our pediatrician said it would. During that time, my other toddler got a fat lip and pulled every book off the bottom shelf of a bookcase. I told my mom that I kept saying, "If you take that book off the shelf, I will... okay, seriously, if you take that next book off the shelf, I really will... this time I mean it, do not touch that book... please? Please dont touch that book?" I really think C knew that Momma was busy and could not get up to wrangle him. The fat lip... he took the box the nebulizer came in, laid his blanket over top of it, and then banged his head on it. Why? Does that even make sense? He looks up and there it was-- a fat lip. For the Pulmicort treatment before bed, I put C in his crib while I gave O his treatment. Containment: a twin moms best friend.

All along this road, every doctor weve spoken to about his wheezing and reactive airways has mentioned his severe RSV back in February (see my blog post, "RSV and premature babies"). Today our pediatrician mentioned it. She said that there are many studies about whether RSV triggers reactive airways or if children with reactive airways just come down with severe cases of RSV-- what comes first? This question has really weighed on my mind. After talking with our doctor today, I dont think it matters so much. Perhaps O has reactive airways because of his severe case of RSV. Perhaps he only had such a severe case of RSV because hes always had reactive airways; remember, his identical twin brother had RSV at the same time and only had an ear infection with fevers-- not even a trip to the ER for him. My heart does break for O. Watching him retract the way he does and holding him against my chest, hearing that wheeze shake his little lungs... I want to protect him.

My mom has always joked that my kids are going to put me through all the things that I put her through. For instance, I was a breath-holder as a baby; my oldest was a breath-holder. (He was the most intense case our pediatrician had ever seen! He grew out of it at three, though he recently had breath-holding episodes in recovery after his umbilical hernia surgery.) I am exceptionally stubborn and I have two very stubborn children. However, both my mom and I agree that I do not want to experience the terror of watching your child suffer from an asthma attack. As a teenager I had a severe asthma attack; my momma was by my side in the ambulance. Right now, when I think about O and his "reactive airways" and possible future with asthma, that fear is what grips my bones.

I feel much better with our Asthma Management Plan in hand. I feel much better knowing that if these meds dont get him under control, we have other options. I feel much better knowing we have a doctor who is invested in our child, managing his asthma, and communicating with us. Im not sure why it was so hard facing an action plan or really getting the help. Perhaps I was afraid of admitting that he could have asthma and could always need to know where his inhaler is or avoid running outside when the seasons are changing or take medications twice a day for the rest of his life. Are those things so bad? Not in the scheme of things. But I didnt really want them for him and it has been hard for me to swallow that maybe... maybe he does have asthma. Right now Im much more comfortable with reactive airways.

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weight loss during pregnancy slimming world | Small changes our new bedtime routine

weight loss during pregnancy slimming world

This blog post on our bedtime routine was inspired by a post I read last night on "Mels 2 Belles" called Bad Habits.

Bedtime is probably the most challenging time of day. By the time bedtime rolls around, your mind is wandering to the bottle of wine you have chilling in the fridge and your body longs to collapse on the couch (with chocolate).

Here was our old bedtime routine:

Dinnertime sometime between 5:30 pm and 6:30 pm, depending on when I started cooking.

After dinner, playing outdoors with the boys.

7:00 pm: bring the toddlers in for bath and pajama time (pajama to the left, pajama to the right, jamma, jamma, jamma, jamma, P! J!) Toddlers then meltdown through entire pajama routine.

7:15-7:30 pm: Toddlers go to bed early because Momma is done listening to meltdowns.

7:45 pm: Momma hollering outside to Husband and preschooler that it is probably time to possibly think about coming inside, maybe?

8:00 pm: Husband wrestles with preschooler through bath time. Preschooler cries through bath time and drags his feet getting pajamas on. A very frustrated-- and rushed-- story time.

8:20-8:40 pm: All the kids usually down for the night. Preschooler is the last one in bed, though the shenanigans in the bathroom and hallway tend to wake up the toddlers.

8:30 pm -ish: Momma starts picking up the rest of the sun room toys, tidying the kitchen and kitchen table, finish packing Husband and preschoolers lunches.

9:15-9:30 pm: Parents finally get to the couch to stare blankly at the television, exhausted by the wrestling match bedtime had become.

Obviously, we needed a change.
So here is our NEW bedtime routine:

Dinnertime, which I already have planned out a week in advance and the ingredients bought via online grocery shopping, is started around 4:30 pm. We usually eat between 5:00-5:30 pm.

Tidy up the kitchen and sun room BEFORE going outside. The toddlers can play outside until, at the latest, 6:45 pm. Bring the toddlers in for pajama time! (Oh, yes, pajama time!) I get them undressed in the same area every night; that way they know what is expected of them ("Okay, it is time to get ready for bed!"). I then have them carry their dirty clothes to the hamper. On bath nights, they go to the bathroom. On nights we arent bathing, we head to their room for pajamas.

Between 7:00 and 7:15 pm, the preschooler and my husband come inside. (If Husband is not home, D comes inside with us when I bring the toddlers in. He either helps with his brothers or listens to a book on tape while I get them ready for bed.) We read stories all together with all three boys in "the reading chair;" when I read to all the kids at the same time, we try to find easy picture books that appeal to both age groups. I then take the toddlers to their bedroom while the preschooler brushes his teeth and puts on his jams. I read the toddlers some toddler stories (Goodnight, Moon, Jamberry, Sandra Boynton) and put them to bed.

After the toddlers go to bed, around 7:30-7:45 pm, I finish tidying up our living spaces. Sometimes I have our preschooler help with this, like have him wipe down the kitchen table. This is when I finish packing the lunches. (I start packing the lunches when I clean up the dinner mess. I usually pack leftovers for my husband and so half of his lunch is already packed.) Then I come out to the reading chair and read the preschooler some preschool stories (our recent library check outs, Roald Dahl, or whatever books he picks out).

After stories with our four-year old, it is off to bed for him! He gets all his current favorite animals and tucks them all in. Then we say prayers and tuck him in. Lights out by 8:00 pm! (Okay, sometimes we get caught up reading and he doesnt go to bed until 8:15 pm.)

Once all the kids are in bed between 8:00 and 8:15 pm, there is nothing else to do. My husband and I are free to watch a movie! Or a DVRd show! Or check our email! I dont have a whole room of toys to clean up or a kitchen full of dirty dishes... nope. Nothing. Ah, it is wonderful.

I get done the same amount of things with our old and new schedule. We consciously rearranged our nightly to-do list to make it work better. The kids arent overtired during bath time and pajama time. By the time we read stories, they are ready to listen. I can relax reading our preschooler stories because I am not thinking about the millions of things I need to get done after he goes to bed. We just made a series of minor adjustments to the schedule. As an unexpected bonus, my husband and I are going to bed earlier. I was staying up until 2 or 3 in the morning (or later) reading and then waking up at 8 am with the kids; this worked until our days got busier and I had less downtime in the afternoon. Now I have time to do the things I want to do much earlier in the evening and dont feel the need to stay up so late to get them done. I am also much more relaxed when the kids go to bed; I felt like I was wound up so tightly before because it was so stressful and there was so much crying.

As a note, the above schedules often say "I do this," instead of my husband doing it. My husband is actually the one who usually does all of this. We try to keep our schedule simplified enough so one person can do it. That way when my husband is home, I can go take care of other things while he takes care of the kids or he can take the preschooler while I take the toddlers. Keeping the schedule simplified also allows me the freedom to go out in the evening, leaving my husband to do bedtime, or vice versa. Weve even had-- gasp!-- a baby-sitter. :)

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