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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

See all MNHQ comments on this thread

To not agree with the nurse practiser's view that my DS has asthma and to think a diagnosis should come from a doctor?

572 replies

PolkadotCircus · 17/02/2013 08:15

Soooo my v healthy but skinny boy 9 has had a nasty winter virus that he has had problems shaking off,symptoms involve a cough that won't go away.Loads of other kids and adults have had/got it here.

The same happened last year and our fab doctor gave him temp inhalers to calm his airways down which worked a treat and were never used again.

His grandad is the same(very skinny and some times gets a chest infection in winter it takes a whole to shake off) but still cycling 16 miles a day at 80.

Anyhow dtwin 1 keeping dtwin 2 awake so tried to get an appointment with our fab GP but because he is so fab it is nigh on impossible so was offered an appointment with a nurse which I reluctantly accepted as all I wanted were temp inhalers and ds better ASAP.

Anyhow after a very lengthy appointment when his puff was measured,history looked at,records filled in,weighed etc she finally gave us some inhalers.Puff was poor(errr yes he has a virus and a temp) and we were told to come back for a follow up asthma review.I said but he doesn't have asthma only to be told well this happened last year etc,etc.

So we went to the review puff beyond normal now and very good,virus over so no surprise.Nurse then said as he had asthma she'd like to see him again,keep him in her records,how many inhalers did he have etc,to keep him topped up when tight in the chest etc etc.

I said very firmly he doesn't have asthma and never gets tight in the chest.She then asked if he had eczema or hay fever.He had eczema as a baby and gets a bit sneezy in the summer ahhhh then they are linked so he does have asthma.Me-no he doesn't he just gets a cough he can't shake some winters.
I don't want asthma on his records unnecessarily.We politely agreed to disagree.

So aibu to think a)he doesn't have asthma and b) a diagnosis should come from a doctor.

OP posts:
trixymalixy · 17/02/2013 16:50

Annual asthma reviews are normal. After DS's hospitalisation we saw the consultant more regularly, but then he was discharged into the care of the asthma nurse and has annual reviews.

ClayDavis · 17/02/2013 16:52

Edam, I think its more of a case that we've just spent 500 posts trying to convince the OP that a specialist NP knows more about asthma than her GP would. And I think Freya is the first person to mention that the NP she saw might not have been an asthma specialist.

FryOneFatManic · 17/02/2013 16:59

Polka I think all this extra stuff giving you food for thought should be mentioned to the GP, it all seems linked.

DS has mild eczema, which seems stress related as it only occurs when his bowel problem flares up. But I do know it's often related to hayfever and asthma, so I've always kept an eye on it. But so far the only coughs he's had have cleared up quickly.

OliviaMumsnet · 17/02/2013 17:03

Hi there OP
Do let us know if you'd like us to move this thread to children's health wont you?

ClaireDeTamble · 17/02/2013 17:04

shush tell me about it. After I had Hmm I asked her if she was sure as I would have though it would need to be next to the skin.

She looked it up- actually Had to use that big medicines book they have and then told me I was right.

I had to bite my tongue to not say No shit Sherlock!

Her excuse was it had been a long day Hmm I'm just glad it wasn't for something more critical. After that appointment I know completely understand why the death rate increases in August!

alimac87 · 17/02/2013 17:05

Eczema as a baby, allergic to cats and needing Piriton..? Yep. Those sorts of things tend to go with asthma, signals that they are atopic.

My (skinny, pale) DD is 11, gets asthma flare-ups every year or two after a bad cold/flu. Tends to also end up with antibiotics after secondary infections. A month ago she had a full-on asthma attack at school just after she went back. Very very scary. The good news is that she takes her preventer medicine religiously (the brown or purple puffer) twice a day, and uses her blue puffer as and when needed. Most of the year she is absolutely fine, quite active and sporty. She also has eczema and a nut allergy (oh joy).

As I understand it people used to try to do without these drugs but the modern thinking is no, you go right in and tackle it and that way you avoid long-term lung damage. And they are very very very safe and one reason I am utterly thankful to live in the 21st century.

I do sort of understand about avoiding labels - it's not a club I've ever wanted to be part of - but if it is asthma, after the initial shock you and your DS will get your heads around it and a good NP should instruct/educate. We have had some great and some not so good nurse experiences (conflicting advice over how to use the puffers) but the main thing to check is that your DS is getting the medicine in their lungs. Younger kids can be bad at co-ordinating the inhalers and their breathing. Annual flu vaccine may also be a good idea.
But yes make sure your DS has medicine and that the school is aware. Best of British.

PolkadotCircus · 17/02/2013 17:11

Said nurse had nurse practitioner on her door(tad confused now)on second appointment however the receptionist initially said it was some kind of chest clinic,had to go to a different town for it as they were so snowed under which may be why we didn't get any leaflets,info etc.It was a manic time my dc said they each had over 10 missing from each of their classes and it lingered for aaaaaages.

Wondering if gp will refer us to an "asthma nurse" if he is of that opinion,ironically after reading all this will push down the asthma route just to double check.Grin

They'll then think I have Munch Hausen!

OP posts:
PolkadotCircus · 17/02/2013 17:12

Olivia yes feel free if you think it would be more useful,probably would.

OP posts:
moosemama · 17/02/2013 17:22

Polka, I don't think you are wrong to ask questions and to want things confirmed by your GP.

I was in a similar position in November 2011 and had a similar reaction initially.

Ds1 (then 9 years old, built like a strip of wind, with not a scrap of weight on him) developed a nasty cough that wouldn't shift, so I took him to our GP. He listened to his chest, gave him antibiotics and said he thought he should be checked for asthma.

I was surprised and felt there was absolutely no way he could have asthma, but thought he'd take the antibiotics, have a clear check up and that would be that. I was wrong.

A few days later ds suddenly started to really struggle to breathe, it got worse and worse and I called for an emergency appointment. We rushed him in, the GP took one look at him, listened to his chest and rushed him straight down the corridor to be nebulised. He said his chest was so tight he was barely getting any air in at all. I am a bit vague on the details of nebulising but was told it had to be stronger or longer than they expected.

GP prescribed both preventer and inhibitor inhalers and told me ds was asthmatic and would need regular monitoring by the nurses in the asthma clinic.

I was shocked. He had never even had a cough in his life before - except - when he got swine flu during the epidemic and at that time we'd been quite worried about him because he was wheezing and fighting to breathe, but of course being mid-epidemic, the doctors didn't want to see him.

He was referred to the asthma clinic, but by the time the appointment came round a couple of weeks later he seemed fine, although was still using the brown inhaler as instructed.

Knowing nothing about asthma myself, I was suprised when they said he had to continue to use the brown (steroid) inhaler to help his chest and they would review him in the spring. (This was late November-ish.)

I wasn't happy about him having to have daily steroids, but having been scared by how ill he was when he had to be nebulised I didn't question it, as there was no way I would risk him having to go through that again.

Ds was absolutely fine from then until his spring appointment. In fact by spring his peak flow was normal and there was absolutely no indication of asthma or any breathing problems. We were able to wean him off the steroid across the summer, but warned that he should start using it again at the first sign of a cold or cough.

Sure enough, November last year, the same thing happened again. An almost identical cough and a downward spiral from there. We put him straight back on the steroid inhaler and he has had to use his ventolin several times since.

We were told that, given the time of year his asthma flares up, he is most likely allergic to leaf mould and that it's actually a fairly common cause of asthma. The underlying reaction to the leaf mould, plus virus or bacterial infection is a bad combination, creating problems in the lungs which result in the asthma. Provided they don't have any problems the rest of the year, the asthma clinic is happy for them to wean off the steroids over the summer and go back onto them in the autumn or at the first sign of any wheezing or coughing.

Ds does get mild hayfever, mostly affecting his eyes, but doesn't wheeze or cough across the spring and summer. Interestingly he has recently developed eczema on his face and hand as well and last time we were at the GP they mentioned the fact that his allergies seem to be increasing.

I do understand your reaction. It took me quite a while to get my head around ds having asthma and to be honest, if he hadn't had that sudden bad attack and needed nebulising I would probably still have doubts. As it is, seeing him in that state once was enough to scare me for life and I now make sure he takes his brown inhaler religiously.

I think it's a good idea to book an appointment and talk it through with your GP. I know my GP would be happy for me to do this and in fact encourages us to ask questions if we are at all unsure.

Abra1d · 17/02/2013 17:44

When my son was diagnosed with asthma I went through a complete period of denial. And anger. How could he have asthma? I had had a healthy pregnancy, lived in the country, had dogs, breastfed him until he was nine months old, wasn't over-hygienic. It was all a terrible mistake, caused by the fact that he'd had both pneumonia and bronchiolitis (sp) at 12 months. His lungs were just a bit sensitive to changing temperatures, that was all.

But he does/did have asthma. As does my daughter.

It was hard to accept. Especially when we discovered, years later, because of investigations into his nasal polyps, that one of the triggers was dogs. We had dogs since before I was pregnant. We still have a dog and are trying to be more disciplined about keeping her away from the rooms he spends most time in.

Nobody really understands what causes asthma in some children. I think that's why parents like me can find it so frustrating. You do your best to bring your children up to be healthy: you keep them clean (but not too clean), feed them well, get them out in the fresh air, keep them fit, and they still get ill? How can this happen?

So I do understand your emotions, OP.

But if you're going to have a childhood illness, controlled asthma isn't the worst one by a long shot. Lots of children have it; nobody blinks when there is a group of small boys playing football and about five blue inhalers go into a pile on the side of the pitch, just in case. :) Some of my friends have children with diabetes. That puts a lot into context if you see how they have to manage their condition.

PolkadotCircus · 17/02/2013 17:56

Thank you Moose and AbraSmile

OP posts:
FreyaSnow · 17/02/2013 18:00

Sorry about creating controversy over different kinds of nurses. It was not my intention and I don't know much about NPs, having always seen an asthma nurse, so can't really comment.

claudedebussy · 17/02/2013 18:01

blubberguts, Montybojangles and everyone who took offence at my post:

i'm not saying nurses are a load of rubbish. i'm not saying gp's are god's gift. i can see that my post did come across like that though.

i didn't actually know that a nurse practitioner is a specialist nurse so i apologise for that. shows how much i know.

i do think that a respiratory physician / pulmonologist knows more than a nurse practitioner specialising in asthma. they've had more training. i'm not implying that that somehow invalidates the work that a nurse practitioner has done. of course it doesn't.

the op said the nurse couldn't answer her questions. maybe the gp can't either. if she's not happy she shouldn't let it rest there.

i can actually see that my post was offensive and i do unreservedly apologise. i don't know what i was thinking. there wasn't a gp in the room to advise me. Confused

careergirl · 17/02/2013 18:03

not sure about that actually. I would think a nurse practitioner specialising in asthma would focus CPD on asthma so may be more up to date in terms of practice/research

higgle · 17/02/2013 18:13

Weblette. I would not want a nurse to misdiagnose asthma and have this on my child's record. if they were going down this route I'd want him seen by the GP and if it if there was any doubt in my mind I'd take ( probably have to pay) for a specialist opinion. Last year I was persuaded to see a practice hurse because my GP was busy, just for a repeat prescription. She began to make comments which cleary indicated her expertise was out of date and I asked her on what research she was basing her opinions. She muttered something about that being what she had been told and was not very happy when I provided her with some up to date references to check out. the problem with technician level qualifications is theat they do not encourage people to thik for themselves.

blubberguts · 17/02/2013 18:18

Higgie - -'technician level qualifications' wtf??? Or are you just winding me up??

blubberguts · 17/02/2013 18:20

Yeah, note to self.... Must not allow self to be wound up by deliberately provokative posts

careergirl · 17/02/2013 18:21

They do a little bit more than an NVQ you know.....I wouldn't have let one operate on my face if I had any doubts!! I really value Nurse Practitioners - the ones I've come across have been brilliant.

SDTGisAnEvilWolefGenius · 17/02/2013 18:22

Nurses have degrees now, higgle. And practice nurses have to have further training too, afaik - certainly they do to be asthma nurses.

Technician level qualifications? What bolleaux!

blubberguts · 17/02/2013 18:23

Ommmmm

ClayDavis · 17/02/2013 18:27

Where might I find one of these nursing NVQs. I quite fancy a career change.

amillionyears · 17/02/2013 18:29

Is a Practice nurse the same as a Nurse Practioner.
And where does the asthma nurse fit into things? Or have they got new names now.
Am more confused than ever.

And a nurse practioner is a specialist nurse in something, or lots of things, including asthma?

Wheresmycaffeinedrip · 17/02/2013 18:30

Online :)

crashdoll · 17/02/2013 18:32

I've read the whole thread and have no idea why a select few think having asthma (even if it was misdiagnosed) on a medical record is such a bad thing! It is hardly a hugely stigmatised 'label' that means they are at risk of discrimination and social exclusion.

CharlieMumma · 17/02/2013 18:35

Nurse practitioners are different to practice nurses just google it for full details. But nurse practitioners are fully able to diagnose conditions within their expertise and are often more expert on these fields than 'general practitioners' GPs! Bored of this thread now the op isn't listening and the attitudes and out of date opinions on nursing is unbelievable!