Father's Experience from Motherhood #2

In the first post of this series, I wrote about how my toddler has been suffering from this cough that will not just go away. The cough comes for a few days, takes a break for a few weeks, and then comes back again. I decided to take him to a clinic (not like it is the first time) again and this time, a couple of tests were recommended, unlike before. The tests were recommended after working on 3 hypotheses on what the origin of the cough could be. The hypotheses are as follows:

1. The could is due to an allergic reaction to a substance or group of substances.
2. The cough could be asthma-related.
3. The cough could be due to an infection of the upper respiratory tract.

So, it was based on these three hypotheses that the physician chose to act with the allergic reaction and the asthma hypotheses being linked together. The physician wrote a prescription consisting of Novalyn linctus and salbutamol syrups. While the former has demulcent and soothing actions which help to naturally relieve throat irritations associated with dry and stubborn coughs, the latter is used to rapidly treat asthma, bronchospasm, and reversible airway obstruction by widening the airways of the lungs.

Along with the prescription, the physician also recommended an asthma test with a blood test. While the prescribed drugs were to be started immediately, the results from the test will show the next step to be taken in getting a permanent solution to the cough that has now become a source of embarrassment.

At the Pharmacy

I took the prescription to the nearest pharmacy because I was eager to start administering treatment. The Pharmacist looked at the paper and mumbled something.

'Salbutamol syrup is available. However, I do not have novalyn linctus syrup but something better than it is available.' He retorted.

'You are the professional. Once you are sure of what you have, I do not have any issue.' I responded.

To cut the long story short, I bought a brand of salbutamol syrup and a brand of cough syrup different from the one prescribed by the physician. No thanks to the Pharmacist.

^{The two drugs purchased at the pharmacy}

At the Diagnostic Center

We got to the diagnostic center and presented the form given to us by the physician. The medical laboratory officer looked at it critically and then muttered under his breathe:

'Five thousand Naira.'

Knowing that I have got very little or no option, I decided to go with the price he quoted, even though I felt it was a bit on the high side.

'Can we wait for the result?' I asked.

'Of course! It will not take more than one hour.' He replied.

I asked the question because I know that some tests take as short as just a few minutes while some might take hours for the result to be read. I know there are 3 methods available to choose from when it comes to testing for asthma:

1. Spirometry test
2. Exhaled nitric oxide tes
3. Challenge test

All the test measures the functionality level of the lung from which the presence of asthma can be deduced. The spiromety test is a simple breathing test. The patient is given a bronchodilator and the amount and the rate at which he or she can exhale air is measured. This test will show if there is any obstruction in the airways and of what magnitude.

For the nitric oxide test, the patient is asked to breathe into a machine which measures the amount of nitric oxide in the breathe.. The presence of the chemical in the breathe is used as an indicator of inflammation in the airway, knowing that asthma itself is a disease caused by the inflammation of the airway.

The challenge test is often required when the above two tests fail to clearly indicate the presence of asthma. The patient is made to inhale increasing amounts of either methacholine aerosol mist or mannitol dry powder. A drop in the functionality of the lung indicated by spasm or narrowing of the airway confirms the presence of asthma. Almost immediately, a bronchodilator is used to make the airway returns to its original condition.

The blood test varies depending on what exactly is being checked in the blood. In this case, I am really not sure what the physician indicated to be checked in the blood.

My toddler was taken inside and afterabout twenty minutes of crying and persuasion, a blood sample was taken and the asthma test conducted. I was not sure which of the methods was used because I was not allowed beyond a certain region of the diagnostic center. We sat down for about another one hour after which the result of the tests was handed to us in a stapled form.

At home

I administered the drugs to my toddler as indicated in the prescrition written by the physician before retiring to bed for the day while keeping a close eye on my toddler. He was uneasy in his sleep throught the night in what represents an unusual sight. He also developed a fever overnight and I started wondering what could be wrong. I quickly went to check the contents of the cough syrup given to me by the Pharmacist and to my chagrin, found out that the cough syrup itself contains salbutamol. Remember that I administered salbutamol and a cough syrup to start with. This clearly showed that I have given him more than the recommended dose of salbutamol.

^{The contents of the cough syrup showed 2g salbutamol per 5ml while the asmalyn also contained 2g salbutamol per 5ml. 5ml of each drug was to be given to the toddler. In summary, an overdose of salbutamol was daministered. Image by the author.}

I was annoyed at myself for trusting the Pharmacist completely on one hand, and with the Pharmacist himself on the other hand. If only I had checked the contents of the cough syrup, this would not have happened. Fast forward to morning and I quickly returned to the clinic with the test results and the cough syrup given to me in place of the one recommended.

The physician chastsized me a bit and asked that the cough syrup be discontinued immediately. After checking the temperature of my toddler to confirm the fever I'd earlier complained about and the result from the lab, she prescribed another drug - Fleming suspension, a brand of amoxicillin and clavulanic acid. SHe also complained of low pack cell volume and prescribed a blood booster for him to be taken after completing the antibiotic dosage. She said that any cough expectorant without a sedative or other unusual component would be fine as well.

Finally

It has been a few days now. The antibiotic dosage has ended, the fever has calmed down completely and the cough has subsided greatly. My toddler has even returned to going to school. Hopefully this time, the cough will not resurface again.

Thank you all for reding.

Resources

• https://my.clevelandclinic.org/health/diagnostics/8958-asthma-testing--diagnosis