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Asthma House Calls

Part I (Asthma and Urgent Care)

  • Lisa: Hi everyone! It’s Lisa with LivingWithAsthma.net, and we’re back with another one of our Asthma House Calls, where we get to sit down and talk with some of the very best doctors who treat children with asthma.Today we’re here with Dr. Sandy Vieder of Lakes Urgent Care and Michigan State University. Dr. Vieder is Chairman and medical director of the Emergency Trauma Center at Botsford Hospital in Farmington Hills and also a clinical professor of medicine at Michigan State University. Dr. Vieder is board certified in emergency medicine.

    Hi, Dr. Vieder! We are so glad you could be with us.

    Dr. Vieder: Thank you for having me.

    Lisa: Now just to start for those parents who have never taken their child to an urgent care center before can you tell us what an urgent care center is and how it is different from a traditional emergency room?

    Dr. Vieder: So an urgent care center really is kind of a hybrid between your pediatrician’s office and the emergency department. It’s important that you try and look for urgent cares that are certified urgent cares because not all urgent cares are certified.

    That certification comes from the Urgent Care Association of America and the big difference there is that these are centers that are really geared towards taking care of a very wide variety of illnesses and injuries. They pretty much operate like an emergency department without the ambulances and without the hospital beds.

    So while we certainly don’t want to take somebody who is really critical to an urgent care, like somebody with chest pain or perhaps has a bone sticking through their skin or something along those lines, pretty much all of the other run of the mill daily things like asthma attacks, upper-respiratory infections, cuts that need stitches, that sort of thing can certainly be taken care of in a qualified urgent care.

    Listen to Part 1 of the interview.

Part II (Why Urgent Care?)

  • Lisa: What are the advantages of going to an urgent care over an emergency room?Dr. Vieder: The biggest advantage really is that if you are going to a certified urgent care center, you are likely going to be cared for by an emergency physician who happens to be working in that urgent care center, similar to what ours is.

    All of our physicians have emergency medicine training so you get the emergency physician without all of the other sort of unwanted issues like long wait times, crowded waiting rooms, but the biggest thing is that the cost is considerably less for anybody to go to an urgent care compared to an emergency department. Your copay is going to be significantly lower and the charges for those people who don’t have insurance is going to be significantly less. So that is probably the number one reason to consider going to an urgent care.

    The other things that it certainly affords is that it’s generally a more comfortable environment, a little bit of a friendlier environment than an emergency department is because of some of the chaotic things that do go on in emergency departments across the country, and also the amount of time that you take. Most urgent cares will see you and treat you within a 60-minute period so that’s start to finish. Whereas it may take you 30 minutes or more just to get into an emergency department to be seen by a physician depending upon what department you go to. Some are excellent and really do get people in and out very, very quickly.

    Listen to Part 2 of the interview.

Part III (When It’s Time for the Emergency Room)

  • Lisa: Now it sounds to me like for a lot of situations, the urgent care can be the go-to for parents when an asthma attack occurs, but are there times when a parent should just head for the ER?Dr. Vieder: Yeah, you know there are some real basic rules I like to share with parents in particular when we’re talking about kids with asthma and that is that if your child is at all unresponsive or seems to be really sleepy, or what we sometimes call lethargic, and they are having trouble breathing and you think it is from their asthma, this is clearly a time when you want to head to the emergency department and not likely an urgent care.

    However, if you’re seeing that your child is having some problems and you’re comfortable with the sort of stages of asthma that they go through and you’re catching it early on, it’s very appropriate to be able to go to an urgent care at that point. They can typically give some steroids to initiate the treatment, breathing treatments to give and often times that can be enough to kind of turn the situation around and you can avoid going to the emergency department.

    But the last rule of thumb is always trust your instincts. Parents who have kids with asthma or other chronic conditions generally have a really good sense as to when their kids are doing well or when they’re in trouble and that’s always the best thing to follow. Follow your intuition. Nobody knows your child like you do. So don’t ever not pay attention to that. That’s a very important element.

    Listen to Part 3 of the interview.

Part IV (Taking Your Child to Urgent Care)

  • Lisa: Dr. Vieder, can you take us through if an asthma attack is occurring in a child, are there things that parents can do to make sure that their child gets the best care possible at an urgent care center?Dr. Vieder: Well there’s basic things that whether you go to an urgent care center or an emergency department are generally going to happen with an acute asthma attack. Because we are really honing down our treatments to one specific area, that being asthma, you’re always going to see breathing treatments that are given.

    You’re likely going to see some form of a steroid being provided whether that is an oral medication which is just as good as an injection, it doesn’t have to be one or the other. They’re both just as efficacious as the other. And the time of onset for steroids that are given is typically 4 to as much as 6 hours after the initial dose, so you’re not going to see a benefit immediately.

    The other thing is that if you have a child who is having a really severe asthma attack, we will sometimes give adrenaline or epinephrine and that too can be given in both of those settings. So those are the things that you’re generally going to be looking for.

    I personally try to avoid doing chest x-rays on kids with asthma because over the course of their lifetime they generally have so many x-rays and more often than not those x-rays are normal. If we know that the issue is asthma and it has been triggered by an upper-respiratory infection or a runny nose or a cold or perhaps an allergen that might be in their environment then there is really no need to do a chest x-ray. And so trying to avoid unnecessary x-rays is important as well.

    Listen to Part 4 of the interview.

Part V (Reducing Emergency Room Stress)

  • Lisa: Are there any things that parents can do to make those late-night trips to the urgent care or the ER less stressful for the child and maybe the parent too?Dr. Vieder: Well, initially the difference between the urgent care and the ER is certainly pretty dramatic in terms of that stress-inducing environment. So certainly going to an urgent care is going to be a little bit less stressful than going to the emergency department.

    But most importantly, I think just being supportive with the child, getting to know your local facilities, maybe even making a trip into that facility when the child feels well, can be a really great way to introduce them so that if and when that time comes where there is an asthma attack that you are not able to effectively treat at home, and now you’re heading to your local facility whether it be an emergency department or an urgent care, that can be really beneficial because now the child kind of knows where they’re going.

    I frequently say to the residents that I teach that stress is the function of what you don’t know. So if you don’t know where you’re going and you’re not aware of your surroundings, that is going to be way more stressful than if you are familiar with your surroundings.

    So sometimes taking a child to a local facility when they’re feeling well, maybe those facilities will give them a little prize or gift or toy, spend a few moments showing them around and making them feel comfortable so that if that moment comes, it’s a little bit less stressful for them.

    Listen to Part 5 of the interview.

Part VI (Managing Asthma Every Day)

  • Lisa: Kind of on that note, are there everyday things that parents can do to manage their child’s asthma and avoid going to an urgent care center?Dr. Vieder: Absolutely, the most important thing is making sure you follow the directions of your primary care physician. Whoever is managing your child’s asthma is likely going to provide you with a roadmap of things that you should do on a regular basis and things that you can do when you start to notice specific symptoms.

    There are some physical symptoms that we can look for in children with asthma and it is not hard to learn but it is certainly something that hopefully your pediatrician or primary care physician will spend some time teaching parents about to look for. And I’ll give you just a couple of examples.

    For instance, nasal flaring and that’s when the nostrils kind of move in and out. It’s something that is pretty easy to see and if you see that happening with your child, what that should tell you is that you know what they’re working a little bit harder than they normally do when they’re feeling well so that’s just going to be a little bit of a red flag. Perhaps they are starting to get into trouble and we need to give an extra treatment or get out the inhaler or the nebulizer at home and make sure that we do what we need to do because again, early intervention as these things progress really make a big difference.

    The other thing is making sure that you address certain environmental issues that trigger the asthma or asthma attack in your child. So you’ll need to learn whether or not if you have pets, are those potential problems? Some kids with asthma do perfectly fine with dogs and cats. Some do not because they have a combination of reactive airway disease and asthma, and environmental allergies and when you add that all together that can be kind of a 1, 2, 3 punch that really puts them over the edge.

    Any one of those elements independently might be just fine and they can tolerate it but when you have that additive effect it can certainly impact their airway and create a worse situation so that’s the other thing you want to kind of look like, is what seems to trigger specific events.

    Perhaps keeping a log is another great idea so that when you notice that your child has a particular problem is there some commonality between the events. Is it something that they ate? Perhaps it is a new food allergy that triggers it as well.

    These are all possibilities. It doesn’t mean that they happen in every child, but certainly something to keep in mind and that can help parents sort of prevent those events from getting worse and having to go to an urgent care or an ER.

    Listen to Part 6 of the interview.

Part VII (Why to Quit Smoking)

  • Lisa: On the flip side, are there things that you see that parents don’t realize can land their child in the urgent care or ER?Dr. Vieder: Probably the number one thing I see is unfortunately where parents are smokers or there are smokers in the home and that creates an environment that is certainly going to get kids into trouble. Generally speaking, most parents who have got kids who have asthma and those kids have been evaluated are pretty much with the program. It’s pretty rare.

    Parents are really great. Once they learn about the disease and once their child has been living with it for some period of time, they generally figure things out and they are generally pretty good about intervening early and trying to prevent bigger problems.

    And once they do end up in the emergency department or urgent care, those are the parents that I find more often than not are really well educated and they’ve done all of the things they can do at home and now it is time for some professional help.

    But going back to the smokers the other issue is that a lot of times I’ll hear parents say, well I don’t smoke in the house which is certainly better than smoking in the house, but even the smoke, the smell of smoke on their clothing or on their skin, can be an irritant that is enough to trigger an asthma attack in some kids who are really sensitive. So that is probably the number 1 thing that we see, particularly in my line of work where people and kids do get into trouble with asthma and that is that exposure to smoking.

    Listen to Part 7 of the interview.

Part VIII (Talking to Your Child About Asthma)

  • Lisa: Do you have any advice for parents for talking to their child about asthma?Dr. Vieder: Absolutely. Unfortunately, there is going to be some percentage of kids who have asthma and move on to be adults who have asthma. And it’s not going to get any better. But it’s certainly manageable. So empowering your children to learn about the disease and empowering your kids to lead as normal a life as possible is really really critical.

    By way of example and this is not directly related to asthma, but I’ve got a son who has got a congenital heart problem and has to take blood thinners because he has an artificial heart valve and we’ve always been supportive of him being involved in certain sports.

    Now I won’t allow him to play contact sports, but we do allow him to participate and play sports to the best of his ability. And so he hasn’t grown up feeling like a cardiac oddity if you will, or a child who can’t be like all of his friends and buddies.

    So making sure that your kids are involved in other activities to their tolerance is really important and being supportive of that. Because again, kids with asthma can do really well in athletic activities. That might require a little extra TLC just before participating. For instance, some kids might require a puff or two of an inhaler before they begin playing in a sport and once they do that, they do absolutely fine.

    So I would be cautious about having kids sort of put into the bubble and not allowed to participate and do the things that their peer group does. To as much as their tolerance, they should be allowed to do that.

    Listen to Part 8 of the interview.

Part IX (Final Advice)

  • Lisa: Is there any other advice you would give parents of children with asthma today?Dr. Vieder: The biggest thing is that if asthma is new to you and your child, take the time to educate yourself because it is such a treatable disease and it is a disease that you can live with and lead a totally normal healthy life. That’s probably the most critical message I would give. And make sure that you become familiar with your local facility, so that when you get into trouble you know where to go and you are a little bit more comfortable.

    And like I previously mentioned, introducing the child to those facilities is something that many facilities would be happy to do. We certainly are at our urgent care and our emergency department. We would welcome that opportunity so that the child is less scared and less apprehensive when they do need to come in when things have not been successfully turned around at home.

    Lisa: Thanks so much for being with us today Dr. Vieder. If people today want to keep up with you what is the best way to do that.

    Dr. Vieder: Well they can certainly look at our website which is www.lakesurgentcare.com and we do have a Facebook page. We post all kinds of informative articles and we try to send out posts at least twice a week so there is always health related links there. But certainly for those who live in our area, we are happy to take care of any of their needs and again I appreciate the opportunity to speak with you today.

    Listen to Part 9 of the interview.