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Lifeisgood
04-03-2009, 09:59 PM
Just wondering if I'm crazy... I noticed a long time ago that everytime Harlie laughs really hard (like if we're tickling her) she goes into a huge coughing fit. Bad enough that we don't even want to tickle her! At first, I thought it was just bad timing. But, it literally happens everytime. So, what gives? Is it the trach? And if so, why? Does this happen to any of your trached kiddos?

Thanks,
Christy

Ainsley's Mom
04-03-2009, 10:45 PM
Of all the weird things we have we don't have that problem. I'm trying to remember back to pre-Nissen. :hmm: But the one thing I can think of is that sometimes they tighten their stomach muscles pretty hard when they laugh. With her vomiting issues I'm wondering if it's possible she could be refluxing when she laughs? Which could then cause coughing? Or maybe the pressure of big sudden bursts of air through the trach makes it tickle, causing a cough? Ainsley has a pretty strong reaction to tickling so, come to think of it, I'm kind of surprised it doesn't make her cough.

Kate
04-03-2009, 11:15 PM
I'm wondering-does she wiggle her head when you tickle her? Just wondering if she is jarring her trach while wiggling??? Which would make her cough?? Maybe?

Gretchen(Celia's mom)
04-03-2009, 11:24 PM
Ok I am going to go in a different direction on this one. I think it is somewhat "normal" to cough after laughing hard, maybe it is just exaggerated in a trached kid because there is more tickle from the trach?
I say this because I sometime cough after a good laugh and so do my older girls. Just a thought.

cherienz
04-04-2009, 07:31 AM
Hi
We don't have this problem. Coughing for us is coughing normally just with a cold or iccky secretions. I noticed in your photo that she is not wearing a PMV or a swedish nose over her trache tube? Could this be it? I have no idea whether it could be - we just never leave Mitchell's uncovered - maybe the extra air intake while laughing makes her cough?.

When Mitchell laughs on his PMV it is so beautiful to hear the sound so I certainly hope you don't have to stop tickling!!! Another thought, perhaps if kids don't have the strength to cough up their own secretions, I think you could aggravate a cough by laughter - just meaning that when there is a low respiratory resolve, that maybe they need a suction but it only becomes apparent when they laugh and it makes their chest work to bring up the secretions? Mitchell didn't laugh for a long time because he didn't have enough energy, so these are just my random thoughts!

These are my thoughts ONLY - we haven't had this, so I am just pondering

Thanks Cherie

Kate
04-04-2009, 09:05 AM
Ok I am going to go in a different direction on this one. I think it is somewhat "normal" to cough after laughing hard, maybe it is just exaggerated in a trached kid because there is more tickle from the trach?
I say this because I sometime cough after a good laugh and so do my older girls. Just a thought.

That's a good thought too Gretchen. Could be so many things. :)

Big Al
04-04-2009, 01:15 PM
I see she has a shiely I have found with some of my clients that have shileys if the ties arnt tight some movements will cause the trach to bob in the airway and with the shielys being so ridged they can stimulate a cough. It can lead to a viscious cycle motion causes cough cough causes motion. Try making sure the ties are snug or put a drain sponge on sometimes it helps. Good luck.

drct1245
04-04-2009, 04:49 PM
Hey Christy,
We have that issue, even after the trach - but it's a prolonged time frame. Like maybe 15-30 minutes of playing and laughing hard. Ayden will then cough and sometimes throw up. In talking w/ our pulm's office, they said it could be similar to EIB - exercise induced broncheospasms (which I can never spell). Ayden has the same issue when he plays too hard as well. We were told, if we know we are going to be playing hard, then we could use xopenex ahead of time.

lynn
04-04-2009, 05:52 PM
I was going to say the same as Dawn- Joseph occasionally coughs after Hard laughing -and, I know that myself- I almost go into an asthma attack if I start laughing too hard-and need my albuterol inhaler.

suzanne2545
04-05-2009, 09:22 AM
This has been a frequent topic of discussion in our home but not in relation to trachs. I'm the one with the problem. If I laugh too hard I'm in a huge coughing fit that can take minutes to recover from. Berkeley has the same problem. Even as an adult I've not figured out why it happens but my best guess is that the air from the laugh is tickling the back of my throat.

TommysDad
04-05-2009, 01:18 PM
I, too, was going to say the samething as Dawn just to see if you thought it could be pulmonology related. The excess negative pressure one puts on their own lungs to laugh and then to take deep inhaled breaths can cause the lungs to spasam making one sometimes cough in excess. I remember my sister, my mom, and even my husband, Tom & his brother all doing this. They all got diagnosed with "asthma" and got a prescription for a broncho-dialator. This helped a lot!

However, our son Tommy has severe bronchomalasia, and we were told NEVER to use broncho-dialating drungs with him per pulmonologist directions. (The special needs ped wanted to give them to Tommy once, but pulmonologist still said NO WAY!) I remember reading somewhere (might have been here, might have been in a medical journal article) that each year, millions of American's get incorrectly diagnosed with asthma, but really, if they go see a pulmonologist and get their lungs scoped, they find they have some form of malasia, NOT ASTHMA, and get the wrong diagnosis and the unnecessary medication that's not treating the right problem. Many docs (many of whom are pulmonologists) just assume it's asthma, and I could see many ENTs just assuming this happens because of the cough because I'm sure they see both cases often enough that they wouldn't risk putting a patient under just to scope them. But our trache (and vent) kids seem to get scoped so regularly, I'd talk to with your pulmonologist about what you are witnessing. Some ENTs & Pulmonolgists work hand-in-hand. When one doc wants to put a patient under for a scope, the other one always wants to be involved. Some docs don't have that "TEAM WORK" attitude. You don't want to go without tickle tourchering you child. It's so fun! And you don't want your child to get a broncho dialator if that's really not what she needs.

Even when Tommy was little and on very high vent settings, we would notice that still was not enough vent pressure for certain activities when he would exert a lot of negative pressure (like laughing, crying hard, pooping, etc.) We just had to LIMIT those activities until his lungs got a little stronger, or increase some vent pressure after those little bursts of activities by handbagging for just a few seconds unti he'd calm down. He never needed drugs (or take them safely according to our pulm).

OR all of this could certainl just be from the trache rubbing like so many other have said as well.

Bottom line is you know your child best. I'm sure you can tell better what you think is causing this...the lungs or the trache. And you'll advocate for her so you be the tickle monster and come to attack her once again!:D

Let us know how all this turns out.

~Maggie

suzanne2545
04-05-2009, 05:08 PM
I remember reading somewhere (might have been here, might have been in a medical journal article) that each year, millions of American's get incorrectly diagnosed with asthma, but really, if they go see a pulmonologist and get their lungs scoped, they find they have some form of malasia, NOT ASTHMA, and get the wrong diagnosis and the unnecessary medication that's not treating the right problem. Many docs (many of whom are pulmonologists) just assume it's asthma, and I could see many ENTs just assuming this happens because of the cough because I'm sure they see both cases often enough that they wouldn't risk putting a patient under just to scope them. But our trache (and vent) kids seem to get scoped so regularly, I'd talk to with your pulmonologist about what you are witnessing.

~Maggie

Hijack alert.

Maggie. Here's my question - in those who are incorrectly diagnosed do the asthma drugs have a positive (or a false positive) effect??? Presumably they do as if the drugs weren't doing what they are supposed to do then you would continue to search for answers.

Interestingly. Parker was considered a severe asthmatic while he had his trach. He was hospitalized a couple of times. By the time he had his LTP he was on advair, singulair, and PRN albuterol nebs which he got often. He was very uncontrolled. That is A LOT of asthma med for a kid who was so young. But it seemed to fit as Daddy is a severe asthmatic. That said - he is now (one year post LTP) off of all asthma meds. He did need the occasional neb over the winter to help move his chest congestion along but that is it. We've always wondered how he could have made such a dramatic turn around. He was off all the meds by the time we were 3 months post LTP. Now I wonder if it was just all wrong! I'm so curious.

Suzanne