A Tale Of Two Teenagers Part I

Ben grew up with asthma, but at 15 he seemed to have outgrown it.  Then this fall he began to cough and feel tight.  His mom took him to a quick-care, where he was prescribed an inhaler. A few weeks later he caught another cold virus, began to cough and wheeze again, and started using the inhaler he had left in his school bag. Ben was a busy teenager, and didn't use his inhaler regularly.  He took puffs only when when he felt tight.  He began to get more tired and out of breath despite the inhaler, but he didn't tell his mom.  He felt this was his business, and his mom nagged him enough as it was- about his grades, his phone use, his messy room.  He didn't need more nagging about his medicine. Then one evening he suddenly couldn't breathe.  It was a struggle to pull in a breath, and he had to tell his mom.  When she saw that he couldn't speak and was so air hungry, she called the ambulance. After an hour in the Emergency Department and lots more medicines, he was put in Intensive Care, still wheezing. Ben's story is common with teenage asthmatics.  Teenagers generally get poor health care, even those with chronic, potentially life-threatening conditions like asthma or depression.  Littler kids see the doctor a lot, given all the vaccines they need.  They get sick a lot more too, meaning more trips to the office. When they get to be teens, there's less reason for kids to go to the doctor.  The vaccines are fewer and far between.  Teens stay pretty well.  When they do get sick, rather than fight to get into their regular doctor, parents sometimes opt for more convenient walk-in clinics. However, losing contact with your child's doctor is a problem.  Sure the vaccines are fewer, but when you don't go to your "medical home" to get seen, you don't get reminded the important teen vaccines and may miss them: the meningococcal vaccine against meningitis, the tetanus booster, and the cancer-preventing HPV vaccine.  And a walk-in doctor is less likely to ask about your teen's chronic conditions which need surveillance, like asthma, or depression. Ashley, 14 years-old, was always a glum kid.  She kept to herself, rarely smiled, had few friends.  About a month ago she broke up with her first boyfriend.  This made her feel even more worthless than usual, and she lately has been thinking that the world would be better without her.  Today she told a friend that she was thinking of taking a lot of pills. Ashley's friend, burdened by this knowledge, stewed through several periods at school, and then told a counselor.  Though this made the friend feel like a tattle-tale, she actually saved Ashley's life. The counselor called in Ashley and her parents, Ashley admitted her suicidal thoughts, and she was brought to the Emergency Department for evaluation. Depression, like asthma, can be a chronic condition in teenagers.  Like our asthmatic teen from above, teens don't like talking to parents about their condition.  They are embarrassed by it; they feel like freaks, with their asthma or depression making them different than others.  They also don't like being nagged.  Throughout her childhood Ashley's parents harped on her about her depression, and she had been to counseling several times.  She didn't like counseling: who wants to talk about their feelings when their feelings are so negative? Having a regular doctor is one way to keep tabs on depression.  At well visits, besides vaccines and school physicals, doctors should be asking teens about their feelings.  If kids seem depressed, their doctor isn't afraid to ask the harder questions: do you want to kill yourself?  Why are things worse now: is it problems with your parents, your friends, your school?  The "medical home" is all about prevention, unlike an Emergency Department or walk-in clinic, where it's about fixing the kid's immediate problem and moving on. If you are worried that your teen is depressed and may be suicidal, fortunately Lafayette has the Jacob Crouch Foundation, a suicide awareness and support group.  You can visit their website at crouchfoundation.org to learn suicide facts and myths, how to recognize signs, and how to get help. Even better, get help earlier by sticking with your kid's doctor!