Taking a Deep Breath: Asthma and Color War from a Camp Doc

By Ron Goldenberg, MD

Dr. Ron we have a boy in the infirmary who can’t breathe.  

This call is common at camp, especially during Color War.  It is mid-August and it is often a hot and humid 85+ degrees. I make my way over to the infirmary and Jacob is hyperventilating, face red, eyes welled up with tears, I can’t breathe.

Being sick or feeling like you cannot breathe is always scary.  At camp, away from home and your parents, it can feel even worse. As a camp doctor, my first job is to calm the camper down and let him know he is going to be ok.

As I work I explain to Jacob what I am doing, I am going to put a pulse oximeter on your finger, this will tell us how much oxygen is in your blood and what your pulse rate is. Are you an A student? Because we are looking for a score of 97 or better. He smiles and the oximeter reads 99%, Congratulations Jacob, you passed.

I ask the nurse for a brown paper bag and have him breathe slowly into the bag while I listen to his lungs. Sometimes kids are be hyperventilating and not having an asthma exacerbation, the bag helps them feel better and gives me a chance to focus on his lungs. He wasn’t wheezing.

While Jacob is breathing into the bag I look at his chart, he does have asthma. I look at his asthma worksheet, which we use at our camp to track campers with asthma.

According to the records, Jacob’s best peak flow is 450. After he finishes his 12 breaths into paper bag, I can see that he has returned to a more natural rhythm and he appears less anxious. I feel much better, he says.  Its a little soon to let him return to Color War so we have him wait. Jacob that is fantastic news. Where is your division right now? He tells me that are playing hockey. We strike a deal on his recovery and he works to take long deep breaths.  How about stick around for 15 minutes, I say to him and we start an egg timer.  Once the timer expires, I reassess him. You look better, how do you feel? He says he feels great and I send him back to Color War with explicit instructions on when and why to return to see me.

This situation could been very different. Jacob could have been having a true asthma attack, requiring different medications and he might have stayed in the health center.  The key to managing asthma at camp is to be patient and allow the medication to work. Easing the anxiety of a camper is vital to getting the most accurate assessment of the situation, and this requires and close doctor-camper relationship.  We acknowledge this is a scary feeling, but reassure them they will be OK.  I have found that one or two nebulizer treatments and a little Gatorade provides the relief the camper needs to safely return to their group.

After Jacob went back to his group I called his parents.  As a camp doctor and a parent of three campers, I how hard it can be to receive that call.  I also know how we run a stellar infirmary and we are  prepared they are to handle any situation that may arise.  We let them know how we addressed his condition, what our plan going forward, and that we will follow up with them should anything change. This is not an easy call to make, but it is a much harder call to receive.

Once I hung up the phone, I headed back to watch Color War in full swing. I know it is only a matter of time before I hear my walkie-talkie calling out, “Dr. Ron, we have a…,”.  Such is the life of a camp doctor and I love it!