$1,000 for a cough

They told us it was allergies.

One winter week, my 7-year-old twins started with stuffed noses and sore throats. We did what parents typically do: We broke out the throat spray, the cough syrup, the decongestant.

Instead of going away, the problem got worse. The pediatrician did a test for strep, which came back negative. After that, he just shrugged and told us it was a viral infection, probably stemming from an allergy to dust and pollen.

It's very difficult to test for a virus, he told us. Pinning down an exact diagnosis would require blood work, and for many children the trauma of having blood drawn to diagnose a condition for which nothing can be done outweighs knowing the actual condition. And with most cases of viral infection, all you can do is wait it out.

There is nothing more frustrating for a parent than to hear the words "just wait it out," but according to Michael Brady, a spokesman for the American Academy of Pediatrics, waiting it out is basically all anyone can do when dealing with a virus.

"Parents want to be part of trying to help their child get better," he said, "but sometimes doing nothing is better than doing something, particularly when the treatment could be worse than the virus itself."

Brady, an Ohio pediatrician specializing in infectious diseases in children, emphasized that cold medicines do nothing to cure a virus. They don't even treat the symptoms they are meant to treat.

"Just say no to cold medicines," he said. "They do not work, and they have some medications in them that make kids irritable and upset. They are more dangerous than helpful. All the over-the-counter meds are discouraged for children of any age."

Brady said that most such medications fall into two camps: antihistamines and decongestants. "Antihistamines do nothing for colds, because there has been no increase in histamines to begin with," he said. "And decongestant syrup is meant to clear the nose and sinuses, but it must go through the patient's bloodstream first, meaning in order to get enough to be effective, you'd have to ingest way too much of it."

Even worse, he said, are cold medicines that include fever reducers, because the mixture makes it difficult for parents to know exactly how much fever reducer their child has taken. "If you need to give Motrin or Tylenol, give it by itself," he said. "Don't waste time or money on combination cold medicines."

Of course, it was already too late for my family. I had my kids take anything they could, hoping something would help. By the next week, their stuffiness had turned into wracking coughs. We went back to the doctor.

This time we were given prescription cough syrup, prescription allergy medication and an inhaler to be used four times a day to decrease the inflammation in the lungs. We were sent home with the same diagnosis: a virus stemming from allergies.

None of that regime worked. My husband and I watched helplessly as the twins coughed and hacked and struggled to breathe each day and night. Our frustration turned to anger. We were going to doctors for this. We had tried to catch it early. We had already spent more than $200 fighting it. Why was nothing helping us?

"A lot of insurances make patients pay co-pays, and as a result, parents come in and pay, and they want to know more than 'it's just a virus, wait it out,' " Brady said. "They feel like they paid for more than that, but really, they got quite a bit because they got someone to confirm that they shouldn't spend money on expensive tests and medicines."

But surely a virus can morph and change and become more severe as time goes on, right? By the third week, our children had shown no improvement, and their breathing was still more difficult. This time the doctor prescribed a nasal allergy spray and told us to invest in a humidifier. The diagnosis remained the same. We now sat at $400.

Brady said that honey works best for coughs and that Vicks VapoRub is better for decongesting than any syrup. He said that while sprays work better than over-the-counter medications, parents should use them for only a few days. Otherwise, they risk damaging the nasal passages. He said the time to really start taking note of symptoms is when a child stops eating regularly, has a fever of higher than 101 or is no longer alert while awake. But even then, he said, call the pediatrician before going to an urgent care or emergency room.

"So many times, the symptoms will worsen at night and the family feels like they don't have access to their normal doctor's office, but many pediatricians are happy to talk to parents over the phone during off hours," Brady said. "They can advise from off-site and make an appointment for the morning, which saves a lot of time and money on the part of the family. Remember, the pediatrician knows their patient better than an emergency room ever could."

For us, the phone call wasn't an option late one night well into the third week. Suddenly, over dinner, one of my daughters could no longer breathe in without coughing continuously. Her lungs were so busy trying to expel whatever was irritating them that they were not allowing any intake of air. She seemed to be suffocating right in front of us. We raced her to the ER. They rushed us to the front of the line.

Four X-rays, five hours and an intense nebulizer treatment later, she was breathing normally and sleeping on her cot with the rough ER blanket pulled around her shoulders. They sent us home with instructions to buy a nebulizer of our own, a prescription for antibiotics (just in case) and steroids to calm the inflammation. They told us to follow up with an allergist. This time the diagnosis was bronchospasms brought on by a virus brought on by allergies. But why, with all of our attention to the symptoms and all our care, had we not been able to prevent her distress from getting worse? We were at wits' end. And now we had $800 in medical bills and countless hours in waiting rooms, all for a diagnosis of "sorry, there's nothing we can do."

My emergency room co-pays came to $150 each. The co-pays for doctor visits were $20 per daughter. Nebulizers aren't cheap, and the costs of over-the-counter medicines were steadily rising.

Over the next week, we used the nebulizer often because the girls' lungs were so irritated they simply couldn't breathe without it.

"Sometimes when a virus gets into the lower airways, those airways become narrowed, and the patients wheeze," Brady said. "But even under those circumstances, unless they have the flu, there is no specific therapy that can treat the virus. You can only treat the symptoms."

Brady said that when a virus starts growing in the upper respiratory tract - meaning the nose and throat - most of the time it ends there. Sometimes, however, it moves into the lower airways. It infects the top layers of cells and kills them. Because those are the cells that clean out the lungs, patients begin to cough, and that coughing inflames the lungs. And there is nothing you can do about it.

"Parents truly need to know that there is nothing they can do to stop this," Brady said. "A virus is going to run its course, no matter what. Treat the symptoms like wheezing and fever early, but understand that you didn't cause your child to get worse, and you can't help your child get better."

Here's what I have learned if this ever happens again. Instead of focusing on stopping the entire thing immediately, I will pay closer attention to the smaller signs and what they mean. Instead of flooding my daughters with cough syrup, I will listen. Does it sound as if it's moving into their lungs? Are they starting to wheeze or crackle at all? At those signs, I will act, getting the medication and treatments we need to help those airways stay clear and avoid the near-shutdown of the lungs we experienced this time. By going to the doctor less but paying more attention, we could save ourselves a lot of money and a lot of heartache.

As for this time, we followed up with an allergist, two months later - a visit with a price tag of $250.

The kicker?

My girls don't have allergies. They had a $1,000 cough.