Wednesday, March 28, 2012

Proactive Mitigation of Anaphylaxis

Tomorrow morning, I meet with Nick's teacher, school nurse, and the principal concerning how Nick's tree nut allergy will be managed if he goes to fifth-grade camp. Did I tell you that I was not selected as a parent volunteer? I was told that kids with medical needs got preference when it came to selecting their parents to go and that I was a shoe-in. Mike and I were pretty upset when we found out I wasn't selected.

For this meeting, Mike wrote up a single sheet of paper for me to use during our discussion. Oh, I love this man. He used phrases like 'proactive mitigation, reactive mitigation,' and 'controlling cross-contamination with the allergen.' He's a brilliant man, but he doesn't roll it out for everyday use. He has nothing to prove, most of the time.

The problem that I knew I'd have is that it is now 2:13 am and I am not asleep. I have trouble relaxing before I present information like this. I'm not angry any more, but I'm afraid they'll gang up on me and try to pressure me into saying Nick can go despite the fact that they haven't managed the 'proactive mitigation' part of our plan. Shoot, they haven't even managed it in the classroom.

Here's what Mike wants. Im not using his language here. He wants Nick to carry his EpiPen at all times. He wants the volunteers, teachers, and counselors to be trained to know where the nuts might show up. Aside from the obvious candy bars, breads, and desserts, there are tree nuts in some types of hot chocolate, hacky sacks, and hand creams! He wants them to understand what Nick will do and look like if he eats a walnut or almond or other nut and what they should do. Nick will tell someone his lip or mouth hurts, his face will get blotchy and possibly swollen, and he will most likely throw up. If they recognize that, they should stab him in the thigh with his EpiPen, count to ten with the needle in, and call 911. Seconds count here and they shouldn't be fumbling with the safety cap on the end. Mike wants to know that the rule against bringing outside snacks will be enforced. Nick will need the kitchen staff to check their labels, prevent cross-contamination of nut residue by properly cleaning their utensils and countertops. The last thing Mike wants is for Nick is to get a nut-free alternative.

I need to emphasize, Nick's doctor says, that planning on using the EpiPen without taking these precautions is dangerous. Remember how I told you that the last time Nick ate a fragment of walnut, using the EpiPen was not working very well for him in the emergency room. She says it's too dangerous to do a skin test on him. He has to have blood drawn.

The teachers have said that they want Nick to gain independence. I'm pointing out that he won't be able to control much in that environment, the menu, the snacks other kids touch and eat, or who touches him. There isn't going to be a lot Nick will be able to control.

Can I sleep yet? Maybe. I'm going to look like hell in the morning, but with a cup of coffee, I'll be able to say what Mike and I need these people to hear. I really want to avoid the words that have been rolling around in my head: You can't learn much if you're dead.

Thank you for listening, jb

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