big kid school, free epi training, and allergy cards

Feb 4, 2014
Day 256

Allergies have been high in our minds the last few weeks - we've moved up to 600mg of walnut powder for the daily dose. Tomorrow we go to 700mg at the allergist. It takes a lot of time, but he's thankfully a very agreeable kiddo.  He gets a bag to take whatever toys he wants... and sometimes he entertains everyone with his costumes and antics. This was 2 weeks ago - my little protector!  I hope he stays this agreeable for the years we have of this in our futures!

The superbowl (and of course party with lots of food) - was a great success, and in no small part to the friends (our local family!) that helped make sure he was safe and that everyone knew not to give him food without a parent okaying it.  Our host/hostess sent us this photo of the "baked goods" end of the table before we even GOT to the party.  :)  We also had him wearing allergy alert stickers so that those folks that don't know him would know not to feed him.

In other news, we just signed him to start kindergarden in July where he will join his big sister at the local Elementary school.  EEK.  We are barely starting those conversations with the school, eventually the school nurse, the teacher (we don't know who yet), and the allergist.   It's a LOT of paperwork, planning, and thinking through what makes sense, how to approach people, and how to most importantly keep him safe.  We don't want to induce some crazy burden on the school, but we don't want them to ever need to inject him with an epi.  Heck, I don't want to ever have to inject him!  (again)
This is amazingly stressful to think about leaving the "nut-free" preschool world and having to depend on others (some of whom we will never know), to keep him safe, at an age where he can't quite protect himself (or read the labels).  We have been researching on the parents of kids with food allergy forums (you need to register), went to a 504 plan webinar (you can watch the video), and talking to teachers, other parents, and anyone with any experience in this area.  The allergist was surprisingly negative about a 504 plan (he said a health plan is fine).  Given what we've researched, we don't agree, but we will talk it out with patience and come in with humility to talk to the school.  It's not a demand list, it's supposed to be a discussion to decide how we can all keep him safe, and a document that details what we agree upon.  We have a health plan in place for our eldest, but her life is not in immediate danger if it's not followed.  We will plod slowly down this path and take lots of notes...  And I will try not to shake every time I talk to anyone at the school about leaving him there without his army of protectors.  Gotta let go sometime...

Other cool stuff...
-FREE (used to be a paid training!) Epinephrine/anaphylaxis training online.  This is pretty awesome.  If you have friends with food allergies, take the 20-30 min and do this.  You may have to save them one day, you need to understand what to do and when to do it.  And THANK YOU epi-kit for making it free!
1. Go to http://www.EpiPenTraining.com and click Sign Up.
2. Fill in the Registration Form and agree to the Terms & Conditions.
3. Click Sign Me Up. 
4. A box will appear confirming that your account was created and that you're logged in.
5. Click Continue.
6. Click Begin or Continue Your Training Course.
7. Click Start.

-Allergy cards for restaurants - we dug all over the place and these things are EXPENSIVE and you get two or three laminated cards that you need to remember to get back from the server each time.  We used vistaprint (just picked a business card template), and printed 200 for about $20.  We put his picture on it, and wrote it as a request from him to help keep him safe (people are more careful when they know it's a child that can't protect themselves).  Don't spend your $ on the fancy "allergy" cards.  You can print EXACTLY what you want and get far more of them online from anyplace that makes create your own business cards.  We put emergency info on the back including please don't hesitate to Epi if you see symptoms.  So far it's been VERY well received.  We decided to do this after reading the restaurant blog (see last post).

Much love to you all - it's sometimes a very carefully planned out world we have to live in, but we do it with the support of all of you!
Alli, Daniel, E and P

In the news and eating out

Day 167 (dose is 200mg)
Nov 7, 2013

So the good news is that allergies have been in the news a lot the last few weeks. The CDC finally posted voluntary guidelines for schools (with some GREAT resources linked).  That will definitely be in our toolkit when we go to talk to the elementary school this year for P.  Some interesting commentary about kids being allowed to self carry, and clear definitions that an allergy constitutes a disability in the language of the ADA (because anaphylaxis) puts breathing, eating, life at risk.  That language is necessary if you decide to ask for a 504 plan (accommodation based on a disability).

Also cool - the Federal bill for encouraging stock epinephrine in schools passed!  This is awesome.  It encourages schools to have better plans in place, to stock unprescribed epis (25% of school allergy emergencies are for unknown (undiagnosed previously!) allergies.  This might save my non-food allergic kid one day (or yours!) when they discover they do indeed have an allergy.  It doesn't mandate anything, but it helps encourage schools to change (and to get federal funding for doing so).  It needs Obama's signature and then it will become law.  It passed the senate on Oct 31st.

Fun stuff - Halloween went off without a hitch, the kids were spiderman/batman and Doc McStuffins (a vet disney character).  We trick or treated with friends and neighbors, and had a ball.  Everybody was very careful about checking candy, and anything labeled as tree nut unsafe or not labeled went right back in the bucket to hand out (get it out of the house!)  It's just one more time of year where a little more caution is in order, but it went really smoothly.

Eating out - still having good luck (although every now and then waitstaff needs a little extra grilling).  West Park Tavern and JD's are forever on my love list for their extra care.  Not too happy to find out that Papa Murphy's pizza dough is listed as not nut safe, and papa Johns is now selling a cookie pizza that is not nut safe.  The word on the allergy blogosphere is that cross contamination is an issue (dough handling, pizza cutters, etc...)  So looks like both of those pizza options are no longer options.  We don't eat it very often but that stinks.  We're not sure that he'd react with the minute amounts of cross contamination but is it worth the risk?  :(  Panera has also pretty much turned into a CYA restaurant.  They have a great allergen list / book, but plastered on every page is the warning that everything might touch everything so run for your life.  (this is me being snarky and rolling my eyes).  This country is so litigious.  If this keeps up he's never going to be able to eat anywhere without a CYA warning.  Which means he might not take those warnings seriously as he gets older.  That bugs me.  All the store bakeries are out for the same reason.  Those CYA warnings on the labels of everything they sell.  They might run a really clean shop and the risk might be zero.  But when the labels say may contain... you lose customers that can't take that risk.  So maybe long term all the chain restaurants are going to be out (not sure that's a bad thing).  The local eateries tend to have better (less processed) food, and actually care and take extra precautions.

All is well - just have to remember to read the labels, every time.  Ask the waitstaff, every time.  Don't eat without the epis with us.  That used to be hard, which is almost amusing now.  We adjust.

Thanks for traveling this road with us!
Alli, D and the mini waltons

research notes - what's with all the allergies? 504 suggestions for tree nuts

108th day
Sep 9, 2013

It's been a heavy research week for me - talked to lots of folks about 504 plans and such.  Everything has been calm, although we had to switch to dinnertime dosages so that we have 2 uninterrupted hours to keep an eye on Patrick.  On workdays we don't always have 2 hours of blocked time with him, so we are now keeping doses in the car (in case we go out to dinner or are running REALLY late), and trying to adjust our schedules.

Things of interest:
Discovery Channel documentary on the epidemic of food allergies in America - you can view this online which is awesome.  They have some good stories (and some very scary ones), and talk about OIT therapy at about the 40 minute mark (which is what we are doing with walnuts right now)

State laws for allergies/asthma by state - NC summary and links to the actual legislation

North Carolina law, Section 115C-375.2 (2005), requires local boards of education to adopt policies authorizing students with asthma or anaphylactic reactions to possess and self-administer asthma medication on school property, at school-sponsored events, and in transit to and from school.  These district policies must include certain provisions: 

• written authorization from the student’s parent or guardian permitting the self-administration of medication
• a written statement from the student’s health practitioner verifying the student’s health condition and prescription of medication
• a written treatment plan for emergency protocol provided by the student’s health practitioner
• back-up asthma medication to be kept on file in the school in the event of an emergency

Some salient points about the NC law and why I care:
-We are at greater risk because asthmatic kids are more prone to anaphylactic reactions
-We can let P self-carry his epinephrine injectors - this is unclear in all the Wake County school documents and varies widely by school.  But if we have to fight for it, we have the tools now.
-If a teacher forgets to move his injector around the school with him, he can always have one on him.  They might not have minutes to run and get it.  And if it's not on hand, they are less likely to use it as fast as they should.
-He can carry to/from school, for sports, and field trips.
-schools have to have school wide policies in place for asthma and anaphylaxis (we need both so this is positive and means the staff are more likely to be trained)
-They don't stock unprescribed epinephrine (yet) - but the bill S.B. 700/H.B. 824 is still pending. 

I'm sure it won't be a walk in the park, but having help navigating the minefield of rules has been fantastic.

504 notes - I talked to a GREAT lady from the POFAK (parents of food allergic kids) forums who helped me to start a list of accommodation requests that seem reasonable for a 504 plan.  Having a tree nut allergy but NOT peanuts changes the list pretty dramatically.  The risks aren't quite as great for us.  (He might not NEED to sit at a nut free table).  I won't send him to school with peanut butter (but he can eat it at home).  Erin doesn't get PB anymore either, there is one boy in her class with a severe peanut allergy.  Sunbutter works just fine, but we have to watch packaged foods.  (Kashi cereal bars, squeeze applesauce, annie's cheddar bunnies, and seed trail mix packs from peanut free planet are all favorites.  We try to pack our own foods but sometimes you're in a pinch!).

The current idea list - modifying as we talk to more folks and figure out what makes sense:

1. All staff who may supervise kiddo must be epi-trained and able to recognize a reaction.  (this should include bus driver, teacher, aides, lunch, specials staff)

2. Kiddo will self-carry epi-pens in a waist pack.  A backup kit with epi-pens, Benadryl, and rescue inhaler will be in the classroom with the teacher or with the nurse. (2 reasons to have the kid only carry epi: so epi is the only choice available and to eliminate risk of another kiddo getting a hold of the liquid/chewable meds).  If he isn't ready to self-carry, word this for teacher to carry and hand off to specials, lunch, etc.  Remove self-administer - he's too young, and honestly most folks having an allergic reaction feel so bad and can be so out of it that they aren't capable of doing it during a reaction.  We can't count on that, adults should be in charge if that is needed)

3. Staff will supervise handwashing (soap, not hand sanitizer) of each student after snack and lunch time.

4. Staff will sanitize tables and chairs after daily snacks with sanitizing wipes. Anything with actual TN ingredients is not served in the classroom as a group food.

5. Classroom will be food free except for the following: daily snack, birthday parties (kiddo's parents must be notified 3 days in advance), Winter and Valentine's parties.  (We might need to be the room parents, have parents send in money for the parties and then we do all the shopping.  This makes sure everything is safe.)

6. Substitutes that are not trained to use epinephrine: Kiddo will be placed in epi-trained teacher's classroom for the day or epi-trained para/TA will remain with the substitute teacher for the day.

7. Regular substitutes will be epi-trained. (i.e., the ones who do a lot of subbing for the school or who will be there for a long-term sub assignment)

8. Lessons that include food or allergy trigger must use safe brands.  Kiddo's parents shall be given a minimum of one week's notice to research and give approval.  If no safe option or accommodation can be made, the lesson will be replaced.

9. Kiddo will have a treat box kept in the classroom for use as needed.  (Covers when mom forgets to pack a snack, random PTA "surprise" food reward, candy handed out by specials teachers, etc.)

10. Food allergy bullying will not be tolerated.  Any bullying will be handled according to district policy.

11. "No shared mouth instruments, parents will provide a dedicated one as needed". (if they use kazoos, music instruments) - higher risk for peanut allergic kids more than ours.

12. Empty food cartons/cans being reused.  Often teachers will "clean" a nut can to hold group supplies or will stock a housekeeping center with empty real food containers.  Discard any unsafe containers of common allergens (nut jars, trail mix containers)

13. pencil pouch/box for his supplies.  Knowing how often little kids touch faces, stick fingers in their mouths, etc., we felt better keeping kiddo's supplies just for him.  

Notes for approaching teachers: "I know you don't want to have to epi my kiddo and this is one way to reduce the risk/make your job a bit easier" helps a lot.  Most don't want to have to be "the one" who messed up or who had to epi.

lunch arrangements.  Our school has a "nut free table".  Patrick eats PB&J just fine, he probably doesn't need to be isolated.  (Although I wouldn't send PB - I'd use sunbutter or wowbutter, etc...)  He's not airborne allergic to his nuts, it should work for him to sit with his class.  Suggested - sit at the end of the table and the kids next to and across from him can't have obvious TNs. 

Thanks to all the other moms and dads for the recommendations/assist on the idea list - keep them coming!  We will keep a running list until the summer and then sort it out with the school, allergist, etc...

100 days of mostly non-events

Sep 4, 2013
Day 100

It's been a while, but here's your status check on not so little Patrick.  2 weeks ago he was supposed to go up to 125mg, but he was fighting an infection (unrelated) and had a nasty cough and cold.  So we went to see the allergist as usual but they decided the safe course was to lower his dose for 2 weeks.  So we went back down to 75mg for 2 weeks.  Have to remind ourselves it's not a race, and that being safe is more important than doing this quickly.


Today is day 100!  And appropriately, we've gone back up to 100mg.

All is well, we're juggling lots of appointments (nothing new), and Patrick is bored at the allergist.  I'll take it.  Bored at the allergist is way better than excitement at the allergist.

We found out that Erin has a kid in her class with a severe peanut allergy, so she's getting only peanut safe snacks at school now too.  (the preschool is nut free).  Thankfully we already have a lot of that stuff for P, so it's not a big deal.  If she starts asking for peanut butter and jelly, we will get some wowbutter or sunbutter.  They keep using food as a reward for good behavior, so we went on amazon and bought some super cheap party favor stuff to donate to the goodie box.  I'd rather do that than have her always bringing home candy (half of which her brother can't have).

This is getting easier day by day, week by week, etc... The kids are more aware, we are more confident, and our circle of friends, schools, etc... that we feel are safe is always growing.

Happy summer everyone!

Plans and new injectors and 504s oh my...

Day 81 - Friday
Aug 16, 2013

Warning this one is long - topics: Preschool update, new "action plan" forms that are MUCH easier to read in a hurry, new types of injectors, and public school 504 plans.  If you don't know much about allergies or don't have a school age kid, skip the 504 part, but know it's a lot of stuff to digest/deal with! :)

Preschool news - P's teachers got a kick out of his Bugabees book.  Started good conversations with the kids and the teachers about what allergies mean and don't mean.  (One of the kids asked if they were still allowed to play with the allergy kids and teacher with an allergy).  Better that they ask the funny stuff now!  One of the teachers has a milk allergy, another child has a fish allergy, and one more is allergic to eggs and peanuts.   So he's not the only one in his room.  We ordered a copy for the schools (the preschool and the elementary school).  He's also been wearing his allergy bracelet (he calls it his allergy watch) more often.   It's finally sunk in with his gymnastics coaches (they've stopped giving him candy from the treasure box that he can't eat, and automatically offer him other options - stickers, extra hand (and feet!) stamps, etc...)  That's a relief for me.

Allergy "action" plans - FARE has a new newsletter and a new easier to read, up to date action plan "form" that adheres to the new guidelines.  Simply put - when in doubt, use epinephrine, it saves lives.  Antihistamines (Benadryl) are being moved to a secondary treatment instead of the primary.  Especially in cases where asthma is an added concern (which applies to us).  We're going to talk to the doc about updating our plan using the new form and copying it for preschool, babysitters, his backpack, etc...
It also has photo directions for all three of the current style epinephrine injectors (Epi-pen, Auvi-Q, and Adrenaclick).  The new ones coming on the market has driven the prices WAY down.  Both Epi-pen and Auvi-Q have $0 copay deals going on right now.  Can't beat some competition!  We much prefer the auvi-q for the moment (less force required to inject, time to injection complete is shorter, it talks and tells you what to do, and it has a much smaller form factor).  We carry 2 injectors, dissolvable benadryl tabs, and usually an emergency (albuterol) inhaler with a spacer.  Check out the new action plan if you know folks with allergies, the guidelines have changed (and should!)  The evidence is there.  Epinephrine saves lives, holding off on using it has cost lives.  When it doubt, get the epi out.

I've also been reading about what we're going to have to go through next July (gasp!) when P starts in public school.  Individual Health Plans (IHPs) vs 504 plans or IEPs.  We have an IHP with Erin for trichotillomania/trichophagia, but it's not a binding agreement.  A 504 would force accommodation for a "disability".  And not being able to breathe by ADA (Americans with Disabilities Act), is indeed a disability.  IEPs are considered more special education needs, 504s are considered regular education (with some accommodation).  I hesitated at first to think it was worth the hassle, but then I started reading about teachers that didn't move epinephrine injectors around as the kids shifted to specials (art, PE, music, computers, etc...) and even on field trips.  Lost injectors that couldn't be found at the end of the school year.  Kids being seated next to kids at lunch eating their allergens.  (especially the ones who have had airborne reactions - usually peanuts).  I wasn't reading looking for horror stories, but I was reading looking for how and why and when to do a 504.  It's mind blowing how complicated this can get and all the myriad of options that are out there.  I finally found some good stuff (See #4).

Samples and links:
1) http://www.kidswithfoodallergies.org/ (paid family membership) - resources, schools, Sample 504 plans.  They discuss things like nut free classrooms, trained staff, epinephrine follows student, self-carry options for students, wipedown procedures for desks and cafeteria, handwashing post handling any food for all students in the class, rules for food brought in from the outside, rules for specials (PE, media center, computers, etc..) and field trips, no food sharing, actions / consequences for food allergy bullying, letters to go to all class parents from the principal, relationship with school nurse and/or cafeteria staff.
2) Contact the department of Educations OCR (Office of Civil Rights) - if denied - they are the enforcers for 504 plans.
3) 1702 form (for Wake County, NC - medication form required for albuterol, epinephrine, and benadryl, etc...)
4) Team Anaphalaxis website/guide - great FAQ!
5) You have to request in WRITING a 504 evaluation based on allergy / anaphylaxis diagnosis.
Also need a letter from the allergist stating that anaphylaxis can be fatal and that epinephrine has been prescribed to go with your request for evaluation.  (Proof of eligibility).  Get a 504 approved BEFORE you start talking about accommodations (and only discuss those in a 504 meeting).  504s allow for unique needs (PER student).
6) http://www.ed-center.com/504 (504s vs IEP)

My brain is scrambled, but at least there is good info out there, you just have to sift through it all and take good notes, get organized, and follow your plans.  We'll get there - no rush, but good to know we have a lot of work to do next summer.