FAHF-2: The Holy Grail?

So my son had his second peanut challenge yesterday.

It has been a LONG quest. As I mentioned in last week's post, he took somewhere around 4600 pills over the last 6 months. During that time, we had no idea whether what he was taking was placebo or the real medication.

Yesterday, we girded our loins and got in the car before sunrise, knowing that this time it was no rehearsal. Since he had no issues with the applesauce on Thursday, we knew the poisoned apple (sauce) was waiting.

As with previous challenges, there were 11 little applesauce containers lined up on the counter of the exam room. After placing an I.V. line and doing some preliminary vitals, the clinical manager handed him the first container.

For the next two hours, I did my best to either read or pretend to read while other people asked him how he felt. Any change? No change from last time? Do you feel o.k. to go on to the next dose?

He did.

Around Dose 4, everyone started visiting a little more. Dose 4 was where he had started noticing the sensation of throat closing last time around. Dose 5 was where it escalated a little; Dose 6 was where they had called it off. 490mg total peanut protein.

Dose 5 came and went uneventfully. Dose 6. Dose 7.

Around Dose 8, my son finally said "I can tell it has peanut it in. I'm starting to feel something in my throat." When asked what the sensation was on a scale from 1 to 10, he answered "1".

Things moved more slowly then. After Dose 9, the sensation in his throat moved up to a "2". After Dose 10, it became a "6". By this time, he was also a little itchy in his throat and the sensation of constriction was getting more and more pronounced. Finally, he coughed a little and the research staff called it off and gave him an antihistamine.

Unfortunately, the feeling of constriction in his throat continued to climb in intensity, despite the antihistamine. My son was starting to feel a little anxious, although nowhere near as anxious as during the initial fail back in April. However, they pulled out the Epi-Pen. In LESS THAN TWO MINUTES (no kidding!), he went from an "8" to a "2" with regard to throat constriction. Thank God for the wonder drug.

All in all, it was less stressful than the first challenge, even though he got a good bit further. While the clinical director said she couldn't tell me exactly how much peanut he consumed until we complete the next set of challenges in January, she did tell me that the total amount for the trial is 5000 mg of peanut flour, somewhere around 16-17 peanuts. My son completed all but the last dose, so that probably put him in the 4000 mg area.

That's almost eight times the amount of peanut he consumed in April.

13 peanuts.

Think about that. He achieved a better result than most of the oral tolerance trials...without any actual peanut consumption. Best of all, the medication has been reformulated so kids can hopefully achieve the same result without needing to take 30 pills each day.

So...here we are. What I thought might come to pass has come to pass, thanks to the hard work of a lot of good researchers and some really brave kids.

A therapy that mitigates the severity of food allergies has been discovered and tested.

I asked it back in May and I will ask it again now: How much risk are you willing to take? How much discomfort will you tolerate? Can your kid take 10 pills a day? 5 pills? Will you be willing to undergo a food challenge at the end of the therapy to see if it worked? Will you be the first to step up...or the last?

For us, the real excitement is all ahead. While it's very nice to have a larger buffer with regard to peanut, what we really want to know is whether our son can now tolerate more MILK. A tablespoon of peanut butter is great, but a tablespoon of milk would be even better. Unfortunately, we are still supposed to avoid all baked milk introduction or additional food challenges until the study completes in January. However, that's not long to wait to see if perhaps everything is better for him.

All his food allergies getting better — that's the real Holy Grail. Here's hoping I can clink chalices with you sometime next year when we confirm we're already there.

A heartfelt thank you to all the wonderful people at Lurie's Children's Hospital who made this both possible and easy. 

Halfway There...But The Second Half Is All Uphill

Yesterday was our first of two food allergy challenges for FAHF-2.

This is going to be a very quick update because the challenge was completely uneventful. My son had a full work-up in the morning, including cardiac, spirometry and many, many Vacutainer® tubes of blood. I asked if they could share anything about RAST levels, since we've had a blood draw every 6 weeks, but this info is apparently being consolidated at Mt. Sinai and will only be shared after the study completes.

After the work-up, he started on the applesauce. (If you haven't read about the FAHF-2 clinical trial before, here's a link that describes the process in excruciating detail.) By Dose 6 or 7, we were all chatting, reading, working...it was obvious nothing was going to be happening. Placebo.

Early on in the morning, I had asked our study manager what type of results they had seen to date. She said that, of the three kids who had completed the second set of challenges, two were able to achieve a four-fold increase in tolerance. (The third probably had placebo, since it's a 2-to-1 ratio of real medication to placebo in the study.)

She also confirmed that I was close on my estimation of the peanut my son had tolerated at the last set of challenges — 490 mg in all, about 1-1/2 to 1-3/4 peanuts. I asked if that was typical for the study and she said he actually reacted sooner than most of the kids — for many of the kids, it took slightly more to set off the reaction. However, my son was a "slow reactor" according to the clinicians, so the time between his doses was increased to half an hour during the first challenges to help ensure he didn't suddenly reach a critical point and have a really bad reaction. Two of the other kids did have bad reactions and her theory was that it may have been related to the dose hitting them all at once.

Here's the bad news: my son's skin tests are actually more reactive now than they were when we started the trial. Does this matter? The trial director shrugged it off, saying that skin tests are notoriously unreliable to start with. However, it made us nervous. Over the last month or so, my son has also noticed a reduced tolerance to "may contain" milk foods that he had previously been eating (with doctor approval) without problem.

Did the medicine actually reduce his tolerance? Has he spent 6 months and taken 4600 pills, only to discover it's actually worsened his allergies?

It's also possible the medicine needs more time to kick in. (And, if we want to be irrationally hopeful, it's possible the applesauce he had yesterday was not placebo and that he's cured. Sure.)

I guess we'll know more after next week. Even if you disagree with me, please think good thoughts for him. He's just a kid and a very courageous one.

The Internet Cult of the Special Needs Mommy

This weekend, I did what I periodically do (and I suggest you do as well): I Googled my name and home town and did my best to clean up public links that included them. It's amazing how quickly things like comments at newspapers can snowball and it's never a good idea for a future employer to think one's entire life consists of funny "Caption This!" contests.

However, in the course of deleting innocuous comments, I ran across one that stopped me cold. Several years back, I had written into Time magazine in response to a (very slanted) article they ran about food allergies and they published my response. The comment itself is long gone from the Time site. However, my name, hometown and a single line from the comment were now part of a support site for moms of diabetic children.

The original comment was, I thought, innocuous. It was about how food allergies are not thought of as a real disease, and how schools protect, for example, diabetic children but don't always extend the same protections for food-allergic children. But man, did the fur fly! You can read it if you like. (But PLEASE don't stir the pot...she'll probably put my name back in just to be spiteful!)

After several emails, the original poster did finally remove my name. I explained (nicely) that I have a sister with Type 1 diabetes and that I was in NO way dissing the severity of the disease. My comparison was made solely regarding the social status of the disease, not the severity.

She did not care at all. In fact, she doubled down in her response, telling me that my experience with my sister was not the same as having a child with the disease. I was clueless and her public raking of me over coals was totally justified.

All of this is like looking through a wormhole. As I mentioned before, I ran a board like that for several years, and yes, people outside the "culture" were regularly taken to the woodshed and trashed. I tried hard to stay about the fray and give people the benefit of the doubt, but I do recall one famous incident where I named and shamed someone (a public figure, but still). Now that Karma was biting my butt, the pain was, well, painful.

I quit running that community for a number of reasons. It's an amazing amount of work, day to day. (My children complained that I loved the chat board more than them.) But, more important, opinions on a chat board always seem to devolve to the most strident and the most conservative. Eventually, people with moderate opinions give up and drop out and the really out-there thought is continually reinforced. I decided that, despite the good of sharing information, the bad (and it was very bad) was actually creating anxiety in people and perhaps even mental illness. I was doing more harm than good.

This blog was born of that realization. I wanted to see if education makes a difference. If I pointed out all these overly-anxious thought patterns, would people see the patterns and want to change? Would they use my own experience as a cautionary tale?

I think it's been a failure.

Yes, a few people have pursued new testing or food challenges as a result of what I post here. And, a few of those have found out their child either no longer has or never had an allergy. That's a huge win, and one of which I'm very proud.

But, for most people, there's just no way to take my experience and transplant it into the consciousness of someone else. As with so many things in life, I think you just have to live it in order to get it. I'm sad that there's apparently no short-cutting the years of anxiety and crazy precautions for most moms...but I've concluded that information not only doesn't help, it often is just more polarizing. The more I talk about anxiety, the more these moms double down on their precautions. I've watched it on chat board after chat board where this blog is discussed.

We need to feel special when our children are young and dealing with food allergies is hard. We need the blue ribbon. We get it from these communities, even if it's at the expense of insular thinking and rampant anxiety (and sometimes dissing others). We're willing to get pulled further and further and further in. It's not ever obvious that gravity has us in its grip until it's too late.

People don't like to be told about this. (It has not escaped my notice that dryer lint has had about the same success building traffic than I have with this blog.) I've become a scold, and who wants to be scolded?

I don't know if I'm totally done, but I definitely need a break. I know a lot of you are interested in FAHF-2, so I'll try to post about that as we go through the challenges in October.

Peace.

What Does It Mean To Be A Good Food Allergy Mother?

As part of the college application process, parents are asked to write a summary of their child's strengths, weaknesses and issues that may have affected their high school performance. The summary is then used by the child's guidance counselor to write a letter of recommendation (one the parent never sees) to the colleges to which the child is applying.

I found myself writing at length about my son's food allergies, including the following:

Other people really don't understand the effect food allergies have on kids, socially and anxiety-wise. My son has had four major reactions that involved breathing difficulties and rescue meds; he's had countless other reactions that did not progress as far, but that made him sick. Coping with the fear of a reaction and learning to make good decisions, cook his own food, and watch out for potential issues (like kissing someone who has eaten peanut butter) has been a major undertaking.

There was more before and after that paragraph: about the clinical trial, about exclusion, anxiety, expectations, maturity. There was a lot. I wrote and wrote and wrote.

And then I took it all back out.

It occurred to me that the high school counselor would likely interpret it, no matter how well written, as overprotectiveness. What exactly is overprotectiveness? I wondered as I looked at the blinking cursor. Would I know if I had the dread disease? Or, is it like racism, where everyone can only see it in others but either don't see it or excuse it in themselves?

And, more important, if my definition and the high school counselor's definition of "appropriately protective" vs. "overprotective" are different, who wins? Clearly, in this situation, what she thinks matters a whole lot more than what I think. I had already had past conversations with this counselor. It was clear that no amount of education was going to change her opinion.Yet her letter will carry enormous weight with these schools.

There is, of course, another way to look at the situation. I could include reams and reams of information about food allergies. I could let my anxiety all hang out. I could emphasize what my son missed out on throughout his school years. I could magnify the bullying incidents. I could complain about the uncaring teaching and support staff. I could rally against a society that teases and marginalizes kids with a medical disorder. I could name the dead kids...quote the test scores...talk about death from food allergy as likely or even certain.

I could be full-out Helicopter Mom in the hopes that the counselor opened her letter to the colleges with:

"In my 20 years of experience as a high school guidance counselor, I have never met a more anxious, over-involved and domineering mother than this student's mother. I am recommending strongly that you accept him at your college as a means of extracting him from this obviously unhealthy home environment."

But that would be incredibly self-centered and stupid. (Wouldn't it?)

So, I am starting the survey over, with the following Rules For Good Mothers of Food-Allergic Children displayed prominently over my monitor:

1. I will not make it all about me. It's about him. If I get gratification from thinking of and portraying myself as a Food Allergy Wondermom who deals with more than other moms, I need to STOMP IT OUT. This is his normal. It needs to be my normal as well. There is no blue ribbon for food allergy mothering. 


2. I will focus on facts, not emotions. My heart is saying HE COULD DIE DIE DIE DON'T LET HIM OUT OF YOUR SIGHT! My head is saying that one child died at college last year from food allergies, out of approximately 100,000 freshmen with food allergies who attended college*. My son literally has a greater chance of dying from a lightning strike (83,000 to 1), presumably even less if we prepare well. 


3. I will not exaggerate! It's so easy to slip into full-out hyperbole. And let's be honest...the more danger there is to our kids, the more justified we can feel about our helicoptering. If death is truly not a possibility, then the protective-vs.-overprotective equation changes dramatically. (That's why so many chat boards emphasize, over and over again, food allergy deaths: because it's the only meaningful excuse for bad parenting behaviors.)
    
4. I will restrict only what I must restrict for these last months before he leaves. I will not confuse more restrictions with more love or care. Avoiding foods, social situations and opportunities because of my own fear is wrong, and really bad parenting. I will deal with my own anxieties so my child can participate in every activity that is not demonstrably dangerous for him.

Such a little list. Such a hard thing to really put in practice. It's amazing how much of my own personal identity (friends, chat boards, activities, this blog) is derived from my son's health issue.

But that's what college is supposed to be about, isn't it? Stepping back and letting the child take control. If I'm honest with myself, I can see that I've made it a lot harder than it had to be, both for me and for him. And isn't that the real definition of a Helicopter Mother?

Guilty as charged.

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*6,000,000 kids with allergies in the U.S. divided by 18 years = 3333,333. 50% college attendance rate ~150,000. I reduced some because kids with allergies skew younger.

Have You Met My Friend: Constant Agitation?

This morning was a pretty typical morning in our household: the kids 20 minutes behind and me sucked into the Siren's call of Facebook when I should be packing lunches. So, the last 5 minutes was a flurry of my son and I both shoving things into a bag.

I grab a dark chocolate Kit Kat (thank you, Peanut Free Planet and Nestle) and shove it in. A moment later, he yanks it back out and mumbles something. I hear "mmrmmmrmmrBLEmme itchy mmrmmr."

"What?" My hand stills as I'm shoving "may contain milk" pretzel crisps into another bag.

"I said that you need to stop packing those in my lunch. They make me itchy. Same with the Junior Mints. There's too much soy in them."

I'm holding the pretzels he's asked for, thinking, what about these? New item we've been trying, have packed it in his lunch before... I go for lecture mode in self-defense.

"You do remember these are 'may contain', right?" I ask.

"Yeah, I remember," he says. What does that mean? Have they been making him itchy too?

"You know you have to be careful with this stuff, because you can get a much bigger dose of milk if they come off the line right after they switch over flavors..."

"I KNOW, Mom," he says, and he's out the door, obviously done with the conversation. I'm left with a very bad taste in my mouth.

Over the last year, we've been playing milk roulette. When my son passed the baked milk challenge a year ago, his doctor told us she thought he could probably tolerate "may contain" foods and that we could start introducing them.

About three years back, we had another formative experience: my son had a reaction to soy. I had done the shopping (always a problem - my husband is the one who has the best handle on brands) and bought an "ice cream" brand that was available in both coconut and soy options, unbeknownst to me. My son ate an entire bowl of the soy stuff before he started to react. The reaction involved wheezing and we did end up in the hospital, but the doctor concluded that his threshold was very high for soy and that we could probably start introducing foods where the soy was listed as one of the last ingredients. Frankly, remembering his childhood reactions to soy, we haven't had the courage to do much of this...other than Junior Mints, with their "soy albumin" as the last ingredient.

At the moment in the kitchen when I stopped like a rabbit, ears up, listening after the itchy, I realized how fragile was my house of cards. What was I doing? How did I get from "try a little" to putting both "may contain" pretzels and dessert in the same lunch? At school! And how long had my kid not been reporting his symptoms?

I want these allergies over. I want them over so much that I can taste it. And now, sitting in the house with the silence all around me, I have to acknowledge that I may have been willfully ignoring those small clues, like my son only eating one stick of the Kit Kat at a time despite loving them.

And yet...there's no way through but through. He almost always had oral symptoms during baked milk dosing, which the doctor told us to push through. Is the itchy mouth from raw milk or micro amounts of soy in the same category?

It's too late. All it took was one comment to pull the whole mental card house down. Who knowingly sends something in their kid's lunch that could kill him?

But what if this is the only way for him to outgrow? What if NOT doing this will result in him going away to college with a threshold that's less than it would have been if we kept pushing through?

Is the FAHF-2 just not working? Oh God - is it placebo after all these pills and months? Or do the oral symptoms simply not matter because the changes are in the gut, not in the mast cells in the mouth? Have I — and his doctor — been mistaking slow-building reactions for tolerance?

Does anyone know anything? 

I don't.


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Are Food Allergy Bans Even Protective?

I just love this picture.
What was this guy thinking about?

There's been wailing and gnashing of teeth this week because the National Association of School Nurses came out with a new position paper regarding food allergies. (It actually came out in June, but it seems to have just hit most of the chat boards this month.) Many food allergy advocates were disappointed because of the statement about food bans:

Maintaining a healthy environment is essential.  All environments in the school setting require special attention to protect students by limiting allergens or providing areas that are allergen safe (National School Boards Association [NBSA], 2011).   Completely banning nuts or other foods is not recommended as it is 1) not possible to control what other people bring onto the school grounds, and 2) does not provide the allergic student with an environment where he/she can safely learn to navigate a world containing nuts.  When a ban is instituted, parents feel their child will not be exposed to allergens.  A ban can create a false sense of security (“Banning allergies from school”, 2012).

There's one phrase in there that's designed to ruffle the feathers of moms of older kids: "false sense of security." That particular wording goes back to the early days of FAAN when Anne Munoz-Furlong was still running the show. There was such strong feeling about this issue that many people stopped contributing to FAAN as a result of that one statement.

Personally, I have always felt a special kindred for AMF because she also has a child with a severe milk allergy, and milk allergy definitely gives you a different perspective on the world. I don't disagree with the "false sense of security" statement.

But that's not what this blog entry is about! We could argue endlessly about peanut bans, and I have addressed them in another blog post. What I'm more interested in talking about today is whether they even do anything to protect most kids.

If you get into debating the need for peanut bans on any of the chat boards, you'll quickly learn that many people believe that  reducing the amount of peanut surrounding their child is, in and of itself, protective. You see a lot of statements like "yes, a ban is not perfect, but it reduces the amount of peanut in the school, even if some people cheat." 

If you stick around longer, you'll probably also notice that people often speak about the peanut in a phobic way. It supposedly "floats in the air" and "sticks to every surface." It's like a tiger, just waiting to jump out and attack our children. The less peanut, the safer the child. 

But does that even make sense? 

Let's go back to last month's post about thresholds. In that post, I cited research that showed that, in the research group studied, 1% of food allergic individuals reacted to 2 mg or less of peanut. Another 16-18% had a threshold that's between 2 and 65 mg. (65 mg is equivalent to 1/5 of a peanut.) 

There's another important concept to threshold: gradual vs. cliff trigger response. What does this mean? 

With a gradual trigger reaction, symptoms would build as the amount of allergen in the system builds. If a child received a micro dose of an allergen, they would have a micro response, and responses would build and remain proportional to the dose.

With a cliff trigger response, a child would go from fine (no symptoms) to reaction. 

My understanding is that the vast majority of reactions out there are the cliff trigger variety. The threshold may change based on different environmental factors (hormones, illness, exercise, etc.), but it takes a certain amount of protein to tip a child into a reaction. Up until that point, there are usually no symptoms. 

The clinical trial we're currently in depends on this being the case. We will return to the hospital in October and my son will go back through the same set of challenges he experienced in April. The success or failure of the medication (assuming he does not have placebo) is predicated on him failing at a particular dose level. Below half a peanut - nothing. Above half a peanut - start of a reaction. (More peanut would certainly escalate things, but it takes a cumulative dose of at least a half peanut to get the ball rolling for him.)  

So, if we put those two concepts together: most children require at least 1/5 of a peanut to get a reaction started, and amounts below 1/5 of a peanut generally causes no trouble.

Is all that a guarantee? Of course not. But I think you can see how thinking about reactions as a cliff response rather than a gradual trigger response can be reassuring for most families. If your child is in the category of hyper reactors, you already know it. They have had reactions (not just hives - reactions) from being at the grocery store, the park, the movie theater. If your child is in this category, they very well may require a ban to be safer at school. 

"But what about contact reactions?" you ask. Yes, kids can get localized hives from contact reactions, but anaphylactic reactions to contact or inhaled peanut are very rare. (Here's a summary from Michael C. Young writing for FARE in Canada about inhalation/contact reactions.)  That's not to say that constant contact reactions aren't a pain in the rear! Again, kids who experience constant contact reactions would probably benefit from a ban. 

For the rest of our children...not so much. Having peanut around them doesn't affect them. Very few children are able to accidentally ingest a fifth of a peanut, unless they're licking their desk surfaces. (Preschools - totally different approach. I strongly believe they should be food-free. Kids at that age clearly do lick their desks, toys and likely each other.)

The sad part of all of this is that, probably at least in part due to the phobia and overreaction of parents who did not need this level of protection, we now have a strong policy statement from the NASN. It's going to make it a LOT harder for the kids who really could benefit from a ban to get one. 

At the end of every ban debate, there's always someone who just comes right out and says it: "why shouldn't I ask for a ban if it could make my child even the tiniest bit safer?" The answer is because invasive actions like food bans have backlash. People do cheat, kids do bully, parents are crappy, organizations do come out with policy statements. Asking for more than we really need always results in backlash. If a ban doesn't even make your child safer, why in the world would you sign up for all that? 

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Why We Don't Use Epinephrine Enough

Sanofi came out with a really cool product today: a credit card-sized epinephrine injector. I've been following the press about the eCue, but this one snuck out of nowhere for me.

It's great. It has step-by-step audio instructions, plus graphics. It seems to be pretty easy to use (just take off the safety cap and inject). It's smaller, so kids  —  especially boys  —  are more likely to carry it, right?

And yet, I doubt it will make a difference.

There are two issues the device fails to address: recognizing anaphylaxis and acting once we see it.

I always hate talking about this topic because it really underlines that I am a slacker mom. We've experienced a lot of reactions in our house. Part of that is because my husband and I were probably a little too lax when my son was young. The rest was because he has a lot of allergies, and very common allergies. It's very, very hard to keep a severely-milk-allergic child safe 100% of the time unless you just never eat out or never use processed foods.

For better or worse, I do have some experience at recognizing food allergy reactions. Other than the few times where my son had a large amount of an allergen, we have never been sure we were dealing with a food allergy reaction.

Here's my theory on why.

1. Reactions change. Each reaction can be different, and reactions over time can be different. My son used to get really spectacular body hives when he was young. Then, suddenly, he didn't. Instead, he got a tell-tale rash around his mouth. Until he didn't. You can see where this is going...with reactions happening infrequently, it's very hard to see the change in symptoms. We often waited around for the hives to show...or the rash to show...or the flushing of his ears to show. But, as he aged, they didn't show and we were left wondering every time what we were dealing with.

Vomiting with fever — probably a virus. But what about vomiting with a hive-like rash and no fever or other symptoms (even feeling sick)? The time this happened to us, it still turned out to be a virus. It would have been awful if I had given him epinephrine on top of his illness, but it was sudden onset and I was very unsure for the first hour.

The point is, I can count on a couple fingers the allergic reactions he's had that followed the "traditional" pattern of itchy mouth/throat and hives, followed by vomiting and swelling, followed by asthma. Now put yourself in the place of the school nurse, or the harried elementary teacher. They don't know the child's history. How can they make sense of any of this?

That's why a reaction plan is so important. We filled the form out ourselves, but we also independently asked our physician to fill it out. We then compared the two and discussed where they differed. We learned a lot from him about what we should be doing, and he learned a lot from us about our son's unique symptoms.

For example, our jr. high action plan called for giving epinephrine in the event of any after-lunch wheezing without fever. This would definitely not be appropriate for every child. However, my son's history made this an appropriate plan for us.

2. The hunt for the allergen. It can be so hard to believe a reaction is happening when your kid hasn't eaten anything new. And yet, several of my son's mild reactions have been situations where we were never able to trace the food for certain.

I have actually found myself on the phone, calling a manufacturer in the middle of a reaction. Did I really think I was going to get an answer in the time I had to make a medication decision? And yet, it just seems so impossible it was happening when there had been no new foods.

We already know a large percentage of foods labeled "may contain peanut" actually DO contain peanut. The 2010 study by Sicherer, et. al., showed more than 5% of "may contain" foods did contain peanut. It shouldn't be surprising, but it is surprising.

3. The frog in the pot. There's a classic story that's told a lot in business environments about how to boil a frog. Supposedly, if one places a frog in a pot of water and turns the water up gradually enough, the frog will never notice it's being made into soup.

Reactions are a lot like frog soup. They can build and build and, because you get used to each level, you may not recognize the overall seriousness of things.

This is also where that expected symptoms list can trip you up. Vomiting can be innocent. Even vomiting and wheezing could just be a virus, especially when there's no known exposure or even likely candidate as an allergen. It's easy to see how other caregivers, and even parents, can misread the symptoms and wait to give epinephrine. They're just waiting for that one. next. thing.

4. The BIG deal. We all know that giving epinephrine is an instant hospital trip and probably a call to the EMTs. It's incredibly stressful for the child. It's at least four hours (usually six) of observation afterward. It's going to cost money.

Of course we shouldn't think about all those things, and we probably don't think about most of them consciously. But we do think about them subconsciously, and our subconscious is often the one calling the shot. Literally.

Before we can stab our child with that device, the voice in our head says, over and over "is this really that big of a deal?"  In addition, there's another voice saying "are you sure?" (Which you never are.) And another voice saying "what if I hurt her with the needle? or the medication?"  And a voice saying "I'll never live this down/trust myself again if I'm wrong."

It is a big deal, there's no denying that. And yet, we have to prime ourselves to push past the voices and make a clear decision, all in the space of about 15 minutes (if we're lucky). Add to this that most people freeze when they're stressed and it's easy to see why this is so hard.

I really love the idea of the new autoinjector. I've already sent the link to my son, along with the inevitable joke about "is that an Epi-Pen in your pocket, or are you just glad to see me?" This will definitely be better.

But I'm also aware that, experience wise, he's starting from scratch. For seventeen years, it has been my experience, my hunt, my frog, my big deal. Now it's his. And, as with so many things in life, there's no way to just transfer my experience into his head.

Instead, he'll have to stand in that restaurant, or cafeteria, or kitchen of the future, holding his awesome tiny new epinephrine injector, and its size won't matter a whit when it comes to making the hard call.

When is it real? When is it bad enough? When is it too late? 


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