It’s early in the morning. Kyle and I each got about five hours of sleep last night. There’s no reason we couldn’t have slept more, but instead of being able to roll over in bed and fall back to sleep I woke up a little bit to change position and then sat upright immediately. Where was the baby? Was she OK? Was she breathing? How was her color? Was there any swelling? Was it time for her meds?
Right now, it seems like an impossible idea that I will ever sleep well again.
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I’m going to write this all out – not because it’s a particularly gripping story but because if you’ve found this post after doing a search on peanut allergies, I want to give you as much information as possible. I thought that I would be prepared for Eva’s first trip to the hospital after an allergic reaction but I wasn’t. Now that she’s fine, I’m actually a bit grateful for everything that happened yesterday because I learned a lot more about her allergies. Up until now, I think I’ve mentally downplayed a lot of her issues. Obviously we take them seriously because we’ve altered her diet and gotten rid of the cats, etc., but I always thanked my lucky stars that having allergies wasn’t a really big deal. I mean there are kids out there with terrible illnesses, but Eva just has to be careful and then she’s fine…which is all true but it glosses over that part where she’s occasionally not careful and then she’s not fine at all. I think I wasn’t able to wrap my brain around “not fine at all” until yesterday, which meant that I made a couple of stupid mistakes that could have been really bad. But I’ll get to that.
To catch you up: Eva is 21 months and she was diagnosed at 19 months with severe allergies to peanuts, tree nuts, sunflower seeds/oil, cats, and dogs. We’ve spent the last couple of months learning about her new diet and cleaning the house a million times to get rid of lingering animal dander from the pets we had to give up. She’s had a few reactions, either to food that must have been cross-contaminated or to small bites of food that we didn’t realize contained allergens, but other than some doses of Benadryl and a few sleepless nights we haven’t had to intervene medically. Eva attends a preschool program here in Salt Lake City and she has an Epi pen and some medicine at school in case there’s a problem. The nut-free classrooms were full when we enrolled her, so she’s in a regular class but they’ve always been good about checking her food.
Yesterday morning, I got a call from Eva’s school around 10 AM. I’ve written before about how you never want to get that phone call because it’s not going to be good news. In this case, they were calling to tell me that Eva had gotten a hold of someone else’s peanut-butter-filled-pretzel. They had served the pretzels as the snack for the day, but gave Eva a graham cracker. Unfortunately, Eva really likes pretzels and when the teacher’s back was turned, she took a friend’s snack. The teacher believed that she had just held it, but they were calling because she had developed some hives on her hand and a little redness around her mouth. They had already administered Benadryl when they called me and they let me know that she was happy and talking and seemed to be fine. They gave me the option of picking her up, but since they had already treated her and it was the last day before two weeks of break (which will be sad because Eva loves school) I decided to let her stay for the rest of the morning.
Mistake #1. If I had picked her up, she would have gotten to the hospital sooner.
About an hour after the first call, I was in the car on my way to the school to pick her up when I got another call. They were debating about giving her an Epi shot because she had some vomiting and her hives were worse. However, they assured me that her mouth/tongue looked fine and that her breathing was fine. I was less than 30 seconds away so I told them to just wait until I got there. When I arrived, there were about seven adults with her and she had obvious swelling on her hands and face, but she was crying loudly with no sounds of choking or wheezing so I just grabbed her stuff and took her out to the car. The hospital is less than a ten minute drive and I figured it wasn’t necessary to call an ambulance as long as she wasn’t having trouble breathing.
Mistake #2 and this one has haunted me ever since I made it. What I didn’t know when I picked her up was that Eva was having trouble breathing but the wheezing was too faint to hear in all the commotion. What I should have done was administered the Epi shot (or had them do it when they first called me) and we should have waited for an ambulance. I hit every damn red light on the way to that hospital and then got caught behind two cars talking to a parking attendant because I didn’t know where the emergency entrance was. In the meantime, Eva vomited twice in the car and I could see her head rolling around and her little eyes rolling back in the rear view mirror. It was a fast drive (I made it in about five minutes) but it was the worst drive of my life. I don’t know what I would have done if she had stopped breathing because I was completely unprepared for it to be an emergency.
Honestly, I think that’s the thing that stopped me from calling the ambulance when I should have known from looking at her that she was in real trouble, so if you’re a parent in a similar situation: pay attention. Eva had vomited twice at school, which indicated a full reaction (I didn’t know that). She had swelling on her cheeks, ears, and hands. She had bright red hives/welts around her neck, under her armpits, on her legs, down her back, around her mouth, and on her hands (I didn’t check under her clothes before we left the school). She was crying hard when I picked her up and the volume kept me from being able to hear the faint wheeze when she inhaled, but I could have realized she was struggling if I had noticed how puffy her eyes were and how she kept tossing her head back.
Unfortunately, I was just in shock and I didn’t accept the fact that she was having a true emergency fast enough because everything happened (from phone call to ER arrival) in less than ten minutes. In retrospect, it’s very obvious that I should have dialed 911 but I just wasn’t prepared to think of the situation as being so severe. When I had thought about anaphylaxis before yesterday, I imagined true choking with no other symptoms. It turns out that that’s not what it usually looks like (especially in toddlers).
I carried her into the ER after a short and vaguely hysterical moment of yelling at the valet because he wanted me to move my car (I’ll spare you the transcript but let’s just say I could have been nicer about it). Kyle works two hospitals over from the children’s hospital so he met us at registration and was able to get her all checked in. They took her in and had her in a room in less than five minutes with a doctor, a nurse practitioner, a nurse, a resident, and a tech. They all seemed to be asking the same questions:
- “Does she have a known allergy?”
- “When did she encounter the allergen?”
- “Was it just a contact encounter or did she ingest it?” (This is still unknown, btw. We’re going on the assumption that she just held it because it’s safer to assume that her reaction is that bad.)
- “Is she allergic to anything else?”
- “How many times has she vomited?”
- “Did you administer Benadryl? How much?”
- “Did you administer Epinephrine?”
- “Is this swelling/redness unusual?”
They also all went through the steps of explaining what an allergic reaction does to the body and then carefully outlined the treatment plan. I understand why they did this, but it was frustrating for Kyle and me because they were all in the room together and they could hear each other, so we don’t know why they didn’t just treat her and get on with it. Eva was awful by this point – almost totally limp, angry welts everywhere, her sad little head rolling around. The doctors were sticking things to her and examining her and she wasn’t even reacting anymore, which was probably worse than her screaming her head off (at least on the maternal fear scale).
After checking her over and connecting monitors to her chest and toes, they gave her an Epi shot and put an IV in the back of her hand so they could administer two more blockers and a steroid as well as some fluids (she had vomited four times by now). She hated the shot and the IV but that last bit of trauma seemed to push her over the edge of exhaustion just enough and she was able to take a nap and let the drugs take effect. The swelling and redness cleared up within 20 minutes and her heart rate slowed down as her oxygen level came back up. I’m a little upset with myself that I didn’t think to take photos of her full reaction, just because it would have been nice to be able to show teachers/caregivers exactly what a bad reaction looked like. By the time I realized it would be a good idea to document her symptoms, the welts had faded into flat, dry patches and her swelling was completely gone.
We stayed in the ER for about two hours before they moved us to the Recovery Treatment Unit, which is a holding area for kids who might need a little more help. With allergic reactions, there’s a possibility that the allergen will cause a second reaction if it’s still in the body so they monitor kids for 12-24 hours after an attack. They also had us brush her teeth and remove her clothes in case there was any peanut residue lingering.
The RTU was much better than the ER. Eva was a little miserable at first because she was still hooked to all of the machines, but my mother came down with some toys from the gift shop and kept her distracted until the doctor came in and told us she didn’t have to be monitored on the machines anymore. After that, Eva still seemed exhausted but she was able to move around the room freely. We just had to watch her IV to make sure she didn’t pull it out.
She was starving at this point, which I hadn’t expected (but which made sense because we missed lunch and she threw up her snack and breakfast). We got crackers and cheese from the nurse and they provided us with a room service menu that would cater to all of Eva’s allergies. I didn’t know what would sound good to her, so I ended up ordering two dinners, two sides, and two drinks – almost all of which Eva ate. The kid was STARVING and I was just happy she was feeling better.
After dinner, she wandered out and picked out some toys from the RTU family area. There weren’t any other kids around, so she was able to explore everything without interference. This kept her entertained for a while, but eventually she started to get really fussy about the fact that we weren’t leaving. We tried to put on a movie and get her to relax, but there was a lot of frustrated crying for about four hours. It’s so challenging that we can’t explain to her why she’s in the hospital, why she has to stay, why she can’t pull out her IV, etc. Everyone says that it gets easier as the kids get older, but that feels very far away right now.
Around ten, the doctors decided that we could go since she seemed fine and it had been about 12 hours since Eva grabbed (ate?) the snack. She had been getting medicine continually and we left with four prescriptions and a treatment plan for the next few days since the allergen might be in the system. Eva fell asleep as soon as we got her home and I checked on her eight times last night but she doesn’t seem to be having any trouble at all. In all fairness, she’s on so many drugs and blockers that I could probably feed her spoons of peanut butter right now and not even get a reaction.
Anyway, it’s a happy ending and a relatively minor incident but I wanted to outline it so you know what to expect (and you don’t make the same stupid mistakes that I did). I had a couple of phone calls from Eva’s school and they’ll be turning her classroom into a nut-free room for the rest of the year so I doubt we’ll have another incident. There’s a holiday party that we’re supposed to go to on Saturday, but I think we’re going to skip it because I can’t handle the stress of a buffet and potential allergens and people touching their food and then touching Eva, etc. Usually we would manage, but right now I just want her to eat her same safe foods in our little safe house so we can get 2012 over with without so much as a hive. We can work on being brave next year.