After the Epi

For everyone in life there are those days from where you measure things: before marriage, after kids, etc. Although it may be a slight exaggeration based on my current frayed nerves and heightened sense of fear and reality, but Monk's latest anaphylactic reactions makes me think that something has changed and we will never view food allergies the same AE (After the Epi.)

This was not the first time that we had to use the Epi Pen on Monk. It was however a day of other firsts. It was the first time that I was alone while he was reacting.  It was the first time that I had to decide to take him to the emergency room. It was the first time that I sped down I-10 while continuing to bop Monk on the head to make sure he was still responsive. It was our first time at the hospital.

Slow Progression of Symptoms
Given the fact that I have three kids, and my oldest had a certain panache for American Ninja Warrior type behavior, I was surprised that we made it this long.

The night before the trip to the ER, while I was baking salmon for dinner I had noticed a small bit of wheezing from Monk.  This had become a regular occurrence within the past few weeks as our trees released a deluge of pollen, so I didn't think much of it beyond giving him a few puffs from his asthma inhaler and getting dinner on the table. I left to met a friend after dinner and came home to quiet house with all three children tucked snugly in their beds (thank you, hubby!)

Morning rolled around and the before school roller coaster began. As I ducked between rooms and school kids I noticed that Monk was wheezing again and breathing very quickly. Could it still be from the fish the night before, of which Monk only had a small bite and spit out?  "Puff, puff" and I finished getting the kids ready for school.  When after 10 minutes the medicine seemed to wear off and Monk's breathing again got rapid and labored again I gave him a second dose and called my dad  (If you haven't read any previous posts or you don't know me, Dad's a pediatrician.) He told me to wait 15 minutes to see if the second dose continued to help him and regularly count his breaths per minute.

I loaded the three kids into the car to run them to school 2 minutes away. During the trip there Jag called from the back seat that Monk had thrown up. It seemed more like spit up so I didn't panic too much, but discovered later from the hubby that he had thrown up the night before too.  I quickly dropped the kids at school, came home, and called my dad again. By this time he breathing was back to being quick and labored. I counted his breaths per minute and they were just above 60 (I was later told that 30-35 was normal). Dad told me to look for chest retractions, which he had below the rib cage and between each rib (also referred to as intercostal retraction.) Web MD has a good definition of chest retractions here and how to use them to determine level of breathing difficulty.

We made the decision that he needed to go to the hospital, so I gave him one last treatment and put him in the car.  At 8:00am in the city, traffic was going to be horrendous getting to the medical center, so I opted to head to the West campus of Texas Children's Hospital (plus, that is where our allergist offices.) I have never gripped the steering wheel so tight and never had such a long drive.

If I had to do it again I would have called for an ambulance. What is typically a 20 minute drive (I have no idea how quickly I got there) is excruciating when you can't see your child in their car seat and have to depend on hearing him breathe or making a noise every so often in response to me grabbing his head and shouting his name.

Finally at the ER
I wasn't sure what was wrong with Monk. Had he developed asthma? Had his seasonal allergies gotten worse (in a week?) or was he in anaphlaxis? The only other times we had experienced an anaphlactic reation in him, it presented as hives and vomiting, so I was confused and scared.

When we arrived at the ER I told them that I wasn't sure whether he was having an asthma attack or whether he was in anaphlaxis.  We were brought into triage straight away to collect his vitals and then moved just as quickly into an ER room.

Within about 10 minutes we had been seen by at least 5 people.  I had no idea who was who but there were doctors, nurses, and respiratory specialists. They determined pretty quickly that it was likely anaphlaxis since he had thrown up, and ordered an Epi Pen.

As soon as it was administered his breathing was back to normal. An IV and pulse oximeter cords kept my active 15 month old from moving in anything larger than a 5 foot circle.  With that, the monitoring time began.  During our monitoring time, fever, blood pressure and respiration checks were done regularly. He received IV steriods, Benadryl and breathing treatments. A side note for medical personnel: A big purple dinosaur-faced nebulizer mouth piece does not make it less scary for children.

Lots of cuddle time while we waited out our monitoring time.

Around the 6 hour mark, when we should have been wrapping up our monitoring time, Monk's breathing relapsed and he starting having retractions again.  While we did not have to administer the Epi Pen a second time, they did put him on oxygen, which was twice as traumatic as Barney the Nebulizer, and decided to admit him overnight for more observation.

The next 24 hours were relatively calm, which the exception of a trip to the X-ray room to rule out pneumonia. Regular doses of medications and vital checks ran every few hours, even throughout the night.  I was actually thankful for the overnight monitoring, even if it meant that I was awakened every few hours.  When he has had reactions at home in the past I have either forced myself to stay up late or set alarms to check on him during the night.  The pulse-ox beeps and the sweet nurse were my alarm.

Finally napping. Steroids and purely being a 15 mo don't make for much rest.

Our discharge the next morning was delayed only by an odd discovery on Monk's X-ray that needed to be run through pulmonology. It was decided that this oddity was neither tied to his reaction nor cause for immediate alarm, so 30 hours after we first stepped through the ER, we were sent on our way.

Questions answered? Zero.

The Cause?
To this day, now three weeks after the original incident, we still don't know for sure what happened.  Monk was given both a skin prick test and blood test to check for an allergy to salmon (and fish in general) and they were both negative.

For now we must avoid all fish (treating them as an allergen) until we can undergo our first oral food challenge in a few months to rule it out completely.

After the Epi
I would like to note that the picture in the header of this post was taken soon after the Epi-Pen was administered.  For a long time both my hubby and I were scared of the Epi-Pen and what it might do, but this picture shows how much better he looked and felt. My fear of the Epi-Pen has somewhat subsided now that I have seen, twice, how quickly it can make my Monk feel better.

So maybe the AE should be an AH (after the hospital) but either way, something has certainly changed.  There is now a clearer sense of reality, that a life of ease with what food we cook or eat is over.  There is a great forum discussion on Kids With Food Allergies that is actually called "After the Epi-Pen" and is a great discussion about downloading all of those post reaction feelings and how to move forward.

For those that have already read my previous post, An Open Invitation to Moms, this was my first step in getting it all out, releasing the stress, anger, confusion of it all.  I wrote that just a few days after we got out of the hospital. This blog, my writing, is my therapy.  As a type-A control freak, food allergies can be a challenge.  It takes away my control, and sharing our story helps me to regain a bit of it.

Thank you for listening,

Please note that I am a mom, not a doctor or medical professional.  My posts should not be taken as medical advice, but are intended as stories about our own experiences. Each and every allergic reaction can present and progress differently.  Always follow your allergy action plan and contact your doctor if you suspect a reaction.