EPI-sode

3 Action Steps:
1. Request my Epi Confidence Weekend Challenge FREEBIE at www.DrAmandaWhitehouse.com/connect

2. Make an appointment with your allergist to review any questions about epinephrine use
FARE Allergy Action Plan: https://www.foodallergy.org/media/935/download

3. Join me for my Epi Experts Group
4-week small group, virtual sessions
Wednesdays 7-8:15 pm EST beginning 8/21
Replays available if you can't join live
www.DrAmandaWhitehouse.com/epi-experts-group

Resources discussed in this EPIsode:

EPINEPHRINE AUTOINJECTOR UTILIZATION AND ACCESS IN A NATIONALLY REPRESENTATIVE FOOD-ALLERGIC ADULT SAMPLE - ScienceDirect

Anaphylaxis: A 2023 practice parameter update - Annals of Allergy, Asthma & Immunology (annallergy.org)

FARE Allergy Action Plan: https://www.foodallergy.org/media/935/download

Proposed Modified Anaphylaxis Criteria for Infants and Toddlers:

Mass General for Children Investigators Propose Modified Criteria for Identifying Anaphylaxis in Infants and Young Children

Development and Evaluation of Modified Criteria for Infant and Toddler Anaphylaxis - The Journal of Allergy and Clinical Immunology: In Practice (jaci-inpractice.org)

Allergy Confidence Activities:
Song - Epi Man by Kyle Dine (kyledine.com)
Power Pose TEd Talk by Amy Cuddy: Your body language may shape who you are | Amy Cuddy | TED - YouTube

Epinephrine injector instructions:
howtouseepipenautoinjector.pdf
ifu-poster.pdf (auvi-q.com)
epinephrine_1872-01_PI_Art5 page 1 without Legend (epinephrineautoinject.com)
 

Special thanks to Kyle Dine for permission to use his song The Doghouse for the podcast theme. www.kyledine.com

You can find Dr. Whitehouse at www.DrAmandaWhitehouse.com
or on Facebook (Dr. Amanda Whitehouse, Food Allergy Anxiety Psychologist)

Transcript

squadcaster-66dc_1_08-01-2024_183435: 0:04

On July 3rd this summer, I was walking laps at the track in a local park while I was waiting for two of my sons who were at their summer camp in the park. And as I was walking, I was thinking and getting the idea to do a podcast episode all about epinephrine. So I stepped off the track and I sat on the grass in the shade and started recording a bunch of different voice memos about the things that I wanted to discuss, which was a focus on why so many people are afraid to use their epinephrine. I picked the boys up shortly afterward and we stayed in the park for an Independence Day event that was going on there that day. And while we waited in the line, standing in the same exact spot that I stopped to record those voice memos, I overheard two moms behind me in line talking about a friend's child who had an allergic reaction that day. I didn't know them and I tried not to eavesdrop and butt into their conversation, but I could feel the panic and the fear being triggered in my own body as they told a story that we've all heard some version of before. How they didn't think that it could be an allergic reaction or couldn't possibly be anaphylaxis because the food had been from a trusted restaurant where they had eaten so many times. How the child had never had an anaphylactic reaction before, so they didn't think that that's what was happening. How their family had never administered epinephrine and wasn't familiar with it or how to do it, how they gave antihistamines repeatedly and waited and waited for things to get better. Eventually, I just couldn't stop myself and I turned around and asked if the child was okay, and I shared some information for them to pass along if they thought that it might be helpful for this family. Again, I don't know the family personally or more of the specifics of what happened in their scenario, but I do know that this happens far too often and it has the potential to be very dangerous. I don't have any intent to shame or blame this family or anyone else that this has happened to either. I think the fact that this happens all too often is evidence that we still have a long way to go in regards to education and awareness about food allergies and epinephrine use. And we'll talk about that more in the fall season of the podcast when we focus on advocacy. But this summer, we're still talking about understanding our anxiety about food allergies. And in my practice, I have found that epinephrine is the number one topic that people are either very unsure about or want to avoid discussing. But of course, knowledge is power and avoiding the topic is not helpful. And if you feel confident about using your epinephrine and knowing when it's necessary and how to do it, that is the number one way to do it. to decrease the anxiety that you fear about your food allergies because you feel prepared to handle them and respond to them. So we are going to dive in and flip our epi fears to help increase our epi confidence in today's episode. Before we start, a quick reminder that I am a psychologist. I am not an allergist or a medical professional. I am sharing resources and information with you, not giving you my own personal medical advice or recommendations. All the information I'm sharing today about epinephrine is readily available from multiple reliable sources, and I will post links in the show notes so that you can look it up for yourself. What I am going to focus on is what I have found to be the biggest barriers to fast and appropriate epinephrine use in the case of allergic reactions. And those are lack of information, lack of access, and the biggest piece, emotional resistance and fear. So let's start with epinephrine. information. What is epinephrine? Epinephrine is adrenaline. It's a hormone that occurs naturally in the body. It's produced during times of stress by the adrenal glands and also by a small number of neurons in a part of the brain called the medulla oblongata, which if you're around my age, you learned that from Adam Sandler in the movie, the water boy. I never forgot that phrase again. This is part of the body's fight or flight response, which I talked about at length in episode one. And if you haven't listened to that, I strongly recommend that you do, because it's really the foundation for my whole approach to addressing food allergy anxiety. The primary purpose of the fight or flight response in the body is to increase heart rate to get more oxygen to the muscles. It is not just used for allergic reactions. It's also used to restore cardiac rhythm in the event of cardiac arrest to control mucus, congestion, glaucoma, asthma reactions. It is also present in many doses of anesthesia administered during dental procedures to help to make the medication last longer and to reduce bleeding. I didn't know that until my dentist told me because I thought I was allergic to Novocaine. So the side effects of epinephrine can include a feeling of anxiety, restlessness, headache, fear, heart palpitations. And remember this is something that's naturally released when the body is in fight or flight. So it feels the same as the physical sensation of being highly stressed or anxious. While it's commonly said that people with heart conditions should use caution with epinephrine, There are no contraindications to epinephrine for anaphylaxis because it is the only medication that will stop the life threatening reaction. So let's go back to the family. I overheard the conversation about and all of the other families that have found themselves in a similar situation. Let's talk about the lack of information or the misconceptions that led to Epi avoidance. She's never had anaphylaxis before, so her allergy isn't that severe. We've eaten at this restaurant before, so we know that the food is safe. We were afraid it would be dangerous to give up anephrine if she didn't really need it. We've never administered Epi, so we didn't know how or we forgot to use it or even maybe we didn't have one in the house or didn't have one with us at the time. So if epinephrine is administered unnecessarily, you will likely experience an increase in heart rate and blood pressure, but the body processes it quickly, and these symptoms will probably subside within about 30 minutes and fully disappear within a few hours. I know several people, including one of my upcoming guests on the show, who have accidentally administered the epinephrine to themselves. thinking that they were practicing with a test injector. All of them, including one who does have a heart condition, are fine, and talk about the symptoms that I just described for you. Quickly resolved, not a serious situation. There's one study showing that about 36 percent of adults believe epinephrine injectors cause life threatening effects. In fact, epinephrine is the only medication that can stop anaphylaxis and it usually does so quickly. And part of the reason that some people believe that the epinephrine is dangerous is because the recommendation is always to go to the hospital when it was utilized, and that is not because the use of the epinephrine was dangerous. That was to monitor the allergic reaction there were new updated allergy and anaphylaxis parameters released that describe the most recent recommendations on when to use epinephrine and all of the details surrounding that. included in that was a change to that recommendation that people must go to the hospital if epinephrine is used in part because people were avoiding using epinephrine in order to avoid going to the hospital. Some of that was financially motivated. If you don't have the money to pay for an ambulance ride or an emergency room visit, then that might be a deterrent to using your epinephrine. And it's my understanding that they changed the parameters in order to avoid. discouraging people from using epinephrine. The new recommendation is that if you use epinephrine quickly and immediately upon symptoms, if the symptoms are improving or are better, and there is not continued concern that it isn't necessary to go to the emergency room. You certainly still can. If there's anything in your history or in your child's history that suggests for some reason that you should, you have a history of biphasic reactions, for instance, where a reaction tends to come back, then you and your doctor can talk about whether this applies to you or whether you might be an exception. However, for most people, this is a change that is both a little bit scary and a little bit encouraging. And I can talk to you about my own experience with it because. We had this experience this summer with my son. In the past, my son unfortunately had an allergic reaction after he had fallen asleep. So during the night at a time when I had been brave enough to venture out of town for a work event and so his dad was home alone with him. With the other two kids in the house called the ambulance and it became quite a production for them to, uh, go and wake up a neighbor who had to come over and stay at the house with the other kids so that his dad could be at the emergency room with him, even though he was better by the time that the ambulance arrived at our house, his symptoms were gone. He was in the ambulance laughing and cracking jokes, but we followed the recommendation with no complaint. that he should go to the emergency room and be monitored. So fast forward to this summer, unfortunately, this happened again and we use the epinephrine, but I had been made aware by my doctor of this new recommendation. So instead of that big production, which created so much additional stress for the family, my son and I use the epinephrine. We noticed that immediately he began to feel better. We sat and talked about it and decided what to do. And in our house, in our scenario, we compromised. He was still feeling that he likes that reassurance of being at the emergency room and knowing that the doctors are there to help him if there is a further complication or a return of his symptoms, epinephrine. So our compromise was since you're feeling better, since you're not in distress, Since using urepinephrine immediately made you feel better. We can just get in the car and we can drive to the emergency room. So we packed some snacks. We got some books. We drove to the emergency room. We parked in the emergency room parking lot and we sat and chatted and we had some snacks and we talked about the experience. We processed it a little bit together. And after a little bit of time, he realized that he was completely feeling better. All of his symptoms had resolved. He was no longer anxious about the possibility of a return. of his symptoms, even though it was a scary experience, nonetheless, and we both felt comfortable going home. So that's. I share that to give an example of working this out as an individual or as a family in terms of what works best for you. There's not a specific requirement. You can still go to the emergency room if you want. You can still call the ambulance if you feel that it's best for you or necessary, but you don't have to. And I think that that change hopefully will help some people to feel more comfortable about their epinephrine and using their epinephrine. One of the things that I was thankful for as we were sitting there in the emergency room parking lot, perfectly safe and not having an emergency any longer, was recognizing our privilege in the ability to drive there and having the epinephrine available to us in knowing that if we needed to go into the emergency room or if we had needed to call the ambulance, we could have afforded to pay for that, even if it was a stressor, but lack of access is a very real problem and one factor in why so many people either don't carry or don't use their epinephrine. The 2022 study that I mentioned before revealed that only 52% of adults with food allergies have even been prescribed an epinephrine injector by their doctor. Um, older people are less likely to be prescribed epinephrine. People with lower incomes are less likely to be given a prescription for the epinephrine, and that's not purchase, that's even just prescribed the epinephrine. People on public health insurance are less likely to be prescribed epinephrine, and not reporting a history of anaphylaxis is associated with not having a prescription. Unfortunately, they found that only 33 percent of the people that they surveyed actually had an unexpired epinephrine auto injector, which is very concerning. So their goal. And their conclusion was that everyone who has a food allergy diagnosis should always carry an unexpired epinephrine and have that accessible to them at all times. And this is a problem that we as patients can't really address globally. But we can push back if we are told that we don't need one. Hopefully this doesn't happen very often, but doctor tells you that you or your child has never had anaphylaxis so they don't need one, you can share the research and express your concerns and insist that you would like the prescription anyway. One common thing that I run into is parents requesting the epinephrine injector for younger children and allergists sharing the information with them, which is statistically true that infants or young toddlers are unlikely to have a very severe allergic reaction upon their first ingestion of the food. So if they've, um, had a rash, they've done a skin test, they've identified an allergy, but the child hasn't actually eaten it and had an anaphylactic reaction. Some doctors are reluctant to prescribe it because it's unlikely that the child would have Anaphylaxis upon the first time of eating the food. However, I think that underestimates the confidence and the security that those parents can have if they have that medication ready, if it's necessary for their child.

14:27

And I think the response to that is the same as we discussed before for patients who are afraid to use the epinephrin. And then pointing out that there's not really any harm for a family who might be at risk or have concerns to have the prescription and have the medication on hand, even if it doesn't need to get utilized.

squadcaster-66dc_1_08-01-2024_183435: 14:45

For the most part, I think the solutions to this problem of lack of access are really beyond us as patients, because this is, you know, taking place based on doctor's recommendations. So this is more of a systemic issue that I'm not going to dwell on here in the podcast, although we will talk about it in the fall when we talk about advocacy and awareness. But for now, I think the most important thing is just to know that you want to have your epinephrine. If you don't have the prescription, please make sure you get one and keep the epinephrine with you all the time.

15:17

If you have an effort is on hand, the next problem that can occur of course, or the next barrier. Is people. Uh, being unsure, whether it's necessary to use it, not feeling confident to identify whether they're having an NFL lactic reaction. And I just want to reassure you that if you aren't. Confident about this. It's not your fault. There is a lot of confusing information out there. Different doctors tell people different things. Sometimes it is a lack of updated information being shared. And sometimes it's because different people do. Require and warrant different responses based on their own personal medical history. One thing that is clear and considered pretty standard is that we always consider an anaphylaxis. If we have one severe symptom. Or the two system rule, which is symptoms from two different bodily systems, the skin. The respiratory system, the digestive system, the cardiovascular system. This sounds complicated, but really it isn't. There's a very nice handout. That's been created by fare food, allergy research and education that describes this and gives information to help you determine which systems can be involved in what the symptoms in each of these areas will be. And you'll find that linked in the show notes below an interesting study published earlier this year in May discusses a recommendation to update the parameters for identifying anaphylaxis in infants and toddlers. So if you have young children, this might be something that would be worth looking up and talking to your kid's doctor about. Basically this research was based on our understanding that infants and toddlers can't necessarily articulate. There are symptoms the way that an older child would. And so they really carefully examined the criteria, um, that are standard right now. And then try to assess how many anaphylaxis cases were being missed or would be more accurately identified if The criteria you were a modified. Some of the symptoms that they pointed out that should be considered important and infants and toddlers are things like flushing, drooling, regurgitation, increased fussiness or irritability, drowsiness horse voice or a swollen tongue. Things that account for age specific differences. How does this present in much younger children? So when they reviewed the charts and assessed. There was a statistically significant difference in being able to accurately identify anaphylaxis in infants using these modified criteria. So their recommendation is that these criteria be considered within the field and additional research has done so that we can better evaluate and identify anaphylaxis and toddlers and infants. And it might be something worth talking to your doctor about if you have a younger trialed. the point is not to panic you is just really to validate that if you're confused, It's because things are confusing and researchers and medical providers are really still working through. Identifying and helping us to. Evaluate accurately when anaphylaxis is occurring.

squadcaster-66dc_1_08-01-2024_183435: 18:35

And so far, none of that information that I've shared is really much different from what's out there on other allergy podcasts, from other advocacy organizations, sharing information, other resources that are really easy to find. and from what hopefully most allergists are telling their patients. So where's the disconnect? That information is already out there, but why are people still not using it? Why are people still not filling their prescriptions, carrying their epinephrine injectors, renewing them after they're expired?, why are the statistics that I shared still true? My answer to that is, remember what we learned in episode one. When we are in an anxious state, or what we refer to as the nervous system's fight, flight, or freeze mode, that's activated when danger is perceived, the logical and rational thinking parts of our brain are not in charge. So in other words, information and statistics Are not the solution to the problem with fear to use epinephrine. Emotional barriers are, But unfortunately, the ways that we're coping with this and the ways that we think we're dealing with this anxiety are actually increasing the risk of having a problem. So how we bridge that gap is not by trying to use logic and to try to rationalize away the fear we have to embrace and understand our fear and anxiety and work with it, not as if it's not powerful or influential and as if it can just be dismissed. So this piece of what I'm here to share with you, what I want to help you start doing is what I think is the missing link between all the information that's out there. And it actually being acted upon or utilized. It's our unhelpful coping skills are unhelpful thinking patterns that we are unaware that we are using or that we are doing. They're actually making our kids less safe and in this specific instance, those are actually the things that are preventing us from using and having access to our epinephrine. So for example, if you're like me and you want to read a copy of the new 2023 parameters about anaphylaxis and you want to print it out and you want to get out your assortment of rainbow colored highlighters and read through and make notes, go for it. If you don't want to do that. If that feels like too much information for you and it's overwhelming and it makes you more stressed out, that's fine too. There is not a right answer here or with almost any of the things that we're talking about, except that you should always carry your epinephrine. Aside from that, there's no shame or guilt for the way that you're dealing with things or no 100 percent right or wrong way to do things. But here is my point. If your elaborate reading and researching and organization becomes a way of fooling yourself into thinking that it can't happen to you, if that becomes a coping skill to either avoid the reality of knowing that having a reaction is a possibility for you or your child, kind of denying that truth, then that thing that could be helpful becomes an unhealthy coping skill.

21:51

If at some point that thinking and reading and talking doesn't translate into the actual actions that you should be taking, like going to your back door and checking the epi pen pack and updating the paperwork and refilling the prescription and talking to your child and practicing. The administration procedures. And then what you're really doing might be avoiding.

squadcaster-66dc_1_08-01-2024_183435: 22:16

On the opposite end, if avoiding it. not talking about it, not reading about it, not asking your doctor the questions, not clarifying or feeling confident about when to use it is your coping skill. You and I are doing the same things. That is also a way of avoiding the reality and not talking or thinking about what is the truth here. Again, that the risk of an. allergic reaction and an anaphylactic reaction is a reality for anybody who has allergies. So on both ends of that spectrum, we're using opposite coping skills in order to avoid the same difficult to face reality and either direction. The solution is to have the epinephrine available to know when to use it and to feel confident about doing so. So what I focus on most with my clients is. Directly talking about their fears instead of talking around them with information and research and stories about other people. We have to circle into the center of that discussion and that intellectualization to the actual fears and emotions that people are experiencing. And on the opposite end, when people aren't comfortable talking about it at all, we have to do the same thing. We have to get to the heart of it and actually express and directly face and state. What the fears are. And for all of us, the fear is that we will have an allergic reaction. So ignoring the problem doesn't make it go away. It creates more problems. By allowing the fear and the resistance to keep the body in fight, flight, or fear mode, and to keep you from actually protecting yourself correctly in the event of an emergency. It's uncomfortable to talk about because talking about it makes the fears seem real. It forces us to face the scary truth, which is the real possibility of having a reaction, being in danger, and the very, very slim reality that we know is unlikely but possible that sometimes people die from anaphylactic reactions. The epinephrine itself is just symbolic or representative of that actual underlying fear. And of course the irony is that delaying or avoiding the epi is the number one risk. of severe injury or death from anaphylaxis. So the biggest thing we can do to protect ourselves is to know when and how to use it and to do it quickly and not let our fears get in the way of doing so. It helps to identify the exact words that come up in your head when you think about this. In therapy, one technique that we use is cognitive therapy. That addresses our thinking, in particular our unhelpful thinking. And we call them, when we're practicing cognitive therapy, our automatic thoughts. Automatic thoughts are not our logical, rational thoughts, but instead these are quick thoughts or even images that just enter our mind. usually when we enter fight or flight mode. It's the things that the worried part of us blurts out that make us feel panicky and scared. And when it's about epinephrine, it tends to be things like, it's going to hurt. I don't wanna go to the hospital. If it's kids, they might think things like, I'll get in trouble. Maybe because they ate a candy that they weren't supposed to, or they snuck a food or they didn't follow a rule. When we catch these thoughts and even say them out loud, we can feel the fight or flight response in them. We can feel the avoidance and we can feel the irrational nature of them saying out loud kind of holds them up to the light for us to analyze and face and recognize. that they're not logical, they're not true. The minimal pain of a small needle is nothing compared to the symptoms that you might already be having or what could happen from an allergic reaction. Kids are afraid that they're going to be blamed for their reactions by their parents for maybe breaking a rule or forgetting to ask or check about a food. But in reality, obviously their parents just want them to be safe. So, when we can bring these automatic thoughts to light, we're usually able to challenge them and to see how they are unhelpful to us and how they're actually putting us in more danger. So once you have really faced your own thoughts around this, if you have kids with allergies, allergies, allergies. Are you ready to address your child's fears about the epinephrine because you have to approach a conversation like this and any work on this from a very calm place to avoid feeding into your kid's fears and amplifying their own fears about the epinephrine. You have to make sure that your language and your approach and your body language, your nervous system is in a very calm and controlled and regulated space so that you can help your child to achieve that while you're talking about something anxiety provoking with them. I have some favorite tricks to do this with kids, and I'm going to share a couple of them here. Unfortunately, it's way too much to share for one podcast episode, and I have tons of ideas and techniques that I use with both adults and kids. But I want to share some of my favorite ones here with you today. And top of the list is a song that I played in one of my previous episodes in my interview with Kyle Dine. He is an allergy. Musician. And he sings songs for kids about topics related to food allergies. He has a song called epi man. And in that song, he talks about conceptualizing the epinephrine as a superhero that comes to save the day. Kyle even talked about how He was inspired to write this song and the two kids who helped him to come up with the idea and create it were two kids who had allergies and dressed up and pretended that they were this epi man. Talking about the epinephrine with language that talks about how it can save you, how it helps you, how it protects you instead of something to be afraid of. You can take this a step further and listen to the music, come up with a name. If you have your own name, instead of Epi man, I've had kids in my office draw pictures, making the epinephrine injector into a superhero, creating a costume and a logo for it. And sometimes I've even had the kids create with paper or fabric, if they were really into it, something to put on their injector. And dress it up like this character that they were creating in their minds. It sounds silly, but being silly and making something funny is one of the best ways to take the fear out of it.

28:47

If you have older kids, or if you're an adult, who's not really into dressing up your epinephrin injector. Another trick is to take that positive thought, that positive language about the epinephrin and write it on a piece of paper and tape it onto the outside of your epinephrin injector so that you see it. If you ever do have to pull it out and use it.

squadcaster-66dc_1_08-01-2024_183435: 29:07

To elaborate on this even more, I like to combine those activities and talking about epinephrine as our superheroes, as our protectors with something that's called power posing. There is research by someone named Amy Cuddy, who's very well known for this. She has a TED Talk that you can easily find if you search her name or if you search TED Talk Power Pose. And there is research that the chemical reactions and the hormones in our brain actually shift when we assume a physical posture or a pose That's associated with a certain mindset or feeling. So for instance, if we stand in the typical pose of a superhero with our feet set wide and firmly apart, our hands on our hips, standing tall, our shoulders back, our chest out, our chins up confidently, and even a confident or calm expression on our faces. And if we hold that pose, and if we look in the mirror at ourselves, holding that pose, even if we don't believe it, even if we definitely will feel silly while we're doing it, we will create a chemical shift in our bodies toward that feeling and that mindset that we are demonstrating with our body language. When I have kids do this, what I like to incorporate is, however they carry their epinephrine, which I always encourage kids to carry it, even if their parents are carrying an additional set of Epinephrine injectors as well, incorporating touching that epinephrine into the pose while the child is posing. So if they have a pack on their waist, then their hand is touching that epinephrine injector. If they have a cross body bag that they carry, one of the hands is clutching the strap of that pouch. And I want them to touch that epinephrine and have a physical reminder that it is there and that they have it with them to enhance that confidence that they have in their epinephrine. And they can use this then anytime they're out in public, if they might be at an event or a gathering where they're starting to feel a little unsafe or nervous about their allergies, they don't have to do an obnoxious pose and look silly in front of everyone, but they can put their hand on that epinephrine and be reminded of that feeling and all the information that they've learned and how they've practiced. viewing their epinephrine and changing those thoughts about it, reminding themselves that it's something safe, that it is something that will protect them and that they're going to be okay, no matter what the scenario is, because they have it with them. And they know that that's the number one way to stop an allergic reaction. If the worst happens and they do have one. And throughout all of this, these explorations, these conversations that we're having, it's really important to highlight. Where your internal and external language, so both what you're saying to yourself inside of your head and how we're talking about it externally with others. is not helping. So words and phrases that you're using that are not creating a sense of calm and trust and confidence in your epinephrine need to go. How does the tone and the content of your thinking and your discussions around it reflect the fears and worries or avoidance? And what changes can you make to shift this? So one of the most obvious examples And the one that I hate the most is any word or phrase, including stab or jab or poke or anything else that sounds violent. In reference to using epinephrine. I've had multiple people in my family say, especially when it was new, right in front of my son, I don't want to have to be the one to stab him with that. Epi. It happened more recently, even though he's getting older now, when we were going into a new scenario and we were showing somebody, an adult in the situation, How to use his epinephrine injector. And she said the same thing about, Oh, I don't know how to stab with that one. So all of these people genuinely care for him. I know they want to keep him safe. I know for sure they would have given him the Epi every single time if he needed it. But my stomach just sinks every time that I hear someone say something like this in front of him, because these comments reflect their own fears. And then they hand them right down to the child who's listening to them say it. In our house, we use words like use epinephrine, you can get clinical with it, and you can call it administering epinephrine. And when we practice with the epi injectors, I make sure to emphasize that contrary to popular belief and how many of us were trained whenever we had a training at work about how to administer epinephrine, don't actually have to. wave our arm up in the air and swing it down and stab ourselves in the thigh with it. We don't have to jab them into our legs. We only have to push hard enough to release the medicine. You only have to push hard enough so that injector clicks and releases the medication.

34:04

So this doesn't mean that we lie to our kids and pretend it's not a needle, especially if they directly ask us, but we certainly aren't going to use it violently. So why would we talk about it as if we would. The way we are going to talk about it is positively is acknowledging that that medicine is what will save us. If we have an emergency. And most importantly, focus on feeling better. If you're having a reaction or if your child is having a reaction, naming what it is, identifying it and knowing this is anaphylaxis. And my epinephrin is going to stop it. My epinephrin is going to make it feel better. If you haven't experienced that yourself having to use the medicine and knowing how quickly it works and how much better it makes you feel, even though it's scary, I encourage you not to avoid it. But instead to talk to somebody who has talked to someone who knows the good feeling that comes when you're having a reaction and you use that medicine and it kicks in so quickly and makes you feel better. I had Kyle dine in episode two, talking about that. I got some guests coming up who are willing, very generously to talk about. Uh, their own experiences and how that up and epinephrin fields when you use it and I'd like you to come up with your own line, your own thought in your mind about what it does. It will make me feel better. It will stop the reaction. And replace that with whatever language you have identified by thinking through this, that is giving you a different mindset about your epinephrin.

squadcaster-66dc_1_08-01-2024_183435: 35:33

So this is just scratching the surface. of what I think needs to happen in many of our homes and our relationships and in our conversations in our heads and externally with people about how we approach epinephrine and how we decrease this barrier between having and knowing about the epinephrine and actually using it when it's needed. But I hope it's a good start. And of course, I'm going to share my three things with you to give you some resources and some steps that you can take to get more confident with this. So step number one, if you go to my website, dramandawhitehouse. com, or you can click the link below in the show notes, you can get a free copy of my Epi Confidence Weekend Challenge. And this will give you a simple plan, three days of simple steps that you can take to Just practical things to make sure that your Eppies are updated, ready to go, and that everybody who needs to know how to administer them is updated on doing so with the mindset that we talked about. With that positive, confident, reinforcing that this is the thing that will always protect you and keep you safe perspective. Step number two, if any of this is unclear to you, if you are unsure about when you administer Epi to yourself or to your child, what to do based on your own specific history, make an appointment with your allergist to discuss it. You do not have to wait for your annual appointment. You don't have to wait for that back to school Epi refill and school form completion appointment to talk to your doctor. So I would encourage you to be really honest, go to your doctor and be direct and just say, listen, I know all this information is out there, but I don't feel a hundred percent confident about when to administer epinephrine. I want you to walk me through it. If you don't want to talk about it in front of your child, then I encourage you to try to make the appointment at a time when the child's other parent or another trusted adult can go with you. And that way the child can be present because most of the doctors will require that. They can't bill your insurance for an appointment if the child isn't present. But then you can excuse the child to the waiting room and you can finish the appointment. speaking openly and honestly with the doctor about your questions about your own fears that you might have that you need them to clarify and reassure for you without worrying about how to phrase things and putting your own worries into your child's head. Then you can take the time to process the information. If it's for your child, think of a way to share it and communicate it age appropriately with your child. Take all of that information and those resources and you can create a plan for your own epinephrine administration when it's necessary, how to do it, the steps to take. To help you get started with this. I will put in the show notes a link to FAIR, which is the Food Allergy Research and Education Organization's Food Allergy and Anaphylaxis Emergency Care Plan. This is a great starting point, but you can take it to the doctor, you can write your questions on it, make your own adjustments if necessary based on your own situation, your medical needs, your history about how to identify symptoms of anaphylaxis, when to use your epinephrine, what to do, and how to take the steps of that emergency. I would also encourage you, and I will put in the show notes, to print out and have on hand the specific instructions for whatever your epinephrine injector is, so that you have those on hand for anyone who might end up needing to administer the medication. And step number three, if you would like to dive into your epi fears a little bit deeper than we can cover in this podcast, if you want to get into your hesitation and your reluctance into more depth and really work through it. You are welcome to sign up for my small group four week workshop, which I'm calling Epi Experts. It is starting on August 21st. It will be held virtually on Wednesday evenings from 7 to 815 and recordings will be available if you can't join us live. This isn't a therapy group. I can't work Therapeutically with people who are outside of New York state. But if you're out of my state or if you're not in the U. S. It's an opportunity for you to work with me in a format that is more like a course. It's education to help you identify your own fears and your blocks by talking about them with other people in your shoes. People who feel similarly have also come up with their own coping skills for working through things. And with me as someone who has Talked through this with a lot of people and can share strategies for shifting communication, for identifying and challenging your worries and fears. Shifting your attitude from one of fear to one of trust and confidence in your epinephrine And finally, if you have a child at home who is the one with the allergies, I will share with you my favorite activities that you can then take and do at home with your child to help create the same changes and shifts in them. You can sign up for that by contacting me in my signup form on my website, which again is dramandawhitehouse. com. Link is in the notes. You can reach out to me and ask me any questions about that group. And if it seems right for you, and if you want to dive deeper into this, I would love to have you.

41:01

And if you are listening to this episode, after that group has closed, which will be in September of 2024. But you're still interested. Please reach out to me and let me know, because I will be making a recorded version of that available in the future.

squadcaster-66dc_1_08-01-2024_183435: 41:18

Thanks for joining me for today's episode. I'm Dr. Whitehouse. And until we chat again, remember don't feed the fear.