The Best Possible Outcome

Justin Zaslavsky

Most lawyers are familiar with President Abraham Lincoln’s words: “He who represents himself has a fool for a client.” The interpretation I’ve always heard – as the son of a criminal defense lawyer – is that being so engrossed in a situation can blind you to its realities, making it difficult to achieve the best possible outcome.

This concept is obviously detrimental in criminal trials, but I recently understood it in a pretty unorthodox context when I went into anaphylaxis during my time working as a research assistant at the Food Allergy Outcomes Research Program with Dr. Ruchi Gupta at Northwestern University in Chicago.

I’ve struggled with food allergies all my life. I spend my day with two EpiPens, forever asking if there are tree nuts or chickpeas or sesame in anything I eat. I was lucky to grow up with a strong parental support system that allowed me to go about my childhood virtually worry free – mainly because my mom worried enough for the both of us. She even made sure that I met with the campus dietitian at Tufts University when I started college to talk about food on campus, so that I could feel safe when eating in dining halls.

Despite all of (or possibly because of) what my mom has done for me, I have been disturbingly careless when it comes to my allergies. As an Emergency Medical Technician (EMT), I am well aware of the dangers of the multi-system allergic reaction known as anaphylaxis. Regardless, I still feel invincible – just like all my other 19-year-old counterparts – when it comes to the impact my allergies have in my life. It is in part this teenage naiveté (or less euphemistically, ignorance) that led to my most recent attack.

The story of that day is well-known in the allergy world: I had thought I read the ingredients on a package of kale chips, but ended up eating a kale chip that included cashews (one of my allergens). My throat began to tingle almost immediately, so I ran out and bought Benadryl. Back in my office, I threw up (a lot) and felt my throat closing tighter and tighter. By the time my supervisor convinced me to go to the hospital emergency department  (about 15 minutes later), I was barely able to breathe. It was one of my worst reactions ever – requiring the equivalent of three EpiPens and three courses of albuterol, to open up the airways in my lungs. I was ultimately admitted to the hospital.

The nuances of this story, however, are less simple. My first mistake: I hadn’t told Dr. Gupta that I had food allergies. I didn’t think it was appropriate or relevant to my ability to do the work requested of me in the lab. This only added to the embarrassment I felt during my reaction, and it made me more inclined to downplay my reaction when it occurred. This also had the potential to create a situation during which epinephrine would be further delayed if I had lost my ability to advocate for myself (e.g. tell her I was going into anaphylactic shock), endangering myself even more.

My second mistake: I delayed using my EpiPen. Typically, an epinephrine auto-injector should be used at the first sign of a severe reaction, but being so well versed in allergic reactions from the perspective of an academic and provider made it difficult for me to recognize the severity of my reaction and respond accordingly. I should have known I needed epinephrine not as an EMT, but as a self-aware person with allergies. Finally, I forgot to follow the tenet of living with severe allergies: always carry your epinephrine auto-injector.

I was very lucky that I worked so close to an emergency department, and I was even luckier that I was with people who understood food allergies. I can assure you that I now always carry my auto-injectors, and that I will try to be more aware of what my body needs. It’s a hard practice – balancing food allergies with a strong work ethic and disdain for being a burden on anyone – but it is something I need to develop. I need to have an internal frame-shift from encumbrance to acceptance of my condition that occasionally requires my full attention and trust in others, so that I survive.

I can’t help but think how I’ve developed my current, skewed understanding of my allergies. Is it that my mom always carried my auto-injector for me and I didn’t need to worry? Is it the mindset that surrounds food allergies in our society? A sense of invincibility? Does one need to have a serious reaction to start taking their allergies seriously? I wish I had the answer, but I sadly do not. For now, though, I am just going to hope this post-reaction hyper-awareness persists.

***

Dr. Ruchi Gupta: Insights of a witness to anaphylaxis

Dr. Ruchi Gupta

Before this reaction, Justin had been working on many of our food allergy and asthma related studies, but I was unaware of how personal both of these topics were to him until the day of his reaction in our lab – a day that will forever be etched into my memory.

I am a pediatrician, food allergy and asthma researcher, and a mother of a child with food allergies. I speak around the world about anaphylaxis management (coincidentally, I frequently speak about teens, independence, and risk-taking).

On this day, I learned how complex “doing the right things, in the right order” really is. After I realized Justin might be having a severe allergic reaction, my mind was flooded with thoughts. What should I do? Did Justin have his EpiPen? Should we head to the Emergency Room two blocks away? Should I listen to Justin, a young adult, or can I tell him what to do?

I was able to see first-hand what I research, and I learned a tremendous amount because of that. I learned just how hard it is in the moment, even as a physician, to know when to call a reaction anaphylaxis and then take the necessary steps to intervene.

I believe Justin taught me more this summer than I taught him. We both learned the importance of always checking labels, being prepared with epinephrine, making sure to react quickly, educating people around you, and the importance of having strong support systems. We both learned how difficult identifying an anaphylaxis emergency and acting on it can be.

We also learned what I often preach  trust your instincts and if there is a suspicion this could be serious, always act! Luckily, even after the confusion, we did act and Justin is doing well and is all the wiser (as am I).

Dangerous Bites: Cultural Implications of Food Allergies

If you have a chance, I highly recommend checking out this article about the cultural implications of food allergies in Asian American communities.  It was published yesterday by Grace Hwang Lynch, a Bay Area writer who I've gotten to know over the last year as she conducted research for the piece.   Her article is one component of "Off the Menu: Asian America", a multimedia project which also features a one-hour PBS primetime special.  Hope you like it!  

Five Fabulous Femmes!


Last night I had the enormous pleasure of attending the premiere anniversary gala held by the amazing non-profit, Demoiselle 2 Femme. If you're not already familiar with their work, their mission is to provide holistic services, education, instruction and training to assist adolescent girls in a successful transition to womanhood. Over the last two decades Demoiselle 2 Femme has provided prevention and education programs to more than 3,000 girls ages 13-19 in the Chicagoland community! Through their programs, girls are challenged and empowered to utilize critical thinking skills to make healthy decisions as they navigate adolescence.

I have long admired the work of D2F and feel so deeply honored to be acknowledged as one of their 2015 Five Fabulous Femmes for my research and advocacy. My fellow honorees last night were:

  • Darlene Hill, Anchor and Host of FOX-TV's Good Morning Chicago
  • Toni Preckwinkle, Cook County Board President  
  • Elizabeth L. Corey, Business Lawyer at Foley & Lardner LLP & 
  • Katherine Darnstadt, Architect and Founder, Latent Design
Thank you so much Demoiselle 2 Femme for the TRULY FABULOUS work you do on behalf of girls and women throughout Chicago!

WBEZ interview this week on food allergy disparities within the Chicago Public Schools


As you may know, I have been collaborating with the Chicago Public Schools for the past few years on a number of research projects aiming to improve food allergy management within CPS.  As a result, I occasionally get opportunities to discuss my work, and the challenges schools and families face in keeping students with food allergy safe.  Today I was on WBEZ's Morning Shift show discussing childhood food allergy disparities within CPS.

You can click here to read or listen to the story (it's about 5 minutes long).  Enjoy!

2015 AAAAI Annual Meeting: Empowering Students with Asthma in Chicago Schools through Photovoice and Videovoice

As I mentioned in my last post, I'm headed to Houston in a few days for the AAAI annual meeting where I'll be making a number of presentations.  Here's a summary of my 2nd presentation, for those of you who want to stay abreast of my latest research.  It's entitledEmpowering Students with Asthma in Chicago Schools through Photovoice and Videovoice, and it reports findings from a recent school-based asthma intervention we carried out in a south-side Chicago school.

As you may know, asthma is a problem of epidemic proportions in Chicago, where childhood prevalence and mortality rates are well above the national average. The objective of this study was to partner with adolescents to improve asthma management and increase community asthma knowledge and support. To do this, middle school students with asthma (N=12) were recruited at a Washington Park school to participate in a 13-week program grounded in Community-Based Participatory Research (CBPR) principles. Students were given mini-tablet mobile devices to investigate socio-environmental factors influencing their asthma.  They did this by taking photographs, recording video Public Service Announcements to educate their communities, and implementing a targeted community intervention.

The major asthma triggers identified by students in their communities included air pollution, smoking and automobile idling. Participants demonstrated significant improvement in asthma self-efficacy and empowerment (p<.05).  Interestingly, their caregivers demonstrated significant improvement in their asthma-related quality of life and asthma knowledge (p<.001).  Use of peak flow meters (p<.01), spacers (p<.05), and asthma action plans (p<0.01) also increased significantly as a result of the program. As a capstone project, students developed and presented videos to peers and caregivers and posted them to a website to disseminate results to the community.  You can view these videos on my new website at http://www.ruchigupta.com/asthma-videos/!