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Friday, December 10, 2010

Living a Peanut Free Lifestyle

As I mentioned a few posts ago one of my grandchildren has a peanut allergy.

Now coming from an engineering-oriented background I am always fascinated by what I observe on the medical science side.  As a software engineer I am always interested in certainty and details because over the years I have learned that its very easy to fool yourself into believing something that is not true.

I have spent a number of years thinking about just how much information is enough to have a high degree of certainty.  Now this concept already exists in statistics and for statistical certainty we can talk about the likelihood that something is true given some observed evidence in a number of ways.  But that's not what I am interested in.

In software it is often the case that we have all the information about something, i.e., the complete set of programs and data, and our interest is in finding out why something is not doing what we expect.  You can call this "debugging".  I put A and B into the computer and expect to get C out but instead I get D.  This, of course, is not just limited to software but any sort of system where you have all the information.

Now you usually cannot have all the information about something as complex as a software system in your head all at once.  For example, think of the machinery of a clock: all the gears and levers ticking away.  Now imagine that you are looking at the insides of the clock through a small hole - small relative to the clock insides.  Given what you can see about the insides of the clock what can you know about how it works?  As the hole gets bigger and bigger more and more of the clock is revealed until finally you see the entire working.

This is sort of like statistical certainty up until you see the whole picture: then one presumes to have the entire, actual picture which makes figuring things out easy.

So lets talk about peanut allergies and my grandson.

Several months ago my daughter and grandson where at my house.  As part of whatever was going on she decided to give him part of a peanut butter and jelly sandwich.  Now he's a year old and prior to this point he had never exhibited any sort of allergies with regard to food.

As he ate his sandwich he started to break out in hives or bumps.  My daughter immediately called the doctor who suggested giving him benadryl.  She gave him some (this is one of the few drugs we actually keep around the house - specifically for this type of thing) and the bumps and hives slowly disappeared.

Immediately the hue and cry began that he was allergic to peanuts.

Being me I though: not so fast.  While it would certainly seem like this is true I thought it was worth a little further thought and investigation.  The first thing I realized was that he we eating a 12 grain bread that I eat that has a large number of various nuts and odd things a child would not normally eat.

So in started to investigate the label but I was too late.  "Its a peanut allergy" my daughter declared.

First thing the next day she called the doctor to schedule an allergy test but they told her that benadryl does not leave his body for several days and to wait.

Long story short there where never conclusive test results identifying peanuts as the direct cause (at least that I recall) but the doctor said, in effect, "it must be a peanut allergy".

Now it turns out that this is quite a problem for people (peanut allergies) and from my perspective I always like certainty as in a conclusive test of some sort that verifies this.  But that, as I recall, was not what happened.

I am also troubled by the fact that up until that particular sandwich the little guy ate just but everything - or at least put it in his mouth.  It seemed unlikely that he would never have encountered something with peanuts before this.  (Now to be fair we fed our children "table food" from fairly early on.  Not so our daughter who followed the modern medical advice of staving off "table food" until much older.)

The consequences of this are two-fold: one is that the food supply must constantly be checked for peanuts and the other is that my daughter keeps an EpiPen with my grandson at all time.

Fast forward to today.  My daughters daycare facility discovers that my grandson is "peanut allergic" and that there is an EpiPen in the bag she leaves with him.  This caused a huge problem.  The daycare owner told my daughter that "insurance does not allow us to administer the EpiPen".

My daughter freaked out, asked if they would instead just watch him die of anaplylaxis, and promptly changed him to a daycare (as in the next day) that would be willing to do this.

(Now to have a daycare in my state you must have Red Cross training which I believe covers exactly this.  So it would be an issue of lawyers; though one imagines that administering an EpiPen incorrectly and killing a child would not be nearly as bad as doing nothing or calling an ambulance and watching the child die in the process of waiting for it to arrive.)

In any case he is now in the new daycare with a staff that has EpiPen training.  He will remain there until the situation is straightened out at the original daycare (which involves my daughter signing a notarized release AND training the staff on the use of the EpiPen).

In the meantime she was at the doctor's office for her other son and somehow this topic arose.

The doctor asked "Isn't your house and daycare peanut free?"

My daughter did not know what to say... Certainly some peanut-containing items where there because other people in the house at them.  No peanut-free daycare centers are available as far as she can see.

My daughter thought about this for a while and reasoned as follows:

1) If she expunged all possible forms of peanuts from the house her child could safely grab anything at any time and put it in his mouth without fear of consequences.

2) Could she really rely on others, like the daycare or guests in her home, to be 100% infallible is this regard?

3) This would teach her son to expect that peanuts never occurred in his environment and therefore learn caution was not necessary.

What would you do?

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