Thursday, February 28, 2013

Complete Organic Gardening Course!


The COMPLETE ORGANIC GARDENING COURSE offered by Edible Corvallis Initiative in collaboration with OSU Extension and Oregon Tilth will take place throughout the month of April.  Learn how to grow your own food using organic methods by participating in hands-on garden activities, in-depth discussions and engaging educational exercises.  There will be a lead instructor with visits by specialist guest instructors from all three organizations.  In April, we'll meet every Wednesday evening from 5:30 - 7:30pm for interactive discussions with our hands-on gardening days being every Saturday from 9am - 1pm. 

You can register HERE 
or email me for more details!  
sage@corvallisenvironmentalcenter.org





Tuesday, February 26, 2013

Nickmom, Bake Sales and Food Allergy Portrayal in the Media

We aren't the first ones to
really, really hate this show...
So I'm trying to get incensed and dig up some outrage over the whole Nickmom allergy video. (The video has already been taken down or I'd link it for you.) But I'm just not feeling it, even after a couple of Red Bulls, despite how good a tirade would probably be for my web traffic.

I watched the video this morning before work so I don't remember everything, but the gist of it seemed to be that the extra demands of FA-aware bake sales stress the moms of non-allergic kids out. There was a table for "milk-free" and one for "peanut-free", etc. etc.

While I was watching it, I thought to myself "What an awesome school! Wouldn't it be great if that were REALLY the way a bake sale went?

Which leads me to ask the question: why was this video so very offensive to allergic moms?

Assuming nirvana was actually reached and the school/PTA/after-school group actually accommodated us and made separate tables at a bake sale for allergens, it probably would be pretty stressful for other moms to figure out. Just restricting peanut foods in the classroom or lunchroom has caused a backlash with some parents. As I've posted before, a national study showed that 50% of Americans think food allergy concerns are blown out of proportion.

Backlash...without the laugh track
So...Nickmom took an issue that we know is polarizing and exaggerated it for humor. That's pretty much the formula for cutting-edge comedy these days. Dozens of television shows (including the ones I wrote about in the very first month of this blog) have done the same thing. It wasn't very funny...but it also shouldn't have been surprising.

It's great that Nickmom has already taken the video down. However, removing the video doesn't change the thinking of the young man who wrote the video. It doesn't change the thinking of the moms who related to it and laughed at it. The video is the symptom of the disease, not the disease itself.

If we want Hollywood to portray food allergies realistically and sympathetically, not as a plot device for laughs or as a means to further divide a country that's already divided over food allergies, we have to change the heart and minds of the people who find the video funny in the first place. I think that's happening naturally to some degree (just as it did with AIDS, another disease that suffered from a social stigma) because more and more people know a child with allergies. But I also think the strident tone of some of the FA moms who posted comments works against us.

I concluded a couple of things after thinking about this for a while:


The pictures of the kids after allergic reactions are far more powerful than any words. There's nothing polarizing about a little baby face all swollen with hives, or a toddler in a crib at the hospital with an IV. We tell our kids to "use their words", but as adults, we need to use our pictures more. The stridency of our words can work against us; the pictures are the compelling message.

Dads need to speak up. I saw one dad comment on the site. His comment was very measured, very well done, and it got the most "likes" of any I saw. Why are our children's fathers not out there speaking for their kids? Let's ask them to do more.

I would love to see the energy from today, and those powerful images, preserved on a web page called something like "The Faces of Food Allergy." Anyone have the energy to make that happen? Perhaps the FARE group will make it a campaign someday.



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Saturday, February 23, 2013

Harmful Things Food Allergy Advocates Say

If you've read my blog for any length of time, you know I have mixed feelings about advocacy and support groups. I do think there's just no other way to really learn the nuances you need to know to keep a food-allergic child safe. However, I also believe they spread fear, misinformation, ultra-conservative thinking...and, even at times, do outright harm. Let me give you some specific examples of where I think advocacy groups have crossed the line.

1. Peanuts are Poison.

This is like telling your child when their pet dies that it has "gone to sleep." It's a dangerous misrepresentation of the situation that is likely to lead to future problems.

In all likelihood, your child will need to undergo a food challenge at some point. It's possible (likely, in the case of milk and egg) that they will outgrow their allergy. (Remember that as many as 20% of children do spontaneously outgrow even a peanut allergy.)

What's going to happen with the child who's been told, over and over, that peanuts are "poison?" My guess is that they're going to have a very hard time adjusting their thinking and going through a challenge. That's how we end up with kids who refuse challenges, even when their doctor thinks the time is right, and who continue to avoid foods even when they've passed a challenge.

Don't do this to your kids. And, when you see advocates promoting this, don't put up with it. It's both technically wrong (an antigen response is nothing like the body's response to a toxin) and psychologically harmful.

2. Vaccines cause food allergies.

I don't know why I was so surprised to see this one come up in my Twitter feed. As I told that Tweeter, we have literally been having this conversation about the link between adjuvants and food allergies for 15 years. (The link above is to my community's old home. The story of why we left there is an instructive one in the abuses of advocacy groups...but probably better left for another day, although I will say that many of us are still disappointed the dedicated ice cream factory never came to fruition...)

This is an excellent poster if you want to be an excellent poster.
Here's the thing: anything that causes mothers not to vaccinate their children needs to have more scientific evidence behind it than "well, it seems like it might be true, so let's post about it." There is real potential for harm here. I have very strong feelings about this because I know a family who lost a baby to pertussis. Their baby was too young to be vaccinated. The neighboring family was anti-vaccine and their children came down with pertussis. They were fine; the baby died.

I'm not going to get into the overall debate about vaccines. However, the idea that peanut oil in vaccines is somehow magically sensitizing children to allergies has no basis in reality. First off, the adjuvant that's most often referenced in all this is a Merck product that was developed in the 1960s, well before the onset of the wave of food allergies. (An adjuvant is an ingredient, most often a metal or  mineral salt, that's added to vaccines as either a preservative or as a "booster" to enhance immune reaction.) Second, any peanut oil used in these situations would be in a highly-purified form that would be extraordinarily unlikely to contain peanut protein residue. Third, a quick perusal of vaccine inserts (I did this years ago, but did it again now just to make sure) does not turn up Merck 65-4 adjuvant or peanut oil in any form that I could find.

There is a philosophical concept called Russell's Teapot: if I want to believe that there is a china teapot orbiting the Earth, the onus is on me to prove my theory. Expressing a theory is not proof. To date, there has been no epidemiological or research link between adjuvants and food allergies. Remember, folks: many of these doctors and researchers are interested in food allergies in the first place because they have a child with food allergies. There is no reason to believe in a grand conspiracy here.

Advocates: before you start spreading this next round of hysteria on your sites, remember that there's a potential negative outcome here. There are babies that will die as a result of people's choices about whether to vaccinate. If you spread it, you own it.

3. Zero tolerance. Strict Avoidance

I am really sick of the conversation about food thresholds. But, I saw this one on an advocate board the other day and it ticked me off all over again.

I worked in the world of medical device during the time latex allergies became prevalent. The FDA at that time attempted a "zero tolerance" initiative for latex. Basically, every component of every machine — even if the components never had potential to come in contact with patients or medical staff — had to be declared. If even one O-ring contained latex, the entire machine was marked "contains latex."

Is this what we want? Do we want products marked for peanut, even if there's no detectable peanut protein? From a practical perspective, that would mean that any food that is ever done in a factory shared at any time with any other peanut products would be suspect. Since the vast majority of lines are shared, that would essentially mean just about everything would be labeled, other than the largest dedicated factories or those who are already catering to us.

We need to live in the real world. We need to understand the nuances of food manufacturing and the limits of testing. Most important, we need to project a willingness to discuss the issues, not just make a declaration, stomp our feet and leave. Why should food manufacturers work with us if we won't work with them, especially when we punish the manufacturers who are honest (and use "may contain" labels) and purchase foods from the manufacturers who don't?

Are there others that bug you? Add them to the comments! 


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What Kind of Father Will You Be?

illustration by Robert Rendo

(click to enlarge)

(Feel free to lift this image and/or article and use it in a free license in your own advocacy material . . . simply provide a byline, nothing more!)



Dr. Burks' Presentation at AAAAI: Related Tweets

So for those of you who are not obsessed with research, this weekend is the annual AAAAI meeting down in San Antonio. A number of immunologists and allergists tweet during the presentations to give those of us who are not lucky enough to attend a glimpse of the presentations.

This morning was Dr. Wesley Burks' highly anticipated talk: Immune Tolerance and Allergy: Can We Produce True Tolerance? Here's what the various tweeters had to say:
Several studies now indicate that food allergy is related to defective T regulatory response” Anne Ellis, M.D ‏@DrAnneEllis
Some studies suggest that when peanut tolerance develops, existing cells do not change, but rather, new populations of cells arise. Peripheral t cell tolerance is key.  Children who have outgrown non IgE-mediated milk allergy demonstrate detectable T regulatory activity. Sakina Bajowala, M.D @allergistmommy
So these are things I've touched on in other columns. Somehow, a child's immune system gets off track when they're first born and develops an immune response that's similar to what the body uses to react to parasites (T2) rather than one that see proteins as harmless (T1).

The $64,000 question is: what, exactly, are these OIT trials (and, by extension, my son's FAHF-2 trial) actually doing? Are they changing the way the body responds? Or are they simply "stretching the balloon" as far as possible, but leaving the maladaptive underlying response intact?

This is important because, if the immune system is really not being changed, then it may be that desensitization and not true tolerance is the best we can hope for.
Allergic individuals form peanut-specific IgE, non-allergic form peanut specific IgG - IgG is a Normal response to a foreign protein. True Peanut allergic patients - their peanut specific IgE continues to rise with ongoing avoidance. Anne Ellis, M.D ‏@DrAnneEllis
Peanut OIT changes antigen specific Tregs and suppresses Th2 response to peanut. Sakina Bajowala, M.D ‏@allergistmommy

So it does appear that these studies are doing something to really change the immune system. That's positive, as there's more hope for true tolerance. It's also important to note that this idea of waiting for IgE levels to fall may not really be the signal for tolerance, as levels generally continue to rise as long as peanut is being avoided. How do the current studies do with regard to inducing desensitization?Assuming it works, how long does it last? Who does it work for?
Burks' studies: OIT for peanut lead to passing a 5000mg challenge while SLIT was only 1000mg. Participants in OIT trials-only 25% passed an oral challenge 4 weeks post treatment discontinuation c/w 75% while still on treatment. Anne Ellis, M.D ‏@DrAnneEllis
41% pts appear to be tolerant after 1-3 years of peanut immunotherapy Matthew Bowdish, M.D ‏@MatthewBowdish
Burks: Peanut OIT - those who developed tolerance had lower baseline PN IgE than those who did not. Dr Melinda Rathkopf ‏@mrathkopf
So there does seem to be a difference in the kids who will respond to the therapy and those who won't. Longer therapy is better. More direct therapy (OIT) works better than smaller doses (SLIT). And, it appears to last for 4 out of 10 kids if it's kept up over time. However, Burks' assessment of all this is:
Critical gaps in OIT/SLIT for food mean its not ready for routine clinical use. David Fischer, MD ‏@IgECPD
A future question to be answered: would starting with younger kids who presumably have more malleable immune systems improve the response? In order to find out:
Impact peanut study. 2000mg maintenance dose for 4 years. Multicenter study. Sakina Bajowala, M.D ‏@allergistmommy
W Burks announces IMPACT study targeting 140 children under 4 with  to peanut.  @WayneShreffler
Burks' next study "Impact" - peanut allergic kids aged 1- 4 to see if OIT will be more likely to induce tolerance if started earlier. Anne Ellis, M.D ‏@DrAnneEllis
So...something to be on the lookout for if you have a child under the age of four and are just starting out on this fun journey.

What a wonderful glimpse into the #AAAAI world!  I am very grateful to these tweeters for sharing these conferences as they occur.

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Friday, February 22, 2013

Dandelion Heralds Spring

First dandelion flower of the season, spring is on its way!
Being blessed with our climate, this time of the year still allows us an opportunity to grow a lot of food. I've covered some of the purposeful plants we're growing, but what about all the goodies we're growing but not necessarily meaning to grow?  This includes things frequently termed "weeds."  Now technically a weed is just a plant that is growing somewhere you don't want it to grow, but many plants are known as rather notorious "weeds."  Dandelions, for example, inspire a lot of people to head out into their yard with death and destruction on their minds, but dandelions are stellar little plants with a change of perspective.  For one, they're quite tasty in a variety of ways.  For those of you who know me, you know I love most things (especially wild things) that are edible.  Well with dandelions, you can eat the root, shoot and flowers.  Dry and roast the roots for a tasty tea.  Eat the young leaves in salad or stir fry (a great bitter, excellent for digestion).  Dandelion flower fritters or flower petal jelly or wine anyone?  Ok, so most people know dandelions are edible, but did you know that nice long taproot is great at pulling up minerals from the soil depths?  Chopping the green tops off your dandelions and letting them decompose in place helps release those nutrients back into your soil, right at the surface where most garden annuals (being short rooted) need it.

Two weeks ago I saw my first dandelion flower out at the garden.  Lovely. It was a great reminder that spring is coming and the full on garden season is on its way.  Until that point though, there are plenty of "volunteer" edibles growing at the garden right now.  You just need a little change of perspective to see many of those "weeds" as wonderful food and free labor in your garden.


Abby's Poem to Tommy Whitelaw

Tommy are you listening, i cant say i understand, 
But i am here, and i am willing, 
so penny for your thoughts?
C'mon Tommy, pick yourself up theres no time for feeling down, 
Your doin ok, and you shouldn't worry, 
Your doing your ol' ma proud.
The small things your doin everyday, 
are brining hope to peoples lives, 
so when your feeling down and in doubt, 
just keep that in your mind

The things that you's faced, all on your own
Send a shiver right up my spine, 
And i gotta tell you one more time, 
Mate, your doing fine.
You told us stories about your ma, 
And God she sounds like a doll, 
A hardworking lady who loved her kids, 
And was madly deeply in love.

Tommy i know cause you told us so, 
The way the story goes, 
The newspaper clippings and scribbled writings, 
To remind her who she was.
That hardworking lady cant remember a thing, 
even the man she loved so true, 
But no 'what ifs' Tommy cause your ol' ma, 
is living and shinning through you.

We have let you down, and your ma, 
and that makes me hell of a sad, 
But Tommy you have spoken to me, 
And i will do all i can.

Tommy your the voice, for all those like you, 
who have also been let down, 
A voice of justice, a voice of reason, 
That together can shout so loud.
You struck a chord in me that day, 
And inspired me in so many ways, 
Don't let the b#####ds get you down Tommy, 
Cause i promise your doing great.
That wedding dress that Joan made, 
Oh Tommy it was a beauty!
so you get out there
And never give up, 
And share with the world, 
Joan and Your Story!

Tommy Whitelaw Talks to 1st & 3rd Year Mental Health Students





Student tweets in response:
Listening to  in a seminar.Hard hitting real life story about carers&their families. Puts things into perspective.

@tommyNtour crying at your talk. Sad but inspirational !

Your story was heartbreaking & inspiring! @tommyNtour Relate 2 u in many ways as carer at home! carers need a voice like u!#gcucarersvoice

@GCUMentalHealth @tommyNtour Had a seminar this morning that I feel will change the course and attitude of our students forever.

What ive learnt today is that its time to step up our game as students. We affect real people & its up to us how we do that. #gcucarersvoice

@tommyNtour absolute inspiration, such a heartbreaking story told so eloquently. you should be so proud of your work and am sure Joan is too

Monday, February 18, 2013

Run for Your Life!


illustration by Robert Rendo

(click to enlarge)

(Feel free to lift this image and/or article and use it in a free license in your own advocacy material . . . simply provide a byline, nothing more!)








How Come No One Paid Me to Blog About Auvi-Q?

The lady was a tramp...
Oh, Sanofi.

I'm so disappointed. I hear from my peeps that you flew a bunch of bloggers out to your headquarters, paid for their trip, wined and dined them...just so they'd have the opportunity to review your Auvi-QTM epinephrine injector.

Now I know what Mary Boleyn must have felt like, after giving it away to King Henry for free. Her sister held out for the Queenship and, sure enough, the king bought the Royal Cow in the end. (Of course, that story ended rather badly...but I'm sure the bloggers all got home safely with their virtue mostly intact.)

Maybe you didn't invite me because you knew I had already done my part to review the Auvi-Q. (Milk...cow...free...back in August, for heaven's sake!) Maybe you didn't invite me because I don't have enough readers.

Maybe you didn't invite me because of the (shhh!!!) bitch in my name.

But see? That's exactly why I've kept the BITCH in my name, despite it being offensive to some people. It reminds me, every single day, that I'm not out to make a buck, or a name for myself. I started this column because I was simply frustrated, and the day I start pandering to corporate overlords is the day I really want to stop writing. (That's what my day job is for.) The "bitch" stops me in my tracks before I start lobbying for FARE advocacy awards. It keeps me from taking myself too seriously.

Not that your funding the bloggers' trips influenced them in any way. I'm sure it didn't. Really.

If you had flown me out, I would have told you that, for the most part, I do like it. I think my son will like it. Smaller is definitely better (not that Mary Boleyn would agree).

But — and I admit this is petty — the name is pretty stupid. "U" and "V" are just not letters that naturally go together. I keep calling this thing an "Audi-Q"...and when I search on it that way, you know what I get.


So, yeah, could have spent a little more money with the branding agency to come up with something that doesn't make me think of cool sports cars or jr. high audio-video equipment.

I also think it's tough to figure out how to carry that second dose of epinephrine. Cell phone in one back pocket, first-dose Auvi-Q in another pocket...where does the second dose go? But again, that's pretty petty.

I also think the woman who does the voiceover ar-ti-cu-lates in an an-noy-ing- way. (Petty again.)

Less petty, though, is my fear of medical device failure. The Epi-Pen is a tried and true device with 25 years of history behind it. I hope the Auvi-Q does equally well when it comes to consistently working when called on...but I'll feel better once it has a track record. Until then, I'll probably ask my son to carry both devices.

Which sort of defeats the purpose.

If you had flown me out to meet, what I most would have wanted to tell you is that people who read my blog (or ANY of the blogs where you - um - encouraged positive product reviews with your generosity) are already using auto injectors. You're preaching to the choir. I guess it's good to take market share from Mylan if you can, but it would be better to simply get more people to carry epinephrine.


Perhaps you already read my column about Slacker Moms (and Mylan's "let them eat cake" product positioning failure ) since now you're apparently getting sued by Mylan for claiming that 2/3rds of the people who should carry epinephrine simply don't. That's great that you're aware of the issue. But, as I said back in August, a cooler device and audio instructions aren't going to be the way into these people's hearts. (And Mylan...really? Meow!)

So, it's probably good you didn't blow all that money to fly me out, because I would have told you something you already knew: the concept of carrying emergency epinephrine is a tough sell. Too many people are willing to play the odds that lightning simply won't strike them.

I think it's great that we have another emergency option. But I can't help wondering what the world would look like if we had poured the money it took to develop and market this new device into research to simply cure this sucker.

It's not a zero-sum game, I know. But I just can't help but think that the $10k you guys probably spent to fly out eight or ten bloggers, just to reach people who are already on-board, is a conspicuous reminder of how much profit is at stake here.

Forgive me for hoping a cure will some day completely dry up your market.


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Sunday, February 17, 2013

Why Food Allergy Parents Won't Use Thresholds

So apparently I woke the Tiger Allergy Moms with the "peanut is probably already in your food" blog post.

As I said in my follow-up post about food allergy cross contamination, I really didn't even realize this was controversial...or not common knowledge. After all, the study I cited (that showed 5% contamination with may-contain products and 2% contamination with products that had no label at all) was sponsored by FAAN (now FARE), overseen by Dr. Sicherer and carried out by FAARP, all cornerstones in our little food allergy castle.

However, poke a Tiger Allergy Mom and you're likely to get scratched. The blog post vaulted into my Top 5 for traffic and generated the longest comments exchange yet. I've puzzled over why this is and the conclusion that I've reached is that I unintentionally took away the Blue Ribbon for Total Avoidance. By saying that people were eating peanut they didn't know about, I was somehow apparently also saying their child's food allergy was not as serious. Here's the logic that I think is at work:

If lower threshold = more allergic

     and 

More allergic kid = need for stricter avoidance of foods

     then 

Not strictly avoiding foods means, by extension, that a child's allergy is less serious

I do understand this logic to a degree, since lower thresholds are often associated with more severe reactions. But — since most of us don't have any idea what our child's threshold is, we use our level of avoidance of allergenic foods to signal to others the severity of our child's allergy. After all, if your child is really allergic, super allergic, most allergic, truly allergic, then it's really important to avoid everything. Even microscopic exposures. Right? And if you haven't been avoiding those exposures (due to mislabeled foods), then your child is probably not as allergic...and you're somehow not as good a mom. Blue ribbon denied.

I didn't actually mean to stir this all up with my post, but it points out an important issue here: the logical approach of FARE and the FDA is in direct conflict with the emotional approach of FA parents.

The unintentional consequence of FALPCA was more food labeling, but not necessarily more helpful food labeling. I have commented before on our post-FALPCA experience of having roughly a quarter of all the processed foods we used suddenly sprout new warning labels. These were foods we had used for years in many cases (and called about in most cases). When we called again to talk to manufacturers, we were told that the food formulas had not been changed at all, but that warning labels had been added to give the most information possible.(In many cases, we suspected it was simply CYA, as some companies put the same, comprehensive warning labels on every food they made.) What were we to do? We dropped the foods, and our son's options were instantly far more restricted.

This is the concern manufacturers have with putting quantitative allergen levels on manufactured foods. If they start labeling, we will start avoiding, even if those foods have been safely eaten up until this point. Why would they willingly restrict their consumer base, especially when these foods are being (for the most part) safely consumed today? Why rock the boat?

FARE and the FDA have been studying the issue of food thresholds to see if there's a better way to report out the amount of allergen in foods than cautionary labels. There is also a lot of work going on right now to determine the distribution of thresholds using both direct research and probabilistic methods. Researchers know that there is a distribution of dose responses to allergens, and that only about 10% of allergic consumers (called the ED10 in industry speak) will react to levels at or below 12 mg, or about 1/25th of a peanut.

There's another important concept that doctors and researchers accept: dose response. The concept here is that there is the start of a reaction where mild symptoms occur and a tipping point where more serious symptoms occur. The ED10 is higher for reactions that cause objective symptoms — things a doctor can actually see happening — vs. those funny sensations in the mouth or throat, or a stomachache. (Hence, the question on the survey about "would you eat a food that would cause only mild symptoms.")

The bottom line, though, is that all this new labeling and data will be useless if food-allergic consumers refuse to use it. Since the last missing piece of the puzzle is a food challenge to determine a child's actual threshold level, and the vast majority of parents will not want to have their child undergo a food challenge, there's going to be limited value to measuring allergens. Without that actual, objective data, food-allergic kids can all continue to be like the children of Lake Wobegon where every child is above average (or, in this case, highly allergic due to a microscopic threshold).

I think many of us parents really don't want to know, as we think quantifying our child's allergy will somehow create a stratification of "really allergic", "somewhat allergic", etc. It's the same resistance I perceived when I talked about the fear associated with component resolved food allergy testing.

I'm not saying this is easy, or cut and dried. But I do think more information is generally better. I hate to see a situation where both food manufacturers and parents of allergic kids really don't want to give – or get – more information. Is ignorance really bliss?


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Wednesday, February 13, 2013

Vice or Virtue?

  

illustration by Robert Rendo

(click to enlarge)

(Feel free to lift this image and/or article and use it in a free license in your own advocacy material . . . simply provide a byline, nothing more!)

We already know the undemocratic consequences of corporate style reforms to public education. We've been living it since NCLB, and now we're attempting to machete our way through its steroid filled cousin, Race to the Top.   

Most of this reform mischaracterizes teachers, bullying them in a false, destructive light. Yet, there is this very tangible realm of protest, questioning, lobbying, and the still functional "write-a-letter-or-pick-up-the-phone-and-tell-your elected-official" strategy that are beginning to light a few key matches in a very parched forest. 

But, really, in all of these slowly burning fuses that stand to potentially burn down privatizing interests, how much voice is reported from a child's point of view? 

Children . . . . remember them? The ones who have among the highest stakes and the weakest voices. The ones whose verbal and body language increasingly spell out stress, anxiety, uncertainty, and a sort of pediatric angst that most children in other modern countries can only dream of or rarely encounter. 

Just as media outlets like Disney and Nickelodeon feature programs where children voice themselves on consumer issues, what media forum really showcases children and what they're experiencing under this whole reform movement? If minors lack autonomy, where at least is their voice, their perceptions, and the articulation of their own self image?

Mainstream media is completely indifferent. Surprise! But what about alternative, off the grid media?

If your students, pre-K through 12th grade, could be interviewed with the same intimacy Oprah approaches Lance Armstrong or the same grace and seriousness Barbara Walters uses with her taffy headed celebrities, what would your students say about how they feel about what and how they are learning? I often wonder about the kind of words that would flow out of those non-adult mouths?

Leslie Stahl of 60 Minutes, Amy Goodman of Democracy Now, the War and Peace Report, and Bill Moyers of PBS . . . . are you listening?

1st Year GCU MH Nursing Student Abby's Stigma Poetry


Anti-discrimination film made by 1st Year GCU Mental Health Nursing Students


Sunday, February 10, 2013

Winter Disbelief

People wandering by SAGE this time of year are always curious, "what are you doing?"  Despite having my boots on, harvesting tool in hand and a big tub filling with greens, people seem to want verbal confirmation that I'm doing what they're observations suggest; harvesting.  I can have rows and rows of kale around me and still people say "kale can last in the winter?"  Yes, it does and it is so easy to grow, you can do it too!

I've been pondering this phenomenon (because it happens to me multiple times a week) and I think, perhaps, people need verbal confirmation of my actions because it is winter and they don't associate that season with gardening.  Yes, we can grow food year round here and I consider us Willamette Valley folks pretty lucky for that.  If you need to see it with your own eyes though, here's some recent photos of the bounty (some, but not all the goodies) we're growing right now.  If still you'd like to see this in person, head on out to SAGE and wander around, you're more than welcome.
                        






Saturday, February 9, 2013

Congrats! Your Child Passed a Baked Milk Challenge!

Clueless. Get it?
Now what?

I get a lot of questions about baked milk dosing: how much, how long to bake, what foods to start with, what order to give them. It's such a helpless feeling to have to say "I don't know" most of the time.

We are back to doing milk dosing, but things have been a bit haphazard in our house. We try to do the milk dosing right after school so there's time to deal with reactions if we have to. However, I have also recently started an on-site job and my son works most weekends, so it's been difficult to find the time.

About a week ago, I gave him his dose (individual rice puddings baked 50 minutes; approx. 1.5 oz. milk in each, or ~1.5 g protein), only to realize that I was signed up to drive car pool that day and had to leave! A frantic call to my husband, followed by him abandoning his work day to drive home, and at least we were covered. However, this is clearly going to get harder and harder for us to do, so I encourage all of you with younger children (and hopefully stay-at-home schedules) to not wait to pursue this until just before college.

Anyway, the point of this post is to summarize a really great article from AINotes about food challenges and baked milk dosing. Here are the recommendations from Mt. Sinai for challenges/food introductions:

  • During the food challenge, give a muffin containing 1.3 g of milk protein (nonfat dry milk powder; Nestle Carnation) baked at 350 F for 30 min.
  • If muffin tolerated, challenged same day (2 hours after muffin) with waffle (<0.625 inches thick to ensure thorough heating), containing 1.3 g of milk protein (nonfat dry milk powder; Nestle Carnation) cooked in a waffle maker at ~500 F for 3 min.
  • If muffin/waffle tolerated, challenged 6 months later to Amy’s cheese pizza (Amy’s Kitchen, Inc), containing 4.6 g of milk protein, baked at 425 F for 13 min or longer.
  • Muffin, waffle, and pizza were administered in 4 equal portions over 1 hour. Subjects were monitored throughout and for 2-4 hours after completion of the challenge.
If the challenge is successful, patients are instructed to ingest 1-3 servings of foods containing milk every day:
  • Store-bought baked products (cookies, breads, bagels) with egg/milk listed as the 3rd ingredient or further down the list of ingredients.
  • Home-baked products that have 1 egg (or 1 cup milk) per 1 cup of flour or 1-2 eggs (or 1 cup milk) per batch of a recipe (yield 6 servings). If you offer home baked products, feed 1 serving at a time with at least 2 hours between servings.
  • Avoid products that do not qualify as baked egg: french toast, scrambled eggs, custard, etc.
There is a special note at the end indicating that, at least in one study, up to 8% of kids who passed a peanut challenge can have a recurrence of the allergy. This may be true of milk and egg as well, especially when these proteins are given in different forms (cheese vs. milk, for example). 

In our case, we've found our son can tolerate virtually any type of baked milk without a problem, baked butter in most instances, and very little baked cheese. This probably makes sense, as the amount of milk protein in cheese is proportionally higher than in liquid milk (which is only about 3% protein). But, the takeaway message is that you do have to be prepared for reactions as you work through this process.

At the very beginning of this article (Table 10:2), there's a note about how often food challenges for milk should be done. I was extremely surprised to see that the recommendation is to test every 12 months, barring history of an anaphylactic episode in that calendar year. By that measure, my son should have been tested for baked milk every year, starting after about age 8 (his last anaphylactic reaction to milk that I remember was around first grade). 

It's a shame that we waited until his late teen years to pursue this. It may not have happened even then, if our allergist's practice had not added a new doctor who had participated in the oral tolerance trial research. I'm heartsick that my son has been so restricted all through his teen years when a simple food challenge might have opened up so many more doors. 

SAFETY NOTE: please remember that I am talking about introducing baked milk only AFTER a child has passed an oral food challenge supervised by an allergist. This is NOT a do-it-yourself project. 

That said, I more than encourage any of you with grade-school-age kids to pursue this and press your allergist hard for challenges. Show them the chart. Show them the protocol. There's a brave new world out there! 


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Friday, February 8, 2013

We Still Have Factories




illustration by Robert Rendo



(click image to enlarge)







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