‘It’s worth everything’ | health beat
On May 22, 2022, the Tomaszewski family planned to kick off summer by splashing around in their pool with friends.
Instead, they found themselves in Helen DeVos Children’s Hospital of Corewell Health in the emergency room with their eldest daughter, Claire “Gigi” Tomaszewski, who suffered a severe anaphylactic reaction.
The culprit: a nut hidden in a brownie.
Now the family is eager to share the lessons they learned that day and express their gratitude for Erica Michiels, MDthe pediatric ER doctor who treated Gigi.
“Dr. Michiels is a hero,” said Jane Tomaszewski, Gigi’s mother. “She literally saved my daughter’s life. If she hadn’t stepped in and recognized the care she needed, we would have had a much more terrible result.
The Tomaszewskis, who live in Ada, Michigan, knew that Gigi, now 7, had an allergy to nuts and pecans.
But his previous reactions had been mild.
When she was 2 years old, Gigi ate a layer of butter pecan ice cream, which made her cough and cry. Benadryl alleviated her symptoms. Another time, Gigi broke into hives after eating ham that touched nuts on a charcuterie board.
They were worried, so they took her to an allergist. Allergy tests revealed the allergy to nuts and pecans, so they eliminated those items from his diet and started taking the doctors prescribed epinephrine, in the form of a epinephrine auto-injector.
This is a medical device used to quickly deliver epinephrine in the event of a severe allergic reaction, called anaphylaxis.
They never used it – until May Day.
“She was in shock”
Jane said some friends they invited to the pool brought brownies that had nuts in them, not knowing Gigi had an allergy. Gigi ate a few bites of her brownie and immediately knew something was wrong.
She said her mouth was itchy, so Jane went to get Benadryl. As she searched for the correct dosage, Gigi’s condition worsened. She broke out with hives and vomited, then started vomiting blood.
Jane called her husband, Dan, and together they administered epinephrine to Gigi, injecting it into her thigh as prescribed.
“We’ve never done this before,” Jane said. “We thought, ‘Isn’t she supposed to get better? How long does it take to work? »
As it was Sunday afternoon, they called their pediatrician’s on-call service and then went to the emergency room.
They piled into the car as fast as they could, still dressed in their bathing suits.
“Gigi was barely lucid and flabby,” Jane said. “I held her in the back seat because we couldn’t put her in the car seat. We were just laying it down there.
At emergency care, a medical assistant immediately called 911. An ambulance transported Gigi to the emergency department of Helen DeVos Children’s Hospital.
Shortly after they arrived, Dr. Michiels entered the room. She knew about Gigi, as paramedics from the ambulance had called on their way to the children’s hospital.
Dr. Michiels was very concerned by what she saw: Gigi’s skin was bright red. Even more alarming, his face, hands and feet were blue.
“She suffered from circulatory collapse due to anaphylaxis,” Dr Michiels said. “She was in shock.”
Dr. Michiels immediately prescribed another dose of epinephrine.
After that, Gigi needed even more. The doctor put Gigi on a continuous intravenous drip of epinephrine, something she’s only needed to do a few times in her entire career.
“She had a severe and persistent case of anaphylaxis that was resistant to standard treatments,” Dr Michiels said. “Usually children respond immediately to that first shot of epinephrine. It’s kind of like a miracle. But Gigi needed a continuous infusion of epinephrine to change that for her.
Anaphylaxis has many symptoms: hives and itching, low blood pressure, weak and rapid pulse, nausea, vomiting, dizziness, fainting and more, Dr. Michiels said.
But perhaps the most well-known symptom is the swelling of the airways, causing coughing, wheezing and difficulty breathing. Gigi was experiencing other serious symptoms, but not this one.
“What terrifies people the most, and rightly so, is that the airways will swell,” she said. “Because Gigi was alert, she was talking with us and her airway was OK. It gave people a little sense of security. »
A big advantage for Gigi: she was in an emergency department that treats children.
“Kids don’t tell you what’s going on,” Dr. Michiels said. “I have the experience of looking at a child and knowing that something is wrong. It takes time, experience, and repeated exposure to what a small child in shock looks like.
She explained that children often compensate better than adults because, in general, they have healthy hearts.
“Kids hang on until they don’t,” she said. “They look better for longer than the adults, until they fall off a cliff. Gigi was heading for the cliff, but she was compensating very well.
Once the care team stabilized Gigi in the emergency department, Dr. Michiels transferred her to the pediatric intensive care unit for 24 hours for further treatment and monitoring.
She visited Jane, Dan, and Gigi later that night.
Dr Michiels said she will always remember the look on Dan’s face as they talked about what Gigi had been through.
“I could see in his eyes that he realized he almost lost Gigi that day, but he didn’t,” Dr Michiels said. “It’s one of those things I’ll never forget.”
Jane hopes other parents can learn from their experience.
“I was totally underprepared,” Jane said. “I knew she was allergic and we had an EpiPen. But I didn’t realize that when you give the EpiPen it gets consumed quickly in the body and she might need more.
Since then, the family has made changes.
Under the care of Amanda Holsworth, DOan allergist with Helen DeVos Children’s Hospital Allergy and Immunologyand her partners in practice, Gigi underwent updated allergy testing.
This confirmed that she is allergic to nuts and pecans. They chose to completely eliminate all nuts from Gigi’s diet.
Dr. Holsworth is thrilled to see Gigi and her family handling everything so well.
“They do a wonderful job,” she said. “They are very vigilant. Gigi is so responsible and asks great questions. She is so bright and she is doing an amazing job, for her 7th birthday, in managing her food allergy. »
‘And now we know’
During a recent visit, Dr Holsworth said he discussed potential therapies that would hopefully reduce the severity of Gigi’s reaction if she suffered another accidental ingestion.
Jane said they told everyone they knew the severity of Gigi’s allergy.
“We weren’t so careful,” Jane said. “And now we know.”
They take far more precautions at home and in public.
For example, on a trip south to Georgia and Florida, where pecans are very common, Gigi wanted pancakes or waffles for breakfast one morning. At the first restaurant they went to, they learned that pecans are regularly cooked on the griddle.
So they headed to another restaurant, where they learned the same thing. They ended up in a fast food restaurant where there were no nuts.
“It’s a risk we’re just not prepared to take,” Jane said.
At school, where Gigi is in second grade, she now sits at a nut-free table for lunch. She has an epinephrine auto-injector in the school desk, as well as in her backpack and with her at all times. She even carries it a short distance down the hall to the dining room.
“She said, ‘I like having him around,'” Jane said. “She understands that she’s been through a really, really difficult thing.”
They dealt with it after that day, as Gigi could.
“At one point, a few days after the incident, Gigi said, ‘Mom, everything was purple. When were we in the car on our way to emergency care, everything was purple. The sky, the trees were purple,” Jane said.
“It’s something really special”
Both Dr Michiels and Dr Holsworth urged families who have been prescribed an epinephrine auto-injector to make sure they always have it and to use it if needed.
“Families are afraid to use it,” Dr. Michiels said. “If you think you should give it, you should give it. There is no downside. It won’t hurt them. The greatest evil is not to give it away.
Then dial 911 or quickly go to the emergency department.
After giving the epinephrine, if the patient does not improve, Dr. Holsworth said, you can give the second dose.
Two auto-injectors are provided with each prescription and they should always be kept together. The second can also be useful if something goes wrong in the administration of the first.
Dr Holsworth said patients should be seen by a medical professional even if epinephrine appears to be working.
Both doctors reminded families that allergic reactions can change over time.
“Past reactions are unfortunately not predictive of future reactions. It can be a good thing or a bad thing,” Dr. Holsworth said.
If an initial reaction was severe, it does not mean that other reactions will be as severe. On the other hand, a previously mild reaction may falsely reassure families that their child will not have a severe reaction.
“Any reaction can, by definition, be serious and life-threatening,” Dr Holsworth said. “That’s why you have to have epinephrine.”
Appropriate actions are outlined in a plan created by a child’s allergist, called a food allergy and anaphylaxis emergency care plan. Dr. Holsworth urges families to familiarize themselves with her and ask questions during appointments.
After their experience, the Tomaszewskis wrote Dr. Michiels a thank you note, handwritten on a card featuring Gigi’s artwork.
The doctor keeps it hanging above his home office, next to photos of his family.
“It’s worth everything. It has a special place in my office,” Dr. Michiels said. “It’s a good reminder, especially in emergency medicine. We meet families on the worst day of their lives. It’s a beautiful reminder to watch and know that there’s not just someone who appreciates what I’ve done, but a little life in the world that I’ve contributed to.
It’s one of the greatest rewards of working in pediatrics, she says.
“Knowing that there is this little girl who has her whole life ahead of her because our team was there that day to care for her,” Dr Michiels said. “Who knows what she will grow up and do and be in the world. It’s something really special.