Okay, this is really just sort of ancillary-- we have a 504 review planned and the counselor (who is brand new on the job, and I don't think has much experience with FA or other chronic medical conditions as a basis for being a QID) decided that the allergist's letter was "dated."
Well, fine. We needed to get something current for the College Board anyway. (They prefer documentation which is within the same year as the first planned exam).
So we are getting an updated magic letter from Dr. Awesome for our 504 team and the school, too-- (Please note that this is the ADOLESCENT version of this document, which is admittedly a complete and total, no-wiggle-room-allowed, no-holds-barred, SLEDGEHAMMER of a document in support of 504 eligibility.)
My profound and eternal thanks to GailW and her DD for letting me see and tweak their original into this eventual form. I'll
forever be paying that debt forward. Truly.
(DATE)
To Whom It May Concern:
I have been asked by {CM DD}'s parents to provide medical information regarding {DD}’s allergies. I understand that you need specific and current information that will be used to determine whether or not {DD} meets the criteria for disability under Section 504 of the Rehabilitation Act of 1973 (ADA and ADAA of 2008). I believe that {DD} qualifies for this designation based upon her diagnosis and clinical history of life-threatening (anaphylactic) food allergy.
Anaphylaxis is defined as a systemic allergic reaction which may cause death or permanent disability. At least 150 people die each year in the United States due to anaphylactic reactions to foods, most commonly to peanuts. Below, I briefly describe the body systems affected during anaphylaxis:
Systems and Symptoms:Skin and subcutaneous tissues: flushing, mouth itching and swelling of the lips, tongue, or mouth, and/or hives.
Gastrointestinal system: nausea, abdominal cramps, vomiting and diarrhea (if severe, can cause intravascular volume depletion and shock).
Respiratory system: sense of tightness/itching in the throat, hoarseness due to edema of the larynx (may close the airway), hacking cough, shortness of breath, and/or wheezing.
Cardiovascular system: “thready” pulse, decreased cardiac function, decrease in blood pressure which may lead to dizziness, loss of consciousness, shock, and possible cardiac arrest. {DD} has required emergent medical care for anaphylaxis on more than one occasion. She has a history of rapidly progressing anaphylaxis involving the skin, gastrointestinal, respiratory, and cardiovascular systems. Due to this reaction history {DD} is at elevated risk for fatal anaphylaxis.
{DD} was diagnosed with life-threatening food allergies at 11 months, following emergency medical care for peanut-induced anaphylaxis. Since that time, she has also been diagnosed with life-threatening allergies to eggs and several tree nuts (almond, pistachio, cashew, etc.). She has a clinical history of reactivity to ingestion of microscopic quantities of allergens, contact with allergens, and inhalation of allergens. Some reactions have been atypically-presenting (without airway or skin features) and therefore very challenging to correctly identify in a timely fashion. Possible anaphylaxis symptoms must be treated as a medical emergency.
For the purposes of a Section 504 designation, I attest that {DD}’s medical condition substantially and significantly affects the life functions of caring for herself, normal immune function, and eating. Anaphylaxis can, when active, also substantially and significantly limit the life functions of breathing, talking, walking, normal cardiovascular function, thinking and performing manual tasks, among others.
There is no cure for food anaphylaxis. Unlike other allergies for which treatment options include medications or immunotherapy (allergy shots), presently all such treatments for food allergy are considered investigational and high-risk. There is no such approved treatment or device that can act as a mitigating measure for those who are anaphylactic to foods. Regular maintenance medications do not eliminate the need to practice avoidance, nor does epinephrine or any other rescue medication or device necessarily resolve anaphylaxis or eliminate the need to seek additional emergent care. Death or permanent disability is a possible outcome any time anaphylaxis is triggered. Peanut is of particular concern since triggering doses may be very small and too variable to be reliably determined for an individual. Therefore, total avoidance of allergenic foods is imperative.
Avoidance of all contact with food allergens (peanut, egg, and tree nuts) is the only way to avoid a potentially life-threatening allergic reaction. Such avoidance is a highly complex task requiring excellent judgment and social skills, particularly when needs place a person in conflict with a peer group. This is difficult for adolescents, whose executive skills are not yet mature and who may take unacceptably large risks or even hide/dismiss emergent symptoms in order to gain social acceptance with peers. Adolescents must be strongly encouraged to advocate assertively for their needs as appropriate and guided toward good management decisions as they assume the responsibility for their food allergies.
Successful avoidance requires a comprehensive written accommodation plan in consultation with the patient, parents, and physician. I consider {DD}’s parents; CM DH, Ph.D., and CM Ph.D., to be knowledgeable about the successful management of their daughter’s medical condition.
Sincerely,
Awesome Person, M.D.
{additional fancy qualifications as he sees fit}
Obviously, there are significant elements there which include my daughter's specific allergens and her specific history. It's probably also true that mentioning one's own qualifications is probably not necessary, but if you
have a terminal degree, (particularly an MD or PhD) it probably doesn't hurt to put it out there since you're basically having the physician say that you are "EXPERTS" yourselves.
I've found that it can garner some street cred when it's sorely needed (as in negotiations with school staff over something that they don't feel like doing).
I'll post the original elementary aged one up in resources tomorrow.