Kara: Well, welcome back to part two of our Back to School Series where we are diving into everything from school forms and 504 plans to how to best work with your allergy immunology doc. And today we are hitting off part two, so if you missed part one, you can go back and listen to that and then come right back here to listen to part two. But I am joined by my esteemed colleagues and bff's, Dr. Amber Patterson and Dr. Meagan Shepherd. 


The 'Perfect Storm': Why Asthma Flares at the Start of School
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Kara: But let's dig back in. Why is it that it's so important for our allergy and especially our asthma patients to plan ahead when it comes to the school year?  

Meagan: Well, one of the things is that, for me, both the school year, start of the school year coincides with, and this is in particular for asthmatics. And aside from being a parent who's sending your kid off into the unknown, away from you with a new teacher and all of that but it is the start of cough and cold season and it is usually right whenever weed season is starting and molds are starting to kick up. And so for asthma in particular, it's, it's a, it's a bad few weeks. We talk about the, the peak week that we've been mentioning several times recently, and that is September, the third week in September. And you know, during that time, we have so much pollen so much stuff in the air. You just have a ton of asthma exacerbations.

And so it's so important to make sure that your kid is prepared for that at school, that they already have their inhaler, they might be needing it for when they're on the playground. We might need to write in their forms just to remember that the school could go ahead and start it whenever they get snotty. Like we talked about before, a lot of kids, their asthma starts with snot first, and so getting that on board before they get very bad it just keeps you from having to chase your tail whenever it comes to asthma treatment.

Kara: There's this saying my parents used to always say, and it's a common saying that an ounce of prevention is really worth a pound of cure. And so if we can, like, stay in that routine or develop a better routine to help keep those symptoms at bay, especially if oh gosh, well last September, Frankie had an exacerbation and oh gosh, look at the insurance statements that happened this September before that too. If you know those patterns, then like, let's get ahead of it.

Amber: Yeah, and I was going to say, we've talked a lot about communicating with the school and the teacher a lot. But also just to point on communicating with your doctor's office to find out what their process is for completing annual med refills, school forms, prior authorizations for any medications, because different offices do it different ways.

At our office, we do all of that together with a patient so that there's some empowerment there, the patients understand the process and what's needed. And so, our cheat code has been that we tell patients, if you're used to doing your annual follow-up for all of these medications and school notes in August, let's kick it back. 


Proactive Planning: How to Work with Your Doctor's Office
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Amber: Let's do it in March or February when we are slower, because all of that lasts a year. And if we can take a time where maybe we have more time to sit with you and walk through all this. And then you have what you need for next school year. And then if, if asthma-geddon hits, we're getting into August and pollen's out, going back to school, getting colds, getting asthma flares, and you need to see us because of a sick visit, then we've got time to do that instead of trying to squeeze in, "Oh, I also don't feel well and need my regular, like, mountain of stuff done."

Kara: Yes. All yes. 


Don't Forget the Spacer! Essential School Supplies
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Meagan: One of the things that just struck me too is we talked about getting extra inhalers and extra epinephrine autoinjectors, but one of the things if your kid has asthma, they're also going to need an extra spacer for their inhaler because I always recommend if you have an aerosolized asthma inhaler, so not a powder coming out, that you always need to use that with a spacer, whether you are a child or a grownup. That's, that's one of my big mantras that you need to use it, but you need to have an extra one to send with them to school so that their medicine is as effective when they get it at school as it is at home.

And so, those used to be sort of available only with prescription, at least in our area. You can get them over-the-counter, usually not at local pharmacies. You do have to have a prescription for that still, which is kind of interesting. But you can order them from Amazon for like $20. Sometimes your doctor's office will carry them. So the point is, is that you need to just remember to grab an extra one of those too whenever your kids are getting all of their little back to school medical kits together.


What is a 504 Plan and Does My Child Need One?
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Amber: Let's talk a minute about 504 plans. What is a 504 plan? And which of our patients could maybe benefit from that?

Kara: So I do not consider myself an expert by any stretch. I will say though, we recently went through kind of this through this process with two of my kids. So I have one kiddo who qualifies for an IEP and one who qualifies for a 504. And my understanding is an IEP is a little more in depth. The 504 is a little more streamlined, but it essentially helps provide a written document that the parents our family, the kiddo, the, the teachers, the administration and the district are all kind of on the same page at how we can best support a kiddo in their learning. Especially when they have health or learning challenges that, that and diagnoses that they live with. And so, for, my kiddo, it's for her ADHD. But they, you also qualify for a 504 plan with different health conditions like food allergies, and asthma too.

Amber: And I think another kind of key difference, and I'll also preface, I'm not an expert, but have experience with my own kids and patients that the IEP tends to be more focused on specific educational learning problems or disabilities and how to support that where the 504 is more around another medical problem that either the medical condition or the things you need to treat that are disruptive to the, your child's school learning situation.

So it's things like a 504 might be something like "my child has eczema and when she washes her hands at school using the soap that's at school, her hands flare up so badly that it then is difficult to write". And so, you might have a 504 plan where it is just a written plan that you, the parent, the teacher, the principal have come up with that says, "Okay, any of the classrooms that your child is in, you can bring your own soap. And she, he will be able to use that instead of the school's soap. So things like that even could be part of a 504".

Meagan: That's a really good point. And in our area we have someone who is a semi-retired attorney who does, or at least did in the past, a ton of pro bono work helping families with their 504 plan and sort of explaining what it was and kind of teaching them to fill it out properly or if they had specific questions or felt like their needs weren't being met. It was a wonderful resource. And so I do know when I have kind of honestly Googled it, you know, like we all do. Google 504,

Amber: Yeah.

Meagan: there's a lot of information out there as well about what you can include in your 504 what you need to do to file it. And it typically involves not just going to like the principal at the school, it's going to be a county school board issue or parish, whatever whatever your state system is. But that is something that may be out there as well. You could also just Google in your area to see if there are any attorneys who do some pro bono work on this side. Or with all of the new, I guess teleconnections that we have and online, there could be other people out there that would do pro bono work and help just so that you could have them look over what you're doing just to make sure it looks okay. Especially if you're fighting with the school system to get what you need.

Amber: To initiate the process, that part I think is pretty straightforward. Usually you just you reach out to the school, email the principal, set a meeting, and just make your request for what you think could help your child. But then, yeah, once you get into the nitty gritty of, "Okay, now we're writing up the 504, that's where it may be helpful to have a mentor of sorts or a guide."

Meagan: Right. It's not usual. Oh, go on.

Kara: I was gonna say, I've even heard of some folks using AI like ChatGPT and other tools just to help get the ball rolling and, and thoughts and suggestions on what might be helpful.

Meagan: Yeah, that is actually a really good idea, and I will clarify that the majority of my patients haven't needed to involve an attorney who's doing pro bono work, but I've had some particular cases where there are certain situations that trigger or cause issues with particular patients.

And so whenever they felt like that was not being addressed, that's whenever they would reach out to someone about the 504 plan to ask sort of the legal pathway to go about making sure that, that, that was met or their expectations were changed about what could be done.

Amber: Yeah. And sometimes that, like we mentioned that in the last episode, sometimes that's it. It's just saying, oh, well maybe we could do this a different way. Still meet the child's needs and maybe not be so structured.


'Peak Week' Explained: Ragweed, Mold, Viruses & More
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Amber: So, okay, we talked about 504's. Let's talk more about peak week. Third week in September. What is going on in the environment, in the world around us? What happens that third week of September that causes such a ruckus?

Kara: So, I'm gonna add to what Meagan kind of already talked about earlier, which, we have all the weeds, pollen, ragweed in particular, which is found in like, I think 49 of the 50 states. We also have mold, spores, especially as it gets a little cooler, damper in certain areas. We have all the cold and flu season stuff that's starting to pick up 'cause every everyone's germs are co-mingling again. And then, on top of it, you know, the, the aspect that we haven't talked about is how disruptive the change in schedules are, right?

If you're listening, you probably hear a little change in the energy in our voice, and if you're watching, you can see some of the silliness going on. As our, as our schedules change when we have, sick kiddos like today with this one who's not so sick, who's home or, when we have like that schedule change come back to the school year, it throws off our routines. And so I, I do really wonder and suspect that, that change in routine, missing medication, forgetting refills, what have you really can lend itself, If you're off your controller or you're not doing as well at remembering your controller inhaler, then well, gosh, maybe, you are gonna be at a disadvantage when you catch that cold or you inhale all that pollen. Your sleep probably isn't as great, right? Like those first few weeks back to school. And I don't know about you, but like the school nutrition too, leave something to be desired.

Meagan: There's a lot of athletes, a lot of sports going on during that time period as well. So, as, as my children have gotten, growing up fall was always football season. And then my children all play soccer and in my mind it's transitioned to fall is soccer season. But whatever it is, there are, there are a ton of people out there being in the weather whenever they often aren't through the other parts of the year.

And they're just out there literally like rolling around in the grass on a daily basis. And so they are, they're getting a lot more exposure than they maybe are you know, otherwise. And so that is also playing a role there, I think.

Amber: Mm-hmm. Yep. So it's that combo of allergens in the air, people co-mingling more in inside settings, in the school building, sharing their germs, more active and all of that can trigger allergies, asthma, and cause these pretty significant flares that fill up the ERs, the urgent cares in our offices. So all the work that we try to do earlier in the year, a lot of times is to prevent flares during that time of year.

Kara: It is a perfect storm of all these different factors that really can that tip the scales, know, outside of our favor.

Amber: Mm-hmm.

Kara: Well, I think we've hit all the things we were thinking about with Back to School, but I would love to continue this conversation in the comments. I'm sure that those families, those parents, those caregivers, maybe even some of the older kids that are tuning in and listening, they have their own struggles or questions or things, we'd love to hear from you and, and continue to workshop.

How can we best support each other and support everyone through this, this, this year after year, the Back to School shuffle. So until next episode, this is 

Allergy, Actually.

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