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Re: [IPp] First week of school & @#$#$#@^%#@ Nurses!

Dear Barbara,

You are right.  All of this sounds like a lack of education on behalf of
diabetes.  (I like to call it ignorance)  I have just found the person
who wrote the policies on taking care of a diabetic child in the school
system for NJ.  If my lawyer lets me, I will be talking to her today. 
What state do you live in again?  I will try to get some helpful
information for you on policies in your state.  I am learning that each
district basically has their own version, but that can easily be changed
when you can contact the right people.  Let me do some leg work for you. 
I can try to get the info and send it to you.  Maybe the woman who wrote
our policies knows the one who wrote them in your state.

Cindy, pump mom to Jessy (8) dx 1/02, Julie (3)non diab. and Trevor
(1)non diab.>From: email @ redacted >Reply-To:
email @ redacted >To:
email @ redacted >Subject: Re: [IPp] First week of
school & @#$#$#@^%#@ Nurses! >Date: Thu, 22 Aug 2002 04:09:23 EDT >
>Alllison, take > off that fire resistant cloak--------it's too hot for
that!!! LOL >It was still 92 here at 9PM. > ><>The >school doesn't need
something separate from that. We have our endo sign our >504 plan each
year.>> > >We didn't go into the IEP with a Dr. signed HCP. What we
presented to >them was the plan we (Zach, us, and ENDO/CDE) wanted
implemented (sp?) >for this school year to avoid last years semester long
absence. We'd >just been to the hospital in July and discussed this with
his Diabetes Team. >We all felt that Zach's having as minimal amount of
contact with the school >nurses would eliminate or decrease his anxiety
and "Nurse Phobia". Plus, >they'd been wanting him to test in class for
the past 2 years and it had >always >been denied as against District
policy. > >They said to attend the meeting, present our proposed plan
(which would >replace the ridiculous/offensive plan the nurses created
against my wishes >last year), get their approval or start the battle. If
approved, they >said to >fax final version to them for signatures. So
naturally, since all was >denied >once again by nurse staff at meeting,
we were walking in on Monday AM >without a policy in place. > >I had
contacted the Endo over the weekend, told her of the meeting, >told her
what was in the plan, and we agreed to proceed as if they'd agreed. >I
faxed orders to her office (she was out of town when we spoke) and >she
promised to have them signed and faxed back as soon as they got >in on
Monday (unfortunately this would be one hour after start of school
>day----thus no orders sitting there when son came into their office.) >
><< IMHO, based on what you have written (I wasn't there), it doesn't
seem >that >the nurse was out of line. She doesn't deal with diabetes
every day and it's >your job to educate (not berate) her on a daily basis
and help her see what >is right for your son.>> > >You do however, reach
a point where you are fed up! This nurse refused >to listen to his Endo
or CDE last year when they would try to explain >what they wanted or why
they wanted it. And it's not like she is new to >treating Diabetics.
She's been there for over 6 years that I know of, and >during that time
she's had 2-5 diabetics per year. Six years ago she had >her first
student go on a pump. She attended an 8 hour seminar on >insulin pumping.
She's had numerous students on pumps since. Matter >of fact, she came to
our elementary at the end of his 5th grade and INSISTED >that we get him
on a pump over the summer so his Diabetes would quit >being a problem
before he got to her. That year she'd had 3 on a pump. >He wasn't ready
and she was furious and spent the entire first semester >last year
telling him he would have his current problem of the moment if he'd >gone
on a pump like she'd requested. > ><< I don't disagree with a little more
control by the school the first week >or two >of classes. Our kids are
going to be high and low the first couple of weeks. >Your going to be
doing basal/ratio changes due to the new schedule. Things >are going >to
be changing alot the first couple of weeks.>> > >I did give in on this
the other day, but with the stipulation that it only >last >for the first
two weeks, not the first few months as they had decided after >his first
moment of confusion/request for assistance. So far we've not >made >any
adjustments to his basals/ratios this week. I'm waiting to see if the
>stress decreases first. If he's fine this weekend and then back high
again >next week, I'll be changing them for the school days until he
destresses. > >< If your 504/IHCP >says he tests at 8:30, then they are
going to want him to test at 8:30 every >day.>> > >Last years nurse
created health care plan (not the one in his IEP) said he >had to test at
8:30 AM, lunch, and 2PM each day. The 8:30 testing was >because they knew
he'd already had two seizures since he'd started pumping >and both had
been 1-1 1/2 hours post breakfast and they wanted to be assured >he was
within okay numbers. This new health care plan I presented to them >and
had faxed to them that day says that suggested times would be in the AM
>around 8:15-8:30 (until he was settled into the school pattern and then
he'd >replace that with one around 10:15-10:30 since lunch is so late he
might need > >a snack), lunch, and 2PM each day (to decide if they felt
comfy putting >him >on a bus), pre-academic tests, and whenever he deems
necessary. > ><< Does your son have a watch with alarms? If not, I highly
recommend one.>> > >He did in 5th grade, but the teacher confiscated it
and threw it out on a >Friday >as she didn't like hearing it beep (to
remind him to go to nurse 10 minutes >before lunch). I've thought about
saving up some money and getting him >one of the watches discussed on the
list. I'll re-read some of those posts >to try to figure out which one
was best. > ><>the >school (who sounds like they are more than willing to
make accommodations) >by being THEIR advocate as well. Helping them help
you, rather than fighting >them and being rude ("repeatedly requesting
the she please shut up"). >> > >Actually, I don't even tell my kids to
"shut up". I was venting in my >E-Mail, >and was saying what I was
thinking not what was actually said. On the phone >I was thinking "Just
shut up please!" but what I was actually saying was >"Debbie please just
put Zach on the phone!" and "Let me speak with my >son!" I went out of my
way last year first semester to be nice and polite >to her even though
she was already verbally mistreating him. I didn't >even get rude till
late in the 2nd semester when I'd gotten fed up with her >keeping him out
of school. And that was when I started to use the >system to fight for
his rights. > >I wasn't rude at the meeting last week. I simply stated
and explained >our proposed plan. When she went balistic and said it was
impossible >and against policy and wouldn't be done as we requested, I
simply >FIRMLY restated what we would be doing, how it was being done in
>the District, what rights he has that allows him to test, etc. She was
>the rude one banging her fist on the table, I was the calm one restating
>what we would be doing. > >And once she was and her assistant had fled
the room to put on their >battle armor, I calmly re-explained to his 7
teachers, the guidance >counselor and the assistant principal, what we
were expecting, why >we were expecting it, and how I could best help them
help Zachary. >They were all accepting and supportive (well accept the
principal who said >she was supportive of the concept, but was wanting to
see District approval >before getting too excited.) Teachers wanted to
see him test his blood, >show them the pump, show them how it was
connected and explain how >it worked. Without the nurses, it would have
been the perfect meeting :) > ><< I am surprised that the school accepted
the liability to calculate the >boluses. >Not many schools (districts)
will do that.>> > >Last year we wanted him to have an aid assigned to
follow him through >the lunch line, watch him add up his carbs on a
calculator using a card >with the foods and carb grams on it, watch him
do the formula and then >make sure he punched the answer into the pump. >
>They decided, that an aid couldn't be responsible for this and it would
have >to be one of the nurses since it involved administering medicine. >
><> > son's bolus ratio's or corrections (times and ratios) change, you
will need > > to either change the IHCP or an easier method, to add an
addendum with the > > change, signed by the doctor. I know that we make
these kinds of decisions > > every day, we change basals, we adjust bolus
ratios, correction ratios, > > determine what times our kids should test,
etc. But this is not the job of > > the school nurse. And she (the nurse)
can only do what the 504/IHCP says > > she > > can do. If you IHCP says
correct over 250, that is what she is legally > > allowed to do. Make her
like easier by keeping your 504/IHCP up-to-date. > > >Actually the new
504 (well we've just turned in a newer one today) had the >correction
formula currently used as well as a range within which that >correction
>formula could be moved. (i.e. we are currently taking blood sugar -100
>divided by 100. But the range says I can say we are currently dividing
>by anything from 60-120. It says the range of acceptable insulin per
>carb unit can be anywhere from .5 to 1.5 and how lunch is currently .8.
> >It said to only do correction boluses at meal time (she attempted to
do one >last year an hour after breakfast.) It didn't say at what number
to start >doing them. Was just contained in the hyperglycemia section. >
>Today's version (already signed by Dr. and dropped off at school) says
>we can also do a correction bolus as early as 10:30 (4 hrs past
breakfast) >if he is high rather than waiting till lunch to do it. It
also now says >to >do correction bolus for blood sugar readings (at those
times) for numbers >starting at 150. > >Whenever I make a change of the
correction formula or insulin to carb >dosage, I have to sign a new
medication letter. Dr. doesn't need to sign >as long as I'm within range.
(I have a stack of these blank forms.) > ><< Try to work with the school
rather than fighting with the school and you >will have a much easier
time of it. >> > >I'm really trying to work with the school. I tried to
work with the nurses >last year. Matter of fact, I was so polite and
allowing that I enabled them >in >their nonsence to keep him out of
school for a whole semester. > ><>your son. Your son IS allowed to test
in the classroom. Your school nurse is >willing to calculate corrections
and basals. You have SOOOOO much more than >many parents do. Your glass
looks half full (not half empty) from over here. > > > > > >I am thankful
for any cooperation I get from the school, as well as any >accomodations
we get. I just ALSO want to make sure that his rights >to an education
are no longer being denied as they were last year. > >And now I'm also
ready to play advocate for all the other diabetic children >in this
district who are still being denied their rights because of lack of
>education about changes, policies, presedents, etc. I will be working to
>see that the District writes and implements a policy for working with
>Diabetics. >If they can have a 4 page one for asthma, they can have one
for caring for >Diabetics. > >Sincerely, > >Barbara A. Petzoldt - Pump
Mama to Zachary (12), Dx 2/93, 508 2/02. >Jennifer (20), Allison (17),
Rachel (6) >Fenton, MO >email @ redacted >Independent Kitchen Consultant
for The Pampered Chef.
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