The Definition of Blessed

Fourteen years ago I walked down an isle that was surrounded by almost 400 people.  I can't even begin to explain the feelings that where building up inside of me but the closer I got to the man that I would soon call my husband, the more peace I could feel come over me.  I kept my eyes on him the whole time aching to finally be standing beside him and to feel the comfort that would come from being in his presence.  As he reached out for my hands and looked into my eyes, the rest of the world disappeared and suddenly nothing else mattered.   I had no idea that the feelings that I was experiencing in the moment would be repeated throughout the rest of my life and that I would come to count on that peace so deeply.

We have come along way since that day in April, and together we have endured many trials and struggles.  I often feel like I did that day when I was walking down that isle... it is still in his presence that I long to be when I feel the pressure of the world on me.  It is in his eyes that I find the courage to keep going and in his touch that I find the peace to over come my struggles.  And still he somehow makes the world disappear when I need him to.

When I was younger God made a covenant with me, he promised to provide me with a source of earthly protection, one to hold me in times of need and lift me up in times of weakness.  Fourteen years ago He fulfilled that promise.... and on that day I felt God hold me in His arms through the earthly arms of my husband.  

This life is full of hardships but God promises that if we are faithful and remain close to Him then He will provide us with all that we need to endure these struggles.  Recently, I was asked to write a letter to a dear friend, giving her advice on her wedding day.   These words that I wrote were from my heart and were born out of the trenches of a marriage that not only survived difficulties but thrived through them year after year.

"The definition of your marriage will be created by the bond you form from battling through the struggles of everyday life. You will learn to appreciate your spouse for the great source of strength that they will provide for you. Together you will face many challenges, some bigger than you think you can bear. It is in those moments that you will learn the real value of this gift that God has given you and the true depth of your love for each other. 

However, even a love this deep will never be able to shelter you from the storms of this world. But if you seek comfort in each other arms you will not only weather these trials but grow stronger because of them. You must rely fully on God and on his protection over the commitment that you are making to each other today. 

Your marriage has a purpose and a plan designed by a God that loves you intimately. Trust Him for direction and you will be blessed beyond measure."

Together, Todd and I have gone to God seeking strength when ours wasn't enough, together we have prayed for comfort when we had none to give, and when neither of us had the clarity needed to lead, together we sought guidance from God for His direction.

What is our secret for having a great marriage?  God!  He is what continues to bring us back together when the world tries to pull us apart.  This marriage is not made up of two people.... but of two people and their God.  We are the true definition of blessed, not because of what we have been given but because we have an intimate relationship with the GIVER.  

Everyone deserves to know this kind of love!

Happy Anniversary Honey, 

because of you I am a BETTER me.  

Thank you for loving me the way I deserve to be loved.  We are so proud of you and how hard you work for our little family.

More of our love story...So His Horse Wasn't White

Our Little Puzzle: Cohen Update

Have you ever spent countless hours working on a puzzle only to find out as you neared the end there were valuable pieces missing?  Sections come together but without these key pieces the image is lost... and so the frustration sets in as you frantically search for those clues necessary for revealing the BIG picture.  Now hold that thought!

Meet our little puzzle....

And quite the complicated one I might add, but with every new appointment we learn more and more about our little superhero.  Our doctors are doing their best to help bring as much clarity as possible to our situation.

One of the most difficult things I have heard thus far is....."We may never know why."  I am a person who likes to research and find answers to problems and it is hard to except that sometimes there just aren't any.

I spend countless hours pouring over my sons's medical records, lab reports and searching for information on the computer, it is my job to keep looking!  When you are dealing with something rare and undereaserched you become the expert for your child!  I have learned some valuable lessons along this journey...

~Even with well-intended physicians you may not receive the best advice, in fact in our case it was quite dangerous.

~Although I don't posses a medical degree I am the expert on my child's illness, not discounting the valuable knowledge of medical professionals but every doctor can't be an expert on every illness.... so we searched for ones experienced with our disease.

~I must always listen to my instincts.... going against incorrect medical advice is not only acceptable but my responsibility.

~People aren't perfect and there are no exceptions in medicine, so I must be prepared for mistakes and have the courage to confront those making them (despite all that was written in Cohen's chart about NO FOOD and the allergy alert bracelet on his leg stating FOOD....they still tried to feed him).

~I have the most amazing support system of friends and family and I don't know where I would be without their love and generosity.

~God's grace is ALWAYS sufficient and will see me through!!

Our Newly Discovered Puzzle Pieces
We met with our new GI, Dr. Putnam at Cincinnati's Children Hospital and I found myself hearing some familiar words.  Much of what he said confirmed what our allergist at Johns Hopkins had stated, but he went a step further.  He was very honest in his explanation.  He discussed with us what is known about FPIES, there is far more that they don't know and may never know, and that they have theories that desperately need research.

Here is the break down on what he believes is going on with OUR superhero:

• Cohen is a severe reactor and we may never know why he reacts to so many foods.

• Refereed to him as a severe hypersensitive immune responder: 

So in other words... When we get sick our bodies respond by creating antibodies so that it will recognize the illness the next time and be able to fight it off easier (pretty awesome handy work God).  For some reason Cohen's immune system responds to food the same way and according to our GI the more we feed him the sicker we are making him.

• Dr. Putnam's theory:  Stop all food trials for as long as we can in an attempt to reset Cohen's immune system and hopefully reintroduce foods later without reactions.  There are no guarantees but we have nothing to loose.  He was very passionate about educating people that children like Cohen only get sicker the more we try to force food on them, which only supports why he is so resistant to eating food. To Cohen FOOD = Pain

• Then we asked the burning question: Are we dealing with an extremely severe case of FPIES or is there more going on?  His response was, "Yes, that is our big question and we will try to figure out more but unfortunately, we may never have all of the answers."

Where Does This Leave Us Now?  
It was determined that Cohen urgently needed a G-tube placed because of his increased risk of aspiration as well as other concerns.  After the surgery we were admitted into the hospital and began the daunting task of gradually increasing formula feed rates and concentrations.  Cohen didn't tolerate the faster rate at first and began to loose weight.  We finally managed to increase both and stop the weight loss, however we never regained any.  Since home he has lost a little more and is weighed weekly by his pediatrician and monitored for belly distention.  Our little man has also been having more issues with blood and mucus stools, which only leaves us with more unresolved questions.

In our FPIES world we are usually left with many uncertainties, filtering through symptoms as best we can.  This is very difficult for the type A in me (yes, I have a slight obsessive compulsive side.... there you go honey I admitted it).  I like concrete answers, written in black and white.... this living in grey is a struggle for me.

So I have learned to triage....deal with what needs attending to at that moment and not dwell on the unknowns of this illness.  I am a work in progress, learning to turn things over and worry less...

God, grant me the serenity
To accept the things I cannot change,
Courage to change the things I can,
and wisdom to know the difference.

We will continue to fight and advocate for our little superhero and diligently work to keep him thriving.  Life isn't easy but it isn't suppose to be.  Our situation makes us far more sensitive to others and what they are dealing with.  My older children look at life differently because of the strength that they see in their little brother.... what a beautiful reminder for all of us that true joy doesn't come from this world!!!

Endurance

A long time ago I began to pray for endurance.  Why?

I am a runner by nature... believe it or not in my not so distant past (okay you may not want to believe that part) I actually had a track scholarship to Marshall University.  So I identify all to well with the training and work ethic needed to compete at that level.  You can't get very far if you don't train, train, and.... yep you guessed it, train some more.

Racing is only fun if you can compete with the crowd around you.... however, the training process to achieve that goal is grueling and less than desirable!  I learned quickly that without those long days of pushing myself hard, past the point of where I thought I could go.... I would never reach my goal.

If you are familiar with training you know that it isn't pleasant, it hurts, and it often feels like punishment.  So how do you convince yourself to do it day after day?  Well, you must overcome your first and most difficult obstacle.... Your Mind!!!    Believing in your ability to achieve your goal will determine whether you reach your goal.

Not only does your body need to be conditioned but more importantly your mind does as well.  I use to have a saying with my personal training clients (I told you running was a large part of my past), "Mind over matter... if you don't mind, it won't matter!" Imagine getting to hear that first thing in the morning from a peppy little trainer running beside you!   

What does all of this have to do with praying for endurance?

en·dur·ance ~ 

noun

    1.  the fact or power of enduring an unpleasant or difficult process or situation without giving way.

One day while I was praying with a friend I prayed for endurance, something I did regularly in my private prayer time.  When we finished she looked confused and questioned me, "Why did you pray for endurance?"  She said that she had never thought about praying for endurance and wondered what prompted me to do so.  

I told her that I see my life in comparison to running a race.... this life is like a marathon for me (which is a big deal when your a sprinter by nature).  I was great with the quick short distances but it's those long ones that have always taken a toll on me. If you have ever experienced long distance runs you know that there is moment when you hit a proverbial wall... or should I say it HITS YOU!!  

It's the point where you want to give up and sercome to the pain that has been slowly taking over your body. Endurance gives you the strength to push through and reach the goal set before you, however, you can't obtain it without hard work.

So how do you train your mind for your race and gain the confidence to believe in the ability to reach your finish line.... by growing stronger spiritually.  If we want endurance in our journeys we must pursue it with persistence.  Spending time daily with God allows Him to fortify us with the ability to keep running when everything in us says, "I can't take anymore!"  

I will hit many "walls" in my life and unfortunately my little, "Mind of matter matter" phrase won't be enough to get me to the other side of my struggles.  So I will continue to request the gift of endurance from the only one that can provide it for me.

I have been on some very long journeys lately, but God's provision of endurance has kept me 
in the race.  My eyes are fixed on the goal before me and I will persevere until I cross the finish line.

1 Corinthians 9:24-27

 In a race all the runners run. But only one gets the prize. You know that, don’t you? So run in a way that will get you the prize.  All who take part in the games train hard. They do it to get a crown that will not last. But we do it to get a crown that will last forever.

So I do not run like someone who doesn't run toward the finish line. I do not fight like a boxer who hits nothing but air. No, I train my body and bring it under control. Then after I have preached to others, I myself will not break the rules and fail to win the prize.

Rumor has it....

There's a rumor that has been passed along for years, it's been circulating for so long it's origin is unclear.  And although it can't be found in the Bible it is quoted frequently along side of scripture......

"God never gives you more than you can handle."

Okay let's be honest most of us are not only guilty of saying it at least once in our lives but also resting in it's false security. Only recently has it come to my attention (through a powerful message on faith) that this wonderful feel good thought is nothing more than a MYTH.  But hold on and hear me out because there is hope....

2 Corinthians 4:8-9 ~ 8 We are hard pressed on every side, but not crushed; perplexed, but not in despair; 9 persecuted, but not abandoned; struck down, but not destroyed."

Although, it is well intended to use this sediment to comfort someone going through a difficult phase in their life, it is absolutely false and misleading.  The Bible is full of people who had far more than they could handle (checkout Hebrew 11 for a nice recap).  These men and women not only survived their trials but thrived and all of them shared one common thread....they all had unshakable, never wavering, undeniable.... FAITH!  Faith not in themselves, or their own abilities but in their Creator... the one that can really handle the circumstances we face.   But first things first.... we need to just start at the basics, we must commit ourselves to the giver of Life so that we may receive His immeasurable source of strength.

Hebrews 6 And without faith it is impossible to please God, because anyone who comes to him must believe that he exists and that he rewards those who earnestly seek him.

Faith! It's the key that unlocks the door to our greatest resource which will enable God's strength to penetrate our lives.  God not only wants to be with us in ALL of the circumstances, but he wants to carry us through our darkest ones... baring the load and comforting our souls.   Our God's shoulders are bigger and stronger...

II Corinthians 3 Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, 4 who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God.

Pastor Marc Sundstorm teaches us in his message "By Faith" that: "You can always endure a little more than you think you can, but you will never have more than you and God can’t handle together.  There is nothing we can’t endure through faith but we must look to the future by fixing our eyes on Jesus, because what is seen is temporary but what is unseen is eternal."  He goes on to remind us that, "When things are good we rely on ourselves but when things are hard we rely on God."

Trials are not meant to destroy us! In fact it is quite the opposite, these times are opportunities for us to strengthen our faith and prove to the world that we live what we believe . Our experiences equip us to help others and point them back to the Father.

James 1:12 "Blessed is the one who perseveres under trial because, having stood the test, that person will receive the crown of life that the Lord has promised to those who love him."

So it's time to put our faith into action and debunk the rumor.  You will never again hear me utter the words...

"God will never give you more than you can handle."

Instead I will share the truth...  

God will never give you more than HE can handle.

Click here to listen to the Holy Spirit clear up this age old rumor through Pastor Marc's powerful message.

The Lord is My Strength Psalm 28:6-8 "Blessed be the LORD, Because He has heard the voice of my supplication. The LORD is my strength and my shield; My heart trusts in Him, and I am helped; Therefore my heart exults, And with my song I shall thank Him. The LORD is their strength, And He is a saving defense to His anointed.…"

Our Sick Little Super Hero

I am so grateful to everyone that has been thinking and praying for us these past few days.  Our little super hero has been a pretty sick little guy.   Thank you everyone who has expressed your concern and asked for updates.

So here's where we are....

We started antibiotics because he had been sick for a few weeks and just couldn't shake it on his own.  He immediately began to have severe diarrhea that was causing open sores which prompted us to discontinue the amoxicillin.

A couple of days later he started running high fevers around the clock.

Since the fevers were spiking pretty high over and over again I decided try to just make do with what we had for the day.... fearing the infection would be worse than the diarrhea ( I guess you could say that I was weighing my odds and going with what seemed least harmful... or so I thought!!!)

So Sunday morning Daddy took the others to church and little man and I stayed behind.  I gave him the antibiotic in hopes of combating this nasty attack on his little body.  After a few cuddles  I set up his feed and put him down for a nap.

When he woke from his nap it was almost two hours exactly and I noticed that he had spit up.  I picked him up and wiped him clean, that's when "IT" began.....and "IT" didn't end for two hours!  I guess I was first hoping that it was just a stomach bug (seems odd to hope for something like that but it beats acknowledging that we were in the midst of another reaction).

When Todd came home he agreed that this wasn't any bug and he needed treatment right away.  I was still totally shocked that it could be the medicine, that isn't a common trigger for kids like Cohen and it just didn't make sense.   After IV fluids and Zofran and a Tylenol suppository,  our little super hero was finally able to hold his head up again and flash his sweet smile.

He was doing really well by the time we got home!  Full of excitement to see his little gang, he even mustered up enough energy to play a little game of hide and seek with his sisters.  But as the night went on those relentless fevers began to rear their ugly heads again... we spent the entire night trying to keep it down and keep him comfortable.  

Monday morning I placed calls to his pediatrician and Allergist at Johns Hopkins and waited to hear back about the antibiotic reaction.

In the mean time... Cohen's tube came out which only complicated things since he was refusing to take any medicine by mouth.  I made a plan to take him to the pediatrician's office and have them help me put his tube back in, but before we could even leave the house his fever spiked to 105 degrees.  

Our amazing pediatrician checked him out and found no visible signs for the fever,  We had  RSV and flu tests at the emergency room but we decided to repeat them anyway.....still all negative.  We all agreed that we had to have an antibiotic without any flavoring to be safe, so they had one compounded  at their in-house pharmacy.

Before I was able to get home I received a call from Teri, the Nurse Practitioner for our allergist at Johns Hopkins.  I explained the events and she agreed that he had definitely had an FPIES reaction to the medicine but she just didn't understand why!  She informed me that the flavoring is artificial and shouldn't have triggered a reaction.  Since she had never seen this before she decided to discuss it with Dr. Wood (our allergist) and then get back to me.

As I was getting everyone in the house my phone rang again, but I wasn't able to get to it in time.  The message that was left on my phone was frantic.....she said "whatever you do DO NOT give him that compounded version of the antibiotic.....I hope I have reached you in time, I will keep trying you!"  When we finally connected she told me that she had reached Dr. Wood in his car on the way to a meeting, she didn't even get through with explaining everything to him when he told her "don't let them give him the amoxicillin, it isn't the flavoring!  I have seen this before, I am absolutely sure that he is reacting to the drug!"  

God's timing is perfect because if that conversation had taken place any later or we had gotten the medicine earlier in the day.... we would have been right back in the ER.  We feel so blessed to have Dr. Wood and his experience leading our care team.  It makes me ill to think about how close we came to making my sweet little man very, very sick again.

Unfortunately, they now believe that the new antibiotic is also causing a reaction, like the first....blood in stools and diarrhea that could progress into an acute reaction again.  They believe is body is treating these medicines as food and rejecting them.  So it looks like we are left with only two option for our little man.....rocephin shots and/or IV antibiotics!!

I love looking at pictures of when he feels well!

Wednesday, I received a call from our pediatrician's office they wanted us to come in for blood work and take urine samples.  It was clear to see that they were all very concerned about him and how to manage his unique care.  They are working very hard to try to get us into Cincinnati Children's hospital as soon as possible.  I was told today by our pediatrician to start making a plan for staying there for several days.

Fevers seem to be down for now, so we will count our blessing where we can however there is still concern because he is having excessive night sweats (which started before the fever).  We have a lot to figure out about our little super hero but one thing is for certain, he is definitely keeping us on our toes!

I need to brag on my little gang for a minute!  I had to take all five with me to Cohen's appointment yesterday and they were incredible. While poor Cohen was being stuck with needles and tubes in one corner of the room, his older siblings were doing reading lessons with the younger ones in another.  The nurses were so amazed with my little ones and so was I.  We arrived at our appointment at 12:45 and didn't walk back out of the doors until 4:00.  I couldn't have asked for more polite and well behaved kids...I am so very proud of them and thankful for all they do for each other!! 

I am one very blessed mama!!!!

Thank you again for all of your prayers, there is such comfort in knowing that so many people care enough to pray and think of us.

Romans 8:28 And we know that in all things God works for the good of those who love him, who have been called according to his purpose.

Being a Mama

Lets face it becoming a mother is job in itself.   We "willing" choose to wreck our bodies enduring the unthinkable for 40 long weeks, trading all physical comfort simply to have our sweet blessings. 

Or we spend countless hours praying little ones into our lives, birthing them through a deep passionate desire and  the blood sweat and tears that come with adoption. 

Regardless of how we were born into the job of motherhood we all under went the same transformation as our hearts grew large enough to accommodate another human being.  And although our stories may look a little different I know that we can all agree on one thing..... This job comes with the most incredible PERKS!

Where else in the world would someone...

  *Desperately want your kisses so badly that they aren't bothered by your morning breath

*Depend solely on you to care for their every need and not complain about the way you're doing it

*Care enough to cry for you when you leave the room

*Frantically search every room in the building just to make sure you haven't left

*Believe your kisses and hugs have magical healing powers

*Be so desperate to be in your arms that they cling to your legs

*Care less about your appearance, putting much more value on your ability to keep them fed, warm, and loved

When in life do you get to...

*Witness someones first "everything"

*Experience someone melting your heart with just a look in their eye

*Feel like the most important person in the world

*Restore your faith in the world by seeing the reflection of true innocence in their little eyes 

*Look past every flaw or mistake you ever made in life with such unconditional love 

*Witness the magic and wonder the world come alive around you by the mere sound of little laughter 

 *Desperately have someone want to be in your constant presence and NEVER tire of you

*Experience someone's NEED for your undivided attention more deeply or deservingly than anyone else in the world

*Be part of a world where dolls talk, reindeer fly, and best friends come with stuffing and fur

*Remove all fear and helplessness for another person, simply by placing your arms around them

*Have the opportunity to watch a tiny helpless person develop into an amazing thinking, achieving, and prosperous member of society.... And know that you had everything to do with it

Sure, this job is difficult and even impossible at times.  I am sure there is a list a mile long of all the things that are unpleasant, but I'll be honest I just can't seem to remember any of them....   

If we were given a chance to do it all over again, enduring whatever we faced to bring these little ones into our lives....We would say without hesitation... ABSOLUTELY!

Take heart dear mamas, your work is not in vein and even know it may go unnoticed by the world today it will become evident in legacy of the lives that we daily nurture.

Proverbs 38:28a  Her children arise and call her blessed.

Johns Hopkins & Cohen (a match made in heaven)

I think I can just about reach one!

Here fishy, fishy...

We are so grateful for all the prayers that have been going up on our behalf.  It is so humbling to walk through this journey with Cohen, where we are in a constant state of learning.  After having four children I had apparently convinced myself that I had seen and experienced almost everything....and then I met Cohen!

We were truly blessed to have been directed to Dr. Robert Wood by a veteran FPIES mother and the founder of the IAFFPE organization.  And lets not forget my very pushy and well intended sister that helped me realize that it was time to change physicians.  Dr. Wood is considered to be one of the top three experts for FPIES and has been not only writing journals about the subject but has been involved in research as well.  He has treated over 500 patients with this condition....it is safe to say HE IS AN EXPERT!!

Cohen, making new friends!

Oh what a difference it makes when you are sitting in the presences of someone that knows your child's illness inside and out.   Todd and I left the appointment with full confidence that our little man was finally in the right hands.

For those of you that don't know Cohen was diagnosed earlier this year with a condition called:
~ Food Protein Induced Entercolitis Syndrome..... or FPIES [pronounced F-pies]

Food Protein Induced Enterocolitis Syndrome (FPIES) is an allergic reaction in the gastrointestinal system. The most common triggers are milk and soy, but any food (even those thought to be hypoallergenic e.g. rice, oat) can cause an FPIES reaction. FPIES typically starts within the first year of life.

Unlike most food allergies, the FPIES reactions are delayed and usually begin about 2 hours after ingestion of the causative food. FPIES reactions are characterized by profuse vomiting and diarrhea. In about 20% of cases the child will have such an extreme reaction to a food that they will go into shock and need to be taken quickly to the Emergency Room for immediate treatment. ~IAFFPE

Where we are now:
Cohen has either vomited and gone into shock or had blood in his stools from every food that we have given him up to this point.  He currently receives all of his nutrition from a special Amino Acid based formula via a NG tube (aside from nursing at bedtime).  We are working to help him take in more formula orally but it has been a challenge.  Trialing foods has also been extremely difficult because Cohen has developed a food aversion.

What we learned at Johns Hopkins:
Dr. Wood impressed us immensely with how thoroughly he had investigated Cohen's case before he ever walked into the room.  He was able to fill in the gaps for us and explain how all of this fits together, shedding some light on the struggles we have faced in the past few months.  

Dr. Wood began to inform us, in a very, "let's cut to the chase" manner, that Cohen has a very complicated case of FPIES, and proceeded to give us a list of expectations. 

 The Hard to Hear

~We are dealing with an atypical or more severe case of FPIES
~We can expect to be on this special formula for a very long time... years
~Cohen's body doesn't handle food well
~It is very likely that he has some additional GI issues
~Given Cohen's history, we must expect to fail far more food trials than we will pass 
~Not to be surprised if we don't have any or only a couple of safe foods by the time he turns two
~Be patient and prepared for a very long difficult road
~There are no tests that can guide us, just our instincts and Cohen's history
~Stop all food trials for the next four weeks and push formula
~Cohen's food aversion will probably get worse before it gets better "because frankly food as always hurt him"
~Consider placing a g-tube into his stomach to feed him his formula
~In 6 weeks we will begin trailing some lower risk foods at home and then later on we will trial big triggers in the hospital

The Hope

~That he and his staff will be there for us every step of the way
~That most kids outgrow this condition around the age of five (probably the only time I smiled during the appointment)

Although nothing Dr. Wood said was a shock to either of us, it was still difficult to hear the words come from him.  I guess there was the hope that things weren't as bad as they seemed.  However, with all that what was said we still brought home a smiling little boy to love-on and enjoy.  

I am learning that moving forward will quite often resemble backwards steps.  Excepting the obstacles ahead allows me to prepare myself for our battle and to no longer feel side blinded by set backs.  Things won't be easy but we are very fortunate to have hope that one day Cohen will no longer have to deal with his allergies.  We are confident that we will eventually find our groove and begin to live a new kind of "normal".... I mean really, who defines "normal" anyway??

What I am sure of:
Cohen is not FPIES, it is merely part of what makes him unique and wonderfully made.   FPIES may slow us down a bit but it will never keep us from making the most of this beautiful life that God has given us.  This journey has so much to teach us and I pray that someday we will be able to use our experience to help others.  

Today, in the midst of learning how to navigate through this new way of life we will focus on finding the good in our circumstance... and give thanks for having been given this wonderful little guy that just happens to need a little extra care!

Psalm 25:1-3a  
In you, Lord my God, I put my trust.  I trust in you; do not let me be put to shame, nor let my enemies triumph over me.  No one who hopes in you will ever be put to shame.

How are journey began...


Current Studies:
http://iaffpe.org/docs/Ruffner_et_al_JACI-IP_2013.pdf

http://iaffpe.org/docs/FPIES_to_trivial_contact_w_rice_EJP_May_2013.pdf