Allergies and After-Hours Clinics...

Today started out like any other day. Eddie and James went to school and work. Will and I went to school. After school, Will and I went and picked up Chick-fil-A and took it to Eddie's office for a quick lunch before picking up James at 1:15 for an allergy appointment. At lunch, Will mentioned he was "fweezing." Lunch is NOT Will's best time of the day so I assumed he was just a little sleepy and we went on our merry little way.

I picked James up from school, went back to Eddie's office to get him and Will, and then we went to the allergist's appointment. It wasn't long, thankfully, before they called us back. James had a TON of allergy testing done last summer so I knew it wouldn't be a very extensive visit. 

We chatted first about the gross nose he's had for a few weeks. She thinks it COULD be allergies or it COULD be a sinus infection or it COULD be residual from a viral infection he had a few weeks ago. Either way, she called him in a very low dose of amoxicillin. His lungs sounded a little wheezy, but he was able to cough and move things around. I got a new inhaler for him a few weeks ago and we'll keep using that as necessary. Following the asthma rule of two, he doesn't need any preventative medicine right now. He's been off all of that for over TWO years! Woohoo!

Asthma is obviously not the biggie with James. Next up, we talked about food allergies. He has still not had another reaction, thanks to lots and lots (and lots and lots) of reading labels. We are label-reading pros most of the time at our house. So here's the thing about James. He always tests positive on his skin and negative on his bloodwork. Always. He is an allergy anomaly. TYPICALLY, bloodwork is right on the money. You can also have false positives on skin so it's POSSIBLE that he doesn't have a food allergy because of those things. BUT, he has had an anaphylactic reaction before. He is sort of a mystery that they don't know what to do with. They don't want to say he ISN'T allergic because he has had a reaction and his skin says that he is. BUT his bloodwork says he isn't and that's normally the correct ruling. 

So. We have a few options. We can continue to live life like we do now where we are checking everything OR we can do a food challenge. If we do it, we will schedule that for this summer. We would take a jar of cashew butter to their office where they are set up for anaphylaxis and he would eat minuscule amounts every 20-30 minutes for about 4 hours  - until he has eaten 3 tablespoons of cashew butter. If, after all 3 tablespoons, he hasn't reacted they will say he is allergy free and that he has outgrown the allergy. If he has a reaction they will stop right where they are, treat the reaction, and then we will continue to avoid it. My concern is that we have conditioned James to believe he is still allergic to something (this was a HUGE problem that our allergist in Macon had...he is completely opposed to scaring a child off of a food) and he will react because he THINKS he will react. Make sense? He immediately said he did NOT want to do it, but later thought he might. We are going to think about it for a while. 

And because I'm on my allergy soapbox, let me remind you that it is NEVER okay to allergy test a child that you think doesn't have an allergy. We have read horror stories about family members and caretakers feeding a kid the allergen because they didn't think the child was allergic. Eddie and I are very, VERY cautious about what James eats so it could be that he has avoided another allergic reaction just because we are cautious.

Moving right along...The boys and I dropped Eddie back off at work and then they wanted a treat. We almost NEVER get treats after school and we've done that twice (because of doctor's appointments) this week. We drove around for a bit enjoying our snack and had a sweet time in the car together. After we got back home I realized that Will was burning up. AWE-SOME. We got in the house and I snuggled him up on the sofa and took his temperature and it was high enough for me to be worried. This is AN HOUR after we left the pediatrician's office, people. Will was exposed to flu on Tuesday at school and again at his well-check so I started to panic a little. I texted a friend that is a NP and asked about the after-hours clinic. She told me that his symptoms just sounded like strep to her but for me to take him tonight because Saturday morning is BUSY. Eddie came home and he was a champ for taking him. (Sometimes it's better to do that job for your germaphobe wife who has already been at the doctor TWICE in one week and works in a preschool. My germ-meter was REALLY about to explode.) They swabbed him and confirmed that he had strep. His temperature was also high enough that they gave him Motrin at the office. (I laughed when Eddie told me he tried to refuse it but the nurse politely told him it was free and so he let Will have it. HA. Typical.) He and Eddie left there and went to pick up Will AND James' antibiotics. Hopefully Will will feel better tomorrow morning or at the very least tomorrow afternoon after 24 hours of medicine.

Whew! What a week! I am so sleepy I can hardly stand it. Here's hoping none of the rest of us wind up sick!

Itchy, Scratchy.

Tuesday we had an appointment to see our new allergist for James. We had an appointment a few weeks ago here in town, but for some reason they didn't want us to come the morning he woke up with a virus SO we rescheduled at their out-of-town office for today. The timing was REALLY stinky since we had to drive, Will didn't have someone to keep him (Granddaddy to the rescue!), and I had book club tonight at my house, BUT we made it work. We were very, VERY much looking forward to this appointment to see if our boy had outgrown any of his allergies.

The first thing we did was to meet with our new allergist, Dr. C., and give her a background on James and his allergies. I have a MILLION posts on his allergies that are labeled with the same allergies label as this post so click on that at the bottom if you're interested on his background. Dr. C. asked questions and familiarized herself with James' case and decided what we would focus on for the appointment - Pulmonary Function Test (PFT) and skin test for tree nuts and legumes only. She offered the whole test, but we chose to just focus on the nuts. The others are seasonal and environmental and James hasn't been on ANY medicine in well over a year so he's doing fine. If there comes a time when things start flaring up for him again we'll re-do that then.

We started with the PFT. There were two parts to it. One was a computerized part - James blew into a tube to keep a hot air balloon above the water and below the clouds. After he got the hang of it he did well. The second part was to blow as hard and as long as he could like he was blowing out birthday candles in one breath. That one took a little longer for him to figure out, but he did get it. After the initial PFT he did a round of Albuterol in a nebulizer. While the Albuterol was going we did his skin test, too.

Because he's a BIG kid they did his allergy test on his arm this time. He wasn't looking forward to that. He was hoping they'd do it on his back so he wouldn't be tempted to scratch. Thankfully, Octonauts was on TV so that kept him occupied. He was also sitting in my lap so that I could keep him from scratching if necessary! For the first fourteen minutes I thought we'd outgrown our allergies! They all popped up right at the end.

On his arm you'll see one BIG welt. That's the histamine mark. That's the control for the rest of the test. They use this to determine accuracy. If someone doesn't react to the histamine they know that they have anti-histamines in their system and the whole test has to be thrown out. You have to stop meds several days in advance. You'll also see a few smaller dots. I didn't get a picture until the grid had been wiped off. We tested for soybeans, peanuts, almonds, pecans, cashews, and walnuts. I thought she said 8 nuts, but those are the only ones I can remember. {He has had a past positive reaction to hazelnuts but they didn't have that allergen in the office.} 

After the skin test and before hearing the results James had to repeat the birthday candles test. They were measuring to see if the Albuterol opened him up any. Once he completed that test we met back with Dr. C. again.

She covered the PFT first. He did well on his first round - it measured him against others his age and size and he was consistently at the top percentile so there was not a big concern. The concern came after he did the Albuterol and repeated the test because his results were SO much better. Obviously, this could be completely because he figured out how to do the test, or it could be because the medicine worked. Either way, he's doing well without allergy and asthma medicines so we'll continue to stay off of those unless we run into a season where he needs them again! That's good news!

Next was to discuss the skin test results. You score a skin test based on how much the spot swells in reaction to the allergen. My understanding is that allergies are ranked on a scale of 1-4, one being the least allergic and four the most allergic. James scored 2+ for cashews and walnuts {walnuts is new!} and a 3+ for soybean {that's also new!}. Unfortunately, he hasn't outgrown cashews AND we either added two new ones, had two false positives, or had two false negatives last time. We'll never know. Soybeans, of course, are in EVERYTHING. Anything processed contains soy. Thankfully, she told us that since he's been ingesting those with no problem all along, we are NOT to start avoiding them now for fear that he'll react to them later in life if we do. That was good news to us! As for the walnuts and cashews, we'll continue to avoid tree nuts and continue to be picky about what he eats {adding in that care takers need to STEER CLEAR of walnuts on their salads! grandparents, take note!!!} and carry an epipen with him.

We are going to repeat blood work either this week or next week just to see what it says as well. After that comes back Dr. C. will call us with those results and discuss what it looks like overall. I highly suspect those will come back negative since he's never had a positive blood test. We shall see!

The epipen was another thing up for discussion. We got a new prescription for the insanely-expensive epipen, BUT we think we're going to try the new high-tech ones. It's actually not an epipen brand, it's something else. It talks you through administering the drug in case someone not trained in doing so winds up having to do it AND so that mamas under pressure don't forget. James thought it was really cool. Even better, it's a smaller size so that men can fit them in their pocket - it's wallet sized - and that makes this mama very happy for the future. We've always wondered about convincing James to carry one when he's older and doesn't want to carry a backpack with his meds everywhere. Hopefully this would help that. I thought it was a great idea, anyway!

Overall, we thought it was a good appointment! We were very happy with our new doctor. She was very friendly and thorough. We spent two hours start to finish and we were moving the whole time, not waiting. We'll follow up with her about blood work soon and then we'll go back in February for another check. We were a little disappointed about the soybean and walnut result, but since it won't change what we already have going it's not THAT terrible. And we're still only getting 2-3+ scores so that's good! I'm not sure he's ever had a 4, but I would have to look at his records. Hopefully we'll just maintain this! We were proud of how brave James was today! It wore him out, though. He talked all the way to the appointment and knocked out on the way home! He slept from the beginning to the end!

Have a great week!!!

James' Five-Year Well-Check.

My biggest boy, his daddy, and I headed to the doctor's office for a well-check yesterday. {Side note: I am raising a germaphobe just like myself. I was wearing a maxi skirt and James told me I might want to re-think my outfit so it wouldn't drag on the ground and I'd get all those germs. Lol!} He wanted to know if he was getting any shots before we went and was a little nervous about that, but otherwise he's pretty much an old pro at the doctor's office. Thankfully, he doesn't go NEARLY as often as he used to. I think in our almost two years of living here he has only been to this practice three times including yesterday! Hallelujah!

We arrived on time and waited FOREVER. The parking lot was SO full. He was pretty antsy in the waiting room, but well-behaved for sure!

They weighed him and measured him and he's a pretty average guy. He was 44 inches (50th percentile) and 44 pounds (58th percentile). His blood pressure was 100/60 and his BMI is in the 67th percentile. He was actually shorter than the doctor expected him to be (he did have on a larger shirt - see yesterday's picture -so I think he just looked longer than that) and she asked the nurse if she was SURE. He is officially tall enough to ride Space Mountain in the Magic Kingdom and Expedition Everest at Animal Kingdom. I'm not sure if you're aware, but that is a mighty big deal.

We talked about his asthma - he has been OFF ALL MEDICINE for over a year! Praise Jesus! - and she's happy that he's doing well. He will have to have a pulmonary function test soon just to check. He had this done at 3.5 years old just to give a baseline, but it wasn't official because he was really too young to do it. 

He is also being referred to an allergist in town to RECHECK for food allergies. We could use some prayers on this one. We are PRAYING that he has outgrown all food allergies! His chances are less than 10%, but we've also easily avoided another reaction in three years and that's pretty great. {I say easily...those that care for him sometimes may not agree. I am a STICKLER for what he puts in his mouth and for reading a food label.} Anyway, we have our fingers crossed that skin tests and RAST (radioallergosorbent - the blood test) tests BOTH come back negative for food allergies. {He has passed a RAST before, but failed the skin test twice.} They'll do the PFT test at the same appointment.

I also have to make him an appointment with an eye doctor soon. This is what I alluded to last week. I didn't mean to cause panic, but I use this as my journaling/documentation for all of our "stuff" and I cannot tell you how many times I've come back to look at WHEN something occurred on here. NOTHING major at all, I didn't mean to be vague about it, I just wanted confirmation. A little over a year ago it was suggested to us that James might have some problems seeing colors. I can't remember if YaYa said something about it or if it was Anna. Anyway, we were at the lake and we pulled up some color blindness tests online and they weren't great, but he passed them. A few times since then we've had some "hmmm" moments with him about colors. Fast forward to last week. His teacher walked him out to my car {this is a rare occurrence because I pick up on the side of the building where Will sits and not where James sits so I almost never see James' teachers}. She said they'd been doing some color sorting and talking about rainbows for St. Patrick's Day and James was having some trouble differentiating between blue and purple. She said she thought he was just being lazy at first and lumping them all together and then she realized he couldn't distinguish between the two colors. His other teacher told her that she'd noticed something earlier in the year, but just hadn't said anything. A little history for you here is that I am a carrier for the color blindness gene. My dad is color blind so it is an inherited family trait. Because I'm a carrier, our boys have a 50% chance of being color blind and it looks like James got landed with that one, too. Poor kiddo. I mentioned it at his doctor's appointment and she told me to make an appointment to see an eye doctor because they'd be the one to handle it. She also wanted him to be seen before he's 7 anyway. His days without glasses are numbered. Eddie and I have TERRIBLE vision. CLEARLY, color-blindness is not a big deal in the grand scheme of things, but it will be something that we'll have to address at school each year. SO far, the only color we've determined he has trouble with is blue, but that doesn't mean he has problems with green and red as well. He knows what being color blind means because there's been some talk of it over the years, so we can't decide if he TRULY cannot see those colors, or if he's just saying he can't because he thinks that WE think he can't {and also the novelty of it...my little hypochondriac has something wrong with him and that's exciting! lol!}. Every time we've talked about color blindness I see Donkey from Shrek saying, "Blue flower, red thorns. Blue flower, red thorns. This would be so much easier if I wasn't COLOR BLIND!"

Overall it was a GREAT check-up. I love the questions that they come up with to ask to be sure kids are growing and learning what they should. Today they asked him what he'd do if someone knocked on the door and we weren't able to answer it, if someone called and he was home alone (seriously?), whether he buckles up, if he wears his bike helmet, and if he eats lots of fruits and veggies. I called him OUT on that last one and he told Dr. D that he DOES like vegetables - potatoes! She laughed at him. :) And she told him to work on that. We are proud that James is a big, healthy five year old boy. I had a flashback to carrying my boy in in his infant seat today. Five years have FLOWN by.

 {I remembered to ask about measles while I was there. I thought about MMR after the Disneyland measles outbreak and she said that Will - and other children - are fine because they've started MMR, but if we were to go somewhere where there are cases of measles then she'd go ahead and give him another booster. Adults are fine because generally most of us still have immunity. And on ANOTHER side note, Eddie, Anna, and I all got whooping cough in the summer of 2006 and adults DO need tDap boosters every ten years. She said often healthcare providers want to just give you tetanus, but to find someone else if they won't offer you the tDap booster. Interesting...Whooping cough was the worst illness I've ever had. I didn't feel bad, but HOLY MOLY it was miserable.}

Allergy Update - FAQ!

I know that most of you reading this could NOT care less about James' allergy issues, but I've actually gotten some emails from people recently that have asked really great questions so I thought I'd answer those today. I am not an allergy expert, this is just our opinion and the way that we've done things for James. Feel free to ask questions in the comments or email me!

The first question I got is actually one we answer often: 

Why can James eat at Chick-fil-A? 

{Actually I think the real statement was: James must not REALLY be allergic to nuts. He eats at Chick-fil-A.} {Chick-fil-A fries their food in peanut oil.}

So the REAL answer is the James is NOT allergic to peanuts so this wouldn't be a problem anyway. :) He has an allergy to tree nuts which is an entirely different food. We have been told to avoid peanuts and peanut products, BUT highly refined peanut oil takes the protein out of the oil {that's the part people are allergic to} so Chick-fil-A is supposed to be safe even for those with a peanut allergy. I have friends that swing both ways on this issue. Some have no problem eating Chick-fil-A and some won't step foot in there. For us, however, it isn't an issue. We HAVE seen pecan oil at the farmer's market and that's not something I'm willing to give him.

The second question I got was:

Why hasn't James ever had a bad reaction? He must not really have an allergy. / He must be outgrowing his allergy.

So the short answer here is that he HAS had a bad reaction. Click HERE to read what started all this and enjoy those pictures. Those pictures are a reaction to less than one cashew. It didn't cause anaphylaxis, but it did cause MAJOR hives, swelling, and vomiting. The longer answer is that Eddie and I have been very, very, very diligent about researching restaurants, reading ingredients, avoiding places and foods, etc. We are VERY strict about what he can and cannot eat. This is a child who is not allowed to eat birthday cake from a bakery. I've dug cake boxes out of trashcans before to read ingredients at a party. We are fairly thorough when it comes to reading ingredients. We also ask his caretakers to do the same thing. His teacher texted me pictures of the ingredients each day they had food at school. He had a box of "emergency treats" at school for birthday parties he couldn't participate in. The scary part is that we don't KNOW how he will react to the other nuts he's allergic to. Will it be a minor skin reaction? {Hives are still awful.} Or will it be the one that sends us to the emergency room? We should have gone to the emergency room the first time. If your child has a reaction like that, TAKE him/her. Don't worry that it's not "bad." Just GO! The people at the ER see other patients who have the sniffles. This is major compared to that. To answer the part about outgrowing his allergy, there is less than a 10% chance that he will. We just don't know. He hasn't been retested for anything so we've still avoided foods that could be triggers. Typically, for those who don't outgrow it, allergies get worse and reactions happen faster every time. That's why we're so cautious about having a reaction in the first place.

The third question was:

My child has just been diagnosed with asthma and I remembered that James has it, too. How have you handled it?

I am so NOT the person to ask about asthma. James was on a nebulizer for several months before we moved him to inhaled steroids. He's been off of his asthma medicine for MONTHS {except for last weekend when he saw his bag of emergency meds with YaYa and took it because I'd forgotten to send instructions} and has done fine. I keep expecting him to get sick because it's grass season and he is HIGHLY allergic to grass. See exhibit A below. If he gets wheezy or gets a cold or just a runny nose we start back on meds, but he has been super healthy recently {yep, it'll bite me next week for saying that!} so we've just not taken medicine in the past few months. I figure anytime we CAN get a break from it, we should! {Actually, that's not true. We really need to be on an antihistamine 100% of the time because of food allergies. Whoops!} Our pediatrician has totally taken over our asthma diagnosis but she wasn't concerned about it. If we ever get back to the point where he's coughing so much that he's throwing up at night, we'll work on a new plan. For now, he's great!

This is a reaction to grass. GRASS! Just playing outside during grass season last year. Crazy. {It's grainy because it's a backwards selfie. Someone got my phone but I realized it was fairly good documentation.}

Okay, and the last question!

How did you handle sending James off to preschool with a severe allergy? We're going in the fall and I am so scared to leave her!

This was a big, "Let go, let God," thing for me. I am very, very, very upfront anytime I drop James off for anything. Like annoyingly so. I'd rather people talk about what a crazy nut I am and NOT feed him things he can't have than be quiet about it, him have a reaction and someone not know what to do. With preschool, we chat with his teachers at orientation and then I sit down and write them an email so they can read it at their leisure. {Open House is just chaotic.} The first teacher he had told me she didn't know what an EpiPen was and blew it off. If I'd been braver back then I would've picked James up and unenrolled him IMMEDIATELY. And I should have. She was a nightmare. Instead, I went to the office and told the director about it and she made sure the teacher knew. The second teacher we had was a God-send. For real. He knew what we needed and He provided. I prayed all summer for her. She had a latex allergy and had to carry an EpiPen so she knew exactly what to do if a problem came up. Last year his teachers had no clue but they were AWESOME. They asked about everything and texted often about things in the room. They were wonderful. James has gone a handful of times to preschool camp and he went to VBS this summer. This means people who don't really know him are with him for just a small amount of time. For all of it, I've taken him his own snack. At VBS I could check things and let him have some things that the others were having. One day we swapped out the Graham Crackers and icing they were having with a different kind and it was fine. Brand to brand everything varies so we ALWAYS check. At camp it's been the same. One week he had to eat the snack I packed, another week he could eat what was provided. {I will say that his second year of preschool they took turns bringing snacks and that was nerve-wracking for me. Opt out of that if you can.} 

If you have other questions, comment or email me and I'll try to answer! It's so much easier now that I have a handle on things. And it will be a TON easier when James can READ. :)