Wednesday, June 24, 2015

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!!!

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