The allergist and his extracts

CC picks dandelions in our courtyard

A few months ago, I read the Alchemist by Paulo Coelho. It is a very profound allegoric novel. Prior to reading this novel, I had never heard of an alchemist. Upon reading the description, I thought immediately of our modern-day allergists with their countless vials of extracts. As a medical student, I had observed a pediatric allergist test his young patients for a number of foods, pollens, and antibiotics. The skin testing used by allergists is considered somewhat controversial as a food allergy can be inferred based on your skin's reactivity to an extract (and not ingestion).  In the more common version of the test, the allergist applies the purified extracts to the skin, then either scratches, or pricks the skin under the extract.  The excess extract is then blotted with a cloth. After a 10-20 minute delay, the allergist measures the skin's response to the extract. Positive and negative controls are also used (histamine and water respectively).

Example of skin testing on forearm

My observational stage with the pediatric allergist took place eight years ago, and I would have never imagined that I would be consulting, within ten years, a pediatric allergist for my child.  Food allergies are very rare in both my husband and my families, so I was very surprised to discover that our daughter reacted with a mild rash to dairy products.  We have been avoiding dairy since I made this discovery. I was hoping that like many children with dairy allergies (up to 80%), she would "grow out of it".  I was not too worried until I discovered that my baby was also allergic to peanuts.  At the recommended age (in the absence of family history of peanut allergies) of 12 months, I introduced peanut butter. She only took one lick, but within a minute she developed a rash all over her body. I pulled her out of her highchair, and administered the appropriate dose of Benadryl. Within 30 minutes, the rash had dissipated, she calmed down, and fell asleep shortly thereafter. I did not sleep very well that night, although my daughter did, probably under the influence of the Benadryl. I was instantly worried because I realized that peanut allergies are often associated with life-threatening anaphylactic reactions. Shortly after this discovery, our pediatrican prescribed an Epi-pen for the baby, and referred us to a pediatric allergist.  I was perplexed by my daughter's peanut allergy. Not only was there not a family history on either side, but I had also avoided peanuts while pregnant and subsequently while breast-feeding. Breastfeeding has also been demonstrated in many studies  to reduce the risk of food allergy, and I had breastfed the baby up until a few weeks ago!

With much trepidation, we met with a pediatric allergist yesterday. Would I discover that my daughter was also allergic to other tree nuts, and a number of other substances that we had not yet tried? Would I be living in fear of an anaphylactic reaction for years? As it happened, the allergist tested only for dairy and peanuts. As she explained it, the risk of false positives and false negatives was high enough, that to test substances that our baby had not yet been in contact with might create false hope, or false fear. Even though the baby was overdue for her afternoon nap, she behaved relatively well for the skin testing. After the extracts, along with negative and positive controls were applied, the baby discovered a large toy truck in allergist's office. This occupied her time, and the 10 minute delay flew by. The allergist got out her special ruler, and declared the skin test positive for peanuts, but negative for dairy. I was somewhat relieved, as I had discovered just how ubiquitous milk products were. Whether in the guise of caseine, whey, or skim milk products, dairy was present in a large number of prepared foods, including lactose-free products. I got the OK from the allergist to re-introduce dairy products such as yogurt and cheese. As for peanuts, the allergist would be re-testing at 31/2  to 4 years of age. And as for other tree nuts, she suggested that we introduce minute amounts of crushed nuts, gradually increases the quantity to a full nut after a few days.

While I have been in no rush to test other nuts, I have already successfully introduced yogurt and cheese sticks. But mostly I am happy I can kiss my daughter after having ingested dairy, and not have to worry about transmitting allergens into her system.  As for Peanuts, thankfully we live in an environment that is relatively conscientious of nut-allergies. Many food products geared towards children mention the words "may contain traces of peanuts", or alternatively "peanut-free". I was surprised to learn from the allergist the other terms for peanuts that may be used in ingredient lists: earthnuts, ground nuts, goober peas, monkey nuts, pygmy nuts and pig nuts. The good news, said the allergist, was that our baby's response to peanuts, although positive, was relatively small. This meant that her chances of falling into the 20% group of children that "grow out of" peanuts allergies was good.

Until then, I have a feeling that I will be attending all birthday parties, restaurant outings and after-school activities with my daughter. Or prevent her from attending. I am turning into my mother (see last post), but at least I have a valid excuse!

Sleepless in Toronto

CC enjoying herself during our absence

As I begin penning this post, I have been back in Montreal for three days. I thought it would have seemed like an eternity, but our long week-end in Toronto actually flew by. My sister and mother were continuously updating me with real-time photos and texts about the baby's activities. The baby seemed to have had a great time in their company; my guess is a few more days, and she would have forgotten completely about her mama and papa.

During waking hours, I did not have much anxiety. The photos, texts, and e-mails were very reassuring; and of course I knew she was in two sets of loving, caring, and experienced hands. The night was a different story.  Despite ingesting 50mg of Gravol on my first two nights in Toronto, my sleep was at best erratic.  I have come to the conclusion that I was anxious on a subconscious level.  How long will this last?, I ask myself. Will I still be anxious right up until my baby grows up and starts a family of her own?

I thought of my own mom, or "worry wart" as we called her growing up, as she would constantly agonize over my two sisters and I. She watched the news daily, and stories about kidnapped children fuelled her over-active imagination. We weren't allowed to partake in after-school activities, as this would only add to her anxiety. The school field trips we attended were infrequent. Neither were we allowed to attend any birthday parties. After about 20 years, my mother's anxiety seemed to diminish somewhat, and she even adapted to certain situations. I moved out when I was 21 so that I could live in close proximity to my medical school. She insisted on staying over the first three days and nights, but then slowly found her way back to her own house. During my residency, we would sometimes not speak for several days due to my irregular schedule. But then one day, I received a page at two in the morning. She said that I had not answered my phone, and that she had grown worried. I explained that I was on call, in the hospital, and unable to get to my home phone. I remember refusing to take any of my mom's calls for an entire week after this incident; this type of operant conditioning labeled extinction may work on some people, and many lab rats, but not so much on my mom.

A case in point, as recently as a few weeks ago, I had gone to the gym one evening while my husband enjoyed the baby's company. I had begun charging my phone before leaving, and neglected to take it with me. Upon my return home, my husband mentioned that he had received a text from my mom. I was not answering my phone, and she had gotten anxious.

Am I becoming my mother?, I ask myself. Will I ever learn to sleep again without relying on chemical agents? Growing up, I found my mother's anxiety stifling. While I have no plans to follow in her footsteps, I now comprehend her overbearing concern.

Countdown

CC brings me the lens cap

Monday June 6
We leave for Toronto in just four days, sans baby.  I find myself wondering if it is a good idea. While I fully trust my mother and sister to take wonderful care of her, will I be able to function without my baby?  I realize babies don't have a great sense of time, and for her four days might be just one really long day.  However, I am concerned that I will be overcome with worry, and won't be able to function, nor enjoy our mini-trip. At the very least, I should be getting more sleep that last night.  The Brat was up every two hours. This sleeping pattern usually heralds a virus, be we had a great, cold-free day today.

Tuesday June 7
As is often the case, one fitful night is followed by a calm night.  For only the third night since birth, she slept through the night!  9PM to 6AM.  Now if only I could learn to sleep earlier, as falling asleep at midnight still doesn't give me much sleep.  We had a great day today; we went for a jog, followed by a short trip to a very nice park in a neighbouring city. I have a feeling that the next two days will fly by, as I will be working both days. Three more days until our separation.

Wednesday June 8
I have put the finishing touches on the "baby care guide" for my mother and sister. This includes the baby's schedule, her preferred meals, emergency contacts, infant Heimlich and CPR. At last count, the document was ten pages long. I am beginning to think that I have gone a little overboard.

Thursday June 9
Today flew by. I packed, I went to work, and now I type.  We leave tomorrow. Normally I would be excited, but instead I find myself anxious. Whoever said Separation Anxiety was uniquely for infants?

Friday June 10
We bade our baby adieu a little after noon today, and headed for the airport. Once we checked in, I headed for the airport bookstore, and perused the magazines. I found myself buying a copy of "Today's Parent". "Really?", my husband asked.

As I type these words, we are about to go to sleep for the night, our first night away from the baby. I anticipate a difficult night for myself, and I have brought along some Gravol just in case!

Invasion of the Daycares

CC builds a sand castle

The foul weather finally cleared up, just in time for the last few days of May.  A few days ago, the sun was in full force, and we decided to head out to the neighbourhood park.  The park, once derelict, had undergone impressive renovations.  There are three sections, one play area for 1-6 your-olds, a play area for 6 years and up, and a water park, consisting of large animal-shaped sprinklers that children can run through.  On this bright morning, we headed to the 1-6 year-old section.  I erroneously assumed that the timing was right, that the neighbourhood children would either be in daycare or in school, and my daughter and I would spend a quiet morning in the park.  As we approached the park, I quickly realized that that would not be the case.  There were roughly 50 screaming children, wearing their daycare garb, scattered amongst two of the three sections of the park.  There were only four adult supervisors for the lot, and I started to quietly curse daycares for invading our neighbourhood park.

I decided to give it a go, despite the screaming children, and the equally screaming supervisors (why couldn't they call their charges in quieter voices?). We settled into the only available space, a small corner in the sand.  We sat on the sand, and played with the shovel and bucket.  My curious baby was intrigued by the older children, and the time flew by quickly.  One of the daycare kids, a boy no older than 3 came up to us.
        
   "Hello," he said.
   "Hi," I replied.
   "I live in a group," he said.
   "You live in a group?"
   "Yes, I live in a daycare group."
   "What about your parents?"
   "No," he replied. "I live in a group."

I simultaneously thought this interaction humorous and pathetic.  But most of all, it cemented my thoughts on daycares.  I am fortunate enough to work in a place that is open 24 hours, and I can choose to work week-ends and evenings, thus negating the need for daycares.  But mostly I want our daughter to grow up knowing she lives with us, not in a group home!