A Long Night in the ER

So here's what happened.  We were at my mom's for Sunday night dinner.  The kids were starving, as dinner was somewhat delayed, and I was coming down with something so it had already been a long day for me when we sat down to eat around 6:15.

Addi had already had a few helpings of salad because that was first to come out.  Tristan sat down, famished, after being too preoccupied with video games to notice that his stomach was grumbling like a volcano about to erupt.  He reached for some salad, then eyed the appetizers that came out next.  They were polenta rounds with a savory topping, an extra tray of something my stepdad had made for a party that afternoon.  "Are they safe for Tristan?"  I asked.

"Yes," he said, nodding.

He has cooked for Tristan a million times.  For some reason, I had a bad gut feeling about it.  Over a matter of a few seconds, my instincts had told me that (1) we had never let Tristan try this particular dish before so I wasn't familiar with it, (2) I hadn't asked exactly what the ingredients were, (3) the dish wasn't meant for him, but rather, a non-allergic guest list, and (4) polenta is often paired with cheese.  But Tristan was so hungry and so willing to try something with mushrooms in it, that I let that momentum overtake my instincts. 

In less than a minute, Tristan was complaining that the dish was "spicy."  I had tried one earlier and had not noticed any spice.  This is a very common first reaction Tristan has to ingesting an allergen.  I wasn't sure, but gave him a Benadryl anyway.  I kept asking him, "How does it feel now?"

"It's spicy, really spicy all over my mouth!"

I was starting to get nervous.  Then, "My stomach hurts!"

"Does this have cheese in it?"  I quickly asked my stepdad.

"Yes," he replied.

I rushed Tristan over to the sofa with a plastic bag.  He started complaining about pain in his stomach.  "Try to throw up," I was saying, over and over again.  He wanted to, but he just couldn't.

As the complaining turned to screaming, I started getting really anxious.  "How is your throat?  Are you having trouble breathing?"

"My stomach just really hurts!" he kept saying.  In a few minutes, Tristan looked at me and said, "My throat is starting to hurt and my breathing is getting hard."  I ran to get the EpiPen and administered it, while he sobbed.

He felt almost instantly better.  We've landed ourselves in the ER after administering an EpiPen a couple of times now, and each time it had felt like a long 4 hours of waiting around and watching a few movies.  I was feeling sinus and body ache, had two other kids to get fed and to bed, and I just really didn't feel like going to the ER.  Tristan was already back to reading the book he had brought along, and I had a fleeting thought to skip the ER.  "Why do we have to go to the hospital, mom?"  Tristan asked as I was contemplating my next steps.

"Well, we go just in case your symptoms come back," I told him.

"Then I think we should go, just in case," he advised me.  My 8-year-old was right.  It was protocol and it was the right thing to do.

Once we got in the car, he asked for the bag and said he felt like throwing up.  His stomach was starting to feel nauseous again, and I knew we had made the right decision, just in time.

When we arrived at the ER, all I had to say was "anaphylaxis," and they admitted us immediately.  They hooked him up to the monitors, and started asking questions.  He was still feeling nauseous, but was well enough to ask for the DVD binder once the nurse had left the room.

The plan was to give him some Zofran for the nausea, then a steroid.  Right before the nurse came in with the meds, Tristan threw up into the plastic bag we had brought along.  The nurse gave the oral Zofran, but after 10 minutes of still experiencing nausea, they decided he wasn't well enough to take the steroid orally.

Plan B was to give the steroid through an IV.  At the next check, his throat was still bothering him and his stomach pain had not gone away, so the team made the decision to go ahead and give another Epi injection.  Then, they set him up with the IV, through which they administered several drugs over the next few hours--Prednisone (steroid), Pepsid, and Benadryl for a rash and hives that had developed and was ill-treated with ice packs. 

After about 2 hours in the ER, Tristan was feeling much better.  He was hungry.  He hadn't had a chance to eat much dinner, and whatever he had eaten that afternoon had been vomited out.  He wanted crackers and juice.  About 10 packs of crackers later, he was smiling and ready to dig into some "real food," some chicken sausages that my mom had brought in as reinforcements.

After a couple of hours in the ER after accidentally ingesting cheese, Tristan is covered in cracker crumbs and on the way to a full recovery.  Hives and rash that had developed while in the ER had disappeared thanks to the meds.

With a full belly, he started getting sleepy.  But his blood pressure had dropped, not out of range for his age, but lower than what he'd been trending so far.  So they administered liquids for hydration through his IV.

After another hour, no change in blood pressure and no other symptoms, they decided he was fit to go home.  It was possible his normal blood pressure was on the low side, and he seemed to be sleeping comfortably. 

One AM in bed never felt so good.  We are so thankful for EpiPens and for the doctors and nurses at the CPMC Pediatric ER for their wonderful treatment.  Thank you for saving my child's life.

The next day in the pediatrician's office for his follow-up--Tristan is all smiles.  The doctor recommended we ask our allergist about shots in the near future.

Upon reflection, I don't know if I should conclude that this is the life of a food allergic kid.  And that having a food allergic kid means accidents will happen.  Maybe his allergies are growing more severe,  maybe he'll grow out of them and maybe he won't...should we expect to just live each day as it comes, be prepared, and try not to let guilt pull us down?  Should there be a more invasive next step?

I do know that being alongside my son as he has been faced with a number of possibly life threatening situations allows me to each time regain clarity in life.  I've been able to reassess what is important and what isn't, to think about our core values and what I want my kids to learn from growing up as a part of our family--empathy, love, kindness, and caring for one another.

It's possible that Tristan's food allergies are part of why he has always been so exuberant about life, seizing every opportunity to try something new or different, ideas constantly swirling around in his mind.  "Oh, I know!" is a common exclamation heard around our house.  Of course, that phrase can be heard on a lazy Sunday afternoon or at the most inopportune time such as bedtime, homework time, middle of his brother's tantrum.

To see life through the vulnerability of a food allergy kid is the greatest gift he could ever give me, filling me with courage, grace, and empowerment.  

The kids have been pretty good this year, and their stockings were certainly filled to the brim with goodies; as for me, I've already gotten my gift.

Baked milk challenge - the results are (kind of) in

I posted last week about readying the kids (and myself) for a baked milk challenge.  Our hope was that passing the baked milk challenge would allow us to start gradually introduce baked milk in their diets, which research has shown, may open the door to outgrowing their milk allergy down the road.  So how did the kids do?

We came.  We scratched.  We reacted.  We didn't eat.  :(

Yup.  The kids did not even pass the initial skin test in which they get a tiny prick and the baked milk item is applied directly onto their open skin.  The kids had to pass the skin test  before it was deemed safe to proceed with the riskier eating of a known allergen.  So the kids didn't really get to take the "food" challenge. 

The outcome of the baked milk challenge was disappointing but informative nonetheless.  The kids' allergist had had the forethought to order skin testing for peanut and tree nut allergies since the kids were already going to be getting pricks for the baked milk.  So we did learn more about the kids' allergies from the visit. The results of Ryken's tree nut allergy tests were consistent with the history of his blood tests:  significant allergic reaction to walnuts and pecans.  He did not react to any other tree nut on the panel.  (Ryken did not undergo a scratch test for peanuts.  Our allergist explained that results of the IgE blood allergy test for peanuts are very predictive of whether someone is allergic to peanuts.  He registers as severely allergic to peanuts so there is no need to put him through an extra, risky test.)

Ryken: 5 and 6 are pecans and walnuts. Far right is the baked milk.

Callan's results were the most eye-opening to me.  According to our allergist, a wheal size between 0 and 2 is considered a negative reaction to the skin test.  While Callan did measure 1s and 2s for almonds, brazil nuts, hazelnuts, pecans, walnuts, pistachios, and peanuts, none were considered reactions.  He tested negative to peanuts and all tree nuts!  The numbers of Callan's previous blood IgE allergy tests had indicated mild allergies to most of these nuts.  Also significant to me was seeing that Callan developed a larger wheal in response to the baked milk than Ryken.  This info followed by a rash on his face from being touched on the face by a child eating a buttery cookie confirmed to my husband and me that Callan's milk allergy is growing more severe.

Callan: the upper left is the control histamine.  Far right is the
baked milk. All clear for the peanuts and 7 tree nuts tested!

The world of allergy testing is still a confusing one for me with different kinds of tests.  Our allergist thinks that we can look upon the skin and blood testing as complimentary but she does believe that the skin test is a better predictor on whether someone does indeed have a food allergy.  She was quick to point out that the skin test is still not 100 percent accurate and told about a patient who had a very strong skin reaction but ended up passing the food challenge without any incident.  Food allergies are such a complicated problem.

In light of Callan's results, we have scheduled a peanut food challenge for him for next month.  It certainly will be a challenge as Callan was very resistant of going through with the allergy appointment this time.  I hope he passes -- not that we would bring peanuts into his diet or into the house with Ryken's strong peanut allergy.  But it would give us some peace of mind if we knew he wasn't at a heightened risk for an allergic reaction when he starts grade school next year. 

My kids have both been consuming almond milk and store-bought almonds without problem.  I plan to continue this.  However I don't foresee introducing any other tree nuts into the kids' diets.  I feel better about not increasing the risk of eating something that may have had cross contact with nuts unsafe to Ryken.  Yeah, I know, I am taking a bit of a risk with almonds but I am hoping to keep this one source of nut protein available to us.  We definitely have our EpiPen Jr. sets with us at all times. 

Baked milk challenge - Here we go....

Today is a big day for us.  The kids will take a baked milk challenge under the care of our allergist. 

Yesterday I set out to bake muffins in preparation for today's challenge.  It was my first time buying cow's milk for our family in several years.  As my youngest sat in the cart with the groceries, he looked at the jug of milk with curiosity -- a forbidden fruit for so long -- and instinctively reached out to touch the cold plastic encasement.  I firmly explained to him that he still needs to be careful because (1) he has a contact allergy to milk and (2) he hasn't even taken the baked milk challenge yet so nothing has been proven safe yet.

After school I really dragged my feet with making the muffins.  Usually I love baking -- you can hardly keep me out of the oven for three days straight without me emerging with some piping hot, sweet goodie.  But yesterday I just wasn't feeling it.  Was it anxiety?  Was it the possibility of our regular avoidance routine being turned on its head, even though it would be for the good?  I wasn't sure.  But when I finally got cracking with the muffin task, I felt totally out of my element.  I realized I was missing a key ingredient (applesauce), ran dangerously low on another (flour), and I couldn't find any muffin liners.  I did remember that I had Halloween muffin liners in our holiday decorations box -- liners adorned with skulls.  SKULLS. Great.  Just perfect for holding a potentially dangerous muffin.

I kid you not about the skulls.

I should backtrack a bit.  


Earlier this year the kids' pediatrician recommended I see another allergist, Dr. Y, within our medical group to get a second opinion on the kids' allergies.  I was all for it.  After all, in the seven years since we first discovered Ryken's milk allergy, the recommendations on how to address and possibly head off full-blown food allergies have changed.  Seven years ago, strict avoidance was the rule and kids susceptible to food allergies were recommended to wait until the age of 3 to try certain foods such as nuts.  In talking with friends and families who are expecting or have food allergies, it sounds like many doctors are advocating the introduction of some common food allergens early on.  A cousin whose her eczemish son tested positive for a peanut allergy at 6 months was advised to expose him to small amounts of peanut butter.  Another doctor whose eldest had a dairy allergy introduced baked milk products to her youngest at an early age.  (Both kids are doing fine under these doctor-recommended courses of action.)  Make no mistake, there definitely isn't agreement on treatment.  There is no cure but much more promising studies that need more time, and research that suggests that for some people, gradual exposure to allergens in certain forms may help them overcome those food allergies down the road.

We went to see Dr. Y for the first time.  Dr. Y explained to us that individuals allergic to milk may often be able to tolerate milk when it is baked as the heating process as the extensive heat changes the shape of the milk protein and the body may no longer recognize the protein as a foreign substance to attack.  After discussing food allergies and a harrowing blood draw experience for both boys, we found the results of my oldest Ryken's IgE blood test for milk allergy at the lowest it's ever been, dropping below a 25.  At Ryken's and Callan's current IgE levels, they have around a 70 percent chance of passing a baked milk challenge.

I jumped at the chance of having the kids undertake the baked milk challenge.  I have had roughly 10 weeks between our last allergy appointment and today's food challenge to warm up the kids to the idea of taking it.  (Last appointment's traumas:  Ryken hid behind the examining table for 10 minutes to avoid a blood draw.  Brave Callan finally broke down in wails after being needled in both arms when the phlebotomist couldn't find a vein in the first.)  The kids are finally ready.  I am a firm believer in telling it like it us and not tricking my kids into thinking something is fun or painless.  So the kids are fully aware that there will be skin prick tests and, hopefully, the eating of something they have not eaten before.  They know we will be at the doctor's office in the care of many trained professionals that will do everything they can to monitor and minimize risk.  They also know there will be DVDs, books, drawing time, and a No School Day at the doctor's office.

The muffins are ready.  The kids are ready.  Am I ready?  I think so.  Avoiding milk has been such a big part of our lives that I'm not sure how I will react if the kids get to take that first bite.  Horror?  Excitement?  Tears of joy?  Whatever the emotions may be, I will embrace them in this bumpy journey living with food allergies.

Chocolate Coconut Brownies - rich with flavor but not with the top allergens

These brownies taste even fudgier after refrigerating them overnight,
if you can stand to wait that long!

The other day I was browsing (because who has the luxury to read?) through a magazine.  I came upon a restaurant review and a dessert photo, a brownie dolled up with all the trimmings.

Brownies.  Classic.  Decadent. 

I love brownies but I also fear them.  Fear because if I'm making them myself --which I usually do because, dang it, I'm too cheap to shell out $3 for a tiny square of a piece -- I worry that my batch won't live up to my expectations.  And it's hard to tell from a recipe what type of brownie you're going to end up with.

You see, there are two distinct sides in the spectrum of brownie types: the dense, fudgy kind and the more conservative cake-like brownies.  I myself am a fudge-leaning type.  I don't like a greasy brick of heavy fudge but I definitely prefer a very moist, slightly chewy brownies to something that is light and fluffy.  I never like brownies that are covered with frosting or icing, ways that artificially moisten the eating experience in my opinion.  I prefer a naked brownie that can stand on its own chocolaty merits and that can definitely not be mistaken for its cousin, chocolate cake.

One impact on a brownie recipe's texture is in the presence of a leavening agent.  Brownie recipes with more baking powder or baking soda will bring more rise and more of the airiness that cakes exhibit.  The dense, fudge-like brownies and many chewy brownies (I consider the chewies a little left of center) tend to do away with any leavening agents.  Bake time will also affect the texture -- more time in the oven can lead to cake-like treats.

In my life before kids with food allergies and plant-based eating, my go-to chocolate brownie recipe was on the back of the Tollhouse Cocoa container.  Oh my, I LIVED for those brownies!  I tried to find a worthy alternative that was free of milk, eggs, or processed margarine (even if it's vegan) but the texture was always a bit too dry like cake or the flavor just wasn't quite right.

I finally found love in a new recipe that incorporates shredded coconut and coconut oil.  I was hesitant at first because I enjoy my brownies straight-forward, no fuss or fancy ingredients, and including coconut stuff seemed a little faddish.  But I had the ingredients on hand so I gave it a try.  These brownies were not the same as the Tollhouse brownies but they still were terrific!  You can make them with strong coffee to intensify the chocolate flavor or substitute the coffee for additional safe milk.  I have tried it both ways.  While the coffee version definitely does add more punch to the chocolate, I prefer to add less punch (and caffeine) to my kids' bodies!  Just after one piece, they were bouncing off the walls and I was wracked with mommy guilt for exposing them to a heightened amount of caffeine.

Two coffee-infused batches: one using white whole wheat flour
and the other using a wheat-free/gluten-free flour blend.  I forgot
which was which, even when I was eating them!

Chocolate Coconut Brownies (can be made free of milk, egg, soy, wheat, gluten, peanuts, tree nuts)
Adapted from DomesticFits' recipe for Chocolate Coconut Brownies

1/3 cup coconut oil, softened (melted is okay, too)
1 cup maple syrup
1/2 cup safe milk substitute (I have used flax milk, soy milk, or almond milk with good results)
1/3 cup strong coffee or additional safe milk substitute
1 Tbsp vanilla extract
1 cup dark cocoa powder
3/4 cup flour of your choice - I have successfully used white whole wheat flour and, on another occasion, a GF flour blend with a scant 1/2 tsp xanthan gum added.
1/4 tsp baking powder, optional
1/2 tsp salt
1/4 cup shredded coconut (I use Let's Do Organic shredded coconut, which is dry and finely shredded)

1. Preheat oven to 350 degrees F.  Grease or line an 8"x8" square pan.
2. In a medium bowl, combine softened coconut oil, maple syrup, milks/coffee, and vanilla extract.  Do your best to break down any chunks of coconut oil.
3. In a separate bowl, whisk together cocoa powder, flour, baking powder, and salt.  Again, break down any clumps of cocoa for more even mixing.
4. Add shredded coconut to flour mixture.
5. Combine wet mixture with flour mixture.  Carefully scrape, spread, and stir the batter just enough so that no lumps or streaks of cocoa/flour are visible.  The batter will not be completely smooth and that's okay.  You don't want to overmix your brownies or it may yield a tough texture. 
6. Pour batter into the square pan.  Bake in preheated 350 degree oven for 18-23 minutes or until the texture of the outer edges of the brownies are looking cake-like.  I have baked them for about 20 minutes when about a 1-inch-wide border of brownies looks done (crackly) and springs back from my touch.  The center of the pan should be dry to the touch though it should not be springy or have the cracks that a baked cake would have.
7. Cool brownies completely before cutting.  The brownies taste even richer if you have time to refrigerate them before serving.  For fudgiest results, store in the refrigerator.

I took the brownies above out of the oven at about 22 minutes.  Two inches of the outer edges are cracked and more cake-like.  The depressed square in the middle was nice and fudgy.  Next time I'll take them out at 20 to yield more fudgy brownies.

Pumpkin Refried Beans

Canned pumpkin.  I am obsessed with you.

Tostada with pumpkin "refried beans", corn, sliced avocado, and chopped
kale and tomatoes.  Don't forget the cilantro and lime juice for garnish.

And how can I not be?  It's full of vitamin A and fiber and Trader Joe's sells an organic variety in BPA-free cans. As soon as Trader Joe's stocked its shelves with the stuff at the start of the season, I stocked my own pantry with several cans.  I've been doing pumpkin bread, pumpkin cupcakes, and pumpkin soup.

One day I was preparing to make some vegan Mexican food, a usual suspect in our weekly meal rotation.  I scoured the pantry for cans of refried beans and discovered that I had none.  And we were already settled into our afterschool down-time routine, too late to make a quick shopping trip with the kids without incurring major protests and drama.  This was a time when I would just have to "make it work" with whatever we had.

We didn't have the beans but we did have that canned pumpkin.  And the consistency of the pureed, packed pumpkin wasn't too far off the beans.  Could I interchange the two?  I decided to find out.  I added some spices that you would typically find in a taco seasoning packet to give the pumpkin some Mexican flare.  In many recipes the recommendation was to add two parts chili powder to one part cumin.  My younger son, Callan, refuses to eat anything with a hint of spiciness so I ease up on the chili and put only half the amount in.

Pumpkin Refried Beans
Spice mix adapted from Bill Echols' taco seasoning recipe on AllRecipes.com

14-oz can of pumpkin (not pie-spiced)
2 Tbsp chopped onions
1 garlic clove, minced
1 1/2 tsp cumin
1 1/2 tsp to 1 Tbsp chili powder
1/2 tsp paprika
1/2 tsp dried oregano
3/4 tsp salt
up to 1/4 cup water

1. In a medium microwave-safe bowl, combine all ingredients except for the water.  Stir in 2 tablespoons of water.  Add a little more water at a time until you get the thin/think bean-like consistency that you desire. 
2. Microwave on high for 2 to 3 minutes or until the pumpkin mixture is very hot and just begins to bubble.  Stir and microwave for an additional 1 to 2 minutes to further cook the onions.
3. Use as a layer on tostadas or as filling in tacos or burritos just as you would refried beans.

After eating half of a tostada, my oldest son Ryken asked, "Mom, what did you use to make this?"  I casually answered, "Canned pumpkin. We didn't have any refried beans."  "Oh," was all he answered.  He could tell there was something different but apparently he didn't mind one bit.  Phew!

As for my Callan, well, he wasn't a fan.  But Mexican food is not on his list of favorite foods to begin with.  He is just starting to like bean burritos but only if enough Daiya Vegan Shreds are involved.  As with many things related to kids, you win some battles and you lose some.

Do you have some leftover cans of pumpkin in your cupboard?  Give this a try and let me know how you like it.