Only Sometimes Clever

Yesterday, we finally had Fiala’s appointment with the “pediatric dermatologist.”  I put that in quotes, because, as I perpetually have difficulty obtaining usable information from Cigna’s website, I had called their helpline to get the name and number of a pediatric dermatologist, via a real person.  What that person gave me was the name and number of a pediatric allergist.  That’s OK, mostly, though I was taken aback that it was not until the exam room with the doctor, talking with him, that I discovered that he was not a dermatologist, but an allergist.  I also feel weird that, even though I talked fairly extensively with a nurse from the doctor’s office over the phone, the discrepancy between specialties was never brought up, even thought I know I said “pediatric dermatologist” to her, and expressed my surprise that a pediatric dermatologist would also, as a matter of course, offer to do skin testing during the first visit.  No matter, as it is likely that an allergist was of more help to us than a dermatologist.

I think the doctor must have read notes of my conversation with the nurse, because one of the first things he said to me was, “I know you want to treat this as naturally as possible.”  However, long story short, I left with a sheaf of FIVE prescriptions, advice for two additional OTC medications, and the full awareness that the doctor did not have much faith for the full healing of Fiala just from me altering her diet and mine.

My plan, after discussing it with my hubby, is to use one of the prescriptions (Keflex, as the doc did say that her face was infected with staph, just from looking at her, not from a culture), and for the next two weeks, avoid the foods we discovered, though the allergist, that she is also allergic to.  After the two weeks are up, if there is not significant improvement, we’ll go ahead and use the other prescriptions until the next appointment with the allergist, and ask for additional testing.

They gave me several sheets of lists of possible allergens, and asked me to circle the items to which I suspected she was allergic.  I had no idea how many or few to circle, so I did about 15 or 20, all food.  They added a number of environmental allergens, too.  The nurse did a prick on my arm to let me know how badly it hurt;  it didn’t.  In fact, when they were pricking Fiala’s back, she was curious, but not even in apparent discomfort, let alone pain.

I am taking the allergy results seriously;  we still need to follow up with RAST blood tests to each of the items for which she tested positive (we were to go to the lab following the appointment, but Fiala fell asleep, and I couldn’t bear to wake her).  However, the doctor nearly blew off my discussion about food intolerances vs. food allergies.  He just said that, yes, there are food allergies that take longer to show up, and if we want to, we can — at a later time — do patches on her back, to hold potential allergens against her skin for a longer period of time, to see if there’s a delayed reaction.  I must have misunderstood the information given to me over the phone, because I could have sworn that the nurse told me that the doctor would gather info on Fiala’s immediate reactions, PLUS I would view the allergic reactions at home so that we could know her quick reactions and her slower-to-surface reactions, all in one fell swoop.  I was incorrect about that;  the doctor’s appointment on Friday was just for her immediate reactions, and all the marks and serum were wiped off her back before we left for home.

I really didn’t know — outside of a few suspects — what to circle to have her poked for.  They said that the next time we come in, we can do some additional ones, especially if it seemed like we hadn’t pinpointed all of them.  That’s good, I guess.

So, the results are that she tested positive for banana, egg, milk, almond, and yeast.  Very surprisingly, she tested negative for soy and pecan.  I have most definitely seen an improvement in Fiala’s skin and digestion since taking soy out, so I will continue to omit that from our diets.  She also tested negative for all environmental allergens, which was a great relief to me, since those are much harder to control.  She also tested negative for corn, potato, and rice.  I can’t remember what else I had them test for, outside of avocado…

What we are going to do, based on the doctor’s recommendations:

1. eliminate allergens
2. take Keflex
3. give Fiala a daily bath (previously, I bathed her 3x/week)

What we are not going to do:

1. Use Pulmicort in our SVN (breathing machine) 1-2x a day, as a preventative.  (Since taking her off of soy about 3 weeks ago, she has not needed any breathing treatments, nor had any asthma attacks.)
2. Use Albuterol every 4-6 hours “as needed.”  Well, we’ll use it truly as needed, as we have for the last several months, but as mentioned above, though she is raspy/rattle-y with a bit of congestion, she hasn’t had coughing fits/asthma since taking her off of soy.
3. Use Protopic on her face twice daily.  Actually, as a treatment for eczema, I’m more of a fan of Protopic — which is a topical immunosuppressant — than I am of topical steroids.  However, before we use any of it, I want to see how great her improvement is with just dietary changes.
4. Use triamcinolone (topical prescription steroid) on her body 2-4x/daily.
5. Use Zyrtec (OTC) syrup 1-2x/daily

What we were doing that we will continue to do:

1. Still eliminate soy (and gluten, of course), in addition to the allergens for which she tested positive.  I have previously been off of egg, but had gone back on.  Same with nuts, though it was like on, then off, then on, and now off again, even before yesterday’s appointment.
2. Use Benedryl liquid, as needed, for extra-itchy nights, especially.
3. Use the homemade olive oil and beeswax salve on her.  The doctor did agree that it can be very hard to find an effective, non-irritating lotion or salve.  He recommended Vanicream (which, last I checked at Target was more than $15!), but he said if my homemade salve is working, to go ahead and use it.

Out of all the allergens, the one that concerns me the greatest is yeast, as that can be very difficult to eliminate.  I was very surprised that her skin tested positive for that.  However, though I’m eliminating yeast from bread, I’m going to wait until I get super-concerned until I get the results from the RAST test.  Her skin reaction to yeast was only redness (erethyma?), and not a raised bump, so I’m hoping that ends up being a false positive.

If taking banana and yeast out of my diet — which are the only things I haven’t ever tried before — (in addition to the other items) doesn’t have any kind of impact after two weeks, I will go ahead and use Protopic for the two weeks leading up to our follow-up visit, and ask that we test her for both additional immediate allergies, and get patches for more long-term ones.

With the doctor himself, the thing that I’m of most concern, long-term, is the thing about him not really giving much credence to food intolerances;  he just equated them with allergies that take longer to surface.  Anyone have thoughts on that?  And, if an allergist is not the right kind of doctor for food intolerances, what is the right kind of doc??  Secondarily, I’m concerned about him talking out of both sides of his mouth — i.e., him saying, “I know you want to treat it naturally and I support that,” then following that up with, literally, “Use these SEVEN drugs on your baby.”