Oral Food Challenge

When I took Spencer in for an oral food challenge this month, I was hopeful that he would test negative.  In fact, I felt fairly confident that he would.  Since he was 1 year old, we have attended yearly appointments with the allergist.  Skin tests have been administered for milk, eggs, shellfish, peanuts, etc.  He has always tested positive to peanuts, and we have always avoided them.  His skin test ranged, but it was generally 20/30 millimeters which is moderately allergic.  He has been allergic to milk since first ingesting it at 6 months.  But, the peanut reaction was always more severe than the milk.  The catch was that he had never eaten peanuts or PB. 

Top hive is the control, bottom is the peanut.

At our latest appointment, he again had a moderate reaction to the skin test.  We talked at length about any possible accidental exposure.  I relayed a story about me eating a PB granola bar, Spencer and I sharing a water bottle and him developing what I thought was a hive on his lips.  I noted it when it happened, but thought it could've been a fluke.  

Before we could do the oral food challenge, the doctor wanted us to get a IgE antibody (RAST) blood test.  He also mentioned a new molecular blood test called Uknow peanut.  We opted to do both.  The Uknow Peanut was $300, but was the latest and greatest in tests.  It would not only tell you if your child was allergic to peanuts, but what type of reaction they would have. 

He 'passed' both tests.  Which is to say--both tests said he had no response to peanuts.  Paydirt!  The doc approved the food challenge, and we didn't hesitate in scheduling for that week.    

The food challenge is not without risk, of course.  And as such, it is conducted in the allergist office, and very tightly monitored over a 3-5 hour time period.  I brought a bag of toys and the iPad to entertain him.  The very first taste was perhaps an 1/8 of a teaspoon.  He reported that it made his tongue itchy.  I dismissed it, still in denial that he could be allergic. Every 15 minutes they check and administer another large dose.   After finishing the second dose he needed to poo.  Nothing abnormal for a 3 year old.  Except Spencer usually reserves his poo for at night, in a pull-up.  

The third dose he gets diarrhea.  I am not sure why at this point I can not see what is happening.  But, I am still blind to the signs.  Jeff has been with us up until now but he needs to leave to get Elliott from school.  I tell them to go ahead and head home after pick up and we will meet them later.  But, my Mommy intuition is sending out red flags.  I felt like asking him to come straight back and to hurry.  I felt nervous, very nervous.  But, instead, I ignore it.

The next dose, he says he might throw up, and starts coughing.  My anxiety level is high and all of the red flags have risen.  He then falls asleep in the stroller-there is a knot in my stomach. The nurse comments that he cant have an anaphylactic response if he is asleep.  I am only slightly relieved by her comment.  But also curious--is that true??

It is time for his next does, and when I wake him his eyes are red, swollen half closed and itchy.  There is a moment of panic amongst the doctors.  I feel like I might throw up, and feel like I am watching the events unfold from above.  They start discussing administering the Epi-pen, and I suggest we start with Benadryl.  I call Jeff and ask him to hurry back, I think he can hear the panic in my voice.  

The Benadryl kicked in quickly, thankfully!  By the time Jeff arrives at the office-it seems that the danger level had gone down from Red to Orange.  But, I was still a bit of a wreck.  Spencer on the other hand is up and around, playing and laughing once again.

This picture doesn't capture the severity of his response.  But, it shows the swollen eyes and flush face.

We spent a total of 4.5 hours in the office.  Between the test and the post reaction waiting phase (for up to 4 hours after a food in ingested a reaction can occur) we spent the better part of our days there.  The doctors could not explain why he tested negative on both blood tests but positive on the skin test and food challenge. 

But the conclusion was that he is certainly allergic to peanuts.  The allergist suggested that he could be allergic to a rare protein in the peanut that the blood tests don't test for.  He wanted to use our case file for research.  

I am pissed at myself for not listening to my intuition.  And for putting him through a traumatic and tragic experience.  It was super scary to watch, and heart wrenching when I look back on it.  I feel like I have PTSD from the experience, as every time I think back on it I feel anxious and sick to my stomach.  I am glad we know that he is in fact allergic so we can ensure he is safe in school and with others.  

The take home message for me was that he will have a reaction if he ingests peanuts, but it is a slow reaction.  Trust my gut.  And, science is awesome, but not always 100% conclusive.  Always carry Benadryl and the Epi-Pen.  

Trea's Birth story

The delivery was a c-section.  My choice. Many people will silently judge me for making that decision.  Many people will envy the fact that I was able to make the decision, when so often women are forced/coerced into having c-sections when they aren't medically necessary.  I chose this option.  The OB on-call tried her hardest to talk me out of it--reminding me of all of the benefits of a vaginal delivery and the possible complications of a c-section.  She was very positive, affirming and persuasive; and I love that she tried so hard to empower me.

Here is my story of why I chose an elective C-section for my final birth.

I was in tremendous pain for several days before the delivery-I've had pubic bone separation and hip pain for months that made walking, moving and standing painful. I have had this since early in pregnancy, however, the last week of my pregnancy was by far the worst.  On top of being in acute pain every time I moved, I was sick--headache, sore throat, fever and body aches.  I was exhausted and wasn't sleeping--3 nights running with little to no sleep.

The day before Trea was born, I had my 40 week OB appointment.  Every time someone touched me for the simplest of procedures I cringed.  My nerves were shot--and I was edgy.  I begged (and actually cried in her office) my OB to induce me on Fri morn. She agreed, after giving me the lecture on risks of uterine rupture (up from  0.5% to 1.5%) and other complications. I went home feeling excited about the next day and optimistic that there was an end in sight.  Tomorrow I would be holding my little girl.

Jeff's parents arrived that afternoon, and I spent the afternoon in bed, hiding under the blankets with a fever.  We got everyone settled for the night and I decided on a bath and then bed, as my indication appt was at 6am.  Best to get as much sleep as possible.  During my bath, I realized that I had not felt Trea move for a while...and she typically moved a lot!  I decided, for the first time in my pregnancy, to do a formal kick count.  I took 90 minutes and had only felt a few movements.  I freaked out.  I made Jeff take me back to L&D to be sure she was OK.

She was fine, but I wasn't.  I was panicked, my heart rate was high, and I was on edge.  I was scared and exhausted.  We spent a good portion of the night in L&D waiting for tests and doctors.  They were very busy with many women in labor and delivering.

I decided then, just a few hours from my induction, and after considering my mental and physical state, the expected size of Trea (9 lbs or more), my hemorrhoids (out of control!), the recovery experience I had with Spencer and the risks, to opt for a c-section. We went home and rested for a few hours--the first chunk of sleep I had in days!  It felt great and I felt at peace.

L&D was busy when we arrived.  Our appt. was moved back several times for emergent C-sections.  Everything went fine during the procedure, though I was so very nervous!  I was most nervous about the epidural (I received a spinal block).  It went fine--though they did stick me twice!  And to make matters worse the nursing staff was counting their instruments while I was getting the spinal block.  The names of the instruments and the counting of them is a disconcerting experience.  I remember it vividly from Elliott's birth.  I tried to go to my happy place, and hoped that I wouldn't feel anything during the surgery (I didn't).

Jeff was able to capture an amazing picture of Trea's first moments of life outside the womb.

Welcome to the world!

After they removed her, Trea had some trouble breathing on her own.  They suctioned a ton of fluid from her tummy and gave her oxygen, but she was still struggling.  The doctors brought her over for a moment, and then they took her to the NICU-Jeff went with her.  I was left alone in the OR while they finished up my surgery and transferred me to the recovery room.

Jeff was moving back and forth from the NICU with Trea, to the recovery room with me.  He was giving updates and checking status--back and forth.  At one point, he was returning from seeing Trea and was about to walk into recovery only to be stopped by the nurses and me telling him to not look and stand back.  I had a slow postpartum hemorrhage, and while it was a lot of blood--it wasn't enough to need a blood transfusion.  But it was enough to cause concern.  After both Trea and I were stable, I was allowed to be wheeled in to see her.  Finally after 4 plus hours--I was able to see my daughter.

During the time that I was in recovery--Trea received an IV, was on CPAP, and oxygen.  She had labs and a chest x-ray.  The initial thought was that she aspirated meconium, as there was some discoloration in my amniotic fluid.  So, they were treating her for possible sepsis.  They also were worried that during her struggle to breathe that she may have collapsed a lung.  Additionally, they worried that she might develop pneumonia, as she had fluid in her lungs.  The doctors didn't know what would happen and all of these variables were floating around with no definitive answer.  It was a stressful time for Jeff and I both.

An emotional reunion.

Our reunion was cut short by me vomiting again (I also vomited right before I hemorrhaged)... and with all of the very sick babies in the NICU they quickly wheeled me back to recovery.  We made our way upstairs to the Maternity floor a few hours later, and then began our 3 hour rotation of visits to the NICU for the next several days.  I will detail that in a later post.

I don't know if my decision to have a C-section caused the respiratory distress in Trea or if the way I was feeling was an external trigger that something was wrong and she needed to be delivered ASAP.  Respiratory distress can happen when babies are delivered via C-section or through a very quick vaginal delivery.  Contractions serve a greater purpose--they not only open the cervix to allow the baby to be born, but they push fluid from the lungs and stomach of babies on their journey out of a woman's body.  I will never know the reason, and I am OK with that.  I do not regret my decision.  I do not mourn the loss of a vaginal delivery like I did after my first c-section.  And I am grateful that Trea was able to get the care she needed right away.  There is no way to know if she would have experienced the same distress during a vaginal delivery, or if she would've needed to be delivered emergently as a result.  All of these factors put my mind at ease.   I knew in my heart that I didn't have the strength to endure labor.  Looking back, I needed to save all of my strength for handling my baby being in the NICU.

I am at peace with my decision.  My daughter is here, she is healthy and she is home.

Trea's Birth day

 The morning of Trea's birth.  One last picture with our family of 4.  

 Grandma and Bobbots welcome their last grandchild into the world.  

 The big brothers finally get to meet their sister.  They look so proud and sweet!

Trea Madaline, born April 5th, 2013 8 pounds 15 ounces 21 inches long.  

Let it begin

Or so I thought...
I woke at 12:30am to pee.  I usually wake 2-4 times a night to see.  I went back to sleep but felt cramps and low back pain that weren't allowing me to rest comfortably.  I ccouldn't really fall back asleep, and thought I was feeling a minor contraction like pain in my cervix area.

At 1:30am I was still laying in bed, and thought I felt a tiny, tiny wetness.  At 1:45am I got up and walked around, feeling simply horrible.  Trying to breathe and relax.  I used the sink to lean on and a gush of fluid was released. I soaked it into pad and bagged it up.  Then I got into shower, just in case this was the real deal.

I was already exhausted from my little running ordeal the days before, plus I had a headache that wouldn't go away, and I was so so tired of being pregnant.

At 2:20am there were still no contractions, so I waited 40 more minutes, and then decided to wake Jeff up.  Rather than wake the kids and our friends for something that may take hours I decided to head to labor and delivery myself and have them test the fluid to be certain.  My water broke with both boys, so it wasn't out of the question that it happened with this pregnancy.  I left around 3:30am.

by 4am, the pad had tested positive and I advised Jeff.  I was so nervous and scared of labor starting and the eminent pain that would be involved.  My body was so tired, my head was killing me, and I had been in pain for long that I was super sensitive to everything.

The OB came in to do a speculum exam around 4:30am, one where she checks for amniotic fluid near the cervix, and checks any progress I have made.  She tested 2 strips and both were negative for fluid.  She was perplexed since the original one was positive.  And decided to take a look under the microscope to be certain.  At 5am, she confirmed that I had pee'ed my pants, and that the slides were negative for amniotic fluid.

Needless to say, I was super embarrassed!  I have never pee'd my pants and felt so silly!  But, I think i was wanting to be in labor so badly that I wasn't paying attention to my body the way I should.

In any case, I went home exhausted and defeated.

Milestone-Elliott

Elliott, who will turn 6 on July 1st, has hit a milestone.  Last night, for the first time I am aware of, was able to wake himself up and get out of bed to pee all on his own.  He didn't call for us either.  I heard him get out of bed, go to the toilet, pee and return to bed.

Since he was little, he has been a 'heavy wetter'.  He was tough to potty train, and had accidents with frequency.  Up until a few months ago, he wore an overnight pull up. He has always been a very hard sleeper.  The pediatrician said that some kids physically aren't ready, and to just wait it out.  I was fine with that, and so was he.

It seems that the wait is over and his body is ready to take charge.  I am glad we allowed him to take it at his pace.