Tuesday, July 17, 2012

The Allergist Drama Continues...

My last post was about how annoyed I was at our allergist.  Well today, the drama thickened.  I got home from taking Cutie Pie and Big Brother to a baseball game (Have you ever taken two small children to a baseball game alone?  One that contains free ice cream and candy?  No?  Well try to imagine the state of my nerves by the time we got home....) and innocently checked the mail.  I saw I had a letter from the allergist's office.  The last time we went he kindly wrote a very nice letter to our pediatrician about the things we had discussed and the current plan of action, so I thought this new letter might be interesting considering I don't think he heard a word I said at our last appointment.  I was right.  I'll just let you enjoy the drama and read it yourself.  I'll put my comments in red.

Dear Todd, (Seems like he should address our pediatrician as "Dr." but whatever)

I wanted to update you on Cutie Pie.  She continues to be breast-fed but has tried some solid foods.  Her mother says that Cutie Pie does much better when she (the mother) avoids dairy, corn, soy, peas, rice, oats, sweet potatoes, and quinoa in her own diet while breast-feeding.  Currently, her mother describes Cutie Pie as a very picky eater who primarily eats watermelon, avocado, potato and chicken with each meal.  (This paragraph wasn't so bad)

Physical Exam - on exam she is happy and healthy appearing and has a normal HEENT and clear lungs (Amazing how he could tell this by never coming closer than the door of the exam room.  He must have super-sonic hearing to hear her lungs over by the exam room door).

Diagnosis - 
1.  Peanut allergy
2.  FPIES - rice creates severe reactions but other grains have not been fed directly to Cutie Pie (except he misspelled her name).  However, when her mother eats corn, oats, or quinoa Cutie Pie has significant problems.  It is unlikely she has FPIES for all these foods but since they seem to bother her we will not advance them just yet.  (Except that she has been fed oats and quinoa and both caused an FPIES reaction.  Corn causes vomiting through my milk which sounds like FPIES to me too.  No mention of any other trigger foods.  If he listened to a word I said or read the paperwork he photocopied and put in her chart he would have known this.)     

Plan - at this time I recommend the following dietary precautions.
1.  Strict avoidance of all peanut and tree nut products.
2.  EpiPen Jr available for potential IgE mediated reaction to peanut.
3.  Continue breast-feeding for as long as desired (No mention as to what to wean her to.  At the appointment he told me there was no need for me to breastfeed her and I needed to wean her to cow's milk)
4.  I instructed her mother to cautiously introduce cheese and other cow's milk products such as yogurt.  She will also try to advance soy, beef, and turkey in Cutie Pie's diet.
5. At follow-up in 6 months we will discuss advancing other foods.  Until then she will avoid rice, sweet potatoes, corn and other grains such as oats and quinoa.

I will keep you up to date with any significant changes.  Thank you for the opportunity to consult in Cutie Pie's care.

Dr. I-Never-Listen

I just don't know where to go with this.  Should I reply back to the allergist?  Just drop-it?  Find a new doctor?  I feel the need to write some snarky letter to him, but I'm thinking maybe I should wait until I'm not so irritated so maybe any type of reply would be more level-headed.  But then again, when it comes to my kids I'm a bit of a mama bear anyway so any reply will most likely be snarky. 

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