What if? What if Little man could tolerate foods in a rotational way? Or with shorter trials? Not putting any extra stress of a drawn out delayed reaction trial on his body? For the past 2years, I have been studying, documenting, logging and evaluating little mans FPIES symptoms and reactions.
FPIES is a syndrome- meaning that it shares common symptoms grouped together. FPIES has the common shared symptoms of profuse vomit, diarrhea, inflammation, dehydration, immune response. But there are also a host of other symptoms, the chronic FPIES noted in some medical literature sheds some light to these other symptoms. In FPIES not all symptoms are seen in all children although there are main features shared. For some (many) FPIES kids, they have 1-2 “triggers”, where others have multiple triggers and other non-IgE reactions; and a few only have a few ‘safe’ foods. Little Man isn’t the only FPIES child at 2 ½ with 5 safe foods, he isn’t the only one needing supplemental nutrition (although many kids are on G-tubes vs. the IV nutrition he gets).
In a recent communication with Dr.J (a research immunologist researching Non-IgE allergies in different populations), whom we saw in consult last spring; she relates that she has theories of there being a difference in kids’ responses to the elimination/elemental diet - some respond very well to it, benefit from the gut rest and time for healing and complete nutrition; while others have different responses- that their immune systems respond differently. What if that is why so many kids are like our little man and struggle to find safe foods after taking much needed breaks? I keep thinking that when Little man was on foods, as we were restricting his diet more and more- some things were getting better and some were getting worse….I keep wondering if we had just identified the corn trigger and moved away from that, if we would have been able to keep his other foods, or go back to them much quicker. But because we were lost for so many months, and his system kept getting more sensitized, stopping foods meant long healing times; but then what? Why have we been unable to add foods back in? Why does he seem to do ok on a food for a little while before he starts to show us sure signs that his body is struggling, or has a full blown reaction? Why does he have this “honeymoon” period? Why did he respond so well to probiotics and why did he respond so well to antibiotics? I feel like for him, the answer must be in his gut flora. Our gut flora even has roles in our immune responses. So, is this why he has delayed responses? From the tie to his gut flora? His body accepts the food initially, or fights too- it has the mediators it needs to fight it (vs. full shock in the first bites), but then it comes back around and attacks it….is this the gradual change in gut flora from the new food in the gut environment? It builds to a level that then pushes the body over its coping ability? The attack methods then win? What if?? And more importantly, what do you do about it?
What if we re-introduced a few foods at once? What if this worked? What if it fooled the immune system and we gained a new food or two? What if he reacted? Well, he runs the risk of reacting any way we do trials. So why not try it? Why not use Little mans body as the guide and push forward- listening to his body signals of intolerance, stopping if he isn't tolerating (whether FPIES or not), making notes and pushing forward. Ideally, this was the scenario for the in hospital trials (recommended by CHOP) to help us identify what else is making his FPIES complex but also to gain a few foods into his tiny menu.
So, the next step was to develop a plan, a plan for a rotational trial. Little mans daddy and I discussed it and we decided on: 3 foods for 3 days, rotate to 3 new foods for 3 days, rotate again and then rotate back. We picked 9 foods, including beef and eggs from a corn-free ranch 3+hrs away that his daddy went to pick up (that took him all day- that’s a dedicated daddy!). Healed from zucchini, we were ready to implement a new plan for little man.
Little man decided that his first day was going to be strawberries! He loved them, ate almost a whole one. The next day had red-rashy cheeks but otherwise was fine so we offered them again- he refused; and has refused every day since- despite multiple offers. The next day he did eat 2 bites of pork, he struggled with the texture but I had unknowingly cooked up a stringer cut so I am hoping he will try again with chops. The following day was potatoes; he barely took nibbles and the next day was an “off” day with lots of clinginess; was it the potatoes or is this too much for him? Noted, moving forward. The following day was the eggs- which he was enthusiastic about but each day has eaten less and less. We tried coconut (flour) and got some all too familiar behavioral symptoms. Coconut in the form of coconut flour may be too hard for him to digest so I will retry that with coconut oil, then came pineapple which we juiced and combined with some water and he LOVES! We have also tried beef (hamburger) and cauliflower- neither which he will even touch or want near him! We will have toddler finicky- ness to deal with I have no doubts but with his relationship with food already being negative and us having no idea if the food is going to cause him to be sick- I am NOT about to make him eat it, or force him or even coerce him. If he wants it, great; if he doesn’t, fine. We’ll just keep moving forward. What if?
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