Semantics

A peanut is a peanut, right?

For most of Susan's life, anything peanut spelled D-A-N-G-E-R.

But now, as Susan moves from participant in clinical trial to private oral immunotherapy patient, it seems not all peanuts are the same.

There is peanut protein...and pure peanut.

On Sunday morning, before her anaphylactic reaction, Susan took what was (and had been for more than eight months), her daily peanut dose in the form of a single Reese's Peanut Butter Cup (she's been taking her dose in the form of a single Reese's Peanut Butter Cup for more than two months).  Susan's dose contained the equivalent of 2000 mg of peanut protein, or about 8 1/2 peanuts.

After her anaphylactic reaction, Dr. Bajowala recommended that we decrease Susan's dose to 3000 mg of pure peanut.  (That's pure peanut.)

Wait.
That sounds like an increase -- especially in this fast-paced world we live in.

In fact, even the doctor now following Susan from PRROTECT was confused.  In response to my e-mail outlining Susan's anaphylactic reaction to her dose and the plan for going forward, she wrote, "You said you decreased to 3000 mg; I thought she was on 2000 mg?"

I get it.
It was confusing to me, too.
Susan's 3000 mg pure peanut dose IS a decrease.

Here's the translation:
1 peanut = approximately 500 mg of pure peanut
1 peanut = approximately 250 mg of peanut protein

So...Susan's current dose SHOULD be about 6 peanuts.

However, while anything peanut has always spelled D-A-N-G-E-R to us, it seems not all peanuts are the same.
There are peanuts, then there are giant fancy peanuts...and then there are runner peanuts.
Huh.
(I'm sure there are all sorts of other peanuts out there, and I mean no disrespect to those types of peanuts I have left off the list -- I just haven't met them yet.)

I hadn't ever really looked closely, but it seems that peanuts really do come in all shapes and sizes.

This morning, Susan's dose -- 3.0 grams according to my scale (which is really a possible range of 2995 to 3004.9 milligrams) -- consisted of 2 whole peanuts and almost all of a half of a peanut.

It doesn't look like much, does it?

(I keep reminding myself that there was a time when Susan experienced anaphylaxis with peanut particles floating around in the air...so while her current dose doesn't look like much, it IS progress.)

But...what happened to the six peanuts Susan was tolerating?
Well...they must not have been very big peanuts.

In time, according to Dr. Bajowala, we won't need to weigh Susan's dose -- she'll just count peanut halves.  I trust Dr. Bajowala, but having a new and improved understanding of all the different sizes and shapes a peanut can come in has given me a new-found appreciation of my scale.

While what we are doing is similar in that Susan is continuing to do oral immunotherapy, we are in a new land...and in this new land, there is a new language of sorts.  

In the end, I think it is just really all about semantics.