Photo by Rebecca Gould Photography

Saturday, August 22, 2015

Turning 13 (A Moral Musing)

Thirteen is a funny age.
Mature, grown, and yet...not really...for think how much growing and maturing most 13-year olds have left to do.

I still remember being struck by the fact that Susan was required to sign an "assent" agreeing to her continued participation in PRROTECT when she turned twelve...

And now that Susan is thirteen, I cannot access her medical records without her assent (I was shocked when our pediatrician's office e-mailed me the form she had to complete in order for us to have continued access to her records).  What happened to turning 18?  21?
(What does this early coming of age mean?)

While we are not Jewish, we live in a community with a significant Jewish population, which means that many of Susan's friends became bat or bar mitzvah over the last year.  Susan's younger brother has a thirst for knowledge, and I often find myself googling things so that I can more fully answer his questions.

Last year, at one point, I found myself reading about what it "truly meant" to become a bat or bar mitzvah.  I was struck by this:  "a bar mitzvah is not a full-fledged adult yet, but Jewish tradition recognizes this age as the point when a child can differentiate between right and wrong and hence can be held accountable for his actions."

The article went on to explain that in most states, children can legally begin working part-time at the age of fourteen (who knew?!) and that in many states, children under the age of 18 can marry, as long as they have parental consent.  The article also noted that children in their teens can be treated as adults in criminal proceedings if the circumstances of the crime warrant such treatment (of this, sadly, as a forensic social worker, I was well aware).

All of this confirmed what I already thought -- that thirteen is a funny age...a sort of in-between...old enough to be responsible and mature, at an age where good decision-making is expected...and yet young enough to still require parental oversight and supervision.

We saw Susan's new allergist, Dr. Bajowala, one day before Susan's thirteenth birthday (for an OIT peanut updose appointment).  During Susan's post-dosing observation period, Dr. Bajowala began exploring what Susan's friends know about her food allergies.  I was initially surprised by Dr. Bajowala's interest, and then I realized where she was going, why she was asking.

I think Susan was a bit surprised by Dr. Bajowala's inquiry, too, for she initially responded without really engaging, saying something along the lines of (simply) "my friends know I have food allergies."  

Despite Susan's somewhat disinterested response, Dr. Bajowala persisted.  As the conversation unfolded, it became clear that Dr. Bajowala wanted to know if Susan's friends would be able to recognize an anaphylactic reaction, if Susan's friends would know what to do if she became unable to ask them for help.

As I listened carefully to the discussion between Susan and Dr. Bajowala, I realized how very right Dr. Bajowala was in pressing Susan to think about these issues -- for Susan is moving into one of the most difficult, risky periods of her life with food allergies -- adolescence.  (While I believe -- and hope -- that Susan's grasp on the severity of her food allergies is such that she will NEVER engage in food-related risky behaviors, and while I believe -- and hope -- that at this point Susan understands the potentially devastating consequences of not have epinephrine when needed, I also understand that -- statistically speaking, at least -- the teenage years are fraught with increased danger for those living with food allergies.  While I also believe -- and hope -- that Susan's progress in OIT will provide her with a substantial layer of protection from any exposure to peanut, I am keenly aware that we are not done yet...and I believe Susan understands this...)

As Susan and Dr. Bajowala talked, my thoughts wandered.
Susan needs friends who understand her food allergies.
Susan needs friends who will respect her dietary restrictions and never, not ever push her to eat something that even might be unsafe.
Susan needs friends who know the symptoms of anaphylaxis (even, especially) the sneaky ones.
Susan needs friends who know where her epinephrine is.
Susan needs friends who will not ever hesitate to administer epinephrine.

Fortunately, Susan has a great group of friends, and I have been consistently impressed with the ways in which they have supported her -- especially during the confusing middle school years.  Before OIT, Susan rarely ate out, ever, anywhere.  Since OIT, and clearance to begin eating at previously unsafe places, Susan has enjoyed countless outings with friends who seem to have just been waiting for the day they can hang out and enjoy a treat together.  Thus far, I've been along for every single outing, but the day will come when I won't be there...(and that's okay -- I really don't need all that ice cream, anyhow!)

Realizing the tremendous importance of what Dr. Bajowala was addressing with Susan, I joined in the discussion to help Susan formulate a plan...although once she understood what Dr. Bajowala was suggesting, she had some very good ideas of her own.

Susan's birthday party was scheduled for the following day, and recognizing the importance of what she and Dr. Bajowala had discussed, Susan decided she wanted to show her friends How To Stay Alive (the epinephrine usage PSA she made over the summer), and then she wanted her friends to practice administering epinephrine by injecting expired EpiPens into an orange.  (That will make an impression, I thought, as we talked about her plan.  Memorable party, for sure.)

As I thought more about it, I wondered how her friends' parents would feel about this part of the birthday party (I also wondered how receptive her friends would be, too), and then I decided that it was important enough to do it that I was going to simply send a quick e-mail telling her friends' parents what we would be doing (along with a link to the PSA) and...proceed.  As scary as it can be to think about (or witness --even after the fact) anaphylaxis, as a mother, I want all of Susan's friends to know what to do in the case of an anaphylactic reaction...and not just for Susan.  I want to be a part of building a community of young teenagers who know how to take care of each other.

It was incredible.
The room was silent for the 7 minute showing of How to Stay Alive.
No one moved.

And when the PSA was over, Susan's friends were eager to administer epinephrine to the orange.  One of Susan's first friends to take a turn injected the EpiPen into the orange quickly and confidently, but then pulled it out too quickly -- we could see medication dripping from the tip of the needle.  Susan was quick to reassure her friend that she had made the same mistake.  The friend asked to try again.  She wanted to get it right.  A younger friend with food allergies studied the orange very seriously before carefully and precisely injecting the EpiPen.  A friend whose youngest brother suffers from more food allergies than I can list swiftly administered the epinephrine, while yet another hesitated and then pulverized the orange.  We learned from each and every one of Susan's friends that day -- including the one who watched carefully but just wasn't quite ready to do it.  

Susan and her brother administered the two expired Auvi-Qs, and even after having used a real Auvi-Q, Susan still thinks she will go for the EpiPen first.  I don't care what she uses, as long as she is able to take care of herself.

I have thought a lot about that day, and I am increasingly glad Susan created an opportunity during her birthday party, when most of her close friends were with her, to do this.  

If we want to teach our children not to bully, not to tolerate racism or random acts of violence or other wrongs in the world, we should also be teaching our children how to take care of each to recognize subtle bullying, how to really, truly see that which is happening around them...including signs of anaphylaxis.

If these young-adult-children-teens are "old enough" to be assigned homework that includes following international news (and they are), they are "old enough" to learn how to take care of each other.  As the mother of a child with life-threatening food allergies, I have a moral responsibility to impart important information regarding food allergies and anaphylaxis to these young-adult-children-teens.  We have to start at some point...and thirteen seems just as good of an age as any other...

For shouldn't I want these young-adult-children-teens to be able to recognize anaphylaxis in the same way we want them to recognize bullying or racism or a random act of violence???

For shouldn't I want these young-adult-children-teens to know what to do in the case of anaphylaxis much as I want them to know how to intervene swiftly, decisively and effectively in the face of bullying or racism or random violence???

Yes -- and now, a group of Susan's closest friends are one step closer to being able to truly, definitively, effectively intervene should they encounter anaphylaxis.  Knowledge is power.

Friday, August 21, 2015

A Single (Plain) Orange M & M

Until recently, the only M & M Susan had ever eaten nearly killed her.
She was thirteen months old, and it was Halloween day.

I had a large bowl of candy I was planning to give out – all chocolate, and my favorites – Reese’s Peanut Butter Cups (I cringe now), Twix, and M & Ms.  In advance of the festivities, I decided to let her try her first real chocolate (she'd had chocolate frosting, but never chocolate candy).  

I started with a single plain M & M.  
I still remember – it was orange.

Even as a toddler, Susan was always good about trying new things – but she wasn’t quite sure what to do with the slippery bright orange disk as she pushed it around on her highchair tray.  (Prior to the orange M & M, the only food Susan ever rejected was a lima bean – and I couldn’t blame her!)

I kept signing to Susan that she should eat the M & M, making "yummy" sounds and then eventually I popped a matching orange candy in my mouth.  Susan followed suit…but even once she had it in her mouth, she still wasn’t exactly sure what to do with it.  Thinking back, Susan probably wondered why I was encouraging her to eat something that looked more like a toy than food!

Gamely, she held the M & M in her mouth, drooling orange.  Eventually, as it melted, she moved it around in her mouth until the drool became an orangey-chocolate mix.  

And then, just as Susan started to look delighted -- a sugar-hitting-tastebuds kind of look -- she started coughing, and turned bright red.  As I fumbled to release Susan from the highchair -- thinking frantically "Heimlich -- get it out...turn her upside down...get it outgetitoutgetitout" food allergies were the furthest thing from my mind.

At some point during my struggle to free Susan from the highchair, the M & M landed on the floor -- a slimy, still-somewhat orange gob of melty chocolate.  I still remember seeing the M & M on the floor and distantly wondering how it could be that Susan was still...choking.  It all happened so fast, but I remember clearly that in the aftermath, I was struck by the incongruence of the M & M lying there on the floor while Susan coughing, gagging...choking.

I cannot recount what all I did or in what order, but I do know that I yelled frantically for help (even though I was home alone with Susan).   When I think back to that day, I am struck by what I now believe is knowledge that something was very wrong.  

What I do know is that eventually Susan, who was by then bright red, blotchy, and crying pitifully, managed to expel a large, thick phlegmy glob of...mucus.  

  (And...odd...for she hadn't been sick.  Where had all that thick, sticky mucus come from?)

Even then, before I knew anything about food allergies, something didn't seem right.  Even then, after the emergency seemed to have passed, Susan was still miserable.  

Shaking, I held her in my arms as she cried, sticking her hand into her mouth and writhing around.  
(Eventually, later, she had diarrhea that made her scream.)

I couldn't figure it out, but I didn't like it.
Something just didn't seem right.

I called our pediatrician. 

Susan is our first child, and while I wouldn't describe myself as an anxious parent, I am sure I called (our now former) pediatrician more than once about something that was...nothing.

I spoke to a nurse, who informed me that "a lot of kids are sick."
She agreed to ask the doctor to call me, who said essentially the same thing:
     There is a stomach virus making the rounds.
     Keep her in.
     No trick-or-treating -- she's so young, she'll never know she didn't go.

I remember trying to explain that really, Susan had not vomited...but I lacked the ability to articulate the horror of it clearly, and Susan's (now former) pediatrician was confident in his diagnosis.

Against a backdrop of reassurance that Susan had merely vomited, I asked the dreaded question that was just barely fully formed in my mind...
"Could she be allergic to chocolate?"

At the time, I could imagine no horror worse.
  Little did I know.

Our (now former) pediatrician assured me that food allergies were not very common, and stressed that chocolate allergies were "really very rare."  

As I thanked my (now former) pediatrician for calling, I was aware of the little voice in the back of my head -- this wasn't vomit.  
This didn't SEEM like a stomach bug.  
(Something wasn't right...)

As the years wore on, Susan became the queen of terrible random gagging, choking episodes that eventually led to vomiting, or at least to something our (now former) pediatrician called vomiting.  Our (now former) pediatrician assured me that I did not need to worry, citing a "weak gag reflux" and explaining that Susan would "grow out" of her "tendency to vomit" as she got older.

Looking back, I wish I could say I just knew Susan had food allergies, but the truth is that...I didn't.

While my momstinct told me something wasn't right, I simply did not have enough experience to know that I was likely witnessing anaphylactic reaction after anaphylactic reaction...and that we were...incredibly...dodging bullet after bullet.

Even now, it chills me when I think about how fortunate we are, as we navigated Susan's early life without a food allergy diagnosis, without epinephrine...

While I will never know for certain what happened that Halloween day when Susan was thirteen months old, I now believe (and will likely always believe) that that was her first anaphylactic reaction to...peanut.
(And to think I was terrified when I thought she might be allergic to chocolate...)

It never occurred to me that Susan could have had such a terrible reaction to a single plain M & M as the result of a peanut allergy, but I now know that plain M & M's can be highly cross-contaminated with peanut protein...and so, in my mind, it will always be a single (plain) orange M & M that nearly took Susan's life when she was thirteen months old.

And so, when Susan turned 13 one day after Dr. Bajowala cleared her to begin eating potentially cross-contaminated foods (one food at a time, one per day), there was no better way for Susan to usher in being 13 than eating the very same food that nearly killed her when she was thirteen months old -- M & M's.  This time, thanks to PRROTECT and her continued OIT treatment with Dr. Bajowala, instead of suffering anaphylaxis after the first one, Susan ate more than we could count -- Plain, Krispy, Mega, Mini, Mint and Pretzel!  (She liked them all, of course!)

So proud of the grit, determination and bravery it took for her to get to this point!

Thursday, August 20, 2015


I think anyone who knows me well would agree that I love surprises...and gift-giving.  I don't even need a reason to give a gift -- just for fun is good enough for me.

Sitting with Dr. Bajowala after Susan took her increased peanut dose, Susan (and I) got a huge surprise -- and since it was the day before Susan's birthday, it also felt like a tremendous gift!

After watching Susan consume 4500 mg of pure peanut (about 2250 mg of peanut protein, or 4 1/2 peanuts), Dr. Bajowala opined that she felt that given how well Susan was tolerating her daily peanut doses, as long as Susan tolerated the updose, Susan could begin eating foods with risk of cross-contamination with peanut.  

(That's a lot of peanut!)
The updose I had feared earlier in the day, it seemed, pushed us over an invisible line...

As we no longer avoid foods with risk of cross-contamination of tree nut (Susan is allergic to some tree nuts, although she eats almonds without issue), this was a tremendous gift! (To those following closely, soy is still a concern, and Susan does not eat anything with concentrated amounts of soy protein, but there are still countless options!)

Ice cream and cupcakes and candy!
Oh my!

Asian and Indian and Thai!
Oh my!

The list of places Susan has never eaten, things Susan has never done stretches endlessly...limitations I have never really allowed myself to consider, focusing far more instead on the daily tasks involved in keeping her safe.  But, when I stop to think about the ways in which Susan's life has been limited, it steals my breath away, makes me teary...for Susan, for the thousands of children walking in similar shoes...and I feel simultaneously thrilled and scared (oh sososo scared) of this giant step out of our carefully constructed comfort zone.

Where to begin?
Carefully, ever so carefully, of course.

After some discussion, we agreed that Susan could try one new food or place a day, and Dr. Bajowala casually noted that there was an Oberweis Dairy store just across the street from her office.  
(I had this feeling she'd said this before.)

Susan was torn -- go directly to GO (err, Oberweis) after her appointment or wait until later in the day to have ice cream with her friends.  And WHERE should her first grand ice cream eating experience be?  (Since it was the end of August, Susan was pretty certain that ice cream was the place to start.)  

While her hour-long observation period ticked by, Susan texted with some of her friends.  I think she maybe even invited them to go with her for ice cream later in the day.  (I'm pretty sure she told two of her friends, who were on vacation, that if they got in the car and started driving, they could be back in time for ice cream!)

And then...she suddenly decided she really didn't want to wait...and I found myself more and more liking the idea of having Susan's first ice cream eating experience near her allergist's office.  

As we sat there, processing the unexpected gift of...freedom, I tried to hide my fear. Before the clinical trial, absolutely every single one of Susan's anaphylactic reactions to peanut were the result of casual contact or airborne exposure -- none of Susan's anaphylactic reactions have ever been the result of actually eating peanut.  Because of our history, I have a very healthy respect for cross-contamination.

That said, this...freedom...her belief in a better, freer what has driven Susan through the hardest parts of the clinical trial.  

My belief that despite the carefully constructed box we have lived in for the last 10+ years of our life, at some point, somewhere, something would happen that would result in Susan having an out-of-the blue anaphylactic reaction has been the driving factor behind supporting Susan's desire to see the clinical trial through -- and to seek additional private oral immunotherapy during the 5-year follow-up study (talk about the best of both worlds!).

My belief that our carefully constructed box would not always contain this awesome child of mine is what drove us to seek treatment -- any treatment, anywhere anyone would have her...

Thrilled and scared beyond measure, I agreed to take Susan to Oberweis Dairy and Ice Cream Store after her appointment with Dr. Bajowala.  And then I got scared.  Really, really scared.  

What if?
What if WHAT?
What if...she has a reaction?

Well...she'll administer epinephrine, and then she'll take Benadryl, and we'll call Dr. Bajowala (that's our protocol, although anyone who receives epinephrine should call 911 and seek care in an Emergency Room immediately).  We've done this, we know what to do.

My what if really wasn't about anaphylaxis.
It was about what it would mean if Susan had a reaction after eating ice cream...or anything else potentially cross-contaminated.

What would THAT mean?
I tried to tell that persistent voice that we would deal with those issues if they came up...and I tried not to think about what it would mean if Susan had a reaction to ice cream...or any of the other things she was excited about trying.

Pushing down the doubting voice, I suggested to Susan that we go shopping at Woodman's Market (which we LOVE and which is also very near to Dr. Bajowala's office) to allow a second hour to pass between her updose and her first-ever typical ice cream experience.  She agreed, and we bumped into a food allergy mom who recognized Susan from her video, which was an interesting surprise for Susan (I don't think she really gets how closely some people are following her journey...).

Next stop, Oberweis Ice Cream and Dairy Store.

The kind scooper at the counter was confused as I explained that Susan had a peanut allergy, and that because of the severity of her peanut allergy, she had never been in an ice cream shop with freedom to taste all sorts of flavors.  I then explained that because of a clinical trial and on-going treatment Susan was involved in, she was now cleared to eat things that might be cross-contaminated with peanuts.  As the scooper shifted into allergy mode, a part of me was tempted to just let her do her thing -- after all, an added layer of protection would be nice, right?!  Well, maybe.  And maybe not really.  For while I was scared of what might happen, the logical side of me knows that for Susan to benefit from all that she has been through, we need to be sure she doesn't need those kinds of accommodations.  And how to explain to the kind scooper that no matter WHAT precautions they have in place, there is NO WAY we would ever have let Susan have ice cream from there before this.

Fighting down my fear and choking back tears, I liberally interpreted Dr. Bajowala's "only one new food or place" a day to mean Susan could try ALL non-nut containing flavors at the Oberweis Ice Cream and Dairy Store.

Chocolate Chip
Birthday Cake
Black Cherry
Chocolate Marshmallow
Cookie Dough
Cookies and Cream
Mint Chip
Dulce de Leche
Expresso Caramel Chip
Raspberry Sherbert
Lemon Sorbet
Blueberry Pie
Orange Sherbert
Key Lime Pie
Apple Pie
Cherry Pie

She tried them all!

And she campaigned to bring some home...
     (How could I say NO?  Especially when Susan suggested we take advantage of their sale...)

But there was NO WAY she was waiting until we got home to dig in, so she picked her two favorites (although they were "all so good") for the car -- Chocolate and Mint Chocolate Chip.


The power of OIT.
The power of believing in the possibility of a better, freer life.

Updosing -- NOT Just Another Day

As the summer draws to a close, the irony of what Susan is going to do today is not lost on me.

On June 30th, 2015 -- after an unplanned one-week delay -- Susan graduated from PRROTECT, a clinical trial that explored the efficacy of Xolair on rapid oral immunotherapy (read:  desensitization) to peanut.  While the clinical trial is still blinded (meaning we can only guess for now), I think everyone involved believes Susan received the placebo initially...

On July 5, 2015, Susan experienced an anaphylactic reaction to her peanut dose.  This was a dose she had been taking since November of 2014, and after eight months, it was a dose she should have tolerated relatively easily.  

Should is a key word, because over the course of the last eight months, Susan has now had three epinephrine-requiring reactions to her daily peanut dose.  

The cause of each of Susan's adverse reactions during the clinical trial (and immediately following) are still uncertain -- we didn't do anything obviously "wrong" (we followed the dosing guidelines and observed the period of rest) and there was never a discernible pattern.  While we will likely never know for certain, I have come to believe that Susan's seemingly random anaphylactic reactions to her dose are the result of a combination of many factors.

And honestly, in many ways, the cause of her anaphylactic reactions doesn't matter, for the bottom line is that they are terrible.

Scary -- every single time -- despite the fact that Susan has had more than her fair share of anaphylactic reactions during her enrollment in PRROTECT.

Life altering.
Can the same thing be life-altering again and again?

I actually think the same thing can be life-altering -- for every time Susan has had an anaphylactic reaction in conjunction with the clinical trial, we have talked about it, shared her experience -- privately and in public.

While I will never know for certain, I believe our openness has helped others understand the importance of early administration of epinephrine.  If even one parent or caregiver does not delay in administering (or supporting self-administration of) epinephrine, Susan's experiences have been life-altering.

And, as Susan's mother, I now feel more certain than I ever would have that Susan will self-administer epinephrine should she need it.

Let me be clear -- there is still that niggling voice in the back of my head that wonders if Susan would really whip out her EpiPen in the middle of her English Literacy class and ever-so-calmly (or not) jab herself in the thigh with it, counting to ten while her teacher called the nurse and the nurse called 911...and hopefully in the chaos of it all someone remembered to call me...

But, after the last 18 months, I have more confidence that Susan would (successfully) self-administer epinephrine than I ever had before.

And -- that's life-altering.
For Susan.
For me...
   for my husband -- for our family.

I now believe in the possibility of college, and travel, and a much more "normal" future than I ever envisioned for Susan.  I don't know if Susan will ever travel to compete, but I no longer believe her peanut allergy will hold her back.

It has absolutely, positively without a doubt been more difficult to get to this point than I ever imagined, but I wouldn't do it any differently -- for as crazy as it might sound, every single anaphylactic reaction brought us one step closer to where we are now.

While I wouldn't suggest our course for anyone, as with anything in life, I honestly believe that, at least for Susan, practice has made more perfect.  (That said, even during her last anaphylactic reaction, Susan didn't self-administer perfectly, but she got the medicine in...and that's what matters.)

Susan's first appointment with her private allergist, Dr. Bajowala, was scheduled for July 6, 2015 -- one convenient day after Susan's anaphylactic reaction to her dose (which she had me record so that she could make a short video about the importance of prompt administration of epinephrine as part of her Girl Scout Silver Award).  

I still remember that day -- sunny, hot and humid -- a true Chicago summer day...followed by a violent thunderstorm which resulted in a twenty degree drop in temperatures across the Midwest.  Even with the crazy weather, it still felt "early" in the summer to me.

Dr. Bajowala decreased Susan's daily peanut dose, from 2000 mg of peanut protein to 1500 mg of peanut protein.  (Actually she decreased her dose from 2000 mg of peanut protein to 3000 mg of pure peanut, but that's...confusing, to say the least.)  She also changed the timing of Susan's daily Zyrtec and added probiotics, Vitamin D and Cranberry Powder -- and instructed Susan to take her dose with applesauce every single time.  Our consumption of GoGoSqueeZes has gone through the roof!  

Over the course of the summer, Dr. Bajowala slowly weaned Susan off the Omeprazole she took for most of the clinical trial and increased Susan's peanut dose from 3000 mg of pure peanut to 3500 mg of pure peanut to 4000 mg of pure peanut -- a move that returned Susan squarely to where she was when the clinical trial ended.  I was out of town with our son for those two appointments, so my husband took Susan.  We have a few photos, but don't expect blog posts from those!

I cannot help but reflect that the summer has been easy...neither updose was of particular concern to me, as Susan had tolerated each of her doses without issue -- gone, even, is the hivey, angry looking skin Susan sometimes contends with.  

I have a friend who counts days (she's impressively good at it, actually...although I have sometimes wondered if she uses some sort of on-line date calculator or something).  I'm purposefully NOT counting days at this point, but I'm really pretty certain that Susan has now gone longer without an adverse reaction to a dose in...well, a very long time.  Let's just say a lot of days.  I'm pretty sure, in fact, that if one were to do the math (which I am NOT going to do, because I'm sometimes sort of superstitious like that), this is the LONGEST Susan has gone without an adverse reaction to her dose since...well, a very long time.

And now, here we are -- about to do something I once doubted would ever happen.  Today, Susan is going to updose to 4500 mg of pure peanut, or 2250 mg of peanut protein.  That's MORE than her daily dose for more than eight months of PRROTECT.  That's more than Susan has ever eaten in a single dose (even the day of the 4000 mg peanut protein challenge during PRROTECT, which did NOT go well, her biggest dose was not that much).

Oddly, I'm a little nervous, but I'm not really scared about this updose.  
(Although really, if I have learned anything from our journey in the clinical trial, I probably should be concerned, for if I did not know it before, I certainly do know now that nothing in life is certain.)

THIS updose is the beginning of the future.

If my theory is right, that the medications Susan was taking in an effort to stabilize her and allow her to tolerate her daily peanut doses in the clinical trial, were interfering with her ability to absorb and digest her peanut doses...

If my theory is right, that the addition of probiotics, Cranberry Powder and Vitamin D to Susan's daily diet have improved the functioning of her immune system...

If the prevailing theory in OIT is right, that when a subject is struggling to tolerate a dose, decreased dosing for a short period of time often enables the subject to resume dosing and move forward to an even higher dose without issue...

Today should go well.