Divvies Egg-free Banana Muffins

It was a bleak and pitiable day a few years ago when Roo received his initial eosinophilic esophagitis diagnosis (EoE). Our GI team assumed that dairy was largely to blame and we eliminated it cold turkey. Just like that, one half hour doctors appointment and no more pizza, ice cream, Goldfish crackers, Parmesan on pasta, you get the idea. Shortly afterward, a skin prick test revealed Roo was also IgE allergic to peanuts and eggs. That's the scary anaphylaxis-causing kind of allergic, as opposed to IgG mediated allergies which cause his EoE. Then he lost all the tree nuts. Then peaches. Beef. And apples.

Suddenly very alone and flailing in a sea of Earth Balance, Veganaise, and Enfagrow Soy Formula with Christmas approaching, I was pulling out all the stops to come up with something remotely palatable to bake that we could all enjoy. It was not going well.

Just as I was about to call off the reindeer and torch the stockings, I discovered Divvies, nut-, dairy-, and egg-free cookies, popcorn, and candy. Thanks to Lori Sandler, Christmas came after all.

Even with dairy and apples back in play for Roo, Divvies is still without a doubt one of my favorite sources for baked goods. The cookies are top notch, not top-notch for allergy-free cookies, but rather, someone please take these things away from me before I eat the whole plate good. The Sandler family's attitude is proactive, inclusive, and upbeat. And though she might not know it, I credit Lori Sandler with single handedly pulling me out of the little pity party I was having for myself when Roo was diagnosed.

So, when Divvies came out with a cookbook, can you guess who was first in line? The Warm Apple-Apricot Cake on page 19 is ridiculous even though we modify it a bit. Apples are ok for Roo now but apricots are still a little too close for comfort to peaches, so I use orange marmalade instead of apricot preserves. The chocolate cupcakes are the best I've ever tasted from a home kitchen. The fudge is decadent and well, super fudgy, but the recipe we end up making more than any other in the book, is the banana bread.

My girls adore quick breads and this banana bread is their favorite of the bunch. Roo, a relative latecomer to the world of breads, will eat this over most any other. Throw some of the batter into mini muffin tins and you have one of our favorite lunchbox treats.

Egg-Free Banana Muffins (or Loaves)
adapted slightly from The Divvies Bakery Cookbook

3 & 1/2 cups all-purpose flour
2 tsp baking soda
1 & 1/2 tsp salt
1 tsp cinnamon
1 tsp nutmeg
1/2 tsp ground cloves
1/2 tsp ground ginger
5 ripe bananas
1 cup baby food pears (or pear puree)
1 cup canola oil
1/2 cup water
2 & 1/2 cups granulated sugar

1. Preheat oven to 375 degrees. Line muffin tins with paper liners or spray with cooking spray. Alternatively, spray loaf pans
2. Whisk together the flour, baking soda, salt, cinnamon, nutmeg, cloves, and ginger. Set aside.
3. Peel the bananas and place in a separate mixing bowl. Beat on medium speed until pureed. Add the pear puree, oil, water, and sugar and beat until all elements are well-combined.
4. Add the dry ingredients to the wet and beat at medium speed until well combined, remembering to scrape down sides of the bowl.
5. Bake full-sized loaves for 65-80 minutes, mini-loaves for 45-60 minutes, muffins for 25-27 minutes, and mini-muffins for 12-15 minutes, testing with a toothpick for doneness.
6. Remove from oven and cool on wire rack (muffins 10 minutes, loaves 20 minutes) then remove from pan and allow to cool completely.

Makes three 9x5-inch full sized loaves, six 5x3-inch mini-loaves, 12 muffins, or 36 mini-muffins

Kid Cultivation

Well Fed Garbage has become Kid Cultivation!

Despite the recent name change our garbage can still eats pretty well sometimes. This week it was chicken, rice, and broccoli casserole. White people food. When will I learn that any time a recipe calls for a can of cream of mushroom soup, I need to just stop. Seriously.

Still, it's exciting to be focusing on the thrill of food again. Reading back on some of my older posts I'm struck by what a whining, driveling fool I sound like sometimes. And while I can't promise that's going to change, I can promise that we're having a lot more fun in the kitchen these days. 

Yes, Roo still has food allergies, eosinophilic esophagitis (EoE), textural sensitivities, and barfs a lot, but for the moment, he's under control. He can't eat peanuts, tree nuts, eggs, beef, or peaches. So that leaves about a billion other things he can eat.

Mufasa's controlling diabetes with diet and exercise alone. No easy feat and he's rocking it with no help from his cake pop-crazed housemates. 

Looly prefers ice cream and pizza to salmon and Brussels sprouts but her self-control is unparalleled. Who eats half a cookie?!

Bean, my little Beanie Bean, dream child of culinary delights, counts kale, lima beans, pickles, hard boiled eggs, avocado, and filet mignon among her top 10 foods and is just about always willing to try a bite. Thank you for having been born.

And as for me, I'd still love to lose 5 (meaning 10) pounds. At some point I am going to have to face the cruel reality that two nightly servings of salted caramel gelato are not part of a healthy weight loss plan. Fortunately today is not that day.

Voting for CURED

I'm not usually a sweepstakes kind of girl, but this one is near and dear to my heart.  On August 27 Vivint Gives Back Project will award 2.5 millions dollars to various charities.  

One of the charities in the running is CURED Foundation - a fantastic organization that has been working tirelessly to raise money for research on eosinophilic disorders since long before Roo was diagnosed.  They work closely with the Cincinnati Children's Hospital, which is at the absolute forefront in research on eosinophilic disorders, and where both Bean and Roo are currently participating in a twins study on EoE.  So, obviously, we would be thrilled to see them receive this generous donation.

Basically, the public votes for the next several weeks for their favorite charity.  On August 27, the charity with the most votes overall, will receive $250,000.  In addition, each charity that receives the most votes in its region, will receive $100,000.  Not too shabby, eh?

The top charity at the moment is located in CURED's region (central region) which means that if we can maintain enough votes to be in 2nd place in our region, CURED will receive the $100,000! The problem is, we're currently in 3rd place, but it's by approximately 30 votes?! Just 30 votes are separating my boy from a $100,000 donation for CURED foundation.  So please vote if you can.  Daily if you'd be so kind.  Yes, it makes you login to Facebook but the whole process takes 15 seconds.  Just click on the link below to get started. 

Vote for CURED - Vivint Gives Back

Feeding Therapy

Our speech therapist thinks Roo has made big progress in the past few months and isn't sure she needs to see him anymore.  I agree that he often eats well in her office.  All the games of Connect 4, sticker charts, balloon timer, and the pretty young speech therapist provide exactly the level of incentive he requires to finish a decent meal.  She believes that at this point it's largely a matter of keeping him motivated.  He can eat.  He just chooses not to most of the time.  And she's right. 

But I'm torn. He can eat when he sets his mind to it.  He crunches up Dum Dum lollipops like nobody's business.  He can eat raw carrots, Ruffles potato chips, pork, bacon, grape tomatoes, and all kinds of other foods that require ample chewing.  But without fail, he still gags on yogurt.  Muffins, most cookies, and soft breads, pancakes and the like are still off limits.  And while we know that his esophagus is clear right now, he still threw up after a single bite of ice cream with sprinkes this weekend.  My theory is that it was a textural issue...the mixing of tiny crunchy pellets along with soft, cold, mushy ice cream.  That kind of stuff still happens a lot.  

If we are to believe the scopes, GI's, ENT, and speech therapist, there's not really a physical cause remaining at this point for the frequent vomiting and general food aversion.  He still takes Prevacid because I think with or without the EoE he suffers from reflux too. I'm thinking of continuing the speech because I don't really know what else to do with him. 

Props for Grampy

Budesonide, or Pulmicort, if you prefer, is an asthma medication.  It comes in individual packets or respules dissolved in a couple of milliters of liquid that are meant to be used in a nebulizer specifically for inhalation to treat, well, asthma, of course.  For eosinophilic esophagitis, the protocol is a bit different.  You have to drink the stuff.  To make it more palatable and stick-to-your-esophagus thick, GI specialists the world over have recommended mixing it with a few packets of Splenda to create a sickly sweet sludge-like consistency which is supposed to adhere to the esophagus walls, thus maximizing the effectiveness of the steroid.  Anyone out there ever eat a whole packet of Splenda?  How about five at a time? 

A few months ago when we were first looking at a budesonide trial for Roo, we were dreading it.  See, we were the teeniest bit skeptical that we could get this kid, who at age three, has yet to ingest a dose of Children's Tylenol successfully due to a hyper-sensitive gag reflex, to swallow five packets of Splenda mixed with medicine.  Not once, but twice a day for eight weeks. 

As I was hemming and hawing about how to make this happen, and whining just a bit perhaps about the unfairness of it all over the phone to my parents, my dad, Grampy to Roo, Bean, and Looly, devised his own brilliant solution.  Sorbet.  Roo can't get enough.  It's thick, tangy, sweet but not too sweet, icy enough to dull the flavor, has few ingredients, and let's face it, way more fun to eat than Splenda.  After one horrifically unsuccessful attempt with the Splenda, I nervously approached our GI team with Grampy's idea and to my surprise they agreed to let us try it.  Roo literally ate it up.  For what ended up being more than ten weeks due to scheduling difficulties with the scope. 

And get this, as it turns out, our GI team is now passing along Grampy's new recommendation to other families starting on budesonide for EoE.  Turns out sorbet is the new Splenda.  And Grampy is the Man!

Growth Charts and Milkshakes

We had our big appointment yesterday with our GI team including our CNP, GI doctor, nutritionist, and various researchers and residents.  Overall, the meeting went better than expected.  Aside from parking garage chaos and Roo's buffoonery which included repeated diving off the examination table, pilfering and eating 3 Dum Dum lollipops from my purse - mostly in front of the nutritionist, and running head first into a porcelain sink that happened to be at his eye level, things went OK.

We're now about 10 days into our Budesonide trial.  I still can't tell if it's working to clear the EoE, but we're cautiously optimistic.  The team gave us an approximate 80 percent chance that the meds will work to clear him up, however temporarily, and said it could take a few weeks before we start seeing results.  I would be a lot more comfortable with 99.9 percent odds in our favor, but I suppose it could be a lot worse than 80.

Exciting for us, though not as much for our CNP, was that Roo tipped the scales at 11.1 kg.  That's 24.4 pounds!  Yes, he was fully clothed, but his shoes were off, so how much can a pair of sweatpants and a long-sleeved t-shirt really weigh?  The CNP was discouraged because he was "down a little bit" (maybe a few ounces - but they weighted him WITH his shoes!) from his last weigh-in at the January scope.  But, as Mufasa and I studied his growth chart in detail, we were happy to point out to her that he is up almost 2 pounds since early November.  In fact, that gap between him and the bottom of the growth chart has closed up quite a bit.  He's still not exactly on the chart, but he's more of a finger width away now, rather than an entire finger length as was once the case. 

We talked about what if the meds don't work, what if they do, NG-tubes (nasogastric - the kind through the nose) versus gastronomy tubes (g-tube - the kinds directly into the stomach).  We talked about his behavior issues and steroids are likely to blame, at least to some extent.  And we have decided to reintroduce dairy to his diet.

According to GI, if the Budesonide is working, he should be able to eat any of the foods that are causing his EoE.  We've opted not to go so far as to put beef, peaches, or apples back into his rotation since he has had at least once positive allergy test to those foods.  Eggs and all nuts are still strictly off limits because they are IgE mediated allergies for him (he reacts immediately).  Dairy, however, has always been questionable.  The prospect of opening up his diet to include dairy is a beautiful beautiful thing.  The fat, the calories, the variety, the possibilities!!  On the other hand, we might be doing more psychological damage here as we allow the kid to indulge in macaroni and cheese, pizza, milkshakes, and full fat cheddar cheese only to take them all away again in a couple of months if the Budesonide course is unsuccessful.  So, where there's an up, there's always a down.  Seven weeks to the next scope.

Roid Rage?

Roo's been taking his Budesonide-raspberry sorbetto slurry two times a day for just over a week.  The first few days were bad - vomiting, crying, food refusal, the gamut.  The next few days were a little better, meaning, he didn't vomit.  A couple of times in there he even acted ravenous.  Then, yesterday he was back to his old tricks.  He didn't eat much, just wanted to sit and suck his thumb.  He did not vomit but he did give us the old shivery-faced pucker that usually indicates he's about to spew after taking a bite of something that's not agreeing with him.  In this case it was chicken, one of his usual favorites.   

Then there's the part where he's become sulky and angry, throwing things both generally and at human targets, insomnia - his, and as a result, ours.  Oh, and plenty of blatant disobedience.  It's unclear whether he's experiencing some sort of toddler Roid Rage or if he's just being a 2.5-year-old boy who had 4 days off from school last week.  Either way it's out of character and I won't be sorry to see this phase end.  Soon. 

This course of steroids will last 8 weeks and then he'll get another scope to determine whether or not it worked.  Of course, I've been scouring the Internet - always a highly recommended activity when attempting to self-diagnose - and it appears as though many (most?  all?) EoE sufferers who respond to the Budesonide treatment respond fully within 2 weeks.  Fingers crossed.

Oh Puke

Why is he still puking so much?  Once last night.  Again this morning, at the dentist I might add.  Incidentally, he's been asked to refrain from all food and drink prior to dentist visits from here on out.  And again tonight at bed time.  How awesome will it be if he's allergic to Budesonide?  Is that even possible? 

Sweetening the Deal

The biopsies are back and lo and behold, Roo's eosinophil counts are worse than ever.  How the heck?!  I have no idea.  Lot's of theories but no answers. This seems to be a trend with this nasty disease.  He's up to 60-70 eosinophils per high power field.  I think his highest count before that was in the 30's so this is not encouraging.  The diagnosis is anything above 15 per hpf. 

Our current theories for the spike include everything from a tomato allergy to a brand spanking new soy allergy to the mold-infested humidifier we diligently placed by his bed following the infamous croup episode after his scope in November.  Fortunately, none of these are relevant at the moment because they are all giving me a headache.  Or maybe that's the mold.

Roo is nearing his big 0-3 birthday and while we'll be sure to mark the occasion with "Under the Hill" balloons and allergy-free treats, he still tips the scale at 23 pounds and at almost 34 inches, he hasn't added height in months.  It's time to take his treatment to the next level.

We've opted to medicate him with Budesonide (the generic name for Pulmicort - a hot topic on the EoE scene these days!).  Twice a day for 8 weeks he supposed to drink a slurry of asthma medicine mixed with multiple packets of Splenda.  Please disregard the "For Inhalation Only" warnings on the box.

As you might imagine, given the oral delay, sensitive gag reflex, food aversion, and pure hatred of anything too sweet the Splenda slurry is not really working out.  Raspberry sorbet on the other hand, seems to be doing the trick.

So, we've been mixing his meds with about a teaspoon of sorbet.  He is on board with his am/pm ice cream treats and I am stunned that we found a way to get him to take it.  The one potential for disaster here, of course, is that I just emailed our GI team to let them know I'm using sorbet, not Splenda.  I expect the phone to burst into flames at any moment.  Fingers crossed.  Taking it has to be better than not taking it, right?

So from here, once again, we wait and see.  If it works, the budesonide is a way to mask symptoms not cure the condition but we're hopeful that if we can make him comfortable for any length of time and get some weight on him, we'll be better prepared to address his diet once symptoms return.  We're taking the first tiny steps toward embracing the idea of a g-tube should it come to that.  And above all, trying our best to focus on the good stuff.  Like raspberry sorbet.

White Plaques and Furrowing

Roo had his third upper endoscopy yesterday.  As usual, he was a total trooper.  I ripped him out of bed at 5:15 am, slapped a clean diaper on him, and pushed him out the door in his PJ's before he'd have the chance to ask for a drink, which of course, he couldn't have.  The procedure went well overall.  He was a little hesitant to go along with the nurses at first but the "little something to relax him" that the anesthesiologist gave him did the trick almost immediately.  He was all grins and giggles, watching the trails from his fingers, and driving his hospital bed back to surgery complete with "beep- beeps". 

Now, I don't condone substance abuse at any age but man how I wish I had a little bit of that happy juice in the fridge to administer to the kids from time to time.  Looly's hysterical because she scraped her elbow?  Happy juice.  Bean's on another biting spree?  Happy juice.  Roo's chucking Legos at the cat and crying when the poor thing seeks shelter in the basement?  Happy juice.  Accidental shopping spree?  A little happy juice for Mufasa's water bottle while handing over the receipts.  Okay, I guess I'm starting to see why they don't dole out gallon jugs to the parents...

Anyway, we won't have the official results for another day or two but I am ceding victory to the know-it-all GI doctor.  I honestly still can't believe it but the results of the scope were not good.  For the first time ever there was visible evidence of allergy cells (eosinophils) in Roo's esophagus.  Essentially, the doctor could see, and provided me with photos, of the inside of his esophagus complete with nasty little white plaques (pussy groups of allergy cells) and mild furrowing (kind of like little ridges) - two of the tell-tale signs of EoE.  The worst part is that in his previous scopes he never had any visible evidence of EoE.  The biopsies revealed EoE, but his esophagus looked healthy.  Seems like it's gotten significantly worse this year. 

I am beyond bummed.  I so thought he was tolerating the milk.  I'm so sorry that he has to be experiencing pain whenever he eats or swallows for that matter.  And selfishly I'm dreading the return to a dairy-free existence.  I'll save the true lament for once the biopsy results are in but it's not looking good folks.  In fact it looks worse than before.  Maybe I could sneak just a tiny bit of that happy juice for me?  Feel like I could use it.

EE strikes again?

Roo had his annual GI check-up today and in all my naivete I was considering it a non-event.  I was planning to blog about how his EoE is under control, he's eating a wider variety of foods, starting to gain weight here and there, doing great.  Right? 

His original GI doctor moved away this spring.  Then, I found out his allergist is no longer at the hospital we use.  So today we met with a wonderful nurse practitioner we saw once last year, a new doctor, a nutritionist, who, no offense intended, but I could give suggestions for increasing caloric intake at this point, and no allergist.  I would love to be witty about the appointment but I just don't have it in me.

Roo needs another scope to check up on his EoE.  That wasn't a surprise.  The part I did find surprising, was the new doctor berating me for reintroducing dairy.  The new doctor is convinced that Roo's allergy cells are back and that the premature reintroduction of dairy is to blame.  Did I mention that it was a flipping GI specialist in the very same hospital who told me to give him dairy back in April!  This is not a huge department.  Given the fact that the new doctor is the department head I'm guessing doctor number two, who told me to put dairy back into the diet, is about to get a workplace whooping.  Unfortunately it still doesn't make me feel any better. 

New doctor argues that the evidence is clear - Roo isn't growing or gaining weight according to the chart, his appetite is meager at best, he vomits, wakes at night, and still seems uncomfortable at times.  Well, I'm not convinced.  He was absolutely, exactly the same when he was NOT eating dairy.  And thank goodness for the blog for giving me a documented history of what he was doing while he was off dairy, namely, vomiting, not eating much, not gaining weight, and waking up at night.  Just like now.  The kid has an oral delay.  He gags.  He has reflux too but let's save that story for another day. 

Ugh, I am so frustrated.  The thought of taking him off dairy again, and this time for longer, makes me want to puke myself.  Maybe the kid just won't eat because his diet gets completely revamped every few months.  I just got him to tolerate some nice buttery, creamy, lusciously high-calorie foods.  Either way, the scope won't lie.  Here's hoping I'm right.

Eosinophil Awareness

Pull out your party hats, it's National Eosinophil Awareness Week!  I haven't written much specifically about eosinophilic disorders lately because Roo's been doing so well.  His last endoscopy in November 2009 was clean, meaning he had no eosinophils (white blood cells) hanging out in his esophagus wreaking havoc on his digestive tract.  

Like so many of these crazy allergic diseases, Eosinophilic Esophagitis was pretty much unheard of until the 1970's.  Since that time, there's been a rapid increase in cases and no one knows exactly why.  The disease is more common in boys than girls, by the way, and while cases appear all over the world across all nationalities, it seems to have a particular affinity for Caucasians.   

We are the lucky ones because we've been able to manage Roo's symptoms through simple diet modification.  Many children are not so fortunate and experience chronic chest and stomach pain, failure to thrive, vomiting, dysphagia (that's when food gets stuck in the esophagus and needs to be surgically removed or regurgitated - one of Roo's big symptoms) from staggeringly long lists of foods and environmental allergens that no one else seems to think twice about.  Can you imagine?  And that's not even taking into account the emotional and social impact these kids suffer.  For many the only "safe" nourishment is specialized amino acid formulas delivered through feeding tubes. 

So, in an attempt to spread the word and garner support for finding a solution to this crappy condition, please visit the American Partnership for Eosinophilic Disorders.  This organization is not flashy but it's incredibly informative, well-organized, accessible, supportive and serves as a fantastic resource for our family and thousands of others dealing with eosinophilic disorders.

GI Update

Thanks for all the well wishes for Roo's Friday GI appointment!  Overall things went as expected with a few surprises. 

As far as the GI doc is concerned, Roo's growth is following a curve.  He's not following "The" growth chart, but he is growing.  He weighed 20 pounds 15 ounces and that put him on a tiny slanting upward arc from where he was three months ago at 19 pounds 10 ounces.  Forgive me for not mentioning to the doctor that the previous weight was taken while he was naked and this one while fully clothed and diapered.  I was all too absorbed by the fact that his height has increased to 32.5 inches which is, drumroll please......officially on "The" chart.  In fact, it's 10th percentile for his age on the chart.  That's non-adjusted for prematurity, regular old 24-month old American boy height.  Yup yup.  Take that size 12-month pants!  We're moving up to 18-months...as long as we can find adjustable waistbands. 

The general consensus is that the eosinophilic esophagitis is not causing his vomiting anymore.  Unless we alter his diet drastically, which we have not, the EoE is not likely to be causing many problems at the moment.  There is no clear single cause for his eating issues and food aversion but rather a combination of EoE, regular food allergies, oral delay, reflux, and his learned avoidance behaviors. 

The recommendation is to see a feeding team.  We have a referral for a different GI doctor who specializes in food aversion.  He works as a team with a gaggle of other specialists - speech therapist, occupational therapist, nutritionist, psychologist, etc.  While Roo has seen all of these therapist types before, the beauty here is that they are all part of an integrated team.  We'll see how it goes. 

Roo will return to his old GI team for an EoE check-up and allergy testing in about six months.  Until then it's status quo for his diet - no eggs, nuts, milk, or beef, and full steam ahead trying to get him to eat, enjoy eating, keep food down, gain weight, and grow.  No problem I'm sure. 

The final surprise of the appointment was that our current GI doctor is leaving Children's Memorial.  I'm not thrilled since he's been good to us, and the fact that he is young, Indian, and has little twins of his own didn't hurt his reputation in our house.  In retrospect, however, I'm not so sure how I feel about him performing Roo's last surgery a couple of weeks after bringing his own newborns home.  Anyway, he's heading out of state to a clinic that currently has no EoE specialist.

Poor Eaters

Book review time.

A few weeks ago I searched for books on the topic of food aversion and didn't find much. After reading a couple of enthusiastic reviews I doled out the 20 bucks for a stuffy looking paperback called Poor Eaters by Joel Macht, Ph.D. My expectations were checked by the amateurish geometric cover design and the fact that it was published almost a decade ago, when EoE cases were far and few between. If our pediatrician, pediatric GI specialist, nutritionist, and speech therapist couldn't give us the magic formula to get Roo to eat, how could this old book possibly help? Well Mr. Macht, please accept my sincerest apologies! Poor Eaters might just save us from the g-tube yet.

To be honest, I hesitate to write this entry for fear that the progress we've made in the past couple of weeks will suddenly shatter if I dare call it that - progress. Still, we've seen changes in Roo in the past 10 days that are more encouraging than anything we've accomplished in the past 10 months. He's eating. Not always enthusiastically, but he's eating. In fact, I think he's even bulked up (gasp!) a few ounces. 

I should mention that the book emphasizes eliminating any physiological issues related to eating before attempting any of Mr. Macht's techniques. For us this is an ongoing struggle. We think we've identified the allergens that affect Roo's esophagus and have eliminated them. He's off all nuts, dairy, eggs, and beef. A clean scope (upper endoscopy) at the end of November, indicated that our dietary changes were working but we are still careful when introducing any new food. And he still surprises us with a projectile vomit now and then so we just don't know for sure.

As is turns out, there's no magic formula. We were already doing many of the suggestions in the book - using contingencies, finding the success points on which to build, ending meals on a positive note, etc. Somehow tweaking our methods, having a clear, measurable path for progress, and being able to relax in knowing that other children have come through this has made all the difference. So thank you, Mr. Macht. Thank you.