I took Elizabeth to an allergy/asthma doctor for an evaluation (the results of her blood test for a pecan/walnut allergy made the pediatrician say she should see a specialist). I always hate the first time doing something new: I’m so anxious when I don’t know what to expect. And it seemed like things got off on the wrong foot from the very first phone call: the receptionist asked me “Is she having a skin test?” and I didn’t know: the pediatrician just told us to see the specialist. So then I was thrown by the question, and felt foolish for feeling thrown, and got into the kind of scrambled-up talking where I have to say to myself that it doesn’t matter if I sound stupid, it only matters that I GET THE WORDS OUT and not sit in silence on my end of the phone. And that it’s okay to say, “Oh! I don’t know! The pediatrician just told us to see the allergist! It’s because she had a blood test that showed a nut allergy.” I was pleased that we could get an appointment so soon: sometimes with specialists it can be AGES.
They sent us some paperwork to fill out before her visit. It asked a lot of questions about things like hives, wheezing, seasonal allergies, etc., and I kept feeling silly because I couldn’t answer. How long has she had this reaction to nuts? Hm. I don’t know, because she hardly ever HAD pecans or walnuts. How long has she had reactive airways? Hm. I don’t know; she was DIAGNOSED last winter, but she’s had those symptoms on and off for…years? I don’t know, I wasn’t even sure if I was supposed to mention it or if she was only here for the allergies. What are her primary symptoms, and how serious are they on a scale of 1 to 10? I don’t know what symptoms would be considered “primary,” and I don’t know how serious they are on a scale of 1 to 10. Etc. So I just filled them out the best I could, with too many little explanatory notes in the margins. When we got to the appointment, they asked all the questions on the form ANYWAY, and no one criticized my patchy form-filling-out, and they DID want to know about the reactive airways because with allergies and breathing issues it’s all a rich tapestry.
She wasn’t supposed to have any antihistamines for 72 hours before the appointment. I was nervous I’d forget, but I didn’t: I put it on the calendar, and also the doctor’s office called 72 hours before the appointment and said “No antihistamines from now until the appointment,” which was nice.
They told us to expect the appointment to take an hour and a half, but it was more like an hour. We were the only ones in the waiting room, so I wondered if they build in time to deal with other patients but didn’t need that time while we were there. First the nurse called us back and got Elizabeth’s weight and height, pulse and blood pressure. She then asked me pretty much every single question that had been on the form, and entered the answers into a laptop.
Next, the nurse did the asthma testing. She set up the laptop to show some animated birthday candles. She had Elizabeth take a huge deep breath in, then breathe out as hard as she could into a plastic tube; the harder she breathed out, the more candles blew out. Then, without taking her mouth off the tube, she had to breathe in again as hard as she could. The nurse had her repeat this three times with short breaks (15-30 seconds) in between. Then she gave her two puffs from an inhaler, waited a few minutes, and had her do it all again. The doctor never said, “Yes, she has asthma”; he just came into the room referring repeatedly to “her asthma.” She’ll have an as-needed inhaler. Right now she only has trouble when she gets sick, so he said we could come back in the winter for another evaluation if the inhaler wasn’t enough.
The doctor came in to talk to us about the allergy testing before beginning. He said there were two ways to do it: the less-torturous, less-accurate way, or the more-torturous, more-accurate way. I was leaning toward the latter, but was having trouble understanding the difference and asked what he’d recommend. He said he recommended the former for children and for first-time screenings, so I went with that. When the nurse came back in, I thought to ask if there was a price difference between the two methods (we have a high deductible, so we’d be paying for the whole visit), and she said she didn’t think there could be because they bill both methods using the same code.
It turns out that the more-torturous way involves marking the child’s back with a grid, then doing a separate needle-stick into each of forty grid squares (in Elizabeth’s case—I don’t know if it’s always forty, or if they do a different number depending on what they’re testing for) and putting a drip of chemical onto each needle-stick. The less-torturous way involves using pre-made blocks of ten needles each, pre-filled with the chemicals. The nurse presses down each block, so it’s ten needle-sticks at a time but only four of them, and it’s over quickly. Pain-wise, Elizabeth said, “Ow. OW” with each press-down—but in sort of an annoyed, “Hello, this HURTS” way rather than in any kind of distressing way. The “less accurate” part is because it’s harder to be consistent with the depth of the needle-sticks, and because the testing sites are closer together: a reaction from one can easily spread into the area reserved for another.
Elizabeth had to lie on her stomach for this, with her shirt off. I think she hated having her shirt off more than she hated the rest of it. She was glad the nurse did the actual testing, because the nurse was female. She had a paper johnny to wear, and that helped a little, but she still felt nervous and exposed.
First the nurse wiped Elizabeth’s back with rubbing alcohol, and then she used a marker to label four areas with A, B, C, and D, so they’d know which area was which testing block, and then she did the needle-stick blocks. After the four blocks of needles had been pressed down, the nurse checked to make sure all of them had worked, and then she gently blotted off the extra chemical. She then used a marker to put a dot by each of the forty test sites.
Then Elizabeth could sit up, and we waited 15 minutes for the test to finish; the nurse set a timer outside the door “so you won’t have to suffer any longer than necessary!” The doctor came and checked twice mid-test, and the nurse also kept checking. Elizabeth said it was very itchy, and that it itched more and more. But she didn’t freak out or cry or anything, just a few irritable complaints. I kept looking at her back—it looked pretty cool and dramatic, because even the places where she had no reaction were pink from irritation, and then of course there were all the dots and letters. Very quickly some of them started looking like mosquito bites; the nurse had left the testing sheet behind, so I could see for myself which ones were which.
When the timer rang, the doctor came in and filled in a chart of the reactions: little dashes if there’d been no reaction, or little size-of-reaction codes (3, 3+, 3-, etc.) if there was. She had reactions to pecans, walnuts, and most of the other tree nuts. He said her skin-test results were nowhere near as bad as her blood-test results had been: if her skin test had matched her blood test, he said the reaction area would have been as big as a plum; instead it was about the size of a mosquito bite. He recommends not having pecans or walnuts in the house, but he didn’t sound too impressed with her reaction. She had no reaction to peanuts or almonds, which is convenient. He prescribed her an Epipen, but said we should use Benadryl instead unless she (1) was struggling to breathe, or (2) turned pink all over her face and down her torso, or (3) threw up the Benadryl.
So! Then we went back to the receptionist, and she made us copies of all the testing forms and also printed out a sheet that included the doctor’s instructions. Meanwhile Elizabeth was rubbing her back against the wall, and I realized I’d forgotten my plan to give her a Benadryl as soon as the testing was over, AND I’d left the water bottle in the car. The receptionist offered her a Zyrtec, but I gave her the water/Benadryl in the car instead. (I was remembering when she had a single dose of children’s Tylenol in the hospital and we were billed $14 for it.)
The whole thing was about what I’d expected, except less stress for Elizabeth: I’d thought she might be weepy and upset during the allergy testing, but she was just annoyed. I was relieved that at this point her allergies and asthma are unimpressive, though I was also a bit stirred up by references to “if she can’t breathe” and so forth. We had lunch out to celebrate having the appointment done with.
[Edited to add: Because our insurance denied the claim, saying there was no referral (sigh, we have a COPY OF THE REFERRAL in our anxious little hands, AND the allergist’s receptionist told us they’d received it), I can also tell you how much this appointment costs without insurance: $1,045. That’s $570 for the nurse to run the allergy tests, $125 for the nurse to run the asthma test, and $350 for the pleasure of the doctor’s company.]
