Friday, June 21, 2013

Day 40 - Going to an Allergist

I have never been to an allergist. While I realize this is not a remotely exciting "I have never..." event, those that know me best can attest to the fact that this is a long-overdue experience. All my life I have suffered from moderate to severe allergies, but about five years ago they decided to kick into high gear. As a result, seasonal changes have caused reactions in my body so severe that I have had to miss work several days per year to tend to my symptoms. Despite this debilitating reaction to many everyday things, my stubborn nature led me to put off visiting a doctor about my allergies for a long time. When I finally decided to do something about it, my primary physician met me with a few years of resistance to the idea of a specialist referral. Finally, with a little motivation from my "I have never..." journey, I took a stand and demanded a referral to an allergist at a recent doctor appointment. In turn, I finally gained the opportunity to see an allergy specialist. With my appointment scheduled for today, I took some time off of work to get tested for allergic reactions. The appointment proved a frightening and insightful experience that left me wondering why I didn't act on going to an allergist sooner.

Getting there...
The day's event began simply enough. I easily found my way to the clinic for my appointment given I had driven to it by accident leading up to my recent experience with Tai Chi. Upon arriving at the clinic, I checked in without issue and found my way to the Allergy and Immunology department. Passing a small waiting area, I noticed a receptionist desk just beyond wooden door on my right. I opened the door without entering and stuck my head in to find some indication I was nearing the correction location. A woman behind the desk just on the other side of the door stopped her work at the sight of my conspicuous behavior. "Hello. Do you have an appointment?" she asked with a slight look of confusion on her face. I responded quietly, still uncertain of my location, "I think so... Is this the allergy testing clinic?" The woman nodded her head before asking for my name. "I'm Caleb. I have a 1:00 appointment," I said as I carried the rest of my body through the doorway and toward the desk. The woman quickly typed some information into the computer in front of her before handing me a clipboard with a form attached to it and explaining my appointment would begin momentarily. "Take this with you and follow that man to the examination room," the lady said gesturing to a man standing at the other end of the long grey desk. On cue, the man responded, "Right this way, Caleb" as he extended his arm toward a hallway just behind him. Caught off guard by the pace of the interaction, I quickly gathered my things and walked toward the man.

The examination room
A short walk down the hallway led us to the examination room that would serve as the site of my allergy tests. With the appointment still moving at a quickened pace, the man directed me to take a seat near a computer and asked me a series of medical history questions. After typing my responses into the computer, the man advised me a nurse practitioner would help me through the rest of my appointment. He proceeded to tell me to fill out the piece of paper on the clipboard while I waited, and the promptly exited the room. As directed, I started reading through the allergy questionnaire on the piece of paper and writing down my allergy history and symptoms.

After working through only two of the more than 20 questions, I heard a light knock on the door. A second later a woman in a white coat walked in with two plastic totes containing small glass bottles of yellow liquid. She set the totes on the examination table before taking a seat at the computer and introducing herself as Mary. Baffled by the speed with which things were moving, I quickly tried to answer more of the questions on the piece of paper as Mary began a review of the information I had provided earlier. I responded with nods and short answers and I scribbled answers onto the piece of paper. Noticing my hurried movements, Mary calmly redirected my attention, "Don't worry about that for now. You can fill it out later."

As I set the clipboard on the computer desk to my right she continued, "Now, bring your chair over to the left side of the examination table and extend out your arms, face up" she said rolling toward the totes on the examination table. Following her instruction, I took my position next to the examination table and laid out my arms. Moving to the opposite side of the table, Mary explained she was going to stick my forearms with a series of different common allergens to gauge my reaction to each. I watched as she pulled an apparatus containing eight points, each of which were submerged in a separate bottle of yellow liquid, from the handle of a tote before her. She leaned over the table and advised me I would feel a slight prick from each point on the tool as she pressed the device into my right arm. Without delay, Mary proceeded to grab an identical tool from another tote and drive eight more points into a lower part of my right forearm. Continuing, she grabbed one more tool from the final tote and stuck its eight points into my left forearm.

It begins...

Mary stated I would start to feel a slight burning and itching if an allergic reaction was occurring and directed me to move back to my previous position near the computer. I moved my chair back to the computer desk and sat down. Mary followed suit, rolling back to her position at the computer after cleaning up the examination table. "Ok, I know its only been a few minutes, but let me take a look at your arms," she said reaching out for my wrists. With a burning feeling starting to overwhelm my skin, I turned my palms upward and extended my arms. Lifting her head to examine the injection sites through her glasses, Mary immediately responded to the sight of my forearms. "Oh my..." she said with obvious concern in her voice, "This is certainly something else..."

My right arm a few minutes into the test
Uneasy at Mary's initial response to the sight of my arms, I looked at the sites where the allergens had been injected. In the few minutes that had passed since the injection occurred, my forearms were a bright red color and 15 of the 24 injection sites had swollen to welts about the size of a pencil eraser. Examining each of them closely, Mary told me to prepare for some intense itching and burning over the remaining 12 minutes of the test. Already feeling as though my arms had been swarmed by mosquitos, I started thinking of ways I could distract myself from the itchy feeling caused by the injections. Understanding my need to do so, Mary struck up a conversation about my family history and my previous experiences with allergies.

The two of us chatted from several minutes about my family and my background. Mary happily fielded my questions about the sources of allergies, the body's reaction to allergens, and the methods to control allergic reactions. Sensing my curiosity, Mary was happy to provide me an in depth background of allergy medicine and the advances that have been made in understanding the sources of allergies. I listened intently and asked more questions in an effort to avoid the intense burning sensation covering my forearm. 10 minutes into the test Mary asked to check my arms once again, which prompted me to once again extend them outward. I looked at the injection sites with amazement upon noticing nine of them had grown to the size of a marble or a dime. Mary took her time looking over each reacting site once more, explaining to me the types of allergens to which I was reacting. "Cat hair, dust mites, maple pollen, birch pollen, elm, and one kind of mold; those are the ones that are really puffing up," she said as she rotated my arms in her hands. "Surprisingly, ragweed, dogs, cockroaches, and most of the remaining molds aren't reacting," she continued as she moved to type her findings into the computer. With my arms now feeling like they were enveloped in a poison ivy rash, I asked her how much longer the test would take. "About four minutes left.." she said lifting a small plastic timer so I could see it, "Only four minutes."

In an effort to stave off the burning, itchy feeling, I balled up my fists and squeezed as I looked toward the ceiling. "I can do this," I thought as I took a deep breath and bit my lip. I took one more glance at the welts on my forearm, which had now started expanding from circular shapes to obscure random forms. Noticing I was looking at them once again Mary did her best to distract me with an appeal to my inquisitive nature. "You know, what's interesting about this is that your reactions are quite random. Some animals but not others, one mold but not most, some weeds but not the most common ones, and only about half of the trees... It's very intriguing how this is coming out." she said glancing at the timer. I smiled at her before lifting my head back toward the ceiling. "Alright, let's start getting our final results," Mary chimed in suddenly despite the fact the timer had not quite struck zero.

My right arm at the end of the test
Grateful for her proactive action to help get to the end of test, I quickly stuck out my arms. Mary proceed to measure each welt on my arm with a small measuring tool she removed from her pocket. After measuring the width of each, she would type some details into the computer related to the size and source of each welt. Acknowledging my discomfort, Mary moved quickly but ensured each measurement was accurate. Eventually, she worked her way to the last measurement and leaned back from the computer. "Alright, it's a good thing you came in" she said looking at me directly. "These big ones are one measurement away from anaphylactic. That's about as severe as it can get without putting you in an emergency room," Mary continued. Swallowing hard at her report, I immediately responded, "Is there a risk it can get to that level? I mean, can my reaction get worse?" Mary was quick to calm me by saying there was very little chance of that happening, but advised me we needed to take some aggressive steps to address my condition. "We're going to try a lot of things of the next few weeks, and then we will meet again, OK?" she said in a reassuring tone. Feeling a slight sense of relief at her response, I agreed, "Yeah, that works... Can I get this stuff off of my arms now?"

Mary laughed and directed me to the sink in the corner of the room. Scrubbing my arms vigorously, I looked on as Mary gathered a handful of medicines for me to take immediately and typed a series of prescriptions into the computer. Returning to my chair, I listened on as Mary gave me specific advice on how to avoid allergens in indoor and outdoor environments. She assured me I could take better control of my symptoms and that our efforts would help me find a way to better manage my allergies. I continued listening to her advise as Mary put together a folder of information for me and provided me a series of recommendations for treating the welts on my arms. Her concern apparent, Mary paused after her explanation and asked me how I was feeling. "It's itchy, but I'll get through it," I said smiling. She acknowledged my remark and reminded me of her contact information before leading me out the door. Wrapping up my appointment, I checked out of the clinic and started making my way home.

My right arm on the drive home
My drive back to my house was rather uneventful, but a strong feeling of fatigue started gripping me as I traveled. Now two hours after injections, I took a quick look at the welts on my arms when stopped at a traffic light. Their size and shape was largely unchanged. Recognizing the fatigue was likely a result of my body's persistent effort to fight the non-threatening injections in my arms, I found my way back to my house and immediately laid down on my couch. Moments later I fell into a deep sleep that lasted well into the evening. Upon waking, I was surprised to see the welts on my arms remained, although slightly diminished. Even now as I write this blog entry the day after my appointment, I'm still treating red, itchy spots on my arms from where the worst reactions took place. In other words, my body's immune system doesn't know when to quit.

Today's trip to the allergist was something I likely needed to do years ago. Although it wasn't exciting or fantastic, the steps I took today are critical to maintaining my health and wellness. Perhaps now I can start to find a path to address my persistent and often overwhelming allergies. Considering they have affected my health and motivation in the past, doing so will be important to making sure I keep my "I have never..." goals on track. Sure, the experience proved uncomfortable and very itchy, but this test revealed some very important information on how I can be better for myself. I can't think of any better takeaway from a new experience.

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