Tag Archives: food challenges

Yet another chicken recipe!

We might be nearly 9 months into life with a NG-tube and in theory should have long since said goodbye to its presence in our world, but the reality is very different. M hasn’t been able to progress beyond our 4 staple foods and it is becoming increasingly challenging to make rice, chicken, cucumber and apple into a tasty and interesting combination for 3 meals a day. 20150710_203444M’s steady consumption of new favourites tempura batter chicken nuggets and arancini di riso has resulted in the purchase of our first-ever deep fat fryer – a piece of kitchen equipment I never envisioned gracing my kitchen’s counter-tops – and I have been concerned about the amount of fried foods he’s now eating on a regular basis. Thanks to a recent post on The Recipe Resource’s Facebook forum, I converted the cornflake-covered chicken balls to a M-friendly version and found a healthier twist to chicken nuggets for him to enjoy.

They were really simple to prepare and it would be easy enough to adapt the recipe to suit your tastes and dietary needs. I’ve added both sage and thyme to the mix and both proved popular with M and G alike and I’m sure you could spice them up with chilli flakes for a more “grown-up” flavour.20150723_190656 The quantities would be easy to adapt too, so that you only make what you need for a meal-time, although M has enjoyed them cold for his packed lunches recently too. I also took the basic recipe and made some crispy fish balls for M’s white fish challenge, which I’m sure, with a little bit more time and effort, could be moulded into all sorts of interesting shapes. It ultimately turned out to be yet another food fail, but M definitely enjoyed the bite-size fish nuggets whilst he could.

Quick update

Stocks-Update-1With 2 weeks left to the end of term, there’s so much going on that I’ve barely got time to sit down and commit any useful thoughts to paper, so I’m afraid this post is just going to be a quick update.  We’ve just had our first appointment in the new “Complex gastro and nutrition” clinic that our consultant and lovely specialist dietician have started at GOSH.  The thinking behind this new clinic is that for children like M, who have a chronic gastro condition such as EGID as well as significant, complex and multiple food allergies, there needs to be regular meetings with both a gastro consultant and a dietician to ensure that everyone is singing from the same song sheet when it comes to treating the health of that child.

Hospital appointments always induce mild nerves in me, but this time round I felt more apprehensive than usual.  We are now into month 8 of the NG-tube, when the initial plans were that M would have it for no more than 3 months at most and I was concerned that there might be discussion about removing the tube in the near future.  M’s health has been so significantly improved since we went elemental in December that I don’t want to rock the boat any more than is necessary until we have a huge improvement with his diet.  generic round label_1265358343With only 4 foods on our “safe” list out of 12 tried so far, it has been a much longer process to reintroduce foods back than any of the medics expected, although, to be honest, Mike and I had always anticipated it taking a full year, if not longer.  At the moment, M is coping well with his tube and is keen to keep trying new foods, so there are no concerns that the presence of the tube is having a detrimental effect on him in any way.

So, in a snapshot, the outcome of our appointment was this:  that on almost every level, his health is remarkably stable right now and even his hay fever isn’t causing too many issues this year; but the area of most concern continues to be his ever-growing list of multiple food allergies.  Our dietician is very worried that M is struggling to tolerate so many foods and now refers to him as one of her “biggest, but loveliest challenges”.  The process of reintroduction has been so slow that until we have at least another 2 or 3 back in his diet, we cannot change the amount of E028 he’s having via his tube and so the tube obviously needs to stay in place.  We have chosen the next 5 foods to try – white fish, pear, GF oats, venison and coconut – and will also be doing some mini-challenges to see if we can have some more spices and flavourings to add into my recipes.  I will continue to remain in regular phone contact with her throughout these trials and we will keep persevering with the food challenges until our next scheduled appointment in around 4 months time.

A cake for every occasion

We might have had Christmas, Easter and at least 2 birthdays since M first had his NG-tube, but they’ve all been celebrated without a morsel of cake passing his lips for 7 months.  He enjoyed Foxes Glacier mints for Christmas lunch, a “fake” cake for his birthday and a passable rice-flour biscuit for Easter; but we were all fully aware that none of them could possibly replace the role of cake in so many celebrations.  PV-2The harsh reality of so few ingredients has meant that even at my most inventive, a successful cake replacement has just not been achievable, but with the re-introduction of apple in the last couple of weeks, M’s dream of cake could, and has, finally been fulfilled.

It is all thanks to one of the lovely Mums that I have become friends with through FABED and whose son, under the care of the same consultant as us and who M met during his hospital stay last December, is a few weeks ahead of M with his food reintroductions after time on the elemental diet.  R and I have spent time chatting, texting and e-mailing about the boys and where we each are along our respective journeys, sharing stories and giving tips whenever possible.  Having gained the advantage of those few extra days, R has had some useful tips when it’s come to preparing food for M, the best one being this M-friendly cake recipe that I was able to try out at long last.20150626_144401

Apple purée is a popular egg-alternative, though not one I have previously used in my M-friendly baking as I have preferred to bake with ground flaxseed meal or mashed banana. With banana being a definite no for the time-being and flaxseed being low in our priorities of new foods to trial, it was finally time to put apple purée to the test. The first job was to prepare some apple purée before having to deal with the tough task of stopping M devouring it all at each and every opportunity that arose until I had a chance to actually try out the cakes. Despite his best efforts and enjoying lashings of purée with his rice pudding, there was just about enough leftover for these delicious apple and rice flour cakes.  The recipe is simple, easy to follow and perfect for anyone with such limited safe foods and, what’s more, I’m certain that it would be easy to replace any of the ingredients with an alternative that suits your particular dietary needs. The cakes are deliciously moist and have been a huge hit with M, who is asking for them morning, noon and night and are definitely a great addition to his school lunch-box.

Another food and an unexpected insight

This moment has been an awfully long time coming, over 4 months and 7 food fails in a row in fact, but finally we have a fourth safe food to add to M’s repertoire: apple.  The last few months have been emotionally tiring as we’ve worked our way down the list of food challenges agreed with our dietitian and M has systematically, and holy-grailsometimes dramatically, failed each and every one.  It has felt as if that elusive fourth food was our personal Holy Grail and there were times when Mike and I both began to wonder when we would ever achieve it.

One of the complicating factors we’ve had to deal with during the food challenges has been the whole host of reactions that we’ve seen along the way.  We were never told, as far as either of us can remember, that it was possible to see so many different allergic responses to the varying foods M was trialling and we were certainly not advised that he could experience some that he’d never had before.  His severe oral reaction to sweet potato was, in many ways, the easiest one to identify, even though horrendous to see happen, as we knew immediately that it had to be an instant fail; but the others have not necessarily been so straight-forward.

complicatedOur main goal is to maintain the improved health and toileting that M has achieved since he first went elemental back in December and even though that has meant ruling out some foods that would have been great to have back in his diet, I remain firm that his well-being, both physical and psychological, is our primary concern.  At our last appointment, we discussed with both M’s consultant and dietitian our approach to the food challenges and agreed that anything that causes a loss of bowel control, of any description, has to be considered an instant fail for the time-being. These foods are not ruled out permanently – well, sweet potato is as far as I’m concerned! – and we will, without a doubt, revisit them at some future point once we have more safe ones back.

Sadly he has reacted to some of his old favourites, but he has coped admirably well with accepting the outcomes.  He still remains reluctant at times to acknowledge exactly how he is feeling and telling us about the aches and pains we know he must be experiencing, but 9 years of parenting M means that I have become highly attuned to his moods and can sense when he’s feeling under the weather.  His willingness to lose a food again at times has indicated to us that he also identifies when it’s making him feel poorly, especially when he has been prepared to fight for those that he believes he can cope with.

Never was that so true as at the start of our apple challenge.  During the first couple of days, his body reacted with hives and itchy skin, just as we saw when we first reintroduced rice and he also struggled a little with his bowel control.  However, unlike with other foods where he has reluctantly agreed that it was likely a negative response to the challenge, this time round M insisted that the fault was his for not listening to his body and responding quickly enough and that he felt he was still in complete control.

10 days on and he has proved to be right, which is a valuable lesson for us all:

We have spent years fighting for our voice to be heard when it has come to M’s health and each step of the way have been shown to be right in our concerns and our thoughts for his ongoing treatment.  It seems that now we need to start listening to what M has to say too and take into consideration his opinions and insights about his body.  Of course, at 9 he is nowhere near old enough or responsible enough to make his own choices or sway our decisions unduly, but, just as I have spent a long time arguing my place as the expert on the subject of M because I’m his Mum, now as Mum I need to encourage him to be his own best advocate and take an active and involved role in his care.  After all, that’s a key part of my parental role.apples7

And whilst I ruminate on this latest insight into M’s development, I’m eagerly gathering ideas and recipes to incorporate apple, in all its glory, into his diet.  So far, we’ve ventured little further than apple juice, apple slices and apple pancakes, but with the help of good friends, including one whose son is just a few steps further down the food challenge road than M, and great resources such as The Recipe Resource, then apple crumble, apple crisps and apple cakes are all on our horizon.

 

Feast or famine

There are times when recipes, just like buses and blog-posts, can be hard to find and then, just when you think you’re in for the long haul, a whole host of them appear from nowhere and flood your every waking moment.  Over the last few weeks, I’ve been desperate to find some more alternatives to plain chicken and rice to tempt M’s taste buds and it is thanks to some canny suggestions from M’s dietitian, a lovely reader and even my hairdresser that this past fortnight has seen me trialling some new inventions of my own.

or-kitchen-gf1Today’s recipe is one that might not appeal to everyone, but it has certainly been a huge hit with M:  Chicken Liver pâté.  Both G and M love pâté and when they were little, I found a quick and easy recipe and regularly used to make my own.  I’m not quite sure why it didn’t cross my mind to revisit this recipe in recent months, but thanks to a throwaway comment from our lovely dietitian about the possibility of cooking lamb’s liver and kidneys when M trials lamb, Chicken liver pâté suddenly sprang to mind. I spent a productive hour or so flitting between my computer and my recipe books, searching out traditional recipes as well as some that are dairy-free and quickly came to the conclusion that, with a clever few tweaks and variations of my own, this was definitely something I could cook up for M.

20150602_182343The base ingredients are easy to source: chicken livers, oil, rice flour, rice milk and herbs and seasonings; and I think that the recipe is easy to follow.  In my latest batch, I also added the last remaining drops of the “Rice whip” rice cream I had managed to buy months ago, which gave the pâté a creamier texture, but isn’t necessary to make a spread that everyone can enjoy. The pâté has given M another fab alternative to the monotony of his daily meals and he’s currently loving his pâté “sandwiches” (rice cakes with pâté) for lunch, instead of the dry alternative.

20150610_175428Pâté perfected, it was now time to put my second plan into action and create a M-friendly version of Beef Wellington.  Sadly at the moment for us there can be no pastry, mustard, mushrooms, crepe or indeed beef, but there is chicken, chicken liver pâté, cucumber and rice and that, I decided, was more than enough.  I carefully cut into a chicken breast and created a pocket, which I filled with thin slices of cucumber and lashings of the pâté.  I coated the filled breast with a rice crumb and then oven-baked.  M tucked into it heartily last night and devoured the lot, which was just amazing to see.  So that’s another dish to add to my repertoire, though perhaps the end result was more “Chicken Kiev“, than “Beef Wellington”, a “Chicken Wellington” you might say!

 

“Elementa(l)ry, my dear Watson”

(with profuse apologies to all Holmes fans out there, but I just couldn’t resist!)

As we head into our 5th month of E028, the positive impact of the elemental diet on M is plain to see.  Family, friends and even casual acquaintances have commented on his improved health, behaviour, appearance and overall much happier demeanour.  We have seen glimpses of the happy-go-lucky, confident and outgoing child he can be when constant pain is not plaguing him and we have celebrated that success with him.  We’ve even embraced the somewhat daunting prospect of food trials despite the lack of useful advice we were originally given and have ploughed on regardless, surviving the highs and lows of this latest rollercoaster ride. Believe me, there have been plenty of both.

The highs have been encouraging; 

highsWe have successfully reintroduced rice, chicken and cucumber to his diet and he’s loving being able to eat something solid once again.  I’ve adapted, tweaked and sometimes created from scratch recipes to give him a range of meals that make meal-times more exciting than just plain boiled rice, grilled chicken and a few slices of cucumber 3 times a day.  We’ve even found a new favourite in rice noodles, something he would never eat when he was small and, thanks to the advice of 1 kind reader, I have even managed to lay my hands on a bag of the elusive rice pasta and he’s enjoying the variety to his diet.  The bonus of finding some amazing allergy-friendly restaurants earlier this month was a real boost and will make a big difference to us all.

M has stayed positive and has very much been involved in making the decisions about what foods he trials next.  We are working closely with our GOSH dietitian to choose our hit-list of foods in a balanced manner and I speak to her every 2 or 3 weeks to provide an update on our progress.  Even better, she is constantly contactable via e-mail, which has given me huge peace of mind as I know I can ask her any questions I might have and she will always come back to me by either phone or email, even if it’s just to say she’s looking into it and will let me know.  We’re once more on a small break, but are looking forward to attempting carrot, corn and apple over the coming few weeks.

And the lows have been exhausting.

exhaustionmanageI never realised just how exhausting the process of food challenges would be and that’s on all levels: physical, mental and emotional.  Each new food starts with the excitement and hope that it will be a safe food for M and managing expectations has become key.  It feels easy at the moment to be downhearted as we have had 4 fails – pineapple, pork, sweet potato and banana – and a question-mark over the 5th – salmon; but it’s critical we stay positive as there are an awful lot more foods for M to try, and every success brings with it many more options for meals.  Unfortunately, every fail leads to disappointment and discouragement and we have to pick ourselves up, brush ourselves off and look forward to the next one as best we can.

The need to be constantly alert to the risks of cross-contamination during food prep, as well as ever-vigilant about rogue additions to lists of ingredients and being constantly alert to any signs of a reaction in M, requires a stamina I didn’t know I had.  That is something I’m sometimes finding it hard to hang on to.  Whilst we are almost desperate to successfully introduce another ingredient to our meagre list, it’s become clear that we have to do it at a pace that suits M’s pernickety digestive system, and that seems to be a very slow rate indeed.

SHERLOCK_HOLMES_-_01-743978However, despite the exhaustion and the blood, sweat and tears shed in the name of finding another safe food, the future is looking bright and M’s better health gives us all a reason to keep going, even when it seems tough.  To have him in the best health we’ve known for 9 years means that our decision to go elemental really was…well…”elementary, my dear Watson.”

Why #allergyawarenessweek is important

This week is Allergy UK’s #allergyawarenessweek and their aim is to raise awareness of the serious, and sometimes severe, impact of allergies on everyday life.  Their campaign #livinginfear has invited allergy sufferers to talk about the frightening side of allergies, not least of which are the statistics that show an astonishing lack of knowledge about how to deal with serious allergic reactions amongst the general public.  Recent research carried out by Allergy UK shows that 44% of allergy sufferers in the UK are living in fear of a serious reaction, whilst 68% of the people surveyed wouldn’t know how to deal with a reaction; and this lack of public knowledge could be forcing sufferers into a life of fear and anxiety.  This useful infographic published this week uses the acronym FEAR to educate us all on how to recognise, help and potentially save the life of someone struggling with a severe reaction:

Courtesy of Allergyuk.org

Courtesy of Allergyuk.org

Whilst M’s allergies are extensive and challenging, I have always been extremely grateful that he has never suffered anaphylactic shock from anything he has eaten, although the question of whether he could experience one has floated at the back of my mind for quite some time.  We were lucky enough to be able to bring home a training epi-pen after our visit to the Allergy UK annual conference in 2014, though other than a cursory look when it first came home, I have to confess it’s been gathering dust in a box on top of one of our kitchen cupboards since then.  We’ve even gone as far as discussing, late at night, whether we should have an epi-pen on hand at home “just in case”, but I’m ashamed to admit that that is as far as we’ve got in actually doing something about it.

Courtesy of foodb.ca

Courtesy of foodb.ca

However, less than a month ago that decision came back to haunt me and I learned unexpectedly just what the reality of the #livinginfear campaign could be like.  We were trialling sweet potato with M, a previous favourite that we were desperately hoping would bring some much-needed variety to his meals.  The first mouthful on that first Friday night had been eagerly received and much enjoyed by M and although the following day was a little more fraught on the toileting front than it had been for a long time, we hoped it was nothing more than a temporary blip to be overcome.  We ploughed on with the food challenges and M had taken to waxing lyrical about how much he was looking forward to including sweet potato in his diet once again.  He even asked how long it would be before he could enjoy a “whole baked potato” once again.

It was at the 3rd meal and the increase to 2 teaspoons of mashed sweet potato that things suddenly and rather dramatically went horribly wrong.  Mike, rather typically, was out for the evening at a charity whisky-tasting event and it was just me and the children enjoying our evening meal at home.  M tasted his mouthfuls of the mash before anything else and then got on with the rest of his dinner.  He got no further than half-way through when he suddenly grabbed at his throat and started gulping down mouthfuls of his glass of rice milk.  He complained that his tongue was stinging and itchy, his whole mouth was itching and it felt as if someone had grabbed his throat and was squeezing hard.  Two glassfuls of milk later and a frantic phone-call to Mike about what was going on, things settled down and M was feeling a lot better.

I had spent those 20 minutes just about holding it all together, whilst running anxiously through all the possible scenarios in my head and trying to work out what I needed to do if things took a turn for the worse:

  • Option 1 – Jump into the car with both children, trying to keep as calm as possible and race to our local hospital, 20 minutes away and with no car parking options on site:  I’d get there, but what if he stopped breathing in the car and I needed G to get involved, even if it was just by using my mobile to phone for back-up?
  • Option 2 – Dash off to one of several nearby friends who are also doctors and ask for their help:  much quicker, but at least one of those was at the same event as Mike and who knew whether the others would be at home
  • Option 3 – Call 999 and wait anxiously for an ambulance to turn up, all the time acting as the proverbial duck (calm on the surface, but paddling furiously beneath the water): how long would it take for an ambulance to reach us? Could I keep both children calm at home as we waited? What would I do if M stopped breathing? What would I do with G if we needed to rush off to hospital?

We were lucky.  The reaction passed, although the stinging pain in his mouth and throat and the sensation of his throat tightening returned at odd times over the next few days.  Following a lengthy conversation with our GOSH dietitian, it seems likely that M actually suffered an oral allergy to sweet potato rather than full-blown anaphylaxis, though it doesn’t quite fit with the known causes and triggers of Oral Allergy Syndrome.  If you are interested to learn more about living with OAS, then I highly recommend the blog Feeding my intolerant child, whose description of her son’s oral reaction to a simple fruit ice lolly whilst on holiday is definitely reminiscent of those frightening moments at home a few weeks ago.

epipenNeedless to say, sweet potato has been banished from M’s diet for the foreseeable future and we are now seeking a local allergist who can help advise us on dealing with any other more serious allergic reactions that M might experience as we continue along the food reintroduction road.  Oh yes, and we’ll also be pleading to get him an epi-pen for our own peace of mind and for the sake of his well-being and I will make sure that we all know how to administer it correctly.

A tri-umph of rice-themed goodies!

Recently I’ve been spending my time baking and cooking up a whirlwind as the days ahead have been looking busy.  With a day for G and M at the holiday club run at Mike’s work, an appointment with M’s consultant and dietitian at GOSH to review his progress 4 months post-tube and a planned short stay in London to see the sights and to dip our toes into the world of being away from home with NG-tube in tow, a plethora of safe snacks and treats for M were much in need.  I prepared rice pudding, rice-flour sugar cookies and rice krispie cakes to satisfy the appetite of my youngest and to reassure myself that we would have some things with us to feed him whilst the rest of us enjoyed some much-missed meals out.  I also used the opportunity whilst trialling banana to add some to the mix and made some banana sugar cookies too.

The recipes can be found in the everything-free recipes section and are so easy to follow that next time round, my plan is to be sitting back with a cup of tea, whilst G and M get on with the task of creating their own delicious masterpieces!

20150314_213802 20150321_191535

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Who knew you could make so much from rice, sugar, rice milk and canola oil?  Any other suggestions for simple recipes will be very gratefully received!

“I like rice…

..Rice is great if you’re hungry and want 2000 of something.”

– Mich Ehrenborg

I never realised just how daunting food could be until we embarked on our dietary journeys with our children.  It might sound ridiculous, but having achieved such a resounding success from M’s move to the elemental diet, the prospect of food reintroductions caused my heart to beat a little faster, my palms to grow a little sweatier and several middle-of-the-night awakenings to contemplate just how the whole process would work.  A big part of the problem was the lack of useful any information from the dietetics team about…well about anything I wanted to know.  I like to have a clear plan to follow and needed to understand how we would choose which foods to start with, how each food should be prepared, how much to give and how often.  The vagaries of sweeping statements such as serve M “a portion”, with no hard and fast details of the specifics drove me insane, but with lots of discussion, frantic e-mailing and a move back to our old and trusted dietitian rather than the one I’d had run-ins with during M’s admission, we finally got the answers we were after.

Courtesy of alternative-doctor.com

Courtesy of alternative-doctor.com

The decision was to begin with rice, commonly considered to be hypoallergenic and therefore a great starting place for M.  Whilst many children reintroducing foods following the elemental diet might trial potato first, this was one of the known triggers for M’s allergic reactions and so we needed to find a basic food that was likely to be safe.  Despite being told that we could comfortably start with a “portion” of rice, I chose instead to take things slow and M had just 1 tablespoon of plain, boiled rice on that first night.  He enjoyed his mouthful and, looking forward to having more the next day, carried on somewhat oblivious to the anxious monitoring I was trying desperately to hide.  The evening passed without event and we all went to bed happily – well, the rest of the family went to bed happily, I went battling the usual Mummy-paranoia that accompanies anything and everything that involves my children and their welfare.

Courtesy of smartwebsite.ru

Courtesy of smartwebsite.ru

Since that day, around 4 weeks ago now, we have been able to gradually increase the amounts of rice M eats each day and have branched out to include rice milk, rice cakes and gluten-free rice cereal – a veritable feast!  This week I even managed a rice batter, using rice flour and sparkling water and made some deep-fried rice balls to tantalise his taste buds.  M has shown an occasional atopic reaction to the rice as it triggered a rash across his shoulders and back, although the hives have now calmed down as his body has become accustomed to eating once again.  Despite this rash, we have seen no reaction in his bowels and are able to count rice as a “safe” food for him.  Even better, we have also been able to add chicken to the mix and this week have been trialling pineapple, though the jury is still out as to whether this may be causing a mild behavioural reaction akin to the one we’ve seen him experience before to soya.  Assuming all is well with the pineapple, we have plans to trial pork, cucumber and carrot over the coming weeks and may even have time to squeeze in another carbohydrate before we head back to GOSH in April.