The words “elimination diet” implied, when I first heard them, the opposite of the process through which we put our five-year-old daughter. I thought an elimination meant taking things out of the diet, one by one, until Sammi felt better and her esophagus ceased to have eosinophils coating its walls. In reality, the process worked in reverse. This was what her fifth year looked like:
- July 2010: We removed dairy, egg, soy, nut, and wheat from her already-vegetarian diet.
- August 2010: A few weeks from the end of this first phase of the diet, we made mistake #1 in implementation of the diet. Mislabeled bags led us to believe she had been exposed to candy made on shared equipment with peanuts. Thanks to the wonderful customer outreach professional at Jelly Belly, we didn’t have to start over.
- September 2010: An endoscopy showed a total absence of eosinophils — exactly what we hoped would happen. That meant that we could choose the first of those eliminated foods to add back into her diet. Eventually, one or more of them would cause a recurrence of symptoms and we’d have found the culprit.
- October 2010: We added eggs back into her diet. In near-mistake #2, a relative ignored our insistence on no restaurant food and fed her a smoothie on potentially contaminated equipment. Once again, corporate communications professionals at Jamba Juice helped us understand the blender sterilization process, and we didn’t have to start all over again.
- November 2010: Another endoscopy showed her esophagus still looking healthy — no eosinophils. Success! Eggs stay, and we add soy back into her diet.
- December 2010: Another endoscopy, another success. No eosinophils after soy. Eggs stayed, soy stayed, and though Sammi had never liked nuts, she still had to try adding them back into her diet, so they were our next trial.
- January 2011: Bags and bags of nuts of all kinds filled our cabinet as we tried to find a combination that Sammi would eat in a large enough quantity to make the trial effective. Each bag was scanned for potential sources of milk or wheat, the last two items she was still avoiding. One day, we gave her peanuts from a different bag, which, on careful checking, had been produced on shared equipment with milk. Our trial began all over again — thankfully, the only time during this year-long process that we lost time to a mistake.
- February 2011: The endoscopy after a full six-week nut trial was also successful, showing that nuts were not the culprit despite our suspicion that her dislike of them was a sign. Down to only two foods left to try, we gleefully added wheat back into her diet.
- April 2011: After six glorious weeks of eating cookies, cakes, and her beloved challah, she went back for another endoscopy. This, too, showed no eosinophil growth. With spring break beginning the next day, we added the last ingredient — dairy — back into her diet, making it the first time in ten months that she was eating an utterly unrestricted diet.
We assumed that this meant dairy would be the thing that caused regrowth of eosinophils, but we had to put her through a trial of dairy anyway, just to prove the theory. The four of us packed up our car and left immediately on a road trip. All the food we hadn’t been able to share — all the restaurant meals we’d been unable to enjoy — were, in my mind, going to be packed into the next six weeks.
After that, she’d avoid dairy for the rest of her life, as I did from my own lactose intolerance, and we’d have our definitive answer. After a year of maybe it’s this and maybe it’s that, to have arrived at this nearly-certain answer was a similar kind of relief to what a runner feels the end of a long race.
In June 2011, Sammi was scheduled for her last endoscopy. That was nearly two months away. She was suspended between freedom and a jail that — while restrictive — was at least larger than the one she’d been in all year. In the next six weeks, I’d have to slowly break the news to her that these were the last chances she had for frozen custard, gooey macaroni and cheese, easily-sought vegetarian meals at restaurants. For just a few days, though, I would sit right there, across from her, and watch her eat ice cream, at a restaurant, grinning ear-to-ear.