It was the summer of 2011 when, with no swallowed steroids and a totally unrestricted diet, my daughter Sammi was declared to be “in remission” from eosinophilic esophagitis, the disease with which she had been diagnosed almost exactly a year prior. Though we had turned our lives upside down to follow the prescribed elimination diet — including replacing our cutting boards, pots and pans to avoid potential cross-contamination — we were suddenly thrust, untethered again, into “normal life.”
Except one thing.
Sammi had been taking a medication called Prevacid for more than three years at that point. Prevacid is often prescribed for GERD — otherwise known as reflux — and is in the class of drugs referred to as PPIs, or proton pump inhibitors. Prevacid and other PPIs don’t just neutralize acid like Tums or Rolaids or even Zantac do. Instead, they effectively shut down the “pump” that releases stomach acid, keeping roughly 99% of the acid produced in the GI tract from being released into the stomach. If no acid gets released into the stomach, a person who tends to have reflux — food that passes up into the esophagus from the stomach — will still have reflux, but it won’t contain acid. The heartburn that is often the main reason people seek treatment for GERD/reflux no longer burns without acid in it.
For Sammi, Prevacid had originally been prescribed for GERD, but as we had learned a year earlier, GERD is the most common misdiagnosis in patients with eosinophilic esophagitis. She remained on Prevacid after the new diagnosis because, though there was little understanding of why it helped, doctors had seen some evidence of improved symptoms for children who stayed on Prevacid even after the correct EoE diagnosis had been made. So, Sammi stayed on it.
For children, Prevacid comes in liquid form and in something called a SoluTab. It is something like a chewable pill, except it required no active chewing; it simply melts in the mouth. Sammi took SoluTabs, 30 minutes before a meal on an empty stomach. Over the years, her dose changed often — 15 mg, 30 mg, at one point 45 mg. Depending on the prescription and the refills and the changes and who did the prescribing, we would sometimes get SoluTabs that were too big for her. Hence: the pill cutter.
Early in the morning, when Sammi woke up, she knew that the first thing she needed to do was to take her medicine. Until she was old enough to keep track herself, the first thing David or I did every morning for years was to go to the pill cutter we kept in a bowl over the sink, check to see if there was already half a pill there, and if not, unwrap one of the individually wrapped Prevacid tablets, slide it into the pill cutter, and, like a guillotine, bring the sharp edge down to cut the pill in half.
There was barely any noise to it. Shhhhccccchhhhhwwwt. As the blade of one pill cutter got dull, the cut would be raggedy. Sometimes we had to tip the pill cutter over Sammi’s open mouth to be sure we got all the small pieces in, lest she not have the full benefit of her dose. We replaced the pill cutter at least once, maybe more.
When she got old enough, she asked us if she could cut the pill in half herself. Why? we asked. Cuz it’s cool! she answered. The very idea made me sad. Every morning: cut the pill, write down the time, wait for breakfast. Cut the pill, write down the time, wait for breakfast. Cutthepillwritedownthetimewaitforbreakfast. For years.
But then, after she was “scoped clean,” her gastroenterologist told us to take her off the Prevacid. He told us to do it in steps, because there can be a rebound effect — the stomach hasn’t had acid in it for so long, it starts to overproduce. He said to cut her dose in half for two weeks, and then take it all away. He told us not to be nervous if she was a little uncomfortable during that rebound period. “Give her some Tums,” he said.
So we took away the Prevacid, her last medication, and her reflux did rebound, but then it seemed to stop. Sometimes she’d ask for Maalox, which she liked better than Tums, possibly because I keep it chilled in the fridge. The Prevacid went away. The pill cutter sat in the bowl over the sink, got dusty, got buried under Box Tops and batteries we meant to recycle.
And Sammi was a normal kid. No medicine. No waiting for breakfast. No endoscopies, no visits to the gastroenterologist. No restrictive diet. No ingredient reading. Just Sammi. I didn’t know how to be her mother, without the pills and the doctors and the special food. I stumbled. What just happened, this last year? These last six years?
We had fifteen glorious months, free like that. I didn’t wait for breakfast anymore, but I admit it: I did wait for the other half of the pill to drop.