Saturday, 23 December 2017

He knew how to keep Christmas well…

There never was such a goose. Bob said he didn’t believe there ever was such a goose cooked. Its tenderness and flavour, size and cheapness, were the themes of universal admiration. Eked out by apple sauce and mashed potatoes, it was a sufficient dinner for the whole family; indeed, as Mrs Cratchit said with great delight (surveying one small atom of a bone upon the dish), they hadn’t ate it all at last! Yet everyone had had enough, and the youngest Cratchits, in particular, were steeped in sage and onion to the eyebrows!
– Charles Dickens: A Christmas Carol

Three months ago, I wrote about my inchoate struggle with food allergies. And then went perfunctorily wheesht… – especially concerning the related battles I ended up fighting as my former fine fettle fell away….

In any event, you don’t need to hear about the baubling and excruciating detail of these common-sense-crushing war-games…. Just to say that I have now begun to emerge, blinking in the light of headway and right-headedness, thrutched pitiably out of the other end (a feeling probably quite similar to having passed through a Brachiosaurus’ digestive tract): firstly, with a credible stab at a diagnosis (aided admirably by my intelligent immunologist); secondly, with an inconceivably constricted diet; and, thirdly, with beggared astonishment at how extremely variable are the capabilities and qualities of the NHS – from the gob-smacking proficiency and thoughtfulness of the local nurses, to the jaw-dropping lack of judgement exhibited by one of our local hospital’s ‘service’ departments (who ended up, with their staggering, swaggering incompetency, setting progress back by just over two months… – thus condemning me to pain, frustration, and the most excruciating ennui, for much longer than should have been necessary). It did not help, of course, that someone (medical) who promised to help – to help resolve this (as was their duty) – did exactly the opposite…. Nuff sed.

Having kept note of everything that happened to me in that time (as is my wont) – reactions to various foods; other puzzling symptoms; thoughts (and a great deal of research) on possible diagnoses that might apply (some minor; some major; others in some bluesy pentatonic…) – I then overloaded my composed consultant with it all…. Hence the conceivable conclusion (however tentative; but definitely tenable…).

It seems (only seems), consequently, that I have acquired my own version of Superman’s green Kryptonite – in my case, heinous histamine… (to be uttered, perhaps, just as one would exclaim the words “Dread Pirate Roberts!”) – although my vulnerability is not only perfectly mundane, but likely (markedly) self-made (‘self-activating’; ‘self-possessed’; and ‘self-destructing’, as it were): that is, generated by, and in, my very own misfiring mucosae.

Normally, histamine production within one’s body (‘endogenously’) is ‘self-sufficient’ (or at least ‘self-contained’) – and balanced perfectly with that entering the body (i.e. via one’s gob; or ‘exogenously’). However, in my case, something has caused it to course out of control: out of containment.

Unfortunately – although it is puzzling to prove (lacking much of the logic of the legion of Sudoku stretching my synapses these mushroomed months past) – this may well have been provoked by the medication I have taken (for the past year or so) to help cope with the intractable pain I (already) live with (see below) – …in which case this demarcates yet another diabolical “downturn” in my health “caused by being on the wrong end of a sequence of road traffic collisions (RTCs)” (…albeit this one having been precipitated somewhat indirectly).

Anyway… the best explanation I have found of this ‘new’ (to me, to you) condition is this:

Histamine intolerance [also known as enteral histaminosis] is defined as a condition whereby the ingestion of food containing high amounts of histamine by subjects with low intestinal histamine inactivation (or inhibition of this inactivation by other food constituents or drugs) leads to absorption of histamine in amounts sufficient to cause adverse reactions. Impaired degradation can follow genetic or acquired impairment of the enzymatic function of [diamine oxidase (DAO)] or histamine-N-methyltransferase (HNMT).
– Yurdagül Zopf et al: The Differential Diagnosis of Food Intolerance

Indeed, one of the possible – credible and coherent – medical treatments is a dose of DAO: either regularly, or (preferably) immediately before eating food that one is unsure of (which is, at the present time, a situation far, far too hair-raising to contemplate…). The drug itself is, however, not currently available on the NHS (nor is assaying the need for it). Not only that, but it (both the drug and the test) is also (of course) rather expensive. Irregardless, it is, I think, far better to address the root cause of the problem – by avoiding (or preferably eliminating) the substance one’s body is being rather bigoted about – rather than chucking (yet) another jagged little pill into the mix (especially when my medicine cabinet is already preternaturally chocker).

[By the way, “the medication I have taken… to help cope…”, referred to above, is a purposeful (and successful) hodgepodge of opiates, which ‘liberate’ histamine; and muscle relaxants, which, conversely, ‘block’ DAO production. (The foods to avoid – or even eliminate – tend to act in the same fashion.) Their ‘antidote’ is a combination of anti-histamines, of course (the clue is in the name!) – which, in my case, are required to target both H1 and H2 receptors – one of which, strangely enough, is the Nortriptyline I take – quite swimmingly – for migraine prophylaxis.]

Up until now, I had not known what was causing my symptoms; nor why I was so hypersensitive: i.e. reacting to the great majority of things that I ate (trying valiantly to ‘exclude’ certain allergens – or so I thought…). (By the way, when I say “reacting”, this could be just with the sniffles; or – at its frequent worst – with a full-blown allergic reaction; then rapidly cascading into a full-blown asthma attack.) I admit that it sounds (possibly) jocular – considering… – when you discover that “Of the one percent of the population who suffer from histamine intolerance, 80 percent are middle aged women”. However, it is anything but when you are struggling to breathe, drowning in fathomless waves of your own mucus. And, anyhoo, I far prefer this epidemiological description…

The prevalence of histamine intolerance is estimated to be 1% of the population, and it has typically presented more often in people who are middle-aged.
– Jill Balla Kohn: Is There a Diet for Histamine Intolerance?

I have, therefore, been fighting, unceasingly, an unknown, unseen, enemy; and have existed (just about) in a scary world of ill-defined hurt. My asthma was out of control (frighteningly so) for the first time (eventually sorted with two ‘rescue’ courses of high-dosage steroids – which came with their own charming selection of side‑effects…) – but only because my symptoms, my reactions were, too, on the rampage. Some days I would end up taking six H1 antihistamines, along with a brace of H2 – on top of my usual cocktail of gullet-rattling tablets. (I have a bowl of all the necessary potions permanently stationed next to my customary armchairliterally within arm’s reach. (Right next to one of my umpteen strategically-sited Salbutamol inhalers.)) Otherwhiles, the stairs might as well have been the east face of the Matterhorn; the accomplishments of summer climbs disregarded and depleted; fitness forgotten, and fitness finished (while my Fitbit gently beeps).

[Oh, how I long for the view from Tysoe Hangings….]

Consequently, I still have not limped further than to the postbox and back (Christmas cards in hand) since this all kicked off; and was really quite upset at the lost opportunity of crunching my way through last week’s sumptuous snow. But – finally – in knowing (or having a reasonable idea of) what is wrong – I can start working with my diligent GP, dedicated nursing manager, and industrious immunologist, to minimize its effects. Unfortunately, the diet I need to follow – especially as I now cannot consume any dairy whatsoever, because of my coextensive allergy to cow’s milk protein (CMP) – does not inspire conviviality! (And I am going to have to seriously trim my espresso habit.)

[Interestingly, I have no detectable CMP-specific IgE pulsing through my veins. However… “IgE can be produced locally… in the gut- or airway-associated lymphoid tissue, as well as in the lymph nodes, of individuals with food allergy….” Why I have become allergic to dairy at the same time as developing histamine intolerance, though, is yet to be determined. (Watch this space!)]

Histamine limitation diets impose complex, non-standardized restrictions that may severely impact the quality of life of patients.
– Yurdagül Zopf et al: The Differential Diagnosis of Food Intolerance

No kidding…!

Thankfully – especially as the Interwebs (typically) exhibit lots of contradictory advice and classifications – there is an app for this – one which (scientifically) allows me to not only customize its listings with my histamine intolerance, but also my dairy allergy – so that it then ranks foods (and even some medications) with a personalized traffic-light system: showing which are suitable in green; which not in red. (Victuals debatable are painted shades of lemon or orange – ironically… – those unresolved, simply sketched in grey.) As many sufferers have discovered, though, it is not quite that simple: some substances may cause a reaction for no obvious reason (or simply because you have consumed too much of them). It is then up to the user to mark these accordingly (having taken a precautionary antihistamine…).

So… this (Saturday) afternoon, we are having a precocious Christmas (eve eve) dinner: a goodly gathering of The Good Lady Bard’s grown-up progeny and partners, with me in tow. As well as having large boxes of (both kinds of) antihistamines ready (my EpiPens swaddled comfortingly in my conscious-as-Woodbine rucksack – now carried everywhere, regardless); my EKG, peak flow meter, pulse oximeter, and “More than a thermometer” within reach; my menu is but a subordinate (yet toothsome) riff on that of the main table. (It seats six. There are seven of us.)

So… no anaphylactic chocolate cheesecake for the Bard, thank you! Not even a vegan mince pie (the spices and citrus fruit are comprehensively verboten…). The never-was-such-a-chicken (sadly not goose) should be fine (just no stuffing); andThanks be to Chestnut… – the sprouts! But no ‘portly’ cranberry sauce to paint them with; and no baby pigs, nor their porcine blankets, to mush into it. And, unfortunately – even though the Intolerances app glows green with delight – I am having a tough time with potatoes, at the moment: so just the one, Mrs Cratchit. But (I am reliably informed) the personalized gravy will be made with love…! (Either that, or – bringing a whole new meaning to the phrase “expiration date” – TGLB has chanced upon the plot, and method, of the perfect murder. (Death by degranulation. Yum.))

Then Bob proposed:
     “A merry Christmas to us all, my dears. God bless us!”
     Which all the family re-echoed.
     “God bless us every one!” said Tiny Tim, the last of all.

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