Well, I was really hoping to give you some sort of definitive THIS IS THE ANSWER sort of update after our latest appointment in regards to Chickadee’s skin, but I should’ve known it wouldn’t happen that way. I mean, we’ve been trying to figure out this rash for three years now; what’s the big hurry?
The good news is that we started out there seeing the doctor who was taking new patients, rather than the one it had been recommended we see. And after two appointments, we ended up seeing the recommended doctor because our regular doctor was unavailable. And apparently the fourth time’s the charm, because yesterday we saw the department head, Headguy. (For those keeping score at home, that means we’ve now seen every doctor they have.)
“When you come to me it’s because we’re tried the standard stuff and everyone else is stumped,” he said. I’d love to paint him as a brash egomaniac, because that would probably make a more interesting story, but really, he seemed pretty down-to-earth. At first, anyway.
For starters, there was the whole nickel test ridiculousness. We came back from vacation early so that Chickadee could have a repeat nickel test, only I’d spent much of the week preceding vacation making phone calls to set up the test here in our town with our local pediatrician, to save us a trip into Atlanta. That was all fantastic except that our ped then discovered that the necessary patches can only be ordered in cases of 20. As the patches cost $500 a pop and they don’t anticipate doing a lot of nickel patch tests in the future, they wisely declined to order and canceled our appointment.
Only just a TEENY bit bitter that we cut our vacation short for that, by the way.
So we thought yesterday they were going to put a nickel patch on her, but Headguy said, “Really, I have to tell you, I think the nickel theory is misguided,” and I just about fell to my knees while shouting “THANK YOU!” I do not understand why every other dermatologist we see is so gosh-darned ready to believe this child has a nickel allergy, despite both a negative patch test AND the weird summer-ness of it all. Who in the world has a SEASONAL nickel allergy? Oh, that’s right. NO ONE. But no matter how many times we explain that this rash is a summer phenomenon, the nickel thing remains a popular idea which many of her doctors are really reluctant to give up.
But Headguy said no, he didn’t think it was nickel. It didn’t fit. Yay! No patch test. Well, what next? “Honey, do you get a rash and then itch, or do you feel itchy and then you get a rash?” he asked Chickadee.
She thought about it for a moment. “I get itchy first,” she said. He nodded, triumphant.
Headguy outlined an aggressive allergy medication regimen; by putting her on three (!!) different types of allergy meds at once, the hope is to force her system to chill the hell out. He didn’t say it quite that way, but I could tell what he meant. “I think this is allergic reaction and sensitive skin gone haywire,” he explained, and went on to detail the different mechanisms of the different medications and why he thought this may well be the solution.
Well. Part of me wants to get excited about the possibility of a solution, and part of me wanted to smack him upside the head. Because nearly two months ago, one of the other doctors suggested this same attack-the-allergy-angle solution with this trio of meds, and then called us later that day and said, “I consulted with Headguy and he suggested you just switch sunscreens, first.”
I doubt Headguy remembered that. I wasn’t going to bring it up, either. But if this IS the solution, my kid suffered half the summer for no reason. And that kind of blows.
But before I could get too worked up thinking about THAT, Headguy turned to me—very intent and serious—and asked, “How badly do you want to solve this problem?”
Chickadee and I blinked at each other. Ever eloquent, I responded, “Uhhhh… pretty badly…?” He continued staring. I added, “I’m… not sure where this is going?”
“Well,” he said. “I’m a cowboy. I’m the last stop, here. You’re in with me because we’re stumped. And this might work, but if it doesn’t, we’re off the beaten track into an area where it’s more art than science.” I nodded. Do I want a dermatologist who’s a cowboy treating my child? Maybe. But if he pulls a lasso out of his pocket, we’re out of here. “What comes after this may mean making some hard choices.”
I felt like this was a well-rehearsed speech, but I still didn’t know what the heck he was trying to tell me. “I’m sorry,” I said, “I’m still not following the ‘how badly do you want to fix this’ connection.”
“What we try after this is going to be riskier. Have more side effects. Cause more problems. You’ll have to make some choices about how far you’re willing to go.” I nodded, again. Why was he giving us this speech? Shouldn’t we at least find out if the prescriptions he just gave us are going to work? Also, “choices about how far you’re willing to go?”
No one should say such a thing to someone like me. I have an overactive imagination, you know.
So… try the allergy meds. It might work. But if it doesn’t, HOW FAR WILL YOU GO to solve this rash, Mir?
Because next month he’s going to suggest leeches. Or amputation. Or a non-FDA-approved application of pastrami to the afflicted areas while in a hyperbaric chamber. Also there’s this new medication that often solves problem skin, but sometimes causes baldness, tuberculosis, or hermaphroditism. I mean, COME ON NOW. HOW FAR WILL YOU GO???
Needless to say, I smiled and told Headguy my money’s on the allergy meds. And we can discuss what comes next when it’s time to do something else.
Give us a week with the new meds before I can tell you for sure whether or not a cowboy dermatologist is a good thing.