Feeding Chloe

 School starting as well as ballet, jazz and karate have really kept us busy around here!  A few things have changed for now with Chloe, so I wanted to write a post for my followers that are family, friends or EOS/food allergy readers.  To briefly recap, Chloe was diagnosed with eosinophilic esophagitis (also called EE or EoE) in late March 2012.  She was started on medication, a proton pump inhibitor (or PPI, such as prevacid) and had repeat biopsies done 6 weeks later on June 13th 2012.  At that point she had gotten much worse, with her eosinophil cell counts doubling and her esophagus covered in abscesses. She was barely eating any solid food at that point and was in significant pain.  Between the first and second scopes, we had allergy testing done (scratch, blood and patch testing) and have a list of possible triggers that would need to be tested, but first we had to get the damage in her throat under control.

Once the second set of biopsies came back looking so bad, she was started on a regiment of swallowed steroids to help control the inflammation. About 2 weeks after she started that medication, on July 11th 2012, she vomited blood and I took her to the E.R.  She only vomited once, and her hemoglobin was normal, but she was quite fragile and was admitted for overnight IV fluids.  It was almost a week before she came home.  The steroid, which she is still on, had caused a fungal infection on top of everything else and she could not eat at all.  At the point of her hospital discharge, she needed an NG tube for nutrition and calories because she was still unable to eat enough.  Following a round of anti-fungal meds, she was only marginally better and only eating only small amounts of yogurt and watered down apple juice so she had a third endoscopy with biopsies on August 15th 2012.  That set of lab results showed that while her eosinophil counts were way down, she still had a fungal infection.  The original infection was so severe that the first round of meds did not get rid of it, so she started on a 3 week course of stronger medication.  By that point, she was taking the anti fungal, a barrier medication to protect her esophagus, the PPI and the steroid, and eating more but still not enough to remove her feeding tube.  In addition school started, so we were glad that she was eating enough to at least skip her lunch bolus so she didn't have to be hooked up to her feeding pump for an hour at school.

One of the things that had come up before and seemed to be an issue again was that when Chloe eats, or has a tube feed in recent cases, that food stays in her stomach for hours, much longer than it should.  This is called gastroparesis, or delayed gastric emptying.  We have not yet had a scan to formally diagnose this condition, but I can say for certain that she will sometimes vomit undigested food 6 to 12 hours, or more, after eating it, and even the liquid diet pumped through her feeding tube will remain in her stomach for several hours which is easy to determine when doing pH checks before starting a new feed.  Gastroparesis can cause stomach pain, vomiting and a constant feeling of fullness which decreases appetite and ability to eat.  These are all symptoms that Chloe has struggled with pretty much her entire life and are in addition to the EoE.  Because of this, she has also started taking a mini dose of erythromycin.  Erythromycin is an antibiotic, however it has the side effect in some people of increasing gastric motility.  Because of this, it is sometimes used to treat gastroparesis.  She has also started taking a prescription antihistamine, and this medication is also being used in Chloe's case for the side effect, not for the antihistamine properties, but because it sometimes acts as an appetite stimulant.

On September 14th, which happened to be our 9th wedding anniversary, we removed Chloe's feeding tube.  About a week later, we stopped the barrier medication, Carafate, since the tube is no longer in and because it can also interfere with the absorption of some other meds, including her PPI and steroid.  At this point in time, Chloe takes the PPI, the steroid, the erythromycin and the antihistamine daily.  She does seem to be eating more, and since the tube came out she has lost just under 3 pounds and is holding steady at 38.2 pounds, which we are happy with.  So the good news is that she is maintaining her weight and while she does still have stomach aches, they are no longer constant.

With her fungal infection gone and her weight at a comfortable level, we got the OK from the doctor to start trying to eliminate foods to control her EoE without the use of steroids.  She has had so many other issues that needed to be dealt with and stabilized first and now that we at least temporarily have some of those things under control, it seems like a better time to start removing foods. Over the last 3-4 weeks she has started complaining more that her throat hurts again. Irritation from the NG tube should no longer be an issue. At the time of her last scope her eosinophil counts were way down, and we have assumed this was because of the steroid.  However at the time that those bioposies were taken, she had not only been on the steroid for 6 weeks, but she also had be fed a diet consisting almost exclusively of hypoallergenic elemental formula, so it is possible that the good results that we had were the result of a combination of the steroids and the restricted diet.  If that is the case, it would explain the return of her pain once she began eating an unrestricted diet again despite still being on steroid medication.  Either way, the hope is that she will start feeling better now that we have removed some foods from her diet.  The first batch, based on the allergy testing in the spring, is all dairy, eggs, peanuts and wheat. Then hope is that if she sticks to this diet for 6-8 weeks, her symptoms will fade and the damage will heal, which will mean that we have properly identified all of the foods that trigger her eosinophilic reaction. It has been almost 2 weeks and so far she has shown no improvement, but it's still a little early to tell.  In another 10 days if she is not starting to feel better, she will have to go back into the O.R. for another scope and set of biopsies.  I'm hoping that things turn around before then, but if not this will be her 4th trip to the O.R. in 7 months. Though she is complaining that her chest and throat are feeling worse, she is still eating pretty well and as of Thursday was still 38.4 pounds, which is a relief even if she does need another procedure.

All in all, she has handled everything that she has been through in the last 6 months really well.  After all, the kid is only 5 and she has been in and out of the operating room 3 times, hospitalized for a week, feeding tube dependent for 2 months and loaded with medications.  She has now had to drastically change her diet and despite pushing through all of this with uncommon spunk, she has been in varying levels of pain the entire time, and probably for almost her entire life. 

She decided to be Wonder Woman for Halloween this year, and when I asked how she chose that, she told me that she wanted to be a super hero, but if she went as herself, it wouldn't be dressing up. Good point, little one.  She's one of my heroes, that's for sure. 

August EOS updates

As I have mentioned in some of my past posts related to the girls' EoE, the diagnosis was life altering for Cassidy, and for all of us.  She requires daily medication and a drastically restricted diet.  She also repeatedly heads into the O.R. for endoscopies and biopsies to monitor the progress of the disease or how well we are doing as far as keeping things under control. The chances of a sibling also having an eosiniphilic GI disorder are less than 10%, some sources say as little as 3%, but in March, Chloe was also diagnosed.  So far things with Chloe have made our experience with Cassidy seem like a stroll down easy street.  But I'll get to that shortly.

I gave a detailed update on Cassidy as far as the EoE and her chronic microscopic colitis is this post, so if you follow my blog to keep up with the girls and you missed that one, it's worth reading.  As mentioned in that post, Cassidy had a CT scan and ultrasound coming up, both were normal which ruled out any structural problems or anything like gallstones as the cause of her colitis or her severe bouts of mid and upper abdominal pain, which were happening 2-4 times a week. We also strictly removed gluten from her diet which, given the other limitations in her diet, has been no small task.  That started on July 6th and don't you know, she has not had a single episode of crippling pain since that day.  She is also less achy, has more energy and just feels generally better.  No matter how hard it is to be free of gluten in addition to eggs, milk, peanuts and a variety of fruits and veggies, it is TOTALLY WORTH IT!  The last step is to try taking her off of the Asacol, which she takes for the inflammation in her colon.  I'm hoping that gluten was the culprit of everything below the esophagus all along, but I'm not completely sure at this point.  She ended up going without her Asacol for 5 days recently, and she did have some pretty severe muscle spasms and changes in her bathroom habits.  It may have been a coincidence, we will know for sure once we officially take her off of the medication for a trial run without it.  Until then, stay tuned, because as of now things are falling into place nicely for her.






Then of course we have Chloe.  Her last update was on July 8th, and she we had gotten pretty bad results from her last scope and biopsy set in mid June.  She had started on a steroid treatment in an attempt to heal the damage in her esophagus.  On July 11th, three short days after I wrote that post, Chloe woke up complaining that she wasn't feeling well, and she was quite lethargic.  She had been dragging a little the night before, but she had begrudgingly eaten dinner as best she could (she was hungry but her throat hurt) and then gone to bed fairly easily.  I knew in the morning that she really didn't feel well, because it was the week of dance camp and she was supposed to be going home from camp with her good friend Elizabeth for a play date.  But she laid on the couch when it was time to get dressed and asked me if she could do it all another day.  So I agreed, let Elizabeth's mom know, asked my mom to come over in case I needed to take Chloe to the doctor later, got Cassidy ready for camp and loaded everyone up.  Right after we dropped Cassidy off, Chloe threw up all over the car.  I pulled into a parking lot to clean her up and realized that the vomit was bloody. So I stripped her down, moved her to Cassidy's seat and headed home to drop the other 2 kids off (thank goodness I asked my mom to come over!) and took her to the E.R. at AI DuPont children's hospital.  Lab work showed that there were no signs of ongoing internal bleeding, but she needed IV fluids and her blood sugar was very low.  Strange, since she ate dinner, had juice in the morning, and vomited undigested food from lunch the day before. They decided to keep her overnight with an IV to make sure she was well hydrated.

So began our almost week in the hospital.  That's right, it wasn't until several days later that she was finally discharged.  She complained of throat pain so severe that she wouldn't eat anything some days, or a few ounces of yogurt others.  She was so depleted from not getting enough to eat for so long, and the doctors were concerned that without the IV and unwilling to eat, she would end up back in the E.R. very quickly.  They also could not tell us why she was having such severe pain.  It's likely that she had been in such pain for a while, but her survival instinct forced her to eat just enough to scrape by.  Now that had an IV to keep her hydrated and help with her blood sugar, it just wasn't worth it.  Also, maybe the steroid treatment had caused a fungal infection in her throat.  No one knew for sure, so she kept the IV and started on an anti fungal medication in addition to the steroid, PPI and a type of coating or barrier medication called Carafate.  The purpose of that last one is to protect the tissue while the other meds have a chance to work.  A few days into the anti fungal and she still refused to swallow.  So we began to discuss placing a feeding tube.  It basically came down to this.  She won't eat or drink, so she either has to stay in the hospital with IV support or go home with another form of hydration and nutrition, which would be the NG tube.  By now the tube seemed more appealing.  In addition, there was also a sense that she needed the nutritional help anyway.  The poor kid had barely gained weight, if any at all, for over a year and a half if I'm not mistaken.  That was part of what landed us in the O.R. looking for a diagnosis in March.  So the tube was placed, I was trained on how to remove it and put it in as well as how to use her feeding pump and how to break down her feeding into calories and how much to give and when.  The next day, she got to come home.  At the time, the thought was that it would help her maintain her current weight and give her a couple of weeks of resting her throat while her meds worked.  It would hopefully act as a bridge to get us across the difficult spot we were in. That was almost 4 weeks ago, and Chloe is still taking very little by mouth.

Next week she will head back into the O.R. for yet another endoscopy with biopsies.  This time none of us know what we are hoping for or what to expect.  Something is making Chloe not want to eat, and none of us, including her doctors at this point, know what it is.  My biggest concern today is that the scope will not show much, and that we will have no answers which also means nothing to treat.  Regardless, the bottom line is that no matter what we do or do not find, until Chloe will eat enough to sustain herself in terms of both calories and nutrition, she will need the support of the feeding tube.  She does seem to have a problem with her stomach emptying very slowly, so I'm sure some additional testing will be scheduled to look into that.  As with Cassidy, anything like that which is diagnosed will be in addition to her EoE.  So at some point, which will be dependent on the condition of her esophagus, we will have to determine for sure which foods trigger the eosinophilic response.  At times it can be difficult to decide which medical condition to tackle first, so we will check
with  her doctor as far as that goes.

It has also become clear over the last month just how much she needs what she is getting through her NG tube.  In the 3 and a half weeks that she has had it, she has gained a full 5 pounds.  That's about a pound and a half a week! And she actually is visibly relieved to have the tube most days.  If she tries to eat and finds it too painful, she doesn't have to choose between feeling weak and hungry (what Chloe calls "that wobbly feeling") or forcing herself so suffer through the pain.  She does her best, then just asks for her feeding pump.  She is also needing less sleep, having fewer headaches and has plenty of energy to run, laugh and play, which is exactly what a 5 year old should be doing during summer vacation.
She will be starting kindergarten with her feeding tube, although that is just fine with her.  Rather than slowing her down, it has made her feel so much better, possibly than she has ever felt. It is very difficult to see your child with tubes coming out of them all day, and sleeping at night while connected to the feeding pump on an IV pole. It's hard to interrupt her playground games to give her medication or connect her for a feed or flush her NG tube.  Keeping a change of clothes and a bucket in the car in case she vomits her formula up while we are out running errands.  Having to double check that we have the formula, pump, backpack, Ph strips, syringe, bottled water and medications also in the car
 before we leave the house. It is heartbreaking when the tube needs to be changed; pulling it out burns and pulling the medical tape off of her delicate skin hurts.  And having her Daddy or Grammie hold her still while I feed tubing up her nose, down her throat and into her stomach while she gags and cries, then taping it to her face and pulling out the guide wire, withdrawing gastric fluid from the end to check placement of the tube, which makes an already crying child visibly more anxious because she is afraid that if it is not quite right she will have to go through the whole thing again.  It's really hard.  But she is also looking less painfully thin.  Her cheeks are pink, she has the energy to play, and maybe best of all, she is smiling a lot more.

This is the short version of Chloe's situation, and so many details have been omitted.  If you have any questions, I welcome them, even if they seem rather personal.  Please feel free to leave them in the comments!

Once school starts and we are settled into a routine, and once things slow down a bit for Chloe, I hope to get back to blogging, probably weekly, and back to recipes and tutorials as well as continuing updates on our life with 2 children with EOS.  In the mean time, thanks to everyone for your support!

Best Part of Summer...Jam!

I thought this blog needed a sunnier, brighter, yummier post after the last couple.  Now I know that those of you following me to keep up with the girls (or eosinophilic disease in general) are probably waiting for an update on Chloe's recent hospitalization, but it's time to throw my recipe followers a bone!  It all ties in anyway.  On days when everyone was feeling well several weeks back, we went cherry picking at local orchards, which I mentioned at the end of this post.  We picked buckets full of red and yellow sweet cherries.  Some we ate fresh, some became beautiful sweet cherry pies, some were transformed into bubbly warm cherry crisp.  And some, perhaps my favorites, were put up as jar after jar of cherry jam.  We made small 4 ounce jars as thank you gifts for Cassidy's teachers and other special school staff.  We made basic cherry jam, some of which we shared with friends.  Then, in an effort to use up some other fruit before it was past it's prime, I whipped up a batch of spiced cherry grapefruit jam.  And it is nothing short of amazing.



I thought it would be nice to share my cherry jam recipes with you today.  For those of you new to canning, I'll go through the process that I use step by step.  The purpose of processing jam in a boiling water bath canner is to make it shelf stable, meaning that you can store it safely in the pantry rather than the refrigerator for at least a year.  If you would rather just keep your jam in the fridge, skip the processing step, and once the jam is ready, just fill the jars with it and pop them in the refrigerator where they will keep for at least 3 months (if it lasts that long!)

If you do decide to process the jam and the whole thing is brand new to you, you do not need to invest in tons of fancy equipment.  You can process the jars in any stock pot (with a lid) large enough to cover the jars with at least one inch of boiling water.  A large stock pot is generally large enough to accommodate standard jelly jars.  You will need something to keep the jars from resting directly on the bottom of the pot.  You can simply fold up a dishtowel and place it in the bottom.  Finally, you will need a way to get the hot jars out when they are finished processing.  So to recap, stock pot, dishtowel, tongs, canning jars.  You probably have everything except the jars, which you can buy in cases of 12 for around $12 at big box stores, kitchen supply stores and many grocery store, especially during the spring and summer.

Accessory Set

Canner with jar rack

If you decide you want to go ahead and jump in to canning, spend a little cash and just buy a canning starter kit.  You can buy the canner with jar rack and accessory set (everything you need except the jars) for about $40.  There are also a variety of options out there in a variety of price ranges, such as the accessory set only (this includes a jar lifter, a lid lifter, wide mouth funnel and a few other things, and is very helpful) for around $10-$15, and I believe the Ball company makes a home canning "Discovery Kit" made to use with a stock pot, which includes a silicone lift out jar rack.  So there are a variety of options in a variety of price ranges depending on your comfort level and what you are willing to spend.  I can a great deal, so I have a big canner and an accessory set.  But the equipment that I have, while good quality, is basic and without bells and whistles so to speak.  I prefer it that way, and it works just fine.


 First, my disclaimer: I have attempted to share safe preserving methods. However, I make no promises. You alone are responsible for your health. Be aware of current safety recommendations. There is a wealth of information from licensed sources about current canning standards available for free on the internet. This is the way that I can for myself and my family. You alone are responsible for your health!

Let's get started!

 1. Wash the jars and lids.  I put my jars in the canner while the water is heating to boil, to make sure they are sterile.  The lids are made up of a ring and a flat lid piece.  Set the rings aside and put the flat lids in a small sauce pan with water.  These you need to warm to just below a simmer, over really low heat.  Do not boil them!  This primes the sealing compound around the edges.






2. Fill the canner or stock pot with enough water to cover the tops of the jars by 1 inch once they are full, and put it on the stove to boil.  This is when I stick my clean, empty jars in, but if you have washed the jars, I feel that this step is probably optional for jam.


 Now for the jam! Because Cassidy is allergic to apples and most commercial pectin is from apple peels, this is a pectin free jam recipe.

You will need:

Sweet Cherry Jam

5 cups of washed, pitted sweet cherries
3 cups of sugar
2 lemons

1. Cut the cherries in half or quarters or both, whatever you prefer.  Toss them into a non-aluminum pot with the juice and zest of the lemons.

2. Cook over medium low heat stirring frequently until they simmer and soften. Put a small plate in the freezer, you will use this to test for jelling shortly.

3. Turn up the heat to medium high and add 3 cups of sugar; stir until evenly mixed.  Keep stirring frequently so that it doesn't burn on the bottom.  Keep this up until the jam starts to thicken.




4. Once it looks like the jam is thickening up and starting to gel, you can do a plate test.  Grab that frozen plate from the freezer and spoon a little jam onto it.  Stick it back in the freezer for a few minutes.  Make sure you keep stirring the jam while you wait, since it is cooking quickly and at a higher temperature at this point.  You don't want to burn it!

5. When you take the plate out again, push your finger slowly through the cooling puddle of jam.  If it wrinkles up across the surface when your finger pushes into it, turn off the burner!  It's ready to go into the jars.  If not, continue to cook and stir for a little longer, then test again.  Be careful not to leave it unattended, or it can overcook quickly.  If that happens it won't taste as good.

 ***If you are making refrigerator jam, you can just fill jars with the hot jam, put lids on them and pop them in the fridge, where they will stay good for 3 months, probably even longer if they last that long!  If you want the jam to be shelf stable, go on to the next step.***



6. When the jam is ready, ladle it into the hot, empty jars (remove them from the boiling water and empty the jars, but leave the water in the pot, on the stove and boiling for processing!).  Fill them to 1/4 inch from the top. The wide mouth funnel comes in handy here if you have it!

7. With a clean, damp cloth, carefully wipe the rim of the filled jars so there is no jam or residue on them. 

8. Adjust the 2 piece canning lids, which have been prepping in hot water.












9. Put the jars on the canning rack and slowly lower them into the water. The water should cover the lids by an inch or two. Put the lid on the pot.

10.Once the water has come to a full boil again, set a timer and process the jars for 10 minutes.

11. After 10 minutes, turn off the burner and carefully lift the jar rack up.  Transfer the jars to a spot where they won't be disturbed, I put them on a towel along the back of the kitchen counter.  Let them cool completely, which may take overnight.

It's a good idea to label the jars with the date and contents.  You can use cute labels, or just write on the top of the lid with sharpie.  The lids are not reusable for canning anyway.

For more information on safety in food preservation, please go to The National Center for Home Food Preservation.


For Spiced Cherry Grapefruit jam, omit the lemon, but add the juice and pulp of 2 grapefruit, and the zest from just one of the grapefruit.  Also stir in 2 teaspoons of cinnamon while the jam is simmering.  The rest of the process is the same.

You could probably substitute most fruits for the cherries in this recipe.  Higher pectin fruits, like blueberries, will result in a thicker jam than low pectin fruits like strawberries.

Cassidy's Next Step

Since my last post brought all of you up to date on Chloe, this one will do the same about Cassidy.  In some areas, we have made, or at least maintained, our progress.  In other areas, not so much.  As I always say, in the process of sorting out the causes and treatments for the kids various health challenges, we also work hard at trying to maintain a normal childhood for them.  It can be difficult to explain how hard this can sometimes be.  I recently saw a short video created to promote awareness of eosinophilic diseases, in which a mother of 2 EGID kids tried to explain how painfully frustrating it is when well meaning people make comments like "But they don't look sick" or "She looks fine to me".  The mother explained that it is more about what you don't see.  You don't see our kids when they are vomiting or have headaches, the fatigue, body aches, abdominal, chest & throat pain.  You don't see the lack of or loss of appetite or difficulty swallowing.  We keep our kids home when they are feeling this way.  So naturally, when most people do see our kids, they "don't look sick".  You also can't see the frustration that goes along with the strict dietary restrictions.  How would your child feel if they could never eat the cake at the birthday parties that they attended?  They can smell the pizza but cannot taste it.  They cannot have ice cream on the playdate or field trip to the creamery or amusement park when everyone else is trying to decide on one scoop or two.  As parents we struggle not only to keep our children nourished, but also to compensate for the things that can make them feel angry, frustrated or left out while also helping them to accept these aspects of their lives and not be defined by them. So while these comments may be well intentioned, they can be irritating to us as parents, and can make our children feel as though no one else really believes there is anything wrong at all.  To a child suffering with chronic pain, frequent tests and procedures, and extensive dietary restrictions, feeling as though someone does not believe that they have suffered is heartbreaking.




Now that I got that out of my system, on to the health update.  At the time of her scopes and biopsies in November, Cassidy's esophagus was clear, her stomach was normal (and had been prior as well) and the microscopic inflammation in her colon had gone from patchy to uniformly covering the colon.  Due to still having abdominal pain and the change in the inflammation, she started taking Asacol to treat her colon in February.  By late April, her lower abdominal pain was better but not completely gone, and she had added bouts of severe, intense mid and upper abdominal pain. On June 20th, one week after Chloe's biopsies, Cassidy went back in to be scoped and have biopsies taken again.  That evening after we came home and the next day she had abdominal pain so severe that we ended up back in the emergency room to rule out complications from the colonoscopy (there were none).  The lab reports showed that her esophagus is still clear (hooray!) but her stomach now shows some chronic inflammation.  It's microscopic, and a single finding of it at this point does not point to anything significant, so for now that information is just tucked away in case it changes down the road. Her colonoscopy still shows microscopic inflammation throughout, although there are some changes from last time.  I don't think it is really accurate to say that it is worse, but it isn't better either, just different.  As in the past colon biopsies, there were neutrophils present.  These are the most common type of white blood cell, and it is my understanding that they are commonly present most of the time where there is inflammation or infection, so that was not a surprise.  Also noted this time were eosinophils.  While that sounds alarming at first, it is important to note that about the only place in the body that it is normal to find small amounts of eosinophils is in the intestinal tract, and the amounts found in Cassidy's biopsies, while not specifically noted before, are within the normal range.  The last type noted were plasma cells. Plasma cells are also a type of white blood cell, and are usually present in cases of either a viral infection or an auto immune problem.  Again, these cells were noted in the lab report, but in small numbers that, at this point, are not specific or indicative of anything.  Maybe all of this will snowball into something worse, but maybe it won't.  Right now we have to take it at face value.  Wouldn't we expect to see less inflammation after months on the Asacol?  Probably.  But there is no way to know for sure if, had she not been on the meds, she would be much worse now.  There are no definitive answers as to whether it is helping or not.  Maybe without it she would have been in horrible shape.  Maybe she would have been fine.  No way to know for sure.  Regardless, while these findings are different, none of them really explain the level of severe pain that she battles from time to time.

So we have a couple of things that fall under "the next step".  First is ruling out any other possible causes of the newest pain.  Coming next week are CT scans of the abdomen and ultrasounds of the liver, pancreas and gallbladder.  Also on the agenda, which we actually started last Saturday, is removing gluten from her diet.  Cassidy does not have Celiac disease, but she could still be sensitive to or unable to tolerate gluten, which could, possibly, be to blame for some or all of her lower GI problems.  This does not change anything as far as her eosinophilic esophagitis, this is in addition to the EoE. So all of the previous dietary restrictions will remain in place as well.  We will be strictly gluten free for 6 weeks. She will either feel better a few weeks into this, or she won't.  Then we will have an answer to the gluten question either way.  Once that is worked out, we will address the Asacol.  She will stop taking it, and she will either stay the same (in which case it wasn't helping anyway, so we can safely wave goodbye to the side effects, such as headaches), or she will get worse, in which case we will have another piece to the puzzle and she will go back on the Asacol or maybe another similar medication that does not cause some of the same side effects for her.  We will wait until after the gluten test for that, because if we make both changes at once and she improves, we will not know for sure which treatment was effective.  Her siblings have been wonderfully supportive of the new restrictions, asking about the ingredients of everything that comes out of the grocery bag, and being careful, when spontaneously hugging their big sister, to not squeeze her "special tummy" too hard.

Maybe we will get some answers next week, maybe in a month, maybe later than that.   At this point, I find myself sometimes just hoping to ever know what is causing my child this chronic pain.  I believe that we are in excellent hands with our gastroenterologist.  I couldn't ask for a more thorough or devoted physician, and he and his staff are always patient with my endless questions.  Even when they are frustrated, the girls love Dr. A as well, which helps so much.  I am also endlessly thankful for the outpouring of support from our friends and family, always offering to help out and always being so understanding when we have to cancel plans at the last minute or need to vent.  Pretty much every ounce of our energy right now goes into helping all 4 kids cope with all of this, and that would be so much more difficult if we did not have the support system and medical team that we have.






Hopefully the rest of the summer will go smoothly.  Beyond the immediate needs associated with all of this, we are also looking forward to this time next year.  In July 2013, the American Partnership for Eosiniphilic Disorders (apfed.org) will be holding their annual conference in Philadelphia.  Only 45 minutes from my house?  Yes, please!  It will be wonderful if things are under control for both girls by then, but either way at least one of us will be attending.  Over the years, Cassidy and Chloe could improve greatly and require fewer, if any, medications and dietary restrictions.  Or they could get worse.  There is really no way to tell.  For now we will focus on getting through the next 6 gluten-free weeks, then the next couple of months after that.  Always moving towards the next step, one step at a time.

Chloe's Next Step

I realize that this post is long overdue, and that many of my readers have been waiting for an update on Cassidy and Chloe.  We have been busy with doctor's appointments, tests and procedures, new treatment attempts, and, just as important, trying to maintain some sense of just being a family and "regular" kids.  I believe my last post that included a significant update was this one, when Chloe went in for her first set of scopes and biopsies. I mentioned shortly after that post that Chloe was, in fact, diagnosed with eosinophilic esophagitis.  So here are the details on Chloe since then...

Chloe's first set of biopsies came back showing eosinophils totaling about 30 per high powered field, which exceeds the diagnostic criteria for eosinophilic esophagitis (greater that 15 eosinophils per field).  Given the fact that she was also having episodes of difficulty swallowing and food getting stuck (dysphagia) and not gaining weight well, and the fact that she has a sibling with the same disease, the gastroenterologist, Dr. A, felt confident in this diagnosis.  So he referred us back over to the allergy and immunology department to complete the 3 types of allergy testing that we went through with Cassidy, which you can read about here.  So we went ahead with the testing, and found that between the scratch testing and blood testing she showed a likely sensitivity or allergy to milk and eggs.  The patch testing was a little trickier, in my opinion.  As I have explained before, patch testing involves placing pure food samples against the skin for 2 days, them removing them.  Results are read 24 hours later.  Having gone through this with Cassidy, I remembered a few of her reactions being quite pronounced the night before the reading, but more mild by the time the doctor saw them.  In Cassidy's case, the mild reactions were still noted in her chart, and it turned out that there were 2 that she could tolerate (corn and bananas) but others that she reacted severely to when we tried to reintroduce them.  With this in mind, I wrote down the numbers of the test areas which had clearly visible reactions at bedtime the day we removed the test strips.  The next day, 5 of the 6 looked much better, showing only mild irritation, so I'm glad that I made note of them.  Hopefully they will not actually be relevant triggers for Chloe, but if removing the 2 foods with clear positive reactions isn't enough, I'll be glad that I have these additional foods to try.



The bottom line for the testing on Chloe is that eggs and milk were positive, and the additional foods that I noted were soy, wheat, celery, beef and sesame.  I learned later that during the test reading, while I thought that none of the mild irritants were noted, her chart does actually list wheat and soy as possibilities, in addition to the eggs and milk.  For now, none of that is immediatly relevant, so bear with me while I explain.

Because Chloe's cell counts were around 30, which is twice the number required for diagnosis but still on the lower end for this disease (to compare, Cassidy's counts were around 50-60 the first time), there are 2 possible treatment options to start with.  One is the method we used with Cassidy, allergy testing followed by removing all possible allergens turned up during that process for 6-8 weeks followed by repeat biopsies to monitor progress. The other option is not removing anything from the diet and just treating Chloe with PPIs (commonly a reflux medication, including brand names Prevacid and Prilosec).  Apparently, in some patients with lower counts this alone is effective.  We ended up trying the medication alone for 6 weeks, although I have to admit that shortly after this decision I just didn't have a good feeling about it.  But we crossed our fingers and hung in there.  2 weeks before the repeat biopsies (which was about 4 weeks on the medication), Chloe started eating less again, waking up in the night and eventually refusing solid food shortly before the procedure.  Mark and I went in the day of the biopsies and scopes, June 13th, with a bad feeling that things would not be much better in there.



We should have been wishing for things to be the same.  After 6 weeks on medication, Chloe's entire esophagus is inflamed to the point that the tissue looks grainy and is friable (bleeds easily),  the furrowing from the lower third of the esophagus is now extending up to include the middle third as well, and her entire esophagus is covered in little white patches, which lab reports confirm are eosinophilic abscesses. The lab listed the cell counts as high as 70, which is more than twice the number that was observed less that 2 months earlier.  No wonder she can't swallow!  Mark and I were horrified.  The gastroenterologist explained his plan of attack to us. Chloe is now on a steroid treatment for a minimum of 3 months.  After 4 weeks we will let the doctor know how she is feeling, and 4 weeks after that, she will have another scope with biopsies to confirm the effectiveness of the meds.  The point here is to help heal the damage enough that she has some respite for what she has been going through, and also to confirm that the medication is effective for her.  Once she is doing much better and has healed, we will address the issue of changing her diet, and hope that making such changes works well enough for her that she will not need to remain on steroid based medication.
Removing the food immediately may seem like a better idea, but the problem with that is that we would not know, once she gets better, which treatment is the one working for her.

So far she has been on the new meds for about a week and a half, and while she does not report any improvement in symptoms, it can take longer than this for enough healing to take place that she will feel noticeably better. She is eating a little better most days, thank goodness.  I should mention that once the allergy testing was completed, I realized that Chloe had been pretty much already on an egg and dairy free diet, mainly because of Cassidy's restrictions and also in case dairy was triggering Chloe's migraines, for nearly 6 months leading up to her first scope (when the cell counts were around 30).  We did reintroduce both in the couple of weeks before her scope, but she was no longer interested in consuming much of either.  Since she is still eating both now, it is possible that this could explain the worsening of her condition.  However, it should also be noted that while this may explain the increase in cell counts from 30 to 70, it also means that something else was causing a reaction that resulted in the initial 30 cell count biopsies.  Maybe milk and eggs will be enough, but I'm not holding my breath just yet.  I'm increasingly glad that I noted the other 5 possible allergens during her testing.

While we do our best to sort all of this out, we are also trying to make sure that Chloe and Cassidy (I'll get to Cass in my next post) are able to just be kids.  True, they don't feel great much of the time, but they still have to be encouraged to enjoy their lives.  Otherwise, it is easy to slip into a rut of feeling sorry for yourself.  Once that happens, you tend to let the disease define you rather that just be an aspect of your life.  So when they are feeling up to it, we encourage them to play, dance, create and goof off.  While they have always been close, we have noticed them growing even closer as they bond over their shared physical discomfort and and the way the disease effects each of them.  What makes them different from other kids is many ways is the same thing that makes them even more like each other, and that bond is proving to be as priceless as the sisterly bond that they have always had.

Life is a Bowl of Cherries

I know that many of you are waiting for a health update on my 2 older girls, as they have had plenty of testing and procedures lately.  I appreciate your support and concern, but I'll be getting to all of that in my next post.  In my last post, I unloaded about the rough week or so that we had recently, and I promised to follow up with a post about how we made up for it once everyone was feeling better.

By the time Chloe's eye had healed, Quinn's concussion and sprained neck were better and Cassidy had completely gotten over strep throat (and the allergic reaction to the first antibiotic), I think we were all ready for some fresh air and sunshine, and probably a little comfort food.  So we spent the next couple of weeks packing plenty of that stuff in.

First, we went hiking. A lot.  I love hiking, and so do the kids.  Sometimes people seem shocked by the fact that my small children will hike 2 or 3 miles with me in an afternoon, which I find puzzling.  It's not as though I drag them out in shackles and force them down a rocky desert landscape!  I think that, given the chance, most kids enjoy walking around in the woods, checking stuff out, which is really what a hike is.  My kids are far more interested in the plants and landscape and animals that we see than they are in any movie or TV show!  So we often, actually very often, pack a lunch and find a sprawling nature center, reserve or wooded park to hike through, and the kids love it!

 We hiked through woods and fields. We saw wild raspberries, deer, toads, chipmunks and honeysuckle.

We walked on boardwalks through marshland, and found aquatic plants, tadpoles, frogs and fish.

We looked up at the trees and the sky and the birds.





















We looked down at the trails and the creeks and all of the magic they held.

At the end of the day, every day that we hiked, I had a group of happy, healthy, tired kids.  Kids that woke up the next day and turned off the TV,
begging to go hiking again.  Fantastic!















In between our hiking adventures, we went cherry picking and stocked up on jam from the fruit.  Stay tuned for the recipes in my next post!

Why I Grow Mint

If you clicked on over here looking for an herb gardening post, I should tell you now that you are barking up the wrong tree.  This post is more along the lines of this one, from about 4 months ago. It deals with the trials and mayhem of hands on parenting, but not so much in a typical day to day way.  This is a glimpse into what it can be like when it just hits the fan, and all you can do is keep everyone's head above water until the storm blows over.  Sound a bit dramatic?  I wish it was!  The bottom line is that we had a RIDICULOUS week or two, but it seems we all survived. In fact, we pretty well made up for it with a super couple of weeks after mayhem descended upon us for what seems to have become it's routine quarterly visit.  But I'll get to that in my next post, which I'll probably start writing tomorrow afternoon while I wait for the results from Chloe's most recent set of  biopsies.

At this point, as before, I'll tell you that if you just dropped by from Pinterest or a Google search to get the drink recipes, scroll down until you come to the pictures of drinks.  If you are interested in why I'm making good use of my favorite cocktail shaker, read on!

So it all started the weekend before Memorial Day weekend.  The weather has been great so far this spring, and the garden is thriving.  The kids love to be outside, so we have been spending most of our time in the fresh air and sunshine.  You may be wondering how a post can start out "mayhem descended upon us", then move on to gardening with kids.  Seems bizarre, right?  This is where we get to the string of stuff I couldn't make up if I tried.  Let me set the stage.  It's Thursday afternoon.  Mark has been at work all day, and River, the twins and I made the most of the beautiful weather, and after school Cassidy joined us in the yard.  I was weeding the butterfly garden, and the kids were sitting around a patch of dirt, digging a garden of their own.  The dog was stretched out enjoying the shade. Birds were singing, the breeze was gentle.  Ah, zen.  Suddenly the peaceful atmosphere was pierced by crying.  Frankly, with 4 kids, ages of 3, 5, 5 and 7, that's not unusual, but you still have to investigate.  Quinn's shovel got caught on a tree root, and accidentally flipped some dirt up and out when it popped free.  That would normally be no biggie, except that the dirt flew up into Chloe's face, and her eyes.  Also not really unusual, her eyes were watering and she wasn't especially happy, but she really just seemed to want a popsicle and a hug, so we moved on with the day.

 An hour later, here left eye was still watering and she complained of blurred vision. Yikes!  In the tub, I rinsed it well with water, but it didn't help.  I'll skip ahead a bit.
The point is that this particular dirt-in-the-face incident resulted in this ------------>

That's what your kid looks like at the emergency room with a corneal abrasion.  Usually a little dirt in the eye just gets washed out by the eye watering or a clear water eye wash.  But sometimes that dirt actually scratches the cornea.  In Chloe's case, she also had a tiny piece of dirt stuck to her eye, which had to be swabbed out (very fast, but still a cotton swab across the eyeball.  Not fun!) The debris was causing the blurred vision, so she came home seeing clearly and is fine now.  Late night, but what can you do other than shrug it off and offer the kid a nap the next day.




Friday, Cassidy went to school and the twins headed off to preschool happily,  Chloe's eyes was still feeling irritated, but she begged to go and it's only a couple of hours.  Smooth sailing. River and I picked up some ferns for the fairy garden we created for the munchkins while the twins were at preschool, then we all had lunch and eventually picked Cassidy up after school.  Chloe fell asleep in the car on the way home from getting Cassidy, no big surprise since we were at the E.R. until 11:30 the night before.  While she slept on the couch, the rest of the kids (and the dog) joined me out back to finish gardening.  Seems we would have learned our lesson the day before, but apparently not.  I was getting the new fern planted, easy peasy.  3 or 4 yards away, Cassidy, Quinn and River grabbed shovels and headed back to their own little garden patch that they had started digging in the day before. River and Quinn sat on the ground with trowels, and Cassidy grabbed her kid sized metal ditch digging shovel from the shed.  River and Quinn were discussing what seeds they needed, and Cassidy alternated between digging a hole and tossing a ball for the dog.  Again with the birds and the breeze.  I should have known from the peaceful feeling that trouble was looming.  With Cassidy and Quinn sitting on either side of her, Cassidy turned and threw the ball for Billie Dog.  Shovel still in hand, she spun back around to rejoin the conversation and smacked Quinn, hard, in the head with the metal shovel.


It was completely an accident, but it knocked him back none the less, and after a stunned pause, he cried with a specific pitch that I haven't heard since he broke his arm when he was 3.  Cassidy was horrified, but she called me over (I was already on the way) and ran inside to grab an ice pack and a towel.  Despite the accident, I have to say I was proud of her 7 year old crisis management skills.

After 10-15 minutes, Quinn was wobbly on his feet, nauseous, and his head looked like this
<---------

Nasty, huh?

A big ol' goose egg doesn't ruffle my feathers, but nausea and dizziness do, so we went to the ER.  Again.  Little Hippie had a concussion, but after 4 hours of being observed by the doctors and nurses, he was finally able to keep graham crackers down so we got to come home.



Fast forward to the next morning.  Cassidy was sort of moping around, I thought she felt guilty about the shovel incident.  Quinn woke up a little later than usual, no big surprise.  He headed into the kitchen for his milk cup (in the fridge), and (yikes!) couldn't open the refrigerator door because it hurt his little neck too much! Crap. The discharge papers from the night before specifically listed, among the list of symptoms that should send you back to the E.R., pronounced neck pain or stiffness.  Upon further inspection, Quinn has limited range of motion and can't turn his head certain ways.  I call, and the triage nurse told me to bring him back in (it's Saturday, so the doctor's office was closed).  That's when this  --------->
picture was taken. Major suckage.  The neck brace was on for a few hours while xrays were taken and read to confirm no fracture or anything serious.  Bottom line at the end of the day was that he also had a sprained neck from the shovel incident.  He was stiff and sore for several days, but is fine now.


By the time we got home from the Emergency Room Saturday afternoon, Cassidy was running a 102 degree fever, and complaining of a very sore throat. Deep breath, continue through the day.  3 Emergency Room visits in 3 days plus a kid with a high fever, Mommy is tired.  Motrin for Cassidy's fever, Quinn's neck/headache and Mommy's headache.  Popsicles for everyone. No more gardening this weekend, that's for sure!  Everyone, including me, went to bed early Saturday night.  Which was good since, as many parents know, fevers seem to go up at night.  2am brought Cassidy 104 degrees, Motrin brought her down to about 101.  For her, this went on through the day Sunday, and her sore throat worsened.  Sometimes it can be tricky to consider that as a symptom for her given the disease process in her esophagus, but with the high fever, I kept her on the motrin and on Monday took her to the doctor.  She had a raging case of strep throat, so after an xray to rule out pneumonia (she had decreased air flow in one lung, but the xrays were clear and by the next day it was fine), we went home with 10 days worth of amoxacillin.

By Wednesday she was starting to feel better, so I thought I'd give her one more day so we were a full 24 hours fever free, and then let her go back to school on Friday.  I mean, at this point, things actually seemed to be on the verge of slowing down.  Chloe's eye felt much better and Quinn could turn his head.  The bruise on his forehead was by now a greenish blue, ghoulish, but healing nicely. Thursday, Cassidy started to complain that her mouth felt itchy, but between the EoE and strep, i just made a casual mental note of it and moved on.  With her evening dose of amoxacillin, the itching got worse.  In fact, within 30 minutes of taking the medication, her mouth and tongue were not the only itchy spots, her feet started to itch next, and then she was scratching all over.  She also complained that she felt like she had been holding her breath.  Thankfully she did not have visible trouble breathing, but she had tightness in her chest and was clammy and dizzy.  It's not uncommon to have an amoxacillin or penicillin allergy pop up a few days into the treatment, which was exactly what had happened to Cassidy.  Quinn is also allergic to amoxacillin and penicillin, and it popped up on day 4 with him the 2nd time he had it for an ear infection.  He had head to toe hives as well.  So Cassidy can now add this to her list of allergies.  Fortunately there are plenty of other antibiotics available, so she was switched to a different one and headed back to school the following Tuesday (Monday school was closed for Memorial Day.

During the holiday weekend, Billie Dog started limping slightly, especially after resting, but it was mild enough that at first we couldn't even figure out which leg she was favoring.  She seemed to walk it off pretty fast once she was up and moving around for a few minutes and still ran in the yard easily, so we just kept and eye on it.  Then a lump developed on the top of one of her front paws.  As the week prgressed, it got worse, not better.  After a good romp in the yard on Thursday, she napped and then got up and hobbled around on 3 legs, and the lump on her paw was bigger.




Friday at the vet ended like this
<-----------------------

Xrays showed some old, fractures, in various states of healing, to her seisamoid bones that we never even knew about, but  according to the radiology reports that followed the swelling had to be a soft tissue injury, such as a sprain, because it was not at the same location as the old fractures.  Maybe because she has some rottweiler in her, but we don't really know why for sure, the sweet girl just doesn't react much to pain. She tends to just keep going.  Which on one hand I suppose is good if it means it doesn't bother her too much.  On the other hand, she must have something pretty nasty going on in there to leave her limping like that.







What does all of this have to do with growing mint?  Oh, that's easy!  You can't make a mojito without it.  And in the sunny weather, few things float my boat at the end of the day (or at the end of a few weeks like these) like the combination of mint, lime and rum.  I prefer mine without the pesky addition of lemon lime soda or sparkling water.  Here is my recipe for a Mojito Martini, I hope you enjoy it as much as I do!  Please try to do so in moderation, these suckers can really sneak up on you!


Mojito Martini

In a cocktail shaker half full of ice, combine the following:

2 ounces lime rum (I use Parrot Bay key lime rum)
2 ounces fresh lime juice (don't bother with bottled, trust me on this)
a slight dash of dry vermouth
a half dozen or so fresh mint leaves
1 tsp. sugar (super fine if you have it)

Shake hard, to make sure you dissolve the sugar and bruise those mint leaves.  Strain into a glass, over ice if desired.



Mmmmm...delicious.  Now isn't that a great reason to grow mint?  Too bad I don't have my own lime tree!  As always, I'd love to hear your comments if you try this one out!

Enjoy!

How does your garden grow?

So far this year we have so many delicious fruits and veggies off to a great start. We are already through the first batch of jam from the strawberries, and the blueberries are ripening every day. I just picked the first batch this afternoon!

 The plum tree is loaded with tiny green plums, and the cherry, pear, peach and fig trees, although still small, young trees, are filling in with fresh green leaves and, in the case of the apple tree, flowers.  The garden beds are also loaded with seedlings and sprouts.

It is worth mentioning that we grow most of our own produce in the summer for several reasons, one of which is that we have control over the growing practices.  What that means for us both in terms of health as well as environmentally is that we do not use any chemical fertilizers or pesticides, at all.   We use natural and non chemical forms of pest control when necessary and we fertilize and enrich the soil only with our own compost.  We have a traditional compost pile outside, and we also have a worm composter.  So far, we have had great success, and peace of mind, with these methods, and don't really find them to be difficult at all.

The garden peas are almost finished for the season already, and the peas we had from them were delicious.  We will plant another batch late in the summer for fall harvest. The asparagus is growing like wildfire, and the long list of plants that will be ready to harvest over the next few months includes yellow squash, butternut squash, watermelon, pumpkins, corn, tomatoes, green beans, jalapenos, bell peppers, red beans, black beans, radishes, turnips, parsnips, carrots, cucumbers (both slicing and pickling varieties), broccoli, cabbage, spinach, romaine, potatoes, beets and lufas, which we grow because I like to make exfoliating soap with them!

We have switched over most of our garden to raised beds, and are using a square foot gardening method.  It has allowed us to fit a lot more in the space, and so far everything is growing extremely well.  The strawberries have grown enough to now take up 2 beds, along the same side of the house as the 3 largest blueberry bushes.  In this picture, you can see one of the covers that Mark built for the raised beds to keep the neighbor's cats out! Further down are some of the blueberry bushes.  If you look closely off to the right, you can see sweet Billie Dog keeping an eye on things for us!











This is one of the beds of corn, about 2 weeks ago.  The plants are about twice that size now.  These beds are 4 feet by 4 feet, and as you can see they are divided up into single square foot sections with simple string.  Each square foot contains 4 corn plants, and there are 16 square feet in the bed.  That means that we have 64 corn plants in each of these beds, and there are 2 beds of corn.  128 corn plants with at least one ear on each plant!  I can't wait!










This is another  4 foot by 4 foot bed, also divided into individual square foot sections.  This one has 6 cabbage plants, 6 broccoli plants and 4 squares of green beans, each of which holds 9 bean plants for a total of 36 pole bean plants.  Shortly after I took this picture, Mark built a trellis for the beans to climb.  Last year we grew a bush variety, and while they produced well, since the pole beans can grow vertically more than bush beans do, this layout has allowed us to put more plants in less space.  If I'm lucky, I'll have enough beans this year to stock the pantry with tangy Dilly Beans (look for that recipe when the harvest starts to ripen!) and still put my green bean frencher to good use (I prefer fresh green beans french cut!)







I didn't get any good pictures yet of the root vegetable beds, but Mark built them 12 inches deep, which is twice the depth of the rest of the raised beds.  We haven't had great luck with carrots in the past because of our soil, but I'm hoping to have plenty of well formed ones this year.  So far they are growing like crazy, and since all 6 of us love them, I can't wait to have fresh organic ones fill the fridge without breaking the bank!  I suppose I could go on and on about why I am excited about each and every fruit and veggie that is growing, and that satisfaction and excitement grows every time I can go out in the yard to literally pick something for dinner (or breakfast or lunch).  If you haven't had a garden before, it may be worth giving it a try this year, I promise you won't be sorry!  The next thing you know, you will be learning how to can fresh produce to preserve the harvest because you won't be able to eat it fast enough.

If you are interested in more information about how we garden, or the square foot gardening method in general, please leave a comment letting me know!

Enchiladas and Margaritas, please!

Spring is in full swing in this unusually warm year, and we have had plenty of days of what we refer to as great deck weather.  Afternoons and evenings when you just want to hang out on the deck and relax!  The kids and the dog wear themselves out playing in the yard, and we like to keep an eye on them while we work in the garden. After we bring them in and stick them in the tub to clean off after all of the good old fashioned fun, we are all ready for a relaxing dinner, after which the hubby and I like to get them all tucked into bed and then go enjoy a cocktail on...you guessed it...the deck.

Days like this, a simple and delicious dinner really hits the spot, and since it is beautiful outside but not yet super hot, we don't have to worry making the whole house sweat by turning on the oven.  Once the days and evenings really heat up, it's grill season, but in the spring (or really any time, to be honest), my favorite dinner is enchiladas.  They have to be made from scratch, I'm not really a fan of canned enchilada sauce.  Also, they have to be paired with one of 2 perfect drinks.  Mexican beer or margaritas.

I've been promising my enchilada recipe to my friend Tricia, or more specifically to her husband Amos, and (as usual) they have been very patient as life with 4 active small children and the unknown perils of gardening with the kids (yes, I said perils of gardening, but I'll save THAT set of stories for my next post, which will definitely contain another strong drink recipe) have delayed things time and again.  I hope that now that I have found the time to sit down and finish this post, which I started almost 2 weeks ago, they will find the time to enjoy it soon!

Enchilada sauce is easy to make, and while there are lengthy, multi-step recipes, mine is pretty fast and easy and I love it.  If I didn't, I wouldn't be sharing it here!  Once you get the sauce made (it's only a 10 minute recipe), throwing together the rest of the enchiladas is a snap as well.  I do add cheese to mine, but when I assemble Cassidy's I just leave the cheese out, which makes it a filling and satisfying allergy friendly recipe.  Here's what you need:


Enchilada Sauce

1/4 cup vegetable oil
2 Tbsp. flour
1/4 cup chili powder
8 oz tomato sauce
1 1/2 cups water
1 Tbsp ground cumin
1 Tbsp minced garlic
2 tsp onion powder
1-2 tsp salt, or to taste

Heat the oil in a skillet over medium heat, then stir in the flour and chili powder. Stirring constantly, cook until lightly brown.
Stir in tomato sauce.
Gradually stir in water, cumin, garlic, onion powder and salt into the flour and chili powder until smooth, and continue cooking over medium heat approximately 10 minutes, or until thickened slightly.

I usually pour this into a glass measuring cup and set it aside so that I can use the skillet for the next step, no need to wash it first!  Of course, you could always just use a second skillet.

Enchilada Filling

1 pound of ground beef
1 small onion, chopped
1 small green pepper, chopped
about 1/4 cup of the enchilada sauce that you just made
black pepper to taste

You will also need enchilada shells (Traditionally enchiladas are made using soft corn tortillas for the shells, but you could also use taco size soft flour tortillas) and green onions.




 Preheat the oven to 350 degrees. Brown the ground beef in a skillet, along with the onion and pepper.  Stir in the enchilada sauce and black pepper. Turn off the heat.

In a 9 x 13 glass pan, spread about 1/4 to 1/3 cup of enchilada sauce in the bottom of the pan. If you are using cheese (shredded sharp cheddar is best!) add some to an enchilada shell. If dairy is a concern for you, rest assured that these are very satisfying and filling with or without cheese. Scoop some filling into the shell.  Wrap closed and place seam side down in the pan. Repeat until you have run out of shells or space in the pan. If you are lucky, you run out of both at the same time!  
Pour the remaining enchilada sauce evenly over the top and top with more cheese (if you are using cheese, of course!) 
Finally, top with sliced green onions.
Pop into the preheated oven for about 20 minutes, and you are all set!

 Something to drink with that?

Strawberry Margaritas (or slushies, for kids and non-drinkers!)


3 cups of strawberries, washed and stems removed
2 cups of ice
1/2 cup tequila
1/2 cup fresh lime juice
1/4 cup triple sec
lime wedges and/or strawberries for garnish


Toss it all in the blender and whirl away.  Some people prefer sugar also added to these, but that makes it too sweet for me.


If you would rather have a non-alcoholic slushy, leave out the tequila and triple sec and add 1/2  cup of orange juice.


Hope you enjoy!