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So after having my legs hurt along the inside of the tibia after running in SwordFit, I went to a doctor and described the pain. A brief description later, he asked whether I have flat feet. Clearly he had generated a working hypothesis and was making a prediction based thereon. It was a pretty good working hypothesis, as I do indeed have flat feet.

The pain was shin splints, an inflammation of the connective tissues about the tibia (the Swedish term, benhinneinflammation, literally means “bone-membrane inflammation”). The solution, the doctor assured me, is custom-made orthotics to provide some arch support and prevent over-pronation.

Fair enough, so I found a place that makes orthotics, and I made an inquiry to my insurance company (the extended health provider through work) to see what they would cover. It turns out that they will cover orthotics (up to $200, I think), but only if I provide a Biomechanical Assessment, which has to come from a podiatrist, chiropodist, or chiropractor(?!). So I have to see a podiatrist. So of course I want a referral to a podiatrist, to get everything covered by insurance I possibly can…

So I got my referral and my podiatry appointment—it was pretty quick, actually, I only had to wait about a week. Today I saw the podiatrist, a Dr. Polonsky, who was a remarkably personable fellow. He concurred with the earlier diagnoses and agreed that orthotics are indicated, but also noticed excessive tightness in my gastroc/soleus group, which is not something obscene but refers to the gastrocnemius and associated muscles in my calves. He was troubled by the limited dorsoflexion of my feet and suggested that this probably contributes to the problem.

So, now I need two things:

  1. I need to see the podiatrist again to have casts made of my feet, in order to make the orthotics. I’m not sure exactly when, but it may be as early as tomorrow!—he won’t know until later in the day whether his schedule permits. If so, I’ll probably miss Mastery tomorrow, but I think it’s worth it. If not, it may be a week or so.

  2. I should start some regular stretching regimen—nothing crazy, just a couple of minutes a day (I believe he actually suggested three minutes, though no great sense of precision was conveyed), so I need to come up with a good set of stretches for the gastrocnemius, or gastro-solius group, or at any rate my calves, which (a) works and (b) is short and simple enough that I have any hope of actually sticking to it. (He also suggested that a stretch known as the dead bug might help with some of my lumbar issues.)

Progress is being made, I suppose.

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For those keeping track, I have two lists of allergies—the first is my list of clinically confirmed allergies; the second is my list of foods that I will not eat because I am clinically confirmed to be allergic to them or because they are related to such foods and I wish to avoid cross-reactivity or because personal experience leads me to strongly suspect that I’m allergic to them. The latter I wish to have clinically tested. I get the impression that simple scratch tests don’t have impressive sensitivity (they are prone to false negatives: The scratch test fails to reveal an allergy that is real) but very high specificity (they are not prone to false positives: If the scratch tests reveals an allergy, it’s very unlikely to be spurious).

  • Some legumes: Peanuts, soya beans, peas, chick peas, lupini beans, fava beans, kidney beans.
  • Some tree nuts: Almonds, hazelnuts.
  • Chicken: This test was more suggestive than conclusive, but it has been tested and it definitely wasn’t a clear negative.
  • Legumes: Because I react to most legumes, I avoid the family as a whole.
  • Tree nuts: I actually tested negative on reactions to brazil, cashew, and pecan nuts, but the risk of cross-reactivity is high and the allergy can be fairly severe; if I ate nuts, I’d risk a high probability of strong reaction in the future.
  • Chicken and turkey: Both seem anecdotally to cause reactions, and the chicken test makes me extra suspicious. I don’t know about other poultry, like ducks or geese.
  • Some fresh fruits: Apples, plums, papaya, and strawberries at the moment; this list would likely grow quickly if I ate more fruit.
  • Button, criminy, and portobello mushrooms.

If you’ve really been keeping track, you’ll note that mushrooms is a new entry. It hasn’t been clinically tested at all, because a couple of years ago, when I had my tests, it wasn’t on the board. In fact, I’m considering today’s reaction the clincher. To illustrate the difficulty of figuring this stuff out, and hopefully convincing you that I am applying critical thinking to my own health—also, because I feel like writing about it—I’ll go over it, though very briefly.

The problem with food allergies is, of course, that short of testing everything you might eat, you can’t know when they’ll appear; and even that doesn’t account for the all-too-common development of new allergies (when I was a child, my list consisted simply of nuts, and peanuts). I have no idea about any new allergy until I eat something that contains the allergen and I feel ill. Today was a particularly annoying case of it—I had run out of bread at home and so gone out for breakfast; my breakfast consisted of a roasted vegetable sandwich with portobello mushroom. I subsequently went to the gym, did a bit of rolling (very badly, but I don’t blame allergies for that), then started feeling very ill and dizzy. After I sat down and my head cleared a bit, the nausea settled into a form that I have learned to associate with mild allergic reactions. But to what?

The problem with figuring this stuff out is that I rarely come across my allergens in isolation. The sandwich didn’t just contain mushrooms, after all; it also had onion, bell pepper, artichoke, and various other things (I don’t even recall all of them—I just noted that none of them were known allergens to me). This is obviously a perfect setup for conflating correlation and causation—I ate the sandwich; the sandwich had mushrooms in it; I got sick—ergo, the mushrooms made me sick. I know of no better way to identify allergens (save allergy tests requiring a referral and a long wait) than to simply note the occasions when I feel thus ill and try to identify common threads.

It gets extra tricky precisely because I have so many allergies. Did I feel sick today because of the mushroom, or something else in the sandwich? Did it contain some sort of legume, or perhaps hummus, that wasn’t mentioned? Was there some contaminant? Or, for that matter, did I feel ill for some entirely separate reason? This clouds the picture at every occasion of a presumed reaction, making it pretty hard to be sure. It doesn’t help to be aware that humans are notoriously prone to a false positive bias (presumably because, in an evolutionary context, seeing imagined patterns is only a little bit costly in terms of energy, whereas failing to see real patterns is often lethal: A limited heuristic budget predisposes us to finding patterns whether they exist or not).

The strongest datum supporting my conclusion occurred the other week, when I made a warm pasta salad I’ve taken to very frequently making for work lunches. I usually make it with whole wheat penne, sautéed red onion, steamed kale (and sometimes spinach), pieces of sundried tomato, and pieces of capocollo ham. (It’s quite tasty.) The other week, however, I was out of capocollo but had some mushrooms—so I sautéed them as a substitute. After eating that, I felt mildly ill, even though I’ve always felt fine when eating the same dish made with capocollo and no mushrooms. As far as it’s possible to isolate variables, I’d say that did it. But even so, that alone was hardly ironclad—all the confounding factors still applied; and at the time, how was I to hold mushrooms as a culprit over, say, kale? I’d never reacted poorly to kale, of course, but I didn’t think I was allergic to mushrooms either! —Well, a number of events like today’s, coupled with that much stronger datum, has lead me to this reluctant conclusion: I’m fairly certain (say, 85%­–90%) that I am, in fact, allergic to these mushrooms; and I shall no longer eat them, if I can avoid it.

I will also try to get a referral to an allergy specialist again. I want this stuff confirmed.

On a side note to this, I looked up the mushroom in question and found that button, criminy, and portobello mushrooms are in fact the same species (Agaricus bisporus, or the table mushroom), harvested at different stages of maturity. This gives me some hope that even assuming that I am right and I am allergic to them (and my evidence is gathered from all three types, so their identity strengthens my conclusion) I may still be able to eat other mushrooms; especially as the fungi are a very, very diverse groups. (Many other edible mushrooms are not in the same genus or family; oyster mushrooms belong to the same order, Agaricales, whereas chanterelles are only related to the above at the level of the class Agaricomycetes.)

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Petter Häggholm

April 2016

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