The Hidden Gem

Tulsa has often been chided as the “Oklahoma step child” in comparison to Oklahoma City, but I think this article refutes that myth.

Tulsa is on the listhttp://www.medscape.com/features/slideshow/best-places-to-practice-2015?src=wnl_edit_specol&uac=45399FY#page=4

#Oklahoma boasts a low cost of living, and #physicians responding to the Medscape survey also reported high incomes: an average of $304,000. At 8.5%, the average state and local tax burden is well below the national average of 9.8%.

Oklahoma doctors may have trouble finding adequate staff support. Oklahoma has just 746 nurses per 100,000 patients—about 15% lower than the national average, according to the #Kaiser Family Foundation—and the percentage of #nurse practitioners (NPs) in the state is about one half the national average. That may contribute to physician frustration: Nearly one quarter of Oklahoma physicians who recently responded to a Physicians Foundation survey say they are adopting, or plan to adopt, a concierge model in the next few years.

City to consider: “Tulsa is pretty much a hidden gem,” says Merritt Hawkins’ divisional vice president Tommy Bohannon. “It has one of the more active #arts communities in the country, and you have terrific dining, shopping, and cultural opportunities.” Tulsa is home to OSU–Tulsa and the University of Tulsa.

Here’s what I like about #Tulsa:

  1. Big city amenities, but still feels like a small town.  A word of caution: be careful who you criticize as small towns make everybody friends!
  2. The shows that come to Tulsa are second to none.  For example, Phantom of the Opera was like watching a Broadway musical on Broadway.
  3. Pick your favorite food and you can find an amazing restaurant that fits the bill!  Fortunately, prices are very reasonable.
  4. Biking & running trails in Tulsa take away all of your excuses for not exercising.  A beautiful view on the Arkansas river takes your mind off the pain.  The good news: an alternative trail will be constructed AROUND the casino to enhance the view.
  5. Navigating the traffic is Tulsa is tolerable, if not even pleasant.  Highways are constructed in a grid, and most places in Tulsa you can get to in under 30 minutes.  (Of course, the more Tulsa grows, the more your blood pressure rises)

So if you’re a doctor or other professional looking for a place to locate, come visit and we’ll be happy to show you around.

Drug Reps Will Give You Asthma

I know you’ve been there before….waiting in the doctor’s office for your appointment and some smartly dressed man or woman barely has to say hello to the receptionist and walks right by your seat, straight to the doctor’s office. “Hey, that’s not fair,” you say to yourself as you dig your nose into that outdated magazine trying to mask the irritation.  “My time is just as valuable as theirs is, put me to the front of the line!”  As a patient, my frustration with the #health care system only percolates at the injustice.  Isn’t the cost of #medication so high in America because of all the drug companies?  If there were no drug reps, wouldn’t my doctor have a better and certainly more unbiased selection of medications?  Granted, the goal of any #pharmaceutical company (employer of drug reps) is to make profit, but they can’t do that unless a product (medication) works well and is taken as directed.  In the end, drug companies want you to be adherent to medications prescribed so they’ll work, you get better, all of which is good for the bottom line.  Almost sounds too good to be true when everybody wins, but hang on and I’ll show you how this is possible. Continue reading Drug Reps Will Give You Asthma

The Future of Medicine

I don’t normally stray from the trail of #allergy topics, but this issue is so important for doctors and ultimately patients that it’s worth investigating. If the doctor shortage becomes severe based on a dwindling supply of physicians, and increased utilization with the Affordable Care Act (ObamaCare), where will you get care when you need it? As #Tulsa County Medical Society (TCMS) president, I am privileged to write about our initiatives in the community and this one is of great importance not only now but for future generations. Here’s the President’s letter from the most recent newsletter:

President’s Letter

I had just finished my training in allergy and was ready to conquer the world. Setting up a practice was no big deal; I just didn’t know what I didn’t know! Small town hospital to the rescue. If my practice didn’t succeed or if my revenue didn’t cover my expenses, I would have the local hospital guarantee my salary for the first 3 years of practice. How comforting and reassuring is that? What I didn’t know is if I was more successful than I anticipated (which most of us are), I had to share the profits with a hospital that literally did nothing to earn the cut. Rookie mistake, but very costly and could have been avoided with a few well-placed stories from my mentor….oh yeah, I didn’t have one either.

So here at TCMS, we tell you we’re more than just a political organization looking out for the practice of medicine. We are involved in watching out for your backside, to be sure, but the summer months allow an opportunity to reach out to our #medical students and residents to let them know about life after residency. You mean there is life after residency? In the grand scheme of life, most of the time you spend practicing medicine will be outside of your time as a resident or medical student.

Bright eyed and bushy tailed for those med school lectures!
Bright eyed and bushy tailed for those med school lectures!

Think about your importance as a physician mentor knowing that #doctors of the next generation will be ill prepared for what lies ahead in their practice careers. Now before you jump up and down in protest at having to attend one of the resident/medical student events, consider the following: Continue reading The Future of Medicine

Tulsa is the Allergy Capital of the Nation

Tulsa is the #allergy capital of the nation.  You wouldn’t believe how many times in a day I hear that!  and it makes sense…countless numbers of patients return to Tulsa and find their #allergies are now out of control. But is this really true?  Does anyone even keep track of which city in America has the highest pollen counts and can thus claim to be the most miserable #pollen city in America? Continue reading Tulsa is the Allergy Capital of the Nation

What Else About Allergy is Out There?

It’s difficult to find good material on the internet related to the practice of #allergy. Here is one such blog site: http://blogs.medscape.com/garystadtmauer.  This blog originates from New York and the practice website is http://www.cityallergy.com.  I will periodically post comments & articles from Dr. Stadtmauer’s blog and I’ve included one below about the coexistence of systemic allergy (that’s a positive skin or blood test) and LOCAL allergic rhinitis which has all the signs & symptoms of allergy, but guess what–skin & blood testing is all negative.  Very frustrating for #patients to experience allergy symptoms, but go in to their local allergist and find nothing. I wish treatment would be more satisfactory, but as you can imagine, it’s unknown what allergens to mix up for your allergy recipe if all testing is negative.  Continue reading What Else About Allergy is Out There?

Do Vaccines prevent Cancer?

This article appeared in KevinMD’s blog and has a very interesting chain of comments.  From just reading the article you would think that certain #vaccines prevent #cancer.  I would like to think that’s true, but nothing is so simple in medicine.  The “cause and effect” relationship to what we do is always the elusive holy grail.  This is somewhat of a brainiac article, so buyer beware!

Ouch! but is it worth the pain?
Ouch! but is it worth the pain?

Continue reading Do Vaccines prevent Cancer?

It’s allergy season and what can I do?

The following YouTube video describes a process called “Rush Immunotherapy” conducted in Ohio.  It’s now a more common way to deliver #allergy shots and reduces the total number of shots required to achieve clinical relief from your #allergies.  Some caveats about #RUSH Immunotherapy need to be included and your bullet list is below the video.

I would make the following corrections to this video:

1.  Unfortunately, you can’t answer all questions about immunotherapy (allergy shots) in a 3 minute news clip.

Continue reading It’s allergy season and what can I do?

Wacky Oklahoma Weather

I love  weather! Growing up on a farm in Kansas brought a variety of weather right to my front doorstep, and that must be one reason I became an allergist.

Nothing like the harvest!
Nothing like the harvest!

You have to be part botanist to do this job anyway, with monitoring pollen counts, making allergy recipes for allergy shots, and knowing what is pollinating at what time of the year. Oklahoma makes predicting weather patterns quite a challenge.  One minute it’s 80 degrees outside and 24 hours later the temperature has dropped back to 50.  We fluctuate from drought to 5 inches of rain in 1 week.  How are you supposed to take care of your lawn, much less predict the pollen counts?  Here’s some clues that might help you anticipate “bad pollen” days based on the weather patterns in Tulsa; and better yet, you might do better than the weatherman! Weather plays an important role in how much pollen is produced, its distribution and how much pollen is in the air at a given time.  (for the full article on weather and pollen counts go to: http://www.weather.com/health/allergy/news/how-weather-impacts-spring-allergies) Allergy symptoms are often reduced on rainy or windless days because pollen does not circulate as much during these conditions. Pollen tends to travel more with warm, dry and windy weather, which can increase your allergy symptoms. Pollen counts vary by time of day, season and weather conditions. Rain, wind and temperature are all important factors to consider when determining if pollen counts will be high, moderate or low on a particular day. Overall, pollen counts tend to be higher in the morning, as well as on warm, dry and windy days. Conversely, lower pollen levels are also typically observed during a stretch of cold and wet days. The National Institue of Heath Medline Plus recommends saving outside activities for late afternoon or after a heavy rain when pollen levels are lower. First, if we’re measuring pollen, what is it we’re measuring? The American Academy of Allergy Asthma & Immunology defines pollen as tiny grains needed to fertilize many kinds of plants.

This is ragweed pollen floating around in the air
This is ragweed pollen floating around in the air

Pollen from plants with colorful flowers usually do not cause allergies. Plants that produce a powdery pollen can easily be spread by the wind and can cause allergy symptoms. Spring allergies are often caused by tree pollen, summer allergies by grasses, and fall allergy by weed pollen. Pollen is transported in the air and enters our respiratory system, triggering an allergic reaction technically called allergic rhinitis. According to the National Institute of Allergies and Infectious Diseases, a branch of the National Institute of Health, approximately 35 million Americans complain of upper respiratory symptoms related to pollen. So how does weather conditions impact spring, summer, and fall allergies? Continue reading Wacky Oklahoma Weather

Food allergy “testing” is usually a bad idea

lynnawiensmd:

Thanks Dr Benaroch for your insights from a pediatricians standpoint. We see patients everyday that have been told based on a “test” that their child has food allergy. The percentages vary, but a majority of children that are found to have a food allergy by testing, tolerate the food just fine after challenge. What are the exceptions? Peanut, tree nut, milk, and egg anaphylaxis should always be asked during patient histories. This is why meeting your patient and asking directed questions is so important!

Originally posted on The Pediatric Insider:

The Pediatric Insider

© 2015 Roy Benaroch, MD

People like tests. You get numbers, and maybe a printout, and there’s science and blood and things just feels more… serious, when testing is done. You can picture Marcus Welby  (or perhaps a more modern physician), looking solemn, declaring “We’d better run some tests.”

Are medical tests magical and mysterious, and can they unlock the secrets of life? Usually, no. And among the worst and most misunderstood tests we do are food allergy tests.

A few recent studies illustrate this well. A review of about 800 patients referred to an allergy clinic found that almost 90% of children who had been told to avoid foods based on allergy testing could in fact eat them safely. The study, bluntly titled “Food allergen panel testing often results in misdiagnosis of food allergy” also found that the positive predictive value of food allergy blood…

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