Flying home from San Francisco spending some time at the AAAAI (American Academy of Allergy, Asthma, and Immunology) was a powerful reminder of how thankful I am for the opportunity to practice allergy here in the Midwest. National meetings give you updates of new procedures, opportunities to meet colleagues, and just a general good time getting out of the routine. What’s new for allergy here in Tulsa is more use of #biologicals (for #asthma), more #food challenges/treatment, and more aggressive treatment of #hives. I’m excited to get started, so let’s go!
When it comes to asthma, it’s not easy fighting the myths of Facebook, Google, or e-mail campaigns. And why are we so resistant to the diagnosis of asthma for our kids and ourselves? For asthma, if you don’t make the correct diagnosis, you’ll never implement the proper treatment. By that I mean, you’re not likely to use prevention, but instead will wait for an asthma attack and then rush in to treat the symptoms. Health care providers are responsible for this phenomenon just as much as patients. Go to any emergency room or urgent care with an asthma attack and you’re likely to receive steroids, antibiotics and the admonition to “see your primary care doctor”. The problem is that patients feel better after steroids and guess what? they never seek medical attention for the prevention of #asthma. After practicing asthma medicine for over 25 years, consider the following reasons for why our asthma treatment often fails to meet the “standard of care” according to published #asthma research:
- Asthma attacks don’t happen all at once. If I can get through an asthma attack in September, what’s the big deal of one course of steroids per year? This paroxysmal nature of asthma makes proper treatment very difficult because we tend to have a very short memory about our last asthma attack.
- As a general rule, we all resist preventive care. Do you miss a regular dental floss or exercise session? As difficult as it seems to continue with good preventive care, think how much more difficult it is to take an inhaler everyday to prevent asthma! Antibiotics are so successful after 10-14 days that we can stop therapy and recover back to our original health. Asthma isn’t the same disease process and many times one attack leads to never ending asthma.
Can I get over asthma? The short answer is usually not. Asthma is a disease of inflammation which means the airways over react to allergy, infections, or irritation. In short, this means lungs with asthma are forever inundated with “triggers” that cause wheezing, coughing, and typical asthma symptoms. If you don’t use preventive inhalers for the next attack, you can be assured it will come.
Excuse my ranting and raving about myths in #allergy, but it’s true our minds need to “get in gear” for what we believe. Does it really make sense and does information we believe come from reliable sources? Let’s try and debunk a few myths about allergy while it’s fresh in your mind.
- Once I start allergy shots, I’ll never have any problems. #Allergy immunotherapy or “allergy shots” are very helpful to relieve symptoms of #hay fever such as sneezing, runny nose and even wheezing, but they don’t cure everything. For instance, if you have sinusitis, don’t count on your shots to cure your symptoms–you have to treat the sinuses for relief. This may include antibiotics/prednisone for one month at a time, or even surgical intervention. This is the reason I will often obtain a CT scan of the sinuses before starting allergy shots–to make sure I’m not missing an infection or anatomical obstruction in the sinus cavities. You wouldn’t expect the patient below to improve with allergy shots because they have a concha bullosa on the left side causing obstruction of nasal airflow. Not a good remedy for allergy shots!
- Benadryl is the antihistamine of choice–pick an ER and you’re likely to find #benadryl used like candy. Medical conditions like #hives and unknown #allergic reactions should be treated with antihistamines, but benadryl, really? Better antihistamines are available OTC and include Zyrtec and Xyzal. They’re stronger, more potent and last up to 24 hours instead of 4-6 hours like cousin benadryl. Next time you get benadryl, substitute with a better antihistamine and see what happens. (I think you’ll be pleased).
- Nasal spray addiction–Here in America, we don’t like using #nasal sprays. Europe has no problem sticking lots of objects up their nose, but in this country, we’d rather take a pill than use the more effective nose sprays. Every single study that compares nasal sprays with antihistamines, finds that nasal sprays such as corticosteroids work much better for allergies than pills and sometimes even allergy shots. WORD of CAUTION: Nasal sprays such as Afrin or 4-way spray can be addictive and harmful to your health. I’m only comparing nasal sprays with antihistamines and #topical steroids which don’t have addictive potential.
- There has to be a cause to my hives—perhaps the most frustrating medical condition of all time is #hives. That pesky rash that can range from a few bumps to your body being covered from head to toe with incredible itch associated with difficulty breathing and swelling. Most patients come in to the office hoping to find a cause or trigger to avoid and thus cure the hives. Unfortunately, the cause for hives is never found in 70% of cases, only leading to more frustration and disgust. I will usually look for allergy, bone marrow problems (tryptase) and alpha gal sensitivity, but that’s about it for finding a cause. Symptom control is key with antihistamines and Xolair, but if you stop your medication, the hives are likely to return.
No, I’m not done with allergy myths, but part 2 is coming up later. Those topics to include the following:
- Can I get over asthma?
- Isn’t everyone allergic in Oklahoma? I’ve come to the right state;
- Food allergy–https://www.usatoday.com/videos/travel/experience/food-and-wine/2018/07/07/these-foods-can-help-you-feel-cool-heat/36661435/
If you don’t believe me, here’s an hour long lecture on “Allergy myths” given by Dr. Dave Stukus (teaches at Ohio State University) at the following link:
I for one am tired how my health score is tied to my existence as a person rather than who I really am. “How to keep up your credit score, what income bracket I’m in, what’s my IQ” are nagging reminders that I may not be anything more than just a number and not a unique person on this planet. Health care is fast approaching this same pigeonhole similar to banks and retailers, but it’s not all bad. Ever heard of personalized medicine?
#Personalized medicine has some pretty awesome benefits on the horizon, but “what’s the catch?” My cholesterol has to be below 120, cigarettes at zero, and my daily cups of coffee can’t be over 5 if I have any hope of living past 80;you just can’t get away from numbers.
According to Wikipedia, Personalized medicine, also termed precision medicine, is a medical procedure that separates patients into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease. So if numbers and health are an integral part of the future of health care, is there such a thing as an allergy or asthma number? Wouldn’t it be nice to find out which asthma inhaler is best for you based on “personalized medicine?” Or what if you suffer from chronic hives and can’t find the cause? Personalized medicine involves many more diseases that just asthma and allergy–just look at the link below, but I have a list as well. Continue reading Something about numbers
Ever notice how everyone has #allergies these days? I kid you not, almost everyday, a patient will tell me that #Tulsa (where I practice) has more allergies than any other place in the country. The irony of it all, is so did patients in Kansas, and patients say the same thing in Virginia and Texas. You get my point–we all love to be known as the Allergy Capital of the World! Maybe it’s because allergies make us feel so miserable, and we love to hear stories about how to deal with the nemesis. Or maybe we want some “inside information” to share with our friends & family who also suffer from allergy. Whatever the reason for our obsession with allergy, you can’t argue with the fact that good allergy advise is not only helpful for better quality of life, but it’s crucial in making sure that allergy sufferers avoid heeding the WRONG advice for treating #hay fever. This is the passion I experienced in order to complete a fellowship training in allergy– I wanted to be able to interact with patients about their #allergic symptoms on their journey to good health. But wait, why practice a specialty that has so much incorrect information on-line and no doubt, “everyone’s an expert in allergy” when you could be doing real medicine to treat someone’s heart attack? Here are four reasons I still practice allergy for your consideration: Continue reading Four reasons I still practice Allergy in the Information Age
I was in my doctor’s office today (yes, I go to the doctor as well) and she asked me if I was taking my #medications. Of course, I said “yes, the ones that are in my chart”, not really having that photogenic list in my head. As we talked, I realized my confession of what my doctor wanted to hear got the priority over what I was really doing. Busted for lying, but not intentional.
I wish it wasn’t so difficult to take care of our bodies. I always overestimate how much I #exercise and how little I eat. Scales don’t lie, so I just don’t weigh myself. Isn’t it a good thing I only see my dentist every 6 months? I only have to lie about flossing twice a year!
#Asthma, however, is no laughing matter. Your asthma control and cost of keeping you out of the hospital depends on how often you take the medications prescribed to CONTROL your asthma not just treat it. The solution is simple, yet very difficult to actually perform correctly. Here’s the issue with asthma–which inhaler do I use when it’s prescribed by my asthma doctor? I’ll bet you confuse the use of controller medications with reliever medications and now that more new inhalers are on the market it’s even more difficult to do the right thing.
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
At first glance, I thought to myself, do we really need another quick acting inhaler? As I thought about inhaler technique and how we use our Ventolin MDI’s, most of use suck on the end of the inhaler which is the wrong technique to use. (all of the medication deposits on the back of the throat) Why not use the appropriate inhaler that’s meant to actuate with your breath anyway? ie, sucking on the inhaler is what you’re supposed to do!
Here’s the link to the article if interested–http://www.pharmatimes.com/Article/15-04-01/FDA_OK_for_Teva_s_acute_asthma_inhaler.aspx