Category Archives: For Brainiacs Only

New research in the field of allergy & asthma

I lie and so do you

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!

We all do this everyday--just kidding!
We all do this everyday–just kidding!

#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.

Continue reading I lie and so do you

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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

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?

What Do Doctors Read?

New Year’s resolutions, gotta lose weight, exercise more.  It does get a bit annoying to read all of our good intentions and then we fall off the wagon one more time!  As I look ahead to 2015, I begin my term (one year) as president of Tulsa County Medical Society (TCMS).  No resolutions I can’t keep, just hard work and lots of meetings.  The best way for me to share my thoughts and vision for 2015 is to let you in on my first newsletter of the year.  (unabridged)

TCMS

It’s Monday morning and I haven’t rested well from the weekend. With a full schedule at the office, I don’t have time for interruptions. I check my e-mail first thing in the morning and today I wish I hadn’t. I have four prior authorization phone calls to complete today, and two of them have already been denied. “What?” I asked as the insurance representative informed me that the patient in question didn’t qualify for the CT sinus study because they hadn’t been on antibiotics for 2 months. “Aren’t we supposed to use antibiotics judiciously?” I asked. But my troubles today were just beginning. Continue reading What Do Doctors Read?

Grapefruit Juice and Drug Interaction

PharmacistAnswers

Newest article is posted on the website!

http://pharmacistanswers.com/grapefruit-juice-drug-interactions.html

Here is our article. Enjoy!

Does Grapefruit Juice Really Interact With My Medication?

      A somewhat odd and alarming warning is listed on the prescription bottle of numerous medications: “Do not take this medication with grapefruit juice”. This warning is in fact listed for the most prescribed medication class in the world, the statin medications for high cholesterol. How could grapefruit juice possibly interact with a medication? Is the interaction actually dangerous? Can I still eat just one grapefruit? These are common questions pharmacists and other health professionals get, yet the exact answers to these questions are usually muddled with a sort of dubiousness by those responding. Information regarding the interaction was sparse at best when it was first discovered and information in scientific literature always seems to change. One year it was okay to eat just one grapefruit or have one glass of juice and the next year that turned intoa…

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Antihistamine Guide

I’ve published stories about allergy to antihistaminesin the past…this guide is much more comprehensive!

PharmacistAnswers

Hello all!

Our antihistamine guide on pharmacistanswers.com is complete and posted for everyone to see!

Check it out: http://pharmacistanswers.com/antihistamine-guide.html

Article Excerpt:

Have you ever walked into your local drug store just to grab an allergy medicine and became instantly overwhelmed with all the choices in front of you? In this guide, we will hopefully simplify your options and give you a better idea of just what medication is the best choice for you.

 

What exactly is “histamine” and why does it cause such annoying symptoms?

 

Histamine plays a central role in the allergic response and it’s main purpose is not to simply cause the symptoms we hate so much (although it feels like that sometimes!). It’s effects on the blood vessels in our body and in our airways is what usually causes the most grief. Histamine also has a major role in the release of stomach acid and the…

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Antihistamines for Colds

More@MedLetter

The next issue of The Medical Letter (November 25, 2013) will include an article on a new combination of the opioid hydrocodone and the first-generation H1– antihistamine chlorpheniramine that will be marketed as Vituz for treatment of cough and cold and allergy symptoms. Hydrocodone (in combination with acetaminophen for treatment of pain—Vicodin, Lortab, and others), as we wrote 2 blogs ago, will likely soon be reclassified as a Schedule II controlled substance because of concerns about its abuse.

One thing has to be said for hydrocodone: it will suppress a cough, which is more than can be said for chlorpheniramine or diphenhydramine (Benadryl), both of which are ubiquitous in over-the-counter cough and cold concoctions. So what are they doing there? They are there for sedation, which has plusses and minuses. And maybe to dry up secretions, which may not be such a good idea…

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Contradictory skin test and ImmunoCAP results–which is better?

This question comes up in my office almost everyday….should I do skin testing or blood work?  As you can see from the response of national experts, it depends.  There is NO test that can boast 100% accuracy to predict whether or not you will react to a food.  In fact, the gold standard if you will, is still the oral food challenge.  Here is some food for thought (really, do you have to pun)

  1. Clinical history is very important in determining food allergy.  If you can eat a food without difficulty breathing, rash, or hives, you are most likely not allergic.  You may have a positive test, but that only means you’ve had previous exposure to the food.
  2. I will often obtain both skin testing and ImmunoCap (blood work) to clarify the presence of IgE-mediated allergy. If both tests are negative, you may have an adverse reaction to a food, not the severe life-threatening anaphylaxis.  Very important distinction!
  3. If in doubt, a food challenge is always a procedure to consider.  Here’s why.
  4. Sometimes the food in question just isn’t worth the trouble to challenge.  No one says you have to eat strawberries!
  5. If you challenge peanuts for example, in the doctor’s office and experience anaphylaxis, better there than at home.  Epinephrine is more readily available and in many cases, IV access and full resuscitation is available within minutes of your reaction. 
  6. This is another reason why a single test or treating allergy without experience is not a good idea.  Read the link below and tell me just how complicated things can become!

Contradictory skin test and ImmunoCAP results.

Blood work can be a problem

Normally, I like to include lab studies for evaluation of patients with chronic infections.  It’s very important to find out if your body can make the right amount of antibodies to fight infection.  But…there’s always the exception.  In this case, IgA can be absent from your bloodstream and not cause a problem because it’s gone.  In short, I call this asymptomatic IgA deficiency (you should see the long version).  The link below comes from the American Academy of Allergy, Asthma, and Immunology–good stuff and easy to understand if you’re interested.

Low IgA with elevated IgE in a relatively asymptomatic.