Allergy Season: Sneezing to find a Doctor
You think it would be easy, finding a doctor. Maybe for some it is, for me, well, it appears to be a challenge. My problem is fairly simple: I suffer from seasonal allergies, and they are particularly rough this time of year, so I thought seeing someone and considering immunotherapy would be a positive step. My symptoms are managed with some over-the-counter medicine, but the thought of having better relief appeals to me <pardon me if I sneeze – I hope your keyboard isn’t wet>.
My wife has been bugging me to see a doctor for a physical since I have known her. I refuse, telling her that a routine examination reveals nothing or little about a person. People can see any physician and have a perfectly normal exam but inside have a horrible cancer, severe heart disease, or the like. I feel pretty good, cook healthy food for my family (as you know). My parents are both in their late 80’s- active – mom has macular degeneration and can’t see too well, and my father refuses to wear his hearing aids. So my medical history- good genes, I don’t smoke cigarettes, and I’m pretty active.
How a doctor looks for another doctor
Still, damn allergy bugs me. So I do what any on-line doctor does, check websites.
First, I look to the therapy for allergies. One of my favorite podcasts, Stuff you Should Know, did a bit about the sublingual immunotherapy – where the antigen is given under the tongue, and overtime it helps overcome the allergy. Mechanism unclear. I see some highly respectful bits about it on websites from Johns Hopkins and WebMD.
Then I look for that specific therapy in Phoenix. Turns out there is a group that does this just blocks from where I live. Their office building is new, beautiful, and then I see their credentials: they are not allergists, they are family doctors. They sell a lot of “nutritional supplements” in their waiting room (with a beautiful wood floor). They talk about holistic – and none of them are graduates from medical schools that I recognize. My spider sense is tingling that this is a woo group, and if it is a woo group, maybe it is a woo therapy.
Drops for Allergy Suffering – sounds good
They offer SLIT (sublingual immunotherapy – where antigens are given under the tongue), but not a single allergen, but multiple allergens. So, it isn’t specific, they toss everything at you. Let me get this right, you are going to prick my back with 60 sticks to find out what specifically is bothering me, then send me off with a bottle of pollens to put under my tongue and I don’t have to come back? Why are you doing that test again? Oh, its a procedure – I get it, for my discomfort, you get a larger charge, and it doesn’t matter what it shows because the therapy is shotgun. Now that is about as backward as a physician can do things. Its like giving an antibiotic for something we don’t know what it is, but it will cover everything. Of course it bothers me that they have a nicer office than I have.
So I look up board certified allergists in Phoenix. The first website I come to is clean – generic website that almost every doctor puts up. They have a “certified pollen counter” who tweets – and their last tweet was in August of 2012, yet they put up the tweets on their site. Ok, not a techy group – so not sure I get them.
I check another group- good credentials, offer SLIT, but not allergists. I begin to wonder- is SLIT really something that any doctor can do. What kind of doctors are these?
I look up another group- allergists, all board-certified, and they don’t offer SLIT. They are upfront about it and note that shots seem to work better. This is bold – telling someone about shots as opposed to sublingual (under the tongue) juice.
I go to the computer again for more people who offer SLIT- and find that a naturopathic doctor offeres it. Now my spider sense is really tingling. Naturopathic doctors do not have an internship, or a residency, or specialized. They go from their “naturopathic school” right into practice. Maybe I’m not as bright as they were, but I was a lot better physician after a year of internship and five years of residency – learned a lot in clinical situations. But these doctors don’t have such. That naturopaths are offering this therapy means I must research it a bit more.
Timothy Grass – works in Europe, what about here?
More research shows that SLIT works well in Europe, especially where something called Timothy grass is the most common problem. Not a grass found in my part of the world (Arizona). In fact, one of the problems with living in Phoenix is that we grow everything here. Ironic that years ago people were told to move to Phoenix for their asthma and allergies, but when everyone else moved to the valley of the sun they brought their favorite, and highly allergenic, plants: like olive trees, ash, juniper, mulberry (of “all around the mulberry bush” fame – I have a 2 year old, I know these songs), , and grasses to make the desert look green but make lots of pollen, and palm trees (which there is one native species in Arizona, a small scrub tree found in the Grand Canyon). In Phoenix you just add water and you can grow anything you want – apparently people decided to grow allergens.
SLIT works well if you have an allergy to Timothy grass, and you use SLIT with a single antigen (an antigen is the material your body thinks is foreign, so it tries to expel it, with lots of upper respiratory symptoms (snot). So how does SLIT work if you use multiple antigens in the material? Apparently not very well. Ideally the sublingual therapy works best if you have single antigen. Meaning the allergist defines what you are allergic to, and instead of tossing lots of things at you, uses specific therapy. That appeals to me. Target what is the problem and go for it.
Now shots. Therapy using shots has been studied extensively, and these seem to work well in areas where there is more than one antigen that is an issue. They are administered by an allergist, they don’t work right away (generally) and yet they are effective over time.
Fancy Office does not mean good care
There are a lot of physicians out there who are not as well trained, jump onto programs that are not well thought out, and yet with slick marketing seem to have it all (beautiful offices on the fancy corridor selling things that don’t work). But careful research shows who is good. One thing I didn’t do: I didn’t research sites like ratemds or others, because what people think of their doctor is less important to me. I have a simple task I need my doctor to do, and I want them to be competent, up-to-date, and well trained. I realize many like a good bedside manner, but for me, I just want relief from these pesky allergies.
It isn’t easy for a doctor finding a doctor- I cannot imagine what it is like for a non-physician. For me this involved some research into a therapy, that turns out to be popular, and many doctors offered it – especially those doctors who were not certified in the field of allergy. While the therapy sounded good (no shots) it turns out it isn’t as effective.
Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and received his MD. Dr. Simpson, then became a renowned weight loss surgeon, and a leading advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he advocates teaching people to improve their health through their food. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcom Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.