Thursday, December 15, 2011

The Importance of Medical Play


Last week, my 3 year old, whose asthma is generally very mild, needed a few treatments of his albuterol inhaler. Because he is unaccustomed to having the spacer device on his face, the process of administering the medication was a bit of an ordeal. When I say a bit of an ordeal, I mean kicking, screaming, tears flowing, hyperventilating -- you know, nothing I can't handle. I finally got the puffs in him, and swore to myself that we weren't going through that again. By that point, we were already late for daycare, so I left the inhaler and spacer on the coffee table and whisked the kids off to school.

That evening, as I was preparing dinner, I heard a strange musical noise, and turned to find Son #2 using his spacer as a vuvuzela. Here was the same child who only that morning was so vehemently resisting his treatment, now dancing around the kitchen with his spacer and inhaler attached to his face.


The sound might have been as annoying as anything coming out of the World Cup stands, but it was music to my ears. Left to his own devices, my child overcame his fear of the unknown by doing what children naturally do -- playing. A second treatment later that evening went remarkably smoothly.

Medical play allows children to gain familiarity with diagnostic procedures in a non-threatening environment. This type of play is especially important for children who may be undergoing chronic treatment for conditions such as asthma, immune deficiency, or cancer. However, medical play can also assist in preparing children for one-time procedures or treatments, such as allergy skin testing or vaccinations. It doesn't require a great deal of specialized equipment- a simple store-bought toy doctor's kit and a stuffed animal are a great start.


There are also a variety of excellent books written for children who require a single routine doctor's visit or chronic medical care. A quick search online or at your library or local bookstore will yield a wealth of resources.

If your child has an upcoming physician's appointment or procedure scheduled, think about incorporating medical play before, during and after the visit. It just may make things easier for everyone. Just ask my spacer/vuvuzela-playing son, who is now breathing easy.



Thursday, December 8, 2011

Want to Decrease Your Child's Risk of Pet Allergy? Better Act Fast!

The past few years have seen increasing interest in potential strategies to reduce the risk of allergy and asthma in young children. One particularly popular topic has been that of early pet exposure potentially decreasing the risk of animal allergy. Indeed, I am often asked by parents of my young patients if I recommend adding a furry pet to the household. However, it has been unclear how early in life the pet exposure needs to occur in order to modify risk. 



A recent analysis of data from the Detroit Childhood Allergy Study sheds some light on this important question. It was published in the July 2011 issue of the peer-reviewed medical journal Clinical & Experimental Allergy. (Clin Exp Allergy. 2011;41:920-922)

Annual interviews from 1987 through 1989, and follow-up interviews at age 18 years, were used to assess study subjects' exposure to indoor dogs and cats. After analyzing pet exposure during the first year of life, specific age ranges, and cumulative lifetime exposure, here's what the researchers discovered:

Cats: For both boys and girls, exposure to household cats during the first year of life was associated with a decreased risk of sensitization to cat at age 18 years. The relative risk (RR) of sensitization was 0.52 compared to children without cat exposure during this time. However, there did not appear to be benefit conferred from cat exposure during later time frames.

Dogs: For both boys and girls born by cesarean section, exposure to household dogs within the first year of life was associated with decreased risk of dog sensitization at age 18 years (RR = 0.33). However, if delivery method was not taken into account, the reduction in risk was significant only for boys (RR = 0.52). Sorry, girls!

Bottom line? Early exposure to household cats and dogs does appear to modify the risk of future hypersensitivity (there is actually some evidence to suggest the tolerance induced during this early period may be long-lived), but the window of opportunity is very small. The benefit does not seem to extend to exposures beginning after the first birthday. As most parents are disinclined to bring a new baby and a new pet into the home simultaneously, it is likely that the main beneficiaries of this protective effect are children born into households where Fido or Fluffy are already firmly established.


Thursday, November 24, 2011

The AllergistMommy's Thanksgiving List

10 things I'm thankful for this Thanksgiving:

1. Increasing awareness of allergies and asthma among family and friends.
2. Schools that recognize the importance of not using food as a reward in the classroom.
3. The availability of novel, high-quality allergy and asthma-friendly products and foods.
4. Laws that protect the public from the dangers of environmental tobacco smoke.
5. The availability of life-saving epinephrine in Illinois schools (and hopefully soon, schools throughout the nation!)
6. A robust community of asthma and allergy parents and physicians sharing their experiences via the magic of social media.
7. Treasured patients who have put their trust in my expertise and care.
8. A steadily growing medical practice which is the beneficiary of kind word-of-mouth referrals (scheduled my 100th patient this month!)
9. The flexibility to set my own schedule, which allows me to a more involved mother.
10. My awesome family (and inspiration)...

Wishing you and yours a holiday season full of people, things, and experiences to be thankful for!

Friday, November 18, 2011

What Anaphylaxis Feels Like -- The AllergistMommy's Own Story

One of the things that helps me be a better allergist is that I know, first hand, what it feels like to experience anaphylaxis. 


I am severely allergic to blueberries. Here's what happened when I experienced my first episode of anaphylaxis:

Red, itchy palms.
They felt hot and uncomfortable (as though they were being cooked from the inside out), and I found myself rubbing them against my thighs because they were so itchy.

Painful abdominal cramping. 
This pain made me feel like my innards were being wrung out like a wet dishrag, and was followed by a sneaking suspicion that if I elected to go the bathroom at that very moment, I might just evacuate the entire contents of my body in a single second.

Incessant throat-clearing. 
I felt like something was caught in my throat, but I just couldn't clear it. I was trying to be quiet, because I didn't want to bother anyone, but I couldn't stop. When I finally spoke up for help, my voice was hoarse.

Involuntary coughing, which I couldn't suppress.
The coughs were dry and weak, as though I didn't have the power to put any gusto into them. It felt unnatural and non-productive for someone accustomed to being able to hack up giant loogies on demand.

A sense of nervousness. 
Many people speak of a feeling of impending doom, but no one is ever going to walk up to you and say, "I feel as though my doom is imminent. Can you please help me?" I just felt that something was not right, and that things were going to get worse before they got better. I found myself looking around the room in hopes that someone would catch the desperation in my eyes and save me from whatever was about to go down.

Stridor.
A whistling noise when inhaling, which was caused by the steadily increasing swelling of my laryngeal tissues. I had to lean forward with my chin jutting out to breathe, looking like a self-conscious waterfowl. If I didn't adopt this unusual pose, I sounded as though I was being strangled. Which is exactly how I felt.

Here's what I didn't have:

Hives and Swelling
Although my previous reactions to accidental blueberry exposure had always been urticaria (hives), on this particular morning, I had happened to take a long-acting antihistamine tablet, which may have prevented any hives or facial swelling from appearing. Nevertheless, my reaction was just as dangerous (if not more so, because the usual tip-offs didn't manifest). Not all severe allergic reactions are obvious to the casual observer. However, it's essential to recognize that just because you don't see someone covered in hives or having their lips blow up like a balloon, it doesn't mean that a serious allergic reaction isn't occurring on the inside of their body, where no one can see it.


Lesson I took away from this experience:
1. Always carry epinephrine. ALWAYS carry epinephrine.

2. Be alert for the sudden onset of throat-clearing and coughing. Anyone who starts doing that in my office gets an immediate evaluation.

3. Take people (especially children!) seriously when they tell you something isn't right. Don't tell a kid who comes to you looking terrified that "Everything will be fine, just drink a glass of water to clear your throat." This feeling of impending doom is real, and scarily accurate. Stay with that person!

4. Don't be afraid to approach someone who appears uneasy, even if they don't ask for help. Many people experiencing allergic reactions try to suppress their symptoms, because they don't want to be a bother. It isn't nosy to ask someone if they need help, it's courteous and caring.

And most importantly...

5. Don't eat blueberries.

Sunday, November 6, 2011

Why Drug Allergies Matter (Or Why Penicillin Allergy is Responsible for My Son's Lopsided Neck)

My 6 year son old just got over a rite of passage - strep throat and scarlet fever. Unfortunately, before we could even celebrate his recovery, I noticed a swelling on the left side of his neck. It was red and tender, and it was GROWING. The pediatrician in me worried, "Damn. Lymphadenitis (infected lymph node)". No sooner had we finished one course of antibiotics than we were onto another, and the side effects were bad enough to keep him out of school for another three days.

Why did my munchkin suffer so? My answer: Drug allergy.

Group A streptococcal bacteria (the cause of strep throat and scarlet fever) is remarkably sensitive to penicillin. Penicillin is the first choice treatment for strep throat, and has been proven to reduce the risk of developing rheumatic fever, a post-infectious complication which can result in chronic heart disease.

Problem is, my son is allergic to antibiotics in the penicillin family. At 11 months of age (8 days into his second ever course of amoxicillin for an ear infection) he developed generalized hives, severe dermatographism (hives after scratching), swollen hands and feet, fever, and giant purple target-shaped lesions all over his body. High-dose antihistamines didn't help. It took a course of oral steroids to ease his misery, and even then, it took nearly 2 weeks for his symptoms to improve. The dermatographism lasted for almost a year. This type of delayed allergic response is known as serum sickness, and is mediated by immune complexes which deposit in various tissues. The photos below are from the beginning stages, before things got really bad... at the peak of his symptoms, his feet were so swollen they wouldn't fit in his shoes.

dermatographism
target-shaped skin rash
targetoid hives spreading over body

I've been practicing medicine since 2003, and the one of the most miserable case of hives I've seen was in my baby boy. For better or for worse, the memory of my son's drug reaction is the yardstick by which I subconsciously measure the severity of my patients' skin conditions.

So you can imagine why I'd fight off an army of flying monkeys before I would deliberately expose my kid to any drug likely to elicit a similar response.

Instead of being able to have his strep infection treated with penicillin, my son had to use what is known as a "second-line" antibiotic. Within a few days, his sore throat and rash improved. But then, he developed the painful and expanding swelling on the side of his neck which indicated that the bacteria had not been fully wiped out by the second choice antibiotic. There was no choice but to go through yet another round of antibiotics. This time, we were stuck with another second-line agent. One, unfortunately, notorious for severe gastrointestinal side effects.

I can't help but wonder if this little ordeal might have been prevented if my child did not have the allergic sensitivity to drugs in the penicillin family. I also can't help but wonder how many people unnecessarily receive second- or third-line antibiotics because they erroneously carry a label of drug allergy. Often, children who experience a mild infection-induced rash while taking an antibiotic (especially amoxicillin) are told to avoid all penicillins and cephalosporin antibiotics. However, they may not truly be drug-allergic. Unfortunately, many people carry this label into adulthood.

My son has a type of allergic reaction (serum sickness) which cannot be tested for, and for which the only practical treatment is avoidance. However, this is not the case for most individuals. There is accurate outpatient testing available for immediate-type penicillin allergy. In fact, the majority of people who have been told that they are penicillin allergic actually test negative and are able to tolerate amoxicillin after all. So, before you accept a label of drug allergy, consider consulting a Board-certified allergist to help you sort through these issues. It may just help you or your child avoid the expense and complications associated with suboptimal therapies.


Thursday, October 27, 2011

Halloween is Here, and It's Easier Than Ever to be Food-Allergy Friendly!

Halloween is just around the corner! I went to the grocery store to pick up candy, and was pleased to find that there are plenty of allergy-friendly options available, both in terms of candy and non-edible treats.

Here's what I picked up:

1. Smarties. Link to their Allergen info: http://www.smarties.com/allergen/
2. Sweet Tarts. (Wonka candies labels its products for inclusion or possible cross-contamination of the 8 major allergens- check your bag to make sure it's safe)
3. Nerds. (Wonka candies labels its products for inclusion or possible cross-contamination of the 8 major allergens- check your bag to make sure it's safe.)
4. Pencils. Yay for Target!
5. Stickers. Again, yay for Target!
6. Halloween-themed silly bands. Did I mention that I love Target?

I keep the candy and the non-edibles in separate bins, and let the kids/parents choose.

This year, my practice is having a Halloween candy "Buy-Back". So, I'll include the following note by the door:



Here's to a spooky (and safe) Halloween!

Thursday, September 29, 2011

Open House on October 12, 2011-- Please Join the Party!

You're Invited to an Open House!

I am thrilled to celebrate the opening of Kaneland Allergy & Asthma Center with an Open House event for my colleagues, patients and community members. We'll be giving tours of our kid-friendly new office, talking about the latest developments in allergy and immunology, sampling yummy allergy-friendly treats, accepting donations for a local Food Pantry and giving away prizes! (iPad, anyone?)

If you have a friend or family member who could use a good allergist, this is a great time to "Meet the Doc" and get a feel for the practice before scheduling an appointment, so bring a buddy!

Where:
66 Miller Drive
North Aurora, IL 60542

When:
Wednesday, October 12, 2011
6:00pm-8:00pm

I'm lucky to share my office building with great neighbors, who will also be opening their offices to the public during this time with similar events. Here's your opportunity to meet all of the professionals at 66 Miller Drive in one evening:

Lighthouse Financial Group (College Planning)
Scott Morris DDS & Associates (Family Dentistry)
The Rainbow Center (Pediatric Physical and Occupational Therapy)

We will be accepting donations for the Aurora Food Pantry. Bring in a canned good, visit each host, and you'll be entered into a drawing for a new iPad!

Friday, September 16, 2011

The AllergistMommy Washes a Pull-Up: A Lesson in How Not to Do Laundry

In a rush to get the kids' clothes clean yesterday, I dumped the laundry basket contents into the washer without taking the time to sort... HUMONGOUS mistake.

After returning home late from a business trip, DH walked into the bedroom asking me about the "crystals" in the laundry. "Crystals?!?! What the heck is my crazy husband talking about?" I wondered to myself upon being woken from my slumber...

Well, this morning, it became "crystal" clear exactly what had transpired.

Son #2, upon being instructed to "Throw all those dirty clothes down the laundry chute", decided to include his Pull-Up in the mix. My washer and all the clothing therein was covered in pieces of super-absorbent polyacrylate gel. Most excellent.


Thankfully, it turns out the AllergistMommy is not the only ridiculous parent to have committed this laundry crime. Laura, the Mellodramamma, has walked this road before me: http://www.melodramamma.com/?p=60

Read her post for tips from the Pampers and Huggies people on how to handle a washed-diaper mess.

Hmmm... guess what I'll be doing this lovely Friday night?

Wednesday, September 14, 2011

Back to School Mommy Fatigue- An Under-Recognized Symptom of Poorly Controlled Environmental Allergies

 Ah, back to school... kids get back into a routine, and mom gets her life back, right?  WRONG! For most moms, back to school is anything but relaxing. However, for some of us "chosen ones", it's even more tiring:
  • Is this the time of year when you struggle to drag yourself out of bed, despite hitting the sack as soon as you put the kids down for the night?
  • Is your focus during the day so scattered that it takes you 3 times longer than usual to accomplish even relatively simple tasks?
  • And when it's finally time for bed again, are you shocked to see a face 10 years your senior staring back at you in the mirror, with dark circles and puffiness?
Many tired moms attribute these seasonal symptoms to the stresses associated with "Back to School".  However, if you're an allergy-mom like me, remember: your kids got those allergy genes somewhere, and you probably had a little something to do with it!

As parents of kids with allergies and asthma, we are often so focused on our children's health needs that we neglect our own. If you aren't experiencing the typical runny nose and sneezing traditionally associated with environmental allergies, it's easy to assume that you're just not getting enough sleep, or that you need to take more vitamins or drink more (gasp!) coffee.

Consider this- you may be suffering from the symptoms of poorly controlled allergic rhinitis. Back to School time coincides with the onset of ragweed season in much of the continental U.S. It also overlaps with high mold counts, especially as the foliage starts to accumulate and decay.

Uncontrolled allergic inflammation can make your fall feel lousy.

The congestion and sinonasal inflammation associated with allergies can contribute to poor sleep, mental fogginess, headaches and irritability. In addition, the lack of adequate drainage from the capillaries under your eyes can result in swelling and dark circles (known to the trade as "allergic shiners", which I think is a great description, because people with them generally feel like they've been beat up).

If you have come to associate Back to School with a deep desire to crawl into a cave and hibernate until after the classroom Halloween party (which just so happens to coincide with the first major frost), don't settle for suffering! Talk to your primary care physician or family allergist to see if there are measures you can take NOW to regain your energy, focus and well-being!

Tuesday, July 26, 2011

Always Sick - Could It Be Immune Deficiency?

As an immunologist, part of my job is to identify and treat immune deficiencies, which can predispose patients to recurrent infection. Primary immune deficiency is remarkably under-diagnosed, and it can often take years of chronic illness before a definitive diagnosis is obtained. This delay in diagnosis is frustrating for both patients and their physicians. However, a proper diagnosis and treatment for immune deficiency can be life-changing. With this in mind, I'd like to share the Warning Signs of Primary Immune Deficicency, courtesy of the Jeffrey Modell Foundation:


10 Warning Signs of Primary Immunodeficiency in Children

1. Four or more new ear infections within one year.
2. Two or more sinus infections within one year.
3. Two or more months on antibiotics with little effect.
4. Two or more pneumonias within one year.
5. Failure of an infant to gain weight or grow normally.
6. Recurrent, deep skin or organ abscesses.
7. Persistent thrush in mouth or fungal infection on skin.
8. Need for intravenous antibiotics to clear infection.
9. Two or more deep-seated infections including septicemia .
10. A family history of primary immunodeficiency.



10 Warning Signs of Primary Immunodeficiency in Adults

1. Two or more new ear infections within one year.
2. Two or more serious sinus infections within one year, in the absence of an allergy.
3. One pneumonia per year for more than one year.
4. Chronic diarrhea with weight loss.
5. Recurrent viral infections (colds, herpes, warts, condyloma).
6. Recurrent need for intravenous antibiotics to clear infections.
7. Recurrent, deep abscesses of the skin or internal organs.
8. Persistent thrush or fungal infection on skin or elsewhere.
9. Infection with normally harmless tuberculosis-like bacteria.
10. A family history of primary immunodeficiency.

If you or a loved one have experienced two or more of these warnings signs, please see a Board-Certified Immunologist to help you determine if an immune deficiency might be to blame for your illness.

Tuesday, July 19, 2011

Harry Potter Gets Funky at the Bajowala House

My boys have recently gotten VERY into the Harry Potter series. Their new favorite game is to play wizard dueling with markers in their hands as wands. Here's a recent exchange:

Son #1: (Pointing a green highlighter at his brother) I'm going to zap your wand! Experiamus!
Son #2: You missed! (Pointing a blue highlighter right back at his big bro) SUPERFLY!

With that slip of my 2 year old's tongue, I was treated to an image of Son #1 suddenly being transformed into Ron O'Neal. Superfly, indeed.

Sunday, June 26, 2011

Kaneland Allergy & Asthma Center Opening July 2011!

I am thrilled to announce that in July, 2011, Kaneland Allergy & Asthma Center will open its doors!



The decision to open my own medical practice did not come easily. The combination of the changing healthcare environment and new economic realities in our nation has caused many to question the viability of private practice medicine altogether. So naturally, I am filled with butterflies at the prospect of starting from scratch....

However, my heart tells me that I am doing the right thing. I believe there is a great need for independent physicians in our nation- physicians who are not answerable to bureaucrats or administrators or insurance companies, but are answerable only to their patients and their own consciences. I believe that patients long for a return to the time when conversation and education created the cornerstone of medical care, rather than pills and procedures. I believe that medicine is still a noble profession- we only need to start believing in it again.

With this in mind, I prepare myself for an incredible adventure ahead. I thank my family in advance for tolerating what will surely be a test of our ingenuity and sheer power of will. I thank my future patients for the trust they will place in my abilities and compassion. Most of all, I thank God for the many blessings continually showered upon me.


Ready... Set... Let's Go!!!

Sunday, June 5, 2011

Free 504/IEP Strategic Advocacy Training

For families in the Illinois Kane-Kendall counties with school-aged children with potentially life-threatening allergies, the following FREE seminar will be of interest. Many children with severe allergies may benefit from having a 504 Plan in place- led by an attorney specializing in special education law, this seminar will aid parents in advocating for their child's right to a safe and healthy learning environment. Please note- as seating is limited, advance registration is required. See the flyer below for details (it will enlarge upon clicking):



Friday, June 3, 2011

Reverse Psychology at Work

Son #1 was in a funk this morning on the way to his last day of school. As Son #2 excitedly chattered on about an upcoming family "baycayshun", my eldest child's normally mild temper was flaring.

Son #1:  "Stop talking about it! I don't ever want to go on vacation again! I just want to stay at Summer Camp!"

Me: "Okay, if that's the way you feel, I guess you can stay home and we'll just take your little brother to Disney without you."

Pensive Pause. (even Son #2 stopped jabbering to hear this response)

Son #1: "Fine. This is the last vacation I'm going on. But then, I'm never going on vacation again!"

Gotta love reverse psychology.



Wednesday, May 18, 2011

The Power of Suggestion

This morning, while getting dressed in his Pull-Ups (yay!) and jeans, the following conversation made it clear that my 2 year old is acutely aware of the power of suggestion:

Son #2: "Mommy, we going to school?"
Me: "Yes, honey, we're getting ready to go to school."
Son #2: "How about Toys R Us?"
Me: "Umm, no. Nice try, though."
Son #2: "How about tomorrow?"

He keeps this up, and we will eventually own a majority stake in the place. The kid has a bright future as a lobbyist.


Monday, May 2, 2011

The Over-Scheduled Child (Or Is It the Over-Scheduled Mother?)

Me: "Honey, we're overscheduling him."
DH: "What are you talking about? He loves these classes, and gets to see his friends!"
Me: "But he wakes up early to go to school, and by the time we get home from afterschool activities, we basically only have time for dinner and homework before it's time for bed."
DH: "Great- that means he's not watching tv."
Me: "So, when does he play outside?"
DH: "Doesn't he have 2 recesses a day at school? And he plays outside all weekend whenever it's nice outside. Actually, I've been thinking that we should get him into a team sport on Sunday mornings."
Me: "Are you kidding me?!!? If I have to drive this kid to any more activities, I'm going to lose it. Between getting the kids ready for school and barely getting to work on time myself, rushing to pick them up before the daycare closes and keeping track of karate, Saturday school, etc., I don't know if I can handle anything else."
DH: "So it's not that we're over-scheduling him, it's that we're over-scheduling you."

Looking back at this conversation, I see how I was projecting my frustration with balancing my child's schedule onto him. I do believe it's possible to over-schedule a child, and at the first sign of "activity-fatigue", I believe it's essential to back off on the extra-curriculars.

However, for many years, there's been an outcry over the "stressed child", even more so now with all the "Tiger-mother" controversy. But you know what? Little kids are great at handling stress- in fact, probably better than adults. This is because they know their limits- when they're tired, they fall asleep. When they're frustrated, they cry. It's the adults that force ourselves into situations we can't handle. I now wonder if some of our parental anxiety over our kids' schedules is actually rooted in anxiety over our own inability to "keep up the pace".

Our family's compromise? Son #1 can join another activity if he wants, but Daddy has to take him!


Tuesday, April 19, 2011

Survey on Food Allergy in the School Setting

Dear Reader,

With the recent media attention surrounding accommodations for food-allergic children in the school setting, and confusion about what reasonable and effective accommodations even are, it is important to gain a better understanding of parental attitudes about food allergies. I recently received this survey from the Kids With Food Allergies Foundation, and wanted to pass it on. Remember, there are no right or wrong answers- this survey is simply evaluating the opinions of parents of both food-allergic and non-allergic children. There is power in numbers, especially when it comes to compiling data. The more parents that complete this survey, the more compelling the results will be!

Thanks in advance,
the AllergistMommy

The Kids With Food Allergies Foundation and some members of its medical advisory board are conducting a research study to examine parental opinions about food allergy management policies and accommodations in schools and child care centers. We are seeking parents to complete a brief, anonymous questionnaire (10 minutes) which asks a series of questions that inquire about your awareness of school food allergy policies and accommodations, and your opinions about the importance of such policies and accommodations. The goal of the study is to obtain the patient's (or their parent's) opinion about school food allergy management policies and accommodations, given that this topic has received mainstream media attention recently.

Click here to Take the Survey!

Wednesday, March 30, 2011

Online Food Allergy Education for Your School Nurse!

Thanks to the Mothers of Children Having Allergies group for passing on the important information below!

-----------------------------------------------------

With the generous support of the Food Allergy Initiative-Chicago there is now a food allergy-specific learning opportunity for school nurses on-line:
 
 
When completed the participant will receive 0.5 INA contact hour for continuing education.  
 
Please share this information with your favorite school nurse.  :-)
 
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In this era of budget cuts and staffing shortages in our schools (especially when it comes to nurses), how wonderful to have easily accessible resources for our school nurses to educate themselves (and earn continuing education credit, to boot) on how to keep children safe! Bravo to the Food Allergy Initiative!



Tuesday, March 22, 2011

Missing My Kids

I'm waiting for my flight home from the 2011 AAAAI Annual Meeting (delayed, naturally). It was a wonderful and educational conference, but I am ready to go home.

I miss my boys.

The time difference made it difficult to connect via phone- I was always calling during naptime, mealtime or mid-car ride to some really unhealthy restaurant meal with DH.

During the one call where I was actually able to speak with them, all I could make out was "Mommy, guess what?" and the rest was garbled. Sigh.

At the airport, there are adorable children everywhere. I know this is an impossibility, because children can only be annoying at airports (last trip, Son #2 actually ran OUT OF THE AIRPORT while we were checking our bags), but as I am not the mother, they are adorable to me.

When I hear a toddler call out, "Mommy!", the reaction is visceral- my throat chokes and my eyes get watery. Similar to hearing a baby's cry when separated from your newborn.

What is this connection between a mother and her children that makes separation so unbearable? Mother nature's ability to pre-wire how our heartstrings are tugged never ceases to amaze me.

Friday, March 18, 2011

The American Academy of Allergy, Asthma and Immunology Annual Meeting Has Arrived!

I am in San Francisco, California for the 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology. It promises to be a very educational and intellectually satisfying meeting. Last year, I tried my hand at live-tweeting from the conference. I'll be doing the same this year- hopefully, it will give folks at home an opportunity to take part in the knowledge sharing remotely.

The exercise is mutually beneficial- in addition to sharing information with others, my tweets will obviate the need for any paper-based note-taking on my part! It really highlights the "green appeal" of social media- so many trees saved!

I will not be alone in this endeavor- my expectation is that we'll see a substantial increase in the number of tweets coming out from the conference compared to 2010. If you'd like to partake in the knowledge-fest, please subscribe to hashtag #AAAAI on Twitter to get a live stream of tweets from the meeting!





Monday, March 14, 2011

Support the Illinois School Access to Emergency Epinephrine Act!

Many thanks to Illinois House Representatives Chris Nybo (R) and John D'Amico (D)  for sponsoring HB3294, the School Access to Emergency Epinephrine Act, on 02/24/2011.

Click here for details regarding this bill: http://www.ilga.gov/legislation/BillStatus.asp?DocNum=3294&GAID=11&DocTypeID=HB&LegId=60664&SessionID=84&GA=97

Synopsis:
"Provides that the purpose of the Act is to allow schools to have access to life-saving emergency epinephrine auto-injectors if and when a student has an anaphylaxis reaction and to allow the school to have personnel trained to administer an emergency epinephrine auto-injector. Provides that a school district may provide emergency epinephrine auto-injectors to trained personnel, and trained personnel may utilize those epinephrine auto-injectors to provide emergency medical. Provides that each public and private elementary and secondary school in the State may make emergency epinephrine auto-injectors and trained personnel available at its school and may designate one or more school personnel to receive initial and annual refresher training. Sets forth provisions concerning trained personnel, minimum standards and training, school plan, and limitation of liability. Effective immediately."

The bill is currently assigned to the Judiciary I - Civil Law Committee. See contact info for members of this committee here: http://www.ilga.gov/house/committees/members.asp?committeeID=895

This bill is a welcome development- I have long believed that "unassigned" emergency epinephrine should be available in all schools for the protection of our children. If you are an Illinois resident, please contact the Civil law Committee members to express support for this bill!

Sunday, February 20, 2011

Of All A Physician's Roles, The Most Important Is That Of Educator

Clinician. Diagnostician. Prognostician. Healer.

A physician has many jobs to perform, all critical to the appropriate management of what ails our patients. Without astute physical exam skills or a keen ability to sort through a medical history to uncover salient data, the physician is no better at diagnosing a patient than a Google search (and we're quite a lot better, in case anyone was wondering). Without a proper understanding of physiology and pharmacology, the physician is no better at healing than a placebo, and might actually do harm!

As patients, we rightfully base our assessments of our physicians' competence on their ability to (as quickly and non-invasively as possible) determine what's wrong, and what to do about it. Unfortunately, we have also come to view physicians as the barrier to care, rather than the source of care. Who stands between the sick patient and the antibiotic? Whose signature is required before the blood test can be performed?

The fundamental problem with this perception is that it equates the technical work-up and the treatment with "care". However, "Take two of these and call me in the morning" isn't real health care, even if the tablets dispensed are indeed "just what the doctor ordered".

I would argue that the value taken away from a visit with your physician isn't in what you have been prescribed, but rather in what you have been taught. At the end of the day, the physician role most essential to fostering a trusting physician-patient relationship is that of Educator.


As an allergist/immunologist, the majority of the care I provide is for chronic illness, such as asthma, food allergy and immunodeficiency. These are conditions my patients need to deal with on a regular basis, day in and day out. There is no magic pill I can prescribe to cure them - no miracle treatment. The most important thing I can do is spend the time to teach them about their physiology, how the medicines I am prescribing work, or why I suggest a particular treatment over another. I can draw pictures, demonstrate the proper use of inhalers and injections, or review an action plan for a severe allergic reaction. Whether the topic at hand is skin care, allergen avoidance or dietary management, there are always opportunities for new education or reinforcement of existing skills.

Quality patient education is a mutually rewarding exercise: 1) the patient gains a more complete understanding of what is going on within his/her own body and has more insight into the rationale behind the physician's recommendations, and 2) the physician builds confidence and trust with the patient and dramatically improves the likelihood of compliance with recommended therapy. This has direct consequences for improved health. It is truly a win-win.

As the continual pressures on physicians to cut costs and optimize efficiency increase, we must resist the push towards gaining these efficiencies at the cost of spending less and less time with our patients. Although it takes a significant investment of time and effort to make patient education a cornerstone of a medical practice, the dividends paid are truly "healthy".


"The most important role of a physician is that of an educator. I believe in empowering patients to optimize health by teaching them to understand how their bodies work."

Saturday, February 19, 2011

I'll Keep Lying To My Kids, Until They Wisen Up

Horrible, isn't it? I feel no guilt whatsoever about the following dishonest charade...

Setting: Trusty Honda Civic, en route to a casual dinner out with the family.

Son #1: I want to go to Red Lobster!

Son #2: Red Lobster! Red Lobster!

DH: (whispering to me) Not tonight. I'll spend the whole time shelling crab legs for him. I just want a relaxing meal.

Allergist Mommy: Okay, kiddo. Let me call the restaurant...

(fake dials phone, lifts to ear) "Hello, Red Lobster? Do you have a table for 4? Yes, for tonight. Oh, really? Well, how soon will a table be open? 11pm?!?! No no, that's too late. Maybe some other time. Thank you. bye."

Honey, they are too full right now. How about Mexican?

Son #1: Okay, Mommy. I like their chips!

DH: Awesome.

This trick will only work for another couple of years. Until then, I intend to milk it dry.

Thursday, February 3, 2011

Sublingual Immunotherapy: Allergy “Drops” Can Offer Relief, Without the Sting of a Shot!


For nearly a century, doctors have known that the best way to control environmental allergy symptoms is by retraining your immune system to tolerate substances that you are currently over-reacting to. This is known as “immunotherapy”. 

Until recently, immunotherapy required multiple small injections over a period of time (subcutaneous immunotherapy). Although allergy injection treatment is very safe and effective, weekly trips to the doctor for shots are not always convenient for today’s busy families. This means that many patients are not able to take advantage of allergen immunotherapy’s numerous health benefits, such as decreased need for medications, improved hay fever and asthma control, prevention of asthma in high-risk children, and a better night’s sleep.

Sublingual immunotherapy, or allergy drops, can offer the benefits of immunotherapy to a wider array of patients. These drops are made from the same FDA-approved allergen extracts used in allergy injection treatments. Sublingual immunotherapy is the most commonly prescribed form of immunotherapy in Europe, and has helped patients manage pollen, animal, mold, and dust mite allergies. Because allergy drops have a very low rate of allergic reactions, they are considered safe enough to give in the home setting. Imagine, reversing your allergies in the comfort and convenience of your own home!

Here’s how the process works: after determination of your environmental sensitivities in the office, your allergist creates a customized set of allergy drops for you or your child to self-administer under the tongue, on a daily basis. Over the course of a few weeks, your dose will gradually increase to what is known as a “maintenance” dose. This is the daily dose required to fully retrain your immune system, so that it no longer produces allergic reactions in response to allergen exposure. Based on extensive experience with allergy injection therapy, a full course of immunotherapy usually takes 3-5 years, after which you can expect to continue the benefits for up to another 10 years after discontinuation. Investigations are still underway to determine if this sustained period of symptom improvement after stopping therapy also applies to allergy "drops", but preliminary studies suggest that it may.

You should know that sublingual immunotherapy is considered an "off-label" use of an FDA-approved product - this means that some health insurance plans may not reimburse for the costs of treatment. Generally, flexible spending accounts and health savings accounts can be used to pay for sublingual immunotherapy. Like all medical therapies, allergy drops are not suitable for every patient. There is evidence that allergy drops work very well for patients with a few specific allergies, but allergy injections work better for patients with multiple environmental allergies.  In addition, only environmental extracts are FDA-approved for allergen immunotherapy. (Immunotherapy for food allergies is still under investigation to determine the safest methods of treatment.) Only your allergy specialist can determine which type of treatment is the best fit for you or your child, so talk to your doctor. 

If you’re tired of taking medication every day for allergies or asthma, and want to treat the cause- allergen immunotherapy may be right for you. Find an allergist, and find relief!

Wednesday, January 19, 2011

My 2 Year-Old Shows Off His Vocabulary

Setting: Son #2's Room, changing table (potty-training hasn't quite happened yet)

Allergist Mommy: Whoa! You stink, kiddo!
Son #2: I apologize.
Dear Husband: What?!?! You're just copying your brother. Do you even know what that means?
Son #2: I sorry.

We stand corrected, smartypants.

Tuesday, January 18, 2011

Allergy Education Offered to Illinois State Board of Ed- Will They Accept?

Dear Members of the Illinois State Board of Education,

As a parent of a child attending Illinois Public Schools, a taxpayer, and a Board-Certified Pediatric Allergist & Immunologist, I was distressed to hear of the irresponsible comments made by Illinois State Board of Education Members Catherine Campbell and Lawrence Gregorash regarding the requirement for Illinois schools to have a food allergy policy in place by 2011.

When the parents of children with severe food allergies send their children to school, they place immense trust in our school system - not only to educate their children, but to keep them safe while in its care. 
The safety of our children in the school setting is of tantamount importance, and the assertion by school board members that protecting children with life-threatening food allergies is "the most ridiculous thing" or “This isn’t the dumbest thing I’ve seen in my 64 years…but it sure ranks in the top 10” is worse than offensive - it is dangerous. 

We need only look to the tragic death of 13-year old Katelyn Carlson in December to remind us that food allergies can not, and should not, be taken lightly.  One can only speculate as to whether this tragedy could have been prevented had a comprehensive food allergy plan been in place and been implemented in a timely manner.

As an "Anaphylaxis Community Expert", I work with a Registered Nurse educator to raise awareness about the recognition and treatment of anaphylaxis.  There are 150 such teams throughout the nation, all committed to the concept that raising awareness about the seriousness of anaphylaxis can save precious lives.  This outreach effort is available free of charge to schools and organizations requesting educational assistance.  In the wake of young Katelyn's untimely death, the Chicago School District has proactively requested education for their nurses and counselors. 

I respectfully suggest that the ISBE might also benefit from learning more about the dangers of life threatening allergy, so as to better fulfill its stated goal to "offer a safe and healthy learning environment for all students".

As a physician and a mother, my most important role is that of an educator.  Only by understanding our bodies and disease processes can we move forward to improve health.  I am hopeful that the ISBE will seize this opportunity to educate itself and create a healthier learning environment for all students in our great state. 

Please feel free to contact me at any time to arrange for an educational seminar for the members of the Illinois State Board of Education.  I would be happy to facilitate a program.

Respectfully,
Sakina Shikari Bajowala, M.D.

Thursday, January 13, 2011

My Son the Buckethead


I have been asked recently if there are plans for a Child #3.
This video should help explain why any family expansion should be very thoughtfully considered in advance.

Sunday, January 9, 2011

Anaphylaxis Community Experts Bring Vital Education to Your Area!

I am pleased to be a part of what I consider a very important educational initiative- the Anaphylaxis Community Experts (ACE) program.  

Co-sponsored by the American College of Allergy, Asthma & Immunology (ACAAI) and the Allergy & Asthma Network - Mothers of Asthmatics (AANMA), the ACE program's mission is to prevent anaphylaxis deaths and reduce anxieties through education, advocacy and outreach.  In light of the tragic death of a peanut-allergic girl at a Chicago school in December, our mission is even more timely.


Who are the ACE team members?
ACE Teams consist of one board-certified allergist and one community member who each share this mission.

Goal: To understand and improve the care of people at risk for anaphylaxis by providing an evidence-based approach to the identification, diagnosis, assessment and management of anaphylaxis in order to prevent deaths from severe allergic reactions.


Objectives:
  • To help patients, families, and healthcare professionals identify who is at risk, and improve recognition of the signs and symptoms of life-threatening allergic reactions
  • To recommend that auto-injectable epinephrine, the first line of treatment, be administered immediately once the signs and symptoms have been identified
  • To develop prevention models that:
o   Promote identification and avoidance of allergens
o   Encourage patients with history of anaphylaxis to be seen routinely by an allergy specialist
o   Provide an Anaphylaxis Action Plan to all patients who are at risk of anaphylaxis
o   Refer patients with a diagnosis of anaphylaxis to an allergist, support groups and educational programs

How Will Objectives be Met?
ACE teams will provide educational seminars in a variety of community and healthcare settings- schools, day-care centers, hospitals, police/fire departments, etc.  In addition, ACE teams will provide interviews with print, radio, internet, and television media to raise awareness about recognition and management of anaphylaxis.  All seminars will be free of charge.



How Can I Request a Seminar in My Community?
ACE teams are eager to bring a seminar to your community!  To find an Anaphylaxis Community Expert near you, please see the following site: http://www.aanma.org/2010/12/find-an-anaphylaxis-community-expert-ace/