Doctor Seeking Doctor: We Know Too Much

March 30, 2013
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immunotherapy specialist

Those beautiful Arizona sunsets are from lots of dust and pollen.

immunotherapy specialist

Those beautiful Arizona sunsets are from lots of dust and pollen.

You think it would be easy, finding a doctor. Maybe for some it is; for me, 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. Nothing that cannot be managed with some over-the-counter medicine, but the thought of having more relief appeals to me, so I thought seeing someone and considering immunotherapy would be a positive step.

My wife has been bugging me to see a doctor for a physical since I have known her. I recite how 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 – but other than that, support one another well. So, my medical history: good genes, I don’t smoke cigarettes, and I’m pretty active.

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 over time it helps overcome the allergy. Mechanism unclear, but appears to work well. 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.

They offer SLIT, 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, it’s 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. It’s 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, a 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 techie 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. These doctors do not have an internship, or a residency, or specialize. They are offering this therapy? I must research it a bit more.

More research shows that this 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. 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 mulberry, olive trees, 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.

So how does SLIT work if you use more 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.

The problem with being a doctor? We just don’t know who we should see, especially if they are in a field far from ours. 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. 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. This involved some research into a therapy that turns out to be popular for people who are not certified in the field. Something that sounded good (no shots) but turns out isn’t effective. It involved wanting to go with people who were board certified. Turns out there was such a person a few blocks from my home. Finding a pediatrician was easy: the OB group used a group close to us, and that group is well respected. If only my OB had allergies….