IMPACT OF ALLERGY ON QUALITY OF LIFE.

He walked  swiftly in my clinic with newspaper in hand and uttered aggressively "'I bet you cant make me alright , no body could !'' I could gauze his angry mood , I thought he must be so upset because of his unbearable malady . I gave him a comforting look and requested him to sit down. He understood my unspoken words and my utmost desire to help him.
He said 'I read your article in Tribune and I thought I should try you also for my misfortune of nose allergy.But I have just one hour with me , my bus for Haridwar is after an hour , I am coming from Solan after submitting my resignation in the school."I said oh my God , why did you resign and what will you do now ? He said I have such severe running of nose all the time that it is impossible for me to even lift my head to take a class . Children make fun of me , I have to  use not a hanky but a towel to wipe my secretions." I said  "so what will you do in Haridwar , you have a new job "? He said , I am a PhD but I will simply run my fathers tiny shop as I am not suited for teaching or anything else due to my  severe allergy.
I thought to myself that what is the use of my super specialisations in Allergies if a young Ph D has to resign from job due to allergy and he has to  severely compromise with his aspiration .
I told my assistant , "Nadeem please go with him and help him take a room in nearby dharamshala "I insisted upon the man that please help me by staying here for two days. I promise I will do my best. He found me very convincing , he stayed back.
Meanwhile I called up his principal as luckily he used to come to me those days for his sons Asthma treatment. He said "yes doctor , how can I help you " I said so and so has submitted his resignation to you , please don't process it for next ten days."He said "Is he your relative , you never told me , well surely I can do it for you , first time in life you asked me for something "I said thanks and thought to my self that he had become my patient so he was indeed my relative!
 I tested him for two days and started treatment . He came back the fourth day and said "doctor I extended my stay as I have some hope in the treatment. I said treatment in Allergies is long so don't over expect. "He was firm on staying back . He came back after five days and he said 'Ok please prescribe for ten days I will keep coming to you from Haridwar."
I said come to me tomorrow. I spoke to the principal and reminded him of that resignation and told him how did he become my relative after reading my article in the bus and now he is ready to come back to the school for his job."The principal found it really strange and complimented me for thinking beyond my duty, he was happy to ignore his resignation. Next day when the gentleman came for his prescription my note also included "FIT to join duties in the school & request school to send him for review periodically as advised."
He was surprised and couldnt believe me . I told him the whole thing . Tears started rolling out of his eyes , he said I never knew doctors could think like this & tears wont stop. I told him stop your tears you are failing my treatment , your nose may also start crying . Me and my assistant treated him to samosa and Lassi and bid him bye. After so many years when I recall that day I am amazed at power of an article which has prevented  a teacher from failing in life due to ailment of allergy!

Cough variant Bronchial Asthma.

He was coughing off and on for past two months.
This  increases on lying down , on laughing and on speaking long sentences.
He visited several practitioners who treated  him  with antibiotics.
When there was no response they changed antibiotics and  added mucolytics.
Nothing improved his cough which was dry in nature and was persistent.
He was investigated  too . The blood workup was normal , the chest X ray also did not reveal any thing abnormal.
It was pulmonary function tests which showed evidence of obstructive airway disease which  reversed on bronchodilators.
Thus obvious diagnosis was Bronchial Asthma . The treatment was inhalers , the preventive inhaler of steroid and long acting bronchodilator inhaler. This comes as a combination inhaler too.
He took it  regularly and the cough was gone.
He was saved of many unnecessary medicines which cause many side effects.
Therefore its essential to keep the  entity COUGH VARIANT BRONCHIAL ASTHMA in mind. THe patients should  be diagnosed early and treated specifically.
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BRONCHIAL ASTHMA REVIEWED .

Lot of new research is being done to control this old malady, but the time tested principals still are the gold standard.
First of all the persistent nasobronchial symptoms particularly cough and definitely recurrent wheezing , breathlessness on speaking long sentences , laughing etc should be investigated for bronchial asthma.
Next most important step is to accept the diagnosis and inhalers.
It is often seen that patients or parents do not  want inhalers for the fear of addiction.
They keep children on unnecessary nebulisation , antibiotics , oral bronchdilators and even oral steroids which are certainly undesired , unscientific and dangerous modes of treatment .
cornerstone of Asthma treatment is inhaled steroids.
Patients must be demonstrated the method of inhalation so the desired salts enter the airways in desired amount.
Patients must also understand that preventive doses of inhaler is essential in fixed doses even if patient feels fine because basically it is for controlling inflammation.
Patients should also know the use of emergency inhaler salbutamol.
In difficult cases and most children Allergy triggers must be investigated which can be  done by simple allergy skin tests.
Based upon the test  results , Food allergy as a factor can be removed . Food allergy is a significant factor in bronchial asthma.
Allergy tests  also help deal occupational and environmental factors too..
Thus inspite of advances in Asthma management , majority of patients would need basic effective tretment which can be made effective with health education.

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EOSINOPHILIC ASCITES.

She was only 12 yr old . went out for christmas break with family in a nearby resort

but had to be hospitalised due to severe abdominal pain.

Was kept on symptomatic treatment and was being investigated thoroughly as the pain was recurrent.

The only clue in investigations was significant  eosinophilia and  Ascites.

All the common causes of ascites were ruled out .

Ascitic fluid was tapped which revealed significant eosinophils in ascitic fluid.

Endoscopy was normal .

She was treated with steroids to which she responded.

Three months later she again developed pain abdomen with bleeding per rectum.

She was hospitalised as ultrasoung examination revealed ascites progressing rapidly.

Ascitic fluid was full of eosinophils,

Colonoscopy was done with biopsies at all levels.

Colon , cecum , ileum , rectum at various levels revealed significant eosinophilic infiltration

EOSINOPHILIC GASTROENTERITIS is a well known entity though is very rare.

She was investigated further for food allergy which revealed SIgE raised for Fish and ST also positive for fish.

History revealed that during both episodes she had consumed fish .

She was treated with steroids but was instructed to avoid all sea food strictly .

She is symptom free for past 7 months.

It does not mean that FISH or sea Foods are bad but it simply means that one mans food can be another ones poison . ROLE of FOOD ALLERGY testing in difficult situations is highlighted here.

ALLERGIC RHINITIS MARCH TO ASTHMA

Symptoms which begin as watery , itchy , blocked nose,  persist for days and keep recurring every now and then could be due to Allergic rhinitis.
People just manage this with home remedies or over the counter pills and carry on for years together.
This results into chronic sinusitis , Asthma , headaches spread of allergy to eyes resulting into red itchy eyes.
Allergy is like growing tree , if the roots are intact new branches are bound to come .
Allergic rhinitis may become quiet but can erupt as Urticaria , rashes , iching etc.
Migraine may also be due to allergy.
Abdominal symptoms can also be due to food allergy or even an accompniment of allergic rhinitis , asthma , skin allergy etc.
the severe manifestations can be recurrent  angioedema which can be life threatening.
I have seen patients with swelling of tongue so that it is difficult to fit tongue within the mouth
resulting into medical emergency.
Laryngeal edema causes choking and is always life threatening.
Therefore nasal allergy should not be neglected.
Treatment is succesful if scientific and persistent.

ALLERGY SEASON APRIL MAY RESPIRATORY ALLERGY.

 Allergy season has started , patients who suffer from seasonal allergies alone have started developing rhinitis and Asthma symptoms.
Even those who suffer from perennial allergy have started having aggravation in symptoms.
All this can be prevented if patients start  preventive treatment in preseason even when they are not suffering.
Its important to educate the patients to visit doctor surely in early March and August for preventive treatment.
Those who are already on treatment have to ensure that they are regular on their nasal spray and inhalers and follow up with doctors.
Nasobronchial seasonal allergy can best be tackled by scientific approach.

ASTHMA EMERGENCY

Every time I see an Asthma  patient in emergency I realize that  its communication by us doctors
which was not effective otherwise nothing could land him in emergency.
He started feeling confident of his Asthma control that he stopped coming for follow up and stopped use of inhaler in Sept October on his own. Remained well for 4 days but landed in emergency on 5th day. He did not have any written protocol , he panicked and started with multiple puffs on Steroid inhale instead of the bronchodilator salbutamol.
This is one of the stories.
Its wrong to abruptly stop the inhaler in the aggravating season even if you feel well.
Inhalers could be changed stopped only  on advise of doctor. Even after stopping ,
one should make use of peak flow meter to judge that airways are not in spasm. If they are ,use brochodilator followed by steroid preventive inhaler
If you get into spasm and have a written protocol you will be more confident to handle
the bronchospasm. Multiple puffs of salbutamol inhaled properly without panic is the key to
reversing the spasm.
There are many other reasons for patients to stop inhalers inappropriately.
Inhalers are safe. Do not be in a hurry to stop them.
Doctors ought to hammer into patient the science and art of inhalers and disease.
Doctors ought to give written protocols to handle emergencies.
Lets win  Asthma , Let there never be an emergency and asthma related death.