dr peper md

Anti-histamines, the Anti-Hero

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The most potent protection against the Allergy Death Star is to start antihistamine medication several days before the allergy season starts.  To understand why, we need to understand what actually causes allergy symptoms.

Pollen, the villain, invades the body via the nasal passages and binds to mast cells, which are white cells with special protective powers. Binding to the cell’s outer surface breaks open the mast cell, which releases chemical substances such as histamine causing a cascade of effects.

Histamine works as a protective mechanism to rid the invading pollen from the body. Mucus membranes swollen and watery to wash the pollen away from the nose. Histamine also causes the eyes to become itchy and watery trying to flush the pollen in the air from the surface of the eyes. The post nasal drip from nasal congestion causes coughing, and when pollen is inhaled into the lungs, histamine released there leads to wheezing.

The body sees pollen as a foreign invader and has evolved the release of histamine from the mast cell as a way to fight the pollen and get rid of it through increased secretions.  In trying to remove the pollen, the body creates the uncomfortable symptoms of what we know as allergies or allergic rhinitis: runny nose, watery eyes, sneezing, coughing and wheezing.

If pollen is the invader and histamine is the protector, the antihistamine is somewhat like the anti-hero, trying to do the right thing in relieving the body’s symptoms but in doing so works against the body’s protection. Anti-histamines block where the histamine needs to bind in the tissues. If you take the antihistamine before pollen exposure, when the histamine is released, it can’t bind to its usual sites. The histamine is blocked so there are no swollen mucous membranes or increased secretions, no sneezing, no post nasal drip or coughing, and no wheezing.

So, as the Histamine Force works to protect the body against Darth Vader’s Pollen Death Star, remember it is the anti-hero Anti-Histamine that ultimately comes to save the day. Only, remember that he has to be at the showdown several days before anyone else arrives!


Can Having A Primary Care Doctor Save Your Life?

Remember all of your checkups with your pediatrician? Sometimes you had to get a shot (and get held down by the nurses), most times they just took your height and weight, and every time you got a lollipop and stickers.  Then, when you went off to college and turned 18, it all stopped.

The untimely death of Jonathan Larsen, the writer and composer of Rent, highlights the danger of not having a primary care doctor. After experiencing crushing chest pains over several days, nearly collapsing at the theater, Larsen went to two different ERs, was treated by two different doctors, and was misdiagnosed twice; ultimately, he died as a result.

Had he had a primary care doctor, would Jonathan Larsen still be alive today? While there’s no way of knowing for sure, having a primary care doctor who could have intervened on his behalf and ordered additional tests at the second ER visit might have made a difference.

Today, after you age out of your pediatrician, what do you do when you get sick? You probably go to an urgent care center, which is okay for most things most of the time. Maybe you’ve just moved to a new city and haven’t had time to find a new doctor, it’s hard to figure out who accepts your insurance, or the convenience of urgent care is appealing.

Here’s the thing: For the best healthcare, you still need a doctor who knows you.

  • They know you so they spend less time collecting information and more time focusing on you, resulting in a shorter but complete visit.
  • They know your family history so red flags can go off depending on your symptoms.
  • They know all the times you’ve been ill and can identify health patterns or problems.
  • They know your lifestyle habits and can provide the often-overlooked health counseling.
  • They know if you need a follow up call to see if you’re feeling better.

While you might not get those lollipops and stickers from your primary care doctor now, you’ll get something even better in return: good health.

Genomics, Geriatrics + Joe

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Genomics or Geriatrics? Which should I include in a cloud diagram on the back of my social media business card? (I know, business cards are not cool but it beats writing out drpepermd.com 50,000 times at the upcoming conference I’m attending). Genomics sounds much more hip but in reality I know more about geriatrics.

Then I saw Joe Biden’s very personal interview with Stephen Colbert and the fields of genomics and geriatrics were no longer separate but fused in a very moving way. Vice President Biden’s recent tragic loss of a his son humbles anyone who hears the interview. At age 72, Biden is a de facto member of the geriatric population and his son Beau died from brain cancer, a very difficult cancer to treat or cure, but because of genomics there is finally optimism for better treatments.

Screen Shot 2015-09-20 at 10.38.43 AMGeriatrics is the medical speciality of old people, usually using the cut off of 65 and older since that’s when people are covered by Medicare, the government subsidized health insurance program. People in this age group have different medical issues specific to getting older. Many people by this time have a few or many medical problems requiring a few or many medications that lead to medication interactions. Difficulties with seeing, hearing and being able to get around have a big impact on their health and lead to other medical problems. And there are issues with memory loss and the development of dementia which is impairment in the ability to figure things out, plan and make normal decisions.

Genomics is the study of a person’s whole DNA, all the genes in the 46 pairs of chromosomes in each person’s cells. A person’s DNA is specific to them but there are special tests and techniques to find differences or mutations in someone’s DNA which can cause disease.

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Just recently, genomic studies found that the most common form of brain cancer (glioblastoma multiforme) is really 4 different types of cancer. GM is a very aggressive cancer with a 2 year survival rate of only 17% , which means after 2 years, 87% of patients with this disease are dead. Genomics has lead to a tremendous breakthrough. Now we can find more specific treatment for each of these 4 types of cancer rather than treating everyone with GM brain cancer the same way with such poor results. More specific therapy means longer survival and a potential cure.

Genomics or Geriatrics? I have to include them both!

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The Art of Explaining Medical Stuff

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If someone asks me how I became interested in social media as a physician, I tell them the story of how I was online looking for the logo of one of my favorite drinks to use for a presentation I was giving to the medical students.

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I had been an attending physician at the hospital in my town teaching the doctors in training about internal medicine which encompasses primary care, hospital medicine and general medicine. We are known as doctors for adults, internists, or internal medicine doctors (sometimes incorrectly confused with those first year residents known as interns). But I left that position after 15 years to follow an unfulfilled passion to do private practice.

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Growing up in the Adirondacks, I didn’t really know the local doctor of my small town but through my reading had a Sinclair Lewis ideal of the physician healer who could make people feel better with listening. Of course you also need to examine them and order tests and medications when appropriate but the heart of the healing comes from compassion. I wanted the opportunity to be that kind of physician for my own patients in private practice and gratefully have cared for many patients that way. Yet I found I wanted to spend more time discussing med tech, social media medicine, mobile health, medicine 2.0  and yes, hashtags. Which leads me back to my story.

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