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As a recertified
Internist and Allergist, I accept patients for diagnosis of all
allergies and for obstructive airway chest diseases (bronchial asthma,
chronic bronchitis, "COPD").
I do not accept patients for "primary care"; but for my patients I do offer "coordination of care". That is, I monitor the care that they are receiving from their several other physicians - and I intervene with advice when it is warranted. The following problems present themselves most often, important to my area of specialty care and generally important to the patient's overall health.
1) Essential Hypertension. "The Silent Killer". Know your blood pressure. If taking BP medications, monitor your BP yourself at least several time per week; and share the findings with your doctor regularly. And "White Coat Syndrome" is often poorly controlled BP.
2) GERD (gastro-esopageal reflux disease) is bad for the stomach and esophagus, may produce laryngeal or sinus disease, and through a neural reflex may worsen bronchial asthma. Do Not Tolerate it. Good medicine is available, including proton pump inhibitors. A GI evaluation may be required.
3) Obstructive Sleep Apnea is an epidemic out there! Good Sleep is critical to good health. Don't miss this diagnosis. It can be easily diagnosed and easily treated; and it can be fatal when missed.
4) See the Category "The Uncommon Common Cold". Nothing common about it for allergic / asthmatic patients, for whom URI's are more common, more involved and more persistent.
5) Smoking, anything, is stupid and injurious for everyone, especially for allergic / asthmatic patients. That includes vaping, "recreational" marijuana, etc. STUPIDO!
6) Obesity - The Disease. See the related Category section. We try to help.
AND REMEMBER: The three most important attributes of a physician - as far as a patient is concerned - are Ability, Affability and Availability...IN REVERSE ORDER! Make sure that your health care provider is Available when you need him or her.
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In a medical practice such as mine, dealing with significant allergic problems - especially bronchial asthma - and dealing also with other chronic respiratory problems like chronic bronchitis over many years, patients often present with or develop over time other medical problems. These may be unrelated to the presenting illness; or they may be in some way related. In either case, the comprehensive diagnosis and treatment of the patient requires that we deal with all of these issues initially and on an on-going basis - patient and physician in a cooperative relationship. It also requires coordination of all treatment with the patient’s primary care physician.
The following are a number of non-allergic diseases seen frequently in our patients.
1) Essential Hypertension (High Blood Pressure)
This disease, generally silent for many years but associated with many serious consequences, is easily diagnosed, and is even predictable in the 30% of Americans with a family history of it. It is easily treated, and responds well to a variety of excellent medications with relatively few side effects. In fact, the only problem is that many patients (and still a few physicians) ignore it, try to wish it away, offer all kinds of excuses for their elevated blood pressures, and are turned off to treatment by old stories of troublesome side-effects like erectile disfunction and depression.
If a person has been noted to have several blood pressure readings over several weeks of 140/90 or above, having a plausible excuse (tension, work pressures, etc.) makes no difference. And the blood pressures should be taken under normal conditions - not in a cool, quiet room with pleasant music playing , after resting for a while. Such a finding requires the person to get a home blood pressure device (no bells or whistles needed) and to self-monitor blood pressures two or three times daily for two weeks - under conditions of ordinary life. The numbers should be recorded and presented to the physician for diagnosis and treatment. Meanwhile, the patient must avoid cold medications and other medicines containing pseudoephedrin-like agents that can affect the blood pressure. Remember: this is a serious disease that is easily diagnosed and easily treated.
G.E.R.D. (Gastro-Esophageal Reflux Disease)
This condition, wherein stomach acids get into the lower food pipe where they are poorly tolerated, may be caused by overweight, by years of chronic lung disease, by hyperacidity, by Helicobacter pylori infection, or for no known reason. The symptoms include heartburn, reflux of acid causing lower chest pain that can mimic heart pain (angina pectoris), and even regurgitation of acid and food up into the airways - with sudden severe coughing, wheezing, etc., usually at night when lying in bed. As is often the case, the disease must be thought of to be diagnosed. That’s where the patient comes in, even if the physician does not ask the pertinent questions. If not treated, it can worsen lung and bronchial disease, and can cause serious disease of stomach and esophagus - even cancer. Once again, treatment is now easy and effective.
COMING SOON ARE OTHER RELATED MEDICAL PROBLEMS, INCLUDING
OBSTRUCTIVE SLEEP APNEA / HYPOXIA
RECURRENT RESPIRATORY TRACT INFECTIONS
LARYNGEAL AND LUNG CANCER