What not to look for in an allergist
That record was broken with Big Guy's recent visit to a new allergist. I'm not naming names, because I'm probably going to cross into libel here. But I'm not sparing details, in hopes that this can be a cautionary tale.
The situation felt funny from the start, when the office insisted that I fax a copy of the insurance company's authorization because they don't do email. Given that the doctor's practice spans a number of locations, I was skeptical that the office was that unwired. Technological ignorance isn't a medical deal-breaker, though.
We arrived for the appointment and found a jammed waiting room, with patients about equally divided between those there for testing and those there for allergy shots. A few minutes later we were taken to the "exam" area - a large room partitioned into three sections. The doctor came back and took a scant history. My radar twitched again, but I knew that Big Guy's file was extensive enough that he could know most of what he needed to know if he'd reviewed the history. IF.
A nurse then came in to administer the scratch test. It would be for 90 possible allergens, she said. We sat the required 20 minutes and watched Big Guy's arms light up like a Christmas tree. The doctor came back, wrote on a paper and told me Big Guy definitely had airborne allergies. He recommended shots.
I'm not surprised, I told him. How about the food allergies?
Food allergies? You can't do those by scratch test.
That's not true, I told him. I've had it done.
Well, I don't do them here. You'll have to go to a lab. Why are you so sure he even needs food allergy testing? Has he ever had a reaction to anything?
My head was about to explode. Clearly, he had read NONE of Big Guy's file or he would have known that he has an extensive history of reactions dating back to when he was 10 months old. And what's this with an allergist of all people treating me like paranoid parent trying to hop on the allegedly trendy food allergy band wagon?
He handed me a paper and told me to check the ones I wanted the lab to test for. I had to write in peanut. It didn't occur to me to ask him to review the airborne results and suggest foods Big Guy might be cross-reactive to because they're botanically similar to pollens he's allergic to.
We went to the lab, where it took another hour and a half. I vowed never to go back to this allergist again. He appeared interested primarily in selling immunotherapy - and if that's your goal, then there's no reason to offer food allergy testing because there's no clinically proven immunotherapy options widely available yet.
Don't get me wrong. I'm a big believer in immunotherapy. To say it changed my life is an understatement. I flunked a test in college once because my eyes were so itchy and the tears were flowing so hard I couldn't see the numbers. Twice a month, I used to have sneezing attacks so violent that the next day my neck felt like I'd been in a car wreck. Years of allergy shots changed all that.
But, as two of my three allergists stressed, shots alone usually don't do the trick. You need to make environmental changes where you can, and if you're highly allergic to a couple of foods for Pete's sake don't pig out on them at the same time.
After I took Big Guy to his primary doctor today, I went from "never going back again" to "we need a second opinion."
When the allergist sent me a copy of Big Guy's airborne results, the page had only check marks next to various allergens. I've been tested twice, and that's not what either of my results looked like. They included annotations of weal size - that's a measure of how big a hive the allergen raises on the arm - as well as a classification between 1 and 4 as to how allergic I was to each substance.
At first, I dismissed this, too. Maybe he's afraid I'll take the paper to some other doctor to have the serum made, I thought. I've actually done that before, when I've moved from one city to another.
But then Big Guy's primary doctor called the results up on her computer today. "Hmmm ..." she said. That's funny. I usually get a number, not just a check mark.
Let's see. We have a doctor who's herding patients in like cattle, not reading their files, not taking a thorough medical history and then playing hide the ball when sharing results with the patient's primary doctors. That's assuming, of course, that the allergist even had complete results. Looking back, he charted them so fast that I'm now convinced he didn't even do a weal measurement.
Yes, I would like a second opinion. No way am I going to trust this person to mix a substance that will be injected into my child's body once a week.
We're going to keep the food allergy results - as discouraging as they were, there's no need to force Big Guy to have five vials of blood drawn again, so soon.
But on the airborne, we'll be starting, um, from scratch.
Copyright 2010 Debra Legg. All rights reserved.