Tuesday, August 19, 2014

But, I do not have allergies Doc

On my drive to work I often wonder what type of day is in store for me. You see, in my walk in medical practice there is no typical day. And that is what I like. I could start my day with a patient who has been up all night with a headache or I may see some on who accidently cut their finger while opening a box with a box cutter. Sometimes the symptoms are precise and the diagnosis obvious at other times however the symptoms may be more general and diagnosis less clear. On such patient was a middle age teacher. She told me that lately she has been feeling very tired and weak.  She was also concerned about her cough. ‘I am okay when I am sitting up, but as soon as I lay down, I cough. ‘Last night, I had to sleep propped up in a couch’.
I examined her. She did not have any fever and her lungs were clear. I did notice that she had fluid behind both her ear drums and her nostrils were swollen from inside. When I looked at her throat carefully, I could see a droplet of clear fluid hanging from her uvula (soft piece of flesh that hangs from the roof of the mouth). I told her that although I am not absolutely certain but her symptoms may be due to allergies.
‘But I do not have allergies Doc’, she protested. ‘Pollen does not bother me and besides this is summer time, not the time for allergies’ she added. 
‘In my exam, I found that your nostrils are swollen and…
‘What does that mean doc’? She interrupted.
‘That means that you may have signs of Rhinitis which simply means inflammation of the nose’ (Rhino is ancient Greek word for nose). ‘There are two types of allergic rhinitis. First, Perennial Allergic Rhinitis is commonly caused by house dust mites, pet dander and mold. Eighty percent of Allergic Rhinitis is either perennial or mixed (both perennial and seasonal).  The second type of rhinitis is called seasonal allergic rhinitis. It is commonly associated with ‘allergies’.  It is caused by pollen, grass or trees.’
‘I think you may have perennial allergic rhinitis.’
‘You said, “May have”, does that mean that you are not sure?’
‘Yes’ I am not 100% sure. However we could do a blood test right here in my office that tell us whether or not you have allergic rhinitis, in addition we may be able to tell you what you may be allergic to.’
‘Okay, I understand that now’, but why am I coughing so much’.
‘In my exam, I did notice that you have a lot of post-nasal drip. When you lay down at night, the post nasal drip can trigger cough. In fact post-nasal drip is the most common cause of chronic cough.
‘Okay so that explains my cough, but why do I feel so tired Doc?’
‘You may be feeling tired because your sleep is interrupted due to coughing’
‘That makes sense! She said, finally smiling.

‘Good, I said, I will be prescribing you some medicines and we will also draw some blood to find out if you have allergies. In addition we may be able to tell exactly what you are allergic to and what measure you can take to minimize the exposure’.