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Areas of Specialty

Bronchitis/ Asthma / COPD (Emphysema)

Patients with pulmonary symptoms require a detailed and thorough review of all of the questions on the initial history along with an assessment of their pulmonary status to determine lung volumes, all of which will guide the diagnosis and treatment. The physician will discuss these at length, so it is essential to provide all the information, if at all possible, as far back as birth, from family members and friends. You will receive pertinent reading material at the time of the visit which will assist you and the physician at Follow Up in determining triggers and responses as well as changes in treatment. Follow Up is essential in order to perform aeroallergen skin testing and revise medical management according to the patient's response to medications and other treatments. Detailed observation and feedback allow the physician to optimize treatment and prevent further pulmonary scarring.


 

Rhinitis: Allergic and Non Allergic

After a lengthy history, physical examination and aeroallergen skin testing, a determination will be made if the patient has, or does not have, allergies. The treatment of Rhinitis depends on whether a patient is, or is not, allergic. The patient’s clinical response to management, which has been selected from a span of treatment options, will be evaluated at the Follow Up visit. Patient’s attention to detail, and Compliance with the prescribed medications is essential in determining the need for adding or changing the plan of treatment to assure the patient is receiving optimal care.


 

Sinusitis

Patients need not suffer with a chronic sinus infection. A lengthy and detailed history will assist the physician in determining the cause of the infection and its appropriate treatment. Attention to detail, Compliance with the prescribed medications and Follow Up is essential to determine the infection’s response to treatment and the resolution, or not, of the sinus infection. If the patient does not respond to the many management options, a Cat Scan of the Sinuses may reveal further data about the infection and the need to improve sinus drainage.


 

Hives / Urticaria / Angioedema

Rashes can be simply annoying or even life threatening, therefore, a lengthy discussion of the characteristics of the rash, and or swelling, as well as associated triggers, is very important and necessary on the first visit. This information, which the patient must gather prior to the initial visit, will determine the necessary initial treatment and what further testing will provide information. A list of suspect foods, and ingredients in products used externally prior to the reaction, are very important in arriving at the diagnosis. Management may be escalated or diminished in Follow Up visits, depending on the patient's timeline diary of events, clinical response to the treatment, and lab results. Unknown to most people, 97% of the causes of Hives Are Not Allergy, but infections which must be treated before further diagnostic testing and expensive medications are prescribed.


 

Itchy Skin / Eczema / Atopic Dermatitis

Patients need not suffer or lose sleep due to dry, scaly, red &/or itchy skin. A lengthy history and discussion of possible triggers of the rash, as well as a list of ingredients in products applied to the area, or food triggers which the patient must gather prior to the initial visit, will assist the physician in the diagnosing and selecting from the many management options available. At the Follow Up visit, the skin’s response may require changes to treatment, further historical information, or laboratory testing. It is always important to keep a timeline diary of reactions, ingredients used, possible triggers and changes noted. 


 

Food Allergies

Patients are often frustrated, if not confused by the presentation of what may be a Food Allergy or a Food Intolerance. Diagnosing a Food Allergy or Intolerance is achieved by obtaining a detailed history of the chain of events before and after consuming the suspect food; information which the patient must gather prior to the initial visit. Food Allergy testing – either by blood or by skin test – is a poor predictor of Food Allergies, but an excellent predictor of “No Allergy Present”. This means the positive reactions on blood or skin testing are usually false if there is no history to back it up, but the negative reactions are almost always “True Negatives”, signifying there is No Allergy Present. If there is No Allergy to the suspect food then what caused the reaction?  This is exactly why a thorough food allergy assessment requires a very detailed history, an intense search for ingredients (ask the chef!) and a great deal of patience.

The fastest and best results are achieved when the patient is able to recreate the episode including the foods and ingredients consumed, the approximate time of day, the activities the patient was involved in prior to and after the food consumption, the symptoms the patient manifested, the names of the treatment provided at the time of the reaction, and the patient’s response to treatments received. The best outcomes in determining the cause of the rash is in patients who bring all past food or allergy test results, a detailed history of the event including the ingredients (lists off of  boxes, cans or other food packaging) which were consumed, and a detailed time line of the symptoms and treatment which resolved, or not, the reaction.