Wake up little Suzie

A nurse at the ER stated she was getting more than enough sleep but still feeling exhausted in the am. She is also is attending school, enrolled with army and raising 4 kids. She smokes and has had an issue with constipation ok with otc softners in addition to her kids needing the same otc's. (over the counter's) My first suggestion was to get a sleep study in order to determine if an abnormal sleep waves could be causing a dangerous problem. She apparently doesnt snore, is not falling asleep at the wheel, not suffering from memory issues and not being awaken by anything in the bedroom environment. The Saguil Approach would be to first teach about sleep hygiene so she can better understand the issues that cause problems. Sometimes when patients understand the pathophysiology of and injury, they may be able to better find the reason that I can't see on the outside. After making sure no dangerous sleep issues are going on, valerian would probably help reduce her reaction to the stress of all that is going on. I would always suggest omega 3 for fighting any unseen seasonal affective disorder (later told me she is on an ssri for chronic depression that is "stable"). The cigarettes have to stop after dinner, caffeine should be tapered to nothing after lunch. I always suggest an early morning wake up alarm the same time 7 days a week. An evening ritual one hour before desired sleep time is also important to start. My experience is that grad students in the same scenario always suffer from and exacerbation of old symptoms in the last year of grad school. Best I can do is make sure nothing dangerous is occuring and provide some supportive suggestions until 3 months after graduation. This would be a complicated patient since there seems to be underlying issues, (chronic constipation, tobacco addiction and multiple endeavors with over extension of normal daily duties). Good thing is she is plugged into other specialists for each issue, bad thing is all these guys are doing there own thing without concern for the other body systems. This is typical for western medicine, treat the disease process not the patient. The brain, the body and the spirit arent considered one. This is where the spirit, would be the biggest component that if worn down would effect the normal functioning of the other body system (speaking on western terms). Truth is I could make anyone go to sleep with the right potent drug but if the true reason isnt found, more and more meds will be needed in addition to other medicines to reverse the side effects from the sleep drugs. We should just hibernate through the winter and wake up in spring, thin with grown kids.

Do I have to take a vitamin?

The american dietetic association is conservative in its suggestions to the public about nutrition in the US. With gas prices forcing people to work longer hours or second jobs, most americans who ate poorly before are now diving into fast food, stress eating or binging after a 12 hour shifts. Kids will follow when at home by themselves or in the care of a non-kitchen friendly guardian. (My brother in law used to joke by saying he would watch the kids by pouring a large bowl of cereal and placing a few boxes of juice box drinks in front of the tv/xbox for the time I was at work....I still wonder if he was kidding or not). Poor nutrition with higher stress living asks the body to go into fight or flight for extended periods of the day. An average human will have enough endorphin and adrenalin to sustain bursts for about a day but then after that, body store depleation. That would be depleation of glucose, glycogen (sounds good for weight loss!) but also neurotransmitters, body steriods controlling bodily function (like pooping, eating, concentration and sleep) and then those nasty hormones responsible for laughing, love and good sex.

Bottom line is that we learn poor eating in high school, keep it up in college, take it to work and teach it to our kids. Vitamins are necessary to sustain a basic level of function when an adult is eating 4 meals of low cholesterol, low fat, high fiber with 3-10 pieces of fruits and/or veggies daily. The average person reading this doesn't eat that way. Personally, I have to go to whole foods, dominics, jewel and target to find the best choices for fruits and veggies and not go broke every month. I like to say I do it for my kids but my fibromyalgia is under control, back pain is gone and I can still do 60 minutes of cardio with 30 min of yoga without needing medicine for blood pressure, inflammation or joint pain.

All these diet and supplement suggestions you hear are for an average american with an average diet. Those that carry medical problems and take medicines to control them need more supplements. (My average patient seen in the ER has 2-3 medical problems, 1-2 medicine they are taking and is under 45 years of age.) It funny that the average patient on cholesterol lowering medicine doesn't follow a low cholesterol diet! Average patient with early diabetes doesn't know how many calories or carbs they are taking daily. Average arthitis sufferer doesn't loose weight or participate in yoga or taichi.

Watch my next post to figure how to pick a supplement.

Are there any sideffects to taking advil?

Healthy young man who exercises 5 days a week for about 1-2 hours came to the ER with acute onset of abdominal pain monday. No other history of medical illness or problems like this before. No history of gallstones, pain not worsened with eating, no change in stools or urine and it hurt to take a deep breath or twist. no fever and no other new activity in the last week. No history of heart disease, cholesterol,high blood pressure and I bluntly asked about drug use and he said no.

I was worried about lung problems with an old history of asthma as a teen but physical exam was normal. Then he remembered he was in a motor vehicle accident about amonth ago and air bag did get deployed. he doesnt remember any pain like this but when asked further, he does admit to taking advils daily since the accident. No history of ulcers in the family and no tobacco or alcohol use. (he works as a banker in a high stress position but he didnt know his blood type- type O has higher chance for ulceration). I was confident he had an ulcer but he wanted an xray anyway. The radiation exposure resulted in a normal xray as I told him it would. The GI cocktail, which usually brings down ulcer pain immediatedly only helped a little, brought 10/10 pain down to 8/10. I told him he should be ok with Prevacid and avoidance of advil, coffee, alcohol for 1-2weeks but his mother wanted to get a surgeon involved. Surgeon said she wanted to scope him to look for the bleedin ulcer and asked a slew of questions on blood tests, imaging studies......All very valid for ruling out life threatening disease and I had no problem ordering everything except the surgical procedure. I pointed out that his physical exam did not point to a bleeding ulcer but a mom that works in trauma surgery is sincerely worried about her son. Ultrasound showed no problems with liver or gallbladder, blood tests reinfored the fact he wasnt actively bleeding from an ulcer, kidneys electrolytes and liver functioning was all normal. He did note that as he waited for the blood tests results and ultrasound, pain continued to get better. The only thing I gave him was a cocktail of maalox, benedryl and lidocaine (numbing medicine for the lining of the stomach).

Advil, ibuprofen, motrin are all the same. They are nonsteroidal antiinflammatories that work to reduce pain sensation by reducing inflammation. One problem with this medicine is that it also decreases stomach mucous production and leaves the lining of the stomach unprotected from its own acid causing the eating away of spots in the stomach (ulcerations). Stomach should be able to protect itself and heal up fast. The lining of the stomach is very quick to regenerate/grow, but with daily exposure to advil, stress daily -(stress tends to cause over production of acid), and indulgence in caffeine and coffee, and most likely stimulants in energy drinks for exercise, ulcerations continue to grow and get deeper. I believe the delay in response to the cocktail meant he had a large ulcer or one in the duodenum more so than the stomach. (the duodenum is the part of the intestines that the stomach dumps food into once it is finished with digestion, sometimes contents are held in the stomach for a few hours before they move onto the duodenum/intestine. Likewise, an ulcer in the duodenum is more important than the ones in the stomach since vital blood vessels are right behind the intestine and a hole in the lining can eat right through to the blood vessel. (big mess) The other bad thing the advil can cause is pain relief......yes good for pain from the airbag hitting the man but bad for the ulcer which usually results in pain saying to the patient...hey, dont take that advil anymore!but with less pain from the ulcer, he doesnt realize what hes doing!

Celebrex was made to be so specific for inflammation and not to hurt the stomach it was thought to be a miracle drug for inflammation especially in ulcer sufferers. Great news till we found it caused heart attacks! Funny thing was when the studies came out, a warning from the celebrex companies came out saying all antiinflammatories medicines could cause heart attacks so avoid all of them. Seems to get the attention off celebrex and place it an the whole antiinflammatory drug class. (see how studies can be misinterpreted or specific portions of studies can be stressed and others ignored depending on who is reporting!)

I'm not just coming down on prescriptions, evenherbal medicines have side effects (like liver failure-see my earlier post on the adventrues of Dr Saguil). Just know what is going in your mouth and dont trust everything you read. When possible, rely on food and healthy living, use supplements wisely and always question the doc, pharmacist, nurse about what you are taking.

My "achin" knees

So my daughter was in class and heard a sudden....eyyyyyooowwww!! Teacher then exclaims, does anyone know a sportsmedicine doctor.....index fingers proceeded to head to the general direction of my offspring. Apparently the teacher, Mrs. M was getting out of her car and as she placed her foot down, one of her knees (probably the knee cap or patella in particular) caused a sudden excruciating pain but then backed off and just ached from that point on. Improvement is probably already happening but with certain positions, the intensity returns just like the car, immobilizing her suddenly then leaving as fast as it came.
I didn't get much more information from my daughter but don't need it. As I always preach, 80% of a diagnosis can be attained from history taking alone. Physical exam backs up the history/diagnosis and tests like blood or xray support the physical exam. In 14 years I have come accustomed to the usual issues that befall the knee. With no preexisting issues like arthritis or surgery, the standard history like this is most likely a patellar injury.

To review the anatomy of the knee, we have a hinge joint like a door that opens and closes. Very simple movement, but this joint in particular is complicated in that it must be able to jump and sprint like a rabbit but at the same time be ready to hold in place up to 200 to 400 pounds (all this for an average of 70-80 years). The two big bones that make the knee are the thigh bone (or femur) and the shin bone (the tibia). These two bones rest on each other with little wafer-cusions (cartilage)between them. To be able to move these bones in a hurry and hold a great quantity of weight, we need long but thick muscles (the front thigh or quads). The Quad muscles originate from around the hip and insert to a small point on the shin. When the leg is straight, quads are straight, when the knee is bent like a squat, the muscle has to rub against something to get from the hip down to the shin. Like a spagetti noodle rubbing over the edge of a fork, it will eventually break so our creator made this thing called the patella that helps guide the muscle over the rough edge of a bent knee. This knee cap (patella) has a smooth surface that comes to a point like the bow of a ship. This bow sits in a groove in the thigh bone. As long as the "bow" is in the "groove" muscle works well, we sprint and lift weight without a problem for 80 years.

Great architecture right? Yes except for when the knee is bent and then is pivoted slightly. When the "bow" of the knee cap has enough force in the wrong direction, it will slip out of the "groove" and crack, scrape, chip the edge of the bow (knee cap). This smooth surface that coats the undersurface of the patella is very delicate and when a large ridge of bone pushes up against it, the soft surface dents, cracks, rubs off, chips. Next time you eat a thight bone from KFC, looks at the white soft cartilage that lines the joint you just broke open. its softer than bone but harder than muscle, easily chewed (or dented,scraped,rubbed,chipped).

I think with her mechanism of injury, our teacher, Mrs M. has suffered a patellar chondral contusion. (Bruise to the cartilage of the knee cap). As with all bruises or scrapes to skin, it takes about 10-14 days to have that scab fall off and skin to heal up right? Well in the case of a knee cap scrape, the knee is constantly being exposed to friction while we are asking it the heal up, this postpones the healing process. Keeping the knee straight (like "Fester from Gunsmoke" or "Madmax" from the Mel Gibson movies) will allow the patella to heal faster but without a big knee immobilizer and crutches from the ER, it's hard to remember to keep the knee straight. What usually happens is we have great intentions in the morning but as the day goes on, occasionally we get into a bad position and eyyyyyoooowww! That little scab to the backside of the knee cap tears open again and then its another 10-14 days of healing.

The Saguil Approach is to use ice during the first three days for 10 minutes at the top of every hour. After that its 10 minutes three times a day. An antiinflammatory is helpful and the good ones can be prescribed by me or the over the counters are sometimes used, (but I think they cause too much stomach upset.) I like using supplements like IF relief from Natures Sunshine or Zyflamend from New Chapter. Anything with turmeric, boswelia, white willow bark, shark cartilage, oregano...all good for speeding up the healing process. Acupuncture works great! (but it is a temporary relief while waiting for the "scab" to heal. Arnica and tea tree oil help. It always is useful for the physical therapist to show you some exercises to strengthen the quads and keep them holding down the patella in the right position. The gifted therapist who knows Maconnel taping can assist the knee cap in staying in the right "groove" for as long as the tape stays on the skin. When this fails and pain continues to the 3-4 week mark, time for xrays and a possible mri. The problem is; the only true way to diagnose a patellar surface injury is to visualize it directly with a surgical scope. Most of the surgeons (and me included) will try a steroid shot as a last ditch effort to reduce inflammation before considering surgical evaluation.

What else can I do for high blood pressure, I get enough exercise at work .........(warehouse/construction/daycare)

When addressing patients for the first time or those that have been taking medicines for a while, I always ask, do you watch your diet and are you exercising. (For those with a large waist to hip ratio it's more of a rhetorical question.) But most will answer they are doing or have tried to do alot of exertion in the form of walking. Most will think of exercise as a form of walking. That is soooo 90's. Most of the articles on introducing exercise into a life style would safely say, try walking first. This was meant to be an intro for the first 6-8 weeks with the idea of progressing on if you didnt suffer and injury or drop of a heart attack. When I see a couple in jogging suits, both with grey hair smiling on a neighborhood trail, I think that is great, I can't wait till retirement! For a 30-40 year old, we should be thinking of "smoking" that speed walking couple but fact is that most of the construction workers, warehouse workers or moms chasing after 2 generations of children would run out of gas in 5 minutes. Remeber the tortois and the hare? The rabbit in this story enventually goes for angioplasty and gets placed on 2 medicines with a blood thinner. This is the threat I give to most of my 30-40 year/olds that are too busy to worry about a little blood pressure issue or slightly elevated cholesterol. True, its easier to take a pill than make a major lifestyle change and cut back on hours at work....but that way of thinking doesnt prepare for the next medical issue that comes then the next one after that. So like most people, someone comes in for a regular check up and without symptoms ends up on 2-3 medicines with medical problems and problem lists that would dwarf the 10 commandments. I always touch on the current life style of high pressure, fast food, poor family communication and lack of proper preventive medicine.

Just that title alone is a misnomer now a days. Preventive Medicine is supposed to be what primary care doctors are teaching in the community but most of the family practice docs, internists I know are finding medical problems and managing them but no one has time to teach exercise, diet, lifestyle modification. Its usually after the diagnosis and after the first or second pill that we highly suggest cutting back hours or sending to a dietician since the sugars are not responding to first line meds. We also have steps in place to check at intervals to find when the changes are going to occur but that is usually the only contact. "Ok Mr Smith, come back in a year and we'll check if the diabetes has begun. Or, keep on checking that blood pressure, 3 random times in a comfortable environment and when they all are above 120/80, I'll start you on something. I would like to develop a branch of medicine to establish nutrition based changes in addition to supplement design that would integrate into current hierarchy of modern medicine. Insurance would probably not pay for this but patients have already showed they would pay for it out of pocket. Imagine, after paying the 400-1000 per month for insurance just in case you get sick, paying even more money to prevent needing to use the insurance plan your dishing out monthly mortgage payments to. Medicine is so screwed up! Sorry, I am trying to redirect my anger and frustration into constructive development of something good for everyone.

Back to hypertension, exercise is supposed to be in the form of 20-30 minutes of any activity that would keep the heart rate in the 140-160 range,(personally I shoot for 160-170 but can only do this 1 time a week for 20 minutes, the rest of the week is standard 150 beats per minute for 60 minutes all preceded by yoga.) One is supposed to repeat this regime 5 times a week. For those on a limited timetable, more bang for the buck with yoga or tai chi. Most people have heard of yoga, a limited amount know tai chi but these two forms of exercise don't get the credit they need. I have had a handfull of patients able to get off medicines running, yoga and tai chi were the only ways. Some did it through fast aggressive weight loss but this was dietary directed with some form of cardio.

There are studies out that have reported stress control throughout the day with 10 minutes of yoga/meditation in the morning. Same with daily tai chi. Eastern philosophy will show if one is well "grounded" that the body is healthier and will repsond to daily stress and infection better. The chakras or meridias of the body communicate and flow better so to make the external layers of the body impenetrable to the environment. In more western terms, someone at peace will be harder to coax into a fight than someone already on the 3rd cup of coffee and running 10 minutes behind to get to the first appointment. This also can be achieved in the form of prayer. If we could all start the day like Bob Marley says; "don't worry"! we may do better in rush hour. Most people I would see in the office with high blood pressure would say "I just ran up a flight of steps for the appointment" or "I was stressed in the waiting room." My come back is if that is what happens in a waiting room, can you imagine what happens to you throughout the day several times a day with confrontations and problems? Bottom line is the heart and brain don't like the high pressure fronts placed on them and soon will suffer with blood vessel damage, muscle enlargement and ischemia. For the rare person that says I'm ready to die, I say the hospital will probably save your life and you will live, being cared for by your family, unable to work, with no medical insurance. Not a pretty picture but I believe it's the job of a doctor and a friend to help see the worst case scenario.

Standard cardio work outs are great. They give the all the organs, the heart in particular, great blood flow, more efficient muscle with millions of hard working mitochondria. When the heart is more efficient with its beating and contraction, it doesnt have to work as hard throughout the day. Lungs work better at extracting oxygen from air, liver gets blood flow so it can get rid of toxins and run it's multistep break down of things that would normally kill us. Even cells will be able to absorb glucose better and in many cases without the need of insulin when exercise excedes a certain level. The endorphin and enkephalin release post exercise is something only an avid exerciser can relate to. One of the reasons we get "bitten" by exercise. It is addictive due to the hypothalamus being stimulated by the hormone release. This would be the same spot morphine works on. Finally, during the 60-120 minutes after exercise, there is usually a blood pressure drop that occurs like after and orgasm. Yes, exercise can be fun. Something a doctor or therapist or personal trainer can do would be to figure which kind of exercise would be appealing enough to catch the attention of a particular individual. If that person can make it through the first 8-12 weeks without injury, they are probably on their way. The enthusiasm drops rapidly with failure to progress or injury. With the diversity of jobs and hours and facilities and paychecks, an advisor has to be well versed with what is available or at least what has worked for others in the same predicament.

From 5K's to rock climbing to martial arts to dance, find what fits the schedule, what is economically feasable and what sounds like fun. The "Saguil Approach" says working a 5 pound sledge hammer 8 hours a day is something a regular person can't do and I am impressed the muscles will tolerate that but that type of exercise is not what the heart considers relaxing and helpful, if anything, that form of exercise can induce a heart attack. Exercise should be prescribed, and I believe it should be paid for (hopefully soon a health savings account will allow this). Activity should be part of anyones rehab and treatment program for staying healthy. Even if you are already "active" and hypertension is found, you may still have to rethink what has to be done to avoid the pills or more urgently, "avoid the knife".

cut and paste to see the ACSM's stance on exercise:
http://www.acsm.org/AM/Template.cfm?Section=Home_Page&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=7764#Under_65

What do I look out for in getting MRSA infections?

Here in Illinois (specifically DuPage county) there have been reports of MRSA. This acronym stands for methicillin resistant staphylococcus aureus. This bacteria has been around for about 30 years but wasn't so prevalent. When I was a resident working at West Suburban Hospital in Oak Park, we would occasionally get it in chronic ventilator patients. These unfortunate people would be on a ventilator for multiple reasons and of course on a ton of medicines. One note is they would most likely be immunocompromised due to multiple reasons.

There are medicines for MRSA but they are limited. Once a patient was found to be cultured with this bacteria, they would usually be placed in isolation for fear the visitors (nurses family and doctors) would spread the bacteria to other patients (kinda like TB in the 60's). Patients would stay in the hospital for multiple antibiotics till infection was showing improvement. Then they would usually be sent to a chronic care facility in the same restricted form of contact.

Now we are emperically treating patients with antibiotics (usually 2 or three at the same time) and sending them home hoping they clean up after themselves at home and work. Now as a review, the reason the staph became resistant was most likely due to overprescription of antibiotics a while back and now we are hitting every little bug that doesn't seem to respond to standard antibiotics with doubles and triples till the follow up visits with their docs and the cultures come back. God help us in the next few years when no antibiotic will touch certain strains of staph or any other bacteria due to this years' MRSA scare.

What people don't realize is that MRSA is a bacteria like any other. If the individual doesn't care for themselves properly in hand washing, showering and using soap and water on new cuts and scrapes, not sharing towels or clothing from others then any bacteria, not just MRSA, will cause an infection. That infection will need to be drained or blasted with antibiotics. Standard infections go away in 10 days, MRSA gets worse in 2-3 days. The front line tactic for MRSA still is the same for any infection: hygiene, rest, eat properly and exercise.

Poor hygiene, a stressed out body, poor nutrition, obesity, lack of exercise, poor sleep will lead to a body that can't fight the initial battle of infection. This is usually exposure to a bacteria and break down of the body barrier.

Skin is the first barrier: well hydrated and moisturized, nothing should get through. Unfortunately, nobody that works 8-10 hours a day likes to drink water since it results in having to urinate soon after. Not the best for a driver, outdoor worker, telephone operator, computer user. (I remember watching the movie "Pursuit of Happiness" with Will Smith playing a stock broker and he stated in the biography, he wouldn't put the phone down in the cradle or drink water cause it would give him an extra few cold calls at the end of the day.) I am also guilty of this, in seeing a day full of patients, I would not want to eat or drink since it may slow me down for 10-15 minutes and that would cost me one patient visit to put me behind and I would be playing catch-up for the entire day. (See my first blog on The Adventures of Dr Saguil for info on the 10 minute visit as paid for by medical insurance.)

Second barrier would be hydration. If well hydrated, the skin would react by producing thin protective oils to keep the outer layers tensile and unbroken. When dry, outer layers are parched, single cells are separated from each other and flaking occurs which further hampers pore function by blocking the skin pore from making sweat and oil to trap bacteria and prevent further deeper invasion. Being well hydrated also produces a very effective vascular volume. More blood to the skin brings more white blood cells to fight invading organism.

Third barrier would be a properly functioning white blood cells. Tobacco, poor nutrition, lack of multivitamins and supplements, or uncontrolled medical disease states (like diabetes) will hamper the way white blood cells work. Lets consider white blood cells to be policemen. Even if we have a large police force in a city, if they don't know how to arrest or pursue, a crime will still occur. Considering that 50% or more of the US population is overweight and eating poorly, this alone will decrease body defense. Throw tobacco, alcohol, high fat diets in the mix and one is asking for an infection to invade.

Forth barrier is more of what doctors are doing and what patients are demanding. Many patients go in to see the doc just for a diagnosis. Many aren't satisfied and also want a prescription medicine. This is especially in the pediatric population. Most parents feel better when they leave having an antibiotic for the fever and cough even if the infection is just a virus and will go away on it's own. Remember, more antibiotics cause more drug resistant bacteria in the community.

To piggyback on the forth barrier, most docs don't suggest acidophyllus use during the antibiotic 5-10 days. All antibiotics kill indiscriminantly. All those colonies in the throat or chest or urine or sinus' will die for sure. Unfortunately, the good ones in the colon, stomach, small intestine, vagina and skin also die. Our "normal flora" found in the GI tract are there to help with digestion and function. When they are all killed, only the worst and strongest bacteria and fungus will remain. Let's consider the normal flora in the colon being an average classroom of highschool kids. When all the "nice" smart hard working kids are kicked out of school, you are left with the truant, delinquent tough streetwise kids. The resultant class is totally different...get it? So after the "nice" kids are gone, if a large influx of some other nice kids come into school, the bad guys are usually kept quiet just by outnumbering force, and the class continues uninterrupted. This is where probiotics come in handy. Two tablespoonfuls of liquid probiotic or one three capsules of acidopyhyllus/bifido will reboost the stomach, small intesting and colon with good flora. (Usually given 2 hours after the antibiotic is dosed)

So in summary, The Saguil Approach is to do what mom always harped on. Wash your hands, eat vegetables, take your vitamins and go to sleep on time. Translated; good hygiene, good nutrition, decreasing stressors, staying hydrated, taking supplements/probiotics, and avoiding and controlling disease issues. Allow no bacteria to get through the barriers and you won't have to worry about MRSA. Of course getting professional opinions when something starts to look unusual would be important if it has already invaded but most people have the potential to fight off infection without antibiotics. Personally, I hate antibiotics, the last time I took one for a self diagnosed sinus infection, I got Pseudomebranous colitis after one pill of zithromax and remember thinking to myself.....this has got to be a ruptured appendix as I tried my hardest to stick acupunture needles everywhere I could to treat nastiest pain in my life. That was about 5 years ago and haven't used anything since while living through Chicago's winters and hundreds of patient encounters with infections of their own. Although I do use some herbals to boost immunity...next blog. (5 bucks to anyone who finds I don't wash with soap or use antiseptic gel after I examine them!)

My allergy medicines aren't working anymore

I was walking through my favorite store that I will keep anonymous, they sell a wide variety or supplements, cooked and whole food. Was talking to a rep for one of the companies that makes omega 3 and couldn't help but notice he had a very nasal sounding voice, a reddish hue to the center of his face and most of all he was set up so the aromatherapy and incense was directly across the aisle from him. I did spend some time inquiring about his product and he answered well, (I usually like to listen intently on how a rep sells his/her product and what basic knowledge they have before I tell them I am a physician and that I use herbal products for myself and my patients). All during this time I try not to focus on his nose but my mind automatically pictures me checking his nostrils in the office with a nasal speculum.......(sometimes this triggered response I have to ordinary situations scares me). I will be talking to someone at a party or chance meeting and while conversing, my mind wanders about a working diagnosis for what I see before me. Anyway, after he is finished and gives me some samples and a dvd (love freebies!) I point to the elderberry in my basket and say to him, "you may need some of this for the rest of the week". He acknowledges and states he is already on Zyrtec (an antihistamine that some how states it is the best thing for cats, cigarette smoke and plant allergie;, although it isn't the substance exposed to, but more the person that is having the histamine reaction we must try to control) and nasonex (A steroid nasal spray that controls local response in the nose only). He had some cat fur on his sweater and after I asked, wouldn't you guess....he has 3 cats that supposedly didnt go in his room at night. Wouldn't that be great if pet dander, pollen and dust mites would stay in areas of the house where they are supposed to stay! When I was in practice, patients with nasal symptoms who had all the classic signs of allergies would usually tell me they were tested and the allergist stated they have no problems with cats, dogs or milk. I still believe that several small allergens all together at the same time will still have the body act in the same way as one big exposure to a single allergen. So with this person, same theory in the "Saguil Approach" goes; if placed on a medicine, it would be as a temporary measure at best. These folks are placed on meds and not told to do much with the environment around them or their diet. Just like echinacea is supposed to be used for short term only, the perscription medicines should be used short term only.
Other herbal medicines are stinging nettles (a favorite or Dr Weil) and butterbur. If things progress over the allergy line and into the infection stage.....all the above continue and then I like andrographis (paniculata), garlic, quercetin, mushroom extract(reishi, cordyceps, shitake) elderberry is a great alternative for kids. Many times in the ER we see kids that are sick but all tests and evaluations yeild nothing to treat so we say go home and wait....well this is where I think alternative medicine excels.

For extinguishing allergic response, there are the typical shots we give to desensitize the patients over a course of a few months. Essentially giving the patients micro amounts of what they are allergic to every week to have the white blood cells(eosinophils) take a little at a time and hopefully learn that the compound is not irritating. Increasing the amount every few weeks will "desensitize" the patient after a while. Immunologists say they have great response but I guess I see a different portion of the population, most of the "average joes" that come into the office are obviously sick and allergic and still getting shots. (Sometimes I see patients that have been getting shots for years!) Usually, these kids have been taken off gluten, casein and wheat already-god bless those parents for being so tolerant to the problem. I have found homeopathy is great at allergies especially since their concept is based on slow exposure to a substance in order to change an eventual reaction the body manifests.

In summary, "Saguil Approach"-
take care of the environment around you
change the pets diet (possibly to human grade meat)
change the pet
vacuum and dust sunday and thursday
allergen central air filter (3M)
alot of fluid for you
spray the nose with saline douche 3-4 times a day
echinacea or stinging nettels- 1 month before allergy season
zyrtec, clarinex, claritin, allegra, asteline if above doesnt work
avoid direct contact with sick people -hand shakes,hugs,kisses,pens
cut down animal protein, no dairy (but take a calcium/vit d3 pill)
add garlic and ginger
elderberry, andrographis, quercetin, mushroom extract
homeopathy drops to desensitize, doctor to look into leaky gut
allergist to test and consider shots and try to avoid long term steroid!

oh...puffs plus or tissue with moisturizer added to prevent abrasion to the nose.