Re: soap box time

[Guest guest]

Addy: I agree with you--it is incredible that so many people rely on a GP to

treat their asthma. When mine flared up at age 48, it never entered my mind to

go anywhere except to an allergist/asthma specialist. Of course that was back

when a patient could choose which doctor they wanted to go to. It meant paying

out of pocket first and then getting reimbursed by the insurance company.

Sometimes it was a little hard paying for the medicine up front, but looking

back, the cost of medical care and medicines was a whole lot cheaper,

comparatively and percentage wise that it is now! Even some of the co-pays now,

especially for meds, are terribly high.

I got off track there for a little--sorry about that--At any rate, I am

always surprised when someone who has asthma tells me they are just treated by

their GP. If their asthma is mild and only seasonal, then I can sort of

understand it. However, I know so many people who have suffered with asthma and

other allergies who finally broke down and went to an allergist and wanted to

kick themselves because they didn't do it sooner.

During the years I taught school, especially in the private school, I had many

students who had asthma. The thing that appalled me at first was that they had

to go to the nurse to use their rescue inhalers! Thanks to a team who came and

spoke to our faculty and administration about the seriousness of asthma and the

rights of asthma patients--students in particular--our older students were

allowed to carry their rescue inhaler with them. I still believe there is a lot

of misinformation and ignorance in our society regarding asthma and allergies in

general.

Just as a side note--I had my last xolair shot about two weeks ago, felt very

lethargic the first two days following (subbed at school one of those days and

my tail was really dragging!), but the third day, I felt really good--lots of

energy--and have been feeling good since! I have even been able to be outside

for lengths of time without having to use albuterol! I am beginning to believe

that gradually I am seeing the results of taking the xolair!

Adah

pyle456 <coachmac@...> wrote:

In response to something Pat said in her recent post, I am aghast and

mortified that 80% of patients with asthma are treated by a GP or

regular pediatrician. I had no idea the rate was that high. I am well

aware that a lot of folks aren't seeing a specialist - but 80%. I do

know that, in the medicaid population where I live, it is really hard

to get pediatricians who serve large numbers of medicaid children to

refer young children to an asthma specialist. I hate to accuse any

provider of being driven by profit, but I dealth with that a lot while

I was working with Head Start. While I admit that singulair does a lot

for about half the allergic/asthmatic children, the others really need

to be under specialty care and we had to fight for every specialist

referral we got.

Addy

Group co-owner

opinions expressed herein are mine alone.

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[Guest guest]

I was diagnosed with Asthma over 20 years ago, have had bad seasonal

allergies for atleast 5 or 6 and was NEVER referred to a specialist

until last January(06). All of the GP's I've seen have treated it

themselves. Last year all the sudden everything started getting worse

and I had allergy testing in Feb and then hospitalizations one after

the other!! Go figure heh

>

> In response to something Pat said in her recent post, I am aghast

and

> mortified that 80% of patients with asthma are treated by a GP or

> regular pediatrician. I had no idea the rate was that high. I am

well

> aware that a lot of folks aren't seeing a specialist - but 80%. I

do

> know that, in the medicaid population where I live, it is really

hard

> to get pediatricians who serve large numbers of medicaid children

to

> refer young children to an asthma specialist. I hate to accuse any

> provider of being driven by profit, but I dealth with that a lot

while

> I was working with Head Start. While I admit that singulair does a

lot

> for about half the allergic/asthmatic children, the others really

need

> to be under specialty care and we had to fight for every specialist

> referral we got.

>

> Addy

> Group co-owner

> opinions expressed herein are mine alone.

>

[Guest guest]

IMHO, primary care physicians (family practice, internal medicine and

pediatrics) are well equipped to care for mild to moderate

intermittent asthma, including acute flareups IF they are clearly

triggered by viral respiratory infections, respond well to standard

treatment and only occur occasionally. But anyone with mild-moderate

intermittent asthma with frequent flareups, persistent asthma, or

with severe asthma of either type should definitely be evaluated by

an allergist for possible allergic triggers. And anyone with severe

asthma or with mild-moderate asthma that doesn't respond well to

bronchodilator and inhaled or pulsed oral steroid treatment should be

seen by a pulmonologist.

Of the top of my head, I can't say what percentage of asthmatics fall

into each category except to say that there are far, far fewer severe

asthmatics than mild to moderate asthmatics. But knowing what I do

about Medicaid and managed care in this country, I'm sure that a lot

of patients who could benefit from specialty care are not getting it.

My 2 cents -

Fran

>

> In response to something Pat said in her recent post, I am aghast

and

> mortified that 80% of patients with asthma are treated by a GP or

> regular pediatrician. I had no idea the rate was that high. I am

well

> aware that a lot of folks aren't seeing a specialist - but 80%. I

do

> know that, in the medicaid population where I live, it is really

hard

> to get pediatricians who serve large numbers of medicaid children

to

> refer young children to an asthma specialist. I hate to accuse any

> provider of being driven by profit, but I dealth with that a lot

while

> I was working with Head Start. While I admit that singulair does a

lot

> for about half the allergic/asthmatic children, the others really

need

> to be under specialty care and we had to fight for every specialist

> referral we got.

>

> Addy

> Group co-owner

> opinions expressed herein are mine alone.

>

[Guest guest]

Adah and Addy - with all due respect, I feel we have to bear in mind the

realities of the field of medicine - that there aren't enough allergists to

go around. For example, I live in a doctor-rich community (because of the

quality of life here attracting them) of about 100,000 people, and there are

only nine or ten " allergists " in town. Four are in the dox group I use, and

they are actually pulmo guys first and allergists second (I think). Only

three are specialists in allergies only.

Given that our community is the medical center for southeastern North

Carolina and serves a much larger overall population - let's say 250,000 -

three guys is not much coverage, and those guys are spread kind of thin.

From what I've seen, dox like these don't see anyone without a referral. I

ran into this when I needed a local infectious disease doc to deal with my

recurrence of MRSA in my sinuses. I wanted to go to someone other than

the three guys in my dox practice group, but the response I got was they

weren't taking any new patients and saw no one without a referral. I even

had a little trouble getting in to see the lead guy in my own dox group

(maybe it's his Harvard Med School mystique).

Part of the problem, of course, is the time factor. My GP spends about 15

minutes or so with me per visit. The pulmo/allergy doc maybe 20 minutes or

more, depending on how screwy my condition is, and the inf. dis. dox spent a

bunch of time per visit - in fact, the one at Duke spent well over an hour

with me.

Considering a lot of people live away from cities in smaller towns where

they're lucky to have a doctor, let alone an allergist, and you have a

recipe for allergist-free treatment of allergies. I know I could probably

see some of the best allergists in the nation if I'd hotfoot it up to Duke,

but I don't want to have to make a 300 mile trip to do it. I'd rather have

someone local who might not be the very best, but at least he's only 15

miles away. And then there's the intimidation/aggravation factor. Going to

a massive institution with three thousand plus dox is a pain - just finding

a place to park in the big, multi-level parking deck is an aggravation, and

then there the 15 minute walk to the doc's location. And if I have a

morning appointment, I have to go up the night before. No, I'll stay local,

and I suspect a lot of people stick with their GPs for similar reasons. Of

course, if I were really miserable enough, I'd go to Duke if I couldn't get

satisfaction locally.

Terry

----- Original Message -----

From: Adah Voigt

Sent: Monday, March 19, 2007 12:10 PM

Subject: Re: [ ] soap box time

Addy: I agree with you--it is incredible that so many people rely on a GP

to treat their asthma. When mine flared up at age 48, it never entered my

mind to go anywhere except to an allergist/asthma specialist. Of course that

was back when a patient could choose which doctor they wanted to go to. It

meant paying out of pocket first and then getting reimbursed by the

insurance company. Sometimes it was a little hard paying for the medicine up

front, but looking back, the cost of medical care and medicines was a whole

lot cheaper, comparatively and percentage wise that it is now! Even some of

the co-pays now, especially for meds, are terribly high.

I got off track there for a little--sorry about that--At any rate, I am

always surprised when someone who has asthma tells me they are just treated

by their GP. If their asthma is mild and only seasonal, then I can sort of

understand it. However, I know so many people who have suffered with asthma

and other allergies who finally broke down and went to an allergist and

wanted to kick themselves because they didn't do it sooner.

During the years I taught school, especially in the private school, I had

many students who had asthma. The thing that appalled me at first was that

they had to go to the nurse to use their rescue inhalers! Thanks to a team

who came and spoke to our faculty and administration about the seriousness

of asthma and the rights of asthma patients--students in particular--our

older students were allowed to carry their rescue inhaler with them. I still

believe there is a lot of misinformation and ignorance in our society

regarding asthma and allergies in general.

Just as a side note--I had my last xolair shot about two weeks ago, felt

very lethargic the first two days following (subbed at school one of those

days and my tail was really dragging!), but the third day, I felt really

good--lots of energy--and have been feeling good since! I have even been

able to be outside for lengths of time without having to use albuterol! I am

beginning to believe that gradually I am seeing the results of taking the

xolair!

Adah

pyle456 <coachmac@...> wrote:

In response to something Pat said in her recent post, I am aghast and

mortified that 80% of patients with asthma are treated by a GP or

regular pediatrician. I had no idea the rate was that high. I am well

aware that a lot of folks aren't seeing a specialist - but 80%. I do

know that, in the medicaid population where I live, it is really hard

to get pediatricians who serve large numbers of medicaid children to

refer young children to an asthma specialist. I hate to accuse any

provider of being driven by profit, but I dealth with that a lot while

I was working with Head Start. While I admit that singulair does a lot

for about half the allergic/asthmatic children, the others really need

to be under specialty care and we had to fight for every specialist

referral we got.

Addy

Group co-owner

opinions expressed herein are mine alone.

---------------------------------

No need to miss a message. Get email on-the-go

with for Mobile. Get started.

[Guest guest]

Hi,

Here is my two or four cents. I had a GP and he said every time I called he

would perscribe cough syrup and tell me it was a cold but what cold lasted for

weeeeks..... I finally called one time and he was on vacation and went to a

clinic and the doctor told me that what I had was not a cold that it was

something else. She told me to go to Dr. Alderman who was and is a

pulmonologist and we have been seeing each other for almost 20 years I started

seeing her 1988. I have had asthma she said since I was a child but it was

always a borderline case. Now I am having a problem because of construction....

I may end up in the hospital for the second time in a month this would be a

first for me in two years and the first time it is within a month. But when

that is what has to be done that is the only way to get me well. that is the

ultimate goal.

Now my GP wants me to see the pulmonary doctor for the asthma and he sees me for

other things. but keeps in touch which is good. I keep him informed and he can

call her anytime.

All for now.

Sr. Volz, C.R.

Adah Voigt <asthmatic50@...> wrote:

Addy: I agree with you--it is incredible that so many people rely on a

GP to treat their asthma. When mine flared up at age 48, it never entered my

mind to go anywhere except to an allergist/asthma specialist. Of course that was

back when a patient could choose which doctor they wanted to go to. It meant

paying out of pocket first and then getting reimbursed by the insurance company.

Sometimes it was a little hard paying for the medicine up front, but looking

back, the cost of medical care and medicines was a whole lot cheaper,

comparatively and percentage wise that it is now! Even some of the co-pays now,

especially for meds, are terribly high.

I got off track there for a little--sorry about that--At any rate, I am always

surprised when someone who has asthma tells me they are just treated by their

GP. If their asthma is mild and only seasonal, then I can sort of understand it.

However, I know so many people who have suffered with asthma and other allergies

who finally broke down and went to an allergist and wanted to kick themselves

because they didn't do it sooner.

During the years I taught school, especially in the private school, I had many

students who had asthma. The thing that appalled me at first was that they had

to go to the nurse to use their rescue inhalers! Thanks to a team who came and

spoke to our faculty and administration about the seriousness of asthma and the

rights of asthma patients--students in particular--our older students were

allowed to carry their rescue inhaler with them. I still believe there is a lot

of misinformation and ignorance in our society regarding asthma and allergies in

general.

Just as a side note--I had my last xolair shot about two weeks ago, felt very

lethargic the first two days following (subbed at school one of those days and

my tail was really dragging!), but the third day, I felt really good--lots of

energy--and have been feeling good since! I have even been able to be outside

for lengths of time without having to use albuterol! I am beginning to believe

that gradually I am seeing the results of taking the xolair!

Adah

pyle456 <coachmac@...> wrote:

In response to something Pat said in her recent post, I am aghast and

mortified that 80% of patients with asthma are treated by a GP or

regular pediatrician. I had no idea the rate was that high. I am well

aware that a lot of folks aren't seeing a specialist - but 80%. I do

know that, in the medicaid population where I live, it is really hard

to get pediatricians who serve large numbers of medicaid children to

refer young children to an asthma specialist. I hate to accuse any

provider of being driven by profit, but I dealth with that a lot while

I was working with Head Start. While I admit that singulair does a lot

for about half the allergic/asthmatic children, the others really need

to be under specialty care and we had to fight for every specialist

referral we got.

Addy

Group co-owner

opinions expressed herein are mine alone.

---------------------------------

No need to miss a message. Get email on-the-go

with for Mobile. Get started.

[Guest guest]

Actually, we tend to forget that many, many asthmatics live the " Advair life " as

I call it. Intermittent symptoms, generally well controlled, running and

frolicking about. If you are on this board, it is because you are one of a

select bunch of people who are taking VERY expensive and VERY " fancy " medication

that should be seen as the exception to the treatment asthma rule and not the

norm. I agree, in the best interest of the allocation of health care resources,

not every asthmatic needs an allergist or a pulmo. Primary care physicians would

be doing a major disservice to the system if they could not deal with the cases

outlined by Fran....(and I firmly believe most are 100% capable of doing so....)

(Living in the land of free healthcare...and by free, I mean give us your tax

dollars....we also have comprehensive drug insurance for all residents so no

complaints from me!)

__________________________________________________

[Guest guest]

I live in a fairly small town, but I have seen all of the allergists

and pulmos in the area. My expereince with the allergist was going in

and telling him I had allergy shots for 15 years and they hadn't

worked. I told him I wasn't going to go through more. He told me my

food allergies were all in my head. He subjected me to scratch tests

(though I gave him a list of my allergies). They had to stop in mid

stream because I had an anaphalactic reaction to the tests. I asked

why I was getting scratch tests. I was told they so that he could make

up my allergy shots.

One pulmo walked into my hospital room by request of my GP when I had

been admitted for a respiratory infection. He announced as soon as he

met me, before we even talked, that he was going to " teach me to

manage my asthma. " He had never taken the time to find out what I did

and didn't know. I wasn't in the hospital because I couldn't manage my

asthma. I had done everything right - had gone to the doc at the first

sign of the infection, had gotten antibiotics, a burst of evil candy

and all, and had ended up being admitted not through the ER, but by my

doctor. That pulmo gave me third grade reading materials on the basics

of asthma (this was after I told him I'd been studying my disease for

25 years and that I am a pharmaceutical chemist). The man did nothing

my GP hadn't already done, though he wanted me to take time off every

two weeks to see him. I finally quit in aggravation because I could

not have a reasonable discussion of drug sensitivites with him

(serevent was giving me migraines). He wanted me to use it anyway

because it couldn't possibly give me migraines!

The last pulmo in the area has a waiting list so long I have never

been able to see her.

I have been to fantastic pulmos in the past in other cities, and owe

my life to a pediatric allergist who taught me how to start taking

responsibility as a child for managing my disease. I keep up on the

latest research as best I can and found out about Xolair myself. It

isn't always possible to find a good pulmo or allergist. My bottom

line is that whoever I'm dealing with has to be a good doctor and

service provider first - willing to listen to me as a patient.

Otherwise, I don't give a darn about their specialty.

>

> Adah and Addy - with all due respect, I feel we have to bear in mind

the

> realities of the field of medicine - that there aren't enough

allergists to

> go around. For example, I live in a doctor-rich community (because

of the

> quality of life here attracting them) of about 100,000 people, and

there are

> only nine or ten " allergists " in town. Four are in the dox group I

use, and

> they are actually pulmo guys first and allergists second (I think).

Only

> three are specialists in allergies only.

>

> Given that our community is the medical center for southeastern North

> Carolina and serves a much larger overall population - let's say

250,000 -

> three guys is not much coverage, and those guys are spread kind of

thin.

> From what I've seen, dox like these don't see anyone without a

referral. I

> ran into this when I needed a local infectious disease doc to deal

with my

> recurrence of MRSA in my sinuses. I wanted to go to someone other than

> the three guys in my dox practice group, but the response I got was

they

> weren't taking any new patients and saw no one without a referral.

I even

> had a little trouble getting in to see the lead guy in my own dox group

> (maybe it's his Harvard Med School mystique).

>

> Part of the problem, of course, is the time factor. My GP spends

about 15

> minutes or so with me per visit. The pulmo/allergy doc maybe 20

minutes or

> more, depending on how screwy my condition is, and the inf. dis. dox

spent a

> bunch of time per visit - in fact, the one at Duke spent well over

an hour

> with me.

>

> Considering a lot of people live away from cities in smaller towns

where

> they're lucky to have a doctor, let alone an allergist, and you have a

> recipe for allergist-free treatment of allergies. I know I could

probably

> see some of the best allergists in the nation if I'd hotfoot it up

to Duke,

> but I don't want to have to make a 300 mile trip to do it. I'd

rather have

> someone local who might not be the very best, but at least he's only 15

> miles away. And then there's the intimidation/aggravation factor.

Going to

> a massive institution with three thousand plus dox is a pain - just

finding

> a place to park in the big, multi-level parking deck is an

aggravation, and

> then there the 15 minute walk to the doc's location. And if I have a

> morning appointment, I have to go up the night before. No, I'll

stay local,

> and I suspect a lot of people stick with their GPs for similar

reasons. Of

> course, if I were really miserable enough, I'd go to Duke if I

couldn't get

> satisfaction locally.

>

> Terry

>