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Medical Forum / Diseases and Disorders / Asthma / May 2006best asthma Dr in the US? or at least Bay Area?
Hi all, Has anyone been able to get treatment at the Jewish Center with an HMO insurance? The best asmtha docs are there, aren't they? Can a PCP authorze treatment at Jewish? If Jewish is not an option, can anyone recommend a good (best) doc in the Bay area, so that I could choose my medical group accordingly? I am a 30 y.o. male, non-smoker, well-conditioned amature endurance athlete. I used to have brochial asthma as a child (supposedly induced by pneumonia), but I don't remember it. This december I got a sore throat which gradually moved down into my lungs, and I developed constant chest conjestion, deep cough, shortness of breath, and a "bubble" in my lungs throughout the day. Even when I am not having an attack, I always have phlegm accumulating deep in my chest, and always feel like I am breathing with a plug in my throat. Blood tests, X-ray and CAT scans did not show anything wrong with my blood/lungs (they suspected lymphoma or lung cancer). I usually do well in spyrometry. It's been very hard to model exactly when the attacks (?) happen, but it seems like diary foods, exercise, stress, and dry mountain air definitely induce them. The most frustrating tihng is that I can not exercise at the performance level I used to be able to. My muscles seem to be fine, but the difficulty of breathing slows me down considerably. Before, I have never had my breathing being the limiting factor in how hard I can exercise. These days, when I go hard, I get sharp pain in my lungs, as if the lungs are constantly on fire, and I develop the feeling of a "bubble" in my lungs. They haven't officially diagnosed me with asmtha, and the treatment at my hospital (Stanford) has been very frustrating:it takes a month to get an appointment or a test done. They see that I am young, skinny, seemingly heallthy, and not dying in front of them, so they set me to the low priority. But the quality of my life have detiriorated dramatically. I feel like a cripple carrying my Albuterol inhaler with me at all times (the thing seems to help a bit when used with a chamber). ...I have been reading this group, foun links to asthmastory.com, and it gave me some hope. Coincidentally, my "asmtha" started out from a sore throat. I went to ER after my 1st asmtha attack (nothing like that has happenned to me before) and they found some "cloudiness" in my lungs and prescribed doxycycline. I took the antibiotic for 2 weeks, as suggested and the symptoms were gone. However, they relapsed after a week ab-free. I took another set (Zpac), with the same cure-and-relapse effect. I noted this to my Stanford doc, but he seemed to ignore this observation completely. Researchers are now saying that asthma is caused by different things, and if it's caused by bacteria, it can be cured once the bacteria is eradicated. That may be something you want to look into, since your initial asthma was thought to be brought on by pneumonia, and got worse with another infection a few months ago. Check out the studies at www.asthmastory.com and see if there are any docs listed in CA. There are a couple of people in CA who have been treated for this, but I don't think all docs have been listed. If you post there indicating where you are in CA, we may be able to come up with some names for you. (I'm a mod there) Unfortunately, the "best" docs are not always the most informed, or the most open minded. Thank you for your response. I am in san francisco, and my docs are at stanford. I am a biochemist, so I can understand most of the literature. It's amazing that doctors even in good teaching hospitals like stanford don't seem to be familiar with Hahn's research. I am a scepticist, by training, and I understand that one should not just jump onto an idea . But at least my doc should have **looked ** into the possiblity of bacterial infection (provided that he reads medical journals on the subject that he specializes in). I mentioned several times to him that it all started with a sore throat, and that a/bs seemed to cause relief. But he shrugged his shoulders and say that it's a coincidence. The thing is, I may have developed tolerance b/c of the low, short-term, dosages of a/bs I've been taking for my sore throat. Anyway, I will print out the papers and bring them to my doc and we will go from there. > But at least my doc should have **looked ** into the possiblity of > bacterial infection (provided that he reads medical journals on the > subject that he specializes in). I agree although there's considerable evidence also that an airway infection can cause lasting hypersensitivity, especially in people with a childhood history of asthma. In other words, while your response to albuterol doesn't mean that you have allergic asthma, I wouldn't say that your response to antibiotics means that you have an infection either. You didn't say whether you have tried any meds besides albuterol. Lou Pecora swears by singulair for his exercise-induced asthma, for example. (See http://groups.google.com.) Steve Freides (sp?) is another workout devotee with exercise-induced problems. Lots of other folks have good luck with Pulmicort and Flovent, which are among the more effective, modern anti-inflammatory drugs. Good luck! Disclaimer: *Of course* I'm not a real doctor.  SignatureAlison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Waging a war is simple, but running a country is very difficult. -- Pham Van Dong, first prime minister of unified Vietnam, 1976 >> But at least my doc should have **looked ** into the >> possiblity of [quoted text clipped - 25 lines] > > Disclaimer: *Of course* I'm not a real doctor. Alison, I haven't seen those studies, so maybe you can answer this for me. Do the studies include people who have had long term asthma who were treated with antibiotics to eradicate bacteria (in other words using something like Dr. Hahn's protocol), and they found they still had hypersensitivity? I wrote: >> I agree although there's considerable evidence also that an airway >> infection can cause lasting hypersensitivity, especially in people >> with a childhood history of asthma. > Do the studies include people who have had long term asthma who were > treated with antibiotics to eradicate bacteria (in other words using > something like Dr. Hahn's protocol), and they found they still had > hypersensitivity? I don't know. What does seems clear is that those of us who had severe asthma problems as children are much more likely to have a recurrence as adults than people who did not have children respiratory difficulty are to have an adult onset. The question is, why? The likelihood of adult recurrence may be genetically caused allergies but I don't see why there couldn't be a genetic predisposition to respiratory infection instead. Here's one pertinent reference from PubMed: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=11344374&query_hl=1&itool=pubmed_docsum Links between pediatric and adult asthma. J Allergy Clin Immunol. 2001 May;107(5 Suppl):S449-55. One unanswered question is whether infections can trigger adult symptoms without persisting. I believe that a whooping cough infection in 1997 caused our current familial asthma difficulties although that doesn't mean that either one of us is at this moment infected with whooping cough. Based on my personal experience, I think that a bad respiratory infection can kick a teetering immune system over the edge into severe dysfunction that persists after the infection is gone. This doesn't mean that some people don't have long-lasting infections. From reading this newsgroup, I've come to view asthma as a lifetime disease. I've stopped taking my current lack of symptoms for granted and find extra motivation for my exercise in thinking about an asthma recurrence. I have also become much more conscious about taking care to avoid respiratory infections. On another topic, this http://en.wikipedia.org/wiki/Asthma strikes me as a very credible article but you may not like: Finally, it has been postulated that some forms of asthma may be related to infection, in particular by Chlamydia pneumoniae.[9] This issue remains controversial, as the relationship is not borne out by meta-analysis of the research.[10] The correlation seems to be not with the onset, but rather with accelerated loss of lung function in adults with new onset of non-atopic asthma.[11] One possible explanation is that some asthmatics may have altered immune response that facilitates long-term chlamydia pneumonia infection.[12]. The response to targeting with macrolide antibiotics has been investigated, but the temporary benefit reported in some studies may reflect just their anti-inflammatory activities rather than their antimicrobic action[10]. The "accelerated loss of lung function" caused by infection is the phenomenon I am referring to above. Since Wikipedia is "the encyclopedia that anyone can edit," go ahead and "be bold." SignatureAlison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Waging a war is simple, but running a country is very difficult. -- Pham Van Dong, first prime minister of unified Vietnam, 1976 Thanks for the links, Alison. I'm wondering if doctors thought lungs became hypersensitive following infection, because they didn't know about the possibility that bacteria could be residing in the tissue. That would be a good thing, since it's something that could be cleared up. And if you have asthma caused by bacteria, it does get worse and worse, which may explain accelerated loss of lung function, as well. I don't think the question about infection causing asthma, while the infection itself is not persisting, is unanswered. The bacteria persists and causes problems long after the infection is no longer active. In other words, you and your family members no longer have whooping cough, but the bacteria that might have accompanied it may be residing in the tissue of your lungs. My belief is a little different than yours. I think if one has a teetering immune system that is sent over the edge with a severe respiratory infection, that the teetering immune system has to be looked into. Why is it teetering? That could be from any number of causes. A severe respiratory infection can probably exacerbate any condition if the bacteria lingers on. If the results are compromised sinuses or lungs, I would seek Dr. Hahn's treatment and then try to figure out why the immune system wasn't stable to begin with. I would think there has to be an underlying cause of that, whether it's a lack of proper vitamin levels or something more serious. Wikipedia is an interesting thing. Kind of neat that anybody can make entries, but because of that reason alone, I tend to avoid it for anything serious. I'm going to save my boldness for something else. Like yelling at my neighbors for not picking up after their dog....lol. > I wrote: >>> I agree although there's considerable evidence also that an [quoted text clipped - 82 lines] > phenomenon I am referring to above. Since Wikipedia is "the > encyclopedia that anyone can edit," go ahead and "be bold." Thanks for the links, Alison. I'm wondering if doctors thought lungs became hypersensitive following infection, because they didn't know about the possibility that bacteria could be residing in the tissue. That would be a good thing, since it's something that could be cleared up. And if you have asthma caused by bacteria, it does get worse and worse, which may explain accelerated loss of lung function, as well. I don't think the question about infection causing asthma, while the infection itself is not persisting, is unanswered. The bacteria persists and causes problems long after the infection is no longer active. In other words, you and your family members no longer have whooping cough, but the bacteria that might have accompanied it may be residing in the tissue of your lungs. My belief is a little different than yours. I think if one has a teetering immune system that is sent over the edge with a severe respiratory infection, that the teetering immune system has to be looked into. Why is it teetering? That could be from any number of causes. A severe respiratory infection can probably exacerbate any condition if the bacteria lingers on. If the results are compromised sinuses or lungs, I would seek Dr. Hahn's treatment and then try to figure out why the immune system wasn't stable to begin with. I would think there has to be an underlying cause of that, whether it's a lack of proper vitamin levels or something more serious. Wikipedia is an interesting thing. Kind of neat that anybody can make entries, but because of that reason alone, I tend to avoid it for anything serious. I'm going to save my boldness for something else. Like yelling at my neighbors for not picking up after their dog....lol. It is known that many asthma exacerbations are triggered by viral infections. Some recent research done in England sheds some light on this. In a nutshell, they found that lung epithelium cells from asthma patients produce too little beta-interferon with the result that rhinovirus can replicate up to 50 times faster in asthma patients' lungs than in non-sufferers. The research team found that replacing the missing beta-interferon re-enabled the cells ability to fight the virus (in vitro), potentially leading to new forms of treatment in the future. So when you get a cold virus, it really is much more serious for an asthma sufferer than for a non-asthmatic because the virus can replicate in a runaway fashion due to faulty lung epithelial cells. See this link: http://news.bbc.co.uk/1/hi/health/4372715.stm Tony Very interesting, Tony. Thanks for the link. > It is known that many asthma exacerbations are triggered by > viral infections. [quoted text clipped - 22 lines] > > Tony > "tony broughton" <tonybDELETE_THIS_SPAM_BLOCKER17v@hotmail.com> > wrote in message >> See this link: >> http://news.bbc.co.uk/1/hi/health/4372715.stm The only prolbem with the news item is that the research was published in the "Journal of Experimental Medicine," which I at least have never heard of before. There are physics journals that will accept any manuscript that authors are willing to pay to have published. I bet that medicine has such journals as well. SignatureAlison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Waging a war is simple, but running a country is very difficult. -- Pham Van Dong, first prime minister of unified Vietnam, 1976 Alison, there are citation indecies that can be used to evaluate a journal's rating. Or, you can just ask an expert on how good that journal is. For instance, I am not an expert in medicine, but I could make a decent judgement about a journal in chemistry, or biocemistry. > The only prolbem with the news item is that the research was published > in the "Journal of Experimental Medicine," which I at least have never > heard of before. There are physics journals that will accept any > manuscript that authors are willing to pay to have published. I bet > that medicine has such journals as well. > The only prolbem with the news item is that the research was published > in the "Journal of Experimental Medicine," which I at least have never > heard of before. There are physics journals that will accept any > manuscript that authors are willing to pay to have published. I bet > that medicine has such journals as well. I greatly doubt that's an issue. The group that did the research have an excellent mainstream science reputation. Prof. Stephen Holgate's name is on the paper, if you do a google search on him you'll find he's widely recognised in the international academic community and sits on the UK Medical Research Council which is a government advisory body. See this profile:- http://www.som.soton.ac.uk/research/iir/respiratory/members/HolgateST/ HolgateST.htm (It seems to me that if you can't give credance to someone with an outstanding record like that then you can't rely on much of anything!) I hope he doesn't mind me posting that here - I haven't asked his permission! (BTW, I don't have any personal connection with his group or their research. I just found that info by googling his name.) The original paper is freely downloadable from the journal at www.jem.org, just hit "search" button, put "holgate" in author, then search, then you can download the paper as a pdf. It appears this is very much at the "basic science" stage at the moment, I would imagine they'd have quite a long way to go to produce an actual therapy based on it. Certainly B-interferon has some adverse effects for MS patients, hopefully they'd want to mitigate those adverse effects as much as possible for long-term asthma patients! But the finding itself is interesting since it explains why when I get a virus infection it's quite a serious illness while non-asthmatic friends and colleagues just suffer a (relatively) minor inconvenience. I would say that virtually all the bad attacks I have are kicked off by virus infections rather than pure allergy such as dust or smoke. If the cold viruses are replicating 50X faster in me than in a normal person, that goes some way to explaining it, and also the longer duration of the infection I typically suffer from than non-asthmatics around me. Of course, they're really reporting an observation; the underlying question is <<why>> asthma patients lungs produce less B-interferon than normal. Genetics? A consequence of the allergic reaction? Changes induced by viral infections? There appear to be some very complex mechanisms underlying this illness. I guess that's Biology in a nutshell though! Tony >> "tony broughton" <tonybDELETE_THIS_SPAM_BLOCKER17v@hotmail.com> >> wrote in message [quoted text clipped - 6 lines] > manuscript that authors are willing to pay to have published. I bet > that medicine has such journals as well. It is one of several journals put out by The Rockefeller University press. Its not in the BMJ/Lancet/NEJM/JAMA league but it is not bad. All of their journals tend to focus more on basic science than on some of the more famous ones. Signature00doc > Very interesting, Tony. Thanks for the link. I hoped you might find it interesting. I wondered if this might have any relation to the C. Pneumoniae hypothesis, since it's kind of in the same area - infections and asthma. Their paper focuses on viruses and C.Pn is a bacterium, but perhaps there's some link. Of course I don't have sufficient expertise to speculate intelligently on this! Tony > Very interesting, Tony. Thanks for the link. In fact it was your "why is the immune system teetering" question that prompted me to post that link. I think this particular piece of research has revealed one of the underlying mechanisms for the asthmatic "teetering immune system". Tony > It is known that many asthma exacerbations are triggered by viral > infections. [quoted text clipped - 6 lines] > vitro), > potentially leading to new forms of treatment in the future. That does suggest possible treatment options. I would think that it would not be hard to nebulize interferon (which is already available for injection). Signature00doc > That does suggest possible treatment options. I would think that it would > not be hard to nebulize interferon (which is already available for > injection). How long do you think a drug like that might take to develop? I got the impression this was a long way off? Tony >> That does suggest possible treatment options. I would think that it would >> not be hard to nebulize interferon (which is already available for >> injection). > > How long do you think a drug like that might take to develop? > I got the impression this was a long way off? It depends on what they have to do. Like I said, inteferon is already out in liquid form (as an injectable). If someone does a study where they put the currently available injectable formulation into a neb machine (as is done with lidocaine and morphine) then others could start using it that way "off-label" immediately. If a drug company decides they want to market it and make a new product then it would take along the lines of 10-15 years to formulate the new product and get FDA approval. Signature00doc The Wikipedia article is based on the popular but flawed notions about breathing, namely that inhalation does not involve suction pressure as a matter of necessity. This flawed science might be the cause of asthma. Think of the circumstantial evidence: An asthma epidemic without any known cause other than the possibility that the treatment is flawed. Avoidance of the issue of techniques to boost inhalation suction (yoga, karate etc) to get more air into the lungs while claiming an exhaustively scientific approach.. Doubts about the good intentions of the pharma industry. If you are happy with your way of treating asthma by the use of airway-dilating drugs to reduce the need for natural suction, then just carry on, but stop disease mongering by preaching pseudoscience for all and sundry. Or does it entail some mystical, more profound wisdom? Regards, Richard Friedel Alison, I was on cingular and predisone. No effect. However, since the disease progresses and changes with time, I can't guarantee that it did not work only that particular time when I tried it (after 3 weeks from my infection), and that it might work now. But since c and p only treat the symptmos, I would rather suffer a bit than take the pills. The reason why I am enthusiastic about the infectious nature of my a is that it did start with an infection. That infection was quite minor, not a full-grown pneumonia. Just 3 days of light fever. And yes, my PCP was telling me that lungs may become hypersensitie after an infection. My allergologist told that "you've aquired asthma, and it will stay even though the infection is gone". Alison Chaiken <alison+gnus20060422T234254@dailyplanet.dontspam.wsrcc.com> wrote: >You didn't say whether you have tried any meds besides albuterol. I don't understand why albuterol is still prescribed. Perbuterol (Maxair) has fewer side effects (such as increased pulse rate) and tastes better than albuterol. Is it just a question of cost? >Lou >Pecora swears by singulair for his exercise-induced asthma, for >example. (See http://groups.google.com.) Steve Freides (sp?) is >another workout devotee with exercise-induced problems. Lots of other >folks have good luck with Pulmicort and Flovent, which are among the >more effective, modern anti-inflammatory drugs. Good luck! I have found the combination of Singulair and Advair to be very effective. A life-changing combination, really, in the way it made me feel free to do things I couldn't previously do (such as go outside without an inhaler). Jack Hamilton jfh@acm.org ----- Though in a state of society some must have greater luxuries and comforts than others, yet all should have the necessities of life; and if the poor cannot exist, in vain may the rich look for happiness or prosperity. The legistlature is never so well employed as when they look to the interests of those who are at a distance from them in the ranks of society. It is their duty to do so; religion calls for it; humanity calls for it; and if there are hearts who are not awake to either of those feelings, their own interests would dictate it. Sir Lloyd Kenyon, Rex vs. Rusby, 1800 |
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