In my home state of West Virginia, we have mold when it’s damp, grass when it’s dry, trees and ragweed—you pretty much know the enemy so you can pre-medicate yourself into a post nasal drip stupor all year. In my new state, Texas, there is nothing to block the wind, so every time someone cleans their hacienda in Juarez, we all get sick in Dallas.
Treating the Crazies
Patients who don’t just live with their allergies (I mean, it’s not a kidney stone, it’s a sneeze), watch TV commercials and spend billions of dollars on stuff. I totally understand. You put a pretty, sniffly girl in a garden with her cat and basket of posies and I’d buy, too.
The patients who actually show up at your office want you to (a) make recommendations to make their allergies go away forever and (b) agree with them when they tell you why your recommendations won’t work because of something they read online. They probably like their funky eyes because it gives them something to talk about with their tennis friends.
This makes it tricky to treat them. Oh, we know that a good antihistamine/mast cell inhibitor, sometimes combined with nasal sprays or pills, taken on an ongoing basis, will get rid of 90% of their symptoms, but they’ve heard of that stuff. The secret is to throw them off their game by assessing what their game is before you spout the cookbook plan. Here are some examples:
1. Ask if they have ever had tofu hot wings. If so, you know they’ll only listen if you recommend something natural and groovy such as herbal teas and watermelon enemas. (Don’t knock it ’til you’ve tried it.)
2. Ask if they went deer hunting recently. They’ll spend the next 15 minutes telling you about their Bigfoot sightings and forget why they came; but they’ll still tell their friends what a great doctor you are.
3. Ask who they are voting for. If they like her, prescribe saline rinses to wipe out their allergies’ hard drives. If they like him, tell them to quit whining and just deal with it.
4. Ask what eye drops they have tried. If none, hand them a tear sample. If they’ve tried a bunch and none were worth a hoot, tell them the story of my band’s drummer who told me, “You know, after I got divorced for the fourth time, I started thinking ‘Maybe it’s me.’”
5. Ask if they have a cat. Prescribe yogurt … for the cat. I’m serious. You’ll see.
6. Ask if anyone has ever swabbed their eyelids. If not, rinse a sterile swab with sterile saline, double evert the lid and wipe it thoroughly with the sterile swab. Don’t worry about their allergies—they’ll never come back.
7. Ask if they smoke. If so, tell them to quit. If they won’t, encourage them by saying, “Good news! You’ll probably die before the allergies cause any permanent damage!”
8. Ask if they want to get well fast or slow. If fast, hit them with a steroid and they’ll call you a genius. If slow, refer back to #6.
I used to be allergic to, well, pretty much everything. I couldn’t drink cow’s milk or orange juice (well, maybe orange juice a few times in college, but we called it a Screwdriver). I couldn’t mow the grass—that actually bothered my sweating, angry brother, but not me, inside watching TV. I couldn’t have a dog inside the house, but the six we had outside were fine.All this allergy talk has me kinda itchy. I’m heading out to get yogurt for the cat and see if anyone has a watermelon.