This is the transcript (provided by www.castingwords.com) Interview with Dr. Joneja.

Warning – this is over 3,000 words.

Just listen to the Podcast of the Interview with Dr. Joneja.

BD:  Hello and welcome to podcasts from the Boogordoctor.com site. I’m Russell Faust, author of this blog. This is an inaugural interview for what I hope to be a series of interviews and discussions with experts in the field of pediatric airway ‑ meaning asthma, allergies, rhinitis, sinusitis, reflux, and related topics.

I’m very proud to have as my first guest, Dr. Janice Joneja, expert in food allergies and food intolerance. Dr. Joneja, first let me welcome you to my medical education blog, Boogordoctor.com.

Dr. Joneja:  Thank you so much. I’m delighted to be here.

BD: Thank you so much for generously agreeing to chat with me today. I sincerely believe that listeners and readers of the blogs, yours as well as mine, will find your insights to be very valuable. Before I ask you about your experiences, I want to take just a moment to introduce you to our listeners. Let me first say that more details can be found on my site with links to your site for those folks who might want further counseling or have questions for you.

There are two main reasons that I wanted to invite you to be the first expert to be interviewed here for these blog podcasts. The first is that, and I’ll speak to my listeners here, she has impeccable scientific credentials. The second is that as a mother of a sick child she was frustrated by what the world of science and medicine had to offer to help care for her child.

So let me just first review some of those scientific credentials and her background a little bit and then open it up. Dr. Joneja is a researcher, an educator, an author, and a clinical counselor with over 30 years of experience in the area of biochemical and immunological reactions involved in food allergy and food intolerance. She holds a Ph. D. in microbiology and immunology, has been a member of the academic faculty of the University of British Columbia and other universities.

Currently she’s adjunct professor in the faculty of agricultural sciences at the University of British Columbia and an honorary research fellow in the School of Biosciences at the University of Birmingham, England. Dr. Joneja is also a registered dietician. She is very well published with more than a dozen articles in scientific and medical journals, has authored six well‑reviewed books including two recent editions that focus on food allergies.

You can find more information about these on the website. As an expert in her field, she has also authored articles in popular magazines and has been a frequent guest expert on radio and television. As you listen to her, you’ll understand why she’s been such a popular speaker.

Finally and perhaps most importantly in her development of her expertise, Dr. Joneja is also a mother. Clearly as she has great scientific credentials she knows her stuff, but she also brings a unique perspective to the world of food allergy, the experience of a mother with an ill child. That is why I’ve invited her here to share her experience and wisdom with us. She is one of the early integrators and pioneers in this field.

She practices in integrative allergy and nutrition counseling, just returning from a workshop where she’s giving a workshop in Oregon. Dr. Joneja joins us from British Columbia this morning. Dr. Joneja, welcome and can you please give us a little bit about your background and your experiences that led you to look beyond what you had learned as a scientist?

Dr. Joneja:  Indeed I can and thank you so much for inviting me. This is a delightful experience for me. I’m really happy to be able to share my experience, as you said, as on both sides of the desk if you like. We can look at it that way. I started my career as a research scientist. I did a doctorate in medical microbiology/immunology and started in at the University of British Columbia as an assistant professor.

My field was focused actually in oral microbiology/immunology and the immunology of mucosal surfaces, which is actually the very point where we see the coming together of the external world with the internal world. Of course there’s nothing more important than that, than the external world of food that becomes internalized in our bodies.

My research was focused on science. Literally, I was a laboratory scientist, and the mechanisms of the immunology of allergy were really where I started in immunology because I did my training in the department at the University of Birmingham where the immunological processes of allergy were actually discovered and delineated.

My background as far as allergy was concerned would probably be as much as was known in those days, and I’m talking over 30 years ago now. As a scientist I knew as much as there was to know about the mechanisms responsible for allergy, but it wasn’t until I had a child of my own with really perhaps the greatest number of allergies that I’ve ever seen in my practice as in the field of clinical allergy. I’ve seen over 4,000 families now.

My son, when he was born actually, had eczema. He very quickly developed quite severe asthma, and even as early as two years of age he was given prednisone and became steroid dependent, a steroid dependent asthmatic. He became anaphylactic to peanuts, and later on in his teenage years started to develop severe migraine headaches.

His father is a neurologist, and so he had every test that was available to find out the origin of his migraines, and nothing was discovered. Now when I was seeing him I could see definitely that he was responding to different foods. So I would speak to his pediatrician about this and discuss it with his respirologist and was told in no uncertain terms there’s no such thing as food allergy. It’s a product of a neurotic and in my case overprotective and overeducated mother. [laughs]

BD: Even 30 years later, now I’m sure many of the listeners are familiar with this response in medicine.

Dr. Joneja:  Oh, dear. I’m really sad to hear that. Now we have so much more research to guide us, but nevertheless you’re absolutely correct because I hear the same thing from the patients who come into my office.

BD: Sure.

Dr. Joneja:  So what was I to do? I knew the mechanisms. I knew what was going on my child, no doubt, and no one was available to help me. I looked to dieticians. They were absolutely uneducated in the field because nobody wanted to consider this as part of traditional medicine. So what happened of course was that he moved into the field of alternative medicine.

It seems that the traditional scientists and the traditional clinicians even today will shy away from a field that is considered fringe medicine unfortunately. So there was not a lot of scientific basis for us to even move into knowing what was going on. So me being what I usually do is, “OK, there’s no one out there to help me. I’ll do it myself.” [laughs]

I went back to university, became a registered dietician by taking all the courses required for registration, doing an internship, and then moving into the field to apply what I knew as a scientist in the field of clinical dietetics. In other words, trying to apply in a practical way all that I’d learned as a scientist to enable other people to help their children and themselves in managing what they knew were adverse reactions to foods.

Now having said that, I would like to at least say that since that time more and more traditional scientists and clinicians have recognized that food allergy is indeed a very important aspect. A lot of this is fueled by the anaphylactic societies who recognize the real danger of food to a sensitized individual because in the most extreme case we have of course a life‑threatening situation.

That itself has fueled tremendous research into the field, which I am happy to say now is what is guiding us in our practice.

BD: And how did things turn out for your boy?

Dr. Joneja:  Ah! [laughs] Well, he’s now in his thirties. He has a child of his own.

BD: Congratulations.

Dr. Joneja:  Thank you. A very small one, but it’s delightful.

[laughter]

Dr. Joneja:  Well, I think, as we experience, because I wasn’t able to intervene at the very early stages where we now see the possibility that we can perhaps reduce if not prevent the onset of food allergy.

Unfortunately he really did get into a very stressful situation where he was in status asthmaticus several times, which is of course an extremely frightening situation for everyone, including his pediatrician. He was steroid dependent, and do you know prednisone at high levels for a young child of six years of age can be devastating?

BD: Oh, yes.

Dr. Joneja:  And with the migraine headaches again, well, that one he solved himself. He decided at the age of 13 that he was going to become vegan. He said, “Mommy, every time I eat anything that is made of meat, it makes me vomit.” And it did. He became a vegan. We took out every animal source from his diet, which I was able to do, thank goodness.

In spite of being anaphylactic to peanuts, his diet was all legumes, no problem. That of course showed me that food allergy is species specific and that the old idea of food families being… I mean we could do a session on that alone of course, Russ.

BD: Sure.

Dr. Joneja:  But it doesn’t mean that you’re going to be allergic to everything in a food family. That is the old‑fashioned idea before we had the new molecular science to guide us on this structure of allergens.

BD: Right.

Dr. Joneja:  He became a vegan. His migraine headaches cleared up instantly.

BD: Amazing.

Dr. Joneja:  And I finally discovered after my methods of elimination and challenge, number one, he was very allergic to pork. We used to eat quite a bit of that in all sorts of forms, bacon and ham and so on. He was allergic to beef also. He was allergic to milk protein and on top of all that, which is very, very common in a steroid‑dependent asthmatic, he was sulphite sensitive. With that knowledge he was then able to, number one, control his migraine headaches. It did to some extent reduce his severity of asthma, because as you know sulphite sensitivity and exposure to sulphites can exacerbate asthma.

BD: Sure.

Dr. Joneja:  And so he’s still asthmatic. He still needs quite a bit of medication, but he does not need steroids. Inhaled steroids yes, but not the systemic steroids.

BD: Not systemic. Right.

Dr. Joneja:  So he doesn’t suffer from the migraine headaches, but he does have an aura. And aura for your listeners is sort of a ‘before headache symptom’ where he may have visual disturbances that would indicate that a migraine may be coming on.

He doesn’t have the migraine headaches. He doesn’t have the severe asthma, it’s controlled. He still has eczema. He never did outgrow that, although he outgrew quite a few of his early food allergies. With eczema we do see the impact of environmental allergens later on where they gain access to the lower tissues through the braided skin of eczema.

BD: Sure.

Dr. Joneja:  Dust mite, mold spores, animal dander and sometimes pollen spores will exacerbate his eczema. But he grew beautifully; he’s six feet four inches.

BD: So not malnourished.

Dr. Joneja:  Not at all, not at all. I make sure of that.

BD: That leads me to ask and there will be listeners who are facing similar situations with their children. It must be very frustrating to have a child, an infant, who is significantly limited, and who has many food allergies. For example, your son, not only being a vegan, but also being limited on even that diet what he could have.

So give us some sense of how you successfully nourished him, raised him. How did you manage to get enough protein into him so the little guy would grow? That’s hugely challenging.

Dr. Joneja:  It is a challenge and it was a challenge because being vegan is very difficult when they start in adolescence and he was very well nourished as far as his legume intake. Interestingly, although he was allergic to peanuts he was not allergic to all nuts. He was allergic to some nuts.

BD: Right. But not all tree nuts?

Dr. Joneja:  No. No.

BD: OK.

Dr. Joneja:  Because as we know, as long as a person is not allergic to a pan‑allergen… We might discuss that in a future series too. He isn’t allergic to all nuts, but we found out he is OK with almonds, he was all right with Brazil nuts, a variety of seeds he was fine with, so I could utilize those in the flours and increase his protein from that source and fortunately, later on he was not allergic to egg and so I was able to introduce that later.

BD: I was going to ask.

Dr. Joneja:  Yes.

BD: So you were able to maintain a fairly high quality breadth of amino acids and proteins to keep him well nourished.

Dr. Joneja:  Indeed.

BD: Yeah. Quite the challenge.

Dr. Joneja:  Which was fine, which was perfectly fine until he went away to school and university and that was where the problem started. In fact, there was a time when unfortunately the way he was eating in the university and he went to boarding school, the way he was eating there. He would vomit after a meal, after most meals. He lost a considerable amount of weight at that time, so this was where the challenge arose for him, when he was away from home.

BD: I think children who can be maintained at home, when this sort of care, meticulous investigation into their diet and elimination and reintroduction, this sort of meticulous care is taken, really do run into trouble when they’re out in that environment, when they go away to school or they go away for a job or something. It’s a huge adjustment.

Dr. Joneja:  Definitely. That is the problem. With young people, young men particularly, they want to be part of the social scene. They don’t want to be seen as different. He did suffer, I must admit, he did suffer a lot.

BD: Sure.

Dr. Joneja:  Young men like to go to the bar and so on and so forth and for a person with his sensitivities as far as fruits and other ingredients, it became really a big problem. It really was. Yes.

BD: Over what sort of time would you say that you began to not only recognize based on your scientific background recognize what was going in your son, but really to work it out, to develop kind of a detailed sense of what he was reacting to and what was safe for him since you didn’t receive a lot of assistance from his pediatricians? You did all this on your own?

Dr. Joneja:  Absolutely. In fact, one of his pediatricians told me to go and find another pediatrician because she couldn’t deal with me anymore.

BD: Oh, that’s so sad.

Dr. Joneja:  Oh, it was terrible. It was his respirologist, the doctor that was helping, or should’ve been helping, with his asthma that literally told me there’s no such thing as food allergy. In those days, in fact, I don’t know whether you would be aware of this, but in the early days of allergy teaching in medical school, asthma and eczema were not considered to be allergic diseases. The only real allergic disease was considered to be hay fever.

BD: Right. Allergic rhinitis.

Dr. Joneja:  Rhinitis. Exactly. And it was denied. In fact, we have research papers in those days denying the allergic component to asthma and eczema.

BD: Unbelievable.

Dr. Joneja:  Then the early papers would say intrinsic and extrinsic asthma, sort of claiming, “OK, we’ve got extrinsic asthma that may be triggered by pollen and animal dander and mold spores” and intrinsic asthma was considered to be just an idiosyncratic response of the body.

BD: Right. An odd physiological response.

Dr. Joneja:  Not to food. Certainly not to food or food components. No. That was completely denied in research papers.

BD: Amazing.

Dr. Joneja:  And then of course I believe there is still within the world of dermatology practitioners who deny the allergic component of eczema. Yeah we know atopic dermatitis and OK, we’ll sort of say that, but fortunately there’s another group of scientists showing quite clearly the triggers in foods that are associated with the onset and the exacerbation of eczema with food and pollen.

BD: Certainly in my field, there’s a recent convergence between pulmonologists and allergists, immunologists, ENT, ear, nose, throat, and otolaryngologists toward the so‑called unified airway theory, which states that the lining of the aerodigestive tract is all the same basically and it’s all exposed to the same toxins or pollutants or allergens and irritation in one area of that tract stimulates in the body various cytokines and other stimulants that can be systemic and irritate the entire tract.

Dr. Joneja:  Precisely. We see that very clearly in two conditions that are being recognized more and more now. They’re usually of adult onset, but we do see them occasionally in children, that would be ‘oral allergy syndrome’ where the initial trigger for IgE, that’s the antibody that mediates allergy, is pollen. So we start with a pollinosis, which would be cedar birch, older pollen and then we see oral symptoms as a result of consuming raw fruits and vegetables and have a very similar structure and can in fact release the mediators from our cells that were not actually sensitized initially by the food.

BD: Were not the original allergens.

Dr. Joneja:  And we also see that with latex allergy, where that can become systemic. The initial trigger is latex. There are many different antigens in latex.

BD: Right.

Dr. Joneja:  And these trigger IgE. Sometimes we’ll get them through the hands where there’s sort of an eczematous reaction to the latex, or even inhaled which would be the powder from latex gloves, become systemic. The IgE is systemic and then a person consumes foods that have similar structures within the protein in the food and then can in fact have an anaphylactic reaction to the foods, although they’re not initially sensitized to the food.

BD: Scary.

Dr. Joneja:  This is where we see that too. As you said, the integration between all of the mucosal surfaces of the body, although they are different. Because we’ve got what we would say the mast, the mucosal associated lymphoid tissue of the respiratory tract and the vault, which is the gut associated lymphoid tissue of the digestive tract, which are very different immunologically.

Yet they’re both mucosal tissues and therefore can respond in the same way and contain very similar cells, particularly mast cells, which can release the mediators that cause allergy. So I think it’s absolutely essential that the integration of these systems is recognized from a scientific point of view.

BD: Absolutely. For listeners, I hope that you’ll return to listen to more from Dr. Joneja regarding food allergies, food intolerance, food reactions, and things like eczema, childhood behaviors. I hope we touch on at some point and other interesting topics and I think that will wrap it up. Thank you so much.

Dr. Joneja:  Thank you.

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Transcription by CastingWords.com.

Transparency and Comment: I have no financial or other relationship with CastngWords.  CastingWords provided excellent service, for a reasonable price, to transcribe my recordings of interviews. I would recommend them highly, and without reservation.

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

You can read more about Dr. Tolan’s impressive credentials below.

To summarize, Dr. Tolan is the real deal, and is perhaps the best-qualified person to answer my question:

Will nasal saline rinses result in death from brain-eating amoeba??

The main points from that conversation are these:

• Using a Neti pot or other methods of doing nasal saline rinses won’t cause your death by brain-eating amoeba.
• Just to be safe, for nasal saline rinses, simply use boiled tap water, or simply buy a jug of distilled water.

There you have it. For the rest of what Dr. Tolan had to say, read on …

Image: Brain-eating amoeba, N. fowleri (image credit: CDC). The central B&W image is a "phase-contrast" from under the microscope; the pics on either side are stained brain tissue showing infection with amoeba ("Amoebic Meningoencephalitis")

As a world-renowned expert on infectious diseases of the central nervous system, I called Dr. Tolan to ask his opinion about the recent cases in the media, specifically cases of “brain-eating Amoeba” – Amoebic Meningoencephalitis (AM), linked to use of a Neti pot.

I wanted to get to the bottom of this because I have colleagues, patients and their families (and readers of this blog), asking me whether it’s safe to be doing nasal saline rinses at all. Are we risking Amoebic Meningitis by doing nasal saline rinses??

There are two reports that I am familiar with, and both have received a lot of attention on the web, in social media like Facebook and Twitter.

Here is what Dr. Tolan had to say:

Boogordoctor: Dr. Tolan, thank you so much for taking time to offer your expert opinion about Amoebic Meningoencephalitis, from Neti pot use.

Dr. Tolan: My pleasure, Dr. Faust, glad to help.

Boogordoctor: Are you familiar with the recent cases of AM linked to Neti pot use?

Dr. Tolan: I am not, since they have not yet been confirmed by the CDC (Centers for Disease Control and Prevention). I have not seen them reported in the MMWR (Morbidity and Mortality Weekly Report). Don’t believe everything that you read on the internet. Many things are sensationalized to boost readership.

On the other hand, there are some important points to make using these examples.

Boogordoctor: Such as?

Dr. Tolan:

• The first point for your readers to keep in mind is that AM is incredibly rare. There are usually about 3 cases per year in this country annually.
• Most of those cases occur after swimming in ponds in warm environments – Southern states.
• The next point to keep in mind is that the organism responsible for those cases is usually Naegleria fowleri. It is important to point out that N. fowleri is EVERYWHERE in our environment, including our municipal water supply. It is ubiquitous.
• N. fowleri is difficult to kill, especially in environments where it is happiest – in the South, for example. There is simply no way to chlorinate our water supply in the South to levels that will eliminate all N. fowleri. The farther South you go, the warmer the water, the greater the risk of having N. fowleri in your tap water (and ponds, lakes, etc.).
• My recommendation is, for people using Neti pots or other methods of nasal saline irrigations, USE DISTILLED WATER, or BOILED tap water. Distilled water is not absolutely sterile, but will have much lower risk of containing amoeba species than tap water.

Regarding these cases of AM related to Neti pot use that are reported online, I will be interested to see what the CDC investigators tell us. Regardless, it is important to emphasize how rare these cases are in this country.

Boogordoctor: Dr. Tolan, that is great advice, and supports what I have been telling people: use distilled water for your Neti pot or squeeze-bottle for nasal saline rinses – whether you use a store-bought salt preparation or make your own from a recipe.

Again, thanks so much for lending your expertise.

Dr. Tolan: You are very welcome, call any time.

My take on this: if you are doing nasal saline rinses, you have little to fear from Amoeba, as long as you are using distilled water or boiled tap water. You have a much (much) higher risk of exposure to N. fowleri by swimming in lakes or ponds in Southern states.

Conclusions

• It’s not about the Neti pot, or even about nasal rinses.
• It’s about the water.
• Just be sure your water is safe. How?
• Use distilled or boiled water for your nasal rinses!

The Life-Cycle of N. fowleri

The image below shows how N. fowleri (and some other amoeba species) get into our brains: simply swimming in ponds or lakes with high concentrations of amoeba (think warm, Southern states), can result in amoeba reaching our noses; they crawl through our “olfactory neuroepithelium” – that part of our noses that give us the sense of smell), and enter our brains that way. Bad news!

Image: Life-cycles of amoeba

Please leave a comment / reply and let us know how you are doing nasal saline rinses.

And thanks for visiting!

____________________________

About Dr. Robert Tolan

Dr. Tolan is a world-renowned expert on infections of the central nervous system.

He is currently Chief, Division of Allergy, Immunology and Infectious Diseases, The Children’s Hospital at Saint Peter’s University Hospital, New Brunswick, New Jersey and Clinical Associate Professor of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.

He earned a Master’s Degree in Microbiology before earning his Medical Degree at Washington University School of Medicine. Following his training in Pediatrics, he pursued advanced training and research in Infectious Diseases at Washington University/St. Louis Children’s Hospital. He is board certified in Pediatrics by the American Board of Pediatrics, and also the Sub-Board of Infectious Diseases. He teaches at Drexel University, where he is Associate Clinical Professor.

Dr. Tolan’s research is funded by the NIH; he studies various infections in children and infants, and his list of publications is longer than I am tall.

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Resources:

http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2332

http://www.medicalnewstoday.com/articles/239422.php – be sure to read the comments: this isn’t about Neti pots! It’s about the WATER.

http://health.yahoo.net/articles/flu/neti-pot-deaths-linked-brain-eating-amoeba-tap-water

http://phoenix.about.com/od/health/qt/Ameba.htm

http://www.wwltv.com/news/health/Doctors-explain-cause-of-brain-eating-amoeba-128043523.html

Image Credit:  All images from the CDC (Centers for Disease Control and Prevention) Image Library, in the Public Domain.

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

There are now several well-written reviews about managing allergic rhinitis during pregnancy. “Why should that be a special problem?” you may ask. Well, ANY time a woman who is growing a person inside of them is exposed to medications, there is the potential for harm to her fetus – that little peanut in the ultrasound pic, above. So the question of how to best treat allergic rhinitis during pregnancy poses some special considerations.

I have listed 4 well-written, erudite (scholarly) reviews below, under the Resources heading at the end of this article. Take a look if you are interested.

Allergic? Really?

There is only one problem with treating Rhinitis of Pregnancy as simple Allergic Rhinitis: most often the rhinitis that women experience during pregnancy is NOT from allergies. It’s not Allergic Rhinitis. So those guidelines may not be useful for the severe nasal congestion that you experience during pregnancy.

So, what exactly IS Rhinitis of Pregnancy?

What is causing that severe nasal stuffiness?

Those Pesky Hormones 

My peanut playing on beach (same peanut in the ultrasound, above)

In a word … hormones. The same thing that is causing most of those other changes that you experience during pregnancy. The same hormones that help increase vascular supply to your growing fetus can also cause vascular changes to the nasal lining, causing swelling of the nasal lining, and nasal congestion.

And, according to published studies, rhinitis of pregnancy may affect nearly a third of pregnant women. When severe, rhinitis of pregnancy can cause complete nasal obstruction.

I’ve said before, but it bears repeating – especially if you are pregnant and you are experiencing severe nasal congestion: the best remedy is daily nasal saline rinsing.

Saline rinses are the simplest, most effective remedy for Rhinitis of Pregnancy, but there are others. Things like reducing your exposure to dust, toxins; eat healthy (duh), get plenty of rest (good luck). Re-visit an old post on the Rhinitis of Pregnancy: What it is, What to Do About It? for more tips.

Also visit Nasopure.com for the best nasal rinse system available (the one that I use for my family, and recommend for my patients), and some great videos. There is a popular video there of a three-year-old girl doing nasal rinses. (It’s pretty difficult to whine about doing them once you see a little girl doing them without complaint.)

This topic – Rhinitis of Pregnancy – is THE most popular topic on this blog site. Let us know about YOUR experience. What, if anything, has worked for you? Leave a comment below so that we can all learn from each other.

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Resources

Treating Asthma and Comorbid Allergic Rhinitis in Pregnancy: A Review of the Current Guidelines. Posted on Medscape Today. In the journal, Journal American Board of Family Medicine. 2007;20(3):289-298.
Link: http://www.medscape.com/viewarticle/558444

Treating allergic rhinitis in pregnancy. In the journal, Current Allergy & Asthma Reports. 2006 May;6(3):232-8.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/16579874

Treatment of allergic rhinitis during pregnancy. In the journal, American Journal of Rhinology. 2004 Jan-Feb;18(1):23-8.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/15035567

Treating allergic rhinitis in pregnancy. Safety considerations. In the journal, Drug Safety. 1999 Apr;20(4):361-75.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/10230583

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

The boogordoctor’s Gratitude List

Thanksgiving

Today is that annual Holiday for Americans when we lounge on the sofa, watch football, and eat our weight in foods that have nothing to do with the Pilgrims or being grateful. That’s okay. It is a wonderful Holiday tradition, and some of us are fortunate enough to spend it with our families.

It is also a reminder of the things that we have to be thankful for. This year, there are many things that I am thankful for – indeed, profoundly grateful  for.

Physicians and surgeons are privileged (and burdened) to witness the best (and worst) of humanity: The brother or sister that sacrifices a kidney for someone they love; the team of physicians and nurses that visits the jungle clinic to help restore the cleft smile of a child to make it whole and beautiful; the extraordinary skill of the surgeon who combines technology (say, a surgical robot) and a gift of manual dexterity to remove a malignant tumor; the list goes on.

This year, the children in my practice, and those I have cared for at my hospital, have reminded me of the many things that I am grateful for. Most of us take these things for granted.

Here is a partial list, in no particular order:

• I have a roof over my head, a dry warm bed to sleep in, and food to eat
• I have all of my original organs, and most are still working pretty well
• I am not intubated, on a mechanical ventilator
• I am still talking and walking on my own
• I am not confused about my gender
• I am not living at a hospital

I am grateful for all of the readers of this simple medical education blog site.

Incredibly, there have been more than 76,000 people have visited since starting this site in March of last year.

There are now more than 8,000 visitors every month, and the number keeps growing!

I am astonished, and humbled. And grateful for the wonderful and kind people I have met through blogging on this site.

I am grateful for the care of children entrusted to me by parents and referring physicians. As a parent, I understand the difficulty of trusting a stranger with the health and lives of my children. The children in my medical practice always make me smile and bring me joy. And inspire me.

I am grateful for my colleagues – physicians, nurses, aides – in the hospitals that I serve. They are a humbling inspiration.

In addition, I am most profoundly grateful for my own wife and children, and for being able to spend time with them. (There was a time when I routinely worked 80 hours per week, and did not spend much time with my kids.)

Finally, let’s all send some supportive thoughts and prayers to the young men and women who are serving in our military, many serving in uncomfortable, far-away places, without friends or family on these Holidays. Wish for peace.

What things are you grateful for? Let us know in a list.

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Image Credit:

US Navy 061123-N-0237L-016 USS Essex (LHD 2) Commanding Officer, Capt. Brian Donegan, cuts a Thanksgiving turkey on the ship’s Mess Decks as Essex’ Supply Officer, Cmdr. Carl Weiss looks on.

Image in public domain, from WikiCommons: http://bit.ly/rpeYgI

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Hi, I’m Russell Faust, author of this medical education blog.

Image: Russell Faust

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Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)