Intro: I have PA and am a physician

Posted on: Sat, 06/10/2006 - 7:40am
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Hello all:

I am new to the board and introducing myself. This will probably be my only post, but I wanted to share my knowledge and experience with all. I am a 52 year old physician -- former ER doctor with severe (SEVERE) peanut allergy.

My allergy is so severe that epinephrine injection is ineffective. The closest I came to death was when I went to an emergency room while in college. While waiting for a doctor, the reaction became more and more severe... I lived, but barely.

This is my protocol for peanut reaction:
#1 (most important) get the peanut out of your stomach. The peanut will swell the stomach and it will not pass easily to the intestines. It sits in the stomach stimulating histamine for a long, long time. It must be vomited up. First I drink about a quart of water. This serves two purposes. first, it dilutes the peanut and buys time. Second, the stomach has a lot of folds and one needs to flush out the peanut in the folds. Second, I induce vomiting by sticking my finger down my throat. If I don't get the peanut out, all the epinephrine and benadryl in the world won't help me. After the first quart is vomited up, I drink a second quart and do it again.

#2 Dristan spray rocks. What is going to kill a person with PA is when the vocal chords swell and the airway is closed. An epi pen is OK for milder PA, but is too slow and nonspecific for me. Dristan and other nasal decongestants contain a synthetic adrenaline product. I open my throat and spray A LOT of Dristan like product on my vocal chords. It is absorbed rapidly and helps with systemic anaphylactic problems as well. I have also purchased epinephrine 1:1000 vials and use the syringe to squirt the stuff on my vocal chords. I may also spray my eyes if they are swelling shut. This needs to be done before and after vominting up the peanuts. It is risky to vomit up the peanuts because small amounts may be aspirated or it can shoot up into the nose. Pretreatment with the spray prevents complications from vomiting up the peanuts.

#3 Liquid Benadryl. Anaphylaxis is caused by release of histamine. Adrenaline stops further release of histamine. Benadryl (or other antihistamine) neutralizes the histamine already released. I use the elixer because it is absorbed faster. Histamine will continue to be released/active even after one throws up the peanuts, so an antihistamine is needed. I use about 200 mg, but this is a lot. It took me a long time to learn what my dosages are.

I leave Dristan and Benadryl in my car, office, home etc. I hope that this is helpful to everyone. Of course, the most important thing is to avoid eating peanut products in the first place - ask and ask again, read labels, don't eat anything that you think might have peanut products in it and when in doubt -- don't eat it!

Posted on: Sat, 06/10/2006 - 11:22am
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Welcome Doc,
Lots of healthcare folks here. Ever seen any sulfite-sensitivity w/ Epi? Haven't needed it since I developed my sulfite problems. Because of this, for milder food reactions they usually treat me w/ Benadryl and Pred...so far, so good.
Thanks,
Daisy
SFA, EA, TNA, sulfites, X-Ray contrast

Posted on: Sat, 06/10/2006 - 1:56pm
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Being a physician, have you looked into taking Xolair?
I'm not in healthcare so I don't know what the cost is like for physicians as opposed to patients. I believe for people who can't get insurance to cover it, it's $10,000 every three months or something crazy like that.
But the studies they've done so far with Xolair and PA have been very promising. Unfortunately they've been discontinued because some people went into anaphylaxis unexpectedly while they were establishing their initial base-line sensitivity. But before they were discontinued, it seemed like Xolair was able to raise tolerance up to a level of something like 3-6 peanuts. The data is on the boards somewhere if you search for Xolair.
Because the studies weren't completed, Xolair is at the moment only approved for severe asthma, which combined with the cost is the reason everyone on this board isn't on it. But being a doctor, you wouldn't have to go through the whole mess of trying to get yourself declared a severe asthmatic to get the drug.
Anyway, if your reactions are that severe and you're having enough of them to have figured out all these precise steps you need to take, Xolair might be beneficial to you. Even if it doesn't end up being as beneficial as the initial findings found, it couldn't hurt to try it if your reactions are that severe.

Posted on: Sat, 06/10/2006 - 3:42pm
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I've done some research on overdose symptoms of Dristan-type sprays and benadryl...and it scares me. I would suggest that before anyone use the method that N8healer described, to talk it over with their primary care/pediatrician first.
I do agree with the "get the peanut out of the body" statement. Once I ate a few bites of a cafeteria roll that had ground peanuts in it, and I drank as much liquid as I could find and then threw up. It was sort of instinctual to me...to get it out of my body.
However, the whole throwing up thing doesn't help too much with the peanut coming back up through the esophagus into the mouth. I swelled up horrifically! In hindsight, I probably should have taken a swig of benadryl liquid (if I'd had it) and then done it again after purging...just to get the benadryl acting on my throat.
In any event...I know you are a physician, but I would like to remind everyone to talk to their own doctor about it before trying the Dristan, possibly OD'ing on benadryl fix...especially with children.
Adrienne
31 year old PA survivor
[This message has been edited by ajgauthier (edited June 11, 2006).]

Posted on: Sat, 06/10/2006 - 5:26pm
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When my son had his first reaction he also vomited later on. The vomit brought the peanuts back up his esophagus into his mouth and sinuses almost totally closing off his airway.
I am very hesitant to recommend induced vomiting in a person who is already in trouble.
Peg

Posted on: Sat, 06/10/2006 - 10:51pm
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In cases where your throat is swelling/closing, then one probably couldn't drink water to get the peanut protein out, right?
Meg

Posted on: Sun, 06/11/2006 - 12:30am
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In my estimation it is extremely dangerous to induce vomiting in anyone who is in trouble medically, or soon to be. Anything can happen. Vomit or water can go into the lungs and then you have a big problem.
Can you imagine peanut vomit in the lungs?
On this board we are dealing mostly with little children. Please think twice (more like 100 times) before you even consider inducing vomiting without medical advice.
Use the epi pen, Benadryl, call 911. Until you have been instructed otherwise by your physician.
Peggy

Posted on: Sun, 06/11/2006 - 1:04am
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No worries, I don't see me trying to do any of these things with my four year old son, I was just kind of wondering out loud.
For us, it will be epi, 911, ambulance, hospital. Meg

Posted on: Sun, 06/11/2006 - 1:39am
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I don`t think he/she is really a physician. Look at #2. Epi is anything but slow. Anyone who has used it would know that.

Posted on: Sun, 06/11/2006 - 1:43am
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If this person is speaking from personal experience then fine but I have an issue with someone telling us that epi does not work but Dristan and Vomiting are good ideas.
That might be what works for this person but we have to make our own ways with PA and right now Epi and Benadryl and 911 work for me.
Peg

Posted on: Sun, 06/11/2006 - 2:24am
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Take a look at the posters name - N8Healer - sounds like NAET to me - Nambudripad's Allergy Elimination Technique - a very controversial approach to "elimination" of allergy.
My advice - Stay FAR, FAR away from this. I think it is not only bad advise, but could infact be quite dangerous.
Beware!
Margaret

Posted on: Sun, 06/11/2006 - 4:30am
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I too would disagree with that method first posted. I would also have to say that Naet doesn't teach that method either. When dd or myself has accidentally ingested an allergen due to cross contamination both of our first response is either vomiting. Not induced though it just happened. Our doctor recommended that at exposure, cross contamination or reaction to take benadryl as quickly as possible but to also use the epi. I would never recommended the advise given. Maybe it works for him but that approach sounds like you are gambling with your life.
Blessings to all to stay nut free, safe and listen to your own doctors advise.
toomanynuts

Posted on: Sun, 06/11/2006 - 6:43am
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Quote:Originally posted by Peg541:
[b]When my son had his first reaction he also vomited later on. The vomit brought the peanuts back up his esophagus into his mouth and sinuses almost totally closing off his airway.
I am very hesitant to recommend induced vomiting in a person who is already in trouble.
Peg[/b]
I agree with that, and after reading some more thoughts I probably wouldn't induce vomiting. However, I my allergist did say to me that drinking water or juice or something does help the stomache deal with the peanut protein.
In all my ingestion reactions though, vomiting just happened. My stomache filled with this mucus-nastiness as a natural protection mechanism (like how your nose will run/stuff up) and you can't help but vomit when that happens. Something to possibly be aware/cautious of for sure.
But yeah, aspirating peanut protein directly into the lungs would not be good.
I'll count my lucky stars that didn't happen to me.
Adrienne
------------------
30-year old survivor of severe peanut/tree nut allergy

Posted on: Sun, 06/11/2006 - 11:05am
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During DS 1st anaphylactic rxn (before diagnosis so no epi and no clue what was happening) he vomited and then wanted lots to drink...he was 2 yrs old. Maybe the body instinctually knows to dilute what's in the stomach? Anyhow, would you follow your child's instincts and allow drinking of lots of fluid knowing it may induce vomiting, which could be dangerous? My tendency is to trust their instinct but it concerns me this could be dangerous. What are the chances of aspirating the vomit? Has this ever happened to anyone?
Luvmyboys

Posted on: Sun, 06/11/2006 - 12:25pm
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Quote:Originally posted by luvmyboys:
[b]During DS 1st anaphylactic rxn (before diagnosis so no epi and no clue what was happening) he vomited and then wanted lots to drink...he was 2 yrs old. Maybe the body instinctually knows to dilute what's in the stomach? Anyhow, would you follow your child's instincts and allow drinking of lots of fluid knowing it may induce vomiting, which could be dangerous? My tendency is to trust their instinct but it concerns me this could be dangerous. What are the chances of aspirating the vomit? Has this ever happened to anyone?
Luvmyboys[/b]
I'm not sure if my instinct to drink was of thirst or to try to get the "taste of peanut" out of my mouth/throat...the taste of hives.
In any event, I just wanted to drink drink drink, which of course made it easier to vomit.
Adrienne
------------------
30-year old survivor of severe peanut/tree nut allergy

Posted on: Sun, 06/11/2006 - 12:48pm
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The original poster appears to be a fraud. This "treatment" could kill somebody. It does nothing to combat anaphylactic shock, which is caused by a drastic drop in blood pressure. Epinephrine is the only treatment that will contract the blood vessels and reverse shock. Also, has anyone ever tried to spray anything on their vocal cords? I can't even see mine! Let's get real here. This person should not be giving medical advice, and the "N8" (=NAET) in his name is huge tip-off.
Cathy

Posted on: Sun, 06/11/2006 - 1:01pm
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Quote:Originally posted by Momcat:
[b]The original poster appears to be a fraud. This "treatment" could kill somebody. It does nothing to combat anaphylactic shock, which is caused by a drastic drop in blood pressure. Epinephrine is the only treatment that will contract the blood vessels and reverse shock. Also, has anyone ever tried to spray anything on their vocal cords? I can't even see mine! Let's get real here. This person should not be giving medical advice, and the "N8" (=NAET) in his name is huge tip-off.
Cathy[/b]
I've reported the thread/poster to Chris (owner of board) to see if he'll remove it...since...it may/is someone who is pretending to be a doctor and posting dangerous advice.
Adrienne
------------------
30-year old survivor of severe peanut/tree nut allergy

Posted on: Sun, 06/11/2006 - 1:34pm
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My first thoughts on this post was 'imposter' ....maybe he is, maybe not--but either way, before anyone tries something 'new' like this--PLEASE check with YOUR OWN doc!!
Take care,
Lisa

Posted on: Sun, 06/11/2006 - 11:46pm
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As soon as I read the sentence "#1 (most important) get the peanut out of your stomach." I sent out a mental message of "PEG YOU ARE NEEDED IN AN INTO THREAD". [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img] I was very glad to see she was already here. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
Quote:Originally posted by N8healer:
[b] What is going to kill a person with PA is when the vocal chords swell and the airway is closed. [/b]
I don't think my throat swelled. However, my heart and lungs did. When they swell enough, the heart cannot pump, and air cannot go into your lungs. Then you die. Even if your vocal chords are fine and the airway is open.
And could one of our real professionals explain a bit about low blood pressure? I just don't understand it well enough to explain it clearly to a *doctor*. [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img]
**********
Has summer break started already?

Posted on: Mon, 06/12/2006 - 2:27am
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I am writing this for the people who may read this thread and actually think that this advice is good. Please ignore this person's advice! For detailed reasoning, see below:
Quote:Originally posted by N8healer:
[b]I am new to the board and introducing myself.[/b] You are not bothering to come back.
Clue one that you are a fraud.
Quote:get the peanut out of your stomach. . . It must be vomited up.
Which will not work and is dangerous to do when your airways are closing.
Clue Two you are a fraud
Quote:First I drink about a quart of water. This serves two purposes. first, it dilutes the peanut and buys time.
Many people react to "may contains" which have a minimal amount of peanut protein on them. I doubt a little extra water will not help and can only harm because (1.) it will delay your taking medicine that will help you and (2.) can be problematic if you throat is closing.
Clue three you are a fraud
Quote: My allergy is so severe that epinephrine injection is ineffective. . . . Dristan and other nasal decongestants contain a synthetic adrenaline product. I open my throat and spray A LOT of Dristan like product on my vocal chords. It is absorbed rapidly and helps with systemic anaphylactic problems as well.
A shot of epinephrine directly into the bloodstrean doesn't help you with a systemic reaction, but I am supposed to believe a spray of Dristan onto your vocal cords will?
Also, I cannot find any dristan product which has adreneline (aka epinephrine) as an ingredient. All I can find are simple decongestant products.
Clue four you are a fraud
Quote:I leave Dristan and Benadryl in my car, ... where, due to extreme heat or cold in the car, they will soon be rendered useless.
Quote: Of course, the most important thing is to avoid eating peanut products in the first place - ask and ask again, read labels, don't eat anything that you think might have peanut products in it and when in doubt -- don't eat it!
the only bit of good advice that you have given.
------------------
Ellen
Allergic to Shellfish/ Mom to Jesse 9/01 who has PA
Sometimes I just want to say "blah blah blah blah blah."
[This message has been edited by ElleMo (edited June 12, 2006).]

Posted on: Mon, 06/12/2006 - 2:49am
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Anonymous (not verified)

Not arguing with you Ellen, but wanted to point out, epinephrine is not given in a vein for anaphylaxis. It is [i]intra-muscular[/i].

Posted on: Mon, 06/12/2006 - 11:29am
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Quote:Originally posted by N8healer:
[B]Hello all:
I am a 52 year old physician -- former ER doctor with severe (SEVERE) peanut allergy.
/B]
I have to say as a new PA Adult (34 yrs old), I find your VERY post insulting because I am new to this site.
For future references, Stay off of these boards unless you have medical scientific proven information that these "so-called" remedies work. You are not doing us any favors.

Posted on: Tue, 06/13/2006 - 11:13am
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Hi everyone;
I'm not an imposter and what I wrote is not a prank. Medically it is not implausible. The decongestent contans a synthetic epinephrine, phenylephrine. It is rapidly absorbed systemically by the lining of the throat and lungs to prevent hypotension and it shrinks any swelling of the throat/lungs rapidly and more effectively than an injection of epinephrine. Ask your own doctors what they think of the idea.
I concur that the vomiting itself is traumatic and a large aspiration would be very grave, but still of major importance. Pretreatment with phenylephrine minimizes the trauma. As long as the peanut is in your system, the mast cells keep releasing histamine. IMHO this is still the best way to go.
So, take the information any way you like, it was intended to be helpful, not a joke.
Discuss it with your doctors.
[This message has been edited by N8healer (edited June 13, 2006).]

Posted on: Tue, 06/13/2006 - 12:07pm
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If you're so confident N8, then please post your real name, dr title/type, location, etc.

Posted on: Tue, 06/13/2006 - 12:26pm
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hiya -
Sorry you suffer from PA also, I've had it my entire life and was diagnosed around age 2. I've had a few severe reactions (anaphylaxis) that required immediate hospital attention and epipen. I've been super careful ever since and haven't had a reaction in over 15 years, due to careful eating habits. Hope you have perused some of our board to see how others cope and some of the strategies we use to stay safe. Even though I grew up with PA, I learned a lot from many on here, as, some of the parents on here are great at researching food manufacturers and listing odd places to find peanuts!
However, I would not ever go to a board certified psychiatrist for treatment of my allergy. I realize that yes, you are an MD and went to medical school, and probably did a rotation in the ER as a general ER doc. You listed yourself as a physician, and while psychiatrists are indeed MDs/physicians, you are not a primary care doc or an allergy specialist and there are many things (medically) you may not be aware of or how peanut allergies are handled/treated by allergists, pediatricians, and primary care docs.
My concern, is that someone who suffers from PA would see your first post, think "oh hey, that's posted by a doctor!" and follow the advice you gave to treat themselves or heaven-forbid their child, without talking with their doctor first. Aye, the problem with the internet!
Why do you think sites such as WebMD or medical discussion boards always have a disclaimer at the bottom? To protect the viewer AND the doctor. There are some doctors and nurses and other medical professionals on here that ALWAYS put a disclaimer after any hints/advice/medical mumbo-jumbo they post.
Ok, I've said my peace and may have also spoken for some others on here.
Just please be careful when you post any medical treatment ideas :-)
And welcome, we have only been harsh on your post b/c a lot of it isn't standard emergency treatment that is accepted.
Adrienne
------------------
30-year old survivor of severe peanut/tree nut allergy

Posted on: Tue, 06/13/2006 - 2:17pm
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Just for the record, my name is Stuart Shipko, M.D. Currently I am a psychiatrist in California. Before residency in psychiatry I was an attending in emergency medicine at a Boston University Hospital. I have treated a fair amount of anyphylaxis. While one size does not fit all this is my opinion, professional and personal.
I understand BBS dynamics, having run my own board on panic disorder for a number of years. I understand how LOUD it can be when a person who is an actual expert posts. But because my situation is so unique, I thought I would share my personal favorite treatment strategy. YMMV.

Posted on: Tue, 06/13/2006 - 3:32pm
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Please understand this. We have many members here dealing with PA and very small children. The only information they get is from their physicians. They HAVE to believe their physicians because we all have to trust someone. It is too scary to think your physician might steer you wrong.
You posted information that was frankly way out there and it is frightening to think some mother or father here could take that to heart and try some of your methods for their child instead of the tried and true recommended epi pen, Benadryl, call 911.
I know you said this was your unique personal experience. Still you threw up enough red flags to make many of us very uneasy.
Peggy

Posted on: Tue, 06/13/2006 - 4:29pm
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Well, also in my professional opinion,
Phenylephrine (correctly identified as the major ingredient in several nasal decongestant preparations) IS NOT THE EQUIVALENT of EPINEPHRINE/ADRENALINE chemically or (more importantly for the purposes of this discussion) [i]pharmacologically[/i].
You [i]may[/i] be a physician. You are clearly NOT a pharmacologist or a medicinal chemist... or you would never have identified these two drugs as interchangeable for one another.
THEY ARE NOT THE SAME.
[b] Phenylephrine is not adrenaline/epinephrine, and it doesn't substitute for it![/b]
My name and credentials are available to anyone who would like to contact me off the public boards. I will not violate my child's privacy by posting them here... suffice it to say that I have a terminal degree in chemistry, have been a professor at a research university, and work as a pharmacologist. I routinely work with beta antagonists and agonists, including epinephrine.
Mostly, I post here as a parent. Now I do so as a professional. I expect that our resident practicing pharmacist will also concur. Primatene mist is the only OTC preparation I am aware of that currently (US) contains epinephrine. Period.
The perspective you have as a [i]mental health professional[/i] is fabulous! A great many of us have literally held our children and known they were dying in our arms. If that can't trigger PTSD, panic disorders, or major depression, then I don't know what can... oh, wait, I do. The constant strain of dealing with a toddler with multiple common foods which are anaphylaxis triggers. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]
Seriously-- so allergy isn't your specialty. That is fine. I value your experiences as a PA adult-- particularly one with a psychiatric specialty. Many of us have had terribly negative experiences with therapists who have told us to just "lighten up." Someone with first hand knowledge of anaphylaxis isn't likely to feel that way.
[This message has been edited by Corvallis Mom (edited June 14, 2006).]
[This message has been edited by Corvallis Mom (edited June 14, 2006).]

Posted on: Tue, 06/13/2006 - 10:54pm
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N8Healer, when reading your original post about how severe your most severe reaction was, I was wondering how long it took before you were treated with epinephrine. It sounds like it could have been awhile. When I was in highschool, I had a very scary reaction...I did not have an epipen at the time and it took me awhile to decide to go to the hospital. (I had had milder anaphylactic events before and had been diagnosed as a child with severe food allergies...but the word "anaphylaxis" never came up in medical appointments.)
I was in respiratory distress and was quite swollen, and the first dose of adrenaline had absolutely no effect....thankfully the second kicked in. I had gone through most of my life thinking that I was just extremely allergic and that there was the chance that the epipen might not be effective in my case. But I learned recently (from the podcast from Dr. Peter Vadas at allergicliving.com) that it is more common to require more than one shot of adrenaline than one might think. In fact, all people with anaphylaxis are advised to carry two.
And my current allergist says that if I had been treated immediately as opposed to 20 minutes after the reaction started that I would have probably been fine. There are no guarantees, but the sooner we take the epipen the more remote the chances are that we will die.
I'd suggest trying the epi first before the other treatments.
Another alternative treatment to the epi:
[url="http://www.allerg.qc.ca/peanutallergy.htm#charcoal"]http://www.allerg.qc.ca/peanutallergy.htm#charcoal[/url]
"Activated charcoal forms non IgE binding complexes with peanut proteins, is the title of a study by Vadas and Perlman in the July 2003 J Allergy Clin Immunol. They report that activated charcoal adsorbs to peanut proteins, forming insoluble complexes that no longer allow the peanut proteins to bind IgE. These data suggest that administration of activated charcoal soon after accidental ingestion of peanut might be a useful adjunct in the management of peanut-induced anaphylaxis. This approach is likely to be applicable to the prevention of more severe and prolonged anaphylactic reactions to other foods as well."
I don't think the activated charcoal (which I hasten to add is not at all the same as regular charcoal) is necessarily a good idea for those of us who can take the epi. But some people can't use the epi---people on beta blockers, for instance.

Posted on: Tue, 06/13/2006 - 11:43pm
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N8healer, how does your malpractice carrier feel about you dispensing medical advice on the internet? It is so hard to find a carrier that covers that sort of thing. So you must have a carrier that covers it, or you would not be dispensing medical advice, especially when you don`t currently practice in the field of food allergy. I don`t know of any carriers that cover it, so which one does?

Posted on: Wed, 06/14/2006 - 3:29am
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I just received an interesting email from Dr. Shipko. I had emailed him to verify that he was indeed posting under the name N8healer. Here is the reply I received:
Quote:
I posted the information, yes. I think that the information is excellant. As I posted, I was an attending in emergency medicine for Boston University as well as having my own very severe problem. Given all of the negative feedback I have received, I request that the thread be deleted and unregister me from the site. As I wrote, I wanted to share my knowledge and experience. If it is not helpful to others then it serves no purpose and should be deleted. I must say that your group is narrow minded and antagonistic and this is the first time that I have extended myself to share information and have had this sort of response. I think that my addendum posts, which included my name and the advice to discuss this with their physicians makes it clear that I am not instructing people to abandon their own strategies in favor of the one I have suggested.
Over the years I have given generously of my time and experience to help share useful medical information. I am sorry if I have been misinterpreted. Medically the advice I gave is quite sound. Given the antagonism and negativity, I would feel most comfortable with the whole thread being deleted. Please take my registration/information out of your database I will not be posting again!
Sincerely,
Stuart Shipko, M.D.
Cathy
------------------
Mom to 7 yr old PA/TNA daughter and 3 1/2 yr old son who is allergic to eggs.

Posted on: Wed, 06/14/2006 - 3:31am
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I also forwarded the original post to my allergist to get his opinion. Here is his reply:
Quote:
Thank you for the interesting e-mail. I must say that the author's recommendations remain unproven by good studies; are physiologically, pharmacologically and immunologically untenable in several respects; and in any case seem fraught with danger and thus are not recommended.
Cathy

Posted on: Wed, 06/14/2006 - 3:53am
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Well, as bad as I think the original advice posted was (as a pharmacologist, here....) I certainly hope that this person will reconsider the boards.
I would HOPE that he recognizes that we are not objecting to [i]him[/i]... only bad medical advice. He needs to keep in mind that the "doctor" label doesn't automatically awe a lot of us here... even those of us who share it. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]
Why isn't he still practicing in emergent care, anyway? Or was this a rotation during med school? No shame in doing what you're best suited for, BTW. Physiology and pharmacology isn't everyone's cup of tea.
I got the sense that he didn't like being questioned/challenged. Some doctors have a God complex at work, and cannot stand challenges to their egos. He seemed a bit hung up on being an "expert." Bit more so than on being "right," truthfully. For the record, he isn't. A medical "expert" in food anaphylaxis, that is. A psychiatric professional (in my own experience) is usually well aware of the limitations imposed by not practicing internal medicine routinely. Unless this was about seeking personal gratification via being "the expert?"
If that is the case, then he's right not to want a place here. [i]Physician, heal thyself.[/i] KWIM?
Personally? I don't expect to offer my opinion here (even professionally, which I rarely do) without evidence to back it up.
If, on the other hand, he would like to "start clean" then that has certainly been done before now! Choosing a new username and starting afresh is perfectly acceptable here. I hope he knows that. We are a very forgiving bunch, y'know... we're all in this boat together, after all.
[img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
[This message has been edited by Corvallis Mom (edited June 14, 2006).]

Posted on: Wed, 06/14/2006 - 4:09am
Momcat's picture
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I hope that for his own sake he reconsiders his treatment plan. At the very least, someone with severe PA should not keep their medication in the car.
Cathy

Posted on: Wed, 06/14/2006 - 4:48am
LisaM's picture
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Well, yes, the original post was inappropriate given that it left the impression that the physician in question was speaking in his professional capacity. Perhaps he was just meaning to say that he is a doctor and that he has come up with an unconventional treatment that he personally follows....but if so (and I'm not clear on whether that was the original intent) he should be very very careful to clarify that he is not giving official medical advice but is speaking from his personal experience. Doctors are not self-authorizing but represent their profession. If they hand out medical advice that they have come up with on their own but has not been tested, published in a peer-reviewed journal, and widely accepted as standard practise, they could get in very, very big trouble.
But this (major) point aside, I think that the atmosphere on this thread seems a bit hostile...maybe not intentionally so, but some of the posts come across that way. And I'm not sure that it is appropriate to publish a private message on a public forum without the individual's permission.
I've noticed that conversations get heated on this board whenever anyone suggests an alternative treatment...
in my view, we should welcome all opinions especially since they won't go uncontested. We should have faith thatpeople are able to think for themselves and not worry so much that they will jump to conclusions because of one unconventional suggestion.
[This message has been edited by LisaM (edited June 14, 2006).]

Posted on: Wed, 06/14/2006 - 5:03am
Corvallis Mom's picture
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I would say that (as a long-time poster on the boards) the real reason for the hostility was that several assumptions were made regarding the motivation and identity of the original poster... based on things said in the first post.
1. Clearly bad advice regarding anaphylaxis... and pharmacological intervention strategy. Notice many of the professionals who [i]could[/i] have commented didn't even enter the fray at this point... because we felt it was pretty obvious this must have been a person misrepresenting themselves somehow...
2. Unfortunate coincidence of username selection being too like a "quack" organization (NAET) that has targeted this board in the past... with a totally bogus "cure" for FA and frankly insulting tone that we aren't all "curing" our kids.
3. Insistence that this would be a solo post. This is usually a BIG tip-off that the person posting is misrepresenting themselves somehow to start with. (As this person should know full well if he in fact ran a BBS for some time, as he says.)
I definitely thought there was something odd about the poster's advice and supposed credentials, myself. But total imposter didn't seem right, either, as he included info in his user profile and had an e-mail addy. So I stayed out of it once it was clear that the regulars on the board understood that phenylephrine isn't epi.
So I don't think that the hostility was directed at the OP because of his "expert" status, as he supposed. It was because of (in part) history on this board that he isn't aware of.
On the other hand, I personally don't think much of his "expertise" based on what he posted, either. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] But I'm not singling him out.... I'm continuously amazed how little pharmacology many MD's retain-- if in fact they ever knew it.

Posted on: Wed, 06/14/2006 - 5:08am
Momcat's picture
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Quote:Originally posted by LisaM:
[b]
I've noticed that conversations get heated on this board whenever anyone suggests an alternative treatment...[/b]
I think this is because so many of us have had the existence of so-called alternative treatments used against us. How many of you have heard:
"If you just (fill in the blank), your child's allergy will be cured".
or
"Does he really need to have the Epipen with him at all times? I know someone with PA and they just (fill in the blank)"
Yes, there is research going on about other treatments. But for now, none of this is proven or recommended.
Cathy

Posted on: Wed, 06/14/2006 - 6:01am
Carefulmom's picture
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I`m still trying to figure out how he saw his own vocal cords, M.D. or no M.D. I guess physicians can get rid of all those laryngoscopes they usually use when they need to see vocal cords, since there is apparently a way to see vocal cords without using one.
Seriously, we have several physicians on this board. None of us post medical advice, and it usually comes up that we are a physician in some other context such as Off Topic.

Posted on: Wed, 06/14/2006 - 6:28am
krasota's picture
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I certainly wouldn't trust a doctor who didn't advocate use of the epi-pen. That said, N8 could easily be "innate", rather than NAET.
I've use inhaled epinephrine to arrest swelling of the palate, tongue, and throat. It did help, especially when I could not get to my epi-pen in time. I've used a combo of inhaled epinephrine and first gen antihistamines (not benadryl, though, I'm allergic to diphenhydramine) and had success.
But the epi-pen should be the first line of defense if the option is there. I'm an adult and can make my own decisions and I recently had a situation where I *needed* an epi-pen and couldn't find any of mine (recent purse switching). Inhaled epinephrine saved my life, but I'd have rather had the injectable.
For your children, treatment should be proactive and *fast*. Life is precious.
ygg

Posted on: Wed, 06/14/2006 - 8:35am
anonymous's picture
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Dr. Shipko - I think your expertise in panic/anxiety issues would be of great help to many of us. Parents of food allergic children have some of the highest stress levels of any group(I think there was even a published journal study about this). I think the strong reactions from members that you have recieved illustrate how passionate we are about keeping our kids safe. It is a lifelong worry.
My son is 6 and yesterday I let him spend the whole day with his best friend's family. Of course a "normal" six year old would have already done this, but my son has life threatening food allergies. I had to really trust the people he was with, and even then, the whole day I felt sick to my stomach and nervous.
Also if you do a google of NAET you will understand the reaction your user name caused!
Be well.
------------------
mom to Ari(6) - severe nut allergies, asthma, you name it - and Maya (8), mild excema

Posted on: Wed, 06/14/2006 - 10:34am
jmarcustry's picture
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well i'll jump in here also..i am trying very hard to undertand a couple of things..
1. i live near about an hour from boston, never did know that boston university had an e.r.? my impression it was a college.ie university unless of course it has change in the past decade or so? not?
2. if someone with a severe, severe ana reaction to the point that nothing works for that person, how on earth could you possibly have the time to drink gallons of water throw up ,use dristan, and look at your vocal cords?? ive seen reactions, experienced one with my dd and believe me there is only time to inject epi and you better be dialing 911 at the same time. i do know first instinct with ana reaction is almost panic, throat closing chest heavy etc.. you get the picture. i know that all i think about is injecting and praying that i dont die or my dd doesnt, god knows i wouldnt have time to do all of the above. JMHO. i'll happily stick to the advice of my doctor, and the 911 operator and the paramedics thank you. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
------------------
i think i must be wearing a "wonder where they went bra".

Posted on: Wed, 06/14/2006 - 10:39am
jmarcustry's picture
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Joined: 10/09/2000 - 09:00

I was an attending in emergency medicine at a Boston University Hospital.
whoops i stand corrected...but none the less i still cant see how anyone would have the time to do all the stuff the good dr. recomemded if the reaction was/is severe severe.. gonna go google the hospital name still doesnt strike me as a familar hospial..but i am probably wrong there...
ok googled..Boston University Hospital founded in 1855 is an affliate now of boston university teaching school of medicine. hmm i learned something new..still sticking to my guns on the other stuff though..
------------------
i think i must be wearing a "wonder where they went bra".
[This message has been edited by jmarcustry (edited June 14, 2006).]

Posted on: Wed, 06/14/2006 - 1:54pm
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Quote:Originally posted by AnnaMarie:
[b]Not arguing with you Ellen, but wanted to point out, epinephrine is not given in a vein for anaphylaxis. It is [i]intra-muscular[/i].[/b]
Ooops, big mistake. But I hope everyone understood what I was trying to say (If an epi doesn't work, why would Dristan?)
------------------
Ellen
Allergic to Shellfish/ Mom to Jesse 9/01 who has PA
Sometimes I just want to say "blah blah blah blah blah."

Posted on: Thu, 06/15/2006 - 12:52am
LisaM's picture
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Joined: 11/04/2005 - 09:00

Quote:Originally posted by Corvallis Mom:
[b]I would say that (as a long-time poster on the boards) the real reason for the hostility was that several assumptions were made regarding the motivation and identity of the original poster... based on things said in the first post.[/b]
Yeah, I can see that now.
I'm getting off topic here....but about alternative medicine....yes, it would be very annoying to have someone suggest that your child could be "cured." Advice like that is pretentious and also minimizes the seriousness of PA. But I was getting the sense from some posts that some members feel like they can't even broach the whole topic of alternative medicine...but maybe that isn't the case....I haven't been on the board long enough to get a sense of the dynamics.

Posted on: Thu, 06/15/2006 - 1:23am
ElleMo's picture
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Joined: 06/19/2003 - 09:00

Quote:Originally posted by LisaM:
[b] Yeah, I can see that now.
I'm getting off topic here....but about alternative medicine....yes, it would be very annoying to have someone suggest that your child could be "cured." Advice like that is pretentious and also minimizes the seriousness of PA. But I was getting the sense from some posts that some members feel like they can't even broach the whole topic of alternative medicine...but maybe that isn't the case....I haven't been on the board long enough to get a sense of the dynamics.[/b]
I can't speak for everyone, but I can speak for myself. I was upset at the post because the information is potentially dangerous and was presented in a way that made it appear there was substantial medical support for this information. I think alternative medicine can be a good choice for certain conditions/circumstances. I have tried some alternative treatments for my daughter's allergy & asthma. However, during an asthma attack or anaphalaxis that alternative medicine goes out the window. I do only what has been proven to stop this life threatening progression.
Momcat, you mentioned you e-mailed the Dr. Did you e-mail him at his professional address on his Web site? I am having a hard time believing that it is Stuart Shipko actually posting and not someone hijacking his name. From the information I have gotten on the internet, he is not only a practicing doctor but an expert witness in many trials and it seems odd to me that someone with so much experience with the law would post medical information on the net. Not only would he be concerned with his liability, but his credibility could be put into question at a trial (or am I watching too many law shows?)
If you read some of the advice he has on power-surge, it's written with a much more cautious tone than the posts on here:
"I'll give you my thoughts on how I would proceed . . ."
"I [b]would try [/b]to avoid . . "
"I [b]would consider[/b] the use . . ."
"Ultimately you [b]might[/b] be better off . . ."
And he doesn't appear to be the type of person who would write "Drystan spray [b]rocks.[/b]" He appears to have a much more proefessional tone in all his writings and an online chat transcript that I have read.
It seems that this was written by an person uneducated in this area who chose phenylephrine because it sounds like epinephrine. There was (probably still ongoing) an internet urban legend about antifreeze in baby wipes. This is not true, it is just that the ingredient in Baby wipes has a similar chemical name to the chemical name of ant-freeze. This thread made me think of that urban legend.

Posted on: Thu, 06/15/2006 - 2:08am
Momcat's picture
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Quote:Originally posted by ElleMo:
[b]Momcat, you mentioned you e-mailed the Dr. Did you e-mail him at his professional address on his Web site? I am having a hard time believing that it is Stuart Shipko actually posting and not someone hijacking his name.
It seems that this was written by an person uneducated in this area who chose phenylephrine because it sounds like epinephrine. [/b]
ElleMo, I had the same feelings of surprise that this is the same Dr. Shipko. So yes, I did go to his website and use the email address there. I did not use the email address in his profile.
I also looked up phenylephrine. It is not exactly "synthetic epinephrine" but it is a related drug and a vasopressor (constricts blood-vessels to reverse low blood pressure). It seems to be used in decongestants, eye-drops and intravenously during anesthesia to reverse low blood pressure.
[url="http://www.americanregent.com/PDF_For_Products/Phenylephrine%20IN0299%20Rev.%205-01.pdf"]http://www.americanregent.com/PDF_For_Products/Phenylephrine%20IN0299%20Rev.%205-01.pdf[/url]
Cathy

Posted on: Sat, 06/10/2006 - 11:22am
Daisy's picture
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Joined: 01/16/2006 - 09:00

Welcome Doc,
Lots of healthcare folks here. Ever seen any sulfite-sensitivity w/ Epi? Haven't needed it since I developed my sulfite problems. Because of this, for milder food reactions they usually treat me w/ Benadryl and Pred...so far, so good.
Thanks,
Daisy
SFA, EA, TNA, sulfites, X-Ray contrast

Posted on: Sat, 06/10/2006 - 1:56pm
starlight's picture
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Joined: 01/16/2004 - 09:00

Being a physician, have you looked into taking Xolair?
I'm not in healthcare so I don't know what the cost is like for physicians as opposed to patients. I believe for people who can't get insurance to cover it, it's $10,000 every three months or something crazy like that.
But the studies they've done so far with Xolair and PA have been very promising. Unfortunately they've been discontinued because some people went into anaphylaxis unexpectedly while they were establishing their initial base-line sensitivity. But before they were discontinued, it seemed like Xolair was able to raise tolerance up to a level of something like 3-6 peanuts. The data is on the boards somewhere if you search for Xolair.
Because the studies weren't completed, Xolair is at the moment only approved for severe asthma, which combined with the cost is the reason everyone on this board isn't on it. But being a doctor, you wouldn't have to go through the whole mess of trying to get yourself declared a severe asthmatic to get the drug.
Anyway, if your reactions are that severe and you're having enough of them to have figured out all these precise steps you need to take, Xolair might be beneficial to you. Even if it doesn't end up being as beneficial as the initial findings found, it couldn't hurt to try it if your reactions are that severe.

Posted on: Sat, 06/10/2006 - 3:42pm
ajgauthier's picture
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Joined: 04/13/2005 - 09:00

I've done some research on overdose symptoms of Dristan-type sprays and benadryl...and it scares me. I would suggest that before anyone use the method that N8healer described, to talk it over with their primary care/pediatrician first.
I do agree with the "get the peanut out of the body" statement. Once I ate a few bites of a cafeteria roll that had ground peanuts in it, and I drank as much liquid as I could find and then threw up. It was sort of instinctual to me...to get it out of my body.
However, the whole throwing up thing doesn't help too much with the peanut coming back up through the esophagus into the mouth. I swelled up horrifically! In hindsight, I probably should have taken a swig of benadryl liquid (if I'd had it) and then done it again after purging...just to get the benadryl acting on my throat.
In any event...I know you are a physician, but I would like to remind everyone to talk to their own doctor about it before trying the Dristan, possibly OD'ing on benadryl fix...especially with children.
Adrienne
31 year old PA survivor
[This message has been edited by ajgauthier (edited June 11, 2006).]

Posted on: Sat, 06/10/2006 - 5:26pm
Peg541's picture
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Joined: 12/29/2002 - 09:00

When my son had his first reaction he also vomited later on. The vomit brought the peanuts back up his esophagus into his mouth and sinuses almost totally closing off his airway.
I am very hesitant to recommend induced vomiting in a person who is already in trouble.
Peg

Posted on: Sat, 06/10/2006 - 10:51pm
mommyofmatt's picture
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Joined: 03/12/2004 - 09:00

In cases where your throat is swelling/closing, then one probably couldn't drink water to get the peanut protein out, right?
Meg

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