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Posted on: Mon, 06/12/2006 - 11:29am
Precious1971's picture
Joined: 12/21/2005 - 09:00

Quote:Originally posted by N8healer:
[B]Hello all:
I am a 52 year old physician -- former ER doctor with severe (SEVERE) peanut allergy.
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
N8healer's picture
Joined: 06/04/2006 - 09:00

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
TwokidsNJ's picture
Joined: 05/28/2005 - 09:00

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
ajgauthier's picture
Joined: 04/13/2005 - 09:00

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.
30-year old survivor of severe peanut/tree nut allergy

Posted on: Tue, 06/13/2006 - 2:17pm
N8healer's picture
Joined: 06/04/2006 - 09:00

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
Peg541's picture
Joined: 12/29/2002 - 09:00

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.

Posted on: Tue, 06/13/2006 - 4:29pm
Corvallis Mom's picture
Joined: 05/22/2001 - 09:00

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.
[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
LisaM's picture
Joined: 11/04/2005 - 09:00

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:
"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
Carefulmom's picture
Joined: 01/03/2002 - 09:00

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
Momcat's picture
Joined: 03/15/2005 - 09:00

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:
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!
Stuart Shipko, M.D.
Mom to 7 yr old PA/TNA daughter and 3 1/2 yr old son who is allergic to eggs.


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