Yuck!  Yuck! 

I have been getting allergy shots at a local group allergy practice, headed by Dr. R.

I actually have an ugly history with this place. 

In 2002, I got allergy shots for awhile from Dr. T.   I get somewhat sick for several days after each shot, but Dr. T finagled me up to concentrate on my non-molds vial - the one with dog in it.  He felt that people tend to have worse reactions to the shots with mold allergens, so he was keeping the doses from the molds vial low and raising the doses just on the non-molds vial. 

Dr. T told me once that I would never get anywhere if I got allergy shots from Dr. R's practice, because they wouldn't do any finagling of the dosages - they would raise doses from both vials in lockstep.  He told me "I don't think much of that place".

His prediction came true, and it was a DISASTER in my life.

Dr. T relocated to Missouri, and I ended up getting allergy shots at Dr. R's practice (I live in a small town and there isn't much choice of allergists). 

I got allergy shots there for 5 years, from 2003-2007.  For the whole time I was at the starting dosage, and later, even more diluted - because they would only mindlessly raise the dosage from my two vials in lockstep. 

Eventually, they stopped my shots. 

That was a fucking disaster.  Soon after that, I became chronically ill without knowing why.  My mind wasn't working, I could hardly think, and I had little energy physically, either. 

How I felt was fairly consistent with how allergies make me feel - but my allergy testing gradually went negative over that time. I saw some allergists as well as other doctors, but no answers.  The allergists discouraged me from investigating allergies as the cause of my illness.

After being sick for 4 years, I finally figured out by doing experiments that I had developed a severe allergy to my dog, who was living in my house.  Even though my allergy tests were negative.

Dr. T had gotten me up to concentrate on the vial with dog allergen, and if I'd been able to continue getting shots from him, I would likely have been up to maintenance on the allergy shots with dog allergen and it's very unlikely my dog allergy would have exploded the way it did. 

I had to move out of my house, I ended up renting a new mobile home in a no-dogs park, which has been pretty good for allergies. 

I found an excellent allergist in NYC who was willing to help me with allergy shots, even with negative allergy tests - although when I went there to get tested, I found that some of my allergies did show up in the allergy testing.  I think that was because I'd been doing all I could to avoid allergen exposure.

Last February, I started getting allergy shots locally, at Dr. S's office.  With additional medications, and finagling the shot dosages for myself, I was able to make a lot of progress on the shot dosages.

Then Dr. S pulled this ugly maneuver of charging me $262 to have his nurse do a Xolair injection for me - price for the injection only, not including the drug!  I only found out about the price hike later, and he refused to adjust the overcharges that had been done without notice. 

That was too much to put up with. 

So, I started getting allergy shots at Dr. R's practice again, the big group allergy practice that had allowed allergies to destroy my life, by stopping my shots. 

Only to find out that they won't let me do the finagling that helps me advance with the shots!  It's too much work for them, they say.  And against their policy. 

For example, I get shots from 3 allergy vials one day of the week.  One time, I asked to keep the dosage from one of the vials the same as the previous week, and increase the other two. 

They refused, and one doctor even attacked me for asking for such things.  As if I were being some kind of princess, rather than desperately trying to get over my allergies as fast as possible!

Yesterday I talked it over with Dr. R in an office visit. 

First, I told him in detail just how bad my allergy situation is. 

Then I told him - by the time my hazy feeling from shots is mild enough that I can increase the dosages, I have no other reactions besides haziness.  No skin reactions, no abdominal pain, nothing.  (I do have skin reactions etc. just after stepping up the shot dosages.)  The hazy feeling isn't medically dangerous - it doesn't imply a risk of anaphylaxis, breathing problems or anything scary like that. 

Being hazy could be dangerous if it were so bad that I was in danger riding my bicycle around - but I don't let the haziness get that bad. 

So I told Dr. R - look, I'm forced to be very conservative with my progress with the shots, because of the hazy feeling.  I'm not running any risk of having scary reactions.  So it doesn't make sense to impose additional restrictions in the name of safety.    I said, why don't you just let me manage my own haziness reactions, by doing what I like with the dosages (within the limits of the schedule). 

My good allergist in NYC doesn't object to me raising the dose on one vial and not others.  This Dr. R is imposing such restrictions ... only because it's their policy! 

He told me he understood what I said and he agreed with me - but he wouldn't let me finagle with allergy shots dosages - and his only reason is, it's their policy!   FUCK their stupid fucking policy. 

I told him his cookbook policies with allergy shots were (part of) why my allergies turned into a disaster. 

He said "90% of our patients have no problem with the shots".  I said, you're abandoning patients with more difficult problems.  He said "we're not abandoning you".  I said, "you certainly did abandon me!".

And actually, it DOES matter for me to be able to be flexible with the shots, now.  Dr. R's practice had forced me stay at the same dosages with some molds and pollens.  I have been having a mild chronic allergic reaction, probably from the fall ragweed.  Having allergic reactions probably makes the shots more difficult to tolerate.  And building up my tolerance to various molds might be important for me to be able to move back into my house, too. 

So yes, while not quite abandoning me with their rigid policies now - they are still interfering and unreasonably hampering my progress.  I asked Dr. R - doesn't it bother you as a doctor, that you aren't helping some patients with more difficult problems? 

Dr. R runs his practice as a fucking business.  He can make plenty of money from the 90% of patients who are OK with his expedited cookbook methods.  And the other 10% of patients?  He doesn't seem to care

He claimed that my good allergist in NYC did the shots differently because he was an ENT.  I told him that my good allergist is not an ENT - not a surgeon, but rather a medical sinusitis specialist. 

I told him Dr. S was willing to be flexible with the shots.  So, he said maybe I should go back to Dr. S. 

Or otherwise, go elsewhere. 

I told him his people had attacked me for my requests for flexibility. 

I called his practice a "lean mean machine" at one point.  He bridled at that - but, it is entirely appropriate!

I told Dr. R that I'd found another place to give me allergy shots.  It's a family practice, and they said if my allergist in NYC makes clear what is OK, they will do it. 

But, this place is 8 miles away.  That's going to be a bit difficult at times.  I'll likely be riding my bike in the rain sometimes, but I bought a bike poncho.  And, it will be getting cold soon, I'm going to have to get some more gear to bike safely 8 miles in the winter.  I can take a taxi on really bad days. 

Dr. R's place is only about 3 miles away, that's part of the appeal.  

Dr. R said at one point, if I make any special requests, the nurse has to see a doctor for approval. 

I told him, I have to ride my bike 8 miles to this family medicine practice that says they'll do what my allergist in NYC asks.  I said, that's much farther than I have to go to your place. 

But, Dr. R's nurses sometimes having to ask a doctor for approval of special requests, matters more to him than me having to ride my bicycle for 10 extra miles. 

I'll be paying more for the shots at the family medicine place, but it's worth it to me. 

My allergist in NYC is technically skilled.  He's very knowledgeable about sinusitis in general. 

But, the main thing that's special about him is that he actually cares enough to help me!  He's willing to do things in a not-totally-standard way because he wants to help me.

And I have to say, I agree with what Dr. T said so many years ago, about Dr. R's practice:  YUCK.  I expect better from doctors than running their practice like a business.  I expect doctors to care about their difficult patients, and try to help them as well!  Not just help the easy patients!

I've thought about giving myself more options by buying a car.  Even though I really dislike owning and driving such a big, wasteful and dangerous machine.  These problems have happened because I live in a small town.  Many people would just find another place to get their allergy shots, and they would drive to it.

But, I would be worried about driving to & from allergy shots because of my haziness after shots.  Perhaps if I were used to driving, I would be OK with driving while hazy.  It's a bit like driving while mildly tipsy.   

Actually, riding my bike 8 miles to this family medicine place for my shots, feels good to my spirit.  The wind in my face, the clean rain sometimes. 

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Comment by Luara on September 27, 2014 at 9:48am

I'm back getting allergy shots at Dr. R's practice ...  

The family medical practice didn't work out.  My allergist in NYC is OK with me stepping up or repeating doses as I choose, and they gave a general permission for me to do that, to the family medical practice.

However, the nurse who runs the allergy shots at the family medical practice told me they wanted specific instructions from my allergist in NYC on which doses to repeat or step up on, EACH time I get allergy shots. 

My allergist in NYC wasn't willing to do this. 

So, I had to go back to Dr. R's office. 

I really dislike the place - it's run as a business, and that is not a positive thing to say about a doctor's office. 

At least while I was at the family medical practice, I managed to even out my allergy shot doses somewhat, by stepping up on the shots that I had less of a reaction to. 

I would like to make a lot of progress on my pollens vial during the fall and winter though.  This is the time to make progress with pollen allergy shots, because there's no pollen in the air. 

And having to step up on my mold vials at the same time as my pollens vial, is likely to hamper progress with my pollens vial.  

Comment by Luara on September 14, 2014 at 6:01am

I described below, how when getting allergy shots at Dr. R's practice, I've felt tiny droplets spritz out of the allergy shot needle, before the injection.  I get the impression the nurses at Dr. R's practice are doing the injections so quickly that they tend to press on the plunger a bit, before the injection.  Does this seem like unacceptably sloppy injection technique?  I don't know if droplets might leak out for some other reason, but I've never noticed droplets spritzing out that way, when I got allergy shots elsewhere.

From the sound of this detailed narrative, your allergist may not want you as his patient

No, as I said Dr. R's cookbook methods with the allergy shots are just how he does things in his practice.  I asked him to do the allergy shots in a less cookbook way with me, in the office visit with him, but he refused.  My request was reasonable:  to be able to individually adjust allergy shot dosages, shuffle the shots from different vials around as needed. 

You might think that if a doctor refuses to accommodate a patient's reasonable request, they just don't want the patient.  But no - what his practice does, is allergy shots as a business.  They want to be able to give shots to each individual patient as fast as possible, that's why they do the shots in a cookbook way.  They can undersell the competition by doing this.  They charge lower prices than other allergists around. 

But they also betray some patients by doing this - by stopping their allergy shots and telling them that "not everyone can get allergy shots", when the truth is that the patient can't tolerate allergy shots, done in a cookbook fashion. 

Medicine isn't just a business, but Dr. R is treating it as such.  He aggressively promotes his allergy practice, by underselling the competition and in other ways. 

I was impressed during the office by how little he felt the need to justify himself.  He agreed that what I said was sensible - that my haziness reactions aren't medically dangerous, I'm forced to be very conservative with the shots because of the hazy reactions, and there's no medical reason to prohibit me from individually adjusting shot dosages.  There's only a business reason:  to process allergy shot patients as quickly as possible, no exceptions. 

Comment by Luara on September 13, 2014 at 6:09am

ps I think the chronic allergen exposure caused my allergy tests to go negative.  I think my hazy feelings from allergy shots are related to my severe late-phase allergic reactions, and I'm guessing my hazy reactions are related to monocytes in the blood, precursors of the dendritic cells that can bind IgE in some allergic people. 

Comment by Luara on September 13, 2014 at 5:48am

Im confused about a severe dog allergy that does not show up with dog allergen tests. It sounds contradictory.

No, it's not contradictory.  It's possible to have an IgE-mediated allergy that is localized in an organ, but doesn't appear in skin or blood allergy testing.

When this happens in the nose, it's called "local allergic rhinitis".  There's a CME course about it, available online.

Local allergic rhinitis seems to be common, actually.  Many cases previously diagnosed as nonallergic rhinitis, probably actually have an allergic cause! 

That means that many people wrongly diagnosed with nonallergic rhinitis, haven't been getting the proper treatment.  Many people with "nonallergic rhinitis", say it's caused by "irritants" like dust, pollen, etc.  Those "irritants" have something in common - they're allergens!

A preliminary study showed that allergy shots can help with local allergic rhinitis.

Local allergic rhinitis may involve delayed hypersensitivity, also. 

Inhalant allergies have an immediate aspect - within a few seconds - and some patients have a delayed reaction that comes on after a few hours. 

For me it's the delayed reaction that is incredibly sensitive.  I don't have a severe allergy in the commonly understood sense.  I've never had to rush to the ER because of breathing problems caused by an allergic reaction.  What does happen, is that a tiny whiff of dog allergen - could be from a dog in a car 50 feet away - has made me sick for 5 days!  Fuzzy-headed, can't think well, sick headache-ish feeling, physically low-energy. 

I've read that in some allergic people, dendritic cells express the high-affinity IgE receptor, FceR1.  Thus, the late-phase allergic reaction can be independently initiated.  I've also read that this late-phase allergic reaction can be extremely sensitive. 

This seems to be what happened to me.  I had a chronic allergic reaction for years, and in that time all sorts of inflammatory tissue and cells probably developed in my nose.  That's why, when I finally figured out I was sick because of a dog allergy, my allergic reactions lasted for 5 days!  Lots of long-term inflammatory things going on. 

My allergic reactions no longer last for 5 days, it's more like about 2 days now, or maybe less. 

I do have immediate allergic reactions, to more intense exposures to dog (and probably cat) allergen.  My immediate allergic reactions aren't nearly as sensitive, though. 

That's why my sickness was so extremely difficult.  I had to figure out on my own that I had a dog allergy.  I saw a couple local allergists, who actually discouraged me from thinking it was allergies! 

I only started to get effective treatment when I saw my allergist in NYC.  He is willing to prescribe allergy shots for me, and he agrees with me that the allergy shots are very important for my recovery!  My allergist in NYC is not the Dr. R who I'm writing about in this blog post.  It's because of bad medical help like I got from Dr. R's practice, that my situation got so horrible. 

My allergist in NYC isn't treating me solely on the basis of my report that I have allergies.  I have had many positive allergy tests in the past.  Also, his office is in a building where dogs also live.  I'm quite allergic to his office, I've started coughing and sneezing and hawking when I've been there, and they have observed the postnasal drip in my throat and swelling in my nose - probably as a reaction to dog allergen in the air. 

I don't physically see my allergist in NYC very often, for that reason.  In the past I've gotten sick both from the busride there (animal dander on people's clothes probably) and from his office.  I hope next time I do go to NYC to see him, I'll have built up enough immunity so I don't get sick from it.  

Comment by Luara on September 13, 2014 at 4:14am

your allergist may not want you as his patient

The allergist Dr. R who I'm complaining about, runs the practice where I was getting allergy shots.  He's administering the shots prescribed by my allergist in NYC.  Dr. R is not my allergist, and there is NO WAY he should be my allergist, since his practice let me down so badly in 2007 when I was "flunked" out of allergy shots. In 2007, I was seeing allergists at Dr. R's practice.  It's very likely my current allergy crisis would have been prevented, if his practice had managed my allergy shots better back then. 

I don't know why you're talking about patients being abusive or dangerous or mentally unsafe.  I haven't acted in that way at all, and nothing in what I wrote indicated that I was being that way.  I was highly critical of his treatment of difficult allergy patients in the office visit, but not abusive about it.  I do my best to deal with problems with my medical care in a mature way, and I know that getting abusive won't help.  If I'm pissed off about something, I usually wait to cool off a bit, before talking about it.  People can express anger without being abusive - I do my best - and my anger at his practice is justified. 

I went into detail about why Dr. R's practice is being unethical as a business and as doctors, in my comment below. 

As a business, they have the right to serve who they choose.

Dr. R didn't tell me I can't be his patient.

Comment by Luara on September 12, 2014 at 5:44am

Dr. R also said during the office visit that if I were a patient at his practice, they would stop my allergy shots because of my hazy feelings after shots!

This was after I told him how allergies had made it impossible for me to live a normal life.  And he knows that my problems haven't been controlled by medications.  Mild allergy problems can be controlled by medications, but severe allergies problems can't. 

I told him "But I desperately need allergy shots!!"  He nodded.

Dr. R did not disagree with my assessment of my situation.  He didn't disagree that there's no medical reason to prohibit me from individually adjusting the allergy shot doses.  He didn't disagree that I need allergy shots.

He simply doesn't want to take on the small amount of extra work that would be required to be flexible with my shots. 

What he's doing with the allergy shots, is giving the shots to patients who can tolerate the shots the cookbook way.  Because he does allergy shots in a cookbook way, he's got it all computerized and quick.  It's very efficient.

So, they can undersell the competition.  Their prices are good:  as a self-pay patient, I was paying $20 for one allergy shot, $24 for two allergy shots. 

But the hidden price is a rigid operation that not all the allergy shot patients will be able to tolerate.

How many allergy shot patients have had their allergy shots stopped at Dr. R's practice, because his cookbook methods didn't work for them? 

I have read other allergy shot patients saying online things like "I wasn't able to make progress with allergy shots until they separated out the dust" (and presumably increased the dust allergen dose more gradually). 

I doubt this is an uncommon problem.

It's so shitty and abusive to Dr. R's patients, to stop the allergy shots of the ones who can't tolerate it, done in a cookbook way!   It would be very discouraging for many such people, and they would continue to suffer, when they could be helped.

People don't like allergy shots much anyway.  A lot of people who would benefit from allergy shots, don't get them, because they don't want to go to a doctor's office once a week, or they have reactions to the shots, or the shots hurt ...  They don't realize that allergy shots offer long-term benefits or cure that outweigh the annoyances. 

And Dr. R is just making this situation worse! 

If he made it clear to patients what he was doing - that his practice is set up for people who don't have complicated problems, his approach might be acceptable.

But of course, he doesn't.  His practice advertises itself far and wide as the top allergy practice in the area, offering the finest medical care...  It's false advertising that they can get away with.

Another thing:  Sometimes when I've gotten allergy shots, a few droplets spritz out of the needle onto my skin.  I don't know whether a significant amount spritzes out or if this is acceptable.  But I didn't experience this with Dr. S's nurses.  I wonder if the nurses at Dr. R's practice have to give shots so fast that they press on the plunger a bit before starting the injection.

My allergies have gotten better since I've been getting allergy shots.  I can't move back to my house yet, but my dog allergy is less severe, and perhaps in a few months I could move back. 

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