neither the el paso medical society its members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor you may have a cough right now you may have the sniffles right now you may have a sore throat you might even have a headache and you just don't know what you have and you're thinking uh oh what's going on again this is the time of covid it's not quite gone yet i know all of us think and wish that it is but we all just kind of think oh it must be allergies it might be a cold and this is spring so during the next hours we have a couple of experts that are going to tell us what symptoms we are feeling and what it might be and also which test we need to take and then kind of take it from there as you know this is a live program the telephone number to call is eight eight one zero zero one three um you'll also get to watch this show later on on both pbs el paso and also the el paso county medical society website but again ask your questions because we're here to answer them that's our job we are live 881-0013 this evening's program is underwritten by the american heart association so we can bring all this information to you we also want to thank texas tech paulo foster school of medicine for providing our medical student here this evening and we have a third year with us melissa huddleson is here and she is a third year medical student and she has joined us quite a few times in the past she originally is from georgia and she will find out next week where her matches do her residency so it's really exciting to have her here i also want to say thank you to the el paso county medical society who has been bringing the show to you now for 25 years this is our 25th anniversary i'm katharine berg and you're watching the el paso physician but i've known them for 20 years we've been doing this show for 20 years you know he talks about farts and he talks about diarrhea and he talks about all kinds of things that nobody wants to talk about and that's what's great about the show because you get to hear those things on the show and go i'm not the only one it's great see you'll pass a physician [Music] thanks again for joining us it is allergy season so i think that all of us have a kleenex or excuse me a tissue can't say brand names on the air um stuffed up our sleeve or in our pockets we've got stuff going on with us this evening we have an allergist also an immunologist that's a word i always feel like throwing an extra n in there but dr adrian cassius is with us this evening and that is his specialty and we're going to talk a lot about allergies and el paso is specific when it comes to allergies a lot of deserts are and we're going to we're going to go into that and then dr diana escobado who's in family medicine you're off in the front line of somebody just yeah i got stuff going on help me out where am i gonna be going with this so on that note um i'm going to start with dr cassius and ask you as an allergist here in el paso i know that you were doing a lot of work in l.a you said you were with ucla for a lot of years and it's different here than it is there and with many disciplines it's not but because we're talking about air and we're talking about quality of air and allergies what is it that you do all day every day and it sounds like such an easy question we can go on for four or five hours but to explain to the audience at home what your specialty is in el paso how would you explain what that you do so as a board-certified allergist immunologist my job is to really combat chronic inflammation that is caused by allergic mechanisms okay so that means diseases like you know as simple as hay fever you know allergic rhinitis uh as a simple variant of that right and then very severe respiratory disease like asthma you know where people really struggle to breathe because of these are both inflammatory diseases they're chronic inflammatory diseases there are many other forms of allergy obviously there's allergies to medications there's allergies to foods right there's even allergies to other people you know i've heard that but i'm not sure i think it's an excuse a lot of people use but but the reality is that so so this is it's a form of inflammation that's triggered by an allergic mechanism a specific type of antibody that some people make when they're unlucky and other people don't it does require exposure to that substance whether it's a drug a food pollen granule a dust mite particle whatever in order to mount that allergic response there are certain things that may promote that allergic response to be worse in some people or not and then there's ways to lessen those effects you know if we talk about treatments and you know if someone's interested we can certainly talk about that yeah and what i'm going to get into in a little while because there's just that curiosity of what makes one person allergic to something and not the other um but that's we've got a whole hour which sometimes seems like a lot but it's not um but dr escobado let's talk about you for a moment and i know i i asked the doctors what do you do all day every day it's like the catchphrase right they say is that what you're asking me um but as a family doctor and i love that you were born in juarez as you said grew up in our house born here and did school in juarez studied in las cruces et cetera et cetera so thank you both for coming back um but talk a little bit about your practice what you do all day every day who in general do you see i'm a community doctor and i'm based in horizon city so it's a pretty you know developing part of el paso we have a lot of dust you know so i see a lot of allergic uh conditions uh but what i do every day uh is taking care of anyone that comes through my door be it babies newborns to older people so it's everybody and everyone so you're going to be the question that is the frontline person okay so somebody comes in what's my problem you're the first one that sees them usually that that way so um we talked a little bit about this so we were just uh on live instagram and we were talking a little bit about why our bodies make mucus you know it's it's one of those things that with all the conditions we're talking about when you have a cold when you have allergies covid the flu just in general our bodies are put into some kind of a gear to make snot to make phlegm to make you know anything that's going on why is it physiologically that our body is doing that what's that reaction creating so basically it's it's a reaction exactly it's a reaction against something so the body's mechanism to to clear things out of the respiratory tract or the gi tract or any mucosal surface is to create something that will that will glide it out of the out of the body if you will okay so that's a good way of describing it gliding it out of the body that's exactly what's happening it's a simple way of thinking about it it's it's our body's way of saying i got to get this stuff out of here and in order to do that i've got to create a river and let it go out somehow okay and it doesn't matter as long as it leaves the body okay and sometimes it happens in unfortunate ways and other times you know a simple tissue will take care of that exactly but you understand so that's basically what mucus is it's a combination of you know proteins and and and sugars that that cat capture certain things and carry them out and that's that's basically what it is it's a it's a it's a cleaning mechanism for the body in a simple way of thinking of it i need to get you out of me and out of me now a question here i'm going to what i'm going to do is i know it is allergy season and it's springtime but the first thing i want to do we've got six really cool slides and i want to throw these up because i think questions are going to then be derived from the slides later on so if we can put up slide number one because the topic this evening is if we have allergies if we have a cold if we have a flu we're going to talk about flu shots in a few moments or two um and then there's again still covet out there and so if we can throw up slide one that has the fever and it's gonna kind of give us a snapshot of what it is that we think we may have if we're not feeling well and this this goes into dr escobedo your questions like somebody's coming to you and just by looking at them clinically sometimes you can't diagnose you have to go into the testing phase but knowing the differences between allergies flu and covid we've got here do you have a fever and why is that such an important thing if you have a fever other than you know or or in combination with the mucus what is that telling people yeah it's telling us that there's some possibly an infection right we see we see we hear fever and we automatically as doctors think you know an infection of some type right which makes it more serious in your head would that automatically go to this is more serious or more about more more about diagnosis right now that we have covariate and flu and all those we need to make sure that we don't have we're not dealing with those two conditions first but some other conditions you know severe allergies can sometimes give you you know people feel that they have a fever but they don't check it right or other autoimmune conditions can give you fever as well it's not always an infection but most of the time it is okay and so we have here up on the screen if you do have a fever chances are it's coveted or the flu if you do not have a fever but still have the itchy eyes and mucous and everything you may have allergies or you may have a cold i mean if we can go to the second slide which is type of viral tests um and like i said i want to not get these out of the way out but i want to look at these so that as questions are coming in we know what we're talking about so the test we say um and and and dr esquire i'm gonna go with you first because again you're that first line right so you now order a flu test you now order a cova test um or both how how is it that you order them do you do it there in the clinic do you dare in your office and how long does it take to get the results back i know coba takes a while but no well there's different types of testing right now we have the convenience of getting an antigen test in the clinic and they actually tell you copen and flu at the same time right so okay that's pretty awesome because you can get that test done and be done with it in 15 minutes right but sometimes well um sometimes the person that's taking your sample and it's it's a nasal swab um it's not as good as taking samples or you're too early to get you know diagnosed right so it could be negative right and you can still so glad you said that and i know i'm interrupting you um and the reason i do that every now and again is i'll hear something and i'll forget it later but you said it could be too early usually if i read this right for exposure of covid to actually show up in a test it's about a five-day process now that we're all most of all of us are vaccinated a five-day is recommended right obviously if you have symptoms before you can test and you might get a positive test but the most reliable is that five to seven days okay if you know you've been exposed uh and if you have symptoms and if you have symptoms some kind of symptoms because now that we're vaccinated we get milder symptoms right like sore throat or nasal congestion that before we would get the cough and then really feeling really sick now it's mild right so even if you have a mild symptom you can test before and you might get a positive test but recommend recommended is five because we have the vaccine okay makes perfect sense and i know we had it on the screen a little bit earlier but if you are negative life is good um you're just going to have to wait it out so to speak but if you are positive i just want to again our job here is to kind of educate the audience but isolate for at least five days i know that used to be ten days and now it's down to five days um and then seek some kind of a you know follow-up test to make sure that you're clear later on and that's to protect others because even if you are you're talking about most people are vaccinated now so your symptoms may be a lot less severe but then there are those that may not have uh been boosted or for whatever reason are are getting it a little bit worse and then monitor your symptoms i think we've we've all heard this over and over again um and when we get a chance we'd like to throw up the slide about the coveted signs and symptoms but uh dr cassius i'd like to kind of jump ahead i know we've got the flu uh chart here but we were talking earlier before the show about when you're tested positive for flu there's flu a and flu b which i never think about i heard about it 10 years ago 15 years ago but i never think about it um so because there's flu shots and we do want to stress that flu shots are still a thing it is spring but it's not too late to get a flu shot so i'd love to talk a little bit about that and then talk about flu string a and flu string b so basically i'll i'll address the the second part uh now and that is you know they're just different strains of influenza okay every year influenza recombines okay it's it's a little more complicated than just simple mutations um because it can recombine from different sources different animal sources okay and this is tracked throughout you know the world health organization tracks all of this to make sure that by the time the flu hits a certain area we kind of can predict which what is the strain that that that predominated and we don't know that sometimes hey there is no influenza b this year it's all influenza hey that's possible it's not always that you have one and the other it just depends on what happened that year you know conditions and so forth and and then one thing you did say you know as part of the first the first inquiry was that you know we are seeing some less now because we've been taking precautions that's been a really good thing agreed it's been a good thing that people now are actually we're thinking well maybe we should wash our hands and for 20 seconds you know don't touch your face wash your hands it's still a thing that's a good thing maybe i should wear a mask maybe i shouldn't go to that place you know with a bunch of yelling screaming people so these are all things that i think have really mitigated a lot of the flu in general and we have seen a lot less who it's bad for us the people that are predicting what strains are coming out because hey there's no cases of flu to study exactly so that that's become a difficulty but still you know people don't realize that a few years ago i mean almost 100 000 people died of the flu yeah you know people tens of thousands of people die of the flu so this is a beautiful transition in strain a strain b and then we're talking about covet invariance and i think about this too is you're saying through the world health organization that there are different parts of the world so that by the time it gets to another part of the world the vaccinations are more specific to what strains are out there and i'd love for you to marry that idea to the idea of covid the delta variant the omnichrome variant a variant that may still come about because that is similar in the way the dance is performed correct um so if you can kind of explain that because that is the big question it's like oh there's delta and then there's omnicron well how many variants are there and how bad is it going to be it's always mutating so so that's correct there's always changes and these these are specific types of viruses that are just they're just easier for it's just easier for them to mutate okay and the rna viruses are classic examples of this and both covid and influenza you know are you know rna-type viruses right so that's just the genetic material that they're made out of and the bottom line is that if you can guess what's going to happen then you know you'll be golden you can design your own vaccine but that life isn't that good right so with the flu is probably one of our worst vaccines because of the fact that we don't always guess right you know the people that are in charge of that they do their best job to do it but sometimes things change after they've reported what they think is going to be the predominant strain and you're like oh yeah and so we may not even have it it's not a perfect science correct it's not it's not so people have to understand that and not everyone responds just as well and so on and so forth and and with kovid what we've seen is that you know it's easy for that virus to mutate as well and we certainly have seen it you know i think we paid attention over the last two years you know what's been going on with covet and what does that mean that it's amazing i think it's educated all of us those of us that weren't paying attention before we're now paying attention exactly right and you know to what for whatever benefit that that that has resulted in i think that uh it's important to understand that vaccines are developed against a certain viral strain if you will uh and and that is because it exists at that time but that can change right can change it's like a bad card game you know you may be dealt with it's like a bad card game this used to be a good hand and it changed you know and that guy i love it right so so i think it's important that because of these variations it can change the molecular structure enough that now the antibodies you made to the original vaccinate vaccination version may no longer really apply or or may not apply to the same effectiveness right people sometimes say well wait a minute i've been vaccinated exactly wait you were vaccinated to you know brand a if you will and now it's not brand a anymore right which is very and i'm so happy you're bringing this up and uh dr escobado i'd like to go to you now i'm i don't assume and imagine because we hear it everywhere it's like well i have been back so i got my first one so i should be okay the questions that are coming to you and how you explain this to again being on the front line do i still need to get vaccinated i haven't been vaccinated yet but covid's over uh the antibodies the idea that yeah we're going to have to get the covid vaccine again next year and the year after and it's going to be a little bit different every year how do you explain to people that come into your clinic the very thing that dr xtias is explaining um but again just truly with the vaccine when i say the vaccine i'm talking about the covid vaccine because i i imagine you're still getting questions on that yes yes definitely and i have uh i've i always answer these questions because i want them to get vaccinated right because i want them to get protected in some way because uh it's not over yet so if you have one vaccine you need your second vaccine at three or four weeks and every time you get a vaccine your symptoms are going to be milder right and even if it's not an exact science you're better to get it than not and that's the part i'd like for you to verbalize somehow because it isn't and i love the reality of the way that you're speaking dr casillas because it's not exact it's not perfect but we do the best that we can with what we've got at any given time and that's so important yes and i've told uh i i how i explain it is you might get covert every two months if you don't get a vaccine right right because it can mutate like we saw omicron and then like two months later we saw another variant right after so and you you get reinfected every time even if you know you when you don't have a vaccine when you have a vaccine i've seen patients that get one vaccine and yes they get they get the symptoms but they're milder as if they compared to the person that didn't get the vaccine right right and when they have the booster they might be in close contact with someone and they don't even have a positive test ever right um getting some questions here from the audience so i'm going to dr casillas what i'd like to do really quick um before i start asking the questions here from the audience when we were talking about uh allergies earlier we were talking about specifically el paso compared to other places in the world fine but in america and you spent some time in l.a and i think sometimes that's similar to our climate a little bit but what is it about el paso that people think wow you know i i travel everywhere when i come back home to el paso or those that have left el paso cut leave and then come back and their allergies come back up what is it that makes us allergic to stuff so el paso is a very unique environment but let me back up a little bit the way you become allergic to anything you get exposed to it you get exposed to it for a period of time so you're not born with allergies you know i get this question all the time well you know my dad had penicillin allergy does that mean i i'm going to have penicillin no no but you have the potential to be allergic to something you have to be exposed gotcha exposure is required okay that's the first step okay your immune system has to see it and not like it okay well it likes it but in the wrong way like a bad relationship likes it too much i am digging the show okay yes okay right so so what are the conditions that make allergies worse in general right okay well number one having more exposure to that which you are allergic to so if if you if you think about it you know pollen and stuff supposed to you know settle on the ground kind of stay there right right but in el paso what's our experience you can't even see the mountain right now because the air is blowing everything every which way so we don't get mild breezes here you know we get this horrendous wind that comes you know it gains speed as it comes down the mountain and just blows all over the place right so we we have re-suspension of pollens and other things that we're capable of being allergic to just by virtue of the fact that we have high wind that's one thing second one we have factors that augment allergic disease at a certain time of year and it took me a while to realize that when i came back to el paso about what six seven years ago after having been in los angeles and houston i began to hear that all the time you know and i don't want to belabor the point but the bottom line was it's like what is it about el paso and it is yes we have all that high wind so everything's in the air blowing around and also when it gets cold the poor people i think you know in juarez start burning strange things those hydrocarbons mix with those allergens a combination augments allergic disease almost 100 times of what it would be otherwise no k hydrocarbons hydrocarbons yeah i used to do research on that and i know that for a fact so you know like diesel particulates to something you're allergic to boosts what you would normally respond with by a hundred times and this is where your body says i don't like this is like that's why our threshold for having symptoms and bad symptoms yeah is much worse in places like el paso and it's a very unique where else that has that combination i mean we have a lot of other stuff right you know but but that's one thing that that got me thinking about el paso as a unique allergen environment so here here's a question that's kind of our day and time with people wearing masks yes the vas were because of covid um but do you see the mass being beneficial in the future let's just pretend the magic person waves a wand and kovid's gone would there be certain times of the year that wearing a mask for people who have severe allergies would be good or is it and the reason i say that that's just respiratory we're not talking about skin allergies and food allergies etc this is just i guess more than anything pollen allergies which spring and fall seem to be the big ones so the question then becomes will masks are they here will they help well they'll help us like like like forget about allergies yeah filter it out so to speak okay and the reason is that we don't i mean we'd have to wear some masks that would be very hard to breathe through because of the size of pollen and and mold particles and these are very small things that can probably penetrate most masks whereas you know viral particles travel on on fomites or pieces of saliva and all that right you know that's how they get to you but having said that does it help it probably does help to some degree but it depends on the type of allergen makes sense that you're allergic to you know so like some mold spores are so small i mean no mask is going to stop that right and if that's what you're in contact with i don't you know you'd have to wear a spacesuit basically exactly beyond a mask but i'm not saying masks are useless i'm just saying that they may help it but particle sizes make a big difference yeah and that's really what mask science is all about okay and you still have the eyes exposed too which which is a big thing uh dr escobado i'm going to ask you this because i it's going to counteract something else i'm going to ask dr casillas when somebody comes into your clinic and they are tested negative let's say 100 they're not covet positive not flu positive so it's a cold or allergies etc and this is where it gets loaded there is you go to any drugstore you go to your walmart wherever you go and there's there's decongestants there's fever reducers even though there's not a fever in general you're looking at a world of medication over the counter what is it that either your patients have asked you or advice that you give them when they are feeling all icky and mucusy but you know they're negative you know it's gonna go away or that it's not something that they're in danger of what what do you tell them and what do they ask you because they're you can't help it there's an entire aisle of stuff to look for and i know sometimes i go there and i'm like i have no i there's a decongestant and there's something that's uh you know well depends on on the symptom right i always ask them what is your main symptom what is the the symptom that's bothering you the most it's nasal congestion well you know there's some decongestants like that can help and like um over-the-counter medication usually has like an allergy medication on it right and a decongestant so you can take that but if you have other conditions like high blood pressure or diabetes or anything like that you you might want to ask your doctor first if you can take certain type of decongestants right because that can elevate your blood pressure etc exactly um but most of the other of the over-the-counter medication works pretty well the other thing that the patients love to ask for is the allergy shot [Music] that's my next question to you so get prepared for that one yeah so when they ask for that i'm like well you know there's not an allergy shock like one like one allergy shot right if you want to get tested for allergies and really know what you're allergic to then you should probably see an allergist but what they're referring to is the steroid shot because i get it every year etc you know so i'm not for that like um it's not like a treatment right i mean exactly if they're severe and all of that well maybe we can consider it but it's not like first line yeah that's not something you can just put in your system just to put in your system so that was a perfect uh way of introducing and i know it's loaded i get it what are you allergic to you meaning the person the person on you know they are watching right now what are they allergic to and once that is found out the series of injections that people may choose to have or do they just choose to take a decongestant the rest of their life etc i know it's loaded and it takes four or five shows to do that but let's first go through the process of people that are just they're just allergic people they're allergic to everything they come to you and they say okay what am i really allergic to and what can i do in the future to just help me more comfortable going forward so that's an excellent question because it is at the crooks of you know what i do you know at what point do you start recommending you need to be desensitized so for some people it's as simple as i get symptoms in the spring and the fall for a couple of weeks i take some antihistamine that's over the counter maybe a nose spray for a few weeks and i'm okay fine you treated your symptoms and that's what was bothering you you can continue their quality of life is still open and that's what's important to think about it i mean most allergy patients they just want to hit that 100 mark they want to be at their full capacity and that may be enough to do it and if i tell them that's fine if that's all it takes and and you're comfortable with that fine but then there's the patient that i'm miserable all year round i don't get a break okay right because every season there's something in that season that i'm allergic to and i'm the one and i i see those patients all the time or i'm allergic to you know what we call a perennial allergen house dust mites right right for example they're always there my son's that guy he's allergic to everything he kills me poor kid you know and and they're miserable yeah they're they're constantly i call him yucas boy totally not kidding he's just got it going on all the time they never get a break yeah they never get a break so this is the kind of patient that i think now you recommend true allergy shots now allergy shots in my you know in my my world means the kind of shots that desensitize you they actually change your immune system and what that means is that right now you're the reason you make allergies at a molecular level is that you make a certain type of antibody it's called ige like elephant um and if you didn't make that you wouldn't mount an allergic response interesting okay you can change that to some degree and that's what allergy shots and then there's other types of allergy therapies that you may have heard of but we're talking about allergy shots and it's a way of telling the immune system we're going to do things a little differently okay and it's by it's just a concept of just it's simply introducing the allergen through a different route i see okay it's kind of that simple but what happens now is that the immune system will will change it'll modulate and and over time this is a process this isn't like a quick fix it's a process and it it it takes effectively a few years to to happen you know i explained to patients you know it's like putting on braces your teeth are not going to be straight right it's a process but it's possible to do and for the patients that are very miserable they really suffer every day of their life just about yeah they're going through medicines like crazy the medicine and there's that worry too right and i and you know you're thinking about all these overcome and you had such an excellent point there are some medications that raise your blood pressure you know there's there's hypertension there's there's all kinds of issues if you're just constantly taking medications and i think that's where the relief is being sought right is there something where i'm not constantly taking the little red pill like my kid that's i feel like we buy these little red pills by bulk you know and that's the big question and how i guess it depends on the person how long does it take for the series of shots to be over like a year like every week for a year uh looking at different things that you're allergic to how does that process and i know it's different for everyone but in general so in general i'm talking about environmental allergens it's a process that usually requires weekly shots for a period of time to reach a maintenance dose once the maintenance dose has been reached then a monthly shot can be pursued at that point and that that will be enough to stimulate the immune system okay to the point that then you can build that repertoire of b cells those are the cells that make the antibodies uh so that it's large enough that it'll last the rest of your life potentially interesting so so you don't have to do weekly shots for you know years and years you shouldn't in fact if you're doing it means something's not working right exactly you know that's when i urge you to come see me i'll fix that because that's not right so bottom line is that you do have to do weekly shots for safety we start at a small dose and work up to a high dose and that's for safety you know otherwise it makes sense yeah there's we're injecting people with stuff they're allergic to exactly and then once you reach that maintenance dose successfully it means your immune system has already made some changes now we want to amplify that effect and so to do that we then go to a monthly injection for another couple of years the best data is anywhere between three and five years okay okay so and so would you say and i don't know if you have this number in your head or even a guesstimate would be fine percentage of population and let's take el paso because you are here now percentage of population that have severe allergies that have to do with our weather that are external allergies not peanut allergies or food allergies um would you say in el paso it's five percent that are and i say severe severe enough to where somebody is seeking help with injections for the rest of their life you know or i'm very lucky knock on wood i allergies don't really affect me and i've been very lucky that way here's the other question why does my poor kid and granted he's got a mother and a father i get it there's genes from from two of us why is that poor kid cursed with just constantly being in you know misery and other people it doesn't bother them at all i mean i can walk into a windstorm go home and i have no issues whatsoever why okay well let me let me start with the more facetious type of okay there are some people there are some people you can cut their arm off and they don't complain okay all right so it's also a matter of perception i did yeah that's good some people can they can sit there and drip mucus all day and they don't care okay i don't have cancer i'm good all right right right so that's part of it how much does it bother you yeah yeah how much does it bother your mother well okay then do it for her right um so anyway you know the percentage of the population you know in general that have pretty severe allergies i mean it's more than five percent is way more than that okay yeah i mean in general it's probably going to be closer to the 30 percent that have some allergies that are of significance to them that they will seek professional help for that that's a pretty that's right that is a high number that is a high number yeah higher than i expected so but then it's a matter of the threshold at what point have i had it i can't do this anymore and there are some people say oh come on dude it's just your pinky it's all right you know it's like but on the other hand it's like wait a minute it's my fingernail i'm not gonna let you you know it doesn't matter how much that's an excellent point it's a matter of perception yeah because most people don't die from their allergies right now that does that excludes you know drug food and other you know dangerous type of allergies but most pollen allergies and aero allergen allergies are not going to kill you although if you have asthma it could so i'm not saying that as a blanket statement okay but so so there's a matter of perception and and you know dr escobel sees it all the time too i'm sure these patients that you see that you know you go wait a minute this is not that bad you could take a you know antihistamines right but they say it's severe yeah they do those are the patients that want the allergy shot yeah exactly give me the steroid and and you had a good point too and dr escobar because you talked about the steroid shot earlier and i do want to bring up asthma because when you do have asthma and this part of the year does kick things up there's also a because you're a family doc and you see all the ages you said earlier which i think is really nice for this question there are kids when i say kids there's a development it seems to me or we've had programs on this before that asthma is kind of developed as a child but then after age 16 17 18 it seems to kind of go away actually for a couple of decades okay so just talk about that phenomenon i i i honestly don't know but that's what it's documented you know and after nine years old it's if you had like childhood uh asthma and all of that nine years old seems to be like the magic age it just goes away so you trade asthma goes away and then you get all those ugly hormones that make you crazy for a couple of years i guess so you know and then after that it comes back i just i've always been fascinated some people don't ever get it back okay they just get over with and that's it so as a family physician and we're talking about again is it a flu is it a cold is it covid i'm having a hard time breathing which in the early days of covid that seems to be the one symptom that people like okay i'm the breathing is very very difficult let's marry that question now with those that have asthma maybe are being treated for asthma now maybe covid enters the picture however you want to answer that question and marry all of that together let me know what your thoughts are on that there's a broad differential diagnosis for anyone that comes in with respiratory right it could be acute bronchitis it could be chronic bronchitis it could be asthma it could be um you know exercise induced asthma covet flu uh pneumonia right so you kind of have to pick and see what what the syndromes right no oh this looks more like cover let's test for code and flu right because covert and flu kind of all the symptoms are very similar now with the omicron and you know the different variants and how we've been vaccinated uh you're not seeing that much of the respiratory with those two flu and covet right but if you're not vaccinated obviously you have to get it in your head that it might still be that right so now we come into march april now it's allergy season so it comes more to the front of your head the allergy and the asthma and the you know all of that stuff is causing your asthma now um so it kind of depends on the whole picture okay and when you're looking at asthma um again as a family doctor goes away around 9-ish years old the children that come in that do have asthma bronchitis etc and they are positively diagnosed now and let's say the symptoms are not severe but they are positive for covid we already know that they have bronchitis we know that they have asthma what are the treatment options there are are the treatments different are they just looked at with a little more caution how does that whole scenario if we're talking about children well there's not really anything that we can use for covet right if you're a little bit older and there's emergency treatments for that right so there are no therapeutics per se for children and so when i say but asthma would be treated the same right okay so asthma okay so if it's exasperated by covid you're still treating the asthma in and of itself even though there's covet and there's not really a therapeutic for coded until and you know what that's a good question until what age are therapeutics um introduced into the scene with covid treatment i'm just throwing out to anybody who wants to answer that well you probably see i see mark okay go for it so is that is that 16 or is it well they've uh they've done 18. they've done 18 above okay yeah okay um but uh and we say therapeutics for the audience i should have said that but therapeutics is a a specific treatment so actually treating covenant there's different types of treatments now right there's the autoimmune treatment the antivirals um so the antivirals are kind of like where we're going to be at maybe next year everyone's going to get an antiviral kind of like flu right you get an antiviral like so if you're diagnosed with covid and showing some symptoms chances are starting next year or so at least what we know people are probably going to get an antiviral and i would say that that's probably going to be a a very cost effective alternative okay i mean we saw with kovad that you know we were rushing to do well first strange things right well we were scared to death by the course yeah then secondly you know we had monoclonal antibodies very expensive but hey they did work they didn't work there's no doubt but very expensive and now that there's a line of antivirals and and certainly you know as as covid becomes endemic and cases become more or less serious the the choice of using those kinds of agents will be something that i think will be more commonplace and we also know that if you have asthma or chronic bronchitis any type of viral infection or bacterial infection can exacerbate those two conditions so right you know we need to be more careful about those particular patients exactly it's funny because there's not funny but there's a caller specifically that just typed in a question right now wondering what the relationship is between allergies and asthma and i don't think technically that there's a relationship but there is there is a strong relationship dr casillas let's take that one so what is the relationship between the two you know basically most asthmatics do have some allergic sensitization and that is going to drive some of the inflammatory response okay certainly not all of them there's there's different kinds of asthma if you will but a large number do have allergies and in fact in the treatment guidelines now doing allergy therapy is is really a strong point and you can actually reverse this in some people um and then some of the biologic agents and by that i mean all those weird tv commercials that you see you know tell your doctor right i can't say that right but anyway that's okay so the the bottom line is that those actually target allergic pathways okay okay all of those all of those drugs that are specific for asthma as biologic agents okay right now and we have right now you know there's there's actually four common ones and a few others are kind of working their way and we're going to hear about a number you know and just throw in the word inhaler because i just feel like asthma inhaler it just goes hand in hand i will okay yeah so anyway uh so those are allergic mechanisms that are addressed by those now asthma inhalers they're just a mechanism of getting particles into the lung that's what an inhaler does okay and the reason they're effective in asthma is that if they can reach those parts of the lung that are having bronchospasm and and the particular drug is a bronchodilator that would be things like albuterol and other long-acting bronchitis that is effective and you can also deliver anti-inflammatory medicine uh through that mechanism as well inhaler is the idea that it's quick it's it's it's immediate or albuterol in the case of albuterol it's pretty quick yeah and and other medicines are pretty quick as well but having said that there are some medicines that are really designed for chronic use and they're not really quick they're just designed to be used every day to control you and then there's albuterol which is what we call a rescue medicine that works i am so familiar again i'm a mom of a boy that's yeah albuterol was our life for many years yeah and yeah um interesting on that i have a question also here from the audience because we were talking about flu shots we were talking about covid we were talking about allergy shots and here's that that question that was raised a lot during the fall when flu shots were being promoted heavily and coveted shots are also being promoted heavily we are now i think you said we're at about a 60 percent uh rate of full vaccinations more or less in el paso um when vaccines are introduced is it okay to get a covet vaccine a flu vaccine and then maybe throw in some allergy shots in there not steroids but let's and however we want to talk about that conversation because it's all about okay let's get ourselves let's get the antibodies going what is the conversation now in the medical field with that and i'm throwing that to either one of you who wants to take it well i can answer the covenant flu okay because you can definitely get those together okay but if you have maybe you know you don't feel as good or you're frail um and you think that you might get side effects from that right being you're fatigued you can be in bed for two or three days and there's nobody to take care of you yeah because we do sometimes feel more fever or fatigue or muscle aches if we get them together i sometimes recommend patients spacing it out maybe two weeks or a month if they're in that situation but they they can definitely get it together if they're let's say 50 or be low right and they're in good health and i do want to say this too because it's a question that's asked of me a lot uh because of this program and just things that we do when people receive the coveted vaccine and the flu vaccine it is for the most part normal for them to have side effects because you hear the old wives tale out there it's like oh well i got the flu shot and it gave me the flu um it will most likely give you a side effect which is good because it says that you're bought in fact that's a good question for you why is it good that your body reacts to a vaccination because you you spot you spotted that earlier so when you get an infection you know by a virus or bacteria or whatever your body responds with inflammation that's what you feel so you know fever redness you know all of those things are parts of a a structure of inflammation that's what you appreciate right okay right that's what you appreciate you know if it's real severe inflammation that's also what kills you right so one has to understand that it's normal if i give you a part of a flu and your immune system says oh my god it thinks it's the real flu guess what it's gonna also mount an inflammatory response you're gonna feel it okay you're gonna feel the soreness you might even get a fever you you know all of those things might happen but you can't get the infection from a piece of a virus right that's what people you have to understand that you can't get an infection from an incomplete viral particle in that say that three or four times because i really want people to understand that you know if you need part a b and c to mount an effective infection and i just give you part a and that's enough to protect you it's going to protect you it's still going to mount inflammation you're still going to feel it but guess what you're not going to have an infection okay there's different ways of achieving that our traditional approach has been just give that piece of protein that's what traditional vaccines have been but now you know there's new types of vaccines and this with the kovid you know we were introduced to the mrna vaccine well that technology is not new it's been explored for many many years and it's just you know who makes that protein do we make it in a lab and give it to the person that's one way or do we give the instructions on how to make that protein to the person and let their own body do it that's what the cova vaccine did that's a beautiful way of saying that do we give the instructions to your body and let your body create the antibodies that's the best way i've had that explained so far yeah thank you for that we are at about a nine minute point of the show ending it goes fast yes cassie yes to uh explain the face to the audience if they can get the flu the oh the allergy shots along with the child sure that's a great question yeah theoretically yes you can do everything you want at the same time we do that to kids all the time we do let's give you five vaccines today you're two months old like here's your sick shot yeah yeah we do it all the time while your immune system's pretty smart it's hard to break it and it's going to it's going to adapt correctly if if that wasn't possible we would have never made it evolutionarily you know because we were exposed to hundreds of thousands of things probably you know throughout our history that you know we had to deal with at the same time so our immune system's kind of used to that so theoretically yes it's when you have a bad reaction and it's real bad it throws you on the floor right or it does worse to you uh-huh ooh which one was it exactly was it the chicken or the egg right you know it was we don't know now you know we don't know uh so that's why it's kind of if you have the luxury of spacing it out then then that's that's probably the smart thing yeah just if you have a reaction then at least you know okay you know what and there are certain patients it's very rare but there are patients that i have recommended do not get this vaccine it's probably going to pose more risk risk to you than benefit okay and when you realize that it's because yeah i had the first vaccine and oh my god this and this happened i said oh my god that's awful yeah you know sometimes you can deal with it and other times it's just too risky it's like what do you mean the hard thing is you just don't know i mean that's again when we come to that if you give five things at once guess what yeah you don't know which one is the one i respect it and that's again that's uh with our audience again we've got the questions and it's it is a science which means it's always evolving and uh revolutioning every day and with us nearing the end of the show as a family medicine doc is there something today that we have not talked about that you'd like to get across the patients or some questions that you're asked of often that you can address while we're here and i'm going to ask the exact same question of you um yes we're in this topic of of mucus all day every day but just in general too yeah um well i just want uh patients in general to understand that you can get covert more than once in a very short period of time because well we were talking about the variance right so um you can doesn't make you immune it doesn't make you immune forever either right it might make you immune to that particular uh covet variant but it won't make you immune to all of them so there's not a reason to let your guard up just yet is that what you're you're trying to put out there um nicely said dr garcia's anything that we haven't covered that you'd like to we still have a couple of minutes but i always like to allow a little extra time for this yep i mean i i encourage people to get their full vaccination uh because vaccines are a way to get you know to to eliminate disease or certainly to bring the severity of it down and i think that's an important thing you know we already live in a complex enough world where we're exposed to things that we weren't exposed to you know toxins of certain sorts you know even you know radioactive sources there's just a lot of things that hit us all the time you know right even the food we eat you know it's got plastic in it now right oh yeah you know yes so so we're we're taking a lot of hits and so maximize your immunity at least you know that's something that you can really rely on and i think it really it really will help you know for the most part yes there are certain cases you're going to hear about where people have adverse reactions people have adverse reactions to many things right you can cross the street and have an adverse reaction and and so there's nothing that's a hundred percent safe right and i think that you know but we have to weigh it in in terms of you know what's the potential risk so i have the burning question i had that it kind of uh belongs in tonight's topic and kind of not it's something i've asked you about before the show are uh and it's kind of like being nine years old and all of a sudden your asthma is gone but talk about people who have not had allergies all their life and we joked about this part of the show right and all of a sudden they're 30 40 50 60 years old and now something that has never bothered them before the exact same substance whatever that is now they're allergic to it how how does our body do that physiologically what's happening you were saying earlier that for us to be allergic to something our body needs to be introduced to it could it be that our body has just been introduced to it so long and now it's fed up or what is the explanation of all of a sudden you're allergic to something you weren't before so it's it's not an easy question to answer directly but so i waited to the very end that's okay first of all you have to be genetically susceptible okay all right um you know if you can pick one parent do it if you can pick two do that you know or if you can pick your grandparents that's even better it might be scary 20 years from now people can do so so genetics is going to play a role can you mount an allergic response to begin with number two is there sufficient exposure to stimulate an allergic response in the immune system and how many exposures does that take god only knows right we don't really know and it's different for different people okay so given those factors you know can you mount a response is there sufficient exposure and length of that exposure those are the factors that are going to go into saying whether or not you are going to be a person that actually suffers from that but you see it all the time especially with medications like well you know i got this medication a few times and it's not to like the 15th dose that oh my god now now you're allergic to it forever right so it's it's it's not a question that it can be answered specifically but it does require a period of time a genetic susceptibility um and then you know and sometimes there's comorbid factors that may go into that process as well that makes sense um and the question too and i know we were talking about a vaccine program um that you have vaccine number one vaccine number two and then the booster it's my understanding that all three are the exact same vaccine exact same amount of vaccine but the body may have rej reacted to it differently the times that it got it and the reason i'm asking this is that because of the perfect storm i think what you're talking about it's the timing it's what's being put in your body it's how your dna is going to react to it anyway is that kind of the same answer of why some people may have not reacted to the first vaccine but then the second vaccine which was the same as the first they did react to that one um again easy for me to ask it's a matter of probabilities there's a probability that after the first vaccine you're going to be protected but if you look at population statistics you're going to say well that's only 60 percent of the population though so we want to we want to try to hit 90 right so by giving vaccine number two we can approach that even though that first 60 percent is already there it's not going to hurt them to do the second part right that's and that's really what this is about this is about you know we could do it or we'll study everyone it's going to cost too much to do that so we do it you know with hepatitis vaccines it's three vaccines right right and there's different vaccines that require different doses for that reason some people will get the protection right away but nothing and some people may never get it that's right it's a very good oh no so tell me why you're one of those i know it's just it's the way it is just the way it is just the way it is well i have other things going on right but right okay i'm being too personal now so here here's a question uh from the audience and from everyone and it's it's a pie in the sky answer question when do you all just in your um your best medical educated guest would we be looking at yet another vaccine for covin i know we're looking at variants we think things are kind of slowing down we've got a whole minute and again it's a guess and i get it no one's going to hold you to it but just in the back your heads you think in the fall we'll probably have to get it there's already an indication for people that are immune deficient okay so you can get the fourth vaccine if um you've already gone four months from your booster okay and so that's usually about the time frame four or five six months okay time will tell but i think it's i think it's probably as this thing becomes more endemic it's going to be something that at least will be yearly right maybe even incorporated with other yearly vaccines with the flu with the flu and that was going to be my next question but we're running out of time uh i thank you god this has been a great show and i know i thought to myself okay we're going to talk about covet again but this has been very enlightening especially introducing allergies in this time of the year so i appreciate very much y'all being here i want to say thank you to the american heart association for underwriting the show and also the el paso county medical society i'm katherine berg and you've been watching the el paso physician [Music] [Music] you