From Patient to VP. BreatheAmerica’s Tim Miller on Allergies.
September 28, 2016
Our Vice President of Revenue Cycle Management, Tim Miller, isn’t just a BreatheAmerica ASAP center advocate because he’s a part of our team. He has experienced firsthand how our specialized insights can change the way you live your life. Here’s his story:
As a child I had severe seasonal allergies which usually involved watery and itchy eyes, sneezing, and hives. As I got older, this effected a promising baseball career (well, not really very promising, but it’s hard to play outfield when you’re rubbing your eyes). My doctor could almost set his calendar by my ear and sinus infection. My high school teachers would put Kleenex boxes on my desk because I had a faucet on my face— also known as my nose. As I became an adult, my symptoms changed and felt more like the flu without a fever. Every six months I’d feel lethargic and ache all over then suddenly have sinus issues. I worked for a large multi-specialty clinic with 110 doctors representing 39 specialties. My internal medicine doctor referred me to the ENTs who diagnosed me with “too much stress” and gave me antibiotics.
I changed jobs and moved, and after about the 5th semi-annual sinus infection, my doctor said “yes, you have a sinus infection, but you’re allergic to penicillin already due to multiple doses you’ve had over the years. I think you should go to an allergist.” I agreed, because I’d come to realize that the antibiotics usually worked after 7 days, but I could also feel better in about a week without them. So, I went to the largest allergy practice in my area. I don’t remember much about the visit other than getting 73 pin pricks on my back and being told that I was allergic to 70 of them. The doctor discussed options and we agreed that immunotherapy was the best option to address the multiple allergies. I followed the therapy for more than three years and did get some relief, but continued to have symptoms during the height of my seasonal allergy seasons.
A friend of mine suggested the ASAP center, telling me that they had a much more comprehensive approach to treating chronic issues. I called to make the appointment and realized immediately that this was going to be a different experience. The scheduler asked more than just when I could come in. She asked questions about my disease history and what things I’d already tried. Since I’d already done immunotherapy shots, she asked if I took additional over the counter medicines and said, “Since you’ve already done shots, we’ll get your records and more than likely not need to re-test you. We’ll schedule you for next Tuesday.” Later that week, I got a call from the office and they told me what to expect, including a 3-4 hour visit, and sent me a link to complete my forms so I wouldn’t have to sit in the waiting room and do it. My first response was “I can’t miss half a day for a doctor visit?!” She responded, “How much work have you missed for being sick? Would you like to get better?” I found that hard to argue.
From the moment I arrived, things felt different. The actual provider interaction was like nothing I’d ever experienced. After the obligatory vitals, etc., the medical assistant asked me to sit in a chair beside a desk with a computer monitor. The nurse practitioner then sat at the desk and spent 10 minutes asking questions about my past medical history and specifically my allergy and sinus issues. It was at about that point that I realized this was not a visit where I’d better get my top 3 questions out quickly because every answer lead to another open ended question with regular affirmation that “yes, those symptoms are terrible.” I didn’t feel like a sickly subject, but like a patient that needed hope to get better.
After 30 or so minutes she did the heart, lung, ear and throat exercises, then said, “Based on your history and the symptoms I’m observing, we’re going to do a couple of tests to confirm the issues. Then we’ll know better how to address them.” I was taken for a pulmonary function test (PFT) and a CT scan of my sinuses. Each encounter with a nurse, technician and provider included an explanation of the test, how it would feel, and what the results would show.
After the tests I returned to the room and the nurse practitioner and doctor came in to review the results. The doctor pulled up the CT scan and pointed things out to me: “See that dark area? That’s a sinus infection, so now you know why your head feels so bad. Your PFT tells me that your lung capacity is being impacted due to inflammation in your airways.” As the nurse practitioner reviewed our conversation with the doctor, he would stop her and ask for my confirmation to ask more questions. Finally, he looked at me and said, “You’ve been clearing your throat and coughing since I’ve come in— how often do you do this?” “This is normal,” I said. He said, “You realize that’s NOT normal?” I said, “It’s my normal,” to which he replied “we can get you better.” Then he told the nurse that, based on what he heard and what he’d seen in the test results, he wanted to do a nitric oxide test: “This will give us a good idea if you have asthma or not.” While nitric oxide is not definitive, it is a good indicator for the presence of asthma and more easily administered than methacholine.
The results indicated mild asthma and impacted my treatment plan.
After all the test results were read and the diagnosis finalized, the nurse practitioner sat and wrote out the treatment plan, reviewing each phase. She wrote down how my symptoms might vary and for each variation what I could do with over the counter drugs if necessary, versus what I should call her about. As I left, I realized for the first time in my adult life that I had affirmation that my symptoms were real and were, to an extent, debilitating. I’d been educated throughout the process on ways that I could manage my disease by avoiding triggers and, if I couldn’t avoid the triggers, the steps I could follow to mitigate their impact.
I’d been invited into a discovery process whereby my issues were named and I was armed with options to manage my own health. That visit in October 2011 was followed by a routine follow-up to review symptoms and ensure that I was using the medications properly. Since October 2011, I have had exactly zero sinus or ear infections and I have not missed a day of work for the issues that had caused me to miss at least 2 to 4 days of work a year.