The Crunchy Allergist 0:05
Are you sick of the fatigue and fog? Fed up with unpredictable flares? Hangry from the super restrictive diets? Hello, and welcome to Success with Sjogren's! A podcast empowering naturally minded and scientifically grounded women looking to reduce or even eliminate their Sjogrenā€™s symptoms. Hi, I'm your host Dr. Kara Wada, a fellow Sjogrenā€™s spoonie, triple board certified allergy immunology and lifestyle medicine physician, coach, medical educator, and mom. As a reminder, although I am a physician, I'm not your physician, and this podcast is for educational purposes only.
The Crunchy Allergist 0:48
Welcome, Hi, I'm Kara Wada your host and I am so excited to talk to you today about five things your immunologist wants you to know. We're going to talk about all the secrets that your immunologist may not quite have the time to talk to you about during your office visit.
The Crunchy Allergist 1:08
So first, let's define what an immunologist is. An immunologist is a physician who has done training either in internal medicine or pediatrics, depending if they're seeing kids or adults. And that training took three years. Then he or she spent an additional two to three years learning how to treat people with misbehaving immune systems.
The Crunchy Allergist 1:35
And this can occur in two different types of training programs. One is an allergist immunologist, which is the training I did and that training specifically helps future allergist immunologist learn how to take care of patients with an overactive immune system that's reacting to many different things in our environment.
The Crunchy Allergist 1:58
So environmental allergies, food allergies, we also learn about certain blood cells that can become problematic. These cells we typically call allergy cells, they are mast cells, and eosinophils and basophils in particular, and we also take care of patients who have underactive immune systems or immune deficiency. So these patients may have frequent infections, or have trouble fighting off infections that make them more susceptible to many times sinus infections, pneumonias, skin infections, and actually increase the risk of autoimmune conditions as well.
The Crunchy Allergist 2:41
We also take care of chronic hives and swelling, also known as chronic urticaria and angioedema, which, interestingly, is an autoimmune phenomenon more often than an allergy phenomenon.
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The other training pathway is a rheumatologist immunologist, rheumatologist have a little more training in overactive immune systems. And their focus is more on conditions that can also affect the joints and muscles.
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So they are very commonly going to take care of patients with rheumatoid arthritis, sjogrens syndrome that we talked about here. They also will take care of patients with lupus, gout and related conditions.
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So if you think about an immunologist, it can be an allergist or rheumatologist, we're looking at the same immune system but from different sides of the coin.
The Crunchy Allergist 3:33
And the first thing your immunologist is going to want you to know is it the immune system is incredibly complicated. I remember starting my fellowship, I was fresh out of my med peds residency med peds residency is a combined program where I learned to be both an internal medicine or an adult doctor and a pediatrician. And we got through the first couple chapters of our our immunology textbook.
The Crunchy Allergist 3:58
So this is we called the basic science textbook, but it's the really nitty gritty about how our immune system is functioning and talking with one another, how it's creating memory to fight off infections, how and then how it is misbehaving. So how it is creating autoimmunity, how it is creating allergy, how it is causing immune deficiency. So it really gets into the specifics of how the cells are talking to one another with different receptors, different cytokines, which are chemical messengers that the cells used to talk to one another.
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And we were making our way teaching each other through these first few chapters, and I was like, Oh, this I got this. This is this is super exciting. I really love the science.
The Crunchy Allergist 4:44
And then we hit chapter four. So we're about a month in we do a chapter a week, and it was like the proverbial poop hit the fan. It got really complicated really quickly and I was thinking goodness, I am not in Kansas anymore. This is really tough. And so there is this phenomenon that we learn about. And you may have seen in pop culture in recent times, called the Dunning Kruger effect. Essentially, some scientists realize that some people don't know what they don't know.
The Crunchy Allergist 5:19
And this I see all the time with immunology, people think they can take a weekend course, and learn how the immune system works, how it misbehaves, and do something about it. And unfortunately, that's not the case.
The Crunchy Allergist 5:36
That's why a rheumatology and an allergy immunology fellowship are a minimum of two years, because it's incredibly complicated, and incredibly nuanced.
The Crunchy Allergist 5:47
Every single person is unique. And certainly there are patterns that we follow that result in particular diseases that we see. But in the end, it's not as easy as it looks. Okay, so that's number one.
The Crunchy Allergist 6:06
Number two, your history. For example, the pattern, the timing, the type of symptoms you're having, is so much more important than your test results. Now, I realize that this probably sounds a little bizarre, since most of the time so many of you are hearing your labs are normal. Don't know, you know, don't know what to tell you. I'm here to tell you just because your labs are normal, doesn't mean there isn't anything going on.
The Crunchy Allergist 6:43
If you are having trouble feeling validated or listened to in your conversations with your care providers, then that is a reason maybe to think about a second opinion or bouncing things off of a trusted advisor or friend, to kind of get some ideas of where to go next.
The Crunchy Allergist 7:02
But in general, and this is very true with allergy and autoimmune, your history or your symptoms are the most important thing. Treat the patient, not the labs, not the numbers.
The Crunchy Allergist 7:17
This is one of the first things you learn as a medical student. But I have to admit, it's probably one of the first things we forget, when we are under a time crunch, or under pressure, suffering from burnout. All these different things that can cause our brain to go on those fast circuits as opposed to really stopping being mindful and thinking about the situation with more time and consideration.
The Crunchy Allergist 7:44
And this is not to throw my colleagues under the bus by any stretch. But I think it is just a take home message of really, it is your story that is so important. And so being able to communicate that story, clearly and effectively to your care team is also really important.
The Crunchy Allergist 8:05
And this is where I really recommend journaling your symptoms in order to take in, take a broad look at what you're experiencing, being able to summarize it and looking for patterns in what you're experiencing, reflecting on what those symptoms are that are really causing you the most trouble and being able then to communicate that during your visit, knowing that those visits are never as long as they should be or really need to be just given the constraints of our health care system. Alright, so that's number two, your history is very important. And only you can know your history. All right.
The Crunchy Allergist 8:48
Number three, your immune system may be misbehaving. But you may not meet criteria for a specific condition yet.
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So when we think about a misbehaving immune system, whether it's the development of allergy, going from eczema, to food allergy to allergic rhinitis, or we're thinking about some of the symptoms that may evolve into an autoimmune condition.
The Crunchy Allergist 9:20
Our lives are like a movie. And those instances where you are spending time in the physician's office. That is just a snapshot. And so in when we get labs, those are just a snapshot in time as well. And sometimes those labs may lag behind where your symptoms are, you know, your what your symptoms are showing you.
The Crunchy Allergist 9:47
So I'll use myself as an example I had symptoms, thinking back years and years ago of Sjogren's maybe dating back even to college. I had some instances of parotitis. So swelling of the glands, the parotid glands. I had a situation where I had a clogged, sawed salivary duct or saliva duct that caused some issues that I recall seeing my primary care doctor for while I was in college.
The Crunchy Allergist 10:19
I didn't have any of these other symptoms yet, I didn't have any known lab problems. But in hindsight, I was probably on my way to developing sjogrens at that time.
The Crunchy Allergist 10:31
Some people are more perceptive and more in tune with their bodies and maybe noticing things happening before they meet a certain list of clinical criteria that is used for diagnosis purposes. This also may mean that doctors won't necessarily recommend specific medication based treatments to treat those until something reaches those criteria.
The Crunchy Allergist 11:06
So again, I think this is helpful to help validate your unique circumstances in your experience. And also, hopefully, by the end provide you with some empowerment as well. And we'll get to that, so stay tuned towards the end for that piece.
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I like to think of this being that window of time where you're noticing things are going wrong, and it's not too late to turn that ship around, and to make changes in what you're doing to try to slow the process down or even reverse it. Alright. Alright, so that's number two, your immune system or number three, excuse me, your immune system is misbehaving. But it may not meet criteria for a specific condition or diagnosis quite yet.
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Number four, the immune system is like a fire. So an inflammation is like a fire, excuse me. So number four, inflammation is like a fire.
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We have certain circumstances like a lightning strike or a match that's lit. This might be a viral infection, physical or emotional stress or trauma might be allergy season. And frankly, it might be bad luck. There are certain aspects that play into the development and the progression of autoimmune conditions and allergy that we don't have fully explained quite yet. But you have that spark?
The Crunchy Allergist 12:50
How we think about how I think about approaching inflammation, then follows this same analogy. So we want to try to prevent the grass from drying out the kindling from building up by living an anti inflammatory lifestyle. This can help the spark from igniting further or even taking hold. In some cases, it's like a flame retardant.
The Crunchy Allergist 13:22
Okay, so one way we can do this, when we think about protecting ourselves against different infections or vaccines, I know that there sometimes is concerned with people who have autoimmune conditions that that they might be at greater risk of for an adverse reactions from vaccines. But so far, when we look at the data, and we look at all comers, including those with autoimmune conditions, vaccines are going to put you at a much lower risk of an adverse reaction than the natural disease. And this has been especially true with COVID.
The Crunchy Allergist 14:02
Okay, so this is a great, amazing preventable medication or preventable treatment, similar with the human papilloma virus, or HPV, which is a virus that is associated not only with cervical cancer, but also had a neck cancer. These are cancers that we also are possibly a greater risk for with sjogrens syndrome.
The Crunchy Allergist 14:25
Okay, the other things we can think about nutrition, eating lots of different plants, different types of fiber from fruits, vegetables, nuts, beans, seeds, spices, herbs, the whole gamut, are going to provide our good gut bugs with the fuel they need to promote anti inflammatory substances called short chain fatty acids to be produced.
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It's going to provide more resilient gut health, which is going to help protect you long term as well. It also is gonna fill you up and steer you away from eating more of those pro inflammatory foods. So things that are pro inflammatory are cured and processed meats, we know that they are carcinogenic or cancer causing some other ways that we can think about anti inflammatory lifestyle, ensuring we're getting adequate and good quality sleep.
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Sleep is super critical in immune system health, helping you fight off infections helping keep the immune system in balance.
The Crunchy Allergist 15:30
Another is stress, we have known stress has an impact on the immune system for decades, it just doesn't get talked about as much as it should. Many of those studies were actually done where I work at Ohio State, and looked at the effect of stress on medical students and saw how their stress levels really altered their white blood cell counts over the course of the semester. It's really incredible work by the doctors Glazer. It was a husband and wife team at at LSU that did that research.
The Crunchy Allergist 16:05
Alright, so those are just a few of the ways we can think about preventing with anti inflammatory lifestyle. And the one other that I almost forgot to mention, which I think is so important. And one of the real key values of the Crunchy Allergist and Success with Sjogrens is community.
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So building meaningful, deep connections with other humans is protective in our health, and really instrumental in our healing, especially if we're dealing with any sort of trauma, either in our personal history or in history from our our relatives in generations past. So generational trauma as well.
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Alright, do you smell smoke? Or is the smoke alarm going off? So your symptoms are that smoke, okay. So if you feel like something's not quite right, this may help point us in the direction of where that fire may be coming from. And so that takes us back to that tip number three, or tip number two that we were talking about, where your experience or your history, the pattern, the type, the timing of your symptoms is really important to help us figure out where that fire may be coming from.
The Crunchy Allergist 17:21
So in the case of Sjogrens, dry eye/dry mouth kind of points us in that direction. If you are dealing with stiffness in your hands and feet, in particular joints in your hands and feet that might point towards rheumatoid arthritis. If you're dealing with low back stiffness or pain that might lend us towards ankylosing spondylitis.
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All of these different symptoms really can help point towards particular diagnosis and show us where that smoke may be coming from.
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All right, now let's think about some of our fire containment systems. We have a sprinkler system or the fire extinguisher that can help the fire when it's small and contained. So this is early treatment with medications or maybe supplements that may have mild anti inflammatory effects. So this may be where something like Tumeric may still be helpful in calming things down. This may be a situation where using a little bit of an NSAID like ibuprofen or Meloxicam might be helpful in getting some of that inflammation under control. It is not going to put out a seven alarm fire.
The Crunchy Allergist 18:32
Alright, so these are, you know, small interventions that are going to help before that fire has really taken over the situation. So as we think about that more significant fire, persistent inflammation may require us to call a fire truck to put out the inflammation, they're going to need to connect that hose to the fire hydrant, and they are really going to need to really extinguish it before it really, you know, is a catastrophe.
The Crunchy Allergist 19:03
And so this may be when someone needs a course of corticosteroids like prednisone or a Medrol dose pack to really turn off that inflammation to get a disease modifying treatment, like in my case, hydroxychloroquine or Plaquenil, or in the case of rheumatoid arthritis, some of the biologic medications, to get that situation turned back around, and to get that fire contained, get it out and get it to stay out without reigniting.
The Crunchy Allergist 19:33
Now certainly, we don't want to have to turn to prednisone or corticosteroids all the time. These medications have significant potential for long term side effects, but sometimes it's what's needed. And sometimes you need to put out the fire before things like anti inflammatory lifestyle and supplements are going to really provide meaningful benefit for the long term. All right. So now we have that catastrophic situation, that multi alarm blaze, all the fire departments are coming to assess the situation.
The Crunchy Allergist 20:13
I remember, I was in grade school, we had a hotel and resort, just down the street. Well down the road, I live down the country. So down the street was like two miles down the road, called the wagon wheel. So if you were from Northern Illinois, Chicago area back in the 50s, and 60s, this was an incredible resort where people would come skiing, Scotty Hamilton did his ice skating training there before he became an Olympian, which, as a figure skater, when I was little, I thought was super cool. But I remember when this place burned to the ground, it was a flames high to the sky, helicopters, fire departments from all over the countryside came to try to put this fire out, in part because the building was built out of old railroad ties and was really toxic.
The Crunchy Allergist 21:12
So that's a whole topic for another day. But when this happens in the immune system, this is something called cytokine storm. And this occurs, sometimes in severe autoimmune conditions, something called like macrophage activation syndrome. But more often, you're going to see patients having this occur in something called sepsis, which is a severe infection that typically has caused infection in the bloodstream. This is when the immune system is in complete chaos.
The Crunchy Allergist 21:48
There are immune system chemicals called cytokines that are being released in huge amounts, it's causing the blood vessels to become very leaky, which in turn causes our blood volume to go down, it causes your heart rate to go up, you have a fever, and it decreases blood flow to kidneys, liver, lungs, brain, people aren't thinking straight, they aren't making urine, they need the ventilator to help them breathe.
The Crunchy Allergist 22:18
This is a major issue that has occurred with COVID and can occur with other infections, bacterial and viral infections as well. Our own cells end up taking the hit as our body is doing everything in its power to fight off the infection that triggered this robust response. And this situation requires a whole lot of help. So these patients tend to end up in the intensive care unit.
The Crunchy Allergist 22:53
There are multiple teams of doctors, nurses, therapists, all bunch of medications that are used to help treat the infection to try to regulate if possible, the inflammation, though, we've had some trouble figuring out the best ways to do that effectively. And really to provide support to the body to help the body through this really scary life threatening situation and help the immune system regain balance. And so that is really the situation that we don't want to end up in.
The Crunchy Allergist 23:32
And this is why if you're worried you have an infection, or if you're on an immune suppressing medication and you develop a fever or an infection, this is why your rheumatologist or your immunologist, allergist immunologist will tell you, you need to let me know, because we may need to put you on antibiotics sooner, do certain lab tests make sure you're okay. So I don't want to share that to scare anyone. But just to make you aware and share the whole analogy of inflammation really being anything from a little fire all the way up to the full forest fire of cytokine storm and sepsis.
The Crunchy Allergist 24:18
So let's recap the five things your immunologist will want you to know.
The Crunchy Allergist 24:23
Number one, immunology is not as easy as some may make it out to be and some people who call themselves immunology experts may not really know what they don't know.
The Crunchy Allergist 24:37
Alright, number two, your work history. As in the timing pattern, types of symptoms you're experiencing are more important than your test results.
The Crunchy Allergist 24:48
Number three, your immune system may be misbehaving but may not meet criteria for a specific condition yet, okay, so keep a good journal of symptoms, and keep touching base over time with your care team, really important, and don't get discouraged. We are here to partner with you, and to help you find an improved quality of life. And however that may look for you and what your goals are.
The Crunchy Allergist 25:22
Alright, number four, inflammation. I'm off here, inflammation is like a fire. And number five, how we're going to wrap up?
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Number five, we have more power than we realize in managing our health through lifestyle.
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Would you believe that 80% of our health is estimated to be based in our daily habits, and only about 20% is really determined by our genetics?
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So how is this the case, what we're learning is that our daily habits, so what we're eating different substances we're exposed to our sleep, our microbiome infections, we're exposed to, all of those things have the power to turn on and turn off our genetic code.
The Crunchy Allergist 26:15
And so even though we may have particular things written in our code that predispose us to conditions, we have some element of power in turning the expression of those on and off. And interestingly, what we're finding out is that some of those on and off switches may take place in generations prior to us to and are passed down to us from our parents.
The Crunchy Allergist 26:45
So for instance, there was a study done on people who were starving during World War Two in the Netherlands. So there was a population of people that were barricaded off, they had no food during a significant period of time. During World War Two, they were living off of tulip bulbs, which are not terribly nutritious, and actually toxic in larger amounts if ingested. And some of these women were pregnant.
The Crunchy Allergist 27:25
And what they found were that children born to these women, who were in these really terrible circumstances during World War Two were small babies, they were born smaller than expected, right, because their moms were starving. So that's not terribly surprising. But as these individuals grew up, they were more prone to being overweight or obese, more prone to type two diabetes, heart disease, strokes, all of these different switches that were signifying the body was in a starvation mode.
The Crunchy Allergist 28:02
So trying to hold on to fat and calories to survive, were turned on in offspring of these women who were exposed to these conditions while the baby was in utero. So we're learning more and more about the power of our habits in our health, and so what I would encourage you to do is slowly but surely work on making some improvements to your daily habits to help support your health and healing.
The Crunchy Allergist 28:38
So and I am a big proponent of what can you add, as opposed to what can you take away in particular as it applies to nutrition and food. Because in those circumstances, if we're adding things that are going to add great nutrition, add great fiber and phytonutrients are aka nutrients from plants to our diet, that's going to just by the nature of eating more of those things decrease some of the things that are less advantageous as as a result, so some other ways we can work on improving our habits are through our our neuroscience or using our brain.
The Crunchy Allergist 29:19
So we can break through self sabotaging behaviors, break out of those loops that we have, that we keep getting caught up on negative thoughts, creating negative feelings, creating negative action, creating negative results. When you break through those cycles and break out of that loop. That is where the real power for lasting sustainable change can occur. And this happens by being aware and being mindful of what you're doing.
The Crunchy Allergist 29:55
That's the first step just really being aware of what some of those 60,000 thoughts we have in our brain every day are when you were able to take a moment, be mindful of those thoughts. Be curious about them. You get to know yourself better. And what I would encourage you to do is to come at that process with curiosity and love in your heart. Because really, the whole purpose of that exercise is to get to know and love yourself on this deep, intimate level. Because when you come at life, and at yourself from that deep knowing and loving, you make decisions that are inherently better for your health and healing. When you can approach this exercise with non judgement, and acceptance of where you are, and acceptance of where you want to go. It's incredibly powerful.
The Crunchy Allergist 31:12
All right, So, we have tackled the five things you're immunologist wants you to know and I want you as your take home message to really start thinking about how you can take a proactive approach to your health and healing Alright?
The Crunchy Allergist 31:33
So, if you are ready To start redefining success with Sjogren's or however your immune system is misbehaving on your terms. My 30-day program will take you from foggy and fatigued to clear and confident. And if you want to learn more about what that looks like and or think about working with me, you can visit www.successwithsjogrens.com for more information.
The Crunchy Allergist 32:01
I also want you to mark your calendars and block out the afternoon Friday, April 1st in the morning of Saturday, April 2nd. We are going to kick off show grounds awareness month with a virtual show grand summit. I am so excited to announce this to everyone. We're going to feature a wide range of fellow Sjogren spoonies, medical and lifestyle medicine experts and we are working on putting together some product demos.
The Crunchy Allergist 29:55
I'm super excited. We're going to have a limited number of V. I. P. registration where you can get a swag bag, otherwise registration is going to be free. We really want this event to be accessible to everyone.
The Crunchy Allergist 32:47
And I am just so excited to gather, gather all of our community and really work on building that community of sjogren spoonies and sjogren sisters to really forge deep meaningful connection between one another.
Because really, I think it's hard for those who aren't experiencing autoimmune disease to truly understand or really experiencing an invisible illness as a whole, to really understand what it's like to walk in our footsteps and to experience what we experience on a daily basis and so to be able to bring that community together, just provides so much meaning and room for healing and space for learning from one another.
The Crunchy Allergist 33:44
So April 1 and 2, if you are thinking about wanting to work with me to work on breaking through some of those self sabotaging behaviors, breaking out of those maladaptive behavior loops, all those negative thoughts and feelings as you're thinking about ways to harness that 80% of the situation that you have control over visit successwithsjogrens.com.
The Crunchy Allergist 34:08
If you have a little extra energy or maybe an extra spoon today, if you wouldn't mind dropping over and leaving a review of the Success with Sjogrens podcast that really helps us leverage the podcast system so that we can reach more people with this incredible message and all this information and really just sharing and building that community even further.
The Crunchy Allergist 34:38
So I hope you have a wonderful rest of your week and weekend if you're listening to this on friday when it's released and I look forward to touching base with everyone at our next podcast and in April for our virtual summit, take care!
