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Well, there are several ways to tell the difference between allergy and cold. The easiest way, is a cold generally is associated with a fever and allergies generally are not. A lot of the symptoms will be the same. You’re talking about nasal congestion and sore throats and such like that. Watery eyes. They can run between both of those. Obviously the treatments would be different, but the easiest way to tell the difference is probably fever. If you have a fever, it’s likely a cold, whether it’s viral or bacterial. If you do not have a fever, it could be allergies.Well, there are several ways to tell the difference between allergy and cold. The easiest way, is a cold generally is associated with a fever and allergies generally are not. A lot of the symptoms will be the same. You’re talking about nasal congestion and sore throats and such like that. Watery eyes. They can run between both of those. Obviously the treatments would be different, but the easiest way to tell the difference is probably fever. If you have a fever, it’s likely a cold, whether it’s viral or bacterial. If you do not have a fever, it could be allergies.

Well, the biggest tip is to know what you’re allergic to and how to address this. So if you don’t know, certainly you find that out, see your doctor. What I do with most of patients is bring them in about a month before allergy season starts and we start them on their allergy regimen at that time. It carries them through. Let’s say they have spring allergies – we get them in, maybe March and start them on their Claritin, Allegra or whatever else we use. Run that through until spring is done and passed and sometime in the summer we take them off of it and that keeps them under control. Some people require those medications year-round. That’s a little different situation. But, the medications, talk with your doctor, is a very good way to do that. Other things you can help to prevent allergies in the home: Certainly Hepa filters are big now, those certainly work very well. When you wash sheets and such, wash them probably weekly, more often if you want to, but weekly is probably best. Make sure you wash them with high temperature water, to get all the little dust mites and such out of them; that helps with allergies, as well. If you know you’re allergic to something, stay away from it. It’s easy to do with foods; a little harder to do with environmental allergies, but if you know you’re allergic to something, don’t go near it.

There are many ways we can use to test and see where these skin allergies, what they’re from, the food allergies, what they may be from. Generally, adults know what they’re allergic to, as far as foods go. By that time, they’ve tried a lot of things, they can do that. So we usually see the food allergies in kids. But nonetheless, tracking down what causes the allergy can be difficult. It’s definitely a work in progress with a lot of patients. You basically backtrack and see what they were exposed to that was different or new. Maybe it was a soap they used, maybe it was some food that they had never had before, some spice that they had never used before, or it could be multiple things. With that being said, once you start eliminating those things, they’ve tried some food, stay away from that food and let’s see what happens and if they have another reaction and they were not taking that, then we start looking for other reasons for it. As far as the gold standard, I should say, for diagnosis, it is skin testing. They take a little bit of what they call antigen, and stick it under your skin with a little needle and if you react to it and you get a big welt, then we know you’re allergic to that. That’s the testing kind of gold standard for those things. We don’t do that in the office here. We use more of a detailed history to kind of test to determine what they’re allergic to or how to determine that.

Well, asthma is essentially a response to the body in the lungs that causes inflammation. It closes down the airways you use to breathe. Think about it kind of like a traffic jam on 75, if there is an accident and they close down one of the lanes in the road, there are fewer lanes for all of that traffic to go through. It makes it very hard to get the traffic through. A lot of people relate it to breathing through a straw, as well, where they just feel like they cannot move the air in and out of their lungs. So, you get this inflammation, it constricts the bronchioles. There are lots of other kinds of underlying things going on, but generally, that’s what causes the wheezing and the shortness of breath. There are many ways to treat that. The big thing, is the inflammation, getting rid of that, and they feel much better.

Wilson: All Nurse Practitioners in our office we see patients just like any of the physicians do. We have our own patient panels but in our office specifically and pretty much everywhere now, we see everybody's patients. And so any acute visit, if you're sick, your long-term, your preventative visits, your follow-up visits all of that stuff. We can do just about everything that the physicians can do in the office so we manage everything.

Bright: APRNs at this point, in Ohio, do have to have a collaborating agreement with the physician so we definitely have kept by that law and have a standard collaboration that we have signed in basically that just recognizes one physician as our doctor that backs us up. Dr. Allen is that for both Sarah and myself. In this setting it has been a huge asset to have that because there are things that may not have seen yet or come across and he is always there to help us in those situations and then it also allows us to work together as a team.

Allen: So the APPs in our office play a role very similar to any other provider. We utilize the APPs in our office to see patients and handle any of the clinical problems that may be arisen or may come up. We really have taken our approach in this office to treat them as much like any other provider, which has been a little bit different than some other offices. They do carry their own panels, they see overflow, they do everything that anybody else would do and everything that I do day-to-day. There's... the credentials and the letters are a little different, there's some orders that I have to sign because I'm the physician in the office, but overall they do essentially 95% of the same work that I do every day.

Allen: So the advantage for the patient in this relationship is that it really allows the patient access to healthcare that they may not have been able to get. I'm one person, I have a limit of how much I can do and see every day. If we find good people around us that can help and, for lack of a better term, extend that ability to take care of the patient, that's their advantage. They have that extension. If you think about these folks here, very similar personalities to mine, very similar way they take care of patients, that allows us now, between the three of us to see maybe 75 patients a day as opposed to 25 for just me. Which I think is very important for the patients; it's access to care.

Wilson: By allowing APPs to bridge that gap a little bit, because there aren't enough family physicians to cover those needs, we kind of can help fill that gap. We can help with a lot of the care needs and things like that, which hopefully are going to keep them from getting to the point where they need to be hospitalized.

Bright: That's the great thing about family practice is that you get to see people sometimes even before they have a problem and you get to maybe help them prevent that problem. That was a big reason for me in choosing to pursue a further degree.