1) Jackson, MS2) Louisville, KY3) Oklahoma City, OK4) Memphis, TN5) Knoxville, TN

2015 WORST CITIES FOR ALLERGIES

VOLUME 10 • ISSUE 1Vital SignsHEALTH WELLNESS EDUCATION

*The data was measured and compared by pollen scores (airborne grass/tree/weed pollen and mold spores), number of allergy medica-tions used per patient and number of allergy specialists per patient. Information from http://www.aafa.org/display.cfm?id=9&sub=33

Seasonal Allergies

2 VITAL SIGNS Volume 10 • Issue 1

Vital SignsVital Signs is brought to you by the physicians of the Greater Louisville Medical Society. It is a free health and wellness publication intended for educating patients on important medical health topics.

Vital Signs TeamDavid Watkins, MDVital Signs Adviser

Bruce A. Scott, MDGLMS President

Robert H. Couch, MDGLMS President-Elect

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Aaron BurchGLMS Communications Specialist

Kate WilliamsGLMS Communications Designer

GLMS Mission Promote the science, art and profession of medicine; Protect the integrity of the patient-physician relationship; Advocate for the health and well-being of the community; Unite physicians regardless of practice setting to achieve these ends.

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Louisville has long struggled with allergens and 2015 appears to be no different. A scientific study recently published by the Asthma and Allergy Foundation of America found Derby City to be the second worst in the country for people with spring allergies behind only Jackson, Mississippi.

Louisville is a challenging city for people with allergies for a number of reasons, but one of the most prominent is the weather. Spring allergies are often triggered by tree pollen and mold. Because Louisville often alternates warm and rainy days, it creates a great environment for rapid plant and tree growth. With that environment comes high pollen counts.

More than 45 million Americans suffer from pollen and grass allergies. The Center for Disease Control announced that approximately 17.6 million people have been diag-nosed with hay fever alone in the past 12 months. There are several over the counter medications which can help combat allergies but for those still in need of assistance, seeing a physician is the next logical step.

The Greater Louisville Medical Society sat down with a couple well versed in allergy care. Dr. Sean Miller practices otolaryngology with Kentuckiana Ear, Nose and Throat. Dr. Natalie Miller, practices as an allergist/immunologist with Family Allergy and Asthma. Together, they offer wonderful advice for the Louisville resident struggling with seasonal allergies.

Seasonal Allergies

A Q&A with Natalie Miller, MD, and Sean Miller, MD

VITAL SIGNS Volume 10 • Issue 1 3

When do seasonal allergies occur?Dr. Natalie Miller: Tree pollen can come as early as Valentine’s Day and typically lasts until Mother’s Day. Grass pollen follows then arrives and stays from May until July 4th. Weed pollen comes last and lasts typically from mid-August until the first freeze. Often times, patients will come in for seasonal allergies but we find they have symptoms later in the year when pollen isn’t around. This is how we discover they may have mold or pet allergies from animals such as cats, dogs or horses.

At what point should a person suffering from allergies visit a physician?Dr. Natalie Miller: Allergies are very much a quality of life issue. When they’re affecting your ability to sleep, to work, to go to school, to care for your family, at that point it would be good to see your doctor because there are so many things we can do to help.

Dr. Sean Miller: Additionally, if your allergies are causing recurrent sinus or ear infections and if you’re having difficulty breathing due to allergies, you should see your doctor.

How can an Ear, Nose and Throat physician help those with allergies?Dr. Sean Miller: Ear, Nose and Throat doctors can complement allergists by offering diagnostic studies or surgical options. When shots or medications don’t give patients the relief they need, we can offer relief from recurrent infections by improving the nasal airway. For a lot of patients, chronic sinusitis and allergic disease is an ongoing issue which will require regular maintenance. But surgery is for some patients a way to achieve better control of their symptoms, less frequent infections and less frequent complications.

What are the common symptoms of seasonal allergies?Dr. Natalie Miller: Frequent nasal congestion, runny nose, post-nasal drainage, frequent clearing of the throat, sneezing, itchy red eyes, shortness of breath and frequent infection, those are the noticeable symptoms. But, we also worry about the long term reaction to allergies which can cause chronic congestion and asthma symptoms. There are a lot of recurrent problems. The only thing that is going to make your body not react to the things you’re allergic to are allergy shots.

Could you talk about the process of a person receiving allergy shots?Dr. Natalie Miller: Allergy shots are a way we change the immune system from being allergic to no longer reacting to allergens. There are several ways for this to take place, but the standard way is for patients to come in two or three times per week for about 12 weeks until they get up to the goal dosage. Then, they visit once per week for about a year and we slowly space the shots out based on how the patient is doing. As symptoms improve and they need less medicine, we space it out with the ultimate goal of eventually getting them off of shots. It’s a good three to five year commitment.

Dr. Sean Miller: Some studies have shown that when not appropriately treated, there is a progression of allergic symptoms from skin manifestations to things which are more severe such as asthma. Intervening early, especially for children, is helpful for avoiding the pro-gression of those symptoms.

If a person is unsure about the severity of their allergies, what is your advice?Dr. Sean Miller: If you’re having recurrent sinusitis, say at least three or four infections per year requiring antibiotics, it may be time to consider an Ear, Nose and Throat doctor. We see patients who have been given antibiotics on a monthly basis and not seen better results. At that time, they are better served by seeing a specialist to have conversations from there because there is a whole host of things that need to be investigated to make sure they’re being properly treated. If it’s a significant burden to you, then you need to consider being evaluated further.

Dr. Natalie Miller: If you have sinus infection like symptoms the same season every year, that’s a good sign allergists should be a consider-ation. If you’re having hay fever symptoms like we described and over the counter medicine isn’t helping, that’s a really good time to see us.

Dr. Sean Miller: I think that’s a good way to put it. If you’re not satisfied with the control you’ve had with the medication you’ve taken so far, maybe it’s time to do further investigations.

4 VITAL SIGNS Volume 10 • Issue 1

Whether by loss of work, natural disaster or medical emergency, there is a constant influx of Louisville residents in need of a helping hand. For 27 years,

Shively Area Ministries (SAM) has been providing that much needed support in southwestern Jefferson County.

In a residential district home to approximately 42,000 Louisvil-lians, more than 11,000 relied on SAM for some form of assistance in the last fiscal year alone. The recent economic downturn has hit this area of Louisville particularly hard. The average income of clients who visit the organization is just $800 per month and the amount of residents below the poverty line increased from 11 to 18 percent between the 2000 and 2010 census.

“Part of the reason for that increase was due to the demolition of public housing in Louisville’s west end as well as the financial cri-sis of 2008. On top of those hurdles, we have an aging population often raising their grandchildren,” said SAM Executive Director Roxanna Trivitt, who believes the key to continued service lies along multiple roads.

Those roads have included continued collaboration with the Louisville metro government and non-profit groups such as Dare to Care which help provide food and services for local families, continued education of residents and strengthening the food pantry, which has been the organization’s centerpiece since its inception 27 years ago.

As part of Louisville Ministries, SAM offers assistance to the 40216

zip code by being a centerpiece of collaboration for numerous charitable organizations as well as the 26 participating churches in the area. There are 15 zip code districts across Jefferson County, each with their own unique ministry and needs. However, hunger and poverty will exist regardless of location.

“One program all 15 Jefferson County ministries have in common is our emergency assistance program,” said Louisville Ministries President and Fern Creek/Highview Ministries Exec. Director Rev-erend Ron Loughry. “Emergency assistance is our basic common denominator. We’re all involved in some degree in emergency food and financial assistance to prevent homelessness, hunger and loss of utilities.”

Ideally, individual churches are meant to act as a security net for their congregation, but what happens when the problem gets too big? When the Shively Pastor’s Association initially committed to the idea for a community food pantry, it was simply a matter of supply and demand. The churches couldn’t handle the needs of the community by acting individually so they came together for everyone’s benefit.

“These churches were seeing the same people return, they couldn’t keep the pantries stocked and were having trouble finding volunteers to help staff each facility,” said Trivitt. “So they thought ‘What if we brought this together and created a ministry to not only feed those in need but spend time figuring out why they’re coming?’ ”

COMPASSION AT WORK

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VITAL SIGNS Volume 10 • Issue 1 5

Pooling their resources into what is now Shively Area Ministries, the group was able to offer the 40216 district a more comprehen-sive food pantry than ever before and offer services that wouldn’t be possible by working separately. The ministry started simply, housing all the food in a church basement under a stairwell. It grew quickly, finding brief homes at locations such as the old Shively Fire Station and then in a farm house on Fern Lea Road.

“One of the churches gave that house for a dollar a year donation. I joined soon after, when the ministry was about seven years old. We stayed in the house for 12 years, and it continued to grow,” said Trivitt, who has now been part of SAM for 20 years.

When she joined, SAM was notably more limited in the assistance it could provide to local residents. There was the ever expanding food pantry, a growing meals on wheels service and very limited emergency financial assistance. Once those evolved to a com-fortable space, SAM added counseling and community education services for residents to benefit from as well.

“We found it much easier to relieve family budgets with food versus finding more financial resources, so that’s the service we really use. Once we help them, we get the residents into an educational series of classes,” said Trivitt, explaining that the first step when families are faced with hard decisions is to ease their immediate anxieties.

“When they come in, all they see is the crisis they’re in. They aren’t worried about tomorrow or the next day or the next. So to talk to them about financial budgeting, they can’t hear it. They don’t engage,” she said

Instead, Shively’s educational courses begin with the basics: how to grow and cook healthy food, how to shop frugally, etc. Once students have taken those courses, taught by church and non-profit volunteers, they end with a financial literacy course taught by volunteers from local banks. Today, this rehabilitation program is part of a very structured relief effort.

Each ministry within Jefferson County is different. While Shively has branched out into counseling and educational classes, some ministries have gone in other directions based on the needs of that region. Some areas focus on after school programs for chil-dren. Others, such as Rev. Loughry’s, focus on areas including day programs for seniors.

“Our adult day center is state licensed and has a nurse on staff. We’re one of only three community ministries to have a center but we felt it was very important to our ministry. Each ministry must be in touch with the individual community so we can un-derstand the needs,” Loughry said. “We’re all similar in our goal of uniting the community to serve the community.”

Visibility is becoming less of an issue for Louisville Ministries, especially as word gets out about the great work being done. When SAM moved to its current home on Dixie Highway in 2008, they saw more visitors than ever before. “The unfortunate thing

was that the stock market crashed the year we moved to a four lane highway. So we couldn’t disseminate whether the numbers were coming from the economy change or increased visibility,” Trivitt said.

The building’s first food pantry was 700 square feet but wasn’t nearly enough for the increased demand. “We couldn’t house the amount of food we needed per month, so that’s when we saw the need to build on the food pantry. That spurred us to begin a campaign and have a vision of what could be done on a bigger scale,” Trivitt explained.

It was around that time that Shively had the idea of restructur-ing their working model to better accommodate the increased demand. “We grew from a founding board which did everything to a working board which still had volunteers, and then to a gov-erning fundraising board which is needed to fuel the mission,” said Trivitt. “I run it professionally like a business, and that’s helped push our ministry forward and lead the way for the other 14 Jefferson County districts.”

All the Louisville Ministries are facing the same issues: declining church membership, poor community health and increased pov-erty. But one way they’ve been able to find assistance is through the help of community partners.

“One of the reasons we formed the association of ministries was for the larger picture, the macro level of what we do. Through that, we’ve been successful in getting Louisville Metro Government to recognize that we’re worthy of receiving funds. Same with LG&E and the Louisville Water Company. We also have the Kentucky Harvest program which builds relationships with restaurants such as KFC. Volunteers go to KFC where employees know how to properly package leftover food, and they can pick up chicken for our residents who need something to eat,” said Loughry.

Louisville ministry food pantries typically operate Monday through Friday. Visiting clients may receive two to three days’ worth of groceries four times per year. The food is provided through private donations and the Dare to Care program which serves 13 counties across Kentucky and Indiana. The important thing is that those suffering can have their problems temporarily eased as they get back on track.

“We seek to provide a little stability for families through our services. If we can get them to where the landlord or utilities organization says they’re fine for another 30 days, we’re doing our part,” said Loughry. “For the most part, that 30-day window is enough to get them stabilized. In some ways, we’re a Band-Aid. We’re not solving the world’s problems, but that’s not our scope. A Band-Aid is essential when you’re bleeding.”

COMPASSION AT WORK

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