- SinusitisSinus disease is a very important health condition impacting 15% of the US population at one time or another. Sinusitis is defined as an inflammation of the sinuses, which are air-filled cavities within the face. Because the nasal cavities are also inflamed, sinusitis may also be called rhinosinusitis. An infection often starts because of inadequate drainage from multiple causes including infections, a narrow opening, allergies, a weak immune system, or some combination of all of the above. Sinusitis is becoming more prevalent. There is also an association between chronic sinusitis, and asthma.
- Pediatric CareDr. Keiley was born and raised in Helena, Montana. He received his undergraduate degree in biology from Cornell University in Ithaca, New York and his MD from the University of Washington in 1987. After completing a three-year residency in pediatrics at Rainbow Babies Hospital in Cleveland, Ohio, Dr. Keiley completed a fellowship in adult and pediatric Allergy and Clinical Immunology at National Jewish Medical and Research Center in Denver, Colorado. He is board certified in allergy and immunolgy by the the American Board of Allergy and Immunology. He recertified in 2011.
- Primary CareYour allergist will perform a very thorough evaluation of your condition. The physician/clinician component of the allergy/asthma evaluation will cost between $170.00 and $300.00. Other testing, such as skin tests or pulmonary function test may be necessary and are charged in addition to your evaluation. It is your responsibility to check your insurance coverage and benefits prior to your appointment. If your insurance requires a referral from your primary care physician, you must bring that with you. This also so applies to Medicaid Healthy Connections.
- Emergency CareFPIES often presents prior to 6 months of age in formulas–fed and infants with repetitive vomiting, lethargy, and dehydration 1-5 hours after food ingestion. The most common foods include milk, soy, rice, and oats. Other foods that have been reported include barley, chicken, turkey, egg, pea, peanut, sweet potato, white potato, free protein, fish, and shellfish. In 60-90% of children, FPIES dissolves by 3 years of age. However, FPIES can occur in adults, especially to shellfish. The reactions can occasionally be extremely severe with significant dehydration requiring emergency room visits, and sometimes hospitalization. FPIES can sometimes be confused with a severe infection called sepsis.
- Pneumonia
- Pregnancy
- Internal MedicineAn allergist/immunologist is a physician specially trained to manage and treat allergies and asthma. An allergist certified by the ABAI graduates with an M.D., undergoes a full three-year residency in internal medicine or pediatrics, goes through an additional 2-3 year fellowship in adult and pediatric allergy and immunology, and then passes a comprehensive American Board of Allergy and Immunology examination.
- EndoscopyThe diagnosis of EoE needs to be made with the help of a procedure called an endoscopy performed by a gastroenterologist. In this procedure, performed under sedation, an endoscope is used to examine the esophagus and take biopsies that are then observed under a microscope. In most cases, there are more than 15 eosinophils per high-power field.
- PsychiatryDr. Palmer is a native of Utah. He graduated from Harvard College with honors in biology. He attended medical school at the University of Connecticut School of Medicine, receiving honors in internal medicine, surgery, psychiatry, and inpatient pediatrics. He completed his residency in internal medicine at Yale-New Haven Hospital, where he served as acting chief resident and received the award for resident teacher of the year. Dr. Palmer then did fellowship training in allergy, asthma, and immunology at the National Jewish Medical and Research Center in Denver, an international referral center for allergic and respiratory problems. While there, he spent a year in the lab researching peanut allergy.
- Computed TomographyThe treatment of rhinitis sinusitis encompasses both symptomatic relief, and the treatment of an underlying infection. Topical and oral decongestants can decrease congestion. Topical nasal steroid sprays, and occasionally oral steroids can provide additional symptom relief. Antibiotics are also used to address picked her growth of the sinuses and decrease the inflammation. Treatment of chronic sinusitis may include prolonged courses of antibiotics. A useful strategy may be to treat for a week beyond complete symptom resolution. Another strategy may be to use prophylactic or preventative macrolide antibiotics such as azithromycin on a chronic basis, and/or through the viral season. If nasal polyps are present, the use of corticosteroids, and possibly doxycycline, may play a crucial role. The presence of nasal polyps might indicate a condition called aspirin exacerbated respiratory disease (AERD). In the future, some of the biological medicines for asthma may be useful in cases of sinusitis with nasal polyps. If a comprehensive treatment regimen is unsuccessful, then a screening CT scan of the sinuses may be obtained. There may also be a role for referral to a sinus specialist called otolaryngologist for possible surgery. In young children, the removal of the adenoids may improve the course of sinusitis. In some cases, an immunodeficiency workup may be obtained, especially if there are other infections such as pneumonia.
- EczemaContact dermatitis is a common skin condition affecting adults and, to a lesser extent, children. It often occurs with other conditions such as eczema. It is characterized by a rash that is red, itchy, with scale (dried peeling skin). There may also be blisters. It may occur anywhere on the body. There are 2 types of contact dermatitis, allergic contact dermatitis (ACD), resulting from a special type of allergic reaction, and irritant contact dermatitis (ICD), a nonspecific reaction to irritants. Symptoms include a burning stinging sensation with redness, swelling, and peeling. It occurs from an allergic reaction to something coming into contact with the skin on a chronic basis. One should suspect contact dermatitis when the skin condition does not respond adequately to therapy or occurs in a skin distribution not typical for eczema (e.g. a rash around the eyes). A common example would be an earlobe rash or a rash under the pant buckle in an individual with contact dermatitis to nickel. Two common contact allergens are nickel, a substance in metals/jewelry, and neomycin, an antibiotic ointment. There are hundreds of other contact allergens that may be involved.
- AllergiesThe two main ways to detect allergies are skin testing and blood allergy testing. Blood allergy testing detects a specific IgE antibody directed at a specific allergen such as grass, cat, or peanut, etc. Skin testing is done more frequently because it is generally less expensive and the results are available more quickly. In many cases skin testing may be more likely to detect an existing allergy than blood allergy testing. Advantages of blood allergy testing include the lack of interference from antihistamines (which have to be withdrawn for skin testing) as well as the greater availability of allergens for testing. In the case of food allergy, it is often important to obtain both skin tests and blood allergy tests.