Transcript
Singers: [00:00:00] Knock, knock, hi.
Will: Knock, knock, hi.
Hello everybody. Welcome to Knock Knock Hi with the Glockenfleckens. I am your host, Will Flannery, also known as Dr. Glockenflecken, and
Kristin: I’m your host, Kristen Flannery, also known as Lady Glockenflecken.
Will: Do you have allergies?
Kristin: Um, I don’t, I don’t know if it counts as an allergy. I mean, I feel like, so mosquitoes, right?
Everybody’s allergic to mosquitoes. That’s why mosquito bites itch, but like, mine get ridiculously large and red. So, I don’t know if that’s an allergy or just, or what.
Will: I have an allergy to puns.
Kristin: Yeah.
Will: I have an allergy to Do you break out in hives? A little bit. Yeah. I have an allergy. I have an allergy to Actually, no, I don’t have any allergies.
No?
Kristin: Well
Will: Cause I’m perfect in [00:01:00] every way.
Kristin: Oh my god. Ugh. I was gonna ask a serious question, but why do I bother? I don’t, I
Will: don’t have any allergies. I feel for people who do, cause they seem pretty terrible, um, but we’re talking all about allergies today.
Kristin: Yes.
Will: Cause I, it’s a part of healthcare that I know very little about.
Yes,
Kristin: and it is part of immunology, which you probably knew, but I did not. I learned that today.
Will: Yep, yep. The immune system is a fickle beast.
Kristin: Yeah, it really is. Kind of a blessing and a curse. It really is.
Will: Um, so, you know, we’re, uh, going in depth about cytokines. No, we’re not. I’m just kidding. We’re not doing that.
It would not make for an exciting podcast.
Kristin: Well, it would to some people. There’d be about ten people that would really be interested in that.
Will: Yeah. I mean, I guess we could do it, but
Kristin: No, no, you can’t. That would be a
Will: very short podcast because I don’t know anything.
Kristin: Exactly.
Will: Interleukins.
Kristin: Okay. That’s a thing.
All right. I’ve heard that word.
Will: MHC complex. All right.
Kristin: People are tuning out already. Complement
Will: pathway. [00:02:00]
Kristin: That one sounds friendly.
Will: It does. There’s direct and indirect. Or is it no? Is it? Oh boy. Okay.
Kristin: Well, today we have Dr. Zachary Rubin. Yes.
Will: You guys probably know him or maybe have seen his content on Tik Tok.
He came up big. He’s got over a million followers verified on Tik Tok. Uh, he’s a hula hooping, bow tie wearing allergist immunologist.
Kristin: Yes. Hard to mistake him for anyone else.
Will: Yep. He’s in private practice. Uh, he sees mostly kids, but as he talks about the scope of what he can do as an allergist immunologist, very common for them to see adults and kids, but he sees mostly kids
Kristin: or kids that turn into adults.
Will: Yes.
Kristin: The lifespan, which
Will: is very common. Um, and so he’s, uh, practicing out there in Illinois and, uh, had a wonderful conversation with him. It was great seeing his content so much. Very
Kristin: smart.
Will: Nice to finally, you know, Talk.
Kristin: Yeah, it is.
Will: Yeah after after interacting on social media so often so And he
Kristin: makes it it’s a very complicated topic, but he makes it all [00:03:00] very simple easy to understand.
Will: Yeah Yeah, it’s he’s got he’s got a gift for the for the medical education for a general audience, which is I found it’s a very valuable skill that that I’m still trying to get better at and Trying to do with all the knock knock eye stuff. Yeah, but so I appreciate any anybody who can can do that and just you know You Take a complicated topic and really, um, make it accessible, you know?
So, um, let’s get to it. Shall we? Here we go. Here’s Dr. Zachary Rubin.
Today’s episode is brought to you by the Nuance Dragon Ambient Experience or DAX for short. Look at this little DAX here to learn about how DAX copilot can help reduce burnout and restore the joy of practicing medicine. Stick around after the episode. Or visit nuance. com slash discover DAX. That’s N U A N C E dot com slash discover D A X.[00:04:00]
All right. We are here with Dr. Zachary Rubin. Zach, thanks so much for joining us. Thank you so much for having me.
Dr. Zachary Rubin: I’m really excited to be able to talk to you. Finally. I don’t know if there’s ever been an allergist next to an ophthalmologist before it’s kind of. Eye catching, really,
Will: I
Dr. Zachary Rubin: mean.
Will: Okay, it, it is.
Eye allergies do exist. Yes. That is true. But, um, but we don’t do, um, like, patching, like the, like, the extensive testing that you are, you know. You
Kristin: don’t drop, like, irritants into the eyeballs to see how they react?
Will: We
Dr. Zachary Rubin: don’t. There was a time, though, when they would do direct challenges back in the 50s. Oh.
You know, that was a thing, very archaic, but we don’t do
Will: that anymore. Well, I want to, I want to get into all the allergy stuff here, because obviously, like, I don’t have an allergist character in my repertoire of, of, you know, characters, hospital characters. And trust me, trust me, Zach, I’ve heard about it from a lot of people, like, I’ve, in fact, maybe you, maybe you were [00:05:00] the one that, it
Singers: was
Dr. Zachary Rubin: me at one point when I was still on Twitter.
I would, I would definitely troll you a little bit being like, where’s that allergist going to come? Yeah. Hey, you’re It’s
Will: fair. Um, so have
Kristin: you ever even interacted with an allergist like in your training? No.
Will: I didn’t think so.
Kristin: Yeah, in fact, in fact,
Will: Zach. He’s got nothing
Kristin: to draw on here. I think
Will: you might be the first allergist I have actually, like, spoken to.
And maybe even seen. That might be true. Yeah, yeah. Do they all look like you? Do they all look like you? No. Is that, No, that’s the thing.
Dr. Zachary Rubin: Because on social media, I have a pretty large following. I’m like the TikTok allergist and so everybody assumes because I kind of fit that stereotype look of somebody who lives with allergies that I must be an allergist, but if you actually meet other allergists, we are very diverse group.
There’s only about 7, 000 board certified allergists in the country, so that’s Oh, that’s not very many. Very few, exactly.
Kristin: That seems like not enough for the amount of allergies that you hear about these days, [00:06:00] right? It seems like allergies are increasing in kids and stuff, like, Like now we can’t send nuts to school with our kids and their lunch and things like that.
Maybe they’re just
Will: more recognized, I don’t know.
Kristin: Yeah, I don’t know. Has there been an increase? Are we getting more
Dr. Zachary Rubin: allergies? Yes, unfortunately, it’s a little bit of yes, we are, we are recognizing it better. We have better diagnostic tools,
Singers: uh, but
Dr. Zachary Rubin: there are more and more kids and adults living with things such as food allergies, which unfortunately can be life threatening.
And part of the reason why I’m on social media is to try to clarify a lot of the misconceptions that people have. And it’s great to talk to you because, You do such a great job discussing issues related to different specialties, and you do it in a fun way, but when it comes to something like food allergies, a lot of the jokes that happen are usually in poor taste.
Will: Oh, yeah. Yeah. I mean, it’s
Kristin: Yeah, they’re usually like at the expense of the person with the allergy, which is not funny when you have one or have a kid that has one.
Will: Well, that’s, that’s, that’s my main rule of social media is you never make fun of patients. Exactly. It’s just not what you do. You know, people, [00:07:00] And especially coming from, you know, the physician side of things, it just undermines the trust that people have in physicians to have, see, see any medical professional really like punching down at a patient.
So, uh, yeah, it’s, uh, I, but I, I definitely appreciate like bringing the. the education about this area of medicine that probably just a lot of people just don’t know much about, right? Uh, but I want to start kind of at the beginning of, of med school for you. So you must have been the student who actually like paid attention during like the cytokine lectures and, uh, you know, learning the immunoglobulins that, that stuff piqued your interest, I assume.
It did,
Dr. Zachary Rubin: it did early on, but I actually was not interested in allergy until I did my clinical rotations. I was. really gung ho on just doing general pediatrics. My dad is a general pediatrician. I’ve always loved working with kids and grew up going to my dad’s private practice. So that was something that I knew very early on that I wanted to do.
And then I started doing rotations and realized, [00:08:00] wow, this is a really unique field. There are very few specialists That can be a pediatrician and take care of adults and vice versa and be an adult doctor and then take care of children. You’ve got palliative care and sleep medicine are the only other specialties besides allergy where you can take care of all ages and only do residency in one age group or potentially both if you do med peds as an example.
Will: Yeah. Oh,
Dr. Zachary Rubin: that’s
Will: interesting.
Dr. Zachary Rubin: I didn’t realize that.
Kristin: What about family practice? Is it not that way?
Dr. Zachary Rubin: Well, family practice takes care of all ages, they start out doing that, but if you’re in general pediatrics, you’re usually locked into taking care of kids, and I realize eventually I’ll get old and, uh, you know, my patients will grow up.
And it’s nice to be able to take care of them when they’re older, but also take care of whole families. And that just opens up a level of continuity of care that I didn’t realize when I was in medical school initially.
Kristin: Right. And are allergies, I mean, they’re pretty hereditary, aren’t they?
Dr. Zachary Rubin: Yeah. They can pass down.
Absolutely. But what we’re seeing now over the last 10 years is people are developing allergies later in life as well. People who do not have food allergies when they’re kids, they’re [00:09:00] starting to develop as an adult, which is becoming more common, unfortunately. Absolutely.
Kristin: Yeah, well, is it Gal Alpha? Alpha Gal?
Dr. Zachary Rubin: Exactly. The meat thing with the chicks. The meat allergy? Yeah. Oh my gosh. I just
Kristin: pulled that out of who knows where. That’s pretty good. I’m a pro. That’s amazing.
Dr. Zachary Rubin: No, that is becoming increasingly more recognized. Most physicians don’t even know what that is. That’s when you want to tell
Will: people,
Dr. Zachary Rubin: tell people what that
Will: is.
Yeah.
Dr. Zachary Rubin: So essentially there’s a specific type of tick called the lone star tick that in its saliva has a sugar molecule called galactose alpha one, three galactose, also known as alpha gal. And if you are out on a hike and you get bit by this tick, they introduce that sugar molecule into your bloodstream and the immune system will look at that and say, We don’t have this in our normal repertoire.
This must be a foreign invader. We’re going to create IgE antibodies and the body becomes sensitized to it. So that when you eat any mammalian meat product, you could have a severe allergic reaction to it. And it’s unusual because it’s delayed. So oftentimes people will eat a steak dinner at night and then they’ll wake up in [00:10:00] the middle of the night with hives and wheezing and have no idea what’s going on and they end up needing an EpiPen for it.
Um, so this is a potentially life threatening situation and the mammalian meat products are not just in the food that you consume like beef, pork, and lamb, but it could be found in gelatin as an example. So various candies, um, it could be in dairy as well. So a lot of patients have to become vegan essentially in order to, you know, live a healthy lifestyle.
And then there’s various medications that may contain alpha galanin as well. The only reason why we knew about this was because there was a, there was a cohort of patients who had severe allergic reactions to situximab, a monoclonal antibody, to treat colorectal cancer. And they were able to trace those patients to those who were getting these tick bites, essentially.
And they were becoming sensitized to this. And, and the, the story behind it is actually fascinating. And we now estimate, based on a recent CDC report, that it’s the 10th most common food allergen in the United States. And it’s growing. Really? Wow. Because of the [00:11:00] exposure to ticks. Wow.
Kristin: And is, and I assume the exposure to ticks is related to climate change, right?
Like winters aren’t cold enough to kill them off in the same way they used to be. They’re moving up north from where they used to be.
Dr. Zachary Rubin: Yeah. We think that does play a role in this. Uh, however, there is a large cohort of patients in Northern Minnesota as well. So some of it is a lifestyle issue where we’re just.
You know, being out outdoors more, you know, you may be exposed to it, but definitely there is this tick that’s starting to march further and further north that we see, especially along the East coast and the Missouri Valley. They’re coming for
Will: us.
Kristin: See, this is all the more reason to not go camping. See, this is a longstanding marital argument.
Will: Well, um, so to a lot of people. The, the, the, the idea of an allergy to meat is horrifying, like to meat lovers out there. So is that the only, is it like you swore off meat? Like that’s it. You can’t, you gotta be vegan. Like what, what can you do? Is it possible to [00:12:00] desensitize yourself to that allergy? You know, can you speak on that a bit?
Yeah. Is there hope? Is there hope for meat lovers out there? So
Dr. Zachary Rubin: there, there, there’s a little bit of hope in, in, in certain aspects. We can’t reliably desensitize the immune system to outgrown allergy right now, unfortunately. Um, avoiding tick bites is of utmost importance because we know that some people, when they get bit by a tick again, they can become resensitized.
And I just read a case report recently of a patient who had a very high IgE level to alpha gal that went down after about three years of abstinence from mammalian meat products and not being bit by a tick. Then they got bit again and their numbers bumped up. And then they had to wait a couple of years and went down and then they were able to do what we call an oral food challenge where we prove to that patient that they’re either allergic or not by eating that food in front of us.
And when it comes to an alpha gal challenge, it’s unusual because they have to eat basically like a cheeseburger or steak at eight in the morning and then sit in clinic all day. In order to see if there’s a delayed reaction. And sometimes you have to do that multiple times [00:13:00] because with this allergy, it’s not reproducible like other food allergies.
You may eat a steak dinner and have no problems. And then you have a taco the next day and you go into anaphylaxis four hours later. So it’s, it’s challenging.
Will: You must have a very interesting clinic.
Dr. Zachary Rubin: Yes. Yes. This is what my day is like all the time, pontificating on the what if and the risk reduction strategies, what could happen.
Will: It’s really interesting every day.
Kristin: I would be so good at that.
Will: Five, five guys like 8am, really? You really want this double cheeseburger? We’re not even open yet. Come on now. That’s ridiculous. I would
Kristin: be really good at that though because you just described every person with anxiety. Okay.
Dr. Zachary Rubin: That’s the problem with a lot of these issues that are potentially life threatening.
There’s overlapping anxiety that develops not just for the patient but their family members too.
Kristin: Oh yeah. Because of
Dr. Zachary Rubin: the potential for cross contamination. If you have a small amount of protein on a surface, And that comes into contact, um, when you ingest something, it can cause serious reactions for some people.
So, [00:14:00] what we have now is a really exciting breakthrough in food allergy treatment. It’s the first medication to treat food allergies, actually. It’s an injection that’s been around since 2003 to treat asthma. Uh, but now it just got approved for food allergies to reduce the chances of having these severe allergic reactions if there’s axial ingestion.
Kristin: And is that, is that like,
Dr. Zachary Rubin: I assume
Kristin: that doesn’t mean that it opens the person up to just eating whatever they’re allergic to, whenever they want, but just if there’s small,
Dr. Zachary Rubin: if there’s small amounts of ingestion or there’s cross contamination, it reduces that anxiety because let’s say you eat a bite of ice cream and didn’t realize that it had cashews in it.
Instead of having that high risk of needing epinephrine, it significantly lowers that risk. That’s a medication, unfortunately, you have to take definitely, though, to maintain that level of therapy, but we didn’t really have much outside of that. We’re trying to work on something called oral immunotherapy that does something similar to that, but you have to take a dose every single day.
And that’s something I do offer in my [00:15:00] clinic, uh, but that’s something that can be difficult for a lot of families to do every single day. This isn’t every two to four week injection.
Will: So I was surprised to hear you say that. I guess there are some allergies that you, you just, you can’t desensitize to. I, I, I guess I thought that was something you could always do with most allergies, right?
You could, you know, the little challenges that get you your immune system to recognize this as not a foreign thing, like
Kristin: a foreign thing. Five year program of right injection, but I guess that’s, that’s not
Dr. Zachary Rubin: always possible, right? So you can do that. You can desensitize the immune system pretty easily to environmental allergens.
So if you’ve got a cat allergy, we could either through drops or injections, slowly increase those doses. And we can usually desensitize most people to that. But when it comes to food, It doesn’t really work that well to, you know, be able to freely eat and it can be quite dangerous. So we’ve tried injections in the past of those specific allergens and it didn’t work out so well.[00:16:00]
Will: So immunotherapy is like the next frontier of That’s like the hot topic now in allergy. Like when you’re going to allergy conferences.
Kristin: Yeah. What do you call it? What is it called? Allergy medicine.
Dr. Zachary Rubin: So it’s allergy immunology actually. So we’re, we’re trained to take care of. Abnormal immune responses to foreign substances, which is the field of allergy.
But also there are the rare set of diseases where, uh, people may be born with a non functioning immune system. So when you think about Bubble Boy and those movies, that’s severe combined immune deficiency. You have a genetic variant that doesn’t allow the immune system to fight off infections. It’s not the same as HIV, which is a secondary form of immune deficiency, but there’s over 300 diseases actually of rare diseases of people.
What we call primary immune deficiencies. And that’s part of our training as well. Not every allergist does that on a regular basis. You need a lot of resources in order to take care of these patients, but they, they come at all ages. You can have adults who develop this later on in life. Um, they may [00:17:00] have overlapping autoimmune diseases or an increased risk of developing cancer as well.
Will: So I want to ask from a, a non allergy physician, you know, viewpoint, because I, obviously Every patient that comes in to see somebody in the medical field, they always have a list of allergies, or maybe they don’t have any allergies, but a lot of them have a fairly extensive list of allergies, but. It’s, it’s, it always feels like this constant battle of like trying to parse out like what’s a true allergy and what’s not a true, and I’m sure this is probably at some level frustrating for, for you as well, because,
Kristin: yeah, maybe like intolerance versus, right.
Will: So like, what is your approach to. Patient said maybe they’ve been told they have an allergy or they think they had an allergy, but, but, you know, you’re not quite sure.
Dr. Zachary Rubin: Right, right. It’s a great question. And just as a quick pivot, because my memory is coming back to me about a skit you did a while ago, [00:18:00] where you were a med student.
interviewing a patient saying, Hey, um, do you have any drug allergies? No. Are you sure you have any drug allergies? No, no. And then you go and talk to the attending, the attending comes back and says, we’re going to give you penicillin. They said, wait, no, actually I have this allergy list. And that is the, that’s the one overlap I’ve seen you talk with allergy.
So I have to, I have to give you props for that because I see that. All the time, unfortunately.
Will: Yeah. Um, that’s a rite of PA rite of passage for med student. Yes. Is the . You get told one thing and then the, and then all of a sudden the patient remembers differently and then the attending hears something else and then you feel like you’re, you did something wrong as the med student.
Right? Yeah. Rite of passage. It is a rite
Dr. Zachary Rubin: of passage. It happened to me many times too. Um. To get back to your original question, the history is the most important aspect of this, and oftentimes we struggle with this because the patient’s told, Oh, when I was a baby, this happened. And then you’re stuck saying, well, what do I do about that?
And it can be challenging. And so understanding what the [00:19:00] potential mechanism is, we go back to medical school, the Jell and Coombs classification scheme of type 1 hypersensitivity reactions and understanding what are the potential symptoms. And I want to see some story that looks like that versus when did this rash occur?
You have to get the timing down. You have to figure out what the symptoms are and does that line up with one of these type of hypersensitivity reactions before you can confidently say, yeah, I think this is an allergy or no, it isn’t. And we do have some availability of skin testing for penicillin if we want to classify the level of risk for a patient with penicillin allergy, which is the most commonly reported drug allergy in the United States.
But we know that about 90 percent of that is probably not real, that most people who report that either they outgrew the allergy, because after 10 years about 80 percent of people outgrow it, or it wasn’t an allergy to begin with, was more of like an intolerance where you get an upset stomach and [00:20:00] diarrhea and everybody thinks that’s an allergy, but that’s a normal expected side effect of the medication.
And that’s why it’s really important that we educate. the general public and physicians in general about what are these potential side effects of the medications and what types of reactions would prompt us to having an allergist go over the details and whether they are truly allergic or not. Uh, it, it’s a really tricky situation that many physicians don’t feel comfortable tackling because it is a liability risk that if they do have another reaction again, what would happen in the future?
Will: Right. Do a lot of, do you get a lot of consults like that? Yeah. Yeah. Yeah. Yeah. Like, you know, this patient needs this medication, but there’s a reported allergy, you know, can you help us solve this? Is that a. I’m just trying to get a sense of where your consults come from. Like what are the, what are the main categories?
Dr. Zachary Rubin: Right. So from a drug allergy standpoint, I don’t get a lot in the community. I’m in private practice. That’s usually, uh, issues that happen directly in the hospital itself, especially in [00:21:00] tertiary care centers. Um, and I do take care of mostly children compared to adults. So, um, a lot of times they don’t, they don’t come to me with these issues specifically.
What I, what I end up getting a lot of consults are for my practice is food allergy, chronic spontaneous urticaria, or hives. Our main ones and then severe asthma, severe eczema, which we take care of. It’s not just pulmonologists and dermatologists. We also take care of those issues as well. And then a lot of people, the bread and butter is the severe allergic rhinitis that continually seasonal allergies continually gets worse and worse every year.
As we get longer and worse pollen seasons, rising temperatures, I had a lot of respiratory issues come into my clinic, either post COVID infection, where they’re getting a chronic cough, or from the wildfire smoke coming in from Canada into my area last summer, a lot of people were getting sick with all sorts of respiratory and sinus issues because of that.
And then I occasionally get nasal polyp consults as well.
Will: Okay.
And so I want to talk [00:22:00] now about your, uh, um, your social media presence here, because, uh, like, like many of us, you know, it was like around COVID, you know, that, you know, lockdown is when I got started on Tik TOK and, and I’m not sure when you started your account, but, um, I guess just, let’s just jump into the hula hooping.
Let’s just, let’s just get that. Let’s, let’s talk about this thing because I think you were known for that. Like that’s. I’ve seen several videos of where you’re, you’re educating people while hula hooping. Yes. Um, I’m just going to stop talking and let you just discuss your hula hooping prowess here. So
Kristin: I’m hearing the question is just, What?
Dr. Zachary Rubin: Yeah, what? What’s going on? If I could do it while we were talking, I would, but I have too much around me, but this is the shtick. This is the story. So, uh, I’m nine years old, I’ve got an older brother, uh, we would go to bar mitzvah parties, right? And, and part of the, the, the gig is there’d be these [00:23:00] different games, you win prizes.
And one of them was a hula hoop contest. And I was absolutely terrible. I’d go up there and I couldn’t do anything with it. And I’d see these kids get these huge chocolate bars and toys and whatever. And I thought, I got, I got to figure out how to do that. So I told my mom one day, take me to the sports authority.
I’m going to figure this out. I bought two green hula hoops, went into my parents basement, and just sat there for hours and taught myself how to do it. And, uh, you know, self taught
Will: hula hoop champion.
Dr. Zachary Rubin: Yeah, this was pre
Kristin: YouTube too, so you didn’t even have something to watch. Exactly.
Dr. Zachary Rubin: I just figured it out myself and, uh, you know, ended up, uh, winning a bunch of contests when I was, you know, 13 years old or whatever.
And, uh, then when it came time to applying for college, I thought to myself, you know, I gotta be a little bit more unique and put something in my personal statement that would be interesting. So I actually wrote about my experiences teaching myself how to do this And, and the concept is if I put my mind to something, I can do it.
And, uh, I was in a [00:24:00] combined undergrad BAMD program. Uh, and that was, that was my shtick talking about that. Um, that’s great. I bet
Will: they love that. I bet they love that. You know, the like, you can imagine coming across that, that personal statement, you know, it’s like, okay. It’s it’s unique. It’s a little
Dr. Zachary Rubin: quirky.
It’s a little weird. And that’s okay. And I, I, I embrace that. I think it’s okay to just share some unique parts of your personality. And that’s one way to do it. So when it came time to going on social media, I started out on Twitter, right down around lockdown. Then a medical student had asked me, Hey, you know, you do a really good job communicating these things.
Why don’t you go to tick tock. And this was spring of 2021. And I said to myself, Okay. I thought this was just a dancing app. I had no idea what this was. And I said, and I said to myself, you know, I’m going to try it. I made some videos. I started talking about COVID initially. And then one day I thought to myself, I saw all these dancing videos.
Why don’t I show people what I can do? And I just one day took one of my old green hula hoops and started hula hooping on camera. And a bunch of people like, Who is this [00:25:00] Dr. Hula Hooping? This is crazy. And it just gained traction and people thought it was, you know, fun, hilarious, and also informative where I, you know, show captions about whatever we’re talking about here.
And then occasionally I’ll do lives where I’m raising money hula hooping and making fun of myself. Uh, exercising, putting on, you know, 80s, 90s music and dancing and hula hooping at the same time to, to showcase that. And we’ve raised over 30, 000 doing that.
Will: That’s awesome. It’s been awesome. It’s the perfect thing for Tik TOK.
It’s like a very great fit for that app. Yeah. So it’s just
Dr. Zachary Rubin: niche and silly. And, and I, and I try to tell people, you know, whether they have difficulty exercising or getting started, that it’s a great activity. You can do, you can have a lot of fun with it. And I want people to be comfortable in their own skin.
You know, with whatever they enjoy doing. And so, you know, you see a doctor doing that and kind of breaking the barriers down and getting comfortable, uh, talking with, with patients and the patients feeling more comfortable talking with their doctors. I’m just trying to break those barriers down. And [00:26:00] do
Kristin: you have a hula hooping clinic?
I wish
Dr. Zachary Rubin: I did, but the rooms are too small. Fair enough.
Kristin: You could come in with a hula hoop and the little unicorn headband and, you know, just really make the whole process less scary for kids.
Will: Well, he’s got his, he’s got his bow ties. He does. That’s what I’d like. Is that
Kristin: what the bow ties are about?
Will: You’re wearing a bow tie now.
A lot of your, I mean, is it all your videos you’re wearing a bow tie pretty much? Almost all of them. So, so,
Dr. Zachary Rubin: you know, oftentimes I’m making videos either right after work or I have a patient cancel, so I’ll make a quick video or whatever. I started wearing bow ties actually, because in between college and medical school, I worked for six months for a charitable foundation that did a lot of work at a public magnet high school and they had a dress code.
So you had to wear a tie to go into the building and uh, I decided, you know, it’d be fun to wear a bow tie. I hadn’t really worn many at the time. So I went on YouTube and taught myself how to tie a bow tie and uh, taught some neurology courses and which, you know, is [00:27:00] fitting because as you, you with your neurology character wear bow ties too sometimes, right?
Um, so one day I was, I said to myself, I’m just going to put on a necktie today. I don’t know why I did it. And I went to school and one of the students looked at me and said, you know, Mr. Rubin, You’re not cool anymore. You’re not wearing your bow tie. And that has stuck with me ever since. Thinking about these impressionable teenagers who were telling me, You gotta wear the bow tie again.
And, uh,
Will: Bow tie culture
Dr. Zachary Rubin: is a
Will: thing in medicine. It, it is. It’s, there’s, there’s, there’s, it, it hits certain specialties. There are certain specialties that are more, More bow tie oriented.
Dr. Zachary Rubin: I, I think, I wonder what the surgeons used to wear them more commonly, like in the fifties. Now it’s scrubs. It was a thing back then, but now, now it’s a little bit different now.
But, uh, I remember when I did my medical school class picture, I was actually kind of embarrassed of it, of like I thought people would look at me kind of weird wearing a bow tie. So I put on a neck tie. And it took that picture. And ever since then, I’ve kind of regretted that. I was [00:28:00] like, why, why did I do that?
That’s not who I am. Like, you never seen me with a necktie. Um, it’s usually with a bow tie and, uh, don’t kids pull on them too? They pull on neckties. So, so they look at this and I’ll have, you know, different patterns. I even have like a, a Pikachu bow tie, you know, um, that, that I’ll wear it and, and kids love it and then they can’t grab at it, it’s cleaner.
And even if it’s just, you know, slightly off angle or whatever it is, it still looks more fun than. You know, a really long crooked necktie.
Will: Do you
Dr. Zachary Rubin: have one that
Will: spins? No,
Dr. Zachary Rubin: I don’t.
Will: I bet we could find you one. I think I have
Dr. Zachary Rubin: one that lights up though.
Will: Oh, that’s good. Pretty cool. Have you ever had any followers send you bow ties?
Dr. Zachary Rubin: Yes, I actually have.
Will: Uh, one family in Colorado
Dr. Zachary Rubin: sent me like 20 bow ties because their 13 year old son actually handmade them. And, and, uh, he had moved out of the house and they had all these extra bow ties lying around and, uh, they sent them to me. Um, I had one guy from the Netherlands send me a bow tie.
The one that’s in my profile picture was [00:29:00] a bow tie maker actually in the Netherlands sent me one. So it’s pretty cool. That’s
Kristin: pretty cool. Yeah.
Will: That’s cool. Well, let’s take a short break. I want to ask you some more questions about being an allergist immunologist.
Oh, Kristen, do I have an AI platform to tell you about?
Kristin: Ooh, tell me.
Will: Yeah, it’s called Precision. This is the first ever EHR integrated infectious disease AI platform.
Kristin: That sounds fancy. Yeah, well,
Will: one of the hardest things about infectious disease is, is like, You know, figuring out what to do with all the information and it’s always coming in at different times and figuring out what works best for the patient.
Kristin: Yeah.
Will: Well, this automatically highlights better antibiotic regimens.
Kristin: Ooh, I would imagine that helps with antibiotic resistance.
Will: It does. To see a demo, go to precision. com slash KKH. That’s precision spelled with an X instead of an E. So, P R X C I S I O N dot com slash KKH.[00:30:00]
All right, we are back with Dr. Zachary Rubin, uh, Zach, so I want you to help me, uh, figure out a character for, for allergy immunology. Okay. So. I, I deal in, in my content, I deal in like interpersonal conflict. Like, are there any, it seems like, like you’re a nice guy. I, it doesn’t seem like you have any conflicts with other like areas of medicine.
The other, are there any, uh, pet peeves? You know, any kind of, um, you know, things that I could really get in there and kind of basically he’s
Kristin: asking you to do his research to
Dr. Zachary Rubin: create a character. Let’s be clear, since I’m like the only one you’ve ever met before. It’s so harsh. You know, like you said, we don’t really have a ton of conflict with other specialties.
We do have some overlapping features with dermatologists, pulmonologists as an example, sometimes rheumatology. So there’s a little bit there. Yeah. But we’re kind of off in our own world, [00:31:00] right? I mean you could think of like someone who’s aloof a little bit to that extent if you if you’re thinking about Imagery, right?
Yeah, right to give you some buzzwords there. Um,
Will: there’s no cardiologist to your nephrologist Exactly,
Dr. Zachary Rubin: you know, we’re not we’re not carrying around, uh, You know, a canister of salt and just screaming into the void. You know, we don’t, we don’t have that.
Singers: Uh,
Dr. Zachary Rubin: It’s probably a good thing. It’s probably a good thing.
It is a good thing for my mental health and my physical health. Yes. That’s
Kristin: right. Well, what are the qualities that make somebody a good immunologist or allergist? Like, what? I mean, you seem to be. Maybe detail oriented? Yes,
Dr. Zachary Rubin: like infectious disease. We’re very detail oriented. Um, you know, it’s one of the jokes that, I don’t know if you’ve ever said this in your videos before, but that infectious disease talks about, we talk about sometimes is, you know, if you’re in the hospital getting a consult, you often do a chart biopsy.
You’re literally going into the nitty gritty details of everything. And for me, drug allergy, we have to do that work. I try to figure out Oh, okay. When did this drug allergy get put into the [00:32:00] chart? When did it actually happen? This was back in 1984? Why? Who did that? And then I can go to the patient and say, Can you tell me what happened on the night of September 7th, 1984?
No. Okay, you know, so, so there’s, there is the element of being detail oriented, a lot of pontificating. Well, you know, if this happens, then maybe this would happen. If we do this test, there’s these sets of risks and benefits. It is often going down into a rabbit hole that that’s actually becoming more common now because It used to be a lot of people, especially in primary care, would just order a panel of tests, like food allergy tests or environmental tests, but we’re learning more and more that that’s really an inaccurate way of doing it.
It can actually cause more problems for the patients if they do that, especially with food allergies, because then you’re avoiding a bunch of things that you don’t need to. Um, so, so we, we often try to spend more time with the patient to discuss risks and benefits of these specific tests that we’re doing and try to convince them, are [00:33:00] you sure you want to do this?
Really want to get that test. Yeah, this is what could happen. So I hope that gives you a little bit more clarity. Yeah,
Kristin: that’s good. Yeah
Will: Hey, what what are are there any things that you would want either, you know, general pediatricians to know or just any any medical Professional to know about allergists that they probably don’t know.
Dr. Zachary Rubin: We’re not really huge fans of prednisone vitamin P. Oh Okay All right.
Kristin: Why is that?
Dr. Zachary Rubin: So, as an example, patients will go to their primary care provider, they’ll say, I have hives all over my body and I can’t get it to get better. And uh, they’ll often kind of try to wave a magic wand and give prednisone to just get that to go down more quickly.
But then they’ll come into my office and they’ll say that their rash is worse than it was before. They’ll get kind of a rebound effect or because they had that relative feeling of, you know, of, you know, the, the rash is quiescent, uh, all of a sudden it’s worse. So it, it, it’s perceived as being worse. And then they’re trying to figure out why this is going on.
And [00:34:00] many times we can’t figure that out. And then they’ll go through this laundry list of saying, is it this detergent? Is the soap? Is it this particular product? And many times it’s actually not any of that. And I think people just need to be a little bit more uncomfortable with uncertainty, uh, when it, when it comes to what is the exact reason why something is happening.
And, uh, being more comfortable understanding that, yeah, you know, you probably have twitchy mast cells. Is what’s going on? It’s just, they’re just dumping a bunch of chemicals for whatever reason. Talk to me
Kristin: about mast cells because that’s also a thing in, in certain forms of like Ehlers Danlos syndrome and like with hypermobility, which is something that I do have.
So what, I mean, that those two things seem totally unrelated, right? To be hypermobile and then to be allergic to something. So what, tell me what the mast cells are, what’s going on there?
Dr. Zachary Rubin: So we do see a, quite a bit of overlap between patients who have Ehlers Danlos syndrome, which is a hypermobility syndrome and having called.
Uh, mass cell activation syndrome. So mass cells are part of your immune system, mainly on the innate side that kind of surveilled to see, Hey, is there, is there a [00:35:00] parasite? Is there a venom? Is there some type of wound going on? And it’ll release several chemical mediators to bring other cells of the immune system towards that.
And so that is the, the actual allergy cell of the body, the typical one that we think about because they will activate in response to pollen, to foods, to latex, to all these other things. And potentially it could be life threatening or it could be a nuisance. There’s a whole spectrum of it. So if anybody has allergies, it is actually a form of abnormal mast cell activation.
But for a certain group of people, we don’t know how common it is. They could seemingly have severe reactions. on a whim and the exact trigger is not really well understood. One of the common ones is stress because stress actually has a hormonal pathway that leads to direct mast cell activation through a hormone called CRH or corticotropin releasing hormone.
There’s that aspect to it. Um, but changes in weather could potentially do it. Uh, foods that you normally can tolerate can just do it on a whim. And then because mast cells are all over the body, if they’re [00:36:00] activating, let’s say near the brain, you could get brain fog and anxiety from it. If it’s in the gut, you can get bloating, diarrhea, vomit, vomiting, and your skin causes flushing, hives, and swelling, um, even can lead to potentially joint pain as well.
So it causes a multi systemic problem that if you take various medications that block the downstream effects of that, such as antihistamines, leukotriene receptor blockers, mast cell stabilizers, and you, you feel better. Uh, after ruling out a bunch of other things, you may have this at mast cell activation syndrome or MCAS.
Will: God, mast cells just
Dr. Zachary Rubin: cause
Will: problems.
Kristin: Yeah. What do we need those for?
Will: Yeah. I mean.
Kristin: I’m just kidding. We need them for
Will: a
Kristin: lot of things. Pretty important. Probably do. Yeah.
Will: Um, all right. So what’s, what is next for you in this online persona that you’ve, you’ve, you’ve built up this, this, uh, Are you going to keep making these videos?
Are you going to like, do you have plans for [00:37:00] this? Is this really just, Hey, this extra thing, I’m just going to keep going with it. And you have your job as a, you know, seeing patients and, and do you have, do you have big plans, I guess is what I’m asking.
Dr. Zachary Rubin: Yeah. So, um, I, I really enjoy what I do on social media in terms of educating people.
I’m starting to. get into some leadership positions, uh, at like the society levels for various allergy societies. So I’ve actually joined a social media subcommittee to try to encourage other allergists to try to help educate, um, and, and, and get the word out and, and encouraging people. Oh man, we need more.
We need more of that. Yeah, we need to help debunk that kind of misinformation. It’s not, it’s not just me, but there’s several Instagram who are doing this kind of work now, which is great. Um, so I’ll be presenting for the first time at a national meeting next fall in Boston. I’m very excited about.
Congrats! I’m thinking about writing a book. Um, so that’s, that’s something that’s going to be in the works. So, um, you know, it’s, it, it, it’s, it’s a, it’s a slow go with it in terms of other potential opportunities that I want to do, but it’s opened the door to a lot of connections, you know, [00:38:00] meeting you guys as an example, it’s, it’s an honor to be able to do this.
Um, it’s, it’s been great meeting other physicians and other specialties and. And, uh, you know, this is something I never thought was possible until I started doing it. That’s my message to anybody else. Who’s a physician out there. It’s like, just go ahead and make some content. You never know where it leads.
Will: Oh, I love that message. And I was going to, you mentioned the leadership positions. I was going to ask you like, what are the, what are the big advocacy issues around your specialty? Like, is there, are there anything specific to what you do that you’re That you’re really focused in on.
Dr. Zachary Rubin: Yeah, one of the things that I’m, I’ve been getting into is in, you know, I really respect a lot of the work you do, you know, calling out insurance companies, but in my field, there’s such a poor access to epinephrine auto injector devices.
They’re ridiculously expensive for no reason, essentially. And so, in Illinois, where I’m at, we actually, starting in January of 25, will cap epinephrine auto injectors to 60 a twin pack, which is a huge deal. Because prices for some people are hundreds of dollars, [00:39:00] making it inaccessible, and then if people have anaphylaxis, they end up, you know, going into the emergency room without any treatment.
Um, People are afraid of needles and we’re about to get our first needle free option for epinephrine and a nasal spray coming out in about six to twelve months. It’s, uh, ironically called Neffy, which I think is a fun name.
Singers: Um,
Dr. Zachary Rubin: you know, so, so there’s actually, uh, a bill that was introduced to Congress recently trying to cap EpiPen prices at 60 a twin pack nationally.
Um, so I’m going to see if I can try to help with that. Uh, there’s, there’s various food allergy research and advocacy groups that, that help with these types of endeavors as an example.
Will: I’ve heard about the EpiPen issue with regard to, like, having them on planes. Like, having that be available, that they’re not in the kits.
Uh, it just seems, it seems so obvious, right? Like, this is This should be part of every first aid kit. Absolutely. Access
Dr. Zachary Rubin: to it is very poor in general.
Kristin: In Europe, aren’t they like five bucks or something? Like, it’s not [00:40:00] necessarily very expensive to make them, right? It’s just, for some reason, people sell them for a lot.
Because you can, I guess.
Will: I don’t know. Oh, I don’t know how cheap, how, how hard it is to make up. I feel like,
Kristin: I feel like it’s one of those things that’s easier to get. I’d squeeze it out of my
Will: own adrenals if I could.
Dr. Zachary Rubin: The actual, to make the drug itself, it’s super cheap. Uh, a lot of it is intellectual property issues, but it’s estimated that it only costs about 30 to make.
Kristin: Okay.
Dr. Zachary Rubin: So it’s, in Europe, you’re right. It’s, it’s sold at a much lower cost, if not free. Um, this is, this is a big problem. And, and like I mentioned earlier, A lot of work needs to be done in terms of educating the public about these issues, especially for the food allergy community, as an example, so that they’re not the butt of all jokes, so that they can go to a restaurant and feel safe there, so that they’re not bullied by other families or even teachers, which has been reported, um, you know, and, and as an example, there was a student in Texas last [00:41:00] fall, who was a football player who disclosed that he had a peanut allergy and students put peanuts in his locker room and he had, uh, hives from it.
Um, and the school district said, no, that’s not bullying. And these, these types, it’s
Kristin: assault. Yeah, exactly.
Dr. Zachary Rubin: It’s a big problem. And so a lot of that comes with just trying to educate the public and trying to normalize. That people live with this. It’s not a fad diet. This is a chronic disease. And so I’m trying to help, uh, put the word out and help people understand why we need to take this seriously.
Well, thanks for
Will: doing that work.
Kristin: Food allergy is such a hard thing too because you have to eat and food is everywhere. And we, you know, at least three times a day, you’ve got like anytime there’s any issue revolve, you know, involving food. That’s going to consume your whole life, you know, because we do have to do it.
We have to do it so much. It’s everywhere and you can’t not do it because you have to eat to survive. So I have real sympathy for, for people.
Will: Well, I, what I want to do now before we, [00:42:00] before we let you go is a little activity.
Kristin: Okay. I
Will: just, I came up with a little game we could play. So. I have, um, these basically Kristen is going to draw two different pieces of paper that are in front of her.
You can’t see. No, no, no, no, no. Leave them there. You
Kristin: gotta fix it. I just messed it up. I was just gonna show
Will: that they’re little
Kristin: tiny scraps of paper that he tore up. Tiny
Will: scraps of paper that I’ve written things on. And
Kristin: apparently, yeah. So
Will: what Kristen is going to do, Zach, is Draw one from one pile and one from the other pile.
Kristin: Okay,
Will: and One even I don’t know
Kristin: what we’re doing before we do this
Will: One pile has a type of allergy like a category of allergy, okay of allergen I guess I should say maybe I don’t know anyway The other the other pile is a number And so she’s going to draw one and then the number and you got, you, I want you to, to give us that number of different [00:43:00] allergies in that group.
Singers: Oh,
Will: okay. Wow. Okay. Let’s try it. I don’t know. Let’s let’s just, let’s just give this a shot. Okay. So Kristen, go ahead and draw one from here first.
Kristin: So this is the category medication.
Will: Okay. And then now a number.
Kristin: Oh, nine.
Will: And then what am I supposed to do with this again?
Kristin: Nine. Give us
Will: nine medication allergies.
Yeah. Like, allergies to nine different medications that you see.
Dr. Zachary Rubin: Okay, that I see. So penicillins, sulfa antibiotics, uh, we’re gonna say aspirin, ibuprofen, neosporin. Those are all the ones I like. Neosporin. Neosporin. Okay. Five. We’re at five. Okay. Uh, Benadryl, ironically. Oh. Oh, okay. Huh. Yeah. Okay. Um. Let’s say, okay, doxycycline.
So the tetracyclines. Oh, yeah. Let me see there. Um, let’s do more [00:44:00] I gotta do two more. Oh my gosh. Two more. Um, well, I’m going to say adhesives, you know, part of bandaging. We see a lot of that.
Will: I see that. I use a lot of tape and ophthalmology.
Dr. Zachary Rubin: And, uh, you know, IV contrast.
Will: There you go. Nicely done. That’s impressive.
That was the highest number, by the way. Oh my gosh. Okay, so it’s going to be easier from
Singers: here.
Will: You got me sweating a little bit there. That was really good though. Is prednisone, is that. Do you see like, like, like allergies to prednisone?
Dr. Zachary Rubin: You know,
Will: I Because I, I see that on people’s list a lot.
Dr. Zachary Rubin: Yeah, so the thing is, is that what I see is usually adverse reactions to it, where they feel really crummy on it, and they put that on there as an allergy, and theoretically you can be allergic to it.
Uh, really any, any large molecule you can be allergic to. Um, but, but the vast majority of the, like we talked about before it’s, it’s more of an expected [00:45:00] side effect. And so if we counsel patients on saying, Hey, when you take prednisone, you could be really hungry, you may not sleep well on this, it could change your mood for a while, it throws off your sugars, and if you know that ahead of time, it can be a little bit easier to manage instead of saying, here’s this medication, good luck.
They take it and they feel terrible, and then they report that, and then somebody will write down that it’s an allergy. We don’t really have a distinction between, you know, the adverse event profile on the chart versus a true allergy and contraindication. Okay, that’s helpful.
Will: All right, let’s do another one.
Kristin: Okay, category is?
Will: I don’t, I don’t, this is, we may not need to be able to, I don’t even know, I just wrote that down.
Kristin: Well, just gonna try. It’s a good start. Okay. Okay. Oh,
Will: let’s do a different number. Okay. Was it too many? It was more than nine. Actually, I forgot I had a ten on there. Oh god. Mix them up.
Kristin: Okay, this is easier.
Three.
Dr. Zachary Rubin: Three. Um, okay. So, uh, [00:46:00] Oh my gosh.
Kristin: I just raffled those right off.
Will: Maybe you could have done 10. My goodness. I’m impressed. I didn’t, what were they again? Penicillium,
Dr. Zachary Rubin: Cladosporium, and Alternaria, which are some of the most common indoor outdoor molds as examples. Okay.
Kristin: Okay. And penicillium is what pen, penicillium
Dr. Zachary Rubin: is what, you know, create a penicillium.
Yes. Okay. All right. I
Will: have no follow up questions.
Kristin: Okay. Next category. Okay. A lot of people are going to be able to relate to this one. I think tree.
Dr. Zachary Rubin: Okay.
Kristin: Seven tree allergies.
Dr. Zachary Rubin: Okay, let’s see if I can do this. Um, oak, maple, box elder, um, birch. Birch is the worst, by the way.
Singers: Huh.
Dr. Zachary Rubin: Yeah, because it can create something called oral allergy syndrome.
So, uh, there are various foods that are mainly fruits and vegetables [00:47:00] that the protein structure is similar to various pollens. Birch is one of the worst because it can create allergies to, uh, peaches, pears, plums, uh, apricots, apples, but there’s a whole list of it. You can always look online. It’s an interesting list.
Causes localized irritation, itching, swelling. You cook can and process it though. You can usually tolerate it if you have that. Rarely do you need an EpiPen for something like that. And I know I digress because I’m trying to think off in my head. You’re buying yourself
Kristin: some time. That’s what you’re doing great.
I think
Dr. Zachary Rubin: you’re, I think you got like four already. Yeah, I got four. Um, uh, Did I say maple already?
Kristin: Yes,
Dr. Zachary Rubin: I think you did. Oh gosh. Okay. Um, Ash. Okay. Okay. That’s five. And then I need what? Two more.
Kristin: Yes. I don’t even think
Dr. Zachary Rubin: maybe there are only five trees out there. No, there’s a lot of trees. It’s just the ones that I’m thinking about that are most allergenic that I test for.
Singers: Yeah.
Dr. Zachary Rubin: And also you’re putting me on the spot, so no pressure. You know, like, like there’s, you know, Bradford pears [00:48:00] as an example. Um, that’s number six, you know, I did
Will: Google a
Dr. Zachary Rubin: little juniper.
Will: Oh, there you go. Yep. That was that’s cedar fever.
Dr. Zachary Rubin: That’s the worst in Texas.
Kristin: Oh, yeah.
Will: I see. Um, Miss skeet. Miss miss skeet is one.
I saw
Dr. Zachary Rubin: Cedar pine
Will: Yeah.
Dr. Zachary Rubin: There we go. So we went over, we went over.
Will: Oh
Dr. Zachary Rubin: yeah. All
Kristin: kinds. So basically all trees.
Will: All trees.
Dr. Zachary Rubin: Every tree. But, so here’s, here’s a little misconception that a lot of people don’t understand. You know, you hear this myth of eat, you know, eat local honey to treat allergies. Hear that all the time.
And, uh. The idea is, well, if you eat honey, you’re eating pollen that you’re allergic to, so you eat higher amounts of it, it’ll desensitize your immune system, but if you were really allergic to that pollen, you’d be having itching in your mouth if you were, but you’re not actually allergic to that pollen because that’s insect pollinated.
Bees have to, to, to move that pollen. That’s not what you’re allergic to because you’re not exposed to it on a regular basis. You’re allergic to the trees that I just mentioned that are wind pollinated. They’re [00:49:00] blowing millions if not billions of particles that you’re breathing in regularly to create that allergy.
Kristin: Yeah. Interesting. So that’s a myth to eat local honey for allergies. How about that? Okay. Let’s do one more. One more. Oh, yeah. Okay. Category is grass.
Dr. Zachary Rubin: Okay.
Kristin: And the number is six.
Dr. Zachary Rubin: Timothy June Bermuda Bahia. Dang, he’s good.
Kristin: I know. I haven’t even heard of some of these things. It’s almost like he’s a professional.
It’s almost like he’s a professional. Okay.
Dr. Zachary Rubin: Uh, okay. Last one’s gonna be hard ’cause I think I named everyone in my panel.
Will: Um, let’s see here. I think you got, I mean, it looks, from what I can see, Google turned four. No, you did not. Okay. That’s on there. Okay. There you go. Ah, there you go. Yeah. I’m impressed. Yeah. I thought this would be a really
Kristin: hard, that’s a hard game. It’s a [00:50:00] hard game. You put me on the spot
Will: too. This was not like playing folks.
I did not. I did not prep you ahead of time. Everyone. So that just shows you, you know, as soon as this call
Kristin: ends, you’re going to be rattling them off in your mind. You know, like just all the pressures. Well,
Will: my last question before, before you go is, is D do you do the skin test? Does that still happen? Yeah.
Yeah. You do that right? Every day. Yeah. Like, all, like, down someone’s back, it’s just like, like,
Dr. Zachary Rubin: Yeah, I either put it on their arms or I put it on their back, depending on the patient, yeah. Is that painful?
Kristin: That sounds miserable.
Dr. Zachary Rubin: So, nowadays, we have plastic that we can use to scratch the skin. It’s not very painful for adults.
For kids, it can be uncomfortable because it’s a, it’s an abnormal sensation. 15 minutes itching. and potentially having like a burning sensation. That’s what I’m thinking. That’s the part that’s tough for patients. And then for older patients, if that plastic, it’s very shallow. I mean, it’s only a couple of millimeters long.
We may not hit those mast cells to create a reaction. So we may have to do [00:51:00] intradermal injections of the allergens. And so that may or may not be, you know, comfortable more less itchy than, than the skin brick testing. But, uh, you know, it depends on the practice you go to. I don’t, I don’t put a ton of tests on because I know that These pollens and different allergens are cross reactive.
The immune system sees parts of it and will react to several different things. So I don’t need to put a hundred things on there. Uh, you know, older school allergists may put a bunch on there, but I don’t think it’s necessary anymore.
Kristin: Yeah.
Will: Well, fascinating. I’ve learned a lot about allergies. Yeah.
Kristin: Me too.
Will: Uh, thank you so much for, for joining us. I’ve
Kristin: also learned that allergists are, are much smarter than you.
Will: Oh, uh, they just like, oh man.
Kristin: Yeah. He’s my benchmark, right? Of like, how smart is a physician? Cause he’s the one I know. I’m
Will: very smart. They’re a lot
Kristin: smarter than you. I’m very
Will: smart about a very specific thing.
That
Kristin: is true. You’re very smart about eyeballs.
Will: I’ll, I’ll answer any question you have about it. You want to know about the nine different layers of the retina? Let’s do it.
Kristin: I don’t.
Will: Okay, well, maybe for another podcast.
Dr. Zachary Rubin: I [00:52:00] guess the one fun thing about this is that you, you study an organ that’s immune privileged.
That’s right. Yeah. That’s right. It’s exciting stuff. So, what does
Kristin: that mean? Like, that it gets protected above other things? It’s Or that it doesn’t get No, it does get allergies.
Will: There, there are certain parts of the eye that, that don’t have blood flow basically and so it doesn’t You don’t have Yeah. Um, like an immune reaction.
Yeah. There’s very few immune cells
Dr. Zachary Rubin: in the eye itself. Yeah. So, you can, you can get away with a lot more research in certain parts Aspects of it because of that. So it’s a cool term, immune privilege.
Will: It is privileged. Well, so let’s tell people where to find you. Um, uh, you’re on, we’ve already covered Tik TOK, obviously.
Uh, so what’s your, what’s your name on Tik TOK? What do you go by? It’s Ruben
Dr. Zachary Rubin: underscore allergy because all the cool allergy names were already taken pretty much when I started. So, so I try to keep that consistent. Um, you know, R U B I N underscore allergy. Tik TOK, Instagram are my main places. [00:53:00] But. I’ve recently tried to start a presence on YouTube and Facebook as well, especially on Facebook because people were stealing my content and
Will: Pretending to be that’s like.
I know what that’s like. Yes, you got to get on you got to get on all the platforms We just have a presence there so that you can keep all your bases covered. And
Kristin: you’re trademarked now like that There have been so many people doing that that I just got it trademarked.
Will: Dr. Glockenflecken trademarked.
Kristin: You could technically be TM
Will: That’s right, dr.
Glockenflecken TM Well, keep it up. Uh, I’ve really enjoyed seeing your content. Uh, it’s, it’s very unique and informative. And so everybody needs to check that out. Um, and yeah, keep it up. Thanks for joining us. Thank you for having me. It was really nice to meet you.
Hey, Kristen, can I interest you in a Demodex might?
Kristin: No, you cannot.
Will: Why look at look how cute they are a little little beady eyes and multiple legs of Thorax and abdomen [00:54:00] doesn’t look cute.
Kristin: No, I mean, you know for it’s a stuffed animal So it it does have a certain quality to it, but I don’t want an actual Demodex.
Well,
Will: the real ones don’t Do hang out on your eyelids.
Kristin: Yeah. See, I don’t want them there.
Will: They cause red, itchy, irritated. Eyelid sometimes like flaky buildup on your eyelashes.
Kristin: I do not want that.
Will: Well, don’t get freaked out by this. Okay. You got to get checked out.
Kristin: Okay. It’s
Will: eye doctors that we’re used to diagnosing demodex blepharitis.
It’s a pretty common disease. You
Kristin: see these little guys in your little microscopes?
Will: My microscope might not be powerful enough to see this, but I can see the telltale signs of it. That’s for sure. To find out more, go to eyelidcheck. com. Again, that’s E Y E L I D check. com to get more information about these little guys that cause demodex blepharitis.
All right. Let’s take a look at a medical story sent in by a listener. So we have a [00:55:00] story from Gene. Gene says when my son was 8 years old, he and his older sister went to our family doctor for a pre scout camp physical, my son’s first physical. He went back to the lab area. My more experienced daughter took the cup from the nurse and slipped into the bathroom to provide a urine sample.
She returned quickly, moving to the next station. The nurse gave my son a cup and guided him into the bathroom. He didn’t come out. And he didn’t come out, and he didn’t come out, everyone was waiting patiently. The nurse came to check, I shrugged, so she went on with her endless flow of tasks. After several minutes, the door opened a crack, so that I just, just my son’s lips showed.
Mom! Come here! I went over to the door, he said, the nurse asked me to get her some tea in this cup. And I can’t find the tea. I explained what he was supposed to do with the cup. His jaw dropped.
Singers: No!
Will: I [00:56:00] affirmed the instructions, yes. The door closed and he came out shortly after, still in shock. He whispered.
So how do girls do that?
Kristin: Go ask your sister.
Will: I remember my first, like, physical as a kid. It’s a weird thing to
Kristin: do.
Will: Cause it was, it was like in a big I feel like it was like at a gym. Like all the kids were there. They’ll like bring the
Kristin: doctor to the school.
Will: Yeah. And like, I remember there were like 15 boys.
Kristin: Yeah.
Will: And we were all standing in a line. We all had to drop our drawers.
Kristin: Right. And
Will: just the doctor went down the line. I
Kristin: don’t know that that would still happen.
Will: That’s how it happened to us back
Kristin: then. That’s how it
Will: happened. Oh, that’s a great story. Thanks, Jean, for sharing that. That is really cute. You can send us your stories.
Knock, knock. Hi at human content. com. Uh, and, um, thanks for joining us. What a fun episode.
Kristin: Yeah. I got to learn a lot. They know so [00:57:00] many things. Yeah. I’m telling you.
Will: I’m telling you. Those are the people that they were interested in all like the the most difficult parts of med school
Kristin: Yeah,
Will: like the cytokines, the
Kristin: rheumatology, infectious disease, allergy, immunology, all the immunology stuff, that is
Will: hard.
Yeah, that’s like my brain. I don’t think I was capable.
Kristin: Yeah. Do you, is it, are they like chemistry kids? Is it,
Will: I don’t know, maybe. Is Probably should have asked that. I don’t know. Probably.
Kristin: I mean, you’ve learned it, right? Was it chemistry?
Will: It’s chemicals. I don’t know. Stop asking me about chemistry.
Kristin: They’re just much smarter than you.
People are going to be mad at me thinking that I’m being mean, but no, it’s just a fact.
Will: All right. Well, um, tell us what you thought of the episode. You want to hear more about different areas of medicine that we don’t talk about a whole lot or different parts of healthcare. You know, allergy is just one of the things I don’t think this is the first time probably that we’ve ever even mentioned allergists, immunology, chemistry on this podcast.
Uh, lots of ways to reach out, email us knock, [00:58:00] knock, hide human dash content. com. You can visit us on our social media platforms. Hang out with us in the human content podcast family on Instagram At Human Content Pods. Thanks to all the great listeners leaving feedback and reviews. If you subscribe and comment on your favorite podcasting app, we can give you a shout out, like on YouTube at Casey Casas Casas 2 4 9 8 said, uh, about the Melanoma Nut Knock eye episode.
Mm-Hmm. in an episode about
Singers: Mm-Hmm.
Will: said, okay, this was horrifying, but fascinating. , thank you again for the I Education. I, no,
Kristin: I wanna point out. It says I ducation. I ducation.
Will: It’s good. It’s
Kristin: good. It hurt you.
Will: No, it’s fine. It’s fine. I, I, that’s a good one. I haven’t heard that one. That’s good. Um, but yes, that was a bit, it is a bit of a horrifying topic.
But, uh, most eyeball things are, to be honest. Full video episodes, uh, are up every week on my YouTube channel at Deagolacomplike. And we also have a Patreon. Lots of fun perks, [00:59:00] bonus episodes. Uh, react to things, hang out with other members of the Knock Knock High community. We’re a growing little township.
Uh, we’re there and have leadership positions in it. Early ad free episode access and our Q& A live stream events, much more patreon. com slash glockenflaken, or go to glockenflaken. com. Speaking of Patreon community perks, new member shout out Joshua M and Lisa P. Thank you both for being patrons. Welcome to the team and shout out to the Jonathans as always.
A virtual head nod to you all. Patrick, Lucia, Sue, Sharon, S, Omar, Edward, K, Steven, G, Jonathan, F, Marion, W, Mr. Grandaddy, Katelyn, C, Brianna, L, KL, Keith, G, JJ, H, Derek, N, uh, Mary, H, Susanna, F, Jenny, J, Muhammad, K, Aviga, Parker, Ryan, Muhammad, L, David, H, Jack, K, Medical, Meg, Bubbly, Salt, and Pink Macho. Patron roulette time.
Random shout out to someone on the emergency medicine tier. Joyce. Oh, Joyce, thank you for being a patron. [01:00:00] And thank you all for listening. We’re your hosts, Will and Kristen Flannery, also known as the Galacanfleckens. Special thanks to our guest, Dr. Zachary Rubin, our editor, our executive producers are Will Flannery, Kristen Flannery, Aaron Corny, Rob Goldman, and Sean T.
Brick. I have to read the producers first. It’s very important.
Kristin: Okay. You do what you need to do. You know what Aaron
Will: would do to us if it. If we did, if we forgot that part. You know what, you tell
Kristin: Aaron to come talk to me. Yeah, okay. Our editor
Will: and engineer, Jason Porteaser, our music is by Omer Bensfieh. I’m not usually afraid of it.
Kristin: Yeah, what’s up with that?
Will: I don’t know. I just, I just, because we just saw him recently. Yeah. And so it just,
Kristin: like,
Will: sometimes he gives it the stare. This is, you know, he’s got a little.
Kristin: He’s got a stare. I feel like it can mean multiple things, though. And usually it just means he’s trying to think of some witty comeback, so.
Will: Uh, did I do music? Music? Yes.
Kristin: Oh, man.
Will: It’s me. It doesn’t
Kristin: deserve any of this.
Will: Oh, I’m sorry. We should put Omar first. I’m going to do that first. Next time [01:01:00] to learn about Eric and go last. Then we learned about our night. Not guys. Program, disclaimer, ethics, policies, vision, verification, licensing terms, and HIPAA release terms.
Go to Glock and play good. com or reach out to us. I can make high team and dash content. com with any questions, concerns, or puns, and I guys even content.
Hey, Kristen, you know what these little stuffed Dax co pilot dragons make me think of?
Kristin: What? These little stuffed animals? Oh! I
Will: need to get Jonathan a little hat like this. A little co
Kristin: pilot hat. And what
Will: if he had wings too?
Kristin: That would just be a game changer. Flying around. Yeah, I’m surprised he doesn’t already have wings.
You should have thought of that. Just
Will: fixing burnout anywhere he goes.
Kristin: Mm
Will: hmm. Well, that’s what you get with the nuanced dragon ambient experience. Did you know that?
Kristin: That’s pretty awesome. Absolutely. Absolutely.
Will: 80 percent of patients actually say their physician is more focused with the Dax Copilot. 85 percent of patients say their physician is more [01:02:00] personable.
And conversational with the Dax Copilot. It really does make a huge difference in patient care.
Kristin: And in that patient physician relationship.
Will: Absolutely. You just get to focus on what got you into medicine in the first place.
Kristin: Right. You
Will: know, not documentation, taking care of the patient. To learn more about the Nuance Dragon Ambient Experience or Dax Copilot, visit Nuance.
com slash Discover Dax. That’s N U A N C E. com slash Discover D A X.
