By Melinda M. Rathkopf, MD, FAAAAI, FACAAI, FAAP
Allergy, Asthma and Immunology Center of Alaska
Assistant Clinical Professor, University of Washington
I grew up in the suburbs of Atlanta. Every spring our cars took on a yellow tint from all the tree pollen. It was a way of life. You just accepted it, especially for me because I didn’t suffer from allergies. After medical school I went on active duty in the U.S. Air Force and my first exotic assignment – Biloxi, MS. After completing my pediatric residency I moved to Valdosta, GA to practice general pediatrics. There I felt my first “call of the wild.” I had the opportunity to oversee a small allergy clinic and the allergy-shot patients. I was fascinated by the role allergies played in my patient population. Over time I found myself enjoying my half-day of weekly allergy clinic time more than anything else I did. It was then that I applied for an allergy/immunology fellowship.
I joke that I was on the “Air Force Interstate-10 plan.” My whole life seemed to point from south Georgia to southern Mississippi to south Texas, following I-10 to San Antonio. I’ll never forget my first lecture in fellowship – CD Markers. We covered all 247 – yes, only 247 at that time, so I am dating myself a little here. Don’t know what they are? That’s okay, neither did I. I went home that night and spent a couple more hours trying to understand what a CD marker even was [cluster of differentiation markers, a system for defining cells based on the molecules on their surface], interspersed with thoughts that I could go back to practicing general pediatrics. I considered myself to be a decent pediatrician and not the imbecile I obviously was now who didn’t even know what a CD marker is!I didn’t give up and am so happy I didn’t. I love what I do. I had the benefit of amazing mentors – both the staff and program directors I trained under – and wonderful co-fellows. They taught me to be passionate about what we do and what a privilege practicing medicine is. As allergists/immunologists we are the detectives and often get to solve the puzzle. I stayed in San Antonio for two additional years after fellowship and got to work with new fellows and to try to pass that passion along. Of course, at San Antonio, we made a sharp detour from I-10.
Cut to the “Deep North.” My family and I came up to Alaska in the summer of 2005 for me to interview. It was breathtakingly beautiful. The temperature was in the high 70s and the sun was out the entire nine days we were there. We thought, “Sure, we can do Alaska.” Little did we know that this was unusually warm. I separated from the Air Force the following summer and we hit the road and the waterways for the 10-day trip to Anchorage. Over time we have adapted to the change in climate and grown to love Alaska. You learn that it is all about the clothing. My kids are not allowed to complain about being cold. There’s no such thing as cold, just insufficiently dressed.
There have been some definite challenges to practicing in Alaska. The most obvious of which is the remoteness and barriers to access. Up until this past year we were the only group of fellowship trained/board certified allergists in the state. Alaska is the largest state in the United States in terms of land area at 663,268 square miles, over twice as large as Texas. It is the westernmost, easternmost and northernmost state in the US. True we only have a population slightly over 730,000, but they are spread across a huge geographical area with most of this land not on the road system. Our practice works around the state with satellite clinics in Wasilla, Valdez, Soldotna, Juneau, Sitka and Kodiak. How many doctors get to fly to their satellite clinic? It is not unusual for one of my patients to travel by dog sled or snowmobile from their village to the next town to then take a small plane to a larger hub and then fly to Anchorage to see me. I am amazed at what lengths patients will travel to spend a few hours with a subspecialist. Our clinic has no late policy. How can you blame someone for being late after flying a couple of hours to see you, or for a driver who brakes for a moose on the only road into town, only to have the moose decide to stop for a rest?
As elsewhere, the seasons play a huge role in the diseases we treat. Cold and flu season lasts most of the year with peaks often into May and June. Cold-induced wheezing occurs year round and imagine living here if you suffer from cold-induced urticaria, which causes your skin to hive whenever it gets cold. When I started out, I routinely recommended to patients who suffer from atopic dermatitis – much worse in a cold, dry climate – that they bathe daily to hydrate their skin. Of course, I didn’t think to ask whether they had running water. Many villages in the bush don’t. Many homes and even schools are heated by wood-burning stoves, so indoor air pollution can be bad. Our homes are built to withstand our cold winters, so they are sealed tightly and indoor allergies can wreak havoc in the winter. I have also encountered some unique allergens, such as whale and seal meat.
But Alaskans are tough with a strong, independent nature that makes living here special and unique. Everyone has a story and loves to share it, whether they grew up here or came for a visit and never left. And yes, we have pollen. Our pollen season is short – typically only May to August – but with those long nights of sunshine, intense. We have some of the highest birch-pollen levels in the world. And of course everyone has cats and eats peanut butter.