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Louisa-Lawrence Co, KY

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Date: 06-16-2015

Kentucky is the most allergic place in the country

“It’s a very, very allergic place along the Ohio Valley. With the vegetation and types of trees, grasses and weeds, typically the spring is the worst.”

The official first day of summer is less than a week away, and with summer’s arrival spring allergy sufferers typically get something of a reprieve.

That reprieve hasn’t been as noticeable in recent years, including this one, as tree pollen is still prevalent throughout most of Kentucky. Grass pollen is also starting to cause problems for people with allergies.

Dr. Ara Makdessian, a specialist at Bluegrass Ear, Nose and Throat in Winchester, works with general otolaryngology and allergy and sinus disorders, and has seen a steady flow of patient visits in his office this spring.

It’s a trend Makdessian, who’s been in Winchester for the past 10 years, doesn’t foresee subsiding anytime soon.

“Basically, Kentucky is the most allergic place in the country,” Makdessian said. “They (Asthma and Allergy Foundation of America) rate cities across the country as the most allergic and Louisville and Lexington in the past five to 10 years are typically in the top five.

“It’s a very, very allergic place along the Ohio Valley. With the vegetation and types of trees, grasses and weeds, typically the spring is the worst.”

Long, cold and snowy winters add to allergy problems, Makdessian said.

“Whenever we have a harsh winter and it’s prolonged, what happens is trees delay in blooming and they kind of all try to pollinate or catch up. All tree species pollinate at the same time in large volumes and they call that the pollen vortex,” he said.

With large volumes of oak, ash, elm, pine, cedar and sycamore pollen in the air, the more sensitive people are to pollen and will experience stronger reactions.

“You become bombarded with various pollen types,” Makdessian said. “Your immune system becomes overwhelmed and it goes into overdrive. You start having the typical symptoms of watery eyes, scratchy eyes, sneezing, coughing and it goes into overdrive.”

Makdessian said in more severe cases, allergy sufferers may begin to break out into hives or have asthma-like symptoms, shortness of breath and wheezing.

In April and May, pollen counts in Winchester and Clark County were consistently around a 10 on a scale of 1 to 12 according to, with 12 being extremely high.

“We had that big storm in February and another in March and that made a big difference,” Makdessian said. “They were pretty severe and it prolonged the winter. Trees are smart and all living things ensure survival by passing on genes, so their way of passing on genes is pollen or cross-pollination. When they sense they’ve missed a week or two they increase their volume.”

Makdessian mentioned now tree pollen numbers are going down, while grass pollen is going up. Typically in Kentucky, the grass pollen season isn’t as severe as tree pollen because the summer months are usually dry and hot, which doesn’t allow grass nutrition.

That and in most urban areas, people mow their lawns which keeps grass from pollinating. However, once fall hits, the ragweed season creates more problems.

Along with ragweed, mold in the fall season becomes a large problem, Makdessian said.

“A lot of people don’t know about mold. Mold is in the atmosphere 12 months out of the year,” he said. “In the winter months that number goes down because here the rainy season is in the spring and fall. The mold count goes up in the fall especially because that season you get a lot of dead leaves on the ground. Molds like organic matter and water. In the fall, they get both.”

Many allergy sufferers can get relief from symptoms by various over-the-counter medications, but with increased symptoms associated with a bad tree pollen season, such as this spring, many visit an allergist to treat symptoms more aggressively.

“In terms of patient volume, it has increased dramatically because of the pollen season this spring,” Makdessian said.

Makdessian said in order for an allergist to properly treat allergies, first a patient’s medical history is looked at before making a proper diagnosis. The two most common ways to test and properly diagnose allergies are blood testing and skin testing. Skin testing is still considered the main standard today.

“The skin test I do is not only a diagnosis, but it’s quantitative which means it tells me the degree of sensitivities you have,” he said. “It not only tells me yes or no, but it tells me how severely you are allergic to a specific pollen.”

Treatment for allergies come threefold with avoidance, medication and immunotherapy.

“Here in Kentucky, it is the most allergic place in the country and I see a lot of patients who have multiple allergies, we call them polysensitized,” Makdessian said. “I rarely see patients who test positive to just ragweed or only to mold or only to grass. Over 90 percent of my patients are polysensitized, which means at the same time they are allergic to dust mites, dog dander, cat dander, molds, tree pollen, grass pollen and wheat pollen. That changes the dynamic of the treatment.”

Immunotherapy is also the only treatment available which will modify the disease process, while medication simply controls symptoms, Makdessian said.

“You’re genetically hard wired to develop sensitivities to your environment and medication does not modify the course of your allergic disease,” Makdessian said. “The only way to make it better is allergy shots. Shots work in the same sense as vaccines, we’re basically exposing your immune system to those allergens and making your immune system tolerant. By the time you finish the therapy, your immune system recognizes it’s nothing harmful.”

Along with shots, allergy drops are a relatively new way of immunotherapy, however the drops are not yet covered by major insurance providers or FDA approved.

Makdessian said allergy drops are more convenient to most simply because they can be administered yourself at home or work anytime.

Makdessian doesn’t see allergy symptoms improving anytime soon.

“Global warming will have a huge impact on when trees will pollinate, either prolonging the pollination period or making trees like this year pollinate in high volumes,” Makdessian said. “In the future, that may even overlap with grass pollen.”

Although allergies are not a serious or life-threatening issue, they do interfere with a person’s quality of life and are a progressive disease which could lead to a sinus infection, asthma or eczema.

By Steve Foley
The Winchester Sun

JUNE 15, 2015

"The American Medical Association, citing growing concerns about monitoring and tracking long-term human health impacts caused by shale gas development, is calling for the public disclosure of all chemicals" used in hydraulic fracturing, Don Hopey reports for the Pittsburgh Post-Gazette. In addition to disclosing chemicals, the organization said monitoring “should focus on human exposure in well water and surface water and government agencies should share this information with physicians and the public.”

Physician Todd Sack, who authored AMA's policy, told Hopey, “Keeping the names of the chemicals secret is preposterous. It places an unreasonable burden on physicians . . . If we don’t know what chemicals are being used at specific well sites, physicians and public health officials can’t do their jobs.”

The industry, which says it meets all state laws, is opposed to making public all chemicals used, "citing commercial proprietary interests for keeping secret the chemicals used in fracking as biocides, friction inhibitors, anti-corrosives and acids to dissolve minerals," Hopey writes. "Most of the 25 states in the U.S. where shale gas drilling and development is occurring either don’t know or don’t publicly disclose all the chemicals used in fracking." (Read more)

Written by Tim Mandell Posted at 6/15/2015

June 9, 2015

Vinson Lawrence Arthur Vinson, BSN, RN, was recently promoted and named as the new Chief Quality Officer with the Quality Management Department for Three Rivers Medical Center effective May 18, 2015, announced Chief Executive Officer Greg A. Kiser, MHA.  He was previously a Clinical Data Abstractor, Quality Coordinator and a Charge/Staff/Staff R.N. with the Medical/Surgical Department.

“As CEO of Three Rivers Medical Center, I am very pleased about the promotion of Lawrence Vinson to the leadership team of the hospital in assuming the leadership and administrative responsibilities for quality operations.  He has excellent credentials in nursing, clinical education and healthcare management to bring to his new role.  He has proven to succeed as a capable leader and will thrive to strengthen hospital administration and quality operations with our facility,” Kiser stated.

Vinson was hired as a Staff R.N. in January 6, 2009.  He received his nursing degree from the Ashland Community and Technical College in December 2008.  Prior to him assuming his nursing responsibilities, he had previously worked at the hospital as a contract employee serving in the position of Financial Counselor in providing financial counseling advice to patients.  He operated his privately owned company, AMAS Financial Services. Vinson later transitioned to the role of Clinical Data Abstractor, Quality Coordinator on May 7, 2012.  Vinson was also honored with the award as Employee of the Quarter for the year 2011.    

Vinson received his Associate Degree in Nursing from Ashland Community and Technical College in December 2008 and his Bachelor of Science Nursing Degree from the University of Phoenix in May 2014.  In October 2014, Vinson completed the Company’s Quality Officer training.

Vinson and his wife Tammie who reside in the Louisa area have two children Brady and Zoe. He is a welcome addition to the Management Team of TRMC.   

June 12, 2015


June 5, 2015



The old adage “Never say never” strikes a loud chord with Judith Bowling Johnson.

As a young woman, she once declared she’d “never be a nurse”, but subsequently became an LPN, then RN, and later earned a Master Degree in Nursing. Most recently, Johnson became a certified Family Nurse Practitioner (NP-C)—and now has been elected to serve a two-year term as secretary for the Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM). 

Making sure patients receive the care they need seems to be what Johnson—who practices at Three Rivers Medical Clinics—was meant to do all along.

Judith Bowling Johnson“Being able to help others understand disease processes that affect their lives, ways to control the negative effects, and teaching healthy behaviors—are all very gratifying,” she says, “especially if the patients are willing to become involved and make lifestyle changes.”

Johnson is especially interested in serving on the board of KCNPNM, citing the organization’s commitment to make healthcare more accessible to all Kentuckians: “KCNPNM has diligently worked with legislators to remove many barriers to nurse practitioner and nurse-midwifery practice,” she says. “Delivering healthcare is not a one-size-fits-all proposition, it is a unique puzzle and providers must find ways to make the pieces fit together to benefit each individual.”  

With passage of the Affordable Care Act giving more people access to healthcare, but a shortage of primary care physicians affecting many areas of the country, nurse practitioners and nurse-midwives play a crucial role in the delivery of healthcare. As a certified nurse practitioner, Johnson is able to provide a wide range of care to all age groups, from diagnosing and writing prescriptions for bacterial infections to helping patients learn how to manage their diabetes. 

She practices at Three Rivers Immediate Care in Louisa, Three Rivers Family Practice in Inez, and Immediate Care in Paintsville. All three locations provide routine wellness exams, preventive screenings, treatment for injuries and illnesses, and care for complex, chronic conditions. 

“We are extremely proud to have someone of Judith’s character and caliber practicing at our medical clinics,” says Greg Kiser, Three Rivers Medical Center CEO. “She is obviously very dedicated to providing for the healthcare needs of people in this area, and her work makes a difference every day.”

Johnson initially worked as a home health clerk and later as a nightshift registration clerk in an Eastern Kentucky hospital where she interacted with patients arriving in the emergency room. That experience prompted her to purse a nursing career, and subsequently seek employment at Three Rivers Medical Center as an RN, where she worked for 10 years.

She obtained her Associates Degree in Nursing from Maysville Community College, her Bachelors of Science in Nursing (BSN) from Jacksonville University in Jacksonville, FL, and her Masters of Science in Nursing from Northern Kentucky University. She received her FNP certification from the American Academy of Nurse Practitioners. 

KCNPNM has 2,200 members; in addition to advocating for its professionals, the organization also keep members updated of changes in laws governing their practices.

ABOUT THREE RIVERS MEDICAL CENTER:  Three Rivers Medical Center is your community healthcare provider; a 90-bed acute care facility accredited by The Joint Commission. We believe in the power of people to create great care. We provide essential hospital services and are proud to house an accredited Chest Pain Center and a Sleep Disorders Center. And we work hard every day to be a place of healing, caring and connection for patients and families in the community we call home.