Xiomara Perez

A trip to the cough clinic to see Mayo allergist Dr. Juan Guarderas spelled big relief for Xiomara Perez

For two years, coughing dominated Xiomara Perez's life. The 57-year-old Jacksonville resident suffered from a chronic tickle in her throat that interfered with her life day in and day out. When a doctor referred her to allergist Dr. Juan Guarderas at Mayo Clinic in Jacksonville, she made an appointment as soon as possible.

"I coughed day and night," says Perez. "I couldn't rest, and I was unhappy."

Through a series of questions on her medical history and gastrointestinal and general allergy testing, Guarderas got to the bottom of the problem.

"Ms. Perez had problems with stomach acid in the past," says Guarderas. "We found out that her problem wasn't being properly managed and put her on a different, stronger medication."

It wasn't long before Perez was feeling better.

"A few weeks later I started feeling relief," says Perez. "A month later it was like a blessing. I felt like another person."

Because of Mayo's team approach, medical problems often can be solved with speed and thoroughness, whether they're caused by allergens or not. To streamline the diagnosis, the Division of Allergy has established allergy clinics. These clinics don't have official signage over the door but are called clinics because they reflect the cooperative working relationship of a group of doctors within Mayo. Clinics are being developed to evaluate and treat people with asthma, coughs, chronic sinus infections, skin allergies and primary immuno-deficiency disorders.

"The comprehensive cough clinic offers patients quick access to testing and specialists who deal with these conditions," says Guarderas. "It's a unique approach. We evaluate symptoms caused by the nose, sinuses, lungs and gastrointestinal tract to determine possible causes, and we're able to pinpoint the problem and treat it without sending patients from office to office."

This works especially well for people like Perez, whose cough turned out to be caused by something more than pollen. About 15 to 20 percent of the population has some allergies, and 5 to 10 percent have some degree of asthma. But, Guarderas says, what looks like an allergy — asthma, for example — may not actually be asthma.

"Not everyone who wheezes has asthma," he says.

Retired New York dentist Louis Lodico's experience is a good example. An ongoing breathing problem sent him to a hometown lung specialist. The doctor diagnosed him with "possible" asthma after testing couldn't pinpoint anything specific. Lodico tried inhalers and other anti-asthma medications, but his condition remained the same.

While staying in his winter home in Jekyll Island, Ga., Lodico decided to make the 87-mile drive to Mayo. Right off the bat, Guarderas ordered a CT scan to determine if he had a neck tumor.

"My neck is a little crooked, and he wanted to check it out," says Lodico. "I'd always assumed it was because I was a dentist for 40 years and my 'dentist posture' caused it."

The results showed that there was indeed a tumor, but not in the neck. It was about the size of a nickel and located in the left bronchial tube, restricting the flow of air to the lung. Surgery successfully removed the tumor, as well as the asthma symptoms. Now, Lodico is doing fine and breathing easy.

Clinic physicians will work with patients' non-Mayo allergists to get to the root of the cause and find the appropriate treatment.

"People develop special relationships with allergists because many of these relationships start at an early age," says Guarderas. "It's important for people to stay with the doctors they know and trust, so when allergists refer patients to us, we keep them in the loop and work together."

(This story first appeared in the September 2005 issue of The Mayo Clinic Checkup, a complimentary newsletter available to anyone interested in the latest news from Mayo Clinic in Jacksonville, Fla.)