Dining Out

Dining Out.

Not necessarily an impossible feat.   But one that now requires preparation.

Yes, in advance -- preparation after-the-fact is called an ER visit.

First, find a restaurant that is able to tell you all of the ingredients in each of its dishes.  Fast food  and extremely small restaurants might not be able to disclose all ingredients, or could have compound food components which must further be broken down into subcomponents (that may or may not be available) before you can determine your risk.  Your goal should be places that can a) provide full ingredient disclosure, b) have facilities that enable them to segregate your food for uncontaminated preparation, and c) have service staff who are genuinely interested in accommodating you.

Three simple steps can tip the odds of a safe dining experience in your favor: 

• Call to Arms:  Call the restaurant and speak to the manager in advance of your visit.  
  1. Inform the manager of your restaurant reservation day and time, or the day and time you plan to show up for a meal -- this allows them to identify the chef and staff who will be on duty at that time, so that they can prep the staff prior to your arrival, and make the necessary modifications in their kitchen practices on that day.  In some instances, they will even do the day's shopping with your constraints in mind.
  2. If they believe they can accommodate you, move on to step two.

• Disclose & Review:  Verbally review your list of allergens with the restaurant manager (use your Allergy Flash Card to ensure that you have mentioned everything).  
  1. Offer to email your list of allergens (Allergy Flash Card) and ask for the manager's email address.  In some cases, the manager will offer his/her mobile number.  Start making that Key Connection now, with further intention to strengthen and broaden this connection when you visit the restaurant.
  2. If they put you in touch with the chef, confirm that this chef will be on duty when you plan to be there; then go through the details of your allergens with the chef. 
  3. If there are small things that you could assist with, like bringing your own soy-free butter or organic coconut oil, make the offer in this conversation -- you should be working together to ensure success.
  4. You might wish to ask if they have ever served anyone with a deadly food allergy.  The answer might (or might not) give you a further sense of comfort or discomfort with this restaurant.  
  5.  After the detailed allergen discussion, get verbal confirmation that they will provide a safe dining experience for you.

• Flash & Bon Appetit:  Bring your Allergy Flash Card to the restaurant.  When you enter the restaurant and approach the maitre d'/host/hostess, identify yourself as the person who called in advance to discuss accommodations for a deadly allergy.  If they have assigned staff to accommodate you, the hand-off will be clear.
  1. Once seated, hand your table server your Allergy Flash Card and form that Key Connection with your server -- some of this work may have already been done as part of the staff prep that took place prior to your arrival -- but cementing it always rests with you, so don't forget.  
  2. Chances are that they will already have a printout of your email in the kitchen, and the chef might even come out to have a pre-dinner chat.  
  3. The manager and/or chef will most likely touch base one or more times during your meal to ensure that a medical emergency has been circumvented.  Try not to feel uncomfortable -- they have appreciated the seriousness of your requirements, and have partnered with you to ensure a successful social experience. 
  4. These are the places that deserve repeat patronage... and a tip that shows your appreciation for having honored your specific survival requirements.

Most importantly, as you leave, share your appreciation for their extraordinary service verbally.  Let your body language agree with the verbal gratitude -- a look in the eye and a genuine smile goes a long way.

Now, hit the town with gusto -- Bon Appetit!

Ode to Thriving

Ode to Thriving.

Thankfully, we all have the right to survive... It's what gave Darwin the Warm Fuzzy, and Apple it's Core. But, once past survival, what's next? How could we kick it up a notch? Churn some evolution?

Simply. By thriving.

According to the Free Online Dictionary, to thrive is

1. To make steady progress; prosper.
2. To grow vigorously; flourish.

I must agree with esteemed blogger, Evelyn Chua -- to thrive is as basic to the human condition as is the need to survive. Not a luxuy, but a right.

Let's all take Evelyn's challenge (Thrive)... When they write your epitah, will you merely have survived, or thrived, having been an agent of wonder and change?

Alas, the Environment

Alas, the Environment.

I ventured out for an invigorating walk on Saturday, January 7th.  My destination was one of my usual paths -- a tree-lined area surrounding a river... A very peaceful and beautiful promenade, allowing humans and wildlife to enjoy a bit of natural habitat close to home.  It was a lovely and unusually warm afternoon -- 60 degrees Fahrenheit in January -- and I was looking forward to disappearing into nature, surrounded by the sounds of small animals... looking forward to admiring the crane, geese and ducks that have made the river their home.  As I passed the halfway mark of a mile, I started to notice a nauseous, burny feeling in my stomach that caused just enough discomfort to have created a feeling of dis-ease... that feeling grew as my short walk wore on.

By the time I reached the mile mark, one of my eyes has started itching in a characteristically hive-ish sort of way -- hot and prickly... By the time I had made it to my door, my ear rims had started itching -- I could feel them swelling, and the inside of my right ear had that eery (no pun intended) feeling that I have only ever felt when my internal organs had started swelling... it was a pressure inside my ear, and a corresponding distortion of my hearing coupled with a tinnitus-like ringing.

Think fast, Simran -- think fast... this is clearly a reaction... was it brunch (which was a combination of garden vegetables that did not cause any reaction when I had eaten two days prior)?  Not likely.  My anaphylactic reactions to ingested food usually involve 

• overall hive coverage, 
• profuse, sheet-like sweating, 
• comprehensive internal organ swelling, 
• acutely diminished lung function (similar to a critical asthma attack),
• tongue swelling, 
• intense gastrointestinal distress, and 
• immediate and forceful expulsion of the contents of my digestive tract.  

Minor implosion.  

No... this was different.  It had to have been environmental.  All of a sudden, I had a flash from my past... I had had an unexplained hive reaction to something that had bloomed six years ago, after having walked/jogged the same path into town on a lovely May morning.  This time, the reaction was more rapid and more intense.

After getting home, I noted how quickly the hives were spreading.  It had started around my left eye, to the palms of both hands and the back of my right hand... and to my ear rims and various parts of my neck... then to my right eyelid.  I took off my coat and hiking shoes, as the itching of my neck intensified.  I resisted scratching as much as possible, because the hives would spread like wildfire if scratched.  These hives looked different to food allergy hives -- they were narrower, pointier and taller than the food allergy hives, which were more disc-like, wider and flatter -- covering more area in a shorter amount of time.

An area on the size of my nose started itching... which heralded an onslaught of rapid-fire sneezes producing drown-worthy amounts of mucus... mucus overdrive continued, as i felt itching and irritation at the back of my mouth and palate, and in my throat... the pathway of a breath of air.

Clearly, the first thing I had to do was eliminate the allergens that were causing topical havoc.  As I disrobed, the neck irritation had spread to my shoulder blades and chest... then to the middle of my back... it was then that I realized that the allergen was on my hair, since the areas of hives on my upper body followed the path of my hair.  Hives had started popping up on my groin by the time I stepped into the shower.  I showered, being careful not to further irritatate areas of reaction, thoroughly rinsing, soaping and rinsing again.  The hives continued to spread.

I moisturized the hive areas, since the swelling stretches the skin... then dressed in loose-fitting clothes, since elastic and tight clothing tend to exacerbate and prolong the hives in those areas.  I took an Allegra (antihistamine), hoping that mind-over-matter would kick in immediately.  As the itching and spreading of hives continued, I remembered that I had bought a homeopathic remedy, Hyland's Hives, for use during some future incident of hives -- that time was now... so I took one of the sugar pills and placed it under my tongue.  I did this every fifteen minutes for the first hour -- by then, the itching had diminished 50%, making it tolerable enough to be distracted by a good book or movie.  During that hour, I also called a relative to ensure support in case I could not arrest the reaction on my own and would need to go to the hospital.

Throughout a reaction like this, I find myself treading the fine line between cerebral composure and panic.  The sight of red, swollen, itchy-hot hives making their way across my landscape remind me of times of the most severe reactions... and all of the uncomfortable symptoms.  If I give one moment's notice to the panic, the potential that I feel for the complication of my reaction will be realized... so, while all of this is in flight, the only way I can win the battle is by staying calm.

I made myself comfortable on the couch -- propped up with pillows, and covered with a blanket.  If I wanted to arrest this reaction, I had to shut down activity to let my immune system stop its madness.  One positive -- it would be an opportunity to catch up on rest -- particularly since a reaction like this takes a significant toll on one's energy.

I continued to take the remedy, increasing the intervals of time as the reaction subsided.  The Allegra in conjunction with Hyland's Hives and rest did the trick.  Six hours later, there was very little swelling left, and the itching had completely subsided.

Specifically, what were the allergenic culprits on that fine day?  My Allergy Immunologist told me that many of my fellow respiratory allergy sufferers were also significantly affected, illustrating a tangible example of the detriments of global warming on human health.  Since the temperature soared to 60, the local vegetation mistook it as a sign that Spring had arrived, and that it was time to blossom.  A plethora of pollens and mold spores were released into the air, before the climate was able to support Spring blossoms... before our bodies were ready to handle the seasonal onslaught.

A warm, sunny day makes us want to spend time outdoors, breathing in lung-fulls of clean, fresh air.  It might be prudent to be thoughtful before setting out.  Back to the drawing board....

Always Flash

Use Flash.

Work it.  When you hand the card to the waiter/waitress, make sure you explain that, if your food comes into contact with any of the items on the list, and you eat it, you will die.  Some form of the word “death” usually catches a server’s attention – you can physically see them perk up, as they listen more intently.  If a server does not seem to understand the gravity of the situation, leave the restaurant.  Earlier on, I paid the price for not having properly gauged a waiter’s lack of concern.

The waiter remembered me from a previous visit, during which, after giving him specific verbal direction (I hadn’t yet devised the flash card strategy), he served my dish with a helping of lettuce on it.  I sent the dish back, explaining that I needed a new meal prepared and that I would need them to put it on a clean plate.  During my second visit, I can only guess that the chef had placed lettuce on my dish, and then removed it after the waiter noticed it.  Unwittingly, I ate dinner, and proceeded to experience part of my anaphylactic reaction on my way home.

Depending on the personalities of the establishment's staff, you might receive the attention of numerous members of the wait staff, management and/or the chef.  I consider this a good sign -- it means that they are giving your requirements due gravity.  They understand that your life hangs in the balance, and that they could be responsible for anything adverse that might occur.  These are the people you want feeding you.

You might also encounter restaurant managers who politely and nervously tell you that they would like you to leave the restaurant, because they are concerned that they will not be able to segregate the preparation of your food perfectly.  This usually follows numerous iterations of questions and answers, and trips to the kitchen.  Use your best judgment to determine whether or not to eat there.

Flash 'em!

Flash 'em!

Ok... Let's keep this G-rated.... 

Want to improve your odds of dining without adverse incident?  Hand the food service manager (e.g.  Restaurant manager, chef) a flash card listing your anaphylactic allergens.  A flash card can be as simple as words typed on a slip of paper, or as elaborate as a laminated card or sheet of paper listing your allergens.  You can buy them online, or make them on your own – making your own ensures that the information will be custom-tailored to your particular case.

Size matters.  Don't believe anyone who says otherwise... It must have large enough type/font so that the average person who is neither legally blind nor a perfect 20/20 can easily make out all of the words on the sheet.  If someone must squint or guess at the items listed on your flash card, then you are effectively engaging in a game of Russian Roulette.

The size of the card matters also.  The card should not be so small that it can easily be lost by your server or  chef -- but it should also be not so large that it is difficult for your waiter/waitress to carry with your order.  I find that 8.5 x 4" is a handy size -- and it doesn't get lost.  5" x 7" works as well.  At times, it will come back to you with oil and/or food stains... most cherished proof that the flash card made it into the hands of a chef.

Content.  Remember the 3 Cs:  Clear, Concise, Comprehensive.  Use simple, clear sentences to convey your requirements.  Assume that your reader could have Attention Deficit Disorder – get the reader’s attention while keeping your message short.  Finally, make sure that all of your allergens are listed – it must be comprehensive enough so as to leave no question in the reader’s mind.

The flash card is a tool that should be incorporated into your repertoire and used any time you are thinking of having food pass your lips.  Make sure your EpiPen is within easy reach at all times.

Sample Anaphylactic Allergy Flash Card:

Mistakes Along the Way

Mistakes have the same value in your lifestyle as they do in pre-anaphylactic life -- they are opportunities for learning and personal growth.  Perfection is an ideal that exists exclusively in Utopia alongside Virtue, Unicorns and 43 year old Virgins; so, from here on in, release yourself of the burden of having to master your lifestyle perfectly.

Each blunder reveals another invaluable clue as to what is happening in our bodies at the cellular level, which causes us to experience such severe reactions.  Without these blunders, we are a powder keg awaiting the next inevitable explosion.

Mistakes are redeemable due to our ability to learn from them... Therefore, PAY ATTENTION.  You know the signs -- when you feel your body launching a reaction, make note (physically, if possible -- through writing, a cell phone text/note, or via a voicemail you leave yourself) of what you ate, smelled, did and came into contact with immediately before reaction onset.  How are you feeling at the moment?  How does it compare to the previous incidents?

Next, CALM DOWN.  Physical activity and panic make the symptoms worsen more quickly.  In asthmatics, if, during an attack, the person gets emotional -- usually upset or panicked -- lung capacity diminishes exponentially.  The minute the asthmatic stops the emotional reaction and forces him/herself to calm down, lung capacity starts to increase.  Not an easy thing to do, but if you can manage it, you will buy yourself some valuable time.  So, help yourself uncomplicate the complexity of your reaction.  Calm down to minimize reaction momentum and enable yourself to think through what needs to be done next to get you into the hands of a competent healthcare team as quickly as possible.

Take your medical insurance card out of your wallet and put it in a pocket or place that will be easily accessible (to you are a healthcare provider) as your reaction progresses.

If the reaction is progressing quickly and you have an Epi Pen, you might have to use it.  When to use the Epi Pen should have been discussed with your physician during the first or second office visit.  Always seek the advice of a licensed healthcare professional before using prescription medication.

Seek someone's attention and ask them to call 911.  Explain what you are experiencing.  If breathing and speaking are getting difficult, then proceed to the path of writing.

If your tongue is swelling, you might not be able to speak clearly -- so write your plea for help on a note.  Pen and paper will never become relics -- always carry them with you.  Include the fact that you are having an anaphylactic/deadly (do yourself a favor and use both words to describe your situation -- some people are unfamiliar with the term "anaphylactic") reaction to [name of your allergen] and to please call 911, and [name of your most reliable emergency contact and his/her telephone number].  Also write down the location of your insurance card (e.g.  "Medical insurance card is in right jacket pocket").  If you have the ability, also write the name and telephone number of your physician.  Ask the ambulance if they can take you to your physician's hospital without incurring unusual charges.

Once in the ambulance and on the heavenly drip of benadryl buzz, remain alert enough to answer questions accurately, know where you are going or being admitted, and answer the questions of the ER personnel once you arrive at the hospital.  After the initial flurry of your arrival, vitals monitoring and a possible administration of medicine, you will have time to doze off... Your emergency contact will hopefully arrive soon thereafter to watch over you. Ask your contact to request copies of your file for this ER visit, so that the record can be shared with your physician.  Survival is dependent on a good, impropmtu delegation plan.  Just don't delegate the relief.  The relief, combined with the IV makes for an intoxicating mix.

After you're home and the drowsiness has worn off (and you WILL be tired -- your body just experienced upheaval of epic proportions), document all you can about this event... With particular emphasis on the hour leading up to the reaction -- this will help identify the trigger.  Read through the notes you jotted down or captured on an electronic device, and listen to the voicemail(s).  Weave the bits together into a set of data that can be presented to your physician during the next visit.

Now schedule that next appointment with your physician.

Action

Action.

Action is the result of your empowerment; it is what will enable you to develop a healthier lifestyle paradigm.

Anaphylaxes had the upper hand, prior to your diagnosis... It could have struck at any time, and, literally, wiped you out.  Now, you are on the look-out for it... And you know the warning signs, and how to deal with it... You will make mistakes, but that's okay -- you'll be able to handle it.  You are now equipped to keep the enemy at bay and win the war.

How do I define "winning the war"?  There is no one definition.  Anaphylactic allergies can be outgrown -- allergists suggest re-testing every seven years.  However, we are not all that lucky.  Some of us are in this for the longest haul of all -- the nature of these allergies, according to modern science, is unpredictable.  So how do we win in this situation?  We win the war by proactively addressing the issue -- by developing a positive lifestyle that allows us to enjoy the luxuries of life, sculpting out the bits that prove to be life-threatening, and erecting allergen barriers that provide us the maximum safety and freedom possible.  We win the war by developing an alternative lifestyle that preserves an acceptable quality of life.

What's "acceptable"?  Only you can define that.  But I advise you to define parameters that are forgiving enough not to leave you feeling frustrated or deprived.  Yep -- I just used the D-word -- only an insane person would see a huge, purple elephant sitting next to him/her and deny it peanuts.  The deprivation mindset can suck you downwards like quicksand -- do yourself and everyone in your life a favor -- don't let it.  It's okay to allow yourself to go there initially -- it does, after all, suck like a neverending Tootsiepop without the Tootsie... But noone will want to accompany you through your perpetual victim saga... And, frankly, the victim mentality spirals downward... Wrong direction.

In all probability, there are things in life that you either missed out on, or underappreciated before your anaphylactic allergy became active.  Things that you might now be more open to trying... And, to your pleasant surprise, liking.  When one door closes, another opens up... Somewhere... You just have to follow the draft.

Back to "action".  Your Action Plan should, first and foremost, help you avoid anaphylactic events.  It should be a "work in progress" for the lifespan of your allergy.  As you have more life experiences and your body ages, you can refine the plan along the way.  Talk to others who live an anaphylactic lifestyle -- ask them how they manage to safely enjoy activities that could potentially lead to an anaphylactic event (e.g.  If yours is a food allergy, how can you continue to eat in restaurants without ending up in the ER at the end of the meal?).... If it makes sense to you, make some of their tricks your own -- create your own repertoire using the benefit of others' experiences in addition to your own.  The best action plan for you is one that only you can devise, because you alone know every single thing you do every moment of the day.

Justice.  Knowledge.  Liberate.  Let's go have some fun!

Director of the Battle

Drive.  Direct.

You've selected your physician.  Great.  No rest for the weary.  Schedule a visit to either agree on the course of therapy that the two of you designed, or obtain the clarification needed to help you further refine the therapy.  Doubtless, more questions and concerns may have arisen since your last appointment.  Jot them down and be sure to bring your list to your next appointment.

After the pleasantries of the day are done, let your physician know that you've given thought to your last conversation and that you subsequently had questions -- you would now like to go through them.  Your physician might ask you to read them, or might ask you for the list to read (some people process spoken words better; others process written words better -- as long as your doctor undstands your message, how s/he takes the information from you should not matter).  Your doctor should answer your questions to the best of his/her ability, and might even provide you with supplementary information and/or reading materials.

Find out the medical designation of the selected therapy.  Is it in clinical trial, or is it an approved therapy?  Does it incorporate a mixture of alternative medicines (e.g.  Western plus Chinese, Western plus Ayurveda, Western plus Homeopathy)?  Is it so radical that it is neither approved nor in clinical trial?

Make sure that you touch on the subject of therapy timelines.  Will you have to receive this therapy once a week for the rest of your life?  Is the therapy designed in 6-month stages, with four stages being the full course?  Is this therapy necessary once a month for seven years, at which point you will be re-tested?

What about the cost?  Is this therapy covered by your insurance plan?  If not fully, what portion will you have to pay out-of-pocket?  Will there be a co-pay for each office visit?  Will it differ from the co-pay amount on your insurance card?  Are there any programs in existence that might subsidize part of your cost?  Does the pharmaceutical company make allowances for patients with hardships?

Lastly, ask what your best case and worst case prognoses would be as the result of your undergoing the selected therapy.  If there would be no change, then you might ask yourself why you should put your body through the trauma, while wasting time and money.  If the strategy would yield any positive result(s) to your health, it might be worthwhile.  If it leads to a cure, it's a no-brainer.  Just be careful of anyone who offers you a seemingly magical solution -- magical solutions don't exist.

Weigh the answers to your questions, and make your choice(s) based on your comfort with your physician and his/her ability to successfully administer the therapy.  Work the therapy schedule into your everyday life -- weave it into the fabric of your life as you would an addition to your family.  It is an addition to your life.  If you do not commit to accepting and living an anphylactic lifestyle, you leave yourself a perpetual victim of anaphylaxes.

I am a survivor.  So far.  Are you?

Gutsy.  Healer.  Indestructible.  Develop a living action plan.

Plan Execution

Execution.  Bloodless execution.

With your thoughts  organized and your supporting documentation in order, it's time to execute your plan -- put it into action and keep the momentum going.

1.  Meet with the physicians and discuss your dossier.  Ask your questions.  Ask the physician what testing methods are used to diagnose an anaphylactic allergy, and make sure you understand the methods well enough to be able to select a method with your doctor's advice.  Ask the physician what methods s/he prefers and why this is his/ her preference.  Decide whether or not you are comfortable with this doctor's approach.

2.  Get diagnosed -- confirm all suspicions.  Become an active participant in your health and well-being.  Ask the doctor to test you for foods/allergens you suspect, including everything in the food/allergen family.  If you are uncertain, let the physician suggest and justify a testing plan for you.  The physician should take your concerns into consideration, and not try to force you to take a course that you do not understand.  "God complexes" should be checked at the door -- if s/he can't physically walk on water, feel empowered to suggest s/he take it down a notch and replant his/her feet on earth -- remember, you are doing him/her the good deed of bringing your business to him/her, not the other way around.  In dealing with your allergy, stress needs to be minimized, since it can be a source of complication.

3.  Discuss the timeline for allergy testing, including an in-person review of test results.

4.  Once your test results are ready, meet with the physician again to review and understand your results.  Your initial meeting conversation revolved around possibilities; now you have definitive detail to discuss.  Solicit the details of the doctor's proposed care plan.  Will additional testing be needed?  Should a traditional allergy therapy be used to treat the condition?  If so, why?  Should a more radical treatment be used to treat or de-sensitize you?  Is this treatment covered by insurance?  What are the risks of one option over another?  Ask the physician if s/he would have his/her mother or child submit to such a treatment if that person had the same diagnosis.

5.  Ask the doctor to provide you a list of steps to take in the event that you find yourself experiencing anaphylaxis in a location that is not near a medical facility.  Knowledge is empowerment; and, in this case, it can mean the difference between being able to preserve lung capacity (calmness in the face of crisis) and suffocating (unbridled panic).  If medication (e.g.  an epi-pen, benadryl, prednisone) is required for any of these steps, make sure you get a prescription for each medication.  Review the list (as well as precisely when it is necessary for you to seek medical attention) with the doctor until you understand the sequence.  You should commit this sequence to memory because it may save your life one day.

6.  Go home and compare notes on the three physicians.  What did they say that was common?  What were the differences?  Use the Internet to help understand the differences -- do your research -- this is your life, after all -- no one will ever take as keen an interest in it as you.  Based on your comparison and your research, who seems to be most knowledgeable and qualified to fill this important role in your life?  Who is most authentic?  Who are you most comfortable with?  Now make your selection.

7.  Never forget that you are your best, most reliable health care provider.  Don't ever give up.

Daring.  Engineer.  Formidable.  Time to direct the mission.

Have a Plan

Have a plan.

First and foremost, calm your nerves.  Realizing that you have an anaphylactic allergy can be very unnerving... If you allow it to, it will unravel the fabric of your being... But you're much stronger than that... How do I know?  Well, all humans are 10,000% resilient -- everyone knows that.  The only thing we can't do is regenerate limbs.  Yet.

Once you've recomposed,

1.  Do some research to identify at least three respected physicians specializing in allergies (most likely allergists or allergy immunologists).  Identify a minimum of three so that you can
          a)  get a few opinions,
          b)  compare their answers and proposed approaches, and
          c)  pick the specialist with whom you feel most comfortable.  This could be a long term relationship (if you've ever been married, you know what that means -- if not, there's time).  Choose wisely.

2.  Before you meet with your short list of specialists, prepare an allergy dossier.  It should include information that will help the physician(s) piece together your history to lead to an accurate diagnosis (emphasis on "accurate" -- an inaccurate diagnosis can be as harmful as no diagnosis at all).  When putting together my dossier, I started by focusing on supplying the answers to the following questions:
          a)  What medical records do you have in support of the anaphylactic event you experienced?  What other allergy records do you have?  Incorporate them into the dossier.        
          b)  What other known allergies do you have?
          c)  What known allergies exist in your family?
          d)  What activities were you engaged in immediately before the anaphylactic event?  What were you engaged in immediately after?  How did you feel?
          e)  At the time of the event, was there a period of time when the reaction symptoms subsided, only to be reactivated later on?  If yes, approximately how much time elapsed in  between the initial reaction and the second (latent) reaction?
          f)  Create a food diary listing everything you ate on the day of the event.  Do you have any idea what caused the reaction?  Think back -- had you ever felt unusual when you had eaten these things before?  "Unusual" could mean numerous things... Perhaps you had an unexplained feeling of anxiety, an unusual rise in body temperature, hives, difficulty breathing, itching/swelling in the mouth or intestinal distress that had escaped your notice until now.
          g)  Prepare a list of questions for the doctor -- it is your body, and you have the right to understand how it is functioning and why it is functioning this way.
          h)  Research the physicians on the internet.  Make sure that they are credentialed and associated with reputable hospitals.  Read patient reviews -- be sure to read through the most negative reviews, in addition to the positive ones.  Extremes could be outliers/the work of those with agendas; however, reading both the good and the bad will help you get a more balanced idea of what it might be like interacting with the physicians.

Alpha.  Bravo.  Charlie.  Now it's time to execute the plan.