Amanda Wilde (Host): Incense is commonly used in many cultural rituals, and it can also have an impact on your health. This is MAIMO MedTalk. I'm your host, Amanda Wilde, and joining me today is Dr. Mary Lee-Wong, Chief of Adult Allergy and Immunology and Medical Director of Asian Outreach and Community Services for the Department of Medicine at Maimonides.

Dr. Lee-Wong is a renowned expert in her field and brings invaluable insights into how everyday cultural practices, such as the use of incense, can impact allergies. Welcome, Dr. Lee-Wong.

Mary Lee-Wong, MD: Yes. Hi. I am Dr. Mary Lee-Wong. I'm a Board Certified Allergist and Immunologist. I always tell people, if you itch, wheeze, or sneeze, you should think of me. And I'm just so delighted to be serving our community. I spend all my days, seeing patients with different atopic allergic disorders. Today we're focusing on incense allergy and problems with incense exposure.

Host: Now, that is not a topic I've heard researched before. Can you share what sparked your interest in researching that link between incense and allergies?

Mary Lee-Wong, MD: I see patients from all different backgrounds and cultural experiences. We happened to have this elderly woman and she presented with asthma and COPD, which is type of a breathing problem disorder and she was already on oxygen therapy and you know, we were giving her all these different medications and inhalers for her breathing, but she continued to have shortness of breath.

So we just couldn't understand what was the problem? Were we not prescribing the correct medications? Was the combination of medications not adequate? We spent a lot of time trying to get a better history of what exposures or what events would precipitate these problems. And apparently she was getting more shortness of breath whenever she was burning incense.

So she would burn incense in front of an altar with photos of her ancestors. And this was a cultural practice that she's done all her life, and we realized that the exposure was actually exacerbating her condition.

Host: So then, did you do further research on this topic to see how far reaching these kind of reactions might be?

Mary Lee-Wong, MD: We did, and apparently, one gram of incense burned gives you 45 milligrams of particulate matter, as opposed to 10 milligrams for cigarettes. So actually, incense was four and a half times as much of a pollutant to your lungs. So we really wanted her to stop, but it was very difficult because culturally her answer was, it's my duty to do this.

Burning incense was culturally meaningful to her because her parents, performed this type of ritual, and her grandparents did this. She remembers burning incense as a child. This was a way of respecting her ancestors showing memorance. It was a cultural activity that was very meaningful to her and her family.

Host: So this is part of who she is, and that is true for many people. So what are your recommendations in this case? As a medical person, you don't want these particulates going into your patient's lungs.

Mary Lee-Wong, MD: Well, as a doctor, as a practitioner, we should always try to understand the patient's perspective. I really believe communicationis trememdously important. It's the key.

You don't want to alienate the patient because that doesn't accomplish anything. You want to be able to talk to the patient. You want to be able to explain to them, why you think certain medications are important, why certain exposures might be bad for their health. You know, every patient is different.

You can't make exceptions about cultural practices that they may or may not have. You can't also be judgmental and just tell them, stop it. You have to understand, what exactly, is going on, what certain activities mean, what certain foods mean to patients.

I think I believe in patient focused, patient centered care. You have to be respectful, not have preconceived notions, and you have to respect patients cultures, beliefs, and faith.

Host: So being in a diverse cultural environment has really informed your approach to medicine and allergy care.

Mary Lee-Wong, MD: It certainly has. And incense, when we looked into this, apparently, is used in many cultures and religious practices. It's used in Hinduism, Buddhism, ancient Judaism, parts of Christianity, including Catholicism. It's not just religious. If you research it further, people use it to deodorize a room, to make a place smell nice, to bring a mood.

Incense is commonly used in yoga practices, in meditation, in spa. It's used more ubiquitously than, you would think, and I think as a healthcare provider, I need to be able to get a good history, and it's a little detective work, but I have to do my job so that I can make my patients well.

Host: So, how do you do that while being respectful and sensitive to personal and cultural norms and preferences?

Mary Lee-Wong, MD: I think it's very important that you have a good history and a good physical. I think nothing replaces that. I think spending the time to know your patient, asking questions and getting details, having a very nonjudgmental, supportive, empathic, approach or tone is very important because you want the patient to feel that they're part of the team.

 You want them to be invested in their care. You want them to know that I, as a doctor, I am their advocate. I'm here to work with them, to help them, to make them feel better. And I think this is very important.

Host: So you're not only listening to your patients, it sounds like you're learning from them as well.

Mary Lee-Wong, MD: I'm always learning. I feel that every time I see a patient, to me, it's an opportunity to make them feel better. And to me, that's really very meaningful. In fact, I had a patient, we were just talking about actually more than one, I've had several patients. I always ask about tobacco smoking, especially those who have respiratory or breathing problems.

It's very hard to quit. And I understand. And I've had patients tell me, Oh, I'm never going to quit. I need to smoke to relieve my stress. I need it because, well, my friends all smoke and that's what we do. We go out for drinks and we smoke. So one of my patients, actually more than one, a couple of my patients, but one just recently, she was one that I was sure was never going to quit smoking because she said to me, I'm not going to quit and you can't make me.

And I would say, no, of course, I'm not going to make you. But I explained to her about all the different health problems you can get from tobacco smoking. We discussed emphysema. We discussed asthma. We discussed different things. And she left and she came back a subsequent visit and said that she really wasn't intending to quit.

But then she said, after I explained everything, she said, you know, to have a doctor care that much about her health, how could she not care? How could she not quit? And to me, that really made me feel good that I made a difference, that I helped someone quit smoking. And this has, over my decades of being a provider, I've helped numerous patients quit smoking and to me, that's a very meaningful change that I made a difference that I helped someone and not just that one person, but I also helped their families, because we know there are health hazards with secondary smoke inhalation. Secondhand smoke, we call it. Now we also have more research discussing thirdhand smoke, because secondhand smoke is when you smoke, and the people around you get exposed. But third hand smoke is when the smoke is now in the furniture and the objects in the room and it could linger and people walking into that room, sitting on that sofa, breathing in the fumes can also be exposed to the health hazards of tobacco smoke or other health hazards.

Host: So actually research is still emerging about this.

Mary Lee-Wong, MD: Absolutely. I feel that we should all spend time reading about research so we can give better care to patients. If I see something unusual or something of interest, I try to speak with my colleagues so that we could research further so we can provide, excellent care using the knowledge base available to us.

 I really, really enjoy teaching, my medical students, my residents, and any students, we have physician associate students, we have nursing students. Maimonides is an academic teaching center. To me, investing in teaching is very important because the young people, meaning young in terms of age, in terms of their level of learning, not age meaning in terms of their age per se.

 To me, investing in, in our students is investing in our future so that we can have even better care for everyone.

Mm-hmm

Host: Exactly, that's what you're describing, an emerging future of allergy care at MAIMO. Dr. Lee-Wong, thank you so much for this intriguing and important conversation on incense and other particulates, allergies, and cultural practices.

Mary Lee-Wong, MD: Thank you very much. I look forward to seeing more patients and helping more people and working in my community to improve healthcare for everyone. Thank you.

Amanda Wilde (Host): Thank you, Dr. Lee-Wong. To make an appointment, call 718-283-2550. To listen to additional episodes of MAIMO MedTalk, visit MAIMO.org. Follow us at MAIMO Health or visit MAIMO.org for more information.