Dr. Michelle Weiss: A Love Story

Michelle Weiss, M.D.

The twelve-year-old girl had an accident; she fell off her bike, hit her head, and broke her teeth.  As a result of the concussion she couldn’t remember the details of the event, but she remembered the feeling. While lying on the bed in the ER and “in the midst of all this confusion” her family pediatrician arrived. His smiling face brought her “such comfort,” and she was extremely grateful simply for his presence. Looking back, she believes that this started her “going down the track of medicine.”

Ellis Island circa 1910

As a daughter of first-generation Americans (whose own parents came through Ellis Island from Eastern Europe) she was taught the value of education. She and her two sisters (one, a twin) were made to believe that there were “no limits” on what they could do in life. That is, as long as they would be either a teacher (like her mother), an accountant (like her father), a lawyer (as her two sisters would eventually become), or a doctor (as she herself would be).  

Dr. Michelle Weiss was a natural and joyous learner, and during her sophomore year at the University of Rochester she excelled and received early acceptance to the medical school. She “recalculated” and quickly switched her major from Biochemistry to Psychology (with an informal Art History “minor”). Everything seemed fine, and she was happy and on her way.But the following year, a month before he had planned to present her with an engagement ring, her boyfriend had an epileptic seizure and died. This threw her “off-target” for quite a while.

As she finished college and then immersed herself in medical school studies she “loved” everything she did. She told me, in fact, that she “loved every minute” and “loved” all of her rotations in the medical specialties. She was most moved, however, by her time spent in pediatrics.On the peds-oncology floor she saw that nobody was “burned out” as they took care of the desperately sick children. How could they be, she thought, as the resilient kids played together, and sold cups of sweetened lemonade?

CHOP

Taken by this, Dr. Weiss did a three-year pediatric residency at Children’s Hospital of Philadelphia (affectionately known as CHOP). Needless to say, she “loved” this, too, as “everybody worked together.”  She recalled, by the way, that a small container of McDonald’s fries (the old recipe!) could create an instant friendship. (The very first Ronald McDonald House was opened, at CHOP, in 1974, with the help of the Philadelphia Eagles.)

But how did Dr. Weiss eventually narrow down her broad interests to become a pediatric allergist/immunologist? The only one in York?

Scene from "Billy Elliot"

The story goes way back. In elementary school, she watched with delight as a fellow student began to show talent, even by the sixth grade. The gym teacher’s son was athletic and charming. In high school, he was a “magnificent” dancer who could “fly through the air like Billy Elliot.” At NYU he majored in the arts. Sadly, he developed AIDS and died before he graduated college.  This affected Dr.Weiss deeply. In fact, she was so "shook up" that she needed to know more. So she took a graduate class in immunology at Rochester (while still an undergraduate).

Kathleen Sullivan M.D., Ph.D.

Her interest in immune T cells, B cells, and histamine release continued through medical school and residency training. And after the three years of general pediatrics she did a two-year fellowship in allergy and immunology at CHOP with the prominent immunologist and noted HIV researcher Dr. Steven Douglas. She worked closely with Dr. Kathleen (Kate) Sullivan (currently chief of Allergy and Immunology at CHOP) who was “kind, and brilliant beyond belief.” It was Dr. Sullivan who taught Dr. Weiss to “go out of your way to help people...to go the extra mile.” Anything less was not acceptable.

Around this time she was finally (doctors are the worst patients) treated for the allergic rhinitis she had suffered from every fall for years. There was sneezing and a runny nose and Dr. Weiss felt terrible. A colleague casually suggested that she should try the antihistamine Seldane. She did, and immediately felt better.  She said that she wished that she had known about this before, as she could “breathe again.” For her, it was, “a miracle drug! " (Seldane was taken off the market in 1997 due to serious heart arrhythmias and was replaced by its safe metabolite, fexofenadine, or Allegra.)

Early on during her fellowship she was offered a month-long pulmonary elective in Israel. Without hesitation, she went. But the rounds on patients in the hospital were in Hebrew and she was (uncharacteristically) not prepared.  So she played the role of tourist, and with a small group tagging behind, she became known as “the map girl.”

Shabbat at the Western Wall

One Friday night they were invited, with others, to the Western Wall, and then to a private residence for a Shabbat dinner. She was 28 and lonely. Most of the guests were much younger, but as Dr. Weiss looked around the lovely home she spotted a young man who, she thought, might be about her age. He was from Australia; they immediately hit it off.  They toured with the group for a while, but it wasn’t long before he wanted the girl “who knew her way around” all to himself. She went along with the plan, and, before long, they fell in love.

Martin (the Aussie) went back home, and she returned to CHOP. A few months later she made her way to Australia to see him.  He was smitten, and did not equivocate: "I am quitting my job, putting my house up for rent, giving my dog away, and moving to Philadelphia. Let's see if this works."

He arrived in Philadelphia in September (it was 1993) and proposed on November 1st. They got married at City Hall on November 30th, and the wedding was in July 1994. A few months later they were starting their family. As Dr. Weiss was finishing her fellowship she had to think about where to practice.  Her parents lived just outside New York City and her sister was in Owings Mills.  Family is vitally important to her and she split the difference, and moved to York.  She worked with  Dr. Greg Lanpher for a few years, and she went out on her own in 1997 (while carrying her second child).

Private practice has had its challenges in the era of corporate medicine but Martin worked behind the scenes to smooth things out as much as possible for his wife, and Dr. Weiss could focus solely on her patients.  When the demands of electronic documentation became too burdensome in the last few years, they adjusted.

The practice of allergy and immunology has, of course, changed substantially over the past 25 years.  There is a much better understanding of the genomic aspects of the so-called innate and adaptive arms of the (exceedingly complex) immune system. The precise molecular mechanisms of specific diseases are now known, opening up novel treatments.  She notes that, “our diagnostics are so much better.”

But, obtaining a meticulous history (from the patient or the parents) is still essential in the detective work to find out which allergens in the environment (inside or outside), or in the diet, set off the abnormal immune response.  This is a skill that Dr. Weiss has carefully honed over the years and it takes time to elicit and record it accurately. She spends the time.

What’s new? What should we know about? Dr. Weiss thought a minute and then remarked that, "everything we knew about food allergies was thrown out the window two years ago.”

It seems that reactions to food are the most common cause of trips to the ER for life-threatening anaphylaxis. The usual culprits in children are cow’s milk, eggs, and peanuts. Yes, peanuts. The incidence of peanut allergy doubled in recent years and there may be as many as 200 deaths yearly in the U.S. attributable to this.  While there is still no effective treatment other than avoiding even a speck of peanuts, there is now good reason for hope.

Israeli Peanut Treat

Dr. Weiss noted that it had been accepted dogma that exposure to peanuts should be avoided in infants and young children to prevent the development of peanut allergy. But this idea was questioned after it was found that Jewish children in Britain had ten times the rate of peanut allergies of Jewish children in Israel of similar genetic and socioeconomic backgrounds. Why? “Bamba,” a ubiquitous 50% peanut/puffed-corn doodle. Israeli infants are given this to suck on.  Eureka! Early exposure seemed to be protective, not harmful.

The proof. A 2015 NEJM study of allergy-prone infants (with eczema or an egg allergy) showed that only 1.9% of those who were given peanut-containing products developed a peanut allergy compared to 13.7% of the infants for whom peanuts were carefully avoided. The official guidelines about feeding infants peanut products were changed in 2017 to reflect this compelling data (and real-life experience). Parents will be able to breathe easier when they do not have to worry about that.

Speaking of breathing, Dr. Weiss is quite pleased that asthma can usually be controlled without using repeated doses of systemic steroids (such as prednisone) that have potentially harmful side effects. She noted that the newer inhaled steroids are very effective, and are safe for use in very young children. In 2015 there were 3,615 deaths in the U.S. attributed to asthma; 219 of those were in children under 19. Alarmingly, the death rate for children under eleven years old had increased nearly 80% since 1980.

Proper and aggressive treatment of chronic asthma and acute exacerbations with beta-agonists, inhaled steroids, leukotriene receptor antagonists (like Singulair), and maybe even the IgE-binding antibody omalizumab (there’s that -mab thing again), she believes, could reduce the numbers substantially.  

What about bee stings, I asked? She said that if there is a history of a severe life-threatening reaction, and a positive skin test to bee or wasp venom, desensitization can easily be done. With the periodic injections the eventual cure rate is 98.6%.  “Not enough people know about this,” she said.

There is much more. Dr. Weiss reads the literature closely (though she is not especially fond of the required periodic exams), has presented more than 20 carefully-prepared Grand Rounds to the medical staff, and has given noon lectures for the residents to enlighten them. She spends much time educating her patients and their anxious families. All of this is done with the same “love” she experienced in her work during her training years, the “love” she found in her Mid-East travels, and the “love” she shares with her family and close friends.

Dr. Weiss remembers the smiling pediatrician who met her in the ER when she was vulnerable and frightened, and she channels that smile as she engages with, and brightens, the world around her. We smile back in return.

Robert Indiana's "LOVE" Sculpture in Philadelphia

(Most recent story.)