Denton Combs Center | Medical Center in Sioux Falls, SD
Welcome to Denton Combs Center for Excellence in Care, where our priority is to deliver quality care to informed patients in a comfortable and convenient setting.
Board Licensed and Certified Family Nurse Practitioner Denton Combs is no stranger when it comes to treating, managing and solving non-surgical ear, nose and throat conditions. For the past 12 years, Denton Combs has been treating and managing patients in the Sioux Falls area. In addition, we provide allergy testing and allergy shot treatment. Denton Combs also specializes in waterless microscopic ear cleaning which in most cases; it takes a few minutes per ear and is typically pain free.
Services we provide:
- Allergy testing
- Allergy shots
- Allergic asthma
- Non-surgical ENT
- Microscopic Ear Cleaning (Water Free)
- Chronic Ear Infections (Failed Ear Tubes)
- Chronic Sinus Issues (Had Sinus Surgery, Symptoms Are Back)
- Postnasal Drip
- Frequent Throat Clearing
- Reflux/Silent Reflux
- Chronic Cough
- Facial Pain/Headaches
At Denton Combs Center for Excellence in Care you can be sure that you are going to get the most thorough treatment. At your appointment, Denton Combs will take the time to listen to your problems and he will thoroughly discuss all of your treatment options with you to find the one that fits you best.
Along with Denton, is Danneil Musser, RN and Samantha Terry, CMA. Out team has worked together for over 6 years now and we have learned how to make this experience for the patient as easy and as comfortable as possible.
Denton Combs Center for Excellence in Care is an independent Family Nurse Practitioner that is locally owned. We are located at 5124 S Western Ave Suite 4, Sioux Falls, SD 57108. Our phone number is 605-274-3898 and our fax number is 605-274-3899.
Referrals aren’t typically necessary but it is always best to check with your insurance before scheduling an appointment.
We have also been featured in Sioux Falls Women Magazine:
5124 S. Western Ave
Sioux Falls SD 57108
Allergy symptoms will not improve overnight. It is a gradual processs that can take 6 months or more before you start feeling better. It may take 12-24 months for full benefits to be evident. You will most likely still need allergy medications during this time to control you r symptoms. About 80% of allergie patients on immunotherapy note significant improvement of symptoms and become less dependent on medications. The goal of allergy shots is to decrease your allergy symptoms and thus your need for allergy and or asthma medications.
Allergy shots are started at a low dose and gradually increased every injection and vial until maintenance is reached. Allergy shots are given twice weekly with at least 2 days between shots until you reach "maintenance." Once you are on maintenance, shots are given once weekly for a full year going through every season. As your symptoms become controlled and you are not allergy medication dependent shots are reduced to once every 2 weeks and then every 3 weeks. After the first injection from each new vial you will need to wait in our office for 20 minutes to make sure no adverse reactions occur. This is for your safety!
It usually takes 2-6 months to reach the maintenance dose. The time may be longer depending on local reactions or if injections are not received on a regular basis. It is very important that you keep on schedule to achieve the best results. If you are unable to receive regular injections immunotherapy should not be started. Immunotherapy may be discontinued at the discretion of your physician if shots are not given on a regular basis as there is an increased risk of reactions under these circumstances. Depending on your symptom control, allergy shots may take 3-5 years to achieve maximum benefit.
Please notify the allergy department if you start ANY new medication, particularly medications for high blood pressure, migraine headaches, and glaucoma. "Beta blocker" medications are contraindicated while on immunotherapy and your injections will need to be discontinued while you are taking a beta blocker. Beta blockers come in several forms such as pills or eye drops. If you are not sure if the medication is a beta blocker please ask.
Immunotherapy is associated with some widely recognized risks. Risk is present because a substance to which you are known to be allergic is being injected into you. Some adverse reactions can be life threatening and may require immediate medical attention.
These are common and are usually restricated to a small area around the injection site. These reactions are more likely to occur as you reach the maintenance dose. Redness, itching and bruising at the injection site are all normal. Tese symptoms should go away within 4-8 hours after receiving the shot. Red raised wheals larger than a 50 cent piece occurring within 30-60 minutes hould be reported to our office so we can adjust the dose accordingly. If the wheal occurs over an hour after injection you may proceed to next scheduled dose.
In rare cases a severe allergic reaction (anaphylactic shock) can occur after an allergy shot usually within the first 20 minutes. Every patient is prescribed an EpiPen which would be used to reverse symptoms of an allergic reaction very rapidly. It is very important that you have your EpiPen at every allergy shot for this reason. Symptoms of anaphylaxis are acute shortness of breath, low blood pressure, throat tightening, wheezing, flushed skin, nausea, coughing, restlessness, heaviness in chest or chest tightness, increased secretions, rapid pulse and sense of impending doom. All allergy patients should also have antihistamines on hand particularly liquid Benadryl to counter act these reactions. If you have a sever allergic reaction you should seek medical attentiona immediately at the nearest emergency facility. Also notify us the next day so we can adjust your vial accordingly. You should not receive another allergy shot until you speak with our office. These systemic reactions can occur at any time whether building or at maintenance without previous warning.
Urticarial reactions (hives) includes various degrees of rash, swelling and/or itching of more than one part of the body. There may be mild to moderate discomfort primarily from the itching. This rare reaction may occur within minutes to hours after an injection.
If you should have an exaggeration of your allergy symptoms ( such as nasal congestion, runny nose or wheezing) in the afternoon or night of your allergy injection, take your antihistamine. Report this to the person giving you your next shot.
For females of childbearing potential: If you become pregnant while on immunotherapy notify our office immediately so that your doctor can determine an appropriate dosage schedule for the injections during pregnancy. Immunotherapy doses will not be advanced during pregnancy, but may be maintained at a constant level.
When you should NOT get an allergy shot:
If you have a fever greater than 100 degrees Fahrenheit please wait 48 hours after you are fever free before getting an allergy shot.
If you received an immunization or vaccination such as flu, MMR, tetanus etc. You should not do an allergy shot the same day as it would be difficult to distinguish which one caused a reaction if one were to occur.
If you are having any breathing difficulties such as asthma exacerbation or an illness such as influenza or pneumonia. If you have a cold or sinus infection you may get a shot if you don't have a fever or breathing difficulties which may be wheezing or chest tightness. If you are unsure if you can have an allergy shot please call our office.
Pateients who are in respiratory distress ( wheezing, coughing, chest tightness, or shortness of breath) should NOT receive allergy injections. If you are experiencing any problems with breathing, you should call our office for an appointment with a physician.
If swelling remains for previous injection. Postpone the next injection until the swelling has subsided.
There should be No strenuous exercise or over heating for 2 hours before and 2 hours after your allergy injection Increased blood flow can promote faster release of allergens from the shot into the blood stream.
Asthma patients will be required to do peak flows prior to each allergy shot to increase safety while doing immunotherapy. Asthma patients will also be followed closely with pulmonary function testing if they do not have a pulmonologist they see regularly. This is to ensure safety as we increase the immunotherapy. Please notify our office of any increase in asthma symptoms such as wheezing, shortness of breath or night time coughing.
You need to have your EpiPen with you at all allergy injections.
You mush fax, mail or bring to your appointment your COMPLETED injection log after receiving 0.50 dose from your treatment vials so we can mix your next vial.
You may start taking medications you were advised to stop such as antihistamines. Use these as a supplement until your allergy shots control your allergy symptoms.
Please let the person giving you allergy injections knnow of any reactions you had from the previous injection.
You may apply ice and/or hydocortisone cream to the injection site to help reduce local reactions of itching, redness and swelling. You can also take an antihistamine such as Zyrtec, Claritin, Benadryl or Allegra on the day you get your shot to prevent reactions.
Please make sure to call our office to set up your next vial appointment at lease two weeks prior to needing a new vial. If you can make an appointment at least two weeks in advance you will be more likely to get the time and day you want.
You MUST reach 0.50 dose before coming in for new vials. If you do not reach 0.50 you will not be able to start your new vials.
Do not hesitate to call with any questions or concerns regarding your immunotherapy. We are more than happy to help you.
Foods to Avoid in Stage 1 for 5 Weeks, maybe longer
- Fresh Fruit
- Dried Fruit
- Canned Fruit
- Fruit Juice
Notes: The high sugar content in fruit feeds the Candida. Fruits like melon may also contain mold.
- Sweet Potatoes
- Corn (Popcorn)
- Brussels Sprouts
- All beans except green beans
Notes: Starchy vegetables will break down into simple sugars and feed the Candida
- All dairy products
- Cheese (all)
- Sour Cream
- Ice Cream
Notes: Holistic practitioners recommend that Candida sufferers dramatically reduce their dairy intake. Candida prevents the body from processing fat properly.
Additives & Preservatives
- Citric Acid
- Anything on the list of ingredients that you do not know or cannot pronounce!
- Brown Rice Syrup
Notes: Citric acid is derived rom yeasts. Chemicals can disrupt your friendly bacteria and allow the Candida yeast to flourish. Citric acid is often found in canned tomatoes.
Alcohol is high in sugar that can feed the growth of the Candida. Alcohol also puts stress on your organs and immune system.
- Energy Drinks
- All Soft Drinks (regular and diet)
Notes: Caffeine, sugar and sweeteners all kickstart Candida. Taurine in energy drinks is another culprit. Even decaffeinated drinks should be avoided=, as they contain residual levels of caffeine.
- Anything made with wheat, rye, oats, or barley (e.g. shite bread, wheat bread, rye bread, pasta, tortillas, baked goods, cereals, etc.)
- Spelt products
Notes: Some Candida sufferers have high sensitivity to Glutens. Give your immune system a break and allow it to focus on the Candida.
- Nuts that are high in mold (e.g. peanuts or pistachios)
Notes: Ingesting mold can promote a Candida breakout. If you like nuts, stick to freshly cracked or whole ones.
Notes: Candida loves to feed on mold and fungi. Leftover food can contain mold that will feed your Candida. If you cannot buy fresh, keep leftovers frozen and then cook on a high heat in the oven, not microwave.
- Ketchup Mayonnaise
- Soy Sauce
- Salad Dressings
Notes: Condiments tend to be high in sugar and can exacerbate your Candid. For an alternative salad dressing, try Paul Bragg's Liquid Aminos, or a simple olive oil and lemon juice dressing.
- Artificial sweeteners
Notes: Read food labels to make sure your food does not contain sugar. Sweeteners like Aspartame, Saccharin, etc. can also make your Candida worse. A small amount of all natural Stevia and Xylitol is acceptable to have.
- All vinegars, except for Apple Cider Vinegar
- All products containing vinegar like pickles, green olives, etc.
Notes: Vinegar is made in a yeast culture; it depletes the stomach of acids and can also cause inflammation in your gut. One particular vinegar, unfiltered apple cider vinegar, can actually be helpful in combating yeast.
Fats and Oils
- Peanut oil
- Cottenseed oil
- Corn oil
- Canola oil
- Soy oil
Notes: Peanut, Cottonseed, corn and Canola oil are mold contaminated. Most soy beans used in soy oil are GMO (if you really like it that's OK, but make sure you buy organic).
Foods to Eat in the Stage 1 Candida Diet
- Chicpeas, Humus (watch added sugars and carbs)
- Coliard Greens
- Garlic (raw)
- Lettuce, any kind
- Olives, Black
- Onions, Yellow only (no sweet ones)
- Peppers, all kinds and colors
- Spaghetti Squash
- Summer Squash
- Swiss Chard
Noes: Vegetables starve the Candida of the sugar and mold diet that feed it. They also absorb fungal poisons and carry them out of your body. Avoid starchy vegetables such as carrots, sweet potatoes, potatoes, yams, parsnips, and all beans except green beans.
You should buy your vegetables fresh and eat them raw, steamed, or grilled. Add a little garlic and onions for flavor as they are especially helpful with Candida.
- Lemon Juice
- Lime Juice
- Ham, Bacon, and Beef Sticks are all okay as long as just meat, no sugars added.
Notes: Proteins almost completely free of sugars and mold, so they fill you up while restricting the Candida. Eat fresh and organic meat if possible. Processed meats are loaded with dextrose nitrates, sulphates, and sugars. Smoked or vacuum packed meats are also best avoided. Most Atkins recipes will also work reasonably well in the Candida Diet. Eggs should be boiled, poached, scrambled, or fired in olive oil.
Nuts and Seeds
- Nuts and seeds that do not contain high mold content
- Almonds (Almond Butter) are the best
Nuts are a high protein and high fiber food that starves Candida and restricts its growth. Avoid peanuts and pistachios as they tend to have a higher mold content. You can remove mold by soaking the nuts in water. Another tip to remove mold; spray the nuts with a diluted grapefruit seed extract solution.
Non-Glutinous Grains and Rice
- Wild Rice
- Brown Rice
- Wild Black Rice
- Oatmeal (slow cooked, no sugar added)
Notes: Grains contain high amount of fiber, excellent for keeping the color clear so Candida does not get a chance to multiply. Grains also act like a pipecleaner in you intestine, grabbing nasty toxins like pollutants, chemicals, pesticides, and heavy metals on their way through.
Hearbs and Spices
- Black Pepper
Notes: Contain antioxidants and anti-fungal properties. Increase circulation and reduce inflammation. Improve digestion and alleviate constipation. Most herbs and spices are beneficial in your fight against Candida. They are great for livening up food if you are on a limited Candida diet.
- Virgin Coconut Oil
- Olive Oil, extra-virgin
- Sesame Oil
- Pumpkin Seed Oil
- Macadamia Oil
- Almond Oil
- Flax Oil
- Coconut Oil
- Coconut butter
- Organic butter
Notes: Use cold pressed oils. Heating or boiling destroys many of the oil's nutrientsSeasoning
- Black Pepper
- Sea Salt
- Cinnamon Tea
- Clove Tea
- Chamomile Tea
- Pau D'arco Tea (available at Wayne & Mary's)
- Peppermint Tea
- Ginger Tea
- Licorice Tea
- Lemongrass Tea
- Green Tea
Notes: All of these herbal teas have anti-fungal properties. If you are missing your morning coffee try Green Tea instead.
- Rice milk and Rice cheese (located at HyVee is okay)
- Xylitol in small amounts for gum (located at Wayne & Mary's)
- Stevia, in small amounts
Notes: Stevia in all natural form and no additives or other artificial sweeteners or sugars and Xylitol are acceptable
What is yeast overgrowth or candidiasis?
Candida albicans is a yeast or fungus that is normally present on the skin and in the mouth, throat, intestines, and vagina. When the healthy bacteria in your intestines are thrown out of balance. such as when you take an antibiotic, this yeast can flourish and grow out of control. This creates a condition of yeast overgrowth, called candidiasis, and it can affect virtually any organ in the body. causing a myriad of negative health symptoms.
What are the symptoms of yeast overgrowth/yeast sensitivity?
The effects of yeast overgrowth are wide-ranging. Five abdominal symptoms commonly associated with yeast sensitivity are abdominal bloating, belching, excessive gas. abdominal cramps and indigestion. Yeast overgrowth can also cause abdominal pain, headaches. fatigue. skin rashes, immune suppression, chemical sensitivity, vaginal yeast infections, depression and joint pain. In the digestive tract, yeast can cause such symptoms as cramping, constipation, heartburn and diarrhea. Inability to concentrate, muscle aches, hives, fungal infections under fingernails and toenails, and athlete's foot can also be caused by yeast overgrowth - the list of yeast-related symptoms goes on and on. Yeast overgrowth can also cause thrush, a white coating on the tongue. Even worse, yeast produces toxins that depress your immune system. making you more reactive to allergies and more susceptible to infections. This often leads to more frequent use of antibiotics, the killing of additional good bacteria, and more yeast overgrowth. This vicious cycle is hard to break.
What causes yeast (Candida) sensitivity?
Yeast sensitivity is caused by an overgrowth of yeast, primarily in the colon, which is the large intestine. Although antibiotics are the worst culprit for causing yeast overgrowth, the use of birth control pills and steroids are also known to stimulate yeast overpopulation. Women who take repeated courses of antibiotics often develop vaginal yeast infections as healthy bacteria are destroyed and Candida proliferates. As yeast toxins are absorbed in the colon and enter the bloodstream, they cause symptoms beyond these sites.
What problems does yeast overgrowth cause in the body?
Yeast is in the same family as mold and fungus. Once yeast overgrows in the colon, it is like weeds in a garden. It cannot be eradicated unless it is killed. Yeast in the system causes two problems: I) it produces toxins which depress the immune system and make it more reactive to allergy, which leads to more infections and more antibiotics, the killing of more good bacteria, and a further increase in yeast levels; 2) an individual with increased levels of yeast in his system often becomes allergic to yeast. and therefore, allergic to food products which contain yeast, such as wine, beer, breads. etc. Once yeast is overgrown in the large intestine, there is an imbalance in the normal microbacterial flora of the colon so that we get less normal healthy bacteria and more yeast.
What is the function of "good bacteria" in our body?
As newborns, our large intestines are colonized by beneficial bacteria with tongue-twisting names like Lactobacillus acidophilus and Bifodobacteria bifidum. These bacteria, acquired from our mothers as we pass through the birth canal, perform a number of functions in our bodies. They manufacture B vitamins, aid in the digestion and absorption of food, and provide a barrier on the mucosa] lining of these various tissues, preventing abnormal bacteria and yeast from entering the system. Besides coexisting peacefully in the colon, beneficial bacteria also reside in the mucous membranes of the throat and in the vagina. These -good bacteria- live within us in a symbiotic, friendly relationship.
How do antibiotics affect yeast in the system?
Whenever an individual takes antibiotics, those antibiotics are meant to kill abnormal bacteria in whatever location the infection exists, whether the infections is sinusitis. pharyngitis, bronchitis or any other infection. Unfortunately, the antibiotics kill not only bad bacteria, but they also kill normal or good bacteria in other areas of the body. Women often will develop yeast vaginitis. Although yeast vaginitis may be treated, the primary reservoir for yeast is within the colon. When you take a course of antibiotics. populations of all bacteria plummet - not just the harmful ones that are the target of the drug, but also the beneficial ones that keep you healthy. At the same time, yeast populations increase because they are not harmed by the antibiotics that kill their normal bacterial competitors.
How do you test for yeast overgrowth?
A blood test can measure the levels of Candida antibodies. While high levels of antibodies are indicative of yeast overgrowth, some patients with a severely depressed immune system do not respond appropriately to Candida and instead show normal or even low levels of antibodies. For this reason, and because laboratory test provide only a snapshot of a patient's health status, we rely on the patient's history and symptoms to determine the likelihood and extent of a yeast problem. Each patient is asked questions relating to their history of infections and other illnesses, their diet, the symptoms they are experiencing, and their past and current use of antibiotics and other prescription drugs. Although antibiotics are the worst culprit behind yeast overgrowth, we also ask patients about their use of steroids and in females, their use of birth control pills and estrogen. These drugs are known to stimulate yeast growth.
How can I effectively treat for yeast?
In order to restore the normal microbacterial flora of the colon, or good bacteria, it is essential that you kill the yeast in your system. A strong antifungal such as Diflucan and Nystatin. that effectively kills the yeast, but does not harm the good bacteria in our digestive tract, can be used. After you eradicate the yeast, it is necessary that you replace and build up the good bacteria such as Lactobacillus acidophilus in your digestive system. There are natural things you can do to alleviate your uncomfortable gastrointestinal symptoms. A healthy yeast-free eating program can help to stop feeding the yeast in your gut. and probiotics will help restore the good bacteria so that you have a healthy intestinal system again. Digestive enzymes can help as well. Digestive enzymes are essential to your body's absorption of nutrients and the complete metabolism of food. The capacity of the body to make enzymes diminishes with age, therefore the efficiency of digestion declines.
What is the yeast-free diet?
A yeast-free, grain-free diet that eliminates dietary sources of yeast and other fungi, vinegar and fermented products. sugar and carbohydrate-rich foods that provide nourishment to yeast is recommended. Yeast grows on sugar, therefore when treating for yeast sensitivity, all sugars and carbohydrates are eliminated. This is known as Stage I of the diet and lasts 5 weeks, maybe even longer. The diet to follow is attached.
Eliminating sugar can be the most difficult part of the yeast-free diet, in part because so many foods contain added sugar. In addition to cane sugar and beet sugar. you will have to avoid honey, corn syrup, maple syrup, molasses, fruit sugar (fructose), milk sugar (lactose), and malt sugar (maltose), because yeast grows on sugar. Refined grains and starchy foods such as bread, pizza, pasta, cereal, potatoes, and rice are also eliminated because they can be quickly broken down into simple sugars. Once you have successfully killed off the yeast through the use of antifungal medications and the yeast-free, grain-free diet, you can introduce some of the foods back into your diet on a rotational basis; it is not to be eaten more frequently than every four days (once or twice a week). This is known as Stage 2.
Are food cravings related to yeast?
Yeast sensitive patients crave sugar and simple carbohydrates. such as breads, cakes, cookies, etc. The reason? Yeast grows on sugar and on any food that can quickly be broken down into sugar. Cravings for sugar are both the cause and consequence of yeast overgrowth and are a primary target of treatment.
What is yeast die-off?
Paradoxically, some patients begin to feel worse, not better, when they begin the anti-yeast program. Though this can be a disturbing experience, it is actually a sign that the treatment is working. These symptoms are the predictable result of yeast die-off, also called the Herxheimer reaction. When large numbers of yeast cells die in a short period of time, the body has a difficult time detoxifying them quickly. As a result, yeast toxins enter circulation and can cause symptoms in the mucous membranes that cover the surfaces of most organs in the body, including the mouth, esophagus, stomach, intestine, sexual and urinary organs, sinuses, ears, and bronchi. Each person's die-off reaction is different. In some patients. preexisting symptoms are exacerbated; in others, new symptoms appear. Symptoms can last anywhere from several days to two weeks. In some cases, reducing the dosage of Nystatin is appropriate to slow down the die-off process and lessen the symptoms. Following the y east-free, grain-free diet is critical to helping you weather this period.
Try to eliminate or limit the following:
- Irritants: Caffeine, Carbonation, Alcohol, Nicotine, Ibuprofen, Aleve, Asprin
- Acidic Foods: oranges, grapefruit, cranberries, pineapple, tomatoes, lemons, limes, and anything made from these
- High fat foods: anything deep fat fried, fatty cuts of meat, ice cream, whole milk, butter, some cheeses and some nuts
- Pepper group (for example: black pepper, chili powder, taco seasoning, Southwest, Southtex, Cajun, hot peppers, salsa, wings and tabasco sauce)
Elevate the head of the bed 4 inches. ( Put a 4x4 black of wood under wheels or headboard.)
Don’t eat or drink 2 hours before bed.
Manage stress by using stress relievers.
Take medications ad directed.
Prilosec, Prevacid, Protonix, Nexium all need to be 30 minutes before or 2 hours after food on an empty stomach. Do not take antacids within 4 hours of these medications.
Diabetic Reflux Diet
Find foods that have a carb to fiber ratio of 3:1 with no or very low sugar. Divide carbs by 3 and that is how many fiber grams you need.
Foods to avoid
- Instant rice or instant oatmeal
- Cereal (unless it has a crb to fiber ratio of 3:1)
- Pop(Diet or Regular)
- Fruit Juice
- Ice Cream
- Caffeinated or Decaf Beverages
- Acidic Fruits (Oranges, Lemons, Grapefruits)
- Tomato and Tomato Products
Foods to Limit - You should only eat 1.2 cup of 1 of the following per meal
- Bread (unless it has a carb to fiber ratio of 3:1)
- Pasta (unless it has a carb to fiber ratio of 3:1)
- White rice
- Orange Squash
- Ripe Sweet Fruits (the less ripe the better-green bananas, sour apples, sour grapes)
- Skim Milk - 1 cup per meal
Foods to Eat Freely
- Green Beans
- Brussel Sprouts
- Beans (hard beans such as pinto, lima, black, red, etc)
- Meat - lean cuts such as 90%-95% lean hamburger, pork, beef, chicken, (should be grilled or broiled, not fried) Do not bread it.
- Fish - grilled or broiled
- Eggs - 2 Whites to each yolk or egg substitute
- Sugar free sherbert