WP: Physicians Use Photos From Patients' Cell Phones to Guide Healthcare

The Washington Post on Aug 31, 2010, published an interesting story where emergency physicians at George Washington Medical Center enabled patients to take a picture of their wound on their cell phone and transmit it to the ER where a physician will take a look and come up with diagnosis and appropriately triage the patient.

In this study, they found that 90% of diagnosis made by this method came out accurate!

What many people may not realize is that some form of "online" consultation including pictures is already being used by physicians including our practice!

At least in our practice, for security purposes, a patient can email us WITH picture attachment using our online email form. This technically can be done via cell phone, but must occur via our website.

Our practice has received over 100 emails in the past 6 months since it was first offered, 25% of which contained picture attachments (typically CT or MRI images).

Read the Washington Post article here.

Check out our email submission form here.

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Nasal Surgery Helps With Snoring

Researchers have found that surgery to improve nasal breathing in setting of nasal obstruction, congestion, and/or resistance can also help with snoring.

Depending on the study, surgical relief of nasal obstruction improves snoring in a range from 35% to as high as 86%. Unfortunately, complete CURE (ie, no snoring whatsoever) is less likely occurring in <15% of patients. What are the possible nasal surgeries one can undergo to relieve nasal obstruction and potentially achieve snoring improvement? They include:

• Septoplasty
• Adenoidectomy
• Turbinate Reduction
• Sinus Surgery

Reference:
Nasal Surgery for Snoring in Patients With Obstructive Sleep Apnea Laryngoscope. 118:354-359, 2008.

Can Snoring Relief After Nasal Surgery be Predicted. Clin Otolaryngol 19:41-44, 1994

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12 Year Old Child Dies After Tonsillectomy

There was a recent report of a 12 year old child who died after a routine tonsillectomy in Florida on Aug 15, 2010. Details on the exact circumstances of what caused her death has not been released and autopsy is pending.

However, this story does illustrate that even though tonsillectomy is one of the most common surgery performed in the United States and is considered routine, NO surgery is without risk.

Medical literature places the mortality rate from tonsillectomy between one in 15,000 and one in 35,000 procedures (0.03% - 0.06%), mostly from anesthesia complications, airway loss, and blood loss. Keep in mind, about 600,000 tonsillectomies are performed in the United States per year... which means about 30 deaths occur per year from this surgery.

As such, tonsillectomy should ONLY be performed if they are truly causing a significant health problem such as obstructive sleep apnea or recurrent tonsillar infections and NOT just because "they are big."

Read the story here.

Read more about tonsillectomy surgery here.

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Book Chapters Authored By Dr. Chang Published On Open Access

Dr. Chris Chang has co-authored two book chapters in a hardcover textbook entitled "Laryngeal Diseases: Symptoms, Diagnosis and Treatments". The book chapters Dr. Chang has co-authored are NOW available for download via Open Access. Melissa Mainville, a voice therapist at Fauquier Hospital, also co-authored one of the book chapters (Chapter 1).

CHAPTER 1: Psychogenic Voice Disorders
by Grace W. Johnson, Carmen T. Gonzalez, Christopher Y. Chang, Sarah L. Maines, Melissa M. Mainville, Amy J. Asbury (Download Chapter Here)

and

CHAPTER 6: Age as a Factor in Responses to Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients
by Christopher Y. Chang, Peter Chabot, James P. Thomas, MD (Download Chapter Here)

This textbook can be purchased here.

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Allergies Associated with Heart Disease!

First weight gain and now heart disease. Allergies is certainly getting bad rap (though it has been associated with decreased risk of cancer).

Researchers in Philadelphia have found an association between allergies and heart disease when analyzing data from more than 8,600 adults aged 20 or older who participated in the National Health and Nutrition Examination Survey conducted between 1988 and 1994.

After adjusting for other related factors, such as age and asthma, there was a 2.6-fold increased risk of heart disease with wheezing and a 40 percent increased risk with rhinoconjunctivitis, compared to no allergies.

Researchers suggested that the intermittent inflammation that comes with allergies may lead to the thickening of artery walls with subsequent development of heart disease. It could also be that some people simply carry genes that are linked to the development of both allergies and heart disease.

Clearly more research is needed to clarify this relationship.

Reference:
Relation Between Common Allergic Symptoms and Coronary Heart Disease Among NHANES III Participants Am J Cardiology Received 19 March 2010; accepted 20 May 2010. published online 13 August 2010.

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Antihistamines Associated With Weight Gain!

Yale researchers have found an association between obesity and antihistamine use based on data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES). In the study, adults taking prescription H1 antihistamines were matched by age and gender with controls and compared on the basis of body measurements, plasma glucose, insulin concentrations, and lipid levels.

What does tbis mean? It means that there is an association and not necessarily a cause-and-effect between weight gain and antihistamine use. In order to truly determine whether antihistamines actually CAUSES weight gain, prospective studies need to be obtained.

It may be that antihistamines does not cause obesity, but that obesity may lead to increased risk of allergies which makes people take more antihistamines.

OR... perhaps there is a 3rd unknown factor that causes both problems?

It's not clear right now and more studies are required to clarify this finding...

Reference:
Association of Prescription H1 Antihistamine Use With Obesity: Results From the National Health and Nutrition Examination Survey Obesity (2010) doi:10.1038/oby.2010.176

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Having Allergies Reduce Risk of Cancer!

Well maybe... According to a May 2010 study where questionnaire-based interviews were performed and encompassed self-reported history of prior medical diagnosis of asthma and eczema, medication use, and several covariates among 3,300 cancer cases and 512 population controls, a history of asthma was negatively associated with all cancer types combined (OR, 0.72; 95% CI, 0.5-1.1) and similarly for a history of eczema (OR, 0.66; 95% CI, 0.4-1.1).

Why would this happen? Well, allergies is due to a hyperreactive immune system that may lead to a more efficient elimination of abnormal cells, thus lowering cancer risks.

More study is needed to verify if this correlation truly exists.

What I would like to see is 3 groups (allergic group treated with meds only, allergic group on immunotherapy, and control group) followed out.

Reference:
History of asthma or eczema and cancer risk among men: a population-based case-control study in Montreal, Quebec, Canada. Ann Allergy Asthma Immunol. 2010 May;104(5):378-84.

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Got Allergies? Maybe It's Actually Non-Allergic Rhinitis

USA Today published a story on Aug 22, 2010 describing a condition called "Non-Allergic Rhinitis" or "Vasomotor Rhinitis" which essentially is having pretty much all the symptoms of classic nasal allergies, but caused NOT by allergies!

Such symptoms include:

- Runny nose
- Nasal congestion
- Post-nasal drainage
- Nasal obstruction
- Sinus pressure
- Sneezing
etc

These individuals also report that their nasal symptoms are triggered not only by pollen and dust, but also perfumes, strong odors, cigarette smoke, chemicals, cold air, high wind, humidity, and certain foods, especially spicy ones.

The way I try to explain this condition from those suffering from it is to consider their nasal lining to be hypersensitive... so hypersensitive that things which ordinarily shouldn't cause any problems, do.

The best way to address this condition is by avoiding known triggers and keeping the nose clean by regular saline washes. The saline washes are quite important in that they clean out the substances which are irritating the nose (much like washing your skin reduces the irritation if you get poison ivy).

Some patients may benefit from medications like anti-histamine and steroid nasal sprays, but such medications do not work as well as for those suffering from classic nasal allergies.

Barrier type of medications like ponaris may also be helpful. Such medications work by creating an oily barrier such that the irritating substances don't actually touch the lining itself when breathed in (much like chapstick on lips).

Some patients with non-allergic rhinitis and large turbinates may benefit from a surgical procedure called turbinate reduction, but rarely cure the problem. At best, there is perhaps a 50% reduction in symptoms.

One should also be aware that you can have BOTH allergic and non-allergic rhinitis.

Read the USA Today article here.

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Practice Website Search Engine Optimized (We Have 900+ Webpages in our Website Now!!!)

It is hard to believe, but our practice now maintains close to 900+ webpages and organizing such a voluminous amount of information is not easily accomplished if weren't for Google.

We have optimized our Google site search engine to allow patients as well as ordinary surfers to efficiently and accurately look for information throughout our website.

On most webpages, there will be a search box link like this on the top left hand corner:

Search Site

Click here to check it out!

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Text Messaging to Find Out Wait Times for Medical Services?

I came across this interesting service offered by a Massachusetts hospital whereby patients can text message the hospital and get an immediate text message back with what the current wait times are in the Emergency Room. (Here's a news article describing the service.)

Which got me thinking... how can text messaging (in general) be used to allow communication between a patient and medical services overall. This would save time and money (frees up a secretary who would otherwise be fielding phone calls) and improve patient satisfaction.

For example... how can it be used to inform patients with wait times in a medical office like ours?

I can think of 2 ways going about establishing this:

1) Purchase a new cell phone and advertise the number for patients to text message inquiries. Of course, I would have to foot the bill of the cell phone as well as subscription plan... as well as dedicate a staff member to reply to all incoming messages.

2) Obtain my very own text messaging short code (ie, 303303) and keyword (ie, WAITTIME) and replies would automatically specify wait times. Of course, I would have to purchase my own short code from CSCA (administration that offers the short code) which can run anywhere from $1000/month for a custom short code to $500/month for a random one. I would also have to dedicate a staff member to keep the wait times up-to-date. However, with this service, I would be able to charge a certain amount per text request and potentially recoup the cost of the service.

In the end... not sure if such a service will ever be offered in a small medical practice like ours, but certainly worth considering in larger health organizations.

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Should Boys Also Get Vaccinated for HPV?

NPR on Aug 20, 2010 aired a story whether boys should also get vaccinated for HPV. It is well established that vaccines like Gardasil (FDA approved for boys last year) and Cervarix protect against two of the HPV types (HPV-16 and HPV-18) that can cause cervical cancer and some other genital cancers including anal, vulvar, vaginal, and penile cancers.

However, it may potentially prevent other types of HPV related disorders (NOT mentioned in the NPR story) involving the head & neck in both men and women, including:

Respiratory Papillomas (benign)
Throat Cancer
Oral Cancer (tongue, tonsil, salivary gland)
Oral ulcers/lesions/warts (benign)

According to epidemiological studies, there has been a dramatic increase in cancer involving the salivary glands and tongue attributed to HPV and were of squamous, acinar, and mucoepidermoid morphologic types. This increase in oral cavity cancer has occurred mainly in the 10-40 years age group and suspected to be secondary to increased acceptance of oral-genital sexual practices.

What is my personal feeling on whether boys should get vaccinated? I believe the answer is yes.

In order to receive the beneficial effect of the vaccine, the vaccine needs to be given in 3 doses (at $130 per dose) ideally between ages 9-26.

Read the NPR article here.

References:
Cancer of the oral cavity and pharynx in young females: increasing incidence, role of human papilloma virus, and lack of survival improvement. Semin Oncol. 36 (5), 451-9.

Prevention of human papillomavirus infections and associated diseases by vaccination: a new hope for global public health. Public Health Genomics. 12 (5-6), 319-30.

The epidemiology behind the HPV vaccine discovery. Ann Epidemiol. 19 (4), 239-44.

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ABC: Boy With Ondine's Curse Must Think to Breathe

ABC news carried a story about a young boy named Liam Derbyshire who has an extremely rare sleeping disorder called Ondine's Curse. The medical name is Central Hypoventilation Syndrome (CCHS).

As those familiar with folklore know, Ondine's curse is after a mortal who fell in love with a German nymph. He swears that his daily breath is a testimony to her love. But when the man is unfaithful, the king punishes him by making him remember all his bodily functions INCLUDING breathing. When the mortal falls asleep he forgets to breathe and dies.

In this real story, the boy most consciously remember to breath ever breath in and out. If he forgets to do so, he literally stops breathing.

For those scientists, this disorder is due to a mutation in the PHOX2B gene.

Read the ABC story here.

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Allergy to Cats, Dogs, or Dust Make Allergy to All Else More Severe

New research published in this month's Annals of Allergy, Asthma & Immunology reported that patients with allergy to cat, dog, and/or dust mite resulted in increased allergy symptom severity to other allergies like ragweed.

In other words, if you have a cat allergy and also allergic to ragweed, the cat will actually make your allergy to ragweed even worse than if you did not have a cat (or have a cat allergy).

These year-round allergies appear to “pre-prime” the immune system so symptoms hit harder, earlier, and faster.

So what can you do if this problem applies to you? Treat the cat, dog or dust mite allergy year round (or get rid of the cat/dog)!

Read a news article on this here.

Reference:
Factors that affect the allergic rhinitis response to ragweed allergen exposure. Ann Allergy Asthma Immunol. 2010 Apr;104(4):293-8.

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Wierdest Nose in the World!

A reader informed me of this interesting video by National Geographics on an animal called the "Star-Nosed Mole".

There are 22 tentacles that make up the nose and it "smells" as well as "sees" by touch (pretty important given the mole is blind). The nose provides information about its surroundings in 25 milliseconds and it moves at lightspeed! Check out the video!

Pretty amazing!

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Fauquier Hyperbaric Oxygen Chamber

On June 9, 2009, Fauquier Hospital opened a wound center that included two hyperbaric oxygen chambers. Hyperbaric oxygen, also known as HBO, has a long and close-knit history with ENT.

What hyperbaric oxygen treatment does, in a nutshell, is provide higher concentrations of oxygen to the bloodstream which allows for faster healing of chronic wounds as well as treatment of carbon monoxide poisoning and "the bends" when SCUBA diving.

The higher concentrations of oxygen is achieved by increasing the surrounding pressure of the patient with higher oxygen concentrations... it is simply not good enough to provide oxygen... it needs to be administered at elevated pressures too.

In order to achieve elevated pressures, the patient needs to be completely enclosed inside an airtight chamber while they "pump" oxygen in. Here's a couple views of the HBO chamber used in the Fauquier Wound Center. And yes... that's a TV on top... a single treatment lasts a few hours!

As the pressure increases, the patient needs to "pop" their ears constantly, much like if you were flying up in an airplane or diving into deep water.

If a patient is unable to pop their ears easily, ENT can surgically place ear tubes so that the patient doesn't have to pop their ears... the tubes pop the ears for the patient automatically!

It is not unusual that I get "urgent" same-day consults for barotrauma sustained during a HBO dive. Ear tubes get placed and the patient is able to immediately resume HBO treatments without delay!

Check out the Fauquier Wound Center here.

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Fauquier Hospital VIPeds Medical Camp Program on Channel 9 News

It was quite cool to see Fauquier Hospital's innovative VIPeds Medical Camp program featured on Channel 9 news. This unique hands-on program is for teenagers to learn more about the health profession and opportunities found inside a hospital.

Local teens learn to apply a cast, to harvest a cornea (I personally have no idea how to do that!), to suturing a wound closed. No ENT related procedures however...

Check out the video segment here.

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Dr. Chang Invited to Be a Judge for the 2010 Web Health Awards

Dr. Chang has been invited to be a judge for the Summer 2010 Web Health Awards. Now in its 12th year, the goal of the Web Health Awards is to recognize high-quality electronic health information. The awards program is organized by the Health Information Resource Center (HIRC), a national clearinghouse for professionals who work in consumer health fields.

Read more about the Web Health Awards here.

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Vitamin D May Treat Or Prevent Allergies!

Vitamin D is being blamed for a great many deal of human illnesses including rickets, depression, chronic fatigue, chronic pain, autoimmune disease, certain cancers, osteoporosis, heart disease, etc.

We might as well add allergies to the list...

Researchers have found that vitamin D may be an effective therapeutic agent to treat or prevent allergies! Low vitamin D levels was found to heighten Th2 reactivity which drives allergy response.

The evidence is compelling enough that it would not hurt to take Vitamin D3 2000 units daily if you have bad allergies!

References:
Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol. 2010 Jul;126(1):52-8.e5. Epub 2010 Jun 9.

Vitamin D in atopic dermatitis, asthma and allergic diseases. Immunol Allergy Clin North Am. 2010 Aug;30(3):397-409.

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Hearing Loss on the Rise in US Teenagers

JAMA published research showing a rise in hearing loss among US teenagers from 15% between 1988-1994 (2928 teens) to 20% from 2005-2006 (1771 teens). The study was a cross-sectional analyses of US representative demographic and audiometric data.

No one quite knows exactly why this has happened... but my guess is the increasing prevalence of portable music players where loud music can cause hearing damage.

Read a story on this in Reuters here.

Reference:
Change in Prevalence of Hearing Loss in US Adolescents. JAMA. 2010;304(7):772-778. doi:10.1001/jama.2010.1124

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Cell Phones Causes Brain Tumor (Acoustic Neuroma)

In 2004, there was a Swedish study published in the International Journal of Epidemiology where researchers found that the risk of developing a benign brain tumor called an acoustic neuroma was almost double for those who started to use phones before their diagnosis. In addition, the tumor risk was almost four times higher on the side of the head where the phone was held.

An acoustic neuroma is a benign tumor that causes symptoms or ringing of the ears (tinnitus) as well as hearing loss.

Of note, all 750 test subjects had been using cell phones for at least 10 years, nearly all using the early analog models that emit more electromagnetic radiation than the digital models now on the market.

Read a CBS news report on this here.

Reference:
Mobile phone use and the risk of acoustic neuroma. Epidemiology. 2004 Nov;15(6):653-9.

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SFChronicle: Say goodnight to snoring with simple surgeries (or not?)

San Francisco Chronicle on Aug 16, 2010 published a story entitled "Say goodnight to snoring with simple surgeries."

Although the article is pretty balanced, especially when discussing how various factors lead to a person's snore, I do feel the success rates mentioned in the article of 80-95% may be overly optimistic when talking about all patients. Such success rates are certainly possible in a select patient population with the appropriate anatomy. Furthermore, the story states that these procedures are not covered by insurance. That's incorrect. At least with turbinate reduction, it IS covered by insurance. Pillar procedure is covered by SOME insurances.

In any case, the Pillar Procedure, as discussed in the article, is performed by placing rods of polyester into the soft palate to make it stiffer and less prone to vibration. Turbinate Reduction is performed by shrinking the inferior turbinates located inside the nose allowing for greater nasal airflow.

Though each procedure DOES help with snoring, there unfortunately are numerous other factors (as mentioned in the article) that can cause a snore including vibration of the throat as well as tongue against the back wall which would not be addressed by these procedures.

A better way to phrase the success rate with these procedures is "80-95% of carefully selected patients find that these procedures help improve snoring. Some may even be cured."

Read the story here.

Read more about snoring here.

Read more about turbinate reduction here.

Some research articles regarding nasal surgery helping with snoring can be found here.

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Cause of Nickle Allergy Determined

There are millions of people who are allergic to nickle which causes itching, burning, and redness upon contact with skin. It's the reason why people have skin reactions when wearing cheap jewelry as well as cell phones.

The cause of such dermatitis was a mystery until recently when scientists in Germany have discovered the underlying mechanism of this reaction. Using mice, they figured out that nickel binds to a protein called toll-like receptor 4 or TLR4, which signals the immune system to initiate an inflammatory response.

Treatment of nickle allergy can be theoretically be made by creating a blocker to his protein.

Reference:
Crucial role for human Toll-like receptor 4 in the development of contact allergy to nickel. Nat Immunol. 2010 Aug 15. [Epub ahead of print]

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Actor Michael Douglas Has Throat Cancer

Though details were initially sparse, People Magazine was the first to report on Aug 16, 2010 that actor Michael Douglas was found to have throat cancer.

He will undergo radiation and chemotherapy for 8 weeks.

In a later report, it is now known Mr. Douglas has stage 4 base of tongue cancer (which is considered "late" stage).

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MRSA-Killing Paint Created

Scientists at Rensselaer Polytechnic Institute has developed a high tech paint that safely kills MRSA. This special paint was developed for use on surgical equipment, hospital walls, and other surfaces. When MRSA touches this special coating, it dies preventing the main way this germ travels from one person to another (which is by contact). 100 percent of MRSA in contact with this special paint were killed within 20 minutes.

The paint contains a naturally occurring enzyme called lysostaphin contained within carbon nanotubes. This compound can be mixed into ordinary house paint before application.

Unlike other antimicrobial coatings, it is toxic only to MRSA, does not rely on antibiotics, and does not leach chemicals into the environment or become clogged over time. It can be washed repeatedly without losing effectiveness and has a dry storage shelf life of up to six months.

Reference:
Antistaphylococcal nanocomposite films based on enzyme-nanotube conjugates. ACS Nano. 2010 Jul 27;4(7):3993-4000.

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Intra-Nasal Cooling System Effectively Chills Brain After Cardiac Arrest

In a study in this month's Circulation, a new nasopharyngeal device was used to initiate cerebral cooling during cardiac arrest. This device, called RhinoChill made by BeneChill cools the major vascular structures of the brain thereby improving neurological outcome.

Use of this device was found to increase survival over CPR alone by 27% and a 26% increase in neurologically intact survival.

Reference:
Intra-Arrest Transnasal Evaporative Cooling. A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Published Online on August 2, 2010.

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Two Book Chapters By Dr. Chris Chang Soon To Be Published!

Dr. Chris Chang has co-authored two book chapters in a soon to be published hardcover textbook entitled "Laryngeal Diseases: Symptoms, Diagnosis and Treatments". The book chapters Dr. Chang has co-authored are entitled:

Psychogenic Voice Disorders
by Grace W. Johnson, Carmen T. Gonzalez, Christopher Y. Chang, Sarah L. Maines, Melissa M. Mainville, Amy J. Asbury

and

Age as a Factor in Responses to Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients
by Christopher Y. Chang, Peter Chabot, James P. Thomas, MD

This textbook is currently at press and anticipated to be released for purchase before the end of 2010. You can purchase it here.

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Dr. Oz Does Nosebleeds (With Some Errors)

A reader informed me that Dr. Oz did a TV show recently on nosebleeds... I took a look at the video clip and it is my opinion that some information Dr. Oz conveyed is not entirely correct. Again, I should stress that this is just my opinion and I'm sure there will be many who may feel differently.

Error #1:
Contrary to what was said on the show, ice packs do NOT help with nosebleeds significantly. Though it makes sense that cold constricts the blood vessels... it does so only at the level of the skin surface and not so much inside the nose where the bleeding is occurring. If it does, it is only to a marginal degree.

Error #2:
Contrary to Dr. Oz's statement... pushing under the upper lip does not help much to stop nosebleeds. Dr. Oz IS correct in stating that blood vessels that contribute to nosebleeds are squeezed shut by this maneuver, but unfortunately, there are several other blood vessels that still supply blood for the nosebleed. The most common location for responsible for over 90% of nosebleeds is in the anterior septum in an area called Kiesselbach's plexus. This plexus is supplied by several blood vessels including:

• anterior ethmoid artery
• great palatine artery
• sphenopalatine artery
• superior labial artery

Only the last artery (superior labial artery) is squeezed shut by pressing under the upper lip. The other three arteries are still pumping away.

Error #3:
Glycerin based liquid applied to the outside of the nose does not do much good either... That's like saying placing chapstick on your chin will helped with healing chapped lips. The application needs to occur directly in the region of the nosebleed. Personally, I'm not a fan physical application of any type of ointment into the nose whether by finger or q-tip. Rather, I recommend use of nasal sprays or nasal drops to get the medication into the nose. My personal favorite is ponaris nasal drops.

So that's my two cents... So what did Dr. Oz get right?

• DO squeeze the fleshy part of your nose together (not on the bone). This applies direct pressure on the most common location of nosebleeds. Pressure is key, just like a stabbing victim has rescuers putting direct pressure where the bleeding is coming from.
• DO lean slightly forward to prevent blood from draining down into the throat where one may swallow the blood which would result in nausea and potentially vomiting.

Read more about nosebleeds here.

Watch Dr. Oz's show on nosebleeds here.

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Disfigured Teen on Cover of Time Magazine To Receive Reconstructive Surgery in US

As reported on MSNBC on August 6, 2010, the Afghan teen on the cover of Time Magazine (Aug 9, 2010) will receive reconstructive surgery to repair the disfigurement of her face. The surgery will be done by Dr. Peter Grossman, a plastic surgeon.

For those who don't know, the teen's nose was cut off as punishment from running away from her abusive husband.

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Fauquier Hospital Medical Directory WebApp Created

A new mobile phone WebApp has been created specifically for cell phones called "Fauquier Med". It provides a listing of all the physicians on staff at Fauquier Hospital broken down by last name, specialty, and practice group. Commonly used hospital numbers are also listed.

The WebApp was created specifically for the iPhone, though other mobile smartphone users (Blackberry and Google Android) should also be able to use without difficulty.

Directions to add to at least your iPhone is shown below. Hope patients and physicians find this useful!

Step 1: Open Safari.
Step 2: Type in the Address Bar: www.FauquierHealth.mobi The WebApp will now load up.
Step 3: The WebApp will now load up. Click on the “+” sign on the bottom.
Step 4: Click on the button “Add to Home Screen”
Step 5: Click on the “Add” button.
Step 6: You now have the WebApp on your application screen!

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Our Practice Now Has a QuickMark Barcode!

Not sure what to do with it however at the moment, but given I am starting to see it plastered in more places, newspapers, magazines, etc, I thought I better jump on the bandwagon as well.

For those not familiar with QuickMark, it is the new 2 dimensional barcodes in the shape of a square meant for mobile phone deciphering. iPhone has a couple apps to decipher using the camera.

The barcode you see to the left is one for our practice... Try it out! There is a more sophisticated QuickMark call DataMatrix which I also created shown below.

You can get your own QuickMark here.

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H. Pylori Infection Can Cause Urticaria and Angioedema!

Thanks to a recent blog post by medical blogger, Dr. Ves Dimov, I was made aware of how H. Pylori (Helicobacter pylori) infection of the stomach can cause chronic (idiopathic) urticaria as well as angioedema and that eradication of H. Pylori thru antibiotics and acid suppression can significantly improve the problem!

For those who do not know what H. pylori is... It is a germ that is the most important cause of gastritis and peptic ulcer disease. It can be diagnosed by measurement of H. pylori-specific (IgA and IgG) antibodies, urea breath test, or upper endoscopy. And... this germ is now becoming implicated in causing problems beyond the digestive system like angioedema and urticaria.

In one study, 88% of infected patients in whom the bacterium was eradicated after therapy showed a total or partial remission of urticaria symptoms. Symptoms remained unchanged in all uninfected patients.

Another study documented the disappearance (67%) or improvement of urticaria (24%) in most antimicrobially treated patients after 3-12 weeks.

Triple therapy is considered to be the standard treatment for children and adults. A proton pump inhibitor combined with two antibiotics has been shown to be very effective in clearing H pylori from the stomach. The current recommendation is treatment with amoxicillin, clarithromycin, and a proton pump inhibitor (Prevpac) for 2 weeks. Triple therapy regimens that are effective in children include a proton pump inhibitor combined with clarithromycin and metronidazole or amoxicillin and metronidazole.

References:
Beneficial effects of Helicobacter pylori eradication on idiopathic chronic urticaria. Dig Dis Sci 1998 Jun;43(6):1226-9.
Prevalence of Helicobacter pylori-associated gastritis in chronic urticaria. Int Arch Allergy Immunol 1998 Aug;116(4):288-94.

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UK First Place in the World to Approve Botox for Migraine Headaches

Wall Street Journal reported on July 9, 2010 that the United Kingdom has become the first country in the world to approve botox injections for migraine headaches.

The U.K. approval could shortly precede a decision on migraine treatment from the U.S. Food and Drug Administration.

Botox treatment for migraines can be obtained currently in the US, but is rarely covered by insurance.

Dr. Chang has been performing botox injections for migraines since 2006.

Read the WSJ article here.

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Botox Bandits Rip Off Physicians

MSNBC reported on Aug 2, 2010 that there are patients who come and undergo thousands of dollars worth of botox injections and than skip out without paying...

Read the story here.

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FDA Potentially to Approve Botox for Migraines

As reported in MSNBC today, FDA regulators seem inclined to approve Allergan Inc's wrinkle drug Botox to prevent migraine headaches in millions of Americans, industry analysts said, based on information the drugmaker released on Monday.

That would be great news for current patients of mine who receive botox for migraines. However, once FDA has approved botox for migraines, it may take awhile before it becomes an insurance "covered" procedure.

Read the MSNBC article here.

Read more about botox here.

Dr. Chang provides botox injections for migraine headaches, TMJ, spasmodic dysphonia, torticollis, and other head and neck spastic disorders.

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Fauquier ENT Now on LinkedIn Networking Site

Fauquier ENT now has a LinkedIN profile. Check out the profile here.

LinkedIn is a business oriented social networking site.

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