Tall Women (Over 5'1") Have Higher Risk of Cancer!

Female models may be tall and beautiful, but they are also at markedly increased risk of developing cancer. The New York Times reported on a fascinating research article regarding height of a women and risk of cancer.

Specifically, for every four-inch increase in height over 5 feet 1 inch, the risk that a woman would develop cancer increased by about 16 percent, especially for:

• Colon Cancer (RR per 10 cm increase in height 1.25, 95% CI 1.19—1.30)
• Rectal Cancer (1.14, 1.07—1.22)
• Malignant Melanoma (1.32, 1.24—1.40)
• Breast Cancer (1.17, 1.15—1.19)
• Endometrial Cancer (1.19, 1.13—1.24)
• Ovarian Cancer (1.17, 1.11—1.23)
• Kidney Cancer (1.29, 1.19—1.41)
• Brain/Spine Cancer (1.20, 1.12—1.29)
• Non-Hodgkin's Lymphoma (1.21, 1.14—1.29)
• Leukaemia (1.26, 1.15—1.38)

It is hypothesized that the levels of growth hormone responsible for human height might also be involved in cancer development or because taller people are at greater risk for mutations simply because their bodies are comprised of more cells.

The increased cancer risk was found to be also true across Asia, Europe, Australia, and North America populations.

Perhaps now there's a reason why the average female is 5 feet, 3.8 inches tall! It's a balance between social preferences for being tall versus negative biological consequences for being tall.

The good news here (if there's any) is that head and neck cancer does not increase with height.

Read the NYT article here.

Read the research abstract here.

Reference:
Height and cancer incidence in the Million Women Study: prospective cohort, and meta-analysis of prospective studies of height and total cancer risk. The Lancet Oncology, Volume 12, Issue 8, Pages 785 - 794, August 2011 doi:10.1016/S1470-2045(11)70154-1

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Tonsillectomy Airway Fire

ABC News reported in 2008 about a California family suing doctors as well as Conmed, an electro-surgical instrument company, for an airway fire that occurred on April 18, 2003 on an 8 years old child during a routine tonsillectomy surgery.

Apparently, an electrocautery device was being used to remove the tonsils when the endotracheal tube caught fire resulting in burns to the child's mouth and airway (no death). It is suspected that the electrocautery device during the surgery either burned a hole into the endotracheal tube where it encountered oxygen resulting in the fire or there was a leak around the endotracheal tube which caught fire. The jury found the surgeon to be negligent, but returned a defense verdict for the device manufacturer Conmed. The other defendants settled.

Use of electrocautery is still popular among ENT surgeons removing tonsils, but has been abandoned by an increasing number of surgeons (including our practice) over the past few years due to risk of airway fire as well as concern for unnecessary thermal injury to surrounding normal peritonsillar tissues. Electrocautery produces temperatures between 400 to 600 degrees Centigrade which both cuts and stops bleeding simultaneously. However, as can be seen in this unfortunate case, it can also burn through an endotracheal tube and cause an airway fire.

Airway fire is another reason why laser tonsillectomy is rarely performed as the risk is the same if not greater than electrocauterization.

Our office uses coblation technology to remove tonsils. Coblation uses a radiofrequency plasma field to cut and stop bleeding simultaneously at near room temperatures thereby avoiding risk of airway fire as well as thermal injury to surrounding oral tissues.

Of note, there are about 500 cases of operating room fires related to use of electrosurgical instruments every year of which 20-30 causes serious injuries.

Read the ABC News report here.

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World's Largest Tonsils Set in Guinness Book of World Records

It's official...

The world's largest tonsils was recently set by a Kansas man who had them removed by tonsillectomy. They measured  in at 2.1 inches long and 1.1 inches wide, thoroughly beating the competition.

Read the story on ABC news here.

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Novel Treatment for Non-Allergic Rhinits

Non-allergic rhinitis is an extremely frustrating sino-nasal disorder that is characterized by all the same symptoms of sinusitis and allergies, but NOT due to sinusitis or allergies. Rather, I consider non-allergic rhinitis to be the over-sensitive nose syndrome whereby breathing in air containing particulates (whether smoke, perfume, dust, pollen, etc) PHYSICALLY irritates the nose causing symptoms.

This is in contrast to allergies where the pollen causes an immunologic reaction causing symptoms or sinusitis which is due to an infection.

Non-allergic rhinitis is diagnosed by a negative allergy test (meaning symptoms are not due to allergies) and normal CT sinus scan (meaning symptoms are not due to a sinus infection).

Usually, treatment encompasses avoiding triggers (ie, perfume, smoke, dust, etc), applying a barrier nasal emollient (ie, ponaris), anti-histamine nasal spray (ie, astelin, astepro, patanase), and nasal hygiene using saline flushes which washes away the irritants causing symptoms.

Well, a new study published this month have shown another mode of treatment is quite helpful... ICX72, a proprietary homeopathic preparation of Capsicum annum and Eucalyptol, otherwise known as Sinus Buster!

When used twice daily over two weeks, symptoms were found to be significantly improved when compared to placebo. Furthermore, sinus buster alleviates symptoms attributable to non-allergic rhinitis within 52.6 seconds on average.

Past studies have shown improvement using Sinus Buster, but this is the first controlled study demonstrating efficacy.

Of note, unlike nasal decongestant sprays like Afrin which can result in addiction over time (rhinitis medicamentosa), there does not appear to be any addictive component with this nasal spray.

Read the study abstract here.

Read more about this condition here.



Reference:
A randomized, double-blind, parallel trial comparing capsaicin nasal spray with placebo in subjects with a significant component of nonallergic rhinitis. Annals of Allergy, Asthma & Immunology. Volume 107, Issue 2, Pages 171-178 (August 2011)

Intranasal Capsicum spray in idiopathic rhinitis: a randomized prospective application regimen trial. Acta Otolaryngol. 2009 Apr;129(4):367-71.

Intranasal capsaicin reduces nasal hyperreactivity in idiopathic rhinitis: a double-blind randomized application regimen study. Allergy. 2003 Aug;58(8):754-61.

The long-term effects of capsaicin aqueous spray on the nasal mucosa. Clin Exp Allergy. 1998 Nov;28(11):1351-8.

Beneficial effects of intranasal applications of capsaicin in patients with vasomotor rhinitis. Eur Arch Otorhinolaryngol. 1991;248(4):191-4.

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2 Years Old Child Dies After Tonsillectomy

In Wichita, Kansas, jury has begun deliberation regarding the death of a 2 years old boy in 2006 the day after tonsillectomy surgery. Read the story here.

Based on the limited information provided, the relevant facts I have gleaned from the story are as follows:

• Child was appropriately admitted to the hospital after surgery
• There is some question regarding what was going on with his oxygen levels and other vital signs during hospitalization
• Autopsy revealed pneumonia confined to a small part of one lung
• Hydrocodone was prescribed for pain
• Lack of accurate communication between nursing and the surgeon
• Unclear patient/family factors
• Child had history of breathing problems (probably asthma)

Overall, it seems that this child's death was the result of many errors that piled upon each other. Any single error certainly wouldn't have resulted in death.

Reading between the lines, I conjecture the following might have occurred, giving as much benefit of the doubt to all parties involved, though I may be totally wrong:

1) Tonsillectomy surgery was uneventful and routine.
2) During extubation, coughing may have occurred with some aspiration of secretions (extubation... cough, cough, cough... strong inhalation with secretions resulting in aspiration)
3) Child was admitted after surgery due to age.
4) Child was overly sedated with hydrocodone and as such, not able to easily cough up secretions. Rather, probably slept more often than not.
5) Vital signs were probably on the low normal side. If truly abnormal, something should have been done immediately (nebulizer treatments, a chest x-ray, etc).
6) Lungs were listened to and potentially clear on auscultation given pneumonia was localized to only a small part of one lung. This exam was probably performed only once or twice. Given the child was sleeping, nursing may have decided (family may also have requested) that he be left alone so he can sleep rather than be disturbed and examined which would have caused him to start crying.
7) Patient was recommended for discharge the next day based on available information.
8) At home, child still overly sedated given hydrocodone administration by parents to treat pain resulting in inadequate lung ventilation thereby not allowing for aspirated secretions to be coughed up and out.
9) Death

A few areas of concern on my part...

It is possible in the parent's misguided resolve to ensure their child will not be in pain, that they may have given hydrocodone even if the child was not complaining of pain. It would be important to know what his hydrocodone narcotic level was in his bloodstream. In any event, this only reiterates that hydrocodone should not have been prescribed in a child this age. Rather plain tylenol or at most tylenol with codiene would have been more appropriate and certainly less sedating.

The story also reported the child had a history of breathing problems, most likely asthma. This fact just exacerbated the overall situation. In a healthy child, the lungs would have been much hardier and less prone to compromise.

Second, a pneumonia that has been present for many days is unlikely if localized to only a small part of one lung (one would expect a large area to be affected). Furthermore, if the pneumonia was as severe as they say BEFORE surgery, high fevers would have been present in which case, surgery would have been cancelled regardless of cause due to concern for febrile seizures induced by anesthesia.

In summary, what likely happened was an unrecognized aspiration event in a child with a history of asthma followed by over-sedation with narcotics which led to this unfortunate demise.

But... that's just my guess based on incomplete information.

Read the story here.

ADDENDUM 7/30/11: Jury ruled in favor of the defendants absolving of any malpractice in this case. Of note, a comment about the case by one of the jurors stated "I was one of the jurors on this case, and it was very hard to come up with a verdict. The reality of the situation is that there was not an acceptable cause of death and there was not enough evidence proving that Wesley and Dr. Kubina more likely than not caused the death."

Read more here

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Can a Deviated Septum Cause Facial Pain?

Yes...

There is a phenomenon caused Sluder's Neuralgia whereby a patient may suffer fairly severe pain over the cheek and around the eye due to a severe deviated septum... not just any deviated septum, but a sub-type called a septal spur.

As an introduction, a nasal septum is a wall that divides the nasal cavity down the middle. This nasal wall is much larger than people realize... perhaps a little bigger than a large man's watch.

In some individuals, the septum (purple arrow) may be deviated to one side causing narrowing resulting in symptoms of nasal obstruction.

In a further subset of individuals, the septum may be even more deviated with a "spur" digging into the side of the nasal cavity as shown by the black arrowhead below.

In this scenario, the patient will feel pain in the cheek and eye region on the same side as the septal spur. If nasal swelling occurs, the pain will become more severe. Such swelling may occur from allergies or a viral infection. As such, the pain fluctuates depending on how much mucosal swelling is present.

This situation is analogous to a bunion on the foot. Just like the septal spur, if the bunion digs too hard into a shoe, a person may feel foot pain. If the foot swells due to standing or edema, the pain may become more severe.

Shown below is a septal spur before and after mucosal lining swelling has occurred.

Treatment is a surgical procedure called septoplasty which basically removes the spur and straightens the septum back to the midline.

Read more about the procedure here.

Read more about this type of headache here.

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Awake Endotracheal Intubation Video

It is a common misconception that you need to be completely asleep and sedated in order to be intubated. That is patently false.

With good local anesthesia, intubation can be performed on a wide-awake patient without any sedation. Take a look at this video where an anesthesiologist instructor essentially intubates himself in front of an audience... I didn't make it, but I wish I did...

This little-used technique is a very important skill to have because in certain dire situations where a patient's breathing is compromised due to upper airway swelling (whether from infection or mass), attempted sedation and intubation may result in airway loss and need for emergency tracheostomy. At worst, death may happen. In such patients where there is airway compromise, awake intubation needs to be performed.

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Test That Distinguishes Between Bacterial or Viral Infections

From the pages of CSI: Miami... a commonly used forensic chemical called luminol to identify traces of blood at crime scenes has been modified to be used in a novel medical test that can help differentiate a viral infection from a bacterial infection.

Why is this important?

Not uncommonly, it is sometimes hard to differentiate between a bacterial infection which is treated with antibiotics from a viral infection which is NOT treated with antibiotics. Unfortunately, in the healthcare system, too often, antibiotics are given if an infection is present whether viral or bacterial which is leading to multi-drug resistant infections like MRSA.

Well with this test, physicians can potentially use it to determine whether antibiotics should be provided or not. Such a test may also be reassuring to patients who desire antibiotics, but can be told with confidence that it is not necessary and at worst, dangerous.

The way this test works is by identifying the characteristic glow "signature" after luminol is applied to a suspect infection. If it glows a certain way... it's a viral infection. If it glows in a different way... it's a bacterial infection.

For those scientifically inclined and curious, the glow is due to a byproduct of the body's defenses fighting off infection called "Reactive Oxygen Species". The luminol reacts with this byproduct creating a glow.

Of note, the test is not yet available, but perhaps soon???

Reference:
Differentiation between Viral and Bacterial Acute Infections Using Chemiluminescent Signatures of Circulating Phagocytes. Anal. Chem., 2011, 83 (11), pp 4258–4265
DOI: 10.1021/ac200596f Publication Date (Web): April 26, 2011

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Snore Absorption Hotel Rooms

First hypoallergenic hotel rooms and now "snore absorption" hotel rooms. No kidding...

Crowne Plaza hotels have debuted on a trial basis specially designed hotel rooms to absorb the sounds of snoring. These hotel rooms utilize many different methods to accomplish this including:

• Sound proofing on walls to absorb the loud frequencies, deflect the sound waves and minimise the impact of snoring. The walls use egg box style foam which reduces the noise reverberating in the room
• A specially designed sound absorbing head board that will work together with the sound proof walling to muffle the echo within the room
• An anti-snoring bed wedge which acts as a body pillow, encouraging snoring guests to sleep on their sides or upright. Lying flat on your back makes the base of the tongue and soft palate collapse to the back wall of the throat which causes snoring
• An anti-snoring pillow which uses rare neodymium magnets to create a natural magnetic field, opening the airways and stiffening the upper palate which vibrates during snoring
• A white noise machine which is proven to help drown out the droning snoring noise and help sleep and relaxation

These specially designed rooms are being trialled in nine Crowne Plaza hotels across Europe and the Middle East.

Of course, there are a variety of surgical methods that can potentially cure a person's snore to make such rooms unnecessary.

Read more about these rooms here.

Read more about snoring treatments here.

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New Webpage on Peritonsillar Abscess Added to Website

Our office has created a new webpage on the evaluation and treatment of peritonsillar abscess.

Peritonsillar abscess is when a pus collection develops behind the tonsil causing a severe sore throat and trouble swallowing.

Read more on how this condition is treated here.

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R&B Singer R. Kelly Undergoes Peritonsillar Abscess Drainage

Reuters on July 20, 2011 reported that R&B singer R. Kelly suffered from a peritonsillar abscess that required emergency drainage.

Peritonsillar abscess is when a pus collection develops within the tonsil causing it to swell. This may occur over a period of 24 hours resulting in a severe sore throat and trouble swallowing. This condition is in contrast to tonsillitis which is when the tonsil itself is infected, but no pus collection is present.

On exam, the affected tonsil may be huge crossing the midline (see picture). The uvula often is pushed to the opposite side and the soft palate may be asymmetrically huge as well.

Treatment is immediate incision and drainage. In an adult, this can be easily performed in the clinic after adequate local anesthesia. The pus is allowed to drain out and the patient often feels much improved within 12 hours. Antibiotics and a short burst of steroids is often prescribed afterwards.

Read the story here.

Read more about peritonsillar abscess management here.

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Robotic Mouth Sings the "Natural" Way

When it comes to robotics, the sounds they make is either due to the machinery that runs them or an electronic recording that comes out of a speaker.

Well, there's a scientist, Hideyuki Sawada, who is working on a robotic "mouth" that produces sound the same way humans do.

- Lungs to power the voice using airflow
- Vocal cords to create the noise to create a voice
- Pharynx (Throat) to create the space and harmonic overtones that affect the "quality" of the voice
- Articulators (lips, teeth, tongue) to produce speech

In this picture of the robot, the lips are pretty obvious (the oval fish-mouth appearing aperture). The lungs are the glass jar on the right. The vocal cords are located where the glass jar connects to the pharynx which is represented by the skin-toned plastic pipe with the pistons attached at the bottom.

Here's a video showing it in action.

Here's another video showing a REAL human voice in action.

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Video Made by Dr. Chang Shown on Animal Planet

On July 17, 2011, Animal Planet aired Swamp Wars "Snake Farm Shootout" where a video made by Dr. Chang was incorporated into the storyline. It was a VERY brief segment of this video clip shown about 30 minutes into the show; specifically, the endoscopic image of the back of the nose. Due to copyright, I can't show the actual video clip. But, here is the video from which the segment was taken.

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Nebulizer Treatment for Chronic Sinusitis

Many people are already aware of nebulizer treatments to help with breathing during asthma attacks and other pulmonary conditions.

What many people may not be aware of is that such nebulizer treatments can also potentially be used for chronic sinus infections. One of the best known company offering such treatment is Sinus Dynamics.

Using one of several different nebulizers, compounded liquid medications (antibiotics and/or steroids) selected by the physician are nebulized/atomized which the patient than breathes into the nasal passages. The small size of the particles allow medication to theoretically move through the tiniest of sinus openings directly onto the infected tissue. Treatments are quick generally lasting 3 – 5 minutes (depending on medication and device). Here's a video demonstrating how it is used.



Sinus Dynamics™ specifically is contracted by over 14,000 insurance companies across the nation, which means that most patients are able to receive their treatment for little to no cost out of pocket.

Most ENT doctors are already familiar with this product.

Personally, I prescribe this mode of treatment for the particularly difficult sinus infection that has not responded to oral antibiotics and sinus surgery. The major advantage of such a device is not only the fact that it is topical, but much stronger antibiotics can be prescribed that otherwise would be toxic if given orally. Furthermore, more than one medication can be administered simultaneously (for example, a steroid, tetracycline antibiotic, and ceftazidime antibiotic).

Typically, I require a culture with sensitivities to determine what medication would be optimal for this mode of treatment. Another requirement is prior sinus surgery given studies showing greater effectiveness of the delivery system.

Once cultures are obtained and a determination of the optimal medication to treat, a prescription is faxed to the company who will than take care of the insurance coverage and than ship the device and medication(s) to you. The normal turn-around time is less than 1 week depending on the prescription.

An instructional video is included with the prescription as well as customer service representatives via phone to walk through the first treatment if needed.

Of course, sinus nebulizer treatment is not the only topical treatment than can be provided.

Other topical sinus treatments which may be just as effective if not more include saline flushes containing medications (which can be compounded by any willing pharmacy) as well as application of antibiotic ointments directly into the sinus cavity (which is performed by the ENT under endoscopic guidance).

It is up to your ENT physician to determine what is the best course of treatment based on your history, endoscopic sinus evaluation, culture results, CT scans, and response to prior medical regimens.

It should also be noted that there have been several studies performed suggesting such nebulizer treatment for sinus infections to be ineffective. However, it certainly is worth trying when all else has failed (or insurance has denied other treatment protocols).

References:
Nebulized antibiotics for the treatment of refractory bacterial chronic rhinosinusitis. Ann Pharmacother. 2011 Jun;45(6):798-802. Epub 2011 Jun 7.

Current concepts in topical therapy for chronic sinonasal disease. J Otolaryngol Head Neck Surg. 2010 Jun;39(3):217-31.

A prospective controlled trial of pulsed nasal nebulizer in maximally dissected cadavers. Am J Rhinol. 2008 Jul-Aug;22(4):390-4.

Nebulized bacitracin/colimycin: a treatment option in recalcitrant chronic rhinosinusitis with Staphylococcus aureus? A double-blind, randomized, placebo-controlled, cross-over pilot study. Rhinology. 2008 Jun;46(2):92-8.

Deposition of aerosolized particles in the maxillary sinuses before and after endoscopic sinus surgery. Am J Rhinol. 2007 Mar-Apr;21(2):196-7.

Comparison of topical medication delivery systems after sinus surgery. Laryngoscope. 2004 Feb;114(2):201-4.

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Dr. Chang Quoted in National Press Release

Dr. Chang has been quoted in a recent national press release regarding the new Sermo iPhone app.

Sermo is a physician only online forum where medical quandaries are discussed and advice requested from physicians by physicians. Dr. Chang was recently contacted by Sermo for an interview regarding the new iPhone Sermo app. In the press release, he is quoted:

"The ability to consult with my colleagues in real-time, from the patient's bedside or my exam room, addresses an unmet need and will be of tremendous benefit, particularly for urgent clinical cases when I need an immediate response," said Christopher Y. Chang, MD, Fauquier ENT Consultants. "Similarly, the capacity to instantly post images and explanations about a patient case and share this information with colleagues through Sermo Mobile helps me provide the best care possible to my patients."

 Read the full press release here.

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New Video on Esophageal Manometry and 24 Hour Multi-Channel pH and Impedance Testing

Our office has created a new video describing what a patient goes through when they undergo esophageal manometry as well as 24 hour multi-channel pH and impedance testing.

This test is often ordered when a patient is suspected to be suffering from reflux, whether acid or non-acid, or is possibly suffering from abnormal muscle activity of the esophagus.

Symptoms that a patient may experience that may lead to such testing include:

- phlegmy throat
- lump sensation in the throat
- chronic throat clearing
- chronic cough
- difficulty swallowing

Watch the video here!

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New Webpage on Bilateral Vocal Cord Paralysis (or Fixation)

We have written up a new webpage discussing the unfortunate situation of bilateral vocal cord paralysis whereby both breathing and vocal quality is adversely affected.

Treatment for bilateral vocal cord paralysis is difficult and there is no perfect solution. Treatment to improve breathing usually makes the voice worse. Treatment to improve the voice usually makes the breathing worse. The best (but not perfect) treatment tries to pick a happy medium to address the breathing while trying not to hurt the voice too much, though some degradation in vocal quality is to be expected. Such treatment includes posterior cordotomy +/- medial arytenoidectomy.

In another situation, the patient may have bilateral vocal cord fixation resulting in the appearance of vocal cord paralysis, but is potentially "curable" with normal breathing and normal voice being the goal.

Click here to read more! Video and audio also included.

To read more about UNILATERAL vocal cord paralysis, click here. Treatment is completely different than for bilateral vocal cord paralysis.

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"Sneeze Whisperer" Target Pharmacy Commercial

Take a look at this commercial promoting Target Pharmacists as a "sneeze-whisperer"...



Though pharmacists are very important healthcare professionals who are essential to the management and distribution of prescription drugs, patients need to be aware that pharmacists may be financially rewarded to encourage patients to use certain drugs and not others without regard to whether a given medication may be better or not health-wise.

In fact, in some cases, pharmacists may automatically switch certain prescriptions to an alternative without patient or physician knowledge. In other situations, pharmacists may call physician offices asking if it is OK to switch a prescribed medication to an alternative for one reason or another (again, possibly due to unclear financial incentives).

To be fair, in an effort to cut costs, pharmacy benefit managers (PBM) who oversee pharmacies including Target Pharmacy as well as pharmaceutical companies, offer various incentives to encourage (or persuade) not only pharmacists to choose certain drugs over another, but also patients and physicians.

Such persuasion include:
- Higher copays for the patient who may ASK a drug to be changed to a cheaper alternative.
- Prior authorizations which in essence is paperwork harassment for the physician who may be influenced to prescribe alternative medications just to avoid the paperwork.
- TV Commercials (yup... just like the commercial mentioned above) informing patients that THEIR drug is the best
- Rebate coupons
etc etc

So... before you start thinking a Target Pharmacist is a true "sneeze-whisperer", consider all the other competing whispers a pharmacist hears... Copays, incentives, rebate coupons, patients, doctors, drug reps, PBMs, etc.

It should be obvious, but did want to point out that pharmacists do not receive any advanced medical training in allergy unlike an allergist who has dedicated literally YEARS to the subject.

References:
The effect of pharmaceutical benefits managers: is it being evaluated? Ann Intern Med. 1996 May 15;124(10):906-13.

Economic impact of pharmacist-reimbursed drug therapy modification. J Am Pharm Assoc (2003). 2011 Jan-Feb;51(1):58-64.

Drug Maker's Efforts to Compete in Lucrative Insulin Market Are Under Scrutiny. New York Times 1/28/2006

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Our Practice Website Completely Renovated (www.FauquierENT.net)

Recently, readers may have noticed that I have not been as prolific with blog articles as I have been in the past. The reason is because I've been in the process of overhauling the our practice's official website (www.FauquierENT.net) to the latest and greatest in webpage coding incorporating HTML5 and CSS3 standards.

Given the official practice website contains over 200 webpages... it just took a very long time and I required the assistance of Chris Ferrell with Pettygrove Full Creative Agency to make it a reality. BTW... I highly recommend him if you need a website or extensive website rework.

The website is best viewed using the most recent version of your browser whether it be Internet Explorer, Safari, or Firefox. Older browser versions will work, but just won't be as pretty and formatting may be slightly off.

Also new to the website is its ability to automatically detect and adjust appearance of the webpages based on whether you are on a regular computer vs tablet vs smartphone. Very cool...

Check it out here!

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Sermo iPhone App Review

Sermo is an online physician-only forum where doctors ask other doctors for advice. It's where we post particularly thorny/difficult medical issues we encounter in our patients (no patient identifiers of course) and pick the brains of thousands of other doctors across many different specialties throughout the Unites States for assistance.

For example, as an ENT, I can post a particularly unusual patient presentation that has me stumped... for example a weird rash on the face... and post it on Sermo. Hopefully, I would than get responses from not only other ENTs across the United States but also input from dermatologists, pathologists, internal medicine, pediatrics, etc.

This kind of multi-brain access has been invaluable, especially since being a solo ENT, I do not have the benefit of having a colleague to easily bounce questions off of.

Until recently, no iPhone app was available to access this forum... until now. Mind you, only physicians are allowed access.

I am fortunate to be one of the first to test out this new iPhone app when Sermo contacted me last month regarding my interest (which I was) and here are my initial impressions when the app was released July 5, 2011.

Overall, it is a functional app that is usable in all the ways I would use it on the desktop.

The homepage is where theoretically, all the most popular destinations on Sermo is shown.

Among the homepage buttons is "Followed" which are postings that I either am following or actively participating in.  It would also be nice if there's a button to direct me to my specialty postings rather than clicking on "Posts" (which lists all postings in chronological order) or "Popular" (which lists the most popular postings in terms of activity) and than selecting "Specialty" which is the 2nd most common destination for me. "History" lists all postings or messages that I recently visited.

Adding a new posting appears to be fairly straightforward with two options... One which is triggered by taking a picture (iConsult) of an abnormality (like a CT scan or a rash) as well as one without the need for a picture (Create Post). The iConsult button is a leap forward better than what the desktop can offer. With iConsult, I can use the iPhone to take a picture, add a brief background history, and post whereas with the desktop, you would have to take a picture, transfer to the computer, logon to Sermo, and add the photo manually when creating a new post. The iConsult has resulted in the addition of a new section on Sermo... when I last checked, there's already been 5 postings to this section.

With any postings, I can add a comment easily or view a brief bio by selecting on the commenter's user handle.

All in all, a great free app currently available for the iPhone only.

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