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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