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December 19, 2014

Dr. Chang Blog Article Published in Newspaper

A blog article I wrote in 12/31/10 was picked up by a local newspaper and reprinted with permission. I'm even listed as a "contributing writer." Check it out!

December 18, 2014

How a Tracheostomy Hole Heals Closed (Time Lapse Photos)

When a patient undergoes a tracheostomy, it is not a permanent thing. Once a patient is healthy enough, the tracheostomy tube can be removed and the existing hole in the throat will spontaneously start to heal closed.

In a process called healing by secondary intention, the body creates granulation tissue along with scarring that slowly but surely closes the trach opening shut. In the rare situation it does not completely close, a surgical procedure can be performed.

Here are some pictures showing a tracheostomy hole becoming smaller each day after the tube was removed. The first picture is day 0 followed by day 1, day 2, etc. All photos were taken on the same patient.

December 13, 2014

Why are Magazines So Old in Doctor Waiting Rooms?

It certainly is a complaint in our practice... Why is it that magazines in doctor waiting rooms (including ours) tend to be so outdated??? And not just old, but the "boring" ones? One factor is that an office staff member has been negligent in replacing old magazines with new ones. Another is that... gasp... patients are stealing the new ones???

Researchers in New Zealand set out to study this common complaint and did find that new magazines tend to "disappear" resulting in waiting rooms that mainly contained old magazines.

The study was conducted by tracking 87 magazines of various ages placed in a waiting room including both gossipy (celebrity photos on the cover) and non-gossipy types (Economist, Time, National Geographic, etc).

What did they find out???

After 31 days, 41 of the original 87 magazines had disappeared. More to the point regarding outdated magazines in the waiting room... 60% of magazines less then 2 months old disappeared after 31 days.

Of those that disappeared, it tended to be the gossipy ones. Using the hazard ratio, on any one day the gossipy magazines disappeared 14.51 times faster than the non-gossipy ones. This basically equates to 1.32 magazines disappearing per day. In fact, by the end of the study, only one gossipy magazine was still left, the rest having "disappeared," presumably taken out of the office by a patient.

So if gossipy and newer magazines tend to disappear... than not surprisingly over time, that will tend to leave waiting rooms with old and boring magazines... and fairly quickly.

Take home message???

Doctor offices do NOT deliberately stock old boring magazines in the waiting rooms. It's because the new and gossipy magazines are being pilfered as quickly as they get put out.

An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study. BMJ 2014;349:g7262

December 10, 2014

Story on Dr. Chang and Dr. Redmon in Warrenton Business Insider


December 07, 2014

President Obama Sees ENT Doctor

President Obama on Saturday, Dec 6, 2014 saw an ENT for a sore throat several weeks in duration. An Army ENT physician conducted a fiberoptic laryngoscopy which suggested the sore throat was due to acid reflux. The exam apparently "revealed soft tissue swelling in the posterior throat", Mr. Obama's doctor, Ronny L Jackson, said in a statement.

Presumably, treatment entailed acid reflux medications as well ask lifestyle changes to minimize the reflux thereby resolving the sore throat.

What are some the medications that may have been recommended? You can actually find them OTC now or on Amazon:


Doctor: Obama's sore throat likely caused by acid reflux. USA Today 12/6/14.

December 05, 2014

Christmas Tree Allergy (Mold and Pollen Studies)

Ever wonder what a live Christmas Tree brings into a home other than happy holiday cheer? For those with Christmas Tree Allergy, a live conifer will also bring allergy and asthma type symptoms that manifest within a week and not uncommonly as soon as 24 hours after introduction into the home. It is estimated that about 7% of allergic patients suffers to some degree, Christmas Tree Allergy.

Sneezing, wheezing, nasal congestion, and transitory rashes are the most common symptoms of Christmas Tree Allergy. It is known that conifer pollen has little or no clinical significance, so why the allergy exacerbations?

A few allergists have attempted to discover what causes Christmas Tree Allergy through home mold and pollen studies both before and after a live Christmas Tree was brought into the house.

In summary, ALL live trees exhibited HEAVY growth of mold including penicillium, epicoccum, and alternaria. However, such mold did not appear to become airborne and disperse into the rest of the house, rather remaining localized to the immediate vicinity of the tree itself. However, such was not the case with pollen.

Live trees contained significant amount of ragweed, grass, and tree pollens that DID become airborne. Presumably, such pollen accumulated directly on the tree as it grew through the years and released them into the home as a Christmas Tree. It was also noted that a further spike in pollen counts occurred about 2 weeks after the Christmas Tree is brought into the home presumably due to retained pollen particles that are released as the tree dries out.

It was also found that the sap on the Christmas tree is responsible for the transitory rashes that individuals often experience. This rash likely represents a contact allergy to the oleoresin of the balsam.

So what to do?

Ideally, don't bring a live Christmas Tree into the home!

But, if you do, "vigorously" wash down the tree first to remove as much of the pollen and mold before bringing it into the house. Also, don't place the tree near an air vent. Wear gloves and long sleeves to prevent skin rashes from sap contact allergy.

Christmas tree allergy: mould and pollen studies. CMA Journal. 103:1272-1276. Dec 5, 1970

Hypersensitivity reactions to christmas tree extracts. Ann Allergy. 1969 Sep;27(9):461-4.

Hypersensitivity reactions to Christmas tree extracts. W V Med J. 1970 Mar;66(3):81.

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