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October 29, 2010

The Man With the World's Largest Mouth!

Francisco Domingo Joaquim's 6.69 inches wide mouth has earned him the dubious title of the 'World's Widest Mouth' by the Guinness Book of World Records. His main claim to fame is the ability to put a can of Coke into and out of his mouth with ease as well as spin it around inside his mouth with his tongue. Watch a video here . Read more about him and his amazing mouth here .
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October 28, 2010

What is Vocal Cord Stroboscopy?

Stroboscopy of the vocal cords is a special exam whereby a scope is introduced down into the throat where the vocal cords can be directly visualized. Using a special light, the vibration of the vocal cords can be examined and allows identification of subtle pathology that can contribute to a raspy voice . The exam is recorded and can be played back at any speed to allow for careful analysis. Here is a YouTube video our office has made showing how this exam is performed!
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Laying on Right Side Worsens Acid Reflux!

Well that's according to a recent New York Times article on October 25, 2010. This claim is based on several studies published whereby “the total amount of reflux time was significantly greater” when the subjects laid on their right side after eating a high-fat meal. This makes sense anatomically. Keep in mind that the stomach is located on the left side and the esophagus (swallowing tube) is located in the middle (comes off the stomach's "right side" so to speak). When…
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October 25, 2010

New Video Produced on Using MediTech EMR on the iPad!

Our office has been instrumental in bringing the Apple iPad to Fauquier Hospital allowing physicians to access MediTech. In order for physicians to see how MediTech can be accessed and used on the iPad, our office has created a YouTube video tutorial. Not only is MediTech shown, but also PACS. This video has been added to our YouTube channel . Please note that this video is in REAL-TIME. It has not been speeded up. The system we are using is Citrix Version XanApp 5 and MediTech Client/Serv…
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October 23, 2010

New Video Produced on How/What a Normal Swallow Looks Like

Our office has produced a new video on what/how a normal swallow looks like from BOTH an x-ray as well as endoscopic view. In order to best illustrate the swallowing mechanism, a modified barium swallow test is shown. The video has been uploaded to our YouTube channel and can be watched here . Watch the video below as well as the slow motion action of what the epiglottis does from the inside during a swallow!
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October 22, 2010

NCIS Character Tony DiNozzo Gets Acute Laryngitis

On October 19, 2010, there was a CBS episode of NCIS (Naval Criminal Investigative Service) called " Cracked " in which Special Agent Tony DiNozzo developed acute laryngitis . The show's chief medical examiner, Dr. Ducky Mallard, examined Special Agent Tony DiNozzo and instructed him on strict voice rest for 24 hours which Tony ignored. If I was on the show, I would have performed a much more thorough examination that would include fiberoptic laryngoscopy (and/or strobosco…
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October 21, 2010

A New Treatment for Meniere's Disease!

I read with interest an MSNBC article that describes a brand new surgical treatment for Meniere's Disease, a debilitating disorder in which a patient suffers spinning attacks that last for hours to days. The treatment is an electrical device surgically implanted into the vestibular system of the ear, much like a cochlear implant for deaf individuals. The device, called "UW/Nucleus Vestibular Implant," is surgically installed behind the affected ear with a small wire threaded …
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Pediatric ENT Care of Warrenton, Virginia (Fauquier County)

Recently, there has been some confusion regarding whether our office deals with adults only or do we see kids as well... Strangely enough, we also get asked by parents whether our office sees adults when seeing a pediatric patient. To clear up any confusion, our office does see kids AND adults... starting from birth to the elderly. Dr. Chang who joined the office in October 2005, was named one of America's Top Physicians by the Consumer's Research Council of America in 2008 as …
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October 19, 2010

Fauquier Hospital MediTech Now Accessible on the Mac (As Well As iPad, Windows PC, iPhone, etc)!

Can I just express how totally excited and grateful I am to Fauquier Hospital Information Technology Department for upgrading their Citrix server?!! I can now access the hospital's MediTech EMR from anywhere using not only Windows PC, but also the iPad and Mac platforms as well!!! Even the iPhone, though the screen is a bit small... GREAT job and appreciate how responsive the department as a whole has been! Thank you! Especially given I'm a Mac person.
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Being a Hairdresser Can Destroy Your Nose!

On Oct 14, 2010, there was a story out of England about a hairdresser whose nose slowly collapsed due to damage sustained from breathing in hair clippings for 35 years. Apparently, over a period of 20 years, the small hair clippings slowly caused damage to her septum to the point it caused a perforation. The perforation than led to infection which further weakened her nose structure to the point it started to collapse... a type of nasal deformity called a saddle nose. Of course, it just …
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October 18, 2010

There are FIVE Different Types of Botox Available in the Market

Not many people know that there are FIVE different types of botox available and FDA approved for use in the United States. The five botox products are as follows: 1) Botox by Allergan 2) Myobloc by Solstice Neurosciences 3) Dysport by Ipsen, Ltd 4) Xeomin by Merz 5) Jeuveau by Evlous Obviously, Botox by Allergan was the first and most popular to the point where its product name "botox" is being used interchangeably to mean any botulinum toxin product; much like "Kleen…
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October 16, 2010

The PERFECTLY Shaped Human Ear

Well, that is according to the International Electrotechnical Commission (IEC) . The "perfect" ear also known as IEC TR 60959, was "defined" in 1990 and is used to allow gadget manufacturers to standardise the acoustic performance of their headphones or cellphones. You can purchase this perfect ear here if you were so inclined. Unfortunately, this perfect ear created in 1990 is actually not so perfect as it was defined using a series of 2D scans, taken at 2mm intervals. T…
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Botox Approved for Migraine Headaches in the United States

On October 15, 2010, the FDA approved botox for use in migraine headaches . It is hoped that eventually, this procedure will soon be covered by most health insurance companies rather than the few who do so now. Dr. Chang has been performing botox injections for migraine headaches since 2005 along with for wrinkles, spasmodic dysphonia , cervical dystonias, oral-mandibular dystonias, etc. Read the NYT article on the FDA approval here . Read the FDA announcement here .
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October 12, 2010

UPDATE #2: iPad and MediTech Electronic Medical / Health Records

This blog article is a continuation of prior blogs ( 6/12/10 and 9/20/10 ) I wrote on the use of the iPad with Meditech . Since June 12, 2010 when I first wrote about my experiences of using the iPad with my hospital's Meditech EMR system, a LOT has happened... First, the hospital has upgraded its Citrix infrastructure to allow iPad (as well as Mac) connectivity to the hospital's MediTech EMR using the Citrix Receiver app (free in iTunes). I reported this back in 9/20/10 . Sinc…
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New Video Created on Intra-Tympanic Steroid Injection for Sudden Hearing Loss

A new video has been uploaded to our office's YouTube Channel on Intra-Tympanic Steroid Injection used to treat patients who suffer sudden sensorineural hearing loss . The steroid injection is usually with decadron, though other types of steroids including methylprednisolone has been used. Watch the video here on YouTube or below.
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New Video Uploaded on Ear Tubes

Our office has created a new video on ear tubes from a variety of perspectives. The video contains five different video clips including ear tube placement, ear tube removal, ear tube replacement, etc. 3 different tube types are also shown including collar button tube, T-Tube, and split tube. This video has been uploaded onto our YouTube Channel , but can be watched below as well:
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October 10, 2010

The Science of Nose-Picking

Most everybody does it whether they admit it or not, both in kids and adults . In fact, according to one research survey , people do it about 4 times a day. In 7.6%, they do it >20 times a day! Nose-picking, also known as rhinotillexomania in medical-speak, generally is a benign, sedentary (and private) solo activity, but when excessive, can lead to a number of medical problems including nosebleeds  (25% of nose-pickers), septal perforation, staph infections , etc. In one extreme case , i…
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Research on Sword Swallowing and Its Side Effects

Research has actually shown that sword-swallowing can cause sore throats! No kidding! This particular research was based on 110 sword-swallowers from 16 different countries and was published in the British Medical Journal in 2006. This research won the 2007 Ig Nobel Prize in Medicine. Watch a YouTube Video of a sword-swallower in action: ENTs regularly perform a similar procedure when we perform "Direct Esophagoscopy". Just like a sword, it is an elongated rigid metal …
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Research Demonstrating How to Effectively Collect Whale Snot/Boogers

No kidding... There was a paper that came out describing how to collect whale snot using a remote controlled helicopter. BTW... this research was awarded the Ig Nobel Prize in Engineering 2010. Which gives me an idea... perhaps I'll write up a paper (or even make a video) on how to effectively remove boogers/snot in humans! Reference: A Novel Non-Invasive Tool for Disease Surveillance of Free-Ranging Whales and Its Relevance to Conservation Programs. Animal Conservation, vol. 13,…
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October 09, 2010

Gaviscon Advance for Non-Acid Laryngopharyngeal Reflux (LPR)

Over time, I have received a number of emails from patients regarding the best type of Gaviscon Advance  or Gaviscon Double Action they should purchase for relief of NON -acidic laryngopharyngeal reflux (LPR) . The blunt answer is to get the Gaviscon Advance Suspension/Liquid made by Reckitt Benckiser which contains at least 500mg of sodium alginate in 5ml dose (1 tsp) or 1 gram in 10cc dose (2 tsps). This formula of Gaviscon Advance cannot be purchased in the United States, but instead o…
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October 08, 2010

INOVA Health System ER Wait Times iPhone App

A reader informed me that INOVA Health System has developed a free iPhone app called InovaER that provides wait times of all 9 emergency rooms within its health system throughout Northern Virginia. The app was released Aug 4, 2010. Pretty cool! Hopefully other hospital systems including  Fauquier Hospital  will join with other regional hospitals (Culpeper, Warren, Prince William, Haymarket) to create a similar program. Download the app here .
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Nurses Followed by Doctors "Need" Coffee the Most According to Survey

CareerBuilder and Dunkin' Donuts performed a survey that was released to public on Sept 27, 2010 that listed those professions who needed coffee the most in rank order. The survey was performed on 3600 workers throughout the United States. According to the survey, the professions with the highest proportions of workers stating they are less productive without coffee vary widely. Those who need coffee the most are: 1) Nurses 2) Physicians 3) Hotel workers 4) Designers/Architects 5…
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October 07, 2010

Botox for "Sale" Due to Market Influences of Supply and Demand

The NYT wrote a somewhat humorous article on Oct 7, 2010 regarding botox injections for wrinkles from both a supply (physician) and demand (patient) viewpoint. In NYC, one can now find neon colored signs advertising botox specials! Read the NYT article here . Of note, our clinic performs botox injections not for just cosmetic reasons (wrinkles), but also medical reasons including migraine headaches , TMJ , spasmodic dysphonia , torticollis, etc.
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Treatment for Hiccups Based on Science

So... I came across a few references addressing treatment of hiccups (otherwise known as singultus) based on science rather than heresay. Here are a few methods than can be done at home without the need for medications or procedures. It is felt that hiccups may be secondary to irritation of the phrenic nerve (which innervates the diaphragm). As such, scientific treatment of hiccups have relied on increasing PaCO2 (breath holding, breathing into a paper bag), therapy using diaphragm relaxati…
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Sleep Apnea Can Mimic Dementia

NYT published a great article on Oct 6, 2010 regarding how obstructive sleep apnea (OSA) can mimic many of the symptoms of dementia, especially in the elderly. Symptoms of OSA that can be confused with dementia include trouble concentrating, inattention, difficulty staying focused, constantly dozing off during the day, and other cognitive deficits. Unfortunately, many elderly patients live alone and nobody is around to see whether there are any sleep issues. Most elderly patients deny …
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CPAP Masks Causes Facial Changes With Time

CPAP is a machine that pushes air into a person while they are sleeping to treat obstructive sleep apnea , a medical condition where a person stops breathing multiple times throughout the night leading to all sorts of medical problems including increased risk of hypertension, stroke, peripheral vascular disease, heart attack, etc. In order for this device to work, a mask must be worn while sleeping in order for the air to get pushed into the lungs. It is considered the gold standard treat…
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October 06, 2010

Cat With Vocal Cord Condition Results In A Singing Voice

A reader forwarded this video (below) to me about a singing cat named Monster. This cat has a supposed "vocal cord condition" which causes operatic singing when yawning. Check it out! Now personally, I can't really think of a vocal cord condition that would cause a more beautiful voice. Wish I could perform fiberoptic laryngoscopy on a "normal" cat and this cat to see what differences are present.
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Loud Noises Can Cause Heart Problems (Not Just Hearing Loss)!

According to a new study , people who work in noisy places for at least a year and a half could have triple the risk of a serious heart problem including a heart attack and severe chest pain compared to those who work in quiet environments. Of course, we all know such loud environment can also cause hearing loss . 6,000 people who were at least 20 years old and employed were surveyed from 1999 to 2004. Other heart risk factors including elevated Body Mass Index and smoking were statisticall…
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October 05, 2010

Fauquier ENT YouTube Channel Ranked As One of the Most Viewed In The World!

Today, it was with pleasant surprise that I was informed that our practice's YouTube channel has been ranked as one of the most viewed channels in the world ! In fact, our YouTube channel now has a ribbon with our ranking. Yes... We are ranked #99 and nowhere even close to breaking the top 10... but still very cool and who knows in the future! As of Oct 5, 2010, our channel has received 97,216,403 views.
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October 04, 2010

Sinus X-Rays Are Worthless

Oftentimes, I see patients come in with sinus x-rays with this or that finding. What many patients as well as physicians may not realize is that sinus x-rays are notoriously unreliable in determining whether sinus infection is present or not. Indeed, I NEVER order a sinus x-ray. Just how unreliable are sinus x-rays? In adults, it may be literally a flip of the coin whether the sinus x-ray is providing a correct diagnosis compared with the gold standard  CT sinus . Depending on what study…
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NPR on Endoscopic Sinus Surgery

NPR published a story on Oct 4, 2010 describing endoscopic sinus surgery using image guidance . The NPR story is actually quite balanced with accurate portrayal of what sinus surgery can or can't do. Just like in the NPR story , our office performs the same high-definition endoscopic sinus surgery using BrainLAB image guidance (which provides the real-time 3-dimenstional guidance). Prior to sinus surgery, a patient must fail medical management first (unless nasal masses like polyps…
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October 02, 2010


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