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September 30, 2012

Why Can't Some Contact Dermatitis Be Diagnosed by Blood Test, EVER?

I often see patients for allergies who desire allergy testing due to mysterious hive-like rash on the skin, and given many are fearful of needles, they opt for a blood test like RAST or immunoCAP to diagnose what they are allergic to. Some would even argue that skin prick testing would not be diagnostic. Though such blood tests have become remarkably accurate (skin prick is still the most accurate way to diagnose what a person is allergic to), there are profound and significant limitation…
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September 29, 2012

There are FOUR Distinct Types of Allergic Reactions

When people think of allergic reactions, they incorrectly believe there is only one kind... the kind that makes a person's nose run or the rash that appears after eating a food one is allergic to. Sounds simple, but sadly it is WAY more complex than that. There are actually 4 distinct types of allergic reactions that occur. All images courtesy of University of Georgia  unless otherwise specified. Type 1 This is the classic type of allergic reaction everyone is familiar with. General…
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September 27, 2012

Customized Cancer Treatment Using Technique Similar to C&S for Infections

Imagine being 24 years old and having undergone 350 surgeries to remove growths from the throat... and expecting to undergo even more in the future. Well, this situation is not unheard of for patients who suffer from a condition called recurrent respiratory papillomatosis (RRP). Although it is not rare for intermittent and sporadic warty growths called papillomas to occur in the mouth and throat due to the HPV virus, RRP is a much more severe condition where such papillomas start appearin…
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September 26, 2012

Sheryl Crow Blames Brain Tumor on Cell Phone Use

On the inaugural episode of Katie Couric's new talk show Katie , Sheryl Crow described her history with a brain tumor called meningioma which was found in her right temporal lobe. This diagnosis was reported in a previous blog post . Most interestingly, during the show, she blames the meningioma on excessive cell phone use years ago when she was on the phone for hours promoting her records using one of those archaic analog cell phones. The relationship between cell phone use and brain…
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After Surgery, Do Patients Have Out-of-Pocket Costs for Follow-Up Visits?

Assuming a patient has insurance, the answer is generally no for a certain period of time... For a period of time after surgery, insurance specifies that a surgeon provides any and all routine  post-operative care for "free" without any patient out-of-pocket charges. This period after surgery is called "global period" and is based on the assumption that the insurance has already paid for not only the surgery, but all the post-operative care that goes along with the sur…
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September 24, 2012

Healthcare Mobile Web Presence

It is pretty much a given that healthcare organizations, medical offices, and physicians maintain a web presence given how frequently consumers turn to the internet and google especially for health information. Given that... I would like to point out that more and more of this web traffic occurs on a smartphone rather than a computer and in an effort to retain consumers who seek healthcare, it behooves that any web presence be also mobile friendly. According to my own personal web statist…
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September 23, 2012

How is Sinusitis Like Diarrhea, Germs and All?

A normal human body is composed of more "bacteria" cells than "human" cells. Indeed, the bacteria collectively living inside a normal healthy person would fill a half-gallon jug; numerically, there are probably 10 times more bacterial cells in the body than human cells. Though the majority of these bacteria have no known effect on the human body (good or bad), some of these organisms perform tasks that participate in maintaining health and are deemed necessary members o…
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September 21, 2012

Dante's Hell of Prescriptions: When Treatment Causes More Ills

Here is a scenario which I unfortunately see all too often... a scenario how prescriptions are provided to a patient to address their ills which due to associated side effects causes even more problems which in turn is treated with even more prescriptions. Take for example a patient who presents with a chief complaint of cough for over 12 months. Suspicion for bronchitis is made and prescription for levaquin (antibiotic) and tussionex (a narcotic cough suppressant) is given to the patien…
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Why Did Hair Turn Green for Residents of a Certain Town?

In 2011, in a certain township called Anderslov in Sweden, formerly blonde residents' hair mysteriously started turning green. Was it a biological problem? Was it a disease? Was it contagious? Nope... Actually, suspicion initially was towards the drinking water and in particular, the copper levels since copper is known to dye things green via a complex oxidation process. When copper oxidizes, it forms minerals that are green (and/or blue) including: brochantite (hydrated copper…
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September 17, 2012

September 16, 2012

How Does Silver Nitrate Cauterize?

Silver nitrate is a chemical compound commonly used by ENT surgeons to stop nosebleeds as well as obliterate granulation tissue (found around tracheostomy stomas as well as intra-orally ). Medical silver nitrate is typically purchased as matchstick applicators and is usually found in combination with potassium nitrate (75% silver nitrate and 25% potassium nitrate). When this applicator is combined with water (moisture inside the nose or blood): AgNO3 + HOH  -->  AgOH + HNO3 Nitric…
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September 15, 2012

Fauquier ENT Blog Redesigned

Over the past two weeks, Fauquier ENT blog has secretly undergone a major facelift which has finally gone public today... I anticipate that there are a few errors here and there that will need to be addressed as I discover them over the next few weeks. So, please help me out and let me know if there's any errors you come across. I would be much appreciative. The custom blog template redesign was done by an Indonesian company 30Dzign who I highly recommend for any customized blogger…
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September 12, 2012

Sinus Surgery Lawsuit Ruled Against ENT

A patient who had undergone endoscopic sinus surgery suffered detachment of the extraocular muscle resulting in double vision that required further surgical intervention. A jury found against the ENT and ambulatory surgery center rewarding $2.5 million dollars to not only the patient, but also the wife "for loss of consortium" . Damage to the eye and vision is part of the normal consent process for endoscopic sinus surgery when considering the geographic proximity of the eye a…
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September 11, 2012

John Mayer Undergoes Second Vocal Cord Surgery

On August 27, 2012, media reported that grammy-award winning singer  John Mayer  underwent vocal cord surgery for a 2nd time in an attempt to permanently remove a recurrent vocal cord granuloma. Fans know that in September 2011,  John Mayer  announced the cancellation of a number of concerts as well as an album due to the development of a  vocal cord granuloma  of his voicebox. Read a  blog article  about this. On Oct 20, 2011,  he underwent surgery  for the first time to remove the …
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September 10, 2012

Yoga Pose to Treat Ear Pain or Pressure

So here's something I learned about yoga... There is a yoga pose called Karnapidasana which can supposedly cure ear pain and pressure gradually over time. The term derives from "Karna" meaning ear and "Pida" which means pain, discomfort, or pressure. So... who knows? Give it a try... if you can physically do it safely. DISCLAIMER: Not recommended for those who are not flexible. Also, not something I personally recommend to treat ear pain and pressure.
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September 08, 2012

Find an ENT Doctor App

If you have an iPhone or Android , get the ENTLink App... You can search for an ENT by current location or by zip code. The search can be narrowed to a specific specialty area (laryngology, neuro-otology, rhinology, etc) as well. Of course, you can search for the same information from the website . Download the app for iPhone and Android .
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September 06, 2012

Yet Another Sinus Dilation Device - AerOS Sinus Dilation System

Sinus dilation has become all the rage in the past few years to treat chronic sinusitis , especially since CPT codes for this procedure has become available as of January 2012. The first company was Acclarent who coined the balloon sinuplasty term. Next was Entellus who produced their simpler system ( XprESS and FinESS ). Now, there is SinuSys who has produced a new way to dilate the sinus opening without use of a balloon like Acclarent and Entellus. It is currently pending FDA appro…
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How to "Grow" Clean Air

The New York Times published a story  regarding how common houseplants can purify the air of chemicals like benzene and formaldehyde. This claim is based on NASA research performed in the 1980s when the agency was trying to figure out ways to keep the air quality as clean as possible within enclosed habitats (like a space station). Of course, you can read the 27 page report ... or read a mom-friendly book that summarizes the findings in an easy-to-understand language from Amazon.com. &…
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September 02, 2012

Website Development Help

Given how extensive the practice website is (250+ webpages; 1300+ if including blog ), I often get asked by patients and other offices how did I go about developing it. First off, I am fortunate that I have some computer programming skills and have been creating websites since the 1990s. I have decent HTML knowledge with a dash of CSS understanding. I am clueless with  making new javascripts, but know how to use ones that have been already created. As such this baseline knowledge of …
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September 01, 2012

Wrong Site Surgery Performed by ENT

In 2010, an ENT performed a tongue tie release on a 5 years old child who was supposed to undergo a tongue lesion biopsy (apparently 1cm in size over the central dorsal tongue). Tongue tie release was NOT consented for nor discussed with the parents who expected a tongue biopsy to be performed instead. In the investigative report  performed by the Department of Public Health: "When the surgeon was asked whether he examined the patient in the preop area prior to the surgery, he stated…
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