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July 30, 2009

Echo-Location In Humans Can Be Learned/Taught!

In the March/April 2009 edition of Acta Acustica Journal, a research paper by Spanish scientists entitled "Physical Analysis of Several Organic Signals for Human Echolocation: Oral Vacuum Pulses" was published. This research has shown scientifically that human beings can develop echolocation, the system of acoustic signals used by dolphins and bats to explore their surroundings. Producing certain kinds of tongue clicks helps people to identify objects around them without needing to see them, something which would be especially useful for the blind.

In order to learn echo-location, the scientists are developing protocols to allow any person learn this unique ability.

Read more about this here.

July 28, 2009

Distortion of Risk Assessment for Surgical Complications

Image courtesy of Stuart Miles
Over time and experience as well as being exposed to some pop psychology by the likes of Malcolm Gladwell, Nassim Taleb, Ori & Rom Brafman, Robert Krulwich, Jad Abumrad, among others, I have realized that patients assess surgical risk in very different ways with most using irrational considerations.

Too often, physicians use statistics, numbers, and facts to counsel patients on risk whether it be surgical or some other medical intervention (medications, CT scan, etc). And we should. However, how patients process this information is more often based on emotive factors and anecdotal stories heard from friends, family, as well as internet.

Such "stories" whether from friends or the internet is perhaps one of my biggest allies as well as bane of my existence. Why? Because patients make decisions based on the experiences of a few individuals. Facts? Statistics? They play only a minor role. To make things worse, such stories are expressed in more negative terms than positive.

Why is that?

I think it's because people who experience a bad outcome are FAR more vocal from a perceived sense of injustice than those who experience the good (and expected) outcome.

As the saying goes, a person with a good outcome tells 1 or their friends whereas a person who has a bad experience tells 5 friends.

It is against just this kind of backdrop that patients "listen" to the statistics, but are influenced by the stories they hear.

To make things worse, risk evaluation is distorted by the lack of control patients feel. It is why there are so many people who are afraid of flying and yet have no trouble driving a car where the risk of death is MUCH higher. Or why most people are horrified by the idea of a gun in the house but won't blink twice about a swimming pool which kills far more kids than guns.

How is a physician to combat such forces in order to allow for a more reasoned decision made by the patient for a given medical intervention?

I have no solution to this problem other than to keep aware of what patients are hearing and being mindful of such emotive factors when providing counselling. In practical terms what does this mean? It means I read... a lot... and not just from medical journals either, but newspapers, magazines, blogs, and other sources that patients probably encounter before seeing a physician. Thank goodness for online news collators (Medical News Today,, etc) as well as Twitter.

I also produce my own online literature to balance out (hopefully) the other materials that are out there, but more so in story format in layperson terms rather than factual & medical regurgitation and use of ambiguous language (where emphasis is "see your doctor" for more specific information) that plague more reputable medical websites.

July 27, 2009

Washington Post: Perfect Pitch CAN Be Taught?!!

There is a fascinating article in the July 27, 2009 edition of the Wasington Post on page A8 entitled "An Elusive Musical Gift Could Be at Children's Fingertips." This article elucidates a technique to teach any child to have perfect pitch, the ability to identify a note simply by hearing it. The technique is called "Eguchi Method" and developed by Kazuko Eguchi who developed it 40 years ago in Japan.

In essence, the technique, in order to be successful, must start before the age of 4 years old and uses colored flags (or any other object) to musical chords. Over time, more colored flags linked to different chords are added. Frequency of practice is more important than duration.

To read more about this, click here.

July 26, 2009

Physician On-Call Communication System for Free! Thanks Google!

Since 2008, many patients in our practice are quite surprised when they actually reach a physician directly when they call our after-hours number.

What the patients don't realize is that our practice is also quite happy with this set-up!

Why? Well, that after-hours number is actually a Google Voice number and it provides amazing functionality that is FREE that would have costed us thousands of dollars otherwise.

Using Google Voice, the after-hours number can be forwarded to any physician who may be on-call easily and immediately. When the physician answers a call, an automated Google message is heard alerting the physician that the incoming call is from a patient. Should the call get missed, the patient can leave an answering machine message. Google Voice TRANSCRIBES the voice mail message and emails it to the physician's cell phone. This last bit is great as often calls come in while we may be in surgery or on another call.

SO, Google Voice provides options for the physician:

1) Answer an incoming call immediately and be alerted that it is a patient calling


2) Read the transcribed voice mail (imitates an answering service and pager all-in-one) before returning a call

How cool is that... and all for free!

Check out the Google Voice service here.

Needle Biopsy of Thyroid Masses Misidentifies 50% of Thyroid Cancers!

Surgeons at the University of Wisconsin found that fine needle aspiration biopsy (FNAB) in 26 of 52 FNAB reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis after thyroidectomy. Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%.

Even for smaller thyroid masses, FNAB is still not 100% accurate with a falsely negative rate of around 10%. Why is that?

Well, one must keep in mind that the FNAB samples (or removes) only a tiny tiny tiny part of the thyroid mass (think of a needle going into an apple and trying to hit the worm in the middle). Should the needle sample a part of the thyroid cancer mass where no cancer is present, it will come back normal, even if it is truly cancer.

What does this mean for a patient with a thyroid mass?

1) The ONLY way to know 100% whether a patient has thyroid cancer or not is to remove the thyroid.
2) IF the FNAB shows thyroid cancer, total thyroidectomy is recommended.
3) IF the FNAB does not show thyroid cancer, thyroid cancer can STILL be there; it's just that the FNAB was just plain wrong. Thyroid lobectomy should still be considered.

Of course, one needs to talk with your local surgeon on what the next step is.

Just keep in mind that the FNAB is not 100% accurate!

Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger. Arch Surg. 2009;144(7):649-655. doi:10.1001/archsurg.2009.116.

False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. Laryngoscope. 2013 May;123(5):1305-9. doi: 10.1002/lary.23861. Epub 2013 Jan 4.

July 19, 2009

Would You Find or Share Your Health Info Online?

In the August 2009 issue of US News & World Report (America's Best Hospitals 2009 Issue), there was an interesting article regarding use of the internet in order to obtain as well as share health information. This article was based on research entitled "The Social Life of Health Information" conducted by the Pew Internet Project and the California Healthcare Foundation.

Some interesting statistics mentioned:

• 61% of American adults look online for health information.
• 86% of all adults ask a health professional, such as a doctor for health information.
• 68% of all adults ask a friend or family member.
• 57% of all adults use the internet.
• 54% use books or other printed reference material.
• 33% contact their insurance provider.
• 39% of e-patients use a social networking site like MySpace and Facebook and, of those, only a small portion have followed their friends’ personal health experiences or updates, posted their own health-related comments, gotten any health information, or joined a health-related group.
• 12% of e-patients use Twitter or another service to share updates about themselves or to see updates about others, and of those, few have posted comments, queries, or information about health or medical matters.

The trends shown here is probably going to grow even more significant in the future. It would behoove physicians to start taking more seriously these trends regarding where patients are finding their information and to take advantage.

Read the US News & World Report Article here.

Read the Pew Report here.

LA Times: Blood Tests for Food Allergies are Often Inaccurate & Misleading

On July 20, 2009, the LA Times came out with two articles discussing food allergy testing... and how often they provide misleading information leading to patient actions that are quite simply wrong.

Specifically regarding RAST food testing... Most people will come back showing some IgE food reactivity even if they are not allergic to that food. As such, patients based on these tests, limit their diets unnecessarily.

Even if a patient is truly allergic, the severity can not be predicted by the RAST scores.

At this time, the BEST way to test for food allergies is by patient history and food challenge tests where a person is fed carefully regulated amounts of food, under close supervision, and the amounts are gradually increased.

Read the articles here:
LA Times Story 1
LA Times Story 2

Contact your local allergist for more information.

July 13, 2009

New Webpage on Vocal Cord Surgery

A new webpage has been posted on vocal cord surgery to remove vocal cord masses including polyps, cysts, papillomas, varix, nodules, etc.

The webpage goes over 3 main approaches to removing vocal cord masses and it behooves any patients considering this surgery to educate themselves in what exactly is involved.

Videos of the different surgical approaches are also included.

Read more here.

July 10, 2009

Rachel Ray Underwent Vocal Cord Surgery

People Magazine on July 10, 2009 reported that celebrity chef, Rachel Ray, underwent vocal cord surgery. As reported in the story, even for celebrities, mandatory voice rest is required after vocal cord surgery!!!

Read the article in People magazine here.

Read more about hoarseness and its treatment here.

Washington Post Medical Mystery: Pulsatile Tinnitus (Noises in the Ear)

The Washington Post on July 7, 2009 published a story on a lawyer who suffered from pulsatile tinnitus (hearing one's heartbeat in the ear) which was ultimately found to be due to a carotid artery dissection. A carotid artery dissection could have resulted in a serious ischemic stroke which thankfully did not happen.

The story goes thru his experiences in trying to find a diagnosis and treatment.

Keep in mind that pulsatile tinnitus is completely different from continuous tinnitus.

Read more about tinnitus here.

July 08, 2009

New NeilMed Sinus Rinse Video

The NeilMed company has produced a sinus rinse video on YouTube. All I can say is it is about time! Our office had to produce a video on this product given the absence previously.

There are also devices that make it easier to rinse your nose and sinuses:

July 04, 2009

NYT Article on Reflux (and NOT the Acid Kind)

A patient brought to my attention the other day that there was an article in the NYT on June 29, 2009 regarding non-acid reflux. Overall, the article is good, but readers should keep in mind that heartburn and other symptoms below the shoulders may NOT be present! Furthermore, the usual reflux medications may not work.

Read the NYT article here.

Read more about reflux here.

RANDOM: Michelangelo's David Statue Has a Goiter???

So, I was looking at a picture of The David statue by Michelangelo standing in front of the Palazzo Vecchio when I noticed something on the neck... a bulge just off the midline and below the thyroid cartilage. Could it be a thyroid goiter or mass?

If David was alive today, I most definitely would obtain a thyroid ultrasound and perhaps a fine needle aspirate if a nodule was found. Thyroid cancer would be the concern I would counsel David about.

Read more about the surgery here or watch the video!

July 03, 2009

Best Cell Phones for People Who Wear Hearing Aids

As wireless carriers move from analog to digital services, accessibility for the deaf and hard of hearing is a concern. Digital technology means more features and improved efficiency—but some digital phones can cause interference for hearing aid users.

Both ATT and Verizon have webpages that list cell phones that are compatible with hearing aids as well as give ratings on the level of compatibility. Such compatibility ratings are M- and T-Ratings. The higher the M- or T-Ratings, the better the cell phone will work the hearing aids.

ATT Webpage
Verizon Webpage

Phones with an M-Rating of M3 or M4 meet FCC requirements and are less likely to generate interference to hearing devices than phones that are not labeled.

A telecoil is a small device that is built into some hearing aids for use with the telephone as well as assistive listening devices. Not all hearing aids have telecoils. Phones with a T-Rating of T3 or T4 meet FCC requirements and are more likely to work well for people who use hearing aids with telecoils with telephones.

More information on M- and T-Ratings...

As always, we recommend to TRY before you buy...

iPods & Other Music Devices Can Cause Permanent Hearing Loss!

The Washington Post wrote up a nice article regarding the increased risk of permanent hearing loss kids these days may suffer due to listening to music devices too loudly. Such noise-induced hearing loss also increases the risk of tinnitus (ringing of the ears). The key things to easily remember to ensure proper music volume is:

1) If people around you can hear the music you are listening to, it's too loud.
2) If you can't hear what people are saying while listening to music, it's too loud.

Every year, we see kids in the upper teens and young 20s with hearing equivalent to someone who is in their 80s. Sad but true, and as kids continue to listen to music too loudly, we expect this trend to increase.

Click here to read the Washington Post article.

If you are concerned that you may be suffering from hearing loss, contact us for an appointment!

Remember, if you suddenly lose your hearing, there is a window of opportunity of 10-30 days where medications may help reverse this hearing loss after which nothing more can be done. Contact your local ENT as soon as possible if this happens to you!

Watch a video of Dr. Sanjay Gupta talking about these dangers on CNN.

July 02, 2009

Allergy/Pollen Tracker for Your iPhone

I was amazed to find that there are a few programs out there for the iPhone that provides allergy count information as well as forecasts... at last check, there are 4 main ones in the app store on iTunes.

Some are rated highly and others not so high. I'm not going to go too much into the description and ratings as this info can be easily found on the iTunes app store. Links are provided.

The most highly rated application I found is called Zyrtec AllergyCast and is FREE!
ZYRTEC® AllergyCast

Another fairly new but so far highly rated program that looks promising is called Allergies! and is $1.99.

There are 2 other programs that didn't get rated so well and include:

Pollen Journal for $4.99
Pollen Journal (Allergy Tracker)

Allergy Alert for FREE
Allergy Alert

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VIDEO: How Does the Human Voicebox Work?


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