Website Updated Utilizing ReCAPTCHA To Avoid Spam Email

Our website over the past few months has been visited over 4000 times a day. Though such high numbers are great, the downside is that we have started seeing an increasing amount of spam email such that more spam is received than legitimate email.

In order to combat such spam, we have had no choice but to institute a system whereby our email address is hidden until 2 word images are correctly typed in. We have selected ReCAPTCHA to provide this service for two main reasons… it is free and by entering the words in the box, we help to digitize texts that were written before the computer age. Read more about this here.

Of course, we still have a secure email submission form which prevents spam as well as protects confidential private information.

Cheap Quality Prescriptions Thru Costco Pharmacy Mail Order

A patient recently brought this to my attention… but Costco Pharmacy offers very good prices on drugs, especially generics, even if a patient has no health insurance. Furthermore, you do NOT have to be a member to purchase these drugs! Even more importantly, the medications can be considered “good” unlike medications purchased from other online sources from Canada or Mexico.

For example, I searched for these drugs on 11/27/09 and these are the prices that came up:

Allegra 180mg
$79.19 for 30 (Brand Name)
$36.18 for 30 (generic)

Prilosec 20mg
$158.13 for 30 (Brand Name)
$15.18 for 30 (generic)

Flonase
$87.36 for 1 (Brand Name)
$15.28 for 1 (generic)

Of course, with insurance, these prices may be even cheaper!

Check it out here. Click on pharmacy at the top and than look for the “Prescription Price Checker” link.

What Is a Pulmonary Stress Test?

At least in the ENT world, a pulmonary stress test is a very useful test when evaluating a patient with symptoms of shortness of breath, stridor, and/or wheezing that occurs only when exercising. The most common reason for an ENT evaluation in these patients is to determine whether paradoxical vocal cord motion is occurring or some other pathology such as tracheomalacia or laryngomalacia. Usually, the patient has already undergone extensive pulmonary testing for asthma and allergies with everything being normal. Even use of inhalers has not been found to be helpful.

The most difficult part of the evaluation in these patients is to perform the exam WHEN the patient is actually having symptoms (ie, during exercise). Doing an evaluation when without symptoms usually results in a normal exam (not surprisingly).

That’s where the pulmonary stress test comes in. The philosophy behind this test is to allow for an evaluation when the patient is actually having symptoms.

Under a controlled situation, the patient is asked to start exercising on a treadmill or bicycle. Heart rate, EKG, respiratory rate, etc are all monitored during exercise. When symptoms of stridor or shortness of breath occur, the ENT performs a fiberoptic laryngoscopy exam on the spot to evaluate vocal cord motion and laryngeal structure. In some cases, even awake bronchoscopy may be performed to look for tracheomalacia.

Our office in cooperation with Fauquier Hospital offers this service.

Image taken from wikipedia.

Cool X-Ray Video of What Happens Anatomically During Speech

Voice is sound production. Speech is what ultimately comes out the mouth after the sound is modified by the tight coordination among the throat muscles, palate, tongue, lips, teeth, etc. An example of a voice problem is hoarseness. A speech problem would be stuttering, or nasal-sounding words, or mumbling.

Speech researcher Christine Ericsdotter precisely captured the intricate movements of the tongue, lips, pharynx and jaw during speech using a rapid-fire X-ray.

Check out the video she created here!

This link provides a cartoon animation of how each sound in the English language is produced from an anatomical standpoint.

Taking Tylenol and Ibuprofen Also Has A Potential Risk of DEATH!

The New York Times in July 6, 2009 published an interesting article regarding the potentially fatal risk of taking tylenol and ibuprofen. The story titled “Reasons Not to Panic Over a Painkiller” states that tylenol (due to liver damage) kills about 400 people and hospitalizes about 42,000 every year in the United States. Ibuprofen is even worse. More than 100,000 Americans are hospitalized each year with complications associated with ibuprofen and an additional 15,000 to 20,000 die from ulcers and internal bleeding linked to their use.

The reason I am mentioning these facts with such a ubiquitous medication like tylenol and ibuprofen is because many patients have a distorted sense of what is risky and what is not. I had one parent who refused to give her child zyrtec or benadryl for severe allergies as she did not want to “add poison to her child’s body.” Though such sentiment is usually laudable (and in some cases, even encouraged by me), in these particular cases, it’s odd to say the least, mainly because she was giving her child repeated doses of motrin and tylenol for symptom relief. As far as I know, zyrtec and benadryl has not killed anyone. Tylenol and motrin have… many times.

Or get this… the average woman puts on herself 515 chemicals on her body everyday through self-inflicted use of body and facial moisturizers, perfumes, deodorants and various other make-up products. Click here to read more on this.

There are many other such examples, but it is always nice to have in perspective that even supposedly “safe” medications really aren’t safe if taken improperly.

Read the NYT story here to read more about the risks of tylenol and ibuprofen.

Machine Gun Sneezing

ABC News on November 11, 2009 aired a story about a 12 year old girl with an unfortunate condition called “machine gun sneezing“. Apparently, she sneezes up to 16 times a minute all day except while sleeping and started after recovering from a mild cold.

To be frank, it’s a condition I’ve never seen before.

Per an allergist interviewed for this story, the condition is extremely rare and “can be triggered by hundreds of causes, including allergies, sinus problems, or growths in the nasal passage.”

Read more here. A video of the report can also be found at the link.

A personal thought of mine, the absence of sneezing during sleep suggests a psychogenic or habitual process. It might not have started out that way, but with all the attention, which is now national, there may be positive feedback from all the doting, to perpetuate the problem.

ADDENDUM: This girl now has a diagnosis called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus)! Read more here.

NYT: Single Gene Mutation Allows Humans to Talk and Not Animals

In the Nov 11, 2009 New York Times Science section, a story has been published titled “Speech Gene Shows Its Bossy Nature” where a single gene known as FOXP2 has been found to be responsible for speech (or lack thereof). All animals have an FOXP2 gene, but the human version’s product differs at just 2 of its 740 units from that of chimpanzees, suggesting that this tiny evolutionary fix may hold the key to why people can speak and chimps cannot.

Read more of the story here.

Google Flu Shot Finder

The brainy folks at Google has been at it again… Not only did they produce a map showing the flu trends in the US… but now they have produced a Flu Shot finder based on zip code for both seasonal as well as H1N1 vaccines. The locations are displayed on their Google Maps page.

Check it out here!

McGovern Nipple for Infants Born Unable to Nasally Breathe

I recently received a phone call regarding a newborn who the pediatrician suspected had bilateral choanal atresia. This is a situation in which the infant is not able to breath through the nose. This inability to nasally breath is a major problem because newborns are obligate nasal breathers (newborns do not know how to mouth-breath unless they are crying).

As such, there are two options to immediately perform in order to allow a newborn to breath to stay alive. Intubate… or place a McGovern Nipple. A McGovern Nipple is made by (see picture below):

1) Cutting off the tip of the nipple used in a milk-bottle creating a hole about 1cm in size. Try to preserve as much length as possible!
2) Inserting the nipple into the newborn’s mouth
3) Placing a surgical mask such that the mask part is behind the baby’s head and using the strings to keep the nipple in place inside the infant’s mouth.

This forces the newborn to mouth-breath. Without this contraption, the child will literally suffocate.

I have specifically created this blog article because I had a lot of problems trying to find a picture of this contraption to show the pediatrician. Hopefully, this will make it easier for others to figure out what the heck a McGovern Nipple is and how to make and use one.

The only way to definitively correct this problem is by surgically removing the blockage that is blocking the infant’s nasal passage.

Source:
Cummings Otolaryngology Head & Neck Surgery 4th Ed. Chapter 178: Congenital Malformation of the Nose. Volume 4, Page 4101.

RANDOM: Washington Post Cartoon Making Fun of ENT

A patient of mine brought the funnies from the Oct 28, 2009 Washington Post of a cartoon by John McPherson poking fun at ENT.