Cocaine As A Medically Approved Medication

Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.

What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.

Cocaine is one of the most potent anesthetic AND vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and pain may be an issue.

Many physicians will use cocaine to help stop nosebleeds (I do not).

Many surgeons use cocaine during sinus surgery to minimize post-operative pain as well as minimize intra-operative bleeding. Use of cocaine also significantly decreases risk of nosebleeds after sinus surgery as well as minimize need for nasal packing.

Cocaine when used for illegal recreational purposes by snorting puts a person at risk for septal perforation due to its vasoconstrictor properties. In essence, the cocaine puts a chemical tourniquet on the blood supply to the septum leading to mucosal necrosis and eventual perforation. Afrin does the same thing, but on a much smaller scale.

Before anybody asks… Cocaine is NEVER prescribed to a patient. It is only ever used in a hospital/office setting and heavily controlled under lock and key. (It is never used in our office.)

Dr. Chang Blog Article Re-Published on KevinMD

One of Dr. Chang’s blog article on laryngeal sensory neuropathy as a potential cause of chronic cough has been re-published on KevinMD, an internationally recognized medical blog and contributor to MedPageToday.

The original blog article by Dr. Chang can be read here.

The blog article re-published on KevinMD can be read here.

Pet Dogs Reduce Allergies in Children, But Cats Increase Them

Man’s best friend also appears to make us healthy in more ways than one including reducing allergies in children by as much as 4 times according to new research from the University of Cincinnati. On the other hand, cats put children at risk of allergies by 13 TIMES!

The data to obtain these results were obtained from 636 children enrolled in the Cincinnati Childhood Allergy & Air Pollution Study (CCAAPS), a long-term study examining the effects of environmental particulates on childhood respiratory health and allergy development. Notably, all these children are at risk for allergies as their parents have them.

Allergy testing was accomplished by skin prick tests.

Read news article on this here.

Reference:
Genetic and environmental risk factors for childhood eczema development and allergic sensitization in the CCAAPS cohort. J Invest Dermatol. 2010 Feb;130(2):430-7. Epub 2009 Sep 17

Opposing Effects of Cat and Dog Ownership and Allergic Sensitization on Eczema in an Atopic Birth Cohort. J Pediatr. 2010 Sep 29. [Epub ahead of print]

Dr. Chang Mentioned in Newspaper Regarding Spasmodic Dysphonia

The Culpeper Star Exponent released a story on Sept 27, 2010 regarding an individual suffering from ABductor spasmodic dysphonia. This voice disorder is characterized by voice breaks while talking making it very difficult to talk as well as to be understood.

This individual has been treated with botox injections by Dr. Chang who was mentioned in the article:

“Taylor has one of the rarest forms of the disorder and therefore the hardest to treat. Nonetheless, she seeks treatment every four months through Dr. Christopher Chang, an ear, nose and throat specialist based in Warrenton. He is a leading expert in vocal chord treatments, and Taylor is happy he’s located so close by.”

Read the story here.

Mutter Medical Museum of the Odd, Strange, and Bizarre

In the spirit of Halloween that is coming up soon, I thought to share with everyone a FASCINATING museum located in Philadelphia, PA. The museum’s full name is “Mütter Museum of College of Physicians of Philadelphia” and contains a fascinating collection of the bizarre aspect of medical sciences. Many of the exhibits are real and not for the faint of heart.

Of course, I should mention that they have a number of exhibits related to ENT… including one of all the foreign bodies removed from the ear, nose, airway, etc.

Even as a physician who was bored with “The Bodies” exhibit, I am STILL fascinated by what I see in this museum.

Go check it out!

Here are a few images, but more can be found on Google Images.

Tilt-Table Test: An Under-Utilized Study To Evaluate Light-Headed Dizziness

We often see patients for dizziness. Many of these patients do not have an ear etiology for their dizziness given principal complaint of light-headedness, especially with standing/sitting up from a laying down position. In this scenario, a blood pressure issue is the more likely cause. Why? Because when you get up from a laying down position, gravity pulls the blood down and away from your head resulting in a transient lack of adequate blood-flow to the brain resulting in light-headedness… and even a fainting spell if severe enough.

Normally, the body is able to compensate for such position changes quickly, but when it doesn’t, watch out… Light-headed dizziness or fainting/blacking out will occur.

The best test to evaluate this problem is a tilt-table test. Check out the video to see how this test is performed. Be aware that not all hospitals offer this type of test.

Even in Hawaii, People Have Vitamin D Deficiency!

Ever since I’ve come across reports that Vitamin D supplementation is helpful to decrease allergy symptoms, I’ve encountered other interesting factoids including this one…

Even in Hawaii where one would expect it’s population to get plenty of sunshine, 51% ended up STILL having low vitamin D levels in a study population consisted of 93 adults (30 women and 63 men) with a mean age of 24!!! Read the study here. (For those not in the know, our bodies make vitamin D only with sun exposure.)

How can that be?

Well, given our ancestors probably were out in the sun a lot in terms of farming and/or hunting… our current culture and population does not come even close to the necessary amount of sunshine exposure to maintain adequate Vitamin D levels. After all, many of us work inside buildings instead of outside. We also are applying a lot of suntan lotion preventing the Vitamin D production within our bodies.

Hmmmmmm… Is it possible that the rampant Vitamin D deficiency present in our society is correlated with the increased numbers of allergies/asthma given allergies are worse with low Vitamin D levels?

Reference:
Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007 Jun;92(6):2130-5. Epub 2007 Apr 10.

Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol. 2010 Jul;126(1):52-8.e5. Epub 2010 Jun 9.

Vitamin D in atopic dermatitis, asthma and allergic diseases. Immunol Allergy Clin North Am. 2010 Aug;30(3):397-409.

New Drug Helps Prevent A Cough From Being Contagious

University of Alberta researchers have developed an experimental new drug that may be able to completely eliminate airborne disease transmission due to cough.

The way this drug works is by reducing/eliminating the amount of droplets that is expelled during a cough by changing the properties of the lung fluid. The drug comes in the form of a spray that can be inhaled by a sick patient.

It is conceived that this drug would help stop the spread of pandemic outbreaks as well as protect healthcare professionals from catching whatever an ill coughing patient may have. Furthermore, this drug would not necessarily be disease specific. If there’s a cough, it’ll work.

Reference:
Effect of artificial mucus properties on the characteristics of airborne bioaerosol droplets generated during simulated coughing. Journal of Non-Newtonian Fluid Mechanics, 2010; DOI: 10.1016/j.jnnfm.2010.07.005

There are TWO Different Allergy Shot Systems (AAAAI and AAOA)

When it comes to allergy shots, many folks are not aware that there are TWO very different allergy shot protocols available in the United States.

The largest allergy shot system available is by the American Academy of Allergy Asthma and Immunology (AAAAI). The physicians who use this protocol come by way of internal medicine training.

The other allergy shot system (which is the protocol we use in our office) is available by way of the American Academy of Otolaryngic Allergy (AAOA). The physicians who use this protocol (like myself) come by way of Otolaryngology-Head & Neck Surgery (aka, ENT or Ear Nose Throat) training.

Each system uses a different method of how the allergy vials are made. Also, the buildup protocol is different. Just as in baking… there are many ways to bake a cake.

Physicians of one or the other system often pooh-pooh the other, but both systems are based on evidence and are effective.

Where I work in Warrenton, Virginia, our practice (using AAOA) and another (using AAAAI) are the only two practices that provide the full suite of allergy testing and allergy shots. Given both our practices use a different system, I’ve seen firsthand the benefits of having two different systems available when it comes to allergy shots.

For whatever reason (and this is a personal observation of mine that I can’t prove), not all patients respond to allergy shots with one system, but DO respond using the other system. It’s not that one system is better than the other… it’s just different… and patients benefit from that.

The analogous scenario which I also see involve allergy medications… for some folks, allegra works best whereas for another, allegra does not work at all, but zyrtec works great.

The basic rule of thumb when it comes to allergy shots is that a patient should experience SOME improvement in their allergies after being on shots for at least 1 year. 80% of patients do… For the other 20%, it may be worthwhile to stop and try the other allergy shot system.

NPR: Injuries To Kids From Swallowed Disc Batteries Are No Joke… It Is An EMERGENCY!!!

In fact it is a STAT emergency… NPR published a story on Sept 20, 2010 regarding Chuck E. Cheese’s recall of two toys (a light-up ring and glasses) due to a disc battery used to power them.

These disc batteries can be access by small children if they smash apart the toy. The Consumer Products Safety Commission says two kids have had problems with batteries; one swallowed it and the other stuck it up his nose.

The danger is that when a disc battery is inserted into a nose (for example), a localized electric current is created between the positive and negative poles of the battery within the nose. This electric current basically “electrocutes” the lining inside the nose leading to tissue damage and ultimately necrosis (tissue death) within an hour. The same applies even if the battery is swallowed or put into the ear canal.

Treatment is IMMEDIATE removal… as soon as possible. Regardless of the day or time. STAT…

In the last 10 years, 13 deaths related to swallowed batteries have been reported, 12 of which are due to disc batteries (20 millimeter lithium cells).

Small children should NEVER be able to access disc batteries.

Read the NPR story here.

Read about the recall itself here (also from NPR).

Reference:
Preventing Battery Ingestions: An Analysis of 8648 Cases Published online May 24, 2010
PEDIATRICS (doi:10.1542/peds.2009-3038)

A Review of Esophageal Disc Battery Ingestions and a Protocol for Management Arch Otolaryngol Head Neck Surg. 2010;136(9):866-871. doi:10.1001/archoto.2010.146

Images of the toys that have been recalled…