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Why Do Physicians Conduct Complete Physical Exams When You Have A Localized Complaint?

One June 20, 2011, NPR aired a great story about how a person may not “see” a person getting beat up on the side of a jogging path when they are focused on a task (pursuing another jogger)… even if they pass RIGHT BY THE FIGHT!!!

In fact, only a third of the subjects reported seeing this mock fight when the experiment was conducted at night. Even more surprisingly, broad daylight didn’t improve the statistics (only 40% noticed the fight).

Though the situation and circumstances do not exactly correspond, there is a lesson to be learned here that applies to a medical visit.

As an ENT, I often see patients for a very specific complaint…

“My right ear hurts.”
“I have a bad cough.”

No matter what the complaint, unless it is for a specific task (there is earwax… can you remove it), I most always still do a complete ear, nose, and throat exam no matter the complaint.

Why??? Read more »

*This blog post was originally published at Fauquier ENT Blog*

New Nasal Spray Is The First Of Its Kind

Meda Pharmaceuticals has announced a new nasal spray “Dymista” that contains both a steroid and an anti-histamine active ingredient. Why is this significant? It’s because it’s the first and only one to do so. Of course, it’s not available yet until the FDA approves it, but at least it has shown effectiveness in Phase 3 clinical trials.

At this time, nasal sprays as it relates to nasal allergies come in two separate flavors:

1) Steroid Nasal Spray (flonase, nasonex, nasacort, rhinocort, veramyst, omnaris, etc, etc)
2) Anti-Histamine Nasal Spray (patanase, astepro, astelin)

This new combo nasal spray “Dymista” contains Read more »

*This blog post was originally published at Fauquier ENT Blog*

Some Asthma Inhalers Can Cause Fungal Laryngitis (Thrush Of The Voice Box)

It is a big bummer to be an asthmatic. Not only is breathing a problem, but even the treatment for asthma can cause problems.

Take for example steroid inhalers like advair, symbicort, fluticasone, etc.

All asthma patients know to rinse their mouth out after inhaler use due to risk of oral thrush, but what about from the back of the mouth down to the vocal cords??? This nether region can’t be gargled very easily. One can swallow water to rinse this area out, but the vocal cord region would still not be addressed (otherwise aspiration would occur).

And that leads to potential vocal problems… like fungal laryngitis (or thrush of the voicebox). Here’s a picture of what that looks like. To compare, normal is shown in the smaller picture.

Note the white patches indicative of fungal growth. This fungal infection can lead to symptoms of a mild (if any) sore throat, but most patients complain of hoarseness as their only symptom. Read more »

*This blog post was originally published at Fauquier ENT Blog*

Nasal Anti-histamine Spray Now Available Over-The-Counter

Up until now, there have been three anti-histamine nasal sprays in the United States market available only by prescription… Astelin, Astepro, and Patanase.

However, in May 2011, Meda Pharma announced a new anti-histamine nasal spray Rhinolast Allergy that is available over-the-counter.

The active ingredient is azelastine, the same one as found in the prescription nasal spray Astelin and Astepro.

Azelastine has a triple mode of action: anti-histamine effect, mast-cell stabilizing effect, and anti-inflammatory effect. Azelastine has a rapid onset of action of 15 minutes.

It can be used from the age of 5 years.

This nasal spray can be used in combination with other over-the-counter anti-histamines medications taken orally like zyrtec, claritin, allegra, and benadryl.

Read more about this new nasal spray here.

Read more about allergy medications in general here.

*This blog post was originally published at Fauquier ENT Blog*

Free Throat, Head, Neck Cancer Screenings May Overstate Their Effectiveness

All over the country in May, hospitals are offering “Free Throat Cancer Screening.” A Google search turned up dozens of results for that specific term or the related “oral, head and neck cancer screening.”

Here’s one example, promoting “Oral, Head and Neck Cancer Awareness Week, May 8-14.”

This promotion uses ominous warnings:

Can you live without your voice?

What about your jaw?

Would you miss it if you couldn’t swallow food?

Throat cancer can take all of those things away, along with your ability to eat, talk and breathe normally. These debilitating problems can be prevented, but you have to catch cancer early.

Some promotions – such as this one – use celebrity pitches such as “If it happened to Michael Douglas, it can happen to you.”

Here’s one that states, “A 10-minute, painless screening could save your life.”

But where’s the evidence for that? Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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