Swine Flu Information

Given the recent concern for a possible swine-origin flu outbreak, here is some information for concerned ciitizens from the friendly folks at the CDC and elsewhere:

About Swine Flu
Anti-Viral Recommendations
Google map depicting swine flu cases in the US and World (the image below is just a picture and not linked).

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New Webpage on Tinnitus (Ringing in the Ears)

A new webpage has been added to our website regarding tinnitus otherwise known as ringing in the ears (or any other sound for that matter). There are 3 basic types of tinnitus for which evaluation and treatment differs and include:

1) Continuous
2) Pulsatile (Rhythmic)
3) Arrhythmic (the sound randomly occurs without any rhythm)

Depending on how a person describes their tinnitus (because the physician often can't hear it), the following may be ordered:

1) Audiogram
2) Carotid Ultrasound
3) MRI or CT Scan
4) Bloodwork (Specifically, TSH and CBC)

To read more about this symptom, click here.

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Can I Take More Than One Allergy Medication???

The blunt answer is yes... but only if the medications are from different categories. What are the different categories? They include:

• Anti-histamines (allegra, zyrtec, claritin, xyzal, clarinex, etc)
• Steroid nasal sprays (flonase, nasonex, nasacort, rhinocort, etc)
• Singulair
• Anti-histamine nasal sprays (astelin, astepro, patanase)
• Saline flushes (Neilmed Sinus Rinse Kit)
• Mast cell stabilizer (NasalCrom)

As such, a person can take one medication from each category and achieve better allergy control than taking just one medication alone.

For a more extensive discussion on each of these medication categories as well as explanation on why an allergic patient may sometimes need to take more than one medication, click here.

To read specifically on taking more than one allergy medication, click here.

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Entertainer's Secret Now Sold in Our Office

We now stock and sell a special throat spray to treat the dry irritated throat called Entertainer's Secret.

Sold in our office for $15.

Amazon.comalso sells this product.

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The Perfect Nasal Bulb Suction and Aspirator for Infants and Small Children

Regardless of the cause of a snotty nose in a young child, it is recommended that parents use a saline spray or saline bullets to the nose followed by nasal bulb suctioning as often as 3 times a day. The problem is finding the perfect nasal suctioning device with the following characteristics:

• Make sure the nasal tip is rounded to prevent nasal trauma no matter how firmly you push against your child's nose
• Make sure you can see into the bulb to ensure adequate suctioning as well as to know when it needs to be cleaned
• Make sure it can be taken apart for cleaning

There are TWO devices that we found meet these criteria illustrated below. We also sell them in our office!


This nasal bulb suction is a regular nasal bulb suction. Note the rounded tip, clear window to see into the bulb, as well as the fact that it can be taken apart (the blue bulb can be separated from the clear plastic).

Nasal bulbs can be purchased from Amazon.com. This particular nasal bulb suction is sold in our office for $12.




This device uses suction produced by the parent in order to remove nasal drainage. Just like the nasal bulb, it has a rounded tip, clear plastic, and can be taken apart for cleaning.

This Nosefrida Nasal Aspirator can be purchased from Amazon.com. Sold in our office for $15.

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New Webpage Listing Ear Specialists in the United States

A new webpage listing all the ear specialists in the United States has been created. We took this step as we have been getting inundated with emails asking for a recommendation of an ear specialist local to where they live.

Ear specialists, otherwise known as otologist or neuro-otologists, are physicians who specialize in only ear problems. They may not even treat any throat or nose problems focussing purely on the ear.

Click here to see the listing.

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New Webpage on the Evaluation and Treatment of Nasal Polyps

A new webpage has been posted describing nasal polyps and how they are treated. The most common cause of nasal polyps is allergies and though surgery may remove all nasal polyps, they WILL come back unless underlying allergies are aggressively contolled by medications and allergy shots. Click here to read more.

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New Webpage on the Evaluation and Treatment of the Snotty or Runny Nose in Kids

A new webpage has been created going over causes and treatment of the snotty nose or runny nose that kids less than 5 years of age often get. Treatment is often frustrating as young kids and infants do not know how to blow the nose. Read here to see what you can do about it!

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Ponaris Nasal Emollient Now to be Sold in Our Office

Given that not many local stores carry Ponaris in stock, we are now selling this product for $15 in our office for patient convenience. Ponaris is a wonderful product to alleviate the dry, irritated, and sometimes burning sensation in the nose, especially during the winter when the air is much drier than normal. It is also a great product to treat nosebleeds and nasal crusting.

I like to think of Ponaris as chapstick, but made for the nose.

To apply, it already comes with an eye-dropper. Just place 1-2 drops for each side of the nose and let it ooze down and coat the entire nasal cavity. Just like chapstick, one can feel the protective barrier for several hours after application. This can be applied up to 4 times a day as needed (just like chapstick).

Alternatively, one can convert Ponaris into a nasal spray form instead of using the eye-dropper. Just purchase a saltwater nasal spray bottle over the counter (ie, Ocean Nasal Spray, Ayr Nasal Spray, etc). Empty the saltwater and clean out the nasal spray bottle thoroughly. Than pour the Ponaris bottle into the nasal spray bottle. That's it!

Call our front desk to purchase it.

NOTE: This product does contain iodine and should not be used by patients with iodine allergy. In those patients, CME Nasal Spray is recommended. CME Nasal Spray is available only as a prescription.

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Dr. Chang Featured in Local Newspaper Talking About Surgical Treatment for OSA

Dr. Chang was recently featured in the Fauquier Times-Democrat (April 3, 2009) in an article discussing surgical treatment for obstructive sleep apnea (OSA). Click the image for a larger view to read.

You can also read the full text here.

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Voice On-Hold for Cheap!

I recently struggled with an un-named company to try and get a voice on-hold system working in our office. For those who don't know, a voice on-hold system allows there to be background music or service/product announcements to be made over the phone while a person is put on-hold. It is a captive audience good for marketing purposes.

With this un-named company, we had to pay $499 to get it set up followed by a subscription of $89 per month thereafter to use a pre-recorded script made professionally by the company. There were several problems which I won't get into, but in the end, we cancelled the service.

Instead, we pursued a cheaper and just as good an option that works for a total one-time cost of only about $300!!!

Step 1: Get the equipment
Equipment needed are:
1) iPod nano off eBay for cost of $100.
2) iPod USB charger for cost of $40.
3) Audio cable from Radio Shack for cost of $5. It's the same cable used in cars to plug your portable music player into the car's radio system.

Step 2: Get professional recording of script you want people to hear when put on-hold
1) Goto www.Voice123.com
2) Hire someone from this website to do the recording and email you the .mp3 of the finished product. I paid about $150 for this job.

Click here to listen to the first 20 seconds of what this sounds like (without the music added yet). If you like her voice, please email her at aflosnik[at]hotmail[dot]com

Step 3: Add music to recorded script
1) Goto www.royaltyfreemusic.com and find music you like to add in the background to the recorded script. Or you can use your own music from iTunes (but make sure no copyright infringement).
2) Given I use a Mac, I used their free software, iMovie, that is included on all Macs. Using this program, I imported the recorded script. Than to a second track, I added the (royalty-free) music.
3) I duplicated this three times back to back to create a single "song" that lasted 12 minutes.
4) I exported this file as a .wav

Click here to listen to the first 20 seconds of the recording now with music. Pretty nice, eh?

Step 4: Import song into iPod
1) On my office computer I never use to download music, I installed iTunes (which is free from apple.com) and imported the .wav file.
2) I synchronized this one song into the iPod.
3) Under settings, I set the iPod to "repeat" the "song" indefinitely.
4) Hit play and the song which is the scipted file starts playing over and over and over again indefinitely.

Step 5: Connect iPod to your office phone system
1) Look for the Audio-In jack on your phone system's central hub. I included a picture below showing this as "EXT. MUSIC" which is what our office's system looks like.
2) Connect an audio cable from your iPod to this Audio-In jack on the phone system hub.
3) Plug the iPod to the USB charger so it will play forever (as long as there is power).

See Zoomed-Out picture with everything installed.

Make sure the iPod is playing in a loop and test it out!

That's it!!!

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New Webpage on Sialadenitis (Salivary Gland Infection/Stone) and Its Treatment

A new webpage has been created describing what sialadenitis is and how it is treated. In essence, sialadenitis is when one of the spit glands of the body (parotid gland or submandibular gland located on the cheek and under the jawbone respectively) becomes infected resulting in swelling and pain. Sometimes, the salivary gland may become secondarily infected due to a salivary stone. Click here to read more about it!

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Over-the-counter products that may be helpful to resolve sialadenitis:

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Sialendoscopy: Minimally Invasive Treatment for Salivary Gland Stones

NO... our office does not provide this treatment option for sialadenitis caused by salivary gland stones. However, given we have received a number of inquiries on this treatment option, we did want to let people know that at least in the mid-Atlantic region, there is only three places that offer this treatment that we are aware of. Specifically, the doctors' names are:

Dr. Arjun Joshi (George Washington University Hospital (Washington DC)
2021 K St NW, Ste 206
Washington, DC 20006
Office Number: 202-741-3250
www.dcheadandneck.com

Dr. M. Boyd Gillespie (Charleston, SC)
Office Number: 843-792-8299
Email: gillesmb@musc.edu

Drs. Barry Schaitkin and Ricardo Carrau (Pittsburgh, PA).
Office Number: 412-621-0123
Email: schaitkinb@upmc.edu

A bit further away is Dr. Michael H. Fritsch at Indiana University.

Read more about sialadenitis here.

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Over-the-counter products that may be helpful to resolve sialadenitis:

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