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Showing posts with label General News. Show all posts
Showing posts with label General News. Show all posts

Saturday, 3 November 2007

Creation of Our Practice's Website

Posted on 09:28 by Unknown
OR, stated another way, "How much did our physician website cost?" So, there have been a few requests over the years on how our website was created which prompted me to write this particular blog where I will go into the details and costs.

•• Summary of Costs ••
Before I go into details, it is important to make sure the costs of running a website is reasonable. After all, if the costs do not justify the expense, no point having a website. A recent blog describing the current costs of setting up a website can be found here.

In any case, here is an overall summary of how much it costs me (one of the physicians in the practice) to develop and maintain our practice's website excluding costs related to time spent. It does help that I as a physician know how to make websites that helps keep costs down.

Expenses
Our domain name "www.FauquierENT.net" purchased at GoDaddy.
• $9.99 per year
Hosting on a Godaddy server the website:
• $50.88 per year
A 128-bit secure SSL for online prescription requests, website email form, appointment requests, etc purchased at Wufoo. Obviously, this is an optional expense. One could just as easily create a webpage stating to call our office for prescription refills or make a form that a patient would have to print out and than fax.
• $24 a month ($288 per year)

Profits
Google Adsense from targeted online advertisement
• About $25 a month ($300 per year)

The wufoo account for online prescriptions, website email, appointments, etc is actually kept as an office expense. The profits I keep to help defray the costs of my expenses maintaining the website.

Keep in mind that our website contains >200 webpages since most web development companies charge for each additional webpage created and maintained.

•• Creating the Website ••
To put it bluntly, one must have some knowledge of how to program in HTML if one wants to have a reasonable appearing website. The creation and maintenance of the website is all performed on my Macintosh MacBook Pro laptop where I have the entire website mirrored on my hard drive. Changes are made on this mirrored website on my computer's hard drive, checked for errors, and than uploaded onto the internet. Given this background, I use the following programs:

Adobe Dreamweaver
My true workhorse program for creating all the different content, images, video, audio, links, etc on the website. Think of it as the Microsoft Word for text documents.

Adobe Photoshop
Powerful graphics program I use to optimize images for web production.

iMovie HD
Free program for owners of Mac computers, I use this program to perform all video editing for web production. This program was heavily used for all the audio-visual effects of the hoarse voice section of our website. The videos themselves were produced on a KayPentax digital system using a chip-on-tip flexible scope.

Adobe Flash
Program used to create the interactive elements of the website. It is used in conjunction with Adobe Dreamweaver. This program is what allows for color changes when a cursor passes over a link or simple animation like a photo slideshow.

DreamsTime
Purchase royalty-free clip art to add to your website for a very low price (less than one dollar). Important as you can't just use random artwork in other websites due to copyright infringement concerns.

Microsoft Word and Adobe Acrobat
These two programs were used to create all forms and documents for patients to download and print at home. Adobe acrobat is the program used to create pdf files which can be opened on any computer whether it be a Windows PC, Mac, Linux, etc.

That's pretty much all that is needed to create and maintain a website!

•• Miscellaneous Website Enhancements ••
So there are various features I have added to the website to make it more useful for visitors such as a google search engine, real-time allergy report, interactive map of our office location, etc. The key thing here is that all these various features are FREE as again, my main motivation is to make the website better without adding cost.

Google Account
This is by far the most important free account to have as Google provides so many free services that many other companies would charge for. Through this account, you can:
• Obtain infinite number of free email accounts with your domain name for everybody in your office (ie, userid@FauquierENT.net). Some knowledge of server protocols is needed, but google does provide a step-by-step instruction.
• Create/Edit your listing under Google's yellow pages.
• Create a Blog (this one!).
• YouTube account for videos.
• Webmaster services to optimize the website for being found by google's search engine.
• Adsense account to insert targeted advertisement within the webpages for which you can get paid
• Get a google search engine for your website.

Google Maps
Add a google map to your website for free pinpointing your office's location. Some programming knowledge is needed.

FeedBurner
A google owned website where you can link info within a blog to your website automatically. You can see this in action on our practice's website (the rotating headlines towards the bottom). This services also provides free enhancement utilities to improve your blog.

Statcounter
Free service which will inform you about your website visitors: how many, which webpages, how long were they on each webpage, what webpages a given visitor saw and in what order, at what time, from where in the world, etc. This is EXTREMELY important information that allows you to figure out how to improve your website from a visitor's perspective.

Pollen Report
Free pollen count report can be added to your website for free. Some programming knowledge required.

Free Web-Based Surveys
Surveys are wonderful tools to determine what patients think of your practice. In the case of a website, it allows you to tap into their thoughts should they volunteer to answer questions you pose to them. SurveyMonkey as well as Wufoo both provide free web-based surveys as well as a more sophisticated format that costs money. I think that for most practices, the free version provides everything you would need. The survey we currently have on our website is located here.

www.LinkTiger.com
This free web-service checks your website weekly for any broken links. That way you can immediately make changes to keep all links functioning because nothing is more aggravating to a website visitor than a website full of broken links.

•• Time Factor ••
People have asked me how much time have I spent creating and maintaining the website. The answer is continuously. Although there may not be any changes needed, I'm constantly thinking of ways to make it better. Questions I keep asking myself are:

• What can I do to make this webpage look better?
• Can I add a piece of relevant artwork without making the webpage too long?
• Why do visitors spend only 5 seconds on this webpage, but 10 minutes on another?
• Are there any new webpages I can add to increase visits to the website?
• Etc

I honestly can't say that our practice's website will ever be completed. Though I don't spend hours and hours every week on it, I do spend a few minutes making minor changes several times a week. Making minor changes on a website takes no longer than making minor changes in a MS Word document, but instead of "saving" the changes, one "uploads" onto the internet any changes.

•• Summary ••
I hope this info is helpful for other medical practices thinking of adding a practice website without the costs from hiring a Web Development Company. I do feel that having a website is imperative in this day and age and I absolutely believe that it has enhanced our practice both in attracting new patients who may have gone elsewhere as well as retaining current ones.
Read More
Posted in Cost, General News, Physician, website creation, website development, Website Update | No comments

Sunday, 28 October 2007

Automatic Appointment Phone Call Reminders

Posted on 15:14 by Unknown
Starting this week, our office will be initiating automatic appointment phone call reminders. There will be the option to confirm the appointment or have the phone call re-directed to our office to cancel or reschedule an appointment. At this point in time, there will be a strange number (Seattle, WA area code) for those with caller ID. However, in a few weeks, our office number will appear instead.
Read More
Posted in General News | No comments

Saturday, 8 September 2007

Botox for Spasmodic Dysphonia: Side Effects and Normal Voice

Posted on 03:16 by Unknown
To What Degree Does Botox Dosage Affect Duration of Side Effects and Duration of Normal Voice After Injection for Adductor Spasmodic Dysphonia?

For many patients who suffer from spasmodic dysphonia, botulinum toxin type A or Botox, injection to the vocal cords is a ritual treatment undergone several times a year to keep the spasms in their voice away. The amount of Botox injected varies from patient to patient. Regardless of the patient and their specific dose, it is intuitive to many patients and healthcare providers that larger doses of Botox injected results in greater side effects (breathy/hoarse voice, dysphagia) and perhaps a longer duration of normal voice. This assumption, logical as it may sound, may not be correct according to a new study published in the June 2007 edition of Otolaryngology-Head & Neck Surgery (Link). According to the study’s author Dr. Christopher Chang (Fauquier ENT Consultants, PLC in Warrenton, Virginia) and coauthors, they actually found that there is a bell curve response of normal voice duration to higher doses of Botox. In other words, at some tipping point, giving higher doses of Botox actually resulted in a decrease in duration of normal voice. The study also reported, not surprisingly, that higher doses of Botox does lead to more severe side effects that lasts longer before normal voice resumes. The impact of this finding is that for some patients, a better and longer response may occur with a LOWER dose of botox.

These results were obtained from 101 patients with adductor spasmodic dysphonia who collectively underwent 876 injections between March 1998 and August 2006. In this study population, the Botox dosage range went from as low as 0.25 Units to as high as 7.5 Units bilaterally. The average dose was 1.62 Units. Based on statistical models, the “ideal” dose was found to be 1.41 Units bilaterally which would give a theoretical zero days of side effects and 87.3 days of normal voice. Based on these same statistical models, giving Botox doses higher than 1.41 units bilaterally theoretically would result in a DECREASE in duration of normal voice while increasing the duration and severity of side effects.

Of course, theory doesn’t always play out in reality as many individuals obtain perfectly good results with Botox dosages much larger than 1.41 Units bilaterally. However, when looking over large numbers of patients with spasmodic dysphonia over many injections over time, the statistical models provided in the study does provide some insights into what may be happening inside the body with each Botox injection.

With larger doses of Botox injected, larger volumes are obviously required. With increased volumes injected, however, there is an increased risk of diffusion of the toxin beyond the vocal cord muscle. Such spread of the toxin beyond the vocal cord muscle would result in a decrease in toxin left behind to exert its effect. Another outcome of this diffusion would be increased side effects as other uninvolved muscles become affected by Botox. As an example stated another way, if 4.0 Units were injected into the vocal cord muscle, 1.5 Units may actually diffuse away affecting other muscles in the area causing side effects. This would leave only 2.5 Units (instead of 4.0 Units) behind to actually affect the vocal cord muscle.

What does this information mean? Well, it does suggest strategies to improve clinical efficacy while causing less severe and shorter duration of side effects. How? By using smaller volumes to decrease risk of diffusion. How can one use less volume, but maintain or even increase effective dosage amounts? By distributing a large dose over multiple injections instead of one injection. By using multiple injections, one is effectively using smaller volumes over multiple injection sites, a strategy known as “saturation of injection site”. Such a strategy may result in improved outcomes after Botox injections without resorting to large doses of Botox with its attendant side effects.

Though physicians throughout the world are investigating other experimental treatment options for spasmodic dysphonia such as selective laryngeal nerve denervation reinnervation, thyroarytenoid myectomy, thyroplasty, and carbon dioxide laser ablation, this study does bring to light that the old standard of Botox injection also has much room to become even better. Although the strategies based on this study have yet to be verified in clinical studies, it does bring up the that fact that even something as straightforward and simple as an injection can be further refined and improved upon.

Dr. Chang does provide Botox injections for patients with spasmodic dysphonia every Friday afternoon in Warrenton, Virignia.



Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More
Posted in botox, General News, spasmodic dysphonia | No comments

Monday, 27 August 2007

Office Will be Closed Sept 17-19, 2007!

Posted on 03:40 by Unknown
Fauquier ENT will be closed Sept 17-19, 2007. Our physicians will be attending a medical conference during that time period. Although office staff will be available for a limited number of hours to answer phone calls, no office visits will be scheduled during that time period and no allergy shots will be given. Please schedule accordingly.
Read More
Posted in General News | No comments

Saturday, 4 August 2007

Intra-Tympanic Steroid Injections Offered at Fauquier ENT

Posted on 18:37 by Unknown
Intra-tympanic steroid injections are offered at Fauquier ENT. This treatment modality is used in patients with sudden sensorineural hearing loss that responds minimally or not at all to systemic steroids (ie, prednisone). This treatment may be used without systemic steroids trial if there are contraindications to systemic steroid use such as intestinal ulcers and diabetes. The downside is that this treatment works best only if given within the first 36 days after the hearing loss occurs.

Intra-tympanic steroid injections have also been found to potentially help certain patients with tinnitus.

Watch video of this being performed here or watch below.

References
• Intratympanic corticosteroids for Meniere's disease and vertigo. Otolarngol Clin N Am. 37:955-972. 2004 Link
• Intratympanic perfusion for the treatment of tinnitus. Otolaryngol Clin N Am. 37:991-1000. 2004 Link
• Intratympanic steroids for sensorineural hearing loss. Otolaryngol Clin N Am. 1061-1074. 2004 Link
• Intratympanic Dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy. Laryngoscope. 117:3-15. 2007. Link
• Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg. 133:251-59. Link
• Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes. Otolaryngol Head Neck Surg. 141:572-578. Link
• Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL. Otolaryngol Head Neck Surg. 141:579-583. Link

Read More
Posted in ear, General News, hearing loss, injection, intra-tympanic, meniere's disease, nerve, NewsFlash, ssnhl, steroid, sudden, tinnitus | No comments

Saturday, 21 July 2007

Websites That Link to Our Website

Posted on 19:27 by Unknown
Recently, it was brought to my attention that websites by other entities have linked to webpages contained within our website. Here is a list of those websites (excluding search engines, directories, wikis, etc):

Allergy Blog
MenieresInfo.com
New York Voice Center
VoiceDoctor.net
MonkeyFilter | Not Speechless Blog
EconoCulture Blog
Blog Fauquier
National Voice Center Referral Database
Read More
Posted in General News | No comments

Wednesday, 11 July 2007

New Voice Team Member!

Posted on 16:33 by Unknown
Her name is Dr. Carmen Ana Ramos Pizarro and she has a PhD in speech-language pathology with an emphasis in voice science. She will be at Fauquier Hospital every Monday afternoon to lend her considerable expertise and experience to assist in caring for patients with vocal problems.

She obtained her speech pathology PhD at University of Wisconsin-Madison majoring in the voice sciences. She went on to be the director of the Voice Clinic at the Grabschied Voice Center in New York City as well as Puerto Rico Medical Center before coming to Northern Virginia.

Addendum 1/3/08:
Her status is pending Virginia Licensure.
Read More
Posted in General News | No comments

Sunday, 24 June 2007

Dr. Chang Elected to Treasurer of the Duke Otolaryngology Alumni Society

Posted on 16:59 by Unknown
On June 22, 2007, Dr. Chang was elected to become the Treasurer of the Duke Otolaryngology Alumni Society for a 2 year term. The Society is a 501(c)(3) organization. The organization's website is:

http://www.DukeOHNS.com
Read More
Posted in alumni, duke, General News, otolaryngology | No comments

Thursday, 14 June 2007

Yet Another Reason to Quit Smoking! A Really Deep Voice...

Posted on 02:41 by Unknown

I recently saw a female patient complaining of a deep voice... and it's been getting deeper over the years. She also is a big-time smoker and talker. Fiberoptic laryngoscopy revealed early stage Smoker's Polyps. An example of Smoker's Polyps with video and audio feed is shown here on our website.

This condition almost always is due to the combination of smoking (a lot) and talking (a lot). Though it is not cancer, it is yet another reason to stop smoking!

--Dr. Chang
Read More
Posted in General News, polyp, vocal cord | No comments

Wednesday, 13 June 2007

Layperson's Cure for Snoring and Obstructive Sleep Apnea?

Posted on 02:34 by Unknown
As people may know from reading our article on snoring on our website, there are many different levels in our upper airway anatomy that may contribute to the noise produced. However, most commonly, the culprit sources are the tongue and palate. Procedures such as the "Pillar Procedure" that has recently received media attention as well as UPPP address only the palate. Procedures like base of tongue reduction, hyoid advancement, etc that address the tongue are more difficult and morbid.

However, I was recently at a conference where a prominent Australian ENT gave a talk where he mentioned one previously unreported way to treat OSA and snoring due to the tongue...

DISCLAIMER: I am not advocating one way or another this treatment! I am just mentioning as something of interest. As always, see your doctor before proceeding with any type of treatment!

Apparently, there is a community in Australia where citizens put tongue bolts in their tongue, not because it looks cool, but because it really, truly helps with snoring as well as OSA. Apparently, when these citizens go to sleep, they place a rubber band around the tongue bolt and anchor it to their front teeth. This method would prevent the tongue from vibrating as it would stretch and stiffen the tongue AND also prevent the tongue from falling backward.

This simple procedure actually duplicates the surgical procedures performed in the United States including hyoid advancement, genioglossus advancement, Repose tongue advancement, etc. All these surgical procedures for the tongue, in essence, try to anchor the tongue forward, just like the tongue bolt/rubber band technique.

Now that's food for thought!
Read More
Posted in General News, obstructive sleep apnea | No comments

Tuesday, 12 June 2007

Pillar Procedure Offered At Fauquier ENT

Posted on 18:06 by Unknown

We have suddenly noticed a number of phone calls to our office as well as inquiries from our established patients regarding the Pillar Procedure for snoring and obstructive sleep apnea after a recent television news report.

We used to offer this procedure, but as of Jan 2010, we no longer do.
Read More
Posted in General News, obstructive sleep apnea, snoring | No comments

Tuesday, 5 June 2007

Original Research By Dr. Chang Published in Peer-Reviewed Otolaryngology Journal

Posted on 06:13 by Unknown

In the June 2007 edition of the journal Otolaryngology-Head & Neck Surgery, Dr. Chang's original research has been published. The title of the paper is "Relationship of botulinum dosage to duration of side effects and normal voice in adductor spasmodic dysphonia." Click here to read the abstract.

Dr. Chang treats patients with spasmodic dysphonia using BOTOX every Friday afternoon. To watch a video of how exactly her performs this procedure in a patient, click here.



Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More
Posted in botox, General News, In The News, spasmodic dysphonia | No comments

Thursday, 5 April 2007

Virginia Voice & Speech Center (VVSC)

Posted on 17:50 by Unknown

A new website heralding the creation of a new organization dedicated to helping people with poor vocal/speech quality has been created. The new organization, called the Virginia Voice & Speech Center, is a consortium of professionals including ENT physicians, speech pathologists, and singing voice instructors.

http://www.VVSC.org
Read More
Posted in General News, NewsFlash, Website Update | No comments

Sunday, 4 March 2007

Tonsillectomy Reduces Frequency of Strep Pharyngitis in Children

Posted on 16:44 by Unknown
A recently published article suggested that tonsillectomy was associated with a decrease in the incidence and frequency and an increase in the time to the next infection in children with recurrent strep throat.

This finding is something many ENTs have suspected, but now there is evidence to support.

Reference: Efficacy of Tonsillectomy in Treatment of Recurrent Group A B-Hemolytic Streptococcal Pharyngitis. Laryngoscope. 116:1946-1950. 2006. Link
Read More
Posted in General News | No comments

Wednesday, 14 February 2007

Office Closed Due to Weather and Email Errors Due to Server Crash

Posted on 12:25 by Unknown
Our office has been closed from 2/13/07 to 2/14/07 due to severe weather conditions. Also, the server handling our email has crashed sometime in 2/13/07. Technicians are working to get this back up so patients can email us. Please call/fax to get in touch with us until repairs have been made (hopefully soon!).

ADDENDUM (2/16/07): Email is working now... Thank you for your patience.
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Posted in General News | No comments

Sunday, 11 February 2007

Article in USA Today on Vocal Cord Dysfunction

Posted on 07:19 by Unknown
I read this article in USA Today on vocal cord dysfunction and though this condition does exist, I do believe it is over-diagnosed. Another common cause of stridor with exercise is due to non-organic stridor where the vocal cords are so pliable, they vibrate even when they are widely apart, especially in young female athletes.

The key for diagnosis is to perform a fiberoptic laryngoscopy when symptommatic. Previous patients of mine know that I make them run laps around our office building until they start having symptoms at which time I will perform the exam. Here is more info on this particular topic.
Read More
Posted in General News, paradoxical vocal cord, vcd, vocal cord dysfunction | No comments

Article in USA Today on Spasmodic Dysphonia

Posted on 07:17 by Unknown
On January 15, 2007, an article appeared on spasmodic dysphonia in USA Today. Click here to read the article.

Dr. Chang treats patients with spasmodic dysphonia using BOTOX every Friday afternoon. To watch a video of how exactly her performs this procedure in a patient, click here.



Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More
Posted in General News, spasmodic dysphonia | No comments

Wednesday, 31 January 2007

Nasal Steroids DO Help Resolve Sinusitis More Quickly Than Antibiotics Alone

Posted on 04:07 by Unknown
Not sure why more doctors don't prescribe nasal steroids (ie, flonase, nasacort, rhinocort, nasonex, etc) in addition to antibiotics to treat sinusitis, especially those in which it is recurrent or chronic. It's been shown that nasal steroids do help more than antibiotics alone. The study I'm most familiar with is the one published in JAMA in 2001.

Reference: Comparison of cefuroxime with or without intranasal fluticasone for the treatment of rhinosinusitis. The CAFFS Trial: a randomized controlled trial. JAMA. 286(24):3097-105, 2001. Link
Read More
Posted in General News | No comments

Wednesday, 17 January 2007

Decongestants and Antihistamines Found Not to Help with Serous Otitis Media

Posted on 05:03 by Unknown
There has been a recent Cochrane review regarding whether serous fluid in the middle ear improves with decongestants and/or anti-histamines which are commonly prescribed by both pediatricians and ENTs for this condition. This review which analyzed the results from 7 studies revealed that these medications had NO impact on the resolution of serous otitis media. In fact, there were significant side effects detected in 1 out of every 9 children prescribed these medications without any significant impact on the fluid.

Reference: Extracts from the Cochrane Library: Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Otolaryngol Head Neck Surg 136(1):11-13, 2007. Link.
Read More
Posted in General News | No comments

Friday, 5 January 2007

Possible Treatment for Tinnitus in a Pill???

Posted on 09:01 by Unknown
One of our patients today brought us an article describing a drug, acamprosate (Campral), used to treat alcoholism that was found to also help with tinnitus in 86.9% of patients in a placebo-controlled drug study. Our practice is open to trying this medication for those interested. More info can be found here.
Read More
Posted in General News | No comments
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