I recently took care of a young patient who was diagnosed with a large neck mass that was compressing his windpipe and carotid and jugular vessels. He was diagnosed with tongue cancer years ago with a recurrence in 2008. He underwent surgery, radiation, and chemotherapy but unfortunately the neck mass developed. He fought hard. His family provided extraordinary support. However, there was nothing medically that could be performed to cure his cancer.
Reviewing his case, I expected to find the cause of the tongue cancer. I expected to see a tobacco history but he never smoked. He had no significant history of alcohol, drug, or tobacco use including chew tobacco. We looked at environmental and work exposures but found no association. He worked in HVAC. Bad things can happen to healthy people.
In medicine, we assess risk factors, find causes, and prevent potential severe medical conditions. We advise people to stop smoking to reduce the chance of heart disease. We encourage exercise and healthy diets to reduce the obesity epidemic. We vaccinate children to prevent Polio, Measles, Mumps, etc...We advise colonoscopies, pap smears, mammograms to prevent cancer. However, as in life, the unexplainable does occur in medicine.
One of the most frustrating aspects in medicine is when bad things happen to healthy people. This young man had no risk factors for tongue cancer yet he was diagnosed at around thirty years of age. The median age for tongue cancer is sixty. Risk factors include tobacco use, alcohol, HPV, and age. The incidence is about three per 100,000 per year (rare). We can only blame a faulty gene. The thought is always what could we have done to prevent this but unfortunately the answer is nothing.
Does this case reduce the importance of preventative medicine and risk factor stratification? No. It makes me appreciate how delicate and precious human life is and to be more cognizant about medical "zebras" and rarities. It makes preventative medicine more important so people can live life to its fullest. Therefore, eat healthy, drink in moderation, avoid drugs, do not smoke, exercise, and laugh. And if something bad does happen, understand that there is always a silver lining somewhere in the clouds, whether it be improving a physician's skill, bringing a family together, or making people appreciate their own lives.
Also, pray for the citizens of Haiti. It is a devastating situation and I wish to all my colleagues who are going to Haiti a safe journey.
Thank you.
Monday, January 25, 2010
Monday, January 18, 2010
Please Stop Smoking!
The past several months I have had a run on severe tobacco related illnesses. Smoking is very detrimental to the vital organs but yet about 46 million adults smoke in the United States. Here are several patient cases...
50 year old male presented to me with complaints of chest pain and shortness of breath. He smokes 2 packs a day for 30 years. He has a history of high blood pressure but was not taking his medication due to cost (but yet could afford his 2 pack a day habit). He was sent to the ER and was found to have a myocardial infarction (heart attack). He underwent cardiac stenting and is now on multiple medications to prevent another heart attack.
70+ year old female presented to the office with chest pain and back pain. She smoked a pack a day for over forty years. A chest xray was done and a mass was found. After further diagnostics, she was diagnosed with lung cancer and the tumor had wrapped around her heart. Surgery could not be performed. Palliative therapy was done and she passed away.
A young twenty-something adult came to me with complaints of exertional shortness of breath. He was hospitalized for pneumonia several months ago. He continues to wheeze and utilizes two inhalers to stabilize his breathing. The patient began smoking when he was eight and continues despite repeated counselling to quit. He is a laborer but now has difficulty with exertional work. His quality of life is poor and he has difficulty keeping up with his young son.
A 60+ year old male saw me in the office with flu-like symptoms. He had trouble breathing, fever of 104, fatigue, and muscle aches for several days. Supportive care was advised with follow up. Several days later, his relative called and said he was confused. He was admitted to the hospital and diagnosed with pneumonia. Despite aggressive antibiotics, steroids, and oxygen support, he decompensated within 24 hours and was intubated (tube placed into his lungs). Upon further investigation, he had smoked 1 and a half pack a day since childhood and his lungs were in poor shape. Due to his smoking history, he developed COPD (chronic obstructive pulmonary disease) which made him very susceptible for respiratory infections and failure. He is recovering.
A 60+ year old female presented to the office with an oral gum lesion for several weeks. It was a raised mass with ulcerations on her lower gum line. She has poor dentition. She had smoked for many years. The patient was reluctant to go to the specialist but eventually listended to my advice. The biopsy revealed squamous cell carcinoma (cancer) and a total excision was performed. This scare resulted in her quitting tobacco.
This is just a sample of cases I see that are tobacco related problems. Smoking can contribute to many health problems such as COPD, lung cancer, heart disease, oral cancers, asthma, strokes, heart attacks, emphysema, pancreatic cancer, bladder cancer, high blood pressure, cervical cancer, peripheral vascular disease, pneumonia, kidney cancer, impotence, psychological disorders, fetal problems, etc....
Help is out there. Call your health care professional to help quit this deadly habit!
50 year old male presented to me with complaints of chest pain and shortness of breath. He smokes 2 packs a day for 30 years. He has a history of high blood pressure but was not taking his medication due to cost (but yet could afford his 2 pack a day habit). He was sent to the ER and was found to have a myocardial infarction (heart attack). He underwent cardiac stenting and is now on multiple medications to prevent another heart attack.
70+ year old female presented to the office with chest pain and back pain. She smoked a pack a day for over forty years. A chest xray was done and a mass was found. After further diagnostics, she was diagnosed with lung cancer and the tumor had wrapped around her heart. Surgery could not be performed. Palliative therapy was done and she passed away.
A young twenty-something adult came to me with complaints of exertional shortness of breath. He was hospitalized for pneumonia several months ago. He continues to wheeze and utilizes two inhalers to stabilize his breathing. The patient began smoking when he was eight and continues despite repeated counselling to quit. He is a laborer but now has difficulty with exertional work. His quality of life is poor and he has difficulty keeping up with his young son.
A 60+ year old male saw me in the office with flu-like symptoms. He had trouble breathing, fever of 104, fatigue, and muscle aches for several days. Supportive care was advised with follow up. Several days later, his relative called and said he was confused. He was admitted to the hospital and diagnosed with pneumonia. Despite aggressive antibiotics, steroids, and oxygen support, he decompensated within 24 hours and was intubated (tube placed into his lungs). Upon further investigation, he had smoked 1 and a half pack a day since childhood and his lungs were in poor shape. Due to his smoking history, he developed COPD (chronic obstructive pulmonary disease) which made him very susceptible for respiratory infections and failure. He is recovering.
A 60+ year old female presented to the office with an oral gum lesion for several weeks. It was a raised mass with ulcerations on her lower gum line. She has poor dentition. She had smoked for many years. The patient was reluctant to go to the specialist but eventually listended to my advice. The biopsy revealed squamous cell carcinoma (cancer) and a total excision was performed. This scare resulted in her quitting tobacco.
This is just a sample of cases I see that are tobacco related problems. Smoking can contribute to many health problems such as COPD, lung cancer, heart disease, oral cancers, asthma, strokes, heart attacks, emphysema, pancreatic cancer, bladder cancer, high blood pressure, cervical cancer, peripheral vascular disease, pneumonia, kidney cancer, impotence, psychological disorders, fetal problems, etc....
Help is out there. Call your health care professional to help quit this deadly habit!
Monday, January 11, 2010
Acute Sinusitis
In recent months, I have seen many complaints of sinus infections. The typical patient will come to the office and complain of facial pain around the cheeks with a fever and nasal drainage. Acute sinusitis is a very common illness in the primary care setting, accounting for about 16 million office visits per year.
Acute sinusitis is inflammation of the sinuses or cavities around the nasal passages. Sinuses are air chambers that make mucus to clear particles and organisms in the air. Cilia, or tiny hairs, clears out the mucus from the sinuses and helps it drain through the nasal canals. The swelling from sinusitis interferes with drainage an
d mucus builds up in the cavities. The mucus then becomes a breeding ground for infection.
The most commonly affected area in adults is the maxillary sinus. In children, it is the ethmoid sinus.
The causes of sinusitis include:
Risk factors include:
Signs and symptoms (up to 4 weeks) include:
Treatment includes:
If the symptoms do not improve after several days, contact your health care professional.
If the symptoms do not improve after sufficient treatments, diagnostic imaging such as a CT may be taken to confirm diagnosis. Specialist referral to an ENT usually are reserved to persistent sinusitis, mental status changes, severe facial or dental pain, severe swelling or redness around the eyes, visual complaints, high fever, and sinusitis refractory to medical management.
Contact your health care professional for more information.
Acute sinusitis is inflammation of the sinuses or cavities around the nasal passages. Sinuses are air chambers that make mucus to clear particles and organisms in the air. Cilia, or tiny hairs, clears out the mucus from the sinuses and helps it drain through the nasal canals. The swelling from sinusitis interferes with drainage an
d mucus builds up in the cavities. The mucus then becomes a breeding ground for infection.The most commonly affected area in adults is the maxillary sinus. In children, it is the ethmoid sinus.
The causes of sinusitis include:
1. Viral (Rhinovirua, Influenza, Adenovirus, Parainfluenza)
2. Bacteria (Streptococcus, Haemophillus, Moraxella)
3. Fungal (Aspergillus, Mucormycosis) in immunocompromised patients (Diabetics, HIV, cancer patients)
Risk factors include:
1. Allergies
2. Nasal passage abnormalities (deviated septum, polyps)
3. Trauma
4. Dental infections
5. Recurrent upper respiratory infections
6. Nasal dryness
7. Inhaled irritants (tobacco smoke)
8. Immune disorder
9. Inflammatory disorder
10. Hormones
Signs and symptoms (up to 4 weeks) include:
1. Pain/pressure in the cheeks, between the eyes, forehead, or nose (worse when leaning forward)
2. Upper teeth pain
3. Headache
4. Fever
5. Bad breath
6. Nasal drainage (yellow/green)
7. Trouble breathing through the nose
8. Reduced ability to taste or smell
9. Cough at night
10. Nausea
11. Fatigue
12. "Double sickening" (Patient begins with a cold, gets better, then gets worse again)
Treatment includes:
1. Saline nasal spray (Ayr or Ocean spray)
2. Short term decongestant (Sudafed)
3. Anti-inflammatory (ibuprofen)
4. Fluids
5. Rest
6. Moist heat on the sinuses (warm compresses)
7. Humidifier
8. Avoid anti-histamines
If the symptoms do not improve after several days, contact your health care professional.
Typically viral sinus infections will improve after 5-7 days. Acute bacterial sinus infections usually require antibiotics.
If the symptoms do not improve after sufficient treatments, diagnostic imaging such as a CT may be taken to confirm diagnosis. Specialist referral to an ENT usually are reserved to persistent sinusitis, mental status changes, severe facial or dental pain, severe swelling or redness around the eyes, visual complaints, high fever, and sinusitis refractory to medical management.
Major complications are extremely rare.
Contact your health care professional for more information.
Thank you and have a nice day.
Sunday, January 3, 2010
Tobacco Cessation
The new year always brings resolutions such as weight loss, exercising, improving relationships, etc. Another very common one is tobacco cessation or trying to quit smoking. Here are some strategies to help with this difficult yet attainable resolution.
1. Go cold turkey if possible. It can be done, especially in cases where an individual smokes less than a pack a day.
2. You need to really want it!!! Daily commitment is a requirement when trying to quit.
3. Set a quit date. Make it a meaningful date such as a wedding anniversary, birthday, or holiday.
4. Take advantage of counselling programs to keep motivated. It can range from phone sessions to group meetings.
5. Understand the positives when quitting such as improved breathing, lower risk for heart disease, whiter teeth, better breath, lower risk for lung cancer, more available money, etc...
6. Utilize social support from friends and family members. If other people smoke, make it a group goal and support one another.
7. Remove cigarettes, ash trays, other related items to reduce the urges.
8. Avoid or change habits that trigger tobacco use (i.e. alcoholic drink at a bar).
9. Avoid smoking environments and eat at non-smoking restaurants.
10. Reward yourself in successful weekly or monthly intervals.
11. Do it for the children...second hand smoke increases asthma attacks, allergies, ear infections, sinus infections, etc.
12. Talk to your physician about medications such as Chantix, bupropion, or nortriptyline, especially if smoking more than one pack a day.
13. Utilize nicotine replacement supplements to help with the cravings and withdrawal symptoms such as the gum, patch, nasal spray, lozenge, or inhaler.
14. Do not let smokers smoke in your house or car.
15. Exercise and eat healthy to keep your weight stable.
16. Chew gum, eat carrot sticks or pretzels, suck on lollipops, to keep your mouth busy.
17. Try alternative therapies such as hypnosis, acupuncture, or acupressure.
18. It is OK to "slip." Try again and get back on track.
19. Stop the excuses.
20. It is all about "one day at a time."
21. Try Quit Meters (available online) to keep track of your success
22. Find a healthy passion to replace smoking such as leading a tobacco cessation group.
23. NEVER GIVE UP!!!
24. Talk to your health care professional...use them as a resource.
Check out the QuitNow website or call 1-800-QuitNow (free service)
Thank you and have a Great New Year!!!
1. Go cold turkey if possible. It can be done, especially in cases where an individual smokes less than a pack a day.
2. You need to really want it!!! Daily commitment is a requirement when trying to quit.
3. Set a quit date. Make it a meaningful date such as a wedding anniversary, birthday, or holiday.
4. Take advantage of counselling programs to keep motivated. It can range from phone sessions to group meetings.
5. Understand the positives when quitting such as improved breathing, lower risk for heart disease, whiter teeth, better breath, lower risk for lung cancer, more available money, etc...
6. Utilize social support from friends and family members. If other people smoke, make it a group goal and support one another.
7. Remove cigarettes, ash trays, other related items to reduce the urges.
8. Avoid or change habits that trigger tobacco use (i.e. alcoholic drink at a bar).
9. Avoid smoking environments and eat at non-smoking restaurants.
10. Reward yourself in successful weekly or monthly intervals.
11. Do it for the children...second hand smoke increases asthma attacks, allergies, ear infections, sinus infections, etc.
12. Talk to your physician about medications such as Chantix, bupropion, or nortriptyline, especially if smoking more than one pack a day.
13. Utilize nicotine replacement supplements to help with the cravings and withdrawal symptoms such as the gum, patch, nasal spray, lozenge, or inhaler.
14. Do not let smokers smoke in your house or car.
15. Exercise and eat healthy to keep your weight stable.
16. Chew gum, eat carrot sticks or pretzels, suck on lollipops, to keep your mouth busy.
17. Try alternative therapies such as hypnosis, acupuncture, or acupressure.
18. It is OK to "slip." Try again and get back on track.
19. Stop the excuses.
20. It is all about "one day at a time."
21. Try Quit Meters (available online) to keep track of your success
22. Find a healthy passion to replace smoking such as leading a tobacco cessation group.
23. NEVER GIVE UP!!!
24. Talk to your health care professional...use them as a resource.
Check out the QuitNow website or call 1-800-QuitNow (free service)
Thank you and have a Great New Year!!!
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