Fauquier Hospital Featured in the Washington Post

Not sure how I missed it, but I was recently informed that Fauquier Hospital was featured in the Washington Post on March 24, 2009 after the hospital received a "designated" status by Planetree Organization. That's a great honor especially when considering Fauquier Hospital is one of only 8 hospitals in the entire country with that honor.

What exactly does this designation mean in terms of patient care?

• Private patient hospital rooms
• Family and friends can drop by any time, day or middle of the night
• Food that's actually good
• Patient friendly architectural features including:

• built-in sleeping accommodations for family members
• carpeted corridors and additional windows
• lamps have replaced overhead lighting
• halls have been carpeted to keep down noise or are finished in faux wood for a warmer feel
• community artwork hangs on the walls
• barriers between patients and staff, such as those sliding-glass windows that close nurses off from patients and the public, have been removed
• elevators for patients and the public are separate
• no constant paging over the intercom system, either; instead, unobtrusive music plays all the time.

Also, a culture fostering patient care is presented.

Given I'm a physician on staff at this hospital, I can say it is all true!

Congratulations to the hospital!

Read the Washington Post article here.

Epiglottitis Killed President George Washington?

I came across a great blog post by Michael Hebert regarding a book review of Joseph Ellis' biography His Excellency: George Washington.

Apparently, at the age of 67, President George Washington died in 1799. I quote from the blog post the following account:

"One morning in mid-December 1799, Washington went out, as it was his daily habit, on horseback from his home to inspect his Mount Vernon property. That particular day the weather was very cold and there was an ice storm. It is said that Washington spent five hours out in freezing rain, then returned home and dined with guests in his wet clothes because he did not want to keep them waiting. The next day he complained of a sore throat and was hoarse, but otherwise appeared well. The following night he awakened Martha to tell her that he felt a severe pain in his throat, and was having trouble breathing.

The next day his personal physician, Dr. James Craik, was summoned. Craik diagnosed the condition as life threatening, and hastily assembled a team of doctors for aggressive treatment. They bled him of five pints of blood, burned his neck, and gave him calomel, a mercury compound used as a purgative but which probably did little more than induce mercury poisoning. Finally, after several days of this torture, Washington displayed the judgment that made him a great president and told them to stop. According to Ellis: “Eventually Washington ordered his doctors to cease their barbarisms and let him go in peace. ‘Doctor,’ he muttered, ‘I die hard, but I am not afraid to go” (p.269). He expired a few hours later."

According to the biographer, Pres. George Washington died of a serious childhood infection called epiglottitis which is an infection of the soft tissue flap (epiglottis) guarding the entrance of the voicebox. It is for which the Hib vaccine given to all kids now makes this type of infection a rarity (in fact, in my entire 10 year career so far as an ENT, I've seen only 3 cases so far).

However, I do agree with the blog article that epiglottitis is unlikely to be the actual cause for Pres. George Washington's sore throat and eventual death. Given his ripe age of 67, he would have developed natural immunity to the germ (Haemophilus influenzae type B) that causes epiglottitis and as such, it would be highly unusual (but not impossible) cause of infection and death. As the blogger stated, a more likely cause of the sore throat that eventually lead to his death is a peritonsillar abscess, a far more common cause of sore throats that could lead to death if not treated. Indeed, I see about 3-4 peritonsillar abscesses in my clinic per month during the winter season. It is also not unusual for a person to go from normal to developing a peritonsillar abscess within 1-2 days.

Ludwig's angina is the other possible culprit the blog post addressed which I also find unlikely. Ludwig's angina in essence is an infection of the submandibular salivary gland and would have presented with a huge swelling under the tongue and under the jawline (see picture to right)... two symptoms I would think that would have been documented in George Washington's history.

In any case, it is entirely possible that his physicians may have contributed to his death... blood-letting of 3.75 liters... Gosh... a human adult has about 5 liters of blood. As far as I'm concerned... that's medical malpractice and one could argue first degree murder. Add mercury poisoning as well.

You can purchase the biography of George Washington here.

Reuters: Damp house linked to kids' risk of nasal allergies

Reuters published a story on July 30 regarding a Finnish study that found that those children who lived in homes with dampness or mold problems were more likely to develop allergic rhinitis during the 6 year study period.

16 percent of children whose parents reported dampness in the home went on to be diagnosed with allergic rhinitis over the next six years. That compared with just under 12 percent of children whose parents reported no dampness problems. Children whose parents reported any mold or water damage in the home at the outset were 55 percent more likely than other children to develop allergic rhinitis -- connected to any allergen, and not just mold.

Read the Reuters story here.

Reference:
Home Dampness and Molds as Determinants of Allergic Rhinitis in Childhood: A 6-Year, Population-based Cohort Study. Am J Epidemiol. 2010 Jul 16.

NYT: Can Foods Trigger Migraines (and Other Symptoms)?

The New York Times published a story on July 26, 2010 discussing how foods can indeed trigger migraines. The story quotes a study where patients were tested for IgG food allergies and their diet modified to either include or exclude the suspect foods. What they found is that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.

Patients should be aware that IgG food allergies are NOT the life-threatening allergies that may can cause airway swelling and even death (ie, peanut allergy). Such life-threatening food allergies are IgE mediated and not IgG. Patients allergic to IgG foods can STILL eat the foods they are allergic to, but it is recommended to limit the intake if they want to feel better.

Other alleged symptoms that IgG foods allergies can cause include the following:
• Nausea
• Fatigue
• Drowsiness
• Flatulence
• Reflux
• Skin disorders
• Globus
• Mild Sore Throat
• Dizziness
• Meniere's
• Ear problems

All of these symptoms are mild and cause more annoyance rather than actual disability.

Read the NYT article here.

Reference:
Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010 Jul;30(7):829-37. Epub 2010 Mar 10.

USNews: Cold versus Allergies... How to Tell The Difference

US News and World Report came out with a story on July 27, 2010 regarding how one can tell the difference between an allergy versus a cold, especially since each has symptoms in common.

Especially with mild symptoms, it may be hard even for an ENT to distinguish the two. Add chronic sinus infections and flu to the mix, it can be downright difficult without allergy testing, CT scans, and other types of testing to come up with a correct diagnosis.

To help distinguish among these possible illnesses, at least based on history, here is a chart our office has made.

NIH also has produced a chart that can be seen here.

Click here to read the US News & World Report story.