Tinnitus

Tinnitus is a condition when someone hears ringing, buzzing, hissing or roaring in one or both ears. The sound may get louder or softer during movement or exercise.  It may also interrupt sleep. A conservative estimate is that 10% of adults have the condition and many don’t even mention it to their physicians. Certain patterns of tinnitus (such as pulsatile or clicking) may merit a specific evaluation.

Tinnitus may be caused by damage to cells in the inner ear caused by loud noises, some medications, head or neck injuries and certain diseases. Tinnitus is more common in women and becomes more common with aging. Tinnitus is difficult to cure but there are treatment options.

There are wearable masking devices available as well as hearing aids. Amplifying the outside sounds can make the inner noise of tinnitus less bothersome. A tinnitus expert can help train you to ignore the sound and biofeedback may make the sound less annoying or stressful. Listening to quiet music or a white noise machine can achieve a lesser degree of masking

Depression is common in people with tinnitus; there are good treatments for depression as well as for tinnitus. Long-term tinnitus is unlikely to go away completely but with help can be less bothersome.

More information: American Tinnitus Association.

Epididymitis

The epididymis is a partner to the testicle in the scrotum. It has an important role in helping sperm mature enough to be able to swim. It is almost always a silent partner – until it’s not. Inflammation of the epididymis develops over several days and is almost always only on one side. Symptoms are a hot, tender and swollen hemi-scrotum. Urination may be frequent and painful.

In young sexually active men the most common causes of epididymitis are chlamydia and gonorrhea. In older men enteric pathogens (bad bowel bacteria) are to blame. Treatment relies on supportive measures, including bed rest, scrotal elevation, and analgesics, in conjunction with empiric antibiotic therapy based on the patient's age and clinical and sexual history. If chlamydia or gonorrhea is confirmed all sexual partners should be treated.

There are some unusual causes of epididymitis, such as drug induced and vasculitis. Withdrawal of the medication and treatment of the underlying disease are appropriate. Almost all cases resolve completely and failure to improve within three days should prompt reevaluation of the diagnosis and/or treatment. It is important to complete a full course of treatment to prevent complications.

More information - with pictures! 

E-prescribing

E-prescribing allows me to electronically send an accurate, error-free and understandable prescription directly to the pharmacy. I can send the prescription to local as well a mail-order pharmacies and I can verify that that the prescription was actually received. In many cases, the software will query the patient’s insurance company and I will be able to see if a less expensive option is possible.

Another advantage of e-prescribing is that I will alerted to potential drug interactions to medication prescriber by other practitioner as well as to potential drug allergies. Patients don’t always remember adverse effects from medications taken long ago but if someone entered that data the software will pull it forward.

In New York, all controlled substance must be electronically prescribed; paper, fax and telephone prescriptions will not be accepted. In contrast, prescriptions for controlled substances in Connecticut must be printed onto tamper-proof paper and presented to the pharmacy along with appropriate identification. Before prescribing any controlled substance the practitioner must check the centralized database that lists all controlled substances dispensed to patient.

From the Connecticut Department of Consumer protection: The purpose of the CPMRS is to present a complete picture of a patient’s controlled substance use, including prescriptions by other providers, so that the provider can properly manage the patient’s treatment, including the referral of a patient to services offering treatment for drug abuse or addiction when appropriate.

It has been years since I have written a paper prescription. I still have a few (locked up) which I will use for travel immunizations from the health department. E-prescribing makes for better patient care. Even though the new narcotic laws may be irritating to patients they too lead to better patient care.

The Department of Consumer Protection has useful information. 

Cataracts

A cataract clouds the lens of the eye and this blocks or changes the way light passes through the eye. If not enough light gets through the person will be blind. A commonly performed surgery can restore better sight.

Risk factors for developing cataracts including aging, overexposure to ultraviolet rays from the sun, smoking, diabetes and long-term steroid use.

Symptoms of a cataract:

·      light seems to be too dim for reading or close-up work or overwhelmingly bright

·      blurred vision, double vision or  a sense of a film over the eyes

·      eyeglass prescriptions change often without improvement in vision.

As part of a comprehensive examination, an ophthalmologist will test vision, eye pressures and assess the density of a cataract. Everyone over the age of 65 should have an eye exam every two years, even if there doesn’t appear to be any problem seeing.

Don't let a cataract limit your life: more information. 

Malaria

Malaria was eliminated form the United States in 1951 but is still deadly around the world. There were 214 million cases and 438,000 deaths in 2015, mostly young children in sub-Saharan Africa. Each year approximately 1,500 travelers become infected abroad and return to the United States.

 

Anyone can get malaria. Usually people get malaria after being bitten by an infective Anopheles mosquito but malaria is also transmitted by shared needles or syringes. It is not sexually transmitted. Symptoms start ten days to four weeks after infection.

Many effective anti-malaria medications are available. It is best to buy the medications in the United States since there is a risk of counterfeit medications and/or the medications may not be safe. There is no vaccine available yet.

A comprehensive review from the CDC answers almost all questions.