* NEW JERSEY MAN ASKS IF HE WILL LOSE HIS THUMB?  READ WHY.

"A few years I had a fungus on my toe.  I had it treated,  and now after having a small accident at work where I cut my thumb, I have contracted a sort of a fungus.  Is it related to my preious fungus or due to my accident.  It does not hurt but have swelling.  Will I lose my thumb?"  ( JS, New Jersey)

Hi JS,

After visiting with you in person, you appear to have onychomycosis (also called tinea unguium), a fungal infection of the nail bed, nail matrix, and or the nail plate.  This infection is most commonly caused by Trichophyton rubrum, which invades the nail bed and underside of the nail plate.   This infection commonly infiltrates the toenails more than the fingernails, and the  fungus most commonly spreads due to exposure to moist environments such as wearing occlusive footwear, walking in gym rooms, spas, or  fitness centers, and not allowing drying of the skin.  

In fact, almost 33% of all skin fungal infections and 50% of all nail disease is linked to onychomycosis.   Fungus in the body may indicate a weakened immune system; thus, your doctor should order tests to check for any immunocompromised states.  In diabetics, onychomycosis may indirectly decrease peripheral circulation worsening venous stasis and diabetic foot ulcers.  

Regardless of the cause, onychomycosis is easily diagnosed, and treatments are readily available.  Although you mentioned applying an over the counter, topical agent to your nails, the spread of the fungus from your toes to your thumb likely suggests that the fungus is in your blood and stronger medicines are needed to kill the fungus.  Commonly used antifungals are terbinafine and itraconazole but doctors may prescribe griseofulvin and  ketoconazole based on the individual patient's allergy and past medical history. 

Your homosexual relations lends credence to the possibility of  you having contracted AIDS and a subsequent weakened immune system.  The weakened immune system lacks the ability to kill bacteria, viruses, and fungus that enter or exist in the blood; thus, pathogens are able to freely float from one extremity of the body to another extremity. 

Set up an appointment with a doctor, let the physician check for any immunocompromised states, have a HIV test done, and upon receiving those results, discuss with your physician the appropriate treatment steps, as needed.   

In the meantime, I humbled by your question and trust.  Happy Holidays.

Respectfully,

Dr. Roshin 

    * EIGHT MONTH PREGNANT PHILIPPINE LADY ASKS ABOUT PELVIC PAIN

"Hello. How r u.  I'm pregnant 8months coming, why I feel so like difficult moving is like pain, but before for my few, I feel not like this, t.  I do not understand. Please explain.

can we Chat now if don't mind if u are not bzy😀ty." 

 (Ms. Aliyah, Philippines)

Dear Ms. Aliyah,

I am glad when you sent your message, I was online, and we were able to promptly Facebook chat.  After asking you many questions concerning your past and present obstetric and gynecology history, I do believe your pregnancy is progressing normally; however, I believe your pain, this past month, is due to a combination of excess weight gain and multiple gestation history. 

You said your lower abdominal pain is " Just annoying , difficult moving" and " If I go to stand, it's pain."  When I asked is your baby moving, you said, " Yes,always moving  I'm scared to get CS."   CS (cesarean section) is a procedure only done if a vaginal delivery develops or has the potential for severe complications.  You said "No" to vaginal bleeding; however, you mentioned, "This 1 week already, my vagina get itchy... And then ever nite, icannot get sleep."  You said the "Itchy outside vagina" however when I asked is the vaginal itchiness the pain you mentioned, you said, no pain " I think inside."  After you told me 'No" vaginal discharge and " no fever,"  I focused questions on the bladder.

I asked if you have sex during pregnancy, you said, " Yes always Hah, of course my husband only."  I asked if you experienced pain during sex, and you said, " I mean if get starting, its pain, but later on no more already."  When I asked if you pee, you said, " Yes I always go pee" however you repeated,  "If I go to stand up, only, I feel my tummy like difficult to moving Is like fatigue It's like weary It's my body heavily."   You said you pee often more than usual, " Yes in nite and day I always go pee," which may indicate episodes of urinary frequency.  Thus, I asked if you could send blood work information, and upon viewing the sent lab results, all your blood cell levels are normal; thus, you do not have anemia, a medical condition that often causes fatigue and tiredness, nor do you have a urinary tract infection.  Judging by your answers to my questions, there may be a very slim chance for a developing interstitial cystitis (painful bladder syndrome); but, your answers to my questions DID NOT positively confirm that possibility.  Interstitial cystitis is often diagnosed when a person has a normal urinalysis, bladder pain for six weeks or more, increased frequency of urination, pain during sex (called dyspareunia), and urgency to pee.  The pain is increased during exercise, sex, and when drinking alcohol (which you confirmed and I mentioned NO drinking during pregnancy). 

However, the more likely explanation for your lower abdominal pain is your history of multiple gestations.  You have given birth five times.  When I asked your normal weight prior to pregnancy, you said. " 42 kilos."  When I asked your weight today you said, "67" kilograms.   This sizeable gain in weight, different from your prior pregnancies, may offer an explanation to the " I feel my tummy like difficult to moving Is like fatigue It's like weary It's my body heavily" especially when " If I go to stand up."  Furthermore, any woman who has had multiple gestations (multiple births) has weakened musculature to support the uterus and other abdominal and pelvic organs, thus, due to gravity, you may be feeling the weight of the uterus and or organs in your lower abdomen.  When I asked if your doctor checked your heart, you said, " don't have history abount my heart."  

Bottom-line, after our discussion, I believe your pregnancy is proceeding normally, and during the remainder of your pregnancy, you should diet, eating healthy foods in smaller quantities, and exercise as tolerable.  Prior to beginning any exercise program, talk to your doctor.  I believe the excess weight, along with multiple gestations, is the cause of your present pain, and upon delivery, your pain should be diminished, if not disappear altogether. 

One item to note is I provided my opinion without any imaging reports.  Thus, please ask your doctor to do a X-Ray or CT of the abdomen and pelvic regions to make sure a cyst, fibroid, tumor, adhesions, or ligaments are not the cause of your pain. 

With that in mind, I am humbled by your question and trust.   Thank you.  Yes, upon birth, I would feel honored to receive a photo of your baby.  God Bless you and God Bless the Philippines.

Respectfully,

Dr. Roshin

 *

     * BANGLADESH MAN ASKS WHY HE HAS FEVER FOR MONTHS AT A TIME?

"Dear sir, can I talk to you???

Can you suggest me some advice to be safe from fever???  In a year, i suffer from fever a lots of time like 3-5 month with isolated period. But this sickness keeps me always weaker than everyone, I want to be healthy. Plz.. Help me  Ok...! Till then I will wait for you."  ("JRahm",  Bangladesh)

Dear "JRahm,"

I am glad we were able to visit on Facebook, 2016 Thanksgiving weekend, as your question revolves around trying to locate a fever of unknown origin.  We doctors try to narrow the source of a fever to the following, four general classes:  human immunodeficiency virus- related (HIV), immunocompromised related, classic, and nosocomial; thus, my questions were directed to target the most likely possible source of your fever.   Your original statements, " I'm from Bangladesh. Fever could me almost 3-4months of an year on different spell," along with telling me you were hospitalized "It was for typhoid.  I was hospitalized on almost a year ago, that's the reason," spoke volumes of information.  Specifically, your fever falls in the "classic" category.  A classic fever is a fever of at least 100.9F or higher, a fever with a duration of greater than three weeks, and a fever requiring an evaluation of at least three outpatient visits or three days in the hospital.  However, when I asked how long were you in the hospital, you said " Just 2days."  Technically, the fact that you were in the hospital only two days places you outside the classic fever category; however, I do believe, your timeline of events might lend an explanation as to why you have had "3-5 months"  of fever after hospitalization. 

Let me explain.  When I asked you what medication did the hospital provide, you said, " I can't remember, and the prescription has run out."  Salmonella typhi is a gram negative bacterium that causes typhoid fever in humans.  Typhoid fever is a disease marked by the following symptoms not limited to prolonged fever, nausea, diarrhea, fatigue, headache, low energy, stomach pain, or sore  throat.  The drug of choice to treat typhoid fever is Ciprofloxicin or Ceftriaxone, both of which are provided to a patient over two weeks.  Other medications that have proven effective against typhoid fever include amoxicillin and trimethoprim-sulfamethoxazole.  There exist over 100 different strains of Salmonella typhi; thus, resistance of this bacteria is common to many antibiotics.  In other words, many antibiotics are not effective in killing the Salmonella typhi.  Although you tried your best to remember details of your typhoid fever treatment, two items became clear to me about you, 1) possibly, the correct antibiotic may not have been chosen to kill the Salmonella bacteria or 2) the antibiotics prescribed may have been correct; however, the duration of treatment may not have been long enough.  Therefore, the Salmonella typhi may still be abundant in your bloodstream, causing the "3-4months of an year" fever. 

Remember, the most common source of infection, in acquiring typhoid fever, is water contaminated by the urine and feces of infected individuals; thus, if possible, as a means to prevent transmission, drink bottled water or boil local water sources prior to ingestion.  Furthermore, once the boiled water has cooled, wash fruits and vegetables in that cleaned water, and ALWAYS WASH YOUR HANDS repeatedly throughout the day.   Typhoid fever is treatable and reversible; however, when the Salmonella typhi bacteria is not killed, a person becomes a carrier and a likely transmitter of infection to other people. 

My recommendation is for you to revisit the hospital personnel, requesting blood work to identify if Salmonella typhi still exists in your blood.  If confirmed, the hospital should be able to run tests that would determine which antibiotic(s) is/are effective to kill those strain(s) of bacteria in your body.   

Thank you for your question and trust in my opinion.  Please stay in touch as I wish to know the outcome of hospital tests.  In the meantime, thanks for your compliments and peaceful prayers.  God Bless you and God Bless Bangladesh.

Respectfully,

Dr. Roshin

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  12/1, 10:32am
  

  "JRahm"
  

  
  

  
  

  Ok...!

  
  

  My prayer always within you

* PHILIPPINE LADY ASKS WHY SHE HAS DEVELOPED CONSTANT EAR NOISE? 

"Roshin?  May i ask what is this nuisance noise in my ears? If you try to cover your ears with your fingers that is the kind of noise i hear even my ears are not covered Its disturbing Thank you.. I really wish that we could talk. Sometimes im thinking perhaps im near to die? Please help me about this.  Thank you." (Eve, Philippines)

Hi Eve,

With regards to your question, "I would like to ask what is this noise in my ears that wont stop its annoying," I believe, after our conversation on Facebook (Nov 15, 2016), the ear noise, that is bothering you, is medication induced.  You asked me  "to close your ears with your two fingers and thats axactly the sound buzzing in my head."   Your description of the ear noise has many possible etiologies, and based on your reply to my questions, I ruled out many of the potential causes, arriving at the conclusion that the medicine, Idezar, you are taking for your hypertension, may be the most likely explanation for your ear noise. 

How did I arrive to this conclusion?  You stated, " I notice this noise maybe 2 weeks ago and sonetimes its quite disturbing."  You also said, "I remember then when im still a child but im not sure if my mother or father had some problem also in ear noise and put a whole pepper or ginger in the ear hole.  The sound i hear is like when you are in the forest and you hear some insects sounds. Or somewhat like try to cover your ears with your fingers its like that."

You said, "The doctor prescribe it, The idezar only 150mg,  to me for hypertention."   You said your blood pressure readings this past month have been " 130/80 120/80 120/70"  and " Maybe 5 timea 140/90."  However, you also told me that you take "75mg on and off" not "150 mg once a day."  When I asked why you do not take a 150 mg tablet as prescribed by your doctor, you said " Im only taking 75 mg a day bcos i dont feel good taking 150mg.  I feel a little dizzy. I feel my heart hold my breath." 

Furthermore, when I asked was your blood pressure normal when you took the 150 mg medication as prescribed, you replied, " Yes.. even i dont take it i feel im ok.. only the sound and some shaking."  You said "Sometimes i feel my body is trembling.  I feel my hands shakes my legs something like that." 

I believe the trembling might be due to your blood sugar levels fluctuating from normal.  In fact,  you mentioned,      "Im sorry.. i thought its only maybe my over dieting. My food intake is not the same. I reduce sugar intake, from rice and other."   Fluctuations in blood sugar can cause dizziness and trembling. 

Most importantly, all my questions regarding other causes of ear noise [such as trauma, ear infection, respiratory illness, throat pain, cardiovascular disease, occupation, circulatory problems, anemia, allergies, an underactive thyroid gland, intracranial hypertension (also called pseudotumor cerebri), Meniere's Disease,  and diabetes] allowed the final conclusion that not being compliant with the dosing of Idezar is causing your ear noise.   Hypertension causes ear noise (referred to as tinnitis).  Thus, when you take 75 mg of Idezar, instead of 150 mg as prescribed, your blood pressure rises, and this is why " Maybe 5 timea 140/90" readings occurred.  A blood pressure greater than or equal to 140/90 is Stage I hypertension, a serious condition that must be controlled before worse complications occur. 

What do I recommend for you?  Visit your doctor, and mention that when taking the 150 mg Idezar,  " i dont feel good."  Your doctor should be able to easily change your blood pressure medication to a different hypertensive medicine that will not cause you adverse side effects.  You should also ask your doctor to check your blood sugar levels, and prescribe appropriate medication, as needed, to keep sugar levels in the normal range. 

The two hours we spent visiting on Facebook was well worth the time.  I believe these suggested conservative measures may easily remedy the present medical concerns you have expressed.  Thank you for question(s) and trust in me.  God Bless you and God Bless the Philippines.  Stay in touch.

Respectfully,

Dr. Roshin

*

* PHILIPPINE MAN QUESTIONS HIS ANTI HIV VIRUS MEDICATION REGIMEN?

"hello doc.  how are u?  can i call?  just a shortwhile pls.  I WISH TO CALL U COZ I HAVE SOME IMPORTANT QUERIES"  (Mr SPinoy, Philippines)

Dear Mr. SPinoy,

I am glad we were able to chat on Facebook video, this past weekend, November 11, 2016, concerning your antiretroviral therapy (called HAART).  You mentioned that your HAART therapy consists of Aluvia with Efavirenz.  Aluvia is a combination pill of Lopinovir/Ritonavir, and Efavirenz is a non-nucleotide reverse transcriptase inhibitor medicine (NNRTI).   Your inquiry was whether this was the correct medication regimen to continue to take for combating the HIV virus. 

Latest HAART guidelines suggest that if a patient has a CD4 count less than 500, that person could be placed on one of the following three medication regimens.

1) 2 NRTI (nucleoside reverse transcriptase inhibitor)  +  1 PI (protease inhibitor)

2) 2 NRTI + Efavirenz

3) 2 NRTI + 2 PI

NRTI medications include the following not limited to Zidovudine (also called AZT), Didanosine, Stavudine, Lamivudine, Tenofovir), and NNRTI medicines include  Efavirenz, Nevirapine, Doravirine, Etravirine, and Delavirdine.  PI (Protease Inhibitors) are not limited to the following which include simeprevir, lopinovir, ritonavir, boceprevir, darunavir, telaprevir, fasamprenavir, indinavir, saquinavir. 

When I asked what your latest CD4 count and viral load were, you said you will "recheck these levels in December 2016".  You also mentioned that "my Cd4 count go up 100 points since last time."   Although the updated guidelines would  change your HAART therapy, my recommendation is for you to stay on the Aluvia + Efavirenz combination treatment.  Why, you might be wondering?  To become healthier and contain AIDs (Acquired  Immune Deficiency Syndrome) side effects, a physician wants the patient's CD4 count to increase and the viral load to decrease.  Thus, as long as your CD4 count continues to increase and the viral load continues to decrease, STAY on this  antiretroviral therapy regimen.  Furthermore, you mentioned "not having" any adverse symptoms, such as rash, confusion, neurologic conditions...etc., from your present medications; thus, you should  STAY on this HAART protocol.  Your medications are making you healthier and providing you a longer life. 

In the end, visit with your doctor, seek counsel, and make a decision that is best for you.  I am humbled by your trust in my opinion.  God Bless you and God Bless the Philippines.

Respectfully,

Dr. Roshin

*

" WHY INTEGRITY MATTERS IN OUR CHOSEN LEADERS." 

Dear Readers,

With just under a week until the 2016 national Presidential elections, I wish to offer a perspective concerning  the importance of integrity in our chosen leaders. 

The President of the United States is considered by people and heads of state alike as the leader of the free world, and that individual must exemplify strong character, morals, a positive, peaceful vision, and most importantly, integrity.    Why is integrity the value I consider the most important in a leader?

Our leaders have virtually no control over events ongoing on the planet.  We choose a leader who we feel will best afford the most conscientious, decision at any moment of potential crisis.  Part of making a resolute decision weighs heavily on whether the information and intelligence we receive has integrity, the leaders on the global stage are trustworthy and their words echo integrity, and is the chosen leader free of any potential conflicts of interests, thus, allowing his/her final decision to carry merit, i.e. integrity, free of any bias or prejudice.

In my opinion, regardless of party, our Presidents have lacked integrity, and the consequences have been profound to our country and the world.

Bill Clinton, in his second term as former US President, lied under oath (1999-2000).  Thus, the message sent to our country and world was the following: if you lie and can get away with your lie, do it.  Immediately after Bill Clinton was not held accountable for perjury, US companies (1999-2007) falsified their annual growth reports, showing profits that never existed.   Thus, the stock market soared to unprecedented levels, allowing politicians, companies, and knowledgeable people to make quick money based on lies.  The fabrication and falsifying of profit reports resulted in the global, earthquake economic collapse of 2007-2008.  Millions of hard working Americans lost their life savings and pensions while the politicians were virtually untouched by the consequences of their decisions. 

George W. Bush, the former 43rd President of the United States, continued the lying started by Bill Clinton, by stating weapons of mass destruction existed in Iraq.  As we know today,  after 9/11, our country initially declared war on the Taliban in Afghanistan; but, we were diverted to Iraq, after President Bush stated Saddam Hussein posed a significant threat to our country due to his (Saddam) possession of weapons of mass destruction.    We began a "shock and awe" campaign that killed hundreds of thousands of innocent Iraqi people.   Since there were no weapons of mass destruction in Iraq, ask yourself, what have been the consequences of this lie?   Increased terror and the largest debt  in our country's history are the undeniable results of this weapons of mass destruction lie.  After all, killing innocent people, has increased resentment and animosity towards our country, and the net result is the profound increase in terror events, global and domestic.  The culmination of economic lies and wartime lies have resulted in the largest debt burden placed on our country's citizens.  Most importantly,  in my opinion, there is a direct link between lies, orchestrated by our Presidents, and the lack of peace in the world.    

If Hillary Clinton becomes the next President of the United States, children in our country and around the world will learn that Bill Clinton, lied under oath; but he still reaped the benefits of his lying by having the honor of becoming the first "First Man" of the United States.  Lying is the gift that keeps on giving to these career politicians.

Thus, upon voting Tuesday November 8, 2016, vote your conscience placing front and center the importance of integrity in our leaders.  Has the time arrived to vote all career politicians, at the local, state, and federal  levels, out of office?   As a person who supports business and the free enterprise market system, I write from a deep concern for the direction of our country, and in my opinion, failure in the integrity of our "leaders".   In 2016, all  establishment "leaders" must go, in other words, all career politicians should be voted out of office.  

Respectfully,

Dr. Roshin

*

WALES MAN EXCRUCIATING HEADACHE PROMPTS REQUEST FOR HELP

"Hi Dr Rowjee. I've suffered from a severe migrate, high temperature, sore throat and intermittent urination and funny taste in mouth for 3 days." ( "Walter", Wales)

Dear "Walter,"

I am glad we were able to converse on Facebook, this past weekend, about your medical condition.  After our discussion, I have concluded that your headache is likely due to a side effect of L-Tyrosine and or, a much less likely, worst case scenario, a brain tumor has developed.  Please allow me to explain.  You mentioned that you had "severe pain when I move my eyes" and you are "seeing colours, yes, almost hallucinating" both of which are contributing to a "headache is extremely severe."  The combination of  the alterations of vision, such as blurry vision, and  headache,  may indicate a brain cancer or tumor; thus, if your pain does not remit in the short term, a doctor in your locale, would be wise to order a CT of the skull to rule out possible brain tumor etiology.  However, the more likely explanation to your headache is the L-tyrosine you are taking.  You mentioned that you take "2000 mg" of tyrosine per day, and when I asked you if you take illicit drugs, you said "no." 

You mentioned "not really"  having migraine headaches in the past; however, you said " I've had an ltyrosine induced headache before but not this bad."   The 2000 mg L-Tyrosine dose is well within a safe, therapeutic dose for your body mass index; but, your high blood pressure poses a potential problem when mixed with tyrosine.  More specifically, people suffering from high blood pressure, like you, should not take supplementary tyrosine without consultation with a physician.  Thus, although tyrosine will help you relieve stress, a sensible next step is for you to visit a doctor before ingesting anymore L-tyrosine.  STOP the L-tyrosine immediately.  You are  more than likely, unknowingly, experiencing a side effect of L-tyrosine, and you must allow time for this drug to be eliminated from your body.  Once the tyrosine clears your system(s), the headache  should promptly disappear, allowing you to return to normal daily living.   Hydrate well and eat healthy foods. 

Thank you for your question and trust.  God Bless you and God Bless Wales.

Respectfully,

Dr. Roshin

*

NYC MAN WITH NONVERBAL LEARNING DISORDER, AN UNRECOGNIZED PSYCHIATRIC CONDITION WORLDWIDE AND IN THE UNITED STATES, ASKS FOR TREATMENT OPTIONS.

"Hello Dr. Rowjee. Are you familiar with a neurological disorder called Nonverbal Learning Disorder?"  (Nicholas, New York City)

Hi Nicholas,

I have heard of this disorder however, in medical school, this condition was not taught or elaborated upon due to not being in the Diagnostic and Statistical Manual, the "Bible" of psychiatric conditions.  More specifically, nonverbal learning disorder is not listed as a diagnosis in the The DSM-5 (Diagnostic and Statistical Manual) and ICD-10 (International Classification of Diseases); yet, there is plenty of literature on this condition as well as avenues of developing research.

Nonverbal learning disorder, also known as nonverbal learning disability, is characterized by an individual with verbal strengths; however, visual-spatial, motor, and social skills difficulties exist.  People with this disorder have difficulty comprehending nonverbal cues, such as tone of voice or facial expression, and these individuals have challenges with mathematics.  Thus, I understand that this disorder has effected aspects of your life including maintaining employment.

 You replied," Hello Dr. Rowjee. I asked you about this disorder because I was diagnosed with it back in 2009. This disorder causes me lots of problems especially with regards to social skills and executive functioning. I often feel like I can't learn many things effectively to become proficient in it. I will do just about anything to rid myself of this condition. I hear that autologous stem cells are a good treatment for neurological conditions. Can you offer any advice on treatments for this disorder that is a permanent fix either here in the US or overseas? "

.

Besides Medical Tourism Company- Affordable Healthcare, Surgery Abroad/ PlacidWay (http://www.placidway.com/) company in Austria, I was able to locate an article entitled, "Stem Cell Crusader Sparks New Hope for Fighting Diabetes, Heart Disease (http://www.bloomberg.com/news/features/2016-06-27/stem-cell-crusader-sparks-new-hope-for-fighting-diabetes-heart-disease)  listing companies with ongoing stem cell research in Japan.    Essentially, the article is a" Who's Who" list of global contacts that could lead to the exact area of ongoing research you  desire. 

After approximately a month of elapsed time, I was thrilled to hear "Hello Roshin. I found a clinical trial using stem cells as treatment for neurological disorders in Florida-Margate, Florida to be exact. I already contacted the clinical trial director to inquire about participating in the trial. If it wasn't for your article on the stem cell treatment in Japan I wouldn't have found the clinicaltrials.gov website.

Nicholas,  I am humbled that we, collectively, were able to find an ongoing research protocol that could end your distress with the manifestations of nonverbal learning disorder.  Please stay in touch, as I wish to learn your progress, praying for a marked improvement in overall quality of life.

Thank you for your trust and question.  God Bless you and God Bless New York City.

Respectfully,

Dr.  Roshin

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