* 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 

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? "

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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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   * NEW JERSEY FATHER ASKS WHY SON'S LYNCH SYNDROME NOT DIAGNOSED EARLY ? WHAT TREATMENTS?

“Hi Dr. Roshin.  I'd like to invite you to my house. My wife is a Japanese girl XOXO. She makes life wonderful and she's a real good cook.  The patient is my son Raymond. He's 27 and married. By the way I'm fortunate enough to have all 4 of my children living with me and plus the 2 wives of my sons. About a year ago the pains became too much and when Raymond went to the emergency room, it took awhile but they discovered a problem. They ended up removing the descending part of the colon. Raymond had the bag and went through about 4 or 5 months of chemo. After a few more months they did an operation to reattach him and discovered more cancer on the small intestine. As I was explaining I'm adopted along with my half brother and sister. We are all from the same mom. They both experienced colon cancer in there 40's. My sister got a positive report for Lynch Syndrome pretty recently. Although we've suspected for awhile. I assume I must have it. One strange thing is that the first report from the Dr's said that Raymond did not have it. And when I showed them my sisters report then they said he did. I assumed it would be more black and white. Dr. can you check about Radio Surgery. Dr. Gil Lederman is on the radio 710 am. Thats the station. Gotta head to work. Good luck in your ministry. God Bless You --- Bruce and XOXO"

Hello Mr. Bruce,

I have to admit, I am baffled by your comments that your son’s Lynch syndrome was not the initial diagnosis afforded by his doctors, with expedient treatments, both screening and curative, provided as early as possible.  Lynch Syndrome, often referred to as hereditary nonpolyposis colorectal cancer (HNPCC), is the most common inherited cause of colon cancer; thus, from the onset, your son’s family history, in other words, his genetic history should have been extensively explored, with an immediate realization that a link to his present symptoms exists.  In fact, for people with Lynch syndrome, colonoscopy cancer screening exams should be scheduled every one to two years beginning in their twenties.  Time is survival; thus, excuses and apologies are unacceptable.  Your son developed colon cancer of the descending colon, which was appropriately resected, used a colostomy bag for four to five months, and underwent a successful surgery to reattach the digestive system tract.  However, during that reattachment surgery, cancer was found in the small intestine, and you wish to discuss radiosurgery. 

Radiosurgery is a procedure that targets tumors using a large dose of radiation, focused on that precise cancerous lesion, for eradication.  Since the high dose of radiation is localized to a small area, as opposed to chemotherapy which floods the body with toxic medication to kill the cancer cells, radiosurgery would be an effective procedure for Raymond’s small intestine cancer.  Radiosurgery, in combination with chemotherapy, is often more effective to ensure total purging of the cancer from your son’s body.  However, the radiosurgery procedure does render many adverse complications not limited to the following:  skin blisters, inability to hold bowel, fatigue, erectile dysfunction in males, vaginal irritation in females, blood in stool, painful bowel movements, and urinary irritation (burning, blood in urine).  There are multiple treatment options on how to deliver the radiation, as well as numerous other treatments options available for bowel cancer; thus, a final decision should only be made after contemplation with Raymond’s physician.

Bruce, I am humbled by your invitation to visit your family.  Thank you for your question(s) and trust.  Please stay in touch, as I wish to know your family’s final treatment decision and most importantly, the outcome.  If you have any questions or simply need a second opinion, feel free to call or write, at your convenience.  In the meantime, although I do not have a ministry, your thought sounds like a reasonable calling, worth considering.  God Bless Raymond, God Bless you, and God Bless New Jersey.

Respectfully,

Dr. Roshin

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