* 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 

* 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

*

  PHILIPPINE LADY LIVING IN SAUDI ARABIA ASKS FOR HELP.   HAS PERICONITIS

"Hi Doc.. Doc please advice me on how to cure a swollen gums around my wisdom tooth😢😢.. It's really painful and I just try to ask you of any home remedies. I can't eat or even drink water. It's really hardto swallow because I felt that my throat is swollen too..  Please Doc.. thank you.."  (Ms. Mary, Philippines)

Dear  Ms. Mary,

After visiting with you, with urgency on Facebook this past weekend,  more than likely, your wisdom teeth need  removal.   Wisdom teeth are given that name due to typically growing during adulthood years.  You said " Im 28 yrs old doc.."  However, not everyone is able to keep these teeth due to a small mouth size causing both crowding and improper growth of teeth.  However, my conclusion was established after you mentioned " Lower jaw left side Doc.. Yesterday doc i felt it was swollen and pain.  my wisdom teeth i felt it was painful and hurt when i try to touch it from my tongue." 

When I asked are you having difficulty breathing, you said " No Doc.."  In addition, you said  " I dont have fever today,  Its painful Doc when it (a toothbrush) touch.., No blood so far Doc (in saliva),  but i felt lately that Im having a headache.. Doc it really hurt me so much."   Finally, when I asked you "does every tooth hurt or only the wisdom tooth on your left lower jaw?"  you said, "Only the wisdom tooth as well as the gums Doc.."  Your swollen gums might indicate a condition called pericoronitis, inflammation of the tissue surrounding the wisdom tooth.

Both the possible extraction (pulling out) of all four wisdom teeth along with diagnosing and treating a possible pericoronitis requires a clinical examination by a dentist.  I realize you are working in Saudi Arabia and are "afraid that it will affect my work here in Saudi.." but the pain you are presently feeling will get worse if you do not immediately visit a dentist.   Thus, I am glad to hear " But I can try to ask permission to go to a dentist Doc..buy for now i want any temporary cure for this pain and hurt I felt.."

Since you "dont had any allergic reactions " there are some home remedies that can temporarily help with pain until you see a dentist.  These remedies include clove oil, peppermint tea bags, vanilla extract, hydrogen peroxide rinse, garlic, salt water treatment, and a liquor (alcohol)-soaked cotton ball.  

Since you mentioned certain items you already have at your home, these are temporary treatments to help decrease the pain.  Mix a crushed garlic clove (or garlic powder) with some table salt or black salt and apply it directly on the affected tooth to alleviate the pain.  If you prefer, you can chew a clove or two of garlic to get relief.  Onions have antiseptic and antimicrobial properties that control a toothache. It can provide relief from pain by killing the germs causing an infection.  Chew raw onion for a few minutes to relieve the pain. If you are not able to chew onion, place a piece of raw onion directly on the bad tooth or gums.  Mix half a spoon of common salt in a glass of hot water and rinse your mouth thoroughly.  The salt water will help reduce swelling and inflammation, as well as fight the bacteria that cause infection.

I was glad to hear " I will try the onion Doc..Thank you so much for your concern, God be with you always Doc..I will surely update you Doc.."  Keep well Mary.  God Bless you, God Bless Saudi Arabia, and God Bless the Philippines.  

Respectfully,

Dr. Roshin

*

Thank u so much Doc..😊😊😊

Mary Aneesa Abayon

Received: August 7, 2016







*

   * 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

*

         "THE MAGIC CURE FOR HCV"  - ONE MAN'S STORY

Doctoradvisor,

"As per your request, I have written a brief story of my experience with the HCV.  I hope this helps some of your readers and wish all of them the best in their quest to eradicate this awful disease."

Cordially,

R.S. (Newark, NJ)

"Harvoni - THE MAGIC CURE for HCV"

I had originally heard about the "MAGIC CURE' in 2012.  I was dealing with Hep C since 2002 (at least that was the year it was discovered) and it was rapidly deteriorating my liver.  My prognosis was not encouraging.  My first severe episode was in February of 2007 when the varices ruptured on my esophagus.  Chance of survival is about 30% but I was fortunate.  They were banded and I lived.  

That was the beginning of the journey.  I had episodes with hepatic encepolopathy and they became more frequent as time went by.  I was moved from Monmouth Medical to University Hospital, and they were able to save my life there.  

The Harvoni treatment was approved by the FDA on December 8, 2013.  I was blessed with a most outstanding Hepatologist, who got me into the program in February of 2014.  At that time my viral load was in the multi-millions.  At the end of the program, no virus was detected.  A true miracle.  My prognosis before treatment indicated that I did not have much time left.  After treatment, prognosis is 15 years or better.

The big issue with the treatment is it's cost.  I was on an 8 week program that cost close to $100,000.  That's something like $1,300 a pill...and you take 2 a day.  Hopefully the cost comes down and everyone can get the treatment.  It is a true miracle.  My doctors now have me on a magic cocktail.  To sum it up, I haven't felt this good in many, many years.

Thank you,

Rico (Newark, New Jersey)

-----------------------

Dear Mr. R.S.,

Thank you for sharing your story with DoctorAdvice4u readers.  You are a walking miracle.

Respectfully,

Dr. Roshin

*

       * PHILIPPINE MAN MAY HAVE POTT'S DISEASE?


“ahh ok sir.  u know about spinal cord disease???  we need an ortho doc.but we only a poor family....his bedridden for almost 6mons.  I'll send u the result of MRI.”  (Ms. Lovely, Philippines)

Hi Ms. Lovely,

After spending almost a month in correspondence with you and after scanning numerous imaging and test results you sent, I believe the 32 year old man you referenced with your question, may have either Pott’s Disease or a leukemia.  Pott’s Disease is a form tuberculosis that effects the spine causing tuberculous arthritis of vertebrae joints.  A leukemia is a cancer of the blood, involving white blood cells.  Allow me to explain.

When I asked you has the man had tuberculosis in the past, you said, “n0 sir.”  Yet, judging by this  man’s MRI report (L3-L4 and L4-L5 dessication / posterior disc bulge at L3-L4 / L4-L5 posterior disc herniation causing mild spinal canal stenois), blood results (extremely high monocyte count with low lymphocyte count), and an apparent effect on the adrenal gland (sodium and potassium levels abnormal),  tuberculosis must not only be considered, tuberculosis tests (Mantoux test, PPD) must be ordered by his doctor.   The PPD will confirm active or past exposure to tuberculosis.  If the PPD is positive, you and this man’s contacts must all be tested for tuberculosis.  The other factor that may lead credence to Pott’s disease is that his blood test showed low levels of hemoglobin and hematocrit, which could have been caused by loosing blood orally or rectally.  Multiple medication regimens will treat tuberculosis. 

This man’s monocyte count was 19.1% (2-6% normal range) and lymphocyte count was 4.9% (20-30% normal range).  His hemoglobin was 113 g/L (135-180 g/L normal range) and hematocrit was 40.9% (44-54% normal range).  Pott’s disease, also known as tuberculous spondylitis, is a combination of osteomyelitis (bone inflammation) and arthritis, frequently involving multiple vertebrae of the lower, lumbar spine which may cause vertebral collapse and compression fractures.  The MRI report appears to reflect many of the signs and symptoms you mentioned in our discussions on Facebook.  With urgency, please locate a doctor who will test this man for tuberculosis exposure.  If you require assistance with the location of a Philippine hospital or clinic, simply ask, and I will make contact with doctors in your country. 

Due to the unusual and abnormally, very high monocyte count ( a type of white blood cell), a leukemia should not be ignored.  A hematologist ( a blood specialist) should be considered for making an absolute confirmation of a leukemia diagnosis.  Chemotherapy is a treatment option for leukemia. 

I am humbled by your trust.  Please write and let me know what evolves from our discussion.  A 32 year old man, bedridden for sixth months, is crying for help, and I pray and hope my suggestions, through your efforts, will reverse his health and life’s fortunes.  God Bless the thirty-two year old man,  God Bless you, and God Bless the Philippines. 

Respectfully,

Dr. Roshin

*

" CHINESE LADY ASKS WHY FACE & FINGERTIPS HAVE PINS & NEEDLES SENSATION?"

“My mom had her thyroid removed so they have to take a lot of other supplements. One of the supplements is calcium. They originally have to take 4 pills (500 mg +D per pill) 2 times a day but it doesn't seems to work for my mom because once in a while, her fingertips and face feels the pins and needles sensation. When she spoke with the endocrinologist, he didn't bother to think of any alternatives but to increase her intake of pills. which means she would have to take additional 2 more pills each time. So my question is should she still take the additional two pills and wont it affect her her kidneys or even makes her constipate?”  

(Ms. Lin, New York City)

  

Hi Ms. Lin,

After visiting with you this past week, your mother presented with “fingertips and face feels the pins and needles sensation,” a term in medicine called paresthesias.  Based on your mom’s past medical history, your mom’s paresthesias have an unknown etiology which must be identified by the doctor.  Specifically, in the medical paperwork you sent me, your mother’s Hemoglobin A1c level was 6.1 (normal <5.7), an indication that her blood glucose levels are likely running much higher than normal.  Why is this important?  Diabetes mellitus could cause paresthesias.  She must work with her doctor to reduce high blood glucose levels, which will help rule out diabetes as a cause of the paresthesias.  In addition, your mom, every day, has been taking 4000 mg calcium (four 500 mg calcium pills morning and night) for the past two years; yet, on the blood test, her calcium level was below normal at 7.1 mg/dL.   Low calcium can cause paresthesias (especially of the face).  Your mom’s doctor recommending she take two additional 500 mg calcium pills morning and night should be followed, if only to increase blood calcium levels back into the normal range (8-10 mg/dL).  Once your mother’s calcium levels have returned to the normal level, hopefully, her paresthesias will disappear. 

However, you are correct, hypercalcemic states, could lead to constipation, kidney stones…etc; however, since your mother had a total thyroidectomy in 2012, the body’s ability to regulate calcium levels became greatly diminished.  Normal recommended daily calcium consumption for adults is 1000-1500 mg/day.  The higher than normal calcium intake might be the new norm for your mom, a value that must be monitored by her physician, and discontinued or modified, if hypercalcemic signs or symptoms occur.

You might suggest to your mom’s physician to run a B12 level, which is also a potential cause of paresthesias.

I will address your brain tumor question in a different post.   Thank you for your question and trust.  God Bless you, God Bless China, God Bless New York, and God Bless New York City.   Stay in touch, and remember, “Always walk in peace.”

Respectfully,

Dr. Roshin








*

           "PHILIPPINE MAN HAS PSA TEST DONE.  DOES HE HAVE CANCER?"

“Hello! Doc, busy? My husband Doc. on this coming tuesday he has a check up again. Can I send you a result of his ultra sound? He feel that he has a frostate enlargement but I said to him you need to go to the doctor to make medical check up, then he noticed that he has a milk calcium syst in the left kedney!” (Ms.DD, Philippines)

Dear Ms. DD,

The last time we visited, you had sent your husband’s sonogram report which confirmed a benign, renal milk calcium cyst.  In addition, I mentioned the following statement to you and your husband (Pepe), “since your husband “feel he has frostate enlargement,” I suggest that your husband ask his doctor to perform a digital rectal exam and run a PSA test (prostate specific antigen) test.  The PSA test results provide a snap shot of potential prostate conditions including benign prostatic hypertrophy, and along with a digital rectal exam, this test will help rule out prostate cancer.  We should make sure that the prostate is not evolving into a future, serious problem.”

Subsequent to our discussion three weeks ago, your husband had a PSA test completed, and you forwarded a scanned picture of the result.  Your husband’s PSA result was a 0.435 ng/ml, a value well within the normal range of 4.40 ng/ml.  Since this is your husband’s first prostate blood test completed, we have no previous reference number to gauge whether Pepe’s symptoms mirror the test result found.  However, he should rest peacefully tonight knowing that the 0.435 result, at face value, does not appear to reflect any pathology or condition of his prostate gland.  My recommendation, is to ask that your husband repeat a PSA test one year from today.  When that result is in hand, please contact me, as a means to guide further treatment if needed.

However, if your husband experiences worsening symptoms including 1) frequent urination at night, 2) urgent need to urinate, 3) difficulty urinating, 4) weak urine stream, 5) a urine stream that repeatedly starts and stops, 6) blood in the urine and or 7) the inability to completely empty the bladder during urination, your husband should have the PSA redone in six months with urgent consultation with his doctor or a urologist to include a prompt digital rectal exam.  The symptoms mentioned above could reflect a worsening prostate condition even though today’s PSA blood test result indicates otherwise.

I am deeply humbled by your trust in me.  Although we are miles apart, do know that I care about the health and well-being of all people who inquire medical assistance.  You all are, in essence, my patients; however, my advice is never a substitute for seeking professional medical services from a doctor or health personnel within your locale.

God Bless you, God Bless Pepe, and God Bless the Philippines.

“Always, walk in peace.”

Respectfully,

Dr. Roshin

* "ARE SWEET POTATOES A TREATMENT FOR RHEUMATOID ARTHRITIS?"

“Is it true sweet potatoes helps rheumatoid arthritis pain?” (Ms. J, New Jersey)

Dear Ms. J,

I have to admit, medical school trained me in a western philosophy medicine thought process; thus, your question required in depth research. After reading eastern philosophy medicine textbook(s) and conversing with an herbal specialist; the following information was discerned. Put simply, sweet potatoes, typically called yams (Convolvulacea family), are different from wild yams (Dioscorea villosa family). The wild yams, and their extracts, due to anti-inflammatory and antispasmodic properties, are considered by many alternative and herbal specialists, to contain many health benefits with disease treatment value.

Wild yams, are often used, but not limited to the following conditions:

1) rheumatoid arthritis 

2) menopause symptoms 

3) vaginal dryness 

4) nausea/ vomiting 

5) stomach cramps 

6) gall bladder pains 

7) diverticulitis pain 

8) hiccups 

9) menstrual cramps

Before self medicating or self treating yourself, always consult your doctor and move forward together to gauge both alternative and general medicine treatment success. With that in mind, thank you for your question and trust.

“Always, walk in peace.”

Respectfully,

Dr. Roshin