* 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 

     * 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

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* 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

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  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

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Thank u so much Doc..😊😊😊

Mary Aneesa Abayon

Received: August 7, 2016







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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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         "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

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       * 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

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