* 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 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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   * 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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