* 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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" 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

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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

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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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NJ MAN GENETIC TEST CONFIRMS LYNCH SYNDROME

"Hi Doctor Roshin. This is the official paperwork about my Lynch diagnosis." 
( Mr. Bruce, New Jersey) 

Dear Mr. Bruce, 

Before I begin any explanation on your sent paperwork, do know that with knowledge, "you can beat cancer." God has afforded you this gift of knowledge, and by knowing the diagnosis, you now have the ability to manage and most importantly, help prevent, if not eliminate the possible manifestations, from cancer. 

Your genetic test was positive for a clinically significant mutation (c.454-13A>G) in the MLH1 gene, which has a direct link to a high risk of colorectal and gastric cancers and an elevated risk of pancreatic cancer. Individuals who carry the mutation in the MLH1 gene have Lynch Syndrome, a condition often referred to as hereditary non-polyposis colon cancer. Men and women with Lynch syndrome have an increased risk of developing colorectal cancer, often at a young age. In fact, there is a 52-82% increased risk of colorectal cancer, as compared to the general population risk of 1.9%, in those people with the MLH1 gene mutation. Females with Lynch Syndrome due to the mutation in the MLH1 gene, have an increased risk of endometrial and ovarian cancer. Additionally, people with Lynch syndrome caused by a mutation in the MLH1 gene, have an increased risk of developing a spectrum of secondary cancers not limited to the following: small intestine, gastric, ureter, pelvic, hepatobiliary tract (liver), brain (glioblastoma), sebaceous gland, and pancreatic. 

Although there are high risks for cancer in patients with Lynch syndrome, many of the risks can be diminished with prompt and steadfast medical guidance and management. Now that you are aware of an increased risk of colorectal cancer, what should you do? Talk with your physician about having a colonoscopy done every 1-2 years searching for polyps (adenomatous), the lesions that lead to colon cancer. If a polyp is found, the gastroenterologist can remove the polyp immediately during the colonoscopy procedure. In addition, a surgical consult should be considered, on an individual basis, to evaluate those parts of the colon which may need to be resected. Finally, the National Comprehensive Cancer Network has suggested that aspirin may decrease the risk of colon cancer in Lynch Syndrome patients; however, there is not enough data to sufficiently make a recommendation for its standard use; yet, this would be a conversation worth having with your physician. Management of Lynch Syndrome will be individualized based on each your and each patient's medical history. 

Knowledge is a powerful entity when used resourcefully. Thus, channel the knowledge of your diagnosis into methods to prevent the side effects of cancer or cancer altogether. You live a rich, quality filled family life, and with support of doctors and new research methodologies, you can easily add years of longevity for a continued robust existence. Thank you for your sharing your story with the world and thank you for your trust. God Bless you and God Bless New Jersey. 


Respectfully, 







Dr. Roshin









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