Hearing Aids in the Olympics

Hearing Aids in the Olympics

Russian skier Elena Yakovishina wears bilateral hearing aids, enabling her to hear the cheers from her fans.

NFL’s Derrick Coleman Powerful Duracell Commercial

http://www.youtube.com/watch?v=u2HD57z4F8E

Seattle Seahawk fullback Derrick Coleman is a long time hearing aid wearer, check out this powerful commercial!

Did you watch the Super Bowl?

Stadium noise at NFL games can reach dangerous levels (90+dB)!  Check out these studies done by OticonUSA:

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Don’t miss your loved one whispering sweet nothings into your ear

Don't miss your loved one whispering sweet nothings into your ear

Check out this month’s newsletter: Facts About Hearing Loss

Sinus and asthma

No question, my patient’s asthma is much better when sinuses fixed. Great op today -endoscopic, image guided, total ethmoids, maxillaries.
http://www.ncbi.nlm.nih.gov/pubmed/15801321

Independent, non hospital owned practice

From the Institute of Healthcare Improvement:
“Increasingly, health care systems, health plans, public health departments, social service agencies, and regional coalitions are organizing their most strategic initiatives to move toward the Triple Aim of better health, better health care, and lower per capita costs. In the US, new models of financing and payment, such as accountable care, are deeply informed by the Triple Aim framework. In health systems around the world, the pursuit of better health, better care, and lower cost  has been adopted as a societal and fiscal imperative.
 
The Triple Aim focuses on serving populations while generating ever increasing value. Whether your focus is global payments or other value-based financing models, Accountable Care Organizations, the medical home, employee health, or responding effectively to assessments of community health needs, the Institute for Healthcare Improvement (IHI), which pioneered the Triple Aim concept, change strategies, and system measures, can help you master the basics and map your strategy to get real traction in producing Triple Aim results.”
and then read this from the N&O:
http://www.newsobserver.com/2012/12/16/2548652/prices-rise-as-hospitals-buy-medical.html#storylink=cpy

from this story: 
“North Carolina patients are likely to pay more for services ranging from heart tests to routine office visits if their doctors are employed by a hospital, a newspaper investigation has found.”

Unfortunately my colleagues and one of our leading hospitals have succumbed to the pressure of the dollar and security to inflate the cost of health care in our area without increasing quality or value one iota.

When and if you need and seek health care, make sure your physician is not owned by a hospital or you will be paying far and beyond what you would pay at an independent, private practice like ours.
“All value, no ripoff”

Allergies, sinus makes asthma much worse

Douglas Holmes, MD‏@drdougholmes

Got asthma? Control much better if sinusitis treated, allergy eliminated. We can do both.

Hearing aids

I was recently fitted with two hearing aids, actually communication devices. Not only do they immensely improve my hearing, they are blue toothed into my cell phone and TV/DVD. What a difference hands free communication via my cell phone directly into my hearing aids has made, and music and TV directly into my hearing aids is better than surround sound. If you have any type of hearing loss, we can now make you hear and function better than when you had ‘normal’ hearing. Check it out for yourself!!

An International City

Raleigh has quickly become an international city. Over the last several years, our practice has seen an influx of patients from Nepal, Eritrea, South America, and the Middle East. Many looking simply for a better way of life. As a physician, I am challenged to keep in mind disease processes that are not common in indigenous North Carolinians, and I also now see our common problems that are much more advanced due to lack of medical care. Not to mention cultural and language barriers … All this is challenging and oh so interesting.

Thyroid surgery – the evolution

Few areas of my medical practice have undergone the evolution that has the surgery of thyroid disorders.  No other area has benefited from such extensive experience over the last 20 yrs, and no other area demonstrates the competency that procedure after procedure has brought to me today.

My initial experience in the OR with thyroid was during my surgical intership.  An endocrine surgeon at Iowa in the general surgery division first captivated me with the detail and precision that this neck procedure requires.  Professor Dr Gurl was meticulous in surgery, and even more meticulous in drawing and documenting his operative findings.  As a benefit of his attending status, he could have allowed the resident on the case to dictate the operative report, but oh no!, Dr Gurl sat down after each and every case and very carefully described the operative findings and his intervention.  My young, learning eyes were watching and soaking up every detail and lesson.

When I had finished residency and fellowship, I had the great fortune in the USAF to be stationed at Travis AFB, California, a tertiary care center for the military.   Again I scrubbed with very experienced and talented thyroid surgeons.  Dr. Lisa Boyle taught me among other things her very successful technique in the presentation and preservation of the parathyroids and the staff endocrinologists shared their nuances of the subsequent post op calcium management.  An environment like this of shared learning without the issues of turf wars is seldom found, but I like to think it was due to our interest in patient care and our military dedication to a higher good that created these possibilities.

So when I started the UNC ENT division at WakeMed and then transitioned to my own private practice, thyroid surgery was firmly in my cache of abilities.  But there is nothing like experience, one after another, to make a capability a specialty.  Such has been the opportunity of being the head and neck consultant for Butner Federal Medical Center and developing laisons with endocrinologists here in Raleigh.  I have had the honor and opportunity to help hundreds of  patients with their goiters and thyroid nodules.  Every case involves the meticulous dissection of the recurrent laryngeal nerve which controls the movements of the vocal cords.  If hurt, the patient would be quite hoarse with a dysfunctional voice (one of my patients was the public address specialist at Seymour Johnson AFB, a damaged voice would have ruined her USAF career, he did more than fine).  This nerve runs right next to the gland, and is mere milimeters away.  The other vital structure to maintain is the parathyroids, which control calcium levels in the bloodstream.  Low post op calcium levels will lead to heart and nerve irregularities that can be fatal.  It is not unusual to require calcium supplements post op in even the best operation.  Fortunately, in my patients, no one has suffered  voice issues or need for prolonged calium supplements post op. 

After the initial incision in the neck, the skin flaps are dissected up and down, and the muscles of the neck are seperated in the midline.  Directly beneath lies the thyroid, with its extensive blood suppy.  The operation requires increment by increment removal and cautery of feeding veins, arteries, and connective tissue, all the while ;ulling the gland over in sponges toward the midline while retracting on skin and muscles laterally by an assistant to gain exposure to the promised land of recurrent laryngeal nerve and parathyroid glands.  Each movement takes only 3 to 4 mm of tissue away, so it is not unusual to spend 2 or more hours per thyroid lobe to successfully complete.

When the gland or lobe (1/2 of the thyroid removed to evaluate a suspicious nodule) is  removed, then full hemostasis (stoppage of bleeding) is assured, and the wound is closed with a only a fine line of incision and therefore scar left.  It is my goal to make it hard to see 6 months later that an operation was ever done.

Few operations require such concentration and surgical skill for hour after hour.  I love it.

bone anchored hearing aid

What a great case!!! Helping someone’s hearing by placing an implantable metal post??
It’s true. It’s called a bone anchored hearing aid, and very few Raleigh area ENT’s or audiologists offer this really neat advancement in hearing rehab. It’s designed for ears that can’t be helped with conventional hearing aids, or for ears that have lost all their hearing and need sound transmitted via the skull to the other ear. So cool!! Involves surgically placing a metal post that integrates into the bone, and when healed and stable is connected to a receiver that vibrates with sound input. Can’t wait for the another two months or so when we connect up this patient, our first. Just another example of being on the cutting edge and offering the very best and latest for our patients!

Alternative to Risky Sinus Surgery

Sinus surgery for chronic infections can be risky, as explained in this WRAL TV video by Dr. Doug Holmes. Dr. Holmes, as you’ll see, recommends a simple same day procedure called Balloon Sinuplasty, which is far less invasive and less risky than past standard surgical approaches.

Rex Health “Beat Sinusitis”

Do you suffer from chronic sinus discomfort with no relief using medication? This video describes a new procedure available at Rex Hospital called Balloon Sinuplasty; a less invasive outpatient procedure that avoids the need to pack the sinuses as in traditional surgery.