Permanent Hearing Loss From Noise May Depend on Time of Day!

Research out of Sweden have discovered that noise-induced hearing loss sustained at night is more likely to become permanent than if it occurred during the day... at least in mice.

Apparently, there are certain genes found to cycle in the cochlea of mice in a pattern that followed the hours of the day. By measuring the auditory nerve activity, they found that mice exposed to moderate noise levels during the night suffered from permanent hearing loss while mice exposed to similar noise levels during the day did not. The ability to heal after noise-induced hearing loss (temporary threshold shift) was linked to the circadian rhythm due to levels of BDNF (brain derived neurotrophic factor).

Specifically, concentration of BDNF increases in the cochlea during the day which protected hearing from permanent damage whereas levels were absent at night. Furthermore, researchers were able to artificially increase BDNF levels at night when normally absent and confer hearing protection with noise exposure.

What does this mean for humans?

IF human ears also have a biologic clock similar to mice, than researchers MIGHT be able to develop a specific way to reverse (or prevent) noise-induced hearing loss. Currently, the only way to treat acute noise-induced hearing loss is high doses of steroids whether orally or by injection directly into the ear.

Also, humans should probably avoid listening to loud music at night (i.e. concerts, night-clubs, restaurants, etc) which elevates risk of permanent hearing loss (compared to during the day).

Reference:
TrkB-Mediated Protection against Circadian Sensitivity to Noise Trauma in the Murine Cochlea. Current Biology, 27 February 2014. 10.1016/j.cub.2014.01.047

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Unhappy with Your Appointment Day/Time with your Doctor?

A common complaint for patients is how long it may take to get in to see a medical specialist. A new patient appointment may be 1-2 weeks away when an earlier appointment may be desired.

What to do?

Of course, one can call around to every single specialist office in the region to see who has the next earliest appointment.

Other options which may work just as well include the following:

• Do NOT limit yourself to a specific day of the week and time. Always use the phrase "the very next available appointment whenever that may be."

• Ask your regular doctor to call and make an appointment for you. Be aware that if you resort to this option, you will have to accept whatever day/time you are given. Do not use this option if you will most likely end up changing the appointment to suit your schedule, otherwise risk being given an appointment far into the future.

• Although in theory, there are appointment wait lists you can put yourself into, it only works if the medical office checks it regularly... which typically does not happen. What works better is to call everyday! On a daily basis, there are ALWAYS cancellations that occur. In my office daily, there are usually 1-2 new patient appointment cancellations and double that in established patient appointment cancellations. Such cancellations usually are called in by 10AM for that afternoon or 4PM for next day cancellations. So call around that time to see if any appointment slots have opened up that you can slip into. This is why medical offices beg patients to always call if you are not going to show up and even charge a fee if you fail to inform in advance. It is to help other patients who desperately want to be seen and who could have been scheduled into your appointment slot that ended up being wasted.

Based on a study by ZocDoc, here are other appointment related trivia:

• Tuesday is the most popular day for doctor appointments; it's also the day with the most last-minute openings.
• For pediatricians, the most popular day for doctor appointments is Monday
• The most popular appointment of the week is Friday at 10AM, followed closely by Friday at 2PM.
• Thursday has the longest wait time.

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Why Do Culture Results Take So Long? [video]

One of the most common questions I get after obtaining a culture of pus whether from the ear or the nose is how long it takes before the culture results are back... especially when MRSA is a concern.

Does it take a few hours? 24 hours? Days?

Disappointingly, it can take up to 5+ days if not longer.

You want to know why?

Well, rather than explaining, watch a 6-minute video that explains the numerous steps that goes into providing a diagnosis after a culture has been obtained... in this particular case, ear drainage though the same steps apply to any culture obtained from anywhere else in the body.

Special thanks to Robin Earl who spent hours hanging out in the microbiology lab video-taping all the relevant video clips as well as Fauquier Health for allowing this video to be made!

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Why Do Biopsy Results Take So Long? [video]

One of the most common questions I get after a surgical procedure is how long it takes before biopsy results are back... especially when a mass was removed and there is a cancer concern.

Does it take a few hours? 24 hours? Days?

Disappointingly, it can take up to 7 days if not longer.

You want to know why?

Well, rather than explaining, watch a 6-minute video that explains the numerous steps that goes into providing a diagnosis after a mass is removed... in this particular case, a neck mass though the same steps apply to any mass removed from anywhere else in the body.

Special thanks to Robin Earl who spent hours hanging out in the pathology lab video-taping all the relevant video clips as well as Fauquier Health System for allowing this video to be made!

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For a Physician, When is the Best Time To Tweet or Publish a Blog?

According to professional bloggers and tweeters, timing of content publication is important in order to maximize getting noticed and shared. From a general topics viewpoint (not healthcare specific; data taken from here):

• 4PM Eastern is the best time to Tweet
• Friday is the best day to Tweet
• 9AM Eastern is the best time to Facebook share
• Saturday and Sunday are the best days to Facebook share
• In the morning is the best time to blog
• Publishing a different blog article multiple times throughout the day is better than once per day

However, I've always wondered if such "rules" similarly apply to healthcare content as by their very nature, people tend to search a problem after seeing their doctor or seeing/reading it on the news.

Ever since I've been monitoring my website statistics starting in 2005, I've noticed some undeniable trends of "when" website activity occurs which presumably reflects "when" healthcare keyword searches occur.

For any given 24 hour period of time (graph shown below is for Nov 14-15, 2011), my ENT practice website got THE most activity between noon and midnight; peak activity being from noon - 3PM.

On a weekly basis (graph shown below is for Mon Nov 14 - Sun Nov 20, 2011), the greatest activity is Monday thru Wednesday after which web traffic drops off almost 50% by Saturday before bouncing back up 100% on Monday.

Such statistical fluctuations have been true for the past 5 years I've been tracking this stuff.

Now I certainly can't explain the "why" this phenomenon happens without more google analytics data from more healthcare websites, but I certainly can take advantage of this knowledge as it pertains to ENT problems (though I suspect that what is true for ENT is true of other health problems when it comes to web traffic).

How can I take advantage of this knowledge?

People are CONSTANTLY adding to the content found on the web, all vying for the attention of eyeballs. Being the first is important as it seems to me that google values original content (not copies that appear later), but just as important is "when" the content first appears as one would like to ride the wave of when healthcare keyword searches occur.

Overall, the holy grail is to come up with great original content, be the first to publish it, but publish it at the right time.

Great, Original Content

Good content is king and #1 in the priority of getting noticed. If your content stinks, being first and when you publish won't matter.

Be the FIRST to Publish

I can't prove it and I don't have supporting evidence for it, but it seems that google does prefer content that appears "first" over copies that appear later. The prime example is Associated Press articles that are syndicated and re-published over a wide variety of different newspaper websites throughout the world.

If google encounters the same exact article 100 times, how does it rank one over the other?

I suspect, it ranks based on two factors:

1) "Popularity" of the website publishing the content
2) Being the first to publish

Obviously, an individual only has control over timing. Take advantage of it.

WHEN to Publish

Though being the first to publish is important, the timing of when to publish is also extremely important. It's almost like surfing... You want to be the first to stake out a place to ride a wave... but you need to be where the waves are.

Given the dramatic... but consistent... fluctuations in healthcare web activity, it is better to wait and publish when people are actively searching. It is more likely to get noticed and hopefully shared, emailed, liked on facebook, tweeted, etc. Going viral is the goal all content publishers dream of.

So, WHEN is the golden moment to publish?

It is around 11AM on Mon, Tues, and Wed based on my limited data.


Conclusion

Now, do I even follow my own advice?

Not necessarily... I tend to go with the "be the first" rule regardless of the time, not because I feel it more important than the timing of publication, but it's just that I have so much other things to do (like taking care of patients), that if I come up with an idea to write about, I just publish it and not worry too much about timing.

BUT, if I do have a moment, I WILL tend to publish things timed between 11AM and 3PM during the week.

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