Dr. Chang Makes Front Page News in Local Newspaper with Practice Merger

On January 31, 2014, Dr. Chang made front page news of the Fauquier Times local newspaper with his planned practice merger with Blue Ridge Orthopaedics and Spine Center to become part of the Greater Piedmont Medical Association. With this merger, he will be also joining Dominion Internal Medicine (Drs. Robert Lin and Michael & Jennifer Ackerman) as well as Urological Associates of the Piedmont (Dr. Pfeffer). In spite of this merger, the practice name, addres, location, staff, phone number, etc will all still remain the exactly same.

Read the article here!

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ENT Question Bank iPhone App for Physicians and Residents

The AAO-HNS has released a nifty iPhone app that contains 400+ Q&A to test one's knowledge in the field of otolaryngology. Called AcademyQ, it is free for 10 sample questions, but $49.99 to access the entire question bank.

Although anybody can download the app (link to app store), it's really meant for busy ENT surgeons. This app may be worthwhile to quiz oneself on esoteric ENT trivia in between surgical cases and patient office visits where one might have a minute or two to go through a few questions.

The questions are similar to the ones one may encounter in the Home Study Course.

More debatable is whether such a question bank is helpful in preparing for Board-Certification or Recertification.

In any case, for example, one of the sample questions is:

Whether you get the question right or wrong, an extensive answer is provided to explain further:

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Presentation on Social Media Given at AAO-HNS Meeting in Vancouver, BC

It was with great honor and pleasure that I was asked by the American Academy of Otolaryngology-Head and Neck Surgery to co-present a 90 minute long mini-seminar on social media in medicine on October 2, 2013 in Vancouver, BC.

Dr. Wendy Stern (Vice Chair - Public Relations Committee of the Board of Governors of the American Academy of Otolaryngology/Head and Neck Surgery) along with Dr. John Carter (AAO-HNS Section for Residents and Fellows) organized this talk coordinating 4 speakers including:

• Dr. Lawrence Simon (Assistant Professor at Louisiana State University) providing an overview of social media and its pervasiveness
• Myself from the view of a private practice
• Dr. Julie Wei (Division Chief at Nemours Childrens Hospital in Orlando, FL) from the perspective of an academic medical practice
• Dr. Lee Eisenberg (Associate Clinical Professor at Columbia University) portraying the medical-legal pitfalls of social media

During this presentation, it was great to hear, see, and meet other otolaryngologists active in social media including @ENTinTraining, @ent_amy,@ithinkalot as well as blogger Dr. Bruce Campbell (Reflections in a Head Mirror; aka @headmirror).

One of my former mentors at Duke University, Dr. Richard Scher, was also present.

Here's a few tweets related to this event...

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New Movie Trailer for Fauquier ENT YouTube

It has been an amazing experience with how successful our videos have been on YouTube. We now have 60+ different videos of ENT procedures that has been viewed over 247 million times since 2007. We also now have over 12,300 subscribers to our video channel.

To celebrate, a movie trailer of sorts has been created to introduce new viewers to the sort of videos they will see and will continue to see from us.

Check it out! And... if you haven't yet subscribed to our video channel, please do so!

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ENT Surgeons Who Use daVinci Robot

Readers know my skepticism on the practicality of the daVinci robot in ENT head and neck surgeries.

However, that does not mean that I do not doubt its effectiveness in certain unique situations... as well as market forces that use such high (and expensive) technology to market a given hospital's services.

In any case, plenty of patients have asked me if there's any ENT surgeons who use the daVinci robot in the region.

There are... and here are two that I am aware of.

Dr. David Shonka at UVA
Dr. Stan Chia at Georgetown

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TV Show HOUSE Exploring ENT Problems

I must clarify that I never really like TV show House for reasons explained here... but patients who love watching House have alerted me to some episodes this season that touched on ENT problems.

So... here goes...

Episode 21 (Season 8): Holding On
Diagnosis: Persistent Stapedial Artery

19 years old cheerleader was admitted after suffering from dizziness, massive nosebleed, and auditory hallucinations. It was ultimately determined that he was suffering from a persistent stapedial artery.

This artery is a congenital defect of the inner ear that should have obliterated during fetal development. However, if persistent, is typically found going through the stapes bone of the middle ear.

It CAN cause symptoms of dizziness as the pulsations of the artery can transmit through the stapes footplate and into the vestibule via the oval window. It can also cause auditory hallucinations by pressing against the nearby temporal lobe as well as a nosebleed. If the artery ruptures, it can only drain through the eustachian tube and out the nose.

However, if the patient presented to the ER with nosebleed and dizziness, a complete physical exam would have been performed and a clearly seen blood-filled middle ear cavity (hemotympanum) would have been seen that even a medical student would have found. That would have indicated an ear issue causing both the dizziness and nosebleed. Also, the patient would have complained of hearing loss with blood in the ear.

From that point, the differential diagnosis is actually quite small and would have been obtained relatively easily.

Episode 17 (Season 8): We Need The Eggs

Diagnosis: Amoebic Meningitis

35 years old man admitted to House’s service after he is discovered crying blood. He later develops light sensitivity, vomiting, and a stiff neck.

After suspecting meningitis, it was discovered that he was using a Neti Pot and was using tap water rather than distilled or sterilized water in order to perform saline flushes. The water happened to contain an amoeba (likely Naegleria fowleri) which caused an amoebic infection of the brain.  The culprit organism Naegleria fowleri causes a life-threatening encephalitis after passing thru the nose and up into the brain where the organism eats neurons for food.

Such brain infections have been recently reported in the news and can be prevented by using water that is boiled, distilled, or filtered.

Fortunately, it is rare.

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Actress Reese Witherspoon's Dad is an Otolaryngologist!

It has recently come to my attention that actress Reese Witherspoon's dad is an eminent otolaryngologist!

John Witherspoon, MD has practiced with a Nashville, TN otolaryngology group for over 30 years and is an instructor in this specialty at Vanderbilt University Medical Center.

He went to medical school at University of Tennessee Health Science Center College of Medicine and completed his residency at Tulane University Hospitals and Clinics.

He unfortunately has come under recent scrutiny from the media which hopefully will pass over quickly!

I wonder if Reese Witherspoon used her dad as a role model in the romantic comedy movie "Just Like Heaven" when she played Elizabeth, a workaholic doctor.

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Dr. Chang a Washingtonian Top Doctor for 2012

For 2012, Dr. Chang was selected as a Washingtonian Top Doctor in the field of otolaryngology (page 120). This year's list was published in the March 2012 issue of the magazine.

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Dr. Chang a Northern Virginia Top Doctor for 2012

Northern Virginia Magazine published their annual list of Top Doctors for 2012 in their February 2012 edition. Dr. Chang was listed as one of Northern Virginia's Top Doctor in the field of Otolaryngology (page 72).

Of note, Dr. Chang was nominated by his doctor peers opposed to nomination by a small panel.

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Robotic Surgery for Obstructive Sleep Apnea

I came across this article the other day regarding use of the daVinci robot to perform base of tongue surgery for obstructive sleep apnea.

For those who don't know, the daVinci robot system made by Intuitive Surgical is a robotic system whereby the surgeon directs the arms of the robot to perform surgery in difficult-to-access areas of the body.

My feeling is that using a robot to perform sleep apnea surgery is way overkill akin to using a $50,000 sniper rifle to kill an ant on the wall.

Everything the daVinci robot can do can also be done without the robot with equivalent patient outcomes. In fact, without the robot, the surgery can be performed more quickly, efficiently, and with less anesthesia than with the robot.

The article also describes sedated (sleep) endoscopy to determine WHERE the obstruction occurs during sleep. The areas of obstruction can than be precisely addressed surgically. Again, this does not require a robot. In fact, I would hazard to say that even the surgeons quoted in the article does not use the robot to perform this procedure.

There are occasions where the robot may be helpful with ENT surgical procedures, but this is not one of them.

Reference:
N.J. surgeons on the cutting edge in fight against sleep apnea.

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Dr. Chang a Castle Connolly Top Doctor in America

In November 2011, Dr. Christopher Chang was added to Castle Connolly's list of Top Doctors in America. Apparently, he is the only Top Doctor in the field of otolaryngology within a 30 mile radius.

It's no surprise given patients travel from as far away as California and even the Philippines to be treated by Dr. Chang.

You can check out his listing here or on US News and World Report of Top Doctors.

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ENT Position Available With Our Practice

Our practice is looking for a board-eligible or board-certified otolaryngology-head & neck surgeon sometime in 2014 time frame with guaranteed income that first year followed by partnership.

We are located in Northern Virginia about 45 minutes directly west of downtown Washington DC and is run by Dr. Chang in solo practice. The practice itself is located on hospital grounds situated in the lovely tree-lined rural city of Warrenton, VA where one can even see the Appalachian mountains from our office. Many city amenities are available within a short 15 minute drive but without the traffic and hassle of big-city congestion.

Interest in general otolaryngology is a must with sub-specialty interest even better. Some facts that may be of interest:

• Full-service ENT office with audiology, hearing aids, allergy testing, and allergy shots
• Near-monopoly services in terms of ENT and allergy in the region. 1 of only 2 otolaryngologists in the county… no otolaryngology services in counties to the West. 1 of only 4 allergists in the county 
• Office fully on electronic medical records
• Office on hospital campus (one office and no satellite offices to cover)
• Hospital and Radiology fully on electronic medical records & PACS, all accessible via iPhone and iPad
• BrainLAB image guidance available
• Office will possibly be moving to a brand new medical office building (still on-campus) in near future with in-house ambulatory surgery center. Ownership opportunity available for both.
• Aggressive social media participation
• Semi-rural, small-town environment
• Call would be 1:3 (with calls rarely occurring after hours)

If there's any interest, please call or email!

For more information about our practice, check out our practice website!

Please note...

We will not deal with recruiters.

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