Is Your Metal Implant MRI Safe? There's a Website for That...

Although one could always contact the manufacturer or surgeon who performed your metal implantation directly to determine whether it is MRI safe or not, there's also a website that contains a comprehensive database of metal implants and how compatible they are with MRI scans.

Who knew that certain metal implants are compatible with MRI scans up to a certain strength?

Who knew a metal implant that may not necessarily be compatible with MRI, but given enough time after implantation (usually 6 weeks), it is still safe to get an MRI scan?

Check this website www.MRIsafety.com out!

The actual searchable list of implants is here.

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Lawsuit for Botched Laser Vocal Cord Surgery

In February 2012, an ENT surgeon removed vocal cord polyps using a laser while the patient was asleep with a Medtronic Laser-Shield II endotracheal tube. Unfortunately, the laser perforated the endotracheal tube, ignited the 100% oxygen being used at the time resulting in catastrophic burns to the patient. [link]

Subsequent lawsuit resulted in favor of the patient who received an award totaling $30 million on 12/5/13.

What Happened?

Even though an endotracheal tube meant for use with laser procedures was utilized, if this specially designed tube sustains enough damage from the laser, it will either perforate or heat to a high enough temperature to ignite. Furthermore, 100% oxygen was administered by the anesthesiologist which just added gasoline to the flame.

Ideally, in such laser procedures, meticulous surgical technique is still required and care taken to avoid damaging the endotracheal tube, even if a "laser-safe" tube is used. The "weak" part of any laser-safe tube is the cuff that is inflated to make a tight seal between the trachea and the tube itself. As such, the cuff material is necessarily thin. Saline-soaked pledgets placed immediately above the cuff helps protect the cuff as well as use of a tube with two cuffs (in case one fails). Also, room air should have been administered to the patient in the event the tube fails in order to minimize oxygen in the area... and the patient placed temporarily on apnea whenever the laser is turned on.

The risk of fire among other reasons are why many ENT surgeons (myself included), have stopped using lasers for procedures done in the mouth and airway.

With vocal cord procedures, I still utilize cold steel techniques which has a zero risk of airway fire.

Sources:
Botched surgery will cost hospital. The Wenatchee World. 12/6/13.

Medtronic slips $18M verdict in surgical fire case. MassDevice. 12/10/13

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Popular Nasal Decongestants Associated with Birth Defects

Researchers have discovered that there is a very small, but significant association between birth defects and use of nasal decongestants in the first trimester of pregnancy. Unfortunately, decongestants (ie sudafed, afrin, etc) are also one of the most popular medications purchased over-the-counter to treat symptoms of nasal congestion, runny nose, and allergies.

In particular, three strong associations were found:

• Phenylephrine and endocardial cushion defects
• Phenylpropanolamine and ear defects
• Phenylpropanolamine and pyloric stenosis

Although these associations were related to ORAL decongestant use and first trimester intake, it was also found that intra-nasal decongestant use during the first trimester was associated with pyloric stenosis and tracheo-esophageal fistula.

Taken in summary, it is perhaps ideal that women in their first trimester of pregnancy avoid decongestant use due to a possible association between birth defects and medication usage. This association accounts for a VERY small percentage increase in birth defects and as such more study is needed.

For example, the baseline prevalence of endocardial cushion defect is 0.34 per 1,000 live births. Phenylephrine exposure increases this risk 8-fold resulting in 2.7 per 1,000 live births. That's an overall increased risk of only 0.27%.

Keep in mind that all these over-the-counter products contain a decongestant ingredient:

• Afrin
• Sudafed
• Tylenol Cold Multi-Symptom Nighttime
• Alka-Seltzer Plus Cold
• Delsym Night Time Multi-Symptom
• Tylenol Cold Multi-Symptom Severe
• Tylenol Cold & Flu Severe
• Vicks Dayquil Cold & Flu Relief
• Benadryl Allergy Plus Sinus Headache
• Theraflu Warming Relief Nighttime Severe Cold & Cough
• Vicks Nyquil Sinus
• Acutrim
• Dexatrim
• Afrin
• Zicam
etc, etc, etc

So what is a pregnant woman to do if her nose gets all stuffed up and wants to avoid decongestant medications to eliminate any possible risk of birth defects? Click here for some suggestions.

Source:
Use of Decongestants During Pregnancy and the Risk of Birth Defects. Am. J. Epidemiol. (2013) doi: 10.1093/aje/kws427

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Can HPV be Caught by Kissing Someone with HPV Throat Cancer?

HPV transmitted by oral sex is the leading cause of oral and throat cancer now. And for spouses/partners of patients diagnosed with HPV throat cancer, the main concern is whether it is "contagious".

After all, if HPV is transmittable by oral sex, than it would seem that kissing can also transfer HPV to the partner as well.

Well, a small Johns Hopkins study suggests that intimately kissing someone who has HPV oropharyngeal cancer does NOT lead to a new HPV infection in the mouth or throat in the partner. Among 93 partners of 164 patients, prevalence of HPV infection in the throat was no higher than would have been expected. Specifically, about 1.2% had HPV which is equivalent to what one would find in couples without history of HPV throat cancer (1.3%). There were only six male partners, none of whom had oral infection with HPV.

Please keep in mind that this study is far from definitive and further study is required before one can say with absolute certainty that kissing and other intimate activities are totally safe. After all, oral sex leading to HPV infection of the mouth is a relatively recent discovery. Who is to say that with enough time and study, even kissing may eventually be found to do the same???

The study was originally presented at the 2013 annual meeting of the American Society for Clinical Oncology and published in April 2014.

Reference:
Oral Human Papillomavirus (HPV) Infection in HPV-Positive Patients With Oropharyngeal Cancer and Their Partners. Journal of Clinical Oncology. April 28, 2014, doi: 10.1200/JCO.2014.55.1341

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Azithromycin Increases Risk of Death Slightly... Well, So Does Tylenol and Ibuprofen

The media has made much fuss about a NEJM study suggesting a slight increased risk of death from taking azithromycin or z-pack. The more unhealthy you are, the higher the risk... no duh... (I would think the sicker you are, the greater the risk of death PERIOD... a sick person by definition is closer to death than a healthy person).

How slight? Compared to amoxicillin, about 47 additional cardiovascular deaths per one million courses of therapy.

Never mind the blatant biases found in the study nicely espoused on by cardiologist Dr. Wes in his blog. I should also point out that there's another study that did NOT find an increased risk of death with azithromycin.

Thinking you should never take a z-pack again due to this slight increased risk of death?

Well, good luck finding an alternative medication (of any kind) because they ALL have a potential risk of death.

Similar to z-pack, these other antibiotics also have an increased risk of sudden cardiac death:

• Avelox
• Bactrim
• Biaxin
• Cipro
• Diflucan
• Erythromycin
• Factive
• Floxin
• Foscavir
• Ketek
• Levaquin
• Sporanox
• Sulfa
• Tequin

It's not just antibiotics. These other common medications (not all-inclusive) also have an increased risk of sudden cardiac death:

• Benadryl (allergy)
• Pepcid (reflux)
• Albuterol (asthma)
• Prozac (depression)
• Serevent (asthma)
• Sudafed (decongestant)

The complete list can be found here.

Let's consider other popular drugs that also has an increased risk of death, though not necessarily from a cardiac trigger.

• ALL antibiotics due to a severe anaphylactic allergic reaction - Take Penicillin for example... about 300 die annually from penicillin allergic reaction in the US
• Tylenol causes liver failure - About 400 deaths per year in the US
• Ibuprofen causes internal bleeding - About 15,000 - 20,000 die per year in the US
• Alcohol related deaths - 75,000 deaths per year in the US
• Smoking related deaths - 443,000 deaths per year (one in five deaths) in the US

Never mind deaths from driving a car, accidental gunfire, drowning in a swimming pool, etc.

Life in general in the United States has a risk of death.

Source:
Azithromycin may up chance of sudden cardiac death. Heartwire 5/16/12
Popular Antibiotic May Raise Risk of Sudden Death. NYT 5/16/12
Azithromycin and the Risk of Cardiovascular Death. New England Journal of Medicine 2012; 366:1881-1890May 17, 2012
Use of Azithromycin and Death from Cardiovascular Causes. N Engl J Med 2013; 368:1704-1712May 2, 2013DOI: 10.1056/NEJMoa1300799

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How to Make Xylitol Nasal Flush at Home

Given the unusually large reader response to my last blog regarding xylitol nasal rinses regarding the "recipe," I thought it easier to write a blog about it!!!

To be brief, xylitol is a naturally-occurring plant-based sugar substitute that apparently has all sorts of anti-bacterial as well as anti-fungal properties. Given these properties, daily xylitol gum chewingor xylitol nasal sprayuse has been shown to help prevent recurrent acute ear infections and sinus infections... safe for use even in infants.

When used as part of nasal flushes to the nose, it seems to work even better than traditional saline flushes to the nose (read more about this here).

So, I have provided below a few different recipes to make xylitol nasal flushes at home. One may be more comfortable than the other, but it is user dependent. Obviously, convenience will play a role as well.

Just as an FYI, you can also purchase pre-packaged packets that contain xylitol for the ultimate convenience. Just open one packet and mix it in with water inside your nasal flush kit of choice (Nasopure, Neti Pot, Neilmed, etc)

Recipe #1 (Complex):
1 cup of water (8 ounces)
1/4 tsp salt
1/2 tsp of xylitol crystals
1/4 tsp baking soda
4 drops of grapefruit seed extract

Recipe #2:

1 cup of water (8 ounces)

1/4 - 1/2 tsp salt

1/2 tsp of xylitol crystals

Recipe #3:

1 cup of water (8 ounces)

1/4 - 1/2 tsp of xylitol crystals

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Are You Able to Use Expired EpiPens Safely?

Though one should always use an EpiPen that is not expired, it is better to use an expired EpiPen to treat anaphylaxis than to do nothing at all.

Some Canadian researchers studied expired EpiPen auto-injectors 1 to 90 months past the expiration date.

What they found was that the older the EpiPen, the less effective it was due to decreased epinephrine bioavailability. The inverse correlation was 0.63 (months past expiration and decreased epinephrine content).

As long as the solution is clear without precipitates or discoloration, it's fine to use the EpiPen. BUT, still better to use an EpiPen that is not expired!!!

Reference:
Outdated EpiPen and EpiPen Jr autoinjectors: past their prime? J Allergy Clin Immunol. 2000 May;105(5):1025-30.

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