Dr. Jerold J. Fadem, M.D.

First, determine why the fungal infection occurred in the first place(which frequently is due to using NASAL STEROID INHALERS for chronic rhinitis/sinusitis, or due to some disorder that compromises the IMMUNE SYSTEM--like diabetes, leukermia, chemotherapy, chronic steroid therapy, chronic suppression of the immune system, etc)

Then, anti-fungal medication(like fluconazole, for example) needs to be taken for a few weeks to eliminate the fungal infection.

Assuming you are talking about true OTITIS EXTERNA (and NOT an ear wax build-up or some other cause of ear canal obstruction, which requires an examination with an otoscope to be certain), which is usually an infection of the external ear canal, a number of of things can be tried: the first is to KEEP THE EARS DRY by staying out of the water or using good ear plugs to block water from getting into the ear canals -- as it's the MOISTURE that sets the stage for infection! Then, if that fails, you can try ear drops with rubbing alcohol, acetic acid (vinegar), or sometimes a topical combination antibiotic/anti-fungal solution like Corticosporin-OTIC (or OPTHALMIC, which will not burn if the ear drum happens to be ruptured). If all of this fails, see a good primary care MD who can examine your ears and knows how to diagnose the problem correctly or an ENT specialist who is probably an expert in these disorders.

If he is very healthy going into surgery, has no concomitant medical issues, has no pre-op neurological deficits or symptoms, and suffers no surgical complications, no neurological injury, and no post-op sequellae, he will probably be be healed up in less than 6 mos, and maybe even less than 2-3 months if all goes perfectly. Good luck!

If all goes perfectly after the spinal fusion surgery (which is frequently done for PERSISTENT AND VERY SYMPTOMATIC DISC HERNIATION related PAIN that fails to respond to 3-6 months of physical therapy and/or epidural steroid injections [i.e., like severe sciatica or other radicular pain syndrome, for example]), I advise my patients NOT to do any weightlifting for at least 6 months AFTER the surgery -- assuming all goes well and the patient returns to baseline.

Then, if their pain and any other related symptoms TOTALLY resolve, and they STILL feel very compelled to continue vigorous weight training, I advise my patients -- who CLEARLY UNDERSTAND THE POTENTIAL RISK OF RECURRENT SYMPTOMS -- to SLOWLY, and incrementally, increase their training to ensure they don't get any, even mild, recurrent symptoms. Then, if they do, they MUST stop and pursue other forms of physical activity so they don't end up with CHRONIC PAIN SYNDROME -- which can compromise one's quality of life permanently!

It MUST be made CRYSTAL clear to the patient that once you have ANY "disc related event," including disc herniation and/or any spine surgery, your RISK OF RECURRENT PAIN goes up, probably forever. And one of the most frequent inciting causes of this is bending and lifting!

Though there are many causes of the sensation of being "short of breath"(SOB), the TWO main categories of causes are CARDIAC(where the heart has some abnormality in pumping blood--like coronary disease, valvular defect, or disease of the heart muscle itself) and PULMONARY(where there may be abnormalities of the bronchial tubes, like asthma and bronchitis, or diseases of the lung tissue, like pheumonia and pulmonary fibrosis.

Rarer causes include blood clots in the lung, anemia, anxiety attacks, or chest wall defects.

There are simple things your doctor can do during a physical examination--like take your blood pressure, pulse and respitatory rate, and listen to your heart and lungs tests--which may provide clues to the underlying cause.

He/she may then order an EKG and/or ECHOCARDIOGRAM to assess the heart, and/or a CXR and PFT'S(pulmonary function tests) to evaluate the lungs.

Generally a competent MD(internal medicine specialist or family physician) will be able to be quickly determine the cause of SOB and be able to recommend proper treatment.

There are a number of variables that factor in on the need or value of PT after spinal fusion, but I would say generally, YES -- unless there are clear cut reasons not to have post-op therapy.

Generally speaking, it will take a few weeks to a few months to recover--depending on the type of spine surgery, the extent of the surgery, any co-morbid conditions, and the pre-operative phsycial condition of the patient.

1) LYRICA (pregabalin) is probably #1, but is NOT cheap and has side effects

2) gabapentin and/or tricyclic antidepressants are probably next in line

3) pain medications (opiates and/or NSAIDS) can be tried if nothing else works or is available

4) Capsaician cream can be tried topically -- as it is approved for painful diabetic neuropathy -- but can take a while to work and may initially cause a burning sensation (at least until "substance P," a pain neurotransmitter, is depleted -- at which time the capsaician's beneficial effect may "kick in."

YES, it WILL be painful, so ask your doctor for a couple of days of pain medication if needed. Also, I would be SURE that doing this test is NECESSARY and is REALLY needed for proper decision making (i.e., whether or not surgery is indicated and have a good chance of helping you). And keep in mind that, generally speaking, back surgery has AT LEAST a 50% or more chance of NOT helping reduce pain or even increasing the back pain.

Yes, chronic kidney disease and dialysis can result in a reduced appetite. Be sure you tell your kidney doctor about this so that you don't suffer any malnutrition or loss of necessary nutrients.

If you have no reversible instigating factors, MEDICATION with anti-convulsants is the main treatment modality. NO medicine is perfect, but with the new medications now available, your neurologist will likely be able to find one that will control your seizures with minimal side effects.

Either a knowledgeable, experienced internal medicine doctor or a good urologist. Possible causes include epididymitis, testicular torsion (an acute syndrome requiring rapid diagnosis and treatment), and testicular cancer.

If you don't respond to IRON supplements (i.e., for iron deficiency anemia that menstruating women can get), then you need to see a doctor for diagnosis and proper advice and treatment.

You can if you want -- but you may have to wait for many hours if it is a busy ED--as the sickest patients are usually "triaged" to be seen first. Less sick patients (i.e., patients less likely to die or suffer harm if treatment is delayed) have to wait until the all of the sicker patients are seen first. You are better off going to a primary care MD or an Urgent care clinic for appropriate treatment.

A pulmonary embolism is a blood clot usually originating in the legs that breaks off from leg veins and migrates into the R heart and then into the lungs. The size of the clot can be small or large. The bigger the size, the more likely it will be clinically significant or even fatal(ie--if it is big enough to block blood flow from the right side of the heart into the lungs.)

Thus it is variable whether or not a blood clot causes major symptoms(or death) or is "stabilized" by the body and is no longer capable of causing significant or fatal consequences. But, it is a proven fact that if a patient who has a blood clot in the lower extremities is treated with blood thinners(or "clot busters"), the odds of having a pulmonary embolism(PE) and dying are MUCH REDUCED.

So, bottom line, even if a blood clot in the legs(or even if it breaks off and goes to the lungs casing a PE) may not always be fatal, it is MANDATORY that once a diagnosis of PE or DVT is made, blood thinners(or "clot busters') be started and then blood thinners be continued for a minimum of 3-6 months, and maybe indefinitely in order to reduce the chances of a fatal PE in the future.

The treatment is antibiotics for 7-10 days--IF it is TRULY a BACTERIAL sinus infection and NOT just sinus "allergies" or nasal/sinus symptoms from a cold or other virus infection (i.e., antibiotics do NOT help with VIRAL infections like "the common cold"). Examples of effective antibiotics are doxycycline, azithromycin (Z-pak), amoxacillin/Augmentin, Septra( sulfa), or a cephalosporin antibiotic. It is BEST to try to AVOID using antibiotics for sinus symptoms UNLESS it is clear that the cause is a BACTERIA, the infection has lasted longer than the much more common "cold," and the cloinics picture is worse than those of a typical virus or allergic sinus condition (i.e., fever, chills, malaise, purulent [green/yellow/bloody]) sinus discharge, severe sinus pain, severe headache, etc. MOST "sinus infections" will resolve and only using OTC antihistamine/decongestants with or without an "NSAID" (like ibuprofen) for pain (i.e., Advil sinus, Alka-seltzer sinus, Tylenol sinus, etc.).

Dermal fillers can last for many YEARS, so, IF it is "overdone," you will be stuck with the consequences for a very long time! So, be SURE you find a skilled doctor to do the procedure and keep your fingers crossed, and understand that you may end up with unattractive but permanent "unintended consequences" (of course in the worst cases, fillers could be removed, but it is NOT easy and NOT a simple procedure).

3 options:

1) If you are totally asymptomatic and not a diabetic, you can do nothing except maybe avoid fatty foods and keep your fingers crossed (and remember that MOST patients with gallstones do NOT suffer any negative consequences)
2) Take a medicine called ACTIGALL (ursodiol) which MAY, again MAY, slowly dissolve cholesterol gall stones, or
3) Surgery--laparoscopic cholecystectomy--this is indicated if the patient is clearly having symptoms (i.e., R upper quadrant abdominal pain, cholecystitis, biliary obstruction/infection, or biliary pancreatitis) due to the stones

An endoscope is a long, flexible tube with a light on the end. It can be used to look into the stomach (upper endoscopy), colon (colonoscopy), sinuses (sinus endoscopy), joints (arthroscopy), etc. Most of these procedures are done with the patient under light anesthesia--so usually there is very little or no pain when done by a very experienced and sophisticated doctor and medical team.

Avoid cigarette or tobacco smoke, smog, fumes, dusts, chemicals in the air, and allergens, exercise, keep your weight down, do all you can to keep your heart healthy (treat high BP and keep your BP less than 130/80 or so), maintain a healthy cholesterol level (with an LDL less than 100 or so), exercise 30 minutes a day or so, keep weight down to avoid type 2 diabetes and undue stress on the heart and lungs, and live in a place with clean, dry air, and away from industry, factories, bad air emissions/smog (i.e., heavy traffic, etc.).