Dr. Cranquis' Mumbled Gripes

Functional Dysphonia: Vocal Cord Massage Brings Mom's Voice Back - ABC News →

I gotta say, the portion of this video which shows a mom getting her “normal” voice back after 4 months of laryngitis, through just 15 minutes of vocal cord massage, is very impressive. Makes me want to learn how to do that technique!

Her ear’s been draining this stuff, it looks like carrot juice, but it smells like a sewer.

Descriptive Mom of child with ear drainage (from a ruptured infected middle ear).

Sunny’s Fast-Lane

imfictional (“Sunny”, winner from the Facebook Fan Page Weekly Theme contest) submitted:

So here’s a weird one for you…

I am one of those people who can crack pretty much any part of my body just by moving a certain way… no one ever has to crack my back, I just kind of twist and it sounds like fireworks or something. This includes my neck. It always cracks (with a short “recharge period” between) super easily. But in May 2010 I had a tonsillectomy due to gross tonsil stones (ew!!!) and since then my right side of my neck has only cracked 22 times. I know the exact number because it took about a year to finally crack and it is really easy to count since it happens so rarely. Is there a cause for this? Especially one that would coincide with a tonsillectomy or is it a really strange coincidence? I took codeine, Phillips stool softeners (due to the codeine) and motrin after the surgery and I don’t know what medication they used as anesthesia… if any of that helps. Happy guessing (or informing!)

Ummm… maybe the anesthesiologist was also a chiropractor and gave you a little sumpin’-sumpin’ extra while you were under?

That is a W.A.G. Here are some more: Maybe the muscle paralytic, given as part of the anesthesia, might’ve affected the way your neck muscles stretch? Or the ibuprofen brought down some swelling around the paraspinal ligaments, making them less stretchy and pop-able? Or maybe your neck really did get a realignment from the position you were placed in on the OR table?

OR MAYBE YOU ARE STILL UNDER THE ANESTHESIA RIGHT NOW AND YOU ONLY THINK YOU’VE BEEN AWAKE AND LESS-NECK-CRACKY FOR TWO YEARS OMG WHAT A TWIST IS M. NIGHT SHYAMALAN YOUR SURGEON?!?

But I am simultaneously impressed and bewildered at the fact that you’ve been counting how many times your neck has cracked since the surgery. (I picture you keeping track by scratching marks onto a wall, like the Count of Monte Cristo.) Sorry, wish I had better info for you! :)

***Pending Cranquis-Mails: 5; Inbox: Closed***

PULSE IN EAR

Hi! I’m so glad I caught your mail while it was open! First, I just want to say that I’m a relatively new follower, but I absolutely love your blog!

Okay, I’ll jump right in. Within the past year, I started hearing my pulse in my ear, really loudly. At first it was more of a swishing sound and I thought it was fluid in my ear until it became clearer and I could hear it was actually my heartbeat. It started when my ear was infected, but I got medication for it and I thought it would go away. Obviously, it hasn’t or I wouldn’t be mentioning it!

It comes on randomly, and can last for hours or minutes. It’s often worse if I stand, sit or lay in certain positions. If I press on my neck it stops. I assumed that it was something to do with my veins or arteries because when I press on my neck I’m clearly blocking the blood flow. But I had my blood pressure checked and my doctor said it was perfect.

When it happens, it’s extremely loud and distracting, but it doesn’t really hurt or anything, though it does feel tingly when it happens. It’s just that when it’s happening I tend to not be able to concentrate on what other people are saying because it’s just so loud. It’s so distracting that I often have to ask people to repeat themselves.

I went to my doctor about it, but he didn’t seem worried and said “Sometime people just hear their heartbeat!” But it seems odd to me that it would happen suddenly and then not go away. I guess what I’m wondering is what you think it could be and whether or not it would be worth seeing an ENT about?

I’m hoping this doesn’t count as two separate questions, just as part a and part b of the same question. If you feel it’s out of line, or whatever, just answer whichever part you think is easiest/most interesting/most applicable.

Thanks so much!!

Hey there! Thanks for reading the blog. ~~Hear~~ Here is a list of possible causes for your pulsatile tinnitus (hearing your pulse in your ear), mainly gleaned from the comprehensive dizziness/hearing website of the renowned Dizzy Doctor, Timothy Hain.

Nothing serious. The most common reason is simply that you have some fluid between your ear drum and a blood vessel in your skull. The blood vessel pulses, causing the fluid to thump into your ear drum, and you hear it.
Something else sitting behind your ear drum. A tumor or a pocket of pus can also transmit sound waves from nearby blood vessels. (Sometimes an infected wisdom tooth will cause pus to build up in just the right place for this.)
Changes in the blood supply near your ear. Anything that makes the neck/head blood vessels pump harder could cause the sound to reach your ear drum. Examples: hypertension, a dilated jugular vein or carotid artery, or an abnormal connection between an artery and vein (“arterio-venous malformation”). Since you notice connections between position/pushing on your neck and the presence/absence of the sound, I wonder if you have something in this category? Just because your BP is normal doesn’t mean that everything is fine with the blood vessels, and only way to know for sure would be with an imaging scan of the neck and head, which is something an ENT would order if they found your symptoms & physical exam suspicious.
“Uncovering” of blood vessels by the skull bones. This is a really uncommon cause, but the symptoms are cool, so I’m mentioning it. Basically, in this syndrome, the bony wall over a blood vessel gets “thinned out” and lets all sorts of wacky things happen, including: getting dizzy or hearing ringing when you hear loud noises or change the air-pressure around you (such as when in a plane or elevator), having hyper-acute hearing of your own voice (to the point that some people notice that their own voice makes them get dizzy!) or feeling as if your voice now sounds like it’s being “broadcast through a crackling microphone”.

Long story short, YES, I think you should get a second opinion from an ENT. Hopefully it’s nothing serious, but…! And I’d love it if you drop me a line in the Submit box sometime if you ever find out what’s causing your symptoms. Good luck!

***Pending Cranquis-Mails: 9; Inbox: Closed***

TSK: Sometimes the Chicken Chokes YOU.

Nurse: Dr. Cranquis, come quick, this guy is choking!
Cranquis: Sir, are you ok?
40-something male patient *sweating, red-faced, but conscious and sitting up; speaking in rough raspy voice*: I'VE GOT A CHICKEN BONE... IN MY THROAT...
Cranquis *listening to lungs, palpating neck, looking in mouth*: How long has it been there?
Patient: OW MY NECK HURTS... 45 MINUTES... IT WON'T MOVE...
Cranquis: We're sending you to the ER right away. NURSE CALL AN AMBULANCE!
Patient: DON'T WANT... AMBULANCE... DRIVE MYSELF...
Cranquis: Oh I don't think so, sir, your BP is 210 over 106 and you're in distress, I want an ambulance to take you in case you pass out before you get there.
Patient: I SAID I DON'T... *swallowing hard* OUCH! *voice suddenly sounds normal* I said I don't want an ambulance. Hey. Wait a second. The pain is gone! *test-swallows again, grins* I think it just passed down!
Cranquis *surreptitiously wiping sweaty palms on scrub pants*: You are one lucky fellow, sir.

TSK: A day at the racetrack

Cranquis: So, Mrs. Pony, what brings you and your 4 (unruly holy-terror fighting yelling destroying-my-exam-room) children in to see us this time?
Mrs. Pony *nonstop loud chatter*: well where do i begin ya know it's like Fillie got this cough a couple weeks ago, and then it went away but now she has a ~STEED STOP PUSHING YOUR BROTHER OFF THE TABLE~ a runny nose and then Stallion said his ear hurt last night but today it's much better but you should probably look in there anyways and ~FILLIE DO YOU WANT ME TO WASH YOUR MOUTH WITH SOAP AGAIN GODDAMMIT~ then little Gelding has a cough and i think it's his asthma acting up but he's not wheezing so can i ~STALLION LET STEED USE THE COLORING BOOK~ still give him albuterol if he's not wheezing and Steed seems fine but i figured you might as well ~STEED DO NOT DRAW ON THE WALL~ check him out while we're here.
Cranquis: And you wanted to be seen as a patient today too?
Mrs. Pony *suddenly barely able to talk in a raspy whisper*: oh i have the worst sore throat and can hardly talk my voice is just gone since ~FILLIE STOP TURNING OFF THE LIGHT SWITCHES AND SIT DOWN THIS INSTANT~ yesterday.

TSK: A little blood goes a long way

Nurse Cranquis: Oh my god, Dr. Cranquis, you should go see the bloody mess in room 3.
Cranquis: Oh, you mean from the guy with the nosebleed that was here earlier?
Nurse: Yes! You know when he first walked in, he was just dripping blood everywhere, so I handed him an emesis basin and he blew his nose into it, and this huge clot came out!
Cranquis: Yeah, those nose-clots can look pretty big.
Nurse: No, this was humongous. It was like he blew a placenta out of his nose!
Cranquis: Ok, maybe we're getting a bit carried away here.

Medically-Correct Nursery Rhymes: Jack and Jill

Jack and Jill went up the hill,

to fetch a pail of water.

Jack fell down, due to dizziness from an inner-ear infection, and suffered a depressed skull fracture with intracranial bleed;

so Jill drank all the water herself, but it turned out to be contaminated with Giardia, resulting in a severe bout of diarrhea.

(These are the kinds of things I think about as I’m singing/patting/whispering Baby Cranquis to sleep.)

HEARING LOSS IN MEDICAL PROFESSIONALS

Hi Cranquis!

Next fall I’m embarking on a fast track RN/Nurse Practitioner program. In spite of my charming personality, I am worried about something. I have bilateral mild/moderate hearing loss due to otosclerosis. I’ve tried to have surgery to correct my hearing, but it looks like I’m stuck with two hearing aids indefinitely.

I was wondering if you knew someone in medicine who has a hearing loss? I guess the thing I’m most worried about is picking up murmurs or something of the like.

Thanks and hopefully my question doesn’t fall on deaf ears.

(Get it?)

HUH? WHAT’S THAT YA SAY, SONNY? SPEAK UP, OLD DOCTOR CRANQUIS’ EARS AIN’T WHAT THEY USEDTA BE, BUT I COULDA SWORE YOU JUST MADE A TERRIBLE PUN AND IT SHORE DID TICKLE ME FUNNY BONE!

:)

Wow, what a tough condition to face while also attempting a healthcare professional training course! I don’t know anyone who had hearing issues during their training for MD/PA/Nursing school, but I do know a couple ~~old~~ mature practitioners who’ve had to retire early or greatly restrict/modify their “scope of practice” due to hearing loss. Even if you plan to specialize in a surgical field or something, where fine-tuned hearing might not be as necessary as with primary care (where you listen to hundreds of heart and lung and stomach sounds per week), at the very least your hearing ability (or lack thereof) will be an issue during your RN/NP training — the training is very broad, and as an NP student you’ll be expected to rotate through different specialties and perform the basic skills of those specialties.

Have you discussed this with the director(s) of your program? Or with graduates of your school? You probably should, at least for the safety and quality-of-care of your future patients.

Good luck!

***Pending Cranquis-Mails: 3; Inbox: Closed***

TSK: Dr. Cranquis is not so serious, sometimes.

Cranquis: So besides your head congestion and cough, have you had any other symptoms.
30-something female patient: Yeah, I had Batman voice for a couple days.
Cranquis: Batman voice? You mean, like --
Patient: Yeah, you know how Christian Bale --
Cranquis: -- makes his voice get all gravely --
Patient: -- Doesn't it sound like he must have laryngitis?
Cranquis: Totally!
Patient: So when my voice got all raspy, I called it --
Cranquis: BATMAN VOICE! I LOVE IT!
Both: *mutual nerd moment*

TSK: I say “Potato”, you say “Witchcraft”

Ok, lady with the abscess on your nose, let us agree to disagree.

Your chart shows “multiple I&D (incision and drainage) of abscesses,” most of which have been “MRSA (a drug-resistant form of Staph) positive”, according to the multiple ER and Urgent Care docs who have been treating you for the past year. Those notes also show that you never follow-up with the dermatologist or general surgeon or infectious disease specialist or WHOEVER you are referred to see about this. And you yourself just admitted to me that “I don’t usually take the whole course of the antibiotics”, which is just making your situation worse.

But what’s your explanation for these recurrent abscesses? Oh, it’s a good one.

It all started after I was in the Philippines a year ago, and I stole this girl’s boyfriend away from her, and she put a boil curse on me.

I can understand your interpretation of these events. But the fact that the first boils of this “curse” showed up in your genital area within days of your “Man Thievery” just tell me that Mister Man had MRSA too. So technically, all 3 of you people in that love triangle were “boil cursed.”

Oh, and speaking of triangles: There’s a reason I’m getting all worried about your nasal abscess and calling a specialist today, and not just “putting you on more of those pills” (which you won’t finish taking anyway). That reason is called The Facial Triangle of Death.

*sigh* No, it’s not the same as the Bermuda Triangle, ma’am.

ORAL HERPES

I think I may have an outbreak of cold sores coming out (I usually get them when I’m stressed etc). They haven’t blistered yet and the tingling sensation hasn’t started either. Anyway, I performed oral sex on a guy last night and I can’t really seem to separate the facts and myths regarding herpes so I was wondering what the chances were that this guy could have contracted some form of the herpes virus?

Wow, Latent Lover — you can actually tell when your cold sores are coming on, BEFORE you get any tingling or blistering? Impressive!

Ok, Herpes Simplex Virus (HSV) comes in two flavors: 1 and 2. Orolabial (mouth/lips) cold sores are usually caused by HSV-1, and genital sores are usually HSV-2…. but not always! And HSV-1 can transmit from one person’s mouth to the other person’s genitals during oral sex, if the giving partner is shedding the virus at the time (which can be BEFORE blisters show up, during reactivation of the latent virus caused by various factors such as, oh, stress…) and if the receiving partner has any skin defects on the genitals (tiny cracks in the skin, scrapes, etc).

So, the moral of the story is: that lucky guy might’ve not been so lucky after all — but only time will tell. As for future prevention, allow me to recommend tossing a condom on there before going downtown — a simple barrier over the skin will protect from HSV spread.

***Pending Cranquis-Mails: 3; Inbox: Closed; Cranquis Christmas Surprise: T minus 3 days, stay tuned!***

CANKER SORES

Hi there!
This is just a quick question about canker sores.
For the past few months, I’ve been getting them pretty frequently. Like once a month, or sometimes even twice a month. And I usually get two at a time and they last about a week.
I’ve read about how they can occur because of stress, nutrition, biting, etc.
I don’t think my nutrition or stress level or biting habits have changed so much these past few months, though, for me to be getting them so much more.
Do you have anything you’d like to add about preventing or causes?

This prior post about canker sores sounds like it would answer your question best, Ouchy Oral Orifice! Good luck!

***Pending Cranquis-Mails: 8; InBox: Closed***

VOICE TROUBLE?

Hey Cranquis!

I am a (was?) a singer. I noticed that my vocal range was seriously cut down when I was pregnant, but I just attributed the change to having a rather large little mooch crowding up my organs and squishing my diaphragm. However, after I gave birth to said little mooch (who is recently a year old! Sorry for the proud mama moment), my voice took a turn for the worse. My voice cracks now when I try to sing and sometimes talk, I sound like a pubescent boy! It’s really embarrassing and hasn’t let up in the past year at all.

My question for you: what in the world happened to my voice? Can it be fixed??

Hey now, no need to apologize for being a proud parent! If that’s your lil’un in your Tumblr icon, he/she sure is kay-ute! If I wasn’t so gol-darned stubborn about hiding my identity on this Tumblr, y’all would be forced to endure an unending barrage of Baby Cranquis pictures! (Seriously, at last count my iPhoto contains 1,600 pictures of my 16-month old son. Dat’s a lotta picshures.)

But I digress. Now let’s clarify your question — there can be crucial differences between “losing your vocal range” and “having a pubescent-like cracking voice”. Both can be caused by the hormonal changes which take place during and after pregnancy (particularly in women who breast-feed: lady-hormones linger longer while lactating!). Along with the “crowding of the diaphragm” effect, the blood vessels into the sinuses become a bit dilated and congested, causing changes in vocal tone and range.

Your cracking/hoarse voice is a bit more concerning. Causes could include simple irritations from acid reflux or post-nasal drainage, or more troublesome problems like vocal cord nodules or vocal cord paralysis. Vocal cord nodules and cysts can happen to anyone, but more often to people who sing or scream a lot. Vocal cord paralysis can happen from viral infections, masses, surgery, or trauma. An ENT evaluation might be useful to evaluate for these. (And not to frighten you, but persistent voice change/hoarseness can also indicate laryngeal cancer — which an ENT can also evaluate for.)

Can a hoarse voice be fixed? Depends on the cause: possible treatments would range all over the place (acid-reducing meds, sinus rinses, voice rest [HA! Fat chance for a momma of a 1 year old!], speech therapy, singer’s vocal therapy, surgery, other options). So you may want to discuss this with your primary care doc, and consider getting a ENT consult. Good luck, and enjoy that cute bebeh.

***Pending Cranquis-Mails: 3; InBox: Closed***

DIRTY AIR

Hi there!

I recently moved to NYC, and it’s awesome. I run around the city like a little child in a toy store. The downfall? It’s dirty. Like gross. I wash my hands a lot and all that jazz, but I think I’m having a hard time adjusting to the air. My sinuses are constantly stopped and every time I blow my nose or cough up something it has streaks of black (which someone told me is dirt & pollution I’m breathing in…if this isn’t the case and I actually have the Black Plague, then please redirect my question to curing the Plague).

Aside from being totally weird and wearing one of those medical masks everywhere I go, is there anything I can do to give my lungs and sinuses a break from all this pollution?

Cheers!

Aww, c’mon — what’s wrong with wearing medical facemasks everywhere you go? You could always opt for the cowboy/girl look, I suppose. And if you really think you’re being exposed to the Black Plague, well heck: turns out there’s a time-tested mask for that too!

Actually, I think your best bet might be taking up a daily habit of sinus saline rinsing. It sounds strange, but is actually quite easy to do and should greatly reduce the amount of airborne crap retained inside your sinuses. You may also want to invest in an air-purifying system for your home and/or office, since all that crud floats into building air systems too!

Perhaps my Constant Readers have other tips?

***Pending Cranquis-Mails: 6; InBox: Closed***