Doctors turn to thumbs for diagnosis and treatment by text

Dr. Anna Nguyen spoke with none of the five patients she treated on a recent weekday morning. She didn’t even leave her dining room.

The emergency physician nevertheless helped a pregnant Ohio woman handle hip pain, examined a Michigan man’s sore throat and texted a mom whose son became sick during a family trip to Mexico.

Welcome to the latest wrinkle in health care convenience: the chat diagnosis.

Nguyen’s company, CirrusMD, can connect patients with a doctor in less than a minute. But such fast service comes with a catch: The patient probably won’t see or talk to the doctor, because most communication takes place via secure messaging.

“We live in a consumer-driven world, and I think that consumers are becoming accustomed to being able to access all types of service with their thumbs,” CirrusMD co-founder Dr. Blake McKinney said.

CirrusMD and rivals like 98point6 and K Health offer message-based treatment for injuries or minor illnesses normally handled by a doctor’s office or clinic. They say they’re even more convenient than the video telemedicine that many employers and insurers now offer, because patients accustomed to Uber-like convenience can text with a doctor while riding a bus or waiting in a grocery store line.

Millions of Americans have access to these services. The companies are growing thanks to a push to improve care access, keep patients healthy and limit expensive emergency room visits. Walmart’s Sam’s Club, for instance, recently announced that it would offer 98point6 visits as part of a customer care program it is testing.

But some doctors worry about the quality of care provided by physicians who won’t see their patients and might have a limited medical history to read before deciding treatment.

“If the business opportunity is huge, there’s a risk that that caution is pushed aside,” said Dr. Thomas Bledsoe, a member of the American College of Physicians.

Message-based care providers say they take steps to ensure safety and recommend in-person doctor visits when necessary. Nguyen, for instance, once urged an 85-year-old woman who contacted CirrusMD about crushing chest pain to head to an emergency room.

These companies note that a thorough medical history is not crucial for every case. They also say doctors don’t always need vital signs like temperature and blood pressure, but they can coach patients through taking them if necessary. Doctors also can opt for a video or phone conversation when needed.

Even so, the companies estimate they can resolve more than 80 percent of their cases through messaging.

About 3 million people nationwide have access to CirrusMD doctors, mostly through their insurance. The insurer or employer providing the coverage pays for the service, allowing patients to chat with doctors at no charge.

At first glance, a visitor to Nguyen’s Sacramento home wouldn’t be able to tell if she was the doctor or the patient during her recent shift. She sat at her dining room table and tapped her iPhone to bounce between patients.

The doctor’s phone started dinging shortly after her five-hour shift began.

She gave physical therapy recommendations to the pregnant woman and helped a Colorado man who hurt his back moving boxes at work. A Michigan man checked in about his sore throat as that conversation wound down.

Then the mom messaged from Mexico. Her 6-year-old started vomiting and developed a fever and diarrhea after his brother and father became sick during a vacation. Nguyen wanted to know how the boy was acting, so she asked several questions and requested a picture.

The emergency physician could tell by his skin color that he wasn’t dehydrated.

“The picture itself looks reassuring,” she said. “If he had encephalitis, he’d be really confused and out of it.”

The doctor said she thought the boy just had a stomach bug, and she told his mother to make sure he kept drinking fluids.

Nguyen said she enjoys this type of care because the format gives her more time with patients.

“I think patients will like it a lot because most really hate going to their doctor,” she said referring to the hassle of setting an appointment, getting to the office and then waiting for the visit.

Some patients simply don’t have time for all that.

Ohio Wesleyan University student Jasmine Spitzer contacted a 98point6 doctor in a panic earlier this year because her throat was sore, and the music education major had an opera recital coming up. She texted for help as she walked to class.

The doctor couldn’t prescribe anything. But she sent pictures of common medications Spitzer could buy, including cough drops with lower levels of menthol, which dries out vocal chords.

“I wish that there is a way for me to … tell her, ‘Thank you so much, you kind of saved my life,'” Spitzer said. “I was able to give my recital and it was great.”

98point6 customers first describe their symptoms to a chatbot that uses a computer program to figure out what to ask. That information is then passed to a doctor for diagnosis and treatment.

“There are many, many cases where the physician does not have to ask a single additional question,” CEO Robbie Cape said.

The company launched its service in January 2018 with 600 customers and expects to have about 1 million people signed up by the end of this year.

K Health also started in 2018 with a business that offers personalized health information to patients who might otherwise Google their symptoms. Those patients then have an option to chat with a doctor.

These companies say their doctors often answer an array of quick questions as well provide care. Nguyen had a Louisiana woman send her a picture of her thumb, which she punctured cleaning out a chicken coop, just to see if the doctor thought it might need attention.

Patients and doctors have long emailed outside of office visits, usually about prescription refills or follow-up questions. These newer, message-based treatments often involve care by a physician who doesn’t know the patient and who may have a limited view of that person’s medical history.

That concerns Bledsoe, the American College of Physicians doctor. He noted, for instance, that a patient who wants a quick prescription for another bladder infection may actually need a cancer test.

“Sometimes what seems to be a limited problem to a patient is actually part of a bigger problem that requires some more evaluation and treatment,” he said.

Virtual care like this also might lead to antibiotic overprescribing, said Dr. Ateev Mehrotra. The Harvard researcher said it’s probably easier for a doctor who knows a patient to explain face to face why they don’t need a medicine than it would be for a stranger to deliver that news by text and risk upsetting a customer.

CirrusMD and 98point6 executives say they closely monitor antibiotic prescription rates and take other precautions. Neither company prescribes highly addictive painkillers, and 98point6 sends doctors through six months of training.

Instead of hurting care, these chat-diagnosis companies say they help by improving access, especially if someone’s regular doctor isn’t available.

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A Brain-Controlled Robotic Suit Allowed This Paralyzed Man to Walk Again

A quadriplegic man was able to walk again using an experimental robotic body suit which he controlled with his brain. The exoskeleton was developed by a team of researchers at the University of Grenoble in France, who hope that their proof-of-concept demonstration will show the possibilities offered by brain-machine interfaces in improving the lives of patients.

The man, named only as Thibault in the study, suffered a cervical spine injury four years ago which left him paralyzed except for limited motion in his biceps and left wrist. Thibault worked closely with the research team for two years, undergoing training to ensure he would be able to operate the suit. This involved placing two implants on the surface of his brain that would allow him to send signals to the exoskeleton and “drive” it.

In a series of trials in laboratory conditions, while wearing a harness for safety and balance, Thibault’s range of motion in the suit gradually improved.

“Two bilateral wireless epidural recorders, each with 64 electrodes, were implanted over the upper limb sensorimotor areas of the brain,” write the team in The Lancet. “Epidural electrocorticographic (ECoG) signals were processed online by an adaptive decoding algorithm to send commands to effectors (virtual avatar or exoskeleton). Throughout the 24 months of the study, the patient did various mental tasks to progressively increase the number of degrees of freedom.”

There remains a lot of research to be done in the field of neuroprosthetics, but this breakthrough illustrates that “semi-invasive” techniques can feasibly introduce a degree of mobility back into the lives of paralyzed patients.

“I forgot what it is to stand,” Thibault told the BBC. “I forgot I was taller than a lot of people in the room.” He also said that being involved in this revolutionary experiment made him feel like the “first man on the moon.”

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Footage shows a TWIG being pulled out of a three-year-old boy’s ear

Stomach-churning footage shows a TWIG being pulled out of a three-year-old boy’s ear

  • The toddler’s mother contacted Audiologist Neel Raithatha, from Leicester
  • He performed an E-suction which gentle sucks the object or wax from the ear
  • The twig was no more than five millimetres and could have punctured a hole

Stomach-churning footage has captured the moment a twig is pulled out a three-year-old boy’s ear.

The unidentified youngster’s mother rushed him to a specialist clinic after he had pushed a ‘branch’ into his ear.

A piece of twig measuring just five millimetres was removed by Neel Raithatha, an audiologist and YouTube sensation.

He has extracted an assortment of items from people’s ears in the past, but this is the first time he has encountered a twig. 

A twig measuring five millimetres was removed from a three-year-old boy’s ear

Discussing the case, Mr Raithatha said: ‘The twig measured 0.5 cm and was very close to the eardrum.

‘It was the first time I have removed a twig out of someone’s ear and therefore I was quite shocked.

‘The mother of the child was very relieved and grateful that I managed to safely extract the twig from her son’s ear.’ 

Mr Raithatha, known as the Wax Whisperer, was contacted by the distressed mother. It is not clear if the boy was in pain.

Once in The Hear Clinic, Oadby, Leicester, Mr Raithatha performed an examination to see where the twig had got lost.

Deep in the ear canal, he found the twig nestled at the root. It is believed the twig was pushed down there by the toddler.

Keeping the patient’s head very still, Mr Raithatha was able to use an ear suction to pull it out in less than minute. 

He used an endoscope, an instrument that can look inside the body and is usually attached to a video monitor so the doctor can see what’s in the ear canal. 


 Mr Raithatha said it’s the first time he has removed a twig from an ear

At the same time, a tiny instrument with gentle suction is able to attach to the object that is obstructing the passage and pull it out.

It is also used to remove build-up of earwax, which Mr Raithatha often films for his 144,000 subscribers on YouTube, reaching millions of views.

It’s not the first time Mr Raithatha has revealed footage of un-blocking ears with strange items, including earrings and pen caps.

Such items, including twigs, can puncture the eardrum, causing sudden ear pain, sometimes bleeding from the ear, hearing loss, or noise in the ear. 

It normally heals on its own but may need surgery, and is the reason health officials urge against using cotton buds.

Mr Raithatha said: ‘Fortunately, there was no trauma or injury caused by the twig, which had a sharp pointed tip, to either the young boy’s ear canal or eardrum. 

‘I have previously removed a tooth comb, pen cap, earbud, earring, 22 hearing aid wax filters, plastic clothes tag, unidentified plastic object as well as several cotton buds from the ear canal.’

In December 2018, footage from Mr Raithatha showed the moment huge chunks of wax and a plastic clothes tag were pulled out of a patient’s ear.  

And in January, Mr Raithatha removed the most dangerous object in his career –  the tooth of a comb. 

WHAT IS EARWAX BUILD-UP?

Earwax usually falls out on its own but, in some cases, it can become blocked.

It cannot be prevented as the wax is there to protect ears from water, dirt germs, infection and foreign bodies. 

You are more likely to suffer buildup if: 

  • You naturally produce more wax
  • You have hairy or narrow ear canals
  • You are elderly because wax hardens with age
  • You wear a hearing aid, headphones or earbuds as these push wax in further

Symptoms include earache, difficulty hearing, itchiness, dizziness, an ear infection and tinnitus.

You can try using over-the-counter wax softening drops or warm water to irrigate your ears.

If this doesn’t work, seek professional medical help in case of infection.

Source: Mayo Clinic

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