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What is Muscle Tension Dysphonia (MTD)?

Muscle tension dysphonia (MTD) is one of the more confounding and misunderstood conditions of the voice.  With this condition the vocal cords and supporting structures may be healthy but they are working too hard.  MTD is caused by the throat muscles being too tight and out of balance with the rest of the voice production system.  The person with MTD may feel that it takes more effort to talk and their voice gets worse the more they talk.  Many patients may feel a soreness of their neck, throat and often their shoulders. Sometimes MTD may develop in trying to compensate for a weak vocal fold or a vocal fold lesion.

MTD is characterized by the following:

  • Voice that sounds rough, hoarse, gravely, or raspy
  • Voice that sounds weak, breathy, airy, or is only a whisper
  • Voice that sounds strained, pressed, squeezed, tight, or tense
  • Voice that suddenly cuts out, breaks off, changes pitch, or fades away
  • Voice that “gives out” or becomes weaker the longer the voice is used
  • Pitch that is too high or too low
  • Difficulty singing notes that used to be easy
  • Pain or tension in the throat when speaking or singing
  • Feeling like the throat is tired when speaking or singing
  • Voice that may sound normal sometimes, such as during laughing or coughing

Once an otolaryngologist has examined you and diagnosed you with MTD, you will typically be referred to a speech pathologist for voice therapy.  In some cases there may be some underlying physical or emotional stress contributing to the dysphonia.  Our voices are very emotional instruments and help to convey a spectrum of emotions including happiness, sadness and anger.  “I’m all choked up” is more than just a figure of speech.  As such, you may ...

What is Pilonidal Disease?

Pilonidal disease is a subcutaneous skin infection that occurs in the upper half of the gluteal cleft (the tailbone area, and/or between the buttocks). 

Etiology

The term “Pilonidal” means nest of hairs.  Interestingly, in 50% of reported cases, there was not any hair found within the pilonidal abscess.  This is routinely the case for females.  Although hair can contribute, the most common cause of pilonidal disease is an exploded follicle called a pit, which is located in the gluteal cleft, or midline region (between the buttocks). 

Who is at risk for Pilonidal disease?

Pilonidal disease is only slightly more common in men than women, and is most likely to occur between the ages of 16 – 26, correlating with puberty.  It should be noted that pilonidal disease can develop in younger and older age groups.  Pilonidal disease occurs less in Asian and black populations.  Other risk factors of pilonidal disease include:

  • Obesity
  • Sedentary lifestyle
  • Individuals with more body hair
  • Occupations with prolonged sitting

Diagnosing Pilonidal Disease

Pilonidal disease, similar to a large pimple, can burst through the skin by itself or may need to be lanced or drained to let the infected fluid escape.  Pilonidal disease is classified into three stages:

Why do people get hemorrhoids?

Hemorrhoids are composed of blood vessels found in the internal and external anal area. Believe it or not, everyone is born with hemorrhoidal tissue. Although there are several theories regarding the function of hemorrhoids, many physicians believe that hemorrhoids help maintain fecal continence.

Why Do People Get Hemorrhoids?

When the blood vessels become enlarged (similar to varicose veins in the leg), hemorrhoids may begin to bleed, become swollen, and can be extremely painful.

There are several reasons why enlargement of these veins can occur. The most common reasons are thought to be related to straining and increased pressure on the abdomen, including:

  • Constipation
  • Prostate problems in men
  • Chronic cough
  • Dietary factors
  • Pregnancy

Should Hemorrhoids Be Treated?

If symptoms are mild or infrequent, then treatment may not be necessary. If symptoms are more severe, such as frequent pain, bleeding, itching, or, difficulty with hygiene, there are several treatment options available.

Treatment options will vary depending upon the size of the hemorrhoid and if it is internal or external. Common treatments include:

  • Sitz baths
  • Prescription medications
  • Rubber band ligation
  • Surgical removal

Most procedures can be completed in the physician’s office and take less than 30 minutes. If surgery is required, patients go home the same day.

Will Hemorrhoids Come Back After Treatment?

Following treatment, a recurrence is uncommon. If hemorrhoids do return, conservative therapy usually corrects the problem.

The ‘Bottom’ Line

You do not have to live with, or schedule your daily activities around your hemorrhoidal discomfort. Our goal is to help find treatment that is right for you.

If you have questions about hemorrhoids or treatment options, call the Swedish Colon & Rectal Clinic at 206-386-6600.

Dr. Bowen tackles mysteries of MS in Scientific American MIND

The last 20 years have held significant gains for people living with multiple sclerosis (MS). Thanks to new studies and a full pipeline of those to come, our understanding of the disease and promises for future remedies grows rapidly.

Dr. James Bowen, Medical Director and neurologist at the MS Center at Swedish, wrote an article on this progress n Scientific American MIND. "Solving the Mystery of MS" unpacks the history of MS treatments, from breakthrough treatments to rethinking the disease origin, and offers a comprehensive view of what we know now as well as what lays ahead.

 

Why you should be eating more fiber

The recommended daily intake of dietary fiber is 25-35 grams per day. Despite this, the average American consumes about 15 grams of fiber per day. You may have heard fiber is important, but read on to learn more about why it matters in your diet.

What is fiber?

Fiber is the portion of plants that is not digested in the gastrointestinal tract. Therefore, it stays in the intestine, aiding in digestion and contributing to stool consistency. Dietary fiber is categorized into soluble fiber and insoluble fiber.

  • Sources of soluble fiber: fruits, legumes, oats, and barley
  • Sources of insoluble fiber: wheat, rye, grains, and many vegetables

What are the health effects of fiber?

  • Decreased risk of coronary artery disease and stroke. This is the leading cause of death in the United States and a diet high in soluble fiber decreases this risk by 40-50%.
  • Decreased risk of type 2 diabetes mellitus and improved glucose control in people with diabetes on a diet high in soluble fiber.
  • Insoluble fiber is beneficial for many digestive diseases including hemorrhoids, diarrhea, constipation, and diverticular disease.

Is there a downside to a high-fiber diet?

Cardiac risks associated with radiation therapy following breast cancer

Recently, there has been increasing media attention to the risks of heart damage associated with adjuvant breast cancer radiotherapy.

This observation and debate has been ongoing for a long time in medical literature. Most recently, an article in the New England Journal of Medicine concluded that adjuvant radiotherapy for breast cancer increases the rate of ischemic heart disease. The authors conclude that the risk is associated with the dose of radiotherapy to the heart and begins a few years after the treatment. Dr. Kesarwala, an expert radiation oncologist from Bethesda, reviewed the data and provided a report in the April issue of the ACR Journal Advisor. She noted that “nearly 80% of patients in this study had mastectomies and over 90% had adjuvant chemotherapy with regimens very different from those currently used. This study mixed lymph node-positive patients (48%) with lymph node-negative patients, two sub-populations with different expected overall survival who would also have received different types of radiotherapy.” Other variables such as stage, presence of internal mammary nodes, type of surgery, or details of radiotherapy were not matched between the control and treated patients.

Because the study does not provide details regarding the radiotherapy specifically, it is difficult to interpret the conclusions. The doses of radiotherapy delivered ...

Why is it hard to swallow?

Many people suffer from difficulty swallowing (dysphagia) acutely or chronically. Difficulty with swallowing may be a result of a problem anywhere from the lips to the stomach. It may be identified by weight loss, coughing or choking when eating, delayed cough or regurgitation, or outright obstruction. This is more likely to be an issue after a stroke or in elderly and frail individuals. In the inpatient population, symptoms suggesting some level of dysphagia may be as high as 34%. So what do you do if you feel like your swallow isn’t quite right?

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