Archives for November 2014

 Masood Mansour, MD

IMG_2715 Presenter:  Masood Mansour, MD, Gastroenterologist
Coastal Gastroenterology & Scripps Center for Voice, Swallowing and MotilityDr. Mansour graduated from UCLA David Geffen School of Medicine in 2007.  Upon completion of Internal Medicine and Gastroenterology residencies at Scripps Clinic, he developed interests in esophageal manometry and pH testing.  In 2014, he joined Scripps Center for Voice, Swallowing & Motility where he conducts a weekly multidisciplinary clinic with speech-language pathologists.  Cases seen at the clinic include reflux, irritable larynx, pharyngeal and esophageal dysphagia, cough, achalasia and esophageal spasms.  Dr. Mansour performs esophagogastroduodenoscopy, high resolution manometry, impedance and pH testing to diagnose their conditions and develop care plans.  He works closely with a laparoscopic surgeon and periodically refers patients for myotomies, fundoplications and LINX procedures.

Case:  Healthy 19yo male with 10 month history of chest pain, nausea, vomiting and dysphagia.  He struggles to consume both liquids and solids, resulting in a 30lb weight loss.  Trial of PPI and Reglan did not improve his symptoms.  EGD 4 weeks ago revealed mild gastritis.  Biopsies were normal.  Esophagram demonstrated poor lower esophageal sphincter relaxation.
PMH:  Generally unremarkable.  Ear infections.
Social:  Sophmore in college.
High Resolution Manometry:

mansour case

Treatment:  Discussed with patient and his family variety of options to manage his condition.  1)  Botox – not recommended due to age and need for repeat injections  2) Pneumatic dilation – norms for good response to this therapy are on females older than 45.  There is risk of perforation and it is likely repeat dilations will be required.  3) Myotomy with partial fundoplication – long-term solution to his condition.  This was the recommended course of therapy.  Risk of post-operative reflux was discussed.  After speaking with the laparoscopic surgeon, the family ultimately decided on option #3.

Surgery:  Uncomplicated laparoscopic esophageal Heller myotomy with Dor fundoplication.  Initiated a soft diet on post-op day 1.  Mild abdominal epigastic tenderness and discomfort so on post-op day 2 underwent esophagram to assure no leak.  The study revealed no obstruction and no Gastrografin leak.  He was discharged home on post-op day 2.

Outcome:  11 days after surgery feels well, no fatigue or pain.  Nausea and vomiting resolved.  He is able to eat and drink anything.  Although he has not gained weight, he exhibits an appropriate body mass index.  Prior to developing achalasia, he was approximately 20lbs overweight.

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We all know that the rise and influence of mobile technology is astounding. Our smart phones are extrinsically becoming an extension of ourselves. Our smart phones have allowed us to do everything from listen to specially tailored radio stations to monitoring our daily calories and movement patterns. The power of this technology is extraordinary. It allows for immediate and constant access to the services and interests that we select. It is not surprising that the power of mobile app technology has been well integrated into the healthcare arena. Patients are now able to monitor their heart rates, check their blood sugar levels and get daily reminders to take their medications. Preliminary research studies have validated that patients are more likely to demonstrate compliance and clinical advancement with use of this technology. It is a powerful vehicle to maintain strong contact between the patient and the medical provider. The most recent wave of applications has now taken residence within the world of skilled voice therapy.

 

iVoiceTherapy is designed to provide clinicians with a unique opportunity to customize a dedicated voice therapy home exercise regimen in an educational and engaging format. It is perfect for all individuals seeking restoration of speaking or singing voice quality. The application blends core elements that translate into optimal levels of patient compliance. They include, exercise programming/cueing, patient education and biofeedback. Clinicians are able to program various settings that will cue patients to perform specific exercises at designated times. Patients’ receive visual and auditory messages prompting the performance of tasks. After completion, each encounter is time dated and stamped for subsequent review with the treating clinician.

 

iVoiceTherapy offers patients the ability to view and explore a gallery of laryngeal pathologies as well as a broad array of educational materials designed to promote enhanced awareness and overall level of engagement. It allows patients to visualize the nature of their impairments as a way of reaffirming their commitment to voice restoration. Similarly, iVoiceTherapy employs a variety of aids to foster understanding and subsequent compliance with designated behaviors to improve laryngeal hygiene and posture.

 

The application is well suited for individuals who sustain acute or chronic voice changes associated with a broad array of diagnoses including traumatic vocal fold lesions, muscle tension dysphonia, Irritable larynx syndrome as well as professional and avocational singers. iVoiceTherapy is designed to be a physician and clinician driven platform that is specially tailored by the medical team. Clinicians are able to identify patients who would benefit from the regimen and suggest download from the iTunes store. Once downloaded, the application will be programmed by the treating clinician to ensure that all salient issues are addressed. Patients are instructed to perform exercises and document progress on a daily basis. This allows both parties to review progress during subsequent visits. The application is fluid in that it can be reprogrammed in order to assist with progression towards stated goals.

 

iVoiceTherapy also serves as an excellent desk reference for clinicians who encounter voice disorders less frequently.  The ear training and pathology labs permit familiarity with the most commonly encountered voice conditions.  Navigation through the Exercises tab provides auditory modeling of resonant voice therapy, paradoxical vocal fold movement strategies, cough suppression, flexibility/strengthening tasks and singing regimens.

 

iVoiceTherapy is currently available on the iTunes store for $12.99. It is optimized for an iPhone.  The application will also work on an iPad.