Author Archives: James Rejowski

Welcome Karen

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March 26  |  Blog, York ENT Blog  |   James Rejowski

Welcome Karen

Karen Heidinger joined our practice last year, taking a position as our office manager. She comes to us from Suburban Cardiology, and brings a wealth of experience in all aspects of this position, including billing, finance, personnel, scheduling, and strategic planning.

Karen began her career in the medical field after completing the medical assisting program at Robert Morris College.  She has worked with a variety of practices over the years in the areas of Primary Care, Allergy, and Cardiology.

She has enjoyed the interaction with the people that she encountered every day in those practices along with the feeling of being able to help them, whether it was with the physical aspect of their medical condition or assisting them with navigating their insurance benefits.

The majority of her career was working in Cardiology. She began working for a six physician group as a medical assistant and was subsequently promoted to the front end supervisor position. Her efforts there resulted in her being appointed Practice Manager, a position she held for more than ten years.

She joined York ENT Surgical Consultants, a member of Amita Health Medical Group, in May of 2015 and she looks forward to the opportunities it presents for her.

In her free time she enjoys spending time with her family and volunteering with Special Olympics.

We enjoy working with her and look forward to our future together.

 

 

Noisy Toys 2015

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December 15  |  Blog, York ENT Blog  |   James Rejowski

Noisy Toys List 2015

 

Each year the Sight & Hearing Association publishes a list of the loudest toys available for sale this holiday season. This year the Animal Babies Nursery: Jumpin’ Lil Monkeys tops the list at 103.4 dB of potential inner ear damaging sound presentation.

The top five are rounded out by:

Disney Frozen: Cool Tunes Sing-Along Boombox at 100.4 dB

Little Tykes Lil’Ocean Explorers Push’n Glow Fish at 93.8 dB

FurReal Friends Dancing Penguin at 93.7 dB

Disney Pixar Inside Out: Bing Bong Musical at 93.6 dB

Prolonged exposure to sound at these levels can be damaging to a child’s hearing and it goes without saying that proper parental supervision is necessary.

I would be remiss if I did not give credit and thanks to Dr. Dawn Violetto for providing these lists each year. Dawn is the Director of Audiology at Child’s Voice. She works with the children there as an educational and diagnostic audiologist. She also runs the Pediatric Early Detection and Intervention program in the surrounding communities and serves on the Illinois New Born Hearing Collaborative and the Illinois New Born Hearing Advisory Committee. Many thanks.

 

A Note From Mary

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August 26  |  Blog  |   James Rejowski

This recent very thoughtful note was sent to our office manager Karen Heidinger.

Dear Karen

Here is my review/testimonial for the fantastic Dr. Rejowski! I would rather my full name not be used but you are welcome to use my first name.

Thanks, Mary

In between the glowing recommendations from my primary care physician, and overwhelming nods of approval from my physician husband and his colleagues, I knew that Dr. Rejowski was excellent and well respected in his field. This definitely boosted my confidence that I was in good hands.

Through a thorough analysis of an ultrasound Dr. R. found a fairly large tumor which needed to be urgently removed. He did not mince his words or patronize but was honest, straight forward and educating. Dr. R was able to break down the complexities of what was going on with me in plain English. I felt very empowered by the information and also reassured by his calming and caring nature. He certainly has one of the best bedside manners I have experienced from a physician!

Dr. R. exudes a calm confidence and strength which is exactly what you need as a patient. Throughout my experience with Dr. Rejowski I found a common trend in the way he worked with me. Firstly I realized it was important to him that I became well; secondly, he looked at me as a person and not just another faceless patient passing through his office. I also noticed that it was important to him that I was informed at every juncture of my treatment, so he made a point of advocating for me and keeping me well informed.

Dr. Rejowski is a gold standard physician. If your priority is to achieve the best outcome for your health, then he would be a great fit for you. He is a master at this craft and takes great pride in his work. Dr. R. is truly excellent, yet remains humble. He is a man of great integrity who will tell you the truth throughout.

Dr. Rejowski performed a partial thyroidectomy on me in May of 2015. I must admit I was very concerned about what the final scar would look like. For a number of reason, one being the fact that summer was around the corner. Apart from that I am a young woman and take pride in my appearance so the thought of having a giant scar (like some of the ones I had seen on the internet) was very upsetting. I can say today that Dr. R. did such an excellent job, that only a few months into my healing the scar is hardly visible. Apart from the superficiality of the scar the overall surgery was a huge success and my health is being very well managed at this point.

You would be hard pressed to find a physician better than Dr. R. at what he does. He is the consummate professional, he cares about people, and he takes absolute pride in his work and is extremely knowledgable. I very, very rarely write reviews but I felt it was my duty as a person who God has blessed with excellent recovery to pay it forward and inform others of where and most specifically who to go to should they encounter health issues.

As a new mother and wife, Dr. R. gave me my health and potentially saved my life so I can live a long full life with my family. As a woman, Dr. R. used his skill to ensure that this treatment didn’t diminish my self-esteem. He is truly wonderful.

From, Mary

 

Facial Frostbite

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March 1  |  Blog, York ENT Blog  |   James Rejowski

Facial Frostbite

For anyone living in Chicago it’s no surprise to hear that this past February was one of the coldest on record.  Such conditions carry the risk of frostbite to those who venture outside.

Frostbite is basically the freezing of skin and the underlying tissues. In the head and neck area, the ears and nose are especially susceptible. It can range from frostnip, a superficial injury, to deeper levels of involvement. This freezing compromises the blood vessels, stopping blood flow, and can lead to tissue death if it is prolonged. Paradoxically, in this respect, it is similar to a burn. Individuals with vascular disease, diabetics, and young children are especially susceptible.

It can occur following either brief or prolonged exposures, depending upon the temperature and wind. Symptoms include numbness and a woody feeling of the skin. Skin color changes ranging from redness to whitish/gray and purple discoloration can occur. Blistering suggests a more severe injury.

The preferred treatment is to get out of the cold and gently rewarm the involved areas to restore blood flow. Warm water is preferable as opposed to aggressive re-heating measures. It can be painful as the feeling comes back. Blisters if present should be left intact. Medical attention should be sought urgently if significant discolorations of the skin or persistent numbness are present. Rubbing of snow on the skin will damage the skin further. Conditions that cause frostbite can lead to hypothermia which should be suspected if slurred speech and sleepiness are present.

Prevention is the key. Alcohol should be avoided. Children’s time outside should be monitored. Those who need to be outside should anticipate the weather, keep the face and ears covered, dress in layers, and keep moving.  Common sense always applies.

 

 

A Possible Link Between Hearing Loss and Mental Decline

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February 1  |  Blog, York ENT Blog  |   James Rejowski

There was an interesting article written by Anne Stein in the Health and Family Section of the Chicago Tribune on Wednesday, January 28, 2015. She references the work of Dr. Frank Lin, an ear specialist at Johns Hopkins University, and Dr. Richard Gurgel from the University of Utah. Their research has suggested that there may be an association between hearing loss, reduction in cognitive ability, and dementia.

The article cites their research, which demonstrates several findings in this regard. One investigation showed a 30-40% faster decline in mental acuity in patients 75-84 years old over six years in those with hearing loss than in those without.

Another work showed that in a group of seniors followed over time, those with hearing loss at the beginning of the study were more likely to develop dementia. More severe losses were associated with a greater likelihood.

The exact mechanisms of these associations are not completely clear and further research is ongoing.

The article points out that many people who could benefit from amplification do not pursue it, either due to the perceived stigma of hearing aids or acceptance of hearing loss as a normal consequence of aging. The results of these efforts may well change this and have positive impact on the quality of people’s lives.

Auditory Services of York ENT Surgical Consultants, serving Hinsdale, La Grange, Bolingbrook, and the surrounding communities, offers comprehensive evaluation of hearing disorders in adults and children as well as a full complement of hearing aid services and fittings.

The Head Mirror

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May 31  |  Blog, York ENT Blog  |   James Rejowski

The Head Mirror

Luke: What is it?

Obi-Wan: Your father’s light saber.  This is a weapon of a Jedi Knight.  Not as clumsy or random as a blaster; an elegant weapon for a more civilized age…….

Star Wars: Episode IV- A New Hope (1977)

The head mirror, still in use with a design originally created more than 150 years ago, remains a symbol of physicians, second only to the stethoscope.  The current design is credited to Dr. Johann Czermak ,who developed a prototype in Budapest in 1857. Remarkably simple in design and effective in use, it has stood the test of time.  The head mirror consists of a small concave mirror with a hole in the center of it, secured by a headband.  When not in use the mirror is reflected upward.  A light source is placed behind the patient’s head, the mirror is flipped down, and the light is then reflected into the patient’s nose or mouth.  The intensity and size of the light beam reflected is adjusted by the physician moving his or her head back and forth.  It takes a bit of practice to do this.  The eye hole in the center of the mirror allows binocular vision by the examiner.  The light is bright and without shadows.  It frees up both hands for the examination since the doctor doesn’t have to hold a flashlight or penlight.

Although otolaryngologists of a certain generation generally still use the head mirror, its use is slowly being replaced by either fiberoptic or LED headlights.  These are currently used in most training programs.  At one time these were quite expensive, but the cost has come down considerably.  I still think that there is a certain panache to the humble head mirror, and seeing a look of amusement and interest on my patient’s faces when I bring it out suggests to me that they feel theMay 2014 017 same.May 2014 020

Medical Decision Making

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March 25  |  Blog, York ENT Blog  |   James Rejowski

Using Dr. House to explain medical decision makingParadigm: A group of ideas about how something should be done or thought about.

Although all parts of the patient’s visit to a physician are important, the concluding aspects carry a special significance.  Recommendations are made regarding evaluation and treatment.  It is also, most likely, the time where the patient feels the most vulnerable, since in effect they are being asked whether they agree or disagree with the advice being given.  It is easy to see how difficult it could be to discern the message from the messenger.  Who would dispute the words of these esteemed physicians?

The answer to this dilemma is to employ a deceptively straightforward scheme, or paradigm, of medical decision making.  It involves consideration of the following three elements:

  1. The illness
  2. The treatment
  3. The benefit

ENTT_2011_08_pp22_01It is important to get a feel for the significance of the medical problem itself.  Is it painful, like an ear infection or tonsillitis?  Does it interfere with normal activities?  If symptoms are not present now, as in hypertension or elevated cholesterol, will it cause health problems down the line?  Does it cause physical or aesthetic deformity, like a large benign tumor or a lipoma?  Could it be malignant?  Basically, before going forward, the illness has to pass the “worth it” test.

The recommended treatment has to be taken into account.  Even well-intended, treatments can be inconvenient, expensive, and not always without risk.  The relative risks of the treatment need to be weighed against the potential risks and downsides of the malady left to its own design.  It would be difficult to proceed if the treatment was worse than the illness.  Other perhaps less invasive treatment options, if available, should be considered.

Finally, the recommended treatment has to have a very substantial probability of success.  Inexpensive innocuous treatments without any chance of benefit don’t really have very much to offer.  If therapy is not much better than no therapy, go with no therapy.

Patients need to involve themselves in this process.  Second or even third opinions are often helpful.  One should never hesitate to bring a list of questions to their visit.  There are no silly questions.  Self-research online has some potential pitfalls, because information there is more readily available than knowledge, but people are comforted when they find that the advice they are receiving is consistent with the accepted prevailing medical opinions posted.

External Otitis, Then and Now

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March 1  |  Blog, York ENT Blog  |   James Rejowski

The American Academy of Otolaryngology- Head and Neck Surgery published a monograph last month regarding the evidence based proper treatment of external otitis, or outer ear infections.  The goal was to promote increased recognition and proper treatment of this common disorder.  Almost one half billion dollars are spent each year in the treatment of such infections.  Among other things, the aim was to avoid the inappropriate use of oral antibiotics, which are prescribed from 20-40% of the time as treatment, and in most cases are unnecessary and ineffective.

External otitis, frequently called swimmer’s ear, is an acute inflammatory disorder of the outer ear.  It is more common in the summer months.  The illness is characterized by the rapid onset of ear pain and itching.  Ear fullness and jaw discomfort are frequently present.  The examination will demonstrate redness and swelling in the ear canal and tenderness of the adjacent cartilages.

The conclusions of the study were as follows:

1) Adequate pain relief should be delivered.

2) Systemic antibiotic treatments should be avoided unless there is infection beyond the ear, or the patient has serious underlying health issues.

3) Other sources of ear discharge and inflammation should be excluded.

4) An assessment of other factors that would influence management such as the presence of tubes or a tympanic membrane perforation should be performed.

5) Topical treatments with antimicrobials should be delivered.

6) The patient should be educated regarding the proper methods of delivering the drops into the ear, including placing a wick into the area to bring the medicines within the canal.

7) In the presence of a perforation of the eardrum or a tube, medicines that could damage the inner ear should be avoided.

8) The patient should be reassessed within 48-72 hours if there is no significant improvement.

This is an elegant and detailed study which will be of great benefit to clinicians treating patients with this disorder.

When I was a medical student, I received a Manual of Otolaryngology originally written by Dr. Stanton A. Friedberg, the Professor and Chairman of the Department of Otolaryngology and Bronchoesophagology at Presbyterian St. Luke’s Medical Center in Chicago.  It was first printed in 1955 and was revised by Dr. Friedberg and Dr. Jim Hutchinson in the 1970s.  It was a practical, carry in your lab coat pocket, type of guide that would be of value to students and junior house officers early in their careers.  Many of the recommendations present in the current review were detailed by Dr. Friedberg and Dr. Hutchinson in their monograph. I apologize for the tiny print.

Sometimes the more things change the more they stay the same.

Dr. F jpeg 1Dr F jpeg 2Dr F jpeg 3Dr F jpeg 4

Posterior Epistaxis

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October 23  |  Blog, York ENT Blog  |   James Rejowski

Epistaxis, or nosebleed, is a common problem that we see and treat in our practice.  60% of the population will suffer a nosebleed at some time in their life.  Most the bleeding is anterior, or from the front of the nose.  This is usually treated in the office with simple cautery or packing.

Posterior epistaxis, or bleeding from the back of the nose, presents more of a problem.  It is frequently seen in older people with underlying health problems such as diabetes or vascular disease.  This type of bleeding can require admission to the hospital for treatment, but fortunately this occurs only in a small percentage of patients.

A recent study compared different modalities of treatment for posterior epistaxis.  Using a national data base of over 50,000 admissions, outcome results for nasal packing, surgical ligation of bleeding vessels, and endovascular embolization were obtained.  Nasal packing involves the placement of a Vaseline gauze, tampon, or balloon in the nasal cavity, leaving it in place for 48-72 hours.  Arterial surgical ligation is usually done with an operation done through a person’s mouth, in the area above the canine teeth.  Dissection proceeds through the maxillary sinus until the arterial feeding vessels are identified and clips are placed on them.  Arterial embolization is done by interventional radiologists, who will place a catheter through the arterial system from the groin and perform very selective occlusions of the vessels behind the nose in order to stop the bleeding.

The length of stay in the hospital for each of these treatments was quite comparable to each other.  The cost of treatment for the embolization group was highest.  There was an increased risk of stroke with the embolization procedures compared to packing, which is not surprising given the fact that particulate matter was injected into the arterial circulation in the former group.

The data in this study was extracted from the discharge diagnosis that was coded following these hospitalizations.  It was not actually done by a review of the individual charts, so it needs to be taken with a grain of salt.  None of the treatments is intrinsically better than the others.  Practically speaking, when we see patients presenting with bleeding it is more efficacious to place a pack and wait a bit to determine its success or failure, rather than go right to the operating room or the angiography suite with a bleeding patient.  The latter treatments are a fall back when the packing, a less invasive procedure, isn’t successful in controlling the bleeding, or if the epistaxis recurs following this initial treatment.

Reference: Recent Trends in Epistaxis Management in the United States 2008-2010, Drs. Vilwock and Jones, JAMA Otolaryngology/Head and Neck Surgery, 2013

Benjamin J. Rejowski, M.D.

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May 12  |  Blog  |   James Rejowski

Our son Ben graduated this weekend from the Indiana University School of Medicine, receiving his M.D. degree. Being a physician is what he wanted to be from the time he was in grammar school, and now he is.

Ben graduated from the University of Notre Dame in 2009 and started at IU that same year. As a first and second year student he traveled to Honduras with fellow students and faculty to work in a university sponsored clinic in a remote rural village.

Making it through four years of medical school can present its challenges; the hours are long and the work is difficult. But Ben and his classmates will find out that the real reward will be a lifetime of having the opportunity to serve others and make a contribution to their lives.

Ben will be doing his residency at the Southern Illinois University School of Medicine in Springfield, Illinois, in General Surgery. All of us are very proud of him.

Good work, son. You did well.

Benjamin J. Rejowski, M.D.