Answer: Sort of. Acid reflux is the same as gastroesophageal reflux which just means that the contents of the stomach are backing up into the esophagus &/or mouth. Occasional reflux is completely normal and can happen to anyone, though usually it is following a meal and there are no real long-term consequences or bothersome symptoms and the episodes of reflux are short-lived. GERD on the other hand is Gastroesophageal Reflux Disease…so that means someone that suffers from GERD has bothersome reflux symptoms that can result in damage to the esophagus and their symptoms are typically a daily or somewhat routine occurrence. These symptoms include things like heartburn, regurgitation of food, and sometimes there is difficulty swallowing. Some people may have a persistent cough and nothing else.
Answer: It is actually a little complicated, but when you eat…food starts in your mouth where you chew it up and then when you swallow it goes into this long muscular tube which is your esophagus and that tube propels the food from your mouth to your stomach. At the end of the esophagus where it meets the stomach it has what we call the lower esophageal sphincter. It is essentially an area on the esophagus that compresses together and keeps stomach contents from coming back up into the esophagus and it has to relax and open up to let food into the stomach. This sphincter can weaken or not have as tight of a seal as normal and when that happens it does a really bad job at keeping things in the stomach…especially is you lay down right after you eat.
Answer: There are some foods that will trigger reflux symptoms in certain people and the more and more that happens the reflux will then progress to GERD. Some things related to increasing your risk of GERD include alcohol, smoking, caffeine, chocolate, certain medications, and so on. Being overweight is also a risk factor for the development of GERD. Studies have shown that losing weight improves reflux symptoms and frequency and can be a reason to undergo weight loss surgery if you are obese. Pregnancy increases your risk, but that usually resolves after delivery. And you can have something called a hiatal hernia which essentially means you have part of your stomach with or without the lower esophageal sphincter pushed up into your chest through your diaphragm which loosens sphincter tone.
Answer: Usually this can be diagnosed on history and symptoms alone if you have the usual symptoms of heartburn and regurgitation and that can usually be treated with a trial of PPIs or proton pump inhibitors which block the acid production in the stomach and see if that gives you relief of your symptoms. If you don’t have the usual symptoms or there is an indication that something more concerning may be occurring you will need some tests. These tests include an EGD (more on that next week…but it is a test where a doctor puts a camera on a long tube or scope into your mouth and looks at your esophagus and stomach), a 24 hours pH monitoring study where a little probe is placed in your esophagus so it can record how many times a day and at what time the pH in your esophagus changes due to the acid and what that number changes to, and also a manometry study which really just checks the pressure of your esophagus…like the whole thing…that helps make sure there is no problem with the way the esophagus moves food and it is in fact the lower sphincter pressure causing the problem.
Answer: It can be bad. Most people don’t have serious complications as long as they are treated. There are some serious complications that can happen if you have severe GERD and do not treat it. You can get a stricture in your esophagus which is scar tissue causing a narrowing or blockage. This can result in difficulty swallowing or food getting stuck in your esophagus. The process of ulcerations that heal over and over again causes this scar tissue and narrowing. You can have erosive esophagitis. This is when the acid causes ulceration in the esophagus and those ulcers can sometimes bleed. You may not vomit blood or see bleeding per se, but blood can be detected in your stool. You can also get Barrett’s esophagus which is where the cells in the lining of the esophagus change to a completely different type of cell from all the damage. The change in these cells can actually change further and develop into cancer. The acid can actually get into your lungs and cause asthma type symptoms or permanent lung damage and it can damage your teeth. Like I said, most people don’t have serious complications, but these complications are why it is so important to see your doctor and discuss your particular case with them and get treatment as soon as possible.
Answer: First and foremost…talk to your doctor. Everyone is different and should be treated as such. Common things work and should be done, but talk to your doctor to make sure you are treating the correct problem before you start trying to self medicate. There are some lifestyle things that can help like avoiding foods that you notice trigger your reflux, don’t eat close to bedtime, and try not to lay down after eating…try to eat several hours before you plan to lay down. You can lift the head of your bed up, but it involves more than just piling up pillows behind you, so really just try to avoid eating before bed. If you are overweight, try to lose weight. Not only for your overall health but like I said earlier, a lot of people have relief from their symptoms after they lose weight. Surgery is an option, but treatment with medication is always tried first because it is the least invasive option. Surgery does not come without its own complications. Talk to your doctor about taking a histamine blocker or PPI for any symptom relief before trying it on your own. Antacids like tums can help treat the minor symptoms, but if you find you’re using those a lot it’s time to see a doctor. If you feel like the reflux is getting worse or you start losing weight and you aren’t trying, or you feel like you’re choking you should also get to your doctor as soon as possible. If you’ve been treated and are still having symptoms then talk to your doctor about changing medication or what surgical options are available to you if you want to explore that option.
Stefanie:
Welcome, everyone! Thank you for joining us today.
My name is Stefanie and I'm part of the team here at MyVirtualPhysician. We are a direct to consumer, multi-specialty, telemedicine provider operating in multiple states.
Welcome to Talk Tuesday. We are continuing our weekly educational series, talking with our expert physicians, exploring some common healthcare concerns, and hopefully answering some questions you may have.
Today our physician expert is Dr. Salome Masghati, a practicing gynecologist and minimally invasive surgeon who is one of our telemedicine providers. We are talking about a complaint our doctors commonly see or treat, and that is URINARY TRACT INFECTIONS or UTIs.
Dr. Masghati, thank you for joining us today.
Stefanie:
So let’s cut to the chase Dr. Masghati, can cranberries cure a UTI?
Dr. Salome Masghati:
Many people believe that cranberries or cranberry juice can treat a UTI, and the answer is it's complicated.
There have been many studies on cranberries as a UTI treatment, and research has shown that an active ingredient in cranberries called “proanthocyanidins,” or PCAs for short, is effective in preventing E. Coli bacteria, the most common cause of UTI infections, from attaching to the bladder wall lining and colonizing or creating an infection.
So PCAs or cranberries may help prevent a urinary tract infection but once there is already an infection, that treatment may not be effective.
A cup of cranberry juice may only contain a small amount of this active ingredient with a lot of sugar! Cranberry tablets or pills may be another option for prevention.
Stefanie:
So if someone wants to try cranberry juice for prevention of a UTI, how much should you drink?
Dr. Masghati:
A recent article in Pharmacy Today recommends at least 36 mg of PAC daily.
For the prevention of UTIs, 300–500 mL of cranberry juice cocktail (26% cranberry juice) daily and 400–800 mg cranberry extract twice daily.
Or 36–72 mg of cranberry PAC equivalents per day, found in about 360–720 mg of cranberry extract, has been shown to be effective.2
The research shows some evidence that cranberry products may reduce the incidence of UTIs but the most effective amount and concentration of PACs that must be consumed and how long they should be taken are unknown.
Stefanie:
So cranberry juice and cranberry extract tablets together may help prevent infections but what about someone who already has a UTI?
Dr. Masghati:
Truly if someone has an infection, either their body will be able to fight off the infection, or they may need an antibiotic medication to kill the bacteria that is causing the infection.
Stefanie:
That’s interesting, so you say in some cases a UTI can go away on its own because the body is able to fight off the infection?
Dr. Masghati:
Yes, in some cases. Approximately 25-42% of the time these uncomplicated UTIs may resolve without any medical treatment.
Stefanie:
Ok, so when would it be time for someone to see a doctor about their UTI?
Dr. Masghati:
Untreated infections can spread and become serious. You should talk to your doctor as soon as you suspect a UTI.
Also for signs such as fever, chills, flank pain, or abdominal pain with nausea or vomiting. These can be signs of a serious infection.
Stefanie:
For someone who is going to make an appointment but has not yet, is there anything that they can do to manage the UTI?
Dr. Masghati:
There are some things you can do for relief, or even after you have seen your doctor while you are waiting for an antibiotic to work.
It is important to stay hydrated, drinking plenty of water flushes out the bladder.
When going to the bathroom it is important to try to empty the bladder completely. Some adults with UTI have a frequent urge to urinate or sensation of pressure in the low abdomen which can make it feel as though you need to urinate. Going to the bathroom frequently to empty the bladder can help.
If there is pain in the low abdomen a heating pad may provide some relief.
Over the counter pain relievers such as Motrin or Tylenol can also be taken to help with discomfort.
Stefanie:
Dr. Masghati you have shared some great information today. I appreciate you joining us for Talk Tuesday and helping us understand more about UTIs and cranberry juice. For everyone else joining us as well, this has been Talk Tuesday with MyVirtualPhysician. If you would like to connect with one of our board certified OB/GYNs, or for more information you can check out our website at www.myvirtualphysician.com. We look forward to seeing you again and we hope you have a great week.
Stefanie:
Welcome, everyone! Thank you for joining us today.
My name is Stefanie and I'm part of the team here at MyVirtualPhysician. We are a direct to consumer, multi-specialty, telemedicine provider operating in multiple states.
It is Talk Tuesday and we are back with our weekly educational series, talking with our experts, exploring some common healthcare concerns that we see, and hopefully answering some questions you may have.
Today our physician expert is Dr. Daniel Kessler and one of our telemedicine providers. We are talking about coping with anxiety during the holidays.
Stefanie:
Well the holiday season is upon us and I know that this year has been challenging for many, so some people are already stressed or anxious and not looking forward to the holidays. Is it normal to have anxiety during this time?
Dr. Daniel Kessler:
It can be common to have feelings of anxiety during this time.
The Oxford dictionary defines anxiety as feelings of worry, nervousness, or unease, typically about an event or something with an uncertain outcome that may be coming. These can be normal and natural. Many people have these feelings from time to time. During the holidays, Americans may feel financial strain as it can be a season of shopping and gift-giving. They may have to come together with family members that they don’t often see or grieve separation from loved ones and relationships can be challenging or cause anxiety and worry. Many adults have unrealistic expectations for the holiday and that can create anxiety. And already busy schedules can feel the burden of holiday events and activities that can make you even more busy, anxious, or restless.
Stefanie:
That makes sense, the holidays can definitely cause anxiety, the worry, nervousness, or unease. So when is anxiety abnormal, or when is it a problem?
Dr. Kessler:
In some cases, those thoughts or feelings become intense and excessive, or individuals may become focused on common everyday events or situations that generally should not produce those feelings or at one time did not make the person feel that way. This type of anxiety usually causes physical symptoms such as sweating, racing heartbeat, or even weakness and feeling tired all the time.
This second more extreme sense of anxiety may be out of the norm, and may require evaluation by a healthcare professional.
Stefanie:
Are there other symptoms, other than the intense feelings you mentioned, that someone could look for or identify as signs that they should get help, or someone they know or care about should see a physician?
Dr. Kessler:
Symptoms of an anxiety disorder can vary from person to person so if someone is concerned they should talk to their doctor.
But some other signs or symptoms could include:
Stefanie:
So Dr. Kessler, these may be reasons to talk to your doctor about your anxiety. But for our listeners who may experience some mild feelings of stress or worry around the holidays, and maybe they are reluctant to talk to anyone about them yet, can you tell us about coping with anxiety, and specifically for coping with anxiety during the holidays?
Dr. Kessler:
Sure, There are definitely some steps you can take to manage mild anxiety.
Probably the most important thing is self care and self awareness. Many people overlook taking care of themselves during this season, which is often about giving to others. But you have to be aware of how you’re feeling, and take care of your mental and physical health during this time.
So here are 6 things that we can all do, to try to stay healthy and happy this holiday and keep anxiety at bay.
Number 1 - Adequate hydration
Don’t forget to drink 8-10 glasses of water each day. When you are dehydrated, you won’t feel your best. Also keep in mind drinks like coffee and alcohol may contribute to anxiety so it can be helpful to limit or cut out caffeine and alcohol for a time.
Number 2 - Good nutrition
Stress can cause changes in your metabolism, or how you burn energy. Skipping meals leads to spikes and drops in blood sugar that can wreak havoc on your system. It is important to eat regularly and maximize your nutrient intake with healthy foods. Taking a multivitamin won’t hurt either.
Number 3 - Get enough sleep
National Sleep Foundation guidelines say that the average adult needs seven to nine hours of sleep. Staying up late at holiday parties and getting up early to wrap presents can be detrimental to your health. Practice good sleep hygiene by setting a bedtime and sticking to it when you can.
Number 4 - Exercise
Studies show that physical activity is excellent for mental health. If you find yourself anxious or worried take a walk or a jog, practice yoga, whatever physical activity that you find enjoyable.
Number 5 - Stay connected to others
Social isolation can be a symptom of anxiety and may also trigger it. During the holiday season, make it a point to stay connected to family and friends. Communicate by phone or in person when possible. When separated from loved ones, look for settings where you can volunteer. Many charities offer opportunities to serve. Being with others can suppress feelings of anxiety or depression. It is helpful to share feelings with others and reach out when you can.
Number 6 - Be intentional with your schedule
Set boundaries with your time, and don’t feel about declining invitations if they cause stress, anxiety, or depression. Limit events that cause excessive worry. You want to be connected, but you also want to be selective in some way, and make the best of your holiday season. It can also be helpful to stick to your normal routine. Change can cause stress so just be aware of that.
Stefanie:
Thank you Dr. Kessler, you have given us some great tips for coping with anxiety during the holidays.
I appreciate you joining us for Talk Tuesday and telling us what we need to know about anxiety. For everyone else joining us as well, this has been Talk Tuesday with MyVirtualPhysician. If you would like to talk with one of our board-certified physicians about your health concerns, you can check out our website at www.myvirtualphysician.com. We look forward to talking with you again, and we hope you have a great week.
Stefanie:
Welcome, everyone! Thank you for joining us today.
My name is Stefanie and I'm part of the team here at MyVirtualPhysician. We are a direct to consumer, multi-specialty, telemedicine provider operating in multiple states.
It is Talk Tuesday and we are back with our weekly educational series, talking with our experts, exploring some common healthcare concerns that we see, and hopefully answering some questions you may have.
Today our physician expert is Dr. Daniel Kessler, Primary Care Physician, and one of our telemedicine providers. We are talking about a topic affecting one in ten Americans, Diabetes.
Dr. Kessler, thank you for joining us today.
Stefanie:
Let’s start by talking about Diabetes statistics. According to the American Diabetes Association, in 2018, 10.5% of Americans were estimated to have diabetes and about one-fifth of those were undiagnosed. Those are pretty significant numbers. Should people be concerned about diabetes?
Dr. Daniel Kessler:
Well that depends. We know about risk factors that can increase the likelihood of getting Type II diabetes. The CDC says you’re at risk for developing type 2 diabetes if you:
If you have non-alcoholic fatty liver disease you may also be at risk for type 2 diabetes.
So for individuals with risk factors, there should be some concern or at least awareness.
Stefanie:
So let’s talk about early detection. Why is it important? Why is early detection key in diabetes?
Dr. Kessler:
Early detection is key in diabetes because early treatment can prevent or at least slow serious complications. When a problem with blood sugar is found, doctors and patients can take effective steps to prevent irreparable damage to the heart, kidneys, eyes, nerves, blood vessels, and other organs.
An article in the Current Opinion in Endocrinology, Diabetes and Obesity journal recognized that there are many reasons why earlier detection of diabetes could be of benefit to the individual and the healthcare system, because it creates the opportunity to treat the high blood sugar.
Furthermore, undiagnosed diabetes is often associated with potentially-preventable, costly complications. ER visits and hospital stays can be expensive!
The base estimated cost of living with diabetes is around $9,600 per year. This includes prescription medications, diabetic testing supplies, doctors appointments, and routine care. This cost will be higher for uncontrolled or unmanaged diabetics who more care, more medications, more doctors appointments. Early detection can save thousands of dollars.
Stefanie:
So Dr. Kessler, for our listeners who may not be familiar with diabetes, can you tell us what a diagnosis of diabetes means? What is diabetes?
Dr. Kessler:
Sure, Diabetes is a metabolic disorder in which your body is not able to efficiently turn the food you eat into energy, leaving sugar to build up in the bloodstream. This creates two problems: the cells are not getting the sugar energy they need, and the sugar is accumulating in the blood. High blood sugar, known as hyperglycemia, causes damage to many tissues and organs of the body. This is why diabetes is a serious condition that can be dangerous.
Normally when you eat, your body breaks food down into glucose. As your blood glucose level rises, the pancreas releases insulin. Insulin is a hormone that tells body cells to let the glucose inside.
In diabetes, either your pancreas does not make insulin correctly, or your body cells do not react to the insulin the way they should. This means that the glucose stays in the blood, which is why diabetics experience high blood sugar, also known as hyperglycemia. Over time, hyperglycemia can damage nerves and blood vessels.
Stefanie:
I understand. And how do doctors know that the pancreas is not making insulin right or the body cells not reacting to the insulin?
Dr. Kessler:
Well, a blood test can determine if a person has diabetes. There are two tests commonly used.
A glycated hemoglobin test, known as a hemoglobin A1c (HbA1c) test, measures the glycated form of hemoglobin to determine the three month average of blood sugar. This blood test takes about a minute to perform, and results are generally available in two to three days. A normal HbA1c is below 5.7%. Prediabetes is 5.7 to 6.4%. A result of 6.5% or more is classified as diabetic. Another test doctors use to detect diabetes is a fasting blood glucose, or fasting blood sugar (FBS), test. This blood test measures the basal (base) sugar levels of the blood. Testing is usually performed in the morning after the patient has had nothing to eat or drink for eight hours or more. This test may take around ten minutes and results can be immediately available. A normal FBS is 70-100 mg/dl (3.9 - 5.6 mmol/L). An abnormal fasting blood sugar test may be repeated by the doctor or additional tests may be performed for confirmation of the abnormal blood sugar reading.
Stefanie:
And what these tests find, high blood sugar, can it go away? Can diabetes go away, or can early diabetes be cured?
Dr. Kessler:
Diabetes is a chronic condition which means it may not go away. It is possible, however, to reverse some of the effects of diabetes, and to even go into a remission state for those with Type II Diabetes. Remission in diabetes means that your blood sugar levels are within the normal range and you have not required medication to manage your blood sugar for six months or more.
Lifestyle changes like a healthy diet, daily exercise, and weight management can improve the way your body uses insulin, and can improve the prognosis for someone diagnosed with diabetes.
Stefanie:
Thank you Dr. Kessler, you have definitely helped me to understand diabetes better and how important it is for individuals to know their risk and talk to their physician to prevent problems and even get diagnosed and treated early!I appreciate you joining us for Talk Tuesday and telling us what we need to know about early detection in diabetes. For everyone else joining us as well, this has been Talk Tuesday with MyVirtualPhysician. If you would like to talk with one of our board-certified physicians about diabetic screening or your risk, you can check out our website at www.myvirtualphysician.com. We look forward to talking with you again, and we hope you have a great week.
Stefanie:
Welcome, everyone! Thank you for joining us today.
My name is Stefanie and I'm part of the team here at MyVirtualPhysician. We are a direct to consumer, multi-specialty, telemedicine provider operating in multiple states.
It is Talk Tuesday and we are continuing our weekly educational series, talking with our experts, exploring some common healthcare concerns that we see, and hopefully answering some questions you may have.
Today our physician expert is Dr. Salome Masghati, a practicing gynecologist and minimally invasive surgeon and one of our telemedicine providers. We are talking about a problem that may affect one in ten couples at some point, Infertility.
Dr. Masghati thank you for joining us today.
Let’s start by talking about what is Infertility?
Dr. Masghati:
Infertility is a diagnosable medical condition in which a couple has been unable to conceive a pregnancy despite unprotected intercourse.
Stefanie:
Can you tell us some of the causes of Infertility?
Dr. Masghati:
Infertility in women can have many different causes, such as abnormal ovulation, pelvic inflammation, endometriosis, hormone abnormalities, tubal scarring etc. Infertility in men is commonly caused by problems with sperm cells. Aside from these physiological causes, factors affecting fertility can include age, health status, and lifestyle factors such as stress, diet, or smoking. They work to keep you healthy later if you are exposed to a live virus. Marijuana use and heavy drinking have also been shown to cause decreased sperm motility in men.
Stefanie:
So when should a couple seek a medical opinion about getting pregnant? Is there a time frame, say?
Dr. Masghati:
The general rule of thumb is one year for women under the age of 35, and for women over the age of 35 they might seek a medical opinion sooner, after maybe six months of trying to get pregnant. Other reasons to see a doctor when planning a pregnancy might include history of miscarriages, men who have trouble maintaining erection or women with irregular menstrual cycles. Also couples who have had sexually transmitted infections and are now unable to conceive a pregnancy may need to see a doctor, and individuals who have been exposed to toxic chemicals or chemotherapy as in the case of a childhood cancer or something of that nature.
Stefanie:
When couples seek help for infertility concerns, what can they expect?
Dr. Masghati:
Usually the doctor will start with a history and physical, and then they may order blood or urine testing, hormone testing. The doctor may evaluate both partners to try to determine if there are any abnormalities, and then they will go over test results and recommendations with you. Some of these tests can be ordered by me through My Virtual Physician visits, but some need to be followed up in person with a physician in the office.
Stefanie:
And after this evaluation, what sort of treatment options might be recommended, or are available?
Dr. Masghati:
There are medications available for men and women that can increase chances of getting pregnant. Intrauterine insemination, or IUI, is a procedure in which a physician can insert sperm into the uterus at the time of ovulation to help with conception. And for other cases, fertility specialists may offer in vitro fertilization, known as IVF, which is a surgical procedure in which a woman’s eggs are retrieved, fertilized, and then transferred back into the woman’s uterus.
Stefanie:
What is the success rate of a procedure like in vitro fertilization?
Dr. Masghati:
Women under the age of 35 can expect about a 50% success rate for in vitro fertilization, but it is a very complex process that requires intense testing and monitoring and can be costly, anywhere for $20,000 - $50,000.
There is also the possibility to address infertility issues through functional medicine, which is a type of medicine where we look at the patient in a more holistic approach. Functional medicine and integrative medicine can be helpful to couples who have been unable to conceive.
Stefanie:
Dr. Masghati, you have shared some great information today and answered questions that I think many couples may have on their minds. I appreciate you joining us for Talk Tuesday and telling us what we need to know about infertility. For everyone else joining us as well, this has been Talk Tuesday with My Virtual Physician. If you would like to connect with one of our board-certified OB/GYNs, or for more information, you can check out our website at www.myvirtualphysician.com. We look forward to seeing you again and we hope you have a great week.
Stefanie (00:00):
The information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics address on talk Tuesdays or for any other medical problem.
Stefanie (00:41):
Welcome everyone. Thank you for joining us today. My name is Stefanie and I'm part of the team here at my virtual physician. We are direct to consumer multi-specialty telemedicine provider operating in multiple States. It's talked to is eight, and we are continuing our weekly educational series to talk with our experts, explore some common healthcare concerns that we see and hopefully answer some questions you may have today. Our physician expert is dr. Coleman. She is a general surgeon, and today we're going to talk about the flu vaccine. So Dr. Coleman, thanks for joining us again.
Dr. Coleman (01:14):
Thanks for having me back. Um, let's start by talking about current recommendations. What was the guideline for vaccination? Again, the center for disease control and prevention, or the CDC recommends that everyone over the age of six months be vaccinated against the flu virus. This year, Americans should get their flu shots around October. So I think now also the American Academy of family physicians recommends a yearly flu shot for everyone over six months old as well. This is because it can safely and effectively prevent severe illness from the flu. Okay.
Stefanie (01:50):
So you said the flu vaccine is safe. Can you talk more about that?
Dr. Coleman(01:54):
Yeah, so the flu vaccine contains either a dead or weakened form of the influenza virus. So when your body receives that part of the virus, it begins to build up some natural defenses and create antibodies. The antibodies are proteins in your body that help you fight off infection. They work to keep you healthy later if you're exposed to the actual live influenza virus. So it gives you a little, little part of the actual virus for your body to get familiar with and fight off. So vaccination is safe. Healthcare providers that administered flu vaccines for well over 50 years, over this time, there's been a lot of research to evaluate the effectiveness and safety of immunizations. So certainly there are some risks involved to certain people, but the risk of any life-threatening reactions is actually very small and manufacturers have demonstrated the safety of their drugs before being administered by getting FDA approval. Okay. So when would it not be safe to get a flu shot or who should not get a flu shot? Yeah, so the advisory committee on immunization practices or the ACP warns some individuals to talk to their doctor about getting a flu shot. If they have certain contraindications, this means specific medical conditions or particular situations that could make treatment unsafe or, or even harmful. So for instance, someone that has an egg allergy would prevent you from getting a flu shot because eggs are used in the manufacturing of the vaccine. So the, the flu shot may contain some trace amounts of egg protein. And if you're, you know, if you get an Anna Filactic reaction to eggs, you obviously don't want to inject yourself with something that's made with eggs.
Dr. Coleman (03:50):
So in addition to egg allergies, there's some other contraindications. So anyone that's had ganbare syndrome should discuss having any vaccinations with their physician before proceeding forward with the flu vaccine. And then if you've, if you've recently been sick, if you've had a pretty severe illness or you've had a really high fever, you probably shouldn't get a flu shot, right. Then, um, you should, you should get over whatever sickness you have going on before you get a flu shot to this may make you any better. Yeah. So just wait until you're healthy to get the flu shot.
Stefanie (04:29):
Um, that's, that's good information. So if it's safe for you to get a flu shot, are there any risks may cause some reactions they're typically mild and they usually go away within 48 to 72 hours. Usually they include things like injection site soreness. I just had my flu shot done last week and it hurts. I mean, I know it's, it's hard to move your arms sometimes. Uh, some people will get headaches, muscling, and a low grade fever, all completely normal, but things to be aware of, sometimes you can have more severe reactions and these could be signs that you have an allergy to the vaccine. If these signs and symptoms arise, then, then you need to seek medical attention right away. And that would be things like wheezing or difficulty breathing, any skin reaction or hives. Uh, so you may have a little bit of redness around the injection site, but if your whole arm turns red or you break out in a rash everywhere, where you have hives all over your body, that's a little concerning and you should go see somebody, any dizziness, weakness, or feigning that, you know, you can't really explain by, you stood up too fast or you haven't been drinking enough water, things like that.
Dr. Coleman (05:45):
If it, if it's related to when you got your flu shot, then that would be something you should go see somebody about. Awesome. Thank you. So what are the risks associated with not getting vaccinated? So not to means you're at risk of getting sick with the flu. You could miss school. If you're a student medical costs, if you have to go into the hospital or, or see your doctor more frequently, most healthy adults can deal with a minor case of the flu by staying home, taking some over the counter medications for symptoms and they'll, there'll be okay. It usually lasts about seven to 14 days. If you get vaccinated, theoretically, it reduces your risk of getting sick with the flu. It all sort of depends on what strain of the flu is going around and what, which one the vaccine contains. So you could still get sick with the flu, even if you get vaccinated, but it decreases your risk of getting sick.
Stefanie (06:49):
Got it. And what about more serious complications like being hospitalized? Is it possible to require hospitalization from the flu? It is possible. So those people that are considered high risk could suffer a much more serious cases of the flu. Some possible complications include and even death. Uh, some of the factors that put you in the high risk category would be anyone that's over the age of 60 pregnant women, children under the age of 12 and any individual that has underlying health conditions, such as heart disease, HIV, asthma, diabetes, things like that. Awesome. Well, thank you, dr. Coleman, you have shared some great information today and answered questions that I think many Americans have on their mind, especially with flu season, right around the corner. I appreciate you joining us or talk Tuesdays and telling us what we need to know about the flu vaccine for everyone else.
Stefanie (07:47):
Joining us as well. This has been Talk Tuesdays with my virtual physician. If you would like to schedule a consultation with one of our doctors or for more information, you can check out our website at www.myvirtualphysician.com. We look forward to seeing you again. We hope you have a great week. Thanks again, dr. Coleman, the information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics address I'm talk Tuesdays or for any other medical problems.
Stefanie (00:00):
The information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics address on talk Tuesdays or for any other medical problem. [inaudible] welcome everyone. Thank you for joining us today. My name is Stefanie and I'm part of the team here at My Virtual Physician. We are a direct to consumer multi-specialty telemedicine provider operating in multiple States. It is Talk Tuesday and we are continuing our weekly educational series to talk with our experts, explore some common healthcare concerns that we see and hopefully answer some questions you may have today. Our physician expert is Dr. Coleman. She is a general surgeon, and today we are going to talk about breast cancer surgery. So thank you
Dr. Ginger Coleman (01:14):
Joining us today. Thanks for having me. Yeah. And welcome back. Okay. So after the biopsy, they told me that I have cancer. So now what, so there's a bunch of different types of cancer. So the first thing will depend on what kind of cancer you have and how big it is, and if lymph nodes are involved. So, so don't panic, there's, there's a lot of options for surgery and every option would be something that you would need to discuss with your personal physician and determine what the best course of action is for you and your particular type of cancer. But, but we'll discuss a couple common options. Um, there's something called breast conservation surgery also known as a lumpectomy or a partial mastectomy. So this is where a small ish incision is made. It's not necessarily right over where the area of cancer is. We try and hide the incisions.
Dr. Ginger Coleman (02:22):
So sometimes we may put it around the nipple. Sometimes we may put it and underneath the breast, sort of in the, in the fold, sometimes we gotta just make an incision across your skin and we try and hide it as best as we can, but it doesn't happen all the time. Essentially, once we make that incision, we remove a small portion of breast where the cancer is as well as some normal breast tissue surrounding it. And in order to do that, because if you had a lesion that wasn't palpable, it was just something abnormal seen on your mammogram. Obviously, we can't it in the, or so we have to have our radiologists localize it for us, what used to be done. And it's still done in a lot of places, but we're moving away from it is what's called a wire localization and you would go to mammography before surgery.
Dr. Ginger Coleman (03:20):
The radiologists would do another mammogram and they would find that area of concern. And then they stick a little wire into the lesion. So we're trying to get away from it because it's not real fun to be wheeled around the hospital with a wire sticking out of your breast, waiting to go to surgery. But that wire is directed to that area where you have cancer or the area of concern that needs to be removed. And they give us mammogram images to use in the operating room to make sure that we know where that is. So, so we'll excise that area more recently, they've moved to using things like radioactive seeds that can be placed by the radiologist and they can, they can be done a couple of days before surgery, some even up to a couple of weeks before surgery. So it's not something you have to come in that day and get done.
Dr. Ginger Coleman (04:10):
You can get it done kind of on your own time, leading up to surgery. And then in the operating room, we use a little, I call it the Geiger counter, but it's a little probe that beeps when you get close to the, the seed or, or whatever it is that they used, there's a whole bunch of different kinds. And, and so that helps locate the area of cancer. And then that gives us an idea and we remove that portion of tissue. And then, like I said, some normal breast tissue around it. And depending on the type of cancer you have will determine how much breast tissue we need to take. And depending on, you know, if you have DCIS or you have invasive cancer, that will also determine if we need to take any lymph nodes from your XLO also known as your armpit. Okay.
Dr. Ginger Coleman (04:59):
So then you said there were more than one type. So what's the other. Yes. And the other type is a mastectomy and that's where your whole breast is removed. There are different types of mastectomies. A simple mastectomy is probably what most people are familiar with. And that would be where all of your breast tissue and your nipple and areola are removed. And you have just a flat chest after that, on that side, there's something called a modified radical mastectomy. And that's a simple mastectomy, except during this operation, all of the lymph nodes in your Exela are removed that's surgery. There's some other mastectomies, a nipple-sparing mastectomy, and skin-sparing mastectomies that are also options. I won't really go into those, but, but really any mastectomy that's done can be followed with breastfeeding plastic surgeon, either during the same operation or at a later date. It all depends on the type of cancer you have and what other treatments that you need after surgery and understanding that there are risks and benefits of each type of surgery and what may be best for you may not be, you know, what you really desired to have done. There's if you need radiation after having a mastectomy, you don't really want to have reconstruction because you're not going to heal and you're going to have more problems and need more surgery. You may not have any complications, but do you want to risk it? So even after a mastectomy, you can get reconstruction, you can get it done that day, and we do that pretty frequently, but it all depends on you in particular, what's going on with you and what treatments that you need.
Stefanie (06:59):
Yeah. Um, so then you S you said lymph nodes. And can you talk to us a little bit about that or why they're removed?
Dr. Ginger Coleman (07:08):
Yeah. So your lymph nodes often are, are said to quote unquote, filter your blood. And so if you have breast cancer that is going to drain into your lymphatic system, and we'll go through those lymph nodes. And usually if you have breast cancer on the right side, you look in the right armpit for the lymph nodes and see if you can feel any that are, you know, big or thick and kind of mad at or anything. And even if they feel normal, it doesn't mean that there's not tumor in them. So if you find tumor in those lymph nodes, it's a sign of metastatic disease and it's more affiliated with invasive cancer. And so that's why it's important for us to evaluate the women, especially in invasive cancer. And you can do it in two ways. Again, there's two ways, there's something called a Sentinel lymph node biopsy, or you can have an auxiliary dissection.
Dr. Ginger Coleman (08:07):
So with a Sentinel lymph node biopsy, you can do this with either breast conservation or a mastectomy. If you do it with breast conservation, it's a separate incision, and it's not real big. We try and hide it in the, you know, one of the creases in your armpit or at the hairline, just to kind of hide the scar, but it is a separate incision. And we go through there to find the lymph nodes. If you do the lymph node biopsy with a mastectomy, it's all through the same incision. So you don't have two separate incisions prior to surgery. You usually go to a nuclear medicine department and get this radioactive tracer injected. And then in the operating room, we use a blue dye, methylene blue. I just often blue something and we inject and everyone does it a little bit different, but we always injected it underneath the nipple, or I'm sorry, underneath Ariel.
Dr. Ginger Coleman (09:03):
And then you do your surgery and, and the axilla is the last thing that you do. So by the time you get there, hopefully all that blue dye has made it swaying to your lymph nodes. And so we use that little Geiger counter thing again, and it helps you find that radioactive tracer, but then we're also looking for blue. So what we want to do is find the blue and radioactive lymph nodes and remove those. And the machine will give you a number and you want to take the highest number because that's theoretically the lymph node that drained first or the Sentinel node. And we usually take about three more or less. It kind of depends on what we see in there. If it's very obvious that all of your lymph nodes are involved, you may then end up with an axillary dissection and not just the Sentinel lymph node biopsy.
Dr. Ginger Coleman (09:57):
So an axillary dissection is actually where all of the lymph nodes are removed. Usually we do this with a mastectomy, so like the modified radical mastectomy, and it's all through the same incision. Sometimes you can do it after a lumpectomy or any other surgery that you've had, or Sentinel lymph node biopsy. If that biopsy came back with signs of invasive cancer that eat, that indicated you you'd need all of the lymph nodes removed. So then we would have to go back and do another operation, but usually we do it with a mastectomy. So it's all one surgery. And we just take out all of those lymph nodes. There are some nerves and blood vessels in the area that are important that we don't disrupt. They can cause some, you know, numbness or tingling of your arm or difficulty moving your shoulder, or even make your shoulder blades stick out.
Dr. Ginger Coleman (10:56):
But injuries to those nerves are not really common. Okay. So then you did your mastectomy or lumpectomy. So what happens after surgery? So depending on the type of surgery you had, you'll either go home that day or you'll stay overnight in the hospital. And usually nobody has to stay more than 23 hours or no more than a day. If you, if you had a lumpectomy and you don't have any serious medical conditions or anything that would be of concern, usually you just go home. So someone will, someone will need to drive you home. And we'll see you in clinic in a couple of weeks and let you know the pathology. If you had a mastectomy, you usually stay in the hospital, at least overnight, uh, you will have a drain or two, depending on if you had to have an axillary dissection or not. Um, and, and every surgeon is different with how they do it, but, but usually you will have at least wondering.
Dr. Ginger Coleman (11:58):
So we'll teach you how to take care of that. We keep you overnight to make sure that there's not a lot of bleeding out of the drain or anything that would be concerning to need to take you back surgery. Uh, if you do, okay, you go back home and then you see us in clinic and we'll take the drains out in clinic and talk about pathology. Uh, and, and if you haven't seen an oncologist already, we'll send you to one. Um, usually they're the ones that send you to us. So that's, that's usually pretty well organized, but that's when you would talk with them about the need for chemo or radiation. And sometimes if, you know, we do breast conservation surgery and maybe we didn't get all of the cancer, it'll be called, you know, you have positive margins. And so at that time, we would have to talk about going back for either re-excision of those areas that were positive and depending on your breast size and the type of cancer you have and all of that, it, it may end up being okay, well, now we need to talk about actually doing mastectomy because the pathology showed whatever it showed, but there is a possibility that you, that you would have to go back to surgery if you do breast conservation.
Dr. Ginger Coleman (13:15):
And it doesn't happen all the time, but it is, you know, one of the risks of trying to preserve the breast tissue.
Stefanie (13:23):
Um, thank you so much, dr. Coleman. I know it's a really hard topic to talk about. Cancer is always something that's pretty scary word. I appreciate you joining us for Talk Tuesday and telling us what we need to know about breast cancer screening and breast cancer surgery for everyone else. Joining us as well. This has been Talk Tuesdays with my virtual physician. You can schedule a consultation with one of our doctors by visiting our website at www.myvirtualphysician.com. We look forward to seeing you again, and we hope you have a great week Nation presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics address in Talk Tuesdays or for any other medical problems.
Speaker 1:
The information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not a diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own health care professional about all topics address on Talk Tuesdays or for any other medical problem.
Speaker 1:
Welcome, everyone. Thank you for joining us today. My name is Stephanie and I'm part of the team here at My Virtual Physician. We are a direct to consumer multi-specialty telemedicine provider operating in multiple States. It is Talk Tuesday and we are continuing our weekly educational series to talk with our experts, explore some common healthcare concerns that we see and hopefully answer some questions you may have today. Our physician expert is dr. Coleman. She is a general surgeon, and today we are going to talk about breast cancer screening and breast cancer surgery. So thank you for joining us today. Thanks for having me. Yeah. And welcome
Speaker 2:
Back October was breast cancer awareness month. So we're going to be doing
Speaker 1:
Again a blog and an episode or two of Talk Tuesday on breast cancer screening. When would someone go in to get a mammogram or if they feel something or they have any history of breast cancer in their family, what's kind of the age range,
Speaker 2:
What to look for. Okay. So there's actually three organizations, probably more, but there's at least three organizations that have opinions on breast cancer screening, depending on which organization you listen to, it could be 40 years old, 45 years old or 50 years old, either way. Everyone agrees that by the age of 50, you should be getting a screening mammogram, most people, uh, and I believe most insurance companies go with the age of 40 breast cancer. Under the age of 40 is pretty rare. If, if you have
Speaker 1:
Breast cancer under the age of 40, usually it's associated
Speaker 2:
With some sort of genetic predisposition. There's the BRC mutation that predispose people to, to breast cancer at a younger age. But there's some other things that can, can run in families. Some other genetic diseases that predispose you at a younger age and typically cancer at a younger age is more aggressive and more advanced when it's found, because who in their thirties thinks that they're going to have breast cancer. So what we learned in residency was at the age of 40, you started getting your screening mammograms, and that's just, you have no symptoms. You have nothing going on. You're 40 years old. It's time to get a mammogram. Just like when you turn 50, you got to get a colonoscopy. It's just a way of life. Some people will come in. Well, I feel a mass I'm worried. And this also kind of depends on your age.
Speaker 2:
If you're younger, the chances of you having a mass that's breast cancer is pretty low. You, you may have these little hard nodules called fibroadenomas. They're pretty common in younger people and they grow and shrink in size with your menstrual cycle. And that's something that people usually will point out like, Oh, I noticed this, I know I was on my period last week and now I don't really feel it so much. And so that's, that's pretty common and we can actually do ultrasounds in clinic. I mean, not everyone, but if you're, if the clinic has an ultrasound, we can do an ultrasound because sometimes it's just breast cyst that can feel like a lump and they can hurt. And if it is a cyst, they can drain it in the office and, and hopefully give you some relief. So when you turn 40, get a mammogram, if you feel something that's concerning, you would need to go into your doctor, talk to them about getting an ultrasound or a mammogram.
Speaker 2:
And again, depending on your age, it may dictate what screening that they do. If you have a family history of breast cancer, then that would be something to coordinate with your doctor to get a screening done earlier. They usually recommend doing screening before 40, uh, it may be an MRI and mammogram alternating every six months starting at the age of 25 30. It just kind of depends on when your family member had breast cancer and what genetic mutation it is that you have. So I've had my screening mammogram and I got called back in for more images, do I have cancer? So not necessarily, this is something we actually deal with quite a lot. It really kind of depends on your age and your breast tissue density. It can be really hard to evaluate the breast tissue on a screening mammogram. If you have really dense breast tissue, there's actually, uh, States that have a requirement when they report on your mammogram, that they disclose to you that there are certain regions, depending on the density of your breasts, that they may not be able to see.
Speaker 2:
So they have to give you that information because then if you end up having breast cancer, but you've, you've had a screening mammogram, you know, why wasn't it caught well, and it, it can just really depend on the density of your arrests. So sometimes you'll get a call that you need to come back in and it's for a more formal or what we call a diagnostic mammogram. The difference in that is with a screening mammogram, you kind of just, you go into a facility, they do the mammogram and you go home. And in a couple of days, they either call you with the results or you go into your doctor's office and they give you the results, a diagnostic mammogram, you go into a facility, but the radiologist is, is physically there. And when they do the mammogram, they try and focus on that area that was questionable in your screening mammogram.
Speaker 2:
And so the radiologist can actually look at it in real-time and determine, okay, well, we need a different view here, or we need to zoom in here and take a better look at that so that you don't get called back in for even more. This is, I'm a little bit better idea of, of what they're looking at. And if it, if it is something that looks suspicious for cancer or not, some patients may actually end up needing an ultrasound to go with their mammogram or an MRI. It's all pretty personalized. So it all just depends on what your breast tissue looks like and what, what exactly it is, that's going on, what was seen, or if you're having symptoms and things like that. So it could just be that you have dense breast tissue, and it does not look abnormal when they do the more focused imaging, or could be something that, that is concerning for breast cancer. But being called back does not mean that you have cancer. You could, but they just need to get better pictures. Yeah.
Speaker 1:
Since so, after I got called in my mammogram showed an area concerning for breast cancer and I need a biopsy. Can you explain what that is?
Speaker 2:
Yeah. So when you need a biopsy, it doesn't necessarily mean that it's cancer again. So, so don't panic, but chances are, they saw something that are concerning and suspicious for cancer, and chances are it is, but I need a tissue sample to say for sure what it is. There's different types of breast cancer, there's DCIS, which maybe you've heard of, or there's invasive cancers by doing the biopsy. It gives you a little sample of tissue to be able to determine what type of cancer it is, what hormone receptors it has if it has any. And, and that helps you tailor your treatment, not only for surgery, but if you need chemo or other things, or even additional surgery, when you meet a bias, it can be done a couple of ways, the most common way, or at least the way that I'm used to it being done from when I was in residency is if you have a mask that can be felt if you came in because you had an that you found and you get a mammogram and they, they say, we need to biopsy.
Speaker 2:
If they can see it, then you can get a biopsy done with an ultrasound and you don't have to go through a mammogram again. If you can't see it on an ultrasound, then you got to get a mammogram again. So not, not super fun for everybody when they do it with under a mammogram, it's done by a radiologist typically, and it's called a stereotactic biopsy. So essentially you lay down on this table and you lay face down and there's, there's a little opening in the table. And the breast with the concerning area goes through this little hole in the table and kind of hangs blue so that the arm on this machine can get in the right position and orientation to access the delusion that the arm on the mammogram machine has a needle on it. And once the area is targeted, the needle goes in, they take a sample of the breast tissue that comes out, but there's also a clip that gets placed in the area that they biopsied.
Speaker 2:
So that on later imaging, you can say, okay, well, we already biopsy this area and everything was normal. Or this is where they had a biopsy before we don't see anything different. Or, you know, now there's something there that, that wasn't there before. And we need to re-investigate it. Sometimes you can't do the stereotactic biopsy and that's for reasons, you know, maybe you can't lay flat, maybe it's too uncomfortable, or you can't breathe. There are weight limitations. And depending on your age, I mean, it may just not be something that you're very capable of laying there because it's not, it's not a five-minute procedure. I mean, it's a 20-minute procedure or so. And it depends on where the lesion is. If it's really close to your chest wall, like the muscles underneath your breasts, they don't usually do the stereotactic biopsy. They can still do a biopsy under a mammogram. It's just done a little bit differently. This is all kind of targeted and oriented and one process. Whereas if they have to do it with, without the stereotactic part, it's done a little bit differently. Now there are some stereotactic biopsy machines where you can actually sit up. I don't know how many places have those. Like I don't, I'm not real familiar with how prevalent they are, but they do exist. So that maybe something that they could do.
Speaker 1:
Thank you so much, Dr. Coleman. I know it's a really hard topic to talk about. Cancer is always something that's a pretty scary word. I appreciate you joining us for Talk Tuesdays and telling us what we need to know about breast cancer screening for everyone else. This has been Talk Tuesdays with My Virtual Physician. You can schedule a consultation with one of our doctors by visiting our website: www.myvirtualphysician.com. We look forward to seeing you again, and we hope you have a great week.
Speaker 1 :
Information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not a diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics addressed on Talk Tuesdays or for any other medical things.
Speaker 1: The information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics address on talk Tuesdays or for any other medical problem.
Speaker 2: Welcome to Talk Tuesdays brought to you by my virtual physician, a direct to consumer multi-specialty telemedicine company that operates in multiple States.
Speaker 1: Thank you for joining us today. My name is Stephanie and I'm part of the team here at my virtual physician. We are a direct to consumer multi-specialty telemedicine provider operating in multiple States. It's taught Tuesday and we are continuing our weekly educational series to talk with experts, explore some common healthcare concerns that we see and hopefully answer some questions you may have today. Our physician expert is Dr. Ginger Coleman. She is a general surgeon and she's going to talk to us about peptic ulcers and what we need to know about them. So Dr. Coleman, thank you for joining us. Thank you for having me. Yeah. So can you start by explaining what is a peptic
Speaker 3: Or gastric ulcer? Yeah, so, um, the word peptic really just sort of means that it's in your digestive tract. So there's, there's two types of ulcers. Um, you can have gastric ulcers or do a Denal ulcers, um, that are in the first part of your small intestine that's connected to your stomach. Um, so peptic sort of encompasses both of those, um, entities. The gastric ulcers are probably the most common, um, and essentially what an ulcer is, is a little tear or break in the lining of your stomach or your small intestine. Um, those, your stomach has a barrier sort of like a mucus barrier that protects it from all of the coffee and other caustic things that you probably consume on a daily basis. And when you get a little tear, um, that you guess is supposed to kind of help protect it and heal, um, when that barrier fails is when you get an ulcer.
Speaker 3: Um, and there's, there's a couple of things that are related to those and can cause them, but essentially it's, it's just a failure of that protective barrier of your stomach and creates this little hole. Okay. So how do you, how does it happen? Why do people get them, um, the most common, um, cause of these that, that we really know about is actually a bacteria called H pylori that's Helicobacter, pylori, um, and it's a little, uh, bacteria that, that actually damages the lining of your stomach and also keeps that mucosal barrier, um, from healing. So it, it kind of just keeps perpetuating this, uh, ulcer. You can get rid of the bacteria and it should heal the ulcer. There are some other things that can cause it things like smoking, drinking, alcohol, um, caffeine, um, even stress, uh, patients that are in the hospital, maybe intubated, you know, on a ventilator or, um, have really severe burns.
Speaker 3: They can get different types of ulcers, but it's the same underlying process. It's, it's decreased blood flow to the area and it, and it damages that you co-sell lining. Okay. How would I know if I had it, the symptoms of an ulcer, some for some people they're pretty vague for a lot of people, they it's just, you have this abdominal pain, it's kind of this gnawing burning upper abdominal pain. Uh, a lot of times you can relate it to when you eat. Um, sometimes it'll hurt when you eat just shortly thereafter, maybe about 30 minutes. And sometimes it'll, it'll take a couple hours. Um, sometimes it feels better when you eat. So those kind of, um, help you differentiate whether it's in your stomach or in your small intestine, but it's not very specific. Um, but it is something to take note of, if you, if you realize that that's what's happening, some people will feel bloated, you can have nausea.
Speaker 3: Um, but most commonly what sends people to, uh, see a doctor is the pain. There may be some aspect of, you know, heartburn or reflux, but, but usually it's just that severe gnawing pain. Yeah. And so can also cause more serious damage or is it just painful? They can, um, they can cause a lot more damage actually. Um, as a surgeon, that's something that we see come through the ER from time to time, um, where you have an ulcer that gets so severe that it essentially erodes all the way through the stomach. And so it, it perforates, um, yeah, it's not very fun for anyone. Um, so it, it actually just sort of ruptures, it opens up whether it's the small intestine or the, or the stomach. Um, and so you get all of those gastric acids and juices sort of flowing through your entire abdomen.
Speaker 3: It can make you very sick. The ulcer can also erode into a blood vessel. So sometimes people will come in bleeding from these ulcers because it's eroded into a vessel that's in the area. Um, so they can be pretty severe and it is something worth, worth seeing a doctor for if you're experiencing some abdominal pain like that. Yeah. And how do you treat them? So predominantly no one will ever see a surgeon for a gastric ulcer. Hopefully, hopefully that is the case. They're, they're pretty much managed with, um, proton pump inhibitors or PPIs that you may have heard Nexium, Omeprazole, things like that. Um, and so it may not be something that you need long-term depending on sort of what caused the ulcer, but most of the time people stay on them for, for a long time. Initially you want to treat it for about six weeks with the proton pump inhibitor.
Speaker 3: There are some other medications you can give that kind of help coat the stomach, the lining of the stomach, and to relieve some of the pain of the ulcer, but also try and help protect that barrier. Um, you can treat the ulcer with medication and if it gets better than you can kind of assume that it's an ulcer, you don't necessarily have to see it to prove it. It's just sort of based on symptoms and ruling out other things. Um, but to definitively diagnose it and treat it, um, you need an endoscopy, which is where they put a camera in your mouth and go and look in your stomach and they can see where it is in the stomach. They can see if you have one, maybe it's just gastritis, which is just, you know, sort of diffuse irritation of your stomach. Um, when they do an endoscopy, they would look at where the ulcer is, how big it is and take biopsies of it to make sure that there's not any, uh, risk of cancer.
Speaker 3: Some of these can, can Harbor underlying malignancy. So, so that is important, but you don't have to do the endoscopy initially. Um, it's purely medical treatment. If it doesn't get better or you have recurrent ulcers that, that don't seem to go away. Um, if it's related to some other, um, diseases where you're prone to getting ulcers, um, that's when you may see a surgeon and may need an operation to remove that acid part, that asset to creating part of your stomach. Um, but usually it's just medicine. Yeah. And, um, but is there a way to treat it at home like yourself versus medicine?
Speaker 1: Do you cut back on caffeine or alcohol or that,
Speaker 3: So you can with it being affiliated, I mean, there's no proof per se, that caffeine causes ulcers may make it worse. Um, nicotine or tobacco smoking that all decreases the blood supply to well, to everything, but especially your stomach. So, so it gets less blood flow, which will make it worse. Um, alcohol can irritate it, it can make the pain worse. It also sort of affects that mucosal barrier. So taking medications like ibuprofen, Aleve, Naproxen, Motrin, anything like that, those are, those are big time medications that are associated with gastric ulcers. If you can stop them, you should stop them. Now, some people aren't able to just for other underlying conditions, but those are a big player in the development and recurrence of gastric ulcers. So stopping those nicotine caffeine, alcohol, all of those things may not cure it, but they can help at least decrease the pain and maybe prevent further injury or worsening of the ulcer.
Speaker 1: Awesome. What are some symptoms that someone would have if they need to seek medical attention immediately for a stomach ulcer?
Speaker 3: Yeah. So if you know, you have one and you're maybe already taking medication, maybe not either way, if you, if you know that you have a cynical, certain use, you experienced or pretty sudden onset of severe sharp pain in your abdomen, that that doesn't get better, that doesn't go away. That actually gets worse with moving and you, and you start to have a fever or things like that. You need to go to the emergency room. Um, other things would include vomiting, blood, or sort of what they call coffee ground emesis. It kind of actually looks like coffee grounds in cycled blood. Um, that's a concerning sign, uh, and then any darker, bloody stools that would be a sign of bleeding that's concerning that, that the ulcer may be involving a blood vessel. Okay.
Speaker 1: Well, thank you, Dr. Coleman, you have shared some really great information today and answered questions that I think many Americans have on their minds. I appreciate you joining us for Talk Tuesday and telling us what we need to know about ulcers and how to treat them when to seek attention, all of that. So for everyone else, joining us as well, this has been talked Tuesdays with my virtual. If you would like to schedule a consultation or find out more information, you can check out our website at www.myvirtualphysician.com. We look forward to seeing you again, and we hope you have a great week.
Speaker 1: The information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics address on Talk Tuesdays or for any other medical problem.
This week on Talk Tuesdays from my Virtual Physician, we have Dr. Daniel Kessler, a Family Practice Doctor.Before a manufacturer can introduce a new drug to the public, a lot of money goes into the research, development, testing, and marketing. Companies can patent their new medications, and are guaranteed exclusivity to make and sell them for five years. This allows manufacturers to recoup some of the cost associated with getting their new brand name drugs to market. After that time, the patent expires. This means other companies can come along and make and sell the same medication under a different name. This “copy-cat” medication is considered a generic medication.
In many ways a generic medication is like the brand name version. To be approved as a generic drug, the pharmacologic characteristics must be the same as the brand name. Generic medications are the same as the brand name when it comes to:dosages and strengthintended useeffects and side effectsroute of administration active ingredientsBy contrast, generic medications can be approved with different inactive ingredients. So different colors, additives, and fillers may be used to help with binding, flavoring, coloring, transporting, or preserving. That means that your generic medication will likely look different. Trademark laws in the U.S. prevent manufacturers from creating a generic that looks exactly like the brand name. The Federal Drug Administration (FDA) regulates generic drugs that are approved for sale in the United States. It provides a process that ensures the medications are safe, effective, and of sufficient quality. Keep in mind that the FDA also investigates complaints about generic and brand name medications including side effects. They can issue a recall any time there is a concern for safety. There are always risks and benefits associated with any medication. Everybody is different and some more sensitive to differences in the drugs.Because the inactive ingredients are not identical, some individuals may experience differences when taking a generic medication vs, a brand name, but this is not always the case. There have been reports of medications affecting patients differently. For instance, when they feel the onset of effects, how long the medication effects last, and even incidence of side effects. It is important to talk to your physician if you are concerned about a generic medication affecting you differently. Generic medications often cost substantially less than the brand name. Again, the company making the generic medication did not have to pass along the cost associated with getting a new drug to market. When a patient is going to be on a drug long term or even for a lifetime, choosing a generic medication can save thousands of dollars a year in medical expenses. Lower cost may mean better compliance for some patients.
The savings to the individual are important but it doesn’t stop there. When multiple manufacturers are able to make and sell a medication the competition can drive the cost down and makes healthcare more affordable for the public. Generic medications save our healthcare system millions of dollars every year. To learn more, schedule a consultation today!
A cyst is a membranous sac or pocket. Cysts form in many places in the body. The term ovarian cyst refers to a cyst that has formed in or on one of the ovaries. Most ovarian cysts are small and harmless. In fact, they commonly occur in regular menstrual periods. A corpus luteum cyst or a follicle cyst may form each month on the ovary when the egg is released. These are called functional cysts. These normally shrink on their own in about 1 to 3 months. Pregnancy can cause a cyst to form. In early pregnancy, a cyst can form to help support the pregnancy as the placenta is forming. Occasionally, this cyst stays on the ovary until later in the pregnancy and may require removal. Ovarian cysts that continue to grow during pregnancy may twist or could cause problems during childbirth.
Ovarian cysts should be checked out by a healthcare provider if you are having symptoms and suspect that is what is going on. Pain or discomfort from an ovarian cyst could feel sharp or dull, and it could come and go. If a cyst breaks open (ruptures) it could cause sudden, severe pain. Also, if a large cyst breaks open it could cause heavy bleeding. If a cyst causes an ovary to twist it may also cause nausea and vomiting. Less common symptoms include Pain during or after sex, discomfort during exercise, unexplained weight gain, pelvic pain, dull low backache, or leg pain, painful periods, unusual vaginal bleeding, breast tenderness, bowel or bladder problems. It is important to talk to your physician if you are concerned about these symptoms. In about 5-10% of cases, an ovarian cyst may require surgical removal. This may be necessary if your cyst does not go away, grows larger, or causes pain. Follow us on Spotify to learn more!
On this Talk Tuesday, we are focusing on Postpartum Depression.
If you are suffering from Postpartum Depression, connect with us, and make an appointment with one of our Board Certified Doctors today! And if you like what you hear, make sure to follow us on Spotify. We upload a new podcast every Tuesday!
