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Sexually transmitted diseases (STDs), also called sexually transmitted infections (STIs), are very common, with around 25 million new diagnoses made yearly in the United States. Young people, ages 15-24 years of age, appear to be the most prevalent group to acquire and spread STDs, accounting for about half of newly diagnosed cases in 2018 per the Centers for Disease Control (CDC). Notably, 1 in 5 people in the United Stated have had an STD.
Oral, vaginal and anal sexual encounters are the methods of transmission and these infections vary greatly in their symptoms, severity, curability and prognosis. Treatment has improved over the years and some lifelong conditions now do not preclude a good quality of life. However, some of these diseases can be quite quiet in terms of initial symptoms, and screening tests, or tests to check if a disease is present even when symptoms are not, are a critical way to help reduce transmission and consequences of these infections.
Bacterial Vaginosis, not categorized itself as a sexually transmitted disease, is a condition named for alterations in the normal balance of bacteria in the vagina, which can lead to an increased risk for susceptibility to STDs, as well as preterm labor. A fishy odor may be noted after vaginal intercourse, and pain, itching and burning in this area or during urination, as well as thin, grey-white vaginal discharge, are among associated complaints. Although many cases of bacterial vaginosis clear on their own, antibiotic treatment may be needed at times. Currently, there is no recommendation for routine screening for BV.
Two of the most predominant, but easily treatable STDs, include chlamydia and gonorrhea. Both can spread through oral, vaginal or anal sex. Though either condition may be asymptomatic, some suspicious findings include abnormal vaginal or penile discharge, burning while urinating and pain or swelling of the testicles. Chlamydia and gonorrhea can also reoccur if infectious sex continues, despite prior treatment. Also, having these infections increases a woman’s risk to develop pelvic inflammatory disease (PID), which is damage to the internal reproductive organs, making future fertility a challenge. If infected during pregnancy, risk for miscarriage, preterm labor, low birth weight or an infection in the fluid surrounding the fetus, called chorioamnionitis, increases. Newborns of untreated mothers may also suffer postnatal complications such as eye infections and pneumonia. Pregnant women < 25 years of age, or older pregnant women at increased risk of exposure to gonorrhea or chlamydia, are typically screened at their first prenatal visit. Similarly, it is recommended to screen all sexually active women < 25 years of age, yearly, for gonorrhea and chlamydia, and older women who have multiple sexual partners. All sexually active gay or bisexual men, should also be screened at least yearly, but more often depending on frequency of new sexual encounters/multiple partners. Testing for these diseases can be as simple as a urine sample ordered by a virtual physician, however it is prudent to discuss symptoms and history to determine the best course of screening.
According to the CDC, every 1 out of 6 people in the United States has herpes simplex virus (HSV) infection, oftentimes without knowing it. HSV can be divided into HSV 1, more commonly known as oral herpes, and HSV 2, known as genital herpes. Although designated as such, either can occur orally or genitally. Many people are infected with HSV 1 in their childhood, through non sexual mediated contact with infected saliva. Oral herpes results in cold sores or fever blisters, around the lip and mouth area. Genital herpes, likewise, can demonstrate sores throughout the genital region of infected individuals. Lack of active sores however does not negate infectious activity and the disease can still spread through unprotected oral, vaginal and anal routes. There is no curative treatment for HSV and the virus can go into a dormant phase where no symptoms occur for years, though patients are at risk for recurrent outbreaks, where an antiviral medication may be prescribed. Devastating effects can occur if left untreated during pregnancy, including life-threatening infection to the newborn. If there is history of infection or active infection at the time of labor, a Cesarean section may be indicated. The United States Preventive Services Task Force does not recommend routine screening for HSV in asymptomatic sexually active adolescents or adults, including pregnant women.
Syphilis is a bacterial infection spread through sexual contact, and is divided into distinct phases, first beginning as painless mouth/oral, genital or anal sore(s) several days to several months after initial exposure. This sore or sores will resolve after a few weeks, even without medication. Then a body rash develops, sometimes with swollen lymph nodes, general fatigue and a fever, later. There can be a long period of “latency”, or no symptoms, followed by the last stage classified by neurological, ocular and cardiac symptoms. This is a curable condition, but can cause life-long consequences if untreated, including dementia and blindness, and can lead to death. Screening is indicated for sexually active individuals on a yearly basis, but more often such as every 3-6 months for high risk features, such as multiple partners. This can be performed through a blood test, which may be ordered through a virtual physician’s visit.
Although there are other methods of transmission, typically hepatitis B may be acquired through the sexually transmitted routes mentioned above. Hepatitis C is less commonly sexually transmitted, but spreads through exposure of infected blood, such as in activities like sharing needles in illicit IV drug abuse. Both conditions, though incited by different viruses, have the same impact on the liver and symptoms can overlap, with fever, fatigue, yellowing of the eyes and skin, abdominal pain and changes in urine color. With the exception of individuals living in extremely low prevalence areas, it is recommended that hepatitis C screening be given to a person at least once after the age of 18 years. Additionally, although hepatitis B is a vaccine preventable illness, the USPSTF recommends screening by blood test, those individuals at high risk such as those who inject drugs or share needles, men who have sex with men and immunocompromised patients, such as those with HIV, as well as those living in areas with a 2% or higher prevalence of the hepatitis B surface antigen, regardless of vaccination status. This is especially important given that hepatitis B is a chronic illness that will need lifelong treatment and both viruses present a higher susceptibility to liver cancer.
HIV, or human immunodeficiency virus, eventually progresses to acquired immunodeficiency syndrome (AIDS). Fortunately, through screening and early detection, appropriate prophylactic and supportive agents can be provided to help maintain CD4 counts and stable immune status in order to prevent, or at least slow, this advancement. It is generally recommended that adolescents beginning at 13 years, through adulthood, into the 60s, be screened via blood test, at least once as part of routine health maintenance. For those in higher risk categories, such as individuals with multiple sexual partners, men who have sex with men and those who share needles, screening may be advised yearly or with more frequent intervals depending on individual circumstances. Once again, this is a blood test that may be ordered through a virtual doctor visit.
While prevention of any illness is optimal through regular visits with a physician, screening tests have proven to be useful in early detection of otherwise asymptomatic diseases, allowing for quicker treatment. In particular, sexually transmitted diseases are relatively easy to screen for through blood or urine samples. If you have questions or concerns regarding your need to be screened for these conditions, it is quite simple to schedule a virtual visit with one of our physicians at My Virtual Physician, and we can help determine which testing is right for you. In addition, depending on the results, oftentimes follow up guidance or medication can also be provided! Schedule a visit today!
Half of adults over the age of 50 are at risk for broken bones. Maintaining healthy bones is important for a long healthy life.
Osteoporosis (OP) is a condition of weakened bones. Thin bones are at risk for fractures. OP screening can be an important part of staying healthy. Early disease detection and treatment may prevent complications later. Broken bones are painful and costly. Luckily, screening tests like the Dual-Energy Xray Absorptiometry (DEXA) scan alert doctors of problems early.
DEXA scans or other OP screening tests are advised for some at-risk groups. To find out if you should be concerned about bone testing today, read on.
OP is more common in adults than you may believe. One health department called it a major public health threat.
OP screening may prevent:
People with OP may not know anything is wrong until they suffer an injury. With advanced bone disease, normal activities can cause bones to break. Studies have shown that many patients do not get the right treatment for low bone density (LBD) despite the great prevalence, complications, and costs of fractures related to bone disease.
Therefore screening tests for bone loss are important to your health. Doctors or specialists can diagnose problems with weak bones before they become serious.
OP affects one-in-three women above 50 years old. It is also a serious condition for men.
It is best to talk to a doctor about when to get a screening test. They can explain the test and treatment options. Physicians will also answer questions about what to expect.
Currently, we have a few recommendations for OP screening.
The NOF advises a DEXA scan of the hip and spine for:
Also, they also encourage testing in those with:
The ISCD has similar guidelines. They recommend DEXA scan of the hip and spine for the same groups above, but also in:
AACE recommends a DEXA scan for
The AACE says that the lumbar spine and proximal femur are the best sites for testing.
The USPSTF recommends screening for OP in women 65 years or older. Also in younger women with certain risk factors. At this time the USPSTF does not have a recommendation for men.
ACOG currently urges screening for women 65 or older and those under age 65 with risk factors for fracture. They also say physicians should screen patients using the FRAX tool to define their risk of a major fracture.
The FRAX® tool evaluates fracture risk in patients. Based on the score, a 9.3% or higher risk should be referred for a DEXA scan.
The DEXA scan is a quick and reliable test for measuring bone mineral density (BMD). It aids in the diagnosis of OP.
The scan usually takes around 15 minutes. And it doesn't hurt. First, the patient lies down on an open table.
Next, a scanner passes over the body. It sends two X-ray beams. And the machine tells how the rays pass through the bones. This shows how thick or thin they are. The results give the doctor a good idea of how healthy the bones are.
Like other medical tests, a DEXA scan is ordered by a healthcare professional. Typically, doctors or specialists can write a prescription or send a referral. Virtual doctors and online physicians can also arrange this test for their patients.
OP screening may be a part of your yearly check-up. Or it can be used to check on certain risk factors.
Thanks to telemedicine, it is now fairly easy to get this important test. An online doctor can tell you about OP screening and answer your questions. Online appointments are convent. Patients meet doctors from wherever they are, on a mobile device or smartphone.
My Virtual Physician offers screening consultations at little or no out-of-pocket cost. They can order blood tests, imaging or scans, X-rays, and more. And in some cases, same-day appointments are available.
Many screening tests are covered by health insurance or medical benefits. Check with your insurance to see if any out-of-pocket payment is required. Medicare pays for bone density testing every two years for adults over 65 with some risk factors.
My Virtual Physician offers full preventive care services for men and women. To talk with one of the top physicians, click to book an appointment now. The MVP caring experts help patients with screening plans that are tailored to their healthcare needs.
If you have ideas for other topics you want to read about, let us know! Don’t forget to follow us on social media.
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This past year tested many young businesses. Telemedicine is not new. But the My Virtual Physician (MVP) business model is. The virtual doctor practice offers the best in online doctor services as a direct-to-consumer multi-specialty provider licensed in multiple states. Regardless of 2020's challenges, the MVP virtual doctor team didn't slow down. They focused on their path to becoming the #1 online doctor and forged ahead.
Over the last 12 months, MVP worked hard to bring high-quality medical care into homes in 15 states. They now offer online pediatric, gynecologic, and primary healthcare services for patients of all ages. Plus, they provide same-day scheduling for online physician appointments, some in-network insurance benefits, and five-star customer service.
As the #1 online healthcare provider, MVP doctors get to know their patients. Quality care is emphasized, and they aim to provide the best patient satisfaction in telemedicine. Here’s what patients are saying about MVP's online doctors:
“I would give My Virtual Physician more stars if I could”
“Dr. Howard has the best personality and is very friendly.”
“The future of medical visits; what better way to social distance.”
“A+ would recommend to everyone.”
Since their launch, MVP has opened new offices and added service lines such as nutrition and diabetic care. The practice has partnered with more online doctors and added office staff. Just this Spring, MVP enhanced their patient portal for self-scheduling, and integrated a program to trend patient reviews.
This one year anniversary milestone is cause for celebration. It is exciting, and this is only the beginning. Despite any challenges that lie ahead for this medical practice, their progress shows that the future is very bright for My Virtual Physician.
Congratulations to Dr. Howard, Dr. Masghati, Dr. Ayyagari, and all of the My Virtual Physician Staff.
Meet Dr. Aravinda Ayyagari! We are ecstatic she has joined our My Virtual Physician practice.
She is a board-certified pediatrician with almost 20 years of experience. She serves on several hospital committees and enjoys volunteering her time in different settings ranging from the local school to the board of Easter Seals, and even traveling to El Paso, TX as a volunteer physician at a migrant center. She also serves as the state of Delaware CATCH grant coordinator to increase children’s access to healthcare services.
In her free time, she enjoys traveling, cooking, exercising, and spending time with friends. She loves hiking with her husband and two children in various destinations both domestically and internationally - covering Asia to South America. As a family, they have been amazed at how people are much more alike than different. They are looking forward to their next adventure!
Dr. Ayyagari speaks Spanish and some Telugu. She enjoys caring for patients of different cultural backgrounds.
Most recently, she started Bridge Care Pediatrics, a direct primary care which provides all pediatric and newborn housecalls. www.bridgecarepeds.com
Menopause is manageable. If you or someone you know is going through this stage of life, you may be wondering how to manage menopause.
Menopause is a natural process that many people associate with uncomfortable symptoms. Many women report mood swings, hot flashes, night sweats, and weight gain. Despite the unpredictability, menopause is manageable. With a basic understanding and simple lifestyle choices, women can thrive during this time.
How do you manage some of the common complaints? Well, it helps to start with a grasp on what causes this change.
Menopause is a time in a woman’s life when the menstrual cycle stops. During this period, the ovaries produce less of a hormone called estrogen. Changing hormonal levels affect many body processes.
Three phases make up the process of menopause:
Premenopause (“pre” means "before"): years before periods stop, estrogen levels decrease and periods may become irregular
Perimenopause (“peri” means "around"): the ovaries lower estrogen production, and periods stop; when a woman has not bled in 12 months, she has reached menopause
Postmenopause (“post” means "after"): after menopause, symptoms become milder and less frequent
Menopause generally affects women in their 40’s or 50’s. Studies show that the onset age of menopause is affected by many factors, including genetics (age the mother began menopause), the number of pregnancies a woman has had, body mass index (BMI), physical activity, and other factors. The average age for menopause in the United States is 52.
Symptoms may last during the postmenopausal time for up to four or five years, but they will become lighter.
Menopause varies among women. Yet, many report some common symptoms.
Empowering women with understanding about the natural process, and recommending lifestyle changes known to improve signs and symptoms, helps patients and their doctors manage menopause.
So, below you will find details about what causes these common complaints, and ways to manage them.
Mood swings happen with menopause because of changing hormone levels. Estrogen decreases during menopause. This important hormone relates to production and regulation of other key hormones such as serotonin, dopamine, and norepinephrine.
Serotonin is a mood-stabilizing hormone. Thus, fluctuating estrogen levels can lead to a disruption in serotonin production.
In other words, women in perimenopause may notice that they feel more emotional, sensitive, anxious, or worried.
To reduce or prevent mood swings, women should practice healthy habits, including:
Doctors believe that night sweats and hot flashes occur during menopause because of hormones. Estrogen and progesterone hormones help to regulate body temperature. During the natural process of menopause, when hormone levels change, many women find that they experience periods of feeling very hot to the point of sweating, even though their environment has not changed. Night sweats are episodes that occur while sleeping.
Hot flashes vary from seconds to minutes. They may happen once a day or 20 times in a day. Some women never experience them at all.
To deal with hot flashes, women could:
Weight gain is another common complaint of menopause. And it happens because, you guessed it, hormone changes. Estrogen plays an essential role in regulating fat storage. As estrogen levels go down during menopause, there are changes in the way the body stores fat. Also, for many women in their 40’s and 50’s, activity levels decrease, and metabolism slows. This triple whammy makes weight gain probable.
To prevent menopausal weight gain, women might consider:
Menopause symptoms generally become less intense and less frequent as time goes on. Some women may experience few or none at all. Yet, if you feel like your symptoms are severe or disrupt your life, you should talk to your doctor. There are other medical treatments, such as medications or hormone replacement therapies, available.
To talk with one of our board-certified physicians, click below to schedule an appointment. My Virtual Physician offers comprehensive OB/GYN services to address women’s healthcare needs. Our caring experts can treat menopausal signs and symptoms. If you have suggestions for other topics you want to read about, let us know! Don’t forget to follow us on social media.
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.
In 2018, about 10.5% of Americans were estimated to have diabetes. Furthermore, about one-fifth of those cases were undiagnosed. It is important that individuals know their risk, and talk to their doctor about screening when it comes to diabetes. So, why is early detection key in diabetes?
Early detection is key in diabetes because early treatment can prevent serious complications. When a problem with blood sugar is found, doctors and patients can take steps to prevent permanent damage to the heart, kidneys, eyes, nerves, blood vessels, and other vital organs.
With simple tests for early detection, patients can make changes to reverse diabetes and even go into remission. Read on to learn more.
Diabetic care often focuses on treatment of the condition. While treatment is important, early detection increases the potential for effective changes early in the disease process.
An article in the Current Opinion in Endocrinology, Diabetes and Obesity journal recognizes that there are many reasons why earlier detection of diabetes could be of benefit to the individual and the health system, because it creates the opportunity to treat the high blood sugar and the risk factors for heart disease that often show up with diabetes. Individuals who don't know that anything is wrong may suffer long-term effects such as cardiovascular disease and stroke.
Furthermore, undiagnosed diabetes often results in potentially preventable, costly complications. Hospital stays could be avoided if patients are aware of their illness and work to manage it.
Diabetes can be expensive. The estimated cost of living with diabetes is around $9,600 per year. This covers prescription medications, diabetic testing supplies, doctors appointments, and hospital care. Medical expenses rise drastically when emergency room visits are needed for unmanaged diabetic complications.
Diabetes is a disease in which your body is not able to efficiently turn the food you eat into energy. Sugar then builds up in the bloodstream. Therefore, two problems arise: the cells are not getting the energy they need, and sugar is accumulating in the blood. High blood sugar, known as hyperglycemia, causes damage to tissues and organs of the body. That is to say, this is why diabetes is a serious condition that can be dangerous.
Normally when you eat, your body breaks food down into sugar molecules, called glucose. After that, the particles get into the bloodstream and your blood glucose level rises, signaling the pancreas to release 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. As a result, 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.
A blood test can determine if a person has diabetes. Doctors commonly use two tests to check for diabetes.
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 way a provider can use a blood test to see if you have 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). The doctor may repeat the fasting blood sugar test or order additional tests to confirm an abnormal blood sugar reading.
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 go into a remission 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.
Diabetes is a global health problem. Health officials expect that rates will only continue to increase. Risk factors such as family history of diabetes, obesity, and sedentary lifestyle increase likelihood that you may get diabetes and so it is important to be proactive in your health and talk to your doctor about your risk for diabetes. .
If you would like more information on diabetic screening, or want to talk about your risk with one of our board-certified physicians, click to schedule an appointment. My Virtual Physician treats conditions including hyperglycemia, diabetic screening, counseling and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our podcasts for more and follow us on social media.
Colagiuri, Stephen; Davies, Daniel The value of early detection of type 2 diabetes, Current Opinion in Endocrinology, Diabetes and Obesity: April 2009 - Volume 16 - Issue 2 - p 95-99 https://doi: 10.1097/MED.0b013e328329302f
Harris, M. I., & Eastman, R. C. (2000). Early detection of undiagnosed diabetes mellitus: a US perspective. Diabetes/metabolism research and reviews, 16(4), 230–236. https://doi.org/10.1002/1520-7560(2000)9999:9999<::aid-dmrr122>3.0.co;2-w
Narayan, K. M., Chan, J., & Mohan, V. (2011). Early identification of type 2 diabetes: policy should be aligned with health systems strengthening. Diabetes care, 34(1), 244–246. https://doi.org/10.2337/dc10-1952
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. [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.
It affects up to one in five adults, and it is a common ailment diagnosed by primary care physicians and specialists. Moreover, it can be a real pain in the neck, or chest rather. I'm talking about gastroesophageal reflux. This big word does not have to be a big deal. Simple lifestyle changes and, in some cases, medication can treat it. So just what is gastroesophageal reflux?
Gastroesophageal reflux is the backflow of acid and other contents from your stomach into the tube the connects the stomach to your mouth, called the esophagus. This reflux can occur naturally on occasion, but when it happens frequently, it can cause problems.
When the backwash of acid and undigested food particles flows back out of the stomach, it can damage the lining of the esophagus. You see, the stomach has a protective lining inside that protects the underlying tissues from the strong stomach acid and other substances that you may eat. Unfortunately, the esophagus does not have that same protection. The harsh back-flow can eat away the esophagus' smooth muscle tissue.
There is a valve at the bottom of your esophagus where it connects to the stomach. It is called the lower esophageal sphincter, or LES. This LES closes after food enters the stomach to prevent it from coming back up. Additionally, your diaphragm is a muscle above the stomach that also helps to support the valve. Sometimes the sphincter relaxes, and stomach contents can escape.
Normal reflux can occur after meals and does not last long. This event rarely occurs when lying down or during sleep.
Abnormal reflux lasts longer and causes troublesome symptoms. Many report feeling discomfort at night when they lay down, rather than just after meals. Chronic reflux causes damage to the digestive system tissues.
If you suspect that you have abnormal reflux or gastroesophageal reflux disease, read on to learn what you can do about it and where to find a quiz to see if you might have reflux.
Gastroesophageal reflux disease (GERD) is caused by the reflux of stomach acid and contents into the esophagus. This condition is related to several factors:
Proton pumps in the stomach wall create enzymes which make stomach acid to break down the food we eat. When they overproduce, reflux is more likely to occur. Coffee is known to increase stomach acid production. Stress also increases stomach acid production. Therefore these can be risk factors for GERD.
The lower esophageal sphincter (LES) closes off the bottom of the esophagus to prevent back-splash. When the muscle tone is relaxed, then the door is not fully closed, and juices can seep back out of the stomach. Smoking and drinking alcohol and caffeinated beverages both contribute to decreased LES tone. These are also risk factors for GERD.
Furthermore, chocolate and mint are known to relax the lower esophageal sphincter.
Moreover, pregnant women have increased progesterone levels. This hormone affects the LES as well.
Two factors that cause increased intra-abdominal pressure are obesity and pregnancy. These both put pressure on the abdominal organs and can lead to gastroesophageal reflux.
An article published in the Gastroenterology Clinics of North America found that obesity, defined as a BMI > 30, was a significant risk factor for reflux and esophagitis (inflammation of the esophagus). The study showed that over one-fourth of participants had weekly reflux symptoms.
A recent study on GERD in pregnancy showed that over 50% of women report reflux symptoms while they are expecting. This can be related to hormonal changes in pregnancy slow digestion and delay stomach emptying.
Reflux can be aggravating and cause symptoms such as:
Less likely but possible signs and symptoms include:
Knowing what we know about reflux and how it happens, there are some simple lifestyle changes you can make if you are suffering from GERD signs and symptoms.
Choose small proportions. Avoid high-fat meals because the fats require the stomach to produce more acid and take longer to digest. Spicy foods (like tomatoes and oranges) can also aggravate reflux.
Maintain a healthy weight.
Sleep habits: Firstly, also avoid eating within three hours of bedtime. Do not lie down after eating. Give your body time to digest the meal.
It can also be helpful to raise your head while resting to let gravity keep the stomach contents down. You can use extra pillows or even raise the head of your bed six to eight inches with bed risers or blocks.
Avoid toxins that could be aggravating your digestion, such as nicotine, alcohol, or excessive caffeine]
Over the counter proton pump inhibitors (PPIs) decrease stomach acid production and may provide some relief. Available options include:
Warning: Do not take these for more than 14 days without talking to your doctor.
There are some urgent signs and symptoms that warrant immediate medical attention. You should call your doctor or seek urgent care for these:
Less serious signs and symptoms that could be related to reflux but should be checked out by a doctor include:
Now that you know what is gastroesophageal reflux, you can make an informed decision about when it is time to talk to your doctor. If you would like to see if you might be suffering from GERD, take this online quiz by the American College of Gastroenterology.
If you still have questions or you would like to discuss your problem with a top-rated doctor, click to schedule an appointment. My Virtual Physician treats conditions, including heartburn, upset stomach, and more. And if you have any suggestions for additional topics that you want to read about, please let us know! And don’t forget to check out our podcasts for more! Share and follow us on social media.
Chang, P., & Friedenberg, F. (2014). Obesity and GERD. Gastroenterology clinics of North America, 43(1), 161–173. https://doi.org/10.1016/j.gtc.2013.11.009
Ramya, R. S., Jayanthi, N., Alexander, P. C., Vijaya, S., & Jayanthi, V. (2014). Gastroesophageal reflux disease in pregnancy: a longitudinal study. Tropical gastroenterology: official journal of the Digestive Diseases Foundation, 35(3), 168–172.
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.
Perhaps you know the feeling, that dull gnawing pain in your stomach. It could be a peptic ulcer. But maybe you are unsure about when to you see a doctor. Here is some helpful information if you’ve found yourself wondering, just what are peptic ulcers?
Peptic ulcers are sores or blisters that develop in the lining of the esophagus, the stomach, or the intestine. They can occur when the body’s natural protective lining is worn away or stops functioning properly and the underlying tissue is damaged.
So why does this happen and what should you do about it? Read on to find out.
An ulcer is an open blister or a sore. The term “peptic ulcer” describes one of these lesions located in the lining of the digestive system, also known as the gastrointestinal (GI) system.
Doctors commonly refer to peptic ulcers according to where they are located:
A normal healthy digestive system is lined with a protective mucous barrier. This mucosal lining prevents harmful substances such as acidic beverages, medication ingredients, and even stomach secretions from damaging the tissues underneath. Sometimes, this physical barrier is compromised and part of the GI tract is irritated.
Peptic ulcers form when the body’s natural protective mucus lining is worn away or is not functioning correctly.
The most common cause is a bacterial infection by Helicobacter Pylori or commonly known as H. Pylori. This organism grows in the stomach lining causing irritation that can prevent it from healing. Ulcers related to H. Pylori infection are seen more commonly in developing nations, but are seen here in the U.S. as well.
Another leading cause of gastric ulcers is the use of non-steroidal anti-inflammatory medications, known as NSAIDs, because these contain ingredients known to irritate the stomach lining. Recent research has found that aspirin users are twice as likely to develop stomach ulcers.
Other risk factors for developing these ulcers are lifestyle factors such as drinking alcohol, smoking cigarettes, and physiologic stress. These can impair the body’s natural defense.
Some patients experience epigastric pain that is the classic sign of a GI ulcer. Many patients describe the discomfort as a dull, gnawing sensation or even a burning in your abdomen. Some individuals may also associate the onset of pain with eating a meal. Meanwhile, others report symptoms including nausea, feeling bloated, or not being able to eat a full meal.
A recent study in the American Journal of Medicine reports that as many as two-thirds of individuals with peptic ulcer disease may not even have any signs or symptoms.
An endoscopy test passes a camera through the GI tract to look for ulcers. This is the best way to diagnose a peptic ulcer.
Talk to your doctor if you think you might have a peptic ulcer. They can treat you and may recommend medications. The most effective treatment today is proton pump inhibitors or PPIs. Usually, they are taken just once in the morning, these are a relatively safe therapy and there are many available over the counter. For example, you may recognize names such as Nexium or Prilosec.
Your physician may also prescribe other drugs to treat your condition such as antibiotics for an infection. Additionally, they can also make recommendations to reduce symptoms.
If you have been diagnosed with an ulcer already then there are a few more signs to be alert for. Serious complications of peptic ulcers include gastrointestinal bleeding or even perforation or tearing of the lining. Signs of these would require urgent medical attention and are reasons to go to an emergency room:
Pain, the classic symptom associated with a stomach ulcer, may or may not be a peptic ulcer. This means that if you have abdominal pain that is bothering you, let your physician know about it. Then they will discuss your symptoms, as well as the best treatment for you.
If you still have questions or you would like to discuss your problem with a specialist click below to schedule an appointment. MyVirtualPhysician treats conditions including abdominal pain, upset stomach, and more. If you have any suggestions for additional topics you want to read about please let us know! Don’t forget to follow us on social media.
Kavitt, R. T., Lipowska, A. M., Anyane-Yeboa, A., & Gralnek, I. M. (2019). Diagnosis and Treatment of Peptic Ulcer Disease. The American journal of medicine, 132(4), 447–456. https://doi.org/10.1016/j.amjmed.2018.12.009
Lukáš M. (2018). Therapy for peptic ulcer disease. Terapie peptického vředu. Vnitrni lekarstvi, 64(6), 595–599.
Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic Ulcer Disease and Helicobacter pylori infection. Missouri medicine, 115(3), 219–224.
MedPage Today published an article stating the following:
1. Medicare is still seeing a high and leveling use of telehealth among medicare beneficiaries.
2. Although Medicare is going down the direction of permanently increasing access to Telemedicine, private payors are actually going in the opposite direction.
3. Confirms that people who adopted telemedicine during the shutdown, and liked it, are likely to make it a permanent part of the way they see their doctors moving forward.
To read the rest of the article, click here.
