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Lung cancer is the second most common cancer in the United States, just behind prostate cancer in men and breast cancer in women. Lung cancer also happens to be the most lethal cancer, accounting for approximately 25% of all cancer deaths. Each year, more men die of lung cancer than from colorectal, prostate, and pancreatic cancers combined, and more women die annually of lung cancer than from breast, cervical, and uterine cancers combined.
The main risk factor for lung cancer is cigarette smoking, associated with 85% of cases. Among smokers, the risk of lung cancer increases with number of cigarettes smoked and duration of smoking history. There is good news though: the risk of lung cancer will decrease with smoking cessation and may even approach that of the nonsmoking population after 10 to 15 years of tobacco abstinence. Meanwhile, associated risks of developing lung cancer from e-cigarettes are currently under investigation.
Each year in the U.S., up to 26,0000 lung cancer deaths occur in never smokers, with an even higher proportion in some geographic areas. This brings us to environmental risk factors of lung cancer, such as exposure to radon, a chemically inert gas from uranium decay, encountered by underground miners and less commonly, residentially, through indoor exposure in the home basement. Asbestos exposure can lead to a type of lung cancer called mesothelioma and can cause other types of lung cancer when combined with smoking.
Arsenic, chromium, nickel, air pollution, and second-hand smoke represent other occupational or environmental exposures associated with lung cancer risk. Patients with treated for breast cancer, Hodgkin and non-Hodgkin lymphomas with high doses of radiation to the chest have increased risk of lung cancer, especially if they smoke cigarettes. Family history is another predictor of increased risk. Other diseases associated with increased lung cancer risk include chronic obstructive pulmonary disease and restrictive lung diseases, including fibrotic disorders like pneumoconiosis.
Finally, there have been dietary associations with lung cancer. An increased risk has been found with diets deficient in vitamins A and C, but supplementation with beta-carotene has been associated with an increased risk (in heavy smokers, the highest-risk populations, in 2 of 3 clinical trials).
On the basis of findings from the NLST trial, screening for lung cancer with low-dose computed tomography (LDCT) scan is recommended for certain patients by the U.S. Preventive Services Task Force (USPSTF). See Table 1.
Table 1. USPSTF Recommendation Summary for Lung Cancer Screening
| Population | Recommendation |
| Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years | The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. |
Adults aged 50 to 80 years have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should screen for lung cancer with LDCT every year. A pack-year is a way of calculating how much a person has smoked in their lifetime. One pack-year is the equivalent of smoking an average of 20 cigarettes (1 pack) per day for a year. These recommendations are available at www.uspreventiveservicestaskforce.org.
If you would like to learn more and connect with a board-certified physician, click to book now on My Virtual Physician. My Virtual Physician offers comprehensive medical services where you can discuss the best screening plan for you with a virtual doctor.
References
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
Siegel RL, Miller KD, Jemal A: Cancer statistics, 2019. CA Cancer J Clin 69: 7-34, 2019. PMID: 30620402.
Jemal A, Thun MJ, Ries LA, et al: Annual Report to the Nation on the Status of Cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 100:1672-1694, 2008. PMID: 19033571.
Omenn GS, Goodman GE, Thornquist MD, et al: Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 334:1150-1155, 1996. PMID: 8602180.
Menkes MS, Comstock GW, Vuilleumier JP, et al: Serum beta-carotene, vitamins A and E, selenium, and the risk of lung cancer. N Engl J Med 315: 1250-1254, 1986. PMID: 3773937.
Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group: The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330:1029-1035, 1994. PMID: 8127329
More than 100 million Americans are living with abnormal blood sugar. Is it possible that you could be one of them? A simple A1c screening blood test shows when levels are too high. Elevated blood sugar means higher risk for diabetes.
A glycated hemoglobin, or hemoglobin A1C, test (HbA1c) is one screening test that checks blood sugar levels. Results show how much sugar is in the bloodstream over time. Testing is accurate since values are not affected by acute illness or stress. A1c screening is recommended for certain populations, including overweight adults and those with other risk factors.
Those thinking about blood sugar testing or wondering about risk factors should talk to their doctor. Here are some common questions about diabetic screening and A1c testing.
The A1c test can detect diabetes because it measures how much sugar, called glucose, is found in red blood cells. The red blood cells give a “glycemic history” of the past 120 days.
Everyone has sugar in their blood. But diabetics have higher levels. Blood sugar that is too high leads to cell and tissue damage.
When someone is diagnosed with diabetes, their doctor will also use the A1c test to monitor how the disease is being controlled.
A1c readings are measured in percentage. Here is what A1c results mean.
Higher blood sugar levels cause greater A1c values, and they equal greater risk for 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.
Here are the current recommendations for A1c screening.
The CDC suggests A1c screening to know a baseline for:
They further recommend that any woman who has ever had gestational diabetes should have an A1c check every three years even if results are normal.
The USPTF also says that adults over age 45 should be checked for diabetes using the A1c test. Furthermore, it recommends repeat testing every three years.
The ADA also recommends the A1c test, or other diabetic screening, for all adults at age 45 and over. Additionally, it advises overweight individuals with one or more risk factors to be screened, regardless of age. If results are normal, repeat screening is recommended every three years or less.
How to Get an A1C Test
If you meet some of these guidelines, you might be wondering how you can get a screening test.
A primary care doctor or other licensed provider can order this common blood test. Results take as little as a few business days.
Those who do not have a doctor to order the test, can still get this valuable screening. An online doctor or virtual physician can help. Telemedicine providers work with laboratory partners to treat patients without unnecessary trips to an office.
An online physician sends referrals and lab orders just like a brick-and-mortar doctors office. After going to a lab for blood work, virtual doctors offices schedule follow up video visits to go over the results, answer questions, and discuss treatment plans.
If you would like to talk with one of our board-certified physicians, book and appointment today. My Virtual Physician offers health screening, lab tests, and counseling to meet all of your healthcare needs.
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In the United States, colorectal cancer (CRC) is the third leading cause of cancer, after breast and lung cancer.
CRC almost always develops from precancerous polyps (abnormal growths in the colon or rectum). Screening tests can find precancerous polyps so they can be removed before they turn into cancer. Screening tests can also find CRC early, when treatment works best.
A screening test is used to look for a disease when a person has no symptoms. (When symptoms are present, diagnostic tests are used to find out the cause.)
Regular screening begins at age 45. The U.S. Preventative Services Task Force (USPSF) recommends adults age 45 to 75 be screened. For adults age 76 to 85, the Task Force recommends asking their doctor for screening recommendations.
Talk to a virtual doctor today!
Several screening tests can be used to find polyps and/or CRC (see Table 1 below). There is no single “best test” for any person. Each test has advantages and disadvantages. Talk to a virtual doctor about which test may be best for you and how often to be tested. Testing modality depends on personal preference, individual medical conditions, the likelihood of testing, and the resources available for testing and follow-up.
Table 1. Screening Tests for CRC
| Test Name | Description | Testing Frequency |
| Stool TestsGuaiac-based fecal occult blood test (FOBT) | Uses the chemical guaiac to detect blood in stool. Test provided by health care provider. At home, use a stick or brush to obtain a small amount of stool. Return the test kit to doctor or lab, where stool samples checked for presence of blood. | Once a year. |
| Fecal immunochemical test (FIT) | Uses antibodies to detect blood in stool. | Once a year. |
| FIT-DNA test (or stool DNA test) | Combines the FIT test with a test that detects altered DNA in the stool. This test requires an entire bowel movement be collected and sent to a lab, where it is checked for cancer cells. | Once every 3 years. |
| Flexible Sigmoidoscopy | During this test, the doctor inserts a short, thin, flexible, lighted tube into the rectum through the sigmoid colon (lower 1/3 of colon). The doctor checks for polyps or cancer there. | Every 5 years, or every 10 years with a FIT every year. |
| Colonoscopy | Similar test to flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for abnormalities inside the rectum and entire colon. During the procedure, the doctor can find and remove most polyps and some cancers. Colonoscopy is also used as a follow-up test if anything unusual is found during one of the other screening tests. | Every 10 years (for people who do not have an increased risk of colon cancer). |
| CT Colonoscopy (Virtual Colonoscopy) | Computed tomography (CT) colonography, also called virtual colonoscopy, uses X-rays and computers to produce images of the entire colon. These are displayed on a computer screen for the doctor to analyze. | Every 5 years. |
The screening testing frequencies above are general guidelines and may be different for you if you have certain risk factors for CRC, such as a family history of CRC or detection of high-risk lesion. Testing is generally more frequent for patients who are high risk. Your doctor will help you decide the optimal screening interval.
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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.
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Sources:
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.
With warm weather comes more opportunity for pool and beach time, and it’s important to refresh ourselves on water safety around our pediatric patients.
According to the Centers for Disease Control (CDC), drowning is the leading cause of injury-related death in kids ages 1-4 years. Drowning is the second leading cause of death, second only to motor vehicle accidents. Males have about a two-fold risk over females and African American children are nearly 5.5 times more likely to die by drowning than their Caucasian peers. The good news: drowning is essentially preventable.
When you see the Pediatrician for routine child well checks, some of the topics discussed fall under the category of anticipatory guidance. Anticipatory guidance are things to expect as a child develops along their trajectory and how to manage it. Water safety is a topic often reviewed during in person or virtual doctor visits. Common questions that may come up during a water safety conversation are:
Important Tip: Remember that a young child can drown in as little as an inch or so of water. We can not emphasize enough the importance of direct and uninterrupted supervision, early and safe water exposure as well as prevention measures.
The American Academy of Pediatrics advises swim lessons begin as early a year old and many swim facilities offer swim readiness training to toddlers and their caretakers. As affordability may be a concern to utilize commercial schools, you can check your town’s park and recreational facility to discover potential options for discounted pricing for more local community programs. The decision to begin swim lessons may vary for some families depending on the child’s physical and emotional development, but swimming is a life skill and starting in toddlerhood has been shown to reduce the risk for drowning. Infant swim lessons are not recommended due to lack of evidence to support that swim lessons in this age group lower drowning risk.
Young children are naturally curious and move quickly. The majority of drownings occur in settings without appropriate supervision or safety in place. An in-ground, residential pool is required to have a barrier fence of at least four feet high and surrounding three sides of the pool with the house acting as the fourth side. If this is the sole barrier, door alarms should be placed on the doors that open to the pool. It is further protective to have an actual four-sided barrier fence surrounding the pool itself with an automatic locking gate. Additionally, another layer of protection is a pool cover, however these should never be used alone without barrier fencing.
Open bodies of water, such as lakes or oceans, present some of their own unique challenges, including poor visibility compared to a pool, and potentially strong currents. Using a life vest approved by the US Coast Guard is always recommended for children exposed to outdoor water.
Aside from physical barriers, supervision is imperative: direct and constant. Equipment malfunction, such as a broken gate latch or failure of proper life vest use, can lead to more risk, which is then mitigated by your constant presence with the child/children. Never take on water supervision with children while intoxicated and never leave older children to watch younger children. “Touch supervision”, or being at arm’s length of the child, is advised by the AAP. Ideally, getting into the water can be more helpful in acquainting children with safety while also promoting a fun experience.
With these ideas in mind, you can feel more secure about your young water-lovers taking on a healthy and splashingly good summer! For any additional questions or concerns you may have regarding swim safety, scheduling an online doctor visit with My Virtual Physician is a quick and convenient way to reach our Board Certified General Pediatricians, who are happy to help! My Virtual Physician provides parents with high quality medical care via video visit and are able to treat a variety of health conditions. Schedule a virtual visit today!
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.
If you have ever wondered if your blood pressure is normal, you are not alone. We know that maintaining readings in a healthy range can help prevent serious life-threatening conditions. So, is there a magic number for blood pressure?
There is no “magic number” for blood pressure, because readings are affected by many factors and can vary throughout the day. Rather, there are clinically defined ranges that doctors consider normal, elevated, or pathologic. A reading is considered "normal" when it is less than 120/80 mmHg.
Hypertension is a medical condition in which blood pressure is too high. The World Health Organization (WHO) says that over a billion people have hypertension, but fewer than one in five have the problem under control. So when does high blood pressure become hypertension, and how do we manage it? Read on to find out.
Blood pressure is determined by the force of the blood that is pumped from the heart into the body’s largest vessels, called arteries.
Readings are written as two numbers. The first or top number, called the systolic reading, should be less than 120. Systolic pressure measures the force inside the arteries when the heart contracts and pushes blood from the heart. The second or bottom number, called the diastolic reading, should be less than 80. Diastolic pressure measures the force inside the arteries when the heart is relaxed or resting, in between beats.
Both readings are measured in millimeters of mercury, written as “mmHg.” Depending on where, when, and how it is checked, you may get slightly different readings. Your numbers change throughout the day. This means that blood pressure readings must be evaluated over time.
According to the American Heart Association, a "good" reading is less than 120/80 mmHg. High blood pressure, or hypertension stage I, starts at 130/80 mmHg. At this stage, your doctor will probably recommend steps to try to lower your pressure. Interestingly, some doctors debate about these numbers, and at what point a patient should be treated.
What is undisputed, however, is that the risk of heart disease and stroke is doubled for each increase of 20 mmHg systolic and 10 mmHg diastolic. Keeping your number under 120/80 decreases the likelihood of health dangers including death.
Many factors affect your readings, including:
Regardless of what causes your high blood pressure, we know that over time it causes serious complications. Hypertension changes the walls of blood vessels. Damaged arteries and vessels stiffen and reduce blood flow. In other words, This process harms vital organs.
Many factors affect what your blood pressure reading is. Similarly, several things can lower your numbers.
The National Institute on Health (NIH) recommends the DASH diet. This eating plan, named the Dietary Approach to Stop Hypertension, gives guidelines for a balanced, heart-healthy diet. You can read more about the DASH eating plan here.
Cardiovascular activity strengthens the heart and can actually lower your systolic and diastolic pressures. The American College of Sports Medicine (ACSM) recommends exercise for prevention and treatment of hypertension. Find the guidelines here. The ACSM asserts that regular exercise can result in reduction of 5-7 mmHg which means a 20-30% risk reduction.
If you are overweight, losing weight will decrease your number. According to Cardiologist Dr. Matthew Alexander, even a 5-10 pound weight loss could lower your blood pressure by 5-20 mmHg.
Stress, anger, and fear-based emotions affect the cardiovascular system. Over time, chronic stress can lead to hypertension.
Practices such as biofeedback, mindfulness, and meditation counteract these feelings. Studies have shown the power of the mind to improve body function. For instance, recent research concluded that stress management therapies can decrease systolic pressure 6-10 mmHg.
If you have high blood pressure, or if you’ve already tried these suggestions to lower your numbers without success, it may be time to talk to your doctor. That is to say, doctors can prescribe a personalized treatment plan to get your readings into a safe range. In some cases, that plan includes medications. For example, there are many drug therapies available today, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers, and more. A doctor can recommend the best treatment for you.
In summary, there really isn’t a “magic number” for everyone because many factors affect the reading. If you worry that yours is too high, be proactive in making lifestyle choices that are known to help lower blood pressure to a safe range.
To talk with one of our board-certified physicians, click below to schedule an appointment. My Virtual Physician offers healthcare services to address all of your healthcare needs. Our caring experts treat high blood pressure and can help with your medication questions. If you have suggestions for other topics you want to read about, let us know! Don’t forget to follow us on social media.
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.
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.
Much mistle-toeing and hearts will be glowing. It’s the most wonderful time of the year, right? For some, the holiday season brings to mind financial strain, complicated relationships, stressful schedules. The hustle and bustle of the holiday season cause worry for many. Coping with anxiety during the holidays can be a challenge.
Coping with anxiety during the holidays is essential to your mental and physical health. It is necessary to know how to cope with anxiety and depression and recognize when support or help may be needed to manage.
Here’s what you need to know.
The holiday season is upon us. It can be common and normal to have feelings of anxiety during this time. Financial pressures, excessive commitments, and unrealistic expectations can trigger stress, anxiety, or depression.
For some, the holidays are a time of memories, some good or some unpleasant. For those separated from loved ones, it can be a time of sadness or grieving. Many experience feelings of isolation and loneliness.
Furthermore, during the winter months, the days are shorter and less sunlight can cause seasonal mood changes.
Anxiety is defined as feeling worried or nervous that something terrible is going to happen. Many people have these feelings from time to time.
During the holidays, Americans may feel the financial strain as it can be a season of shopping and gift-giving. They may have to come together with family members who they don’t often see or grieve separation from loved ones, and relationships can be challenging or cause anxiety and worry.
Furthermore, many adults have unrealistic expectations for the holidays, 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.
In some cases, anxious thoughts or feelings can become intense and excessive.
Individuals may become overly focused on common everyday events or situations that should not produce fear or worry, 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.
Signs and symptoms of an anxiety disorder could include:
This second more extreme anxiety may be out of the norm, and may require a healthcare professional evaluation.
Many people overlook self-awareness and self-care during this season that is often about giving to others. But don’t forget, it’s hard to pour from an empty cup. You must take care of your mental and physical health to give others your time, effort, and resources.
When unpleasant feelings of worry or restlessness seem magnified or more frequent, here are some things you should be doing to make sure you can effectively cope with anxiety during the holidays:
If you have tried these tips above and don’t feel any relief, or if you battle with intense anxiety that interferes with your daily life, it may be time to ask for help.
A primary care physician can talk to you about your anxiety or may recommend further treatment.
SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental or substance use disorders.
If you would like more information on anxiety or want to talk about your symptoms with one of our board-certified physicians, click to schedule an appointment. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our weekly education series Talk Tuesday on our podcast page, and follow us on social media.
My Virtual Physician now offers virtual doctor visits in Las Vegas. Their telemedicine visits offer comprehensive services in the following areas:
In the middle of a pandemic, along with a cold and flu season, many residents fear going out in public. Due to high patient volume, Las Vegas physician offices are busy. In some cases, patients can't get an appointment with their physician when they need it... until now. Las Vegas residents can now conveniently access a virtual doctor with My Virtual Physician.
Patients emphasize the convenience of having an online doctor visit where they receive the personalize care they need, all from the comfort, privacy, and safety of their homes. Patients can skip the waiting rooms and old magazines and enjoy waiting for their appointment in their own home. When it comes time to talking with the provider, their doctor is ready to connect and focus with them one on one. My Virtual Physician can effectively treat the following gynecology conditions during an online visit:
Our patients rave about our primary care services. The virtual doctors at My Virtual Physician understand getting to know their patients, their medical histories, and the factors impacting health and wellness. With top-notch and on-demand Las Vegas primary care telemedicine services, My Virtual Physician can effectively treat patient health concerns involving:
Residents in Las Vegas, Nevada can schedule a virtual doctor appointment or choose a provider through a secure and fast online booking system. Our Las Vegas OBGYN accepts Medicaid. Contact us to learn more about our services!
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.
Starting a family is a goal for many couples. Unfortunately, one in ten couples may have some difficulty getting pregnant and require medical treatment. If you've been affected, you might be wondering about infertility: when is it time to see a doctor? My Virtual Physician has board certified physicians who specialize in infertility and are available for virtual doctor visits.
Infertility is a diagnosable medical condition in which a couple cannot conceive a pregnancy despite unprotected intercourse. It can be caused by many factors.
In women, most often, abnormal ovulation causes infertility. In men, usually problems with sperm cells, such as sperm count or function, cause difficulty conceiving.
Aside from these physiological causes, factors affecting a couple's fertility include their age, health status, and lifestyle factors such as stress, diet, or smoking.
According to the American College of Obstetricians and Gynecologists, women who are overweight, underweight, or exercise too much may have difficulty getting pregnant, and men who are heavy drinkers or smoke marijuana since these are known to lower sperm count and movement.
In some cases, doctors cannot determine the cause and refer to these cases as unexplained infertility.
Generally, it is time to consult your physician about getting pregnant if you are under the age of 35 and have been unable to conceive after one year of unprotected sex. Women over the age of 35 and those who have irregular menstrual cycles or have known abnormalities with their reproductive system, should talk with their doctor much sooner, after six months.
Infertility affects both people in the relationship. There is a 30% chance the infertility is related to male factors in a traditional couple, 30% related to female factors, and a 30% chance a combination of both factors. Therefore, anyone in the relationship may need to discuss options for starting a family. Here are some reasons to see a virtual doctor:
When you consult your physician about infertility, you can expect that they will begin your care with a complete history and physical exam. They may order blood testing, urinalysis, hormone tests, or other diagnostics to check for abnormalities. It may be necessary to have your partner undergo an exam and diagnostic testing also. Your physician may order an ultrasound or an X-ray as well.
After all of the tests, you will meet with your physician to discuss the results and go over treatment options and recommendations. After you decide on the treatment plan that is best for you, you will receive support and guidance in your process to get pregnant.
Medical treatment and new technologies can increase your chances of getting pregnant. One or both partners in a couple may undergo treatment.
Medications may be taken by mouth or injected. There are drug therapies for both men and women aimed at increasing egg production or sperm count. A list of medicines frequently prescribed for infertility treatment can be found here.
In some cases, blockages, scar tissue, or abnormal growths require surgical intervention. Procedures may be laparoscopic: meaning performed through small incisions in the abdomen for a minimally-invasive procedure.
Today, the two most common infertility treatments are intrauterine insemination (IUI) and in vitro fertilization (IVF).
IUI is a procedure during which a physician injects sperm into the uterus at the ovulation time. This method is least invasive and most cost-effective but has lower success rates. The estimated success rate is 10-20% for a single cycle of IUI, but additional rounds increase chances, and in three to six cycles, the success rate is up to 80%.
IVF is a complicated procedure requiring surgical retrieval of a woman's eggs, fertilization in a laboratory, and then transferring the fertilized eggs back into the uterus. Women under the age of 35 can expect a 50% success rate for IVF treatment, but this process requires intense testing and monitoring and can cost $20,000 to $50,000.
Starting a family can be challenging, and your physician may offer options to guide you through the process. Infertility is a medical condition that affects many couples, and there are treatments available.
Need to talk to a physician now? My Virtual Physician has Board-Certified OB/GYN's that are available for virtual doctor appointments and are able to answer any questions you have and guide you in the right direction. The online doctors at My Virtual Physician, not only address infertility and reproductive endocrinology, but also irregular periods and painful periods, and many more gynecological conditions.
If you still have questions or you would like to discuss your problem with our board-certified OB/GYN specialists, click below to schedule an appointment. My Virtual Physician treats conditions, including infertility, irregular periods, sexually transmitted infections, 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.
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 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.
With much focus on the coronavirus this year, don't forget about another viral infection that threatens your health. Each year the Influenza virus affects 5-20% of Americans. This illness puts millions at risk of lost work and sick days, medical expenses, and possible health problems. A flu shot lowers that risk. You may be wondering, should you get a flu shot?
The Center for Disease Control and Prevention (CDC) recommends that everyone over the age of six months should be vaccinated against the flu virus this year. With a few exceptions, Americans need their shots around October or in early fall.
Many people worry about just how the flu shot will affect them. If you're one of these, keep on reading to find out what you should know about getting vaccinated this year.
The American Academy of Family Physicians (AAFP) recommends a yearly flu shot for everyone over six months old. This is because the flu vaccine can safely and effectively prevent severe illness.
Flu vaccines contain dead or weakened forms of the Influenza virus. Your cells begin to build up a natural defense system when they receive these parts of the virus. Then, your body creates antibodies. These proteins help your body fight infection. Antibodies work to keep you healthy later on if you are exposed to the flu virus.
The Journal of the American Medical Association (JAMA) recently looked at the best time to get your flu shot. In their study, researchers found that the U.S. flu season usually starts in December. After a flu shot, your body takes about two weeks to build up a response to the vaccine. Therefore, flu shots give the most protection when given in the fall, around October.
Vaccination is safe. Doctors have recommended flu vaccines for over 50 years. Over this time, a lot of research has evaluated the effectiveness and safety of immunizations. Certainly, the risk of serious reactions is low. Furthermore, manufacturers demonstrate the safety of their drugs before the FDA gives their approval.
The Advisory Committee on Immunization Practices (ACIP) warns some individuals to talk to their doctor about the flu shot if they have certain contraindications. This means a specific situation, condition, or factor that could make a treatment unsafe or even harmful.
For instance, egg allergy prevents some from getting a flu shot. This is a contraindication because manufacturers use eggs to make the vaccine. Therefore, the flu shot may contain trace amounts of ovalbumin (egg protein).
In addition to contraindications, there are precautions for some individuals. For example, those with a history of Guillain-Barre Syndrome or who have an illness with fever may want to discuss vaccination with their doctor.
The flu shot may cause reactions. These are typically mild and go away within 48 – 72 hours. They may include:
In some cases, more severe reactions occur. These could be signs of a rare allergic reaction to the vaccine. If these signs or symptoms arise, you must seek medical attention right away:
The risk of not getting vaccinated is getting sick. You could miss work or school, incur medical costs, or suffer mild to moderate health complications.
Most healthy adults deal with a minor case of the flu virus by staying home and taking over the counter medication to ease symptoms. The infection generally lasts 7-14 days.
On the other hand, those considered "high-risk" could suffer much more serious cases. Some possible complications include hospitalization and even death. Here are some factors that put you in the high-risk category:
In conclusion, you and your healthcare provider will decide if a flu shot is right for you. You must talk with your physician about your past history and risk factors to decide whether or not to be vaccinated.
Talk to your physician if you still have questions about the influenza vaccine. They can help you with additional information.
If you still have questions or you would like to discuss your medical condition with a specialist, click below to schedule an appointment. MyVirtualPhysician treats conditions like the common cold, flu-like illness, 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.
Rubin R. Is It Possible to Get a Flu Shot Too Early? JAMA. 2018;320(22):2299–2301. DOI:10.1001/jama.2018.18373
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.
In the United States, FDA-approved generic medications account for 90% of prescriptions filled. Your doctor or pharmacy may have asked you about your preference for a generic or brand name drug. This could have left you wondering: are generic medications the same as brand names?
Generic medications are not exactly the same as brand names. This is because generic medications can have different ingredients, look dissimilar, or have individual effects. In many ways, the FDA ensures that the medications are the same. But here is what you need to know about generic vs. brand name:
A lot of money goes into research, testing, and marketing before a company can introduce a new drug to the public. Then, they can patent their new medication and own the right to make and sell their product exclusively for five years. This short time allows manufacturers to recoup some of the costs associated with getting their new brand name drug to market.
The patent expires after that time. This means other companies can come along and produce the same medication under a different name. This “copy-cat” is considered a generic medication.
So you may be asking… what is the difference anyway? Well, 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. This means that generic medicines are the same when it comes to:
By contrast, generic medications can be approved with different inactive ingredients. So colors, additives, and fillers used to help with binding, flavoring, coloring, or preserving may not be the same. That means that your generic medication will likely look different. Trademark laws in the U.S. prevent drug makers from creating a version 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 all 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 are more sensitive to differences in the drugs.
Because the inactive ingredients are not the same, some individuals may notice 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 example, when the onset of effects is felt, how long the medication effects last, and even the side effects can vary when comparing drugs made by different companies or labs.
Keep in mind that some pharmaceutical companies produce both brand and generic forms of medication, so even some of the generics are very close to the original.
It is important to talk to your physician if you are concerned about a generic medication affecting you differently.
The FDA requires drug companies to prove generics are effective for treatment in the same way brand name medications are. Some generic medications have been on the market for years and shown to be as effective and a solid choice for some consumers.
Some individuals choose generic versions because they work just as well but cost much less than the brand name. Again, the company making the generic did not have to pass along the cost associated with getting a new drug to market.
So 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 costs 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 medicines save our healthcare system millions of dollars every year.
This answer may be different for each person. As with many choices in your health and medical care, you have to weigh the risks and benefits.
Is it worth it for you to spend more on a brand name medication? Cost is an important factor when deciding what is best. For example, when a person is on medication for a lifetime, opting for a generic version may save thousands of dollars in healthcare costs. On the contrary, generic medication for an acute illness that will resolve quickly could mean a different decision.
Today, many pharmacies routinely fill the generic versions for cost savings to the insurance companies and the customers. The FDA says that increasing the availability of generic drugs in the marketplace encourages competition in the pharmaceutical market which improves access to healthcare.
Although generic medications are not identical to their brand name counterparts, the FDA ensures that customers are getting safe, effective, quality options when they chose an approved generic. Although they may have different ingredients, appearances, and effects, the pharmacologic effects are the same. As with all medications, there are risks and benefits that should be weighed when making a personal choice.
If you would like to know more or have questions about your medications, our doctors are available for a virtual consultation. MyVirtualPhysician is a multi-specialty provider with physicians available for a consultation now. Click below to schedule an appointment. 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.
Did you know that many women have ovarian cysts? Most are harmless and resolve without problems. In some cases, serious complications can occur. Here's what you need to know about this common diagnosis:
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.
Women have two ovaries, one on each side of the uterus in the lower abdomen. These ovaries are part of a normal reproductive system. Normally, an ovary releases an egg each month as part of a woman's menstrual cycle. This process of forming a sac-like pocket on the organ is just one type of ovarian cyst.
Most ovarian cysts are small and harmless and 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.
There are multiple other conditions that may cause a cyst to form. Other types of ovarian cysts include endometriomas, dermoid cysts, and cystadenomas. These are less common though. Most cause no problems and may go unnoticed.
In some cases, multiple cysts may occur at once. In polycystic ovary syndrome (PCOS), many small cysts are formed on the ovaries and the normal reproductive cycle may be interrupted. Women with PCOS experience hormone imbalances, which can cause irregular menstrual periods.
According to Dr. David Howard, M.D., Ph.D., what really causes concern is "when a cyst becomes too big, above 5 cm, that's when cysts almost always are going to start causing pain and pressure symptoms." He compares a large cyst to a large piece of fruit hanging from a branch. The size and weight of the cyst can cause the blood supply of the ovary to twist. Any organ that does not get adequate blood flow could potentially die without urgent treatment.
Only about 8% of premenopausal women develop large cysts that need treatment. After menopause, these cysts are less common. Still, ovarian cysts can occur at any age. Although most are not problematic, ovarian cysts can be cancerous and could lead to ovarian cancer. It is important to talk to your physician if you think you have a cyst.
Since ovarian cysts should be checked out by a healthcare provider, you might be asking what are the symptoms?
As we said most cysts are asymptomatic. Many are found incidentally, on ultrasound or on exam.
If a cyst does cause symptoms, you may experience pain or pressure in the low abdomen. Pain or discomfort from an ovarian cyst could feel sharp or dull, and it could come and go. If a cyst breaks open 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, this is called torsion and could be serious because it decreases blood flow to the organ. This may be associated with nausea and vomiting.
It is important to talk to your physician if you are concerned about these symptoms. Your provider may do a pelvic exam to feel for a cyst on your ovary. Additionally, they may order further testing. Some tests which may help diagnose an ovarian cyst include ultrasound, pregnancy test to rule out pregnancy, hormone levels, and other blood tests.
There are treatment options for ovarian cysts. These may include pain medication or comfort measures such as heat therapy. Using a heating pad to the painful area may bring some relief. Another option is hormonal birth control methods which can prevent ovulation and therefore lower the risk of forming more cysts.
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.
An ovarian cystectomy is a surgical procedure that removes the ovarian cyst. In some cases, the doctor may suggest removing the affected ovary. An oophorectomy is a procedure that removes an ovary. After a surgery like this, you may stay in the hospital for 2 to 4 days. You should also avoid strenuous activity or exercise for a time. Your physician will give you instructions depending on your situation.
If you still have questions or you would like to discuss your symptoms with a specialist, Dr. David Howard, M.D., Ph.D. is available for consultation. MyVirtualPhysician treats OB/GYN conditions including irregular periods, vaginal bleeding, hormone imbalances, and more. Click below to schedule an appointment. 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.
