Doctor Rennie's Blog

January 23, 2014

Seborrheic Dermatitis – Dandruff, Cradle Cap and Adult Seborrhea

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Photo credit: http://hardinmd.lib.uiowa.edu/dermnet/seborrheicdermatitis22.html

Photo credit:  http://siklusair.com/seborrheic-dermatitis-eyes

Photo credit:  http://medicalcontent.hubpages.com/hub/Seborrheic-Dermatitis-Pictures-on-Face-Scalp-Hair-loss-Causes-Treatment

 

Seborrheic dermatitis is a common skin condition that occurs in infants and adults and can cause redness, greasy scales, skin flaking along the eyebrows and itching.  It is one of the most common skin conditions that I see as an urgent care physician.

Seborrheic dermatitis (also called seborrhea) is an inflammation of the skin that usually occurs in areas that have an abundance of oil glands such as on the scalp, face, around the eyes, ears, neck, and even the diaper area.  In men, it’s more common in areas where there is hair on the face.  Infants often have seborrhea on their scalp that is known as cradle cap.  A mild form of seborrhea is known as dandruff and that is when it is confined to the scalp in children or adults.  Some symptoms may be:

1)   Skin scales – white or yellow and usually oily/greasy

2)   Itching

3)   Mild redness

4)   Skin lesions or plaques

The exact cause of seborrheic dermatitis is unknown but there is some evidence that it seems to flair up in times of stress, hormonal changes or during particular seasons (ie. During extreme cold or warm weather).  It is more common in those people with weakened immune systems, in people who have oily skin, or certain neurological conditions such as Parkinson’s Disease.

Diagnosis:  Your healthcare provider is usually able to diagnose seborrheic dermatitis by examining you and taking a history.  A biopsy (sample of skin that is surgically removed and sent to a doctor to examine under a microscope) is rarely needed.

Treatment:  Usually tailored toward the individual patient and what part of the body is affected.  Some possible treatments include:

1)   Medicated shampoos such as Neutrogena T-Gel or T-Sal, Head and Shoulders or Nizoral are commonly prescribed.   These shampoos usually contain Salicylic acid, Coal Tar, Zinc, Selenium Sulfide, Ketoconazole, or Resorcin.  Even if you do not have dandruff, these shampoos may be used on the face and/or other body areas and usually work best if they are left in place for 5-10 minutes before rinsing.

2)   Topical Steroid creams, lotions, foams or shampoos:  Low, medium or even high potency steroid creams are sometimes prescribed to help decrease the inflammation depending on the severity and where the rash is. Usually the lower potency creams are used on the face (such as Desonide 0.05% lotion).

3)   Antibacterial creams:  Sometimes topical antibacterials such as Sodium Sulfacetamide with sulfur are prescribed.

4)   Antifungal creams:  Ketoconazle 2% cream, and Ciclopirox 1% creams are commonly used.

5)   Other anti-inflammatory medications such as pimecrolimus cream or tacrolimus ointment are sometimes prescribed for use on facial seborrhea.

6)   Dermatologists sometimes recommend a compound or mixture of a combination of a steroid cream along with an anti-fungal or antibacterial agent.

Cure:  Unfortunately there is no cure for seborrheic dermatitis. It is a chronic life-long condition. It may go away for months or years and then return (relapse).  We usually focus on controlling seborrhea often by using a combination of the strategies for treatment listed above along with decreasing known triggers such as emotional stress, extreme cold temperatures and decreasing body weight.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: http://doctorrennie.wordpress.com

Rectal Bleeding – A discussion about possible causes

Colon-Endoscopes
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Photo credit:  http://www.naturalhealingsolutionsllc.com/learn-about-colon-hydrotherapy.html

Photo credit:  http://www.thenurseslockerroom.com/2013/03/sigmoidoscopy-screening-test-for.html

One of the more common problems that bring patients into the doctor believe it or not is seeing blood in the toilet, on the stool or on the toilet paper after having a bowl movement.  Since I’ve had a few patients recently who have come in because of this problem, I thought I’d discuss some possible causes.

Healthcare providers take this issue seriously because sometimes blood noticed after having a bowl movement can be a sign of colon or rectal cancer.  Fortunately, most of the time the causes of rectal bleeding is not cancer however.

Causes of rectal bleeding:

1)  Hemorrhoids:  Swollen blood vessels can occur in the rectum or anus and cause itching and/or pain and can sometimes bleed.  Usually hemorrhoids produce a blood that is described by patients as being a “bright red color.”  It may sometimes coat the surface of the stool or may drip into the toilet and turn the water red or be noticed on the toilet paper.  Hemorrhoids do not have to be painful – in fact painless rectal bleeding at the time of having a bowl movement is common in hemorrhoids.

2)  Anal Fissure:  If the lining of the anus has a tear, it can cause bleeding and sometimes there may be pain with having a bowl movement.

3)  Other causes such as infection, colitis (which could be due to an auto immune disease such as ulcerative colitis or Crohn’s disease), colon polyps or colon cancer can also cause bleeding.  If the bleeding comes from higher in the digestive system such as in or above the stomach, the blood may look dark black or have a tarry appearance.

Diagnosis/Testing:  In order to find out the cause of the bloody stools, your healthcare provider may perform some tests or refer you to a specialist to help determine the cause.  They will take into account the information you provide, your past history and symptoms as well as your age.

1)   Rectal exam:  Your healthcare provider will usually examine the rectum and look for a source of bleeding such as a hemorrhoid or anal fissure.  This may also include a digital rectal exam (where to doctor inserts a gloved and lubricated finger into the rectum to feel for possible rectal cancers).

2)  Anoscopy:  Your doctor may use a small plastic device with an attached light to get a better look for the source of bleeding.  Most of the time this is not painful (although perhaps a bit uncomfortable) and can be done in the office.

3)  Sigmoidoscopy:  This is a procedure that is usually done in an outpatient treatment center and the patient is usually not sedated.  There are rigid or flexible sigmoidoscopes.  Usually a flexible sigmoidoscope is used.  A flexible tube (it is approximately 70cm long and 1cm wide) with a tiny video camera and a light is inserted into the anus and gently into the colon while air is inserted into the colon to enlarge the area and help the doctor get a better view.  Often a biopsy (small sample of colon tissue) is taken with the use of a tiny biopsy tool.  The sigmoidoscopy allows visualization of the anus, rectum, sigmoid colon and top of the descending colon.  It does not allow visualization of the entire colon so it may miss seeing cancers, polyps or sources of bleeding in some areas.

4)  Colonoscopy:  This procedure is similar to the sigmoidoscopy but allows the doctor to examine the entire colon using a longer flexible tube. The Colonoscope (about 140cm in length) is able to reach the areas seen by the sigmoidoscope and also allows visualization of the transverse colon, ascending colon and cecum.  The patient is usually sedated during this procedure.

When to seek help:  It is impossible to know the cause of rectal bleeding without an examination, therefore everyone who has rectal bleeding should talk to their healthcare provider to help determine the cause and what examination is needed.  Even though there are common causes of rectal bleeding that are not cancerous, bleeding can be caused by cancer or precancerous conditions.

Precancerous polyps may be present in the colon for years before they become cancerous and may be removed safely from the colon, preventing them from becoming cancer.  These polyps may cause symptoms which are very similar to an innocent hemorrhoid.

I’ve met patients who have ignored rectal bleeding for years because they thought it was because they had a hemorrhoid and it turned out to be cancer.  With increased age comes an increased risk for polyps and colon cancer .

Colon Cancer Screening:  For patients who is at average risk, colon cancer screening is started by checking the stool for small amounts of blood (which may be hidden) each year starting at age 50.  It is also recommended to have your first colonoscopy at age 50 (unless you have other risk factors for colon cancer) and every 10 years thereafter unless you are at increased risk based on your family history or a previous diagnosis or biopsy result.

People at increased or high risk:

If you are at an increased or high risk of colorectal cancer, you should begin colorectal cancer screening before age 50 and/or be screened more often. The following conditions make your risk higher than average:

1)  A personal history of colorectal cancer or adenomatous polyps

2)  A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s)

3)  A strong family history of colorectal cancer or polyps

4)  A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: http://doctorrennie.wordpress.com

January 11, 2014

What is a Pressure Ulcer (AKA Pressure sore)?

shutterstock_89421025bed-soresPhoto credit:  http://diseasespictures.com/bedsores/

A patient came in to see me today with a sore on his heel that’s been bothering him for the past few months.  He’s diabetic and has lost feeling in the bottom of his feet.  He’s had these pressure sores in the past but has trouble getting them to heal up.

Pressure sore:  Areas of skin that have been damaged by pressure such as sitting or lying in one position for a very long period of time.  They can also be called “bedsores.”  The are more commonly found in areas of the body where the bone is near the surface of the skin such as on the hips, elbows, ankles and back/buttocks. The skin and soft tissues become damaged because not enough oxygenated blood can get to the area to promote healing usually due to the compression of the damaged skin and soft against hard bone tissue.

Appearance:  The sores change in the way they look depending on how long they’ve been present and how much damage has been done.  In the beginning, the sore appears as a small red patch of skin, and if not treated, the skin will break down and cause a hole or crater to form (we call this an ulcer).

Stage 1:  The skin is intact without ulcers but when you push on the skin it does not change colors to indicate good blood flow.  Usually, healthy tissue will be pink and when you push on the area with your finger you can notice it will become less pink and in a couple seconds the pinkness will return.  This does not happen in the damaged skin at this stage – it may have a darkly pigmented color.

Stage 2:  There is an open, shallow ulcer with a red-pink color at the base of the wound.  Sometimes there may be blisters present which are either intact or ruptured.

Stage 3:  Structures beneath the skin such as fat may be exposed but at this stage, you should not see bone, tendons or muscle tissue.

Stage 4:  Structures beneath this skin including bone, tendon and muscle may be seen in the bottom part of the ulcer

People at Risk:  Some patients are more at risk than others of getting pressure sores.

1)   Patients who cannot move very well because they have a medical problem.  These people may sit or lay in one position for a long time.  They need help to move to a different position so that the skin doesn’t form sores.

2)   Older people are more prone to pressure sores because they often don’t move around as much and their skin is more fragile and thinner than a younger person.

3)   Patients who have diabetes or nerve problems in their feet may not feel when a small pebble or area gets into their shoe or pressure pushes on the foot causing injury.

4)   Patients in the hospital or nursing home are at especially high risk for many of the factors noted above – increased age, decreased mobility, and other complicated medical problems.

Prevention:  Some things can be done to lower the chances of getting pressure sores

1)   Repositioning the patient’s body every two hours so that they are not lying on one area where the skin is being crushed, pinched or pressure is building

2)   Putting pillows between the ankles and knees to decrease the pressure on the skin over these boney areas

3)   Raising the head of the bed when the patient is lying on their side to decrease the pressure on the hip bone

4)   Getting special foam or soft mattresses that decrease the pressure on the areas of the body that have the most pressure on them

For patients in wheelchairs:

1)   Use a special cushioned seat if possible to prevent pressure on the sacrum

2)   Every hour tilt forward or to the side to release pressure on the seat

3)   If ankles or heels press on the chair, use foam padding to protect against sores

4)   Check skin regularly for signs of pressure or ulcers

Treatment:  Pressure sores are treated differently depending on the stage of ulceration and how severe the damage to the skin is.

1)   If there is mild erythema, the treatment is generally off-loading the area but decreasing the amount of time that this area is compressed by body re-positioning, and/or using pillows to cushion the area.  We also use transparent films over the ulcers to protect the areas.

2)   In patients who have diabetes, adequately managing blood sugars to keep them under good control is very important.  Elevated blood sugars impede wound healing.

3)   If there is dead or dying skin or soft tissues, this often needs to be removed to help prevent infection.

4)   Special bandages may be needed to keep the healing tissue moist but prevent tissue maceration (from being too moist). Sometimes the dressings that we use to treat wounds can be very expensive.

5)   Antibiotics may be prescribed if there is a wound infection

6)   Medication for pain may also be prescribed

There are some tools to score the pressure and grade the healing process.  These are helpful for patients who come back for repeat visits to wound care clinic or their primary care provider and there is a need to grade the healing by giving them a score.  Some clinical features that are examined include:

1)   Amount of Exudate

2)   Skin color surrounding the wound

3)   Peripheral tissue swelling

4)   Peripheral tissue firmness around the wound

5)   Amount of granulation (healing) tissue

6)   How much epithilization is present

It’s important to optimize the nutritional status of patients with wounds.  Particularly for patients who have Stage 3 and 4 ulcers, they need enough protein and calories to help heal these wounds.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: http://doctorrennie.wordpress.com

January 7, 2014

A Discussion About Wilderness Medicine – Hawaii Public Radio January 6, 2014

Here’s a link to a discussion I had with Dr. Kathy Kozak about Wilderness Medicine on Hawaii Public Radio on 1/6/14.

 

Listen Here:

 

Happy New Year,

Scott Rennie, DO

 

December 22, 2013

Learning about amateur radio

Filed under: Uncategorized — Dr. Scott Rennie @ 11:47 pm

A great video introducing ham (amateur) radio…

July 4, 2013

30 Things to think about when moving to Hawaii

Honl-Beach-1Many of my friends and family members ask me about what it’s like to live in Hawaii.  There are many things that are great, and a few things that you might not have considered.  I decided to write down a list of things that I learned about after moving to Hawaii.

1)   You will become instantly popular with your friends and family who live on the mainland.  Try to get a place with a spare bedroom so you can accommodate visitors.

2)   If you have a pet, consider getting your animal’s rabies vaccinations up to date well in advance of moving.  The animals need to be current on their vaccinations and they also need to get blood work done to prove that they have built up immunity to rabies.  It can take up to 4 months to get this process done and if you prepare ahead of time, it might save you being away from your pet.

3)   If you want to ship your pet to Hawaii from the mainland, you’ll also need to have your pet given a good bill of health from your local veterinarian.  Some airlines don’t allow certain dog breeds to fly in the hot summer season (think Boxer or dogs with Brady cephalic heads).  It’s also expensive to ship them and if they’re a larger breed, they will likely need to ride in the cargo hold and my dogs and I aren’t too fond of that idea.

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4)   The weather can be great, but it isn’t always sunny.  Sometimes we have VOG (Volcanic Fog) from the active volcano on the big island that clouds the skies.  It looks similar to smog that you might see in LA or another big city.  If you have allergies or asthma, you might benefit from bringing your eye drops, antihistamine or an albuterol inhaler with you.  It can rain very hard suddenly and without much warning if you live in certain areas of Hawaii.

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5)   Traffic in Honolulu and Waikiki can be horrible.  We’ve all heard this before, but I moved from Seattle and thought we had bad traffic there.  Ha!  You might also consider that many people on the roads are visiting from other places (even other countries) and aren’t familiar with the roads.  Also if you drive in rural areas like the famous road to Hana, be prepared for some small roads, one-lane bridges and some areas where there’s not any protection between you and falling over a large cliff beside you.  Drive carefully!

 

 

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6)   The food is amazing.  If you’re visiting Honolulu and enjoy trying different kinds of foods – Asian, Hawaiian, Portuguese and a fusion of many others, you won’t be disappointed especially if you have a chance to get outside of Waikiki.  The restaurant selections on islands other than Oahu might be a less abundant however.

7)   It’s expensive – gasoline, groceries, eating out, movies, and many other things can cost quite a bit more than on the mainland!  You knew that already though, and as you learn where to go shopping (think Costco if there is one on the island you visit) you will learn how to adjust. If a grocery store offers a membership or discount card, get it!  I usually don’t spend as much money on “extras” here though.  When I want to enjoy a day off, I usually don’t spend any money visiting the beach!

8)   Things rust and wear out quickly if you don’t take care of them.  Wash your car once a week if you can, then wipe it dry so you don’t get hard water spots.  Then wax your car to protect the clear coat!

Unprotected-paint

9)   Be patient!  Sometimes things move slower – traffic or lines at the cash register for example. It’s a fact of life. Try not to get frustrated; it will make your day more enjoyable.

10)  Get to know people who’ve lived here for a long time.  They can show you places and teach you things about the islands that you will not learn in a book or blog post.

11)  If you ship a car to Hawaii, it’s a process to get the registration changed to Hawaii.  Just take a day off work and plan on spending the whole day to get this done.  Even if you have car insurance from a large company like State Farm or Farmer’s, you’ll need to get a local agent.  Once you have your auto insurance agent and your new insurance ID card for Hawaii, you can go get your car safety inspected.  These inspection stations can be busy, and they’ll check the tint color of your windows, your signals, mirrors and if your car checks out, they will give you a slip of paper that you can bring to the department of licensing.  You may have to wait in line at the DOL for half a day, so be prepared.  Bring something to read and some snacks and don’t forget to take a number.  Licensing your car in Hawaii might be more expensive than in your Mainland State.  Once your car is registered, you need to drive back to the safety inspection office and have them stick a safety sticker on your car.  I told you it was a process didn’t I?

12)  It can be hot and muggy, especially in the summer months.  There are days when the trade winds aren’t blowing or the “Kona” winds blow up from the south and the weather can be a bit uncomfortable for those of us who are not used to the humidity.  The trade winds usually keep it pleasant because they blow a cool breeze over the islands but don’t count on that 100% of the time.  You may want to have an air-conditioner where you live.  Do you pay the electric bill?  See #7 about things being expensive in Hawaii – including electricity.

13)  There are centipedes, cockroaches, scorpions, geckos, lots of different birds, frogs, and of course mosquitos.  I don’t mind the geckos, birds and most frogs – I enjoy them except when they occasionally keep me awake at night.  Centipedes, scorpions, cockroaches and mosquitos I don’t like however I learn to take proper precautions to avoid them.  Take your trash bags outside every night before you go to bed!

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14)  Be persistent if you’re trying to reach someone be telephone or email.  I learned that sometimes people don’t get back to you right away.  If you’re trying to rent a house or apartment, or conduct any form of business be persistent (not annoying) because sometimes people in Hawaii might not call or email you back immediately.   Because this can be frustrating for me sometimes, I try to get back to other people as quickly as possible.

15)  You don’t need as many clothes.  Pick out a few pairs of shorts, aloha or T-shirts, some slippers, sunglasses and a hat and you’re ready for most days. On work days, wear some nice lightweight pants and shoes.  Even most business professionals don’t wear a tie (even most doctors) but you’ll want to check with your employer on their standards.  You might need one lightweight sweatshirt or sweater but unless you’re spending lots of time on Haleakala, Mauna Kea or one of the other mountains you probably won’t need a coat.

16)  Wear sunscreen every day.  The sun here is intense and you can get burned very quickly.  I can’t tell you how many tourists that I’ve treated for sunburns while working as a physician in Hawaii.  Melanoma, and carcinoma of the skin are also very common.  You’ve probably seen people who have wrinkly skin and walk around with amazing suntans all the time but you don’t want to be one of them.

17)  Be aware of scooters and motorcycles.  They’re sometimes hard to see and are very common in Hawaii.  You might be more aware of them than you want to be if you hear them racing down Ala Moana Boulevard at 1am.

Lahaina motorcycles

18)  Watch what you eat.  As I mentioned in #6, the food is great but if you eat too much local food like rice, macaroni salad, lau-lau, Portuguese sausage, and Loco-Moco you might end up gaining weight quickly.  We have more diabetic patients here in Hawaii than anywhere else I’ve worked.

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19)  Flying from one Hawaiian island to another can be expensive.  I’ve been to all of the major islands (except Niihau and Kahoolawe) and I can say that the cost per mile of flight is more expensive in Hawaii and anywhere else I’ve been.  A one-way ticket to Maui from Oahu is around $100 per person unless you find a special deal.

20)  Having a small car might be an advantage especially if you live on Oahu because parking can be difficult, and gas prices are high.

21)  If you buy things on the Internet, be aware that shipping prices can be extremely expensive!  You may often pay more to ship an item to Hawaii from the mainland than what the price of the item is.  Look for free shipping or have things shipped to the mainland and bring them with you if you travel back and forth.

22)  You will hear people talk pidgin – the local language that is actually a mixture of many different languages.  You may not understand it but if you live here long enough, you will learn some of the words.

pidgin-to-da-max

23)  There are natural disasters such as hurricanes and tsunamis here that you might not be used to on the mainland.  Register yourself and your family with the emergency contact registry and get a weather radio.  Consider getting a ham (amateur) radio license to be able to communicate in a disaster.

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24)  Hawaii does not have daylights savings time.

25)  Don’t leave items in your car in plain sight.  This isn’t just in Hawaii but anywhere.  I’ve heard many stories about tourists who arrive in Hawaii and drive right to Costco from the airport with their luggage in their car only to come back from shopping to find everything gone.

26)  Each island in Hawaii is different.  I’ve met so many people who have been to Hawaii year after year and they come to the same island and often stay in the same place.  Each island has it’s own charisma and things about it that make it unique. Kauai is the most beautiful place I’ve been, Oahu has something from everyone, Maui has a unique valley and some of the best windsurfing in the world, Lanai has a couple great resorts and is very expensive to visit, Molokai has awesome sea cliffs and also has Kalaupapa, a place where patients with leprosy (Hanson’s disease) were quarantined and the Big Island has an active volcano and some of the most amazing places to star-gaze in the world.  Check them all out before you decide where you want to live.  Learn the difference between the Big Island of Hawaii and the island of Oahu where Honolulu and Waikiki are.

27)  Living in Hawaii is not a 24/7 vacation.  I’ve worked longer hours in Hawaii than any other job since residency.  There are some weeks that I never get to the beach.

28)  The school system is different than the mainland.  I don’t have children, but if I did I would learn all I could about public versus private schools and where the best schools are in Hawaii and take that into account when deciding where to live.

29)  Some people get “island fever” also known as “rock fever.”  They have a feeling of being trapped on the island.  I’ve never experienced that feeling but I recommend that you try living in Hawaii for a few months before deciding that you want to up-root your family and move here permanently.

30)  This list is a work in progress and will change as I live here longer.

I hope that you’ve found some of this information useful.

Aloha!

Scott Rennie, DO

March 29, 2013

What you need to know about the HPV (Human Papillomavirus Vaccine)

shutterstock_167922080One of the most controversial topics in medicine recently has been the HPV vaccine.  It can save lives by helping prevent cervical cancer but must be given at an early age.

What is HPV?  Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States.  More than half of sexually active men and women are infected with HPV at some time sin their lives.

About 20 million American are currently infected, and about 6 million more get infected each year.  HPV is usually spread through sexual contact.

Most HPV infections don’t cause any symptoms, and go away on their own.  HPV can cause cervical cancer in women.  Cervical cancer is the 2nd leading cause of cancer deaths among women around the world.  In the United States, about 12,000 women get cervical cancer every year about 4,000 are expected to die from it.

HPV is also associated with several less common cancers, such as vaginal and vulvar cancers in women, and anal and oropharyngeal (back of the throat, including base of the tongue and tonsils) cancers in both men and women.  HPV can also cause genital warts and warts in the throat.

There is no cure for HPV infection, but some of the problems it causes can be treated.

HPV vaccine: Why get vaccinated?  The HPV vaccine is one of two vaccines that can be given to prevent HPV.  It may be given to both males and females. This vaccine can prevent most cases of cervical cancer in females, if it is given before exposure to the virus.  In addition, it can prevent vaginal and vulvar cancer in females, genital warts and anal cancer in both males and females.  Protection from HPV vaccine is expected to be long-lasting.  Vaccination however is not a substitute for cervical cancer screening.  Women should still get regular Pap tests.

Who should get the HPV vaccine and when?  HPV vaccine is given as a 3-dose series.  The first dose is initially given, with the second dose 1-2 months after the first dose and the final third dose is given 6 months after dose 1. Additional (booster) doses are not recommended.  The HPV vaccine is recommended for girls and boys 11 or 12 years of age.  It may be given starting at age 9.

Why is HPV vaccine recommended at 11 or 12 years of age?  HPV infection is easily acquired, even with only one sex partner.  That is why it is important to get HPV vaccine before any sexual contact takes place.  Also, response to the vaccine is better at this age than at older ages.

Catch-Up Vaccination:  This vaccine is recommended for females ages 13-26 years of age who have not completed the 3-dose series or males 13-21 years old who have not completed the 3-dose series.  This vaccine maybe given to men 22 through 26 years of age who have not completed the 3-dose series. It is recommended for men through age 26 who have sex with men or whose immune system is weakened because of HIV infection, illness or medications.   It may be given at the same time as other vaccines.

Some people should not get HPV vaccine or should wait:  Anyone who has ever had a life-threatening allergic reaction to any component of the HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine.  Tell your doctor if the patient has any severe allergies, including an allergy to yeast. HPV vaccine is not recommended for pregnant women, however receiving the vaccine when pregnant is not a reason to consider terminating the pregnancy.  Women who are breast feeding may get the vaccine.  Any woman who learns that she is pregnant when she got the vaccine is encourage to contact the manufacturer’s HPV-in-pregnancy registry at 800-986-8999.  This will help us learn more about how pregnant women respond to the vaccine.

What are the risks from this vaccine?  The HPV vaccine has been used in the U.S. and around the world for about six years and has been very safe.  Any medication however could possibly cause a serious problem or severe allergic reaction.  The risk of vaccines causing serious injury or death however is very small.  Life-threatening allergic reactions from vaccines are very rare.  If they do occur, it would happen within a few minutes to hours after the vaccination.  Several mild to moderate problems are known to occur with this vaccine.  These symptoms do not last long and go away on their own.

1)      Reactions in the arm where the shot was given

2)     Pain around the injection site

3)     Redness or swelling around the injection site

4)     Mild fever up to 100 degrees F

5)     Moderate fever up to 102 degrees F

6)     Headache

7)     Fainting during the procedure – usually caused from being nervous

What if there is a moderate or severe reaction – what should I look for?  Any unusual condition such as high fever or behavior changes of the person who received the vaccination.  Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, fast heart rate or dizziness.  If any of these occur, call a medical provider or 911 immediately.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: http://doctorrennie.wordpress.com

This information comes from the U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC).

March 28, 2013

Celiac Disease – Adopting a Gluten Free Diet to Manage Intolerance or Sensitivity

shutterstock_146760950One of the hottest topics in medicine these last few years has been the gluten free diet.  I’ve had countless numbers of patients ask me about “going gluten free” to help with weight reduction, low energy levels, gas, constipation, heart burn, or for various other reasons.  The information about gluten and reasons for avoiding it are rather widespread – some of the information released is valid while others are rumors or just downright advertising.

What is Celiac disease, gluten intolerance and gluten sensitivity?  In the medical field we refer to a condition called Celiac disease which is a condition that affects perhaps up to 1% of our population.   The affected patient’s immune system can damage their small intestine as a reaction to Gluten, a common protein found in most modern day diets. People with the condition are advised to avoid wheat, rye, barley and many prepared foods because they may feel very ill if they consume these products.

Celiac disease is also called gluten sensitive enteropathy, Celiac sprue or nontropical sprue.  Gluten intolerance may also be sometimes called gluten sensitivity, a less severe disorder that affects perhaps up to 10% of our population.  Symptoms may be milder than with Celiac disease and may affect other areas of the body in addition to the gastrointestinal tract. The definition of gluten intolerance has been changing over the years as we work to understand more about the condition.

The small intestine is the part of the body which absorbs nutrients from the food that we eat.  In patients with Celiac disease, the small intestine becomes damaged by the immune system so patients have problems absorbing nutrients from the food that they eat.  Gluten is fairly indigestible in most people and some experts believe that there is a certain amount of gluten intolerance in all of us.

What are the symptoms of Celiac disease?  Patients may experience diarrhea, weight loss, abdominal discomfort, excessive gas and vitamin/mineral deficiencies.  Patients with gluten intolerance may be more prone to osteoporosis, iron deficiency anemia, autoimmune problems with the thyroid, liver, type 1 diabetes, and nervous system problems.

In addition, patients with Celiac disease may be more likely develop lymphoma which is a cancer of the intestinal lymph system.  This is uncommon but we think that avoiding gluten can help prevent the development of lymphoma.  Celiac disease has also been associated with a skin condition called dermatitis herpetiformis.  This causes itchy, raised fluid filled areas on the skin mostly in areas such as the elbows, knees, buttocks, lower back, face, neck, trunk and sometimes in the mouth. The symptoms of this skin condition are mostly the intense itching and burning.  Once the blisters rupture, the itching is relieved but scratching the blisters can rupture them and leave dark areas of skin and permanent scarring.  Eliminating gluten for the diet may help the condition improve after several weeks of remaining on a gluten free diet.  A medicine called Dapsone may be taken to help with the itching but this medication does not help heal the intestine which was damaged by the immune system.

How can you test me for Celiac disease?  If you have symptoms that are very suspicious for Celiac disease there are a variety of tests that can help make the diagnosis in addition to being evaluated by a medical provider.  One of the gold standard tests to help us determine whether you have Celiac disease is to take a biopsy of the lining of the small intestine.  A small sample of tissue from your intestine is examined with a microscope after it has been collected during a procedure called an endoscopy.  As you can imagine, this is not a procedure that is done while patients are awake so it is usually performed in the hospital or an outpatient surgical center where nurses and other medical providers can give you medication through an IV to help make you comfortable.

There are also blood tests that can help determine whether a patient has Celiac disease.  These tests are often part of a “Celiac blood panel” but can be ordered separately.  They are antibodies called the anti-total tissue transglutaminase (TTG) and anti-endomysium antibody (EMA) total imunoglobin A (total IGA), anti DGP antibody, antigliadin antibody (AGA), anti-F-actin test and sometimes antireticulin antibody (ARA).  Your medical provider will help determine which tests are appropriate and interpret the results.

There is not a test however for gluten intolerance.  The blood tests and intestinal biopsies may be completely normal for those who have gluten intolerance but they simply feel better eating a gluten free diet.

Who gets Celiac disease?  We aren’t sure why people get Celiac disease but we think there is a genetic component.  It is rare if people from northern Asia or Southern Africa and more common in patients from Europe, North and South America, South Asia, Middle East and North Africa.

Treatment:  About 70% of people feel better two weeks after they stop eating foods with gluten.  The blood antibody levels often return back to normal as patients stop eating foods with gluten.  Gluten is the group of proteins found in wheat, rye and barley.  It’s also hidden in a large number of prepared foods and supplements.  It can be very challenging to eliminate gluten from your diet because it takes some major lifestyle changes.  It is important to avoid eating gluten and being exposed to it in the air as well.

I recommend consultation with a dietician who specializes in helping patients with Celiac disease.  They can help patients learn what foods to avoid and what foods you need in order to get a balanced diet.

There are a large number of stores that are now offering gluten free foods in certain areas of the United States.

1)      Examples of gluten free foods are rice, corn, potato, beans, legumes (beans, etc.), nuts, seeds, and soy

2)     Foods to avoid are obviously anything with wheat, rye, barley, brewer’s yeast, oats (unless labeled gluten free), and malts

3)     Some people with Celiac disease cannot tolerate oats even if they are labeled gluten free

4)     Wine is usually gluten free unless it contains gluten free flavorings

5)     Most beers have gluten unless they are labeled “gluten free”

6)     Many people with Celiac disease have trouble with dairy products until their intestines return to normal.

7)     Make sure you are getting enough calcium and vitamin D

8)     If you have Celiac disease, you should have blood tests for iron, folic acid, vitamin B12 and vitamin D to make sure your levels are adequate.

9)     There is concern about patients with Celiac disease developing osteoporosis (low bone density) so some clinicians recommend getting a bone density test (DEXA) to measure your bone density.

I think that I may have gluten sensitivity, gluten intolerance or even Celiac disease – should I try a gluten free diet?  I suggest you talk with your health care provider and a dietician before starting a gluten free diet because cutting out gluten doesn’t mean you will be healthier.  After consultation with a medical provider, perhaps you be get tested for Celiac disease with some blood work and/or a biopsy.  If these tests are negative, you can still try a gluten free diet to see if you feel better, but I’d recommend getting help from a dietician to make sure you understand where “hidden sources” that are not obvious in the foods that we eat.  You also don’t want to miss out on the vitamins and minerals that wheat products provide.  Manufactures of gluten free products may add sugar or fat to their products to simulate the texture of foods that contain gluten have.  Gluten free products also often contain less iron, vitamin B and vitamin D than bread products so it’s important to make sure you’re getting enough of these in your diet from other sources.

Where can I find more information about Celiac disease? 

1)      American Celiac Disease Alliance:  www.americanCeliac.org

2)     American Gastroenterological Association:  www.gastro.org/patient-center/digestive_conditions/Celiac-disease

3)     Celiac Disease Foundation:  www.Celiac.org

4)     Gluten Intolerance Group of North America:  www.gluten.net

5)     National Foundation for Celiac Awareness (NFCA):  www.Celiaccentral.org

6)     National Library of Medicine: www.nlm.nih/gov/medlineplus/Celiacdisease.html

7)     North American Society for the Study of Celiac Disease:  www.nasscd.org

8)     Celiac.com:  www.Celiac.com

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: http://doctorrennie.wordpress.com

References:  Ciclitira PJ, King AL, Fraser JS. AGA technical review on Celiac Sprue. American Gastroenterological Association. Gastroenterology 2001; 120:1526

March 27, 2013

Diabetes Foot Care

shutterstock_110360354Patients who have diabetes need to pay extra attention to their foot care to help prevent infections.  I’ve had numerous patients with diabetes need foot or toe amputations that could have been prevented with excellent foot hygiene.  Small scrapes in the skin or ingrown nails can become extremely bad very quickly with diabetes because patients who have diabetes often don’t have as much sensation (due to damage to the nerve endings and blood vessels in your feet).  This can make it difficult to detect sores and once an infection is present it can be very difficult to treat.  I thought I’d put together some tips to help you keep your feet healthy and decrease the risk for infections.

1)      Stop smoking:  If you smoke, this can decrease the blood flowing to your feet and make foot problems worse.

2)     Inspect your feet everyday:  Look for blisters, cuts, cracks or sores.  If you cannot see your feet well then use a mirror or have a family member help you.

3)     Wash your feet everyday:  Use warm (not hot) water – be sure to check the temperature with your hands rather than your feet.

4)     Dry your feet well:  Pat them dry and do not rub the skin on your feet too hard.  Dry between each toe.  If the skin on your feet stays moist, bacteria or fungus can grow and that might lead to a foot infection.

5)     Keep your feet soft:  Use a skin moisturizer such as Aveeno, Dove or Cetaphil on your feet to keep your skin soft and prevent calluses and cracks.  Don’t put the cream between your toes unless you are treating athlete’s foot with a fungal cream.  Make sure to wear socks or traction on your feet after applying the cream so you don’t slip and fall.

6)     Clean under your toenails carefully:  Don’t use sharp objects under your toenails.  Instead use the blunt end of a nail file or other rounded tool to decrease the chance of piercing the skin.

7)     Trim and file your toenails straight across:  This helps prevent ingrown nails.  Use a nail clipper instead of scissors.  Then use an emery board to smooth the edges.  If you need help trimming your nails, schedule an appointment with your medical provider.

8)     Change your socks everyday:  Socks should have a thick cushion and fit loosely around your feet.  Socks without seams are best because seams often rub the feet.  Do not wear stockings, socks, or garters that come up to the thigh or knees unless your medical provider advises you to do so because they can decrease the blood flow to your feet.

9)     Look inside your shoes before putting them on:  Check them every day for gravel, torn linings, or thorns that can cause blisters or sores.

10)  Do not go barefoot:  Don’t wear sandals or shoes with thin soles because these types of shoes are easy to puncture.  They also do not protect your feet from hot pavement or cold weather.

11)  Have your medical provider check your feet during each visit:  If you notice a problem with your feet, see your medical provider right away rather than trying to treat it with a home remedy.  Some home remedies or treatments that you can buy without a prescription (such as corn removers) can be harmful.

12)  Keep your blood sugar down:  Watch what and how you eat, monitor your blood sugar, take your medications and get regular exercise.

When to seek medical help:

A)      If you cannot do proper foot care

B)     If you have a foot sore or ulcer that is not healing after 3 days (including corns, calluses or ingrown nails)

C)     If you have black and blue areas in your toes or feet

D)    If you have peeling skin or blisters between your toes

E)     If you have a fever for more than 24 hours and a foot sore

F)     If you have new numbness or tingling in your feet that does not go away after you move your feet or change positions

G)    If you have unexplained or unusual swelling of your foot or ankle

H)    Anytime you have questions about your feet or concerns it is best to contact your medical provider

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: http://doctorrennie.wordpress.com

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