HPV or Human Papillomavirus Vaccination

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Update 

          HPV or human papilloma virus is one of the most common sexually transmitted diseases, infecting more than half of sexually active individuals at some time in their lives.  Because some types of HPV can cause genital, anal and throat cancer, the American Academy of Pediatrics and the Centers for Disease Control and Prevention have extended their vaccination recommendations to include immunizing boys as well as girls with a three doses series of HPV vaccine at age 11 to 12 years.  The review article published on HealthyChildren.org provides a good summary of the Human Papilloma Virus Infection and the HPV Vaccine Recommendations.

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Diverticulosis

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A Common Colonic Condition in the Western World 

          Diverticulosis is a condition characterized by a series of small, pea to marble sized pouches that extend outward from the colon into the abdominal space, almost like a small hernia in the muscle wall of the colon.  The inside of the pouch is connected to the inside of the colon and it is lined only by the mucosal tissue layer.  It occurs most commonly in the distal or sigmoid colon on the left side of the abdomen and the number of diverticula present may vary from one to many.  Diverticulosis is quite common in the western world, affecting half of individuals in their 70s and 80s.  On the other hand, it is much less common in those under 40 years of age, those living in the rural regions of Asia and Africa and those following a vegetarian diet. 

Cause of Diverticular Disease 

          Now that we have seen who is most likely to develop diverticular disease, we get a hint as to the cause of this common condition.  Most of the research points to a combination of insufficient dietary fiber, increased pressure and contractility of the colon and reduced transit time through the intestine.  Diets high in fats and refined carbohydrates are also thought to contribute to the development of diverticulosis.  Obesity, constipation and postponement of defecation are other possible contributing factors.  Tics, as they are affectionately known in the medical world, are most often asymptomatic and unless they flare up, do not need any treatment other than perhaps to increase the fiber in the diet. 

Diverticulitis 

          The main significance of having diverticulosis is that it can progress to diverticulitis.  Diverticulitis is an inflammation in the pouch protruding from the colon caused by obstruction at the neck of the diverticulum, usually by fecal matter.  A bacterial infection can develop in the pouch, in a manner similar to the mechanism that causes the usually quiescent appendix to progress to appendicitis.  Occasionally this can lead to perforation and the development of peritonitis, an infection of the peritoneum which is a thin membrane that lines the inner abdominal wall and covers the organs contained therein.  Between 15 and 25% of patients with diverticulosis will develop diverticulitis. 

Symptoms and Diagnosis 

          Diverticulosis is usually asymptomatic and often detected only as an incidental finding during a routine colonoscopy.  Some patients may, however, experience abdominal discomfort, bloating, constipation or rectal bleeding.  Up to 85% of diverticula occur in the sigmoid or descending colon, which are located on the left side.  For this reason the most common symptom of diverticulitis is left lower abdominal pain, often with fever.  Patients may also have a change in bowel habits, rectal bleeding, nausea and vomiting, and symptoms related to the urinary tract.  As is often the case, a good history and physical examination is one of the best ways to diagnosis diverticulitis, but a CT scan of the abdomen and pelvis is the definitive confirmatory test.  In addition, a CBC or complete blood count will usually show an elevated white blood cell count. 

Treatment and Prevention 

          Increasing the amount of fiber in the diet is a good idea for individuals of all ages.  It may be especially important for those with known diverticula.  Avoiding constipation by increasing activity and drinking plenty of fluids may also help.  When diverticulitis is present, the treatment consists of antibiotics.  Mild diverticulitis without evidence of peritonitis can usually be treated at home with oral antibiotics, but patients with complicated diverticulitis or other significant medical conditions are usually treated in the hospital with intravenous antibiotics.  Surgery is usually not necessary after a single episode of diverticulitis since only 25% will go on to have another.  In cases of recurrent diverticulitis or in the presence of other complications, surgery may be necessary.  While colonoscopy is not advised during the acute phase of diverticulitis, it should be performed after it has resolved to rule out malignancy.  It is important to consult your health care provider if you have any questions about diverticular disease.

Video Clip Showing What Diverticula Look Like on Colonoscopy         

[yframe url=’http://www.youtube.com/watch?v=Mwa1qu9W2mM’]

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Scabies

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The Seven Year Itch

          Recognized since biblical times, scabies is a contagious, itchy skin infection caused by the burrowing parasitic mite, Sarcoptes scabiei.  The name is derived from the Latin word scabere, meaning ‘to scratch’, and the infestation was known as the ‘seven year itch’ before effective treatment was available.  These tiny, eight-legged critters related to spiders and ticks are usually not visible to the naked eye.  It is the female who burrows into the outer layer of the host’s skin to lay her eggs which then hatch in three to ten days.  The movement of the mites under the skin cause severe itching which is allergic in nature.  Scabies is one of the most common skin diseases in children and it is estimated that 300 million cases occur throughout the world each year. 

Transmission 

          Scabies is transmitted by direct personal contact, particularly during sex, and is not necessarily prevented by the use of condoms.  Because sexual contact is one of the most common ways that scabies is transmitted, it is sometimes considered a sexually transmitted disease.  The longer the direct skin to skin contact the more likely the infestation will be spread.  While scabies can also be contracted from objects such as sheets, clothing and furniture, this is much less common than transmission through direct contact with skin.  The mites can survive away from the host for 24 to 36 hours, accounting for their ability to spread through contact with these inanimate objects.  Scabies can spread quickly in crowded environments like nursing homes and day care centers, but is less likely to do so in the school setting.  

Diagnosis 

          As with so many afflictions of the human body the presence of a scabies infestation can usually be diagnosed by a good history and physical examination.  The itching begins a month to six weeks after exposure and is typically worse at night and with exposure to warmth.  Often another member of the family will also complain of itching.  Typical areas of the body that are affected with the small red bumps and blisters typical of the rash include the soft skin webs between the fingers, the ventral wrist area (same side as the palm), the underarm area, the feet, buttocks and external genitals, particularly in males.  The hands are often the first site to become infected.  Sometimes burrows appearing like thin, curved pencil marks can be detected and excoriation of the skin is common due to scratching.  All of these signs can be magnified in elderly and in immunocompromised individuals.  A definitive diagnosis can be made from a skin scraping and identification of eggs and feces during examination under the microscope. 

Treatment and Prevention 

          Scabies can be effectively treated with the application of permethrin cream prescribed by your health care provider.  The cream is usually applied to the entire body from the neck down at bedtime and then washed off in the shower eight to fourteen hours later.  A full body treatment is necessary, regardless of where the rash is located.  In some cases the cream must also be applied to the head, scalp and face and occasionally it is necessary to repeat this application one week later.  Itching often persists for a week or so even after effective treatment and can be alleviated by the use of antihistamines.  To prevent reinfestation, any clothing, bed sheets or towels that the patient has used should be washed and dried using high heat.  It is often necessary to treat the entire household even if they do not have symptoms in order to irradiate scabies.  If you suspect that you might have scabies it is important to contact your healthcare provider for proper diagnosis and treatment.

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Five Healthy New Year’s Resolutions

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With the holidays over and the New Year upon us it’s time once again to make our New Year’s resolutions.  This annual tradition of setting goals to accomplish in the coming year has its roots in one way or another in most of the major religions…the concept of reflecting upon self improvement on an annual basis.  While the success rate of keeping resolutions varies widely among individuals, the idea is worthy and many are rewarded for their efforts.  Goals related to health are among the most popular New Year’s resolutions and the following are five of my suggestions to help you achieve a year of better health in 2012.

1)  Strive for Your Ideal Weight

Obesity has become a national epidemic for a variety of reasons, including overeating, lack of exercise, and sedentary lifestyle.  It now affects all age groups from children to young and middle age adults to the elderly.  While men used to start showing some extra abdominal weight when they entered middle age, it is now common to see men in their early twenties sporting a ‘beer belly’.  Abdominal weight contributes to other health problems and is the most difficult fat to get rid of.  Here are my recommendations for getting a good start on controlling your weight:

-Invest in a good quality bathroom scale and weigh yourself every day just before stepping into the shower.  If you are close to your ideal weight, take time to get familiar with how your weight changes from day to day, what causes it to change and the weight at which you ‘feel right’.  To maintain that weight, cut back on intake when the scale shows you are trending upwards.  For those who are beginning with excess weight, use your daily weigh-ins to help you resist adding any additional pounds at least for starters.

-Next, set modest goals that you can achieve.  Consult your health care provider, who can help you establish a realistic weight loss program.

-Familiarity with the fat and calorie composition of the food we eat is important.  Check out the free healthy eating apps available for your smart phone (see link below) and use them while shopping or ‘grazing’ at home.

-Substitute those high calorie sodas with water or tea.  Remember it takes about 15 minutes of running to burn off 150 calories and there are 140 calories in a 12 oz coke and 140 to 200 calories in a 12 oz beer.

-Make mealtime a time to sit down and relax.  Eat slowly to give the satiety center in your brain sufficient time to recognize that you have had enough so that it can turn off the hunger pangs.

-Consider joining a weight loss support program like Weight Watchers or TOPS.

2)  Establish an Exercise Routine

Exercise can help keep your weight under control, improve stamina and reduce stress.  Before embarking on a new exercise routine, it is important to consult your health care provider to determine the level of activity that is safe for you.  Whether you join a gym, play school sports, take a daily walk or participate in exercise classes in a nursing home, the benefits will accrue over time.  Personally, I have joined a gym (24 Hour Fitness) and stick to a regular routine that has made a big difference in how I feel (and maybe even a little difference in how I look).  Walking is one of the best ways to get exercise without putting stress on your joints…and it’s free!  Other great forms of exercise include swimming, bike riding or just working in the yard.  You may not be able to fit exercise time into your busy schedule every day, but aim for an average of 30 minutes a day over a week’s time.  Finally, I urge you to get involved in your children’s schools to ensure that they are getting adequate activity on a daily basis.  In middle school and high school this should include a full period of physical education every day.

3)  Reduce Stress

Stress not only produces an unpleasant feeling, but it also contributes to other health problems, such as heart disease.  For most of us a certain amount of stress in our lives is a given…for some more than others, depending on your own personal situation.  There are ways to control and reduce stress that will improve the quality of your life as well as your health.  Sports and exercise are great ways to help reduce stress.  Taking time out each day just for ‘you’ is important especially for caregivers, whether you are caring for your children or your parents or a disabled loved one.  Even if it means just sitting down and relaxing with a glass of wine while listening to your favorite music, everyone needs to have time for themselves.  Finally, pursue your dreams.  Go back to school, learn something new, travel.  Take time for you.

Other actions that may help reduce stress might be getting finances under control, mending relationships, or volunteering your services to a worthy cause.  There is nothing like helping others to make you feel good about yourself.  Additionally, if you are not getting enough sleep, make adjustments in your sleep habits.  Connecting with others who have a positive outlook and avoiding those who do not can help reduce stress.  Social interaction through church activities, a hobby club or just going out to lunch with friends is a great way to get started.  Finally, I’m a firm believer in ‘positive self talk’.  Don’t be too hard on yourself when you haven’t lived up to all of your self expectations.  Give yourself a pep talk now and then.  Sometimes, you may be the only one you can count on to do so.

4)  Rein in Bad Habits

This is perhaps the most common and least fulfilled of the New Year’s resolutions.  While it may be the most difficult to achieve, it can reap the most rewards for those who are successful.  There is little question that quitting smoking, moderating alcohol intake, cutting down on food intake or giving up drugs will improve your health and most likely extend your life significantly.  Some folks are able to do it on their own by slowly cutting down or even by going ‘cold turkey’.  Others will need help.  Don’t hesitate to talk to your health care provider about any unhealthy habits you may have.  There are many resources available to help you take control and you should take advantage of them.

5)  Get Regular Check-ups

Have you been putting off that colonoscopy, prostate exam, flu shot or maybe that visit to the dentist?  There are now many worthwhile preventive measures such as screening tests and immunizations that can help maximize your health.  Many of us procrastinate because we either don’t think we have time or perhaps are afraid of what the test results might show.  Don’t let these be excuses for not taking advantage of the many services available.  Often preventive medicine services are included in health plans with no additional co-pay or are available for a reasonable fee.  Your health care provider can set up a schedule of screening tests tailored to your specific situation based on age, sex and family history.  Check the links below for more specific information on immunizations, health screening tests and examinations.  Resolve to make this the year you follow through on these important health measures for you and your family.

Best wishes for a safe, healthy and happy New Year!

Additional Resources:

Adult Health Screening Guidelines

Healthy New Year’s Resolutions for Kids

Pediatric Screening Guidelines

Immunization Recommendations

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Battery Ingestion Can Cause Serious Injury

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Today’s Batteries Are Smaller and More Powerful 

          With the Christmas season revving up and soon to be in high gear, this seems like a good time to review the potential danger of battery ingestion.  When it comes to Christmas presents, little has changed over the years.  Toys are still the name of the game for ‘kids from one to ninety-two’.  What has changed is the plethora of electronic games and devices now on everyone’s Christmas list and the number and variety of batteries required to operate these and other popular toys.  As many of these devices have become smaller, batteries have had to accommodate them by becoming more compact and more powerful.  At any time of the year it is important to be aware of the potential danger posed by batteries and to take steps to keep them out of reach of younger children. 

Types of Injury 

          One of the most common battery types is the disk or button battery used in many electronic devices.  The small size of these batteries belies the serious injury they can cause when ingested.  These batteries contain heavy metals such as lithium as well as caustic electrolytes.  When one of these batteries is ingested, usually accidentally by children under the age of 4 years or by elderly individuals, it can lodge in the esophagus, the tube connecting the mouth and the stomach.  If this happens, injury can be caused in several ways: (1) by the electrical current that occurs, (2) from the pressure exerted against the wall of the esophagus, or (3) by the leakage of caustic alkali.  These injuries can lead to burns and even perforation of the esophagus.  Occasionally a small battery will become lodged in the airway and cause difficulty breathing.  This, again, is a true medical emergency and requires immediate evaluation and treatment.  It is important to note that button type batteries placed in the nose or ears can also cause injury. 

Symptoms 

          Because serious injury can occur in as little as two hours, it is important to recognize the problem early and seek medical attention.  There may be no obvious symptoms of battery ingestion, but patients may have vomiting, cough, difficulty swallowing, decreased appetite, abdominal pain, low grade fever, irritability or drooling.  You should not wait until symptoms develop before seeking medical care.  While the great majority of ingested batteries pass through the esophagus and the rest of the GI tract until they are eliminated in the stool, about 10 percent of ingestions can lead to serious injury and sometimes even death. 

Treatment 

          Battery ingestion is a medical emergency, so if it is suspected you should go immediately to the nearest emergency room.  The patient should have nothing by mouth until they can be evaluated by a medical professional.  If it is possible to identify the suspected battery without delaying definitive evaluation and treatment, this information may be helpful for emergency room personnel.  Your health care provider will take an x-ray to confirm that a battery has been ingested, particularly if the patient is a child twelve years of age or younger.  An x-ray will also help distinguish between a coin, a button or a battery.  If an x-ray confirms that a battery has been ingested, but has passed beyond the esophagus, it should be monitored until it has been eliminated.  Most batteries will pass in the stool within 72 hours, but can take as little as 12 hours or as long as 14 days.  If the battery is lodged in the esophagus, it must be removed immediately, usually under direct visualization by endoscopy.         

Prevention 

          Batteries should be stored in childproof containers and the battery compartments on toys and other electronic devices should be securely fastened.  Elderly individuals should not keep batteries near pills and the mouth or teeth should not be used to hold batteries while they are being replaced.  If there is any question whether someone has ingested a battery it is best to seek immediate treatment at the nearest emergency room.  Both patients and health care providers can consult the National Battery Ingestion Hotline at the National Capital Poison Center by calling 202-625-3333 any time of the night or day.  Here’s hoping you have a safe and happy holiday season.

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Concussion

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A Common Injury 

          With the high school football season reaching a crescendo as Fall days get shorter, this seems like a good time to discuss one of the most common sports injuries…concussion.  According to the Centers for Disease Control and Prevention (CDC) up to 3.8 million sports related concussions occur in the U.S. every year.  While a concussion is usually not life threatening and most individuals recover, it can occasionally have serious consequences with long-lasting problems.  Recently, several prominent cases that have been covered in the national news have brought this topic home to student athletes, parents and health care providers alike.  Because of the attention these cases received, a number of new laws and guidelines have been suggested. 

Definition 

          Concussion is a mild form of traumatic brain injury (TBI).  Over the past decade the wars in Iraq and Afghanistan have increased public awareness of TBI, also known as the ‘silent epidemic’ because it can have debilitating symptoms for those affected even though they may have no obvious physical signs of injury.  The word concussion is derived from the Latin concussus meaning the action of striking together and from the Latin concutere meaning to shake violently.  As indicated from these Latin derivations, concussion can occur from either a blow to the head or as a result of the head and brain moving quickly back and forth.  While both the classification and definition of concussion are still evolving in the medical community, there is general agreement that a concussion results from a brain injury that involves temporary impairment of neurological function that heals itself with time. 

Signs and Symptoms 

          A concussion can be difficult to diagnose.  It is possible to have a concussion and not lose consciousness or pass out.  Some of the more common signs and symptoms include difficulty concentrating or not thinking clearly, difficulty remembering recent information, headache, blurred vision, nausea and vomiting, dizziness, fatigue, change in mood and changes in the usual pattern of sleep.  For most affected individuals these symptoms occur right away and resolve quickly, but for others they may not manifest themselves until later and the symptoms may be slow to resolve. 

Treatment  

          The presence of certain signs and symptoms should prompt an immediate visit to a physician.  These include a worsening headache, nausea and vomiting, weakness, numbness, slurred speech, drowsiness, confusion or seizure activity.  Any loss of consciousness, even brief, should be taken seriously and warrants an evaluation by a health care professional.  Whenever there is any question whether a concussion has been sustained, a health care provider should be consulted to make the determination.  Athletes with a concussion should not return to sports activities until they have been evaluated and cleared by a physician.  Returning to sports too soon runs the risk of sustaining another concussion which only compounds the problem.  Multiple concussions over time can lead to serious, long term consequences. 

Prevention 

          Of course, not all concussions are sports related.  Wearing seat belts while driving or riding in a car is extremely important for preventing concussions.  Making living spaces safe from slipping, tripping and falling hazards is another easy way to prevent head injury.  It is also important to prevent fighting, which often results in a concussion.  Athletes participating in contact sports such as football, hockey and boxing are at particularly high risk of head injury, so wearing protective gear, including helmets is paramount.  Wearing a protective helmet during activities such as bike riding, skateboarding, and horseback riding is an important strategy in the prevention of concussion in all age groups. 

Take the Online Training 

          The CDC has developed a free online concussion training specifically designed for youth and high school sports coaches, parents and athletes.  Participants will learn important information regarding prevention, recognition and response to a concussion.  Check out this helpful course called “Heads Up Concussion” at the link below.

‘Heads Up Concussion’ Online Course

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