What should we do about male-pattern hair growth on females?

What should we do about male-pattern hair growth on females?  The medical term for this condition is hirsutism.  Hirsutism affects 5-10% of premenopausal women and is usually an indication of an underlying endocrine disorder like polycystic ovarian syndrome.  Women with hirsutism have coarse dark hairs in androgen-sensitive areas like the upper lip, chin, back, and buttocks.  Please see your physician to investigate the root cause of the hirsutism.

There was a recent meta-analysis, where many studies are combined to get a more robust result.  The best treatment for hirsutism is birth control pills with combined estrogen-progestin pills.  Other medications that help curb this hair growth are antiandrogens like finasteride or metformin a medication used mostly for diabetics.

Want more information?  J Clin Endocrinol Metab 2018: 103 (4): 1258-1264.

I hope this helps.

Posted in General Medicine- Adults, Uncategorized, Women's Health | Tagged , , , , , , , , , , , ,

Are you older than 50? Get your Shingrix!

Are you older than 50?  Get your Shingrix!

What is Shingrix?  It is the “new” shingles vaccine.  Shingrix, also called recombinant zoster vaccine, is a rockstar of vaccines.

It decreases shingles infections

  • For those 50-59 years, Shingrix decreases shingles by 96%
  • For those 60 to 69 years, Shingrix decreases shingles by 97%
  • For those 70 and older, Shingrix decreases shingles by 91%.

It also decreases postherpetic neuralgia, the medical term for long-term nerve pain where the shingles rash was.  This can continue after the rash has cleared.

  • For those 50 to 69 years,  Shingrix decreases postherpetic neuralgia by 89%
  • For those 70 and older, Shingrix decreases postherpetic neuralgia by 89%

The FDA suggests that if you received Zostavax in the past, you should get the Shingrix vaccine.  In comparison, Zostavax is only 51% effective in preventing shingles and 67% effective in preventing long-term nerve pain.

Want more information? https://www.aafp.org/afp/2018/1015/p539.html

the vaccines

flickr.com/photos /lavid/ 01793987


Posted in Dermatology, General Medicine- Adults, Uncategorized, Vaccines | Tagged , , , , , , ,

What helps knee arthritis pain?

What helps knee arthritis pain?  It depends on how long the knee present has been present…

For those with 4 to 12 weeks of knee pain, beneficial interventions are

  • tai chi,
  • home-based exercise (physical therapy can help get you started),
  • transcutaneous electrical nerve stimulation (a TENS unit), and
  • self-management programs like strength, agility, and pain-coping skills.

For those with 12 to 16 weeks of knee pain,

  • platelet-rich plasma injections (of which most insurances do not pay and this is a cash-pay treatment) and
  • home-based or self-management skills (as above) may help.
  • Glucosamine and chondroitin supplements may have medium-term, but no known long-term benefits.

For those with pain for more than 26 weeks, beneficial interventions include

  • agility training,
  • exercise programs,
  • self-massage,
  • acupressure, and
  • weight loss.
  • img_0821
Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , ,

How to decrease nausea and vomiting during pregnancy?



How to decrease nausea and vomiting during pregnancy?

There are lots of treatments.  First, the pregnant woman should change lifestyle modifications.  Eating frequent small meals, avoiding foods that smell or taste adversely, avoid high-protein or fatty foods which can slow gastric emptying.

There are also over the counter treatments that may help.  Vitamin B6 (pyridoxine), doxylamine (Unisom) and even P6 acupressure.  See https://exploreim.ucla.edu/self-care/acupressure-point-p6/ for more information about this.

If all of these do not work, ask your physician for prescription medication.

Want more information?  https://www.aafp.org/afp/2018/1101/p595.html

I hope this helps.

Posted in General Medicine- Adults, pregnancy, Uncategorized, Women's Health | Tagged , , , , , , , , , ,

What is deprescribing and why you should want it?!

What is deprescribing and why you should want it?!  Deprescribing is the act of removing medications that are no longer needed or beneficial.

Our health care system is geared toward starting medications and not stopping them.  Did you know that nearly half of older adults take five or more medications and studies have shown that as many as 20% of the prescriptions are potentially inappropriate?

Polypharmacy is the concurrent use of multiple medications by a patient.  When medications are combined in the body, there is a potential for harm as medications may interact with each other or conditions or cumulative harms can outweigh the medication’s benefits.

What should be done?  This is a prime opportunity for shared decision making between the physician and patient AND to focus on the patient and their wishes.

Your physician should prioritize ongoing treatments.  Which medications should continue?

Assess your body’s ability to break down the medication.  As we age our ability to metabolize the medication through our liver or kidneys may decrease.  This may mean that a medication dosage should be decreased or stopped to avoid adverse effects.  This lower dosage may still achieve the same benefit.

As we age our goals of treatment evolve.  This conversation allows patients the choice regarding continuing or stopping medications.  For instance, when you are 90 years old do you want to take a cholesterol-lowering medication?

How should your physician go about this deprescribing pathway?

  1. Identify potentially inappropriate medications (Is it causing drowsiness which may lead to a fall?)
  2. Can the dose be reduced?  or the medication discontinued? (Was the medication started for a condition like reflux which is now controlled?)
  3. make a plan to taper medication dosage (Should a drug holiday be used to see if symptoms recur?  or just taper and then discontinue?)
  4. monitor the patient for symptoms requiring restarting or increasing dosage of medication
  5. document outcomes in the chart (like how is the blood pressure now that the medication has been changed)
elderly people walking

flickr.com/ photos/ tokaris/ 207335658

Want more information?

http://medstopper.com/  is a deprescribing tool for both patients and physicians.


I hope this helps.

Posted in end-of-life issues, General Medicine- Adults, medication issues, Uncategorized | Tagged , , , , , , , , , , , , , ,

Your prescriptions are being monitored!

img_2545Your prescriptions are being monitored!  For years I have received information from insurance companies to let me know which patients are not compliant with their medications.  How do they know this?  They watch how often you pick up a refill on your chronic medications from the pharmacy.

Now, there is an additional prescription monitoring plan. Nevada Board of Pharmacy how has an “enhancement” to the Nevada Prescription Monitoring Drug Program for controlled substances (think opioids, benzodiazepines, and prescription sleep medicine).  The new support tool is called NarxCare.  NarxCare will “aggregate and analyze” prescription information from providers and pharmacies.  It will give the physician visual, interactive information in addition to advanced analytic insights, machine learning risk scores and other information to help physicians and pharmacists provide better patient safety.

NarxCare will give physicians a NarxScore and an Overdose Risk Score.

I do believe that this information will be helpful to pool the data (meaning add together the controlled prescriptions from different pharmacies and physicians), but it also feels a little big brother-ish.


Posted in General Medicine- Adults, medication issues, Uncategorized | Tagged , , , , , , , , , ,

Take teething bead necklaces off of children

Take teething bead necklaces or bracelets off of children.

Why?  The FDA reports children have choked on beads that break off and an 18 month-old has died from strangulation from a necklace during a nap.

What are they?  Teething jewelry is often necklaces or bracelets made of amber, wood, marble or silicone.  They are marketed to parents to “help relieve teething pain.”

What is a less dangerous teething treatment?  Massaging the teething child’s gums or giving them a hard rubber teething ring to gnaw on.  Avoid gels, creams, and products containing benzocaine… as benzocaine can also be harmful.

Do no harm.

Want to read more?  https://www.fda.gov/Safety/MedWatch/HowToReport/ucm2007306.htm

Posted in Uncategorized