I am a myth-buster! Myth-busting at musculoskeletal issues…

Yes, call me a myth-buster!  In my recent family medicine journal there is a fantastic article (with research to back up their recommendations) that helps with musculoskeletal issues.  Which of these categories do you fit in?!

Are you a middle-aged patient with a meniscal tear (and little to no arthritis in that knee)?  If so, consider NOT having arthroscopic surgery as long-term outcomes with pain or function may be better after conservative management of physical therapy.

Do you have knee pain with degenerative joint disease?  If so, injections of (expensive) hyaluronic acid help only minimally more than placebo injections.

If you have knee osteoarthritis consider buying normal walking shoes, not “specially-designed walking shoes” as they both help with pain and function the same

If you have chronic low back pain, consider physical therapy to help for pain and disability, only have a lumbar fusion surgery as a last resort.

If you have chronic non-cancer pain, avoid long-acting opioids.  Long-acting opioids significantly increase the risk of premature death.

More myth-busting to come…

Posted in General Medicine- Adults, Uncategorized, vitamins and supplements | Tagged , , , , , , , , , ,

To follow is NOT a sexy topic, but very important– how to prevent falls for yourself (…or your parent)

To follow is NOT a sexy topic, but very important– how to prevent falls for yourself (…or your parent.)

Why is this important?  Every 20 minutes an older adult dies from a fall.  Each fall-related hospitalization costs an average of $30,000.  Medicare spends $31 billion on falls annually.   If you fall and break a hip, the chance you will EVER return home is slim.

There’s good news!  There are evidence-based (meaning they’ve been researched and they WORK!) interventions that can prevent falls.

The CDC started the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative.  This has three core elements: screen patients to identify their fall risk, assess their modifiable fall risk factors, and intervene.

This includes stopping medications which can make the patient drowsy or unsteady (like sleeping aides and narcotic pain medicine).  Decreasing other medications if they cannot be stopped entirely.  Pick up throw rugs in the moving.  Move electrical cords to avoid a tripping-hazard.  Add secure grab bars to bathrooms and showers.  Add secure grab bars near stairs.  Using a bedside commode during the night.

If you’d like to learn more, refer to http://www.cdc.gov/steadi

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

Top 10 list of allergens…


flickr.com/ photos/ vilseskogen/ 5996576130

The top 10 allergens (and how to avoid exposure) …

  • Tixocortol pivalate (a steroid)
  • Propylene glycol
  • Methylchloroisothiazolinone
  • Formaldehyde
  • Cocamidopropylbetaine
  • Lanolin
  • Benzalkonium chloride
  • Fragrance and balsam of peru
  • Neomycin
  • Nickel

Tixocortol pixilate is a steroid present in creams like hydrocortisone acetate.  Usually this sensitivity comes across as a failure in treating a rash..or the rash gets worse.

Propylene glycol, benzalkonium chloride, and neomycin are frequentlflickr.com/photos/ espelina/ 24831708y found in topical creams.

Lanolin (also known as wool alcohol) is often found in emollients, medications and some personal care products.

Methylchloroisothiazolinone may be found in wet wipes and some sensitive skin products.

If you feel like you get a reaction, check the ingredients of your products.  If you do not have a clinical improvement after 8 weeks, I’d consider testing by a specialist.





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

Do you need one more reason to breastfeed?

IMG_3419Do you need one more reason to breastfeed?

Breastfeeding has been found to help the infant populate their gut biome.   A study was recently done which showed that there is vertical transfer of microbes from the mother to her infant.  The infant gut is born without much gut bacteria and breast milk AND contact with the mother’s skin on her breast has been shown to seed the infant gut micro biome and maintain it even after solid foods are introduced.

This transfer of bacteria from mothers’ milk and skin to the infants’ gut is most prominent during the first month of the infant’s life and declines over time as formula and solid food are introduced.

Breastfeeding is suggested by the World Health Organization and American Academy of Pediatrics to be the exclusive form of nutrition from birth until 6 months and continued with food until at least 12 months.

Posted in Pediatrics, safety, Uncategorized | Tagged , , , , , , , ,

What you should know about spider bites




As the weather gets cooler, spiders may come inside and here are some tips you should know about spider bites.

There are two medically important families of spiders.  Theridiidae (or widow spiders) and Loxoscelidae (or brown recluse spiders).

  • When black widow spiders bite it may feel like a sharp pinch with subsequent pain that develops over the next 30 minutes.The bite site may be surrounded by pale skin and then ringed with red.  The patient may also have systemic symptoms over the next 60 minutes or abdominal pain, sweating, nausea, vomiting, seizures and, very rarely, death.  If left untreated, symptoms resolve within 48 hours.
  • The bite of a brown recluse spider is often undetected with pain beginning over the next several hours.  The bite site may develop a blue macule or a characteristic red lesion with surrounding pale skin and then ringed with area of blue skin.  Over the next week a scab may develop and then fall off.  Systemic symptoms associated with a brown recluse bite are a flu-like illness with fever, headache and fatigue.  Rarely, patients can have muscle and blood breakdown and kidney failure.

What blood work do you need?

  • Black widow bite needs no labs.
  • Brown recluse (if severe envenomation suspected with systemic symptoms) may need complete blood count, electrolytes, kidney functioning and blood and muscle lab work if concerned about muscle and blood breakdown.

How can your physician confirm the diagnosis?  This is a clinical diagnosis, meaning no lab is needed for diagnosis.

What is spider bite treatment?

  • Black widow treatment includes local wound care including ice and elevation.  Watch for infection.  Tetanus vaccine should be given.  Pain medicine and muscle relaxants to be given, when needed.  An antivenom is available and considered for severe envenomation.
  • Brown recluse treatment also includes local wound care including ice and elevation  pain medicine.  Tetanus vaccine.  Antibiotics are not indicated unless the skin surrounding appears infected.  If there is significant skin sloughing, excision of skin may be warranted.

How to avoid a spider bite?

  1. Be aware that spiders prefer warmer temperature and they gravitate to dark locations like a shoe, glove and infrequently used clothing.
  2. Consider shaking out gloves, clothes, and shoes before putting them on.
  3. Wear long-sleeved shirts and pants outdoors (to avoid unearthing spiders under rocks and logs).

I hope this helps.

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

My high school reunion side-bar medical question…

holding hands

flickr.com/photos /hebe/ 3310171434

I attended my high-school reunion this weekend and a friend sidelined me to ask if she could ask me a medical question.  Of course!

Truly, I am a family physician everywhere I go.  Medicine is a passion and a way of life.

Her question was “Should I have my teenagers get the HPV vaccine?”  What an easy question to answer.  “YES!”

HPV, human papilloma virus, is the known virus that changes cells on the cervix from normal cells to cancer cells.  It is also associated with head and neck cancers in males.  Per the CDC, every year 31,000 US women and men are diagnosed with a cancer caused by HPV.  Specifically, there are 12,000 women diagnosed with cervical cancer yearly with 4400 women dying from cervical cancer annually.  And, for men, 9100 men each year are diagnosed with HPV-related oropharyngeal cancers.

The HPV vaccine series is either a set of 2 or 3 vaccines, depending on what age you start the series.  If the first dose is given before age 13, it is 2 vaccines.  If first dose is after the 13th birthday, then it is a 3-dose vaccine series.

HPV vaccine is safe.  Please review the safety profile by CDC  https://www.cdc.gov/vaccinesafety/pdf/data-summary-hpv-gardasil-vaccine-is-safe.pdf

I hope this helps.  If you want more information look on the http://www.cdc.gov website.

Posted in Uncategorized

I’m teaching doctors obstetrics!

I’m teaching doctors obstetrics here at University of Nevada School of Medicine family medicine residency program.

Posted in Uncategorized