FREE medical treatment!

May 7, 10, & 14: Student Outreach Clinics

UNR Med students will provide FREE medical services in Lovelock and Reno to Northern Nevadans who are uninsured, underinsured, or without a social security number at three events in the next two weeks.

  • Rural Outreach Clinic, Sunday, 9 a.m.—1 p.m., May 7: Lovelock Community Church, 1055 Dartmouth Ave., Lovelock, Nevada, 8941
  • General and Pediatrics Clinic, 6 p.m., Tuesday, May 10: University Health Building, 745 W. Moana Lane, Reno
  • Women’s Clinic, 8 a.m., Saturday, May 14: University Health Building, 745 W. Moana Lane, Reno
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Osteoporosis and menopause: What you should know…

Osteoporosis and menopause: What you should know…

femur (thigh bone) fracture
  • How common is osteoporosis?  Almost half of women older than 50 years will experience a fracture related to osteoporosis in their lifetimes.  These fractures often resulting in significant symptoms and impairment of function and quality of life.  Hip fractures may require surgery, a rehab stay or long-term nursing home.  Osteoporosis is substantially underdiagnosed and undertreated.  Ask your physician if a bone density (DEXA) test is right for you.
  • Estrogen deficiency at menopause is the primary cause of bone loss leading to osteoporosis.
  • Even with good nutrition and regular physical activity, osteoporosis progresses with advancing age unless treated.  There is no cure for osteoporosis so life-long management is required once the diagnosis has been made.
  • Hormone therapy is the most appropriate choice to prevent bone loss at the time of menopause for healthy women, particularly those who have menopause symptoms.
  • Bone mineral density measured while on treatment correlates with the patient’s current risk of fracture, providing justification for the use of the T-score at the hip as an appropriate clinical target. Therapy should be reviewed after each bone density test.
  • Although antiremodeling drugs such as bisphosphonates and denosumab are the drugs chosen to treat most patients with osteoporosis, a new paradigm of beginning treatment with a bone-building agent, followed by an antiremodeling agent, is recommended for women at very high risk of fracture.  Talk to your doctor about what may be right for you.
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Urinary complications of menopause

Urinary complications of menopause.

flickr.com/photos/ vinceandjoy/ 319681936/

Stress incontinence: leaking.

1.One nonsurgical intervention is an intravaginal pessary help give support to the bladder neck.

2.Surgical options: Mesh (the size of scotch tape) can form a hammock to keep the urethra upright.  The mesh is the best treatment that urogynecologists have.  The media does not like mesh and attorneys seem to love it

Overactive bladder: urge to urinate. 

  1. First steps: voiding diary.  24-hour diary (writing down how much she drinks and how much she urinates at every bathroom trip) as this gives insight as how well the bladder is functioning.
  2. 2. Pelvic floor muscle strength.  This is assessed during a pelvic exam. 
  3. 3. Common medications are in the family of anticholinergics. The medication limits bladder contractility which is good, but can also cause dry mouth and constipation.
  4. Other nonmedication treatments: PTNS percutaneous tibial (which is on the leg) nerve stimulation.  This is a treatment that can be done multiple times in a urology office.
  5. Intravesical botox.  Botox is inserted into the bladder at your urology office. This helps relax the bladder.
  6. Spinal stimulation with implantable pulse generator can also give long-lasting relief.

Urinary tract infections: UTIs are more frequent after menopause. 

1.The role of estrogen in the urologic system is to help to maintain a beneficial vaginal flora to help decrease infections.  Use of estrogen helps decrease UTIs by half.  Estrogen can be in the vaginal in the form of cream, pill, or ring.

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The sexual history questions your physician may ask…

The sexual history questions your physician may ask…

flickr.com/ photos/ tokaris/ 207335658

The Centers for Disease Control and Prevention (CDC) recently updated their “A Guide to Taking a Sexual History.”  The list is usually tailored to those questions that seem appropriate for the patient.

Any sexually active person, regardless of age, should be asked these questions. The STI rate in postmenopausal women increased 50% in the past decade. The most important predictor of STIs in older persons is the number of sexual partners they’ve had in the past year.

1. Partners: Are you currently having sex of any kind—oral, vaginal, or anal—with anyone? In recent months, how many sex partners have you had? What is the gender(s) of your partner(s)? Do you or your partner(s) currently have other sex partners?

2. Practices: What parts of your body are involved when you have sex? Do you have genital sex, anal sex, oral sex? Do you meet your partners online or through apps?

3. Protection: Do you and your partner(s) discuss prevention of STIs? If so, what kind of prevention tools do you use, and how often do you use it?

4. History of STIs: Have you been diagnosed with an STI in the past? When? Did you get treatment? Do you have any of those symptoms that return? Do you know the HIV status of your partner(s)?

5. Pregnancy intention: Do you think you would like to have [more] children at some point? When do you think that might be? How important is it to you to prevent pregnancy [until then]? Are you or your partner using contraception or practicing any form of birth control?

6. Experts recommended an “aspirational” question addressing pleasure, but has not been included in the guide: Are you satisfied with the sex that you are having?

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How to decrease your risk of getting breast cancer?

How to decrease your risk of getting breast cancer?

https:flickr.com/photos/seniwati/3179821198
flickr.com/photos/seniwati/3179821198

Breastfeed your babies!  It is also convenient, good for baby, and free.

Lose weight.  For postmenopausal women with obesity (BMI >30), there is a 20-40% INCREASED risk of breast cancer.  In premenopausal women who are obese and have breast cancer, there is an increased chance they will have a more-aggressive triple-negative breast cancer.  Obesity is associated with worse breast cancer outcomes for women of all ages (shorter time to recurrence and increased risk of death from breast cancer).  This may be due to adipose (fat cells) holding onto estrogen, causing inflammation and being associated with hyperinsulinemia.  These abnormalities can cause disrupted cellular mechanisms and downregulate immunity, letting cellular abnormalities (cancer cells) to go unchecked.

WHAT you eat is important.  High total fruit and vegetable consumption is associated with a reduced risk overall risk of breast cancer.  Starchy vegetables (corn, peas, potatoes) do not count, so avoid those. Whole grains are also helpful.

DO physical activity.  1 in 8 breast cancers can be prevented with physical activity.  The 2020 American cancer Society Guidelines for Diet and Physical Activity for Cancer Prevention recommend 150 to 300 minutes of moderate-intensity (or 75 minutes of vigorous) physical activity weekly.  Get active.

Avoid alcohol.  Alcohol is considered a carcinogen and is linked to seven types of major cancers, including breast cancer. Any amount of alcohol increases the risk of breast cancer.  More alcohol use is associated with higher risk. Alcohol causes systemic changes of increased acetaldehyde, interference with metabolizing folate, inflammation, and increased estradiol.

I hope this helps.

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How to decrease your chance of getting a blood clot while traveling?

How to decrease your chance of getting a blood clot while traveling?

Burning Man 2020

Asymptomatic blood clots, otherwise called deep venous thrombosis (DVT), is most common form, occurs in 2-4% of high-risk travelers.

What is a “high-risk” traveler?  Currently have cancer, recently given birth, obesity (BMI more than 30), long travel, recent surgery, hormone therapy, and previous history of a blood clot.

Do compression stockings help?  Yes! There was a recent study that looked at how well do compression stockings work in flights >5 hours to help patients NOT get a blood clot. The bottom line is that compression stockings ARE effective in asymptomatic DVTs in both high and low risk populations. The number needed to treat (NNT) is 37 in high-risk individuals.  This means that 37 people will wear compression stockings for ONE person to avoid getting a blood clot. But, that person to NOT get a blood clot could be you!  Overall, there is little harm in wearing compression stockings and they may help you. 

You can buy compression stockings online and are now available in lively patterns.

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Pertussis. Whooping cough. What you should know…

Pertussis.  Whooping cough.  What you should know…

Pertussis is also called whooping cough.  It continues to be a public health concern (with nearly 20 million infections worldwide yearly) despite there being an effective vaccine.  My husband got whooping cough years ago, we remember it well.

What are the symptoms of pertussis?  First, the patient has a runny nose, then coughs with a classic “whoop.”  A whoop is when you cough sooooo much that there is no more air in your lungs and you make a “whooping” sound while filling your lungs back up with air.  Then, the last stage of pertussis is a persistent cough. Overall, the uncontrolled coughing can last for MONTHS, even if you are treated with antibiotics. Antibiotics make you not contagious, it does not cure the cough. Additionally, studies have not shown any medications that decrease the pertussis-cough.

How to test for pertussis?  The diagnosis is made by a polymerase chain reaction test (PCR) using a nasopharyngeal swab with results coming back in 1-2 days. In the past we did cultures that took a week to result, but these are no longer done. 

How to avoid pertussis?  Get a Tdap vaccine, avoid sick people, and consider wearing a mask!  The Tdap vaccine is a combination tetanus AND pertussis vaccine. 

Who gets a Tdap vaccine?  Everyone should.  We give the vaccine to children (and it is required by most school districts to attend in-person school). The last scheduled dose is given to teens at age 11-12.  After age 12 a tetanus vaccine should be given every 10 years and ONE of the tetanus vaccines can be a TdaP (with pertussis) as an adult.  All pregnant women, regardless of the timing of their last Tdap, should receive a Tdap vaccine in their third trimester as this gives some immunity to the newborn.  More than 85% of pertussis deaths occur in infants too young to receive the pertussis vaccine.  Newborns get the pertussis vaccine at ages 2,4, and 6 months of age and are not thought to be immune to the infection until after their 6 month dose.  This is why it is important for those who have exposure to newborns (like grandparents) to get the Tdap vaccine if they have not had one as an adult.

How to treat pertussis?  We give antibiotics.  But, the antibiotics does not shorten the disease course or improve symptoms in the person infected.  Antibiotics DO prevent transmission of pertussis to others. Antibiotics should also be considered for those within 21 days of a known exposure to pertussis.  Azithromycin is the preferred antibiotic. 

I hope this helps…

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Emergency contraception, an interesting topic….

Are you wondering what form of emergency contraception is the safest and most effective for preventing pregnancy?

If a woman has a single episode of unprotected intercourse, she can conceive a child.  Nearly 50% of US pregnancies are unintended.  The likelihood of pregnancy after a single episode of unprotected intercourse is highly variable depending on where the woman is in her cycle.  Emergency contraception is the use of a device or medication to prevent pregnancy and this can be MORE THAN 95% effective at preventing pregnancy when used within 5 days of intercourse.

Research involved nearly 60,500 women who had engaged in a single act of unprotected intercourse.  The result showed the most effective method to prevent pregnancy is mifepristone. A one-time dose of mifepristone was more effective than any dose of oral levonorgestrel (Plan B One-Step).  A moderate-dose mifepristone (25 to 50 mg) was more effective than mifepristone 25 mg.  Ulipristal (Ella) is more effective than oral levonorgestrel. 

Copper IUD can be inserted up to 5 days after unprotected intercourse for use as emergency contraception.  Then it can be used for emergency contraception and can stay in place for 10 years.  The copper IUD is as effective as mifepristone for emergency contraception. 

One other method of emergency contraception is the combination (estrogen and progesterone) oral contraceptive pills often used for long-term birth control.  This is used (with a different dosing regimen) for emergency contraception and is not as effective as the rest of the methods. 

Of course, I suggest abstinence OR use of routine contraception (condoms, birth control pills, IUDs, etc) before I suggest emergency contraception. 

Ask your physician for emergency contraceptive pills. You can have them at-the-ready at home.

Be ready….

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Treatment of the common cold

The common cold is exactly that…. Very common.

There are only a few safe and effective treatments available. 

Common cold symptoms: thin nasal drainage, nasal congestion, cough, sore throat, fatigue, low-grade fever.

Treatment: Antibiotics should NOT be used for an apparent viral respiratory illnesses.  This is because antibiotics work on bacteria, not on viruses.

Over the counter analgesics (acetaminophen or ibuprofen), zinc (80-92 mg a day), nasal decongestants (like Afrin for 3 days or less)with or without antihistamines and ipratropium for cough. Nasal saline (like a Neti Pot) irrigation helps.  Menthol rub may help “open up the chest.”  Honey is suggested for sore throat for patients OLDER than 12 months.  (Honey under 12 months could cause botulism.)

Maybe lactobacillus casei may help in older adults.

What should not be used: 1. No OTC cold medicines in children less than 4 years. 2. Codeine and other cough-suppressants have not been proven effective.

When should you expect to feel better?  Most colds last for one week.  It is common for a cough to last longer, especially in smokers.

When should the patient get follow up care?  If you have a fever higher than 101 degrees, productive cough, difficulty breathing, or very bad headaches.

To help decrease spread: Wash hands!

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Do you have a TRUE penicillin allergy?

Do you have a TRUE penicillin allergy?

I often hear from patients that they have a penicillin allergy.  Penicillin allergy is the most commonly documented drug allergy in medical records.  Approximately 10% of patients report a penicillin allergy.  HOWEVER, up to 90% of patients with a reported penicillin allergy tolerate penicillin on allergy testing. 

What is the downside of having penicillin allergy reported when indeed you are not?! When penicillins cannot be used for an infection, patients are often started on an alternative broader-spectrum antibiotic with potentially poorer effectiveness and less favorable safety profile.  When patients are on broader-spectrum antibiotics this can lead to increased multidrug-resistant organism, treatment failures and increasing healthcare costs and longer hospitalizations.

There is a validated clinical prediction rule for penicillin allergy.  The PEN-FAST (penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe, treatment) rule was made from a study of 600+ patients in Australia.  There were five independent predictors identified that are important.  The risk factors to include in the clinical prediction rule are:

Allergy event occurred five or less years ago (2 points)

Anaphylaxis/angioedema or severe adverse skin reaction (2 points)

Treatment required of penicillin allergy (1 point)

Total scoring ranged from 0 to 5 points.

If patient has 0 points, there is a 0.6% risk of really having a significant penicillin allergy.

If the patient has 1 or 2 points, there is 5% risk

If the patient has 3 points, there is a 19% risk

If the patient has 4 or 5 points, there is a 53% risk of penicillin allergy.

Consider seeing a physician who specializes in allergy testing. 

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