Nausea medicines: Many causes and different solutions

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Nausea.  This is a common symptom.  It can be treated by a variety of medicines.

Nausea and vomiting are mediated by three neurotransmitter pathways: visceral stimulation releases dopamine and serotonin; vestibular and central nervous system activation release histamine and acetylcholine; and chemoreceptor trigger zone activation releases dopamine and serotonin.

If your doctor treats your nausea by targeting the appropriate pathway, then this will save you money and time (meaning…. time feeling awful).

  • For patients with vertigo, antihistamines and anticholinergics (like Antivert) are most effective.
  • Gastroenteritis ( intestinal “flu”) is best treated with dopamine antagonists like Reglan.
  •  Pregnancy-related nausea is best treated with an over the counter medicine called pyridoxine and adding doxylamine with pyridoxine  may help even more.  Ginger also helps.
  •  Those with migraine headache-associated nausea may best be treated with metoclopramide (Reglan).
  • For pregnancy related hyperemesis gravidarum (extreme condition of vomiting and dehydration), ondansetron (Zofran) works great.
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Infantile hemangiomas

hemangiomaOften a baby is born with a little red dot and then within a few weeks that dot has transformed into a large vascular lesion.  This occurs in 5% of births.  They are called infantile hemangiomas.  Usually they appear by four weeks of age and STOP enlarging by five months of age.  Most involute (resolve) by age four.

Management of infantile hemangiomas is often “benign neglect.”  This means … watchful-waiting.  If indicated, ultrasound may be done to see how much blood flow and to watch the underlying structures.  Other structural abnormalities may be present.  If the vascular lesion is near the airway or the mouth or the eye this may cause functional impairment and warrants closer investigation.

Elective treatment may be performed to reduce the likelihood of disfigurement as up to 70% of infantile hemangiomas lead to residual skin changes (increased blood vessels at the site or redundant/extra skin or scarring).

Treatment may include systemic (or injected) steroids or blood pressure medications or laser therapy.  Surgical resection is not recommended because of the higher risk of surgery complications to the child.

Watchful waiting until the child is age 4 and then addressing any resultant skin changes may be the best treatment.  Talk to your doctor about what is right for your child.

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Three HPV vaccine types to choose from…

flickr.com/photos /hebe/ 3310171434

flickr.com/photos /hebe/ 3310171434

There are three HPV vaccines.  The vaccines cover a different number of HPV subtypes: One of them covers for two , one with four and the newest one that covers NINE subtypes.   The 9 subtype vaccine offers a small advantage over the quadrivalent (4) vaccine.  The added protection against infection and disease caused by HPV types 31, 33, 45, 52, and 58 offers the potential to prevent an additional 30 to 35% more high-grade cervical lesions on females and to increase cervical cancer prevention from approximately 70% to 90%.

The key is to vaccinate BEFORE sexual contact. The HPV vaccine has no impact on HPV infections acquired before vaccination.  The 9-valent vaccine is 96.7% effective against the 9 HPV subtypes that it immunizes against.  This is amazing!  There are lots of medicines and vaccines that are not this effective.  The CDC suggests the vaccine be given at age 11 or 12, but may be started at age 9.  This vaccine should be given to both males and females as it has shown to decrease risk of oral cancers AND cervical cancers.

For more information, look at  http://www.cdc.gov/hpv/parents/vaccine.html

Posted in General Medicine- Adults, infections, Pediatrics, Sexually Transmitted Infections, Vaccines, Vaccines | Tagged , , , , , , , , , , , , , , | Comments Off on Three HPV vaccine types to choose from…

Free medical care at the Med School!


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Free mammograms in Reno

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What treatment is best for appendicitis?

https://www.photos /jjjohn/3924006096

https://www.photos /jjjohn/3924006096

Appendicitis is when a part of the small intestine (called the appendix) is inflamed.  Each of us has an approximate 7% lifetime risk of having appendicitis.

Why is appenditis important?  Death can result if appendicitis isn’t treated.  If the appendix gets  inflamed, this can lead to an abscess (pus pocket) and if it bursts the infection can be transmitted throughout the abdomen (called peritonitis).

What is the treatment for appendicitis?  Standard of care has been emergent surgical removal of the appendix.  Recent studies (which are weak and may be confounded) have shown  benefit with antibiotics.  There were also no studies done on children, so we are unsure how antibiotics and surgery compare to eachother in the treatment of children.

At this point, if I (or my child) had appendicitis, I would ask for surgical resolution of the problem.

FYI

 

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Who and why should we screen for diabetes?

flickr.com/photos/ 93571575@N03/

flickr.com/photos/ 93571575@N03/

Why should we care about diabetes screening?  Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease.

Does it work?  Screening patients before signs and symptoms has been found to lead to earlier diagnosis (and treatment!) but has not been found to reduce rates of end-organ damage– meaning kidney and heart failure.  Studies have found that screening for type 2 diabetes does not reduce mortality after 10 years, but maybe the patient sees benefits after 23 to 30 years.

There are differing opinions of when to screen.  The US Preventive Services Task Force suggests screening overweight or obese patients who are 40 to 70 years old.  If blood sugar results are normal, then this glucose lab should be repeated every three years.  If an individual is at “higher risk” then screening can be done earlier and more frequently than every 3 years.  Whereas the American Diabetes Association suggests that patients 45 years and older are screened yearly for their blood sugar.  If patients have major risk factors of diabetes like obesity, then patients can be screened younger than 45 years old.

What lab values are significant?  Diabetes can be made with a fasting plasma glucose more than 126 or a hemoglobin A1c more than 6.5%.  Results of fasting blood sugar should be confirmed with a repeat test.  A single random blood sugar more than 200 is also indicative of diabetes.

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LGBTQ youth gets hope from “It Gets Better”

The “It Gets Better” Program was started in 2010 and it connects to youth through the internet in the form of videos of celebrities and politicians with the message… “It Gets Better.”

What is LGBTQ?  This is the term for lesbian, gay, bisexual, transgender, and questioning  people.

Why does this program exist?  LGBTQ youth may feel isolated from elders and mentors and the program is intended to show these at-risk youth who may live in rural towns and enduring teenage-hood that life will improve over time.  The Centers for Disease Control and Prevention (the CDC) states that suicide is the second-leading cause of death in youths aged 10-24 years old.  A LGB youth of color further increases that risk.  For those who identify as transgender as many as 25% report suicide attempt.  Of the 300 million Americans, 5% identify as LGBTQ.  It is not thought that mental illness is higher in this population, but rather they are tied to society’s lack of understanding and support of this population.

Visit http://www.itgetsbetter.org/ for more information!

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The Zika Virus: What to know?!

.flickr.com/photos/sanofi-pasteur/ 5284040324

.flickr.com/photos/sanofi-pasteur/ 5284040324

How long has this infection been around?  The Zika virus has been in the news recently. But, it is not new.  It was first isolated from a monkey in 1947 in Uganda.  Then there was an outbreak in Micronesia in 2007.  It is when the Zika Virus arrived in the western Hemisphere in 2014 that it came “on our radar.”  The first infection in Brazil was in May 2015 and the World Health Organization declared it a public emergency of international concern February 1, 2016!

How is it transmitted?  It’s transmitted by a bite from an infected Aedes aegypti mosquito.  When infected, the virus can be detected in all sorts of bodily fluids: blood, urine, semen, saliva, spinal fluid, amniotic fluid AND even breast milk.  And, transmission from mother to fetus can occur anytime during pregnancy.

What are the symptoms?  Symptoms are acute onset of low-grade fever, raised rash starting on the face and spreads to the chest, back and limbs, joint pains in the hands and feet,  and “pink eye.”  After infected, there is a 2 – 14 day incubation period.  Most symptoms resolve within 7 days.  Interestingly, the virus is only detectable in the blood for 7 days.  Once infected,  we think patients are protected from future infections.

What are the complications?  When females are pregnant and contract the infection, this can cause microcephaly (a small head in the child) and miscarriage (if within the first 13 weeks of pregnancy).  If not pregnant, the Zika infection may increase your risk of getting Guillian Barre Syndrome, which is a neurologic condition causing paralysis that starts in the feet and travels upward in the body.

How do you get tested?  You need blood work within 7 days of onset of symptoms.  The Nevada State Public Health Laboratory collects specimens and ships them to the CDC.  Call the Nevada Health Department at 775 328 2447 for consultation and approval of testing.  The Zika Virus is a reportable disease in the United States… this means if you suspect it, you need to test for it, and report any “positive” results to the CDC.

Who should be tested?  Pregnant patients who travel to an area with ongoing Zika transmission, even if they are without symptoms.  Pregnant patients living in an area with ongoing transmission.  Any patient with Zika symptoms who have traveled to an affected area within 2 weeks.  Infants born to mothers with positive or inconclusive test results for Zika.  Children with microcephaly whose mothers were in an affected area.

How to manage Zika infection?  Stay hydrated.  Take acetaminophen (Tylenol) for pain.  Avoid aspirin and ibuprofen until Dengue Fever ruled out.

How to prevent?  Avoid mosquito bites (Stay indoors.  Wear long sleeves and pants.  Wear insect repellant with DEET or picaridin, IR 3535, or oil of lemon eucalyptus.)  Avoid standing water to collect so that mosquitos do not have breeding sites.  Avoid travel to Zika transmission areas if pregnant.  Do not have sex (or use condoms) during travel.  Men with a pregnant partner should not have sex (or should wear a condom) for the remainder of the pregnancy.

We anticipate a vaccine in 1-2 years.

Want more information?  Call CDC Zika Hotline 770-488-7100.

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Do you like sugary drinks?

Sugar-sweetened beverages are now linked with a 27% increase in visceral adipose tissue, (meaning fat).  Also, sugar-sweetened drinks are linked with cardiovascular diasease and type 2 diabetes.  There is a growing body (…pun intended!) of literature showing that these beverages may be harmful to our health.

Consider changing to water or unsweetened tea.  It may take a few weeks to appreciate a less sugary beverage …

flickr.com/photos/environmental_illness_network/ 16559453226/

flickr.com/photos/environmental_illness_network/ 16559453226/

as it takes a while for your taste buds to change.

I hope this helps.

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