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“A sure sign of spiritual growth: you want more freedom and less stuff.” -Lisa Villa Prosen 

I woke up yesterday with a sudden and very powerful urge to get rid of a ton of my stuff. I don’t have a whole lot to begin with, but my closet was full of a bunch of clothes I hadn’t worn in years and my shelves were stuffed with books that no longer applied to my life.

I’ve moved cities three times in the past four years (no doubt impulsive and unproductive attempts to outrun my problems), and each time I would lug all these boxes of stuff containing possessions that had long since gone stale. Yet for some reason, I continued to drag all these things with me from place to place, clinging to memories, past periods of my life, and a distant hope that I could reenter certain joyful snippets of time through these objects.

As I continue on my path of rediscovery, I have noticed that I am shedding layers of myself that I have been holding onto for a long time. Usually this happens in the form of releasing emotions or changing my perception about a past experience, but yesterday it came in the form of wanting to pack up garbage bag after garbage bag of shit that has long overstayed its welcome.

Can you believe it is already time to shop for the holidays?! Where has this year gone? I love this season, but sometimes it is hard to decide what to get your loved ones. There are so many stores out there and so many commercials telling you what you need to get your boyfriend, sister, mother, father, best friend…..teacher, neighbor, etc. The list goes on and on. I decided to stop at ONE store and pick out some of my favorite gift ideas to make it just a little bit easier on you to shop!

Clearly I love stuffed animals…haha! They are the perfect things to cuddle with…especially with these cute and cozy slouchy tops. Shop the Mint offers a discount on these tops every Sunday, but with my unique code JUST for my followers, y’all can shop this look ANY day of the week! Hello, Holiday Shopping. I love these tops because they are an oversized fit which pairs great with leggings and a hat. I love throwing one on when I just want to relax. Not to mention, THEY ARE SO SOFT. These

I love this dress! It is one of my favorites that I have in my closet. I love the turtle neck with the small stripe detail all throughout the dress. The length is GREAT too! I love me a good modest dress. I got this dress last year from a small boutique in Waco, Texas (Courtney’s Boutique). I paired it with a simple long necklace from Francesca’s I got about three years ago. Lastly, I put on my favorite booties this season, these suede black booties from DSW (Mark Fisher). I could rock

I wore this outfit last year and I still love it! The suede skirt is still trendy and who could not love this gold glitter sweater?! Both of these items I got when I worked at the store RiffRaff in Dallas. That location closed (so sad), but they are still open in Arkansas and online!  They have a bunch of adorable new arrivals all the time! And their holiday gear is just to die for! I love pairing a cozy sweater with a cute skirt. It really dresses up your chunky sweater. This would be

If this outfit doesn’t scream CHRISTMAS TIME to you, I don’t know what will! I love the holiday season. All things Christmas have my heart. I love dressing up the “tacky” Christmas gear and making it look cute! Like this big Christmas Tree necklace I got from Francesca’s a couple years ago; it looks so cute!! I went for the Christmas look by pairing this necklace with a bright red sweater from Target and some white jeans from Abercrombie. Lastly, I wore my favorite tan booties from

Anyone else a Pinterest-aholic? I am always on Pinterest. Whether that is on my phone or my computer, I am constantly getting new ideas and inspiration from this awesome platform. I assume everyone knows what Pinterest is by now, but in case you don’t, Pinterest is a site where you can create your own boards specific to a topic and pin ideas and inspirations to it that you are interested in. You can also send your friends pins that you think they might like, collaborate with others on a board, …

If you haven’t noticed, I like to keep these posts organized. Did you notice that I’ve been talking about things related to the GI system for a while? I just think it makes more sense this way, and you have a better chance of understanding. With that in mind, this one will seem like it’s out of place. In a way it is, but not really. Here goes… So last time I talked to you about lactose intolerance and mentioned how much we need calcium and Vitamin D, especially for our bones. Not having enough could set you up for having osteoporosis.

Osteoporosis is a disease where your bones are thin and very weak. A simple fall could easily turn into a broken hip.

Remember these commercials? Let’s say she has osteoporosis and can’t get up because her hip is broken. I’ll give a worst case (but definitely possible) scenario…

We’ll call her Helen. She just finished washing her hands after using the bathroom, and turned to leave the bathroom. One of the legs of her walker got caught in the bathroom rug, and she fell down. Her hip is broken so she can’t stand up. She’s in the bathroom so there’s no phone in the room. It hurts too bad for her to try to crawl to the phone. Helen lives alone, so all she can do is lay on the floor and scream for help. The next day a neighbor finally finds her after noticing she didn’t get her newspaper off of the porch. At the hospital, she has surgery to fix her hip but now she has pneumonia too. That means more time in the hospital, and then rehab. While she’s in the hospital, bed sores develop on her heels and get infected. Even more time in the hospital, and now Helen may go to a nursing home when she leaves.

This is a really sad situation, and I saw it several times while I worked in the hospital. It’s amazing how sick and weak you can get after a fall like this. Age and how healthy you are play a big part in this.

The only way to know if you have osteoporosis is by having a DEXA scan. (DEXA stands for dual energy x-ray absorptiometry.) Basically you lay down and it scans your low back and hips. It’s looking at how thick, or dense, these bones are. Thinner bones tend to be weaker and more likely to break. Sometimes they can break with normal activity like cleaning your house or even rolling over in bed!

Osteoporosis is usually seen in those aged 65 and older BUT certain problems in younger people make providers think a person may have osteoporosis…

• Eating disorders (your body isn’t getting the nutrients it needs)
• Smoker
• Chronic kidney disease
• Family history of osteoporosis
• Taking a daily steroid for at least a few months
• Breaking a bone while doing a normal activity
• Early menopause (including if because of hysterectomy)
• Getting shorter (yikes!). It’s because of compression fractures in the back.

 

There isn’t really a set timeline for how often you should get a DEXA scan. But, it is suggested to wait at least 2 years before having another scan. Actually, the longer you wait the better the test is for predicting if you’ll break a bone.

So You Have Osteoporosis…

Osteoporosis is one of those ‘it is what it is’ conditions. Once you’ve been diagnosed, you will always have osteoporosis. There is a sort of middle ground between normal bones and osteoporosis that I haven’t mentioned yet. It’s called osteopenia. This is where your bones are thinner but not thin enough to be called osteoporosis. The take home points are: having a healthy lifestyle and starting early with supplements. Try not to use the word ‘diet’. It gives the impression that what you’re doing is just temporary. Lifestyle includes EVERYTHING you do e.g. what you eat/drink, exercise, sleep, managing stress, taking your medicines. For women, I would strongly suggest taking a Calcium-Vitamin D supplement once you start menopause. Ask your provider to check your Vitamin D level too.

**Menopause isn’t just about hot flashes or personal summers. Estrogen is the main female hormone. Once menopause starts, not as much estrogen is produced. Can you guess one thing that estrogen is important for?? Yep, making and maintaining bone.

 

 

 

 

“In the end, we will remember not the words of our enemies, but the silence of our friends.” – Dr. Martin Luther King, Jr.

 

I don’t know what she (he) ate that started this situation but I do know that if you’re lactose intolerant and eat lactose, this could very well be you in the bathroom!

So what exactly is lactose?

Lactose is a type of sugar in milk and dairy products. If you remember the blog, Hot Like Fire, I explained how when you swallow, food travels down the esophagus and into the stomach. From the stomach, food moves to the small intestine. This is actually where most of your food is digested and where an enzyme called lactase is made. Lactase breaks down lactose into two smaller sugars that the body can absorb. Meaning, without lactase you cannot digest lactose.

What is lactose intolerance?

It’s a condition where when you eat lactose (ex. Milk, cheese, dairy products) you get symptoms like bloating, diarrhea, and gas. This happens because…

• Either the small intestine doesn’t make enough lactase aka Lactase deficiency

OR

• Your body isn’t absorbing the lactose well aka Lactose malabsorption (which could be because you don’t make enough lactase).

 

Let’s go back to the path food travels once you swallow. Recap… Food goes down your esophagus and into your stomach. From there it moves through the small intestine where most of digestion happens AND lactase breaks down the lactose so it can be absorbed too. Next, “food” moves into the large intestine aka colon. At this point, it’s not really food anymore. It’s stool, poop, Mr. Hanky (remember him from South Park?) or whatever you want to call it. The colon is also where our bodies absorb water. Any lactose that wasn’t digested is broken down by bacteria. When it’s broken down this way, it creates a lot of gas and diarrhea. Yikes! Are you starting to imagine how uncomfortable this can be??

Everyone with lactose intolerance is different so it’s definitely possible that they can eat some lactose without having any symptoms.

Could I be lactose intolerant? 

This is my son and I when he was 5 months. I’m sharing this particular picture for a reason. Lactose intolerance is not the same as being allergic to milk. An allergy is when your immune system overreacts to something you would commonly eat or have some type of contact with. Allergies can be mild e.g. itching, rash or severe e.g. throat swelling, hard time breathing. So, if there’s a milk allergy this is something you would definitely find out by the time your child is one-year-old.

On the other hand, lactose intolerance usually starts as a teenager or adult.

You may have noticed…

A lot of Black people are lactose intolerant. It’s also more common in Hispanics, Native Americans and Asian Americans. About 10 years ago, Cornell University released a study that gave a very interesting reason for this. Turns out that where your ancestors came from has a lot do with whether or not you’ll become lactose intolerant. If your ancestors (before 1900) lived in places where they were able to raise animals that produce dairy products e.g. cows and chickens, without problems like disease or extremely hot or cold weather, then you probably won’t become lactose intolerant. Europe is an example of one of these places. But, places like Africa and Asia did have problems raising these kinds of animals.

Cornell Study on Lactose Intolerance

 

That video from White Chicks shows you most of the symptoms of lactose intolerance. Here’s a full list:

• Gas
• Diarrhea
• Stomach pain and/or cramps
• Nausea
• Bloated stomach

 

Usually, symptoms start anywhere from 30 minutes to 2 hours after eating something with lactose.

“I could just not drink or eat any dairy. That way I won’t have any stomach problems. “

Not so fast! Those foods that you’re thinking of avoiding are the best ways to get calcium and vitamin D. If you can’t handle eating very much dairy, then you probably need to take a calcium and vitamin D supplement.

Because of all of those milk commercials, I think most people know that calcium is important for bones. Not getting enough calcium can cause your bones to be thinner and weaker. And, guess what helps your body absorb the calcium? Yep, Vitamin D. In older adults, this could mean having bones that are easily broken, or even osteoporosis. (I’ll talk about osteoporosis in another post.)

But, how do you get enough calcium if you’re lactose intolerant?

Here are some foods that are high in calcium…

• Sardines, with bones
• rhubarb
• Dark leafy greens e.g. kale, spinach, collard greens, turnips
• canned salmon, with bones
• Orange juice

When this is all you want to do…

I know the symptoms aren’t pleasant but you’ll need to figure out how much (or little) lactose you can get away with eating. You may even find out that you can eat certain dairy products without having ‘bubble guts’.

Lactaid products – “Real” dairy that has been treated with the lactase enzyme. This line has milk, ice cream, cottage cheese, and even egg nog. Who knew?! They also make pills and chewables. *Very important: Take the pills or chewables with the first bite/sip of dairy.

Basically all you can do is either stay away from/limit how much dairy you eat, or take a separate supplement of lactase.

 

Did you Know…

Sometimes lactose is hidden in foods. Check the label for ingredients like whey, curds, sweet cream, and casein.

Humans are the only species that drink the milk of other animals.

 

“Never be limited by other people’s limited imaginations.” – Dr. Mae Jemison

Isn’t this a great reason to make an appointment with your doctor/nurse practitioner?! Said no one ever. Wanna know what patients are doing? They’re playing up other things like “my knee hurt really bad one time about 6 months ago”, “this rash has been coming and going on my arm for 3 years”, and then there’s my favorite “personal”. I’ve had patients literally refuse to tell anyone, including my nurse, what’s going on. They only want to talk to me. I can’t really blame them though. Just talking about your “private parts” even when nothing is wrong, is uncomfortable for A LOT of people. So, I can really respect them for coming in to see me.

 

I think most people know what hemorrhoids are in terms of what they look like, but not what they actually are. Hemorrhoids are actually inflamed veins right around the anus (the opening where stool comes out). These veins get swollen because of high pressure on them. This pressure usually comes from straining to have a bowel movement. Remember Elsa from the last blog post? Other possible reasons: chronic constipation, sitting on the toilet for too long (if your butt gets numb or your legs fall asleep, that’s too long), heavy lifting, pregnancy, obesity. These can also make hemorrhoids get worse.

They’re equally as common in men and women. Actually, by the age of 50 at least half of all people have hemorrhoids!

As you can see in the picture above, hemorrhoids can be external or internal. There’s also a third kind, prolapsed. These are basically internal hemorrhoids that drop down enough to where you can see them just outside of the anus. Sometimes they will go back inside on their own, or you can gently push it back inside.

 

Common Signs:

Seeing bright red blood on your stool or in the toilet

Seeing streaks of blood on the toilet paper after you wipe

Uncomfortable/hurts when you sit on your butt

Irritation or itching around the anus

 

The best way to know if you have hemorrhoids is with a (gasp!) rectal exam. Don’t be scared. These exams aren’t comfortable, but they don’t hurt.  I’ll admit I don’t know that personally but I have been doing quite a few of them lately. Don’t even ask. Depending on your age, medical history, and family history, your provider may suggest doing a colonoscopy just to make sure everything is okay. This is the test where a camera is used to look at your entire intestinal tract. Stay tuned. I’ll be talking to you more about this exam in the future.

Let’s treat them anyway, okay?

Try over the counter meds first.

• Preparation H
• Tucks Pads (did you know these are basically cotton pads soaked in witch hazel??)

 

Prescriptions are next…

• Proctosol
• Proctofoam

 

Surgery, if nothing else works.

It’s called rubber band ligation. Basically a rubber band is tied to the hemorrhoid, cutting off its blood supply. It eventually falls off.

 

 

 

 

“You don’t make progress by standing on the sidelines whimpering and complaining. You make progress by implementing ideas.” – Shirley Chisholm

I have to give credit to the pharmaceutical rep that came to the clinic a few weeks ago with a prescription med for constipation for the name of this blog post. If you’re familiar with the movie Frozen, you have to admit that this new version in the picture above is pretty hilarious!!

If you’re dealing with rocks (constipation) or rivers (diarrhea), I promise I’m not laughing at you or making light of your situation. At least be honest with yourself. EVERYONE has dealt with rocks or rivers at some point.

Let’s get something straight first. Constipation and diarrhea are defined by how often a bowel movement does/does not happen, not by how solid or liquid it is. There’s no such thing as having diarrhea one time. When patients say this to me, I know they’re really saying there was one time yesterday that I had a really soft/liquid bowel movement. In a perfect world, we would all have a bowel movement for every meal that we eat. I don’t have any science to prove it, but I think more than 90% of people don’t go that many times a day. I think it’s more like once a day. How else can I explain patients eating those Ex-Lax chocolates like it’s really candy, or drinking entire bottles of Magnesium Citrate like it’s juice?

 

F.O.S. (you can figure this one out )

I don’t know that there’s one set definition for how long you have to go without having a bowel movement to be considered constipated. It’s different for different people. I’ve had patients tell me they’ve gone longer than a week without one, and they’re not uncomfortable at all. Then, there are others who are miserable after missing 1 or 2 days. I just ask “What’s your normal?”

What’s not normal: Pooping rocks or little balls

Straining (like Elsa). You should not feel like you’re pushing out a baby!

I won’t get into color and consistency here, but trust me it’s coming in a future post.

If a patient complains about having stomach pain, constipation is one of the first things I think of. Did you know an x-ray can show if you’re constipated? Yep, we can literally see that you’re full of it!

If you’re taking any kind of medicine on a regular basis, consider this as a reason for the constipation (especially if it’s narcotic type pain medication e.g. Percocet, Hydrocodone). Also, are you drinking enough water? Are you diabetic? Diabetes affects the body in so many ways, and it’s no way to predict when or where. In this case, it can cause gastroparesis. With this condition, food moves very slowly out of your stomach and through your intestines. Do you have irritable bowel syndrome (IBS)? Unfortunately, for many people we just can’t find a reason for their constipation. Please note: This info isn’t meant to diagnose the cause of your constipation. These are just a few ideas for possible causes.

 

What’s Next?

Take baby steps to keep from going to rocks to rivers for real.

1. Drink more water. Eat more fiber/take a fiber supplement
2. Over the counter medicines e.g. Miralax, dulcolax, Senokot, Magnesium Citrate, Fleet Enema.
3. Consider trying a prescription medicine e.g. Amitiza, Linzess

If there is some type of medical condition going on that’s either causing or playing a role in it, you and your provider should always be working to get it/keep it under control.

 

The River Flows

This is a lot easier to define. When you have diarrhea, food is moving too fast through your intestines. Of course you’re running to the bathroom more often, and it tends to be very soft/mushy or all liquid. More than likely you’re having more bowel movements than the number of times you’ve eaten. Possible reasons for diarrhea:

• Side effects of medicines you’re taking
• Too much laxative
• Stomach virus
• Conditions like irritable bowel syndrome (IBS)
• Anxiety

What’s Next?

If it’s a side effect from a medicine, it will usually be something that you’ve just started taking. Here’s an example: Metformin, a common medicine for diabetes, has this as a side effect. It only lasts for about 2 weeks after starting it. Just hang in there! Stomach viruses usually go away in about 1 or 2 days, so if it’s lasting a lot longer than that something else is wrong. You can try Imodium (over the counter) but know that you could be just dragging out the virus because diarrhea is one way the body gets rid of that virus or whatever bad food you’ve eaten.

I don’t want to go into too much detail about IBS in this post, but know that you can have mainly constipation, diarrhea, or a mixture of both with it. IBS is one of those diagnoses you end up with when everything else has been ruled out. There aren’t any specific tests for it.

Here’s what I think is most important about diarrhea: dehydration. It’s an even bigger concern if you’re not drinking enough fluid to at least balance out what you’re losing. Depending on how healthy you are to start with, dehydration can start in as soon as 2 days! Refer back to Is It Hot Enough for You?! for a reminder of the signs of dehydration.

 

“It isn’t the mountains ahead to climb that wear you down. It’s the pebble in your shoe.” – Muhammad Ali

Remember that song by Aaliyah, Hot Like Fire? You just started singing it didn’t you?! It’s okay, I’m doing the same thing. There’s nothing wrong with thinking you’re hot like fire either. But, what if you literally feel like that on the inside?

 

I know exactly how it feels. Yes, your favorite superhero is hot like fire! LOL!!!!

 

 

 

Call it acid reflux, heartburn, indigestion, or if you’re really fancy GERD (gastroesophageal reflux disease). It’s all basically the same. Based on the patients I’m seeing at the clinic, friends/family, and even my own experience A LOT of people are dealing with this.

“I know what it feels like. I just want to know why it’s happening.”

This is pretty much what my patients say to me. I’m using this picture to help you understand. When you eat and drink, you swallow. When you swallow, everything travels down your esophagus and then to your stomach. What you may not know is that there is a sphincter between your esophagus and stomach. Think of a sphincter like a trap door that closes behind you, and you can’t turn around to walk back through it. Once food is in your stomach, the stomach starts making acid to digest it and kill off any bad bacteria that may have been in your food. Usually, the problem has to do with this sphincter and not that your stomach is making too much acid.

When the trap door won’t stay shut

Most of the time we just don’t know why the sphincter is weak! In some cases, the problem may be a hiatal hernia.

Can you tell what’s wrong in the picture?

 

The diaphragm is a muscle that sits just above the stomach and right below the lungs. For some reason, you only really hear about it when it comes to singing or public speaking to project your voice. A hiatal hernia happens when there’s a weak spot in the diaphragm and a piece of the stomach slides through it. So now there’s pressure against that sphincter (or trap door) forcing it open in the opposite direction and all of that acid comes back up into the esophagus causing (drum roll please……) HEARTBURN!

Let’s be honest. Most of us don’t think to mention this to our providers. I think because so many people have it, and there are so many home remedies and over the counter meds available, it just doesn’t seem like a big deal. BUT, the question is why?? Why do YOU have heartburn?

Here are the usual reasons:

Overeating

Eating and laying down right after (aka ‘itis’. Don’t get brand new! You know what it is.)

Spicy food

Greasy food

Chocolate

Mint

Citrus (oranges, lemons)

Overweight/Obese

Pregnant

Smoking

 

So this is where providers start, looking at what you’re eating. At first, we may encourage you to use antacids like Tums or Rolaids when you need them. Also, I would suggest keeping a food diary. Whenever you start feeling heartburn, write down what you last ate or drank. You may be surprised at what you find. For me, it was eggs. Specifically, the egg yolk. Weird, right? Yeah I know. If these don’t work, or you’re taking them every day and several times a day, then it’s time to move to a pill

You know I don’t use big medical words on this blog, but this one time I have to break from that to show you the differences in these medicines. It’s not important for you to remember the names of these classes. Just remember that they work in different ways.

H2 Receptor Blockers                                                                        Proton Pump Inhibitors (PPIs)

Zantac                                                                                                             Prilosec

Pepcid                                                                                                             Nexium

Tagamet                                                                                                          Protonix

Axid                                                                                                                   Zegerid

You probably already know that you can buy Zantac, Pepcid, and Tagamet over the counter. Prilosec, Nexium and Zegerid are the same. Have you ever noticed that the Prilosec, Nexium and Zegerid that you can buy is only enough for about 2 weeks? But, you can buy a bottle of Zantac with more than 50 pills. Medicines like Prilosec are only meant to be taken for about 8 weeks at one time.

So why has my friend/mother/grandmother, etc. been taking Prilosec for 3 years?

Because it works! It’s really hard to get patients off of these meds because they feel good, or at least a lot better than if they didn’t have it. Also, many have already tried to stop taking it and got rebound heartburn that’s even worse than it when it first started. Of course, they go right back and start the medicine again when this happens.

 

   I talked about this some in my very first post, A Mother’s Heart. Severe heartburn can feel just like a heart attack. This is serious business, like life or death. If you don’t remember anything from this post, remember this: If you’re having chest pain AND heartburn/indigestion, sweating, don’t feel well, left arm pain or numbness GO TO THE ER!!! This is nothing to play with. The ER can quickly find out if the problem is your heart or stomach. Please don’t talk yourself out of going because of not having insurance, no money to pay the ER bill, the time you will spend in the ER, etc. Things and money can be replaced, not people.

Leave a comment below or email me at asknpstephanie@gmail.com if you have questions about acid reflux.

Thanks for reading!

Aaliyah Hot Like Fire because you know you want to watch the video now!!

 

“I have discovered in life that there are ways of getting almost anywhere you want to go, if you really want to go.” – Langston Hughes

If you’ve been following this blog you know I love to use videos to get my point across. This is from the movie I’m Gonna Git You Sucka. Ladies, how many of you have wanted to just snatch up somebody like that when you’re on your period? I won’t even ask who’s actually done it …

Natural treatments for PMS

Most of us are already using products like Aleve, ibuprofen, Midol, and Pamprin. Midol and Pamprin each have a few products in their lines and the brands are VERY similar in terms of the actual medicines that are in them. Here’s an example: Pamprin Multi Symptom Extra Strength and Midol Complete both have acetaminophen (Tylenol), caffeine, and an antihistamine. The caffeine helps get rid of the bloating and water weight, and the antihistamine also helps to get rid of the water weight.

And another that I just noticed a few weeks ago…

The next time you’re in the pharmacy section, compare Pamprin Max to Excedrin. You’ll be surprised at how similar they are!

Like I’ve told you several times before, follow the money. While preparing this blog, I even noticed that Menstridol (used to be called Midol Extended Relief) is naproxen. You probably recognize naproxen more by its brand name, Aleve.

 

 

So who knows how many of us are buying what we think are different products, but they’re actually the same.

 

 

 

Let’s get back to treating PMS. Other than those medicines I just mentioned, there are a few supplements that can be helpful.

• Evening Primrose Oil

This plant grows in North America and the seeds are used to make capsules that are taken. I’m not sure of their size, but the suggested dose for PMS is 6 capsules a day! If you’re on a medicine to thin your blood like Coumadin, Plavix or Xarelto DO NOT use this. It can make them work even better, meaning that if you cut yourself it will take even longer to get it to stop. Or, if you’re on Coumadin it will be hard to get your dose right.

• Chaste Tree

This is actually a shrub that grows in Europe and the Mediterranean. It comes in a liquid, dry powder, and capsule. The dose depends on which form you get. Be careful with this one if you’re on any psych meds e.g. anxiety, depression, bipolar, schizophrenia. A few studies have been done on this one and all showed less breast tenderness, headaches, swelling and tension.

• Clary

Only available as an essential oil. No clear dosage is recommended. DO NOT use this and drink alcohol at the same time. It will increase the effects of the alcohol.

• Dong Quai

This is a popular herb in Chinese medicine for anemia and symptoms related to menopause, in addition to PMS. Similar to the evening primrose oil, don’t use this one if you’re taking a blood thinner.

 

*Remember, supplements are NOT regulated by the FDA like prescription meds or even over the counter meds like Tylenol. It’s a lot harder to know exactly where a product was grown and how it was processed into a capsule, powder, etc. Do your own research!!! Don’t just take my word or that of the person working in the store where you’re buying from. AND, tell your provider if you’re thinking of using or have started using any kind of supplement.  

I couldn’t resist adding this video from In Living Color! Men, are we really this bad?!

https://www.youtube.com/watch?v=TldT_Y6yLRI

 

 

 

I’m breaking from the Ugly Part of Me Series to talk about disaster prep. As many of you know, over the last several days Hurricane Matthew has affected the Caribbean, Haiti, Florida, Georgia, South Carolina, and North Carolina. Whether it’s a hurricane, tornado, flooding, or earthquake, how you prepare is basically the same. Put together supplies with the mindset that you won’t have access to electricity, technology (no Internet connection, ATMs won’t work), or running water.

Think about what this could possibly mean.

• What can you eat that won’t need to be refrigerated, cooked or heated? If it’s in a can, do you have a manual can opener?
  • Don’t forget the option of using an outdoor grill to cook. Great idea to keep meat from spoiling if the power is out for a while!
• What will you drink? (I suggest mainly water.) How much water do you need?
  • The more you weigh, the hotter it is, health conditions, etc help determine how much water you need to drink every day. Refer back to Is It Hot Enough for You?!
  • Have enough water for at least 3 days in your stockpile (for each person in your house)
  • If you have enough time in advance, fill your bathtubs with water. This can be used for drinking, washing, and flushing toilets. Just be careful if you have small children in your home.
• Food in the refrigerator and freezer
  • There’s no way to know how long you’ll be without power. If you have time and can find enough, grab several bags of ice and put items like milk, breastmilk, leftovers, yogurt (food that will spoil easily) on ice in a cooler.
  • Try not to open the refrigerator or freezer. The temperature inside will stay cool for as long as possible.
• Personal care (If you have small children, include diapers, wipes, formula, etc.)
• Medications (don’t ever run out of prescription medicines)
  • Try to have enough for at least a few days
  • Remember, if you evacuate and leave the state your provider won’t be able to send you any new meds. This is because of state licensing. Unless the provider is licensed in the state where you’re needing it sent, you’ll have to think of other options. You CAN get a prescription you already have transferred!
  • Grab basic over the counter meds e.g. Tylenol, ibuprofen, cough medicine, and upset stomach relief. Don’t forget the children’s versions!
  • Some medicines (ex. Insulin) need to be refrigerated. Don’t forget to put them on ice!
• Allergies
  • Don’t forget the Epi-Pen if someone has a severe allergy
  • Be mindful of food allergies when packing food and snacks
• Back up chargers for electronics
• Important documents (do you know where they are?)
• Insurance
  • Do you have it?
  • You need to know exactly what is covered!
  • If you’re renting, the owner’s insurance DOES NOT cover your belongings. Get renters insurance!
• Gas for your car, generator, or grill
  • Pumps at gas station may not work in a power failure
  • Gas stations may run out of gas because of high demand
• Pets
• Cash (ATMs may not work or be out of cash. Also power failure may mean businesses can’t accept credit/debit cards but will accept cash.)
• How will you communicate with family members that haven’t made it home? Let extended family/friends know that you’re okay?
  • There are quite a few family locator apps available
  • Some cell phone companies, have what’s called a glimpse that can be sent in a text message. This will tell you where a person is.
  • Use social media. Facebook even has a page to mark yourself as okay during an event.

 

Most people learn and remember things if you use scenarios or specific examples that they can see themselves in. Let’s do that really quick!

 

1. You’re trying to evacuate, and get stuck in traffic

This picture is from Houston, TX as residents tried to evacuate ahead of Hurricane Rita in September 2015. To give a quick background, this was about a month after Hurricane Katrina hit New Orleans and many of those who were displaced came to the Houston area.

This is one of those situations where “It is what it is”. It may take you at least two or three times as long as usual to get somewhere. This is why you need to fill up your gas tank. You’ll need food, drinks and something to keep everyone entertained. Seriously consider cutting off your car while you’re sitting in traffic to save gas. Some people literally run out of gas sitting in this kind of traffic.

2. You’re trying to get home, and all of a sudden your car is under water

 I think we’ve all heard the saying “Turn around, don’t drown!” Sometimes people do take too much of a risk trying to drive down flooded streets. But, there are other times where you honestly don’t realize how deep the water is. Let’s assume it’s the second one. If the water is deep enough to where your car will sink, the front of the car will tilt down first because of the weight of the engine. Get to the back of the car and try to open a door or window. Remember, the electrical system may stop working so you may not be able to let down automatic windows. In this case, just kick it out. You’ll surprise yourself with your own strength. Oh! Don’t forget the sunroof if you have one. Climb out that way. Here’s where it gets tricky. Should you stay on top of the car or try to swim? Generally, I would suggest staying with the car unless you see a water rescue and they’re throwing you a life-line. You never know how fast the water is moving, and you can guess what happens to most people who are swept away in the water .

3. You’re at home and your house is starting to flood.

These pictures are from Hurricane Katrina, 2005 New Orleans. This is currently going on in Lumberton, NC. The estimates are that about 1500 people are stranded on their roof tops! Honestly, all you can do is grab what you can (water and something to shield yourself from rain, heat or cold) and go to the roof.  Of course, you can stay in the upper levels of your house but if you do that rescue workers have no way of knowing you’re there AND alive. You should know that during a disaster, first responders approach things a little differently. Heads up: This next sentence will be a tough pill to swallow. Efforts are focused mainly on rescuing those who are alive/not injured and those who are injured but not severely. This doesn’t mean that a lot of people are left behind. They’re just trying to rescue all of the people who have the best chance of survival.

 

In times of crisis and chaos, we let go of differences and disagreements, and simply rise to the occasion to help another human being survive. #victimsdied #survivorslived #wesurvivedhurricanematthew2016

If you’d like to help, consider donating to…

American Red Cross

United Way

Salvation Army

The Humane Society (pets are displaced too!)

Local churches or food banks

 

I borrowed this title from a song by Avery Sunshine. If you haven’t seen the video, you HAVE to watch it before you keep reading. It’s hilarious (seriously it is, especially when the boyfriend is hiding under the covers), plus it gives you some perspective on this 2-part series. Pay attention men! This might save your life one day . If you’re a Michael Jackson fan, look out for the nod to the Thriller video.

 

What’s wrong with her?

PMS or premenstrual syndrome is the ball of emotions, bloating, headaches, and even body aches that lead up to a women’s period aka menstrual cycle. For every 20 women, about 15 will have some type of PMS symptoms! Most women get through it without any major issues. However, there are some women that have it so bad that they just mentally can’t deal with anything. It can go as far as causing depression or even panic. When it’s that extreme it’s called premenstrual dysmorphic disorder (PMDD). I won’t be discussing PMDD here but I think it’s important for men and women to know there is a such thing. Maybe I’ll talk about it in another blog post. Hmmm……

 

The menstrual cycle decoded

Let’s get some definitions straight first. The days where a woman is bleeding or having her period is called menstruation. The menstrual cycle lasts for about 1 month, and is the process that prepares a woman’s body for pregnancy. So, every month a woman’s body gets itself ready in case she gets pregnant. Kind of cool right?

Here’s what happens: For about the first 2 weeks of the menstrual cycle, the amount of estrogen (main female hormone) increases and makes the lining of the uterus get thicker. The uterus is the place where the baby grows, and its lining helps feed the baby at the very beginning of pregnancy. At the same time, an egg from one of the ovaries matures and is released. When the egg is released, this is called ovulation. It travels through the fallopian tubes to the uterus and waits for sperm to come and fertilize it. A few days before the egg release, all the way to the day of release is the time that a woman is most likely to get pregnant. If the egg isn’t fertilized, it just falls apart. The amount of estrogen decreases causing the lining of the uterus to shed aka the period to start.

But why is this happening to me?!

It’s complicated!!

 

 

 

The medical community doesn’t know exactly because it seems to be several things happening at the same time. First, there’s a definite relationship between the ups and downs of hormones during the menstrual cycle and PMS symptoms. These ups and downs go away during pregnancy and with menopause (and so do those PMS symptoms). Second, there may be chemical changes in the brain. One particular chemical, serotonin, is very important for mood. If its levels go up and down, this could cause PMS. Not having enough serotonin can even contribute to depression, fatigue, and those crazy food cravings we get during that time of the month.

 

In part 2, I’ll be talking about some natural ways you can deal with PMS. Until then, men just leave the chocolate (or whatever she’s craving) and back away!

 

Yeah, I know I’m probably pushing the envelope with this one. But, that’s what makes my blog unique. This is real talk. Pretty much everything I bring to you here I’ve seen in my patients (as an NP), patients I’ve taken care of as a nurse, or I’ve experienced it myself (NOT this one though). This topic is no different. I don’t typically ask my female patients if they’re having vaginal odor or itch. Usually I stay very general and ask about any problems with their period, or concerns about ‘down there’. Most of the time it’s at the pap smear appointments where I find out. I guess it’s because they know I’m looking inside the vagina anyway and will either see ‘it’ or smell ‘it’.

People tend to think that if something itches or smells “not so fresh”, it must be dirty. When it comes to the vagina this isn’t necessarily true. Think of the vagina like a self-cleaning oven. Let’s say you bake a pan of macaroni and cheese, and some of it bubbles over out of the pan and spills on the bottom of the oven. After you’re done cooking and let the oven cool down, you turn on the self-cleaning cycle to remove the spill. The next time you cook something in the oven it’s all clean. No problem. Suppose you don’t turn on the self-cleaning cycle after the macaroni and cheese spill. You just turn off the oven. The next morning you use the oven to cook bacon. You completely forgot about the spill until you notice the bacon doesn’t smell quite right while it’s cooking.

The vagina literally does work to clean itself (not a substitute for soap and water. Thanks on behalf of all providers! Don’t ask  ).

If something is introduced to the vagina e.g. bubble bath, ejaculate, STD, douche, or the body as a whole e.g. antibiotics it works to keep a balance. There’s different types of bacteria there and all of them have to stay in their place. In this case, the bacteria are NOT a bad thing. Yes, there are good bacteria. They keep the bad ones in check.

 

When the self-cleaning cycle doesn’t work

Scenario 1: Remember the example of the pan of macaroni and cheese? Okay, let’s say the self-cleaning cycle didn’t clean it up. With that in mind, suppose a woman gets a sinus infection and gets an antibiotic from her provider. The antibiotic kills the bacteria making her sick but also kills some of the bacteria in her vagina. Keep in mind what I told you earlier, that every type of bacteria has to stay in their place. Every woman is different, so the effect of a medication won’t necessarily be the same in any two women. That one antibiotic can cause enough of a shift that the vagina just can’t get back to a balance on its own. This is called a yeast infection. Douching and bubble baths can also cause this. Now you know the reason why a provider will generally tell you not to douche. If you have that “not so fresh feeling”, make an appointment and let us help you figure out what’s wrong.

 

Note: Men, if your significant other ever tells you that she has a yeast infection, NO SEX until after she finishes treatment and it clears. YOU CAN get it from her during sex, and the two of you can pass it back and forth!!

 

Scenario 2: The STD. If you haven’t already, read the post: Trichs, Claps, Fish and Clams! This one is pretty straightforward. It’s just too big of a mess for the self-cleaning oven (vagina) to handle on its own. You’ll need an antibiotic, and I would also suggest taking a probiotic at the same time.

Okay! Wait, what?

Probiotics are like the opposite of antibiotics. An antibiotic helps kill the bad bacteria (and some of the good bacteria), while a probiotic helps the good bacteria to grow. Just remember, you always want the good to outweigh the bad. You can buy probiotics at any pharmacy, Walmart, Target, or even the grocery store. Some people may choose to eat yogurt instead of taking them but I think the pill will probably give you more of the probiotic versus a serving of yogurt.

 

Vaginal itch

There are so many reasons for this. Examples: Hair growth (especially if you shave), fungal infection on the skin, bacterial vaginosis (BV), trichomoniasis. Another reminder: You can read up on BV and trichomoniasis in the Trichs, Claps, Fish, and Clams post. BV isn’t an STD but it can make you itch and have green vaginal discharge. All of these are easily treated IF you actually speak up about it, hint hint…

 

Vaginal odor

When you visit your family or friends, have you ever noticed that each of their houses smells different? I don’t really mean air fresheners or plug-ins, but just the actual smell of the house. It could be from cigarettes, products they use to clean or wash clothes, or just the natural body odor of the people who live there. The vagina works the same way.

Every woman will have her own unique smell and taste. Go ahead and read that last sentence again. Yes, I said it! We’re all adults here right? So smell and taste depends on hygiene of course, but also what a woman eats and even the medicines she takes. With that being said, sometimes it’s hard to figure out what smells fresh and what smells not so fresh because every woman is different.

So if you ever get that not so fresh feeling, just go see your provider. Here’s a cheat sheet I made to give you some ideas of what may be going on ‘down there’.

Condition	What it Looks/Smells Like	How it’s diagnosed	How it’s treated
Bacterial Vaginosis (BV)	· Green vaginal        discharge · Fishy odor	· Based on your symptoms · Pelvic exam (provider looks in the vagina and inserts 2 fingers) to look for infection · Look at sample of discharge under microscope	Antibiotics
Yeast infection	· White discharge that looks like cottage cheese · Vaginal itching and soreness · No odor	· Based on your symptoms and recent medical history · May do pelvic exam to see discharge	· Over the counter creams e.g. Monistat · Prescription antifungal pill
Fungal infection (basically jock itch)	· Itchy, red/dark rash to inner thighs or groin	· Based on your symptoms and visual exam	· Over the counter creams e.g. Lotrimin · Prescription antifungal cream
Urinary tract infection (UTI)	· Burning with peeing · Peeing a lot · Vaginal irritation · Pain in your side	· Test your urine · Based on your symptoms	· AZO (over the counter) · Prescription antibiotic
Vaginitis	· Intense vaginal itch, irritation · Pain during sex · Change in normal vaginal discharge (color, amount) · May/may not have an odor	· Based on your symptoms · Pelvic exam	· Depends on the cause o   Antibiotic o   Vaginal lubricant

One more thing: The vagina is NOT meant to be dry. Think of how uncomfortable it is for your mouth to be dry. The vagina has similar tissues.

Can you believe it’s October already?! In case you didn’t know, this is breast cancer awareness month. The leading cause of death in women is NOT breast cancer, it’s actually heart disease. The second leading cause is cancer. Within the cancer category, lung cancer causes the most deaths, and then breast cancer. Did you know that? Based on all of the pink you see in October, you would think that breast cancer kills more women than anything else.

Today’s post isn’t really about breast cancer. I’m focusing more on prevention of breast cancer e.g. self-breast exams and mammograms.

Ladies I’m keeping it real, as always, and saying this because I care. STOP acting like touching your breasts is bad! How is it okay to wash them in the shower, dry them, put lotion on them, and put them in a bra but not actually touch them to feel for a lump? Here’s what I’ve started telling my female patients: “You’re with you all day, every day. If anyone should be touching them all of the time, it’s you.” This always makes them laugh! It’s true though…

 

Self-Breast Exams

 

My hump, my hump, my hump

My lovely lady lumps, check it out…

 

Sound familiar? That’s a few lines from The Black Eyed Peas “My Humps”. Click here if you want to see the video. Your lady lumps are your breasts. Ladies, Fergie is telling us to check them out! Okay, sort of. She’s really telling the guys to check out her body. But anyway…

Just like men should be doing testicular self-exams every month, women should be doing self-breast exams (SBE) every month. *Men can get breast cancer too! The actor Richard Roundtree (Shaft) had it. *

The best time to do a monthly SBE is 3 to 5 days after your period starts. Why you ask? Because usually your breasts aren’t as sore or lumpy at this point in your cycle. Side note: This is another reason other than trying/not trying to get pregnant to keep up with your period. I’ll admit that I don’t really tell my patients this. I think it’s confusing and the patient still doesn’t really know exactly when to do it, and you run the risk of her forgetting. Also, this is hard to apply to a woman that either doesn’t have regular periods or doesn’t get them at all e.g. menopause, certain birth controls, pregnancy. What matters is that you do it at the same time every month.

**Take Note**

• When standing in front of the mirror, start off with your hands on your hips. Do you notice any lumps? Major difference in size between the two? Then, raise your arms above your head and look for the same.

• Palpate (touch) with light, medium, and then deep pressure. Go in circles over the entire breast. This doesn’t have to be done in the shower but the hot water definitely helps if your breasts are tender are sore.

• When you lay down, don’t forget to feel under your arms for lumps. There’s breast tissue there too.

What am I feeling?

This is an excellent picture that gives you an idea of how breast cancer may look, or really any change in your breasts that is NOT normal! I actually have a pamphlet that includes this picture.

 

These nuts! Got ‘em!

I can’t begin to tell you how much I hated this joke in middle and high school. Then, it became popular again after that Vine video. You know which one I’m talking about.

I still don’t get why people think it’s so funny. However, it does grab your attention. Men, this bonus post is just for you!

Let’s get to it. How many of you are doing TSEs (testicular self-examinations)? I’m guessing only a few, and those men are probably too embarrassed to admit it. TSE is NOT masturbation! If yours turns into that, then that’s your business. Just know I won’t be discussing it. Anyway…

Did you know that testicular cancer is the most common cancer in men ages 15 – 35? The average age at diagnosis is 33 years old. This is young. To be honest, it’s an age where many of us still have an “it could never happen to me” type of attitude. While there’s nothing you can do to keep this from happening to you, there is something you can do to catch it early: testicular self-exams.

Technically, a testicular exam should be included in a regular physical but most providers (including me) don’t do them unless the patient reports having a problem in that area e.g. pain, swelling. As a matter of fact, we’re barely asking our male patients if they’re doing TSEs at home. The exception to this is pediatricians. On the other hand, we’ll ask every woman about doing self-breast exams and depending on her age, mammograms. Things that make you go hmmmm……

Who? When?

Once a male hits puberty he should start doing a TSE every month. The best time to do it is during or right after a bath/shower because the skin is relaxed.

What is normal?

• One testicle is a little bigger than the other
• One testicle hangs a little lower than the other
• “Lumps” that are actually the normal tissues, blood vessels, or tubes that carry sperm

 

I think this picture does a great job in showing how to do it. If you’re concerned or just not sure about what you feel, make an appointment with your provider.

 

 

 

 

 

Important notes

• If you suddenly start having severe pain, get to the ER immediately. There are some conditions that require immediate surgery, or else you could lose a testicle !
• Neither the penis or testicles have bones, it’s soft tissue with A LOT of blood vessels. This means that technically you can’t ‘break’ them. However, you can do some serious damage to them. No need to explain or give examples for this. Use your imagination.

 

 

On another note, you should have noticed by now how much I include pictures and videos. I ran across these stress balls during my search. I think it’s more of a gag gift but it’s definitely a real product. There’s even one that you can hang underneath your desk!

It’s okay to laugh! I know you want to. We’re constantly surrounded by so many negative or hurt emotions. Grab a smile or laugh wherever you can. Trust me, you’ll feel so much better.

 

 

In June, I did a 4-part series called, It’s All about Him. In the third part, I talked about the prostate. Today’s post is like a continuation of that topic, so feel free to go back and read it again.

See the patient’s face in the picture? I promise that’s the look I get every time I ask a patient about testing their prostate!

Quick Recap

As you can see in the picture, the prostate sits right underneath the bladder, and surrounds the urethra at its connection to the bladder. The bladder is a storage container for urine before you pee. After urine leaves the bladder, it goes through the urethra and out of the body. The prostate also makes the liquid portion of semen, the fluid that comes out when a man ejaculates. The urethra also carries semen out of penis.

 

PSA Screenings

Prostate specific antigen (PSA) is a protein made by the prostate. If the PSA is increased, it’s very likely that a man has prostate cancer. In my experience, most men already know this but are confused about when they should start having this test done, and how often it should be done. Here’s what the American Cancer Society says:

• Age 50 for men at average risk of developing prostate cancer and are expected to live at least 10 more years. *I underlined ‘and’ because the thought of the medical community is that if a man is only expected to live a few more years, at most, then there’s no benefit to screening for prostate cancer.
• Age 45 for men at high risk of developing prostate cancer. High risk includes African American men, family history of prostate cancer (father, brother, or son) before age 65.
• Age 40 for men at even higher risk. This is men with more than one family member diagnosed with prostate cancer before age 65.

What’s considered normal for the PSA depends on your age. For men in their 50s and younger, 2.5 is the upper cutoff for normal. In older men, PSA tends to be higher.

Have you noticed yet that this screening has a lot of ‘ifs’? Screening for prostate cancer screenings is one of those where what’s considered normal is relative. Here’s an example: Imagine two men who are the same age, and have the same PSA level (2.5). Both have problems urinating and get up several times at night to use the bathroom. Each man decides to have more testing done but only one is finally diagnosed with prostate cancer.

In general if the PSA is less than 2.5, you should retest every 2 years. If it’s higher than 2.5, then retest every year. Men, your prostate (actually your overall health) is very important! DO NOT just depend on your provider to catch something that’s not normal or remember that it’s time to test again. Also, it’s not your wife/significant other/mother’s responsibility to keep up with it. Yes, I’ve had mothers come to the appointment with their adult sons. Sigh…

Along with keeping an eye on your PSA, you also need to look at what’s called the PSA velocity. This is how fast your PSA level changes. Let’s say your PSA two years ago was 0.2. This year it was 2.3.  It’s still normal, but that increase happened pretty fast. Every provider is different. Some may refer you to a urologist (provider that treats illness of bladder and prostate), do a digital rectal exam (DRE), check the PSA again next year, or any combination of these. Prostate cancer usually grows very slow so if your overall health is poor e.g. several chronic illnesses and you aren’t expected to live past the next 10 years, your provider may not offer you the PSA as often or send you to a urologist.

Other reasons for a higher PSA that are NOT cancer

• Urinary tract infection
• Infection of the prostate (prostatitis)
• Recent sex or ejaculation (in the last 2 days)

 

You want to put your finger where?! 

A DRE may be done at the same time as the PSA, or it could be after finding out the PSA is high. Like the PSA, the DRE is only a screening test for prostate cancer. Neither one can actually diagnose it. I’ve shared with you before about learning how to do this exam on a real person. Of course it’s not comfortable having someone’s finger there but it should NOT hurt!

 

Can You Really Feel it?

I think this picture does a great job of showing what we’re feeling for. I will admit that more of the finger usually has to go inside (okay, pretty much the entire finger) to be able to feel the prostate. The prostate feels smooth and kind of squishy. Normally it’s about the size of a walnut. Side note: Providers also do this exam if we think you may have hemorrhoids on the inside, or if you tell us that you see blood when you have a bowel movement.

 

 

Black men, listen up!

For some reason, you are more likely to get prostate cancer, have a more aggressive type, and die from it. We don’t know why. This is even more reason for you to make sure you’re getting the PSA. You may want to start earlier than 45 years old even if you don’t have a family history of prostate cancer. As far as I know, there aren’t any set guidelines for when African American men should start being screened. I would suggest starting at age 40, and having it done at least every 2 years after that. Of course if it is high (more than 2.5), or just under 2.5 you should seriously think about getting the test every year.

 

Treatment for prostate cancer

I won’t get in to specifics because I’m not a specialist in cancer treatment or urology. However, I will tell you that there are A LOT of options. Do your own research on the treatments that are being considered for you, AND the provider that’s treating you. Think about getting a second opinion, and also connecting with a support group for yourself and your family. It’s a good chance that you know someone who had prostate cancer. Find out what kind of treatment they had. What kind of side effects did they have? Knowing what they know now, would they still choose the same thing? Sometimes we’re more willing to accept advice from someone that’s actually experienced what we’re going through. Here’s a link to more info on prostate cancer treatments.

Prostate Cancer Foundation

“If you think wellness is expensive, try disease.” – Dr. Chris Jones

A recent experience with a patient

Let’s call this patient Kathryn. She’s 67 years old, and made a same day appointment to be seen for a sore throat, cough, loss of appetite, fever, and just generally not feeling well since yesterday. She wanted “help” (her word, not mine) for these symptoms, and an antibiotic. Let me tell you something about providers. Usually we already have at least two or three ideas for what’s going on with you before we even walk into the room. The fancy medical term for these ideas, is differential diagnoses. Anyway, the first one on my list was a cold. She didn’t have a fever when I saw her. When it comes to fevers, everything is relative. What I’m saying is that it just depends on what your normal temperature is. I know 98.6F is what most think of as normal, but some people may be as low as 97F. Also, as you get older your body doesn’t respond to illness in the same way. Your temperature may not get as high as a younger person when you have a fever. With that being said, this patient said her normal temperature is 97F and her fever was 99F. Even considering her age that’s not a fever to me. Anyway, she insisted that she needed “help”. This is where it gets tricky for us providers. When everything in the history and physical exam points to a virus aka common cold, but the patient still insists on getting an antibiotic. Once again, follow the money trail people!

In case you didn’t know, Medicare is shifting to reimbursements that are heavily based on patient satisfaction. You qualify for Medicare based on your age (65 years old), and Medicaid is based on your income. Remember it like this: We care for our elderly and give aid to those who can’t afford it. The 65 and older age group will outnumber everyone else in about another 10-15 years. So this change is HUGE! We’re pressured to give in to these demands, even when we know it’s not needed, in an effort to keep patients satisfied so we’ll be reimbursed as much as possible.

And guess what. I gave her an antibiotic, and offered a throat spray. Oh! It gets better though. She decided that wasn’t enough “help” and told me she was going to the ER. Please refer to my post Emergencies and Urgencies for my thoughts on that. Sigh…

 

 

So when should I get an antibiotic?

The simple answer is when you have a bacterial infection, not a virus. Antibiotics have no effect on viruses. Here are some examples of viruses: colds, flu, HIV/AIDS. There are anti-viral medications but usually these are only used for illness like HIV/AIDS. Last week I did a blog on the flu. Tamiflu, the medicine that we usually give when a patient tests positive for the flu, is NOT an antiviral. It doesn’t really fight the virus itself, it just helps your body to fight it off and hopefully shorten how long you’re sick.

 

How do I know if I have a bacterial infection or a virus?

Not trying to be sarcastic, but you should really leave that to your provider to figure out. However, I’ll give you some pointers on when to know your home treatments aren’t enough, and you need to see a medical professional.

• Symptoms have been going on for 5 days or longer, and they’re either getting worse or not getting any better
• You’re using ibuprofen or Tylenol around the clock for 3 or more days in a row to keep a fever down
• Difficult swallowing due to a severe sore and/or swollen throat
• Can’t keep down any food or liquid for more than a few days
• Non-stop loose or liquid diarrhea for more than a few days

*If you are diabetic, especially if on insulin, I would suggest at least calling your provider sooner rather later. Being sick can really throw off your blood sugar. You may even want to check your blood sugar more often.

These antibiotic prescriptions are definitely a big deal! In the blog on influenza, I told you about how viruses are quick learners. Okay, bacteria aren’t dummies either. The more we take antibiotics that aren’t really needed, or don’t finish the antibiotics that we need (you know who you are) the more bacteria become resistant and eventually certain medicines stop working. Most people have heard of MRSA. This is pretty much how it came about.

Here’s another not so fun fact and money trail for you to follow. It’s been more than 10 years since a new antibiotic class was introduced. The few that have been introduced are in classes that already exist. FYI: Medicines that are in the same class all work in the same way. Most of the antibiotics that are used today were developed between the 1960s and 1990s. Developing any new medication takes time and money, easily hundreds of millions of dollars. For some reason most of the research now is focused on chronic disease. When I went to the medical conference last month, most of the drug reps had medicines for diabetes and chronic pain. Think about the drug commercials you see. Most of them are for diabetes, psoriasis, rheumatoid arthritis, depression, COPD, etc. These are all chronic diseases! How many people do you know that have one or more of these? What’s it really about? Helping sick people get well (or at least not get any sicker), or making money? 

 

“If you think wellness is expensive, try disease.” – Dr. Chris Jones