Homosexual men, women, and African Americans are at highest risk...

Syphilis infections are on the rise worldwide since 2000, especially in the population of men who have sex with men, young women, and African American populations, in the ages from 20-36.  HCP's aren't really sure why because there is SO much education on prevention of STD's being done in the world.  So, the best way to ensure that you are safe and sound is to have the knowledge of the signs and symptoms and know how to prevent the infection.  Syphilis was a heavily studied disease back in the day, known as the Tuskegee Trials (and probably one of the most horrific studies done by the US Government) where from 1932-1972 they infected a bunch of African American men from Macon County Tennessee with Syphilis and watched how their bodies reacted from the disease in the short and long term.  This study lead to laws about ethical treatment of study patients and requirements for informed consent for biomedical studies.  And, actually, in 1767 syphilis was an issue, mostly due to a lack of contraception, but one of the first true surgeons, John Hunter, infected himself to learn more about the disease, and learn to treat it.  As it ends up, a quick shot of penicillin will do the trick, but what John Hunter learned is a fascinating part of the disease; you can get a couple of days of subtle signs of infection, then they go away and you can have no symptoms at all, but still transmit the disease and have long term complications.

What is Syphilis?
Syphilis is a bacterial infection (from the bacteria Treponema Pallidum) that is spread through unprotected sex and can cause a painless sore on the genitals, in your mouth, around the anus, or rectum and direct contact with the sore will lead to infection.  It is an infection that goes in stages and early on, it can be simply treated with antibiotics to prevent the infection from spreading, but if undiagnosed over the long term it can cause cardiac (heart) and neurological (brain/nerves) problems.

What are signs and symptoms of syphilis?
Primary Stage:
The round painless sore that occurs is called a chancre and it usually pops up 10-90 days after initial infection (average is 21 days after infection) and can be one sore or multiple sores and they appear where the syphilis entered the body (so if you had anal sex with an infected partner, it will show up around the anus, etc) and usually lasts 3-6 weeks then goes away on its own without treatment.  This DOES NOT mean that the infection is gone, it just progresses to the secondary stage.  As you can see from the pictures below, some of the chancre are things you cannot miss on yourself, an others might be easier to miss...

www.gettestedchicago.com

Secondary Syphilis:

In secondary syphilis, you get a larger rash on the skin (can be on the palms of hands, bottom of feet, back, really anywhere!) that is not itchy and consists of rough reddish brown lesions on the skin.  Sometimes the rashes are so faint that people don't even notice them, especially because they don't cause any discomfort, if it is on your back, for example, you wouldn't know that you had it unless someone pointed it out to you.  Rarely you can also have symptoms of a fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue....who doesn't have some of these symptoms sometimes, especially during high flu/cold season?  This is why syphilis can easily be overlooked.

It should also be noted that if the skin on these rashes is broken, the disease can be transmitted to another!  As well, the rashes will go away on their own, without treatment, but then lead to the latent/end stage of the disease.

Late/Latent Stage:

You are considered to have latent stage syphilis once you have had both of the previous stages and are now without symptoms of syphilis, you continue to have the syphilis infection inside your body and can last for years, but can appear 10-20 years after first infected (and trust me, people come in and they have complications from syphilis at the age of 80 without knowing that they were ever infected!!)  In these late stages you have damage to the internal organs, brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.  This can cause uncoordinated muscle movements, gradual blindness, and severe dementia that can cause death.

Pregnant Women:

WILL transmit the infection to their babies and it will cause the infection which can either cause a stillbirth OR severe infection and seizures after birth.  It requires immediate treatment of the baby.

How am I Diagnosed?

So, if you show up to your HCP and you have a chancre, we can take a swab and study it under a dark microscope and it will show the bacteria.  And, it is shown through blood tests because the body builds up antibodies against it.  So, when you go for your regular STD testing, you will be tested for it (one of the cheapest blood tests to do!)

What are the treatment options?

If you are in the early stages of infection (under a year) one intramuscular injection of (usually) penicillin (or another antibiotic based on allergies) will treat the infection.  It will kill off the current bacteria but it will not undo the damage that has been done by the bacteria already.  As well, if you have a chancre but get treatment, you still must wait until that chancre is healed until you have sex, and you need to notify all sexual partners of your syphilis infection so that they can receive treatment in case they were also infected. 

Also, just because you have had syphilis and have been treated successfully, you still are able to contract the disease again! So, please be safe and get regular STD testing.  As with most STD's, when you have one, you are at a much higher risk of contracting the HIV virus, so please use protection and get tested regularly.  AND use common sense when hooking up!  I cannot emphasize enough, if something doesn't look right on your partner, question them about it and if it looks creepy, it probably is, so don't touch it!! And if you wouldn't touch it with your bare hand, a condom will protect you, but is it worth it??

Yours in Good Health

B

700,000 US cases a year....are you at risk?

Gonorrhea (AKA "the clap") is estimated by the CDC to infect 700,000 Americans a year, and over half have no idea that they are infected, allowing for the infection to spread to other partners and the babies of pregnant women.  Yikes!  Sadly, these infections are on the rise worldwide, despite STD education being promoted by HCP's and starting at younger ages.  Parents need to start having these conversations at a younger age too...so my goal is to give you the facts and let you know how the infection can occur, your risks and preventions, but also give you info, if you are a parent, to give to your kids.

What is a gonorrhea infection?
It is an STD from the Neisseria Gonorrhoeae bacteria that can be transmitted with equal rates to men and women from oral, anal, and vaginal sex that has a 2-10 day incubation period that can infect the urethra, rectum, and throat.  Women have the ability to also contract cervical infections and if they contract the infection whilst pregnant, the babies can have vision problems and eventually go blind if the infection isn't treated.  Also, it can cause pre-term labor.  Having one STD puts you at a higher risk for contracting another STD, especially HIV.

Symptoms:
Men (urethra):
Painful urination
Pus colored discharge from the tip of the penis
Pain or swelling in one testicle

Women (urethra or cervix):
Increased vaginal discharge (may smell differently and have  different color/consistency)
Painful urination
Vaginal bleeding between periods and/or after sexual intercourse
Abdominal pain
Pelvic pain (during sex)

In the rectum:
Itching
Pus like discharge
Straining when needing to poop
Bloody stains on toilet paper

Eyes:
Pain
Pus discharge
Light sensitivity  

www.the-clap.com

 

Throat:
Red, sore throat
Swollen lymph nodes

www.lib.uiowa.edu

**There may also be very subtle symptoms that you miss, best idea is to get checked for STD's regularly if you have unprotected sex in any form with different partners.

What are common Risk Factors?
Young age
Previous Gonorrhea infection
New Sex partner
Multiple sexual partners
Unprotected sex

Long-term Complications:
The most major long-term complications for both men and women is infertility.  It can also cause chronic pelvic inflammatory disease (PID) in women.  As well, the bacteria, when left untreated, can get into the bloodstream and go into your joints and cause swelling, stiffness, and pain along with fevers, rashes, and skin sores as the infection spreads.  All of these infections can be spread to babies at birth in untreated infected mothers and cause these same complications (along with blindness).  And, as stated above, having this untreated infection, puts you at a much higher risk to contract HIV/AIDS and the disease can progress faster due to an already decreased immune system.

How is it diagnosed?
Gonorrhea is diagnosed through a urine test and/or by swabbing the area (even if discharge isn't present. Most often, your HCP will draw some blood to also check for other STD's, just to be safe and ensure that you are being treated appropriately.

Treatment:
You will get either an oral or injected antibiotic (penicillin is cheapest and easiest, but due to allergies, your HCP may choose a different antibiotic for you).  As well, not only you but your partner also needs to be treated, even if they have no symptoms so that you don't get reinfected or spread the infection.  Babies at risk are usually treated with antibiotic ointment to their eyes at birth and if they show other signs of infection are given further antibiotic treatment.

Prevention:
USE PROTECTION!  It is the best way to prevent STD's if you are sexually active.  You should get tested regularly if you are sexually active, even if you use protection, with multiple partners, and ask your partners if they get tested, when the last time they were tested, and if they have ever had an STD.  If you are hooking up with someone and notice something that looks a little strange anywhere in their genitals, just stop...ask them about it, and just think about calling it a night there- totally not worth it to carry on and put yourself at risk for anything!

These infections are on the rise for many reasons, but one of which is that many teens "don't count" oral sex as sex; it is still sex and you can contract STD's. There is no form of sex with multiple partners that is safe unless you use protection.  Despite HCP's talking to teens at younger ages, and discussing these issues with single adults, we need people to use common sense (i.e. if something doesn't look right, stop) and get regular screening.  We need parents to talk to their children, or have an adult that their child feels comfortable with talk to them about their risks and prevention, and know that there are free STD clinics that they can go to for testing, but they will usually need parents permission before treatment (but that is a state by state issue).  But, this information on risks, symptoms, and prevention needs to get out there to the general public so that we can get more people regularly screened, and be aware of the signs of the infections.

So, now YOU know!  Talk to your friends, partners, etc and go get tested and treated (both you and your partner), and please check out your partners junk before you hook up...and save yourself the trip to the clinic if it looks funky!

Yours in Good Health
B

Is waxing really safe?

I am a huge proponent of waxing, and I have never had a problem with it BUT that is not to say that there isn't a risk going to get waxed, whether it is a quick eyebrow wax or a brazilian bikini wax.  You are at risk for skin infections from the wax or from the person doing the waxing, and from the bacteria that live on your own skin!  Fear not, there are ways to decrease the risk of infection, so that you can be safe and hair free!

What are the risks?
Skin burns- from using wax that is too hot, it can rip off a couple layers of skin and be super painful and cause some scabbing and possible scaring.
Skin Irritation- some peoples skin is very sensitive and can become bruised or have some  small skin tears and bleeding from waxing.  The irritation shouldn't last more than a day, and use of aloe cream or antibacterial cream can help
In-grown hairs- since every time you wax, the hair grows back thinner and thinner, it gets to the point that sometimes the hair cannot break through the skin. Products like Tend Skin can help to prevent them when used daily after waxing and prior to waxing .
Pain- taking 200mg of Ibuprofen before waxing can decrease inflammation and prevent some of the pain.  There are also products with lidocaine to numb the skin, that I don't think work, but men think that it decreases pain with waxing chests like GiGi Pre-wax anesthetic cream and Satin Smooth Res Q Analgesic Spray.

 Infections/abcess - Sometimes after waxing because of the sensitivity of your skin you can get infections from from Staphylococcus aureus, and  Streptococcus pyogenes from your own skin, from the skin of the person waxing you, OR (which is the creepiest) from the skin of the person before you!  If the waxer double dips the applicators in a multi use pot of wax, you are at risk from a skin infection from their bacteria that are hosted in the wax.  The wax is NOT hot enough to kill off bacteria, contrary to what many salons will tell you.  These infections can usually be treated with oral antibiotics but sometimes can lead to the need for IV antibiotics and hospitalization.

Contraindications to waxing:
Contagious skin conditions, thin or fragile skin, the use of steroid creams, Accutane use, and allergies to the products used.  Also, make sure that you tell you waxer if you are using any skin products or antibiotics, they can make the skin more sensitive an easy to tear.

How can I reduce the risk of infection?
Only go to professional salons that look clean (if they appear clean, then most likely it is really clean)
Make sure that the linens are clean in the treatment room- no stains or wax from a prior client
Request that your waxer wears gloves (especially for bikini or brazilian bikini waxes)
Ensure that your waxer has washed his/her hands
Watch to make sure that they do not "double dip" in the wax pot- a new applicator should be used for each dip of wax (you don't want to get something from the person before you and you don't want to spread your bacteria to others)
Don't allow them to go over broken skin more than once
If you feel uncomfortable at any time, just leave- it's your body and your health!

Rest assured that the risks are low, but they do happen, and if you are at an increased risk of infection due to uncontrolled diabetes or other conditions that would lower your immune system, just be very careful and ensure that the people who are waxing you are professionals and trained to perform your waxing services.  Also, ensure that they are taking all measures to prevent infection for you.  You can also be like me, and just wax yourself...just as easy and I know its only me using my wax (but not for the faint of heart!!)  Be careful, and realize that even a "quick" eyebrow wax at a place that isn't so clean can cause you an infection that can last months to clear!  Be safe and there is no shame in walking out of a situation that you think is unclean!!

Yours in Good Health
B

Having trouble sleeping? Light may be the issue....

You may want to get rid of the normal night lights in your kids rooms, and to light your hallways and exchange them for red lights!  Recent studies have shown that even the smallest amount of light can be transmitted through your eyelids and cause disturbances in your sleep.  I know that I've talked about sleep aids for sleep, but there is a lot of new research supporting the effects of light on the circadian rhythm (the bodies natural sleep/wake cycle).

How does this happen?
Well, there are light sensitive cells in our retinas and they send signals to the brain letting us know whether it is day or night and if we should be awake or sleeping.  These cells can get pretty confused due to jet lag or off shift work.  So, exposure of these cells to bright white light (from TV's, lamps, etc) at night can cause the cells to overwork and become confused, which can lead to sleeping disorders.  As well, people who work inside with exposure to dull light all day, like from overhead lights and from computer screens, can cause confusion to the cells.

http://healthysleep.med.harvard.edu/healthy/science/how/external-factors

The signals from the cells in the retina push for a drive to be awake, no matter ow tired you are.  After extensive sleep deprivation, that drive wears off and the sleep cycle begins because of a build up of adenosine in the brain, but no one likes to go through the day exhausted and barely getting through, so we drink caffeine which blocks the adenosine and keeps you awake.

So what can I do?
Decrease all light in the bedroom. If you sleep during the day, get black out shades and limit caffeine before bed.  Keep TV's off, and if you do need a nightlight, you can change it to a low red bulb OR get a very, very dim white bulb that is not in your direct vision or area of your eyes.  Also, try to decrease the amount of light stimulation right before bed; so don't read in bed with a bed side light, so that the retinal cells are not directly stimulated right before bed. Also, you may want to make your bedroom temperature a little lower, REM sleep is better attained when temperatures in the room are cool, so you can cozy up and get some good sleep!

Also, not to be overlooked but whether you have a sleep partner that is human, or not (i.e. dog, cat, etc), you need to work with any problems they might have.  So, if there are any snoring problems, or sleeping disorders that they might have, it can affect you!  Sleep studies are covered by most insurances, so it is worth going to your HCP for you or your partner if you have extensive sleep problems that are effecting either of you to get adequate sleep, because long term sleep deprivation can cause obesity, depression, and other issues.  But, try to keep down bright lights, and give yourself time to get to sleep (i.e. turn in about 30 minutes before you "need" to get to sleep so that you decrease light stimulation and give your body time to wind down.)

Yours in Good Health
B

Antidepressant Use and Miscarriage

 A large study out of Canada, that was performed over a 5 year time period came out with some surprising statistics related to the use of SSRI's (selective serotonin reuptake inhibitors) and miscarriage rates.  The specific drugs that were found to have a higher rate of miscarriage, 68% higher risk (than those who have never used antidepressants ever), were Prozac, Paxil, and Effexor.  Paxil actually has a 75% higher risk of miscarriage, specifically. It was originally found that in pregnant rats, there were high numbers of miscarriages, thus the study moved to humans because a few years ago, the medical community, for the most part, advocated for the use of antidepressants in pregnant women because the benefit to the mother outweighed the risk to the fetus.

The study, from the Canadian Journal of Medicine, looked at just shy of 70,000 Canadian women from ages 15 to 45, of which some took antidepressants, some just had a history of depression, and some had none of the risk factors.  To make things a little clearer, the risk of miscarriage compared to those on Antidepressants versus women who have never used them is 68%, the risk for women who have a history of SSRI use versus those on them during pregnancy is 61%, and the risk factor of having a history of depression is 19%. But, in the US out of the roughly 2 million pregnancies per year, there are approximately 600,000 miscarriages within the first trimester (20 weeks), so the baseline risk of miscarriage in the US is about 20-31% anyway.

Now, this is not to say, that if you are pregnant, you should stop taking antidepressants because the risk factor is there, based on this large study, but it is unknown why exactly the rate of miscarriage is higher.  It is theorized that the change in serotonin levels can put pressure on the uterus in an early stage of pregnancy, and possibly cause the miscarriage.  But, despite this study being rather large and appear to be non-biased, it doesn't take into effect some of the risk factors that are associated with depression in pregnancy, such as smoking, obesity, and older age.  It is also theorized that the stress related to depression itself on your body, may be the cause of the increased rate of miscarriage; much more research needs to be done in this area.

Thus, you need to speak with your HCP about your specifics needs related to depression and the health of your baby.  It wouldn't be healthy for you to stop taking the medications, go into withdrawal and a severe depression because of it, so there may be behavior modifications that you can do, or switch to a different medication, that may have a decreased risk.  Plus, if you are more in tune to the fact that you are at a higher risk for miscarriage, you may be more likely to notice different changes in your body, perhaps take it easy the first few months of your pregnancy, and follow-up with your OB/GYN more closely at first.

What are some non-medication treatments for depression used in Pregnancy?
Most of these have not been well studied, but are used by some HCP's with positive responses from their patients, so again, talk to your HCP and don't start any of these therapies without their approval!
-Addition of Omega-3 fatty acids to your diet
-Bright light therapy which can help with Seasonal Affective Disorder (30-40 minutes of bright light per day either out in the sun OR using specific light bulbs)
-Exercise can keep endorphins up and make you feel better about yourself
-Psychotherapy; talking to a licensed therapist can alleviate stress and depression symptoms
-And behavioral cognitive therapy can reduce symptoms of depression (a type of psychotherapy that emphasizes the role of thinking in what we do and how we feel- so you think and make active choices in your life)

If you have depression, and whether or not you are being treated for it, you should talk to your Primary Care Provider (PCP) and OB/GYN (and possibly Psychiatrist) before getting pregnant about the risks, possibly change medications or decrease doses, and your other options for treatment during pregnancy.  And if you get pregnant and it was unplanned, go to your HCP ASAP and discuss your options and risks. DO NOT take yourself off of your medications based on these few studies!  There are many different options, and you will just need to be watched closer, and try to de-stress any way you can, such as go out with friends for a walk, go to the spa for a facial, get your nails done, spend time with your significant other...whatever helps you to relieve stress, do it!  Make time for yourself and pay attention to your body.  And, don't feel horrible if you call your HCP every time you are worried...it is YOUR body and your baby, and you know how your body feels.

Yours in Good Health
B

Beating the holiday bulge: Are low carb, high protein diets the answer?

I hear a lot of people, especially around holiday time, say that they are gaining weight, so they need to cut out carbs, and they will be back to their old shape in no time. This isn't necessarily true, and I don't actually believe in the low/no carb diets mostly because I get so horribly bitchy without carbs that the entire human race benefits from me eating a normal diet!  (Friends have actually learned to carry some skittles on them in case I miss a meal because I can go from me to exorcist in a hot second without food.....a handful of skittles and I am back in no time!!)  But, for those of you who tolerate forgoing the carbs, I want to let you know what is actually going on in your body and the pros and cons of this diet....it may not be best for you in the long term.  As well, I want to give some tips on beating the holiday bulge!!

What happens when I ditch the carbs?
Your body normally primarily uses carbohydrates to feed the brain, and all of your vital organs because carbs are quickly processed by the liver and turned into ATP (if you remember from my hangover blog how the liver breaks down simple carbs) which is easily used by the body as an energy source.  When you suddenly take away those carbs and that ATP as an energy source, the body needs to find the energy to go on from somewhere, so it starts using stored fat as a source of energy.  It sounds great right?  This is also known as starvation mode for your body, it is a state of Ketosis.  Ketones are formed when the glycogen (sugar) stores in the liver are low, which is important because the ketones are used in the brain as energy as they can cross the blood brain barrier (the bodies natural defense against keeping toxins out of the brain), because the brain cannot use fatty acids as energy, but it takes about 48 hours of no carbs for the brain to be able to use ketones as an energy source.  So, the rest of the body uses fat stores for energy, and when fat stores get low, the body starts breaking down protein...and by that I mean the protein IN your body, such as your muscles!  The body will store whatever small amounts of glucose that it gets as an emergency storage, in case it runs out of fat to burn because your body does not want to muscle waste.  So, when you lose whatever weight you want to, you go back to your normal diet, all those carbs that you take in go right into the emergency storage and it takes about 48 hours on the reverse side for your body to go back to using glucose from carbs as its main source of energy.  That being said, after 2-4 weeks after starting this diet, your body normalizes to it and the feeling of crabiness and missing carbs is said to disappear.

How is it useful?
Well, it is used medically sometimes for people with epilepsy, it was first used in the 1920's, and it is not truly understood why, but numerous studies have shown that a high protein/fat, low carb diet decreases seizures and seizure-like activity diminishes on EEGs (brain wave studies).
It also does help people drop weight very quickly, using fat stores instead of glucose and those who do it, are big proponents of it.

What are the cons?
-All of these extra ketones in your body can cause gout, kidney stones, and can cause kidney strain and failure (your kidneys rid the body of ketones so they tend to be overworked in this diet).
-Cholesterol levels can be extremely elevated to unhealthy levels due to the amounts of fat most people take in their diet, and you cannot have fiber in the form of oatmeal, etc to help decrease cholesterol levels and can increase your risk of heart disease, stroke, and cancer.
-Many people skip eating vegetables and fruit because of the amount of "carbs" present, so they re missing out on essential vitamins, nutrients, fiber, and antioxidants.
-When your body goes into a ketotic state, you get really horrible breath...kind of a creepy "fruity" breath

Who should NOT do this diet?
Diabetics, people with heart disease or any risk factors for heart disease and stroke, anyone with kidney function disorders.  Even if you think that you are totally healthy, you should still talk to your HCP before starting this diet.

How do I beat the holiday bulge?
I know that it is the season to want eat a ton with family and friends, and eat stuff that you wouldn't at holiday parties, etc. but really the best way to beat the holiday bulge is to continue to exercise, and eat until you feel full...not until you need to unbutton your pants!!  If you do, instead of laying on the couch and "sleeping it off" go for a walk, a brisk 20 minute walk will increase your metabolism, and help you to break down those foods faster and feel like less of a porker the next day, I promise!! Even doing the dishes, having an impromptu dance party (which I happen to be a fan of), play Wii sports with the crew tournament style (not great exercise but better than nothing), or pop in a yoga/exercise DVD to get that blood flowing to the stomach to break down food AND the brain makes you burn more calories and helps you digest faster.  Also, make sure to drink lots of water, as many holiday foods are high in sodium and try to keep alcohol to a minimum (or not, I like to imbibe as much as the next guy....but make sure you keep active!) Get your family and friends to get involved; it is always harder to force yourself to get some exercise, but if other people want to go for a walk, or have a pooch that needs some exercise, get in on it and get the blood flowing!

Also, don't forget, it is actually a good idea to strap on the old feedbag every once in a while to really stimulate your metabolism and make it work!  Granted, eating tons of crap for two months is not what I mean, but having a big meal once a month or so isn't a bad idea, as long as you continue to exercise and don't let it become a habit.  If you think that you won't be as honest with your exercise as you think, then hire a personal trainer for the holiday season, if you have someone to hold you accountable for your health, you are more likely to keep in shape!!

I also want to let people remember, "diets" are only useful if sustainable for the long term and it is more of a lifestyle change, otherwise it is just a yo-yo diet and you lose and gain weight constantly.  So, make a life change that you can stick with.  But any way you choose to beat the holiday bulge, be it a no carb diet, exercise, or your own way, please be safe and remember that a healthy lifestyle means a healthy you!

Yours in Good Health

Hepatitis happens....

Hepatitis C is a virus that attacks the liver and causes inflammation and liver damage but it can be a silent virus with no symptoms until late in the infectious process. The infection is on the rise worldwide, and is replacing HIV/AIDS as the most feared disease among those at high risk as there is no cure and the treatments are difficult to tolerate. The CDC estimates that 150,000-170,000 new cases of Hepatitis C are documented each year! For this reason, I wanted to let you know about the disease, its transmission, treatments, ways to live with this chronic disease, and prevention.

What is Hepatitis C?
It is a chronic viral infection that causes liver inflammation and liver damage, and the most serious of all the Hepatitis infections.  The liver damage can lead to the need for a liver transplant, which won't cure the disease, but allow for the person with the infection to live longer and keep the infection at bay for a while; there is NO CURE.  It is transmitted through blood to blood contact, in a similar way to HIV transmission.

Symptoms:
Fever
Fatigue
Nausea
Decreased appetite
Muscle and joint pains
Tenderness over your liver (right upper quadrant of your abdomen under your rib cage)
Jaundice of the skin (yellowing of the skin)
Jaundice of the sclera (the whites of the eyes become yellow)
*The symptoms can be none at all and the Hep C is merely detected through lab tests at a routine physical with your HCP- it can be unknown by a patient for years.  But you should be aware that generalized long term flu-like symptoms, if you are at risk, can be a sign of Hep C, so you should go see your HCP for a work up and let them know of your risk.

Are you at risk?
Screening criteria usually include:
-Anyone who has injected drugs
-Anyone with abnormal Liver Function Tests (aka LFT's)
-Babies born to mothers with Hep C
-Healthcare workers with past needle sticks or other blood exposures
-Hemophiliacs treated with clotting factors or blood prior to 1987
-Long-term dialysis patients
-People with blood transfusions or transplants before 1992
-People with sexual partners (protected or unprotected) that are Hepatitis C positive

Transmission:
Hepatitis C is a very strong virus and can live outside of the body for up to 4 days, which is a long time for a virus, and it means that you can even contract Hep C from dried blood.  For example, if you use someone else's toothbrush that may has bleeding gums, and you have just flossed or have a canker sore or any other opening of the mucosa in your mouth, you could contract Hep C.  Also, another reason why you wouldn't want to use someone else's tweezers....not to mention others used needles to inject!  It is also transmitted through unprotected sexual intercourse, from blood transfusions or solid organ transplant (heart, kidney, lung, liver, pancreas, kidney) prior to 1992 (the testing for Hep C then became universal), and some babies can become infected through childbirth from infected mothers.

Complications from the Disease:
Due to the chronic inflammation from the virus, the liver can become damaged through a build up of scar tissue (cirrhosis) and not work well which can lead to total liver failure, sometimes requiring a liver transplant.  As well, patients with Hep C are at a higher risk for liver cancer due to all the stress on the liver from the chronic infection.  Due to all of the stress and inflammation on the liver, there are numerous changes that can occur such as chronic kidney insufficiency, skin rashes, jaundice, increased bleeding times, and a build-up of stomach fluid called ascites (it can make the stomach look pregnant).  Ascites can only be removed by certain diuretics and though paracentesis (where a needle is inserted into the stomach to drain the fluids off) and despite treatment it always comes back.  Also, because the liver filters out toxins from the blood, when it doesn't work well, because it becomes scarred and hard (cirrhosis) it doesn't filter well which can lead to a build up of ammonia in the brain and can cause confusion and lead to coma or death, the confusion is called encephalopathy.  When the liver becomes very diseased, patients need to have a low sodium and low protein diet to prevent further complications.

montana.edu

Treatment options:
Not all patients require treatment, despite its severity.  The chronic infection can start slowly and only allow for small amounts of initial inflammation; once your liver function tests become deranged (abnormal) your HCP will most likely send you to an Infectious Disease or Hepatology specialist for treatment. A Hepatologist will perform a core punch biopsy in which they put a large bore needle into your liver, and take those cells out and study the actual damage under a microscope to visualize the damage that is shown in the abnormal LFT's.  You will be started on antiviral medications, which attempt to clear the virus from your body, you will have one treatment "round" which lasts 4-6 weeks, have your liver functions re-tested, then based on those results either get another round of treatment OR just be watched closely by your HCP through blood tests and liver ultrasounds. One antiviral medication, Interferon, is still being tested, and thus far the results are mixed because while it seems to work well at eradicating the virus, many patients cannot handle the side effects and stop taking the drug, plus it is very expensive and not available everywhere.  There are currently 25 new drugs being studied for the treatment of Hepatitis C, as of this summer/fall and I will update the drugs as they show promising results and are closer to approval by the FDA, and hopefully more available.

Alternative Therapies:
The one alternative therapy that is used sometimes, although the studies are poor due to size and design, milk thistle supplementation is said to help up-regulate the liver, so it works more efficiently, and prevent/treat jaundice.

Living with Hep C:
The best things you can do to help yourself live a happy and healthy life with Hepatitis C are:
Be honest with your family/partner/HCP's about your disease to prevent/limit their exposure
Limit (if not stop) all alcohol intake
Live a healthy life with  a diet full of fresh foods, exercise, and water (lay off preservatives and things that do not come from the earth directly!)
Stop injecting drugs, if you cannot stop, please use clean new needles and find a needle exchange (I urge you to get help)
Cover all cuts with bandages to limit blood exposure to others
Don't let others share your grooming products (razors, tweezers, toothbrushes, etc.)
Talk to your HCP about all medications you take to prevent taking ones that are toxic to the liver.
Get adequate sleep
Keep stress to a minimum! ( I know, so much easier said than done!!)

And most importantly....Prevention:
If you are going to get tattoos or piercings, please go to a place that is clean in appearance and ensure that they are using new clean sterile needles on you and new pots of INK- the blood can be in the ink and the virus then transmitted.
Don't share needles for injections (again please get help to stop)
Don't share grooming products
Practice safe sex
Ask your partners for their status of HIV/AIDS and Hep C
Most importantly, if you are at risk, go to your HCP and ASK to be tested!!

While Hepatitis C can be a silent killer, in that the symptoms can be really generic, and it can be slow to onset, along with no current cure or vaccination.  So, please be aware of the signs and symptoms and be proactive about your life, if you feel that you are at risk, or you are unsure, then please got o get tested, the earlier you know that you have the disease, the earlier you can start treatment and get on the road to a healthy life to prevent further damage to your liver!

Yours in Good Health
B

Lupus: You may be at risk.

 Lupus is an chronic inflammatory autoimmune disease (where your bodies cells attack itself) that primarily affects women ages 15 to 35.  There are four types of Lupus: Systemic Lupus Erythematosus (SLE), discoid lupus erythematosus, neonatal lupus, and drug-induced lupus erythematosus, of which SLE is the most common and serious form.  Because it is an autoimmune disease, your immune system attacks not only viruses and bacteria that are trying to invade your cody, but the healthy cells of your body too, which causes inflammation and can damage your joints, heart, skin, kidneys, lungs, blood vessels, and brain.  It is presumed that you are predisposed to having lupus, not lupus itself, but them something from the environment can trigger the lupus and then it will become a chronic disease with flare ups and remission.  It is being studied a great deal because there is so much unknown about this disease and why it occurs.

What are the four types?
SLE: Can effect nearly every part of your body (as noted above: heart, skin, joints, kidneys, lungs, blood vessels, brain) and is the most common form of lupus; usually what people are talking about when they are referring to lupus.
Discoid Lupus Erythematous (AKA cutaneous lupus): affects the skin and usually is in the form of a rash on the face, neck, and scalp.  Some cases can lead to SLE but it is rare.
Drug-induced Lupus Erythematous: Can happen with a lot of different prescription meds, and mimics SLE, but the symptoms stop when you stop taking the meds (read the drug inserts from the pharmacy and if you get the side effects, call your HCP).
Neonatal Lupus: A rare form of lupus in which the mother (who may not display signs of lupus) can pass the antibodies associated with autoimmunity to the baby and the baby will get a skin rash that usually subsides within several weeks. It will go away but it some serious cases can cause long term cardiac disturbances.

Are there any risk factors?
Female, age 15-40, usually affects blacks/latinos/asians, exposure to sun may trigger a response, prescription medications, infection with Epstein-Barr virus, and exposure to chemicals (mercury, silica, and cigarettes).

What are the complications?
Kidneys: almost 3/4 of the people with SLE will have renal problems from the disease which can usually be treated with medications and in severe cases dialysis.
Brain: headaches, dizziness, confusion, behavior changes, seizures, and memory problems.
Blood vessels: can cause inflammation of the blood vessels (vasculitis), along with blood clots, and anemia.
Lungs: risk of pleurisy (an inflammation of the chest wall lining), and it puts you at a higher risk of pnemonia
Heart: a risk of endocarditis and myocarditis (inflammation of the heart) and pericarditis (inflammation of the heart membrane), and this chronic inflammation increase your risk of heart attacks and long term cardiac disease. You can also develop hypertension and high cholesterol levels, leading to atherosclerosis.
Infection: are at a higher risk of infection due to the medications (usually corticosteroids) to treat the other symptoms of the disease.  Some of these infections can become quite serious and cause death, as the infection can lead to further inflammation requiring more steroids to squelch the flare up.
Cancer: having lupus apparently increases your risk of cancer, possibly due to the drugs used to treat the disease and cause immunosupression, the good news is that you are less likely to die from the cancers (it's unknown why.)
Bone tissue death: blood supply to the bones can diminish because of micro clots and the bones become brittle and break, and the bone dies.  Most often the hip bone is affected.
Pregnancy: Women with lupus are at a higher risk for miscarriage, as well they are at risk for severe high blood pressure (preeclampsia), and pre term birth.

Treatments:
Non-Steroidal Anti Inflammatory Drugs (NSAIDS): such as Aleve, Ibuprofen are used to treat the symptoms initially, but can cause renal damage in high doses and stomach ulcers, so your HCP will need to regulate this dosage despite it being and over the counter (OTC) medication.
Anti Malarials: For some reason antimalarial drugs work very well at helping with the symptoms of lupus and may prevent flare ups.  Hydroxychloroquine (plaquenil) is one example, and most commonly prescribed.
Corticosteroids: They decrease the swelling but have major long term complications such as: weight gain, osteoporosis, high blood pressure, diabetes, and increased risk of infection.  The risks are higher with higher doses, so your HCP will work with you to find the lowest possible dose, and increased doses that may be needed for flare ups.
Immunosuppressants: medications that are given to patients after transplants are used to decrease your immune response, and also have serious long term complications, but can be used in severe lupus cases, or for flare ups.  some of the side effects can be infertility, infection, increased risk of cancer, and liver damage.
There are also numerous drugs being studied at the moment, that hopefully have less side effects.

How to treat yourself:
-Get enough rest, and don't let your body get too overtired
-Wear adequate SPF in the sun, and try not to spend extended amounts of time in the sun
-Exercise 30 minutes a day 4-5 days a week, but don't over tax your body.
-Don't smoke because it can increase your risk of heart and lung disease associated with lupus.
-Eat a healthy diet full of fresh fruit and veg with whole grains, and if you have renal issues watch your sodium intake or other dietary restrictions you HCP may give you.

All forms of Lupus can be difficult to diagnose at first, and your HCP will have to run a bunch of tests to rule out other diseases or causative factors for your symptoms.  So, it can be a very difficult and frustrating road at first, but there are people that will support you and help you through every step of the diagnosis and treatment.

I hope this gives some insight to those of you who might know someone with any for of lupus and might give you an idea of their daily struggles and how you can help them.  As well, if you have any of these symptoms, please go see your HCP to get checked out.

Yours in Good Health
B

Bottles: plastic, aluminum...what is best?

There has been such controversy about drinking bottled water since it became a trend years ago because of the cost and the issue with lack of bottle recycling, and now the issue is about what you drink your (hopefully home filtered tap water) out of.  There are a couple of issues that many people might not even be aware of: seepage of BPA (Bisphenol A) from plastic versus aluminum absorption from metal bottles. So what are we supposed to do??

Bisphenol A:
BPA has been talked about since the early 2000's but gained a LOT of press around 2009 when some studies came out showing how bad it was for babies and the fact that it was in so many baby bottles and other products.  There have been numerous studies in animals that have shown various mal effects, despite the National Institute of Health (NIH) stating they have "mild concerns" about BPA in humans and the National Toxicology Panel making a statement that they had the same level of concern with children and "negligible" concern related to the health effects of BPA on pregnant women. BUT there have been some animal studies showing issues with: increase of obesity, neurological disorders, dopaminergic systems (creating hyperactivity), adverse effects on thyroid function, promote growth of neuroblastoma cells, impaired testicular growth and prostate cancer.  Most of the animal studies are pretty weak and have not been correlated with human studies, as well the levels of BPA administered to the animals were pretty high.  A study in 2008 in the Journal of American Medical Association (JAMA) which is a big journal, did a BPA study on 1,500 humans and found links with BPA and diabetes, heart disease, and poor liver function but stated that the results required further investigation.  They followed up their study in January 2010 and found that there was only a slight increase in risk of heart disease with BPA present in adult humans urine.  Am I saying its safe?  No.  Am I saying its as horrible for adults as most people think?  I'm not convinced; I try to stay away from BPA but I am not a total freak about it.

If you read the recycle codes on the bottom of bottles #7 and #3 plastics usually contain BPA, although some companies do make #7 plastic bottles in BPA free. So steer clear of those two numbers and don't use them to as refillable, that's when most of the seepage occurs.  Stick to recycle codes 2, 4, 5, and 6 on the bottom of bottles if you still want to use plastic.

The Aluminum Issue:
Are you actually absorbing aluminum from the aluminum lined stainless steel bottles?  Numerous studies from the New England Journal of Medicine (NEJM) starting from the 1980's has shown significant seepage of aluminum (from cans and bottles) into the food substances and absorption in the GI tract causing numerous health issues.  Most of the aluminum that we absorb is from aluminum pots and pans, aluminum foil in contact with food, beverage cans, many antacids, and as a filler in a bunch of different foods.  As long ago as the mid 1980's, there was strong research out of Germany showing the relation of aluminum intake to Alzheimer's-like syndrome, as aluminum inhibits the uptake of choline and dopamine, which causes: progressive dementia, shaking, trembling, an inability to pronounce words, a lack of coordination, fatigue, and a decrease in brain cell energy.  The older you are, the higher you absorption rate of aluminum is, and while it isn't completely understood as to the rate of absorption across the blood-brain barrier (which usually protects your brain from bad stuff), we know it occurs and  causes major disturbances.  So, while I originally jumped on the bandwagon and grabbed a Sigg bottle, once I researched the whole deal I felt perplexed!!

What do I do?
Honestly, I drink out of GLASS as often as possible, that is cleaned in hot water without corrosive cleansers, and I do drink out of plastic when I am at work (no other choice, really) or when I work out (the last thing I want to do is lug around a glass bottle and smash it!) as long as they are #2,4, 5 recycle code bottles, I really don't worry too much. I do have glass bottles that I can put my Brita water in from home for when I go on errands and whatnot (I have a big purse- which i know isn't helpful for men) but you have to look at what is best for you.  I do think that we should not expose babies to it, and there are tons of options on the market for glass bottles with BPA free nipples, and/or plastic bottles that are #2,4,5, and 7 BPA free.  Check your canned goods too; while some have only small amounts of aluminum in them, many are lined with BPA (a double whammy!!)  Many companies are trying to find another option, based on the recent studies, mostly to assuage consumers fears.

So, be aware of what is better, and make the best choices for you and your family, and what works best for your wallet- making these changes can be pricey but possibly better for your health.

Yours in Good Health
B

Is too much exercise bad for your immune system?

For years and years HCP's have been telling you that "moderate" amounts of exercise are good for you and your immune system especially during the winter months to prevent colds, flu, respiratory infections, etc. And, I am not going to tell you any different, BUT I am going to give you an explanation as to why exercise can boost your immune system and how much exercise can actually put a strain on your immune system.  Actually, one study showed that people who didn't exercise and started 12 weeks of moderate exercise had over a 50% drop in sick days over the next year!!

Who can benefit?
The best part is that everyone can!  Even with chronic diseases or autoimmune diseases, you can find YOUR level of moderate exercise and it will only benefit your body, your general health, and support a healthy immune system.  For example, if you are bed bound, there are arm exercises, rolling in bed, leg lifts...a form of exercise depends on what you are used to.  So, everyone should be getting some form of moderate exercise, there is NO excuse!

How does it support your immune system?
So, the immune system is a whole network that has been created by our body to protect it from invasions from viruses and bacteria using various different hormones, chemicals, and cells to attack, as well as to remember, the viruses in the future to prevent further attacks and hone your bodies response.  In an effort to not get too deep into cellular anatomy and physiology, I just want to explain that some of the cells that respond are called cytokines (of which there are many different types).  Some of the cytokines release a signal to your white blood cells (the ones that increase in number to attack when their is an invader present in your system- your number will be elevated if you have a cold, for example, and get your blood drawn at your HCP, but it will drop back down to a "normal" level when you aren't sick) that there is an invader, then there is an inflammatory response, and the white blood cells know to go in for the kill.  So, why am I telling you this?  Well, with a moderate amount of exercise, the cytokines are produced and released in moderate amounts, so your immune system is being challenged a little bit every time you exercise, and it strengthens your immune system because it is constantly working.

Why is too much bad?
If you overtrain, or exercise too much, you can cause damage to some of the muscles, or various different cells in your body, and it can stress your body.  When your body feels stressed, overexerted, or over taxed your immune system is actually decreased because your body is working so hard to recover your muscles from training, that your immune responses can be lowered due to a release of higher cortisol levels.  Cortisol is a natural hormone that is released from the adrenal gland that helps to regulate metabolism, the immune system, inflammatory responses, as well as having other functions; it is basically your "stress" hormone and the one that jazzes you up during your "fight or flight" response.  The problem with is being constantly elevated, is that your body is never truly relaxed (which can occur in our modern way of living where everyone is running around, working tons and constantly stressed even when we don't realize it) and this can lead to slower immune system responses and slower healing by the body due to the way that cortisol makes your body react.   So, too much exercise can depress the cytokine release, and make your body slower to react to minor pathogens (viruses/bacteria) that may be trying to invade your body.

What is considered Moderate exercise?
Usually it is defined as 20-30 minutes of exercise 5 days a week.  For me, that is not enough because my baseline is much more than that, so that is a great guideline but it needs to be based on your level of exercise specifically.  So, I would tell you that "moderate" really means what you feel comfortable with in exercise, can get through without feeling tortured and on a scale of 1-10 (one being barely any effort and 10 being extreme effort), it would be a level 4-6; where you are comfortable and can even talk during the exercise (not a lot mind you, but you aren't struggling for breath).  Moderate exercise can vary with days that are a 6-8(a little harder) and days that are a 4-5 (a little easier) but try to stay around that range for cardio.  You can push harder twice a week, for better results, but if you are happy with how in shape you are, try to keep it relatively even.  As far as lifting, you definitely want to add some muscle strength on top of your cardio, but again, don't stress yourself out (i.e. you can barely lift your arms afterwards), but push yourself daily to the point that you know you have worked out and feel stronger.

What is too much?
Pushing yourself to run at a super fast pace and for a long distance when every step you feel like to want to stop...that is too much.  You need to listen to your body (and non-runners, will probably say, "my body says that every time I run" I'm talking to those who are runners baseline).  Or if you are working out on the scale of an 8-10 every day, that is too much!!  You can go 8-10 once or twice a week, but really no more than that. If you feel strains in your muscles or muscle tears, you need to take a break and your body will let you know.  I totally understand the feeling of wanting to push your body to the limits EVERY time you work out, I have done that in the past, and I looked fantastic, but it isn't sustainable over time, because as you overtrain, your body loses interest in wanting to work out and it gets harder and harder to push yourself to do so.

For my avid exercising readers, just listen to your body; it will tell you when you are overtraining!  Sometimes every step feels so horrible you just can't exercise- then STOP,  just lift weights, or take a break and catch up on some missed TV shows and DON"T FEEL GUILTY about it!! Just go back to your normal routine the next day, Nurses orders :) You really need to look at exercise as everything else, do it in moderation, and it will be sustainable over your whole life, not something that you stop and start.

For those of you who don't exercise, I hope this inspires you to park farther away from the store and get a walk, skip the elevator and take the stairs, and grab a friend (bundle up) and go for a wintery walk and a cup of coffee/tea!  Try to get out there and get that heart pumping to stimulate your immune system!!  It actually is good for you, gets you out, and can help you also beat the winter blues (check my blog tomorrow!)

Yours in Good Health
B

Why should I add probiotics to my diet?

Probiotics are live microorganisms that benefit the host in which they live. They can aid in digestion, and normalize the intestinal flora.  There are currently many studies being done to look at the use of probiotics in preventing the symptoms for IBS (Irritable Bowel Syndrome), IBD (Inflammatory Bowel Disease) as well as some other chronic diseases.  The most common probiotic is the lactobacillus strain and it is found in raw milk (unpasteurized), most yogurts, as a dietary supplement, or in Kombuchas (fermented teas.)

A Little History....
Just for a little background, in the beginning of the 20th century, it was presumed that the bacteria that is in our guts (totally normal and appropriate) can cause toxins when we breakdown certain foods, like proteins (they are called proteolytic bacteria).  This process, diet and body depending, can build up a lot of toxins in the gut an cause various stomach discomforts like bloating, gas, diarrhea, constipation, etc. So, a Russian scientist at the Pasteur Institute in Paris, who had noticed a link between long life span (completely observational in his hometown in rural Russia)and drinking fermented milk (AKA sour milk), started drinking it himself, and found that he felt much healthier.  After that, he started to test it on friends and patients, and it became a widely followed trend in Europe and MD's even prescribed it to patients as a treatment for stomach ailments.  They found that the lactic-acid bacteria helped to change the pH in the intestine and prevented the proteolytic bacteria from having damaging effects.  In 1989 Roy Fuller defined probiotics as "A live microbial feed supplement which beneficially affects the host animal by improving its intestinal microbial balance." And thus, the modern studies of probiotics on health really began!

Why are they so good for me?
All of the modern research on probiotics is very new and hasn't had the full battery of testing including randomized control trials (the gold standard in research!) Lactobacillus has been shown to prevent antibiotic associated diarrhea and is being studied for its usefulness in other diseases.
Lactose Intolerance: The strain of bacteria turns lactose into lactic acid, so you are able to tolerate more lactose than you would have.  For example, eat some yogurt before eating ice cream (or pizza with cheese) and you won't get the normal response that you usually get. It is being tested to see how many different strains of bacteria aid in this process.
Lowering Cholesterol: In animal studies the addition of probiotics has shown to increase the breakdown of bile (which is stored in the gallbladder and released into the stomach when you ingest food) in the stomach before it gets reabsorbed; when bile is re-absorbed it is in the form of cholesterol. It needs MUCH more human testing.
Lowering Blood Pressure: A few small studies have shown that fermented milk with certain strains of probiotics can break down and create these peptides, which are similar to proteins in chemical nature but smaller, and they can have similar effects to certain blood pressure lowering medications (specifically ACE inhibitors). It needs larger studies to be performed.
Strengthening immune system and prevent Infection: Some studies have been performed and it has shown that they can reduce respiratory infections, by increasing the number of "killer" cells that attack pathogens (viruses and bacteria that we are exposed to) and can decrease cavities in children.  As well, induction of probiotics in your diet has been studied as far as decreasing the severity of rotavirus and shortening symptoms, along with preventing altogether. (rotavirus is a highly contagious virus that causes usually stomach issues like diarrhea along with fevers and it is very common among children.)
AND, probiotic use is still being studied (very promising) in the areas of: colon cancer prevention, IBS, IBD, eczema, reducing inflammation (generalized in the body), improving absorption, in relief of UTI and bacterial vaginosis, and the decrease of ulcers during stress.

Any side effects?
You are introducing live bacteria to your system, so immunocompromised people (due to illness or medications taken) should probably not add probiotics to your diet.  As well, you need to be very careful with the very young and the elderly; babies immune systems are not fully developed, and I am generalizing when I say "elderly", but for the most part, older adults have other chronic medical issues which puts their immune system under strain and they are considered immunocompromised.  Also, as I've stated a billion times, full side effects aren't known because more studies are needed to find out the short and long term effects of probiotic use.  One study did show that children under six months of age that were given doses of various probiotics had much higher rates of food allergies/sensitivities!

Best Sources of probiotics:
Yogurts, pickles (naturally fermented- not with vinegar), miso, kimchi (pickled cabbage), Kefir (fermented milk), buttermilk, raw milk, raw or aged cheeses, kombuchas, and probiotic supplements that can be added to a smoothie, for example, or other foods.
Oral Supplements:
A few of them are align, culturelle, phillips, jarrow, and nature made brands.  You can find them at basically any pharmacy, grocery store, or health food/vitamin store.

Personally, I am a huge believer in probiotics even though some of the data is weak.  I eat only raw dairy products and try to eat foods that are high in probiotics whenever I can.  I did used to take supplements, but I don't think they are absorbed as well, and you need to ingest them regularly to see their effects, and I am HORRIBLE with taking supplements; I always forget, which is why I just eat a healthy diet!  So the choice is up to you, and if you do have medical issues I would discuss with your HCP if probiotics are right for you.  If you are healthy, the choice is yours if you want to wait for more studies to come out or not!

Yours in Good Health
B

Is Anilingus safe?

Soooooo, I know a lot of people don't necessarily admit to doing this, despite it being a totally acceptable (and I hate to use the word, but) normal sexual practice, since it isn't talked about frequently, I wanted to talk about the risks and how to be safe.  Technically, Anilingus is oral-anal sex (AKA "rimming", "rim job", etc.) and is the act of kissing, licking, and/or putting the tongue into the anus.  There are risks along with this practice and ways to do it safely.

What are the risks?

Well, firstly, there is always a risk with any form of unprotected sex for HIV (and yes, oral sex "counts" as sex in the medical world), that being said, the risk is very low for this practice, as long as your there are no bleeding gums, hemorrhoids, open sores, other STDs present.  Any time there are other STDs present, and you or your partners HIV status is unknown, there is a higher risk for transmission due to a portal of entry and a weakened immune system. Other than that, there are risks of other STDs such as gonorrhea, syphilis, chlamydia, herpes (HSV 1 & 2), genital warts (HPV), Hepatitis A, Hepatitis B, Hepatitis C, E. Coli, and parasites.  Specifically Hepatitis A and E. Coli is transmitted through the oral fecal route (which is why you are encouraged to wash your hands after using the restroom, changing diapers, picking up dog poop, etc); you will usually get some pretty decent diarrhea, and then it will pass in a few days (like a viral infection, but there is a risk for an E.Coli infection to get pretty serious, and if that is the case, then please see your HCP.)  The parasites and other STDs will require a trip to your HCP and a treatment with antibiotics to treat them, although we all know that herpes is the gift that keeps on giving, and you will need a diagnosis so that you can learn how to prevent breakouts and how to be sexually healthy with herpes and prevent transmission.  With HPV, not only are the warts an issue, but I urge you to read my earlier blog related to oral cancer and HPV (having more than 5 partners for oral sex increases your risk of oral cancer by up to 250%)!  As you may know, Hepatitis C is a chronic disease than can cause liver failure, to which their is no cure currently, and it is transmitted just like HIV/AIDS. Hepatitis B can also be transmitted like HIV/AIDS and Hep C, but most people (approximately 90%- per the Hepatitis B Foundation) will get the virus with few to no symptoms and rid the body of the virus and create antibodies against it, as well many healthcare workers and people at risk for bodily fluids are vaccinated against it.

How can I prevent these risks?

So there are a couple of different options to decrease your risks, but knowing the HIV and STD status of your partner is key!  If you don't know their status and/or you don't really care, you need to use protection.  How?  I am sure that you don't have a dental dam in your back pocket, although it is deemed as the best form of protection because it is created for oral sex (cunnilingus/anilingus). 

If you don't have a dental dam, you can cut a condom open and use that as a dental dam, and here is a link to instructions to doing it properly.  And if that isn't an option, you can always use saran wrap in a pinch.  Saran wrap has never been officially studied and accepted by the medical community as a "prescribed" barrier method, but it is a barrier and better than nothing.  Due to it being thicker than a condom or a dental dam, you can have decreased sensation, but it is much safer than going without!  To decrease the risk of fecal/oral transmission of E. Coli and Hepatitis A, some people use and enema to clean out their anus before anilingus and feel safe that the risks are decreased, so it is safe not to use protection.  Honestly, it does decrease the risk, but it doesn't eliminate the risk completely, because the bacteria/viruses usually are present still around and inside the anus. 

I am also not saying that you will get sick from doing this every time, but there is a risk of it happening, and with new partners, there is always a risk of STDs.  If you are in a monogamous relationship and don't want to use any barrier, just make sure that the areas are clean before going in for the kill to prevent as much oral-fecal transmission as possible :)

So, enjoy yourself, but be responsible and keep it clean kids!!

Yours in Good Health

B

Cholera: what's the big deal?

I know that Cholera is all over the news lately because of the outbreak in Haiti, but sadly it is still a risk in many places around the world.  Most people don't even know what it is because it isn't a huge risk for most in the modern world, but it still effects people in parts of Africa, Mexico, Asia, India, and Central/South America, and is still one of the world wide leading causes of death.

What is Cholera?
It is a bacterial infection in your small intestine caused by the Vibrio cholerae bacteria. The bacteria releases a toxin in your colon that causes an increase in water release, leading to large amounts of watery diarrhea.  This expelled diarrhea is filled with tons of the bacteria, and can infect the water/food source of others.

Symptoms:
The symptoms usually start one to five days after initial infection and start suddenly and all at the same time. Profuse explosive diarrhea (like EXPLOSIVE and it can smell fishy), abdominal pain, vomiting, fever, and dehydration.  The signs of dehydration can be subtle, so be aware to know when you are dehydrated:
-dry membranes in your mouth
-dry skin
-excessive thirst
-glassy/sunken eyes
-lack of tears
-lethargy
-low amounts of urine (or really dark)
-nausea
-fast heart rate
-dizziness when standing up from sitting

How do you get Cholera?
It is transmitted through water that has been infected with the bacteria, usually with feces from an infected person or vomit.  Any water that is used to wash foods or is used as drinking water that has been affected can cause the infection.  Also, shellfish that live in affected water can be infected then pass the bacteria along.  People who take antacids are at a higher risk because stomach acids can kill off the ingested bacteria, as well those with weakened immune systems due to chronic diseases and those that are malnourished are at risk. People die all of the time during cholera outbreaks due to the dehydration, and it is a serious risk.

How will I be Diagnosed?
If you suspect cholera, or just have really vile smelling diarrhea, your HCP will draw some blood to culture and test for bacteria. As well, you will be asked to bring in a stool (poop) sample and they will study for various parasites and culture for cholera bacteria.

What is the treatment?
Depending on how far along the infection is, you might need IV fluids, but usually oral replacements of fluids are suitable (this is one time where coconut water is the BEST treatments). And, oral antibiotics (tetracycline) are usually acceptable as treatment. In extreme cases, IV antibiotics would be needed to treat the infection.

How do I prevent it?
There is an injectable vaccine that is good for 2-3 years ad an oral vaccine as well but they are not available in the US and the CDC does not recommend their use. The best prevention is to be aware of where you are and where you are traveling; check with the CDC and if you are traveling to an area with a recent or current outbreak, and make sure to drink bottled water, and eat fruits and veg that you peel the skin off of, so there isn't a risk of bacteria on the skin.  If you are helping someone with the infection make sure to clean all clothes/bed linens in boiling hot water and bleach (if possible), and boil (to sterilize) anything that comes in contact with them.  Also wash your hands thoroughly after touching them and anything they have come in contact with until the infection is treated.

So, read up before you travel abroad, and just be really careful about what you eat and drink (lay off the ice) and if you think you have any of the symptoms, drink lots of fluids (preferably coconut water, if available) and go see your HCP ASAP to prevent the spread to your fellow travelers!!

Yours in Good Health
B

That's loko....

I didn't really know what Four Loko was, but I knew that it was causing all sorts of uproars on college campuses nationwide.  So, what is the big deal?  Why is it being banned by college campuses and now on state levels?

So, basically it is an 'alcopop' an alcoholic energy drink named Four because of its four main ingredients: alcohol, guarana, taurine, and caffeine. It is basically a caffeinated, alcoholic malt beverage. It ranges in alcohol by Volume (ABV) from 6 to 12.5 depending on state regulations, and comes in different flavors: orange, blue raspberry, lemon lime, lemonade, cranberry lemonade, grape, fruit punch, and citrus.  One 23.5oz can of Four Loko has the equivalent to 5-6 cans of beer and two cups of coffee or 1.5 cans of Red Bull!  It has been dubbed "blackout in a can" and "liquid cocaine" so clearly, it is really good to binge drink (BEING SUPER SARCASTIC!!)

It sounds just like any other fruity malt beverage at the liquor store, right?  Well, the real issue is the caffeine, guarana, and taurine that have been added.  When you drink alcohol along with caffeine, the caffeine keeps you alert and awake, and you feel less drunk, so you tend to drink more. You are mixing an "upper" (caffeine) with a "downer" (alcohol) which can give you energy and relax you all at the same time.  The problem with drinking these super energy drinks with alcohol is that you get jazzed up on the caffeine, guarana, taurine, so you have a great time, and totally booze it up, your body is hyper metabolizing the alcohol.....and then the energy effects wear off, your body has all of this alcohol in your blood that it needs to metabolize, and before you know it, you are super drunk and have alcohol poisoning.

In 2008, Anheuser-Busch actually reformulated drinks that they had on the market, that were of a similar vein, after the Attorney General started to question the safety of these products, looking into possible health risks due to masking the feelings of intoxication.  But, smaller companies didn't fall under investigation due to the size of their companies and smaller companies popping up all the time.  This fall, Temple University, Boston University, and Northeastern University all sent emails to their students and staff warning of the dangers of Four Loko stating that it contains unhealthy amounts of caffeine and alcohol.

The actual health risks of these drinks are many: rapid heart rate, increased blood pressure (people with cardiac problems are put at risk for heart attack and stroke), severe dehydration, and there is a much higher rate of alcohol poisoning (as earlier stated).  Also, seeing as Guarana and Taurine are not FDA regulated supplements, you really don't know what you are putting in your body...but you do know that you will get an energy boost.

A study performed at the University of Florida, Gainesville showed that students who drank alcohol and caffeine beverages thought that they were less drunk and able to drive safely, more than students who just drank alcohol.  Also, when people drink caffeine and alcohol they tend to over-judge their abilities and take more risks than they normally would (including drug use and unprotected sex). That is pretty scary.

Numerous college Heath Centers are reporting hospitalizing students due to blackouts and alcohol poisoning at much higher rates when Four Loko is involved. In October 2010, 50 students got sick and 9 students at Central Washington University were sent to the hospital with alcohol poisoning after being at a party serving Four Loko, and their Blood Alcohol Levels ranged from 0.12 to 0.35.  Also at Ramapo College in New Jersey, 17 students and 6 visitors were hospitalized after partying with Four Loko and the liquor was then banned on campus.  Unfortunately, this October and November there have been tons of similar stories just like this...too much alcohol in a can and students drink too much and can get very ill or die. Honestly, it is just a matter of time before someone dies from this.

It had been banned in the state of Michigan and on numerous college campuses nationwide. Just today the University of Rhode Island has banned the possession of Four Loko and other energy enhanced alcoholic beverages campus-wide.  Under investigations from various Attorneys General and HCP's speaking out about the effects seen in Emergency Rooms nationwide due to this beverage specifically, and others like it, Four Loko may be banned nationally soon.

The fact that it tastes yummy, you don't know you are getting drunk until it is too late to reverse it, and the risk taking behaviors that young adults are taking on these beverages, is a serious health concern.  So, if you do imbibe, just be aware of the effects, and please go slow!  And, you may be out of luck finding it at your local liquor store soon!  Also, parents please talk to your college age kids about the risks of this drink.  It is so much more dangerous than college kids realize, and another scary tidbit is that younger kids are drinking these beverages because they think they taste good and are getting seriously messed up!  Please talk to your kids....and lay off the Loko yourself!!

Yours in Good Health
B

Diabetes: What's the deal Type 1 vs Type 2? My risk?

There are always things on the news "linking" various foods or behaviors to Type 2 Diabetes, and in honor of national diabetes month, I wanted to talk about the different types, and risk factors that are totally preventable!  It is estimated that 24 million people have diabetes an 57 million are at risk for developing the disease, in the US, and 171 million people are affected worldwide; let's make sure that we aren't on that list of 'at risk'!!

Just as a background, Diabetes Mellitus is a metabolic disorder in which you have high blood sugar due to either decreased production of insulin or because your cells don't respond to the insulin your body creates.  Diabetes can also be mimicked my taking corticosteroids for various disease processes or simply gestational that will be reversed once you have your baby or stop taking steroids!  As well, type 2 diabetes can be "reversible"....read on!

Type 1 Diabetes:
Type 1 was originally dubbed "juvenile onset diabetes" or "Insulin dependent diabetes" and really the body fails to produce insulin from the pancreas because the body attacks itself (an autoimmune disorder), therefore people affected need to give themselves insulin injections to level their blood sugars.

Type 2 Diabetes:
It is a result of poor diet and lifestyle, usually, and is characterized by insulin resistance; your body makes insulin but the insulin receptor cells reject it, and usually there is a lower insulin release baseline.  This is the most common type of diabetes and affects 90% of Americans that are classified with diabetes.  Early on when insulin levels are just decreased, there are oral medications that can be taken to improve insulin sensitivity (basically make the most out of what your body is already producing) and/or reduce glucose production by the liver.

Pre-Diabetes:
A term that has been dubbed for people who have elevated blood glucose levels as a baseline, but not high enough to diagnose as Type 2 Diabetes.  At this stage, with lifestyle changes, you can usually prevent it from turning into a diabetes diagnosis.

What are warning signs?
Polyuria (frequent urination), Polydipsia (increased thirst), and polyphagia (increased hunger)which can be sudden in Type 1 Diabetes and may occur over a slower period of time with Type 2 Diabetes.  Prolonged elevated glucose levels can cause changes to the retina which can lead to blurry or changed vision, slow healing cuts/bruises, tingling/numbness in hands and feet, and/or recurring skin/gum/bladder infections.

biomed.com

What should glucose levels be?

	Fasting	After eating	2-3 hours after eating
Normal	80-100mg/dl	170-200mg/dl	120-140mg/dl
Impaired Glucose	101-125mg/dl	190-230mg/dl	140-160mg/dl
Diabetic	126+mg/dl	220-300mg/dl	200+mg/dl

How do I know if I have it?
If you have any of these warning signs, or are concerned, go to your HCP who will test your glucose in the office, and check a fasting glucose or perform a glucose tolerance test: check a fasting blood sugar which should be less than 126mg/dl, with a glucose tolerance test the should be glucose level less than 200 two hours after ingesting 75g of glucose, and they will check an Hb A1C (a sample of hemoglobin from the blood which helps to determine an average of glucose levels over time) which should be less than or equal to 6.5%

Why is it such a big deal?
There are TONS of complications that can occur from diabetes taht can occur in both the long and short-term of having the disease, which is why it is crucial to check your blood sugar frequently throughout the day AND treat your elevated blood sugars with your prescribed insulin (or other treatment).  Some of the more acute and life threatening are:
hypoglycemia: Severely low blood glucose levels and can be characterized by shakiness, hunger, sweating, confusion, pale skin, jerky movements, clumsiness, etc and the treatment is drinking 4oz (1/2 glass) of juice or soda, 1 tablespoon of honey, 2 tablespoons of raisins.  Then, re-check your glucose levels in 20 minutes.
diabetic ketoacidosis:  from extremely elevated blood glucose levels, the breath becomes fruity (or smells like acetone), breathing can change to rapid deep breaths, abdominal pain with nausea and vomiting, and can lead to altered mental states and coma (it can happen quickly and I'v seen it hundreds of times!)It is VERY SERIOUS and a medical EMERGENCY!!  You need to be treated in the hospital.
hyperosmolar hyperglycemic nonketotic syndrome: Usually in type 2 diabetes and is usually brought on by illness or infection; your blood sugars to rise to a severe level (>600) then your body attempts to get rid of excess sugar through getting rid of body water, you will rid your body of all its free fluids, your urine will be very dark and concentrated and once you get severely dehydrated you are at risk for seizures, coma, and death.  It can happen over days or weeks.  You need to be treated with IV fluids if it goes to far, it is also a medical EMERGENCY!  It can also occur after a diabetic drinks to much alcohol....so be aware with diabetic younger adults!!!

Long-term complications can be:
peripheral vascular disease
cardiovascular diseases
retinal damage
chronic renal failure

What can I do to prevent Type 2 Diabetes?
Lifestyle changes!!! Eat a healthy, sensible diet full of fruits and veggies, lay off processed foods and foods high in sugars. Exercise moderately 4-5 days a week of 20-30 minutes of moderate exercise (you are short of breath and work up a good sweat!)  See your HCP regularly to have your sugars checked.  If you are overweight, use a dietician to lose weight in a healthy way and get to a healthy weight, find a exercise buddy, or better yet, go for a long walk on your lunch break for the days you can't go for a heavier workout.

Treatments Type 1: 
Injectable insulins (regular, NPH) and/or synthetic long acting insulin.  They can be injected into the fatty tissue of the skin, and can be injected a few times daily (after checking blood sugars) OR administered through an insulin pump which is a continuous ow rate of insulin (much like our body secretes) and you can increase rates based on your blood sugars to treat when you are going to ingest high amounts of glucose.

Treatments Type 2:
Make those aforementioned lifestyle changes to help and reverse the diabetes!  The medications prescribed can stimulate the pancreas to produce and secrete more insulin, inhibit the production and release of glucose from the liver, and/or block the actions of the stomach enzymes that break down carbohydrates and make cells more sensitive to insulin.
Medications that increase Insulin production:
(Oral)
Saxagliptin (onglyza)
Sitagliptin (Januvia)
Glyburide (DiaBeta)
Glipizide (Glucotrol)
Glimepiride (Amaryl)
(injections)
 Exenatide(Byetta)
Medications that improve effectiveness of insulin: (all oral)
Metformin (glucophage, Avandia)
Pioglitazone (Actos)
Medications that alter food absorption: (oral)
Acarbose (Precose)
Miglotol (Glyset)
All of these medications have varying side effects, and your HCP will decide which will work best for you.  it may be some trial an error regarding which works best and it is totally dependent upon your body and why you have diabetes.

Please go see your HCP if you have any of the warning signs, and take control of your (pre)diabetes if you have it.  Also, remember that just because Type 1 isn't reversible, you should still live a healthy lifestyle with fresh foods, exercise, and frequently check your blood sugars!!  If you have signs or symptoms of hyperosmolar hyperglycemic nonketotic syndrome or diabetic ketoacidosis please seek medical treatment immediately!!

Yours in Good Health
B