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Sunday, October 30, 2011

Internet Self-Medicating

Internet Access
It was naive of me not to realize that just about anything can be found via the Internet these days...medications that normally require a doctor's prescription are easily obtained and used in whatever way the person sees fit.  But fit, is what you'll be missing if you do this with just any drug.  The reason that physicians and non-physician licensed providers can write prescriptions is because they are responsible for the welfare of their patient and have the opportunity to let the person know about side effects, intended effects and so forth.  The pharmacists can double check the appropriate usage and dose of the med such that the patient can be confident of a good outcome.  If you purchase what you believe you need over the web because you read it in a blog somewhere, beware!

Case in Point
A young woman realized that she was pregnant and figured out that it was likely in the very early stages of development...about 8 weeks along.  She confided in her girlfriend that she wasn't planning to carry the baby to term and was seeking an abortion; however, she was in a foreign country and didn't want to look for medical assistance.  Her girlfriend, who was not a medical professional, told her about a medication called Cytotec (misoprostol), a drug developed for stomach disorders, that would cause her uterus to abort the pregnancy.  The friend knew that this drug could be bought without a prescription on the Internet and taken in privacy without medical follow up.  What she didn't know is how dramatic and frightening the drug's effects could be.  The blogs that she consulted failed to mention some key risks including the fact that the unintended pregnancy might be lodged in fallopian tube (ectopic pregnancy) and result in death. 

The young woman took the Cytotec anyway, and she did indeed have a much worse outcome that what she imagined.  Her bleeding was severe, forcing her to seek emergency medical care despite her strong wishes to avoid just that.  Ultimately, she was fine, but getting her through that experience made me stop and think how many thousands of other women have tried to go it alone for medical abortion and a host of other medical problems because they knew that the Internet afforded an end-around play to avoid a doctor.

It's just not wise.  If you have a medical issue, and you've read about the treatment in the blogosphere or gotten the advice of a non-medical person, don't believe that it will be fine to go it alone when it comes to treatment.  Even though there might be a YouTube "How To" video somewhere, you probably wouldn't take out a kitchen knife to remove your own appendix; likewise, you definitely shouldn't take out your laptop and order up pharmaceuticals either.

Saturday, October 22, 2011

Rip-Roaring Vaginitis

An Old Professor Used to Say...
When I was in medical school at the Medical College of Virginia back in the day, there was an old professor (he was old then, and he's still out there on the lecture circuit even now!) who used to like to talk about what happens when women get out to the beach in the summer, cavort in the sand (his words, not mine), drink beer, etc....they would inevitably develop what he called "rip-roarin' vaginitis" quaint.  He was right though.  As I spend time for the next few months in a warm, sandy-filled environment (Kuwait), I will likely see more and more of what I have already agreed constitutes "rip-roarin' vaginitis."

Yeast infections of the vagina and the outer skin (vulva) are common regardless of whether or not you are at the beach, but there are certain things that can make these pesky, itchy outbreaks even more frequent.  Yeast, a fungal organism, is different from bacteria.  In fact, one of the risks for developing yeast vaginitis is being on an antibiotic for treatment of a bacterial infection.  Antibiotic medications actually kill off the type of vaginal bacteria that will prevent overgrowth of fungus (lactobacilli).  So it is not unusual for someone taking, say, minocycline for their facial acne, to always have symptoms of a yeast infection.

In addition to antibiotics, certain other medications and conditions are known to increase the potential of getting a yeast infection of the vagina and vulva.  This includes hormone therapies like birth control pills because estrogen has an effect on the vaginal wall cells that causes the cells to store more sugar - a known yeast magnet.  For a similar reason, uncontrolled diabetes can drastically increase the number of episodes of infection.

The classic symptoms include itching and/or burning sensation on the skin along with a fairly copious vaginal discharge that typically has no odor.  If there is associated burning with urination, it is usually going to be burning on the skin that surrounds the urethra (where the bladder empties out) as opposed to the lower abdomen - that type of burning pain is more associated with an actual bladder infection.  But sometimes the burning is hard to pin down, and women just know that it hurts somewhere down's up to the doc to figure it out.

Because the symptoms of yeast vaginitis can mimic other skin conditions, an exam is important at least once in a while to confirm that the fungal organisms are actually causing the problem.  Trichomonas, a protozoan organism (similar to bacteria), causes the very same symptoms of itching/burning and discharge, but the treatment is far different from that of a simple yeast infection.  A specific antibiotic must be prescribed to kill the trichomonads, and any sexual partner must also be treated to avoid receiving the infection right back after therapy.  For yeast infections, there is no reason to treat the sexual partner.  Occasionally, an uncircumcised man can trap yeast beneath the foreskin and cause recurrent yeast infections in his partner, but that is uncommon.

The examination consists of a basic pelvic assessment using a speculum in the vagina to swab a bit of the discharge and view it under the microscope.  If yeast is present, the slide will have numerous hair-like strands of yeast with tiny buds protruding from the surface.  The skin of the vulvar can be very inflamed and have a spreading rash or even cracks in the skin from the itching and irritation over time....hence the term "rip-roaring" vaginitis.

Treatment is simple in most cases, but some people have a strain of yeast that is resistent to the usual therapies of Monistat Cream or Diflucan pills.  In those difficult situations, an actual culture to find out the strain of yeast and sensitivities to various antifungal medications could be helpful.  I have seldom had to resort to a culture because I have found that most yeast infections will resolve in due time if the patient and doctor have the determination to treat aggressively and for a long enough period of time.  This can take weeks in severe cases.  Prophylactic treatment while a person is taking antibiotics for some other condition can help prevent a terrible outbreak in people who are known to be susceptible to yeast.  So before you take that antibiotic or birth control pill and head out to the beach, you might want to have a chat with your doctor about how to recognize and thwart a rip-roarin' vaginitis of your own.

Saturday, October 1, 2011

Pregnancy and Listeriosis

The recent news media's focus on food recalls due to contamination with the bacteria known as listeria monocytogenes has rightly identified an at-risk group: pregnant women.  These types of outbreaks are not so uncommon, but they are usually limited and contained by various government measures via the FDA's alerts to keep our food safe.  However, when an outbreak is noted, it is the higher risk groups of people who need to really take notice.  Pregnant women are nearly always more likely to have problems. Not only must they deal with the infection in their own body, but they also have to be concerned about the infection being transmitted across the placenta to the baby.

A full-blown listeria infection in a pregnant woman can result in preterm birth, miscarriage or stillbirth, so treatment of a recognized infection using intravenous antibiotics (penicillin or sulfa antibiotics are effective) is important to prevent fetal problems and can even be life-saving.  Unfortunately, there is no vaccination against listeria, but prevention of exposure by following some basic, standard food safety measures is key.  The symptoms of infection are vague and common to many viral illnesses to include fever, aching muscles, nausea/vomiting and diarrhea.  They usually resolve within a week even with no treatment.

Thoroughly washing fruits and vegetables will go a long way toward removing harmful bacteria such as listeria because even refrigeration is not enough to suppress it.  Thoroughly heating food such as hot dogs will also reduce the potential exposure.  Keeping uncooked meats away from vegetables in the kitchen is always important along with liberal use of antibacterial wipes/cleansers/hand-washing.  Pregnant women should not consume unpasteurized products at all.

If you think or know you have been exposed to listeria while you are pregnant, but you have no symptoms, you should still let your provider know.  The symptoms of listeria infection can be delayed by several weeks beyond the consumption of the contaminated food.