Talk Tuesday

Q: Last week when we talked about GERD and acid reflux you mentioned a procedure called an EGD and that we would talk about it more this week…so can you tell me what that is? A: An EGD is the abbreviation for a word I struggle to say and probably why everyone calls it an EGD or an upper endoscopy…but it stands for esophago-gastro-duodenoscopy…right? Hard. Anyway, this procedure is how a physician can look at your esophagus, stomach, and duodenum which is the first part of your small intestines that connects to your stomach. This allows us to see ulcers, irritation, tumors, bleeding and so on in any of those areas by using a small camera on the end of a flexible tube. It sounds a lot scarier than it actually is.  Q: Yeah…can you explain what actually happens and what to expect? A: Normally this is an outpatient procedure. That means you come in that day of and leave maybe an hour or less after it’s done, assuming there are no complications. We will discuss those in a bit, but major complications are not very common. Anyway, you will come in and be seen by a nurse and have to put on a gown and get your heart rate and blood pressure taken and then you will have a nurse, the physician/endoscopist doing the procedure, and possibly an anesthesia provider asking you the same questions…medical problems, reason for the procedure, allergies, when was the last time you ate, etc. You are given instructions prior to coming in for the procedure where they will tell you not to eat or drink anything for anywhere from 8-24 hours beforehand. They may ask you to stop taking certain medications like blood thinners or aspirin but that will all be personalized to your situation. After you talk to all the people and you’re ready to go you will taken into a small procedure room where the EGD will take place. Some physicians prefer to do these with the assistance of an anesthesiologist and some prefer to do their own sedation…either way…you won’t remember it and the next thing you know you’ll be in recovery. Everyone will stop what they are doing and say your name and what procedure is being done so that everyone knows they are doing the correct procedure on the correct person. After that you will be given medication that will make you tired and kind of just makes you forget what’s going on. You might not be fully asleep, but you won’t remember anything. I have heard some physicians do not use medication for sedation and they only numb the back of your throat, but I have never seen that done so I don’t know how common that is. Once the medication is given this little plastic block with a hole in the center is put in in your mouth. This bite block keeps you from biting down on and ruining a very expensive scope with your teeth. The scope is usually about the size of an adult finger in width. There is a light and high end cameras on the end of the tubing. Once you are asleep the camera is put through the bite block and down your esophagus…a lot of times we have to ask people to swallow it because they are awake enough to do that, but they don’t ever remember it afterwards. With the camera in your esophagus we can look for all those things I mentioned earlier, like ulcers and such, but we can also take pictures and biopsies of anything that looks concerning or suspicious…or even normal…but we sort of do this backwards and look at the esophagus on the way out. On the way down we just want to get into the stomach. We look all around for all the same things, take pictures, take biopsies and then we go through the pylorus which is the muscle that separates the stomach from the small intestine and helps regulate how much food gets released from the stomach once its been digested. In the small intestine we look for the opening where the common bile duct from your liver and pancreatic duct from your pancreas drain into the small intestine and we also look for tumors or any signs of disease. We then pull the camera back into the stomach…and then into the esophagus and take a good look around on the way out. Once the camera is out, the bite block is removed, you’re taken to recovery and sent home usually in about an hour. You’ll be given instructions and someone will have to drive you home…so they are also given those same instructions because you probably won’t remember them. Then if biopsies were taken they will see you back in the office in about 2 weeks and talk about the pathology and go from there.  Q: …whatever you want to say about all that crazy crap I just mentioned hahaha…what are the complications you mentioned earlier?  A: Some of the complications can be an adverse reaction to the medication, an allergic reaction to the medication, redness or pain around your IV site. That’s why you have so many people asking you about allergies and things beforehand. You can have some bleeding from biopsy sites. It is not common for the bleeding to be severe and it will usually subside on its own. Aspiration is a more serious concern…that happens when you inhale into your lungs the contents from your stomach. It can result in a pneumonia and other lung complications and why it is so important to not eat or drink before your EGD and be honest about the timing of your last meal. The most serious complication and that the scope can put a hole in your esophagus, stomach, or small intestines either from pressure from the scope or from a biopsy that was maybe a little too deep. This is known as a perforation. If a perforation is noted at the time of the EGD…depending on where it is…it can be clipped closed and you would be monitored in the hospital overnight. A lot of times it isn’t noticed at the time of the EGD…and it can be in any of those 3 locations. A perforation can result in serious complications and even death it you don’t call your doctor or come to the ER immediately when you are having concerning symptoms. A perforation usually results in an operation. That operation can be in the neck, chest, or abdomen depending on where the perforation is and may mean you will be in the hospital for several days and may need further operations. A perforation is a very serious, but rare complication of this procedure. Symptoms that should prompt you to seek immediate medical attention would be things like severe abdominal pain that is worse than just gas pain, a firm and distended abdomen, severe abdominal pain with movement, vomiting, a fever, difficulty swallowing or severe throat pain, a crunching feeling under the skin of the neck, and passage of bright red or black material in your vomit or stools.  I know this sounds super scary and like the worst things can happen, but I promise it’s not that bad. I had one done a few years ago and I didn’t have a bad experience at all. I don’t remember anything after getting into the room and then I woke up in the recovery room. I will tell you…do not drink coffee or eat spicy food or anything like that afterwards…especially if they took biopsies…it does not feel good.  As with everything…talk to your doctor about your concerns and ask questions before hand. Don’t be afraid to ask questions about the procedure, what to expect, what you need to do, etc. The more you know the more you will feel comfortable with what’s going on and it’s our job to explain things so ask away. Just remember, everyone is different so what works for your friend or your neighbor may not be what works for you and it is so important to discuss your specific complaints with your doctor to make sure you get what is best for you!For more information visit www.myvirtualphysician.com

Question: Is acid reflux the same thing as GERD? Answer: Sort of. Acid reflux is the same as gastroesophageal reflux which just means that the contents of the stomach are backing up into the esophagus &/or mouth. Occassional reflux is completely normal and can happen to anyone, though usually it is following a meal and there are no real long term consequences or bothersome symptoms and the episodes of reflux are short lived. GERD on the other hand is GastroEsophageal Reflux Disease…so that means someone that suffers from GERD has bothersome reflux symptoms that can result in damage to the esophagus and their symptoms are typically a daily or somewhat routine occurrence. These symptoms include things like heartburn, regurgitation of food, and sometimes there is difficulty swallowing. Some people may have a persistent cough and nothing else.  Q: How does reflux or GERD happen? A: It is actually a little complicated, but when you eat…food starts in your mouth where you chew it up and then when you swallow it goes into this long muscular tube which is your esophagus and that tube propels the food from your mouth to your stomach. At the end of the esophagus where it meets the stomach it has what we call the lower esophageal sphincter. It is essentially an area on the esophagus that compresses together and keeps stomach contents from coming back up into the esophagus and it has to relax and open up to let food into the stomach. This sphincter can weaken or not have as tight of a seal as normal and when that happens it does a really bad job at keeping things in the stomach…especially is you lay down right after you eat.  Q: What makes the sphincter weaker?  A: There are some foods that will trigger reflux symptoms in certain people and the more and more that happens the reflux will then progress to GERD. Some things related to increasing your risk of GERD include alcohol, smoking, caffeine, chocolate, certain medications and so on. Being overweight is also a risk factor for development of GERD. Studies have shown that losing weight improves reflux symptoms and frequency and can be a reason to undergo weight loss surgery if you are obese. Pregnancy increases your risk, but that usually resolves after delivery. And you can have something called a hiatal hernia which essentially means you have part of your stomach with or without the lower esophageal sphincter pushed up into your chest through your diaphragm which loosens sphincter tone.  Q: How do I know if I have GERD? A: Usually this can be diagnosed on history and symptoms alone if you have the usual symptoms of heartburn and regurgitation and that can usually be treated with a trial of PPIs or proton pump inhibitors which block the acid production in the stomach and see if that gives you relief of your symptoms. If you don’t have the usual symptoms or there is an indication that something more concerning may be occurring you will need some tests. These tests include an EGD (more on that next week…but it is a test where a doctor puts a camera on a long tube or scope into your mouth and looks at your esophagus and stomach), a 24 hours pH monitoring study where a little probe is placed in your esophagus so it can record how many times a day and at what time the pH in your esophagus changes due to the acid and what that number changes to, and also a manometry study which really just checks the pressure of your esophagus…like the whole thing…that helps make sure there is no problem with the way the esophagus moves food and it is in fact the lower sphincter pressure causing the problem.  Q: You said there may be damage to the esophagus…is that bad? What do I need to worry about? A: It can be bad. Most people don’t have serious complications as long as they are treated. There are some serious complications that can happen if you have severe GERD and do not treat it. You can get a stricture in your esophagus which is scar tissue causing a narrowing or blockage. This can result in difficulty swallowing or food getting stuck in your esophagus. The process of ulcerations that heal over and over again causes this scar tissue and narrowing. You can have erosive esophagitis. This is when the acid causes ulceration in the esophagus and those ulcers can sometimes bleed. You may not vomit blood or see bleeding per se, but blood can be detected in your stool. You can also get Barrett’s esophagus which is where the cells in the lining of the esophagus change to a completely different type of cell from all the damage. The change in these cells can actually change further and develop into cancer. The acid can actually get into your lungs and cause asthma type symptoms or permanent lung damage and it can damage your teeth. Like I said, most people don’t have serious complications, but these complications are why it is so important to see your doctor and discuss your particular case with them and get treatment as soon as possible.  Q: What do I have to do to treat GERD? A: First and foremost…talk to your doctor. Everyone is different and should be treated as such. Common things work and should be done, but talk to your doctor to make sure you are treating the correct problem before you start trying to self medicate. There are some lifestyle things that can help like avoiding foods that you notice trigger your reflux, don’t eat close to bedtime and try not to lay down after eating…try to eat several hours before you plan to lay down. You can lift the head of your bed up, but it involves more than just piling up pillows behind you, so really just try to avoid eating before bed. If you are overweight, try to lose weight. Not only for your overall health, but like I said earlier, a lot of people have relief from their symptoms after they lose weight. Surgery is an option, but treatment with medication is always tried first because it is the least invasive option. Surgery does not come without it’s own complications.  Talk to your doctor about taking a histamine blocker or PPI for any symptom relief before trying it on your own. Antacids like tums can help treat the minor symptoms, but if you find you’re using those a lot it’s time to see a doctor. If you feel like the reflux is getting worse or you start losing weight and you aren’t trying, or you feel like you’re choking you should also get to your doctor as soon as possible. If you’ve been treated and are still having symptoms then talk to your doctor about changing medication or what surgical options are available to you if you want to explore that option

Welcome, everyone! Thank you for joining us today. My name is Stefanie and I'm part of the team here at MyVirtualPhysician. We are a direct to consumer, multi-specialty, telemedicine provider operating in multiple states. Welcome to Talk Tuesday. We are continuing our weekly educational series, talking with our expert physicians, exploring some common healthcare concerns, and hopefully answering some questions you may have.Today our physician expert is Dr Salome Masghati, a practicing gynecologist and minimally invasive surgeon who is one of our telemedicine providers. We are talking about a complaint our doctors commonly see or treat, and that is URINARY TRACT INFECTIONS or UTIs. Dr. _Masghati thank you for joining us today.PRESENTATIONSo let’s cut to the chase Dr. Masghati, can cranberries cure a UTI?Many people believe that cranberries or cranberry juice can treat a UTI, and the answer is ______________________.There have been many studies on cranberries as a UTI treatment, and research has shown that an active ingredient in cranberries called “proanthocyanidins,” or PCAs for short, is effective in preventing E. Coli bacteria, the most common cause of UTI infections, from attaching to the bladder wall lining and colonizing or creating an infection. So PCAs or cranberries may help prevent a urinary tract infection but once there is already an infection, that treatment may not be effective.A cup of cranberry juice may only contain a small amount of this active ingredient with a lot of sugar! Cranberry tablets or pills may be another option for prevention.So if someone wants to try cranberry juice for prevention of a UTI, how much should you drink? A recent article in Pharmacy Today recommends at least 36 mg of PAC daily.For the prevention of UTIs, 300–500 mL of cranberry juice cocktail (26% cranberry juice) daily and 400–800 mg cranberry extract twice daily.Or 36–72 mg of cranberry PAC equivalents per day, found in about 360–720 mg of cranberry extract, has been shown to be effective.2 The research shows some evidence that cranberry products may reduce the incidence of UTIs but the most effective amount and concentration of PACs that must be consumed and how long they should be taken are unknown.So cranberry juice and cranberry extract tablets together may help prevent infections but what about someone who already has a UTI? Truly if someone has an infection, either their body will be able to fight off the infection, or they may need an antibiotic medication to kill the bacteria that is causing the infection. That’s interesting, so you say in some cases a UTI can go away on its own because the body is able to fight off the infection?Yes, in some cases. Approximately 25-42% of the time these uncomplicated UTIs may resolve without any medical treatment. Ok, so when would it be time for someone to see a doctor about their UTI?Untreated infections can spread and become serious. You should talk to your doctor as soon as you suspect a UTI.Also for signs such as fever, chills, flank pain, or abdominal pain with nausea or vomiting. These can be signs of a serious infection.For someone who is going to make an appointment but has not yet, is there anything that they can do to manage the UTI?There are some things you can do for relief, or even after you have seen your doctor while you are waiting for an antibiotic to work. It is important to stay hydrated, drinking plenty of water flushes out the bladder. When going to the bathroom it is important to try to empty the bladder completely. Some adults with UTI have a frequent urge to urinate or sensation of pressure in the low abdomen which can make it feel as though you need to urinate. Going to the bathroom frequently to empty the bladder can help.If there is pain in the low abdomen a heating pad may provide some relief.Over the counter pain relievers such as Motrin or Tylenol can also be taken to help with discomfort. 

My name is Stefanie and I'm part of the team here at MyVirtualPhysician. We are a direct to consumer, multi-specialty, telemedicine provider operating in multiple states. It is Talk Tuesday and we are back with our weekly educational series, talking with our experts, exploring some common healthcare concerns that we see, and hopefully answering some questions you may have.Today our physician expert is Dr. Daniel Kessler and one of our telemedicine providers. We are talking about coping with anxiety during the holidays.Good morning Dr. Kessler, thank you for joining us today.Well the holiday season is upon us and I know that this year has been challenging for many, so some people are already stressed or anxious and not looking forward to the holidays. Is it normal to have anxiety during this time?It can be common to have feelings of anxiety during this time. The Oxford dictionary defines anxiety as feelings of worry, nervousness, or unease, typically about an event or something with an uncertain outcome that may be coming. These can be normal and natural. Many people have these feelings from time to time. During the holidays, Americans may feel financial strain as it can be a season of shopping and gift-giving. They may have to come together with family members that they don’t often see or grieve separation from loved ones and relationships can be challenging or cause anxiety and worry. Many adults have unrealistic expectations for the holiday and that can create anxiety. And already busy schedules can feel the burden of holiday events and activities that can make you even more busy, anxious, or restless.That makes sense, the holidays can definitely cause anxiety, the worry, nervousness, or unease. So when is anxiety abnormal, or when is it a problem?In some cases, those thoughts or feelings become intense and excessive, or individuals may become focused on common everyday events or situations that generally should not produce those feelings or at one time did not make the person feel that way. This type of anxiety usually causes physical symptoms such as sweating, racing heartbeat, or even weakness and feeling tired all the time. This second more extreme sense of anxiety may be out of the norm, and may require evaluation by a healthcare professional.Are there other symptoms, other than the intense feelings you mentioned, that someone could look for or identify as signs that they should get help, or someone they know or care about should see a physician?Symptoms of an anxiety disorder can vary from person to person so if someone is concerned they should talk to their doctor. But some other signs or symptoms could include:Uncontrollable or intrusive thoughtsFears that prevent someone from doing things like driving, going to certain places, or being aloneWorries that interfere with school, work, or family responsibilitiesSudden episodes of panicTrouble concentratingEpisodes of DizzinessFrequent upset stomach or diarrheaInsomnia or difficulty sleepingSo Dr. Kessler, these may be reasons to talk to your doctor about your anxiety. But for our listeners who may experience some mild feelings of stress or worry around the holidays, and maybe they are reluctant to talk to anyone about them yet, can you tell us about coping with anxiety, and specifically for coping with anxiety during the holidays?Sure, There are definitely some steps you can take to manage mild anxiety. Probably the most important thing is self care and self awareness. Many people overlook taking care of themselves during this season, which is often about giving to others. But you have to be aware of how you’re feeling, and take care of your mental and physical health during this time. So here are 5 things that we can all do, to try to stay healthy and happy this holiday and keep anxiety at bay.Number 1 - Adequate hydrationDon’t forget to drink 8-10 glasses of water each day. When you are dehydrated, you won’t feel your best. Also keep in mind drinks like coffee and alcohol may contribute to anxiety so it can be helpful to limit or cut out caffeine and alcohol for a time.Number 2 - Good nutritionStress can cause changes in your metabolism, or how you burn energy.  Skipping meals leads to spikes and drops in blood sugar that can wreak havoc on your system. It is important to eat regularly and maximize your nutrient intake with healthy foods. Taking a multivitamin won’t hurt either.Number 3 - Get enough sleepNational Sleep Foundation guidelines say that the average adult needs seven to nine hours of sleep. Staying up late at holiday parties and getting up early to wrap presents can be detrimental to your health. Practice good sleep hygiene by setting a bedtime and sticking to it when you can.  Number 4 - Stay connected to othersSocial isolation can be a symptom of anxiety and may also trigger it. During the holiday season, make it a point to stay connected to family and friends. Communicate by phone or in person when possible. When separated from loved ones, look for settings where you can volunteer. Many charities offer opportunities to serve. Being with others can suppress feelings of anxiety or depression. It is helpful to share feelings with others and reach out when you can.Number 5 - Be intentional with your scheduleSet boundaries with your time, and don’t feel about declining invitations if they cause stress, anxiety, or depression. Limit events that cause excessive worry. You want to be connected, but you also want to be selective in some way, and make the best of your holiday season. It can also be helpful to stick to your normal routine. Change can cause stress so just be aware of that.Thank you Dr.Kessler, you have given us some great tips for coping with anxiety during the holidays. I appreciate you joining us for Talk Tuesday and telling us what we need to know about anxiety. For everyone else joining us as well, this has been Talk Tuesday with MyVirtualPhysician. If you would like to talk with one of our board-certified physicians about your health concerns, you can check out our website at www.myvirtualphysician.com. We look forward to talking with you again, and we hope you have a great week. 

Let’s start by talking about Diabetes statistics. According to the American Diabetes Association, in 2018, 10.5% of Americans were estimated to have diabetes and about one fifth of those were undiagnosed. Those are pretty significant numbers. Should people be concerned about diabetes?Well that depends. We know about risk factors that can increase the likelihood of getting Type II diabetes. The CDC says you’re at risk for developing type 2 diabetes if you:Have prediabetesAre overweightAre 45 years or olderHave a parent, brother, or sister with type 2 diabetesAre physically active less than 3 times a weekHave ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than 9 poundsAre African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)If you have non-alcoholic fatty liver disease you may also be at risk for type 2 diabetes.So for individuals with risk factors, there should be some concern or at least awareness.So let’s talk about early detection. Why is it important? Why is early detection key in diabetes? Early detection is key in diabetes because early treatment can prevent or at least slow serious complications. When a problem with blood sugar is found, doctors and patients can take effective steps to prevent irreparable damage to the heart, kidneys, eyes, nerves, blood vessels, and other organs.An article in the Current Opinion in Endocrinology, Diabetes and Obesity journal recognized that there are many reasons why earlier detection of diabetes could be of benefit to the individual and the healthcare system, because it creates the opportunity to treat the high blood sugar.Furthermore, undiagnosed diabetes is often associated with potentially-preventable, costly complications. ER visits and hospital stays can be expensive!The base estimated cost of living with diabetes is around $9,600 per year. This includes prescription medications, diabetic testing supplies, doctors appointments, and routine care. This cost will be higher for uncontrolled or unmanaged diabetics who more care, more medications, more doctors appointments. Early detection can save thousands of dollars. For our listeners who may not be familiar with diabetes, can you tell us what a diagnosis of diabetes means? What is diabetes? Sure, Diabetes is a metabolic disorder in which your body is not able to efficiently turn the food you eat into energy, leaving sugar to build up in the bloodstream. This creates two problems: the cells are not getting the sugar energy they need, and the sugar is accumulating in the blood. High blood sugar, known as hyperglycemia, causes damage to many tissues and organs of the body. This is why diabetes is a serious condition that can be dangerous.Normally when you eat, your body breaks food down into glucose. As your blood glucose level rises, the pancreas releases insulin. Insulin is a hormone that tells body cells to let the glucose inside. In diabetes, either your pancreas does not make insulin correctly, or your body cells do not react to the insulin the way they should. This means that the glucose stays in the blood, which is why diabetics experience high blood sugar, also known as hyperglycemia. Over time, hyperglycemia can damage nerves and blood vessels.And how do doctors know that the pancreas is not making insulin right or the body cells not reacting to the insulin? Well, a blood test can determine if a person has diabetes. There are two tests commonly used.A glycated hemoglobin test, known as a hemoglobin A1c (HbA1c) test, measures the glycated form of hemoglobin to determine the three month average of blood sugar. This blood test takes about a minute to perform, and results are generally available in two to three days. A normal HbA1c is below 5.7%. Prediabetes is 5.7 to 6.4%. A result of 6.5% or more is classified as diabetic. Another test doctors use to detect diabetes is a fasting blood glucose, or fasting blood sugar (FBS), test. This blood test measures the basal (base) sugar levels of the blood. Testing is usually performed in the morning after the patient has had nothing to eat or drink for eight hours or more. This test may take around ten minutes and results can be immediately available. A normal FBS is 70-100 mg/dl (3.9 - 5.6 mmol/L). An abnormal fasting blood sugar test may be repeated by the doctor or additional tests may be performed for confirmation of the abnormal blood sugar reading. And what these tests find, high blood sugar, can it go away? Can diabetes go away, or can early diabetes be cured? Diabetes is a chronic condition which means it may not go away. It is possible, however, to reverse some of the effects of diabetes, and to even go into a remission state for those with Type II Diabetes. Remission in diabetes means that your blood sugar levels are within the normal range and you have not required medication to manage your blood sugar for six months or more. Lifestyle changes like a healthy diet, daily exercise, and weight management can improve the way your body uses insulin, and can improve the prognosis for someone diagnosed with diabetes.Thank you Dr. Kessler, you have definitely helped me to understand diabetes better and how important it is for individuals to know their risk and talk to their physician to prevent problems and even get diagnosed and treated early!I appreciate you joining us for Talk Tuesday and telling us what we need to know about early detection in diabetes. For everyone else joining us as well, this has been Talk Tuesday with MyVirtualPhysician. If you would like to talk with one of our board-certified physicians about diabetic screening or your risk, you can check out our website at www.myvirtualphysician.com. We look forward to talking with you again, and we hope you have a great week. 

Infertility: When Is It Time to See a DoctorStarting a family is a goal for many couples. Unfortunately, one in ten couples may have some difficulty getting pregnant and require medical treatment. You might be wondering about infertility: when is it time to see a doctor?Infertility: When Is It Time to See a Doctor?Generally, it is time to consult your physician about getting pregnant if you have been unable to conceive a pregnancy after one year of unprotected sex if you are under the age of 35. Women over the age of 35 and for those who have irregular menstrual cycles or have known abnormalities with their reproductive system should talk with their doctor sooner, after six months. What is Infertility?Infertility is a diagnosable medical condition in which a woman has been unable to conceive a pregnancy despite unprotected intercourse. What Causes Infertility?Infertility in women is usually caused by abnormal ovulation. Infertility in men is commonly caused by problems with sperm cells such as how many there are or how they function. Aside from these physiological causes, factors that can affect a couple’s fertility include their age, health status, and lifestyle factors such as stress, diet, or smoking.According to the American College of Obstetricians and Gynecologists, women who are overweight, underweight, or exercise too much may have a difficult time getting pregnant, as well as men who are heavy drinkers or smoke marijuana since these are known to lower sperm count and movement. In some cases the cause of infertility cannot be determined and in these cases is referred to as unexplained infertility. Who Should See a Physician?Infertility affects both people in a couple. In a traditional couple, there is a 30% chance the infertility is related to male factors, 30% related to female factors, and 30% chance a combination of both factors. Therefore, anyone in a couple may need to discuss their options with their physician about starting a family. Here are some reasons to see a doctor:couples unable to conceive after twelve months of unprotected intercourse without birth controlwomen are over thirty-five years oldcouples who have had two or more miscarriagesmen who have difficulty maintaining an erectionwomen who have abnormal menstrual cycles (no periods, irregular periods, or very heavy periods)couples who have had sexually transmitted infectionswomen who have ever undergone chemotherapy treatmentWhat Should I Expect for Infertility Treatment?When you consult your physician about infertility, you can expect that they will start your care with a complete history and physical exam. They may order blood testing, urinalysis, hormone tests or other diagnostics to check for any abnormalities. It may be necessary to have your partner undergo an exam and diagnostic testing also. Ultrasound or X-ray test could be ordered as well.After all of the tests you will meet with your physician to discuss the results as well as go over treatment options and recommendations. After you make a decision about the treatment plan that is best for you, you will receive support and guidance in your process to get pregnant. What Can I Do About Infertility?Medical treatment and new technologies can increase your chances of getting pregnant. One or both partners in a couple may undergo treatment. MedicationMedications may be taken by mouth or injected. There are drug therapies for both men and women, aimed at increasing egg production or sperm count. A comprehensive list of medicines frequently prescribed for infertility treatment can be found here. Surgical TreatmentIn some cases, blockages, scar tissue, or abnormal growths require surgical intervention. This may be done laparoscopically by making a small incision in the abdomen and inserting a small camera and instruments for a minimally invasive procedure.IVF and IUIThe two most common infertility treatments today are intrauterine insemination (IUI) and in vitro fertilization (IVF).IUI is a non-surgical outpatient procedure in which a physician inserts sperm into the uterus at the time of ovulation. This method is least invasive and most cost effective, but has lower success rates. The estimated success rate is 10-20% for a single cycle of IUI, but additional cycles increase chances and in three to six cycles the success rate is up to 80%.IVF is a complex procedure requiring surgical retrieval of a woman’s eggs, fertilization in a laboratory, and then transfer of the fertilized eggs back into the uterus. Women under the age of 35 can expect about a 50% success rate for IVF treatment but this process requires intense testing and monitoring, and can cost $20,000 to $50,000.  ConclusionStarting a family can be challenging and your physician may be able to offer options to guide you through the process. Infertility is a medical condition that affects many couples and there are treatment and hope available. If you still have questions or you would like to discuss your problem with our board certified OB/GYN specialists, click below to schedule an appointment. My Virtual Physician treats conditions including infertility, irregular periods, sexually transmitted infections and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our podcasts for more and follow us on social media.

Thanks for joining us on Talk Tuesdays!  Today we have Dr. Coleman, a general surgeon to talk to us about the flu vaccine!   Let’s start by talking about current recommendations. What is the guideline for vaccination against the fluThe Center for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months be vaccinated against the flu virus this year. With a few exceptions, Americans should get their shots around October this year.Also The American Academy of Family Physicians recommends a yearly flu shot for everyone over six months old. This is because it can safely and effectively prevent severe illness.Is the flu vaccine safe?Flu vaccines contain dead or weakened forms of the Influenza virus. When your body receives this part of the virus, it begins to build up a natural defense system and creates antibodies. These antibody proteins help your body fight infection. They work to keep you healthy later if you are exposed to a live virus.Vaccination is safe. Healthcare providers have administered flu vaccines for over 50 years. Over this time, a lot of research has evaluated the effectiveness and safety of immunizations. Certainly, the risk of life-threatening reactions is minuscule. Furthermore, manufacturers demonstrate the safety of their drugs before the FDA gives their approval. So when would it not be safe to get a flu shot, or who should NOT get a flu shot?The Advisory Committee on Immunization Practices (ACIP) warns some individuals to talk to their doctor about the flu shot if they have certain contraindications. This means a specific situation, condition, or factor that could make a treatment unsafe or even harmful. For instance, egg allergy prevents some from getting a flu shot. This is a contraindication because manufacturers use eggs to make the vaccine. Therefore, the flu shot may contain trace amounts of ovalbumin (egg protein). In addition to contraindications, there are precautions for some individuals. For example, those with a history of Guillain-Barre Syndrome or who have an illness with fever may want to discuss vaccination with their doctor.Are there any risks to getting the flu shot? The flu shot may cause reactions. These are typically mild and go away within 48 – 72 hours. They may include:Injection site sorenessHeadacheMuscle achesLow-grade feverIn some cases, more severe reactions occur. These could be signs of a rare allergic reaction to the vaccine. If these signs or symptoms arise, you must seek medical attention right away:Wheezing or difficulty breathingSkin reaction or hivesDizziness, weakness, or faintingWhat are the risks associated with not getting vaccinated?The risk of not getting vaccinated is getting sick. You could miss work or school, incur medical costs, or suffer mild to moderate health complications. Most healthy adults deal with a minor case of the flu virus by staying home and taking over the counter medication to ease symptoms. The infection generally lasts a 7-14 days.What about more serious complications, like being hospitalized? Is it possible to require hospitalization from the flu?Those considered "high-risk" could suffer much more serious cases. Some possible complications include hospitalization and even death. Here are some factors that put you in the high-risk category:Adults over the age of 60Pregnant womenChildren under the age of 12Individuals with underlying health conditions such as heart conditions, HIV, asthma, or diabetesIf you would like to schedule a consultation with our doctors or for more information you can check out our website at www.myvirtualphysician.com.  

Welcome to Talk Tuesdays.  This is part 2 with Dr. Coleman.  Today we are talking about Breast Cancer Surgery.What options are there for breast cancer surgery?There are different types of cancer so first things will depend on what kind of cancer you have. Not all abnormalities that need surgery are cancer and not all cancer operations mean you will lose your whole breast. Again, don’t panic, there are a lot of options for surgery. You will need to discuss everything with your physician to determine what is the best course of action for you, but we will discuss some options. Breast conservation: this is also known as a lumpectomy or partial mastectomy. This is where a small-ish incision is made and the area of concern is removed with a small portion of normal breast tissue surrounding it. This is sometimes done using wire localization, but more recently this has moved to using radioactive seeds and such that can be located using a probe in the operating room. If a wire is used, this is placed by a radiologist into or close to the area of concern and secured/covered so as to help prevent dislodgment prior to surgery. Depending on if you have DCIS or invasive cancer will determine if you need any lymph nodes from your axilla (AKA armpit) removed. Mastectomy is where the whole breast is removed. There are different types of mastectomies out there. A simple mastectomy removes the nipple/areola/ and all breast tissue. A modified radical mastectomy is the same as a simple mastectomy except in this operation all of the lymph nodes in your axilla are removed as well. There are nipple sparing and skin sparing mastectomies as options also. All of these mastectomies can follow with breast reconstruction by a plastic surgeon either during the same operation or at a later date depending on the type of cancer you have and the other treatments that are needed after surgery. Understand that there are risks and benefits of each type of surgery and what may be best for you may not be the option you desire.  What are lymph nodes and why are they removed?The lymph nodes often times are said to “filter your blood”. If you have breast cancer that cancer is going to “drain” from your breast to those lymph nodes. If tumor is found in those nodes that is a sign of metastatic cancer. That’s why it is important to evaluate the lymph nodes in certain types of cancer, especially invasive cancer. This can be done in 2 ways - a sentinel lymph node biopsy or an axillary dissection. A sentinel lymph node biopsy can be done with breast conservation or mastectomy. When done with breast conservation a separate incision is made in the armpit to access the lymph nodes. With a mastectomy the same breast incision is used. A radioactive tracer is injected by nuclear medicine prior to surgery as well as a blue dye in the operating room. Both of these tracers help find the “sentinel” node. At least 3 nodes need to be taken in most cases and sometimes it will be more than that depending on whats seen in the OR. An axillary dissection involved removing all of the lymph nodes in the axilla. This is usually done at the time of mastectomy through the same incision. Sometimes it will be done after a SLN biopsy has shown metastatic disease that needs to be removed. But all the tissue is removed in this area. There are nerves and blood vessels there that can be injured and can make it difficult to lift your arm or cause your shoulder blade to stick out, but injury is not super common. What happens after surgery?Depending on the type of surgery you had you may be able to leave that day or you may stay in the hospital. After a mastectomy you will have a drain. if you had an axillary dissection you will likely have 2 drains. You typically go home the day after surgery and drains will come out at your next clinic appointment where the pathology from the OR will be discussed in more detail. You will see an oncologist to discuss any need for chemotherapy and radiation. Depending on the cancer if breast conservation was done and there are “positive margins” you will then need more surgery and the details of that can be discussed at that time.  For more information, please visit myvirtualphyscian.com

Today on the podcast we have Dr. Coleman, a general surgeon.  We are talking about Breast Cancer ScreeningTopics include:When should I get a mammogram?Depending on age, anything you notice that is abnormal, and genetics What does it mean if I get called back after my mammorgram? My MMG showed an area concerning for cancer and I need a biopsy. What is that?1st do not panic. That’s a big challenge to most women. 2nd. The biopsy can be done several ways. If you have a mass that can be felt this can be biopsied by a radiologist or sometimes in the office under ultrasound guidance if it can be seen with an ultrasound. If you need a biopsy using a MMG this is done by a radiologist. If you are getting what is called a stereotactic biopsy you will lay on a table face down and the breast of concern will hang through a hole in the table where it can be visualized via MMG. A machine is used to target the lesion on the MMG and a needle is inserted into the breast tissue and a sample of breast tissue is removed and sent for evaluation. A small metal clip is also placed into the area of the biopsy so that it can be found on future imaging. Stay tuned for part 2 of this episode next week! For more information, please visit myvirtualphyscian.com 

This week on Talk Tuesdays we have Dr. Ginger Coleman, a general surgeon.   She talks with us about peptic and gastric ulcers.  What to look for, symptoms, treatments and when to go to get it checked out immediately.   For more information, please visit myvirtualphyscian.com

This week on Talk Tuesdays from my Virtual Physician, we have Dr. Daniel Kessler, a Family Practice Doctor.Before a manufacturer can introduce a new drug to the public, a lot of money goes into the research, development, testing, and marketing. Companies can patent their new medications, and are guaranteed exclusivity to make and sell them for five years. This allows manufacturers to recoup some of the cost associated with getting their new brand name drugs to market. After that time, the patent expires. This means other companies can come along and make and sell the same medication under a different name. This “copy-cat” medication is considered a generic medication.  In many ways a generic medication is like the brand name version. To be approved as a generic drug, the pharmacologic characteristics must be the same as the brand name. Generic medications are the same as the brand name when it comes to:dosages and strengthintended useeffects and side effectsroute of administration active ingredientsBy contrast, generic medications can be approved with different inactive ingredients. So different colors, additives, and fillers may be used to help with binding, flavoring, coloring, transporting, or preserving. That means that your generic medication will likely look different. Trademark laws in the U.S. prevent manufacturers from creating a generic that looks exactly like the brand name. The Federal Drug Administration (FDA) regulates generic drugs that are approved for sale in the United States. It provides a process that ensures the medications are safe, effective, and of sufficient quality. Keep in mind that the FDA also investigates complaints about generic and brand name medications including side effects. They can issue a recall any time there is a concern for safety. There are always risks and benefits associated with any medication. Everybody is different and some more sensitive to differences in the drugs.Because the inactive ingredients are not identical, some individuals may experience differences when taking a generic medication vs, a brand name, but this is not always the case. There have been reports of medications affecting patients differently. For instance, when they feel the onset of effects, how long the medication effects last, and even incidence of side effects. It is important to talk to your physician if you are concerned about a generic medication affecting you differently. Generic medications often cost substantially less than the brand name. Again, the company making the generic medication did not have to pass along the cost associated with getting a new drug to market. When a patient is going to be on a drug long term or even for a lifetime, choosing a generic medication can save thousands of dollars a year in medical expenses. Lower cost may mean better compliance for some patients.  The savings to the individual are important but it doesn’t stop there. When multiple manufacturers are able to make and sell a medication the competition can drive the cost down, and makes healthcare more affordable for the public. Generic medications save our healthcare system millions of dollars every year. To learn more visit MyVirtualPhysician.com

A cyst is a membranous sac or pocket. Cysts form in many places in the body. The term ovarian cyst refers to a cyst that has formed in or on one of the ovaries. Most ovarian cysts are small and harmless. In fact, they commonly occur in regular menstrual periods. A corpus luteum cyst or a follicle cyst may form each month on the ovary when the egg is released. These are called functional cysts. These normally shrink on their own in about 1 to 3 months. Pregnancy can cause a cyst to form. In early pregnancy, a cyst can form to help support the pregnancy as the placenta is forming. Occasionally, this cyst stays on the ovary until later in the pregnancy and may require removal. Ovarian cysts that continue to grow during pregnancy may twist or could cause problems during childbirth.  Ovarian cysts should checked out by a healthcare provider, if you are having symptoms and suspect that is what is going on. Pain or discomfort from an ovarian cyst could feel sharp or dull, and it could come and go. If a cyst breaks open (ruptures) it could cause sudden, severe pain. Also, if a large cyst breaks open it could cause heavy bleeding. If a cyst causes an ovary to twist it may also cause nausea and vomiting.Less common symptoms include:Pain during or after sexDiscomfort during exerciseUnexplained weight gainPelvic painDull low backache or leg painPainful periodsUnusual vaginal bleedingBreast tendernessBowel or bladder problemsIt is important to talk to your physician if you are concerned about these symptoms. In about 5-10% of cases, an ovarian cyst may require surgical removal. This may be necessary if your cyst does not go away, grows larger, or causes pain. To learn more visit MyVirtualPhysician.com 

To learn more visit MyVirtualPhysician.com