Conjunctivitis

 

What is conjunctivitis?

Conjunctivitis is an eye condition caused by infection or allergies.

What are the symptoms of conjunctivitis?

It can affect both the eyes, and make them pink, red, burn, gritty, watery, produce pus that sticks to the lashes, itching

How is conjunctivitis diagnosed and treated?

Consult your healthcare provider immediately.

If it is bacterial conjunctivitis, antibiotics are prescribed.

If it is viral or allergic conjunctivitis, different medicines are prescribed.

What are some things I can do at home?

Use clean cotton wool (1 piece for each eye). Boil water and then let it cool down. Dip the cotton wool in cool water and gently rub your eyelashes to clean off the crusts.

Hold cold flannel on your eyes for a few minutes to cool them down.

Do not wear contact lenses until your eyes are better.

Wash hands frequently with soap and water.

Wash personal clothing, pillowcases, with hot water and detergent.

What are the danger signs?

Unusual pain in the eyes, fever, vision loss, intense redness, unusual headaches.

Get immediate medical help if there are danger signs.

 Acute purulent conjunctivitis

 Image result for acute conjunctivitis

 

Skin cancer melanoma

What is melanoma?

Melanoma is a serious form of skin cancer. It can be genetic.

Normal skin cell convert to abnormal cancer cells and form melanoma.

Melanoma can form of the skin anywhere in the body, including hard to see places like the scalp, in the lining of the mouth, in between fingers, toes, bottom of the feet, fingernails, toenails,

buttocks, genitals, back, etc. 

What are the symptoms of melanoma?

Melanoma can appear as a brown or black mole or birthmark.

But melanoma has some other features which your healthcare provider can diagnose.

They are asymmetric [one half looks different than the other half], Uneven borders, different colors, Larger than the eraser on the end of a pencil, it can grow bigger, change color, shape, Bleed,

become red, swollen, crusty. 

Unfortunately, melanoma can be aggressive and spread to deeper organs in the body.

How is melanoma diagnosed?

Please to see your healthcare provider as soon as possible.

The healthcare provider will perform skin exam all over your body.

If there is a suspicion for skin cancer, a 'biopsy'is performed. The skin is numbed with an injection, and the abnormal skin is removed.

It is then sent to another healthcare provider to look at the skin under the microscope to rule out cancer.

How is melanoma treated?

If the biopsy is positive for melanoma, staging is done.

Staging determines how deep the cancer has spread in the skin. Treatment will depend on the staging.

Some of the treatment methods are Surgery, immunotherapy, targeted therapy, chemotherapy, radiation therapy.

Your healthcare provider will determine the right treatment for you. 

What happens after treatment?

Your healthcare provider will recommend frequent follow-ups to check the skin to see if the melanoma has come back, or if new melanomas appear.

They will perform imaging tests to see if melanoma has spread to other organs in the body.

You should check your skin frequently, at least once in six months, to look for any suspicious skin lesions. You should obtain help from your family member to look in hard to see places for abnormal

suspicious skin lesions.

Seek your healthcare providers help immediately if you suspect any abnormal skin lesion.

What happens if melanoma comes back or new melanoma appears?

See your healthcare provider immediately.

Treatment in the form of surgery, radiation therapy, chemotherapy, immunotherapy will be recommended by your healthcare provider.

How can I prevent melanoma?

Melanoma can be prevented by protecting the skin from sun rays, UV rays.

Start using sun protection as a baby or as early as possible. 

Stay out of the sun in the middle of the day between 10 AM-4 PM.

Wear sunscreen with SPF more than 50, reapply frequently.

Use UV rays barrier protection like widebrimmed hats, longsleeved shirts, or long pants.

Do not use tanning beds.

People with genetic risk should be screened frequently by healthcare providers.

Melanoma of the skin

 Image result for melanoma skin cancer

 

 

H Pylori

A patient wanted to know what options are available for diagnosing H Pylori and estimates for treatment. Hence this post. 

 

 If your provider thinks your symptoms may be caused by an H. pylori infection, they may recommend one of the following tests:

  • a urea breath test – you'll be given a special drink containing a chemical that's broken down by H. pylori; your breath is then analysed to see whether or not you have an H. pylori infection ($150 paid for initial consult, $100 for a follow up after the test; $10 for administration to be paid to New Horizons; A separate fee $195 for the lab which takes four days to provide result - So initial diagnosis and treatment will cost you $250 as our fees and $195 as lab fees; You may also repeat the test in one month after treatment to confirm cure)
  • a stool antigen test – a small stool sample is tested for the bacteria ($150 paid for initial consult, $100 for a follow up after the test;  A separate fee $195 for the lab; We generally do not recommend this )
  • a blood test – a sample of your blood is tested for antibodies to the H. pylori bacteria (antibodies are proteins produced naturally in your blood and help to fight infection); this has now largely been replaced by the stool antigen test ($150 paid for initial consult, $100 for a follow up after the test;  A separate fee $195 for the lab; We generally do not recommend this - It is is less accurate to diagnose acute presentations )

If you test positive for H. pylori, you'll need treatment to clear the infection, which can heal the ulcer and prevent it returning.

When to get this test done?

When you have acid reflux, signs of ulcer or frequent heartburn, discuss with your provider if they want to rule out H Pylori infection.

 

What happens if the test is positive?

If the test is positive, you will be put on a combination of medicines and you must take these medication for a month.

 

What happens after a month?

You must come back again for a follow up test to confirm that infection has cleared up. This follow up is charged at $100.

 

How to avoid H Pylori infections?

Eat at home as much as possible. If you have to eat at restaurants, choose hot entrees over cold ones, drink water from your own water bottle.

Skin cancer nonmelanoma

What is skin cancer?

Skin cancer happens when normal cells in the skin change into cancer cells.

Two main types of skin cancer are melanoma and nonmelanoma.

Skin cancer occurs commonly in sun exposed parts of the body on the head, face, neck, back of the arms, hands, legs.

The risk of skin cancer increases with increased exposure to sunlight, tanning beds, UV rays. 

There are other noncancerous, precancerous skin lesions that can occur with chronic exposure to sunlight.

What is nonmelanoma?

Nonmelanoma is divided mainly into basal cell cancer and squamous cell cancer.

What are the symptoms?

Nonhealing skin rash which is pink, reddish, swollen, peeling repeatedly, bleeding, open sores, thick and crusty skin.

 How is skin cancer diagnosed?

You should see your healthcare provider immediately.

Your healthcare provider will perform an exam and check the skin all over your body.

A 'biopsy' is done on the skin rash. After numbing the skin the rash is removed by your healthcare provider. It is sent to another healthcare provider, who looks at the skin sample under the

microscope to make sure there is no cancer.

If the Biopsy test is reported positive for cancer, further tests are ordered to make sure the cancer has not spread to other places in the body.

Further treatment is based on the type of cancer, the extent of cancer, age, and several other criteria.

How is skin cancer treated?

Surgery, radiation therapy, topical strong prescription skin creams, light therapy [photodynamic therapy]. 

The extent of treatment is different for different patients. Your healthcare provider will determine the treatment based on your condition.

Early treatment will prevent the cancer from spreading to the rest of the body.

 What should I do after skin cancer is treated?

Your healthcare provider will advise you skin checkups every so often to see if the skin cancer has come back or if new skin cancer is present.
 
You are recommended to check your skin frequently for any skin changes and report to your healthcare provider immediately.
 
What should I do if the skin cancer comes back?
 
You should see your healthcare provider immediately.
 
They would recommend surgery, radiation, topical strong prescription skin creams based on your condition.
 

Is there a prevention for skin cancer?

Skin protection from sunrays, UV rays starting at a young age, or as soon as possible.

Stay out of the sun in the middle of the day between 10 AM-4 PM.

Wear sunscreen with SPF over 50, reapply frequently.

Wear UV barrier protection like wide brimmed hat, long sleeve shirts, long pants.

Avoid tanning beds.

Patients at risk for skin cancer should get annual skin checkups from their healthcare provider. 

Basal cell cancer

 Image result for basal cell carcinoma

 
Squamous cell cancer
 
 Image result for squamous cell carcinoma
 

Genital Herpes

Genital herpes is a sexually transmitted infection (STI) passed on through vaginal, anal and oral sex. Treatment from us can help. Symptoms clear up on their own but can come back.

See us in the clinic as soon as possible if you have:

  • small blisters that burst to leave red, open sores around your genitals, anus, thighs or bottom
  • tingling, burning or itching around your genitals
  • pain when you pee
  • in women, vaginal discharge that's not usual for you

These can be symptoms of genital herpes.

Come to the clinic even if you have not had sex for a long time, as blisters can take months or years to appear.

 

What happens when you come to visit us

 

The doctor or nurse at the clinic will:

  • ask about your symptoms and your sexual partners
  • use a small cotton bud (swab) to take some fluid from 1 of your blisters or sores for testing

The test cannot:

  • be done if you do not have visible blisters or sores
  • tell you how long you have had herpes or who you got it from

Please note that swab taking can be painful. Please do not do Google review saying it was painful. We already know that. 

Symptoms might not appear for weeks or even years after you're infected with the herpes virus.

If you have genital herpes, your previous sexual partners should get tested.

The doctor or nurse at the clinic can discuss this with you and help you tell your partners without letting them know it's you who has the virus.

 

Treatment

There's no cure. Symptoms clear up by themselves, but the blisters can come back (an outbreak or recurrence).

Treatment from our clinic can help.

 

When you are  tested positive for the first time

You may be prescribed:

  • antiviral medicine to stop the symptoms getting worse – you need to start taking this within 5 days of the symptoms appearing
  • cream for the pain

If you have had symptoms for more than 5 days before you come to our clinic, you can still get tested to find out the cause. But blood test may not be accurate.

 

Treatment if the blisters come back

Come to our clinic if you have been diagnosed with genital herpes and need treatment for an outbreak.

Antiviral medicine may help shorten an outbreak by 1 or 2 days if you start taking it as soon as symptoms appear.

But outbreaks usually settle by themselves, so you may not need treatment.

Recurrent outbreaks are usually milder than the first episode of genital herpes.

Over time, outbreaks tend to happen less often and be less severe. Some people never have outbreaks.

Some people who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months.

If you still have outbreaks of genital herpes during this time, you may be referred to a specialist.

 

Do

  • keep the area clean using plain or salt water to prevent blisters becoming infected
  • apply an ice pack wrapped in a flannel to soothe pain
  • apply petroleum jelly (such as Vaseline) or painkilling cream (such as 5% lidocaine) to reduce pain when you pee
  • wash your hands before and after applying cream or jelly
  • pee while pouring water over your genitals to ease the pain

Don't

  • do not wear tight clothing that may irritate blisters or sores
  • do not put ice directly on the skin
  • do not touch your blisters or sores unless you're applying cream
  • do not have vaginal, anal or oral sex until the sores have gone away

Our methods

We realized that local lab results are not accurate in detecting HSV virus. So we use PCR technology from  a Phoenix based lab to get conclusive evidence. The turn around time for this test is three business days. The PCR test for men's health also check many other organisms. So our patients get conclusive answers if they are suspecting any infection.

We also test the patient who are presenting with herpes symptoms for HIV.  Herpes infection can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. This provides a way for HIV to enter the body. Even without visible sores, having genital herpes increases the number of CD4 cells (the cells that HIV targets for entry into the body) found in the lining of the genitals. Because Herpes with HIV is much more serious and need additional treatment. So whenever we suspect HSV, we also proactively test for HIV to rule out any additional complications.

 

Prevention of further breakouts when you are already infected.

Once you have the virus, it stays in your body.

It will not spread in your body to cause blisters elsewhere. It stays in a nearby nerve and causes blisters in the same area.

If you can, avoid things that trigger your symptoms.

Triggers can include:

  • ultraviolet light – for example, from sunbeds
  • friction in your genital area – for example, from sex (lubricant may help) or tight clothing

Some triggers are unavoidable, including:

  • being unwell
  • having a period
  • surgery on your genital area
  • a weakened immune system – for example, from having chemotherapy for cancer

 

Information

At the time of office visit, please present your insurance card.  We bill your visit to the insurance card you present. 

In the event of an error in your insurance, please let our front office staff know.

We are in network with most insurances. However individual plans may vary and not known till a claim is adjudicated.

We are a smoke free facility.

We need every patient to finish all the forms online and check in online if possible. 

Most visits start on time, so please plan to be at the office, fifteen minutes before your appointment.

Habitual no show patients are terminated from the patient panel.

We charge a no show fee.

If you are not able make the commute, or take time off for commute , explore tele medicine available now.