Our methods are effective in preventing health complications. 

We do Pap Smear and HPV test during our well women exam.

Pap Smear is used to determine malignancy. HPV is used to determine the presence of HPV virus that is linked to future incidence of cervical cancer that can lead to malignancy.  This post is for explaining HPV test.

The human papilloma virus (HPV) test detects the presence of the human papillomavirus, a virus that can lead to the development of genital warts, abnormal cervical cells or cervical cancer. 

The HPV test is a screening test for cervical cancer, but the test doesn't tell you whether you have cancer. Instead, the test detects the presence of HPV, the virus that causes cervical cancer, in your system. Certain types of HPV — including types 16 and 18 — increase your cervical cancer risk. Knowing whether you have a type of HPV that puts you at high risk of cervical cancer means that you and your doctor can better decide on the next steps in your health care. Those steps might include follow-up monitoring, further testing, or treatment of abnormal or precancerous cells.

 

Results

Results from your HPV test will come back as either positive or negative.

  • Positive HPV test. A positive test result means that you have a type of high-risk HPV that's linked to cervical cancer. It doesn't mean that you have cervical cancer now, but it's a warning sign that cervical cancer could develop in the future. Your doctor will probably recommend a follow-up test in a year to see if the infection has cleared or to check for signs of cervical cancer.
  • Negative HPV test. A negative test result means that you don't have any of the types of HPV that cause cervical cancer.

Depending on your test results, your doctor may recommend one of the following as a next step:

  • Normal monitoring. If you're over age 30, your HPV test is negative and your Pap test is normal, you'll follow the generally recommended schedule for repeating both tests in five years.
  • Colposcopy. In this follow-up procedure, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix.
  • Biopsy. In this procedure, sometimes done in conjunction with colposcopy, your doctor takes a sample of cervical cells (biopsy) to be examined more closely under a microscope.
  • Removal of abnormal cervical cells. To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells.
  • Seeing a specialist. If your Pap test or HPV test results are abnormal, your health care provider will probably refer you to a gynecologist for a colposcopic exam. If test results show that you might have cancer, you may be referred to a doctor who specializes in treating cancers of the female genital tract (gynecologic oncologist) for treatment.

If pap or HPV test is positive, we typically have patient come back to office and choose appropriate care plan. 

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

 

One of the important aspect of having a primary care in your care team is reduction of risk of adverse events during and after the surgeries.  We provide Pre Op Visits to our patients approximately three to four weeks before the planned date of the surgery. 

It is very important to have this Pre-Op visit with your primary care. We monitor 14 different subsystems and hence are well equipped to asses the risk and then mitigate it through medicine changes, control of lab levels and management of the care plan post surgery.

 

What happens before the Pre Op?

  1. Please book an appointment that is at least three weeks prior to your surgery.
  2. Ask your surgeon to send a pre-op request to us (your primary care) ; This request can specify the procedure planned and labs expected.
  3. Show up for your Pre-Op appointment. Please let the front office know you are here for the Pre-Op. Do not discuss your other problems during this visit.

What happens during your Pre Op visit?

  1. Your primary care physician will assess the procedure planned and agree for the procedure. You can discuss about the procedure and risk and benefits.
  2. Our office will do certain labs as requested by the surgeon or your primary care physician
  3. We may also send additional referrals if your condition warrants
  4. We collect all the information from lab, imaging and consults and your primary care physician assesses if procedure is safe given your condition. Your physician communicates her decision along with risk score for the surgery (calculated if enough data is available)
  5. We also make you read our surgery check list so that you can plan a safer surgery and a safer care giving at home
  6. You also book an appointment to see us after your surgery (Post Op Visit)
  7. If you need any additional care giver help, we will provide you signed orders so that you can set up additional care (home health, physical therapy) 

Surgery Check List

Once you are scheduled for surgery, please take a few moment to read through the checklist here to reduce the risk of adverse events. Please let us know if any additional information needs to go here. This is constantly updated.

Before the surgery

  1. Vacuum the house; Mow the lawn; Rake leaves or do any chores you normally do. You may be out of action for a week. So get this done now. Also vacuuming the house has added benefit in reducing risk of infections.
  2. Create a safe room in the house.  This room must have a door that can be secured. Especially useful if you have a pet who has a habit of jumping on you to show affection. You do not want your pet to jump on you when you have drains sticking out of you.
  3. Create a sterile dressing kit.  This should have all the dressing, alcohol wipes, iodine and a few medicines at one place. Keep some space in the kit for the bag of medicines you receive after the surgery.
  4. Safe room preferably must have large windows with ample sunlight. Sunlight is a good disinfectant. However the windows must also have curtains so that you can sleep peacefully.
  5. Make sure house has no loose carpets or other furniture that can make you trip and fall. 
  6. Safe room can get air purifier with  HEPA filter. You just do not want any secondary infection.
  7. Talk to your family and friends and make a duty roster for them. They will take turns to care for you.
  8. Make sure safe room as well as whole house is hygienic. Make sure all the linen on the bed is fresh. 
  9. If a TV needs to be moved make sure it is moved now. After surgery you do not have strength to do these things. 
  10. Talk to the surgeon's nurse to understand what kind of drains if any will be used post surgery and how to operate them. Get a sample drain and understand how to operate it now. And make sure the family member/friend caring for you knows this as well.
  11. Make a list of all the medications; Get a pre-op physical done at our office  so that we can flag any big misses; Just before the surgery some medications may be stopped and new medications may be started. Make sure you have complete list in the Pre-Op note. 
  12. Talk to the surgeon's office and get their cell number to contact them in the case of any emergency.
  13. Talk to the surgeon's office and get the list of instructions for post operative care following surgery. If you need dressings changed, make sure your home nurse/ care giver is able to do that. 
  14. It is important to know who is going to do the surgery. Avoid non physicians and residents. Insist on getting physicians to care for you. Be shameless. This is your life. You do not want any compromise.
  15. Provide information to your insurance that certain procedure is planned and they will be getting bills from various entities and ask them to validate if the hospital is in network and ask them to make sure every body who treats you are paid fairly so that the claim can be processed as in network. If insurance pays very poorly that they are not able to find an in network physician ask them to pay usual and customary rates  for out of network physician and ask physicians to waive off charges above usual customary rates. (Physicians never harm the patients and will be glad to work with you .. but not your insurance. So inform the insurance early and often so that they can plan and assist you) 
  16. Meet the hospital administration and provide them a letter saying you have asked your insurance to pay the UCR rates for out of network claims and you are requesting hospital to agree for UCR rates. 
  17. Make a list of medications you will need after the surgery and if needed get your insurance to agree. Many times we have seen insurance companies denying medicines that are needed. 
  18. Book appointment for Post Operative Visit to your primary care. These visits must be done within 7 or 14 days after the hospital discharge so that they can effectively manage your discharge.  During these visits, your primary care can go through your surgery notes and address any emerging situation.  They can also prevent complications by watching the progress and change medications. 
  19. Plan your drive back from the hospital to home.  You will not be able to drive. Even if the procedure is small, you may still have difficulty due to anesthesia. So you must have a designated driver to drive you back from the hospital.
  20. Plan your car to be trouble free for the ride. Having a flat tire or dead battery that will prevent you from using your car, can spoil your safe journey back home.
  21. Clean your car. Use generous disinfectant to clean the seat, sides of the doors.  Remove all the trash from the car. 
  22. Plan the route your driver takes while driving you home. As the anesthetics wear out even a small bump can be really painful. So plan on the route that has less acceleration and deceleration and also less bumps. 
  23. Buy some Miralax and keep it in your dressing kit ( You can ask if the front office can provide you free of cost during your Pre Op Visit); Pain medications can cause severe constipation and this helps.
  24. Get some protein shakes and stock them up (  Front office can provide you coupons if available ). Immediately after surgery for a few days you may not be able to eat regular food and these shakes can be lifesaver.

After the surgery

  1.  Follow up with surgeon's office on pre-planned visits.
  2. Maintain a picture of sutures or dressing. It helps to see if there is any problem later on. Any infection must be immediately reported.
  3. When you are called to surgeon's office for suture removal, make sure a physician or someone designated by the physician removes the sutures.  We know a world class surgeon in Denver who does amazing surgery but hospital where he worked had mid level who  used to yank the drains without cutting a knot the surgeon was putting.  So always make sure only physicians are around you even after the surgery. Mid levels working on their own are not safe.
  4. Within 7 days or within 14 days, sooner the better, see your primary care physician and ask for a hospital discharge visit. You will be asked to fill a form and we will go over the procedure notes and address all the open issues. Please remember this visit is really important. We can see many more things what a patient cannot. We have access to surgeon's notes as well we know how to read it. So we fix glaring issues at this stage, all the time. 
  5. Ask your surgeon's office for surgery notes and give a copy of the note to your primary care. 
  6. If a tumor is removed, ask your primary care to provide an assessment on how efficiently it was done. Many time your primary care can read the surgery notes and see if the margins were correctly taken. 
  7. Your medications may need to be reconciled. Please visit your primary care. 

 

 

This is another true story of a great save. Patient set up care with us because his insurance wanted a letter for annual physicals.  We did annual physicals and noted all the baseline values in the chart and told the patient to see us for health issues. Patient subsequently booked appointment with us following an ER visit for worsening abdominal pain. During this visit, we noted the tell tale signs of something very serious but missed out by the ER. Patient had elevated Lipase in thousands! But ER nurse practitioner forgot to connect the dots for elevated lipase and abdominal pain. 

We insisted that patient go back to same ER and get tests done and provide differential diagnosis so that ER nurse practitioner can fix the earlier miss. They were reluctant to repeat the imaging (Earlier imaging said ulcers) ; When imaging was repeated after we provided the differential diagnosis, the radiologist confirmed pancreatic cancer. 

 

If you have elevated Lipase make sure you get checked for Pancreatitis. After ER visit or hospital visit, book a follow up appointment with your primary care.

 

Good primary care treats you for most of the issues. Great primary care puts your interest above that of the third parties  who have infested healthcare in America.  Patient was very reluctant to go back to ER  for talking to them about elevated lipase. But we are glad he changed the mind after our persistence and pancreatic cancer was not missed. 

We are getting reports on the progress of the patient through chemo and surgery and we are glad that our patient is safe.