Genital Herpes

The absolute LAST thing I want to discuss with a patient.  Ever.  Is genital herpes.

Maybe you’ve had that talk with your doctor.  Sitting, standing or lying naked from the waist down, covered only by a thin paper sheet, you hear the dreaded words “This sure looks like a herpes outbreak.”

Maybe you visited Dr. Google and searched for your symptoms (yes, I know you do that).  Maybe it’s not a complete shock.  But maybe it is, and you truly thought it was just a yeast infection.  Or you got something caught on a zipper.  Or are having a reaction to your new body wash.

Whether the patient has an inkling this topic is coming or not, it is one of my least favorite diagnoses to give.  It is like no other infection for causing angst and heartbreak.  Patients are afraid I’m going to judge them, they generally know it’s not curable, and they immediately question their partner’s faithfulness.

If you have genital herpes, you probably remember what it was like the day you were diagnosed.  If you don’t have it, you may know someone who does, or (God forbid) you may be told sometime in the future that you have it.

I have 4 things I wish I could tell all patients with genital herpes on the day they are diagnosed.

  1. You aren’t alone.  According to the most recent data available to the CDC, 16.2% of Americans have genital herpes.  Black people, particularly black women, are at much higher risk, sometime estimates are over 40%.  Up to 40% of adults with genital herpes do not know that they have it.
  2. Herpes doesn’t always look or feel like herpes.  The “my-parts-are-on-fire” burning itching pain that is how herpes is described is not always how it feels.  I want people to know that recurrent discomfort of ANY sort in the area of the body that would be covered by a pair of boxer shorts could be genital herpes.  Recurrent yeast infections, recurrent “shingles” on the buttocks, recurrent urinary tract infections (especially if cultures keep coming up negative), hemorrhoids and recurrent jock itch could all be herpes.  Not all doctors are on the lookout for it, though, so asking the doctor if your symptoms could be genital herpes would be reasonable.
  3. Being diagnosed with a new genital herpes infection does NOT mean your partner was unfaithful to you.  DO NOT call and pick a fight with your partner!  Research has shown that if partners avoid sex during an outbreak (and let’s face it, who wants to have sex when you have what feels like a yeast infection?), there is a 4% per year chance that a woman will give herpes to her male partner and an 8% per year chance that a man will give herpes to his female partner.  Over a 10-year relationship, that’s still a 43% chance that a woman will stay herpes-free, and a 66% chance that a man will avoid infection.  (I’m not sure of the figures for same-gender sexual partnerships.)
  4. It’s important to find out if your partner has herpes too.  As I mentioned above, transmission rates are surprisingly low for this infection (although I had one very sweet teenager who was unlucky enough to catch genital herpes with her very first sexual experience).  If your partner does not have it, taking daily oral medication and using condoms will further decrease the chance of transmission.  Any skin-to-skin contact, especially during an outbreak, can share the infection, so preventing virus shedding with oral medication is important.  If you love your partner, do what you can to decrease the risk that you’ll infect them with an incurable virus.

This is a common infection.  Any time you begin a new sexual relationship there’s a chance you will be exposed to a sexually transmitted infection.  You’re a grownup, I know you know there are cooties out there!  Be careful and be smart, ask to be tested and ask your new partner to be tested too.

God knows if I never have to tell another patient they have genital herpes, it will be too soon.

QUESTION:  Did anything in this post surprise you?

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Rotator Cuff Injury

Now that the weather is getting colder and snow is in the forecast, I know I’m going to be seeing patients in the office who injure their shoulders shoveling snow and slipping on the ice.  Unfortunately shoulder injuries are something we see all the time in the office.

The shoulder is the most commonly injured joint in the body.  It is an unstable joint by design and has an enormous range of motion.  After all, we are primates and evolved to swing through trees, right?  Think of all the directions you can reach with your hands.

You can hurt your shoulder in any number of ways.  For example, you can lift something that’s too heavy for you, you can fall on it, or you can perform the same movement over and over until you develop a repetitive-motion injury.

One very common cause of shoulder pain is a rotator cuff injury.  This type of injury damages one or more of the tendons of four muscles that act to support and stabilize the shoulder joint.  There are excellent diagrams of the rotator cuff at the American Academy of Orthopedic Surgeons’ patient-information website.

When I was in Denver a few weeks ago for my conference, I listened to a really excellent lecture about upper-extremity injuries and one of the topics was rotator cuff injury.  The speaker described it as the shoulder “committing suicide.”  This is a great description and highlights why it’s so important to get a shoulder injury addressed quickly.

The big muscles of the shoulder girdle largely act to pull the arm UP.  The deltoid and trapezius are the muscles that pull your arm out to the side and let you work overhead.  The rotator cuff muscles act to pull the upper arm bone (the humerus) DOWN and keep the head of the humerus sitting in its socket.

When your shoulder hurts, your brain naturally tells you to rest your arm.  Don’t use it, right?  The problem with this is that the little muscles of the rotator cuff get weak VERY quickly.  This weakness makes the stability of the shoulder worse.  The head of the humerus tends to be pulled up and out of place more and more, which puts stress on the cartilage and makes pain worse.

As the pain gets worse and worse, you tend to avoid using the arm more and more, to the point that the capsule of the shoulder joint shrinks and the shoulder gets stiff.  This is called adhesive capsulitis or “frozen shoulder.”  Can you see why a rotator cuff injury can be described as the shoulder “committing suicide?”  Pain makes you use it less, which makes it weak, which makes it more and more unstable, which makes it hurt more.  Like a snowball rolling downhill.

The treatment for a rotator cuff injury is NOT rest.  The treatment is exercises to strengthen the muscles of the rotator cuff.  Anti-inflammatory medication and cortisone shots can help, but exercise is the main treatment.  It is important to get a shoulder injury evaluated right away.  The longer the injury goes untreated, the longer it will take to get the shoulder healed and the pain resolved.

If you have pain in your shoulder please see the doctor right away.  It may not be a rotator cuff injury, but if it is, the longer you wait the more it will hurt and the more work it will take to heal it.

QUESTION:  Have you had a rotator cuff injury?  How long did it take to get it healed?

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Sports Nutrition

Ow.  I just tested for purple belt in Goshin Jujutsu.  Having studied martial arts for well over half my life, the fatigue and muscle soreness after testing are not a new experience for me.  I also know from personal experience how important sports nutrition is and how it can improve performance and shorten recovery time.

This is fair warning – I’m going to talk about Shaklee products in this post.  If you’re not an athlete, are not concerned about optimizing your athletic performance or increasing the gains you get in endurance and muscle strength from exercise, or don’t want to read about Shaklee nutritional supplements, STOP reading now.

When you are training for an endurance athletic event several things are crucial.  Believe me, if you don’t believe a martial arts promotion test is an endurance event, you’ve never participated in one!  Obviously, eating right, getting plenty of rest and staying well hydrated are very important.  What else can we do to optimize our performance as athletes?

I’m a big believer in having a strong basic daily nutrition regimen.  In addition to eating right, for me that includes Shaklee’s Life Plan daily.  In the past I have used the Vitalizing Plan (before the Life Plan was introduced) and that worked well too.  I have patients who use the Essentials Plan for a more economical approach.  I recommend a multivitamin, B complex (for energy and stress), Vitamin C (for tissue recovery – it’s needed for collagen synthesis), probiotics to support digestion and immunity, omega-3 fatty acids for their anti-inflammatory effects, and high-quality protein for muscle building and energy.

Nutritional measures are helpful before, during and after an athletic event to improve performance and shorten recovery time.  Olympic athletes know this very well, and more than 50 Olympic athletes have won over 120 medals while using Shaklee products to power their training and performance.  Here’s a short video about the Shaklee Pure Performance Olympic athletic team (only 90 seconds but great information!).

What products helped me during my test today?  I started with Energizing Tea (although the Energy Chews work great too for a boost before exercise) and used Performance hydration drink during the test.  Performance hydrates better than water, maintains energy and optimal blood sugar during exercise better than water, and doesn’t promote the formation of kidney stones like the leading sports electrolyte drink does.

After exercise it’s important to get both protein and carbohydrates to your muscles to optimize strength and stamina gains.  Also, if you don’t give your body protein and carbohydrates within about 45 minutes after exercise, you’re more likely to see your metabolism drop.  Your body goes into “famine mode” and that’s really going to short-circuit efforts to lose weight.

Shaklee has a number of options for recovery.  Physique is specifically made to be used after exercise.  A carefully designed blend of whey protein and carbohydrate gives the muscles what they need to recover quickly and improve in strength.  I don’t use dairy (whey protein is from milk) so I use Life Shake for my recovery protein.  Four yummy flavors, both soy and non-soy plant-based protein options, Life Shake is part of my diet every day.

If you’re an athlete, whether in serious training or just for fun, consider adding nutritional support to your regimen to improve your performance.  Basic nutrition to start, then targeted products to optimize your training.  You will see better baseline health, better performance during exercise and quicker recovery afterwards.  Watch this short video, click on the links to see more information about the products mentioned above, or email me at drjen@jenniferwurstmd.com for more information.

QUESTION:  What is your favorite form of exercise?  Do you use nutritional products to improve your performance and recovery?

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Prostate Cancer Screening

This week a gentleman I’ve known for a number of years came to the office with lab results to discuss.  He had had bloodwork done as part of routine screening by his employer, including a PSA (prostate specific antigen) test.  He felt well and had no symptoms to suggest a problem with his prostate but the PSA was done and it came back abnormal.

Recently there has been a lot of controversy about prostate cancer screening.  My patient and I had the opportunity to discuss the current recommendations and decide on a plan to address that abnormal result, but I also wanted to share the current recommendations and the reasoning behind them with all of you.  (Last week’s blog post was for the ladies, and this one’s for the gentlemen in the audience, LOL.)

So what’s the prostate gland?  It is a gland about the size of a walnut that sits underneath the bladder.  It provides fluids to protect and nourish sperm after ejaculation.

The prostate gland is very sensitive to testosterone and tends to gradually get larger as a man ages.  Unlike women, men don’t really go through a “menopause” phase of life when their gonads stop making sex hormones.  Testosterone production may decrease as a man gets older but it doesn’t stop altogether.

Cancer of the prostate gland is the most common cancer in men.  In the US about 233,000 men are diagnosed every year with prostate cancer and over his lifetime a man has a 16% chance of developing prostate cancer.  Given how common it is, a lot of effort has been devoted to finding a good screening test.

There are two main problems with screening for prostate cancer.  Prostate cancer is certainly common enough to be a good candidate for screening, but we just do not have a good screening test.  An abnormal PSA blood test (over 4.0 is the most commonly used upper-limit-of-normal), has a 70% false-positive rate, and the only way to determine whether a level over 4.0 actually represents a cancer is to do a biopsy.  Biopsies miss 10% of prostate cancers and are associated with anxiety, pain, fever and blood in the urine and semen.

Worse, as many as 15% of men who have a PSA less than 4.0 will have prostate cancer if you do a biopsy.  Adding a digital rectal exam to the PSA blood test really doesn’t add any additional benefit.

The bigger problem with screening for prostate cancer, though, is that finding and treating it early does NOT save lives.  I know that’s hard to believe, especially with all the press about breast cancer screening.  Unlike breast cancer which tends to be aggressive, prostate cancer tends NOT to be aggressive.  50% of prostate cancers found on screening will not cause symptoms in the patient’s lifetime.  The 15-year mortality rate for low-grade prostate cancers is less than 5%.

How many of you men out there would be comfortable with a watch-and-wait approach if you were told you had prostate cancer?  I know, not many of you.  90% of American men diagnosed with prostate cancer choose to be treated.  However, treating prostate cancer can involve surgery, chemotherapy, radiation, or a combination of all three.  These treatments have risks in and of themselves.

Removing the prostate gland often damages the nerves of the pelvis and can cause urinary incontinence and loss of erectile function.  Chemotherapy obviously weakens the immune system, leading to infections, and can cause other side effects like permanent nerve pain.  Radiation to the pelvis can cause urinary incontinence, stool incontinence, diarrhea and pain.

Current recommendations are NOT to screen men routinely for prostate cancer.  If a man has symptoms related to his prostate, then by all means we will check it out, but at that point the test is NOT for screening, it is a diagnostic test.  We definitely should not be screening men at low risk for prostate cancer before age 50 or after age 70, or if a man’s life expectancy is less than 10 years.

Men at higher risk of prostate cancer should have a thorough discussion with their doctor about the risks and benefits of screening.  These include black men and men with a family history (father or brother) of prostate cancer diagnosed before age 65.

At this point prostate cancer screening is an example of the medical field overtesting and overtreating.  We find cancers that won’t cause problems for the patients, take a healthy man and give him a scary diagnosis that steals his peace of mind.  Then we subject him to treatments that CAUSE illness without PREVENTING illness.

More research is needed to discover better tests to screen for prostate cancer.  Until that time, and until we have less toxic treatments, routine screening is not recommended.

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