Testing, Testing, 1, 2, 3

Teens have MANY questions about Sexually Transmitted Infections (STI's). One of their most consistent themes is "do my parents have to know?" Typically, that is followed up with, "my mom would kill me if she found out..." Teens- rest assured, though your parents may not be thrilled, in 15 years of practice I have NEVER seen a truly bad outcome from a kid telling their parent that they are sexually active. Believe me, as a parent, we'd rather have the discussion about your sexual activity BEFORE you have a viral STD like HIV, herpes or warts, and BEFORE you get pregnant. So, back to the questions:

1. Do I have to tell my Mom if I had an STD? In the state of Texas, anyone can be tested & treated for STDs without parental consent. However, if your parent is paying the bill (using their insurance) the doctor cannot lie and say they are treating or testing for something else- that is fraud, and the doctor can lose their license. I would strongly encourage anyone living with their parents to share this information- your parents love you & you will get through this together.

2. Can I get tested without a doctor ordering the test, like from an online source? Yes, there are multiple labs that allow you to order STD tests yourself. You can typically choose a single test you might be worried about (like your new partner tells you they have genital herpes) or a panel, that includes multiple tests. The key here is this: if your test is POSITIVE, meaning that you do have an STD, that lab cannot treat you. You are instructed to take the results to your physician for further treatment.

3. How much does it cost to get tested for "everything" if I pay cash? This has a huge range of answers, depending on where you go for testing and how much income you have. Online tests average around $30 per test, with a full panel being roughly $200. Community clinics and Planned Parenthood offer reduced rate testing, and some places offer free HIV testing. Please do not let cost stop you from seeking testing or treatment- timing is critical!

BOTTOM LINE: There are multiple options for STD testing that will allow anonymity, and work with your financial situation. Get yourself tested!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

MORE Teen Sex Q&A

More questions I hear from teens...
Which Sexually Transmitted Diseases can be cured? Trichomonas (a parasite), crabs (public lice), gonorrhea & chlamydia (both bacteria) can all be completely CURED if caught early and treated. If gonorrhea & chlamydia sit around for months or years untreated, they can cause permanent damage that leads to infertility or pelvic pain- and though the infection can still be cured, the damage to the genital tract cannot.

Which STDs can NOT be cured? Right now, we have treatments but no cures for the viral diseases: HIV (which causes AIDS), HPV (the human papilloma virus), Herpes (both oral and genital) and Hepatitis A, B & C.

When should I get tested- after how many partners? In a perfect world, you really should be tested after intimacy with any new partner. Since most STDs are silent, the only way you can no for sure that you will not be giving a new partner disease is to go and get tested.

How do they test for these diseases? A simple urine test can be used for gonorrhea, chlamydia, and trichomonas. A blood test is required for HIV, syphilis, hepatitis, and herpes. Pap tests with DNA testing check for different strains of HPV. Pubic lice can be detected by simple visual inspection, sometimes aided with looking at a pubic hair under a microscope.

More on testing tomorrow...too many questions for one post!
BOTTOM LINE: Let's answer teen questions about sex and STDs!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

MORE Teen Sex Questions- Brazilian & "Crabs"?

Continuing my theme of questions that teens ask me about STDs & sex education...here are a few on the pubic region:

1. Can you get genital acne? Acne on the buttocks is common, but most “acne” in the pubic area is from infected hair follicles from shaving.

2. What are crabs? “Crabs” are pubic lice. They are different than the lice that people get on their head. “Crabs” prefer pubic hair, underarm hair, beards, eyebrows & eyelashes. Head lice stay on the head, and do not cause sexually transmitted disease.

3. Can you get crabs if you don’t have any pubic hair? Yes, because the pubic lice can still reach the hair follicle. However, there is definitely a decreased incidence of crabs in women who remove their pubic hair. At least one study has found a decreased incidence of pubic lice since the popularity of the "Brazillian" in the UK.

4. Can you get STD’s from sleeping in dirty beds? Yes, you can catch crabs (pubic lice) from linens or towels, though the majority of cases are passed during sex. No other diseases are transmitted via linens or clothing, however. Crabs are actually the most infectious of all the STDs- meaning that from one direct contact, you have the highest chance of catching a disease from an infected partner (> 90% with pubic lice.)

BOTTOM LINE: Teens have tons of QUESTIONS- let's get them accurate answers!
PS. For more details, FAQ, answers & stories, check out Seductive Delusions

Teen Sex Questions

I really enjoy teenagers. NO, that is not sarcasm, and YES, we have our own at home! Pre-teens & teens have always been my favorite group to work with, as a physician or girl scout leader or school volunteer. I love seeing how much potential they have, and more importantly, seeing THEM recognize their own strengths, and figure out how to most effectively use those talents to ultimately shape their future career choices. I think many adults make the mistake of talking down to teens, dismissing their heartaches, homework loads and stresses as trivial in the scheme of life (which, in fairness, is often how they look from our vantage point.) The reality is that their stress level is enormous, and that even if it is "puppy love" or "just a middle school test", these challenges are the greatest they have faced so far in their young lives. I believe we as adults can give perspective, but it is important not to minimize what they are going through.

All that being said, one of my educator roles is talking to youth about sexually transmitted diseases. I have been speaking to teens on this topic for roughly three years, and every time, I require the participants to write down a question at the end of my talk. I give them index cards (so they all look the same) and have them directly hand me the cards, so no one sees what anyone else has written. Not surprisingly, there are some common themes, though it might surprise you that I am primarily talking to straight A, service-minded, "good kid" student leaders. I thought I would spend the next several blog entries sharing some of their questions (and my answers) so both teens and parents can see what is being discussed. I'll start today with some questions about pregnancy:

1. Does birth control work?
Yes, but it is not foolproof. Oral contraceptives (the pill) are 99% effective when they are taken correctly- at the SAME TIME, every day; no skipped pills. Combining the pill with condom use as well is highly recommended. Remember, condoms alone are only effective 11-20% of the time, but adding them to the pill decreases the chances of conceiving as well as offering some protection against STDs.

2. Is it better to use two condoms at the same time, “doubling up”, in case one breaks?
NO, absolutely not. Using two condoms at once actually decreases effectiveness (due to sliding and breakage.)

3. Can you get pregnant without intercourse?
Usually not, but if semen enters the vagina, which can happen with “outercourse” or in the process of anal sex, it is possible. Young girls are very fertile – that is the take home message.

BOTTOM LINE: Talk with your teens about STDs, LISTEN to their questions, and help them find the correct answers!
PS. For more details, FAQ, answers & stories, check out Seductive Delusions

If You Take "The Pill" to Avoid Pregnancy- READ THIS!

Are you taking generic birth control? There is a PACKAGING ERROR that has reversed the order of the weekly pills, which significantly decreases the contraceptive effectiveness (translation- you can get pregnant more easily.) Qualitest Pharmaceuticals is recalling multiple lots of the following pills:

Cyclafem 7/7/7, Cyclafem 1/35, Emoquette, Gildess FE 1.5/30, Gildess FE 1/20, Orsythia, Previfem and Tri-Previfem

To find out if your generic pill has been affected, click on the link above to check your lot number, or head to your local pharmacy and ask your pharmacist if your prescription is included in the recall.

This is a great opportunity to talk about birth control effectiveness. When used correctly, oral contraceptives are considered to be 99% effective. If that is true, why do we hear about so many cases of women getting pregnant while they were on the pill? The primary reason is that many people forget to take it. Skipping a day, especially the first day of the cycle, greatly increases your risk of ovulating (and therefore, your risk of conceiving.) Additionally, it is important to take the pill at the same time every day. Taking it "when you get up" does NOT work if you sleep in on weekends! Fluxuating your time by minutes is no big deal, but by HOURS is NOT okay. Additionally, other medications can decrease the effectiveness of the pill, particularly antibiotics or antifungals (like oral medications for yeast infections.) Whenever you receive a new prescription, ask your pharmacist if there is a potential interaction. Finally, do the math- if the pill is 99% effective, but you have millions of women taking it, by sheer numbers there are going to be a significant number of pregnancies from that 1%.

BOTTOM LINE: Birth control effectiveness is maximized by taking the pill at the same exact time every day, and being aware of possible decreased efficacy with other medications. If you take a generic pill, make sure it is not part of this nationwide recall.

Having Trouble Taking All Your Medications?

Today I'd like to say a few words about medications. Often physicians need to prescribe multiple medications for the same patient. One is each morning, another twice a day, a couple are "as needed" and yet another is recommended at bedtime. One must be taken with food, and another is restricted to an "empty stomach". Before you know it, our patient is supposed to take a half a dozen pills per day- at different times, and with different restrictions- and then we wonder why they are "noncompliant"!

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.

Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!

FIRE! Are You Prepared?

The last week has been a challenging one for Central Texas, as FIRES have consumed the majority of Bastrop (still only 70% contained) and several other communities have lost many homes. The landscape looks like a war zone, with burned grounds and few standing brick fireplaces remaining. The scope of the devastation is mind-boggling- not just homes destroyed, but businesses and many livestock as well as family pets. People are suffering financially, emotionally and physically.

There are always lessons to be learned in tragedies such as this, so today I'd simply like to encourage everyone to make sure their smoke detectors are working. Do you check the batteries on the first of each month? Do you have a "fire plan" for your family?

Many of our patients have shared their stories of the 30 seconds they had to run and grab their most cherished possessions before they evacuated their homes. Some grabbed financial papers (deeds, titles & mortgages or insurance papers), many grabbed computers, and all who were able grabbed photos. Thanks to the bravery and efficiency of our central Texas firefighters, very few human lives were lost despite the magnitude of these fires.

What is the medical fall-out? Obviously there will be emotional trauma. Happily, computerized prescription records at pharmacies allowed us to easily refill patients' medications lost in the fires. What we are seeing the most right now, though, is upper respiratory irritation. The smoke particles in the air are creating allergy-like symptoms with nasal congestion, headaches and coughs. Remember to use a decongestant (phenylephrine, like Sudafed) if you are stuffed up, hydrate with extra fluids to keep the mucus thin, and schedule an appointment with your family doctor if your symptoms are not improving.

BOTTOM LINE: Fires can happen EVERYWHERE. Make sure your home has a working smoke detector, and check that battery every month (when you check your air filters!)

Black Spots & Blurred Vision- Sometimes a Simple Fix

Have you ever stood up quickly and seen black spots in front of your eyes? The room sways and you might think you are going to pass out, but then it all clears in a few seconds. What's going on? The medical term is "orthostatic hypotension". When you change from lying down or sitting to standing, your blood pressure should increase enough to keep blood flow constant to your brain. When the pressure is not adequate, that's when these symptoms of blurred vision and lightheadedness occur.

What makes it happen? The most common cause for an isolated incident of this in a healthy person is DEHYDRATION. Think about the process like a garden hose filled with water and held upwards. The less water in the hose, the more pressure it will take to push the water to the top, right? You have to squeeze in on the sides of the hose more, or increase the pressure pushing up to get the water to flow upwards. Your blood vessels work the same way, so if your blood volume is depleted from dehydration, voila- not enough blood makes it to your head! The good news here is that simply increasing your water intake will fix the problem.

This process can also be the result of faulty "squeezing" mechanisms, which can occur in diseases like diabetes or Parkinson's disease. Medications can also be the culprit, especially blood pressure , antidepressants and pain pills. How can your doctor test for this process? Often simply taking your blood pressure sequentially in lying, sitting and standing positions will give us the answer. If your systolic pressure (the top number) drops more than 20mm Hg or bottom number drops more than 10mm Hg when standing compared with sitting, you've got orthostatic hypotension. Sometimes more sophisticated testing is required, but the vast majority of the time, these simple office readings are enough.

BOTTOM LINE: If you are getting lightheaded or having temporary blurred vision when you stand up, grab a glass of water- drink it- and call your doctor to schedule an appointment to figure out the cause & cure for your symptoms.

Beware the Scorpions!

With temperatures still skyrocketing here in Texas, many unwanted critters are showing up in our homes as they seek water and shade, which means more exposure to pests such as scorpions. It never ceases to amaze me how they rear up in full attack mode as I lean forward to kill them...and that each and every time it scares me enough to hesitate before I strike.

So, what do you do if you (or a friend or family member) is stung by a scorpion? First of all, don't panic! Most of the time, a scorpion sting is like a bee sting- pain, burning, mild swelling and maybe numbness locally, that will resolve fairly quickly. If you live in Texas, we are fortunate that our scorpions, scary as they can look, are not severely poisonous. If you live in New Mexico or Arizona, watch out for the dreaded bark scorpion, which can cause more serious reactions such as severe swelling, shortness of breath, shock and even death. If you are stung and your symptoms rapidly escalate, go directly to an emergency room.

For the majority of stings, however, first aid will do. Wash the area immediately with soap and water. Ice and elevate the area if possible. Remove any rings, bracelets, watches or other constrictive accessories. If you are starting to swell up, take a diphenhydramine (benadryl) tablet/capsule. Topical steroid wont hurt, and might help a bit. Ice the area for about ten minutes.
A non-scientifically proven, but much recommended home remedy is to very quickly apply a paste of meat tenderizer (with papaya extract) and a bit of water directly onto the area that was stung. This seems to alleviate the pain more rapidly, and at worst case, it is not harmful. Finally, check the date of your last tetanus shot- if it is more than 7 years ago, go get a new one.

BOTTOM LINE: If you are stung by a scorpion in Texas, wash it with soap & water, apply ice, take some benadryl and see your doctor if symptoms escalate (or if you are behind on your tetanus booster.)
PS. Happy September 1st! You know what to do- change those AIR FILTERS!