CDC Now On Board for GARDASIL for BOYS

This week the Advisory Committee on Immunization Practices (ACIP) unanimously voted to recommend that 11-12 year old boys be vaccinated against HPV (the Human Papilloma Virus)- hooray! Girls have NO monopoly on genital warts, which affect over one million Americans each year. They are COMMON. Sadly, in my clinical experience, little harms self-image like a young person developing these genital lesions, especially because we cannot simply cure them and make them go away forever.

Genital warts are transmitted by direct skin-to-skin contact, and though this usually occurs during sex, actual intercourse is certainly not required to pass them on. They are very contagious, with transmission rate of up to 65%. Warts typically recur despite treatment, and frankly, the treatment is unpleasant at best- we burn the warts chemically or with liquid nitrogen. If you've ever had a wart frozen/burned off your knee, you know what that feels like, and the genital area has more nerve endings. Enough said!

The Gardasil vaccine immunizes recipients against the two strains of HPV (6& 11) that cause 90% of genital warts. Additionally, Gardasil protects against the two strains of HPV that cause the majority of cervical cancers. While males don't have a cervix to get cancer, they do have other parts that get HPV-related cancers (anal & penile, as well as some head and neck cancers,) although certainly these cancers are less common.

Gardasil was approved for use in males over two years ago, but the public has mainly been aware of the use in females. I'm glad the CDC and ACIP are on board, and hope that with increased education, we can help protect the next generation against HPV-related diseases.
BOTTOM LINE: Gardasil- it's not just for girls! Talk to your family doctor about immunizing ALL your kids.

PS. I am NOT on anyone's payroll for this vaccine- but I absolutely do recommend it.

Teen Sexting- the Harsh Reality

If you have a teenager (or if you ARE a teen), please take a few minutes and read this New York Times article: A Girl's Nude Photo, and Altered Lives The gist of the story is that an 8th grade girl sent a nude photo of herself to her 8th grade boyfriend on her cellphone. After they broke up, that boy forwarded the picture to another girl, who labeled it rudely and passed it to her contacts, encouraging every recipient to pass it on. Within hours, this naked photo was seen by thousands of people, including everyone at their school and numerous other schools as well as off into cyberspace.

As a parent, I can only begin to imagine the devastation. Three children were arrested and prosecuted, and could have been held for child pornography charges, complete with the permanent label of sex offender. All this in 8th grade- age 14. How does this happen?

I regularly speak to adolescents about sexually transmitted diseases. Regardless of their social, economic and religious status, what they tell me is that oral sex is NBD- no big deal -(90%) and anal sex isn't really either (50%). They don't "count" these activities as "real sex" and are unaware that these activities are risky for virtually every sexually transmittable disease- especially herpes. While the 40-plus crowd is gasping, let me rephrase- adolescents are very, very desensitized to sexual issues.

As such, it doesn't shock me that sexting (sending sexually explicit messages and/or pictures) is increasing. With that feeling of privacy and anonymity that an electronic device instills, combined with sexual acts being NBD, why wouldn't they feel comfortable sending these messages?

As parents, we have to deal with our own discomfort on the subject, and start having frank discussions with our kids about ALL forms of sexual intimacy- including oral sex, anal sex, and sexting. Please note that I am not saying you can't choose to promote abstinence based on your faith. I AM saying that if you define sex as traditional intercourse, you are leaving the door wide open for these other forms of intimacy...and the kids are walking right through that door with full belief that they are maintaining their virginity.
This is exactly why I wrote Seductive Delusions, which shares stories of "good kids" catching STDs, often despite their "virginity".

BOTTOM LINE: Educate yourself first, then push aside your embarrassment and start talking with your teen.

Doctor, this COUGH won't go away!

Did you know that a lingering cough is one of the most common reasons people head to see their family doctors? With most "colds", after you get past the headaches, and stuffy nose part, you find yourself coughing. Sometimes it's a minor "clear your throat" type of cough, while other times, it's the crazy fits of coughing that keep you from sleeping.

Is there anything that can be done for a cough that wont go away? Absolutely, and that is the point of today's blog. "Cough" literally makes the top ten list every year for reasons to visit your doctor. After many upper respiratory viruses, coughs will linger... for up to SIX weeks! A cough does NOT mean you definitely need an antibiotic- in fact, typically, you do NOT. However, a cough that is not managed with over the counter medicines should be addressed by your physician. Coughing all day long at school or work (or keeping up your spouse with coughing all night) is NOT a good plan!

What can your doctor do? First of all, they do need to rule out any secondary infection such as a pneumonia. If you are a week into your symptoms, and suddenly you feel a ton worse and develop a fever, this might be a bacterial infection setting up shop AFTER the virus cleared the way past your body's defenses. More commonly, though, you may have developed some over-reactive airways and may benefit from some inhalers or other asthma-style of medicines. A prescription cough syrup used at night may help with the nighttime exacerbations, and your doctor can remind you of some traditional home remedies such as cool mist humidifiers that may help. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.

BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- don't expect antibiotics, but know there are other treatment options!!

FLU News: 2011 Season

Flu season can be a scary, challenging time for all of us, especially the last two years, thanks to H1N1 (formerly known as the Swine Flu). The BAD news this year is that we're already seeing some cases of the flu, but the GOOD news is that we already have this year's flu vaccine available, and it will provide immunity to several strains of the flu, including the 2009 H1N1. In fact, each year the flu vaccine has three parts, including an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

There are two types of vaccines offered- a live vaccine, which is a weakened version of the virus (this is the nasal spray vaccine) and a "killed" vaccine, the traditional injection. I often hear patients say they "got the flu" from the vaccine, but that is impossible from the injection because those viral particles are NOT ALIVE- they can NOT cause disease. It takes about two weeks for your body's immunity to kick in after the shot, so plan ahead, especially if you are traveling.

In the 2010-2011 flu season, which peaked in early February 2011, was less severe than the pandemic flu season the year before, but still had very significant impact on our population. While most people infected have a miserable several days to a week of symptoms, there were over 300 deaths confirmed to be from influenza, including over 100 pediatric deaths (average age around 6 years.) This is not a disease to be ignored.

WHO should get the flu vaccine this year? The CDC recommends that "EVERYONE 6 months of age and older should get a flu vaccine as soon as the 2011-2012 vaccines are available." And that is NOW! Don't worry about the effects wearing off before the end of flu season, by the way, because the effects last throughout the whole season.

When is flu season? Though typically we say October to January, it really starts with September and most likely extend beyond February this year. Let's be proactive and line up early to receive a vaccination, and then follow up with consistent hand-washing and STAYING HOME if we get sick! I LOVE that all our grocery stores, and many other public places now have the anti-bacterial cleansers positioned right as you enter their store- USE IT!

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!

My Halloween TRICK for Treats

Can you believe that Halloween is right around the corner? We are officially in "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...

Before you toss that bag of yummy Halloween candy in your grocery cart this week, recognize that Halloween is still four weeks away. Will that bag still be around at the end of the month? Come on, now, you know if you are buying it now, you are going to be eating it sooner than later. So, let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. And forget the excuses here: "if I don't buy it now, they wont have my favorite kind", "I wont remember, then we wont have candy to give out", or "but I LOVE those little chocolate candy bars- how many calories does just one have?"

Okay, you asked, so here are a few of my favorites: Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

PS. It's a new month, so CHANGE THOSE AIR FILTERS!

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